bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improvements in lower-extremity patient-reported outcomes after lumbar interbody fusion
Authors: Kim Yong-Chan , Lee Keun-Ho , Kim Gab-Lae , Kim Ki-Tack , Ha Kee-Yong , Ko Seung Nam , Luo Qiang , Eom Tae Won , Gwak Hyun Gon 
Published: September 2021

OBJECTIVE
Recently, new patient-reported outcome measures (PROMs) of the spine were designed to overcome the limitations of previous spinal PROMs and to consider the whole spine as a single kinetic functional unit. Owing to the significance of spine-hip-knee and global body balance, the spine and lower extremities cannot be considered separately. However, no reports have evaluated lower-extremity functional outcome using PROMs after lumbar spine surgery. The authors aimed to elucidate changes in hip and knee PROMs after lumbar interbody fusion and to evaluate the sagittal spinopelvic radiographic parameters that were most strongly correlated with lower-extremity PROMs.

METHODS
In 2018, the authors consecutively evaluated patients who underwent lumbar interbody fusion surgery with at most three levels. Preoperative and 1-year postoperative clinical and radiographic data were assessed. Spinal functional outcomes were measured with the Oswestry Disability Index (ODI), visual analog scale (VAS) for pain, and Scoliosis Research Society–22r (SRS-22r) questionnaire. Lower-extremity functional outcomes were evaluated with the Harris Hip Score (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Linear regression was used to evaluate the relationship between spinal and lower-extremity PROMs and spinopelvic radiographic parameters.

RESULTS
The authors enrolled 67 patients, with a mean age of 66.4 years. The average number of surgical levels was 1.7. All assessed PROMs improved significantly after surgery (p < 0.001 for ODI, p < 0.001 for VAS, p = 0.017 for SRS-22r, p = 0.042 for HHS, and p = 0.033 for WOMAC). Spinopelvic parameters, including lumbar lordosis (LL), pelvic tilt (PT), C7 sagittal vertical axis, and sagittal radiographic parameters of hip and knee, significantly improved after surgery. On linear regression analysis, HHS and WOMAC correlated with LL and PT, respectively (β = 0.554 and p = 0.043 for correlation of HHS with LL; β = 1.573 and p = 0.021 for correlation of WOMAC with PT).

CONCLUSIONS
The current study demonstrated that lumbar fusion surgery may induce postoperative improvements in lower-extremity functional and radiological outcomes. However, among radiographic parameters, changes in LL and PT were the most strongly associated with lower-extremity PROMs.
Acute failure of S2-alar-iliac screw pelvic fixation in adult spinal deformity: novel failure mechanism, case series, and review of the literature
Authors: Martin Christopher T. , Polly David W. , Holton Kenneth J. , San Miguel-Ruiz Jose E. , Albersheim Melissa , Lender Paul , Sembrano Jonathan N. , Hunt Matthew A. , Jones Kristen E. 
Published: September 2021

OBJECTIVE
Pelvic fixation with S2-alar-iliac (S2AI) screws is an established technique in adult deformity surgery. The authors’ objective was to report the incidence and risk factors for an underreported acute failure mechanism of S2AI screws.

METHODS
The authors retrospectively reviewed a consecutive series of ambulatory adults with fusions extending 3 or more levels, and which included S2AI screws. Acute failure of S2AI screws was defined as occurring within 6 months of the index surgery and requiring surgical revision.

RESULTS
Failure occurred in 6 of 125 patients (5%) and consisted of either slippage of the rods or displacement of the set screws from the S2AI tulip head, with resultant kyphotic fracture. All failures occurred within 6 weeks postoperatively. Revision with a minimum of 4 rods connecting to 4 pelvic fixation points was successful. Two of 3 (66%) patients whose revision had less fixation sustained a second failure. Patients who experienced failure were younger (56.5 years vs 65 years, p = 0.03). The magnitude of surgical correction was higher in the failure cohort (number of levels fused, change in lumbar lordosis, change in T1–pelvic angle, and change in coronal C7 vertical axis, each p < 0.05). In the multivariate analysis, younger patient age and change in lumbar lordosis were independently associated with increased failure risk (p < 0.05 for each). There was a trend toward the presence of a transitional S1–2 disc being a risk factor (OR 8.8, 95% CI 0.93–82.6). Failure incidence was the same across implant manufacturers (p = 0.3).

