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ObjectiveThe aim of the study was to evaluate the incidence of peripheral inserted central catheter (PICC) tip malposition when the catheter is inserted under real-time ultrasound (RTUS) guidance when compared with conventional landmark (CL) technique in neonates. Additional objectives were to evaluate the PICC longevity and central line associated blood stream infections (CLABSI).Study designIn this randomised controlled trial, neonates were randomised to ‘RTUS’ (n = 40) or ‘CL’ (n = 40) groups. PICC tip was placed under ultrasound guidance in lower third of superior vena cava in the RTUS group. In ‘CL’ group, PICC was inserted as calculated by anatomical landmarks.ResultsThe birth weight (1286 (926, 1662) vs. 1061 (889, 1636) g) and gestation (31.12 (3.1) vs. 31.4 (3.6) wks) were comparable among the groups. RTUS guidance during PICC insertion reduced incidence of tip malposition by 52% (67.5 vs. 32.5%; RR: 0.48; 95% CI: 0.29–0.79). The longevity of PICC and episodes of CLABSI were however similar in the two groups.ConclusionsReal-time ultrasound guidance during PICC placement reduces the incidence of tip malposition.

Purpose Hearing aid fitting can be challenging when tinnitus accompanies hearing loss, as speech intelligibility and quality of life are affected by both hearing loss and tinnitus perception. However, studies focusing on the optimal hearing aid fitting for this group are scarce. Here, we aim to investigate the performance of alternative hearing aid fitting scenarios in improving hearing aid benefit and managing tinnitus. Methods Sixty-six participants were included in the study and randomly divided into three groups based on the fitting formula: NAL-NL2, DSL pediatric and hybrid gain fitting procedure (covering NAL-NL2 for low frequencies and DSL pediatric formulas for high frequencies). Hearing aid benefit was evaluated using the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire and speech perception in noise (SPIN). To evaluate tinnitus perception, psychoacoustic characteristics of tinnitus were determined, and the Tinnitus Handicap Inventory (THI) was gathered. Results The NAL-NL2 fitting procedure showed better results in hearing aid benefit and SPIN compared to the DSL pediatric procedure. In the DSL pediatric procedure, better results were obtained in tinnitus management compared to NAL-NL2. There was no difference between the hybrid fitting procedure and DSL pediatric in tinnitus management. The hybrid fitting procedure also did not differ from NAL-NL2 in SPIN and hearing aid benefit. Conclusion Here, we propose a hybrid gain fitting procedure that can be a better alternative to boost hearing aid performance and tinnitus management in clinical practice.

The number of total knee arthroplasty (TKA) procedures continuously increases, with good to excellent results. In the last few years, new surgical techniques have been developed to improve prosthesis positioning. In this context, patient-specific instrumentation is included. The goal of this study was to compare the perioperative parameters and the spatial positioning of prosthetic components in TKA procedures performed with patient-specific instrumentation vs traditional TKA. In this prospective comparative randomized study, 15 patients underwent TKA with 3-dimensional magnetic resonance imaging (MRI) preoperative planning (patient-specific instrumentation group) and 15 patients underwent traditional TKA (non–patient-specific instrumentation group). All patients underwent postoperative computed tomography (CT) examination. In the patient-specific instrumentation group, preoperative data planning regarding femoral and tibial bone resection was correlated with intraoperative measurements. Surgical time, length of hospitalization, and intraoperative and postoperative bleeding were compared between the 2 groups. Positioning of implants on postoperative CT was assessed for both groups. Data planned with 3-dimensional MRI regarding the depth of bone cuts showed good to excellent correlation with intraoperative measurements. The patient-specific instrumentation group showed better perioperative outcomes and good correlation between the spatial positioning of prosthetic components planned preoperatively and that seen on postoperative CT. Less variability was found in the patient-specific instrumentation group than in the non–patient-specific instrumentation group in spatial orientation of prosthetic components. Preoperative planning with 3-dimensional MRI in TKA has a better perioperative outcome compared with the traditional method. Use of patient-specific instrumentation can also improve the spatial positioning of both prosthetic components. [The number of total knee arthroplasty (TKA) procedures continuously increases, with good to excellent results. In the last few years, new surgical techniques have been developed to improve prosthesis positioning. In this context, patient-specific instrumentation is included. The goal of this study was to compare the perioperative parameters and the spatial positioning of prosthetic components in TKA procedures performed with patient-specific instrumentation vs traditional TKA. In this prospective comparative randomized study, 15 patients underwent TKA with 3-dimensional magnetic resonance imaging (MRI) preoperative planning (patient-specific instrumentation group) and 15 patients underwent traditional TKA (non–patient-specific instrumentation group). All patients underwent postoperative computed tomography (CT) examination. In the patient-specific instrumentation group, preoperative data planning regarding femoral and tibial bone resection was correlated with intraoperative measurements. Surgical time, length of hospitalization, and intraoperative and postoperative bleeding were compared between the 2 groups. Positioning of implants on postoperative CT was assessed for both groups. Data planned with 3-dimensional MRI regarding the depth of bone cuts showed good to excellent correlation with intraoperative measurements. The patient-specific instrumentation group showed better perioperative outcomes and good correlation between the spatial positioning of prosthetic components planned preoperatively and that seen on postoperative CT. Less variability was found in the patient-specific instrumentation group than in the non–patient-specific instrumentation group in spatial orientation of prosthetic components. Preoperative planning with 3-dimensional MRI in TKA has a better perioperative outcome compared with the traditional method. Use of patient-specific instrumentation can also improve the spatial positioning of both prosthetic components. [ Orthopedics. 2015; 38(4):e271–e280.]

