bluuebunny/crossref_metadata_2025 huggingface dataset:
RECOMMENCING NOAC THERAPY WITHIN 24 HOURS OF TOTAL KNEE AND HIP ARTHROPLASTY, AND ITS EFFECTS ON PATIENT OUTCOMES AND COMPLICATION RATES
Authors: Jewell E. , Martin S. , Metusela C. , Scholes C.
Published: February 2023

Novel oral anticoagulant (NOAC) use in Australia has increased significantly since their introduction to the Pharmaceutical Benefits Scheme (PBS). Currently, there are no specific guidelines regarding recommencement of NOAC therapy post-operatively for patients concurrently on a NOAC and undergoing arthroplasty. To address this gap in the literature, the aim of this study was to compare the clinical and patient-reported outcomes in a patient cohort recommencing a therapeutic dose of NOAC within 24 hours of total hip or knee arthroplasty.

Data was retrieved from a prospective registry (ACTRN1262000079698) containing hip and knee arthroplasties. Cases were labelled based on whether they presented on a therapeutic dose of NOAC prior to surgery or not. Descriptive statistics were used to summarise patient outcomes.

Of 291 patients undergoing 331 primary arthroplasties, 9.3% were undertaking NOAC therapy prior to their surgery. In the NOAC cohort, there was a 34.5% adverse event rate, however on closer analysis of each event, it was found that none of these events were complications in relation to NOAC use. This was compared to 15.6% of the comparison cohort who experienced a range of complications, some involving bleeding events. PROMs improved to a similar degree amongst both groups.

This study showed that recommencing therapeutic doses of NOACs in patients post hip and knee arthroplasty within 24 hours was safe. These findings will help guide larger scale analysis to better inform clinical guidelines pertaining to hip and knee arthroplasty.
EARLY PROMS FOLLOWING TOTAL HIP ARTHROPLASTY WITH AND WITHOUT COMPUTER NAVIGATION SYSTEM: A STUDY FROM THE AUSTRALIAN NATIONAL JOINT REPLACEMENT REGISTRY
Authors: Lourens E.C. , Kurmis A.P. , Harries D. , de Steiger R. N.
Published: February 2023

Total hip arthroplasty (THA) is an effective treatment for symptomatic hip osteoarthritis (OA). While computer-navigation technologies in total knee arthroplasty show survivorship advantages and are widely used, comparable applications within THA show far lower utilisation. Using national registry data, this study compared patient reported outcome measures (PROMs) in patients who underwent THA with and without computer navigation.

Data from Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) PROMs program included all primary THA procedures performed for OA up to 31 December 2020. Procedures using the Intellijoint HIP® navigation system were identified and compared to procedures using other computer navigation systems or conventional instrumentation only. Changes in PROM scores between pre-operative and 6-month post-operative time points were analysed using multiple regression model, adjusting for pre-operative score, patient age, gender, ASA score, BMI, surgical approach, and hospital type.

There were 65 primary THA procedures that used the Intellijoint HIP® system, 90 procedures used other types of computer navigation, and the remaining 5,284 primary THA procedures used conventional instrumentation. The estimated mean changes in the EuroQol visual analogue scale (EQ VAS) score and Oxford Hip score did not differ significantly when Intellijoint® was compared to conventional instruments (estimated differences of 2.4, 95% CI [-1.7, 6.5], p = 0.245, and −0.5, 95% CI [-2.5, 1.4], p = 0.592, respectively). The proportion of patients who were satisfied with their procedure was also similar when Intellijoint® was compared to conventional instruments (rate ratio 1.06, 95% CI [0.97, 1.16], p = 0.227).

The preliminary data demonstrate no significant difference in PROMs when comparing the Intellijoint HIP® THA navigation system with both other navigation systems and conventional instrumentation for primary THAs performed for OA. Level of evidence: III (National registry analysis)
THE EFFECT OF SURGEON VOLUME AND RISK OF REVISION FOLLOWING TOTAL KNEE ARTHROPLASTIES WITH AND WITHOUT PATELLAR RESURFACING: A STUDY FROM THE AUSTRALIAN ORTHOPAEDIC ASSOCIATION NATIONAL JOINT REPLACEMENT REGISTRY
Authors: Lourens E.C. , Kurmis A.P. , Harries D. , Lewis P.L.
Published: February 2023

Strategy regarding patella resurfacing in total knee replacement (TKR) remains controversial. TKR revision rates are reportedly influenced by surgeon procedure volume. The study aim was to compare revision outcomes of TKR with and without patella resurfacing in different surgeon volume groups using data from the AOANJRR.

The study population included 571,149 primary TKRs for osteoarthritis. Surgeons were classified as low, medium, or high-volume based on the quartiles of mean primary TKR volume between 2011 and 2020. Cumulative percent revision (CPR) using Kaplan-Meier estimates of survivorship were calculated for the three surgeon volume groups with and without patella resurfacing. Cox proportional hazards models, adjusted for age and sex, were used to compare revision risks.

High-volume surgeons who did not resurface the patella had the highest all-cause CPR (20-year CPR 10.9%, 95% CI [10.0%, 12.0%]). When the patella was resurfaced, high-volume surgeons had the lowest revision rate (7.3%, 95% CI [6.4%, 8.4%]). When the high-volume groups were compared there was a higher rate of revision for the non-resurfaced group after 6 months. When the medium-volume surgeon groups were compared, not resurfacing the patella also was associated with a higher rate of revision after 3 months. The low-volume comparisons showed an initial higher rate of revision with patella resurfacing, but there was no difference after 3 months. When only patella revisions were considered, there were higher rates of revision in all three volume groups where the patella was not resurfaced.

