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OBJECTIVE To assess use of directional stimulation in Parkinson's disease and essential tremor patients programmed in routine clinical care. MATERIALS AND METHODS Patients with Parkinson's disease or essential tremor implanted at Cleveland Clinic with a directional deep brain stimulation (DBS) system from November 2017 to October 2019 were included in this retrospective case series. Omnidirectional was compared against directional stimulation using therapeutic current strength, therapeutic window percentage, and total electrical energy delivered as outcome variables. RESULTS Fifty-seven Parkinson's disease patients (36 males) were implanted in the subthalamic nucleus (105 leads) and 33 essential tremor patients (19 males) were implanted in the ventral intermediate nucleus of the thalamus (52 leads). Seventy-four percent of patients with subthalamic stimulation (65% of leads) and 79% of patients with thalamic stimulation (79% of leads) were programmed with directional stimulation for their stable settings. Forty-six percent of subthalamic leads and 69% of thalamic leads were programmed on single segment activation. There was no correlation between the length of microelectrode trajectory through the STN and use of directional stimulation. CONCLUSIONS Directional programming was more common than omnidirectional programming. Substantial gains in therapeutic current strength, therapeutic window, and total electrical energy were found in subthalamic and thalamic leads programmed on directional stimulation.

Although segmentectomy has become a routine procedure, atypical segmentectomies are less popular than their typical counterparts, probably because anatomical and surgical data are lacking. The left superior lingular S4 segment is considered relatively small, usually resected along with other segments. However, S4 segment size varies among patients, and resection of this single segment can be a valuable lung-preserving procedure in carefully selected patients with tumors located at the border of the upper division and lingular segments. We present here the anatomical and surgical features required for a methodological left S4 segmentectomy based on our experience and the literature.

A population of chromosome segment substitution lines was developed using KDML105 as the recurrent parent and one of DH212 (IR68586-F2-CA-143) or DH103 (IR68586-F2-CA-31) as the donor parent. The donor parents are part of a doubled haploid population from a cross between CT9993, an upland japonica accession, and IR62266, a lowland indica accession. Multiple QTL that are relevant to drought avoidance, drought tolerance and yield traits under drought stress were mapped in this doubled haploid population and the segments selected for the chromosome segment substitution lines were chosen to capture these QTL. The chromosome segment substitution line population was phenotyped under irrigated and mild drought stress conditions, which identified that many yield traits under drought stress had been introduced into the chromosome segment substitution lines.

Fronto-orbital advancement (FOA) of the anterior skull and orbital bandeau is standard of care for craniosynostosis with anterior morphology. Fronto-orbital retrusion, temporal hollowing, and bony contour irregularities are commonly seen in long-term follow-up. In this study, we report several technical adaptations of a new FOA technique described in Fearon et al that help facilitate adaptation of the single-segment neo-bandeau FOA technique in preparation of use in younger patients, and perform a craniometric analysis of the technique. Five consecutive patients who underwent the single-segment neo-bandeau FOA in 2020 with available pre- and post-operative three-dimensional head computed tomography scans were studied. Using Materialise Mimics (Materialise, Ghent, Belgium), cranial length, cranial height, cranial widths, and intracranial volume were measured. Two (40%) patients were male and all were non-Hispanic White with a median age at surgery of 18.6 months (interquartile range 10.4-45.7). Three patients (60%) had bicoronal or other multi-suture craniosynostosis, and 1 each had metopic and sagittal craniosynostosis. Intraoperatively measured intracranial pressure decreased from 17.8 mmHg (R 13.0-20.0) before craniectomy to 4.8 mmHg (R 2.0-11.0; P = 0.038) after craniectomy. Anterior cranial width increased postoperatively (mean 92.6 mm; R 74.9-111.5 versus 117.6 mm; R 109.8-135.2, P = 0.005). Intracranial volume increased from preoperative (mean 1211 cm3; R 782-1949 cm3) to postoperative (1387 cm3; R 1022-2108 cm3; P = 0.009). The authors find in this small sample that a single-segment neo-bandeau FOA demonstrates volumetric expansion similar to conventional FOA techniques and is feasible in infants under 1 year of age.

