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OBJECTIVE To explore whether the pre-laminectomy extension can effectively prevent spinal cord injury (SCI) due to spinal shortening after 3-column osteotomy in goat model.METHODS A total of twenty healthy goats were included and done with 3-column osteotomy of T13 and L1 under the somatosensory evoked potential (SSEP) monitoring. The samples were divided into two groups. The first group with ten goats was the control group; the second group with ten goats (the pre-laminectomy extension group): a laminectomy extension was performed on 10 mm cranial to L2. The SSEP measured after 3-column osteotomy was set as the baseline, and the SSEP decreased by 50% from the baseline amplitude and/or delayed by 10% relative to the baseline peak latency was set as positive results, which indicated spinal cord injury. The vertebral column was gradually shortened until the SSEP monitoring just did not show a positive result. The height of the initial osteotomy gap (the distance from the lower endplate of T12 to the upper endplate of L2), the shortened distance (△H), the number of spinal cord angulated and the changed angle of the spinal cord (△α) were measured and recorded in each group. Neurologic function was evaluated by the Tarlov scores on day 2 postoperatively.RESULTS All the goats except one of the first group due to changes in the SSEP during the osteotomy were included and analyzed. In the first group, the height of the initial osteotomy segment and the safe shortening distances were 61.6 ± 2.6 mm and 35.2 ± 2.6 mm, respectively; the spinal cord of 5 goats was angulated (46.4 ± 6.6°), the other four goats were kinked and not angulated. In the second group, the height of the initial osteotomy segment and the safe shortening distances were 59.8 ± 1.5mm and 43.3 ± 1.2mm, respectively, and the spinal cord of ten goats were angulated (97.6 ± 7.2°). There was no significant difference in the height of the initial osteotomy segment between the two groups by using Independent-Samples T-Test, P = 0.095 (P > 0.05); there were significant difference in the safe shortening distance and the changed angle of the spinal cord between the two groups by using Independent-Samples T-Test (both △H and △α of P °. Significant difference was found in the number of spinal cord angulation between the two groups through Fisher's exact test, P = 0.033 (bilateral).CONCLUSIONS After 3-column osteotomy, the pre-laminectomy extension can effectively prevent spinal cord injury in the process of spinal shortening by facilitating spinal cord angulation rather than spinal cord kinking and increasing the safe shortening distance.

Realizing stretchable conductive fibers with a trade-off between stretchability and conductivity is important for wearables. Fibrous triboelectric nanogenerators (FTENGs) represent a promising device for wearable power sources and self-powered sensors. However, the relationship between conductivity and triboelectric outputs of FTENG remains unfathomed. Herein, a simple strategy for fabricating stretchable conductive fibers with binary rigid-soft conductive components and dynamic compensation conductive capability is reported. Wet-spun thermoplastic polyurethane (TPU)/silver flakes (AgFKs) (TA) composite fiber is fabricated and coated by a water-borne polyurethane (WPU) thin layer, bridging the subsequent liquid metal (LM) coating to obtain TPU/AgFKs/WPU/LM (TAWL) fibers. The TAWL fiber shows outstanding elongation (~600% strain), electrical conductivity of ~2 Ω cm−1 (~3125 S cm−1), and reversible resistance response within 70% tensile strain. Encapsulated by polydimethylsiloxane (PDMS), the TAWL fiber is demonstrated as single electrode FTENG with the maximum output voltage, current, and transferred charge of 7.5 V, 167 nA, and 3.2 nC, respectively. The FTENG shows 150% stretchability without output dropping, demonstrating the superiority of TAWL fibers to sustain large deformation and conductivity degradation but maintain stable triboelectric outputs. As self-powered sensors, the FTENG can detect joint bending such as for fingers, elbows, and knees, as well as for pressure and location identification. This work was supported by Key Laboratory of Textile Science & Technology (Donghua University), Ministry of Education (2232022G-01), and National Natural Science Foundation of China (52103254, 52273244).

