Minimal Invasive Methods Research Articles

Capnodynamic assessment of mixed venous oxygen saturation in a porcine experimental endotoxemic model.

Sepsis continues to be a major cause of death and illness globally, posing significant challenges for healthcare professionals. In the pursuit of more accurate and timely monitoring tools, the concept of capnodynamically derived mixed venous oxygen saturation (Capno-SvO2) has emerged as a promising method. Capno-SvO2 provides a non-invasive way to assess and track SvO2 and could serve as an additional tool alongside more invasive methods like the pulmonary artery catheter. This could potentially be of great value in the care of critically ill patients with sepsis, where alternative minimal invasive monitoring methods may vary in reliability. The aim of the current study was to compare capno-SvO2 against values obtained through pulmonary artery blood sample CO-oximetry and continuous fiberoptic SvO2 monitoring, using a well-established porcine experimental sepsis model. Anesthetized pigs were exposed to a standardized endotoxin infusion sepsis protocol, followed by a series of maneuvers typically applied in sepsis care. Simultaneous recordings were done throughout the experiment for all three monitoring methods. Bland-Altman analysis corrected for repeated measurements was used to assess the agreement of absolute values between the paired recording of CO-oximetry and Capno-SvO2 as well as between CO-oximetry and fiberoptic SvO2. The ability of Capno-SvO2 and fiberoptic SvO2 to track changes was assessed by concordance rate. A total of 10 animals and 275 paired datapoints were included in the study. The majority of the animals displayed pronounced hemodynamical instability in response to endotoxin exposure and subsequent treatment interventions. Analysis of all paired data points showed a bias between Capno-SvO2 and CO-oximetry SvO2 of + 1% with 95% limits of agreement of -14% to + 17%. The corresponding numbers for fiberoptic SvO2 and CO-oximetry SvO2 were -4% and -15% to + 8%. The concordance rate as compared to CO-oximetry, were 97% and 93% for Capno-SvO2 and fiberoptic SvO2, respectively. In this experimental sepsis model, continuous, non-invasive Capno-SvO2 generates average absolute values comparable to the gold standard CO-oximetry albeit with relatively wide limits of agreement. Capno-SvO2 displayed a concordance rate of 97% against CO-oximetry and exhibits better trending ability compared to invasive fiberoptic SvO2.

Meta-analysis of application of minimally-invasive ablation methods and classical surgical approach in osteoid osteoma and osteoblastoma

Abstract Osteoblastoma and osteoid osteoma are rare benign bone tumours, sometimes considered variations of the same pathologic process. However, they differ in location, incidence, age group, and size. The gold standard treatment is surgical excision for osteoblastoma and radiofrequency ablation for both. Minimally invasive techniques, including radiofrequency ablation, microwave ablations, cryoablation, ultrasound ablation, and laser ablation, are increasingly used. This meta-analysis aimed to review current treatments, focusing on minimally invasive methods versus traditional surgical excision. A data comparison of 17 original articles from the PubMed database (2014-2024) was conducted, examining treatment methods, patient numbers, success rates, pre/post-operative pain scores, and complication rates. New ablation methods achieve similar clinical results to traditional surgery for treating osteoid osteoma and osteoblastoma while minimizing invasiveness. Most procedures have technical success rates near 100%. Both invasive and non-invasive methods significantly reduce preoperative pain. Classical surgery has higher minor complication rates compared to minimally invasive treatments. Among ablation techniques, magnetic resonance guided focused ultrasound surgery is the least invasive, avoiding radiation and antibiotic-related complications. However, in ablation methods caution is needed to prevent thermal damage to nearby joints and nerves. Protective methods, such as skin protection, hydrodissection, gas dissection, and intraoperative neurostimulation, are recommended. New ablation methods provide less invasive alternatives to surgery, with high clinical and technical success rates and lower complication rates. Among these, magnetic resonance guided focused ultrasound surgery is the least invasive and most promising, though more clinical data is needed due to its recent development.

