What is the “safe zone” for transition of coronal alignment from systematic to a more personalised one in total knee arthroplasty? A systematic review

Purpose In total knee arthroplasty (TKA), implants are increasingly aligned based on emerging patient-specific alignment strategies, such as unrestricted kinematic alignment (KA), according to their constitutional limb alignment (phenotype alignment), which results in a large proportion of patients having a hip-knee angle (HKA) outside the safe range of ± 3° to 180° traditionally considered in the mechanical alignment strategy. The aim of this systematic review is to investigate whether alignment outside the safe zone of ± 3° is associated with a higher revision rate and worse clinical outcome than alignment within this range. Methods A systematic literature search was conducted in PubMed, Embase, Cochrane and World of Science, with search terms including synonyms and plurals for “total knee arthroplasty”, “alignment”, “outlier”, “malalignment”, “implant survival” and “outcome”. Five studies were identified with a total number of 927 patients and 952 implants. The Oxford Knee Score (OKS) and the WOMAC were used to evaluate the clinical outcome. The follow-up period was between 6 months and 10 years. Results According to HKA 533 knees were aligned within ± 3°, 47 (8.8%) were varus outliers and 121 (22.7%) were valgus outliers. No significant differences in clinical outcomes were found between implants positioned within ± 3° and varus and valgus outliers. Likewise, no significant differences were found regarding revision rates and implant survival. Conclusion The universal use of the “safe zone” of ± 3° derived from the mechanical alignment strategy is hardly applicable to modern personalised alignment strategies in the light of current literature. However, given the conflicting evidence in the literature on the risks of higher revision rates and poorer clinical outcomes especially with greater tibial component deviation, the lack of data on the outcomes of more extreme alignments, and regarding the use of implants for KA TKA that are actually designed for mechanical alignment, there is an urgent need for research to define eventual evidence-based thresholds for new patient-specific alignment strategies, not only for HKA but also for FMA and TMA, also taking into account the preoperative phenotype and implant design. It is of utmost clinical relevance for the application of modern alignment strategies to know which native phenotypes may be reproduced with a TKA. Level of evidence IV.

Zaraza nadchodzi i odchodzi – myślenie o chorobach epidemicznych utrwalone w języku

In this article, I present selected aspects of the linguistic image of the plague (I am especially interested in names and their etymology, the causes of the disease, images of the plague, and remedies). I mainly rely on materials related to Polish folk culture, but I also mention some contemporary contexts to show a certain durability of beliefs related to the plague. I use the notion of a linguistic and cultural image of the world understood as a colloquial interpretation of reality that can be explicated not only using verbal data, but also with non-verbal data preserved in petrified texts of culture. In my considerations, I refer to the so-called cognitive definition. The material basis of the analysis presented (in line with Jerzy Bartmiński’s assumptions) consists of lexical and textual data: names (confirming the “perspective of reality”), information transmitted on an onomasiological basis, revealed in the etymological and word-formation analysis, meanings given in the definitions in Polish and dialectal dictionaries, word-formation derivatives, metaphorical extensions, phraseologisms, collocations (phrases), metaphors, proverbs, healing formulas, etc. In Polish folk culture, the plague was imagined as a living creature (woman) who could roam the land (come and go), come to the village, talk to people, put them to death, or save the ones she chose to live. These images of the plague made peasants try to secure their space and to create a safe zone for themselves and their community by means of various magical procedures.

Enhanced IoT Based Child Missing Alert System Using RSSI

Our proposed system discusses the concept of a smart wearable device connected to their parent’s mobile phone for children and their parents respectively. In this project we propose that to let the system be divided into three parts, namely the safe, intermediate and danger zones. If the child is within the safe zone, then no buzzer is sounded whereas if the child is in the intermediate range a buzzer alert will be sounded. If the child crosses the ‘danger’ zone, the buzzer is sounded with an immediate notification sent to the parent. In case the child goes out of danger zone, a GPS module is attached that would help parent know the exact location of the child once he/she is outside the 100meters of radius from the parent. This project also has features to sense the child’s temperature and heartbeat along with notifying the child’s parent in case the child has an accident using the temperature, heartbeat and pressure sensors respectively. The RSSI is used for distance sensing whereas GSM is used for notification sending to the parent’s mobile phone.

Anatomical Considerations for Appropriate Mini-plate Positioning in Open-Door Laminoplasty To Avoid Plate Impingement and Screw Facet Violation

Objective This study aimed to describe a safe zone for mini-plate positioning that can avoid instrument-related complications in laminoplasty. Methods The posterior surface length and inferior pole angle of the lateral mass were measured at each level using computed tomography. The safe zone was defined based on these measurements. Incidences of screw facet violation and plate impingement were recorded. Results Among 40 patients included, 15 (37.5%) had inappropriate plate positioning, causing screw facet violation or plate impingement, which more commonly occurred at distal (C5, C6) and proximal (C3, C4) levels, respectively. Lateral mass posterior surface length was shorter at the proximal levels, and the inferior pole angle of the lateral mass was smaller at the distal levels, signifying that the lateral mass became thin and long at the distal levels. Inserting the mini-plate with plate-to-lateral mass inferior pole distances of 4–5 mm and 5–6 mm at the C3–C5 and C6–C7 levels, respectively, would avoid instrument-related complications. Conclusion The risk of plate impingement was higher at the proximal level, whereas the risk of screw facet violation was higher at the distal level in open-door cervical laminoplasty. These risks coincide with anatomical differences at each level.

Accuracy of vertebral puncture in percutaneous vertebroplasty

Purpose To clarify the accuracy of vertebral puncture of the vertebral tertile area needling (VETERAN) method puncturing the pedicle superimposed on one-third of the width between the lateral vertebral line to the contralateral medial lamina line compared with Cathelin-needle-assisted puncture (CAP) method puncturing using the Cathelin needle as a guide in percutaneous vertebroplasty. Materials and methods 449 punctures by CAP method and 125 punctures by VETERAN method were enrolled. We compared the puncture accuracy of both methods. We estimated a vertebral estimated tilting ratio (VET-ratio) defined as ratio of the distance between the lateral vertebral line and the contralateral medial laminal line to the distance between the vertebral lateral line and the puncture point measured by computed tomography. We also estimated the procedural items and clinical outcomes. Results VETERAN method with 100% of punctures within safe zone (cortical breaches within 2 mm) had significantly higher accuracy than CAP method with 97.8% (p < 0.01) for the 2 mm incremental evaluation. No cases with a VET-ratio of 36% or less had cortical breaches. VETERAN method had shorter operative time per puncture (p < 0.01) and exposure time per puncture (p < 0.05). Conclusion VETERAN method reduced the occurrence of the inaccurate puncture, operative times, and exposure times. A VET-ratio with 36% or less is associated with a safe puncture using VETERAN method.