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Echocardiographic evaluation of mitral valve gradients after percutaneous mitral valve repair is pivotal for decision making and double envelope spectral Doppler is a real challenge in this setting. The case in this E-Challenge presents a hydraulic explanation behind this phenomenon, providing a practical approach when it occurs during the procedure.

Purpose Listeners shift their listening strategies between lower level acoustic information and higher level semantic information to prioritize maximum speech intelligibility in challenging listening conditions. Although increasing task demands via acoustic degradation modulates lexical-semantic processing, the neural mechanisms underlying different listening strategies are unclear. The current study examined the extent to which encoding of lower level acoustic cues is modulated by task demand and associations with lexical-semantic processes. Method Electroencephalography was acquired while participants listened to sentences in the presence of four-talker babble that contained either higher or lower probability final words. Task difficulty was modulated by time available to process responses. Cortical tracking of speech—neural correlates of acoustic temporal envelope processing—were estimated using temporal response functions. Results Task difficulty did not affect cortical tracking of temporal envelope of speech under challenging listening conditions. Neural indices of lexical-semantic processing (N400 amplitudes) were larger with increased task difficulty. No correlations were observed between the cortical tracking of temporal envelope of speech and lexical-semantic processes, even after controlling for the effect of individualized signal-to-noise ratios. Conclusions Cortical tracking of the temporal envelope of speech and semantic processing are differentially influenced by task difficulty. While increased task demands modulated higher level semantic processing, cortical tracking of the temporal envelope of speech may be influenced by task difficulty primarily when the demand is manipulated in terms of acoustic properties of the stimulus, consistent with an emerging perspective in speech perception.

Electrocardiography (ECG) signals play an important role in the cardiac disorder diagnosis and arrhythmia detection since they reflect all the electrical activities of the heart and include information about heart function and heart conditions. Due to the subtle alterations in the amplitude, duration and morphology of the ECG, the development of computer-based intelligent system in the arrhythmia diagnosis field is attractive in terms of the amount of data and the importance of the data it contains for the classification of heartbeats from different types of arrhythmias. In the present study we propose a novel technique for the automatic detection of cardiac arrhythmia with one-lead ECG signals based upon variational mode decomposition (VMD), Shannon energy envelope, phase space reconstruction (PSR) and deterministic learning theory. First, VMD is employed to decompose the ECG signals into different intrinsic modes, in which the first four intrinsic modes contain the majority of the ECG signals’ energy and are considered to be the predominant intrinsic modes. Second, Shannon energy is used to extract the characteristic envelope of predominant intrinsic modes. Third, phase space of the Shannon energy envelope (SEE) is reconstructed, in which properties associated with the nonlinear ECG characteristics are preserved. Three-dimensional (3D) phase space reconstruction (PSR) together with Euclidean distance (ED) has been utilized to derive features, which demonstrate significant difference in ECG system dynamics between normal versus abnormal individual heartbeats. Fourth, neural networks are then used to model, identify and classify ECG system dynamics between normal (healthy) and arrhythmic ECG signals based on deterministic learning theory. Finally, experiments are carried out on the MIT-BIH arrhythmia database to verify the effectiveness of the proposed method, in which 626 ECG signal fragments for one lead (MLII) from 28 persons of five classes of heartbeats were extracted. These five classes are normal sinus rhythm (NSR), premature ventricular contraction (PVC), paced beat (PB), left bundle branch block (LBBB), and right bundle branch block (RBBB). By using the 10-fold cross-validation style, the achieved average classification accuracy is reported to be 98.72 $$\%$$ . Experimental results verify the effectiveness of the proposed method and indicate that it has the potential to serve as a candidate for the automatic detection of myocardial dysfunction in the clinical application.

Objectives To model the cost-effectiveness of the TYRX Absorbable Antibacterial Envelope when used in patients at increased risk of cardiac implantable electronic device (CIED) infection in the context of 3 European healthcare systems: Germany, Italy, and England. Methods A decision tree model with a lifetime horizon was populated using data from the Worldwide Randomized Antibiotic Envelope Infection Prevention Trial, a large multicenter randomized controlled trial. Use of the antibacterial envelope adjunctive to standard of care was compared to standard of care infection prevention alone. Patients in the model were divided into subgroups based on presence of factors known to increase infection risk. Results The antibacterial envelope had the most favorable cost-effectiveness profile when patients had previously experienced CIED infection, had a history of immunosuppressive therapy, or had a Prevention of Arrhythmia Device Infection Trial (PADIT) score indicating high risk of infection (scores ≥6) at cost-effectiveness thresholds of €50 000 in Germany (assumed in the absence of an official threshold), €40 000 in Italy, and £30 000 in England. Probabilistic sensitivity analysis indicated that the antibacterial envelope was likely to be cost-effective in patients with other risk factors (including replacement of high power CIEDs, generator replacement with lead modification, and PADIT scores indicating intermediate risk of infection) when used with some device types and in some countries. Conclusions The absorbable antibacterial envelope was associated with cost-effectiveness ratios below European benchmarks in selected patients at increased risk of infection, suggesting the envelope provides value for European healthcare systems by reducing CIED infections.

Surgical techniques for robot-assisted partial nephrectomy are driven by the aims of simplifying the most challenging surgical steps, maximizing functional and oncologic outcomes, and consistently pushing the envelope on possibilities. Over the past several years, we have seen an emergence in not only innovation in surgical technique, and robotic platforms, but integration of a variety of imaging techniques. We believe with developing robotic expertise, practicing urologists will continue to push the envelope in nephron preservation and complication-free recovery.

Human reaction plays a key role in improved protection upon emergent traffic situations with motor vehicles. Understanding the underlying behaviour mechanisms can combine active sensing system on feature caption and passive devices on injury mitigation for automated vehicles. The study aims to identify the distance-based safety boundary (“safety envelope”) of vehicle–pedestrian conflicts via pedestrian active avoidance behaviour recorded in well-controlled, immersive virtual reality-based emergent traffic scenarios. Via physiological signal measurement and kinematics reconstruction of the complete sequence, we discovered the general perception-decision-action mechanisms under given external stimulus, and the resultant certain level of natural harm-avoidance action. Using vision as the main information source, 70% pedestrians managed to avoid the collision by adapting walking speeds and directions, consuming overall less “decision” time (0.17–0.24 s vs. 0.41 s) than the collision cases, after that, pedestrians need enough “execution” time (1.52–1.84 s) to take avoidance action. Safety envelopes were generated by combining the simultaneous interactions between the pedestrian and the vehicle. The present investigation on emergent reaction dynamics clears a way for realistic modelling of biomechanical behaviour, and preliminarily demonstrates the feasibility of incorporating in vivo pedestrian behaviour into engineering design which can facilitate improved, interactive on-board devices towards global optimal safety.

