Accuracy of a smartphone-assisted novel labeling method for marking target axial position in cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the convenience and accuracy of a novel smartphone-assisted “any-point two-step method” for finding the target axial position in cataract phacoemulsification combined with intraocular lens(IOL)implantation.METHODS: Prospective observational study. A total of 62 cases(62 eyes)of patients with age-related cataracts who underwent cataract phacoemulsification combined with IOL implantation in our hospital from October 2021 to April 2022 were selected. They were randomly divided into two groups: 31 cases(31 eyes)in the control group were applied with the “traditional two-step method” using slit lamp to mark the target axial position of the IOL, and 31 cases(31 eyes)in the experimental group were applied with the smartphone-assisted “two-step method” to mark the target axial position of the IOL. The Callisto eye navigation system was used as a standard reference, and the deviation of the reference marking point(deviation-1), the deviation of the target axial marking point(deviation-total), and the deviation of the angle from the reference marking point to the target axial marking point(deviation-2)were calculated and recorded as the preoperative axial marking time.RESULTS:Both deviation-1 and deviation-total values were lower in the experimental group than those in the control group(1.06°±1.39° vs 2.48°±2.23°, 1.77°±1.54° vs 2.81°±1.58°, all P<0.01), but there was no significant difference in the deviation-2 values between the two groups(1.35°±1.40° vs 1.48°±1.79°, P>0.05). The preoperative axial marking took shorter time in the experimental group than in the control group(1.77±1.70 min vs 2.88±3.20 min, P<0.01).CONCLUSION: The smartphone-assisted “any-point two-step method” for finding the target axial position in cataract phacoemulsification combined with IOL implantation is simple, time-saving, and accurate compared with the “traditional two-step method”.

O-arm navigation versus C-arm navigation for guiding percutaneous long sacroiliac screws placement in treatment of Denis type Ⅱ sacral fractures / 中国修复重建外科杂志

OBJECTIVE@#To compare the effectiveness of O-arm navigation and C-arm navigation for guiding percutaneous long sacroiliac screws in treatment of Denis type Ⅱ sacral fractures.@*METHODS@#A retrospective study was conducted on clinical data of the 46 patients with Denis type Ⅱ sacral fractures between April 2021 and October 2022. Among them, 19 patients underwent O-arm navigation assisted percutaneous long sacroiliac screw fixation (O-arm navigation group), and 27 patients underwent C-arm navigation assisted percutaneous long sacroiliac screw fixation (C-arm navigation group). There was no significant difference in gender, age, causes of injuries, Tile classification of pelvic fractures, combined injury, the interval from injury to operation between the two groups ( P>0.05). The intraoperative preparation time, the placement time of each screw, the fluoroscopy time of each screw during placement, screw position accuracy, the quality of fracture reduction, and fracture healing time were recorded and compared, postoperative complications were observed. Pelvic function was evaluated by Majeed score at last follow-up.@*RESULTS@#All operations were completed successfully, and all incisions healed by first intention. Compared to the C-arm navigation group, the O-arm navigation group had shorter intraoperative preparation time, placement time of each screw, and fluoroscopy time, with significant differences ( P<0.05). There was no significant difference in screw position accuracy and the quality of fracture reduction ( P>0.05). There was no nerve or vascular injury during screw placed in the two groups. All patients in both groups were followed up, with the follow-up time of 6-21 months (mean, 12.0 months). Imaging re-examination showed that both groups achieved bony healing, and there was no significant difference in fracture healing time between the two groups ( P>0.05). During follow-up, there was no postoperative complications, such as screw loosening and breaking or loss of fracture reduction. At last follow-up, there was no significant difference in pelvic function between the two groups ( P>0.05).@*CONCLUSION@#Compared with the C-arm navigation, the O-arm navigation assisted percutaneous long sacroiliac screws for the treatment of Denis typeⅡsacral fractures can significantly shorten the intraoperative preparation time, screw placement time, and fluoroscopy time, improve the accuracy of screw placement, and obtain clearer navigation images.

O uso do planejamento virtual na cirurgia ortognática / The use of virtual planning in orthognathic surgery

Introdução: A cirurgia ortognática envolve manipulação da arquitetura óssea facial, através de osteotomias, para restaurar a forma e a função, corrigindo a má oclusão, as desproporções maxilomandibulares e assimetrias faciais. O planejamento virtual em cirurgia ortognática é realizado com ajuda de softwares que utilizam as medidas reais do esqueleto craniofacial e registros da oclusão do paciente, através de uma análise 3D. Método: Foram avaliados 18 pacientes com deformidades dentofaciais, de acordo com a classificação de Angle submetidos a cirurgia ortognática com o uso do planejamento virtual, entre 2018 e 2019. Os critérios de inclusão foram pacientes entre 16 e 60 anos com desproporções maxilo-mandibulares nas quais o tratamento ortodôntico isolado não era suficiente. Os critérios de exclusão foram a presença de lesões císticas ou tumorais nos maxilares e comorbidades clínicas que contraindicavam a cirurgia. O planejamento virtual foi realizado em todos os pacientes, utilizando o software Dolphin® Imaging 11 e os guias cirúrgicos confeccionados em impressora 3D. Resultados: O guia cirúrgico intermediário apresentou adaptação perfeita nas faces oclusais promovendo grande estabilidade para o reposicionamento e fixação da maxila na oclusão intermediária. Os 18 pacientes operados responderam como "totalmente satisfeitos" em relação ao resultado estético-funcional nessa série estudada. Foi encontrada uma semelhança muito grande da posição do esqueleto maxilofacial no planejamento virtual préoperatório e o obtido no pós-operatório, através da avaliação das telerradiografias. Conclusão: O planejamento virtual em cirurgia craniomaxilofacial possui inúmeras vantagens, como diminuição do tempo laboratorial pré-operatório, maior precisão na confecção dos guias cirúrgicos e melhor reprodutibilidade dos resultados simulados.

