Deformity Correction with Interbody Fusion Using Lateral versus Posterior Approach in Adult Degenerative Scoliosis: A Systematic Review and Observational Meta-analysis.

This study was designed to systematically review and meta-analyze the functional and radiological outcomes between lateral and posterior approaches in adult degenerative scoliosis (ADS). Both lateral (lumbar, extreme, and oblique) and posterior interbody fusion (posterior lumbar and transforaminal) are used for deformity correction in patients with ADS with unclear comparison in this cohort of patients in the existing literature. A literature search using three electronic databases was performed to identify studies that reported outcomes of lateral (group L) and posterior interbody fusion (group P) in patients with ADS with curves of 10°-40°. Group P was further subdivided into minimally invasive surgery (MIS-P) and open posterior (Op-P) subgroups. Data on functional, radiological, and operative outcomes, length of hospital stay (LOHS), fusion rates, and complications were extracted and meta-analyzed using the random-effects model. A total of 18 studies (732 patients) met the inclusion criteria. No significant difference was found in functional and radiological outcomes between the two groups on data pooling. Total operative time in the MIS-P subgroup was less than that of group L (233.86 minutes vs. 401 minutes, p <0.05). The total blood loss in group L was less than that in the Op-P subgroup(477 mL vs. 1,325.6 mL, p <0.05). Group L had significantly less LOHS than the Op-P subgroup (4.15 days vs. 13.5 days, p <0.05). No significant difference was seen in fusion rates, but complications were seen except for transient sensorimotor weakness (group L: 24.3%, group P: 5.6%; p <0.05). Complications, such as postoperative thigh pain (7.7%), visceral injuries (2%), and retrograde ejaculation (3.7%), were seen only in group L while adjacent segment degeneration was seen only in group P (8.6%). Lateral approach has an advantage in blood loss and LOHS over the Op-P subgroup. The MIS-P subgroup has less operative time than group L, but with comparable blood loss and LOHS. No significant difference was found in functional, radiological, fusion rates, pseudoarthrosis, and complications, except for transient sensorimotor deficits. Few complications were approach-specific in each group.

Outcomes of Anterior Decompression and Anterior Instrumentation in Thoracolumbar Burst Fractures-A Prospective Observational Study With Mid-Term Follow-up.

OBJECTIVE: To analyze the functional, neurological, and radiological outcomes after anterior surgery in thoracolumbar burst fractures. DESIGN: Prospective observational study. SETTING: Tertiary care hospital. PATIENTS: Thirty-six patients with thoracolumbar burst fractures (T11-L2). INTERVENTION: Anterior decompression, anterior column reconstruction with mesh cage, and instrumented stabilization. OUTCOME: Functional (Visual Analog Score, Oswestry Disability Index, and Spinal Cord Independence Measure), neurological (ASIA Impairment Scale), and radiological (kyphosis, anterior vertebral height loss, canal encroachment %) parameters. RESULTS: Patients were prospectively followed for a mean duration of 5.9 ± 3.2 years (2.4-10 years). Statistically significant improvement was noted in functional outcomes from preop values (P-value < 0.001). 29 patients (80.5%) had improvement in neurology after surgery at the final follow-up with a positive correlation with % change in canal encroachment (r = 0.64, P -0.018). The mean preoperative kyphosis of 29.1 ± 11.9 degrees got corrected to 9.4 ± 3.8 degrees in immediate postop and 15.7 ± 11.8 at the final follow-up(P < 0.001). Preoperative mean canal encroachment of 58.5 ± 15.7% was reduced to 6.5 ± 3.2% postoperatively (P < 0.001). Two patients developed neurological complications (subacute progressive ascending myelopathy), and 5 patients developed pulmonary complications. No pseudarthrosis, implant loosening, or cage migration was noted in any patient. CONCLUSION: Anterior surgery performed in 36 patients with thoracolumbar burst fractures in our study showed good outcomes. 80.5% of patients improved in neurology after surgery by at least one ASIA Impairment Scale grade. There was statistically significant improvement noted in radiological outcome (Kyphosis and Canal encroachment %) and functional outcome (Visual Analog Score, Oswestry Disability Index, and Spinal Cord Independence Measure score) after surgery in immediate postop and at the final follow-up. Only 13.8% of patients developed pulmonary complications that were managed successfully with chest drain. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Phosphonomethyl iminodiacetic acid functionalized metal organic framework supported PAN composite beads for selective removal of La(III) from wastewater: Adsorptive performance and column separation studies.

The rare earth elements being toxic in nature are being accumulated in water bodies as their industrial usage is growing exponentially, thus their efficient separation holds an immense significance. Herein, ligand functionalized metal organic framework (MOF), Phosphonomethyl iminodiacetic acid coordinated at Fe-BTC, was synthesized post-synthetically and incorporated subsequently in polyacrylonitrile polymer to prepare the composite beads via nonsolvent induced-phase-inversion technique for selective adsorption of La(III) from the wastewater in batch and dynamic column mode. XPS NMR, and FTIR were used to establish the interaction between functionalized ligand and unsaturated metal nodes of MOF. The adsorption capacity was 232.5 mg/g and 77.51 mg/g at 298 K of the functionalized MOF and composite beads respectively. Adsorption kinetics followed a pseudo-second order rate equation, and isotherm indicated the best fitting with Langmuir model. The dynamic behavior of the adsorption column packed with MOF/Polymer beads was fairly described by the Thomas model. The breakthrough time of 23.2 h could be attained with 12 cm of bed height and 10 ml/min of flow rate. These MOF/Polymer beads shown the selectivity of La over transitional metals were recycled over 5 times with about 15% loss of adsorption capacity. The findings provide suggestive insights of the potential use of functionalized MOF towards the separation of the rare earth element.

