Unprecedented journey to 650 transpedicular screws using freehand technique and intraoperative C-arm imaging with technical nuances.

Introduction: Pedicle screw placement plays a crucial role in treating various cases such as fractures, scoliosis, degenerative spine issues, and kyphosis, reinforcing all three spinal columns simultaneously. While three-dimensional navigation-assisted pedicle screw placement is considered superior, the freehand technique relies on anatomical landmarks and tactile feedback, with observed low complication rates. Materials and Methods: This was a prospective single-center study conducted over a period of 3 years. It included all patients of dorsal, lumbar, and sacral spinal instability of myriad etiology. Previously operated patients and sick obtunded patients were excluded from the study. Results: In our study, we included 102 patients including 62 (60.7%) males and 40 (39.2%) females. More than half of patients were young in the age group of 20-50 years. Our study population had a varied etiology with 43.1% of patients having vertebral column instability due to trauma. The other etiologies were spondylolisthesis and lumbar canal stenosis (39.2%), Pott's spine (11.7%), tumors (2.9%), and osteoporotic fractures (2.9%). Majority of patients (44.1%) presented with lower backache with radiculopathy. All the transpedicular screws inserted were evaluated by C-arm to assess for screw fixation. In the first year of our study, an average of 4 anteroposterior (AP) and 4 lateral C-arm X-ray shots were taken per screw placement. In the next year, an average of 3 AP and 3 lateral shots and finally in the last year of our study only 2 AP and 2 lateral C-arm X-ray shots were taken per screw placement. Out of 650 screws placed, 4 screws were identified to cause breach with maximum breaches in the lumbar spine fixation. In dorsal spine fixation, there was 1 lateral breach at D10. In lumbar spine fixation, there were 3 breaches: two medial one each at L4 and L5 and one anterior at L2 level. The various complications include wound infection, temporary and permanent neurological deficit, screw breakage, screw misplacement, cerebrospinal fluid leaks, nonunion, and spinal epidural hematoma. Conclusions: Our study has provided strong encouragement to persist with the freehand technique in transpedicular fixation surgeries after a certain number of cases given the minimal breaches and complications observed. There are subtle technical nuances as we increase the number of cases with less exposure of anatomical landmarks and X-rays. Success hinges on experience, adherence to technique, and thorough preoperative planning. Further research and extended follow-up periods are necessary to firmly establish this technique as the gold standard.

Arm muscle area is correlated to handgrip strength in postmenopausal women.

OBJECTIVE: To analyze the correlation between arm muscle area and handgrip strength among postmenopausal community dwelling low-income women in order to provide an easy anthropometric indicator to assess muscle mass quantity and quality. METHODS: This was a cross-sectional study involving postmenopausal women (n = 171) from three urban-marginal communities of Guayaquil, Ecuador. Corrected arm muscle area was calculated using the Frisancho formula. Dynapenia was defined as HGS < 16 kg. Spearman's correlation coefficient was calculated at a 5% significance level to test the correlation between corrected arm muscle area and handgrip strength. RESULTS: Median (interquartile range: IQR) age of the sample was 72.0 years (17.0). The median of corrected arm muscle area was 34.8 cm2 (20.7). The overall prevalence of dynapenia was 57.9% (n = 99). There was a significant decreasing trend with age regarding all anthropometric characteristics and handgrip strength, as well as a higher prevalence of dynapenia with age. For the whole sample, a statistically significant positive correlation was found between corrected arm muscle area and handgrip strength [r = 0.267; p < .001].There was a significant yet weak positive correlation between corrected arm muscle area and handgrip strength in this postmenopausal sample. There is a need for additional research in this regard.

Functional Outcome in Obese Patients Undergoing Image-Based Cruciate Retaining Robotic-Assisted Total Knee Arthroplasty Using the Subvastus Approach: A Short-Term Study.

