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OBJECTIVES: To observe the body surface temperature of the lumbosacral region and relevant back-shu points in patients with lumbar disc herniation (LDH) induced low back pain utilizing infrared thermography, and to explore the functional attribute changes of acupoints under pathological conditions. METHODS: A total of 50 patients with LDH induced low back pain were included as the observation group, and 45 healthy subjects were included as the control group. Using infrared thermography, the body surface temperature of the lumbosacral region and bilateral Sanjiaoshu (BL 22), Shenshu (BL 23), Qihaishu (BL 24), Dachangshu (BL 25), Guanyuanshu (BL 26), Xiaochangshu (BL 27), and Pangguangshu (BL 28) was measured in both groups. The temperature difference values between the bilateral lumbosacral regions and back-shu points of the two groups were calculated. Additionally, the body surface temperature of the affected and healthy sides of the lumbosacral region and relevant back-shu points was compared in the observation group. RESULTS: Compared with the control group, the body surface temperature of the lumbosacral region and the bilateral temperature difference values of the lumbosacral regions were increased in the observation group (P<0.001). The body surface temperature difference values of bilateral Shenshu (BL 23), Qihaishu (BL 24), Dachangshu (BL 25), Guanyuanshu (BL 26) and Xiaochangshu (BL 27) in the observation group were higher than those in the control group (P<0.05, P<0.01, P<0.001). In the observation group, the body surface temperature of the affected side of the lumbosacral region as well as Shenshu (BL 23) and Dachangshu (BL 25) was elevated compared with that of healthy side (P<0.001). CONCLUSIONS: The patients with LDH induced low back pain have imbalanced and asymmetrical distribution of body surface temperature in the lumbosacral region and related back-shu points, Shenshu (BL 23) and Dachangshu (BL 25) have the relative specificity.

Gestational Hypoxia Impaired Endothelial Nitric Oxide Synthesis Via miR-155-5p/NADPH Oxidase/Reactive Oxygen Species Axis in Male Offspring Vessels.

BACKGROUND: Nitric oxide (NO) is the most important vasodilator secreted by vascular endothelial cells, and its abnormal synthesis is involved in the development of cardiovascular disease. The prenatal period is a critical time for development and largely determines lifelong vascular health in offspring. Given the high incidence and severity of gestational hypoxia in mid-late pregnancy, it is urgent to further explore whether it affects the long-term synthesis of NO in offspring vascular endothelial cells. METHODS AND RESULTS: Pregnant Sprague-Dawley rats were housed in a normoxic or hypoxic (10.5% O2) chamber from gestation days 10 to 20. The thoracic aortas of fetal and adult male offspring were isolated for experiments. Gestational hypoxia significantly reduces the NO-dependent vasodilation mediated by acetylcholine in both the fetal and adult offspring thoracic aorta rings. Meanwhile, acetylcholine-induced NO synthesis is impaired in vascular endothelial cells from hypoxic offspring thoracic aortas. We demonstrate that gestational hypoxic offspring exhibit a reduced endothelial NO synthesis capacity, primarily due to increased expression of NADPH oxidase 2 and enhanced reactive oxygen species. Additionally, gestational hypoxic offspring show elevated levels of miR-155-5p in vascular endothelial cells, which is associated with increased expression of NADPH oxidase 2 and reactive oxygen species generation, as well as impaired NO synthesis. CONCLUSIONS: The present study is the first to demonstrate that gestational hypoxia impairs endothelial NO synthesis via the miR-155-5p/NADPH oxidase 2/reactive oxygen species axis in offspring vessels. These novel findings indicate that the detrimental effects of gestational hypoxia on fetal vascular function can persist into adulthood, providing new insights into the development of vascular diseases.

Toward certifiable optimal motion planning for medical steerable needles.

