Residual Gap Research Articles

Single pararectus approach combined with three-dimensional guidance for the treatment of acetabular fracture.

Surgery for acetabular fractures involving both columns is difficult and traumatic, making it necessary to explore a minimally invasive and accurate surgical method. This retrospective case-control study analyzed the clinical data of 34 patients and divided them into two groups: a control group (9 males and 8 females) and a research group (11 males and 6 females) with acetabular fractures involving the anterior and posterior columns. All patients were placed in the supine position via the pararectus approach. A three-dimensional (3D) guide was placed at the position where the posterior column screw was inserted in the second window, and a posterior column screw was placed percutaneously on the medial side of the iliac spine in the research group. The operation time, intraoperative blood loss, and fracture union time of the two groups were recorded. Pelvic radiographs and computed tomography (CT) scans were routinely performed before and after surgery to evaluate reduction and fixation. Residual gap and step displacement were measured using a standardized CT-based method after the surgery. Hip mobility was assessed according to the modified Merle, d'Aubigné, and Postel criteria. All patients were followed up for 6-30 (16.941±6.571) months. The operation times of the two groups were 126 [interquartile range (IQR), 95-133] min (control group) and 110 (IQR, 85-124) min (research group), the intraoperative blood losses were 430 (IQR, 290-550) mL (control group) and 380 (IQR, 260-500) mL (research group). All patients achieved bone healing, with a union time of 15 (IQR, 12-17) weeks (control group) and 13 (IQR, 11.5-15) weeks (research group). According to the standardized CT-based method, the reduction after surgery was acceptable in 13 (control group) and 14 (research group) of these patients (defined as a gap <5 mm or a step-off <1 mm), and the anatomical reduction rates were 76.47% and 82.35%, respectively. The use of a single pararectus approach combined with 3D guide-assisted percutaneous anterograde posterior column screws can shorten the operation time and place effective posterior column screws precisely with minimal invasiveness. At the same time, the acetabular reduction and functional recovery are satisfactory, and there are fewer postoperative complications, which makes this procedure an ideal surgical option.

Initial and Residual 3D Fracture Displacement Is Predictive for Patient-Reported Functional Outcome at Mid-Term Follow-Up in Surgically Treated Tibial Plateau Fractures.

Conventional measures of fracture displacement have low interobserver reliability. This study introduced a novel 3D method to measure tibial plateau fracture displacement and its impact on functional outcome. A multicentre study was conducted on patients who had tibial plateau fracture surgery between 2003 and 2018. Eligible patients had a preoperative CT scan (slice thickness ≤ 1 mm) and received a Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. A total of 362 patients responded (57%), and assessment of initial and residual fracture displacement was performed via measurement using the 3D gap area (mm2). Patients were divided into four groups based on the 3D gap area size. Differences in functional outcome between these groups were assessed using analysis of variance (ANOVA). Multiple linear regression was used to determine the association between fracture displacement and patient-reported outcome. Functional outcome appeared significantly worse when initial or residual fracture displacement increased. Multivariate linear regression showed that initial 3D gap area (per 100 mm2) was significantly negatively associated with all KOOS subscales: symptoms (-0.9, p < 0.001), pain (-0.0, p < 0.001), ADL (-0.8, p = 0.002), sport (-1.4, p < 0.001), and QoL (-1.1, p < 0.001). In addition, residual gap area was significantly negatively associated with the subscales symptoms (-2.2, p = 0.011), ADL (-2.2, p = 0.014), sport (-2.6, p = 0.033), and QoL (-2.4, p = 0.023). A novel 3D measurement method was applied to quantify initial and residual displacement. This is the first study which can reliably classify the degree of displacement and indicates that increasing displacement results in poorer patient-reported functional outcomes.

Understanding the disability voting gap in the UK

Using nationally representative longitudinal data from Understanding Society we explore the relationship between disability and political participation in the UK. More specifically, we examine the determinants of the ‘disability voting gap’, and assess how it varies by the severity, type and chronicity of disability. After accounting for demographic characteristics, the disability voting gap across UK General Elections between 2010 and 2019 is found to be 6.2 percentage points. More than half of this gap is explained by the channels of resources and recruitment, with evidence of a residual disability gap consistent with additional disability-specific barriers to participation. We find a larger disability voting gap for those with more severe disability, disabilities relating to mental health and chronic disabilities. Applying panel data methods, however, we find no evidence that transitions in disability status are related to changes in voter turnout.

