Pulmonary passage of canine adipose tissue-derived mesenchymal stem cells through intravenous transplantation in mouse model.

IMPORTANCE: The intravenous administration of adipose tissue-derived mesenchymal stem cells (AdMSCs) in veterinary medicine is an attractive treatment option. On the other hand, it can result in severe complications, including pulmonary thromboembolism (PTE). OBJECTIVE: The present study assessed the occurrence of PTE after the intravenous infusion of canine AdMSCs (cAdMSCs) into experimental animals. METHODS: Five-week-old male BALB/c hairless mice were categorized into groups labeled A to G. In the control group (A), fluorescently stained 2 × 106 cAdMSCs were diluted in 200 µL of suspension and injected into the tail vein as a single bolus. The remaining groups included the following: group B with 5 × 106 cells, group C with 3 × 106 cells, group D with 1 × 106 cells, group E with 1 × 106 cells injected twice with a one-day interval, group F with 2 × 106 cells in 100 µL of suspension, and group G with 2 × 106 cells in 300 µL of suspension. RESULTS: Group D achieved a 100% survival rate, while none of the subjects in groups B and C survived (p = 0.002). Blood tests revealed a tendency for the D-dimer levels to increase as the cell dose increased (p = 0.006). The platelet count was higher in the low cell concentration groups and lower in the high cell concentration groups (p = 0.028). A histological examination revealed PTE in most deceased subjects (96.30%). CONCLUSIONS AND RELEVANCE: PTE was verified, and various variables were identified as potential contributing factors, including the cell dose, injection frequency, and suspension volume.

A Beginner's Perspective on Biportal Endoscopic Spine Surgery in Single-Level Lumbar Decompression: A Comparative Study with a Microscopic Surgery.

Background: The application of biportal endoscopic spinal surgery (BESS) in spine surgery is increasing. However, the clinical results of related studies have been inconsistent. In this study, the perioperative and clinical outcomes of two techniques in single-level lumbar decompression surgery were compared using the perspective of a spine surgeon experienced in microscopic surgery but inexperienced in BESS. Methods: This is a retrospective study performed with prospectively collected data. From April 2019, 50 consecutive patients who underwent a single-level lumbar decompression surgery with BESS were evaluated. Additionally, the data of 150 consecutive patients who underwent the same microscopic surgery before April 2019 were collected. We performed 1 : 1 ratio propensity score matching for these two groups to adjust for baseline variables. The postoperative patient-reported outcome measures included the Oswestry Disability Index (ODI) and numeric rating scale for the back and leg preoperatively and at 6 months after surgery. The laboratory data (C-reactive protein [CRP, mg/L] and hemoglobin [Hb, g/dL]) were measured preoperatively and 3 times (1, 2, and 3 or 4 days) postoperatively. In these periods, the peak and lowest CRP and Hb concentrations were evaluated. The perioperative outcomes, operation time (from skin incision to dressing), length of hospital stay, drainage (for 24 hours after surgery), and surgery-related complications were also evaluated. Results: Forty-seven patients (27 men and 20 women) were included in each group. The postoperative 6-month ODI was significantly lower in the BESS group than in the microscope group (6.90 ± 5.98 vs. 11.54 ± 9.70). The peak CRP concentration (16.63 ± 19.41 vs. 42.40 ± 37.73, p < 0.001) and CRP increment (peak CRP minus preoperative CRP, 14.69 ± 19.47 vs. 40.71 ± 37.32, p < 0.001) were significantly higher in the microscope group. Operation time (83.72 ± 35.71 vs. 70.27 ± 23.24, p = 0.047) was significantly longer in the BESS group. Surgery-related complications were found in 6 and 3 cases in the BESS group (3 revisions, 2 dural tears, and 1 conversion to open surgery) and microscope group (2 revisions and 1 hematoma), respectively. Conclusions: BESS as a new technique resulted in satisfying short-term outcomes. It was a well-tolerated option for surgical treatment of single-level lumbar degenerative disease. The relatively high incidence of recurrence at the index level and incidental dural tears should be considered for surgeons new to BESS; however, these were manageable complications.

Biomimetic lipid-fluorescein probe for cellular bioimaging.

