Biomechanical evaluation of a low profile, anchored cervical interbody spacer device in the setting of progressive flexion-distraction injury of the cervical spine

Introduction

Anterior cervical decompression and fusion is a well-established procedure for treatment of degenerative disc disease and cervical trauma including flexion-distraction injuries. Low-profile interbody devices incorporating fixation have been introduced to avoid potential issues associated with dissection and traditional instrumentation. While these devices have been assessed in traditional models, they have not been evaluated in the setting of traumatic spine injury. This study investigated the ability of these devices to stabilize the subaxial cervical spine in the presence of flexion-distraction injuries of increasing severity.

Methods

Thirteen human cadaveric subaxial cervical spines (C3–C7) were tested at C5–C6 in flexion–extension, lateral bending and axial rotation in the load-control mode under ±1.5 Nm moments. Six spines were tested with locked screw configuration and seven with variable angle screw configuration. After testing the range of motion (ROM) with implanted device, progressive posterior destabilization was performed in 3 stages at C5–C6.

Results

The anchored spacer device with locked screw configuration significantly reduced C5–C6 flexion–extension (FE) motion from 14.8 ± 4.2 to 3.9 ± 1.8°, lateral bending (LB) from 10.3 ± 2.0 to 1.6 ± 0.8, and axial rotation (AR) from 11.0 ± 2.4 to 2.5 ± 0.8 compared with intact under (p < 0.01). The anchored spacer device with variable angle screw configuration also significantly reduced C5–C6 FE motion from 10.7 ± 1.7 to 5.5 ± 2.5°, LB from 8.3 ± 1.4 to 2.7 ± 1.0, and AR from 8.8 ± 2.7 to 4.6 ± 1.3 compared with intact (p < 0.01). The ROM of the C5–C6 segment with locked screw configuration and grade-3 F-D injury was significantly reduced from intact, with residual motions of 5.1 ± 2.1 in FE, 2.0 ± 1.1 in LB, and 3.3 ± 1.4 in AR. Conversely, the ROM of the C5–C6 segment with variable-angle screw configuration and grade-3 F-D injury was not significantly reduced from intact, with residual motions of 8.7 ± 4.5 in FE, 5.0 ± 1.6 in LB, and 9.5 ± 4.6 in AR.

Conclusions

The locked screw spacer showed significantly reduced motion compared with the intact spine even in the setting of progressive flexion-distraction injury. The variable angle screw spacer did not sufficiently stabilize flexion–distraction injuries. The resulting motion for both constructs was higher than that reported in previous studies using traditional plating. Locked screw spacers may be utilized with additional external immobilization while variable angle screw spacers should not be used in patients with flexion-distraction injuries.     

Radiological Evaluation of Acetabular Erosion After Antibiotic-Impregnated Polymethylmethacrylate Spacer (Spacer-G)

Different types of hip spacers have been described (hand-made, custom-molded or prefabricated) for treatment of a chronic hip infection. A potential disadvantage of monoblock prefabricated spacer is that it may cause acetabular bone loss. This study assesses the radiological acetabular erosion using an antibiotic-impregnated pre-fabricated polymethylmethacrylate Spacer-G. We retrospectively reviewed the radiographs of thirty five patients who were managed with Spacer-G to treat chronic hip infection. No acetabular erosion were observed in thirty two patients with a mean time from the first to second stage and from the first to the last radiograph of 5.09 and 3.77 months respectively. In three patients the time between the radiographs was more than one year and the second stage was not performed; two developed a protrusion acetabuli whereas the other one a destruction of the acetabular roof. Using a Spacer-G in chronic hip infection treatment for less than one year is not associated with radiological acetabular erosion if the patient is maintained at partial weight bearing.     

几种灵芝rDNA基因间隔序列分析与鉴定

目的  基于基因间隔序列（ITS）序列对灵芝进行分类。方法  培养灵芝、提取DNA、优化聚合酶链反应（PCR）体系、纯化与克隆、测序、构建遗传进化树、进行遗传分析。结果  经过一系列的梯度实验得知优化的PCR体系为25μl反应混合物中含模板DNA 25 ng、Mg2+为2.0 mmol/L、dNTPs 200μmol/L、Taq 1.5 U、引物为20 pmol;最佳反应程序为93℃预变性4 min,93℃变性40 s,59℃退火40 s,72℃延伸1 min,共35个循环,72℃继续延伸7 min,4℃无限循环。所采用的HZ002、DZ003、NZ004和XC005在遗传进化树上面十分接近,说明其可以划分为同一菌属,同属于灵芝菌属。结论  基于ITS序列对灵芝进行分类,与其他的分子标记技术所取得的分类结果一致,证实依据ITS序列来对真菌菌属进行分类是十分合理的。

