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Objective: This pilot study aimed to evaluate, for the first time, the changes in facial tissues following the placement of a single dental implant. Method and materials: Patients were scanned with a 3D facial scanner (3dMD) before implant surgery, immediately after surgery (T1), at 7 days postoperatively (T2), and at the impression stage (T3). Acquired images were processed using the 3dMDvultus (3dMD) software program and volume differences and linear depth measurements were calculated to determine the morphometric changes over time. A total of 11 patients were included in the analyses. Descriptive statistics were employed to analyze the data. Results: The volumetric changes and maximum depth differences indicated an initial increase, followed by a progressive decrease in tissue volume after implant placement in the area of the surgery. The volume change values ranged between 2.5 and 3.9 cm³ for T1, whereas for T2, the volume change decreased to a range of 0.8 to 1.8 cm³. Maximum depth differences ranged between 2.06 and 2.80 mm in the soft tissues immediately after the implant surgery and reduced to around 2.01 to 0.55 mm at the impression stage. The amount of painkiller used was not related to the magnitude of linear depth measurements at any assessed time point. Conclusion: There was a longitudinal decrease in soft tissue volume and depth difference in extraoral soft tissues in the region of implant placement after surgery up to 6 weeks. The use of a facial scanner is a promising noninvasive method to monitor 3D morphometric changes after implant surgery. [ABSTRACT FROM AUTHOR]

In this review, we elaborate on how musculoskeletal (MSK) modeling combined with dynamic movement simulation is gradually evolving from a research tool to a promising in silico tool to assist medical doctors and physical therapists in decision making by providing parameters relating to dynamic MSK function and loading. This review primarily focuses on our own and related work to illustrate the framework and the interpretation of MSK model-based parameters in patients with 3 different conditions, that is, degenerative joint disease, cerebral palsy, and adult spinal deformities. By selecting these 3 clinical applications, we also aim to demonstrate the differing levels of clinical readiness of the different simulation frameworks introducing in silico model-based biomarkers of motor function to inform MSK rehabilitation and treatment, with the application for adult spinal deformities being the most recent of the 3. Based on these applications, barriers to clinical integration and positioning of these in silico technologies within standard clinical practice are discussed in the light of specific challenges related to model assumptions, required level of complexity and personalization, and clinical implementation. [ABSTRACT FROM AUTHOR]

Purpose: To determine which clinical factors might affect the postimplantoplasty presence of residual threads, platform alterations, and level of surface roughness. Materials and Methods: A total of 60 implants were placed in 20 resin models (10 edentulous maxillary models and 10 partially dentate mandibular models), and 5-mm peri-implant bone defects were created. These models were then placed in simulation mannequins. A single researcher performed the implantoplasties, which were divided into the following groups: favorable situation (FS; maxillary incisors without adjacent teeth), unfavorable situation (US; mandibular molars with adjacent teeth), crown (C; mandibular premolars with a prosthetic crown and adjacent teeth), and noncrown (NC; mandibular premolars with adjacent teeth and without a prosthetic crown). The presence of residual threads, gaps in the implant-abutment interface, and silicone debris was assessed using a scanning electron microscope (SEM), and the surface roughness (Sa and Sz) was analyzed with a confocal optical microscope. A descriptive and bivariate analysis was conducted. Results: The postimplantoplasty surfaces were significantly smoother than the original implant surfaces. The surface roughness was significantly higher in the US group than in the FS group. Gaps in the implant-abutment interface were infrequent (6.67%; 95% CI = 2.62 to 15.93) and only appeared in the posterior zone. The odds ratio for the presence of residual threads and silicone debris (US group vs FS group) was 7.1 (95% CI = 4.15 to 12.14; P < .001) and 5.53 (95% CI = 3.21 to 9.53; P < .001), respectively. When a prosthetic crown was present, residual threads were 7 times more likely to be found (OR = 7.0; 95% CI = 3.5 to 13.99; P < .001). Conclusions: Implantoplasty leads to a significant reduction in the surface roughness of implants but is affected by several variables. Performing implantoplasty on posterior mandibular implants with adjacent teeth seems to be more challenging compared to implants placed in the anterior region of a fully edentulous maxilla. The presence of a prosthetic crown should also be considered as a relevant factor. Furthermore, implantoplasty can sometimes cause gaps in the implant-abutment interface and an accumulation of silicone debris, especially in areas with limited access. [ABSTRACT FROM AUTHOR]

Introduction Clinical investigations have attributed lumbar spine injuries in combat to the vertical vector. Injury prevention strategies include the determination of spine biomechanics under this vector and developing/evaluating physical devices for use in live fire and evaluation-type tests to enhance Warfighter safety. While biological models have replicated theater injuries in the laboratory, matched-pair tests with physical devices are needed for standardized tests. The objective of this investigation is to determine the responses of the widely used Hybrid III lumbar spine under the vertical impact-loading vector. Materials and Methods Our custom vertical accelerator device was used in the study. The manikin spinal column was mounted between the inferior and superior six-axis load cells, and the impact was delivered to the inferior end. The first group of tests consisted of matched-pair repeatability tests, second group consisted of adding matched-pair tests to this first group to determine the response characteristics, and the third group consisted of repeating the earlier two groups by changing the effective torso mass from 12 to 16 kg. Peak axial, shear, and resultant forces at the two ends of the spine were obtained. Results The first group of 12 repeatability tests showed that the mean difference in the axial force between two tests at the same velocity across the entire range of inputs was <3% at both ends. In the second group, at the inferior end, the axial and shear forces ranged from 4.9-25.2 kN to 0.7-3.0 kN. Shear forces accounted for a mean of 11 ± 6% and 12 ± 4% of axial forces at the two ends. In the third group of tests with increased torso mass, repeatability tests showed that the mean difference in the axial force between the two tests at the same velocity across the entire range of inputs was <2% at both ends. At the inferior end, the axial and shear forces ranged from 5.7-28.7 kN to 0.6-3.4 kN. Shear forces accounted for a mean of 11 ± 8% and 9 ± 3% of axial forces across all tests at the inferior and superior ends. Other data including plots of axial and shear forces at the superior and inferior ends across tested velocities of the spine are given in the paper. Conclusions The Hybrid III lumbar spine when subjected to vertical impact simulating underbody blast levels showed that the impact is transmitted via the axial loading mechanism. This finding paralleled the results of axial force predominance over shear forces and axial loading injuries to human spines. Axial forces increased with increasing velocity suggesting the possibility of developing injury assessment risk curves, i.e. the manikin spine does not saturate, and its response is not a step function. It is possible to associate probability values for different force magnitudes. A similar conclusion was found to be true for both magnitudes of added effective torso mass at the superior end of the manikin spinal column. Additional matched-pair tests are needed to develop injury criteria for the Hybrid III male and female lumbar spines. [ABSTRACT FROM AUTHOR]

Introduction: Extra-uterine life support technology could provide a more physiologic alternative for the treatment of extremely premature infants, as it allows further fetal growth and development ex utero. Animal studies have been carried out which involved placing fetuses in a liquid-filled incubator, with oxygen supplied through an oxygenator connected to the umbilical vessels. Hence, by delaying lung exposure to air, further lung development and maturation can take place. This medical intervention requires adjustments to current obstetric procedures to maintain liquid-filled lungs through a so-called transfer procedure. Methods: Our objective was to develop obstetric device prototypes that allow clinicians to simulate this birth procedure to safely transfer the infant from the mother’s uterus to an extra-uterine life support system. To facilitate a usercentered design, implementation of medical simulation during early phase design of the prototype development was used. First, the requirements for the procedure and devices were established, by reviewing the literature and through interviewing direct stakeholders. The initial transfer device prototypes were tested on maternal and fetal manikins in participatory simulations with clinicians. Results & discussion: Through analysis of recordings of the simulations, the prototypes were evaluated on effectiveness, safety and usability with latent conditions being identified and improved. This medical simulation-based design process resulted in the development of a set of surgical prototypes and allowed for knowledge building on obstetric care in an extra-uterine life support context. [ABSTRACT FROM AUTHOR]

