Search Results (1,284)

Patient-specific lattice implants (PSLIs) and modular porous scaffolds have emerged as promising solutions for treating diaphyseal segmental defects of the femur and tibia, particularly where conventional reconstruction methods fall short. This second part of our two-part review focuses on how current studies transform computed tomography (CT) and $\mathsf{\mu }$CT datasets into architected lattice implants, as well as how these constructs are fabricated and numerically, mechanically, biologically, and clinically verified. We outline imaging pipelines, including Digital Imaging and Communications in Medicine (DICOM) acquisition, segmentation, contralateral mirroring, and Hounsfield Units (HU)–density–elasticity mapping, and show how these choices impact finite element (FE) models and print-ready geometries. Next, lattice design strategies and mixed-material concepts are compared and linked to specific additive manufacturing routes in metals, polymers, and bioceramics, such as laser powder bed fusion (LPBF), electron beam melting (EBM), fused deposition modeling (FDM), material jetting, and extrusion-based bioprinting. Methodological overviews of linear–elastic models and homogenized finite element (FE) models, along with bench-top mechanical tests, in vitro cell assays, in vivo animal studies, and early clinical series, are utilized to categorize the studies into four pathways: simulation (S), mechanical (E_mech), biological (E_bio), and validation (V). Based on the reviewed literature, we establish a general workflow for CT implants. We identify common gaps in the process, observe insufficient reporting of imaging and modeling details, note a lack of data on fatigue and remodeling, and recognize the limited size of clinical cohorts. Additionally, we provide practical recommendations for developing more standardized and scalable planning pipelines. Part 1 of this two-part review studied defect patterns, anatomical location, and fixation strategies for patient-specific lattice implants used in femoral and tibial segmental reconstruction, with emphasis on how defect morphology and subregional anatomy influence construct selection and mechanical behavior. It established a defect- and fixation-centered review that provides the clinical and anatomical context for the workflow and validation analysis presented in Part 2. Full article

Background: Interhemispheric coherence, a coherence value between symmetrically opposite electroencephalography (EEG) electrodes, can be considered as a representation of connectivity through commissural fibers. In general, these commissural fibers are the major pathway of communication between hemispheres. However, in patients with drug-resistant generalized epilepsy (GE), these fibers also play an important role in propagating seizure activities to the contralateral hemisphere. The differences in interhemispheric coherence between epilepsy patients and patients without epilepsy (non-E) remain poorly understood. This study compared interhemispheric coherence values between these groups and discussed the potential usage of coherence analysis in the field of epilepsy. Methods: We retrospectively collected EEG data from patients with severe non-lesional GE over 20 years old who underwent corpus callosotomy. To compare interhemispheric coherence, EEG data from 10 non-E patients were prepared. In each patient, EEG data during non-rapid eye movement (NREM) sleep were collected. Interhemispheric coherence in eight pairs of electrodes in five frequency bands was calculated. Interhemispheric coherence values were compared between GE and non-E groups. Results: In each frequency band and electrode pair, interhemispheric coherence values of P3-P4 in delta, C3-C4 in theta, C3-C4 in alpha, F3-F4 and C3-C4 in beta, and C3-C4 and P3-P4 in gamma frequency band were significantly lower for GE than for non-E. The overall interhemispheric coherence value was significantly lower for GE than for non-E. Conclusions: Interhemispheric coherence values were lower for severe GE than for non-E in adults during NREM sleep. Full article

