Plane Deviation Research Articles

Setup Accuracy in Craniospinal Irradiation: Implications for Planning Treatment Volume Margins

PurposeCraniospinal irradiation (CSI) using tomotherapy has advantages over standard 3-dimensional techniques. However, there is a paucity of published data on craniospinal setup reproducibility to guide appropriate planning treatment volume (PTV) margins. We sought to evaluate the setup accuracy of patients undergoing CSI to optimize PTV margins. Methods and MaterialsWe measured residual setup deviation between simulation computed tomography (CT) and daily megavoltage CT after couch shifts made by therapists after megavoltage CT-based image registration for 10 patients who completed CSI at our institution. Translational displacement values were recorded at the sella, top of T1, and top of L5 in the anteroposterior (AP) and lateral planes. Systematic and random error were calculated from displacement values. Using z score analysis, we calculated minimal PTV margins to encompass 90% of recorded fractions at each level. We evaluated whether patient characteristics predict for increased setup error using standard statistical techniques. ResultsThe mean setup deviation in the AP plane across all treatments was 2.49, 3.40, and 3.83 mm at the sella, T1, and L5, respectively. Mean lateral setup error was 2.86, 4.02, and 5.46 mm at the sella, T1, and L5, respectively. Systematic error ranged from 0.75 to 1.01 mm at the sella, 1.09 to 1.37 mm at T1, and 1.30 to 1.50 mm at L5. Random error ranged from 1.35 to 1.41 mm at the sella, 1.48 to 1.73 mm at T1, and 2.26 to 2.37 mm at L5. The minimum margin to cover 90% of the treatments was 6.4, 8.2, and 10.5 mm at the sella, T1, and L5, respectively. There appeared to be a correlation between older age and lateral setup error in the L spine approaching statistical significance (R, 0.629; P = .052). ConclusionsSetup error increases in the caudal direction of the spine and is greater in the lateral plane compared with the AP plane. We recommend a PTV margin of 5 to 7 mm in the brain and 10 mm in the spine.

Correction of Maxillary Occlusal Plane Deviation with the Aid of Miniscrew Device

The maxillary occlusal plane deviation, also known as the canted maxillary occlusal plane, is one of the most frequent orthodontic disorders. Treatment varies to the point where surgical intervention may be required

Eliminating 2D spinal assessments and embracing 3D and 4D: clinical application of surface topography.

The Adams Forward Bend Test recognizes the rotational aspect of the curve with the spine in flexion, and the AP X-ray measures the coronal plane deviation by using the Cobb Angle. However, modern techniques including CT-scan, biplanar radiograph, ultrasound, and surface topography allow the clinician to better evaluate and visualize the true 3-D nature of the spine. Surface Topography imaging uses the surface of the trunk to estimate the spine position using a mathematical algorithm that has been found to be accurate when compared to the radiologic Cobb Angle. The sagittal balance of the spine measured by surface topography is compared in three different situations, namely, "standing up straight," "standing relaxed," and "walking," which will help to best assess posture and risk of proximal junctional kyphosis before and after the treatment. Coronal imbalance (lateral deviation) and a range of maximal vertebral surface rotation (amplitude in either direction) are considered as the parameters with an excellent to good reproducibility. COP displacement or symmetry from the midline is used to measure the stability of the trunk. Therefore, those selected spine shape parameters and COP deviation would be considered as the best descriptors in the assessment of postural sway and outcome of PSSE in children with AIS.

POS0016 THE EVALUATION OF FUNCTIONAL ABILITIES OF PATIENTS WITH OSTEOPOROTIC VERTEBRAL FRACTURES AS A BASIS FOR REHABILITATION PROGRAMS DEVELOPING

