Instrumentation Kinematics Research Articles

Comparative Evaluation of the Effectiveness of Rotary and Reciprocating Single File Systems on Postoperative Pain After Biomechanical Preparation in Patients With Chronic Apical Periodontitis: A Randomized Clinical Trial.

Background and objective Postoperative pain after biomechanical preparation of root canals can be equally distressing to the patient as well as the dentist and can mold the patient's attitude and trust for future dental procedures. This randomized clinical trial aimed to evaluatethe effectiveness of rotary and reciprocating single-file systems on postoperative pain after biomechanical preparation in patients with chronic apical periodontitis. Materials and methods In this randomized clinical trial (CTRI Reg No-CTRI/2021/04/032841), 94 patients with chronic apical periodontitis in single straight-rooted teeth were divided equally into two groups, according to a standardized protocol. Biomechanical preparation of the root canal was done by a single operator using the Hyflex Electrical Discharge Machining (EDM) rotary file system (Coltene, Altstätten, Switzerland) in group 1 and Reciproc Blue (VDW Dental, Munich, Germany) file system in group 2, respectively. Standardized instrumentation and irrigation techniques were followed in both groups. Participants (blinded to the instrumentation technique) rated their pain intensity at 24 hours, 48 hours, and 72 hours following the root canal instrumentation appointment using the Visual Analog Scale (VAS) and Numerical Pain Rating Scale (NPRS). Statistical analysis The number and time of analgesic intake were also recorded. The data was analyzed using repeated ANOVA, post hoc test, Student T-test, and independent T-test at a 5% level of significance with 80% power of the study. Results and discussion Both the file systems showed low mean postoperative pain intensity at all three time-points assessed. The mean pain value was found to be greater in the Hyflex EDM group at 24 hours, but less at 48 hours and 72 hours when compared to the Reciproc Blue group. However, this difference in pain values was not statistically significant at any of the assessed time points(p>0.05). No significant difference in pain was found based on gender and analgesic intakebetween the two groups(p>0.05). A low incidence of postoperative pain detected in this study can be attributed to the advanced endodontic devices and methodsused during routine endodontic procedures, which provide more appropriate chemo-mechanical disinfection. Conclusion There was no statistically significant difference in postoperative pain between the rotary single file system and reciprocating single file systems at all the assessed time intervals. Hence, this study concluded that the instrumentation kinematics (single-file reciprocating or single-file rotary) had no impact on the intensity of postoperative pain after biomechanical preparation, and no file system is superior to the other in terms of postoperative pain, and hence, both file systems can be used clinically with equal efficiency when considering postoperative patient discomfort.

The effect of different instrumentation kinematics on the change in substance P levels in patients with symptomatic apical periodontitis. A randomized controlled trial

The effect of different instrumentation kinematics on the change in substance P levels in patients with symptomatic apical periodontitis. A randomized controlled trial

Non-immersive virtual reality based treatment for children with unilateral cerebral palsy: Preliminary results.

Unilateral cerebral palsy (UCP) represents about 30-40% of overall cerebral palsy diagnoses. Upper limb impairment has a significant negative impact on activities of daily living (ADL), and recent studies have shown that the use of virtual reality (VR) can increase motivation and promote an improvement in ADL. This preliminary study was aimed at exploring the acceptability and usability of a VR rehabilitation treatment, using the VITAMIN Platform, for children with UCP. A secondary goal of the study was to compare the results of usual standardized clinical scales and questionnaires with kinematic results as well as with the quantitative measures acquired by the VITAMIN platform in each exercise of the rehabilitation sessions. Six children with UCP (aged 7-15) were recruited for a preliminary investigation in using a non-immersive VR system. The treatment was composed of 10 weekly sessions of 45 minutes. Each child played five types of exergames, using the impaired upper limb to hit virtual objects projected on a wide screen. Standardized clinical scales, kinematic analysis, and questionnaires were used to extensively assess upper limb function before and at the end of treatment. Five typically-developing children provided a reference for the instrumented kinematic assessment. At the end of the treatment, Melbourne Assessment 2 (MA2) scores increased for all the participants (mean increase in range of movement (ROM) + 19.1%, accuracy + 4.6%, dexterity + 13.1%, fluency + 10.3%). Shoulder flexion-extension ROM also improved (mean increase + 10.5°), and according to the kinematic analysis, shoulder movements became more similar to reference profiles. These results were confirmed by a general improvement in performing ADL, assessed by the ABILHAND-Kids questionnaire. Finally, a general agreement among the different measures and indexes emerged from the acquired data. The results show that VR treatment with the VITAMIN platform could be engaging and functional for rehabilitation of children with UCP. The good agreement among the qualitative and quantitative measures and indexes confirms the potential of such novel treatment. However, due to the limited sample size and small number of sessions, further and larger investigations are required to evaluate the effectiveness and to generalize the results.

