Correcting of Calf Atrophy With a Custom-Made Silicone Implant: Contribution of Three-Dimensional Computer-Aided Design Reconstruction: A Pilot Study.

BACKGROUND: Calf shape is an essential aesthetic parameter of the leg, and calf atrophy can lead to complex problems. The functional consequences of calf atrophy are generally moderate. Prefilled silicone gel implants represent the vast majority of currently placed prostheses, but this technique does not ensure optimal adaptation of the implant shape due to loss of volume. OBJECTIVES: The aim of this study was to describe an innovative procedure for correcting acquired calf atrophy based on 3-dimensional (3D) modeling. METHODS: The study involved 22 patients treated for calf atrophy caused by illness. Implants were made with solid rubber silicone, and 3D reconstructions were created by computer-aided design based on computed tomography scans. The implants were introduced through a horizontal popliteal incision. RESULTS: Forty-one implants were placed. No cases of infection, hematoma, or compartment syndrome were encountered. We experienced 1 case of skin necrosis and 1 case of periprosthetic seroma. In addition, lipofilling was performed in 5 cases. Two patients sought to benefit from a surgical reduction in implant size. CONCLUSIONS: Our innovative procedure to correct calf atrophy with custom solid rubber silicone implants produces a calf shape that better adapts to volume loss than prefilled silicone gel implants. The material maintains its shape and facilitates retrofitting of the prosthesis. There is no risk of hull formation or breakage, and the life span of the implants is limitless. This 3D computer-aided design approach has optimized our reconstructions.

Treatment of complex airway stenoses using patient-specific 3D-engineered stents: a proof-of-concept study.

Anatomically complex airway stenosis (ACAS) represents a challenging situation in which commercially available stents often result in migration or granulation tissue reaction due to poor congruence. This proof-of-concept clinical trial investigated the feasibility and safety of computer-assisted designed (CAD) and manufactured personalised three-dimensional (3D) stents in patients with ACAS from various origins. After CAD of a virtual stent from a CT scan, a mould is manufactured using a 3D computer numerical control machine, from which a medical-grade silicone stent is made. Complication rate, dyspnoea, quality of life and respiratory function were followed after implantation. The congruence of the stent was assessed peroperatively and at 1 week postimplantation (CT scan). The stent could be implanted in all 10 patients. The 3-month complication rate was 40%, including one benign mucus plugging, one stent removal due to intense cough and two stent migrations. 9 of 10 stents showed great congruence within the airways, and 8 of 10 induced significant improvement in dyspnoea, quality of life and respiratory function. These promising outcomes in highly complex situations support further investigation on the subject, including technological improvements.​ TRIAL REGISTRATION NUMBER: NCT02889029.

Hominin fossils from Kromdraai and Drimolen inform Paranthropus robustus craniofacial ontogeny.

Ontogeny provides critical information about the evolutionary history of early hominin adult morphology. We describe fossils from the southern African sites of Kromdraai and Drimolen that provide insights into early craniofacial development in the Pleistocene robust australopith Paranthropus robustus. We show that while most distinctive robust craniofacial features appear relatively late in ontogeny, a few do not. We also find unexpected evidence of independence in the growth of the premaxillary and maxillary regions. Differential growth results in a proportionately larger and more postero-inferiorly rotated cerebral fossa in P. robustus infants than in the developmentally older Australopithecus africanus juvenile from Taung. The accumulated evidence from these fossils suggests that the iconic SK 54 juvenile calvaria is more likely early Homo than Paranthropus. It is also consistent with the hypothesis that P. robustus is more closely related to Homo than to A. africanus.

Dynamic three-dimensional virtual environment to improve learning of anatomical structures.

