Abstract
BACKGROUND: The failure modes, time to development, and clinical relevance are known to differ between proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). However, ...there are no reports that study the risk factors of PJK and PJF separately.
OBJECTIVE: The aim of this study was to investigate the risk factors for PJK and PJF separately.
METHODS: A retrospective study of 160 consecutive patients who underwent a long instrumented fusion to the sacrum for adult spinal deformity with a minimum follow-up of 2 years was conducted. A separate survivorship analysis of PJK and PJF was performed using the Cox proportional hazards model for the 3 categorical parameters of surgical, radiographic, and patient factors.
RESULTS: PJK developed in 27 patients (16.9%) and PJF in 29 patients (18.1%). The median survival time was 17.0 months for PJK and 3.0 months for PJF. Multivariate analyses revealed that a high body mass index was an independent risk factor for PJK (hazard ratio HR = 1.179), whereas the significant risk factors for PJF were older age, the presence of osteoporosis, the uppermost instrumented vertebra level at T11-L1, and a greater preoperative sagittal vertical axis (HR = 1.082, 6.465, 5.236, and 1.017, respectively). A large correction of sagittal deformity was shown to be a risk factor for PJF on univariate analyses, but not on multivariate analyses.
CONCLUSION: PJK developed at a median of 17 months and PJF at a median of 3 months. A high body mass index was an independent risk factor for PJK, whereas older age, osteoporosis, uppermost instrumented vertebra level at the thoracolumbar junction, and greater preoperative sagittal vertical axis were risk factors for PJF.
In this work, the authors report materials, fabrication strategies, and applications of biodegradable microsupercapacitors (MSCs) built using water‐soluble (i.e., physically transient) metal (W, Fe, ...and Mo) electrodes, a biopolymer, hydrogel electrolyte (agarose gel), and a biodegradable poly(lactic‐co‐glycolic acid) substrate, encapsulated with polyanhydride. During repetitive charge/discharge cycles, the electrochemical performance of these unusual MSCs is dramatically enhanced, following from the role of pseudocapacitance that originates from metal‐oxide coatings generated by electrochemical corrosion at the interface between the water‐soluble metal electrode and the hydrogel electrolyte. Systematic studies reveal the dissolution kinetics/behaviors of each individual component of the MSCs, as well as those of the integrated devices. An encapsulation strategy that involves control over the thickness, chemistry, and molecular weight of the constituent materials provides a versatile means to engineer desired functional lifetimes. Demonstration experiments illustrate potential applications of these biodegradable MSCs as transient sources of power in the operation of light‐emitting diodes and as charging capacitors in integrated circuits for wireless power harvesting.
An entirely biodegradable microsupercapacitor is successfully fabricated using water‐soluble metal electrodes, agarose gel electrolyte, and poly(lactic‐co‐glycolic acid) substrate. The development of biodegradable, high performance supercapacitors represents an important advance in the area of transient electronics, with potentially important consequences in technologies for biomedicine, environmental monitoring, sustainable electronics, and other areas.
•253 target micropollutants(MPs) were quantified using high-resolution mass spectrometry.•11 MPs were detected consistently by providing 75% of total concentration.•Pesticides and pharmaceutical ...substances exhibited a strong first flush effect.•Stormflow and antecedent dry conditions could influence the MPs release into water.
