CAOS-R: Character-Based Barcoding.

CAOS-Barcoding is a culmination of traditional taxonomy and modern DNA barcoding. CAOS identifies taxa by diagnostic characters as is done in traditional taxonomy and produces an identification matrix for taxon discrimination similar to DNA barcoding distance matrices. Here, I describe how to set up the CAOS-Barcoder and CAOS-Classifier software, which input data is needed, and how to interpret the output data. With the CAOS-Barcoder, single marker or concatenated data can be processed into diagnostic barcodes for taxon discrimination. The CAOS-Classifier can use the diagnostic barcodes for specimen identification.

Characteristic Attribute Organization System (CAOS): Identifying Classification Rules Based on Phylogenetically Organized Sequences.

Classification is a technique that labels subjects based on the characteristics of the data. It often includes using prior learned information from preexisting data drawn from the same distribution or data type to make informed decisions per each given subject. The method presented here, the Characteristic Attribute Organization System (CAOS), uses a character-based approach to molecular sequence classification. Using a set of aligned sequences (either nucleotide or amino acid) and a maximum parsimony tree, CAOS will generate classification rules for the sequences based on tree structure and provide more interpretable results than other classification or sequence analysis protocols. The code is accessible at https://github.com/JuliaHealth/CAOS.jl/ .

Current advancements in therapeutic approaches in orthopedic surgery: a review of recent trends.

Recent advancements in orthopedic surgery have greatly improved the management of musculoskeletal disorders and injuries. This review discusses the latest therapeutic approaches that have emerged in orthopedics. We examine the use of regenerative medicine, including stem cell therapy and platelet-rich plasma (PRP) injections, to accelerate healing and promote tissue regeneration. Additionally, we explore the application of robotic-assisted surgery, which provides greater precision and accuracy during surgical procedures. We also delve into the emergence of personalized medicine, which tailors treatments to individual patients based on their unique genetic and environmental factors. Furthermore, we discuss telemedicine and remote patient monitoring as methods for improving patient outcomes and reducing healthcare costs. Finally, we examine the growing interest in using artificial intelligence and machine learning in orthopedics, particularly in diagnosis and treatment planning. Overall, these advancements in therapeutic approaches have significantly improved patient outcomes, reduced recovery times, and enhanced the overall quality of care in orthopedic surgery.

Household chaos and parenting: The effect of household chaos does not depend on sensory-processing sensitivity and self-regulation.

Previous studies have found evidence for a causal effect of household chaos on parenting and suggest that this effect may be stronger for parents with higher sensory-processing sensitivity (SPS) or lower self-regulation. This study investigates whether primary caregivers of children around age 1.5-2 years show greater improvement in parenting after a decrease in household chaos if parents have higher SPS or lower self-regulation. The study employs a randomized controlled trial (RCT) design with an intervention aimed at reducing household chaos. A total of 125 parents of toddlers participated in the study. All participants were living in the Netherlands at the time of the study, 89% identified with the Dutch ethnicity and 11% with a non-Dutch ethnicity. Self-report as well as objective measures were used, including videotaped parent-child interactions and home observations. The effect of the intervention on parenting did not depend on SPS or self-regulation. When studying the relation between change in measures of household chaos and posttest parenting, decreased self-reported household chaos was related to less harsh discipline in parents with higher self-regulation, and to more harsh discipline in parents with lower self-regulation. However, this is a tentative finding that should be further explored in future research.

