Total Fusion Research Articles

Comparison of patient demographics, utilization trends, and costs of total ankle arthroplasty and ankle fusion in the United States from 2010 to 2019.

Contemporary studies evaluating utilization and trends of total ankle arthroplasty (TAA) and ankle fusion (AF) for tibiotalar osteoarthritis are sparse. Therefore, the purpose of this study was to utilize a nationwide administrative claims database from 2010 to 2019 to compare: (1) baseline demographics; (2) utilization, (3) in-hospital length of stay (LOS), and (4) costs of care. Using the PearlDiver database, a retrospective query from January 1st, 2010 to December 31st, 2019 was performed for all patients who underwent TAA and AF for tibiotalar osteoarthritis. Baseline demographics, comorbidities, and geographic utilization were compared using Pearson Chi-square analyses. Linear regression was used to compare differences in procedure utilization and in-hospital LOS during the study interval. Reimbursements between the two cohorts during the study interval were compared. A p value less than 0.05 was statistically significant. In total, 14,248 patients underwent primary TAA (n = 5544) or AF (n = 8704). Patients undergoing AF were generally younger (< 60) with greater comorbidity burden driven by hypertension, diabetes mellitus, obesity, and tobacco use compared to TAA patients (p < 0.0001). Over the study interval, TAA utilization remained constant (912 vs 909 procedures; p = 0.807), whereas AF utilization decreased by 42.5% (1737 vs 998 procedures; p = 0.0001). Mean in-hospital LOS for patients undergoing TAA decreased (2.5days vs. 2.0days, p = 0.0004), while AF LOS increased (2.6days vs. 3.5days, p = 0.0003). Reimbursements for both procedures significantly declined over the study interval (TAA: $4559-$2156, AF: $4729-$1721; p < 0.013). TAA utilization remained constant, while AF utilization declined by 42.5% from 2010 to 2019. There was divergence in the LOS for TAA versus AF patients. Both procedures significantly declined by over 50% in reimbursements over the study interval.

Comparing the Results of Total Ankle Arthroplasty Vs Tibiotalar Fusion (Ankle Arthrodesis) in Patients with Ankle Osteoarthritis since 2006 to 2020- A Systematic Review.

This study compares the outcomes of patients undergoing total ankle arthroplasty (TAA) and tibiotalar fusion (ankle arthrodesis) in patients with end-stage osteoarthritis. The primary outcome assessed was Patient Reported Outcome Measures (PROMS); secondary outcomes included the incidence of revision, re-operation, and complications. A systematic review of studies examining the outcomes of patients undergoing TAA and/or tibiotalar fusion from 2006 to 2020 was conducted. Individual cohort studies and randomized control trials were included. Outcomes were assessed at two and five years. 21 studies were included: 16 arthroplasty (2,016 patients) and 5 arthrodesis (256 patients) studies. No significant difference in PROMS was evident two years post-surgery - American Orthopaedic Foot and Ankle Society (AOFAS) scores were 78.8 (95% CI-confidence interval: 76.6-80.8; n=1548) and 80.8 (95% CI: 80.1-81.5; n=206 patients) for the arthroplasty and arthrodesis groups respectively. Two years post-surgery the revision rates for the arthroplasty and arthrodesis groups were similar - 3.5% (n=9) and 3.7% (n=61) respectively (OR-odds ratio: 1.05; 95% CI: 0.51-2.13); however, the re-operation rate was 2.5 times higher for the arthroplasty group (12.2%) in comparison to the arthrodesis group (5.1%) (OR: 2.57; 95% CI: 1.43-4.62). Documented complications in the arthroplasty group were half those documented in the arthrodesis group two years post-surgery (OR: 0.53; 95% CI: 0.37-0.77). No arthrodesis studies were found which contained mean 5-year follow-up data within the study period. Despite recent developments in TAA design, we found no clear evidence as to their superiority over ankle arthrodesis when considering patient outcomes two years postoperatively. However, this conclusion could be debatable in some types of patients such as diabetic patients, posttraumatic patients and patients with stiff hindfoot and midfoot.