TKR performed by high and medium-volume surgeons without patella resurfacing had higher revision rates compared to when the patella was resurfaced. Resurfacing the patella in the primary procedure protected against revision for patella reasons in all surgeon volume groups.

Level of evidence: III (National registry analysis)
EXPLORING EXPERIENCES OF GENDER BIAS IN ORTHOPAEDIC TRAINING IN NEW ZEALAND
Authors: Scherf E.
Published: February 2023

This qualitative study aims to explore and highlight the experiences of trainees in the Orthopaedic Surgical Education Training (SET) program in New Zealand, with a focus on identifying gender-specific biases which may impact professional development.

Orthopaedic SET trainees in New Zealand were invited to complete a qualitative, semi-structured questionnaire exploring their experiences in the Orthopaedic SET program. A broad range of topics were covered, addressing culture, belonging, learning styles and role modelling. Recurrent themes were identified using inductive methods.

Analysis of questionnaire responses identified several key themes for women in the Orthopaedic SET program, compared to their male counterparts, including (1) role incredulity, (2) confidence vs. competence, (3) adaptation, (4) interdisciplinary relationships and (5) role modelling. Female participants described experiencing gender bias or discrimination by both patients and interdisciplinary colleagues at a higher rate than their male counterparts. The majority of female participants described feeling as competent as their male counterparts at the same SET level, however, identified that they do not typically exhibit the same confidence in their surgical abilities. Whilst similar numbers of female and male participants described experiencing barriers to career progression, female participants described having to adapt both physically and socially to overcome additional gender-specific barriers. Positive influences on training experience included role modelling and supportive relationships amongst trainee groups.

This study highlighted gender-specific biases experienced by trainees in the Orthopaedic SET program in New Zealand. Further investigation is warranted to determine how these experiences affect professional development, and how they may be addressed to foster increased gender equity in the surgical profession. This will likely require system-level interventions to create meaningful and sustainable culture change.
REMOTE EVALUATION OF POSTOPERATIVE OUTCOMES USING WEARABLE SENSORS COMPARING ROBOTIC-ASSISTED AND CONVENTIONAL KNEE ARTHROPLASTY
Authors: Zaidi F. , Bolam S.M. , Yeung T.C. , Besier T.F. , Hanlon M. , Munro J.T. , Monk A.P.
Published: February 2023

Patient-reported outcome measures (PROMs) have failed to highlight differences in function or outcome when comparing knee replacement designs and implantation techniques. Ankle-worn inertial measurement units (IMUs) can be used to remotely measure and monitor the bi-lateral impact load of patients, augmenting traditional PROMs with objective data. The aim of this study was to compare IMU-based impact loads with PROMs in patients who had undergone conventional total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and robotic-assisted TKA (RA-TKA).

77 patients undergoing primary knee arthroplasty (29 RA-TKA, 37 TKA, and 11 UKA) for osteoarthritis were prospectively enrolled. Remote patient monitoring was performed pre-operatively, then weekly from post-operative weeks two to six using ankle-worn IMUs and PROMs. IMU-based outcomes included: cumulative impact load, bone stimulus, and impact load asymmetry. PROMs scores included: Oxford Knee Score (OKS), EuroQol Five-dimension with EuroQol visual analogue scale, and the Forgotten Joint Score.

On average, patients showed improved impact load asymmetry by 67% (p=0.001), bone stimulus by 41% (p<0.001), and cumulative impact load by 121% (p=0.035) between post-operative week two and six. Differences in IMU-based outcomes were observed in the initial six weeks post-operatively between surgical procedures. The mean change scores for OKS were 7.5 (RA-TKA), 11.4 (TKA), and 11.2 (UKA) over the early post-operative period (p=0.144). Improvements in OKS were consistent with IMU outcomes in the RA-TKA group, however, conventional TKA and UKA groups did not reflect the same trend in improvement as OKS, demonstrating a functional decline.

Our data illustrate that PROMs do not necessarily align with patient function, with some patients reporting good PROMs, yet show a decline in cumulative impact load or load asymmetry. These data also provide evidence for a difference in the functional outcome of TKA and UKA patients that might be overlooked by using PROMs alone.
SHOULDER ARTHROPLASTY IN ANTICOAGULATED PATIENTS: A COHORT STUDY
Authors: Faulkner H. , Levy G. , Hermans D. , Duckworth D.
Published: February 2023

To determine whether pre-operative cessation of anticoagulant or antiplatelet medication is necessary for patients undergoing total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA).

A prospectively maintained database was used to identify 213 consecutive patients treated with TSA or RTSA performed by a single surgeon across 3 centres. This cohort included 24 patients on an anticoagulant agent (warfarin, apixaban, rivaroxaban, dabigatran), 52 patients on an antiplatelet agent (aspirin, clopidogrel), and a control group of 137 patients not on anticoagulant or antiplatelet medication. Patients on anticoagulant or antiplatelet medications continued these agents peri-operatively. Outcomes included haemoglobin drop, intra-operative blood loss, operative time, transfusion requirements and post-operative complications.

