Search Results (175)

Background: The aim of this study was to assess pedicle screw (PS) accuracy and identify perforation patterns using computed tomography (CT) navigation in adolescent idiopathic scoliosis (AIS) surgery. Methods: A total of 107 AIS patients were retrospectively reviewed. Preoperative CT navigation was used in 48 patients (853 screws), and intraoperative CT with a second 3D scan was used in 59 patients (1059 screws). Postoperative CT images were analyzed using the Rampersaud grading system. Results: Overall PS accuracy (grade A + B) was significantly higher in the intraoperative CT group than the preoperative group (97% vs. 95%, p = 0.008). In Lenke type 1 cases, accuracy was also higher in the intraoperative group (97.8% vs. 95.1%, p = 0.014). Grade D perforations were most frequent on the concave side of the proximal thoracic (PT) zone in both groups. Ten screws were re-inserted during surgery in the intraoperative group based on findings from the second 3D scan. Conclusions: The concave PT zone is a common site for PS misplacement. Intraoperative CT navigation with a second 3D scan enhances PS accuracy compared with preoperative CT navigation. Full article

Background: The atlanto-axial segment is highly mobile and, therefore, prone to instability in the setting of inflammatory disease, infection, tumor or trauma. While minimally invasive surgical (MIS) techniques have gained acceptance in the thoracolumbar spine due to their advantages over traditional approaches, their use at the atlanto-axial segment is controversial due to the surgical risk associated with its complex anatomy. To evaluate the current evidence on MIS atlanto-axial fixation, we carried out a systematic review of the literature and compared the reported results with those of open procedures. Methods: This systematic review follows PRISMA-DTA 2020 guidelines. A comprehensive search was conducted in November 2023 across PubMed/Medline, Google Scholar and clinicaltrials.gov using specific keywords related to minimally invasive atlanto-axial fixation. Data regarding study characteristics, patient demographics, surgical techniques, and outcomes were extracted from included studies. Results: This systematic review included 13 articles reporting on the results of surgery in 305 patients, in whom a total of 683 screws were inserted through a posterior MIS approach. N = 162 screws were inserted using the Harms–Goel technique, while N = 521 were placed using the Magerl technique. N = 40 screws were inserted using navigation guidance, while N = 643 were introduced with fluoroscopy assistance. Eight screws were misplaced. A Vertebral Artery (VA) injury was reported in three patients. With a mean value of 26.2 ± 15.3 months, the rate of fusion ranged between 80% and 100%. Conclusions: This study highlights the potential of MIS for posterior atlanto-axial fixation, which was achieved using Magerl transarticular screws in a large majority of cases. Despite technical challenges, MIS approaches appear to achieve satisfactory clinical and radiological outcomes with complication rates similar to those of open techniques. Future studies may help refine the indications for MIS and identify those cases better suited for open approaches. Full article

Misplaced confidence disguised as competence can lead to broad business blunders. The Dunning–Kruger effect (DKE) is an infamous illusory superiority cognitive bias in which people who perform poorly in certain skills erroneously perceive their task execution as superior to the performance of others. Although it is a metacognitive phenomenon with implications for various domains, it is yet to be directly investigated with managers. The purpose of this study is to bridge the research gap by qualitatively exploring the DKE’s manifestation among managers through 20 semi-structured interviews in agricultural businesses. We found that the DKE manifests at all levels of management; however, it seems that lower-level managers are more susceptible to this cognitive bias. We also present a conceptual framework that highlights the various antecedents and consequences of the DKE, based on our content analysis. This study presents a novel domain affected by the DKE, which was discovered by an unconventional methodological approach. Through the recommendations made, the study also contributes to the SDGs and sustainable leadership and management in agricultural businesses. Full article

