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The present study aimed to evaluate the morphological characteristics of the sphenoid sinus (SS), and the impact of potential influencing factors on the morphometric features using CBCT imaging. CBCT scans of 148 patients, aged between 15 and 85 (32.88 ± 15.33) years were retrospectively evaluated. DICOM files from the CBCT scans were imported into semi-automatic software and the SS of each patient was assessed for the morphological characteristics including configuration, symmetry, extension, shape, septation, volume, and maximum diameter. Furthermore, potential influencing factors such as age, gender, side, and sinus condition were analysed. A significant association was observed between sinus extension and age. Septation was also found to be significantly associated with age, gender and sinus condition. Besides, sinus volume was significantly associated with gender and sinus condition. No significant influence of shape and side on the morphometric features was noticed. The average volume and diameter of the SS were 6576.92 ± 3748.12 mm3 and 30.48 ± 9.28 mm, respectively. In conclusion, the present findings indicate that age, gender and sinus condition have a significant impact on the morphometric characteristics of the SS. Mature sinuses exhibit a post-sellar extension pattern until middle age. In addition, males, and sinuses with healthy sinus condition have larger volumes compared to females and pathological sinuses. ispartof: ANATOMICAL SCIENCE INTERNATIONAL vol:96 issue:4 pages:544-555 ispartof: location:Japan status: published

Background There has been significant recent emphasis on the use of patient-specific instrumentation (PSI) in shoulder arthroplasty. However, clinical data are lacking to support the increased time and expense associated with PSI. Our purposes were to determine whether PSI significantly improves implantation accuracy during total shoulder arthroplasty (TSA) and to analyze available techniques and correlation with clinical outcomes. We hypothesized that PSI may improve glenoid component position radiographically but without correlation with clinical outcomes. Methods The MEDLINE, Scopus, Embase, and Cochrane Library databases were queried. Included articles reported use of any preoperative or intraoperative PSI techniques, models, or guides to assist with TSA prosthesis implantation. The primary outcomes were mean deviation from the preoperative plan in version (in degrees), inclination (in degrees), and entry-point offset on the glenoid (in millimeters). Results Among the included articles, 518 TSA procedures (352 anatomic and 166 reverse) were performed. The mean postoperative errors in both version and inclination angles were 5° or less in 20 articles (90.9%) using PSI. Meta-analysis revealed no statistically significant differences in version error (P > .999, I2 = 64.6%), inclination error (P = .702, I2 = 82.2%), or positional offset (P = .777, I2 = 85.7%) between PSI and standard instrumentation. No data regarding patient-reported outcome measures, range of motion, strength, or glenoid component loosening and longevity were reported. Conclusions Meta-analysis revealed no significant differences in accuracy between PSI and standard instrumentation. Although PSI may possess the potential to improve TSA techniques, further investigations regarding long-term clinical outcomes, impact on operating room time, and cost-effectiveness are warranted before PSI can be routinely recommended over conventional instrumentation.

Background The reconstruction of complex cranial defects is challenging and is associated with a high complication rate. The development of a patient-specific, titanium-reinforced, calcium phosphate–based (CaP-Ti) implant with bone regenerative properties has previously been described in 2 case studies with the hypothesis that the implant may improve clinical outcome. Objective To identify whether the introduction of CaP-Ti implant has the potential to improve clinical outcome. Methods A retrospective review of all patients having undergone CaP-Ti cranioplasty was conducted. Comprehensive clinical data were collected from the hospital computer database and patient records. Bone formation and osseointegration were analyzed in a single retrieval specimen. Results Fifty patients, with 52 cranial defects, met the inclusion criteria. The patient cohort displayed a previous failure rate of 64% (32/50) with autologous bone, alloplastic materials, or both. At a median follow-up time of 25 months, the explantation rate due to either early postoperative infection or persistent wound dehiscence was 1.9% (1/53) or 3.8% (2/53), respectively. Surgical intervention with local wound revision was required in 2 patients without the need of implant removal. One patient had a brain tumor recurrence, and the implant was explanted 31 months after implantation. Histologic examination showed that the entire implant was partly yet evenly transformed into vascularized compact bone. Conclusion In the present study the CaP-Ti implant appears to have improved the clinical outcomes in a cohort of patients with a high rate of previous cranioplasty failures. The bone regenerative effect may in particular have an impact on the long-term success rate of the implant.

The development of the three-dimensional (3D) exoscope is a marvel of technological innovation in modern surgical practice. While its predecessor, the operating microscope (OM), has long been the gold-standard surgical visualization modality, its particular limitations in terms of accessibility and ergonomic demand have led to the development of a more sophisticated, 3D model. Specifically, the 3D exoscope allows for an enhanced image quality of the surgical field, while also being more ergonomically favorable. Moreover, this device's ability to handle delicate microsensitve procedures, along with its alleviation of surgeon fatigue, indicates great potential for neurosurgical application. For this narrative review, the authors queried PubMed database using the keyword "exoscope" to identify relevant studies involving the specialty of neurosurgery that were published in English language full text. The search yielded full-text English language-related articles regarding neurosurgical exoscope, its applications and limitations. The 3D exoscope uniquely allows for enhanced surgeon comfort and superior imaging of the patient's real-time anatomy. However, the OM was described to having a slight image favorability with fusion and decompression surgery. Cost analysis is highlighted for its potential disparity. 3D exoscopes will potentially be incorporated with intelligent carriers and robotic surgical systems. Ultimately, with further studies highlighting its use, the 3D exoscope is expected to continue to imprint its status as one of the most efficient technological visualization tools in the future of neurosurgical practice.

