bluuebunny/crossref_metadata_2025 huggingface dataset:
Response to Surgery Assessments for Sparing Radioiodine Remnant Ablation in Intermediate-Risk Papillary Thyroid Cancer
Authors: Zhang Xin , Liu Jie-Rui , Mu Zhuan-Zhuan , Cheng Xin-Qi , Lin Yan-Song
Published: December 2022

Context

Using response to surgery when tailoring radioiodine (RAI) therapy for papillary thyroid cancer (PTC) is valued but lacks prospective validation.

Objective

To spare RAI thyroid remnant ablation among patients with intermediate-risk PTCs using 3-tiered assessments with response to surgery highlighted, in addition to the risk of the recurrence stratification and TNM staging.

Methods

Patients with no evidence of disease (NED) identified as excellent response (ER) or indeterminate response (IDR) to surgery were spared from RAI thyroid remnant ablation after informed consent and prospectively enrolled under active surveillance. Those involved in other trials or without sufficient follow-up data were excluded. Dynamic responses were followed and compared longitudinally. The main outcome measures were NED presenting as durable ER or IDR for over 12 months.

Results

Of the enrolled 215 patients, 47.4% (102/215) ER and 52.6% (113/215) IDR were identified regarding RAI decision-making. After a median of 23.6 (interquartile range 13.8-31.6) months, the share of ER increased to 82.8% (178/215) and IDR decreased to 16.3% (35/215), with 85 patients shifting from IDR to ER over time, only 0.5% (1/215) structural incomplete response and 0.5% (1/215) biochemical incomplete response observed. Successful remnant ablation was observed in 27.7% (26/94) of the patients completing 2 diagnostic whole-body scans after a median interval of 13.0 months, indicating a theranostic effect. In the 173 patients followed for over 12 months, the NED rate did not differ between ER and IDR subgroups (100% vs 97.9%, P = .20).

Conclusion

Through the 3-tiered assessments with response to surgery highlighted, postoperative ER and IDR spared from RAI remnant ablation may indicate similar favorable responses in intermediate-risk patients with PTC during 23.6 months of follow-up.
Intestinal microbiota and obesity
Authors: Zuziak Patrycja , Ilnicka Natalia , Abod Leila , Matyja Daria , Sadlik Maria
Published: December 2022

Introduction and purpose:

The growing number of obese people is one of the greatest problems of modern medicine. It is estimated that every 10th person is obese. Recent studies also suggest that the gut microbiome may contribute to the pathogenesis of obesity.

Description of the state of knowledge:

Microbiota is named a super organ that has the ability to evolve in response to changing conditions within the host organism. It is named so because it is made up of over 100,000 billion cells that belong to different groups of organisms. Microbiota consists of bacteria, fungi, protists, viruses and archaea. This taxonomically diverse collective plays a vital role in maintaining the homeostasis of the human body. A well-balanced intestinal flora protects the digestive tract from colonization by pathogenic microorganisms, it is also important in maintaining the integrity of the intestinal walls, is involved in the synthesis of certain vitamins and plays a role in nourishing mucosa cells. Moreover, it is known that the microflora can influence body weight, insulin sensitivity, and  metabolism of certain sugars and lipids. Disturbances in the composition of the microbiome (dysbiosis) lead to an increased absorption of short-chain fatty acids, which leads to an increase in endogenous YY peptide synthesis. This protein slows down the intestinal transit and indirectly leads to increased absorption of nutrients. This predisposes to the development of obesity. The use of prebiotics, probiotics and some antibiotics reduces intestinal dysbiosis. For obese patients, it is associated with reduction of insulin resistance and decrease in blood glucose level.

Conclusions:

In the light of the available studies, it can be concluded that intestinal dysbiosis may play a role in the pathogenesis of obesity. Unfortunately, the practical application of this knowledge is not yet well documented. Therefore this topic requires further experiments and analysis.
Penetapan kadar alkohol pada kosmetik menggunakan metode kromatografi gas
Authors: Albab Farah Qisth , Mahfudh Nurkhasanah
Published: December 2022

Alkohol merupakan bahan yang banyak digunakan di farmasi, salah satunya kosmetik. Â Penggunaan alkohol pada kosmetik biasanya memiliki fungsi sebagai pelarut, astrigent, desinfektan, mengurangi tegangan permukaan, dan meningkatkan daya pembersih. Â Penggunaan alkohol di kosmetik menurut Majelis Ulama Indonesia diperbolehkan asalkan tidak berasal dari industri khamr, namun sekarang banyak kosmetik yang terdapat label free alcohol. Tujuan penelitian ini adalah untuk mengidentifikasi kandungan alkohol pada produk kosmetik yang mengklaim free alcoholÂ  dan mengetahui kadar alkohol pada kosmetik. Metode penelitian dilakukan mengunakan teknik obsevasional survey, non probability berupa simple random sampling pada kosmetik di swalayan. Salah satu validasi metode analisa yaitu uji kesesuaian sistem dilakukan sebelum analis sampel untuk memastikan bahwa instrumen dapat menghasilkan data yang dapat diterima yaitu nilai tR sampel untuk mengetahui mengandung alkohol atau tidak. Analisis kuantitatif dilakukan dengan rasio AUC etanol-isopropanol dengan kadar dan dibuat regresi linear. Hasil uji kesesuaian sistem dengan parameter RSD tR 0,2231%; TF 0,9568; N 2872,5318; dan Rs 1,874 memenuhi syarat kecuali RSD AUC 10,0277% tidak memenuhi syarat sehingga sistem akan mengahasilkan data yang dapat diterima.Â  Empat sampel dari 6 sampel kosmetik micellar water dan toner positif mengandung alkohol tidak sesuai dengan label pada kemasan yaitu produk kosmetik Wardah, Mustika Ratu, Pixy dan Pondâ€™s. Dua sampel negatif tidak mengandung alkohol adalah Nivea dan Himalaya. Range kadar alkohol yang terdapat pada kosmetik tersebut dari 2,48 x10-4% - 4,96 x10-4 %.
Project-Based and Flipped Learning in the Classroom: A Strategy for Enhancing Students’ Scientific Literacy
Authors: Sholahuddin Arif , Anjuni Nadya , Leny Leny , Faikhamta Chatree
Published: December 2022

