1
|
Cho SS, Farber SH, DiDomenico JD, Teng CW, Park MT, Chang SW, Snyder LA, Mirzadeh Z, Uribe JS, Turner JD. Radiographic and Clinical Outcomes After Stand-Alone Anterior Lumbar Interbody Fusion for Symptomatic L5-S1 Retrolisthesis. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00979. [PMID: 38038471 DOI: 10.1227/ons.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/06/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Degenerative lumbar spondylolisthesis is associated with significant pain and disability. The literature on the treatment options and clinical outcomes for lumbar anterolisthesis is robust, but very few reports specifically evaluate lumbar retrolisthesis. This study investigated surgical outcomes for symptomatic L5-S1 retrolisthesis treated with stand-alone L5-S1 anterior lumbar interbody fusion (ALIF). METHODS All patients with symptomatic L5-S1 retrolisthesis treated with stand-alone L5-S1 ALIF at a single institution over a 7-year period were identified. Exhaustive nonoperative management had failed for all patients. Patients with previous lumbar fusion were excluded. Preoperative and postoperative radiographic images and patient-reported outcome measures for 20 patients (14 males and 6 females; mean [SD] age, 50.3 [13.7] years) were analyzed. RESULTS The mean (SD) follow-up was 43.0 (23.7) months (range, 12.1-102.5 months). Patients experienced postoperative improvements in L5-S1 retrolisthesis (P = .048), L5-S1 disk height and angle (P < .001), L5 foraminal height (P < .001), L5-S1 lordosis (P < .001), and lumbar lordosis (P = .01). There were no significant changes in spinopelvic parameters. At the most recent follow-up, minimal clinically important differences in Oswestry Disability Index score, 36-Item Short-Form Survey (SF-36), and numerical rating scale score for leg pain were achieved in 11 of 20 (55%), 7 of 14 (50%), and 7 of 13 (54%) patients, respectively. All patients demonstrated fusion with no graft subsidence at up to 32 months. No patient experienced intraoperative complications, was readmitted, or required a subsequent posterior decompression or fusion because of refractory symptoms. CONCLUSION In our cohort, stand-alone L5-S1 ALIF was associated with radiographic and clinical improvement in patients with symptomatic L5-S1 retrolisthesis.
Collapse
Affiliation(s)
- Steve S Cho
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - S Harrison Farber
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joseph D DiDomenico
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Clare W Teng
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marian T Park
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Laura A Snyder
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Zaman Mirzadeh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| |
Collapse
|
2
|
Chiew SF, Looi LM, Cheah PL, Teoh KH, Chang SW, Abdul Sani SF. Epithelial-mesenchymal transition profiles in triple negative breast carcinoma may explain its aggressive nature. Malays J Pathol 2023; 45:363-374. [PMID: 38155378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Epithelial-mesenchymal transition (EMT) is increasingly explored in cancer progression. Considering that triple negative (TN) breast cancer has the poorest survival among molecular subtypes, we investigated 49 TN, 45 luminal and 25 HER2-enriched female breast carcinomas for EMT expression (using E-cadherin and vimentin immunohistochemistry) against lymphovascular and/or lymph node invasion. E-cadherin and vimentin expressions were semi-quantitated for positive- cancer cells (0=0-<1%, 1=1-10%, 2 =11-50%, 3=>50%) and staining intensity (0=negative, 1=weak, 2=moderate, 3=strong), with final score (low=0-4 and high=6-9) derived by multiplying percentage and intensity scores for each marker. Low E-cadherin and/or high vimentin scores defined EMT positivity. Low E-cadherin co-existing with high vimentin defined "complete" (EMT-CV), while low E-cadherin (EMT-C) or high vimentin (EMT-V) occurring independently defined "partial" subsets. 38 (31.9%) cancers expressed EMT, while 59.2 % TN, 13.3% luminal and 12% HER2-enriched cancers expressed EMT (p<0.05). Among the cancers with lymphovascular and/or lymph node invasion, EMT positivity by molecular types were 66.7% TN, 7.4% luminal and 11.8% HER2-enriched (p<0.05). Although EMT-V, associated with stem-cell properties was the dominant TN EMT profile, EMT-CV, a profile linked to vascular metastases, was encountered only in TN. EMT appears important in TN cancer and different EMT profiles may be associated with its aggressive nature.
Collapse
Affiliation(s)
- S F Chiew
- University of Malaya Medical Centre, Department of Pathology, 59100 Kuala Lumpur, Malaysia.
| | - L M Looi
- University of Malaya, Faculty of Medicine, Department of Pathology, 50603 Kuala Lumpur, Malaysia
| | - P L Cheah
- University of Malaya, Faculty of Medicine, Department of Pathology, 50603 Kuala Lumpur, Malaysia
| | - K H Teoh
- University of Malaya, Faculty of Medicine, Department of Pathology, 50603 Kuala Lumpur, Malaysia
| | - S W Chang
- Institute of Biological Sciences, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - S F Abdul Sani
- University of Malaya, Faculty of Science, Department of Physics, 50603 Kuala Lumpur, Malaysia
| |
Collapse
|
3
|
Nguyen TT, Bui HT, Nguyen GT, Hoang TN, Van Tran C, Ho PH, Hoai Nguyen PT, Kim JY, Chang SW, Chung WJ, Nguyen DD, La DD. Facile preparation of porphyrin@g-C 3N 4/Ag nanocomposite for improved photocatalytic degradation of organic dyes in aqueous solution. Environ Res 2023; 231:115984. [PMID: 37156354 DOI: 10.1016/j.envres.2023.115984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/13/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
In the quest of improving the photocatalytic efficiency of photocatalysts, the combination of two and more semiconductors recently has garnered significant attention among scientists in the field. The doping of conductive metals is also an effective pathway to improve photocatalytic performance by avoiding electron/hole pair recombination and enhancing photon energy absorption. This work presented a design and fabrication of porphyrin@g-C3N4/Ag nanocomposite using acid-base neutralization-induced self-assembly approach from monomeric porphyrin and g-C3N4/Ag material. g-C3N4/Ag material was synthesized by a green reductant of Cleistocalyx operculatus leaf extract. Electron scanning microscopy (SEM), X-ray diffraction (XRD), FT-IR spectroscopy, and UV-vis spectrometer were utilized to analyse the properties of the prepared materials. The prepared porphyrin@g-C3N4/Ag nanocomposite showed well integration of porphyrin nanostructures on the g-C3N4/Ag's surface, in which porphyrin nanofiber was of the diameter in nanoscales and the length of several micrometers, and Ag NPs had an average particle size of less than 20 nm. The photocatalytic behavior of the resultant nanocomposite was tested for the degradation of Rhodamine B dye, which exhibited a remarkable RhB photodegrading percentage. The possible mechanism for photocatalysis of the porphyrin@g-C3N4/Ag nanocomposite toward Rhodamine B dye was also proposed and discussed.
Collapse
Affiliation(s)
- Thanh Tung Nguyen
- Institute of Materials Science, Vietnam Academy of Science and Technology, Hanoi, 11307, Viet Nam; Graduate University of Science and Technology, Vietnam Academy of Science and Technology, Hanoi, 11307, Viet Nam.
| | - Hoa Thi Bui
- Institute of Materials Science, Vietnam Academy of Science and Technology, Hanoi, 11307, Viet Nam
| | - Giang Thi Nguyen
- Institute of Materials Science, Vietnam Academy of Science and Technology, Hanoi, 11307, Viet Nam; The Faculty of Chemistry, Hanoi University of Education, Hanoi, Viet Nam
| | - Tung Nguyen Hoang
- Institute of Materials Science, Vietnam Academy of Science and Technology, Hanoi, 11307, Viet Nam
| | - Chinh Van Tran
- Institute of Chemistry and Materials, Hoang Sam, Nghia Do, Cau Giay, Ha Noi, Viet Nam
| | - Phuong Hien Ho
- The Faculty of Chemistry, Hanoi University of Education, Hanoi, Viet Nam
| | - Phuong T Hoai Nguyen
- Institute of Chemistry and Materials, Hoang Sam, Nghia Do, Cau Giay, Ha Noi, Viet Nam
| | - J Yup Kim
- Department of Chemical Engineering, Dankook University, Yongin, 16890, Republic of Korea
| | - S W Chang
- Department of Environmental Energy Engineering, Kyonggi University, Republic of Korea
| | - W Jin Chung
- Department of Environmental Energy Engineering, Kyonggi University, Republic of Korea
| | - D Duc Nguyen
- Department of Environmental Energy Engineering, Kyonggi University, Republic of Korea.
| | - D Duc La
- Institute of Chemistry and Materials, Hoang Sam, Nghia Do, Cau Giay, Ha Noi, Viet Nam.
| |
Collapse
|
4
|
Keerthana Devi M, Manikandan S, Oviyapriya M, Selvaraj M, Assiri MA, Vickram S, Subbaiya R, Karmegam N, Ravindran B, Chang SW, Awasthi MK. Recent advances in biogas production using Agro-Industrial Waste: A comprehensive review outlook of Techno-Economic analysis. Bioresour Technol 2022; 363:127871. [PMID: 36041677 DOI: 10.1016/j.biortech.2022.127871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
Agrowaste sources can be utilized to produce biogas by anaerobic digestion reaction. Fossil fuels have damaged the environment, while the biogas rectifies the issues related to the environment and climate change problems. Techno-economic analysis of biogas production is followed by nutrient recycling, reducing the greenhouse gas level, biorefinery purpose, and global warming effect. In addition, biogas production is mediated by different metabolic reactions, the usage of different microorganisms, purification process, upgrading process and removal of CO₂ from the gas mixture techniques. This review focuses on pre-treatment, usage of waste, production methods and application besides summarizing recent advancements in biogas production. Economical, technical, environmental properties and factors affecting biogas production as well as the future perspective of bioenergy are highlighted in the review. Among all agro-industrial wastes, sugarcane straw produced 94% of the biogas. In the future, to overcome all the problems related to biogas production and modify the production process.
Collapse
Affiliation(s)
- M Keerthana Devi
- College of Natural Resources and Environment, Northwest A&F University, Taicheng Road 3# Shaanxi, Yangling 712100, China; Department of Biotechnology, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha Nagar, Thandalam, Chennai 602 105, Tamil Nadu, India
| | - S Manikandan
- Department of Biotechnology, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha Nagar, Thandalam, Chennai 602 105, Tamil Nadu, India
| | - M Oviyapriya
- Department of Biotechnology, Kamaraj College of Engineering and Technology, Near Virudhunagar, Madurai 625 701, Tamil Nadu, India
| | - Manickam Selvaraj
- Department of Chemistry, Faculty of Science, King Khalid University, P.O. Box 9004, Abha 61413, Saudi Arabia
| | - Mohammed A Assiri
- Department of Chemistry, Faculty of Science, King Khalid University, P.O. Box 9004, Abha 61413, Saudi Arabia
| | - Sundaram Vickram
- Department of Biotechnology, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha Nagar, Thandalam, Chennai 602 105, Tamil Nadu, India
| | - R Subbaiya
- Department of Biological Sciences, School of Mathematics and Natural Sciences, The Copperbelt University, Riverside, Jambo Drive, P O Box 21692, Kitwe, Zambia
| | - N Karmegam
- Department of Botany, Government Arts College (Autonomous), Salem 636 007, Tamil Nadu, India
| | - Balasubramani Ravindran
- Department of Environmental Energy and Engineering, Kyonggi University, Youngtong-Gu, Suwon, Gyeonggi-Do 16227, South Korea; Department of Medical Biotechnology and Integrative Physiology, Institute of Biotechnology, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Thandalam, Chennai, 602 105, Tamil Nadu, India
| | - S W Chang
- Department of Environmental Energy and Engineering, Kyonggi University, Youngtong-Gu, Suwon, Gyeonggi-Do 16227, South Korea
| | - Mukesh Kumar Awasthi
- College of Natural Resources and Environment, Northwest A&F University, Taicheng Road 3# Shaanxi, Yangling 712100, China.
| |
Collapse
|
5
|
Sai Preethi P, Hariharan NM, Vickram S, Rameshpathy M, Manikandan S, Subbaiya R, Karmegam N, Yadav V, Ravindran B, Chang SW, Kumar Awasthi M. Advances in bioremediation of emerging contaminants from industrial wastewater by oxidoreductase enzymes. Bioresour Technol 2022; 359:127444. [PMID: 35691504 DOI: 10.1016/j.biortech.2022.127444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/04/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
The bioremediation of emerging recalcitrant pollutants in wastewater via enzyme biotechnology has been evolving as cost-effective with an input of low-energy technological approach. However, the enzyme based bioremediation technology is still not fully developed at a commercial level. The oxidoreductases being the domineering biocatalysts are promising candidates for wastewater treatments. Henceforth, comprehending their global market and biotransformation efficacy is mandatory for establishing these techno-economic bio-enzymes in commercial scale. The biocatalytic strategy can be established as a combinatorial approach with existing treatment technology to achieve towering bioremediation and effective removal of emerging pollutants from wastewater. This review provides a novel insight on the toxicological xenobiotics released from industries such as paper and pulps, soap and detergents, pharmaceuticals, textiles, pesticides, explosives and aptitude of peroxidases, nitroreductase and cellobiose dehydrogenase in their bio-based treatment. Moreover, the review comprehensively covers environmental relevance of wastewater pollution and the critical challenges based on remediation achieved through biocatalysts for future prospectives.