Background/Objectives: Juvenile osteochondritis dissecans (JOCD) of the knee is commonly treated using conservative or joint-preserving surgical techniques. While clinical outcomes are generally favorable, the risk of early cartilage degeneration remains unclear. Joint space width (JSW) on weight-bearing radiographs serves as an indirect marker of cartilage health. Artificial intelligence (AI)-based JSW assessment may enable sensitive and reproducible detection of early degenerative changes. Methods: This cross-sectional feasibility study included 21 skeletally immature patients treated for JOCD of the distal femur between 2002 and 2017. Treatment modalities comprised conservative management, retrograde drilling, and fragment refixation. Fully automated JSW measurements were performed on standardized anteroposterior knee radiographs using a validated AI-based software IB Lab KOALA™, Version 2.4. JSW of the affected compartment was compared with the contralateral knee and between treatment groups. Clinical outcomes were assessed using the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) score. Additionally, a systematic review of the literature on post-treatment degenerative changes following OCD therapy was conducted according to PRISMA guidelines. Results: Compared with manually reviewing images, the software IB Lab KOALA™, Version 2.4 as easy to implement. AI-based analysis revealed no significant differences in JSW between the affected and contralateral knees, nor between treatment modalities. Average JSW exceeded 6 mm in all groups after a median follow-up of 64 (min. 27, max. 177) months. Clinical scores were high and comparable across treatments. A moderate positive correlation was observed between the JSW and Lysholm score, while increasing age and longer follow-up were associated with a reduced JSW. The systematic review identified ten relevant studies, reporting generally favorable long-term clinical outcomes with a low but present risk of osteoarthritis progression. Conclusions: Our AI-based analysis showed no differences in JSW between conservative and joint-preserving surgical treatments of JOCD in the follow-up. This technology can provide a valuable tool for standardized and sensitive radiographic monitoring in young patients. Full article

Background/Objectives: A1 segment asymmetry, including hypoplasia and aplasia, is a well-recognized anatomical variation associated with altered hemodynamic stress and anterior communicating artery (ACoA) aneurysm formation. However, its influence on subsequent aneurysm rupture risk remains controversial. This study aimed to evaluate the relationship between A1 segment morphology and aneurysm rupture risk, as well as its association with aneurysm size and morphological complexity. Methods: A retrospective single-institution analysis was conducted on 211 patients treated for ACoA aneurysms between June 2016 and March 2025. A1 segment morphology was assessed using digital subtraction angiography and categorized as symmetric, hypoplastic (diameter < 1 mm or <50% of the contralateral vessel), or aplastic. Demographic, clinical, and radiological variables were recorded. Statistical analyses included univariate comparisons with Bonferroni correction for multiple testing and multivariable logistic regression to identify independent predictors of aneurysm rupture. Results: The study population had a mean age of 54.72 ± 10.97 years, with a male-to-female ratio of 1.24:1 (55.5% male, 44.5% female). Symmetric A1 segments were observed in 49.3% of patients, hypoplastic segments in 31.3%, and aplastic segments in 19.4%. No statistically significant association was identified between A1 morphology and aneurysm rupture rates (p = 0.251) or mean aneurysm diameter (p = 0.996). Univariate analysis demonstrated that younger age (p = 0.006), male sex (p = 0.016), and smoking (p = 0.033) were associated with rupture. However, none of these factors, including A1 morphology, remained independent predictors of rupture in the multivariable logistic regression model. Conclusions: Although A1 segment asymmetry is common in patients with ACoA aneurysms, it does not independently influence rupture risk or aneurysm morphology. Our findings suggest that rupture behavior is driven primarily by dynamic hemodynamic factors rather than static anatomical variations. Full article

Gasless Transaxillary Robotic Thyroidectomy (G-TART) has undergone significant refinement through the adoption of novel strategies to enhance surgical precision and safety. In this paper, we describe a novel technique that integrates dynamic endoscope repositioning, called the “swing technique”, with the use of a specialized intraoperative neuromonitoring (IONM) probe—Modena Robotic Probe—designed for robotic applications. The procedure, performed using the Da Vinci Xi system (Intuitive Surgical, Sunnyvale, CA, USA), incorporates intermittent IONM during recurrent laryngeal nerve (RLN) dissection. The swing technique involves real-time adjustment of the 30° endoscope between robotic ports to improve visualization within the confined transaxillary (TA) surgical field, particularly during contralateral dissection. Simultaneously, the Modena Robotic Probe, a custom monopolar stimulation probe developed in collaboration with Dr. Langer Medical GmbH for connection to the AVALANCHE^® SI2 neuromonitor, allows precise RLN mapping and verification throughout the operation. This approach could facilitate accurate anatomical tracking, minimize the risk of thermal or mechanical nerve injury, and enable safe navigation in a narrow operative TA tunnel. The adoption of advanced imaging techniques in conjunction with specialized robotic instrumentation may contribute to enhanced surgical safety and accuracy, emphasizing the importance of procedure-specific robotic approaches in thyroid surgery. Full article

