Correct Placement Research Articles

Endoscopic Stricturoplasty with Linear Stapler: An Efficient Alternative for the Refractory Rectal Anastomotic Stricture

IntroductionSymptomatic anastomotic stricture is a rare but major complication after left-sided colorectal surgery. Hydraulic balloon dilatation is the first-line treatment in cases where the complication occurs, but 20% of patients present with refractory strictures after multiple sessions. Endoscopic stricturoplasty with the use of a linear stapler is a novel therapeutic alternative for those difficult cases.Materials and MethodsWe identified all patients in our department who underwent endoscopic stricturoplasty with a linear stapler between 2004 and 2022. The technical, periinterventional, and follow-up data of the patients were retrospectively analyzed.ResultsWe identified nine patients who fulfilled our inclusion criteria. The procedure was technically possible in eight cases, whereas in one case, the anatomy of the anastomosis did not allow for a correct placement of the stapler. All patients with a technically successful procedure were relieved from their symptoms and could have their ostomy reversed. There was no periprocedural morbidity and mortality. Two patients presented with a recurrent stricture eight and 26 months after the initial stricturoplasty, and the procedure was successfully repeated in both cases.ConclusionsEndoscopic stricturoplasty is a feasible, safe, and minimally invasive alternative for the treatment of refractory anastomotic strictures in the distal colon and rectum for patients with a suitable anatomy.

Results of a survey of ophthalmologists on the special aspects in performing and interpreting optical coherence tomography examination of the macula

BACKGROUND: Optical coherence tomography (OCT) is the main method for in vivo examination of the morphology of ocular posterior segment structures, used in modern ophthalmological practice.
 AIM: Study of special aspects in performing and interpreting the results of OCT of the macula by ophthalmologists working in the healthcare system of the Russian Federation.
 MATERIALS AND METHODS: In the anonymous survey, conducted using an original online questionnaire of 12 questions 59 respondents took part. They confirmed being ophthalmologists with experience in performing OCT and gave their consent to took part in the survey.
 RESULTS: The majority of respondents (79.6%) reported that they face the need to perform OCT without obtaining the patients clinical data. 66.1% of respondents always evaluate the correct placement of segmentation boundaries. Only 56% of the respondents always or often perform frontal (en face) scans during OCT examination of the macula. At the same time, 16.9% of specialists indicated that they did not know what segmentation boundaries are, and 8.5% noted that they did not understand the term en face scan. The principle of layer-by-layer analysis is used by 94.9% of respondents when describing images. Significant discrepancies were also revealed in the interpretation by the respondents of some parameters on specific examples of OCT scans. 71.2% of respondents have experience in using templates when describing OCT images, and 13.6% use them constantly. The proportion of specialists who consider it expedient to develop and introduce into clinical practice a standard protocol (template) for describing macular OCT images was 84.7%.
 CONCLUSIONS: Insufficient awareness of some ophthalmologists about particular principles of interpreting the results of an OCT imaging and about certain practical aspects of its application was revealed. This indicates the need in improving the quality of informational support and training of specialists. A request was received from ophthalmologists about the need to develop a standard protocol (template) for describing OCT images of the macular area with the aim of subsequent implementation into the clinical practice of the healthcare system of the Russian Federation.

Mean S1 inlet and outlet view angles are not safe for all individuals according to three-dimensional tomographic measurements.

Although there are many studies evaluating optimal inlet and outlet angles required for the correct placement of S1 iliosacral screws, there is no study evaluating reliability and feasibility of these angles for all individuals on three-dimensional (3D) anatomical models. A total of 100 women and 100 men were selected randomly. A vertical line was created according to long axis of the tomography device on which patient was lying in supine position. The automatized best-fit planes were created on superior and inferior endplates, anterior cortex including notch region and posterior cortex of first sacral vertebrae using 3D imaging software to measure mean inlet and outlet angles. We observed no statistically significant difference between gender groups in terms of inlet and outlet angles. Mean inlet view is obtained for anterior cortex of S1 in 22.5 ± 9.5° and for posterior cortex in 46.5 ± 9.3°. Mean fluoroscopic view angle of S1 for superior outlet is 40.3 ± 7.6 and for inferior outlet is 46.9 ± 8.8. Mean anterior and posterior S1 inlet view angles do not accurately visualize anterior cortex of 74 (37%) and posterior cortex of 66 (33%) individuals. Mean superior and inferior S1 outlet view angles do not accurately visualize superior endplate of 74 (37%) and inferior endplate of 56 (28%) individuals. Due to individual alterations of spatial position of sacrum, mean inlet and outlet view angles of S1 are not sufficient to visualize the iliosacral screws under fluoroscopy in many individuals.