Urban rainfall events can lead to the runoff of pollutants, including industrial, pesticide, and pharmaceutical chemicals. Transporting micropollutants (MPs) into water systems can harm both human health and aquatic species. Therefore, it is necessary to investigate the dynamics of MPs during rainfall events. However, few studies have examined MPs during rainfall events due to the high analytical expenses and extensive spatiotemporal variability. Few studies have investigated the occurrence patterns of MPs and factors that influence their transport, such as rainfall duration, antecedent dry periods, and variations in streamflow. Moreover, while there have been many analyses of nutrients, suspended solids, and heavy metals during the first flush effect (FFE), studies on the transport of MPs during FFE are insufficient. This study aimed to identify the dynamics of MPs and FFE in an urban catchment, using high-resolution monitoring and machine learning methods. Hierarchical clustering analysis and partial least squares regression (PLSR) were implemented to estimate the similarity between each MP and identify the factors influencing their transport during rainfall events. Eleven dominant MPs comprised 75% of the total MP concentration and had a 100% detection frequency. During rainfall events, pesticides and pharmaceutical MPs showed a higher FFE than industrial MPs. Moreover, the initial 30% of the runoff volume contained 78.0% of pesticide and 50.1% of pharmaceutical substances for events W1 (July 5 to July 6, 2021) and W6 (August 31 to September 1, 2021), respectively. The PLSR model suggested that stormflow (m3/s) and the duration of antecedent dry hours (h) significantly influenced MP dynamics, yielding the variable importance on projection scores greater than 1.0. Hence, our findings indicate that MPs in urban waters should be managed by considering FFE.
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is the widely available source of spirulina that contains distinctive natural pigments, including carotenoids and C-phycocyanin (C-PC). In this study, the major carotenoid and C-PC contents were ...determined in seven commercially available spirulina powder products and laboratory-prepared
trichomes (AP-1) by an LC-DAD method and UV-Visible spectrometry, respectively. The correlation of these two pigment content levels with Hunter color coordinates and antioxidant activity was also evaluated. The
value failed to show a significant correlation with pigment content, but a positive correlation was observed between
values and the contents of total carotenoid and C-PC. As
values decreased, the chlorophyll a and C-PC contents increased. AP-1 exhibited the highest content of total carotenoids, chlorophyll a and C-PC, and antioxidant activities among the samples. This observation could be related to degradation of these pigments during the mass production process. The carotenoid profiles suggested that the commercial spirulina powders originated from two different sources,
and
. Total carotenoid and C-PC content exhibited positive significant correlations with antioxidant activities measured by 1,1-diphenyl-2-picrylhydrazyl (DPPH) and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) (ABTS) assays. These results provide a strong scientific foundation for the establishment of standards for the commercial distribution of quality spirulina products.
Purpose. The purpose of our study is to compare the results of spinal decompression using the full-endoscopic interlaminar technique, tubular retractor, and a conventional microsurgical laminotomy ...technique and evaluate the advantages and clinical feasibility of minimally invasive spinal (MIS) lumbar decompression technique in the lumbar canal and lateral recess stenosis. Methods. The authors retrospectively reviewed clinical and radiological data from 270 patients who received microsurgical (group E: 72 patients), tubular (group T: 34 patients), or full-endoscopic decompression surgery (group E: 164 patients) for their lumbar canal and lateral recess stenosis from June 2016 to August 2017. Clinical (VAS, ODI, and Mcnab criteria), radiologic (spinal canal diameter, segmental dynamic angle, and disc height), and surgical outcome parameters (CPK level, Operative time, blood loss, and hospital stay) were evaluated pre- and postoperatively and compared among the three groups by means of statistical analysis. Failed cases and complications were reviewed in all groups. Results. The mean follow-up period was 6.38 months. The Overall clinical success rate was 89.4%. All groups showed favorable clinical outcome. The clinical and radiologic results were similar in all groups. Regarding surgical outcome, group E showed longer operation time than group M and T (group E: 84.17 minutes/level, group M: 52.22 minutes/level, and group T: 66.12 minutes/level) (p<0.05). However, groups E and T showed minimal surgical invasiveness compared with group M. Groups E and T showed less immediate postoperative back pain (VAS) (group E: 3.13, group M: 4.28, group T: 3.54) (p<0.05), less increase of serum CPK enzyme (group E: 66.38 IU/L, group M: 120 IU/L, and group T: 137.5 IU/L) (p<0.05), and shorter hospital stay (group E: 2.12 days, group M: 4.85 days, and group T: 2.83 days) (p<0.05). The rates of complications and revisions were not significantly different among the three groups. Conclusions. MIS decompression technique is clinically feasible and safe to treat the lumbar canal and lateral recess stenosis, and it has many surgical advantages such as less muscle trauma, minimal postoperative back pain, and fast recovery of the patient compared to traditional open microscopic technique.