Scientific literacy is a critical competency for people to take an essential role in science, technology, and social advancement. It is important to note that this competence is still a problem for most students worldwide. Therefore, this study analysed students' scientific literacy differences between a project-based learning flipped classroom (PjBL-FC) and a project-based learning (PjBL) class assisted by learning resources in wetlands environments. This quasi-experimental study used a non-equivalent control group design involving Class X Senior High School as the sample. The data were inferentially analysed by t-test. The results showed that the scientific literacy of students in the class that applied the PjBL-FC was better than those who applied only PjBL. Furthermore, all the indicators reach the high to very high category except the ability to propose a hypothesis, which is in the medium category. It was concluded that flipped classroom makes the PjBL take place more efficiently and effectively. Further studies can be carried out to determine how students use the learning materials, how teachers design the PjBL strategy in an online platform, their effect on scientific literacy, and how to combine PjBL with other approaches.
Computationally efficient adaptive decompression for whole slide image processing
Authors: Li Zheyu , Li Bin , Eliceiri Kevin W. , Narayanan Vijaykrishnan
Published: December 2022

Whole slide image (WSI) analysis is increasingly being adopted as an important tool in modern pathology. Recent deep learning-based methods have achieved state-of-the-art performance on WSI analysis tasks such as WSI classification, segmentation, and retrieval. However, WSI analysis requires a significant amount of computation resources and computation time due to the large dimensions of WSIs. Most of the existing analysis approaches require the complete decompression of the whole image exhaustively, which limits the practical usage of these methods, especially for deep learning-based workflows. In this paper, we present compression domain processing-based computation efficient analysis workflows for WSIs classification that can be applied to state-of-the-art WSI classification models. The approaches leverage the pyramidal magnification structure of WSI files and compression domain features that are available from the raw code stream. The methods assign different decompression depths to the patches of WSIs based on the features directly retained from compressed patches or partially decompressed patches. Patches from the low-magnification level are screened by attention-based clustering, resulting in different decompression depths assigned to the high-magnification level patches at different locations. A finer-grained selection based on compression domain features from the file code stream is applied to select further a subset of the high-magnification patches that undergo a full decompression. The resulting patches are fed to the downstream attention network for final classification. Computation efficiency is achieved by reducing unnecessary access to the high zoom level and expensive full decompression. With the number of decompressed patches reduced, the time and memory costs of downstream training and inference procedures are also significantly reduced. Our approach achieves a 7.2× overall speedup, and the memory cost is reduced by 1.1 orders of magnitudes, while the resulting model accuracy is comparable to the original workflow.
Low-cost high-speed rapidly reconfigurable integrated half-duplex optical transceiver front-end
Authors: Li Dan , Li Jing , Huang Wei , Fan Yonghui , Tan Chen , Yu Chuanhao , Huang Shiti , Li Jia , Zhao Wanqing , Xia Yifei , Zhang Bing , Gui Xiaoyan , Geng Li
Published: December 2022

We present and demonstrate an integrated approach to make low-cost high-speed half-duplex optical transceiver with rapid reconfigurability. A single Distributed-Feedback (DFB) diode is employed as the unified E/O-O/E device, which is dynamically biased as laser or photodetector in transmitter or receiver mode. The bias for the DFB and the transmit/receive (T/R) signal path are provided by a custom-designed reconfigurable CMOS chip, which contains the biasing circuitry, a high-speed T/R switch and a burst-mode transimpedance amplifier (BM-TIA). The transceiver front-end operates up to 5 Gb/s for both transmitter (Tx) and receiver (Rx) mode experimentally, while its reconfiguration time is less than 131 ns. This integrated approach not only halves the transceiver optics to facilitate low cost, but also enables high-speed signal transmission as well as rapid reconfiguration, which will be critical for the fiber-to-everything paradigm shift in the near future.
Leader-laggard synchronization of polarization chaos in mutually coupled free-running VCSELs
Authors: Zhang Xiaomai , Li Pu , Jia Zhiwei , Shore K. Alan , Wang Yuncai
Published: December 2022