Introduction Knee osteoarthritis (OA) is a prevalent degenerative joint disease that significantly affects quality of life, especially among obese and morbidly obese individuals. Total knee arthroplasty (TKA) is an effective treatment for end-stage OA, but it presents unique challenges in obese patients. The mini-subvastus approach (SA) and robotic-assisted TKA (RA-TKA) are emerging techniques that may address these challenges. This study evaluates the clinical and radiological outcomes of cruciate-retaining (CR) RA-TKA using the mini-subvastus approach in obese and morbidly obese patients. Methods This study included 114 obese patients (215 knees) with primary OA who underwent CR RA-TKA (Maxx Meril CR knee, USA) using the Cuvis Joint® robotic system. Patients had a BMI of ≥30 kg/m² (n=101) and morbid obesity with a BMI ≥40 kg/m² (n=13). Preoperative planning involved CT scans and the J-planner for optimal implant size and positioning. Surgery was performed without tourniquets, and patients were mobilized postoperatively. Clinical outcomes were assessed using visual analog scale (VAS) scores and the American Knee Society Score (AKSS) at three and six months. Results The study included 85 females and 29 males with an average age of 61.8 years. Satisfactory knee exposure was achieved in all cases using SA, with no major complications such as wound infections, deep vein thrombosis, or component misalignment. Intraoperative challenges were managed effectively, including two cases of medial collateral ligament avulsion and one partial patellar tendon avulsion. Postoperative VAS scores showed significant pain reduction from pre-op (6.54) to post-op day 3 (1.3). AKSS improved from a pre-op average of 33.9 to 70.7 at three months and 80.9 at six months. Most patients (80%) achieved exceptional range of motion (ROM) ≥120° at six months. Discussion The mini-subvastus approach in RA-TKA offers several advantages, including reduced postoperative pain, faster recovery, and improved quadriceps strength, even in obese patients. The use of robotic assistance ensures accurate component positioning and alignment, mitigating the challenges typically associated with obese patients undergoing TKA. Conclusion The study demonstrates the feasibility and effectiveness of CR RA-TKA using the mini-subvastus approach in obese and morbidly obese patients. This technique provides adequate exposure, reduces pain, and promotes early mobilization and recovery with satisfactory clinical and radiological outcomes. The findings support the potential for wider adoption of this approach in managing knee OA in obese populations, though further studies with longer follow-up are warranted.

Evidence for interacting but decoupled controls of decisions and movements in non-human primates.

Many recent studies indicate that control of decisions and actions is integrated during interactive behavior. Among these, several carried out in humans and monkeys conclude that there is a co-regulation of choices and movements. Another perspective, based on human data only, proposes a decoupled control of decision duration and movement speed, allowing for instance to trade decision duration for movement duration when time pressure increases. Crucially, it is not currently known whether this ability to flexibly dissociate decision duration from movement speed is specific to humans, whether it can vary depending on the context in which a task is performed, and whether it is stable over time. These are important questions to address, especially to rely on monkey electrophysiology to infer the neural mechanisms of decision-action coordination in humans. To do so, we trained two macaque monkeys in a perceptual decision-making task and analyzed data collected over multiple behavioral sessions. Our findings reveal a strong and complex relationship between decision duration and movement vigor. Decision duration and action duration can co-vary but also "compensate" each other. Such integrated but decoupled control of decisions and actions aligns with recent studies in humans, validating the monkey model in electrophysiology as a means of inferring neural mechanisms in humans. Crucially, we demonstrate for the first time that this control can evolve with experience, in an adapted manner. Together, the present findings contribute to deepening our understanding of the integrated control of decisions and actions during interactive behavior.

A Study of Functional Outcome and Assessment of Role of Proximal Humerus Internal Locking System (Philos) Plating in Elderly Population with Proximal Humerus Fracture: A Case Series.

Introduction: The purpose of the study was to assess the functional outcome of proximal humerus fractures (2 part, 3 part, and 4 part) managed with a proximal humerus internal locking system (PHILOS). Materials and Methods: This retrospective study included 27 cases of proximal humerus fractures managed surgically between February 2021 and February 2022 with a proximal humerus internal locking system (PHILOS) plate. NEER classification was used to categorize the fractures. Functional assessment was done using Constant Murley's shoulder score and disabilities of the arm, shoulder, and hand. Subjects having metastatic and pathological fractures; associated fractures in the ipsilateral limb; having major nerve injury and cases of open fracture were excluded from this study. Results: The mean age was 55.63 ± 10.37 years. Of the total 27 cases of proximal humerus fractures, functional outcome was excellent (score 85-100) in 3.70% (n = 1) cases, good (score 71-85) in 81.49% (n = 22) cases, moderate (score 56-70) in 14.81% (n = 4), and poor (score 0-55) in none of the (n = 0) cases. In 92.60% of cases, follow-up showed no complications. Varus collapse and subacromial impingement, both occurring in 3.70% (n = 1) of the subjects, were noted in this study. Conclusion: Based on the findings of this retrospective study, it can be opined that PHILOS plating appears to be a secure option for proximal humerus fracture cases. It offers solid fixation, prompt mobilization, and excellent functional outcomes as observed in this study. In addition, very few post-operative complication rates again support our conclusion.

