3D Group Research Articles

3D‐printed degradable hydroxyapatite bioactive ceramics for skull regeneration

AbstractHydroxyapatite (HA) bioceramics have been extensively employed as bone tissue scaffolds owing to their biodegradability and osteoinductivity. In our work, HA, a significant component of natural bone tissue used as the raw material to produce porous scaffolds employing three‐dimensional (3D)‐printing technology. Physical and chemical properties, porosity, and compression resistance of the scaffolds were investigated in vitro. The scaffold was confirmed to have a large number of interconnected pore structures on the surface and inside HA scaffolds showed good cell compatibility and cell adhesion in cell text. To analyze the effect of the scaffold on bone repair and regeneration in vivo, the large‐size defect of beagle skull was repaired with a 3D printing group and an autologous bone group (ABG) for 8 months. Images and histological analysis of the 3D printing group indicated better integration with adjacent tissues. However, there were obvious gaps in the ABG, which indicates weak bone regeneration ability of this group due to unmatched implant dimension. Immunohistochemistry and immunofluorescence results showed that 3D‐printed scaffolds had a highly vascularized structure. This study indicates that 3D‐printed bioceramics scaffolds that are osteoinductivity and biodegradable have great potential in maxillofacial bone regeneration.

THREE-DIMENSIONAL HEADS-UP VITRECTOMY VERSUS CONVENTIONAL MICROSCOPIC VITRECTOMY FOR PATIENTS WITH EPIRETINAL MEMBRANE.

To investigate the efficacy and safety of 3D heads-up display (3D-HUD) vitrectomy compared with conventional microscopy (CM) vitrectomy in epiretinal membrane (ERM) surgery. Epiretinal membrane removal with or without internal limiting membrane (ILM) peeling was performed using a 3D-HUD or CM system. The mean changes in best-corrected visual acuity (BCVA) and in central macular thickness (CMT) and postoperative complications were assessed. Baseline demographics were comparable except for the follow-up period. Both BCVA and CMT improved at the final visit (all P < 0.05). The ERM recurrence and dissociated optic nerve fiber layer (DONFL) rates were lower in the 3D group (both P < 0.05). conventional microscopic vitrectomy (odds ratio [OR] = 12.86, P = 0.02) and absence of ILM peeling (OR = 45.25, P < 0.05) were associated with ERM recurrence. In the DONFL, CM vitrectomy (OR = 1.98, <0.05) and combined phacovitrectomy (OR = 2.33, P = 0.03) were analyzed as risk factors for DONFL. The improvement in BCVA and CMT in ERM surgery using a 3D-HUD is comparable with that of CM vitrectomy, with a significantly low rate of ERM recurrence and DONFL occurrence. Therefore, 3D vitrectomy might have an advantage for ERM surgery.

Three-Dimensional Visualization System for Vitreoretinal Surgery: Results from a Monocentric Experience and Comparison with Conventional Surgery.

To describe the experience of our centre (Careggi University Hospital, Florence, Italy) in using a heads-up three-dimensional (3D) surgical viewing system in vitreoretinal surgery, making a comparison with the conventional microscope surgery. We retrospectively analyzed data taken from 240 patients (240 eyes) with surgical macular diseases (macular hole and epiretinal membrane), retinal detachment or vitreous hemorrhage who underwent vitreoretinal surgeries, by means of the NGENUITY 3D Visualization System (Alcon Laboratories Inc., Fort Worth, TX, USA), in comparison with 210 patients (210 eyes) who underwent vitreoretinal surgeries performed using a conventional microscope. All surgeries were performed with standardized procedures by the same surgeons. We analyzed data over a follow-up period of 6 months, comparing the surgical outcomes (best-corrected visual acuity, anatomical success rate and postoperative complication rate) between the two groups. the 3D group included 74 patients with retinal detachment, 78 with epiretinal membrane, 64 with macular hole and 24 with vitreous hemorrhage. There were no significant differences in the demographic and clinical characteristics between the 3D group and the conventional group. We found no significant differences in outcome measures at three and six months follow-up between the two groups (p-value ≥ 0.05 for all comparisons). Surgery durations were similar between the two groups. In our experience, a heads-up 3D surgical viewing system provided comparable functional and anatomical outcomes in comparison with conventional microscope surgery, proving to be a valuable tool for vitreoretinal surgery in the treatment of different retinal diseases.

