Image-guided lens extraction surgery: a systematic review

A systematic review of the recent literature regarding the current image-guided systems used for cataract surgery or refractive lens exchange was performed based on the PubMed and Google Scholar databases in March 2018. Literature review returned 21 eligible studies. These studies compared image-guided systems with other keratometric devices regarding their accuracy, repeatability and reproducibility in measurement of keratometric values, astigmatism magnitude and axis, as well as in IOL power calculation. Additionally, the image-guided systems were compared with conventional manual ink-marking techniques for the alignment of toric IOLs. In conclusion, image-guided systems seem to be an accurate and reliable technology with measurements of high repeatability and reproducibility regarding the keratometry and IOL power calculation, but not yet interchangeable with the current established and validated keratometric devices. However, they are superior over the conventional manual inkmarking techniques for toric IOL alignment.

Recent advances of variational model in medical imaging and applications to computer aided surgery

In this paper, we review some mathematical models in medical image processing. Due to the superiority in modeling and computation, variational methods have been proven to be powerful techniques, which have been extremely popular and dramatically improved in the past two decades. On one hand, many models have been proposed for nearly all kinds of applications. On the other hand, a lot of models can be globally optimized and also many computation tools have been introduced. Under the variational framework, we focus on two basic problems in medical imaging： image restoration and segmentation, which are core components for kinds of specific tasks. For image restoration, we discuss some models on both additive and multiplicative noises. For image segmentation, we review some models on both whole image segmentation and specific target delineation, with the later being a key step in computer aided surgery. Additionally, we present some models on liver delineation and give their applications to living donor liver transplantation.

Real-time fluorescence image-guided gastrointestinal oncologic surgery:Towards a new era

Technological improvements are crucial in the evolution of surgery.Real-time fluorescence-guided surgery(FGS)has spread worldwide,mainly because of its usefulness during the intraoperative decision-making processes.The success of any gastrointestinal oncologic resection is based on the anatomical identification of the primary tumor and its regional lymph nodes.FGS allows also to evaluate the blood perfusion at the gastrointestinal stumps after colorectal or esophageal resections.Therefore,a reduction on the anastomotic leak rates has been postulated as one of the foreseeable benefits provided by the use of FGS in these procedures.Although the use of fluorescence in lymph node detection was initially described in breast cancer surgery,the technique is currently applied in gastric or splenic flexure cancers,as they both present complex and variable lymphatic drainages.FGS allows also to perform intraoperative lymphograms or sentinel lymph node biopsies.New applications of FGS are being developed to assist in the detection of peritoneal metastases or in the evaluation of the tumor resection margins.The present review aims to provide a general overview of the current status of real-time FGS in gastrointestinal oncologic surgery.We put a special focus on the different applications of FGS,discussing the main findings and limitations found in the contemporary literature and also the promising near future applications.

Complications of CAD/CAM Fabricated Surgical Template for Static Computer-Aided Implant Surgery

Purpose: Surgical templates produced by digital simulation and CAD/CAM allow for three-dimensional control of implant placement. However, due to clinical limitations, there are complications during the use of the template. The purpose of this study was to summarize the complications associated with the use of surgical templates for static computer-aided implant surgery. Methods: Complications were collected during the observation period, and then their implant sites were reanalyzed with simulation software. Results: There were 104 cases during the observation period, 5 cases had complications. Mechanical complications were observed in four cases, including three cases in which the frame of the template fractured during implant placement surgery and one case in which the sleeve fell off the surgical template. In one case, there was an error in the planned position. All cases were mandibular molar cases, and all cases of frame fracture were at the free end defect site. All cases had a Hounsfield unit of more than 700 at the implant site, and some of them had a significantly small jaw opening. Conclusion: Although the spread of CAD/CAM surgical templates has made it possible to avoid problems caused by the position of the implant, it has been difficult to avoid fractures in cases of mandibular free end defects with high Hounsfield unit.

