Comparison of Radiological and Clinical Outcomes between Expandable and Non-expandable Cages Following Cervical Corpectomy: A Systematic Review and Meta-analysis

Anterior cervical corpectomy and fusion is considered the mainstay of surgical treatment in cervical pathology. Expandable and nonexpandable cages are preferred over autogenous bone graft because of donor-related morbidity. However, the choice of the cage type remains a debatable topic as studies report conflicting results. Thus, we evaluated the outcomes of expandable and non-expandable cages following cervical corpectomy. Studies were searched in various electronic databases (MEDLINE, PubMed, EMBASE, CINAHL, Scopus, and Cochrane) between 2011 and 2021. Forest plot was made to compare the radiological and clinical outcomes between expandable and non-expandable cages following cervical corpectomy. Altogether, 26 studies (1,170 patients) were included in the metaanalysis. The mean change in segmental angle was significantly greater in the expandable cage group than in the non-expandable cage group (6.7° vs. 3.0°, p 0.05). The improvement in segmental angle is better with expandable cages. Higher subsidence is a major problem with non-expandable cages, but it seems to be beneficial as evidenced by the high fusion rate and minimal effect on clinical outcome in patients with this cage.

Dual split and dislocation----a variant of Schatzker type-I tibial plateau fracture: A case report / 中华创伤杂志(英文版)

Schatzkter type-I tibial plateau fracture is a split fracture of the lateral tibial plateau in sagittal plane, consequent to valgus impaction caused by low velocity of trauma. However, a deep understanding of the different columns of the tibial plateau and patho-mechanisms of the injury led to the unmasking of atypical fractures around the tibial plateau. We have encountered 2 cases with unusual fracture pattern of the lateral tibial condyle caused by road traffic accidents. The fracture pattern and severity of injury deviate from the original description of Schatzker type 1; in view of dual plane split, there is rotation of the posterolateral column fragment along its sagittal plane plus grade-III medial collateral ligament injury. The patients were initially treated with knee spanning external fixator and after a latency of 5 days, definitive fracture specific fixation was done, combined with repair of grade-III medial collateral ligament injury. At the 6 months follow-up both the patients achieved satisfactory knee functions (knee society score case 1: 100 and case 2: 92) and returned to their jobs. The severity of fracture pattern and displacement as described should prompt for examination of associated ligament injury. Because of timely diagnosis, early and appropriate care promised an excellent function outcome even in such a severe nature of knee injury. To prompt the description of injury pattern we coined the name "dual split and dislocation" of lateral tibial plateau, as a complex injury variant of split fracture of lateral tibial plateau fracture.

Role of procalcitonin in diagnosis of neonatal sepsis and procalcitonin guided duration of antibiotic therapy

Background: Neonatal sepsis is one of the important causes of neonatal morbidity and mortality particularly in the developing countries. Accurate and quick diagnosis is difficult because clinical presentation is non-specific, bacterial cultures are time-consuming and other laboratory tests lack sensitivity and specificity. Procalcitonin (PCT) is often reported to be more superior to C-reactive protein (CRP), being more sensitive and specific, starts to rise earlier and returns to normal concentration more rapidly than CRP.Methods: It is a hospital based prospective observational study. Blood samples were obtained and analyzed for blood culture, septic screen including serum CRP and PCT. Neonates were categorized into proven sepsis (n=39), probable sepsis (n=21) and clinical sepsis (n=40) groups on the basis of laboratory findings and risk factors. Data was analyzed by using standard statistical tests using SPSS 16.Results: Out of 100 cases, elevated PCT level >0.5 ng/dl was detected in 75 and >2 ng/dl was detected in 51 whereas CRP was positive only in 61 cases. Among the 39 culture positive cases, elevated serum PCT level was noticed in 39 (100%) cases whereas CRP level was noticed in 30 (76.9%) cases. Mean PCT levels were significantly high according to infection severity (P<0.01). Procalcitonin (sensitivity 87.2%, specificity 72.13%, positive predictive value 66.7% and negative predictive value 89.8% and with p value of <0.001) is more superior than CRP to predict sepsis in neonate. The mean duration of antibiotic therapy was 12.46±4.62 days in definite sepsis, 4.53±1.78 days in probable sepsis group and in clinical sepsis group 3.75±1.33 days by serial PCT measurement.Conclusions: Serum PCT levels >2 ng/dl has got a better sensitivity and NPV, which help us not only in the early diagnosis but also in the prognosis and duration of antibiotic therapy.