Fluorescence probe is one of the most powerful tools for cellular imaging. Here, three phospholipid-mimicking fluorescent probes (FP1-FP3) comprising fluorescein and two lipophilic groups of saturated and/or unsaturated C18 fatty acids were synthesized, and their optical properties were investigated. Like in biological phospholipids, the fluorescein group acts as a hydrophilic polar headgroup and the lipid groups act as hydrophobic non-polar tail groups. Laser confocal microscope images illustrated that FP3, which contains both saturated and unsaturated lipid tails, showed great uptake into the canine adipose-derived mesenchymal stem cells.

Postoperative Segmental Motion up to 1 Year Following Single-Level Anterior Cervical Discectomy and Fusion: Plate versus Non-plate.

STUDY DESIGN: Retrospective observational study. PURPOSE: This study aimed to investigate the impact of plating on postoperative serial segmental motion and its correlation with clinical outcomes in single-level anterior cervical discectomy and fusion (ACDF) for up to 1 year. OVERVIEW OF LITERATURE: The advantages and disadvantages of using cervical plating in ACDF have been well discussed; however, few studies compared the early serial segmental motions at the postoperative level between plating and non-plating. METHODS: In retrospectively collected data, 149 patients who underwent single-level ACDF for degenerative disease were enrolled and divided into non-plating (n=66) and plating (n=83). Interspinous motion (ISM) at the arthrodesis segment, Numeric Rating Scale (NRS) for neck pain, and Neck Disability Index (NDI) were serially evaluated at 3, 6, and 12 months postoperatively. Predictable factors for fusion, including age, sex, plating, diabetes, smoking, and type of grafts, were investigated, and fusion was defined as ISM <1 mm. RESULTS: In both groups, ISM was the highest at 3 months and gradually decreased thereafter, and the plating group showed significantly lower serial ISM than the non-plating group at 12 months. The plating group had lower NRS and NDI scores than the nonplating group at 12 months, and the difference in the NRS scores was statistically significant, particularly at 3 and 6 months, although that of the NDI scores was not. In a multivariate analysis, plating was the most powerful predictor for fusion. CONCLUSIONS: Plating significantly decreases the serial ISM compared with non-plating in single-level ACDF, and such decreased motion is correlated with decreased neck pain until 12 months postoperatively, particularly at 3 and 6 months. Given that plating was the most predictive factor for fusion, we recommend plating even in single-level ACDF for better early clinical outcomes.

The Significance of Extra-Cage Bridging Bone via Radiographic Lumbar Interbody Fusion Criterion.

STUDY DESIGN: Prospective observational study. OBJECTIVES: We aimed to analysis the distributional patterns of the intra- and extra-cage bridging bone (InCBB and ExCBB) and the significance of ExCBB using suggested lumbar interbody fusion criterion. METHODS: This study included the patients with planned single-level transforaminal lumbar interbody fusion. We divided bridging bone into InCBB (in void of right or left cage) and ExCBB (outside of cages; anterior, posterior, intermediate, right, or left) and graded bridging scores from 0 to 2 on postoperative 1-year computed tomography. The fusion was defined as at least having one or more graded 2 and the evaluation were conducted twice by 2 raters. RESULTS: Sixty-five patients were enrolled. All values of intra- and inter-rater reliability in left InCBB, anterior, and posterior ExCBB showed good agreements (≥0.75). Both InCBBs showed similar mean bridging scores (Rt:1.43 vs Lt:1.48), and in ExCBBs, the anterior was the highest (1.43), followed by the posterior (1.14); the right and left were the lowest (0.49 and 0.52 respectively). In subjects determined as fusion (85.4%), complete bridging was observed more in ExCBB (88.8%) than in InCBB (69.9%). CONCLUSIONS: Given the higher bridging scores in both InCBBs and Ant. ExCBB, bone grafting is important promoting factor to increase the interbody bridging bone regardless of outside or in void of cages. Based on our suggested criterion, ExCBB has a greater proportion compared to InCBBs for determining the fusion and extra-cage bone grafting should be considered as important procedures for interbody fusion.

Forward Bending in Supine Test: Diagnostic Accuracy for Acute Vertebral Fragility Fracture.