Background:Due to the demand for special rehabilitation programs for patients with osteoporotic vertebral fractures (VFs), it is of interest to study the functional abilities of those patients. The scientific hypothesis suggests that osteoporotic VFs would cause muscle weakness, muscle dysfunction and conditional disturbances.Objectives:to estimate muscle strength, motor function and coordination disorders in patients with VFs in the setting of systemic osteoporosis as a basis for rehabilitation programs developing.Methods:120 patients aged 43−80 with primary osteoporosis were enrolled. Study group comprised of 60 subjects (56 women, 4 men) with at least 1 VF confirmed by X-rays. Control group included 60 subjects (56 women, 4 men) with osteoporosis but without any osteoporotic fracture. The examination program included back muscles tenzodynamometry, balance tests and stabilometry.Results:Muscle strength deficiency was estimated in study group in trunk flexors (TF) — 40.9% and in trunk extensors (TE) — 18.1% with an adequate function of the left lateral flexors (LLF) and in right lateral flexors (RLF). Patients with VFs had the lower muscle strength vs controls of TE (15.64±9.8 vs 27.73±9.9 kg, p=0.00002), TF (14.61±8.98 vs 21.28±8.38 kg, p=0.0006), LLF (13.10±7.2 vs 24.06±8.9 kg, p=0.005) and RLF 13.44±7.43 vs 24.26±7.65 kg, p=0.0003). Patients with VFs lose their balance faster during one-leg-standing test with open eyes (5.0 [1.0; 10.0] vs 7.5 [5.0; 10.5] sec in control group, p=0.03) and with closed eyes (2.0 [0; 3.0] vs 3.5 [3.0; 5.0] sec, p=0.04). Fukuda-Unterberger test showed greater side dislocation in study group — 40° [25; 45] vs controls 30° [10; 45], (p=0.02). According to stabilometry study group was characterized vs control group by lower balance coefficient with open eyes (77.2±7.6 vs 85.7±9.4%, p=0.002) and with closed eyes (67.1±9.8 vs 73.4±9.9%, p=0.03), greater sagittal displacement (6.8 [2.1; 37.7] vs 4.8 [1.8; 10.7] mm, p=0.025) and deviation in the saggital plane (1.2 [-1.07; 1.5] vs -1.2 [-1.5; 1.2] mm, p=0.01), and also less pressure center velocity (9.51±4.4 vs 7.1±2.7 mm/sec, р=0.009).Conclusion:Osteoporotic VFs are associated with reduction of trunk muscles strength and negatively affect static and dynamic balance function that should be taken into account when developing rehabilitation programs for these patients.Disclosure of Interests:None declared.

The calibration method of the circle-structured light measurement system for inner surfaces considering systematic errors

Light plane deviation and motion direction deviation of stage systems are the two main sources of systematic errors in circle-structured light inner surface measurement systems. In this paper, we propose a new two-step calibration method to compensate these systematic errors. In the first step, a more accurate initial light plane calibration result is obtained by multi-position binocular-structured light calibration. Then, in the second step, the initial result is optimized by measuring the inner radius of a standard ring gauge to obtain the optimal light plane calibration result. Based on this result, the real motion direction is also calibrated by optimization using the inner surface scanning measurement data of the standard ring gauge. The proposed method improves the system calibration accuracy through the second calibration step, making it convenient to operate without using complex calibration targets or expensive equipment. Therefore, this calibration method has the potential to be used in actual measurements. The experimental results show that the mean relative measurement error can reach 0.015% in our homemade measurement system and validate that the measurement system calibrated by our proposed method realizes high-precision and high-repeatability measurements for inner surfaces.

Numerical Simulation of the Flow around the Ducted Fan of a Quadcopter and Determination of Its Thrust Characteristics in Various Flight Modes

A numerical simulation of the flow induced by rotation of the ducted fan blades of a quadcopter is carried out using the vortex-resolving approach that assumes solution of the full Navier–Stokes equations. Based on the numerical simulation results, the aerodynamic characteristics of the ducted fan are determined in various flight modes with asymmetric airflow over the surface swept by the propeller. In the problem formulation, various angles of the ducted fan rotation plane deviation from the vertical were considered for various flight modes of a multicopter type aircraft as well as characteristics of the non-perturbing incident air flow.