CONCLUSIONS
All failures involved large-magnitude correction and resulted from stresses that exceeded the failure loads of the set plugs in the S2AI tulip, with resultant rod displacement and kyphotic fractures. Patients with large corrections may benefit from 4 total S2AI screws at the time of the index surgery, particularly if a transitional segment is present. Salvage with a minimum of 4 rods and 4 pelvic fixation points can be successful.
Improved estimates of strength and stiffness in pathologic vertebrae with bone metastases using CT-derived bone density compared with radiographic bone lesion quality classification
Authors: Alkalay Ron N. , Groff Michael W. , Stadelmann Marc A. , Buck Florian M. , Hoppe Sven , Theumann Nicolas , Mektar Umesh , Davis Roger B. , Hackney David B. 
Published: September 2021

OBJECTIVE
The aim of this study was to compare the ability of 1) CT-derived bone lesion quality (classification of vertebral bone metastases [BM]) and 2) computed CT-measured volumetric bone mineral density (vBMD) for evaluating the strength and stiffness of cadaver vertebrae from donors with metastatic spinal disease.

METHODS
Forty-five thoracic and lumbar vertebrae were obtained from cadaver spines of 11 donors with breast, esophageal, kidney, lung, or prostate cancer. Each vertebra was imaged using microCT (21.4 μm), vBMD, and bone volume to total volume were computed, and compressive strength and stiffness experimentally measured. The microCT images were reconstructed at 1-mm voxel size to simulate axial and sagittal clinical CT images. Five expert clinicians blindly classified the images according to bone lesion quality (osteolytic, osteoblastic, mixed, or healthy). Fleiss’ kappa test was used to test agreement among 5 clinical raters for classifying bone lesion quality. Kruskal-Wallis ANOVA was used to test the difference in vertebral strength and stiffness based on bone lesion quality. Multivariable regression analysis was used to test the independent contribution of bone lesion quality, computed vBMD, age, gender, and race for predicting vertebral strength and stiffness.

RESULTS
A low interrater agreement was found for bone lesion quality (κ = 0.19). Although the osteoblastic vertebrae showed significantly higher strength than osteolytic vertebrae (p = 0.0148), the multivariable analysis showed that bone lesion quality explained 19% of the variability in vertebral strength and 13% in vertebral stiffness. The computed vBMD explained 75% of vertebral strength (p < 0.0001) and 48% of stiffness (p < 0.0001) variability. The type of BM affected vBMD-based estimates of vertebral strength, explaining 75% of strength variability in osteoblastic vertebrae (R2 = 0.75, p < 0.0001) but only 41% in vertebrae with mixed bone metastasis (R2 = 0.41, p = 0.0168), and 39% in osteolytic vertebrae (R2 = 0.39, p = 0.0381). For vertebral stiffness, vBMD was only associated with that of osteoblastic vertebrae (R2 = 0.44, p = 0.0024). Age and race inconsistently affected the model’s strength and stiffness predictions.

CONCLUSIONS
Pathologic vertebral fracture occurs when the metastatic lesion degrades vertebral strength, rendering it unable to carry daily loads. This study demonstrated the limitation of qualitative clinical classification of bone lesion quality for predicting pathologic vertebral strength and stiffness. Computed CT-derived vBMD more reliably estimated vertebral strength and stiffness. Replacing the qualitative clinical classification with computed vBMD estimates may improve the prediction of vertebral fracture risk.
Freehand screw insertion technique without image guidance for the cortical bone trajectory screw in posterior lumbar interbody fusion: what affects screw misplacement?
Authors: Ishii Masayoshi , Ohnishi Atsunori , Yamagishi Akira , Ohwada Tetsuo 
Published: September 2021

OBJECTIVE
Cortical bone trajectory (CBT) screw insertion using a freehand technique is considered less feasible than guided techniques, due to the lack of readily identifiable visual landmarks. However, in posterior lumbar interbody fusion (PLIF), after resection of the posterior anatomy, the pedicles themselves, into which implantation is performed, are palpable from the spinal canal and neural foramen. With the help of pedicle wall probing, the authors have placed CBT screws using a freehand technique without image guidance in PLIF. This technique has advantages of no radiation exposure and no requirement for expensive devices, but the disadvantage of reduced accuracy in screw placement. To address the problem of symptomatic breaches with this freehand technique, variables related to unacceptable screw positioning and need for revisions were investigated.

METHODS
From 2014 to 2020, 182 of 426 patients with single-level PLIF were enrolled according to the combined criteria of L4–5 level, excluding cases of revision and isthmic spondylolisthesis; using screws 5.5 mm in diameter; and operated by right-handed surgeons. We studied the number of misplaced screws found and replaced during initial surgeries. Using multiplanar reconstruction CT postoperatively, 692 screw positions on images were classified using previously reported grading criteria. Details of pedicle breaches requiring revisions were studied. We conducted a statistical analysis of the relationship between unacceptable (perforations > 2 mm) misplacements and four variables: level, laterality, spinal deformity, and experiences of surgeons.

