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This study aimed to describe a safe zone for mini-plate positioning that can avoid instrument-related complications in laminoplasty. Fifty-one patients who underwent laminoplasty and were followed up for at least 1 year were retrospectively reviewed. The posterior surface length and inferior pole angle of the lateral mass were measured at each level using computed tomography. The safe zone was defined based on these measurements. Incidences of screw facet violation and plate impingement were recorded. Patient-reported outcome measures were compared between the appropriate position (AP) and inappropriate position (IP) groups. Among 40 patients included, 15 (37.5%) had inappropriate plate positioning, causing screw facet violation or plate impingement, which more commonly occurred at distal (C5, C6) and proximal (C3, C4) levels, respectively. Lateral mass posterior surface length was shorter at the proximal levels, and the inferior pole angle of the lateral mass was smaller at the distal levels, signifying that the lateral mass became thin and long at the distal levels. Patient-reported outcome measures were not significantly different between the two groups. However, cervical range of motion at the final follow-up was significantly less in the IP group ( p  = 0.01). The suggested safe zone demonstrates that inserting the mini-plate with plate-to-lateral mass inferior pole distances of 4–5 mm and 5–6 mm at the C3–C5 and C6–C7 levels, respectively, would avoid instrument-related complications. The risk of plate impingement was higher at the proximal level, whereas the risk of screw facet violation was higher at the distal level in open-door cervical laminoplasty. These risks coincide with anatomical differences at each level. Despite inappropriate positioning of the mini-plate, clinical outcomes were not adversely affected.

Serial femtosecond crystallography (SFX) using X-ray free electron lasers (XFELs) enables the determination of room-temperature structures of biological macromolecules without radiation damage. The accuracy of detector geometry parameters, including the crystal-to-detector distance (CTDD), is critical for reliable data processing. In SFX experiments, the CTDD may shift during data collection due to changes in the experimental setup or installation of the sample delivery system. Such CTDD variations can affect the quality of SFX datasets; however, their impact has not been fully elucidated in the context of SFX data processing. In this study, we investigated the influence of CTDD variations on SFX datasets collected at Pohang Accelerator Laboratory X-ray Free Electron Laser (PAL-XFEL) with thermolysin, lysozyme, and glucose isomerase crystals processed by four indexing algorithms. At the optimized CTDD, the distribution of unit cell parameters exhibited a Gaussian pattern; however, it became distorted as the CTDD deviated further from the optimal value. Data analysis indicated that the CTDD tolerance for successful data processing and structure determination was approximately ±3–5 mm from the optimized CTDD. These findings provide insight into indexing behavior in SFX data processing at PAL-XFEL and offer practical guidance for improving data processing efficiency.

Myoglobin (Mb), a heme-containing protein, plays crucial roles in storing and transporting oxygen in muscle cells. Various Mb structures have been extensively determined using conventional cryogenic crystallography, providing valuable information for understanding the molecular mechanisms of the protein. However, this approach has limitations attributable to cryogenic temperatures and radiation damage. Serial femtosecond crystallography (SFX) using X-ray free-electron lasers is an emerging technique that enables the determination of biologically relevant room-temperature structures without causing radiation damage. In this study, we assessed the crystallization, collection, and processing of SFX diffraction data of Mb from equine skeletal muscle. Needle- and needle cluster-shaped Mb crystals were obtained using the microbatch method. Fixed-target SFX data collection was performed at the Pohang Accelerator Laboratory X-ray Free Electron Laser, yielding 1389 indexed diffraction patterns. The phase problem was solved by molecular replacement. The preliminary Mb structure determined at 2.3-Å resolution in this study exhibited subtle structural differences in the heme environment compared with previously reported Mb structures determined by SFX. These results both confirm the feasibility of myoglobin SFX experiments and establish a foundation for future time-resolved studies aiming to visualize ligand binding and oxygen transport.

Serial femtosecond crystallography (SFX) provides opportunities to observe the dynamics of macromolecules without causing radiation damage at room temperature. Although SFX provides a biologically more reliable crystal structure than provided by the existing synchrotron sources, there are limitations due to the consumption of many crystal samples. A viscous medium as a carrier matrix reduces the flow rate of the crystal sample from the injector, thereby dramatically reducing sample consumption. However, the currently available media cannot be applied to specific crystal samples owing to reactions between the viscous medium and crystal sample. The discovery and characterisation of a new delivery medium for SFX can further expand its use. Herein, we report the preparation of a polyacrylamide (PAM) injection matrix to determine the crystal structure with an X-ray free-electron laser. We obtained 11,936 and 22,213 indexed images using 0.5 mg lysozyme and 1.0 mg thermolysin, respectively. We determined the crystal structures of lysozyme and thermolysin delivered in PAM at 1.7 Å and 1.8 Å resolutions. The maximum background scattering from PAM was lower than monoolein, a commonly used viscous medium. Our results show that PAM can be used as a sample delivery media in SFX studies.

