Potential of Three-Dimensional Portable Document Format for Article Publication in Craniofacial Surgery.

The portable document format (PDF) is a globally recognized standard file format of Word documents. The PDF supports the embedding of three-dimensional objects. This three-dimensional PDF can contribute to new ways of presenting and disseminating medical information in future medical journals.

Measurement of lymphatic vessel depth using photoacoustic imaging.

OBJECTIVES: Information regarding the depth of lymphatic vessel is important for lymphatic surgeons because rapid identification of functional lymphatic vessels and veins is necessary to perform good lymphaticovenular anastomosis, which is a surgical procedure for lymphedema cases. Photoacoustic lymphangiography (PAL) may be useful for such identification because it allows the assessment of the depth of lymphatic vessels. Thus, we aimed to measure the lymphatic vessel depth using images obtained by PAL. METHODS: This study included healthy individuals and patients with lymphedema. In all participants, indocyanine green dissolved in dextrose was injected subcutaneously into the first and fourth webs of the foot and the lateral malleolus, and PAL was performed on the medial side of the lower leg. The lymphatic vessel depth was measured from the ankle joint, 10 cm above the medial malleolus, and 20 cm above the medial malleolus on PAL in the cross-sectional view and was compared between the participant groups. RESULTS: The healthy group (mean age, 43.3 ± 12.9 years) included 21 limbs of 4 male and 16 female healthy individuals (bilateral limbs of 1 patient were considered). The lymphedema group (mean age, 62.0 ± 11.7 years) included 17 limbs of 3 male and 14 female patients with lymphedema. The average lymphatic vessel depths from the ankle joint, 10 cm above the medial malleolus, and 20 cm above the medial malleolus were 2.6, 4.7, and 5.6 mm in the healthy group and 3.6, 7.3, and 7.4 mm in the lymphedema group, respectively. Lymphatic vessels were significantly deeper in the lymphedema group than in the healthy group at all measurement locations. CONCLUSIONS: Using PAL, we determined the lymphatic vessel depth in living bodies. By searching for the lymphatic vessels based on our findings, even surgeons who are relatively inexperienced with lymphatic surgery may be able to identify functional lymphatic vessels more efficiently.

A technique for decreasing reflection during cadaveric photography.

To create anatomical educational materials that can be viewed in three dimensions using stereo photographs and photogrammetry, multiple photographs must be taken from different directions. In this process, shadows and reflections from different positions in each photograph are undesirable for creating three-dimensional (3D) anatomy educational materials. Although a ring flash eliminates shadows, allowing light to enter from all directions, reflections cannot be eliminated. In particular, Thiel-embalmed cadavers, which are widely used in clinical anatomy, are highly wet and exhibit strong specular highlights. In this study, a straight polarization filter was attached to a handheld camera lens and ring flash, and shooting was performed using cross-polarization photography. Consequently, even in Thiel-embalmed cadavers, the details lost due to the effects of reflections and shadows can be recovered, and good results can be obtained when taking stereo photos or creating a 3D model using photogrammetry.

Imaging of the venous plexus of Rektorzik using CT-digital subtraction venography: a retrospective study.

PURPOSE: The venous plexus of Rektorzik (VPR), first described by Rektorzik in 1858, is a venous plexus around the internal carotid artery in the carotid canal. However, the VPR has never been investigated using the recently developed imaging modalities. In this study, we analyzed the VPR using computed tomography-digital subtraction venography (CT-DSV). METHODS: This study included 253 patients who had undergone head CT-DSV. The presence or absence of the right and left VPRs and their connecting veins were visually examined by two researchers. RESULTS: The VPR was observed in 60 patients (24%), 39 of which showed VPR only on the right side, 10 only on the left side, and 11 on both sides. VPR was significantly more common on the right side (p = 0.0002) and was observed more frequently around the horizontal segment of the internal carotid artery than around the vertical segment. The most common veins identified as distal and proximal VPR connections were the cavernous sinus (63/71, 89%) and the anterior condylar confluence (27/71, 38%), respectively. The mean age was significantly lower in patients with the VPR than in those without (53 vs. 57 years, p = 0.02). CONCLUSION: The VPR was significantly more frequent on the right side and in younger patients but was not a radiographically constant structure. In most cases, the VPR connected the cavernous sinus and anterior condylar confluence. Preoperative evaluation of VPR may lead to refined surgical procedures.