Introduction: Orthognathic surgery involves the manipulation of facial bone architecture through osteotomies to restore form and function, correcting malocclusion, maxillomandibular disproportions, and facial asymmetries. Virtual planning in orthognathic surgery is carried out with the help of software that uses real measurements of the craniofacial skeleton and records of the patient's occlusion through 3D analysis. Method: 18 patients with dentofacial deformities were evaluated, according to Angle's classification, who underwent orthognathic surgery using virtual planning between 2018 and 2019. The inclusion criteria were patients between 16 and 60 years old with maxylo-mandibular disproportions in which orthodontic treatment alone was not sufficient. Exclusion criteria were the presence of cystic or tumoral lesions in the jaw and clinical comorbidities that contraindicated surgery. Virtual planning was carried out on all patients, using Dolphin® Imaging 11 software and surgical guides made with a 3D printer. Results: The intermediate surgical guide presented perfect adaptation on the occlusal surfaces, promoting great stability for the repositioning and fixation of the maxilla in intermediate occlusion. The 18 operated patients responded as "completely satisfied" in relation to the aesthetic-functional result in this series studied. A very great similarity was found between the position of the maxillofacial skeleton in the preoperative virtual planning and that obtained post-operatively through the evaluation of teleradiography. Conclusion: Virtual planning in craniomaxillofacial surgery has numerous advantages, such as reduced pre-operative laboratory time, greater precision in the creation of surgical guides, and better reproducibility of simulated results.

Trajetória para implementação de programa de navegação de pacientes na oncologia: relato de experiência / The path to implementing a patient navigation program in oncology: an experience report

OBJETIVO: Descrever a trajetória para a implementação de um Programa de Navegação para pacientes oncológicos. MÉTODO: Estudo descritivo, tipo relato de experiência realizado em um Centro de Oncologia do Sul do Brasil. RESULTADOS: O processo de implementação da navegação ocorreu em quatro etapas: a primeira iniciou com implementação da navegação para pacientes privados com câncer de cabeça e pescoço; a segunda envolveu o piloto do programa de navegação de pacientes com câncer de mama para entender as principais barreiras enfrentadas pelas pacientes; a terceira etapa, foi elaborar e aprovar a Política do Programa de Navegação Institucional. Na última, o Programa de Navegação da linha de cuidado da mama foi implementado para pacientes com indicação de neoadjuvância. Obteve-se redução de 70% na mediana de tempo de indicação e primeira consulta oncológica, de 28,6% no tempo entre sintoma e diagnóstico, 26,0% no tempo entre diagnóstico e início de tratamento. CONCLUSÃO: A implementação de um Programa de Navegação para pacientes com câncer exige dedicação e comprometimento institucional onde se evidencia um melhor cuidado oncológico, tendo o enfermeiro como protagonista da gestão e efetivação do processo.

OBJECTIVE: To describe the process of implementing a Navigation Program for cancer patients. METHOD: Descriptive study, type of experience report carried out in an Oncology Center in Southern Brazil. RESULTS: The process of implementing navigation took place in four stages: the first began with the implementation of navigation for private patients with head and neck cancer; the second involved piloting the navigation program for breast cancer patients to understand the main barriers faced by patients; the third stage, was to draw up and approve the Institutional Navigation Program Policy. In the last stage, the Breast Care Navigation Program was implemented for patients with neoadjuvant indications. A 70% reduction was achieved in the median time between indication and first oncology consultation, 28.6% between symptom and diagnosis, and 26.0% between diagnosis and start of treatment. CONCLUSION: Implementing a Navigation Program for cancer patients requires dedication and institutional commitment, leading to better cancer care, with nurses playing a leading role in managing and implementing this process.

Experience of care nurses: approaches to the principles of navigation of cancer patients / Experiencia de enfermeros de cuidado: aproximaciones a los principios de navegación de pacientes con cáncer / Experiência de enfermeiras assistenciais: aproximações aos princípios da navegação de pacientes oncológicos

ABSTRACT Objective: To understand the experiences of nurses assisting cancer patients, according to Harold Freeman´s principles of navigation. Method: A qualitative study conducted in a large public hospital in the State of São Paulo in December 2021. Six nurses were interviewed using a semi-structured script with questions about the care of cancer patients and their families. The data were submitted to content analysis with theoretical framework of Harold Freeman. Results: Five categories emerged from the statements: fluidity in care; integration between teams; bond with patients and families; competencies of care nurses in the navigation of cancer patients; valorization and facilities in team training. Conclusion: According to the categories observed, we can consider that the experiences of care nurses working in an oncology unit revealed the strengthening of navigation principles contributing to the care and minimization of barriers, which can facilitate and/or soften the therapeutic path of the cancer patient.

