Real-Time Monitoring of Thermal Phenomena during Femtosecond Ablation of Bone Tissue for Process Control.

Femtosecond (fs) laser technology is currently being considered in innovative fields such as osteotomy and treatment of hard tissue thanks to the achievable high resolution and ability to prevent tissue damage. In a previous study, suitable process parameters were obtained to achieve competitive ablation rates on pork femur processing. Nevertheless, a better control of thermal accumulation in the tissue during laser ablation could further improve the postoperative regeneration of the treated bone compared with conventional procedures and push forward the exploitation of such technology. This study presents methods for real time analyses of bone tissue temperature and composition during fs laser ablation and highlights the importance of implementing an efficient cooling method of bone tissue in order to achieve optimized results. Results show that it is possible to achieve a larger process window for bone tissue ablation where bone tissue temperature remains within the protein denaturation temperature in water-based processing environment. This is a key outcome towards a clinical exploitation of the presented technology, where higher process throughputs are necessary. The effects of process parameters and environments on bone tissue were confirmed by LIBS technique, which proved to be an efficient method by which to record real-time variation of bone tissue composition during laser irradiation.

Benefits of Femtosecond Laser 40 MHz Burst Mode for Li-Ion Battery Electrode Structuring.

In Li-ion batteries, ion diffusion kinetics represent a limitation to combine high capacity and a fast charging rate. To bypass this, textured electrodes have been demonstrated to increase the active surface, decrease the material tortuosity and accelerate the electrolyte wetting. Amongst the structuring technologies, ultrashort pulse laser processing may represent the key option enabling, at the same time, high precision, negligible material deterioration and high throughput. Here, we report a study on the structuring of electrodes with both holes and grooves reaching the metallic collector. Electrochemical models emphasize the importance of hole and line dimensions for the performances of the cell. We demonstrate that we can control the hole and line width by adjusting the applied fluence and the repetition rate. In addition, results show that it is possible to drill 65 µm-deep and ~15 µm-wide holes in nearly 100 µs resulting in up to 10,000 holes/s. To further reduce the takt time, bursts of 40 MHz pulses were also investigated. We show that bursts can reduce the takt time by a factor that increases with the average power and the burst length. Moreover, at comparable fluence, we show that bursts can shorten the process more than theoretically expected.

Sex life and low back pain: The impact of intradiscal ozone therapy in patients with herniated lumbar disc.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To assess the improvement of sexual impairment after percutaneous intradiscal ozone therapy in patients complaining of low back pain (LBP) due to lumbar disc herniation. METHODS: Between January 2018 and June 2021, 157 consecutive imaging-guided percutaneous intradiscal ozone therapies were performed on 122 patients with LBP and/or sciatic pain due to lumbar disc herniation. Oswestry Disability Index (ODI) was administered before the treatment and at 1-month and 3-month follow-ups and the ODI Section 8 (ODI-8/sex life) values were retrospectively reviewed to evaluate the improvement of sexual impairment and disability. RESULTS: Mean age of patients was 54.63 ± 12.40. Technical success was achieved in all cases (157/157). Clinical success was registered in 61.97% (88/142) of patients at 1-month follow-up and in 82.69% (116/142) at 3-month follow-up. The mean ODI-8/sex life was 3.73 ± 1.29 before the procedure, 1.71 ± 1.37 at 1-month follow up and 0.44 ± 0.63 at 3-month follow-up. Compared to older patients, subjects under 50 years showed a significantly slower recovery of sexual impairment (p = 0.003). The treated levels were L3-L4, L4-L5, and L5-S1 in 4, 116, and 37 patients, respectively. Patients with L3-L4 disc herniation showed less sexual disability at presentation, with a significantly faster improvement of sexual life (p = 0.03). CONCLUSIONS: Percutaneous intradiscal ozone therapy is highly effective in reducing sexual impairment due to lumbar disc herniation, and the improvement is faster in older patients and in the case of L3-L4 disc involvement.

Vasari Scoring System in Discerning between Different Degrees of Glioma and IDH Status Prediction: A Possible Machine Learning Application?