Background Conventional percutaneous vertebroplasty (PVP) are mainly guided by C-arm fluoroscopy, and it usually leads to excessive X-ray radiation exposure to patients, surgeons, and anesthetists. Moreover, multi-time fluoroscope may prolong the operation time. 3D-printed template could help minimize fluoroscopy shot times and fluoroscopy dosage during operation, and shorten operation time. We perform this study to compare the efficacy and accuracy of PVP assisted by “three-dimensional printed individual guide template” versus conventional PVP. Method Patients who suffered acute painful single segment osteoporotic vertebral compression fracture(OVCF) needed operative treatment were randomly assigned into three-dimensional printing individual guide template-assisted percutaneous vertebroplasty group (group A) or conventional PVP guided by C-arm fluoroscopy group (group B) at a 1:1 ratio. Fluoroscopy times for puncture points (FTPP), total radiation dosages (TRD), total fluoroscopy time (TFT), and total operation time (TOT) were recorded as the main evaluation factors to evaluate the two operation procedures. Results A total of 36 acute painful single segment OVCF patients were successfully operated on, and each group has 18 patients. None of the patients presented symptomatic complications. The surgical success rate in group A was 94.4%(17/18), one patient in the group A was failed and then operated by conventional procedure. FTPP (1.8 ± 0.8 in group A vs 5.2 ± 1.9 in group B, P < 0.05), TRD (4.9 ± 0.9 mGy vs 7.9 ± 1.6 mGy, P < 0.05), TFT (16.7 ± 2.9 vs 26.6 ± 5.3, P < 0.05), and total operation time (19.4 ± 2.4 min vs 27.8 ± 4.0 min, P < 0.05) were presented statistically difference in the two groups. The incidence of cement leakage occurred in group A (3/18, 16.7%) was less than that occurred in group B (7/18, 38.9%) (P > 0.05). Conclusions Compared with the conventional PVP, “three-dimensional-printed individual guide template-assisted PVP” could minimize fluoroscopy shot times during operation and fluoroscopy dosage, shorten operation time, and is a more precise and feasible operation method. Trial registration The present study was registered with the Chinese Clinical Trial Registry (ChiCTR) (http://www.chictr.org.cn), and its registration no. is ChiCTR1900024283.

Objective: To report a case of hypercorrection of astigmatism (Cyl) after implantation of 2 segments of short arch ring for keratoconus treatment and to describe its replacement by long arch segment. Methods: This is a case report of a patient with keratoconus and no adaptation to glasses or contact lenses, who was implanted 2 ring segments: upper nasal (155o/ 200μm) and inferior temporal (155o/ 250μm). Results: First postoperative month: CVA = 20/ 50 (-10.50-2.50x135°) and SimK K1 = 48.4x143° and K2 = 51.2x53° (Cyl 2,8D). In the 3rd year: CVA 20/ 30 (-6.00-2.50x135o), with inversion of the axes: K1 = 49,5x60o and K2 = 52,0x150o (Cyl 2,6D). The hypercorrection increased up to the 8th year: CVA = 20/40 (-4,50-6,00x75o) and SimK 47,8x51o/ 60,4x141o (Cyl 12,6D). The 2 segments were replaced for a single segment (320o/ 300μm) and after 1 month: CVA = 20/ 25 (-5,75 spherical) with SimK 46,8x38o/ 48,9x128o (Cyl 2,1D). Conclusion: The ring aims to flatten the most curved meridian, but surpassing the previous value induces astigmatism in the opposite meridian. The hypercorrection of the 2 short segments must occur due to its movement of the extremities, which does not occur with the single long arc segment (≥ 300o). Abbreviations: CVA = Corrected visual acuity, SimK = Simulated keratometry, LE = Left eye, RE = Right eye.

Study design Observational study on prospectively collected data. Objectives The aim of this study was to compare long-term patient-reported outcomes and complications after anterior or posterior cervical spine surgery for subaxial fractures. Summary of background data There is no consensus in the literature regarding the optimal surgical approach when treating spine fractures in the subaxial region. Methods A total of 200 individuals who had been treated with either anterior or posterior surgery due to a subaxial single segment, or single vertebra, injury between 2006 and 2016 and had at least 1 year follow-up were identified in the Swedish Spine register. Cases were matched 1:1 for age (±5 years). Outcomes were Neck Disability Index (NDI) and EQ-5D-3L, and reoperations, mortality, and surgeon- and patient-reported wound complications within 90 days. t Tests and χ2 tests were used statistical comparisons. Results At follow-up, NDI was 23 (21) in the anterior group and 29 (21) in the posterior group (P = 0.07). EQ-5D-3L index was 0.62 (0.37) in the anterior group and 0.54 (0.39) in the posterior group (P = 0.13). Patient satisfaction was higher in the anterior group (89% vs. 73%, P = 0.03). No deaths occurred within the first 90 days after surgery, six individuals in the anterior group and three individuals in the posterior group were reoperated (P = 0.31), and five individuals in the anterior group and 24 in the posterior group suffered a wound infection (P Conclusion Anterior surgery and posterior surgery were associated with similar neck disability and general quality of life at follow-up, whereas anterior surgery was associated with higher patient satisfaction and lower infection rates.Level of Evidence: 3.

