Classification of Sagittal Imbalance Based on Spinal Alignment and Compensatory Mechanisms

Introduction Sagittal balance is an independent predictor of clinical outcomes in spinal care. Surgical treatment is challenging and jeopardized by frequent complications. Guidelines for surgical treatment are currently not based on a classification of the disease. A comprehensive classification of sagittal balance, based on regional deformities and compensatory mechanisms combined with deformity patterns is proposed. Though the sagittal shape of the spine can change due to degeneration or trauma, correlations between sagittal shape parameters and pelvic incidence (PI) have been described. Pelvic incidence is not changed by degeneration, thus representing a permanent source of information on the original sagittal shape of the spine. Material and Methods A total of 128 full-spine lateral standing radiographs of patients with different spinal conditions were evaluated and classified by one rater. One random subseries of 35 patients was evaluated by two raters for calculation of interrater agreement. Spinopelvic parameters were measured in all the radiographs. The internal validity of the classification system was evaluated comparing the values of regional sagittal parameters that distinguish one category from the others. Results Eight different patterns were identified regarding the site of the deformity and the presence of compensatory mechanisms: cervical, thoracic, thoracolumbar junction, lumbar, lower lumbar, global and pelvic kyphosis, and normal sagittal alignment. Interrater agreement was almost perfect (j = 0.963). Statistically significant differences were found comparing the means of selected sagittal spinopelvic parameters that conceptually divide pairs or groups of categories: C2-C7 SVA for cervical kyphosis versus all other patients, TK-PI mismatch for thoracic kyphosis versus all other patients, T11-L2 kyphosis for thoracolumbar kyphosis versus all other patients, global alignment (LL? TK-PI) and SVA for lumbar kyphosis versus global kyphosis, and pelvic tilt for pelvic kyphosis versus lumbar, lower lumbar, and global kyphosis. Conclusion A comprehensive classification of sagittal imbalance is presented. This classification permits a better interpretation of the deformity and muscle forces acting on the spine, and helps surgical planning. Preliminary validation has been provided

Classification of Degenerative Segment Disease in Adults with Deformity of the Lumbar or Thoracolumbar Spine

Introduction Lumbar and thoracolumbar deformity in the adult is a condition with impairment of health status that can need surgical treatment. In contrast with adolescent deformity, where magnitude of the curve plays a significant role in surgical indication, the aspects relevant in adult deformity are pain and dysfunction that correlate with segment degeneration and imbalance. Previous classifications of adult deformity have been of little use for surgical planning. Materials and Methods Chart review and classification of radiographic and clinical findings. A classification of degenerative disc disease based on distribution of diseased segments and balance status of the spine is presented. Results Four main categories are presented: Type I (limited nonapical segment disease), Type II (limited apical segment disease), Type III (extended segment disease: apical and nonapical), and Type IV (imbalanced spine: IVa, sagittally imbalanced; IVb, sagittally and coronally imbalanced). Conclusion Types I and II can be treated by fusion of a selective area of the curve. Type III needs fusion of all the extension of the coronal curve. Type IV usually needs aggressive corrective procedures, frequently including posterior tricolumnar osteotomies. This classification permits interpreting the extension and magnitude of the disease and can help establish a surgical plan regarding selective fusion and methods of sagittal correction. Future research is needed to validate the classification

Primary vascular bone tumors in the spine: a challenge for pathologists and spine oncology surgeons

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Pure-breeding with sexed semen and crossbreeding with semen of double-muscled sires to improve beef production from dairy herds: Factors affecting heifer and cow fertility and the sex ratio

Using sexed semen to produce purebred replacement heifers makes it possible to mate a large proportion of dairy cows to double-muscled sires and to quantitatively and qualitatively improve beef production and increase the income from dairy herds. Net profit first depends on changes in the farm's overall fertility rate. The objective of this study was to analyze the conception rate in herds using a combination of conventional dairy semen (for pure- and crossbreeding), X-sorted dairy semen (to produce purebred replacement heifers), and conventional beef semen (for terminal crossbreeding). Data were obtained from 50,785 inseminations of 15,580 dairy cows (78% Holstein-Friesian, 15% Brown Swiss, 2% Simmental, and 5% crossbreds) from 106 dairy farms (average milk yield 35.1 ± 9.4 kg/d, with 3.76 ± 0.83% fat and 3.32 ± 0.39% protein contents). To account for the main potential confounders, we used separate generalized linear mixed-effects models for cows and virgin heifers. The results showed that the odds ratio of conception improved (1.00 to 1.34) with an increase in the average milk yield of the herd but worsened (1.12 to 0.70) with an increase in the milk yield of individual cows within herd. The summer months showed a strong reduction in the odds ratio of conception in cows (0.56 in July and August) but not in virgin heifers. Multiparous cows had a lower odds ratio of conception (0.85) than primiparous cows (1.00). The order of insemination did not affect the fertility of the cows or heifers, whereas the odds ratio of conception improved with advancing lactation (1.00 to 2.12). The Simmental cows were more fertile than Holstein-Friesians (1.37 vs. 1.00), whereas the fertility of the heifers was not affected by breed. Taking all these possible confounders into account simultaneously, in pure-breeding the odds ratio of conception using sexed semen did not differ from that using conventional dairy semen in cows (0.90 vs. 1.00) or in virgin heifers (0.95 vs. 1.00). However, crossbreeding using conventional beef and dairy semen improved the odds ratio of conception (1.10 and 1.17, respectively) in cows (1.37 using beef semen) and heifers (1.25 using dairy semen). The proportion of newborn heifer calves was ≥90% using sexed dairy semen. The combined use of sexed semen, especially on heifers, to produce purebred replacement females and beef semen to produce terminal crossbred calves was shown to have the potential to increase overall herd fertility, which could be further improved using sexed dairy semen to produce dairy crossbreds instead of purebred replacement heifers

