Surgical Management of Lumbar Spinal Canal Stenosis with Instrumentation at the Yaounde Central Hospital: Comparison of Unilateral versus Bilateral Pedicle Screw Fixation Combined with Transforaminal Lumbar Interbody Fusion

Introduction: The choice of adopting unilateral pedicle screw fixation or using bilateral pedicle screw fixation in lumbar spinal stenosis remains controversial. In our context, very few studies have been performed comparing the clinical effectiveness of unilateral versus bilateral fixation in the surgical management of lumbar spinal canal stenosis. Objective: Evaluate the impact on quality of life and clinical efficacy of unilateral spondylodesis compared to bilateral spondylodesis in the surgical management of lumbar spinal canal stenosis at the Yaounde Central Hospital. Methods: This was a retrospective descriptive cross-sectional study for a period of 4 years, from June 2015 to June 2019. It involved all patients operated for lumbar canal stenosis and who underwent spondylodesis or spinal fusion at the neurosurgery department of the Yaounde Central Hospital. Results: A total of 68 participants were recruited during our study period. 32 (47%) of the study population were in the 50 - 60 age group, with a mean age of 56.98 years ranging from 41 to 75 years. Females, housewives and farmers were the most affected. In our study, 72% of patients had unilateral spondylodesis and 28% had bilateral fusion. Preoperatively, 71% of patients had insurmountable pain, refractory to medical treatment. At 3 months postoperatively, 73.7% of patients with bilateral setup had moderate pain compared to 69% of those with unilateral setup. At 6 months postoperatively, 79% of patients with bilateral fusion had mild pain compared to 82% of patients with unilateral setup. At 1 year postoperatively, all patients had mild pain. Preoperatively, 66.2% of patients were unable to walk and 19.1% of patients were bedridden according to the Oswestry score. At 3 months postoperatively, 10.2% of patients with unilateral setup were unable to walk compared to 10.5% of patients with bilateral fixation, while 67.3% of patients with unilateral fixation had moderate disability compared to 52.6% of patients with bilateral fixation. At 6 months postoperatively, 51% of patients with unilateral setup had moderate disability compared to 47.4% of patients with bilateral fixation, while 42.9% of patients with unilateral fixation had mild disability compared to 42.1% of patients with bilateral fixation. At 1 year postoperatively, 81.6% of patients who underwent unilateral fixation had only mild disability compared to 73.7% of patients with bilateral fixation. Conclusion: The assessment of quality of life according to the set-up used shows similar results at 3 months, 6 months and 1 year, with no statistically significant differences. Single-sided pedicle screw fixation combined with transforaminal lumbar interbody fusion or mounting has the advantage of being faster, with less bleeding and is less expensive compared to bilateral fixation.

Cost-effectiveness of patient specific vs conventional instrumentation for total knee arthroplasty:A systematic review and meta-analysis

BACKGROUND Over the past years,patient specific instrumentation(PSI)for total knee arthroplasty(TKA)has been implemented and routinely used.No clear answer has been given on its associated cost and cost-effectiveness when compared to conventional instrumentation(CI)for TKA.AIM To compare the cost and cost-effectiveness of PSI TKA compared to CI TKA.METHODS A literature search was performed in healthcare,economical healthcare,and medical databases(MEDLINE,EMBASE,CINAHL,Web of Science,Cochrane Library,EconLit).It was conducted in April 2021 and again in January 2022.Relevant literature included randomised controlled trials,retrospective studies,prospective studies,observational studies,and case control studies.All studies were assessed on methodological quality.Relevant outcomes included incremental cost-effectiveness ratio,quality-adjusted life years,total costs,imaging costs,production costs,sterilization associated costs,surgery duration costs and readmission rate costs.All eligible studies were assessed for risk of bias.Meta-analysis was performed for outcomes with sufficient data.RESULTS Thirty-two studies were included into the systematic review.Two were included in the metaanalysis.3994 PSI TKAs and 13267 CI TKAs were included in the sample size.The methodological quality of the included studies,based on Consensus on Health Economic Criteria-scores and risk of bias,ranged from average to good.PSI TKA costs less than CI TKA when considering mean operating room time and its associated costs and tray sterilization per patient case.PSI TKA costs more compared to CI TKA when considering imaging and production costs.Considering total costs per patient case,PSI TKA is more expensive in comparison to CI TKA.Meta-analysis comparing total costs for PSI TKA,and CI TKA showed a significant higher cost for PSI TKA.CONCLUSION Cost for PSI and CI TKA can differ when considering distinct aspects of their implementation.Total costs per patient case are increased for PSI TKA when compared to CI TKA.

