Decision Method of Optimal Needle Insertion Angle for Dorsal Hand Intravenous Robot.

In the context of COVID-19, the research on various aspects of the venipuncture robot field has become increasingly hot, but there has been little research on robotic needle insertion angles, primarily performed at a rough angle. This will increase the rate of puncture failure. Furthermore, there is sometimes significant pain due to the patients' differences. This paper investigates the optimal needle entry angle decision for a dorsal hand intravenous injection robot. The dorsal plane of the hand was obtained by a linear structured light scan, which was used as a basis for calculating the needle entry angle. Simulation experiments were also designed to determine the optimal needle entry angle. Firstly, the linear structured optical system was calibrated and optimized, and the error function was constructed and solved iteratively by the optimization method to eliminate measurement error. Besides, the dorsal hand was scanned to obtain the spatial point clouds of the needle entry area, and the least squares method was used to fit it to obtain the dorsal hand plane. Then, the needle entry angle was calculated based on the needle entry area plane. Finally, the changes in the penetration force under different needle entry angles were analyzed to determine the optimal needle insertion angle. According to the experimental results, the average error of the optimized structured light plane position was about 0.1 mm, which meets the needs of the project, and a large angle should be properly selected for needle insertion during the intravenous injection.

The standard sagittal starting point and entry angle for tibia intramedullary nails results in malreduction of proximal tibial fractures.

INTRODUCTION: The aim of this study was to determine the sagittal starting point and entry angle necessary for anatomic reduction in proximal tibial fractures and to compare reductions obtained using a standard versus modified sagittal entry angle. METHODS: Extra-articular proximal tibial fracture sawbone models were divided into three groups. The first group was used to determine the sagittal starting point and entry angle necessary for an anatomic reduction by inserting nails into the distal fragment and then reducing the proximal fragment over the nail. The second and third groups had nails inserted through the standard coronal and sagittal starting point using the standard sagittal entry angle (parallel to the anterior cortex) versus a more posteriorly directed modified sagittal entry angle (directed at the center of the tibia at the level of the tibia tubercle prominence). Fracture gapping and translation in the sagittal plane were measured for each group. RESULTS: Anatomic reduction was only possible with a sagittal starting point that was too posterior for actual use. The standard sagittal entry angle resulted in greater posterior fracture translation and less anterior fracture gapping then the modified sagittal entry angle, 10.6 ± 1.1 versus 1.6 ± 2.8 mm (p < 0.01) and 1.3 ± 0.5 versus 5.3 ± 2.5 mm (p = 0.01), respectively. CONCLUSION: Anatomic reduction was not achieved with the standard sagittal starting point and entry angle. Considering these finding, surgeons should have a low threshold to utilize adjunct reduction methods for these injuries.

The Optimal Approach for a Superior Hypogastric Plexus Block.

INTRODUCTION: Superior hypogastric plexus block (SHGPB) is technically difficult, and an accurate procedure is required to avoid potential complications. We attempted to determine the reference angles for fluoroscopy-assisted SHGPB and to establish a predictor as a guide to select the optimal approach between the classic posterior approach and transdiscal approach. METHODS: Abdominopelvic computed tomography (CT) scans from 268 patients diagnosed with pelvic malignancies were examined. The oblique and axial angles needed for the fluoroscope were measured both for posterior and transdiscal approaches by simulating the needle trajectory on CT imaging. We developed an SHGPB index defined by the ratio (%) of the interposterior iliac border distance to the L5 body transverse diameter, which represents the relative transverse diameter of the bony pelvis. We evaluated whether it can help select the optimal approach for the SHGPB between the posterior and transdiscal approaches. RESULTS: Males had a significantly smaller angle than females (right oblique angle for posterior approach, males 14 [range 12 to 17] degrees vs. females 19 [range 16 to 23] degrees; P < 0.001). An SHGPB index of < 150 was an independent predictor for failure of the classic posterior approach (odds ratio 31.3, 95% confidence interval 5.1 to 104.7). CONCLUSIONS: The optimal right oblique angle of fluoroscopy for the posterior approach is 13° to 15° in males and 19° to 20° in females. The transdiscal approach may be favored over the posterior approach when the bony pelvis is narrow relative to the target vertebral body, which can be measured by the SHGPB index being < 150.

New Optimal Needle Entry Angle for Cervical Transforaminal Epidural Steroid Injections: A Retrospective Study.