We systematically study the leader-laggard synchronization of polarization chaos in mutually coupled free-running vertical cavity surface emitting semiconductor lasers in two cases of parallel and orthogonal injection. Specifically, we quantitatively investigate the effect of critical external parameter mismatch such as the coupling intensity and frequency detuning on the leader-laggard relationship utilizing the cross-correlation function. When the difference between two main cross-correlation peak values exceeds 0.1, the leader-laggard relationship can be viewed to be stable. Our results demonstrate that compared with the coupling strength, the frequency detuning is the dominant factor in determining the stability of the leader-laggard relationship. The exchange of the leader-laggard role occurs within a frequency detuning region from -5 GHz to 5 GHz for both parallel and orthogonal injection. Once the leader-laggard relationship is stable, the difference between the two cross-correlation values can reach 0.242 for negative frequency detuning, but the corresponding value is only 0.146 under positive frequency detuning.
Simultaneously improving the quality factor and outcoupling efficiency of organic light-emitting field-effect transistors with planar microcavity
Authors: Gong Qiaoxia , Zhang Wenbo , He Jiuru , Ma Fengying , Song Li , Cheng Liwen , Zhang Jun , Wang Lijun , Hu Yongsheng
Published: December 2022

Organic light-emitting field-effect transistors (OLEFETs) are regarded as an ideal device platform to achieve electrically pumped organic semiconductor lasers (OSLs). However, the incorporation of a high-quality resonator into OLEFETs is still challenging since the process usually induces irreparable deterioration to the electric-related emission performance of the device. We here propose a dual distributed Bragg reflector (DBR)-based planar microcavity, which is verified to be highly compatible with the OLEFETs. The dual DBR planar microcavity shows the great advantage of simultaneously promoting the quality (Q) factor and outcoupling efficiency of the device due to the reduced optical loss. As a result, a moderately high Q factor of ∼160, corresponding to EL spectrum linewidth as narrow as 3.2 nm, concomitantly with high outcoupling efficiency (∼7.1%) has been successfully obtained. Our results manifest that the dual DBR-based planar microcavity is a promising type of resonator, which might find potential applications in improving the spectra and efficiency performance of OLEFETs as well as in OLEFET-based electrically pumped OSLs.
Tunable spatial fractional derivatives with graphene-based transmit arrays
Authors: Jalil-Abadi Fatemeh Sedaghat , Habibiyan Hamidreza , Khavasi Amin
Published: December 2022

The optical implementation of mathematical spatial operators is a critical step toward achieving practical high-speed, low-energy analog optical processors. In recent years, it has been shown that using fractional derivatives in many engineering and science applications leads to more accurate results. In the case of optical spatial mathematical operators, the derivatives of the first and second orders have been investigated. But no research has been performed on fractional derivatives. On the other hand, in previous studies, each structure is dedicated to a single integer order derivative. This paper proposes a tunable structure made of graphene arrays on silica to implement fractional derivative orders smaller than two, as well as first and second orders. The approach used for derivatives implementation is based on the Fourier transform with two graded index lenses positioned at the structure's sides and three stacked periodic graphene-based transmit arrays in middle. The distance between the graded index lenses and the nearest graphene array is different for the derivatives of order smaller than one and between one and two. In fact, to implement all derivatives, we need two devices with the same structure having a slight difference in parameters. Simulation results based on the finite element method closely match the desired values. Given the tunability of the transmission coefficient of the proposed structure in the approximate amplitude range of [0,1] and phase range of [-180, 180], on top of the acceptable implementation of the derivative operator, this structure allows obtaining other spatial multi-purpose operators, which are a prelude to achieving analog optical processors and even improving the optical studies performed in image processing.
Study of SO2 measurement based on a dual optical path Fabry-Perot correlation spectroscopy
Authors: Lv Yinsheng , Xie Pinhua , Xu Jin , Li Ang , Hu Zhaokun , Li Youtao , Zhang Huarong , Zhang Zhidong , Tian Xin , Hu Feng , Zheng Jiangyi , Ye Yingjie
Published: December 2022

This paper investigates a method for measuring SO2 concentration using Fabry–Perot interferometer correlation spectroscopy. In this method, the experimental system is designed as a separated beam, with the beam entering the F–P cavity at two incidence angles simultaneously to match the peak and valley positions of the SO2 absorption cross-section. The system achieves a 2σ detection limit of 28.2 ppm·m(15 cm) at a sampling frequency of 10 Hz. An outfield comparison experiment with the differential optical absorption spectroscopy method shows good agreement for the simultaneous measurement of SO2 concentration from sulfur combustion, with a correlation coefficient of R2 = 0.93. This study introduces a non-dispersive, highly accurate, and fast gas detection technique.
Potential of ytterbium doped silica glass for solid-state optical refrigeration to below 200 K
Authors: Topper Brian , Neumann Alexander , Albrecht Alexander R. , Flores Angel S. , Kuhn Stefan , Häßner Denny , Hein Sigrun , Hupel Christian , Nold Johannes , Haarlammert Nicoletta , Schreiber Thomas , Sheik-Bahae Mansoor , Mafi Arash
Published: December 2022

We report on the optical refrigeration of ytterbium doped silica glass by >40 K starting at room temperature, which represents more than a two-fold improvement over the previous state-of-the-art. A spectroscopic investigation of the steady-state and time-dependent fluorescence was carried out over the temperature range 80 K to 400 K. The calculated minimum achievable temperature for our Yb3+ doped silica sample is ≈150 K, implying the potential for utilizing ytterbium doped silica for solid-state optical refrigeration below temperatures commonly achieved by standard Peltier devices.
Into the Vœrtex: Case study of a stereoscopic abstract animation installation
Authors: Hattler Max , Cheung Terrie Man-Chi
Published: December 2022