RESULTS
Three screws in L4 and another in L5 were revised during initial surgeries. The total rate of unacceptable screws on CT examinations was 3.3%. Three screws in L4 and another in L5 breached inferomedial pedicle walls in grade 3 and required revisions. The revision rate was 2.2%. The percentage of unacceptable screws was 5.2% in L4 and 1.7% in L5 (p < 0.05), whereas other variables showed no significant differences.

CONCLUSIONS
A freehand technique can be feasible for CBT screw insertion in PLIF, balancing the risks of 3.3% unacceptable misplacements and 2.2% revisions with the benefits of no radiation exposure and no need for expensive devices. Pedicle palpation in L4 is the key to safety, even though it requires deeper and more difficult probing. In the initial surgeries and revisions, 75% of revised screws were observed in L4, and unacceptable screw positions were more likely to be found in L4 than in L5.
Acute, severe traumatic spinal cord injury: improving urinary bladder function by optimizing spinal cord perfusion
Authors: Hogg Florence R. A. , Kearney Siobhan , Solomon Eskinder , Gallagher Mathew J. , Zoumprouli Argyro , Papadopoulos Marios C. , Saadoun Samira 
Published: September 2021

OBJECTIVE
The authors sought to investigate the effect of acute, severe traumatic spinal cord injury on the urinary bladder and the hypothesis that increasing the spinal cord perfusion pressure improves bladder function.

METHODS
In 13 adults with traumatic spinal cord injury (American Spinal Injury Association Impairment Scale grades A–C), a pressure probe and a microdialysis catheter were placed intradurally at the injury site. We varied the spinal cord perfusion pressure and performed filling cystometry. Patients were followed up for 12 months on average.

RESULTS
The 13 patients had 63 fill cycles; 38 cycles had unfavorable urodynamics, i.e., dangerously low compliance (< 20 mL/cmH2O), detrusor overactivity, or dangerously high end-fill pressure (> 40 cmH2O). Unfavorable urodynamics correlated with periods of injury site hypoperfusion (spinal cord perfusion pressure < 60 mm Hg), hyperperfusion (spinal cord perfusion pressure > 100 mm Hg), tissue glucose < 3 mM, and tissue lactate to pyruvate ratio > 30. Increasing spinal cord perfusion pressure from 67.0 ± 2.3 mm Hg (average ± SE) to 92.1 ± 3.0 mm Hg significantly reduced, from 534 to 365 mL, the median bladder volume at which the desire to void was first experienced. All patients with dangerously low average initial bladder compliance (< 20 mL/cmH2O) maintained low compliance at follow-up, whereas all patients with high average initial bladder compliance (> 100 mL/cmH2O) maintained high compliance at follow-up.

CONCLUSIONS
We conclude that unfavorable urodynamics develop within days of traumatic spinal cord injury, thus challenging the prevailing notion that the detrusor is initially acontractile. Urodynamic studies performed acutely identify patients with dangerously low bladder compliance likely to benefit from early intervention. At this early stage, bladder function is dynamic and is influenced by fluctuations in the physiology and metabolism at the injury site; therefore, optimizing spinal cord perfusion is likely to improve urological outcome in patients with acute severe traumatic spinal cord injury.
Effects of prolonged peri-neural bupivacaine infusion in rat sciatic nerves (axon and myelin)
Authors: Butler John T. , Robinson Tobias J. , Edwards Jared R. , Grafe Marjorie R. , Kirsch Jeffrey R. 
Published: September 2021

