A three-dimensional morphological assessment for evaluating pre and post-surgery in cervical laminoplasty

OBJECTIVE

The efficacy of medical treatments and the changes in radiological imaging before and after treatment have consistently remained pivotal factors. This is particularly critical for surgical procedures, where precise evaluation of disparities pre- and post-surgery or the accuracy of implantation is paramount. Based on three-dimensional morphological interests, we provide an automatic quantification evaluation method that delivers an evident base for assessing the outcomes of a widely employed surgical technique, cervical laminoplasty.

METHODS

The sample study included patients who underwent cervical laminoplasty for cervical spondylotic myelopathy/ossification of the longitudinal ligament. We present a superimposition method that facilitates a unique and precise assessment between pre and post-surgery. The degree of expansion was evaluated by the canal volume increase and canal expansion rate after surgery.

RESULTS

There were 31 patients with 112 vertebral segments measured. The target cervical's pre- and post-operative canal areas were 122.63 ± 30.34 and 196.50 ± 37.10 mm2, respectively (P < 0.001). The average cervical canal expansion rate was 64.42%. The expansion effect of C5 cervical laminoplasty was the maximum (71.01%), and the canal volume of other segments expanded by approximately 60%. The functional outcomes demonstrated significant improvements in symptoms.

CONCLUSIONS

The quantification evaluation method can be utilized for any morphology changes before and after laminoplasty, as it does not lead to errors or variations from different inspection machines or human factors. The automatic method delivers an evident base for assessing the outcomes of a widely employed surgical technique.

Metacarpophalangeal joint reconstruction using a costal osteochondral graft: A case report

RATIONALE

The conventional treatment of giant cell tumors is intralesional curettage with local adjuvant therapy. Because hand tumors have a high local recurrence, the primary goal for treating tumors of the hand is to eradicate the lesion.

PATIENT CONCERNS

To preserve the metacarpophalangeal (MCP) joint function as well as avoid further recurrence after surgery.

DIAGNOSES

The giant cell tumor invades the patient's MCP joint in an index proximal phalanx.

INTERVENTIONS

Using computer-aided design and three-dimensional printing techniques, we reformed the original shapes of the MCP joint and its peripheral bone to replica models. The surgeon then performed an en bloc resection and proximal phalanx with MCP joint reconstruction by fabricating the patient's costal osteochondral graft during the operation.

OUTCOMES

After 6 months of rehabilitation, the patient's finger functions could pinch and grasp objects naturally. At the 1-year follow-up, the range of motion of the MCP, proximal interphalangeal, and distal interphalangeal joints improved from flexion of 35° to 60°, 75° to 85°, and 60° to 80°, respectively. The hand function achieved the mean performance of non-preferred hands for young females at the postoperative 3-year follow-up.

LESSONS

The customized prototyping technique has the potential to replica the original patient's bony graft to reach the goal of minimizing the defects at the donor site and maximizing the function of the reconstructed MCP joint.

Combining Laminoplasty With Artificial Disc Replacement for the Treatment of Cervical Spondylotic Myelopathy With Congenital Cervical Stenosis

BACKGROUND

Cervical spondylotic myelopathy (CSM) is a very common and devastating spinal disease. Congenital cervical stenosis (CCS) is the most common cause. We aimed to elucidate the security, effectivity, and feasibility of surgery combining laminoplasty with artificial disc replacement (ADR) to treat CSM patients with radiculopathy, especially for preserving the range of motion (ROM) of the cervical spine.

METHOD

Between August 2008 and April 2019, 39 patients with multiple CSM caused by CCS were enrolled in the present study. All patients received laminoplasty first and then ADR. We used a retrospective collection of data for evaluating the functional and radiologic outcomes, especially regarding preservation of ROM.

RESULTS

Each patient underwent at least a 2-year postoperative follow-up. The Japanese Orthopedic Association score showed great improvements at 6 months. The ADR index-level ROM was preserved during follow-up. The subaxial Cobb angle could also be retained in the whole cervical spine, and the spinal canal diameter could be expanded by more than 52.6%. There were no severe complications or side effects, and no patients needed secondary surgery.

CONCLUSIONS

We aimed to treat multiple levels of CSM with adequate decompression without too many intervertebral disc replacements. We were able to expand the spinal canal directly for these patients with CCS and needed only 1- or 2-level ADR to treat them with associated radiculopathy. This combined surgical strategy was secure, effective, and was able to preserve the ROM of the cervical spine.

LEVEL OF EVIDENCE: 4

An Automatic Voxel-Based Method for Optimal Symmetry Plane Generation for the Maxillofacial Region in Severe Asymmetry Cases

Symmetry is representative of aesthetics and health in all kinds of vertebrates, especially the human face. Therefore, to automatically locate the appropriate symmetry plane is crucial. The aim of this study was to develop an automatic and reliable method to determine the symmetry plane of the maxillofacial region. We compared the proposed method of determining the symmetry plane by assessing landmark-based and surface-based methods by way of quantitative symmetry assessments. Statistical analysis was applied to evaluate whether significant difference existed among these three kinds of symmetry planes. Twenty cases who had a diagnosis of severe facial asymmetry were evaluated retrospectively. The results showed that searching for the symmetry plane using a voxel-based method, named the optimal symmetry plane (OSP), achieved the most representative symmetry according to the outcomes of the trials. The OSP was significantly more symmetrical than the other two planes, as determined by other methods. The paired-voxel computation method proposed in this research is a robust and reliable method for identifying the unique symmetry plane for patients with severe facial asymmetry. Symmetry is of crucial significance for all kinds of vertebrates, including its clinical implications for surgical planning in orthognathic surgery.