Role of decision aids in orthopaedic surgery

Medical treatment of patients inherently entails the risk of undesired complication or side effects. It is essential to inform the patient about the expected outcomes, but also the possible undesired outcomes. The patients preference and values regarding the potential outcomes should be involved in the decision making process. Even though many orthopaedic surgeons are positive towards shared decision-making, it is minimally introduced in the orthopaedic daily practice and decision-making is still mostly physician based. Decision aids are designed to support the physician and patient in the shareddecision-making process. By using decision aids, patients can learn more about their condition and treatment options in advance to the decision-making. This will reduce decisional conflict and improve participation and satisfaction.

Nursing Care of 13 Cases with Acute Retinal Necrosis Associated with HIV/AIDS during Day Surgery

Objective: Summarizing the nursing points from the treatment of the 13 cases of AIDS-related acute retinal necrosis syndrome (ARNS). Methods: Retrospective analysis of clinical nursing process of 13 cases (15 eyes) of AIDS-related ARNS patient treated in our hospital from January to December 2019. Results: The retina of all the patients were flat after operation. Postoperative visual acuity: bilateral visual acuity < 0.05 in 3 cases, >0.1 in 11 eyes, 0.01 - 0.1 in 3 eyes, >0.1 in 1 eye. No adverse events and nursing safety events occurred. Patients recovered well after operation during the follow-up after discharge. Conclusion: The focus of nursing care for patients with HIV/AIDS combined with acute retinal necrosis during daytime surgery is multifaceted, apart from the daily, perioperative nursing in day-care unit, continuous nursing, psychological counseling, disinfection and isolation should be paid attention to. At the same time, with the help of promotion and application of information education means, the treatment compliance of patients can be improved, which plays an essential role in the advance of the treatment effect.

A novel technique for sacropelvic fixation using image-guided sacroiliac screws:a case series and biomechanical study

In this study, we sought to assess the safety and accuracy of sacropelvic fixation performed with image-guided sacroiliac screw placement using postoperative computed tomography and X-rays. The sacroiliac screws were placed with navigation in five patients. Intact specimens were mounted onto a six-degrees-of-freedom spine motion simulator. Long lumbosacral constructs using bilateral sacroiliac screws and bilateral S1 pedicle and iliac screws were tested in seven cadaveric spines. Nine sacroiliac screws were well-placed under an image guidance system(IGS);one was placed poorly without IGS with no symptoms. Both fixation techniques significantly reduced range of motion(P<0.05) at L5-S1. The research concluded that rigid lumbosacral fixation can be achieved with sacroiliac screws,and image guidance improves its safety and accuracy. This new technique of image-guided sacroiliac screw insertion should prove useful in many types of fusion to the sacrum, particularly for patients with poor bone quality,complicated anatomy, infection, previous failed fusion and iliac harvesting.

HIV/AIDS患者合并耳鼻咽喉头颈外科肿瘤的临床分析(附8例报告)

目的总结HIV/AIDS患者合并耳鼻咽喉头颈外科相关肿瘤的临床表现及治疗情况。方法对我科2012年11月至2017年4月收治的HIV/AIDS合并耳鼻咽喉头颈外科肿瘤的8例患者进行回顾性分析,总结其临床表现、围术期免疫指标、手术方式及后续治疗,复诊情况及有无复发,追访患者转归。结果本组中1例颞骨巨细胞瘤,1例鼻腔鼻窦鳞状细胞癌合并内翻性乳头状瘤、霉菌性鼻窦炎,1例鼻腔鼻窦内翻性乳头状瘤,1例喉部卡波西肉瘤,2例喉鳞状细胞癌,1例甲状腺微小乳头状癌伴颈淋巴结转移,1例鼻腔NK/T细胞淋巴瘤。所有患者均实施手术治疗,其中5例有效,1例死亡,1例失访,1例无效。结论 HIV/AIDS合并耳鼻咽喉头颈外科肿瘤患者,其诊断、治疗与正常患者无显著差异,该类患者应予以积极治疗,对于延长患者的生存时间和提高其生活质量都有很大的作用。

Augmented reality technology for preoperative planning and intraoperative navigation during hepatobiliary surgery: A review of current methods