Background: Regional anaesthesia education, especially for ocular procedures, necessitates reliable surgical training models. While cadaveric models offer anatomical fidelity, conventional embalming methods may compromise tissue integrity. We aimed to assess the effectiveness of Thiel cadavers for training in sub-Tenon's blocks by evaluating ocular tissues and measuring insertion forces. Methods: Experimental design, using twenty eyes from ten Thiel cadaver heads. These cadavers were specifically prepared to test the administration of sub-Tenon's blocks. The research was conducted in a controlled laboratory setting appropriate for handling cadaveric materials and conducting precise measurements. Each cadaver eye underwent an initial ultrasound examination, and its axial length was noted. An intravitreal injection of heptastarch solution followed, to re-establish the eye's sphericity. After this volume injection, the axial length and intraocular pressure were measured again. Mock sub-Tenon's blocks were administered in 2 separate quadrants of the eye, with insertion forces measured using a pressure gauge. These were compared to a data set of insertion forces measured in a series of isolated pig's eyes on which STBs had been performed. Main outcome measurements were macroscopic assessment of the ocular tissue layers and the insertion forces required for the sub-Tenon's blocks. In a second set of 10 Thiel cadaver heads, 5 ml of sodium chloride were injected as sub-Tenon's blocks and the emergence of a periocular "T-sign" ascertained and measured by ultrasound. Results: Four of twenty eyes (20%) retained near-natural sphericity, with the remaining requiring volume injection to approximate physiological shape and pressure. The conjunctiva and Tenon's layer were intact, and correct cannula placement was achieved in all cases. In 16 of 20 eyes where T-signs could be measured, the median thickness of the T-sign amounted to 2.72 mm (range 1.34 mm–5.28 mm). The average maximum cannula insertion force was 2.92 Newtons. Insertion forces in intact Thiel cadaver heads were consistently higher than in isolated pig's eyes (3.6 N vs 2.0 N). Conclusion: These findings suggest that Thiel cadavers are a promising model for training in sub-Tenon'sblocks, despite the challenge of often desiccated and involuted eyes. Key points: • Thiel cadaver eyes were evaluated as training model for sub-Tenon's blocks for the first time • The cadaver eyes were often involuted and required fluid injection to reproduce physiological bulbar tonus • The ocular tissues and anatomical layers were well preserved • T-signs as a hallmark of successful sub-Tenon's block can be ascertained in Thiel cadaver eyes • Dynamic insertion forces were measured during cannula placement and can be used as reference for future studies comparing haptics of different models by an objective measure-insertion force. [ABSTRACT FROM AUTHOR]

To present an ex-vivo bovine model for retrograde intrarenal surgery (RIRS) training. The model was specifically developed for a pre-congress course organized as part of the National Pediatric Urology Congress. The course involved a 2-day online theoretical segment followed by hands-on training. Bovine kidneys were chosen for their anatomical resemblance to human kidneys. The kidneys were sourced from a local slaughterhouse, ensuring the intactness of the pelvis, ureters, and perirenal fat. A Modified Larssen solution was used for tissue preservation. The tissue was positioned within a cardboard box, with specific preparation techniques to ensure realism. During the hands-on training, participants utilized a flexible ureterorenoscope for practice. After the course, participants completed an 18-question survey assessing the model and training experience. Twenty-four participants completed the training and survey. Four out of 8 procured kidneys were suitable. The model's cost was 18 euros. Around 87.5% of participants reported increased RIRS confidence. Those with prior course experience rated the model's anatomical resemblance higher (P =.016). No significant difference was observed in feedback on the model's durability or tactile feedback based on prior experience (P >.05). The ex-vivo bovine model provides a promising alternative for RIRS training. While further studies are needed to validate its widespread application, initial feedback suggests it offers a balance between cost-effectiveness and realistic training experience. [ABSTRACT FROM AUTHOR]

Anatomical models have key applications in radiotherapy, notably to help understand the relationship between radiation dose and risk of developing side effects. This review analyses whether age-specific computational phantoms, developed from healthy subjects and paediatric cancer patient data, are adequate to model a paediatric population. The phantoms used in the study were International Commission on Radiological Protection (ICRP), 4D extended cardiac torso (XCAT) and Radiotherapy Paediatric Atlas (RT-PAL), which were also compared to literature data. Organ volume data for 19 organs was collected for all phantoms and literature. ICRP was treated as the reference for comparison, and percentage difference (P.D) for the other phantoms were calculated relative to ICRP. Overall comparisons were made for each age category (1, 5, 10, 15) and each organ. Statistical analysis was performed using Microsoft Excel (version 16.59). The smallest P.D to ICRP was for Literature (-17.4%), closely followed by XCAT (26.6%). The largest was for RT-PAL (88.1%). The rectum had the largest average P.D (1,049.2%) and the large bowel had the smallest (2.0%). The P.D was 122.6% at age 1 but this decreased to 43.5% by age 15. Linear regression analysis showed a correlation between organ volume and age to be the strongest for ICRP (R2 = 0.943) and weakest for XCAT (R2 = 0.676). The phantoms are similar enough to ICRP for potential use in modelling paediatric populations. ICRP and XCAT could be used to model a healthy population, whereas RT-PAL could be used for a population undergoing/after radiotherapy. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to present optimized device‐specific low‐dose cone‐beam computed tomography (CBCT) protocols with sufficient image quality for pre‐surgical diagnostics and three‐dimensional (3D) modelling of cleft defects. Methods: Six paediatric skulls were acquired, and an artificial bony cleft was created. A high‐resolution CBCT scan acted as a reference standard (Accuitomo 170, Morita, Kyoto, Japan) for comparing eight low‐dose protocols of Newtom VGi‐evo (QR Verona, Cefla, Verona, Italy), which included Eco and Regular protocols with different field of views (FOVs). Delineation of lamina dura, cementoenamel junction (CEJ), trabecular bone and bony bridge were assessed. A 3D model of the defect was also evaluated. Result: The dose area product of low‐dose protocols ranged from 31 to 254 mGy*cm2. Despite the dose difference of up to eight times between applied protocols, trabecular bone and CEJ exhibited appropriate image quality in all scans. However, Regular small FOV protocols (5 × 5 and 8 × 5 cm2), for both lamina dura and bony bridge, demonstrated a significant improvement in image quality compared to Eco FOV counterparts. Based on 3D defect analysis, no significant difference existed between low‐dose protocols and the reference standard. Conclusion: The findings highlight the possibility of achieving a considerable reduction (up to eight times) in the radiation dose using low‐dose CBCT protocols while maintaining sufficient image quality for assessing anatomical structures and 3D modelling in cleft cases. [ABSTRACT FROM AUTHOR]

BACKGROUND: High-flow nasal cannula (HFNC) systems employ different methods to provide aerosol to patients. This study compared delivery efficiency, particle size, and regional deposition of aerosolized bronchodilators during HFNC in neonatal, pediatric, and adult upper-airway and lung models between a proximal aerosol adapter and distal aerosol circuit chamber. METHODS: A filter was connected to the upper airway to a spontaneously breathing lung model. Albuterol was nebulized using the aerosol adapter and circuit at different clinical flow settings. The aerosol mass deposited in the upper airway and lung was quantified. Particle size was measured with a laser diffractometer. Regional deposition was assessed with a gamma camera at each nebulizer location and patient model with minimum flow settings. RESULTS: Inhaled lung doses ranged from 0.2-0.8% for neonates, 0.2-2.2% for the small child, and 0.5-5.2% for the adult models. Neonatal inhaled lung doses were not different between the aerosol circuit and adapter, but the aerosol circuit showed marginally greater lung doses in the pediatric and adult patient models. Impacted aerosols and condensation in the non-heated HFNC and aerosol delivery components contributed to the dispersion of coarse liquid droplets, high deposition (11-44%), and occlusion of the supine neonatal upper airway. In contrast, the upright pediatric and adult upper-airway models had minimal deposition (0.3-7.0%) and high fugitive losses (~24%) from liquid droplets leaking out of the nose. The high impactive losses in the aerosol adapter (56%) were better contained than in the aerosol circuit, resulting in less cannula sputter (5% vs 22%), fewer fugitive losses (18% vs 24%), and smaller inhaled aerosols (5 µm vs 13 µm). CONCLUSIONS: The inhaled lung dose was low (1-5%) during HFNC. Approaches that streamline aerosol delivery are needed to provide safe and effective therapy to patients receiving aerosolized medications with this HFNC system. [ABSTRACT FROM AUTHOR]

Background: Promoting bonding and neurodevelopmental care is an important element in the cardiovascular intensive care unit (CICU); however, holding of infants by family members is inconsistently practiced. Objectives: This quality improvement study aimed to safely increase the holding of medically complex infants in the CICU by developing a holding guideline and offering simulation-based staff education. Methods: Using consensus methodology and high-fidelity simulation, an expert work group created a holding guideline and training to increase staff confidence and competence in holding critically ill infants in the CICU. The effectiveness of the intervention was tested via a postintervention survey used to assess participants' confidence in and comfort with holding critically ill infants and elicit suggestions for further support. Participants who engaged with the mannequin were surveyed to assess the validity of the simulation trainer. Results: After the intervention, participants (N = 130) reported increased confidence with infant holding (76%) and greater confidence in preparing families to hold their infants. Participants (95%) strongly agreed that the simulation enabled realistic, safe practice in holding a medically complex infant with catheters and tubes. More years of experience and engagement with the simulation trainer were associated with increased posttraining confidence. Participants cited increased resources, practice, and adherence monitoring as key supports for infant holding. Conclusions: Expert group consensus with high-fidelity simulation training is a feasible, safe, and reliable method for teaching higher risk skills and guiding protocol development. [ABSTRACT FROM AUTHOR]

New technologies in additive manufacturing and patient-specific CT-based custom implant designs make it possible for previously unimaginable salvage and limb-sparing operations a practical reality. This study presents the design and fabrication of a lattice-structured implant for talus replacement surgery. Our primary case involved a young adult patient who had sustained severe damage to the talus, resulting in avascular necrosis and subsequent bone collapse. This condition caused persistent and debilitating pain, leading the medical team to consider amputation of the left foot at the ankle level as a last resort. Instead, we proposed a Ti6Al4V-based patient-specific implant with lattice structure specifically designed for pan-talar fusion. Finite element simulation is conducted to estimate its performance. To ensure its mechanical integrity, uniaxial compression experiments were conducted. The implant was produced using selective laser melting technology, which allowed for precise and accurate construction of the unique lattice structure. The patient underwent regular monitoring for a period of 24 months. At 2-years follow-up the patient successfully returned to activities without complication. The patient's functional status was improved, limb shortening was minimized. [ABSTRACT FROM AUTHOR]