Medical steerable needles can follow 3D curvilinear trajectories to avoid anatomical obstacles and reach clinically significant targets inside the human body. Automating steerable needle procedures can enable physicians and patients to harness the full potential of steerable needles by maximally leveraging their steerability to safely and accurately reach targets for medical procedures such as biopsies. For the automation of medical procedures to be clinically accepted, it is critical from a patient care, safety, and regulatory perspective to certify the correctness and effectiveness of the planning algorithms involved in procedure automation. In this paper, we take an important step toward creating a certifiable optimal planner for steerable needles. We present an efficient, resolution-complete motion planner for steerable needles based on a novel adaptation of multi-resolution planning. This is the first motion planner for steerable needles that guarantees to compute in finite time an obstacle-avoiding plan (or notify the user that no such plan exists), under clinically appropriate assumptions. Based on this planner, we then develop the first resolution-optimal motion planner for steerable needles that further provides theoretical guarantees on the quality of the computed motion plan, that is, global optimality, in finite time. Compared to state-of-the-art steerable needle motion planners, we demonstrate with clinically realistic simulations that our planners not only provide theoretical guarantees but also have higher success rates, have lower computation times, and result in higher quality plans.

Assessing the ecological risk of croplands in loess drylands by combining environmental disturbance with ecosystem vulnerability.

Agroecosystems suffer various ecological risks due to the intensive production of crops. However, comprehensive assessments of cropland ecological risks remain limited. This study developed an assessment method for cropland ecological risks by combining environmental disturbance with ecosystem vulnerability. Environmental disturbance reflects stresses caused by risk sources in an environment, while ecosystem vulnerability is the susceptibility of an ecosystem to adverse disturbances and its capacity to cope and adapt. The proposed method is conducive to understanding the complex exposure-response relationship between croplands and environmental stresses. Cropland ecological risk was evaluated by conducting a case study on a loess dryland region in Shaanxi. The hot spots and driving factors of risk were explored using spatial autocorrelation and quantile regression methods, respectively. Results show that overall cropland ecological risk is at medium low level. Risk hot spots are concentrated in the north of the loess dryland. Ecosystem vulnerability exerts greater effect on the distribution of hot spots than environmental disturbance in the study area. Road density (RDD), river density, and soil organic matter exert the most important effects on cropland ecological risk. Moreover, the same driving factor exhibits various effects on cropland ecological risk in different risk level areas. RDD, slope, precipitation, elevation, fertilizer application rate, gross domestic product, and distance to town center have greater effects on risk in regions with high cropland ecological risk than in regions with low cropland ecological risk. The findings of this study must be considered in formulating targeted policies for controlling cropland ecological risk in loess drylands to realize sustainable crop production.

Calcium signals and potential therapy targets in ovarian cancer (Review).

Ovarian cancer (OC) is a deadly disease. The poor prognosis and high lethality of OC are attributed to its high degrees of aggressiveness, resistance to chemotherapy and recurrence rates. Calcium ion (Ca2+) signaling has received attention in recent years, as it appears to form an essential part of various aspects of cancer pathophysiology and is a potential therapeutic target for OC treatment. Disruption of normal Ca2+ signaling pathways can induce changes in cell cycle progression, apoptosis, proliferation and migration and invasion, leading to the development of the malignant phenotype of tumors. In the present review, the main roles of ion channel/receptor/pump­triggered Ca2+ signaling pathways located at the plasma membrane and organelle Ca2+ transport in OC are summarized. In addition, the potential of Ca2+ signaling as a novel target for the development of effective treatment strategies for OC was discussed. Furthering the understanding into the role of Ca2+ signaling in OC is expected to facilitated the identification of novel therapeutic targets and improved clinical outcomes for patients.

Autonomous medical needle steering in vivo.

The use of needles to access sites within organs is fundamental to many interventional medical procedures both for diagnosis and treatment. Safely and accurately navigating a needle through living tissue to a target is currently often challenging or infeasible because of the presence of anatomical obstacles, high levels of uncertainty, and natural tissue motion. Medical robots capable of automating needle-based procedures have the potential to overcome these challenges and enable enhanced patient care and safety. However, autonomous navigation of a needle around obstacles to a predefined target in vivo has not been shown. Here, we introduce a medical robot that autonomously navigates a needle through living tissue around anatomical obstacles to a target in vivo. Our system leverages a laser-patterned highly flexible steerable needle capable of maneuvering along curvilinear trajectories. The autonomous robot accounts for anatomical obstacles, uncertainty in tissue/needle interaction, and respiratory motion using replanning, control, and safe insertion time windows. We applied the system to lung biopsy, which is critical for diagnosing lung cancer, the leading cause of cancer-related deaths in the United States. We demonstrated successful performance of our system in multiple in vivo porcine studies achieving targeting errors less than the radius of clinically relevant lung nodules. We also demonstrated that our approach offers greater accuracy compared with a standard manual bronchoscopy technique. Our results show the feasibility and advantage of deploying autonomous steerable needle robots in living tissue and how these systems can extend the current capabilities of physicians to further improve patient care.

