Simulation of biatrial conduction via different pathways during sinus rhythm with a detailed human atrial model.

In order to better understand biatrial conduction, investigate various conduction pathways, and compare the differences between isotropic and anisotropic conductions in human atria, we present a simulation study of biatrial conduction with known/assumed conduction pathways using a recently developed human atrial model. In addition to known pathways: (1) Bachmann's bundle (BB), (2) limbus of fossa ovalis (LFO), and (3) coronary sinus (CS), we also hypothesize that there exist two fast conduction bundles that connect the crista terminalis (CT), LFO, and CS. Our simulation demonstrates that use of these fast conduction bundles results in a conduction pattern consistent with experimental data. The comparison of isotropic and anisotropoic conductions in the BB case showed that the atrial working muscles had small effect on conduction time and conduction speed, although the conductivities assigned in anisotropic conduction were two to four times higher than the isotropic conduction. In conclusion, we suggest that the hypothesized intercaval bundles play a significant role in the biatrial conduction and that myofiber orientation has larger effects on the conduction system than the atrial working muscles. This study presents readers with new insights into human atrial conduction.

Mandible reconstruction assisted by preoperative virtual surgical simulation.

OBJECTIVE: In this study, we evaluated the clinical efficacy of mandible reconstruction with preoperative virtual planning, which focused on esthetics and occlusion. STUDY DESIGN: A series of 9 patients were enrolled prospectively to undergo mandibulectomy and simultaneous reconstruction. Preoperative spiral CT scans of the maxillofacial region and the fibula region were performed. Virtual surgery of tumor resection and fibula reconstruction was performed in the Mimics platform. The reconstructed mandible models were fabricated with CAD/CAM technique. The reconstruction plate and the positioning template were accommodated to the stereolithographic model as the surgical template. RESULTS: Surgery was performed accurately according to the templates. All the fibula flaps survived. The appearance and occlusion of the patients were satisfactory. CONCLUSIONS: With preoperative virtual planning, the spatial relationship of the mandible and the fibula graft can be planned individually, which helps achieve optimum appearance and occlusion relationship.

Mandible reconstruction assisted by preoperative simulation and transferring templates: cadaveric study of accuracy.

PURPOSE: In this study we tried to define tumor resection, fibula cutting, and positioning by surgical templates to perform the mandible reconstruction surgery according to the preoperative simulation. The accuracy was evaluated through cadaveric surgery. MATERIALS AND METHODS: Five cadaveric mandibles and fibulas were obtained. Preoperative surgical simulation was performed. Surgical templates that defined tumor resection, fibula cutting, and positioning were designed and fabricated. Translation, angular deviation, and rotation of bone grafts, as well as translation of condyles, were measured. RESULTS: The reconstructed mandibles showed high similarity to the surgical planning. The mean translation, angular deviation, and rotation of fibula segments of the reconstructed mandibles were 1.35 ± 0.86 mm, 3.36° ± 1.86°, and 8.13° ± 5.35°, respectively. In the mandible remnants, the translation of condyles was measured, with a mean of 1.39 ± 0.66 mm. CONCLUSIONS: Our method of defining the tumor resection, fibula cutting, and positioning by surgical templates was accurate enough for mandible reconstruction surgery.

[Six degree-of-freedom acquisition and analysis of jaw opening and closing with motion capture system].

OBJECTIVE: To explore the six degrees of freedom of jaw opening and closing movement with motion capture and analysis system to establish a quantitative method for studying mandibular movement and a digital basis for virtual reality study of mandibular movement. METHODS: In a male adult with normal dentition without temporomandibular joint disorders, 3 fluorescent markers were pasted in the upper dentition and 4 in the lower dentition. Six cameras of the motion capture system were arranged in a semi-circular fashion. The subject sat in front of the camera at an 80-cm distance with the Frankfort plane kept parallel to the horizontal plane. The degree-of-freedom (3 linear displacement and 3 angular displacement) of jaw opening and closing movement was obtained by collecting the marker motion. RESULTS: Six degrees of freedom of jaw opening and closing were obtained using the motion capture system. The maximum linear displacements of X, Y and Z axes were 5.888 089 cm, 0.782 269 cm, and 0.138 931 cm, and the minimum linear displacements were -3.649 83 cm, -35.961 2 cm, -5.818 63 cm, respectively. The maximum angular displacements of X, Y and Z axes were 0.760 088°, 2.803 753°, and 0.786 493°, with the minimum angular displacements of -2.526 18°, -0.625 94°, and -25.429 8°, respectively. Variations of linear displacements during jaw opening and closing occurred mainly in the Y axis, and those of angular displacement occurred mainly in the Z axis. CONCLUSION: The six degree-of-freedom of mandibular movement can be accurately obtained with the motion capture system to allow quantitative examination of the mandibular movement.