RESUMEN Objetivo: Comprender las experiencias de enfermeros que asisten a pacientes con cáncer, según los principios de navegación de Harold Freeman. Método: Estudio cualitativo realizado en un gran hospital público del Estado de São Paulo en diciembre de 2021. Seis enfermeros fueron entrevistados utilizando un guión semiestructurado con preguntas sobre el cuidado de pacientes con cáncer y sus familias. Los datos fueron sometidos al análisis de contenido con el referencial teórico de Harold Freeman. Resultados: De los enunciados surgieron cinco categorías: fluidez en el cuidado; integración entre equipos; vínculo con pacientes y familias; competencias de los enfermeros asistenciales en la navegación de pacientes oncológicos; valoración y facilidades en la formación de equipos. Conclusión: De acuerdo con las categorías observadas, podemos considerar que las experiencias de los enfermeros asistenciales que actúan en una unidad de oncología revelaron el fortalecimiento de los principios de navegación contribuyendo al cuidado y minimización de barreras, lo que puede facilitar y/o suavizar el camino terapéutico del cáncer paciente.

RESUMO Objetivo: Compreender as experiências de enfermeiras assistenciais aos pacientes oncológicos, segundo os princípios da navegação de Harold Freeman. Método: Estudo de abordagem qualitativa, realizado em hospital público de grande porte no interior do Estado de São Paulo no mês de dezembro de 2021. Foram entrevistadas seis enfermeiras por meio de roteiro semiestruturado com questões acerca do atendimento ao paciente oncológico e familiares. Os dados foram submetidos à análise de análise de conteúdo com referencial teórico de Harold Freeman. Resultados: Cinco categorias emergiram dos depoimentos: fluidez na assistência; integração entre as equipes; vínculo com pacientes e familiares; competências das enfermeiras assistenciais na navegação de pacientes oncológicos; valorização e facilidades no treinamento das equipes. Conclusão: De acordo com as categorias observadas, podemos considerar que as experiências de enfermeiras assistenciais que atuam em unidade oncológica revelaram o fortalecimento dos princípios de navegação contribuindo para o atendimento e minimização de barreiras, o que pode facilitar e/ou suavizar o trajeto terapêutico do paciente oncológico.

Private health plan operator: breast care navigation program and care line / Operadora de planes de salud privados: programa de navegación y línea de asistencia para el cuidado de las mamas / Operadora de plano de saúde privado: programa de navegação e linha de cuidado de atenção à mama

ABSTRACT Objective: to develop a navigation program for patients in the breast care line, beneficiaries of a private health plan operator. Method: a convergent care research study, related to the stages of the Guide for the Development and Implementation of Patient Navigation Programs, consisting of the phases: diagnosis; planning; implementation; and evaluation, using instruments specifically designed for each phase. It was conducted from January to September 2022 in Porto Alegre, Brazil. Results: during the diagnosis, the patients' demographic profile was identified and the flow they followed through the health services was analyzed. Interviews were carried out with the professionals involved in patient care, and the main barriers that might be faced by patients were surveyed. In planning, the program structure was considered. During implementation, a navigation pilot was carried out with two nurses from different areas; and the nurse navigators' performance profile and a proposal of topics for team training were constructed. An evaluation was carried out using the Plan, Do, Study and Act tool at the end of each stage. A breast care line and navigation program were created for the patients. Conclusion: two products were developed: Planned Care Line, with important prevention actions favoring screening and early diagnosis of the disease; and the Navigation Program for line assistance, in which attention is centered on the patients, with an evaluation of their needs, elimination of barriers that make it difficult for them to navigate the health system and guidance in each stage of the path.

RESUMEN Objetivo: desarrollar un programa de navegación para pacientes de la línea de asistencia para el cuidado de las mamas, en mujeres afiliadas a una operadora de planes de salud privados. Método: investigación convergente y asistencial, relacionada a las etapas propuestas en la Guía para el Desarrollo e Implementación de Programas de Navegación de Pacientes, compuesto por las siguientes fases: diagnóstico, planificación, implementación y evaluación, utilizando instrumentos elaborados específicamente para cada fase. El estudio se realizó entre enero y septiembre de 2022 en Porto Alegre, Brasil. Resultados: en el diagnóstico se identificó el perfil demográfico de las pacientes, al igual que se analizó el camino que recorrieron en los servicios de salud. Se realizaron entrevistas con los profesionales involucrados en atender a las pacientes, y se sondearon los principales obstáculos que podrían enfrentar las mujeres. En la planificación se contempló la estructura del programa. En la implementación se llevó a cabo una prueba piloto de navegación con dos enfermeras de distintas áreas, además de elaborarse el perfil de actuación de los enfermeros navegadores y una propuesta de temas para capacitar al equipo. Se realizó una evaluación con la herramienta Plan, Do, Study and Act al término de cada etapa. Se creó una línea de asistencia para el cuidado de las mamas y un programa de navegación para las pacientes. Conclusión: se desarrollaron dos productos: Línea de Asistencia Planificada, con importantes acciones de prevención que favorecen el screening y diagnóstico temprano de la enfermedad; y el Programa de Navegación para cumplir con la línea de asistencia, en el que la atención se centra en la paciente, evaluando sus necesidades, eliminando obstáculos que le dificultan transitar por el sistema de salud y orientándola en cada etapa del trayecto.

