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Reliable and sensitive virus detection is essential to prevent airborne virus transmission. The polymerase chain reaction (PCR) is one of the most compelling and effective diagnostic techniques for detecting airborne pathogens. However, most PCR diagnostics rely on thermocycling, which involves a time-consuming Peltier block heating methodology. Plasmonic PCR is based on light-driven photothermal heating of plasmonic nanostructures to address the key drawbacks of traditional PCR. This study introduces a methodology for plasmonic PCR detection of air-sampled influenza virus (H1N1). An electrostatic air sampler was used to collect the aerosolized virus in a carrier liquid for 10 min. Simultaneously, the viruses collected in the liquid were transferred to a tube containing gold (Au) nanorods (aspect ratio = 3.6). H1N1 viruses were detected in 12 min, which is the total time required for reverse transcription, fast thermocycling via plasmonic heating through gold nanorods, and in situ fluorescence detection. This methodology showed a limit of detection of three RNA copies/µL liquid for H1N1 influenza virus, which is comparable to that of commercially available PCR devices. This methodology can be used for the rapid and precise identification of pathogens on-site, while significantly reducing the time required for monitoring airborne viruses.

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The severe acute respiratory syndrome (SARS-CoV-2) outbreak triggered global concern and emphasized the importance of virus monitoring. During a seasonal influenza A outbreak, relatively low concentrations of 103-104 viral genome copies are available per 1 m3 of air, which makes detection and monitoring very challenging because the limit of detection of most polymerase chain reaction (PCR) devices is approximately 103 viral genome copies/mL. In response to the urgent need for the rapid detection of airborne coronaviruses and influenza viruses, an electrostatic aerosol-to-hydrosol (ATH) sampler was combined with a concanavalin A (ConA)-coated high-throughput microfluidic chip. The samples were then used for PCR detection. The results revealed that the enrichment capacity of the ATH sampler was 30,000-fold for both HCoV-229E and H1N1 influenza virus, whereas the enrichment capacities provided by the ConA-coated microfluidic chip were 8-fold and 16-fold for HCoV-229E and H1N1 virus, respectively. Thus, the total enrichment capacities of our combined ATH sampler and ConA-coated microfluidic chip were 2.4 × 105-fold and 4.8 × 105-fold for HCoV-229E and H1N1 virus, respectively. This methodology significantly improves PCR detection by providing a higher concentration of viable samples.

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The interest in removing contagious viruses from indoor air using ventilation and filtration systems is increasing rapidly because people spend most of the day indoors. The development of an effective platform to regenerate the antiviral function of air filters during use and safe abrogation of used filters containing infectious viruses is a challenging task, because an on-demand safe-by-design manufacture system is essential for in-place antiviral coatings, but it has been rarely investigated. With these considerations, an electrically operable dispenser was prepared for decorating continuous ultrafine Fe-Zn, Fe-Ag, or Fe-Cu particles (<5 nm) onto SiO2 nanobeads (ca. 130 nm) to form nanobulges (i.e., nanoroughness for engaging coronavirus spikes) in the aerosol state for 3 min direct deposition on the air filter surfaces. The resulting nanobulges were exposed to human coronaviruses (HCoV; surrogates of SARS-CoV-2) to assess antiviral function. The results were compared with similar-sized individual Zn, Ag, and Cu particles. The nanobulges exhibited comparable antiviral activity to Zn, Ag, and Cu particles while retaining biosafety in both in vitro and in vivo models because of the significantly smaller metallic fractions. This suggests that the bimetallic bulge structures generate reactive oxygen species and Fenton-mediated hydroxyl radicals for inactivating HCoV.

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Cervical myelopathy is a clinical syndrome resulting in symptoms of neurologic deficits due to prolonged spinal cord compression or ischemia in the cervical spine. Spinal cord compression can be caused by ossification of the posterior longitudinal ligament and hypertrophy of ligamentun flavum in addition to degenerative cervical spondylosis, degenerative disc disease, and progressive cervical kyphosis. Degenerative cervical myelopathy (DCM) is a series of disease entities caused by spinal cord compression by various nontraumatic and non-infectious causes. The pathophysiology of DCM includes spinal cord structure and function abnormalities caused by both static and dynamic factors. Surgical decompression for patients with moderate to severe cervical myelopathy not only inhibits the progression of neurological deterioration, but also improves functional status, pain, and quality of life. However, the role of nonsurgical treatment in patients with mild spinal cord compression is controversial. In general, patients with cervical myelopathies who do not undergo surgery have a poor prognosis. Appropriate surgical treatment is recommended when spinal cord compression is confirmed on image study in patients with reasonable symptoms of cervical myelopathy. The patient’s overall health, degree of compression, presence of concurrent cervical radiculopathy, and cervical spine alignment, in addition to lesion location and etiology, should be considered when determining an appropriate surgical procedure. This review covers the updated issues, including pathophysiology, clinical manifestations, differential diagnosis, and available treatments for DCM.