An objective skill assessment framework for microsurgical anastomosis based on ALI scores

IntroductionThe current assessment and standardization of microsurgical skills are subjective, posing challenges in reliable skill evaluation. We aim to address these limitations by developing a quantitative and objective framework for accurately assessing and enhancing microsurgical anastomosis skills among surgical trainees. We hypothesize that this framework can differentiate the proficiency levels of microsurgeons, aligning with subjective assessments based on the ALI score.MethodsWe select relevant performance metrics from the literature on laparoscopic skill assessment and human motor control studies, focusing on time, instrument kinematics, and tactile information. This information is measured and estimated by a set of sensors, including cameras, a motion capture system, and tactile sensors. The recorded data is analyzed offline using our proposed evaluation framework. Our study involves 12 participants of different ages (35.42±9.78\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$35.42\\pm 9.78$$\\end{document} years) and genders (nine males and three females), including six novice and six intermediate subjects, who perform surgical anastomosis procedures on a chicken leg model.ResultsWe show that the proposed set of objective and quantitative metrics to assess skill proficiency aligns with subjective evaluations, particularly the ALI score method, and can effectively differentiate novices from more proficient microsurgeons. Furthermore, we find statistically significant disparities, where microsurgeons with intermediate level of skill proficiency surpassed novices in both task speed, reduced idle time, and smoother, briefer hand displacements.ConclusionThe framework enables accurate skill assessment and provides objective feedback for improving microsurgical anastomosis skills among surgical trainees. By overcoming the subjectivity and limitations of current assessment methods, our approach contributes to the advancement of surgical education and the development of aspiring microsurgeons. Furthermore, our framework emerges to precisely distinguish and classify proficiency levels (novice and intermediate) exhibited by microsurgeons.

Can instrumentation kinematics affect postoperative pain and substance P levels? A randomized controlled trial

BackgroundThis study aimed to assess the influence of continuous rotation and reciprocation kinematics on postoperative pain (POP) levels and substance P (SP) levels in patients diagnosed with irreversible pulpitis and symptomatic apical periodontitis (SAP).Materials and subjectsA total of twenty patients were randomly assigned into two groups: Continuous Rotation Group (CRG) (n = 10), subjected to mechanical preparation with the EdgeEndox7 rotary system (Albuquerque, NM, USA), and Reciprocation Group (RG) (n = 10), treated with the EdgeOne Fire reciprocating system (Albuquerque, NM, USA). Apical fluid (AF) samples were collected, and SP levels were quantified through radioimmunoassay. POP was assessed using the Numerical Rating Scale (NRS) at various time intervals (preoperatively, 6 h, 12 h, 24 h, 48 h, and 72 h). Data were statistically analyzed utilizing the independent t-test, Mann-Whitney U test, Friedman’s test, and Nemenyi post hoc test.ResultsThere was a significant increase in SP levels in the reciprocating group compared to the continuous rotation group (P ≤ 0.05). Additionally, patients in the reciprocating group reported significantly higher POP levels (P ≤ 0.05) at all measured intervals (6 h, 12 h, 24 h, and 48 h), with both groups exhibiting similar pain level reductions at the 72-hour mark.ConclusionOur findings suggest that continuous rotation kinematics in root canal preparation leads to a considerable reduction in SP expression and POP.Trial registrationThe study protocol was retrospectively registered on the www.clinicaltrials.gov database (NCT06081335) at (13/10/2023) after the approval of the Ethics Committee, Faculty of Dentistry, Ain Shams University (FDASU-RecIM012135).

