Three-dimensional-printed marker-based augmented reality neuronavigation: a new neuronavigation technique

OBJECTIVE The aim of this study was to assess the precision and feasibility of 3D-printed marker-based augmented reality (AR) neurosurgical navigation and its use intraoperatively compared with optical tracking neuronavigation systems (OTNSs). METHODS Three-dimensional-printed markers for CT and MRI and intraoperative use were applied with mobile devices using an AR light detection and ranging (LI DAR) camera. The 3D segmentations of intracranial tumors were created with CT and MR images, and preoperative registration of the marker and pathology was performed. A patientspecific, surgeon-facilitated mobile application was developed, and a mobile device camera was used for neuronavigation with high accuracy, ease, and cost-effectiveness. After accuracy values were preliminarily assessed, this technique was used intraoperatively in 8 patients. RESULTS The mobile device LIDAR camera was found to successfully overlay images of virtual tumor segmentations according to the position of a 3D-printed marker. The targeting error that was measured ranged from 0.5 to 3.5 mm (mean 1.70 +/- 1.02 mm, median 1.58 mm). The mean preoperative preparation time was 35.7 +/- 5.56 minutes, which is longer than that for routine OTNSs, but the amount of time required for preoperative registration and the placement of the intraoperative marker was very brief compared with other neurosurgical navigation systems (mean 1.02 +/- 0.3 minutes). CONCLUSIONS The 3D-printed marker-based AR neuronavigation system was a clinically feasible, highly precise, low-cost, and easy-to-use navigation technique. Three-dimensional segmentation of intracranial tumors was targeted on the brain and was clearly visualized from the skin incision to the end of surgery

Evaluation of complications and quality of life of patient after surgical extraction of mandibular impacted third molar teeth

Abstract Background The aim of our study is to evaluate the postoperative complications after the extraction of impacted third molar teeth and to investigate the effects of these complications on the quality of life of patients. Methods Demographic, clinical, and radiological evaluations were conducted, covering factors like age, gender, and tooth position. Clinical measurements, pain and edema assessments, and quality of life evaluations through OHIP-14 scores were performed. Preoperative and postoperative mouth opening, trismus, alveolitis and dehiscence were evaluated. Results A total of 100 patients were included in our study. No significant gender-based differences were found in measurements, pain, or swelling. There was no statistically significant difference between the preoperative and postoperative results of difference A-C, difference B-E, difference A-D, and difference mouth opening. Procedure duration correlated positively with age, alveolar osteitis, trismus, and swelling. Postoperative quality of life, assessed by OHIP-14, demonstrated a negative correlation with age and trismus. It was observed that the gender and the tooth positions of the patients had no effect on the severity of postoperative pain and edema. Conclusions As the age of the patients increases and the duration of the procedure increases, the rate of postoperative complications increases and it is concluded that the quality of life decreases significantly

The Effect of Reduction Mammaplasty on the Vertebral Column: A Radiologic Study

Some studies emphasized that anatomic mechanisms of vertebral aberrations could be associated with large breasts. The effect of mammaplasty operation on the vertebral column and body posture seems to be beneficial; in this trial, it was planned to investigate the objective radiologic effect of reduction mammaplasty on the posture of the vertebral column in a group of patients operated due to the large breasts. Thirty-four white women with large breasts were enrolled in this study. The patients were divided into three groups according to their breast cup sizes. Anteroposterior and lateral radiographs of the lumbosacral and thoracic spine were taken at baseline preoperatively, and the same radiographic images were taken in an average of 12 months later than the reduction mammaplasty operation. All were evaluated and compared for thoracic kyphosis angle and lumbar lordosis angle both preoperatively and postoperatively. The mean thoracic kyphosis angle was 40,53 preoperatively and 39,38 postoperatively. However, there was no statistically significant difference between the preoperative and postoperative measurements in all groups (P>0,05). The mean lumbar lordosis angle was 54,71 preoperatively and 53,18 postoperatively. Regarding the preoperative and postoperative measurements of lumbar lordosis angles, no statistically significant difference was found between the groups (P>0,05). Although breast size may be an important factor that affects body posture, reduction mammaplasty operations have little or no radiologic effect on the vertebral column

Smoke-free Ege: An attempt for an integrative prevention strategy for tobacco control at a University setting