Supercritical Carbon Dioxide Decellularized Xenograft-3D CAD/CAM Carved Bone Matrix Personalized for Human Bone Defect Repair

About 30-50% of oral cancer patients require mandibulectomy and autologous fibula reconstruction. Autograft is the gold standard choice because of its histocompatibility; however, it requires additional surgery from the patient and with possible complications such as loss of fibula leading to calf weakening in the future. Allograft and xenograft are alternatives but are susceptible to immune response. Currently, no personalized bone xenografts are available in the market for large fascial bone defects. In addition, a large-sized complex shape bone graft cannot be produced directly from the raw material. We propose the use of porcine bones with 3D CAD/CAM carving to reconstruct a personalized, wide range and complex-shaped bone. We anticipate that patients can restore their native facial appearance after reconstruction surgery. Supercritical CO2 (SCCO2) technology was employed to remove the cells, fat and non-collagenous materials while maintaining a native collagen scaffold as a biomedical device for bone defects. We successfully developed 3D CAD/CAM carved bone matrices, followed by SCCO2 decellularization of those large-sized bones. A lock-and-key puzzle design was employed to fulfil a wide range of large and complex-shaped maxillofacial defects. To conclude, the 3D CAD/CAM carved bone matrices with lock and key puzzle Lego design were completely decellularized by SCCO2 extraction technology with intact natural collagen scaffold. In addition, the processed bone matrices were tested to show excellent cytocompatibility and mechanical stiffness. Thus, we can overcome the limitation of large size and complex shapes of xenograft availability. In addition, the 3D CAD/CAM carving process can provide personalized tailor-designed decellularized bone grafts for the native appearance for maxillofacial reconstruction surgery for oral cancer patients and trauma patients.

Protective effects of flavonoids from the leaves of Carya cathayensis Sarg. against H2O2-induced oxidative damage and apoptosis in vitro

Hydrogen peroxide (H2O2) can induce apoptosis by releasing reactive oxygen species (ROS) and reactive nitrogen species, which cause mitochondrial damage. The present study aimed to investigate the protective effects of flavonoids from the leaves of Carya cathayensis Sarg. against H2O2-induced oxidative damage and apoptosis in vitro. The bioactivity of total flavonoids (TFs) and five monomeric flavonoids [cardamonin (Car), pinostrobin chalcone, wogonin, chrysin and pinocembrin] from the leaves of Carya cathayensis Sarg. (LCCS) were tested to prevent oxidative damage to rat aortic endothelial cells (RAECs) induced by H2O2. Oxidated superoxide dismutase, glutathione peroxidase, malondialdehyde, lactate dehydrogenase and ROS were analyzed to evaluate the antioxidant activity. Gene and protein expression patterns were assessed using reverse transcription-quantitative PCR and western blotting, respectively. The results indicated that TFs and Car inhibited H2O2-induced cytotoxicity and apoptosis of RAECs. Additionally, they regulated the level of oxidase and inhibited the production of ROS. Overall, the TFs extracted from LCCS could potentially be developed as effective candidate drugs to prevent oxidative stress in the future; moreover, they could also provide a direction in investigations for preventing antioxidant activity through the ROS pathway.

Reconstruction of three-dimensional lumbar vertebrae from biplanar x-rays

Objective. Vertebrae models from computer tomographic (CT) imaging are extensively used in image-guided surgical systems to deliver percutaneous orthopaedic operations with minimum risks, but patients may be exposed to excess radiation from the pre-operative CT scans. Generating vertebrae models from intra-operative x-rays for image-guided systems can reduce radiation exposure to the patient, and the surgeons can acquire the vertebrae's relative positions during the operation; therefore, we proposed a lumbar vertebrae reconstruction method from biplanar x-rays.Approach. Non-stereo-corresponding vertebral landmarks on x-rays were identified as targets for deforming a set of template vertebrae; the deformation was formulated as a minimisation problem, and was solved using the augmented Lagrangian method. Mean surface errors between the models reconstructed using the proposed method and CT scans were measured to evaluate the reconstruction accuracy.Main results. The evaluation yielded mean errors of 1.27 mm and 1.50 mm inin vitroexperiments on normal vertebrae and pathological vertebrae, respectively; the outcomes were comparable to other template-based methods.Significance. The proposed method is a viable alternative to provide digital lumbar to be used in image-guided systems, where the models can be used as a visual reference in surgical planning and image-guided applications in operations where the reconstruction error is within the allowable surgical error.