Comparison of Global Evaluative Assessment of Robotic Surgery with objective performance indicators for the assessment of skill during robotic-assisted thoracic surgery

BackgroundThe Global Evaluative Assessment of Robotic Skills is a popular but ultimately subjective assessment tool in robotic-assisted surgery. An alternative approach is to record system or console events or calculate instrument kinematics to derive objective performance indicators. The aim of this study was to compare these 2 approaches and correlate the Global Evaluative Assessment of Robotic Skills with different types of objective performance indicators during robotic-assisted lobectomy. MethodsVideo, system event, and kinematic data were recorded from the robotic surgical system during left upper lobectomy on a standardized perfused and pulsatile ex vivo porcine heart–lung model. Videos were segmented into steps, and the superior vein dissection was graded independently by 2 blinded expert surgeons with Global Evaluative Assessment of Robotic Skills. Objective performance indicators representing categories for energy use, event data, movement, smoothness, time, and wrist articulation were calculated for the same task and compared to Global Evaluative Assessment of Robotic Skills scores. ResultsVideo and data from 51 cases were analyzed (44 fellows, 7 attendings). Global Evaluative Assessment of Robotic Skills scores were significantly higher for attendings (P < .05), but there was a significant difference in raters’ scores of 31.4% (defined as >20% difference in total score). The interclass correlation was 0.44 for 1 rater and 0.61 for 2 raters. Objective performance indicators correlated with Global Evaluative Assessment of Robotic Skills to varying degrees. The most highly correlated Global Evaluative Assessment of Robotic Skills domain was efficiency. Instrument movement and smoothness were highly correlated among objective performance indicator categories. Of individual objective performance indicators, right-hand median jerk, an objective performance indicator of change of acceleration, had the highest correlation coefficient (0.55). ConclusionThere was a relatively poor overall correlation between the Global Evaluative Assessment of Robotic Skills and objective performance indicators. However, both appear strongly correlated for certain metrics such as efficiency and smoothness. Objective performance indicators may be a potentially more quantitative and granular approach to assessing skill, given that they can be calculated mathematically and automatically without subjective interpretation.

Comparative evaluation of different instrument kinematics on contact percentage, dentin removal and apical debris extrusion in oval canals.

The aim of this study was to compare four different instrument kinematics in oval canals. Distal root of sixty extracted first mandibular molars with single oval canal were allocated randomly to four groups (n = 15) namely protaper universal [PTU] (Rotary), self-adjusting file [SAF] (Adaptive), TruShape [TS] (Rotary) and WaveOne [WO] (Reciprocating). The percentage of untouched and touched surfaces of the root canal was evaluated using micro-computed tomography (MCT). Pre- and post-instrumentation weight was assessed using digital microbalance for determining the amount of dentin removed and apical extrusion of debris. The results were tabulated, and their mean difference was statistically analysed using one-way ANOVA and Tukey's HSD test. PTU and SAF exhibited significantly less mean percentage of untouched surface compared to TS. TS files removed less dentin and extruded less debris in long oval canals.

