Risk factors and clinical significance of posterior slip of the proximal vertebral body after lower lumbar fusion

BACKGROUND Adjacent segment disease(ASD)after fusion surgery is frequently manifests as a cranial segment instability,disc herniation,spinal canal stenosis,spondylolisthesis or retrolisthesis.The risk factors and mechanisms of ASD have been widely discussed but never clearly defined.AIM To investigate the risk factors and clinical significance of retrograde movement of the proximal vertebral body after lower lumbar fusion.METHODS This was a retrospective analysis of the clinical data of patients who underwent transforaminal lumbar interbody fusion surgery between September 2015 and July 2021 and who were followed up for more than 2 years.Ninety-one patients with degenerative lumbar diseases were included(22 males and 69 females),with an average age of 52.3 years(40-73 years).According to whether there was retrograde movement of the adjacent vertebral body on postoperative X-rays,the patients were divided into retrograde and nonretrograde groups.The sagittal parameters of the spine and pelvis were evaluated before surgery,after surgery,and at the final follow-up.At the same time,the Oswestry Disability Index(ODI)and Visual Analogue Scale(VAS)were used to evaluate the patients’quality of life.RESULTS Nineteen patients(20.9%)who experienced retrograde movement of proximal adjacent segments were included in this study.The pelvic incidence(PI)of the patients in the retrograde group were significantly higher than those of the patients in the nonretrograde group before surgery,after surgery and at the final follow-up(P<0.05).There was no significant difference in lumbar lordosis(LL)between the two groups before the operation,but LL in the retrograde group was significantly greater than that in the nonretrograde group postoperatively and at the final follow-up.No significant differences were detected in terms of the|PI–LL|,and there was no significant difference in the preoperative lordosis distribution index(LDI)between the two groups.The LDIs of the retrograde group were 68.1%±11.5%and 67.2%±11.9%,respectively,which were significantly lower than those of the nonretrograde group(75.7%±10.4%and 74.3%±9.4%,respectively)(P<0.05).Moreover,the patients in the retrograde group had a greater incidence of a LDI<50%than those in the nonretrograde group(P<0.05).There were no significant differences in the ODI or VAS scores between the two groups before the operation,but the ODI and VAS scores in the retrograde group were significantly worse than those in the nonretrograde group after the operation and at the last follow-up,(P<0.05).CONCLUSION The incidence of posterior slippage after lower lumbar fusion was approximately 20.9%.The risk factors are related to a higher PI and distribution of lumbar lordosis.When a patient has a high PI and insufficient reconstruction of the lower lumbar spine,adjacent segment compensation via posterior vertebral body slippage is one of the factors that significantly affects surgical outcomes.

Roles of voltage in semi-insulating GaAs photoconductive semiconductor switch

An experimental study of leakage current is presented in a semi-insulating（SI） Ga As photoconductive semiconductor switch（PCSS） with voltages up to 5.8 kV（average field is 19.3 kV/cm）. The leakage current increases nonlinearly with the bias voltage increasing from 1.2×10^-9 A to 3.6×10^-5A. Furthermore, the dark resistance, which is characterized as a function of electric field, does not monotonically decrease with the field but displays several distinct regimes. By eliminating the field-dependent drift velocity, the free-electron density n is extracted from the current, and then the critical field for each region of n（E） characteristic of PCSS is obtained. It must be the electric field that provides the free electron with sufficient energy to activate the carrier in the trapped state via multiple physical mechanisms, such as impurity ionization, fielddependent EL2 capture, and impact ionization of donor centers EL10 and EL2. The critical fields calculated from the activation energy of these physical processes accord well with the experimental results. Moreover, agreement between the fitting curve and experimental data of J（E）, further confirms that the dark-state characteristics are related to these field-dependent processes. The effects of voltage on SI-Ga As PCSS may give us an insight into its physical mechanism.