Development of an educational three-dimensional anatomical structure replication tool and its application to medial open-wedge high tibial osteotomy.

BACKGROUND: With the standardization of surgical techniques and continuous development of plate fixators, medial open-wedge high tibial osteotomy (OWHTO) has become an option for the treatment of medial knee osteoarthritis. However, it is also associated with several complications. To reduce the risk of these complications, it is essential for surgeons to accurately understand the three-dimensional (3D) anatomical structures, including the surroundings of the surgical field. Gross dissection using a cadaver provides a large surgical field and is the best learning method for studying anatomical structures in three dimensions; however, it is not available at all medical institutions. METHODS: One female cadaveric knee, fixed using the Thiel method, was used in this study, and OWHTO was performed. A series of photographs was taken from approximately 60 different angles at each stage of the autopsy for digital photogrammetry to ensure that there was at least a 60% overlap between photographs. RESULTS: Each 3D object was created to be faithful to the original specimen and displayed on an augmented reality headset. It was created to capture the subtle nuances of irregular shapes and structures, highlighting the unique ability of photogrammetry to capture pathology. This method allows surgeons to visualize the location of neurovascular injuries in the intraoperative field of view. CONCLUSIONS: Using a technique that applies digital photogrammetry to create 3D objects from handheld photographs, this reports for the first time an educational tool that can reproduce the anatomy related to high tibial osteotomy in three dimensions.

A Novel Dissection Method of the Internal Mammary (Thoracic) Artery: Anastomotic Vessel of the DIEP Flap.

Deep inferior epigastric perforator flaps are commonly used for breast reconstruction using autologous tissue. For such free flaps, the internal mammary artery provides stable blood flow as the recipient for anastomosis. We report a novel dissection method of the internal mammary artery. First, the perichondrium and costal cartilage of the sternocostal joint are dissected with electrocautery. Then, the incision on the perichondrium is extended along the cephalic and caudal ends. Next, this C-shaped superficial layer of perichondrium is elevated from the cartilage. The cartilage is incompletely fractured with electrocautery, with the deep layer of perichondrium intact. Then, the cartilage is completely fractured by leverage and removed. The remaining deep layer of perichondrium is incised at the costochondral junction and shifted aside, revealing the internal mammary artery. The preserved perichondrium creates a rabbet joint to protect the anastomosed artery. This method not only enables a more reliable, safer dissection of the internal mammary artery, but also allows reusage of the perichondrium as underlayment in the setting of anastomosis, and coverage for the incised rib edge, protecting the anastomosed vessels.

Multi-Camera Multi-Person Tracking and Re-Identification in an Operating Room.

Multi-camera multi-person (MCMP) tracking and re-identification (ReID) are essential tasks in safety, pedestrian analysis, and so on; however, most research focuses on outdoor scenarios because they are much more complicated to deal with occlusions and misidentification in a crowded room with obstacles. Moreover, it is challenging to complete the two tasks in one framework. We present a trajectory-based method, integrating tracking and ReID tasks. First, the poses of all surgical members captured by each camera are detected frame-by-frame; then, the detected poses are exploited to track the trajectories of all members for each camera; finally, these trajectories of different cameras are clustered to re-identify the members in the operating room across all cameras. Compared to other MCMP tracking and ReID methods, the proposed one mainly exploits trajectories, taking texture features that are less distinguishable in the operating room scenario as auxiliary cues. We also integrate temporal information during ReID, which is more reliable than the state-of-the-art framework where ReID is conducted frame-by-frame. In addition, our framework requires no training before deployment in new scenarios. We also created an annotated MCMP dataset with actual operating room videos. Our experiments prove the effectiveness of the proposed trajectory-based ReID algorithm. The proposed framework achieves 85.44% accuracy in the ReID task, outperforming the state-of-the-art framework in our operating room dataset.

