Fusion rate of Escherichia coli-derived recombinant human bone morphogenetic protein-2 compared with local bone autograft in posterior lumbar interbody fusion for degenerative lumbar disorders.

BACKGROUND CONTEXT: The use of recombinant human bone morphogenetic proteins-2 (rhBMP-2) for spinal fusion has been reported to be effective. However, most studies have focused on posterolateral and anterior lumbar interbody fusion, and few have investigated posterior lumbar interbody fusion (PLIF). PURPOSE: This study aimed to determine the effectiveness and safety of the delivery of Escherichia coli-derived rhBMP-2 (E.BMP-2) with hydroxyapatite (HA) and ß-tricalcium phosphate (ß-TCP) poloxamer hydrogel composite carriers for PLIF. STUDY DESIGN: A retrospective study. PATIENT SAMPLE: Patients who underwent 1 to 3 levels of PLIF for lumbar degenerative disc disorders between 2015 and 2020 with a follow-up of ≥1 year were enrolled. In total, 254 patients (357 levels) were included in the analysis. The evaluation was performed at each segment level. In the E.BMP-2 group, 160 patients (221 levels) received autologous local bone with E.BMP-2 (maximum 0.5 mg/level), and in the control group, 94 patients (136 levels) received only local bone graft. OUTCOME MEASURES: The primary outcome of this study was to compare the X-ray and CT fusion rates between the two groups. Secondary outcomes included analysis of the patients' clinical outcomes and postoperative complications on CT scans. METHODS: Clinical evaluations were performed using a visual analog scale for back pain, the Oswestry Disability Index for disability, and physical and mental component summaries of the Short Form 36-Item Form Health Survey to assess functional effects and quality of life. The fusion was evaluated using radiography and CT. On radiography, solid fusion was defined when the difference between extension and flexion was less than 5°. On CT, solid fusion was defined when the upper and lower vertebral bodies were connected by the trabecular bone (bone bridge formation). In addition, complications such as osteolysis, cage subsidence, and screw loosening were investigated using CT. RESULTS: All clinical results for low back pain, disability, and quality of life in both groups were excellent and showed statistically significant improvements compared with baseline (p<.0001). According to the X-ray evaluations, fusion was achieved in 92.31% (204/221) of the patients in the E.BMP-2 group and 82.35% (112/136) of the patients in the control group (p=.0041). According to the CT evaluations, the fusion rates were 93.21% (206/221) and 88.24% (120/136) in the E.BMP-2 and control groups (p=.1048), respectively. Except for screw loosening, which had a significantly higher incidence in the control group (p=.0014), the rates of most postoperative complications were not significantly different between the groups. CONCLUSIONS: This study demonstrated that the adjunctive use of a low dose of E.BMP-2 with HA and ß-TCP hydrogel can effectively promote bone fusion, making it a promising option for patients with limited autograft availability or compromised bone quality in PLIF.

Novel C-arm-based planning robotic spinal surgery in a cadaver model using quantitative accuracy assessment methodology.

BACKGROUND: This preclinical study emulating the clinical environment quantitatively analysed the accuracy of pedicle screw insertion using a navigated robotic system. METHODS: Pedicle screws were placed from T7 to L5 in the whole-body form of a cadaver. After the insertion of multiple artificial markers into each vertebra, errors between the planned insertion path and the inserted screw were quantified using the Gertzbein-Robbins system (GRS) and offset calculation. RESULTS: A total of 22 screws were placed. Almost all (95.45% [21/22]) were classified as GRS A or B, while one (4.55%) was GRS C. The mean and standard deviations of entry, tip, and angular offset were 1.78 ± 0.94 mm, 2.30 ± 1.01 mm, and 2.64 ± 1.05°, respectively. CONCLUSIONS: This study demonstrated that pedicle screw insertion using a navigated robotic system had high accuracy and safety. A future clinical study is necessary to validate our findings.

Postoperative spinal deformity and instability after cervical spinal cord tumor resection in adults: A systematic review and meta-analysis.