Background: Augmented reality(AR) technology is used to reconstruct three-dimensional(3D) images of hepatic and biliary structures from computed tomography and magnetic resonance imaging data, and to superimpose the virtual images onto a view of the surgical field. In liver surgery, these superimposed virtual images help the surgeon to visualize intrahepatic structures and therefore, to operate precisely and to improve clinical outcomes.Data Sources: The keywords "augmented reality", "liver", "laparoscopic" and "hepatectomy" were used for searching publications in the Pub Med database. The primary source of literatures was from peer-reviewed journals up to December 2016. Additional articles were identified by manual search of references found in the key articles.Results: In general, AR technology mainly includes 3D reconstruction, display, registration as well as tracking techniques and has recently been adopted gradually for liver surgeries including laparoscopy and laparotomy with video-based AR assisted laparoscopic resection as the main technical application. By applying AR technology, blood vessels and tumor structures in the liver can be displayed during surgery,which permits precise navigation during complex surgical procedures. Liver transformation and registration errors during surgery were the main factors that limit the application of AR technology.Conclusions: With recent advances, AR technologies have the potential to improve hepatobiliary surgical procedures. However, additional clinical studies will be required to evaluate AR as a tool for reducing postoperative morbidity and mortality and for the improvement of long-term clinical outcomes. Future research is needed in the fusion of multiple imaging modalities, improving biomechanical liver modeling,and enhancing image data processing and tracking technologies to increase the accuracy of current AR methods.

Current and future role of three-dimensional modelling technology in rectal cancer surgery:A systematic review

BACKGROUND Three-dimensional(3D)modelling technology translates the patient-specific anatomical information derived from two-dimensional radiological images into virtual or physical 3D models,which more closely resemble the complex environment encountered during surgery.It has been successfully applied to surgical planning and navigation,as well as surgical training and patient education in several surgical specialties,but its uptake lags behind in colorectal surgery.Rectal cancer surgery poses specific challenges due to the complex anatomy of the pelvis,which is difficult to comprehend and visualise.AIM To review the current and emerging applications of the 3D models,both virtual and physical,in rectal cancer surgery。METHODS Medline/PubMed,Embase and Scopus databases were searched using the keywords“rectal surgery”,“colorectal surgery”,“three-dimensional”,“3D”,“modelling”,“3D printing”,“surgical planning”,“surgical navigation”,“surgical education”,“patient education”to identify the eligible full-text studies published in English between 2001 and 2020.Reference list from each article was manually reviewed to identify additional relevant papers.The conference abstracts,animal and cadaveric studies and studies describing 3D pelvimetry or radiotherapy planning were excluded.Data were extracted from the retrieved manuscripts and summarised in a descriptive way.The manuscript was prepared and revised in accordance with PRISMA 2009 checklist.RESULTS Sixteen studies,including 9 feasibility studies,were included in the systematic review.The studies were classified into four categories:feasibility of the use of 3D modelling technology in rectal cancer surgery,preoperative planning and intraoperative navigation,surgical education and surgical device design.Thirteen studies used virtual models,one 3D printed model and 2 both types of models.The construction of virtual and physical models depicting the normal pelvic anatomy and rectal cancer,was shown to be feasible.Within the clinical context,3D models were used to identify vascular anomalies,for surgical planning and navigation in lateral pelvic wall lymph node dissection and in management of recurrent rectal cancer.Both physical and virtual 3D models were found to be valuable in surgical education,with a preference for 3D printed models.The main limitations of the current technology identified in the studies were related to the restrictions of the segmentation process and the lack of 3D printing materials that could mimic the soft and deformable tissues.CONCLUSION 3D modelling technology has potential to be utilised in multiple aspects of rectal cancer surgery,however,it is still at the experimental stage of application in this setting.