An in vitro assessment of the residual dentin after using three minimally invasive caries removal techniques

To evaluate the efficiency and effectiveness of three minimally invasive (MI) techniques in removing deep dentin carious lesions. Forty extracted carious molars were treated by conventional rotary excavation (control), chemomechanical caries removal agent (Brix 3000), ultrasonic abrasion (WOODPECKER, GUILIN, China); and Er, Cr: YSGG laser ablation (BIOLASE San Clemente, CA, USA). The assessments include; the excavation time, DIAGNOdent pen, Raman spectroscopy, Vickers microhardness, and scanning electron microscope combined with energy dispersive X-ray spectroscopy (SEM–EDX). The rotary method recorded the shortest excavation time (p < 0.001), Brix 3000 gel was the slowest. DIAGNOdent pen values ranged between 14 and 18 in the remaining dentin and laser-ablated surfaces recorded the lowest reading (p < 0.001). The Ca:P ratios of the remaining dentin were close to sound dentin after all excavation methods; however, it was higher in the ultrasonic technique (p < 0.05). The bur-excavated dentin showed higher phosphate and lower matrix contents with higher tissue hardness that was comparable to sound dentin indicating the non-selectiveness of this technique in removing the potentially repairable dentin tissue. In contrast, the MI techniques exhibited lower phosphate and higher organic contents associated with lower microhardness in the deeper dentin layers. This was associated with smooth residual dentin without smearing and patent dentinal tubules. This study supports the efficiency of using MI methods in caries removal as conservative alternatives to rotary excavation, providing a promising strategy for the clinical dental practice.

P1177 Perceptions of patients with Inflammatory Bowel Disease and first degree relatives on prediction and prevention of disease

Abstract Background Significant advances have been made in understanding the preclinical stages of IBD, and in identifying risk factors and biomarkers to predict IBD onset. With the use of predictive testing to identify patients at risk of developing the disease, it would be possible to intervene and try to mitigate that risk. However, the feasibility of such strategy, would depend on whether individuals at risk of developing IBD would be willing to undergo predictive testing and preventive interventions. Methods A Redcap® electronic survey, available in five languages, was disseminated by clinicians and patient’s associations to patients with IBD, first-degree relatives (FDRs) of those with IBD, parents with IBD and healthy children at risk (based on family history), and healthy couples with multiple children including one with IBD. Participants were asked to express their concerns regarding their own or offspring’s risk of developing IBD and acceptable predictive testing and preventive interventions. Results 817 individuals (75% women, mean age of 41±12 years) living in 28 different countries participated. The majority were parents with IBD of healthy at-risk children (59%). Among individuals with IBD, 50% had Crohn's disease, 55% were on biologic treatment, 25% had undergone surgery, and 62% reported a significant impact on their quality of life. Overall 85% expressed willingness for predictive testing, favoring minimally-invasive methods. Half of participants would agree to cross-sectional imaging and 38% would accept a colonoscopy. The main benefits recognized with predictive testing were the possibility of starting preventive interventions to minimize the risk of developing IBD (74%) and obtaining an earlier diagnosis (63%). Anxiety from a positive result was a concern (57%). A total of 98% would accept preventive interventions. The most accepted were quitting smoking (64%), physical exercise (81%), dietary modification/supplementation (86%/71%) and probiotics (79%); with the optimal duration of the intervention to last up to one year (33%). Participants deemed a risk of minor adverse events up to 10% acceptable, with 33% tolerating a higher risk if disease risk was reduced by 75%. Half agreed that costs should be supported entirely or shared (39%) with the government. Conclusion In this international survey of patients with IBD or parents of children at-risk of developing IBD, minimally-invasive predictive testing would be well accepted as well as non-pharmacological and highly effective preventive interventions.

Management of lumbar spondylolisthesis: A retrospective analysis of posterior lumbar interbody fusion versus transforaminal lumbar interbody fusion.