Redox flow batteries (RFBs) are among the most promising grid-scale energy storage technologies. However, the development of RFBs with high round-trip efficiency, high rate capability, and long cycle life for practical applications is highly restricted by the lack of appropriate ion-conducting membranes. Promising RFB membranes should separate positive and negative species completely and conduct balancing ions smoothly. Specific systems must meet additional requirements, such as high chemical stability in corrosive electrolytes, good resistance to organic solvents in nonaqueous systems, and excellent mechanical strength and flexibility. These rigorous requirements put high demands on the membrane design, essentially the chemistry and microstructure associated with ion transport channels. In this Review, we summarize the design rationale of recently reported RFB membranes at the molecular level, with an emphasis on new chemistry, novel microstructures, and innovative fabrication strategies. Future challenges and potential research opportunities within this field are also discussed.

Background Up to date, surgical outcome of multilevel thoracic ossification of posterior longitudinal ligament (T-OPLL) with high canal occupation ratio is less satisfactory. Objective To explore the result of thoracic column antedisplacement and fusion (TCAF) in treatment of multilevel T-OPLL with high canal occupation ratio. Methods A total of 5 patients who underwent TCAF procedure for T-OPLL were retrospectively reviewed. Parameters including extent of OPLL, thickness of the maximal OPLL (max-OPLL), maximal canal occupying ratio (max-COR) of OPLL, effective canal diameter (ECD) at the max-OPLL level, antedisplacement distance of thoracic columns, ASIA grades, Japanese Orthopedic Association (JOA) scores, and complications were collected and analyzed at preoperation and the last follow-up. Results All patients (5 F, mean age 61.0 yr, mean follow-up 18.0 months) underwent TCAF successfully and no spinal cord injury or cerebrospinal fluid leakage occurred. The mean extent of OPLL was 2.8 vertebral bodies. The mean preoperative thickness of the max-OPLL was 5.9 mm. The average antedisplacement distance of thoracic columns was 5.6 mm. The mean ECD was improved from 6.5 mm to 10.9 mm, and the max-COR was improved from 50.7% to 7.1% at last follow-up. Two patients showed improvement in ASIA grades and JOA scores were significantly improved from 5.6 points to 10.4 points at final follow-up. The overall therapeutic results of 1 patient were classified into good and 4 into fair at last follow-up. Conclusion TCAF may be a safe and effective procedure in treatment of multilevel T-OPLL with high canal occupation ratio.

In this experiment, Mn@TiO2 nanofibers in the form of membranes were fabricated by ordinary electrospinning and a higher temperature calcination process. Field-emission scanning, X-ray diffraction analysis, X-ray photoelectron spectroscopy, Raman spectra, UV-visible diffuse spectra, UV-visible spectroscopy, and Brunauer–Emmett–Teller (BET) evaluation were used to characterize the resulting samples. The study revealed that, upon the addition of the manganese ion, the continuous and mechanical properties of the nanofibers and nanofilms were substantially enhanced. Notably, after 60 minutes, the Mn@TiO2-0.10 degradation efficiency reached 94.92% under ultraviolet light, which was 5 times greater than that for TiO2 nanofibers. It was due to the controlled mixture phase and palpable raised specific surface area, which ensured a pronounced enhanced photocatalytic activity of the nanofibers. In addition, the application of nanofibers on the capacitor aspect was explored by electrochemical workstations. The highest photoactivity sample performed mass-specific capacity as high as 5.09 F g−1. Such efficient capacity and higher photoactivity of the photocatalyst shed light on the preparation of soft inorganic materials and their application in energy conversion.

