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Purpose: The primary objective of this study was to evaluate how the utilization of virtual surgical planning (VSP) and the epidemiological profile of patients undergoing orthognathic surgery (OGS) have changed in the past decade., Methods: The records of patients who had undergone orthognathic surgery at a national dental hospital were reviewed. Trends in VSP, epidemiological data, presentation of dentofacial deformity, and management details were recorded., Results: A total of 1184 patients were included in this study. The majority of the patients seeking treatment in this dental hospital were young Chinese adults with dentofacial deformities requiring bimaxillary surgeries. Most patients presented with a skeletal Class III pattern (79.0%), and asymmetry was diagnosed in 80.8% of all cases., Conclusion: There was an initial slow pick-up rate for VSP, but this rapidly increased to a high adoption rate of 98.7-100% between 2019 and 2021. Together with an increasing body of evidence suggesting greater accuracy in VSP, utilization in this technology can be enhanced with greater familiarity with the technology and improvements in the VSP services., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: To evaluate the accuracy of dynamic computer-aided implant surgery (dCAIS) and compare it with static computer-aided implant surgery (sCAIS) and freehand implant placement (FH) in partially or fully edentulous patients., Data: Studies that analyzed the accuracy of dynamic computer-assisted implant surgery in partially or fully edentulous patients., Sources: This meta-analysis included studies published in English and Mandarin Chinese from January 2013 to February 2023 from MEDLINE/PubMed, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CNKI (China National Knowledge Infrastructure)., Study Selection: Only clinical studies were included. Accuracy was the primary outcome. Seventeen studies met the inclusion criteria. A total of 2,025 implants were analyzed. Meta-regression was conducted to compare the six different navigation systems. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment was adopted as a collective grading of the evidence., Conclusions: Dynamic navigation is a clinically reliable method for implant placement. Significantly lower angular deviation was observed for dCAIS compared to both sCAIS and FH, while significantly lower global platform and apex deviations were displayed between dCAIS and FH. Overall, dynamic navigation allowed for higher accuracy compared to both sCAIS and FH in a clinical setting; however, additional large sample RCT studies should be conducted, and patient-reported outcome measures (PROMs) reported., Clinical Significance: This systematic review analyzed the accuracy of dynamic computer-assisted implant surgery in partially or fully edentulous patients compared with static navigation. The results demonstrated that dynamic navigation could decrease implant placement angular deviations., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Article Title and Bibliographic Information: Wei SM, Zhu Y, Wei JX, Zhang CN, Shi JY, Lai HC. Accuracy of dynamic navigation in implant surgery: A systematic review and meta-analysis. Clin Oral Implants Res. 2021 Apr;32(4):383-393. doi: 10.1111/clr.13719., Source of Funding: Shanghai Jiao Tong University School of Medicine (grant no. DLY201822); Shanghai Clinical Research Center for Oral Diseases (grant no. 19,411,950,100); Clinical Research Plan of SHDC (grant no. 16CR3033A)., Type of Study/design: Systematic review with meta-analysis., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To evaluate the accuracy of trephine bur drilling at different depths guided by dynamic navigation system in 3D printing in vitro model., Methods: A model at the depth of 5 mm, 10 mm, and 15 mm from the outer surface of which hemispherical cavities was reserved and the 3D printing technology was used to make the standardized model with Veroclear resin. The cone beam CT (CBCT) was taken and the data were imported into the dynamic navigation software (DCARER, China) to establish navigation path programming. Under the guidance of dynamic navigation, a trephine bur with a diameter of 4.5 mm was used to complete the access operation. At each depth, 10 approaches were completed. The postoperative model CBCT was taken. The approach trajectory under navigation was reconstructed and compared with the designed path. The two-dimensional distance deviation, depth deviation, three-dimensional distance deviation, and angle deviation between the actually prepared path and the designed path were calculated., Results: At the depth of 5 mm, the two-dimensional distance deviation between the end position of the prepared path and the designed path was (0.37±0.06) mm, the depth deviation was (0.06±0.05) mm, the three-dimensional distance deviation was (0.38±0.07) mm, and the angle deviation was 2.46°±0.54°; At the depth of 10 mm, the four deviations between the end position of prepared path and the designed path were (0.44±0.05) mm, (0.16±0.06) mm, (0.47±0.05) mm, and 2.45°±1.21°, respectively; At the depth of 15 mm, the four deviations were (0.52±0.14) mm, (0.16±0.07) mm, (0.55±0.15) mm, and 3.25°±1.22°, respectively. With the increase of entry depth, the three-dimensional and depth accuracy of dynamic navigation system decreased ( P < 0.01), and the positioning angle deviation had no relation with the entry depth ( P >0.01)., Conclusion: Dynamic navigation technology can achieve high positioning accuracy in the depth range of 15 mm, but its deviation increases with the increase of entry depth.

