Handheld and Cost-Effective Fourier Lightfield Microscope.

In this work, the design, building, and testing of the most portable, easy-to-build, robust, handheld, and cost-effective Fourier Lightfield Microscope (FLMic) to date is reported. The FLMic is built by means of a surveillance camera lens and additional off-the-shelf optical elements, resulting in a cost-effective FLMic exhibiting all the regular sought features in lightfield microscopy, such as refocusing and gathering 3D information of samples by means of a single-shot approach. The proposed FLMic features reduced dimensions and light weight, which, combined with its low cost, turn the presented FLMic into a strong candidate for in-field application where 3D imaging capabilities are pursued. The use of cost-effective optical elements has a relatively low impact on the optical performance, regarding the figures dictated by the theory, while its price can be at least 100 times lower than that of a regular FLMic. The system operability is tested in both bright-field and fluorescent modes by imaging a resolution target, a honeybee wing, and a knot of dyed cotton fibers.

Avaliação da acurácia dos modelos dentários digitais obtidos para cirurgia ortognática / Assessment of the accuracy of digital dental models obtained for orthognathic surgery

O objetivo deste estudo laboratorial foi avaliar a acurácia dos modelos digitais obtidos por duas técnicas de escaneamento (escâner intraoral - Itero 5d Element® - e escâner de bancada -Straumann ®) de um modelo experimental (Nacional Ossos ®) da arcada superior confeccionada em poliuretano e do modelo de gesso obtido desta arcada. Os pontos A ­ 3mm acima do elemento 17; B ­ 3mm acima do elemento 14; C ­ 3mm acima do elemento 24; D ­ 3mm acima do elemento 27; E ­ cúspide mesiovestibular do elemento 16; F - ponto de contato mais incisal entre os elementos 11 e 21; G - Cúspide mesiovestibular do elemento 26 foram utilizados como referência para as medidas realizadas. As medidas foram realizadas em um software (Geomagic®) de simulação cirúrgica e analisadas quanto a validade e precisão das técnicas de escaneamento utilizadas em todos os grupos (1 a 5). O grupo 1 corresponde ao grupo padrão-ouro; o 2 ao grupo do escaneamento com escâner intraoral do modelo de poliuretano; o 3 ao escaneamento de bancada do modelo; o 4 ao escaneamento com escâner intraoral do modelo de gesso; e 5 ao escaneamento de bancada do modelo de gesso. Na análise da validação, todas as técnicas apresentaram-se válidas quando comparadas ao grupo controle com exceção da medida FG que apresentou diferenças estatisticamente significativas (p<0,05) entre os grupos 1 e 2. A precisão foi avaliada através do índice de correlação intraclasse (CCI) e todas as técnicas apresentaram-se altamente precisas com (CCI) próximo de 1. Desta forma, conclui-se que o escâner intraoral e o escâner de bancada utilizados neste estudo foram confiáveis quando comparados ao grupo controle e que os dois modelos de escâner utilizados se apresentaram com alta precisão (AU).

The objective of this experimental study was to evaluate the accuracy of digital models generated by two scanning techniques (intraoral scanner - Itero 5d Element® - and desktop scanner -Straumann ®) of an experimental model of the upper arch (Nacional Ossos ®) made of polyurethane and the plaster model obtained from this arch. Points A ­ 3mm above element 17; B ­ 3mm above element 14; C ­ 3mm above element 24; D ­ 3mm above element 27; E ­ mesiobuccal cusp of element 16; F - most incisal point of contact between elements 11 and 21; G - Mesiobuccal cusp of element 26 were used as a reference for the measurements performed. The measurements were performed in a surgical simulation software (Geomagic ®) and analyzed for the validity and precision of the scanning techniques used in all groups (1 to 5). Group 1 corresponds to the gold standard group; 2 to the scanning group with intraoral scanner of the polyurethane model; 3 to the desktop scan of the model; 4 to intraoral scanner scanning of the plaster model; and 5 to the desktop scan of the plaster model. In the validation analysis, all techniques showed to be valid compared to the control group, except the FG measure, which showed statistically significant differences (p<0.05) between groups 1 and 2. Precision was assessed using the intraclass correlation(ICC) index, and all techniques were highly accurate with an ICC close to 1. Thus, it is concluded that the intraoral scanner and the bench scanner used in this study were reliable compared to the control group and that the two scanner models used presented themselves with high precision (AU).

Assessment of clinical measures of total and regional body composition from a commercial 3-dimensional optical body scanner.