PD01-01 ENHANCED KINEMATICS AND MULTI-MODALITY LEARNING TO IMPROVE AUTOMATION OF SUTURING SKILLS ASSESSMENT

You have accessJournal of UrologyCME1 Apr 2023PD01-01 ENHANCED KINEMATICS AND MULTI-MODALITY LEARNING TO IMPROVE AUTOMATION OF SUTURING SKILLS ASSESSMENT Loc Trinh, Timothy N. Chu, Ahmed Ghazi, John W. Davis, Brian J. Miles, Clayton Lau, Anand Malpani, Yan Liu, and Andrew J. Hung Loc TrinhLoc Trinh More articles by this author , Timothy N. ChuTimothy N. Chu More articles by this author , Ahmed GhaziAhmed Ghazi More articles by this author , John W. DavisJohn W. Davis More articles by this author , Brian J. MilesBrian J. Miles More articles by this author , Clayton LauClayton Lau More articles by this author , Anand MalpaniAnand Malpani More articles by this author , Yan LiuYan Liu More articles by this author , and Andrew J. HungAndrew J. Hung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003218.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous work have shown that surgeons’ technical skill scores are strong predictors of urinary continence recovery following robot-assisted radical prostatectomy (RARP). Computer vision techniques can help automate the evaluation of suturing skills. In this study, we capture enhanced kinematics (granular motion tracking) of surgical instruments and leverage complementary information between videos and instrument kinematics to improve the performance of automated skill assessments. METHODS: 43 surgeons across 5 institutions completed 5 VR exercises on the Surgical Science™ Flex VR simulator. Instrument kinematic data were captured at 30 Hz, including up to 70 features (XYZ + rotations of each instrument, needle, target, and camera). Videos were segmented into three sub-stitch phases (Needle Handling, Driving, and Withdrawal) and labeled by 3 human raters after standardized training with a validated suturing assessment method. The learning framework extracted features from RGB color and optical flow frames (video) using a pre-trained convolutional network (Alexnet). Visual features are concatenated to kinematic features and encoded using a Transformer encoder. The self-attention mechanism within the Transformer correlated information across both modality (video + kinematic) for all timesteps (Figure 1a). RESULTS: This study included 35 expert surgeons (median caseload 362 [IQR 250-1250]) and 8 training surgeon 64 [ 25-75]) with a total 3448 virtual sutures captured and labelled. Enhanced kinematics models outperformed basic kinematics from previous studies across all domains (+1-12% improvement in AUC; Figure 1b). Video models outperformed enhanced kinematics model on two sub-skills (Needle Hold Angle and Driving Smoothness), demonstrating the usefulness of videos. Multi-modal learning with video and kinematic data in a Transformer encoder yields the best performance for the key sub-skills of Needle driving and Needle withdrawal domains (+1-5.5% improvement in AUC; Figure 1b). CONCLUSIONS: This study demonstrated the best performance of automated assessment of suturing technical skills to date. Enhanced kinematics information and advanced multi-modal learning techniques can improve automated assessment and provide accurate feedback to training surgeons. Source of Funding: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R01CA251579. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e62 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Loc Trinh More articles by this author Timothy N. Chu More articles by this author Ahmed Ghazi More articles by this author John W. Davis More articles by this author Brian J. Miles More articles by this author Clayton Lau More articles by this author Anand Malpani More articles by this author Yan Liu More articles by this author Andrew J. Hung More articles by this author Expand All Advertisement PDF downloadLoading ...

Negotiating the second mesiobuccal canal: A comparison of nickel titanium files through the experience of undergraduate dental students.

The aim of this study was to compare the ability of undergraduate students to reach working length (WL) in second mesiobuccal root canals (MB2) of maxillary first molars (n=210) by using Reciproc Blue without glide path preparation, and One Curve with glide path preparation. The students (n=105) attended theoretical and practical courses. The first group (n=53) shaped MB2 root canals using the One Curve system and then Reciproc Blue; the second group (n=52) shaped MB2 root canals following the reverse sequence. Participants completed a questionnaire. The chi-square and Mann-Whitney U test were used for statistical analysis using significance of p<0.05. The full WL was reached and shaping procedures were completed without complications in Reciproc Blue and One Curve groups at rates of 86.67% and 82.85%, respectively (p>0.05). Treatment time was shorter in Reciproc Blue (p<0.05). More (62.9%) students felt the One Curve system safer, while 61% felt the Reciproc Blue system faster. Within the limitations of this study, instrument kinematics and glide path preparation did not interfere with undergraduate students' ability to achieve the WL in MB2 root canals.

Recognizing human functional patterns in IADLs through hand detection and artificial intelligence.

Cognitive impairment is one of the characteristics shown by patients with Alzheimer's dementia (Montenegro et al., 2020; Kelley & Petersen, 2007). This affects the executive functions of most of these patients from the early stage (Guarino et al., 2019) and consequently, have difficulty in carrying out their daily activities (Dubbelman et al., 2020). These activities require precise coordination of the person's movements and interaction with their environment, so instrumental activities of daily living (IADLs) are predictors of such impairment (Barberger-Gateau & Dartigues, 1993), as several research studies have shown(Brovelli et al., 2017). Therefore, assessing the performance of IADLs by analyzing human biomechanical markers such as hand movements is of great interest. This, together with the application of artificial intelligence techniques, in particular deep learning, will allow the development of technological tools for the creation of an automated model to support the early diagnosis of Alzheimer's disease. This work was inspired by the development of Alejandro Acosta et al, where human biomechanical markers were analyzed throughout the performance of IADL activities to recognize the human functional pattern (Acosta-Franco et al., 2021). To improve the accuracy of the baseline model, we propose a hand detection algorithm based on a probabilistic approach considering skin color as a descriptor. To test the proposed algorithm, we used the dataset of egocentric videos containing the performance of IADL activities, which is organized into four classes, based on the prehensile patterns of the hands: force and precision, and on the kinematics of the instruments: displacement and manipulation. With the improvement made to the base model we obtained an accuracy higher than 74% in recognizing movement patterns of displacement and manipulation of objects, and a good prediction of the depth of the anatomical planes. Our improved model obtained a good percentage of recognition accuracy for the instrument's kinematics, which can help in the development of technological tools for the creation of an automated model to support the diagnosis of early Alzheimer's disease.

