Efficacy of custom-made soft keratoconus lenses on corneal aberrations and photic phenomena in patients with keratoconus:a corneal topography imaging based study

AIM:To evaluate the efficacy of custom-made soft keratoconus(KC)lenses on corneal aberrations and photic phenomena in two different optical zones in patients with KC.METHODS:Sixty eyes of 42 patients with KC were examined at baseline and after fitting HydroCone(Toris K)soft silicone hydrogel lenses.Best spectacle-corrected visual acuity(BSCVA)and contact lens-corrected visual acuity(CLCVA)were recorded.Lower-and higher-order corneal aberrations(LOAs and HOAs)were measured with and without Toris K lenses and compared in central 4.5 mm and 7 mm zones.Mesopic pupil diameter and subjective photic phenomena were also assessed.RESULTS:Mean CLCVA was significantly improved compared to BSCVA(P<0.0001).Corneal curvature and refractive measurements were found to be significantly reduced by the use of Toris K lenses,except for posterior corneal curvature values.In the 4.5 mm central optical zone,all wavefront aberrations decreased significantly after lens fitting(P<0.0001).In contrast,in the 7 mm(peripheral)optical zone,values for HOAs,spherical and residual aberrations,and optical path differences were increased,while LOAs,trefoil,and quadrifoil coefficients were decreased.The rate of photic phenomena was significantly higher in participants with a pupil size>6.00 mm(85.7%).CONCLUSION:Toris K lenses provide good visual results and a significant reduction in central corneal aberrations in patients with KC but could cause an increase in peripheral aberrations.This practical and nonsurgical approach appears to be an effective method for the visual management of KC.

Computer-aided Design and Custom-made Guide in Corrective Osteotomy for Complex Femoral Deformity

Summary： Preoperative planning of corrective osteotomy with traditional radiography has limitations in regards to determining the ideal osteotomy location and orientation in three-dimensional femoral de- formities. Though a successful operation can be planned preoperatively, intraoperative contingencies might adhere to the procedural plan in the performance of operation. To efficiently perform a planned procedure, proposed is a design to implement three-dimensional reconstruction photography, based on computer-tomography （CT） scan. A custom-made guide was designed to navigate the osteotomy as planned, and additionally, a personalized intramedullary nail was used for fixation after osteotomy. Three-dimensional （3D） photography of deformed femur was established based on the CT dataset and transferred into 3D photography processing software for further planning. Osteotomy planes were de- signed and adjusted at deformity sites to correct the 3D deformities. The methodology of a custom-made osteotomy guide was introduced in femoral corrective osteotomy, for the first time, to navigate the op- eration as planned. After the virtual osteotomy and reduction of bone segments, the parameters of a custom-made intramedullary nail were measured for manufacturing. Findings Virtual operation in computer shows complete correction of the 3D deformity. The osteotomy guide, obtained by rapid-prototyping techniques, navigates mimicking surgery on rapid-prototyping model of the involved femur as planned. Internal fixation was achieved using the custom-made intramedullary nail. Interpreta- tion three-dimensional visualization introduces an advantage in preoperative planning for corrective os- teotomy of 3D femoral deformity, and the custom-made osteotomy guide is crucial to realize such a de- liberate plan during the actual procedures. The internal fixator, such as an intramedullary nail, can be modified or personalized for fixation in unique cases.

Effectiveness of a Custom-Made Temporary Obturator after Bilateral Total Maxillectomy

Large oro-antral communication, associated with total maxillectomy, may lead speech and/or swallowing dysfunction. These surgical defects are packed with obuturator or prosthesis following surgery;however, achieving retention and stability is dependent on anatomical conditions. A 68-year-old Japanese female with large oro-antral communication arising because of bilateral total maxillectomy was referred for evaluating application of obturator. The temporary obturator was constructed as underlying 3 mm thick and covereing 1.5 - 2 mm thick ethylene vinyl acetate sheet (EVA). These two sheets formed the flexible hollow bulb portion, which aided retention and stability by engaging the undercut portion of the surgical defect. For the patients who have difficulty anatomical features for conventional prosthesis, this type of temporary obturator made with EVA sheets could be an effective solution in the early postoperative period.

