Mechanical and structural characteristics of the new BONE-LOK cortical-cancellous internal fixation device

The purpose of this study was to evaluate the structural and mechanical characteristics of a new and unique titanium cortical-cancellous helical compression anchor with BONE-LOK (Triage Medical, Inc., Irvine, CA) technology for compressive internal fixation of fractures and osteotomies. This device provides fixation through the use of a distal helical anchor and a proximal retentive collar that are united by an axially movable pin (U.S. and international patents issued and pending). The helical compression anchor (2.7-mm diameter) was compared with 3.0-mm diameter titanium cancellous screws (Synthes, Paoli, PA) for pullout strength and compression in 7# and 12# synthetic rigid polyurethane foam (simulated bone matrix), and for 3-point bending stiffness. The following results (mean +/- standard deviation) were obtained: foam block pullout strength in 12# foam: 2.7-mm helical compression anchor 70 +/- 2.0 N and 3.0-mm titanium cancellous screws 37 +/- 11 N; in 7# foam: 2.7-mm helical compression anchor 33 +/- 3 N and 3.0-mm titanium cancellous screws 31 +/- 12 N. Three-point bending stiffness, 2.7-mm helical compression anchor 988 +/- 68 N/mm and 3.0-mm titanium cancellous screws 845 +/- 88 N/mm. Compression strength testing in 12# foam: 2.7-mm helical compression anchor 70.8 +/- 4.8 N and 3.0-mm titanium cancellous screws 23.0 +/- 3.1 N, in 7# foam: 2.7-mm helical compression anchor 42.6 +/- 3.2 N and 3.0-mm titanium cancellous screws 10.4 +/- 0.9 N. Results showed greater pullout strength, 3-point bending stiffness, and compression strength for the 2.7-mm helical compression anchor as compared with the 3.0-mm titanium cancellous screws in these testing models. This difference represents a distinct advantage in the new device that warrants further in vivo testing.     

A Review of Emerging Access Technologies for Individuals With Severe Motor Impairments

Research and development in the field of access technologies for individuals with severe motor impairments has accelerated over the past 10 years. Many emergent alternatives to conventional mechanical switches, such as infrared sensing, electromyography, oculography, and computer vision, have been investigated for those retaining some limited volitional motor ability. At the same time, electroencephalography, electrocorticography, intracortical recordings, and electro-dermal activity have been explored for those presenting as locked in. The relevant literature is scattered across many disciplines, obfuscating the strength of the clinical evidence in support of the different access technologies currently in development. This article systematically organizes the literature on the aforementioned access technologies, summarizing their underlying operational mechanisms while reviewing the clinical evidence reported between 1996 and 2006. Research evidence within this period is generally found to be at the case study or uncontrolled study level, with very modest sample sizes. Novel mechanical switches and electroencephalography-based access systems dominate the literature, whereas many other movement-based access modalities have emerged with promising early findings. Access methods for those without extant physical movement constitute a critical direction for future and ongoing research efforts.     

Influence of residency training on multiple attempts at endotracheal intubation

Purpose

Endotracheal intubation (ETI) of critically ill patients is a high-risk procedure that is commonly performed by resident physicians. Multiple attempts (≥2) at intubation have previously been shown to be associated with severe complications. Our goal was to determine the association between year of training, type of residency, and multiple attempts at ETI.

Methods

This was a cohort study of 191 critically ill patients requiring urgent intubation at two tertiary care teaching hospitals in Vancouver, Canada. Multivariable logistic regression was used to model the association between postgraduate year (PGY) of training and multiple attempts at ETI.

Results

The majority of ETIs were performed for respiratory failure (68.6%) from the hours of 07:00–19:00 (60.7%). Expert supervision was present for 78.5% of the intubations. Multiple attempts at ETI were required in 62%, 48%, and 34% of patients whose initial attempt was performed by PGY-1, PGY-2, and PGY-3 non-anesthesiology residents, respectively. Anesthesiology residents required multiple attempts at ETI in 15% of patients, regardless of the year of training. The multivariable model showed that both higher year of training (risk ratio [RR] 0.74; 95% confidence interval [CI] 0.54-0.93; P < 0.01) and residency training in anesthesiology (RR 0.52; 95% CI 0.20-1.0; P = 0.05) were independently associated with a decreased risk of multiple intubation attempts. Finally, intubations performed at night were associated with an increased risk of multiple intubation attempts (RR 1.3; 95% CI 1.0-1.4; P = 0.03).

Conclusion

Year of training, type of residency, and time of day were significantly associated with multiple tracheal intubation attempts in the critical care setting.     

