Optimization of forensic identification through 3-dimensional imaging analysis of labial tooth surface using open-source software.

Purpose: The objective of this study was to determine the minimum number of teeth in the anterior dental arch that would yield accurate results for individual identification in forensic contexts. Materials and Methods: The study involved the analysis of 28 sets of 3-dimensional (3D) point cloud data, focused on the labial surface of the anterior teeth. These datasets were superimposed within each group in both genuine and imposter pairs. Group A incorporated data from the right to the left central incisor, group B from the right to the left lateral incisor, and group C from the right to the left canine. A comprehensive analysis was conducted, including the evaluation of root mean square error (RMSE) values and the distances resulting from the superimposition of dental arch segments. All analyses were conducted using CloudCompare version 2.12.4 (Telecom ParisTech and R&D, Kyiv, Ukraine). Results: The distances between genuine pairs in groups A, B, and C displayed an average range of 0.153 to 0.184 mm. In contrast, distances for imposter pairs ranged from 0.338 to 0.522 mm. RMSE values for genuine pairs showed an average range of 0.166 to 0.177, whereas those for imposter pairs ranged from 0.424 to 0.638. A statistically significant difference was observed between the distances of genuine and imposter pairs (P<0.05). Conclusion: The exceptional performance observed for the labial surfaces of anterior teeth underscores their potential as a dependable criterion for accurate 3D dental identification. This was achieved by assessing a minimum of 4 teeth.

Can 3-dimensional cranial ultrasound be used to successfully reconstruct a 2-dimensional image without compromising on image quality in a neonatal population?

BACKGROUND: Cranial ultrasound is frequently performed in neonatal intensive care units and acquiring 2-dimensional (D) images requires significant training. Three-D ultrasound images can be acquired semi-automatically. OBJECTIVE: This proof-of-concept study aimed to demonstrate that 3-D study image quality compares well with 2-D. If this is successful, 3-D images could be acquired in remote areas and read remotely by experts. MATERIALS AND METHODS: This was a prospective study of 20 neonates, who underwent both routine 2-D and 3-D cranial ultrasounds. Images were reconstructed into standard views extracted from the 3-D volume and evaluated by three radiologists blinded to the acquisition method. The radiologists assessed for the presence of anatomical landmarks and overall image quality. RESULTS: More anatomical structures were identified in the 3-D studies (P<0.01). There was a trend that 3-D ultrasound demonstrated better image quality in the coronal plane, and 2-D in the sagittal plane, only reaching statistical significance for two coronal views and two sagittal views. CONCLUSION: Overall, this study has demonstrated that 3-D cranial ultrasound performs similarly to 2-D and could be implemented into neonatal practice.

Learning curve for fusion magnetic resonance imaging targeted prostate biopsy and three-dimensional transrectal ultrasonography segmentation.

OBJECTIVE: To report the learning curve of multiple operators for fusion magnetic resonance imaging (MRI) targeted biopsy and to determine the number of cases needed to achieve proficiency. MATERIALS AND METHODS: All adult males who underwent fusion MRI targeted biopsy between February 2012 and July 2021 for clinically suspected prostate cancer (PCa) in a single centre were included. Fusion transrectal MRI targeted biopsy was performed under local anaesthesia using the Koelis platform. Learning curves for segmentation of transrectal ultrasonography (TRUS) images and the overall MRI targeted biopsy procedure were estimated with locally weighted scatterplot smoothing by computing each operator's timestamps for consecutive procedures. Non-risk-adjusted cumulative sum (CUSUM) methods were used to create learning curves for clinically significant (i.e., International Society of Urological Pathology grade ≥ 2) PCa detection. RESULTS: Overall, 1721 patients underwent MRI targeted biopsy in our centre during the study period. The median (interquartile range) times for TRUS segmentation and for the MRI targeted biopsy procedure were 4.5 (3.5, 6.0) min and 13.2 (10.6, 16.9) min, respectively. Among the 14 operators with experience of more than 50 cases, a plateau was reached after 40 cases for TRUS segmentation time and 50 cases for overall MRI targeted biopsy procedure time. CUSUM analysis showed that the learning curve for clinically significant PCa detection required 25 to 45 procedures to achieve clinical proficiency. Pain scores ranged between 0 and 1 for 84% of patients, and a plateau phase was reached after 20 to 100 cases. CONCLUSIONS: A minimum of 50 cases of MRI targeted biopsy are necessary to achieve clinical and technical proficiency and to reach reproducibility in terms of timing, clinically significant PCa detection, and pain.

Automated artificial intelligence-based three-dimensional comparison of orthodontic treatment outcomes with and without piezocision surgery.