Comparison of three-dimensional reconstruction and CT-guided Hook-wire segmental resection for pulmonary nodules: a propensity score matching study

ObjectiveTo analyze and compare the clinical application value of three-dimensional reconstruction and computed tomography (CT)-guided Hook-wire localization for row lung segment resection of pulmonary nodules.MethodsRetrospective analysis of the clinical data of 204 patients suffering from pulmonary nodules admitted to the Department of Thoracic Surgery of Gansu Provincial People’s Hospital from June 2016 to December 2022. According to the preoperative positioning method, the group was divided into a 3D reconstruction group (98 cases) and a Hook-wire group (106 cases), respectively. The two groups of patients were propensity score matching (PSM) to compare their perioperative outcomes.ResultsAll patients in both groups underwent successful surgeries without perioperative deaths. After PSM, 79 patients were successfully matched in each group. Two cases of pneumothorax, three cases of hemothorax, and four cases of decoupling occurred in the Hook-wire group; no complications of pneumothorax, hemothorax, and decoupling occurred in the 3D reconstruction group. Compared to the Hook-wire group, the 3D reconstruction group has shorter operative time (P = 0.001), less intraoperative bleeding (P < 0.001), less total postoperative chest drainage (P = 0.003), shorter postoperative tube placement time (P = 0.001), shorter postoperative hospital stay (P = 0.026), and postoperative complications (P = 0.035). There was no statistically significant difference between the two groups in terms of pathological type, TNM staging, and number of lymph node dissection.ConclusionThree-dimensional reconstruction and localization of pulmonary nodules enables safe and effective individualized thoracoscopic anatomical lung segment resection with a low complication rate, which has good clinical application value.

3D imaging assistance impact on atrial fibrillation cryoablation efficiency, a method validation study

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): CGRA: CARD; CGRB: 31’297 Background Pulmonary vein isolation (PVI) by cryoballoon ablation is a well-known therapy for the treatment of atrial fibrillation (AF). Current 3D-navigation technologies usually used with RF ablation allow for a drastic reduction of intra-procedural X-ray exposure and imaging aided/guided methods allow for better anatomical characterization improving acute and long-term procedural results. 3D imaging fusion on real-time fluoroscopy is a well-known technology but the incremental value of 3D imaging fusion as a guiding tool on AF cryoballoon ablation therapy has not been studied yet. Purpose To increase procedural efficiency by integration of 3D imaging guidance in conventional cryoballoon PVI. Methods Using semi-automatic segmentation (Alphenix, Canon Medical Systems Corporation) obtained from pre-procedural cardiac computed tomography (CT); two anatomic volumes were fused on the real-time fluoroscopy display: left atrium (LA), including pulmonary veins (PV) and spine with proximal rib section (most radio-opaque body part in the thoracic area). The merging was performed by 3D registration of the bone segment with fluoroscopic acquisitions in three standard positions (AP, LAO, RAO), acquired at the beginning of the procedure. To standardize treatment workflow, the study was restricted to patients with paroxysmal atrial fibrillation. Results Twenty patients were included in the study: 10 in the control group (conventional fluoroscopy based cryoballoon ablation), and 10 in the 3D assisted group. Mean age was 59±15 SD years for the conventional group and 61.3±15.1 SD years for the 3D group with an 80% male population, in both groups. Acute PVI was achieved in all 20 patients. A decrease of both procedure time 86.8±16.1 SD in the control group Vs. 78.4±15.32 SD in the 3D group, and left sided dwelling time 69.7±14.31 SD in the control group Vs. 63.9±13.96 SD in the 3D group, although this trend did not reach statistical significance, while radiation time and cryo application time remained similar. Conclusions 3D imaging integration is feasible and safe and allows for an exact PV anatomy depiction on fluoroscopy. The assistance workflow might help increase AF cryoablation efficiency and safety (lower left sided dwelling time). Further research is needed to evaluate the incremental value of 3D imaging to assist fluoroscopy-based cryoballoon ablation. This could also impact long-term results since 3D Imaging assistance could reduce the likeability of missing intermediate PVs during AF ablation procedures.

