Cranioplastia do Osso Frontal com a Utilização de Implantes Customizados através de Protótipo 3D: Relato de Caso / Frontal Bone Cranioplasty using Customized Implants through a 3D Prototype: Case Report

A cranioplastia para os tratamentos de defeitos ósseos cranianos tem como o seu principal objetivo a reconstrução tridimensional e funcional da calota craniana. As cirurgias assistidas por computador (CAS) vem sendo utilizadas desde os anos 90 de forma eficiente e trazendo melhorias e otimização nas abordagens cirúrgicas craniofaciais reconstrutivas, principalmente em grandes defeitos ósseos. Este relato de caso clínico aborda o planejamento virtual e de tecnologia CAD/CAM na reconstrução craniofacial secundária com a utilização de polimetilmetacrilato (PMMA). Paciente de sexo masculino, 48 anos, apresentava dois defeitos ósseos em região frontal com deiscência da pele para dentro do seio frontal. Foi realizada uma tomografia computadorizada com cortes de 1mm e convertidos em um modelo 3D do osso frontal e no molde do defeito ósseo em tamanho real. Para abordagem dos defeitos ósseos, houve a participação de um neurocirurgião para o tratamento em dura-máter, cranialização do seio frontal e obliteração do ducto naso-frontal, sendo finalizada pela equipe de cirurgia bucomaxilofacial. Após a cirurgia, foi realizado um exame tomográfico sendo observados uma perfeita adaptação entre a prótese e os contornos ósseos e um ótimo contorno anatômico do osso frontal, tornando-se satisfatório ao planejamento cirúrgico inicial. A utilização de um planejamento virtual e do sistema CAD/CAM resultou em uma maior previsibilidade e maior segurança ao procedimento de reconstrução craniofacial além de redução do tempo transoperatório. O material utilizado, o PMMA, apresentou-se como um material de fácil manipulação, baixo custo e com perfeita adaptação aos contornos ósseos.

Cranioplasty for the treatment of cranial bone defects has as its main objective the three-dimensional and functional reconstruction of the skull. Computer-assisted surgeries (CAS) have been used since the 1990s efficiently and bring improvements and optimization in reconstructive craniofacial surgical approaches, especially in large bone defects. This clinical case report addresses virtual planning and CAD/CAM technology in secondary craniofacial reconstruction using polymethylmethacrylate (PMMA). A 48-year-old male patient had two bone defects in the frontal region with skin dehiscence into the frontal sinus. A computed tomography was performed with 1mm slices and converted into a 3D model of the frontal bone and in the mold of the bone defect in real size. To address the bone defects, a neurosurgeon was involved in the treatment of dura mater, cranialization of the frontal sinus, and obliteration of the nasofrontal duct, and was completed by the oral and maxillofacial surgery team. After the surgery, a tomographic exam was performed, and a perfect adaptation between the prosthesis and the bone contours and a great anatomical contour of the frontal bone were observed, making it satisfactory to the initial surgical planning. The use of virtual planning and the CAD/CAM system resulted in greater predictability and greater safety for the craniofacial reconstruction procedure, as well as a reduction in the perioperative time. The material used, PMMA, presented itself as a material of easy manipulation, low cost, and with perfect adaptation to bone contours.Keywords: PMMA, Bone transplantation, Maxillofacial Prosthesis, Cranioplasty, Customized implants.

Three-dimensional finite element model construction and biomechanical analysis of customized titanium alloy lunate prosthesis / 中国修复重建外科杂志

