Central nervous system tumors and three-dimensional cell biology: Current and future perspectives in modeling

Central nervous system(CNS)tumors are a variety of distinct neoplasms that present multiple challenges in terms of treatment and prognosis.Glioblastoma,the most common primary tumor in adults,is associated with poor survival and remains one of the least treatable neoplasms.These tumors are highly heterogenous and complex in their nature.Due to this complexity,traditional cell culturing techniques and methods do not provide an ideal recapitulating model for the study of these tumors’behavior in vivo.Two-dimensional models lack the spatial arrangement,the heterogeneity in cell types,and the microenvironment that play a large role in tumor cell behavior and response to treatment.Recently,scientists have turned towards three-dimensional culturing methods,namely spheroids and organoids,as they have been shown to recapitulate tumors in a more faithful manner to their in vivo counterparts.Moreover,tumor-on-a-chip systems have lately been employed in CNS tumor modeling and have shown great potential in both studying the pathophysiology and therapeutic testing.In this review,we will discuss the current available literature on in vitro threedimensional culturing models in CNS tumors,in addition to presenting their advantages and current limitations.We will also elaborate on the future implications of these models and their benefit in the clinical setting.

A theory for three-dimensional response of micropolar plates

Through combined applications of the transfer-matrix method and asymptotic expansion technique,we formulate a theory to predict the three-dimensional response of micropolar plates.No ad hoc assumptions regarding through-thickness assumptions of the field variables are made,and the governing equations are two-dimensional,with the displacements and microrotations of the mid-plane as the unknowns.Once the deformation of the mid-plane is solved,a three-dimensional micropolar elastic field within the plate is generated,which is exact up to the second order except in the boundary region close to the plate edge.As an illustrative example,the bending of a clamped infinitely long plate caused by a uniformly distributed transverse force is analyzed and discussed in detail.

Oxygen tension modulates cell function in an in vitro three-dimensional glioblastoma tumor model

Hypoxia is a typical feature of the tumor microenvironment,one of the most critical factors affecting cell behavior and tumor progression.However,the lack of tumor models able to precisely emulate natural brain tumor tissue has impeded the study of the effects of hypoxia on the progression and growth of tumor cells.This study reports a three-dimensional(3D)brain tumor model obtained by encapsulating U87MG(U87)cells in a hydrogel containing type I collagen.It also documents the effect of various oxygen concentrations(1%,7%,and 21%)in the culture environment on U87 cell morphology,proliferation,viability,cell cycle,apoptosis rate,and migration.Finally,it compares two-dimensional(2D)and 3D cultures.For comparison purposes,cells cultured in flat culture dishes were used as the control(2D model).Cells cultured in the 3D model proliferated more slowly but had a higher apoptosis rate and proportion of cells in the resting phase(G0 phase)/gap I phase(G1 phase)than those cultured in the 2D model.Besides,the two models yielded significantly different cell morphologies.Finally,hypoxia(e.g.,1%O2)affected cell morphology,slowed cell growth,reduced cell viability,and increased the apoptosis rate in the 3D model.These results indicate that the constructed 3D model is effective for investigating the effects of biological and chemical factors on cell morphology and function,and can be more representative of the tumor microenvironment than 2D culture systems.The developed 3D glioblastoma tumor model is equally applicable to other studies in pharmacology and pathology.

Three-dimensional cell-based strategies for liver regeneration

Liver regeneration and the development of effective therapies for liver failure remain formidable challenges in modern medicine.In recent years,the utilization of 3D cell-based strategies has emerged as a promising approach for addressing these urgent clinical requirements.This review provides a thorough analysis of the application of 3D cell-based approaches to liver regeneration and their potential impact on patients with end-stage liver failure.Here,we discuss various 3D culture models that incorporate hepatocytes and stem cells to restore liver function and ameliorate the consequences of liver failure.Furthermore,we explored the challenges in transitioning these innovative strategies from preclinical studies to clinical applications.The collective insights presented herein highlight the significance of 3D cell-based strategies as a transformative paradigm for liver regeneration and improved patient care.