Mitigation of EH36 ship steel biocorrosion using an antimicrobial peptide as a green biocide enhancer.

In this study, a 13-mer antimicrobial peptide (RRWRIVVIRVRRC) named by E6 was used as an enhancer of a green biocide to mitigate the biocorrosion of EH36 ship steel. Results show that a low concentration of E6 (100 nM) alone was no-biocidal and could not resist the Desulfovibrio vulgaris adhesion on the EH36 steel surface. However, E6 enhanced the bactericidal effect of tetrakis hydroxymethyl phosphonium sulfate (THPS). When E6 and THPS were both added to the bacteria and steel system, both the sessile D. vulgaris cells and biocorrosion rate of EH36 steel decreased significantly. Compared with the 80 ppm THPS alone treatment, the combination of 100 nM E6 + 80 ppm THPS led to an extra 1.6-log reduction in the sessile cell count. Fewer sessile D. vulgaris cells led to a lower extracellular electron transfer (EET) rate, directly resulting in 78% and 83% decreases in weight loss and pit depth of EH36 steel, respectively. E6 saved more than 50% of THPS dosage in this work to achieve a similar biocorrosion mitigation effect on EH36 steel.

Efficacy and Safety of Erector Spinae Plane Block for Perioperative Pain Management in Lumbar Spinal Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Since the application of ultrasound-guided erector spinae plane block (ESPB) in 2016, the approach has been gradually applied to perioperative analgesia in various surgeries. In recent years, more and more studies have focused on the effect of ESPB in perioperative analgesia of lumbar spinal surgery, but its clinical effect remains controversial. Objective: This systematic review and meta-analysis was designed to explore the efficacy and safety of ESPB used for perioperative pain management in lumbar spinal surgery. Methods: The Pubmed, Web of Science, Cochrane Library, and EMBASE databases were comprehensively searched for relevant articles from inception to March 2022. Randomized controlled trials (RCTs) comparing ESPB with placebo or without ESPB in lumbar spinal surgery were included. The Review Manager 5.3 software was employed for this meta-analysis. Results: Nineteen RCTs with 1381 participants were included for final analysis. ESPB group exhibited lower intraoperative consumption of sufentanil and remifentanil, lower total opioid consumption within 24 h and 48 h after surgery, lower incidence of rescue analgesia, longer time to first rescue analgesic and lower number of PCA button presses compared to the control group (P<0.05). Moreover, the ESPB group had significantly lower pain scores at rest and on movement within 48 h after surgery compared with the control group (P<0.05). In terms of opioid-related adverse reactions, ESPB reduced the incidence of postoperative nausea, vomitting, somnolence and itching in comparison to the control group (P<0.05). ESPB-related serious complications were not reported in included studies. Conclusion: This meta-analysis demonstrated that ESPB used in lumbar spinal surgery was effective in relieving postoperative pain, decreasing the perioperative consumption of opioids, as well as decreasing the incidence of postoperative opioid-related adverse reactions.

Redox-Enhanced Photoelectrochemical Activity in PHV/CdS Hybrid Film.

Semiconductive photocatalytic materials have received increasing attention recently due to their ability to transform solar energy into chemical fuels and photodegrade a wide range of pollutants. Among them, cadmium sulfide (CdS) nanoparticles have been extensively studied as semiconductive photocatalysts in previous studies on hydrogen generation and environmental purification due to their suitable bandgap and sensitive light response. However, the practical applications of CdS are limited by its low charge separation, which is caused by its weak ability to separate photo-generated electron-hole pairs. In order to enhance the photoelectrochemical activity of CdS, a polymer based on viologen (PHV) was utilized to create a series of PHV/CdS hybrid films so that the viologen unit could work as the electron acceptor to increase the charge separation. In this work, various electrochemical, spectroscopic, and microscopic methods were utilized to analyze the hybrid films, and the results indicated that introducing PHV can significantly improve the performance of CdS. The photoelectrochemical activities of the hybrid films were also evaluated at various ratios, and it was discovered that a PHV-to-CdS ratio of 2:1 was the ideal ratio for the hybrid films. In comparison with CdS nanoparticles, the PHV/CdS hybrid film has a relatively lower band gap, and it can inhibit the recombination of electrons and holes, enhancing its photoelectrochemical activities. All of these merits make the PHV/CdS hybrid film as a strong candidate for photocatalysis applications in the future.