(1) The aim of our study is to evaluate the capacity of the Visually AcceSAble Rembrandt Images (VASARI) scoring system in discerning between the different degrees of glioma and Isocitrate Dehydrogenase (IDH) status predictions, with a possible application in machine learning. (2) A retrospective study was conducted on 126 patients with gliomas (M/F = 75/51; mean age: 55.30), from which we obtained their histological grade and molecular status. Each patient was analyzed with all 25 features of VASARI, blinded by two residents and three neuroradiologists. The interobserver agreement was assessed. A statistical analysis was conducted to evaluate the distribution of the observations using a box plot and a bar plot. We then performed univariate and multivariate logistic regressions and a Wald test. We also calculated the odds ratios and confidence intervals for each variable and the evaluation matrices with receiver operating characteristic (ROC) curves in order to identify cut-off values that are predictive of a diagnosis. Finally, we did the Pearson correlation test to see if the variables grade and IDH were correlated. (3) An excellent ICC estimate was obtained. For the grade and IDH status prediction, there were statistically significant results by evaluation of the degree of post-contrast impregnation (F4) and the percentage of impregnated area (F5), not impregnated area (F6), and necrotic (F7) tissue. These models showed good performances according to the area under the curve (AUC) values (>70%). (4) Specific MRI features can be used to predict the grade and IDH status of gliomas, with important prognostic implications. The standardization and improvement of these data (aim: AUC > 80%) can be used for programming machine learning software.

Radiomics Applications in Head and Neck Tumor Imaging: A Narrative Review.

Recent advances in machine learning and artificial intelligence technology have ensured automated evaluation of medical images. As a result, quantifiable diagnostic and prognostic biomarkers have been created. We discuss radiomics applications for the head and neck region in this paper. Molecular characterization, categorization, prognosis and therapy recommendation are given special consideration. In a narrative manner, we outline the fundamental technological principles, the overall idea and usual workflow of radiomic analysis and what seem to be the present and potential challenges in normal clinical practice. Clinical oncology intends for all of this to ensure informed decision support for personalized and useful cancer treatment. Head and neck cancers present a unique set of diagnostic and therapeutic challenges. These challenges are brought on by the complicated anatomy and heterogeneity of the area under investigation. Radiomics has the potential to address these barriers. Future research must be interdisciplinary and focus on the study of certain oncologic functions and outcomes, with external validation and multi-institutional cooperation in order to achieve this.

Bone Laser Patterning to Decipher Cell Organization.

The laser patterning of implant materials for bone tissue engineering purposes has proven to be a promising technique for controlling cell properties such as adhesion or differentiation, resulting in enhanced osteointegration. However, the possibility of patterning the bone tissue side interface to generate microstructure effects has never been investigated. In the present study, three different laser-generated patterns were machined on the bone surface with the aim of identifying the best surface morphology compatible with osteogenic-related cell recolonization. The laser-patterned bone tissue was characterized by scanning electron microscopy and confocal microscopy in order to obtain a comprehensive picture of the bone surface morphology. The cortical bone patterning impact on cell compatibility and cytoskeleton rearrangement on the patterned surfaces was assessed using Stromal Cells from the Apical Papilla (SCAPs). The results indicated that laser machining had no detrimental effect on consecutively seeded cell metabolism. Orientation assays revealed that patterns with larger hatch distances were correlated with higher cell cytoskeletal conformation to the laser-machined patterns. To the best of our knowledge, this study is the first to consider and evaluate bone as a biological interface that can be engineered for improvement. Further investigations should focus on the in vivo implications of this direct patterning.

Neurological manifestations of COVID-19: a retrospective observational study based on 1060 patients with a narrative review.

BACKGROUND: In the past two decades, three coronavirus epidemics have been reported. Coronavirus disease 2019 (COVID-19) is caused by a severe acute respiratory syndrome (SARS)-like coronavirus (SARS-CoV-2). In most patients, the disease is characterized by interstitial pneumonia, but features can affect other organs. PURPOSE: To document the radiological features of the patients and to perform a narrative review of the literature. MATERIAL AND METHODS: We conducted a retrospective, single-center study on 1060 consecutive hospitalized patients with COVID-19 at our institution. According to the inclusion criteria, we selected patients to be studied in more radiological detail. All images were obtained as per standard of care protocols. We performed a statistic analysis to describe radiological features. We then presented a systematic review of the main and conventional neuroimaging findings in COVID-19. RESULTS: Of 1060 patients hospitalized for COVID-19 disease, 15% (159) met the eligibility criteria. Of these, 16 (10%) did not undergo radiological examinations for various reasons, while 143 (90%) were examined. Of these 143 patients, 48 (33.6%) had positive neuroimaging. We found that the most frequent pathology was acute ischemic stroke (n=16, 33.3%). Much less frequent were Guillain-Barre syndrome (n=9, 18.8%), cerebral venous thrombosis (n=7, 14.6%), encephalitis or myelitis (n=6, 12.5%), intracranial hemorrhage and posterior hemorrhagic encephalopathy syndrome (n=4, 8.3%), exacerbation of multiple sclerosis (n=4, 8.3%), and Miller-Fisher syndrome (n=2, 4.2%). CONCLUSION: Our data are coherent with the published literature. Knowledge of these patterns will make clinicians consider COVID-19 infection when unexplained neurological findings are encountered.

