Placement Technique Research Articles

Simple Trocar Placement for Robotic Liver and Pancreatic Surgery: Multiple Access Devices at 5-cm Single Umbilicus Incision with 2 Robotic Ports.

Robotic trocars are recommended to be placed 6-8 cm apart, and assistant trocars are placed 7 cm away from the horizontal line of the robotic trocar placement. However, adhering to these rules may be difficult, particularly in lean patients. This study aims to demonstrate our standardized simple trocar placement, 5-cm single umbilicus incision + 2 ports for robotic liver resection (RLR) and robotic pancreaticoduodenectomy (RPD). During 2022-2024, patients undergoing RLR and RPD at The University of Tokyo were identified from a prospectively maintained database. Our standardized trocar placement consisted of multiple access devices at the 5-cm umbilicus incision, including two robotic trocars and one assistant trocar, and two other robotic trocars inserted to shape a hemi-circle around the surgical object. A total of 29 and 31 consecutive patients underwent RLR and RPD, respectively. The 5-cm single umbilicus incision + 2 ports method was used in 82.8% of patients undergoing RLR and 100% of patients undergoing RPD. No patients undergoing RLR developed hepatic insufficiency and bile leakage with the median postoperative hospital stay of 5 days. No patients undergoing RPD developed clinically relevant pancreatic fistula, delayed gastric emptying, and bile leakage with the median postoperative hospital stay of 8 days. Our standardized trocar placement technique is simple and widely feasible for lean-to-obese patients, allowing for RLR and RPD while minimizing incisions for patients.

Investigation of the Effect of Indirect Ultrasonic Force and Different Cements on the Bond Strength of Glass Fiber Posts in Teeth with Different Post Space Preparation Methods

(1) Background: The main aim of this study was to investigate the effects of different cements (Panavia V5, RelyX U200) and placement techniques (indirect ultrasonic vibration and manual method) on the bond strength of glass fiber posts in teeth with different post space preparation methods and to evaluate the failure types. (2) Methods: A total of 120 human upper central teeth were collected for the study. One week after root canal treatment, 10 mm long post space preparation was performed using post drills. Post spaces were irrigated in three different ways, namely NaOCl, NaOCl + EDTA solutions, and passive ultrasonic irrigation of NaOCl and EDTA solutions. Glass fiber posts were divided into two groups for resin cement systems, namely RelyX U200 (3M ESPE) or Panavia V5 (Kuraray Medical). Two different methods, namely the indirect ultrasonic vibration and the manual method, were applied for post placement. Then, 1.2 mm sections were taken from the middle and coronal regions of the inserted fiber posts for a push-out test. (3) Results: the Irrigation × Cement (p = 0.002), Cement × Section (p = 0.043) and Placement × Section (p = 0.049) pairwise interactions were statistically significant. (4) Conclusions: in our study, the effects of different post cavity preparations, different cement types, and different placement techniques on the bond strength of the fiber post were observed.

Practice Pattern Variations in the Use of Neuromonitoring, Image Guidance, and Robotics for Lumbar Pedicle Screw Placement Based on a Nationwide Neurosurgery Survey

Lumbar pedicle screw placement surgery involves various assistive technologies, including fluoroscopic, stereotactic, or robotic navigation and intraoperative neuromonitoring (IONM). We aimed to discern neurosurgeons' preferences for screw placement techniques and IONM utility, while also considering the influence of experience. A survey was distributed to members of the Congress of Neurological Surgeons using REDCap software, collecting demographic data and querying preferred techniques for screw placement and IONM modalities. Opinions on IONM use during stereotactic or robotic navigation were also obtained. Responses were analyzed using Pearson's Chi Square and ANOVA tests via R software. Of 188 responses, 35.5% (n=67) reported 1-10 years of experience and 64.5% (n=121) reported ≥11 years. Less experienced neurosurgeons utilized stereotactic navigation more than those with greater experience (p < 0.001). Seasoned neurosurgeons utilized fluoroscopic guidance more often (p = 0.038). Less experienced neurosurgeons employed 1.69 (±0.11) techniques for their fixation surgeries compared to 1.50 (±0.0.8) for more experienced neurosurgeons. Robotic navigation utilization was low and comparable between the groups. Surgeons employing multiple techniques utilized t-EMG the most (62.1%, p = 0.024). No strong opinions emerged on the necessity of multi-modality IONM with robotic or stereotactic navigation. This national survey shows that stereotactic navigation is the predominant technique for pedicle screw placement among less experienced neurosurgeons, with seasoned neurosurgeons leaning towards fluoroscopic guidance. Robotic guidance was the least utilized technique with no observed difference based on experience. Neurosurgeons employing multiple techniques use IONM the most, compared with surgeons who only use stereotactic navigation and/or robotic guidance.

