Objective To evaluate the bi‐planar robot navigation system for insertion of cannulated screws in femoral neck fractures. Method Between January 2016 and December 2016, 60 patients with femoral neck fractures were separately treated using percutaneous cannulated screws assisted by the bi‐planar robot navigation system (robot group) and conventional freehand surgery (freehand group). The fluoroscopy time, the number of drilling attempts, and the operation time were recorded during operations; the dispersion and parallelism of the cannulated screws on the posteroanterior and lateral images were measured after operations. Patients were followed up for 12–24 months and the Harris scores and the final results of the two groups were compared. Results During bi‐planar robot navigation system‐assisted surgery, the fluoroscopy time for acquisition of images was 2.3 seconds on average, and the time for planning screws during the operation was 2.8 min on average. The average fluoroscopy time during the placement of the guide pin was 5.7 seconds and 14.14 seconds (P = 0.00), respectively. The average time of the placement of the cannulated screws was 12.7 min and 19.4 min (P = 0.00), respectively, in the robot group and the freehand group. In the robot group, only one guide pin was replaced during the operation, and the average number of adjustments for each guide pin was 2.39 in the freehand group. The screw parallelism and dispersion measured by postoperative imaging in the robot group were significantly superior to those in the freehand group. From postoperative CT it was evident that there were 5 cases of screws exiting the posterior cortex in both groups. During the follow‐up phase, 1 case of femoral head necrosis and 5 cases of femoral neck shortening of more than 10 mm occurred in the robotic navigation group; 3 cases of femoral head necrosis, 1 case of fracture nonunion, and 2 cases of shortening of more than 10 mm occurred in the freehand group. At 18 months after surgery, the average Harris scores of the patients were 85.20 and 83.45, respectively, with no significant difference. Conclusion Using bi‐planar robot navigation system‐assisted placement of femoral neck cannulated screws can significantly reduce the time of intraoperative fluoroscopy, drilling attempts, and operation time. The placed screws are superior to the screws placed freehand in relation to parallelism and dispersion. However, it is still necessary for surgeons to have a good reduction of the femoral neck fracture before surgery and to be proficient in the operation of the robot navigation system. In summary, the bi‐planar robot navigation system is an effective assistant instrument for surgery.

Background:Sacroiliac (SI) screw fixation is a demanding technique, with a high rate of screw malposition due to the complex pelvic anatomy. TiRobot™ is an orthopedic surgery robot which can be used for SI screw fixation. This study aimed to evaluate the accuracy of robot-assisted placement of SI screws compared with a freehand technique.Methods:Thirty patients requiring posterior pelvic ring stabilization were randomized to receive freehand or robot-assisted SI screw fixation, between January 2016 and June 2016 at Beijing Jishuitan Hospital. Forty-five screws were placed at levels S1 and S2. In both methods, the primary end point screw position was assessed and classified using postoperative computed tomography. Fisher's exact probability test was used to analyze the screws’ positions. Secondary end points, such as duration of trajectory planning, surgical time after reduction of the pelvis, insertion time for guide wire, number of guide wire attempts, and radiation exposure without pelvic reduction, were also assessed.Results:Twenty-three screws were placed in the robot-assisted group and 22 screws in the freehand group; no postoperative complications or revisions were reported. The excellent and good rate of screw placement was 100% in the robot-assisted group and 95% in the freehand group. The P value (0.009) showed the same superiority in screw distribution. The fluoroscopy time after pelvic reduction in the robot-assisted group was significantly shorter than that in the freehand group (median [Q1, Q3]: 6.0 [6.0, 9.0] s vs. median [Q1, Q3]: 36.0 [21.5, 48.0] s; χ2 = 13.590, respectively, P < 0.001); no difference in operation time after reduction of the pelvis was noted (χ2 = 1.990, P = 0.158). Time for guide wire insertion was significantly shorter for the robot-assisted group than that for the freehand group (median [Q1, Q3]: 2.0 [2.0, 2.7] min vs. median [Q1, Q3]: 19.0 [15.5, 45.0] min; χ2 = 20.952, respectively, P < 0.001). The number of guide wire attempts in the robot-assisted group was significantly less than that in the freehand group (median [Q1, Q3]: 1.0 [1.0,1.0] time vs. median [Q1, Q3]: 7.0 [1.0, 9.0] times; χ2 = 15.771, respectively, P < 0.001). The instrumented SI levels did not differ between both groups (from S1 to S2, χ2 = 4.760, P = 0.093).Conclusions:Accuracy of the robot-assisted technique was superior to that of the freehand technique. Robot-assisted navigation is safe for unstable posterior pelvic ring stabilization, especially in S1, but also in S2. SI screw insertion with robot-assisted navigation is clinically feasible.

