"Early Efficacy and Safety of Unilateral Biportal Endoscopic Lumbar Interbody Fusion Versus Minimal Invasive in the Treatment of Lumbar Degenerative Diseases".

STUDY DESIGN: This was a retrospective cohort study. OBJECTIVE: To compare the early clinical efficacy and radiologic outcomes between unilateral biportal endoscopic lumbar interbody fusion (ULIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). SUMMARY OF BACKGROUND DATA: Along with the continuous development of endoscopic technology, the early safety and effectiveness of ULIF technology are still unknown. MATERIALS AND METHODS: This retrospective study included 61 patients who underwent fusion surgery through ULIF or MIS-TLIF in 2021. Twenty-nine patients underwent ULIF (group A), and 32 underwent MIS-TLIF (group B). Fusion rate, bone graft volume, hidden blood loss (HBL), C-reactive protein level, operative time, Oswestry Disability Index , Visual Analog Scale score, and MacNab criteria were assessed in both groups. RESULTS: The Visual Analog Scale score for back pain in the early postoperative period was significantly lower in group A than in group B ( P <0.05). All other clinical scores showed improvement, with no significant difference between the 2 groups ( P >0.05). There was no statistically significant difference in postoperative C-reactive protein levels and fusion rates between the 2 groups ( P >0.05). However, HBL was higher and operative time was longer in group A than in group B ( P <0.05). Most importantly, there were no statistically significant differences between groups A and B in fusion rate, length of stay and bone graft volume ( P >0.05). No serious surgical complications occurred in our study. CONCLUSIONS: ULIF is a new option for lumbar fusion. Despite the drawbacks of longer operation time and higher HBL, ULIF may be a viable alternative to MIS-TLIF as technology advances.

[Treatment of stage â ¡-â ¢ Kümmell disease with robot-assisted bone cement-augmented pedicle screw fixation].

OBJECTIVE: To evaluate the early clinical efficacy of robot-assisted percutaneous short-segment bone cement-augmented pedicle screw fixation in the treatment of stageⅡ-Ⅲ Kümmell disease. METHODS: The clinical data of 20 patients with stageⅡ-Ⅲ Kümmell's disease who underwent robot-assisted percutaneous bone cement-augmented pedicle screw fixation between June 2017 and January 2021 were retrospectively analyzed. There were 4 males and 16 females, aged from 60 to 81 years old with an average age of (69.1±8.3) years. There were 9 cases of stageⅡand 11 cases of stage Ⅲ, all of which were single vertebral lesions, including 3 cases of T11, 5 cases of T12, 8 cases of L1, 3 cases of L2, and 1 case of L3. These patients did not exhibit symptoms of spinal cord injury. The operation time, intraoperative blood loss, and complications were recorded. The position of pedicle screws and the filling and leakage of bone cement in gaps were observed using postoperative CT 2D reconstruction. The data of the visual analogue scale (VAS), Oswestry disability index (ODI), kyphosis Cobb angle, wedge angle of the diseased vertebra, and anterior and posterior vertebral height on lateral radiographs were statistically analyzed preoperatively, 1 week postoperatively, and at the final follow-up. RESULTS: Twenty patients were followed up for 10 to 26 months, with an average follow-up of (16.0±5.1) months. All operations were successfully completed. The surgical duration ranged from 98 to 160 minutes, with an average of (122±24) minutes. The intraoperative blood loss ranged from 25 to 95 ml, with an average of (45±20) ml. There were no intraoperative vascular nerve injuries. A total of 120 screws were inserted in this group, including 111 screws at grade A and 9 screws at grade B according to the Gertzbein and Robbins scales. Postoperative CT indicated that the bone cement was well-filled in the diseased vertebra, and cement leakage occurred in 4 cases. Preoperative VAS and ODI were (6.05±0.18) points and (71.10±5.37)%, respectively, (2.05±0.14) points and (18.57±2.77)% at 1 week after operation, and (1.35±0.11) points and (15.71±2.12) % at final follow-up. There were significant differences between postoperative 1 week and preoperative, and between final follow-up and postoperative 1 week(P<0.01). Anterior and posterior vertebral height, kyphosis Cobb angle, and wedge angle of the diseased vertebra were(45.07±1.06)%, (82.02±2.11)%, (19.49±0.77) °, and (17.56±0.94) ° preoperatively, respectively, (77.00±0.99)%, (83.04±2.02)%, (7.34±0.56) °, and (6.15±0.52) ° at 1 week postoperatively, and (75.13±0.86)%, (82.39±0.45)%, (8.38±0.63) °, and (7.09±0.59) ° at the final follow-up. CONCLUSION: Robot-assisted percutaneous short-segment bone cement-augmented pedicle screw fixation demonstrates satisfactory short-term efficacy in treating stageⅡ-Ⅲ Kümmell's disease as an effective minimally invasive alternative. However, longer operation times and strict patient selection criteria are necessary, and long-term follow-up is required to determine its lasting effectiveness.