The development of connected vehicle technology presents opportunity for hybrid electric vehicle (HEV) to further improve its energy efficiency. Within this horizon, the energy management strategy (EMS) considering connective information is an enabling technology. In this paper, a hierarchical EMS combining velocity planning and power split management is proposed for HEV under connective scenarios. Particularly, the driving route is separated into several segments, and the length of single segment is adaptively adjusted according to the possibility pre-judgment for preceding vehicle crossing the upcoming intersection. Furthermore, the velocity trajectory is optimized by incorporating the preceding vehicle pre-judgment and traffic information with dynamic programming. The equivalent consumption minimization strategy (ECMS) is used to realize the power split optimal distribution in lower level. Finally, the simulation results demonstrate the effectiveness of proposed method.

Epistasis plays an important role in manipulating rice tiller number, but epistatic mechanism still remains a challenge. Here we showed the process of epistatic analysis between tillering QTLs. A half diallel mating scheme was conducted based on 6 single segment substitution lines and 9 dual segment pyramiding lines to allow the analysis of 4 epistatic components. Additive-additive, additive-dominance, dominance-additive, and dominance-dominance epistatic effects were estimated at 9 stages of development via unconditional QTL analysis simultaneously. Unconditional QTL effect (QTL cumulative effect before a certain stage) was then divided into several conditional QTL components (QTL net effect in a certain time interval). The results indicated that epistatic interaction was prevalent, all QTL pairs harboring epistasis and one QTL always interacting with other QTLs in various component ways. Epistatic effects were dynamic, occurring mostly within 14d and 21–35d after transplant and exhibited mainly negative effects. The genetic and developmental mechanism on several tillering QTLs was further realized and perhaps was useful for molecular pyramiding breeding and heterosis utilization for improving plant architecture.

To explore 1) whether the degree of facet joint distraction during single-segment anterior cervical discectomy and fusion for cervical spondylotic radiculopathy affects functional outcome and 2) whether the degree of facet joint distraction is related to cervical sagittal parameters.This study retrospectively analyzed data from 72 patients with single-segment cervical spondylotic radiculopathy from January 2013 to December 2018. Lateral cervical radiographs were performed preoperatively and 12 months postoperatively. Disc height, interfacet distance, and segmental angle were measured from the lateral cervical radiographs to evaluate facet joint distraction, and cervical sagittal parameters were measured. The outcome measures included visual analog scale (VAS) and Neck Disability Index scores.Sixty-eight patients were included. ΔInterfacet distance was statistically significant in relation to ΔVAS score (P0.01). In a receiver operating characteristic curve analysis, less than the mean ΔVAS score for all patients was set as a positive result, and the critical value of Δinterfacet distance was 0.7 mm (P = 0.024, area under the curve = 0.659, sensitivity = 46.8%, specificity = 78.8%). According to the critical value determined by the receiver operating characteristic curve, all patients were divided into the appropriate distraction group or the excessive distraction group. There was a significant difference in VAS scores between the 2 groups (P0.05).After undergoing single-segment ACDF for the treatment of cervical spondylotic radiculopathy, patients with an interfacet distance of 0.7 mm or more had worse VAS pain scores. However, this was not related to the improvement in postoperative Neck Disability Index scores; changes in the interfacet distance were not associated with changes in the cervical sagittal parameters.

BACKGROUND Lumbar disc herniation is a common disease. Endoscopic treatment may have more advantages than traditional surgery. AIM To compare the clinical efficacy and safety of microendoscopic discectomy (MED) and open discectomy with lamina nucleus enucleation in the treatment of single-segment lumbar intervertebral disc herniation. METHODS Ninety-six patients who were operated at our hospital were selected for this study. Patients with single-segment lumbar disc herniation were admitted to the hospital from March 2018 to March 2019 and were randomly divided into the observation group and the control group with 48 cases in each group. The former group underwent lumbar discectomy and the latter underwent laparotomy and nucleus pulpectomy. Surgical effects were compared between the two groups. RESULTS In terms of surgical indicators, the observation group had a longer operation time, shorter postoperative bedtime and hospital stay, less intraoperative blood loss, and smaller incision length than the control group (P < 0.05). The excellent recovery rate did not differ significantly between the observation group (93.75%) and the control group (91.67%). Visual analogue scale pain scores were significantly lower in the observation group than in the control group at 1 d, 3 d, 1 mo, and 6 mo after surgery (P < 0.05). The incidence of complications was significantly lower in the observation group than in the control group (6.25% vs 22.92%, P < 0.05). CONCLUSION Both MED and open discectomy can effectively improve single-segment lumbar disc herniation, but MED is associated with less trauma, less bleeding, and a lower incidence of complications.

