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Aims Whether to perform hybrid surgery (HS) in contrast to anterior cervical discectomy and fusion (ACDF) when treating patients with multilevel cervical disc degeneration remains a controversial subject. To resolve this we have undertaken a meta-analysis comparing the outcomes from HS with ACDF in this condition. Methods Seven databases were searched for studies of HS and ACDF from inception of the study to 1 September 2019. Both random-effects and fixed-effects models were used to evaluate the overall effect of the C2-C7 range of motion (ROM), ROM of superior/inferior adjacent levels, adjacent segment degeneration (ASD), heterotopic ossification (HO), complications, neck disability index (NDI) score, visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, Odom’s criteria, blood loss, and operating and hospitalization time. To obtain more credible results contour-enhanced funnel plots, Egger’s and Begg’s tests, meta-regression, and sensitivity analyses were performed. Results In total, 17 studies involving 861 patients were included in the analysis. HS was found to be superior to ACDF in maintaining C2-C7 ROM and ROM of superior/inferior adjacent levels, but HS did not reduce the incidence of associated level ASD. Also, HS did not cause a higher rate of HO than ACDF. The frequency of complications was similar between the two techniques. HS failed to achieve more favourable outcomes than ACDF using the NDI, VAS, JOA, and Odom’s scores. HS did not show any more advantages in operating or hospitalization time but did show reduction in blood loss. Conclusion Although HS maintained cervical kinetics, it failed to reduce the incidence of ASD. This finding differs from previous reports. Moreover, patients did not show more benefits from HS with respect to symptom improvement, prevention of complications, and clinical outcomes. Cite this article: Bone Joint J 2020;102-B(8):981–996.

It is an open question whether cell transplantation can provide safety and effective outcome to spinal cord injury (SCI) patient which has remained controversial for almost 40 years. This study aimed to evaluate the safety and efficacy of cell transplantation in SCI patients.Studies of the cell transplantation for SCI were retrieved from PubMed, Embase, Medline, Cochrane Library and analyzed quantitative data by Review Manager 5.3.Twenty-one clinical controlled studies with 973 patients were included. The pooled results suggested that cell transplantation significantly improved ASIA score, ASIA motor score, ASIA sensory score, Barthel Index score, residual urine volume, rehabilitative time of automatic micturition. Furthermore, subgroup analysis indicated that the stem cells exhibited more potent than the non-stem cells in spinal cord repair. Cell transplantation at more than 14 days after injury showed more significant improvements than that within 14 days from injury. The dosage of cell transplantation between 1-5 × 10Cell transplantation appears to be a safe therapeutic strategy possessing substantial beneficial effects in the patients with SCI in clinic. Moreover, treating SCI with stem cell, the dosage of cells between 1-5 × 10

Whether to perform hybrid surgery (HS) in contrast to anterior cervical discectomy and fusion (ACDF) when treating patients with multilevel cervical disc degeneration remains a controversial subject. To resolve this we have undertaken a meta-analysis comparing the outcomes from HS with ACDF in this condition.Seven databases were searched for studies of HS and ACDF from inception of the study to 1 September 2019. Both random-effects and fixed-effects models were used to evaluate the overall effect of the C2-C7 range of motion (ROM), ROM of superior/inferior adjacent levels, adjacent segment degeneration (ASD), heterotopic ossification (HO), complications, neck disability index (NDI) score, visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, Odom's criteria, blood loss, and operating and hospitalization time. To obtain more credible results contour-enhanced funnel plots, Egger's and Begg's tests, meta-regression, and sensitivity analyses were performed.In total, 17 studies involving 861 patients were included in the analysis. HS was found to be superior to ACDF in maintaining C2-C7 ROM and ROM of superior/inferior adjacent levels, but HS did not reduce the incidence of associated level ASD. Also, HS did not cause a higher rate of HO than ACDF. The frequency of complications was similar between the two techniques. HS failed to achieve more favourable outcomes than ACDF using the NDI, VAS, JOA, and Odom's scores. HS did not show any more advantages in operating or hospitalization time but did show reduction in blood loss.Although HS maintained cervical kinetics, it failed to reduce the incidence of ASD. This finding differs from previous reports. Moreover, patients did not show more benefits from HS with respect to symptom improvement, prevention of complications, and clinical outcomes. Cite this article