Theatre without theatres: Investigating access barriers to mediatized theatre and digital liveness during the covid-19 pandemic.

In each stage of the Covid-19 pandemic, we have witnessed initiatives that, through digital technologies, have attempted to ensure the presence of theatre and to nurture the relationship with audiences. Our research asks which entry barriers to the artistic field have been strengthened or weakened by implementing theatre initiatives for online audiences and how these initiatives have affected the regional performing arts scene. The study consists of three parts. In the first part, analysis of Italian calls for digital performance projects was carried out to investigate the institutional construction of beneficiaries and imagined audiences. In the second part, we analysed the case of the digital-theatre season MPA - Marche Palcoscenico Aperto. The MPA project provided funding for artists from the Marche region in Italy to realize online performances between February and May 2021. Eleven focus groups were conducted with 41 of the 60 participating companies. In the third phase, four in-depth interviews were conducted with the project's organisers. Findings show how the increased dependence of theatre artists on the artistic system imposed by Covid has simultaneously produced an increase in the collective awareness of the artistic class, but also a stronger distinction between professionalism and amateurism.

The Diagnostic Performance of Multi-Detector Computed Tomography (MDCT) in Depiction of Acute Spondylodiscitis in an Emergency Department.

BACKGROUND: The diagnosis of acute spondylodiscitis can be very difficult because clinical onset symptoms are highly variable. The reference examination is MRI, but very often the first diagnostic investigation performed is CT, given its high availability in the acute setting. CT allows rapid evaluation of other alternative diagnoses (e.g., fractures), but scarce literature is available to evaluate the accuracy of CT, and in particular of multi-detector computed tomography (MDCT), in the diagnosis of suspected spondylodiscitis. The aim of our study was to establish MDCT accuracy and how this diagnostic method could help doctors in the depiction of acute spondylodiscitis in an emergency situation by comparing the diagnostic performance of MDCT with MRI, which is the gold standard. METHODS: We searched our radiological archive for all MRI examinations of patients who had been studied for a suspicion of acute spondylodiscitis in the period between January 2017 and January 2021 (n = 162). We included only patients who had undergone MDCT examination prior to MRI examination (n = 25). The overall diagnostic value of MDCT was estimated, using MRI as the gold standard. In particular, the aim of our study was to clarify the effectiveness of CT in radiological cases that require immediate intervention (stage of complications). Therefore, the radiologist, faced with a negative CT finding, can suggest an elective (not urgent) MRI with relative serenity and without therapeutic delays. RESULTS: MDCT allowed identification of the presence of acute spondylodiscitis in 13 of 25 patients. Specificity and positive predictive value were 100% for MDCT, while sensitivity and negative predictive value were 68% and 50%, respectively, achieving an overall accuracy of 76%. In addition, MDCT allowed the identification of paravertebral abscesses (92%), fairly pathognomonic lesions of spondylodiscitis pathology. CONCLUSIONS: The MDCT allows identification of the presence of acute spondylodiscitis in the Emergency Department (ED) with a satisfactory accuracy. In the case of a positive CT examination, this allows therapy to be started immediately and reduces complications. However, we suggest performing an elective MRI examination in negative cases in which pathological findings are hard to diagnose with CT alone.

Vascularization of Cell-Laden Microfibres by Femtosecond Laser Processing.