Current perspectives of viral hepatitis

Viral hepatitis represents a major danger to public health,and is a globally leading cause of death.The five liver-specific viruses:Hepatitis A virus,hepatitis B virus,hepatitis C virus,hepatitis D virus,and hepatitis E virus,each have their own unique epidemiology,structural biology,transmission,endemic patterns,risk of liver complications,and response to antiviral therapies.There remain few options for treatment,in spite of the increasing prevalence of viral-hepatitiscaused liver disease.Furthermore,chronic viral hepatitis is a leading worldwide cause of both liver-related morbidity and mortality,even though effective treatments are available that could reduce or prevent most patients’complications.In 2016,the World Health Organization released its plan to eliminate viral hepatitis as a public health threat by the year 2030,along with a discussion of current gaps and prospects for both regional and global eradication of viral hepatitis.Today,treatment is sufficiently able to prevent the disease from reaching advanced phases.However,future therapies must be extremely safe,and should ideally limit the period of treatment necessary.A better understanding of pathogenesis will prove beneficial in the development of potential treatment strategies targeting infections by viral hepatitis.This review aims to summarize the current state of knowledge on each type of viral hepatitis,together with major innovations.

The combined application of stem cells and three-dimensional bioprinting scaffolds for the repair of spinal cord injury

Spinal cord injury is considered one of the most difficult injuries to repair and has one of the worst prognoses for injuries to the nervous system.Following surgery,the poor regenerative capacity of nerve cells and the generation of new scars can make it very difficult for the impaired nervous system to restore its neural functionality.Traditional treatments can only alleviate secondary injuries but cannot fundamentally repair the spinal cord.Consequently,there is a critical need to develop new treatments to promote functional repair after spinal cord injury.Over recent years,there have been seve ral developments in the use of stem cell therapy for the treatment of spinal cord injury.Alongside significant developments in the field of tissue engineering,three-dimensional bioprinting technology has become a hot research topic due to its ability to accurately print complex structures.This led to the loading of three-dimensional bioprinting scaffolds which provided precise cell localization.These three-dimensional bioprinting scaffolds co uld repair damaged neural circuits and had the potential to repair the damaged spinal cord.In this review,we discuss the mechanisms underlying simple stem cell therapy,the application of different types of stem cells for the treatment of spinal cord injury,and the different manufa cturing methods for three-dimensional bioprinting scaffolds.In particular,we focus on the development of three-dimensional bioprinting scaffolds for the treatment of spinal cord injury.

Virtual and augmented reality systems and three-dimensional printing of the renal model—novel trends to guide preoperative planning for renal cancer

ObjectiveThis study aimed to explore the applications of three-dimensional (3D) technology, including virtual reality, augmented reality (AR), and 3D printing system, in the field of medicine, particularly in renal interventions for cancer treatment.MethodsA specialized software transforms 2D medical images into precise 3D digital models, facilitating improved anatomical understanding and surgical planning. Patient-specific 3D printed anatomical models are utilized for preoperative planning, intraoperative guidance, and surgical education. AR technology enables the overlay of digital perceptions onto real-world surgical environments.ResultsPatient-specific 3D printed anatomical models have multiple applications, such as preoperative planning, intraoperative guidance, trainee education, and patient counseling. Virtual reality involves substituting the real world with a computer-generated 3D environment, while AR overlays digitally created perceptions onto the existing reality. The advances in 3D modeling technology have sparked considerable interest in their application to partial nephrectomy in the realm of renal cancer. 3D printing, also known as additive manufacturing, constructs 3D objects based on computer-aided design or digital 3D models. Utilizing 3D-printed preoperative renal models provides benefits for surgical planning, offering a more reliable assessment of the tumor's relationship with vital anatomical structures and enabling better preparation for procedures. AR technology allows surgeons to visualize patient-specific renal anatomical structures and their spatial relationships with surrounding organs by projecting CT/MRI images onto a live laparoscopic video. Incorporating patient-specific 3D digital models into healthcare enhances best practice, resulting in improved patient care, increased patient satisfaction, and cost saving for the healthcare system.