BACKGROUND: The accurate assessment of total body and regional body circumferences, volumes, and compositions are critical to monitor physical activity and dietary interventions, as well as accurate disease classifications including obesity, metabolic syndrome, sarcopenia, and lymphedema. We assessed body composition and anthropometry estimates provided by a commercial 3-dimensional optical (3DO) imaging system compared to criterion measures. METHODS: Participants of the Shape Up! Adults study were recruited for similar sized stratifications by sex, age (18-40, 40-60, >60 years), BMI (under, normal, overweight, obese), and across five ethnicities (non-Hispanic [NH] Black, NH White, Hispanic, Asian, Native Hawaiian/Pacific Islander). All participants received manual anthropometry assessments, duplicate whole-body 3DO (Styku S100), and dual-energy X-ray absorptiometry (DXA) scans. 3DO estimates provided by the manufacturer for anthropometry and body composition were compared to the criterion measures using concordance correlation coefficient (CCC) and Bland-Altman analysis. Test-retest precision was assessed by root mean square error (RMSE) and coefficient of variation. RESULTS: A total of 188 (102 female) participants were included. The overall fat free mass (FFM) as measured by DXA (54.1 ± 15.2 kg) and 3DO (55.3 ± 15.0 kg) showed a small mean difference of 1.2 ± 3.4 kg (95% limits of agreement -7.0 to +5.6) and the CCC was 0.97 (95% CI: 0.96-0.98). The CCC for FM was 0.95 (95% CI: 0.94-0.97) and the mean difference of 1.3 ± 3.4 kg (95% CI: -5.5 to +8.1) reflected the difference in FFM measures. 3DO anthropometry and body composition measurements showed high test-retest precision for whole body volume (1.1 L), fat mass (0.41 kg), percent fat (0.60%), arm and leg volumes, (0.11 and 0.21 L, respectively), and waist and hip circumferences (all <0.60 cm). No group differences were observed when stratified by body mass index, sex, or race/ethnicity. CONCLUSIONS: The anthropometric and body composition estimates provided by the 3DO scanner are precise and accurate to criterion methods if offsets are considered. This method offers a rapid, broadly available, and automated method of body composition assessment regardless of body size. Further studies are recommended to examine the relationship between measurements obtained by 3DO scans and metabolic health in healthy and clinical populations.

High-speed super-resolution imaging of rotationally symmetric structures using SPEED microscopy and 2D-to-3D transformation.

Various super-resolution imaging techniques have been developed to break the diffraction-limited resolution of light microscopy. However, it still remains challenging to obtain three-dimensional (3D) super-resolution information of structures and dynamic processes in live cells at high speed. We recently developed high-speed single-point edge-excitation sub-diffraction (SPEED) microscopy and its two-dimensional (2D)-to-3D transformation algorithm to provide an effective approach to achieving 3D sub-diffraction-limit information in subcellular structures and organelles that have rotational symmetry. In contrast to most other 3D super-resolution microscopy or 3D particle-tracking microscopy approaches, SPEED microscopy does not depend on complex optical components and can be implemented onto a standard inverted epifluorescence microscope. SPEED microscopy is specifically designed to obtain 2D spatial locations of individual immobile or moving fluorescent molecules inside sub-micrometer biological channels or cavities at high spatiotemporal resolution. After data collection, post-localization 2D-to-3D transformation is applied to obtain 3D super-resolution structural and dynamic information. The complete protocol, including cell culture and sample preparation (6-7 d), SPEED imaging (4-5 h), data analysis and validation through simulation (5-13 h), takes ~9 d to complete.

Accuracy of EOS Imaging Technology in Comparison to Computed Tomography in the Assessment of Vertebral Rotational Orientation in Instrumented Spines in Adolescent Idiopathic Scoliosis.

