Complications and outcomes after three-column osteotomy: a 5-year follow-up.

BACKGROUND: Three-column spinal osteotomies (3-CO) are powerful techniques used to correct spinal deformity. These surgeries are associated with an elevated risk of complications. While outcomes have been reported in the literature with 2 years follow-up, longer-term outcomes of three-column osteotomies remain understudied. OBJECTIVES: This study aims to examine patient reported outcomes and complications for three-column osteotomies at 5 years. STUDY DESIGN: Retrospective review of a prospectively collected spinal deformity cases database. PATIENT SAMPLE: All consecutive adult patients at a single spine surgery center treated with either a pedicle subtraction osteotomy (PSO) or vertebral column resection (VCR) for spinal deformity, and with a minimum 5-year follow-up were included. OUTCOME MEASURES: Visual-analog scale (VAS) for back pain score (0 to 10), Oswestry Disability Index (ODI) score (0 to 100), number of complications, revision rate, sagittal balance, lumbar lordosis at preoperative and at 5-year visit. METHODS: Data was extracted from a prospectively collected spinal deformity surgery database continuously updated since 2002 with data from operative reports, patients' medical visit notes and patients' self-reported VAS and ODI questionnaires completed at each office visit. Radiographic measurements were performed on standing full-length spine radiographs taken at pre-op and 5-year visits. Descriptive statistics, comparison of means and proportions among groups, and a logistic regression analysis were conducted using the statistical software package SPSS version 28. Statistical significance was set at p<.05. RESULTS: Of 127 consecutive adult patients with minimum of 5-year follow-up undergoing a 3-CO posterior spinal surgery for spinal deformity were identified and included in the study, 79 (62%) were treated with PSO, and 48 (38%) with VCR. Both PSO and VCR groups demonstrated significant improvements in VAS (PSO pre-op: 6.7, 5-year: 4.6, p<.001; VCR pre-op: 7.1, 5-year: 5.2, p<.001), and ODI (PSO pre-op: 52.9, 5-year: 45.4, p<.001; VCR pre-op: 57.5, 5-year 43.0, p<.001) that were maintained at 5 years. Major and minor complications occurring within 5 years were not statistically different between the PSO and VCR groups (major: 59.5% vs 56.3%, p=.85; minor: 45.6% vs 37.5%, p=.46). The rate of revision surgery within 5 years was 39.4% overall. Of the fifty patients requiring revision, 37.5% were for nonunion, 27.1% instrumentation failure, 14.6% proximal junctional kyphosis (PJK), 12.5% vertebral fracture, 6.3% motor weakness, and 2.1% infection. Improvements in lumbar lordosis were maintained at 5 years in both the PSO (29.9° vs 47.2°, p<.001) and VCR (34.6° vs 48.5°, p<.001) groups while sagittal balance maintained significant improvement in the VCR group (9.5 cm vs 6.3 cm, p=.008) but not the PSO (11.4 cm vs 9.3 cm, p=.065). CONCLUSION: Patients undergoing three-column osteotomies had a major complication rate of 57.5% and a minor complication rate of 42.5% after 5 years. Improvements in lumbar lordosis were maintained at 5-year follow-up, but sagittal balance was only maintained in the VCR group. Despite these radiographic findings, both VCR and PSO groups maintained significant clinical improvements in both VAS and ODI scores at 5-year follow up.

VespAI: a deep learning-based system for the detection of invasive hornets.

The invasive hornet Vespa velutina nigrithorax is a rapidly proliferating threat to pollinators in Europe and East Asia. To effectively limit its spread, colonies must be detected and destroyed early in the invasion curve, however the current reliance upon visual alerts by the public yields low accuracy. Advances in deep learning offer a potential solution to this, but the application of such technology remains challenging. Here we present VespAI, an automated system for the rapid detection of V. velutina. We leverage a hardware-assisted AI approach, combining a standardised monitoring station with deep YOLOv5s architecture and a ResNet backbone, trained on a bespoke end-to-end pipeline. This enables the system to detect hornets in real-time-achieving a mean precision-recall score of ≥0.99-and send associated image alerts via a compact remote processor. We demonstrate the successful operation of a prototype system in the field, and confirm its suitability for large-scale deployment in future use cases. As such, VespAI has the potential to transform the way that invasive hornets are managed, providing a robust early warning system to prevent ingressions into new regions.

Laminectomy Adjacent to Instrumented Fusion Increases Adjacent Segment Disease.

