Three-dimensional virtual bone bank system workflow for structural bone allograft selection: a technical report

Structural bone allograft has been used in bone defect reconstruction during the last fifty years with acceptable results. However, allograft selection methods were based on 2-dimensional templates using X-rays.Thanks to preoperative planning platforms, three dimensional (3D) CT-derived bone models were used to define size and shape comparison between host and donor. The purpose of this study was to describe the workflow of this virtual technique in order to explain how to choose the best allograft using a virtualbone bank system. We measured all bones in a 3D virtual environment determining the best match. The use of a virtual bone banksystem has allowed optimizing the allograft selection in a bone bank, providing more information to the surgeons before surgery.In conclusion, 3D preoperative planning in a virtual environment for allograft selection is an important and helpful tool in order to achieve a good match between host and donor.Fil: Ritacco, Lucas. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Farfalli, Germán Luis. Hospital Italiano; ArgentinaFil: Milano, Federico Edgardo. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Ayerza, Miguel Ángel. Hospital Italiano; ArgentinaFil: Muscolo, Domingo L.. Hospital Italiano; Argentina. Hospital Italiano; ArgentinaFil: Aponte Tinao, Luis. Hospital Italiano; Argentin

Three-Dimensional Printing and Navigation in Bone Tumor Resection

One of the most promising advances raised by the current computer age is performing research “in silico,” which means computer-assisted. The objective of this chapter is firstly to evaluate if a 3D in-silico model of an oncological patient could be used to make a 3D-printed prototype in real scale, discriminating precisely healthy tissues, tumoral tissues and oncological margins. Secondly, the objective is to evaluate if this prototype could be representative enough to allow testing osteotomies under navigated guidance based on images. A tumor resection for a patient with diagnosed metaphyseal osteosarcoma of the proximal tibia was transferred into a rapid prototyping model, fabricated using 3D printing and representing different structures in different colors. The planned osteotomy was executed using Stryker Navigator to guide the cutting saw and the prototype was opened to verify the precision of the performed osteotomy. Both osteotomy planes showed successful correspondence with the safe margin, with a maximum error of 1 mm. The application of these techniques in general orthopedics would help to reduce the incidence of unforeseen intraoperative failures, contributing to obtain predictable surgical procedures. This would implement a new way of performing development, research and training in orthopedics and traumatology by in-silico technology

Robotic therapy : Cost, accuracy, and times. New challenges in the neonatal intensive care unit

Background: The medication process in the Neonatal Intensive Care Unit (NICU), can be challenging in terms of costs, time, and the risk of errors. Newborns, especially if born preterm, are more vulnerable to medication errors than adults. Recently, robotic medication compounding has reportedly improved the safety and efficiency of the therapeutic process. In this study, we analyze the advantages of using the I.V. Station\uae system in our NICU, compared to the manual preparation of injectable drugs in terms of accuracy, cost, and time. Method: An in vitro experimental controlled study was conducted to analyze 10 injectable powdered or liquid drugs. Accuracy was calculated within a 5% difference of the bottle weight during different stages of preparation (reconstitution, dilution, and final product). The overall cost of manual and automated preparations were calculated and compared. Descriptive statistics for each step of the process are presented as mean \ub1 standard deviation or median (range). Results: The median error observed during reconstitution, dilution, and final therapy of the drugs prepared by the I.V. Station\uae ranged within \ub15% accuracy, with narrower ranges of error compared to those prepared manually. With increasing preparations, the I.V. Station\uae consumed less materials, reduced costs, decreased preparation time, and optimized the medication process, unlike the manual method. In the 10 drugs analyzed, the time saved from using the I.V. Station\uae ranged from 16 s for acyclovir to 2 h 57 min for teicoplanin, and cost savings varied from 8% for ampicillin to 66% for teicoplanin. These advantages are also capable of continually improving as the total amount of final product increases. Conclusions: The I.V. Station\uae improved the therapeutic process in our NICU. The benefits included increased precision in drug preparation, improved safety, lowered cost, and saved time. These advantages are particularly important in areas such as the NICU, where the I.V. Station\uae could improve the delivery of the high complexity of care and a large amount of intravenous therapy typically required. In addition, these benefits may lead to the reduction in medication errors and improve patient and family care; however, additional studies will be required to confirm this hypothesis

Estímulo no crescimento e na hidrólise de ATP em raízes de alface tratadas com humatos de vermicomposto: i - efeito da concentração.

O vermicomposto contém uma concentração elevada de substâncias húmicas e já é bem conhecido o efeito do seu uso sobre as propriedades do solo. No entanto,a ação direta das substâncias húmicas sobre o metabolismo das plantas é menos conhecida. O objetivo deste trabalho foi avaliar o uso de humatos extraídos de vermicomposto de esterco de curral com KOH 0,1 mol L-1 sobre o desenvolvimento e metabolismo de ATP em plântulas de alface. Após a germinação, plântulas de alface foram tratadas com os humatos em concentrações que variaram de 0 a 100 mg L-1 de C, durante quinze dias. Foram avaliados o crescimento da raiz e a atividade das bombas de H+ isoladas da fração microssomal do sistema radicular. Foi observado aumento na matéria fresca e seca do sistema radicular, bem como no número de sítios de mitose, raízes emergidas do eixo principal, na área e no comprimento radiculares, com o uso do humato na concentração de 25 mg L-1 de C. Também foi observado, nessa concentração, aumento significativo na hidrólise de ATP pelas bombas de H+, responsáveis pela geração de energia necessária à absorção de íons e pelo crescimento celular