STUDY DESIGN: Retrospective radiographic reliability study. OBJECTIVE: The aim of this study was to assess the validity of EOS 3D imaging technology in the determination of vertebral rotations in the spine of patients with previous instrumentation. SUMMARY OF BACKGROUND DATA: There is a lack of evidence on the accuracy of vertebral rotational measurement using EOS 3D morphological analysis in the instrumented spine. METHODS: A retrospective review of 31 patients with adolescent idiopathic scoliosis (AIS) who underwent instrumented fusion and postoperative computed tomography (CT) scans of the spine was performed. Vertebral rotations of the apex vertebra, the uppermost (UIV) and lowermost (LIV) instrumented vertebra, the noninstrumented vertebra one level cranial to the UIV (UIV + 1) and one level caudal to LIV (LIV + 1) were determined using EOS 3D reconstruction. The vertebral rotation was also measured using reformatted CT axial images. Relative vertebral rotational difference (VRD) were calculated for UIV to apex, UIV + 1 to apex, LIV to apex, LIV + 1 to apex, UIV to LIV and UIV + 1 to LIV + 1. Paired t tests were used to compare the VRD measured using the two different imagining modalities. For values where P > 0.05, the Bland-Altman plot was used to assess the agreement between the measures. Interclass correlation (ICC) was used to determine interobserver and intraobserver reliabilities of EOS and CT measurements. RESULTS: EOS analysis of relative VRD was found to be significantly different from that of CT for UIV to apex (P = 0.006) and UIV + 1 to apex (P = 0.003). No significant differences were found for LIV to apex (P = 0.06), LIV + 1 to apex (P = 0.06), UIV to LIV (P = 0.59) and UIV + 1 to LIV + 1 (P = 0.64). However, Bland-Altman plots showed that agreement was poor, and variance was beyond acceptable. ICC showed good interobserver and good to very good intraobserver reliability for EOS. CONCLUSION: EOS 3D morphological analysis of VRD in the instrumented levels of the spine demonstrated significant difference and unacceptable variance in comparison to CT measurement.Level of Evidence: 4.

Three-Dimensional Facial Scanning at the Fingertips of Patients and Surgeons: Accuracy and Precision Testing of iPhone X Three-Dimensional Scanner.

BACKGROUND: The iPhone X (Apple, Inc., Cupertino, Calif.) is the first smartphone to be released with a high-fidelity three-dimensional scanner. At present, half of all U.S. smartphone users use an iPhone. Recent data suggest that the majority of these 230 million individuals will upgrade to the iPhone X within 2 years. This represents a profound expansion in access to three-dimensional scanning technology, not only for plastic surgeons but for their patients as well. The purpose of this study was to compare the iPhone X scanner against a popular, portable three-dimensional camera used in plastic surgery (Canfield Vectra H1; Canfield Scientific, Inc., Parsippany, N.J.). METHODS: Sixteen human subjects underwent three-dimensional facial capture with the iPhone X and Canfield Vectra H1. Results were compared using color map analysis and surface distances between key anatomical landmarks. To assess repeatability and precision of the iPhone X three-dimensional scanner, six facial scans of a single participant were obtained and compared using color map analysis. In addition, three-dimensionally-printed facial masks (n = 3) were captured with each device and compared. RESULTS: For the experiments, average root mean square was 0.44 mm following color map analysis and 0.46 mm for surface distance between anatomical landmarks. For repeatability and precision testing, average root mean square difference following color map analysis was 0.35 mm. For the three-dimensionally-printed facial mask comparison, average root mean square difference was 0.28 mm. CONCLUSIONS: The iPhone X offers three-dimensional scanning that is accurate and precise to within 0.5 mm when compared to a commonly used, validated, and expensive three-dimensional camera. This represents a significant reduction in the barrier to access to three-dimensional scanning technology for both patients and surgeons.

Evaluation of a Novel Three-Dimensional Wound Measurement Device for Assessment of Diabetic Foot Ulcers.

Objective: The initial wound measurement and regular monitoring of diabetic foot ulcers (DFU) is critical to assess treatment response. There is no standardized, universally accepted, quick, reliable, and quantitative assessment method to characterize DFU. To address this need, a novel topographic imaging system has been developed. Our study aims at assessing the reliability and practicality of the WoundVue® camera technology in the assessment of DFU. Approach: The WoundVue system is a prototype device. It consists of two infrared cameras and an infrared projector, and it is able to produce a three-dimensional (3D) reconstruction of the wound structure. Fifty-seven diabetic foot wounds from patients seen in a multidisciplinary foot clinic were photographed from two different angles and distances by using the WoundVue camera. Wound area, volume, and maximum depth were measured for assessment of reliability. Thirty-one of these wounds also had area calculated by using the established Visitrak™ system, and a correlation between the area obtained by using both systems was assessed. Results: WoundVue images analysis showed excellent agreement for area (intraclass correlation coefficient [ICC]: 0.995), volume (ICC: 0.988), and maximum depth (ICC: 0.984). Good agreement was found for area measurement by using the WoundVue camera and Visitrak system (ICC: 0.842). The average percentage differences between measures obtained by using the WoundVue from different angles for assessment of different sizes and shapes of wounds were 2.9% (95% confidence interval [CI]: 0.3-5.4), 12.9% (95% CI: 9.6-35.7), and 6.2% (95% CI: 2.3-14.7) for area, maximum depth, and volume, respectively. Innovation: This is the first human trial evaluating this novel 3D wound measurement device. Conclusion: The WoundVue system is capable of recreating a 3D model of DFU and produces consistent data. Digital images are ideal for monitoring wounds over time, and the WoundVue camera has the potential to be a valuable adjunct in diabetic foot wound care.