The Effects of Two Instrumentation Techniques for VDW.Rotate Instruments on the Apical Extrusion of Debris and Irrigants: An In Vitro Study

Objectives: This study compared the amount of apically extruded debris and irrigant using VDW.ROTATE instruments with different kinematics (continuous rotation and reciprocation motion) and the ProTaper Gold system. Methods: Sixty extracted mandibular premolar teeth were selected. The teeth were prepared for the agar gel model. The roots were randomly divided into three groups (n=20). In two groups, the root canals were instrumented using the following movement kinematics: VDW.ROTATE reciprocation motion and continuous rotation. In the other group, root canals were prepared with ProTaper Gold. Apically extruded debris and irrigant during instrumentation were collected into preweighed Eppendorf tubes and were assessed with an electronic balance. All procedures were performed in a 35oC hot water bath. The data were analyzed using the Shapiro–Wilk and Kruskal–Wallis tests at a 5% significance level. Results: ROTATE-Reciprocation extruded the least amount of debris, but this finding was not significant when compared with the amount of debris and irrigant extruded by the ProTaper Gold and ROTATE-Rotation (p&gt;.05). Conclusion: All instrumentation kinematics were associated with apical debris and irrigant extrusion. Movement kinematics did not affect the amount of apically extruded debris and irrigants when using VDW.ROTATE instruments.

Instrumentation kinematics does not affect bacterial reduction, post-operative pain, and flare-ups: A randomized clinical trial.

This randomized clinical trial aimed to assess the effect of instrumentation kinematics (reciprocation or continuous rotation) on bacterial reduction, post-operative pain, and incidence of flare-ups after root canal treatment of single-rooted mandibular premolars with asymptomatic apical periodontitis. Sixty-six patients were included in this prospective, parallel, randomized clinical trial. Patients were randomly allocated into two groups (N=33) according to the kinematics of the shaping instrument: WaveOne Gold (WO) used in reciprocation or One Shape (OS) used in continuous rotation. Under complete asepsis, bacterial samples were taken before (S1) and after (S2) a standard cleaning and shaping protocol. Evaluation of bacterial reduction was done by both culture technique and quantitative real-time polymerase chain reaction (qPCR) analysis. Post-operative pain was evaluated using the visual analogue scale (VAS) after 24, 48, and 72h following treatment, while flare-ups were recorded as a binary outcome (Yes/No). Independent and paired t-tests were used for inter- and intra-group comparisons for bacterial count data, respectively. For post-operative pain score, inter-group comparisons were analyzed using the Mann-Whitney U-test while intra-group comparisons were analyzed using Friedman test followed by pairwise comparisons utilizing the Wilcoxon signed rank test with Bonferroni correction. The significance level was set at p≤.05 within all tests. All the allocated participants received the intervention and were analysed. The comparison between culture and qPCR methods showed that qPCR analysis demonstrated significantly higher pre-instrumentation baseline bacterial count (p<.05). The percentage of bacterial reduction, detected by either method, significantly decreased after instrumentation using either rotation or reciprocation kinematics (p<.05). However, the difference between the WOG or OS files was statistically non-significant (p>.05). The intra-group comparisons showed a significant reduction in post-operative pain with time (p<.05) for both groups. However, the inter-group comparison demonstrated that the difference in post-operative pain after the use of either WOG or OS was statistically non-significant (p>.05). The incidence of flare-ups between both groups was also not-significant (p=1). Shaping kinematics, either rotation or reciprocation motions, had no impact on bacterial reduction and the incidence of post-operative pain and flare-ups after root canal preparation of single-rooted premolars with asymptomatic apical periodontitis.

