Individual Arms Research Articles

Operator Experience With Robot-Assisted Laparoscopic Rectal Resection and the Impact of Using an Extra Arm on Surgical Outcomes.

Although robot-assisted surgery has been rapidly gaining popularity in recent years, few reports have examined the impact of individual robotic arm movements on surgical outcomes. This study investigated the relationship between extra arm (EA) usage and experience of surgeons in robot-assisted surgery. A total of 176 robot-assisted rectal resections were performed by three surgeons from 2018 to 2022. Each surgeon's first 20 cases categorized in the Early group and the 21st-40th cases in the Late group. Sixty cases in the Early group and 60 cases in the Late group were included to compare patient background, EA motion, and surgical outcomes. More anastomoses were performed closer to the anus in the Late group (p = 0.001). Console time was significantly shorter in the Late group (196 min vs. 153 min, p = 0.020). EA injuries, improper grasping, and intraoperative problems (intraoperative bleeding, misidentification of layers) were significantly less frequent in the Late group (p = 0.001). As experience with robot-assisted surgery increases, appropriate and safe use of an EA was achieved, and operative time and intraoperative problems were reduced.

Bimekizumab Effect on the Need for Concomitant Rescue Interventions by HiSCR Response Level in Patients with Moderate to Severe Hidradenitis Suppurativa from BE HEARD I&II

Introduction: Hidradenitis suppurativa (HS) is a chronic, systemic, inflammatory skin disease characterized by deep, painful lesions that negatively impact patients’ (pts’) quality of life.1 These lesions are difficult to treat and require multifaceted treatment, including the need for rescue interventions alongside conventional therapy.1 Bimekizumab (BKZ) is a monoclonal IgG1 antibody that inhibits interleukin (IL)-17F in addition to IL-17A.2 Here, the relationship between increasingly stringent HS Clinical Response (HiSCR) levels achieved with BKZ and the proportion of pts not requiring rescue concomitant interventions is investigated.Procedure/Study: Pooled data are presented from the phase 3 BE HEARD I&II trials maintenance treatment period (Weeks [Wks]16–48).3 Pts were randomized 2:2:2:1 (initial/maintenance treatment period) to BKZ 320 mg every 2 wks (Q2W)/Q2W, BKZ Q2W/Q4W, BKZ Q4W/Q4W, or placebo (PBO)/BKZ Q2W. Data for the individual BKZ randomization arms and pooled across these arms (BKZ Total) are reported. BKZ-randomized pts were grouped by achievement of mutually exclusive HiSCR levels (<50% improvement from baseline [<HiSCR50]; HiSCR50–<75; HiSCR75–100) at Wk16. The incidence of pts not requiring any concomitant rescue interventions during the maintenance treatment period, including medical (antibiotics, analgesics) and procedural (incision/drainage, intralesional triamcinolone injection) interventions, are reported. Data reported as observed case. Results: Overall, 868 pts were randomized to BKZ Q2W/Q2W (N=288), BKZ Q2W/Q4W (N=292), or BKZ Q4W/Q4W (N=288). In BKZ Total, 76.0%/83.2%/89.1% of pts in the HiSCR<50/50–<75/75–100 bands did not receive rescue intervention through Wks16–48, demonstrating a numerical increase with increasing HiSCR bands. Comparable trends across HiSCR<50/50–<75/75–100 bands were observed in pts receiving BKZ Q2W/Q2W (79.8%/90.0%/90.9%), BKZ Q2W/Q4W (75.0%/78.3%/89.0%) or BKZ Q4W/Q4W (73.3%/81.4%/87.1%). Similar trends were observed from the lowest to highest HiSCR bands when separating into any medical or procedural interventions. Conclusion: Overall, the majority of BKZ-randomized pts did not require any concomitant rescue medical or procedural interventions through Wks16–48 and the proportions of these pts increased with increasingly stringent HiSCR bands. These data highlight the additional value to pts of a decreased need for concomitant rescue interventions when they achieve higher HiSCR response levels.

Evaluating Joint Angle Data for Clinical Assessment Using Multidimensional Inverse Kinematics with Average Segment Morphometry.