A High-Precision Quartz Resonant Ultra-High Pressure Sensor with Integrated Pressure Conversion Structure.

A quartz resonant pressure sensor is proposed for high-precision measurement of ultra-high pressure. The resonant unit realizes a push-pull differential layout, which restrains the common-mode interference factor, and the resonator is only subject to axial force. The pressure conversion unit is made in an integrated manner, avoiding output drift problems caused by residual stress and small gaps during assembly, welding, and other processes in sensor preparation. Theoretical and simulation analysis was conducted on the overall design scheme of the sensor in this paper, verifying the feasibility. Sensor prototypes were created and performance experiments were conducted. The experimental results show that the sensitivity of the ultra-high pressure sensor is 46.32 Hz/MPa at room temperature within the pressure range of 120 MPa, and the comprehensive accuracy is 0.0266%. The comprehensive accuracy of the sensor is better than 0.0288% FS in the full temperature range environment. This proves that the sensor scheme is suitable for high-precision and high-stability detection of ultra-high pressure, providing new solutions in special pressure measurement fields such as deep-sea and oil exploration.

The Saint-Joseph Acetabular score: a reproducible and accurate prediction of the outcome of open reduction and internal fixation of acetabular fractures.

Acetabular fractures are associated to an increased risk of subsequent hip osteoarthritis. The only available score for post-operative reduction assessment in acetabular fractures (Matta's score) is x-ray based. CT-scan was shown superior to X-rays in post-operative reduction assessment. We aim to describe a CT-scan-based post-operative reduction score in acetabular fractures and evaluate its accuracy and reproducibility. This is a retrospective study that includes 138 patients who underwent surgery for an acetabular fracture in our tertiary referral centre with a mean follow-up of 104.39±42.2 months. The post-operative CT-scan was reviewed and residual displacement (maximum gap and step) measured by three independent observers. The association between the occurrence of THA and the CT-scan measurements was evaluated. This led to a new prognostic score. The interobserver reliability and accuracy of this score were calculated. Interobserver reproducibility for the residual maximal gap was 0.82 (95% CI [0.70-0.89]) and 0.61 (95% CI [0.52-0.70]) for the residual maximal step displacement measurements. We created a score from a logistic regression model, attributing 1 point for every 1 mm of residual maximal step displacement and 1 point for every 2 mm of residual maximal gap displacement. The interobserver reproducibility of this score was 0.78 (95% CI [0.71-0.84]), and its AUC was 0.79 (95% CI [0.69-0.88]). This is the first CT-scan-based score for the assessment of residual displacement of a surgically treated acetabular fracture. It shows good interobserver reproducibility and accuracy in predicting the risk for secondary THA. It should be regularly used per-operatively (if per-operative 3D imaging is available) and post-operatively to predict the prognosis.

Uncovering the roots of obesity-based wage discrimination: The role of job characteristics

This paper investigates the roots of potential labor-market discrimination underlying the negative correlation between obesity and hourly wages. Using a panel dataset of white individuals drawn from the U.S. 1997 National Longitudinal Survey of Youth (NLSY97), we test whether residual wage gaps could be attributed to prejudice (taste-based discrimination) and/or statistical discrimination. To this end, we examine how these two types of discrimination hinge on a wide range of obese individuals’ specific job and occupational characteristics (drawn from the O*Net Online database). In particular, our analysis sheds light on whether discrimination originates from clients’ attitudes, fellow workers or employers. Our findings are consistent with taste-based discrimination against obese females, especially as they become older, in jobs requiring frequent communication with either clients or employers. However, the evidence on this issue is weaker for males. We conjecture that these differences may originate from both an over-representation of males among employers and different image concerns against people of the same gender.