OBJECTIVE(S): This study aims to evaluate the influence of the piezocision surgery in the orthodontic biomechanics, as well as in the magnitude and direction of tooth movement in the mandibular arch using novel artificial intelligence (AI)-automated tools. MATERIALS AND METHODS: Nineteen patients, who had piezocision performed in the lower arch at the beginning of treatment with the goal of accelerating tooth movement, were compared to 19 patients who did not receive piezocision. Cone beam computed tomography (CBCT) and intraoral scans (IOS) were acquired before and after orthodontic treatment. AI-automated dental tools were used to segment and locate landmarks in dental crowns from IOS and root canals from CBCT scans to quantify 3D tooth movement. Differences in mesial-distal, buccolingual, intrusion and extrusion linear movements, as well as tooth long axis angulation and rotation were compared. RESULTS: The treatment time for the control and experimental groups were 13.2 ± 5.06 and 13 ± 5.52 months respectively (P = .176). Overall, anterior and posterior tooth movement presented similar 3D linear and angular changes in the groups. The piezocision group demonstrated greater (P = .01) mesial long axis angulation of lower right first premolar (4.4 ± 6°) compared with control group (0.02 ± 4.9°), while the mesial rotation was significantly smaller (P = .008) in the experimental group (0.5 ± 7.8°) than in the control (8.5 ± 9.8°) considering the same tooth. CONCLUSION: The open source-automated dental tools facilitated the clinicians' assessment of piezocision treatment outcomes. The piezocision surgery prior to the orthodontic treatment did not decrease the treatment time and did not influence in the orthodontic biomechanics, leading to similar tooth movements compared to conventional treatment.

Clinical assessment of various imaging systems for dental plaque scoring after the use of 3 different toothpastes.

Purpose: This study was conducted to compare dental plaque scores obtained through clinical examinations and various imaging techniques, as well as to assess the effectiveness of herbal and conventional toothpastes for plaque removal. Material and Methods: Thirty volunteers were divided into 3 groups. Each group was given a different toothpaste (from 2 herbal toothpastes and a conventional toothpaste) with which to brush their teeth for 21 days. Both initially and after brushing, dental plaque samples were collected, and plaque on the buccal surfaces of anterior teeth was scored using several imaging systems after staining with a disclosing agent. Specifically, digital dental photography, intraoral digital scanning, and FluoreCam imaging were employed to capture intraoral images. The Turesky Modified Quigley-Hein Plaque Index was used for clinical examination and image analysis. Quantitative polymerase chain reaction analyses and correlational assessments between clinical examination and imaging scores were conducted before and after toothpaste use. The Shapiro-Wilk test and Pearson correlations were utilized. Results: The lowest mean value was observed in the clinical examination without staining, while the highest was obtained using the FluoreCam method. No significant change was found in the level of any microorganism assessed following toothpaste use (P<0.05), with the exception of a decrease in S. mutans levels after using conventional toothpaste (P<0.05). Conclusion: Herbal toothpaste demonstrated plaque-removal effectiveness comparable to that of conventional toothpaste. The use of imaging methods for measuring plaque index has been suggested as a means to educate patients about plaque control and promote ongoing oral care.

Validity and reliability of two-dimensional video-based assessment to measure joint angles during running: A systematic review and meta-analysis.

Two-dimensional video analysis systems (2DVAS) are commonly used by clinicians and researchers to determine angles during running. The aim of this systematic review (PROSPERO: CRD42022322798) was to synthesize the literature on the criterion validity and reliability of 2DVAS for measuring angles during running compared to three-dimensional motion analysis systems (3DMAS). We searched for articles on MEDLINE/Pubmed, EMBASE, SciELO, and LILACS up to October/2022. We included studies that evaluated the validity of 2DVAS (when compared to 3DMAS) and/or the reliability of 2DVAS measurements of lower limb and trunk angles during running. Qualitative and quantitative analyses were performed. Seven hundred and five studies were found and 17 were included. Ten studies analysed criterion validity between 2DVAS and 3DMAS and the results ranged from poor to excellent, with most of the parameters assessed presenting poor or moderate validity. Inter-rater reliability of 2DVAS was assessed in nine studies and most of the parameters investigated had good to excellent reliability. Intra-rater reliability (between-day processing) of angular running parameters - investigated in ten studies - was considered excellent for most of the parameters analysed. Inter-session reliability was assessed in three studies and was defined as good or excellent for most of the variables assessed. 2DVAS is a reliable method for measuring joint angles during running. However, the validity of 2DVAS compared to 3DMAS ranges from low to moderate for most running parameters. Therefore, based on the available evidence, caution should be taken when applying 2DVAS, particularly for frontal and transverse plane angles.

Slim the face or not: 3D change of facial soft and hard tissues after third molars extraction: a pilot study.

