Three-dimensional High-definition Exoscope in Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Retrospective Cohort Study.

OBJECTIVES: The operative microscope (OM) has revolutionized the field of modern spine surgery, however, it remains limited by several drawbacks. Recently, the exoscope (EX) system has been designed to assistant spine surgery. It provides a three-dimensional (3D) high-definition (HD) operative experience and becomes an alternative to the OM. The aim of the study was to evaluate the clinical outcomes, advantages and limitations of EX-assisted minimally invasive transforaminal lumbar interbody fusion (EMIS-TLIF) and OM-assisted MIS-TLIF (OMIS-TLIF). METHODS: The clinical outcomes were assessed in 47 patients with lumbar degenerative diseases (LDD) who underwent MIS-TLIF assisted with the OM or EX between January 2019 and September 2020. A total of 22 were treated with EMIS-TLIF, and 25 received OMIS-TLIF. Perioperative parameters (including sex, age, number of fusion levels and body mass index), perioperative parameters (operation time, intraoperative blood loss, postoperative drainage, postoperative hospitalization stay, and duration of follow-up), visual analogue scale (VAS) of back pain, VAS of leg pain, Oswestry disability index (ODI) scores and clinical outcomes were assessed and compared. Image quality, handling of equipment, ergonomics, 3D glasses and educational usefulness were scored according to a questionnaire. RESULTS: Operation time in the OMIS-TLIF group (121.92 ± 16.92 min) was significantly increased compared with that in the EMIS-TLIF group (111.00 ± 19.87 min) (P < 0.05). The VAS of the back pain and ODI scores in the EMIS-TLIF group were significantly lower compared with the OMIS-TLIF group at 1 week postoperatively (P < 0.05). The good-excellent outcomes rate was 90.91% in the EMIS-TLIF group and 88.00% in the OMIS-TLIF group, and there was no significant difference. A total of 44 visits completed the questionnaire. The results of the questionnaire showed that the EX has exhibited advantages regarding handing of equipment, ergonomics and educational usefulness, and comparable image quality as compared with the OM, however, operating surgeons complained uncomfortable sensation when wearing 3D glasses. CONCLUSIONS: The EMIS-TLIF was a safe and effective procedure in the management of LDD as compared with the OMIS-LIF. Meanwhile, EMIS-TLIF might resulted in a short operation time.

A real-time 3D electromagnetic navigation system for percutaneous transforaminal endoscopic discectomy in patients with lumbar disc herniation: a retrospective study.

BACKGROUND: In this study, we present a novel electromagnetic navigation (EMN) system for percutaneous transforaminal endoscopic discectomy (PTED) procedure. The objective of this study was to investigate the safety and effectiveness of the PTED with the assistance of the EMN system and compare it with the conventional PTED with the assistance of fluoroscopic guidance (C-arm). METHODS: The clinical data of 79 patients (32 in EMN group and 47 in C-arm group) undergoing PTED for lumbar disc herniation (LDH) from January to September of 2019 were analyzed retrospectively. The radiation time, puncture time, operation time, visual analog scale (VAS), Oswestry disability index (ODI), modified MacNab criteria, and radiological parameters were recorded in both groups. RESULTS: Radiation time, puncture time, and operation time were significantly reduced in the EMN group compared with the C-arm group (P < 0.05). Compared with the C-arm group, a steeper learning curve was observed in the EMN group. There were no significant differences between the two groups regarding VAS and ODI scores at different time points (P > 0.05). The satisfaction rates of the EMN and C-arm groups were 90.63 and 87.23%, respectively, but no significant difference was found between the two groups (P > 0.05). There was no significant difference regarding translation and angular motion between the two groups at preoperation and postoperation (P > 0.05). CONCLUSIONS: The EMN system can be applied to facilitate the PETD procedure. It can significantly reduce the intraoperative radiation time, puncture time, and operation time, and reshape the learning curve of PTED. Due to limitations of a retrospective study, results may need validation with larger prospective randomized clinical trials.