Background Exoscopic surgery promises alleviation of physical strain, improved intraoperative visualization and facilitation of the clinical workflow. In this prospective observational study we investigate the clinical usability of a novel 3D4K-exoscope in routine neurosurgical interventions. Methods Questionnaires on the use of the exoscope were carried out. Exemplary cases were additionally video-documented. All participating neurosurgeons (n=10) received initial device training. Changing to a conventional microscope was possible at all times. A linear mixed model was used to analyze the impact of time on the switchover rate. For further analysis we dichotomized the surgeons in a frequent (n=1) and an infrequent (n=9) user group. A one-sample Wilcoxon signed rank test was used to evaluate, if the number of surgeries differed between the two groups. Results 39 operations were included. No intraoperative complications occurred. In 69.2% of the procedures, the surgeon switched to the conventional microscope. While during the first half of the study the conversion rate was 90%, it decreased to 52.6% in the second half ( p =0.003). The number of interventions between the frequent and the infrequent user group differed significantly ( p =0.007). Main reasons for switching to ocular-based surgery were impaired hand-eye coordination and poor depth perception. Conclusion The exoscope investigated in this study can be easily integrated in established neurosurgical workflows. Surgical ergonomics improved compared to standard microsurgical setups. Excellent image quality and precise control of the camera added to overall user satisfaction. For experienced surgeons, the incentive to switch from ocular-based to exoscopic surgery greatly varies.

The present studies were conducted to evaluate key serum proteins and other components that mediate anchorage-independent growth (3-D growth) of LNCaP prostate cancer cells as spheroids. The cells were cultured on ultra-low attachment plates in the absence and presence of fetuin-A and with or without extracellular vesicles. The data show that fetuin-A (alpha 2HS glycoprotein) is the serum protein that mediates 3-D growth in these cells. It does so by sequestering extracellular vesicles of various sizes on the surfaces of rounded cells that grow as spheroids. These vesicles in turn transmit growth signals such as the activation of AKT and MAP kinases in a pattern that differs from the activation of these key growth signaling pathways in adherent and spread cells growing in 2-D. In the process of orchestrating the movement and disposition of extracellular vesicles on these cells, fetuin-A is readily internalized in adhered and spread cells but remains on the surfaces of non-adherent cells. Taken together, our studies suggest the presence of distinct signaling domains or scaffolding platforms on the surfaces of prostate tumor cells growing in 3-D compared to 2-D.

The development of transcatheter mitral valve replacement therapies requires accurate post-processing analysis tools to provide D-shaped mitral annulus dimensions from 3-dimensional (3D) data. The agreement between two semi-automated, software packages to process 3D transesophageal echocardiography (TEE) data for the measurement of the mitral valve annulus dimensions was evaluated. 3DTEE data of patients with moderate-severe mitral regurgitation (MR) were postprocessed with semi-automated, vendor-independent (VI) software and vendor-specific (VS) software. Both post-processing software provided key measurements for the selection of transcatheter valve prosthesis size: annulus area, annulus circumference and the septal-to-lateral distance of the annulus. The intertrigonal distance was provided only by the VS software. The inter- and intra-observer agreements were assessed with Bland-Altman analysis. Of 105 patients (63.8 +/- 11 years, 66% male) with MR, 28 had secondary MR, 45 fibroelastic deficiency, and 32 Barlow's disease. Using VS software, the dimensions for the overall population were 16.1 +/- 4.6 cm(2) for annulus area, for circumference 14.4 +/- 1.9 cm, intertrigonal distance 3.4 +/- 0.5 cm and septal-to-lateral distance 3.8 +/- 0.6 cm. Similar dimensions were obtained using VI software: 15.7 +/- 4.6 cm(2) for annulus area, 14.5 +/- 2.0 cm for circumference, and 4.1 +/- 0.6 cm for septal-to-lateral distance. The inter- and intra-observer agreement for both software programs was excellent. In conclusion, current post-processing software programs for 3DTEE data of the mitral valve annulus provide good reproducibility of key measurements to select the transcatheter prosthesis size.

Staphylococcus aureus is a prominent human pathogen in bone and soft-tissue infections. Pathophysiology involves abscess formation, which consists of central staphylococcal abscess communities (SACs), surrounded by a fibrin pseudocapsule and infiltrating immune cells. Protection against the ingress of immune cells such as neutrophils, or tolerance to antibiotics, remains largely unknown for SACs and is limited by the lack of availability of in vitro models. We describe a three-dimensional in vitro model of SACs grown in a human plasma-supplemented collagen gel. The in vitro SACs reached their maximum size by 24 h and elaborated a fibrin pseudocapsule, as confirmed by electron and immunofluorescence microscopy. The in vitro SACs tolerated 100× the MIC of gentamicin alone and in combination with rifampin, while planktonic controls and mechanically dispersed SACs were efficiently killed. To simulate a host response, SACs were exposed to differentiated PLB-985 neutrophil-like (dPLB) cells and to primary human neutrophils at an early stage of SAC formation or after maturation at 24 h. Both cell types were unable to clear mature in vitro SACs, but dPLB cells prevented SAC growth upon early exposure before pseudocapsule maturation. Neutrophil exposure after plasmin pretreatment of the SACs resulted in a significant decrease in the number of bacteria within the SACs. The in vitro SAC model mimics key in vivo features, offers a new tool to study host-pathogen interactions and drug efficacy assessment, and has revealed the functionality of the S. aureus pseudocapsule in protecting the bacteria from host phagocytic responses and antibiotics.