Untreated adolescent idiopathic scoliotic girls display altered balance modalities during self-paced voluntary body sways compared to able-bodied girls

IntroductionThis study investigated self-paced voluntary oscillations of scoliotic and non-scoliotic girls. Temporal variables and frequency coherence were calculated for the overall, low and high frequency bandwidths of the center of pressure excursions and free-moment to identify which variables best describe sway balance modalities in both groups. MethodsTwenty-three girls with adolescent idiopathic moderate scoliosis (spinal curves to the right) formed the scoliotic group and 19 matched able-bodied girls formed the non-scoliotic group. Each girl performed self-paced voluntary medio-lateral and antero-posterior sways while standing on a force platform. Center of pressure displacements, out of plane deviation and free-moment were measured and their frequency content calculated. The magnitude of the coherence was calculated for each signal pairs for three frequency ranges. ResultsIn both sway conditions, the center of pressure excursion parameters were on average 28% higher for the scoliotic group. Factor analysis revealed that balance modalities were essentially based on frequency coherence pair interactions whereas temporal parameters play a secondary role. However, these balance modalities were altered in the scoliotic group. They relied essentially on 2 additional principal components and 3 additional variables reflecting a fine tuning of the control mechanism to maintain dynamic balance. InterpretationScoliotic girls appear to be performing a wide ellipsoidal trajectory when performing whole body oscillations. Superfluous variables could be related to the difficulty in preserving balance during body sway tasks and could parasitize the scoliotic dynamic control balance modalities. Self-paced voluntary sways could be an appropriate complementary balance test for untreated scoliotic girls.

Sexual Differentiations of Morphological and Postural Status of Lower Grade Primary School Students

A system of fifteen variables (7 morphological and 8 variables for assessing postural status) was applied to a sample of 284 male and female students from the first to the third grade of primary school, with the aim of determining the differences between boys and girls. The results showed that there were statistically significant differences between the examined samples in the following morphological variables: in the first class (body weight and skin fold of the triceps), in the second class (body height, body weight, skin fold of the triceps and skin fold of the biceps) and in third grade (body height, skin fold of triceps, skin fold of back, skin fold of biceps, and skin fold of lower leg). Statistically significant differences in the variables for assessing postural status exist in the following variables: in the first grade (head posture, shoulder posture, shoulder posture, chest shape and leg shape), in the second grade (shoulder posture, chest shape, and spinal deviation in frontal plane) and in the third grade (deviation of the spinal column in the frontal plane, holding the anterior abdominal wall and the shape of the legs). Based on the obtained results, it can be concluded that in the younger school-age in morphology there is a significant sexual dimorphism and with it in connection with the change of postural status.

The evaluation of functional abilities of patients with osteoporotic vertebral fractures as a basis for rehabilitation programs developing

Background.Due to the demand for special rehabilitation programs for patients with osteoporotic vertebral fractures (VFs), it is of interest to study the functional abilities of those patients. The scientific hypothesis suggests that osteoporotic VFs would cause muscle weakness, muscle dysfunction and conditional (basic motor) disturbances.
 Objective:to estimate muscle strength, motor function and coordination disorders in patients with VFs in the setting of systemic osteoporosis as a basis for rehabilitation programs developing.
 Methods. 120 patients aged 4380 with primary osteoporosis were enrolled. Study group comprised of 60 subjects (56 women, 4 men) with at least 1 VF confirmed by X-ray. Control group included 60 subjects (56 women, 4 men) with osteoporosis but without any osteoporotic fracture. The examination program consist of back muscles tenzodynamometry, balance tests and stabilometry.
 Results. Muscle strength deficiency was estimated in study group in trunk flexors (TF) 40.9% and in trunk extensors (TE) 18.1% with an adequate function of the left lateral flexors (LLF) and in right lateral flexors (RLF). Patients with VFs had the lower muscle strength vs controls of TE (15.64 9.8 vs 27.73 9.9 kg, p = 0.00002), TF (14.61 8.98 vs 21.28 8.38 kg, p = 0.0006), LLF (13.10 7.2 vs 24.06 8.9 kg, p = 0.005) and RLF 13.44 7.43 vs 24.26 7.65 kg, p = 0.0003). Patients with VFs lose their balance faster during one-leg-standing test with open eyes (5.0 [1.0;10.0]vs 7.5 [5.0;10.5]sec in control group, p=0.03) and with closed eyes (2.0[0;3.0] vs 3.5[3.0;5.0]sec, p = 0.04). Fukuda-Unterberger test showed greater side dislocation in study group 40 [25;45]vs controls 30 [10; 45], (p=0.02). According to stabilometry study group was characterized vs control group by lower balance coefficient with open eyes (77.27.6 vs 85.79.4%, p=0.002) and with closed eyes (67.19.8 vs 73.49.9%, p=0.03), greater sagittal displacement(6.8 [2.1;37.7]vs4.8 [1.8;10.7]mm, p=0.025) and deviation in the saggital plane(1.2 [-1.07;1.5]vs-1.2 [-1.5;1.2]mm, p = 0.01), and also less pressure center velocity (9.51 4.4 vs 7.1 2.7 mm/sec, р=0.009).
 Conclusions.VFs in osteoporotic patients are associated with reduction of trunk muscles strength and negatively affect static and dynamic balance function. The obtained data should be taken into account when developing rehabilitation programs for patients with osteoporosis who have suffered compression VFs.