A Complex Meta-Regression Model to Identify Effective Features of Interventions From Multi-Arm, Multi-Follow-Up Trials.

Network meta-analysis (NMA) combines evidence from multiple trials to compare the effectiveness of a set of interventions. In many areas of research, interventions are often complex, made up of multiple components or features. This makes it difficult to define a common set of interventions on which to perform the analysis. One approach to this problem is component network meta-analysis (CNMA) which uses a meta-regression framework to define each intervention as a subset of components whose individual effects combine additively. In this article, we are motivated by a systematic review of complex interventions to prevent obesity in children. Due to considerable heterogeneity across the trials, these interventions cannot be expressed as a subset of components but instead are coded against a framework of characteristic features. To analyse these data, we develop a bespoke CNMA-inspired model that allows us to identify the most important features of interventions. We define a meta-regression model with covariates on three levels: intervention, study, and follow-up time, as well as flexible interaction terms. By specifying different regression structures for trials with and without a control arm, we relax the assumption from previous CNMA models that a control arm is the absence of intervention components. Furthermore, we derive a correlation structure that accounts for trials with multiple intervention arms and multiple follow-up times. Although, our model was developed for the specifics of the obesity data set, it has wider applicability to any set of complex interventions that can be coded according to a set of shared features.

Evaluation of Microplate Handling Accuracy for Applying Robotic Arms in Laboratory Automation.

An inexpensive single-arm robot is widely utilized for recent laboratory automation solutions. The integration of a single-arm robot as a transfer system into a semi-automatic liquid dispenser without a transfer system can be realized as an inexpensive alternative to a fully automated liquid handling system. However, there has been no quantitative investigation of the positional accuracy of robot arms required to transfer microplates. In this study, we constructed a platform comprising aluminum frames and digital gauges to facilitate such measurements. We measured the position repeatability of a robot arm equipped with a custom-made finger by repeatedly transferring microplates. Further, the acceptable misalignment of plate transfer was evaluated by adding an artificial offset to the microplate position using this platform. The results of these experiments are expected to serve as benchmarks for the selection of robot arms for laboratory automation in biology. Furthermore, all information for replicating this device will be made publicly available, thereby allowing many researchers to collaborate and accumulate knowledge, hopefully contributing to advances in this field.

Effects of Disturbed Body Perception on Arm Function in Patients With Frozen Shoulder.

Purpose Considering pain-related beliefs, this study aimed to investigate the influence of disturbed body perception on arm function in patients with frozen shoulder (FS). Methods This study included 90 patients with FS who visited the orthopedic outpatient clinic. We recorded measurements including the Visual Analog Scale (VAS) for pain at rest and during movement, the quick disability of the arm, shoulder, and hand (QDASH) questionnaire for perceived arm function, the short version of the Pain Self-Efficacy Questionnaire-2 (PSEQ-2) for self-efficacy in pain, the short version of the Pain Catastrophizing Scale (PCS-6) for catastrophic thoughts about pain, the short version of the Tampa Scale for Kinesiophobia (TSK-11) for fear of movement, and the Fremantle Shoulder Awareness Questionnaire (FreSHAQ) for disturbed perception around the shoulder. For statistical analysis, we constructed three models. Model 1 used the QDASH score as the dependent variable, with gender, age, duration of disease onset, VAS score at rest, and VAS score during movement as control variables. Model 2 included pain-related beliefs (PSEQ-2, PCS-6, and TSK-11) added to the variables in Model 1. Model 3 further included the FreSHAQ to the variables in Model 2. We calculated the difference in the adjusted coefficients of determination (R² adj) from Model 1 to Model 2 and Model 3 to determine the amount of change (ΔR² adj). Additionally, we calculated the standardized regression coefficient (ß-value) of the input factors to examine their effects. Result Hierarchical multiple regression analysis showed a ΔR² adj of 0.13 and 0.17 for Models 2 and 3, respectively, indicating an increase in ΔR²adj after adding the FreSHAQ. Furthermore, the FreSHAQ had the largest effect of all factors, with ß = 0.27 (p<0.05). Conclusions The influence of disturbed body perception on perceived arm function in patients with FS was demonstrated, suggesting the importance of considering somatosensory factors in clinical practice.