Highlights • Advances in 3D bioprinting have tremendous potential in therapeutic development for multiple cardiovascular applications. • 3-dimensional bioprinting is moving toward in vivo studies to evaluate printed construct functionality and safety. • Bioprinting techniques predominantly use extrusion-based, inkjet, and light-based printing. • Bioinks are composed of cells and matrix material and consist of both scaffold-based and scaffold-free inks., Summary Three-dimensional (3D) bioprinting may overcome challenges in tissue engineering. Unlike conventional tissue engineering approaches, 3D bioprinting has a proven ability to support vascularization of larger scale constructs and has been used for several cardiovascular applications. An overview of 3D bioprinting techniques, in vivo translation, and challenges are described., Central Illustration

Background. Validation of three-dimensional (3D) reconstructions of full dental arches with crowns and roots based on cone beam computed tomography (CBCT) imaging represents a key issue in 3D digital dentistry. Objectives. The aim of the study was to search for the most accurate in vivo windowing-based manual tooth segmentation using CBCT. The null hypothesis was that all applied windowing protocols were equivalent in terms of in vivo tooth volume measurement using CBCT. Material and methods. This retrospective study was based on preoperative CBCT images from patients who underwent further tooth extractions for reasons independent of this study. Written informed consent was obtained from all the participants, and the study was approved by the Ethics Committee of Cliniques Universitaires Saint Luc (Brussels, Belgium). The radiological protocol was I-CAT CBCT, 0.3 mm slice thickness, 8 cm × 16 cm field of view, 120 kVp, and 18 mAs. A total of 36 teeth were extracted from 14 patients between the ages of 18 and 68 years. Using 3D Slicer software, segmentations were performed twice by 2 independent observers, with a 1-month time period between the 2 segmentations to study intra- and inter-observer repeatability and reproducibility. Four windowing protocols (level/window) were applied: 1. 1131/1858, 2. 2224/4095, 3. 1131/4095, and 4. AUTO, an automatic protocol provided by default by the software. A total of 576 segmentations were performed. Tooth volumes were automatically calculated using the software. To compare the volumes obtained from CBCT segmentations with a gold-standard method, we laser-scanned the extracted teeth. Results. Excellent intra- and inter-observer intraclass correlations were found for all of the protocols used. The best windowing protocol was 1131/1858 for both observers. Tooth volumes were obtained by manual segmentation of the CBCT images and using windowing protocol 1131/1858. No significantly different tooth volumes were found by laser scanning. Conclusions. Our null hypothesis was rejected. Only windowing protocol 1131/1858 allowed for significantly closer 3D in vivo segmentation of a tooth compared to I-CAT CBCT, with excellent intra-observer repeatability and inter-observer reproducibility., SCOPUS: ar.j, info:eu-repo/semantics/published

Two-dimensional (2D) strain analysis is constrained by geometry-dependent reference directions of deformation (i.e. radial, circumferential, and longitudinal) following the assumption of cylindrical chamber architecture. Three-dimensional (3D) principal strain analysis may overcome such limitations by referencing intrinsic (i.e. principal) directions of deformation. This study aimed to demonstrate clinical feasibility of 3D principal strain analysis from routine 2D cine MRI with validation to strain from 2D tagged cine analysis and 3D speckle tracking echocardiography. Thirty-one patients undergoing cardiac MRI were studied. 3D strain was measured from routine, multi-planar 2D cine SSFP images using custom software designed to apply 4D deformation fields to 3D cardiac models to derive principal strain. Comparisons of strain estimates versus those by 2D tagged cine, 2D non-tagged cine (feature tracking), and 3D speckle tracking echocardiography (STE) were performed. Mean age was 51 ± 14 (36% female). Mean LV ejection fraction was 66 ± 10% (range 37–80%). 3D principal strain analysis was feasible in all subjects and showed high inter- and intra-observer reproducibility (ICC range 0.83–0.97 and 0.83–0.98, respectively—p

The serpentine flow channel can be considered as one of the most common and practical channel layouts for a polymer electrolyte membrane fuel cell (PEMFC) since it ensures an effective and efficient removal of water produced in a cell with acceptable parasitic load. Water management is one of the key issues to improve the cell performance since at low operating temperatures in PEMFC, water vapor condensation starts easily and accumulates the liquid water droplet within the flow channels, thus affecting the chemical reactions and reducing the fuel cell performance. In this article, a comprehensive three dimensional numerical simulation is carried out to understand the water droplet mobility in a serpentine gas flow channel for a wide range of surface properties, inlet air velocities, droplet positions (center or off-center, bottom or top) and droplet sizes by deploying a finite volume based methodology. The liquid-gas interface is tracked following the volume-of-fluid (VOF) method. The droplet transport is found to be greatly influenced by the surface wettability properties, inlet velocities, number of droplets emerged and initial droplet positions. Super hydrophobic surface property is not always preferable for designing the gas flow channels. It depends upon the inlet velocity conditions, droplet positions, number of droplets and surface properties.

Introduction Two-dimensional laparoscopy for living donor nephrectomy is the current standard of care. We report the first case of three-dimensional laparoscopy for living-donor nephrectomy with vaginal extraction. Presentation of case The procedure was performed in a 66-year-old woman donating his left kidney to her son with the HD S 3D column (Karl Storz, Tuttlingen, Germany). Preoperative computed tomography showed one left renal artery. The warm ischemic time was 2 min 20 s and the operative time was 200 min. There was no loss of blood and no intraoperative or postoperative complications. Discussion This report demonstrates the feasibility of using 3D laparoscopy which allows for a more in-depth vision, greater overall definition of planes, better accuracy of dissection and reduced operative times, for nephrectomy with vaginal extraction for kidney donation. Conclusion Three-dimensional laparoscopy for living-donor nephrectomy with vaginal extraction is feasible and could become a new standard.

Mass spectrometry imaging (MSI) has emerged as a powerful tool in biomedical research to reveal the localization of a broad scale of compounds ranging from metabolites to proteins in diseased tissues, such as malignant tumors. MSI is most commonly used for the two-dimensional imaging of tissues from multiple patients or for the three-dimensional (3D) imaging of tissue from a single patient. These applications are potentially introducing a sampling bias on a sample or patient level, respectively. The aim of this study is therefore to investigate the consequences of sampling bias on sample representativeness and on the precision of biomarker discovery for histological grading of human bladder cancers by MSI. We therefore submitted formalin-fixed paraffin-embedded tissues from 14 bladder cancer patients with varying histological grades to 3D analysis by matrix-assisted laser desorption/ionization (MALDI) MSI. We found that, after removing 20% of the data based on novel outlier detection routines for 3D-MSI data based on the evaluation of digestion efficacy and z-directed regression, on average 33% of a sample has to be measured in order to obtain sufficient coverage of the existing biological variance within a tissue sample.Significance: In this study, 3D MALDI-MSI is applied for the first time on a cohort of bladder cancer patients using formalin-fixed paraffin-embedded (FFPE) tissue of bladder cancer resections. This work portrays the reproducibility that can be achieved when employing an optimized sample preparation and subsequent data evaluation approach. Our data shows the influence of sampling bias on the variability of the results, especially for a small patient cohort. Furthermore, the presented data analysis workflow can be used by others as a 3D FFPE data-analysis pipeline working on multi-patient 3D-MSI studies.