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The assemblies of anisotropic nanomaterials have attracted considerable interest in advanced tumor therapeutics because of the extended surfaces for loading of active molecules and the extraordinary responses to external stimuli for combinatorial therapies. These nanomaterials were usually constructed through templated or seed-mediated hydrothermal reactions, but the lack of uniformity in size and morphology, as well as the process complexities from multiple separation and purification steps, impede their practical use in cancer nanotherapy. Gas-phase epitaxy, also called aerotaxy (AT), has been introduced as an innovative method for the continuous assembly of anisotropic nanomaterials with a uniform distribution. This process does not require expensive crystal substrates and high vacuum conditions. Nevertheless, AT has been used limitedly to build high-aspect-ratio semiconductor nanomaterials. With these considerations, a modified AT was designed for the continuous in-flight assembly of the cell-penetrating Fenton nanoagents (Mn-Fe CaCO3 (AT) and Mn-Fe SiO2 (AT)) in a single-pass gas flow because cellular internalization activity is essential for cancer nanotherapeutics. The modified AT of Mn-Fe CaCO3 and Mn-Fe SiO2 to generate surface nanoroughness significantly enhanced the cellular internalization capability because of the preferential contact mode with the cancer cell membrane for Fenton reaction-induced apoptosis. In addition, it was even workable for doxorubicin (DOX)-resistant cancer cells after DOX loading on the nanoagents. After combining with immune-checkpoint blockers (antiprogrammed death-ligand 1 antibodies), the antitumor effect was improved further with no systemic toxicity as chemo-immuno-chemodynamic combination therapeutics despite the absence of targeting ligands and external stimuli.

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Objective@#The objective of this study was to compare and evaluate the diagnostic value of serum carbohydrate antigen 125 (CA125) and/or human epididymis protein 4 (HE4) and a panel of novel multiple biomarkers in patients with ovarian tumors to identify more accurate and effective markers for screening ovarian cancer. @*Methods@#Candidate ovarian cancer biomarkers were selected based on a literature search. Dozens of candidate biomarkers were examined using 143 serum samples from patients with ovarian cancer and 157 healthy serum samples as noncancer controls. To select the optimal marker panel for an ovarian cancer classification model, a set of biomarker panels was created with the number of possible combinations of eight biomarkers. Using the set of biomarkers as an input variable, the optimal biomarker panel was selected by examining the performance of the biomarker panel set using the Random Forest algorithm as a non-linear classification method and a 10-fold cross-validation technique. @*Results@#The final selected optimal combination of five biomarkers (CA125, HE4, cancer antigen 15-3, apolipoprotein [Apo] A1, and ApoA2) exhibited a sensitivity of 93.71% and specificity of 93.63% for ovarian cancer detection during validation. @*Conclusion@#Combining multiple biomarkers is a valid strategy for ovarian cancer diagnosis and can be used as a minimally invasive screening method for early ovarian cancer. A panel of five optimal biomarkers, including CA125 and HE4, was verified in this study. These can potentially be used as clinical biomarkers for early detection of ovarian cancer.

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This study was conducted to confirm the performance of the microRNA (miRNA) biomarker combination as a new breast cancer screening method in Korean women under the age of 50 with a high percentage of dense breasts. To determine the classification performance of a set of miRNA biomarkers (miR-1246, 202, 21, and 219B) useful for breast cancer screening, we determined whether there was a significant difference between the breast cancer and healthy control groups through box plots and the Mann– Whitney U-test, which was further examined in detail by age group. To verify the classification performance of the 4 miRNA biomarker set, 4 classification methods (logistic regression, random forest, XGBoost, and generalized linear model plus random forest) were applied, and 10-fold cross-validation was used as a validation method to improve performance stability. We confirmed that the best breast cancer detection performance was achievable in patients under 50 years of age when the set of 4 miRNAs were used. Under the age of 50, the 4 miRNA biomarkers showed the highest performance with a sensitivity of 85.29%, specificity of 93.33%, and area under the curve (AUC) of 0.961. Examining the results of 4 miRNA biomarkers was found to be an effective strategy for diagnosing breast cancer in Korean women under 50 years of age with dense breasts, and hence has the potential as a new breast cancer screening tool. Further validation in an appropriate screening population with large-scale clinical trials is required.