Is the disability wage gap a gendered inequality? Evidence from a 13-year full population study from Norway

Recent research has confirmed the employment disadvantages of disabled people, but disability wage gaps in interaction with gender have not been sufficiently explored. This article asks how the disability wage gap can be accounted for, how the unexplained disability wage gap has evolved over time and how the intersections of disability and gender relate to wage penalties. Norwegian nation-wide annual registry data from the period 2005–2017 (N = 8.5 million) are used to estimate longitudinal pay gaps of disabled men and women in relation to nondisabled workers. The analyses arrive at a persistent residual wage gap for disabled employees. Results confirm that gender is a defining predictor for income, and that disabled women are especially disadvantaged. Implications for intersectional theory are discussed. The current study is a reminder that antidiscrimination legislation and implementation of regulations has not been successful in levelling out injustices experienced by disabled people in the labour market.

Discussion to: Outcomes and residual gap analysis after the modified cryomaze procedure performed via right minithoracotomy versus sternotomy

Discussion to: Outcomes and residual gap analysis after the modified cryomaze procedure performed via right minithoracotomy versus sternotomy

High efficacy single catheter standardized workflow for radiofrequency ablation of atrial fibrillation in the high-power short-duration era

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Dr. Valeriano and Dr. Fabbricatore have been supported by a research grant provided by the Cardiopath PhD program (University of Naples Federico II) Background Recent developments in radiofrequency (RF) ablation technologies have improved the efficacy of pulmonary vein isolation (PVI). The combination of the ablation index, lesion tags, and optimized inter-lesion distance (CLOSE protocol) has further reduced the incidence of gaps along the ablation lines. This high acute success rate challenged the use of conventional circular mapping catheters and prompted a single catheter-approach ablation strategy. Modulating the relationship between resistive and conductive heating, high-power short-duration (HPSD) ablation technology can potentially increase lesion-to-lesion consistency. A novel catheter with optimized temperature control and microelectrodes has been recently designed to further improve workflow efficiency. Purpose: This study aimed to assess the efficacy and efficiency of HPSD ablation in a standardized single-catheter workflow for PVI. Methods: Data on consecutive AF ablations performed with HPSD catheter from December 2020 to December 2021 at a single tertiary-care center were prospectively collected. The workflow consisted of a procedure sequence including single transeptal access with a bidirectional steerable sheath, 3D modeling with 3D rotational angiography, assessment of PV potentials with microelectrodes in each vein (figure 1), followed by radiofrequency encircling of the PVs using a high-power setting of 50W in a temperature- and flow-controlled mode with CLOSE-guided protocol. Isolation was validated by reassessing the previously observed PV potentials and by pacing within the lesion set. Results: A total of 73 consecutive AF patients (67% paroxysmal, 33% persistent) were included. All patients received PVI, 15 underwent additional cavotricuspid isthmus ablation and 6 received additional treatments (table 1). Mean procedure time was 68±27 min with minimal fluoroscopy time and dose (3.2±2.1 min; 4.7±3.9 Gycm2). Complications were infrequent with 1 cardiac tamponade and 1 pericarditis. First-pass isolation was achieved in 91% of the circles and validation by microelectrodes successfully identified the residual gaps with 100% of acute procedural success. In a selected cohort of 20 patients with paroxysmal AF undergoing PVI-only procedure performed by an expert operator, the ablation time was 22.8±5.1 min with a skin-to-skin time of 47.3±7.1 min (table 2). The median follow-up duration was 397 days (IQR: 367-462). AT/AF free survival rate was 90% at 12 months. Conclusions: HPSD ablation using a standardized single-catheter workflow improved the procedural efficiency of PVI and resulted in a high rate of first-pass isolation with a low recurrence rate at 12-month follow-up.

Isoperistaltic gastric tube for long gap esophageal atresia (LGEA) in newborn, infants, and toddlers: a case-control study from a tertiary center.

