Instrumented Lumbar Corpectomy and Spinal Reconstruction Comparing rhBMP-2/Compression-Resistant Matrix, rhBMP-2/Absorbable Collagen Sponge/Ceramic Granules Mixture, and Autograft in Two Different Devices: A Study in Sheep

Study Design. Fusion success with rhBMP-2 and autograft in titanium or PEEK corpectomy devices was evaluated in a sheep lumbar corpectomy model. The 6 treatment groups included titanium mesh or PEEK corpectomy devices filled with rhBMP-2 on a compression-resistant matrix (CRM) carrier; rhBMP-2 in a morselized absorbable collagen sponge (ACS) carrier combined with resorbable ceramic granules; and autograft. Objective. The aim of this study was to determine fusion rates associated with 2 different preparations of rhBMP-2 as well as autograft in an instrumented ovine lumbar corpectomy model 6 months postoperatively. Summary of Background Data. Vertebral reconstruction with corpectomy devices requires bone graft. Bone graft substitutes have the potential to avoid a second operation, donor site pain, and attendant morbidity associated with autograft. Methods. Twenty-four sheep in 6 treatment groups underwent lumbar corpectomy via a retroperitoneal trans-psoas approach. Spines were reconstructed with autograft, rhBMP-2 on a CRM, or rhBMP-2 on an ACS mixed with ceramic granules. Grafting materials were placed in either a titanium mesh or PEEK conduit in spines with internal fixation. Computed tomographic (CT) scans were evaluated for fusion. Undecalcified histology was used to evaluate for fusion as well as the amount and extent of graft incorporation and graft resorption. Results. Regardless of corpectomy device used, rhBMP-2/CRM or rhBMP-2/ACS with MASTERGRAFT resulted in a 100% fusion rate. The autograft group had a lower (75%) radiographic fusion rate. Using either preparation of rhBMP-2 resulted in the length of the defect filling with solid bone. Autograft fragments and ceramic granules were incorporated into the fusion masses with much of the ceramic granules being resorbed by 6 months. Conclusion. Both of the rhBMP-2 formulations have the potential to effect bony fusion and vertebral reconstruction within the corpectomy devices

The three-dimensional Event-Driven Graphics Environment (3D-EDGE)

Stanford Telecom developed the Three-Dimensional Event-Driven Graphics Environment (3D-EDGE) for NASA GSFC's (GSFC) Communications Link Analysis and Simulation System (CLASS). 3D-EDGE consists of a library of object-oriented subroutines which allow engineers with little or no computer graphics experience to programmatically manipulate, render, animate, and access complex three-dimensional objects

Multiple-Choice Testing Using Immediate Feedback-Assessment Technique (IF AT®) Forms: Second-Chance Guessing vs. Second-Chance Learning?

Multiple choice testing is a common but often ineffective method for evaluating learning. A newer approach, however, using Immediate Feedback Assessment Technique (IF AT®, Epstein Educational Enterprise, Inc.) forms, offers several advantages. In particular, a student learns immediately if his or her answer is correct and, in the case of an incorrect answer, has an opportunity to provide a second response and receive partial credit for a correct second attempt. For a multiple choice question with five possible answers, the IF AT® form covers spaces labeled A through E with a thin opaque film; when the film is scratched away, a star indicates the correct answer. This study was conducted in order to assess learning after an initial incorrect answer. Based on random chance, students should have mathematically a 25% chance of guessing a correct second answer (i.e. 1 of 4 remaining answers on the IF AT® form). Analysis of second responses for 8775 questions on IF AT® forms in 22 classes over 3 years showed that the percent of correct second answers was 44.9%, significantly higher than one might expect from random guessing. This indicates that students learned from an incorrect answer and, possibly by re-reading the problem, were able to demonstrate some level of mastery of the material. This data leads us to conclude that IF AT® forms are useful assessment tools

How Long Do Endoprosthetic Reconstructions for Proximal Femoral Tumors Last?