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Microbial extracellular polymeric substances (EPS) have gained increasing attention for various water treatment applications. In this study, EPS produced from nitrogen-limited glycerol/ethanol-rich wastewater were used to recover Cu2+ and Pb2+ from aqueous solutions. Continuous flow-through tests were conducted on a column packed with silica gel coated with polyethyleneimine, to which EPS were irreversibly attached as shown by optical reflectometry. These immobilised EPS excellently adsorbed Cu2+ and Pb2+, with 99.9% of influent metal adsorbed before the breakthrough points. Metal desorption was achieved with 0.1M HCl, with an average recovery of 86% for Cu2+ and 90% recovery for Pb2+. For the first time, we successfully showed the possibility to regenerate and reuse the immobilised EPS for five adsorption-desorption cycles (using Cu2+ as an example) with no reduction in the adsorbed amount at the breakthrough point (qbp). Based on the mass balance of the associated metal ions participating in the adsorption process, ion exchange was identified as the major mechanism responsible for Cu2+ and Pb2+ adsorption by EPS. The results demonstrate the potential of wastewater-produced EPS as an attractive and perhaps, cost-effective biosorbent for heavy metal removal (to trace effluent concentrations) and recovery (86-99%).

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Objectives@#To compare and analyze the rate and risk factors of implant failure according to the use of solid pedicle screws or cement augmented cannulated pedicle screws in lumbar fusion surgery.Summary of Literature Review: In previous studies, the use of cement augmented cannulated pedicle screws was found to improve the pull-out strength and to reduce the risk of implant failure in patients with osteoporosis. However, the clinical risk factors for implant failure have not been established. @*Materials and Methods@#From January 2016 to December 2018, 177 patients with spine fracture and degenerative thoracolumbar disease were included in a retrospective study, and the patients underwent spinal fusion surgery using pedicle screws. Solid pedicle screws were used in 118 patients and cement augmented cannulated pedicle screws were used in 59 patients. During the follow-up period, simple radiography and computed tomography were performed to evaluate cases of implant failure, including pedicle screw loosening, migration, and pull-out, and to analyze risk factors for implant failure. @*Results@#Implant failures were observed in 21 patients (11.9%, 21/177) during the follow-up period. Of the 21 patients with implant failure, 18 were in the solid pedicle screw group (15.3%, 18/118), and 3 patients were in the cement augmented cannulated pedicle screw group (5.1%, 3/59). The difference was statistically significant (p<0.05). Age over 65 years, osteoporosis, autoimmune disease (rheumatoid arthritis, systemic lupus erythematosus, etc.), chronic kidney disease, and steroid use (<0.05) were statistically significantly more common in patients who experienced implant failure. In a multiple logistic regression analysis, age over 65 (odds ratio, 4.47;p=0.032), osteoporosis (odds ratio, 3.68; p=0.017), autoimmune disease (odds ratio, 3.59; p=0.039), and chronic kidney disease (odds ratio, 4.67; p=0.043) were statistically significant risk factors for implant failure. @*Conclusions@#Patients underwent thoracolumbar fusion who were over 65 years of age, had osteoporosis, chronic kidney disease, or autoimmune disease showed a high implant failure rate. The use of cement augmented cannulated pedicle screws might be an effective method to significantly decrease the likelihood of implant failure in patients with these risk factors.

