Current trends and key considerations in the clinical translation of targeted fluorescent probes for intraoperative navigation

The rapid development of fluorescence imaging for intraoperative navigation has spurred further development of targeted fluorescent probes in the past decade.Only a few nontargeted dyes,including indocyanine green and methylene blue,are currently applied for fluorescence guided surgery in the clinic.While no targeted fluorescent probes have been approved for the clinic,a number of them have entered clinical trials.These probes have emission wavelengths in the visible and near infrared(NIR)-I(700-900 nm)range.Among them,activatable probes and nanoprobes have generated special interest.Compared with NIR-I fluorescent probes,NIR-II(1000-1700 nm)fluorescent probes exhibit better intravital performance in terms of increased penetration depths,reduced tissue autofluorescence,and higher signalto-background ratios.However,more challenges are expected before the successful translation of NIR-II probes from bench to bedside.This review provides a brief overview of targeted fluorescent probes under clinical evaluation and recent achievements in the field of NIR-II fluorescence imaging.In addition,we outline key considerations concerning the design of fluorescent probes for clinical translation.

Integrated Product Development in Rhinoplasty:A Case Study

The 3D simulation in preoperative design for nasal plastic surgery was studied to help patients see the postoperative effects and reduce medical disputes.The study developed and clinically tested an innovative design for surgical guides for nasal plastic surgery,which showed positive results in patient satisfaction and accuracy in achieving the preoperative simulated effect.The study also investigated the process of designing and producing nasal prostheses and how patient feedback could be obtained using third-party social media voting.Patient satisfaction information was collected and evaluated using the Likert scale,and the data statistical analysis was carried out with the SPSS19.0 software.More than 94.1% of the patients were satisfied with the postoperative results.The study provides a good reference case for the integration of knowledge and skills from the medicine,design,and engineering fields in the development of medical devices.

Accuracy and complications of posterior C2 screw fixation using intraoperative three-dimensional fluoroscopy-based navigation

Background The peculiar and highly variable C2 anatomy can make screw fixation more challenging and prone to potential vertebral artery or neurologic injury. Conventional C-arm fluoroscopy has several drawbacks. The aim of this research was to evaluate the accuracy of posterior C2 screw fixation using intraoperative three-dimensional fluoroscopy- based navigation （ITFN） and assess the perioperative complication rate related to screw placement. Methods A retrospective review identified patients who underwent operative management with C2 instruments using ITFN at our hospital between January 2006 and December 2012. Clinical data were obtained from medical records and final screw positions were graded according to a modified classification of Gertzbein and Robbins. Grade A and B screws were considered well positioned. Results The study included 99 patients （53 males and 46 females） who underwent posterior C2 screw fixation using ITFN. The mean Japan Orthopedic Association score improved from （6.7±1.9） points before surgery to （12.5±2.7） points at 6-month follow-up （z= ＋8.628, P 〈0.01）. The mean visual analogue scale improved from （4.1±1.2） points before surgery to （0.7±0.9） points at 6-month follow-up, with an improvement of 83.7% （z= 8.638, P 〈 0.01）. Of the 196 screws analyzed using computed tomography and chart review, 126 transarticular, 64 pedicle, and 6 pars screws were placed with 82.5% （104/126）, 89.1% （57/64）, and 100% （6/6） accuracy （grade A）, respectively; 98.5% （193/196） of screws were grade A or B （grade C, 1.5% （3/196））, and no neurologic injuries occurred. In normal C2 cases, 93 transarticulars and 47 pedicles were placed with high accuracy rates of 90.3% （84/93） and 93.6% （44/47） （grade A）, respectively. However, in cases with C2 deformity, 33 transarticular, 17 pedicle, and 6 pars screws were placed with only 60.6% （20/33）, 76.5% （13/17）, and 100% （6/6） accuracy （grade A）, respectively. Conclusion ITFN is a safe, accurate, and effective tool for posterior C2 fixation. Chin Med J 2014;127 （14）： 2654-2658