Background: To evaluate the perinatal outcomes in women with selective termination using ultrasound-guided radiofrequency ablation (RFA)., Methods: Complicated monochorionic (MC) twin pregnancies and multiple pregnancies with an indication for selective termination by ultrasound-guided coagulation of the umbilical cord with RFA under local anesthesia between July 2013 and Jan 2020 were reviewed. We analyzed the indications, gestational age at the time of the procedure, cycles of RFA, duration of the procedure, and perinatal outcome., Results: Three hundred and thirteen patients were treated during this period. Seven of whom were lost of follow-up. The remaining 306 cases, including 266 pairs of monochorionic diamniotic (MCDA) twins (86.93%), two pairs of monoamniotic twins (0.65%), 30 dichorionic triamniotic (DCTA) triplets (1%), and three monochorionic triamniotic (MCTA) triplets (0.98%), were analyzed. Indications included twin-to-twin transfusion syndrome (TTTS) (n = 91), selective fetal growth restriction (sFGR) (n = 83), severe discordant structural malformation (n = 78), multifetal pregnancy reduction (MFPR) (n = 78), twin reverse arterial perfusion sequence (TRAPS) (n = 19), and twin anemia-polycythemia sequence (TAPS) (n = 3). Upon comparison of RFA performed before and after 20 weeks, the co-twin loss rate (20.9% vs. 21.5%), the incidence of preterm premature rupture of membranes (PPROM) within 24 h (1.5% vs. 1.2%), and the median gestational age at delivery [35.93 (28-38) weeks vs. 36 (28.54-38.14) weeks] were similar (p > 0.05)., Conclusions: RFA is a reasonable option when indicated in multiple pregnancies and complicated monochorionic pregnancies. In our experience, the overall survival rate was 78.76% with RFA in selective feticide, and early treatment increases the likelihood of survival for the remaining fetus because the fetal loss rate is similar before and after 20 weeks., (© 2021. The Author(s).)

MRgFUS has just been made available for the 1.7 million Parkinson's disease patients in China. Despite its non-invasive and rapid therapeutic advantages for involuntary tremor, some concerns have emerged about outcomes variability, non-specificity, and side-effects, as little is known about its impact on the long-term plasticity of brain structure. We sought to dissect the characteristics of long-term changes in brain structure caused by MRgFUS lesion and explored potential biological mechanisms. One-year multimodal imaging follow-ups were conducted for nine tremor-dominant Parkinson's disease patients undergoing unilateral MRgFUS thalamotomy. A structural connectivity map was generated for each patient to analyze dynamic changes in brain structure. The human brain transcriptome was extracted and spatially registered for connectivity vulnerability. Genetic functional enrichment analysis was performed and further clarified using in vivo emission computed tomography data. MRgFUS not only abolished tremors but also significantly disrupted the brain network topology. Network-based statistics identified a U-shape MRgFUS-sensitive subnetwork reflective of hand tremor recovery and surgical process, accompanied by relevant cerebral blood flow and gray matter alteration. Using human brain gene expression data, we observed that dopaminergic signatures were responsible for the preferential vulnerability associated with these architectural alterations. Additional PET/SPECT data not only validated these gene signatures, but also suggested that structural alteration was significantly correlated with D1 and D2 receptors, DAT, and F-DOPA measures. There was a long-term dynamic loop between structural alteration and dopaminergic signature for MRgFUS thalamotomy, which may be closely related to the long-term improvements in clinical tremor., Competing Interests: Declaration of Competing Interest The authors declare no competing financial interests., (Copyright © 2021. Published by Elsevier Inc.)