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Objectives@#To compare and analyze the rate and risk factors of implant failure according to the use of solid pedicle screws or cement augmented cannulated pedicle screws in lumbar fusion surgery.Summary of Literature Review: In previous studies, the use of cement augmented cannulated pedicle screws was found to improve the pull-out strength and to reduce the risk of implant failure in patients with osteoporosis. However, the clinical risk factors for implant failure have not been established. @*Materials and Methods@#From January 2016 to December 2018, 177 patients with spine fracture and degenerative thoracolumbar disease were included in a retrospective study, and the patients underwent spinal fusion surgery using pedicle screws. Solid pedicle screws were used in 118 patients and cement augmented cannulated pedicle screws were used in 59 patients. During the follow-up period, simple radiography and computed tomography were performed to evaluate cases of implant failure, including pedicle screw loosening, migration, and pull-out, and to analyze risk factors for implant failure. @*Results@#Implant failures were observed in 21 patients (11.9%, 21/177) during the follow-up period. Of the 21 patients with implant failure, 18 were in the solid pedicle screw group (15.3%, 18/118), and 3 patients were in the cement augmented cannulated pedicle screw group (5.1%, 3/59). The difference was statistically significant (p<0.05). Age over 65 years, osteoporosis, autoimmune disease (rheumatoid arthritis, systemic lupus erythematosus, etc.), chronic kidney disease, and steroid use (<0.05) were statistically significantly more common in patients who experienced implant failure. In a multiple logistic regression analysis, age over 65 (odds ratio, 4.47;p=0.032), osteoporosis (odds ratio, 3.68; p=0.017), autoimmune disease (odds ratio, 3.59; p=0.039), and chronic kidney disease (odds ratio, 4.67; p=0.043) were statistically significant risk factors for implant failure. @*Conclusions@#Patients underwent thoracolumbar fusion who were over 65 years of age, had osteoporosis, chronic kidney disease, or autoimmune disease showed a high implant failure rate. The use of cement augmented cannulated pedicle screws might be an effective method to significantly decrease the likelihood of implant failure in patients with these risk factors.

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Methods@#A nationwide database (2012–2016) acquired from the Korean Health Insurance Review and Assessment Service was analyzed. International disease categories in the 10th revision of the International Statistical Classification of Diseases and Related Health Problems codes, medical procedure codes, and examination codes were used to identify and sort OVCF patients aged >50 years. @*Results@#There were 644,500 OVCF cases from 2012 to 2016. OVCF was most common in patients in their seventies (45%) and the number of patients increased from 117,361 in 2012 to 139,889 in 2016 (p <0.001). During 2012–2016, 8.9% of patients visited the emergency department; of those, 54.3% were hospitalized and 35% underwent magnetic resonance imaging. In OVCF treatment, bone cement augmentation rates increased from 23.4% in 2012 to 25.2% in 2016 (p <0.001), while conservative treatment rates slightly decreased from 76.5% in 2012 to 74.7% in 2016 (p <0.001). The total health insurance cost was $193,210,353.55 in 2012 and $281,968,877.65 in 2016. @*Conclusions@#The 5-year incidence of OVCF per 100,000 persons was 852.24 cases, and 45% of OVCF in South Korea occurred in patients in their seventies. The bone cement augmentation rate and total cost of OVCF are continuously increasing.

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Chronic compression or ischemia of the spinal cord in the cervical spine causes a clinical syndrome known as cervical myelopathy. Recently, a new term “degenerative cervical myelopathy (DCM)” was introduced. DCM encompasses spondylosis, intervertebral disk herniation, facet arthrosis, ligamentous hypertrophy, calcification, and ossification. The pathophysiology of DCM includes structural and functional abnormalities of the spinal cord caused by static and dynamic factors. In nonoperative patients, cervical myelopathy has a poor prognosis. Surgical treatments, such as anterior or posterior decompression accompanying arthrodesis, arthroplasty, or laminoplasty, should be considered for patients with chronic progressive cervical myelopathy. Surgical decompression can prevent the progression of myelopathy and improve the neurologic status, functional outcomes, and quality of life, irrespective of differences in medical systems and sociocultural determinants of health. The anterior surgical approach to the cervical spine has the advantage of removing or floating the intervertebral disk, osteophytes, and ossification of the posterior longitudinal ligament that compress the spinal cord directly. The posterior surgical approach to the cervical spine is mainly used for multisegment spinal cord compression in patients with cervical lordosis. In this review article, we addressed the pathophysiology, clinical manifestations, differential diagnosis, and treatment options for DCM.