Increasing number of medical students and limited availability of cadavers have led to a reduction in anatomy teaching through human cadaveric dissection. These changes triggered the emergence of innovative teaching and learning strategies in order to maximize students learning of anatomy. An alternative approach to traditional dissection was presented in an effort to improve content delivery and student satisfaction. The objective of this study is to acquire three-dimensional (3D) anatomical data using structured-light surface scanning to create a dynamic four-dimensional (4D) dissection tool of four regions: neck, male inguinal and femoral areas, female perineum, and brachial plexus. At each dissection step, identified anatomical structures were scanned using a 3D surface scanner (Artec Spider™). Resulting 3D color meshes were overlaid to create a 4D (3D+time) environment. An educational interface was created for neck dissection. Its implementation in the visualization platform allowed 4D virtual dissection by navigating from surface to deep layers and vice versa. A group of 28 second-year medical students and 17 first-year surgery residents completed a satisfaction survey. A majority of medical students (96.4%) and 100% of surgery residents said that they would recommend this tool to their colleagues. According to surgery residents, the main elements of this virtual tool were the realistic high-quality of 3D acquisitions and possibility to focus on each anatomical structure. As for medical students, major elements were the interactivity and entertainment aspect, precision, and accuracy of anatomical structures. This approach proves that innovative solutions to anatomy education can be found to help to maintain critical content and student satisfaction in anatomy curriculum.

Field response of Dendroctonus frontalis (Coleoptera: Scolytinae) to synthetic semiochemicals in Chiapas, Mexico.

Dendroctonus frontalis Zimmermann (Coleoptera: Scolytinae) is the most serious pest of pines (Pinus spp.) in Mexico. Conspecifics are attracted to trees undergoing colonization by the aggregation pheromone frontalin, which is synergized by odors of pine oleoresin released from beetle-damaged host tissue. Synthetic racemic frontalin combined with turpentine has been the operational bait used in traps for monitoring populations of D. frontalis in Mexico as well as the United States. Recently, racemic endo-brevicomin has been reported to be a synergist of the frontalin/turpentine bait and as an important component of the aggregation pheromone for D. frontalis populations in the United States. To determine whether racemic endo-brevicomin also might function as an aggregation synergist for the geographically isolated D. frontalis populations of Central America and Mexico, we performed a field trapping trial in Lagunas de Montebello National Park, Chiapas, Mexico, during July and August 2007. The combination of endo-brevicomin (placed either directly on the trap or 4 m away) plus racemic frontalin and turpentine caught at least 5 times more D. frontalis of both sexes than did turpentine either alone or in combination with either frontalin or endo-brevicomin. The addition of endo-brevicomin to the frontalin/turpentine bait also increased the proportion of females trapped. We conclude that the addition of endo-brevicomin might substantially improve the efficiency of the frontalin/turpentine bait for monitoring of D. frontalis in Central America and Mexico. We discuss factors that reconcile our results with previous studies that reported endo-brevicomin to be an attractant antagonist for populations of D. frontalis in Mexico and Honduras.

Correcting Poland Syndrome with a Custom-Made Silicone Implant: Contribution of Three-Dimensional Computer-Aided Design Reconstruction.

BACKGROUND: Poland syndrome is historically associated with hypoplasia of the pectoral major muscle and abnormalities of the upper limbs. The authors propose an innovative procedure for correcting Poland syndrome thoracic malformations using three-dimensional modeling. Moreover, the authors evaluated aesthetic improvement, satisfaction, and quality of life after reconstruction with computer-aided design customized silicone implants. METHODS: Since 1993, the authors have treated 129 patients for Poland syndrome. Before 2007, the implants were made from plaster molds; since 2007, they have been made using three-dimensional computer-aided design. Patient satisfaction was assessed using a standardized questionnaire, and quality of life was evaluated using the Medical Outcomes Study 36-Item Short-Form Health Survey. RESULTS: Lipofilling was performed in combination with computer-aided design in one-third of cases, and breast prostheses were required in 24 percent of cases. We found three exposed prostheses and two infections. Cosmetic results were excellent in more than 90 percent of cases, and more than 80 percent of patients were very satisfied or satisfied, with no significant difference between men and women (p = 0.382). The Medical Outcomes Study 36-Item Short-Form Health Survey scores revealed significant improvements in role emotional (p < 0.05), emotional well-being (p < 0.001), and social functioning (p < 0.001). CONCLUSIONS: Correcting Poland syndrome using a computer-aided design silicone implant fulfilled aesthetic and psychological demands, and significant improvements were seen in quality of life. The technique is simple and reliable and yields high-quality results, and three-dimensional computer-aided design has optimized the authors' reconstructions. Nevertheless, associated procedures and secondary corrections remain necessary to obtain optimal results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Integration of 3D printing and additive manufacturing in the interventional pulmonologist's toolbox.