Collapse
Affiliation(s)
- P Sai Preethi
- College of Natural Resources and Environment, Northwest A&F University, Taicheng Road 3# Shaanxi, Yangling 712100, China; Department of Biotechnology, Sree Sastha Institute of Engineering and Technology, Chembarambakkam - 600 123, Tamil Nadu, India
| | - N M Hariharan
- Department of Biotechnology, Sree Sastha Institute of Engineering and Technology, Chembarambakkam - 600 123, Tamil Nadu, India
| | - Sundaram Vickram
- Department of Biotechnology, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha Nagar, Thandalam, Chennai - 602 105, Tamil Nadu, India
| | - M Rameshpathy
- School of Bio Sciences and Technology, Vellore Institute of Technology (VIT), Vellore - 632 014, Tamil Nadu, India
| | - S Manikandan
- Department of Biotechnology, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha Nagar, Thandalam, Chennai - 602 105, Tamil Nadu, India
| | - R Subbaiya
- Department of Biological Sciences, School of Mathematics and Natural Sciences, The Copperbelt University, Riverside, Jambo Drive, P O Box 21692, Kitwe, Zambia
| | - N Karmegam
- Department of Botany, Government Arts College (Autonomous), Salem 636 007, Tamil Nadu, India
| | - Vivek Yadav
- State Key Laboratory of Crop Stress Biology in Arid Areas, College of Horticulture, Northwest A & F University, Yangling 712100, China
| | - Balasubramani Ravindran
- Department of Environmental Energy and Engineering, Kyonggi University, Youngtong-Gu, Suwon, Gyeonggi-Do, 16227, South Korea; Department of Medical Biotechnology and Integrative Physiology, Institute of Biotechnology, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Thandalam, Chennai 602 105, Tamil Nadu, India
| | - S W Chang
- Department of Environmental Energy and Engineering, Kyonggi University, Youngtong-Gu, Suwon, Gyeonggi-Do, 16227, South Korea
| | - Mukesh Kumar Awasthi
- College of Natural Resources and Environment, Northwest A&F University, Taicheng Road 3# Shaanxi, Yangling 712100, China.
| |
Collapse
|
6
|
Bohl M, Kakarla UK, Chang SW, Sethi R, Farrokhi F, Leveque JC. Establishing a Reference Procedure Length for Anterior Cervical Fusions: The Role for Standards in Surgical Process Improvement. Cureus 2022; 14:e22615. [PMID: 35371809 PMCID: PMC8958152 DOI: 10.7759/cureus.22615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/24/2022] Open
Abstract
Surgical process improvement strategies are increasingly being applied to specific procedures to improve value. A critical step in any process improvement strategy is the identification of performance benchmarks. Procedure length is a performance benchmark for anterior cervical discectomy and fusion (ACDF) procedures; therefore, we sought to establish reference procedure lengths for 1-level, 2-level, and 3-level ACDFs at both teaching and non-teaching institutions and to describe methods for using this information to advance surgical process improvement initiatives. We performed a retrospective analysis of consecutive ACDFs performed at a resident teaching institution (RT) and a non-teaching institution (NT) for all 1-level, 2-level, and 3-level ACDFs. Mean case lengths and patient outcomes were calculated for individual surgeons and institutions. After limiting cases to 1-level, 2-level, and 3-level ACDFs and applying all exclusion criteria, 991 cases at the RT institution and 131 cases at the NT institution (a total of 1122 cases) were available for analysis. The mean (SD) procedure length for 1-level, 2-level, and 3-level ACDFs at the RT versus NT institutions were 121.9 min (36.3 min) and 73.6 min (29.7 min) (p<0.001), 172.7 min (44.8 min) and 112.0 min (43.0 min) (p<0.001), and 218.3 min (54.9 min) and 167.6 min (54.2 min) (p<0.001), respectively. Thirty-day outcomes were the same between institutions, except that the RT institution had a shorter mean hospital length of stay for 2-level ACDFs (1.6 days versus 2.9 days, p=0.001). This study is the first to attempt to establish a standard reference procedure length for 1-level, 2-level, and 3-level ACDFs. These data can guide efforts in surgical process improvement.
Collapse
|
7
|
Farber SH, Zhou JJ, Smith MA, Porter RW, Chang SW. Supine lateral lumbar interbody fusion: cadaveric proof of principle for simultaneous anterior and lateral approaches. World Neurosurg 2021; 158:e386-e392. [PMID: 34763102 DOI: 10.1016/j.wneu.2021.10.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) are commonly performed in separate stages with a change in patient positioning to provide arthrodesis in the lumbar spine. Interest has recently emerged in performing these approaches as a single-stage surgery with the patient in the lateral decubitus position. The objective of this study was to evaluate the technical feasibility of performing minimally invasive anterolateral fixation in a single supine position. METHODS Two fresh-frozen cadavers were used and placed supine. Standard minimally invasive anterior access was obtained by the approach surgeon. An ALIF was performed at L5-S1 using standard techniques. A lateral incision was marked over the L4-5 disc space using fluoroscopy. Direct palpation and bimanual dissection were achieved through the same anterior incision, allowing access to the retroperitoneal space. Dilator and retractor docking was performed under fluoroscopic guidance. Direct visualization of the docking hardware through the anterior incision was used to ensure the safety of peritoneal contents and vasculature. The LLIF was then performed using standard techniques at L4-5. RESULTS Plain radiographs confirmed acceptable positioning of both the ALIF and LLIF grafts. No injury to the cadaveric peritoneum, vasculature, or lumbar plexus was observed. A slightly enlarged anterior incision also permitted retroperitoneal access and visualization of the L3-4 disc space. CONCLUSION This cadaver feasibility study demonstrates that combined minimally invasive ALIF and LLIF procedures may be performed as a single-stage with the patient in the supine position. Clinical consideration and study of this approach are warranted.
Collapse
Affiliation(s)
- S Harrison Farber
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - James J Zhou
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael A Smith
- Department of Thoracic Surgery, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Randall W Porter
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
| |
Collapse
|
8
|
Dinh NT, Nguyen TH, Mungray AK, Duong LD, Phuong NT, Nguyen DD, Chung WJ, Chang SW, Tuan PD. Biological treatment of saline domestic wastewater by using a down-flow hanging sponge reactor. Chemosphere 2021; 283:131101. [PMID: 34182628 DOI: 10.1016/j.chemosphere.2021.131101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 03/29/2021] [Accepted: 06/02/2021] [Indexed: 06/13/2023]
Abstract
In this study, the effect of salinity on the removal of organic matter and nitrogen concentrations in bioreactor was investigated using a hybrid bench scale down-flow hanging sponge (DHS) system for 145 days of operation. The reactor had three identical sections that were filled to 30% volume with Bio-Bact to serve as attached media. The DHS reactor was fed with domestic wastewater that was mixed with increasing concentration of sodium chloride from 0.5 to 3.0% stepwise. The influent and effluent concentrations of BOD5, CODCr, NH4+-N, and TN were analyzed to evaluate the performance of the DHS reactor during the operational period. Results indicate that when salinity was increased from 0.5 to 3.0%, the removal efficiency gradually decreased from 80.3% to 61.5% for CODCr, 76.4%-65.0% for BOD5, 64.1%-48.4% for NH4+-N, and 50%-36% for TN. Besides, the changes in biofilm characteristics with increasing salinity were observed during the operational period. The results indicate that salinity has a significant influence on the removal of organic matters and nitrogen transformation in the biofilm of the bioreactor. Even so, the DHS reactor revealed a good potential for treating saline wastewater.
Collapse
Affiliation(s)
- Nga T Dinh
- Research Institute for Sustainable Development, Hochiminh City University of Natural Resources and Environment, Viet Nam.
| | - T Hiep Nguyen
- Research Institute for Sustainable Development, Hochiminh City University of Natural Resources and Environment, Viet Nam
| | - Arvind Kumar Mungray
- Department of Chemical Engineering, Sardar Vallabhbhai National Institute of Technology, Surat, Gujarat, India
| | - La Duc Duong
- Institute of Chemistry and Materials, Nghia Do, Cau Giay, Hanoi, Viet Nam
| | - Nguyen-Tri Phuong
- Département de Chimie, Biochimie et Physique, Université Du Québec à Trois-Rivières (UQTR), Trois-Rivières, QC G8Z 4M3, Canada; Laboratory of Advanced Materials for Energy and Environment, Université du Québec à Trois-Rivières (UQTR), 3351 Boulevard des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
| | - D Duc Nguyen
- Faculty of Environmental and Food Engineering, Nguyen Tat Thanh University, 300A Nguyen Tat Thanh, District 4, Ho Chi Minh City, 755414, Viet Nam; Department of Environmental Energy Engineering, Kyonggi University, 442-760, Republic of Korea.
| | - W Jin Chung
- Department of Environmental Energy Engineering, Kyonggi University, 442-760, Republic of Korea
| | - S W Chang
- Department of Environmental Energy Engineering, Kyonggi University, 442-760, Republic of Korea
| | - Phan D Tuan
- Research Institute for Sustainable Development, Hochiminh City University of Natural Resources and Environment, Viet Nam
| |
Collapse
|
9
|
Huang SH, Chang SW, Wang AY. Gynaecological transurethral resection of the prostate syndrome-induced acute pulmonary oedema treated with high-dose nitro-glycerine: a case report. Hong Kong Med J 2021; 26:339-341. [PMID: 32807737 DOI: 10.12809/hkmj198139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- S H Huang
- Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan
| | - S W Chang
- Division of Acute Care Surgery and Traumatology, Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan
| | - A Y Wang
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.,Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei City, Taiwan.,Department of Critical Care Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| |
Collapse
|
10
|
Farber SH, Mauler DJ, Sagar S, Pacult MA, Walker CT, Bohl MA, Snyder LA, Chapple KM, Sonntag VKH, Uribe JS, Turner JD, Chang SW, Kakarla UK. Perioperative and swallowing outcomes in patients undergoing 4- and 5-level anterior cervical discectomy and fusion. J Neurosurg Spine 2021:1-8. [PMID: 33799303 DOI: 10.3171/2020.10.spine201307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is a common and robust procedure performed on the cervical spine. Literature on ACDF for 4 or more segments is sparse. Increasing the number of operative levels increases surgical complexity, tissue retraction, and risks of complications, particularly dysphagia. The overall risks of these complications and rates of dysphagia are not well studied for surgery on 4 or more segments. In this study, the authors evaluated their institution's perioperative experience with 4- and 5-level ACDFs. METHODS The authors retrospectively reviewed patients who underwent 4- or 5-level ACDF at their institution over a 6-year period (May 2013-May 2019). Patient demographics, perioperative complications, readmission rates, and swallowing outcomes were recorded. Outcomes were analyzed with a multivariate linear regression. RESULTS A total of 174 patients were included (167 had 4-level and 7 had 5-level ACDFs). The average age was 60.6 years, and 54.0% of patients (n = 94) were men. A corpectomy was performed in 12.6% of patients (n = 22). After surgery, 56.9% of patients (n = 99) experienced dysphagia. The percentage of patients with dysphagia decreased to 22.8% (37/162) at 30 days, 12.9% (17/132) at 90 days, and 6.3% (5/79) and 2.8% (1/36) at 1 and 2 years, respectively. Dysphagia was more likely at 90 days postoperatively in patients with gastroesophageal reflux (OR 4.4 [95% CI 1.5-12.8], p = 0.008), and the mean (± SD) lordosis change was greater in patients with dysphagia than those without at 90 days (19.8° ± 13.3° vs 9.1° ± 10.2°, p = 0.003). Dysphagia occurrence did not differ with operative implants, including graft and interbody type. The mean length of time to solid food intake was 2.4 ± 2.1 days. Patients treated with dexamethasone were more likely to achieve solid food intake prior to discharge (OR 4.0 [95% CI 1.5-10.6], p = 0.004). Postsurgery, 5.2% of patients (n = 9) required a feeding tube due to severe approach-related dysphagia. Other perioperative complication rates were uniformly low. Overall, 8.6% of patients (n = 15) returned to the emergency department within 30 days and 2.9% (n = 5) required readmission, whereas 1.1% (n = 2) required unplanned return to surgery within 30 days. CONCLUSIONS This is the largest series of patients undergoing 4- and 5-level ACDFs reported to date. This procedure was performed safely with minimal intraoperative complications. More than half of the patients experienced in-hospital dysphagia, which increased their overall length of stay, but dysphagia decreased over time.
Collapse
|
11
|
Vinoth Kumar KC, Jani Subha T, Ahila KG, Ravindran B, Chang SW, Mahmoud AH, Mohammed OB, Rathi MA. Spectral characterization of hydroxyapatite extracted from Black Sumatra and Fighting cock bone samples: A comparative analysis. Saudi J Biol Sci 2021; 28:840-846. [PMID: 33424374 PMCID: PMC7785448 DOI: 10.1016/j.sjbs.2020.11.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/25/2020] [Accepted: 11/01/2020] [Indexed: 11/09/2022] Open
Abstract
At present, chicken business is occupying a major portion in the market and huge amount of bone wastes are dumped into the open places lead in environmental pollution. In this analysis, natural hydroxyapatite was extracted by thermal calcination process at different temperature ranges from 700 °C, 900 °C and 1100 °C and compared its spectral characteristics. The crystalline nature, functional groups and morphological characteristics of hydroxyapatite obtained from both bone samples were studied using XRD, FTIR and SEM analysis. The crystallite size, lattice parameters, specific surface area, volume and degree of crystallinity were measured using XRD data. The mean grain size of Black Sumatra and Fighting Cock bone hydroxyapatite was 62.67 nm and 31.34 nm respectively. The FTIR spectrum showed major peaks at 634.58 cm−1 and 470.63 cm−1, 1413.82 cm−1 and 1460 cm−1 indicates the presence of carbonate group and phosphate groups in both samples. The SEM micrograph confirmed the existence of maximum pores in matrix of fighting cock bone than Black Sumatra bone sample. Thus, the comparative analysis concluded that nano-sized hydroxyapetite obtained from bone wastes of fighting cock can be utilized as a low-cost biomaterial for the production of various implant coating materials and substitute for ceramics in bones and dentistry applications.