Tissue engineering aims to gain mechanistic insights into human diseases and to develop new treatment protocols. Although 2-dimensional (2-D) flat petri dish culture and in vivo disease-based models are the industrial gold standards for understanding the underlying disease pathophysiology and for drug screening/testing, they are associated with certain limitations. While the 2-D cell culture systems fail to mimic in vivo signaling, animal-based disease models are associated with long incubation period, high cost, ethical constraints as well as depiction of human pathology in different species. Therefore, there has been a paradigm shift towards the development of 3-dimensional (3-D) based in vitro disease models. These models act as bridging gaps between the aforementioned conventional strategies thereby fastening clinical translation. In this regard, biomedical engineering plays a key role towards the development of tissue engineering based 3-D disease models. These models have demonstrated success in recapitulating human diseases in terms of in vivo morphology and signaling. This chapter will present examples of biomaterials-based 3-D engineered disease models with a focus on cancer. Refereed/Peer-reviewed

The hammer throw in athletics has been the subject of published research since the 1980s. This has focused on case studies of individual athletes or small cohorts and has identified a number of key performance indicators such as the speed profile of the hammer during the wind-up phase. To use these key performance indicators with current athletes a bespoke analysis tool is required for frequent data collection. An unobtrusive two cameras system was proposed and a non-standard planar calibration method that allows the safety cage to remain in place was designed. The performance of the non-standard calibration method was compared to the standard calibration method using simulated data. The non-standard method was found to be suitable when intrinsic camera parameters were not recomputed. The method is a suitable alternative for volumes that cannot easily be accessed with a calibration object or volumes that are too large for practically sized calibration objects

Background: Both 3-dimensional (3D) laparoscopic gastrectomy (LG) and 2-dimensional (2D) LG are commonly used for gastric cancer (GC). To investigate their safety and efficacy, we performed this meta-analysis. Methods: PubMed, The Cochrane Library, Science Direct, Embase, Scopus, and Web of Science were systematically searched to identify relevant studies. The total number of lymph node dissections (LNDs), operation time, blood loss, postoperative hospital stay, postoperative complications, and hospitalization cost were extracted as major endpoints. Results: Among 904 articles that were enrolled, 9 studies were included for analysis. The 3D group was observed to have shorter operation times [95% confidence interval (CI): −0.54 to −0.06; P = .01] and less blood loss (95% CI: −0.41 to −0.19; P

A 54-yr-old man presented with the radiological recurrence of a glioblastoma at the level of the left anterior cingulate gyrus, 46 mo after first surgery, which had been complicated by bone flap infection. Due to the relatively small recurrence, the long survival, and the good neurological status, surgery was warranted. A new, high-definition (4 K) and 3-dimensional exoscope (ORBEYE; Sony Olympus Medical Solutions Inc, Tokyo, Japan) was used during the surgical approach and throughout tumor removal, which was aided by five-aminolevulinic acid (5-ALA) derived fluorescence. The postoperative course was characterized by supplementary motor area syndrome, which quickly improved, leading to a discharge home 1 wk after surgery. Histological examination confirmed a wild-type (WT) IDH1/2, MGMT (DNA repair enzyme O6-methylguanine-DNA methyltransferase) methylated glioblastoma with a proliferative index focally as high as 20%. He is now being considered for a second-line treatment. As recently reported for spinal surgery,1 we believe this technology has significant potential for its small dimension (which can provide optimal positioning even in ergonomically challenging positions), ease of movement, and image quality, including 5-ALA fluorescence. The patient's consent was obtained for publication.

For the steady forced convection cooling of an isothermal spherical object in an axially symmetric incompressible fluid flow at high Peclet numbers, where the heat transport occurs mainly in a thin thermal boundary layer near the surface of the object, the relation: N u ∝ P e 1 / 2 or N u ∝ P e 1 / 3 between the Nusselt number and the Peclet number is generally found. In this paper we investigate for the general case of a 3-dimensional object immersed in a 3-d incompressible fluid flow the connection between these two characteristic numbers and obtain a similar relation: N u ∝ P e 1 / k + 2 with integer values k ≥ 0 , where k depends only on the boundary conditions of the fluid flow field at the surface of the object.