Estudios anteriores han encontrado evidencia de un efecto casual del caos en el hogar sobre la crianza y sugieren que este efecto pudiera ser más fuerte para progenitores con una más alta sensibilidad del proceso sensorial (SPS) o más baja autorregulación. Este estudio investiga si quienes primariamente cuidan a los niños de alrededor de 1.5-2 años muestran un más alto nivel de mejoras en la crianza después de una disminución en el caos del hogar si los progenitores poseen un alto nivel de SPS o baja autorregulación. El estudio emplea un diseño RCT con una intervención dirigida a reducir el caos en el hogar. En el estudio participaron 125 progenitores de niños pequeñitos. Todos los participantes vivían en Holanda al momento del estudio, 89% se identificaba con la etnicidad holandesa y 11% con una etnicidad no holandesa. Se usaron auto reportes, así como medidas de objetivos, incluyendo interacciones entre progenitor y niño grabadas en video y observaciones en casa. El efecto de la intervención sobre la crianza no dependió de SPS o de la autorregulación. Cuando se estudiaba la relación entre el cambio en las medidas del caos en el hogar y la crianza posterior a la prueba, la disminución del auto reportado caos en el hogar se relacionó con menos disciplina dura en progenitores con más alta autorregulación, así como con más disciplina dura en progenitores con más baja autorregulación. Sin embargo, se trata de un resultado tentativo que se debe explorar más en la futura investigación.

Des études précédentes ont trouvé peu de preuves à un effet de cause du chaos domestique sur le parentage et suggèrent que cet effet pourrait être plus fort pour les parents avec une sensibilité du traitement sensoriel (STS) plus élevée et une auto-régulation plus faible. Cette étude évalue si les personnes prenant soin des enfants autour de l'âge de 1,5-2 ans font preuve d'une plus grande amélioration dans le parentage avec moins de chaos domestique si les parents ont une STS plus élevée ou une autorégulation plus basse. Cette étude a employé un plan ECR avec une intervention destinée à réduire le chaos domestique. 125 parents de jeunes enfants ont participé à l'étude. Tous les participants vivaient aux Pays Bas au moment de l'étude, 89% s'identifiant comme d'ethnicité hollandaise et 11% d'ethnicité non hollandaise. Des auto-évaluations ainsi que des mesures objectives ont été utilisées, en utilisant des interactions parent-enfant filmées à la vidéo et des observations à domicile. L'effet de l'intervention sur le parentage n'a pas dépendu de la STS ou de l'auto-régulation. En étudiant la relation entre le changement dans les mesures de chaos domestique et de parentage posttest, le chaos autosignalé décru à une discipline moins sévère chez les parents avec une autorégulation plus élevée, et à une discipline plus sévère chez les parents avec une autorégulation moins élevée. Cependant c'est une constatation tentative qui devrait être explorée plus profondément dans des recherches futures.

Correcting Hip Dysplasia in Young Adults: Intraoperative Navigation and Outcomes.

Developmental dysplasia of the hip (DDH) often leads to characteristic acetabular dysplasia and typical femoral anomalies. There are numerous treatments for skeletally mature patients with DDH including hip arthroscopy, pelvic and femoral osteotomies, as well as total hip arthroplasty. Before proceeding to an arthroplasty procedure, it can be helpful to obtain an opinion of a hip preservation specialist to ascertain if alternative surgical treatments could contribute to the patient's care. In general, the use of robotic navigation has been associated with a higher proportion of cups placed in the Lewinnek safe zone, larger improvements in Harris Hip Scores, and no difference in overall complication rates in comparison to manual total hip arthroplasty. The use of robotic navigation allows for both 2-dimensional and 3-dimensional preoperative templating, enabling the surgeon to plan the position of the construct such that it achieves maximum bony purchase and hip stability. In complex DDH cases, surgeons can work with a biomechanics department to complete a fit check assessment, which utilizes 3-dimensional templating software to ascertain the appropriateness of the implant's geometry with the patient's anatomy. Furthermore, a 3-dimensional printed plastic model of the pelvis and/or femur can be constructed in order to complete a rehearsal procedure, which may be particularly helpful for those cases involving osteotomies. The literature on the use of robotic-assisted total hip arthroplasty in patients with DDH demonstrates improved component positioning in comparison to navigated as well as manual methods; however, studies with long-term follow-up in this patient population are lacking.

The prognosis of neonatal respiratory status within three years after birth in chronic abruption-oligohydramnios sequence.