We investigate the impact of organizational form on operational efficiency using a large sample covering manufacturing and non-manufacturing sectors in the United States over 30 years. We quantify operational efficiency using various measures, and find robust evidence that segments of diversified firms are operationally more efficient than their single-segment industry peers. The difference is more noticeable in industries where financing needs are high due to greater growth potential and where access to external markets is constrained due to higher information asymmetry.

The paper presents the method of approximating curves with a single segment of the B-Spline and Bézier curves. The method for determining a single curve segment using the optimization methods in the CATIA environment is shown. The algorithms of simulated annealing and design of experiment are used for optimization. For the same purpose, a new original procedure for determining the distance between the given curves using explicit parameters in the CATIA environment was also used. This approximation of the cyclic curves results in the curve oscillation as shown in the examples. The results show that the approximation method with Bézier curve using control points as “free” points can be applied to obtain the best results of approximation.

Purpose: This study aims to investigate the necessity of cement-augmented pedicle screw fixation in single-segment isthmic spondylolisthesis with osteoporosis.Method: Fifty-nine cases were reviewed retrospectively. Thirty-three cases were in the polymethylmethacrylate-augmented pedicle screw (PMMA-PS) group, and the other 26 cases were in the conventional pedicle screw (CPS) group. Evaluation data included operation time, intraoperative blood loss, hospitalization cost, hospitalization days, rates of fusion, screw loosening, bone cement leakage, visual analog scores (VAS), Oswestry disability index (ODI), lumbar lordosis (LL), pelvic tilt (PT) and sacral slope (SS).Results: The operation time and blood loss in the CPS group decreased significantly compared to those in the PMMA-PS group (P < 0.05). The average hospitalization cost of the PMMA group was significantly higher than that of the CPS group (P < 0.05). There was no significant difference in the average hospital stay between the 2 groups (P > 0.05). The initial and last follow-up postoperative VAS and ODI improved significantly in the two groups (P < 0.05). There were no significant differences in VAS and ODI at each time point between the 2 groups (P > 0.05). The last postoperative spine-pelvic parameters were significantly improved compared with those preoperatively (P < 0.05). In the PMMA-PS group, the fusion rate was 100%. The fusion rate was 96.15% in the CPS group. No significant difference was found between the two groups for the fusion rate (P > 0.05). Nine patients in the PMMA-PS group had bone cement leakage (27.27%). There was no screw loosening in the PMMA-PS group. There were 2 cases of screw loosening in the CPS group. There were no significant differences in screw loosening, postoperative adjacent segment fractures, postoperative infection or postoperative revision between the 2 groups (P > 0.05).Conclusions: The use of PMMA-PS on a regular basis is not recommended for posterior lumbar interbody fusion for the treatment of single-segment isthmic spondylolisthesis with osteoporosis.

Dynamic regulation of QTLs remains mysterious. Single segment substitution lines (SSSLs) and conditional QTL mapping and functional QTL mappings are ideal materials and methods to explore dynamics of QTLs for complex traits. This paper analyzed the dynamics of QTLs on plant height with SSSLs in rice. Five SSSLs were verified with plant height QTLs first. All five QTLs had significant positive effects at one or more developmental stages except QTL1. They interacted each other, with negative effects before 72 d after transplanting and positive effects since then. The five QTLs selectively expressed in specific periods, mainly in the periods from 35 to 42 d and from 49 to 56 d after transplanting. Expressions of epistasis were dispersedly in various periods, negative effects appearing mainly before 35 d. The five QTLs brought the inflexion point ahead of schedule, accelerated growth and degradation, and changed the peak plant height, while their interactions had the opposite effects. The information will be helpful to understand the genetic mechanism for developmental traits.