Objective: To construct a preoperative evaluation system for partial nephrectomy using CT three-dimensional visualization technology and to explore its practical value., Methods: The clinical data of the patients who underwent partial nephrectomy for renal tumors in Department of Urology, Peking University First Hospital were collected retrospectively. At the same time, the homogenized standard data of patients who underwent partial nephrectomy for renal tumors were collected in 16 clinical centers in China. The CT three-dimensional visualization system was applied (IPS system, Yorktal) to evaluate tumor anatomy, blood supply, perirenal fat and other information. The parameters were summarized to build a three-dimensional nephrometry system, on the basis of which virtual surgery design and intraoperative navigation were completed., Results: A three-dimensional visualization image was established based on the enhanced CT urography. The nephrometry system included the longest diameter and volume of the tumor, proportion volume of tumor invading the parenchyma, maximum depth of the tumor invading the parenchyma, contact surface area, flatness of the tumor surface, renal segment where the tumor was located, vascular variation, and perirenal fat. The average two-dimensional diameter of the tumor was (2.78±1.43) cm, the average three-dimensional maximum diameter was (3.09±1.35) cm, and the average postoperative pathological size was (3.01±1.38) cm. The maximum tumor diameter in the three-dimensional image was significantly related to the prolonged renal artery clamping time and intra-operative blood loss ( r =0.502, P =0.020; r =0.403, P =0.046). The three-dimensional and pathological tumor volume were (25.7±48.4) cm 3 and (33.0±36.4) cm 3 , respectively ( P =0.229). The tumor volume was significantly related to the intraoperative blood loss ( r =0.660, P < 0.001). The proportion volume of the tumor invading into renal parenchyma was significantly related to the prolongation of renal artery clamping and the occurrence of postoperative complications ( r =0.410, P =0.041; r =0.587, P =0.005). The tumor contact surface area and the presence of vascular variation did not show correlation with the perioperative data and postoperative complications. While the preoperative evaluation was completed, the reconstructed three-dimensional image could be zoomed, rotated, combined display, color adjustment, transparency, and simulated cutting on the Touch Viewer system. The process generally consisted of showing or hiding the tissue, adjusting the transparency of the interested area, rotating and zooming the image to match the position of the surgical patient. Together, these functions met the requirements of preoperative virtual surgery plan and intraoperative auxiliary navigation., Conclusion: Three-dimensional images can provide a more intuitive anatomical structure. The CT three-dimensional visua-lization system clearly displays tumor anatomical parameters, blood supply and perirenal fat. The three-dimensional nephrometry system for renal tumors can help predict the difficulty of partial nephrectomy and perioperative complications. Importing the reconstructed three-dimensional visualization image into the specified program or robot operating system can complete virtual surgery and intraoperative navigation, helping the surgeon to better grasp the surgical process. The indexes included in the nephrometry system and the score weights of each index need to be confirmed and perfected by multi-center study with large samples.

Objective: To explore the application of mixed reality technique for the surgery of oral and maxillofacial tumors., Methods: In this study, patients with a diagnosis of an oral and maxillofacial tumor who were referred to Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from December 2018 to January 2020 were selected. The preoperative contrast-enhanced computed tomography data of the patients were imported into StarAtlas Holographic Medical Imaging System (Visual 3D Corp., Beijing, China). Three-dimensional (3D) model of tumor and key structures, such as skeleton and vessels were reconstructed to three-dimensionally present the spatial relationship between them, followed with the key structures delineation and preoperative virtual surgical planning. By using mixed reality technique, the real-time 3D model was displayed stereotactically in the surgical site. While keeping sterile during operation, the surgeon could use simple gestures to adjust the 3D model, and observed the location, range, and size of tumor and the key structures adjacent to the tumor. Mixed reality technique was used to assist the operation: 3D model registration was performed for guidance before tumor excision; intraoperative real-time verification was performed during tumor exposure and after excision of the tumor. The Likert scale was used to evaluate the application of mixed reality technique after the operation., Results: Eight patients underwent mixed reality assisted tumor resection, and all of them successfully completed the operation. The average time of the 3D model registration was 12.0 minutes. In all the cases, the surgeon could intuitively and three-dimensionally observe the 3D model of the tumor and the surrounding anatomical structures, and could adjust the model during the operation. The results of the Likert scale showed that mixed reality technique got high scores in terms of perceptual accuracy, helping to locate the anatomical parts, the role of model guidance during surgery, and the potential for improving surgical safety (4.22, 4.19, 4.16, and 4.28 points respectively). Eight patients healed well without perioperative complications., Conclusion: By providing real-time stereotactic visualization of anatomy of surgical site and guiding the operation process through 3D model, mixed reality technique could improve the accuracy and safety of the excision of oral and maxillofacial tumors.