Application value of mixed reality in hepatectomy for hepatocellular carcinoma

BACKGROUND As a new digital holographic imaging technology,mixed reality(MR)technology has unique advantages in determining the liver anatomy and location of tumor lesions.With the popularization of 5 G communication technology,MR shows great potential in preoperative planning and intraoperative navigation,making hepatectomy more accurate and safer.AIM To evaluate the application value of MR technology in hepatectomy for hepatocellular carcinoma(HCC).METHODS The clinical data of 95 patients who underwent open hepatectomy surgery for HCC between June 2018 and October 2020 at our hospital were analyzed retrospectively.We selected 95 patients with HCC according to the inclusion criteria and exclusion criteria.In 38 patients,hepatectomy was assisted by MR(Group A),and an additional 57 patients underwent traditional hepatectomy without MR(Group B).The perioperative outcomes of the two groups were collected and compared to evaluate the application value of MR in hepatectomy for patients with HCC.RESULTS We summarized the technical process of MR-assisted hepatectomy in the treatment of HCC.Compared to traditional hepatectomy in Group B,MR-assisted hepatectomy in Group A yielded a shorter operation time(202.86±46.02 min vs 229.52±57.13 min,P=0.003),less volume of bleeding(329.29±97.31 mL vs 398.23±159.61 mL,P=0.028),and shorter obstructive time of the portal vein(17.71±4.16 min vs 21.58±5.24 min,P=0.019).Group A had lower alanine aminotransferas and higher albumin values on the third day after the operation(119.74±29.08 U/L vs 135.53±36.68 U/L,P=0.029 and 33.60±3.21 g/L vs 31.80±3.51 g/L,P=0.014,respectively).The total postoperative complications and hospitalization days in Group A were significantly less than those in Group B[14(37.84%)vs 35(60.34%),P=0.032 and 12.05±4.04 d vs 13.78±4.13 d,P=0.049,respectively].CONCLUSION MR has some application value in three-dimensional visualization of the liver,surgical planning,and intraoperative navigation during hepatectomy,and it significantly improves the perioperative outcomes of hepatectomy for HCC.

Posterior Reduction and Monosegmental Fusion with Intraoperative Three-dimensional Navigation System in the Treatment of High-grade Developmental Spondylolisthesis

Background： The treatment of high-grade developmental spondylolisthesis （HGDS） is still challenging and controversial. In this study, we investigated the efficacy of the posterior reduction and monosegmental fusion assisted by intraoperative three-dimensional （3D） navigation system in managing the HGDS. Methods： Thirteen consecutive HGDS patients were treated with posterior decompression, reduction and monosegmental fusion ofL5/S1, assisted by intraoperative 3D navigation system. The clinical and radiographic outcomes were evaluated, with a minimum follow-up of 2 years. The differences between the pre- and post-operative measures were statistically analyzed using a two-tailed, paired t-test. Results： At most recent follow-up, 12 patients were pain-free. Only l patient had moderate pain, There were no permanent neurological complications or pseudarthrosis. The magnetic resonance imaging showed that there was no obvious disc degeneration in the adjacent segment. All radiographic parameters were improved. Mean slippage improved from 63.2% before surgery to 12.2% after surgery and 11.0% at latest follow-up. Lumbar lordosis changed from preoperative 34.9 ± 13.3° to postoperative 50.4 ±9.9°, and 49.3 ± 7.8° at last follow-up. L5 incidence improved from 71.0 ± 11.3° to 54.0 ± 1 1.9° and did not change significantly at the last follow-up 53.±1 15.4°. While pelvic incidence remained unchanged, sacral slip significantly decreased from preoperative 32.7± 12.5° to postoperative 42.6 ± 9.8°and remained constant to the last follow-up 44.4 ± 6.9°. Pelvic tilt significantly decreased from 38.4±12.5° to 30.9± 8.1° and remained unchanged at the last fbllow-up 28.1± 11.2°. Conclusions： Posterior reduction and monosegmental fusion of L5/S1 assisted by intraoperative 3D navigation are an effective technique for managing high-grade dysplastic spondylolisthesis. A complete reduction of local deformity and excellent correction of overall sagittal balance can be achieved.

Face transplantation for massive mandibular defects: considerations for allograft design and surgical planning

Modern face transplant techniques have advanced to allow for the transfer of vascularized skeletal components in addition to overlying soft tissue.This represents significant opportunity for individuals with mandibular defects that are not amenable to traditional reconstruction.Care must be taken when planning and executing transplants with these complex grafts,as satisfactory functional and aesthetic outcomes rely on achieving proper spatial relationships between the mandible,skull base,and midface.Which donor skeletal elements are included in the allograft and how they are harvested are important considerations in this planning and are associated with controversy.To optimize outcomes in the reconstruction of single-jaw defects,some advocate for transplantation of only the affected jaw while others support bimaxillary transplantation.Clinical evidence in this debate is not conclusive at this time.In current practice,including donor dentoalveolar anatomy by utilizing a bilateral sagittal split osteotomy of the mandible is favored to optimize outcomes such as dental occlusion.It has been suggested that harvesting the mandible at the level of the condyle or even the temporal bone may also be possible and may improve temporomandibular joint-related outcomes.Despite encouraging preclinical evidence,these strategies remain controversial.After allograft design,successful mandibular reconstruction with face transplantation relies on surgical precision in the donor and recipient procedures.Computerized surgical planning,computer-aided design and manufacturing,and intraoperative navigation are technologies currently in use to mitigate operative complexity.Results in both cadaveric and clinical face transplantations suggest these technologies are reliable and beneficial,although some room for improvement remains.