To face the increasing demand for organ transplantation, currently the development of tissue engineering appears as the best opportunity to effectively regenerate functional tissues and organs. However, these approaches still face the lack of an efficient method to produce an efficient vascularization system. To answer these issues, the formation of an intra-volume channel within a three-dimensional, scaffold free, mature, and cell-covered collagen microfibre is here investigated through laser-induced cavitation. An intra-volume channel was formed upon irradiation with a near-infrared, femtosecond laser beam, focused with a high numerical aperture lens. The laser beam directly crossed the surface of a dense and living-cell bilayer and was focused behind the bilayer to induce channel formation in the hydrogel core while preserving the cell bilayer. Channel formation was assessed through confocal microscopy. Channel generation inside the hydrogel core was enhanced by the formation of voluminous cavitation bubbles with a lifetime longer than 30 s, which also improved intra-volume channel durability. Twenty-four hours after laser processing, cellular viability dropped due to a lack of sufficient hydration for processing longer than 10 min. However, the processing automation could drastically reduce the cellular mortality, this way enabling the formation of hollowed microfibres with a high density of living-cell outer bilayer.

Spectral Photon-Counting Computed Tomography: A Review on Technical Principles and Clinical Applications.

Photon-counting computed tomography (CT) is a technology that has attracted increasing interest in recent years since, thanks to new-generation detectors, it holds the promise to radically change the clinical use of CT imaging. Photon-counting detectors overcome the major limitations of conventional CT detectors by providing very high spatial resolution without electronic noise, providing a higher contrast-to-noise ratio, and optimizing spectral images. Additionally, photon-counting CT can lead to reduced radiation exposure, reconstruction of higher spatial resolution images, reduction of image artifacts, optimization of the use of contrast agents, and create new opportunities for quantitative imaging. The aim of this review is to briefly explain the technical principles of photon-counting CT and, more extensively, the potential clinical applications of this technology.

Ablation of Bone Tissue by Femtosecond Laser: A Path to High-Resolution Bone Surgery.

Femtosecond lasers allow for high-precision, high-quality ablation of biological tissues thanks to their capability of minimizing the thermal loads into the irradiated material. Nevertheless, reported ablation rates remain still too limited to enable their exploitation on a clinical level. This study demonstrates the possibility to upscale the process of fs laser ablation of bone tissue by employing industrially available fs laser sources. A comprehensive parametric study is presented in order to optimize the bone tissue ablation rate while maintaining the tissue health by avoiding excessive thermal loads. Three different absorption regimes are investigated by employing fs laser sources at 1030 nm, 515 nm and 343 nm. The main differences in the three different wavelength regimes are discussed by comparing the evolution of the ablation rate and the calcination degree of the laser ablated tissue. The maximum of the ablation rate is obtained in the visible regime of absorption where a maximum value of 0.66 mm3/s is obtained on a non-calcined tissue for the lowest laser repetition rate and the lowest spatial overlap between successive laser pulses. In this regime, the hemoglobin present in the fresh bone tissue is the main chromophore involved in the absorption process. To the best of our knowledge, this is the highest ablation rate obtained on porcine femur upon fs laser ablation.

Intra-volume processing of gelatine hydrogel by femtosecond laser-induced cavitation.

Cell oxygenation and nutrition are crucial for the viability of tissue-engineered constructs, and different alternatives are currently being developed to achieve an adequate vascularisation of the engineered tissue. One of the alternatives is the generation of channel-like patterns in a bioconstruct. Here, the formation of full-formed channels inside hydrogels by laser-induced cavitation was investigated. A near-infrared, femtosecond laser beam focused with a high numerical aperture was employed to obtain intra-volume modifications of a block of gelatine hydrogel. Characterisation of the laser-processed gelatine was carried out by optical microscopy and epifluorescence microscopy right after and 24 h after the laser process. Rheology analyses on the unprocessed gelatine blocks were conducted to better understand the cavitation mechanism taking place during the intense laser interaction. Different cavitation patterns were observed at varying dose values by changing the repetition rate and the overlap between successive pulses while keeping the laser fluence and the number of passes fixed. This way, cavitation bubble features and behaviour can be controlled to optimise the formation of intra-volume channels in the gelatine volume. Results showed that the generation of fully formed channels was linked to the formation of large non-spherical cavitation bubbles during the laser interaction at high dose and low repetition rates. In conclusion, the formation of fully formed channels was made possible with a near-infrared, femtosecond laser beam strongly focused inside gelatine hydrogel blocks through laser-induced cavitation at high dose and low repetition rates.