BACKGROUND: Whether slim the face or not after removed third molars is the concern of some orthodontic treatment candidates. The aim of this article is to explore the volume changes of facial soft and hard tissues after third molars extraction, as well as develop a reproducible clinical protocol to precisely assess facial soft tissue volume change. METHODS: A non-randomized, non-blind, self-controlled pilot study was conducted. 24 adults aged 18-30 had ipsilateral third molars extracted. The body weight change was controlled within 2 kg. Structured light scans were taken under a standardized procedure pre-extraction (T0), three (T1), and six (T2) months post-extraction; CBCTs were taken at T0 and T2. The projection method was proposed to measure the soft tissue volume (STV) and the soft tissue volume change (STVC) by the Geomagic software. The hard tissue volume change (HTVC) was measured in the Dragonfly software. RESULTS: The final sample size is 23, including 5 males (age 26.6 ± 2.5 years) and 18 females (age 27.3 ± 2.5 years). The HTVC was - 2.33 ± 0.46ml on the extraction side. On the extraction side, the STV decreased by 1.396 (95% CI: 0.323-2.470) ml (P < 0.05) at T1, and increased by 1.753 (95% CI: -0.01-3.507) ml (P = 0.05) at T2. T2 and T0 had no difference (P > 0.05). The inter and intra-raters ICC of the projection method was 0.959 and 0.974. There was no correlation between the STVC and HTVC (P > 0.05). CONCLUSIONS: After ipsilateral wisdom teeth extraction, the volume of hard tissue on the extraction side reduces, and the volume of facial soft tissue does not change evidently. However, further research with large sample size is still needed. The STV measurement has excellent repeatability. It can be extended to other interested areas, including forehead, nose, paranasal, upper lip, lower lip and chin, which is meaningful in the field of orthodontics and orthopedics. TRIAL REGISTRATION: ChiCTR, ChiCTR1800018305 (11/09/2018), http://www.chictr.org.cn/showproj.aspx?proj=28868 .

3D-validation of a simple tool to measure tibiofemoral axial rotation in tibial plateau fractures.

OBJECTIVES: Rotated tibial plateau fractures (TPF) frequently involve multiple planes of movement, yet current presurgical assessment methods do not account for tibiofemoral axial rotation. This study introduces and validates a simple tool to measure rotation-the Gerdy-Tibial-Tuberosity-Surgical-Epicondylar-Axis (GTT-SEA) angle. METHODS: Forty-seven preoperative 2D CT from a TPF database at a tertiary trauma center were retrieved, and 3D models reconstructed. Three observers made repeated 2D and 3D measurements of the GTT-SEA angle, spaced 4 weeks apart, for 20 patients. Inter- and intra-observer agreement and 2D-3D correlation were calculated. A reference angle was defined from non-operated patients, to classify 28 patients with MRI into neutral, external rotation, and internal rotation groups. The classification agreement and soft tissue involvement between groups were analyzed. RESULTS: Mean 2D GTT-SEA angle was 17.65 ± 2.36° in non-operated patients, and 13.86 ± 3.90° in operated patients. 3D GTT-SEA angle was 18.92 ± 4.53° in non-operated patients, and 14.76 ± 6.03° in operated patients. 2D-3D correlation was moderate to good (ICC 0.64 ~ 0.83). Two-dimensional (ICC 0.70) and 3D (ICC 0.55) inter-observer agreements were moderate; 2D (ICC 0.82 ~ 0.88) and 3D (ICC 0.76 ~ 0.95) intra-observer agreements were good to excellent. Rotation classification agreement was slight (kappa 0.17) for 2D and good (kappa 0.76) for 3D. More popliteofibular ligament injury was detected in rotated knees (p = 0.016). CONCLUSIONS: The GTT-SEA angle offers simple, accessible, yet reliable measurement of tibiofemoral axial rotation. Though a true reference range remains to be determined, this tool adds valuable information to existing TPF classifications, potentially allowing assessment of soft tissue involvement in TPF. CLINICAL RELEVANCE STATEMENT: The GTT-SEA angle will benefit patients who sustain tibial plateau fractures, by allowing physicians to more accurately measure and plan for the injury in 3D, and raising suspicion for otherwise undetected soft tissue injuries, which can impact operative outcomes. KEY POINTS: • Traumatic fractures of the tibial plateau may contain rotation-induced soft tissue injuries. • A new tool to measure axial rotation between the femur and tibia was found to have moderate to excellent inter- and intra-rater reliability. • The tool may have potential in predicting soft tissue injury and assisting with the decision to receive MRI.

Three-dimensional (3D) area and volume measurements for rhinoplasty.