To assess the utility of machine learning (ML) algorithms in predicting clinically relevant atrial high-rate episodes (AHREs), which can be recorded by a pacemaker. We aimed to develop ML-based ...models to predict clinically relevant AHREs based on the clinical parameters of patients with implanted pacemakers in comparison to logistic regression (LR). We included 721 patients without known atrial fibrillation or atrial flutter from a prospective multicenter (11 tertiary hospitals) registry comprising all geographical regions of Korea from September 2017 to July 2020. Predictive models of clinically relevant AHREs were developed using the random forest (RF) algorithm, support vector machine (SVM) algorithm, and extreme gradient boosting (XGB) algorithm. Model prediction training was conducted by seven hospitals, and model performance was evaluated using data from four hospitals. During a median follow-up of 18 months, clinically relevant AHREs were noted in 104 patients (14.4%). The three ML-based models improved the discrimination of the AHREs (area under the receiver operating characteristic curve: RF: 0.742, SVM: 0.675, and XGB: 0.745 vs. LR: 0.669). The XGB model had a greater resolution in the Brier score (RF: 0.008, SVM: 0.008, and XGB: 0.021 vs. LR: 0.013) than the other models. The use of the ML-based models in patient classification was associated with improved prediction of clinically relevant AHREs after pacemaker implantation.
Homocysteine is an intermediary metabolite in the methionine cycle. Accumulation of homocysteine is caused either by mutation of relevant genes or by nutritional depletion of related vitamin(s). This ...review covers the historical background of hyperhomocysteinemia in which indispensable subjects in relation to underlying pathophysiological processes are discussed with the view of metabolism and genetics of folate and methionine cycles. This review emphasizes the unique role of homocysteine that is clearly distinct from other risk factors, particularly cholesterol in the development of vascular disease. The critical issue in understanding the role of homocysteine is the relation with plasma folic acid. The majority of subjects with homocysteine > 15 μmol/L exhibit plasma folate < 9 nmol/ L, indicating that depletion of folate is the main cause of hyperhomocysteinemia irrespective of the presence or absence of vascular disease. Furthermore, only the group of subjects with homocysteine levels > 15 μmol/L demonstrated a higher prevalence of vascular disease. Analytic approaches to treat hyperhomocysteinemia are discussed in which stepwise administration with nutritional doses of folic acid, 5-methyitetrahydrofolate (5-MTHF), and betaine is provided singly or by combined manner based on clinical and laboratory evaluations. Whether correction of hyperhomocysteinemia is able to prevent the development of homocysteine-associated vascular disease remains an unresolved issue. The review discussed a biochemical and mechanistic approach to resolve questions involved in the relation between homocysteine and the development of atherosclerotic vascular disease.
A forward osmosis membrane consisting of graphene oxide (GO) nanosheets cooperatively cross-linked by ethylenediamine (EDA) molecule and poly(acrylic acid) (PAA) polymer chain is proposed. Desirable ...GO-based nanocomposite membrane must satisfy the conflicting requirements of high water flux and salt rejection simultaneously, which is yet to be achieved. In this study, the GO/EDA/PAA nanocomposite structure demonstrates that good water flux (52 LMH) and salt rejection (97%) can be achieved simultaneously by cooperatively employing the short monomer molecule EDA and the long PAA polymer chain within the channel region of the GO nanocomposite membrane structure. It is suggested that the membrane-wide network of hydrogen bonds between the GO nanosheets and the PAA chains aligned parallel to them is supplemented by anchoring carbon-nitrogen covalent bonds between GO and EDA molecules to form the nanocomposite structure. The nanocomposite structure resulting from the configurations of EDA molecules and PAA chains within the channel region provide an optimal condition for blocking hydrated salt ions while allowing the flow of water molecules. Also, it functions as a reinforcement of the membrane structure for the improved structural integrity.
