Impact of enhanced recovery program implementation on postoperative outcomes after liver surgery: a monocentric retrospective study.

INTRODUCTION: It is still unclear whether enhanced recovery programs (ERPs) reduce postoperative morbidity after liver surgery. This study investigated the effect on liver surgery outcomes of labeling as a reference center for ERP. MATERIALS AND METHODS: Perioperative data from 75 consecutive patients who underwent hepatectomy in our institution after implementation and labeling of our ERP were retrospectively compared to 75 patients managed before ERP. Length of hospital stay, postoperative complications, and adherence to protocol were examined. RESULTS: Patient demographics, comorbidities, and intraoperative data were similar in the two groups. Our ERP resulted in shorter length of stay (3 days [1-6] vs. 4 days [2-7.5], p = 0.03) and fewer postoperative complications (24% vs. 45.3%, p = 0.0067). This reduction in postoperative morbidity can be attributed exclusively to a lower rate of minor complications (Clavien-dindo grade < IIIa), and in particular to a lower rate of postoperative ileus, after labeling. (5.3% vs. 25.3%, p = 0.0019). Other medical and surgical complications were not significantly reduced. Adherence to protocol improved after labeling (17 [16-18] vs. 14 [13-16] items, p < 0.001). CONCLUSIONS: The application of a labeled enhanced recovery program for liver surgery was associated with a significant shortening of hospital stay and a halving of postoperative morbidity, mainly ileus.

Effect of virtual reality hypnosis on intraoperative sedation needs and functional recovery in knee arthroplasty: a prospective randomized clinical trial.

BACKGROUND AND OBJECTIVES: Perioperative psychological stress and pharmacological anxiolysis can negatively affect the quality of recovery after total knee arthroplasty. We aimed to assess whether hypnosis combined with virtual reality could reduce intraoperative pharmacological sedation and improve quality of recovery after total knee arthroplasty surgery. METHODS: In this prospective randomized clinical trial, 60 patients scheduled for total knee arthroplasty with spinal anesthesia were randomly divided into 2 groups of 30 patients each. Intraoperatively, intermittent boluses of midazolam 1 mg were administered at 5 min intervals at the patient's request, with a maximum driven by the clinical assessment of sedation depth. During surgery, patients received standard care (group control) or virtual reality hypnosis (group VRH). An unblinded observer recorded the total dose of midazolam administered during surgery, and changes in the Quality-of-Recovery 15-item score, comfort, fatigue, pain and anxiety before and 1, 3 and 7 days after surgery. RESULTS: Patients in the VRH group required a lower dose of midazolam (mg; median (range)) intraoperatively (group VRH: 0 (0-4) and group control: 2 (0-9), p<0.001). Quality-of-Recovery 15-item, anxiety, and pain were similar between groups. CONCLUSIONS: In total knee arthroplasty with spinal anesthesia, VRH reduces the requirement for intraoperative pharmacological sedation, without a change in the quality of recovery. TRIAL REGISTRATION NUMBER: NCT05707234.

HADS and SOMS-2 brief score evaluation can prevent unnecessary minimal invasive spine interventions - a prospective blinded observational clinical trial.

INTRODUCTION: To test the hypothesis, whether HADS/SOMS is practical in a spine surgery consultation setting and that patients with CLBP, but a high-risk of psychic comorbidities using above screenings will not improve after minimal-invasive spine interventions (MIS). METHODS: n = 150 completed HADS and SOMS prior to the acquisition of history and examination. Primary outcome was improvement by numeric rating scale (NRS), Pain disability index (PDI) and oswestry disability index (ODI) at baseline and 6 months after intervention. In case of sciatica due to disc herniation epidural neurolysis, for facet or SI-joint-syndrome, radiofrequency and for discogenic pain intradiscal electrothermal therapy (IDET) was performed. RESULTS: 6 months after interventions, pat. with a high-risk of anxiety or depression showed no clinically important improvements in NRS, PDI and ODI, whereas in the low-risk group all 3 parameters were significantly reduced. We found a statistically significant difference in the improvement of NRS (p < 0·05), PDI (p < 0·001), ODI (p < 0·001) between high- and low-risk HADS-anxiety and depression groups and in the improvement of NRS and PDI (p < 0·05) between high- and low-risk SOMS-2-subgroups. CONCLUSIONS: In this group of CLBP patients, the easy-to-administer HADS/SOMS reliably predicted outcome after MIS due to the detection of somatoform comorbidities. Thus, 30 out of 150 patients were invasively treated without improvement. This is alarming not only because of unnecessary MIS being performed on these individuals, but also because it represents an inefficient allocation of increasingly limited healthcare funds. LEVEL OF EVIDENCE: II.

