Patient-specific Three-dimensional Bone Model for the Diagnosis and Treatment of Orthopedic Diseases of the Hip: Opinions of Orthopedic Surgeons on New Medical Technology

( Seung-won Choi ),( Kyung-soon Park ),( Taek-rim Yoon ) 대한고관절학회 2021 Hip and Pelvis Vol.33 No.2

Purpose: To examine the perceptions and opinions of orthopedic surgeons on new medical technology for patient-specific three-dimensional (3D) bone models in the diagnosis and treatment of orthopedic diseases related to the hip joint. Materials and Methods: A total of 75 doctors who were trained in orthopedic surgery or were current residents in the Republic of Korea were surveyed via questionnaires. Eight questions were included regarding the utility and current issues in the diagnosis and treatment of orthopedic disease using a customized 3D bone model made from s patient’s computed tomography (CT) image. In addition to the questionnaire, the simple plain radiography and 3D CT image of the patient and 3D printed models of two actual patients were presented for comparison. Results: An average of 92.7% of the orthopedic surgeons answered “very much” or “yes” to questions regarding the effectiveness of diagnosis, treatment, education, and simulation of surgery using the patient-specific 3D bone model. To the question, “Do you think you must have medical insurance to provide better medical services by using a new patient-specific 3D bone model medical technology for simulated surgery?” 93.3% of orthopedic surgeons answered either “very much” or “yes”. Conclusion: Patient-specific 3D bone models of new medical technology can provide breakthrough support in the diagnosis, treatment, and education of orthopedic diseases in the field of hip joints. Therefore, it seems that efforts should be made to change governmental policy for coverage of patient-specific 3D bone modeling.

Contributed Mini Review : iPSC technology-Powerful hand for disease modeling and therapeutic screen

( Chang Sung Kim ) 생화학분자생물학회(구 한국생화학분자생물학회) 2015 BMB Reports Vol.48 No.5

Cardiovascular and neurodegenerative diseases are major health threats in many developed countries. Recently, target tissues derived from human embryonic stem (hES) cells and induced pluripotent stem cells (iPSCs), such as cardiomyocytes (CMs) or neurons, have been actively mobilized for drug screening. Knowledge of drug toxicity and efficacy obtained using stem cell-derived tissues could parallel that obtained from human trials. Furthermore, iPSC disease models could be advantageous in the development of personalized medicine in various parts of disease sectors. To obtain the maximum benefit from iPSCs in disease modeling, researchers are now focusing on aging, maturation, and metabolism to recapitulate the pathological features seen in patients. Compared to pediatric disease modeling, adult-onset disease modeling with iPSCs requires proper maturation for full manifestation of pathological features. Herein, the success of iPSC technology, focusing on patient-specific drug treatment, maturation-based disease modeling, and alternative approaches to compensate for the current limitations of patient iPSC modeling, will be further discussed. [BMB Reports 2015; 48(5): 256-265]

Computational analysis of the electromechanical performance of mitral valve cerclage annuloplasty using a patient-specific ventricular model

Lee, Kyung Eun,Kim, Ki Tae,Lee, Jong Ho,Jung, Sujin,Kim, June-Hong,Shim, Eun Bo The Korean Society of Pharmacology 2019 The Korean Journal of Physiology & Pharmacology Vol.23 No.1

We aimed to propose a novel computational approach to predict the electromechanical performance of pre- and post-mitral valve cerclage annuloplasty (MVCA). Furthermore, we tested a virtual estimation method to optimize the left ventricular basement tightening scheme using a pre-MVCA computer model. The present model combines the three-dimensional (3D) electromechanics of the ventricles with the vascular hemodynamics implemented in a lumped parameter model. 3D models of pre- and post-MVCA were reconstructed from the computed tomography (CT) images of two patients and simulated by solving the electromechanical-governing equations with the finite element method. Computed results indicate that reduction of the dilated heart chambers volume (reverse remodeling) appears to be dependent on ventricular stress distribution. Reduced ventricular stresses in the basement after MVCA treatment were observed in the patients who showed reverse remodeling of heart during follow up over 6 months. In the case who failed to show reverse remodeling after MVCA, more virtual tightening of the ventricular basement diameter than the actual model can induce stress unloading, aiding in heart recovery. The simulation result that virtual tightening of the ventricular basement resulted in a marked increase of myocardial stress unloading provides in silico evidence for a functional impact of MVCA treatment on cardiac mechanics and post-operative heart recovery. This technique contributes to establishing a pre-operative virtual rehearsal procedure before MVCA treatment by using patient-specific cardiac electromechanical modeling of pre-MVCA.

