Abstract: Fusion of the lumbosacral spine is a common surgical procedure to address a range of spinal pathologies. Fixation in lumbar fusion has traditionally been performed using pedicle screw (PS) augmentation. However, an alternative method of screw insertion via cortical bone trajectory (CBT) has been advocated as a less invasive approach which improves initial fixation and reduces neurovascular injury. There is a paucity of robust clinical evidence to support these claims, particularly in comparison to traditional pedicle screws. This study aims to review the available evidence to assess the merits of the CBT approach. Six electronic databases were searched for original published studies which compared CBT with traditional PS and their findings reviewed. Nine comparative studies were identified through a comprehensive literature search. Studies were classified as retrospective cohort, prospective cohort or case control studies with medium quality as assessed by the GRADE criteria. The available literature is not cohesive regarding outcomes and complications of CBT versus PT procedures. Most studies found no difference in operative time, but reported less blood loss during CBT. Radiological outcomes show no difference in slippage at one year although CBT is associated with greater bone-density compared to PT. Results for post-operative pain are inconclusive.
THE increasing data collection capability of space platforms, from cislunar to deep-space missions, is outpacing the downlink capacity of legacy telecommunications architectures. Legacy point-to-point streaming data service models require spacecraft to downlink directly to preselected ground antennas to telemeter their entire data volume. Improvements to spacecraft design and launch services in both commercial and government sectors are increasing the number of space assets and improvements in payload technologies allowed for the collection of increasingly large data sets on increasingly smaller space platforms. Together, these trends produce data volumes that congest existing TT&C (tracking, telemetry, and control) links. This congestion results in additional costs to build new ground stations, shifts to less congested frequencies (X-, Ka-, and Ku-band), higher prices for existing link services, and, ultimately, fewer link opportunities. The foreseeable economic climate for space science necessitates a frugality that cannot support scaling inefficient legacy architectures. In addition to expanding the number of ground systems, multiple space agencies are pursuing technologies to more efficiently share space and ground telecommunications assets. One such effort, delay-tolerant networking (DTN), standardizes the multipath, multihop, packetized data definitions necessary to create internetworks from space and ground assets. DTN provides an Internet-style data exchange to space communications challenged by the link disruptions and signal propagation delays that prevent the smooth operation of terrestrial protocols such as the Internet protocol (IP) [1]. Packetized internetworking relieves congestion in space-to-ground
Diabetic ketoacidosis is a potentially fatal complication of diabetes mellitus that may result in hypertriglyceridemia. Rarely, the resulting hypertriglyceridemia may precipitate acute pancreatitis. We report a case of acute pancreatitis secondary to hypertriglyceridemia precipitated by diabetic ketoacidosis and postulate that this unusual presentation is due to the patient being prone to ketosis.
Chronic care is an eminent application of implantable body sensor networks (IBSN). Performing physical activities such as walking, running, and sitting is unavoidable during the long-term monitoring of chronic-care patients. These physical activities cripple the radio frequency (RF) signal between the implanted sensor nodes. This is because various body postures shadow the RF signal. Although shadowing itself may be short, a prolonged activity will significantly increase the effect of the RF-shadowing. This effect dampens the communication between implantable sensor nodes and hence increases the chance of missing life-critical data. To overcome this problem, in this paper we propose a link quality-aware medium access control (MAC) protocol called HACMAC, which adapts the access mechanism during different human activities based on the wireless link-quality. Our simulation results show that compared with the access mechanism suggested by the IEEE 802.15.6 standard, the reliability of the wireless communication is increased using HACMAC even while transmitting at a strongly low transmission power of 25μW effective isotropic radiated power (EIRP) set by the IEEE 802.15.6 standard.
The global rise in orthopaedic care coupled with increasing costs necessitates surgical auditing. Orthopaedic registries in the United States (US) and Norway survey data to discern practice differences and improve clinical decisions, but they have key distinctions. In this study, we elucidate the creation, growth, and clinical relevance of registries in the US and Norway, emphasizing distinguishing features and effects on orthopaedic practice. Registries were selected based on geographic representation, enrollment, and scholarly relevance. The databases surveyed were PubMed, MEDLINE, The Texas Medical Center Library, The University of Texas System Library, and Google Scholar. Registry reports, websites, and direct conversations with staff were also utilized. Twelve US and five Norwegian registries were studied. Norwegian registries began in 1987, publish more clinical practice changes than US registries, are federally mandated, and operate on the national level. US registries began in 1969, are fragmented, and not mandated. The majority of US and Norwegian registries gather level II and III data, while some report level IV data. Delayed US registry adoption is due to scale, patient identification, and a multi-payer system, impediments absent in Norway. Norwegian registries produce annual reports and publish clinical improvements in open journals. We recommend similar US registry accessibility to advance patient care. Additionally, we convey that the American Joint Replacement Registry is poised to become a prodigious national registry due to high demographic diversity, data volume, and potential to collect level IV elements. Overall, US orthopaedic practice may benefit by incorporating aspects of the Norwegian registry system.
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