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The short- and long-time equilibrium transport properties of a hydrodynamically interacting suspension confined by a spherical cavity are studied via Stokesian dynamics simulations for a wide range of particle-to-cavity size ratios and particle concentrations. Many-body hydrodynamic and lubrication interactions between particles and with the cavity are accounted for utilizing recently developed mobility and resistance tensors for spherically confined suspensions (Aponte-Rivera & Zia, Phys. Rev. Fluids, vol. 1(2), 2016, 023301). Study of particle volume fractions in the range $0.05\leqslant \unicode[STIX]{x1D719}\leqslant 0.40$ reveals that confinement exerts a qualitative influence on particle diffusion. First, the mean-square displacement over all time scales depends on the position in the cavity. Additionally, at short times, the diffusivity is anisotropic, with diffusion along the cavity radius slower than diffusion tangential to the cavity wall, due to the anisotropy of hydrodynamic coupling and to confinement-induced spatial heterogeneity in particle concentration. The mean-square displacement is anisotropic at intermediate times as well and, surprisingly, exhibits superdiffusive and subdiffusive behaviours for motion along and perpendicular to the cavity radius respectively, depending on the suspension volume fraction and the particle-to-cavity size ratio. No long-time self-diffusive regime exists; instead, the mean-square displacement reaches a long-time plateau, a result of entropic restriction to a finite volume. In this long-time limit, the higher the volume fraction is, the longer the particles take to reach the long-time plateau, as cooperative rearrangements are required as the cavity becomes crowded. The ordered dynamical heterogeneity seen here promotes self-organization of particles based on their size and self-mobility, which may be of particular relevance in biophysical systems.

Liposomal irinotecan plus 5-fluorouracil/leucovorin (nal-IRI + 5-FU/LV) has shown to provide survival benefits for patients with gemcitabine-refractory metastatic pancreatic ductal adenocarcinoma (PDAC) in NAPOLI-1 trial, in which Asian patients experienced more hematological toxicity and subsequent dose modification. A retrospective chart review to investigate the administration pattern, therapeutic efficacy and safety profile of nal-IRI + 5-FU/LV in 44 consecutive patients with gemcitabine-refractory advanced PDAC treated between December 2016 and December 2018 in National Cheng Kung University Hospital, Taiwan. Most of them had metastatic diseases (88.6%), one-line of prior treatment (72.7%), ECOG PS 0-1 (72.7%) and starting dose of nal-IRI at 60 mg/m2 (≈52 mg/m2 irinotecan free-base) in 65.9%. The overall response rate was 9.1%. The median OS was 6.6 months for the entire cohort, and 7.8 and 2.7 months for patients of ECOG PS 0-1 and>2, respectively. The median OS of ECOG PS 0-1 patients with nal-IRI starting doses at 80 mg/m2 (≈70 mg/m2 irinotecan free-base, n = 13) and 60 mg/m2 (n = 19) were 7.5 and 8.4 months, respectively. Thirty-four percent of patients experienced manageable grade 3-4 hematological toxicity. Our results confirm the clinical benefit of nal-IRI + 5-FU/LV for patients of gemcitabine-refractory advanced PDAC with good performance status in a real-world setting.

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This paper proposes the implementation of fuzzy motion control based on reinforcement learning (RL) and Lagrange polynomial interpolation (LPI) for gait synthesis of biped robots. First, the procedure of a walking gait is redefined into three states, and the parameters of this designed walking gait are determined. Then, the machine learning approach applied to adjusting the walking parameters is policy gradient RL (PGRL), which can execute real-time performance and directly modify the policy without calculating the dynamic function. Given a parameterized walking motion designed for biped robots, the PGRL algorithm automatically searches the set of possible parameters and finds the fastest possible walking motion. The reward function mainly considered is first the walking speed, which can be estimated from the vision system. However, the experiment illustrates that there are some stability problems in this kind of learning process. To solve these problems, the desired zero moment point trajectory is added to the reward function. The results show that the robot not only has more stable walking but also increases its walking speed after learning. This is more effective and attractive than manual trial-and-error tuning. LPI, moreover, is employed to transform the existing motions to the motion which has a revised angle determined by the fuzzy motion controller. Then, the biped robot can continuously walk in any desired direction through this fuzzy motion control. Finally, the fuzzy-based gait synthesis control is demonstrated by tasks and point- and line-target tracking. The experiments show the feasibility and effectiveness of gait learning with PGRL and the practicability of the proposed fuzzy motion control scheme.

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