In Max Hattler’s stereoscopic installation Vœrtex two-dimensional abstract animation is turned into immersive images with strong three-dimensional depth. Utilizing a two-screen, semi-Cave Automatic Virtual Environment, Vœrtex creates a unique viewing experience for the viewer, a hybrid space situated halfway between immersion-in-abstraction and the real world of the gallery space, allowing the viewer to be in two spaces simultaneously. This article discusses the technical set-up, production processes and stereoscopic techniques, including binocular colour rivalry and depth displacements employed in Vœrtex. This is followed by a discussion of Vœrtex in relation to the concept of lucidity and an audience study into viewers’ perception of the work. The hybrid set-up of Vœrtex, combining both stereoscopic and interactive visual texts, allows for a sense of creative inspiration and inquiry into the dreaming mind, and participants can actively choose to explore different aspects of their perception by oscillating between two divergent states: an immersive dream sensation and a sense of being anchored in the real world.
Revealing the unseen: Altering modes of viewing practice to explore the aesthetics of seeing more than one frame at a time
Authors: Horne Bronwyn
Published: December 2022

Contemporary animation is typically viewed in a digital format which is subject to the mechanics of cinema: a frame-by-frame presentation of a sequence of images (at a constant rate) so that the illusion of continuous motion is experienced by the viewer. In this article I argue that by altering the way we view animation, we could influence the viewer’s experience and understanding of an animated work. The research is a culmination of my Ph.D. by creative practice, which unpacks modes of viewing practice through the creation of an experimental short film and the presentation of an art exhibition that reveal movement for the viewer in a deliberately playful manner. The short film expands on the experimental animation technique known as strata-stencil that uses a multiple layered approach, revealing the consecutive frames of a movement on every frame. Drawing on techniques of nineteenth-century chronophotography, my work focuses on the representation of movement in classic cartoon-style animation and reveals the construction of animation for the viewer through static and animated sequences. My interest lies in the imperceptible moments that are lost in standard viewing practice, forcing the viewer to question their understanding of a movement and the aesthetics involved in seeing more than one frame at a time. I propose that we look at the individual animation frames not in isolation but simultaneously as sequences, so that the notion of seriality informs the viewer’s understanding of animated movement as a distinct aesthetic experience. In doing this, I challenge the viewer to look at animation in a different way and create an innovative viewing experience.
The animator’s sensorium: The impact of acting and animation experience on creating reference performances
Authors: Kennedy Jason
Published: December 2022

This research provides an initial investigation into strategies for creating reference performances for animation. The term reference performance has various meanings in animation production; in this article, I use it to refer to a recording of a person performing physical and emotional cues, from which performance elements of an animated character may be derived. Beginning with Max Fleischer’s invention of the rotoscope process in 1915, animation studios began to record actors as a means to inject greater believability into the movements and expressions of animated characters. Throughout this article, I reference Pallant’s understanding of ‘believability’ as a ‘[reconciliation of] realism within the animated form’. While various methods exist today to capture reference performances, it remains axiomatic that the utility of the reference is only as good as a performer’s ability to produce the desired performance. While seasoned actors would seem ideally suited to the task, large-scale animation studios frequently require animators to film their own reference performances, even though the animators may have limited (or non-existent) acting experience. By comparison, smaller studios and independent productions may not have the time or ability for each animator to self-produce reference; instead, they may opt for an animation director/supervisor to record reference for every character, to work from clips available through online video sites (e.g. YouTube) or to forgo video reference altogether. This research examines the potential for acting experience to enhance reference performances and specifically explores three different preconditions of experience when producing animation reference: an actor with no animation experience, an animator with no acting experience and an academic with both acting and animation experience. As an additional site of inquiry, this research explores the use of head-mounted cameras in the production of animation reference as a means to more fully and reliably capture the research participants’ expressive range. This research engages with ethnographic and autoethnographic research models to compare the creative choices of each participant and their ability to produce meaningful expressions, gestures and body movements as reference performance for a short, auteur 3D animated film in a predominantly realistic style. From these analyses, the maximal performance utility of each participant is gauged. By extension, this limited data provides an initial suggestion that acting experience is an essential precondition when producing useful reference performances for the type and style of animation explored in this study. Furthermore, this article relates the acting strategies of its participants to the acting theory of Ivana and the theory of emotional effector patterns as described by . This research suggests that these practice-informed performance theories may prove useful to animator when producing their own reference, regardless of performance experience.
Emotion in Animated Films, Mieke Uhrig (ed.) (2018)
Authors: Yazdandoost Farzaneh
Published: December 2022

Review of: Emotion in Animated Films, Mieke Uhrig (ed.) (2018)

New York: Routledge, 238 pp.,

ISBN 978-0-36758-477-1, p/bk, $48.95
Native microbiomes in danger: Could One Health help to cope with this threat to global health?
Authors: Zunino Pablo
Published: December 2022