Computed tomography-guided intraoperative navigation in children with congenital scoliosis versus freehand/fluoroscopy methods

BACKGROUND: The choice of techniques for the treatment of children with congenital spinal deformities remains one of the most significant problems of spinal surgery. This topic is relevant given the peculiarities of the disease course, severity and rigidity of deformities, their steady and rapid progression, formation of compensatory curvature, and a significant decrease in the quality and life expectancy of patients.
 AIM: To compare screw misposition, adverse outcomes, intraoperative blood loss, and time required for pedicle screw placement with further deformity correction under computed tomography (CT) guidance with intraoperative navigation versus fluoroscopy.
 MATERIALS AND METHODS: This single-center, prospective comparative study was conducted from 2019 to 2022 at the National Scientific Center of Traumatology and Orthopedics named after academician N.D. Batpenov. Patient demographics and surgical outcomes were obtained from the medical records. All patients underwent a comprehensive clinical and radiological examination before surgery, after surgery, and at the stages of dynamic observation. Data of patients with congenital malformations of the spine were analyzed. The study involved 42 patients aged 318 years with congenital kyphoscoliosis of the thoracic and/or lumbar spine. The patients were divided into two groups according to the method of surgical correction used: the O-arm navigation group and the C-arm group.
 RESULTS: Data of patients who underwent surgery for congenital scoliosis of the spine were analyzed. The patients were divided into the O-arm navigation group, which included patients who underwent surgery using the O-arm mobile intraoperative CT with the seventh-generation Stealth Station navigation system in combination with intraoperative neuromonitoring, and the C-arm group, which included patients who underwent surgery under the control of the intraoperative C-arm. In both groups, 364 screws were placed, of which 189 screws were placed under neuronavigation, and 175 screws were placed using the C-arm. The effectiveness of the intraoperative neuronavigation system in combination with neuromonitoring showed 97.11% correct placement (grades A and B) of pedicle screws. The use of an intraoperative C-arm showed 89.63% (grades A and B) correctness. The proportion of misplaced screws corresponding to GertzbeinRobbins classes CE was higher in the C-arm group (10.37%) than in the navigation group (1.49%) (p 0.005). No severe neurological disorders, postoperative infection, or adverse clinical outcomes were observed in both groups.
 CONCLUSIONS: The installation of pedicle screws using CT-guided navigation (O-arm) did not prolong the operation time, did not increase blood loss, and reduced the risk of screw mispositioning compared with freehand and fluoroscopy pedicle screw placement.

Umbilical Venous Catheter Position: The Value of Acquiring a Lateral in Addition to a Frontal Chest Radiograph.

Introduction Umbilical venous catheters (UVCs) are standardly used for central venous access in acutely sick neonates. Complications associated with UVCs include thrombosis, infection, diffuse intravascular coagulopathy, arrhythmia, tamponade, and liver injury, many of which are related to misplacement of the catheters. Therefore, this study aimed to institute a policy of obtaining lateral and frontal radiographs to improve the determination of the UVC position. Methods We retrospectively reviewed UVC placement from 132 radiographs. We compared interpretations by different reviewers of frontal versus frontal and lateral chest radiographs for the most accurate determination of the UVC position. The reviewers completed questionnaires indicating their assessment of the catheter tip position, as well as the appropriate catheter manipulation required for optimal positioning. Their assessment was derived from frontal chest radiographs followed by frontal plus lateral view radiographs a week later. Results The reviewers (junior neonatology fellow, senior neonatology fellow, pediatric radiology fellow, and senior pediatric radiologist) revised their assessment with regard to the UVC positioning between frontal and frontal plus lateral radiographs in 24.6%, 22.7%, 19.6%, and 15.9% of cases, respectively, and indicated that the lateral view was helpful in 18%, 13.6%, 19.6%, and 31% of the cases, respectively. UVCs were placed appropriately at the first attempt in only 13.6% of the cases. Conclusion Correct initial placement of a UVC is uncommon. A lateral radiograph is beneficial in determining the UVC position. Hence, we suggest the inclusion of a lateral view along with the frontal chest radiograph for the evaluation of the UVC position if real-time ultrasound cannot be performed before UVC usage.