One of the most frequent etiologies for spinal surgery is unstable lumbar spondylolisthesis (ULS). To decompress affected structures while maintaining or restoring stability through fusion, surgeons utilize a variety of procedures. When paired with interbody fusion, posterior fusion is most applied, resulting in greater fusion rates. The two most popular techniques for implementing spinal fusion are posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF). As a result, these two procedures have been assessed formally. A retrospective analysis of patients who underwent interbody fusion for lumbar stenosis through PLIF and minimally invasive (MI)-TLIF was performed. The patients were followed up for 24 months and fusion rates, Visual Analog Score (VAS), and Oswestry Disability Index (ODI) alongside the MacNab clinical outcome score, were assessed. The Bridwell interbody fusion grading system was used to evaluate fusion rates in computed tomography (CT). Operations were performed in 60 cases where patients suffered from ULS. PLIF was performed on 33 patients (55%) (14 males and 19 females) and 27 patients (45%) (11 males and 16 females) who underwent MI-TLIF. In 87% of our respective cohort, either the L4-5 or the L5-S1 level was operated on. Overall fusion rates were comparable between the two groups; however, the TLIF group improved more in terms of VAS, ODI, and MacNab scores. On average, MI-TLIF surgery was longer and resulted in reduced blood loss. MI-TLIF patients were more mobile than PLIF patients postoperatively. With well-established adequate results in the literature, TLIF offers benefits over other methods used for interbody lumbar fusion in ULS or other diseases of the spine. However, MI-TLIF may procure more advantageous for patients if MI methods are implemented. In this instance, TLIF outperformed PLIF due to shorter operating times, less blood loss, faster ODI recovery, better MacNab scores, and a greater decline in VAS pain ratings.

Evaluation of the Efficacy of Minimal Invasive Methods Versus Conventional Methods for Caries Removal in Primary Molars.

Evaluating the efficacy of two "minimal invasive methods"of caries removal (Brix 3000/ceramic bur) in comparison with the conventional method in the management of dental caries in primary molars. Materials and methods: A sum of 60 teeth from children ranging from four to nineyears old of both sexes were selected for this study and randomly assigned to three groups: Group I (Brix 3000), Group II (ceramic bur), and Group III (diamond bur), with 20 teeth per group. Regarding the efficacy of caries removal, the Brix 3000 group had significantly the lowest efficacy, while the ceramic bur and diamond bur groups were significantly the highest without significant differences between the ceramic and diamond groups. Regarding caries removal time, the Brix 3000 group was significantly the highest, while the diamond bur group was significantly the lowest, and the ceramic bur group was intermediate between them. Regarding pain perception, the Brix 3000 and ceramic bur groups were significantly the lowest, with insignificant differences between them, while the diamond bur group was significantly the highest. Ceramic bur is an excellent alternative treatment for caries removal in children in comparison with conventional methods and CMCR. Brix 3000®, despite being less painful in comparison with drilling methods, has lower efficacy and efficiency.

Undertaking the biological sex assessment of human remains: The applicability of minimally-invasive methods for proteomic sex estimation from enamel peptides

Being a part of the cultural heritage, skeletal human remains and grave objects are often the only evidence of people who lived many years, or even centuries or millennia, ago, and their preservation for future generations is thus of the utmost importance. The first task in analyzing skeletal remains is to build a biological profile of the individual, including in particular a sex estimation. Recently developed proteomic sex analysis, based on the detection of two sex-dependent forms of the amelogenin protein in tooth enamel, could offer a minimally-invasive and reliable approach applicable to both recent and past populations.The aims of the present study are: 1) to validate the proteomic sex estimation approach with a delicate, minimally-destructive protocol using protein etching in recent and sub-recent identified samples of adult individuals; 2) for the first time, to evaluate the invasiveness of the extraction of amelogenin protein from teeth for proteomic analysis via scanning electron microscope (SEM) and microcomputed tomography (micro-CT); 3) to apply the method to an archaeological sample of unknown adult and juvenile individuals.An assemblage of 60 teeth (32 males and 28 females) of recent and sub-recent origin was used to validate the approach. A sub-sample of 20 teeth (10 males and 10 females) was used to assess the invasiveness of the amelogenin extraction procedure. For the application of the method, samples of 15 adult and 32 juvenile teeth, both originating from medieval populations, were used.Proteomic sex estimation achieved 100% accuracy in this sample. An SEM and micro-CT comparison of the dental surfaces before and after chemical treatment showed an approximately 10% loss of enamel and only 2% loss of dentine. The suitability and minimally-invasive character of the protocol for proteomic analysis in biological sex estimation was demonstrated, as was its applicability to archaeological samples.