RESUMO Objetivo: Desenvolver um programa de navegação para pacientes da linha de cuidado de atenção à mama, beneficiárias de uma operadora de plano de saúde privado. Método: Pesquisa convergente assistencial, relacionada às etapas do Guia de Desenvolvimento e Implantação de Programas de Navegação de Pacientes, composto pelas fases: diagnóstico, planejamento, implantação e avaliação, utilizando instrumentos elaborados para cada fase. Foi realizada em Porto Alegre, Brasil, de janeiro a setembro de 2022. Resultados: No diagnóstico, identificou-se o perfil demográfico dos pacientes, análise do fluxo percorrido por eles nos serviços de saúde. Realizaram-se entrevistas com os profissionais envolvidos no atendimento ao paciente, e fez-se levantamento das principais barreiras que poderiam ser enfrentadas por ele. No planejamento, contemplou-se a estrutura do programa. Na implantação, realizou-se piloto de navegação com duas enfermeiras de áreas distintas; e construíram-se o perfil de atuação do enfermeiro navegador e uma proposta de temas para capacitação da equipe. Realizou-se avaliação com a ferramenta Plan, Do, Study and Act ao término de cada etapa. Construíram-se às pacientes, linha de cuidado de atenção à mama e o programa de navegação. Conclusão: Desenvolveram-se dois produtos: Linha de Cuidado Planejada, com ações importantes de prevenção favorecendo o rastreamento e diagnóstico precoce da doença; e o Programa de Navegação para atendimento à linha, em que a atenção é centrada no paciente, com avaliação de suas necessidades, eliminação de barreiras que lhe dificultam trafegar no sistema de saúde e seu direcionamento em cada etapa da jornada.

Floor Maze Test is capable of differentiating spatial navigation between frail and pre-frail institutionalized older persons / Floor Maze Test é capaz de diferenciar a navegação espacial entre idosos institucionalizados frágeis e pré-frágeis

ABSTRACT. Investigation of the association between physical frailty and cognitive performance through spatial navigation is important to enable the identification of individuals with cognitive impairment and physical comorbidity. Objective: To analyze the association between spatial navigation and frailty in frail and pre-frail institutionalized older adults. Methods: Forty older people of both sexes, aged 60 years or over, residing in four Brazilian Long-Term Care Facilities (LTCFs) participated in this study. The following tests were applied: Mini-Mental State Examination (MMSE), 2.44m Timed Up and Go, Floor Maze Test (FMT), and Fried's frailty criteria. For data analysis, the Mann-Whitney and independent t-tests were used to compare the groups (frail x pre-frail), principal component analysis was used to explore the main variables related to the data variance, and binary logistic regression to estimate associations. Results: There was a significant difference in performance in the FMT immediate maze time (IMT) (p=0.02) and in the delayed maze time (DMT) (p=0.009) between the pre-frail and frail older adults. An association between FMT DMT performance and frailty was found, showing that older people with shorter times on the DMT (better performance) had approximately four times the chance of not being frail (odds ratio - OR=4.219, 95% confidence interval - 95%CI 1.084-16.426, p=0.038). Conclusion: Frailty is associated with impaired spatial navigation ability in institutionalized older adults, regardless of gait speed performance.

RESUMO. A investigação da associação entre fragilidade física e desempenho cognitivo por meio da navegação espacial é importante para possibilitar a identificação de indivíduos com déficit cognitivo e comorbidade física. Objetivo: Analisar a associação entre navegação espacial e fragilidade em idosos institucionalizados frágeis e pré-frágeis. Métodos: Participaram deste estudo 40 idosos de ambos os sexos, com idade igual ou superior a 60 anos, residentes em quatro instituições de longa permanência (ILPI) brasileiras. Foram aplicados os seguintes testes: Miniexame do Estado Mental (MEEM), 2,44m Timed Up and Go, Floor Maze Test (FMT) e os critérios de fragilidade de Fried. Para a análise dos dados, foram utilizados os testes t independente e de Mann-Whitney para comparar os grupos (frágeis x pré-frágeis), foi feita análise de componentes principais para explorar as principais variáveis relacionadas à variância dos dados e regressão logística binária para estimar associações. Resultados: Houve diferença significativa no desempenho do FMT no tempo imediato do labirinto (TIL) (p=0,02) e no tempo posterior do labirinto (TPL) (p=0,009) entre os idosos pré-frágeis e frágeis. Encontrou-se associação entre o desempenho no FMT TPL e fragilidade, mostrando que idosos com menor tempo de TPL (melhor desempenho) tiveram aproximadamente quatro vezes mais chance de não serem frágeis (odds ratio - OR=4,219, intervalo de confiança de 95% - IC95% 1,084-16,426, p=0,038). Conclusão: A fragilidade está associada à habilidade de navegação espacial prejudicada em idosos institucionalizados, independentemente do desempenho da velocidade da marcha.

Research Progress of Indocyanine Green Fluorescence Laparoscopic Technique in Clinical Application / 中国医疗器械杂志

Indocyanine green (ICG) is the most commonly used near-infrared fluorescent (NIRF) dye in clinical practice, and its mediated near-infrared fluorescence imaging technology is gradually applied in clinical practice. It has shown great potential in invasive surgery (MIS) and is expected to become the standard technology for surgical diagnosis and treatment of diseases. The clinical application of ICG fluorescence laparoscopy is reviewed here.