Short communication: Pure-breeding with sexed semen and crossbreeding with semen from double-muscled sires to improve beef production from dairy herds: Weight and value of calves.

The use of sexed semen to produce purebred replacement heifers allows a large proportion of dairy cows to be mated to double-muscled sires and for quantitative and qualitative improvements to be made to beef production from dairy herds. A survey of 1,285 crossbred calves showed that they are destined not only for veal production (like purebred dairy calves) but also for beef production. Crossbred calves obtained from Belgian Blue sires (sold on average at 34 d of age and 64 kg of weight) had a higher market value (€363/calf) than those obtained from double-muscled INRA 95 sires (€297/calf, used for veal production) and from Limousin sires (€216/calf for veal and €271/calf for beef production). As a sire breed, Simmental did not differ significantly from Belgian Blue, but as a dam breed, the crossbred calves fetched a higher price (€5.11/kg) than when Holstein was the dam breed (€4.50/kg). Compared with heifer calves, crossbred bull calves at sale were younger (34.1 vs. 37.2 d) and heavier (64.0 vs. 62.6 kg of live weight), fetched a higher price (€5.13 vs. €4.99/kg), and had a greater value (€328 vs. €312/calf). As the value of purebred dairy calves was about €80 to €100/calf, we are able to confirm that the combined use of sexed semen for pure-breeding and conventional beef semen for terminal crossbreeding can increase the income from dairy farms, especially when the sires are double-muscled beef bulls

Successful correction of sagittal imbalance can be calculated on the basis of pelvic incidence and age

Introduction Sagittal imbalance is an independent predictor of outcome in adult degenerative spinal deformity. Restoration of sagittal spinopelvic parameters correlates with a better postoperative outcome. Several methods of preoperative calculation for sagittal correction have been proposed, most of them geometrical. A nongeometrical method, based on data of spinopelvic relationships in normal subjects, that uses the patient's pelvic incidence and age to calculate target lumbar lordosis and thoracic kyphosis is proposed. The goal of this study is to describe and validate this nongeometrical method in terms of sensitivity and specificity to predict satisfactory spinopelvic alignment. Materials and Methods A retrospective cohort study of patients operated for sagittal imbalance with pedicle subtraction osteotomies (PSO). Two calculation algorithms (method a: LL = −[32.56 + PI × 0.54], method b: LL = −[PI + 10 degrees]); in both TK = PI/r (see text for definitions) obtain theoretical lumbar lordosis (LL) and thoracic kyphosis (TK) solely based on pelvic incidence and age, for surgical planning. The sample is categorized according to two parameters: planning goals (LL and TK) achieved or not and satisfactory alignment (SVA < 50 mm and PT < 20 degrees) achieved or not. Two × two tables are built and odds ratio, sensitivity and specificity and PPV/NPV are calculated for each planning method. Different levels of tolerance for undercorrection are analyzed to refine the use of the method. Results Of the 50 patients included in the study, 23 presented satisfactory alignment postoperatively. With a tolerance of hypocorrection of 10 degrees (LL) and 30 degrees (TK), correction target was achieved in 23 patients according to method a (S = 0.89, Sp = 0.87%, OR = 53.33 [95% CI: 9.677–293.931]; p < 0.001), 23 patients according to method b (S = 0.93, Sp = 0.91, OR = 131.25 [95% CI:17–1013]; p < 0.001). The best prediction of satisfactory alignment was obtained with method b and tolerance 0 degrees (LL) and 10 degrees (TK). All patients with complete correction of LL (both methods) achieved good alignment. Overall, 22 of the 24 (91%) patients with less than 10 degrees of undercorrection of LL (method b) achieved good alignment. Conclusion Calculation of the target lordosis based only in the value of PI and age is a reliable method that can predict good outcomes in terms of alignment. The rule LL = −(PI + 10 degrees) is an easy to calculate and very effective method of planning for lumbar lordosis and good alignment can be expected with high confidence when the final lordosis is within 10 degree of undercorrection. Including TK in surgical planning can improve the results in terms of restoration of the less known "spinopelvic balance" parameter