[Role of Orai 1-mediated store-operated calcium entry in the immune function of CD4+ T cells in septic mice]

Objective: To investigate the role of Orai1-mediated store-operated calcium entry in the immune damage of CD4⁺ T cells in septic mice. Methods: Sepsis mouse model was established by cecal ligation and puncture(CLP). Balb/c mice of clean grade were sacrificed 1, 3, and 5 days after operation. Spleen samples were harvested at given intervals. Splenic CD4⁺ T cells were selected by immunomagnetic beads and the expression of Orai1 protein was detected by western blotting, the storage operated calcium entry (SOCE) was detected by flow cytometry, the apoptosis of CD4⁺ T cells was detected by flow cytometry, the proliferation of CD4⁺ T cells was detected by CCK-8, and the IFN-γ and IL-4 were detected by enzyme-linked immunosorbent assay (ELISA). Then the expression of Orai1 protein was regulated to further detect the SOCE and immune function of splenic CD4⁺ T cells in mice. The experiment was divided into 4 groups, sham group, CLP3 group, Orai1 down group (Orai1-down group) and Orai1 up regulation group (Orai1-up group). Results: The relative expression of Orai1 protein in splenic CD4⁺ T cells in sham group was 1.03±0.16. Compared with sham group, Orai1 protein levels in CLP Group were all significantly lower (F=19.64, P=0.000 5). The increased value of splenic CD4⁺ T cells fluorescence intensity in sham group was 494±41. Compared with sham group, the levels of SOCE in CLP Group were all lower (F=30.01, P=0.001). The ratio of early and late apoptosis of CD4⁺ T cells in sham group was 8.7%±1.5%. Compared with sham group, the early and late apoptosis rates of CLP Group were significantly higher (F=32.29, P=0.000 1). The OD of sham group was 0.81±0.10 at 450 nm. Compared with sham group, the proliferation ability of splenic CD4⁺ T cells in CLP Group were significantly decreased (F=7.26, P=0.001 8). Compared with sham group, the secretion of IFN-γ and IL-4 by CD4⁺ T cells and the ratio of IFN-γ/IL-4 in CLP Group were all significantly decreased (F=19.690, 6.183, 11.230, all P<0.05). Compared with CLP3 group, the increased value of fluorescence intensity of CD4⁺ T cells was significantly decreased, the early and late apoptosis ratio of CD4⁺ T cells was significantly increased, the OD450 nm value of CD4⁺ T cells was decreased, the multiplication capacity of splenic CD4⁺ T cells were decreased, the level of IFN-γ and IL-4 secreted by T cells were decreased, and the value of IFN-γ/IL-4 in orai1-down group was decreased (t=4.819, 7.952, 2.988, 28.760, 3.140, 7.670, all P<0.05). However, Orail-up group showed the opposite trend. Conclusion: Orai1-mediated store-operated calcium entry can alleviate the immune dysfunction of CD4⁺ T cells in septic mice.

Molecular docking simulation and in vitro studies on estrogenic activities of flavonoids from leaves of Carya cathayensis Sarg

The main purpose of this study was to evaluate the estrogenic properties of total flavonoids (TFs) and five flavonoid monomers (cardamonin (Car), pinostrobin chalcone (PC), wogonin (Wo), chrysin (Chr) and Pinocembrin (PI)) from leaves of Carya cathayensis Sarg (LCC). TFs from LCC were isolated and determined using HPLC. The 3-[4,5-dimethylthiazole-2-yl]-2,5-diphenyltetrazolium bromide (MTT) assay and flow cytometry were performed to assess the effects of flavonoids on cell proliferation and cell cycle, respectively. The molecular docking technique was applied to investigate binding conformations of the monomers from LCC to the estrogen receptor ERα and ERβ. Gene and protein expression patterns were assessed using quantitative real-time PCR (qRT-PCR) and western blot, respectively. The results showed that TFs, Car, PC, Wo and Chr promoted proliferation of MCF-7 cells and cell transition from the G1 to S phase, and inhabitation of MCF-7 cell proliferation was observed after the treatment of PI. Molecular docking studies confirmed ERs as molecular targets for the monomers. TFs, Car, PC, Wo and Chr from LCC promoted gene expression of ERα, ERβ, progesterone receptor (PR) and pS2. Our collective results demonstrated that TFs and monomers from LCC may exert ER agonist activity through competitively bind to ER, inducing ER upregulation and active ER to estrogen response element (ERE)- independent gene regulation. As an abundant natural product, LCC may provide a novel medicinal source for treatment of diseases caused by estrogen deficiency.

Discussion on the Management Method of COVID-19 Infection Prevention in Medical Residents

Background:

To explore the homogenized management method of infection prevention and control in medical resident under COVID-19 epidemic situation.

Methods:

Overall, 268 members in Ningbo Medical Group which was participating in the management of novel coronavirus pneumonia in Wuhan, China were managed homogeneously in terms of personal cleaning and disinfection of articles, prevention and control of infection in life, training and assessment of relevant infection knowledge in hospitals.

Results:

In the epidemic situation, the homogenization management of infection prevention and control in the resident of medical team is an important measure to block the transmission link.

Conclusion:

1. Conduct homogenization management on the training of hospital infection knowledge for medical staff. 2. Conduct homogeneous management of effective assessment of training knowledge. 3. Conduct homogenization management from personal cleaning and disinfection, as well as infection prevention and control in daily life.

3D-Customized Guiding Template for Posterior Fixation in Complex Atlantoaxial Instability-Preliminary Experiences of National Cheng Kung University Hospital

Objective  Atlantoaxial fixation is technically demanding and challenging, especially in cases with anatomical abnormality. The purpose of this study is to report the effectiveness of the three-dimensional (3D)-customized guiding template for placement of C1 and C2 screws in cases with abnormalities. Method  Two patients with anatomical abnormality and one without were included. The preoperative computed tomography (CT) image was analyzed using our software. The entry point, trajectory, and depth of the screws were designed based on these images. Templates with screw guiding cylinders and cervical spine model were created. In operation, guiding templates were applied directly to the laminae. Drilling, tapping, and screwing were performed through the cylinders. To evaluate the accuracy, deviation of the screw axis from the preplanned trajectory was measured on postoperative CT. A classification system was taking to evaluate the pedicle screw insertion. Results  In complex cases, one of C2 screws has grade 2 deviation, and two has grade 1. There was no deviation in screws of C1. All patients achieved symptoms free after 6 months follow-up. Conclusion  Although 3D-printed template for atlantoaxial fixation still has limitation in complex cases, it has been proved usefulness and makes the most difficult and dangerous spinal posterior fixation easy to achieve.