Research Progress and Prospect Analysis of Vascular Interventional Surgical Robot / 中国医疗器械杂志

Vascular interventional surgery is an important means to treat cardiovascular and cerebrovascular diseases, but the particularity of its working environment will bring greater radiation threat to doctors. Vascular interventional surgery robots can effectively improve the working environment of doctors and can provide more stable operations, improve the success rate of surgery. This study mainly introduces the current research status, key technologies, and future application of vascular interventional surgical robots.

Comparative study of endoscopic spine surgery with and without assistance of an electromagnetic navigation surgical robot in the treatment of lumbar disc herniation / 中华显微外科杂志

Objective:To compair the clinical effect of endoscopic spine surgery with and without assistance of an electromagnetic navigation surgical robot(ENSR) system in the treatment of lumbar disc herniations(LDH).Methods:From March 2021 to December 2021, 73 patients with LDH underwent endoscopic minimally invasive treatment in the Department of Spine Surgery, Limin Hospital of Weihai High District. Thirty-eight patients were treated with endoscopic spine surgery assisted by domestic ENSR system(ENSR group), and 35 patients were treated with endoscopic spine surgery alone(endoscopic group). The patients received follow up regularly by telephone or Wechat. The intraoperative fluoroscopy times, puncture times, upper facet arthroplasty times, operation time, preoperative and postoperative Visual Analogue Scale(VAS), Japanese Orthopaedic Association Scores(JOA), and the MOS item short from health survey(SF-36)were compared between the 2 groups. The early postoperative efficacy was evaluated by modified MacNab criteria at 1 week after surgery. SPSS 26.0 was used to analyse the data. P<0.05 was considered that the difference was statistically significant. Results:The age, gender, body mass index(BMI) and other general data of the 2 groups were basically the same, and there was no statistically significant difference( P>0.05). There was no significant difference in the excellent and good rate of postoperative treatment between ENSR group(97.37%) and endoscopic group(94.29%)( Z=0.90, P>0.05). In terms of operation time, intraoperative fluoroscopy times, puncture times, and plasty times, ENSR group[(67.00±17.00) min, (4±2) times, 1 time, 1 time, respectively] was compared with the endoscopic group[(82.00±16.00] min, (17±6) times, (9±5) times, (5±2) times], and the difference was statistically significant( t=3.87,12.62, 9.87, respectively, P<0.05). There were significant differences in VAS, JOA and SF-36 scores between the 2 groups between before and after surgery( F=106.42, 112.14, 26.88, respectively, P<0.05). There was no significant difference in VAS, JOA and SF-36 scores before and after surgery between the 2 groups( F=0.95, 3.54, 0.97, respectively, P>0.05). Conclusion:The endoscopic spine surgery assisted by the ENSR can achieve satisfactory clinical results and is a safe and effective surgical assistance system. For the endoscopic surgery, assisted by the ENSR has obvious advantages in reducing the times of fluoroscopy, puncture, and facet arthroplasty, and shortening the operation time.

Blue velvet arena test to detect spatial memory in patients with chronic insomnia disorder: a clinical study / 中华神经科杂志

Objective:To investigate the feasibility of blue velvet arena test (BVAT) in evaluating spatial memory function in patients with chronic insomnia disorder (CID).Methods:From June 1, 2021 to May 31, 2022, 62 CID outpatients or inpatients were enrolled continuously in the Department of Sleep Disorders, the Affiliated Chaohu Hospital of Anhui Medical University, and 56 good sleepers in the same period were enrolled to serve as controls. Pittsburgh Sleep Quality Index (PSQI) was used to assess their sleep quality. Montreal Cognitive Assessment Scale (MoCA), nine box maze test (NBMT), and BVAT were used to assess general cognition and memories.Results:Compared to the controls, the CID patients had increased PSQI score [15.0 (12.8, 16.0) vs 0 (0, 1.0); Z=-9.47, P<0.001], and decreased MoCA score [24.5 (21.5, 27.0) vs 27.0 (26.0, 28.0); Z=-4.18, P<0.001]; increased numbers of errors in the spatial working [1.0 (0.8, 2.0) vs 1.0 (0, 1.0); Z=-2.24, P<0.05], object working [1.5 (0.8, 3.0) vs 0 (0, 1.0); Z=-4.36, P<0.001] and object recognition [0 (0, 0) vs 0 (0, 0); Z=-2.10, P<0.05] memories in NBMT; and increased average erroring distance in BVAT [23.0 (16.4, 27.2) cm vs 18.7 (16.6, 20.7) cm; Z=-3.30, P<0.01]. Partial correlation analysis showed that in the CID patients, the average erroring distance in BVAT was positively correlated with erroneous numbers in spatial working memory in NBMT ( r=0.54, P<0.001). Principal components analysis showed that the average erroring distance of BVAT (load=0.844) and the errors of spatial working memory in NBMT (load=0.801) were jointly attributed to the first factor. Receiver operating characteristic curve analysis showed that the sensitivity of BVAT was higher than that of NBMT (0.575 vs 0.250, P<0.05) for spatial memory detection in total sample. Conclusion:The BVAT has a higher reliability in the functional assessment of spatial memory in CID patients.