Fused silica ablation by double femtosecond laser pulses: influence of polarization state.

Glass processing is a subject of high interest for many industrial fields such as optics manufacturing, smart electronics or medical devices. With respect to nanosecond technology, the use of femtosecond lasers allows to achieve high processing quality thanks to nonlinear absorption properties. Nevertheless, the throughput of femtosecond processing is still very low when compared to other laser technologies. Temporal and spatial pulse shaping is a smart and flexible solution to further increase the efficiency of femtosecond laser processing by driving efficiently both electron dynamics and absorption involved during laser irradiation. In the present work, the effect of temporal pulse shaping on fused silica ablation is investigated by single-wavelength (1030nm) double femtosecond pulses pump-pump experiment. Two sub-pulses are focused on the top surface of fused silica with two different polarization configurations: (i) orthogonally-crossed linear polarization or (ii) counter-rotating circular polarization. The investigated parameters are the pulse-to-pulse delay, set with a delay line, the total fluence and the polarization configuration. The results are discussed in term of optical transmission, modification and ablation thresholds, and ablated volume. A numerical model describing the electron dynamics and the absorbed energy density is also presented to support interpretation of experimental results. It is demonstrated that pulse-to-pulse delay has a major influence on ablated volume, modification and ablation threshold. Polarization state has also, to a lesser extent, a significant influence on ablated volume. Their cooperative effect on the ablation efficiency is discussed.

Towards Laser-Textured Antibacterial Surfaces.

Escherichia coli and Staphylococcus aureus bacterial retention on mirror-polished and ultrashort pulse laser-textured surfaces is quantified with a new approach based on ISO standards for measurement of antibacterial performance. It is shown that both wettability and surface morphology influence antibacterial behavior, with neither superhydrophobicity nor low surface roughness alone sufficient for reducing initial retention of either tested cell type. Surface structures comprising spikes, laser-induced periodic surface structures (LIPSS) and nano-pillars are produced with 1030 nm wavelength 350 fs laser pulses of energy 19.1 µJ, 1.01 µJ and 1.46 µJ, respectively. SEM analysis, optical profilometry, shear force microscopy and wettability analysis reveal surface structures with peak separations of 20-40 µm, 0.5-0.9 µm and 0.8-1.3 µm, average areal surface roughness of 8.6 µm, 90 nm and 60 nm and static water contact angles of 160°, 119° and 140°, respectively. E. coli retention is highest for mirror-polished specimens and spikes whose characteristic dimensions are much larger than the cell size. S. aureus retention is instead found to be inhibited under the same conditions due to low surface roughness for mirror-polished samples (Sa: 30 nm) and low wettability for spikes. LIPSS and nano-pillars are found to reduce E. coli retention by 99.8% and 99.2%, respectively, and S. aureus retention by 84.7% and 79.9% in terms of viable colony forming units after two hours of immersion in bacterial broth due to both low wettability and fine surface features that limit the number of available attachment points. The ability to tailor both wettability and surface morphology via ultrashort pulsed laser processing confirms this approach as an important tool for producing the next generation of antibacterial surfaces.

Upconversion Nanoparticles Synthesized by Ultrashort Pulsed Laser Ablation in Liquid: Effect of the Stabilizing Environment.

The distinctive feature of upconverting compounds to absorb and emit light in the near-infrared region has made upconverting nanoparticles of great interest in various application fields. Nevertheless, these colloids show a highly hydrophobic behavior, and therefore, the use of a proper stabilizing agent is necessary in most cases. Although few chemical techniques for colloid stabilization are available, it is still difficult to achieve a fully reproducible synthesis method for stable upconverting nanoparticle colloids. In this work, upconversion 18 %Yb:1 %Er:NaYF4 nanoparticles were produced by ultrafast pulsed laser ablation in a water and 2-[2-(2-methoxyethoxy)- ethoxy]acetic acid (MEEAA) environment to assess the stabilization effect of the surfactant on the nanoparticle colloid properties. The effects of the laser fluence and MEEAA concentration on the nanoparticles' properties were investigated by TEM, EDS, and emission spectra analyses. The results show that ultrashort pulsed laser ablation in liquid allows generating highly spherical nanoparticles with conserved stoichiometry and optical properties. Moreover, it is possible to obtain colloids with significantly higher stability and preserved optical properties by one-step PLAL processes directly in the MEEAA environment.