Objective: A cervical epidural steroid injection is one of the most commonly performed interventions to manage chronic neck pain and cervical radiculopathy. Despite its many severe complications, cervical transforaminal epidural steroid injection (CTFESI) is a clinically necessary modality for managing neck pain and cervical radiculopathy. We aimed in this study to find a safer optimal needle entry angle to decrease the chance of an accidental vertebral artery (VA) puncture even with a proper needle entry angle and to visualize the target of the needle tip. Methods: This retrospective study included 312 patients with neck pain or cervical radiculopathy who had undergone magnetic resonance imaging scans for diagnosis and treatment. The first line was drawn from the midpoint of the two articular pillars and passed through the exact midline of the spinous process. The second line was drawn parallel to the ventral lamina line (conventional transforaminal approach line, CTAL). The third line was drawn parallel to the ventral margin at the midpoint of the superior articular process's ventral border (new transforaminal approach line, NTAL). The angle of intersection between the midline and CTAL versus with NTAL were measured from both sides (right and left) at C5-6, C6-7, and C7-T1 levels. Also, the distance of CTAL and NTAL from VA were measured from both sides at each level. We examined whether the CTAL and NTAL would penetrate the ipsilateral VA, internal carotid artery (ICA), and internal jugular vein (IJV). Results: There were significant differences between CTAL and NTAL angles at all levels (P < 0.001). There were significant differences between the distance of CTAL and NTAL from VA at all levels (P < 0.001). There were also significant differences between the observed frequency of CTAL and NTAL that would penetrate the major ipsilateral vessel (VA, ICA, and IJV) on all levels and sides (P < 0.001~0.030). Conclusion: The angle of NTAL (approximately 70°) is safer than the angle of CTAL (approximately 50°) when considering vascular injuries to vessels, such as the VA, ICA, and IJV.

Kinematic Analysis of 2-Point and 3-Point Jump Shot of Elite Young Male and Female Basketball Players.

Basketball shooting is one of the most important offensive skills in basketball. Winning or losing a game mostly depends on the shooting effectiveness. The study aims to compare the selected kinematic variables of 2-point (2-pt) and 3-point (3-pt) jump shots (after making a cut and receiving the ball) and ascertain the differences between elite male under 16 and 18 (U16M, U18M) and female under 16 and 18 (U16F, U18F) basketball players. Overall, forty-eight young male and female basketball players participated in the study. 3D motion analysis using an inertial suit with the addition of utilizing a smart ball was performed for assessing the 2-pt and 3-pt shooting techniques. Players in male categories shot for 2-pt with a higher center of mass difference in the vertical direction (U16M 5.7 cm, U18M 3.9 cm vs. U16F 1.4 cm, U18F 0.6 cm), with higher release shoulder angle (U16M 110.9, U18M 113.8 vs. U16F 103, U18F 105), and with a higher entry angle of the ball (U16M 34, U18M 32 vs. U16F 30, U18F 30) when compared to female categories (p < 0.001). In the 3-pt shooting, there were differences between male and female categories in the shoulder angle when releasing the ball (p < 0.001). In the players shooting speed, there were differences between U16M vs. U18F (0.95 ± 0.1 vs. 0.88 ± 0.1; p = 0.03) and U16F vs. U18F (0.96 ± 0.06 vs. 0.88 ± 0.1; p = 0.02) players. Male categories shot 3-pt shots with a smaller center of mass difference in the horizontal direction when compared to 2-pt shots (p < 0.001). The entry angle was higher in successful shooting attempts compared to unsuccessful shooting attempts when shooting for 3-pt (p = 0.02). Player shooting speed was higher in all categories (except U18F) when shooting for 3-pt (p < 0.001). It appears that performers show difference in kinematic variables based on distance from the basket. Basketball coaches and players should work to minimize the kinematic differences between 2-pt and 3-pt shooting and to optimize the shooting technique.

Determination of adequate entry angle of lumbar sympathetic ganglion block in korean.

BACKGROUND: The target of lumbar sympathetic ganglion block is the anterolateral surface of the L2, 3 and 4 vertebral bodies, where the lumbar sympathetic ganglion usually lies. In most cases, a block-needle is inserted approximately 5-8 cm lateral to spinous process on the skin and directed to the anterolateral surface of vertebral body obliquely. The purpose of this study is to determine the safe entry angle and entry point in Korean by using the abdominal CT scan images. METHODS: The abdominal CT images of eighty five patients were recruited to this study. The minimal angle aimed at the lumbar sympathetic ganglion that can pass through the lateral aspect of body and maximal angle that avoids puncturing the kidney, ureter or retroperitoneal space were measured. The distance from midline to skin entry point was also measured. RESULTS: There was no significant difference in entry angle among L2, 3, and 4 level. The entry angle was similar in the right and left side, and in males and females. The entry angle of old age group was significantly smaller than that of young age group. The calculated safe entry angle was 30.5 +/- 0.4 degrees and entry point was 7.7 +/- 0.2 cm and 6.7 +/- 0.1 cm lateral from midline in males and females respectively. CONCLUSIONS: These measurements can be used as a reference for lumbar sympathetic ganglion block and radiofrequency lesioning. Prior to performing the lumbar sympathetic ganglion block for cancer patients, the abdominal CT scan should be reviewed to prevent complications.