Introduction: Arthrodesis of the sacroiliac joint (SIJ) has evolved over the last 5 years, with many trajectory strategies emerging. Innovation has outpaced data generation on the safety and efficacy of novel SIJ arthrodesis techniques. This retrospective review of the use of a SiLO TFX SIJ fusion system provides 12-month post-implant outcome data that can be compared with other techniques from published literature. Methods: A retrospective analysis was performed on patients that underwent the SiLO TFX sacroiliac joint fusion procedure at eight sites with data on pain reduction and functional improvement from baseline, as measured by a numerical rating scale (NRS) and Oswestry Disability Index (ODI), along with some safety and device integrity assessments recorded at 12 months post-implant. Safety was assessed by identifying key serious adverse events (bleeding, infection, nerve injury), and device integrity was assessed by evaluating misplaced or malfunctioned devices. ODI and NRS outcomes were compared with published rates from the literature. Results: Between 16 March 2023 and 20 February 2024, 42 subjects with 12-month ODI data available were enrolled. The subjects had a mean age of 60 ± 11 years, and 71% were female. The mean ODI score of 33 ± 15 at baseline improved to 17 ± 11 at 12 months, with a statistically significant improvement from baseline of 16 ± 15 (p < 0.0001). Furthermore, 52% of subjects had a 15-point absolute ODI improvement. Mean NRS of 7.1 ± 2.8 at baseline improved to 2.9 ± 2.2 at 12 months with a statistically significant reduction in pain of 4.2 ± 3.4 (p < 0.0001). No key serious adverse events or device integrity complications were noted. Subgroup analyses for a cohort of subjects with baseline ODI ≥ 30 and VAS pain ≥ 50 demonstrated that performance was similar to that in previously published literature with a mean improvement in ODI of 23.3 ± 12.7 (p < 0.0001) with 78% of subjects achieving a 15-point improvement at 12 months, and mean NRS improving by 4.7 ± 3.0 (p < 0.0001) with 88.9% achieving an improvement of 2 points. Conclusions: This data supports the safety and efficacy of SiLO TFX for SIJ fusion. The retrospective outcomes are comparable to those published for lateral-approach SIJ fusion. As follow up is limited to 12 months in this retrospective dataset; long-term fusion and cost-effectiveness remain to be addressed. Prospective, randomized controlled trials with a larger cohort are needed further to compare SiLO TFX to other available SIJ fusion techniques. Full article

The sensitivity analysis of line-of-sight estimation to measurement errors in the L-shaped antenna array contributes to the deeper understanding of how the measurement errors affect a 3D localization system aimed to be used in the next generation of inter-satellite links. First, the proposed 3D localization model in the Cartesian coordinate system is given, where, for simplicity, the origin of the coordinate system is the origin of the L-shaped antenna array. The proposed localization method relies on three measurements: range measurement and line-of sight angles with the x- and y-axis, respectively. The sensitivity analysis revealed that the variation in the L-shaped antenna array geometry (variation of the antennas placements) has an impact on the 3D positioning precision: a misplaced antenna—placed closer than intended—will have a larger line-of-sight error for small distances/ranges in the presence of range measurement errors. Notably, a misplaced antenna will result in a larger line-of-sight error for large distances/ranges in the presence of phase measurement errors. Full article

Background/Objectives: Posterior pelvic ring fractures are severe injuries requiring surgical stabilization, often through sacroiliac (SI) screw fixation. However, improper screw placement poses risks of neurovascular injury and implant failure. Defining a precise safe zone for screw placement is crucial to improving surgical accuracy and reducing complications. Methods: A computational study was conducted using a CT scan of a 75-year-old male patient to establish a safe zone for SI screw placement. Manual segmentation and 3D modeling techniques were used to analyze bone density distribution. A 2D lateral projection of the sacrum was generated to identify high-density regions optimal for screw placement. While the general principle of targeting areas of higher bone density for screw insertion is well established, this study introduces a novel computational method to define and visualize such a safe zone. The resulting region, termed the Ramadanov–Zabler Safe Zone, was delineated based on this analysis to ensure maximal intraosseous fixation with minimal risk of cortical breaches. Results: A high-resolution 3D model of the sacral region was successfully generated. Standard thresholding methods for segmentation proved ineffective due to low bone density, necessitating a freehand approach. The derived 2D projection revealed regions of higher bone density, which were defined as the Ramadanov-Zabler Safe Zone for screw insertion. This zone correlates with areas providing the best structural integrity, thereby reducing risks associated with screw misplacement. Additionally, intraoperative and postoperative imaging from a representative case is included to illustrate the translational feasibility of the proposed technique. Conclusions: The Ramadanov–Zabler Safe Zone offers a reproducible, CT-based computational approach to guide for SI screw placement, enhancing surgical precision and patient safety. This CT-based computational approach provides a standardized reference for preoperative planning, minimizing neurovascular complications and improving surgical outcomes. This pilot technique is supported by preliminary clinical imaging that demonstrates feasibility for intraoperative application. Further validation across diverse patient populations is recommended to confirm its clinical applicability. Full article