Emergency braking intention detection has a vital practical value for improving driving safety. This paper proposed an electromyography (EMG)-based method to detect emergency braking intention from soft braking and normal driving intentions. Temporal and spectral signatures of EMG signals of emergency braking, soft braking, and normal driving intentions were investigated. Common spatial pattern (CSP) was used to generate virtual channels. The power spectrum density and linear envelope amplitude of EMG signals were used as features, respectively. Chi-square test (Chi) was used to select features. Regularized linear discrimination analysis was developed to detect emergency braking intention from the other two driving intentions. Experiment results showed significant differences in temporal and spectral domains between three kinds of driving. Furthermore, on average, the proposed method based on spectral features can detect emergency braking intention 155.70 ms before behavior under emergency situations with a system accuracy of 95.72%. The proposed method based on EMG signals for predicting emergency braking intention can be applied to develop active driving assistance systems and improve driving safety.

The conventional milling cutter design is based on a solid body. A cutter designed in this way has a guaranteed rigidity, but at the expense of tool dynamics. Computational methods of designing reduce the mass of a cutter in locations with lower stress density. This approach increases stiffness relative to the weight of the cutter. This paper analyses the benefits of modifications in the design of a lightweight cutter. The design uses an envelope of a conventional milling cutter that is filled by walls. Each modification changes the elasticity in different directions. These changes are monitored by displacements at the centre of the cutting inserts under load. Simulations confirm that even a small weight gain can mean a significant increase in tool stiffness.

Enveloped viruses infect host cells via fusion of their viral envelope with the plasma membrane. Upon cell entry, viruses gain access to all the macromolecular machinery necessary to replicate, assemble, and bud their progeny from the infected cell. By employing molecular dynamics simulations to characterize the dynamical and chemical-physical properties of viral envelopes, researchers can gain insights into key determinants of viral infection and propagation. Here, the Frontera supercomputer is leveraged for large-scale analysis of authentic viral envelopes, whose lipid compositions are complex and realistic. VMD with support for MPI is employed on the massive parallel computer to overcome previous computational limitations and enable investigation into virus biology at an unprecedented scale. The modeling and analysis techniques applied to authentic viral envelopes at two levels of particle resolution are broadly applicable to the study of other viruses, including the novel coronavirus that causes COVID-19. A framework for carrying out scalable analysis of multi-million particle MD simulation trajectories on Frontera is presented, expanding the the utility of the machine in humanity’s ongoing fight against infectious disease.

Introduction The soft tissue envelope around the knee can have an impact on the ease of performing surgery such as total knee replacement (TKR). BMI is often used in planning theatre time but may be a poor indicator of the soft tissue around the knee due to varying distribution of adipose tissue. Radiological images directly show the soft tissue. We therefore aim to develop a method of quantifying the soft tissue envelope around the knee using radiographs. Method Plain weight-bearing radiographs were used to measure the total knee (soft tissue and bony) width at the level of the epicondyles of the knee and the bony epicondylar width of the femur. The ratio of the two widths was defined as the Soft Tissue Radiological Knee (SToRK) Index. The validity of the index as a true measure of soft tissue envelope was assessed using cross sectional areas on axial MRI cuts at the level of the epicondyles. The inter-observer reliability was assessed using the intra-class correlation coefficient. SToRK Index values were correlated with patients’ BMI, gender and operative time. Results The results show there is a close correlation between the ratio of cross sectional area of MRI axial cuts at the level of epicondyles and the ratio of linear widths measured on plain radiographs, validating the SToRK Index as a measure of soft tissue envelope. There was also good to excellent inter-rater reliability of measurements of these widths. There was a close correlation between BMI and SToRK Index with differences between men and women. Discussion We believe the SToRK Index is a validated method of quantifying soft tissue distribution around the knee and gives surgeons a better descriptor of the knee envelope than BMI. It is easy to use, needs simple investigations and is reproducible.

The objectives were to compare the coronal joint configuration of the knee joints, coronal gap imbalances requiring substantial medial release, and patient-reported outcomes, including the forgotten joint score, between knees in which residual varus alignment was intentionally allowed according to an individualised lower limb analysis and those with mechanical alignment in total knee arthroplasty for varus osteoarthritis. Consecutive primary navigated total knee arthroplasty procedures for varus osteoarthritis were retrospectively reviewed. The study cohort was stratified based on whether residual varus alignment was intentionally allowed. Propensity-score matching was performed based on the baseline characteristics, including demographic characteristics, preoperative radiological measurements, and the Western Ontario and McMaster University Osteoarthritis Index (mechanical alignment group vs residual varus group). The patient-reported outcomes and coronal joint line orientation of the knee (relative to the ground) and ankle were evaluated. Coronal gap differences and coronal gap imbalances were analysed using intraoperative gap measurements. Relative to the ground and ankle, the postoperative knee joint line orientation slanted down laterally in the mechanical alignment group (− 3.05˚ ± 1.62, relative to the ground; − 2.65˚ ± 1.56, relative to the ankle joint), but was parallel in the residual varus group (− 0.75˚ ± 1.59, relative to the ground; − 0.95˚ ± 1.71, relative to the ankle joint). Coronal gap differences at extension and the proportion of coronal gap imbalances requiring substantial medial release were 1.27 ± 1.53 and 6% in the residual varus group and 2.32 ± 1.24 and 15% in the mechanical alignment group. Postoperatively, the residual varus group showed higher Western Ontario and McMaster University Osteoarthritis Index scores and total forgotten joint scores than the mechanical alignment group (6.97 ± 4.75 vs. 10.31 ± 5.74 and 56.42 ± 12.85 vs. 45.69 ± 14.49, respectively). Intentionally allowed residual varus alignment with individualised analysis of lower limb alignment restored the parallel joint line of the knees, preserved the soft tissue envelope, and reduced joint awareness after total knee arthroplasty for varus osteoarthritis. Therapeutic, Level III retrospective case–control study

Multiple applications of dual energy computed tomography (DECT) have been described for the evaluation of disorders in the head and neck, especially in oncology. We review the body of evidence suggesting advantages of DECT for the evaluation of the neck compared with conventional single energy computed tomography scans, but the full potential of DECT is still to be realized. There is early evidence suggesting significant advantages of DECT for the extraction of quantitative biomarkers using radiomics and machine learning, representing a new horizon that may enable this technology to reach its full potential.