Reaching the cognitive-motor interface: effects of cognitive load on arm choice and motor performance after stroke.

A vexing characteristic of motor disability after stroke is that many individuals fail to use their affected arm effectively despite having the capacity to do so, a phenomenon termed arm nonuse. Based on the hypothesis that nonuse is influenced by the competing cognitive demands of many daily activities, we examined the effects of cognitive load on arm choice and motor performance in individuals with stroke using a novel virtual reality paradigm that mimics the demands of real-life visual search, object selection, and reaching to targets. Twenty individuals with single left or right hemispheric chronic stroke (11 left cerebrovascular accident; 9 right cerebrovascular accident) and 10 age-matched neurotypical participants completed the Virtual Reality Arm Choice task, in which they reached for target objects in an array under varied cognitive demand. To manipulate cognitive demand, we varied the semantic similarity of objects in the reaching space and the presence or absence of a secondary task. The results showed reduced use of the paretic arm under increased demand. Under cognitive load, participants with stroke also showed slower reach initiation, slower movements, increased reach curvature, and increased performance differences between the paretic and non-paretic arms. The arm choice of neurotypical individuals was also modulated under cognitive load. These data indicate that cognitive factors influence arm choice and motor performance in naturalistic reaching tasks in individuals with chronic stroke. Performance decrements under cognitive load may in turn influence reduced paretic arm use during daily activities.

2D/3D registration based on biplanar X-ray and CT images for surgical navigation.

BACKGROUND AND OBJECTIVES: Image-based 2D/3D registration is a crucial technology for fluoroscopy-guided surgical interventions. However, traditional registration methods relying on a single X-ray image into surgical navigation systems. This study proposes a novel 2D/3D registration approach utilizing biplanar X-ray images combined with computed tomography (CT) to significantly reduce registration and navigation errors. The method is successfully implemented in a surgical navigation system, enhancing its precision and reliability. METHODS: First, we simultaneously register the frontal and lateral X-ray images with the CT image, enabling mutual complementation and more precise localization. Additionally, we introduce a novel similarity measure for image comparison, providing a more robust cost function for the optimization algorithm. Furthermore, a multi-resolution strategy is employed to enhance registration efficiency. Lastly, we propose a more accurate coordinate transformation method, based on projection and 3D reconstruction, to improve the precision of surgical navigation systems. RESULTS: We conducted registration and navigation experiments using pelvic, spinal, and femur phantoms. The navigation results demonstrated that the feature registration errors (FREs) in the three experiments were 0.505±0.063 mm, 0.515±0.055 mm, and 0.577±0.056 mm, respectively. Compared to the point-to-point (PTP) registration method based on anatomical landmarks, our method reduced registration errors by 31.3%, 23.9%, and 26.3%, respectively. CONCLUSION: The results demonstrate that our method significantly reduces registration and navigation errors, highlighting its potential for application across various anatomical sites. Our code is available at: https://github.com/SJTUdemon/2D-3D-Registration.

Ultrasound-guided radial nerve release at the arm under WALANT.

Radial nerve entrapment at the LIS is an aching pain in the distal, lateral upper arm and leads to weakness in wrist and thumb/index finger extension. Additionally, a positive scratch collapse test and localized pain on pressure at the entrapment site are observed. The described approach uses a minimally invasive percutaneous ultrasound-guided technique under local anesthesia.

Reference values for cerebral and peripheral tissue oximetry in children: A clinical TD-NIRS study.

AIM: Current non-invasive near-infrared spectroscopy (NIRS) tissue oximetry suffers from suboptimal reproducibility over probe repositioning, hindering clinical threshold establishment. Time Domain-NIRS (TD-NIRS) offers higher precision but lacks sufficient paediatric data, preventing effective clinical application. We aimed to establish reference ranges for cerebral and mid-upper arm (MUA) tissue haemodynamics in paediatric subjects using TD-NIRS and explore correlations with auxological variables. METHODS: TD-NIRS measurements were conducted acquiring data from cerebral and MUA regions with the NIRSBOX tissue oximeter. Morphological and clinically relevant information were collected to explore potential correlations with TD-NIRS derived parameters. RESULTS: TD-NIRS assessment was applied in 350 children (8.4 ± 5.0 years). Precision of TD-NIRS was demonstrated with standard deviations of 0.9% (StO2) and 4.2 µM (tHb) for frontotemporal cerebral cortex, and 0.8% (StO2) and 3.7 µM (tHb) for MUA. No user dependency was observed. The trends of values for cerebral and peripheral regions vary differently according to age and auxological parameters. CONCLUSION: This study reports resting-state optical and haemodynamic values for a healthy paediatric population, providing a foundation for future investigations into clinically relevant deviations in these parameters. Furthermore, correlations with anthropometric and demographic values provide valuable insights for a deeper understanding of tissue haemodynamic evolution in childhood.

