Prioritization of Patients with Abnormal Breast Findings in the Alerta Rosa Navigation Program to Reduce Diagnostic Delays

IntroductionIn Mexico, there are considerable health system delays in the diagnosis and treatment initiation of women with breast cancer. Alerta Rosa is a navigation program in Nuevo Leon that aims to reduce barriers that impede the timely management of these patients.Patients and MethodsSince December 2017, women who registered to receive medical evaluations by Alerta Rosa were stratified based on their clinical characteristics into three priority groups (“Red,” “Yellow,” and “Green”). According to the category assigned, patients were scheduled imaging studies and medical appointments with breast specialists on a preferential basis.ResultsUp until December 2019, 561 patients were scheduled for medical evaluations. Of them, 59% were classified as “Red,” 25% “Yellow,” and 16% “Green” priority. The median time from stratification to first medical evaluation was 4, 6, and 7 days, respectively (p = .003). Excluding those who had a prior breast cancer diagnosis, 21 patients were diagnosed by Alerta Rosa, with the initial “Red” priority classification demonstrating a sensitivity of 95% (95% confidence interval [CI], 75.1%–99.9%) and specificity of 42% (95% CI, 37.1%–47.1%) for breast cancer. The median time elapsed from initial patient contact to diagnosis and treatment initiation was 16 days and 39 days, respectively. The majority (72%) of patients were diagnosed at an early stage (0–II).ConclusionThis patient prioritization system adequately identified women with different probabilities of having breast cancer. Efforts to replicate similar triage systems in resource‐constrained settings where screening programs are ineffective could prove to be beneficial in reducing diagnostic intervals and achieving early‐stage diagnoses.Implications for PracticeLow‐ and middle‐income countries such as Mexico currently lack the infrastructure to achieve effective breast cancer screening and guarantee prompt access to health care when required. To reduce the disease burden in such settings, strategies targeting early detection are urgently needed. Patient navigation programs aid in the reduction of health system intervals and optimize the use of available resources. This article presents the introduction of a triage system based on initial patient concern. Appointment prioritization proved to be successful at reducing health system intervals and achieving early‐stage diagnoses by overcoming barriers that impede early access to quality medical care.     

Intraoperative three-dimensional navigation for surgical treatment of osteoid osteoma in the foot and ankle – A series of 14 cases

BackgroundThe surgical treatment for osteoid osteoma (OO) in the foot and ankle is challenging. It is difficult to locate the lesion and the anatomy is crowded by sensitive structures. The purpose of this study was to describe the outcomes of navigated mini open-intralesional curettage (NMIC) or navigated minimally invasive radiofrequency ablation (NMRFA) in treating these lesions.MethodsAll patients who underwent surgery for OO in the foot and ankle between 2015 and 2020 were included. O-arm navigation was used in All procedures. The choice of NMIC versus NMRFA was made by the surgeon according to the location of the lesion and its proximity to sensitive anatomic structures.ResultsFourteen patients were included. Ten were operated by NMRFA and 4 by NMIC. All patients’ symptoms related to OO resolved following a single procedure. Average AOFAS score increased by 18.7 (P < .001). Three patients had the following complications: pathologic fracture, superficial infection and transient deep peroneal nerve sensory loss.ConclusionNavigated surgical treatment of OO in the foot and ankle is accurate, efficient and safe.     

The Glenoid Vault Outer Cortex (GVOC) radiological reference for shoulder arthroplasty evaluated in aging scapulae

BackgroundAccurate glenoid component positioning is an important determinant of outcome in a shoulder arthroplasty surgery. Optimal glenoid placement is determined using bony landmarks of the scapula. The Glenoid Vault Outer Cortex (GVOC) has been recently described as a new, more accurate radiological reference. This has, however, only been evaluated against current standard references in young patients. Further investigation of the GVOC in older patients is therefore warranted. We, therefore, evaluated the effect of aging on the accuracy and stability of the GVOC, in determining glenoid anatomy as compared to the commonly used Scapular Border (SB) plane.MethodsComputed tomography imaging of 129 individual scapulae was obtained retrospectively from a cohort of patients who had undergone either total body or region-specific computed tomography imaging which included the shoulder region. This comprised of 35 males and 33 females (64 and 65 scapulae respectively) who were aged from 30 to 92 years. Imaging of 54 scapulae was from patients aged ≥60 years. The accuracy of the GVOC plane was then assessed against the SB plane.ResultsIn all patients, the mean difference between estimates using the GVOC plane and the GR (actual) was 2.2° (standard deviation [SD], 4.2) for version, and 1.8° (SD, 4.9) for inclination (P < .001). This contrasted with values of 7.6° (SD, 7.6) for version, and 22.9° (SD, 10.8) for inclination when using the SB reference plane (P < .001). Within the group aged ≥60 years, the mean difference between estimates using the GVOC plane and the glenoid rim (actual) was 3.2° (SD, 4.7) for version and 1.9° (SD, 3.1) for inclination, (P < .001). This contrasted to 10.0° (SD, 7.2) for version, and 23.4° (SD, 10.7) for inclination when using the SB plane (P < .001).Separately it was noted that the GVOC’s relationship to the glenoid rim remained constant throughout aging as opposed to the SB which changed significantly over time effecting estimates of glenoid retroversion.ConclusionsThe GVOC is a new plane of reference developed specifically for the use in shoulder arthroplasty. It is shown to be more accurate and stable in the aging scapulae than the currently used SB plane. The future development of guides and planning softwares that utilize the GVOC may provide an important opportunity for improved accuracy and outcome in shoulder arthroplasty.     