Potential Adjunctive Role of Radiosynovectomy in Primary Synovial Osteochondromatosis of the Knee: A Case Report / 대한핵의학회잡지

Primary synovial osteochondromatosis (PSOC) is a rare but clinically significant cause of morbidity especially in the male population. Surgery is the primary treatment of choice, but the recurrence rate is reported to be high. Moreover, the presence of widespread loose bodies makes it a cumbersome procedure. The complete removal of the disease is tough at times and results in early recurrence. Radiosynovectomy is an established technique for treating various joint arthropathies. The role of radiosynovectomy in case of PSOC has not yet been explored. This case report described the case of a young male with PSOC of the knee joint who was treated with radiosynovectomy for pain relief. The patient reported complete relief from the pain along with significant improvement in joint mobility. The post-therapy three-phase bone scan also validated the reduction in joint inflammation. The patient was taken for surgical removal of the redundant loose bodies after a significant improvement in the pain and reduction in inflammation. Post-therapy radiation fibrosis of the synovium also helped in the en bloc removal of the disease. The role of radiosynovectomy in PSOC needs to be further explored concerning its potential role as an adjuvant to surgical procedures.

A validated and densitometric HPTLC method for the simultaneous quantification of reserpine and ajmalicine in Rauvolfia serpentina and Rauvolfia tetraphylla

ABSTRACT High performance thin layer chromatographic method (HPTLC) has been developed for the quantification of reserpine and ajmalicine in root part of two different population of Rauvolfia serpentina (L.) Benth. ex Kurz and Rauvolfia tetraphylla L., Apocynaceae, collected from Punjab and Uttarakhand. HPTLC of methanolic extract of root containing indole alkaloids, i.e., reserpine and ajmalicine, was performed on TLC Silicagel 60 F254 (10 cm × 10 cm) plates with toluene:ethyl acetate:formic acid (7:2:1), as mobile phase. Quantification of the reserpine and ajmalicine was performed in the absorption–reflection mode at 268 nm. The recovery of reserpine and ajmalicine were 99.3 and 98.7% respectively. The calibration curves were linear for both the reserpine and ajmalicine, in the range of 200–1200 ng. HPTLC densitometry has been performed for the estimation of reserpine and ajmalicine in root part of R. serpentina and R. tetraphylla for the first time. The method is simple, rapid and cost effective and can be used for routine analysis of ajmalicine and reserpine in different Rauvolfia species as well as for quality control of herbal drugs containing Rauvolfia species.

Comparative HPTLC analysis of bioactive marker barbaloin from in vitro and naturally grown Aloe vera

ABSTRACT Aloe vera (L.) Burm. f., Xanthorrhoeaceae, a succulent, produces barbaloin, a bioactive compounds used in various pharmaceutical products. Extracts prepared from the leaves have been widely used as bittering agents, taste modifiers and also as cathartic agent against severe constipation. Barbaloin is reported for its anti-inflammatory, anticancer, antiviral and anticancer activities and these properties are mostly mediated by its antioxidative capacity. Presently, a study has been conducted on the comparative High Performance Thin Layer Chromatography analysis of barbaloin from the dried leaf skin powder of in vivo and in vitro grown A. vera. Shoot tips of A. vera were cultured in Murashige and Skoog media supplemented with different combination of 6-benzylaminopurine and 1-naphthaleneacetic acid. [Best multiplication response was noted in benzylaminopurine (2.0 mg/l) + 1-naphthaleneacetic acid (0.1 mg/l) supplemented Murashige and Skoog media]. The quantitative determination of barbaloin was performed on silica gel 60 F254 HPTLC plates as stationary phase. The linear ascending development was carried out in a twin trough glass chamber saturated with a mobile phase consisting of ethyl acetate: methanol: water (100:16.5:13.5) at room temperature (22 ± 2 ºC). CAMAG Thin Layer Chromatography scanner-3 equipped with CATS software (version: 1.4.4.6337) was used for spectrodensitometric scanning and analysis in the ultraviolet region at λ = 366 nm. The method was validated for linearity, precision and accuracy. Correlation coefficient, limit of detection, limit of quantification as well as recovery values were found to be satisfactory. Out of the five populations studied, the leaf skin of A. vera collected from Jodhpur (Rajasthan, India) and raised in vitro was found to contain higher amount of barbaloin (2.78%) when compared to its naturally growing counterparts (2.46%) and other plant populations.