AIM: Chronic abruption-oligohydramnios sequence (CAOS), which is characterized by vaginal bleeding and oligohydramnios, adversely affects the lungs of fetuses due to bloody amniotic fluid and oligohydramnios. The criteria for termination of pregnancy remain controversial. This study aimed to examine respiratory function in infants within 3 years after birth and risk factors for respiratory prognosis, and to clarify the management of CAOS. METHODS: This study is a case series of patients with CAOS managed at our institution between 2010 and 2020. The clinical data of the patients and their infants within 3 years after birth were reviewed. The amniotic fluid volume was measured using the maximum vertical pocket (MVP). RESULTS: Six of 17 neonates (35.3%) used inhaled nitric oxide (iNO) to improve oxygenation. Women with longer periods of MVP <1 cm delivered more neonates using iNO; however, periods of MVP <2 cm were not associated with iNO use. Almost half of the infants required home oxygen therapy when discharged, regardless of amniotic fluid volume. At 18 months corrected age, only one child needed respiratory support, and the others discontinued. Two neonates, both born at 23 weeks of gestational age, died within 1 month after birth because of extremely preterm birth. CONCLUSIONS: The amniotic fluid volume could predict the use of iNO in neonates, but it did not affect the child's respiratory function after the newborn period. Almost all children born to women with CAOS can improve their respiratory function as they grow up.

Aplicaciones de la Teoría del caos en medicina

La Teoría del Caos surgió relacionada con las ciencias naturales, pero en la actualidad su campo de aplicación es cada vez más amplio porque el pensamiento complejo ha ofrecido solución a numerosos sistemas en la naturaleza, la biología y otras muy diversas esferas de la vida, como la economía y la lingüística, entre otras. En este artículo se pretende ofrecer una panorámica sobre las principales aplicaciones del caos en medicina, dado que muchos procesos en medicina manifiestan aparente desorden, complejidad y caos. Se analizarán, en particular, las opiniones existentes entre los investigadores sobre la presencia y significado del caos en los procesos metabólicos, las enfermedades cardíacas y la actividad cerebral, ya que son las áreas médicas que expresan los comportamientos más complejos. También se expondrán los resultados de la aplicación de las matemáticas del caos en la epidemiología. Es importante apropiarse de este nuevo enfoque porque comprender el caos confiere al hombre, en cualquier campo que se desempeñe, una visión más clara de la realidad. El abordaje científico aplicando la teoría del caos, conlleva la creación de un equipo multidisciplinario, que enfrente la complejidad desde todas las aristas posibles y del que puedan surgir ideas que rebasen las fronteras del paradigma científico tradicional. Según los expertos sobre el tema, la Teoría del Caos seguirá teniendo un espacio importante en el futuro. Es un reto, una necesidad y un deber para los investigadores de las diferentes ramas y especialidades, estar preparados.

Chaos Theory arose in connection with the natural sciences, but today its field of application is increasingly broad because complex thinking has offered solutions to numerous systems in nature, biology and other very diverse spheres of life, such as economics and linguistics, among others. This article aims to offer an overview of the main applications of chaos in medicine, given that many processes in medicine show apparent disorder, complexity and chaos. In particular, the existing opinions among researchers about the presence and meaning of chaos in metabolic processes, heart disease and brain activity will be analyzed, since these are the medical areas that express the most complex behaviors. The results of the application of the mathematics of chaos in epidemiology will also be presented. It is important to appropriate this new approach because understanding chaos gives man, in whatever field he works, a clearer vision of reality. The scientific approach applying chaos theory entails the creation of a multidisciplinary team that faces complexity from all possible angles and from which ideas can arise that go beyond the borders of the traditional scientific paradigm. According to experts on the subject, Chaos Theory will continue having an important space in the future. It is a challenge, a necessity and a duty for researchers from different branches and specialties to be prepared.

Hybrid curvature-geometrical detection of landmarks for the automatic analysis of the reduction of supracondylar fractures of the femur.