Cranioplasty of Calvarial Skull Defects: A Comparative Study between Using Three Dimensional Custom-Made Cranioprostheses versus Hand-Made Bone Cement in Restoring Skull Configuration

Introduction: Cranioplasty is the surgical repair of a bony defect or deformity in the skull that is caused after cranial surgery or trauma. It carries cosmetic and protective benefits. Many types of materials are allowed. The subject of this study is to compare the outcome of two different manufacturing processes in reconstruction of calvarial skull defects by using 3D custom-made cranioprostheses versus hand-made bone cement implants. Patient and Methods: This is a prospective comparative study conducted on 20 patients of calvarial skull defects of different etiologies, sites and sizes, admitted in the neurosurgical departments of Cairo and Fayoum Universities in the period from August 2017 to February 2018. Patients are divided into two study groups: (group 1) 10 patients operated upon by 3D custom-made implant;(group 2) operated upon by hand-made bone cement implant. Statistical Analysis Used: Mann-Whitney test and Chi-square test. Results: Craniotomy using 3D custom-made implants gives better results than using bone cement in the functional restoration of skull shape and cranial protection with shorter operative time and less rate of postoperative complications. There is no statistically significant difference between the two study groups regarding cosmetic outcome. Conclusion: 3D custom-made implant is recommended for large and complex skull defects. Further and large studies might be needed.

Computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction for bone sarcomas:long-term outcomes

Background:Computed tomography(CT)and magnetic resonance imaging(MRI)data can be fused to identify the tumor boundaries.This enables surgeons to set close but tumor-free surgical margins and excise the tumor more precisely.This study aimed to report our experience in performing computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction to treat bone sarcoma in the diaphysis and metaphysis of the femur and tibia.Methods:Between September 2008 and December 2015,24 patients with bone sarcomas underwent surgical resection and joint-sparing reconstruction under image-guided computer navigation.The cohort comprised 16 males and eight females with a median age of 19.5 years(range:12-48 years).The tumor location was the femoral diaphysis in three patients,distal femur in 19,and proximal tibia in two.The tumors were osteosarcoma(n=15),chondrosarcoma(n=3),Ewing sarcoma(n=3),and other sarcomas(n=3).We created a pre-operative plan for each patient using navigation system software and performed navigation-aided resection before reconstructing the defect with a custom-made prosthesis with extracortical plate fixation.Results:Pathological examination verified that all resected specimens had appropriate surgical margins.The median distance from the tumor resection margin to the joint was 30 mm(range:13-80 mm).The median follow-up duration was 62.5 months(range:24-134 months).Of the 24 patients,21 remain disease free,one is alive with disease,and two died of the disease.One patient developed local recurrence.Complications requiring additional surgical procedures occurred in six patients,including one with wound hematoma,one with delayed wound healing,one with superficial infection,one with deep infection,and two with mechanical failure of the prosthesis.The mean Musculoskeletal Tumor Society score at the final follow-up was 91%(range:80%-100%).The 5-and 10-year implant survival rates were 91.3%and 79.9%,respectively.Conclusions:Computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction with extracortical plate fixation is a reliable surgical treatment option for bone sarcoma in the diaphysis and metaphysis of the femur and tibia.

Workflow and Principles for Precisely Designing a Custom-Made Polyetheretherketone Implant Applied in Irregular Craniofacial Bone Defects

Irregular craniofacial bone defects caused by craniofacial fractures always result in craniofacial bone and contour asymmetry and should therefore be reconstructed.Polyetheretherketone(PEEK)is an ideal substitute for autologous bone grafts and has been widely used in craniofacial bone defect reconstruction.The precise design of custom-made PEEK implants is particularly important to optimise reconstruction.Herein,the workflow and principles for the design and manufacture of PEEK implants are summarised,and a protocol for the precise design of an irregular craniofacial bone defect PEEK implant is presented.According to the method and principles,the design flow was efficient and could be standardised,and design errors could be avoided as much as possible.