Projection-dependent input processing for 3D object recognition in human robot interaction systems

Human-Robot Interaction (HRI) provides assisted services in different real-time applications. The robotic systems identify objects through digital visualization wherein a three-dimensional (3D) image is converged to a plane-based projection. The projection is analyzed using the co-ordinates and identification points for recognizing the object. In such a converging process, the misidentification of projections in different planes results in recognition errors. This article proposes projection-dependent input processing (PDIP) method to reduce the misidentifications in object recognition. In this method, the input is the visualizing image projected in all the possible dimensions to identify the conjoining indices. The conjoined indices without intersection are segregated using labeled analysis. The non-correlating indices are identified in the possible dimension projections to prevent errors. The deviations in planes and indices matching are prevented by correlating the input with similar stored inputs with labels. The proposed method is verified using the metrics recognition ratio (96.4%), time (630.36 ms), complexity (5.93), and error (0.605).

Kinematic and aerodynamic analysis of a bat performing a turning-ascending maneuver

The flapping flight of many bat species is characterized by a high degree of maneuverability and provides fertile ground for biomimetic design. However, there has been little prior work toward understanding bat flight maneuvers, particularly using a coupled kinematic and aerodynamic framework. Here, wing kinematic data of a large insectivorous bat (Hipposideros armiger) in straight and turning flight is investigated. Fundamental to turning flight are asymmetries in the wing kinematics and consequently asymmetries in the aerodynamic forces. Forces were calculated from the wing kinematics using aerodynamic numerical simulations. Aspects of the wing kinematics in the turn that were distinguishable from straight flight were an increase in stroke plane deviation angle, nominal increase in flapping amplitude, and a decrease in the horizontal stroke plane angle of the wing inside the turn. While prior work on the mechanics of turning flight in animals has focused on classifying a turn as either banking or yawing, in the present work we show evidence of simultaneous and synergistic banking and yawing mechanisms. During the initiation of the turn, the bank angle was low, and elevated thrust by the outside wing generated a significant yaw rotational moment during both the upstroke and downstroke. Later in the turn, the bank angle increased to approximately 25 degrees tilting the net force vector toward the inside of the turn providing centripetal acceleration thereby turning the bat. Understanding the details of the turning mechanism—combined yaw and bank—provides useful design and control principles for biomimetic flapping MAVs.

Relationship between menton deviation and temporomandibular disc displacement in adult patients

ABSTRACT Purpose: This study investigated the relationships among characteristics of maxillomandibular asymmetry in patients with menton deviation and temporomandibular joint (TMJ) disc conditions, including normal disc position (NDP), anterior disc displacement with reduction (ADDwR), rotational disc displacement with reduction (RDDwR), and anterior and/or rotational disc displacement without reduction (DDwoR). Materials and methods: Eighty-six patients with menton deviation (62 female patients and 24 male patients) were included. The TMJ magnetic resonance images were categorized into four groups: bilateral-NDP (n = 15), ADDwR (n = 13), RDDwR (n = 19) and DDwoR (n = 39). The characteristics of menton deviation and maxillomandibular asymmetry were determined using posteroanterior and lateral cephalograms. Differences in cephalometric variables among the groups were statistically analysed. Results: Patients with menton deviation under Skeletal Class I, and Skeletal Class II relationship showed a higher rate of DDwoR on lateral cephalograms. Significant differences were detected among groups on posteroanterior cephalograms with respect to the cant of the frontal mandibular plane and menton deviation. These two variables were significantly greater in the DDwoR group than in the bilateral-NDP group. Conclusion: The anteroposterior jaw relatioship and mandibular deviation may be associated with the severity of TMJ disc displacement.