STUDY DESIGN: Retrospective cohort. OBJECTIVE: To determine if performing a simultaneous laminectomy at an unfused level adjacent to an instrumented fusion increases the risk of adjacent segment disease(ASD). SUMMARY OF BACKGROUND DATA: Laminectomy adjacent to instrumented fusion has uncertain outcomes. The increased mechanical forces at the unfused laminectomy may lead to more ASD. Few studies have examined the development of ASD with regards to laminectomy performed adjacent to instrumented fusions. METHODS: 789 patients underwent instrumented lumbar fusion and laminectomy at the same level(s) (n=676) or with an additional adjacent level laminectomy (n=113) with a minimum of 2-year follow-up. Diagnoses were degenerative spondylosis (n=241), degenerative spondylolisthesis (n=485) and isthmic spondylolisthesis (n=63) in addition to central stenosis. Primary outcome measures included development of ASD, time to development of ASD, revision surgery, and time to revision surgery. RESULTS: The adjacent laminectomy group developed ASD at a significantly greater rate of 57.5% (n=65), compared with 35.2% (n=238) of the non-adjacent laminectomy group (P<0.001). Revision surgery rate was also greater in the adjacent laminectomy group (22.1% v 13.5%, P<0.001). There was no difference in time to revision surgery (31.1 v 32.6 mo, P=0.71) or time to ASD development (31.2 v 32.3 mo, P=0.72). ODI and VAS scores did not differ, nor did patient baseline demographics including sex, BMI, Charleston Comorbidity Index, and tobacco use. The exception was the adjacent laminectomy group average age was 67.6 while the non-adjacent laminectomy group average age was 62.3 (P<0.001). However, age was not found to be an independent predictor of ASD development (P=0.44). CONCLUSION: Surgeons should be cautious when performing a laminectomy adjacent to an instrumented fusion, as this increases the rate of ASD as well as revision surgery.

A Missed Diagnosis of Intraprosthetic Dislocation in a Dual-Mobility Bearing Following Closed Reduction.

Dual-mobility bearings have been found to reduce the rate of dislocation following both primary and revision total hip arthroplasty. Their unique design involves two articulating surfaces which increases construct stability but also leaves them susceptible to a unique complication known as intraprosthetic dislocation (IPD). We report the case of a 33-year-old female who sustained an IPD following closed reduction. Following a missed radiographic diagnosis, the patient experienced pain and mechanical symptoms secondary to her implant failure. Surgical removal of the dislodged liner with component revision was required. This case highlights several crucial steps in the management of patients with dislocated total hip arthroplasties including implant identification and careful review of postreduction radiographs. We also discuss several strategies to properly diagnose, manage, and avoid IPD.

Non-oncologic Total Femoral Arthroplasty: A Case Report.

As patient longevity continues to improve, the rate of lower limb revision arthroplasties will continue to increase as patients outlive the expiration of their implants. With continued bone loss and reduced stability, there is a limit to the number of revision operations that can be performed. Total femoral arthroplasty (TFA) is an increasingly popular limb-salvaging alternative that can restore some degree of daily function to patients. This report presents a 73-year-old male with multiple right lower-limb operations following two extreme motorcycle accidents in the last 22 years. Due to continued pain and poor femoral bone stock following multiple total knee arthroplasty (TKA) revisions, a TFA was performed. The procedure was successful and post-operative expectations were met despite setbacks in immediate rehabilitation. Overall, TFA is an effective alternative to lower limb amputation in the setting of aseptic, non-oncologic bone loss following multiple knee revisions. However, careful management is necessary to reduce the risk of infection and other complications.

Associations Between Change Over Time in Pandemic-Related Stress and Change in Physical Activity.

BACKGROUND: Physical activity (PA) mitigated psychological distress during the initial weeks of the COVID-19 pandemic, yet not much is known about whether PA had effects on stress in subsequent months. We examined the relationship between change over time in COVID-related stress and self-reported change in PA between March and July 2020. METHODS: Latent growth modeling was used to examine trajectories of change in pandemic-related stress and test their association with self-reported changes in PA in an international sample (n = 679). RESULTS: The participants reported a reduction in pandemic-related stress between April and July of 2020. Significant linear (factor mean = -0.22) and quadratic (factor mean = 0.02) changes (Ps < .001) were observed, indicating a deceleration in stress reduction over time. Linear change was related to change in PA such that individuals who became less active during the pandemic reported less stress reduction over time compared with those who maintained or increased their PA during the pandemic. CONCLUSIONS: Individuals who experienced the greatest reduction in stress over time during the pandemic were those who maintained their activity levels or became more active. Our study cannot establish a causal relationship between these variables, but the findings are consistent with other work showing that PA reduces stress.

Spreading of Thin Droplets of Perfect and Leaky Dielectric Liquids on Inclined Surfaces.

The spreading of droplets may be influenced by electric fields, a situation that is relevant to applications such as coating, printing, and microfluidics. In this work we study the effects of an electric field on the gravity-driven spreading of two-dimensional droplets down an inclined plane. We consider both perfect and leaky dielectric liquids, as well as perfectly and partially wetting systems. In addition to the effects of electric fields, we examine the use of thermocapillary forces to suppress the growth of the capillary ridge near the droplet front. Lubrication theory is applied to generate a set of coupled partial differential equations for interfacial height and charge, which are then solved numerically with a finite-difference method. Electric fields increase the height of the capillary ridge in both perfect and leaky dielectric droplets due to electrostatic pressure gradients that drive liquid into the ridge. In leaky dielectrics, large interfacial charge gradients in the contact-line region create shear stresses that also enhance ridge growth and the formation of trailing minor ridges. The coalescence of these ridges can significantly affect the long-time thinning rate of leaky dielectric droplets. In partially wetting liquids, electric fields promote the splitting of smaller droplets from the primary droplet near the receding contact line due to the interplay between electrostatic forces and disjoining pressure. Cooling from below and heating from above generates thermocapillary forces that counteract the effects of electric fields and suppress the growth of the capillary ridge. The results of this work have important implications for manipulating the spreading of droplets down inclined surfaces.