Objective To clarify the safe limit of shortening of the spinal cord in thoracolumbar bivertebral column resection in a goat model. Methods Ten healthy goats were selected for the experiment. Radiographs were taken before surgery to measure the height of T13, L1, and the initial osteotomy segment (distance from the lower end plate of T12 to the upper end plate of L2). A procedure of thoracolumbar bivertebral column resection (T13 and L1) was completed under the monitoring of somatosensory evoked potential (SSEP) monitoring. The SSEP measured after vertebral resection was set as the baseline. SSEPs decreased by 50% from the baseline amplitude and/or delayed by 10% relative to the baseline peak latency were set as positive results, indicating spinal cord injury. The initial height of the osteotomy gap was measured first and the spinal column was gradually shortened until the SSEP monitoring did not show a positive result. Then the height of the osteotomy gap was recorded again. The safe limit of shortening was measured and recorded when any morphologic change of the spinal cord was observed. Hindlimb function was evaluated by the Tarlov scores on day 2 postoperatively. Results The safe limit of shortening of the spinal cord in thoracolumbar bivertebral columns resection was 35.2 ± 2.6 mm, which was roughly equal to 127.6% of the mean osteotomy vertebral height and 57.1% of the initial osteotomy gap height. Pearson correlation test showed that the safe limit of shortening of the spinal cord was correlated with the height of T13, the height of L1, the mean height of T13 and L1, and the height of the initial osteotomy gap. Conclusions The safe limit of shortening distance of the bivertebral column resection was roughly equal to 127.6% of the mean osteotomy vertebral height and 57.1% of the initial osteotomy gap height with good correlation. Moreover, the safe limit of shortening distance of the bivertebral column resection was longer than that in single vertebral column resection. Increasing the number of vertebrae resected may prevent spinal cord injury because of excessive shortening.

In recent years, photocatalytic reactions on anodic TiO2 nanotubes have been intensively investigated. In order to show photocatalytic activity, anodically formed nanotubes need to be crystallized to anatase. This is conventionally done by thermal annealing in air at temperatures 400–600 °C. Recently, a so‐called “water annealing” treatment has been reported to be effective to also create a highly active form for photocatalysis. Here we report on the feasibility of using a water annealing treatment of TiO2 nanotubes to create a photocatalyst for H2 production that is as active as conventional thermal annealing. If the water‐annealed samples are additionally hydrogenated to a so‐called “grey” modification, a further significant improvement of the photocatalytic activity for H2 evolution can be achieved – this without the use of any noble metal co‐catalyst. A combination of water annealing, thermal annealing, followed by hydrogenation can deliver a H2 generation activity that is more than five times higher than that achieved by thermal annealing of anodic TiO2 nanotubes.

Background: Intraspinal upper cervical C1-C2 tumors pose a challenge in resection. Internal fixation has routinely been used to prevent the occurrence of instability after atlantoaxial laminectomy for resection of C1-C2 intraspinal tumors, that sacrifices the motion of upper cervical spine. We therefore present this report to evaluate the efficacy and safety of one-stage posterior resection of these tumors through the atlantoaxial lamina space without internal fixation. Methods: Ten suitably selected patient with C1-C2 intraspinal tumors were included in this study (period January 2016 to January 2018). All the patients underwent one-stage posterior resection through atlantoaxial lamina space without internal fixation. The efficacy of the procedure was documented by comparing postoperative and preoperative outcome scores [The visual analogue scores (VAS), Japanese Orthopedic Association scores (JOA), neck disability index (NDI)], cervical physiological curvature and range of flexion-extension. Safety was assessed by documenting the complications associated with surgery and subsequent sequale. Results: 6 Male and 4 female patients with mean age 36 years (range 17 years to 50 years) underwent total tumor resection through posterior only approach using the atlantoaxial lamina space for the following tumors: 4 neurofibromas, 3 schwannomas and 3 meningiomas. The mean follow-up was 31.2 months (range 24–36 months). These patients’ pathological types included. Postoperative VAS and NDI were lower than those of pre-operation with statistical significance (p < 0.05) while postoperative JOA was higher than that of pre-operation (p < 0.05). The physiological curvature and activity of cervical spine were maintained at latest follow up. Three patients suffered cerebrospinal fluid leakages that was managed consertaviley with no added intervention required. No patient had local recurrence at latest follow-up. Conclusion: One-stage posterior resection through atlantoaxial lamina space without fixation is an effective and safe treatment for the upper cervical intraspinal tumor. In our experience this technique can remove tumor completely and does not cause instability to C1-C2 joint.