[The specificity of body surface temperature of relevant back-shu points in patients with chronic persistent asthma based on infrared thermal imaging technology].

OBJECTIVE: To detect the body surface temperature of the relevant back-shu points in patients with chronic persistent asthma by infrared thermal imaging technology, and observe the specific changes of the body surface temperature of the relevant back-shu points under the condition of lung disease. METHODS: Forty-five patients with chronic persistent asthma (observation group) and 45 healthy subjects (control group) were selected. The body surface temperature of bilateral Feishu (BL 13), Geshu (BL 17), Pishu (BL 20) and Shenshu (BL 23) were measured by BK-MT02A medical infrared thermography. RESULTS: The body surface temperature of bilateral Feishu (BL 13), Geshu (BL 17), Pishu (BL 20) and Shenshu (BL 23) in the observation group was higher than that in the control group (P<0.01, P<0.05). The body surface temperature of bilateral Feishu (BL 13) and Geshu (BL 17) was higher than that of ipsilateral Pishu (BL 20) and Shenshu (BL 23) in the two groups (P<0.01, P<0.05). There was no statistically significant difference in body surface temperature between ipsilateral Feishu (BL 13) and Geshu (BL 17), between ipsilateral Pishu (BL 20) and Shenshu (BL 23) (P>0.05). CONCLUSION: The pathological increase of body surface temperature of Feishu (BL 13), Geshu (BL 17), Pishu (BL 20) and Shenshu (BL 23) in patients with chronic persistent asthma indicates that above acupoints have specificity in reflecting lung diseases. The Feishu (BL 13) and Geshu (BL 17), which have significantly increased body surface temperature, not only provide objective basis for the pathological pathogenesis of "deficiency in origin and excess in symptom" in patients with chronic persistent asthma, but also reflect the different expressions of different acupoints on the same meridian for the lung diseases.

A systematic review and meta-analysis of cemented and uncemented bipolar hemiarthroplasty for the treatment of femoral neck fractures in elderly patients over 60 years old.

Background: Currently, whether bone cement can be applied in bipolar hemiarthroplasty to treat femoral neck fractures (FNFs) in elderly patients is controversial. The aim of this systematic review and meta-analysis was to compare the effectiveness and safety of cemented bipolar hemiarthroplasty (CBH) versus uncemented bipolar hemiarthroplasty (UCBH) in the treatment of FNFs among elderly patients over 60 years old. Materials and methods: The Pubmed, Web of science, Cochrane Library and EMBASE databases were searched comprehensively for relevant articles from their inception to May 2022. Studies about comparing outcomes between CBH and UCBH for FNFs in elderly patients aged more than 60 years were included. Outcomes including operation time, intra-operative blood loss, length of hospital stay, wound infections, residual pain, revisions, re-operations, complications related to prosthesis, general complications, and mortality. The Review Manager 5.3 software provided by the Cochrane Collaboration Network was used to perform the meta-analysis of comparable data. Results: A total of 6 randomized controlled trials (RCTs) and 9 observational studies were included in this analysis, with 33,118 patients (33,127 hips). Results of the meta-analysis indicated that the operation time [WMD = 13.01 min, 95% CI (10.79, 15.23)], intra-operative blood loss [WMD = 80.57 ml, 95% CI (61.14, 99.99)], incidence of heterotrophic ossification [OR = 2.07, 95% CI (1,14, 3.78)], were increased in the CBH group but the incidence of intra-operative fractures [OR = 0.24, 95% CI (0.07, 0.86)], periprosthetic fractures [OR = 0.24, 95% CI (0.18, 0.31)], aseptic loosening of prosthesis [OR = 0.20, 95% CI (0.09, 0.44)], wound infections [OR = 0.80, 95% CI (0.68, 0.95)] and re-operation rates [OR = 0.61, 95% CI (0.54, 0.68)] were lower in the CBH group by comparison with the UCHB group. However, there were no significant differences in residual pain, length of hospital stay, prosthetic dislocation, prosthetic subsidence (> 5 mm), acetabulum erosion, revisions, pulmonary infections, pulmonary embolisms, urinary tract infections, deep venous thromboses, decubitus, cardiovascular accidents (arrhythmia/myocardial infarction), and respiratory failure between the two groups. In terms of mortality, perioperative mortality (within 72 h) [OR = 2.39, 95% CI (1.71, 3.32)] and 1-week mortality postoperatively [OR = 1.22, 95% CI (1.05, 1.41)] in CBH group were higher than those in UCBH group, but there were no significant differences in mortality at 1 month, 3 months, 1 year, and 2 years postoperatively between CBH group and UCBH group. Conclusion: This meta-analysis found that elderly patients over 60 years old with FNFs who underwent CBH had longer operation time, higher incidence of heterotrophic ossification, intra-operative blood loss, and mortality within 72 h of operation and at 1-week postoperatively, but lower incidence of periprosthetic fractures, aseptic loosening of prosthesis, intra-operative fractures, wound infections and re-operations. Other outcomes were not significantly different between the two groups. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021274253.