The CCD instrument background of the SMILE SXI

The ESA and CAS SMILE mission orbit is highly elliptical and will pass through multiple radiation environments.The Soft X-ray Imager(SXI)instrument aboard has a radiation shutter door designed to close when the surrounding radiation flux is high.The shutter door will close when passing below an altitude threshold to protect against trapped particles in the Earth’s Van Allen Belts.Therefore,two radiation environments can be approximated based on the shutter door position:open and closed.The instrument background for the CCDs(Charge-Coupled Devices)that form the focal plane array of the SXI were evaluated for the two environments.Due to the correlation of the space environment with the solar cycle,the solar minima and maxima,the background was also evaluated at these two extremes.The results demonstrated that the highest instrument background will occur during solar minima due to the main contributing source being Galactic Cosmic Rays(GCRs).It was also found that the open background was highest for solar minima and that the closed background was highest during solar maxima.This is due to the radiation shutter door acting as a scattering centre and the changes in the energy flux distribution of the GCRs between the two solar extremes.

Journal of Measurement Science and Instrumentation

Journal of Measurement Science and Iustrumentation(CN14-1357/TH,ISSN 1674-8042)is published by North University of China.It is a comprehensive academic journal,aiming to present scientifie research papers in the fields of measurement science and instrumentation,ineluding general and instrumentation of measurement and control applied to such academie and industrial fields asprineiples.

AVEVA Instrumentation Engineer在仪表系统设计中的应用研究

本文分析AVEVA Instrumentation软件功能模块Engineer在仪表系统设计中的应用。重点探讨借助AVEVA Instrumentation软件实现跨专业、跨软件的数据交互开发及仪表专业清单文件、数据表的模板定制。

Metallosis with spinal implant loosening after spinal instrumentation:A case report

BACKGROUND Spinal metallosis is a rare complication following spinal instrumentation whereby an inflammatory response to the metal implants results in the development of granulomatous tissue.CASE SUMMARY We describe the case of a 78-year-old woman who had recurrence of back pain 5 years after lumbar spine posterior decompression and instrumented fusion.Lumbar spine radiographs showed hardware loosening and magnetic resonance imaging showed adjacent segment disease.Revision surgery revealed evidence of metallosis intraoperatively.CONCLUSION Spinal metallosis can present several years after instrumentation.Radiography and computed tomography may demonstrate hardware loosening secondary to metallosis.Blood metal concentrations associated with spinal metallosis have yet to be established.Hence,metallosis is still an intraoperative and histopathological diagnosis.The presence of metallosis after spinal instrumentation likely indicates a more complex underlying problem:Pseudarthrosis,failure to address sagittal balance,infection,and cross-threading of set screws.Hence,identifying metallosis is important,but initiating treatment promptly for symptomatic implant loosening is of greater paramount.

Exploring the Mysteries of the Universe, and Innovation Leading the Future——Astronomical Techniques and Instruments

Dear Readers:Astronomical Techniques and Instruments is a professional English journal of open access devoted to recent develop-ments,discoveries,and theories in astronomical techniques,methods,and instruments.It will serve as a platform for dis-course,learning,and information sharing for astronomic and astrophysics professionals worldwide.