Despite its high incidence rate, vertebral fragility fracture (VFF) is frequently underdiagnosed due to the absence of marked symptoms. This study evaluated the diagnostic accuracy of our suggested physical examinations and compared them with that of plain radiographs. Patients over 65 years of age with sudden back pain within the preceding 3 weeks were enrolled. Physical examinations in three different positions and a closed-fist percussion test were performed, and the presence of VFF was evaluated through confirmatory radiographic tools. We assessed the diagnostic accuracy of each physical examination and compared them with the interpretation of plain radiographs and examined the patient-reported pain locations based on the VFF level. A total of 179 patients were enrolled. The forward bending in supine (FB-SU) test demonstrated superior diagnostic values (sensitivity: 90.6%, specificity: 71.2%), which outperformed those of plain radiographs (sensitivity: 68.9%, specificity: 71.9%). The location of patient-reported pain was generally close to or lower than the index fracture level. FB-SU showed the highest diagnostic accuracy and was more valuable than plain radiographs in diagnosing acute VFF. FB-SU is a simple and affordable screening test. If positive, physicians should highly suspect VFF even when based on vague evidence of acute fracture provided by plain radiographs.

Surgical Causes of Significant Intraoperative Neuromonitoring Signal Changes in Three-Column Spinal Surgery.

STUDY DESIGN: Retrospective case series. PURPOSE: To evaluate the risks and causes of neurologic complications in three-column spinal surgery by analyzing intraoperative neurophysiological monitoring (IONM) data. OVERVIEW OF LITERATURE: Three-column spinal surgery, which may be required to correct complex spinal deformities or resection of spinal tumors, is known to carry a high risk of neurologic complications. However, few studies reported a specific surgical procedure related to a significant IONM signal change during surgery. METHODS: Multimodality IONM data, including somatosensory-evoked potentials (SSEP) and motor-evoked potentials (MEP), were reviewed in 64 patients who underwent three-column spinal surgery from 2011 to 2015. Surgical procedures included posterior vertebral column resection, pedicle subtraction osteotomy, total en bloc spondylectomy, piecemeal spondylectomy, and corpectomy with laminectomy (n=27) in three cervical, 34 thoracic, and 31 lumbar procedures. RESULTS: Significant IONM signal changes occurred in 11 of 64 (17.1%) patients. SSEP and MEP were changed in 11 patients. Postoperative neurologic deterioration occurred in 54.5% (6 of 11) of the patients, and two of them were permanent. There was no postoperative neurologic deterioration in patients without significant signal change. Suspected causes of IONM data changes are as follows: adhesion/tethering, translation, contusion, and perfusion. CONCLUSIONS: Based on the results of this study, to enhance neurologic safety in three-column spinal surgery, surgeons should pay attention to protect the spinal cord from mechanical insult, especially when the spinal column was totally destabilized during surgery, and not to compromise perfusion to the spinal cord in close cooperation with a neurologist and anesthesiologist.

Identification of a multi-stack structure of graphene electrodes doped layer-by-layer with benzimidazole and its implication for the design of optoelectronic devices.

Optical properties of benzimidazole (BI)-doped layer-by-layer graphene differ significantly from those of intrinsic graphene. Our study based on transmission electron microscopy and X-ray photoelectron spectroscopy depth profiling reveals that such a difference stems from its peculiar stratified geometry formed in situ during the doping process. This work presents an effective thickness and optical constants that can treat these multi-stacked BI-doped graphene electrodes as a single equivalent medium. For verification, the efficiency and angular emission spectra of organic light-emitting diodes with the BI-doped graphene electrode are modeled with the proposed method, and we demonstrate that the calculation matches experimental results in a much narrower margin than that based on the optical properties of undoped graphene.

Anterior Bridging Bone in a Newly Designed Cage for Lumbar Interbody Fusion: Radiographic and Finite Element Analysis.