26例AIDS/HIV感染产科手术中职业暴露防范体会

目的:探讨艾滋病(AIDS)/人类免疫缺陷病毒(HIV)感染的孕妇,产科手术对医务人员职业暴露的危险因素及职业暴露的防范。方法:2005年1月￣2007年12月我院收治住院26例AIDS/HIV感染孕妇,由10位助产人员(其中,医生4人,助产护士6人)给予接产,并实施产科手术28次(其中,接产11次,剖宫产15次,剖腹探查术2次),对其产科手术中职业暴露的危险因素及防范方法进行分析。结果:10位产科人员中,1人次发生职业暴露,危险行为4处4次,经规范紧急处理、随访观察后,没有发生职业感染。结论:产科人员对AIDS/HIV感染处于高度暴露的环境;只要加强防范意识,严格执行艾滋病医院感染管理中的防范、处理措施,可以大大减少产科中艾滋病的职业暴露,并预防职业感染。

HIV／AIDS合并外科疾病18例手术治疗体会

目的探讨HIV／AIDS患者合并外科疾病手术治疗的效果和安全性。方法回顾性分析18例HIV／AIDS合并外科疾病的临床资料和处理方法。结果术后伤口一期愈合8例，伤口感染延期愈合6例，伤口感染不愈合4例。3例在35d内死亡。结论HIV／AIDS不是手术的禁忌证，合理的手术治疗是挽救部分HIV／AIDS病人唯一有效的方法。

Recent advances in computerized imaging and its vital roles in liverdisease diagnosis, preoperative planning, and interventional liversurgery: A review

The earliest and most accurate detection of the pathological manifestations of hepatic diseases ensures effective treatments and thus positive prognostic outcomes.In clinical settings,screening and determining the extent of a pathology are prominent factors in preparing remedial agents and administering approp-riate therapeutic procedures.Moreover,in a patient undergoing liver resection,a realistic preoperative simulation of the subject-specific anatomy and physiology also plays a vital part in conducting initial assessments,making surgical decisions during the procedure,and anticipating postoperative results.Conventionally,various medical imaging modalities,e.g.,computed tomography,magnetic resonance imaging,and positron emission tomography,have been employed to assist in these tasks.In fact,several standardized procedures,such as lesion detection and liver segmentation,are also incorporated into prominent commercial software packages.Thus far,most integrated software as a medical device typically involves tedious interactions from the physician,such as manual delineation and empirical adjustments,as per a given patient.With the rapid progress in digital health approaches,especially medical image analysis,a wide range of computer algorithms have been proposed to facilitate those procedures.They include pattern recognition of a liver,its periphery,and lesion,as well as pre-and postoperative simulations.Prior to clinical adoption,however,software must conform to regulatory requirements set by the governing agency,for instance,valid clinical association and analytical and clinical validation.Therefore,this paper provides a detailed account and discussion of the state-of-the-art methods for liver image analyses,visualization,and simulation in the literature.Emphasis is placed upon their concepts,algorithmic classifications,merits,limitations,clinical considerations,and future research trends.

33例HIV/AIDS患者胃肠道穿孔临床特点分析

目的分析HIV/AIDS患者胃肠道穿孔的病因及手术治疗效果。方法回顾性分析首都医科大学附属北京地坛医院2015年1月—2019年12月因胃肠道穿孔进行手术治疗的33例HIV/AIDS患者的临床资料,分析患者胃肠道穿孔病因和手术治疗效果,以及与HIV感染状态的关系。结果与体内HIV控制良好的患者相比,HIV未有效控制的患者CD4^(+)T细胞计数和CD4^(+)/CD8^(+)比值更低,机会性感染和相关性肿瘤因素导致的胃肠道穿孔更多,术后住院时间更长(P均<0.05),但手术效果无显著性差异(P>0.05)。结论HIV/AIDS患者胃肠道穿孔的病因更加多样,病情更加复杂。HIV感染状态不影响手术治疗效果,但对合并的机会性感染和相关性肿瘤的治疗效果会影响住院时间和预后。

数字化技术在颞下颌关节外科中的应用进展

颞下颌关节是颌面部唯一的双侧联动关节,支持咀嚼、吞咽、言语及部分表情等功能活动,其复杂的解剖结构以及狭小的手术操作空间,使该部位外科手术的开展受到很大限制。随着计算机技术在医学领域的广泛应用,精准化、数字化外科技术逐渐为各类外科手术提供了新的思路和方案,其中也包含颞下颌关节外科领域。颞下颌关节手术中,数字化技术的运用可以提高手术操作的精准性,减少并发症发生。未来,将数字化技术与临床检查、临床信息结合,能够为患者提供更具个性化的治疗,并为颞下颌关节相关研究提供更加完善的数据。