O-arm navigation assisted hemivertebra resection and bone grafting and internal fixation for the congenital cervicothoracic hemivertebra / 中华骨科杂志

Objective:To investigate the clinical efficacy and precautions of O-arm combined with navigation-assisted steotomy and hemivertebra resection for congenital cervicothoracic hemivertebra.Methods:From February 2016 to October 2020, the clinical data of 12 patients with cervicothoracic hemivertebra admitted in Henan Provincial People's Hospital were retrospectively analyzed, including 5 males and 7 females, aged 9.4±2.6 years (range, 4-15 years). Intraoperative neural monitoring system was used to ensure the safety of surgical correction process and O-arm navigation system assisted the implantation of pedicle screws,hemivertebra resection, and scoliosis deformity correction. Postoperative CT was used to evaluate the accuracy of screw placement, and routine preoperative and postoperative X-ray films of the full-length spine in standing position were taken to measure the coronal and sagittal Cobb angles. The correction rate of scoliosis and kyphosis, internal fixation, shoulder height difference and bone graft fusion were calculated at the final follow-up.Results:A total of 108 pedicle screws were inserted in 12 patients, and the screw placement accuracy rate was 96.3% (104/108). The follow-up time was 37.9±10.2 months (range, 24-61 months). The number of fused segments was 5.4±1.1 (range, 4-7). One week after surgery, the correction rate of Cobb angle was 78.5%±3.2% for scoliosis and 70.1%±5.4% for kyphosis. There were statistically significant differences in side and kyphosis Angle and Scoliosis Research Society (SRS)-22 score between preoperative and 1 week after surgery ( P<0.05). There was no significant difference between the operation and the last follow-up ( P>0.05). At the last follow-up, all the 12 patients achieved gradeⅠ fusion. SI was 2.4±0.8 cm before operation, 1.0±0.6 cm at 1 week after operation, and 0.7±0.5 cm at last follow-up, and the difference was statistically significant ( F=38.30, P<0.001). No pseudojoint formation, significant loss of correction Angle, or rupture of internal fixation relaxant occurred during the operation or during follow-up. Conclusion:O-arm combined with navigation-assisted steotomy and hemivertebra resection for the treatment of congenital cervicothoracic hemivertebra has the advantages of good orthopedic effect, reduced radiation exposure and fewer complications, and accurate pedicle screw implantation and hemivertebra resection.

Mini-open excision of osteoid osteoma using burrs with the guidance of O-arm navigation / 中华骨科杂志

Objective:To investigate the surgical method and clinical effect of O-arm navigation mini-open burring for osteoid osteoma.Methods:Eighteen patients with osteoid osteoma were treated with O-arm guided grinding drill from June 2021 to May 2022, including 15 males and 3 females, the age was (18.4 ±10.9) years (range 2 to 44 years), and the course of disease ranged from 1 week to 3 years (mean 14.2 months). The lesions sites included 6 cases of proximal femur, 3 cases of distal femur, 4 cases of proximal tibia, 1 case of distal tibia, 2 cases of proximal fibula and 1 case of distal and proximal humerus. During the operation, the O-arm navigation was used to determine the location of the focus, the muscle and soft tissue was peeled off to the bone surface through a 1-4 cm small incision, the channel retractor was placed, and the burr was registered as a navigation recognition device to gradually remove the bone on the surface of the tumor nest, and the tumor nest was scraped with a curette for pathological examination; according to the navigation image, the focus was enlarged removed with burr and the grinding range was confirmed by the O-arm X-ray machine before the end of the operation. The patients were followed up for 6 to 15 months (mean 9.5 months). CT scans were performed before and after surgery for imaging comparison in order to figure out whether it had residual lesions or recurrence. The visual analogue score (VAS) of pain was used as a parameter for evaluating the clinical efficacy.Results:The operation time of 18 cases was 40-175 min, with an average of 89.3 min. The time required to establish navigation image was 18.0 ±4.1 min (range 13 ~ 22 min). The length of the incision was 2.7±1.1 cm (range 1-4 cm). All patients achieved complete curettage of the lesions, and osteoid osteoma was confirmed by pathology after operation. All the patients could move to the ground 24 hours after operation, and the pain was significantly relieved from 3 to 7 d after operation, and the pain almost disappeared 3 months after operation. The VAS score of 18 cases was 5.33±1.24 before surgery, 2.79±1.32 on the 3rd day, 1.86±1.21 on the 7th day, 0.86±0.93 on the 1st month, 0.33±0.48 on the 3rd month, and 0.09±0.29 on the 6th month after operation, and the difference was statistically significant ( F=58.50, P<0.001). There were no serious complications during and after operation, and the success rate of treatment (no recurrence of symptoms, no residual recurrence of imaging lesions, no serious complications after operation) was 100%. Conclusion:Treatment of osteoid osteoma with mini-open excision using burrs under the navigation of O-arm is a simple, safe, minimally invasive and efficient technique. Intraoperative precise positioning and the use of burr with navigation to remove a larger area than the tumor nest are the keys to successful treatment.