Synthesis, stereochemical, single crystal X-ray structural and antimicrobial studies of some isobutyl-1,2,6-triaryl-4-(arylamino)-1,2,5,6-tetrahydropyridine-3-carboxylates: Exploring RAHB with S(6) graph set

A new set of compounds which are intra-molecularly hydrogen bonded have been synthesized and analyzed with special reference to Resonance Assisted Hydrogen Bonding (RAHB). The structure and stereochemistry of the synthesized compounds (1–10), were established on the basis of their analytical and spectral data (IR, 1H, 13C NMR, HOMOCOSY, NOESY, HSQC and HMBC). The structure in the solid state for 5, 9 and 10 is clearly established by single crystal X-ray diffraction analysis. Spectral and single crystal X-ray structural study confirms the flattened boat conformation of the heterocyclic ring which is analyzed with the help of dihedral angles and the mean plane deviations. Hirshfeld surface analysis is carried out and the packing interactions are discussed. The prevalent intramolecular hydrogen bonding is well proved by XRD analysis and the type of hydrogen bonding is classified as S(6), and the resonance assistance for the hydrogen bonding is also quantified and discussed explicitly. Antimicrobial studies were performed for the synthesized compounds against some Gram positive and Gram negative bacterial strains and some fungal strains and the results are summarized.

Correction of Valgus Lesser Toes by Percutaneous Closing Wedge Osteotomy of the Proximal Phalanx

Category:Lesser Toes; BunionIntroduction/Purpose:Deformities of the lesser toes are usually described in the sagittal plane. Coronal plane deviation is also common, yet there is a paucity of literature on the management of these challenging deformities. Traditional soft tissue procedures and translational Weil osteotomies are unpredictable and can lead to post-operative stiffness. We present the results of a novel percutaneous osteotomy of the proximal phalanx to treat valgus deformity of the 2nd toe.Methods:29 patients underwent 38 osteotomies at a mean age of 59+/-9 years. Through a 2mm dorsomedial incision, a percutaneous proximal metaphyseal medial closing wedge osteotomy is performed using a low speed, high torque 2x8mm burr. The toe is then taped for 2 weeks. Mean follow up was 29+/-18 months. Post-operative weight bearing radiographs were performed at a mean of 27+/-18 months. Dichotomous variables were assessed using a Chi square test. After confirming normality using a Kolomgrov-Smirnov test, continuous variables were measured using paired and independent t-tests.Results:90% (n=26) patients responded. 88% (n=23) patients were satisfied or extremely satisfied with the procedure. 24% reported a partial (n=4) or complete recurrence (n=2) of deformity. Patients who perceived recurrence were significantly more likely to be dissatisfied (p=0.001). Radiographs were available for 27/38 osteotomies. Mean valgus angle decreased from 21+/-10° to 9+/-8° (p=0.001). All osteotomies united with no delayed union. There were no wound complications or infections. 2 patients reported long term numbness in the toe and 1 patient complained of a floating toe.Conclusion:Percutaneous closing wedge osteotomies to correct (valgus)coronal plane deformity is technically straight forward with a low complication rate and high patient satisfaction. Future studies should assess the role of this technique to correct medial crossover deformities and compare outcomes with other techniques.

Multi-segment foot model reveals distal joint kinematic differences between habitual heel-toe walking and non-habitual toe walking

Toe walking is observed in pathological populations including cerebral palsy, stroke, and autism spectrum disorder. To understand pathological toe walking, previous studies have analyzed non-habitual toe walking. These studies found sagittal plane deviations between heel-toe and toe walking at the hip, knee, and ankle. Further investigation is merited as toe walking may involve altered biomechanics at more distal joints, such as the midtarsal joint. The purpose of this study was to examine biomechanical differences between rearfoot strike walking (RFSW) and non-rearfoot strike walking (NRFSW) in the midfoot and ankle. We hypothesized that during NRFSW, midtarsal kinematics would diverge from those during RFSW in all three cardinal planes and ankle kinematics would display increased supination. Twenty-four healthy females walked overground with both walking patterns. Motion capture, electromyography (EMG), and force plate data were collected. A validated multi-segment foot model was used with mean difference waveform analyses to compare walking conditions during stance. Significantly different kinematics were found in all three planes for the midtarsal and ankle joint during NRFSW. The NRFSW midtarsal joint exhibited increased plantarflexion, eversion, and adduction with the largest differences occurring at initial contact and in the sagittal plane. The NRFSW ankle exhibited increased supination at initial contact and during early stance. These findings indicate that toe walking alters both distal and proximal foot joint kinematics in multiple planes. This may further the understanding of altered biomechanics during toe walking while providing a basis for future analyses of pathological gait.