[Correlation between Movement Distance of Small Intestinal Contents and Survival Time in Female Rats after Feeding]

OBJECTIVES

To study the correlation between the movement distance of small intestinal contents and survival time in female SD rat models after one-time satiation, and to evaluate its application value for postmortem interval estimation.

METHODS

Adult female SD rats were randomly divided into postprandial groups （1, 2, 3, 4 and 5 h after feeding） and control group. The postprandial groups were fed for 1 h, meanwhile control group was kept fasting. All rats were sacrificed at the given time. The contents in stomach and small intestine were observed, described, compared and photographed, and the movement distance of small intestinal contents was measured. The data of postprandial groups were analysed by one-way analysis of variance.

RESULTS

The stomach and duodenum of control group were empty with a little thin and yellow small intestinal liquid. The gastral cavities of 1 h postprandial group were full of undigested food. The evolutionary changes of character, colour and content were observed in the gastric and small intestinal contents of other postprandial groups. The movement distance of intestinal contents increased while the empty part decreased gradually. The differences among the postprandial groups were statistically significant （P<0.05）.

CONCLUSIONS

After a 24 h fasting with free drinking and the following 1 h feeding, an ideal animal model can be established successfully on female SD rats, which can provide an experimental basis for postmortem interval estimation based on the changes of small intestinal contents in forensic practice.

Short-segment decompression and fixation for thoracolumbar osteoporotic fractures with neurological deficits

Objective

We assessed our results of short-segment decompression and fixation for osteoporotic thoracolumbar fractures with neurological deficits.

Methods

We evaluated 20 elderly patients (age, 60–89 years; mean, 73.2 years) with osteoporotic thoracolumbar fractures and neurological deficits. They underwent short-segment decompression and fixation and followed up for 40.6 (range, 24–68) months. A visual analog scale (VAS) and the Oswestry Disability Index (ODI) were used to measure back pain and disability. We also analyzed patients’ radiologic findings and neurological status. Perioperative and postoperative complications were recorded.

Results

At the latest follow-up, the average VAS score for back pain and ODI scores had significantly improved. The radiologic assessment showed significant improvements in local kyphosis, anterior vertebral height, and the vertebral wedge angle compared with the original measures. Neurological function also improved in 18 of 20 patients. No major complications occurred perioperatively. Our techniques included preservation of the posterior ligament complex, decortication of facet joints for fusion, no tapping to increase the screw insertional torque, pre-contouring of the rods according to the “adaptive” curve obtained from postural reduction, and postoperative spinal bracing.

Conclusions

Posterior short-segment decompression and fixation could be an effective surgical option for osteoporotic thoracolumbar burst fractures with neurological deficits.

Effect of mannose on the lung function of rats with acute pancreatitis

The present study aimed to investigate the mechanisms by which mannose protects the lung injury induced in rats with acute pancreatitis (AP). An AP combined with Acute Lung Injury (ALI) model was established. A total of 90 healthy adult male Sprague-Dawley rats (300±50g weight) were randomly divided into three groups: sham operation group (SO group), severe acute pancreatitis lung injury group (SAP group), and mannose intervention group (MT group). Subsequently, each group was divided into two subgroups based on the time passed from intervention, namely 6 and 12 h. Each subgroup comprised 15 rats. The ratio of wet/dry weight of the lung tissue exhibited no significant change at different time points in the SO group. This parameter was significantly increased in the SAP group compared with the SO group at each time point of the treatment (P less than 0.05) and it was significantly lower in the MT group than that in the AP group (P less than 0.05) and it was significantly increased in the AP group at each time (P less than 0.05) compared with the SO group. The levels of TNF-α in the lung tissue in the SO group exhibited no significant change at different time points, but they were significantly decreased in the MT group at each time point (P less than 0.05) compared with the SAP group. The mannose receptor (MR) mRNA and protein levels in the lung tissues exhibited no significant change at different time points. The mRNA and protein levels of MR in the SAP group were significantly decreased at each time point (P less than 0.05) compared with the SO group. The mRNA and protein levels of MR, in the lung tissue of the MT group were significantly increased at each time point compared with the SAP group (P less than 0.05). Mannose could reduce the injury caused to the lung tissue of rats with severe acute pancreatitis by up-regulation of the expression of MR mRNA and protein.

[Age Estimation of Adult Living Donor by Pubic MSCT Three-dimensional Reconstruction]

OBJECTIVES

To establish a method for the age estimation of adult living donor based on pubic MSCT three-dimensional reconstruction and verify its accuracy and reliability.

METHODS

The volume rendering （VR） image data of pubic symphysis surface were collected from 300 volunteers aged over 17 years old. According to different age groups, the age estimation of these volunteers was performed by the method and formula of pubic symphysis surface.

RESULTS

In the 300 volunteers, the difference between biological age and actual age was <1 year in 117 cases, >1-2 years in 178 cases, >2 years in 5 cases.

CONCLUSIONS

MSCT three-dimensional reconstruction technology of pubic symphysis surface can be used to estimate the age of adult living donor, which can provide a high accurate and reliable result.