Purpose The traditional fitting method for cochlear implants (CI), the single-channel fitting (SCF), is effective but time-consuming. A fitting method that is significantly faster to perform, but provides at least equivalent speech understanding and subjective benefit would be of clinical usefulness. The study explored the ability of flat strategy-based fitting (FSBF) maps to fill this need. Methods Participants were 16 experienced CI users. They were fit with: SCF maps; the maps that the participants used in their everyday lives, called fine-tuned clinical (FTC) maps; and FSBF maps. The fittings were assessed objectively via speech understanding in noise, time needed to create the map, deviation from FTC map, and correlation between auditory response telemetry thresholds and normalized charge levels; and subjectively via spectral balance and hearing quality. Results FSBF maps were significantly faster to generate. FTC maps provided the best subjective hearing quality. In all other assessments, no significant differences were found. Discussion FSBF maps can save time and provide CI users with the same level of speech understanding in noise. Participants may have preferred the FTC maps that they were already acclimated to them. These results suggest that the FSBF method could be used in first-fittings or in challenging fitting situations, but subsequent fine-tuning is required in follow-up appointments to improve sound quality. Conclusion The FSBF method can be a useful and time-saving alternative fitting method in first-fittings or in challenging fitting situations.

Purpose. To preliminarily evaluate the feasibility and accuracy of using rapid prototyping drill templates (RPDTs) for C1 lateral mass screw (C1-LMS) and C2 pedicle screw (C2-PS) placement. Methods. 23 formalin-fixed craniocervical cadaver specimens were randomly divided into two groups. In the conventional method group, intraoperative fluoroscopy was used to assist the screw placement. In the RPDT navigation group, specific RPDTs were constructed for each specimen and were used intraoperatively for screw placement navigation. The screw position, the operating time, and the fluoroscopy time for each screw placement were compared between the 2 groups. Results. Compared with the conventional method, the RPDT technique significantly increased the placement accuracy of the C2-PS (p<0.05). In the axial plane, using RPDTs also significantly increased C1-LMS placement accuracy (p<0.05). In the sagittal plane, although using RPDTs had a very high accuracy rate (100%) in C1-LMS placement, it was not statistically significant compared with the conventional method (p>0.05). Moreover, the RPDT technique significantly decreased the operating and fluoroscopy times. Conclusion. Using RPDTs significantly increases the accuracy of C1-LMS and C2-PS placement while decreasing the screw placement time and the radiation exposure. Due to these advantages, this approach is worth promoting for use in the Harms technique.

Exoskeletons and active prostheses promise to enhance human mobility, but few have succeeded. Optimizing device characteristics on the basis of measured human performance could lead to improved designs. We have developed a method for identifying the exoskeleton assistance that minimizes human energy cost during walking. Optimized torque patterns from an exoskeleton worn on one ankle reduced metabolic energy consumption by 24.2 ± 7.4% compared to no torque. The approach was effective with exoskeletons worn on one or both ankles, during a variety of walking conditions, during running, and when optimizing muscle activity. Finding a good generic assistance pattern, customizing it to individual needs, and helping users learn to take advantage of the device all contributed to improved economy. Optimization methods with these features can substantially improve performance.