The mean age of the cohort was 74.3 years (range 47 – 93) and 75 (35.2%) of the patients were male. TSA was performed in 63 cases and RTSA in 150 cases. The mean haemoglobin drop in the control group was 17.3 g/L, compared to 19.3 g/L in the anticoagulant group (p = 0.20) and 15.6 g/L in the anti-platelet group (p = 0.14). The mean intra-operative blood loss in the control group was 107.8 mL, compared to 143.0 mL in the anticoagulant group (p = 0.03) and 134.3 mL in the anti-platelet group (0.02). The mean operative time in the control group was 49.3 minutes, compared to 47.1 minutes in the anticoagulant group (p = 0.56) and 50.3 minutes in the anti-platelet group (p = 0.78). Post-operatively no patients developed a wound infection or haematoma requiring intervention. Three patients not on anticoagulant or antiplatelet medication developed pulmonary embolism.

Continuing anticoagulant or antiplatelet medication was associated with higher intra-operative blood loss, but produced no statistically significant differences in haemoglobin drop, operative time, transfusion requirements or post-operative complications. We now do not routinely stop any anticoagulant or antiplatelet medication for patients undergoing total shoulder arthroplasty.
OSSEOINTEGRATION OUTCOMES FOLLOWING AMPUTEE LENGTHENING
Authors: Hoellwarth J. , Chavan A. , Oomatia A. , Lu W. , Al Muderis M. , Preda V.
Published: February 2023

Percutaneous EndoProsthetic Osseointegration for Limbs (PEPOL) facilitates improved quality of life (QOL) and objective mobility for most amputee's discontent with their traditional socket prosthesis (TSP) experience. Some amputees desiring PEPOL have residual bone much shorter than the currently marketed press-fit implant lengths of 14-16 cm, potentially a risk for failure to integrate. We report on the techniques used, complications experienced, the management of those complications, and the overall mobility outcomes of seven patients who had femur distraction osteogenesis (DO) with a Freedom nail followed by PEPOL.

Retrospective evaluation of a prospectively maintained database identified nine patients (5 females) who had transfemoral DO in preparation for PEPOL with two years of follow-up after PEPOL. Six patients had traumatic causes of amputation, one had perinatal complications, one was performed to manage necrotizing fasciitis and one was performed as a result of osteosarcoma.

The residual femurs on average started at 102.2±39.7 mm and were lengthened 58.1±20.7 mm, 98±45% of goal (99±161% of the original bone length). Five patients (56%) had a complication requiring additional surgery. At a mean of 3.4±0.6 (2.6-4.4) years following osseointegration six patients had K-level >2. The 6 Minute Walk Test remained unchanged (267±56 vs 308 ± 117 meters). Patient self-rating of prosthesis function, problems, and amputee situation did not significantly change from before DO to after osseointegration. Six patients required additional surgery following osseointegration: six to remove fixation plates placed to maintain distraction osteogenesis length at osseointegration; two required irritation and debridement for infection.

Extremely short residual femurs which make TSP use troublesome can be lengthening with externally controlled telescoping nails, and successfully achieve osseointegration. However, it is imperative to counsel patients that additional surgery to address inadequate regenerate or to remove painful hardware used to maintain fixation may be necessary. This may improve the amputee's expectations before beginning on a potentially arduous process.
DISTAL RADIUS FRACTURE CLASSIFICATION USING DEEP LEARNING ALGORITHMS
Authors: White J. , Wadhawan A. , Min H. , Rabi Y. , Schmutz B. , Dowling J. , Tchernegovski A. , Bourgeat P. , Tetsworth K. , Fripp J. , Mitchell G. , Hacking C. , Williamson F. , Schuetz M.
Published: February 2023

Distal radius fractures (DRFs) are one of the most common types of fracture and one which is often treated surgically. Standard X-rays are obtained for DRFs, and in most cases that have an intra-articular component, a routine CT is also performed. However, it is estimated that CT is only required in 20% of cases and therefore routine CT's results in the overutilisation of resources burdening radiology and emergency departments. In this study, we explore the feasibility of using deep learning to differentiate intra- and extra-articular DRFs automatically and help streamline which fractures require a CT.

Retrospectively x-ray images were retrieved from 615 DRF patients who were treated with an ORIF at the Royal Brisbane and Women's Hospital. The images were classified into AO Type A, B or C fractures by three training registrars supervised by a consultant. Deep learning was utilised in a two-stage process: 1) localise and focus the region of interest around the wrist using the YOLOv5 object detection network and 2) classify the fracture using a EfficientNet-B3 network to differentiate intra- and extra-articular fractures.

The distal radius region of interest (ROI) detection stage using the ensemble model of YOLO networks detected all ROIs on the test set with no false positives. The average intersection over union between the YOLO detections and the ROI ground truth was Error! Digit expected.. The DRF classification stage using the EfficientNet-B3 ensemble achieved an area under the receiver operating characteristic curve of 0.82 for differentiating intra-articular fractures.