An efficient approach of meshless node placement in three-dimensional subsurface flow modeling

Meshless methods are valuable tools for real-time subsurface flow modeling and are particularly beneficial for adaptively adjusting node positions when incorporating supplementary measurements. However, an algorithm is required for automatically generating high-quality meshless nodes to adapt to irregularly shaped aquifers and arbitrarily distributed wells. This paper introduces a three-dimensional adaptive meshless node placement technique based on advancing front nodes and proposes a sigmoid exclusion circle to ensure adaptability to specific positions of interest. It is crucial for groundwater simulations to have specified computational points at wellbore locations. The generated meshless nodes were used as computational points in the generalized finite difference method. The node quality was assessed by comparing the numerical solutions to the analytical solution, achieving errors of the order of 10–12. The application scenarios of irregularly shaped aquifers demonstrated the high efficiency of the three-dimensional node placement in generating up to 10,000 nodes in <5 s. The effectiveness of the algorithm was verified using three-dimensional irregular computational domains. The algorithm could be easily adapted to two-dimensional problems, and an irregular boundary example is presented. The validation and application cases highlighted the versatility of the proposed method and established its potential for real-world hydrogeological applications.

Major clinical relevance and considerations of zygomatic implants in elderly patients: a systematic review

For decades, zygomatic implants (ZI) have been used to rehabilitate atrophic maxillae and reconstruct maxillary defects, demonstrating significant survival rates, and have emerged as an alternative to extensive bone grafting. Despite their efficacy, surgical techniques for ZI placement have consistently been associated with perioperative complications, with additional problems arising later, especially in elderly patients. Objective: The present study developed a systematic review to address the main clinical relevance and considerations of zygomatic implants in elderly patients. Methods: The present study followed a concise systematic review model. The search was carried out in the PubMed, Embase, Ovid, Cochrane Library, Web of Science, and Scopus databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 220 articles were found. In total, 77 articles were fully evaluated and 57 were included and evaluated in this study, and of the total of 57 articles, only 42 articles were developed in the item results of the systematic review. Of the initial total of articles, 108 articles were excluded because they did not meet the GRADE and AMSTAR-2 classification, and 20 were excluded because they presented a risk of bias that could compromise the credibility of the studies. The symmetric funnel plot does not suggest a risk of bias. According to the GRADE instrument, most studies presented homogeneity in their results, with X2=85.6%&gt;50%. It was concluded the ZI has a high rate of survival accumulated in 12 years, with the majority of failures occurring in the early stages of the postoperative period. The main complication observed related to zygomatic implants in elderly patients was sinusitis, which can appear several years after implantation surgery. The presence of increased maxillary sinus pneumatization with advanced resorption of the posterior alveolus may result in insufficient bone to anchor the implant. Bone augmentation is generally necessary under these conditions to allow the placement of a sufficient number and length of implants. Another more serious condition would be defects of maxillectomy, aplasia of the maxillary sinus, and cleft deformities. Zygomatic implants appear to be a consolidated therapeutic option for a significantly atrophic maxilla in elderly patients, offering a promising alternative to costly heavy bone graft techniques, fewer complications, less time for rehabilitation, less required prosthodontic work, and significantly higher survival rates.

Analysis of the accuracy between orthopedic robot-assisted and traditional manual pedicle screw placement techniques in adult degenerative scoliosis posterior surgery