Minimally-invasive and non-invasive methods of thermal destruction in the treatment of patients with aggressive fibromatosis

The purpose of the study was to characterize various methods of local physical destruction used in the treatment of patients with aggressive fibromatosis and demonstrate international experience of their use.Material and Methods. literature search was conducted in the electronic databases Rsci (Russian science citation index) and NcBi (National centre for Biotechnology information) in the interval time between 2002 and 2022. The review was devoted to the thermal ablation modalities (radiofrequency, microwave ablation, cryodestruction, high-intensity focused ultrasound ablations) used in therapy of patients with desmoid fibromas of various locations, as well as their safety and efficacy.Results. The review presents the current data on safety and efficacy of minimally-invasive and non-invasive methods of hypo- and hyperthermic local destruction in patients with aggressive fibromatosis, gives the characteristics of exposure and biological effects when performing radiofrequency and microwave ablation, cryodestruction, high-intensity focused ultrasound therapy, describes the main limitations of the methods, indications and contraindications for their application, as well as the methods of prevention of the development of desmoid fibromas.Conclusion. The described methods of local destruction are used in clinical practice mainly for palliative and symptomatic purposes, in case of persistent tumor growth or recurrence, ineffectiveness of other treatment options or contraindications to them due to concomitant somatic pathology or functional status of the patient. Inclusion of these methods in the treatment plan of patients with aggressive fibromatosis can contribute to the reduction of pain syndrome, improvement of functional status of patients as well as long survival with no evidence of tumor progression.

Minimally-invasive pancreatic surgery in high volume centers in the Czech Republic - current status and possible implementations.

Minimally-invasive surgical methods have been becoming ever more common also in the segment of pancreatic surgery. The aim of this paper was to analyze the current state of minimally-invasive surgery in the Czech Republic and the justification and potential of implementing such procedures. Analysis of high volume centers using healthcare providers´ and payers´ data. Thirteen pancreatic surgical centers meet the proposed criteria for being called a high volume center - a center of highly specialized care in pancreatic surgery based on the annual number of at least 17 major resections of the pancreas. According to data from healthcare payers, laparoscopy was used in 0.6%-65.7% of procedures in individual centers. However, these are not resection procedures. The centers themselves report a significantly smaller number of minimally-invasive pancreatic resection procedures. The actual numbers of minimally-invasive resection procedures in the current system are practically impossible to verify. The potential for implementing minimally-invasive pancreatic surgery in the Czech Republic can be estimated based on the identification of candidate patients. Due to the fragmentation of this operative segment, its costs and small numbers of patients suitable for minimally-invasive pancreatic surgery even among high volume centers, the implementation rate of these methods is very slow. The need to centralize this segment of care appears to be very urgent from all points of view.

