Video-assisted lateral intertransverse process arthrodesis. Validation of a new minimally invasive lumbar spinal fusion technique in the rabbit and nonhuman primate (rhesus) models

STUDY DESIGN: Cadaveric anatomic and in vivo survival animal studies were performed to develop a new arthrodesis technique for the lumbar spine. OBJECTIVES: To examine the feasibility, efficacy, and safety of a minimally invasive lumbar intertransverse process arthrodesis technique using an osteoinductive growth factor (rhBMP-2) delivered in a collagen sponge carrier. The technique was first developed using a rabbit model and modified for the nonhuman primate (rhesus monkey), a larger animal with the most similar bone biology to humans. SUMMARY OF BACKGROUND DATA: The morbidity of conventional posterolateral lumbar intertransverse process arthrodesis includes graft donor site morbidity; paraspinal muscle devascularization, denervation, and scarring and nonunion in up to 36% of patients. Minimally invasive anterior lumbar interbody arthrodesis techniques have been developed, but these often require a metal implant and carry risks to major vessels and development of retrograde ejaculation. A minimally invasive technique for posterolateral intertransverse process arthrodesis has not been described previously. METHODS: In Part 1, we examined seven New Zealand white rabbits and five rhesus monkeys at necropsy and during nonsurvival surgeries to determine the best access routes and to develop special instruments for video-assisted lateral intertransverse process arthrodesis. In Part 2, 38 New Zealand white rabbits underwent L4-L5 intertransverse process arthrodesis: the "OPEN" group (n = 16) underwent a standard open muscle-splitting approach using rhBMP-2 (bone morphogenetic protein) and collagen as a bone graft substitute; the "video-assisted control" group (n = 6) underwent video-assisted lateral intertransverse process arthrodesis with the collagen implant only (no growth factor); and the "video-assisted-BMP" group (n = 16) underwent video-assisted lateral intertransverse process arthrodesis with rhBMP-2 and collagen as the graft material. In Part 3, rhesus monkeys (n = 4) underwent video-assisted lateral intertransverse process arthrodesis using rhBMP-2 and collagen after laminectomy of L4-L5. RESULTS: In Part 1, we identified expedient, minimally invasive routes to the intertransverse process interval appropriate for each species: an intermuscular approach for the rabbit and a lateral, extramuscular approach for the rhesus monkey. In Part 2, all rabbits in the OPEN and video-assisted-BMP groups achieved solid intertransverse process lumbar fusions when assessed at 10 weeks. There were no neurologic impairments nor any difference between the two groups in the frequency of postoperative infection or other complications. None of the animals in the video-assisted control group showed evidence of fusion. In Part 3, exposure, decortication and grafting with rh-BMP-2 and collagen was accomplished successfully in all four monkeys through the video-assisted minimally invasive approach without complications. CONCLUSION: Video-assisted lateral intertransverse process arthrodesis is a feasible, effective, and safe method of lumbar spinal fusion in the rabbit and rhesus monkey. Use of this arthrodesis procedure will minimize the morbidity of paraspinal muscle denervation and devascularization seen with open intertransverse process fusion techniques, and the use of an osteoinductive growth factor will eliminate the problem of graft donor site morbidity and possibly increase the chances for successful fusion.     

Encephalopathy during oral treatment with bismuth salts

Side effects of orally administered bismuthic salts have been known for many years. Many systems are involved, including the digestive and urinary. The authors discuss a recently discovered effect on the central nervous system, termed "bismuth encephalopathy". In the light of the medical literature reviewed, two original aspects are stressed: the clinical symptoms are stereotyped and completely reversible, and the distribution of the disease is almost epidemic, being limited in time and space. The prodromes include confusion, asthenia, slowing of mental functions and disturbance of gait. The clinical picture is dominated by four major symptoms: confusion (again), ataxia, dysarthria and, above all, myoclonic jerks. In conclusion, various pathogenetic hypotheses are considered. The purpose of this study is to enable the general practitioner to detect the development of this condition early in treatment with oral bismuthic salts. Withdrawal of the medication always results in normalization of the patient's condition.     