Optical coherence tomography for fast bedside imaging, assessment and monitoring of autoimmune inflammatory skin diseases?

Optical coherence tomography (OCT) is a non-invasive, high-resolution imaging technique with a growing impact in dermatology. The principle of OCT is comparable to that of sonography, except that it uses infrared laser light instead of ultrasound waves. It has been clinically demonstrated that OCT is suitable for discriminating between different types of non-melanoma skin cancer at an early stage of disease. Optical coherence tomography generates two- or three-dimensional images of up to 2 mm penetration depth, a field of view of 6 mm × 6 mm, and an acquisition time of seconds. The resolution capability of OCT is more than 3 to 100 times higher than that of ultrasound imaging. It is of particular interest that the additional information on vasculature provided by OCT angiography enables the assessment and monitoring of inflammatory skin diseases. The use of OCT to locate exact blister levels was demonstrated for diagnosing autoimmune bullous diseases. It is anticipated that detection of subclinical lesions could indicate a relapse of the disease. In the future, this could enable intervention and early treatment. Furthermore, the development of high-speed OCT could allow fast scanning and bedside imaging of large body sites.

Assessment of nest building and social interaction behavior in mice exposed to acute social defeat stress using a three-dimensional depth camera.

Nest building is an instinctive behavior toward protection from predators, body temperature regulation, and courtship. Previously, we discovered that acute and chronic social defeat stress suppresses the onset of nest-building behavior in male mice (C57BL/6J). Here, we analyzed nest building and other behavioral deficits induced by acute social defeat stress (ASDS). We utilized a customized cage and specifically developed observational programs for nest building, social avoidance, and other behaviors using an infrared depth camera to acquire three-dimensional (3D) data of animal behavior (Negura system). We determined the volume of nesting materials from these 3D depth images. Mice exposed to ASDS showed increased spontaneous activities, decreased rearing, and delayed nest building; however, nest-building activity was gradually recovered during the dark period of the 24 hr observation interval. At the endpoint following 24 hr, the ASDS and control groups showed no differences in nest volumes. Furthermore, we observed the time courses of both nest building and social avoidance behaviors and their relationship using the Negura system. Our data demonstrated a weak positive correlation between nest-building delay and social avoidance in ASDS mice. The Negura system can observe various behaviors that reflect the effects of social defeat stress.

Usefulness of three-dimensional printing of superior mesenteric vessels in right hemicolon cancer surgery.

The anatomy of the superior mesenteric vessels is complex, yet important, for right-sided colorectal surgery. The usefulness of three-dimensional (3D) printing of these vessels in right hemicolon cancer surgery has rarely been reported. In this prospective clinical study, 61 patients who received laparoscopic surgery for right hemicolon cancer were preoperatively randomized into 3 groups: 3D-printing (20 patients), 3D-image (19 patients), and control (22 patients) groups. Surgery duration, bleeding volume, and number of lymph node dissections were designed to be the primary end points, whereas postoperative complications, post-operative flatus recovery time, duration of hospitalization, patient satisfaction, and medical expenses were designed to be secondary end points. To reduce the influence of including different surgeons in the study, the surgical team was divided into 2 groups based on surgical experience. The duration of surgery for the 3D-printing and 3D-image groups was significantly reduced (138.4 ± 19.5 and 154.7 ± 25.9 min vs. 177.6 ± 24.4 min, P = 0.000 and P = 0.006), while the number of lymph node dissections for the these 2 groups was significantly increased (19.1 ± 3.8 and 17.6 ± 3.9 vs. 15.8 ± 3.0, P = 0.001 and P = 0.024) compared to the control group. Meanwhile, the bleeding volume for the 3D-printing group was significantly reduced compared to the control group (75.8 ± 30.4 mL vs. 120.9 ± 39.1 mL, P = 0.000). Moreover, patients in the 3D-printing group reported increased satisfaction in terms of effective communication compared to those in the 3D-image and control groups. Medical expenses decreased by 6.74% after the use of 3D-printing technology. Our results show that 3D-printing technology could reduce the duration of surgery and total bleeding volume and increase the number of lymph node dissections. 3D-printing technology may be more helpful for novice surgeons.Trial registration: Chinese Clinical Trial Registry, ChiCTR1800017161. Registered on 15 July 2018.