Background: Corona Virus Disease 2019 (COVID-19) is highly infectious and spreads rapidly across the world. Some patients occurred liver damage for unexplained reasons. Our study aims to explore whether Traditional Chinese Medicine (TCM) causes severe abnormal liver function compared to that of Western Medicine during the treatment process of COVID-19.Methods: We selected eligible studies with strict inclusion and exclusion criteria after systematically searching 7 databases up to May 30, 2020. Then, the study quality was assessed by the Cochrane risk of bias tool. Finally, we conducted a meta and subgroup analysis in the random-effects model to calculate risk ratio (RR) and 95% confidence intervals (95% CI) to evaluate the risk changes after adding TCM and the influence factor to RR. Results: A total of 2648 articles were searched, and 3 randomized controlled studies were included. Our results indicated that the occurrence of abnormal liver function had no statistical difference in the group added with TCM from Western Medicine groups. (RR=0.55[0.16,1,85], I2=58%, P=0.09>0.05). We also found that the high heterogeneity existed in two subgroups of common cases and all typecases, and it was statistically significant (I2=76.3%, P=0.04

Background: The optimal surgical timing for acute traumatic central cord syndrome (ATCCS) without fracture or instability has not been established. The purpose of this study is to explore the outcome of delayed surgery in treatment of ATCCS and to investigate potential factors associated with postoperative neurological improvement. Methods: Patients who underwent delayed surgery for ATCCS with at least 2 year follow up time were retrospectively reviewed. Parameters including age, gender, traumatic mechanism, interval to operation, surgical procedures, and complications were collected. Magnetic resonance imaging was performed to determine levels of spinal cord signal change and concomitant pathology. American Spinal Injury Association (ASIA) classification and Japanese Orthopedic Association (JOA) scores were evaluated and compared at admission and the 2 year follow-up visit for neurologic function assessment. Correlations of neurological improvement and age, traumatic mechanism, interval to operation, surgical procedures, concomitant pathology, and preoperative neurological function were investigated by Spearman ’ s correlation test. Results: A total of 39 patients (M:F=28:11, mean age 52.2±10.4 yrs) were enrolled into this study. 21 cases were caused by falls followed by 16 by motor-vehicle accidents and 2 by sports. 19 patients presented with preexisting cervical disc herniation (CDH)，12 with spinal canal stenosis (SCS), 5 with OPLL, and 3 with a combined pathology of CDH and CS. 14 samples received ACDF procedure, 8 obtained ACCF, and 17 underwent posterior unilateral open-door laminoplasty. The mean interval from trauma to surgery was 20.8±3.7 days. All cases except three (ASIA B) showed improvement of ASIA grades with a mean improvement of 1.1±0.5 grades at 2-year follow-up. JOA scores significantly improved from 6.3±3.1 points at admission to 11.4±3.9 points at 2-year follow up. No difference of neurological improvement was found between different procedures groups. No correlation was showed between neurological improvement and age, concomitant pathology, traumatic mechanism, interval to operation, surgical procedures, or preoperative neurological function. Conclusions: Delayed surgery was a feasible and effective therapy for ATCCS without fracture or instability although long-term outcome and more details still need to be investigated.