BACKGROUND AND OBJECTIVE: The analysis of the features of certain tissues is required by many procedures of modern medicine, allowing the development of more efficient treatments. The recognition of landmarks allows the planning of orthopedic and trauma surgical procedures, such as the design of prostheses or the treatment of fractures. Formerly, their detection has been carried out by hand, making the workflow inaccurate and tedious. In this paper we propose an automatic algorithm for the detection of landmarks of human femurs and an analysis of the quality of the reduction of supracondylar fractures. METHODS: The detection of anatomical landmarks follows a knowledge-based approach, consisting of a hybrid strategy: curvature and spatial decomposition. Prior training is unrequired. The analysis of the reduction quality is performed by a side-to-side comparison between healthy and fractured sides. The pre-clinical validation of the technique consists of a two-stage study: Initially, we tested our algorithm with 14 healthy femurs, comparing the output with ground truth values. Then, a total of 140 virtual fractures was processed to assess the validity of our analysis of the quality of reduction. A two-sample t test and correlation coefficients between metrics and the degree of reduction have been employed to determine the reliability of the algorithm. RESULTS: The average detection error of landmarks was maintained below 1.7 mm and 2∘ (p< 0.01) for points and axes, respectively. Regarding the contralateral analysis, the resulting P-values reveal the possibility to determine whether a supracondylar fracture is properly reduced or not with a 95% of confidence. Furthermore, the correlation is high between the metrics and the quality of the reduction. CONCLUSIONS: This research concludes that our technique allows to classify supracondylar fracture reductions of the femur by only analyzing the detected anatomical landmarks. A initial training set is not required as input of our algorithm.

The Surgical Treatment of Osteoarthritis.

Osteoarthritis is a degenerative condition affecting the whole joint with the underlying bone, representing a major source of pain, disability, and socioeconomic cost worldwide. Age is considered the strongest risk factor, albeit abnormal biomechanics, morphology, congenital abnormality, deformity, malalignment, limb-length discrepancy, lifestyle, and injury may further increase the risk of the development and progression of osteoarthritis as well. Pain and loss of function are the main clinical features that lead to treatment. Although early manifestations of osteoarthritis are amenable to lifestyle modification, adequate pain management, and physical therapy, disease advancement frequently requires surgical treatment. The symptomatic progression of osteoarthritis with radiographical confirmation can be addressed either with arthroscopic interventions, (joint) preservation techniques, or bone fusion procedures, whereas (joint) replacement is preferentially reserved for severe and end-stage disease. The surgical treatment aims at alleviating pain and disability while restoring native biomechanics. Miscellaneous surgical techniques for addressing osteoarthritis exist. Advanced computer-integrated surgical concepts allow for patient personalization and optimization of surgical treatment. The scope of this article is to present an overview of the fundamentals of conventional surgical treatment options for osteoarthritis of the human skeleton, with emphasis on arthroscopy, preservation, arthrodesis, and replacement. Contemporary computer-assisted orthopaedic surgery concepts are further elucidated.

Reflexión desde la Entropía: un análisis de la realidad según la violencia en la sociedad / Reflection from Entropy and Chaos: an analysis of reality according to violence in society / Reflexão da Entropia e Caos: uma análise da realidade de acordo com a violência na sociedade

Resumen Introducción: la teoría del caos se usa para explicación de fenómenos complejos, cuya naturaleza no responde a comportamientos lineales y que a su vez no permite determinar con exactitud medidas y cálculos, pero que a pesar de ello se han logrado avances significativos en la ciencia, pudiéndose expandir además hasta las explicaciones de fenómenos sociales, siendo en este caso la violencia. Materiales y Métodos: se emplearon expresiones matemáticas para validar un modelo de realidad que describa aproximadamente índices de violencia a partir de datos reales. Resultados: se obtuvieron relaciones matemáticas que describen el comportamiento caótico, las cuales dependiendo de la tasa de violencia define si el valor tiende a cero, a un valor constante o un comportamiento caótico. Conclusiones: se obtuvo una relación matemática que describe el comportamiento entrópico de la violencia en sociedad, cuya tendencia caótica describe aproximadamente índices de violencia reales.

Abstract Introduction: chaos theory is used to explain complex phenomena, whose nature does not respond to linear behavior and which in turn does not allow exact measurements and calculations to be determined, but despite this, significant advances have been made in science, being able to also expand to the explanations of social phenomena, in this case being violence. Materials and Methods: mathematical expressions are used to validate the reality, which describes rates of violence from real data in Colombia. Results: mathematical relationships describing chaotic behavior were obtained, which, depending on the rate of violence, define whether the value tends to zero, a constant value or chaotic behavior. Conclusions: a mathematical relationship was obtained that describes the entropic behavior of violence in society, whose chaotic trend approximately describes real violence values.

