Correlation of Foraminal Parameters with Patient-Reported Outcomes in Patient with Degenerative Lumbar Foraminal Stenosis.

The relationship between quantitative anatomic parameters in MRI and patient-reported outcomes (PROs) before and after surgery in degenerative lumbar foraminal stenosis remains unknown. We included 58 patients who underwent transforaminal lumbar interbody fusion (TLIF) for single-level degenerative disc disease with foraminal stenosis between February 2013 and June 2020. PROs were evaluated using the visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and EuroQol-5D (EQ-5D). The foraminal parameters assessed using preoperative MRI included foraminal height, posterior intervertebral disc height, superior and inferior foraminal width, and foraminal area. The correlation between foraminal parameters and PROs before operation, at 1 year follow-up, and change from baseline were assessed. The associations between the aforementioned parameters were examined using linear regression analysis. The analysis revealed that among these parameters, superior foraminal width was found to be significantly correlated with ODI and EQ-5D at the 1 year follow-up and with change in ODI and EQ-5D from baseline. The associations remained significant after adjustment for confounding factors including age, sex, body mass index, and duration of hospital stay. The results indicated that in degenerative lumbar foraminal stenosis, decreased superior foraminal width was associated with better improvement in disability and quality of life after TLIF.

Two-dimensional C-arm robotic navigation system (i-Navi) in spine surgery: a pilot study.

PURPOSE: Pedicle screws placement is very common procedure in spinal surgery. Robotic assisted surgery has been widely used in this operation. We assessed the accuracy of thoracolumbar spine trans-pedicle screws (TPS) implantation utilizing a noval robotic navigation system (i-Navi robotic navigation system) by planning with two-dimensional (2-D) C-arm. METHODS: This study was approved by the Institutional Review Board of the Cathay General Hospital on June 21, 2018 (IRB number: CGH-P 106,092), and written informed consents were obtained from all the patients. There are 18 patients were enrolled in the study. All the patients received the posterior fusion with TPS insertion under the assistant of our robotic navigation system. RESULTS: There are 18 patients were included into our study, there are 2 patients were quitted from the study due to the equipment setup was not complete. Other 16 patients completed the entire procedure successfully. There is total 88 pedicle screws were inserted through i-Navi robotic navigation system. There are 79 of 88 screws were graded A, and 9 screws were graded B; no screws were graded C or D. No vascular or nerve injuries were noted after the operations. CONCLUSION: We present our i-Navi robotic navigation system, by planning with 2-D C-arm imaging and pre-operative CT scans. According to the results of study, we think it can provide a reliable and easy tool to perform the TPS in thoracic lumbar spine surgery.

Replication of a Dog-Origin H6N1 Influenza Virus in Cell Culture and Mice.

The world's first natural avian-origin H6N1 influenza A virus infection case in dogs was confirmed in Taiwan in 2014. The H6N1 virus in chickens has been endemic in Taiwan since 1972. Whether the dog H6N1 virus has interspecies transmission potential is the key issue we aim to understand. Following one virus passage in embryonated eggs and two further passages in MDCK cells, we obtained two virus derivatives, E01EE (PB1 739E and PB2 627E) and E01GK (PB1 739G and PB2 627K), respectively. The pathogenicity of E01EE and E01GK was investigated using plaque assay, growth dynamic analysis and cell viability quantification in cells from different animal species. The impact of amino acid mutation on PB1 739 and PB2 627 on viral ribonucleoprotein (RNP) activity was also analyzed. Further mouse infection experiments were performed. The results showed that both E01EE and E01GK decreased cell relative viability of canine MDCK cells, human A549 cells and chicken DF1 cells. E01Gk caused greater cellular harm in MDCK and A549 cells and had significantly higher virus titers in all of the cells compared to E01EE. The PB2 627K but not PB1 739G was the critical mutation that influenced the viral RNP activity. Both E01EE and E01GK caused mice pneumonia and considerable virus shedding, especially E01GK. This report verifies PB2 E627K mutation in virulence and spotlights the potential for the dog H6N1 virus to extend interspecies transmission.

Implementation and performance evaluation of a drilling assistive device for distal locking of intramedullary nails.

Intramedullary nailing is a common treatment for long bone fractures. The nail might deform during implantation because of the shape of medullary cavity. Thus, surgeons take many X-ray images to position distal locking holes and check the drilling process. In this study, we developed a positioning algorithm with a passive or active (robot arm) assistive device for promptly positioning of distal locking holes and stably drilling guidance and support. Using the passive device, the surgeon could manually align the positioning probe with locking hole within 60 seconds based on 20 test cases. In 36 test cases, the active device aligned the positioning probe with locking hole automatically with average errors of 2.2 mm in position and 3.19° in direction. The passive device provides a reliable and low-cost solution for distal locking of intramedullary nails, while the active device is easy and friendly to use.

