Assessment of Cement Leakage in Decompressed Percutaneous Kyphoplasty.

Symptomatic osteoporotic compression fractures are commonly addressed through vertebroplasty and kyphoplasty. However, cement leakage poses a significant risk of neurological damage. We introduced "aspiration percutaneous kyphoplasty", also known as "decompressed kyphoplasty", as a method to mitigate cement leakage and conducted a comparative analysis with high viscosity cement vertebroplasty. We conducted a retrospective study that included 136 patients with single-level osteoporotic compression fractures. Among them, 70 patients underwent high viscosity cement vertebroplasty, while 66 patients received decompressed percutaneous kyphoplasty with low-viscosity cement. Comparison parameters included cement leakage rates, kyphotic angle alterations, and the occurrence of adjacent segment fractures. The overall cement leakage rate favored the decompressed kyphoplasty group (9.1% vs. 18.6%), although statistical significance was not achieved (p = 0.111). Nonetheless, the risk of intradiscal leakage significantly reduced in the decompressed kyphoplasty cohort (p = 0.011), which was particularly evident in cases lacking the preoperative cleft sign on X-rays. Kyphotic angle changes and the risk of adjacent segment collapse exhibited similar outcomes (p = 0.739 and 0.522, respectively). We concluded that decompressed kyphoplasty demonstrates efficacy in reducing intradiscal cement leakage, particularly benefiting patients without the preoperative cleft sign on X-rays by preventing intradiscal leakage.

The Evolution of Spinal Endoscopy: Design and Image Analysis of a Single-Use Digital Endoscope Versus Traditional Optic Endoscope.

Spinal endoscopy has evolved significantly since its inception, offering minimally invasive solutions for various spinal pathologies. This study introduces a promising innovation in spinal endoscopy-a single-use digital endoscope designed to overcome the drawbacks of traditional optic endoscopes. Traditional endoscopes, despite their utility, present challenges such as fragility, complex disinfection processes, weight issues, and susceptibility to mechanical malfunctions. The digital endoscope, with its disposable nature, lighter weight, and improved image quality, aims to enhance surgical procedures and patient safety. The digital endoscope system comprises a 30-degree 1000 × 1000 pixel resolution camera sensor with a 4.3 mm working channel, and LED light sources replacing optical fibers. The all-in-one touch screen tablet serves as the host computer, providing portability and simplified operation. Image comparisons between the digital and optic endoscopes revealed advantages in the form of increased field of view, lesser distortion, greater close-range resolution, and enhanced luminance. The single-use digital endoscope demonstrates great potential for revolutionizing spine endoscopic surgeries, offering convenience, safety, and superior imaging capabilities compared to traditional optic endoscopes.

Impact of Aspiration Percutaneous Vertebroplasty in Reducing Bone Cement Leakage and Enhancing Distribution-An Ex Vivo Study in Goat Vertebrae.

Osteoporosis-induced vertebral compression fracture (OVCF) occurs commonly in people over the age of 50, especially among menopausal women. Besides conservative therapy, minimally invasive percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used in clinical treatment and achieved good efficacy. However, the leakage of bone cement (CL) during vertebroplasty (PV) is a major risk that can cause (serious) complications such as compression of the spinal cord, pulmonary embolism, or even paraplegia. In this study, we introduced a new aspiration technique with standard PV procedures (APV) to ameliorate the risk of leakage with quantitative verifications of its effectiveness. APV intends to create a differential pressure to guide the direction of cement flow within the vertebrae. To test this technique, Nubian goats' ex vivo vertebral bodies (VBs) were used to simulate the PV surgical process in humans. Results show that the proposed APV has a lower leakage rate of 13% compared to the 53% of conventional PV. Additionally, the APV approach achieves more uniform cement distribution via the 9-score method with a value of 7 ± 1.30 in contrast to 4 ± 1.78 by conventional PV.

Light-emitting devices with tunable color from ZnO nanorods grown on InGaN/GaN multiple quantum wells.

Based on the composite consisting of ZnO nanorods (NRs) grown on InGaN/GaN multiple quantum wells (MQWs), we have demonstrated a novel light-emitting device (LED) that has the capability to emit dual beam radiations. Interestingly, the relative intensity between the dual emissions is able to be manipulated by their polarizations. The underlying mechanism can be well understood in terms of the anisotropic optical properties arising from the geometric structures of constituent nanoscale materials. The results shown here may be extended to many other nanocomposite systems and pave a new pathway to create LEDs with tunable properties.