Periodontal health of anterior teeth with two types of fixed retainers.

OBJECTIVE: To compare the periodontal health of maxillary and mandibular anterior teeth retained with two types of fixed retainers. MATERIALS AND METHODS: A fixed straight retainer (SR) group had 39 subjects, and a fixed wave retainer (WR) group had 35 subjects. Subjects were between the ages of 13 and 22 years and had been in fixed retention for 2 to 4 years. Pocket probing depths, bleeding on probing, plaque index, calculus index, recession, and gingival crevicular fluid volume were compared between the two retainer groups. A four-question oral hygiene survey was given to each subject. The Mann-Whitney U-test and Fisher exact test was used to analyze the data. RESULTS: There was no clinically significant difference between the retainer groups regarding plaque index, gingival crevicular fluid volume, calculus index, recession, bleeding on probing, and pocket probing depths. A statistically significant increase in the reported frequency of flossing (P  =  .006) and ease of flossing (P < .001) was associated with the WR group. There was no significant difference between the groups in reported frequency of brushing and comfort of the retainer. CONCLUSIONS: Under the conditions of this study, no clinical difference was found in the periodontal health of anterior teeth retained with a SR or WR for a period of 2 to 4 years. Subjects in the WR group reported an increase in frequency and ease of flossing.

Create three distinct career paths for innovators.

Large companies say they Create Three Distinct want to be Career Paths for Innovators innovative, but they fundamentally mismanage their talent. Expecting innovators to grow along with their projects-from discovery to incubation to acceleration--sets them up to fail. Most people excel at one of the phases, not all three. By allowing innovation employees to develop career paths suited to their strengths, companies will create a sustainable innovation function.

Receptor-assisted combinatorial chemistry: thermodynamics and kinetics in drug discovery.

Current drug discovery using combinatorial chemistry involves synthesis followed by screening, but emerging methods involve receptor-assistance to combine these steps. Adding stoichiometric amounts of receptor during library synthesis alters the kinetics or thermodynamics of the synthesis in a way that identifies the best-binding library members. Three main methods have emerged thus far in receptor-assisted combinatorial chemistry: dynamic combinatorial libraries, receptor-accelerated synthesis, and a new method, pseudo-dynamic libraries. Pseudo-dynamic libraries apply both thermodynamics and kinetics to amplify library members to easily observable levels, and attain selectivity heretofore unseen in receptor-assisted systems.

Amplification of screening sensitivity through selective destruction: theory and screening of a library of carbonic anhydrase inhibitors.

A new method for identifying enzyme inhibitors is to conduct their synthesis in the presence of the targeted enzyme. Good inhibitors form in larger amounts than poorer ones because the binding either speeds up synthesis (target-accelerated synthesis) or shifts the synthesis equilibrium (dynamic combinatorial libraries). Several groups have successfully demonstrated this approach with simple systems, but application to larger libraries is challenging because of the need to accurately measure the amount of each inhibitor. In this report, we dramatically simplify this analysis by adding a reaction that destroys the unbound inhibitors. This works similar to a kinetic resolution, with the best inhibitor being the last one remaining. We demonstrate this method for a static library of several sulfonamide inhibitors of carbonic anhydrase. Four sulfonamide-containing dipeptides, EtOC-Phe(sa)-Phe (4a), EtOC-Phe(sa)-Gly (4b), EtOC-Phe(sa)-Leu (4c) and EtOC-Phe(sa)-Pro (4d), were prepared and their inhibition constants measured. These inhibitors migrated to the carbonic anhydrase compartment of a two-compartment vessel. Although higher concentrations of the better inhibitors were observed in the carbonic anhydrase compartment, the concentration differences were small (1.83:1.71:1.54:1.46:1 for 4a:4b:4c:4d:5, where 5 is a noninhibiting dipeptide EtOC-Phe-Phe). Addition of a protease rapidly cleaved the weaker inhibitors (4d and 5). Intermediate inhibitor 4c was cleaved at a slower rate, and at the end of the reaction, only 4a and 4b remained. In a separate experiment, the ratio of 4a to 4b was found to increase over time to a final ratio of nearly 4:1. This is greater than the ratio of their inhibition constants (approximately 2:1). The theoretical model predicts that these ratios would increase even further as the destruction proceeds. This removal of poorer inhibitors simplifies identification of the best inhibitor in a complex mixture.