Objective: Corneal disease is one of the main causes of blindness for humans globally nowadays, and deep anterior lamellar keratoplasty (DALK) is a widely applied technique for corneal transplantation. However, the position of stitch points highly influences the success rate of such surgery, which would require accurate control and manipulation of surgical instruments., Methods: In this paper, we present a deep learning framework for augmented reality (AR) based surgery navigation to guide the suturing in DALK. It can robustly track the excised corneal contour by semantic segmentation and the reconstruction of occlusion. We propose a novel optical flow inpainting network to recover the missing motion caused by occlusion. The occluded regions are detected by weakly supervised segmentation of surgical instruments and reconstructed by key frame warping along the completed optical flow. Then we introduce two types of loss function to adapt the inpainting network in the optical flow space., Results: Our techniques are tested and evaluated by a number of real surgery videos from Shandong Eye Hospital in China. We compare our approaches with other typical methods in the corneal contour segmentation, optical flow inpainting and occlusion regions reconstruction. The tracking accuracy reachs 99.2% in average and PSNR reaches 25.52 for the reconstruction of the occluded frames., Conclusion: From the experimental evaluations and user study, both the qualitative and quantitative results indicate that our techniques can achieve accurate detection and tracking of corneal contour under complex disturbance in real-time surgical scenes. Our prototype AR navigation system would be highly useful in clinical practice., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: To evalute the accuracy and clinical outcome of a real-time navigation system for the placement of quad zygomatic implants. Methods: Twenty-four patients [9 males and 15 females, mean age was (50.8±14.7) years old], from January 2015 to December 2019, with 96 zygomatic implants placed under a real-time navigation system in Department of Second Dental Center and Department of Oral Implantology of Ninth People's Hospital, Shanghai Jiaotong University School of Medicine were included in the study. The preoperative and the postoperative multislice CT or cone-beam CT were fused to measure and record the entry, exit and angle deviation between the planned and placed implants. The implants were divided into groups according to implant insertion approach (real-time navigation and free-hand), implant length (<47.5 mm and ≥47.5 mm) and implant position (proximal and distal implant). And the differences of implant accuracy were analyzed. The intraoperative and postoperative complications were also recorded. The implant survival rate was evaluated after 6 months follow-up. A P value<0.05 indicates statistical significance. Results: The mean entry, exit and angle deviation of zygomatic implants were (1.49±0.64) mm, [2.03(1.58, 2.40)] mm and (2.49°±1.12°), respectively. The average entry, exit and angle deviation of the navigation guided implant insertion group were (1.45±0.60) mm, (1.96±0.44) mm and (2.66±1.13°) respectively, while those of the free-hand group were (1.50±0.64) mm, (2.04±0.79) mm and (2.50°±1.13°) respectively. There was no significant difference between the two groups ( P >0.05). The average entry, exit and angle deviation of the group with length<47.5 mm were (1.42±0.60) mm, (2.13±0.60) mm and (2.61°±1.08°) respectively and those of the group with length ≥ 47.5 mm were (1.52±0.65) mm, (1.98±0.82) mm and (2.43°±1.14°) respectively. No significant difference was found between the two groups ( P >0.05). In proximal implant group, the average entry, exit and angle deviation were (1.55±0.69) mm, (2.05±0.92) mm and (2.48°±1.16 °) respectively while those of distal implant group were (1.43±0.57) mm, (2.01±0.57) mm and (2.49°±1.10°), respectively. No significant difference was detected between the two groups ( P >0.05). All zygomatic implants were placed uneventfully. There were no intra-operative complications, and post-operative reversible complications developed in 3 patients. Two zygomatic implants were lost and the overall zygomatic implant survival rate was 97.9% (94/96) within a follow-up of 6 months. Conclusions: Quad zygomatic implant placement can be achieved with high accuracy and predictable clinical outcome under guidance of a real-time navigation system.

Objective: To test the feasibility of image-guided Baha Attract implant surgery with mixed reality (MR) in the form of the HoloLens to visualize critical structures and facilitate precise Baha implant placement., Methods: A cadaveric case study of bilateral Baha Attract implant approaches was conducted using Star Atlas MR three-dimensional (3D) medical interaction system guidance at the Otolaryngology Department of PUMCH, Beijing, China. The accuracy of visual surface registration was determined by the target registration error (TRE) between the predefined points on the preoperative 3D holographic Baha Attract implant model and the postoperatively reconstructed 3D model., Results: Bilateral Baha Attract implantation was completed successfully for all four cadaveric heads using the Star Atlas MR 3D medical interaction system with the HoloLens. The preoperative 3D digital model characteristics (including bone quality and thickness and avoidance of cranial vessels, air cells, and cranial sutures) corresponded well with the 3D model of the actual implantation reconstructed postoperatively. The median TRE of our system was 2.97 mm (ranging from 1.98 to 4.58 mm) in terms of distance and 2.76 degrees (ranging from 0.59 to 6.4 degrees) in terms of angle., Conclusions: Applying MR technology in the form of the HoloLens in Baha Attract implant surgery is feasible and could improve the accuracy of the surgery. The described MR system for Baha Attract implantation has the potential to improve the surgeon's confidence, as well as the surgical safety, efficiency, and precision.