OBJECTIVE@#To design customized titanium alloy lunate prosthesis, construct three-dimensional finite element model of wrist joint before and after replacement by finite element analysis, and observe the biomechanical changes of wrist joint after replacement, providing biomechanical basis for clinical application of prosthesis.@*METHODS@#One fresh frozen human forearm was collected, and the maximum range of motions in flexion, extension, ulnar deviation, and radialis deviation tested by cortex motion capture system were 48.42°, 38.04°, 35.68°, and 26.41°, respectively. The wrist joint data was obtained by CT scan and imported into Mimics21.0 software and Magics21.0 software to construct a wrist joint three-dimensional model and design customized titanium alloy lunate prosthesis. Then Geomagic Studio 2017 software and Solidworks 2017 software were used to construct the three-dimensional finite element models of a normal wrist joint (normal model) and a wrist joint with lunate prosthesis after replacement (replacement model). The stress distribution and deformation of the wrist joint before and after replacement were analyzed for flexion at and 15°, 30°, 48.42°, extension at 15°, 30°, and 38.04°, ulnar deviation at 10°, 20°, and 35.68°, and radial deviation at 5°, 15°, and 26.41° by the ANSYS 17.0 finite element analysis software. And the stress distribution of lunate bone and lunate prosthesis were also observed.@*RESULTS@#The three-dimensional finite element models of wrist joint before and after replacement were successfully constructed. At different range of motion of flexion, extension, ulnar deviation, and radial deviation, there were some differences in the number of nodes and units in the grid models. In the four directions of flexion, extension, ulnar deviation, and radial deviation, the maximum deformation of wrist joint in normal model and replacement model occurred in the radial side, and the values increased gradually with the increase of the range of motion. The maximum stress of the wrist joint increased gradually with the increase of the range of motion, and at maximum range of motion, the stress was concentrated on the proximal radius, showing an overall trend of moving from the radial wrist to the proximal radius. The maximum stress of normal lunate bone increased gradually with the increase of range of motion in different directions, and the stress position also changed. The maximum stress of lunate prosthesis was concentrated on the ulnar side of the prosthesis, which increased gradually with the increase of the range of motion in flexion, and decreased gradually with the increase of the range of motion in extension, ulnar deviation, and radialis deviation. The stress on prosthesis increased significantly when compared with that on normal lunate bone.@*CONCLUSION@#The customized titanium alloy lunate prosthesis does not change the wrist joint load transfer mode, which provided data support for the clinical application of the prosthesis.

Effects of Customized Vestibular Rehabilitation on Static balance among Adults with Benign Paroxysmal Positional Vertigo (Kesan Rehabilitasi Vestibular Disesuaikan Ke Atas Keseimbangan Static Dalam Kalangan Dewasa Dengan Masalah Benign Paroxysmal Positional Vertigo) / Jurnal Sains Kesihatan Malaysia

@#The aim of this study was to detemine the effectiveness of Customized vestibular rehabilitation (CVR) in addition to the standard Canalith repositioning maneuver (CRM) on static balance among adults with posterior canal Benign Paroxysmal Positional Vertigo (BPPV). In this randomised controlled trial, 28 adults with idiopathic unilateral posterior canal BPPV were randomized to either the control or experimental group. The experimental group (n=14, mean age: 50.71±9.88 years) received CVR in addition to CRM, and the control group (n=14, mean age: 54.36±8.55 years) received only CRM for 6 weeks. Measurements of static balance (postural sway) using a portable kinematic sensor were performed at baseline, four and six weeks after treatment for both groups while standing on firm and foam surface with eyes open (EO) and closed (EC). Only standing on foam surface with EC was observed to have a significant interaction effect, F (2, 52) =5.28, p<0.05. This suggest that the groups were affected differently by the intervention and greater improvement was demonstrated in the experimental group. Post hoc test showed that a significant difference (p<0.05) in static balance was shown between baseline and 6th week after intervention. The results of our study indicate that CVR in addition to CRM improved static balance in adults with UPC BPPV at 6th week after intervention for persons with BPPV.

Research on medical insurance data sharing mode based on " City-customized Medical Insurance" / 中华医院管理杂志

With the explosive growth of " City-customized Medical Insurance" products, the voice of commercial health insurance needs medical insurance data support is increasing.The authors took " City-customized Medical Insurance" as the representative of commercial health insurance, analyzed the demands and motivations of stakeholders in medical insurance data sharing through the power-interest matrix model, and summarized the medical insurance data sharing path at the commercial insurance product design end and claim settlement end. It is suggested to strengthen the top-level design, build the implementation path of standardized sharing of medical insurance data and the operation mechanism of hospital data docking, to realize the value increment of all stakeholders.

