Middle cranial fossa approach to repair tegmen defects assisted by three‐dimensionally printed temporal bone models

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138399/1/lary26438.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138399/2/lary26438_am.pd

3D printing is a transformative technology in congenital heart disease

Survival in congenital heart disease has steadily improved since 1938, when Dr. Robert Gross successfully ligated for the first time a patent ductus arteriosus in a 7-year-old child. To continue the gains made over the past 80 years, transformative changes with broad impact are needed in management of congenital heart disease. Three-dimensional printing is an emerging technology that is fundamentally affecting patient care, research, trainee education, and interactions among medical teams, patients, and caregivers. This paper first reviews key clinical cases where the technology has affected patient care. It then discusses 3-dimensional printing in trainee education. Thereafter, the role of this technology in communication with multidisciplinary teams, patients, and caregivers is described. Finally, the paper reviews translational technologies on the horizon that promise to take this nascent field even further

GATA4 is essential for bone mineralization via ERα and TGFβ/BMP pathways

Osteoporosis is a disease characterized by low bone mass, leading to an increased risk of fragility fractures. GATA4 is a zinc-finger transcription factor that is important in several tissues, such as the heart and intestines, and has recently been shown to be a pioneer factor for estrogen receptor alpha (ERα) in osteoblast-like cells. Herein, we demonstrate that GATA4 is necessary for estrogen-mediated transcription and estrogen-independent mineralization in vitro. In vivo deletion of GATA4, driven by Cre-recombinase in osteoblasts, results in perinatal lethality, decreased trabecular bone properties, and abnormal bone development. Microarray analysis revealed GATA4 suppression of TGFβ signaling, necessary for osteoblast progenitor maintenance, and concomitant activation of BMP signaling, necessary for mineralization. Indeed, pSMAD1/5/8 signaling, downstream of BMP signaling, is decreased in the trabecular region of conditional knockout femurs, and pSMAD2/3, downstream of TGFβ signaling, is increased in the same region. Together, these experiments demonstrate the necessity of GATA4 in osteoblasts. Understanding the role of GATA4 to regulate the tissue specificity of estrogen-mediated osteoblast gene regulation and estrogen-independent bone differentiation may help to develop therapies for postmenopausal osteoporosis

Approach to amiodarone induced thyroid storm: A case report

Thyroid storm is a thyroid emergency with increased risk for mortality due to elevated levels of circulating thyroid hormone. While it can be caused by a variety of etiologies, thyroid storm secondary to amiodarone can be particularly challenging to manage. This paper describes a case of a 65-year-old man who presented from outside hospital with persistent ventricular tachycardia and multiple implantable defibrillator firings from thyroid storm following amiodarone infusion. Despite conventional first-line pharmacotherapy, he developed cardiogenic shock and multi-organ failure requiring therapeutic plasma exchange. Due to continued deterioration, he underwent emergent total thyroidectomy. Following surgery, the patient experienced clinical stabilization and has now made a complete recovery. In this paper, we highlight the complexities in the management of amiodarone induced thyrotoxicosis and offer a treatment algorithm and indications for early, definitive management with thyroidectomy

A Deployable Curriculum with 3D Printed Skills Trainers for Altered Airway Management

http://deepblue.lib.umich.edu/bitstream/2027.42/191954/2/2024_BMC Med Ed_Deployable Curriculum with 3D Printing for Altered Airways.pdfPublished versionDescription of 2024_BMC Med Ed_Deployable Curriculum with 3D Printing for Altered Airways.pdf : Published versio

To Pack a Nose: High-Fidelity Epistaxis Simulation Using 3D Printing Technology

BACKGROUND: Initial management and stabilization of epistaxis is managed by a diverse offset of clinical providers with variable levels of training. OBJECTIVE: To determine the anatomic and clinical fidelity and ease of use of a novel simulator for the training and assessment of epistaxis management skills. STUDY DESIGN: Qualitative Research Study using expert questionnaire\u27s for validation of a newly developed simulator. METHODS: We performed a quasi-experimental intervention with 22 otolaryngology faculty and 10 trainees who independently evaluated the simulator. Data were collected in three phases: phase 1 (preliminary evaluation), phase 2 (final expert evaluation), and phase 3 (trainee evaluation). We designed a three-dimensional (3D) printed model from a de-identified patient computed tomography scan. Artificial blood was circulated through catheters to simulate bleeding from three distinct sites (sphenopalatine, Kiesselbach\u27s plexus, and anterior ethmoid). Four domains were assessed: Physical and anatomic attributes, Realism of experience, Ability to perform tasks, and Value and clinical relevance. Internal structure and validity were measured with Cronbach\u27s alpha and item outfit mean-square statistics. RESULTS: Results from otolaryngology faculty showed very high median ratings for Value of the simulator as a training tool (4.0/4) and high ratings for Relevance to practice (4.0/4), and realism of experience (4.0/4). Responses from otolaryngology trainees demonstrated high value for clinical training (4.0/4) and high likelihood to recommend use for future trainees (4.0/4). Confidence in managing epistaxis before (1.0/4) and after (3.0/4) simulator use was statistically improved (P = .03). CONCLUSIONS: Using 3D printing technology, we created a novel simulator for epistaxis management. Preliminary evidence suggests the model is cost-effective, anatomically realistic, relevant to trainees\u27 educational needs, and valuable as a training tool. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:747-753, 2022