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•The GO nanosheets are cooperatively cross-linked by EDA and PAA simultaneously.•The configurations of EDA molecules and PAA chains in the membrane form a nanocomposite structure.•The GO/EDA/PAA 8.1:0.9:1 membrane overcomes the trade-off relationship between the flux and rejection.•The d-spacing and performance of membrane can be controlled by its compositions.•A good structural stability is achieved by incorporating the cross-linkers to GO.
A combined sonication and microwave irradiation procedure provides the most effective functionalization of ethylenediamine (en) and branched primary diamines of 1‐methylethylenediamine (men) and ...1,1‐dimethylethylenediamine (den) onto the open metal sites of Mg2(dobpdc) (1). The CO2 capacities of the advanced adsorbents 1‐en and 1‐men under simulated flue gas conditions are 19 wt % and 17.4 wt %, respectively, which are the highest values reported among amine‐functionalized metal‐organic frameworks (MOFs) to date. Moreover, 1‐den exhibits both a significant working capacity (12.2 wt %) and superb CO2 uptake (11 wt %) at 3 % CO2. Additionally, this framework showcases the superior recyclability; ultrahigh stability after exposure to O2, moisture, and SO2; and exceptional CO2 adsorption capacity under humid conditions, which are unprecedented among MOFs. We also elucidate that the performance of CO2 adsorption can be controlled by the structure of the diamine ligands grafted such as the number of amine end groups or the presence of side groups, which provides the first systematic and comprehensive demonstration of fine‐tuning of CO2 uptake capability using different amines.
MOFs capture CO2: Diamine‐grafted metal–organic framework (MOF) CO2 adsorbents are prepared through amine functionalization. The frameworks show excellent CO2 adsorption and working capacities; superior recyclability; ultrahigh stability after exposure to O2, moisture, and SO2; and exceptional CO2 adsorption capacity under humid conditions that are unprecedented among MOFs.
Background
Spinal percutaneous biportal endoscopic surgery (PBES) is a minimally invasive surgery; however, it is associated with several poor outcomes. This study aimed to analyze unsuccessful PBES ...outcomes and verify their relationships with patient satisfaction.
Methods
From May 2015 to June 2018, PBES was performed at several institutions. Unsuccessful outcomes (reoperation and prolonged hospital stay) due to various reasons (hematoma, lesion recurrence, incomplete decompression, dural tear, instability, ascites, and infection) were analyzed. To verify the relationships between surgical experience and unsuccessful outcomes, the first 50 cases and the later cases were compared. Logistic regression was used to assess the relationships between unsuccessful outcomes and patient dissatisfaction.
Results
Among 866 patients, 797 cases with 1-year follow-up and complete data were analyzed. In total, 82 patients with unsuccessful outcomes were identified (10.29%). The incidences of hematoma (
p
< 0.04), incomplete operation (
p
< 0.01), and dural tear (
p
< 0.01) were significantly higher in the first 50 cases than in the later cases. Analyses of the relationship between unsuccessful outcomes and patient dissatisfaction showed that incomplete decompression (odds ratio (OR) 4.06), postoperative instability (OR 3.64), hematoma (OR 3.25), ascite (OR 3.25), dural tear (OR 3.02), and local recurrence (OR 2.45, 95%) contributed significantly.
Conclusions
Unsuccessful PBES outcomes were mostly associated with hematomas, incomplete decompression, and dural tears; instability, ascites, and infection contributed to a lesser extent. Incomplete decompression, instability, hematoma, ascite, dural tear, and local recurrence were significantly related to patient dissatisfaction. The potential for poor outcomes should be described to the patient and considered prior to surgery.
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