A comparative study of robot-assisted and traditional surgeries in the treatment of thoracolumbar fractures based on 1-year follow-up observation.

BACKGROUND: There are conflicting results for robot-assisted (RA) pedicle screw fixation compared with freehand (FH) pedicle screw fixation. OBJECTIVE: This study was designed to retrospectively compare the accuracy and efficacy of RA percutaneous pedicle screw fixation and traditional freehand FH pedicle screw fixation in the treatment of thoracolumbar fractures. METHODS: A total of 26 cases were assigned to the RA group, and 24 cases were assigned to the FH group. The operation time, bleeding volume, and visual analog scale (VAS) score 1 day after the operation, and the anterior/posterior (A/P) vertebral height ratio of the injured vertebrae at 3 days and at internal fixation removal 1 year after the operation were compared between the two groups. Pedicle screw position accuracy was assessed according to Gertzbein criteria. RESULTS: The operation times of the RA group and FH group were 138.69 ± 32.67 minutes and 103.67 ± 14.53 minutes, respectively, and the difference was statistically significant. The intraoperative blood loss was 49.23 ± 22.56 ml in the RA group and 78.33 ± 23.90 ml in the FH group, and the difference was statistically significant. There was a significant difference in the A/P vertebral height ratio of the injured vertebrae 3 days after the operation compared with before the operation in both groups (P < 0.05). There was a significant difference in the A/P vertebral height ratio of the injured vertebrae 3 days after the operation compared with that at fixation removal in both groups (P < 0.05). CONCLUSION: The application of RA orthopedic treatment for thoracolumbar fractures can achieve good fracture reduction.

Wide-angle and high-efficiency flat retroreflector.

We propose a flat retroreflector that can efficiently reflect the electromagnetic waves back along its incident direction in a wide continuous range of angles. This retroreflector consists of a quadratic metalens and a flat metallic reflector at the focal plane of the former. The quadratic metalens is a dielectric pillar array encoded with a quadratic phase profile and it is embedded in the top side of the substrate. The flat reflector is on the bottom side of the substrate. The designed retroreflector has a diameter of 40 mm, a thickness of 15 mm, and a working frequency of 77 GHz. Through meta-units optimization, a retroreflection efficiency of 38.51% at ± 60° incidence and an average retroreflection efficiency of 46.39% for the incident angles from 0° to 60° can be numerically demonstrated. This flat retroreflector is easy for integration, which is promising for potential applications in the miniature wireless communication systems.

High-efficiency one-dimensional metalens for 3D focusing.

We demonstrate a high-efficiency on-chip one-dimensional metalens for three-dimensional (3D) light focusing. The metalens consists of a one-dimensional dielectric nano-antenna array, which scatters the evanescent wave of a nano-waveguide into free space and focuses this scattered light into a 3D ring. The corresponding phase profile of the metalens is controlled by the relative locations of antennas in the array. Through antenna-waveguide distance optimization, the designed metalens only scatters 1.5% of propagation light into free space and 55% of the scattered energy is focused into the 3D ring. When we use the antennas with an optimized shape, 50.18% of the focused energy is concentrated in a circular arc of the ring, which subtends an angle of 48°. This high-efficiency on-chip one-dimensional metalens is promising for non-invasive optical signal detection in photonic integrated chips.