BACKGROUND: Morphometric changes achieved in rhinoplasty are mostly analyzed on two-dimensional (2D) images. However, most of these alterations are amenable to three-dimensional (3D) analysis. OBJECTIVES: Objective measurements for rhinoplasty are currently done on 2D photographic analyses. We believe that newer techniques will develop. This is a study to help define new parameters. METHODS: Landmarks that are widely used in the literature were used to define the boundaries of these measurements. They comprised certain parts of the nose (tip, dorsum, radix, etc.). Measurements were done on a generic face (GF) 3D model. The model's nose was then morphed using the free, open-source 3D modeling software (Blender) to generate seven different deformed noses and to perform the area and volume measurements. RESULTS: Each nose with a different type of deformity demonstrated significant area and volume differences. For example, comparing area measurements to GF-Pleasant nose, GF-Snub nose showed a significant difference at the tip (43.3% reduction). Volume measurements were found to be mostly parallel to the area measurements; however, some incongruences were noted. CONCLUSIONS: We show that new area and volume measurements can be reliably developed for 3D-scanned images. These measurements can be utilized and will enrich the facial analysis and evaluation of the outcomes of rhinoplasty.

First experience of evaluation of the impact of high-matrix size reconstruction in image quality in arterial CT runoff studies of the lower extremities.

OBJECTIVES: To determine whether image reconstruction with a higher matrix size improves image quality for lower extremity CTA studies. METHODS: Raw data from 50 consecutive lower extremity CTA studies acquired on two MDCT scanners (SOMATOM Flash, Force) in patients evaluated for peripheral arterial disease (PAD) were retrospectively collected and reconstructed with standard (512 × 512) and higher resolution (768 × 768, 1024 × 1024) matrix sizes. Five blinded readers reviewed representative transverse images in randomized order (150 total). Readers graded image quality (0 (worst)-100 (best)) for vascular wall definition, image noise, and confidence in stenosis grading. Ten patients' stenosis scores on CTA images were compared to invasive angiography. Scores were compared using mixed effects linear regression. RESULTS: Reconstructions with 1024 × 1024 matrix were ranked significantly better for wall definition (mean score 72, 95% CI = 61-84), noise (74, CI = 59-88), and confidence (70, CI = 59-80) compared to 512 × 512 (wall = 65, CI = 53 × 77; noise = 67, CI = 52 × 81; confidence = 62, CI = 52 × 73; p = 0.003, p = 0.01, and p = 0.004, respectively). Compared to 512 × 512, the 768 × 768 and 1024 × 1024 matrix improved image quality in the tibial arteries (wall = 51 vs 57 and 59, p < 0.05; noise = 65 vs 69 and 68, p = 0.06; confidence = 48 vs 57 and 55, p < 0.05) to a greater degree than the femoral-popliteal arteries (wall = 78 vs 78 and 85; noise = 81 vs 81 and 84; confidence = 76 vs 77 and 81, all p > 0.05), though for the 10 patients with angiography accuracy of stenosis grading was not significantly different. Inter-reader agreement was moderate (rho = 0.5). CONCLUSION: Higher matrix reconstructions of 768 × 768 and 1024 × 1024 improved image quality and may enable more confident assessment of PAD. CLINICAL RELEVANCE STATEMENT: Higher matrix reconstructions of the vessels in the lower extremities can improve perceived image quality and reader confidence in making diagnostic decisions based on CTA imaging. KEY POINTS: • Higher than standard matrix sizes improve perceived image quality of the arteries in the lower extremities. • Image noise is not perceived as increased even at a matrix size of 1024 × 1024 pixels. • Gains from higher matrix reconstructions are higher in smaller, more distal tibial and peroneal vessels than in femoropopliteal vessels.

Comparison of prone and upright, stereotactic, and tomosynthesis-guided biopsies with secondary analysis of ultrasound-occult architectural distortions.