Computational analysis of the electromechanical performance of mitral valve cerclage annuloplasty using a patient-specific ventricular model

이경은,김기태,이종호,정수진,김준홍,심은보 대한약리학회 2019 The Korean Journal of Physiology & Pharmacology Vol.23 No.1

We aimed to propose a novel computational approach to predict the electromechanical performance of pre- and post-mitral valve cerclage annuloplasty (MVCA). Furthermore, we tested a virtual estimation method to optimize the left ventricular basement tightening scheme using a pre-MVCA computer model. The present model combines the three-dimensional (3D) electromechanics of the ventricles with the vascular hemodynamics implemented in a lumped parameter model. 3D models of pre- and post-MVCA were reconstructed from the computed tomography (CT) images of two patients and simulated by solving the electromechanicalgoverning equations with the finite element method. Computed results indicate that reduction of the dilated heart chambers volume (reverse remodeling) appears to be dependent on ventricular stress distribution. Reduced ventricular stresses in the basement after MVCA treatment were observed in the patients who showed reverse remodeling of heart during follow up over 6 months. In the case who failed to show reverse remodeling after MVCA, more virtual tightening of the ventricular basement diameter than the actual model can induce stress unloading, aiding in heart recovery. The simulation result that virtual tightening of the ventricular basement resulted in a marked increase of myocardial stress unloading provides in silico evidence for a functional impact of MVCA treatment on cardiac mechanics and post-operative heart recovery. This technique contributes to establishing a pre-operative virtual rehearsal procedure before MVCA treatment by using patient-specific cardiac electromechanical modeling of pre-MVCA.

3D 프린팅 기술의 의료적용에 관한 종설

이상욱,김태훈,홍다영,옥준혁,권재영,권은서,권진희,서준범,채은진,양동현,김청수,경윤수,고범석,최세훈,사호석,김남국 대한영상의학회 2019 대한영상의학회지 Vol.80 No.2

Three-dimensional (3D) printing technology, with additive manufacturing, can aid in the production of various kinds of patient-specific medical devices and implants in medical fields, which cannot be covered by mass production systems for producing conventional devices/implants. The simulator-based medical image demonstrates the anatomical structure of the disease, which can be used for education, diagnosis, preparation of treatment plan and preoperative surgical guide, etc. The surgical guide is used as a patient-specific medical device for guiding incision, resection, insertion, and marking. As 3D printers can output materials that can be inserted into the human body, the patient-specific implant device that reflects the patient’s anatomy and surgical plan could be of relevance. In addition, patient-specific aids, including gibs, splints, prostheses, and epitheses, could be used for a better outcome. Finally, bio-printing is also used to cultivate cells to produce functional artificial tissues. 3D 프린팅은 재료를 붙여서 만드는 제조기법으로 다품종 소량생산이 가능하다는 장점이 있다. 대량생산 시스템을 기반으로 한 의료기기 및 재료 분야에서 커버하지 못하는 다양한 의료분야에서 환자 맞춤형 의료기기 및 삽입 보형물 제작에 활용될 수 있다. 시뮬레이터는 질환의 해부학적 구조를 환자 영상을 기반으로 제작하여 교육용, 진단, 치료 계획 수립용, 수술전 모의 수술용 등으로 활용된다. 수술 가이드는 외과수술 계획에 맞춤형으로 제작되어 절개, 절제, 삽입, 마킹 등을 하는 환자 맞춤형 의료기기로 활용된다. 특히, 3D 프린터가 인체 삽입이 가능한 재료를 출력할 수 있게 되면서 환자의 해부학적 구조나 수술 계획을 반영한 맞춤형 삽입 보형물을 사용할 수 있게 되었고, 기존에 맞춤형으로 제작하기 힘들거나 결손된영역에 대하여 보완이 가능하게 되었다. 보조기기로는 깁스나 부목, 의수, 의족, 에피테제 등이 있다. 바이오프린팅을 통해 지지체에 세포를 배양하거나 직접 세포를 출력하여 기능성 인공조직을 만드는 연구도 활발히 이루어지고 있다.