数字化正颌外科技术在临床实践中面临的挑战

计算机辅助正颌外科经过多年的发展、完善,其优势已被广泛认可,但在临床实际应用中,这项技术仍面临着诸多挑战。从影像数据采集、数字化技术的辅助诊断、数据处理及计算机辅助手术设计,到最后将虚拟方案转移到实际手术中,计算机辅助正颌外科流程中的每一步都可能产生误差,诸多误差的累计、放大,将会影响到最终的手术效果。目前正在探索的误差控制的思路包括:使用数字化设备,例如口内扫描仪;使用自动化方法和算法;使用个性化的骨块定位方式等。同时,术后软组织的精准模拟、下颌骨功能性运动评估、可吸收内固定材料等难题尚未得到完善的解决。只有充分理解当下计算机辅助正颌外科存在的不足之处,才能为继续优化现有方法提供方向,同时在临床实际工作中规避潜在的风险,充分发挥其优势,得到最佳的治疗效果。个体化钛板、人工智能和手术机器人等新技术的应用与发展,将进一步推动本学科的发展,期待未来数字化正颌外科技术在自动化、智能化、个性化方面的革新。

手术病人决策辅助的研究进展

介绍病人决策辅助的定义、使用情景、意义、内涵、形式以及开发的理论基础、质量评价、应用现状、目前存在的问题,以期为我国开展相关研究提供参考。

口内扫描配准种植机器人在种植牙手术中的应用

目的探讨口内扫描与锥形束CT(CBCT)术前配准在口腔种植机器人辅助种植牙手术中的应用。方法回顾性分析2023年11月—2024年5月机器人辅助种植的牙列缺损病例资料40例,手术前将佩戴定位标志物的口内扫描数据与CBCT数据分别与初始CBCT图像自动配准融合并计算配准误差,术中计算定位标志物注册平均误差并对术后的植入精度进行分析。结果40例牙列缺损患者佩戴定位标志物的口内扫描数据和CBCT数据分别与初始CBCT影像均成功配准融合,配准误差值分别为(0.157±0.026)mm和(0.154±0.033)mm,统计学分析表明二者差异无统计学意义。定位标志物注册误差值为(0.0373±0.0036)mm。共完成55枚种植体植入,植入点、根尖点的总误差分别为(0.78±0.41)、(0.89±0.28)mm,横向误差分别为(0.44±0.36)、(0.58±0.25)mm,深度误差分别为(0.51±0.32)、(0.54±0.36)mm;植入角度误差为1.24°±0.67°。结论基于口内扫描与CBCT配准融合技术能够满足口腔种植机器人术前配准的精度需求,增加了机器人辅助种植牙手术术前配准方式的选择并减少了患者多次辐射暴露。

耳硬化症的治疗进展

耳硬化症是一种原发于骨迷路的骨质重建障碍,可导致各种类型的听力下降。目前的治疗方案包括药物治疗、常规助听器、镫骨成形术、植入式电子听觉系统及人工耳蜗等。对于听力无明显下降的早期耳硬化症或拒绝手术治疗的患者,可以考虑药物治疗或助听器;对于传导性听力下降为主的前庭窗型耳硬化症,镫骨手术常作为一线治疗方案;对于感音神经性或混合型听力下降的耳蜗型及混合型耳硬化症,可以根据听力损失的程度选择植入式电子听觉系统或人工耳蜗。在决定治疗方案时,要根据患者的病变部位、听力损失类型、程度、自身诉求、费用等方面综合考虑,做到个体化分型治疗。

艾滋病病人腹部外科围术期护理质量评价体系的构建

目的:构建艾滋病病人腹部外科围术期护理质量评价体系。方法:通过文献学习、经验总结和半结构式访谈,拟定初稿,采用德尔菲法对18名专家进行两轮函询。结果:两轮专家函询问卷有效回收率均为100%,专家权威系数为0.858和0.823,Kendall′s W值为0.195和0.194(P<0.001),建立3个一级指标、13个二级指标、78个三级指标构成的艾滋病病人腹部外科围术期护理质量评价体系。结论:构建的艾滋病病人腹部外科围术期护理质量评价体系符合临床要求,具有可行性。