OBJECTIVES: Compare prone and upright, stereotactic, and tomosynthesis-guided vacuum-assisted breast biopsies (prone DM-VABB, prone DBT-VABB, upright DM-VABB, and upright DBT-VABB) in a community-practice setting and review outcomes of ultrasound-occult architectural distortions (AD). METHODS: Consecutive biopsies performed at two community-based breast centers from 2016 to 2019 were retrospectively reviewed. Technical details of each procedure and patient outcomes were recorded. Separate analyses were performed for ultrasound-occult ADs. Two sample t-tests and Fisher's exact test facilitated comparisons. RESULTS: A total of 1133 patients underwent 369 prone DM-VABB, 324 prone DBT-VABB, 437 upright DM-VABB, and 123 upright DBT-VABB with 99.2%, 100%, 99.3%, and 99.2% success, respectively (p-values > 0.25). Mean lesion targeting times were greater for prone biopsy (minutes: 6.94 prone DM-VABB, 8.54 prone DBT-VABB, 5.52 upright DM-VABB, and 5.51 upright DBT-VABB; p-values < 0.001), yielding longer total prone procedure times for prone biopsy (p < 0.001). Compared to DM-VABB, DBT-VABB used fewer exposures (p < 0.001) and more commonly targeted AD, asymmetries, or masses (p < 0.001). Malignancy rates were similar between procedures: prone DM-VABB 22.4%, prone DBT-VABB 21.9%, upright DM-VABB 22.8%, and upright DBT-VABB 17.2% (p-values > 0.19). One hundred forty of the 1133 patients underwent 145 biopsies for ultrasound-occult AD (143 DBT-VABB and 2 DM-VABB). Biopsy yielded 27 malignancies and 47 high-risk lesions (74 of 145, 51%). Malignancy rate was 20.7% after surgical upgrade of one benign-discordant and two high-risk lesions. CONCLUSIONS: All biopsy procedure types were extremely successful. The 20.7% malignancy rate for ultrasound-occult AD confirms a management recommendation for tissue diagnosis. Upright biopsy was faster than prone biopsy, and DBT-VABB used fewer exposures than DM-VABB. CLINICAL RELEVANCE: Our results highlight important differences between prone DM-VABB, prone DBT-VABB, upright DM-VABB, and upright DBT-VABB. Moreover, the high likelihood of malignancy for ultrasound-occult AD will provide confidence in recommending tissue diagnosis in lieu of observation or clinical follow-up. KEY POINTS: • Upright and prone stereotactic and tomosynthesis-guided breast biopsies were safe and effective in the community-practice setting. • The malignancy rate for ultrasound-occult architectural distortion of 20.7% confirms the management recommendation for biopsy. • Upright procedures were faster than prone procedures, and tomosynthesis-guided biopsy used fewer exposures than stereotactic biopsy.

A learning curve in 3D virtual surgical planned orthognathic surgery.

OBJECTIVES: To assess the surgical accuracy of 3D virtual surgical planned orthognathic surgery and the influence of posterior impaction and magnitude of the planned movements on a possible learning curve. MATERIALS AND METHODS: This prospective cohort study included subjects who underwent bimaxillary surgery between 2016 and 2020 at the Department of Oral and Maxillofacial Surgery of the Radboud University Medical Center, Nijmegen. 3D virtual surgical planning (VSP) was performed with CBCT data and digitalized dentition data. By using voxel-based matching with pre- and postoperative CBCT data the maxillary movements were quantified in six degrees of freedom. The primary outcome variable, surgical accuracy, was defined as the difference between the planned and achieved maxillary movement. RESULTS: Based on 124 subjects, the surgical accuracy increased annually from 2016 to 2020 in terms of vertical translations (0.82 ± 0.28 mm; p = 0.038) and yaw rotations (0.68 ± 0.22°; p = 0.028). An increase in surgical accuracy was observed when combining all six degrees of freedom (p = 0.021) and specifically between 2016 and 2020 (p = 0.004). An unfavorable learning curve was seen with posterior impaction and with a greater magnitude of movements. CONCLUSION: The present study demonstrated a significant increase in surgical accuracy annually and therefore supports the presence of a learning curve. CLINICAL RELEVANCE: Cases with planned maxillary posterior impaction and/or a great magnitude of jaw movements should be transferred from the 3D VSP with extra care to obtain a satisfactory surgical accuracy.

A novel method of objectively detecting tooth ankylosis using cone-beam computed tomography: A laboratory study.

Purpose: The aim of this study was to objectively detect simulated tooth ankylosis using a novel method involving cone-beam computed tomography (CBCT). Materials and Methods: Tooth ankylosis was simulated in single-rooted human permanent teeth, and CBCT scans were acquired at different current levels (5, 6.3, and 8 mA) and voxel sizes (0.08, 0.125, and 0.2). In axial reconstructions, a line of interest was perpendicularly placed over the periodontal ligament space of 21 ankylosed and 21 non-ankylosed regions, and the CBCT grey values of all voxels along the line of interest were plotted against their corresponding X-coordinates through a line graph to generate a profile. The image contrast was increased by 30% and 60% and the profile assessment was repeated. The internal area of the resulting parabolas was obtained from all images and compared between ankylosed and non-ankylosed regions under different contrast enhancement conditions, voxel sizes, and mA levels using multi-way analysis of variance with the Tukey post hoc test (α=0.05). Results: The internal area of the parabolas of all non-ankylosed regions was significantly higher than that of the ankylosed regions (P<0.05). Contrast enhancement led to a significantly greater internal area of the parabolas of non-ankylosed regions (P<0.05). Overall, voxel size and mA did not significantly influence the internal area of the parabolas (P>0.05). Conclusion: The proposed novel method revealed a relevant degree of applicability in the detection of simulated tooth ankylosis; increased image contrast led to greater detectability.

Effects of individual shock wave therapy vs celecoxib on hip pain caused by femoral head necrosis.