Design of ITER neutron flux monitor system back-end electronics

The primary aim of the International Thermonuclear Experimental Reactor (ITER) Neutron Flux Monitor (NFM) system is to diagnose the total neutron emission rate and fusion power of the plasma fusion reaction. The neutron flux is measured directly by the system and the fusion power can be calculated according to the neutron flux result. The NFM system is composed of detectors and back-end electronics. This paper focuses on the work of NFM#7 back-end electronics design and development. The back-end electronics consist mainly of four parts: Firstly, the pre-amplifiers are used to charge integrate and amplify the signal of fission chambers. Secondly, the output of pre-amplifiers will be transmitted to Signal Processing Unit (SPU) for analog signal conditioning, data processing, and measurement result uploading. Thirdly, pre-amplifiers and fission chambers have different electricity sources. Pre-amplifiers receive electricity generated from low voltage power whilst fission chambers receive electricity generated from high voltage power. Lastly, the Instrument and Control (I&C) is designed as the interface between NFM hardware and ITER central system and its functions are configuration & control, monitoring, calibration, data communication & archiving and clock synchronization. All the four parts are well integrated and tested in neutron field. The system design also follows the guidelines and standards of ITER.

Circumferential Fusion Employing Transforaminal vs. Direct Lateral Lumbar Interbody Fusion-A Potential Impact on Implants Stability.

BackgroundDifferent fusion techniques were introduced in clinical practice in patients with lumbar degenerative disc disease, however, no evidence has been provided on the advantages of one technique over another.The Objective of This StudyIs to assess the potential impact of circumferential fusion employing transforaminal lumbar interbody fusion (TLIF) vs. direct lateral interbody fusion (DLIF) on pedicle screw stability.Materials and MethodsThis is a single-center prospective evaluation of consecutive 138 patients with degenerative instability of lumbar spinal segments. Either conventional transforaminal lumbar interbody fusion (TLIF) with posterior fusion or direct lateral interbody fusion (DLIF) using cages of standard dimensions, were applied. The conventional open technique was used to supplement TLIF with pedicle screws while percutaneous screw placement was used in patients treated with DLIF. The duration of the follow-up accounted for 24 months. Signs of pedicle screws loosening (PSL) and bone union after fusion were assessed by the results of CT imaging. Fisher‘s exact test was used to assess the differences in the rate of CT loosening and revision surgery because of implant instability. Logistic regression was used to assess the association between potential factors and complication rate.ResultsThe rate of PSL detected by CT and relevant revision surgery in groups treated with TLIF and DLIF accounted for 25 (32.9%) vs. 2 (3.2%), respectively, for the former and 9 (12.0%) vs. 0 (0%) for the latter (p < 0.0001 and p = 0.0043) respectively. According to the results of logistic regression, a decrease in radiodensity values and a greater number of levels fused were associated with a rise in PSL rate. DLIF application in patients with radiodensity below 140 HU was associated with a considerable decrease in complication rate. Unipolar or bipolar pseudoarthrosis in patients operated on with TLIF was associated with a rise in PSL rate while patients treated with DLIF tolerate delayed interbody fusion formation. In patients treated with TLIF supplementary total or partial posterior fusion resulted in a decline in PSL rate.ConclusionEven though the supplementary posterior fusion may considerably reduce the rate of PSL in patients treated with TLIF, the application of DLIF provide greater stability resulting in a substantial decline in PSL rate and relevant revision surgery.