TEVAR (thoracic endovascular aortic repair) is the preferred approach for treating descending thoracic aortic aneurysm (DTAA). After the procedure, patients require lifelong CTA (computed tomography angiography) follow-up to monitor the aorta's remodeling process and the possible development of associated complications. With CTA, the aorta is usually measured with maximum diameters taken at specific locations, and even in experienced centers, this type of evaluation is prone to inter-observer variability. We introduce a new volumetric analysis of aortic changes after TEVAR using three-dimensional (3D) anatomical models. We applied the volumetric analysis to 24 patients who underwent TEVAR for DTAA. For each patient, the descending thoracic aorta was evaluated using both the maximum diameter from CTA and the volume from 3D reconstructions, at discharge and 12 months after TEVAR. Both volume and diameter evaluations were then related to the development of TEVAR complications. The group with TEVAR-related complications showed a 10% volume increase in the descending aorta, while the group with no TEVAR-related complications only had a 1% increase. An increase of 40 mL in the descending aorta volume at 12 months seemed to be predictive of complications, with 94% specificity and 75% sensitivity. Volumetric analysis is a promising method for monitoring DTAA remodeling after TEVAR, and it may help in the early identification of high-risk patients who may benefit from a stricter follow-up, even if further evaluations on a larger sample size are required to confirm these preliminary results. [ABSTRACT FROM AUTHOR]

Activity of central amygdala (CeA) PKCδ expressing neurons has been linked to appetite regulation, anxiety-like behaviors, pain sensitivity, and addiction-related behaviors. Studies of the role that CeA PKCδ+ neurons play in these behaviors have largely been carried out in mice, and genetic tools that would allow selective manipulation of PKCδ+ cells in rats have been lacking. Here, we used a CRISPR/Cas9 strategy to generate a transgenic Prkcd-cre knock-in rat and characterized this model using anatomical, electrophysiological, and behavioral approaches in both sexes. In the CeA, Cre was selectively expressed in PKCδ+ cells. Anterograde projections of PKCδ+ neurons to cortical regions, subcortical regions, several hypothalamic nuclei, the amygdala complex, and midbrain dopaminergic regions were largely consistent with published mouse data. In a behavioral screen, we found no differences between Cre+ rats and Cre− wild-type littermates. Optogenetic stimulation of CeA PKCδ+ neurons in a palatable food intake assay resulted in an increased latency to first feeding and decreased total food intake, once again replicating published mouse findings. Lastly, using a real-time place preference task, we found that stimulation of PKCδ+ neurons promoted aversion, without affecting locomotor activity. Collectively, these findings establish the novel Prkcd-Cre rat line as a valuable tool that complements available mouse lines for investigating the functional role of PKCδ+ neurons. [ABSTRACT FROM AUTHOR]

Ozone (O3) is one of the most harmful and widespread air pollutants, affecting crop yield and plant health worldwide. There is evidence that O3 reduces the major limiting factor of photosynthesis, namely CO2 mesophyll conductance (gm), but there is little quantitative information of O3‐caused changes in key leaf anatomical traits and their impact on gm. We exposed two O3‐responsive clones of the economically important tree species Populus × canadensis Moench to 120 ppb O3 for 21 days. An anatomical diffusion model within the leaf was used to analyse the entire CO2 diffusion pathway from substomatal cavities to carboxylation sites and determine the importance of each structural and subcellular component as a limiting factor. gm decreased substantially under O3 and was found to be the most important limitation of photosynthesis. This decrease was mostly driven by an increased cell wall thickness and length of subcellular diffusion pathway caused by altered interchloroplast spacing and chloroplast positioning. By contrast, the prominent leaf integrative trait leaf dry mass per area was neither affected nor related to gm under O3. The observed relationship between gm and anatomy, however, was clone‐dependent, suggesting that mechanisms regulating gm may differ considerably between closely related plant lines. Our results confirm the need for further studies on factors constraining gm under stress conditions. [ABSTRACT FROM AUTHOR]

Background:. Mitral transcatheter edge-to-edge repair (m-TEER) is a minimally invasive procedure for treating mitral regurgitation (MR). m-TEER is a highly technical procedure, and a steep learning curve needs to be overcome for operators to ensure optimal patient outcomes and minimise procedural complications. Training via online simulation and observation of procedures is not sufficient to establish operator confidence; thus, advanced hands-on training modalities need to be explored and developed. Methods:. In this study, a novel anatomical simulator for m-TEER training was evaluated in comparison to a standard model. The proposed simulator resembled the anatomical features of the right and left atrium, left ventricle and mitral valve apparatus. Participants in the questionnaire (n = 18) were recruited across 4 centres in London with (n = 8) and without (n = 10) prior experience in m-TEER. Participants were asked to simulate procedures on both an idealised, routinely used simulator and the newly proposed anatomical model. The questionnaire was designed to assess (i) participants' confidence before and after training and (ii) the realism of the model in the context of the m-TEER procedure. The results of the questionnaires were collected, and statistical analysis (t-test) was performed. Results:. Both models were equally beneficial in increasing operator confidence before and after the simulation of the intervention (P = 0.43). However, increased confidence after training with the anatomical model was recorded (P = 0.02). Participants with prior experience with m-TEER therapy were significantly more confident about the procedure after training with the anatomical model than participants who had no prior experience (P = 0.002). On average, all participants thought that the anatomical model was effective as a training simulator (P = 0.013) and should be integrated into routine training (P = 0.015)). Participants with experience thought that the anatomical model was more effective at reproducing the m-TEER procedure than the idealised model (P = 0.03). Conclusions:. This study showed how a more realistic simulator can be used to improve the effectiveness of m-TEER procedural training. Such pilot results suggest planning future and large investigations to evaluate improvements in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: Distal femur fractures comprise approximately 4% of all femoral fractures, with lateral plating being a common fixation technique. In recent years, dual plating with an additional medial plate has shown added benefit for Arbeitsgemeinschaft für Osteosynthesefragen C-type fractures, comminuted, osteoporotic distal femur fractures and non-union or malunion complications postsingle lateral plating. However, to our knowledge, there is no commercially available distal femur medial plate for fracture fixation. The aim of our study was to determine which of our current commercially available pre-contoured plates fit the medial distal femur best in an Asian population. Methods: We evaluated 13 different pre-contoured angular plates on standardized sawbone models. The plates were first applied onto the medial distal femur and subsequent anterior–posterior and lateral radiographs were taken postapplication. The appropriateness of the fit of each plate was objectively compared using a scoring system derived from pre-determined plate- and screw-related factors. Results: The proximal humerus internal locking system plate had the best anatomical fit with the highest 'best fit score,' followed by the variable angle proximal tibia plate. Conclusion: While non-anatomical plates may be successfully utilized, in view of the anatomical variations of the femur, ultimately an anatomical plate for the medial distal medial femur should be developed for ease of fixation. [ABSTRACT FROM AUTHOR]

The nasal administration of therapeutic fluids and vaccines is used to treat allergic rhinitis, sinusitis, congestion, coronaviruses and even Alzheimer's disease. In the latter, the drug must reach the olfactory region, so it finds its way into the central nervous system. Effective administration techniques able to reach the olfactory region are challenging due to the tortuous anatomy of the nasal cavity, and are frequently evaluated in vitro using transparent anatomical models. Here, the liquid distribution inside a 3D printed human nasal cavity is quantified for model fluids resulting from the discharge of a 1-mL syringe with either a spray-generating nozzle, and a straight tip emitting a collimated fluid stream. Experiments using two model fluids with different viscosities suggest that a simple, correctly positioned straight tip attached to a syringe is able to efficiently deliver most of a therapeutic fluid in the human olfactory region in the side-laying position, avoiding the adoption of head-back and head-down positions that can be difficult for patients in the age range typical of Alzheimer's disease. Furthermore, we demonstrate by computer simulations that the conclusion is valid within a wide range of parameters. A collimated liquid jet efficiently reaches the olfactory zone in a human nasal cavity model. Left panel: Experimental set up. Middle panel: Poor delivery of liquid to the olfactory zone (region 2) by a spray-producing cone. Right panel: efficient delivery to the olfactory zone by a collimated stream of fluid generated by a straight duct [Display omitted] [ABSTRACT FROM AUTHOR]