As the life expectancy of patients with musculoskeletal tumors improves, long-term studies of endoprosthetic reconstructions are necessary to establish realistic expectations for the implants and compare them to other reconstruction approaches. (1) What is the long-term survival of cemented bipolar proximal femoral replacements? (2) How does prosthesis survival compare to patient survival among patients with Stage I, II, and III disease? (3) Do modular implants outperform custom-built prostheses? (4) Do some proximal femoral replacements require conversion to THA? We retrospectively reviewed all 86 proximal femoral replacements used for tumor reconstruction from 1982 to 2008. Primary diagnoses were 43 high-grade tumors (IIA/IIB), 20 low-grade tumors (IA/IB or benign), and 23 with metastatic disease. We reviewed prosthesis survival, patient survival, complication rates, functional outcomes, and rates of conversion to THA. Five of 86 patients (5.8%) required revision of the femoral component. Five-, 10-and 20-year implant survivorships were 93%, 84%, and 56%, respectively. All patients with low-grade disease survived; the 5-year survival rate for patients with metastatic disease was 16%; the 5-, 10-, and 20-year survival for IIA/IIB patients was 54%, 50%, and 44%, respectively. Five of 86 patients (5.8%) underwent conversion to THA for groin pain. Cemented bipolar proximal femoral replacements after tumor resection proved a durable reconstruction technique. The implants outlived patients with metastatic disease and high-grade localized disease while patients with low-grade disease outlived their implants. The survival of modular prostheses was comparable to that of older, one-piece custom designs. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence

Thermocapillary actuation of liquid flow on chemically patterned surfaces

We have investigated the thermocapillary flow of a Newtonian liquid on hydrophilic microstripes which are lithographically defined on a hydrophobic surface. The speed of the microstreams is studied as a function of the stripe width w, the applied thermal gradient |dT/dx| and the liquid volume V deposited on a connecting reservoir pad. Numerical solutions of the flow speed as a function of downstream position show excellent agreement with experiment. The only adjustable parameter is the inlet film height, which is controlled by the ratio of the reservoir pressure to the shear stress applied to the liquid stream. In the limiting cases where this ratio is either much smaller or much larger than unity, the rivulet speed shows a power law dependency on w, |dT/dx| and V. In this study we demonstrate that thermocapillary driven flow on chemically patterned surfaces can provide an elegant and tunable method for the transport of ultrasmall liquid volumes in emerging microfluidic technologies

Climate Change Predicted to Shift Wolverine Distributions, Connectivity, and Dispersal Corridors

Boreal species sensitive to the timing and duration of snow cover are particularly vulnerable to global climate change. Recent work has shown a link between wolverine (Gulo gulo) habitat and persistent spring snow cover through 15 May, the approximate end of the wolverine’s reproductive denning period. We modeled the distribution of snow cover within the Columbia, Upper Missouri, and Upper Colorado River Basins using a downscaled ensemble climate model. The ensemble model was based on the arithmetic mean of 10 global climate models (GCMs) that best fit historical climate trends and patterns within these three basins. Snow cover was estimated from resulting downscaled temperature and precipitation patterns using a hydrologic model. We bracketed our ensemble model predictions by analyzing warm (miroc 3.2) and cool (pcm1) downscaled GCMs. Because Moderate-Resolution Imaging Spectroradiometer (MODIS)-based snow cover relationships were analyzed at much finer grain than downscaled GCM output, we conducted a second analysis based on MODIS-based snow cover that persisted through 29 May, simulating the onset of spring two weeks earlier in the year. Based on the downscaled ensemble model, 67% of predicted spring snow cover will persist within the study area through 2030–2059, and 37% through 2070–2099. Estimated snow cover for the ensemble model during the period 2070– 2099 was similar to persistent MODIS snow cover through 29 May. Losses in snow cover were greatest at the southern periphery of the study area (Oregon, Utah, and New Mexico, USA) and least in British Columbia, Canada. Contiguous areas of spring snow cover become smaller and more isolated over time, but large (.1000 km2) contiguous areas of wolverine habitat are predicted to persist within the study area throughout the 21st century for all projections. Areas that retain snow cover throughout the 21st century are British Columbia, north-central Washington, northwestern Montana, and the Greater Yellowstone Area. By the late 21st century, dispersal modeling indicates that habitat isolation at or above levels associated with genetic isolation of wolverine populations becomes widespread. Overall, we expect wolverine habitat to persist throughout the species range at least for the first half of the 21st century, but populations will likely become smaller and more isolated