Custom, 3-Dimensional Patient-Specific Instrumentation in Anatomic Total Shoulder Arthroplasty: Part 1—Preoperative Assessment, Preoperative Planning, and Guide Design

Successful total shoulder arthroplasty relies on a multitude of factors specific to patients, implant selection, and surgical technique. Among technical factors, correct intraoperative placement of prosthetic components is paramount. Three-dimensional computed tomography has emerged as a vital tool, allowing surgeons to measure glenoid inclination, glenoid version, and humeral head subluxation more accurately and reproducibly. Several commercial preoperative planning software resources are available to determine the optimal size and positioning of prosthetic components yet do so at significant cost and with meaningful time constraints. At our institution, we have applied the principles of these technologies to develop a custom, 3-dimensionally printed glenoid guide for accurate placement of the central pin. In this technical note, we describe our evaluation of patients with glenohumeral arthritis, as well as our step-by-step procedure for designing and printing a custom patient-specific instrumentation glenoid guide for anatomic total shoulder arthroplasty.

Electrically evoked compound action potentials in cochlear implant users with preoperative residual hearing.

Residual hearing in cochlear implant (CI) candidates requires the functional integrity of the nerve in particular regions of the cochlea. Nerve activity can be elicited as electrically evoked compound action potentials (ECAP) after cochlear implantation. We hypothesize that ECAP thresholds depend on preoperative residual hearing ability. In a retrospective study, we analyzed 84 adult cochlear implant users who had received a Nucleus® CI632 Slim Modiolar Electrode and who preoperatively had had residual hearing. Inclusion criteria were severe to profound hearing loss with preoperative measurable hearing in the ear to receive the implant, postlingual hearing loss, German as native language and correct placement of the electrode, inserted completely into the scala tympani. Electrically evoked compound action potential (ECAP) was recorded intraoperatively. The angular insertion was measured for each electrode contact from postoperative computed tomography to estimate the corresponding spiral ganglion frequency. Pure-tone audiometry and allocated ECAP thresholds were tested to investigate possible correlation. The average of hearing thresholds, tested at 0.5, 1, 2, and 4 kHz (4FPTA) was 82 ± 18 (range 47-129) dB HL. The success rate for recording ECAP thresholds was 96.9%. For all comparable pure-tone frequencies (1, 2, 4, and 8 kHz), there was significant correlation between preoperative hearing levels and intraoperative ECAP thresholds (p < 0.001). Higher hearing thresholds are associated with increased ECAP thresholds. In CI candidates with adequate residual hearing, intraoperative electrophysiological measurement records lower thresholds. This outcome may be explained by the neural survival density of the peripheral system, with less neural degeneration.

Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF): A Video Technique Guide.

Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has been established as an excellent alternative to the traditional open approach for the treatment of degenerative conditions of the lumbar spine1-3. The procedure is performed with the patient under general anesthesia and on a radiolucent table in order to allow for intraoperative fluoroscopy. The procedure is performed through small incisions made over the vertebral levels of interest, typically utilizing either a fixed or expandable type of tubular dilator, which is eventually seated against the facet joint complex4. A laminectomy and/or facetectomy is performed in order to expose the disc space, and the ipsilateral neural elements are visualized5. The end plates are prepared, and an interbody device is placed after the disc is removed. Pedicle screws and rods are then placed for posterior fixation. Nonoperative alternatives include physical therapy and corticosteroid injections. Other operative techniques include open TLIF or other types of lumbar fusion approaches, such as posterior lumbar interbody fusion (PLIF), anterior lumbar interbody fusion, lateral or extreme lateral interbody fusion, or oblique lumbar interbody fusion. Open TLIF was developed in order to obtain a more lateral approach to the lumbar disc space than was previously possible with PLIF. The goal of this was to minimize the amount of thecal-sac and nerve-root retraction required during PLIF4. Additionally, as the number of patients who required revision after PLIF increased, the need arose for an approach to the lumbar spine that circumvented the posterior midline scarring from previous PLIF surgical sites6. MI-TLIF was introduced to reduce the approach-related paraspinal muscle damage of open TLIF5. Indications for MI-TLIF include most degenerative pathology of the lumbar spine, including disc herniation, low-grade spondylolisthesis, and spinal and foraminal stenosis7. However, MI-TLIF allows for less robust correction of deformity than other minimally invasive approaches; therefore, MI-TLIF may not be as effective in cases of substantial spinal deformity or high-grade spondylolisthesis8. MI-TLIF results in significantly less blood loss, postoperative pain, and hospital length of stay compared with open TLIF1-3. Although some studies have suggested increased operative time for MI-TLIF9,10, meta-analyses have shown comparable operative times between the 2 techniques1-3. It is thought that the discrepancy in reported operative times is the result of a learning curve and that, once that is overcome, the difference in operative time between the 2 techniques becomes minimal11,12. One disadvantage of MI-TLIF that has remained constant in the literature is its increased intraoperative fluoroscopy time compared with open TLIF3,13. The complication rate has largely been found to be equivalent between open and MI-TLIF1-3 or slightly lower with MI-TLIF14, especially in the hands of an experienced surgeon15. Finally, the fusion rate and improvement in patient outcome scores have also been found to be largely equivalent1-3. We suggest placing the ipsilateral pedicle screw after the interbody cage has been inserted.Fully visualize the Kambin triangle16 prior to performing the facetectomy. Protect the exiting and traversing nerve roots by placing small cottonoids around them and retracting delicately.Bone removed during facetectomy can be utilized as autograft for the interbody cage.Avoid removing pedicle bone during decompression.If central stenosis is present, the neural decompression should be extended medial to the epidural fat so that the dura mater can be visualized all of the way to the contralateral pedicle.Perform an adequate end plate preparation prior to interbody insertion while being mindful to avoid injuring the end plate, to minimize the risk of future cage subsidence.Confirm correct placement of the interbody device on intraoperative fluoroscopy.If bone morphogenic protein is utilized, be careful not to pack too much posteriorly as this may cause nerve irritation. TLIF = transforaminal lumbar interbody fusionMI-TLIF = minimally invasive TLIFPLIF = posterior lumbar interbody fusionALIF = anterior lumbar interbody fusionLLIF = lateral lumbar interbody fusionXLIF = extreme lateral interbody fusionOLIF = oblique lumbar interbody fusionDLIF = direct lateral interbody fusionMRI = magnetic resonance imagingA/P = anteroposteriorEMG = electromyographicBMP = bone morphogenic proteinXR = x-ray (radiograph)OTC = over the counterDVT = deep vein thrombosisPE = pulmonary embolismMI = myocardial infarctionMIS = minimally invasive surgeryOR = operating roomLOS = length of stayVAS = visual analog scaleODI = Oswestry Disability IndexM-H = Mantel-HaenszelRR = risk ratioCI = confidence intervalNSAIDs = nonsteroidal anti-inflammatory drugs.

Morbidity and mortality related to type II odontoid fractures in octogenarians undergoing surgery: a retrospective study with 5 year follow up.

The prevalence of trauma is increasing in the geriatric population. The optimal therapy for type II odontoid fractures in the elderly is controversial. This study aims to assess the morbidity and mortality associated with odontoid fractures in octogenarians undergoing C1/C2 posterior screw fixation and describe the perioperative and post-operative complications and risk factors associated with mortality. Electronic medical records from a single institution pertaining to the period between September 2005 and December 2020 were retrieved. Data on patient demographics, neurological conditions, surgical characteristics, complications, hospital course, and 90-day mortality were collected. Over a 16-year period, 60 patients aged ≥80 years diagnosed with type II odontoid fractures were enrolled in the study. The mean age was 85.0 ± 1.9 years. The mean Charlson Comorbidity Index (CCI) was >6 indicating a poor baseline reserve (8.5 ± 1.9), while cardiovascular diseases were the most prevalent among comorbidities. The mean surgical duration was 217.5 ± 65.9 min, with a mean blood loss of 725.5 ± 275.7 mL. The in-hospital was 5-0% and the 90-day mortality rates increased at 10.0%. No revision surgery was needed in any of the cases. Intraoperative and post-operative X-ray and computed tomography (CT) imaging revealed correct screw placement. Proper alignment of the atlantoaxial spine and fusion could be achieved in all cases. The unique risk factors for mortality included the presence of comorbidities and the occurrence of post-operative complications. The complication and mortality rates associated with odontoid fractures in octogenarians are relatively high. However, the therapeutic goals in this population also include bone union and preservation of neurological status. Despite the often-high comorbidity rate, we still recommend that surgery should be considered in patients over 80 years. However, it is necessary to evaluate several approaches when treating such frail patients.

