Experience with the utilization of new-generation shared-control robotic system for spinal instrumentation.

BACKGROUND: Robotic assistance in spine surgery is emerging as an accurate, effective and enabling technology utilized in the treatment of patients with surgical spinal pathology. The safety and reproducibility of robotic assistance in the placement of pedicle screw instrumentation is still being investigated. The objective of this study was to present our experience of instrumented spinal fusion utilizing an intraoperative robotic guidance system. METHODS: We retrospectively reviewed all cases of spinal instrumentation of the thoracic and lumbo-sacral spine using the Mazor X robotic system (Medtronic Inc, Minneapolis, MN, USA), performed at our institution by one surgeon between July 2017 and June 2020. Wilcoxon Rank test was used to compare time taken to place each screw during the first 20 cases and the cases thereafter. RESULTS: A total of 28 patients were included. A total of 159 screws were placed using the Mazor X robotic system. The overall mean time for screw placement was 7.8±2.3 minutes and there was a significant reduction in the mean time for screw placement after the 20th case or 120 screws (8.70 vs. 5.42 min, P=0.008). No postoperative neurologic deficit or new radiculopathy was noted to occur secondary to hardware placement. No revision surgery was required for replacement or removal of a mispositioned screw. CONCLUSIONS: From this single-center, single-surgeon series we conclude that robot-assisted spine surgery can be safely and efficiently integrated into the operating room workflow, which improves after a learning curve of approximately 20 operative interventions. We found robot-assisted spinal instrumentation to be reliable, safe, effective and highly precise.

Utilization of lateral anterior lumbar interbody fusion for revision of failed prior TLIF: illustrative case.

BACKGROUND: The use of the lateral decubitus approach for L5-S1 anterior lumbar interbody fusion (LALIF) is a recent advancement capable of facilitating single-position surgery, revision operations, and anterior column reconstruction. To the authors' knowledge, this is the first description of the use of LALIF at L5-S1 for failed prior transforaminal lumbar interbody fusion (TLIF) and anterior column reconstruction. Using an illustrative case, the authors discuss their experience using LALIF at L5-S1 for the revision of pseudoarthrosis and TLIF failure. OBSERVATIONS: The patient had prior attempted L2 to S1 fusion with TLIF but suffered from hardware failure and pseudoarthrosis at the L5-S1 level. LALIF was used to facilitate same-position revision at L5-S1 in addition to further anterior column revision and reconstruction by lateral lumbar interbody fusion at the L1-2 level. Robotic posterior T10-S2 fusion was then added to provide stability to the construct and address the patient's scoliotic deformity. No complications were noted, and the patient was followed until 1 year after the operation with a favorable clinical and radiological result. LESSONS: Revision of a prior failed L5-S1 TLIF with an LALIF approach has technical challenges but may be advantageous for single position anterior column reconstruction under certain conditions.

The effect of lower-limb prosthetic alignment on muscle activity during sit-to-stand.

People with a transtibial amputation (TTA) have altered motion during daily tasks, which may be influenced by prosthetic alignment. This study aimed to determine the effect of medial/lateral prosthetic alignment shifts on muscle activity, measured by integrated electromyography (iEMG), and to compare muscle activity between people with and without TTA during sit-to-stand. We quantified ground reaction forces and three-dimensional center-of-mass position to interpret muscle activity results. Compared to the prescribed alignment, the bilateral knee extensors had greater activity in the medial alignment (p < 0.001) and the amputated side gluteus medius and less activity in the lateral alignment (p = 0.035), which may be a result of altered muscular requirements for postural control. In people with TTA, smaller intact side gluteus medius activity was associated with frontal plane motion of the center-of-mass, which was not observed in non-amputees. Compared to non-amputees, people with TTA had greater iEMG in the intact side tibialis anterior (p = 0.031) and amputated side rectus femoris (p < 0.001), which may be required to brake the body center-of-mass in the absence of amputated side tibialis anterior. These results suggest that lateral alignment shifts may reduce muscle activity during sit-to-stand for people with TTA and emphasize the importance of analyzing sit-to-stand in three dimensions.

Cerebrospinal fluid macrophage migration inhibitory factor: a potential predictor of cerebral vasospasm and clinical outcome after aneurysmal subarachnoid hemorrhage.

