Introduction: Traditional open discectomy and intervertebral fusion surgery is the common strategy for lumbar disc herniation (LDH). However, it has the disadvantages of long recovery time and severe paravertebral soft tissue injury. Zina percutaneous screw fixation combined with endoscopic lumbar intervertebral fusion (ZELIF), as a novel minimally invasive surgical technique for LDH, has the advantages in quicker recovery, less soft tissue destruction, shorter hospital stays and less pain. We report a novel technique of ZELIF under intraoperative neuromonitoring (INM) for the treatment of LDH. Patient concerns: A 51-year-old male presented to our hospital with left lower extremity pain and numbness for 1 year. Diagnosis: Lumbar disc herniation (LDH). Interventions: This patient was treated with Zina percutaneous screw fixation combined with endoscopic neural decompression, endplate preparation, and intervertebral fusion through Kambin's triangle. Each step of the operation was performed under INM. Outcomes: The follow-up period lasted 12 months; the hospitalization lasted 4 nights; the blood loss volume was 65 ml, and the time of operation was 266 min. INM showed no neurological damage during the surgery. No surgical complications, including neurological deterioration, cage migration, non-union, instrumentation failure or revision operation, were observed during the follow-up period. Visual Analogue Scale (VAS) score reduced from 7 to 1; the Oswestry Disability Index (ODI) decreased from 43 to 14; the EQ-5D score was 10 preoperatively and 15 at the final follow-up visit; the Physical Component Summary of the 36-Item Short Form Health Survey (SF-36) was 48 preoperatively and 49 at the last follow up visit; the SF-36 Mental Component Summary was 47 before surgery and decreased to 41 postoperatively. Conclusion: ZELIF under INM may represent a feasible, safe and effective alternative to endoscopic intervertebral fusion and percutaneous screw fixation, for decompressing the lumbar's exiting nerve root directly with minimal invasion in selected patients.
Abstract. To study the flow characteristics of a new swashplate rotary valve distribution double-row axial piston pump, an instantaneous flow model was developed for the pump, the influences of structural parameters on the flow pulsation and uneven coefficient of flow were determined, and the ideal plunger distribution parameters were derived. On this basis, a valve distribution model was developed for the pump, the flow superposition process in the plunger cavity was analyzed, and the high-speed switching valve's control strategy was optimized. Additionally, the effects of parameters such as the plunger motion frequency, the plunger cavity's dead zone volume, the spool valve's preloading force, and the spool's equivalent mass on the flow characteristics were studied. The results show that the new pump had a small flow pulsation when there were five plungers in both the inner and outer rows and the dislocation angle was 18∘. The plunger's reverse-suction effect at the moment when the discharge valve opened and the suction valve closed and the plunger cavity's dead zone volume size were the primary factors affecting the size of the pump's flow spike. The discharge valve's opening was delayed by 3 ms to be consistent with the suction valve's closing time; for this case, the flow peak was small and the volumetric efficiency was the highest. The discharge valve began to close 2 ms early and closed completely at the critical point when the plunger transferred from the discharge stroke to the suction stroke, which helped the suction valve to open on time and improved the pump's oil absorption capacity. The active opening and closing control of the discharge valve improved the coordination of the flow distribution to a large extent, reduced the hysteresis of the suction valve, and ultimately improved the pump's volumetric efficiency and flow stability. The results of this study can provide theoretical guidance for the flow control of balanced double-row axial piston pumps with valve distribution.
Objective A retrospective study of the clinical and radiological results between local bone graft with a cage and without cage in patients treated with unilateral fixation and posterior lumbar interbody fusion surgery. Methods A total of 52 patients who underwent PLIF in our institution were evaluated from January 2015 to January 2018. 30 of these patients received PLIF with local bone graft combined with using one cage, and 22 patients received PLIF with local bone graft without using cage. The clinical data and perioperative complications of the two groups were recorded. X-ray were taken before, after operation and at the end of follow-up to calculate the height of intervertebral disc and the fusion rate. SUK's criteria were used to evaluate the quality of spinal fusion at the follow-up time. The results between the cage and non- cage group were compared. Results There was no statistical difference in baseline data between the two groups, and The mean follow-up time was 18.43 months in cage group and 17.50 months in non- cage group (P = 0.553). In additions, the significant difference was not found in the comparison of perioperative evaluation data between the two groups, such as operation time (P = 0.299), blood loss (P = 0.342) and incidence of complications (P = 1.000). Furthermore, the significant difference of VAS score cannot be found in preoperation (Pleg=0.731, Plowback=0.786), postoperation (Pleg=0.534, Plowback=0.725) and the final follow-up (Pleg=0.654, Plowback=0.362) between the two groups. The same results were also obtained in the comparison of ODI index (Ppre=0.682, Pfinal=0.712) and intervertebral height (Ppost=0.363, Pfinal=0.094). The final fusion rates were 96.7% (cage group) and 86.4% (non- cage group) respectively, and there was no statistical difference (P = 0.553). Conclusion Local bone graft has the same advantages as a cage in unilateral PLIF. Comparing with local bone graft using cage, we believe that the local bone graft is a more ideal way in unilateral PLIF, and decrease operation cost.