Reconstruction of the Medial Patellofemoral Ligament Using Hamstring Tendon Graft With Different Methods:a Biomechanical Study

Objective To measure the tensile strength of the normal medial patellofemoral ligament(MPFL),and evaluate the biomechanics of different fixation methods of the hamstring tendon graft on the patella.Methods Eight fresh cadaver knees were prepared by isolating the patella,leaving only the MPFL as its attachment to the medial condyle of femur.The MPFL was reconstructed by three different methods:four-suture fixation,anchors-single suture fixation,and anchors-double suture fixation.The tensile strength and the elongation of the normal MPFL and the tendon grafts were measured.Results The tensile strength of the four-suture fixation group(234.86±49.02 N)was stronger than that of the normal MPFL(146.91±25.30 N,P=0.0014)and the anchors-single suture group(159.17±49.07N,P=0.0077),while weaker than that of the anchors-double suture group(314.74±78.46 N,P=0.0052)Conclusions With regard to the tensile strength,the four-suture fixation method is reliable for clinical use.Compared with the anchor-suture method,the four-suture fixation method which has no specific implants is more economical,convenient and efficient.

Endoscopic mucosal resection of a bile duct polyp: A case report

BACKGROUND Bile duct polyps are difficult to diagnose and are usually excised by open abdominal surgery or snare polypectomy using choledochoscopy via the T-tube sinus tract. However, these two resection methods require the surgeon to open the abdomen and cut the bile duct to place the “T” tube. Moreover, simple snare polypectomy, without submucosal injection, can only remove pedunculated polyps and not flat polyps. Therefore, a new method is required for the excision of bile duct polyps, including flat polyps. CASE SUMMARY A 63-year-old woman was hospitalized following epigastric pain lasting a month. She had a 30-year history of cholelithiasis and had undergone cholecystectomy because of cholecystolithiasis, and had undergone cholangiolithotomy twice due to choledocholithiasis. Computed tomography (CT) and magnetic resonance imaging showed a communication between the bile duct and duodenal bulb. Inside the communication, CT showed a high-density shadow which was a hypointense lesion in T2 weighted image. The lesion showed no enhancement in T1 weighted image contrast enhanced. Gastroscopy revealed an incarcerated bile duct stone in the anterior wall of the duodenal bulb, which was removed with a basket under gastroscopy. Thereafter, a choledochoduodenal fistula was revealed. Finally, a flat polyp was detected in the lower part of the common bile duct and was removed by endoscopic mucosal resection (EMR) through the fistula. To our knowledge, this is the first reported case of the removal of a bile duct polyp using EMR. CONCLUSION EMR is a safe, effective, and low-cost method for the resection of all bile duct polyps.

Preparation and Characterization of UV-absorbing PVDF Membranes via Pre-irradiation Induced Graft Polymerization

Herein, excellent UV-absorbing poly(vinylidene fluoride)(PVDF) membranes were fabricated through the pre-irradiation induced graft polymerization method. The PVDF chains irradiated with ^(60)Co γ-ray were modified with the polymerizable UV absorber 2-[2-hydroxy-5-[2-(methacryloyloxy)ethyl]phenyl]-2 H-benzotriazole(RUVA-93). The influences of irradiation dose and monomer concentration on the prepared PVDF-g-PRUVA-93 membranes were investigated, and the optimal condition was eventually obtained. The chemical structures of the films were studied by ~1H-NMR, FTIR, and XRD. UV light transmittance and DSC tests were used to characterize the UV-absorbing performance and thermal property of the PVDF films before and after modification. The results proved that the PRUVA-93 side chains were successfully incorporated into the PVDF main chains and the obtained PVDF-g-PRUVA-93 films possessed remarkable UV-absorbing property. The modified membrane made under the optimized experiment condition could completely block the UV light in the range of 200-387 nm. Additionally, the transmittance of the PVDF-g-PRUVA-93 film could be reduced to0.04% in 280-320 nm, where the light irradiation could damage polymer materials most seriously.