High-speed autopolarization synchronization modulation three-dimensional structured illumination microscopy

In recent years,notable progress has been achieved in both the hardware and algorithms of structured illumination microscopy(SIM).Nevertheless,the advancement of three-dimensional structured illumination microscopy(3DSIM)has been impeded by challenges arising from the speed and intricacy of polarization modulation.We introduce a high-speed modulation 3DSIM system,leveraging the polarizationmaintaining and modulation capabilities of a digital micromirror device(DMD)in conjunction with an electrooptic modulator.The DMD-3DSIM system yields a twofold enhancement in both lateral(133 nm)and axial(300 nm)resolution compared to wide-field imaging and can acquire a data set comprising 29 sections of 1024 pixels×1024 pixels,with 15 ms exposure time and 6.75 s per volume.The versatility of the DMD-3DSIM approach was exemplified through the imaging of various specimens,including fluorescent beads,nuclear pores,microtubules,actin filaments,and mitochondria within cells,as well as plant and animal tissues.Notably,polarized 3DSIM elucidated the orientation of actin filaments.Furthermore,the implementation of diverse deconvolution algorithms further enhances 3D resolution.The DMD-based 3DSIM system presents a rapid and reliable methodology for investigating biomedical phenomena,boasting capabilities encompassing 3D superresolution,fast temporal resolution,and polarization imaging.

Assessment of public perspectives and barriers towards dengue preventive practices using the Health Belief Model in Puducherry,India:A cross-sectional study

Objective:To assess the perspectives and barriers towards dengue preventive practices among the residents of Puducherry,India.Methods:A cross-sectional survey was conducted in 300 households in Puducherry,using a population-proportionate(7:3)distribution from urban and rural areas by grid sampling.One adult interview per household was conducted and the participants were selected using a KISH grid.A semi-structured questionnaire based on the Health Belief Model(HBM)with additional questions on knowledge assessment was used.Knowledge was assessed based on the correctness of answers and the HBM scores were calculated on a 5-point Likert scale.Participants were categorized based on the median score under each domain.Logistic regression was used for adjusted analysis and models were built to predict the performances in each domain.Results:Four percent of the participants lacked basic knowledge regarding dengue transmission.While 208(69.3%)participants did not consider themselves at risk of contracting dengue within the next year,majority perceived dengue as a disease with low severity.Around 49.3%(148)were skeptical about the benefit of time and money spent on dengue prevention.Inadequate government efforts were stated as the major barrier(47.0%)and frequent reminders(142,47.3%)as the major cue to action.Age above 50 years(aOR 1.78,95%CI 1.04-3.06,P=0.037)and rural locality(aOR 2.68,95%CI 1.52-4.71,P=0.001)were found to be significantly associated with poor knowledge scores.Urban participants had a significantly higher chance to perceive low susceptibility as compared to the rural counterparts(aOR 1.74,95%CI 1.05-2.9,P=0.03).Participants with less than a high school education had low perceived benefits(aOR 2.46,95%CI 1.52-3.96,P<0.001)and low self-efficacy scores(aOR 2.66,95%CI 1.61-4.39,P<0.001).Conclusions:This study identifies key gaps in dengue prevention,including low perceived susceptibility,mild disease perception,limited knowledge of breeding sites,and overreliance on government efforts.Tailoring interventions to community needs,stratified to factors influencing the community perspectives can significantly improve dengue prevention efforts.

Enhancing global hepatocellular carcinoma management:Bridging Eastern and Western perspectives on dexamethasone and Nacetylcysteine before transarterial chemoembolization

This article explores the integration of Eastern and Western perspectives on the use of dexamethasone and N-acetylcysteine as premedications in transarterial chemoembolization for hepatocellular carcinoma(HCC).By examining key concerns raised by Western researchers,particularly regarding the different etiologies of liver cirrhosis,and contrasting them with robust clinical data from Asia,this article highlights the necessity for region-specific research and proposes future directions for global HCC management.

Recent advances and perspectives of zinc metal-free anodes for zinc ion batteries

Zinc-ion batteries(ZIBs) are recognized as potential energy storage devices due to their advantages of low cost, high energy density, and environmental friendliness. However, zinc anodes are subject to unavoidable zinc dendrites, passivation, corrosion, and hydrogen evolution reactions during the charging and discharging of batteries, becoming obstacles to the practical application of ZIBs. Appropriate zinc metal-free anodes provide a higher working potential than metallic zinc anodes, effectively solving the problems of zinc dendrites, hydrogen evolution, and side reactions during the operation of metallic zinc anodes. The improvement in the safety and cycle life of batteries creates conditions for further commercialization of ZIBs. Therefore, this work systematically introduces the research progress of zinc metal-free anodes in “rocking chair” ZIBs. Zinc metal-free anodes are mainly discussed in four categories: transition metal oxides,transition metal sulfides, MXene(two dimensional transition metal carbide) composites, and organic compounds, with discussions on their properties and zinc storage mechanisms. Finally, the outlook for the development of zinc metal-free anodes is proposed. This paper is expected to provide a reference for the further promotion of commercial rechargeable ZIBs.

