Direct Current Electrical Stimulation Increases the Fusion Rate of Spinal Fusion Cages

Study Design. A randomized experimental evaluation of direct current stimulation in a validated animal model with an experimental control group, using blinded radiographic, biomechanical, histologic, and statistical measures. Objectives. To evaluate the efficacy of the adjunctive use of direct current stimulation on the fusion rate and speed of healing of titanium interbody fusion cages packed with autograft in a sheep lumbar interbody fusion model. Summary of Background Data. Titanium lumbar interbody spinal fusion cages have been reported to be 90% effective for single-level lumbar interbody fusion. However, fusion rates are reported to be between 70% and 80% in patients with multilevel fusions or with risk factors such as obesity, tobacco use, or metabolic disorders. The authors hypothesized that direct current stimulation would increase the fusion rate of titanium interbody fusion cages packed with autograft in a sheep lumbar interbody fusion model. Methods. Twenty-two sheep underwent lumbar discectomy and fusion at L4–L5 with an 11- × 20-mm Bagby and Kuslich (BAK) cage packed with autograft. Seven sheep received a BAK cage and no current. Seven sheep had a cage and a 40-μA current applied with a direct current stimulator. Eight sheep had a BAK cage and a 100-μA current applied. All sheep were killed 4 months after surgery. The efficacy of electrical stimulation in promoting interbody fusion was assessed by performing radiographic, biomechanical, and histologic analyses in a blinded fashion. Results. The histologic fusion rate increased as the direct current dose increased from 0 μA to 40 μA to 100 μA (P \u3c 0.009). Histologically, all animals in the 100-μA group had fusions in both the right and left sides of the cage. Direct current stimulation had a significant effect on increasing the stiffness of the treated motion segment in right lateral bending (P \u3c 0.120), left lateral bending (P \u3c 0.017), right axial rotation (P \u3c 0.004), left axial rotation (P \u3c 0.073), extension (P \u3c 0.078), and flexion (P \u3c 0.029) over nonstimulated levels. Conclusion. Direct current stimulation increased the histologic and biomechanical fusion rate and the speed of healing of lumbar interbody spinal fusion cages in an ovine model at 4 months

The PL calibration for Milky Way Cepheids and its implications for the distance scale

The rationale behind recent calibrations of the Cepheid PL relation using the Wesenheit formulation is reviewed and reanalyzed, and it is shown that recent conclusions regarding a possible change in slope of the PL relation for short-period and long-period Cepheids are tied to a pathological distribution of HST calibrators within the instability strip. A recalibration of the period-luminosity relation is obtained using Galactic Cepheids in open clusters and groups, the resulting relationship, described by log L/L_sun = 2.415(+-0.035) + 1.148(+-0.044)log P, exhibiting only the moderate scatter expected from color spread within the instability strip. The relationship is confirmed by Cepheids with HST parallaxes, although without the need for Lutz-Kelker corrections, and in general by Cepheids with revised Hipparcos parallaxes, albeit with concerns about the cited precisions of the latter. A Wesenheit formulation of Wv = -2.259(+-0.083) - 4.185(+-0.103)log P for Galactic Cepheids is tested successfully using Cepheids in the inner regions of the galaxy NGC 4258, confirming the independent geometrical distance established for the galaxy from OH masers. Differences between the extinction properties of interstellar and extragalactic dust may yet play an important role in the further calibration of the Cepheid PL relation and its application to the extragalactic distance scale.Comment: Accepted for Publication (Astrophysics & Space Science

Polyetheretherketone as a Biomaterial for Spinal Applications

Threaded lumbar interbody spinal fusion devices (TIBFD) made from titanium have been reported to be 90% effective for single-level lumbar interbody fusion, although radiographic determination of fusion has been intensely debated in the literature. Using blinded radiographic, biomechanic, histologic, and statistical measures, we evaluated a radiolucent polyetheretherketone (PEEK)-threaded interbody fusion device packed with autograft or rhBMP-2 on an absorbable collagen sponge in 13 sheep at 6 months. Radiographic fusion, increased spinal level biomechanical stiffness, and histologic fusion were demonstrated for the PEEK cages filled with autograft or rhBMP-2 on a collagen sponge. No device degradation or wear debris was observed. Only mild chronic inflammation consisting of a few macrophages was observed in peri-implant tissues. Based on these results, the polymeric biomaterial PEEK may be a useful biomaterial for interbody fusion cages due to the polymer\u27s increased radiolucency and decreased stiffness

Combined material flow analysis and life cycle assessment as a support tool for solid waste management decision making