Collapse
Affiliation(s)
- K C Vinoth Kumar
- Department of Physics, Udaya College of Arts and Science, Udaya Nagar, Ammandivilai, Kanyakumari, Tamil Nadu, India
| | - T Jani Subha
- Department of Chemistry, Rohini College of Engineering & Technology, Anjugramam, Kanyakumari, Tamil Nadu, India
| | - K G Ahila
- Department of Biotechnology, Udaya College of Arts and Science, Udaya Nagar, Ammandivilai, Kanyakumari, Tamil Nadu,India
| | - B Ravindran
- Department of Environmental Energy and Engineering, Kyonggi University Youngtong-Gu, Suwon, Gyeonggi-Do 16227, South Korea
| | - S W Chang
- Department of Environmental Energy and Engineering, Kyonggi University Youngtong-Gu, Suwon, Gyeonggi-Do 16227, South Korea
| | - Ahmed Hossam Mahmoud
- Department Zoology, College of Science, King Saud University, P.O Box 2455, Riyadh 11451, Saudi Arabia
| | - Osama B Mohammed
- Department Zoology, College of Science, King Saud University, P.O Box 2455, Riyadh 11451, Saudi Arabia
| | - M A Rathi
- Department of Biochemistry, Sree Narayana Guru College, Coimbatore 641 105, Tamil Nadu, India
| |
Collapse
|
12
|
Ravindran B, Karmegam N, Yuvaraj A, Thangaraj R, Chang SW, Zhang Z, Kumar Awasthi M. Cleaner production of agriculturally valuable benignant materials from industry generated bio-wastes: A review. Bioresour Technol 2021; 320:124281. [PMID: 33099155 DOI: 10.1016/j.biortech.2020.124281] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 06/11/2023]
Abstract
Bio-wastes from different agro-based industries are increasing at a rapid rate with the growing human population's demand for the products. The industries procure raw materials largely from agriculture, finish it with the required major product, and produce huge bio-wastes which are mostly disposed unscientifically. This creates serious environmental problems and loss of resources and nutrients. Traditional bio-wastes disposal possess several demerits which again return with negative impact over the eco-system. Anaerobic digestion, composting, co-composting, and vermicomposting are now-a-days given importance due to the improved and modified methods with enhanced transformation of bio-wastes into suitable soil amendments. The advanced and modified methods like biochar assisted composting and vermicomposting is highlighted with the updated knowledge in the field. Hence, the present study has been carried to compile the effective and efficient methods of utilizing industry generated bio-wastes for circularity between agriculture - industrial sectors to promote sustainability.
Collapse
Affiliation(s)
- Balasubramani Ravindran
- Department for Management of Science and Technology Development, Ton Duc Thang University, Ho Chi Minh City, Viet Nam; Faculty of Environment and Labour Safety, Ton Duc Thang University, Ho Chi Minh City, Viet Nam; Department of Environmental Energy and Engineering, Kyonggi University, Youngtong - Gu, Suwon 16227, South Korea
| | - Natchimuthu Karmegam
- Department of Botany, Government Arts College (Autonomous), Salem 636 007, Tamil Nadu, India
| | - Ananthanarayanan Yuvaraj
- Vermitechnology and Ecotoxicology Laboratory, Department of Zoology, School of Life Sciences, Periyar University, Salem 636 011, Tamil Nadu, India
| | - Ramasundaram Thangaraj
- Vermitechnology and Ecotoxicology Laboratory, Department of Zoology, School of Life Sciences, Periyar University, Salem 636 011, Tamil Nadu, India
| | - S W Chang
- Department of Environmental Energy and Engineering, Kyonggi University, Youngtong - Gu, Suwon 16227, South Korea
| | - Zengqiang Zhang
- College of Natural Resources and Environment, Northwest A&F University, Taicheng Road 3#, Yangling, Shaanxi 712100, China
| | - Mukesh Kumar Awasthi
- College of Natural Resources and Environment, Northwest A&F University, Taicheng Road 3#, Yangling, Shaanxi 712100, China.
| |
Collapse
|
13
|
Bohl MA, McBryan S, Pais D, Chang SW, Turner JD, Nakaji P, Kakarla UK. The Living Spine Model: A Biomimetic Surgical Training and Education Tool. Oper Neurosurg (Hagerstown) 2020; 19:98-106. [PMID: 31740969 DOI: 10.1093/ons/opz326] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Living Spine Model (LSM) is a three-dimensionally printed, surgical training platform developed by neurosurgical residents. OBJECTIVE To evaluate the face and content validity of this model as a training tool for open posterior lumbar surgery. METHODS Six surgeons with varying experience were asked to complete L3-5 pedicle screw fixation and L3-4 laminectomy on an LSM. Face validity was measured using a questionnaire, and content validity was measured using the National Aeronautics and Space Administration Task Load Index (NASA TLX) tests. Student's t-test was used to compare NASA TLX responses between junior and senior residents and to compare responses for live surgery vs simulated surgery on the LSM. RESULTS Junior residents took the longest time to complete the procedure, followed by senior residents and the attending surgeon (136.5, 98.3, and 84 min, respectively). The junior residents placed fewer successful pedicle screws (7/12) than senior residents and attending surgeon (18/18). All tested components of the model had excellent face validity, with scores ranging from 60% to 97%. Content validity testing demonstrated that the LSMs created overall workloads and specific types of work like live operating conditions. CONCLUSION The overall validity testing of the LSM demonstrates the high-potential utility of this model as a surgical education and testing platform for open posterior lumbar procedures. The LSM has great potential as an adjunct to surgical education, and it may become an increasingly important component of surgical resident curricula in the future.
Collapse
Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Sarah McBryan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Danielle Pais
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| |
Collapse
|
14
|
Nguyen TKL, Ngo HH, Guo WS, Chang SW, Nguyen DD, Nghiem LD, Nguyen TV. A critical review on life cycle assessment and plant-wide models towards emission control strategies for greenhouse gas from wastewater treatment plants. J Environ Manage 2020; 264:110440. [PMID: 32217320 DOI: 10.1016/j.jenvman.2020.110440] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/13/2020] [Accepted: 03/14/2020] [Indexed: 06/10/2023]
Abstract
For decades, there has been a strong interest in mitigating greenhouse gas (GHG) emissions from wastewater treatment plants (WWTPs). Numerous models were developed to measure the emissions and propose the quantification. Existing studies looked at the relationship between GHG emissions and operational cost (OCI), which is one of the most important indicators for decision-makers. Other parameters that can influence the control strategies include the effluent quality (EQI) and total environmental impacts. Plant-wide models are reliable methods to examine the OCI, EQI and GHG emissions while Life cycle assessment (LCA) works to assess the potential environmental impacts. A combined LCA and plant-wide model proved to be a valuable tool evaluating and comparing strategies for the best performance of WWTPs. For this study involving a WWTP, the benchmark model is used while LCA is the decision tool to find the most suitable treatment strategy. LCA adds extra criteria that complement the existing criteria provided by such models. Complementing the cost/performance criteria is proposed for plant-wide models, including environmental evaluation, based on LCA, which provides an overall better assessment of WWTPs. It can capture both the dynamic effects and potential environmental impacts. This study provides an overview of the integration between plant-wide models and LCA.
Collapse
Affiliation(s)
- T K L Nguyen
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NWS, 2007, Australia
| | - H H Ngo
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NWS, 2007, Australia; NTT Institute of Hi-Technology, Nguyen Tat Thanh University, Ho Chi Minh City, Viet Nam.
| | - W S Guo
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NWS, 2007, Australia
| | - S W Chang
- Department of Environmental Energy & Engineering, Kyonggi University, 442-760, Republic of Korea
| | - D D Nguyen
- Department of Environmental Energy & Engineering, Kyonggi University, 442-760, Republic of Korea; Institution of Research and Development, Duy Tan University, Da Nang, Viet Nam
| | - L D Nghiem
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NWS, 2007, Australia
| | - T V Nguyen
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NWS, 2007, Australia
| |
Collapse
|
15
|
Bohl MA, McBryan S, Newcomb AGUS, Lehrman JN, Kelly BP, Nakaji P, Chang SW, Uribe JS, Turner JD, Kakarla UK. Range of Motion Testing of a Novel 3D-Printed Synthetic Spine Model. Global Spine J 2020; 10:419-424. [PMID: 32435561 PMCID: PMC7222693 DOI: 10.1177/2192568219858981] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
STUDY DESIGN Biomechanical model study. OBJECTIVE The Barrow Biomimetic Spine (BBS) project is a resident-driven effort to manufacture a synthetic spine model with high biomechanical fidelity to human tissue. The purpose of this study was to investigate the performance of the current generation of BBS models on biomechanical testing of range of motion (ROM) and axial compression and to compare the performance of these models to historical cadaveric data acquired using the same testing protocol. METHODS Six synthetic spine models comprising L3-5 segments were manufactured with variable soft-tissue densities and print orientations. Models underwent torque loading to a maximum of 7.5 N m. Torques were applied to the models in flexion-extension, lateral bending, axial rotation, and axial compression. Results were compared with historic cadaveric control data. RESULTS Each model demonstrated steadily decreasing ROM on flexion-extension testing with increasing density of the intervertebral discs and surrounding ligamentous structures. Vertically printed models demonstrated markedly less ROM than equivalent models printed horizontally at both L3-4 (5.0° vs 14.0°) and L4-5 (3.9° vs 15.2°). Models D and E demonstrated ROM values that bracketed the cadaveric controls at equivalent torque loads (7.5 N m). CONCLUSIONS This study identified relevant variables that affect synthetic spine model ROM and compressibility, confirmed that the models perform predictably with changes in these print variables, and identified a set of model parameters that result in a synthetic model with overall ROM that approximates that of a cadaveric model. Future studies can be undertaken to refine model performance and determine intermodel variability.
Collapse
Affiliation(s)
- Michael A. Bohl
- Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Sarah McBryan
- Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Anna G. U. S. Newcomb
- Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Jennifer N. Lehrman
- Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Brian P. Kelly
- Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Peter Nakaji
- Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Steve W. Chang
- Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Juan S. Uribe
- Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Jay D. Turner
- Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - U. Kumar Kakarla
- Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA,U. Kumar Kakarla, c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, 350 W Thomas Road, Phoenix, AZ 85013, USA.
| |
Collapse
|
16
|
Wang GC, Gao CQ, Liu YJ, Han GS, Wang YC, Zhang GQ, Ding LL, Li B, Wang BC, Chang SW. [Retrospective analysis of curative effect of total pelvic organ resection and anal preservation in 20 patients with recurrence of cervical cancer after radical radiotherapy]. Zhonghua Zhong Liu Za Zhi 2020; 42:242-246. [PMID: 32252204 DOI: 10.3760/cma.j.cn112152-20190806-00504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the surgical method and effect of en bloc pelvic resection and anal preservation after radical radiotherapy for cervical cancer. Methods: Clinical data of 20 cervical cancer patients with central recurrence after radical radiotherapy underwent en bloc pelvic resection in the Tumor Hospital of Zhengzhou University and Hainan Provincial People's Hospital from January 2013 to December 2017 were retrospectively analyzed. The operative time, intraoperative blood loss, length of stay, postoperative anal function and postoperative complications were evaluated. Results: The median operation time of 20 patients with anal preservation after en bloc pelvic resection was 135.2 min, the median intraoperative blood loss was 680 ml, and the median hospitalization time was 16.5 days. Among them, 18 patients had good postoperative healing, and the anal function gradually returned to normal within 6 months after surgery, defecated 1~2 times per day.One patient showed incomplete adhesion between the external colon and the anus. One patient presented with pre-sacral infection. Postoperative pathology confirmed the recurrences in 20 patients, of which 11 cases were squamous cell carcinoma, 7 cases were adenocarcinoma, 2 cases were adenosquamous cell carcinoma. Conclusions: It is safe and reliable to preserve anus after en bloc pelvic resection for cervical cancer patients with radical radiotherapy. The anus function is good enough to improve the postoperative life quality of patients significantly.
Collapse
Affiliation(s)
- G C Wang
- Department of General Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - C Q Gao
- Department of General Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Y J Liu
- Department of General Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - G S Han
- Department of General Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Y C Wang
- Department of General Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - G Q Zhang
- Department of General Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - L L Ding
- Department of General Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - B Li
- Department of General Surgery, Hainan People's Hospital, Haikou 570100, China
| | - B C Wang
- Department of General Surgery, Hainan People's Hospital, Haikou 570100, China
| | - S W Chang
- Department of General Surgery, Hainan People's Hospital, Haikou 570100, China
| |
Collapse
|
17
|
Biruntha M, Karmegam N, Archana J, Karunai Selvi B, John Paul JA, Balamuralikrishnan B, Chang SW, Ravindran B. Vermiconversion of biowastes with low-to-high C/N ratio into value added vermicompost. Bioresour Technol 2020; 297:122398. [PMID: 31759857 DOI: 10.1016/j.biortech.2019.122398] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 06/10/2023]
Abstract
Seaweed (T1), sugarcane trash (T2), coir pith (T3) and vegetable waste (T4) with cowdung (1:1, w/w) were vermicomposted using Eudrilus eugeniae (50 days). The pH in vermicomposts showed a decrease while electrical conductivity showed increment. The organic matter content, organic carbon, lignin, cellulose, C/N and C/P ratios in vermicompost was significantly lower than compost. Total NPK contents of vermicompost were significantly elevated (P < 0.05) with 12.04-63.75%, 19.05-31.58% and 22.47-42.55%, respectively. The significantly higher growth rate of 1.41 and 7.74 mg/worm/day was observed in T1 on 10th and 50th day respectively, with 23.91 initial C/N ratio; while it was 0.85 and 4.81 mg/worm/day in T4 with 69.81 initial C/N ratio. A similar pattern was reflected in cocoon production, hatchling success and hatchling number/cocoon. Results revealed that vermicompost quality, worm growth, and reproduction depend on C/N ratio. The study suggests that amendment materials like cowdung are necessary to reduce C/N ratio for effective vermicomposting.