[Sphenopalatine ganglion block : a promising approach for headache and supratentorial intracranial surgery ?] / Le bloc du ganglion sphénopalatin : un traitement prometteur pour les céphalées et la chirurgie intracrânienne supratentorielle ?

We aimed to determine whether sphenopalatine ganglion block (SPGB) had a place as a treatment for headache, as well as its place as an anterior component of scalp block for supratentorial intracranial surgery. Using the keywords «sphenopalatine ganglion¼, «sphenopalatine ganglion block¼, «pain¼, «surgery¼ and «craniotomy¼ in PubMed and Google Scholar, we identified 14 relevant articles. The methods used to perform the block and the treatment of control groups differed between studies. The main outcomes studied were reduction in pain scores and hemodynamic variations during supratentorial intracranial surgery. All articles concluded that SPGB was equal or superior compared with other procedures. Although there are still several points to be studied, considering the ease of application, the low number of complications and the results of the studies, the use of SPGB for the headache treatment and in neurosurgery as an anterior component of scalp block seems appropriate.

Cette revue de la littérature narrative vise à déterminer la place du bloc du ganglion sphénopalatin (BGSP) comme traitement des céphalées ainsi que sa place comme composante antérieure du bloc de scalp pour la chirurgie intracrânienne supratentorielle. Avec les mots-clés «ganglion sphénopalatin¼, «bloc du ganglion sphénopalatin¼, «douleur¼, «chirurgie¼ et «crâniotomie dans PubMed et Google Scholar, nous avons identifié 14 articles pertinents. Les méthodes de réalisation du bloc ainsi que les traitements des groupes témoins différaient selon les études. Les résultats principaux étudiés étaient la réduction des scores de douleur ainsi que les variations hémodynamiques au cours de la chirurgie intracrânienne supratentorielle. Tous les articles ont conclu à la non-infériorité ou la supériorité du BGSP en comparaison à d'autres procédures. Bien que plusieurs points restent à étudier, compte tenu de la facilité d'application, du peu de complications et des résultats, l'utilisation du BGSP pour le traitement des céphalées et en neurochirurgie comme composante antérieure du bloc de scalp semble appropriée.

Oral as compared to intravenous tranexamic acid to limit peri-operative blood loss associated with primary total hip arthroplasty: A randomised noninferiority trial.

BACKGROUND: Oral as compared to intravenous tranexamic acid (TXA) is an attractive option, in terms of cost and safety, to reduce blood loss and transfusion in total hip arthroplasty. Exclusion criteria applied in the most recent randomised trials may have limited the generalisability of oral tranexamic acid in this indication. Larger and more inclusive studies are needed to definitively establish oral administration as a credible alternative to intravenous administration. OBJECTIVES: To assess the noninferiority of oral to intravenous TXA at reducing intra-operative and postoperative total blood loss (TBL) in primary posterolateral approached total hip arthroplasty (PLTHA). DESIGN: Noninferiority, single centre, randomised, double-blind controlled study. SETTING: Patients scheduled for primary PLTHA. Data acquisition occurred between May 2021 and November 2022 at the University Hospital of Liège, Belgium. PATIENTS: Two hundred and twenty-eight patients, randomised in a 1 : 1 ratio from a computer-generated list, completed the trial. INTERVENTIONS: Administration of 2 g of oral TXA 2 h before total hip arthroplasty and 4 h after incision (Group oral) was compared to the intravenous administration of 1 g of TXA 30 min before surgery and 4 h after incision (Group i.v.). MAIN OUTCOME MEASURES: TBL (measured intra-operative and drainage blood loss up to 48 h after surgery, primary outcome), decrease in haemoglobin concentration, D-Dimer at day 1 and day 3, transfusion rate (secondary outcomes). RESULTS: Analyses were performed on 108 out of 114 participants (Group i.v.) and 104 out of 114 participants (Group oral). Group oral was noninferior to Group i.v. with regard to TBL, with a difference between medians (95% CI) of 35 ml (-103.77 to 33.77) within the noninferiority margins. Median [IQR] of estimated TBL was 480 ml [350 to 565] and 445 ml [323 to 558], respectively. No significant interaction between group and time was observed regarding the evolution of TBL and haemoglobin over time. CONCLUSIONS: TXA as an oral premedication before PLTHA is noninferior to its intravenous administration regarding peri-operative TBL. TRIAL REGISTRATION: European Clinical Trial Register under EudraCT-number 2020-004167-29 ( https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-004167-29/BE ).