Objective: To comparing the accuracy of pedicle screw placement in posterior surgery for adult degenerative scoliosis (ADS) between robotic-assisted and traditional freehand techniques. Methods: This retrospective study included 92 patients with ADS who underwent posterior spinal surgery at the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) between March 2019 and December 2023. There were 19 males and 73 females with a mean age of (63.6±9.8) years. The patients were divided into two groups based on the technique used for pedicle screw placement: robot-assisted group (34 cases) and manual group (58 cases). Operative duration, intraoperative blood loss, facet joint violation, postoperative complications, magnitude of curve correction, visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores preoperatively, 1 week postoperatively, and 1 month postoperatively were compared and analyzed between the two groups. The Gertzbein-Robbins classification criteria was used to assess the accuracy of screw placement. Results: Differences in baseline data, operative duration, intraoperative blood loss, magnitude of curve correction, and VAS and ODI scores preoperatively, 1 week postoperatively, and 1 month postoperatively between the two groups exhibited no statistically significant differences (all P>0.05). The accuracy of pedicle screw placement in the robot-assisted group was significantly higher than that in the manual group [90.9% (416/458) vs 80.1% (697/870), P<0.001]. In terms of surgical segments, in T1-T12 and L1-S1 segments, the accuracy of pedicle screw placement in the robot group were both significantly higher than those in the control group [91.5% (130/142) vs 77.8% (186/239), P=0.001; 90.3% (271/300) vs 80.8% (502/621), P<0.001]. However, no significant differences was observed in the accuracy of S2-alar-iliac (S2AI) screw placement between the two groups [90.0%(9/10) vs 93.8%(15/16), P=0.727]. Moreover, no significant differences was found in the deviation direction of the cortical screw penetration between both groups (P=0.133). Significant differences were observed in the accuracy of screw placement between the Nash Moe 2 and 3 vertebral bodies in the robot group compared with those in the control group [88.9% (88/99) vs 71.0% (115/162), P=0.001; 89.2% (83/93) vs 60.2% (68/113), P<0.001]. Additionally, the incidence and grade of facet joint violation in the manual group were both significantly higher than those in the robot-assisted group (both P<0.001). No statistically significant differences was identified in postoperative complications between the two groups (P=0.841). Conclusion: It suggests that robot-assisted pedicle screw placement in posterior surgery for patients with ADS can significantly improve the accuracy of screw placement and reduce the incidence of facet joint violation.

Current research status and prospects for clinical application of robotics in spinal surgery

With the rapid advancement of artificial intelligence and the increasing integration of medical engineering, robot-assisted (RA) technology in spinal surgery has made significant strides, with its clinical application range continuously expanding. This article provides a comprehensive review of relevant literature on spinal surgery robots over the past decade, summarizing recent advancements in screw placement techniques such as cervical, thoracic, and lumbar pedicle screws; cortical bone trajectory (CBT) screws; cervical lateral mass screws; and S2 sacroiliac (S2AI) screws. It also discusses RA-guided targeted puncture and endoscope placement through intervertebral foramen as well as decompressive laminectomy procedures. Furthermore, this article systematically analyzes the advantages and disadvantages of RA technology while elucidating its accuracy, safety, and practicality. We believe that this article will help clinicians to gain a deeper understanding of the current clinical application status of spinal surgery robots while promoting further enhancements and wider adoption of RA technology to ultimately benefit more patients.

Description and Outcomes of an Ultrasound-Guided Technique for Catheter Placement in the Canine Quadratus Lumborum Plane: A Cadaveric Tomographic Study and Clinical Case Series.

This study aimed to describe an ultrasound-guided technique for implanting catheters for local anesthetic administration into the quadratus lumborum (QL) inter-fascial plane in canine cadavers and assessing the spread along the vertebral bodies (VBs) by computed tomography (CT). Phase 1: eight canine cadavers received one catheter per hemiabdomen, followed by injection of contrast media solution [low volume (LV) 0.3 mL kg-1 or high volume (HV) 0.6 mL kg-1]. Phase 2: postoperative pain of five dogs was managed by injecting 0.3 mL kg-1 of ropivacaine 0.5% through QL catheters every eight hours, up to 72 h after abdominal surgery. Pain was assessed using the Short Form of the Glasgow Composite Measure Pain Scale, and methadone 0.2 mg kg-1 was administered intravenously when the pain score was ≥6. The number of VBs stained by the contrast solution between the QL and psoas minor muscles was significantly higher in group HV than group LV. The catheter tip was visualized in the retroperitoneal space in 1/16 and 2/10 hemiabdomens in phases 1 and 2, respectively. Rescue analgesia was required in 3/5 dogs during the postoperative period. The QL catheter placement technique appears feasible and may be included in a multimodal analgesic approach for dogs undergoing abdominal surgeries.

Recent advances in acupuncture for pain relief.