Movement analysis is a critical tool in understanding and addressing various disabilities associated with movement deficits. By analyzing movement patterns, healthcare professionals can identify the root causes of these alterations, which is essential for preventing, diagnosing, and rehabilitating a broad spectrum of medical conditions, disabilities, and injuries. With the advent of affordable motion capture technologies, quantitative data on patient movement is more accessible to clinicians, enhancing the quality of care. Nonetheless, it is crucial that these technologies undergo rigorous validation to ensure their accuracy in collecting and monitoring patient movements, particularly for remote healthcare services where direct patient observation is not possible. In this study, motion capture technology was used to track upper extremity movements during a reaching task presented in virtual reality. Kinematic data was then calculated for each participant using a scaled dynamic inertial model. The goal was to evaluate the accuracy of joint angle calculations using inverse kinematics from motion capture relative to the typical movement redundancy. Shoulder, elbow, radioulnar, and wrist joint angles were calculated with models scaled using either direct measurements of each individual's arm segment lengths or those lengths were calculated from individual height using published average proportions. The errors in joint angle trajectories calculated using the two methods of model scaling were compared to the inter-trial variability of those trajectories. The variance of this error was primarily within the normal range of variability between repetitions of the same movements. This suggests that arm joint angles can be inferred with good enough accuracy from motion capture data and individual height to be useful for the clinical assessment of motor deficits.

Addressing the Evidence Gap in Aneurysmal Subarachnoid Hemorrhage: The Need for a Pragmatic Randomized Trial Platform.

Aneurysmal subarachnoid hemorrhage (aSAH) occurs less often than other stroke types but affects younger patients, imposing a disproportionately high burden of long-term disability. Although management advances have improved outcomes over time, relatively few aSAH treatments have been tested in randomized clinical trials (RCTs). One lesson learned from COVID-19 is that trial platforms can facilitate the efficient execution of multicenter RCTs even in complex diseases during challenging conditions. An aSAH trial platform with standardized eligibility criteria, randomization procedures, and end point definitions would enable the study of multiple targeted interventions in a perpetual manner, with treatments entering and leaving the platform based on predefined decision algorithms. An umbrella institutional review board protocol and clinical trial agreement would allow individual arms to be efficiently added as amendments rather than stand-alone protocols. Standardized case report forms using the National Institutes of Health/National Institute of Neurological Disorders and Stroke common data elements and general protocol standardization across arms would create synergies for data management and monitoring. A Bayesian analysis framework would emphasize frequent interim looks to enable early termination of trial arms for futility, common controls, borrowing of information across arms, and adaptive designs. A protocol development committee would assist investigators and encourage pragmatic designs to maximize generalizability, reduce site burden, and execute trials efficiently and cost-effectively. Despite decades of steady clinical progress in the management of aSAH, poor patient outcomes remain common, and despite the increasing availability of RCT data in other fields, it remains difficult to perform RCTs to guide more effective care for aSAH. The development of a platform for pragmatic RCTs in aSAH would help close the evidence gap between aSAH and other stroke types and improve outcomes for this important disease with its disproportionate public health burden.

Effects of Hyperthermia on Telomere Length Changes in <i>Arabidopsis thaliana</i> Plants

Telomeres are highly conserved nucleoprotein structures involved in the defense mechanisms of eukaryotic organisms. Their length depends on a variety of biotic and abiotic factors, such as environmental stressors. Being stationary, plants are particularly susceptible to environmental stresses. This article explores the effects of heat stress on telomere length in Arabidopsis thaliana. Telomere length was measured for individual chromosome arms. It was shown that hyperthermia at 42 °C altered telomere length in some chromosome arms of the wild-type A. thaliana plants, as well as in the long telomeres of the knockout mutants for the gene OLI5/RPL5A. The high temperatures caused the telomeres to become shorter, with the longer telomeres showing a stronger response to the stress. This suggests that the complex regulation of telomere length may be associated with exposure to environmental stressors.

Navigating the landscape of the unfolded protein response in CD8+ T cells.

Endoplasmic reticulum stress occurs due to large amounts of misfolded proteins, hypoxia, nutrient deprivation, and more. The unfolded protein is a complex intracellular signaling network designed to operate under this stress. Composed of three individual arms, inositol-requiring enzyme 1, protein kinase RNA-like ER kinase, and activating transcription factor-6, the unfolded protein response looks to resolve stress and return to proteostasis. The CD8+ T cell is a critical cell type for the adaptive immune system. The unfolded protein response has been shown to have a wide-ranging spectrum of effects on CD8+ T cells. CD8+ T cells undergo cellular stress during activation and due to environmental insults. However, the magnitude of the effects this response has on CD8+ T cells is still understudied. Thus, studying these pathways is important to unraveling the inner machinations of these powerful cells. In this review, we will highlight the recent literature in this field, summarize the three pathways of the unfolded protein response, and discuss their roles in CD8+ T cell biology and functionality.