Clinical and Radiographic Outcomes of Single Implant-Supported Zirconia Crowns Following a Digital and Conventional Workflow: Four-Year Follow-Up of a Randomized Controlled Clinical Trial.

PURPOSE: This study aimed to compare the clinical and radiographic outcomes of single posterior screw-retained monolithic implant crowns following a digital and conventional workflow and to report on the survival/complication rate after a mean 4-year follow-up. MATERIALS AND METHODS: Thirty patients with a single posterior tooth missing were rehabilitated with a bone-level implant. After a healing period of ≥3 months, they were subjected to both a digital and conventional workflow to fabricate two screw-retained monolithic implant crowns. The quantitative clinical adjustments to both crowns (intrasubject comparison) and a questionnaire were recorded at try-in. Thereafter, a crown of the digital and conventional workflows was randomly inserted. At the last follow-up, the marginal bone level (MBL), peri-implant health-related parameters (bleeding on probing (BoP), plaque, pocket probing depth (PPD)), and functional implant prosthodontic score (FIPS) were assessed. Furthermore, the implant survival and success rates and technical complications were evaluated. RESULTS: A total of 27 patients were followed for a mean period of 4.23 ± 1.10 years. There was no significant difference between the digital and conventional workflows regarding clinical adjustments and questionnaire outcomes. More than twice as many participants recommended digital (n = 16) compared to conventional impressions (n = 7) to friends. The implant survival and success rate were 100% and 96.3%, respectively. Furthermore, two de-cementations and one fracture of the ti-base abutment occurred. There were no significant differences in BoP, plaque, and PPD metrics between the two groups. The changes in the MBL between implant crown insertion (baseline) and the last follow-up were 0.07 ± 0.19 mm and 0.34 ± 0.62 mm in the digital and conventional groups, respectively (p = 0.195). The mean overall FIPS score was 8.11 ± 1.37 (range: 5-10). CONCLUSIONS: The clinical and radiographic outcomes of single screw-retained monolithic implant crowns were similar between both workflows after a mean of 4 years of service. The patients did not clearly prefer an impression technique for their restoration, although they would recommend the digital impression more often to friends. Thus, decision regarding clinical workflows may be based on the patient's and/or clinician's preference.

Effect of preoperative warming on intraoperative hypothermia and postoperative functional recovery in total hip arthroplasty: a randomized clinical trial.