Resumo Introdução: a teoria do caos é utilizada para explicar fenômenos complexos, cuja natureza não responde ao comportamento linear e que por sua vez não permite determinar medidas e cálculos exatos, mas apesar disso, avanços significativos foram feitos na ciência, expandindo para as explicações de fenômenos sociais, neste caso a violência. Materiais e Métodos: foram utilizadas expressões matemáticas para validar um modelo de realidade que descreve aproximadamente as taxas de violência a partir de dados reais. Resultados: foram obtidas relações matemáticas que descrevem o comportamento caótico, que, dependendo da taxa de violência, definem-se o valor que tende a zero, um valor constante ou um comportamento caótico. Conclusões: obteve-se uma relação matemática que descreve o comportamento entrópico da violência na sociedade, cuja tendência caótica descreve de forma aproximada os índices reais de violência.

Optimal definitions for computing HKA angle in caos: an in-vitro comparison study.

The goal of this study was to assess and compare the precision and accuracy of nine and seven methods usually used in Computer Assisted Orthopedic Surgery (CAOS) to estimate respectively the Knee Center (KC) and the Frontal Plane (FP) for the determination of the HKA angle (HKAA). An in-vitro experiment has been realized on thirteen cadaveric lower limbs. A CAOS software application was developed and allowed the computation of the HKAA according to these nine KC and seven FP methods. The precision and the accuracy of the HKAA measurements were measured. The HKAA precision was highest when the FP is determined using the helical method. The HKAA accuracy was highest using the helical approach to determine the FP and either the notch or the tibial spines to determine the KC. This study shows that the helical approach to determine the FP and either the notch or the middle of tibia spines are the combinations that provide both a good enough accuracy and precision to estimate the HKA.

The significance of clinical symptoms of subchorionic hematomas, "bleeding first", to stratify the high-risk subgroup of very early preterm delivery.

OBJECTIVE: To investigate the factors that stratify high-risk cases among subchorionic hematomas (SCHs) patients with persistent vaginal bleeding in early pregnancy. MATERIALS AND METHODS: A total of 56 patients who required hospitalization for SCH with vaginal bleeding in early pregnancy were classified into two groups: 1) no hematoma by ultrasonography when vaginal bleeding occurred, and then hematoma was observed by ultrasonography "bleeding to hematoma (BH group, n = 15)" and 2) no vaginal bleeding when hematoma was observed by routine ultrasonography, and then vaginal bleeding occurred later "hematoma to bleeding (HB group, n = 41)". Retrospective cohort study was performed and maternal and neonatal outcomes were evaluated. RESULTS: The duration of SCHs and/or vaginal bleeding was significantly longer in the BH group than in the HB group (mean: 60.8 days [BH group] vs. 33.3 days [HB group], p = 0.015). BH group patients delivered earlier than HB group patients significantly (mean: 27.3 weeks [BH group] vs. 35.6 weeks [HB group], p = 0.0028). The frequency of chronic abruption and oligohydramnios sequence (CAOS) was significantly higher in the BH group than in the HB group (3/15; 20.0% [BH group] vs. 0/41; 0.0% [HB group], p = 0.016). The frequency of sever fetal distress (Apgar score <4 points) was significantly higher in the BH group than in the HB group (4/15; 26.7% [BH group] vs. 0/41; 0.0% [HB group], p = 0.0037). The levels of factor XIII were relatively lower in the BH group than in the HB group (mean: 54.8% (n = 4) [BH group] vs. 76.1% (n = 7) [HB group], p = 0.077). CONCLUSION: The order of the symptoms, bleeding first, is an important feature that reflects the subsequent prolonged duration of SCHs/vaginal bleeding, resulting in very early preterm delivery. Continuous hemorrhage consumes coagulation factor XIII, which further worsen the hemostasis.

A novel bone registration method using impression molding and structured-light 3D scanning technology.