MRI와 3D 스캔 데이터를 이용한 3D 프린팅 유방 인공보형물의 제작 알고리즘

정영진,최동헌,김구진 한국멀티미디어학회 2019 멀티미디어학회논문지 Vol.22 No.12

In this paper, we propose a method to fabricate a patient-specific breast implant using MRI images and 3D scan data. Existing breast implants for breast reconstruction surgery are primarily fabricated products for shaping, and among the limited types of implants, products similar to the patient's breast have been used. In fact, the larger the difference between the shape of the breast and the implant, the more frequent the postoperative side effects and the lower the satisfaction. Previous researches on the fabrication of patient-specific breast implants have used limited information based on only MRI images or on only 3D scan data. In this paper, we propose an algorithm for the fabrication of patient-specific breast implants that combines MRI images with 3D scan data, considering anatomical suitability for external shape, volume, and pectoral muscle. Experimental results show that we can produce precise breast implants using the proposed algorithm.

Bayesian Network Model to Evaluate the Effectiveness of Continuous Positive Airway Pressure Treatment of Sleep Apnea

Olli-Pekka Ryynänen,Timo Leppänen,Pekka Kekolahti,Esa Mervaala,Juha Töyräs 대한의료정보학회 2018 Healthcare Informatics Research Vol.24 No.4

Objectives: The association between obstructive sleep apnea (OSA) and mortality or serious cardiovascular events over a long period of time is not clearly understood. The aim of this observational study was to estimate the clinical effectiveness of continuous positive airway pressure (CPAP) treatment on an outcome variable combining mortality, acute myocardial infarction (AMI), and cerebrovascular insult (CVI) during a follow-up period of 15.5 years (186 ± 58 months). Methods: The data set consisted of 978 patients with an apnea-hypopnea index (AHI) ≥5.0. One-third had used CPAP treatment. For the first time, a data-driven causal Bayesian network (DDBN) and a hypothesis-driven causal Bayesian network (HDBN) were used to investigate the effectiveness of CPAP. Results: In the DDBN, coronary heart disease (CHD), congestive heart failure (CHF), and diuretic use were directly associated with the outcome variable. Sleep apnea parameters and CPAP treatment had no direct association with the outcome variable. In the HDBN, CPAP treatment showed an average improvement of 5.3 percentage points in the outcome. The greatest improvement was seen in patients aged ≤55 years. The effect of CPAP treatment was weaker in older patients (>55 years) and in patients with CHD. In CHF patients, CPAP treatment was associated with an increased risk of mortality, AMI, or CVI. Conclusions: The effectiveness of CPAP is modest in younger patients. Long-term effectiveness is limited in older patients and in patients with heart disease (CHD or CHF).

Computational analysis of the electromechanical performance of mitral valve cerclage annuloplasty using a patient-specific ventricular model

Kyung Eun Lee,Ki Tae Kim,Jong Ho Lee,Sujin Jung,June-Hong Kim,Eun Bo Shim 대한생리학회-대한약리학회 2019 The Korean Journal of Physiology & Pharmacology Vol.23 No.1

Artificial Intelligence Based Machine Learning Models Predict Sperm Parameter Upgrading after Varicocele Repair: A Multi-Institutional Analysis

Ory Jesse,Tradewell Michael B.,Blankstein Udi,Lima Thiago F.,Nackeeran Sirpi,Gonzalez Daniel C.,Nwefo Elie,Moryousef Joseph,Madhusoodanan Vinayak,Lau Susan,Jarvi Keith,Ramasamy Ranjith 대한남성과학회 2022 The World Journal of Men's Health Vol.40 No.4