Effect of probiotics plus antibiotics on inflammatory cytokines and quality of life in patients with non-biliary severe acute pancreatitis

AIM

To investigate the effect of probiotics plus antibiotics on inflammatory cytokines and the quality of life in patients with non-biliary severe acute pancreatitis (SAP).

METHODS

A total of 68 patients with non-biliary SAP treated from December 2013 to September 2017 at our hospital were selected and divided into a control group (n = 34) and a study group (n = 34). Both groups were given routine intervention and antibiotics (ceftriaxone + ornidazole + gentamycin), and the study group was additionally given probiotics (Bifidobacterium triple live bacteria). Both groups were treated for 7 d. The improvements of symptoms (time for blood amylase back to normal, time for body temperature back to normal, time to abdominal pain remission, and time to anal exhaust), hospitalization time, serum levels of calcitonin (PCT), C reactive protein (CRP), and interleukin-6 (IL-6) at admission and after treatment, quality of life (SF-36) score, and the incidence of adverse reactions were statistically compared between the two groups.

RESULTS

Time for blood amylase back to normal, time for body temperature back to normal, time to abdominal pain remission, and hospitalization time were significantly shorter in the study group than in the control group (P < 0.05). Before treatment, there was no significant difference in the levels of serum PCT, CRP, or IL-6 between the two groups. After treatment, the levels of serum PCT, CRP, and IL-6 in both groups were significantly lower than those before treatment, and the decrease was significantly greater in the study group than in the control group (P < 0.05). There was no significant difference between the two groups in SF-36 score before treatment. After treatment, the SF-36 scores in both groups were significantly higher than those before treatment, and SF-36 score in the study group was significantly higher than that in the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the study group and the control group (14.71% vs 8.82%, P > 0.05).

CONCLUSION

Probiotics combined with antibiotics in the treatment of non-biliary SAP patients can effectively relieve clinical symptoms, shorten hospitalization time, reduce serum inflammatory cytokine levels, alleviate the inflammatory response in the body, and improve patients' quality of life, without increasing the risk of adverse reactions.

Expression and clinical significance of rhubarb on serum amylase and TNF-alpha of rat model of acute pancreatitis

The aim of this study was to evaluate the therapeutic effect of rhubarb extract on acute pancreatitis. Ninety-six healthy Sprague Dawley rats, weighing 301±5.12 g were randomly divided into 4 groups: sham surgery (group A), acute pancreatitis model (group B), acute pancreatitis with normal saline (group C), and acute pancreatitis model with rhubarb (group D). The levels of serum amylase (AMY) and TNF-α were measured at 1st, 6th, 12th and 24th hour after modeling, and the pancreatic tissue were used to observe the pathologic changes. Compared to the sham group, the serum AMY and serum tumor necrosis factor (TNF-α) levels were significantly increased in the other groups (p <0.05). Compared to the model group and the saline group, the serum AMY, serum TNF-α level and pathological changes of rats in the rhubarb group were significantly lower (p <0.05). The serum AMY and TNF-α levels increased in acute pancreatitis. The rhubarb reduced the serum AMY and TNF-α level in rats with acute pancreatitis and reduced the pathological changes of pancreas and other tissues.

A novel method of C1-C2 transarticular screw insertion for symptomatic atlantoaxial instability using a customized guiding block: A case report and a technical note

Atlantoaxial instability treated with the C1-2 transarticular screw fixation is biomechanically more stable; however, the technique demanding and the potential risk of neurovascular injury create difficulties for clinical usage, and there is still lack of clinical experience till now.We reported an adult female patient with symptomatic atlantoaxial instability due to rheumatoid arthritis that was successfully treated with a bilateral C1-C2 transarticular screw fixation using a customized guiding block. We preoperatively determined the trajectories for bilateral C1-C2 transarticular screws on a 3-dimensional reconstruction model from the computed tomography (CT) and self-developed computer software, and designed a rapid prototyping customized guiding block in order to offer a guide for the entry point and insertion angle of the C1-C2 transarticular screws.The clinical outcome was good, and the follow-up period was >3 years. The accuracy of the screws is good in comparison with preoperative and postoperative CT findings, and no neurovascular injury occurred.The patient was accurately and successfully treated with a bilateral C1-C2 transarticular screw fixation using a customized guiding block.

Increasing speed to improve arm movement and standing postural control in Parkinson's disease patients when catching virtual moving balls

Research has shown that moving targets help Parkinson's disease (PD) patients improve their arm movement while sitting. We examined whether increasing the speed of a moving ball would also improve standing postural control in PD patients during a virtual reality (VR) ball-catching task. Twenty-one PD patients and 21 controls bilaterally reached to catch slow-moving and then fast-moving virtual balls while standing. A projection-based VR system connected to a motion-tracking system and a force platform was used. Dependent measures included the kinematics of arm movement (movement time, peak velocity), duration of anticipatory postural adjustments (APA), and center of pressure (COP) movement (movement time, maximum amplitude, and average velocity). When catching a fast ball, both PD and control groups made arm movements with shorter movement time and higher peak velocity, longer APA, as well as COP movements with shorter movement time and smaller amplitude than when catching a slow ball. The change in performance from slow- to fast-ball conditions was not different between the PD and control groups. The results suggest that raising the speed of virtual moving targets should increase the speed of arm and COP movements for PD patients. Therapists, however, should also be aware that a fast virtual moving target causes the patient to confine the COP excursion to a smaller amplitude. Future research should examine the effect of other task parameters (e.g., target distance, direction) on COP movement and examine the long-term effect of VR training.