Background: Motor imagery-based brain-computer interfaces (MI-BCIs) enable individuals who are unable to perform physical movements to interact with the external world by imagining movements. Users are typically classified as good performers or BCI-illiterate based on the classification accuracy of distinct EEG patterns (e.g., 60% or 70%). Yet, studies show that approximately 70% of users fall within intermediate accuracies between 60% and 80%, and although exceed the chance level, they often fail to achieve reliable MI-BCI control. Intermediate users often exhibit asymmetric motor imagery abilities between left and right hands, highlighting the need for refined early assessment and stratified training approaches. Methods: We employed ICA to decompose each participant’s EEG data and extract independent ERD/ERS components as indicators using a rule-based automated framework. This framework integrated dipole localization, ERD/ERS characteristics, and frequency-band power features of ICs. Importantly, we applied a power spectral parameterization approach to remove the 1/f-like background activity in power estimation and used statistical methods to precisely estimate the latency and duration of ERD. The extracted indicators were subsequently subjected to clustering analysis to categorize participants into four groups. Results: In addition to good performers (24.8%) and poor performers (35.8%), two groups were identified: LgoodRpoor (27.5%), who performed well in left-hand MI but poorly in right-hand MI, and LpoorRgood (11.9%), who showed the opposite pattern. Notably, these unilateral performers did not show significant differences in contralateral ERD but exhibited substantial differences in ipsilateral ERS. Conclusions: The proposed independent event-related brain dynamics model enables more refined stratification of MI-BCI users. Findings from this characterization study may inform the design of graded training protocols, especially for users demonstrating unilateral motor imagery proficiency. Full article

Background/Objectives: To investigate the rate of exudative progression over time in patients with non-exudative macular neovascularization (NE-MNV) associated with various acquired macular degenerations presenting with a double-layer sign (DLS) or triple-layer sign (TLS) on optical coherence tomography (OCT), and to identify potential predictors of this progression. Methods: Fifty-one eyes of fourty-nine patients with a DLS or TLS on OCT images were identified. OCT angiography (OCTA) was performed to detect NE-MNV, and only eyes with confirmed NE-MNV were included in the final analysis. Central macular thickness (CMT), choroidal thickness (CT), morphology of the abnormal vessels, the duration of follow-up, progression to active exudative MNV, and the status of the contralateral eye were assessed. Results: The final analysis included 32 eyes of 30 participants with NE-MNV. The median observation period was 46 months. The causes of NE-MNV were age- related macular degeneration (AMD) in 59.38% of eyes, pachychoroid epitheliopathy (PPE) in 37.50%, and other causes in 3.12%. Exudation developed in 15.62% of eyes (median time to onset: 24 months), predominantly in the AMD subgroup. Abnormalities in the fellow eye were present in 59.38% of cases. Neither age nor other factors, including sex, cause of MNV, CMT, CT, MNV morphology, or fellow eye status, were statistically significant predictors of progression to active MNV (p = 0.67, p > 0.99, p = 0.62, p = 0.09, p = 0.09, p = 0.2, p = 0.62, resp.). Conclusions: NE-MNV is an asymptomatic condition that may occur in the course of various retinal diseases. While DLS and TLS demonstrate high sensitivity and specificity for the diagnosis of NE-MNV, their presence does not always indicate concurrent MNV. Multimodal imaging is essential for accurate monitoring of these patients and detection of potential disease progression. Full article