Faster 3D saturation-recovery based myocardial T1 mapping using a reduced number of saturation points and denoising.

PURPOSE: To accelerate the acquisition of free-breathing 3D saturation-recovery-based (SASHA) myocardial T1 mapping by acquiring fewer saturation points in combination with a post-processing 3D denoising technique to maintain high accuracy and precision. METHODS: 3D SASHA T1 mapping acquires nine T1-weighted images along the saturation recovery curve, resulting in long acquisition times. In this work, we propose to accelerate conventional cardiac T1 mapping by reducing the number of saturation points. High T1 accuracy and low standard deviation (as a surrogate for precision) is maintained by applying a 3D denoising technique to the T1-weighted images prior to pixel-wise T1 fitting. The proposed approach was evaluated on a T1 phantom and 20 healthy subjects, by varying the number of T1-weighted images acquired between three and nine, both prospectively and retrospectively. Following the results from the healthy subjects, three patients with suspected cardiovascular disease were acquired using five T1-weighted images. T1 accuracy and precision was determined for all the acquisitions before and after denoising. RESULTS: In the T1 phantom, no statistical difference was found in terms of accuracy and precision for the different number of T1-weighted images before or after denoising (P = 0.99 and P = 0.99 for accuracy, P = 0.64 and P = 0.42 for precision, respectively). In vivo, both prospectively and retrospectively, the precision improved considerably with the number of T1-weighted images employed before denoising (P<0.05) but was independent on the number of T1-weighted images after denoising. CONCLUSION: We demonstrate the feasibility of accelerating 3D SASHA T1 mapping by reducing the number of acquired T1-weighted images in combination with an efficient 3D denoising, without affecting accuracy and precision of T1 values.

3-Dimensional optical scanning for body composition assessment: A 4-component model comparison of four commercially available scanners.

BACKGROUND & AIMS: Body composition assessment via 3-dimensional optical (3DO) scanning has emerged as a rapid and simple evaluation method. The aim of this study was to establish the precision of body composition estimates from four commercially available 3DO scanners and evaluate their validity as compared to a reference 4-component (4C) model. METHODS: The body composition of 171 participants was assessed using four commercially-available 3DO scanners (FIT3D®, Naked Labs®, Size Stream®, and Styku®) and a 4C model utilizing data from dual-energy x-ray absorptiometry, air displacement plethysmography, and bioimpedance spectroscopy. Body composition estimates were compared via equivalence testing, Deming regression, Bland-Altman analysis, concordance correlation coefficients (CCC), root mean square error (RMSE), and related metrics. Precision metrics, including the root mean square coefficient of variation (RMS-%CV), precision error, and intraclass correlation coefficient, were generated for duplicate scans in 139 participants. RESULTS: All scanners produced reasonably reliable estimates, with RMS-%CV of 2.3-4.3% for body fat percentage (BF%), 2.5-4.3% for fat mass (FM), and 0.7-1.4% for fat-free mass (FFM). ICC values ranged from 0.975 to 0.996 for BF% and 0.990 to 0.999 for FM and FFM. All scanners except Styku® demonstrated equivalence with 4C, using 5% equivalence regions, and constant errors of <1% for BF% and ≤0.5 kg for FM and FFM. However, the slopes of regression lines differed from the line of identity for most scanners and variables. CCC values ranged from 0.74 to 0.90 for BF%, 0.85 to 0.95 for FM, and 0.93 to 0.97 for FFM. RMSE values ranged from 3.7 to 6.1% for BF% and 2.8-4.6 kg for FM and FFM. Bland-Altman analysis indicated proportional bias of varying magnitudes was present for all scanners. CONCLUSIONS: Commercially available 3DO scanners produce relatively reliable body composition estimates. Three out of four scanners demonstrated equivalence with a 4C model for assessments of BF%, FM, and FFM, although other metrics of validity varied among scanners, and proportional bias was present for all scanners.

Validation of two handheld devices against a non-portable three-dimensional surface scanner and assessment of potential use for intraoperative facial imaging.