The Use of Tail as a Minimal-Invasive Method to Detect a Large Set of Biochemical Responses in the Italian Wall Lizard Podarcis siculus (Rafinesque, 1810)

Conventional methods to analyze biochemical processes related to contaminant toxicity usually require the sacrifice of animals to collect tissues and organs. However, for ethical reasons and especially for endangered species, non- or minimal-invasive methods should be preferred. Among vertebrates, reptiles show a general decline worldwide and therefore the use of non- or minimal-invasive methods to measure some biochemical processes in these animals are encouraged. It is well known that most lizards use a common safety behavior implying the natural loss of tail in the case of predation events. Therefore, if common analyses testing contaminant toxicity could be performed in tail tissue, this method, not implying the sacrifice of the animals, could be considered as a good minimal-invasive method. The aim of this study is to test on wild Italian wall lizard Podarcis siculus the use of tail to detect a large set of biomarkers including oxidative stress (TOSCAROO, TOSCAOH, CAT, tGSH, MDA), biotransformation processes (EROD, GSTs) and neurotoxicity (AChE, BChE). All the biochemical responses, excluding EROD and MDA, resulted to be analytically detectable in tail tissues of P. siculus, although the mean values obtained with this minimal-invasive method were significantly lower than those obtained with invasive one.

Preface to the first issue of SJORANM

Radiology with its increasing numbers of steadily improving diagnostic and minimal invasive therapeutic methods in combination with the skills of diagnostic and therapeutic procedures in nuclear medicine are meanwhile essential tools on a very high level of patient treatment and care in tight cooperation with the clinicians. Our new Journal (SJORANM) wants to give the chance for quick online access to new ideas, new scientific research and results in the diagnostic and therapeutic field of Radiology and Nuclear Medicine.

An evaluation of distal radiocephalic side-to-side anastomosis performed for hemodialysis in patients with end-stage chronic renal failure

Aim: In our study we evaluate the early and late term patency ratio, time to maturation and fistula associated complication rates in cases with an arteriovenous fistula (AVF) created via a distal radiocephalic side-to-side anastomosis without ligation of distal cephalic vein in patients with end-stage renal failure (ESRF) and suggest that the fistulae complications can be diagnosed and treated with simpler and minimally-invasive methods. &#x0D; Methods: The demographic data, outpatient clinic follow-up records on day 1, week 1, month 1 and year 1, fistula-related complications and treatments given for complications of patients were evaluated.&#x0D; Results: Of the 50 operated patients, five(10%) developed fistula thrombosis on postoperative day 1 and underwent thrombectomy with a Fogarty catheter inserted via the distal cephalic vein; the fistula remained active after thrombectomy in two patients. Of the 47 patients followed at Month 1, 37 had a functional fistula and two had a functional fistula following thrombectomy. The early-term primary and secondary patency ratio was 78.7% and 82.9%, respectively. Of the 45 patients who attended the 1-year follow-up, 33(76.7%) had a non-intervened fistula, and with the addition of the two patients who underwent early-term thrombectomy, 35(81.3%) patients in total had fully functional fistulae. The one-year primary and secondary patency ratio was 76.7% and 81.3%, respectively. None of the patients developed such complications as venous hypertension or distal ischemia.&#x0D; Conclusions: Arteriovenous fistula created via distal radiocephalic side-to-side anastomosis without ligation of distal cephalic vein can be successfully used as a vascular access in patients with ESRF.

Usage of thread implantology and injection technologies in cosmetology

For the past years, there have been lots of minimal invasive methods developed regarding to the anti-aging therapy, and, according to practical experience, many of them can be safely and effectively combined. Complex approaches in patients’ treatment allow to achieve the most optimal results. In this work we described issues of effective combinations of thread implantology and injection technologies, safety of these combinations, performance efficacy and algorithms for the case management.

Bayesian machine learning optimization of microneedle design for biological fluid sampling

The deployment of microneedles in biological fluid sampling and drug delivery is an emerging field in biotechnology, which contributes greatly to minimally-invasive methods in medicine.