OBJECTIVE: To evaluate the distribution of multiple anterior bridging bone (ABB) patterns using a newly designed interbody cage with 4 anterior holes that enable communication between the inside and outside of the cage and to estimate its mechanical effect by finite element analysis (FEA). METHODS: Patients underwent single-level lumbar interbody fusion using ABB cages. Two raters evaluated the distribution patterns of ABB on computed tomography scans 1 year after surgery. We defined the term H-fusion as the presence of complete anterior extracage and intracage bone bridging, with ≥1 ABBs between them. We performed finite element analysis to investigate the effect of ABB on maximal stiffness. RESULTS: The study enrolled 98 patients. ABB was most frequently observed in the medial hole of the cages (73.7%). The mean number of ABBs was 3.65, and H-fusion was observed at 135 levels (34%). Postoperative improvement in the Oswestry Disability Index was significantly higher in patients who achieved interbody fusion and H-fusion than in patients who did not. As ABB was added, the increment in the relative maximal stiffness was most affected under flexion and extension forces. CONCLUSIONS: We observed an average of 3.65 complete ABBs. Finite element analysis demonstrated that ABB could increase the stability in fused segments, especially under flexion and extension stress. Our results suggest that the ABB cage, which allows communicating cross-bridging between inside and outside of the cage, may facilitate a more stable fusion process than a conventionally designed cage.

Solvent-assisted strongly enhanced light-emitting electrochemiluminescent devices for lighting applications.

Rubrene-based electrochemiluminescence (r-ECL) cells with two different solvent systems is prepared, one in a co-solvent system with a mixture of 1,2-dichlorobenzene and propylene carbonate (DCB : PC, v/v 3 : 1) and another in a single solvent system of tetrahydrofuran (THF), as the medium to form a liquid-electrolyte (L-El). By simply changing the solvent systems, from the co-solvent DCB : PC (v/v 3 : 1) to the single solvent THF, with the same amount of electrochemiluminescent rubrene (5 mM) and Li-based salt, a dramatically enhanced brightness of over 30 cd m-2 is observed for the r-ECL cell in L-ElTHF which is approximately 7-times higher than the brightness of 5 cd m-2 observed for the r-ECL in L-ElDCB:PC(v/v 3:1).

Clinical Significance of Radiologic Improvement Following Single-Level Oblique Lateral Interbody Fusion With Percutaneous Pedicle Screw Fixation.

Indirect decompression using oblique lateral interbody fusion (OLIF) improves spinal canal dimensions by reducing spondylolisthesis and restoring intervertebral disk height in patients with degenerative lumbar diseases. However, the clinical significance of these radiological improvements has not been fully evaluated in the literature. To examine the relationship between the clinical and radiological outcomes following OLIF, the authors prospectively studied 41 patients who underwent single-level OLIF with percutaneous pedicle screw fixation for lumbar degenerative disease, including degenerative and spondylolytic spondylolisthesis and spinal stenosis with disk height loss. Clinical scores were obtained preoperatively and at 1 year postoperatively using multiple questionnaires. Radiological outcomes were evaluated using plain radiographs, computed tomography (CT) scans, and magnetic resonance imaging (MRI) at 1 year postoperatively. Following a single-level OLIF, all categories of clinical scores showed statistically significant improvement. Rate of cage subsidence was 14.6% and 31.7% at 1 week and 1 year postoperatively, respectively. Patients with subsidence had higher Oswestry Disability Index (P=.026) scores and lower physical composite summary scores on the Short Form-36 Health Survey (P=.007). On CT scan, 28 (68.3%) patients showed a complete interbody fusion and 13 (31.7%) had intermediate fusion. All parameters from the MRI, except for foraminal width, showed significant improvement at 1 year postoperatively. The improvement ratio of foraminal height was associated with the percent improvement of lower-extremity radiating pain (Pearson coefficient=0.384; P=.013) and the walking ability score of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (Pearson coefficient=0.319; P=.042) at 1 year postoperatively. Restoration of foraminal height while preserving the endplates is associated with favorable results following OLIF. [Orthopedics. 2020;43(4):e283-e290.].

Impact of Bone Mineral Density on the Incidence of Age-Related Vertebral Fragility Fracture.