[Application of three-dimensional laser scanning-based maxillofacial soft tissue reconstruction in orthodontic treatment].

OBJECTIVE: To establish a convenient and rapid method for constructing a digital model of the maxillofacial soft tissue based on three-dimensional laser surface scanning to allow direct and accurate observation of the soft tissue changes in the course of orthodontic treatment. METHODS: The point cloud data of three-dimensional laser scanning of the maxillofacial region were acquired from a healthy woman with Angle Class I occlusion, who maintained a horizontal Frankfort plane during scanning with the scanner placed at a distance of 80 cm. The scanning was repeated twice after wearing the dental cast for an Angle Class I occlusion. The three-dimensional digital model of the maxillofacial soft tissue was constructed based on the point cloud using GeoMagic10.0 software. RESULTS: The high-resolution three-dimensional model of the maxillofacial soft tissue reconstructed allowed accurate observation of the distinct facial anatomical landmarks and represented directly the soft tissue changes in the process of orthodontic treatment by merging the models. Using the analytic tool provided by the software, this model also allowed direct quantitative measurement of the nasolabial angle and the distances from the esthetic plane to the upper lip, labral inferior, and mentolabial sulcus, which were 111.86°, -3.57 mm, -2.54 mm, and 3.95 mm before orthodontic treatment as compared to 114.31°, -2.73 mm, -1.06 mm, and 3.46 mm during treatment, and 116.53°, -0.15 mm, 0.64 mm, and 3.11 mm after the treatment, respectively. CONCLUSION: Three-dimensional laser surface scanning enables accurate and rapid construction of the digital model of the facial soft tissues, which may provide valuable assistance in orthodontic treatment.

[Construction of the digital models of masseter and temporal muscles with three-dimensional laser scanning].

OBJECTIVE: To explore a new method for establishing digital models of the masseter and temporal muscles and superficial soft tissue using three-dimensional laser scanning technique. METHODS: One adult male cadaveric head without malformation was dissected to expose the superficial portion of the masseter and temporalis. Multiple aspects of the sample were scanned with three-dimensional laser scanning system, and the point clouds of the masseter and temporal muscles were generated. The specimen was scanned again after the masseter and temporal muscles had been removed. The digital model of the muscles was reconstructed with the point clouds using Geomagic software, and the morphology of the muscle model was observed and measured. RESULTS: The 3-D digital models of the masseter and temporal muscles with the anatomical characteristics were reconstructed based on the point clouds using Geomagic 8.0 software. CONCLUSION: The digital model of the muscles can vividly demonstrate the muscle contours, which provides a basis for morphological study and biomechanical analysis of the muscles.

[Three-dimensional design of surgery for mandibular retrusion].

OBJECTIVE: To explore the feasibility of surgical design for mandibular retrusion using three-dimensional software. METHODS: Three-dimensional reconstruction was performed by Mimics software based on the preoperative CT data. The model of the maxillofacial region was imported into Rapidform software for measuring the associated parameters and Geomagic software for simulation of osteotomy. The reliability of the virtual operation was validated during the surgery. RESULTS: The model of mandibular retrusion was reconstructed and successfully used to simulate the surgery. The simulation result was applied in subsequent actual surgery and good surgical outcomes were achieved. CONCLUSION: The three-dimensional software can be used to simulate the surgery for mandibular retrusion and improve the predictability and accuracy of the surgery.