The integration of AI tools like ChatGPT in education has sparked debates on their benefits and limitations, particularly in subjects requiring region-specific knowledge. This study examines ChatGPT’s ability to generate accurate and contextually rich responses to assignments in Romanian history and geography, focusing on topics with limited digital representation. Using a document-based analysis, this study compared ChatGPT’s responses to local archival sources, monographs, and topographical maps, assessing coverage, accuracy, and local nuances. Findings indicate significant factual inaccuracies, including misidentified Dacian tribes, incorrect historical sources, and geographic errors such as misplaced landmarks, elevation discrepancies, and incorrect infrastructure details. ChatGPT’s reliance on widely digitized sources led to omissions of localized details, highlighting a fundamental limitation when applied to non-digitized historical and geographic topics. These results suggest that while ChatGPT can be a useful supplementary tool, its outputs require careful verification by educators to prevent misinformation. Future research should explore strategies to improve AI-generated educational content, including better integration of regional archives and AI literacy training for students and teachers. The study underscores the need for hybrid AI-human approaches in education, ensuring that AI-generated text complements rather than replaces verified academic sources. Full article

Objectives: Monitoring pregnancies is essential for community well-being. However, not all pregnancies progress normally, and some require termination. The objective was to emphasize the importance of trust in the doctor–patient relationship during this challenging time for expectant parents. Case report: During fetal morphology examination, parents were warned of a poor fetal prognosis, prompting a request for pregnancy termination. They consulted another specialist, who reassured them that the fetus appeared normal, though slightly hypotrophic. The child was born at 35 weeks gestational age and admitted to the neonatal ICU level III in an impaired general condition and polymalformative syndrome (triangular facies, epicanthic eyes, hypertelorism, retrognathia, low base of the nose, triangular mouth, lips angled downward, and small, dysplastic, and low-set earlobes). The child had syndactyly of fingers and toes. Cytogenetic analysis revealed a karyotype of 69, XX, +mar. The indirect DNA analysis revealed that the third gonosome is a Y chromosome. Death occurred 30 days post delivery, following severe dyspnea and bronchial obstruction, with desaturation and bradycardia. Conclusions: Triploid pregnancies are usually lost in the first trimester; however, very rarely, live births can occur. Hope for a positive outcome encouraged parents to continue the pregnancy, leading to a profoundly sorrowful experience and added strain on the healthcare system. Complex decisions put pressure on the patient–doctor relationship, as misplaced hope can impact both parties. Expectant parents facing difficult diagnoses require attentive support during this challenging time, grounded on a foundation of trust between doctor and patient. Full article

Proper cellular function hinges on appropriate subcellular protein localization. When cellular proteins become mislocalized, they can accumulate, cause cellular damage, and disrupt many biochemical and cellular processes. Notably, mislocalized protein accumulation and the resulting cytotoxic effects are salient features of neurodegenerative diseases including Alzheimer’s, Parkinson’s disease, and ALS. The detrimental cellular consequences of mislocalized proteins accumulation make it crucial to develop techniques and approaches that counteract this malfunction. Remarkably, a recent study by Ng et al. introduced targeted relocalization-activating molecules (TRAMs) as a novel molecular tool for relocalizing endogenous target proteins to counteract disease-associated mislocalized proteins. The authors developed a quantitative single-cell analysis to evaluate the strength and relocalization capability of TRAMs by coupling a target protein and a shuttle protein. Herein, we briefly highlight and discuss the potential molecular implications for targeted protein relocalization as an effective approach for correcting mislocalized proteins. Full article

