Robotic-assisted laminectomy (RAL) is an emerging technique in spine surgery that can potentially improve precision, safety, and efficiency. While robotic-assisted pedicle screw placement is well established, RAL remains in early stages with varied methodologies and primarily pre-clinical validation. This narrative review evaluates current evidence on RAL, focusing on bone cutting tools, resection strategies, state recognition techniques for real-time identification of bone type and surgical endpoints, and clinical applications to inform future advancements. A comprehensive literature search was conducted using PubMed, Embase, and Cochrane databases with relevant keywords and operators to maximize sensitivity. Twenty-seven studies met predefined inclusion and exclusion criteria. Evaluated cutting tools included burrs, drills, and ultrasonic osteotomes. Burrs and drills provided superior state recognition feedback, while ultrasonic devices offered better force control and reduced thermal damage. Cyclic dorsal–ventral drilling was found to be superior to layer-by-layer resection for ultrasonic cutting. The only clinical study of RAL in a human patient is a case report demonstrating robotic-guided, surgeon-operated laminar bone removal. While RAL shows promise in improving surgical accuracy, the lack of in vivo data and standardized methodology remains a key barrier to clinical adoption. Future research should prioritize comparative evaluation of cutting modalities, clinical validation in human subjects, and long-term outcome studies to support the broader integration of RAL into spine surgery.

The cervical spine poses many complex challenges that require complex solutions. Anterior cervical discectomy and fusion (ACDF) has been one such technique often employed to address such issues. In order to address the problems with ACDF and assess the modifications that have been made to the technique over time, finite element analyses (FEA) have proven to be an effective tool. The variations of cervical spine FEA models that have been produced over the past couple of decades, particularly more recent representations of more complex geometries, have not yet been identified and characterized in any literature. Our objective was to present material property models and cervical spine models for various simulation purposes. The outlining and refinement of the FEA process will yield more reliable outcomes and provide a stable basis for the modeling protocols of the cervical spine.

Methods: Model 1 (M1) was an intact C2C6 model with a 0.5 mm endplate. In model 2 (M2), a cage was implanted after removal of the C4–C5 and C5–C6 discs with preservation of the osseous endplate. In model 3 (M3), 1 mm of the osseous endplate was removed at the upper endplate. Model 4 (M4) resembles M3, except that 3 mm of the osseous endplate was removed. Results: The range of motion (ROM) at C2C6 in the M2–M4 models was reduced by at least 9º compared to the M1 model. The von Mises stress results in the C2C3 and C3C4 interbody discs were significantly smaller in the M1 model and slightly increased in the M2–M3 and M3–M4 models. Migration and subsidence decreased from the M2–M3 model, whereas further endplate removal increased the migration and subsidence as shown in the transition from M3 to M4. Conclusions The M3 model had the least subsidence and migration. The ROM was higher in the M3 model than the M2 and M4 models. Endplate preparation created small stress differences in the healthy intervertebral discs above the ACDF site. A 1 mm embedding depth created the best balance of mechanical strength and contact area, resulting in the most favorable stability of the construct.

INTRODUCTION: Lactogenesis II (LaII) failure can be prevented in at-risk mothers with simple proactive interventions. In a randomised trial, we investigated the efficacy of early and regular breast milk expression in establishing LaII, using an electric double-breast pump. METHODS: Mothers with uncomplicated singleton deliveries were randomised to intervention (n = 31) or control (n = 29) groups. The former commenced breast milk expression with an electric pump within one hour of delivery and maintained regular expression with direct breastfeeding. Control mothers directly breastfed without regular pump expression. Expressed milk volumes were analysed for citrate, lactose, sodium and protein. RESULTS: Median time of LaII was Day 3 (interquartile range [IQR] 1 day) with intervention and on Day 4 (IQR 1 day) among controls (p = 0.03). Biochemical steady-state concentrations were achieved around early Day 4 (sodium, total protein) and Days 4-5 (citrate, lactose). Sodium, protein and lactose levels were similar in both groups over seven days, at 5.80 mM, 0.68 mM and -13.38 mM, respectively. Mean daily milk volume with intervention was 73.9 mL on Day 3 and 225.2 mL on Day 7, greater than controls (25.4 mL on Day 3 and 69.2 mL on Day 7; p < 0.2). Mean infant weights were similar on Day 8 at 3,477 g with intervention and 3,479 g among controls. CONCLUSION LaII is established by postnatal Day 3 with early initiation of regular breast milk expression, a useful intervention for mothers at risk of early-onset breastfeeding failure.
Adult ; Breast Feeding ; methods ; Breast Milk Expression ; methods ; Citrates ; analysis ; Female ; Humans ; Infant Formula ; Infant, Newborn ; Lactation ; physiology ; Milk, Human ; chemistry ; physiology ; Mothers ; Proteins ; analysis ; Sodium ; analysis ; Young Adult

Expressed sequence tags (ESTs) are widely used in gene survey research these years. The EST Pipeline System, software developed by Hangzhou Genomics Institute (HGI), can automatically analyze different scalar EST sequences by suitable methods. All the analysis reports, including those of vector masking, sequence assembly, gene annotation, Gene Ontology classification, and some other analyses, can be browsed and searched as well as downloaded in the Excel format from the web interface, saving research efforts from routine data processing for biological rules embedded in the data.
Automation ; Base Composition ; Computational Biology ; methods ; Databases, Genetic ; Expressed Sequence Tags ; Software ; User-Computer Interface