Rationale: Intraoperative neurophysiological monitoring (IONM) is widely used in spinal surgeries to prevent iatrogenic spinal cord injury (SCI). Most surgeons focus on avoiding neurological compromise intraoperatively, while ignoring the possibility of nerve damage preoperatively, such as neck positioning. Thus, this study aims to report a case with transient neurological deterioration due to improper neck position detected by IONM during cervical surgery. Patient concerns: A 63-year-old male patient had been suffering from hypoesthesia of the upper and lower extremities for three years. Diagnoses: Severe cervical stenosis (C5-C7) and cervical ossification of a posterior longitudinal ligament. Interventions: The cervical stenosis patient underwent an anterior cervical corpectomy decompression and fusion (ACDF) surgery with the assistance of IONM. When the lesion segment was exposed, the SSEP and MEP suddenly elicited difficulty indicating that the patient may have developed SCI. All the technical causes of IONM events were eliminated, and the surgeon suspended operation immediately and suspected that the IONM alerts were caused by cervical SCI due to the improper position of the neck. Subsequently, the surgeon repositioned the neck of the patient by using a thinner shoulders pad. Outcomes: At the end of the operation, the MEP and SSEP signals gradually returned to 75% and 80% of the baseline, respectively. Postoperatively, the muscle strength of bilateral biceps decreased from grade IV to grade III. Besides, the sensory disturbance of both upper extremities aggravated. However, the muscle power and hypoesthesia were significantly improved after three months of neurotrophic therapy and rehabilitation training, and no complications of nerve injury were found at the last follow-up visit. Lessons: IONM, consisting of SSEP and MEP, should be applied throughout ACDF surgery from the neck positioning to suture incisions. Besides, in the ward 1to 2 days before operation, it is necessary for conscious patients with severe cervical stenosis to simulate the intraoperative neck position. If the conscious patients present signs of nerve damage, they can adjust the neck position immediately until the neurological symptoms relieve. Therefore, intraoperatively, the unconscious patient can be placed in a neck position that was confirmed preoperatively to prevent SCI.
Organoids are three-dimensional cell accusations generated from pluripotent stem cells or adult stem cells in vitro. With many advantages over cell and animal models, organoids have been increasingly used in drug and clinical medical research in recent years. Chinese herbal medicine (CHM) is characterized by multi-target and multi-pathway treatment methods; however, there is no commonly accepted study method regarding efficacy and underlying mechanisms. In this review we summarized the important applications of organoid models in pharmacodynamic mechanism studies, efficacy and safety evaluations, and CHM personalized medicine, thus providing the theoretical basis for its development and innovation.
To improve the performance of electrochemical deburring for microhole drilling (MD-ECD), the distribution and dynamic change of the current density in the machining area during the electrolysis process were analyzed, and the synchronous change relationship between the current density and the burr profile was studied. The effects of process parameters, such as machining voltage U, initial machining gap d, electrolyte concentration C, and electrode radius r1 on the deburring process, were studied. The results show that the magnitude of the current density value in the burr area reflects the MD-ECD’s deburring performance. The current density near the burr tip is high, and the material is preferentially removed. The non-processed area has a low current density and slow material removal. As the machining progresses, the burr tip becomes blunt and the current in the burr area gradually transfers to the non-machining area, resulting in the transfer of the material removal area from the burr area to the adjacent non-machining area. Then, a chamfer is formed at the orifice; the chamfer width is larger than the chamfer height. When U = 4 V, d = 0.35 mm, C = 12%, and r1 = 0.4 mm, the burr removal efficiency and accuracy can be guaranteed. The chamfer width and chamfer height obtained from the test are 29 μm and 17 μm, and the burr removal effect is good.
INTRODUCTION AND OBJECTIVES: Minimally invasive prostatectomy (MIRP) has diffused rapidly despite limited data on outcomes and greater costs than for retropubic radical prostatectomy (RRP). A previous study comparing the effectiveness of the two approaches relied on claims databases, which have imprecise information about two important consequences of prostatectomy: incontinence and impotence. The present study compared the two procedures using patient self-report information as outcomes.METHODS: A questionnaire about current and presurgical urinary and sexual function was mailed to 1500 randomly selected prostate cancer patients from the Utah Cancer Registry (UCR) who met the following criteria: prostatectomy more than one year previously, age 70 or younger, no metastatic disease, and no other cancer therapy. Information about chronic diseases, in-hospital complications, and length of stay was obtained from the UCR and the uniform hospital discharge abstract. Regression analysis was used to compare patient outcomes measured for MIRP and RRP after taking into account a number of patient risk factors including age, general health, diabetes, and pre-surgical sexual function.RESULTS: 767 participants who had surgery between 1988 and 2008 completed a questionnaire, and 678 met inclusion criteria. After eliminating responding patients who did not meet inclusion criteria, had perineal surgery, were treated by a low volume surgeon, or were treated by an unidentified or out of state surgeon, there were 464 patients evaluated in this analysis; 58 had MIRP and 406 had RRP. The respective rates of a poor outcome for MIRP and RRP were 22% versus 19% (NS) for leaking urine more than once a day, 45% versus 32% (Pϭ0.06) for not having an erection, 10% versus 19% (Pϭ0.09) for a complication, and 16% versus 13% (NS) for not being satisfied with care. The respective mean lengths of hospital stay were 1.4 days versus 2.4 days (PϽ0.0001). After adjusting for patient characteristics using regression analysis, the only statistically significant difference between the MIRP and RRP groups was for length of stay.CONCLUSIONS: This preliminary study suggests that MIRP definitely reduces length of stay and may reduce complication rate, but probably does not substantially improve quality of life.
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