Age- and sex-specific reference intervals for complete blood count parameters in capillary blood for Chinese neonates and infants: A prospective study.

BACKGROUND: The reference intervals (RIs) of laboratory tests are essential for disease diagnosis, therapy monitoring, and health assessment. They are also significant for clinicians to discriminate between subjects with disease and healthy subjects. However, RIs for complete blood count (CBC) parameters in capillary blood for children are deficient. This study aimed to establish capillary blood RIs for blood cell parameters in neonates and infants from birth to 2 years of age in Zhengzhou. METHODS: We prospectively collected a total of 1840 capillary blood specimens from healthy subjects from birth to 2 years of age. Hematology RIs were established by analyzing capillary blood sample data, and RIs and 90 % confidence intervals (CIs) were calculated according to Clinical and Laboratory Standards Institute (CLSI) C28-A3 guidelines. RESULTS: RIs were established for hematological parameters of capillary blood in neonates and infants from birth to 2 years of age. The levels of almost all hematological parameters, except for the lymphocyte (LYMPH), platelet (PLT), and thrombocytocrit (PCT) parameters, peaked in the first month after birth and then decreased to lower levels within 6 months. There were significant sex differences in most erythrocyte-related parameters, with higher levels in males than in females. Erythrocyte-related parameters showed an increasing tendency with increasing age after the second month. Neutrophil (NEUT) levels were high on the third day of life, declined to a nadir in the first month, and then slowly increased with age. LYMPH levels were low at birth and began to increase after birth, peaked at approximately-six months of age and then gradually declined with age. PLT and PCT levels showed an increasing trend during the first month, while the other parameters showed a decreasing trend. All platelet-related and leukocyte-related parameters showed no significant difference with sex. CONCLUSION: We provide comprehensive age- and sex-specific RIs, including RIs for neonates in Henan. Our study provides more comprehensive reference ranges for Child Health Hospital and children's medical institutions, which may facilitate preliminary screening, diagnosis, and therapy.

Resolution-Optimal Motion Planning for Steerable Needles.

Medical steerable needles can follow 3D curvilinear trajectories inside body tissue, enabling them to move around critical anatomical structures and precisely reach clinically significant targets in a minimally invasive way. Automating needle steering, with motion planning as a key component, has the potential to maximize the accuracy, precision, speed, and safety of steerable needle procedures. In this paper, we introduce the first resolution-optimal motion planner for steerable needles that offers excellent practical performance in terms of runtime while simultaneously providing strong theoretical guarantees on completeness and the global optimality of the motion plan in finite time. Compared to state-of-the-art steerable needle motion planners, simulation experiments on realistic scenarios of lung biopsy demonstrate that our proposed planner is faster in generating higher-quality plans while incorporating clinically relevant cost functions. This indicates that the theoretical guarantees of the proposed planner have a practical impact on the motion plan quality, which is valuable for computing motion plans that minimize patient trauma.