Femoral Access with Ultrasound-Guided Puncture and Z-Stitch Hemostasis for Adults with Congenital Heart Diseases Undergoing Electrophysiological Procedures

Aims:Although the application of ultrasound-guided vascular puncture and Z-stitch hemostasis to manage femoral access has been widely utilized,there is limited data on this combined application in adult congenital heart disease(ACHD)patients undergoing electrophysiological(EP)procedures.We sought to evaluate the safety and efficacy of ultrasound-guided puncture and postprocedural Z-stitch hemostasis for ACHD patients under-going EP procedures.Methods and Results:The population of ACHD patients undergoing transfemoral EP pro-cedures at the University of Zurich Heart Center between January 2019 and December 2022 was observed and analyzed.During the study period,femoral access(left/right,arterial/venous)was performed under real-time ultrasound guidance.At the end of the procedure,a single Z-stitch was performed at the puncture site.We eval-uated the incidence of in-hospital complications associated with femoral access puncture in this population.Among 101 patients who had a total of 147 previous ipsilateral vascular punctures(mean 1.5 per person),100 patients underwent successful femoral vascular access for EP procedures.The median age of the patients was 47±15 years and 34(34%)were male.Z-stitches were performed after the procedure in 100 patients with 303 femoral vascular accesses(mean 3 punctures per person).No patient developed vascular puncture relevant inguinal hematoma,pseudo aneurysm,arteriovenousfistula,venous or arterial thrombosis.Conclusion:In ACHD patients undergoing EP procedures,optimal femoral access management can be achieved with ultra-sound-guided puncture and postprocedural Z-stitch hemostasis.

Active Micro-Nano-Collaborative Bioelectronic Device for Advanced Electrophysiological Recording

The development of precise and sensitive electrophysiological recording platforms holds the utmost importance for research in the fields of cardiology and neuroscience.In recent years,active micro/nano-bioelectronic devices have undergone significant advancements,thereby facilitating the study of electrophysiology.The distinctive configuration and exceptional functionality of these active micro-nano-collaborative bioelectronic devices offer the potential for the recording of high-fidelity action potential signals on a large scale.In this paper,we review three-dimensional active nano-transistors and planar active micro-transistors in terms of their applications in electroexcitable cells,focusing on the evaluation of the effects of active micro/nano-bioelectronic devices on electrophysiological signals.Looking forward to the possibilities,challenges,and wide prospects of active micro-nano-devices,we expect to advance their progress to satisfy the demands of theoretical investigations and medical implementations within the domains of cardiology and neuroscience research.

Reform of Teaching Practice of Modern Instrumental Analysis in Biotechnology Programs

Through the online and offline practical reform of the Modern Instrumental Analysis course of biotechnology majors from teaching content,teaching method,teaching demonstration to teaching effect,the traditional single offline lecture is transformed into diversified and interactive modern teaching.The practical reform enriches and optimizes the course content,perfects and improves the course assessment system,and improves the teaching quality.It achieves the student-centered and application-oriented teaching goal,and also provides reference for further cultivating high-quality applied talents.

Application of an electrophysiological technique combined with auricular acupuncture in gynecological perioperative gastrointestinal dysfunction