Introduction Advantages in 3-dimensional (3D) laparoscopy are mostly described in adults for better depth perception, precise visualization of anatomical structures, as well as for complex surgical maneuvers in small spaces. Using Visionsense III stereoscopic endoscopy system (Neuromed Spa), we performed a comparative study between surgical skills achievements using 2-dimensional (2D) and 3D laparoscopic equipment in a pediatric laparoscopic surgery simulator model. Materials and Methods Three skills were evaluated both in 2D and 3D modalities. Pediatric residents ( n = 20) without any previous laparoscopic experience were randomly divided in 2 groups and evaluated doing the established tasks in a laparoscopic simulator validated for pediatric surgery. Switching the type of vision from 2D to 3D or vice versa, we evaluated bimanual dexterity, efficiency, and efficacy. Three tasks were proposed—task 1: transfer of objects (6 pegs transferred one-by-one on a pegboard); task 2: pattern cutting (cutting a paper, following a circular dotted line); and task 3: threading eyelet (transfer, twisting and passing through a eyelet-shaped support, a specific 3D object). Performance was measured using a scoring system rewarding precision and speed. Any physical discomfort related to the 3D vision was recorded. Results Of the 20 participants included, 10 began the skills in the 2D modality and then performed them in 3D, and the other 10 began in 3D and ended in 2D. Overall task 1 performance (time and number of errors) was significantly better using stereoscopic compared with monoscopic visualization. Both groups experienced a 35.6% decrease in the time needed to complete the peg transfer using 3D instead of 2D. In task 2, the 3D performance was superior (less time to correctly cut the paper along the dotted line), but did not reach statistical significance. In task 3, the residents experienced with 3D a 31.7% decrease in the time necessary to complete the passage of the object trough the eyelet. Most participants (65%) "subjectively" defined 3D laparoscopy easier overall; 6 participants (30%) did not experience any issue related to the use of 3D technology; and 1 person (5%) of group 1 found more difficulties using 3D compared with 2D. Headache (25%), nausea (20%), and visual disturbance (1%) were the most common issues reported by the students during 3D procedures. Finally, the results show that residents achieved significantly better results working with 3D vision rather than with 2D vision. Discussion As other studies have demonstrated, there was improvement in the overall performance using the 3D laparoscope. This was the first attempt to verify 3D skills in naive subjects, directly on a simulator conceived exclusively for pediatric surgery; therefore, bias was limited by using a population without surgical experience. Conclusions 3D laparoscopic surgical skills showed superior to 2D, with higher percentages of tasks completion, less time in performing them, and a shorter learning curve. Our results indicate that 3D was subjectively easier than 2D in performing complex tasks in the skills laboratory setting.

Understanding the role of autophagy in cancer has been limited by the inability to measure this dynamic process in formalin-fixed tissue. We considered that 3-dimensional models including ex vivo tumor, such as we have developed for studying mesothelioma, would provide valuable insights. Using these models, in which we could use lysosomal inhibitors to measure the autophagic flux, we sought a marker of autophagy that would be valid in formalin-fixed tumor and be used to assess the role of autophagy in patient outcome. Autophagy was studied in mesothelioma cell lines, as 2-dimensional (2D) monolayers and 3-dimensional (3D) multicellular spheroids (MCS), and in tumor from 25 chemonaive patients, both as ex vivo 3D tumor fragment spheroids (TFS) and as formalin-fixed tissue. Autophagy was evaluated as autophagic flux by detection of the accumulation of LC3 after lysosomal inhibition and as autophagy initiation by detection of ATG13 puncta. We found that autophagic flux in 3D, but not in 2D, correlated with ATG13 positivity. In each TFS, ATG13 positivity was similar to that of the original tumor. When tested in tissue microarrays of 109 chemonaive patients, higher ATG13 positivity correlated with better prognosis and provided information independent of known prognostic factors. Our results show that ATG13 is a static marker of the autophagic flux in 3D models of mesothelioma and may also reflect autophagy levels in formalin-fixed tumor. If confirmed, this marker would represent a novel prognostic factor for mesothelioma, supporting the notion that autophagy plays an important role in this cancer.

The effects of therapy on constricted ears are evaluated subjectively and objectively. However, previous methods are not specific, comprehensive, precise, or effective in diagnosing and predicting surgical outcomes. This study aimed to present a personalized, subjective evaluation scale and new objective indices utilizing a digital method for the accurate evaluation of constricted ears. Nine consecutive patients with constricted ears were selected. To perform subjective evaluations, the patients’ parents were contacted by telephone within 3 to 6 months after surgery and asked to answer questions using a scale. To perform objective evaluations, the constricted and normal ears of each patient were scanned using a 3-dimensional scanner before and 14 days after surgery. The vertical height of the auricle (VHA), transverse diameter of the auricle, minimum length of the helix (MLH), length of the inner auricle (LIA), and transverse diameter of the inner auricle were calculated using Mimics software. The Wilcoxon matched pairs signed-rank test was used for data analysis. High satisfaction scores were reported. The folds of the ear and helix had the highest median scores, whereas the crus of the antihelix had the lowest. The difference in LIA and postoperative MLH was greater than that in VHA and preoperative MLH. The mean values of the 5 indices of the normal ear were greater than those of the indices of the preoperative constricted ear (P

Destructive respiratory diseases are predicted to become the 3rd global cause of morbidity and mortality within the next few decades. Despite their high prevalence, there are no treatments due to the limited regenerative capacity of lung tissues. End-stage sufferers of severe respiratory disease ultimately require tissue or whole organ transplantation, which is associated with low success rate and severely offset by donation shortages. The ever-growing field of tissue engineering offers the potential to not only regenerate human tissue equivalents of respiratory epithelia for surgical implantation, but also to provide an ethical research platform for respiratory pathology research, OH&S toxicology studies and more efficient pharmaceutical screening. However, progress has been hindered by difficulties in maintaining lung-specific cell phenotypes in vitro due to poorly understood or neglected cellular requirements. There is opportunity for a biomimetically-inspired bioreactor approach to provide an optimised culture environment for respiratory tissue engineering. This body of work details the development and validation of such an integrated bioreactor system that captures key in vivo conditions experienced by respiratory tissues during breathing. The system incorporates a unique magnetically driven linear actuator, a porous 3-D tissue scaffold and a scaffold straining mechanism that synergistically exposes cultured cells to air and culture medium at physiological strain rates. A modular compatible perfusion unit was designed and developed, and potential control of the immediate gas environment of a cell culture was conceptually developed. Biological studies with a human lung carcinoma cell line cultured on the integrated system successfully demonstrated that the scaffold-straining unit sustained cellular establishment, growth and proliferation in vitro under dynamic culture conditions. Furthermore, actuation at an air-liquid interface was shown to confer superior proliferation, scaffold infiltration and distribution compared to a static submerged control, thus meeting identified design and functional requirements and validating the underlying biomimetic design philosophy. This system overcomes major limitations of current lung tissue models by producing an organotypic, dynamic, air-liquid interfacing environment. In addition, this system is compatible with standard cell culture techniques, enabling potential large-scale use in research. Overall, the system presented shows great potential for use in regeneration of airway tissues in vitro.