Acupuncture therapy has achieved global expansion and shown promise for health promotion and treatment of acute/chronic pain. To present an update on the existing evidence base for research and clinical practice supporting acupuncture analgesia. This Clinical Update elaborates on the 2023 International Association for the Study of Pain Global Year for Integrative Pain Care "Factsheet Acupuncture for Pain Relief" and reviews best evidence and practice. Acupuncture is supported by a large research evidence base and growing utilization. Mechanisms of acupuncture analgesia include local physiological response at the needling site, suppression of nociceptive signaling at spinal and supraspinal levels, and peripheral/central release of endogenous opioids and other biochemical mediators. Acupuncture also produces pain relief by modulating specific brain networks, integral for sensory, affective, and cognitive processing, as demonstrated by neuroimaging research. Importantly, acupuncture does not just manage pain symptoms but may target the sources that drive pain, such as inflammation, partially by modulating autonomic pathways. Contextual factors are important for acupuncture analgesia, which is a complex multifaceted intervention. In clinical practice, historical records and many providers believe that acupuncture efficacy depends on specific acupoints used, the technique of needle placement and stimulation, and the person who delivers the procedure. Clinical research has supported the safety and effectiveness of acupuncture for various pain disorders, including acupuncture as a complementary/integrative therapy with other pain interventions. Although the quality of supportive evidence is heterogeneous, acupuncture's potential cost-effectiveness and low risk profile under standardized techniques suggest consideration as a neuromodulatory and practical nonpharmacological pain therapy.

Sinop Balatlar Excavation Pebble Mosaic Pavement

During the 2022 Sinop Balatlar Excavation, a pebble stone mosaic floor was unearthed. The design of the mosaic, which adorns the andron room of a private residence, is U-shaped and the east-west kline sections are planned without decoration. The pebble floor placed horizontally and vertically on a pink nucleus is called the “hedgehog” model. Surrounded by ranke, wave and palmette motifs, a small part of the mosaic, which we think shows a flying Eros and his wingtips on it, has been preserved in the southwestern corner of the main panel. It is very important with the placement technique of the stones on it and the pattern repertoire created with white pebbles on a black ground. Compared to contemporary examples, the pebble mosaic dated to the end of the 5th century BC includes the Gordion and Olynthos mosaics, where the mosaic tradition in Asia Minor dates back, it occupies an important place in the ancient mosaic chronology as it indicates its existence in the 5th century BC.

EBWO‐GE: An innovative approach to dynamic VM consolidation for cloud data centers

SummaryCloud data centers (CDCs) have revolutionized global computing by offering extensive storage and processing capabilities. Nevertheless, the environmental impact of these processes, including their substantial energy consumption and carbon emissions, calls for implementing more efficient techniques. Efficient virtual machine (VM) consolidation is crucial in optimizing resource utilization and reducing energy consumption. Current methods for enhancing energy efficiency often lead to issues such as service level agreements (SLAs) violations and quality of services (QoS) degradation. This study presents a novel approach to host selection using a grey‐extreme (GE) machine learning model, which accurately predicts over and underutilized hosts. In addition, a VM placement technique called enhanced black widow optimization (EBWO) utilizes black widow optimization heuristic techniques and a differential evolutionary approach to optimize VM placement. The proposed dynamic VM consolidation technique optimizes energy utilization while meeting strict SLA requirements and enhancing QoS metrics in CDCs. Extensive analyses were conducted using the Cloudsim toolkit to validate the approach's effectiveness. These analyses encompassed conditions such as random workloads in heterogeneous environments. The simulation results showed that GE‐EBWO outperforms other techniques and improves energy efficiency by 12%–15%. In addition, it significantly decreases VM migrations by 11%–14% compared to other advanced methods. The study validates the practicality of the proposed technique in moving towards environmentally friendly CDCs.

Simulator practice of temporary anchorage device (TAD) insertion on inter-radicular sites improves learning and confidence in dental residency.

This exploratory study elicited the procedural considerations and inter-radicular site placement techniques of experts and investigated how the use of a simulator, with and without feedback, influenced novice learners' procedural considerations, placement techniques, and confidence. Three orthodontic/oral maxillofacial surgery expert clinicians participated in a temporary anchorage device (TAD) insertion assessment accompanied by a think-aloud protocol. Expert transcripts were coded according to a coding scheme to analyze clinicians' (N=18) procedural considerations and placement techniques. Residents were randomly allocated to control and intervention groups. Two placement sessions were conducted at two inter-radicular sites with audio recordings. The intervention group received real-time feedback on root contact from the simulator's sensor and postoperative radiographs for self-assessed feedback. Residents' confidence levels were compared before and after placements, and subjective feedback about the simulator was obtained. This study utilized the think-aloud protocol to capture experts' procedural considerations and placement techniques during TAD insertion and revealed a disparity between residents' and experts' thought processes. Only four out of 15 expert themes were mentioned by more than 50% of the residents. The use of the TAD insertion simulator in combination with feedback broadened residents' procedural considerations after one round of placement. Residents' confidence increased significantly in both groups (p<0.05), but there was no significant difference between them (p>0.482). When used in conjunction with feedback, simulator practice of TAD insertion broadened residents' procedural considerations after one round of placement. It improved residents' confidence level and was well received as a learning tool.