Development of a toroidal soft x-ray imaging system and application for investigating three-dimensional plasma on J-TEXT

A toroidal soft x-ray imaging(T-SXRI)system has been developed to investigate threedimensional(3D)plasma physics on J-TEXT.This T-SXRI system consists of three sets of SXR arrays.Two sets are newly developed and located on the vacuum chamber wall at toroidal positionsφof 126.4°and 272.6°,respectively,while one set was established previously atφ=65.50.Each set of SXR arrays consists of three arrays viewing the plasma poloidally,and hence can be used separately to obtain SXR images via the tomographic method.The sawtooth precursor oscillations are measured by T-SXRI,and the corresponding images of perturbative SXR signals are successfully reconstructed at these three toroidal positions,hence providing measurement of the 3D structure of precursor oscillations.The observed 3D structure is consistent with the helical structure of the m/n=1/1 mode.The experimental observation confirms that the T-SXRI system is able to observe 3D structures in the J-TEXT plasma.

Intraoperative application of three-dimensional printed guides in total hip arthroplasty: A systematic review

BACKGROUND Acetabular component positioning in total hip arthroplasty(THA)is of key importance to ensure satisfactory post-operative outcomes and to minimize the risk of complications.The majority of acetabular components are aligned freehand,without the use of navigation methods.Patient specific instruments(PSI)and three-dimensional(3D)printing of THA placement guides are increasingly used in primary THA to ensure optimal positioning.AIM To summarize the literature on 3D printing in THA and how they improve acetabular component alignment.METHODS PubMed was used to identify and access scientific studies reporting on different 3D printing methods used in THA.Eight studies with 236 hips in 228 patients were included.The studies could be divided into two main categories;3D printed models and 3D printed guides.RESULTS 3D printing in THA helped improve preoperative cup size planning and post-operative Harris hip scores between intervention and control groups(P=0.019,P=0.009).Otherwise,outcome measures were heterogeneous and thus difficult to compare.The overarching consensus between the studies is that the use of 3D guidance tools can assist in improving THA cup positioning and reduce the need for revision THA and the associated costs.CONCLUSION The implementation of 3D printing and PSI for primary THA can significantly improve the positioning accuracy of the acetabular cup component and reduce the number of complications caused by malpositioning.

Surgeon Perspectives on Anastomotic Leaks and FluidAI’s StreamTM Platform: Integrating Qualitative Insights for Technological Innovation

Purpose: This article investigates the critical importance of integrating surgeons’ direct input into the development of innovative technologies that address gaps in surgical care, including those aimed at reducing anastomotic leaks (AL), a major complication in gastrointestinal surgery. While traditional quantitative research methods are prevalent, they often overlook the invaluable insights of the surgeons who manage these complications firsthand. Subjects and Methods: This study employs a qualitative approach, utilizing semi-structured interviews with 40 surgeons from various specialties, including general, bariatric, colorectal, trauma, hepato-biliary, and thoracic surgery. The interviews were designed to probe the needs of surgeons, challenges currently faced, and gaps in clinical practice, research, and technology for detection and/or management of AL. The data were analyzed using thematic analysis, which revealed significant gaps in current technologies for early detection and prevention of leaks. Results: Surgeons expressed strong interest in FluidAI’s Stream™ Platform, a non-invasive medical device designed to monitor postoperative drainage fluid in real-time, providing continuous data on AL risk. The ability of this platform to offer early prediction through pH and electrical conductivity analysis was particularly appealing to participants, who emphasized the importance of timely interventions in improving patient outcomes. The study’s findings highlight not only the clinical challenges but also the emotional toll that AL takes on surgeons, underlining the need for innovations that are both data-driven and humanistic. Conclusion: By centering surgeons’ perspectives, this research advocates for a human-centered approach to technological advancement, ensuring that new tools are both clinically effective and aligned with the real-world needs of surgical practitioners.