The Evaluation of Different Radiological Measurement Parameters of the Degree of Collapse of the Vertebral Body in Vertebral Compression Fractures.

For compression fracture, vertebral body height loss (VBHL) and kyphotic angle (KA) are two important imaging parameters for determining the prognosis and appropriate treatment. This study used previous measurement methods to assess the degree of VBHL and KA, compare and examine differences between various measurement methods, and examine the correlation between relevant measurement parameters and intravertebral cleft (IVC) in the vertebral body. The radiographic images (lateral view of the T-L spine) of 18 patients with a single-level vertebral compression fracture were reviewed. We measured 9 characteristic lengths and angles on plain radiographs, including anterior vertebral height (AVH) and AVH of the adjacent upper and lower levels, middle vertebral height (MVH) and MVH of the adjacent upper and lower levels, posterior vertebral height (PVH), and vertebral body width, and assessed 6 parameters, including vertebral compression ratio (VBCR), percentage of anterior height compression (PAHC), percentage of middle height compression (PMHC), kyphotic angle (KA), calculated kyphotic angle (CKA), and IVC. The results showed that VBCR is a simple and rapid method of VBHL assessment, but it may result in an underestimation of the degree of VBHL compared to PAHC. When PMHC < 40% or kyphotic angle > 15°, the probability of IVC occurring on the vertebral body was higher which means the higher risk of vertebral body instability. The results of this study could provide a reference for surgeons when using imaging modalities to assess the degree of vertebral body collapse.

C-Arm Image-Based Surgical Path Planning Method for Distal Locking of Intramedullary Nails.

Due to the curvature of the bone marrow cavity, the intramedullary nail used in long bone fracture fixation can be deformed, causing displacement of the locking holes. In this study, an algorithm using only one C-arm image to determine the center positions and axial directions of locking holes was developed for drilling guidance. Based on conventional method that the axial direction of locking hole would be identified when locking hole contour is presented as a circle, the proposed method can locate the circle contour centroid by using one C-arm image including two elliptical contours. Then the two distal locking holes' axial direction and centers would be determined. Three experiments were conducted to verify the performance of the proposed algorithm, which are (1) computer simulation, (2) use of real intramedullary nails, and (3) actual drilling test with the bone model. The experimental results showed that the average error of the axial direction and center position were 0.62 ± 0.6°, 0.73 ± 0.53 mm (simulation) and 3.16 ± 1.36°, 1.10 ± 0.50 mm (actual nail), respectively. The last ten drilling test sets were completed successfully (with an average duration of 48 seconds). Based on the experimental results, the proposed algorithm was feasible for clinic applications.

Expression of an Oncidium gene encoding a patatin-like protein delays flowering in Arabidopsis by reducing gibberellin synthesis.

The involvement of lipase in flowering is seldom studied, and this research provides evidence that fatty acids produced by lipase affect flowering. OSAG78 encoding a patatin-like protein was isolated from Oncidium Gower Ramsey. OSAG78 fused with green fluorescent protein was found to localize at the cell membrane. Transgenic Arabidopsis overexpressing OSAG78 demonstrated higher lipase activity than the wild-type control. In addition, the amount of free linoleic acid and linolenic acid in transgenic Arabidopsis was found to be higher than that in the wild type. Transgenics overexpressing OSAG78 exhibited altered phenotypes, including smaller leaves and rounder flowers, and also demonstrated a late flowering phenotype that could be rescued by gibberellin A(3) (GA(3)) application. Several flowering-related genes were analyzed, indicating that the expression of gibberellin-stimulated genes was decreased in the plants overexpressing OSAG78. Also, the expression of AtGA2ox1, AtGA3ox1 and AtGA20ox1 genes encoding GA2-, GA3- and GA20-oxidases, respectively, which are mainly responsible for gibberellin metabolism, was decreased, and the level of GA(4), a bioactive gibberellin, measured by gas chromatography-mass spectrometry was also reduced in the overexpressing lines. Furthermore, the expression levels of AtGA3ox1 and AtGA20ox1 were significantly decreased in wild-type Arabidopsis treated with linoleic acid, linolenic acid or methyl jasmonate. The membrane-bound OSAG78 might hydrolyze phospholipids to release linoleic acid and linolenic acid, and then depress the expression of genes encoding GA3- and GA20-oxidase. These changes reduced the bioactive gibberellin level, and, finally, late flowering occurred. Our results indicate that a patatin-like membrane protein with lipase activity affects flowering through the regulation of gibberellin metabolism.