Purpose: To evaluate the accuracy of 6D computed-derived implant guides made in China, in order to provide methods and basis for reducing deviation., Methods: 3D rapid prototyping technique was used to fabricate implant guides for auxiliary surgical implantation in edentulous patients, and the position deviation between the preoperative design and the actual implant was measured. Sixteen edentulous patients with 172 implantation sites were measured. In 10 patients, six implants were implanted in the maxilla, 4 implants in the mandible, and 6 implants were implanted both in the maxilla and mandible of 6 patients. A total of 28 implants were tilted implant in 14 patients. Preoperative cone-beam CT(CBCT) data were imported into the 6D Dental Planning Software to design and make the implant guides. Digital guides were used to assist implant placement. Preoperative design and postoperative CBCT were imported into the software for 3D reconstruction and registration, and then exported to Geomagic Studio software for analysis to obtain the deviation between the preoperative design and the implantation, so as to analyze the accuracy of the guides. The differences were analyzed by SPSS 25.0 software package with paired t-test and single factor analysis of variance., Results: The distance deviation of implant neck center point was (0.83±0.27) mm and the horizontal deviation was (0.60±0.21) mm. The distance deviation of implant bottom center point was (1.11±0.35) mm, and the vertical deviation was (0.45±0.19) mm. The angle deviation was (3.16±1.73)°., Conclusions: The 6D computed-derived implant guides made in China can improve the accuracy and efficiency of implant surgery for edentulous patients and obtain a better long-term clinical effect to meet clinical requirements well. Since the deviation is similar to other implant guide plate systems that reported aborad, it must be taken into account in the process of clinical design, in order to avoid risks and unnecessary complications. This method is worthy of wide clinical application.

Objectives: This study aimed to identify Chinese parents' knowledge and attitudes toward transthoracic device closure of ventricular septal defect (VSD)., Methods: This cross-sectional study collected data on a total of 203 Chinese parents of patients with VSD were included, and an author-designed three-page questionnaire was used., Results: A total of 73.9% of the parents had heard of transthoracic device closure of VSD; however, they lacked detailed knowledge. 88.2% parents expressed their willingness to undergo this procedure. Although there was no significant correlation between knowledge about the occluder material and acceptance of the method, knowledge of other information was significantly related to willingness to undergo the procedure. Some parents expressed some concerns and high expectations, but the postoperative risk reduced their desire for accepting the procedure. This study also found that most parents did not have a detailed understanding of such procedure., Conclusion: Parents of patients with VSD in China need continued education regarding transthoracic device closure of VSD, especially in terms of its benefits and limited postoperative complications. In addition, it is essential to reduce the cost of this procedure to promote its development and application.