Biodrying of municipal solid waste under different ventilation modes: drying efficiency and aqueous pollution

Ventilation is very important during the biodrying process because it affects the biodrying efficiency and secondary pollution. In this study, three ventilation modes-intermittent negative ventilation (IN), continuous negative ventilation (CN) and intermittent positive ventilation (IP)-were used to provide the same amount of total air during biodrying of municipal solid waste (MSW). During the entire 16-day experiment, 68.4%, 68.7% and 67.2% of water contained in the initial waste was removed under IN, CN and IP trials respectively. The ratio of water loss to volatile solid loss was used to evaluate the biodrying efficiency, with values of 5.35, 5.93 and 4.82 being observed for IN, CN and IP trials respectively. The total organic carbon concentrations of the leachate generated from the biodrying of waste were as high as 25,000 mg/l, while those of the condensate were not higher than 3500 mg/l. During the entire process, the average ammonia concentrations of leachate and condensate were 1350 mg/l and 2140 mg/l respectively. From the aspect of biodrying efficiency, continuous negative ventilation was the most preferable ventilation mode for biodrying of MSW, while special care should be taken to prevent aqueous pollution if it is used in a MSW treatment plant.

Odor compounds from different sources of landfill: characterization and source identification

This study investigated the odor compounds from different areas in a landfill site, which included the municipal solid waste (MSW)-related area, the leachate-related area and the sludge-related area. Nine sampling points were placed and 35 types of odorous substances were measured and quantified from these grabbed samples. The results showed that the main odorous substances emitted from landfill site were styrene, toluene, xylene, acetone, methanol, n-butanone, n-butylaldehyde, acetic acid, dimethyl sulfide, dimethyl disulfide and ammonia. In the MSW-related area, the highest concentrations of oxygenated compounds were observed at the gas extraction wells (GW), while sulfur compounds were rare. Ammonia in the sludge-related area was very abundant. Sludge discharge area (SD1) and sludge disposal work place (SD2) were representative points of pre- and post-drying, in which the characterizations of the emitted odorous gas were different. After chemical drying, the concentration of ammonia increased, whereas those of volatile fatty acids and sulfur compounds decreased. In the leachate-related area, relatively low concentrations of all those odorants were detected in leachate storage pool (LS), which may be due to the enclosure operation of the leachate storage pool. Using principal components analysis and cluster analysis, GW, SD1 and SD2 were distinguished from the other sampling points. The typical odorants in GW were acetaldehyde, ethyl benzene, xylene, methylamine and dimethyl formamide. The typical odorants in SD1 were methyl mercaptan, valeric acid and isovaleric acid, while those in SD2 were carbon disulfide, acetone, 3-pentanone, methanol and trimethylamine. The typical odorants in other sampling points were hydrogen sulfide, n-butylaldehyde and acetic acid.

Trunk-arm coordination in reaching for moving targets in people with Parkinson's disease: comparison between virtual and physical reality

We used a trunk-assisted prehension task to examine the effect of task (reaching for stationary vs. moving targets) and environmental constraints (virtual reality [VR] vs. physical reality) on the temporal control of trunk and arm motions in people with Parkinson's disease (PD). Twenty-four participants with PD and 24 age-matched controls reached for and grasped a ball that was either stationary or moving along a ramp 120% of arm length away. In a similar VR task, participants reached for a virtual ball that was either stationary or moving. Movement speed was measured as trunk and arm movement times (MTs); trunk-arm coordination was measured as onset interval and offset interval between trunk and arm motions, as well as a summarized index-desynchrony score. In both VR and physical reality, the PD group had longer trunk and arm MTs than the control group when reaching for stationary balls (p<.001). When reaching for moving balls in VR and physical reality, however, the PD group had lower trunk and arm MTs, onset intervals, and desynchrony scores (p<.001). For the PD group, VR induced shorter trunk MTs, shorter offset intervals, and lower desynchrony scores than did physical reality when reaching for moving balls (p<.001). These findings suggest that using real moving targets in trunk-assisted prehension tasks improves the speed and synchronization of trunk and arm motions in people with PD, and that using virtual moving targets may induce a movement termination strategy different from that used in physical reality.

The emission patterns of volatile organic compounds during aerobic biotreatment of municipal solid waste using continuous and intermittent aeration

Because volatile organic compounds (VOCs) are one of the main concerns during municipal solid waste (MSW) treatment, the release patterns and the environmental effects of VOCs were investigated during laboratory-scale aerobic biotreatments of MSW with continuous and intermittent negative ventilation. When the same airflow amounts were used, intermittent ventilation was found to reduce the total VOC emissions from continuous ventilation process by 28%. In this study, 23 types of volatile organic compounds were analyzed, of which butyraldehyde, ethanol, and butanone were emitted in the highest concentrations of 748, 372, and 260 mg/m3, respectively. During the aerobic biotreatment process, ketones, aldehydes, and alcohols were primarily released during the first 4 days, accounting for 86-98% of the total VOC emissions during this period. The emission concentrations of malodorous sulfide compounds displayed two peaks on day 4 and day 9, with the contribution to the total VOC emissions being enhanced from less than 10% to 76-83%. The release of terpenes and aromatics lasted for more than 10 days with no significant emission peaks and the proportions of those compounds in the total VOCs increased gradually, but no more than 50% even at the end of the process. Considering the strength of the odors, aldehydes were the predominant contributors at the beginning of the experiment, whereas malodorous sulfide compounds became the most odorous compound as the biological process continued. Most of the VOCs emitted at the concentrations beneath the level causing health threat to the workers.