AbstractMaterial flow analysis (MFA) and life cycle assessment (LCA) have both widely been applied to support solid waste management (SWM) decision making. However, they are often applied independently rather than conjointly. This paper presents an approach that combines the MFA and LCA methodologies to evaluate large and complex SWM systems from an environmental perspective. The approach was applied to evaluate the environmental performance, focusing on greenhouse gas (GHG) emissions, of a local authority SWM system and to compare it with alternative systems to assess the potential effectiveness of different waste policy measures. The MFA results suggest that national recycling targets are unlikely to be met even if the assessed policies are implemented optimally. It is likely that for the targets to be met, investigated policies would need to be combined with additional policies that target reductions in waste arisings. The LCA results found landfilling of residual waste to be the dominant source of GHG burdens for the existing system, whilst material reprocessing was found to result in GHG benefits. Overall, each of the alternative systems investigated were found to result in lower GHG impacts compared to the existing system, with the diversion of food waste from the residual waste stream found to be potentially the most effective strategy to reduce GHG emissions. The results of this study demonstrate that the complementary methodologies of MFA and LCA can be used in combination to provide policy and decision makers with valuable information about the environmental performance of SWM systems

Genetic Parameters for Human-Directed Behavior and Intraspecific Social Aggression Traits in Growing Pigs

This study aimed to estimate heritabilities and genetic and phenotypic correlations for human-directed behavior and intraspecific social aggression traits in growing pigs, and to explore genetic and phenotypic correlations among them. Pigs (n = 2,314) were mixed into groups of 18 animals at 69 ± 5.2 d of age and skin lesions (SL) were counted 24 h (SL24h) and 5 weeks (SL5WK) post-mixing. Individual behavioral responses to isolation in a weighing crate (CRATE, 1 = pig performing exploratory behavior to 4 = pig performing serious, persistent attempts to escape) or when alone in an arena while a human directly approached them (IHAT) were assessed within 48 h post-mixing. During the IHAT, three separate scores were given for each pig based on the severity (0 = none to 3 = severe reaction) of their movement, vocalizations, and vigilance. Additionally, pigs were tested for behavioral responses to the presence of a single human observer walking in their home pen in a circular motion (WTP) within 1 and 4 weeks post-mixing recording pigs that followed, nosed or bit the observer. An animal model was used to estimate genetic parameters for all studied traits using the DMU software. Heritabilities (h2) for SL, CRATE and IHAT responses were low to moderate (0.17 to 0.29), with the greatest h2 estimated for speed of moving away from the approaching observer in the IHAT. Low but significant h2 were estimated for nosing (0.09) and biting (0.11) the observer at 4 weeks post-mixing in the WTP test. Positive high genetic correlations (rg) were observed between CRATE and IHAT responses (0.55 to 0.90), and within SL traits (0.60 to 0.94) while positive low to high rg were estimated within the WTP test (0.24 to 0.59) traits. Positive moderate rg were observed between CRATE and central and posterior SL24h. Genetic correlations between CRATE and IHAT test responses and WTP test traits were low, mostly negative (-0.21 to 0.05) and not significant. Low positive rg (0.06 to 0.24) were observed between SL and the WTP test traits except for the lack of rg between posterior SL24h and pigs biting or following the observer during both tests. Phenotypic correlations between CRATE and IHAT responses and SL or WTP test traits were mostly low and not significant. Under the conditions of this study, h2 estimates for all studied traits suggest they could be suitable as a method of phenotyping aggression and fear and/or boldness in pigs for genetic selection purposes. Additionally, there was evidence of genetic associations between aggression and fear indicators. These findings suggest applying selection pressure to reduce the accumulation of lesions is likely to make pigs more relaxed in a crate environment, but to alter the engagement with humans in other contexts that depends on the location of the lesions under selection

Bioresorbable Film for the Prevention of Adhesion to the Anterior Spine After Anterolateral Discectomy

Background context The development of scar tissue and adhesions postoperatively is a natural consequence of healing but can be associated with medical complications and render reoperation difficult. Many biocompatible products have been evaluated as barriers or deterrents to adhesions. Purpose To evaluate the efficacy of a bioresorbable polylactide film as a barrier to adhesion formation after anterolateral discectomy. Study design Experimental study. Methods Seven, skeletally mature female sheep underwent a retroperitoneal approach to the anterolateral lumbar spine. A discectomy was performed at two levels with an intervening unoperated disc site. One site was treated with a polylactide film barrier (Hydrosorb Shield; MacroPore Biosurgery, San Diego, CA) affixed with tacks manufactured from the same material. The second site was left untreated. Treatment and control sites were randomly assigned. Postmortem analysis included scar tenacity scoring on five spines and histological evaluation on two spines. Results The application of the Hydrosorb film barrier allowed a definite dissection plane during scar tenacity scoring and there was a significant difference in the development of adhesions to the disc between the control and treated sites. Histological evaluation revealed evidence of barrier formation to scar tissue and no significant adverse inflammatory reactions. Conclusions Hydrosorb Shield appears to be an effective postoperative barrier to scar tissue adhesion after anterolateral discectomy. The use of polylactide tacks was beneficial to affix the barrier film in place. Safety issues associated with delayed healing or adverse response to the film or tacks were not observed. Hydrosorb film may be useful as an antiadhesion barrier facilitating dissection during surgical revision in anterior approaches to the spine. Further studies are indicated to evaluate the performance of the bioresorbable material as an antiadhesion barrier in techniques of spinal fusion and disc replacement