Chronic alcohol consumption may lead to progressive cardiac dysfunction. The aim of this study was to evaluate the feasibility of using real-time 3-dimensional echocardiography (3DE) on assessing left ventricular (LV) function in chronic alcoholics. We classified 92 male alcoholics into mild, moderate, and severe groups; 30 age-matched controls were also recruited. LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction (LVEF), LV mass (LVM), LV mass index (LVMI), and systolic dyssynchrony index (SDI) were measured by 3DE and 2-dimensional echocardiography (2DE). Compared to the control group, LV volume and mass were higher in the moderate and severe alcoholic groups (P

© 2014, Springer Science+Business Media Dordrecht. The quantification and modeling of myocardial scar is of expanding interest for image-guided therapy, particularly in the field of arrhythmia management. Migration towards high-resolution, three-dimensional (3D) MRI techniques for spatial mapping of myocardial scar provides superior spatial registration. However, to date no systematic comparison of available approaches to 3D scar quantification have been performed. In this study we compare the reproducibility of six 3D scar segmentation algorithms for determination of left ventricular scar volume. Additionally, comparison to two-dimensional (2D) scar quantification and 3D manual segmentation is performed. Thirty-five consecutive patients with ischemic cardiomyopathy were recruited and underwent conventional 2D late gadolinium enhancement (LGE) and 3D isotropic LGE imaging (voxel size 1.3 mm3) using a 3 T scanner. 3D LGE datasets were analyzed using six semi-automated segmentation techniques, including the signal threshold versus reference mean (STRM) technique at >2, >3, >5 and >6 standard deviations (SD) above reference myocardium, the full width at half maximum (FWHM) technique, and an optimization-based technique called hierarchical max flow (HMF). The mean ejection fraction was 32.1 ± 12.7 %. Reproducibility was greatest for HMF and FWHM techniques with intra-class correlation coefficient values ≥0.95. 3D scar quantification and modeling is clinically feasible in patients with ischemic cardiomyopathy. While several approaches show acceptable reproducibility, HMF appears superior due to maintenance of accuracy towards manual segmentations.

PurposeWe evaluated the survival of patients with muscle invasive bladder cancer undergoing radical cystectomy without neoadjuvant chemotherapy to confirm the utility of existing clinical tools to identify low risk patients who could be treated with radical cystectomy alone and a high risk group most likely to benefit from neoadjuvant chemotherapy.Materials and methodsWe identified patients with muscle invasive bladder cancer who underwent radical cystectomy without neoadjuvant chemotherapy at our institution between 2000 and 2010. Patients were considered high risk based on the clinical presence of hydroureteronephrosis, cT3b-T4a disease, and/or histological evidence of lymphovascular invasion, micropapillary or neuroendocrine features on transurethral resection. We evaluated survival (disease specific, progression-free and overall) and rate of pathological up staging. An independent cohort of patients from another institution was used to confirm our findings.ResultsWe identified 98 high risk and 199 low risk patients eligible for analysis. High risk patients exhibited decreased 5-year overall survival (47.0% vs 64.8%) and decreased disease specific (64.3% vs 83.5%) and progression-free (62.0% vs 84.1%) survival probabilities compared to low risk patients (p

BACKGROUND: Although the potential benefits of 3-dimensional (3-D) vs 2-dimensional (2-D) and high-definition (HD) vs standard-definition (SD) endoscopic visualization have long been recognized in other surgical fields, such endoscopes are generally considered too large and bulky for use within the brain. The recent development of 3-D and HD neuroendoscopes may therefore herald improved depth perception, better appreciation of anatomic details, and improved overall surgical performance. OBJECTIVE: To compare simultaneously the effectiveness of 3-D vs 2-D and HD vs SD neuroendoscopy. METHODS: Ten novice neuroendoscopic surgeons were recruited from a university hospital. A preclinical randomized crossover study design was adopted to compare 3-D vs 2-D and HD vs SD neuroendoscopy. The primary outcomes were time to task completion and accuracy. The secondary outcomes were perceived task workload using the NASA (National Aeronautics and Space Administration) Task Load Index and subjective impressions of the endoscopes using a 5-point Likert scale. RESULTS: Time to task completion was significantly shorter when using the 3-D vs the 2-D neuroendoscopy (P = .001), and accuracy of probe placement was significantly greater when using the HD vs the SD neuroendoscopy (P = .009). We found that 3-D endoscopy significantly improved perceived depth perception (P < .001), HD endoscopy significantly improved perceived image quality (P < .001), and both improved participants’ overall impression (P < .001). CONCLUSION: Three-dimensional neuroendoscopy and HD neuroendoscopy have differing but complementary effects on surgical performance, suggesting that neither alone can completely compensate for the lack of the other. There is therefore strong preclinical evidence to justify 3-D HD neuroendoscopy. ABBREVIATIONS: HD, high definition SD, standard definition

Mooting is modelled principally on appellate advocacy. However, the skill set developed by participating in a moot programme – being that necessary to persuade someone to your preferred position – is indispensible to anyone practising law. Developing effective mooting skills in students necessitates the engagement of coaches with an appropriate understanding of the theories underlying mooting and advocacy practice and their interconnection with each other. This article explains the relevance of the cognitive domain to mooting performance and places it in context with the psychomotor and affective domains.