Background Owing to the remarkable evolution of percutaneous endoscopic lumbar discectomy (PELD), the application of spinal endoscopy is shifting from the treatment of soft disk herniation to complex lumbar spinal stenosis. This study aim to compare the surgical efficacy of a newly designed endoscopic visualized trephine and a conventional trephine for PELD with foraminoplasty for patients with single-segment lumbar disc herniation (LDH). Methods A total of 54 patients who were diagnosed with single-segment LDH and received PELD with foraminoplasty at Xuzhou Central Hospital (Xuzhou, China) from January 2016 to June 2020 were included in this case-control study. Data related to the length of incision, amount of intraoperative bleeding, the time required to create the working channel, and intraoperative and postoperative complications were recorded. The Visual Analog Scale (VAS) score was used to assess low back pain and leg pain. Besides, the Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA) scores were utilized to evaluate patients’ pain intensity and their sitting and standing abilities. The X-ray fluoroscopy was performed to measure the horizontal and angular displacements of lumbar extension-flexion, and to evaluate the stability of lumbar spine. Results All the patients successfully underwent surgical procedures, except for two patients with injuries in the spinal nerve root of the responsible segment in the conventional trephine group, who were given nutritional supplements for nerve treatment. Besides, there was no significant difference in incision length and operative blood loss between the modern trephine and the conventional trephine groups. However, the time required to create the channel and the duration of fluoroscopy in the modern trephine group were significantly less than those in the conventional trephine group (34.24 ± 5.38 vs. 44.76 ± 6.37 min, P

Introduction Incidentally found congenital pulmonary airway malformations (CPAM) in older children are extremely rare and have traditionally been managed with minimally invasive versus open lobectomy of the affected lobe. Presentation of case In this report, we present a 11-year-old male who presented with a recurrent spontaneous pneumothorax and was found to have a large symptomatic CPAM confined to a single segment of the right lower lobe. The patient was successfully treated with thoracoscopic segmentectomy without any residual disease seen on follow up imaging. Discussion Minimally invasive thoracoscopic approach has many advantages over open approach including better pain control, reduced hospital length of stay, and decreased intraoperative blood loss. With increasing use of minimally invasive approaches, lung-sparing surgery has demonstrated to be a viable and an attractive option for definitive resection of CPAM, without compromising resection margins and/or future lung function. Conclusion This report demonstrates that minimally invasive lung-sparing surgical treatment of a large CPAM is feasible in older children., Highlights • Older children with CPAM can present with a spontaneous pneumothorax. • CPAM confined to a segment of a single lobe should be managed with segmentectomy. • VATS segmentectomy for CPAM in older children can be successful.

Background: Dynamic regulations of QTLs still remain mysterious. Single segment substitution lines and conditional QTL mapping, functional QTL mappings are ideal materials and methods to explore epistatic interactions, expression patterns and functions of QTLs for complex traits.Results: Based on single segment substitution lines five QTLs on plant height in rice were identified first in this paper, and then their epistatic interactions, expression patterns and functions were systemmatically studied by tailing after each QTL. Unconditional QTL mapping showed the five QTLs were with significant effects at one or more stages, all of which increased plant height except QTL1. They interacted each other as homeostatic mechanisms to regulate plant height with negative effects before 72d after transplanting and positive since then. Conditional QTL mapping revealed the expression quantities and periods for the five QTLs and their epistases. Temporal expression pattern was verified again by selective expressions of QTLs in specific periods. QTL1 expressed negatively while QTL2 and QTL4 positively, mainly occurring in the periods from 35 to 42d and from 49 to 56d after transplanting. Epistatic expressions were dispersedly in various periods, mainly with negative effects before 35d while positive since then. Functional QTL mapping discovered the five QTLs brought the inflexion point ahead of schedule, accelerated the growth and the degradation, and changed the peak of plant height, while their interactions had the opposite effects approximately. This paper uncovered the dynamic rules of five QTLs and their interactions on plant height systematically, which will be helpful to understand the genetic mechanism for developmental traits.Conclusions: Five single segment substitution lines were tested with significant additive, dominant and epistatic effects of QTLs on plant height. Additive and dominant expressions were mainly in two periods, while epistasis dispersedly. The five QTLs and their interactions significantly regulated the developmental trajectory of plant height.