Importance: Predicting nasal soft tissue envelope (STE) thickness is an important component of the preoperative evaluation for rhinoplasty that presently lacks validated tools. Objective: Assess for patient facial features and factors that can help predict nasal STE thickness. Design, Setting, and Participants: Retrospective review and prospective assessment conducted at an academic tertiary referral center. This study included 190 adult patients and four expert raters. The patients had high-resolution maxillofacial CT scans and standardized facial photographs on file and did not have a history of nasal fracture, septal perforation, rhinoplasty, or other surgery or medical conditions altering nasal form. Main Outcomes and Measures: Assess each face for features that could help predict nasal STE thickness: sebaceous quality of skin, visibility of nasal tip cartilages, presence of freckles, presence of telangiectasias, Fitzpatrick skin type, patient age, sex, and body mass index (BMI). Measure actual nasal STE thickness using high-resolution CT scans. Analyze which facial features and patient factors help predict nasal STE thickness. Results: Pearson correlations were calculated between actual nasal STE thickness and patient facial features and factors. These showed that more sebaceous skin, telangiectasias, higher Fitzpatrick skin type, male sex, and higher BMI were associated with a thicker nasal STE. Increased visibility of nasal tip cartilages, freckles, lower Fitzpatrick skin type, female sex, and lower BMI were associated with a thinner nasal STE. Conclusions and Relevance: There are patient facial features and factors that can help surgeons predict nasal STE thickness before rhinoplasty. An accurate prediction of nasal STE thickness can improve preoperative planning for rhinoplasty, allowing implementation of pre-, intra-, and post-operative treatments to optimize the nasal STE, which may ultimately improve patient outcomes and satisfaction.

Aims The integrity of the soft tissue envelope is crucial for successful treatment of infected total knee arthroplasty (TKA). The purpose of this study was to evaluate the rate of limb salvage, infection control, and clinical function following microvascular free flap coverage for salvage of the infected TKA. Methods We retrospectively reviewed 23 microvascular free tissue transfers for management of soft tissue defects in infected TKA. There were 16 men and seven women with a mean age of 61.2 years (39 to 81). The median number of procedures performed prior to soft tissue coverage was five (2 to 9) and all patients had failed at least one two-stage reimplantation procedure. Clinical outcomes were measured using the Knee Society Scoring system for pain and function. Results In all, one patient was lost to follow-up prior to 12 months. The remaining 22 patients were followed for a mean of 46 months (12 to 92). At latest follow-up, four patients (18%) had undergone amputation for failure of treatment and persistent infection. For the other 18 patients, 11 patients (50%) had maintained a knee prosthesis in place while seven patients had undergone resections for persistent infection but retained their limbs (32%). Reoperations were common following coverage and reimplantation. The median number of additional procedures was two (0 to 6). Clinical function was poor in patients who underwent reimplantation and retained a knee prosthesis following free flap coverage with a mean KSS score for pain and function of 44 (0 to 70) and 30 (0 to 65), respectively. All patients required an assistive device. Extensor mechanism problems and extensor lag requiring bracing were common following limb salvage and prosthesis reimplantation. Conclusion Microvascular tissue transfer for management of infected TKA can be successful in limb salvage (82%) but clinical outcomes in salvaged limbs were poor. Cite this article: Bone Joint J 2020;102-B(6 Supple A):176–180.

Preparation and planning for orthognathic surgery in late adolescence depends on the complexity of unresolved problems with which the patient presents. Different strategies are presented to address these unresolved problems in the adult patient with cleft lip and palate. Different surgical and orthodontic treatments are presented to correct the class III malocclusion in patients with cleft lip and palate in ranges that are analogous to the envelope of discrepancy. For complex cases, the principles of achievability, stability, and esthetics should guide the decision-making process for planning the preparation for orthognathic surgery.

Neural oscillations synchronize with the periodicity of external stimuli such as the rhythm of the speech amplitude envelope. This synchronization induces a speech-specific, replicable neural phase pattern across trials and enables perceived speech to be classified. In this study, we hypothesized that neural oscillations during articulatory imagination of speech could also synchronize with the rhythm of speech imagery. To validate the hypothesis, after replacing the imagined speech with overt speech due to the physically unobservable nature of imagined speech, we investigated (1) whether the EEG-based regressed speech envelopes correlate with the overt speech envelope and (2) whether EEG during the imagined speech can classify speech stimuli with different envelopes. The variability of the duration of the imagined speech across trials was corrected using dynamic time warping. The classification was based on the distance between a test data and a template waveform of each class. Results showed a significant correlation between the EEG-based regressed envelope and the overt speech envelope. The average classification accuracy was 38.5%, which is significantly above the rate of chance (33.3%). These results demonstrate the synchronization between EEG during the imagined speech and the envelope of the overt counterpart.

Nipple-sparing mastectomy has been associated with superior aesthetic outcomes and oncologic safety. However, traditional contraindications, such as breast ptosis/macromastia, have excluded a large number of patients. The purpose of this study was to determine whether a staged approach would expand the indications for nipple-areolar complex preservation and permit greater control over nipple-areolar complex position and skin envelope following autologous reconstruction.A retrospective analysis was conducted of female patients with a diagnosis of breast cancer or BRCA mutation with grade 2 or 3 ptosis and/or macromastia who underwent bilateral (oncoplastic) reduction/mastopexy (stage 1) followed by bilateral nipple-sparing mastectomy with immediate reconstruction with free abdominal flaps (stage 2). The authors were specifically interested in the incidence of mastectomy skin necrosis and nipple-areolar complex necrosis and malposition following stage 2.Sixty-one patients with a mean age of 45.1 years (range, 28 to 62 years) and mean body mass index of 32.6 kg/m (range, 23.4 to 49.0 kg/m) underwent reconstruction with 122 flaps. The mean interval between stage 1 and 2 was 16.9 weeks (range, 3 to 31 weeks). Clear margins were obtained in all cases of invasive cancer and in situ disease following stage 1. Complications following stage 2 included partial nipple-areolar complex necrosis (n = 5, 8.2 percent), complete nipple-areolar complex necrosis (n = 4, 6.6 percent), nipple-areolar complex malposition (n = 1, 1.6 percent), and mastectomy skin necrosis (n = 4, 6.6 percent). No flap loss was noted in this series.Patients with moderate to severe breast ptosis and/or macromastia who wish to undergo mastectomy with reconstruction can be offered nipple-sparing approaches safely if a staged algorithm is implemented.Therapeutic, IV.

Facial structure, nasal shape, and aesthetic nasal preferences vary broadly among patients of African descent who seek rhinoplasty. This variation reflects the broad diversity in this ethnic group and is highlighted by lapses in computer vision algorithms in accurately recognizing black faces. Across ethnicities, patients who seek rhinoplasty have similar goals: a reshaped nose that fits their facial features and enhances their facial beauty. Among patients of African descent, there is a particularly strong desire for maintaining nasal features that are ethnically sensitive and culturally congruent. This article discusses the nuances of managing the lower third of the African nose.