To summarize the progress in treatment of unstable atlas fracture, the existing problems, and the research direction.Related literature at home and abroad was reviewed. The stability evaluation of atlas fracture and treatment methods were introduced, and the selection of surgical approach and fixation instruments in treatment of unstable atlas fracture were summarized and analyzed.At present, atlas fractures are considered as unstable fractures except single anterior arch fractures with complete transverse ligament or simple posterior arch fractures. The treatment of unstable atlas fracture has been developed from nonsurgical treatment and traditional fusion surgery to single-segment fixation. Nonsurgical treatment is less effective, while traditional fusion surgery has a disadvantage of limited the motion of the upper cervical spine. Single-segment fixation can not only restore and fix the fracture, but also preserve the upper cervical motion function. Single-segment fixation approaches include posterior and transoral approaches, and the fixation instruments are being constantly improved, mainly including screw-rod system, screw-plate system, and plate system.For unstable atlas fracture, single-segment fixation is an ideal surgical method, and has more advantages when compared with nonsurgical treatment and traditional fusion surgery. Single-segment fixation via transoral approach is more direct for atlas anterior arch fracture reduction, but there is a high risk of infection; and single-segment fixation via posterior approach is less effective for the reduction of atlas anterior arch fracture. Therefore, a better reduction method should be explored.总结不稳定性寰椎骨折的治疗进展，提出存在问题并展望研究方向。.通过查阅国内外不稳定性寰椎骨折治疗的相关文献，就寰椎骨折稳定性评价及治疗方法、手术入路以及内固定器械选择等方面进行总结分析。.目前，临床上认为除横韧带完整的寰椎前弓单处骨折或单纯后弓骨折外的所有寰椎骨折，均为不稳定性骨折。不稳定性寰椎骨折的治疗从传统非手术治疗、融合术，逐渐发展至单节段固定治疗。非手术治疗效果欠佳，融合术牺牲了上颈椎活动度，而单节段固定不仅能复位固定骨折，同时保留了上颈椎运动功能。单节段固定手术入路分为后路及经口入路，术中采用的内固定器械也在不断改良，主要包括钉棒系统、钉板系统以及钢板系统等。.对于不稳定性寰椎骨折，单节段固定较非手术及传统融合术更具优势，是理想的手术方式。其中，经口入路单节段固定复位寰椎前弓骨折更直接，但存在感染风险；后路单节段固定对寰椎前弓骨折的复位效果欠佳，有待进一步探究更加有效的复位方法。.

This study, taking into consideration of teachers’ as well as students’ judgments, explored the generalizability and consistency of the results of linking speaking test of IELTS to China’s Standards of English Language Ability (CSE). Nine college English teachers and 81 undergraduate students judged the degree of congruence between the IELTS speaking test and 72 relevant CSE descriptors to generate evidence of generalizability; 2 teachers judged the CSE levels of 11 videos of IELTS speaking test and 113 students assessed themselves based on the self-assessment scale, to provide data for exploring consistency from three perspectives: consistency of teachers’ judgments, consistency between teachers’ judgments and empirical scores, and consistency between students’ actual ability and the ability demonstrated in the self-assessment scale. The evidence showed that the linking results performed well both in generalizability and consistency from the perspective of both teachers and students, but students rated comparatively low than teachers both in the two facets. However, considering that certain descriptors are relatively abstract and separate from daily life situations in IELTS speaking test, it is understandable that students rate low in generalizability; and considering students' insufficient self-assessment ability, their relative low recognition in consistency also get explained. In general, therefore, the linking results show good generalizability and consistency.&nbsp

Paracetamol is a safe and widely used antipyretic and analgesic drug, however, with the drawbacks of gastrointestinal first-pass effect and short intervals of administration. Transdermal drug delivery system can effectively avoid the liver metabolism caused by excess oral ingestion of paracetamol. Herein, a silk fabric-based medical dressing decorated by a thermo-responsive hydrogel for sustained release of paracetamol is proposed. Genipin as a bio-safe cross-linker is applied to assist gelation of a thermo-responsive hydrogel system coupled with chitosan and glycerol-phosphate disodium salt around body temperature (37 °C), as well as densifying the microporous gel to improve mechanical strength. The in situ sol-gel transition enabled hydrogel well penetrate and coat the silk fabric, forming a hierarchical hydrogel structure capable of prolonging the sustained release of drug to 12 h, twice as long as a blank fabric. The silk fabric with a thin gel coating maintains a good water vapor transmission rate, compatible for skin contact application. The drug release properties can be tuned by regulating the genipin content and fabric braiding structure. The silk fabric dressing exhibits temperature-dependent instant release behavior within the first 2 h. The sustained release mechanism of paracetamol well matches with the Korsmeyer-Peppas model in a non-Fickian diffusion.