Assessment of postoperative pain after single-visit root canal treatment using rotary and reciprocating file systems: an in vivo study.

BackgroundVarious instrument kinematics used in single-visit endodontics influence the occurrence of pain after endodontic therapy. This study aimed to evaluate the occurrence of pain after mechanical instrumentation with Hyflex EDM (HEDM) and WaveOne Gold (WOG) during single-visit endodontic therapy.MethodsSixty patients diagnosed with asymptomatic irreversible pulpitis and normal apical tissues in mandibular premolar teeth were included in the study for single-visit root canal therapy. The patients were divided into two groups (n = 30) according to the rotary instrument used during root canal preparation (group A [HEDM] and group B [WOG]). Pain was evaluated after endodontic therapy at 8, 24, and 48 h intervals using the visual analog scale (VAS). Data obtained were analyzed using the chi-square test, independent t-test, MannWhitney U test, and Wilcoxon matched-pairs test.ResultsStatistically significant differences were observed between the two groups (P < 0.001) at 8, 24, and 48 h, with WOG exhibiting less pain than HEDM files.ConclusionPostoperative pain was lower in the WOG file system than in the HEDM file system after single-visit root canal therapy at 8, 24, and 48 h.

Survival Analysis Using Surgeon Skill Metrics and Patient Factors to Predict Urinary Continence Recovery After Robot-assisted Radical Prostatectomy

BackgroundIt has been shown that metrics recorded for instrument kinematics during robotic surgery can predict urinary continence outcomes. ObjectiveTo evaluate the contributions of patient and treatment factors, surgeon efficiency metrics, and surgeon technical skill scores, especially for vesicourethral anastomosis (VUA), to models predicting urinary continence recovery following robot-assisted radical prostatectomy (RARP). Design, setting, and participantsAutomated performance metrics (APMs; instrument kinematics and system events) and patient data were collected for RARPs performed from July 2016 to December 2017. Robotic Anastomosis Competency Evaluation (RACE) scores during VUA were manually evaluated. Training datasets included: (1) patient factors; (2) summarized APMs (reported over RARP steps); (3) detailed APMs (reported over suturing phases of VUA); and (4) technical skills (RACE). Feature selection was used to compress the dimensionality of the inputs. Outcome measurements and statistical analysisThe study outcome was urinary continence recovery, defined as use of 0 or 1 safety pads per day. Two predictive models (Cox proportional hazards [CoxPH] and deep learning survival analysis [DeepSurv]) were used. Results and limitationsOf 115 patients undergoing RARP, 89 (77.4%) recovered their urinary continence and the median recovery time was 166 d (interquartile range [IQR] 82–337). VUAs were performed by 23 surgeons. The median RACE score was 28/30 (IQR 27–29). Among the individual datasets, technical skills (RACE) produced the best models (C index: CoxPH 0.695, DeepSurv: 0.708). Among summary APMs, posterior/anterior VUA yielded superior model performance over other RARP steps (C index 0.543–0.592). Among detailed APMs, metrics for needle driving yielded top-performing models (C index 0.614–0.655) over other suturing phases. DeepSurv models consistently outperformed CoxPH; both approaches performed best when provided with all the datasets. Limitations include feature selection, which may have excluded relevant information but prevented overfitting. ConclusionsTechnical skills and “needle driving” APMs during VUA were most contributory. The best-performing model used synergistic data from all datasets. Patient summaryOne of the steps in robot-assisted surgical removal of the prostate involves joining the bladder to the urethra. Detailed information on surgeon performance for this step improved the accuracy of predicting recovery of urinary continence among men undergoing this operation for prostate cancer.

Surgeon Automated Performance Metrics as Predictors of Early Urinary Continence Recovery After Robotic Radical Prostatectomy—A Prospective Bi-institutional Study

