Mixed Reality Combined with Three‐Dimensional Printing Technology in Total Hip Arthroplasty: An Updated Review with a Preliminary Case Presentation

Three‐dimensional (3D) printing technology, virtual reality, and augmented reality technology have been used to help surgeons to complete complex total hip arthroplasty, while their respective shortcomings limit their further application. With the development of technology, mixed reality (MR) technology has been applied to improve the success rate of complicated hip arthroplasty because of its unique advantages. We presented a case of a 59‐year‐old man with an intertrochanteric fracture in the left femur, who had received a prior left hip fusion. After admission to our hospital, a left total hip arthroplasty was performed on the patient using a combination of MR technology and 3D printing technology. Before surgery, 3D reconstruction of a certain bony landmark exposed in the surgical area was first performed. Then a veneer part was designed according to the bony landmark and connected to a reference registration landmark outside the body through a connecting rod. After that, the series of parts were made into a holistic reference registration instrument using 3D printing technology, and the patient's data for bone and surrounding tissue, along with digital 3D information of the reference registration instrument, were imported into the head‐mounted display (HMD). During the operation, the disinfected reference registration instrument was installed on the selected bony landmark, and then the automatic real‐time registration was realized by HMD through recognizing the registration landmark on the reference registration instrument, whereby the patient's virtual bone and other anatomical structures were quickly and accurately superimposed on the real body of the patient. To the best of our knowledge, this is the first report to use MR combined with 3D printing technology in total hip arthroplasty.     

境外生中医诊断学教学方法探讨

对如何提高境外生中医诊断学教学质量进行探讨,认为应消除语言障碍,提高汉语水平;联系前后内容,注重横向比较;改善教学手段,教学方法多样;授课重点突出,总结归纳要点;合理安排作业,督促课后复习.     

利用"疾病监测信息报告管理系统"评估肺结核病疫情现状

目的:运用“疾病监测信息报告管理系统”分析深圳市肺结核疫情现状。方法:收集“疾病监测信息报告管理系统”肺结核网络直报、“广东省结核病控制项目报表系统”季报表材料进行分析。结果:2005年1~9月肺结核报告数3 379例,与去年同期对比增加68.8%;登记3 295例,与去年同期对比增加64.6%;其中,流动人口新登记率与去年同期对比明显增加。结论:外来人口结核病已成为影响本区域结核病疫情的重要因素,人口的剧增及加强报病管理,是本年疫情报告数增加的原因。     

人用药品注册技术要求国际协调会议关于通用技术文件的协调进展及其启示

本文旨在遵从药品注册技术要求一致化的原则下,对人用药品注册技术要求国际协调会议(ICH)所倡导执行的通用技术文件(CTD)进行比较全面的阐述和理解,详细介绍CTD在ICH6上的进展情况,就美国食品药品监督管理局对CTD的实施过程予以简介和研究,并深入探讨其对于我国药品注册规范等方面的影响和启示。     

3种配准方式下肺癌图像引导放射治疗摆位误差的比较

目的研究滑轨CT不同配准方式对肺癌大分割调强放疗摆位误差的影响。方法选取2016年10月至2017年10月在安徽医科大学第一附属医院放疗科就诊的肺癌患者24例,每周行滑轨CT扫描所得图像与原计划图像行灰度、骨性、手动3种模式在线配准,得出X、Y、Z轴3个方向平移误差,并进行统计分析。结果灰度配准、骨性配准和手动配准方式测量的X、Y、Z轴摆位误差分别为(0. 21±0. 16)、(0. 29±0. 15)、(0. 37±0. 22) cm,(0. 27±0. 16)、(0. 35±0. 25)、(0. 29±0. 19) cm,(0. 18±0. 12)、(0. 28±0. 16)、(0. 23±0. 14) cm,结果显示Y轴平移误差最大,其次为X轴,Z轴最小,且3组数据的差异有统计学意义(P <0. 05)。其中灰度模式在X、Y、Z轴上平移误差较骨性模式均缩小,灰度模式在X、Z轴上平移误差较手动模式有所缩小,差异有统计学意义(P <0. 05)。结论肺癌患者行图像引导大分割调强放疗时,应用滑轨CT中的灰度模式可缩小摆位误差。     

