Laser Spine Institute

This paper examines the effect of incremental forming parameters on the process of a 304L stainless-steel biomedical part, which is inserted between the prosthesis and the cup to minimize wear and extend the lifespan of the prosthesis. The methodology involves several steps. First, the tool trajectory is determined. Then, modeling and numerical simulation are performed to select the optimal configuration, evaluate the final product geometry and forming tool force in relation to the forming angle, define the forming tool dimensions, and determine the axial step. Finally, the evaluation of the spring-back is conducted, along with an analysis of the parameters that influence the thinning of the component. The results highlight the relationship between punch diameter and axial displacement on the geometric quality of the deformed component. Furthermore, the force exerted varies as a function of axial steps, forming tool geometry, and the dimensions of the deformed component. Additionally, the number of contact points and the forming angle have an impact on the thinning.

Stiff Person Syndrome (SPS) is a rare autoimmune condition marked by extremely painful muscle spasms, stiffness, and rigidity throughout the body. Its rarity often translates to limited treatment options for patients and, occasionally, challenges in obtaining a definitive diagnosis. SPS also impacts patients' mental health, social and economic involvement, and overall quality of life. A 43-year-old man was initially being seenfor lumbar radicular pain. A clinical diagnosis of SPS was made by a neurologist and confirmed by in-clinic follow-ups and anti-glutamic acid decarboxylase (anti-GAD) antibody testing. The Pain Management doctor agreed with this diagnosis and offered intravenous (IV) ketamine treatment, which he hasfound to positively impact the treatment of similar disorders. After an initial 10-day infusion, the patient reported improvement in pain and function. For almost two years, the patient received intravenous immunoglobulin (IVIg) and IV ketamine treatments to manage their condition and maintain pain control as well as quality of life. When the patient's symptoms began worsening after IVIg infusions, the decision to withdraw IVIg infusions and continue ketamine infusions was made. After discontinuing IVIg infusions, the patient reported improvement in function and pain level and continues to receive monthly two-day ketamine boosters. Outside of the infusions, the patient was able to discontinue the use of fentanyl patches and continued taking ketamine lozenges, oxycodone-acetaminophen, and dextromethorphan for at-home pain management. The patient's symptoms continue to be managed effectively with their current regimen, enabling their return to work and experiencing an enhanced quality of life. This case illustrates the potential benefits of IV ketamine treatment for patients with treatment-resistant SPS and similar neurologic and autoimmune disorders. Understanding and examining treatment alternatives for rare syndromes is crucial for achieving optimal patient outcomes. Additionally, documenting such cases offers valuable insights into the mechanism of ketamine, extending beyond these syndromes.

Mesoscopic methods serve as a pivotal link between the macroscopic and microscopic scales, offering a potent solution to the challenge of balancing physical accuracy with computational efficiency. Over the past decade, significant progress has been made in the application of the discrete Boltzmann method (DBM), which is a mesoscopic method based on a fundamental equation of nonequilibrium statistical physics (i.e., the Boltzmann equation), in the field of nonequilibrium fluid systems. The DBM has gradually become an important tool for describing and predicting the behavior of complex fluid systems. The governing equations comprise a set of straightforward and unified discrete Boltzmann equations, and the choice of their discrete format significantly influences the computational accuracy and stability of numerical simulations. In a bid to bolster the reliability of these simulations, this paper utilizes the finite volume method as a solution for handling the discrete Boltzmann equations. The finite volume method stands out as a widely employed numerical computation technique, known for its robust conservation properties and high level of accuracy. It excels notably in tackling numerical computations associated with high-speed compressible fluids. For the finite volume method, the value of each control volume corresponds to a specific physical quantity, which makes the physical connotation clear and the derivation process intuitive. Moreover, through the adoption of suitable numerical formats, the finite volume method can effectively minimize numerical oscillations and exhibit strong numerical stability, thus ensuring the reliability of computational results. Particularly, the MUSCL format where a flux limiter is introduced to improve the numerical robustness is adopted for the reconstruction in this paper. Ultimately, the DBM utilizing the finite volume method is rigorously validated to assess its proficiency in addressing flow issues characterized by pronounced discontinuities. The numerical experiments encompass scenarios involving shock waves, Lax shock tubes, and acoustic waves. The results demonstrate the method's precise depiction of shock wave evolution, rarefaction waves, acoustic phenomena, and material interfaces. Furthermore, it ensures the conservation of mass, momentum, and energy within the system, as well as accurately measures the hydrodynamic and thermodynamic nonequilibrium effects of the fluid system. Compared with the finite difference method, the finite volume method is also more convenient and flexible in dealing with boundary conditions of different geometries, and can be adapted to a variety of systems with complex boundary conditions. Consequently, the finite volume method further broadens the scope of DBM in practical applications.

This paper provides an analysis of the use of Intelligent Transport Systems (ITS) in Slovakia. The aim of the analysis is to evaluate the current implementation of ITS and provide an overview of their use in transport operations. Based on available data and information, typical examples of ITS in Slovakia are identified. It also includes results from a questionnaire survey in the context of the use of Smart City solutions in Slovakia.