A self-seeded X-ray free-electron laser (XFEL) is a promising approach to realize bright, fully coherent free-electron laser (FEL) sources in the hard X-ray domain that have been a long-standing issue with longitudinal coherence remaining challenging. At the Pohang Accelerator Laboratory XFEL, we have demonstrated a hard X-ray self-seeded XFEL with a peak brightness of 3.2 × 1035 photons s–1 mm–2 mrad–2 0.1% bandwidth (BW)–1 at 9.7 keV. The bandwidth (0.19 eV) is about 1/70 times as wide (close to the Fourier transform limit) and the peak spectral brightness is 40 times higher than in self-amplified spontaneous emission (SASE), with substantial improvements in the stability of self-seeding and noticeably suppressed pedestal effects. We could reach an excellent self-seeding performance at a photon energy of 3.5 keV (lowest) and 14.6 keV (highest) with the same stability as the 9.7 keV self-seeding. The bandwidth of the 14.6 keV seeded FEL was 0.32 eV, and the peak brightness was 1.3 × 1035 photons s–1 mm–2 mrad–2 0.1%BW–1. We show that the use of seeded FEL pulses with higher reproducibility and a cleaner spectrum results in serial femtosecond crystallography data of superior quality compared with data collected using SASE mode.A hard X-ray self-seeded X-ray free-electron laser at the Pohang Accelerator Laboratory provides X-ray pulses with peak brightness of 3.2 × 1035 photons s–1 mm–2 mrad–2 0.1%BW–1 at 9.7 keV and a very small shot-to-shot electron energy jitter of 0.012%.

This retrospective comparative study aimed to compare the efficacy of selective caudal fixed screw constructs with all variable screw constructs in anterior cervical discectomy and fusion (ACDF). Thirty-five patients who underwent surgery using selective caudal fixed screw construct (SF group) were compared with 44 patients who underwent surgery using all variable constructs (AV group). The fusion rate, subsidence, adjacent level ossification development (ALOD), adjacent segmental disease (ASD), and plate-adjacent disc space distance were assessed. The one-year fusion rates assessed by computed tomography bone bridging and interspinous motion as well as the significant subsidence rate did not differ significantly between the AV and SF groups. The ALOD and ASD rates and plate-adjacent disc space distances did not significantly differ between the two groups at both the cranial and caudal adjacent levels. The number of operated levels was significantly associated with pseudarthrosis in the logistic regression analysis. The stability provided by the locking mechanism of the fixed screw did not lead to an increased fusion rate at the caudal level. Therefore, the screw type should be selected based on individual patient’s anatomy and surgeon’s experience without concern for increased complications caused by screw type.

Backgrounds The basic method of surgical treatment for extracapsular hip fractures (ECFs), including intertrochanteric fracture and basicervical fracture (BCF), is osteosynthesis. Intramedullary nails are among the most commonly used fixation devices for these fractures. Our study aimed to report the clinical outcomes of ECF treatment with two different nail devices and to analyze the risk factors associated with screw cut-out. Methods We retrospectively reviewed the medical records of 273 patients (300 cases) from a single institution who underwent surgical treatment for ECF between January 2013 and October 2018. Overall, 138 patients were eligible for the study and were divided into two groups according to the osteosynthesis device used. We evaluated the clinical outcomes of fracture surgery and performed univariate and multivariate regression analyses to identify risk factors associated with screw cut-out in each group. Results We used proximal femoral nails (group 1) to treat 83 patients and cephalomedullary nails (group 2) to treat 55 patients. Nine cut-outs (group 1, 6 cases; group 2, 3 cases) occurred during follow-up. The patients’ high body mass index (BMI) ( p  = 0.019), BCFs ( p  = 0.007), non-extramedullary reduction in the anteroposterior and lateral planes ( p  = 0.032 and p  = 0.043, respectively), and anti-rotation screw pull-outs ( p  = 0.041) showed a positive correlation to screw cut-out in the univariate analysis of group 1. In group 2, only BCFs was positively correlated ( p  = 0.020). In the multivariate analysis of group 1, the patients’ BMIs ( p  = 0.024) and BCFs ( p  = 0.024) showed a positive correlation with cut-out. Meanwhile, the multivariate analysis of group 2 did not identify any factors associated with cut-out. Conclusions The cut-out risk was significantly higher in the BCF cases, regardless of the nail design used. Considerable attention should be paid to treating such unstable fractures. We expect that new-generation nails using a helical blade, or interlocking derotation and interlocking screws may improve surgical outcomes.