[Study on the three dimensional hepatic virtual operation based on the data of 64-slice helical CT scanning].

OBJECTIVE: To study the surgery plan and simulation effect of the three dimensional (3D) hepatic virtual operation based on the data of 64-slice helical CT scanning and to probe the feasibility of the virtual operation based on the FreeForm Modeling System. METHODS: The volunteer liver was scanned to collect two dimensional (2D) DICOM data of 64-slice helical CT scanning and the 3D hepatic and intrahepatic vessels model were reconstructed by MIMICS software. The reconstructed liver, the intrahepatic vessels model and the artificial tumor models were output into the FreeForm Modeling System in the STL format. The device PHANTOM with the characterization of dynamo-feedback was applied to make the operation on the 3D hepatic. RESULTS: The spatial relationship between the tumour and the intrahepatic vessels were clearly observed by rotation and enlargement of the target. According to the operation principle, the left lobe of liver resection was simulated by manipulating the device PHANToM. Through the liver transparence surface, the intrahepatic vessels were easily distinguished. The operation procedure was accord with the clinic hepatic surgery. Meanwhile, during the operation, by adjusting the incision objective intensity, the dynamo-feedback intensity was definitely touched. CONCLUSIONS: By using the FreeForm Modeling System,the hepatic operation procedure can be simulated ahead of time. The operation complication in the practical surgery can be anticipated and the individualization operation schema can be reasonable instituted.

[Establishment of a testing system of three-dimensional spinal kinematics in vivo based on two- and three-dimensional image registration].

OBJECTIVE: To investigate the feasibility of using two- and three-dimensional (2D/3D) image registration for establishing a testing system of 3D kinematics of the spine in vivo. METHODS: CT data of the adult human lumbar spine were collected and the two orthogonal images of the same specimen were captured using an X-ray fluoroscope at two different positions. The 3D computer models of L3 and L4 vertebrae were reconstructed. A virtual fluoroscope was then created with solid modeling software to reproduce the relative positions of the orthogonal images. Two virtual cameras in the software were used to represent the X-ray sources. The 3D computer models of the L3 and L4 vertebrae were then introduced into the virtual fluoroscope respectively and projected onto the orthogonal images by the two virtual cameras. By matching the projections of the 3D model to the orthogonal images of L3 and L4 vertebrae, the 3D positions of L3 and L4 were obtained. After calculation, the relative displacement and angle of L3 were determined. RESULTS: After 2D/3D image registration, the relative displacement and angle were calculated. Compared with position I, the positional changes of L3 were represented with an extension of 5.86 degrees, left bending of 1.85 degrees and right rotation of 2.96 degrees. CONCLUSION: 2D/3D image registration allows the simulation of 3D kinematics of the spine in vivo, but the efficiency and accuracy of this technique need further evaluation.

[Construction of artificial nerve bridge by three-dimensional culture of Schwann cells with human hair keratins].

OBJECTIVE: To culture Schwann cells (SCs) and human hair keratins (HHKs) for artificial nerve bridge construction. METHODS: SCs were purified by primary culture and labeled with BrdU, which were then cultured with HHKs decorated by ECM. The artificial nerve bridge was implanted into the defect of sciatic nerve, beneath the skin, and in the skeletal muscles of SD rat, respectively. The morphology of the SCs cultured with HHKs was monitored by inverted microscope and evaluated by immunocytochemical staining. Growth of BrdU-labeled SCs in vivo was observed by immunocytochemical staining on paraffin sections. RESULTS: In vitro cultured SCs were capable of adhering to HHKs and grew well four weeks after implantation. The HHK component in the artificial nerve bridge underwent degradation in the defect of the sciatic nerve, beneath the skin, and in the skeletal muscles of SD rat, and SC survival and proliferation were verified. CONCLUSION: SCs can survive in three-dimensional culture with HHKs for construction of artificial nerve bridge to repair nerve defects.

[In vitro study of formalin-fixed bone tissues for allogeneic bone grafting].