Planetary health faces an emergency associated with global change. Climate change, the increase in world population and urban concentration, the hyperintensification of productive systems, and the associated changes in land use, among other factors, are generating a risky substrate for global health deterioration. The emergence of the coronavirus disease 2019 pandemic is an example of the problems that this situation can provoke. Several researchers and health professionals have addressed the role of microorganisms, particularly bacteria, in promoting global health, mainly in the past decades. However, global change has contributed to the extinction of a wide array of bacterial species and the disruption of microbial communities that support the homeostasis of humans, animals, and the environment. The need to protect the diversity and richness of native microbiomes in biotic and abiotic environments is crucial but has been frequently underestimated. The "One Health" approach, based on integrating traditionally unconnected fields such as human, animal, and environmental health, could provide a helpful framework to face this challenge. Anyway, drastic political decisions will be needed to tackle this global health crisis, in which the preservation of native microbial resources plays a critical role, even in preventing the risk of a new pandemic. This review aims to explain the importance of native microbiomes in biotic and abiotic ecosystems and the need to consider bacterial extinction as a crucial problem that could be addressed under a One Health approach.
Reliability and Diagnostic Accuracy of Standard Dermatomes and Myotomes for Determining the Pathologic Level in Surgically Verified Patients With Cervical Radiculopathy
Authors: Hong Chul Gie , Nam Woo Dong
Published: December 2022

Objective: This study aimed to investigate the reliability and diagnostic accuracy of typical dermatomes and myotomes for determining the pathologic level in surgically verified patients with cervical radiculopathy.Methods: Patients who underwent single-level surgery due to cervical radiculopathy with at least a 60% reduction in preoperative symptoms or recovery of muscle power after surgery were included. The observed clinical symptoms (pain, paresthesia, motor weakness) were compared to those of typical cervical dermatomes and myotomes.Results: Among the 227 patients reviewed, 142 (62.6%) had a standard dermatomal pattern, and 74 of 110 (67.3%) had a standard myotomal pattern. The myotome of C5/6 radiculopathy showed much more variance than those of other cervical segments. Among the patients with severe motor weakness (muscle strength ≤ grade 3 or obvious muscle atrophy), all those with involvement of root C5, C7, and C8 showed a typical pattern (C4/5: 13 of 13 patients, C6/7: 5 of 5 patients, C7/T1: 3 of 3 patients), while only 2 of the 6 patients (33.3%) with severe motor weakness caused by C5/6 radiculopathy fit the typical pattern.Conclusion: Among various symptoms, cervical myotome is of great value in determining the pathological level. However, it should be noted that there is high variability in human dermatomes and myotomes, especially for motor weakness due to C6 root compression, which is more variable than others.
Risk Analysis Index and Its Recalibrated Version Predict Postoperative Outcomes Better Than 5-Factor Modified Frailty Index in Traumatic Spinal Injury
Authors: Conlon Matthew , Thommen Rachel , Kazim Syed Faraz , Dicpinigaitis Alis J. , Schmidt Meic H. , McKee Rohini G. , Bowers Christian A.
Published: December 2022

Objective: To assess the discriminative ability of the Risk Analysis Index-administrative (RAI-A) and its recalibrated version (RAI-Rev), compared to the 5-factor modified frailty index (mFI-5), in predicting postoperative outcomes in patients undergoing surgical intervention for traumatic spine injuries (TSIs).Methods: The Current Procedural Terminology (CPT) and International Classification of Disease-9 (ICD-9) and ICD-10 codes were used to identify patients ≥ 18 years who underwent surgical intervention for TSI from National Surgical Quality Improvement Program (ACS-NSQIP) database 2015–2019 (n = 6,571). Multivariate analysis and receiver operating characteristic (ROC) curve analysis were conducted to evaluate the comparative discriminative ability of RAI-Rev, RAI-A, and mFI-5 for 30-day postoperative outcomes.Results: Multivariate regression analysis showed that with all 3 frailty scores, increasing frailty tiers resulted in worse postoperative outcomes, and patients identified as frail and severely frail using RAI-Rev and RAI-A had the highest odds of poor outcomes. In the ROC curve/C-statistics analysis for prediction of 30-day mortality and morbidity, both RAI-Rev and RAI-A outperformed mFI-5, and for many outcomes, RAI-Rev showed better discriminative performance compared to RAI-A, including mortality (p = 0.0043, DeLong test), extended length of stay (p = 0.0042), readmission (p < 0.0001), reoperation (p = 0.0175), and nonhome discharge (p < 0.0001).Conclusion: Both RAI-Rev and RAI-A performed better than mFI-5, and RAI-Rev was superior to RAI-A in predicting postoperative mortality and morbidity in TSI patients. RAI-based frailty indices can be used in preoperative risk assessment of spinal trauma patients.
Full Endoscopic Ligamentum Flavum Sparing Unilateral Laminotomy for Bilateral Recess Decompression: Surgical Technique and Clinical Results
Authors: Kwon Woo-Keun , Kelly Katherine A. , McAvoy Malia , Sivakanthan Sananthan , Ogunlade John , Yap Natalie Kai Yi , Durfy Sharon , Hofstetter Christoph P.
Published: December 2022