OBJECTIVE: In patients with aneurysmal subarachnoid hemorrhage (aSAH), poor outcomes have been shown to be correlated with subsequent cerebral vasospasm (CV) and delayed cerebral ischemia (DCI). The identification of novel biomarkers may aid in the prediction of which patients are vulnerable to developing vasospasm, cerebral ischemia, and neurological deterioration. METHODS: In this prospective clinical study at North Shore University Hospital, patients with aSAH or normal pressure hydrocephalus (NPH) with external ventricular drains were enrolled. The concentration of macrophage migration inhibitory factor (MIF) in CSF was assessed for correlation with CV or DCI, the primary outcome measures. RESULTS: Twenty-five patients were enrolled in the aSAH group and 9 were enrolled in the NPH group. There was a significant increase in aggregate CSF MIF concentration in patients with aSAH versus those with NPH (24.4 ± 19.2 vs 2.3 ± 1.1 ng/ml, p < 0.0002). Incidence of the day of peak MIF concentration significantly correlated with the onset of clinical vasospasm (rho = 0.778, p < 0.0010). MIF concentrations were significantly elevated in patients with versus those without evidence of DCI (18.7 ± 4.93 vs 8.86 ± 1.28 ng/ml, respectively, p < 0.0025). There was a significant difference in MIF concentrations between patients with infection versus those without infection (16.43 ± 4.21 vs 8.5 ± 1.22 ng/ml, respectively, p < 0.0119). CONCLUSIONS: Preliminary evidence from this study suggests that CSF concentrations of MIF are correlated with CV and DCI. These results, however, could be confounded in the presence of clinical infection. A study with a larger patient sample size is necessary to corroborate these findings.

Social Models Enhance Apes' Memory for Novel Events.

Nonhuman primates are more likely to learn from the actions of a social model than a non-social "ghost display", however the mechanism underlying this effect is still unknown. One possibility is that live models are more engaging, drawing increased attention to social stimuli. However, recent research with humans has suggested that live models fundamentally alter memory, not low-level attention. In the current study, we developed a novel eye-tracking paradigm to disentangle the influence of social context on attention and memory in apes. Tested in two conditions, zoo-housed apes (2 gorillas, 5 chimpanzees) were familiarized to videos of a human hand (social condition) and mechanical claw (non-social condition) constructing a three-block tower. During the memory test, subjects viewed side-by-side pictures of the previously-constructed block tower and a novel block tower. In accordance with looking-time paradigms, increased looking time to the novel block tower was used to measure event memory. Apes evidenced memory for the event featuring a social model, though not for the non-social condition. This effect was not dependent on attention differences to the videos. These findings provide the first evidence that, like humans, social stimuli increase nonhuman primates' event memory, which may aid in information transmission via social learning.

Asymmetries in the production of self-directed behavior by chimpanzees and gorillas during a computerized cognitive test.

Self-directed behaviors (SDBs) are a commonly used behavioral indicator of arousal in nonhuman primates. Experimental manipulations, designed to increase arousal and uncertainty, have been used to elicit SDB production in primates. Beyond measuring rates of SDB production, researchers have also recorded their lateralized production by primates, thought to reflect laterality of hemispheric brain control and response to emotion. Although a handful of such studies exist, all have been conducted with chimpanzees. Expanding on this line of inquiry, we tested both chimpanzees (N = 3) and gorillas (N = 3) in a serial learning task presented on a touchscreen interface that incorporated both EASY (two-item list) and HARD (four-item list) versions of the task. Although SDB production by the apes did not differ across the two levels of task complexity, both species produced higher rates of SDB when they made an error, regardless of task difficulty. Furthermore, the apes made more SDB with the left hand-directed to the right side of their body (contralateral SDB) and left side of their body (ipsilateral SDB)-when they made an incorrect response. There was no difference in the rate of SDB produced with the right hand across correct compared to incorrect trials. The apes' responses reflect previous reports that show humans are quicker at selecting negative emotional stimuli when using their left, compared to their right, hand (the reverse is true for positive stimuli). However, previous work has shown that chimpanzees are more likely to produce (contralateral) SDB with their right hand when aroused and so we discuss our results in relation to these findings and consider how they relate to the 'right hemisphere' and 'valence' models of emotional processing in apes.

Evaluating the physiological and behavioral response of a male and female gorilla (Gorilla gorilla gorilla) during an introduction.