INTRODUCTION: Evolving trends in medical education and modern curricular changes have reduced the amount of time and resources allocated for anatomy education. As the amount of dedicated anatomy education time decreases, more self-directed learning is required. Cadaveric dissection and didactic teaching have been supplemented with multimedia, clinical anatomy, and imaging for over 20 years, with mixed results. Specifically, the use of videobased anatomy teaching increases medical learning, if done methodically. METHODS: A 20-minute video was produced highlighting surgical anatomy using the following operative cases: perineal anatomy (artificial urinary sphincter case), inguinal and testicular anatomy (scrotal orchidopexy for acute testicular torsion), prostate anatomy (robotic radical prostatectomy), and bladder anatomy (endoscopy). The annotated video was shown to first-year medical students. Pre- and post-video multiple choice question quizzes were given to the students. Once submitted, the students completed a survey. RESULTS: Overall, 191 first-year medical students participated in our study. Average scores were similar between each quiz (50±16% vs. 49±17%) and there was no statistically significant change. Seventy-seven percent of participants felt the video improved their knowledge of urologic anatomy and 83% agreed the video should be shown to future classes. Sixty percent of participants felt the video solidified their anatomy knowledge, 78% felt the video was stimulating and entertaining, and 43% of the students felt the video increased their interest in pursuing urology as a career choice. CONCLUSIONS: Anatomy teaching can be supplemented using surgical videos, especially in a time when in-person anatomy teaching is limited. Further study is required to determine whether this teaching modality improves long-term anatomy knowledge retention. [ABSTRACT FROM AUTHOR]

Purpose: Three-dimensional printing has evolved into a cost-effective and accessible tool. In orthopedic surgery, creating patient-specific anatomical models and instrumentation improves visualization and surgical accuracy. In pediatric orthopedics, three-dimensional printing reduces operating time, radiation exposure, and blood loss by enhancing surgical efficacy. This review compares outcomes of three-dimensional printing–assisted surgeries with conventional surgeries for upper and lower extremity pediatric surgeries. Methods: A complete search of medical literature up to August 2023, using Ovid Medline, EMBASE, Scopus, Web of Science, and Cochrane Library was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Broad search terms included "pediatrics," "orthopedic," and "3D-printing." Eligible studies were assessed for intraoperative time, blood loss, and fluoroscopy exposure. Results: Out of 3299 initially identified articles, 14 articles met inclusion criteria. These studies included 409 pediatric patients, with ages averaging 9.51 years. The majority were retrospective studies (nine), with four prospective and one experimental study. Studies primarily utilized three-dimensional printing for navigation templates and implants. Results showed significant reductions in operative time, blood loss, and radiation exposure with three-dimensional printing. Complication occurrences were generally lower in three-dimensional printing surgeries, but there was no statistical significance. Conclusions: Three-dimensional printing is an emerging technology in the field of orthopedics, and it is primarily used for preoperative planning. For pediatric upper and lower extremity surgeries, three-dimensional printing leads to decreased operating room time, decreased intraoperative blood loss, and reduced radiation exposure. Other uses for three-dimensional printing include education, patient communication, the creation of patient-specific instrumentation and implants. Level of evidence: Level III [ABSTRACT FROM AUTHOR]

Background: The use of high-fidelity simulators (manikins) and standardized patients (SPs) in simulation has been incorporated into many nursing schools throughout the nation to augment the clinical rotation experience. There is little to no data available on comparing undergraduate students' preferences between SPs and manikins in psychiatric nursing. Methods: A quantitative descriptive exploratory design was used to evaluate pre-licensure nursing students' preferences in both traditional 4-year Bachelor of Science in Nursing (BSN) and accelerated BSN programs (ABSN). Results: Overall, students preferred having an SP over a manikin to learn how to properly perform a nursing assessment on a psychiatric patient. Conclusions: Standardized patients offer a more realistic experience when assessing various domains of the mental status examination and when practicing therapeutic communication techniques in psychiatric nursing. The growth of SP training programs should be fostered. Well-trained SPs are an asset to simulation, especially in psychiatric nursing. [ABSTRACT FROM AUTHOR]

BACKGROUND: The bag-valve-mask (BVM) or manual resuscitator bag is used as a first-line technique to ventilate patients with respiratory failure. Volume-restricted manual resuscitator bags (eg, pediatric bags) have been suggested to minimize overventilation and associated complications. There are studies that both support and caution against the use of a pediatric resuscitator bag to ventilate an adult patient. In this study, we evaluated the ability of pre-hospital clinicians to adequately ventilate an adult manikin with both an adult- and pediatric-size manual resuscitator bag without the assistance of an advanced airway or airway adjunct device. METHODS: This study was conducted at an international conference in 2022. Conference attendees with pre-hospital health care experience were recruited to ventilate an adult manikin using a BVM for 1 min with both an adult and pediatric resuscitator bag, without the use of adjunct airway devices, while 6 ventilatory variables were collected or calculated: tidal volume (VT), breathing frequency, adequate breaths (VT > 150 mL), proportion of adequate breaths, peak inspiratory pressure (PIP), and estimated alveolar ventilation (EAV). RESULTS: A total of 208 participants completed the study. Ventilation with the adult-sized BVM delivered an average VT of 290.4 mL compared to 197.1 mL (P < .001) when using the pediatric BVM. PIP with the adult BVM was higher than with the pediatric BVM (10.6 cm H2O vs 8.6 cm H2O, P < .001). The median EAV with the adult bag (1,138.1 [interquartile range [IQR] 194.0-2,869.9] mL/min) was markedly greater than with the pediatric BVM (67.7 [IQR 0-467.3] mL/min, P < .001). CONCLUSIONS: Both pediatric- and adult-sized BVM provided lower ventilation volumes than those recommended by professional guidelines for an adult. Ventilation with the pediatric BVM was significantly worse than with the adult bag when ventilating a simulated adult subject. [ABSTRACT FROM AUTHOR]

The introduction of three-dimensional (3D) printed anatomical models has garnered interest in pre-operative planning, especially in orthopedic and trauma surgery. Identifying potential error sources and quantifying their effect on the model dimensional accuracy are crucial for the applicability and reliability of such models. In this study, twenty radii were extracted from anatomic forearm specimens and subjected to osteotomy to simulate a defined fracture of the distal radius (Colles' fracture). Various factors, including two different computed tomography (CT) technologies (energy-integrating detector (EID) and photon-counting detector (PCD)), four different CT scanners, two scan protocols (i.e., routine and high dosage), two different scan orientations, as well as two segmentation algorithms were considered to determine their effect on 3D model accuracy. Ground truth was established using 3D reconstructions of surface scans of the physical specimens. Results indicated that all investigated variables significantly impacted the 3D model accuracy (p < 0.001). However, the mean absolute deviation fell within the range of 0.03 ± 0.20 to 0.32 ± 0.23 mm, well below the 0.5 mm threshold necessary for pre-operative planning. Intra- and inter-operator variability demonstrated fair to excellent agreement for 3D model accuracy, with an intra-class correlation (ICC) of 0.43 to 0.92. This systematic investigation displayed dimensional deviations in the magnitude of sub-voxel imaging resolution for all variables. Major pitfalls included missed or overestimated bone regions during the segmentation process, necessitating additional manual editing of 3D models. In conclusion, this study demonstrates that 3D bone fracture models can be obtained with clinical routine scanners and scan protocols, utilizing a simple global segmentation threshold, thereby providing an accurate and reliable tool for pre-operative planning. [ABSTRACT FROM AUTHOR]

Background: Screw loosening is a commonly reported issue following spinal screw fixation and can lead to various complications. The initial cause of screw loosening is biomechanical deterioration. Previous studies have demonstrated that modifications in screw design can impact the local biomechanical environment, specifically the stress distribution on bone-screw interfaces. There are several different designs of screw tips available for clinically used pedicle screws; however, it remains unclear whether these variations affect the local stress distribution and subsequent screw anchorage ability. Methods: This study conducted comprehensive biomechanical research using polyurethane foam mechanical tests and corresponding numerical simulations to investigate this topic. Models of pedicle screw-fixed osteoporotic polyurethane foam were created with two different clinically used screw tip designs (flat and steep) featuring varying tip lengths, taper angles, and diameters, as well as identical flank overlap areas and thread designs. The anchorage ability of the different models was assessed through toggle and pull-out test. Additionally, numerical mechanical models were utilized to compute the stress distributions at the screw and bone-screw interfaces in the different models. Results: Mechanical tests revealed superior anchorage ability in models utilizing flat-tipped screws. Furthermore, numerical modeling indicated improved anchorage ability and reduced stress concentration tendency in these models. Conclusion: Changes in screw tip design can significantly impact the biomechanical anchoring capability of screws. Specifically, flatter tip pedicle screws may mitigate the risk of screw loosening by alleviating stress concentration on bone-screw interfaces. [ABSTRACT FROM AUTHOR]