Objective: Interlaminar endoscopic spine surgery has been introduced and utilized for lumbar lateral recess decompression. We modified this technique and utilized it for bilateral lateral recess stenoses without significant central stenosis. Here we present the surgical details and clinical outcome of ligamentum flavum sparing unilateral laminotomy for bilateral recess decompression (ULBRD).Methods: Prospectively collected registry for full-endoscopic surgeries was reviewed retrospectively. One hundred eighty-two consecutive cases from a single center between September 2015 and March 2021 were reviewed and 57 of them whom underwent ULBRD were enrolled for analysis. Basic patient demographic data, perioperative details, surgeryrelated complications, and clinical outcome were reviewed. The detailed surgical technique is presented as well.Results: Among the 57 patients enrolled, 37 were males while the other 20 were females. The mean age was 58.53 ± 14.51 years, and a bimodal age distribution at the age of mid-fifties and mid-sixties or older was noted. The later age-peak was related to coexistence of degenerative scoliosis. The average operative time per lamina was 70.34 ± 20.51 minutes and mean length of stay was 0.56 ± 0.85 days. Four perioperative complications were reported (7.0%) and the overall reoperation rate at the index level within 1 year was 8.8%. The preoperative back/leg visual analogue scale scores and functional outcome scales including EuroQol-5 dimension questionnaire, Oswestry Disability Index presented significant improvement immediately after surgery and were maintained until final follow-up.Conclusion: ULBRD for bilateral lateral recess stenoses without significant central stenosis resulted in good clinical outcomes with acceptably low perioperative complications rates. Sufficient decompression was achieved with the central ligamentum flavum being preserved.
Impact of Mechanism of Injury on Long-term Neurological Outcomes of Cervical Sensorimotor Complete Acute Traumatic Spinal Cord Injury
Authors: Bak Alex B. , Moghaddamjou Ali , Malvea Anahita , Fehlings Michael G.
Published: December 2022

Objective: Mechanism of injury is a largely understudied descriptor of acute traumatic spinal cord injury (tSCI). This study sought to compare the impact of high-energy and low-energy mechanisms of injury in neurological outcomes of cervical sensorimotor complete tSCI.Methods: Patients with tSCI were identified in 4 prospective, multicenter clinical trials and registries. American Spinal Injury Association Impairment Scale (AIS) grade was assessed ≤ 72 hours postinjury and followed up between 12 to 52 weeks. Patients were included if they had a cervical and sensorimotor complete (AIS–A) injury at baseline. Study outcomes were change in AIS grade and lower extremity motor, upper extremity motor, and total motor scores. Propensity score matching between high-energy mechanisms of injury (HEMI; e.g. , motor vehicle collisions) and low-energy mechanisms of injury (LEMI; e.g. , falls) groups was performed. Adjusted groups were compared with paired t-tests and McNemar test.Results: Of 667 patients eligible for inclusion, 523 experienced HEMI (78.4%). HEMI patients were younger, had lower body mass index, more associated fractures or dislocations, and lower baseline lower extremity motor scores. After propensity score matching of these baseline variables, 118 pairs were matched. HEMI patients had a significantly worse motor recovery from baseline to follow-up based on their diminished change in upper extremity motor scores and total motor scores.Conclusion: Cervical sensorimotor complete tSCIs from HEMI were associated with significantly lower motor recovery compared to LEMI patients. Our findings suggest that mechanism of injury should be considered in modelling prognosis and in understanding the heterogeneity of outcomes after acute tSCI.
Relationship Between Syrinx Resolution and Cervical Sagittal Realignment Following Decompression Surgery for Chiari I Malformation Related Syringomyelia Based on Configuration Phenotypes
Authors: Lu Chunli , Ma Longbing , Guan Jian , Liu Zhenlei , Wang Kai , Duan Wanru , Chen Zan , Wu Hao , Jian Fengzeng
Published: December 2022

Objective: Combined with different configuration types of syringomyelia, to analyze the correlation between syrinx resolution and changes in cervical sagittal alignment following Foramen magnum and Magendie dredging (FMMD) for syringomyelia associated with Chiari I malformation (CM-I), and to further explore the respective relationship with clinical outcome.Methods: A consecutive series of 127 patients with CM-I and syringomyelia who underwent FMMD in our center met the inclusion criteria of this study. Their clinical records and radiologic data were retrospectively reviewed. The Japanese Orthopedic Association (JOA) scoring system and the Chicago Chiari Outcome Scale (CCOS) were used to evaluate the surgical efficacy. The phenotypes of syringomyelia and the clinical characteristics of the patients were analyzed according to grouping by cervical curvature at baseline.Results: The preoperative straight or kyphotic cervical alignment is more common in the moniliform syrinx. After surgery, the syrinx resolution and cervical sagittal realignment in the moniliform group are more obvious, and the corresponding prognosis is relatively better. Spearman correlation analysis showed that the ΔS/C ratio (the change ratio of syrinx/cord) was positively correlated with the CCOS (p = 0.001, r = 0.897) and ΔC2–7A (the change of lower cervical angle) (p = 0.002, r = 0.560). There was also a correlation between the ΔJOA score (the change rate of the JOA score) and ΔC2–7A (p = 0.012, r = 0.467).Conclusion: After decompression surgery, syrinx resolution may coexist with the changes in the subaxial lordosis angle, especially for syrinx in moniliform type, and the relationship between syrinx resolution and cervical sagittal realignment might be valuable for evaluating the surgical outcome.
Clinical Impact and Correlations of Odontoid Parameters Following Multilevel Posterior Cervical Fusion Surgery
Authors: Lee Jae-Koo , Hyun Seung-Jae , Yang Seung Heon , Kim Ki-Jeong
Published: December 2022