Search for a viable nucleus–nucleus potential in heavy-ion nuclear reactions

We have constructed an empirical formulae for the fusion and interaction barriers using experimental values available till date. The fusion barriers so obtained have been compared with different model predictions based on the proximity, Woods-Saxon and double folding potentials along with several empirical formulas, time dependent Hartree-Fock theories, and the experimental results. The comparison allows us to find the best model, which is nothing but the present empirical formula only. Most remarkably, the fusion barrier and radius show excellent consonance with the experimental findings for the reactions meant for synthesis of the superheavy elements also. Furthermore, it is seen that substitution of the predicted fusion barrier and radius in classic Wong formula [C. Wong, Phys. Rev. Lett. {31}, 766 (1973)] for the total fusion cross sections satisfies very well with the experiments. Similarly, current interaction barrier predictions have also been compared well with a few experimental results available and Bass potential model meant for the interaction barrier predictions. Importantly, the present formulae for the fusion as well as interaction barrier will have practical implications in carrying out the physics research near the Coulomb barrier energies. Furthermore, present fusion barrier and radius provide us a good nucleus-nucleus potential useful for numerous theoretical applications.

Outcomes following Distal Radioulnar Joint Arthroplasty in the Setting of Total or Partial Wrist Fusion.

Purpose To evaluate the functional outcome and complications following primary ulnar head or total distal radial ulnar joint (DRUJ) arthroplasty in patients who have a partial or total wrist fusion. Methods We conducted a retrospective review of 33 primary DRUJ implants in 31 patients who had a partial or total wrist fusion. Follow-up time averaged 67 months. There were 11 partial and 22 total wrist fusions with 22 ulnar head prosthesis and 11 total DRUJ implants. The mean age of the patients was 49 years. Eighty-one percent had previous surgeries with an average number of 4.6 previous wrist procedures. Pre- and postoperative pain levels were recorded. Mayo Wrist Scores were calculated. Grip strength, range of motion (ROM), and post-operative complications were noted. Results The pain scores improved in 67% of the patients. The Mayo Wrist Score improved significantly from a mean of 39 preoperatively to 51 postoperatively. The grip strength and pro-supination remained stable. The wrist ROM also remained stable in the patients with partial wrist fusions. During the follow-up period, 10 (30%) of the DRUJ implants were explanted, with a trend toward higher explantation rates in total wrist fusions with one in the partial fusion group and nine in the total wrist fusion group. Four of the explantations happened in the first postoperative year. Nineteen (61%) of the patients required a second surgery for a DRUJ implant-related complication; this rate was similar between the partial and total fusion groups. Conclusions DRUJ replacement resulted in improved pain scores and Mayo wrist scores in the majority of patients; however, the combination of primary DRUJ arthroplasty and total wrist fusion was associated with high complication rates. Surgeons should be aware of the high complication rate seen with DRUJ arthroplasty when combined with total wrist fusion.

Scaphocephaly and increased intra-cranial pressure in non-operated adults: A controlled anthropological study on 21 skulls

Aim and scopeThe prevalence of increased intra-cranial pressure (ICP) in patients with scaphocephaly is controversial. Here, based on anthropological material, we aimed to determine whether adults with non-operated sagittal synostosis show indirect signs of increased ICP. Materials and methodsThirty-eight dry skulls (21 skulls with sagittal craniosynostosis and 17 controls) were selected from the collections of the National Museum of Natural History (Paris, France). All skulls registered as ‘fused sagittal suture’ or ‘scaphocephaly’ in the registry of the Museum were included. All had total fusion of the sagittal suture. Controls were selected within skulls of similar origin (France), without visible craniofacial anomalies. The 38 skulls were CT-scanned using a standard medical CT-scan with a protocol dedicated to dry bone imaging. Eight radiological signs associated with raised ICP were assessed: (1) calvaria and (2) skull base thinning, (3) dorsum sellae erosion, (4) sella turcica lengthening, (5) copper beaten skull, (6) suture diastasis, (7) persistent metopic suture, and (8) small frontal sinus. Scaphocephaly was assessed based on head circumference, cranial index, intra-cranial volume, fronto-nasal angle, and inter-zygomatic distance. Linear and non-linear logistic models were used to compare groups. Results19/21 skulls with sagittal synostosis were significantly scaphocephalic. None of the criteria for ICP were significantly different in skulls with scaphocephaly relative to controls. Nevertheless, 5 individual skulls with scaphocephaly had ≥ 3 signs in favor of a history of raised ICP.We do not report the significant prevalence of indirect signs of raised ICP in adults with scaphocephaly. These results do not allow ruling out a history of early raised ICP or of minor prolonged raised ICP. Even though our findings support the fact that scaphocephaly is not significantly associated with prolonged raised ICP, individual cases (5/21) with clear signs in favor of a history of brain compression indicate that scaphocephaly correction should be considered as a functional procedure until the production of clear evidence. Cognitive assessments of non-operated adult patients with scaphocephaly could contribute to tackle this recurring question in craniofacial surgery.