Safety and efficacy of pulmonary vein isolation using pulsed field ablation with or without 3D mapping system for paroxysmal atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulsed field ablation (PFA) has recently been introduced as a novel routine ablation technology for paroxysmal atrial fibrillation (PAF). PFA can be performed "cryo-style" using fluoroscopy only, or additional pre- and post-ablation high-density 3D bipolar voltage maps can be performed to assess lesion formation and acute pulmonary vein isolation. We compared 6-month outcome after PFA using fluoroscopy only (X-ray) vs. PFA guided by 3D mapping (3D). Methods In PAF patients, PVI in conscious sedation using a steerable sheath and a pentaspline over-the-wire basket and flower PFA catheter was performed. In a subset of patients, pre- and post-ablation high-density bipolar voltage 3D maps (Carto 3D) were performed. Procedural parameters, acute success, in-hospital safety and arrhythmia recurrence were assessed over 6-month follow-up. Efficacy was evaluated by freedom from a ≥ 30-sec. recurrence of AF/atrial flutter (AFL)/atrial tachycardia (AT). Follow-up included 7-day Holter ECGs and/or telephonic interviews at days 90 and 180 after ablation. Results This study included a total of 101 patients (mean age: 65±10 years; 42% female) in whom 6-month follow-up data were available. There were no selection criteria for the use of 3D mapping. Pre- and post-ablation high-density maps were performed in 34/101 (34%) of patients. Mean CHA2DS2-VASc-score was 2,1±1,6. Median duration since first AF diagnosis was 21 [3-60] months. Skin-to skin procedure time was 56±20 in the X-ray group vs. 118±22 min in the 3D group, respectively (p&amp;lt;0,0001). Fluoroscopy time was 17±7 in the X-ray group vs. 21±6 in the 3D group, respectively (p&amp;lt;0,01). Acute pulmonary vein isolation rate was 100% in both groups. Primary adverse events occurred in 0% of patients in the X-ray group vs. 2/34 (6%) in the 3D group (2 pericardial tamponades), respectively (p=ns). During a mean follow-up of 204±82 days, 54/67 (81%) in the X-ray group vs. 27/34 (79%) in the 3D group remained free of any symptomatic or documented AF/AFL/AT episode after a single procedure (p=ns). In 4/13 (31%) patients in the X-ray group, a re-do procedure was performed, 2 patients had durable PVI with typical or atypical atrial flutter, 1 patient had reconnection of both posterior carinae and 1 patient had typical atrial flutter degenerating in AF. In 3/7 (43%) patients in the 3D group, a re-do procedure was performed, 2 patients had durable PVI with typical or atypical atrial flutter and 1 patient had reconnection of the LIPV. Conclusions PVI using PFA with or without 3D mapping system resulted in a similar 6-month atrial arrhythmia recurrence rate and safety profile. Procedure and fluoroscopy times were significantly shorter in the fluoroscopy only group.

Differences in acute outcomes and complications of pulmonary vein isolation using pulsed field ablation with or without 3D mapping system for paroxysmal atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulsed field ablation (PFA) has recently been introduced as a novel routine ablation technology for paroxysmal atrial fibrillation (PAF). It is also used as off-label therapy for persistent AF. PFA can be performed "cryo-style" using fluoroscopy only, or additional pre- and post-ablation high-density 3D bipolar voltage maps can be performed to assess lesion formation and acute pulmonary vein isolation. We compared acute outcome after PFA using fluoroscopy only (X-ray) vs. PFA guided by 3D mapping (3D). Methods In patients with AF, PVI in conscious sedation using a steerable sheath and a pentaspline over-the-wire basket and flower PFA catheter was performed. In a subset of patients, pre- and post-ablation high-density bipolar voltage 3D maps (Carto 3D) were performed. Procedural parameters, acute success and in-hospital safety were assessed. Results A total of 4 operators treated 218 patients (mean age 66 years (range 35–86), female 43%, mean BMI 28 kg/m2 (range 20-42), mean CHA2DS2-VaSc score of 2,5 (range 0-7), first-time ablation 93%, paroxysmal AF/persistent AF/re-do 72/21/7%). Mean duration since first AF diagnosis was 42 months (range 1-336). Most procedures were performed under deep conscious sedation without intubation (99%). There were no selection criteria for the use of 3D mapping. Pre- and post-ablation high-density maps were performed in 28% of cases. Skin-to skin procedure time was 54±22 in the X-ray group vs. 123±35 min in the 3D group, respectively (p&amp;lt;0,0001). Fluoroscopy time was 17±7 in the X-ray group vs. 20±6 in the 3D group, respectively (p&amp;lt;0,01). Acute pulmonary vein isolation rate was 100% in both groups. There were no phrenic nerve palsies or esophageal complications. Major complications (3,7%) were pericardial tamponade (2,8%) and stroke (0,9%); one stroke resulted in death (0,5%). They occurred in 3,2% of patients in the X-ray group (3 pericardial tamponades, 2 strokes) vs. 4,8% in the 3D group (3 pericardial tamponades), respectively (p=ns). Minor complications (1,4%) were vascular (0,5%) and transient ischemic attack (TIA) (0,9%). Conclusions In a large, single center cohort of unselected patients, PVI using PFA with or without 3D mapping system resulted in a similar acute outcome and safety profile. Procedure and fluoroscopy times were significantly shorter in the fluoroscopy only group. There were no PFA-specific complications, but the frequency of catheter complications in this relatively old patient population demonstrates that there is still room for improvement.