The proposed DRF classification framework using ensemble models of YOLO and EfficientNet achieved satisfactory performance in intra- and extra-articular fracture classification. This work demonstrates the potential in automatic fracture characterization using deep learning and can serve to streamline decision making for axial imaging helping to reduce unnecessary CT scans.
SMARTPHONE-BASED STEP-COUNT MEASURES CORRELATE WITH KOOS-12 FUNCTION AND UCLA ACTIVITY PROMS DURING EARLY TKA RECOVERY
Authors: McMahon S. , Coffey S. , Sullivan J. , Petterwood J. , Ponder C. , Slotkin E. , Wakelin E.A. , Orsi A.D. , Plaskos C.
Published: February 2023

Passive smartphone-based apps are becoming more common for measuring patient progress after total knee arthroplasty (TKA). Optimum activity levels during early TKA recovery haven't been well documented. This study investigated correlations between step-count and patient reported outcome measures (PROMs) and how demographics impact step-count preoperatively and during early post-operative recovery.

Smartphone capture step-count data from 357 TKA patients was retrospectively reviewed. Mean age was 68±8years. 61% were female. Mean BMI was 31±6kg/m2. Mean daily step count was calculated over three time-windows: 60 days prior to surgery (preop), 5-6 weeks postop (6wk), and 11-12 weeks postop (12wk).

Linear correlations between step-count and KOOS12-function and UCLA activity scores were performed. Patients were separated into three step-count levels: low (<1500steps/day), medium (1500-4000steps/day), and high (>4000steps/day). Age >65years, BMI >30kg/m2, and sex were used for demographic comparisons.

Student's t-tests determined significant differences in mean step-counts between demographic groups, and in mean PROMs between step-count groups.

UCLA correlated with step-count at all time-windows (p<0.01). KOOS12-Function correlated with step-count at 6wk and 12wk (p<0.05). High step-count individuals had improved PROMs compared to low step-count individuals preoperatively (UCLA: ∆1.4 [p<0.001], KOOS12-Function: ∆7.3 [p<0.05]), at 6wk (UCLA: ∆1 [p<0.01], KOOS12-Function: ∆7 [p<0.05]), and at 12wk (UCLA: ∆0.8 [p<0.05], KOOS12-Function: ∆6.5 [p<0.05]).

Younger patients had greater step-count preoperatively (3.8±3.0k vs. 2.5±2.3k, p<0.01), at 6wk (3.1±2.9k vs. 2.2±2.3k, p<0.05) and at 12wk (3.9±2.6k vs. 2.8±2.6k, p<0.01). Males had greater step-count preoperatively (3.7±2.6k vs. 2.5±2.6k, p<0.001), at 6wk (3.6±2.6k vs. 1.9±2.4k, p<0.001), and at 12wk (3.9±2.3 vs. 2.8±2.8k, p<0.01). No differences in step-count were observed between low and high BMI patients at any timepoint.

High step count led to improved PROMs scores compared to low step-count. Early post-operative step-count was significantly impacted by age and sex. Generic recovery profiles may not be appropriate across a diverse population.
THE UTILITY OF 3D PRINTING FOR PREOPERATIVE CREATION OF PATIENT-SPECIFIC IMPLANTS FOR SHOULDER ARTHRODESIS
Authors: Sun J. , Tan SL E. , Sevao J.
Published: February 2023

Anatomically specific fixation devices have become mainstream, yet there are anatomical regions and clinical conditions where no pre-contoured plates are available, such as for glenohumeral arthrodesis. In a case series of 4 glenohumeral arthrodesis patients, a consultant orthopaedic surgeon at GCUH implemented 3D printing technology to create reconstructions of each patient's shoulder girdle to pre-contour arthrodesis plates. Our aim was to quantify the cost-benefit & intra-operative time savings of this technique in glenohumeral arthrodesis.

We hypothesized that the use of 3D printing for creating patient specific implants through pre-operative contouring of plates will lead to intra-operative time and cost savings by minimising time spent bending plates during surgery.

This study analysed 4 patients who underwent shoulder arthrodesis by a single consultant orthopaedic surgeon at GCUH between 2017-2021. A CT-based life-size model of each patient's shoulder girdle was 3D printed using freely available computer software programs: 3D Slicer, Blender, Mesh Mixer & Cura.

Once the patient's 3D model was created, plate benders were used to contour the plate pre-op, which was then sterilised prior to surgery. Arthrodesis was performed according to AO principles of fixation. The time spent pre-bending the plate using the 3D model was calculated to analyse the intra-op time and cost-saving benefits.

For the 4 cases, the plate pre-bending times were 45, 40, 45 & 20 minutes (average 38.8 mins). The intra-op correction time to make small adjustments to the plate was 2 min/ case. 3 plates needed minor (3 degree) adjustment to fine-tune scapula spine contouring. 1 plate needed a 5 degree correction to fine-tune hand position. On average, the pre-bending of the plate saved approximately 38.8 mins intra-op/ case. These shorter anaesthetic and operating times equate to approximately $2586 saving/ case, given an estimate of $4000/hour of theatre costs.

We conclude that pre-bending plates around 3D-printed life-size models of an individual's shoulder girdle prior to surgery results in approximately 38.8 mins time saving intra-op when used in shoulder arthrodesis. This is a viable and effective technique that will ultimately result in significant operative time and financial savings.
IMPACT OF COVID-19 RESTRICTIONS ON UPPER LIMB TRAUMA IN A TERTIARY TRAUMA CENTRE: 2021 SECOND WAVE
Authors: Lai S. , Zhang X. , Xue K. , Bubra P. , Baba M.
Published: February 2023

The second wave of COVID-19 infections in 2021 resulting from the delta strain had a significantly larger impact on the state of New South Wales, Australia and with it the government implemented harsher restrictions.