New 3D technologies are rapidly entering into the surgical landscape, including in interventional pulmonology. The transition of 2D restricted data into a physical model of pathological airways by three-dimensional printing (3DP) allows rapid prototyping and fabrication of complex and patient-specific shapes and can thus help the physician to plan and guide complex procedures. Furthermore, computer-assisted designed (CAD) patient-specific devices have already helped surgeons overcome several therapeutic impasses and are likely to rapidly cover a wider range of situations. We report herein with a special focus on our clinical experience: i) how additive manufacturing is progressively integrated into the management of complex central airways diseases; ii) the appealing future directions of these new technologies, including the potential of the emerging technique of bioprinting; iii) the main pitfalls that could delay its introduction into routine care.

Addition of difluoromethyl radicals to glycals: a new route to alpha-CF2-D-glycosides.

The synthesis of synthetically useful alpha-CF2-glycosides by radical addition of ethyl bromodifluoroacetate onto 2-benzyloxyglycals is described. The methodology provides an access to alpha-O-glycoside mimics and, potentially, to valuable alpha-O-glycoconjugate analogues.

Stenting of Complex Malignant Central-Airway Obstruction Guided by a Three-Dimensional Printed Model Of The Airways.

Conversion of anatomic images into physical objects using three-dimensional printing (3DP) is changing the way surgeons anticipate selected technical challenges. We report herein a case of malignant central airway obstruction in the right main bronchus. Because stenting of the primary right carina is difficult, as it depends on many diameters and distance measurements, we used 3DP to plan and guide the procedure. After virtual resolution of the extrinsic compression, a three-dimensional printed model of the airways helped us choose the model and dimensions of the stent, and allowed us to modify its accuracy before insertion.

Identification of Human Cathelicidin Peptide LL-37 as a Ligand for Macrophage Integrin αMß2 (Mac-1, CD11b/CD18) that Promotes Phagocytosis by Opsonizing Bacteria.

LL-37, a cationic antimicrobial peptide, has numerous immune-modulating effects. However, the identity of a receptor(s) mediating the responses in immune cells remains uncertain. We have recently demonstrated that LL-37 interacts with the αMI-domain of integrin αMß2 (Mac-1), a major receptor on the surface of myeloid cells, and induces a migratory response in Mac-1-expressing monocyte/macrophages as well as activation of Mac-1 on neutrophils. Here, we show that LL-37 and its C-terminal derivative supported strong adhesion of various Mac-1-expressing cells, including HEK293 cells stably transfected with Mac-1, human U937 monocytic cells and murine IC-21 macrophages. The cell adhesion to LL-37 was partially inhibited by specific Mac-1 antagonists, including mAb against the αM integrin subunit and neutrophil inhibitory factor, and completely blocked when anti-Mac-1 antibodies were combined with heparin, suggesting that cell surface heparan sulfate proteoglycans act cooperatively with integrin Mac-1. Coating both Gram-negative and Gram-positive bacteria with LL-37 significantly potentiated their phagocytosis by macrophages, and this process was blocked by a combination of anti-Mac-1 mAb and heparin. Furthermore, phagocytosis by wild-type murine peritoneal macrophages of LL-37-coated latex beads, a model of foreign surfaces, was several fold higher than that of untreated beads. By contrast, LL-37 failed to augment phagocytosis of beads by Mac-1-deficient macrophages. These results identify LL-37 as a novel ligand for integrin Mac-1 and demonstrate that the interaction between Mac-1 on macrophages and bacteria-bound LL-37 promotes phagocytosis.