PurposeTo describe the safety and feasibility of C2 medial window screw (C2MWS) as an alternative salvage method for C2 pedicle screws in cases of high-riding vertebral artery (HRVA) or narrow pedicle.MethodsThe C2MWS technique involves screw insertion by intentionally breaching the medial cortex of the pedicle to avoid vertebral artery injury. Twelve patients who underwent C2 screw insertion via the C2MWS were retrospectively reviewed. C2MWS was indicated in cases of high-riding vertebral artery (HRVA) or narrow pedicle (pedicle width ≤ 4 mm). The width of the canal breach by screw, vertebral artery groove (VAG) breach, solid fusion, neck pain visual analogue scale (VAS) score, and Japanese Orthopedic Association (JOA) score were assessed as outcome measurements.ResultsC2MWS was indicated due to both HRVA and narrow pedicle for 11 screws, narrow pedicle for one screw, and HRVA for two screws. No screw VAG breach or vertebral artery injury was noted postoperatively. The mean width of canal breach was 2.9 ± 1.3 mm. There were no cases demonstrating neurologic deterioration, and 11 patients (91.7%) demonstrated solid fusion at 1-year follow-up. Furthermore, neck pain VAS and JOA scores significantly improved after the surgery.ConclusionsThe C2MWS technique can provide 3-column fixation while reliably avoiding VA injury. C2MWS could be considered as a salvage alternative method when the insertion of C2 pedicle screw is complicated by HRVA or a narrow pedicle, while there is a need to provide firmer fixation strength than that provided by pars or translaminar screws.Level of evidence4

Thus far, attempts to develop drugs that target corticotropin-releasing hormone receptor 1 (CRF 1 R), a drug target in stress-related therapy, have been unsuccessful. Studies have focused on using high-resolution G protein-coupled receptor (GPCR) structures to develop drugs. X-ray free-electron lasers (XFELs), which prevent radiation damage and provide access to high-resolution compositions, have helped accelerate GPCR structural studies. We elucidated the crystal structure of CRF 1 R complexed with a BMK-I-152 antagonist at 2.75 Å using fixed-target serial femtosecond crystallography. The results revealed that two unique hydrogen bonds are present in the hydrogen bond network, the stalk region forms an alpha helix and the hydrophobic network contains an antagonist binding site. We then developed two antagonists—BMK-C203 and BMK-C205—and determined the CRF 1 R/BMK-C203 and CRF 1 R/BMK-C205 complex structures at 2.6 and 2.2 Å, respectively. BMK-C205 exerted significant antidepressant effects in mice and, thus, may be utilized to effectively identify structure-based drugs against CRF 1 R. Drug discovery: Hormone receptor structure helps search for new antidepressants Structural studies of complexes of a receptor protein for corticotropin-releasing hormone and specific small molecules could guide the development of new antidepressants and drugs for stress-related diseases. The activity of the corticotropin-releasing hormone receptor 1 protein has been associated with many human diseases, including psychiatric disorders, diabetes, cancer, osteoporosis, cardiovascular conditions and neurodegeneration. Hoyoung Kim at Yonsei University in Seoul, South Korea, utilized X-ray free electron laser technology, a method that minimizes sample damage, to determine the protein complexes. Through their study, they unveiled subtle, previously overlooked structural characteristics at two crucial sites. Leveraging these insights, they developed multiple ‘antagonist’ compounds that disrupt the protein’s normal function. One of these antagonists demonstrated significant antidepressant effects in mouse models, sparking hope for potential similar benefits in humans.

Microcrystal delivery instruments are pivotal to performing serial femtosecond crystallography experiments at the XFEL facilities. We present a novel sample delivery technique based on a micro-tubing reeling system (MRS). Despite the tiny size of the micro-tubing, the MRS device has the advantage of operating without real-time position adjustment of the tube to match with the XFEL pulses. Moreover, the applicable repetition rate is more flexible than the previously reported chip-based one-dimensional fixed target system.