Computer-assisted three-dimensional individualized extreme liver resection for hepatoblastoma in proximity to the major liver vasculature

BACKGROUND The management of hepatoblastoma(HB)becomes challenging when the tumor remains in close proximity to the major liver vasculature(PMV)even after a full course of neoadjuvant chemotherapy(NAC).In such cases,extreme liver resection can be considered a potential option.AIM To explore whether computer-assisted three-dimensional individualized extreme liver resection is safe and feasible for children with HB who still have PMV after a full course of NAC.METHODS We retrospectively collected data from children with HB who underwent surgical resection at our center from June 2013 to June 2023.We then analyzed the detailed clinical and three-dimensional characteristics of children with HB who still had PMV after a full course of NAC.RESULTS Sixty-seven children diagnosed with HB underwent surgical resection.The age at diagnosis was 21.4±18.8 months,and 40 boys and 27 girls were included.Fifty-nine(88.1%)patients had a single tumor,39(58.2%)of which was located in the right lobe of the liver.A total of 47 patients(70.1%)had PRE-TEXT III or IV.Thirty-nine patients(58.2%)underwent delayed resection.After a full course of NAC,16 patients still had close PMV(within 1 cm in two patients,touching in 11 patients,compressing in four patients,and showing tumor thrombus in three patients).There were 6 patients of tumors in the middle lobe of the liver,and four of those patients exhibited liver anatomy variations.These 16 children underwent extreme liver resection after comprehensive preoperative evaluation.Intraoperative procedures were performed according to the preoperative plan,and the operations were successfully performed.Currently,the 3-year event-free survival of 67 children with HB is 88%.Among the 16 children who underwent extreme liver resection,three experienced recurrence,and one died due to multiple metastases.CONCLUSION Extreme liver resection for HB that is still in close PMV after a full course of NAC is both safe and feasible.This approach not only reduces the necessity for liver transplantation but also results in a favorable prognosis.Individualized three-dimensional surgical planning is beneficial for accurate and complete resection of HB,particularly for assessing vascular involvement,remnant liver volume and anatomical variations.

Mistreatment during Childbirth: Impact on Maternal Outcomes and Importance of Provider Perspectives

Background: Dying in childbirth is one of the most common causes of death for women. While maternal mortality rates, defined as deaths per 100,000 live births, have been steadily dropping in most countries worldwide, maternal mortality rates have doubled in the United States in the last twenty years. This commentary examines the various contributing factors to this trend. Methods: A literature review was performed using the keywords: maternal mortality, United States, disrespectful maternity care, obstetric violence, provider perspectives, and disparities. Maternal mortality statistics were obtained from the World Health Organization website. Results: Medical factors associated with maternal mortality include increased maternal age and cardiovascular conditions. Social factors include barriers to healthcare access, delays in receiving medical care, reduction in reproductive health services in some states, and non-obstetrical deaths such as accidents, domestic violence, and suicide. Racial inequities and disparities of care are reflected in higher maternal mortality rates for minorities and people of color. Disrespectful maternity care or obstetric violence has been reported worldwide as a factor in delay of lifesaving obstetrical care and reluctance by a pregnant person to access the healthcare system. About one in five US women has reported experiencing mistreatment, varying from verbal abuse to lack of privacy, from coerced procedures to neglect during childbirth. Conclusion: This commentary highlights the importance of inclusion of providers in research on respectful maternity care. Provider burnout, moral distress, limited time, and burden of clinical responsibilities are known challenges to respectful and comprehensive medical care. The association of disrespectful care with poor maternal outcomes needs to be studied. Exploring root causes of disrespectful childbirth care can empower nurses, midwives, and physicians to improve their environment and find solutions to reduce a potential cause of maternal mortality.

Three-dimensional numerical analysis of plant-soil hydraulic interactions on pore water pressure of vegetated slope under different rainfall patterns

Understanding the pore water pressure distribution in unsaturated soil is crucial in predicting shallow landslides triggered by rainfall,mainly when dealing with different temporal patterns of rainfall intensity.However,the hydrological response of vegetated slopes,especially three-dimensional(3D)slopes covered with shrubs,under different rainfall patterns remains unclear and requires further investigation.To address this issue,this study adopts a novel 3D numerical model for simulating hydraulic interactions between the root system of the shrub and the surrounding soil.Three series of numerical parametric studies are conducted to investigate the influences of slope inclination,rainfall pattern and rainfall duration.Four rainfall patterns(advanced,bimodal,delayed,and uniform)and two rainfall durations(4-h intense and 168-h mild rainfall)are considered to study the hydrological response of the slope.The computed results show that 17%higher transpiration-induced suction is found for a steeper slope,which remains even after a short,intense rainfall with a 100-year return period.The extreme rainfalls with advanced(PA),bimodal(PB)and uniform(PU)rainfall patterns need to be considered for the short rainfall duration(4 h),while the delayed(PD)and uniform(PU)rainfall patterns are highly recommended for long rainfall durations(168 h).The presence of plants can improve slope stability markedly under extreme rainfall with a short duration(4 h).For the long duration(168 h),the benefit of the plant in preserving pore-water pressure(PWP)and slope stability may not be sufficient.