Assessment of the calcium-silicate Polonite as a sorbent for thin-layer capping of metal contaminated sediment

Sediments contaminated with hazardous metals pose risks to humans and wildlife, yet viable management options are scarce. In a series of laboratory experiments, we characterized Polonite® – an activated calcium-silicate – as a novel sorbent for thin-layer capping of metal-contaminated sediments. We tested a fine-grained by-product from the Polonite production as a cheap and sustainable sorbent. First, Polonite was reacted with solutions of Cu, Pb, and Zn, and the surface chemistry of the Polonite was examined using, e.g., scanning electron microscopy to investigate metal sorption mechanisms. Batch experiments were conducted by adding Polonite to industrially contaminated harbor sediment to determine sorption kinetics and isotherms. Importantly, we measured if the Polonite could reduce metal bioavailability to sediment fauna by performing digestive fluid extraction (DFE). Finally, a cap placement technique was studied by applying a Polonite slurry in sedimentation columns.The results showed rapid metal sorption to Polonite via several mechanisms, including hydroxide and carbonate precipitation, and complexation with metal oxides on the Polonite surface. Isotherm data revealed that the sediment uptake capacity (Kf) for Cu, Pb, and Zn increased by a factor of 25, 21, and 14, respectively, after addition of 5% Polonite. The bioavailability of Cu, Pb, and Zn was reduced by 70%, 65%, and 54%, respectively, after a 25% Polonite addition. In conclusion, we propose that sediment treatment with low doses of the Polonite by-product can be a cheap, sustainable, and effective remediation method compared to other more intrusive methods such as dredging or conventional isolation capping.

Sacral neuromodulation update in 2024: Insights from the ICS workshop 2023

Purpose:This review is based on the International Continence Society (ICS) Workshop on Hands-On Sacral Neuromodulation (SNM)- Ideal Lead Placement presented at the Annual Congress in 2023. This workshop briefly reviewed appropriate patient selection, focused most of the time on hands on skills to teach appropriate needle and lead placement techniques. Six very experienced experts worked with attendees on lifelike models to teach them how to achieve lead placement efficiently and appropriately. Tips and tricks for getting the best responses were reviewed. Materials and methods: The review follows the structure adopted by workshop, where SNM-Ideal Lead Placement is discussed in four sections: main/extended indications and ideal patient profile, sacral neuromodulation techniques included basic evaluation (PNE), advanced evaluation, ideal lead placement and novel technology. Results:The learning objectives were achieved at the end of the workshop. These were: understanding the role of sacral neuromodulation, recognize the latest technological developments, their clinical implications and getting the best outcome with SNM, stress the importance of patient selection process and current SNM indications, reviewing standard surgical technique for optimal lead placement and gain understanding of choices for recharge versus fixed battery (as well as use in neurological disease). Conclusions:Hands-on training workshops on sacral neuromodulation is efficient training modules to ensure learning objectives for participants. Accurate needle/temporary lead placement, lead placement with permanent lead, smart programming with programmers are the main parts of hands-on training session with using realistic phantom and 3D printed models in workshop.

Experiences with the infra-acetabular screw placement technique in acetabular fracture surgery