Comparison of virtual reality versus physical reality on movement characteristics of persons with Parkinson's disease: effects of moving targets

OBJECTIVE

To compare the performance of reaching for stationary and moving targets in virtual reality (VR) and physical reality in persons with Parkinson's disease (PD).

DESIGN

A repeated-measures design in which all participants reached in physical reality and VR under 5 conditions: 1 stationary ball condition and 4 conditions with the ball moving at different speeds.

SETTING

University research laboratory.

PARTICIPANTS

Persons with idiopathic PD (n=29) and age-matched controls (n=25).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Success rates and kinematics of arm movement (movement time, amplitude of peak velocity, and percentage of movement time for acceleration phase).

RESULTS

In both VR and physical reality, the PD group had longer movement time (P<.001) and lower peak velocity (P<.001) than the controls when reaching for stationary balls. When moving targets were provided, the PD group improved more than the controls did in movement time (P<.001) and peak velocity (P<.001), and reached a performance level similar to that of the controls. Except for the fastest moving ball condition (0.5-s target viewing time), which elicited worse performance in VR than in physical reality, most cueing conditions in VR elicited performance generally similar to those in physical reality.

CONCLUSIONS

Although slower than the controls when reaching for stationary balls, persons with PD increased movement speed in response to fast moving balls in both VR and physical reality. This suggests that with an appropriate choice of cueing speed, VR is a promising tool for providing visual motion stimuli to improve movement speed in persons with PD. More research on the long-term effect of this type of VR training program is needed.

Effects of virtual reality training on functional reaching movements in people with Parkinson’s disease: a randomized controlled pilot trial

Objective: To investigate whether practising reaching for virtual moving targets would improve motor performance in people with Parkinson’s disease.

Design: Randomized pretest–posttest control group design.

Setting: A virtual reality laboratory in a university setting.

Participants: Thirty-three adults with Parkinson’s disease.

Interventions: The virtual reality training required 60 trials of reaching for fast-moving virtual balls with the dominant hand. The control group had 60 practice trials turning pegs with their non-dominant hand.

Main outcome measures: Pretest and posttest required reaching with the dominant hand to grasp real stationary balls and balls moving at different speeds down a ramp. Success rates and kinematic data (movement time, peak velocity and percentage of movement time for acceleration phase) from pretest and posttest were recorded to determine the immediate transfer effects.

Results: Compared with the control group, the virtual reality training group became faster ( F = 9.08, P = 0.005) and more forceful ( F = 9.36, P = 0.005) when reaching for real stationary balls. However, there was no significant difference in success rate or movement kinematics between the two groups when reaching for real moving balls.

Conclusion: A short virtual reality training programme improved the movement speed of discrete aiming tasks when participants reached for real stationary objects. However, the transfer effect was minimal when reaching for real moving objects.

A comparative study of transfection methods for RNA interference in bone marrow-derived murine dendritic cells

Selective gene silencing using RNA interference (RNAi) has been shown to be an efficient method for manipulation of cellular functions. In this study, we compare three previously established methods for transfection of murine bone marrow-derived DC (BM-DC). We tested the efficacy of electroporation with the Mouse Nucleofector kit((R)) from Amaxa Biosystems and lipid-based transfection methods using transfection reagents from Santa Cruz Biotechnology or Genlantis. To analyse the transfection efficacy we used FITC-conjugated siRNA as a positive control together with CD80 and CD86 specific siRNA. We show that electroporation using the Mouse Nucleofector kit((R)) from Amaxa Biosystems was not an efficient method to transfect BM-DC with siRNA in our hands. Transfection with Santa Cruz Biotechnology reagents resulted in up to 59% FITC-siRNA positive cells, but did not result in effective silencing of CD80 surface expression. In contrast, the most effective method was the lipid-based method using the siRNA transfection reagent GeneSilencer((R)) from Genlantis. This protocol resulted in up to 92% FITC-siRNA positive cells after 4 h which declined to 62% and 59% 24 and 48 h post-transfection, respectively. The transfected BM-DC remained CD11c positive, expressed high MHC class II and intermediate CD40 and were functional as APC. In conclusion, this protocol was effective for manipulation of murine BM-DC function through the use of specific siRNA and such methods can be important for the future study of DC-T cell interactions.

Antibacterial phenolic components from Eriocaulon buergerianum

Five phenolic components, 1,3,6-trihydroxy-2,5,7-trimethoxyxanthone (1), 7,3'-dihydroxy-5,4',5'-trimethoxyisoflavone (2), toralactone-9-O-beta-D-glucopyranoside (3), patuletin-3-O-[2-O-E-feruloyl-beta-d-glucopyranosyl-(1-->6)-beta-d-glucopyranoside] (4), patuletin-3-O-[beta-d-glucopyranosyl-(1-->3)-2-O-E-caffeoyl-beta-D-glucopyranosyl-(1-->6)-beta-D-glucopyranoside] (5), along with 19 known compounds were isolated from Eriocaulon buergerianum (Eriocaulaceae). Their structures were determined by spectroscopic and chemical methods. All 24 isolated compounds were tested against the pathogenic bacteria Staphylococcus aureus (ATCC 25923); as a result, 10 compounds were found to exhibit antibacterial activity with MICs ranging from 32 to 256 microg/ml.