Rupture of the triceps tendon - A case series / 中华创伤杂志(英文版)

Triceps rupture is the least common among all tendon injuries. The usual mechanism of injury is a fall on an outstretched hand, although direct contact injuries have also been reported to cause this injury. The diagnosis of acute triceps tendon rupture may be missed, which can result in prolonged disability and delayed operative management. We presented three cases of acute triceps tendon rupture each at different site showing the spectrum of injury to the muscle and mechanism of injury and management were also discussed.

Central nervous system mycosis: Analysis of 10 cases.

Aim: To describe the clinicopathological features in patients with fungal infections of the central nervous system (CNS) presenting as mass lesions. Materials and Methods: A retrospective analysis of records obtained from 10 patients was done with histopathologically confirmed fungal infections presenting as ICSOL, diagnosed in the department of pathology. Clinical features at presentation, findings of radiological investigations performed and histopathology were noted for each patient and subjected for analysis. Results: Infection was higher in males, and paranasal sinusitis was the most common predisposing factor. Location was intraparenchymal followed by sphenoid wing. Four dural-based lesions mimicked meningioma clinically. The most common fungus identified was zygomycosis (seven cases), followed by phaeohyphomycosis (two cases) and aspergillosis (one case). Conclusion: There is a rising trend of CNS mycosis, both in immunocompromised and immunocompetent patients. Intracranial fungal granuloma may mimic radiologically as glioma or meningioma, therefore a high index of suspicion is needed to detect early CNS fungal infections, especially in immunocompetent young patients with no predisposing illness. Fungi should always be excluded in patients with inflammatory or granulomatous pathology of CNS.

A rare case of bilateral idiopathic brachymetacarpia and brachymetatarsia.

We present a rare case of bilateral idiopathic 4th metacarpal and metatarsal shortening. Patient was thoroughly investigated to rule out syndromic association. No intervention was done as the patient was asymptomatic.

HPTLC detection of altitudinal variation of the potential antivenin stigmasterol in different populations of the tropical ethnic antidote Rauvolfia serpentina

OBJECTIVE@#To determine the altitudinal variation of stigmasterol, a potential antivenin, in roots from seven populations of Rauvolfia serpentina (L). Benth. ex Kurz. (Apocynaceae) (R. serpentina), an important herb found in Indian subcontinent which has long been used in the treatment of snakebite, blood pressure and schizophrenia.@*METHODS@#Altitudinal variation of stigmasterol content in R. serpentina roots was analyzed by high performance thin layer chromatography. Chromatography was performed on silica gel 60 F254 thin layer chromatography plates with benzene-acetone 86:14 (v/v) as mobile phase. Densitometric analysis was done at λ=366 nm after derivatization with vanillin-10% (v/v) sulphuric acid alcohol reagent. The method was validated for precision and recovery.@*RESULTS@#The present experiment demonstrates a simple, rapid, precise and sensitive high performance thin layer chromatography protocol for qualitative and quantitative determination of stigmasterol from different populations of R. serpentina. Results demonstrated that in root samples stigmasterol was present at Rf value of 0.44.@*CONCLUSIONS@#This investigation demonstrates that stigmasterol content in R. serpentina roots varies in different altitudes. Popular ethnomedicinal use of this herb against snakebite may be contributed by the occurrence of stigmasterol in its roots.