Background: Medical emergencies are the leading cause of high mortality and morbidity rates in rural areas of higher and lower-income countries than in urban areas. Medical emergency readiness is healthcare providers' knowledge, skills, and confidence to meet patients' emergency needs. Rural healthcare professionals' medical emergency readiness is imperative to prevent or reduce casualties due to medical emergencies. Evidence shows that rural healthcare providers' emergency readiness needs enhancement. Education and training are the effective ways to improve them. However, there has yet to be a scoping review to understand the efficacy of educational intervention regarding rural healthcare providers' medical emergency readiness. Objectives: This scoping review aimed to identify and understand the effectiveness of educational interventions in improving rural healthcare providers' medical emergency readiness globally. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews were used to select the papers for this scoping review. This scoping review was conducted using MEDLINE, CINHAL, SCOPUS, PUBMED and OVID databases. The Population, Intervention, Comparison and Outcome [PICO] strategies were used to select the papers from the database. The selected papers were limited to English, peer-reviewed journals and published from 2013 to 2023. A total of 536 studies were retrieved, and ten studies that met the selection criteria were included in the review. Three reviewers appraised the selected papers individually using the Joanna Briggs Institute [JBI] critical appraisal tool. A descriptive method was used to analyse the data. Results: From the identified 536 papers, the ten papers which met the PICO strategies were selected for the scoping review. Results show that rural healthcare providers' emergency readiness remains the same globally. All interventions were effective in enhancing rural health care providers' medical emergency readiness, though the interventions were implemented at various durations of time and in different foci of medical emergencies. Results showed that the low-fidelity simulated manikins were the most cost-effective intervention to train rural healthcare professionals globally. Conclusion: The review concluded that rural healthcare providers' medical emergency readiness improved after the interventions. However, the limitations associated with the studies caution readers to read the results sensibly. Moreover, future research should focus on understanding the interventions' behavioural outcomes, especially among rural healthcare providers in low to middle-income countries. [ABSTRACT FROM AUTHOR]

Background: The minimally invasive approach for the treatment of displaced scapular neck or body fractures has the advantages of less trauma and minimal muscle dissection. In clinical practice, the minimally invasive approach combined with an anatomical locking plate has been used to treat scapular body fractures. In addition, we have made minor modifications to the minimally invasive approach. However, the biomechanical study about the approach combined with an anatomical locking plate in treating scapular body fractures was limited. Methods: Finite element analysis (FEA) was used to conduct the biomechanical comparison between the anatomical locking plate (AP model) and reconstructive plate (RP model) in the treatment of scapular body fractures through the modified minimally invasive approach. A healthy male volunteer with no history of scapula or systemic diseases was recruited. High-resolution computed tomography images of his right scapula were obtained. Two scapula models were constructed and analyzed by the software of Mimics 21.0, Geomagic Wrap 2021, SolidWorks 2021, and ANSYS Workbench 2022, respectively. Results: Through static structural analysis, in terms of equivalent von Mises stress, equivalent elastic strain, and total deformation, the AP model exhibited superior safety characteristics, enhanced flexibility, and anticipated stability compared with the RP model. This was evidenced by lower maximum stress, lower maximum strain and displacement. Conclusion: The minimally invasive approach combined with an anatomical locking plate for scapular body fractures had better biomechanical stability. The study provided a biomechanical basis to guide the clinical treatment of scapular body fractures. [ABSTRACT FROM AUTHOR]

BACKGROUND: Nowadays, there are increasing reports on the digitization and visualization system of acupuncture points for adults in traditional Chinese medicine, and the digitization and visualization system of acupuncture points for children in traditional Chinese medicine and the simulation system of acupuncture manipulation for Mongolian medicine training have been reported. However, there are no reports on relevant systems for children in Mongolian medicine. OBJECTIVE: To develop a simulation system of acupuncture points for children in Mongolian medicine, in the hope that it can be used for clinical teaching, manipulation practice and research on acupuncture safety. METHODS: Based on the tomographic anatomical dataset of preschool boys, a three-dimensional (3D) digital virtual anatomical model of children with multiple internal organs and tissues was constructed by using PhotoShop.2021 and Digihuman Reconstruction System software. The relevant annotation information database of 27 acupoints such as Dinghui acupoint of Mongolian medicine was compiled by the Unity database language. The Mongolian gold needle and silver needle were selected to record the acupuncture point teaching video on the 3D printed head and neck resin model of children. In Unity3D software, children’s anatomical model, acupoint annotation information database and acupuncture operation video were integrated and coded, and a 3D digital children’s Mongolian acupuncture acupoint visualization system integrating simulation acupuncture training, clinical teaching and acupuncture safety research was successfully created. RESULTS AND CONCLUSION: This study was based on real children’s specimens. In order to reduce the error of two-dimensional segmentation, the manual layer-by-layer segmentation section image method was used to ensure the accuracy of the 3D model to the greatest extent. The Digihuman Reconstruction System was used to extract and save the individual segmentation data while maximizing the accuracy of the 3D model. PhotoShop.2021 software was used to complete the 3D reconstruction of the outer skin of the head and neck of children and the internal bony structure, cervical spinal cord, blood vessels and nerves, muscles and ligaments. After 3D reconstruction, the basic morphology of each independent structure and the integrity of the overall contour were verified in MeshLab software and the final fine adjustment and anatomical position confirmation were conducted using 3-matic research 13.0 software. The real anatomical morphology of the head and neck of preschool children was successfully simulated and restored. Unity3D software was used to integrate the 3D model of children, acupuncture operation video and acupoint annotation database, and the 3D digital Mongolian acupuncture acupoint visualization system for children was successfully constructed. Based on the real continuous fault ultra-thin dataset of preschool boys in China, China’s first 3D digitization and visualization system of acupuncture points in the head and neck of children in Mongolian medicine was developed. Compared with the previous acupuncture soft works, this system is more suitable for the anatomical morphological development characteristics of Asian children, and has a high value of application in the fields of research on the safety of acupuncture in Mongolian medicine, clinical teaching and acupuncture simulation training. [ABSTRACT FROM AUTHOR]

3D printing technology has revolutionized product development in numerous industries. Due to 3D printing, innovative ways of directly giving drugs to patients, anatomical models for surgical planning and training, and tailored prosthetics and other medical equipment are all within the realm of possibility in the medical industry. 3D printing in healthcare has sparked a paradigm shift in creating medical implants and prosthetics. As a result of their exceptional mechanical, thermal, electrical, and optical qualities, polymers and composites made of them have gained widespread use in the medical industry. In this review article, we look at the most recent and cutting-edge benefits of 3D printing technology to create medical products out of polymers and composites. This article summarizes recent findings in patient-specific medical device and prosthesis design and manufacture and anatomical model development for surgical training and planning. Various 3D printing techniques, i.e., stereolithography, fused deposition modeling, and selective laser sintering methods, were examined, along with the pros and cons. Finally, we discuss the importance of 3D printing, which could significantly alter how medical devices are designed and produced, enhancing healthcare services and improving patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Scar substrate in nonischemic cardiomyopathy (NICM) patients is often difficult to identify. Advances in cardiac imaging, especially using late iodine‐enhanced computed tomography (LIE‐CT), allow better characterization of scars giving rise to ventricular tachycardia (VT). Currently, there are limited data on clinical correlates of CT‐derived scar substrates in NICM. We sought assess the relationship between scar location on LIE‐CT and outcomes after radiofrequency catheter ablation (RFCA) in NICM patients with VT.From 2020 to 2022, consecutive patients with NICM undergoing VT RFCA with integration of cardiac CT scar modeling (inHeart, Pessac, France) were included at two US tertiary care centers. The CT protocol included both arterial‐enhanced imaging for anatomical modeling and LIE‐CT for scar assessment. The distribution of substrate on CT was analyzed in relation to patient outcomes, with primary endpoints being VT recurrence and the need for repeat ablation procedure.Sixty patients were included (age 64 ± 12 years, 90% men). Over a median follow‐up of 120 days (interquartile range [IQR]: 41–365), repeat ablation procedures were required in 32 (53%). VT recurrence occurred in 46 (77%), with a median time to recurrence of 40 days (IQR: 8–65). CT‐derived total scar volume positively correlated with intrinsic QRS duration (r = .34, p = 0.008). Septal scar was found on CT in 34 (57%), and lateral scar in 40 (7%). On univariate logistic regression, septal scar was associated with increased odds of repeat ablation (odds ratio [OR]: 2.9 [1.0–8.4]; p = 0.046), while lateral scar was not (OR: 0.9 [0.3–2.7]; p = 0.855). Septal scar better predicted VT recurrence when compared to lateral scar, but neither were statistically significant (septal scar OR: 3.0 [0.9–10.7]; p = 0.078; lateral scar OR: 1.7 [0.5–5.9]; p = 0.391).In this tertiary care referral population, patients with NICM undergoing VT catheter ablation with septal LIE‐CT have nearly threefold increased risk of need for repeat ablation. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the effect of foraminoplasty using large-channel endoscopy during TESSYS on the biomechanics of the lumbar spine. Methods: A complete lumbar spine model, M1, was built using 3D finite elements, and models M2 and M3 were constructed to simulate the intraoperative removal of the superior articular process of L5 using a trephine saw with diameters of 5 mm and 8.5 mm, respectively, and applying normal physiological loads on the different models to simulate six working conditions—anterior flexion, posterior extension, left-right lateral bending, and left-right rotation—to investigate the displacement and facet joint stress change of the surgical segment, and the disc stress change of the surgical and adjacent segments. Results: Compared with the M1 model, the M2 and M3 models showed decreased stress at the L4-5 left FJ and a significant increase in stress at the right FJ in forward flexion. In the M2 and M3 models, the L4-5 FJ stresses were significantly greater in left lateral bending or left rotation than in right lateral bending or right rotation. The right FJ stress in M3 was greater during left rotation than that in M2, and that in M2 was greater than that in M1. The L4-5disc stress in the M3 model was greater during posterior extension than that in the M1 and M2 models. The L4-5disc stress in the M3 model was greater in the right rotation than in the M2 model, and that in the M2 model was greater than that in the M1 model. Conclusion: Foraminoplasty using large-channel endoscopy could increase the stress on the FJ and disc of the surgical segment, which suggested unnecessary and excessive resection should be avoided in PTED to minimize biomechanical disruption. [ABSTRACT FROM AUTHOR]

