Patient Outcomes for Anterior Multi-level Cervical Fusions: A Comparative Analysis of AO and DOC Instrumentation

The purpose of this study is to compare the efficacy of the DePuy-Acromed DOC implant with the Synthes AO plate by means of analysis of subjective and objective data. A retrospective review of 56 consecutive instrumented, anterior multi-level cervical fusions by two orthopedic spine specialists was completed. Biographical, clinical, surgical and radiographic data was collected for patients who underwent anterior multi-level cervical fusions between 12/13/96 and 4/8/99. Twenty-five of the patients received a DOC implant and 31 received the AO plate. No major complications occurred during or following surgery directly related to either implant. Both groups however, did contain cases of transient dysphasia and lingering pain. Generally, patients that received the DOC implant experienced a greater percent decrease in post-operative pain levels though both study groups exhibited significant improvement. The use of a DOC implant was also correlated with a loss of fewer working days amongst those in the study group. Psuedoarthrosis and a return to pre-operative pain levels occurred in patients using the AO implant at higher frequencies than in those with the DOC. Screw loosening occurred less frequently with the AO plate than with the DOC implant. However, the one case of AO screw loosening required subsequent hardware removal. The DOC also appears to have the added benefit of offering a dynamic system that can reduce the amount of load shielding of the bone graft during the time that it is fusing. It appears that the newer DOC implant offers desirable benefits over the traditional AO locking plate. The dysphasia and cost were liabilities that seem to be offset by the patient satisfaction level with surgeries involving the DOC implant

The Chattanooga Procedure: A New Technique Used for Anterior Multi-level Cervical Fusions

STUDY DESIGN: A preliminary assessment of anterior cervical fusion performed with interbody cage and DOC plate. OBJECTIVES: To describe and evaluate the efficacy and safety of the Chattanooga Procedure , a modified technique in achieving anterior cervical fusion. SUMMARY OF BACKGROUND DATA: Anterior cervical fusion with interbody bone graft and anterior plating is connnonly performed. Unfortunately, the plate has been reported to shield the graft from loading thus reducing fusion rates. The use of interbody fusion cages has been effective in the lumbar spine and has gained acceptance in the cervical spine. METHODS:. Twenty-five patients received The Chattanooga Procedure between 7/24/98 and 4/8/99. All patients had anterior discectomies and carpectomies, placement of a Harms cage packed with carpectomy bone, and application ofDePuy-Acromed DOC. Fusion was defined by radiographic evidence of trabecular bone bridging across the Harms cage. CT scans were performed on twelve randomly chosen patients to verify fusion. No external bracing was used except a soft collar as needed. Pre- and post-operative pain and functional capacity data were collected and statistically analyzed using paired t-tests. RESULTS: There were no cases of pseudoarthrosis, major neurological, vascular, or wound complications. Only one case of unresolved dysphasia was noted. The average operative time (11 0 minutes) was comparable to standard instrumented multi-level anterior cervical fusion surgeries. The average estimated blood loss was 113 ml (range, 50-750 ml). Both visual analog pain scale and Oswestry functional capacity data were significantly improved post-operatively (p\u3c 0.01). DISCUSSION: Advantages of the Chattanooga Procedure include immediate stability, support, elimination of donor site pain to iliac crest bone autograft, and a decrease in pseudoarthrosis by dividing the fusion surfaces by half. Concerns regarding this technique include an increased risk for dysphasia due to the DOC\u27s high profile. Pseudoarthrosis or instrumentation migration could also become problematic since the removal of the Harms cage could be difficult if necessary

Star Unfolding Convex Polyhedra via Quasigeodesic Loops

We extend the notion of star unfolding to be based on a quasigeodesic loop Q rather than on a point. This gives a new general method to unfold the surface of any convex polyhedron P to a simple (non-overlapping), planar polygon: cut along one shortest path from each vertex of P to Q, and cut all but one segment of Q.Comment: 10 pages, 7 figures. v2 improves the description of cut locus, and adds references. v3 improves two figures and their captions. New version v4 offers a completely different proof of non-overlap in the quasigeodesic loop case, and contains several other substantive improvements. This version is 23 pages long, with 15 figure