OBJECTIVE: Cochlear implant (CI) signal processing degrades the spectral components of speech. This requires CI users to rely primarily on temporal cues, specifically, amplitude modulations within the temporal envelope, to recognize speech. Auditory temporal processing ability for envelope modulations worsens with advancing age, which may put older CI users at a disadvantage compared to younger users. In order to evaluate how potential age-related limitations for processing temporal envelope modulations impact spectrally degraded sentence recognition, noise-vocoded sentences were presented to younger and older normal-hearing listeners in quiet. Envelope modulation rates were varied from 10-500 Hz by adjusting the low-pass filter cut-off frequency (LPF). The goal of this study was to evaluate if age impacts recognition of noise-vocoded speech and if this age-related limitation existed for a specific range of envelope modulation rates. DESIGN: Noise-vocoded sentence recognition in quiet was measured as a function of number of spectral channels (4, 6, 8, and 12 channels) and LPF (10, 20, 50, 75, 150, 375, and 500 Hz) in 15 younger normal-hearing listeners and 15 older near normal-hearing listeners. Hearing thresholds and working memory were assessed to determine the extent to which these factors were related to recognition of noise-vocoded sentences. RESULTS: Younger listeners achieved significantly higher sentence recognition scores than older listeners overall. Performance improved in both groups as the number of spectral channels and LPF increased. As the number of spectral channels increased, the differences in sentence recognition scores between groups decreased. A spectral-temporal trade-off was observed in both groups in which performance in the 8- and 12-channel conditions plateaued with lower-frequency amplitude modulations compared to the 4- and 6-channel conditions. There was no interaction between age group and LPF, suggesting that both groups obtained similar improvements in performance with increasing LPF. The lack of an interaction between age and LPF may be due to the nature of the task of recognizing sentences in quiet. Audiometric thresholds were the only significant predictor of vocoded sentence recognition. Although performance on the working memory task declined with advancing age, working memory scores did not predict sentence recognition. CONCLUSION: Younger listeners outperformed older listeners for recognizing noise-vocoded sentences in quiet. The negative impact of age was reduced when ample spectral information was available. Age-related limitations for recognizing vocoded sentences were not affected by the temporal envelope modulation rate of the signal, but instead appear to be related to a generalized task limitation or to reduced audibility of the signal.

The amplitude envelope of speech carries crucial low-frequency acoustic information that assists linguistic decoding at multiple time scales. Neurophysiological signals are known to track the amplitude envelope of adult-directed speech (ADS), particularly in the theta-band. Acoustic analysis of infant-directed speech (IDS) has revealed significantly greater modulation energy than ADS in an amplitude-modulation (AM) band centered on ∼2 Hz. Accordingly, cortical tracking of IDS by delta-band neural signals may be key to language acquisition. Speech also contains acoustic information within its higher-frequency bands (beta, gamma). Adult EEG and MEG studies reveal an oscillatory hierarchy, whereby low-frequency (delta, theta) neural phase dynamics temporally organize the amplitude of high-frequency signals (phase amplitude coupling, PAC). Whilst consensus is growing around the role of PAC in the matured adult brain, its role in the development of speech processing is unexplored.Here, we examined the presence and maturation of low-frequency (Graphical abstractHighlightsLongitudinal EEG study in which 4, 7- & 11-month infants listened to nursery rhymesWe demonstrate cortical speech tracking via delta & theta neural signals (mTRF)Periodogram (PSD) analysis revealed stimulus related delta & theta PSD peaksDelta and theta driven phase amplitude coupling (PAC) was found at all agesGamma frequency amplitudes displayed stronger PAC to low frequency phases than beta

This paper deals with the design and optimization process of a quadruple 3-phase electrically excited synchronous machine (EESM) with isolated star points targeted for a 48V battery electric vehicle (BEV) traction drive. The EESM is designed for the operation with a high frequency rotating inductive contactless energy transfer system (CET) integrated into the shaft. A multi-objective optimization routine considering electro-magnetic and mechanical constraints with the total drive efficiency at the torque-speed envelope and the active machine weight as objectives is developed. The gear ratio, maximum phase current and rotor MMF are considered as parameters in order to find an optimal balance between machine size and total drive efficiency. The operating points at the torque-speed envelope are calculated computationally efficient by taking the location of the short-circuit current and its influence on the behavior of the machine into account. The developed optimization algorithm is tested by optimizing the 48V iEESM traction drive towards an output power of 60kW and the electro-magnetic and mechanical results are discussed.

This single-blinded, randomized, controlled study aimed to clinically and radiographically evaluate hard tissue volume stability beyond the bony envelope using three-dimensional preformed titanium mesh (3D-PFTM) for peri-implant dehiscence defects in the anterior maxilla. A total of 28 patients who wished to undergo implant surgery combined with guided bone regeneration (GBR) after extraction of a single maxillary anterior tooth were randomly assigned to two groups depending on the type of collagen membrane used, additionally with the 3D-PFTM—test (n = 14, cross-linked collagen membrane, CCM) and control (n = 14, non-cross-linked collagen membrane, NCCM) groups. Each implant was evaluated radiographically using CBCT at baseline, immediately after surgery, and at 6 months postoperatively. The relative position and distances from the bony envelope to the outlines of the augmented ridge were further determined immediately after GBR and 6 months after healing. At the platform level, the mean horizontal hard tissue gain (HG) at all the sites was 2.35 ± 0.68 mm at 6 months postoperatively. The mean HG rate was 84.25% ± 14.19% in the CCM group and 82.56% ± 13.04% in the NCCM group, but the difference was not significant between the groups. In all cases, HG was maintained beyond the bony envelope even after 6 months of GBR. This study suggests that 3D-PFTM should be considered a valuable option for GBR for peri-implant dehiscence defects in the anterior maxilla. In addition, 3D-PFTM may confer predictable hard tissue volume stability even after the healing period of hard tissue augmented outside the bony envelope by GBR.

With limited fundamental frequency (F0) cues, cochlear implant (CI) users recognize Mandarin tones using amplitude envelope. This study investigated whether tone recognition training with amplitude envelope enhancement may improve tone recognition and cue weighting with CIs. Three groups of CI-simulation listeners received training using vowels with amplitude envelope modified to resemble F0 contour (enhanced-amplitude-envelope training), training using natural vowels (natural-amplitude-envelope training), and exposure to natural vowels without training, respectively. Tone recognition with natural and enhanced amplitude envelope cues and cue weighting of amplitude envelope and F0 contour were measured in pre-, post-, and retention-tests. It was found that with similar pre-test performance, both training groups had better tone recognition than the no-training group after training. Only enhanced-amplitude-envelope training increased the benefits of amplitude envelope enhancement in the post- and retention-tests than in the pre-test. Neither training paradigm increased the cue weighting of amplitude envelope and F0 contour more than stimulus exposure. Listeners attending more to amplitude envelope in the pre-test tended to have better tone recognition with enhanced amplitude envelope cues before training and improve more in tone recognition after enhanced-amplitude-envelope training. The results suggest that auditory training and speech enhancement may bring maximum benefits to CI users when combined.

