Ultrasonic bone scalpel: utility in cervical corpectomy. A technical note.

PURPOSE: Anterior cervical corpectomy and fusion (ACCF) is a technically challenging surgery. Use of conventional instruments like high-speed burr and kerrison rongeurs is associated with high complication rates such as increased blood loss and incidental durotomy. Use of ultrasonic bone scalpel (UBS) in cervical corpectomy helps to minimize such adverse events. METHODS: We performed a retrospective study based on the data of 101 consecutive patients who underwent cervical corpectomies with UBS for different cervical spine pathologies from December 2014 to December 2016. Total duration of surgery, time taken for corpectomy, estimated blood loss, and incidental durotomies were noted. RESULTS: Total surgical time was 30-80 min (59.36 ± 13.21 min) for single-level ACCF and 60-120 min (92.74 ± 21.04 min) for double-level ACCF. Time taken for single-level corpectomy was 2 min 11  ± 10 s and 3 min 41  ± 20 s for double-level corpectomy. Estimated blood loss ranged from 20-150 ml (52.07 ± 29.86 ml) in single level and 40-200 ml (73.22 ± 41.64 ml) in double level. Four (3.96%) inadvertent dural tears were noted, two during single-level corpectomy and other two during double-level corpectomy. CONCLUSIONS: Use of UBS is likely to provide a safe, rapid, and effective surgery when compared to conventional rongeurs and high-speed burr. The advantages such as lower blood loss and lower intra-operative incidental dural tears were noted with the use of UBS.

Does the Surgical Timing and Decompression Alone or Fusion Surgery in Lumbar Stenosis Influence Outcome in Cauda Equina Syndrome?

STUDY DESIGN: A retrospective comparative analysis of 64 patients with cauda equina syndrome (CES), who underwent either decompression alone (NF) or fusion (F) surgery. PURPOSE: We compared the outcomes and timing effects. OVERVIEW OF LITERATURE: CES can cause loss of autonomic control of vesicular function and lower limb neurological deficits. Prompt diagnosis and emergency surgery markedly improve outcome. Although decompression only is a mainstream technique, there is guarded recovery of vesicular dysfunction. Decompression ventrally in a narrow window requires manipulation of neural tissue in an already jeopardised critical canal and may accentuate irreversible damages. In F surgery, the adequate exposure leads to a lower neural manipulation. METHODS: Until January 2008, we treated CES with decompression (laminectomy and/or discectomy). However, from that month forward, all our single-level CES patients have received a fusion operation. In this study, characteristic categorical variables and outcomes were analysed. RESULTS: In a retrospective analysis of 64 patients, NF (n=37) and F (n=27) who received treatment, we found that both groups improved significantly on follow-up in all objective parameters. Although, the comparison of clinical and functional outcome data between the two groups was statistically insignificant, the average value of objective outcome such as vesicular function, low back pain (LBP), and complications was better for patients in F group compared with NF group. However, the patient satisfaction for the F group was also lower, in view of their residual symptoms and disabilities. Contrary to common perceptions, we found that the timing of surgery does not influence the recovery rate for either approach. CONCLUSIONS: Although both the techniques appear to be equally effective, the fusion approach overall showed a definite edge over non-fusion, with respect to reduced incidence of iatrogenic dural tears, LBP, and overall outcome, even despite the lower patient satisfaction.

The Relationship of Facet Joint Orientation and Tropism with Lumbar Disc Herniation and Degenerative Spondylolisthesis in the Lower Lumbar Spine.

STUDY DESIGN: Retrospective study. PURPOSE: This study aimed to clarify the relationship of both facet tropism (FT) and the sagittally aligned facet (SAF) joint with lumbar disc herniation (LDH) and degenerative spondylolisthesis (DS). OVERVIEW OF LITERATURE: Despite several studies conducted, there is no consensus on the association of the SAF joint and FT with DH and DS. METHODS: Between June 2015 and December 2017, magnetic resonance imaging scans of 250 consecutive patients who underwent surgery for LDH and DS were analyzed. The facet angles at all the lower lumbar levels were calculated, and SAF and FT were noted. The relationship between the side of disc herniation and that of the SAF joint were also determined. Statistical analysis was performed, and the relation of SAF and FT to LDH and DS was noted. RESULTS: We observed a positive relationship between SAF and LDH at L4-5 and L5-S1 with a p-value of 0.02 (<0.05). FT demonstrated a positive association with LDH at L4-5 (p=0.047) but not at L3-4 or L5-S1. SAF demonstrated a positive relationship with DS at L3-4 (p<0.001) but not at L3-4 or L5-S1. FT demonstrated a significant relation with DS at L4-5 (p<0.001), whereas no positive association was observed at L3-4 and L5-S1. CONCLUSIONS: The L4-5 level demonstrated a significant association with SAF and FT in LDH and DS. Moreover, SAF at L5-S1 demonstrated a positive association with LDH. These findings provide useful information for future longitudinal studies to elucidate the possible causes for such phenomena.

Kaposi's sarcoma-associated herpesvirus ORF57 protein binds and protects a nuclear noncoding RNA from cellular RNA decay pathways.

The control of RNA stability is a key determinant in cellular gene expression. The stability of any transcript is modulated through the activity of cis- or trans-acting regulatory factors as well as cellular quality control systems that ensure the integrity of a transcript. As a result, invading viral pathogens must be able to subvert cellular RNA decay pathways capable of destroying viral transcripts. Here we report that the Kaposi's sarcoma-associated herpesvirus (KSHV) ORF57 protein binds to a unique KSHV polyadenylated nuclear RNA, called PAN RNA, and protects it from degradation by cellular factors. ORF57 increases PAN RNA levels and its effects are greatest on unstable alleles of PAN RNA. Kinetic analysis of transcription pulse assays shows that ORF57 protects PAN RNA from a rapid cellular RNA decay process, but ORF57 has little effect on transcription or PAN RNA localization based on chromatin immunoprecipitation and in situ hybridization experiments, respectively. Using a UV cross-linking technique, we further demonstrate that ORF57 binds PAN RNA directly in living cells and we show that binding correlates with function. In addition, we define an ORF57-responsive element (ORE) that is necessary for ORF57 binding to PAN RNA and sufficient to confer ORF57-response to a heterologous intronless beta-globin mRNA, but not its spliced counterparts. We conclude that ORF57 binds to viral transcripts in the nucleus and protects them from a cellular RNA decay pathway. We propose that KSHV ORF57 protein functions to enhance the nuclear stability of intronless viral transcripts by protecting them from a cellular RNA quality control pathway.

Tris(mercaptoimidazolyl)borate complexes of the coinage metals: syntheses and molecular structures of the first gold compounds and related copper and silver derivatives.

The first tris(mercaptoimidazolyl)borate complexes of gold, Au(Tm(tBu)) and (Tm(tBu))Au(PPh3), have been prepared and structurally characterized. Together with their copper and silver analogues M(Tm(tBu)) and (Tm(tBu))M(PPh3)(M = Cu, Ag), these compounds constitute the first two complete series of Tm(R) derivatives to be isolated for the coinage metals. In order to evaluate the steric and electronic effects of the bulky tert-butyl substituents in these species, comparative structural analyses with the known methyl-substituted analogue Ag(Tm(Me)) and various (Tm(Me))M(PR3) derivatives (M = Cu, Ag) are also presented.