Mid-carpal Arthrodesis Using Staples

Limited carpal fusion offers patients with degenerative wrist conditions reliable pain relief without the complication profile of total wrist arthroplasty and preserves motion compared to total wrist fusion. The authors of this study present the technique of limited carpal fusion with nitinol memory compression staples, which offer a reliable and consistent, alternative to classic methods of intercarpal fusion. Multiple studies have demonstrated outcomes equivalent to traditional fusion alternatives.

Multi-impurity chiral Kondo model: Correlation functions and anyon fusion rules

The multichannel Kondo model supports effective anyons on the partially screened impurity, as suggested by its fractional impurity entropy. It was recently demonstrated for the multi-impurity chiral Kondo model, that scattering of an electron through the impurities depends on the anyon's total fusion channel. Here we study the correlation between impurity spins. We argue, based on a combination of conformal field theory, a perturbative limit with a large number of channels $k$, and the exactly solvable two-channel case, that the interimpurity spin correlation probes the anyon fusion of the pair of correlated impurities. This may allow, using measurement-only topological quantum computing protocols, to braid the multichannel Kondo anyons via consecutive measurements.

Recent Advances in Assessment and Treatment in Kienböck's Disease.

Kienböck’s disease is a rare disease described as progressive avascular osteonecrosis of the lunate. The typical manifestations include a unilateral reduction in wrist motion with accompanying pain and swelling. Besides recent advances in treatment options, the etiology and pathophysiology of the disease remain poorly understood. Common risk factors include anatomical features including ulnar variance, differences in blood supply, increased intraosseous pressure along with direct trauma, and environmental influence. The staging of Kienböck’s disease depends mainly on radiographic characteristics assessed according to the modified Lichtman scale. The selection of treatment options is often challenging, as radiographic features may not correspond directly to initial clinical symptoms and differ among age groups. At the earliest stages of Kienböck disease, the nonoperative, unloading management is generally preferred. Patients with negative ulnar variance are usually treated with radial shortening osteotomy. For patients with positive or neutral ulnar variance, a capitate shortening osteotomy is a recommended option. One of the most recent surgical techniques used in Stage III Kienböck cases is vascularized bone grafting. One of the most promising procedures is a vascularized, pedicled, scaphoid graft combined with partial radioscaphoid arthrodesis. This technique provides excellent pain management and prevents carpal collapse. In stage IV, salvage procedures including total wrist fusion or total wrist arthroplasty are often required.

Long-term outcomes of the four-corner fusion of the wrist: A systematic review.