     

Genotype distribution of clinical isolates of Trichosporon asahii based on sequencing of intergenic spacer 1

The sequence polymorphisms of intergenic transcribed spacer and the antifungal susceptibility profile of 18 Trichosporon asahii isolates from Spain, Argentina, and Brazil together with 43 intergenic transcribed spacer 1 sequences deposited in the GenBank were analyzed. Six genotypes were detected instead of 5 genotypes described previously. Genotype 1 was the most common found comprising 57.3% of all strains, followed by genotype 3 (14.7%) and genotype 5 (13.1%). Spanish strains had members in all genotypes except 2, whereas South American isolates were grouped with genotypes 1, 3, and 6. Our results indicate that all genotypes are present in at least 2 countries suggesting a worldwide distribution. On the other hand, genotype 6 was not previously described but was only composed of 2 South American strains isolated from a subcutaneous abscess and skin. All isolates showed amphotericin B MICs>or=2 mg/L supporting the in vitro resistance of this species to this antifungal. Three isolates from South America showed high MICs to all antifungals analyzed. The true epidemiologic usefulness of classifying T. asahii in genotypes should be ascertaining analyzing a high number of isolates from many countries.     

Comparison of Internal Transcribed Spacers and Intergenic Spacer Regions of Five Common Iranian Sheep Bursate Nematodes

Background

Accurate identification of sheep nematodes is a critical point in epidemiological studies and monitoring of drug resistance in flocks. However, due to a close morphological similarity between the eggs and larval stages of many of these nematodes, such identification is not a trivial task. There are a number of studies showing that molecular targets in ribosomal DNA (Internal transcribed spacer 1, 2 and Intergenic spacer) are suitable for accurate identification of sheep bursate nematodes. The objective of present study was to compare the ITS1, ITS2 and IGS regions of Iranian common bursate nematodes in order to choose best target for specific identification methods.

Methods

The first and second internal transcribed spacers (ITS1and ITS2) and intergenic spacer (IGS) of the ribosomal DNA (rDNA) of 5 common Iranian bursate nematodes of sheep were sequenced. The sequences of some non–Iranian isolates were used for comparison in order to evaluate the variation in sequence homology between geographically different nematode populations.

Results

Comparison of the ITS1 and ITS2 sequences of Iranian nematodes showed greatest similarity among Teladorsagia circumcincta and Marshallagia marshalli of 94% and 88%, respectively. While Trichostrongylus colubriformis and M. marshalli showed the highest homology (99%) in the IGS sequences. Comparison of the spacer sequences of Iranian with non-Iranian isolates showed significantly higher variation in Haemonchus contortus compared to the other species.

Conclusion

Both the ITS1 and ITS2 sequences are convenient targets to have species-specific identification of Iranian bursate nematodes. On the other hand the IGS region may be a less suitable molecular target.     

A Study on High Strength,High Plasticity,Non-Heat Treated Die-Cast Aluminum Alloy

The non-heat-treated, die-cast aluminum alloy samples were prepared meticulously via die-casting technology. The crystal structure, microstructure, and phase composition of the samples were comprehensively studied through electron backscatter diffraction (EBSD), metallographic microscopy, spectrometer, and transmission electron microscopy (TEM). The microhardness and tensile properties of the samples were tested. The die-cast samples were found to have desirable properties by studying the structure and performance of the samples. There were no defects, such as pores, cold partitions, or surface cracks, found. The metallographic structure of the samples was mainly α-Al, and various phases were distributed at the grain boundaries. Before heat treating, α-Al grains were mainly equiaxed with a great number of second phase particles at the grain boundaries. After heat treating, the α-Al grains were massive and coarsened, and the second phase grains were refined and uniformly distributed, compared with those before the heat treating. The EBSD results showed that the grain boundary Si particles were solid solution decomposed after heat treatment. The particles became smaller, and their distribution was more uniform. Transmission electron microscopy found that there were nano-scale Al-Mn, Al-Cu, and Cu phases dispersed in the samples. The average microhardness of the samples before heat treating was 114 HV_0.1, while, after the heat treating, the microhardness reached 121 HV_0.1. The mechanical features of the samples were tremendous, and the obtained die-cast aluminum alloy had non-heat-treatment performance, which was greater than the ordinary die-cast aluminum alloys with a similar composition. The tensile strength of the aluminum alloys reached up to 310 MPa before heat treatment.     