Near unity transmission and full phase control with asymmetric Huygens' dielectric metasurfaces for holographic projections.

Huygens' metasurfaces are transparent arrays of nanostructures that enable phase-front manipulation. This is achieved by simultaneous excitation of electric dipole (ED) and magnetic dipole (MD) resonances with equal amplitudes and phases in the constituent meta-atoms. In usual designs, the size changes of the meta-atoms, necessary to map the phase front, can detune the overlapping of ED and MD resonances, decreasing the transmission and limiting the operating bandwidth. In this report, we demonstrate that ED and MD resonances can be almost perfectly tuned together over a large wavelength range, keeping their spectral overlap, in a silicon metasurface by using anisotropic meta-atoms. In particular, we show near-unity transmission (>95% in simulations) and 2π phase control in a wavelength range from 760 to 815 nm using cuboidal nanoantennas. Using this concept, we also experimentally demonstrate clear reconstruction from holograms of a single metasurface spanning the near infrared and the whole visible spectral range.

Potential biomarkers and resistance mechanisms of atezolizumab in a patient with lung squamous cell carcinoma.

Background: At present, only a small fraction of patients with cancer benefit from treatment with immune checkpoint inhibitors, the reasons for which are not fully understood. Monitoring molecular and immunologic changes during treatment with immune checkpoint inhibitors would help to identify potential biomarkers and mechanisms associated with resistance and guide subsequent treatment. Methods: The authors report on a patient previously treated for lung squamous cell carcinoma who received atezolizumab-based therapy for 24 months. Results & Conclusion: Analysis of samples before and after atezolizumab treatment suggested that genetic mutations in EGFR exon 20 insertion, phosphatase and PTEN and NOTCH1 as well as changes in tumor immune microenvironment may be associated with acquired resistance to immune checkpoint inhibitor therapy.

Lay abstract The authors aimed to figure out potential biomarkers and mechanisms associated with immune checkpoint inhibitor resistance by monitoring changes during treatment in a lung squamous cell cancer patient. Interestingly, EGFR exon 20 insertion, decreased PTEN copy number and NOTCH1 mutation as well as changes in CD8⁺ T cells and macrophages were observed after disease progression. Thus, the authors suggest that these changes may be associated with atezolizumab resistance.

Percutaneous Transforaminal Endoscopic Decompression for Lumbar Lateral Recess Stenosis.

Objective: The aim of this study was to evaluate the treatment efficacy of lateral spinal stenosis through the decompression of the nerve root under a multiple planar endoscope. Methods: From January 2017 to March 2019, 52 patients with lumbar spinal stenosis or lumbar spinal stenosis combined with intervertebral disc herniation had been treated via transforaminal approach spinal endoscopy. Our study retrospectively analyzed the treatment outcome. All patients experienced complications with different degrees of facet joint hyperplasia and ligamentum flavum hyperplasia and hypertrophy. Some patients suffered disc herniation. All patients were treated with percutaneous transforaminal approach multiple planar endoscopic decompression. The visual analog scale (VAS) and the Oswestry Disability Index (ODI) were compared before and after the operation, as were the horizontal foramen areas of the medial margins of the upper and lower pedicles of the vertebral arch. The treatment effectiveness was evaluated. Results: VAS and ODI scores were significantly improved at postoperative 3 days, 3 months, 6 months, and the last follow-up (P < 0.05). The area of the intervertebral foramen was 422.5 ± 159.2 mm2 preoperatively and 890.8 ± 367.7 mm2 postoperatively, the difference was statistically significant (P < 0.05). Conclusion: Percutaneous transforaminal approach multiple planar endoscopic decompression could achieve an accurate and effective decompression of the lumbar lateral spinal canal. This procedure has good short-term effects, and is especially suitable for elderly patients.

Nanoparticle trapping and manipulation using a silicon nanotrimer with polarized light.