Objective: To observe the clinical effect percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of single lumbar disc herniation. Methods: From August 2017 to June 2019, 42 patients with low lumbar single segment lumbar disc herniation were treated with percutaneous transforaminal endoscopic discectomy surgery in our hospital. The operation time, incision size, bleeding volume and hospitalization time were recorded respectively. The patients were evaluated before operation, 1 month and 6 months after operation. Visual analogue scale (VAS) and assessment were used to evaluate the lumbocrural pain. The JOA score and the Oswestry disability index (ODI) were used to evaluate the lumbar function, and the modified macnab score was used to evaluate the clinical effect in the last follow-up. Results: All the 42 patients successfully completed the operation without any other operation. There were no severe complications such as dural injury and nerve root injury. The operation time was (76.98 ± 8.58) min, the incision size was (8.45 ± 1.2) mm, the bleeding volume was (20.14 ± 2.93) ml, and the hospitalization time was (4.55 ± 1.13) d. One month and six months after the operation, the visual analogue scale (VAS), the evaluation of lumbar function (Oswestry) and the disability index (ODI) were significantly improved compared with those before the operation (P < 0.05). The last follow-up evaluation of the clinical effect of modified macnab: excellent in 30 cases, good in 8 cases, fair in 3 cases and poor in 1 case. The excellent rate was 90.47%. One patient developed back pain and discomfort. One case recurred. Conclusion: The treatment of low lumbar but segmental lumbar disc herniation with percutaneous intervertebral foramen, with small incision, less bleeding and quick recovery, can improve the pain and dysfunction of patients.

Posterior lumbar interbody fusion (PLIF) with a spacer and posterior instrument (PI) via minimally invasive surgery (MIS) restores intervertebral height in degenerated disks. To align with MIS, the spacer has to be shaped with a slim geometry. However, the thin spacer increases the subsidence and migration after PLIF. This study aimed to propose a new lumbar fusion approach using bone cement to achieve a larger supporting area than that achieved by the currently used poly aryl-ether-ether-ketone (PEEK) spacer and assess the feasibility of this approach using a sawbone model. Furthermore, the mechanical responses, including the range of motion (ROM) and bone stress with the bone cement spacer were compared to those noted with the PEEK spacer by finite element (FE) simulation. An FE lumbar L3-L4 model with PEEK and bone cement spacers and PI was developed. Four fixing conditions were considered: intact lumbar L3-L4 segment, lumbar L3-L4 segment with PI, PEEK spacer plus PI, and bone cement spacer plus PI. Four kinds of 10-NM moments (flexion, extension, lateral bending, and rotation) and two different bone qualities (normal and osteoporotic) were considered. The bone cement spacer yielded smaller ROMs in extension and rotation than the PEEK spacer, while the ROMs of the bone cement spacer in flexion and lateral bending were slightly greater than with the PEEK spacer. Compared with the PEEK spacer, peak contact pressure on the superior surface of L4 with the bone cement spacer in rotation decreased by 74% (from 8.68 to 2.25 MPa) and 69.1% (from 9.1 to 2.82 MPa), respectively, in the normal and osteoporotic bone. Use of bone cement as a spacer with PI is a potential approach to decrease the bone stress in lumbar fusion and warrants further research.

To compare and evaluate the efficacy and safety of nonstructural versus structural interbody fusion, using a combination of autograft and allograft bone for treatment of single segment thoracic and lumbar spinal tuberculosis (TB) via a posterior-only approach.We retrospectively analyzed 37 patients who were surgically treated in our department for thoracic and lumbar spinal TB between March 2015 and March 2018 and met our inclusion criteria. Eighteen of these 37 patients underwent nonstructural interbody fusion (group A), whereas the other 19 underwent structural interbody fusion with the aid of titanium mesh cages (group B). We compared and analyzed visual analog scale scores, erythrocyte sedimentation rate, blood loss, operation time, bone fusion rates, and correction angles.The average duration of follow-up was 20.33 ± 4.73 months (range, 12-26 months) in group A and 19.63 ± 4.63 months (range, 12-26 months), in group B. All patients showed significant improvement in neurologic function by 1 or 2 grades. Bone fusion was achieved in all patients, with no statistically significant difference between the 2 groups (P0.05). However, there were significant between-group differences in operation time (mean, 196.28 ± 43.49 minutes [range, 128-300 minutes] in group A vs. 223.26 ± 46.34 minutes [range, 150-300 minutes] in group B; P0.05) and estimated blood loss (mean, 474.44 ± 224.37 mL [range, 200-900 mL] in group A vs. 585.79 ± 378.82 mL [range, 200-1500] in group B; P0.05).The 2 surgical techniques may well have achieved similar results in terms of decreasing bone fusion time, improving neurologic function, and correcting kyphotic angles. However, the nonstructural interbody fusion technique exhibited less blood loss and faster operation time, and thus could serve as an alternative surgical technique for treatment of single-segment thoracic and lumbar spinal TB.