Hybrid surgery for aneurysm of the arch and descending part of the aorta. Right-left subclavian bypass as a variant of subtotal debranching

The article presents the experience of our team in various surgical methods of treating aortic pathology. Surgical pathology of the thoracic aorta, namely aneurysms and dissections, remains controversial for the «heart team». In recent years, endovascular aortic replacement (TEVAR) has proven itself as a treatment option for many aortic diseases with a mortality rate up to 7.5 %. According to the latest clinical recommendations, TEVAR has become the method of choice in the treatment of acute aortic dissection, showing better results compared to medical therapy and open surgery. However, the endovascular approach requires certain anatomical features that allow the correct placement of the stent-graft, which is not always possible. Thus, when the brachiocephalic arteries are involved in the pathological process, artificial blood circulation is required with the use of additional methods to protect the brain, such as cerebral perfusion and hypothermia. All these factors increase the risk of intra- and postoperative complications, as well as early mortality. Different methods of open surgery to replace all or most of the thoracic aorta are described, which represent a radical approach and require a high level of professional skills of the surgeon and experience in working with artificial blood circulation.

Comparison of lung ultrasound technique versus clinical method to evaluate the accuracy of size and placement of left endobronchial double lumen tube in patients undergoing elective thoracic surgery: a prospective observational study.

Anthropometric measurements like height and gender have been frequently found to be inaccurate in prediction of size of double lumen tube (DLT). A tracheal ultrasonography (TUS) is a technique that can be used to predict the size of DLT and its correct placement for lung isolation. We aim to check the accuracy of ultrasound over clinical methods. This prospective study included 68 patients undergoing elective thoracic surgery requiring one-lung ventilation (OLV) with DLT. The groups were assessed for the size of DLT by either anthropometric measurement using height and gender (Group C) or ultrasound method (Group U). Further, the accuracy of placement of DLT was assessed through, either lung auscultation in group C or various ultrasonographic and ventilatory parameters such as lung isolation in the first attempt (lung sliding and lung pulse sign), oxygenation status and peak airway pressure, in group U. Surgeon satisfaction score was also compared in both the groups. The accuracy of predicted DLT size between Group C and Group U was statistically significant (p=0.044). In Group C, 56% of patients showed a mismatch between the predicted DLT size and the actual size required, while in Group U, the mismatch was only 32.4%. The accuracy of DLT placement through group C was 41% as compared to 79% in Group U. Surgeon satisfaction score was also significantly higher in Group U as compared to Group C (p=0.0028). Thus, our study suggests that tracheal and chest ultrasonography for DLT size selection and placement for lung isolation is superior to clinical methods.

Comparison of dynamic versus static ultrasound to confirm endotracheal tube depth

IntroductionAfter endotracheal intubation is performed, the location of the endotracheal tube (ETT) is confirmed followed by assessment of ETT depth. Physical examination can be unreliable and chest radiographs can lead to delayed recognition. Ultrasound may facilitate rapid determination of ETT depth at the bedside; however, the ideal technique is unknown. MethodsThis was a randomized trial comparing the static versus dynamic technique for ETT depth assessment using a cadaver model. The ETT was randomized to correct versus deep placement. Seven physicians blinded to ETT location assessed the location using static (direct visualization of an inflated cuff) versus dynamic (active inflation of the ETT cuff) visualization. Outcomes included diagnostic accuracy, time to identification, and operator confidence with subgroup analyses by physician ultrasound experience. Results420 total assessments were performed. The static technique was 99.1% (95% CI 94.8%–100%) sensitive and 97.1% (95% CI 91.9%–99.4%) specific. The dynamic technique was 100% (95% CI 96.7%–100%) sensitive and 100% (95% CI 96.7%–100%) specific. Time to identification was faster for the static technique (6.6 s; 95% CI 5.9–7.4 s) versus the dynamic technique (8.7 s; 95% CI 8.0–9.5 s). Operator confidence was lower for the static technique (4.4/5.0; 95% CI 4.3–4.5) versus the dynamic technique (4.7/5.0; 95% CI 4.6–4.8). There were no differences in the findings when assessed among expert or non-expert sonographers. ConclusionThere was no statistically significant difference in the accuracy of ETT depth identification between the static or dynamic technique. However, utilizing the dynamic technique showed a statistically significant improvement in sonographer confidence and a concomitant increase in time to identification.