Objective: C2 slope (C2S), a cervical parameter mathematically approximated as T1 slope minus cervical lordosis (T1S–CL), predicts functional improvement in cervical deformity patients. Nonetheless, C2S is a positional parameter based only on the horizontal axis. The current study aims to introduce novel odontoid parameters and establish their relationships with patient-reported health-related quality of life (HRQoL).Methods: Lateral plain radiographs of 32 adults who underwent multilevel posterior cervical fusion were analyzed. The odontoid parameters included odontoid incidence (OI), C2S, odontoid tilt (OT), and gravity line-C2 distance (GL-C2), while the cervical parameters were the Cobb angle at C0–1, C1–2, C0–2, C2–7, C2–7 sagittal vertical axis (cSVA), T1 slope, and T1S–CL. The range of motion (ROM) of the occipito-atlantoaxial complex was measured in flexion and extension plain radiographs. Scores on the Neck Disability Index (NDI) and visual analogue scale (VAS) for axial neck (VASn) and arm pain were measured.Results: Compared to asymptomatic subjects, patients had larger C2S, cSVA, and T1S–CL, and smaller OT. Preoperatively, OI was significantly correlated with the ROM of C1–2 (r = 0.37, p < 0.05) and C0–2 (r = 0.46, p < 0.01). OT and C2S had significant correlations with the C0–1, C1–2, and C0–2 angles, GL-C2, and T1S–CL. Postoperative NDI scores were significantly correlated with OI (r = -0.40, p < 0.05) and OT (ρ = -0.37, p < 0.05). VASn was significantly correlated with GL-C2 (r = -0.35, p < 0.05).Conclusion: The odontoid parameters were significantly correlated with established cervical parameters and HRQoL measures. OI is a constant parameter representing the individual's compensatory reservoir at the upper cervical spine.
Therapeutic Approaches Targeting Vascular Repair After Experimental Spinal Cord Injury: A Systematic Review of the Literature
Authors: Roolfs Laurens , Hubertus Vanessa , Spinnen Jacob , Shopperly Lennard K. , Fehlings Michael G. , Vajkoczy Peter
Published: December 2022

Traumatic spinal cord injury (SCI) disrupts the spinal cord vasculature resulting in ischemia, amplification of the secondary injury cascade and exacerbation of neural tissue loss. Restoring functional integrity of the microvasculature to prevent neural loss and to promote neural repair is an important challenge and opportunity in SCI research. Herein, we summarize the course of vascular injury and repair following SCI and give a comprehensive overview of current experimental therapeutic approaches targeting spinal cord microvasculature to diminish ischemia and thereby facilitate neural repair and regeneration. A systematic review of the published literature on therapeutic approaches to promote vascular repair after experimental SCI was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards. The MEDLINE databases PubMed, Embase, and OVID MEDLINE were searched using the keywords “spinal cord injury,” “angiogenesis,” “angiogenesis inducing agents,” “tissue engineering,” and “rodent subjects.” A total of 111 studies were identified through the search. Five main therapeutic approaches to diminish hypoxia-ischemia and promote vascular repair were identified as (1) the application of angiogenic factors, (2) genetic engineering, (3) physical stimulation, (4) cell transplantation, and (5) biomaterials carrying various factor delivery. There are different therapeutic approaches with the potential to diminish hypoxia-ischemia and promote vascular repair after experimental SCI. Of note, combinatorial approaches using implanted biomaterials and angiogenic factor delivery appear promising for clinical translation.
Description of the Diversity in Surgical Indication and Surgical Strategies for Primary Spinal Cord Tumors: A Nationwide Survey by the Neurospinal Society of Japan
Authors: Hijikata Yasukazu , Ueda Shigeo , Yasuhara Takao , Umebayashi Daisuke , Endo Toshiki , Takami Toshihiro , Mizuno Masaki , Hida Kazutoshi , Hoshimaru Minoru
Published: December 2022

Objective: To assess the current management of primary spinal cord tumors (PSCTs) and determine whether and to what extent there are differences in surgical strategies for PSCTs.Methods: The Neurospinal Society of Japan conducted a survey between April 1 and 30, 2021. Certified spine surgeons were requested for information on the frequency of surgeries in 2020 and the surgical strategies adopted for each PSCTs. The following tumor histologies were focused: schwannoma, meningioma, and cauda equina tumor as extramedullary tumors; and ependymoma, hemangioblastoma, astrocytoma, and cavernoma as intramedullary tumors. The participants were divided according to their response as follows: experts, who had experienced ≥ 100 surgeries for PSCTs, and nonexperts.Results: Among 308 participants (63%), 35 (11%) were experts. The total number of PSCTs in 2020 was 802 of which 564 tumors were extramedullary and 223 were intramedullary. Schwannoma accounted for 53% of the extramedullary tumors, and ependymoma accounted for 39% of the intramedullary tumors. Surgical strategies significantly differed among both the experts and nonexperts groups. Some discrepancies in the adopted surgical strategies were observed between groups. Some of the nonexperts, and none of the experts, ruled out surgery for schwannomas (Eden type 4), astrocytomas, or cavernomas. Five nonexperts (2.2%), and none of the experts, resected the entire dura for meningiomas.Conclusion: A nationwide survey revealed that a sufficient consensus did not exist regarding surgical strategies for PSCTs. A disease-specific registry for PSCTs is necessary in academic societies.
Prevalence, Distribution, and Concomitance of Whole-Spine Ossification of the Posterior Longitudinal Ligament and Ossification of the Ligament Flavum in South Koreans: A Whole-Spine-CT-Based Cross-Sectional Study
Authors: Choi Yun Hee , Lee Je Hoon , Kwon Young Min
Published: December 2022