Optical tweezers based on plasmonics experience a tremendous development on manipulating nanoparticles but are unable to avoid the problem of Joule heating. In this Letter, we report a silicon nanotrimer to optically trap and manipulate nanoparticles with negligible local heating. The optical forces and trapping potential of the nanotrimer are investigated using the finite-difference time-domain method. The results indicate that the trapping position can be shifted by tuning the polarization of the incident light. Furthermore, the silicon nanotrimer enables simultaneous trapping of multiple nanoparticles using circularly polarized illumination. Our work provides a promising building block for an integrated all-dielectric platform to realize optically driven nanomanipulation, which offers new possibilities for on-chip optical applications.

Dual-layer achromatic metalens design with an effective Abbe number.

Planar achromatic metalenses with a thickness of the order of wavelength have attracted much attention for their potential applications in ultra-compact optical devices. However, realizing single-layer achromatic metalenses across a wide bandwidth requires that the corresponding meta-atoms have complex cross-sections for correct phase profile and dispersion compensation. Herein, we introduce an effective Abbe number and use lens maker equations to design a dual-layer achromatic metalens in which we compensate the dispersion by using a plano-convex liked metalens combined with a plano-concave liked metalens. The stacked metalens are designed based on simple high refractive index dielectric cylindrical meta-atoms with different radii, which simplify the design and fabrication processes. We demonstrate that a dual-layer achromatic metalens has a small focal length difference across the visible wavelength range and an average focusing efficiency above 50%, which proves that the design method is promising for many potential applications in multi-functional flat optical devices.

Computer-navigated versus conventional total knee arthroplasty: A randomized controlled trial protocol in China.

BACKGROUND: The literature lacks studies that confirm whether the improved radiographic alignment that can be achieved with computer-navigated total knee arthroplasty (TKA) improves patients' activities of daily living or the durability of total knee prostheses. Thus, in this protocol, we designed a randomized controlled trial to compare implant alignment, functional scores, and survival of the implant using computer-assisted surgery versus a conventional surgical technique. METHODS: This prospective, blinded randomized controlled trial was conducted at our single hospital. This study was approved by the ethics committee of Jiaxing Second Hospital. The patient inclusion criteria were age 20 to 80 years' old, a body mass index of ≤35 kg/m, and consented for primary knee arthroplasty performed through a medial parapatellar approach by the senior author. We randomized consented study participants on a 1:1 ratio to 1 of 2 study groups using a computer-generated list of random numbers in varying block sizes. The primary outcome in this study was the Knee Injury and Osteoarthritis Outcome Score. Secondary outcomes were the Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, complications, and range of motion together with alignment and rotational positioning of the implant. Statistical significance was defined as a P value of ≤0.05. CONCLUSIONS: Authors hypothesized that computer-assisted surgery in primary TKA improves implant alignment, functional scores, and survival of the implant compared to the conventional technique.

Nanophotonic Array-Induced Dynamic Behavior for Label-Free Shape-Selective Bacteria Sieving.

Current particle sorting methods such as microfluidics, acoustics, and optics focus on exploiting the differences in the mass, size, refractive index, or fluorescence staining. However, there exist formidable challenges for them to sort label-free submicron particles with similar volume and refractive index yet distinct shapes. In this work, we report an optofluidic nanophotonic sawtooth array (ONSA) that generates sawtooth-like light fields through light coupling, paving the physical foundation for shape-selective sieving. Submicron particles interact with the coupled hotspots which impose different optical torques on the particles according to their shapes. Unstained S. aureus and E. coli are used as a model system to demonstrate this shape-selective sorting mechanism based on the torque-induced body dynamics, which was previously unattainable by other particle sorting technologies. More than 95% of S. aureus is retained within ONSA, while more than 97% of E. coli is removed. This nanophotonic chip offers a paradigm shift in shape-selective sorting of submicron particles and expands the boundary of optofluidics-based particle manipulation.

Design of random and sparse metalens with matrix pencil method.