BACKGROUND: The aim of this study was to compare accuracy and timing of two handheld, mobile three-dimensional surface imaging (3DSI) devices against an established non-portable medical imaging system, and to evaluate future intraoperative use for facial surgery. METHODS: Surface-to-Surface root mean square analysis was used to evaluate both a consumer device (Sense 3D) and a professional surface scanner (Artec Eva) against a reference imaging system (Vectra XT). Two assessors repeatedly 3D-imaged the facial region of an imaging phantom and 30 volunteers in two separate sessions. Using both mobile devices, intraoperative 3DSI of 10 rhinoplasty patients was compared with preoperative reference imaging. Intraclass Correlation Coefficient was calculated for repeated measurements. RESULTS: Artec Eva yielded mean deviations below 0.5 mm for the whole face and all subunits excluding the eye region. Sense 3D showed similar deviations for the whole face, but otherwise only in the central and lateral forehead unit and the medial cheek. Variability was low for both the non-portable Vectra XT and Artec Eva, whereas full-face assessment using Sense 3D resulted in high variability. When compared to the preoperative reference images, intraoperative rhinoplasty 3DSI revealed low deviations for Artec Eva and high deviations for Sense 3D. CONCLUSIONS: The 3D surfaces captured by Artec Eva showed a similarly desirable accuracy for facial imaging as Vectra XT reference images. This handheld device presents a suitable option for the objective documentation during rhinoplasty surgery. Sense 3D was unable to accurately capture complex facial surfaces and is therefore limited in its usefulness for intraoperative 3DSI.

Septate uterus according to ESHRE/ESGE, ASRM and CUME definitions: association with infertility and miscarriage, cost and warnings for women and healthcare systems.

OBJECTIVES: To estimate the differences in frequency of diagnosis of septate uterus using three different definitions and determine whether these differences are significant in clinical practice, and to examine the association between diagnosis of septate uterus, using each of the three definitions, and infertility and/or previous miscarriage as well as the cost of allocation to surgery. METHODS: This was a secondary analysis of data from a prospective study of 261 consecutive women of reproductive age attending a private clinic focused on the diagnosis and treatment of congenital uterine malformations. Reanalysis of the datasets was performed according to three different means of defining septate uterus: following the recommendations of the American Society for Reproductive Medicine (ASRM), a 2016 update of those of the American Fertility Society from 1988 (ASRM-2016: internal fundal indentation depth ≥ 1.5 cm, angle of internal indentation < 90° and external indentation depth < 1 cm); following the recommendations of the European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy (ESHRE/ESGE), published in 2013 and reaffirmed in 2016 (ESHRE/ESGE-2016: internal fundal/uterine indentation depth > 50% of uterine-wall thickness and external indentation depth < 50% of uterine-wall thickness, with uterine-wall thickness measured above interostial/intercornual line); and using a definition published last year which was based on the decision made most often by a group of experts (Congenital Uterine Malformation by Experts; CUME) (CUME-2018: internal fundal indentation depth ≥ 1 cm and external fundal indentation depth < 1 cm). We compared the rate of diagnosis of septate uterus using each of these three definitions and, for each, we estimated the association between the diagnosis and infertility and/or previous miscarriage, and anticipated the costs associated with their implementation using a guesstimation method. RESULTS: Although 32.6% (85/261) of the subjects met the criteria for one of the three definitions of septate uterus, only 2.7% (7/261) of them were defined as having septate uterus according to all three definitions. We diagnosed significantly more cases of septate uterus using ESHRE/ESGE-2016 than using ASRM-2016 (31% vs 5%, relative risk (RR) = 6.7, P < 0.0001) or CUME-2018 (31% vs 12%, RR = 2.6, P < 0.0001) criteria. We also observed frequent cases that could not be classified definitively by ASRM-2016 (gray zone: neither normal/arcuate nor septate; 6.5%). There were no significant differences (P > 0.05) in the prevalence of septate uterus in women with vs those without infertility according to ASRM-2016 (5% vs 4%), ESHRE/ESGE-2016 (35% vs 28%) or CUME-2018 (11% vs 12%). Septate uterus was diagnosed significantly more frequently in women with vs those without previous miscarriage according to ASRM-2016 (11% vs 3%; P = 0.04) and CUME-2018 (22 vs 10%; P = 0.04), but not according to ESHRE/ESGE-2016 (42% vs 28%; P = 0.8) criteria. Our calculations showed that global costs to the healthcare system would be highly dependent on the criteria used in the clinical setting to define septate uterus, with the costs associated with the ESHRE/ESGE-2016 definition potentially being an extra US$ 100-200 billion over 5 years in comparison to ASRM-2016 and CUME-2018 definitions. CONCLUSIONS: The prevalence of septate uterus according to ESHRE/ESGE-2016, ASRM-2016 and CUME-2018 definitions differs considerably. An important limitation of the ASRM classification, which needs to be addressed, is the high proportion of unclassifiable cases originally named, by us, the 'gray zone'. The high rate of overdiagnosis of septate uterus according to ESHRE/ESGE-2016 may lead to unnecessary surgery and therefore unnecessary risk in these women and may impose a considerable financial burden on healthcare systems. Efforts to define clinically meaningful and universally applicable criteria for the diagnosis of septate uterus should be encouraged. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Útero septo según las definiciones de ESHRE/ESGE, ASRM y CUME: la relación con la infertilidad y el aborto espontáneo, el costo y advertencias para las mujeres y los sistemas de salud OBJETIVO: Evaluar el rendimiento de la velocidad sistólica máxima de la arteria cerebral media fetal (MCA-PSV, por sus siglas en inglés) ≥1,5 múltiplos de la mediana (MdM) para la predicción de la anemia moderada-severa en fetos sometidos a transfusión y no sometidos. MÉTODOS: Se realizó una búsqueda sistemática para identificar estudios observacionales relevantes reportados en el período 2008-2018 que evaluaron el rendimiento de la MCA-PSV, utilizando un umbral de 1,5MdM para la predicción de la anemia fetal. El diagnóstico de la anemia fetal mediante la toma de muestras de sangre fue el estándar de referencia. Se utilizaron modelos de efectos aleatorios para la elaboración de una curva jerárquica resumen de las características operativas del receptor (hSROC, por sus siglas en inglés). Se realizaron análisis de subgrupos y metarregresión, según el número de transfusiones intrauterinas previas. RESULTADOS: En el metaanálisis se incluyeron doce estudios y 696 fetos. El área bajo la curva (ABC) hSROC para la anemia moderada-severa fue del 83%. La sensibilidad y especificidad agrupadas (IC 95%) fueron del 79% (70-86%) y 73% (62-82%), respectivamente, y los cocientes de verosimilitud positivos y negativos fueron 2,94 (IC 95%: 2,13-4,00) y 0,272 (IC 95%: 0,188-0,371). Cuando solo se consideraron los fetos no sometidos a transfusión, la predicción mejoró, pues se logró un ABC del 87%, una sensibilidad del 86% (IC 95%: 75-93%) y una especificidad del 71% (IC 95%: 49-87%). Se observó una disminución en la sensibilidad de la predicción de la anemia moderada-severa mediante la MCA-PSV ≥1.5MdM (estimación, -5,5% (IC 95%: -10,7 a -0,3%), P=0,039) en función del aumento del número de transfusiones previas. CONCLUSIONES: El uso de la MCA-PSV ≥1.5MdM para la predicción de la anemia moderada-severa en fetos no sometidos a transfusión muestra una precisión moderada (86% de sensibilidad y 71% de especificidad), que disminuye con el aumento del número de transfusiones intrauterinas.