Objective:This study aimed to evaluate the effectiveness and safety of combining low-frequency pulsed electrophysiological techniques with auricular acupuncture(a fusion of traditional Chinese and Western medicine)for patients experiencing perioperative gastrointestinal dysfunction(POGD)following gynecological surgery.Methods:Eighty patients undergoing gynecological surgery were randomly assigned to an experimental group and a control group.Both groups received enhanced recovery after surgery(ERAS)care,with the experimental group receiving additional treatment combining electrophysiology and auricular acupuncture.Postoperative recovery indicators,including bowel sound recovery time,time to first exhaust and defecation,duration and incidence of abdominal pain and distension,nausea and vomiting,and specific gastrointestinal markers(HSP70,I-FABP,DAO,D-lactate),were monitored and compared between the two groups.Results:After treatment,the postoperative bowel sound recovery time,first postoperative exhaust time,duration of abdominal pain,and duration of abdominal distension were shorter in the experimental group than in the control group(P<0.05).The 6-hour and 48-hour integral values of the experimental group were significantly lower than those of the control group.In the experimental group,60%of the patients were completely cured of gastrointestinal function after surgery,whereas only 32.5%of the patients in the control group were cured.The main symptom scores(abdominal pain,abdominal distension,nausea and vomiting)on the third postoperative day and the total symptom scores on the third postoperative day were significantly lower in the experimental group than in the control group(P<0.05).The values of HSP70,I-FABP,DAO,and D-lactate in the experimental group on postoperative day one were significantly lower than those in the control group(P<0.05).Conclusion:The combination of the Chinese and Western medicine ERAS programs of low-frequency pulse electrophysiology technology plus auricular acupuncture can accelerate local gastrointestinal blood circulation during the perioperative period of gynecology,promote the recovery of gastrointestinal function,promote anal exhaustion,and prevent the occurrence of postoperative abdominal pain and bloating.The combination of Chinese and Western medicine ERAS can increase gastrointestinal fluid secretion,increase gastrointestinal hormone and blood flow values,increase gastrointestinal electrophysiological detection values,and change the indicators of gastrointestinal dysfunction.

Development and validation of an instrument to assess knowledge,attitudes,and practices on digital health among nursing officers

Objective:Validation is an important aspect of an instrument,and it ensures the confidence of researchers to employ the instrument in their studies.This study was conducted to develop and validate an instrument to assess knowledge,attitudes,and practices(KAP) on digital health among nurses since digital health capacity is a major concern in health care that needs to be assessed.Methods:We conducted a methodological study to assess the content validity and reliability of the instrument.First,items were generated through a comprehensive literature review and by obtaining an expert opinion.Second,content and face validity were assessed by a panel of 7 experts.Both the item-level content validity index(I-CVI) and the scale-level content validity index(S-CVI) were established.Moreover,test–retest reliability and internal consistency of the instrument were assessed.Data were analyzed using SPSS version 25.Results:The initial pool consisted of 60 items and after obtaining content,face,and construct validity,51 items remained.Items with an I-CVI <0.78 were considered relevant.The S-CVI for relevancy,clarity,ambiguity,and simplicity were 0.93,0.91,0.94,and 0.92,respectively.Five subcomponents were constructed in each knowledge and attitudes domain,and the test–retest reliability test revealed that the instrument has good reliability,showing correlation coefficient values for the KAP domains and the total questionnaire of 0.76,0.98,0.99,and 0.99,respectively.The independent Cronbach's α for all items was 0.76,indicating good internal consistency.Conclusions:The present study established the acceptable validity and ensured the good reliability and internal consistency of the instrument,which can serve as an assessment tool of KAP on digital health among healthcare professionals.

Analysis Of Urban Planning Instruments in Comala,Colima,Mexico(1997-2009)from a Gender Perspective-A Secondary Publication

This work is carried out based on the analysis of urban planning instruments,taking the gender perspective as a foundation.It arises from the inclusion of women in the participation of urban development,through an analysis of the gender gaps that have marked the history of women,the inequalities serve as a basis for carrying out this study.It highlights the challenges we face today as a society in the process of building citizen participation,where we must all be recognized and have equal opportunities within the territory in which we live.This article analyzes the extent to which the Municipal Urban Development Programs of the Mexican municipality of Comala,Colima,Mexico,consider the recommendations on gender and urbanism,established since the 1990s by international entities and applied transversally to urban planning policies.Considerable differences are found between women and men in terms of empowerment and participation in urban territorial planning instruments,mainly in the oldest instrument(1997).Significant progress is observed in the most recent document and is currently in force in the municipality of Comala(2009).