Objective: No studies assessing the prevalence of ossification of the spinal ligament were conducted using whole-spine positron emission tomography and computed tomography (PET-CT) in healthy Koreans. We aimed to determine the prevalence of ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligament flavum (OLF) in healthy Koreans using whole-body PET-CT.Methods: We reviewed whole-body PET-CT images captured during general health checkups at the General Health Promotion Center of our institution from January 2015 to 2020. OPLL and OLF were identified by the presence of heterotopic ossification in the posterior longitudinal ligament and ligament flavum on axial and sagittal PET-CT images.Results: A total of 1,934 adults (1,645 men, 289 women) were included. The mean age was 48.05 years (range, 28–86 years). Among the 1,934 patients, 173 had OPLL (8.9%). The most commonly involved cervical vertebra levels arranged according to frequency were C4, C5, C3, and C6. OLF was observed in 125 patients (6.5%). The most commonly involved thoracic levels were T10, T11, and T5. The prevalence of OPLL and OLF was the highest in patients aged 60–69 years. Among the C-OPLL patients, 15.1% had T-OPLL, 5.0% had L-OPLL, and 25.8% had T-OLF.Conclusion: Our study revealed the prevalence of OPLL and OLF in healthy Korean subjects. It was consistent with that in other Asian countries. The presence of OPLL and OLF at most locations correlated with the presence or absence of spinal ossification at other locations.
Measurement of Deformity at the Craniovertebral Junction: Correlation of Triangular Area and Myelopathy
Authors: Chang Chih-Chang , Wu Jau-Ching , Ko Chin-Chu , Chang Hsuan-Kan , Kuo Yi-Hsuan , Kuo Chao-Hung , Tu Tsung-Hsi , Huang Wen-Cheng
Published: December 2022

Objective: Diseases of the craniovertebral junction (CVJ) are commonly associated with deformity, malalignment, and subsequent myelopathy. The misaligned CVJ might cause compression of neuronal tissues and subsequently clinical symptoms. The triangular area (TA), measured by magnetic resonance imaging/images (MRI/s), is a novel measurement for quantification of the severity of compression to the brain stem. This study aimed to assess the normal and pathological values of TA by a comparison of patients with CVJ disease to age- and sex-matched controls. Moreover, postoperative TAs were correlated with outcomes.Methods: Consecutive patients who underwent surgery for CVJ disease were included for comparison to an age- and sex-matched cohort of normal CVJ persons as controls. The demographics, perioperative information, and pre- and postoperative 2-year cervical MRIs were collected for analysis. Cervical TAs were measured and compared.Results: A total of 201 patients, all of whom had pre- or postoperative MRI, were analyzed. The TA of the CVJ deformity group was larger than the healthy control group (1.62 ± 0.57 cm2 vs. 1.01 ± 0.18 cm2, p < 0.001). Moreover, patients who had combined anterior odontoidectomy and posterior laminectomy with fixation had the greatest reduction in the TA (1.18 ± 0.58 cm2).Conclusion: In CVJ deformity, the measurement of the cervical TA could indicate the severity of brain stem compression. After surgery, the TA had a varying degree of improvement, which could represent the efficacy of surgery.
Surgical Strategies and Perioperative Considerations for Cervical Deformity With Cerebral Palsy: A Comprehensive Review of the Literature
Authors: Kim Hyung Cheol , Oh Sung Han , Oh Jae Keun , Ha Yoon
Published: December 2022

The complex nature of the cervical spine makes surgical intervention challenging when treating cervical deformity in patients with cerebral palsy (CDCP). However, few studies have investigated the unique characteristics of cerebral palsy that create the need for surgery, the most effective surgical strategies, and the possible perioperative complications. The intended benefit and the potential risk of postoperative complications must be considered when deciding to operate for CDCP. Because the approach and correction strategy depend on the type of cervical deformity, as well as the patient’s comorbidities and functional status, a customized strategy is needed. Perioperatively, botulinum toxin injections and muscle division techniques can help control excessive involuntary movements and improve the spinal fusion success rate. Surgical intervention for CDCP requires a multidisciplinary approach, and the information presented in this article is intended to help in the perioperative management and surgical treatment of CDCP.
Classification(s) of Cervical Deformity
Authors: Kaidi Austin C. , Kim Han Jo
Published: December 2022

Cervical spine deformities (CSD) are complex surgical issues with currently heterogenous management strategies. The classification of CSD is still an evolving field. Rudimentary classification schemas were initially proposed in the late 20th century but were largely informal and based on the underlying etiology (i.e. , postsurgical, traumatic, or inflammatory). The first formal classification schema was proposed by Ames et al. in 2015 who established a standard nomenclature for describing these deformities. This classification system established 5 deformity descriptors based on curve apex location (cervical, cervicothoracic, thoracic, craniovertebral junctional, and coronal deformities) and 5 deformity modifiers which helped surgeons utilize a standard language when discussing CSD patients. Koller et al. in 2019 subsequently established a classification system for patients with rigid cervical kyphosis based on regional and global sagittal alignment. Most recently, Kim et al. in 2020 proposed an updated classification system utilizing dynamic cervical spine imaging to guide surgical treatment of CSD patients. It identified 4 major groups of deformities – (1) those with “flat-neck” deformities caused by cervical lordosis T1 slope mismatch; (2) those with focal kyphotic deformities between 2 cervical vertebrae; (3) those with cervicothoracic deformities caused by large T1 slope; and (4) those with coronal deformities. Group 2 deformities most often required combined anterior-posterior approaches with short constructs, and group 3 deformities most often required posterior-only approaches with 3-column osteotomies.