Recent Developments on the Roles of Calcium Signals and Potential Therapy Targets in Cervical Cancer.

Intracellular calcium (Ca2+) concentration ([Ca2+]i) is implicated in proliferation, invasion, and metastasis in cancerous tissues. A variety of oncologic therapies and some candidate drugs induce their antitumor effects (in part or in whole) through the modulation of [Ca2+]i. Cervical cancer is one of most common cancers among women worldwide. Recently, major research advances relating to the Ca2+ signals in cervical cancer are emerging. In this review, we comprehensively describe the current progress concerning the roles of Ca2+ signals in the occurrence, development, and prognosis of cervical cancer. It will enhance our understanding of the causative mechanism of Ca2+ signals in cervical cancer and thus provide new sights for identifying potential therapeutic targets for drug discovery.

High-Performance Planar-Type Photodetector Based on Hot-Pressed CsPbBr3 Wafer.

Considering the disadvantages of the common methods for CsPbBr3 single crystal growth including the high cost of the melt method and the low shape controllability of the solution method, a facile hot-pressed (HP) approach has been introduced to prepare CsPbBr3 wafers. The effects of HP temperature on the phase purity of HP-CsPbBr3 wafers and the performance of the corresponding photodetectors have been investigated. The HP temperature for preparing phase-pure, shape-regular, and dense CsPbBr3 wafers has been optimized to be 150 °C, and the HP-CsPbBr3 wafer based planar-type photodetectors exhibit an ultrasensitive weak light photoresponse. Under the illumination of a 530 nm LED with a light power density of 1.1 µW cm-2, the responsivity, external quantum efficiency, and detectivity of the devices reach 19.79 A W-1, 4634%, and 2.14 × 1013 Jones, respectively, and a fast response speed with a rise time of 40.5 µs and a fall time of 10.0 µs has been achieved.

Reference intervals for coagulation parameters in non-pregnant and pregnant women.

Established reference intervals (RIs) of coagulation parameters generally based on the general population are not applicable to specific women. In order to accurately evaluate the coagulation status of non-pregnant women and pregnant women, specific RIs should be established. Our study recruited 465 non-pregnant women and 1972 pregnant women aged 20-45 years. Eight tests including antithrombin (AT), protein C (PC), free protein S (fPS), lupus anticoagulant (LA), D-dimer, fibrin/fibrinogen degradation products (FDP), coagulation factor VII (FVII), and factor VIII (FVIII) were performed on ACL TOP automated coagulation instrument. The RIs for these tests were established in non-pregnant and pregnant women at different gestational weeks. Compared to the non-pregnant group, the medians of AT and fPS were lower, while the medians of PC, LA normalized ratio, D-dimer, FDP, FVII, and FVIII were higher. During pregnancy, AT and fPS activity showed a decreasing trend, with the increase of gestational age. PC activity, LA normalized ratio, D-dimer concentrations, FDP concentrations, FVII, and FVIII activity presented an increasing trend, with the increase of gestational age. The non-pregnant women-specific RIs and the gestational age-specific RIs of AT, PC, fPS, LA normalized ratio, D-dimer, FDP, FVII, and FVIII needed to be established for accurate clinical diagnoses.

A Metric for Finding Robust Start Positions for Medical Steerable Needle Automation.

Steerable needles are medical devices with the ability to follow curvilinear paths to reach targets while circumventing obstacles. In the deployment process, a human operator typically places the steerable needle at its start position on a tissue surface and then hands off control to the automation that steers the needle to the target. Due to uncertainty in the placement of the needle by the human operator, choosing a start position that is robust to deviations is crucial since some start positions may make it impossible for the steerable needle to safely reach the target. We introduce a method to efficiently evaluate steerable needle motion plans such that they are safe to variation in the start position. This method can be applied to many steerable needle planners and requires that the needle's orientation angle at insertion can be robotically controlled. Specifically, we introduce a method that builds a funnel around a given plan to determine a safe insertion surface corresponding to insertion points from which it is guaranteed that a collision-free motion plan to the goal can be computed. We use this technique to evaluate multiple feasible plans and select the one that maximizes the size of the safe insertion surface. We evaluate our method through simulation in a lung biopsy scenario and show that the method is able to quickly find needle plans with a large safe insertion surface.