BACKGROUND: Vertebral fragility fracture (VFF) is a common fracture related to osteoporosis. However, VFF might be asymptomatic and often occurs in patients without osteoporosis. Therefore, we investigated the characteristics of age-related VFF and their correlation with bone mineral density (BMD). Furthermore, we analyzed other factors affecting VFF. METHODS: Medical records from a single center were retrospectively reviewed for 2,216 patients over 50 years old with vertebral fractures conservatively treated from 2005 to 2016. Patients' age, gender, body mass index (BMI), BMD, fracture level, previous vertebral fractures, and anti-osteoporosis medications were obtained. Patients were divided into fragility/non-fragility groups and age sub-groups. The odds ratio for VFF in relation to BMD was evaluated. We also identified other predictive factors for VFF by age groups. RESULTS: The fragility group had a higher women ratio, older age, lower BMI, lower BMD, and greater incidence of previous vertebral fractures than the non-fragility group. VFFs were seen in 41.18% of normal BMD patients aged 50-59 and 67.82% of those aged 60-69. The proportion of VFFs increased with age in all WHO osteoporosis classifications. Patients with osteopenia and osteoporosis were 1.57 and 2.62 fold more likely to develop VFFs than normal BMD. In the younger group (under 70), age, women, BMD, and previous vertebral fracture were significant factors affecting VFF, and in the older group (70 and over), age, women, and BMD were factors. In the fragility group, anti-osteoporosis medication rates were 25.08% before and 45.96% after fracture. CONCLUSION: Considerable VFFs occurred in the younger age groups without osteoporosis and age itself was another important predictor of VFF especially in older age groups. The discrepancy between the incidence of VFF and BMD suggests the necessity of supplemental screening factors and anti-osteoporosis treatment guidelines using only BMD should be reconsidered.

Ginseng Gintonin Contains Ligands for GPR40 and GPR55.

Gintonin, a novel ginseng-derived glycolipoprotein complex, has an exogenous ligand for lysophosphatidic acid (LPA) receptors. However, recent lipid analysis of gintonin has shown that gintonin also contains other bioactive lipids besides LPAs, including linoleic acid and lysophosphatidylinositol (LPI). Linoleic acid, a free fatty acid, and LPI are known as ligands for the G-protein coupled receptors (GPCR), GPR40, and GPR55, respectively. We, herein, investigated whether gintonin could serve as a ligand for GPR40 and GPR55, using the insulin-secreting beta cell-derived cell line INS-1 and the human prostate cancer cell line PC-3, respectively. Gintonin dose-dependently enhanced insulin secretion from INS-1 cells. Gintonin-stimulated insulin secretion was partially inhibited by a GPR40 receptor antagonist but not an LPA1/3 receptor antagonist and was down-regulated by small interfering RNA (siRNA) against GPR40. Gintonin dose-dependently induced [Ca2+]i transients and Ca2+-dependent cell migration in PC-3 cells. Gintonin actions in PC-3 cells were attenuated by pretreatment with a GPR55 antagonist and an LPA1/3 receptor antagonist or by down-regulating GPR55 with siRNA. Taken together, these results demonstrated that gintonin-mediated insulin secretion by INS-1 cells and PC-3 cell migration were regulated by the respective activation of GPR40 and GPR55 receptors. These findings indicated that gintonin could function as a ligand for both receptors. Finally, we demonstrated that gintonin contained two more GPCR ligands, in addition to that for LPA receptors. Gintonin, with its multiple GPCR ligands, might provide the molecular basis for the multiple pharmacological actions of ginseng.

Does Surgical-site Multimodal Drug Injection After Palmar Plating of Distal Radius Fractures Improve Pain Scores?