Limited evidence exists about outcomes after gastric tube formation as "rescue" technique to avoid esophageal replacement in long gap esophageal atresia (LGEA). The last ERNICA Consensus Conference on the Management of LGEA has placed the techniques of gastric tubulization among the priorities for future research. Evaluate personal experience with Isoperistaltic Gastric Tube (IGT) and compare its outcomes with other more popular techniques for LGEA. A case-control study has been conducted. A retrospective monocentric analysis of LGEA patients (period: 2010-19) has been conducted in all consecutive IGT patients and each of these has been type matched with two cases of LGEA treated with other techniques. The follow-up (FU) considered was 24-months. IGT and controls showed no statistically significant differences regarding preoperative variables like sex, gestational age, birth weight, syndromes, and EA type. However, IGT patients had a significantly longer esophageal GAP under boost pressure (4.5 vertebral bodies vs. 3.6, p = 0.019) at time of surgery. The analysis showed no statistical difference among the two groups about perioperative outcomes, ICU, or overall postoperative stay. No differences have been shown between IGT and controls during the follow-up regarding GERD, esophagitis, fundoplication, dysphagia, vocal cord paralysis, stenosis, and dilatations, auxologic data, need for anastomosis revision, oral aversion, and death. Isoperistaltic Gastric Tube is safe and effective even in LGEA patients with longer gaps, with good perioperative, post-operative and middle-term outcomes. This procedure may be considered as an alternative to avoid esophageal substitution when a primary anastomosis seems impossible for a residual gap after traction and growth techniques.

A multicenter study of factors affecting nonunion by radiographic analysis after intramedullary nailing in segmental femoral shaft fractures

The factors affecting the outcomes of segmental femoral shaft fractures are currently unknown. We evaluated the outcomes of intramedullary (IM) nail fixation and investigated factors affecting nonunion of femoral shaft segmental fractures. A total of 38 patients who underwent IM nail fixation for femoral shaft segmental fractures (AO/OTA 32C2) at three university hospitals with a minimum 1-year follow-up period were retrospectively reviewed. The patients were divided into union (n = 32) and nonunion (n = 6) groups. We analyzed smoking status, diabetes mellitus, location of the segmental fragment, segment comminution, filling of the IM nail in the medullary canal, residual gap at the fracture site, use of a cerclage wire or blocking screws as factors that may affect the surgical outcome. In the union group, the average union time was 5.4 months (4–9 months). In the nonunion group, five patients required additional surgery within an average of 7.2 months (5–10 months) postoperatively, whereas one patient remained asymptomatic and did not require further intervention. On comparing the two groups, insufficient canal filling of the IM nail (union, 25.0%; nonunion, 83.3%; p = 0.012) and the presence of a residual gap at the fracture site after reduction (union, 31.3%; nonunion, 83.3%; p = 0.027) were significantly different. In the multivariate analysis, only insufficient canal filling of the IM nail was found to be a factor affecting nonunion, with an odds ratio of 13.3 (p = 0.036). In this study, a relatively high nonunion rate (15.8%) was observed after IM nail fixation. Insufficient IM nail canal filling and a residual gap at the fracture site post reduction were factors affecting segmental femoral shaft fracture nonunion after IM nail fixation.

Outcomes and residual gap analysis after the modified cryomaze procedure performed via right minithoracotomy versus sternotomy

ObjectivesDevelopments in both technique and technology have enabled surgeons to perform the maze procedure via right minithoracotomy (RMT) to treat atrial fibrillation (AF). This study aimed to clarify the outcomes of the modified cryomaze procedure via the RMT approach compared with the sternotomy approach. MethodsThe study cohort comprised 803 consecutive patients who underwent a modified cryomaze procedure (130 via RMT and 673 via sternotomy) for paroxysmal AF and persistent AF from January 2001 to March 2022. The Gray test was applied to compare the incidence of recurrent atrial tachyarrhythmias. Additionally, residual electrical gaps were investigated in the patients who underwent additional catheter ablation for recurrent atrial tachyarrhythmias. ResultsThe respective 1-, 2-, and 3-year cumulative incidences of recurrent atrial tachyarrhythmias were 13.1%, 19.5%, and 23.1% in the RMT group, and 9.3%, 10.9%, and 12.8% in the sternotomy group (Gray test P = .036). All 31 patients with recurrent atrial tachyarrhythmias underwent additional catheter ablation, comprising 14 (10.8%) in the RMT group and 17 (2.5%) in the sternotomy group. There was a significant intergroup difference in the site of residual electrical gaps; the RMT group more frequently had residual gaps in the tricuspid annulus than the sternotomy group (6.2% vs 0.4%; P < .001). ConclusionsIn the modified cryomaze procedure via the RMT approach, ablation failure is more likely to occur at the tricuspid annulus, where the surgical field of view is relatively poor compared with the sternotomy approach. Therefore, surgical ablation should be performed with caution when the RMT approach is used.