Enlightenment of the cooperative mode between social and commercial of Medicare in the United States on development of " City-customized Medical Insurance" in China / 中华医院管理杂志

As a powerful attempt by government to promote the construction of the multi-level healthcare security system and social and commercial integration in China, " City-customized Medical Insurance" still has many problems to be solved at the beginning of its development, such as unclear boundary between government and enterprises, limited coverage and strength of security. On the basis of clarifying the current situation of " City-customized Medical Insurance", and combing the management experience of social and commercial integration in Medicare Part C plan of the United States, the authors put forward that China should make full use of the advantages of the combination of promising government and efficient market, guide differentiated product design, and establish market access and evaluation mechanism, so as to promote the effective connection between China′s commercial health insurance and basic healthcare insurance, and further reduce the people′s medical burden.

Cicatrizadores personalizados: relato de caso / Customized healing abutments: case report

Quando feita a instalação de um implante imediato pode se optar entre a instalação de uma coroa provisória clínica, um cicatrizador ou pode se optar pelo fechamento do implante para um tratamento em duas etapas cirúrgicas. O uso de cicatrizadores personalizados sela os implantes e leva a uma cicatrização individualizada, que favorece a confecção das coroas subsequentes. O presente trabalho objetiva relatar um caso clínico envolvendo um implante imediato e a instalação de um cicatrizador personalizado, demonstrando os resultados e a importância de conhecimento dessa técnica pelo cirurgião-dentista.

When installing an immediate implant, you can choose between installing a temporary clinical crown, healing abutments, or to close the implant for a two-step surgical treatment. The use of customized healing abutments seals the implants and leads to individualized healing, which favors the creation of subsequent crowns. The present study aims to report a clinical case involving an immediate implant and the installation of customized healing abutments, demonstrating the results and the importance of knowledge of this technique by the dentist.

Actualización en Implantes Subperiósticos: Ranc-Implants Presentación de un Caso Clínico y Revisión de la Literatura / Innovations in Subperiosteal Dental Implants: Ranc-Implants. Case Report and Literature Review

RESUMEN: Los implantes subperiósticos (ISP) han sido relegados poco a poco en favor de los implantes endóseos debido a la aparición de implantes cortos, técnicas all-on-4, elevaciones sinusales, lateralizaciones y transposición del nervio dentario inferior, colocación de implantes en arbotantes anatómicos en el maxilar superior y de modernas técnicas de regeneración óseas. El objetivo del presente artículo es el de realizar una revisión de la evolución que han ido experimentando los ISP desde su invención en 1943, así como exponer una actualización de estos, los Ranc-Implants, mediante la presentación de un caso clínico. Los Ranc-Implants suponen una alternativa viable en casos de atrofias severas de los maxilares que, en otros casos, requerirían procedimientos de regeneración óseos avanzados para la inserción de implantes convencionales.

ABSTRACT: Subperiosteal implants (ISP) have slowly been downgraded, in favor of endosseous implants, short implants, all-on-4 techniques, sinus elevations, lateralization and transposition of the inferior alveolar nerve, anatomical buttresses in the maxilla, as well as modern bone regeneration techniques. The aim of this article is to review the evolution of ISPs since their invention in 1943, and present an update of these techniques, Ranc-Implants, by presenting a clinical case. Ranc-Implants represent a viable alternative in cases of severe atrophy of the jaws that, in other cases, would require advanced bone regeneration procedures for the insertion of conventional implants.