BackgroundDuring robotic surgeries, kinematic metrics objectively quantify surgeon performance. ObjectiveTo determine whether clinical factors confound the ability of surgeon performance metrics to anticipate urinary continence recovery after robot-assisted radical prostatectomies (RARPs). Design, setting, and participantsClinical data (patient characteristics, continence recovery, and treatment factors) and surgeon data from RARPs performed between July 2016 and November 2018 were prospectively collected. Surgeon data included 40 automated performance metrics (APMs) derived from robot systems (instrument kinematics and events) and summarized over each standardized RARP step. The data were collected from two high-volume robotic centers in the USA and Germany. Surgeons from both institutions performed RARPs. The inclusion criteria were consecutive RARPs having both clinical and surgeon data. InterventionRARP with curative intent to treat prostate cancer. Outcome measurements and statistical analysisThe outcome was 3- and 6-mo urinary continence recovery status. Continence was defined as the use of zero or one safety pad per day. Random forest (SAS HPFOREST) was utilized. Results and limitationsA total of 193 RARPs performed by 20 surgeons were included. Of the patients, 56.7% (102/180) and 73.3% (129/176) achieved urinary continence by 3 and 6 mo after RARP, respectively. The model anticipated continence recovery (area under the curve = 0.74, 95% confidence interval [CI] 0.66–0.81 for 3-mo, and area under the curve = 0.67, 95% CI 0.58–0.76 for 6 mo). Clinical factors, including pT stage, confounded APMs during prediction of continence recovery at 3 mo after RARP (Δβ median –13.3%, interquartile range [–28.2% to –6.5%]). After adjusting for clinical factors, 11/20 (55%) top-ranking APMs remained significant and independent predictors (ie, velocity and wrist articulation during the vesicourethral anastomosis). Limitations included heterogeneity of surgeon/patient data between institutions, although it was accounted for during multivariate analysis. ConclusionsClinical factors confound surgeon performance metrics during the prediction of urinary continence recovery after RARP. Nonetheless, many surgeon factors are still independent predictors of early continence recovery. Patient summaryBoth patient factors and surgeon kinematic metrics, recorded during robotic prostatectomies, impact early urinary continence recovery after robot-assisted radical prostatectomy.

Functional objective parameters which may discriminate patients with mild cognitive impairment from cognitively healthy individuals: a systematic review and meta-analysis using an instrumented kinematic assessment.

a systematic review in 2015 showed kinematic gait and balance parameters which can discriminate patients with mild cognitive impairment (MCI) from cognitively healthy individuals. this systematic review and meta-analysis aims to summarise and synthesise the evidence published after the previous review about the functional objective parameters obtained by an instrumented kinematic assessment which could discriminate patients with MCI from cognitively healthy individuals, as well as to assess the level of evidence per outcome. major electronic databases were searched from inception to August 2019 for cross-sectional studies published after 2015 examining kinematic gait and balance parameters, which may discriminate patients with MCI from cognitively healthy individuals. Meta-analysis was carried out for each parameter reported in two or more studies. Ten cross-sectional studies with a total of 1,405 patients with MCI and 2,277 cognitively healthy individuals were included. Eight of the included studies reported a low risk of bias. Patients with MCI showed a slower gait speed than cognitively healthy individuals. Thus, single-task gait speed (d= -0.44, 95%CI [-0.60 to -0.28]; P< 0.001), gait speed at fast pace (d= -0.48, 95%CI [-0.72 to -0.24]; P< 0.001) and arithmetic dual-task gait speed (d= -1.20, 95%CI [-2.12 to -0.28]; P= 0.01) were the functional objective parameters which best discriminated both groups. the present review shows kinematic gait parameters which may discriminate patients with MCI from cognitively healthy individuals. Most of the included studies reported a low risk of bias, but the grading of recommendations assessment, development and evaluation criteria showed a low level of evidence per outcome.

A Comparison of the Effect of Different Instrument Kinematics on Apical Debris Extrusion

A Comparison of the Effect of Different Instrument Kinematics on Apical Debris Extrusion

A Comparison of the Effect of Different Instrument Kinematics on Apical Debris Extrusion

Objective: The Aim of this study was to evaluate the effect of instrument kinematics on the apical extrusion of debris. Materials & Methods: Fourteen single rooted mandibular premolars with single single canals were used in this study. The teeth were divided into to two groups: Group 1: WaveOne Group (Reciprocation Group) and Group 2: OneCurve group (Continuous Rotation Group). The teeth were then accessed and the buccal cusp was reduced so that the external tooth length of all the teeth was 18 mm. The teeth were secured using composite resin in pre-weighed Eppendorf tubes and instrumentation of the canals using the different instruments was done. The teeth were then removed from the tubes and the tubes were incubated for 15 days and then weighed to evaluate the amount of extruded debris. Results: No significant difference in the amount apical extruded debris was found between the WaveOne Gold and the OneCurve instrument. Conclusions: The kinematics of the instruments used in this study did not affect the amount of extruded debris.