BACKGROUND: Celecoxib has been used to treat hip discomfort and functional difficulties associated with osteonecrosis of the femoral head (ONFH), although significant adverse reactions often follow long-term use. Extracorporeal shock wave therapy (ESWT) can delay the progression of ONFH, alleviate the pain and functional limitations it causes, and avoid the adverse effects of celecoxib. AIM: To investigate the effects of individual ESWT, a treatment alternative to the use of celecoxib, in alleviating pain and dysfunction caused by ONFH. METHODS: This was a randomized, controlled, double-blinded, non-inferiority trial. We examined 80 patients for eligibility in this study; 8 patients were excluded based on inclusion and exclusion criteria. A total of 72 subjects with ONFH were randomly assigned to group A (n = 36; celecoxib + alendronate + sham-placebo shock wave) or group B (n = 36; individual focused shock wave [ESWT based on magnetic resonance imaging three-dimensional (MRI-3D) reconstruction] + alendronate). The outcomes were assessed at baseline, at the end of treatment, and at an 8-wk follow-up. The primary outcome measure was treatment efficiency after 2 wk of intervention using the Harris hip score (HHS) (improvement of 10 points or more from the baseline was deemed sufficient). Secondary outcome measures were post-treatment HHS, visual analog scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. RESULTS: After treatment, the pain treatment efficiency of group B was greater than that of group A (69% vs 51%; 95%CI: 4.56% to 40.56%), with non-inferiority thresholds of -4.56% and -10%, respectively. Furthermore, the HHS, WOMAC, and VAS scores in group B dramatically improved during the follow-up period as compared to those in group A (P < 0.001). After therapy, the VAS and WOMAC in group A were significantly improved from the 2nd to 8th wk (P < 0.001), although HHS was only significantly altered at the 2 wk point (P < 0.001). On the 1st d and 2nd wk after treatment, HHS and VAS scores were different between groups, with the difference in HHS lasting until week 4. Neither group had severe complications such as skin ulcer infection or lower limb motor-sensory disturbance. CONCLUSION: Individual shock wave therapy (ESWT) based on MRI-3D reconstruction was not inferior to celecoxib in managing hip pain and restrictions associated with ONFH.

Influence of age and diet consistency on the oral muscle pressure of orthodontically treated and untreated subjects with normal occlusion and comparison of their 3D facial shape.

OBJECTIVES: (1) To investigate the effect of age and diet consistency on maximum lips, tongue and cheek pressure of orthodontically treated and untreated subjects with normal, Class I dental occlusion, (2) to find out whether there is a muscle imbalance between anterior tongue and lip pressure in the same subjects at different ages and (3) to compare the 3D facial shape of treated and untreated individuals. MATERIAL AND METHODS: Subjects with normal occlusion were prospectively grouped into orthodontically treated/untreated and in children/adolescents/adults. Iowa Oral Performance Instrument was used to record the maximum muscle pressure. Two-way ANOVA and Tukey post hoc test analysed age-specific differences in muscle pressure. Two-way ANCOVA analysed the effect of diet consistency on muscle pressure. Lips and tongue imbalance was analysed using z-scores and 3D faces using a generalized Procrustes analysis. RESULTS: One hundred thirty-five orthodontically untreated and 114 treated participants were included. Muscle pressure was found to increase with age in both groups, except for the tongue in treated subjects. No differences in the balance between lips and tongue muscle pressure were found, but a higher cheek pressure in untreated adults (p<0.05) was observed. 3D facial shapes showed subtle differences. Untreated subjects with soft diet consistency showed lower lip pressure (p<0.05). CONCLUSION: Oral muscle pressure of orthodontically treated patients without relapse does not differ from that of untreated patients with Class-I occlusion. CLINICAL RELEVANCE: This study provides normative lip, tongue and cheek muscle pressure in subjects with normal occlusion, which can be used for diagnosis, treatment planning and stability.

Exploration of thoracoabdominal aortic mixed reality optimisation and its clinical application value in type A aortic dissection.

OBJECTIVES: This study aimed to explore the feasibility of low-dose computed tomography (CT)-based mixed reality and its clinical role in type A aortic dissection (TAAD) operations. METHODS: Eighty-seven patients diagnosed with TAAD were prospectively enrolled and underwent thoracoabdominal aorta mixed reality. They were randomly divided into a low-dose mixed reality group, a conventional mixed reality group and a conventional thoracoabdominal aorta computed tomography angiography (CTA) group. Three-dimensional modelling, mixed reality and CT reconstruction technology were selected. The radiation dose and image quality were compared using Student's t test. Doctors with different seniorities evaluated the clinical application value of thoracoabdominal aorta mixed reality using a Likert scale. The consistency was assessed using the Cohen kappa coefficient (k). The Pearson chi-square test was used to test the correlation of perioperative index results in TAAD operations. RESULTS: Low-dose CT technology can be effectively applied to thoracoabdominal aorta mixed reality and reduces the radiation dose by approximately 59% and the operation time and auxiliary cardiopulmonary bypass time by approximately 22% and 29%, respectively. The subjective scores of doctors with different seniorities on the clinical application value of thoracoabdominal aorta mixed reality were higher than those of thoracoabdominal aorta CTA (all p > 0.05). CONCLUSIONS: Low-dose CT can be effectively used in thoracoabdominal aortic mixed reality to reduce the radiation dose while ensuring quality. Low-dose thoracoabdominal aortic mixed reality has clinical application value and can effectively reduce the operation time and auxiliary cardiopulmonary bypass time in TAAD operations. KEY POINTS: • Low-dose CT technology can ensure the mixed reality quality of the thoracoabdominal aorta with a radiation dose reduction of approximately 59%. • Compared with thoracoabdominal aorta CTA, low-dose thoracoabdominal aorta mixed reality can reduce the operation time and auxiliary cardiopulmonary bypass time by approximately 20% and 29%, respectively, in TAAD operations. • The application value of low-dose thoracoabdominal aorta mixed reality in operation scheme formulation, operation risk assessment, operation navigation and diagnosis and treatment under safe distance was greater than that of thoracoabdominal aorta CTA in TAAD.