Assessment of the customized birth weight formula in a low risk Indian population

Background: Birth weight is probably the single most important factor that affects neonatal mortality, infant and childhood morbidity in both developed and developing countries. Objective of the study was to formulate a model for prediction of fetal weight at term based on individualized fetal growth parameters.Methods: 131 participant low risk gravidas were enrolled into the study. The participants underwent an ultrasound 7 days prior to delivery. All fetal variables of growth of a random 100 participants were incorporated in an equation derived using multiple regressions to predict birth weight at term. The new equation was then prospectively applied to another 31 pregnant women for validation. The diagnostic performance of the new regression formula was then compared to the Hadlock formula.Results: The customised birth weight formula predicted a higher accuracy with MPE±SD of 0.790±9. compared to the Hadlock formula with MPE±SD - 4.42±8.73. The new formula also explained a greater variance in birth weight of 56% compared to the Hadlock formula of 49%.Conclusions: The new model based on individualized fetal growth parameters recognizes the capacity to modulate an accurate final birth weight, thus emphasizing the need for customized population specific birth weight formulas.

Evaluating usability of and satisfaction with two types of dental CAD software

PURPOSE: This study evaluated the usability of and satisfaction with two types of computer-aided design (CAD) software among users who had experience with dental implant CAD software and those who did not. MATERIALS AND METHODS: Dental technicians (n = 20) who had previous experience with dental implant CAD Software and students from the College of Dentistry (n = 12) who had never designed implant custom abutments were asked to evaluate two types of CAD Software, Exocad and Deltanine. In addition, the participants were asked to fill out a structured questionnaire (Section 1: Entering basic information and retrieving files; Section 2: Setting conditions before abutment design; Section 3: Setting abutment design; and Section 4: Overall satisfaction). For the statistical analysis of the collected data, Mann-Whitney U test was used (α = .05). RESULTS: The ease of design and satisfaction with the implant CAD Software, evaluated with respect to 21 statements divided into four Stages, were significantly higher for Exocad in both groups for Secion 1. For Sections 2 and 3, participants with experience evaluated Deltanine to be significantly better. For Section 4, both groups evaluated Exocad Software to be better. CONCLUSION: Overall, the Exocad Software was evaluated as having better usability and offering greater satisfaction. However, in terms of performance in the core of the design process, i.e. Sections 2 and 3, Deltanine was rated higher by the experienced users. Thus, if the user interface design parts are supplemented, Deltanine CAD Software could be put to a wider use in clinics.

Transmastoidslotted labyrinthotomy approach cochlear implantation with customized electrode for patients with common cavity deformity / 中华耳鼻咽喉头颈外科杂志

Objective@#To discuss the benefit of using transmastoid slotted labyrinthotomy approach (TSLA) and customized electrode for common cavity deformity (CCD) patients, and to evaluate the audiological outcomes.@*Methods@#A retrospective analysis of the intraoperative monitoring data and postoperative auditory outcomes of 10 CCD cases who received cochlear implantation in Beijing Tongren Hospital,Capital Medical University from April 2016 to December 2017, was conducted using TSLA and customized electrod as a test group.At the same time, 10 cases of age and gender matched children with severe or severe sensorineural hearing loss and normal inner ear structures were recorded as a control group. Four questionnaires were collected from the two groupspre-operative, 6 months and 1 year after start-up. The Wilcoxon signed rank sum test was used to compare the scores of different time points. Rank sum test of two independent samples was used to compare the scores between different groups.@*Results@#None of the patients exhibited CSF leakage or facial paralysis after operation. The average impedance of 8 CCD children in the experimental group was below 5 kΩ. The total extraction rate of auditory neural response telemetry (ART) of all stimulating electrodes was 55% (33/60), and the amplitude of the electricity induced complex action potential (ECAP) of electrodes at different positions ranged from 50.69 to 170.3 μV.The average surgical time of the TSLA group was 46.4 min, shorter than the traditional approach.There was significant difference between the scores of pre-operative, 6 months and 1 year after start-up for the TSLA group(categories of auditory performance,CAP: 2.0 (2.0,3.0) vs. 4.0 (3.8,4.0) , Z=-3.109, P=0.002; speech intelligibility rating,SIR: 2.0 (2.0,2.3) vs. 3.0 (2.8,4.0) , Z=-2.952, P=0.003; meaningful use of speech scale,MUSS: 4.0 (3.3,6.0) vs. 9.0 (6.0,11.8) , Z=-3.421, P=0.001; meaningful auditory integration scale, MAIS or infant-toddler and meaningful auditory integration scale, IT-MAIS: 5.5 (3.8,9.0) vs. 15.5 (10.8,18.5) , Z=-3.522, P=0.000 for the latter two).In addition, The scores of the TSLA group were significantly worse than the control group at 6 months and 1 year after start-up.The high-resolution CT scan showed good adhesion of the electrodes without displacementone week and one year after surgery.@*Conclusions@#For CCD patients, TSLA and customized electrode is recommended due to lower surgical difficulty and post-operative risk, shortened surgical time; Intraoperative ART monitoring can be used to determine the integrity of the auditory pathway. Children with common cavity deformity have a longer period of auditory rehabilitation, and the individual differences in speech rehabilitation are significantly different, which is significantly worse than those with normal structure.