Sensing soluble molecules through SERS substrates in one-step procedure: unrevealing the Meiji woodblock printing materials

Ultrasensitive SERS substrates allowed us to detect complex mixtures of coloring components from Meiji Japanese woodblock prints (1868–1912). In museum settings, compositional analyses have limitations due to restrictions to sampling advised by conservators and curators for the adequate preservation of the objects. An additional layer of complexity is brought by the high heterogeneity of heritage materials, usually not resolved with commercial portable instruments. High-performance instruments for in situ analyses are seldom available in museums. Furthermore, the chambers of most instruments for morphological or chemical characterization accommodate small samples rather than large or medium-sized objects. The innovative sampling strategy herein proposed comprises the gentle touch-dry removal of small coloring molecules weakly bound to the surface of heritage objects, transferred through a silicone sampler to planar SERS substrates with selected solvents in a one-step procedure. The analytical protocol reduces the amount of sample necessary for reliable identification of color components down to nanograms. The selectivity of the solvents combined with the geometry of the planar SERS sensing devices produces reliable signals for molecular identification, with no need for incision or wetting of the printed material. Further, 3D Raman imaging allowed us to reach an unprecedented degree of molecular discrimination, advancing previously available minimally-invasive instrumental methods used in heritage science research. The validation with historical inks from Meiji woodblock prints led to the identification of soluble synthetic azo β-naphthols, barium sulfonic lakes, purple anilines, Prussian blue, glass arsenic sulfides and other traditional coloring media.

A comparison of minimally-invasive sampling techniques for ZooMS analysis of bone artifacts

Bone and antler are important raw materials for tool manufacture in many cultures, past and present. The modification of osseous features which take place during artifact manufacture frequently make it difficult to identify either the bone element or the host animal, which can limit our understanding of the cultural, economic, and/or symbolic factors which influence raw material acquisition and use. While biomolecular approaches can provide taxonomic identifications of bone or antler artifacts, these methods are frequently destructive, raising concerns about invasive sampling of culturally-important artifacts or belongings. Collagen peptide mass fingerprinting (Zooarchaeology by Mass Spectrometry or ZooMS) can provide robust taxonomic identifications of bone and antler artifacts. While the ZooMS method commonly involves destructive subsampling, multiple minimally-invasive sampling techniques also exist. In this paper, we compare three previously proposed minimally-invasive sampling methods (forced bag, eraser, and polishing film) on an assemblage of 15 bone artifacts from the pre-contact site EjTa-4, a large midden complex located on Calvert Island, British Columbia, Canada. We compare the results of the minimally-invasive methods to 10 fragmentary remains sampled using the conventional destructive ZooMS method. We assess the reliability and effectiveness of these methods by comparing MALDI-TOF spectral quality, the number of diagnostic and high molecular weight peaks as well as the taxonomic resolution reached after identification. We find that coarse fiber-optic polishing films are the most effective of the minimally-invasive techniques compared in this study, and that the spectral quality produced by this minimally-invasive method was not significantly different from the conventional destructive method. Our results suggest that this minimally-invasive sampling technique for ZooMS can be successfully applied to culturally significant artifacts, providing comparable taxonomic identifications to the conventional, destructive ZooMS method.

Minimally-invasive methods of acute pancreatic postnecrotic pseudocysts treatment

Minimally-invasive methods of acute pancreatic postnecrotic pseudocysts treatment

Self-collection of capillary blood and saliva to determine COVID-19 vaccine immunogenicity in patients with immune-mediated inflammatory diseases and health professionals.