Prolonged stress responses can lead to infertility and death; therefore monitoring respective indicators like stress-related hormones and behaviors is an important tool in ensuring the health and well-being among zoo-housed animal populations. Changes in social structure, such as the introduction of a new conspecific, can be a source of stress. In April 2010, a sexually mature female western lowland gorilla (Gorilla gorilla gorilla) was brought to Lincoln Park Zoo (LPZ; Chicago, IL) from the Chicago Zoological Park (Brookfield, IL) for a breeding recommendation from the Gorilla Species Survival Plan. Fecal glucocorticoid metabolites (FGMs) were monitored in two gorillas prior to, during and immediately following the social introduction. Reproduction events, such ovarian cyclicity and pregnancy, were monitored using behavior and fecal progestagen metabolite (FPM; female) and fecal androgen metabolite (FAM; male) analyses. Mean (± standard error) FGM concentrations for the male were elevated (P = 0.002) during the introduction (20.61 ± 0.83 ng/g) compared to the pre- and post-introduction phases (11.31 ± 0.48 ng/g and 12.42 ± 0.65 ng/g, respectively). For the female, mean FGM concentrations were lower (P < 0.001) during the post-introduction (17.91 ± 1.07 ng/g) than during the pre- and introduction phases (30.50 ± 3.42 and 27.38 ± 1.51 ng/g, respectively). The female maintained normal FPM cyclicity throughout the study and became pregnant in the post-introduction phase. These results suggest the importance of both behavioral and physiological monitoring of zoo animals and demonstrate the potential stress that can occur during social introductions. Zoo Biol. 33:394-402, 2014. © 2014 Wiley Periodicals Inc.

The choice to access outdoor areas affects the behavior of great apes.

Outdoor access is often cited as a critical component of appropriate housing for great apes in captivity, and although studies have shown that offering primates choices can improve welfare, choice to access specific areas has been empirically neglected. Behavioral data were collected on chimpanzees and gorillas housed in naturalistic enclosures while (a) restricted to an indoor enclosure and (b) permitted free access to an adjacent outdoor area. To isolate the factor of choice, only the sessions in which apes remained indoors were compared. With choice, chimpanzees showed more frequent social, F(1, 5) = 20.526, p = .006, and self-directed behaviors, F(1, 5) = 13.507, p = .014, and lower inactivity levels, F(1, 5) = 9.239, p = .029. Gorillas were more frequently inactive, F(1, 8) = 22.259, p = .002, and produced lower levels of object manipulation, F(1, 8) = 8.243, p = .021, and feeding, F(1, 8) = 5.407, p = .049. Results are consistent with an association between choice and the expression of species-typical and arousal behaviors in chimpanzees. The effects are less evident in gorillas, but this outcome may be buffered by the species' lower motivation to utilize the outdoor spaces. Findings highlight species-specific reactions to access to choice that may offer insight for enclosure design, management, and nonhuman animal welfare.

Serum-free and feeder-free culture expansion of human embryonic stem cells.

Human embryonic stem cells (hESCs) are pluripotent stem cells derived from the inner cell mass of human blastocysts. hESCs have become a great asset to studying human diseases and genetic functions of healthy organisms. The rate at which hESCs are being used in laboratories is exponentially increasing, and with that, the need for xeno-free hESCs is also increasing. Xeno-free grade hESCs, cells that have not come into contact with any animal-derived components except those of human origin, are critical for eventual drug therapy, cell therapy, and disease treatment in humans. However, advances toward a xeno-free hESC environment are still being developed. Replacement of murine feeder layers with extracellular matrix proteins has advanced the research, and some advances toward a serum-free and feeder-free environment for hESCs are described in this chapter.

Chimpanzee (Pan troglodytes) birth patterns and human presence in zoological settings.

In response to work demonstrating a negative correlation between human staff activity and parturition in laboratory-managed primates, this study examined the distribution of 231 captive chimpanzee (Pan troglodytes) births that occurred in accredited American zoological institutions by the day of the week on which the birth was discovered. We hypothesized that if chimpanzee parturition patterns displayed sensitivity to human presence, then fewer births per day would be reported during the weekend period, when the visitor density was high, as compared with the lower density working week. Analyses indicated that chimpanzee births were randomly distributed throughout the week. In the context of the questionable sensitivity of primate parturition to external influence, results suggest that variations in human presence do not affect the fine-level timing of birth in chimpanzees managed in a zoological setting.