Mandibular defect reconstruction with the help of mirror imaging coupled with laser stereolithographic modeling technique

With the advent of microsurgery, composite defect in the mandible can be repaired with various forms of osteocutaneous free flaps. However, it is difficult to accurately reconstruct a large defect in the mandible when not enough mandibular reference blueprints remain. This case report describes a large ameloblastoma at the left lower molar region and ascending ramus of the mandible in a 53-year-old male patient. Before surgery, spiral computed tomography scanning of the whole skull of the patient was performed. Using three-dimensional reconstruction and mirror imaging coupled with laser stereolithographic technique, a complete mandibular biomodel with idealized shape was fabricated. A titanium reconstruction plate was made using the biomodel as a guide. The tumor mass together with the left mandible from the second premolar to the condylar head area was resected en bloc. The large mandibular defect was then reconstructed with the precontoured titanium plate and three segments of vascularized fibular bone graft fixed along the plate. The temporomandibular joint was restored with temporal is muscle as an interpositional disc replacement. The complex defect in the mandible was thus repaired with satisfactory functioning and esthetic result. We suggest that with the help of mirror imaging coupled with laser stereolithographic technique, a precontoured titanium plate can be made for the reconstruction of large mandibular defects.

Comparison of 2 methods of making surgical models for correction of facial asymmetry

PURPOSE

Stereolithography is useful in reconstructive surgery in that the surgical template or customized implant can be prefabricated on the models. To correct facial asymmetry, prior reshaping of the replica of the original structures is frequently required before it can be used as a surgical model. This is traditionally accomplished by direct sculpturing. This method has its limitations in clinical use. Recently, we developed a method using computer techniques to reconstruct the required structures. We herein report several of its applications in a variety of clinical situations and compare this virtual method with the traditional method.

PATIENTS AND METHODS

With the traditional method, reconstruction of the models was handmade on the replica of the original structures. In the virtual method, the anticipated reconstructions were completed on the computer using various image-processing tools and were verified by the surgeons before sending to stereolithography. Thirteen patients who had undergone surgical correction of facial asymmetry using models made by either method were retrospectively reviewed. The traditional method was used in 5 of them while the virtual method was applied in the other 8 patients. The surgical models and the patients following the reconstruction were evaluated for symmetry and esthetics.

RESULTS

To construct implants or to precontour fixation plates, an average of 1.4 models was fabricated for each patient using the traditional method, whereas only 1.1 models were made for each patient in the virtual method group. Both methods worked satisfactorily in restoring symmetry of the bony structures on the models. However, the projection of the chin on the model created by the traditional method was inadequate, as showed postoperatively in 1 patient. There was surface roughness on the customized area of the models made by the virtual method. The surgical result was poor in symmetry in 1 case in the traditional method group. One patient in the virtual method group showed irregularities on the temporal region following augmentation with prefabricated bone cement implant.

CONCLUSIONS

Both methods of making models were useful and effective in surgical reconstruction for facial symmetry in selected cases. The virtual method was preferred in cases where midline structures had already been deformed, or when soft tissue was involved in reconstruction. From the technical standpoint, the virtual method was superior because of its versatility, predictability, precision, communicability, and the convenience of storage and documentation.

The IFN regulatory factor family participates in regulation of Fas ligand gene expression in T cells

TCR engagement leads to the transcriptional activation of cytokine genes and activation-induced cell death. Activated T cells undergo apoptosis upon expression and ligation of Fas ligand (FasL) to Fas/APO-1 (CD95) receptor. FasL expression is under the transcriptional regulation of multiple factors. The present study demonstrates that TCR-inducible FasL expression is also under the direct influence of the IFN regulatory factor (IRF) transcription factor family. Deletion and mutagenesis of a putative IRF-1 binding site in the FasL promoter results in deficient expression of FasL. EMSAs demonstrate specific FasL promoter binding by IRF-1 and IRF-2. Forced expression of either IRF-1 or IRF-2 leads to FasL promoter activation in T cells and FasL expression in heterologous cells. Finally, suppression of IRF-1 expression in T cells results in deficient TCR-induced FasL expression. These results confirm that the IRF family participates in the regulation of FasL gene expression.

Portable system for quantifying motor abnormalities in Parkinson's disease

In order to quantify motor disabilities in Parkinson's disease (PD), we designed a compact, portable, neurophysiological system based upon a personal computer to measure tremor, bradykinesia, and muscle tone. Tremor was detected by solid state accelerometers and translated into a digital signal. The system displayed the root mean square displacements and frequency distribution of the tremor in the horizontal and vertical planes, along with a reconstructed graphic image of the displacement. Bradykinesia was measured using a panel that detects release and depression of switches in response to auditory and visual signals; the system calculated subjects' reaction times and movement times in milliseconds. Tone at the elbow was measured by strapping the upper extremity to a lightweight low-friction cradle and then passively moving the cradle with an instrumented handle. Signals representing torque and arm angle were processed by the computer and displayed in real time on the screen with stiffness as a mean slope in Nm/degree. In clinical tests, quantitative measures of tremor, movement time and rigidity were significantly abnormal in PD patients compared to control subjects. We conclude that this system is a convenient and accurate method to quantitate important aspects of the parkinsonian syndrome, and may be applied to quantitate other movement disorders.