OBJECTIVE: To investigate the incidence of cervical spine deformity and instability after posterior cervical spinal cord tumor (CSCT) resection without fusion or fixation in adults and examine relevant risk factors by reviewing and summarizing previously reported studies. METHODS: We selected peer reviewed articles published between January 1990 and December 2020 from the MEDLINE and Cochrane Library databases using relevant key words. Articles in which the authors mainly described spinal cord tumor resection through posterior surgery without fusion or fixation in adults were selected for analysis. Patient's data including age, sex, extensive number of laminectomy levels, laminectomy at C2, C3, or C7, multilevel facetectomy, facet destruction, preoperative cervical kyphosis, and preoperative motor deficit were documented. Comparable factors were assessed using the odds ratio (OR) and weighted mean difference (WMD) of 95% confidence intervals (CI). RESULTS: Among 133 articles identified, 18 met selection criteria. Overall incidence of deformity and instability after CSCT surgery was 0%-41.7% and 0%-20.5%, respectively. Younger age (WMD, -5.5; 95% CI, -10.52 âˆ¼ -0.49; P = 0.03), C2 laminectomy (OR, 5.33; 95% CI, 2.39 âˆ¼ 11.91; P < 0.0001), more laminectomy level (WMD, 2.77; 95% CI, 1.78 âˆ¼ 3.76; P < 0.00001) were identified as risk factors for deformity and instability after CSCT surgery. CONCLUSION: Patients undergoing CSCT resection should receive careful follow-up for postoperative spinal deformity and instability. Younger age, C2 laminectomy, and more laminectomy level were significantly associated with occurrence of deformity and instability after CSCT surgery. Upfront spinal fixation at the time of resection should be considered in selected patients.

Factors Affecting Postoperative Complications and Outcomes of Cervical Spondylotic Myelopathy with Cerebral Palsy : A Retrospective Analysis.

OBJECTIVE: Cervical surgery in patients with cervical spondylotic myelopathy (CSM) and cerebral palsy (CP) is challenging owing to the complexities of the deformity. We assessed factors affecting postoperative complications and outcomes after CSM surgery in patients with CP. METHODS: Thirty-five consecutive patients with CP and CSM who underwent cervical operations between January 2006 and January 2014 were matched to 35 non-cerebral palsy (NCP) control patients. Postoperative complications and radiologic outcomes were compared between the groups. In the CP group, the Japanese Orthopaedic Association score; Oswestry neck disability index; modified Barthel index; and values for the grip and pinch, Box and Block, and Jebsen-Taylor hand function tests were obtained preand postoperatively and compared between those with and without postoperative complications. RESULTS: Sixteen patients (16/35%) in the CP group and seven (7/35%) in the NCP group (p=0.021) had postoperative complications. Adjacent segment degeneration (p=0.021), postoperative motor weakness (p=0.037), and revisions (p=0.003) were significantly more frequent in the CP group than in the NCP group; however, instrument-related complications were not significantly higher in the CP group (7/35 vs. 5/35, p=0.280). The number of preoperative fixed cervical deformities were significantly higher in CP with postoperative complications (5/16 vs. 1/19, p=0.037). In the CP group, clinical outcomes were almost similar between those with and without postoperative complications. CONCLUSION: The occurrence of complications during the follow-up period was high in patients with CP. However, postoperative complications did not significantly affect clinical outcomes.

Multiple Spontaneous Intracerebral Hematoma without Presenting Risk Factors.

The incidence of intracerebral hemorrhage in those aged 45-84 years is 0.3-0.5%. In people over 80 years of age, this incidence increases 25-fold compared with that of the total population. The most common causes of spontaneous intracerebral hemorrhage in the younger population are vascular malformation, aneurysm, and overuse of drugs. In contrast, common causes in the elderly include hypertension, tumors, and coagulation disorders. Here, we present a case involving a 72-year-old male patient who, without any of these predisposing conditions, was admitted to the hospital with spontaneous intracerebral hemorrhage and showed signs of multifocal intracerebral hemorrhage during his stay. We conclude that spontaneous intracerebral hemorrhage can occur without any predisposing factors, and can lead to a patient's death. Therefore, the possibility of recurrent spontaneous intracerebral hemorrhage must be considered in patients with primary spontaneous intracerebral hemorrhage.

Solution Processed Organic Photovoltaic Cells Using D-A-D-A-D Type Small Molecular Donor Materials with Benzodithiophene and Diketopyrrolopyrrole Units.