This retrospective cohort study aims to explore how the increased restrictions affected hand trauma presentations and their treatment. Retrospective analysis was performed on patients who underwent hand surgery from the period of June 23 – August 31 in 2020 and 2021 at a level one trauma centre in Western Sydney.

During the second-wave lockdown there was an 18.9% decrease in all hand trauma presentations. Despite widespread restrictions placed on the manufacturing, wholesale, retail and construction industries, there was an insignificant difference in work injuries.

Stay-at-home orders and reduced availability of professional tradespersons likely contributed to an increase in DIY injuries. Significant reductions in metacarpal and phalangeal fractures coincided with significantly curtailed sporting seasons. The findings from this study can assist in predicting the case-mix of hand trauma presentations and resource allocation in the setting of future waves of COVID-19 and other infectious diseases.
CHOOSING WISELY: THE LACK OF VALIDITY OF ULTRASOUND SCANS IN THE INVESTIGATION OF SHOULDER INSTABILITY
Authors: Mohammed K. , Oorschot C. , Austen M. , O'Loiughlin E.
Published: February 2023

We test the clinical validity and financial implications of the proposed Choosing Wisely statement: “Using ultrasound as a screening test for shoulder instability is inappropriate in people under 30 years of age, unless there is clinical suspicion of a rotator cuff tear.”

A retrospective chart review from a specialist shoulder surgeon's practice over a two-year period recorded 124 patients under the age of 30 referred with shoulder instability. Of these, forty-one had already had ultrasound scans performed prior to specialist review. The scan results and patient files were reviewed to determine the reported findings on the scans and whether these findings were clinically relevant to diagnosis and decision-making. Comparison was made with subsequent MRI scan results. The data, obtained from the Accident Compensation Corporation (ACC), recorded the number of cases and costs incurred for ultrasound scans of the shoulder in patients under 30 years old over a 10-year period.

There were no cases where the ultrasound scan was considered useful in decision-making. No patient had a full thickness rotator cuff tear. Thirty-nine of the 41 patients subsequently had MRI scans. The cost to the ACC for funding ultrasound scans in patients under 30 has increased over the last decade and exceeded one million dollars in the 2020/2021 financial year. In addition, patients pay a surcharge for this test.

The proposed Choosing Wisely statement is valid. This evidence supports that ultrasound is an unnecessary investigation for patients with shoulder instability unless there is clinical suspicion of a rotator cuff tear. Ultrasound also incurs costs to the insurer (ACC) and the patient. We recommend x-rays and, if further imaging is indicated, High Tech Imaging with MRI and sometimes CT scans in these patients
A Quantile Regression Analysis of the Impact of Electricity Production Sources on CO2 Emission in South Asian Countries
Authors: Majumder Shapan Chandra , Voumik Liton Chandra , Rahman Md. Hasanur , Rahman Md. Maznur , Hossain Mohammad Nasir
Published: February 2023

This study wants to fill a gap in the empirical literature by looking at how the sources of electricity affect CO2 emissions in South Asian countries. Because of the consistent production levels and economic growth in South Asian countries, energy generation is becoming a key issue. The data, which covers from 1972 to 2015, is subjected to quantile regression (QR). The quantile regression coefficients’ findings are statistically significant at a 1% level of significance. According to the regression results, all energy generation sources and associated variables have a positive impact on CO2 emissions. Coal-fired power plants have a bigger impact on the environment than other types of pollution. On the other hand, renewable energy sources have the minimum impact on environmental degradation. Possible alternatives for reducing carbon dioxide emissions instead of coal, oil, and gas-based energy production sources have been presented. The policy implications also suggest that environmental policy should be improved by applying renewable energy, wind energy, hydroelectric sources, and nuclear energy. The link between economic growth and energy concentration needs to be looked into more with the help of more economic indicators and the parameters of electricity-generating sources.
Desenvolvimento de uma solução tecnológica de apoio ao processo de ensino aprendizagem do componente teórico EXA 702 Álgebra Vetorial e Geometria Analítica do curso de Engenharia de computação
Authors: Arthur Henrique Mota Brito Santos  , Claudia Pinto Pereira
Published: February 2023

Atrelado à crescente inclusão de estudantes em instituições de ensino superior (LORENZONI, 2001), a quantidade de pessoas que desistem de seus cursos antes da formatura também se tornou expressiva, em especial em cursos de engenharia, nos quais esse fato ocorre com 50% dos estudantes (MONACO, 2013).
Phosphaturic Mesenchymal Tumor-induced Osteomalacia Masquerading as an Orthopedic Polytrauma Patient: A Case Report and Review of the Literature
Authors: Robles Abrianna S , Rockov Zachary A , Brien Earl W , Little Milton Thomas Michaell
Published: February 2023