Patients and physicians have long looked to physical therapists to help determine an athlete’s readiness to return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR). This is a complex decision that must take into account biological healing, joint stability, functional performance, and psychological readiness. Considering that the vast majority of medical professionals use time as the sole determinant of an athlete’s readiness, and few are using performance-based criteria, it appears as though our profession is failing to capture the necessary information to make this weighty recommendation. The time is now to take a hard look at current practice patterns with RTS testing and push the envelope forward. The purpose of this clinical commentary is challenge our failing status quo by disseminating a robust model for RTS testing that incorporates temporal and criterion-based factors, as well as intrinsic and extrinsic data. Level of Evidence 5

Objectives This study tested whether speech perception and spatial acuity improved in people with single-sided deafness and a cochlear implant (SSD+CI) when the frequency allocation table (FAT) of the CI was adjusted to optimize frequency-dependent sensitivity to binaural disparities. Design Nine SSD+CI listeners with at least 6 months of CI listening experience participated. Individual experimental FATs were created to best match the frequency-to-place mapping across ears using either sensitivity to binaural temporal-envelope disparities or estimated insertion depth. Spatial localization ability was measured, along with speech perception in spatially collocated or separated noise, first with the clinical FATs and then with the experimental FATs acutely and at 2-month intervals for 6 months. Listeners then returned to the clinical FATs and were retested acutely and after 1 month to control for long-term learning effects. Results The experimental FAT varied between listeners, differing by an average of 0.15 octaves from the clinical FAT. No significant differences in performance were observed in any of the measures between the experimental FAT after 6 months and the clinical FAT one month later, and no clear relationship was found between the size of the frequency-allocation shift and perceptual changes. Conclusion Adjusting the FAT to optimize sensitivity to interaural temporal-envelope disparities did not improve localization or speech perception. The clinical frequency-to-place alignment may already be sufficient, given the inherently poor spectral resolution of CIs. Alternatively, other factors, such as temporal misalignment between the two ears, may need to be addressed before any benefits of spectral alignment can be observed.

Reconstructing the locomotor behavior of extinct animals depends on elucidating the principles that link behavior, function, and morphology, which can only be done using extant animals. Within the human lineage, the evolution of bipedalism represents a critical transition, and evaluating fossil hominins depends on understanding the relationship between lower limb forces and skeletal morphology in living humans. As a step toward that goal, here we use a musculoskeletal model to estimate forces in the lower limb muscles of ten individuals during walking. The purpose is to quantify the consistency, timing, and magnitude of these muscle forces during the stance phase of walking. We find that muscles which act to support or propel the body during walking demonstrate the greatest force magnitudes as well as the highest consistency in the shape of force curves among individuals. Muscles that generate moments in the same direction as, or orthogonal to, the ground reaction force show lower forces of greater variability. These data can be used to define the envelope of load cases that need to be examined in order to understand human lower limb skeletal load bearing., Summary: A musculoskeletal model of human walking reveals the consistency, timing, and magnitude of lower limb muscle forces across the stance phase.

Background Preservation rhinoplasty (PR) techniques are continuously evolving and many variations of established techniques have been proposed since Daniel coined this term in 2018. Objectives The aim of this study was to describe indications for a new “3-level impaction” technique, allowing, in selected cases, a complete profile correction and dorsal reduction without dissection of the dorsal soft tissue envelope (STE). Methods Three hundred and fifty primary closed rhinoplasty cases were retrospectively studied from January 2018 and October 2019. Age, sex, race, technical details, surgical time, and complications were registered. Ninety-five dorsa were reduced and shaped without dissecting the dorsal STE by combining: (1) a swinging-door septoplasty with low septal strip resection, (2) endonasal bony cap mosaic osteotomies, and (3) let-down or push-down operation. Results All patients showed a dramatic change in profile height and shape without either dorsal STE dissection or bony cartilage dorsal tissue resection. Mosaic osteotomies converted the dorsal keystone area from S- to V-shaped dorsum, let-down-operation and low septal strip resection enabled impaction, and profile setting was achieved by quadrangular cartilage flap rotation. The average follow-up time was 14 months (range, 12-16 months). Conclusions In selected patients, dorsum can be preserved without STE dissection. By combining multiple endonasal maneuvers it is possible to obtain a dramatic change without dissecting the STE, while simultaneously avoiding any dorsal tissue resection. This method offers a versatile technique in selected patients, which leads to fast recovery and natural results. Level of Evidence: 4

Auditory attention decoding (AAD) algorithms decode the auditory attention from electroencephalography (EEG) signals that capture the listener's neural activity. Such AAD methods are believed to be an important ingredient towards so-called neuro-steered assistive hearing devices. For example, traditional AAD decoders allow detecting to which of multiple speakers a listener is attending to by reconstructing the amplitude envelope of the attended speech signal from the EEG signals. Recently, an alternative paradigm to this stimulus reconstruction approach was proposed, in which the directional focus of auditory attention is determined instead, solely based on the EEG, using common spatial pattern filters (CSP). Here, we propose Riemannian geometry-based classification (RGC) as an alternative for this CSP approach, in which the covariance matrix of a new EEG segment is directly classified while taking its Riemannian structure into account. While the proposed RGC method performs similarly to the CSP method for short decision lengths (i.e., the amount of EEG samples used to make a decision), we show that it significantly outperforms it for longer decision window lengths., Comment: 5 pages

Various studies have characterized head kinematics in specific everyday activities by looking at linear and/or rotational acceleration characteristics, but each has evaluated a limited number of activities. Furthermore, these studies often present dissimilar and sometimes incomplete descriptions of the resulting kinematics, so the characteristics of normal everyday activities as a whole are not easily collectively summarized. The purpose of this study was to evaluate the literature investigating head kinematics associated with everyday activities and to generate a comprehensive kinematic boundary envelope describing these motions. The envelope constructed constitutes the current state of published knowledge regarding ‘normally occurring’ head accelerations. The envelope of kinematics represents activities commonly encountered and posing zero to minimal risk of injury to healthy individuals. Several kinematic measures, including linear accelerations, rotational velocities, and rotational accelerations, one may encounter as a result of normal everyday activities are summarized. A total of 11 studies encompassing 49 unique activities were evaluated. Examples of activities include sitting in a chair, jumping off a step, running, and walking. The peak resultant linear accelerations of the head reported in the literature were all less than 15 g, while the peak resultant rotational accelerations and rotational velocities approach 1375 rad/s2 and 12.8 rad/s, respectively. The resulting design envelope can be used to understand the range of acceleration magnitudes a typical active person can expect to experience. The results are also useful to compare to other activities exposing the head to motion or impact including sports, military, automotive, aerospace and other sub-injurious and injurious events.

