Supracondylar Dome Osteotomy With a Posterior Triceps-splitting Approach for Acute Correction of Posttraumatic Cubital Axis Deformities in Adolescent Patients.

BACKGROUND: Fractures around the elbow are common in children. Their management remains challenging. Inadequate treatment often leads to malunion, causing growth disturbance or avascular necrosis. This can develop into cubital axis deformities. This study evaluated our modified supracondylar dome osteotomy technique for acute correction of posttraumatic cubital axis deformities in adolescent patients. METHODS: Eighteen cases of posttraumatic cubital axis deformity that underwent acute correction through supracondylar dome osteotomy in our department between 2012 and 2019 were retrospectively evaluated. The radiologic results were measured through the carrying angle. The clinical functional outcomes were assessed using the Mayo Elbow Performance Index. RESULTS: No neurovascular injuries occurred and there was no notable loss of muscular strength or functional deficiencies in any of the patients. Symmetrical cubital axes were achieved in all cases. All cases were consolidated in a timely matter and no malunion was observed upon consolidation. Besides 1 case of hardware damage caused by a severe fall due to heavy alcohol intoxication, there was no correction loss, no secondary displacement, and no implant-related discomfort. None of the patients were left with a limited range of motion or reduced weight-bearing capacity. An excellent level of elbow functionality was achieved in all cases, with an average Mayo Elbow Performance Index of 97.8. CONCLUSIONS: The supracondylar dome osteotomy technique showed promising results in both radiologic outcomes and clinical performance, with a low complication rate. The dome-shaped osteotomy allows simultaneous multiplanar correction of not only varus or valgus deformities but also additional extension or flexion deformities. This technique also enables translation of the distal fragment in the frontal plane, which contributes to a more balanced anatomic geometry of the distal humerus. We consider the posterior triceps-splitting approach to be a safe technique that preserves muscle strength and improves the cosmetic appearance of the surgical scar. We recommend a cast-free plate fixation to allow early movement after surgery. We believe any residual deformities that present 18 months after the initial trauma should be addressed through surgical correction before clinical symptoms become apparent to avoid the chronic manifestation of functional deficiencies. LEVEL OF EVIDENCE: Level IV, therapeutic study, case series.

Optimising metameric spectra for integrative lighting to modulate the circadian system without affecting visual appearance.

Smart integrative lighting systems aim to support human health and wellbeing by capitalising on the light-induced effects on circadian rhythms, sleep, and cognitive functions, while optimising the light's visual aspects like colour fidelity, visual comfort, visual preference, and visibility. Metameric spectral tuning could be an instrument to solve potential conflicts between the visual preferences of users with respect to illuminance and chromaticity and the circadian consequences of the light exposure, as metamers can selectively modulate melanopsin-based photoreception without affecting visual properties such as chromaticity or illuminance. This work uses a 6-, 8- and 11-channel LED luminaire with fixed illuminance of 250 lx to systematically investigate the metameric tuning range in melanopic equivalent daylight illuminance (EDI) and melanopic daylight efficacy ratio (melanopic DER) for 561 chromaticity coordinates as optimisation targets (2700 K to 7443 K ± Duv 0 to 0.048), while applying colour fidelity index Rf criteria from the TM-30-20 Annex E recommendations (i.e. Rf [Formula: see text] 85, Rf,h1 [Formula: see text] 85). Our results reveal that the melanopic tuning range increases with rising CCT to a maximum tuning range in melanopic DER of 0.24 (CCT: 6702 K, Duv: 0.003), 0.29 (CCT: 7443 K, Duv: 0) and 0.30 (CCT: 6702, Duv: 0.006), depending on the luminaire's channel number of 6, 8 or 11, respectively. This allows to vary the melanopic EDI from 212.5-227.5 lx up to 275-300 lx without changes in the photopic illuminance (250 lx) or chromaticity ([Formula: see text] [Formula: see text] 0.0014). The highest metameric melanopic Michelson contrast for the 6-, 8- and 11-channel luminaire is 0.16, 0.18 and 0.18, which is accomplished at a CCT of 3017 K (Duv: - 0.018), 3456 K (Duv: 0.009) and 3456 K (Duv: 0.009), respectively. By optimising ~ 490,000 multi-channel LED spectra, we identified chromaticity regions in the CIExy colour space that are of particular interest to control the melanopic efficacy with metameric spectral tuning.

Quantifying observer metamerism of LED spectra which chromatically mimic natural daylight.

When LEDs are used to mimic daylight, a side-by-side comparison of the chromaticity difference between the LED spectrum and natural daylight will be perceived differently by individual observers. The magnitude of this effect depends on the LED light's spectral power distribution and can be assessed by using individual observer functions. To minimize the computational effort, an observer metamerism index can be utilized. Here, we compare three methods from the literature to define an observer metamerism index by carrying out a correlation analysis, in which reference spectra of the whole daylight range (1600 K to 88000 K) are used together with an empirical study. The recommended metric is based on a principal component analysis of 1000 individual observers' color matching functions to define a deviate observer. Using the proposed metamerism index significantly simplifies the calculation of the observer metamerism evaluation. Thus, this metric can be applied in spectral optimization pipelines, which are embedded in smart and adaptive multi-primary LED luminaires.

PupilEXT: Flexible Open-Source Platform for High-Resolution Pupillometry in Vision Research.