To investigate the application experiences and effectiveness of the infra-acetabular screw (IAS) placement technique in acetabular fracture surgery. A clinical data of 34 patients with complex acetabular fractures with anterior and posterior columns separation, who were admitted between January 2019 and October 2023 and treated with IAS fixation, was retrospectively analyzed. There were 23 males and 11 females with an average age of 55.3 years (range, 18-78 years). The acetabular fractures caused by traffic accident in 20 cases, falling from height in 12 cases, crushing injury in 1 case, and bruising with a heavy object in 1 case. According to the Letournel-Judet classification, there were 7 cases of anterior column fracture, 8 cases of anterior wall/column plus posterior hemi-transverse fracture, 2 cases of T-shaped fracture, and 17 cases of both-column fracture. The time from injury to surgery was 4-21 days (mean, 8.6 days). The time of IAS placement and the intraoperative blood loss were recorded. After surgery, the X-ray film and CT scan were re-examined, and the modified Matta score was used to assess the quality of fracture reduction. The trajectory of IAS in the channel was analyzed based on CT scan, and the screw length was measured. During follow-up, the fracture healing was observed and the hip function was assessed according to the modified Merle d'Aubigné-Postel scoring system at last follow-up. The IAS was successfully implanted in all 34 patients. The length of IAS ranged from 70 to 100 mm (mean, 86.2 mm). The time of IAS placement ranged from 10 to 40 minutes (mean, 20.7 minutes). The intraoperative blood loss ranged from 520 to 820 mL (mean, 716.8 mL). All patients were followed up 8-62 months (mean, 21.8 months). After surgery, 4 patients developed lateral femoral cutaneous nerve injury, 2 developed popliteal vein thrombosis of the lower extremity, 3 developed incision infection, and no surgical complication such as arteriovenous injury or obturator nerve palsy occurred. At last follow-up, the hip function was rated as excellent in 14 cases, good in 13 cases, fair in 4 cases, and poor in 3 cases according to the Merle d'Aubigné-Postel scoring system, with an excellent and good rate of 79.41%. Imaging re-examined showed that the quality of fracture reduction was rated as excellent in 9 cases, good in 19 cases, and poor in 6 cases according to the modified Matta score, with an excellent and good rate of 82.35%; and 25 (73.53%) IAS trajectories were located in the channel. All fractures obtained bony union, and the healing time was 12-24 weeks (mean, 18 weeks). During follow-up, there was no loosening or fracture of the plate and screws. IAS placement technique can effectively strengthen internal fixation and prevent fracture re-displacement, making it a useful adjunct for treating complex acetabular fractures with anterior and posterior columns separation.

Technique, Safety, and Accuracy Assessment of Percutaneous Pedicle Screw Placement Utilizing Computer-Assisted Navigation in Lateral Decubitus Single-Position Surgery.

Percutaneous pedicle screw (PPS) placement has become a pivotal technique in spinal surgery, increasing surgical efficiency and limiting the invasiveness of surgical procedures. The aim of this study was to analyze the accuracy of computer-assisted PPS placement with a standardized technique in the lateral decubitus position. A retrospective review of prospectively collected data was performed on 44 consecutive patients treated between 2021 and 2023 with lateral decubitus single-position surgery. PPS placement was assessed by computed tomography scans, and breaches were graded based on the magnitude and direction of the breach. Facet joint violations were assessed. Variables collected included patient demographics, indication, intraoperative complications, operative time, fluoroscopy time, estimated blood loss, and length of stay. Forty-four patients, with 220 PPSs were identified. About 79.5% of all patients underwent anterior lumbar interbody fusion only, 13.6% underwent lateral lumbar interbody fusion only, and 6.8% received a combination of both anterior lumbar interbody fusion and lateral lumbar interbody fusion. Eleven screw breaches (5%) were identified: 10 were Grade II breaches (<2 mm), and 1 was a Grade IV breach (>4 mm). All breaches were lateral. About 63.6% involved down-side screws indicating a trend toward the laterality of breaches for down-side pedicles. When analyzing breaches by level, 1.2% of screws at L5, 13% at L4, and 11.1% at L3 demonstrated Grade II breaches. No facet joint violations were noted. PPS placement utilizing computer-assisted navigation in lateral decubitus single-position surgery is both safe and accurate. An overall breach rate of 5% was found; considering a safe zone of 2 mm, only 1 screw (0.5%) demonstrated a relevant breach. PPS placement is both safe and accurate. Breaches are rare, and when breaches do occur, they are lateral.

The safety and efficacy of through-and-through wire technique for ureteral Double-J stent placement.