IMPORTANCE: Preoperative assessment of nasal soft-tissue envelope (STE) thickness is an important component of rhinoplasty that presently lacks validated tools. OBJECTIVE: To measure and assess the distribution of nasal STE thickness in a large patient population and to determine if facial plastic surgery clinicians can predict nasal STE thickness based on visual examination of the nose. DESIGN, SETTING, AND PARTICIPANTS: This retrospective review and prospective assessment of 190 adult patients by 4 expert raters was conducted at an academic tertiary referral center. The patients had high-resolution maxillofacial computed tomography (CT) scans and standardized facial photographs on file and did not have a history of nasal fracture, septal perforation, rhinoplasty, or other surgery or medical conditions altering nasal form. Data were analyzed in March 2019. MAIN OUTCOMES AND MEASURES: Measure nasal STE thickness at defined anatomic subsites using high-resolution CT scans. Measure expert-predicted nasal STE thickness based on visual examination of the nose using a scale from 0 (thinnest) to 100 (thickest). RESULTS: Of the 190 patients, 78 were women and the mean (SD) age was 45 (17) years. The nasal STE was thickest at the sellion (mean [SD]) (6.7 [1.7] mm), thinnest at the rhinion (2.1 [0.7] mm), thickened over the supratip (4.8 [1.0] mm) and nasal tip (3.1 [0.6] mm), and thinned over the columella (2.6 [0.4] mm). In the study population, nasal STE thickness followed a nearly normal distribution for each measured subsite, with the majority of patients in a medium thickness range. Comparison of predicted and actual nasal STE thickness showed that experts could accurately predict nasal STE thickness, with the highest accuracy at the nasal tip (r, 0.73; prediction accuracy, 91%). A strong positive correlation was noted among the experts’ STE estimates (r, 0.83-0.89), suggesting a high level of agreement between individual raters. CONCLUSIONS AND RELEVANCE: There is variable thickness of the nasal STE, which influences the external nasal contour and rhinoplasty outcomes. With visual analysis of the nose, experts can agree on and predict nasal STE thickness, with the highest accuracy at the nasal tip. These data can aid in preoperative planning for rhinoplasty, allowing implementation of preoperative, intraoperative, and postoperative strategies to optimize the nasal STE, which may ultimately improve patient outcomes and satisfaction. LEVEL OF EVIDENCE: NA.

OBJECTIVES: A surge of literature indicated that temporal integration and temporal envelope perception contribute largely to the perception of speech. A review of literature showed that the perception of speech with temporal integration and temporal envelope perception in noise might be affected due to sensorineural hearing loss but to a varying degree. Because the temporal integration and temporal envelope share similar physiological processing at the cochlear level, the present study was aimed to identify the relationship between temporal integration and temporal envelope perception in noise by individuals with mild sensorineural hearing loss. MATERIALS AND METHODS: Thirty adult males with mild sensorineural hearing loss and thirty age- and gender-matched normal-hearing individuals volunteered for being the participants of the study. The temporal integration was measured using synthetic consonant–vowel–consonant syllables, varied for onset, offset, and onset–offset of second and third formant frequencies of the vowel following and preceding consonants in six equal steps, thus forming a six-step onset, offset, and onset–offset continuum, each. The duration of the transition was kept short (40 ms) in one set of continua and long (80 ms) in another. Temporal integration scores were calculated as the differences in the identification of the categorical boundary between short- and long-transition continua. Temporal envelope perception was measured using sentences processed in quiet, 0 dB, and −5 dB signal-to-noise ratios at 4, 8, 16, and 32 contemporary frequency channels, and the temporal envelope was extracted for each sentence using the Hilbert transformation. RESULTS: A significant effect of hearing loss was observed on temporal integration, but not on temporal envelope perception. However, when the temporal integration abilities were controlled, the variable effect of hearing loss on temporal envelope perception was noted. CONCLUSION: It was important to measure the temporal integration to accurately account for the envelope perception by individuals with normal hearing and those with hearing loss.

Purpose: To evaluate the effect of speaking rate on speech perception with unprocessed (UP) and envelope enhancement in noise on normal hearing younger adults (YAG) and older adults (OAG).Method: A...

Pectopexy, a laparoscopic method for prolapse surgery, showed promising results in previous transient testing by this group. It was shown that a single suture, yielding an ultimate load of 35 N, was equivalent to continuous suturing. This was demonstrated in an in vitro cadaver study. This transient data were used to establish an elastic stress–strain envelope. It was now possible to proceed to dynamic in vitro analysis of this surgical method to establish time to functional stability. Cyclic testing of this fixation method was performed on human female embalmed cadaver (cohort 1) and fresh, non-embalmed cadaver (cohort 2) pelvises. The testing envelope was 5–25 N at a speed of 1 mm/s. 100 load regulated cycles were applied. 100 cycles were completed with each model; no overall system failure occurred. Steady state, i.e., functional stability was reached after 14.5 (± 2.9) cycles for the embalmed group and after 19.1 (± 7.2) cycles for the non-embalmed group. This difference was statistically significant p = 0.00025. This trial showed in an in vitro cyclic testing of the pectopexy method that functional stability may be achieved after no more than 19.1 cycles of load exposure. When remaining within the established load envelope of below 25 N, patients do not need to fear global fixation failure. Testing did demonstrate differences in non-embalmed and embalmed cadaver testing. Embalmed cadaver testing tends to underestimate time to steady state by 26.3%.

Purpose: The perception of speech is affected by many physical, physiological and pathological factors related to the stimuli and the listener. Researchers have addressed the effect of each of thes...

Speech perception in a noisy environment is a significant challenge for individuals with auditory processing deficits. Evidence exists that exaggerating the slow temporal modulations may enhance speech perception for these individuals in the absence or presence of background noise. Nevertheless, a comprehensive assessment of envelope enhancement algorithms is lacking. In the present research study, two different schemes of envelope enhancement (dynamic and static) were evaluated subjectively and objectively for different types and levels of background noise with and without applying a noise reduction algorithm. In the subjective assessment, the dynamic envelope enhancement algorithm was evaluated with three different subjective groups including, twelve normal adults, twelve normal children, and eleven children with suspected auditory processing disorder (APD). The subjective results revealed that the speech intelligibility scores were lower for APD subjects compared to both normal adults and normal children. The subjective results also demonstrated that enhancing the temporal envelope is much more beneficial for subjects with suspected APD when compared to normal adults and children participating in the subjective experiment. In the objective assessment, the Hearing Aid Speech Perception Index (HASPI) was employed to predict the speech intelligibility scores which correlated highly with the subjective data. Comprehensive objective experiments demonstrated that both dynamic and static envelope enhancement algorithms are only effective in improving speech perception under certain processing conditions that depended on the type, level and location of the background noise. It is also shown that the application of a noise reduction algorithm prior to the envelope enhancement algorithms will increase their range of effectiveness.