The human pupil behavior has gained increased attention due to the discovery of the intrinsically photosensitive retinal ganglion cells and the afferent pupil control path's role as a biomarker for cognitive processes. Diameter changes in the range of 10-2 mm are of interest, requiring reliable and characterized measurement equipment to accurately detect neurocognitive effects on the pupil. Mostly commercial solutions are used as measurement devices in pupillometry which is associated with high investments. Moreover, commercial systems rely on closed software, restricting conclusions about the used pupil-tracking algorithms. Here, we developed an open-source pupillometry platform consisting of hardware and software competitive with high-end commercial stereo eye-tracking systems. Our goal was to make a professional remote pupil measurement pipeline for laboratory conditions accessible for everyone. This work's core outcome is an integrated cross-platform (macOS, Windows and Linux) pupillometry software called PupilEXT, featuring a user-friendly graphical interface covering the relevant requirements of professional pupil response research. We offer a selection of six state-of-the-art open-source pupil detection algorithms (Starburst, Swirski, ExCuSe, ElSe, PuRe and PuReST) to perform the pupil measurement. A developed 120-fps pupillometry demo system was able to achieve a calibration accuracy of 0.003 mm and an averaged temporal pupil measurement detection accuracy of 0.0059 mm in stereo mode. The PupilEXT software has extended features in pupil detection, measurement validation, image acquisition, data acquisition, offline pupil measurement, camera calibration, stereo vision, data visualization and system independence, all combined in a single open-source interface, available at https://github.com/openPupil/Open-PupilEXT.

The Expanding Role of Endoscopic Robotics in Mitral Valve Surgery: 1,257 Consecutive Procedures.

BACKGROUND: The role of robotic instruments in mitral valve (MV) surgery continues to evolve. The purpose of this study was to assess the safety, efficacy, and scope of MV surgery using a lateral endoscopic approach with robotics (LEAR) technique. METHODS: From 2006 to 2013, a dedicated LEAR team performed 1,257 consecutive isolated MV procedures with or without tricuspid valve repair or atrial ablation. The procedures were performed robotically through five right-side chest ports with femoral artery or ascending aortic perfusion and balloon occlusion. Operative videos and data were recorded on all procedures and reviewed retrospectively. RESULTS: The mean age of all patients was 59.3 ± 20.5 years, and 8.4% (n = 105) had previous cardiac surgery. The MV repair was performed in 1,167 patients (93%). The MV replacement was performed in 88 patients (7%), and paravalvular leak repair in 2 patients. Concomitant atrial ablation was performed in 226 patients (18%), and tricuspid valve repair in 138 patients (11%). Operative mortality occurred in 11 patients (0.9%) and stroke in 9 patients (0.7%). Predischarge echocardiograms demonstrated mild or less mitral regurgitation in 98.3% of MV repair patients. At mean follow-up of 50 ± 26 months, 44 patients (3.8%) required MV reoperation. Application of the LEAR technique to all institutional isolated MV procedures increased from 46% in the first year to more than 90% in the last 3 years. CONCLUSIONS: Mitral valve repair or replacement, including concomitant procedures, can be performed safely and effectively using the LEAR technique. With a dedicated robotic team, the vast majority of patients with MV disorders, either isolated or with concomitant problems, can be treated using the LEAR technique.

Dangerous errors in the diagnosis and treatment of bony tuberculosis.

BACKGROUND: In rare diseases such as tuberculosis of bone, the diagnosis may be missed despite clear and overt clinical manifestations if the findings are misinterpreted and the causative organism escapes detection. CASE PRESENTATION AND FURTHER CLINICAL COURSE: A 30-year-old man who had been successfully treated for acute lymphatic T-cell leukemia (T-ALL) 18 years earlier developed multiple osteolytic lesions with compression fractures in the cervical spine, accompanied by an elevated serum concentration of C-reactive protein (CRP). One of the foci was biopsied, and the histological findings were interpreted as showing recurrent T-ALL. Induction chemotherapy was performed; this was followed by progressive osteolysis, abscesses, and visual disturbances due to an intracerebral infectious granuloma. High-dose chemotherapy was then planned, but the patient refused to undergo it. Further biopsies of the cranium and iliac crest revealed sterile abscesses. The newly proposed diagnosis was chronic, recurrent multilocular osteomyelitis (CRMO), for which treatment was begun with prednisolone and indomethacin. A fall in the CRP concentration and transient symptomatic improvement resulted. Two months later, however, the patient developed an intra-abdominal abscess. After this was surgically drained, mycobacteria were demonstrated for the first time, finally enabling a correct diagnosis. The patient underwent tuberculostatic treatment with 4 different drugs for 2 years. His CRP became normal, and all of the abscesses and other symptoms resolved completely. CONCLUSIONS: A T-ALL recurrence confined to bone would have been an extremely rare event, and this putative diagnosis should have been critically questioned. The high-dose chemotherapy that was proposed would have been life-threatening for a patient with florid tuberculosis. Inflammatory responses in bone can mimic the histological appearance of CRMO. The staining method can be problematic for the microbiological demonstration of tuberculosis. In this case, the causative organism was finally demonstrated with an auramine stain and fluorescence microscopy.

Thermally activated Peierls dimerization in ferromagnetic spin chains.

We demonstrate that a Peierls dimerization can occur in ferromagnetic spin chains activated by thermal fluctuations. The dimer order parameter and entanglement measures are studied as functions of the modulation of the magnetic exchange interaction and temperature, using a spin-wave theory and the density-matrix renormalization group. We discuss the case where a periodic modulation is caused by spin-phonon coupling and the case where electronic states effectively induce such a modulation. The importance of the latter for a number of transition metal oxides is highlighted.