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Because of enhanced efficacy and lower side effects, cancer immunotherapies have recently been extensively investigated in clinical trials to overcome the limitations of conventional cancer monotherapies. Although engineering attempts have been made to build nanosystems even including stimulus nanomaterials for the efficient delivery of antigens, adjuvants, or anticancer drugs to improve immunogenic cancer cell death, this requires huge R&D efforts and investment for clinically relevant findings to be approved for translation of the nanosystems. To this end, in this study, an air-liquid two-phase electrospray was developed for stable bubble pressing under a balance between mechanical and electrical parameters of the spray to continuously produce biomimetic nanosystems consisting of only clinically relevant compounds [paclitaxel-loaded fake blood cell Eudragit particle (Eu-FBCP/PTX)] to provide a conceptual leap for the timely development of translatable chemo-immunotherapeutic nanosystems. This was pursued as the efficacy of systems for delivering anticancer agents that has been mainly influenced by nanosystem shape because of its relevance to transporting behavior to organs, blood circulation, and cell-membrane interactions. The resulting Eu-FBCP/PTX nanosystems exhibiting phagocytic and micropinocytic uptake behaviors can confer better efficacy in chemo-immunotherapeutics in the absence and presence of anti-PD-L1 antibodies than similar sized PTX-loaded spherical Eu particles (Eu-s/PTX).

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Due to antimicrobial resistance and the adverse health effects that follow broad and inappropriate use of antibacterial agents, new classes of antibacterials with broad and strong bactericidal activity and safety for human use are urgently required globally, increasingly so with the onset of climate change. However, R&D in this field is known to be rarely profitable, unless a cost-effective, flexible, and convenient platform that ensures the production of workable candidate antibacterials can be developed. To address this issue, inorganic nanomaterials have been considered for their bactericidal activities, yet further investigations of composition crystalline modifications and/or surface biomaterial coatings are still required to provide effective and safe antibacterial nanoparticles. In this study, we developed a plug-in system comprising a spark plasma reactor and a flow heater under nitrogen gas flow to supply precursor inorganic nanoparticles (Cu-Te configuration) that can be modulated in-flight at different temperatures. From antibacterial and toxicological assays in both in vitro and in vivo models, bactericidal and toxicological profiles showed that the plug-in system-based platform can be used to identify key parameters for producing safe-by-design agents with antibacterial activity [>88% (in vitro) and >80% (in vivo) in antibacterial efficiency] and safety (>65% in in vitro viability and >60% in in vivo survival rate).

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PURPOSE: The objective of this study was to compare dosimetric characteristics of three-dimensional conformal radiotherapy (3D-CRT) and two types of intensity-modulated radiotherapy (IMRT) which are step-and-shoot intensity modulated radiotherapy (s-IMRT) and modulated arc therapy (mARC) for thoracic esophageal cancer and analyze whether IMRT could reduce organ-at-risk (OAR) dose. MATERIALS AND METHODS: We performed 3D-CRT, s-IMRT, and mARC planning for ten patients with thoracic esophageal cancer. The dose-volume histogram for each plan was extracted and the mean dose and clinically significant parameters were analyzed. RESULTS: Analysis of target coverage showed that the conformity index (CI) and conformation number (CN) in mARC were superior to the other two plans (CI, p = 0.050; CN, p = 0.042). For the comparison of OAR, lung V5 was lowest in s-IMRT, followed by 3D-CRT, and mARC (p = 0.033). s-IMRT and mARC had lower values than 3D-CRT for heart V30 (p = 0.039), V40 (p = 0.040), and V50 (p = 0.032). CONCLUSION: Effective conservation of the lung and heart in thoracic esophageal cancer could be expected when using s-IMRT. The mARC was lower in lung V10, V20, and V30 than in 3D-CRT, but could not be proven superior in lung V5. In conclusion, low-dose exposure to the lung and heart were expected to be lower in s-IMRT, reducing complications such as radiation pneumonitis or heart-related toxicities.

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A 22-year-old female patient visited the emergency room (ER) after a pedestrian traffic accident in a drunken state. An examination at the ER revealed fractures at the right side of the sacral ala, sacral foramina, left anterior acetabulum, right inferior ramus, and right superior articular process of S1. She underwent spino-pelvic fixation and iliosacral (IS) screw fixation. One year later, bone union was completed and implant removal was performed and the treatment was completed without complications. The authors recommend spino-pelvic fixation and IS screw fixation for unstable sacral fractures as one of the excellent methods for obtaining posterior stability of the pelvis among the various treatments of unstable sacral fractures.