Accurate bone registration is critical for computer navigation and robotic surgery. Existing registration systems are expensive, cumbersome, limited in accuracy and/or require intraoperative radiation. We recently reported a novel method of registration utilizing an inexpensive, compact, and X-ray-free structured-light 3D scanner. However, this technique is not always practical in a real surgical setting where soft tissue and blood can obstruct the continuous line-of-sight required for structured-light technology. We sought to remedy these limitations using a novel technique using rapid-setting impression molding to capture bone surface features and scan the undersurface of the mold with a structured-light scanner. The photonegative of this mold is compared to the preoperative computed tomography (CT)-scan to register the bone. A registration accuracy study was conducted on 36 CT-scanned femur sawbones, simulating typical exposure in hip/knee arthroplasty and bone tumor surgery. A cadaver experiment was also conducted to evaluate the feasibility of using the impression molding in a more realistic operating room setting. The registration accuracy of the proposed technique was 0.50 ± 0.19 mm. This was close to the reported accuracy of 0.43 ± 0.18 mm using a structured-light scanner without impression molding (p = 0.085). In comparison, historical values for "paired-point" and intraoperative CT image-based registration methods currently used in modern robotic/computer-navigation systems were 0.68 ± 0.14 mm (p = 0.004) and 0.86 ± 0.38 mm, respectively. The registration accuracy of the cadaver experiment was consistent with that of sawbone experiments. Although future studies are needed to extend to human subjects, this study shows that the impression molding method can produce comparable or better registration accuracy than the existing techniques.

Novel robotic technology for the rapid intraoperative manufacture of patient-specific instrumentation allowing for improved glenoid component accuracy in shoulder arthroplasty: a cadaveric study.

BACKGROUND: Accurate prosthesis placement in arthroplasty is an important factor in the long-term success of these interventions. Many types of guidance technology have been described to date often suffering from high costs, complex theater integration, time inefficiency, and problems with day-to-day usability. We present a novel, intraoperative robotics platform, capable of rapid, real-time manufacture of low-cost patient-specific guides while overcoming many of the issues with existing approaches. METHODS: A prototype robotics platform was assessed in a 24-specimen cadaveric trial during sequential simulated shoulder arthroplasty procedures. The platform consisted of a tableside robot with sterile drapes and sterile disposable components. The robot itself comprised a 3D optical scanner, a 3-axis sterile robotic drill, and a 2-axis receptacle into which the disposable consumables were inserted. The consumable was composed of a region of rapidly setting moldable material and a clip allowing it to be reversibly attached to the robot. Computed tomographic (CT) imaging was obtained for all cadaveric specimens, and a surgical plan was created focusing on glenoid component position-specifically, guidewire position to allow for accurate glenoid preparation before implant insertion. Intraoperatively, for every specimen, the relevant osseous anatomy was exposed and humeral and glenoid preparation undertaken in the usual manner. The sterile disposable was used to create a mold of the joint surface. Once set, the mold was inserted into the robot and an optical scan of the surface was undertaken followed by automatic surface registration with the CT data and surgical plan. An automatic guide hole was subsequently drilled into the molded blank, which was removed from the robot and placed back into the patient, with the melded surface ensuring exact replacement. The guidewire was then driven through the guide hole in accordance with the preoperative plan. RESULTS: The novel robotic platform achieved average angular accuracies of 1.9° (standard deviation [SD] 1.3) version and 1.2° (SD 0.7) inclination with positional accuracy of 1.1 mm (SD 0.7) compared to a preoperative plan. DISCUSSION: We have described a novel robotics platform that is able to reliably produce patient-specific intraoperative guides to allow for accurate guidewire placement. Guidance is provided using a portable intraoperative device. The results suggest achieved accuracy levels may be equivalent to those seen in other existing guidance technologies; however, eventual in vivo trials and analysis is required. This technology has potential transferability to improve accuracy in other areas of arthroplasty.

A virtual reality simulator for training the surgical reduction of patient-specific supracondylar humerus fractures.