Introduction: Phosphaturic mesenchymal tumor (PMT) is a rare benign tumor (500 cases to date) that can present in combination with a paraneoplastic syndrome called tumor-induced osteomalacia (TIO). To the best of our knowledge, it is the first case to date that presented as an orthopedic trauma patient. Case Report: This is a case of a 61-year-old male who initially presented as a polytrauma patient, but further investigation revealed a PMT causing TIO. This report describes his initial diagnosis and management from 2015 to 2021. Conclusion: TIO resultant of PMT may lead to severe bone pain, impending fractures, and delayed or misdiagnosis. This case demonstrates the importance of careful diagnosis and a team-based approach to managing PMT and its sequelae. Keywords: Pathological fracture, phosphaturic mesenchymal tumor, tumor-induced osteomalacia
Outcome Analysis of En bloc Resection and Reconstruction by Non-vascularized Proximal Fibular Autograft in Giant Cell Tumor of Distal Radius supplemented with Brachytherapy
Authors: Dahuja Anshul , Singh Manraj , Singh Jagdeep , Arora Sagar , Kaur Rashmeet , Kaur Haramritpal
Published: February 2023

Introduction: Giant cell tumors of the bone are aggressive and potentially malignant lesions. Juxtaarticular giant cell tumors of the lower end radius are common and is a challenge for reconstruction after tumor excision. Several reconstructive procedures like vascularized and non-vascularized fibular graft, osteoarticular allograft, ceramic prosthesis, and megapros thesis are in use for substitution of the defect in the distal radius following resection. Here, we have analyzed the results of aggressive benign Giant cell tumor of the distal radius treated by en bloc excision and reconstruction using autogenous non-vascularized fibular graft along with brachytherapy. Material and Methods: Eleven patients with either Campanacci Grade II or III histologically proven giant cell tumors of lower end radius were treated with en bloc excision and reconstruction with ipsilateral non-vascularized proximal fibular autograft. Host graft junction was fixed with low contact dynamic compression plate (LC-DCP) in all cases. Fixation of the head of the fibula with carpal bones and distal end of the ulna, if not resected, using K-wires at graft host junction was done. Brachytherapy was given in all 11 cases. Routine radiographs and clinical assessments regarding pain, instability, recurrence, hand grip strength, and functional status were done using Mayo modified wrist score at regular intervals. Results: The follow-up ranged from 12 to 15 months. At last follow-up, the average combined range of motion was 76.1%. The average union time was 19 weeks. Out of 11 patients, two patients had good results, five patients had fair results, and four patient had poor results. There was no case of graft fracture, metastasis, death, local recurrence, or significant donor site morbidity. Conclusion: En bloc resection of giant cell tumors of the lower end radius is a widely accepted method. Reconstruction with non-vascularized fibular graft and internal fixation with LC-DCP along with brachytherapy minimizes the problem and gives satisfactory functional results with no recurrence. Keywords: GCT, brachytherapy, en bloc resection, recurrence
Aggressive Thoracic Hemangioma of Spine Presenting as Painful Adolescent Scoliosis – Diagnosis and Management
Authors: Kuppan Naveenkumar , Muthu Sathish , Krishnakumar R
Published: February 2023

Introduction: : Spinal hemangioma is the most common benign lesion of the spine with an incidence of 10–12%. Aggressive hemangioma presents with back pain, deformity, or neurologic deficit. Aggressive hemangioma presenting as painful scoliosis is very rare and literature reporting them is very limited. Case Report: We present the case of a boy in his second decade who presented with back pain for 1 month radiating to his right chest with a deformity in his back. MRI showed a hyperintense lesion involving the sixth dorsal vertebra in the T2-weighted image and a hypointense lesion with striations in STIR images suggestive of hemangioma. Pre-operative embolization was done using micro platinum coils. The patient underwent a decompressive laminectomy and vertebral body decompression. The patient also underwent 12 cycles of adiotherapy. The patient had complete resolution of the deformity without any recurrence at 2 years. Conclusion: Management of aggressive hemangiomas with neurologic deficit needs a multidisciplinary approach with surgery, pre-operative embolization, and post-operative radiotherapy. Keywords: Adolescent scoliosis, spinal hemangioma, laminectomy, embolization, scoliosis
In Scientific Literature, We Trust!
Authors: Nene Abhay
Published: February 2023

Text books have always been the traditional and definitive seat of learning for us as orthopedic postgraduates. However, as we move forward from our student lives, orthopedic surgeons begin to rely more on more on research papers and journal articles to update new information on their specific fields of interest. It soon becomes the norm for practicing orthopedic surgeons to read interesting articles in popular journals and then intuitively translate their conclusions to information and knowledge which is then transmitted to their junior peer as “standard teaching.” Concurrently, contributing to scientific literature, conducting our own research, and publishing it, has remained a huge attraction for doctors. It not only pushes us up in the academic circuit, but also potentially enhances our career progression In many institutions, it has become mandatory to publish for promotions! As a result over the last few decades, the clamor to have research papers published in journals has multiplied and as a result, the number of journals available to print your research work has also multiplied It is pure demand supply mathematics. But then what happens to quality? The deep question is – does an exponential increase in the published literature, not have an adverse effect on the quality of each publication? And now with a situation where there is some journal on the other available to publish whatever you have written, the deeper question remains – “can we blindly rely on everything we read in scientific journals.” As a logical derivation, from the above discussion, the obvious answer is No! The impact of transferring conclusions – from inadequately conducted research papers which have been published in haste by journals to fill up their pages – as knowledge to young peers, can be far reaching, as you can imagine. As postgraduates, there is little effort made to teach us how to analyze a scientific publication and to look into loopholes and flaws in the research methodology, and determine truly if a paper and its conclusions are worthy we need to inculcate this education quickly, to our peers and of course ourselves – and control this potential side-effect of the publication boom that we are in! Happy reading!
Deterministic manipulation of steering between distant quantum network nodes
Authors: Ma Lixia , Lei Xing , Cheng Jialin , Yan Zhihui , Jia Xiaojun
Published: February 2023