Plate treatment is currently the standard treatment of proximal tibia fracture. Morphological characteristics can help orthopedic surgeons understand anatomic information of tibia and choose well-matched plate for reducing difficulties in plate treatment. However, manual measurement of morphological characteristics of patient's tibia is time-consuming and labor-intensive. Therefore, this study proposes an automatic method to accurately estimate the morphological characteristics of patient's tibia for assisting plate treatment. In the off-line stage, an average shape with typical characteristics was computed from 422 tibia models, and the morphological characteristics of the average shape were measured by the orthopedic surgeon. In the on-line stage, the point's correspondence between the average shape and every tibia model was created by the proposed morphable model matching method firstly. Then, the morphological characteristics of tibia for every patient were estimated automatically based on the point's correspondence and characteristics of average shape. The effectiveness of the method was validated by comparing the manual measured and automatic-estimated characteristics. In addition, the basic experiments of virtual and real plate implantation preliminarily confirmed that the automatic-estimated morphological characteristics were helpful for plate treatment. In all, we propose an automatic and accurate estimation method of morphological characteristics for a large-scale library of Chinese tibia models, which provides orthopedic surgeons with scientific and quantitative description of tibia., Competing Interests: Declaration of Competing Interest The authors of this manuscript have nothing to disclose., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: Virtual surgical planning (VSP) and custom fabricated cutting guides for maxillofacial reconstruction have been shown to improve the accuracy of bony reconstruction and overall surgical efficiency and decrease the ischemia time. Our aim was to describe an in-house VSP technique for maxillofacial reconstructive procedures., Materials and Methods: We used 2 free software applications. 3DSlicer (available at: http://www.3dslicer.org) was used to extract the bones of interest for the recipient and the donor sites from the computed tomography scan's DICOM (digital imaging and communications in medicine) data. The Autodesk Meshmixer (Autodesk Inc, San Rafael, CA) was used to perform VSP and fabrication of the cutting guides. A reconstructed jaw model was printed in-house using a commercially available fused deposition modeling-based desktop 3-dimensional (3D) printer (Qidi Technology, Zhejiang, China) and used to prebend the reconstruction plate. The cutting guides were printed using a commercially available resin-based stereolithography apparatus desktop 3D printer (Form 2, Dental SG Resin; Formlabs, Somerville, MA) to allow for sterilization of the guides. We performed this technique for 19 consecutive patients with maxillofacial benign or malignant tumors requiring microvascular bony reconstruction. We calculated the average time and associated costs using this in-house VSP technique., Results: The technique was found to be simple and repeatable. The average time required for VSP was 158 minutes (2 hours, 38 minutes). The average cost for printing the reconstructed model per case was $5.21 Canadian dollars (CAD), and the average cost for printing the cutting guides per case was $12.80 CAD., Conclusions: Using this technique, in-house VSP and 3D printing can be performed by the treating surgeon, without an engineering background, within a reasonable period., (Copyright © 2019 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Study Design: A retrospective study evaluating cranial facet joint violation (FJV) by cortical bone trajectory (CBT) screw., Objective: To determine the incidence and risk factors of FJV following CBT screw placement for different techniques., Summary of Background Data: CBT is a novel technique for lumbar fusion, and FJV is one of the most common complications, leading to poor prognosis. No studies have investigated the incidence and risk factors of FJV for the CBT technique during different methods., Methods: The authors reviewed 91 consecutive patients who underwent CBT screw instrumentation from June 2015 to August 2018. In the fluoroscopic-open group (FOG), 42 patients received an open procedure. In the navigation-open group (NOG), 24 patients underwent open instrumentation. In the navigation-percutaneous group, 25 patients underwent percutaneous instrumentation. Postoperative computed tomography scans were obtained to determine the degree and incidence of FJV. Clinical and imaging data were analyzed to clarify the risk factors of FJV., Results: The incidence of FJV occurred in 35.7% of patients and 16.9% of screws in the FOG, 4.2% of patients and 3.8% of screws in the NOG, and 8.0% of patients and 8.0% of screws in the navigation-percutaneous group. Open instrumentation using navigation led to a lower risk of FJV compared with the conventional approach. There was no difference in the rate of FJV between percutaneous and open surgery with navigation assistance. Risk factors affecting FJV include: (1) left-side screw, facet angle ≥45 degrees, and scoliosis for fluoroscopy-assisted CBT instrumentation; (2) body mass index ≥30 kg/m, facet angle ≥45 degrees, and scoliosis for navigation-assisted CBT instrumentation., Conclusions: Lumbar fusion through CBT instrumentation would reduce FJV. Computer-assisted navigation resulted in a lower incidence of FJV. Percutaneous instrumentation with navigation assistance is not a risk factor for FJV. Special care should be taken in patients with body mass index ≥30 kg/m, left-side screw, facet angle ≥45 degrees, and scoliosis., Level of Evidence: Level III.

Orbital fractures and orbital floor reconstruction surgery is characterized by limited surgical exposure and high risks. Before the advent of digital technology, the design and implementation of the surgical scheme of orbital floor reconstruction surgery mainly depended on the intuitive understanding of imaging and the clinical experience of the surgeons, with strong unpredictability and experience dependence.Surgical navigation systems with real-time positioning and imaging functions, when used in orbital reconstruction surgery, can detect the real-time intraoperative position, avoid risks, and assist locating the reconstruction position to ensure the accuracy of orbital reconstruction, with the help of a preoperative surgical plan. Many studies have confirmed its effect. Unilateral orbital fractures and orbital floor reconstruction surgery is one of the earliest and most widely used surgical techniques in maxillofacial surgery. Experts from the Oral and Maxillofacial Surgery Committee of the Chinese Stomatological Association have fully discussed and formulated this expert consensus on navigation-guided unilateral orbital fractures and orbital floor reconstruction techniques, to standardize the clinical surgical procedures and promote its application.

Objective: To evaluate the feasibility and outcome of computer assisted distraction osteogenesis in the treatment of extensive alveolar cleft. Methods: Four patients [1 male and 3 females, aged (15.5±3.7) years] received treatment in the Department of Oral-Maxillofacial Surgery and Plastic Surgery, School of Stomatology, China Medical University from June 2016 to April 2018 were involved in this study. All the patients with extensive alveolar cleft [cleft width (7.64±1.29) mm] were performed orthodontic treatment to expand the dental arch and interdental space between the first molar and premolars. Three-dimensional (3D) model of the maxilla and the osteotomy guider were printed according to the CT data. The fix wings of the distractor were pre-shaped according to the 3D model. The osteotomy was performed at the interdental space and horizontal plate of palate to dissociate the alveolar bone segment. The distractor was fixed on the predetermined position. Distraction (0.4-0.8 mm/day) was performed in 7 days later and stopped when the incision connected with the canine. The distractor was removed after six months. Results: The distraction period was (10.8±2.5) d in four cases. The cleft was completely closed with interdental bone anchored distraction in four cases. The imaging examination in six months showed good new bone structure in the distraction zone and bone connection of the cleft. Conclusions: Computer assisted distraction osteogenesis was effective and feasible to close the extensive alveolar cleft and provide sufficient new bone tissue.