PURPOSE: Virtual reality has been used as a training platform in medicine, allowing the repetition of a situation/scenario as many times as needed and making it patient-specific prior to an operation. Of special interest is the minimally invasive plate osteosynthesis (MIPO). It represents a novel technique for orthopedic trauma surgery, but requires intensive training to acquire the required skills. In this paper, we propose a virtual reality platform for training the surgical reduction of supracondylar fractures of the humerus using MIPO. The system presents a detailed surgical theater where the surgeon has to place the bone fragments properly. METHODS: Seven experienced users were selected to perform a surgical reduction using our proposal. Two paired humeri were scanned from a dataset obtained from the Complejo Hospitalario de Jaén. A virtual fracture was performed in one side of the pair, using the other as contralateral part. Users have to simulate a reduction for each case and fill out a survey about usability, using a five-option Likert scale. RESULTS: The subjects have obtained excellent scores in both simulations. The users have notably reduced the time employed in the second experiment, being 60% less in average. Subjects have valued the usability (5.0), the intuitiveness (4.6), comfort (4.5), and realism (4.9) in a 1-5 Likert scale. The mean score of the usability survey was 4.66. CONCLUSION: The system has shown a high learning rate, and it is expected that the trainees will reach an expert level after additional runs. By focusing on the movement of bone fragments, specialists acquire motor skills to avoid the malrotation of MIPO-treated fractures. A future study can fulfill the requirements needed to include this training system into the protocol of real surgeries. Therefore, we expect the system to increase the confidence of the trainees as well as to improve their decision making.

Patient-specific guides in orthopedic surgery.

The interest of patient-specific guides (PSGs) lies in reliable intraoperative achievement of preoperative planning goals. They are a form of instrumentation optimizing intraoperative precision and thus improving the safety and reproducibility of surgical procedures. Clinical superiority, however, has not been demonstrated. The various steps from design to implementation leave room for error, which needs to be known and controlled by the surgeon who is responsible for final outcome. Instituting large-scale patient-specific surgery requires management systems for guides and innovative implants which cannot be a simple extension of current practices. We shall approach the present state of knowledge regarding PSGs via 5 questions: (1) What is a PSG? Single-use instrumentation produced after preoperative planning, aiming exclusively to optimize procedural exactness. (2) How to use and assess PSGs in orthopedic surgery? Strict rules of use must be adhered to. Any deviation from the predefined objective is, necessarily, an error that must be identified as such. (3) Do PSGs provide greater surgical exactness? The contribution of PSGs varies greatly between procedures. Exactness is enhanced in the spine, in osteotomies around the knee and in bone-tumor surgery. In the shoulder, their contribution is seen only in complex cases. Data are sparse for hip replacement, and controversial for knee replacement. (4) What are the expected benefits of PSGs? As well as improving exactness, PSGs allow a lower radiation dose and shorter operating time. They also enable junior surgeons to train in techniques otherwise reserved to hyperspecialists. (5) How to include PSGs in everyday practice? As well as their potential clinical interest, PSGs involve deep changes in organization, equipment provision and economic model. LEVEL OF EVIDENCE: V; expert opinion.

Cultura del caos / Chaos Culture

La Teoría del Caos, considerada la tercera revolución de la física, se ha convertido en un método científico para abordar sistemas complejos que no pueden ser explicados por los recursos tradicionales de la ciencia. Su campo de aplicación es cada vez más amplio, porque el pensamiento complejo ha ofrecido solución a numerosos sistemas en la naturaleza, la biología y muy diversas esferas de la vida. El objetivo de este trabajo es ofrecer una panorámica general sobre el tema, desde una postura no estrictamente matemática. Se realizó una revisión en la literatura y se expone el conocimiento sedimentado en el tiempo, por los estudiosos y expertos en la materia. Se ofrece una visión general de la Teoría del Caos, las condiciones para su surgimiento, así como sus aspectos y propiedades generales expresadas en sus dos dimensiones: tiempo (sistemas dinámicos) y espacio (fractales). Se hacen explícitos en cada caso, los conceptos y definiciones necesarias para entender y hablar de Caos. En un segundo artículo se expondrán las principales aplicaciones de esta teoría en la medicina y en particular en el campo de las neurociencias. Para los profesionales del sector salud, resulta un reto necesario familiarizarse con este nuevo enfoque, entender su esencia, principios y conceptos, para adquirir una cultura del Caos(AU)