Three-Dimensional Finite Element Analysis of PEEK Customized Reconstruction Plate for Mandibular Defect / 医用生物力学

Objective To study the stress distributions of mandible defect by reconstruction with polyetheretherketone (PEEK) and its composite reconstruction plate through three-dimensional finite element analysis. Methods The finite element models of reconstruction plate of titanium alloy, PEEK, carbon-fiber-reinforced polyetheretherketone (CFR)-PEEK with 30% endless carbon fibers and CFR-PEEK with 68% endless carbon fibers were established by CBCT scanning，Mimics software，SolidWorks, Geomagic Studio and ANSYS Workbench software, and titanium alloy served as control. Two occlusal situations were simulated in the mandible model. Loading I: anterior region loading with 300 N; loading II: left posterior region with 300 N. Results The ratio of the maximum Von Mises stress of the reconstructed plate to its yield strength under two load situations: PEEK system ＞ 30%CFR-PEEK system ＞ titanium alloy system ＞ 68% CFR-PEEK system; the maximum stress of the mandible: PEEK system ＞ 30% CFR-PEEK system ＞ titanium alloy system ＞ 68% CFR-PEEK system. In the PEEK system, the maximum Von Mises stress of reconstructed plate and mandibular exceeded its yield strength under loading I; in the other systems, the maximum Von Mises stresses of mandible and reconstruction plate were below the yield strength. Conclusions The reconstruction plate of CFR-PEEK with 68% endless carbon fibers distributed the stresses in a similar manner as the titanium reconstruction plate, which could meet the mechanical strength requirements of mandible defect reconstruction. The fracture risk of the reconstructed plate was lower than that of titanium alloy, but the incidence of stress shielding was slightly higher. The result can provide references for the selection of materials and clinical application of reconstruction plate for mandibular defects.

The effect of fixation plate use on bone healing during the reconstruction of mandibular defects

OBJECTIVES: This study sought to compare efficiency results between the use of a customized implant (CI) and a reconstruction plate (RP) in mandibular defect reconstruction in an animal model. MATERIALS AND METHODS: Fifteen rabbits underwent surgery to create a defect in the right side of the mandible and were randomly divided into two groups. For reconstruction of the mandibular defect, the RP group (n=5) received five-hole mini-plates without bone grafting and the CI group (n=10) received fabricated CIs based on the cone-beam computed tomography (CBCT) data taken preoperatively. The CI group was further divided into two subgroups depending on the time of CBCT performance preoperatively, as follows: a six-week CI (6WCI) group (n=5) and a one-week CI (1WCI) group (n=5). Daily food intake amount (DFIA) was measured to assess the recovery rate. Radiographic images were acquired to evaluate screw quantity. CBCT and histological examination were performed in the CI subgroup after sacrifice. RESULTS: The 1WCI group showed the highest value in peak average recovery rate and the fastest average recovery rate. In terms of reaching a 50% recovery rate, the 1WCI group required the least number of days as compared with the other groups (2.6±1.3 days), while the RP group required the least number of days to reach an 80% recovery rate (7.8±2.2 days). The 1WCI group showed the highest percentage of intact screws (94.3%). New bone formation was observed in the CI group during histological examination. CONCLUSION: Rabbits with mandibular defects treated with CI showed higher and faster recovery rates and more favorable screw status as compared with those treated with a five-hole mini-plate without bone graft.