High Versus Low Energy Intertrochanteric Hip Fractures in Young Patients: Injury Characteristics and Factors Associated with Complications.

To compare fracture patterns and associated injuries for young patients with high-versus low-energy intertrochanteric hip fractures and to report on factors associated with complications after surgical fixation of high-energy fractures. Retrospective comparative study. Academic Level 1 Trauma Center. A total of 103 patients < 50 years old were included: 80 high-energy fractures and 23 low-energy fractures. Cephalomedullary nailing (CMN) (N=92) or a sliding hip screw (SHS) (N=11). Radiographic characteristics of fracture morphology, implant position, and reduction quality as well as post-operative complications. Compared to young patients with low-energy fractures, those with high-energy fractures had more fracture comminution (p=0.013) and higher ISS scores (p<0.003), and were more likely to require open reduction (p<0.001). Patients with low-energy fractures from a ground level fall had higher rates of alcohol abuse (0.032), cirrhosis (0.010), and chronic steroid use (0.048). Overall reoperation rate for high-energy fractures was 7% including 2 IT fracture nonunions (5%) and 1 deep infection (2%). For high-energy fractures, ASA class (p=0.026), anterior lag screw position (p=0.001), and varus malreduction (p<0.001) were associated with malunion. Four-part fracture (OTA/AO 31A2.3/Jensen 5) (p=0.028) and residual calcar gap >3mm (p=0.03) were associated with reoperation. Surgical treatment of high-energy IT fractures in young patients is technically demanding with potential untoward outcomes. Injury characteristics and severity are significantly different for young patients with high-energy IT fractures compared to low-energy fractures. For young patients with a high-energy IT fracture, surgeons can anticipate a high rate of associated injuries and complex fracture patterns requiring open reduction. For young patients with a low-energy IT fracture, co-management with a hospitalist or geriatrician should be considered since they may be physiologically older.

Structural and Mechanical Investigation of Class I Biomimetic Composite Dental Filling by X-ray Computed Tomography, Scanning Electron Microscopy, and Microtensile Bond Strength Testing

Nowadays, short fiber-reinforced composites are broadly used in modern restorative dentistry. The tensile strength, Young's modulus, density, and polymerization shrinkage of these materials are developed to mimic the original teeth tissue best. The shrinkage, however, will occur during any polymerization process, which can cause residual stress and gap formation between the tooth and the filling. These can lead to the propagation of cracks, reduction in the adhesive bond strength, or even cause separation in the restoration. During this research, a biomimetic dental restoration was created on a surgically removed third molar with EverX short-fiber reinforced dental composite by bulk-filling technique. The restored tooth sample was examined by X-ray computed tomography to obtain a 3D image of the whole restoration. The volume of the used adhesive, the material discontinuities, and internal cavities were determined. A cut-out slice was further investigated by scanning electron microscopy to examine the adhesive layer thickness, the gap formation, and the quality of the filling. Finally, microtensile specimens were machined to evaluate the bond strength between the tooth dentin and the filling material.

Transoral Robotic Surgery for Head and Neck Cancer: Advances and Residual Knowledge Gaps.

Minimally invasive surgery is a growing field in surgical oncology. After acquiring its first Food and Drug Administration approval in 2009 for T1-T2 malignancies of the oral cavity, oropharynx, and larynx, transoral robotic surgery (TORS) has gained popularity thanks to its wristed instruments and magnified three-dimensional view, enhancing surgical comfort in remote-access areas. Its indications are expanding in the treatment of head and neck cancer, i.e., resection of tumors of the larynx, hypopharynx, or parapharyngeal space. However, this expansion must remain cautious and based on high-level evidence, in order to guarantee safety and oncological outcomes which are comparable to conventional approaches. This narrative review assesses the current role of TORS in head and neck cancer from an evidence-based perspective, and then identifies what knowledge gaps remain to be addressed.