Enhancement of laser action in ZnO nanorods assisted by surface plasmon resonance of reduced graphene oxide nanoflakes.

We report the discovery of an enhancement of the random laser action in a nanocomposite comprising reduced graphene oxide nanoflakes and ZnO nanorods. We show that both emission intensity and lasing threshold exhibit an obvious improvement. Based on our theoretical calculations, the mechanism underlying the enhanced stimulated emission can be attributed to coupling between the optical transition and the surface plasmon resonance of the reduced graphene oxide nanoflakes, induced by the ZnO nanorod surface roughness. The approach we describe here will be very useful for the future development of high-efficiency optoelectronic devices and offers an alternative route for application of reduced graphene oxide.

Enhancement of laser action in ZnO nanorods assisted by surface plasmon resonance of reduced graphene oxide nanoflakes.

We report the discovery of an enhancement of the random laser action in a nanocomposite comprising reduced graphene oxide nanoflakes and ZnO nanorods. We show that both emission intensity and lasing threshold exhibit an obvious improvement. Based on our theoretical calculations, the mechanism underlying the enhanced stimulated emission can be attributed to coupling between the optical transition and the surface plasmon resonance of the reduced graphene oxide nanoflakes, induced by the ZnO nanorod surface roughness. The approach we describe here will be very useful for the future development of high-efficiency optoelectronic devices and offers an alternative route for application of reduced graphene oxide.

Effects and Safety of Lumbar Fusion Techniques in Lumbar Spondylolisthesis: A Network Meta-Analysis of Randomized Controlled Trials.

STUDY DESIGN: Network meta-analysis of randomized controlled trials. OBJECTIVES: Lumbar spondylolisthesis is a common indication for spinal fusion. Lumbar interbody fusion (LIF) is popular method to achieve arthrodesis, but previous syntheses usually used head-to-head comparison of 2 surgical methods, and no of them pooled analysis with high-quality. This network meta-analysis of randomized controlled trials was carried out to simultaneously compare fusion techniques in the treatment of lumbar spondylolisthesis. METHODS: Three databases were searched for randomized controlled trials (RCTs) on this topic. After critical appraisal, fusion rate, overall adverse events, operative time, Oswestry Disability Index, and pain were extracted for analysis. We conduced network meta-analysis using contrast-based method. Primary outcomes were reported as risk ratio (RR) with 95% confidence interval (CI). RESULTS: Fifteen RCTs (n = 992) met our eligibility criteria. The RCTs treated patients posterolateral fusion (PLF), posterior LIF (PLIF), transforaminal LIF (TLIF), minimally invasive (MIS) TLIF, extreme lateral LIF (XLIF), and circumferential fusion. The pooled estimate showed that circumferential fusion led to significantly higher fusion rate than PLF (RR = 2.15, 95%CI:1.41-3.28), PLIF (RR = 2.11, 95%CI:1.38-3.22), TLIF (RR = 2.13, 95%CI:1.39-3.27), MIS-TLIF (RR = 2.13, 95%CI:1.35-3.35), and XLIF (RR = 2.01, 95%CI: 1.25-3.22). Moreover, circumferential fusion exhibited the best balance in probability between fusion rate and adverse event rate. No evidence showed inconsistency or small-study effect in the results. CONCLUSIONS: Collectively, circumferential fusion might be worth to be recommended because it exhibits the best balance between fusion rate and overall adverse event. PLF is still an inferior procedure and requires shorter operative time.

Method of estimating the effective zone induced by rapid impact compaction.

This paper proposes a method for estimating the effective zone, including effective depth and effective range of compaction degree, from rapid impact compaction (RIC) on sand layer whose fines content is less than 10%. The proposed method utilizes a string of microelectromechanical system accelerometers to monitor the acceleration at various depths and propagation distances during compaction. To interpret and extract useful information from monitored data, peak-over-threshold (POT) processing and normal distribution function were used to analyze the recorded acceleration. The mean and standard deviation of the threshold peak acceleration were used to evaluate the effective depth and the effective range of compaction degree during RIC compaction. Moreover, spatial contours were used to determine the correlation of the threshold peak acceleration against depth and propagation distance from the RIC impact point. These contours help indicating the distribution of the effect zone after compaction. Lastly, a proposed method is suggested for frequent use in trial tests to quickly determine RIC's required depth and impact spacing.