Introduction: The conventional method of placing transcranial direct current stimulation (tDCS) electrodes is just above the target brain area. However, this strategy for electrode placement often fails to improve motor function and modulate cortical excitability. We investigated the effects of optimized electrode placement to induce maximum electrical fields in the leg regions of both M1 and SMA, estimated by electric field simulations in the T1 and T2-weighted MRIbased anatomical models, on motor performance and cortical excitability in healthy individuals. Methods: A total of 36 healthy volunteers participated in this randomized, triple-blind, sham-controlled experiment. They were stratified by sex and were randomly assigned to one of three groups according to the stimulation paradigm, including tDCS with (1) anodal and cathodal electrodes positioned over FCz and POz, respectively, (A-P tDCS), (2) anodal and cathodal electrodes positioned over POz and FCz, respectively, (P-A tDCS), and (3) sham tDCS. The sit-to-stand training following tDCS (2 mA, 10 min) was conducted every 3 or 4 days over 3 weeks (5 sessions total). Results: Compared to sham tDCS, A-P tDCS led to significant increases in the number of sit-to-stands after 3 weeks training, whereas P-A tDCS significantly increased knee flexor peak torques after 3 weeks training, and decreased shortinterval intracortical inhibition (SICI) immediately after the first session of training and maintained it post-training. Discussion: These results suggest that optimized electrode placement of the maximal EF estimated by electric field simulation enhances motor performance and modulates cortical excitability depending on the direction of current flow. [ABSTRACT FROM AUTHOR]

Traditionally, constructing training datasets for automatic muscle segmentation from medical images involved skilled operators, leading to high labor costs and limited scalability. To address this issue, we developed a tool that enables efficient annotation by non-experts and assessed its effectiveness for training an automatic segmentation network. Our system allows users to deform a template three-dimensional (3D) anatomical model to fit a target magnetic-resonance image using free-form deformation with independent control points for axial, sagittal, and coronal directions. This method simplifies the annotation process by allowing non-experts to intuitively adjust the model, enabling simultaneous annotation of all muscles in the template. We evaluated the quality of the tool-assisted segmentation performed by non-experts, which achieved a Dice coefficient greater than 0.75 compared to expert segmentation, without significant errors such as mislabeling adjacent muscles or omitting musculature. An automatic segmentation network trained with datasets created using this tool demonstrated performance comparable to or superior to that of networks trained with expert-generated datasets. This innovative tool significantly reduces the time and labor costs associated with dataset creation for automatic muscle segmentation, potentially revolutionizing medical image annotation and accelerating the development of deep learning-based segmentation networks in various clinical applications. [ABSTRACT FROM AUTHOR]

Digital technology has permeated allfields of activity, therefore it is absolutely necessary to use it in the education system as well. Today s students should benefit from the conveniences offered by the digital world; the information activity must thus be permanently adapted to the digital evolution, so that the future specialists can face the demands of society. Kinesiotherapy and Special Motricity students, future kinesiotherapists, need solid knowledge of human anatomy, this knowledge being a support for their whole activity. Digital technology can supplement the traditional way of learning human anatomy. Various apps have been designed for learning human anatomy, among them Complete Anatomy. Created in 2009 by 3D4Medical, now part of Elsevier, Complete Anatomy is an application that offers an alternative to physical anatomical models, through interactive anatomical models; the application can be installed on various devices: laptop, tablet, smartphone and can be accessed anytime and anywhere the student is, both during class/lab and outside them, for individual study. Using the Complete Anatomy app, muscle actions can be visualized; movement analysis being important in the training of future kinesiotherapists. In addition to detailed 3D anatomical models, the app also provides anatomical information and a video library. For the research, the group of subjects was made up of first-year students from the Faculty of Physical Education, Sport and Kinesiotherapy, specialization in Kinesiotherapy and Special Motricity, Romanian-American University of Bucharest. Following the use of a questionnaire, it was found that, regardless of the experience of previous use or not of some applications in learning, students are eager to use digital technology for learning human anatomy through the Complete Anatomy application. [ABSTRACT FROM AUTHOR]

INTRODUCTION: With advancements in laser technology, urologists have been able to treat urinary calculi more efficiently by increasing the energy delivered to the stone. With increases in power used, there is an increase in temperatures generated during laser lithotripsy. The aim of this study was to evaluate the thermal dose and temperatures generated with four laser settings at a standardized power in a high-fidelity, anatomic model. METHODS: Using high-fidelity, 3D-printed hydrogel models of a pelvicalyceal collecting system with a synthetic BegoStone implanted in the renal pelvis, surgical simulation of ureteroscopic laser lithotripsy was performed with the Moses 2.0 holmium laser. At a standard power (40 W) and irrigation pressure (100 cm H2O), we evaluated operator duty cycle (ODC) variations with different time-on intervals at four different laser settings. Temperature was measured at two separate locations: at the stone and ureteropelvic junction. RESULTS: Greater cumulative thermal doses and maximal temperatures were achieved with greater ODCs and longer laser activation periods. There were statistically significant differences between the thermal doses and temperature profiles of the laser settings evaluated. Temperatures were greater closer to the tip of the laser fiber. CONCLUSIONS: Laser energy and frequency play an important role in the thermal loads delivered during laser lithotripsy. Urologists must perform laser lithotripsy cautiously when aggressively treating large renal pelvis stones, as dangerous temperatures can be reached. To reduce the risk of causing thermal tissue injury, urologists should consider reducing their ODC and laser-on time. [ABSTRACT FROM AUTHOR]

In recent years, the interest in transcranial magnetic stimulation (TMS) has surged, necessitating deeper understanding, development, and use of low-frequency (LF) numerical dosimetry for TMS studies. While various ad hoc dosimetric models exist, commercial software tools like SimNIBS v4.0 and Sim4Life v7.2.4 are preferred for their user-friendliness and versatility. SimNIBS utilizes unstructured tetrahedral mesh models, while Sim4Life employs voxel-based models on a structured grid, both evaluating induced electric fields using the finite element method (FEM) with different numerical solvers. Past studies primarily focused on uniform exposures and voxelized models, lacking realism. Our study compares these LF solvers across simplified and realistic anatomical models to assess their accuracy in evaluating induced electric fields. We examined three scenarios: a single-shell sphere, a sphere with an orthogonal slab, and a MRI-derived head model. The comparison revealed small discrepancies in induced electric fields, mainly in regions of low field intensity. Overall, the differences were contained (below 2% for spherical models and below 12% for the head model), showcasing the potential of computational tools in advancing exposure assessment required for TMS protocols in different bio-medical applications. [ABSTRACT FROM AUTHOR]

3D printing technology holds tremendous promise for applications in the medical field, particularly in the creation of anatomical models. The accuracy of 3D-printed anatomical models is of utmost importance, especially for surgeons engaged in complex surgical planning. The goal of this study was to create an anatomically precise model of brain tissue using data obtained from an MRI scan, with a resin-based Masked Stereolithography 3D printer, and to assess the model's potential uses. The process of creating an anatomical brain model with an SLA 3D printer was divided into six fundamental stages. The 3D printing process for this project necessitated 55.4 g of resin, and the total printing time was 4 h and 56 min. Any liquid resin residues on the brain structure eliminated through cleaning have been conducted using 99.6 % pure isopropyl alcohol. Following the printing phase, the produced model underwent a curing process in a chamber illuminated with ultraviolet light at a wavelength of 405 nm to ensure complete solidification. Once solidification is completed, the dimensions of the brain are measured with a micrometer and compared with those digitally generated from the MRI scan data. The results showed that the overall dimensional error was less than 1 %. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Medical students are the ones who are counted on to respond promptly by providing CPR in any emergency situation. Although their contribution to effective CPR is crucial, studies have often demonstrated that they have average knowledge and poor skills, as far as international guidelines and recommendations are concerned [5,6]. Objectives: To assess the knowledge, level of confidence and skills of MBBS students towards the technique of hands-only CPR before the training and after training by CBME curriculum and to assess the improvement in knowledge or level of confidence about CPR after training. Methodology: A comparative study was conducted in MGMMC, Indore on 140 1st prof MBBS students of batch 2022. They were selected using simple random sampling by using pre-designed pre-tested semi-structured questionnaire for a period of 6 months (Sept. 2022– Feb 2023) duration. MBBS students of the admission batch of 2022at MGMMC, Indore were included. Students who were absent, not willing to participate were excluded. Results: Mean pre-test and post-test scores of knowledges among the participants were 3.64 ± 0.43 and 13.89 ± 0.65 respectively. The difference was statistically significant (P value < 0.001). Confidence level of students about knowledge of CPR pre training and post training was1.81±0.84 and 3.16±0.93, confidence level of students about technique of administering chest compression pre training and post training was 1.67±0.78 and 3.03±0.80 and Confidence level about handling a person when it collapses pre training and post training was 1.48±0.63 and 2.67±0.8 respectively. A total of 92.14% of the students could place their hands at the proper location and about 72.9% of the students could achieve proper depth of compression on skill assessment manikin. Conclusion: There is improvement in knowledge and selfconfidence regarding CPR and the students develop an acceptable level of skills after the training [ABSTRACT FROM AUTHOR]