Development of the Anthropomorphic Arm for Collaborative and Home Service Robot CHARMIE

Service robots are rapidly transitioning from concept to reality, making significant strides in development. Similarly, the field of prosthetics is evolving at an impressive pace, with both areas now being highly relevant in the industry. Advancements in these fields are continually pushing the boundaries of what is possible, leading to the increasing creation of individual arm and hand prosthetics, either as standalone units or combined packages. This trend is driven by the rise of advanced collaborative robots that seamlessly integrate with human counterparts in real-world applications. This paper presents an open-source, 3D-printed robotic arm that has been assembled and programmed using two distinct approaches. The first approach involves controlling the hand via teleoperation, utilizing a camera and machine learning-based hand pose estimation. This method details the programming techniques and processes required to capture data from the camera and convert it into hardware signals. The second approach employs kinematic control using the Denavit-Hartenbergmethod to define motion and determine the position of the end effector in 3D space. Additionally, this work discusses the assembly and modifications made to the arm and hand to create a cost-effective and practical solution. Typically, implementing teleoperation requires numerous sensors and cameras to ensure smooth and successful operation. This paper explores methods enabled by artificial intelligence (AI) that reduce the need for extensive sensor arrays and equipment. It investigates how AI-generated data can be translated into tangible hardware applications across various fields. The advancements in computer vision, combined with AI capable of accurately predicting poses, have the potential to revolutionize the way we control and interact with the world around us.

Tractor Three-Point Hitch Control for an Independent Lower Arms System

The three-point hitch, found on agricultural tractors, facilitates the raising and lowering of an attached implement. Some tractors include a rock shaft that comprises a physical shaft that interconnects and facilitates the raising and lowering of the lower arms of the three-point hitch in a synchronized manner. In this study, we deal with a hitch system with the lower arms actuated by two independent hydraulic cylinders. This innovative tractor hitch system design allows the implement to follow the terrain, instead of the tractor, about the fore–aft (roll) axis of the tractor. However, since the two lower arms are independent, a specialized controller is needed to move these arms in unison. First, we present a position controller for individual arms and a roll controller to move these arms together. Second, we present a unique algorithm to emulate a physical rock shaft while the implement is operating in float mode. The algorithm ensures that the implement does not roll around the fore–aft axis while making sure it moves up and down vertically to follow the terrain. We present experimental results from the step response of the hitch system’s height while tracking a velocity reference. With the roll of the implement defined as the difference between the left arm’s position in percentage and that of the right arm in percentage, we observe that the largest mean roll was 0.23% with a flail mower attached and 0.26% without any implement. We then present results from the implement’s position in the float mode when the software rock shaft was activated and compare them with the case without the software rock shaft. The experiments showed that, when the software rock shaft was turned on, the mean roll reduced from 4.64% to 0.58% with a seed drill implement and from −3.99% to −0.59% with a flail mower implement. The standard deviations in these two implement cases improved from 16.77% to 2.79% and 6.45% to 3.53%, respectively, proving the effectiveness of the software rock shaft and its potential to replace the physical rock shaft found on the traditional tractors.

Atomistic investigation of the interaction between an edge dislocation and 1/2 interstitial dislocation loops in irradiated tungsten

By impeding dislocation motion, the irradiation-induced dislocation loops cause irradiation hardening and further embrittlement of plasma-facing tungsten in fusion reactors, leading to its performance degradation. But fundamental questions regarding the mechanisms remain to be clarified and predictive model for loop hardening remains to be built. In this paper, interactions between gliding edge dislocations and interstitial dislocation loops (with Burger vector bL = ½<111>) are studied using atomistic simulations. The influences of bL orientations, dislocation-loop intersection positions, loop sizes, and loading conditions (temperature and strain rate) on the interactions are systematically calculated and analyzed. Results show a large variety of interaction mechanisms, depending mainly on the relative orientations of bL to dislocation slip plane, while slightly affected by loading conditions. Although loops with bL parallel to the plane can be easily swept away by gliding dislocations, loops with bL inclined to dislocation slip plane can strongly pin the gliding dislocation by forming a sessile 〈100〉 segment, which would bend the dislocation line into a screw dipole. Thus, high stress is required for the dislocation line to break away from the inclined loops by cross-slip of each individual arm of the screw dipole coupled with glide of the 〈100〉 segment. On the other hand, increasing temperature and/or decreasing strain rate hardly change the above mechanisms, but monotonically reduce the obstruction by these loops. Simplifying the complex motion of the edge dislocation pinned by the inclined loops as a thermally-activated process of a 1/2[111] edge dislocation overcoming barriers, a hardening model for the inclined loops is proposed. This model well describes the dependence of loop strength on loop sizes, temperatures and strain rates. The model is then applied to predict irradiation hardening at experimental strain rates, and it shows reasonable agreement with experimental results.