Worldwide excellence in evidence

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D for dominant: porcine circovirus 2d (PCV-2d) prevalence over other genotypes in wild boars and higher viral flows from domestic pigs in Italy

IntroductionPorcine circovirus 2 (PCV-2) is a key pathogen for the swine industry at a global level. Nine genotypes, differing in epidemiology and potentially virulence, emerged over time, with PCV-2a, -2b, and -2d being the most widespread and clinically relevant. Conversely, the distribution of minor genotypes appears geographically and temporally restricted, suggesting lower virulence and different epidemiological drivers. In 2022, PCV-2e, the most genetically and phenotypically divergent genotype, was identified in multiple rural farms in North-eastern Italy. Since rural pigs often have access to outdoor environment, the introduction from wild boars was investigated.MethodsThrough a molecular and spatial approach, this study investigated the epidemiology and genetic diversity of PCV-2 in 122 wild boars across different provinces of North-eastern Italy.ResultsMolecular analysis revealed a high PCV-2 frequency (81.1%, 99/122), and classified the majority of strains as PCV-2d (96.3%, 78/81), with sporadic occurrences of PCV-2a (1.2%, 1/81) and PCV-2b (2.5%, 2/81) genotypes. A viral flow directed primarily from domestic pigs to wild boars was estimated by phylogenetic and phylodynamic analyses.DiscussionThese findings attested that the genotype replacement so far described only in the Italian domestic swine sector occurred also in wild boars. and suggested that the current heterogeneity of PCV-2d strains in Italian wild boars likely depends more on different introduction events from the domestic population rather than the presence of independent evolutionary pressures. While this might suggest PCV-2 circulation in wild boars having a marginal impact in the industrial sector, the sharing of PCV-2d strains across distinct wild populations, in absence of a consistent geographical pattern, suggests a complex interplay between domestic and wild pig populations, emphasizing the importance of improved biosecurity measures to mitigate the risk of pathogen transmission

Experimental analysis of an air–water heat pump with micro-channel heat exchanger

A multi-port extruded (MPE) aluminium flat tube air heat exchanger was compared to a round tube finned coil (FC). The MPE heat exchanger has parallel flow vertical tube configuration with headers in horizontal position and conventional folded louvred fins. The two heat exchangers were mounted on a 10 kW cooling capacity R410A packaged air heat pump. They were sized to approximately obtain the same cooling and heating capacities in chiller and heating mode, respectively. Climatic room steady state tests without frosting phenomena occurring during heat pump operation, demonstrated that the round tube and the flat tube heat exchanger performance are comparable. The MPE heat exchanger was tested with different refrigerant inlet distributor/outlet tubes configurations to investigate the effect of liquid refrigerant distribution. Cycling frosting/defrosting operations were tested with two equivalent machines placed in parallel outdoor and working at full load condition, one of the units was equipped with the MPE heat exchanger while the other mounted a standard finned coil. Penalization factors were analytically introduced to evaluate frosting associated heating energy and energy efficiency degradation. Test results indicate that both the heat pumps are penalized by frost formation but both the penalization factors are higher for the MPE-unit than the FC-unit one in the -6 to 4 °C air dry bulb temperature range. For the two units, a roughly linear dependence of the heating energy penalization factor and of the energy efficiency factor from the difference between outdoor air and saturated air at the evaporation temperature humidity ratio can be pointed out

A data-driven approach for fault diagnosis in HVAC chiller systems

Faulty operations of Heating, Ventilation and Air Conditioning (HVAC) chiller systems can lead to discomfort for the user, energy wastage, system unreliability and shorter equipment life. Faults need to be diagnosed early to prevent further deterioration of the system behaviour and energy losses. Since it is not a common practice to collect historical data regarding unforeseen phenomena and abnormal behaviours for HVAC installations, in this paper a semi-supervised, data-driven approach is employed for fault detection and isolation that makes no use of a priori knowledge. The proposed method exploits Principal Component Analysis to distinguish between anomalies and normal operation variability and a reconstruction-based contribution approach to isolate variables related to faults. The diagnosis task is then tackled by means of a decision table. The fault diagnosis algorithm performance is assessed by exploiting an experimental dataset from a frictionless centrifugal chiller system