Multipartite Einstein-Podolsky-Rosen (EPR) steering is a key resource in a quantum network. Although EPR steering between spatially separated regions of ultracold atomic systems has been observed, deterministic manipulation of steering between distant quantum network nodes is required for a secure quantum communication network. Here, we propose a feasible scheme to deterministically generate, store, and manipulate one-way EPR steering between distant atomic cells by a cavity-enhanced quantum memory approach. While optical cavities effectively suppress the unavoidable noises in electromagnetically induced transparency, three atomic cells are in a strong Greenberger-Horne-Zeilinger state by faithfully storing three spatially separated entangled optical modes. In this way, the strong quantum correlation of atomic cells guarantees one-to-two node EPR steering is achieved, and can perserve the stored EPR steering in these quantum nodes. Furthermore, the steerability can be actively manipulated by the temperature of the atomic cell. This scheme provides the direct reference for experimental implementation for one-way multipartite steerable states, which enables an asymmetric quantum network protocol.
Highly-time-resolved FMCW LiDAR with synchronously-nonlinearity-corrected acquisition for dynamic locomotion
Authors: Sun Caiming , Chen Zhen , Ye Shusheng , Lin Jing , Shi Wu , Li Binghui , Teng Fei , Li Xuejin , Zhang Aidong
Published: February 2023

Highly-time-resolved and precise tracking of position, velocity, and acceleration is urgently required when highly dynamic legged robots are walking, trotting, and jumping. Frequency-modulated continuous-wave (FMCW) laser ranging is able to provide precise measurement in short distance. However, FMCW light detection and ranging (LiDAR) suffers from a low acquisition rate and poor linearity of laser frequency modulation in wide bandwidth. A sub-millisecond-scale acquisition rate and nonlinearity correction in the wide frequency modulation bandwidth have not been reported in previous studies. This study presents the synchronous nonlinearity correction for a highly-time-resolved FMCW LiDAR. The acquisition rate of 20 kHz is obtained by synchronizing the measurement signal and the modulation signal of laser injection current with a symmetrical triangular waveform. The linearization of laser frequency modulation is conducted by resampling of 1000 intervals interpolated in every up-sweep and down-sweep of 25 µs, while measurement signal is stretched or compressed in every period of 50 µs. The acquisition rate is demonstrated to be equal to the repetition frequency of laser injection current for the first time to the best of authors’ knowledge. This LiDAR is successfully used to track the foot trajectory of a jumping single-leg robot. The high velocity up to 7.15 m/s and high acceleration of 365 m/s2 are measured during the up-jumping phase, while heavy shock takes place with high acceleration of 302 m/s2 as the foot end strikes the ground. The measured foot acceleration of over 300 m/s2, which is more than 30 times gravity acceleration, is reported on a jumping single-leg robot for the first time.
Confined-doped fiber enabled kilowatt-level all-fiber laser with 1.28 GHz linewidth
Authors: Li Wei , Ma Pengfei , Chen Yisha , Ren Shuai , Yu Deng , Liu Wei , Pan Zhiyong , Chen Zilun , Zhou Pu , Si Lei
Published: February 2023

In this manuscript, a narrow linewidth fiber amplifier based on confined-doped fiber is established, and the power scaling and beam quality maintaining capabilities of this amplifier are investigated. Benefitted from the large mode area of the confined-doped fiber and precisely controlling the Yb-doped region in the fiber core, the stimulated Brillouin scattering (SBS) and transverse mode instability (TMI) effects are effectively balanced. As a result, a 1007 W signal laser with just 1.28 GHz linewidth is obtained by combining the advantages of confined-doped fiber, near-rectangular spectral injection, and 915 nm pump manner. As far as we know, this result is the first beyond kilowatt-level demonstration of all-fiber lasers with GHz-level linewidth, which could provide a well reference for simultaneously controlling spectral linewidth, suppressing the SBS and TMI effects in high-power, narrow-linewidth fiber lasers.
Sparse deconvolution for background noise suppression with total variation regularization in light field microscopy
Authors: Wang Chuhui , Gul Ijaz , Jiang Chenyao , Zhong Xiaoyun , Chen Zhenglin , Lei Zhengyang , Ma Shuyue , Lam Tsz Kwan , Yu Dongmei , Qin Peiwu
Published: February 2023

In this Letter, we present a method aiming at background noise removal in the 3D reconstruction of light field microscopy (LFM). Sparsity and Hessian regularization are taken as two prior knowledges to process the original light field image before 3D deconvolution. Due to the noise suppression function of total variation (TV) regularization, we add the TV regularization term to the 3D Richardson–Lucy (RL) deconvolution. By comparing the light field reconstruction results of our method with another state-of-the-art method that is also based on RL deconvolution, the proposed method shows improved performance in terms of removing background noise and detail enhancement. This method will be beneficial to the application of LFM in biological high-quality imaging.
Seguimiento otológico en niños con Síndrome de Down
Authors: Losada-Campa Juan , Benito-Orejas José Ignacio , Álvarez-Álvarez María , González-Sosto Mariana , Santos-Pérez Jaime , Muñoz-Moreno Maria Fe
Published: February 2023