Long-Term Outcomes in Unicompartmental Knee Arthroplasty: Survivorship of Medial versus Lateral Unicompartmental Knee Arthroplasty.

Unicompartmental knee arthroplasties (UKAs) currently represent an important portion of knee arthroplasty procedures and their usage is on an upward trend. Despite offering better functional outcomes and a quicker recovery compared to total knee arthroplasties (TKAs), UKAs are often scrutinized for their longevity. This article provides an in-depth examination of the technical nuances and survival rates of medial versus lateral UKAs, drawing on recent advances and findings in the field. This manuscript thoroughly evaluates the comparability of patient populations undergoing medial and lateral UKAs, considering their anatomical, biomechanical, and demographic differences. It delves into the specific technical challenges associated with each type and systematically assesses the factors that influence failure, including the intricacies of implant design and patient-specific variables. Despite relevant anatomical and biomechanical contrasts between medial and lateral UKAs, recent literature points to comparable survival rates. The prevalence of early failures within the initial five years post-operation underscores the criticality of precise patient selection and refined surgical techniques. The paper succinctly summarizes pivotal literature and provides essential guidance for optimizing UKA survivorship. It underscores the importance of meticulous patient selection and precise surgical techniques, alongside the identification and mitigation of potential pitfalls that impact outcomes. Finally, robotic technology in UKA has considerably enhanced the precision and reproducibility, representing a viable solution to effectively meet and achieve the recommended technical objectives.

Resource-optimized cnns for real-time rice disease detection with ARM cortex-M microprocessors.

This study explores the application of Artificial Intelligence (AI), specifically Convolutional Neural Networks (CNNs), for detecting rice plant diseases using ARM Cortex-M microprocessors. Given the significant role of rice as a staple food, particularly in Malaysia where the rice self-sufficiency ratio dropped from 65.2% in 2021 to 62.6% in 2022, there is a pressing need for advanced disease detection methods to enhance agricultural productivity and sustainability. The research utilizes two extensive datasets for model training and validation: the first dataset includes 5932 images across four rice disease classes, and the second comprises 10,407 images across ten classes. These datasets facilitate comprehensive disease detection analysis, leveraging MobileNetV2 and FD-MobileNet models optimized for the ARM Cortex-M4 microprocessor. The performance of these models is rigorously evaluated in terms of accuracy and computational efficiency. MobileNetV2, for instance, demonstrates a high accuracy rate of 97.5%, significantly outperforming FD-MobileNet, especially in detecting complex disease patterns such as tungro with a 93% accuracy rate. Despite FD-MobileNet's lower resource consumption, its accuracy is limited to 90% across varied testing conditions. Resource optimization strategies highlight that even slight adjustments, such as a 0.5% reduction in RAM usage and a 1.14% decrease in flash memory, can result in a notable 9% increase in validation accuracy. This underscores the critical balance between computational resource management and model performance, particularly in resource-constrained settings like those provided by microcontrollers. In summary, the deployment of CNNs on microcontrollers presents a viable solution for real-time, on-site plant disease detection, demonstrating potential improvements in detection accuracy and operational efficiency. This study advances the field of smart agriculture by integrating cutting-edge AI with practical agricultural needs, aiming to address the challenges of food security in vulnerable regions.

Psychometric Properties of the Serbian Version of the Arm, Shoulder, and Hand Disability Self-Assessment Questionnaire: Criterion Validity, Construct Validity, and Internal Consistency.