Background/Objectives: Knee osteoarthritis (KOA) is associated with pain, functional decline, and altered biomechanics. The Step-Up and Down-Forwards (StUD-F) task provides an ecologically relevant assessment of challenging movements. This study investigated neuromuscular activation and lower-limb kinematics of leading and trailing-limbs during the StUD-F in individuals with KOA. Methods: Forty participants with KOA (65.3 ± 7.68 years; 21M/19F; BMI 28.9 ± 4.52 kg/m²) completed a 25 cm box StUD-F task. Surface electromyograph recorded bilateral activation of the vastus medialis (VM), vastus lateralis (VL), bicep femoris (BF), and semitendinosus (ST). Triplanar hip, knee, and ankle joint angles were estimated using inertial measurement units. StUD-F events (initial stance; step contact; ascent completion; descent preparation; step-down touchdown; and descent completion) were identified using custom algorithms. Pain was assessed using visual analogue scales and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Limb differences were analysed for leading or trailing roles using paired samples t-tests or non-parametric equivalents; waveforms were visually inspected. Results: Distinct neuromuscular and kinematic asymmetries were observed when affected and contralateral limbs were compared within each role (leading/trailing). During step-up, the affected leading limb demonstrated higher quadriceps activation at initial stance (VM: p = 0.035; VL: p = 0.027) and reduced trailing-limb activation at step contact (VM: p = 0.015; VL: p = 0.018), with sagittal-plane ankle differences (p = 0.004). During step-down, when the affected limb initiated ascent, trailing limb activation was higher at descent completion (VL: p < 0.001; VM: p = 0.003; BF: p = 0.009), with coronal-plane hip deviations (p < 0.001). When the contralateral limb-initiated ascent, trailing-limb muscles activation differences (VM: p < 0.001; VL: p = 0.015; BF: p = 0.007) and ankle/coronal-plane asymmetries (p ≤ 0.049) persisted. Conclusions: The StUD-F task elicits altered strategies in KOA, including elevated quadriceps–hamstring co-activation and altered sagittal/coronal alignment, and habitual limb choice across ascent and descent. These adaptations may enhance stability and joint protection but could increase medial compartment loading. The findings support rehabilitation focused on dynamic control, alignment, and shock absorption. Full article

Background/Objectives: Autologous fat grafting (AFG) is widely used in breast reconstruction; however, graft retention remains unpredictable due to recipient-bed variability. Photoacoustic imaging (PAI) is a contrast-free, noninvasive modality enabling visualization of vascular structures in detail. This study used PAI to visualize and quantitatively assess neovascularization and vascular structure in breasts reconstructed with AFG. Methods: In this retrospective, cross-sectional study, data from eight patients who underwent PAI of both reconstructed and contralateral breasts at least three months after their final AFG procedure for total breast reconstruction were used. Excluding the nipple–areola complex and skin markings, four 3 × 3 cm regions of interest (one per quadrant) were selected in the periareolar region. Vascular density in terms of depth from the skin surface was analyzed in five cases with adequate contact between the device and the skin. Visible vessel diameters within the regions of interest were manually measured and categorized as small, medium, or large to assess distribution patterns. Results: PAI successfully enabled visualization of vascular structures on the reconstructed side in all cases, even at depths greater than 10 mm. In five cases, vascular density in the superficial layer (0–2.5 mm) was higher on the reconstructed side than on the contralateral side. A longer postoperative interval was associated with a higher proportion of small vessels and fewer large vessels. Conclusions: PAI enabled noninvasive visualization of vascular structures consistent with neovascularization on the reconstructed side after AFG. Temporal changes in vessel diameter distribution suggest ongoing vascular remodeling, supporting the potential utility of PAI in assessing vascular structural changes in grafted tissue over time. Full article

Background/Objectives: Restoration of mandibular anatomy following complex trauma remains challenging when conventional anatomical and occlusal references, such as dental occlusion, contralateral morphology, condylar position, or mandibular continuity are lost. This technical note describes the clinical application of a mandibular statistical shape model as an alternative anatomical reference for diagnosis, virtual planning, and postoperative evaluation in patients with severe post-traumatic deformities. Methods: The MAGIC-SSM, an open-source, age-, and sex-specific three-dimensional model derived from a normative population dataset, enables reconstruction of plausible mandibular geometry in the absence of residual landmarks. Three clinical cases were analyzed using MAGIC-SSM-based reference alignment, with distance mapping applied when indicated. Results: The model provided an additional anatomical reference that supported decision-making in secondary correction, hybrid reconstruction with patient-specific implants, and quantitative evaluation of postoperative outcomes. Conclusions: By replacing lost spatial references with population-based geometry, the MAGIC-SSM offered support for restoring mandibular form and symmetry. These preliminary findings illustrate the feasibility of applying the MAGIC-SSM as an anatomical framework in complex trauma when conventional guides are absent. As its clinical application involved clinician-guided alignment and scaling, reproducibility and reliability remain to be established and require further validation. Full article

