Assessment of Navigated Pedicle Screws From Intraoperative Imaging: A Prospective Study of Accuracy and Agreement.

BACKGROUND: Intraoperative (IO) image guidance surgery using 3-dimensional fluoroscopic navigation methods, such as the O-arm system, has improved the accuracy of pedicle screw placement in instrumented spine surgery. IO and postoperative (PO) validation of the implant's correct position from radiological images is a decisive step to ensure patient safety and avoidance of complications related to implant misplacement. In this prospective single-center study, the authors investigated the accuracy and agreement of assessment of pedicle screws from IO O-arm images in comparison to PO computed tomography images. This study aimed to determine whether final evaluation of pedicle screws can safely be conducted from IO images that supersedes the PO computed tomography control. METHODS: A prospective single-center study was carried out at the Spine Unit in the Department of Orthopedics at Umeå University Hospital between 2019 and 2021. All patients enrolled in the study underwent instrumented thoracolumbar spine surgery using navigation. Imaging data were obtained from IO and PO examinations. Four reviewers-2 attending senior spine surgeons, 1 final year resident in orthopedics, and 1 attending neuroradiologist-classified pedicle screws using the Gertzbein and Robbins classification system. Agreement and accuracy of the reviewers were studied to evaluate the assessment of pedicle screws from IO and PO images. RESULTS: A total of 70 patients (422 screws) were included in the study. There was high accuracy among surgeons both on IO and PO images (0.96-0.97, 95% CI [0.94-0.99] and 0.97, 95% CI [0.94-0.99], respectively), and the overall agreement between all raters was 92% to 98% (95% CI [0.90, 1.00]). The discrepancy in assessment between optimal (Group 1) and suboptimal (Group 2) screws between IO and PO images was as low as 1% to 1.7%, which indicates that very few suboptimal screws are missed in the assessment of IO images. CONCLUSIONS: The assessment of navigated pedicle screws using IO images is safe and reliable and may replace the need for further assessment using PO imaging.

Ni-Cr Powders Modified with Rhenium as a Novel Coating Material-Physical Properties, Microstructure, and Behavior in Plasma Plume.

The aim of this work was to develop a new coating material based on Ni20Cr alloy modified with up to 50%wt. rhenium. The modification was carried out by the mechanical mixing of the base powder and ammonium perrhenate with the subsequent thermoreduction in an H2 atmosphere. The obtained powder consists of a nickel-chromium core surrounded by a rhenium shell. The characterization of the powders-including their microstructure, phase and chemical composition, density, flowability, particle size distribution, and specific surface area-was performed. The influence of plasma current intensity and hydrogen gas flow on in-flight particle temperature and velocity were investigated. The results indicate that there is interdiffusion between the base Ni20Cr and the rhenium shell, resulting in intermediary solid solution(s). The modified powders have a higher specific surface area and a lower flowability, but this does not prevent them from being used as feedstock in plasma spraying. In-flight measurements reveal that increasing the content of rhenium allows for the higher temperature of particles, though it also reduces their speed.

Long-term survival following postoperative myocardial infraction after coronary artery bypass surgery.

BACKGROUND: Postoperative myocardial infraction (MI) is a serious complication among patients undergoing Coronary Artery Bypass Grafting (CABG). Data on the impact of postoperative MI on patients undergoing CABG, specifically with respect to their long term outcomes are sparse. METHODS: We retrospectively analyzed all patients who underwent isolated CABG between January 2014 and December 2016 and identified those who fulfilled the definition of the type 5MI following CABG according to the Fourth Universal Definition of Myocardial Infarction. RESULTS: A total of 4,642 CABG patients were identified, of whom 141 (3.04%) were diagnosed with postoperative MI. The mean follow-up time was 5.1±2.07 years (range, 4.4-6.9 years). Postoperative MI was more common in patients with recent acute coronary syndrome, when compared to stable angina (22.8% vs. 31.9%; P=0.011) and in those with non-elective versus planned surgery (28.4% vs. 18.4%; P=0.003). Postoperative MI after CABG was associated with an increased rate of postoperative complications, including cardiac tamponade and re exploration for bleeding. Mortality after postoperative MI was higher at short-term follow-up (up to one year) and long-term follow-up (up to five years). The risk factors for postoperative MI after CABG were incomplete revascularization (IR) [OR (95% CI): 2.25 (1.59-3.12), P=0.001], non-elective surgery [OR (95% CI): 1.68 (1.10-2.54), P=0.015] and female gender [OR (95% CI): 1.48 (1.01-2.18), P=0.045]. CONCLUSIONS: PMI after CABG is associated with reduced short- and long-term survival. The main risk factors for postoperative MI are IR, female gender, and non-elective surgery.

Analysis of factors influencing levee safety using the DEMATEL method.

River embankments are the basic and the oldest measures of protecting areas potentially subjected to flooding, and at the same time pose a serious threat to their environment in the event of damage or failure. The technical condition of the levees and its regular evaluation is a key element of their safety. A general assessment of the technical condition of a levee is the result of many interacting factors and parameters that depend on each other to a varying degree. Therefore, it is necessary to consider the cause-and-effect links between the interrelationships of numerous parameters and sensors of significant impact. In this article the decision-making trial and evaluation laboratory (DEMATEL) method was applied to develop a cause-and-effect model for factors impacting the condition and safety of levees. Effective factors impacting the technical condition of a levee were identified; relationships between these factors were determined; a cause-and-effect model was developed based on identified factors; factors were categorized based on the dependence scale and influential indicators of each factors used in the DEMATEL method. The obtained results demonstrate that three following factors: hydrological factor, type and condition of soils in levee body and condition of levee areas (inter-levee and landside) play the most important role for levee safety. The results of this study can support traditional assessments of hydrotechnical structure or assist entities managing levees.

Semi-Hybrid CO2 Laser Metal Deposition Method with Inter Substrate Buffer Zone.

This article presents the results of the metal deposition process using additive materials in the form of filler wire and metal powder. An important problem in wire deposition using a CO2 laser was overcome by using a combination of the abovementioned methods. The deposition of a multicomponent alloy-Inconel 625-on a basic substrate such as structural steel is presented. The authors propose a new approach for stopping carbon and iron diffusion from the substrate, by using the Semi-Hybrid Deposition Method (S-HDM) developed by team members. The proposed semi-hybrid method was compared with alternative wire and powder deposition using laser beam. Differences of S-HDM and classic wire deposition and powder deposition methods are presented using metallographic analysis, within optic and electron microscopy. Significant differences in the obtained results reveal advantages of the developed method compared to traditional deposition methods. A comparison of the aforementioned methods performed using nickel based super alloy Inconel 625 deposited on low carbon steel substrate is presented. An alternative prototyping approach for an advanced high alloy materials deposition using CO2 laser, without the requirement of using the same substrate was presented in this article. This study confirmed the established assumption of reducing selected components diffusion from a substrate via buffer layer. Results of metallographic analysis confirm the advantages and application potential of using the new semi-hybrid method for prototyping high alloy materials on low alloy structural steel substrate.