[Radiographic diagnosis of distal fibula avulsion fractures: Comparison of ankle X-ray and three-dimensional reconstruction of CT].

OBJECTIVE: To investigate the difference in sensitivity between X-ray and three-dimensional reconstruction of computed tomography (3D-CT) for the diagnosis of distal fibular avulsion fracture, and the radiographic presentation of the ossicle. METHODS: From January to October 2018, 92 patients with distal fibular avulsion fracture were visited for surgical treatment in Department of Sports Medicine, Peking University Third Hospital, and 60 cases were finally enrolled according to the inclusion and exclusion criteria. Intraoperative detection was regarded as the gold standard, and the diagnostic sensitivity of preoperative ankle X-ray and 3D-CT for the distal fibular avulsion fractures was statistically determined. The ossicle maximum diameter as well as the degree of its displacement were also measured. On 3D-CT, the distance from the ossicle center point to the anterior fibular tuberosity (a), the distance to the fibular tip (b), and the a/b value was used to present the ossicle displacement. RESULTS: Among the 60 patients, 36 and the 52 patients were correctly detected by X-ray and 3D-CT, respectively, and the sensitivities was 60.0% and 86.7%, respectively (P=0.004). The mean diameter of the ossicle on X-ray and 3D-CT was (9.2±3.9) mm and (10.5±3.2) mm, respectively. The mean distance from the ossicle center to the anterior fibular tuberosity (a) was (17.5±3.6) mm and the mean distance to the fibular tip (b) was (17.4±4.8) mm, with mean a/b values of 1.1±0.7. The intraclass correlation coefficients (ICC) for each measurement ranged from 0.891-0.998 with a high degree of consistency. CONCLUSION: Compared with X-ray, 3D-CT has higher sensitivity in diagnosing distal fibular avulsion fractures, can help clinicians evaluate ossicle's location and choose surgical methods, and is recommended to be performed in patients with suspected distal fibula avulsion fractures in clinical practice.

[Automatic determination of mandibular landmarks based on three-dimensional mandibular average model].

OBJECTIVE: To explore an efficient and automatic method for determining the anatomical landmarks of three-dimensional(3D) mandibular data, and to preliminarily evaluate the performance of the method. METHODS: The CT data of 40 patients with normal craniofacial morphology were collected (among them, 30 cases were used to establish the 3D mandibular average model, and 10 cases were used as test datasets to validate the performance of this method in determining the mandibular landmarks), and the 3D mandibular data were reconstructed in Mimics software. Among the 40 cases of mandibular data after the 3D reconstruction, 30 cases that were more similar to the mean value of Chinese mandibular features were selected, and the size of the mandibular data of 30 cases was normalized based on the Procrustes analysis algorithm in MATLAB software. Then, in the Geomagic Wrap software, the 3D mandibular average shape model of the above 30 mandibular data was constructed. Through symmetry processing, curvature sampling, index marking and other processing procedures, a 3D mandible structured template with 18 996 semi-landmarks and 19 indexed mandibular anatomical landmarks were constructed. The open source non-rigid registration algorithm program Meshmonk was used to match the 3D mandible template constructed above with the tested patient's 3D mandible data through non-rigid deformation, and 19 anatomical landmark positions of the patient's 3D mandible data were obtained. The accuracy of the research method was evaluated by comparing the distance error of the landmarks manually marked by stomatological experts with the landmarks marked by the method of this research. RESULTS: The method of this study was applied to the data of 10 patients with normal mandibular morphology. The average distance error of 19 landmarks was 1.42 mm, of which the minimum errors were the apex of the coracoid process [right: (1.01±0.44) mm; left: (0.56±0.14) mm] and maximum errors were the anterior edge of the lowest point of anterior ramus [right: (2.52±0.95) mm; left: (2.57±1.10) mm], the average distance error of the midline landmarks was (1.15±0.60) mm, and the average distance error of the bilateral landmarks was (1.51±0.67) mm. CONCLUSION: The automatic determination method of 3D mandibular anatomical landmarks based on 3D mandibular average shape model and non-rigid registration algorithm established in this study can effectively improve the efficiency of automatic labeling of 3D mandibular data features. The automatic determination of anatomical landmarks can basically meet the needs of oral clinical applications, and the labeling effect of deformed mandible data needs to be further tested.