Harmonising the land-use flux estimates of global models and national inventories for 2000–2020

Abstract. As the focus of climate policy shifts from pledges to implementation, there is a growing need to track progress on climate change mitigation at the country level, particularly for the land-use sector. Despite new tools and models providing unprecedented monitoring opportunities, striking differences remain in estimations of anthropogenic land-use CO2 fluxes between, on the one hand, the national greenhouse gas inventories (NGHGIs) used to assess compliance with national climate targets under the Paris Agreement and, on the other hand, the Global Carbon Budget and Intergovernmental Panel on Climate Change (IPCC) assessment reports, both based on global bookkeeping models (BMs). Recent studies have shown that these differences are mainly due to inconsistent definitions of anthropogenic CO2 fluxes in managed forests. Countries assume larger areas of forest to be managed than BMs do, due to a broader definition of managed land in NGHGIs. Additionally, the fraction of the land sink caused by indirect effects of human-induced environmental change (e.g. fertilisation effect on vegetation growth due to increased atmospheric CO2 concentration) on managed lands is treated as non-anthropogenic by BMs but as anthropogenic in most NGHGIs. We implement an approach that adds the CO2 sink caused by environmental change in countries' managed forests (estimated by 16 dynamic global vegetation models, DGVMs) to the land-use fluxes from three BMs. This sum is conceptually more comparable to NGHGIs and is thus expected to be quantitatively more similar. Our analysis uses updated and more comprehensive data from NGHGIs than previous studies and provides model results at a greater level of disaggregation in terms of regions, countries and land categories (i.e. forest land, deforestation, organic soils, other land uses). Our results confirm a large difference (6.7 GtCO2 yr−1) in global land-use CO2 fluxes between the ensemble mean of the BMs, which estimate a source of 4.8 GtCO2 yr−1 for the period 2000–2020, and NGHGIs, which estimate a sink of −1.9 GtCO2 yr−1 in the same period. Most of the gap is found on forest land (3.5 GtCO2 yr−1), with differences also for deforestation (2.4 GtCO2 yr−1), for fluxes from other land uses (1.0 GtCO2 yr−1) and to a lesser extent for fluxes from organic soils (0.2 GtCO2 yr−1). By adding the DGVM ensemble mean sink arising from environmental change in managed forests (−6.4 GtCO2 yr−1) to BM estimates, the gap between BMs and NGHGIs becomes substantially smaller both globally (residual gap: 0.3 GtCO2 yr−1) and in most regions and countries. However, some discrepancies remain and deserve further investigation. For example, the BMs generally provide higher emissions from deforestation than NGHGIs and, when adjusted with the sink in managed forests estimated by DGVMs, yield a sink that is often greater than NGHGIs. In summary, this study provides a blueprint for harmonising the estimations of anthropogenic land-use fluxes, allowing for detailed comparisons between global models and national inventories at global, regional and country levels. This is crucial to increase confidence in land-use emissions estimates, support investments in land-based mitigation strategies and assess the countries' collective progress under the Global Stocktake of the Paris Agreement. Data from this study are openly available online via the Zenodo portal (Grassi et al., 2023) at https://doi.org/10.5281/zenodo.7650360.

Pressure and shear flow singularities: Fluid splitting and printing nip hydrodynamics

A numerical simulation of the fluid flow in the gravure printing nip, based on a discontinuous Galerkin algorithm, is used to study the fluid-splitting process and the transition between point and lamella splitting. We study the pressure and shear singularities at the contact point of the printing cylinder and substrate as a function of the variable microscopic residual gap and variations of the printing fluid quantities introduced to the nip. As the hydrodynamic boundary value problem is ill-defined by the nip singularity, we enhance the simulation using renormalization group and algebraic scaling techniques in order to obtain a numerically stable and physically meaningful prediction. Our simulations are compared to analytical results from lubrication theory and to experimental observations on a gravure press.