BACKGROUNDFour-corner fusion (4CF) is a motion sparing salvage procedure that is used to treat osteoarthritis secondary to advanced scapholunate collapse or longstanding scaphoid nonunion advanced collapse. Little is known about the long-term survivorship and outcomes of 4CF. AIMTo report on clinical and functional long-term outcomes as well as conversion rates to total wrist fusion or arthroplasty.METHODSThe systematic review protocol was registered in the international prospective register of systematic reviews (PROSPERO) and followed the PRISMA guidelines. Original articles were screened using four different databases. Studies with a minimum Level IV of evidence that reported on long-term outcome after 4CF with a minimum follow-up of 5 years were included. Quality assessment was performed using the Methodological Index for Non-Randomized Studies criteria.RESULTSA total of 11 studies including 436 wrists with a mean follow-up of 11 ± 4 years (range: 6-18 years) was included. Quality assessment according to Methodological Index for Non-Randomized Studies criteria tool averaged 69% ± 11% (range: 50%-87%). Fusion rate could be extracted from 9/11 studies and averaged 91%. Patient-reported outcomes were extracted at last follow-up from 8 studies with an average visual analog scale of 1 ± 1 (range: 0-2) and across 9 studies with an average Disabilities of the Arm, Shoulder and Hand score of 21 ± 8 (range: 8-37). At last follow-up, the cumulative conversion rate to total wrist fusion averaged 6%. There were no conversions to total wrist arthroplasty.CONCLUSIONThe 4CF of the wrist is a reliable surgical technique, capable of achieving a good long-term patient satisfaction and survivorship with low rates of conversion to total wrist fusion.

MEMe: A Mutually Enhanced Modeling Method for Efficient and Effective Human Pose Estimation.

In this paper, a mutually enhanced modeling method (MEMe) is presented for human pose estimation, which focuses on enhancing lightweight model performance, but with low complexity. To obtain higher accuracy, a traditional model scale is largely expanded with heavy deployment difficulties. However, for a more lightweight model, there is a large performance gap compared to the former; thus, an urgent need for a way to fill it. Therefore, we propose a MEMe to reconstruct a lightweight baseline model, EffBase transferred intuitively from EfficientDet, into the efficient and effective pose (EEffPose) net, which contains three mutually enhanced modules: the Enhanced EffNet (EEffNet) backbone, the total fusion neck (TFNeck), and the final attention head (FAHead). Extensive experiments on COCO and MPII benchmarks show that our MEMe-based models reach state-of-the-art performances, with limited parameters. Specifically, in the same conditions, our EEffPose-P0 with 256 × 192 can use only 8.98 M parameters to achieve 75.4 AP on the COCO val set, which outperforms HRNet-W48, but with only 14% of its parameters.

Bilateral Isolated Third Metacarpophalageal Arthritis at Long-Term Follow Up After Bilateral Wrist Fusion

Total wrist fusion is an established surgical option for the management of severe wrist arthritis. Long-term sequelae of wrist fusion are numerous and incompletely understood. The following case documents a patient who developed third metacarpophalangeal (MCP) joint arthritis following radiocarpal wrist fusion with a plate and screw construct from the radius to the third metacarpal. An MCP arthroplasty was subsequently performed and outcomes reported. This case report outlines the need for further study of the force transmission through and motion of the MCP joint following a radiocarpal wrist arthrodesis.

Systematic study of fusion suppression for tightly bound projectiles at above-barrier energies

The present work aims to explore the effects of projectile breakup on fusion cross section at energies near the Coulomb barrier to well above it. The complete fusion cross section for the strongly bound non-$\ensuremath{\alpha}$-cluster projectile $^{14}\mathrm{N}$ in interaction with a $^{181}\mathrm{Ta}$ target was obtained by summing the experimentally measured channel-by-channel cross section data of evaporated residues. The obtained total fusion cross section was compared with the theoretical code ccfull and the results were found to be consistent with each other. Further, the experimental fusion function data on $^{181}\mathrm{Ta}$ target with $^{14}\mathrm{N}$ projectile were deduced and compared with those obtained for other strongly bound projectiles, viz., $^{12,13}\mathrm{C}$, $^{16}\mathrm{O}$, and $^{19}\mathrm{F}$, in order to get some systematics in fusion reactions. The analysis of experimental fusion functions was performed within the framework of a benchmark curve called the universal fusion function (UFF). A suppression of about 5--25% with respect to UFF was observed for the presently studied systems at energies above the Coulomb barrier, indicating that the suppression is essentially due to the prompt breakup of the projectiles and is a strong function of breakup threshold of projectiles. The magnitude of such suppression was found to be lower for $^{14}\mathrm{N}$ projectile as compared to other strongly bound projectiles. Moreover, an interesting exponential relation between the experimentally deduced suppression factor and the breakup threshold of the projectile was obtained.