A contemporary review of machine learning in otolaryngology–head and neck surgery

One of the key challenges with big data is leveraging the complex network of information to yield useful clinical insights. The confluence of massive amounts of health data and a desire to make inferences and insights on these data has produced a substantial amount of interest in machine-learning analytic methods. There has been a drastic increase in the otolaryngology literature volume describing novel applications of machine learning within the past 5 years. In this timely contemporary review, we provide an overview of popular machine-learning techniques, and review recent machine-learning applications in otolaryngology–head and neck surgery including neurotology, head and neck oncology, laryngology, and rhinology. Investigators have realized significant success in validated models with model sensitivities and specificities approaching 100%. Challenges remain in the implementation of machine-learning algorithms. This may be in part the unfamiliarity of these techniques to clinician leaders on the front lines of patient care. Spreading awareness and confidence in machine learning will follow with further validation and proof-of-value analyses that demonstrate model performance superiority over established methods. We are poised to see a greater influx of machine-learning applications to clinical problems in otolaryngology–head and neck surgery, and it is prudent for providers to understand the potential benefits and limitations of these technologies. Laryngoscope, 130:45–51, 2020     

Extragastric diseases associated with Helicobacter pylori infection

This paper critically reviews the current literature on extragastric diseases associated with Helicobacter pylori infection, with an emphasis on methodologic issues that complicate interpretation of study findings. This review reveals common study limitations and overall uncertainty that H. pylori infection plays a role in extragastric diseases, although such a role has not been clearly ruled out for specific diseases of relevance. Evidence suggests that anti-H. pylori therapy may lead to improvement of a few extragastric diseases, in particular, idiopathic thrombocytopenic purpura, iron deficiency anemia, and chronic idiopathic urticaria, but the data from randomized controlled trials are insufficient to confirm this beneficial effect; if the benefit of anti-H. pylori therapy for specific diseases is real, it is not clear if it results from removing H. pylori-specific injurious effects, eliminating some other infectious pathogen, or reducing the total infectious burden.     

Patient-Reported Compliance with Thromboprophylaxis Using an Oral Factor Xa Inhibitor (Rivaroxaban) Following Total Hip and Total Knee Arthroplasty

This prospective study examines patient non-compliance (NC) for an oral factor Xa inhibitor (Rivaroxaban) when used as venous thromboembolic (VTE) prophylaxis following lower limb arthroplasty. A total of 3145 patients underwent surgery from May 2010 to December 2011. At 6 weeks patients completed an anonymous self-administered questionnaire. Postoperatively 2947 (94%, 2947/3145) received Rivaroxaban. 2824 (96%, 2824/2947) completed all in-hospital doses. Seven percent (203/2824) of patients did not attend the 6-week follow-up. Two thousand one hundred sixty-three (83%, 2163/2621) completed all prescribed doses, 98 (4%, 98/2621) were NC and 360 (14%, 360/2621) had incomplete data. Gender, age, body mass index and preoperative hemoglobin all correlated with NC (p < 0.05). Type and side of surgery did not correlate with compliance (p > 0.05). Patient-reported NC for Rivaroxaban is 4% which compares favorably to other VTE prophylaxis modalities.     

Mechanical characteristics of the new BONE-LOK bi-cortical internal fixation device

The purpose of this study was to evaluate the mechanical characteristics of a new and unique titanium compression anchor with BONE-LOK (Triage Medical, Inc, Irvine, CA) technology for compressive, bi-cortical internal fixation of bone. This device provides fixation through the use of a distal grasping anchor and an adjustable proximal collar that are joined by an axially movable pin and guide wire. The titanium compression anchor, in 2.0-, 2.7-, and 3.5-mm diameters, were compared with cortex screws (Synthes USA, Paoli, PA) of the same diameter and material for pullout strength in 20 lb/cu ft and 30 lb/cu ft solid rigid polyurethane foam; and for compression strength in 20 lb/cu ft foam. Retention strength of the collar was tested independently. The results showed significantly greater pullout strength of the 2.7-mm and 3.5-mm titanium compression anchor as compared with the 2.7-mm and 3.5-mm cortex screws in these test models. Pullout strength of the 2.0-mm titanium compression anchor was not statistically different in comparison with the 2.0-mm cortical screws. Compression strength of the titanium compression anchor was significantly greater than the cortical screws for all diameters tested. These differences represent a distinct advantage with the new device, which warrants further in vivo testing. Collar retention strength testing values were obtained for reference only and have no comparative significance.