This article describes the trepan technique for treating single segment ossification of the ligamentum flavum (OLF) using an endoscope. OLF is the most common cause of thoracic spinal stenosis. The most common surgical procedures involve semi‐lamina or full‐lamina resection and decompression. However, considering the anatomical structure of the thoracic spinal canal and the combination of OLF, traditional surgery has higher risks, more complications, and greater technical requirements. In the past ten years, with the development of endoscopic technology, spinal endoscopy has been increasingly applied for the treatment of intervertebral disc herniation and spinal canal stenosis. The present study demonstrated the effectiveness of visual trepan decompression under spinal endoscopy used for patients with single segment OLF. This surgical procedure had many advantages, including a shorter operation time, minimal trauma, less expenditure, and better functional recovery over the conventional open surgery.

To review the clinical efficacy of minimally invasive pedicle fixation combined with anterior small incision focus debridement for single-segment lumbar spine tuberculosis, a total of 31 patients with single-segment marginal lumbar tuberculosis were enrolled in the study. All the patients received quadruple anti-tuberculosis chemotherapy for 2 weeks before surgery and treatment with minimally invasive posterior internal fixation, anterior small incision focus debridement, and bone graft fusion. Those patients with preoperative kyphosis deformity were initially treated with appropriate posterior distraction correction. Except for 1 patient who healed 2 weeks after medical dressing change, the remaining 30 patients healed as expected. All the patients had no screwrelated surgical complications, neurological dysfunction, vascular injury, and other complications. The average visual analog scale scores at 3 months postoperatively were significantly decreased to 1.4 ± 1.5 ( P < 0.05). In conclusion, under the premise of treatment using appropriate, effective anti-tuberculosis agents, this surgical procedure for managing patients with lumbar vertebral tuberculosis achieved satisfactory results, effectively reducing the exposure range and fusion segments in simple anterior focus debridement and internal fixation. Using minimally invasive posterior pedicle screw fixation can effectively increase spine stability, reduce fusion segment, and decrease anterior surgical trauma and complications.

Background To report the results of a phase I/II study of helical IMRT-based stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC). Methods Eligibility included Child–Turcotte–Pugh class A or B, ≤3 lesions, and cumulative tumor diameter ≤6 cm. Dose was escalated from 36 Gy to 60 Gy delivered in 4 fractions. Grade ≥3 gastrointestinal toxicities (CTCAE v3.0) or radiation-induced liver disease defined dose-limiting toxicity (DLT). Results Thirty-two patients were enrolled: seven in dose levels 1–2 (36–44 Gy) and 25 in levels 3–4 (42–60 Gy). Failures included 1 local, 14 outfield intrahepatic, 2 distant, 1 concurrent local and outfield, 1 concurrent outfield and distant, and 1 concurrent local, outfield, and distant. Nine had grade 3 hematologic toxicities and 5 had grade 2 hepatic toxicities; no patient experienced DLT. Two-year local control (LFFS), outfield intrahepatic control (OutFFS), and overall survival (OS) rates were 80.9%, 46.7%, and 81.3%, respectively. Dose levels 3–4 and pre-radiotherapy multi-segment recurrence were independent prognostic factors for LFFS and OutFFS, respectively. Two-year LFFS, OutFFS, and OS were significantly higher for patients who were treated with dose-levels 3/4 for tumor(s) involving single segment compared with the rest of the patients. Conclusions Helical IMRT-based SBRT was safe and effective, and patients with multi-segment recurrences prior to SBRT need to be closely followed.

An elite backcrossed inbred line Z550 with increased grains per panicle was identified from advanced backcrosses between Nipponbare and Xihui 18 by simple sequence repeat (SSR) marker-assisted selection (MAS). Z550 carries 13 substitution segments distributed on chromosomes 1, 6, 7, 8, 9, 10, and 12, with an average substitution length of 1.68 Mb. Compared with the Nipponbare parental line, plant height, panicle length, spikelets per panicle, grains per panicle, and grain weight for Z550 were significantly increased. While the grain width of Z550 was significantly narrower, and the seed setting ratio (81.43%) was significantly lower than that of Nipponbare, it is still sufficient for breeding purposes. Quantitative trait loci (QTLs) mapping for important agronomic traits was conducted with the F2 population derived from Nipponbare crossed with Z550 using the restricted maximum likelihood (REML) method. A total of 16, including 12 previously unreported QTLs were detected, with contribution rates ranging from 1.46 to 10.49%. Grains per panicle was controlled by 8 QTLs, 5 of which increased number of grains whereas 3 decreased it. qGPP-1, with the largest contribution (10.49%), was estimated to increase grains per panicle by 30.67, while qGPP-9, with the minimum contribution rate (2.47%), had an effect of increasing grains per panicle by 15.79. These results will be useful for further development of single segment substitution lines with major QTLs, and for research of their molecular functions via QTL cloning.