Progression-free survival as a surrogate endpoint for overall survival in patients with relapsed or refractory multiple myeloma.

The goal of the research was to assess the quantitative relationship between median progression-free survival (PFS) and median overall survival (OS) specifically among patients with relapsed/refractory multiple myeloma (RRMM) based on published randomized controlled trials (RCTs). Two bibliographic databases (PubMed and Embase, 1970-2017) were systematically searched for RCTs in RRMM that reported OS and PFS, followed by an updated search of studies published between 2010 and 2022 in 3 databases (Embase, MEDLINE, and EBM Reviews, 2010-2022). The association between median PFS and median OS was assessed using the nonparametric Spearman rank and parametric Pearson correlation coefficients. Subsequently, the quantitative relationship between PFS and OS was assessed using weighted least-squares regression adjusted for covariates including age, sex, and publication year. Study arms were weighted by the number of patients in each arm. A total of 31 RCTs (56 treatment arms, 10,450 patients with RRMM) were included in the analysis. The average median PFS and median OS were 7.1 months (SD 5.5) and 28.1 months (SD 11.8), respectively. The Spearman and Pearson correlation coefficients between median PFS and median OS were 0.80 (P < 0.0001) and 0.79 (P < 0.0001), respectively. In individual treatment arms of RRMM trials, each 1-month increase in median PFS was associated with a 1.72-month (95% CI 1.26-2.17) increase in median OS. Analysis of the relationship between PFS and OS incorporating more recent studies in RRMM further substantiates the use of PFS to predict OS in RRMM.

Exploratory and Confirmatory Factor Analyses Support the Unidimensionality of the Arabic Quick Disabilities of the Arm, Shoulder and Hand

The objective of this investigation was to assess the structural validity of the Arabic Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) in individuals suffering from upper extremity musculoskeletal disorders, utilizing both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). A group of participants with upper extremity musculoskeletal disorders attending physical therapy clinics were recruited. Upon their initial visit to physical therapy, participants were requested to complete the Arabic versions of the QuickDASH, as well as the Numeric Pain Rating Scale. In order to determine the number of factors, parallel analysis was employed in the EFA, while maximum likelihood was utilized for extraction. The fit of the model identified using EFA was subsequently examined using CFA, incorporating multiple fit indices. The outcomes of the EFA indicated the existence of a one-factor structure, accounting for a considerable 50.22% of the total variance. It was observed that all of the QuickDASH items displayed loadings on the single factor, with values ranging from 0.35 to 0.77. However, the multiple fit indices obtained from the CFA did not provide sufficient support for the fit of the initially proposed unidimensional structure. The data showed good fit to the unidimensional model after adding error covariance: chi-square = 100.52 [degrees of freedom (df) = 40, P &lt; 0.001], chi-square/df = 2.51, Tucker–Lewis index = 0.94, comparative fit index = 0.95, root mean square error of approximation = 0.077 [90% confidence interval (CI) = 0.058-0.096], and standardized root mean residual = 0.048. Ultimately, the findings from the EFA provided evidence supporting the unidimensionality of the Arabic QuickDASH, while the CFA supported the unidimensionality of the QuickDASH after addressing the issue of local dependency between some scale items.