Background/Aims: Recent developments in radiological technology allowed acquisition of images with high spatial resolution that facilitate effective 3-dimensional (3D) reconstruction of fusion images. Present study utilized 3D cholangiography and angiography with multi-detector-row computed tomography (MDCT) to acquire information regarding operative simulations. Methodology: 3D-fusion images were evaluated in 39 patients with hepatobiliary malignancies who underwent surgical resections. Results: An aberrant branch of segment 3 over the umbilical portal vein, a large hepatoma compressed the hilar vessels, an aberrant branch of the caudate lobe vasculature in case of metastatic liver tumor with a right-sided umbilical portal vein and transected biliary leakage were clearly observed by 3D imaging system. Four patients with intrahepatic cholangiocarcinoma underwent multiple biliary stent placements and adequate placement of biliary stents was possible. In 22 patients with extrahepatic biliary carcinomas, visualization of the extent of tumor invasion by 3D-fusion images was equivalent to conventional cholangiography. In 2 patients, adequate placement of multiple stents could be visualized with this system. In 2 patients who underwent hepatectomy, more extended cancer invasion was observed than was visualized by 3D-fusion images. Conclusions: 3D fusion images were very useful for preoperative simulations in order to understand relationships between tumors and adjacent vasculatures., Hepato-gastroenterology, 59(118), pp.1748-1757; 2012

In this paper, the low velocity impact characteristics and impact damage of sandwich composites, produced at four different core thicknesses from 3-dimensional (3D) integrated sandwich fabrics, with and without foam filling, have been examined. The 3D sandwich fabrics have been produced using the same yarn and weaving densities. Thus, the impact characteristics are only affected by the core thickness and whether foam filling is used or not. Low velocity impact tests have been conducted at 32 and 48 J energy levels. The impact behavior has been determined as a function of the peak load, the energy to peak load, the time to peak load and the absorbed energy. The impact damage and the change in the compressive strength after impact have been analyzed. The findings obtained indicate that core-skin delamination on 3D sandwich composites has been fully prevented. Impact tests carried out on integrated 3D sandwich structures have shown that impact damage is limited to the vicinity of the point of impact and does not affect the integrity of the structure. This indicates that such damage can be easily repaired and the service life of the product can be sustained.

Colloid cysts are among rare benign tumours of the third ventricle. Although the most frequent symptoms are headache and syncope, arrest hydrocephalus or sudden death could appear with colloid cysts. The aim of this pictorial essay was to increase awareness of the clinical presentation, computed tomography (CT) and magnetic resonance (MR) imaging spectrum, and treatment options of the colloid cysts. The data of 11 patients with histopathologically and/or clinically proven colloid cyst were analysed, retrospectively; and the neuroradiologic appearances of the cysts were evaluated. The CT and MR appearance of colloid cysts may change, depending on the viscosity or the cholesterol content of the cysts. However, the cystic content is the most important factor that could affect the success of treatment. Cysts that are especially rich in protein and cholesterol tend to be hyperdense on CT, hypointense on T2-weighted sequences and hyperintense on T1-weighted sequences. These cysts are viscous, and the success of aspiration is significantly low. In the diagnosis and evaluation of small-sized cysts that have an ingredient similar to cerebrospinal fluid, 3-dimensional sequences might be useful. The radiologic appearances of colloid cysts could play an important role in directing these patients to alternative surgical modalities, including resection.

Full-field optical coherence tomography (FFOCT) acquires image data in parallel. It has a big advantage in high-speed imaging because 2-dimensional mechanical raster scanning in the sample arm, which is essentially needed in a common fiber-based OCT system, does not exist anymore. Swept-source FFOCT (SSFFOCT) further makes the system free of depth scanning that significantly increases the operation speed. National Instrument's LabVIEW is a powerful tool to fast develop optical-electronic systems which have motion/vision units, signal processing functions and easy-to-generate Graphic User Interface (GUI). In this paper, we describe the design and implementation of Labview program prepared for an SSFFOCT system. Basically, there are four modules of Labview programming in such a system: 1. Wavelength sweeping control; 2. Synchronized image grabbing; 3. SSFFOCT signal processing; 4. 3-dimensional tomogram displaying mode selection. A general graphic user interface is used to input the parameters and monitor all necessary data and curves. The tomographic images can be displayed at any given cutting direction. More details and examples are provided and discussed. © 2011 Copyright Society of Photo-Optical Instrumentation Engineers (SPIE)., Photonics North 2011, May 16-18, 2011, Ottawa, Ontario, Canada, Series: Proceedings of SPIE; no. 8007

Coronary artery bifurcations are a common challenging lesion subset accounting for approximately 10% to 20% of all percutaneous coronary interventions. The provisional T-stenting approach is generally recommended as the first-line management of most lesions. Carina shift is suggested to be the predominant mechanism of side-branch pinching during provisional T-stenting and has been indirectly inferred from bench work and other intravascular imaging modalities. Offline 3-dimensional (3D) reconstructions of patients studied in the first-in-man trial of the high-frequency (160 frames/s) Terumo optical frequency domain imaging system were undertaken using volume-rendering software. Through a series of 3D reconstructions, several novel hypothesis-generating concepts are presented. (J Am Coll Cardiol Intv 2011;4:921-31) (C) 2011 by the American College of Cardiology Foundation