[Application of navigation in the fractured spine]. / Einsatz von Navigation in der Traumatologie an der Wirbelsäule.

OBJECTIVE: Computer navigation is used in patients with spine fractures to optimize the accuracy of pedicle screws and thereby reduce intra- and postoperative complications, such as injuries to vessels, nerves and accompanying structures. In addition, the ideal screw length and diameter for each pedicle can be detected to ensure optimal stability. INDICATIONS: Intraoperative navigation is suitable for the treatment of spine fractures, which require dorsal stabilization or fusion. It is primarily used for dorsal procedures ranging from the cervical to lumbar/sacral spine. CONTRAINDICATIONS: Computer navigation relies on rigid fixation of the dynamic reference base (DRB) at the spinous process. Failure of DRB fixation is the major contraindication for navigation in the spine. SURGICAL TECHNIQUE: After acquisition of an intraoperative three-dimensional (3D) scan, a digital relation between the anatomy and the 3D scan is established with the navigation system and its infrared camera. Pedicle screws are planned percutaneously with a calibrated pointer. In the next step K­wires (or screws) are implanted after the pedicles are drilled with a calibrated drill guide. After implantation, an additional 3D scan is performed to verify accurate K­wire placement. POSTOPERATIVE MANAGEMENT: Postoperative management does not differ compared to nonnavigated procedures. RESULTS: Intraoperative navigation in combination with modern imaging systems leads to very high accuracy for pedicle screws. Immediate intraoperative control of K­wires as well as screws and fracture reduction can avoid revision surgery. Image guidance can reduce radiation exposure for the surgical team.

Open reduction and internal fixation assisted by computer virtual surgery in the treatment of complex proximal humeral fracture / 中华创伤杂志

Objective:To investigate the effect of open reduction and internal fixation assisted by computer virtual surgery in the treatment of complex proximal humeral fracture.Methods:A retrospective case series study was performed on clinical data of 36 patients with complex proximal humeral fracture admitted to Dongfang Hospital Affiliated to Tongji University from January 2018 to June 2020. There were 13 males and 23 females, aged 22-86 years [(56.4±4.8)years]. They were all closed fractures. According to Neer classification, there were 20 patients with three-part fractures and 16 with four-part fractures. Precise pre-surgical designs made by using the digital orthopedic surgery planning system of the E-3D were applied to assist the implementation of precise fracture reduction and internal fixation with the locking plate. The fracture healing was observed. The effect of the real surgery assisted by the virtual surgical designs was assessed by comparing the humeral neck shaft angle and humeral head height measured at the virtual surgery and at day 1 after the real surgery. The humeral neck shaft angle, humeral head height, shoulder range of motion (abduction, external rotation and forward flexion), Constant shoulder function score and visual analogue score (VAS) were recorded at 1 day, 3 months and 12 months after the real surgery. The stability of the medial column was assessed at 1 day after the real surgery. The complications were recorded.Results:All patients were followed up for 12-38 months [(18.5±1.8)months]. The fracture showed bony union in all patients with the union time of 6.6-17.2 weeks [(10.2±1.0)weeks]. The humeral neck shaft angle and humeral head height showed no significant differences measured at the virtual surgery and at 1 day after the real surgery, and were also not significant different at 1 day, 3 months and 12 months after the real surgery (all P>0.05). At 3 months and 12 months after the real surgery, the shoulder abduction [(119.4±11.8)°, (155.3±13.7)°], external rotation [(37.6±6.3)°, (46.8±7.4)°], forward flexion [ (94.8±10.2)°, (126.9±1.6)°] and Constant function score [(66.8±8.4)points, (82.4±9.6)points] were all higher than those at 1 day after the real surgery [(53.8±4.5)°, (21.6±3.3)°, (44.6±7.8)°, (34.3±6.1)points], while the VAS [(4.1±0.5)points, (1.2±0.2)points] was lower than that at 1 day after the real surgery [(8.3±1.4)points] (all P<0.05). The medial column was stable in 34 patients and unstable in 2 at 1 day after the real surgery. Complications included screw cutting out in the articular surface in 1 patient and humeral head necrosis in 1. Conclusion:Treatment of complex proximal humeral fractures with open reduction and internal fixation assisted by computer virtual surgery is conducive to maintaining reduction effect, promoting shoulder joint function, relieving pain and reducing complications.