Collapse
Affiliation(s)
- Muniyandi Biruntha
- Vermiculture Technology Laboratory, Department of Animal Health and Management, Alagappa University, Karaikudi 630 003, Tamil Nadu, India
| | - Natchimuthu Karmegam
- Department of Botany, Government Arts College (Autonomous), Salem 636 007, Tamil Nadu, India
| | - Jeyaprakasam Archana
- Vermiculture Technology Laboratory, Department of Animal Health and Management, Alagappa University, Karaikudi 630 003, Tamil Nadu, India
| | - Balan Karunai Selvi
- Department of Botany, V. V. Vanniaperumal College for Women (Autonomous), Virudhunagar 626 001, Tamil Nadu, India
| | - James Arockia John Paul
- Department of Zoology, Arumugam Pillai Seethai Ammal College, Tiruppattur 630 211, Tamil Nadu, India
| | - B Balamuralikrishnan
- Department of Food Science and Biotechnology, Sejong University, Seoul, Republic of Korea
| | - S W Chang
- Department of Environmental Energy and Engineering, Kyonggi University, Youngtong - Gu, Gyeonggi - Do 16227, South Korea
| | - B Ravindran
- Department of Environmental Energy and Engineering, Kyonggi University, Youngtong - Gu, Gyeonggi - Do 16227, South Korea.
| |
Collapse
|
18
|
Abstract
Insight into the historic contributions made to modern-day spine surgery provides context for understanding the monumental accomplishments comprising current techniques, technology, and clinical success. Only during the last century did surgical growth occur in the treatment of spinal disorders. With that growth came a renaissance of innovation, particularly with the evolution of spinal instrumentation and fixation techniques. In this article, the authors capture some of the key milestones that have led to the field of spine surgery today, with an emphasis on the historical advances related to instrumentation, navigation, minimally invasive surgery, robotics, and neurosurgical training.
Collapse
|
19
|
Bohl MA, Hlubek RJ, Turner JD, Reece EM, Kakarla UK, Chang SW. Novel Surgical Treatment Strategies for Unstable Lumbar Osteodiscitis: A 3-Patient Case Series. Oper Neurosurg (Hagerstown) 2019; 14:639-646. [PMID: 28961732 DOI: 10.1093/ons/opx162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 06/27/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lumbar osteomyelitis frequently affects patients with medical comorbidities and poor preoperative health. Surgery is indicated when medical management fails or patients present with spinal instability or neural compromise. Successful arthrodesis can be difficult and sometimes requires alternative surgical techniques. OBJECTIVE To report 3 novel methods, each illustrated by a case, for achieving arthrodesis for lumbar osteomyelitis. METHODS A retrospective review was performed of 3 cases of surgical treatment of lumbar osteomyelitis. Novel aspects of the surgical techniques are reported, as are perioperative clinical details and imaging results. RESULTS In the first patient, a vascularized iliac crest graft on a quadratus lumborum pedicle was rotated into the posterolateral fusion bed of the affected level. In the second, an anterior approach with debridement of affected lumbar levels was followed by rotation of a vascularized iliac crest graft on an iliacus muscle pedicle into the anterior lumbar defect. In the third, a structural, nonvascularized iliac crest graft was harvested via a lateral approach to provide better surgical access, and an autologous tricortical bone graft was obtained for placement in the debridement defect. Follow-up imaging suggested successful early incorporation of all the grafts in the fusion beds. CONCLUSION Patients with multiple risk factors for pseudarthrosis and recurrent infection often require alternative surgical strategies to augment fusion. These 3 novel methods for lumbar debridement, fixation, and fusion using vascularized or nonvascularized autograft accommodate posterior, anterior, and lateral surgical approaches. Further experience with these techniques is required to compare outcomes with those of traditional techniques.
Collapse
Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Randall J Hlubek
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Edward M Reece
- Arizona Center for Hand Surgery-Reconstructive Plastic Surgery, Phoenix, Arizona
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| |
Collapse
|
20
|
Bohl MA, Mooney MA, Catapano JS, Almefty KK, Turner JD, Chang SW, Preul MC, Reece EM, Kakarla UK. Pedicled Vascularized Bone Grafts for Posterior Occipitocervical and Cervicothoracic Fusion: A Cadaveric Feasibility Study. Oper Neurosurg (Hagerstown) 2019; 15:318-324. [PMID: 29301014 DOI: 10.1093/ons/opx258] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 11/01/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Arthrodesis is critical for achieving favorable outcomes in reconstructive spine surgery. Vascularized bone grafts (VBGs) have been successfully used to augment fusion rates in a variety of skeletal pathologies, and pedicled VBG has numerous advantages over free transfer VBG. Pedicled VBG has not previously been described for the posterior occipitocervicothoracic spine. OBJECTIVE To identify, describe, and assess potential donor sites for pedicled VBGs from occiput to T12 using a cadaver model and to describe important technical considerations for graft harvest and placement. METHODS A multidisciplinary team of plastic surgeons and neurosurgeons hypothesized that it is feasible to rotate a pedicled VBG from the occiput to T12 via a posterior approach. In 6 cadavers, 3 VBG donor sites were identified as anatomically feasible: occiput, scapula, and rib. RESULTS Split- and full-thickness occipital VBGs were mobilized on a semispinalis pedicle. Occipital VBGs could be mobilized from occiput to T1 and span up to 4 levels. Scapular VBGs were mobilized on a subscapular pedicle and could be mobilized from occiput to T7 and span up to 8 levels. Rib VBGs were mobilized on subcostal pedicles and could be mobilized from C6 to T12. Ribs T2 to T4 and T11 and T12 could cover 2 levels, and ribs T5 to T10 could cover 3 levels. The first rib was anatomically unsuitable as a VBG due to its primarily ventral course. CONCLUSION Pedicled VBGs can feasibly be applied to posterior spinal arthrodesis from occiput to T12. Patients at high risk for nonunion may benefit from this strategy.
Collapse
Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kaith K Almefty
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark C Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Edward M Reece
- Reconstructive Plastic Surgery, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.,Arizona Center for Hand Surgery, Phoenix, Arizona
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| |
Collapse
|
21
|
Bohl MA, Mooney MA, Sheehy JP, Cantwell AM, Chang SW, Chapple KM, Kakarla UK, Spetzler RF. Overlapping Surgeries Are Not Associated With Worse Patient Outcomes: Retrospective Multivariate Analysis of 14 872 Neurosurgical Cases Performed at a Single Institution. Neurosurgery 2019; 83:53-59. [PMID: 29029182 DOI: 10.1093/neuros/nyx472] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/17/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Overlapping surgeries have recently become a controversial topic. OBJECTIVE To evaluate the effect of overlapping surgeries on patient outcomes. METHODS A retrospective analysis of all neurosurgical procedures performed at a single institution from July 2013 to May 2016 was conducted. Variables extracted from the electronic medical records included sex, age, procedure type, resident years of training, evening case, emergency case, American Society of Anesthesiologists Physical Status Score, illness severity, mortality risk, and percentage of case overlap. Univariate and multivariate analyses were performed for the following primary outcomes: procedure length, length of hospital stay, return to operating room (OR), disposition upon discharge, hospital readmission, and mortality. Separate analyses were performed for overlap thresholds of 0%, 20%, 50%, and 100%. RESULTS A total of 14 872 cases were performed during the study period, and all were included in the statistical analyses. Univariate analysis showed a benefit for overlapping surgeries in terms of hospital length of stay, return to OR, and disposition status (all P < .001). No difference was found for hospital readmission or mortality. Overlapping surgeries were significantly longer and were staffed by more senior residents (P < .001). Multivariate analysis showed a benefit for overlapping surgeries, or no difference, for all the measured outcomes except procedure length. CONCLUSION These results reject the hypothesis that overlapping surgeries are predictive of worse outcomes. When considered in the context of the current debate regarding overlapping surgeries, these results argue against claims that overlapping surgeries are dangerous or harmful to patients.
Collapse
Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - John P Sheehy
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Abigail M Cantwell
- Undergraduate Student, School of Science and Engineering, Tulane University, New Orleans, Louisiana
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kristina M Chapple
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Robert F Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| |
Collapse
|
22
|
Bohl MA, Mauria R, Zhou JJ, Mooney MA, DiDomenico JD, McBryan S, Cavallo C, Nakaji P, Chang SW, Uribe JS, Turner JD, Kakarla UK. The Barrow Biomimetic Spine: Face, Content, and Construct Validity of a 3D-Printed Spine Model for Freehand and Minimally Invasive Pedicle Screw Insertion. Global Spine J 2019; 9:635-641. [PMID: 31448198 PMCID: PMC6693063 DOI: 10.1177/2192568218824080] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Description and evaluation of a novel surgical training platform. OBJECTIVES The purpose of this study was to investigate the face, content, and construct validity of 5 novel surgical training models that simulate freehand and percutaneous (minimally invasive surgery [MIS]) pedicle screw placement. METHODS Five spine models were developed by residents: 3 for freehand pedicle screw training (models A-C) and 2 for MIS pedicle screw training (models D and E). Attending spine surgeons evaluated each model and, using a 20-point Likert-type scale, answered survey questions on model face, content, and construct validity. Scores were statistically evaluated and compared using means, standard deviations, and analysis of variance between models and between surgeons. RESULTS Among the freehand models, model C demonstrated the highest overall validity, with mean face (15.67 ± 5.49), content (19.17 ± 0.59), and construct (18.83 ± 0.24) validity all measuring higher than the other freehand models. For the MIS models, model D had the highest validity scores (face, content, and construct validity of 11.67 ± 3.77, 18.17 ± 2.04, and 17.00 ± 3.46, respectively). The 3 freehand models differed significantly in content validity scores (P = .002) as did the 2 MIS models (P < .001). The testing surgeons' overall validity scores were significantly different for models A (P = .005) and E (P < .001). CONCLUSIONS A 3-dimensional-printed spine model with incorporated bone bleeding and silicone rubber soft tissue was scored as having very high content and construct validity for simulating freehand pedicle screw insertion. These data has informed the further development of several surgical training models that hold great potential as educational adjuncts in surgical training programs.
Collapse
Affiliation(s)
| | - Rohit Mauria
- Creighton University School of Medicine, Omaha, NE, USA
| | | | | | | | | | | | | | | | | | | | - U. Kumar Kakarla
- Barrow Neurological Institute, Phoenix, AZ, USA,U. Kumar Kakarla, MD, c/o Neuroscience Publications,
Department of Neurosurgery, Barrow Neurological Institute, St Joseph’s Hospital and
Medical Center, 350 West Thomas Road, Phoenix, AZ 85013, USA.
| |
Collapse
|
23
|
Bohl MA, Hlubek RJ, Mooney MA, Chapple KM, Preul MC, Chang SW, Turner JD, Kakarla UK. Disc Geometry is an Accurate Predictor of Lordotic Correction in the Thoracolumbar Spine Following Schwab Grade 2 Osteotomy: A Cadaveric Study and Biomechanical Analysis of Disc Space Changes Following Lordotic Correction. Oper Neurosurg (Hagerstown) 2019; 17:303-310. [PMID: 30544146 DOI: 10.1093/ons/opy362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 10/23/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Posterior column osteotomy (PCO) is a powerful technique for correcting lordosis, but the surgical literature lacks objective evidence on preoperative predictors of achievable lordotic correction following PCO. OBJECTIVE To measure the correlation between disc geometry and achievable lordotic correction following Schwab grade 2 osteotomies and to describe geometric changes to disc space following lordotic correction. METHODS Schwab grade 2 osteotomies were performed from T1 to S1 in 5 cadavers. Lateral radiographs were taken before and after posterior column compression. Anterior disc height (ADH), middle disc height (MDH), posterior disc height (PDH), and lordotic angles were measured. The association between disc height and lordotic correction was analyzed using linear regression. RESULTS For all spinal levels (n = 79), PDH was most strongly correlated with lordotic correction (r = 0.72, P < .001). Regional subset analyses showed the strongest correlation between PDH and lordotic correction achievable within the lumbar spine (n = 22, r = 0.77, P < .001), followed by ADH for lower thoracic spine (n = 29, r = 0.65, P < .001) and PDH for upper thoracic spine (n = 28, r = 0.61, P = .001). Postcorrection analysis of disc heights revealed that as lordotic correction increases, the PDH decreases, and the ADH expands. CONCLUSION PDH is a strong predictor of achievable lordotic correction following Schwab grade 2 osteotomies and compression of an intact disc space. In the lumbar spine, 50% of lordotic change is predictable using PDH alone. Further testing of our linear regression equation is planned for prospective clinical studies, and further testing of postcorrection disc space geometry is planned for future biomechanical and surgical technique studies.
Collapse
Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Randall J Hlubek
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kristina M Chapple
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark C Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| |
Collapse
|
24
|
Bohl MA, McBryan S, Nakaji P, Chang SW, Turner JD, Kakarla UK. Development and first clinical use of a novel anatomical and biomechanical testing platform for scoliosis. J Spine Surg 2019; 5:329-336. [PMID: 31663044 PMCID: PMC6787359 DOI: 10.21037/jss.2019.09.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/19/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous studies have demonstrated that, by using various three-dimensional (3D) printing technologies, synthetic spine models can be manufactured to mimic a human spine in its gross and radiographic anatomy and the biomechanical performance of bony and ligamentous tissue. These manufacturing processes have not, however, been used in combination to create a long-segment, biomimetic model of a patient with scoliosis. The purpose of this study was to describe the development of a biomimetic scoliosis model and early clinical experience using this model as a surgical planning and education platform. METHODS Synthetic spine models were printed to mimic the anatomy and biomechanical performance of 2 adult patients with scoliosis. Preoperatively, the models were surgically corrected by the attending surgeon of each patient. Patients then underwent surgical correction of their spinal deformities. Correction of the models was compared to the surgical correction in the patients. RESULTS Patient 1 had a preoperative coronal Cobb angle of 40° from L1 to S1, as did the patient's synthetic spine model. The patient's spine model was corrected to 17.6°, and the patient achieved a correction of 17.3°. Patient 2 had a preoperative mid-thoracic Cobb angle of 88° and an upper thoracic Cobb angle of 43°. Preoperatively, the patient's spine model was corrected to 19.5° and 9.2° for the mid-thoracic and upper thoracic curves, respectively. Immediately after surgery, the patient's mid-thoracic and upper thoracic Cobb angles measured 18.7° and 9.5°, respectively. In both cases, the use of the spine models preoperatively changed the attending surgeon's operative plan. CONCLUSIONS A novel synthetic spine model for corrective scoliosis procedures is presented, along with early clinical experience using this model as a surgical planning platform. This model has tremendous potential not only as a surgical planning platform but also as an adjunct to patient consent, surgical education, and biomechanical research.
