Patient-specific three-dimensional printing spine model for surgical planning in AO spine type-C fracture posterior long-segment fixation

Objective: The aim of this study was to compare duration of surgery, intraoperative fluoroscopy exposure, blood loss and the accuracy of pedicular screw placement between 3D model- assisted surgery and conventional surgery for AO spinal C-type injuries. Methods: In this study 32 patients who were admitted with thoracolumbar AO spinal C-type injuries were included. These patients were divided randomly into two groups of 16 where one group was operated on using conventional surgery and the other group was operated on using 3D model-assisted surgery. During surgery, instrumentation time, amount of blood loss and intraoperative fluoroscopy exposure were recorded. Moreover, the status of the screws in the pedicles was assessed as described by Learch and Wiesner's and regional sagittal angles (RSA) were measured preop and postoperatively. Results: It was found that there was a statistically significant difference in instrumentation time, blood loss and intraoperative fluoroscopy exposure in the 3D model-assisted surgery group (61.9 +/- 4.7 min, 268.4 +/- 42.7 ml, 16.3 +/- 1.9 times) compared to the conventional surgery group (75.5 +/- 11.0 min, 347.8 +/- 52.2 mL, 19.7 +/- 2.4 times) (t = 4.5325, P < 0.0001 and t= 4.7109, P < 0.0001 and t = 4.4937, P < 0.0001, respectively) Although the screw misplacement rate of the conventional surgery group was higher than that of the 3D model-assisted surgery group, the only statistically significant difference was in the medial axial encroachment (t = 5.101 P = 0.02). There was no severe misplacement of pedicle screws in either group. There were no statistically significant differences between postoperative RSA angles and were in both groups restored significantly. Conclusion: The results of this study have shown us that the 3D model helps surgeons see patients' pathoanatomy and determine rod lengths, pedicle screw angles and lengths preoperatively and peroparatively, which in turn shortens operative time, reduces blood loss and fluoroscopy exposure

Can the success of structured therapy for giggle incontinence be predicted?

ABSTRACT Introduction: To evaluate possible factors that can guide the clinician to predict potential cases refractoriness to medical treatment for giggle incontinence (GI) and to examine the effectiveness of different treatment modalities. Material and methods: The data of 48 children referred to pediatric urology outpatient clinic between 2000 and 2013 diagnosed as GI were reviewed. Mean age, follow-up, GI frequency, associated symptoms, medical and family history were noted. Incontinence frequency differed between several per day to less than once weekly. Children were evaluated with uroflowmetry-electromyography and post-void residual urine. Clinical success was characterized as a full or partial response, or nonresponse as defined by the International Children's Continence Society. Univariate analysis was used to find potential factors including age, sex, familial history, GI frequency, treatment modality and dysfunctional voiding to predict children who would possibly not respond to treatment. Results: Mean age of the patients was 8.4 years (range 5 to 16). Mean follow-up time and mean duration of asymptomatic period were noted as 6.7±1.4 years and 14.2±2.3 months respectively. While 12 patients were treated with only behavioral urotherapy (Group-1), 11 patients were treated with alpha-adrenergic blockers and behavioral urotherapy (Group-2) and 18 patients with methylphenidate and behavioral urotherapy (Group-3). Giggle incontinence was refractory to eight children in-group 1; six children in-group 2 and eight children in-group 3. Daily GI frequency and dysfunctional voiding diagnosed on uroflowmetry-EMG were found as outstanding predictive factors for resistance to treatment modalities. Conclusions: A variety of therapies for GI have more than 50% failure rate and a standard treatment for GI has not been established. The use of medications to treat these patients would not be recommended, as they appear to add no benefit to symptoms and may introduce severe adverse effects

Surgical advantages of using 3D patient-specific models in high-energy tibial plateau fractures

Aktuglu, Kemal/0000-0001-8058-0364; GOKMEN, Figen/0000-0001-9635-6308WOS: 000530776400003PubMed: 32377923Purpose Treatment of tibial plateau fractures are difficult due to the intra-articular nature of the proximal tibia and extensive involvement of the soft tissue envelope. in this study, we investigated the surgical experience acquired using digitally designed life-size fracture models to guide as a template to place plates and screws in the treatment of tibial plateau fractures and anatomic reduction of joint. Methods 20 tibial plateau frature patients were divided into two equal surgery groups as conventional versus 3D model assisted. the fracture line angles, depression depth, and preoperative/postoperative Rasmussen knee score were measured for each patient. Results the duration of the operation, blood loss volume, turniquet time and number of intraoperative fluoroscopy was 89.5 +/- 5.9 min, 160.5 +/- 15.3 ml, 74.5 +/- 6 min and 10.7 +/- 1.76 times, for 3D printing group and 127 +/- 14.5 min, 276 +/- 44.8 ml, 104.5 +/- 5.5 min and 18.5 +/- 2.17 times for the conventional group, respectively. 3D model-assisted group indicated significantly shorter operation time, less blood loss volume, shorter turniquet and fluoroscopy times, and better outcome than the conventional one. Conclusions the customized 3D model was user friendly, and it provided a radiation-free tibial screw insertion. the use of these models assisted surgical planning, maximized the possibility of ideal anatomical reduction and provided individualized information concerning tibial plateau fractures