IntroductionBeing able to independently determine vaccine induced antibody responses by minimal-invasive methods is of great interest to enable a flexible and effective vaccination strategy. This study aimed to evaluate (1) the accuracy, feasibility, usability and acceptability of capillary blood and saliva self-sampling to determine SARS-CoV-2 antibody responses in patients with immune-mediated inflammatory diseases (IMIDs) and health professionals (HP).MethodsIMID patients and HP having received two doses of SARS-CoV-2 vaccines, self-collected capillary blood (Tasso+) and saliva samples. Capillary samples were considered interchangeable with venous blood if three criteria were met: Spearman's correlation coefficient (r) > 0.8, non-significant Wilcoxon signed-rank test (i.e., p > 0.05), and a small bias or 95% of tests within 10% difference through Bland-Altman. Participants completed a survey to investigate self-sampling usability (system usability scale; SUS) and acceptability (net promoter score; NPS). Study personnel monitored correct self-sampling completion and recorded protocol deviations.Results60 participants (30 IMID patients and 30 HP) were analyzed. We observed interchangeability for capillary samples with an accuracy of 98.3/100% for Anti-SARS-CoV-2 IgG/IgA antibodies, respectively. Fifty-eight capillary blood samples and all 60 saliva samples were successfully collected within the first attempt. Usability of both self-sampling procedures was rated as excellent, with significantly higher saliva ratings (p < 0.001). Capillary self-sampling was perceived as significantly (p < 0.001) less painful compared to traditional venous blood collection. Participants reported a NPS for capillary and saliva self-sampling of +68% and +63%, respectively. The majority of both groups (73%) preferred capillary self-sampling over professional venous blood collection.ConclusionOur results indicate that capillary self-sampling is accurate, feasible and preferred over conventional venous blood collection. Implementation could enable easy access, flexible vaccination monitoring, potentially leading to a better protection of vulnerable patient groups. Self-collection of saliva is feasible and safe however more work is needed to determine its application in clinical practice.

COMPARATIVE VARIATION OF RESULTS IN MANAGEMENT OF EXTRAARTICULAR DISTAL TIBIAL FRACTURES BY INTRAMEDULLARY NAILING VS MINIMAL INVASIVE PLATE OSTEOSYNTHESIS

Background: Distal metadiaphysealtibial fractures are commonly seen lower limb fractures. Intramedullary nail fixation (IMN) and Minimal invasive plate Osteosynthesis (MIPO) are the two mainstay treatments for tibial fractures, but agreement on the best internal fxation for distal tibial fractures is still controversial. This meta-analysis was designed to compare the success of IMN and MIPO fxations in the treatment of distal metadiaphysealtibial fractures, in terms of complications and functional recovery Aims: To evaluate the results of management of distal tibial fractures by Intramedullary nail and minimal invasive plate osteosynthesis Methods: The present study will be conducted on patients attending Emergency and outpatient department of Orthopaedics, GovernmentMedical College, OrailJalaun, UttarPradseh for the period of January 2019 to July 2021. A minimum of 30 cases will be taken in the study those who are fracture distal tibia. Result: In my thesis, we take total 60 patient which divided into two group of 30-30 patients. Group One for In Minimal invasive plate Osteosynthesis (MIPO) and Group Two for Intramedullary nail. Only signifcant difference seen in my study in length of incision in nailing length of incision is less as compare to plating group Conclusion:The study of management of distal tibia fracture by MIPO and IMN. I found that no significant difference in final result. In MIPO group only 2 patient have superficial infection and IMN group only 1 patient has superficial infection that means the rate of infection more in plating as compare to nailing.

Toolkit article: Approaches to measuring social inequities in health in human biology research.

Across populations, human morbidity and mortality risks generally follow clear gradients, with socially-disadvantaged individuals and groups tending to have higher morbidity and mortality at all life stages relative to those more socially advantaged. Anthropologists specialize in understanding the proximate and ultimate factors that shape variation in human biological functioning and health and are therefore well-situated to explore the relationships between social position and health in diverse ecological and cultural contexts. While human biologists have developed sophisticated methods for assessing health using minimally-invasive methods, at a disciplinary level, we have room for conceptual and methodological improvement in how we frame, measure, and analyze the social inequities that might shape health inequities. This toolkit paper elaborates on some steps human biologists should take to enhance the quality of our research on health inequities. Specifically, we address: (1) how to frame unequal health outcomes (i.e., inequalities vs. disparities vs. inequities) and the importance of identifying our conceptual models of how these inequities emerge; (2) how to measure various axes of social inequities across diverse cultural contexts, and (3) approaches to community collaboration and dissemination. We end by discussing (4) future directions in human biology research of health inequities, including understanding the ultimate causes of sensitivity to social inequities and transitioning from research to action.