Purpose There remains controversy as to whether computer-navigated total knee replacement (TKR) improves the overall prosthesis alignment and patient function. The aim of this study was to determine whether computer-assisted total knee arthroplasty provides superior prosthesis positioning when compared to a conventional jig-assisted total knee replacement and whether this affected the functional outcome. Methods This prospective, randomised controlled study compared computer navigated and conventional jig-assisted total knee replacement in 37 patients who underwent bilateral TKR. A quantitative assessment of the spatial positioning of the implant in the 74 total knee replacements was determined using a low-dose dual-beam CT scanning technique. This resulted in six parameters of alignment that were compared. Functional outcomes using the high activity arthroplasty score and Knee Society score were assessed pre-operatively, postoperatively, at three years and at five years. Patients also indicated which knee they felt was subjectively the best. Results There was no statistically significant difference in the prosthesis alignment between both groups and the number of outliers was not decreased with navigation. All function scores improved from pre-operative to postoperative but there was no statistically significant difference between the groups at five years. At five years, 40.6 % of patients thought their jig-assisted knee was the better knee compared with 21.9 % their computer assisted knee and 37.5 % of patients who felt they were the same. Conclusion Computer-assisted implantation of total knee replacements does not offer a significant advantage in prosthesis alignment. There was no difference in functional outcome or subjective “best knee” between the computer-assisted or jig-assisted knee.

PurposeThe success of total knee arthroplasty (TKA) depends on many factors. The position of a prosthesis is vitally important. The purpose of the present study was to evaluate the value of a computer-aided establishing lower extremity mechanical axis in TKA using digital technology.MethodsA total of 36 cases of patients with TKA were randomly divided into the computer-aided design of navigation template group (NT) and conventional intramedullary positioning group (CIP). Three-dimensional (3D) CT scanning images of the hip, knee, and ankle were obtained in NT group. X-ray images and CT scans were transferred into the 3D reconstruction software. A 3D bone model of the hip, knee, ankle, as well as the modified loading, was reconstructed and saved in a stereolithographic format. In the 3D reconstruction model, the mechanical axis of the lower limb was determined, and the navigational templates produced an accurate model using a rapid prototyping technique. The THA in CIP group was performed according to a routine operation. CT scans were performed postoperatively to evaluate the accuracy of the two TKA methods.ResultsThe averaged operative time of the NT group procedures was 46.8±9.1 min shorter than those of the conventional procedures ( 57.5±12.3 min). The coronal femoral angle, coronal tibial angle, posterior tibial slope were 89.4∘±1.5∘ , 89.3∘±1.4∘ , 6.8∘±1.6∘ in NT group and 87.3∘±3.8∘ , 88.1∘±1.9∘ , 10.9∘±4.6∘ in CIP group, respectively. Statistically significant group differences were found.ConclusionsThe navigation template produced through mechanical axis of lower extremity may provide a relative accurate and simple method for TKA.

This research note describes a planned project to design, implement, and evaluate remote care for adults using cochlear implants and compare their outcomes with those of individuals following the standard care pathway. Sixty people with cochlear implants will be recruited and randomized to either the remote care group or a control group. The remote care group will use new tools for 6 months: remote and self-monitoring, self-adjustment of device, and a personalized online support tool. The main outcome measure is patient empowerment, with secondary outcomes of stability in hearing and quality of life, patient and clinician preference, and use of clinic resources. The clinical trial ends in summer 2016. Remote care may offer a viable method of follow-up for some adults with cochlear implants.

We carried out a multicentre study to compare the postoperative femorotibial radiographic axis in two total knee replacement groups; one using manual instrumentation and the other using navigation. In the latter group, three navigation systems were used: Stryker, Orthopilot and Navitrack. The prior circumstances of patients in terms of age, weight, aetiology, epicondylar perimeter, patellar tendon length and knee deformity was similar in both groups. The duration of the operation was longer in the group with navigation (16.7 min). A normal femorotibial axis was more frequently obtained in the group with a navigator compared to the manual group (48.1% and 30%, respectively). A varus axis was most common in the manual group (42.2 and 26.9%, respectively). When we analysed the final postoperative radiographic axis, taking 180 degrees to be a normal result, we noted that cases where manual instrumentation was used deviated by 1.19 degrees more than those carried out with navigation, with this difference being statistically significant (P<0.001). No significant differences were found in the final angle of the extremity with the different navigation systems. The navigation systems used in this study improve the frontal angle of the arthroplasty.