Characterization of plant growth-promoting traits of Enterobacter sp. and its ability to promote cadmium/lead accumulation in Centella asiatica L.

In the present study, we characterized the plant growth-promoting traits of Enterobacter sp. FM-1 (FM-1) and investigated its ability to promote growth and increase IAA, P, and Fe concentrations as well as Cd and Pb accumulation in Centella asiatica L. (C. asiatica L.) in upstream area (UA) soil and downstream area (DA) soil that we collected from Siding mine. The results demonstrated that FM-1 secreted IAA, produced siderophores, and had P-solubilization ability even under Cd exposure. IAA secretion reached a maximum of 108.3 ± 1.3 mg L-1 under Cd exposure at 25 mg L-1. Siderophore production reached a maximum of 0.94 ± 0.01 under Cd exposure at 50 mg L-1. Pot experiments indicated that FM-1 successfully colonized the roots of C. asiatica L. In both soils, inoculation with FM-1 decreased the pH in rhizosphere soil and increased the bioavailability of both Cd and Pb. In addition, inoculation with FM-1 increased the IAA, P, and Fe concentrations and simultaneously promoted both Cd and Pb accumulation in C. asiatica L. The Cd and Pb concentrations in leaves increased 1.73- and 1.07-fold in the UA soil and 1.25- and 1.11-fold in the DA soil, respectively. Thus, the Cd-resistant strain FM-1 presented excellent PGP traits and could facilitate Cd and Pb phytoremediation by C. asiatica L.

A real-time 3D electromagnetic navigation system for percutaneous pedicle screw fixation in traumatic thoraco-lumbar fractures: implications for efficiency, fluoroscopic time, and accuracy compared with those of conventional fluoroscopic guidance.

PURPOSE: Navigation is becoming more useful in percutaneous pedicle screw fixation (PPSF). The aim of this study was to compare the efficiency, fluoroscopic time, accuracy, and clinical outcomes of PPSF with a novel electromagnetic navigation (EMN) system for thoraco-lumbar (TL) fractures with those of PPSF with conventional C-arm fluoroscopic (CF) guidance. METHODS: A retrospective study was conducted. A total of 162 screws were implanted in 29 patients with the assistance of the EMN system (EMN group), and 220 screws were inserted in 40 patients by using CF guidance (CF group). The duration of surgery, placement time per screw, fluoroscopic time per screw, accuracy of pedicle screw placement, and clinical outcomes were compared between the two groups. RESULTS: The duration of surgery and placement time per screw in the EMN group were significantly lower than those in the CF group (P < 0.05). The fluoroscopic time per screw in the CF group was significantly longer than that in the EMN group (P < 0.05). The learning curve of PPSF in the EMN group was steeper than that in the CF group. The accuracy of pedicle screw placement in the EMN group was more precise than that in the CF group (P < 0.05). The VAS scores in the EMN group were significantly lower than those in the CF group at one-week postoperatively (P < 0.05). CONCLUSION: Compared with PPSF by using conventional fluoroscopic guidance, PPSF with the aid of the EMN system can increase the efficiency and accuracy of pedicle screw placement and reduce the fluoroscopic time.

Three-dimensional high-definition exoscope (Kestrel View II) in anterior cervical discectomy and fusion: a valid alternative to operative microscope-assisted surgery.