A 15-year-old competitive right-handed high school baseball pitcher experienced an acute onset of right elbow pain when throwing. He initially treated it conservatively with rest alone for 3 months, but on return to throwing, he was still experiencing pain. Radiographs revealed that he had a persistent olecranon physis. He proceeded with a trial of low-intensity pulsed ultrasound therapy and attained radiographic evidence of bony union at 7 months postinjury, thus avoiding surgical intervention. He returned to pitching competitively 9 months after injury without elbow pain. This is the first reported case of using ultrasound bone stimulation for treatment of a symptomatic persistent olecranon physis in a baseball pitcher.

Post-treatment Lyme disease syndrome (PTLDS) is a pain disorder for which there remains no gold standard treatment option. Here, we report a case of PTLDS in a female patient whose pain was refractory to treatment options such as radiofrequency ablation, vitamin infusion therapy, opioid analgesics, and other pharmacotherapies. The patient commenced an experimental intravenous ketamine infusion therapy at the Florida Spine Institute (Clearwater, FL, USA) and achieved relief from her chronic pain, an improved quality of life, reduced depression and suicidal ideation, and reduced opioid consumption.

If nonoperative treatment for lumbar stenosis fails, surgery may be considered. This traditionally includes decompression often combined with fusion. Desire for less extensive surgery led to developing new techniques and implants, including an interlaminar device designed with the goal of providing segmental stability without fusion, following decompression. The purpose of this study was to investigate 5-year outcomes associated with an interlaminar device. This prospective, randomized, controlled trial was conducted at 21 centers. Patients with moderate to severe lumbar stenosis at one or two contiguous levels and up to Grade I spondylolisthesis were randomized (2:1 ratio) to decompression and interlaminar stabilization (D+ILS; n=215) using the coflex(®) Interlaminar Stabilization(®) device (Paradigm Spine, LLC) or decompression and fusion with pedicle screws (D+PS; n=107). Clinical evaluations were made preoperatively and at 6 weeks and 3, 6, 12, 18, 24, 36, 48, and 60 months postoperatively. Overall Food and Drug Administration success criteria required that a patient meet 4 criteria: 1) >15 point improvement in Oswestry Disability Index (ODI) score; 2) no reoperation, revision, removal, or supplemental fixation; 3) no major device-related complication; and 4) no epidural steroid injection after surgery. At 5 years, 50.3% of D+ILS vs. 44% of D+PS patients (p>0.35) met the composite success criteria. Reoperation/revision rates were similar in the two groups (16.3% vs. 17.8%; p >0.90). Both groups had statistically significant improvement through 60 months in ODI scores with 80.6% of D+ILS patients and 73.2% of D+PS patients demonstrating >15 point improvement (p>0.30). VAS, SF-12, and ZCQ scores followed a similar pattern of maintained significant improvement throughout follow-up. On the SF-12 and ZCQ, D+ILS group scores were statistically significantly better during early follow-up compared to D+PS. In the D+ILS group, foraminal height, disc space height, and range of motion at the index level were maintained through 5 years. Both treatment groups achieved and maintained statistically significant improvements on multiple outcome assessments throughout 5-year follow-up. On some clinical measures, there were statistically significant differences during early follow-up favoring D+ILS. At no point were there significant differences favoring D+PS. Results of this 5-year follow-up study demonstrate that decompression and interlaminar stabilization with coflex is a viable alternative to traditional decompression and fusion in the treatment of patients with moderate to severe stenosis at one or two lumbar levels. This is a Level I study. Institutional approval was received at each of the sites participating in the trial. Each patient gave informed consent to participate in the trial.

Pain is the most common reason for physician consultation in the United States. One out of three Americans is affected by chronic pain annually. The number one reason for missed work or school days is musculoskeletal pain. Currently accepted therapies consist of non-steroidal anti-inflammatory drugs, steroid injections, opiate pain medications and surgery, each of which carries their own specific risk profiles. What is needed are effective treatments for pain which have an acceptably low risk-profile. For over forty years, low level laser (light) therapy (LLLT) and LED (light emitting diode) therapy (also known as photobiomodulation) has been shown to reduce inflammation and edema, induce analgesia, and promote healing in a range of musculoskeletal pathologies. The purpose of this paper is to review the use of LLLT for pain, the biochemical mechanisms of action, the dose response curves, and how LLLT may be employed by orthopedic surgeons to improve outcomes and reduce adverse events. With the predicted epidemic of chronic pain in developed countries, it is imperative to validate cost-effective and safe techniques for managing painful conditions which would allow people to live active and productive lives. Moreover the acceptance of LLLT (which is currently being used by many specialties around the world) into the armamentarium of the American health care provider would allow for additional treatment options for patients. A new cost-effective therapy for pain could elevate quality of life while reducing financial strains.