We propose a matrix pencil method for designing one- or two- dimensional (1D or 2D) metalenses with randomly distributed meta-atoms. In contrast to the standard random synthesis algorithm that only randomizes the position of the meta-atoms, the proposed method designs both the position and phase of each meta-atom rigorously. Several all-dielectric random metalenses, in both 1D and 2D operating at 220 GHz, are presented by using our proposed algorithm. Minimum reduction of focusing efficiency can be achieved with respect to a standard metalens with periodically arranged meta-atoms. In contrast to previously reported random metalenses, our random metalenses achieve much higher efficiency, while staying polarization-independent. This synthesis method will pave a way for future random-metasurface-based device designs, which could have more degrees of freedom to information multiplexing.

[A case control study of perpendicular or parallel double plate for the treatment of young and middle-aged patients with type C fractures of distal humerus].

OBJECTIVE: To compare clinical outcomes of perpendicular or parallel double plate in treating type C fractures of distal humerus in adults. METHODS: From March 2009 and March 2013, 40 adult patients with type C distal humerus fractures were treated. The patients were divided into two groups according to fixed form. In perpendicular group(group A), there were 13 males and 9 females with a mean age of (37.56±9.24) years old(ranged 18 to 56);while in parallel plating group(group B), including 11 males and 7 females, with a mean age of (41.35±9.03) year old(ranged 20 to 53). All fractures were fresh and closed without blood vessels or nerve damaged. Incision length, operating time, blood loss, hospital stay, preoperative and postoperative radiological change, range of activity of elbow joint, Mayo score, flexor and extensor elbow strength, and postoperative complications were observed and compared. RESULTS: All incisions were healed well. One patient occurred myositis ossificans between two groups. Two patients in group A and 1 patient in group B occurred elbow joint stiffness. All fractures were obtained bone union. Group A were followed up from 20 to 36 months with an average of (25.2±7.1) months, while group B were followed up from 18 to 35 months with an average of(24.3±6.0) months. There were significant differences in blood loss and operative time, while there was no obvious meaning in incision length, hospital stay, muscle strength, fracture healing time, range of activity of elbow joint. Mayo score of group A was 82.27±10.43, 6 cases obtained excellent results, 12 good, 3 moderate and 1 poor;in group B was 81.94±12.02, 5 cases obtained excellent results, 9 good, 3 moderate and 1 poor;and there were no statistical significance between two groups. CONCLUSIONS: There was no significant differences in clinical effects between perpendicular and parallel double plate for adult patients with type C distal humerus fractures, while the operation should choose according to facture and proficiency of operator.

[Curative effect comparison of two methods of treatment for distal tibial fractures].

OBJECTIVE: Evaluation of two different methods of treatment of distal tibial fractures of the clinical indications, complications and efficacy. METHODS: Forty-five cases of closed distal tibial fractures were assigned to two groups, 25 cases in group A included 18 males and 7 females, according to the AO/ASIF classification: 4 cases of type A, 14 cases of B, 7 cases of C, open reduction and anatomic plate fixation were used. Twenty cases in group B included 12 males and 8 females, 5 of type A, 9 of B, 6 of C, minimally invasive percutaneous locking compression plate osteosynthesis were used. Observed on the postoperative pain, skin necrosis of the incision, the incidence of deep infection and other complications, as well as the healing of fractures, ankle motor function for comparative study. RESULTS: All patients were followed up 10 to 15 months, according to the visual analogue scale (VAS) score, group A were moderate to severe in, group B were mild to moderate between. Bone healing time: group A averaged (16.0+/-4.2) weeks, group B averaged (13.0+/-3.2) weeks, the difference was significant (P<0.01). Postoperative complications of group A was more than that of group B (P<0.05), there were significant differences. Ankle function in accordance with the assessment criteria Kofoed, the good and excellent rate of group B was higher than that of group A (P<0.05), there were significant differences. CONCLUSION: Minimally invasive percutaneous locking compression plate osteosynthesis compared open reduction and anatomic plate fixation for distal tibial fractures with less trauma surgery, bone blood supply to the affected small, fracture healing faster, less complications, and ankle function better advantage of. It is consistent with the biomechanics of internal fixation, and is the treatment of tibial fractures ideal method.