BACKGROUND: Intraoperative hypothermia is associated with increased morbidity and impaired postoperative recovery. Direct anterior-approached total hip arthroplasty (ATHA) may lead to significant thermal loss. We aimed to assess whether preoperative warming had an impact on intraoperative hypothermia and postoperative functional recovery after ATHA. METHODS: In this prospective randomized controlled clinical trial 40 patients scheduled for ATHA were randomly divided into two groups of 20 patients each. Group W received, prior to the induction of general anesthesia, a 30 minutes 43 °C forced-air preoperative warming. Group C did not receive any preoperative warming. A blinded observer noted the core body temperature at the time of induction and at fixed time points, i.e. every five minutes during the first hour of surgery. The evolution of postoperative patient perceived thermal comfort (TC) and functional recovery (QoR-15) was assessed 24, 48 and 72 hours after surgery. Length of stay in the post-anesthesia care unit (PACU) was noted. RESULTS: The temperature drop was significantly faster and of higher amplitude in group C than in group W, during first hour of surgery (P<0.001). Evolution of QoR-15 and TC was significantly better in group W than in group C (P<0.001 for QoR-15 and P<0.001 for thermal comfort), with shorter length of stay (median [IQR]) in the PACU (minutes; 73 [61-79] for group C and 98 [83-129] for group W, P<0.001). CONCLUSIONS: In ATHA, pre-warming delays and reduces intraoperative heat loss, impacting patient comfort and postoperative functional recovery.

Serial Lift-Out: sampling the molecular anatomy of whole organisms.

Cryo-focused ion beam milling of frozen-hydrated cells and subsequent cryo-electron tomography (cryo-ET) has enabled the structural elucidation of macromolecular complexes directly inside cells. Application of the technique to multicellular organisms and tissues, however, is still limited by sample preparation. While high-pressure freezing enables the vitrification of thicker samples, it prolongs subsequent preparation due to increased thinning times and the need for extraction procedures. Additionally, thinning removes large portions of the specimen, restricting the imageable volume to the thickness of the final lamella, typically <300 nm. Here we introduce Serial Lift-Out, an enhanced lift-out technique that increases throughput and obtainable contextual information by preparing multiple sections from single transfers. We apply Serial Lift-Out to Caenorhabditis elegans L1 larvae, yielding a cryo-ET dataset sampling the worm's anterior-posterior axis, and resolve its ribosome structure to 7 Å and a subregion of the 11-protofilament microtubule to 13 Å, illustrating how Serial Lift-Out enables the study of multicellular molecular anatomy.

[Plasma biomarkers in traumatic brain injury : current status]. / Biomarqueurs plasmatiques dans le traumatisme crânien : état des lieux.

Traumatic Brain Injury (TBI) is a common trauma and a worldwide major cause of mortality or disability in both civilian and military populations. TBI is not a pathological entity in its own, but rather a pattern of heterogeneous traumas with diverse and varied mechanisms and clinical expressions. Therefore, no universal medical response can be settled to it. Instead, medical management must be tailored to each individual's specific needs. If the current identification and prognosis of TBI is basically based on neurological examination and computerized tomography, specific biomarkers could represent a valuable aid in this diagnostic and therapeutic challenge. The potential implications of these markers are broad, encompassing among others the detection of unsuspected TBI, the monitoring of trauma severity, short-, intermediate- and long-term prognosis and apprehension of the extent of the sequelae. This topic has received broad and growing interest over the past decade, and the current literature is extensive. This short narrative review summarizes the latest advances in the field of plasma biomarkers in TBI patients.

Le traumatisme crânien (TC) est une pathologie courante et une cause majeure de mortalité ou d'invalidité dans le monde, tant chez les civils que chez les militaires. Le TC ne constitue pas une entité pathologique à part entière, mais plutôt un ensemble de lésions hétérogènes dont les mécanismes et les expressions cliniques sont divers et variés. Par conséquent, aucune prise en charge universelle ne peut être établie et les traitements médicaux doivent être adaptés et ajustés à l'individu. Si, actuellement, l'identification et le pronostic des TC reposent essentiellement sur l'examen clinique neurologique et la tomodensitométrie, des biomarqueurs spécifiques pourraient représenter une aide précieuse dans ce défi diagnostique et thérapeutique. L'implication potentielle de ces marqueurs est vaste, avec un rôle à jouer, entre autres, dans la détection de la présence d'un TC insoupçonné, le suivi de la sévérité du traumatisme, le pronostic de morbi-mortalité à court, moyen et long termes, et la prédiction de la gravité et de l'étendue des séquelles. Ce sujet a suscité un intérêt large et croissant au cours de la dernière décennie, et la littérature actuelle est abondante. Cette brève revue narrative résume les dernières avancées dans le domaine des biomarqueurs plasmatiques lors d'un TC.