Clinical effects of 3D printing-assisted posterolateral incision in the treatment of ankle fractures involving the posterior malleolus.

To explore the clinical outcomes of a 3D printing-assisted posterolateral approach for the treatment of ankle fractures involving the posterior malleolus. A total of 51 patients with ankle fractures involving the posterior malleolus admitted to our hospital from January 2018 to December 2019 were selected. The patients were divided into 3D printing group (28 cases) and control group (23 cases). 3D printing was performed for ankle fractures, followed by printing of a solid model and simulation of the operation on the 3D model. The operation was then performed according to the preoperative plan, including open reduction and internal fixation via the posterolateral approach with the patient in the prone position. Routine x-ray and CT examinations of the ankle joint were performed, and ankle function was evaluated using the American Foot and Ankle Surgery Association (AOFAS) ankle-hindfoot score. All patients underwent x-ray and CT examinations. All fractures healed clinically, without loss of reduction or failure of internal fixation. Good clinical effects were achieved in both groups of patients. The operation time, intraoperative blood loss and intraoperative fluoroscopy frequency in the 3D printing group were significantly less than those in the control group (p < 0.05). There was no significant difference between the two groups in the anatomical reduction rate of fractures or the incidence of surgical complications (p > 0.05). The 3D printing-assisted posterolateral approach is effective in the treatment of ankle fractures involving the posterior malleolus. The approach can be well planned before the operation, is simple to perform, yields good fracture reduction and fixation, and has good prospects for clinical application.

3D printing of foetal vascular rings: feasibility and applicability

BackgroundVascular rings (VRs) exhibit complex and diverse forms that are difficult to conceptualize using traditional two-dimensional (2D) schematic. Inexperienced medical students and parents who lack a medical technology background face significant challenges in understanding VRs. The purpose of this research is to develop three-dimensional (3D) printing models of VRs to provide new technical imaging support for medical education and parental consultation.MethodsThis study included 42 fetuses diagnosed as VRs. Foetal echocardiography, modeling and 3D printing were performed, and the dimensional accuracy of models was analyzed. The value of 3D printing in the teaching of VRs was analyzed based on comparing the test results before and after the teaching intervention of 48 medical students and the satisfaction survey. A brief survey was conducted to 40 parents to assess the value of the 3D printed model in prenatal consultations.ResultsForty models of VRs were successfully obtained, which reproduced the anatomical shape of the VRs space with high dimensional accuracy. No differences in the prelecture test results were noted between the 3D printing group and the 2D image group. After the lecture, the knowledge of both groups improved, but the postlecture score and the change in the prelecture versus postlecture score were greater in the 3D printing group, and the subjective satisfaction survey feedback in the 3D printing group was also better (P < 0.05). Similar results were observed from the parental questionnaire, the vast majority of parents have an enthusiastic and positive attitude towards the use of 3D printed models and suggest using them in future prenatal consultations.ConclusionsThree-dimensional printing technology providing a new tool for effectively displaying different types of foetal VRs. This tool helps physicians and families understand the complex structure of foetal great vessels, positively impacting medical instruction and prenatal counselling.