Organic photovoltaic Cells (OPVs) have been considered to be a next-generation energy source to overcome exhaustion of resources. Currently, OPVs are developed based on two types of donor material with polymer and small molecule. Polymeric donor materials have shown better power conversion efficiency (PCE) than small molecular donor materials, since it's easy to control the morphology of photoactive film. However, the difficulty in synthetic reproducibility and purification of polymeric donor were main drawback to overcome. And then, recently small molecule donor materials have been overcome bad morphology of OPVs film by using appropriate alkyl substituents and relatively long conjugation system. In this study, we designed and synthesized D-A-D-A-D type small molecular donor materials containing alternatively linked benzodithiophene (BDT) and diketopyrrolopyrrole (DPP) units. Also, we studied on the effect of photovoltaic performance of prepared small molecular D-A-D-A-D type donor with variation of thiophene links and with/without hexyl substituent. Our small molecular donors showed HOMO energy levels from -5.26 to -5.34 eV and optical bandgaps from 1.70 to 1.87 eV by CV (cyclic voltammetry) and UV/Vis spectroscopy, respectively. Finally, 3.4% of PCE can be obtained using a mixture of BDT(DPP)2-T2 and PCBM as an active layer with a Voc of 0.78 V, a Jsc of 9.72 mA/cm2, and a fill factor of 0.44 under 100 mW/cm2 AM 1.5G simulated light. We will discuss the performance of D-A-D-A-D type small molecular donor based OPVs with variation of both terminal substituents.

Syntheses of D-A-A Type Small Molecular Donor Materials Having Various Electron Accepting Moiety for Organic Photovoltaic Application.

Small molecular donor, DTDCTB achieved a high power conversion efficiency (PCE) value of 6.6 ± 0.2% in vacuum-deposited planar mixed heterojunction (PMHJ) structure. However, the same material just recorded PCE of 0.34% in solution processed small molecule based bulk heterjunction (BHJ) organic photovoltaic cells. For the improvement of organic photovoltaic cells (OPVs), In this study, we designed and synthesized several D-A-A (donor-acceptor-acceptor) type molecular electron donating materials. Ditolylaminothienyl moiety as an electron donating group connected to 1,2,5-benzothiadiazole as a conjugated electron accepting unit, simultaneously with an electron accepting terminal group such as cyano alkyl acetate and N-alkyl rhodanine. The thermal, photophysical, and electrochemical properties of prepared small molecules were investigated by DSC, UV/Vis spectroscopy and Cyclic Voltametry, respectively. As a result, 0.89% of PCE can be obtained from OPV using a mixture of DTATBTER and PCBM as an active layer with a Voc of 0.87 V, a Jsc of 3.20 mA/cm2, and a fill factor of 31.9%.

Efficient CH3 NH3 PbI3 Perovskite Solar Cells Employing Nanostructured p-Type NiO Electrode Formed by a Pulsed Laser Deposition.

Highly transparent and nanostructured nickel oxide (NiO) films through pulsed laser deposition are introduced for efficient CH3 NH3 PbI3 perovskite solar cells. The (111)-oriented nanostructured NiO film plays a key role in extracting holes and preventing electron leakage as hole transporting material. The champion device exhibits a power conversion efficiency of 17.3% with a very high fill factor of 0.813.

Trials of clear aceclofenac-loaded soft capsules with accelerated oral absorption in human subjects.

To develop an effective oral drug delivery system with accelerated absorption in human subjects for a poorly water-soluble acelofenac, five aceclofenac-loaded soft capsule preparations containing various ratios of different solubilizers were prepared and their dissolution tests were carried out. Among five preparations tested, a preparation with ethanolamine was selected as a formula of aceclofenac soft capsule (Korea United Pharm. Co. Ltd., Clanza S, since it was clear in appearance and showed the fastest dissolution rate due to the solubility-enhancing effect of aceclofenac. To evaluate and compare the pharmacokinetics of acelofenac-loaded soft capsules with the conventional aceclofenac tablets (Dae-Woong Pharm. Co. Ltd., Airtal) in human subjects; 14 normal healthy male volunteers (age 20-25 years old) were divided into two groups and a randomized 2 x 2 cross-over study was performed. Following oral administration of one tablet or capsule, each containing 100mg of aceclofenac, blood samples were collected at the predetermined time intervals and the concentration of aceclofenac in plasma was determined by HPLC method using UV detector. The AUC, Cmax, MRT, t1/2 and Kel of aceclofenac delivered from soft capsule were not significantly different from those from aceclofenac-loaded conventional tablet. However, soft capsule gave significantly higher initial concentration and significantly faster Tmax of aceclofenac than did conventional tablet, suggesting that the soft capsule with ethanolamine showed the faster absorption of aceclofenac in human subjects. Thus, the clear aceclofenac-loaded soft capsule with ethanolamine was a more effective oral dosage form with fast absorption for poorly water-soluble aceclofenac.