Long-term safety and efficacy of frameless subthalamic deep brain stimulation in Parkinson’s disease

BackgroundBilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) is standard of care for Parkinson’s disease (PD) patients and a correct lead placement is crucial to obtain good clinical outcomes. Evidence demonstrating the targeting accuracy of the frameless technique for DBS, along with the advantages for patients and clinicians, is solid, while data reporting long-term clinical outcomes for PD patients are still lacking.ObjectivesThe study aims to assess the clinical safety and efficacy of frameless bilateral STN-DBS in PD patients at 5 years from surgery.MethodsConsecutive PD patients undergoing bilateral STN-DBS with a frameless system were included in this single-center retrospective study. Clinical features, including the Unified Parkinson’s Disease Rating Scale (UPDRS) in its total motor score and axial sub-scores, and pharmacological regimen were assessed at baseline, 1 year, 3 years, and 5 years after surgery. The adverse events related to the procedure, stimulation, or the presence of the hardware were systematically collected.ResultsForty-one PD patients undergone bilateral STN-DBS implantation were included in the study and fifteen patients already completed the 5-year observation. No complications occurred during surgery and the perioperative phase, and no unexpected serious adverse event occurred during the entire follow-up period. At 5 years from surgery, there was a sustained motor efficacy of STN stimulation: STN-DBS significantly improved the off-stim UPDRS III score at 5 years by 37.6% (P < 0.001), while the dopaminergic medications remained significantly reduced compared to baseline (− 21.6% versus baseline LEDD; P = 0.036).ConclusionsOur data support the use of the frameless system for STN-DBS in PD patients, as a safe and well-tolerated technique, with long-term clinical benefits and persistent motor efficacy at 5 years from the surgery.

Accuracy of two-rescuer adult CPR performed by medical registrars at a South African university.

Cardiopulmonary resuscitation (CPR) is performed to manually keep brain function intact until the patient's spontaneous blood circulation and breathing are restored. In South Africa, registrars, who are qualified doctors training to specialise in a medical field, are usually the team leaders and oversee junior doctors and nurses during resuscitation. This study aimed to determine the accuracy of the execution of two-rescuer adult CPR on a Resusci-Anne® manikin performed by registrars from the University of the Free State, South Africa. A cross-sectional study was conducted. From a target population of 142 registrars, 47 participated, of whom 44 were included in the analysis. During five cycles of CPR, compression quality was assessed. During a subsequent five cycles, airway management was assessed. Participants were evaluated executing CPR on the Resusci-Anne® manikin, with a recently Basic Life Support trained student researcher as second rescuer. A modified version of the American Heart Association's tick sheet for two-rescuer adult CPR was completed by two student researchers. Department, gender and the date of the most recent CPR training attended were recorded. The median total percentage score was 82.2% (range 33.3% to 100.0%). Results showed that 88.6% of registrars consistently demonstrated correct hand placement, 25.0% correct compression rate, 93.2% correct compression depth, and 61.4% allowed complete chest recoil during compressions. Consistently correct E-C technique was found in 77.3%, and correct ventilation rate in 93.2%. Only 63.6% correctly managed an open airway, and 61.4% achieved visible chest rise. A consistently correct compression-to-ventilation ratio was performed by 59.1% of registrars. The study found that registrars were not consistently performing high-quality CPR on a Resusci-Anne® manikin and identified areas needing attention. The results of this study highlight the need for compulsory CPR training and regular fire drills for registrars.