Circular external fixation offers an important option for reconstructive surgeons. When the soft tissue envelope is compromised, either by disease or trauma, external fixation offers a chance to address limb abnormalities that may otherwise be delayed. The application of the Iizarov apparatus requires skills and experience to address unique scenarios, starting prior to surgery and extending months following application. This article will offer practical management concepts based on the authors’ experience using the Orthofix Truelok system. It is our hope that the information provided will lend to improved management strategies and outcomes for the practitioner and patient.

Purpose A longstanding finding in persons who stutter is that stuttering frequency significantly reduces during choral reading when compared to the solo reading condition. Here, we tested the hypothesis that this decrease in stuttering frequency may be because speech of the normal speaker dictates the speech rhythm of a person who stutters. We used an automated, sensitive acoustic technique—Envelope Modulation Spectral (EMS) analysis— that allowed us to document speech rhythm. Method Seventeen adults who stutter (AWS) read sentences under two conditions: solo reading and choral reading. Percentage of syllables stuttered (%SS), the rate of speech, and speech rhythm were calculated from the recorded sentences from AWS. Further, AWS speech rhythm during solo reading was compared with typical adults. EMS was extracted for the full signal and seven-octave bands. From the extracted envelope six predictor variables (peak frequency, peak amplitude, energy in the spectrum 3–6 Hz, energy in the spectrum from 0 to 4 Hz, energy in the spectrum from 4 to 10 Hz, and the ratio of energy below4 Hz/above 4 Hz) were computed. Results Significant decrease in stuttering frequency and rate of speech was noticed in choral reading when compared to the solo reading condition. Further, analysis of EMS results suggested the statistically significant difference between two reading conditions (for peak frequency and peak amplitude), and between two groups for all predictor variables. Conclusion Overall, current results highlight that decreases in stuttering during the choral reading is characterized by a decrease in rate and changes in some aspects of speech rhythm in Kannada speaking AWS.

Peripheral hearing impairment cannot fully account for speech perception difficulties that emerge with advancing age. As the fluctuating speech envelope bears crucial information for speech perception, changes in temporal envelope processing are thought to contribute to degraded speech perception. Previous research has demonstrated changes in neural encoding of envelope modulations throughout the adult lifespan, either due to age or due to hearing impairment. To date, however, it remains unclear whether such age- and hearing-related neural changes are associated with impaired speech perception. In the present study, we investigated the potential relationship between perception of speech in different types of masking sounds and neural envelope encoding for a normal-hearing and hearing-impaired adult population including young (20-30 years), middle-aged (50-60 years), and older (70-80 years) people. Our analyses show that enhanced neural envelope encoding in the cortex and in the brainstem, respectively, is related to worse speech perception for normal-hearing and for hearing-impaired adults. This neural-behavioral correlation is found for the three age groups and appears to be independent of the type of masking noise, i.e., background noise or competing speech. These findings provide promising directions for future research aiming to develop advanced rehabilitation strategies for speech perception difficulties that emerge throughout adult life. ispartof: HEARING RESEARCH vol:370 pages:189-200 ispartof: location:Netherlands status: published

Objectives The study aimed to compare two electrode montages commonly used for recording speech-evoked envelope following responses. Design Twenty-three normal-hearing adults participated in this study. EFRs were elicited by a naturally spoken, modified /susa∫i/ stimulus presented at 65 dB SPL monaurally. EFRs were recorded using two single-channel electrode montages: Cz-nape and Fz-ipsilateral mastoid, where the noninverting and inverting sites were the vertex and nape, and the high forehead and ipsilateral mastoid, respectively. Montage order was counterbalanced across participants. Results Envelope following responses amplitude and phase coherence were significantly higher overall in the Cz-nape montage with no significant differences in noise amplitude. Post hoc testing on montage effects in response amplitude and phase coherence was not significant for individual stimuli. The Cz-nape montage also resulted in a greater number of detections and analyzed using the Hotelling's T2. Conclusions Electrode montage influences the estimated characteristics of speech-evoked EFRs.

The objective of this study was to reconstruct the envelope surface of the condyle and the four-dimensional trajectory model in mandibular border movement in normal adults. Eleven healthy subjects were selected as volunteers. Cone-beam computed tomographic (CBCT) scanning was performed on the volunteers. The three-dimensional (3D) movement path of the mandible was recorded using a virtual articulator (PN-300), which was based on a 3D model of the mandible. We used Proplan CMF 3.0 (Materialise) software to perform this from the DICOM data generated by CBCT scans. The distance of condylar movement was measured in this model during volunteers' mouth opening, protrusion, and lateral excursions. The envelope surface of the condyle was reconstructed by merging a functional condylar surface at each recording moment during the movement of the whole border. In the mandibular digital models, the condyle moved downward firstly, and moved upward to the position of maximum mouth opening. The condyle moved forward and downward during protrusion. The working condyle rotated slightly and the non-working condyle moved forward, downward, and inward during lateral excursions. The mean (SD) movement distance of 11 subjects was 19.04 (4.37) mm during mouth opening (including downward and upward) and 9.75 (2.38) mm during protrusion. During lateral excursions the mean (SD) movement distance of the working condyle was 2.87 (1.13) mm, the mean (SD) movement distance of the non-working condyle was 10.85 (3.25) mm. The envelope surface of healthy volunteers showed a double-peak pattern. The envelope surface of the condyle and four-dimensional movement model can be reconstructed by merging the trajectory of the mandible recorded from the novel virtual articulator PN300 and a 3D image of the mandible.

Closed degloving injury involving a toe represents a rare phenomenon in which the bones of the toe dislocate but the soft-tissue envelope remains intact. It has been described sparingly throughout the medical literature, and outcomes have been poor. This article presents a case report of the unique injury while also investigating trends through a detailed review of the literature.

The integration of visual and auditory cues is crucial for successful processing of speech, especially under adverse conditions. Recent reports have shown that when participants watch muted videos of speakers, the phonological information about the acoustic speech envelope is tracked by the visual cortex. However, the speech signal also carries much richer acoustic details, e.g. about the fundamental frequency and the resonant frequencies, whose visuo-phonological transformation could aid speech processing. Here, we investigated the neural basis of the visuo-phonological transformation processes of these more fine-grained acoustic details and assessed how they change with ageing. We recorded whole-head magnetoencephalography (MEG) data while participants watched silent intelligible and unintelligible videos of a speaker. We found that the visual cortex is able to track the unheard intelligible modulations of resonant frequencies and the pitch linked to lip movements. Importantly, only the processing of intelligible unheard formants decreases significantly with age in the visual and also in the cingulate cortex. This is not the case for the processing of the unheard speech envelope, the fundamental frequency or the purely visual information carried by lip movements. These results show that unheard spectral fine-details (along with the unheard acoustic envelope) are transformed from a mere visual to a phonological representation. Aging affects especially the ability to derive spectral dynamics at formant frequencies. Since listening in noisy environments should capitalize on the ability to track spectral fine-details, our results provide a novel focus on compensatory processes in such challenging situations.