Clinical study of radiation exposure from atrial fibrillation catheter ablation guided by magnetic navigation system and cryoballoon / 中华放射医学与防护杂志

Objective:To identify the method to reduce X-ray exposure during ablation of atrial fibrillation (AF) by comparing the cryoballoon (CRYO) ablation and remote magnetic navigation (RMN) ablation.Methods:A retrospective analysis was conducted on 144 patients undergoing CRYO ablation (CRYO group) and 121 patients undergoing RMN ablation (RMN group) in our hospital. Entrance surface doses at reference points online, exposure time during procedure and outcomes were analyzed for different types of patients.Results:Compared with the RMN group, the procedure time for the CRYO group significantly decreased [(165.0±23.6), (97.8±18.4) min, t=26.05, P<0.001]. However, the entrance surface dose value [(232.3±130.7), (669.0±387.5) mGy, Z=-12.29, P<0.001] and X-ray exposure time [(8.1±3.1), (23.4±6.2) min, t=-24.57, P<0.001] increased significantly for the CRYO group. No significant difference was found between the two groups in the proportion of maintaining sinus rhythm during follow-up of patients (71.9%, 75.7%, P=0.618). Multiple regression analysis showed that obese patients, patients with non-paroxysmal AF and patients with variant pulmonary veins were associated with an increase in entrance surface dose values in the CRYO group ( t=5.47, 2.23, 3.39, P<0.05). The X-ray exposure time for the three types patients above in the CRYO group also increased ( t=2.87, 3.86, 3.25, P<0.05) in the CRYO group. However, only obese patients in the RMN group had an increase in entrance surface dose value ( Z=-4.15, P<0.001) and no increase in exposure time. For the three types of patients above, there was no significant difference in proportion of maintaining sinus rhythm between the CRYO group and the RMN group during follow-up ( P>0.05). Conclusions:Compared with RMN ablation, the radiation exposure of CRYO AF ablation significantly increased, especially in obese patients, patients with non-paroxysmal AF and patients with pulmonary veins variation. The use of RMN for these types of patients may reduce the radiation exposure without affecting the procedure outcomes.

Development and application of the virtual simulation teaching experiment software of the bronchoscopy intelligent navigation-based fiducial marker implantation technology / 中华放射医学与防护杂志

Objective:To investigate the necessity and feasibility of the virtual simulation teaching experiment software of the bronchoscopy intelligent navigation-based fiducial marker implantation technology in the clinical application of radiotherapy.Methods:This study developed a 3D virtual operation and interactive system using the Unity3D engine, tools including 3Dmax and Maya, and the SQL database. The scenes in the system were produced using the currently popular next-generation production process. Targeting the priorities and difficulties in the implantation of fiducial markers, the system developed in this study allowed for simulated demonstration and training based on 12 steps and 10 knowledge points. Internal tests and remote evaluation tests were adopted in this system to obtain the test result of each subject. Then, the application value of the system was analyzed based on the test result.Results:As of May 1, 2022, the system had received 2 409 views and 425 test participants, with an test completion rate of 100% and an experiment pass rate of 96.5%. Moreover, this system won unanimous praise from 167 users, primarily including the students majoring in multilevel medical imaging technology and medical imaging science from the Fujian Medical University, as well as the radiotherapy-related staff of this university.Conclusions:The virtual simulation teaching experiment software of the bronchoscopy intelligent navigation-based fiducial marker implantation technology can be applied to the teaching of students and the training of related professionals.

Ultrasound fusion navigation-guided core needle biopsy for lesions involved the parapharyngeal space, infratemporal fossa, and skull base: a pilot study / 中华超声影像学杂志

Objective:To explore the value of ultrasound fusion navigation technology in the biopsy of parapharyngeal-infratemporal fossa-skull base (PIS) lesions.Methods:This study was conducted at the First Affiliated Hospital of Sun Yat-Sen University from March 2021 to March 2022 and included 8 patients [3 females and 5 males; age, (50±20) years; range, 16-76 years] with PIS lesions who needed to clarify the pathological diagnosis. The ultrasound fusion navigation with CT or MRI was used to guide lesion biopsy, and the technical feasibility, pathological diagnostic results and complications were evaluated.Results:The biopsy procedures were successful in all 8 patients, and the lesion size ranged from 2.2 to 6.5 cm. The exact pathological diagnosis was obtained in 7 patients, and the diagnostic rate was 87.5% (7/8). No major complication was observed after the biopsy. Mild complications occurred in 1 case, with a incidence of 12.5% (1/8).Conclusions:Ultrasound fusion navigation-guided biopsy is feasible, effective, and safe in the biopsy of deep head and neck lesions.

Research progress in application of artificial intelligence to intraoperative navigation assisted by an orthopedic robot / 中华创伤骨科杂志

Orthopedic robots, as intelligent medical devices, have achieved good outcomes in clinical application in some orthopedic surgeries. Artificial intelligence (AI) has played an important role in the development of orthopedic robots due to its powerful capabilities of information processing and decision-making. The developing trends of orthopedic robotics are automation and intelligentization. Since AI has demonstrated great advantages in preoperative planning, an increasing number of researchers have been devoted to AI application in intraoperative navigation by an orthopedic robot. This paper outlines the exploratory efforts in applying AI technology to the intraoperative navigation assisted by an orthopedic robot, describes the advantages of AI in improving accuracy and reducing radiation, and forecasts research prospects in application of AI technology to orthopedic robots based on the current situation.