Avoiding Lateral Laxity in Robotic Arm-Assisted Total Knee Arthroplasty-A Surgical Technique Describing a New Method of Gap Capture and Balancing Strategy.

Optimal flexion-extension gap balancing is an important factor in outcomes after total knee arthroplasty. Knees with varus deformities are commonly associated with a greater degree of lateral laxity both in extension and flexion. Residual lateral laxity could be encountered by surgeons during component trialling after robotic-assisted total knee arthroplasty (RATKA), necessitating additional medial soft tissue release for a thicker insert. This study describes a new technique of gap assessment during RATKA and we propose a functional alignment based balancing strategy to avoid residual lateral laxity. This surgical technique was prospectively employed in 105 patients undergoing primary MAKO® (Stryker, Kalamazoo, Michigan) RATKA for osteoarthritis of the knee with varus deformity, between January 2021 and July 2021. Patients included had an initial lateral extension laxity of more than 24mm. Surgical data points collected consisted of characterization of the laxity profile of the knee using the medial and lateral extension and flexion initial gap captures, final gap captures after dynamic balancing with a functional alignment strategy, and residual lateral extension gap laxity in millimeters at the end of implantation. The mean initial lateral extension gap was 25.76mm (standard deviation [SD]=1.47) and the mean lateral flexion gap was 24.4mm (SD=1.94). Balance was achieved in all the patients with a 9 or 11mm insert, with a mean residual lateral laxity of 0.51mm (SD=0.73, range 0-2mm). The majority of patients (n=66, 62.85%) had zero lateral laxity at the end of final implantation while 24 patients (22.8%) had 1mm of residual lateral laxity. Residual lateral joint laxity can be avoided consistently and predictably in RATKA cases with initial gap capture of up to 30mm in lateral extension and flexion with this new technique of gap capture and employing various steps of balancing strategy described.

The fintech gender gap

Can fintech close the gender gap in access to financial services? Using novel survey data for 28 countries, this paper finds a large and ubiquitous ‘fintech gender gap’: while 29% of men use fintech products, only 21% of women do. This difference exceeds the gender gap in bank account ownership at traditional financial institutions. While country characteristics and individual-level controls explain about a third of the fintech gender gap, the residual gap declines by 60% when accounting for gender differences in the willingness to use new financial technology, the suitability of fintech products, and the willingness to use fintech entrants if they offer cheaper products. The paper concludes by discussing drivers of differences in attitudes and implications for policy to foster financial inclusion with new technology.

Effect of contact vector direction on achieving cavotricuspid isthmus block

Cavotricuspid isthmus (CTI) ablation is an important treatment strategy for CTI-dependent atrial flutter (AFL). The location of the catheter contact area is confirmed by the contact vector direction (CVD) through three-dimensional mapping during the procedure. However, the relationship between CVD during radiofrequency ablation and its efficacy in achieving CTI block has not been clarified. This study aimed to investigate the relationship between CVD and efficacy in achieving CTI block. CVDs during radiofrequency ablation were divided into proximal vectors against the distal tip (P-vector) and other vectors (normal-vector). In 39 patients who underwent CTI linear ablation, the CTIs were divided into two segments: the tricuspid valve area (anterior) and inferior vena cava area (posterior). The frequency of the residual conduction gap was compared between segments in which the P- and normal-vectors were observed. P-vectors were observed in 13 of the 78 segments. The median ablation index was not significantly different between segments in which the P-vector and normal-vector were observed (398.2 [384.2–402.2] vs. 393.3 [378.3–400.1], p = 0.15). However, residual conduction gaps were significantly more frequently observed in the segment in which the P-vector was observed than those in which only the normal-vector was observed (6/13, 46.2% vs. 3/65, 4.6%; p < 0.01). During a 6-month follow-up, two patients required a second session of ablation due to AFL recurrence. A residual conduction gap was observed in one patient at the site where the P-vector was observed in the first session. Avoiding the P-vector might be an important factor in improving CTI block and reducing AFL recurrence.