A new neuroanatomical two-dimensional fitting three-dimensional imaging techniques in neuroanatomy education

BackgroundNeuroanatomy is the most abstract and complex anatomy. Neurosurgeons have to spend plenty of time mastering the nuances of the autopsy. However, the laboratory that can meet the requirements of neurosurgery microanatomy is only owned by several large medical colleges because it is an expensive affair. Thus, laboratories worldwide are searching for substitutes,but the reality and local details might not meet the exact requirements of the anatomical structure. Herein, we compared the traditional teaching mode, the 3D image generated by the current advanced hand-held scanner and our self-developed 2D image fitting 3D imaging method in the comparative study of neuroanatomy education.MethodsTo examine the efficacy of two-dimensional fitting three-dimensional imaging techniques in neuroanatomy education. 60 clinical students of grade 2020 in Wannan Medical College were randomly divided into traditional teaching group, hand held scanner 3D imaging group and 2D fitting 3D method group, with 20 students in each group.First, the modeling images of the hand held scanner 3D imaging group and the 2D fitting 3D method group are analyzed and compared, and then the teaching results of the three groups are evaluated by objective and subjective evaluation methods. The objective evaluation is in the form of examination papers, unified proposition and unified score; The subjective evaluation is conducted in the form of questionnaires to evaluate.ResultsThe modeling and image analysis of the current advanced hand-held 3D imaging scanner and our self-developed 2D fitting 3D imaging method were compared.The images (equivalent to 1, 10, and 40 × magnification) of the model points and polygons using the Cinema 4D R19 virtual camera of 50, 500, and 2000 mm showed 1,249,955 points and 2,500,122 polygons in the skull data obtained using the hand-held scanner. The 3D model data of the skull consisted of 499,914 points, while the number of polygons reached up to 60,000,000, which was about fourfold that of the hand-held 3D scanning. This model used 8 K mapping technology, and hand-held scanner 3D imaging 3D scanning modeling used a 0.13 K map based on the map data, thereby indicating that the 2D fitting 3D imaging method is delicate and real. Comparative analysis of general data of three groups of students.The comparison of test results, clinical practice assessment and teaching satisfaction of the three groups shows that the performance of hand held scanner 3D imaging group is better than that of traditional teaching group (P < 0.01), and that of 2D fitting 3D method group is significantly better than that of traditional teaching group (P < 0.01).ConclusionsThe method used in this study can achieve real reduction. Compared to hand-held scanning, this method is more cost-effective than the cost of the equipment and the results. Moreover, the post-processing is easy to master, and the autopsy can be performed easily after learning, negating the need to seek professional help. It has a wide application prospect in teaching.

High Thermoelectric Performance of a Novel γ-PbSnX2 (X = S, Se, Te) Monolayer: Predicted Using First Principles.

Two-dimensional (2D) group IV metal chalcogenides are potential candidates for thermoelectric (TE) applications due to their unique structural properties. In this paper, we predicted a 2D monolayer group IV metal chalcogenide semiconductor γ-PbSn2 (X = S, Se, Te), and first-principles calculations and Boltzmann transport theory were used to study the thermoelectric performance. We found that γ-PbSnX2 had an ultra-high carrier mobility of up to 4.04 × 103 cm2 V-1 s-1, which produced metal-like electrical conductivity. Moreover, γ-PbSn2 not only has a very high Seebeck coefficient, which leads to a high power factor, but also shows an intrinsically low lattice thermal conductivity of 6-8 W/mK at room temperature. The lower lattice thermal conductivity and high power factors resulted in excellent thermoelectric performance. The ZT values of γ-PbSnS2 and γ-PbSnSe2 were as high as 2.65 and 2.96 at 900 K, respectively. The result suggests that the γ-PbSnX2 monolayer is a better candidates for excellent thermoelectric performance.

3D Da Vinci robotic surgery: is it a risk to the surgeon’s eye health?

Da Vinci three-dimensional (3D) system has been increasingly used in customary surgical settings, gaining fundamental relevance for abdominal, urological, and gynecological laparoscopic surgery. The aim of this research is to evaluate the degree of discomfort and potential changes in the binocular vision and ocular motility of surgical operators, who employ 3D vision systems during Da Vinci robotic surgery. Twenty-four surgeons were enrolled in the study, including twelve who typically use the 3D Da Vinci system and twelve who routinely employ 2D system. Routine general ophthalmological and orthoptic examinations were conducted at baseline (T0), the day before surgery, and 30 min after the 3D or 2D surgery (T1). In addition, surgeons were interviewed using a questionnaire of 18 symptoms, with each item containing three questions regarding the frequency, severity, and bothersomeness of the symptoms, in order to evaluate the degree of discomfort. Mean age at evaluation was 45.28 ± 8.71 years (range 33–63 years). Cover test, uncover test, and fusional amplitude showed no statistically significant difference. After surgery, no statistical difference was observed in the Da Vinci group on the TNO stereotest (p > 0.9999). However, the difference in the 2D group resulted statistically significant (p = 0.0156). Comparing participants (p 0.0001) and time (T0–T1; p = 0.0137), the difference between the two groups was statistically significant. Surgeons using 2D systems reported more discomfort than those using 3D systems. The absence of short-term consequences following surgery with the Da Vinci 3D system is a promising conclusion, considering the numerous advantages of this technology. Nonetheless, multicenter investigations and more studies are required to verify and interpret our findings.