Collapse
Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Sarah McBryan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| |
Collapse
|
25
|
Cheah PL, Li J, Looi LM, Koh CC, Lau TP, Chang SW, Teoh KH, Mun KS, Nazarina AR. Screening for microsatellite instability in colorectal carcinoma: Practical utility of immunohistochemistry and PCR with fragment analysis in a diagnostic histopathology setting. Malays J Pathol 2019; 41:91-100. [PMID: 31427545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Since 2014, the National Comprehensive Cancer Network (NCCN) has recommended that colorectal carcinoma (CRC) be universally tested for high microsatellite instability (MSI-H) which is present in 15% of such cancers. Fidelity of resultant microsatellites during DNA replication is contingent upon an intact mismatch repair (MMR) system and lack of fidelity can result in tumourigenesis. Prior to commencing routine screening for MSI-H, we assessed two commonly used methods, immunohistochemical (IHC) determination of loss of MMR gene products viz MLH1, MSH2, MSH6 and PMS2 against PCR amplification and subsequent fragment analysis of microsatellite markers, BAT25, BAT26, D2S123, D5S346 and D17S250 (Bethesda markers) in 73 unselected primary CRC. 15.1% (11/73) were categorized as MSI-H while deficient MMR (dMMR) was detected in 16.4% (12/73). Of the dMMR, 66.7% (8/12) were classified MSI-H, while 33.3% (4/12) were microsatellite stable/low microsatellite instability (MSS/MSI-L). Of the proficient MMR (pMMR), 95.1% (58/61) were MSS/MSI-L and 4.9% (3/61) were MSI-H. The κ value of 0.639 (standard error =0.125; p = 0.000) indicated substantial agreement between detection of loss of DNA mismatch repair using immunohistochemistry and the detection of downstream microsatellite instability using PCR. After consideration of advantages and shortcomings of both methods, it is our opinion that the choice of preferred technique for MSI analysis would depend on the type of laboratory carrying out the testing.
Collapse
Affiliation(s)
- P L Cheah
- University Malaya, Faculty of Medicine, Department of Pathology, Lembah Pantai, 59100, Kuala Lumpur, Malaysia.
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Savardekar AR, Rodriguez-Martinez NG, Newcomb AGUS, Reyes PM, Soriano-Baron H, Chang SW, Kelly BP, Crawford NR. Comparing the Biomechanical Stability of Cortical Screw Trajectory Versus Standard Pedicle Screw Trajectory for Short- and Long-Segment Posterior Fixation in 3-Column Thoracic Spinal Injury. Int J Spine Surg 2019; 13:245-251. [PMID: 31328088 DOI: 10.14444/6033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Information on the performance of posterior fixation with cortical screw (CS) versus pedicle screw (PS) trajectories for stabilizing thoracolumbar burst fractures is limited. Therefore, we sought to analyze stability with CS versus PS in short- and long-segment fixations using a 3-column spinal injury model. Methods Nondestructive flexibility tests: (1) intact, (2) intact + short fixation, (3) intact + long fixation, (4) after burst fracture, (5) short fixation + burst fracture, and (6) long fixation + burst fracture using thoracic spine segments (7 CS, 7 PS). Results With CS, the range of motion (ROM) was significantly greater with short-segment than with long-segment fixation in all directions, with and without burst fracture (P ≤ .008). With PS and burst fracture, ROM was significantly greater with short fixation during lateral bending and axial rotation (P < .006), but not during flexion-extension (P = .10). Groups with CS versus PS were not significantly different after burst fracture during flexion-extension and axial rotation, with short (P ≥ .58) or long fixation (P ≥ .17). During lateral bending, ROM was significantly greater with CS versus PS, without burst fracture (long fixation, P = .02) and with burst fracture (short and long fixation, P ≤ .001). Conclusions CS trajectory is a valid alternative to PS trajectory for thoracic spine fixation in 3-column spinal injuries, and long-segment fixation is superior to short-segment fixation with either.
Collapse
Affiliation(s)
- Amey R Savardekar
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Nestor G Rodriguez-Martinez
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Anna G U S Newcomb
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Phillip M Reyes
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Hector Soriano-Baron
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Brian P Kelly
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Neil R Crawford
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| |
Collapse
|
27
|
Reece EM, Vedantam A, Lee S, Bhadkamkar M, Kaufman M, Bohl MA, Chang SW, Porter RW, Theodore N, Kakarla UK, Ropper AE. Pedicled, vascularized occipital bone graft to supplement atlantoaxial arthrodesis for the treatment of pseudoarthrosis. J Clin Neurosci 2019; 74:205-209. [PMID: 31036507 DOI: 10.1016/j.jocn.2019.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/10/2019] [Accepted: 04/12/2019] [Indexed: 12/01/2022]
Abstract
Atlantoaxial pseudoarthrosis is a challenging postoperative complication. The use of a local, vascularized bone graft, without free tissue transfer, to support a revision atlantoaxial fusion has not been previously described. We report the first surgical patient who received a semispinalis capitis muscle pedicled, occipital bone graft for supplementation of a revision atlantoaxial arthrodesis. A 72-year-old female had a failed atlantoaxial fusion and developed neck pain from continued instability and fractured hardware. The fixation and fusion were revised and supplemented with a novel, pedicled occipital bone graft. A craniectomy was performed in the occipital bone while still attached to the semispinalis capitis muscle to provide graft vascularity. This graft was rotated inferiorly from the skull base to the C1 arch and C2 spinous process in order to supplement a revision atlantoaxial arthrodesis. The patient had excellent clinical recovery over 18-month clinical follow up. The bone graft harvesting and rotation were performed safely and without complication. The 6-month postoperative CT scan showed partial fusion into the graft. This novel surgical technique leverages the advantages of vascularized structural autograft without adding extensive time or morbidity to the procedure as observed in free-tissue transfers. It is a safe and useful salvage technique to supplement revision atlantoaxial fusion surgeries.
Collapse
Affiliation(s)
- Edward M Reece
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Aditya Vedantam
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Sungho Lee
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Mohin Bhadkamkar
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew Kaufman
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Randall W Porter
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Alexander E Ropper
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
| |
Collapse
|
28
|
Gandhi A, Ferry C, Inzana JA, Chang SW, DenHaese R. Adjustable Rigid Interspinous Process Fixation: A Biomechanical Study of Segmental Lordosis and Interbody Loading in the Lumbar Spine. Cureus 2019; 11:e4317. [PMID: 31183297 PMCID: PMC6538115 DOI: 10.7759/cureus.4317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Rigid interspinous process fixation (ISPF) may serve as a minimally disruptive adjunct to lumbar interbody fusion. Previous biomechanical assessments of ISPF have demonstrated particularly advantageous outcomes in stabilizing the sagittal plane. However, ISPF has not been well characterized in regard to its impact on interbody load, which has implications for the risk of cage migration or subsidence, and sagittal alignment. The purpose of this study was to biomechanically assess in vitro the interbody load (IBL), focal lordosis (FL), and spinous process loading generated by in situ compression/distraction with a novel ISPF device capable of incremental in situ shortening/extension. Bilateral pedicle screw fixation (BPSF) was used as a control. Methods Two fresh frozen human lumbar spines were thawed and musculature was removed, leaving ligaments intact. Seven functional spinal units were iteratively tested, which involved a standard lateral discectomy, placement of a modified lateral cage possessing two load cells, and posterior fixation. BPSF and ISPF were performed at each level, with order of fixation was randomized. BPSF was first performed with maximum compressive exertion followed by 75% exertion to represent clinical application. The ISPF device was implanted at a neutral height and incrementally shortened/extended in situ in 1-mm increments. IBL and FL were measured under each condition. Loads on the spinous processes were estimated through bench-top mechanical calibration. Results No significant differences in IBL were observed, but the ISPF device produced a significantly greater change in FL compared to the clinically relevant BPSF compression. IBL, as a function of ISPF device height, expressed linear behavior during compression and exponential behavior during distraction. Conclusions The novel ISPF device produced clinically effective IBL and FL, performing well in comparison to BPSF. Additionally, incremental ISPF device manipulation demonstrated predictable and clinically safe trends regarding loading of the interbody space and spinous processes.
Collapse
Affiliation(s)
- Anup Gandhi
- Orthopaedics, Zimmer Biomet Spine, Westminster, USA
| | - Chris Ferry
- Orthopaedics, Cooper Medical School of Rowan University, Camden, USA
| | | | - Steve W Chang
- Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Ryan DenHaese
- Neurosurgery, AXIS Neurosurgery and Spine, Buffalo, USA
| |
Collapse
|
29
|
Bohl MA, Zhou JJ, Mooney MA, Repp GJ, Cavallo C, Nakaji P, Chang SW, Turner JD, Kakarla UK. The Barrow Biomimetic Spine: effect of a 3-dimensional-printed spinal osteotomy model on performance of spinal osteotomies by medical students and interns. J Spine Surg 2019; 5:58-65. [PMID: 31032439 DOI: 10.21037/jss.2019.01.05] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background The Schwab osteotomy grading scale-a unified osteotomy classification system created in 2014 by Schwab et al.-is one of many concepts in spine surgery that require detailed knowledge of 3-dimensional (3D) anatomy. 3D-printed spine models have demonstrated increasing utility in spine surgery as they more quickly communicate information on complex 3D anatomical relationships than planar imaging or 2-dimensional images. The purpose of this study was to evaluate the utility of a custom, 3D-printed spine model to help surgical trainees understand and perform the Schwab osteotomy grading scale. Methods Eight participants were randomized into 2 groups: group 1 received written instructional materials about the Schwab osteotomy grading scale, whereas group 2 received both written materials and a 3D-printed model of the spine with osteotomy regions demarcated. All participants were administered written and practical examinations. Results The group randomized to receive the 3D-printed model performed significantly better on both the written assessment (mean score, 7.75±0.50 vs. 5.75±0.50, P=0.023) and the practical examination (mean score, 1.75±0.32 vs. 1.08±0.09, P=0.025) than the group that received only written instructions. Conclusions Our results support the conclusion that this 3D-printed spine model is an effective adjunct to help early surgical trainees understand the Schwab osteotomy grading scale. Participants who received the model in addition to the source manuscript demonstrated improved theoretical knowledge and better performance on practical tests of complex spinal osteotomies. Similar models are likely to have utility in surgical training programs and as patient education models.
Collapse
Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - James J Zhou
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Garrett J Repp
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Claudio Cavallo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| |
Collapse
|
30
|
Cheng DL, Ngo HH, Guo WS, Chang SW, Nguyen DD, Kumar SM. Microalgae biomass from swine wastewater and its conversion to bioenergy. Bioresour Technol 2019; 275:109-122. [PMID: 30579101 DOI: 10.1016/j.biortech.2018.12.019] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/02/2018] [Accepted: 12/06/2018] [Indexed: 05/21/2023]
Abstract
Ever-increasing swine wastewater (SW) has become a serious environmental concern. High levels of nutrients and toxic contaminants in SW significantly impact on the ecosystem and public health. On the other hand, swine wastewater is considered as valuable water and nutrient source for microalgae cultivation. The potential for converting the nutrients from SW into valuable biomass and then generating bioenergy from it has drawn increasing attention. For this reason, this review comprehensively discussed the biomass production, SW treatment efficiencies, and bioenergy generation potentials through cultivating microalgae in SW. Microalgae species grow well in SW with large amounts of biomass being produced, despite the impact of various parameters (e.g., nutrients and toxicants levels, cultivation conditions, and bacteria in SW). Pollutants in SW can effectively be removed by harvesting microalgae from SW, and the harvested microalgae biomass elicits high potential for conversion to valuable bioenergy.
Collapse
Affiliation(s)
- D L Cheng
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NWS 2007, Australia
| | - H H Ngo
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NWS 2007, Australia.
| | - W S Guo
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NWS 2007, Australia; Department of Environmental Energy & Engineering, Kyonggi University, 442-760, Republic of Korea
| | - S W Chang
- Department of Environmental Energy & Engineering, Kyonggi University, 442-760, Republic of Korea
| | - D D Nguyen
- Department of Environmental Energy & Engineering, Kyonggi University, 442-760, Republic of Korea; Institution of Research and Development, Duy Tan University, Da Nang, Viet Nam
| | - S M Kumar
- Department of Civil Engineering, Indian Institute of Technology Madras, Chennai, Tamilnadu 600 036, India
| |
Collapse
|
31
|
Bohl MA, Mooney MA, Catapano JS, Almefty KK, Turner JD, Chang SW, Preul MC, Reece EM, Kakarla UK. Pedicled Vascularized Bone Grafts for Posterior Lumbosacral Fusion: A Cadaveric Feasibility Study and Case Report. Spine Deform 2019; 6:498-506. [PMID: 30122384 DOI: 10.1016/j.jspd.2018.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/11/2018] [Indexed: 11/29/2022]
Abstract
STUDY DESIGN Cadaveric feasibility study and case report. OBJECTIVE To determine if it is feasible to rotate pedicled vascularized bone graft (VBG) from L1 to S1 via a posterior approach. SUMMARY OF BACKGROUND DATA VBG has been used to successfully augment fusion rates in various skeletal pathologies. Pedicled VBG has numerous advantages over free-transfer VBG, including the maintenance of a robust vascular supply to the graft without the need for vascular anastomoses. Pedicled VBG options have not been well described for posterior lumbosacral fusion. METHODS A multidisciplinary team of plastic surgeons and neurosurgeons hypothesized that it is feasible to rotate pedicled VBG from L1 to S1 via a posterior approach. In six cadavers, two VBG donor sites were evaluated: posterior element (PE-VBG) and iliac crest (IC-VBG). A single case report of a patient with lumbar Charcot joint treated with IC-VBG is also presented. RESULTS For the PE-VBG, the laminae and spinous processes were mobilized en bloc via Gill laminectomy on a unilateral sacrospinalis pedicle. Mean ± standard deviation (SD) length × width graft dimensions were 2.8±0.48 cm × 2.2±0.81 cm. The inter-transverse process (inter-TP) distance was less than the corresponding lamina length at all levels. For the IC-VBG, iliac crest was mobilized on a quadratus lumborum pedicle. Mean±SD length × width × thickness graft dimensions were 7.7±1.28 cm × 2.2±0.69 cm × 1.5±0.79 cm. The IC-VBGs reached from L1 (T12-S1) to S1 (S1-S3), and all IC-VBGs were able to cover three levels. CONCLUSIONS This feasibility cadaveric study and the case report are the first demonstrations that pedicled VBGs can be successfully applied to posterior lumbosacral spinal arthrodesis. Patients at high risk for nonunion may benefit from these strategies. Further clinical experience with these techniques is warranted. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Kaith K Almefty
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Mark C Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ 85013, USA
| | - Edward M Reece
- Reconstructive Plastic Surgery, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ 85013, USA
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ 85013, USA.