HPTLC detection of altitudinal variation of the potential antivenin stigmasterol in different populations of the tropical ethnic antidote Rauvolfia serpentina

Objective: To determine the altitudinal variation of stigmasterol, a potential antivenin, in roots from seven populations of Rauvolfia serpentina (L). Benth. ex Kurz. (Apocynaceae) (R. serpentina), an important herb found in Indian subcontinent which has long been used in the treatment of snakebite, blood pressure and schizophrenia. Methods: Altitudinal variation of stigmasterol content in R. serpentina roots was analyzed by high performance thin layer chromatography. Chromatography was performed on silica gel 60 F

Proposed Methods for Real-Time Measurement of Posterior Condylar Angle during TKA

PURPOSE: Conventional instruments are known to result in high numbers of outliers in restoring femoral component rotation primarily due to fixed degree of external rotation resection relative to the posterior condylar line (PCL). Outliers can be reduced by determining the patient specific posterior condylar angle (PCA) preoperatively or intraoperatively. There is a paucity of methods that can be used during surgery for determining the PCA. We propose two simple, real-time methods to determine the PCA and hence to measure the axial anatomical variation during surgery. MATERIALS AND METHODS: The study was conducted using axial computed tomography (CT) scans of the knees of 26 patients. The commercial software K-PACS and our proposed two methods (trigonometric and protractor) were used to measure the angle between the transepicondylar axis and PCL, i.e., PCA. Statistical comparison between the mean angles obtained by K-PACS and our methods were done. RESULTS: The three methods resulted in similar PCAs. The mean PCA measured by the three methods were similar. The mean PCA value measured by the K-PACS, trigonometric method and protractor method was 6.27degrees (range, 0degrees to 12degrees), 6.23degrees (range, 0degrees to 11.11degrees) and 6.31degrees (range, 0degrees to 12degrees), respectively. There were significant correlations between the K-PACS measured PCA and trigonometrically or protractor measured PCA. CONCLUSIONS: Our novel, simple, easily reproducible, real-time and radiation-free PCA measurement methods obviate the need for preoperative CT scan for identification of patient specific PCA.

Antibiotic pressure mediated selection of non-biofilm forming strain of Elizabethkingia meningosepticum causing fatal nosocomial meningitis in a term infant.

We describe a fatal case of hospital acquired meningitis in a term infant due to the antibiotic pressure mediated selection of Elizabethkingia meningosepticum. The antibiotics were administered for multi-drug resistant Acinetobacter baumannii infection. The strain was also phenotypically characterized for beta lactamase production, biofi lm forming capability and resistance to in use disinfectants.

Role of Moringa oleifera in regulation of diabetes-induced oxidative stress

OBJECTIVE@#To evaluate the antioxidant activity of aqueous extract of Moringa oleifera (M. oleifera) young leaves by in vivo as well as in vitro assays.@*METHODS@#In vitro study included estimation of total phenolic, total flavonol, total flavonoid and total antioxidant power (FRAP assay). In addition, in vivo study was done with the identified most effective dose of 200 mg/kg of its lyophilized powder on normal and diabetic rats. Its effect on different oxidative free radical scavenging enzymes,viz, superoxide dismutase (SOD), catalase (CAT), glutathione-S-transferase (GST), lipid peroxide (LPO) contents were measured.@*RESULTS@#Significant increase in activities of SOD, CAT, GST while, a decrease in LPO content was observed. Whereas, total phenolic, flavonoid and flavonol contents in the extract were found to be 120 mg/g of GAE, 40.5 mg/g of QE and 12.12 mg/g of QE, respectively. On the other hand, FRAP assay results of M. oleifera leaves was (85.00 ± 5.00) μM/g of extract powder.@*CONCLUSIONS@#The significant antioxidant activities of M. oleifera leaves from both in vivo as well as in vitro studies suggests that the regular intake of its leaves through diet can protect normal as well as diabetic patients against oxidative damage.

Reconstruction of chronic acromioclavicular joint disruption with artificial ligament prosthesis / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Management of Rockwood type 3 acromioclavicular disruptions is a matter of debate. Should we adopt conservative or operative measures at first presentation? It is not clear but most of the evidences are in favour of conservative management. We present our experience in managing these patients surgically.</p><p><b>METHODS</b>We present a prospective series of eight cases of chronic Rockwood type 3 acromioclavicular joint disruptions treated surgically. Anatomical reconstruction of the coracoclavicular ligament was done by artificial braided polyester ligament prosthesis.</p><p><b>RESULTS</b>All the patients were able to perform daily activities from an average of the 14th postoperative day. All patients felt an improvement in pain, with decrease in average visual analogue scale from preoperative 6.5 points (range 3-9 points) to 2.0 points (range 0-5 points), Constant score from 59% to 91% and American Shoulder and Elbow Surgeons shoulder score from 65 to 93 points postoperatively. These results improved or at least remained stationary on midterm follow-up, and no deterioration was recorded at an average follow-up of 46 months.</p><p><b>CONCLUSION</b>This midterm outcome analysis of the artificial ligament prosthesis is the first such follow-up study with prosthesis. Our results are encouraging and justify the further use and evaluation of this relatively new and easily reproducible technique.</p>

Alleviation of lindane induced toxicity in testis of Swiss mice (Mus musculus) by combined treatment with vitamin C, vitamin E and a- lipoic acid.