Effects of robot therapy on upper body kinematics and arm function in persons post stroke: a pilot randomized controlled trial

BackgroundRobot-based rehabilitation for persons post-stroke may improve arm function and daily-life activities as measured by clinical scales, but its effects on motor strategies during functional tasks are still poorly investigated. This study aimed at assessing the effects of robot-therapy versus arm-specific physiotherapy in persons post-stroke on motor strategies derived from upper body instrumented kinematic analysis, and on arm function measured by clinical scales.MethodsForty persons in the sub-acute and chronic stage post-stroke were recruited. This sample included all those subjects, enrolled in a larger bi-center study, who underwent instrumented kinematic analysis and who were randomized in Center 2 into Robot (R_Group) and Control Group (C_Group). R_Group received robot-assisted training. C_Group received arm-specific treatment delivered by a physiotherapist. Pre- and post-training assessment included clinical scales and instrumented kinematic analysis of arm and trunk during a virtual untrained task simulating the transport of an object onto a shelf. Instrumented outcomes included shoulder/elbow coordination, elbow extension and trunk sagittal compensation. Clinical outcomes included Fugl-Meyer Motor Assessment of Upper Extremity (FM-UE), modified Ashworth Scale (MAS) and Functional Independence Measure (FIM).ResultsR_Group showed larger post-training improvements of shoulder/elbow coordination (Cohen’s d = − 0.81, p = 0.019), elbow extension (Cohen’s d = − 0.71, p = 0.038), and trunk movement (Cohen’s d = − 1.12, p = 0.002). Both groups showed comparable improvements in clinical scales, except proximal muscles MAS that decreased more in R_Group (Cohen’s d = − 0.83, p = 0.018). Ancillary analyses on chronic subjects confirmed these results and revealed larger improvements after robot-therapy in the proximal portion of FM-UE (Cohen’s d = 1.16, p = 0.019).ConclusionsRobot-assisted rehabilitation was as effective as arm-specific physiotherapy in reducing arm impairment (FM-UE) in persons post-stroke, but it was more effective in improving motor control strategies adopted during an untrained task involving vertical movements not practiced during training. Specifically, robot therapy induced larger improvements of shoulder/elbow coordination and greater reduction of abnormal trunk sagittal movements. The beneficial effects of robot therapy seemed more pronounced in chronic subjects. Future studies on a larger sample should be performed to corroborate present findings.Trial registrationwww.ClinicalTrials.gov NCT03530358. Registered 21 May 2018. Retrospectively registered.

The Effect of Reciprocating and Rotary Systems on Postoperative Endodontic Pain: A Systematic Review and Meta-analysis.

The objective of this study was to evaluate the influence of the instrumentation kinematics on endodontic postoperative pain. PubMed, Scopus, Web of Science, Lilacs, Cochrane Library and the System for Information on Gray Literature in Europe were searched electronically without time or language limitations up to June 2020. Subsequently, data extraction, quality assessment and meta-analysis were conducted. The meta-analysis was performed using random-effects inverse-variance methods, and heterogeneity was tested using the I 2 index (P<0.05). A total of 318 articles were successfully identified in the search. Sixteen studies were used in qualitative synthesis and fourteen used for quantitative synthesis. Meta-analysis showed that patients treated with reciprocating system had lower risk of pain 48 h after endodontic treatment (Risk ratio [RR]=1.04, 95% Confidence interval [CI]=1.01-1.06, P=0.003) (I2=0%), but the mean postoperative pain for the reciprocating system was greater 24 h post endodontic treatment (Standardized mean difference [SMD]=0.25, 95% CI=0.06 to 0.44, P=0.01) (I2=43%). Other time points presented similar rates of postoperative pain (P>0.05). The certainty of evidence ranges from very low to high. The rate of postoperative endodontic pain was low, and reciprocating systems evoked more pain within the 24 h interval. Overall, the incidence and level of postoperative pain did not vary between reciprocating and rotary systems. There is no consensus if there is a relationship between the kinematics (rotary and reciprocating) and the incidence of postoperative pain.