Mandibular angle osteotomy (MAO) and mandibular angle splitting osteotomy (MASO) are the two main surgical approaches used to correct a square mandible for a desirable aesthetic appearance. However, there are concerns about the safety and accuracy of both procedures as they may lead to unsatisfactory results such as injury to the nerve. To achieve symmetry and security we designed and evaluated a 3-dimensional printed surgical template, which indicates the outer cortex splitting line of the MASO, and the curved cutting line of the MAO. We operated on 11 patients who had been diagnosed with broad mandibles using the assisted template. The mean duration of osteotomy, degree of numbness of the inferior alveolar nerve, and reduction in the width of the mandible (Go-Go) were recorded. The mandibular curve before and after operation was fitted to evaluate its accuracy. The results showed that mean duration of osteotomy and numbness of the nerve were reduced, and there was no significant difference between simulation and postoperatively. The mean (SD) reduction in the mandibular width was 15.2 (1.6)mm. The template facilitated accuracy and safety in both procedures., (Copyright © 2018. Published by Elsevier Ltd.)

Background: This study sought to investigate the feasibility, safety and effectiveness of transcatheter closure of atrial septal defects (ASDs) under the guidance of transesophageal echocardiography (TEE) in children., Methods: We reviewed the medical records of patients who underwent percutaneous ASD closure at our center from August 2016 to December 2017. For a total of 88 patients who were identified as having a single-hole defect and were undergoing percutaneous transcatheter ASD closure, a procedure completely guided by TEE was performed. There were 31 male patients and 57 female patients. The patients' mean age was 60.09 ± 36.42 months (13-182 months), and their mean body weight was 20.16 ± 10.04 kg (9-77 kg). Patients were followed up by performing transthoracic echocardiography and obtaining chest X-rays and electrocardiograms., Results: The transcatheter closure of ASDs was successful in all patients. The mean ASD size was 11.58 ± 5.31 mm (3-28 mm), and the mean size of the occlusion device was 16.07 ± 5.29 mm (6-36 mm). The mean procedural times were 13.33 ± 2.82 minutes (6-16 minutes). The mean hospitalization costs were 27,259.66 ± 2507.04 RMB (25,200.00-33,911.45 RMB). The mean postoperative hospital stay was 3.22 ± 0.53 days (3-5 days). Residual shunt, occlusion device shedding or displacement, and pericardial effusion were not observed during or after the operation., Conclusion: Percutaneous transcatheter ASD closure completely guided by TEE is a feasible, safe, non-invasive and easy procedure.

The authors made a profound review on the development and the recent status of craniomaxillofacial surgery in China during past three decades. The emphases were placed on the following aspects: the modifications of the reconstructive procedure and minimal invasive mode, the researches on molecular genetic characteristics of the congenital craniofacial malformations, the clinical applications of three-dimensional digital computer-aided techniques (including three-dimensional printing and prefabricated template for precious osteotomies), the craniomaxillofacial defects reconstructing by using the distraction osteogenesis and osseous integrated titanium implant and prothesis, etc . Finally, the authors outlooked prospectively the future trends of the craniomaxillofacial surgery.

We used circulating tumor cells (CTCs) as biomarkers to evaluate the efficacy of pre-irreversible electroporation (IRE) and post-IRE for unresectable pancreatic cancer (PC). Real-time qPCR was used to detect potential biomarker genes in CTCs, and magnetic-activated cell sorting (MACS) and fluorescence-activated cell sorting (FACS) were performed on 43 patients with PC who underwent IRE. Some patients experienced adverse reactions within 30 days of the operation, including arrhythmia (6.9%), intraoperative transient change of blood pressure (25.5%), cough (11.6%), nausea and vomiting (23.3%), ascites (25.6%), fever (9.3%), and pain of puncture point (60.5%). The number of CTCs decreased significantly with postoperative time (P < 0.01). Delta cycle threshold values for the CTC-related genes CEA, Ep-CAM, and CK19 increased significantly after IRE. Furthermore, the expression of CEA, Ep-CAM, and CK19 decreased significantly with time after IRE (P < 0.01). Detecting CTCs by RT-qPCR and FACS combined with MACS has significant diagnostic and prognostic value for evaluating the efficacy of IRE in patients with unresectable PC.