Comparison between supra-inguinal fascia iliaca and pericapsular nerve group blocks on postoperative pain and functional recovery after total hip arthroplasty: A noninferiority randomised clinical trial.

BACKGROUND: Pain after a posterolateral approach for total hip arthroplasty (THA) may affect early functional recovery. Supra-inguinal fascia iliaca (SFIB) and pericapsular nerve group (PENG) blocks have been proposed as promising analgesia techniques. OBJECTIVES: This trial was conducted to compare a PENG with a SFIB for controlling postoperative pain and for providing functional recovery. DESIGN: Noninferiority monocentric randomised controlled study. SETTING: One hundred and two patients scheduled for a total hip arthroplasty via the posterolateral approach under spinal anaesthesia were prospectively allocated to two groups. Data acquisition occurred between October 2021 and July 2022 at the University Hospital of Liege. PATIENTS: One hundred and two patients completed the trial. INTERVENTIONS: Group SFIB received supra-inguinal fascia iliaca block (SFIB) (40 ml ropivacaine 0.375%), whereas group PENG received a PENG block (20 ml ropivacaine 0.75%). MAIN OUTCOME MEASURES: Rest and mobilisation pain on a 0 to 10 numeric rating scale at fixed time points: 1 and 6 h after surgery, on day-1 and day-2 at 8 a.m.,1 p.m. and 6 p.m. On day-1 and day-2, evolution of quality-of-recovery-15 score was assessed, and timed-up-and-go, 2 and 6 min-walking tests. The noninferiority margin was set as 1 numeric rating scale point 6 h after surgery. RESULTS: Six hours after surgery, pain scores in group PENG were noninferior to those of group SFIB, with a difference between medians at 0 (95% CI -0.93 to 0.93). There were no significant differences between the groups regarding rest and dynamic pain trajectories during the first 48 postoperative hours, with no significant effects of group (rest P  = 0.800; dynamic P  = 0.708) or interaction between group and time (rest P  = 0.803; dynamic P  = 0.187). Similarly, no significant differences were observed regarding motor and functional recovery as assessed by timed-up-and-go ( P  = 0.197), 2 min ( P  = 0.364), and 6 min walking ( P  = 0.347) tests and quality-of-recovery-15 ( P  = 0.417) score. CONCLUSION: Following a total hip arthroplasty via the posterolateral approach, a PENG block is noninferior to SFIB regarding postoperative pain control 6 h after surgery, and functional recovery. TRIAL REGISTRATION: European Clinical Trial Register under EudraCT-number 2020-005126-28 ( https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-005126-28/BE ).

Comparison of Virtual Intersection and Occlusal Contacts between Intraoral and Laboratory Scans: An In-Vivo Study.