Purpose: To compare the biomechanical behaviors of different surgical options that are preferred for implant-supported fixed prosthetic rehabilitation of the atrophic edentulous maxilla. Materials and Methods: A 3D finite element analysis (FEA) model was generated from the computed tomography data of a patient with an atrophic edentulous maxilla. Four scenarios were created in the atrophic maxilla. In model 1, the maxilla was reconstructed with an onlay bone graft harvested from the anterior iliac crest, and sinus augmentation procedures were performed. Standard dental implants were placed in the lateral incisor, first premolar, and first molar regions on each side. In model 2, the anterior part of the atrophic maxilla was reconstructed with an onlay bone graft harvested from the mandibular ramus, and zygomatic implants were placed in the posterior part of the maxilla. In models 3 and 4, two-piece subperiosteal implants made of titanium and polyether ether ketone (PEEK) materials, respectively, were placed in the atrophic maxilla. All implants were loaded with 150-N and 50-N forces in vertical and lateral directions, respectively. Stress accumulation on bones, implants, abutments, and prosthetic frameworks was investigated. Results: The tensile stress in both cortical and trabecular bone was highest in the iliac bone grafting group under vertical loading. The compressive stress in both cortical and trabecular bone was the highest in the PEEK subperiosteal implant model, and the compressive stress value on the trabecular bone exceeded the strength of the trabecular bone. The highest von Mises stress in the implants was obtained in the iliac bone grafting group under vertical loading. The highest stress value in the abutments was detected for the titanium subperiosteal implant. The highest von Mises stress in the prosthetic framework was detected in the titanium subperiosteal implant group, under both vertical and lateral loading. Conclusion: Based on the stress accumulation results of the four different scenarios, it can be seen that there is no ideal treatment modality for the fixed implant-supported prosthetic rehabilitation of the atrophic edentulous maxilla. Various intraoperative and prosthetic modifications are suggested to decrease the risk of biomechanical complications during long-term follow-up. [ABSTRACT FROM AUTHOR]

Background: Final year medical students and postgraduate doctors regularly contend with feelings of under-preparedness when transitioning into new areas of clinical practice. This lack of confidence is most evident in the context of on-call work which frequently requires sound clinical prioritisation, rigorous decision making and the management of acutely unwell patients, often with reduced senior support and staffing. This has prompted the emergence of on-call simulation which seeks to enhance participant confidence in performing on-call tasks and facilitate the development of key clinical and non-technical skills. This narrative review examined the use of on-call simulation in medical student and newly qualified doctor cohorts, its effectiveness in achieving its stated outcomes and to identify novel areas for the development of existing models. Method: A search strategy was developed in conjunction with a specialist medical librarian. OVID Medline and Embase searches identified articles related to the use and design of on-call simulation in medical education with no restrictions placed upon date or language of publication. Key findings from articles were summarised to develop comprehensive themes for discussion. Results: Twenty Three unique publications were reviewed which unanimously reported that on-call simulation had a positive effect on self-reported participant confidence in performing on-call roles. Furthermore the value on-call simulation when used as an induction activity was also evident. However, there was limited evidence around improved patient and performance outcomes following simulation. It also remains resource intensive as an educational tool and there is a distinct absence of interprofessional education in current models. Conclusions: We concluded that on-call simulation must adopt an interprofessional educational approach, incorporating other clinical roles. Further studies are needed to characterise the impact on patient outcomes. It remains highly useful as a confidence-boosting induction activity, particularly in specialities where clinical exposure is limited. Virtual and tabletop simulation formats, could potentially address the resource burden of manikin-based models, particularly with ever growing demands on medical educators and the expansion of training posts. [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis (KOA) represents a widespread degenerative condition among adults that significantly affects quality of life. This study aims to elucidate the biomechanical implications of proximal fibular osteotomy (PFO), a proposed cost-effective and straightforward intervention for KOA, comparing its effects against traditional high tibial osteotomy (HTO) through in-silico analysis. Methods: Using medical imaging and finite element analysis (FEA), this research quantitatively evaluates the biomechanical outcomes of a simulated PFO procedure in patients with severe medial compartment genu-varum, who have undergone surgical correction with HTO. The study focused on evaluating changes in knee joint contact pressures, stress distribution, and anatomical positioning of the center of pressure (CoP). Three models are generated for each of the five patients investigated in this study, a preoperative original condition model, an in-silico PFO based on the same original condition data, and a reversed-engineered HTO in-silico model. Results: The novel contribution of this investigation is the quantitative analysis of the impact of PFO on the biomechanics of the knee joint. The results provide mechanical evidence that PFO can effectively redistribute and homogenize joint stresses, while also repositioning the CoP towards the center of the knee, similar to what is observed post HTO. The findings propose PFO as a potentially viable and simpler alternative to conventional surgical methods for managing severe KOA, specifically in patients with medial compartment genu-varum. Conclusion: This research also marks the first application of FEA that may support one of the underlying biomechanical theories of PFO, providing a foundation for future clinical and in-silico studies. [ABSTRACT FROM AUTHOR]

Background: The use of three-dimensional(3D) printing is broadly across many medical specialties. It is an innovative, and rapidly growing technology to produce custom anatomical models and medical conditions models for medical teaching, surgical planning, and patient education. This study aimed to evaluate the accuracy and feasibility of 3D printing in creating a superficial femoral artery pseudoaneurysm model based on CT scans for endovascular training. Methods: A case of a left superficial femoral artery pseudoaneurysm was selected, and the 3D model was created using DICOM files imported into Materialise Mimics 22.0 and Materialise 3-Matic software, then printed using vat polymerization technology. Two 3D-printed models were created, and a series of comparisons were conducted between the 3D segmented images from CT scans and these two 3D-printed models. Ten comparisons involving internal diameters and angles of the specific anatomical location were measured. Results: The study found that the absolute mean difference in diameter between the 3D segmented images and the 3D printed models was 0.179±0.145 mm and 0.216±0.143mm, respectively, with no significant difference between the two sets of models. Additionally, the absolute mean difference in angle was 0.99±0.65° and 1.00±0.91°, respectively, and the absolute mean difference in angle between the two sets of data was not significant. Bland-Altman analysis confirmed a high correlation in dimension measurements between the 3D-printed models and segmented images. Furthermore, the accuracy of a 3D-printed femoral pseudoaneurysm model was further tested through the simulation of a superficial femoral artery pseudoaneurysm coiling procedure using the Philips Azurion7 in the angiography room. Conclusions: 3D printing is a reliable technique for producing a high accuracy 3D anatomical model that closely resemble a patient's anatomy based on CT images. Additionally, 3D printing is a feasible and viable option for use in endovascular training and medical education. In general, 3D printing is an encouraging technology with diverse possibilities in medicine, including surgical planning, medical education, and medical device advancement. [ABSTRACT FROM AUTHOR]

Developing mmWave radar sensors for indoor crowd motion sensing and tracking faces a critical challenge: the scarcity of large-scale, high-quality training data. Traditional human experiments encounter logistical complexities, ethical considerations, and safety issues. Replicating precise human movements across trials introduces noise and inconsistency into the data. To address this, this study proposes a novel solution: a movable platform equipped with a life-size mannequin to generate realistic and diverse data points for mmWave radar training and testing. Unlike human subjects, the platform allows precise control over movements, optimising sensor placement relative to the target object. Preliminary optimisation results reveal that sensor height impacts tracking performance, with an optimal sensor placement above the test subject yields the best results. The results also reveal that the 3D data format outperforms 2D data in accuracy despite having fewer frames. Additionally, analysing height distribution using 3D data highlights the importance of the sensor angle—15° downwards from the horizontal plane. [ABSTRACT FROM AUTHOR]

Three-dimensional (3D) printing is dramatically improving breast reconstruction by offering customized and precise interventions at various stages of the surgical process. In preoperative planning, 3D imaging techniques, such as computer-aided design, allow the creation of detailed breast models for surgical simulation, optimizing surgical outcomes and reducing complications. During surgery, 3D printing makes it possible to customize implants and precisely shape autologous tissue flaps with customized molds and scaffolds. This not only improves the aesthetic appearance, but also conforms to the patient's natural anatomy. In addition, 3D printed scaffolds facilitate tissue engineering, potentially favoring the development and integration of autologous adipose tissue, thus avoiding implant-related complications. Postoperatively, 3D imaging allows an accurate assessment of breast volume and symmetry, which is crucial in assessing the success of reconstruction. The technology is also a key educational tool, enhancing surgeon training through realistic anatomical models and surgical simulations. As the field evolves, the integration of 3D printing with emerging technologies such as biodegradable materials and advanced imaging promises to further refine breast reconstruction techniques and outcomes. This study aims to explore the various applications of 3D printing in breast reconstruction, addressing current challenges and future opportunities. [ABSTRACT FROM AUTHOR]