Total Wrist Fusion with an Intramedullary Device: A Single-Institution Series with a Minimum of One Year Follow-Up.

Objective The primary purpose of this study was to evaluate the functional and surgical outcomes of total wrist fusion (TWF) following the use of a locked intramedullary nail (IMN). Methods A single institution study was performed, which entailed in-person reexamination of 18 patients ( n = 19 wrists), out of 35 eligible patients, who underwent TWF with an IMN from 2010 to 2017. For each patient, demographic, preoperative diagnosis, physical examination, wrist radiograph, and outcome questionnaire data were obtained. The questionnaires included the visual analog scale (VAS), quick disabilities of the arm, shoulder, and hand (QuickDASH), and Mayo Wrist Score assessments. In addition, complication and reoperation data for all TWFs with an IMN during the 2010 to 2017 period (35 patients, n I = 38 wrists) were noted. Results In the 18 patients, age was 47.6 ± 13.9 years, 12 (63.2%) were female, and median follow-up was 150 weeks (range: 74-294). The VAS score was 0 ± 0 in 5 of 19 wrists with rheumatoid arthritis (RA) and 1.82 ± 2.78 in 14 of 19 wrists without RA. It was found that 21 of 38 wrists (55.3%) had an implant-related complication and 5 wrists (13%) underwent a reoperation due to the implant itself. Conclusions To date, no sufficient data are present demonstrating a clear advantage of an IMN over dorsal plating for TWF at intermediate-term follow-up. Surgeons should be knowledgeable of the several potential complications of this IMN prior to its use for TWF. Level of Evidence This is a Level IV, therapeutic study.

Coulomb breakup reaction of loosely bound F17 with dynamic polarization potentials

We investigate the elastic scattering, inelastic scattering, breakup reaction, and total fusion reactions of the $^{17}\mathrm{F}+^{208}\mathrm{Pb}$ system using an optical model approach by including the dynamical polarization potential. In particular, we focus on the breakup reaction channels, whose effects on other reactions have been argued to be small. By exploiting two different potentials composed of a surface-type Woods-Saxon potential, which were obtained by a fitting analysis, and a Love-type optical potential, the breakup reaction cross sections are explained with other elastic and quasielastic scattering cross sections. For the breakup reaction at ${E}_{\text{lab}}=170$ MeV in the forward angle region, where only exclusive reaction data are known, inclusive breakup reaction data are deduced from available theoretical and experimental $E1$ strength values. We discuss the breakup reaction effects on the other nuclear reactions related to the $^{17}\mathrm{F}$ projectile in detail.

“I could have a proper ankle” – a qualitative study of patients’ perceptions of total ankle replacement and ankle fusion surgery

BackgroundEnd-stage ankle osteoarthritis typically causes severe pain and impaired function. Surgical treatment involves total ankle replacement (TAR) or ankle fusion. Definitive evidence about which procedure is optimal is lacking. No previous studies have thoroughly explored patients’ experiences across the entire TAR/ankle fusion pathway. This study aimed to address this gap by exploring perceptions of surgery, education, rehabilitation and outcomes among patients who had undergone TAR or ankle fusion.MethodsSeven participants were purposively selected from an orthopaedic centre in northern England (3 females, 4 males). Participants had undergone primary TAR without revision (n = 2), TAR requiring revision (n = 3) or ankle fusion (n = 2). Each participant completed a single semi-structured interview. Interviews were digitally recorded, transcribed verbatim and analysed thematically.ResultsThree themes, each with two subthemes, were identified: decision-making (seeking help; surgical options), perceptions of support (information/education; clinical support) and impact on the individual (personal circumstances and beliefs; post-operative outcomes). Pain affecting participants’ valued activities was key to their decision to seek help. Participants’ decision between TAR and ankle fusion was influenced by multiple factors. Concerns regarding the lack of joint flexibility following fusion were highlighted, with some participants perceiving TAR as a “proper ankle” that would enable them to avoid limping. Participants obtained information from various sources, with most feeling that the education from their care team was inadequate. Participants’ individual circumstances and beliefs influenced their decision-making and perceptions of their post-operative outcomes. Finally, whilst most participants were pleased with their outcomes, some experienced substantial ongoing problems such as difficulty walking and chronic pain.ConclusionsThis study demonstrates the importance of providing adequate education about TAR and ankle fusion to enable patients to make informed decisions. Most participants felt that the education and clinical support they received did not fully meet their needs. Participants’ personal circumstances and beliefs had a strong influence on their decision-making and perceptions of their post-operative outcomes, highlighting the need to personally tailor education and clinical support. Future work with a larger sample of patients and other key stakeholders is required to develop consensus-based guidelines on pre- and post-operative support for patients undergoing TAR/ankle fusion.