Chaos Theory, considered the third revolution in physics, has become a scientific method to address complex systems that cannot be explained by the traditional resources of science. Its field of application is increasingly wide, because complex thinking has offered solutions to numerous systems in nature, biology and very diverse spheres of life. The objective of this work is to offer a general overview of the subject, from a non-strictly mathematical position. A literature review was carried out and the knowledge settled over time, by scholars and experts in the field, is exposed. An overview of Chaos Theory is offered, the conditions for its emergence, as well as its aspects and general properties expressed in its two dimensions: time (dynamic systems) and space (fractals). The concepts and definitions necessary to understand and speak of Chaos are made explicit in each case. In a second article, the main applications of this theory in medicine and in particular in the field of neurosciences will be exposed. For professionals in the health sector, it is a necessary challenge to become familiar with this new approach, understand its essence, principles and concepts, to acquire a culture of Chaos(AU)

Preoperative Guidance With Weight-Bearing Computed Tomography and Patient-Specific Instrumentation in Foot and Ankle Surgery.

The use of preoperative and intraoperative guidance in foot and ankle surgery has grown substantially in recent years. Weight-bearing computed tomography (WBCT) and patient-specific instrumentation (PSI) are used in total ankle arthroplasty (TAA) to achieve precise bone cutting and implant positioning, and intraoperative 3-dimensional (3D) imaging has been used to reduce complications and improve clinical outcomes in other foot and ankle surgical procedures. This narrative review of the literature focuses on the evidence supporting the use of WBCT and PSI in TAA and looks at other promising technologies used to guide foot and ankle surgery.

Computer-assisted surgery and navigation in foot and ankle: state of the art and fields of application.

Computer-assisted orthopaedic surgery (CAOS) is a real-time navigation guidance system that supports surgeons intraoperatively.Its use is reported to increase precision and facilitate less-invasive surgery.Advanced intraoperative imaging helps confirm that the initial aim of surgery has been achieved and allows for immediate adjustment when required.The complex anatomy of the foot and ankle, and the associated wide range of challenging procedures should benefit from the use of CAOS; however, reports on the topic are scarce.This article explores the fields of applications of real-time navigation and CAOS in foot and ankle surgery. Cite this article: EFORT Open Rev 2021;6:531-538. DOI: 10.1302/2058-5241.6.200024.

A New Technique that Combines Navigation-Assisted Lateral Interbody Fusion and Percutaneous Placement of Pedicle Screws in the Lateral Decubitus Position with the Surgeon Using Wearable Smart Glasses: A Small Case Series and Technical Note.

BACKGROUND: We describe a new technique that combines navigation-assisted extreme lateral interbody fusion (NALIF) and percutaneous placement of pedicle screws in the lateral decubitus position with the surgeon using wearable smart glasses. METHODS: We explain our method for nonfluoroscopic NALIF and single-position (SP)- percutaneous pedicle screw (PPS) surgery for patients with degenerative lumbar diseases using wearable smart glasses. The wearable smart glasses provide a semitransparent overlay of the navigation information onto the image seen through the lenses. This technique does not require fluoroscopy during lateral interbody fusion or PPS insertion. It is convenient because it does not require a Jamshidi needle or guidewire when inserting PPSs. RESULTS: Using this method, the surgeon can glance at the 3-dimensional images on the wearable smart glasses while still viewing the operation field. A review of 24 cases yielded an average operation time of 89.5 ± 16.4 minutes and 66.7 ± 67.0 mL of blood loss, without any severe intra- or postoperative complications. CONCLUSIONS: Nonfluoroscopic NALIF and SP-PPS placement surgery is a safe and effective means for implanting cages and PPSs in this minimally invasive approach without compromising the results. Although further investigations are needed, the wearable smart glasses may be a useful surgical aid when performing NALIF and SP-PPS placement in patients with degenerative lumbar diseases.