Image Fusion of Real-Time Ultrasonography with Computed Tomography: Factors Affecting the Registration Error and Motion of Focal Hepatic Lesions

Factors affecting the registration error (RE) and motion of focal hepatic lesions (FHLs) in image fusion of real-time ultrasonography (US) with computed tomography (CT) images were prospectively assessed by focusing on respiratory movement and FHL location. Real-time US and pre-acquired CT images at end-inspiration were fused with FHLs for 103 patients. Three-dimensional US data containing FHLs were obtained during end-inspiratory/expiratory phases. Multivariate analysis revealed that diaphragm motion (p < 0.001), chronic liver disease (p = 0.02) and the absolute difference in distance between the FHL and the central portal vein (CPV) during respiration (p = 0.03) were the independent factors that revealed the maximum effect on RE. In contrast, diaphragm motion (p < 0.001) and distance between the FHL and CPV at inspiration (p = 0.036) revealed the maximum effect on FHL motion. In conclusion, RE and FHL motion are affected by the degree of respiratory movement and the location of the FHL. Therefore, image fusion with CT images should be used with caution if the degree of respiratory motion is significant or if the FHL is located at the periphery of the liver.     

A comparative cost analysis of the Vaccination Program for US-bound Refugees

BackgroundVaccination Program for US-bound Refugees (VPR) currently provides one or two doses of some age-specific Advisory Committee on Immunization Practices (ACIP)-recommended vaccines to US-bound refugees prior to departure.MethodsWe quantified and compared the full vaccination costs for refugees using two scenarios: (1) the baseline of no VPR and (2) the current situation with VPR. Under the first scenario, refugees would be fully vaccinated after arrival in the United States. For the second scenario, refugees would receive one or two doses of selected vaccines before departure and complete the recommended vaccination schedule after arrival in the United States. We evaluated costs for the full vaccination schedule and for the subset of vaccines provided by VPR by four age-stratified groups; all costs were reported in 2015 US dollars. We performed one-way and probabilistic sensitivity analyses and break-even analyses to evaluate the robustness of results.ResultsVaccination costs with the VPR scenario were lower than costs of the scenario without the VPR for refugees in all examined age groups. Net cost savings per person associated with the VPR were ranged from $225.93 with estimated Refugee Medical Assistance (RMA) or Medicaid payments for domestic costs to $498.42 with estimated private sector payments. Limiting the analyses to only the vaccines included in VPR, the average costs per person were 56% less for the VPR scenario with RMA/Medicaid payments. Net cost savings with the VPR scenario were sensitive to inputs for vaccination costs, domestic vaccine coverage rates, and revaccination rates, but the VPR scenario was cost savings across a range of plausible parameter estimates.ConclusionsVPR is a cost-saving program that would also reduce the risk of refugees arriving while infected with a vaccine preventable disease.     

Treatment effect analysis of curettage for jaw cysts based on volumetric assessment and image registration

The study was conducted to develop a visual and intuitive quantitative evaluation method for maxillary cystic lesions after curettage. Mimics 16.0 and Geomagic Studio 2013 were used to form a precise reconstruction of the cystic lesion morphology of 60 cases; the average reduction rates and 95% confidence interval were calculated. Computed tomography (CT) registration was performed before and after surgery to observe morphology features of the bone regeneration of the cystic area. The average reduction rates (RR) of the cysts after curettage were (43.56 ± 16.79)%, (54.33 ± 17.15)% and (68.53 ± 15.99)% at 3 months, 6 months and 12 months after surgery, respectively. The average monthly reduction rates (MRR) were (12.07 ± 4.35)%, (8.16 ± 2.84)% and (5.35 ± 1.52)% at 3 months, 6 months and 12 months after surgery, respectively. Correlation analysis by comparing with each group showed that the effect of sex and age in the 3-month group and the initial size in the 12-month group on RR and MRR were statistically significant. Within the limitations of the study it seems that the chosen approach for quantitative evaluation of the therapeutic effect of curettage for jaw cystic lesions might facilitate visual and quantitative follow-up of cyst curettage and timely detection of recurrence.