BACKGROUND: Operative microscope (OM) has greatly advanced modern spine surgery, but remains limited by several drawbacks. Therefore, a three-dimensional (3D) high-definition (HD) exoscope (EX) (Kestrel View II, Mataka Kohli, Japan) system has been developed and used as an alternative to the OM. The aim of this study was to assess and compare the perioperative data and clinical outcomes of anterior cervical discectomy and fusion (ACDF) procedure with either an EX or OM. METHODS: Forty-eight patients with cervical spondylotic myelopathy (CSM) underwent ACDF assisted by the EX or OM between January 2019 and December 2019. We collected and compared data on operative time, intraoperative bleeding, postoperative hospitalization stay, complications, and clinical outcomes between the two groups. The clinical outcomes were evaluated by using visual analogue scale (VAS) scores, Japanese Orthopedic Association (JOA) scores, the recovery rate of JOA scores, and Odom criteria. RESULTS: The operative time in the EX group was significantly shorter than that in the OM group (P < 0.05). The VAS and JOA scores were significantly improved in both groups after surgery (P < 0.05). In addition, the VAS scores in the EX group were significantly lower than those in the OM group at 1 week postoperatively (P < 0.05). The good-to-excellent outcome rates were 90.48 and 88.89% in the EX group and OM group, respectively, whereas the complication occurrence rates of the EX group and OM group were 4.76 and 11.11%, respectively. CONCLUSIONS: EX-assisted and OM-assisted ACDF resulted in similar clinical outcomes for CSM, while EX-assisted surgery may be related to a short operative time and fewer complications.

Clinical outcomes of transforaminal endoscopic lateral recess decompression by using the visualized drilled foraminoplasty and visualized reamed foraminoplasty: a comparison study.

BACKGROUND: Lateral recess stenosis (LRS) is a common degenerative disease in the elderly. Since the rise of comorbidity is associated with increasing age, transforaminal endoscopic lateral recess decompression (TE-LRD) is advocated. The objective of this study was to compare the clinical outcomes of TE-LRD in patients with LRS via visualized drilled foraminoplasty (VDF) or visualized reamed foraminoplasty (VRF) technique. METHODS: A total of 45 and 42 consecutive patients with limp or unilateral radiculopathy symptoms underwent TE-LRD using the VDF and VRF technique, respectively. The radiation exposure and operation time, time to return to work, and complications were compared between two groups. Their clinical outcomes were evaluated with the visual analogue scale (VAS) leg pain score, VAS back pain score, Oswestry Disability Index (ODI) and modified MacNab's criteria. RESULTS: The average values of radiation exposure and operative time in the VDF group were significantly higher than those in the VRF group (P <  0.05). The postoperative VAS and ODI scores in both groups were significantly improved compared with those before the operation (P <  0.05). In addition, the VAS score of the leg pain and ODI score in the VRF group were significantly lower than those in the VDF group at the 1-week follow-up (P <  0.05). The good-to-excellent rates of the VDF group and VRF group were 88.89 and 90.48%, respectively, whereas the complication occurrence rates were 6.67 and 4.76% in the VDF group and VRF group, respectively. CONCLUSIONS: TE-LRD performed by using VRF technique can be applied to treat LRS safely and effectively with short radiation exposure and operation time. This technique was comparable to the VDF technique with improved VAS leg pain and ODI scores in the short period after the operation. However, potential complications and risks still need to be considered.

Manganese accumulation and plant physiology behavior of Camellia oleifera in response to different levels of potassium fertilization.

The effects of potassium (K) fertilization (KCl, analytically pure; 0, 60, 200, and 400 mg kg-1) on the growth and Mn accumulation of Camellia oleifera in two types of Mn-contaminated soils were investigated. The potential mechanisms underlying the impacts of K fertilization were explored. C. oleifera accumulated high amounts of Mn in both soil conditions. The addition of K fertilizer decreased the soil pH and promoted Mn accumulation in C. oleifera. However, the plant biomass decreased significantly under the high level of K fertilization (400 mg kg-1), and the oxidative stress was stimulated under Mn contamination. But an appropriate concentration of K fertilizer (200 mg kg-1) was necessary for the formation of photosynthesis pigments, nonenzymatic antioxidants and antioxidant enzymes, metabolic processes, and nutrient uptake. Furthermore, when plants supplemented with a low level of K fertilization (200 mg kg-1), the catalase activity in C. oleifera leaves was enhanced to alleviate oxidative stress and protect the plant from Mn contamination. Our study demonstrated that 200 mg kg-1 of K fertilizer has the potential to further enhance the efficiency of Mn phytoremediation by C. oleifera.