Background: The accidental puncture of the supra-aortal arteries during central venous catheterization is a rare but potentially life-threatening complication. Traditional management often requires open surgical repair, which is associated with significant morbidity. This study evaluates an endovascular approach for managing such cases using an Angio-Seal™ vascular closure device (Terumo Medical Corporation, Somerset, NJ, USA). Methods: Between January 2010 and December 2024, 47 patients with misplaced catheters in supra-aortal arteries were treated at our institution. Of these, 37 cases involving subclavian artery catheter misplacements were managed using a standardized algorithm and form the focus of this study. Additional interventions, such as stent graft placement or balloon inflation, were performed as needed. Results: Primary technical success was achieved in 86.5% of cases. Four patients required stentgrafts and one balloon inflation for persistent extravasations. One patient developed a small subclavian pseudoaneurysm, which resolved spontaneously. Primary assisted technical success and clinical success rates were both 100%. Conclusions: This study demonstrates the efficacy and safety of our minimally invasive endovascular approach for managing subclavian artery catheter misplacements. With a high success rate, low complication rate, and the avoidance of open surgery, this algorithm offers a promising alternative for treating this rare but serious complication of central venous catheterization. Full article

Crypto wallets store and protect the private keys needed to sign transactions for crypto currencies; they are secured by multi-factor authentication schemes. However, the loss of a wallet, or a dysfunctional factor of authentication, can be catastrophic, as the keys are then lost as well as the crypto currencies. Such difficult tradeoffs between the protection of the private keys and factors of authentication that are easy to use are also present in public key infrastructures, banking cards, smartphones and smartcards. In this paper, we present protocols based on novel challenge–response pair mechanisms that protect private keys, while using factors of authentication that can be lost or misplaced without negative consequences. Examples of factors that are analyzed include passwords, tokens, wearable devices, biometry, and blockchain-based non-fungible tokens. In normal operations, the terminal device uses all factors of authentication to retrieve an ephemeral key, decrypt the private key, and finally sign a transaction. With our solution, users can download the software stack into multiple terminal devices, turning all of them into backups. We present a zero-knowledge multi-factor authentication scheme allowing the secure recovery of private keys when one of the factors is lost, such as the token. The challenge–response pair mechanisms also enable a novel key pair generation protocol in which private keys can be kept secret by the user, while a Keystore can securely authenticate the user and transmit the public key to a distributed network. The standardized LWE post-quantum cryptographic CRYSTALS Dilithium protocol was selected in the experimental section. Full article

Objectives: the current study investigates the link between health insurance coverage and child nutritional status in Pakistan. Methods: Using data from the Pakistan Demographic and Health Survey (PDHS) 2017–18, encompassing 4499 children under 5, a binary logistic regression was applied to analyze the relationship between health insurance and child nutritional status. Due to the non-randomized sample, assessing health insurance continuously posed a practical challenge. To mitigate the sample selection bias, the cross-sectional-based propensity score matching (PSM) using the nearest neighbor method was utilized for the causal relationship, based on potential socio-economic covariates. Results: The prevalence rates of stunting, underweight, and wasting among children under five were 38.13%, 23.04%, and 8.05%, respectively. Malnutrition was found in 43.64% of non-insured children compared with 5% in insured children. The findings of PSM supported a causal relationship, given the cross-sectional nature and potential misplaced variables, as the PSM findings revealed that insured children had significantly better nutritional outcomes compared with non-insured children, with a significance level of 1%. The logistic regression outcomes for the covariates of child nutritional outcome indicated that health insurance coverage, higher wealth status, mother’s education, improved water and sanitation facilities, mother’s normal BMI, and urban residence reduced the likelihood of child malnutrition. The logistic regression results for the covariates of child health insurance depicted that factors such as higher birth order, mother’s low BMI, poor water and sanitation facilities, higher wealth status, women’s employment, higher education level, and child illnesses like diarrhea and malnutrition increased the likelihood of obtaining health insurance. The logistic results confirmed that health insurance coverage reduced the likelihood of child malnutrition, and, similarly, child malnutrition and other illnesses increased the chances of obtaining health insurance coverage. Conclusions: The findings underscore the critical need for health insurance, highlighting its role in enhancing child nutritional status. The government should expand health insurance programs, with a special emphasis on child nutrition and health. Full article