BACKGROUND: Although palmar locked plating is a stable fixation method frequently used to treat unstable distal radius fractures (DRFs), surgical treatment may be painful, and so interventions to decrease that pain might improve our patients' experiences with surgery. Some surgeons use local multimodal drug injections to decrease postoperative pain after lower-extremity arthroplasty, but little is known about the effectiveness of a local multimodal drug injection in patients who undergo palmar plating for DRFs. QUESTIONS/PURPOSES: (1) Do patients who receive a local multimodal drug injection after palmar plating for unstable DRFs have better pain scores at 4, 8, 24, and 48 hours after surgery than patients who have not received such an injection? (2) Do patients who receive a local multimodal drug injection have lower fentanyl consumption and administration of anti-emetic drugs within the first 48 hours after surgery than patients who have not received such an injection? METHODS: A randomized controlled study was performed between August 2018 and August 2019 at a single tertiary care referral center. Patients who underwent palmar plating for DRFs under general anesthesia were eligible for inclusion. Patients were allocated into two groups: Those who received a local multimodal drug injection, and those who did not receive an injection. During the study period, 101 patients treated with palmar plating for DRFs met the inclusion criteria and were enrolled and randomized. Fifty-two patients were allocated to the multimodal injection group and 49 were allocated to the control group. Three patients (two in the multimodal injection group and one in the control group) were excluded after randomization because their pain level was not registered at any timepoint and so they could not be analyzed; our analysis was by intention to treat, and there was no crossover. After palmar plating, patients in the multimodal injection group received an injection of ropivacaine (10 mL), morphine (5 mL), ceftezole (5 mL) as well as normal saline (5 mL) to the periosteal area, pronator quadratus muscle, subcutaneous area, and skin. There were no differences between the groups in terms of age (62 years ± 13 years in the multimodal injection group versus 62 years ± 11 years in the control group; p = 0.93), gender (84% [42 of 50] women in the multimodal injection group versus 77% [37 of 48] women in the control group; p = 0.39), hand dominance (70% [35 of 50] dominant wrist in the multimodal injection group versus 60% [29 of 48] dominant wrist in the control group; p = 0.32) and AO/Orthopaedic Trauma Association (AO/OTA) classification (p = 0.57). All patients underwent treatment with the same perioperative protocol, and 25 µg of fentanyl was injected intravenously when a patient complained of pain and asked for additional pain control after surgery. In addition, when a patient complained of nausea or vomiting associated with fentanyl use, an anti-emetic drug was also injected. All nursing staff who administered the analgesics and anti-emetic drugs were blinded to treatment allocation. These two groups were compared regarding their pain level using a 100-mm VAS at 4, 8, 24, and 48 hours postoperatively. The minimum clinically important difference (MCID) for the VAS score was set to 20 mm. VAS scores were also collected by nursing staff who remained blinded to the treatment allocation. The total amount of fentanyl use and the number of patients who received anti-emetic drugs associated with administration of fentanyl within the first 48 hours were also recorded. RESULTS: With an MCID of 20 points, we found no clinically important reduction in VAS scores among patients who received a local multimodal injection compared with those who did not receive an injection at 4 hours (34 ± 15 versus 41 ± 20, mean difference -7.079 [95% CI -13.986 to -0.173]; p = 0.045), 8 hours (27 ± 16 versus 40 ± 19, mean difference -12.263 [95% CI -19.174 to -5.353]; p = 0.001), 24 hours (18 ± 12 versus 29 ± 20, mean difference -11.042 [95% CI -17.664 to -4.419]; p = 0.001), and 48 hours (9 ± 8 versus 10 ± 6, mean difference -1.318 [95% CI -4.000 to 1.365]; p = 0.33). Within the first 48 hours after surgery, fentanyl consumption was lower in patients receiving a local multimodal injection than in control patients (25 µg [range 0-100 µg] versus 37.5 µg [range 0-125 µg], difference of medians -12.5; p = 0.01). There was also a difference between the study groups in terms of the proportion of patients who received anti-emetic medications (16% [8 of 50] in the multimodal injection group versus 35% [17 of 48] in the control group, odds ratio = 2.879 [95% CI 1.102 to 7.519]; p = 0.03). CONCLUSIONS: Our data suggest that patients who received a surgical-site multimodal analgesic injection after palmar plating for a distal radius fracture had no clinically important reduction in pain scores, but they did consume lower doses of opioid analgesics and fewer of these patients received anti-emetic drugs within 2 days of surgery. The high-potency opioids or other analgesia usually used for postoperative pain management have many side effects. Thus, reducing additional analgesia is as important as postoperative pain management and a surgical-site multimodal analgesic injection is one of the methods to achieve this a goal. LEVEL OF EVIDENCE: Level I, therapeutic study.

Ultraflexible and transparent electroluminescent skin for real-time and super-resolution imaging of pressure distribution.

The ability to image pressure distribution over complex three-dimensional surfaces would significantly augment the potential applications of electronic skin. However, existing methods show poor spatial and temporal fidelity due to their limited pixel density, low sensitivity, or low conformability. Here, we report an ultraflexible and transparent electroluminescent skin that autonomously displays super-resolution images of pressure distribution in real time. The device comprises a transparent pressure-sensing film with a solution-processable cellulose/nanowire nanohybrid network featuring ultrahigh sensor sensitivity (>5000 kPa-1) and a fast response time (<1 ms), and a quantum dot-based electroluminescent film. The two ultrathin films conform to each contact object and transduce spatial pressure into conductivity distribution in a continuous domain, resulting in super-resolution (>1000 dpi) pressure imaging without the need for pixel structures. Our approach provides a new framework for visualizing accurate stimulus distribution with potential applications in skin prosthesis, robotics, and advanced human-machine interfaces.