Three-dimensional analysis of dermal backflow in cancer-related lymphedema using photoacoustic lymphangiography.

BACKGROUND: Dermal backflow (DBF), which refers to lymphatic reflux due to lymphatic valve insufficiency, is a diagnostic finding in lymphedema. However, the three-dimensional structure of DBF remains unknown. Photoacoustic lymphangiography (PAL) is a new technique that enables the visualization of the distribution of light-absorbing molecules, such as hemoglobin or indocyanine green (ICG), and can provide three-dimensional images of superficial lymphatic vessels and the venous system. This study reports the use of PAL to visualize DBF structures in the extremities of patients with lymphedema after cancer surgery. METHODS: Patients with a clinical or lymphographic diagnosis of lymphedema who previously underwent surgery for cancer at one of two participating hospitals were included in this study. PAL was performed using the PAI-05 system. ICG was administered subcutaneously in the affected hand or foot, and ICG fluorescence lymphography was performed using a nearinfrared camera system prior to PAL. RESULTS: Between April 2018 and January 2019, 21 patients were enrolled and examined using PAL. The DBF was composed of dense, interconnecting, three-dimensional lymphatic vessels. It was classified into three patterns according to the composition of the lymphatic vessels: a linear structure of lymphatic collectors (pattern 1), a network of lymphatic capillaries and lymphatic collectors in an underlying layer (pattern 2), and lymphatic capillaries and precollectors with no lymphatic collectors (pattern 3). CONCLUSIONS: PAL showed the structure of DBF more precisely than ICG fluorescence lymphography. The use of PAL to visualize DBF assists in understanding the pathophysiology and assessing the severity of cancer-related lymphedema.

Calcineurin/Crz1 destabilizes Msn2 and Msn4 in the nucleus in response to Ca(2+) in Saccharomyces cerevisiae.

Although methylglyoxal is derived from glycolysis, it has adverse effects on cellular function. Hence, the intrinsic role of methylglyoxal in vivo remains to be determined. Glyoxalase 1 is a pivotal enzyme in the metabolism of methylglyoxal in all types of organisms. To learn about the physiological roles of methylglyoxal, we have screened conditions that alter the expression of the gene encoding glyoxalase 1, GLO1, in Saccharomyces cerevisiae. We show that the expression of GLO1 is induced following treatment with Ca2+ and is dependent on the MAPK (mitogen-activated protein kinase) Hog1 protein and the Msn2/Msn4 transcription factors. Intriguingly, the Ca2+-induced expression of GLO1 was enhanced in the presence of FK506, a potent inhibitor of calcineurin. Consequently, the Ca2+-induced expression of GLO1 in a mutant that is defective in calcineurin or Crz1, the sole transcription factor downstream of calcineurin, was much greater than that in the wild-type strain even without FK506. This phenomenon was dependent upon a cis-element, the STRE (stress-response element), in the promoter that is able to mediate the response to Ca2+ signalling together with Hog1 and Msn2/Msn4. The level of Ca2+-induced expression of GLO1 reached a maximum in cells overexpressing MSN2 even when FK506 was not present, whereas in cells overexpressing CRZ1 the level was greatly reduced and increased markedly when FK506 was present. We also found that the levels of Msn2 and Msn4 proteins in Ca2+-treated cells decreased gradually and that FK506 blocked the degradation of Msn2/Msn4. We propose that Crz1 destabilizes Msn2/Msn4 in the nuclei of cells in response to Ca2+ signalling.

Hand Motion-Aware Surgical Tool Localization and Classification from an Egocentric Camera.