BACKGROUND: The inaccurate maxillomandibular relationship of virtual casts following alignment by the vestibular scan may result in intersection (intermesh penetration) between opposing dental arch surfaces. Intersection occurs at short interocclusal distances in the occlusal contact area (OCA) and may result in infra-occluded definitive restorations. The purpose of this clinical study was to compare initial (by the proprietary scanner software) and new alignments (by a standalone 3D software) of virtual casts regarding OCA and intersection failure. New alignments aimed to rectify intersections by refinement of occlusal contacts. MATERIAL AND METHODS: The virtual casts of 30 patients following digital and conventional impression-taking were analyzed, which were acquired for single implant restoration in the posterior site. Digital impressions were performed by both IOS 1 (3M True Definition) and IOS 2 (TRIOS 3), either as complete- or partial-arch scans, respectively. Mounted gypsum casts were digitized as complete-arch by a laboratory scanner (LS) in enabled and disabled mode to avoid intersection [LS (+)/LS (-)]. All virtual casts were newly aligned by a 3D software. The difference of the OCA and the area of intersection were calculated for initial and new alignments, using interocclusal distance ranges of 0-100 µm, 0-10 µm or <0 µm (=intersection). The difference of the OCA was compared using a linear mixed model. The distribution of occlusal contact points per modality and alignment was assessed independently by three observers and estimated by inter- and intraclass correlation (ICC) coefficients. RESULTS: Virtual casts following initial alignment demonstrated intersections irrespective of the modality. The mean area of the intersection was most for IOS 2 (79.23 mm2), followed by IOS 1 (48.28 mm2), LS (-) (2.77 mm2), and LS (+) (2.01 mm2) in partial-arch scans. Complete-arch scans demonstrated an area of intersection of 70.63 mm2 for IOS 1 followed by 65.52 mm2 (IOS 2), 6.13 mm2 [LS (-)] and 2.76 mm2 [LS (+)]. Newly aligned scans showed no intersections. The overall distribution of occlusal contact points demonstrated moderate reliability (ICC 0.63). Good reliability could be observed (ICC 0.9) for LS (-) scans. CONCLUSIONS: Intersections in the area of occlusal contact points are a phenomenon restricted to virtual casts, which should be considered in CAD/CAM. Initial alignments of LS are less affected by this virtual phenomenon, and contact points may be more distinct according to their anatomic region compared to IOS. Furthermore, intersections can be rectified in a 3D software by adjustment of the maxillomandibular relationship.

Bone Graft Packing and Its Association with Bone Regeneration in Maxillary Sinus Floor Augmentations: Histomorphometric Analysis of Human Biopsies.

Research in maxillary sinus floor augmentation (MSFA) focussed on the optimisation of microstructural parameters such as microporosity and particle size of bone substitute particles (BS). However, little is known about the impact of BS packing and the corresponding (void) interparticular space on bone regeneration. The aim of this study was to characterise the spatial distribution of BS and its association with BS integration 6 ± 1 months after MSFA. Histological thin-ground sections of 70 human sinus biopsies were histomorphometrically analysed: In serial zones of 100 µm proceeding from the sinus floor (SF) up to the apical end of the biopsy, we measured the distribution of BS particles within these zones in terms of volume (BSV/TV), number and size of BS particles, interparticle spacing (BS.Sp) and bone-to-BS contact. BS particles were not homogeneously distributed over the length of biopsies: The first 200 µm directly adjacent to the SF represented a zone poor in BS particles but with high osteogenic potential. Graft packing density increased from the SF towards the apical part of the AA. Integration of BS particles was inversely associated with the distance to the SF and the graft packing density. A high packing density through excessive compaction of BS particles should be avoided to optimise the macrostructural environment for bone regeneration.

In situ structural analysis reveals membrane shape transitions during autophagosome formation.

Autophagosomes are unique organelles that form de novo as double-membrane vesicles engulfing cytosolic material for destruction. Their biogenesis involves membrane transformations of distinctly shaped intermediates whose ultrastructure is poorly understood. Here, we combine cell biology, correlative cryo-electron tomography (cryo-ET), and extensive data analysis to reveal the step-by-step structural progression of autophagosome biogenesis at high resolution directly within yeast cells. The analysis uncovers an unexpectedly thin intermembrane distance that is dilated at the phagophore rim. Mapping of individual autophagic structures onto a timeline based on geometric features reveals a dynamical change of membrane shape and curvature in growing phagophores. Moreover, our tomograms show the organelle interactome of growing autophagosomes, highlighting a polar organization of contact sites between the phagophore and organelles, such as the vacuole and the endoplasmic reticulum (ER). Collectively, these findings have important implications for the contribution of different membrane sources during autophagy and for the forces shaping and driving phagophores toward closure without a templating cargo.

Volumetric macromolecule identification in cryo-electron tomograms using capsule networks.