Bioconjugation Strategy for Ceramic Membranes Decorated with Candida Antarctica Lipase B—Impact of Immobilization Process on Material Features

A strategy for the bioconjugation of the enzyme Candida antarctica lipase B onto titania ceramic membranes with varied pore sizes (15, 50, 150, and 300 kDa) was successfully performed. The relationship between the membrane morphology, i.e.,the pore size of the ceramic support, and bioconjugation performance was considered. Owing to the dimension of the enzyme (~33 kDa), the morphology of the ceramics allowed (50, 150, and 300 kDa) or did not allow (15 kDa) the entrance of the enzyme molecules into the porous structure. Such a strategy made it possible to better understand the changes in the material (morphology) and physicochemical features (wettability, adhesiveness, and surface charge) of the samples, which were systematically examined. The silane functionalization and enzyme immobilization were accomplished via the covalent route. The samples were characterized after each stage of the modification, which was very informative from the material point of view. As a consequence of the modification, significant changes in the contact angle, roughness, adhesion, and zeta potential were observed. For instance, for the 50 kDa membrane, the contact angle increased from 29.1 ± 1.5° for the pristine sample to 72.3 ± 1.5° after silane attachment; subsequently, it was reduced to 57.2 ± 1.5° after the enzyme immobilization. Finally, the contact angle of the bioconjugated membrane used in the enzymatic process rose to 92.9 ± 1.5°. By roughness (S_q) controlling, the following amendments were noticed: for the pristine 50 kDa membrane, S_q = 1.87 ± 0.21 µm; after silanization, S_q = 2.33 ± 0.30 µm; after enzyme immobilization, S_q = 2.74 ± 0.26 µm; and eventually, after the enzymatic process, S_q = 2.37 ± 0.27 µm. The adhesion work of the 50 kDa samples was equal to 136.41 ± 2.20 mN m⁻¹ (pristine membrane), 94.93 ± 2.00 mN m⁻¹ (with silane), 112.24 ± 1.90 mN m⁻¹ (with silane and enzyme), and finally, 69.12 ± 1.40 mN m⁻¹ (after the enzymatic process). The materials and physicochemical features changed substantially, particularly after the application of the membrane in the enzymatic process. Moreover, the impact of ceramic material morphology on the zeta potential value is here presented for the first time. With an increase in the ceramic support cut-off, the amount of immobilized lipase rose, but the specific productivity was higher for membranes possessing smaller pores, owing to the higher grafting density. For the enzymatic process, two modes of accomplishment were selected, i.e., stirred-tank and cross-flow. The latter method was characterized by a much higher effectiveness, with a resulting productivity equal to 99.7 and 60.3 µmol h⁻¹ for the 300 and 15 kD membranes, respectively.     

A New General Fatigue Limit Diagram and Its Application of Predicting Die Fatigue Life during Cold Forging

Traditional fatigue fracture theory and practice focus principally on structural design. It is thus too conservative and inappropriate when used to predict the high-cycle fatigue life of dies used for metal forming, especially cold forging. We propose a novel mean stress correction model and diagram to predict the high-cycle fatigue lives of cold forging dies, which focuses on the upper part of the equivalent fatigue strength curve. Considering the features of die materials characterized by high yield strength and low ductility, a straight line is assumed for the tensile yield line. To the contrary, a general curve is used to represent the fatigue strength. They are interpolated, based on the distance ratio, when finding an appropriate equivalent fatigue strength curve at the mean stress and stress amplitude between the line and curve. The approach is applied to a well-defined literature example to verify its validity and shed light on the characteristics of die fatigue life. The approach is also applied to practical forging and useful qualitative results are obtained.     

主-肺动脉间隔缺损矫治术的护理配合

目的探讨先天性心脏病主-肺动脉间隔缺损矫治术的护理配合方法。方法术前加强营养,注意保暖,预防感冒,避免剧烈活动,间断吸氧,服用卡托普利,控制心衰和感染;术中配备米力农、保达新溶液等特殊药品维持循环稳定,防止术后肺高压危象;精确监测鼻咽温、肛温,积极做好脑保护,使用温控垫及暖风毯同步复温等深低温护理。结果有效缩小了组织温差,均匀升温,缩短了转机和手术时间。结论做好手术全过程的护理,是提高手术成功率的重要保证。