Maternal views on facilitators of and barriers to breastfeeding preterm infants

Background: The supply of breast milk to preterm infants tends to occur at a lower rate than that recorded among term infants. We aimed to investigate the facilitators of and barriers to breastfeeding during hospital stay according to the experiences of mothers that gave birth to premature infants requiring admission to neonatal intensive care unit. Methods: A cross-sectional questionnaire survey was conducted. Mothers who had delivered a newborn with a gestational age 6433 weeks requiring intensive care, entered the study. Basic subjects' characteristics and infant feeding practices were also recorded. Results: A total of 64 mothers were enrolled, leading to a total of 81 infants. At discharge, any breastfeeding was recorded in 66% of infants, with 27% of those infants being exclusively breastfed. Any infant was exclusively fed directly at the breast. Most mothers experienced adequate support during their infant's hospitalization and reported satisfaction with breastfeeding. Almost all mothers felt that feeding their infant human milk was beneficial for the infant's health. Thirty percent of the mothers reported that they had experienced some obstacles to breastfeeding. Specifically, infants born to mothers who experienced difficulties in pumping breast milk (OR = 4.6; CI 1.5-13.9) or in providing an adequate amount of milk to the infant (OR = 3.57; CI 1.1-11.5) were at higher risk of being fed with formula at discharge. Conclusions: On the basis of the present results, health care professionals should target their efforts to optimize breastfeeding support for mothers of premature infants admitted to level III care, especially by improving breast milk production and endorsing direct breastfeeding

Complementary feeding practices in a cohort of Italian late preterm infants

Limited data are available on complementary feeding in preterm infants, who show increased nutritional needs and are at risk of altered postnatal growth. The aim of this study was to investigate the timing and content of complementary feeding in a cohort of late preterm infants. We conducted a prospective, observational study, including mothers who had given birth to infants admitted to level I or II of care with a gestational age between 34 and 36 weeks. Mothers were contacted at 3, 6 and 12 months after delivery by phone calls and were asked about their infant\u2019s mode of feeding and the timing and schedule of the introduction of different solid foods types. A total of 49 mothers and 57 infants completed the study. The mean postnatal age of the introduction of complementary foods was 5.7 \ub1 0.7 months. Low energy and/or low protein-dense foods were first introduced in most infants. Fruit as the first type of complementary food in the infant\u2019s diet was associated with a 1.6-month advance in initiating complementary feeding. The present findings provide further insight into complementary feeding practices in late preterm infants and underline the need for specific recommendations addressing this vulnerable population

Postoperative assessment in computer assisted selection of femur osteoarticular allograft

El objetivo de nuestro trabajo fue comparar dos grupos de pacientes tratados con trasplantes osteoarticulares del fémur distal en términos de: 1) el volumen del fémur distal del receptor y del trasplante, 2) la superficie articular de contacto del fémur distal del receptor y del trasplante, 3) el ángulo del valgo anatómico femoral del fémur distal del receptor y del trasplante. Material y métodos: se realizó una búsqueda retrospectiva entre 2002 y 2012 analizando a pacientes tratados con un trasplante osteoarticular de fémur distal. Se incluyó un total de 32 pacientes. Estos fueron divididos en dos grupos de acuerdo con el método de selección del trasplante: Grupo 1, conformado por 16 pacientes con trasplantes seleccionados mediante 2D (tomografía) y Grupo 2, 16 pacientes con trasplantes seleccionados a través de un método 3D. La evaluación fue realizada por un observador independiente y ciego para los dos grupos. Resultados: las diferencias en las pruebas de estimación de volumen y superficie articulares entre el donante y el receptor no fueron estadísticamente significativas (p>0,05). Sin embargo, la diferencia entre los ángulos de valgo del fémur receptor y el fémur donante, seleccionados por el método 2D fue significativa (p0,05). Conclusión: el método de relación de un donante con un banco de huesos virtual luego de resección y reconstrucción con un aloinjerto osteoarticular permite obtener una mejor alineación particular que aquellos seleccionados solo con un método bidimensional.The aim of our study was to compare two groups of patients treated with distal femur osteoarticular allograft in terms of: 1) the volume of the distal femur of the allograft and patient, 2) the articular surface contact, 3) the anatomical femoral valgus angle. Material and methods: a retrospective review was performed between 2002 and 2012 and all patients with an osteo-articular allograft of the distal femur were analysed. A total of 32 patients were included in the study. Patients were divided into two groups according to the selection method of the allograft: Group 1, 16 patients with allograft selected by 2D (CT) and Group 2, 16 patients selected through a 3D method. The evaluation was done by an independent and blind observer. Results: the differences in terms of volume estimation and joint surface contact between the donor allograft and patient distal femur were not statistically significant (p>0.05). However, the difference between the valgus angle showed significant differences between donor and patient femurs selected by the 2D method (p0.05). Conclusion: the 3D method for allograft selection of the distal femur showed better results in limb alignment compared to 2D selection method.Fil: Milano, Federico Edgardo. Instituto Tecnológico de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Albergo, José Ignacio. Hospital Italiano; ArgentinaFil: Farfalli, Germán Luis. Hospital Italiano; ArgentinaFil: Aponte Tinao, Luis Alberto. Hospital Italiano; ArgentinaFil: Ayerza, Miguel Angel. Hospital Italiano; ArgentinaFil: Muscolo, Domingo L.. Hospital Italiano; ArgentinaFil: Ritacco, Lucas Eduardo. Hospital Italiano; Argentin

Selection of massive bone allografts using shape-matching 3-dimensional registration

Background and purpose Massive bone allografts are used when surgery causes large segmental defects. Shape-matching is the primary criterion for selection of an allograft. The current selection method, based on 2-dimensional template comparison, is inefficient for 3-dimensional complex bones. We have analyzed a 3-dimensional (3-D) registration method to match the anatomy of the allograft with that of the recipient