Recognition of depressed affect in hospitalized psychiatric patients: staff and patient perceptions

A comparison of self-report vs. observer rating of depressed mood in a heterogenous inpatient population revealed wide variations in concordance among diagnostic groups. Patients diagnosed as having Affective Psychosis and "Other' illnesses showed the highest correlation between four self-report scales and an observer rating scale. Patients with a diagnosis of depressive Neurosis showed only modest correlation, while Schizophrenics revealed no significant correlation, on these instruments, suggesting inconsistent communication of affect from Schizophrenic patients to observers. In contrast, when self-report scales were intercorrelated, patients in all four diagnostic categories showed highly significant correlations, indicating that they were consistently reporting their affective state on these instruments. The implications of these findings for future research as well as for practical clinical management are discussed.     

Growth and dielectric properties of Ta_2O_5 single crystals grown by laser heated pedestal growth technique

Ta2O5 single crystals have been grown by the laser heated pedestal growth (LHPG) technique up to several centimeters length with diameter of 1.1 mm. The crystal, characterized by X-ray diffraction, dielectric measurement, and thermal expansion analysis, has Htri-Ta2O5 symmetry. Dielectric permittivity, loss tangent along [001] and [110] direction were investigated over the temperature range from -80 ℃ to 100 ℃. Large dielectric anisotropy in Ta2O5 single crystal was observed. At room temperature, the dielectric permittivities (1 MHz) along [001] and [110] are 33.2 and 231.9, respectively. The reason of dielectric enhancement in Ta2O5 crystal grown by LHPG was also discussed.     

基于流形正则化非负矩阵分解的高光谱数据降维

采用基于流形正则化非负矩阵分解(MR-NMF)的高 光谱数据降维方法。新方 法通过构建样本的近邻图描述数据几何结构,然后将其作为正则项加入NMF的目标函 数中进行组合优化。在真实的高光谱数据集HYDICE上进行的实验结果表明,新方法能 够提高高光谱图像分类的精度。     

PREHEP: human error probability based process unit selection

The paper describes a methodology to use human error probabilities (HEPs) as a basis for selecting functional process units in the design phase. The method helps us to understand the influence of human error (HE) on functional robustness of the units in earlier design phases, e.g., at the functional analysis level. This methodology can be used to detect the need for human operator support. The method consists of several steps. First alternative configurations of functional process units with different complexities are developed. For each configuration, a fault tree is developed to find the initiating events (failures of equipment) which lead to a chosen top event. This top event is an undesired event such as an overflowing tank. The initiating events are used to create event trees (ET) with special emphasis on operator actions, such as monitoring the process and fault diagnosis. A diagnosis diagram is used to simulate the fault diagnosis process and to identify the initiating failures. The probability of a top event due to human error can then be found by using existing HEP-data and by normalizing the failure probabilities of the equipment. The methodology is demonstrated for two examples of functional process units, each with two levels of complexity     

电厂蒸汽回路系统中腐蚀损伤的决定论预测

局部腐蚀,包括点腐蚀、应力腐蚀开裂和腐蚀疲劳是导致电厂发电装置损伤的重要原因,它们诱发50%以上的意外停机事故。迄今,腐蚀破坏的预测一直沿用经验和统计的方法,但是,由于已证实该方法的适用性和其结果的准确性欠佳,故不宜作为例行检修规程的基础。本文提出了预测局部腐蚀损伤的决定论方法,并使用这个方法说明点腐蚀如何引发低压蒸汽轮机涡轮盘Wilson线下游部位的应力腐蚀开裂(SCC),我们的计算表明SCC的萌发与扩展对蒸汽小氧含量、冷凝液膜的环境和涡轮盘所承受的应力这三个因素敏感。