Histologic Evaluation of the Efficacy of rhBMP-2 Compared With Autograft Bone in Sheep Spinal Anterior Interbody Fusion

Study Design. The sheep anterior lumbar spinal fusion model was used to study the efficacy of recombinant human bone morphogenetic protein-2 (rhBMP-2)–collagen composite in comparison with autograft to enhance spinal interbody fusion. Comparisons were drawn from temporal radiographic and end-point biomechanical and histologic data. Objective. To analyze histologically the ability of rhBMP-2 to achieve complete arthrodesis between vertebral bodies. Summary of Background Data. Studies using rhBMP for enhancement of anterior interbody fusion have used numerous endpoints. However, systematic histologic evaluation of the fusion has not been conducted. Methods. Twelve sheep underwent single-level anterior lumbar interbody fusion performed with a cylindrical fenestrated titanium interbody fusion device (INTER FIX, Medtronic Sofamor Danek, Inc., Memphis, TN). The device was filled either with rhBMP-2–collagen (n = 6) or autogenous iliac crest bone graft (n = 6). Radiologic evaluation was carried out at 2-month intervals, and all sheep were killed 6 months after surgery. Nondestructive biomechanical testing for stiffness to flexion, extension, and lateral bending moments, un-decalcified histology, and qualitative and quantitative histologic evaluation were performed. Results. Radiographs revealed a bony bridge anterior to the cage in five of six rhBMP-2-treated animals, whereas it was present only in one of five in the autogenous bone graft group. Segments treated with rhBMP-2 were 20% stiffer in flexion than autograft-treated segments at 6 months. Six of six in the rhBMP-2 group and two of six in the autograft group showed complete fusion. There was a significantly higher rate of bony continuity observed at the fenestrations of the rhBMP-2 group. Three times more number of cage fenestrations in the rhBMP-2 group demonstrated “all-bone” when compared with the autograft group (P \u3c 0.001). Further, the scar tissue in and around the autograft-treated cages was 16-fold more (P \u3c 0.01) than that seen for rhBMP-2-treated cages. Conclusions. The study demonstrates that rhBMP-2 can lead to earlier radiologic fusion and a more consistent increased stiffness of the segments when compared with autograft in sheep anterior lumbar interbody fusion. Furthermore, a three times higher histologic fusion rate is attainable with significantly reduced fibrous tissue around the implant when rhBMP-2 is used

Commercial-off-the-shelf simulation package interoperability: Issues and futures

Commercial-Off-The-Shelf Simulation Packages (CSPs) are widely used in industry to simulate discrete-event models. Interoperability of CSPs requires the use of distributed simulation techniques. Literature presents us with many examples of achieving CSP interoperability using bespoke solutions. However, for the wider adoption of CSP-based distributed simulation it is essential that, first and foremost, a standard for CSP interoperability be created, and secondly, these standards are adhered to by the CSP vendors. This advanced tutorial is on an emerging standard relating to CSP interoperability. It gives an overview of this standard and presents case studies that implement some of the proposed standards. Furthermore, interoperability is discussed in relation to large and complex models developed using CSPs that require large amount of computing resources. It is hoped that this tutorial will inform the simulation community of the issues associated with CSP interoperability, the importance of these standards and its future

X-ray Spectral Variability and Rapid Variability of the Soft X-ray Spectrum Seyfert 1 Galaxies Ark 564 and Ton S180

The bright, soft X-ray spectrum Seyfert 1 galaxies Ark 564 and Ton S180 were monitored for 35 days and 12 days with ASCA and RXTE (and EUVE for Ton S180). The short time scale (hours-days) variability patterns were very similar across energy bands, with no evidence of lags between any of the energy bands studied. The fractional variability amplitude was almost independent of energy band. It is difficult to simultaneously explain soft Seyferts stronger variability, softer spectra, and weaker energy-dependence of the variability relative to hard Seyferts. The soft and hard band light curves diverged on the longest time scales probed, consistent with the fluctuation power density spectra that showed relatively greater power on long time scales in the softest bands. The simplest explanation is that a relatively hard, rapidly-variable component dominates the total X-ray spectrum and a slowly-variable soft excess is present in the lowest energy channels of ASCA. Although it would be natural to identify the latter with an accretion disk and the former with a corona surrounding it, a standard thin disk could not get hot enough to radiate significantly in the ASCA band, and the observed variability time scales are much too short. The hard component may have a more complex shape than a pure power-law. The most rapid factor of 2 flares and dips occurred within ~1000 sec in Ark 564 and a bit more slowly in Ton S180. The speed of the luminosity changes rules out viscous or thermal processes and limits the size of the individual emission regions to <~15 Schwarzschild radii (and probably much less), that is, to either the inner disk or small regions in a corona