Influence of sampling on three-dimensional surface shape measurement

In order to accurately measure an object’s three-dimensional surface shape,the influence of sampling on it was studied.First,on the basis of deriving spectra expressions through the Fourier transform,the generation of CCD pixels was analyzed,and its expression was given.Then,based on the discrete expression of deformation fringes obtained after sampling,its Fourier spectrum expression was derived,resulting in an infinitely repeated"spectra island"in the frequency domain.Finally,on the basis of using a low-pass filter to remove high-order harmonic components and retaining only one fundamental frequency component,the inverse Fourier transform was used to reconstruct the signal strength.A method of reducing the sampling interval,i.e.,reducing the number of sampling points per fringe,was proposed to increase the ratio between the sampling frequency and the fundamental frequency of the grating.This was done to reconstruct the object’s surface shape more accurately under the condition of m>4.The basic principle was verified through simulation and experiment.In the simulation,the sampling intervals were 8 pixels,4 pixels,2 pixels,and 1 pixel,the maximum absolute error values obtained in the last three situations were 88.80%,38.38%,and 31.50%in the first situation,respectively,and the corresponding average absolute error values are 71.84%,43.27%,and 32.26%.It is demonstrated that the smaller the sampling interval,the better the recovery effect.Taking the same four sampling intervals in the experiment as in the simulation can also lead to the same conclusions.The simulated and experimental results show that reducing the sampling interval can improve the accuracy of object surface shape measurement and achieve better reconstruction results.

The use of carbon-based particle electrodes in three-dimensional electrode reactors for wastewater treatment

The use of three-dimensional(3D)electrodes in water treatment is competitive because of their high catalytic efficiency,low energy consumption and promising development.The use of particle electrodes is a key research focus in this technology.They are usually in the form of particles that fill the space between the cathode and anode,and the selection of materials used is important.Carbon-based materials are widely used because of their large specific surface area,good adsorption performance,high chemical stability and low cost.The principles of 3D electrode technology are introduced and recent research on its use for degrading organic pollutants using carbon-based particle electrodes is summarized.The classification of particle electrodes is introduced and the challenges for the future development of carbon-based particle electrodes in wastewater treatment are discussed.

Three-dimensional visualization technology for guiding one-step percutaneous transhepatic cholangioscopic lithotripsy for the treatment of complex hepatolithiasis

BACKGROUND Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide.Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional multisession percutaneous transhepatic cholangioscopic lithotripsy(PTCSL).AIM To study one-step PTCSL using the percutaneous transhepatic one-step biliary fistulation(PTOBF)technique guided by three-dimensional(3D)visualization.METHODS This was a retrospective,single-center study analyzing,140 patients who,between October 2016 and October 2023,underwent one-step PTCSL for hepatolithiasis.The patients were divided into two groups:The 3D-PTOBF group and the PTOBF group.Stone clearance on choledochoscopy,complications,and long-term clearance and recurrence rates were assessed.RESULTS Age,total bilirubin,direct bilirubin,Child-Pugh class,and stone location were similar between the 2 groups,but there was a significant difference in bile duct strictures,with biliary strictures more common in the 3D-PTOBF group(P=0.001).The median follow-up time was 55.0(55.0,512.0)days.The immediate stone clearance ratio(88.6%vs 27.1%,P=0.000)and stricture resolution ratio(97.1%vs 78.6%,P=0.001)in the 3D-PTOBF group were significantly greater than those in the PTOBF group.Postoperative complication(8.6%vs 41.4%,P=0.000)and stone recurrence rates(7.1%vs 38.6%,P=0.000)were significantly lower in the 3D-PTOBF group.CONCLUSION Three-dimensional visualization helps make one-step PTCSL a safe,effective,and promising treatment for patients with complicated primary hepatolithiasis.The perioperative and long-term outcomes are satisfactory for patients with complicated primary hepatolithiasis.This minimally invasive method has the potential to be used as a substitute for hepatobiliary surgery.