Picture-Hanging Puzzles

We show how to hang a picture by wrapping rope around n nails, making a polynomial number of twists, such that the picture falls whenever any k out of the n nails get removed, and the picture remains hanging when fewer than k nails get removed. This construction makes for some fun mathematical magic performances. More generally, we characterize the possible Boolean functions characterizing when the picture falls in terms of which nails get removed as all monotone Boolean functions. This construction requires an exponential number of twists in the worst case, but exponential complexity is almost always necessary for general functions.Comment: 18 pages, 8 figures, 11 puzzles. Journal version of FUN 2012 pape

‘Savage times come again’ : Morel, Wells, and the African Soldier, c.1885-1920

The African soldier trained in western combat was a figure of fear and revulsion in the late nineteenth and early twentieth centuries. My article examines representations of African soldiers in nonfictional writings by E.D. Morel about the Congo Free State (1885-1908), the same author’s reportage on African troops in post-First World War Germany, and H.G. Wells’s speculative fiction When the Sleeper Wakes (1899, 1910). In each text racist and anti-colonialist discourses converge in representing the African soldier as the henchman of corrupt imperialism. His alleged propensity for taboo crimes of cannibalism and rape are conceived as threats to white safety and indeed supremacy. By tracing Wells’s connections to the Congo reform campaign and situating his novel between two phases of Morel’s writing career, I interpret When the Sleeper Wakes as neither simply a reflection of past events in Africa or as a prediction of future ones in Europe. It is rather a transcultural text which reveals the impact of European culture upon the ‘Congo atrocities’, and the inscription of this controversy upon European popular cultural forms and social debates

Locked and Unlocked Chains of Planar Shapes

We extend linkage unfolding results from the well-studied case of polygonal linkages to the more general case of linkages of polygons. More precisely, we consider chains of nonoverlapping rigid planar shapes (Jordan regions) that are hinged together sequentially at rotatable joints. Our goal is to characterize the families of planar shapes that admit locked chains, where some configurations cannot be reached by continuous reconfiguration without self-intersection, and which families of planar shapes guarantee universal foldability, where every chain is guaranteed to have a connected configuration space. Previously, only obtuse triangles were known to admit locked shapes, and only line segments were known to guarantee universal foldability. We show that a surprisingly general family of planar shapes, called slender adornments, guarantees universal foldability: roughly, the distance from each edge along the path along the boundary of the slender adornment to each hinge should be monotone. In contrast, we show that isosceles triangles with any desired apex angle less than 90 degrees admit locked chains, which is precisely the threshold beyond which the inward-normal property no longer holds.Comment: 23 pages, 25 figures, Latex; full journal version with all proof details. (Fixed crash-induced bugs in the abstract.

National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-Versus-Host Disease: III. The 2014 Biomarker Working Group Report

Biology-based markers to confirm or aid in the diagnosis or prognosis of chronic GVHD after allogeneic hematopoietic cell transplantation (HCT) or monitor its progression are critically needed to facilitate evaluation of new therapies. Biomarkers have been defined as any characteristic that is objectively measured and evaluated as an indicator of a normal biological or pathogenic process, a pharmacologic response to a therapeutic intervention. Applications of biomarkers in chronic GVHD clinical trials or patient management include: a) diagnosis and assessment of chronic GVHD disease activity, including distinguishing irreversible damage from continued disease activity, b) prognostic risk to develop chronic GVHD, and c) prediction of response to therapy. Sample collection for chronic GVHD biomarkers studies should be well-documented following established quality control guidelines for sample acquisition, processing, preservation and testing, at intervals that are both calendar- and event-driven. The consistent therapeutic treatment of subjects and standardized documentation needed to support biomarker studies are most likely to be provided in prospective clinical trials. To date, no chronic GVHD biomarkers have been qualified for utilization in clinical applications. Since our previous chronic GVHD Biomarkers Working Group report in 2005, an increasing number of chronic GVHD candidate biomarkers are available for further investigation. This paper provides a four-part framework for biomarker investigations: identification, verification, qualification, and application with terminology based on Food and Drug Administration and European Medicines Agency guidelines