| |
Collapse
|
32
|
Bohl MA, Morgan CD, Mooney MA, Repp GJ, Lehrman JN, Kelly BP, Chang SW, Turner JD, Kakarla UK. Biomechanical Testing of a 3D-printed L5 Vertebral Body Model. Cureus 2019; 11:e3893. [PMID: 30911450 PMCID: PMC6424546 DOI: 10.7759/cureus.3893] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background We examined the biomechanical performance of a three-dimensional (3D)-printed vertebra on pedicle screw insertional torque (IT), axial pullout (APO), and stiffness (ST) testing. Materials and methods Seventy-three anatomically identical L5 vertebral body models (146 pedicles) were printed and tested for IT, APO, and ST using single-threaded pedicle screws of equivalent diameter (6.5 mm), length (40.0 mm), and thread pitch (2.6 mm). Print properties (material, cortical thickness [number of shells], cancellous density [in-fill], in-fill pattern, print orientation) varied among models. One-way analysis of variance was performed to evaluate the effects of variables on outcomes. Results The type of material significantly affected IT, APO, and ST (P < 0.001, all comparisons). For acrylonitrile butadiene styrene (ABS) models, in-fill density (25-35%) had a positive linear association with APO (P = 0.002), ST (P = 0.008), and IT (P = 0.10); similarly for the polylactic acid (PLA) models, APO (P = 0.001), IT (P < 0.001), and ST (P = 0.14). For the nylon material type, in-fill density did not affect any tested parameter. For a given in-fill density, material, and print orientation, the in-fill pattern significantly affected IT (P = 0.002) and APO (P = 0.03) but not ST (P = 0.23). Print orientation also significantly affected IT (P < 0.001), APO (P < 0.001), and ST (P = 0.002). Conclusions 3D-printed vertebral body models with specific print parameters can be designed to perform analogously to human bone on pedicle screw tests of IT, APO, and ST. Altering the material, in-fill density, in-fill pattern, and print orientation of synthetic vertebral body models could reliably produce a model that mimics bone of a specific bone mineral density.
Collapse
Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Clinton D Morgan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Garrett J Repp
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Jennifer N Lehrman
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Brian P Kelly
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| |
Collapse
|
33
|
Bohl MA, Hlubek RJ, Xu DS, Cavallo C, Preul MC, Chang SW, Turner JD, Uribe JS, Kakarla UK. Posterior open-wedge anterior longitudinal ligament release: Cadaveric technique analysis. Clin Anat 2018; 32:348-353. [DOI: 10.1002/ca.23317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/18/2018] [Accepted: 09/21/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Michael A. Bohl
- Department of Neurosurgery; Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; Phoenix Arizona
| | - Randall J. Hlubek
- Department of Neurosurgery; Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; Phoenix Arizona
| | - David S. Xu
- Department of Neurosurgery; Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; Phoenix Arizona
| | - Claudio Cavallo
- Department of Neurosurgery; Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; Phoenix Arizona
| | - Mark C. Preul
- Department of Neurosurgery; Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; Phoenix Arizona
| | - Steve W. Chang
- Department of Neurosurgery; Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; Phoenix Arizona
| | - Jay D. Turner
- Department of Neurosurgery; Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; Phoenix Arizona
| | - Juan S. Uribe
- Department of Neurosurgery; Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; Phoenix Arizona
| | - Udaya Kumar Kakarla
- Department of Neurosurgery; Barrow Neurological Institute, St. Joseph's Hospital and Medical Center; Phoenix Arizona
| |
Collapse
|
34
|
Chang SW, Bohl MA, Kelly BP, Wade C. The segmental distribution of cervical range of motion: A comparison of ACDF versus TDR-C. J Clin Neurosci 2018; 57:185-193. [DOI: 10.1016/j.jocn.2018.08.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 08/14/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022]
|
35
|
Do MH, Ngo HH, Guo WS, Liu Y, Chang SW, Nguyen DD, Nghiem LD, Ni BJ. Challenges in the application of microbial fuel cells to wastewater treatment and energy production: A mini review. Sci Total Environ 2018; 639:910-920. [PMID: 29929329 DOI: 10.1016/j.scitotenv.2018.05.136] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/10/2018] [Accepted: 05/10/2018] [Indexed: 05/21/2023]
Abstract
Wastewater is now considered to be a vital reusable source of water reuse and saving energy. However, current wastewater has multiple limitations such as high energy costs, large quantities of residuals being generated and lacking in potential resources. Recently, great attention has been paid to microbial fuel cells (MFCs) due to their mild operating conditions where a variety of biodegradable substrates can serve as fuel. MFCs can be used in wastewater treatment facilities to break down organic matter, and they have also been analysed for application as a biosensor such as a sensor for biological oxygen which demands monitoring. MFCs represent an innovation technology solution that is simple and rapid. Despite the advantages of this technology, there are still practical barriers to consider including low electricity production, current instability, high internal resistance and costly materials used. Thus, many problems must be overcome and doing this requires a more detailed analysis of energy production, consumption, and application. Currently, real-world applications of MFCs are limited due to their low power density level of only several thousand mW/m2. Efforts are being made to improve the performance and reduce the construction and operating costs of MFCs. This paper explores several aspects of MFCs such as anode, cathode and membrane, and in an effort to overcome the practical challenges of this system.
Collapse
Affiliation(s)
- M H Do
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NWS 2007, Australia
| | - H H Ngo
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NWS 2007, Australia; Joint Research Centre for Protective Infrastructure Technology and Environmental Green Bioprocess, Department of Environmental and Municipal Engineering, Tianjin Chengjian University, Tianjin 300384, China.
| | - W S Guo
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NWS 2007, Australia; Joint Research Centre for Protective Infrastructure Technology and Environmental Green Bioprocess, Department of Environmental and Municipal Engineering, Tianjin Chengjian University, Tianjin 300384, China
| | - Y Liu
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NWS 2007, Australia
| | - S W Chang
- Department of Environmental Energy & Engineering, Kyonggi University, 442-760, Republic of Korea.
| | - D D Nguyen
- Department of Environmental Energy & Engineering, Kyonggi University, 442-760, Republic of Korea; Institution of Research and Development, Duy Tan University, Da Nang, Viet Nam
| | - L D Nghiem
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NWS 2007, Australia
| | - B J Ni
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NWS 2007, Australia
| |
Collapse
|
36
|
Cheng DL, Ngo HH, Guo WS, Chang SW, Nguyen DD, Kumar SM, Du B, Wei Q, Wei D. Problematic effects of antibiotics on anaerobic treatment of swine wastewater. Bioresour Technol 2018; 263:642-653. [PMID: 29759819 DOI: 10.1016/j.biortech.2018.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 06/08/2023]
Abstract
Swine wastewaters with high levels of organic pollutants and antibiotics have become serious environmental concerns. Anaerobic technology is a feasible option for swine wastewater treatment due to its advantage in low costs and bioenergy production. However, antibiotics in swine wastewater have problematic effects on micro-organisms, and the stability and performance of anaerobic processes. Thus, this paper critically reviews impacts of antibiotics on pH, COD removal efficiencies, biogas and methane productions as well as the accumulation of volatile fatty acids (VFAs) in the anaerobic processes. Meanwhile, impacts on the structure of bacteria and methanogens in anaerobic processes are also discussed comprehensively. Furthermore, to better understand the effect of antibiotics on anaerobic processes, detailed information about antimicrobial mechanisms of antibiotics and microbial functions in anaerobic processes is also summarized. Future research on deeper knowledge of the effect of antibiotics on anaerobic processes are suggested to reduce their adverse environmental impacts.
Collapse
Affiliation(s)
- D L Cheng
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NWS 2007, Australia
| | - H H Ngo
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NWS 2007, Australia.
| | - W S Guo
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NWS 2007, Australia
| | - S W Chang
- Department of Environmental Energy & Engineering, Kyonggi University, 442-760, Republic of Korea
| | - D D Nguyen
- Department of Environmental Energy & Engineering, Kyonggi University, 442-760, Republic of Korea
| | - S Mathava Kumar
- Department of Civil Engineering, Indian Institute of Technology Madras, Chennai, Tamilnadu 600036, India
| | - B Du
- School of Resources and Environment, University of Jinan, Jinan 250022, PR China
| | - Q Wei
- Key Laboratory of Chemical Sensing & Analysis in Universities of Shandong, School of Chemistry and Chemical Engineering, University of Jinan, Jinan 250022, PR China
| | - D Wei
- School of Resources and Environment, University of Jinan, Jinan 250022, PR China
| |
Collapse
|
37
|
Walker CT, Godzik J, Xu DS, Theodore N, Uribe JS, Chang SW. Minimally Invasive Single-Position Lateral Interbody Fusion With Robotic Bilateral Percutaneous Pedicle Screw Fixation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2018; 16:E121. [DOI: 10.1093/ons/opy240] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/26/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
Lateral interbody fusion has distinct advantages over traditional posterior approaches. When adjunctive percutaneous pedicle screw fixation is required, placement from the lateral decubitus position theoretically increases safety and improves operative efficiency by obviating the need for repositioning. However, safe cannulation of the contralateral, down-side pedicles remains technically challenging and often prohibitive. In this video, we present the case of a 59-yr-old man with refractory back pain and bilateral lower extremity radiculopathy that was worse on the left than right side. The patient provided written informed consent before undergoing treatment. We performed minimally invasive single-position lateral interbody fusion with robotic (ExcelsiusGPS, Globus Medical Inc, Audubon, Pennsylvania) bilateral percutaneous pedicle screw fixation for the treatment of asymmetric disc degeneration, dynamic instability, and left paracentral disc herniation with corresponding stenosis at the L3-4 level. A left-sided minimally invasive transpsoas lateral interbody graft was placed with fluoroscopic guidance. Without changing the position of the patient or breaking the sterile field, an intraoperative cone-beam computed tomography image was obtained for navigational screw placement with stereotactic trackers in the iliac spine. Screw trajectories were planned using the robotic navigation software and were placed percutaneously in the bilateral L3 and L4 pedicles using the robotic arm. Concomitant lateral fluoroscopy may be used if desired to ensure the fidelity of the robotic guidance. The patient recovered well postoperatively and was discharged home within 36 h, without complication. Single-position lateral interbody fusion and percutaneous pedicle screw fixation can be accomplished using robotic-assisted navigation and pedicle screw placement. Used with permission from Barrow Neurological Institute.
Collapse
Affiliation(s)
- Corey T Walker
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - David S Xu
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Nicholas Theodore
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| |
Collapse
|
38
|
Hlubek RJ, Bohl MA, Cole TS, Morgan CD, Xu DS, Chang SW, Turner JD, Kakarla UK. Safety and accuracy of freehand versus navigated C2 pars or pedicle screw placement. Spine J 2018; 18:1374-1381. [PMID: 29253631 DOI: 10.1016/j.spinee.2017.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 12/05/2017] [Accepted: 12/11/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND CONTEXT C2 pedicle and pars screws require accurate placement to avoid injury to nearby neurovascular structures. Freehand, fluoroscopically guided, and computed tomography (CT)-based navigation techniques have been described in the medical literature. PURPOSE The present study aims to compare the safety and accuracy of the freehand technique versus stereotactic navigation for the placement of C2 pedicle and pars screws. STUDY DESIGN/SETTING This study was a retrospective review of consecutive patients treated with posterior fixation constructs. PATIENT SAMPLE A total of 220 consecutive patients were treated with posterior fixation constructs containing C2 pars or pedicle screws placed at our institution. OUTCOME MEASURES Computed tomography imaging was used to assess the accuracy of screw placement. Intraoperative complications and incidence of stroke or mortality within 30 days of the operation were analyzed. METHODS A retrospective review was conducted of consecutive patients treated with posterior fixation constructs containing C2 pars or pedicle screws placed by spine surgeons between January 1, 2010, and August 31, 2016. Clinical and radiographic data were collected and analyzed. Screw accuracy was graded independently by two reviewers according to the following criteria: grade A (no breach), grades B-E (breach with transverse foramen obstruction of 1%-25%, 26%-50%, 51%-75%, or 76%-100%, respectively), and grade M (medial breach). Screws were divided into acceptable (grades A and B) and unacceptable (grades C-E and M). RESULTS A total of 426 C2 pars or pedicle screws (312 freehand, 114 navigated) were placed in 220 patients (160 freehand, 60 navigated). Complications were similar between the groups: three vertebral artery injuries (two [1%] freehand, one [2%] navigated; p>.99), five deaths (four [3%] freehand, one [2%] navigated; p>.99), and one (2%) stroke in the navigated group (p=.61). Computed tomography imaging was available for accuracy grading of 182 screws (131 freehand, 51 navigated). No breaches (grade A) occurred in 113 of the freehand screws (86%) and in 34 of the navigated screws (67%) (p=.006). More screws had acceptable placement in the freehand group (123 of 131, 94%) than in the navigated group (42 of 51, 82%) (p=.02). CONCLUSIONS In patients with postoperative CT imaging (43%), the freehand technique was found to be more accurate than CT-based navigation for C2 pedicle or pars screw placement. Complication rates did not differ between the two techniques in this study.