Background/Objectives: The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a widely employed self-report tool for assessing upper extremity function. The aim of this study was to assess the psychometric properties of the Serbian version of the DASH by determining its criterion and construct validity, as well as internal consistency. Methods: This cross-sectional study was conducted among patients with hand and wrist disabilities at the Institute for Orthopedics "Banjica", Serbia. The psychometric properties of the Serbian version of the DASH were analyzed through an examination of its factorial structure and internal consistency. The DASH consists of 30 items, 24 of which assess function, 21 of which focus on physical function and three on social/role function. The remaining six items evaluate symptoms related to pain, tingling/numbness, weakness, and stiffness. Results: A total of 297 patients were included in the study. The mean age was 47.4 ± 16.8 years, with 50.5% males. Three models were assessed to determine the reliability and validity of the questionnaire across different domains. Model 1 examined a single-factor structure. In Model 2, the items were divided into two domains: Physical Function and Psychosocial/Symptoms. In Model 3, items were subdivided into three domains: Physical Function, Symptoms, and Psychosocial. All models demonstrated an excellent internal consistency with a Cronbach's alpha > 0.9 for most domains. The values for the fit indices Tucker-Lewis index (TLI) and Comparative-Fit Index (CFI) were above their cut-off criteria of 0.9, while the Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR) were below the suggested value of 0.06, indicating an excellent level of models fit. Standardized factor loadings were statistically significant (p < 0.05). Conclusions: The present study provided the evidence for the appropriate metric properties of the Serbian version of the DASH. Results support both the unidimensional and multidimensional structures of the DASH.

Case report: Hand-arm vibration syndrome in a dental technician.

Occupational exposure to vibration using hand-held tools may cause hand-arm vibration syndrome (HAVS) among workers. We report the case of a 39-year-old lady with a 5-year work exposure to repetitive wrist movements and vibration from hand tools in the dental fabrication laboratory, working as a dental technician. She presented with a 3-year history of chronic pain over the wrists and positive symptoms of numbness and tingling in the hands, pain and discomfort of the fingers during cold exposure, and poor grip strength. Symptoms over the right hand were worse than the left. She is right-hand dominant. She had bilateral median nerve neuropathy at the wrist. Nerve conductive tests were consistent with minimal bilateral carpal tunnel syndrome. MRI showed evidence of soft tissue damage from repetitive strain injury of the right wrist. Neurosensory grading for hand-vibration syndrome (HAVS) using the Stockholm Workshop Scale (SWS) was performed and she was graded as Stage 1SN with numbness or tingling symptoms. Using the International Consensus Criteria (ICC) grading for HAVS, she was graded Stage N1 with numbness and/or tingling (symptoms) of finger. A workplace risk health assessment (WHRA) was performed, and exposure scores for her work tasks in dental fabrication and risk levels were determined using the HSE (Health and Safety UK) Assessment of Repetitive Tasks (ART) tool. The processes of teeth setting using dental burs (exposure score 23), divestment work with stone clippers (score 20), and use of pneumatic drills (score 21) were deemed high-risk activities for repetitive strain injury. The use of carving tools (score 12), packing with the use of flask clamps, and trimming (score 14) were classified as medium high-risk activities for repetitive strain injuries. Workplace modifications and workplace vibration exposure level monitoring protocols were subsequently established with the stabilization of the patient's symptoms.

Perceptions of stakeholders on the use of a simplified, combined protocol for treatment of acute malnutrition in Central African Republic.

Treatment of acute malnutrition requires novel approaches to improve coverage, reduce costs and improve the efficiency of standard protocols that separate the management of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). The use of simplified, combined protocols to treat both MAM and SAM has drawn research and policy interest among global, regional and national stakeholders. However, the perspectives of local communities and health care workers regarding the use of protocols to treat acute malnutrition in a routine health care system are generally lacking. This was a cross-sectional mixed-methods study aimed at assessing the perceptions of different stakeholders on the use of a simplified, combined protocol in two districts in the Central African Republic. Most of the respondents preferred the simplified, combined protocol over the standard protocol. They generally agreed that the protocol was easy to understand, allowed more children to receive treatment and was effective in treating acute malnutrition. The protocol modifications were well received, including the expanded admission criteria, use of mid-upper arm circumference (MUAC) only for admission and discharge criteria and reduced and simplified ready-to-use therapeutic food quantity to treat MAM and SAM. Some caregivers expressed concern with the use of MUAC only to declare recovery, flagging that underlying illnesses could still be present. The caregivers recommended the provision of other food basket interventions to improve the treatment. The support by caregivers and health care workers on the idea of training community health volunteers to treat acute malnutrition points to the potential of scaling up decentralized treatment to increase coverage in remote areas.

O-arm navigation without apnoea in thoracolumbar and lumbar spine surgery: Outcomes and considerations in a prospective study.