Intrasystemic Contradictions in Punctuation Marks of Appositives and Introductory Words in Ossetian: Causes and Solutions

The subject of analysis is the punctuation marks of appendices and introductory words in the Ossetian — one of the problematic phenomena in contemporary Ossetian studies. The relevance of the study is determined, firstly, by the absence of works in Ossetian linguistics dedicated to the investigation of punctuation theory issues, and secondly, by the necessity of codifying punctuation norms in the Ossetian. The novelty of the research lies in the attempt to conduct a contrastive analysis of the reasons and circumstances of separating appendices and introductory words in Ossetian and Russian, as well as identifying gaps in Ossetian punctuation. It is demonstrated that actual punctuation practice does not deviate from the established norm in cases where the reasons for separating appendices and introductory words coincide in Ossetian and Russian. Special attention is given to the issues of distinguishing appendices and introductory words in positions that have no analogues in the Russian. The significance of word order and the presence of clitics in a sentence for the correct placement of punctuation marks in complex sentences is demonstrated. The punctuation formatting of appendices that have two qualifying words or a common postposition with a qualifying word is justified. The separation of introductory words that are part of an accentual complex is also commented on.

Intrinsic and atomic layer etching enhanced area-selective atomic layer deposition of molybdenum disulfide thin films

For continual scaling in microelectronics, new processes for precise high volume fabrication are required. Area-selective atomic layer deposition (ASALD) can provide an avenue for self-aligned material patterning and offers an approach to correct edge placement errors commonly found in top-down patterning processes. Two-dimensional transition metal dichalcogenides also offer great potential in scaled microelectronic devices due to their high mobilities and few-atom thickness. In this work, we report ASALD of MoS2 thin films by deposition with MoF6 and H2S precursor reactants. The inherent selectivity of the MoS2 atomic layer deposition (ALD) process is demonstrated by growth on common dielectric materials in contrast to thermal oxide/ nitride substrates. The selective deposition produced few layer MoS2 films on patterned growth regions as measured by Raman spectroscopy and time-of-flight secondary ion mass spectrometry. We additionally demonstrate that the selectivity can be enhanced by implementing atomic layer etching (ALE) steps at regular intervals during MoS2 growth. This area-selective ALD process provides an approach for integrating 2D films into next-generation devices by leveraging the inherent differences in surface chemistries and providing insight into the effectiveness of a supercycle ALD and ALE process.

Endosonographic monitoring of Sphinkeeper® prostheses movements: does physical activity have an impact?

The Sphinkeeper® procedure for treating faecal incontinence (FI) may be associated with potential implant migration (IM) and dislocation (ID), with considerable variations regarding their occurrence and effects on consecutive functional outcome. This study assessed IM and ID following the Sphinkeeper® procedure and its correlation with physical activity. This was a prospective observational clinical study of ten patients undergoing Sphinkeeper® operation due to FI between August 2020 and November 2020 at the Medical University of Vienna. Patients were followed-up after 1, 2, 3 and 6 months and 1 year postoperatively. Each follow-up visit included endosonographic monitoring of protheses location and manometric examinations. Additionally, functional outcome and physical activity were assessed using validated standardized questionnaires. The median number of prostheses implanted was 10 (IQR 9–10). The St. Mark’s incontinence (SMS) score improved significantly until the last follow-up (p = 0.049), without observing a significant effect on the physical SF-12 score. The median rate of implants leading to IM and ID was 3 (range 1–4) and 2 (range 1–2) after 3 months of follow-up. A strong association of deltaSMS with number of dislocated prostheses at one month after Sphinkeeper® implantation was observed (r = 0.654, p = 0.078). Physical activity, assessed by the international physical activity questionnaire, did not have an impact on the correct prosthesis placement (1 month: p = 0.527; 2 months: p = 0.886; 3 months: p = 0.180; 6 months: p = 0.111). IM and ID of Sphinkeeper® prostheses occurred frequently early after surgery and affected functional outcome negatively. Physical activity did not have an influence on the implants displacement.