Rehabilitation with implant-supported fixed dental prostheses using digital duplication technique on customized artificial tooth, interim denture and implant surgical template: A case report / 대한치과보철학회지

Bone and soft tissue conditions are important for successful implant treatment. But, the placement itself is also very important. Implants which is installed in the wrong position result in the biological, esthetical and mechanical problems. In order to place an implant in the correct position, the final restoration and diagnostic wax-up should be considered prior to the surgery. If the artificial teeth for the interim denture are directly transferred from the diagnostic wax-up, the operator can try the form of diagnostic wax-up in the mouth. If the surgical template is produced by duplicating the interim denture, the implant can be placed in the planned position. In this case, the polymethyl methacrylate (PMMA) artificial tooth was precisely milled by the digital duplication of diagnostic wax-up. And interim denture was fabricated by using these milled teeth. After the patient adapted for a sufficient period, the implant was placed at the planned position with surgical template produced by duplicating the interim denture. After confirming sufficient osseointegration, the final prostheses were made to reflect the shape of diagnostic wax-up. Through this procedure, the satisfactory functional and esthetic outcome could be acquired.

Customized Vestibular Rehabilitation in the Patients with Bilateral Vestibulopathy: A Pilot Study in One Referred Center / 대한평형의학회지

OBJECTIVES: Bilateral vestibulopathy is characterized with unsteadiness and oscillopsia when walking or standing, worsening in darkness and/or on uneven ground. To establish the effect of customized vestibular rehabilitation in bilateral vestibulopathy, we analyzed the questionnaires and functional status before and after treatment. METHODS: Among 53 patients with customized vestibular rehabilitation from January 1st to November 30th in 2018, 6 patients (3 males; median age, 71 years; range, 54–75 years) who regularly exercised with good compliance were retrospectively enrolled. They were educated and trained the customized vestibular rehabilitation once a month or two by a supervisor during 40 minutes, and then exercised at home for 30 minutes over 5 days in a week. Dizziness handicap inventory (DHI), Korean vestibular disorders activities of daily living scale (vADL), Beck's depression index (BDI), test for dynamic visual acuity (DVA), and Timed Up and Go test (TUG) were performed before and after the customized vestibular rehabilitation. RESULTS: The patients exercised for median 5.5 months (range, 2–10 months) with the customized methods of vestibular rehabilitation, which included gaze and posture stabilization and gait control exercises. DHI score and TUG was improved after rehabilitation (DHI before vs. after rehabilitation=33 vs. 16, p=0.027, TUG before vs. after rehabilitation=12 vs. 10, p=0.026). BDI, DVA, and vADL scores did not differ between before and after treatment. CONCLUSIONS: Customized vestibular rehabilitation can improve dizziness and balance state in bilateral vestibulopathy. The steady exercises adapted individual peculiarities is the most important for vestibular rehabilitation.

Factors Associated with Patient Satisfaction in Customized Vestibular Exercise: A Pilot Study / 대한평형의학회지

OBJECTIVES: Numerous studies have been reported on the effect of customized vestibular exercise (cVE), but only a few studies have been reported on the satisfaction of cVE. Therefore, this study aims to investigate the factors that affect the satisfaction of cVE. METHODS: A telephone survey was conducted on 37 patients who underwent cVE from January to November 2018. The questionnaire consisted of a total of 10 items, including subjective symptom, compliance and satisfaction of exercise, preferred methods of exercise, and appropriate costs. Based on the questionnaire of satisfaction, the clinical features, improvement of symptom, compliance, preferred methods of exercise were compared between satisfactory and unsatisfactory groups. RESULTS: Of the 20 patients who responded to the telephone survey (response rate 57%), 10 patients were included in the satisfactory group and the remaining 10 were included in the unsatisfactory group. There were no significant differences between the 2 groups in age, sex, severity of subjective symptom before cVE, preferred methods of exercise. However, patients in the unsatisfactory group were significantly more likely to have chronic vestibulopathy and abnormal findings in dynamic posturography test than those in the satisfactory group. Subjective dizziness after cVE was significantly decreased in the satisfactory group, but there was no significant difference in the unsatisfactory group. These patients in the unsatisfactory group still had dizziness, but tended not to continue to exercise. CONCLUSIONS: The satisfaction of cVE was significantly lower in patients with chronic vestibulopathy, postural instability, less improvement of dizziness, and poor compliance.