Purpose: Varicocele repair is recommended in the presence of a clinical varicocele together with at least one abnormal semen parameter, and male infertility. Unfortunately, up to 50% of men who meet criteria for repair will not see meaningful benefit in outcomes despite successful treatment. We developed an artificial intelligence (AI) model to predict which men with varicocele will benefit from treatment. Materials and Methods: We identified men with infertility, clinical varicocele, and at least one abnormal semen parameter from two large urology centers in North America (Miami and Toronto) between 2006 and 2020. We collected pre and postoperative clinical and hormonal data following treatment. Clinical upgrading was defined as an increase in sperm concentration that would allow a couple to access previously unavailable reproductive options. The tiers used for upgrading were: 1–5 million/mL (ICSI/IVF), 5–15 million/mL (IUI) and >15 million/mL (natural conception). Thus moving from ICSI/IVF to IUI, or from IUI to natural conception, would be considered an upgrade. AI models were trained and tested using R to predict which patients were likely to upgrade after surgery. The model sorted men into categories that defined how likely they were to upgrade after surgery (likely, equivocal, and unlikely). Results: Data from 240 men were included from both centers. A total of 45.6% of men experienced an upgrade in sperm concentration following surgery, 48.1% did not change, and 6.3% downgraded. The data from Miami were used to create a random forest model for predicting upgrade in sperm concentration. On external validation using Toronto data, the model accurately predicted upgrade in 87% of men deemed likely to improve, and in 49% and 36% of men who were equivocal and unlikely to improve, respectively. Overall, the personalized prediction for patients in the validation cohort was accurate (AUC 0.72). Conclusions: A machine learning model performed well in predicting clinically meaningful post-varicocelectomy sperm parameters using pre-operative hormonal, clinical, and semen analysis data. To our knowledge, this is the first prediction model to show the utility of hormonal data, as well as the first to use machine learning models to predict clinically meaningful upgrading. This model will be published online as a clinical calculator that can be used in the preoperative counseling of patients.

고관절 수술에서 3D 프린팅의 응용: 현재 그리고 미래

원희재(Heejae Won),백승훈(Seung-Hoon Baek),김신윤(Shin-Yoon Kim) 대한정형외과학회 2022 대한정형외과학회지 Vol.57 No.1

고관절과 골반은 해부학적 특성으로 인해 3D 프린팅(three-dimensional printing) 기술이 활발하게 임상에 도입되고 있다. 현재 고관절 수술에서 사용되는 3D 프린팅 기술은 수술 전 계획이나 모의 수술을 위한 골 모형, 환자 맞춤형 수술기구(patientspecific instrument), 삽입물의 안정적인 고정을 위한 표면 처리(surface treatment), 환자의 해부학적 특성에 맞는 맞춤형 삽입물(customized implant)의 4가지 형태로 활용되고 있다. 정형외과 의사는 3D 프린팅 기술을 통해 수술법을 개선하고, 수술 중 발생 가능한 합병증을 최소화하며, 환자에게 좀더 적합한 삽입물을 정확한 위치에 고정할 수 있다. 근래에는 3D 프린팅을 위한 새로운 재료들이 탐색되고 있으며, 출력물의 제작 과정 개선을 통한 비용 및 제작 시간의 효율성이 향상되고 있다. 또한 표면 처리를 개선하여 지속적으로 약물을 전달하거나, 증강현실 등 다른 신기술과의 융합도 시도되고 있으며, 3D 생체 프린팅 기술을 이용한 조직이나 기관의 재생 역시 활발하게 연구되고 있다. 무엇보다도 정형외과 의사는 기존의 치료 방법만 고수할 것이 아니라 이러한 새로운 경향들을 익히고 연구함으로써 환자들에게 최선의 치료법을 제공할 수 있도록 노력해야 할 것이다. Three-dimensional (3D) printing is increasing gradually in orthopedic surgery. Currently, the use of 3D printing in hip surgery is as follows: a bone model for preoperative planning or simulation, patient-specific instruments, surface treatment for stable fixation of implant, and customized implants tailored to the patient’s anatomical characteristics. Orthopedic surgeons can utilize 3D printing technology to improve the surgical techniques, minimize complications during surgery, and provide implants that are more suitable for patients in the correct position. In recent years, new materials for 3D printing are being explored, and the efficiency of cost and production time is improved by developing the production process. In addition, constant drug delivery by improving surface treatment, fusion with other new technologies, such as augmented reality, and tissue or organ regeneration using 3D bioprinting technology is being actively conducted. Above all, orthopedic surgeons should strive to provide the best treatment to patients by learning and researching these new trends, not just adhering to existing treatment methods.