Valorisation of waste galvanizing dross: Emphasis on recovery of zinc with zero effluent strategy.

Galvanizing dross-a waste product from steel industries but it can be a potential secondary resource for zinc through urban mining and recycling. In this concern, a novel and scalable recycling route with zero effluent strategy is developed for the recovery of zinc from galvanizing dross as high grade zinc salts along with value-added products through hydrometallurgical processing. In particular, as-such dross block was leached in 9% (v/v) sulphuric acid medium, wherein strong hydrogen gas effervescence results in alleviating the pulverization and stirring requirements; which are material and energy intensive. Leached zinc is purified and recovered as high purity ZnSO4.(H2O/7H2O) and Zn3(PO4)2.4H2O through controlled crystallization and phosphate precipitation respectively; which find application in fertilizers and anti-corrosive paints. Temperature difference method was opted for the crystallization of zinc sulfate salts, wherein 70 °C and 30 °C were found to be stability range of crystallization of ZnSO4.H2O and ZnSO4.7H2O respectively. ZnSO4-H2O phase diagram is developed using Factsage calculations to corroborate crystallization study. Moreover, exhaustive thermodynamic analysis of Zn2+-PO43--H2O system at 303 K on precipitation of zinc phosphate using di-ammonium hydrogen phosphate (80-240 g/L) is conducted and the results reveal that with increasing pH (3-6), intermediate hydrogen phosphate species (H3PO4, H2PO4- and H2PO42-) decompose to produce stable PO43- ions leading to zinc phosphate precipitation. Impurity like Iron and supernatant solution left after crystallization are recovered as hydrated iron-calcium sulfate mixture and ammonium sulfate salt respectively. This explored route is economical and easily adaptable with zero effluents, therefore, transcends serious challenges in terms of energy requirement, scale-up and effluent generation.

Traversing the profile of biomimetically nanoengineered iron substituted hydroxyapatite: synthesis, characterization, property evaluation, and drug release modeling.

Even though ion substituted hydroxyapatite nanoparticles are associated with promising features for biomedical applications, green synthesis with precise control of size and shape to produce uniform nanoparticles remains elusive. To overcome this, we herein propose a room temperature, biomimetic approach to synthesize iron substituted nano-hydroxyapatite (m-HA) along with thorough physicochemical and biological evaluation. The study revealed that 10% iron could be isomorphously doped into hydroxyapatite crystal structure. Stress, strain, energy density and atomic occupancy, as a result of substitution, have been ascertained by Williamson-Hall and Rietveld analysis using X-ray diffraction data. X-Ray photoelectron spectroscopy has been employed to confirm the elemental composition, chemical state and environment of m-HA. In addition, vibrating sample magnetometer of m-HA shows a trend towards superparamagnetic behaviour. Further, fluorescence assisted cell sorting and scanning electron microscope studies confirmed increase in the cell density with increasing iron concentration. Excellent antibacterial property, enhanced biocompatibility and bioactivity have also been interestingly observed. More controlled and sustained drug release has been observed with the inclusion of iron. A mathematical model developed to elucidate drug diffusion coefficient reveals Fickian mechanism to govern the release profile up to 8 hours followed by a non-Fickian transport. With these distinct features, this versatile material holds immense potential as bone repair material for osteoporosis where targeted delivery of calcium is required, as a heating mediator in cancer treatment and as a vehicle for site specific delivery of drug.

Comparison of extramedullary and intramedullary devices for treatment of subtrochanteric femoral fractures at tertiary level center.

OBJECTIVE: The treatment of subtrochanteric fractures is challenging and treatment modalities and implants are constantly evolving. This study attempts to revisit and compare extramedullary vs. intramedullary devices in relatively young population. METHODS: Thirty patients with subtrochanteric fractures were enrolled and treated with extramedullary or intramedullary devices and follow-up continued one year for clinico-radiological assessment. RESULTS: The mean age of patients was 37.53 years. Most were males between 21-40 years. The dominant mode of injury was traffic accidents (66%). Fractures were classified according to Russell-Taylor classification. Forty percent were Russell-Taylor type IA, 37% type IB and 23% type IIA. Average time to surgery was 3.6 days from the time of admission to hospital. Mean duration of surgery was 45 minutes for intramedullary device (group A) and 105 minutes for extramedullary device (group B). Average blood loss was 100 ml in group A and 200 ml in group B. Mean duration of radiation exposure was 130 seconds and 140 seconds for groups A and B, while average duration of hospital stay was 12 days and 16 days respectively. Excellent results were seen in 47% of cases in group A and 33% of cases in group B. CONCLUSION: Intramedullary device is a reliable implant for subtrochanteric fractures. It has high rates of union with minimal soft-tissue damage. Intramedullary fixation has biological and biomechanical advantages, but surgery is technically demanding. Gradual learning and patience is needed to make this method truly rewarding.