High-Contrast, Low-Cost, 3-D Visualization of Skin Cancer Using Ultra-High-Resolution Millimeter-Wave Imaging.

The goal of this paper is to develop a new skin imaging modality which addresses the current clinical need for a non-invasive imaging tool that images the skin over its depth with high resolutions while offering large histopathological-like contrasts between malignant and normal tissues. We demonstrate that by taking advantage of the intrinsic millimeter-wave dielectric contrasts between normal and malignant skin tissues, ultra-high-resolution millimeter-wave imaging (MMWI) can achieve 3-D, high-contrast images of the skin. In this paper, an imaging system with a record-wide bandwidth of 98 GHz is developed using the synthetic ultra-wideband millimeter-wave imaging approach, a new ultra-high-resolution imaging technique recently developed by the authors. The 21 non-melanoma skin cancer (NMSC) specimens are imaged and compared with histopathology for evaluation. A programmable measurement platform is designed to automatically scan the tissues across a rectangular aperture plane. Furthermore, a novel frequency-domain imaging algorithm is developed to process the recorded signals and generate an image of the cancerous tissue. The high correlations achieved between MMWI images and histological images allow for rapid and accurate delineation of NMSC tissues. The millimeter-wave reflectivity values are also found to be statistically significant higher for cancerous areas with respect to normal areas. Since MMWI does not require tissue processing or staining, it can be performed promptly, enabling diagnosis of tumors at an early stage as well as simplify the tumor removal surgery to a single-layer excision procedure.

Volumetric Assessment of Pediatric Vascular Malformations Using a Rapid, Hand-Held Three-Dimensional Imaging System.