Background: Posterior cervical fusion (PCF) is widely used for cervical spinal cord decompression with/without fusion. In our hybrid operating room, intraoperative computed tomography (iCT) is routinely used to verify screw placement. This study analyzed clinical and radiological outcomes after PCF and evaluated iCT benefits for detecting screw misplacement. Methods: Nineteen patients underwent PCF between March 2012 and April 2016 for degenerative (n = 6), neoplastic (n = 7), and traumatic (n = 6) conditions. Seven patients had primary PCF, while twelve underwent PCF following anterior fusion due to segmental instability with cervical malalignment (n = 11) or tumor progression (n = 1). Results: The mean patient age was 59 ± 11 years, with 63% male patients. The median follow-up was 21 months. PCF averaged 4.74 segments (range: 1–9). At follow-up, 79% reported pain improvement and normal sensorimotor function. Of six patients with preoperative paresis, five showed improved muscle strength. No persistent gait disturbances occurred. Complications requiring revision occurred in four patients (21%): three surgical site infections and one cerebrospinal fluid leak. One perioperative death occurred (5%). iCT detected incorrect screw placement in seven patients (36%), allowing the immediate repositioning of eight screws, preventing later revision surgeries. The overall fusion rate was 92%. Conclusions: PCF with iCT is safe and effective for various cervical spine pathologies, yielding good long-term clinical outcomes. iCT effectively detects and enables immediate correction of screw malposition, reducing revision surgery needs. This imaging modality demonstrates high sensitivity and specificity for identifying clinically relevant screw malpositions. Full article

Background and Objectives: Double-J stents are urinary catheters that are frequently used in urology. They are now also used in other specialist areas such as obstetrics and gynecology. However, the use of double-J stents is not without side effects. The aim of this review was to highlight the indications and possible adverse effects of the use of these stents in obstetrics and gynecology. Materials and Methods: We analyzed works published after 1995 in the PUBMED, SCOPUS, and Web of Science databases related to the use of double-J stents in obstetrics and gynecology, as well as reported adverse events. We carried out a narrative review of the available literature on this topic. Results: We identified 69 relevant publications that we included in the review. In obstetrics, indications include the treatment of gestational hydronephrosis, some urological conditions during pregnancy, such as obstructive urinary calculi, with or without superinfection, or intraoperative use for cesarean section or hysterectomy after cesarean section, to protect from, or to solve, ureteral lesions. In gynecology, they are used preoperatively or intraoperatively to protect the ureter during gynecological operations in the pelvic area or postoperatively to repair some ureteral injuries. They are also indicated for ureteral obstructions that occur after pelvic radiotherapy for gynecological neoplasms. Complications associated with the use of double-J stents include more frequent urinary tract infections, lower urinary tract symptoms, calcifications and misplacements. Conclusions: Double-J stents are widely used in obstetrics and gynecology and are characterized by good efficiency and safety, although some side effects may occur (lower urinary tract symptoms, hematuria, complications in birth outcomes), which do not limit their use. Summary of evidence: In this review, we analyzed the indications and complications of double-J ureteral stenting in obstetric and gynecologic patients. We found that the procedure is safe, both in the treatment of ureteral obstruction and in the resolution of postoperative complications. No serious complications of ureteral stenting have been noted that would constitute a contraindication to its use. Future prospective studies in large patient cohorts are necessary to validate our data. Full article

We propose a self-training scheme, SURABHI, that trains deep-learning keypoint detection models on machine-annotated instances, together with the methodology to generate those instances. SURABHI aims to improve the keypoint detection accuracy not by altering the structure of a deep-learning-based keypoint detector model but by generating highly effective training instances. The machine-annotated instances used in SURABHI are hard instances—instances that require a rectifier to correct the keypoints misplaced by the keypoint detection model. We engineer this scheme for the task of predicting keypoints of cattle from the top, in conjunction with our Eidetic Cattle Recognition System, which is dependent on accurate prediction of keypoints for predicting the correct cow ID. We show that the final cow ID prediction accuracy on previously unseen cows also improves significantly after applying SURABHI to a deep-learning detection model with high capacity, especially when available training data are minimal. SURABHI helps us achieve a top-6 cow recognition accuracy of 91.89% on a dataset of cow videos. Using SURABHI on this dataset also improves the number of cow instances with correct identification by 22% over the baseline result from fully supervised training. Full article