Background/Objective: Peripheral-nerve blocks (PNBs) using continuous-infusion of local anesthetics are used to provide perioperative analgesia. Yet little research exists to characterize the histopathological effects of continuous long-duration PNBs. Herein we test the hypothesis that continuous peri-neural bupivacaine infusion (3-day vs. 7-day infusion) contributes to histologic injury in a duration-dependent manner using an in vivo model of rat sciatic nerves. Methods: We placed indwelling catheters in 22 rats for infusion with low-dose (0.5mg/kg/hr) bupivacaine or normal saline proximal to the right sciatic nerves for 3 or 7 consecutive days. Hind-limb analgesia was measured using Von-Frey nociceptive testing. At infusion end, rats were sacrificed, bilateral nerves were sectioned and stained with hematoxylin and eosin and CD68 for evaluation of inflammatory response, and eriochrome to assess damage to myelin. Results: Animals receiving continuous infusion of bupivacaine maintained analgesia as demonstrated by significant decrease (50% on average) in nociceptive response in bupivacaine-infused limbs across time points. Both 7-day saline and bupivacaine-infused sciatic nerves showed significantly-increased inflammation by H&E staining compared to untreated native nerve controls ( P = 0.0001, P < 0.0001). Extent of inflammation did not vary significantly based on infusate (7-day saline vs. 7-day bupivacaine P > 0.99) or duration (3-day bupivacaine vs 7-day bupivacaine P > 0.99). No significant change in sciatic nerve myelin was found in bupivacaine-infused animals compared to saline-infused controls, regardless of duration. Conclusions: Long-duration (7-day) bupivacaine infusion provided durable post-operative analgesia, yet contributed to equivalent neural inflammation as short duration (3-day) infusion of bupivacaine or saline with no evidence of demyelination.
Evaluation of Herbal Extract of Gentiana diffusa for Antianxiety Activity
Authors: Dakua Sudipta , Gawaly Rakesh , Jain Pratyush , Jain Alok Pal 
Published: September 2021

The present study was designed to authenticate the anti-anxiety activity (by using elevated plus maze model) of methanolic extract of the leaves of Gentiana diffusa. by authors Swiss Albino mice were treated with different doses of the leaf extracts (200 mg / kg p.o.) and Diazepam (2mg/ kg, p.o) was used as a positive control. Results of study show that methanolic extract in higher doses (200 mg/kg) possesses marked anti-anxiety activity and was comparable to the effect produced by diazepam. The plant can be developed as a commercial source of anxiolytic agent. Further studies are in process to isolate the active constituent responsible for this activity and mechanism of action.
Keywords: Leaves, Methanol, Anxiety, Diazepam
Методологія оцінки допустимих товщин елементів трубопроводів АЕС із вуглецевих сталей в умовах ерозійно-корозійного зносу
Authors: Ageiev S. 
Published: September 2021

У статті описано підхід до оцінки ступеня небезпеки ерозійно-корозійного зносу елементів трубопроводів АЕС із вуглецевих сталей. З метою апробації запропонованого підходу проведено комплекс розрахунково-аналітичних робіт, зокрема: а) проаналізовано існуючий підхід до оцінки ступеня небезпеки ерозійно-корозійного зносу на АЕС України; встановлено його недоліки; б) розроблено алгоритм оцінки ступеня небезпеки ерозійно-корозійного зносу з використанням експрес-оцінки та уточненої процедури; в) верифіковано розрахункові моделі співставленням з іншими існуючими розрахунковими моделями та експериментальними даними з метою демонстрації їх коректності; г) за розробленим підходом виконано оцінку ступеня небезпеки ерозійно-корозійного зносу систем трубопроводів енергоблоків №№ 1 та 4 Відокремленого підрозділу «Запорізька атомна електростанція», виявлених у період експлуатації з 2012 року по 2016 рік.
Розроблений підхід дозволяє: 1) оцінювати ступінь небезпеки ерозійно-корозійного зносу не тільки в окружному напрямку поперечного перерізу труби внаслідок дії внутрішнього тиску (підхід, що базується на вимогах ПНАЭ Г-7-002-86, щодо визначення допустимої товщини стінки бездефектного трубопроводу), але й уздовж осі трубопроводу від одночасної дії внутрішнього тиску, осьового зусилля та моментів згину. Такий підхід особливо актуальний для трубопровідних систем, які, переважно, мають складну просторову конфігурацію, що призводить до виникнення в них осьових зусиль та моментів згину внаслідок дії масових характеристик трубопроводів та арматури, температурних, сейсмічних впливів тощо; 2) оцінювати ступінь небезпеки ерозійно-корозійного зносу не тільки за його глибиною (підхід ИН-Т.0.03.190-14), а й з урахуванням довжини та ширини ерозійно-корозійного зносу. На відміну від існуючого підходу, це дозволяє коректніше оцінювати ступінь небезпеки ерозійно-корозійного зносу.
Основні результати аналізу подій на АЕС України, пов’язаних із захисною оболонкою
Authors: Shugailo O-i , Ligotskyy O. , Serafyn R. , Pecherytsia O. , Panchenko А. 
Published: September 2021