To observe the early clinical effect of perfusion bone cement screw for lumbar degenerative diseases with osteoporosis.The clinical data of 28 patients with lumbar degenerative diseases combined with moderate to severe osteoporosis treated by posterior lateral graft fusion with perfusion of bone cement screws from June 2015 to June 2017 were retrospectively analyzed. There were 9 males and 19 females, aged from 55 to 86 years old with an average of 76 years. Anteroposterior, oblique, and dynamic radiography were performed before operation, and the diagnosis was confirmed by CT, MRI and dual energy X-ray absorptionmetry(DXA). All the patients had moderate to severe lumbar spinal stenosis, including 16 cases with degenerative scoliosis, 12 cases with degenerative lumbar spondylolisthesis, and 16 cases with lumbar disc herniation. According to Jikei grade of osteoporosis, 9 cases were grade II and 19 cases were grade III. Visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score were used to assess the improvement of lumbar leg pain, and neurological function. Imaging data were used to observe the circumstance of pedicle loosening, prolapse, breakage and bone cement leakage, and comprehensively evaluate the fusion.The hospital stay was from 10 to 14 days with an average of 12 days; the operative time was 100 to 150 min with an average of 120 min;the blood loss was 200 to 600 ml with an average of 350 ml (for operations more than 3 vertebral segments, blood filtration recovery was intraoperatively used);the postoperative drainage volume was 150 to 600 ml with an average of 300 ml, no allogeneic blood was used in all the patients. Bone cement of 2 to 3 ml were injected into each vertebral body, and bone cement leakage occurred in 2 cases during injection, both of which were paravertebral vessel leakage, and there was no evidence of intravertebral leakage. The injection of bone cement was terminated in a timely manner without serious complications such as nerve injury, bone cement toxicity, and vascular embolization and pulmonary embolism. According to the fusion criteria by X-ray, 18 cases achieved strong bone fusion, and 10 cases were inaccurate fusion, but no pseudarthrosis occurred in the fusion segment. No screw loosening, prolapse or fracture were found, and postoperative VAS, JOA scores were significantly improved.Perfusion bone cement screw technique can obtain satisfactory effect in treating lumbar degenerative diseases with osteoporosis.

By combing the properties of chaos optimization method and genetic algorithm, an adaptive mutative scale chaos genetic algorithm (AMSCGA) was proposed by using one-dimensional iterative chaotic self-map with infinite collapses within the finite region of [−1, 1]. Some measures in the optimization algorithm, such as adjusting the searching space of optimized variables continuously by using adaptive mutative scale method and making the most circle time as its control guideline, were taken to ensure its speediness and veracity in seeking the optimization process. The calculation examples about three testing functions reveal that AMSCGA has both high searching speed and high precision. Furthermore, the average truncated generations, the distribution entropy of truncated generations and the ratio of average inertia generations were used to evaluate the optimization efficiency of AMSCGA quantificationally. It is shown that the optimization efficiency of AMSCGA is higher than that of genetic algorithm.

The film spallation, a typical film / substrate failure style, could be caused by many reasons. The strong impact on the film/substrate can also lead to this failure phenomenon. So the film spallation induced by the strong impact is explored in this paper. Here the strong impact comes from the laser-driven flyer loading. In the numerical simulating process, the Finite Element Method (FEM) and Johnson-Cook material constitutive model have been used, moreover, some ideal film spallation results were got, which are helpful for us to understand this failure phenomenon.

The spall phenomenon has been a subject of constant interest for many years, and it is still widely investigated in various ways including the experiment. This paper uses the method of smoothed particle hydrodynamics and the model of Johnson-Cook tensile cumulative damage to simulate the process of spall induced by the laser-driven flyer loading. Using this method, some numerical simulation results can be obtained, like the different time of the 2D image of damage distribution and the rear free surface velocity histories of target material. These results could offer some useful messages for the study on spall damage.

This paper applied the Data Envelopment Analysis (DEA) method to evaluate the input-output efficiency of constructing the enterprise information. Through projecting the inefficacy DEA unit to make the DEA effective in the unit, the data from projection can be used to train the BP network. In the pure BP network model, some flaws exist in BP network model such as slow speed in convergence and easily plunging into the local minima. On the contrary, artificial immune model has a few advantages such as antibody diversity inheritance mechanism and cell-chosen mechanism, which have been applied in this research. In this research, the BP network has been designed, and the IA-BP network model established. By taking the enterprise information application level, enterprise human resources state and information benefit index as the inputs, and the enterprise investing as the output, this model carries out the network training, until to get the satisfied investment decision method. Basing on this model, the enterprise can realize the maximized return on investment. This model not only constructs a new viable method to effectively use the research data, but also overcomes the drawbacks of non-linear description in the traditional information investment decision. The application results show that the model can satisfy the requirements of enterprise information, and provide the best decision method for enterprises as well.