Detecting surgical tools is an essential task for the analysis and evaluation of surgical videos. However, in open surgery such as plastic surgery, it is difficult to detect them because there are surgical tools with similar shapes, such as scissors and needle holders. Unlike endoscopic surgery, the tips of the tools are often hidden in the operating field and are not captured clearly due to low camera resolution, whereas the movements of the tools and hands can be captured. As a result that the different uses of each tool require different hand movements, it is possible to use hand movement data to classify the two types of tools. We combined three modules for localization, selection, and classification, for the detection of the two tools. In the localization module, we employed the Faster R-CNN to detect surgical tools and target hands, and in the classification module, we extracted hand movement information by combining ResNet-18 and LSTM to classify two tools. We created a dataset in which seven different types of open surgery were recorded, and we provided the annotation of surgical tool detection. Our experiments show that our approach successfully detected the two different tools and outperformed the two baseline methods.

Surgical Applications of Lymphatic Vessel Visualization Using Photoacoustic Imaging and Augmented Reality.

Lymphaticovenular anastomosis (LVA) is a widely performed surgical procedure for the treatment of lymphedema. For good LVA outcomes, identifying lymphatic vessels and venules is crucial. Photoacoustic lymphangiography (PAL) is a new technology for visualizing lymphatic vessels. It can depict lymphatic vessels at high resolution; therefore, this study focused on how to apply PAL for lymphatic surgery. To visualize lymphatic vessels, indocyanine green was injected as a color agent. PAI-05 was used as the photoacoustic imaging device. Lymphatic vessels and veins were visualized at 797- and 835-nm wavelengths. First, it was confirmed whether the branching of the vasculature as depicted by the PAL was consistent with the actual branching of the vasculature as confirmed intraoperatively. Second, to use PAL images for surgical planning, preoperative photoacoustic images were superimposed onto the patient limb through augmented reality (AR) glasses (MOVERIO Smart Glass BT-30E). Lymphatics and venule markings drawn using AR glasses were consistent with the actual intraoperative images obtained during LVA. To anastomose multiple lymphatic vessels, a site with abundant venous branching was selected as the incision site; and selecting the incision site became easier. The anatomical morphology obtained by PAL matched the surgical field. AR-based marking could be very useful in future LVA.

Photoacoustic lymphangiography before and after lymphaticovenular anastomosis.

BACKGROUND: Lymphaticovenular anastomosis (LVA) is a minimally invasive surgical procedure used to treat lymphedema. Volumetric measurements and quality-of-life assessments are often performed to assess the effectiveness of LVA, but there is no method that provides information regarding postoperative morphological changes in lymphatic vessels and veins after LVA. Photoacoustic lymphangiography (PAL) is an optical imaging technique that visualizes the distribution of light-absorbing molecules, such as hemoglobin or indocyanine green (ICG), and provides three-dimensional images of superficial lymphatic vessels and the venous system simultaneously. In this study, we performed PAL in lymphedema patients before and after LVA and compared the images to evaluate the effect of LVA. METHODS: PAL was performed using the PAI-05 system in three patients (one man, two women) with lymphedema, including one primary case and two secondary cases, before LVA. ICG fluorescence lymphography was performed in all cases before PAL. Follow-up PAL was performed between 5 days and 5 months after LVA. RESULTS: PAL enabled the simultaneous visualization of clear lymphatic vessels that could not be accurately seen with ICG fluorescence lymphography and veins. We were also able to observe and analyze morphological changes such as the width and the number of lymphatic vessels and veins during the follow-up PAL after LVA. CONCLUSIONS: By comparing preoperative and postoperative PAL images, it was possible to analyze the morphological changes in lymphatic vessels and veins that occurred after LVA. Our study suggests that PAL would be useful when assessing the effect of LVA surgery.

Overhead Multiview Camera System for Recording Open Surgery.

Supplemental Digital Content is available in the text.