Instrument Automation Control System Faults and Maintenance

This article explores the topic of fault diagnosis and maintenance strategies for instrument automation control systems,analyzing them through specific cases.The aim of this research is to improve the stability and reliability of the system by conducting a thorough investigation of faults and maintenance in instrument automation control systems.By doing so,this research hopes to provide a strong guarantee for the smooth progress of industrial production.

Design of Signal Lamp Filament Monitoring Alarm Instrument

To improve the reliability of the light emitting diode(LED)signal lamp filament current monitoring alarm instrument for metro systems,a new type of hot standby online monitoring apparatus was developed which is based on synchronous transmission data(STD)bus technology.In this system,a double hot standby mode can be achieved by adopting bus arbitration.In addition,to detect the effective value of alternating current which is from 0 to 200 mA in the signal lamp lighting circuit,a precision rectifier signal conditioning circuit and an isolated acquisition circuit were designed.This new type of alarm instrument has high detection accuracy and could meet the functional requirements for metro signal systems after comparing it with some industry products that were applied on the spot.

浅析AVEVA Instrumentation在仪表设计中的应用

设计领域数字化转型是产业数字化的重要方向,各种专业设计软件强大的数据存储和处理能力,可以为制造业数字化转型提供大量的数据源。为了借助各种专业软件实现业务需求及数据需求,需要对各种专业设计软件进行大量的二次开发工作。AVEVA系列软件作为石化行业主流设计软件,对于设计领域的数字化转型尤为重要。本文基于海上石油平台仪表设计的工作流程,从仪表专业设计的角度分析了AVEVA INSTRUMENTION的各个功能模块及其在相关专业间的协同设计应用,重点探讨围绕VEVA INSTRUMENTION各功能模块进行的规则库、属性库、材料目录库等标准数据库的开发,经导航项目测试效果良好,为海洋工程设计领域的数字化转型奠定了良好的基础,也为后续的实际项目应用及二次开发具有一定的借鉴作用。

Effect of iron overload on electrophysiology of slow reaction autorhythmic cells of left ventricular outflow tract in guinea pigs

Objective: To investigate the electrophysiology effects and mechanism of iron overload on the slow response autorhythmic cells in the left ventricular outflow tract of guinea pigs.Methods: Standard microelectrode cell recording techniques were adopted to observe the electrophysiological effects of different concentrations of Fe^(2+)(100 μmol/L, 200 μmol/L) on the left ventricular outflow tract autorhythmic cells.Heart tissues were perfused with FeSO_4(200 μmol/L) combing with CaCl_2(4.2 mmol/L), Verapamil,(1 μmol/L), and nickel chloride(200μmol/L) respectively to observe the influences of these contents on electrophysiology of FeSO_4(200μmol/L) on the left ventricular outflow tract autorhythmic cells.Results: Fe^(2+)at both 100 μmol/L and 200 μmol/L could change the electrophysiological parameters of the slow response autorhythmic cells of the left ventricular outflow tract in a concentrationdependent manner resulting into decrease in Vmax, APA and MDP, slower RPF and VDD, and prolonged APD_(50) and APD_(90)(P all <0.05).Besides, perfusion of increased Ca^(2+) concentration could partially offset the electrophysiological effects of Fe^(2+)(200 μmol/L).The L-type calcium channel(LTCC) blocker Verapamil(1 μmol/L) could block the electrophysiological effects of Fe^(2+)(200 μmol/L).But the T-type calcium channel(TTCC) blocker nickel chloride(NiCl_2, 200 μmol/L) could not block the electrophysiological effects of Fe^(2+)(200 μmol/L).Conclusions: Fe^(2+) can directly change the electrophysiological characteristics of the slow response autorhythmic cells of the left ventricular outflow tract probably through the L-type calcium channel.