Surgical pitfalls with custom-made porous hydroxyapatite cranial implants

Aim:Cranioplasty implants are used primarily in cases of surgical cranial decompression following pathological elevations of intracranial pressure.Available bone substitutes include porous hydroxyapatite(HA)and polymethylmethacrylate.Whichever material is used,however,prosthetic cranial implants are susceptible to intra-and postsurgical complications and even failure.The aim of this study was to investigate such occurrences in HA cranioplasty implants,seeking not only to determine the likely causes(whether correlated or not with the device itself)but also,where possible,to suggest countermeasures.Methods:We analyzed information regarding failures or complications reported in postmarketing surveillance and clinical studies of patients treated worldwide with custom-made HA cranial implants(Custom Bone Service Fin-Ceramica Faenza,Italy)in the period 1997-2013.Results:The two most common complications were implant fractures(84 cases,2.9%of the total fitted)and infections(51 cases,1.77%).Conclusion:Although cranioplasties are superficial and not difficult types of surgery,and use of custom-made implants are often considered the“easy”option from a surgical perspective,these procedures are nonetheless plagued by potential pitfalls.If performed well they yield more than satisfactory results from the points of view of both the patient and surgeon,but lack of appropriate care can open the door to numerous potential sources of failure,which can compromise-even irreparably-the ability to heal.

供需平衡视角下“定制式”高质量护理人才培养模式探析

目的:基于供需平衡视角构建“定制式”高质量护理人才培养模式,并检验其应用效果,为我国高质量护理人才培养提供参考。方法:通过专家会议法和焦点小组访谈法,综合把握临床需求、学科发展和人才培养三大主线,并以高质量发展为导向,拟定培养方案并实施,通过工作幸福感问卷、培养人才数量、人才分布、专科护理服务开展情况、成果产出评估应用效果。结果:2021年—2022年共培养330名“定制式”高质量护理人才,院内培养、院内外联合培养、院外培养护士工作幸福感总分分别为(52.91±4.45)、(52.83±4.87)、(52.83±5.00)分,与实施前相比,差异有统计学意义(P<0.05),专科护理服务数量和成果产出显著增多。结论:供需平衡视角下“定制式”高质量护理人才培养模式在优化护士人才培养路径、强化护理发展驱动力方面具有良好效果,可为我国高质量护理人才培养提供一定的参考。

基于生命周期评价的定制家具碳足迹与减排策略研究

基于生命周期评价方法对定制家具生产过程中的碳足迹进行研究,分析定制家具在生产过程中不同阶段碳排放数量。从原材料使用、生产工艺优化以及零部件三方面提出了不同的优化方案,降低板式家具在生产过程中造成的环境污染,达到定制家具“减量化”设计的目的。

国产定制型全颞下颌关节假体的研发与应用

颞下颌关节(temporomandibular joint,TMJ)假体置换是关节重建的有效方法之一。与自体骨移植置换关节相比,人工关节置换具有无需开辟第二术区、手术时间短、即刻功能恢复等优势,目前已成为国际上关节重建的首选方案。其中定制型假体具有量身定制、去骨少等优势,然而中国尚无此类产品,因此研发一款国产化、定制型且符合中国人颌骨解剖特征的全TMJ假体十分重要。自2009年开始,笔者团队开始自主研发适合于中国人的全TMJ假体,历经3代假体的研发,已逐步实现了多孔钛合金与超高分子量聚乙烯(ultra-high molecular weight polyethylene,UHMWPE)的稳定连接,金属-非金属连接关节窝假体制造工艺日益成熟。2017年团队实现关键技术突破,采用搅拌摩擦焊接技术成功研发出第3代定制型全TMJ假体。国产定制型假体的相关力学性能已超过国际同类产品,其临床初步应用也取得了令人满意的短期随访结果。同时为了确保假体从设计加工到临床应用的高效性和精确性,笔者团队制定了一条较为成熟的标准化流程,并改进了假体植入手术。该文对国产定制型全TMJ假体系统近10余年的研发与应用进行了系统性的梳理和总结,并对未来国产假体的发展进行了展望。