OBJECTIVE: To conduct an in vitro study to assess the preliminary possibility of using formalin-fixed, instead of fresh, human bone tissues for allografting. METHODS: Fresh cadaveric bone tissues were fixed by formalin for more than 6 months and dissected into 5 mmx5 mmx5 mm pieces and 5 mmx5 mmx40 mm sticks, followed by chemical treatments to prepare the allograft bone materials. When alls treatments were completed, the bone grafts were centrifuged and their properties and cellular compatibility assessed in comparison with the currently used bone grafts clinically. RESULTS: The residual formaldehyde of the fixed allograft bone material was much below the controlled level and no significant differences were noted between the bone graft materials tested in regard to the chemical and mechanical properties and biocompatibility. CONCLUSION: This material we have prepared may meet the clinical demands for bone grafting, with good biocompatibility and less chance for infection by pathological agents.

Construction of dataset for Virtual Chinese Male No.1.

OBJECTIVE: To establish digitized Virtual Chinese Human Male No.1 (VCH-M1) image dataset with a 0.2-mm equal interval. METHODS: The body of a 24-year-old male was used for this study. Perfusion with phenol and vermilion of the arteries was performed, followed by body shape adjustment by cold saline and pre-embedding with broken ices in an upside-down position, which was completed in a stepwise procedure to minimize body shape deformation. Section milling was conducted subsequently with the section thickness of 2 mm and the section images were captured by digital camera, which were immediately transferred to a computer for storage and processing. RESULTS: A total of 9 232 sections were obtained for the whole body, and the resolution of each of the image in TIF format was 3 024x2 016 pixels, resulting in the size of approximately 18 M for each image and about 161 G for the whole dataset. CONCLUSIONS: Compared with VCH-F1, the image quality in VCH-M1 dataset is significantly improved, demonstrated by much clearer tissue boundary in the images and minimized body shape deformation during the embedding process.

[Establishment of Internet-based database of the Virtual Chinese Human dataset].

To establish an Internet-based database for the dataset of Virtual Chinese Human that is accessible to the interested researchers, modifications and compression of the original VCH-format dataset of Virtual Chinese Human were performed before it was uploaded to the server, and RAID0+1 storage technology was adopted with specific download accesses designed for different users. After dataset modification and compression, the data size was considerably reduced to allow convenient data storage and transfer. The RAID0+1 storage technology guarantees the security and high-speed download of data through different means established. Internet-based database provides important accesses for sharing the achievement in virtual human study between world-wide researchers, which has been imperative in the present situation of science development.

[Registration of the image data of the Virtual Chinese Female No.1].

In this study, the authors attempt to find a solution for the image registration before three-dimensional reconstruction of digitized Virtual Chinese Female No.1 (VCH-F1) image data can be completed. On the basis of a thorough understanding of the features of the image data, the parameters were determined based on the marker outside the specimen and the least-square procedure performed on the outline offset distance between two images, prior to the completion of the image registration by means of rigid body transformation with the parameters. In the trial application of these two methods in image registration for these image data, good results were obtained, which approved of the application of the two methods for accomplishing the image registration with simpler calculation processes and easier computer processing.

[Research report of experimental database establishment of digitized virtual Chinese No.1 female].

OBJECTIVE: To establish digitized virtual Chinese No.1 female (VCH-F1) image database. METHODS: A 19 years old female cadaver was scanned by CT, MRI, and perfused with red filling material through formal artery before freezing and em- bedding. The whole body was cut by JZ1500A vertical milling machine with a 0.2 mm inter-spacing. All the images was produced by Fuji FinePix S2 Pro camera. RESULTS: The body index of VCH-F1 was 94%. We cut 8 556 sections of the whole body, and each image was 17.5 MB in size and the whole database reached 149.7 GB. We have totally 6 versions of the database for different applications. CONCLUSIONS: Compared with other databases, VCH-F1 has good representation of the Chinese body shape, colorful filling material in blood vessels providing enough information for future registration and segmentation. Vertical embedding and cutting helped to retain normal human physiological posture, and the image quality and operation efficiency were improved by using various techniques such as one-time freezing and fixation, double-temperature icehouse, large-diameter milling disc and whole body cutting.