BACKGROUND: Despite recent advances in cellular cryo-electron tomography (CET), developing automated tools for macromolecule identification in submolecular resolution remains challenging due to the lack of annotated data and high structural complexities. To date, the extent of the deep learning methods constructed for this problem is limited to conventional Convolutional Neural Networks (CNNs). Identifying macromolecules of different types and sizes is a tedious and time-consuming task. In this paper, we employ a capsule-based architecture to automate the task of macromolecule identification, that we refer to as 3D-UCaps. In particular, the architecture is composed of three components: feature extractor, capsule encoder, and CNN decoder. The feature extractor converts voxel intensities of input sub-tomograms to activities of local features. The encoder is a 3D Capsule Network (CapsNet) that takes local features to generate a low-dimensional representation of the input. Then, a 3D CNN decoder reconstructs the sub-tomograms from the given representation by upsampling. RESULTS: We performed binary and multi-class localization and identification tasks on synthetic and experimental data. We observed that the 3D-UNet and the 3D-UCaps had an [Formula: see text]score mostly above 60% and 70%, respectively, on the test data. In both network architectures, we observed degradation of at least 40% in the [Formula: see text]-score when identifying very small particles (PDB entry 3GL1) compared to a large particle (PDB entry 4D8Q). In the multi-class identification task of experimental data, 3D-UCaps had an [Formula: see text]-score of 91% on the test data in contrast to 64% of the 3D-UNet. The better [Formula: see text]-score of 3D-UCaps compared to 3D-UNet is obtained by a higher precision score. We speculate this to be due to the capsule network employed in the encoder. To study the effect of the CapsNet-based encoder architecture further, we performed an ablation study and perceived that the [Formula: see text]-score is boosted as network depth is increased which is in contrast to the previously reported results for the 3D-UNet. To present a reproducible work, source code, trained models, data as well as visualization results are made publicly available. CONCLUSION: Quantitative and qualitative results show that 3D-UCaps successfully perform various downstream tasks including identification and localization of macromolecules and can at least compete with CNN architectures for this task. Given that the capsule layers extract both the existence probability and the orientation of the molecules, this architecture has the potential to lead to representations of the data that are better interpretable than those of 3D-UNet.

A transformation clustering algorithm and its application in polyribosomes structural profiling.

Improvements in cryo-electron tomography sample preparation, electron-microscopy instrumentations, and image processing algorithms have advanced the structural analysis of macromolecules in situ. Beyond such analyses of individual macromolecules, the study of their interactions with functionally related neighbors in crowded cellular habitats, i.e. 'molecular sociology', is of fundamental importance in biology. Here we present a NEighboring Molecule TOpology Clustering (NEMO-TOC) algorithm. We optimized this algorithm for the detection and profiling of polyribosomes, which play both constitutive and regulatory roles in gene expression. Our results suggest a model where polysomes are formed by connecting multiple nonstochastic blocks, in which translation is likely synchronized.

Improvements in cryo-electron tomography sample preparation, electron-microscopy instrumentations, and image processing algorithms have advanced the structural analysis of macromolecules in situ. Beyond such analyses of individual macromolecules, the study of their interactions with functionally related neighbors in crowded cellular habitats, i.e. "molecular sociology", is of fundamental importance in biology. Here we present a NEighboring Molecule TOpology Clustering (NEMO-TOC) algorithm. We optimized this algorithm for the detection and profiling of polyribosomes, which play both constitutive and regulatory roles in gene expression. Our results suggest a model where polysomes are formed by connecting multiple nonstochastic blocks, in which translation is likely synchronized.

Effect of suprainguinal fascia iliaca compartment block on postoperative opioid consumption and functional recovery in posterolateral-approached total hip arthroplasty: a single-blind randomized controlled trial.