法式刺绣在服饰配件中的运用

法式刺绣具有多样的表现形式和工艺手法,在服装配饰中得到了广泛的应用。法式刺绣通过造型、色彩、图案等方式表达出独有的艺术性与内涵,结合现代审美原则,将其结合形式美原则运用在服饰配件中,可以提升产品的溢价能力和时尚性。

Custom Made Fenestrated Stent Graft Collapse after Thoracic Endovascular Aortic Repair: A Case Report

We present a case of stent graft collapse after performing thoracic endovascular aortic repair with a custom-made fenestrated stent graft. The patient was a 70-year-old woman with an asymptomatic aneurysm of the distal aortic arch, and thoracic endovascular aortic repair was performed. The patient showed a blood pressure difference between the left arm and the right arm on postoperative day (POD) 17 prompting the performance of a chest computed tomography scan which revealed stent graft collapse. She then underwent staged debranching of thoracic endovascular aortic repair. Stent graft collapse is a rare but well-described complication of thoracic endovascular repair. Therefore, patients who undergo such a procedure should be carefully monitored for signs and symptoms, which suggest the possibility of stent collapse.

基于快速成型的个体化人工半膝关节的研制——计算机辅助设计与制造

目的 设计并制造一种用于复合异体半关节移植的个体化人工半膝关节 ,为解决异体骨移植关节软骨坏死和异体 -自体关节形状不匹配时提供一种方案。 方法 利用提取的股骨髁关节软骨三维轮廓数据 ,在 Surfacer9.0图像处理软件上进行个体化人工半膝关节的计算机辅助设计 ,得到三维模型 ,进行数据格式转换 ,在 L PS6 0 0快速成型机上制出快速成型树脂模 ,对树脂模进行修整、抛光获得理想的个体化人工半膝关节模型 ,经硅胶翻模、制作蜡模、成壳、浇铸 ,获得钛合金关节。将快速成型不易加工的融合笼焊接到关节上 ,抛光后即获得钛合金个体化人工半膝关节成品。并选择 1例 14岁患者 ,因右股骨下段骨肉瘤切除异体骨段保肢术后复发为临床应用。 结果 设计、制造出 1例新型复合异体半关节移植的个体化人工半膝关节 ,术中见假体与异体骨、对侧关节匹配良好。手术顺利 ,患者 5周可下地行走 ,6个月异体 -自体骨愈合 ,随访 1年患膝无不适 ,膝关节功能良好。 结论 经 CT数据获得骨骼三维轮廓信息 ,利用快速成型技术建模、熔模制造 ,可获得满意的个体化人工半膝关节假体 ,临床应用 1例明显改善膝关节功能 ,较好解决了异体

快速成型的个体化人工半膝关节的研制——股骨髁的三维建模

目的 探讨由螺旋 CT扫描数据获取关节软骨表面轮廓信息的方法 ,为基于快速成型技术的个体化人工半膝关节研究奠定基础。 方法 采用 Picker 6 0 0 0螺旋 CT机对股骨远端进行层厚 1mm扫描 ,在 CT机 Voxel Q图像工作站进行三维容积重建 ,之后对重建数据间隔 0 .1mm下载二维断层图像。应用自行开发的数据格式转换软件 ,对下载图像进行滤波、去噪等处理 ,求出断面图像的二维边缘轮廓矢量化数据 ,输入 Surfacer 9.0软件进行矢量化三维重建。针对关节软骨轮廓的识别及假体设计的需要 ,提取出较精确的关节软骨表面轮廓三维图像 ,用于个体化人工半膝关节的计算机辅助设计。 结果 实现了 CT图像信息的矢量转换 ,获得了有关的关节软骨表面轮廓三维实体模型。 结论 由螺旋 CT数据进行关节软骨外形轮廓的矢量化重建 ,可获得精确的关节软骨轮廓三维实体模型 ,其可编辑性强 ,为复合大段异体骨移植的人工半膝关节假体计算机辅助设计和快速成型制造奠定了基础 ;对医学图像信息的矢量转换简便易行 ,在骨科。