The Optimal Strategy of Vitamin D for Sarcopenia: A Network Meta-Analysis of Randomized Controlled Trials.

Sarcopenia is a disease of gradual loss of muscle mass in elderly people, and the most common treatment options include nutritional supplementation and exercise. Vitamin D has potential beneficial effects for skeletal muscle tissue and has often been included in nutritional therapy formulations. However, the therapeutic effect of vitamin D for the treatment of sarcopenia has not yet been determine and there is a lack of high-quality supporting evidence. We searched three databases for randomized controlled trials (RCTs) on this topic. Changes in hand grip strength, gait speed, chair-stand test, fat mass, relative skeletal muscle index, and muscle mass were assessed for analysis. Network meta-analysis was further employed, based on the frequentist approach. Outcomes were reported as weighted mean differences (WMD) with 95% confidence intervals (CIs). A total of 9 RCTs (n = 1420) met our eligibility criteria, which treated patients with vitamin D (D), protein (P, n = 165), exercise (E, n = 124), iso-caloric product (I, n = 226), usual care without nutritional supplement (n = 65), P + D (n = 467), D + E (n = 72), P + E (n = 69), D + E + I (n = 73), and P + D + E (n = 159). The pooled estimate showed that the P + D + E intervention induced a greater improvement in hand grip strength than iso-caloric product intervention (WMD = 3.86; 95%CI, 0.52-7.21). Vitamin D intervention could lead to shorter chair-stand time (WMD = -1.32; 95%CI, -1.98 to -0.65), but no significant findings could be found for gait speed and muscle mass outcomes. Our synthesis found that combining vitamin D supplementation with protein supplementation and exercise can significantly increase grip strength and also showed a trend toward increasing muscle mass. This result implies that adding vitamin D to a standard treatment protocol for sarcopenia may be helpful for regaining function.

Safety of Lumbar Interbody Fusion Procedures for Degenerative Disc Disease: A Systematic Review With Network Meta-Analysis of Prospective Studies.

STUDY DESIGN: A network meta-analysis. OBJECTIVES: Lumbar degenerative disc disease (LDDD) is an important issue in aging population, for which lumbar interbody fusion (LIF) is a feasible management in cases refractory to conservative therapy. There are various techniques available to perform LIF, including posterior (PLIF), transforaminal (TLIF), and anterior (ALIF) approaches. However, the comparative safety profile of these procedures remains controversial. Our study aimed to evaluate comparative adverse events of the LIF procedures in patients with LDDD. METHODS: We searched 5 databases for relevant prospective cohort studies and randomized clinical trials. After quality assessments, we extracted neural, spinal, vascular, and wound events for conducting contrast-based network meta-analysis. Results were reported in risk ratio (RR), 95% confidence interval (CI), and surface under the cumulative ranking (SUCRA). RESULTS: We identified 14 studies involving 921 participants with LDDD. Pooled result showed that open PLIF (OPLIF) leads to significantly higher overall adverse event rate than does open TLIF (OTLIF; RR = 3.43, 95% CI = 1.21-9.73). OTLIF confers the highest SUCRA in neural (78.7) and spinal (80.8) event rates. Minimally invasive TLIF has the highest SUCRA in vascular event (84.2), and minimally invasive PLIF has the highest SUCRA in wound event (88.1). No inconsistency or publication bias was detected in the results. CONCLUSIONS: Based on our results, perhaps OPLIF should be avoided in the management of LDDD due to the inferiority of overall complications. Specifically, TLIF seems to have the safest profile in terms of neural, spinal, and vascular events. Nevertheless, shared decision making is still mandatory when choosing the proper LIF procedure for patients with LDDD in clinical practice.

Effects of teriparatide and bisphosphonate on spinal fusion procedure: A systematic review and network meta-analysis.