Transpedicular Intravertebral Cage Augmentation in a Patient with Neurologic Deficits After Severely Collapsed Kummel Disease: Minimum 2-Year Follow-Up.

OBJECTIVE: We have reported the surgical outcomes of an anterior column support procedure, the intravertebral cage augmentation technique for the osteoporotic spine. METHODS: A total of 10 consecutive osteoporotic patients with severely collapsed plana-type vertebrae, causing delayed neurologic deficits, were enrolled in cohort manner. They underwent intravertebral cage augmentation using a single posterior approach. The postoperative follow-up period was >2 years. The patients were divided into 2 groups: group I, fractured index vertebra at the thoracolumbar; and group II, fractured index vertebra at the lower lumbar. The radiographic analysis included the restored ratio of anterior vertebral height, local kyphotic angle, thoracolumbar kyphosis, and lumbar lordosis. The radiographic and clinical results, ambulatory status, and Oswestry disability index were evaluated. RESULTS: Compared with preoperatively, the average restored ratio of the anterior vertebral height was 2.98 and 2.35 times greater, and the local kyphotic angle had been corrected from an average of 20.3° and 14.8° to an average of 3.0° and 0.2° at the final follow-up visit in groups I and II, respectively. The thoracolumbar kyphosis in group I had been corrected from an average of 32.9° to 19.7° and the lumbar lordosis in group II had improved from an average of -15.8° to -32.3° at the final follow-up visit. All patients who could not independently ambulate preoperatively became able to walk, except for 2 patients who required a cane. Also, all the patients showed significant improvement in the Oswestry disability index (group I: average, from 38.2 to 12.8; group II, from 37.3 to 19.3). CONCLUSIONS: The introduced technique is a valuable surgical option for obtaining anterior column support in osteoporotic patients with severely collapsed Kummel disease who require decompression and stabilization procedures using only a posterior approach.

Predicting the Natural Course of Hemivertebra in Early Childhood: Clinical Significance of Anteroposterior Discordance Based on Three-dimensional Analysis.

STUDY DESIGN: A retrospective cohort, radiographic study. OBJECTIVE: The aim of this study was to compare the progression of scoliosis owing to single hemivertebra (HV) during early childhood, according to the anteroposterior discordance obtained from the three-dimensional computed tomography (3D-CT) studies. SUMMARY OF BACKGROUND DATA: Previous studies have utilized 3D-CT for the classification of congenital spinal deformities and have introduced the concept of two types of deformity: unison and discordant anomalies. However, there have been no further studies on the clinical significance of these discordant deformities, especially in the identification of deformities that will progress and require an operation. METHODS: We retrospectively analyzed 97 cases of single HV with thoracolumbar scoliosis, diagnosed in children before the age of 3 years and followed up past the age of 6 years. The segmentation of the anterior and posterior components, and anteroposterior discordance of the HV were evaluated using 3D-CT images. Coronal segmental curve angle (SCA) and balance were measured using whole spine plain radiographs. RESULTS: Using 3D-CT, 41 (42.3%) cases of unison HV and 56 (57.7%) discordant HV were identified. Unison HV comprised 21 (21.6%) cases of fully segmented (FS) unison HV and 20 (20.6%) cases of semi-segmented unison HV with corresponding anterior and posterior segmentation. Fifty-six cases of discordant HV were further classified into 4 different types. In the 86 patients who were followed without operation between the ages of 3 and 6 years, the average progression of SCA was significantly larger in FS unison HV (one-way analysis of variance, P < 0.001). Ten of 86 (11.6%) patients showed a coronal imbalance at the age of 6 years, but the proportion of patients with coronal imbalance was not significantly different among the deformity types. CONCLUSION: Anteroposterior discordance on 3D analysis is a useful indicator for the progression of congenital scoliosis due to single HV in early childhood. LEVEL OF EVIDENCE: 4.

Impact of Preoperative Diagnosis on Clinical Outcomes of Oblique Lateral Interbody Fusion for Lumbar Degenerative Disease in a Single-institution Prospective Cohort.