The effect of percutaneous, surgical, and medical therapies for vascular malformations (VMs) is often difficult to quantify volumetrically using cross-sectional imaging. Volumetric measurement is often estimated with serial, expensive MRI examinations which may require sedation or anesthesia. We aim to explore whether a portable 3D scanning device is capable of rapid, accurate volumetric analysis of pediatric VMs. Using an iPad-mounted infrared scanning device, 3D scans of patient faces, arms, and legs were acquired over an 8-month study period. Proprietary software was use to perform subsequent volumetric analysis. Of a total of 30 unilateral VMs involving either the face, arms, or legs, 26 (86.7%) VMs were correctly localized by discerning the larger volume of the affected side compared to the normal contralateral side. For patients with unilateral facial VMs (n = 10), volume discrepancy between normal and affected sides differed compared with normal controls (n = 19). This was true for both absolute (60 cc ± 55 vs 15 cc ± 8, p = 0.03) as well as relative (18.1% ± 13.2 vs 4.0% ± 2.1, p = 0.008) volume discrepancy. Following treatment, two patients experienced change in leg volume discrepancy ranging from - 17.3 to - 0.4%. Using a portable 3D scanning device, we were able to rapidly and noninvasively detect and quantify volume discrepancy resulting from VMs of the face, arms, and legs. Preliminary data suggests this technology can detect volume reduction of VMs in response to therapy.

Low-Cost Stereoscopic Recordings of Neurologic Surgery Operative Microscopy for Anatomic Laboratory Training.

OBJECTIVE: Stereoscopic video recordings of operative microscopy during neuroanatomic dissections are an important component of surgical training and research in well-financed medical schools and teaching hospitals. However, the high cost of the latest operative microscopes with integrated video recording equipment can be a limiting factor in their worldwide use. The aim of the present work is to provide a simple low-cost 3-dimensional (3D) stereoscopic operative microscope recording system that can be used even in economically and resource-limited locations. This is achieved by using readily available smartphones, smartphone accessories, and computer software. METHODS: Stereoscopic recording is accomplished by attaching and aligning matched or similar smartphones to the eyepieces of an operative microscope using readily available smartphone mounting connectors. Video recordings from the smartphones are then transferred to a personal computer and processed with a video-editing software to generate stereoscopic movies that are viewed on a smartphone using virtual-reality glasses. RESULTS: The setup time to mount and align the smartphone cameras typically requires 15-30 minutes. Video image quality and 3D depth presentation is more than sufficient for surgical training and research purposes. The implementation cost ranges from $1,315-$7,066, or much less if smartphones and a computer are already available. CONCLUSIONS: The 3D video system demonstrated herein can be implemented on any type of operative microscope, including older units for which commercial stereo recording systems are not available. The system and method presented herein can be readily and affordably implemented in low-budget environments for clinical training and research.

Three-Dimensional High-Definition Ventriculoscope: Single-Center Case Series.

OBJECTIVE: Three-dimensional (3D), high-definition (HD) endoscopy has been recently introduced in neurosurgery, and its value has been discussed extensively in endonasal skull base surgery. Because there has been no reported clinical series on the use of a recent 3D-HD ventriculoscope, the aim of this study was to describe our initial experience with this novel device. METHODS: Patients consecutively operated on from June 2016 to June 2018 with a 3D-HD ventriculoscope were prospectively collected. The system is a 6-mm, 0-degree optic with a 105-degree field of view, with a central working channel of 2.2-mm diameter and 2 side channels of 1.3-mm diameter. Patients' demographic data, preoperative symptoms, and neurologic status; neuroradiologic data; type of surgery; operative time; intraoperative and postoperative complications, and follow-up data were prospectively recorded and retrospectively reviewed. RESULTS: Twenty-four patients (age range: 3-84 years) underwent 25 procedures including endoscopic third ventriculocisternostomy, biopsy, and cyst fenestration. The technical goal of surgery was obtained in all patients. There were no intraoperative complications, expect for 1 intraoperative epileptic seizure. Postoperative complications included asymptomatic subdural collections in 2 patients, infection, and delayed endoscopic third ventriculocisternostomy closure in 1 patient each. Relative limits of the system are its size and the availability of only a 0-degree optic. Image quality appeared satisfactory in all procedures. The lack of a dedicated introducer was resolved, exploiting a vascular "peel-away" system. CONCLUSIONS: 3D-HD technology seems to provide potential advantages in ventricular surgery. This initial experience is promising but must be confirmed by larger series.