У цій статті наведені основні результати аналізу експлуатаційних подій на АЕС України та світу, пов’язаних з захисною оболонкою та системами, які забезпечують її працездатність.
Основною метою цього аналізу було здобуття загальних та конкретних уроків, які дозволять запобігти повторенню подій у майбутньому. Обсяги аналізу охоплюють структурні елементи споруди захисної оболонки та інші системи, необхідні для забезпечення її функціонування. Під час проведення аналізу розглянуті експлуатаційні події розділено на категорії (ті, що впливають або можуть вплинути на виконання захисною оболонкою своїх локалізуючих функцій, і ті, що не впливають). Встановлено, що до категорії подій, що впливають на виконання захисною оболонкою проєктних функцій, належать випадки відмови арматурних канатів системи переднапруження захисної оболонки і ці випадки розглянуто детально, починаючи з 1980 року з урахуванням історії та причин зміни проєктних значень зусиль натягу арматурних канатів.
The Therapeutic Efficacy of Adipose Tissue-Derived Mesenchymal Stem Cell Conditioned Medium on Experimental Colitis Was Improved by the Serum From Colitis Rats
Authors: Qi Li-li , Fan Zhe-yu , Mao Hai-guang , Wang Jin-bo 
Published: September 2021

Adipose derived mesenchymal stem cells (AD-MSCs) have shown therapeutic potential in treatments of inflammatory bowel disease (IBD). Due to the harsh host environment and poor survival of the cells, controversy concerning the homing, proliferation and differentiation of MSCs in lesion tissue still remains. It has been reported that conditioned media from MSCs could improve the colitis, whereas the therapeutic efficiency could be significantly elevated by the stimulation of pro-cytokines. In this study, we pre-treated the adipose derived MSCs with the serum from colitis rats and then the activated conditioned media (CM-AcMSC) were collected. To compare the therapeutic effects of CM-MSC and CM-AcMSC on IBD, we constructed dextran sodium sulphate (DSS)-induced colitis rat models. The colitis was induced in rats by administrating 5% DSS in drinking water for 10 days, and the disease symptoms were recorded daily. The colon histopathological changes were observed by different staining methods (H&amp;E and PAS). The expression levels of MUC2 and tight junctions (TJs) were determined by RT-qPCR. The levels of inflammatory cytokines were analyzed by ELISA and western blot analysis. Our findings suggested that CM-AcMSC was more effective in ameliorating the clinical features and histological damage scores. Treatment with CM-AcMSC significantly increased the expression of MUC2 and TJs and suppressed the production of pro-inflammatory cytokines in colonic tissues of colitis rats. The inhibitory effects of CM-AcMSC on inflammatory responses of colitis rats were mediated by NF-κB signaling pathway. These results suggested that pre-activation of MSCs with serum from colitis rats could promote the production of paracrine factors and improve the therapeutic effects of conditioned medium on colitis rats.
Evaluation of Bi-Layer Silk Fibroin Grafts for Tubular Ureteroplasty in a Porcine Defect Model
Authors: Gundogdu Gokhan , Okhunov Zhamshid , Cristofaro Vivian , Starek Stephanie , Veneri Faith , Orabi Hazem , Jiang Pengbo , Sullivan Maryrose P. , Mauney Joshua R. 
Published: September 2021

Ureteral reconstruction with autologous tissue grafts is often limited by tissue availability and donor site morbidity. This study investigates the performance of acellular, bi-layer silk fibroin (BLSF) scaffolds in a porcine model of ureteroplasty. Tubular ureteroplasty with BLSF grafts in combination with transient stenting for 8 weeks was performed in adult female, Yucatan, mini-swine (N = 5). Animals were maintained for 12 weeks post-op with imaging of neoconduits using ultrasonography and retrograde ureteropyelography carried out at 2 and 4 weeks intervals. End-point analyses of ureteral neotissues and unoperated controls included histological, immunohistochemical (IHC), histomorphometric evaluations as well as ex vivo functional assessments of contraction/relaxation. All animals survived until scheduled euthanasia and displayed mild hydronephrosis (Grades 1-2) in reconstructed collecting systems during the 8 weeks stenting period with one animal presenting with a persistent subcutaneous fistula at 2 weeks post-op. By 12 weeks of scaffold implantation, unstented neoconduits led to severe hydronephrosis (Grade 4) and stricture formation in the interior of graft sites in 80% of swine. Bulk scaffold extrusion into the distal ureter was also apparent in 60% of swine contributing to ureteral obstruction. However, histological and IHC analyses revealed the formation of innervated, vascularized neotissues with a-smooth muscle actin+ and SM22α+ smooth muscle bundles as well as uroplakin 3A+ and pan-cytokeratin + urothelium. Ex vivo contractility and relaxation responses of neotissues were similar to unoperated control segments. BLSF biomaterials represent emerging platforms for tubular ureteroplasty, however further optimization is needed to improve in vivo degradation kinetics and mitigate stricture formation.