Comparison of static balance and mobility between nursing home residents and community-dwelling elderly.

Background: Postural control is considered to be a complex motor skill derived from the interaction of multiple sensorimotor processes. Objectives: To compare the static balance and mobility of nursing home residents with community-dwelling elderly and verify which confounders imply in a worse postural balance on nursing home residents. Methods: Were included elderly aged 60 and more, both sexes, living at nursing homes (NHs) and at the community. The static balance was evaluated by a force platform and the mobility by the Timed Up and Go test (TUG). The confounders available were length of institutionalization, age, gender, body mass index, number of falls and number of medication. Comparisons were made by unpaired t-tests and by the Mann-Whitney test. The risk of falls was evaluated by Fisher’s Exact Test. Pearson or Spearman correlation analysis was performed to identify the independent variables with a significant relationship with the dependent variables. The simple linear regression analysis and R2 was analyzed to ascertain the coefficient of determination of the percentage variation. A value of p≤0.05 was considered significant. Results: 21 nursing home residents and 21 community-dwelling elderly were included. The NHs residents presented significantly higher values of COP oscillation than the community group (total displacement: p=0.0002; mean velocity: p=0.001, 95% ellipse area: p=0,04, and standard deviation in the frontal plane: p=0.01). The NHs group presented longer time to perform the TUG test than the community group (17.28±4.5 s and 13.21±3.9 s, p=0.002). Was observed that the number of medications showed a significant correlation with the TUG (r=0.52; p=0.01), and none variable showed correlation with the static balance. Conclusion: The results showed that the nursing home residents with a normal cognitive condition had greater center of gravity oscillation, worse mobility, and higher risk of falls than community elders. In addition, it was found that in nursing home residents, the ingestion of five or more drugs had relation with mobility.

Relationship Between Primary Acquired Nasolacrimal Duct Obstruction, Paranasal Abnormalities and Nasal Septal Deviation.

This study aimed to investigate the relationship between nasal septal deviation and paranasal abnormalities in the etiology of primary acquired nasolacrimal duct obstruction (PANDO). A total of 37 (8 men, 29 women) patients (48 eyes with PANDO) between the ages 20 and 77 years (mean age, 52.8 ± 13.1 years) were included in the study. In the axial sections of paranasal sinus computed tomography, the transverse diameters at the most upper part and the most distal part of the nasolacrimal canal were separately measured. In addition, the relationships between PANDO and nasal septal deviation, inferior turbinate hypertrophy, agger nasi cells, paradoxical middle turbinate, concha bullosa, and the angle between the bony inferior turbinate and medial wall of the maxillary sinus were investigated. A statistically significant relationship was found between PANDO and the axial location of septal deviation classification, axial angle of septal deviation classification, paradoxical middle turbinate, angle between the bony inferior turbinate and medial wall of the maxillary sinus and inferior meatus measure. The authors concluded that the location and angle of the nasal septal deviation in the axial plane, width of the angle between the bony inferior turbinate and medial wall of the maxillary sinus, inferior meatus measure, and paradoxical middle turbinate may be effective factors in the etiology of PANDO.