Understanding the lower limb kinematic, kinetic, and electromyography (EMG) data interrelation in controlled speeds is challenging for fully assessing human locomotion conditions. This paper provides a complete dataset with the above-mentioned raw and processed data simultaneously recorded for sixteen healthy participants walking on a 10 meter-flat surface at seven controlled speeds (1.0, 1.5, 2.0, 2.5, 3.0, 3.5, and 4.0 km/h). The raw data include 3D joint trajectories of 24 retro-reflective markers, ground reaction forces (GRF), force plate moments, center of pressures, and EMG signals from Tibialis Anterior, Gastrocnemius Lateralis, Biceps Femoris, and Vastus Lateralis. The processed data present gait cycle-normalized data including filtered EMG signals and their envelope, 3D GRF, joint angles, and torques. This study details the experimental setup and presents a brief validation of the data quality. The presented dataset may contribute to (i) validate and enhance human biomechanical gait models, and (ii) serve as a reference trajectory for personalized control of robotic assistive devices, aiming an adequate assistance level adjusted to the gait speed and user’s anthropometry., Measurement(s) walking • Lower Extremity Technology Type(s) motion capture • electromyography • force platform Factor Type(s) sex • age • height • mass • leg length • foot length Sample Characteristic - Organism Homo sapiens Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.13169348

This paper is about an automated system for extracting valuable features from PCG signal which can be used to detect heart diseases. A Graphical user interface is being build where anyone can select a specific PCG recordings and then the system will provide S1S2 distance in milliseconds and A2P2 distance in milliseconds. At first Shannon energy envelope is used to find the S1 (first heart sound) and S2 (second heart sound) areas more easily. Peak detection algorithm is used to detect desired peaks. Using threshold algorithm unwanted peaks were removed. Then using these peak distances cardiac cycle was located. Using cardiac cycle and estimate second heart sound distance range S1S2 distance and A2P2 distance are calculated. A2P2 distance is the time difference between two components (Aortic valve closure & Pulmonic valve closure) of second heart sound(S2). S1S2 distance and A2P2 distance are two very important features of heart sound. Many heart diseases are associated with these two features. These two features can be used to detect these heart diseases. So the project will help to build an automated heart diseases detection system in future.

Traditionally in total knee arthroplasty (TKA), a post-operative neutral alignment was the gold standard. This principle has been contested as functional outcomes were found to be inconsistent. Analysis of limb alignment in the non-osteoarthritic population reveals variations from neutral alignment and consideration of a personalized or patient-specific alignment in TKA is challenging previous concepts. The aim of this review was to clarify the variations of current personalized alignments and to report their results. Current personalized approaches of alignment reported are: kinematic, inverse kinematic, restricted kinematic, and functional. The principle of “kinematic alignment” is knee resurfacing with restitution of pre-arthritic anatomy. The aim is to resurface the femur maintaining the native femoral joint line obliquity. The flexion and extension gaps are balanced with the tibial resection. The principle of the “inverse kinematic alignment” is to resurface the tibia with similar medial and lateral bone resections in order to keep the native tibial joint line obliquity. Gap balancing is performed by adjusting the femoral resections. To avoid reproducing extreme anatomical alignments there is “restricted kinematic alignment” which is a compromise between mechanical alignment and true kinematic alignment with a defined safe zone of alignment. Finally, there is the concept of “functional alignment” which is an evolution of kinematic alignment as enabling technology has progressed. This is obtained by manipulating alignment, bone resections, soft tissue releases, and/or implant positioning with a robotic-assisted system to optimize TKA function for a patient’s specific alignment, bone morphology, and soft tissue envelope. The aim of personalizing alignment is to restore native knee kinematics and improve functional outcomes after TKA. A long-term follow-up remains crucial to assess both outcomes and implant survivorship of these current concepts.

Hip arthroscopy is technically demanding and presents a steep learning curve. Joint access and maneuverability of surgical tools are impeded by a large soft-tissue envelope. Furthermore, cam resection is challenging owing to the small size of the lesion and the difficulty in delineating what is normal and where the cam starts. Thus, the number of incomplete resections is high and represents the bulk of indications for revision hip arthroscopy. The search for assistive technologies to improve on diagnostics and surgical accuracy is consequently substantial and unquestionably needed. Intraoperative feedback will improve our resection accuracy while decreasing the learning efforts of both expert and novice surgeons.

The development of sophisticated computational tools to quantify changes in the brain's oscillatory dynamics across states of consciousness have included both envelope- and phase-based measures of functional connectivity (FC), but there are very few direct comparisons of these techniques using the same dataset. The goal of this study was to compare an envelope-based (i.e. Amplitude Envelope Correlation, AEC) and a phase-based (i.e. weighted Phase Lag Index, wPLI) measure of FC in their classification of states of consciousness. Nine healthy participants underwent a three-hour experimental anesthetic protocol with propofol induction and isoflurane maintenance, in which five minutes of 128-channel electroencephalography were recorded before, during, and after anesthetic-induced unconsciousness, at the following time points: Baseline; light sedation with propofol (Light Sedation); deep unconsciousness following three hours of surgical levels of anesthesia with isoflurane (Unconscious); five minutes prior to the recovery of consciousness (Pre-ROC); and three hours following the recovery of consciousness (Recovery). Support vector machine classification was applied to the source-localized EEG in the alpha (8–13 Hz) frequency band in order to investigate the ability of AEC and wPLI (separately and together) to discriminate i) the four states from Baseline; ii) Unconscious (“deep” unconsciousness) vs. Pre-ROC (“light” unconsciousness); and iii) responsiveness (Baseline, Light Sedation, Recovery) vs. unresponsiveness (Unconscious, Pre-ROC). AEC and wPLI yielded different patterns of global connectivity across states of consciousness, with AEC showing the strongest network connectivity during the Unconscious epoch, and wPLI showing the strongest connectivity during full consciousness (i.e., Baseline and Recovery). Both measures also demonstrated differential predictive contributions across participants and used different brain regions for classification. AEC showed higher classification accuracy overall, particularly for distinguishing anesthetic-induced unconsciousness from Baseline (83.7 ± 0.8%). AEC also showed stronger classification accuracy than wPLI when distinguishing Unconscious from Pre-ROC (i.e., “deep” from “light” unconsciousness) (AEC: 66.3 ± 1.2%; wPLI: 56.2 ± 1.3%), and when distinguishing between responsiveness and unresponsiveness (AEC: 76.0 ± 1.3%; wPLI: 63.6 ± 1.8%). Classification accuracy was not improved compared to AEC when both AEC and wPLI were combined. This analysis of source-localized EEG data demonstrates that envelope- and phase-based FC provide different information about states of consciousness but that, on a group level, AEC is better able to detect relative alterations in brain FC across levels of anesthetic-induced unconsciousness compared to wPLI.