Accuracy between 2D Photography and Dual-Structured Light 3D Facial Scanner for Facial Anthropometry: A Clinical Study.

(1) Background: Facial scanners are used in different fields of dentistry to digitalize the soft tissues of the patient's face. The development of technology has allowed the patient to have a 3-dimensional virtual representation, facilitating facial integration in the diagnosis and treatment plan. However, the accuracy of the facial scanner and the obtaining of better results with respect to the manual or two-dimensional (2D) method are questionable. The objective of this clinical trial was to evaluate the usefulness and accuracy of the 3D method (a dual-structured light facial scanner) and compare it with the 2D method (photography) to obtain facial analysis in the maximum intercuspation position and smile position. (2) Methods: A total of 60 participants were included, and nine facial landmarks and five interlandmarks distances were determined by two independent calibrated operators for each participant. All measurements were made using three methods: the manual method (manual measurement), the 2D method (photography), and the 3D method (facial scanner). All clinical and lighting conditions, as well as the specific parameters of each method, were standardized and controlled. The facial interlandmark distances were made by using a digital caliper, a 2D software program (Adobe Photoshop, version 21.0.2), and a 3D software program (Meshlab, version 2020.12), respectively. The data were analyzed by SPSS statistical software. The Kolmogorov-Smirnov test revealed that trueness and precision values were normally distributed (p > 0.05), so a Student's t-test was employed. (3) Results: Statistically significant differences (p ≤ 0.01) were observed in all interlandmark measurements in the 2D group (photography) to compare with the manual group. The 2D method obtained a mean accuracy value of 2.09 (±3.38) and 2.494 (±3.67) in maximum intercuspation and smile, respectively. On the other hand, the 3D method (facial scanner) obtained a mean accuracy value of 0.61 (±1.65) and 0.28 (±2.03) in maximum intercuspation and smile, respectively. There were no statistically significant differences with the manual method. (4) Conclusions: The employed technique demonstrated that it influences the accuracy of facial records. The 3D method reported acceptable accuracy values, while the 2D method showed discrepancies over the clinically acceptable limits.

Current Perspective of Metaverse Application in Medical Education, Research and Patient Care

As virtual and augmented reality simulation technologies advance, the use of such technologies in medicine is widespread. The advanced virtual and augmented systems coupled with a complex interactive, immersive environment create a metaverse. The metaverse enables us to connect with others in a virtual world free of spatial restrictions and time constraints. In the educational aspect, it allows collaboration among peers and educators in an immersive 3D environment that can imitate the actual classroom setting with learning tools. Metaverse technology enables visualization of virtual 3D structures, facilitates collaboration and small group activities, improves mentor–mentee interactions, provides opportunities for self-directed learning experiences, and helps develop teamwork skills. The metaverse will be adapted rapidly in healthcare, boost digitalization, and grow in use in surgical procedures and medical education. The potential advantages of using the metaverse in diagnosing and treating patients are tremendous. This perspective paper provides the current state of technology in the medical field and proposes potential research directions to harness the benefits of the metaverse in medical education, research, and patient care. It aims to spark interest and discussion in the application of metaverse technology in healthcare and inspire further research in this area.

High absolute neutrophil count with type 2 diabetes is associated with adverse outcome in patients with coronary artery disease: A large-scale cohort study.