Modulation of Spc1 stress-activated protein kinase activity by methylglyoxal through inhibition of protein phosphatase in the fission yeast Schizosaccharomyces pombe.

Methylglyoxal, a ubiquitous metabolite derived from glycolysis has diverse physiological functions in yeast cells. Previously, we have reported that extracellularly added methylglyoxal activates Spc1, a stress-activated protein kinase (SAPK), in the fission yeast Schizosaccharomyces pombe [Y. Takatsume, S. Izawa, Y. Inoue, J. Biol. Chem. 281 (2006) 9086-9092]. Phosphorylation of Spc1 by treatment with methylglyoxal in S. pombe cells defective in glyoxalase I, an enzyme crucial for the metabolism of methylglyoxal, continues for a longer period than in wild-type cells. Here we show that methylglyoxal inhibits the activity of the protein phosphatase responsible for the dephosphorylation of Spc1 in vitro. In addition, we found that methylglyoxal inhibits human protein tyrosine phosphatase 1B (PTP1B) also. We propose a model for the regulation of the activity of the Spc1-SAPK signaling pathway by methylglyoxal in S. pombe.

Diagnosis of cell death induced by methylglyoxal, a metabolite derived from glycolysis, in Saccharomyces cerevisiae.

Methylglyoxal (MG) is a ubiquitous metabolite derived from glycolysis; however, this aldehyde kills all types of cell. We analyzed the properties of MG-induced cell death of the budding yeast Saccharomyces cerevisiae. The MCA1 gene encodes a caspase homologue that is involved in H2O2-induced apoptosis in yeast, although the disruption of MCA1 did not repress sensitivity to MG. In addition, the intracellular oxidation level did not increase under conditions in which MG kills the cell. Furthermore, the disruption of genes encoding antioxidant enzymes did not affect the susceptibility to MG. Here, we demonstrate that yeast cells killed by MG do not exhibit the characteristics of apoptosis in a TUNEL assay or an annexin V staining, but show those of necrosis upon propidium iodide staining. We demonstrate that MG at high concentrations provokes necrotic cell death without the generation of reactive oxygen species in S. cerevisiae.

Enrichment of yeast thioredoxin by green tea extract through activation of Yap1 transcription factor in Saccharomyces cerevisiae.

Thioredoxin (TRX) is an important antioxidant present in all types of organisms. Besides its role as an antioxidant, TRX protects the gastric mucosa due to its antiinflammatory effect. In addition, TRX decreases allergenicity; therefore, the oral administration of TRX is of considerable interest with respect to its clinical use as well as the development of functional foods containing TRX. We have attempted to enrich the cellular TRX content in Saccharomyces cerevisiae, and found that green tea extract (Sunphenon), which is rich in catechins (polyphenols), activates the Yap1 transcription factor, leading to the induction of TRX2, a target of Yap1. Production of yeast TRX was monitored by both a TRX2-lacZ reporter expression assay and Western blotting using an anti-yeast TRX antibody. Maximal production of TRX was achieved in a medium containing 0.1% green tea extract at pH 7.6. We discuss the underlying mechanism by which green tea extract activates Yap1.

Distinct regulatory mechanism of yeast GPX2 encoding phospholipid hydroperoxide glutathione peroxidase by oxidative stress and a calcineurin/Crz1-mediated Ca2+ signaling pathway.

The GPX2 gene encodes a homologue of mammalian phospholipid hydroperoxide glutathione peroxidase in Saccharomyces cerevisiae. Previously, we have reported that the oxidative stress-induced expression of GPX2 is strictly regulated by Yap1 and Skn7 transcription factors. Here, we found that the expression of GPX2 is induced by CaCl(2) in a calcineurin (CN)/Crz1-dependent manner, and the CN-dependent response element was specified in the GPX2 promoter. Neither Yap1 nor Skn7 was required for Ca(2+)-dependent induction of GPX2, therefore, distinct regulation for the oxidative stress response and Ca(2+) signal response for GPX2 exists in yeast cells.