Kinematics after unilateral femoral derotation osteotomy in children with diplegic cerebral palsy

IntroductionFemoral derotation osteotomy (FDO) is a treatment option in children and adolescents with cerebral palsy who have transverse plane deviations in their lower limbs. When the transverse kinematic deviations are asymmetric, the osteotomy indication can be unilateral. HypothesisUnilateral FDO has a kinematic effect on ipsilateral transverse plane deviations along with those of the pelvis and contralateral side. Materials and methodsAmong the 170 diplegic children that our team has operated on, 34 underwent unilateral FDO. Their mean age was 12.5±2.7 years; 12 were GMFCS level I and 22 were level II. The kinematic changes 18 months after surgery were evaluated with a paired Student's t test and correlations were determined with the Spearman test (p<0.05). The mean preoperative femoral anteversion was 45°±8°. In terms of kinematics, on the operated side, the children had a mean internal hip rotation of 26°±7°, external pelvis rotation of −8°±6° and inward foot progression angle of 8°±12°. ResultsThe anteversion was corrected surgically by −28°±5°. Postoperatively, the ipsilateral hip rotation (10°±10°), pelvis rotation (−2°±5°) and foot rotation (6°±12°) were significantly improved. No correlations were identified between the resulting kinematic parameters and surgical correction. The five feet that had inward rotation (13°±9°) were improved to (−5°±7°). DiscussionUnilateral FDO of the hip in patients with asymmetry not only reduces the internal rotation of the operated hip, it also normalizes the rotation of the pelvis and both feet. However, these improvements are not directly related to the amount of surgical correction. Level of evidenceIV: case series.

Joint dynamic optimization of the target orbit and flight trajectory of a launch vehicle based on state-triggered indices

This paper solves the problem of the on-line joint optimization of the target orbit and flight trajectory of a launch vehicle experiencing a thrust drop failure, and proposes state-triggered indices to improve the solving efficiency. The ‘highest-height index’ is triggered first to find the maximum-height circular orbit (MCO) in the orbital plane formed at the time of failure. If the orbital altitude is less than the perigee height of the prescribed target orbit, the MCO will be regarded as the optimal circular orbit to ensure safety. If not, the ‘minimal orbital plane deviations index’ is triggered to subsequently find the optimal elliptical orbit (OEO), where the orbital inclination and longitude of the ascending node are preferentially adjusted on the basis of the MCO. Furthermore, if the OEO is coplanar with the target orbit, a ‘minimal orbital shape deviations index’ is triggered to find the optimal rescue orbit, which eliminates the deviations of the perigee altitude, semi-major axis and perigee argument on the basis of the OEO. Estimation of the geocentric angle of the injection point, construction of the approximated sub-problem, and convexification processing are adopted to provide initial guesses to boost the computing. Monte Carlo simulations show that the method not only converges to the optimal or sub-optimal solution for different failure states, which avoids suspended calculations, non-convergence, and constraint violations that are common when directly solving this type of rescue problem, but also meets the basic requirements of on-line applications.

New-onset extreme right axis deviation in acute myocardial infarction: clinical characteristics and outcomes

BackgroundQRS axis deviation can occur during myocardial infarction (MI); to date, little is known about the significance of extreme right axis deviation (ERAD) in the frontal plane, i.e. a shift in QRS axis between +180° and +270°, during MI. We sought to investigate the clinical characteristics and outcomes of patients with new-onset ERAD in the absence of complete bundle branch blocks (BBB) in the setting of acute coronary syndromes (ACS). MethodsA single-center retrospective observational study was conducted, including patients with new-onset ERAD in the absence of complete BBB admitted for ACS to our Cardiac Intensive Care Unit. Clinical, electrocardiographic, echocardiographic, angiographic features at baseline and cardiovascular events during hospitalization and at mid-term follow-up were collected. ResultsThe study population consisted of 30 consecutive patients (23 men) from January 2014 to September 2018. The most frequent clinical presentation was ST-segment elevation MI (n = 22, 73.4%) and the most frequent electrocardiographic MI location was anterolateral (n = 11, 36.7%). Left anterior descending (LAD) was the most frequent infarct-related artery (n = 21, 70%); 15 patients (50%) had multivessel coronary artery disease. Cardiac arrest due to ventricular fibrillation (VF) at presentation (n = 5, 16.6%), cardiogenic shock during the hospital stay (n = 10, 33.3%), cardiac arrest due to VF after revascularization (n = 6, 20%) and cardiac death (n = 7, 23.3%) were common. ConclusionNew-onset ERAD during MI may be related to extensive myocardial ischemia and/or necrosis causing an “electrical escaping” with an extreme dislocation of the QRS axis. In our limited series we found several acute arrhythmic and hemodynamic complications and high mortality.