Collapse
Affiliation(s)
- Randall J Hlubek
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Tyler S Cole
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Clinton D Morgan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - David S Xu
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.
| |
Collapse
|
39
|
Bohl MA, Xu DS, Daniels L, Chang SW, Nakaji P, Porter RW, Kakarla UK. The Barrow Innovation Center Case Series: Early Clinical Experience with Novel, Low-Cost Techniques for Bone Graft Containment in the Posterolateral Fusion Bed. World Neurosurg 2018; 116:285-295. [PMID: 29857211 DOI: 10.1016/j.wneu.2018.05.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/18/2018] [Accepted: 05/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND A frequently encountered problem during posterolateral fusion (PLF) is bone graft displacement from the posterolateral space during closure. Commercially available solutions to this problem are seldom used because of their exceptionally high cost. The purpose of this report is to describe 3 novel, low-cost techniques we developed for bone graft containment during PLF. METHODS Three low-cost bone graft containment techniques are described: rapid suture weave, makeshift bone bag, and cellulose rooftop. Early clinical experience with these techniques is reported for a 5-patient case series. RESULTS One or more of these bone graft containment techniques were used in 5 patients who underwent PLF. Rapid suture weave was the least expensive (<$5.00) but required the longest additional time to perform (20 minutes). Makeshift bone bag and cellulose rooftop cost approximately the same ($48.00 and $46.00, respectively); the makeshift bone bag took less additional time (3 minutes) but created a potential barrier between the bone graft and the host site, whereas the cellulose rooftop took slightly longer to perform (5 minutes) but permitted direct contact between the bone graft and host site. CONCLUSIONS These 3 novel surgical techniques for bone graft containment in the posterolateral space add minimally to the cost and length of the procedure. Our early clinical experience suggests that these techniques are safe and effective. Additional clinical experience is warranted, and prospective data collection is ongoing.
Collapse
Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - David S Xu
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Lorin Daniels
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Randall W Porter
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
| |
Collapse
|
40
|
Godzik J, Kalb S, Reis MT, Reyes PM, Singh V, Newcomb AGUS, Chang SW, Kelly BP, Crawford NR. Biomechanical evaluation of interbody fixation with secondary augmentation: lateral lumbar interbody fusion versus posterior lumbar interbody fusion. J Spine Surg 2018; 4:180-186. [PMID: 30069505 DOI: 10.21037/jss.2018.05.07] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Many approaches to the lumbar spine have been developed for interbody fusion. The biomechanical profile of each interbody fusion device is determined by the anatomical approach and the type of supplemental internal fixation. Lateral lumbar interbody fusion (LLIF) was developed as a minimally invasive technique for introducing hardware with higher profiles and wider widths, compared with that for the posterior lumbar interbody fusion (PLIF) approach. However, the biomechanics of the interbody fusion construct used in the LLIF approach have not been rigorously evaluated, especially in the presence of secondary augmentation. Methods Spinal stability of 21 cadaveric lumbar specimens was compared using standard nondestructive flexibility studies [mean range of motion (ROM), lax zone (LZ), stiff zone (SZ) in flexion-extension, lateral bending, and axial rotation]. Non-paired comparisons were made among four conditions: (I) intact; (II) with unilateral interbody + bilateral pedicle screws (BPS) using the LLIF approach (referred to as the LLIF construct); (III) with bilateral interbody + BPS using the PLIF approach (referred to as the PLIF construct); and (IV) with no lumbar interbody fusion (LIF) + BPS (referred to as the no-LIF construct). Results With bilateral pedicle screw-rod fixation, stability was equivalent between PLIF and LLIF constructs in lateral bending and flexion-extension. PLIF and LLIF constructs had similar biomechanical profiles, with a trend toward less ROM in axial rotation for the LLIF construct. Conclusions LLIF and PLIF constructs had similar stabilizing effects.
Collapse
Affiliation(s)
- Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Samuel Kalb
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Marco T Reis
- Spinal Biomechanics Laboratory, Department of Neurosurgery Research, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Phillip M Reyes
- Spinal Biomechanics Laboratory, Department of Neurosurgery Research, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | - Anna G U S Newcomb
- Spinal Biomechanics Laboratory, Department of Neurosurgery Research, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Brian P Kelly
- Spinal Biomechanics Laboratory, Department of Neurosurgery Research, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Neil R Crawford
- Spinal Biomechanics Laboratory, Department of Neurosurgery Research, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| |
Collapse
|
41
|
Muijres FT, Chang SW, van Veen WG, Spitzen J, Biemans BT, Koehl MAR, Dudley R. Escaping blood-fed malaria mosquitoes minimize tactile detection without compromising on take-off speed. ACTA ACUST UNITED AC 2018; 220:3751-3762. [PMID: 29046418 DOI: 10.1242/jeb.163402] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/14/2017] [Indexed: 11/20/2022]
Abstract
To escape after taking a blood meal, a mosquito must exert forces sufficiently high to take off when carrying a load roughly equal to its body weight, while simultaneously avoiding detection by minimizing tactile signals exerted on the host's skin. We studied this trade-off between escape speed and stealth in the malaria mosquito Anopheles coluzzii using 3D motion analysis of high-speed stereoscopic videos of mosquito take-offs and aerodynamic modeling. We found that during the push-off phase, mosquitoes enhanced take-off speed using aerodynamic forces generated by the beating wings in addition to leg-based push-off forces, whereby wing forces contributed 61% of the total push-off force. Exchanging leg-derived push-off forces for wing-derived aerodynamic forces allows the animal to reduce peak force production on the host's skin. By slowly extending their long legs throughout the push-off, mosquitoes spread push-off forces over a longer time window than insects with short legs, thereby further reducing peak leg forces. Using this specialized take-off behavior, mosquitoes are capable of reaching take-off speeds comparable to those of similarly sized fruit flies, but with weight-normalized peak leg forces that were only 27% of those of the fruit flies. By limiting peak leg forces, mosquitoes possibly reduce the chance of being detected by the host. The resulting combination of high take-off speed and low tactile signals on the host might help increase the mosquito's success in escaping from blood-hosts, which consequently also increases the chance of transmitting vector-borne diseases, such as malaria, to future hosts.
Collapse
Affiliation(s)
- F T Muijres
- Experimental Zoology Group, Wageningen University & Research, PO Box 338, 6700 AH, Wageningen, The Netherlands
| | - S W Chang
- Department of Integrative Biology, University of California, Berkeley, CA 94720, USA
| | - W G van Veen
- Experimental Zoology Group, Wageningen University & Research, PO Box 338, 6700 AH, Wageningen, The Netherlands
| | - J Spitzen
- Laboratory of Entomology, Wageningen University & Research, PO Box 16, 6700 AA, Wageningen, The Netherlands
| | - B T Biemans
- Experimental Zoology Group, Wageningen University & Research, PO Box 338, 6700 AH, Wageningen, The Netherlands
| | - M A R Koehl
- Department of Integrative Biology, University of California, Berkeley, CA 94720, USA
| | - R Dudley
- Department of Integrative Biology, University of California, Berkeley, CA 94720, USA
| |
Collapse
|
42
|
Vo Hoang Nhat P, Ngo HH, Guo WS, Chang SW, Nguyen DD, Nguyen PD, Bui XT, Zhang XB, Guo JB. Can algae-based technologies be an affordable green process for biofuel production and wastewater remediation? Bioresour Technol 2018; 256:491-501. [PMID: 29472123 DOI: 10.1016/j.biortech.2018.02.031] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 06/08/2023]
Abstract
Algae is a well-known organism that its characteristic is prominent for biofuel production and wastewater remediation. This critical review aims to present the applicability of algae with in-depth discussion regarding three key aspects: (i) characterization of algae for its applications; (ii) the technical approaches and their strengths and drawbacks; and (iii) future perspectives of algae-based technologies. The process optimization and combinations with other chemical and biological processes have generated efficiency, in which bio-oil yield is up to 41.1%. Through life cycle assessment, algae bio-energy achieves high energy return than fossil fuel. Thus, the algae-based technologies can reasonably be considered as green approaches. Although selling price of algae bio-oil is still high (about $2 L-1) compared to fossil fuel's price of $1 L-1, it is expected that the algae bio-oil's price will become acceptable in the next coming decades and potentially dominate 75% of the market.
Collapse
Affiliation(s)
- P Vo Hoang Nhat
- Joint Research Centre for Protective Infrastructure Technology and Environmental Green Bioprocess, School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo, NSW 2007, Australia and Department of Environmental and Municipal Engineering, TianjinChengjian University, Tianjin 300384, China
| | - H H Ngo
- Joint Research Centre for Protective Infrastructure Technology and Environmental Green Bioprocess, School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo, NSW 2007, Australia and Department of Environmental and Municipal Engineering, TianjinChengjian University, Tianjin 300384, China.
| | - W S Guo
- Joint Research Centre for Protective Infrastructure Technology and Environmental Green Bioprocess, School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo, NSW 2007, Australia and Department of Environmental and Municipal Engineering, TianjinChengjian University, Tianjin 300384, China
| | - S W Chang
- Department of Environmental Energy & Engineering, Kyonggi University, 442-760, Republic of Korea
| | - D D Nguyen
- Department of Environmental Energy & Engineering, Kyonggi University, 442-760, Republic of Korea; Institution of Research and Development, Duy Tan University, Da Nang, Viet Nam
| | - P D Nguyen
- Faculty of Environment and Natural Resources, University of Technology, Vietnam National University-Ho Chi Minh, District 10, Ho Chi Minh City, Viet Nam
| | - X T Bui
- Faculty of Environment and Natural Resources, University of Technology, Vietnam National University-Ho Chi Minh, District 10, Ho Chi Minh City, Viet Nam
| | - X B Zhang
- Joint Research Centre for Protective Infrastructure Technology and Environmental Green Bioprocess, School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo, NSW 2007, Australia and Department of Environmental and Municipal Engineering, TianjinChengjian University, Tianjin 300384, China
| | - J B Guo
- Joint Research Centre for Protective Infrastructure Technology and Environmental Green Bioprocess, School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo, NSW 2007, Australia and Department of Environmental and Municipal Engineering, TianjinChengjian University, Tianjin 300384, China
| |
Collapse
|
43
|
Bohl MA, Almefty KK, Preul MC, Turner JD, Kakarla UK, Reece EM, Chang SW. Vascularized Spinous Process Graft Rotated on a Paraspinous Muscle Pedicle for Lumbar Fusion: Technique Description and Early Clinical Experience. World Neurosurg 2018; 115:186-192. [PMID: 29673822 DOI: 10.1016/j.wneu.2018.04.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Vascularized bone grafts (VBGs) are described as having superior osteogenicity, osteoconductivity, and osteoinductivity compared with other graft types and have been used in high-risk patients to augment arthrodesis. Pedicled VBGs are rotated on an intact vascular pedicle and therefore maintain all the benefits of VBGs but avoid many of the challenges and additional morbidity of free-tissue transfer. This study describes a novel surgical technique for rotating vascularized spinous process into the posterolateral space for augmenting arthrodesis in patients undergoing posterolateral fusion (PLF). METHODS A technique is described for rotating the spinous process into the posterolateral space on an intact vascular pedicle of paraspinal muscle. Early clinical and radiographic outcomes are reported for 4 patients who have undergone this procedure. RESULTS Four patients were treated with a single or 2-level PLF combined with posterior, anterior, or lateral interbody fusion and vascularized spinous process graft. Three-month postoperative computed tomography scans demonstrated a dislodged graft in 1 patient and successful arthrodesis in 3 patients. Additional operative time taken for graft harvest and implantation ranged from 22 minutes for the first patient to 6 minutes for the fourth patient. CONCLUSIONS Rotation of vascularized spinous process graft for augmentation of posterolateral arthrodesis in the lumbar spine is a potentially safe, effective surgical technique that results in successful arthrodesis in as little as 3 months but requires further study. This technique is expected to add little additional time or morbidity to the traditional lumbar PLF because it requires no separate incision or additional bone removal.
Collapse
Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kaith K Almefty
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mark C Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Edward M Reece
- Departments of Neurosurgery and Plastic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
| |
Collapse
|
44
|
Bohl MA, Mooney MA, Repp GJ, Cavallo C, Nakaji P, Chang SW, Turner JD, Kakarla UK. The Barrow Biomimetic Spine: Comparative Testing of a 3D-Printed L4-L5 Schwab Grade 2 Osteotomy Model to a Cadaveric Model. Cureus 2018; 10:e2491. [PMID: 29922532 PMCID: PMC6003793 DOI: 10.7759/cureus.2491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction The Barrow Biomimetic Spine project is an ongoing effort to develop a three-dimensional (3D)-printed synthetic spine model with high anatomical and biomechanical fidelity to human tissue. The purpose of this study was to evaluate the biomechanical performance of an L4-L5 3D-printed synthetic spine model in a lordotic correction test after Schwab grade 2 osteotomies as compared to human cadaveric spines that have undergone the same osteotomies and lordotic correction. Methods Ten different L4-L5 synthetic spine models were 3D printed. Each print varied in either the material used for the soft tissue components, the infill density of the bony and soft tissue structures, the pre-correction disc height, or the model orientation on the print bed. Each print was instrumented with pedicle screws and underwent a Schwab grade 2 osteotomy. Changes in disc height measurements and end-plate angle were compared against cadaveric data acquired using the same study method. Results A simple linear correlation analysis demonstrated that for horizontally printed models using PolyFlex (Polymaker, New York, NY, USA)(models 1-3, 8, 10), the pre-correction posterior disc height and lordotic correction were moderately correlated (r = 0.56), but this correlation did not achieve statistical significance (P = 0.12). Regression analysis demonstrated a very strong correlation between lordotic correction and change in posterior disc height (r = 0.92, P < 0.001). Models printed either vertically (models 4-6) or with low bone density and high soft tissue density (model 10) appeared to perform the most similarly to the cadaveric tissue. Discussion The 3D-printed synthetic spine models demonstrated predictable and reliable performance in a lordotic correction test based on their respective material qualities and print densities. The print variables tested further demonstrated that this model is capable of achieving high biomechanical fidelity to cadaveric tissue when subjected to the same lordotic correction test after Schwab grade 2 osteotomies.