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Delayed eruption disorders caused by systemic or local conditions are mostly found during childhood and can be treated with orthodontic forced eruption. When the disorder is not found nor treated during childhood, however, orthodontic eruption might become a difficult option while prosthodontic restoration can be considered as an another option. Considerations for the prosthodontic treatment plan include the extent of tooth loss, interdental mesio-distal space and interarch space, and age of the patient. In this case report, oral rehabilitation of the patient with delayed eruption disorder through zirconia partial fixed prostheses for both maxilla and mandible was performed.

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STUDY DESIGN: Case report OBJECTIVES: To report a case of Brown-Séquard syndrome after blunt cervical trauma. SUMMARY OF LITERATURE REVIEW: Brown-Séquard syndrome is a rare disease characterized by hemisection of the spinal cord, and it shows the best prognosis of the various types of incomplete spinal cord injuries. MATERIALS AND METHODS: A patient with Brown-Séquard syndrome that occurred after a traffic accident was followed up for 2 years and 6 months. RESULTS: We observed normal recovery of motor strength, but sensory impairment and deep tendon hyperreflexia remained. CONCLUSIONS: Brown-Séquard syndrome is known to have a good prognosis, but in this case, the neurological abnormality did not fully recover; therefore, we report this rare case and present a review of the literature.

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STUDY DESIGN: Retrospective study. PURPOSE: We examined the clinical and radiological outcomes of patients who received revision surgery for pseudarthrosis or adjacent segment disease (ASD) following decompression and instrumented posterolateral fusion (PLF). OVERVIEW OF LITERATURE: At present, information regarding the outcomes of revision surgery for complications such as pseudarthrosis and ASD following instrumented PLF is limited. METHODS: This study examined 60 patients who received PLF for degenerative lumbar spinal stenosis and subsequently developed pseudarthrosis or ASD leading to revision surgery. Subjects were divided into a group of 21 patients who received revision surgery for pseudarthrosis (Group P) and a group of 39 patients who received revision surgery for ASD (Group A). Clinical outcomes were evaluated using the visual analogue scales for back pain (VAS-BP) and leg pain (VAS-LP), the Korean Oswestry disability index (K-ODI), and each patient's subjective satisfaction. Radiological outcomes were evaluated from the extent of bone union, and complications in the two groups were compared. RESULTS: VAS-LP at final follow-up was not statistically different between the two groups (p =0.353), although VAS-BP and K-ODI at final follow-up were significantly worse in Group P than in Group A (all p <0.05), and only 52% of the patients in Group P felt that their overall well-being had improved following revision surgery. Fusion rates after the first revision surgery were 71% (15/21) in Group P and 95% (37/39) in Group A (p =0.018). The rate of reoperation was significantly higher in Group P (29%) than in Group A (5%) (p =0.021) due to complications. CONCLUSIONS: Clinical and radiological outcomes were worse in patients who had received revision surgery for pseudarthrosis than in those who had revision surgery for ASD. Elderly patients should be carefully advised of the risks and benefits before planning revision surgery for pseudarthrosis.

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STUDY DESIGN: Case report OBJECTIVES: To report a case of video-assisted thoracoscopic (VAT) minimally invasive anterior interbody fusion of the T11-T12 level using direct lateral interbody fusion (DLIF) devices. SUMMARY OF LITERATURE REVIEW: Interbody fusion of the thoracolumbar junction (especially T11-T12) is technically challenging from anterior, lateral, or posterior approaches. A VAT anterior interbody fusion approach using DLIF devices is a safe, minimally invasive alternative approach to the thoracolumbar spine. MATERIALS AND METHODS: A 37-year-old male pedestrian was struck by a car sustaining fracture-dislocation at the T11-T12 level. The accident resulted in complete paraplegia of both lower extremities and multiple lower extremity fractures. A classical instrumented posterolateral fusion from T8 to L3 and staged VAT anterior interbody fusion at the T11-T12 level were performed. RESULTS: At one year postoperatively, he was capable of independent ambulation using a wheelchair without back pain, and plain radiographs and CT scans showed a solid fusion at the T11-T12 level. CONCLUSIONS: VAT anterior interbody fusion using DLIF devices provides excellent access to the anterior spinal column with the added benefits of an improved field of view and can be a safe and effective alternative to open thoracotomy in the management of various thoracolumbar junction problems.

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