A Review Of Distraction Arthroplasty Vs Ankle Arthrodesis Vs Ankle Replacement

Recent developments in surgical techniques have led to new methods to treat ankle arthritis and perhaps produce a better effect on joint function and gait improvement. The indications for total ankle replacement, ankle fusion, or distraction arthroplasty in the management of ankle arthritis are controversial. The aim of this study is to evaluate different approaches with an overview of the literature. Core tip: Ankle arthritis is a common debilitating chronic disease that is not only present in the geriatric population, but also younger populations. The main method to treat end stage arthritis is ankle fusion. Ankle replacement is currently improving in popularity. Both treatment options manage end stage arthritis. It is important to consider the role of distraction arthroplasty in the context of these two other well accepted treatments. Here we examine the literature from 1941 to 2020 considering our own experience and the growing role regenerative techniques and biologics.

Sirenomelia with associated systemic anomalies – an autopsy report in a full term neonate

The mermaid syndrome, also known as sirenomelia, is considered an extremely rare congenital developmental disorder characterized by anomalies of the lower spine and lower limbs. Affected babies are born with partial or total leg fusion. Sirenomelia is thought to affect one in every 60,000 to 100,000 infants. We report acase of sirenomelia occurring in a28-year-old multiparous woman, aheavy smoker with gestational diabetes. In the other 5 pregnancies, however, she gave birth to normal babies. The post mortem examination completed the diagnosis, revealing also multiple malformations of several systems: respiratory, gastro-intestinal, genito-urinary and cardiovascular. In our full term neonate case with grade VI sirenomelia, the presence of asingle umbilical artery plus the abdominal aorta with an aberrant trajectory that ends in the umbilical cord differentiates this condition from caudal regression syndrome and also explains the under-development of pelvic organs (secondary to vascular steal phenomena).

Smart-City-based Data Fusion Algorithm for Internet of Things

Increasingly, Wireless Sensor Networks (WSNs) are contributing enormous amounts of data. Since the recent deployments of wireless sensor networks in Smart City infrastructures, significant volumes of data have been produced every day in several domains ranging from the environment to the healthcare system to transportation. Using wireless sensor nodes, a Smart City environment may now be shown for the benefit of residents. The Smart City delivers intelligent infrastructure and a stimulating environment to citizens of the Smart Society, including the elderly and others. Weak, Quality of Service (QoS) and poor data performance are common problems in WSNs, caused by the data fusion method, where a small amount of bad data can significantly impact the total fusion outcome. In our proposed research, a WSN multi-sensor data fusion technique employing fuzzy logic for event detection. Using the new proposed Algorithm, sensor nodes will collect less repeated data, and redundant data will be used to increase the data's overall reliability. The network's fusion delay problem is investigated, and a minimum fusion delay approach is provided based on the nodes’ fusion waiting time. The proposed algorithm performs well in fusion, according to the results of the experiment. As a result of these discoveries, It is concluded that the algorithm describe here is effective and dependable instrument with a wide range of applications.