Dynamic Manipulation and Stiffness Modulation of Cooperative Continuum Robots: Theory and Experiment

Abstract Cooperative continuum robots (CCRs) are composed of multiple coupled continuum arms to cooperatively conduct manipulation tasks. They can highly enhance the performance of individual continuum arms by providing extra stiffness, leading to increased accuracy, payload capacity, and dynamic stability of the robot. This study aimed to investigate the stiffness analysis of tendon-driven supportive-type CCRs (S-CCRs). For this purpose, first, a generalized framework for the dynamic mathematical formulation and numerical solution of S-CCRs was proposed, their dynamic response to complex scenarios was obtained, and the accuracy of the model was experimentally evaluated. Then, the capability of stiffness modulation of S-CCRs was studied. Tendon-driven S-CCRs are potentially capable of changing the stiffness with structural configuration, providing active stiffness control at the design level. Hence, in this study, the effects of the connection point location/angle of the supportive arms to the operative arm, as well as the imposed tendon limitations of the supportive arm on the stiffness of the robot, and consequently on the dynamic payload manipulation, were studied and practical solutions were proposed to develop a simple but effective stiffness control mechanism. This study showed that a typical S-CCR can increase its stiffness, just by a modular connector design up to 84% during manipulation, bringing a novel opportunity for stiffness modulation of CCRs.

Finite-Time Frequentist Regret Bounds of Multi-Agent Thompson Sampling on Sparse Hypergraphs

We study the multi-agent multi-armed bandit (MAMAB) problem, where agents are factored into overlapping groups. Each group represents a hyperedge, forming a hypergraph over the agents. At each round of interaction, the learner pulls a joint arm (composed of individual arms for each agent) and receives a reward according to the hypergraph structure. Specifically, we assume there is a local reward for each hyperedge, and the reward of the joint arm is the sum of these local rewards. Previous work introduced the multi-agent Thompson sampling (MATS) algorithm and derived a Bayesian regret bound. However, it remains an open problem how to derive a frequentist regret bound for Thompson sampling in this multi-agent setting. To address these issues, we propose an efficient variant of MATS, the epsilon-exploring Multi-Agent Thompson Sampling (eps-MATS) algorithm, which performs MATS exploration with probability epsilon while adopts a greedy policy otherwise. We prove that eps-MATS achieves a worst-case frequentist regret bound that is sublinear in both the time horizon and the local arm size. We also derive a lower bound for this setting, which implies our frequentist regret upper bound is optimal up to constant and logarithm terms, when the hypergraph is sufficiently sparse. Thorough experiments on standard MAMAB problems demonstrate the superior performance and the improved computational efficiency of eps-MATS compared with existing algorithms in the same setting.

Abstract 1639: Telomere dynamics in aging and cancer by nanopore long-read sequencing

Abstract Telomeres are the protective, nucleoprotein structure at the ends of linear eukaryotic chromosomes. The accurate measurement of both telomeric length and composition of individual telomeres in mammalian cells has been challenged by the length and repetitive nature of telomeres. With the advent of third generation sequencing technologies, it is now technically possible to sequence entire telomeres and map them to individual chromosome arms. Here, we report a reliable method to enrich, sequence and analyze human telomeres using Oxford Nanopore Technologies long-read sequencing. To enrich for telomeric sequences we combine the ligation of adapters complementary to the telomeric G-overhang with restriction enzyme digest to sequence the telomeric C-strand and part of the adjacent subtelomere. The subtelomeric information is harvested to map individual telomeric reads to specific chromosome arms and even alleles. We have measured bulk, chromosome-arm-specific telomere length dynamics during cellular aging of cultured primary cells and in a patient-derived aging cohort. To address the impact of the telomere maintenance mechanism on telomere length and composition, we have sequenced matched pairs of fibroblasts and induced pluripotent stem cells, as well as five well-established telomerase- and ALT-positive cancer cell lines. Our results suggest that based on nanopore telomere long-read sequencing ALT-positive cells can be easily discriminated from normal and telomerase-positive cancer cells. Further, telomere sequencing allows to evaluate the methylation status of the subtelomeric CpG islands adjacent to telomeres. In summary, nanopore telomere long-read sequencing allows to measure the length and composition of individual telomeres and their mapping to specific chromosome arms. Telomere long read sequencing methods will be valuable tools to study telomere biology during aging and cancer. Citation Format: Tobias T. Schmidt, Carly Tyer, Preeyesh Rughani, Candy Haggblom, Jeff Jones, Xiaoguang Dai, Kelly A. Frazer, Fred H. Gage, Sissel Juul, Scott Hickey, Jan Karlseder. Telomere dynamics in aging and cancer by nanopore long-read sequencing [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1639.