Correction of Pectus Excavatum by Custom-Made Silicone Implants: Contribution of Computer-Aided Design Reconstruction. A 20-Year Experience and 401 Cases.

BACKGROUND: In the absence of demonstrable functional impairment, pectus excavatum is merely a congenital deformity, albeit with a marked psychological impact. Many patients do not wish to undergo thoracic remodeling operations, which are invasive and do not clearly result in respiratory or cardiac improvement. METHODS: From 1993 to 2015, the authors designed 401 custom-made silicone implants to treat funnel chests. Before 2007, implants were made from plaster chest molds. Beginning in 2007, three-dimensional reconstructions were made from computed tomographic scans by computer-aided design. The authors prospectively recorded all assessments and follow-up data since 1993. Preoperative and postoperative photographs of two random groups of 50 patients were analyzed, in a blinded manner, by two surgeons independently. Intraoperative and postoperative complications, clinical outcomes, patient satisfaction, and quality of life were evaluated. RESULTS: One infection and three hematomas were recorded. Periprosthetic seroma was evident in all cases. Patients rated the cosmetic outcomes of computer-aided design implants significantly higher than those of the earlier implants made using plaster molds (p = 0.030). Malformations were better corrected in the computer-aided design group (86 percent) than in the plaster group (72 percent) (p = 0.038). Patient satisfaction was higher in the former group (p = 0.011). Medical Outcomes Study 36-Item Short-Form Health Survey scores revealed significant improvements, both socially and emotionally. CONCLUSIONS: Correction of pectus excavatum using a computer-aided design silicone implant fulfils aesthetic and psychological demands. The technique is simple and reliable and yields high-quality results. In the medium term, the approach may render invasive techniques obsolete. These operations remain risky and of doubtful functional utility. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Magic-angle spinning (31)P NMR spectroscopy of condensed phosphates in parasitic protozoa: visualizing the invisible.

We report the results of a solid-state (31)P nuclear magnetic resonance (NMR) spectroscopic investigation of the acidocalcisome organelles from Trypanosoma brucei (bloodstream form), Trypanosoma cruzi and Leishmania major (insect forms). The spectra are characterized by a broad envelope of spinning sidebands having isotropic chemical shifts at approximately 0, -7 and -21 ppm. These resonances are assigned to orthophosphate, terminal (alpha) phosphates of polyphosphates and bridging (beta) phosphates of polyphosphates, respectively. The average polyphosphate chain length is approximately 3.3 phosphates. Similar results were obtained with whole L. major promastigotes. (31)P NMR spectra of living L. major promastigotes recorded under conventional solution NMR conditions had spectral intensities reduced with respect to solution-state NMR spectra of acid extracts, consistent with the invisibility of the solid-state phosphates. These results show that all three parasites contain large stores of condensed phosphates which can be visualized by using magic-angle spinning NMR techniques.

Magnetic resonance imaging of right ventricular papillary endothelial hyperplasia.

Papillary endothelial hyperplasia (PEH) is a benign process characterized by endothelial cell proliferation in a papillary pattern, usually occurring in reaction to traumatic vascular stasis or a thrombus. Commonly found in the soft tissues of the neck and extremities, intracardiac lesions in the left atrium, left ventricle, and coronary atherotomy specimens associated with trauma or thrombus have rarely been reported. A single prior report of a pure, isolated form of intracardiac PEH in the literature is noted. To the best of our knowledge, the imaging characteristics have not been described. We describe the dynamic magnetic resonance characteristics of a pure, isolated PEH occurring in the right ventricle.