INTRODUCTION: Posterolateral-approached total hip arthroplasty (PLTHA) is followed by moderate to severe postoperative pain. Suprainguinal fascia iliaca compartment block (SFICB) has been proposed as a promising analgesia technique. METHODS: Data from 86 patients scheduled for PLTHA with spinal anesthesia were analyzed in this prospective randomized controlled trial. Patients were randomly divided into two groups of 43 patients each. As opposed to the control group (group C), ropivacaine group (group R) received additional SFICB using 40 mL of 0.375% ropivacaine. As primary endpoint, blind observers noted total morphine consumption at postoperative 48 hours. Secondary endpoints were pain at rest and mobilization on 0-10 Numeric Rating Scale (rest and dynamic NRS) at fixed time points (1 hour and 6 hours after surgery, and at day 1 and day 2 at 8:00, 13:00 and 18:00 hours), walking performance at day 1 and day 2; postoperative complications including morphine-related side effects or orthostatic intolerance symptoms such as dizziness, nausea, blurred vision or vasovagal syncope. RESULTS: A 48-hour morphine consumption (mg; median (IQR)) was significantly lower in group R than in group C (11 (8.5-15.5)) vs 26 (21-33.5), p<0001), as well as incidence of morphine-related side effects such as nausea at day 1 (p=0.04) and day 2 (p<0.01). Rest and dynamic NRS were globally significantly lower in group R than in group C (p<0.01). Group R showed less orthostatic intolerance at day 1 (p<0.001) and day 2 (p<0.01) and better functional walking performance at day 1 (<0.001) and day 2 (<0.001). DISCUSSION: In PLTHA, SFICB provides opioid sparing, improved postoperative pain control, and enhanced functional recovery. TRIAL REGISTRATION NUMBER: NCT04574479.

Retrospective Evaluation of Implants Placed in Iliac Crest Autografts and Pristine Bone.

OBJECTIVE: Iliac crest autografts can compensate for severe mandibular atrophy before implant placement. However, the implant success in the augmented bone is not entirely predictable. Here we performed a retrospective cohort study to determine the success and related parameters of implants placed in augmented bone and pristine bone for up to 11 years. MATERIAL AND METHODS: We analyzed 18 patients where 72 implants were placed six months after iliac crest transplantation and 19 patients where 76 implants were placed in pristine bone. The primary endpoint was implant loss. Secondary endpoints were the implant success, peri-implant bone loss, and the clinical parameters related to peri-implantitis. Moreover, we evaluated the oral-health-related quality of life (OHIP). RESULTS: Within a mean follow-up of 5.8 ± 2.2 and 7.6 ± 2.8 years, six but no implants were lost when placed in augmented and pristine bone, respectively. Among those implants remaining in situ, 58% and 68% were rated as implant success (p = 0.09). A total of 11% and 16% of the implants placed in the augmented and the pristine bone were identified as peri-implantitis (p = 0.08). Bone loss was similar in both groups, with a mean of 2.95 ± 1.72 mm and 2.44 ± 0.76 mm. The mean OHIP scores were 16.36 ± 13.76 and 8.78 ± 7.21 in the augmentation and the control group, respectively (p = 0.35). CONCLUSIONS: Implants placed in iliac crest autografts have a higher risk for implant loss and lower implant success rates compared to those placed in the pristine bone.

A feature-guided, focused 3D signal permutation method for subtomogram averaging.

Advances in electron microscope instrumentation, cryo-electron tomography data collection, and subtomogram averaging have allowed for the in-situ visualization of molecules and their complexes in their native environment. Current data processing pipelines commonly extract subtomograms as a cubic subvolume with the key assumption that the selected object of interest is discrete from its surroundings. However, in instances when the object is in its native environment, surrounding densities may negatively affect the subsequent alignment and refinement processes, leading to loss of information due to misalignment. For example, the strong densities from surrounding membranes may dominate the alignment process for membrane proteins. Here, we developed methods for feature-guided subtomogram alignment and 3D signal permutation for subtomogram averaging. Our 3D signal permutation method randomizes and filters voxels outside a mask of any shape and blurs the boundary of the mask that encapsulates the object of interest. The randomization preserves global statistical properties such as mean density and standard deviation of voxel density values, effectively producing a featureless background surrounding the object of interest. This signal permutation process can be repeatedly applied with intervening alignments of the 3D signal-permuted subvolumes, recentering of the mask, and optional adjustments of the shape of the mask. We have implemented these methods in a new processing pipeline which starts from tomograms, contains feature-guided subtomogram extraction and alignment, 3D signal-permutation, and subtomogram visualization tools. As an example, feature-guided alignment and 3D signal permutation leads to improved subtomogram average maps for a dataset of synaptic protein complexes in their native environment.