标准化和增材制造个性化多孔钽植入体的研究进展

阐述了标准化多孔钽植入体的发展历程以及制备工艺、性能和临床应用的现状。在精准化医疗的背景下,对增材制造个性化多孔钽的研究现状、存在的问题进行了分析,并提出了未来研究的发展方向。

应用快速成型技术制造骨科个体化内植物

目的 :探讨基于快速成型技术的个体化人工内植物制造方法。方法 :拟制造一个人工半膝关节。对猪股骨下端进行螺旋CT扫描 ,利用自主开发的图像格式转换软件进行矢量转换 ,经矢量化三维重建后 ,提取出感兴趣的软骨下骨和关节软骨表面轮廓的三维图像 ,然后进行假体的计算机辅助设计 ,在LPS 60 0快速成型机上制出快速成型树脂模 ,经精密铸造 ,获得钛合金假体 ,然后进行动物实验 ,对制造精度进行检验。结果 :制造出个体化人工膝关节 ,经动物实验 ,与软骨下骨、对侧关节匹配良好。结论 :经CT数据获得骨骼三维轮廓信息 ,利用快速成型技术建模、熔模铸造可以快捷地制造出个体化假体 。

国产3D打印个性化全颞下颌关节的临床初步应用

目的·初步验证国产3D打印个性化全颞下颌关节假体临床应用的安全性、有效性和精确性。方法·收集2例颞下颌关节骨关节病患者,术前拍摄颌面部CT。将CT数据导入Mimic 18.0软件中,个性化设计符合患者关节的解剖结构全颞下颌关节假体,并通过3D打印等技术加工生产。经过力学性能检测符合标准后,进行临床手术。手术选择改良耳颞切口,显露关节后切除病变的关节结节和髁突,放入该假体并固定,检查咬合关系良好后关创、缝合。术后1周、1个月和3个月时进行临床随访和影像学检查;并将术前CT设计的假体位置和术后CT中假体的植入位置进行拟合,分析假体植入位置的偏差。结果·假体静态下的平均最大承载力为3 100 N;疲劳性能检测中未见裂纹或断裂;消毒灭菌后生物监测均合格。2例患者术中假体均就位顺利,与骨面贴合且固位稳定;术后1周、3个月的X线片均未见假体移位、松动和断裂等;术后3个月,患者的疼痛、饮食和张口度都有明显的改善。术前与术后拟合结果显示:关节窝假体植入的平均误差为(0.904±0.292)mm,下颌假体植入的平均误差为(0.528±0.198)mm,总体平均误差为(0.878±0.259)mm。结论·自行研制的3D打印个性化全颞下颌关节假体在临床应用中具有较好的安全性和有效性。

保留萎缩眼球定制个性化义眼

目的:探讨保留萎缩眼球定制个性化义眼的方法及效果。方法:轻中度眼球萎缩19例行患眼角膜浅板层切除联合全结膜瓣遮盖术,术后2wk定制个性化义眼,随访4～10mo,观察其临床效果。结果:患者配戴个性化义眼后,双侧睑裂高度、眼睑饱满度、眼球突出度接近,虹膜、巩膜颜色和结膜充血程度相似。患者对个性化义眼外形、颜色、活动性、固位性、舒适性评价总满意率(满意和基本满意)分别为84%,90%,79%,100%,95%。个性化义眼水平活动度20°～35°,垂直活动度15°～20°。结论:轻中度萎缩眼球行角膜浅板层切除联合全结膜瓣遮盖术,术后定制个性化义眼可获得良好的仿真效果。

选择性激光熔化技术在口腔医学领域中的应用

选择性激光熔化技术(SLM)是一种直接快速成型任意复杂表面结构和内部腔隙试件的制造技术,具有高效率、高柔性和高度数字化等特点,代表了当前快速成型技术的最新发展方向。随着数字化三维成像技术和SLM的不断发展,其病例的个性化诊断和治疗得以广泛地应用于口腔颌面外科、口腔修复、口腔种植和口腔正畸领域,极大地简化了手术操作步骤,降低了传统制作方法的误差累积,获得了理想的个性化治疗效果,是口腔医学今后发展的方向和热点。