Application of virtual reality in dental implants: a systematic review

Background and objectiveA treatment approach that is widely used as a permanent and natural replacement for missing or extracted teeth is dental implants .VR is a computer-generated simulation that creates a three-dimensional (3D) image or environment. Advances in VR -based learning allow learners and students to practice and also help professionals plan a wide variety of surgical procedures, including the correct placement of dental implants. Therefore, in this systematic review, our aim was to investigate and evaluate the available virtual reality tools for dental implants and their effectiveness.Materials and methodsStudies published up to 01/30/2023 which report the applications of using virtual reality technology in dental implants, were reviewed in three databases, including PubMed, Web of Science, and Scopus. All studies with evidence reporting the role of virtual reality technology in the field of dental implants were included in our analyses, written in English and published in peer-reviewed form, are included. Theoretical articles, and letters that did not provide original data, as well as studies that reported incomplete information, were excluded. Two reviewers independently assessed search results, extracted data, and assessed the quality of the included studies, and decisive agreement was reached by discussion and consultation with the third researcher. Narrative synthesis was undertaken to summarize and report the findings.ResultsOut of 1633 initial search results, nine were included in the present study based on the inclusion criteria. The focus of seven studies was on teaching and learning, and two studies have examined the implant planning procedure. The most commonly used hardware and software were head-mounted display and Unity3D, respectively. In almost all studies, the results showed that the use of virtual reality-based systems improves and enhances the skills of users, including dental students and specialists.ConclusionsOur findings showed that VR is an effective method for teaching and planning the implant process. Although the use of VR technology is limited for various reasons such as cost, it can increase the skills of dental professionals in performing dental implants.

Image Quality and Related Outcomes of the ShuntScope-Guided Catheter Implantation in Adult Hydrocephalus: Experience of 63 Procedures.

Ventricular catheter (VC) placement in the selected subset of adult hydrocephalus can be highly challenging due to abnormal anatomical configuration or the need for trans-aqueductal stent placement. Transluminal endoscopy with the ShuntScope has been invented to increase the success rate of catheter placement. This study evaluates the image qualities of ShuntScope and related surgical outcomes in adults. A retrospective analysis of all adult patients undergoing VC placement using the ShuntScope from November 2011 to July 2022 in the authors' department was performed. Demographic, clinical, and radiologic data were evaluated. The visualization quality of the intraoperative endoscopy was stratified into excellent, medium, and poor, and compared to the postoperative catheter tip placement. Follow-up evaluation included the surgical revision rate due to proximal catheter misplacement. A total of 63 ShuntScope-assisted surgeries have been performed on 60 adults. The mean age of the patients was 48.43 years. The most common underlying pathology was a tumor- or cyst-related cerebrospinal fluid (CSF) impairment in 38.33%, followed by a pseudotumor cerebri in 21.66%. The achieved image quality was excellent in 39.68%, medium in 47.62%, and poor in 12.7%. Ideal catheter placement was achieved in 79.37%. There were no intraoperative complications associated with the use of the ShuntScope. The revision rate due to suboptimal proximal VC placement was 4.76% during a mean follow-up period of 27.75 months. A statistical correlation between the image quality and accuracy of the catheter position was observed (p < 0.001). The ShuntScope can be considered an important addition to standard surgical tools in treating a selected subset of adult hydrocephalus. Direct visualization might even help achieve correct placement of the catheter in the cases with blurred vision and limited visual overview.

Performance of Point-of-Care Ultrasonography in Confirming Feeding Tube Placement in Mechanically Ventilated Patients.

A feeding tube (FT) is routinely placed in critically ill patients, and its correct placement is confirmed with a chest X-ray (CXR), which is considered the gold standard. This study evaluated the diagnostic accuracy of ultrasonography (USG) in verifying FT placement compared to a CXR in an intensive care unit (ICU). This was a prospective single-blind study conducted on patients admitted to the ICU of a tertiary hospital in Malaysia. The FT placements were verified through a fogging test and USG at the neck and subxiphoid points. The results of confirmation of FT placement through USG were compared with those obtained using CXRs. A total of 80 patients were included in this study. The FT positions were accurately confirmed by overall USG assessments in 71 patients. The percentage of FT placements correctly identified by neck USG was 97.5%, while the percentage of those identified by epigastric USG was 75%. The corresponding patients' CXRs confirmed correct FT placement in 76 patients. The overall USG assessment had a sensitivity of 92.11% and specificity of 75%, a positive predictive value of 98.59%, and a negative predictive value of 33.33%. The USG findings also showed a significant association between FT size and BMI. FTs with a size of 14Fr were better visualized (p = 0.008), and negative USG findings had a significantly higher BMI (p < 0.001). USG is a simple, safe, and reliable bedside assessment that offers relatively high sensitivity in confirming correct FT placement in critically ill patients.