BACKGROUND: Giving patients anti-osteoporotic agents peri-operatively is a well-accepted strategy to increase fusion rate and prevent complications. The purpose of this study was to investigate effectiveness of teriparatide and bisphosphonate on fusion surgery of thoracic and lumbar spine. METHODS: We searched EMBASE and PubMed for randomized clinical trials (RCTs) and prospective comparative studies using teriparatide or bisphosphonate in peri-operative spinal fusion surgery. Our synthesized data of fusion rate, Oswestry disability index (ODI), and adverse event in contrast-based network meta-analysis. Pooled results were presented in risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). RESULTS: Our search hit eight RCTs and three prospective studies with 676 patients receiving spinal surgery. Pooled result showed that teriparatide+Denosumab leads to significantly higher fusion rate than placebo (RR, 2.84; 95% CI: 1.22 to 6.60) and bisphosphonate (RR, 2.59; 95% CI: 1.13 to 5.96). We did not observe significant finding among placebo, teriparatide, and bisphosphonate in the two network models. CONCLUSION: This is the first network meta-analysis providing an overview of the use of teriparatide and bisphosphonate for spinal fusion surgery. Teriparatide treatments are worth to be consider for spinal fusion surgery.

Fat distribution may predict intra- or extra-capsular hip fracture in geriatric patients after falling.

INTRODUCTION: Hip fractures can be divided into intra-capsular and extra-capsular fracture based on fracture location; these two types of fracture have different pathogeneses, treatments and prognoses. Many factors influence the patterns of hip fractures, including the injury mechanism, areal bone mineral density and the geometry of the hip. However, the relationship between body composition and hip fracture pattern has not yet been discussed. In this investigation, an analysis of the body compositions of geriatric patients with hip fractures were conducted to identify differences between fat and muscle distributions between patients with intra- and extra-capsular hip fractures. MATERIAL AND METHODS: From December 2017 to February 2019, 139 patients with a hip fracture were prospectively enrolled in this study. The groups of patients that were diagnosed as having intra- and extra-capsular hip fractures were compared in terms of patient demographics, pre-operative laboratory data, bone mineral density (BMD) and body composition including muscle and fat distributions obtained using dual-energy X-ray absorptiometry (DXA) . RESULTS: Eighty-six and 53 patients were diagnosed with intra-capsular and extra-capsular hip fractures, respectively. A significantly higher serum glucose level, a lower hemoglobin level, a lower T-score level in the proximal femur region, a lower T-score of all parts of interest, and a lower percentage fat content on the region of bilateral proximal hips (gynoid region) and in the lower limb region, were observed in patients with an extra-capsular hip fracture than in those with an intra-capsular hip fracture. However, with all confounding factors controlled for, only the T-score at the proximal femur, percentage fat content in the region of bilateral proximal hips and the ratio of android fat content to gynoid fat content (A/G ratio) are the most relevant factors in predicting the patterns of hip fracture in geriatric patients after falling. CONCLUSION: This work demonstrates that lower fat content in the region of bilateral proximal hips and a lower BMD on the proximal femur may predict greater vulnerability of geriatric patients to extra-capsular rather than intra-capsular hip fracture after a falling accident.

All carbon-based photodetectors: an eminent integration of graphite quantum dots and two dimensional graphene.

Photodetectors with ultrahigh sensitivity based on the composite made with all carbon-based materials consisting of graphite quantum dots (QDs), and two dimensional graphene crystal have been demonstrated. Under light illumination, remarkably, a photocurrent responsivity up to 4 × 10(7) AW(-1) can be obtained. The underlying mechanism is attributed to the spatial separation of photogenerated electrons and holes due to the charge transfer caused by the appropriate band alignment across the interface between graphite QDs and graphene. Besides, the large absorptivity of graphite QDs and the excellent conductivity of the graphene sheet also play significant roles. Our result therefore demonstrates an outstanding illustration for the integration of the distinct properties of nanostructured carbon materials with different dimensionalities to achieve highly efficient devices. Together with the associated mechanism, it paves a valuable step for the further development of all carbon-based, cheap, and non-toxic optoelectronics devices with excellent performance.

Malignant solitary fibrous tumor of the urinary bladder.

A 67-year-old man was examined for persistent pain over his lower abdomen and was found to have a large pelvic tumor. During surgery, we detected a 16 × 9 × 9 cm(3) urinary bladder tumor with small intestinal adhesions, and performed partial cystectomy and segmental resection. Histological and immunohistochemical examinations established the diagnosis of malignant solitary fibrous tumor (SFT). Only 10 cases of urinary bladder SFT have been reported in the English literature; our patient is the second one with malignancy and had a longer follow-up period than the other case.