Comparative analysis of visual outcomes and ocular aberrations following wavefront optimized and topography-guided customized femtosecond laser in situ keratomileusis for myopia and myopic astigmatism: A contralateral eye study

Purpose: To compare the visual outcomes and higher order aberrations (HOAs) following wavefront optimized (WFO) laser in situ keratomileusis (LASIK) versus topography-guided customized ablation (TCAT) LASIK for myopia and myopic astigmatism. Methods: Patients who underwent femtosecond-assisted LASIK for myopic correction between August 2016 and October 2017 were included in this interventional prospective case series. The following parameters were evaluated preoperatively and at 3 months' postoperative visit: uncorrected distance vision acuity (UDVA) and corrected distance vision acuity (CDVA), manifest refraction, and HOAs. Results: Two hundred eyes of 100 patients were included in the study. At 3 months' postoperative visit, 92% and 90% eyes in the TCAT and WFO groups, respectively, demonstrated a UDVA of 20/20 or better (P = 0.90). A residual manifest spherical equivalent within 0.5 D was achieved in 100% and 95% of the eyes in the TCAT and WFO groups, respectively (P = 0.10). No significant difference was observed in the HOAs induced in both the groups, with slightly lower induction of trefoil and horizontal coma in the TCAT group. Conclusion: Both groups demonstrated similar refractive efficacy and predictability, with greater gain of CDVA following TCAT ablation. HOAs induced were not significantly different between the two groups. Further studies are needed to validate the superiority of one procedure over the other.

Preliminary application of 3D printed customized guide in bone tumor biopsy / 上海交通大学学报（医学版）

Objective • To explore the feasibility of applying customized guide, based on digital image processing and 3D printing technology, to bone biopsy. Methods • Eleven patients (6 males and 5 females; 7-69 years old, average age of 36 years) diagnosed with bone tumor from July 2017 to March 2018 in Shanghai Ninth People's Hospital were enrolled in this study. Routine CT and/or MRI data were taken as reference in designing the customized biopsy guide for 3D printing by Medraw Print software. Needle insertion points were set under the supervision of surgeons to avoid damaging important anatomical structures such as nerves and blood vessels. 3D printed customized guide was designed to match local surface. The success of the puncture was confirmed by X-ray or CT, and the accuracy of the puncture results was evaluated by the pathological results of resection operation as a reference standard. The complications were analyzed. Results • The 11 patients included 4 cases with neoplasms in femur, 3 cases in pelvis, 2 cases in tibia, 1 case in scapula and 1 case in metacarpal. The needling positions in operation were consistent with the preoperative virtual design, and the guide plates fitted perfectly to the body surface. The results of biopsy of 8 patients (88.9%) matched with the postoperative pathology, while another 2 patients did not receive bone tumor resection because of the benign biopsy. No complications were observed during or after the procedure. Conclusion • Customized guide by digital image processing and 3D printing may have a great value in improving the accuracy of preoperative tumor diagnosis and the effectiveness of its treatment.