Inflammatory processes crucially modulate the development, progression, and outcomes of coronary artery disease (CAD). Since hyperglycemia could alter inflammatory responses, this study aimed to investigate the effect of ANC, a novel and rapidly available inflammatory biomarker, on the prognosis of patients undergoing PCI with or without type 2 diabetes (T2D). A total of 7,826 patients with CAD hospitalized for PCI at Fuwai Hospital were consecutively recruited. According to the median ANC value, patients were stratified as having high ANC (ANC-H) or low ANC (ANC-L) and were further classified into four groups by T2D. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs), including all-cause mortality, myocardial infarction, stroke, and target vessel revascularization. During a median follow-up of 2.4 years, 509 (6.5%) MACCEs were documented. Diabetic patients with increased ANC were at significantly higher risk of MACCEs (aHR, 1.55; 95% CI, 1.21-1.99; P = 0.001) compared to those in the ANC-L/non-T2D group (P for interaction between T2D and ANC categories = 0.044). Meanwhile, multivariable regression analysis demonstrated the highest MACCE risk in diabetic patients with a higher level of ANC than others (P for trend <0.001). This study suggests that stratification of patients with elevated ANC and T2D could provide prognostic information for CAD patients undergoing PCI.

The mechanical testing and performance analysis of three-dimensionally produced lingual retainers.

Introducing three-dimensional (3D) printing has opened new visions in the orthodontic field. This research evaluates three-dimensionally produced orthodontic retainers and their future possible uses. For this purpose, in vitro tests were performed for these groups, including bond strength, failure analysis, discoloration, and biodegradation. A total of 30 specimens (n=30), lower incisor human teeth, were randomly divided into three groups for a bond strength failure analysis (for each group n=10). In the experimental groups, lingual retainers were fabricated using 3D systems (group 1 with 3D dental pen and group 2 with 3D-printed). In the control group (group 3), the retainer system was a combination of a wire and composite, which is being used worldwide. A total of 30 specimens (n=30) from the 3D dental pen and 3D-printed for discoloration and biodegradation tests were divided into three groups (water, tea, and coffee). Data were analyzed using the Mann-Whitney U test, ANOVA, and chi-square test. For all parameters tested, significant differences were determined among groups. The 3D pen group had the highest score for bond strength, whereas discoloration differed significantly. According to the limitations of this research, 3D-printed retainers have the potential for clinical use in the near future.

OWN EXPERIENCES IN THE APPLICATION OF INTRAOPERATIVE 3D SPATIAL IMAGING IN THE ENDOSCOPIC SURGERY OF THE PARANASAL SINUSES

Introduction: Intraoperative spatial imaging using a high-resolution 3D camera is a state-ofthe-art technique applied to endoscopic paranasal sinus surgery. It enables better visualization of the surgical site, improves depth perception and facilitates tissue identification. All 3D endoscopy capabilities are still under review. The purpose of this study is to compare analogous endoscopic surgeries performed with 3D technique and those performed with traditional 2D technique based on the analysis of length of surgery, blood loss, occurrence of intraoperative complications and hospital stay time. Material: The material included 346 patients who underwent endoscopic paranasal sinus surgery with unilateral or bilateral sinus opening. In case of 152 patients, corrective surgery of the nasal septum was additionally performed. The patients were divided into two groups (2D group and 3D group) comprising 173 patients each, who underwent paranasal sinus opening using 2D and 3D endoscopic visualization. Each group was divided into four subgroups: the first were patients after bilateral paranasal sinus surgery (PSS), the second were patients after bilateral endoscopic paranasal sinus surgery and nasal septal correction surgery (PSS+NS), the third were patients after unilateral paranasal sinus surgery (UPSS), and the fourth group was patients after unilateral endoscopic paranasal sinus surgery and nasal septum correction surgery (UPSS+NS). Methods: The surgery was carried out using a TipCam 3D endoscope from Storz (Germany), 18 mm in length, 4 mm in diameter, with 30° optics, with an integrated camera capable of transmitting 3D images, as well as classic 2D endoscopes, 16 mm in length, 4 mm in diameter and 30° optics, along with a video track and instrument set. Patients underwent unilateral or bilateral endoscopic surgery with opening of the maxillary sinuses, frontal sinuses, anterior and posterior ethmoid as well as corrective surgery of the nasal septum. Patients underwent unilateral or bilateral endoscopic surgery with opening of the maxillary sinuses, frontal sinuses, anterior and posterior ethmoid as well as corrective surgery of the nasal septum. Results: The length of surgery were as follows in the 2D group: 2D/PSS+NS group — 107 min. (±22); 2D/PSS group — 95 min (±24); 2D/UPSS+NS group — 68 min (±21); 2D/UPSS group — 53 min (±14); The length of surgery in the 3D group: 3D/PSS+NS group — 91 min. (±17); 3D/PSS group — 83 min (±20); 3D/UPSS+NS group — 69 min (±15); 2D/UPSS group — 49 min (±10); Among the complications were early and late postoperative bleeding, eyelid or orbital hematomas, and eyelid edema. There were 17 complications in the 2D group (9.82%), and 7 complications in the 3D group (4.05%). Conclusions: It was found that 3D endoscopic surgeries significantly reduced the length of surgery, especially in serious bilateral paranasal sinus surgeries. and influenced a decrease in perioperative complications. 3D endoscopic surgeries had no significant effect on the amount of blood loss and the length of the patient’s stay at the Clinic.