Modeling of the condensed phase in a solid rocket motor engine is typically accomplished via a two-fluid Eulerian approach or a direct Lagrangian approach. Each approach has its advantages and intrinsic disadvantages in terms of describing a polydispersed population of aluminum particles while it burns and convects within the carrier flow. A more unconventional approach is the Population Balance Equation (PBE) approach which solves a convection equation for a number density field, representative of the particulate phase. In the most general case the PBE is an integro-differential equation and can account for aerodynamic drag on particles, their combustion, breakage and agglomeration, via representative constitutive models. Here we will describe the PBE approach and will adopt it to simulate the aluminum particulate phase in a solid rocket engine. The results will be compared to those yielded by a more conventional Lagrangian approach. While the Lagrangian approach is spatially 3-dimensional, the PBE approach will adopt a quasi 1-dimensional assumption, leaving the extra two dimensions available for ”internal” particle coordinates such as particle radius and velocity. The characterization of the two-phase flow in a heterogeneous solid-propellant rocket chamber and nozzle is crucial in ballistic/performance predictions, aeroacoustic studies, erosion analyses, slag accumulation rate estimates, predictions of thermal loads, plume analyses etc. In particular, aluminum particles initially embedded within the binder and injected in the flow during the burning of the grain, undergo mechanical and chemical interactions with the flow itself, and constitute a principal component of the condensed phase. Among the numerous techniques used to model the solid phase a Lagrangian approach 2,3,7 - coupled to an Eulerian formalism for the continuous phase - is possibly the most widely accepted. In the latter, also known as a ’discrete element’ model, the kinematics of each particle is solved in parallel with the fluid flow by integrating a large system of ODE’s. Such formulation has the advantage of attempting a direct numerical simulation of the two-phase flow thereby avoiding the requirement of any additional constitutive laws for the dispersed phase. Typically in such context only larger particles are modeled via the Lagrangian setting, whereas the very small particles (aluminum oxide smoke) are modeled as a continuum . 3,7 The individual motion of the large particles is tracked by integrating their momentum equation which couples to the continuous phase through an aerodynamic drag term evaluated from the fluid field properties at the particle location. Similarly, the combustion of aluminum particles is modeled through burn rate relations which depend both on the particle and on the surrounding fluid field states. Complete two-way coupling between solid and gas phase is achieved by ad-hoc source terms in the gas phase equations supplying the continuous phase with mass and energy from the condensed phase. The combustion process also produces

Study Design. The present study verifies the 3-dimensional anatomic features of the lateral atlantoaxial joints with reference to a local reference frame using a direct in vitro approach. Objective. To study the concordance between the axial and atlantal articular surfaces. Summary of Background Data. Detailed information of joint-configurations is imperative for understanding the complex kinematics of the upper cervical joint. Data on the quantitative morphology of the human spinal facet joints has been published, but did not include the atlanto-occipital and atlantoaxial joints. Methods. In 20 fresh spine specimens, metal markers were implanted on the cranium, the atlas, and the axis. After registration of the intact specimens, the bony segments were separated and markers and anatomic landmarks were digitized. The size, shape, and orientation relative to the local reference frame of the axis were derived from the relative position data of the joint surface landmarks. Results. The diameters and surface areas of the inferior articular surfaces of the atlas are slightly smaller than the corresponding surfaces on the superior aspects of the axis (17.7 mm and 235 mm(2) vs. 17.0 and 212 mm(2)). In this sample of older-aged specimens, the curvature of the articulating surfaces is nearly flat. The absolute angle between the left and right surface areas is about 130 and corresponds well between axis and atlas. The orientation of the joint surfaces of axis and atlas with respect to the sagittal plane of the axis indicates a good congruency. Conclusion. There seems to be a strong relationship between the anatomic features of the lateral articulating surfaces of atlas and axis. Differences in the orientation of joint surfaces to the frontal plane may be related to deviations from the neutral position. This issue raises the problem of the definition of three-dimensional-neutral joint positions.

Purpose The purpose of this study was to compare four graft-tunnel angles (GTA), the femoral GTA formed by three different femoral tunneling techniques (the outside-in, a modified inside-out technique in the posterior sag position with knee hyperflexion, and the conventional inside-out technique) and the tibia GTA in 3-dimensional (3D) knee flexion models, as well as to examine the influence of femoral tunneling techniques on the contact pressure between the intra-articular aperture of the femoral tunnel and the graft. Materials and Methods Twelve cadaveric knees were tested. Computed tomography scans were performed at different knee flexion angles (0°, 45°, 90°, and 120°). Femoral and tibial GTAs were measured at different knee flexion angles on the 3D knee models. Using pressure sensitive films, stress on the graft of the angulation of the femoral tunnel aperture was measured in posterior cruciate ligament reconstructed cadaveric knees. Results Between 45° and 120° of knee flexion, there were no significant differences between the outside-in and modified inside-out techniques. However, the femoral GTA for the conventional inside-out technique was significantly less than that for the other two techniques (p

Imaging in confocal microscopy is characterized by the ability to make a selective image of just one plane inside a specimen, virtually unaffected -within certain limits-by the out-of-focus regions above and below it. This property, called optical sectioning, is accompanied by improved imaging transverse to the optical axis. We have coupled a confocal microscope to a computer system, making the combination of both an excellent instrument for mapping the 3-dimensional structure of extended specimens into a computer memory/data array. We measured that the volume element contributing to each data point has, under typical fluorescence conditions, a size of 0.2 x 0.2 x 0.72 μm. The data can be analysed and represented in various ways, i.e., stereoscopical views from any desired angle. After a description of the experimental arrangement, we show various examples of biological and food-structural studies. The microscope can be operated either in reflection or in fluorescence. In the latter mode a spectral element allows selection of the wavelength band of fluorescence light contributing to the image. In this way, we can distinguish various structures inside the cell and study their 3-dimensional relationships. Various applications in biology and the study of food structure are presented.

The normal human adult kidney contains between 300,000 and 1 million nephrons (the functional units of the kidney). Nephrons develop at the tips of the branching ureteric duct, and therefore ureteric duct branching morphogenesis is critical for normal kidney development. Current methods for analysing ureteric branching are mostly qualitative and those quantitative methods that do exist do not account for the 3- dimensional (3D) shape of the ureteric "tree". We have developed a method for measuring the total length of the ureteric tree in 3D. This method is described and preliminary data are presented. The algorithm allows for performing a semi-automatic segmentation of a set of grey level confocal images and an automatic skeletonisation of the resulting binary object. Measurements of length are automatically obtained, and numbers of branch points are manually counted. The final representation can be reconstructed by means of 3D volume rendering software, providing a fully rotating 3D perspective of the skeletonised tree, making it possible to identify and accurately measure branch lengths. Preliminary data shows the total length estimates obtained with the technique to be highly reproducible. Repeat estimates of total tree length vary by just 1-2%. We will now use this technique to further define the growth of the ureteric tree in vitro, under both normal culture conditions, and in the presence of various levels of specific molecules suspected of regulating ureteric growth. The data obtained will provide fundamental information on the development of renal architecture, as well as the regulation of nephron number.