OBJECTIVES: Oblique lateral interbody fusion is considered a useful surgical option for various lumbar degenerative diseases with favorable clinical results and few complications. However, clinical outcomes following oblique lateral interbody fusion stratified according to the preoperative diagnosis have not been fully evaluated in a large cohort. The purpose of the present study was to evaluate the clinical outcomes following oblique lateral interbody fusion for lumbar degenerative disease and to identify differences in outcomes when stratified according to preoperative diagnosis. METHODS: All patients receiving oblique lateral interbody fusion for lumbar degenerative diseases were included in the current study and were stratified into four diagnostic groups: (i) degenerative spondylolisthesis; (ii) spondylolytic spondylolisthesis; (iii) spinal stenosis without spondylolisthesis and instability; and (iv) deformity. Clinical outcomes were assessed using multiple patient-reported questionnaires. Radiologic outcomes, including cage subsidence and completion of fusion, were also evaluated. RESULTS: Overall, 169 patients with 262 operative levels were included in the study. All clinical scoring items showed significant improvement at 1 year postoperatively for all diagnostic groups. Net and percent improvement, and a proportion of patients reaching a threshold for substantial clinical benefit were not significantly different between the diagnostic groups in all scoring items, except for lower extremity radiating pain of the deformity group. Although the deformity group had the highest overall complication rate, neurologic complications were more frequent in the spondylolytic spondylolisthesis group. The rate of complete fusion and cage subsidence for individual levels at 1 year postoperatively was 62.7% and 32.6% respectively, with no significant difference between the diagnostic groups. CONCLUSIONS: The large single-institution prospective cohort of the present study showed favorable clinical outcomes following oblique lateral interbody fusion for lumbar degenerative disease, even in spinal stenosis without spondylolisthesis and instability.

Mechanistic Understanding of Improved Performance of Graphene Cathode Inverted Organic Light-Emitting Diodes by Photoemission and Impedance Spectroscopy.

Modification of multilayer graphene films was investigated for a cathode of organic light-emitting diodes (OLEDs). By doping the graphene/electron transport layer (ETL) interface with Li, the driving voltage of the OLED was reduced dramatically from 24.5 to 3.2 V at a luminance of 1000 cd/m2. The external quantum efficiency was also enhanced from 3.4 to 12.9%. Surface analyses showed that the Li doping significantly lowers the lowest unoccupied molecular orbital level of the ETL, thereby reducing the electron injection barrier and facilitating electron injection from the cathode. Impedance spectroscopy analyses performed on electron-only devices (EODs) revealed the existence of distributed trap states with a well-defined activation energy, which is successfully described by the Havriliak-Negami capacitance functions and the temperature-independent frequency dispersion parameters. In particular, the graphene EOD showed a unique high-frequency feature as compared to the indium tin oxide one, which could be explained by an additional parallel capacitance element.

Optical Analysis of Power Distribution in Top-Emitting Organic Light Emitting Diodes Integrated with Nanolens Array Using Finite Difference Time Domain.

Recently, we have addressed that a formation mechanism of a nanolens array (NLA) fabricated by using a maskless vacuum deposition is explained as the increase in surface tension of organic molecules induced by their crystallization. Here, as another research using finite difference time domain simulations, not electric field intensities but transmitted energies of electromagnetic waves inside and outside top-emitting blue organic light-emitting diodes (TOLEDs), without and with NLAs, are obtained, to easily grasp the effect of NLA formation on the light extraction of TOLEDs. Interestingly, the calculations show that NLA acts as an efficient light extraction structure. With NLA, larger transmitted energies in the direction from emitting layer to air are observed, indicating that NLAs send more light to air otherwise trapped in the devices by reducing the losses by waveguide and absorption. This is more significant for higher refractive index of NLA. Simulation and measurement results are consistent. A successful increase in both light extraction efficiency and color stability of blue TOLEDs, rarely reported before, is accomplished by introducing the highly process-compatible NLA technology using the one-step dry process. Blue TOLEDs integrated with a N, N'-di(1-naphthyl)- N, N'-diphenyl-(1,1'-biphenyl)-4,4'-diamine NLA with a refractive index of 1.8 show a 1.55-times-higher light extraction efficiency, compared to those without it. In addition, viewing angle characteristics are enhanced and image blurring is reduced, indicating that the manufacturer-adaptable technology satisfies the requirements of highly efficient and color-stable top-emission displays.