Development of a static test apparatus for evaluating the performance of three PM2.5 separators commonly used in China.

PM2.5 separator directly affects the accuracy of PM2.5 sampling. The specification testing and evaluation for PM2.5 separator is particularly important, especially under China's wide variation of terrain and climate. In this study, first a static test apparatus based on polydisperse aerosol was established and calibrated to evaluate the performance of the PM2.5 separators. A uniform mixing chamber was developed to make particles mix completely. The aerosol concentration relative standard deviations of three test points at the same horizontal chamber position were less than 0.57%, and the particle size distribution obeyed logarithmic normal distribution with an R2 of 0.996. The flow rate deviation between the measurement and the set point flow rate agreed to within ±1.0% in the range of -40 to 50°C. Secondly, the separation, flow and loading characteristics of three cyclone separators (VSCC-A, SCC-A and SCC112) were evaluated using this system. The results showed that the 50% cutoff sizes (D50) of the three cyclones were 2.48, 2.47 and 2.44 µm when worked at the manufacturer's recommended flow rates, respectively. The geometric standard deviation (GSD) of the capture efficiency of VSCC-A was 1.23, showed a slightly sharper than SCC-A (GSD =1.27), while the SCC112 did not meet the relevant indicator (GSD = 1.2 ±â€¯0.1) with a GSD = 1.44. The flow rate and loading test had a great effect on D50, while the GSD remained almost the same as before. In addition, the maintenance frequency under different air pollution conditions of the cyclones was summarized according to the loading test.

Concentrations and seasonal variation of ambient PM(2.5) and associated metals at a typical residential area in Beijing, China.

In this study, continuous monitoring of PM2.5 was carried out for 1 year period at one of the largest residential areas in Beijing. Annual mean of PM2.5 during sampling period was 100.4 µg/m(3). The seasonal variation trend of PM2.5 was winter > spring > autumn and summer. The total mass concentrations of metals in PM2.5 ranged from 0.4 to 13.2 µg/m(3). There were significant (p < 0.05) seasonal variations for concentrations of Ca, Al, Mn, As, Rb, Cr, Ni, Cd and Co, seasonal variations in PM-associated metals were not necessarily the same as the seasonal variation in PM2.5, related to differing seasonal trends in source types. The impact of meteorological factors (e.g., wind speed) on metals levels of PM2.5 was found to be significant by regression models. The EFs value of Ag, Ca, Cd, Pb, Zn, As, Cu, and Cr were higher than ten, suggesting that those elements were primarily contributed by anthropogenic sources. Seasonal characteristic of EFs were found for As, Cr, Ca and Ag, which indicating the seasonal pollution sources types for those metals. Overall, these findings indicated that the pollution control of ambient PM2.5 should not be negligible in residential area in Beijing and the local government should pertinent and accurate prevent and control of air pollution as well as protect human health.

[Newly leaching method of copper from waste print circuit board using hydrochloric acid/n-butylamine/copper sulfate].

A newly leaching method of copper from waste print circuit board was established by using hydrochloric acid-n-butylamine-copper sulfate mixed solution. The conditions of leaching were optimized by changing the hydrochloric acid, n-butylamine, copper sulfate,temperature and other conditions using copper as target mimics. The results indicated that copper could be leached completely after 8 h at 50 degrees C, hydrochloric acid concentration of 1.75 mol/L, n-butylamine concentration of 0.25 mol/L, and copper sulfate mass of 0.96 g. Under the conditions, copper leaching rates in waste print circuit board samples was up to 95.31% after 9 h. It has many advantages such as better effects, low cost, mild reaction conditions, leaching solution recycling.