Characteristics, Progression, and Output of Randomized Platform Trials

Platform trials have become increasingly common, and evidence is needed to determine how this trial design is actually applied in current research practice. To determine the characteristics, progression, and output of randomized platform trials. In this systematic review of randomized platform trials, Medline, Embase, Scopus, trial registries, gray literature, and preprint servers were searched, and citation tracking was performed in July 2022. Investigators were contacted in February 2023 to confirm data accuracy and to provide updated information on the status of platform trial arms. Randomized platform trials were eligible if they explicitly planned to add or drop arms. Data were extracted in duplicate from protocols, publications, websites, and registry entries. For each platform trial, design features such as the use of a common control arm, use of nonconcurrent control data, statistical framework, adjustment for multiplicity, and use of additional adaptive design features were collected. Progression and output of each platform trial were determined by the recruitment status of individual arms, the number of arms added or dropped, and the availability of results for each intervention arm. The search identified 127 randomized platform trials with a total of 823 arms; most trials were conducted in the field of oncology (57 [44.9%]) and COVID-19 (45 [35.4%]). After a more than twofold increase in the initiation of new platform trials at the beginning of the COVID-19 pandemic, the number of platform trials has since declined. Platform trial features were often not reported (not reported: nonconcurrent control, 61 of 127 [48.0%]; multiplicity adjustment for arms, 98 of 127 [77.2%]; statistical framework, 37 of 127 [29.1%]). Adaptive design features were only used by half the studies (63 of 127 [49.6%]). Results were available for 65.2% of closed arms (230 of 353). Premature closure of platform trial arms due to recruitment problems was infrequent (5 of 353 [1.4%]). This systematic review found that platform trials were initiated most frequently during the COVID-19 pandemic and declined thereafter. The reporting of platform features and the availability of results were insufficient. Premature arm closure for poor recruitment was rare.

Abstract A115: DNA repair biomarkers to guide usage of combined PARP inhibitors and chemotherapy: A meta-analysis and systematic review

Abstract A115: DNA repair biomarkers to guide usage of combined PARP inhibitors and chemotherapy: A meta-analysis and systematic review

Examination of knee extensor and valgus moment arms of the patellar tendon in older individuals with and without knee osteoarthritis

BackgroundJoint moment arm is a major element that determines joint torque. This study aimed to investigate factors associated with knee extensor and valgus moment arms of the patellar tendon in older individuals with and without knee osteoarthritis. MethodsThirty-six participants with knee osteoarthritis (mean age, 78.1 ± 6.0 years) and 43 healthy controls (mean age, 73.0 ± 6.3 years) were analyzed. Magnetic resonance images (MRI) from the knee joint and thigh were acquired using a 3.0 T MRI scanner. The three-dimensional moment arm was defined as the distance between the contact point of the tibiofemoral joint and the patellar tendon line. The three-dimensional moment arm was decomposed into sagittal and coronal components, which were calculated as knee extensor and valgus moment arms, respectively. Quadriceps muscle volume, epicondylar width, bisect offset, Insall–Salvati ratio, and Kellgren–Lawrence grade were assessed. Multiple regression analyses were performed in the healthy control and knee osteoarthritis groups, with knee extensor and valgus moment arms as dependent variables. FindingsKnee extensor moment arm was significantly associated with epicondylar width and the Insall–Salvati ratio in the healthy control group and with Kellgren–Lawrence grade, epicondylar width, and quadriceps muscle volume in the knee osteoarthritis group. Valgus knee moment arm was significantly associated with bisect offset in both the groups. InterpretationKnee size, osteoarthritis severity, and quadriceps muscle volume affect the knee extensor moment arm in knee osteoarthritis, whereas lateral patellar displacement affects the valgus knee moment arms in older individuals with and without knee osteoarthritis.

Robotic hernia repair with the novel HUGO robot system – An initial experience from a tertiary centre