Computerised tomography vs magnetic resonance imaging for modeling of patient-specific instrumentation in total knee arthroplasty

AIM: To summarise and compare currently available evidence regarding accuracy of pre-operative imaging, which is one of the key choices for surgeons contemplating patient-specific instrumentation(PSI) surgery.METHODS: The MEDLINE and EMBASE medical literature databases were searched, from January 1990 to December 2013, to identify relevant studies. The data from several clinical studies was assimilated to allow appreciation and comparison of the accuracy of each modality. The overall accuracy of each modality was calculated as proportion of outliers > 3% in the coronal plane of both computerised tomography(CT) or magnetic resonance imaging(MRI). RESULTS: Seven clinical studies matched our inclusion criteria for comparison and were included in our study for statistical analysis. Three of these reported series using MRI and four with CT. Overall percentage of outliers > 3% in patients with CT-based PSI systems was 12.5% vs 16.9% for MRI-based systems. These results were not statistically significant. CONCLUSION: Although many studies have been undertaken to determine the ideal pre-operative imaging modality, conclusions remain speculative in the absence of long term data. Ultimately, information regarding accuracy of CT and MRI will be the main determining factor. Increased accuracy of pre-operative imaging could result in longer-term savings, and reduced accumulated dose of radiation by eliminating the need for post-operative imaging and revision surgery.

Current concepts in total knee arthroplasty: Patient specific instrumentation

Patient specific instrumentation(PSI) in total knee arthroplasty(TKA) promises faster operation time(by using less instruments and individual cutting jigs), less blood loss, faster rehabilitation, better implant sizing and accuracy, superior overall outcome, and at the end- less costs. However, as evident for every new development, its superiority remains to be provenover the conventional systems. Whilst dissatisfaction is reported to be eminent in up to 30% of patients having undergone conventional TKA, it is unclear, whether PSI can address to these patients as a suitable option in the future. The author believes that the current evidence does not support superiority of PSI in TKA over conventional systems. However, future long-term level I and II studies might aid to show its cost-effectiveness stating same results, accuracy, and overall outcome with less operation time.

Anesthetic Technique for Transesophageal Electrophysiology Studies in Pediatric Patients with Wolff-Parkinson-White Syndrome

Objective: Patients with Wolff-Parkinson-White (WPW) Syndrome require risk assessment to determine their potential for sudden cardiac death. Transesophageal electrophysiology studies (TEEPS) are an effective risk stratification tool. The purpose of this study is to describe a minimially invasive, effective anesthetic technique to employ during transesophageal electrophysiology studies. Methods: A retrospective review of anesthetic technique utilized during TEEPS. Inclusion criteria;WPW on ECG;age <18 years;and no history of tachycardia, palpitations, or syncope and patient had TEEPS under monitored anesthesia care (MAC). Midazolam, Fentanyl, and Propofol were used in various combinations. Sevoflurane was used during induction period in all GA cases and discontinued 10 minutes prior to initiation of TEEPS. Results: Inclusion criteria were met by 20 patients with an average age of 11.9 years, average weight of 48.9 kg and average height of 149.2 cm. IV sedation was performed on 15%, MAC on 10% and GA in remainder. Airway management techniques included 13.3% LMA, 20% endotrachael tube (ETT) and 66% mask. IV sedation, the initial anesthetic, was found to be cumbersome and uncomfortable. Next was ETT and LMA but trouble pacing was encountered due to positional change of the esophagus relative to the left atrium during ventilation. Mask induction was then performed in remaining 10 patients with TEEPS probe inserted through a nare while anesthesiologist continued mask ventilation. All mask procedures were successful without complications. Conclusions: Induction of anesthesia to perform TEEPS procedures on pediatric patients with Wolff-Parkinson-White syndrome underwent numerous attempts to make the procedure easy, reliable and reproducible for anesthesia and electrophysiologist. The eventual technique that proved to meet these criteria during a transesopheagel electrophysiology procedure was utilization of mask induction with continuous IV sedation.