To evaluate the efficacy and safety of the through-and-through wire (TTW) technique for antegrade ureteral Double-J stent placement after failure of either antegrade or retrograde ureteral stent placement. This retrospective study analyzed the medical records of consecutive patients who underwent Double-J stent placement with the TTW technique at Asan Medical Center and Gil Medical Center between January 2016 and February 2023. Patient histories, reasons for employing the TTW technique, TTW pathways, and complications were reviewed. Eight patients were included in the study. The reasons for using the TTW technique were failure to advance a larger-diameter catheter, balloon catheter, or Double-J stent passing over the guidewire beyond the stricture (6/8, 75.0%); failure to negotiate the stricture with a guidewire (1/8, 12.5%); and guidewire passing through a ureteropelvic junction defect (1/8, 12.5%). TTW was applied either between a percutaneous nephrostomy (PCN) and the urethral orifice (n=4), between a PCN and an ileostomy pouch (n=3), or between a left and right PCN (n = 1). Urologic assistance was required for retrograde ureteral cannulation in one male patient (12.5%). Subsequently, balloon dilation and/or Double-J stent placement were performed in all eight patients, resulting in 100% technical success. No major or minor complications occurred. The TTW technique was safe and effective in the undertaking of PCN and antegrade Double-J stent placement in patients for whom either antegrade or retrograde access had failed.

Transfer learning-accelerated network slice management for next generation services

The current trend in user services places an ever-growing demand for higher data rates, near-real-time latencies, and near-perfect quality of service. To meet such demands, fundamental changes were made to the traditional radio access network (RAN), introducing Open RAN (O-RAN). This new paradigm is based on a virtualized and intelligent RAN architecture. However, with the increased complexity of 5G applications, traditional application-specific placement techniques have reached a bottleneck. Our paper presents a Transfer Learning (TL) augmented Reinforcement Learning (RL) based networking slicing (NS) solution targeting more effective placement and improving downtime for prolonged slice deployments. To achieve this, we propose an approach based on creating a robust and dynamic repository of specialized RL agents and network slices geared towards popular user service types such as eMBB, URLLC, and mMTC. The proposed solution consists of a heuristic-controlled two-module-based ML Engine and a repository. The objective function is formulated to minimize the downtime incurred by the VNFs hosted on the commercial-off-the-shelf (COTS) servers. The performance of the proposed system is evaluated compared to traditional approaches using industry-standard 5G traffic datasets. The evaluation results show that the proposed solution consistently achieves lower downtime than the traditional algorithms.

Surgical Tips for Robotic Assisted Laparoscopic Abdominal Cerclage: A Minimally Invasive Approach.

Preterm birth is the leading cause of perinatal and neonatal morbidity and mortality in the developed world. An important cause of preterm birth is cervical insufficiency, leading to membrane prolapse, premature rupture of membranes, and mid-trimester pregnancy loss. A cerclage can be placed vaginally or abdominally to treat cervical insufficiency. In cases of failed prior transvaginal cerclage (TVC), transabdominal cerclage (TAC) is the alternative. The procedure can be completed via laparoscopy or open approach. The suture is placed at the internal os giving greater structural support.1 In this article, we review the definition of cervical incompetence, we present the indications for TAC, we discuss the outcomes of minimally invasive TAC compared to open approach, and we review surgical tips and tricks for robotic assisted (RA) TAC placement that can be used prior to pregnancy or in early gestation. The included images delineate the surgical technique for safe placement of robotic assisted laparoscopic abdominal cerclage in the management of cervical insufficiency.

Hydrocephalus: A Review of Etiology-Driven Treatment Strategies.

Hydrocephalus is a broad term usually understood as cerebrospinal fluid (CSF) accumulation resulting in cerebral ventricular system expansion. The production of CSF is by the choroid plexus in lateral ventricles, flowing between the third and fourth ventricles and eventually to the subarachnoid space. It is critical for proper neuronal function. Hydrocephalus is a neurological pathology linked to high morbidity from neurocognitive and motor impairment. It is classified as either communicating or non-communicating. Communicating hydrocephalus is understood as a deficit at cranial arachnoid villi and granulation absorption sites. However, there has been evidence that extracranial lymphatic vessels in the ethmoid bone region also play a role, as indicated by decreased lymphatic absorption in rat models of hydrocephalus. Treatment typically involves surgical shunt placement or endoscopic third ventriculostomy (ETV) technique with or without choroid plexus cauterization (CPC). These surgical interventions have high failure risks and complications that require re-intervention, further increasing morbidity and mortality risks. To date, there are few nonsurgical treatment strategies, but many have proved limited benefit, and many patients still require surgery. This analysis lays out the typical treatments and explores new, innovative interventions by highlighting the active role of brain parenchymal tissue in the pathogenesis of hydrocephalus.