Collapse
Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Garrett J Repp
- Biomedical Engineering, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Claudio Cavallo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| |
Collapse
|
45
|
Cheng DL, Ngo HH, Guo WS, Liu YW, Zhou JL, Chang SW, Nguyen DD, Bui XT, Zhang XB. Bioprocessing for elimination antibiotics and hormones from swine wastewater. Sci Total Environ 2018; 621:1664-1682. [PMID: 29074241 DOI: 10.1016/j.scitotenv.2017.10.059] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/24/2017] [Accepted: 10/07/2017] [Indexed: 06/07/2023]
Abstract
Antibiotics and hormones in swine wastewater have become a critical concern worldwide due to the severe threats to human health and the eco-environment. Removal of most detectable antibiotics and hormones, such as sulfonamides (SAs), SMs, tetracyclines (TCs), macrolides, and estrogenic hormones from swine wastewater utilizing various biological processes were summarized and compared. In biological processes, biosorption and biodegradation are the two major removal mechanisms for antibiotics and hormones. The residuals in treated effluents and sludge of conventional activated sludge and anaerobic digestion processes can still pose risks to the surrounding environment, and the anaerobic processes' removal efficiencies were inferior to those of aerobic processes. In contrast, membrane bioreactors (MBRs), constructed wetlands (CWs) and modified processes performed better because of their higher biodegradation of toxicants. Process modification on activated sludge, anaerobic digestion and conventional MBRs could also enhance the performance (e.g. removing up to 98% SMs, 88.9% TCs, and 99.6% hormones from wastewater). The hybrid process combining MBRs with biological or physical technology also led to better removal efficiency. As such, modified conventional biological processes, advanced biological technologies and MBR hybrid systems are considered as a promising technology for removing toxicants from swine wastewater.
Collapse
Affiliation(s)
- D L Cheng
- Joint Research Centre for Protective Infrastructure Technology and Environmental Green Bioprocess, School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo NSW 2007, Australia and Department of Environmental and Municipal Engineering, Tianjin Chengjian University, Tianjin 300384, China
| | - H H Ngo
- Joint Research Centre for Protective Infrastructure Technology and Environmental Green Bioprocess, School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo NSW 2007, Australia and Department of Environmental and Municipal Engineering, Tianjin Chengjian University, Tianjin 300384, China; Institution of Research and Development, Duy Tan University, Da Nang, Viet Nam.
| | - W S Guo
- Joint Research Centre for Protective Infrastructure Technology and Environmental Green Bioprocess, School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo NSW 2007, Australia and Department of Environmental and Municipal Engineering, Tianjin Chengjian University, Tianjin 300384, China
| | - Y W Liu
- Joint Research Centre for Protective Infrastructure Technology and Environmental Green Bioprocess, School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo NSW 2007, Australia and Department of Environmental and Municipal Engineering, Tianjin Chengjian University, Tianjin 300384, China
| | - J L Zhou
- Joint Research Centre for Protective Infrastructure Technology and Environmental Green Bioprocess, School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo NSW 2007, Australia and Department of Environmental and Municipal Engineering, Tianjin Chengjian University, Tianjin 300384, China
| | - S W Chang
- Department of Environmental Energy & Engineering, Kyonggi University, 442-760, Republic of Korea.
| | - D D Nguyen
- Department of Environmental Energy & Engineering, Kyonggi University, 442-760, Republic of Korea; Institution of Research and Development, Duy Tan University, Da Nang, Viet Nam
| | - X T Bui
- Faculty of Environment and Natural Resources, University of Technology, Vietnam National University-Ho Chi Minh, District 10, Ho Chi Minh City, Viet Nam
| | - X B Zhang
- Joint Research Centre for Protective Infrastructure Technology and Environmental Green Bioprocess, School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo NSW 2007, Australia and Department of Environmental and Municipal Engineering, Tianjin Chengjian University, Tianjin 300384, China
| |
Collapse
|
46
|
Bohl MA, Hlubek RJ, Kakarla UK, Chang SW. Divergent Bilateral Posterior Lumbar Interbody Fusion with Cortical Screw Fixation: Description of New Trajectory for Interbody Technique from Midline Exposure. World Neurosurg 2018; 113:e480-e485. [PMID: 29462734 DOI: 10.1016/j.wneu.2018.02.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND A major drawback to use of cortical bone trajectory pedicle screws (CBTPSs) with traditional posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion grafts is that traditional graft insertion trajectories require wider posterior exposure. This wider exposure, beyond the limits otherwise required for CBTPS placement, negates a primary benefit of CBTPS fixation. The aim of this study was to define an alternative surgical technique for interbody graft placement that, when used in conjunction with CBTPS fixation, permits both minimal soft tissue dissection and optimal graft placement. METHODS A team of neurosurgeons specializing in treatment of spinal pathologies developed a surgical technique for insertion of bilateral PLIF grafts that complements the principles of CBTPS fixation. This technique is illustrated in a patient undergoing lumbosacral decompression, CBTPS fixation, and 3-column arthrodesis. RESULTS The described technique uses a divergent trajectory of bilateral PLIF grafts rather than the traditional parallel or convergent trajectories. CONCLUSIONS By aiming medially to laterally with the interbody graft, one recapitulates many advantages of CBTPSs, including avoidance of wide tissue dissection, greater intergraft volume available for bone grafting, and greater graft coverage of the hypophyseal ring. The prospective collection of outcome data for patients who undergo lumbosacral fusion using the divergent PLIF technique is ongoing.
Collapse
Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Randall J Hlubek
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
| |
Collapse
|
47
|
Chen C, Guo WS, Ngo HH, Chang SW, Nguyen DD, Zhang J, Liang S, Guo JB, Zhang XB. Effects of C/N ratio on the performance of a hybrid sponge-assisted aerobic moving bed-anaerobic granular membrane bioreactor for municipal wastewater treatment. Bioresour Technol 2018; 247:340-346. [PMID: 28950144 DOI: 10.1016/j.biortech.2017.09.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 06/07/2023]
Abstract
This study aimed to evaluate the impact of C/N ratio on the performance of a hybrid sponge-assisted aerobic moving bed-anaerobic granular membrane bioreactor (SAAMB-AnGMBR) in municipal wastewater treatment. The results showed that organic removal efficiencies were above 94% at all C/N conditions. Nutrient removal was over 91% at C/N ratio of 100/5 but was negatively affected when decreasing C/N ratio to 100/10. At lower C/N ratio (100/10), more noticeable membrane fouling was caused by aggravated cake formation and pore clogging, and accumulation of extracellular polymeric substances (EPS) in the mixed liquor and sludge cake as a result of deteriorated granular quality. Foulant analysis suggested significant difference existed in the foulant organic compositions under different C/N ratios, and humic substances were dominant when the fastest fouling rate was observed. The performance of the hybrid system was found to recover when gradually increasing C/N ratio from 100/10 to 100/5.
Collapse
Affiliation(s)
- C Chen
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - W S Guo
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NSW 2007, Australia.
| | - H H Ngo
- Centre for Technology in Water and Wastewater, School of Civil and Environmental Engineering, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - S W Chang
- Department of Environmental Energy & Engineering, Kyonggi University, 442-760, Republic of Korea
| | - D D Nguyen
- Department of Environmental Energy & Engineering, Kyonggi University, 442-760, Republic of Korea; Institute of Research and Development, Duy Tan University, Da Nang, Viet Nam
| | - J Zhang
- Shandong Key Laboratory of Water Pollution Control and Resource Reuse, School of Environmental Science and Engineering, Shandong University, Jinan 250100, China
| | - S Liang
- Shandong Key Laboratory of Water Pollution Control and Resource Reuse, School of Environmental Science and Engineering, Shandong University, Jinan 250100, China
| | - J B Guo
- Department of Environmental and Municipal Engineering, Tianjin Chengjian University, Jinjing Road 26, Tianjin 300384, China
| | - X B Zhang
- Department of Environmental and Municipal Engineering, Tianjin Chengjian University, Jinjing Road 26, Tianjin 300384, China
| |
Collapse
|
48
|
Ho TH, Chang SW, Yeh HW, Yeh CB. Occult Perforation with Circumferential Ischaemic Injury of the Sigmoid Colon following Seat-Belt Trauma: A Case Report. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791702400210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Seat-belt syndrome is defined as the presence of a seat-belt sign predominantly involving thoracolumbar vertebral fractures and intra-abdominal organ injury following the use of a seat belt during a traffic collision. Isolated sigmoid colon perforation occurring as part of seat-belt syndrome is rare. We report a 34-year-old patient who presented seat-belt sign after his car collided with a guardrail. The patient was initially haemodynamically stable and complained lower abdomen pain. Serial clinical examination with abdominal computed tomography (CT) scans illustrated sigmoid colon with ischaemic change without perforation. Exploratory laparotomy was performed and isolated sigmoid colon perforation was diagnosed. Therefore, in cases of persistent abdominal pain or tenderness despite an initially negative CT scan, repeated examinations of the abdomen with following abdominal CT are recommended because of the high risk of seat-belt sign and the possibility that the peritoneal symptoms can be hidden, such as in the retroperitoneal duodenum or sigmoid colon. Thus, we recommend using repeat abdominal CT as an adjunct to secondary survey for clarifying the haemodynamic status of patients with seat-belt trauma.
Collapse
Affiliation(s)
| | - SW Chang
- Chung Shan Medical University Hospital, Department of Surgery; and Chung Shan Medical University, Department of Surgery, School of Medicine, Taichung, Taiwan
| | - HW Yeh
- Chang Gung University, School of Medicine, No. 259, Wenhua 1st Road, Guishan District, Taoyuan City 33302, Taiwan
| | | |
Collapse
|
49
|
Mooney MA, Brigeman S, Bohl MA, Simon ED, Sheehy JP, Chang SW, Spetzler RF. Analysis of overlapping surgery in patients undergoing microsurgical aneurysm clipping: acute and long-term outcomes from the Barrow Ruptured Aneurysm Trial. J Neurosurg 2017; 129:711-717. [PMID: 29099301 DOI: 10.3171/2017.5.jns17394] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Overlapping surgery is a controversial subject in medicine today; however, few studies have examined the outcomes of this practice. The authors analyzed outcomes of patients with acutely ruptured saccular aneurysms who were treated with microsurgical clipping in a prospectively collected database from the Barrow Ruptured Aneurysm Trial. Acute and long-term outcomes for overlapping versus nonoverlapping cases were compared. METHODS During the study period, 241 patients with ruptured saccular aneurysms underwent microsurgical clipping. Patients were separated into overlapping (n = 123) and nonoverlapping (n = 118) groups based on surgical start/stop times. Outcomes at discharge and at 6 months, 1 year, 3 years, and 6 years after surgery were analyzed. RESULTS Patient variables (e.g., age, smoking status, cardiovascular history, Hunt and Hess grade, Fisher grade, and aneurysm size) were similar between the 2 groups. Aneurysm locations were similar, with the exception of the overlapping group having more posterior circulation aneurysms (18/123 [15%]) than the nonoverlapping group (8/118 [7%]) (p = 0.0495). Confirmed aneurysm obliteration at discharge was significantly higher for the overlapping group (109/119 [91.6%]) than for the nonoverlapping group (95/116 [81.9%]) (p = 0.03). Hospital length of stay, discharge location, and proportions of patients with a modified Rankin Scale (mRS) score > 2 at discharge and up to 6 years postoperatively were similar. The mean and median mRS, Glasgow Outcome Scale, Mini-Mental State Examination, National Institutes of Health Stroke Scale, and Barthel Index scores at all time points were not statistically different between the groups. CONCLUSIONS Compared with nonoverlapping surgery, overlapping surgery was not associated with worse outcomes for any variable at any time point, despite the complexity of the surgical management in this patient population. These findings should be considered during the discussion of future guidelines on the practice of overlapping surgery.
Collapse
|
50
|
Chang SW, Shim KS, Kim YC, Jee KK, Zhu Q, Perinpanayagam H, Kum KY. Cyclic fatigue resistance, torsional resistance, and metallurgical characteristics of V taper 2 and V taper 2H rotary NiTi files. Scanning 2016; 38:564-570. [PMID: 26792574 DOI: 10.1002/sca.21301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 12/31/2015] [Accepted: 01/07/2016] [Indexed: 06/05/2023]
Abstract
The aim of this study was to compare the cyclic fatigue resistance, torsional resistance, and metallurgical characteristics of conventional NiTi wire (V taper 2, V2) and CM wire (V taper 2H, V2H)-based files. Cyclic fatigue and torsional resistance of V2 and V2H were investigated by measuring the number of cycles to fracture, maximum torque at fracture, and maximum angle at fracture. The typical patterns of fatigue and torsional fractures were investigated using a scanning electron microscope (SEM). The metallurgical characteristics were investigated by differential scanning calorimetry (DSC) from -100 °C to 100 °C. The austenite finishing temperature (Af) of each instrument was also measured. The microstructures of the instruments were investigated by a transmission electron microscope (TEM) along with selected area diffraction pattern analysis. The results were statistically analyzed by Mann-Whitney U-test (p = 0.05). V2H showed significantly higher cyclic fatigue resistance and torsional resistance than V2. SEM images of the fractured surfaces showed typical patterns of fatigue and torsional fracture. The DSC analysis of V2 showed one small peak in both the heating and cooling curves. The Af of V2 was -0.32 °C. V2H showed two remarkable peaks in the heating curve and one remarkable peak in the cooling curve. The Af of V2H was 33.25 °C. The TEM analysis showed that both V2 and V2H are mainly composed of austenite. In conclusion, V2H showed higher cyclic fatigue resistance and torsional resistance than V2. The superior properties of V2H could be attributed to the annealing effect and possibly the martensite phase. SCANNING 38:564-570, 2016. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- S W Chang
- Department of Conservative Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - K S Shim
- Department of Conservative Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Y C Kim
- Biomedical Research Institute, Korea Institute of Science and Technology, Seoul, Korea
| | - K K Jee
- Future Convergence Research Division, Korea Institute of Science and Technology, Seoul, Korea
| | - Q Zhu
- Division of Endodontology, Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, University of Connecticut Health Center, Farmington, Connecticut
| | - H Perinpanayagam
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - K Y Kum
- Department of Conservative Dentistry, Dental Research Institute and BK21 Program, Seoul National University Dental Hospital, Seoul National, University School of Dentistry, Seoul, Korea
| |
Collapse
|