Three Dimensional Printing Technique and Its Application to Bone Tumor Surgery / 대한정형외과학회잡지

Orthopaedics is an area where 3-dimensional (3D) printing technology is most likely to be utilized because it has been used to treat a range of diseases of the whole body. For arthritis, spinal diseases, trauma, deformities, and tumors, 3D printing can be used in the form of anatomical models, surgical guides, metal implants, bio-ceramic body reconstruction, and orthosis. In particular, in orthopaedic oncology, patients have a wide variety of tumor locations, but limited options for the limb salvage surgery have resulted in many complications. Currently, 3D printing personalized implants can be fabricated easily in a short time, and it is anticipated that all bone tumors in various surgical sites will be reconstructed properly. An improvement of 3D printing technology in the healthcare field requires close cooperation with many professionals in the design, printing, and validation processes. The government, which has determined that it can promote the development of 3D printing-related industries in other fields by leading the use of 3D printing in the medical field, is also actively supporting with an emphasis on promotion rather than regulation. In this review, the experience of using 3D printing technology for bone tumor surgery was shared, expecting orthopaedic surgeons to lead 3D printing in the medical field.

Customized Vestibular Exercise / 대한이비인후과학회지

Vestibular rehabilitation is an excellent treatment option that can improve dizziness and balance through specific exercises in patients with dizziness who cannot be expected to improve with medication or surgical treatment. Vestibular rehabilitation treatment, especially customized exercise requires a long and complicated process of various evaluation processes, customized prescription of exercise, education, and training. Effective vestibular rehabilitation requires specialists with knowledge of vestibular rehabilitation, patient's commitment to recovery and understanding for the vestibular rehabilitation, and a medical system that can support the time, human resources, and place needed for vestibular rehabilitation. In 2017, customized vestibular exercise is finally approved as a new medical technology, and active treatment for dizziness has become possible for patients who need vestibular rehabilitation. Customized vestibular exercise is an individualized exercises in accordance with the symptoms and disabilities of the patient to improve dizziness and balance problem. Customized exercise consists of an evaluation process to find out the patient's problem, and exercise prescription and training.

In vitro and in vivo test of a customized system for extracorporeal life support / 中华急诊医学杂志

Objective We tried to develop a reliable,stable and effective customized ECLS system through a well designed in vitro and in vivo study.Methods An in vitro test model of the ECLS system,mainly consisting of a pseudo-patient (a blood reservoir),bladder,oxygenator,pump tube (outer diameter:1/4 inch),roller pump and the heater,was built.Performances of the pump,monitors,and the heater were observed every day.The precision of the pump flow (pressure monitor or the heater) was compared with a transonic flow-meter (Medtronic ECMO system or thermometer).The monitors were tested to see if they could meet the requirements.Four healthy and two mild ARDS piglets were supported with the customized ECLS system for 24 hours.Hemodynamics,lung mechanics,gas change and hematological parameters of the piglets and performances of the machine were recorded.Agreement between the customized ECLS system and other devices including the transonic flow-meter,Medtronic ECMO system and thermometer was evaluated by the Bland-Altman method.Results The pump,the monitors,and the heater functioned well without accidently stopping working.The 95％ limits of agreement of pump flow,pre-pump pressure,post-pump pressure,post-membrane pressure,and temperature were (-0.04 L/min,0.03 L/min),(-3 mmHg,3 mmHg),(-5 mmHg,6 mmHg),(-6 mmHg,6 mmHg),(0.1 ℃,0.3 ℃).The pressure monitors and the bladder could alarm and stop the pump fast during a 100 times trail.The bubble detector could respond well (alarm and stop the pump) to 60 of the 100 bubbles injected into the circuit.The alarming temperature of the heater was (42.3±0.2) ℃.The customized ECLS worked well without complications throughout the in vivo test.A temporary decrease of Cdyn and increase of A-aDO2 and OI were observed in healthy piglets while an escalating trend of Cdyn and a downtrend of A-aDO2 and OI in ARDS piglets.Mean arterial blood pressure of the piglets supported with the customized ECLS system maintained stable while the Hb and PLT decreased.Conclusion In vitro and in vivo test showed the pump,pressure monitors and the heater of the customized ECLS system functioned well,and the feasibility,safety and stability of the system were preliminarily verified from the cytosol of the cell to the lumen of the sarcoplasmic reticulum.