Background: Intra operative three dimensional navigation-assisted pedicle screw insertion typically requires apnoea for reliable image production. However this carries potential risks to the physiologically compromised patients such as patients having COPD, obesity, cardiac illnesses, and anaemia. In such patients' safe apnoea time may be as low as 1 min, and can cause life threatening complications. Therefore, this study was done to evaluate the accuracy of thoracolumbar and lumbar pedicle screw insertion using O-arm without using apnoea during imaging, to prevent such possible complications. Methods: This is a single centre prospective study of 238 patients treated with pedicle screw implantation under O-arm guidance, without using apnoea while imaging. The pedicle breach rate during screw insertion was graded on Gertzbein classification. Also, two senior spine surgeons independently evaluated motion artifacts in the intra operative images and rated them as 'Significant' or 'Non-Significant' for the procedure. Values of p < 0.05 were considered statistically significant. Results: Despite not using apnoea in 238 patients with 1120 screws, there were nil screw related complications. Only in one paediatric case of dorsal spine deformity, there were blurred and inaccurate images because of chest expansion, without apnoea. Hence he was given apnoea to render the image reliable for pedicle screw insertion. The screw placement in the pedicles was checked intraoperatively and graded for breach. Grade 2 breach were seen in only 2 cases (n = 3 screws) which were revised intra operatively. The interobserver agreement on motion artifacts was good (κ = 0.565, p < 0.001). Conclusions: The results of pedicular screw insertion performed without induced apnea are comparable to those achieved with apnea when using O-arm imaging. This technique has proven to be a safe and reliable method for pedicle screw insertion in the thoracolumbar and lumbar spine, potentially mitigating physiological complications. Nonetheless, even minor motion artifacts, on the order of a few millimeters, can significantly impact outcomes in the cervical and upper thoracic spine. Therefore, further research is warranted to evaluate the efficacy and safety of this approach in these regions of the spine.

Enhanced Safety and Efficacy of O-Arm Navigation Over C-Arm Guidance in Percutaneous Kyphoplasty for Patients With Osteoporotic Vertebral Compression Fractures and Spinal Deformity: A Comparative Study.

OBJECTIVE: Although percutaneous kyphoplasty (PKP) under C-arm guidance is an effective treatment for osteoporotic vertebral compression fractures (OVCF), obtaining high-definition images in patients with OVCF and spinal deformities can be challenging or insufficient using traditional C-arm guidance, prompting our institution to adopt the O-arm navigation system-which offers comprehensive 3D imaging and precise navigation-and this study compares its safety and efficacy with conventional C-arm-assisted PKP. METHODS: This was a retrospective study. From February 2019 to February 2022, we enrolled 28 patients with OVCF (44 vertebrae) with spinal deformity treated with O-arm navigation-assisted PKP and 30 patients with OVCF (42 vertebrae) with spinal deformity treated with C-arm-guided PKP. We recorded puncture times, single-segment operation time, number of cases with bone cement leakage, and length of stay. The visual analog scales (VASs), Oswestry disability indexes (ODIs), recovery of Cobbs angle, and vertebral height were used to assess treatment effect before the operation, on the first day postoperation, the first month postoperation, and at the final follow-up. The chi-squared test was utilized for comparing discrete variables, an independent samples t-test was used for continuous variables, and Pearson's chi-squared test and Fisher's exact test were applied for categorical data. RESULTS: Demographic features were comparable between the groups. The O-arm navigation group showed a significant reduction in puncture adjustment per vertebrae, single-segment operation time, and the rate of trocar needle malposition compared to the C-arm guidance group. The rate of cement leakage was decreased in the O-arm-guided PKP group, and other complications did not differ between the two groups. Intragroup comparisons revealed significant improvements in VAS scores and ODI on the first day, first month, and final follow-up after the operation (p < 0.05). The VAS score was significantly lower in the O-arm navigation-assisted PKP group than in the C-arm-guided PKP group on the first day postoperatively (p = 0.049). However, no significant differences in VAS scores were observed between the groups at the first month postoperatively or at the final follow-up. In each follow-up period, there was no significant difference in ODI, Cobb angle, and the percent of anterior vertebral height (AVH %) between the groups. CONCLUSION: O-arm navigation-assisted PKP demonstrates better clinical safety and efficacy than C-arm-guided PKP, marking it as a minimally invasive, safe, and effective procedure for treating patients with OVCF with spinal deformity.