Application of digital technology in the reconstruction of orbital fractures: research progress / 中华创伤杂志

Orbital fracture often leads to facial collapse, diplopia, enophthalmos, and even blindness. Traditional surgery relies on the experiences of physicians to achieve fracture reduction and orbital wall reconstruction, but the repair effect is not satisfactory. In recent years, with the development of digital technology, technologies such as computer-assisted surgery, 3D printing, surgical navigation systems, and intraoperative CT imaging have become increasingly widespread in the field of orbital reconstruction. Such techniques can avoid dependence on physicians′ experiences and make it easy for estimating and positioning the implantation sites, which subsequently contributes to better surgery efficiency and precise reconstruction of the orbit, improving aesthetics and visual function of patients. To this end, the authors reviewed the recent progress in application of digital technology for orbital fracture reconstruction, so as to provide reference and theoretical basis for clinical practice.

Efficacy of O-arm combined with CT three-dimensional navigation system assisted versus manual screw placement in the treatment of lower cervical fracture and dislocation / 中华创伤杂志

Objective:To compare the clinical efficacies of O-arm combined with CT three-dimensional navigation system assisted screw placement versus manual screw placement in treating lower cervical fracture and dislocation.Methods:A retrospective cohort study was used to analyze the clinical data of 41 patients with lower cervical fracture and dislocation, who were treated in Honghui Hospital, Xi′an Jiaotong University from May 2021 to February 2022. The patients included 26 males and 15 females, aged 31.5-48.6 years [(41.5±15.0)years]. The injured segments were C 3 in 3 patients, C 4 in 12, C 5 in 13, C 6 in 10 and C 7 in 3. Nineteen patients were treated with cervical pedicle screws by O-shaped arm combined with CT three-dimensional navigation system (navigation group, 76 screws) and 22 by bare hands (traditional group, 88 screws). The total operation time, effective operation time, single nail placement time, single screw correction times, screw distance from anterior cortex, intraoperative blood loss, intraoperative fluoroscopic radiation dose, incision length and length of hospital stay were compared between the two groups, and the height of intervertebral space, Cobb angle, interbody slip distance and American Spinal injury Association (ASIA) grade were compared before operation and at 3 days after operation. Visual analogue score (VAS), Japanese Orthopedic Association (JOA) score, and neck dysfunction index (NDI) were evaluated before operation, at 3 days, 3 months after operation and at the last follow-up. Accuracy of screw placement and incidence of complications (adjacent facet joint invasion, infection, screw loosening) were detected as well. Results:All the patients were followed up for 11.1-13.9 months [(12.5±1.4)months]. The total operation time, intraoperative blood loss, intraoperative fluoroscopic radiation dose and incision length in the navigation group were more or longer than those in the traditional group (all P<0.05). The effective operation time, single nail placement time, single nail correction times and screw distance from anterior cortex in the navigation group were markedly less or smaller than those in the traditional group (all P<0.05). There was no significant difference in the length of hospital stay between the two groups ( P>0.05). There were significant improvements in the height of intervertebral space, Cobb angle and interbody slip distance between the two groups at 3 days after operation (all P<0.05). There was no significant difference in the height of intervertebral space, Cobb angle, interbody slip distance or ASIA grade between the two groups before operation or at 3 days after operation (all P>0.05). Compared with pre-operation, the VAS, JOA score and NDI were significantly improved in both groups at 3 days, 3 months after operation and at the last follow-up (all P<0.05), with further improvement with time. There was no significant difference in VAS between the two groups before operation or at 3 months after operation (all P>0.05), but it was markedly lower in the navigation group compared with the traditional group at 3 days after operation and at the last follow-up (all P<0.05). There were no significant differences in JOA score or NDI between the two groups before operation or at 3 days and 3 months after operation (all P>0.05), but both were lower in the navigation group compared with the traditional group at the last follow-up (all P<0.05). The accuracies of placement of grade 0 and grade 0+1 screws were 92.0% (70/76) and 96.6% (73/76) in the navigation group, respectively, which were markedly higher than 88.7% (78/88) and 93.5% (82/88) in the traditional group (all P<0.05). The rates of adjacent facet joint invasion of A, B, and C degrees were 71.2% (54/76), 28.8% (22/76) and 0% (0/76) in the navigation group, respectively, while the invasion rates were 60.5% (53/88), 32.3% (28/88) and 7.3% (7/88) in the traditional group ( P<0.05). No screw loosening was noted in the navigation group, but the screw loosening rate was 9.1% (8/88) in the traditional group ( P<0.01). Conclusion:Compared with manual screw placement, O-arm combined with CT three-dimensional navigation system assisted screw placement for lower cervical fracture and dislocation has the advantages of shorter effective operation time, quicker screw placement, stronger screw holding force, better cervical stability, slighter postoperative pain, higher screw placement accuracy, and lower facet joint invasion and screw loosening rates.

New advances of research in minimally invasive surgery for gastric cancer / 中华消化外科杂志

With the 30 years' development of minimally invasive surgery, the field of gastric cancer surgery is undergoing a paradigm shift from traditional laparotomy to minimally invasive surgery. To chart new trends and directions in the development of gastric surgery, the author briefly reviews the latest advances, mainly focusing on new evidence, new techniques, new models, and new trends in the clinical research of gastric cancer surgery. The long-term non-inferiority outcomes of 5-year overall survival of minimally invasive surgery for locally advanced distal gastric cancer has been confirmed by the CLASS-01 and KLASS-02 trials. Upgrading and innovation of minimally invasive technology, function-preserving surgery, new modes of neoadjuvant therapy, and the application of new technologies are continuing to inject new vitality into minimally invasive surgery for gastric cancer.