The facial asymmetry associated with vertical maxillary excess and mandibular prognathism is one of the more complicated types in the field of oral and maxillofacial surgery. The purpose of this study was to investigate the efficacy of combined orthognathic surgeries, together with guiding templates and splints fabricated by rapid prototyping technique, for the correction of facial asymmetry. Fourteen patients with facial asymmetry associated with vertical maxillary excess and mandibular prognathism were included. A maxillary Le Fort I osteotomy, a sagittal split ramus osteotomy on the shorter side of the face, and an intraoral vertical ramus osteotomy on the longer side of the face were performed with the aid of guiding templates and splints fabricated by rapid prototyping technique. Parameters reflecting maxillary canting, ramal inclination, mandibular deviation, and chin inclination were measured before surgery, 7 days after surgery, and 1 year after surgery, and compared. Significant differences in these parameters were found between the two sides preoperatively, whereas no differences were observed postoperatively. Facial asymmetry was corrected in all patients with satisfactory outcomes. In conclusion, combined orthognathic surgery and guiding templates and splints can offer improvements in accuracy, complexity, and duration over traditional procedures for the correction of facial asymmetry associated with vertical maxillary excess and mandibular prognathism., (Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: The purpose of our study was to determine whether postoperative sagittal component alignments of primary total knee arthroplasty (TKA) using the conventional and navigated technique differed significantly. Additionally, we determined whether the use of navigation systems resulted in hyperextension of the femoral components in Chinese patients., Methods: This retrospective study reviewed 36 consecutive patients (72 knees) who underwent simultaneous bilateral primary TKAs at our hospital from February 2011 to March 2012. One knee was replaced using a computer-assisted navigation system, and the contralateral knee was replaced with the conventional technique. The radiographic and clinical results of both groups were compared. The relationship between preoperative anatomic angles and component alignments in conventional TKA and navigated TKA was examined., Results: The radiographic results showed statistically significant differences only between the navigated and conventional groups for individual femoral coronal and sagittal component alignment. Femoral sagittal component alignment showed less deviation and tended to have hyperextension using the navigated technique (-0.35°) compared with the conventional technique (2.77°). There was no significant difference observed for the Knee Society Score (KSS) between the two groups at 2 years postoperatively., Conclusions: The sagittal component alignment of primary TKA obtained using the conventional and navigated techniques differed significantly. Navigated TKAs resulted in a higher risk of hyperextension of the femoral components in Chinese patients.

Resection of left atrial myxoma and large atrial septal defect repair were performed in 55 patients using the da Vinci S surgical system to evaluate device safety and efficacy. Fifty-five patients underwent resection of left atrial myxomas (n=10) or secundum-type ASD (n=45) repairs with three cases of concomitant tricuspid valve repairs, using the da Vinci S surgical system. Mean age of the patients was 38+/-12.2 years (range 12-61 years). Cardiopulmonary bypass was achieved peripherally, aortic occlusion was performed with Chitwood cross-clamp, and antegrade cardioplegia was administered via anterior chest. Via four port incisions in the right chest and a 2-2.5-cm working port, all the procedures were completed with the da Vinci robot. All patients had successful resection or repairs. The mean CPB times and aortic cross-clamp times were 108.6+/-12.5 min and 45+/-11.5 min, respectively. There were no operative deaths, strokes, or device-related complications. One patient was reexplored for bleeding. There were no incisional conversions. All the patients were discharged. da Vinci S surgical system has no limitations to safe resection of left atrial myxomas and of ASD repairs, surgical results are excellent, and this technology is of reproducible value with excellent cosmetic results.

The virtual human is an interactive computer model integrating anatomical, biophysical, physiological and biomechanical characteristics of human being. The virtual Chinese human female number 1 (VCH-F1) is a high-resolution dataset of a standard Chinese female. This paper covers our 5-year work with VCH-F1 dataset. We will introduce the reconstruction of VCH-F1 three-dimensional (3D) model and our efforts to put this dataset into practical task such as the construction of the health sciences educational facilities, the research about the mechanism of acupuncture and the realization of virtual image-guided neurosurgery. Our experience with this work demonstrates a broad scope and variety of applications of VCH-F1 dataset in medicine and biology. Further works still need to be done to make this dataset a routine clinical tool.

The field of image-guided tumour ablation has gained great attention from Asian physicians because it represents a safe and effective technique for many commonly seen tumours in this population, showing minimal morbidity and excellent local control rates. Based on the current survey data from Asian physicians who are currently performing image-guided tumour ablation, thermal ablation has been mainly performed for patients with unresectable liver tumours. Radiofrequency ablation has replaced many other local ablation techniques such as microwave or ethanol ablation in treating small focal hepatic tumours for the last 5 years. Surgery and transcatheter arterial chemoembolization also have a unique role as curative and palliative treatment options for patients with more extensive tumour burden. Although radiofrequency ablation represents a paradigm shift in local therapy, more sophisticated strategies to enhance the therapeutic efficacy are necessary and more randomized and controlled investigations to estimate its clinical benefit are warranted.