Use of a Multifunctional Cocktail for Postoperative Bleeding and Pain Control in Spinal Fusion: A Randomized, Double-blind, Controlled Trial.

STUDY DESIGN: A prospective, randomized, double-blind controlled trial. OBJECTIVE: To explore the effect of multifunctional cocktail for bleeding and pain control after spinal fusion. SUMMARY OF BACKGROUND DATA: Managing postoperative bleeding and pain after spinal fusion remains a challenge. Topical application of tranexamic acid or anesthetic agents for bleeding or pain management just started recently, and the multifunctional cocktail for bleeding and pain control simultaneously after spinal fusion have never been published. METHODS: Ninety patients who underwent posterior spinal fusion were enrolled in this study. The multifunctional cocktail was injected into the incision before wound closure in the cocktail group. In the control group, an equal volume of normal saline was injected and a patient-controlled analgesic pump was used. Visual analogue scale score; opioid consumption; intraoperative, postoperative, hidden and total blood loss; volume of drainage, hematocrit levels of drainage; hemoglobin levels; and complications were compared between the two groups. RESULTS: There were no differences in the visual analogue scale within 48 hours after surgery between the two groups. However, the opioid dosages in the control group were higher than those in the cocktail group. The postoperative blood loss, total blood loss, and hidden blood loss were lower in the cocktail group than in the control group. The drainage volume showed no differences between the two groups; however, the hematocrit level of drainage at 24 hours after surgery was lower in the cocktail group than in the control group. The hemoglobin level was higher in the cocktail group than in the control group at postoperative day 3. Thirteen patients with unbearable nausea and vomiting in the control group, whereas no complications in the cocktail group. CONCLUSION: Topical application of a multifunctional cocktail that we designed provides an effective and safe method for reducing pain and bleeding after spinal fusion.

Design Considerations for a Steerable Needle Robot to Maximize Reachable Lung Volume.

Steerable needles that are able to follow curvilinear trajectories and steer around anatomical obstacles are a promising solution for many interventional procedures. In the lung, these needles can be deployed from the tip of a conventional bronchoscope to reach lung lesions for diagnosis. The reach of such a device depends on several design parameters including the bronchoscope diameter, the angle of the piercing device relative to the medial axis of the airway, and the needle's minimum radius of curvature while steering. Assessing the effect of these parameters on the overall system's clinical utility is important in informing future design choices and understanding the capabilities and limitations of the system. In this paper, we analyze the effect of various settings for these three robot parameters on the percentage of the lung that the robot can reach. We combine Monte Carlo random sampling of piercing configurations with a Rapidly-exploring Random Trees based steerable needle motion planner in simulated human lung environments to asymptotically accurately estimate the volume of sites in the lung reachable by the robot. We highlight the importance of each parameter on the overall system's reachable workspace in an effort to motivate future device innovation and highlight design trade-offs.

Backward Planning for a Multi-Stage Steerable Needle Lung Robot.

Lung cancer is one of the deadliest types of cancer, and early diagnosis is crucial for successful treatment. Definitively diagnosing lung cancer typically requires biopsy, but current approaches either carry a high procedural risk for the patient or are incapable of reaching many sites of clinical interest in the lung. We present a new sampling-based planning method for a steerable needle lung robot that has the potential to accurately reach targets in most regions of the lung. The robot comprises three stages: a transorally deployed bronchoscope, a sharpened piercing tube (to pierce into the lung parenchyma from the airways), and a steerable needle able to navigate to the target. Planning for the sequential deployment of all three stages under health safety concerns is a challenging task, as each stage depends on the previous one. We introduce a new backward planning approach that starts at the target and advances backwards toward the airways with the goal of finding a piercing site reachable by the bronchoscope. This new strategy enables faster performance by iteratively building a single search tree during the entire computation period, whereas previous forward approaches have relied on repeating this expensive tree construction process many times. Additionally, our method further reduces runtime by employing biased sampling and sample rejection based on geometric constraints. We evaluate this approach using simulation-based studies in anatomical lung models. We demonstrate in comparison with existing techniques that the new approach (i) is more likely to find a path to a target, (ii) is more efficient by reaching targets more than 5 times faster on average, and (iii) arrives at lower-risk paths in shorter time.