Background: Transcranial electrical stimulation (tES) generates an electric field (or current density) in the brain through surface electrodes attached to the scalp. Clinical significance has been demonstrated, although with moderate and heterogeneous results partly due to a lack of control of the delivered electric currents. In the last decade, computational electric field analysis has allowed the estimation and optimization of the electric field using accurate anatomical head models. This review examines recent tES computational studies, providing a comprehensive background on the technical aspects of adopting computational electric field analysis as a standardized procedure in medical applications. Methods: Specific search strategies were designed to retrieve papers from the Web of Science database. The papers were initially screened based on the soundness of the title and abstract and then on their full contents, resulting in a total of 57 studies. Results: Recent trends were identified in individual- and population-level analysis of the electric field, including head models from non-neurotypical individuals. Advanced optimization techniques that allow a high degree of control with the required focality and direction of the electric field were also summarized. There is also growing evidence of a correlation between the computationally estimated electric field and the observed responses in real experiments. Conclusions: Computational pipelines and optimization algorithms have reached a degree of maturity that provides a rationale to improve tES experimental design and a posteriori analysis of the responses for supporting clinical studies. [ABSTRACT FROM AUTHOR]

Objective: Creation of a novel 3D-printed physical cochlear model that demonstrated the feasibility of creating the model, and impact of a Graphical User Interface (GUI) system on training insertion metrics. Study Design: Feasibility study with a pilot prospective data collection. Setting: Tertiary academic center. Methods: The study was IRB exempt. Five resident trainees (PGY1-PGY5) practiced electrode insertions in cadaveric temporal bones before using the simulator. Nine students were educated on how to hold the electrodes and position them, and then allowed to use the simulator. All trainees were instructed that slower insertions were favorable. One cochlear implant (CI) surgeon used the simulator. The GUI captured the real video feed, but also provided distance, trajectory, and velocity measurements. The program is designed to plot the real-time depth of insertion and speed of insertion of the electrode; the user is also provided real-time occurrence of any kinks and back-outs. Results: A total of 14 trainees and 1 CI surgeon inserted the electrode at least 5 times without the use of the GUI (before) and then at least 5 times with the use of the GUI (after). Average Speed before and after (100.84 and 53.23 mm/s); Average minimum speed before and after (59.34 and 9.65 mm/s); and Average maximum speed before and after (416 and 285.81 mm/s). Statistically significant improvements were noted in all the measured speeds of insertion (P <.001). The other variables improved but not to a statistical significance. Conclusions: Real-time training using the 3D-printed model and GUI for cochlear implantation can help improve surgical resident training and comfort levels with electrode insertion for surgical trainees. The advantage of this model is that surgeons/trainees can use it as many times as they like, as the whole set-up is easy, economical, and reusable. The real time graphical user interface enhances training and retention of the practiced skills. [ABSTRACT FROM AUTHOR]

Objectives: The acetabular cup design plays a critical role in reducing contact stress between femur head acetabular cup. Many studies used ellipsoidal and spheroidal geometry in acetabular cup design to effectively reduce contact stress. The present study focuses on elevated acetabular cup rim with round corner design to reduce contact stress with round corner geometry. Methods: The cobalt chromium femur head and cup are considered for finite element (FE) model of hip resurfacing. The gait loads of routine activities of humans like normal walking, stair ascending and descending and sitting down and getting up gait activities are applied to the developed 3D FE model. Five microseparations of 0.5, 1, 1.5, 2 and 2.5 mm are considered in the present study. The acetabular cup inclination angle considered for this study are 35°, 45°, 55°, 65° and 75°. The contact stress and von Mises stress plot for each gait activities under these microseparations are analyzed for betterment of longevity of implants. Results: Overall elevated cup rim design helped in reducing contact stress to a greater extent than conventional cup with different geometries. Also, the predicted von Mises stress for all the parameters considered in the current study are well within the yield strength of CoCr material. Therefore, elevated cup rim could be used as a better alternative to spline and, ellipsoidal and circular geometries of cup. [ABSTRACT FROM AUTHOR]

Objective: Developing skills in rigid endoscopy poses challenges to the surgical trainee. This study investigates whether a modified manikin can improve the technical skill of junior operators by providing direct quantitative feedback. Methods: A force-sensing pad was incorporated into the oral cavity of a life support manikin. Junior trainees and senior otolaryngologists were invited to perform rigid endoscopy and received real-time feedback from the force sensor during the procedure. Results: There was a significant inverse correlation between operator seniority and the weight applied to the oral cavity (p < 0.0001). All junior trainee operators applied less weight after five attempts (346 ± 90.95 g) compared to their first attempt (464 ± 85.79 g). This gave a statistically significant decrease of 118 g (standard deviation = 107.27 g, p = 0.007) when quantitative feedback was provided to learning operators. Conclusion: This low-cost, simple model allows trainees to rehearse a high-risk procedure in a safe environment and adjust their operative technique. [ABSTRACT FROM AUTHOR]

In this study, finite element (FE) models of an anatomical normal and a degenerated disc of L4–L5 motion segment, developed using different methodologies of volume mesh constructions, and ways of defining the spinal components' material properties, were exercised and analyzed. The geometrics details were obtained using digitizing technique and segmentation of computed tomography (CT) scans; with material and structural properties of the spinal components defined based on the literature and greyscale values of CT images for the normal and degenerated L4–L5 motion segments, respectively. The predicted kinematic responses under five different physiological loadings in three anatomical reference planes for both models together with published data were analyzed. The predicted results correlated well within the range and in similar trends with published experimental results. The overall predicted responses showed different volume mesh constructions and the representation of spinal components' material properties were accurate enough to predict the kinematic responses, although experimental results exhibit considerable divergence due to different experimental techniques. Both models exhibited different rotational and translation segmental stiffness in each corresponding loading configuration. The normal L4–L5 segment exhibited greatest axial torsional stiffness, and least extensional stiffness. The degenerated L4–L5 segment was least flexible (greatest stiffness) in extension and most flexible (least stiffness) in flexion. For compression, the axial stiffness of segment of normal segment was about 10% larger than that of the degenerated segment. The en-bloc efforts of all spinal components have contributed to the different nonlinear kinematic characteristics and segmental stiffness of these different L4–L5 motion segments. [ABSTRACT FROM AUTHOR]

Blended learning offers the advantages of both instructor-led and self-instruction methods in basic life support (BLS). Our study aims to compare the effects of blended learning with those of traditional instructor-led methods on the performance of laypersons taking BLS courses. A total of 108 participants were randomly assigned to three groups: traditional instruction (group A, n = 36), blended learning with two rounds of practice (group B, n = 36), and blended learning with three rounds of practice (group C, n = 36). Group A received a 90-min lecture and a 30-min hands-on practice session using a manikin and a metronome. Participants in groups B and C received 18-min standardized online video lessons and performed hands-on practice twice and thrice, respectively. The primary outcome was chest compression at a correct speed (100–120 compressions per min) after the training course. Secondary outcomes included knowledge test scores, attitudes and confidence, and individual skill performance after training. Patient characteristics were similar between the groups. Blended learning with practicing thrice resulted in the highest compressions at a correct speed (group A vs. B vs. C, 68.09 vs 80.03 vs 89.42, p = 0.015) and the shortest average hands-off time (group A vs. B vs. C, 1.12 vs 0.86 vs 0.17 s, p = 0.015). Both blended groups performed better in confirming environmental safety (p < 0.001). No differences in scores of the knowledge test, attitude, or confidence were noted among the three groups. Blended learning with three rounds of hands-on practice may be considered an alternative teaching method. [ABSTRACT FROM AUTHOR]

The study of the phenomena occurring in the plantar region is remarkably intriguing, especially when performing a normal gait cycle where the foot is under loading conditions. The effects presented in the foot while walking provide relevant indicators regarding clinical means for enhancing regular performance or rehabilitation therapies. Nevertheless, more than traditional methods are needed to biomechanically evaluate foot structural conditions, leading to an incomplete database for determining the patient's needs so that advanced methodologies provide detailed medical assessment. Therefore, it is necessary to employ technological engineering tools to optimize biomechanical plantar pressure evaluations to reach suitable personalized treatments. This research initially evaluated numerically the pressure points in the foot sole region in each one of the five stance phases in a normal gait cycle. Medical imaging techniques were utilized to construct an anatomically accurate biomodel of the soft tissues of the right foot. The Finite Element Method was employed to predict peak plantar pressure in barefoot conditions for all stance phases; results from this case study presented a close alignment with gait experimental testing implemented to analyze the feasibility and validation of all mechanical considerations for the numerical analyses. Hence, having a solid foundation in the biomechanical behavior from the first case study close estimates, a 3D-printable patient-specific insole was designed and numerically analyzed to observe the mechanical response in the plantar critical zones utilizing a personalized orthotic device. Results from the second case study notably demonstrated a crucial decrement in excessive pressure values. Employing morphological customization orthopedics modeling combined with 3D-printable materials is revolutionizing assistive device design and fabrication techniques. The fundamental contribution of this research relies on deepening the knowledge of foot biomechanics from an interdisciplinary approach by numerically analyzing pressure distribution in critical regions for all five stances phases; thus, based on the methods employed, the results obtained contribute to the advances of patient-specific foot orthopedics. [ABSTRACT FROM AUTHOR]