Facet-sparing lumbar decompression with a minimally invasive flexible MicroBlade Shaver® versus traditional decompression: quantitative radiographic assessment.

BackgroundLaminectomy/laminotomy and foraminotomy are well established surgical techniques for treatment of symptomatic lumbar spinal stenosis. However, these procedures have significant limitations, including limited access to lateral and foraminal compression and postoperative instability. The purpose of this cadaver study was to compare bone, ligament, and soft tissue morphology following lumbar decompression using a minimally invasive MicroBlade Shaver® instrument versus hemilaminotomy with foraminotomy (HL).MethodsThe iO-Flex® system utilizes a flexible over-the-wire MicroBlade Shaver instrument designed for facet-sparing, minimally invasive "inside-out" decompression of the lumbar spine. Unilateral decompression was performed at 36 levels in nine human cadaver specimens, six with age-appropriate degenerative changes and three with radiographically confirmed multilevel stenosis. The iO-Flex system was utilized on alternating sides from L2/3 to L5/S1, and HL was performed on the opposite side at each level by the same investigator. Spinal canal, facet joint, lateral recess, and foraminal morphology were assessed using computed tomography.ResultsSimilar increases in soft tissue canal area and decreases in ligamentum flavum area were noted in nondiseased specimens, although HL required removal of 83% more laminar area (P < 0.01) and 95% more bone resection, including the pars interarticularis and facet joints (P < 0.001), compared with the iO-Flex system. Similar increases in lateral recess diameter were noted in nondiseased specimens using each procedure. In stenotic specimens, the increase in lateral recess diameter was significantly (P = 0.02) greater following use of the iO-Flex system (43%) versus HL (7%). The iO-Flex system resulted in greater facet joint preservation in nondiseased and stenotic specimens. In stenotic specimens, the iO-Flex system resulted in a significantly greater increase in foraminal width compared with HL (24% versus 4%, P = 0.01), with facet joint preservation.ConclusionThe iO-Flex system resulted in significantly better decompression of the lateral recess and foraminal areas compared with HL, while preserving posterior spinal elements, including the facet joint

Method of remotely characterizing thermal properties of a sample

A sample in a wind tunnel is radiated from a thermal energy source outside of the wind tunnel. A thermal imager system, also located outside of the wind tunnel, reads surface radiations from the sample as a function of time. The produced thermal images are characteristic of the heat transferred from the sample to the flow across the sample. In turn, the measured rates of heat loss of the sample are characteristic of the flow and the sample

Eigenvalue Spacing Distribution for the Ensemble of Real Symmetric Toeplitz Matrices

Consider the ensemble of Real Symmetric Toeplitz Matrices, each entry iidrv from a fixed probability distribution p of mean 0, variance 1, and finite higher moments. The limiting spectral measure (the density of normalized eigenvalues) converges weakly to a new universal distribution with unbounded support, independent of p. This distribution's moments are almost those of the Gaussian's; the deficit may be interpreted in terms of Diophantine obstructions. With a little more work, we obtain almost sure convergence. An investigation of spacings between adjacent normalized eigenvalues looks Poissonian, and not GOE.Comment: 24 pages, 3 figure

Myocarditis, disseminated infection, and early viral persistence following experimental coxsackievirus B infection of cynomolgus monkeys.

Coxsackievirus B (CVB) infection is a common cause of acute viral myocarditis. The clinical presentation of myocarditis caused by this enterovirus is highly variable, ranging from mildly symptoms to complete hemodynamic collapse. These variations in initial symptoms and in the immediate and long term outcomes of this disease have impeded development of effective treatment strategies. Nine cynomolgus monkeys were inoculated with myocarditic strains of CVB. Virological studies performed up to 28 days post-inoculation demonstrated the development of neutralizing antibody in all animals, and the presence of CVB in plasma. High dose intravenous inoculation (n = 2) resulted in severe disseminated disease, while low dose intravenous (n = 6) or oral infection (1 animal) resulted in clinically unapparent infection. Transient, minor, echocardiographic abnormalities were noted in several animals, but no animals displayed signs of significant acute cardiac failure. Although viremia rapidly resolved, signs of myocardial inflammation and injury were observed in all animals at the time of necropsy, and CVB was detected in postmortem myocardial specimens up to 28 days PI. This non-human primate system replicates many features of illness in acute coxsackievirus myocarditis and demonstrates that myocardial involvement may be common in enteroviral infection; it may provide a model system for testing of treatment strategies for enteroviral infections and acute coxsackievirus myocarditis

The effect of reciprocity priming on organ donor registration intentions and behavior

Background: Internationally the demand for organ transplants far exceeds the available supply of donated organs. Purpose: We examine if a digital reciprocity prime based on reciprocal altruism can be used to increase organ donor registration intentions and behavior. Methods: 420 participants (223 females) from England and Scotland aged 18+ who were not currently registered organ donors were randomized by block allocation using a 1:1 ratio to receive either a reciprocity prime or control message. After manipulation, they were asked to indicate their organ donation intentions and whether or not they would like to be taken to an organ donation registration and information page. Results: In line with our previous work, participants primed with a reciprocity statement reported greater intent to register as an organ donor than controls (using a 7-point Likert scale where higher scores = greater intention; prime mean = 4.3 (1.6) vs. control mean = 3.7 (1.4), P =< .001, d =0.4 [95%CI = 0.21-0.59]). There was again however, no effect on behavior as rates of participants agreeing to receive the donation register web-link were comparable between those primed at 11% (n= 23/210) [95%CI = 7.4-16.0] and controls at 12% (n= 25/210) [95%CI = 8.1-17.1], X²(1) = 0.09, p = .759. Conclusions: Reciprocal altruism appears useful for increasing intention towards joining the organ donation register. It does not however appear to increase organ donor behavior

Emerging investigator series: moving beyond resilience by considering antifragility in potable water systems

It is inherently difficult to plan water systems for a future that is non-predictive. This paper introduces a novel perspective for the design and operation of potable water systems under increasing water quality volatility (e.g., a relatively rapid and unpredicted deviation from baseline water quality). Increased water quality volatility and deep uncertainty stress water systems, confound design decisions, and increase the risk of decreased water system performance. Recent emphasis on resilience in drinking water treatment has partly addressed this issue, but still establishes an adversarial relationship with change. An antifragile system benefits from volatile change. By incorporating antifragility, water systems may move beyond resilience and improve performance with extreme events and other changes, rather than survive, or fail and quickly recover. Using examples of algal blooms, wildfires, and the COVID-19 pandemic, this work illustrates fragility, resilience, and antifragility within physicochemical process design including clarification, adsorption and disinfection. Methods for increasing antifragility, both individual process options and new system design tools, are discussed. Novel physicochemical processes with antifragile characteristics include ferrate preoxidation and magnetic iron (nano)particles. New design tools that allow for systematic evaluation of antifragile opportunities include artificial neural networks and virtual jar or pilot “stress testing”. Incorporating antifragile characteristics represents a trade-off with capital and/or operating cost. We present a real options analysis approach to considering costs in the context of antifragile design decisions. Adopting this antifragile perspective will help ensure water system improved performance during extreme events and a general increase in volatility