Background: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder and most frequently involves the posterior semicircular canal (PSC). Atypical apogeotropic variants of PSC-BPPV may present with pure down-beating positional nystagmus, mimicking contralateral anterior semicircular canal involvement and resulting in diagnostic and therapeutic uncertainty. Objective: To assess the effectiveness of the Bascule/Pendular maneuver in managing patients with pure down-beating positional nystagmus and suspected apogeotropic PSC-BPPV. Methods: A total of 178 patients presenting with pure down-beating positional nystagmus without a torsional component were evaluated using a standardized diagnostic protocol under video-Frenzel goggle monitoring. All patients underwent the Bascule/Pendular maneuver, a modification of the classical Semont maneuver designed to mobilize otoconial debris along the vertical canal planes (Left Anterior–Right Posterior and Right Anterior–Left Posterior), regardless of precise lateralization. Conversion of nystagmus from the apogeotropic to the geotropic variant was considered the primary outcome. Results: The maneuver was well tolerated, with no procedural interruptions or complications. Immediate conversion to the geotropic variant was achieved in 86 patients (48.3%) after a single maneuver. In the remaining patients, successful conversion was obtained after additional maneuvers, most commonly following a second application on the contralateral plane. Once geotropization was achieved, all patients were successfully treated using a standard posterior canal repositioning maneuver. Conclusions: The Bascule/Pendular maneuver is a practical and effective approach for patients presenting with pure down-beating positional nystagmus and suspected apogeotropic PSC-BPPV. By facilitating conversion to the geotropic form, it allows prompt treatment with conventional repositioning maneuvers and may represent a useful first-line strategy in atypical BPPV presentations. Full article

Background: Adjuvant tamoxifen reduces recurrence in patients with ER-positive DCIS treated with lumpectomy and radiation, but its benefit after mastectomy remains unclear. Methods: We retrospectively analyzed 287 patients who underwent mastectomy for pure DCIS at Siriraj Hospital between 2008 and 2017. Recurrence risk factors were assessed using log-rank test, and survival probabilities were estimated with Kaplan–Meier analysis. Results: Of 180 patients with hormone receptor (HR)-positive pure DCIS treated with mastectomy, 120 (66.7%) received tamoxifen, while the remaining 60 (33.3%) did not. The median follow-up was 8.07 years (0.05–13.8 years). Sixteen (8.9%) recurrences were identified, with 5 in the tamoxifen group and 11 in non-endocrine-therapy (ET) group. The 10-year recurrence-free survival (RFS) was 94.7% in the tamoxifen group compared with 77.9% in the non-ET group. Patients with HR-positive DCIS treated with tamoxifen following mastectomy had significantly less subsequent breast cancer (HR = 0.178; p = 0.001). Conclusions: Recurrence of breast cancer after mastectomy for DCIS is rare; however, it carries a high mortality rate for those who relapse. Adjuvant tamoxifen after mastectomy demonstrated a significant reduction in the risk of recurrence in ER-positive DCIS. This study supports the decision to prescribe adjuvant ET in patients with DCIS who underwent mastectomy. Full article