Abstract Background: Hernia repair using robotic platforms has been on the rise in the last decade. The HUGO robotic-assisted surgery (RAS) system, introduced in 2021, is a new addition to the field. In this study, we share our experience with this innovative system for the management of ventral and groin hernias. Patients and Methods: The aim of our study was to evaluate the feasibility and safety of using the HUGO robotic platform for hernia surgeries. We conducted a retrospective analysis of all hernia surgeries performed with the HUGO system over a 1-year study period. The study assessed various aspects, including the technical manoeuvres of the robotic system, duration of surgery, length of hospital stay, post-operative pain levels and 30-day morbidity rates. Results and Conclusions: A total of seven hernia surgeries were performed using the HUGO system, including five ventral hernias and two groin hernias. The average duration of surgery was 128 min, with a docking duration of 22.8 min. Notably, there were no intraoperative or post-operative adverse events reported during these procedures. The HUGO system features an open console that provides a panoramic view of the operating room. In addition, the individual arm carts can be easily manoeuvred around the operating table, facilitating improved access to multiple quadrants during surgery. In our case series, Robotic hernia repair using the HUGO system has demonstrated feasibility, with post-operative outcomes comparable to traditional approaches. This innovative system serves as an additional tool in the armamentarium of hernia surgery and shows potential for improving surgical outcomes. However, further investigation through large-scale prospective studies is necessary to comprehensively evaluate its efficacy and benefits.

Efficacy and safety of catheter ablation for atrial fibrillation in elderly patients: a systematic review and meta-analysis.

Catheter ablation (CA) is a well-established therapy for patients with atrial fibrillation (AF); however, there is paucity of data for elderly patients. We aimed to assess long-term efficacy and safety of CA for elderly patients with AF. Medline, BVS, Cochrane, and Embase were searched through April 2023 to investigate comparative outcomes between elderly patients > 75 or 80years, as per-study cutoff, and individuals ≤ 75/80years, undergoing CA. Primary efficacy and safety endpoints (AF recurrence and procedure-related major complications) were pooled with the Comprehensive Meta-Analysis 3.0 software. Subgroup analyses were performed by age groups and type of procedure (radiofrequency vs. cryoballoon). Four thousand eight hundred twenty-nine titles were screened, and 27 studies were included, being 26 observational and 1 randomized trial, comprising 117,869 patients, being 8714 (7.4%) elderly > 75/80years, with follow-up from 11.7 to 72.3months. In comparative studies (N = 17 studies), elderly > 75/80years had a higher risk of AF recurrence compared to those ≤ 75/80: relative risk (RR) 1.16 (95% CI 1.05-1.27, p = 0.002. However, funnel plot indicated publication bias, and after imputation of 5 studies, the groups were similar (RR 1.07 (95% CI 0.97-1.19)). The rates of major complications (N = 14 studies) were higher in elderly > 75/80years (RR 1.30 (95% CI 1.10-1.54), I2 = 0, p = 0.002), but were similar in cryoablation studies (N = 7) (RR 1.10, 95% CI 0.94-1.29, p = 0.24, I2 = 0.0). Results were similar when individual study arms (N = 27 studies) were pooled. AF ablation is feasible in elderly patients > 75/80years, with success rates compared to younger individuals. Complication rates, however, were higher.

Modified Chinese disabilities of arm, shoulder and hand tool: Validity and reliability for upper extremity injuries

DesignClinimetric evaluation study. IntroductionThe Chinese Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire has necessitated the development of a revised version to the specific needs of individuals with upper extremity injuries with the progress of times and lifestyle changes. Purpose of the studyThis research aimed to evaluate the reliability and validity of Modified Chinese Disability of Arm, Shoulder and Hand (MC-DASH) questionnaire in individuals with upper extremity injuries. MethodsOne hundred and one individuals with upper extremity injuries (UEI) were recruited. The function of upper extremity was measured using the electronic version of MC-DASH, and compared against the Chinese Disability of Arm, Shoulder and Hand. The MC-DASH was reassessed within three days in all individuals. We investigated the internal consistency, test-retest reliability, content validity, criterion validity, and construct validity of MC-DASH. ResultsThe internal consistency was deemed sufficient, as indicated by a Cronbach's alpha of 0.986 and an intraclass correlation coefficient of 0.957. Moreover, the mean total scores of MC-DASH on the first-test and retest were 37.86 and 38.19, respectively (ICC: 0.957, 95 %CI: 0.937–0.971, p < 0.001). Furthermore, the MC-DASH version exhibited satisfactory content validity evidenced by its strong correlation (R= 0.903, p < 0.001) with the Chinese DASH. Three major influencing factors were identified from 37 items. The cumulative variance contribution rate of the MC-DASH questionnaire was 75.76 %, confirming its construct validity. ConclusionThe Modified Chinese Disability of Arm, Shoulder and Hand questionnaire has been shown to be a valid, reliable, and practical tool for use in patients with upper extremity injuries.