Mitigation of lindane induced toxicity in testis of Swiss mice by combined treatment with vitamin C, vitamin E and -lipoic acid has been evaluated. Male healthy mice (40), 8-10 weeks old were randomly selected and divided into 4 groups, control (C); lindane (L); antioxidant (A) and antioxidant plus lindane (A+L). Group C animals were administered only the vehicle (olive oil); in group L lindane was administered orally at a dose of 40 mg/kg body wt.; in group A combination of antioxidants at a dose of 125 mg/kg body wt.(vitamin C: 50 mg/kg body wt., vitamin E: 50 mg/kg body wt. and α-lipoic acid: 25 mg/kg body wt.) was administered orally; in group A+L both antioxidants (125 mg/kg body wt.) and lindane (40 mg/kg body wt.) were administered at their respective doses. In group A+L antioxidants were administered 1 h prior to lindane administration. All treatments were continuously given for 60 days. Histopathological changes due to lindane intoxication indicated shrunken and distorted seminiferous tubules, sparse Leydig cells and blood vessels and atrophy in the tissue. The testis weight also decreased significantly. Lindane treated group showed increased lipid peroxidation, whereas glutathione, glutathione peroxidase, superoxide dismutase, catalase and protein were significantly decreased compared to control. Lindane induced damage was minimized by administration of antioxidants. Results suggest that combined pretreatment with antioxidants can alleviate the damage caused to testis by lindane.

Studies on oxidative stress induced nerve conduction deficits in cigarette smokers.

An important role of oxidative stress for the development of vascular and neurological complications has encouraged us to undertake a study to assess the oxidative stress induced nerve conduction deficits among cigarette smokers. Eighteen regular male cigarette smokers and twenty nine male non - smokers were diagnosed for clinical neuro-physiological tests viz., motor and sensory nerve conduction velocity (MNCV and SNCV) and redox status. Significant depletion of reduced glutathione (GSH) level (p < 0.05) and significant increase in malondialdehyde (MDA) level (p < 0.01) was found in smokers compared to non - smokers. Motor and sensory nerve conduction velocity showed no significant difference among smokers compared to non - smokers. The present study shows that smoking can induce oxidative stress among smokers but could not exacerbate to nerve conduction deficits.

Ameliorative effect of a combination of vitamin E, vitamin C, α- lipoic acid and stilbene resveratrol on lindane induced toxicity in mice olfactory lobe and cerebrum.

Acute dose of lindane (40 mg/kg body weight, ip) caused significant reduction in butyrylcholinesterase (BChE) activity both in olfactory lobe and cerebrum of mice along with reduction in catalase (CAT), total protein and elevation in superoxide dismutase (SOD) and cholesterol contents. Pretreatment by a combination of antioxidants, vitamin E, vitamin C, α- lipoic acid and stilbene resveratrol (125 mg/kg body weight, ip) significantly augment the altered level of BChE and protect the other parameters in both the brain regions. The results were adequately in agreement with the histochemical findings, suggesting the neuroprotective efficacy of combination of antioxidants studied on the lindane induced neurotoxicity.

Unusual lymphocytosis with systemic lupus erythematosus.

A 15-year-old boy with systemic lupus erythematosus, who on a follow up visit complained of recurrent episodes of fever, easy fatiguability, and seizures. Investigations revealed lymphocytosis (95%), anemia, and a positive PCR for cytomegalovirus (CMV). Electron microscopy of the lymphocytes revealed intranuclear inclusion bodies supporting the diagnosis of CMV infection. The child was treated with ganciclovir and discharged. At discharge the child was afebrile. However, lymphocytosis persisted even after 9 months of discharge. Repeated screening for possible lymphoreticular malignancy was negative. It is likely that lymphocytosis in this child was due to persistence of CMV infection in host cells leading to continued provocation of the host immune system.