肝胆外科从数字虚拟人、三维可视化到数字智能化发展的现状

数字智能化肝胆外科的发展经历了十几年的演进过程,从数字虚拟人技术到质控化、同质化三维可视化精准诊疗体系的建立;从三维可视化到数字智能化技术临床转化及诊疗模式的转换;实现了疾病的经验性诊断到深度学习智能化诊断与治疗和经验性手术到多模态影像实时手术导航的技术创新;从肿瘤的形态学诊断深入到分子影像学精准诊断的研究。在这个过程中只有不断地进行研究创新、理论创新和技术创新才能给数字智能化外科赋予新的生命力。未来,从关键分子功能可视化实现肝癌分子、细胞层面边界界定和早诊早治,对改变肝癌患者肝切除术后的预后具有重大的临床价值。此外,为了实现智能化肝切除手术导航,突破技术瓶颈,研发具有自动导航技术、机器学习智能规划技术和多模态影像融合技术的智能化机器人实时导航肝切除手术系统具有重要的临床意义,给数字智能化肝胆外科的发展带来了新的机遇和挑战。     

Anatomical features of tibia and femur: Influence on laxity in the anterior cruciate ligament deficient knee

Background

Until now, there has been a lack of in vivo analysis of the correlation between bony morphological features and laxity values after an anterior cruciate ligament (ACL) injury.

The relationship between anteroposterior stability and medial–lateral stability of the bi-cruciate stabilized total knee arthroplasty

Background

Acquisition of appropriate anteroposterior (AP) stability depends on the prosthetic design and intraoperative soft tissue handling. A bi-cruciate stabilized (BCS) total knee arthroplasty (TKA) has a two cam-post mechanism, which substitutes for the anterior cruciate ligament and posterior cruciate ligament (PCL). Therefore, appropriate AP stability is expected. Because the PCL is sacrificed during BCS TKA, medial stability and lateral stability are thought to be important factors to determine AP stability. However, no previous study has reported AP stability after BCS TKA and the relationship between AP and medial–lateral stability.

Evaluation of two dental registration-splint techniques for surgical navigation in cranio-maxillofacial surgery

BackgroundSurgical navigation requires precise registration of the pre-operative image dataset to the patient in the operation theatre. Different marker-based and marker-free registration techniques are available, each of them with advantages and disadvantages regarding precision and clinical handling. In this model study, the precision of two dental splint techniques for marker-based registration is analyzed.Materials and methodsA synthetic full-size human skull was registered with its cone beam computed tomography dataset using (a) a dentally-mounted “rapid” occlusal splint with five titanium screws directly attached to the splint, (b) an “extender”, a dentally-mounted occlusal splint with similar fiducials fixed to an extension of the splint. The target registration error was measured for 170 landmarks distributed over the viscero- and neurocranium in 10 repeats per splint type using the Vector Vision² (BrainLAB AG, Heimstetten, Germany) navigation system. Statistical and graphical evaluations were performed per anatomical region.ResultsIn the periorbital region, the rapid splint, with an average deviation of 1.50 mm (SD = 0.439) showed greater accuracy than the extender with 1.76 mm (SD = 0.525). The viscerocranial results for both splints were similar (extender 1.84 mm, SD = 0.559, rapid occlusal splint 1.86 mm, SD = 0.686). In the cranial vault region, registration with the extender (2.33 mm, SD = 0.685) proved to be more precise than with the rapid splint (2.86 mm, SD = 0.929).ConclusionsDue to the more compact dimension of the rapid occlusal splint, errors close to the splint were smaller compared to the extender technique. The advantage of greater distances between the registration fiducials on the extender is particularly important in areas such as the orbital roof, the cranial vault, and the lateral skull base.