Хирургическое лечение осложненной начальной катаракты вторым этапом после витреоретинальной хирургии у пациентов с пролиферативной диабетической ретинопатией

Purpose. To evaluate the efficacy of phacoemulsification of primary cataract by the second stage after vitreoretinal surgery of PDR patients. Material and methods. 124 cases of surgery treatment of patients with PDR and complicated primary cataract were enrolled. Thier patients were divided into two groups depending on the treatment tactics. In the 1st group patients were subjected to a two–step surgical procedure: vitreoretinal surgery with silicone oil tamponade performed as the 1st step in their treatment; followed by the 2d step, phacoemulsification surgery and silicone oil removal, and the IOL implantation, respectively. In the 2d group phacoemulsification performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity. Results. In the long-term postoperative period, functional results were better in group I patients than in group II patients (p &lt; 0.001). Conclusion. Outcomes of the preliminary studies suggest that it is more viable to perform phacoemulsification surgery sometime later along with silicone oil removal on PDR patients with complicated primary cataract. This sequence of treatment procedure ensures a more gentle approach to the anatomic structures of the eye during the first stage (vitreoretinal surgery) and contributes to the reduction in the number of intraoperative and postoperative complications. Keywords: diabetic retinopathy, cataract, vitreoretinal surgery

Improved Crystallization of High-Solubility Non-Fullerene Electron Acceptors for Enhanced Photoelectric Conversion Efficiency: Effect of the Terminal Group

Organic small-molecule acceptors with acceptor–donor–acceptor–donor–acceptor (A-DA′D-A)-type configurations typically exhibit photoinduced intra- and intermolecular charge transfer (CT) dynamics. Herein, using steady-state and transient absorption spectroscopy, we studied the impact of the three-dimensional (3D) terminal group on the intra- and intermolecular CT in the A-DA′D-A-type small-molecular acceptor and the effect of the photoelectric conversion process in the corresponding blend film. The results show that 3D terminal groups have little impact on intramolecular charge transfer but significantly improve solubility and regulate intermolecular interactions. 3D terminal groups can improve exciton generation and enhance exciton diffusion distance by preventing the film from over-aggregating, thus benefiting the charge transfer and photoelectric conversion in the blend film. This work demonstrated the advantages of the 3D terminal group and revealed the fundamental importance of regulating the intra- and intermolecular CT in enhancing photoelectric conversion.

Higher-order nonlinear anomalous Hall effects induced by Berry curvature multipoles

In recent years, it has been shown that Berry curvature monopoles and dipoles play essential roles in the anomalous Hall and the nonlinear Hall effects, respectively. In this work, we demonstrate that Berry curvature multipoles (the higher moments of Berry curvatures at the Fermi energy) can induce higher-order nonlinear anomalous Hall (NLAH) effects. Specifically, an AC Hall voltage perpendicular to the current direction emerges, where the frequency is an integer multiple of the frequency of the applied current. Importantly, by analyzing the symmetry properties of all the 3D and 2D magnetic point groups, we note that the quadrupole, hexapole, and even higher Berry curvature moments can cause the leading-order frequency multiplication in certain materials. To provide concrete examples, we point out that the third-order NLAH voltage can be the leading-order Hall response in certain antiferromagnets due to Berry curvature quadrupoles, and the fourth-order NLAH voltage can be the leading response in the surface states of topological insulators induced by Berry curvature hexapoles. Our results are established by symmetry analysis, effective Hamiltonian, and first-principles calculations. Other materials which support the higher-order NLAH effect are further proposed, including 2D antiferromagnets and ferromagnets, Weyl semimetals, and twisted bilayer graphene near the quantum anomalous Hall phase.