Imaging is the gold standard for diagnosing osteoarthritis (OA). However, it remains challenging to precisely assess OA in murine models. The aim of this study is to establish μCT-based geometric indices for assessing the disease severity of post-traumatic OA (PTOA) and age-related OA (AROA). Following medial meniscectomy (MMS) in adult C57BL/6 mice, distal femoral length remained unchanged, whereas its width increased significantly. As a result, distal femoral width-to-length ratio was markedly elevated at 4 and 8 weeks after MMS (1.33 ± 0.05 and 1.47 ± 0.1, n = 7 and 5 joints, respectively) compared to contralateral normal joints (1.19 ± 0.04, n = 9), yielding an area under the curve (AUC) of 1.0 (95% CI, 1.0–1.0). Similarly, the tibial secondary ossification center (IIOC) height decreased, whereas its width increased after MMS. Consequently, the tibial IIOC height-to-width ratio was significantly reduced at 4 and 8 weeks post-MMS (0.25 ± 0.02 and 0.24 ± 0.02, respectively) compared with a normal joint (0.304 ± 0.011), with an AUC of 1.0 (95% CI, 1.0–1.0). Bland–Altman analysis demonstrated strong interrater reproducibility, with intraclass correlation coefficients of 0.853 (95% CI, 0.681–0.936) for the femoral ratio and 0.887 (95% CI, 0.748–0.952) for the tibial ratio. Notably, these MMS-induced changes in femoral and tibial geometric indices were attenuated in mice with genetic deletion of GM-CSF, a key mediator of OA. Importantly, μCT-derived geometric indices were validated by histological analysis. Furthermore, increased distal femoral width-to-length ratio and reduced tibial IIOC height-to-width ratio were also observed in the knee joints of 28-month-old mice with AROA. In addition, an enlarged patella and a calcified synovium–capsule serve as a reference for AROA and PTOA. Collectively, μCT-based geometric indices are useful and easily quantifiable metrics for assessing disease severity and therapeutic response of PTOA and AROA models in murine. Of note is that the distal femoral and proximal tibial geometric indices were developed based on severe OA induced by MMS, and their applicability to mild OA requires further investigation. Full article

Background: Evidence comparing the Direct Anterior Approach (DAA) for total hip arthroplasty (THA) to other approaches is conflicting, particularly regarding patient-reported outcomes. This study aimed to compare the outcomes and preferences of the DAA and Posterolateral (PLA) and Lateral (LA) Approaches within a crossover cohort. Methods: This retrospective crossover study included 69 patients who underwent staged bilateral THA with a DAA on one hip and either a PLA (n = 29) or LA (n = 40) on the contralateral hip. At a minimum 12-month follow-up, patient-reported outcomes, including length of stay, mobilization, crutch use, functional scores (mHHS, HOOS-PS, and NRPS), and preferences, were collected via telephone survey and analyzed using a paired t-test. Results: Compared to other approaches, the DAA resulted in a significantly shorter length of stay (p < 0.001), earlier mobilization (p < 0.001), and shorter duration of crutch use (p < 0.001). At 12 months, the DAA group also reported higher modified Harris Hip Scores (p < 0.05) and lower pain scores (p < 0.05). The majority of patients preferred DAA to both PLA (60.7%) and LA (72.5%). Conclusions: In this within-patient comparison, DAA provided a significantly faster early recovery and was strongly preferred by patients. These early postoperative advantages are critical for patients, and should be prominent in the shared decision-making process for THA. Full article

Objective: This study compared the effects of submaximal and supramaximal accentuated eccentric loading (AEL) on lean mass and function in the trained (TL) and contralateral non-trained (NTL) legs of women. Methods: Twenty recreationally trained women were randomly assigned to submaximal (90% 1-RM) or supramaximal (120% 1-RM) AEL leg press training (2/week, 10 weeks, 4 sets of 8 repetitions) with 30% 1-RM concentric loading. Total thigh lean mass (TTLM), unilateral leg press 1-RM, mechanical power at 40% (P40), 60% (P60), and 80% (P80) of 1-RM, unilateral countermovement (CMJ) and drop jump (DJ) height, and muscle endurance (XRM) were assessed for each leg before and after intervention. Results: Regarding the TL, the submaximal group showed significant (p < 0.05) increases in 1-RM, P40, CMJ, and DJ, while the supramaximal group showed increased TTLM, 1-RM, P40, P60, and XRM. No significant differences were observed between groups. In the NTL, both groups showed significant increases in 1-RM and P40. Additionally, the submaximal group demonstrated improvements in P60, while the supramaximal group showed significant increases in both P60 and P80, and in TTLM. TL and NTL changes correlated significantly for 1-RM, CMJ, and TTLM. However, TL and NTL changes differed significantly for 1-RM and P40 in the submaximal group and for TTLM in the supramaximal group. Conclusions: Submaximal and supramaximal AEL resulted in similar neuromuscular improvements in both TL and NTL in women. Supramaximal loading provided additional benefits in mechanical power lean mass, while submaximal loading improved explosive performance. Supramaximal loading may not be necessary for active women. Full article