Purpose: To determine the effect of a single-segment intrastromal corneal ring segment (ICRS;Intacs-SK) on early keratoconus (KCN) or pellucid marginal degeneration (PMD).Methods: It is a prospective interventional study. One-hundred-twenty-four eyes (99 patients) with KCN and 36 eyes (26 patients) with PMD at early stage (the maximum keratometric reading less than 55 diopters) were included to ICRS implantation using femtosecond laser at a tertiary university-based hospital and a private outpatient center. The uncorrected distance and spectacle-corrected visual acuity (UDVA and SCDVA), manifest spherical and cylindrical refractions, and keratometry indices were measured preoperatively and postoperatively, 1 week, 2 and 6 months.Results: One week after surgery, significant improvements were observed in UDVA, SCDVA, cylinder and keratometry readings of both KCN and PMD groups (all PConclusion: Visual acuity and keratometry values reached stability at 1 week, after one-segment Intacs-SK implantation in KCN and PMD groups. The short-term efficacy of the procedure was more in early KCN compared to early PMD.

Background: We sought to investigate the clinical outcomes of posterior-only approach using poly-ether-ether-ketone (PEEK) cage combined with single-segment instrumentation in the treatment of lumbar tuberculosis in children.Methods: Between February 2008 and August 2017 in our hospital, 18 children with single-segment lumbar tuberculosis were enrolled in this study. Children were treated by a posterior-only approach using PEEK cage combined with single-segment instrumentation. Medical records and radiographs were retrospectively analyzed. Visual analogue scores (VAS) were used to evaluate measures of quality of daily life. Criteria defined from the American Spinal Injury Association (ASIA) were used to evaluate measures of neurological function.Results: Mean follow-up time was 54.6 ± 12.1 months (39–84 months). No severe complications were noted to have occurred. Measures indicated there was satisfactory bone fusion for observations for all patients. Mean Cobb angles were significantly decreased from the mean preoperative angle (19.8° ± 13.1°) to those both postoperatively (-4.9° ± 7.6°) and at final follow-up (-3.5° ± 7.3°) (both P < 0.05), with a mean angle loss of 1.7° ± 0.9°. Th erythrocyte sedimentation rate (ESR) returned to normal levels for all patients within 3 months postoperatively. All patients had significant postoperative improvement in respect to neurological performance and VAS scores.Conclusions: The posterior-only approach using PEEK cage combined with single-segment instrumentation was found to be an effective and feasible treatment option for children with lumbar tuberculosis. Such procedures can likely be used to help patients by facilitating reconstruction of spinal stability, and increasing retainment of lumbar mobility in conjunction with reduced invasiveness compared to counterpart treatments.

To describe a novel surgical technique for iridodialysis repair using an iris retractor segment and report its clinical results. Fifty-three eyes of 53 patients who underwent iridodialysis repair using an iris retractor segment were enrolled in this retrospective study. Data recorded from patient files consisted of age, sex, degree of iridodialysis, surgical techniques, number of segments used, preoperative and postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), complications, and follow-up time. Mean follow-up time was 34.4 months. The subjects included 29 men (54.7%) and 26 women (45.3%), and the mean age was 56.6 ± 14.0 years. According to the degree of iridodialysis, the patients were divided into Group 1 (60°–89°, n = 19) and Group 2 (90°–270°, n = 34). During the iridodialysis repair for Group 1, a single segment was sufficient; however, in Group 2, one segment was used in 18 eyes (52.9%), two segments in 15 eyes (44.1%), and three segments in one eye (2.9%). The pre- and postoperative last control CDVA value in Group 2 was significantly lower than in Group 1. The pre- and postoperative IOPs for Group 2 were significantly higher than Group 1. Iridodialysis repair using an iris retractor segment is a minimally invasive technique and found to be safe and effective. It will be a good option for patients with large iridodialysis, as it avoids excessive surgical manipulations and prolonged surgical time.