Introducción y objetivo: La trisomía 21 es la alteración cromosómica más frecuente. Los avances terapéuticos han conducido a un incremento de la esperanza de vida, que implica unos cuidados más especializados.
Las manifestaciones de la esfera ORL son un foco dominante de morbilidad en los niños con Síndrome de Down (SD). Los problemas auditivos son más habituales que en el resto de población, pudiendo mediatizar la evolución educativa y social, afectando su calidad de vida.
El objetivo de este trabajo consiste en analizar los resultados del seguimiento otológico de los niños con SD estudiados en nuestro Servicio de ORL, durante los últimos 29 años.
Método: Estudio prospectivo/retrospectivo del registro que realizamos en el Servicio ORL del HCU de Valladolid, de los 83 niños con SD que acudieron a consulta desde 1993 a 2021 y de los datos introducidos tras una revisión actual de sus historiales.
Resultados: El 63% de los niños estudiados con SD fueron varones, 77% con menos de 5 años de edad y procedentes en el 88% de Valladolid y provincia. El 19% nacieron en nuestro hospital y un 29% se perdió durante el seguimiento.
Detectamos un 66% de malformaciones de oído externo. La patología de oído medio estuvo presente en el 92%. Realizamos pruebas auditivas al 93% y un 60% tenía hipoacusia, bilateral en un 78% y de grado leve/moderado en el 87% (8% profunda). Un 39% de las hipoacusias fue de tipo neurosensorial. La adaptación protésica con audífonos se llevó a cabo en el 48% de los niños con hipoacusia; recibiendo un 11% una prótesis osteointegrada y un 4% un implante coclear. Se realizó cirugía ORL al 62%, destacando en frecuencia, la adenoidectomía y la colocación de drenajes transtimpánicos.
Discusión y conclusiones: El seguimiento ORL recomendado para los niños con SD resulta una tarea difícil de organizar. Se suman además otros obstáculos inherentes al SD, como la discapacidad intelectual, las dificultades en la exploración, el carácter fluctuante de la hipoacusia, unos peores resultados en el tratamiento médico/quirúrgico, que se acompaña de mayor morbilidad y con unas indicaciones en ocasiones, enfrentadas en la literatura… y unos padres que se cansan de tantas visitas y de la cronicidad de los procesos.
Dada la frecuencia de patología ORL en el niño con SD y de las repercusiones que puede tener en su evolución, consideramos necesario este seguimiento, pero se impone el reto de desarrollar una planificación específica, que lo haga posible en nuestro sistema público de salud.
¿Quién piensa en un carcinoma escamoso de oído medio?
Authors: Losada-Campa Juan , Benito-Orejas José Ignacio , Bauer Michael , Viveros-Díez Patricia , Álvarez-Quiñones-Sanz María , Santos-Pérez Jaime
Published: February 2023

Introducción y objetivo: El carcinoma epidermoide de oído medio es una neoplasia infrecuente, de clínica silente y diagnóstico habitualmente tardío. El pronóstico depende de la localización, de la extensión y del tipo tumoral.
Método: Se trata de un varón de 71 años, con antecedentes de anemia megaloblástica de posible origen autoinmune y diabetes mellitus insulino dependiente (DMID). No se refieren antecedentes otológicos.
Acude a urgencias por otalgia, supuración e hipoacusia del oído derecho (OD) de 3 semanas de duración, que no mejora con tratamiento antibiótico. 24 horas antes de su ingreso, comienza con parálisis facial del mismo lado.
La otoscopia muestra un tímpano edematoso y abombado, con efusión sero-purulenta, que se cultiva y facilita el drenaje, a través de un diábolo transtimpánico. Se objetiva también una parálisis facial, grado IV de House-Brackmann, de predominio inferior.
Resultados: Los estudios de imagen (tomografía computarizada y resonancia magnética) muestran una ocupación del oído medio y de la mastoides, con integridad de la cadena osicular, sin lesiones ocupantes de espacio, ni signos de destrucción del canal facial y con un engrosamiento del conducto auditivo externo, que sugieren una otitis media agresiva. El cultivo confirma la presencia de varios microorganismos, entre ellos Pseudomona Aeruginosa.
Dados los antecedentes del paciente (DMID) se inicia un tratamiento parenteral orientado hacia la otitis externa maligna, mejorando parcialmente la sintomatología. Pero ante la persistencia de la clínica tras dos meses, se solicita un estudio inmunológico de vasculitis que resulta negativo y se consigue obtener una biopsia de la mucosa del oído medio, a través de la perforación residual timpánica, tras extruirse el drenaje, que es compatible con el diagnóstico de carcinoma escamoso de oído medio. La gammagrafía con tecnecio fue negativa.
Discusión y Conclusiones: El carcinoma primario de oído medio es una patología excepcional, que con frecuencia se asocia a otitis media crónica, no soliendo considerarse en el diagnóstico diferencial de cuadros clínicos similares al descrito. Este retraso diagnóstico permite su extensión, habitualmente hacia el endocráneo, pudiendo también metastatizar a cerebro, pulmones, huesos, piel e hígado.
El tratamiento consiste en cirugía ablativa seguida de radioterapia (y en ocasiones quimioterapia). La identificación del epicentro tumoral y de la extensión (de los que depende el pronóstico) es muy complejo.
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