Introduction Ege University is a pioneering university at Ege region with its 70 000 students and approximately 3000 academic staff. Tobacco control policies, parallel to the current regulations in the country, are an important issue for Ege University too, yet it bares important opportunities as well as barriers for an integrative approach for tobacco control on University Campus. Aim This study aims to explain the construction of Smoke-Free Ege Working Group, its formal initiation at the World No Tobacco Day (May 31st) and its subsequent action plan structured in the light of MPOWER. Methods Since 1999, smoking cessation outpatient service delivery points have been the main units of motivation for tobacco control policies at Ege University. Although Turkey is moving well about tobacco regulations, adherence to regulations is deficient and high prevalence of smoking among university staff and students remains as a major concern throughout the years. In March 2018, the administrative bodies of Medical School, have dealt their concerns to the units serving care for cessation and have gathered them at a first meeting. The Dean and Medical Manager of Medical Faculty, with a non-smoker administrative team, mentored and facilitated these efforts. Starting at this point, with regular meetings, the representatives determined their objectives, current barriers and opportunities. The construction of Smoke-Free Ege Working Group has rooted from these consecutive meetings. In the light of MPOWER, specific objectives at University Campus were listed. The major aim of the group was recognized as “changing the norms and culture for smoking”. This needed a good promotion strategy as well as collaboration with staff, students and administrative units. The efforts were collaborated with the Communications Unit of the University. A logo was created, brochures to raise awareness for the Smoke Free issue and the Working group, were prepared. The formal presentation of the Working Group was planned as a colorful activity on World No Tobacco Day, May 31st. To gather more visibility at the social media and press, representatives from three major opponent sports teams of Izmir city were invited. Results The Working Group was introduced to the media in the presence of the Rector, Dean, Medical managerl and all administrative units of the Medical School. Staff who succeeded to stop smoking, at the cessation service of the University, were awarded with certificates. The media showed great interest in the activity as it was put as “the famous sportsmen are supporting the efforts for a Smoke-free university”. Students and staff attended and shared the activity in social media as the entrance of the meeting was also colorfully designed for such promotion. Conclusions The Working Group has achieved to attract attention of staff, students and responsible bodies of the University and now moving forward for Smoke –Free Councils with students and staff representatives. Barriers and opportunities will be discussed, actions in the light of MPOWER, will be planned at these Councils. Smoke –Free Unit certifications and awards, designing smoking points outside of education and hospital settings and changing the “norm” are targeted

Awareness and Knowledge of Pneumococcal Vaccination in Cardiology Outpatient Clinics and the Impact of Physicians' Recommendations on Vaccination Rates

Aim: We aimed to evaluate the awareness of pneumococcal vaccination (PCV13, PPSV23) in general cardiology outpatient clinics and impact of physicians' recommendations on vaccination rates. Methods: This was a multicenter, observational, prospective cohort study. Patients over the age of 18 from 40 hospitals in different regions of Turkey who applied to the cardiology outpatient clinic between September 2022 and August 2021 participated. The vaccination rates were calculated within three months of follow-up from the admitting of the patient to cardiology clinics. Results: The 403 (18.2%) patients with previous pneumococcal vaccination were excluded from the study. The mean age of study population (n = 1808) was 61.9 +/- 12.1 years and 55.4% were male. The 58.7% had coronary artery disease, hypertension (74.1%) was the most common risk factor, and 32.7% of the patients had never been vaccinated although they had information about vaccination before. The main differences between vaccinated and unvaccinated patients were related to education level and ejection fraction. The physicians' recommendations were positively correlated with vaccination intention and behavior in our participants. Multivariate logistic regression analysis showed a significant correlation between vaccination and female sex [OR = 1.55 (95% CI = 1.25-1.92), p < 0.001], higher education level [OR = 1.49 (95% CI = 1.15-1.92), p = 0.002] patients' knowledge [OR = 1.93 (95% CI = 1.56-2.40), p < 0.001], and their physician's recommendation [OR = 5.12 (95% CI = 1.92-13.68), p = 0.001]. Conclusion: To increase adult immunization rates, especially among those with or at risk of cardiovascular disease (CVD), it is essential to understand each of these factors. Even if during COVID-19 pandemic, there is an increased awareness about vaccination, the vaccine acceptance level is not enough, still. Further studies and interventions are needed to improve public vaccination rates

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)