A retrospective comparison of the conventional versus three-dimensional printed model-assisted surgery in the treatment of acetabular fractures

Objective: the aim of this study was to compare the clinical and radiological outcomes of the conventional versus individualized three-dimensional (3D) printing model-assisted pre-contoured plate fixation in the treatment of patients with acetabular fractures. Methods: the data from 18 consecutive patients who underwent surgery for the acetabular fractures were retrospectively analyzed. the patients were divided into two groups (9 in each): conventional and 3D printed model-assisted. the groups were then compared in terms of the duration of surgery, time of instrumentation, time of intraoperative fluoroscopy, and volume of blood loss. the quality of the fracture reduction was also evaluated postoperatively by radiography and computed tomography in both the groups. the quality of the fracture reduction was defined as good (2 mm) based on the amount of displacement in the acetabulum. Results: the conventional group included 9 patients (9 males; mean age=41.7 years; age range=16-70) with a mean follow-up of 11.9 months (range=8-15); the 3D printed model-assisted group consisted of 9 patients (9 males; mean age=46.2 years; age range=30-66) with a mean follow-up of 10.33 months (range=7-17). the average duration of surgery, mean time of instrumentation, time of intraoperative fluoroscopy, and mean volume of blood loss were 180.5±9 minutes, 36.2±3.6 minutes, 6±1 times, and 403.3±52.7 mL in the 3D printed model-assisted group, and 220±15.6 minutes, 57.4±10.65 minutes, 10.4±2.2 times, and 606.6±52.7 mL in the conventional group, respectively. Procedurally, the average duration of surgery, mean time of instrumentation, and mean time of fluoroscopy were significantly shorter, and the mean volume of blood loss was significantly lower in the 3D printed model-assisted group (p<0.05). the quality of the fracture reduction was good in 7 patients (78%) in the conventional group and 8 patients (89%) in the 3D printed model-assisted group. Conclusion: As compared with the conventional surgery, the 3D printing model-assisted pre-contoured plate fixation technique can improve the clinical and radiological outcomes of the acetabular fractures, with shorter surgery, instrumentation, intraoperative fluoroscopy times, and blood loss

A prospective, randomized comparative study of monopolar transurethral resection of the prostate photoselective vaporization of the prostate with GreenLight 120-W laser, in prostates less than 80 cc

Objective: In this study we aimed to compare photoselective vaporization (PVP) with the GreenLight 120-W Laser and monopolar transurethral resection as surgical treatments of prostates less than 80 cc in men with obstructive benign prostatic hyperplasia. Methods: From February 2009 to March 2012 we allocated 101 patients with a prostate glands of less than 80 cc; patients were randomly assigned for surgical treatment with monopolar transurethral resection of the prostate (TURP) ( n  = 62) or PVP ( n  = 39). Serum prostate specific antigen (PSA), International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM), maximum flow rate (Q max ) postmicturition residual (PMR), transrectal ultrasound volumes (TRUS), postvoid urine residual (PVR), complications, re-operations and hospitalization time were collected. The patients were seen in the follow up at 6, 12 and 24 months. Results: Median age was 69 (56–87) years old in the TURP group and 67 (51–87) years old in the PVP group. Mean preoperative prostate volume was 55 cc (40–72) and 60 cc (41–75) cc in the TURP group versus the PVP group. There was no statistically difference in subjectively (IPSS, SHIM) and objectively (Q max -PMR) parameters and postoperatively complication rates between the two groups ( p   >  0.05). A significant difference was observed in the PVP group with a 2 (1–4) days hospital stay compared with 5 (3–9) days for the TURP group ( p  <  0.001). Conclusion: Prostate PVP and TURP are effective surgical treatments for benign prostatic hyperplasia. Postoperative functional improvements were durable and equivalent in the two groups. The two techniques have a similar complication rate

CASC11 promotes aggressiveness of prostate cancer cells through miR-145/IGF1R axis

Background Prostate cancer (PCa) is the most common malignancy diagnosed among men after lung cancer in developed countries. Investigation of the underlying molecular mechanisms of PCa is urgently needed in order to develop better therapeutic strategies and to reveal more effective therapeutic targets. In this study, we aimed at exploring the potential functions of CASC11 in association with miR-145 and IGF1R during the malignant progression of PCa cells. Methods We initially investigated the oncogenic potential of noncoding members of CASC gene family and analyzed the effects of CASC11 overexpression on proliferation, migration, and colony formation ability of DU145, LNCaP, and PC3 PCa cells. We, then, exprlored the association of CASC11, miR-145, and IGF1R expression and their impacts on PI3K/AKT/mTOR signaling pathway in in vitro models. Results In silico analysis revealed that of the CASC family only CASC11 showed consistent results considering its differential expression as well as its association with the overall survival of patients. We demonstrated that ectopic overexpression of CASC11 significantly increased the proliferation, colony formation, and migration capacity in all three cell lines. CASC11 overexpression caused suppression of miR-145 and overexpression of IGF1R, leading to activation of PI3K/AKT/mTOR signaling pathway. Conclusion In summary, we found that CASC11 is upregulated in PCa cells and clinical tumor samples in comparison to corresponding controls and revealed that ectopic CASC11 overexpression promotes cellular phenotypes associated with PCa progression through CASC11/miR-145/IGF1R axis