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Certain congenital craniofacial malformations can cause upper airway obstruction. Due to neurological involvement, these craniofacial deformities with upper airway blockage frequently require tracheostomy. Children who need weeks or months of continuous ventilator assistance require tracheostomies, which improve pulmonary toilet and decrease laryngotracheal lesions such subglottic stenosis and tracheomalacia. In this case report we will be discussing about two patients who underwent Pediatric tracheostomy for Pierre Robin sequence and supraglottic stenosis in our institute. This paper emphasizes on some of the rare causes of pediatric upper airway obstruction – Pierre Robin sequence and supraglottic stenosis. Also the importance of tracheostomy procedure, which is the gold standard for management of upper airway obstruction in patients who are not responding to conservative management is emphasized. [ABSTRACT FROM AUTHOR]

Problem: Smart cities have become the mainstream of urbanization with the advancement of the internet of things (IoT). Utilizing the Internet, smart devices are permitted by the IoT networks to gather and process data among the smart city infrastructure. Therefore, faster adaptions of smart cities were limited by challenges like centralization, security, privacy, transparency, scalability, and verifiability. Motivation: A novel ORLLTMLP-based attack detection and blockchain-aware security framework using LCTFA in smart city applications were proposed in this study. The major motivation of this research is to perform efficient attack detection and secure data storage using the blockchain and DL approaches, which comprehensively pondered the security and efficiency of data sharing. Methods: In this model, the sensed data's dimensionality is diminished using MRC-LDA. Then, the attack detection and secure storage of data are carried out using ORLLTMLP and LCTFA, respectively. Results: Finally, the experiential analysis reveals that an accuracy of 97.5% was accomplished by the proposed model. Implications: The experiential outcomes exposed that the proposed scheme is efficient among the prevailing techniques for secure and efficient data sharing. [ABSTRACT FROM AUTHOR]

Purpose: To quantitatively assess the dynamic changes of Lactate in lumbar discs under different physiological conditions using MRS and T2r. Methods: In step1, MRS and T2r sequences were standardized in 10 volunteers. Step2, analysed effects of high cellular demand. 66 discs of 20 volunteers with no back pain were evaluated pre-exercise (EX-0), immediately after targeted short-time low back exercises (EX-1) and 60 min after (EX-2). In Step 3, to study effects of high glucose and oxygen concentration, 50 lumbar discs in 10 volunteers were analysed before (D0) and after 10 days intake of the calcium channel blocker, nimodipine (D1). Results: Lactate showed a distinctly different response to exercise in that Grade 1 discs with a significant decrease in EX-1 and a trend for normalization in Ex-2. In contrast, Pfirrmann grade 2 and 3 and discs above 40 years showed a higher lactate relative to proteoglycan in EX-0, an increase in lactate EX-1 and mild dip in Ex-2. Similarly, following nimodipine, grade 1 discs showed an increase in lactate which was absent in grade 2 and 3 discs. In contrast, exercise and Nimodipine had no significant change in T2r values and MRS spectrum of proteoglycan, N-acetyl aspartate, carbohydrate, choline, creatine, and glutathione across age groups and Pfirrmann grades. Conclusion: MRS documented changes in lactate response to cellular demand which suggested a 'Lactate Symbiotic metabolic Pathway'. The differences in lactate response preceded changes in Proteoglycan/hydration and thus could be a dynamic radiological biomarker of early degeneration. [ABSTRACT FROM AUTHOR]

Purpose: To probe the pathophysiological basis of Modic change (MC) by multimodal imaging rather than by MRI alone. Methods: Nineteen radiological signs found in mild infections and traumatic endplate fractures were identified by MRI and CT, and by elimination, three signs unique to infection and trauma were distilled. By ranking the Z score, radiological 'Endplate Infection Probability Score' (EIPS) was developed. The score's ability to differentiate infection and traumatic endplate changes (EPC) was validated in a fresh set of 15 patients each, with documented infection and trauma. The EIPS, ESR, CRP, and Numeric Pain Rating Scale (NRS) were then compared between 115 patients with and 80 patients without MC. Results: The EIPS had a confidence of 66.4%, 83% and, 100% for scores of 4, 5 and, 6, respectively, for end plate changes suggesting infection. The mean EIPS was 4.85 ± 1.94 in patients with Modic changes compared to − 0.66 ± 0.49 in patients without Modic changes (p < 0.001). Seventy-eight (67.64%) patients with MC had a score of 6, indicating high infection possibility. There was a difference in the NRS (p < 0.01), ESR (p = 0.05), CRP (p < 0.01), and type of pain (p < 0.01) between patients with and without MC. Conclusion: Multimodal imaging showed many radiological signs not easily seen in MRI alone and thus missed in Modic classification. There were distinct radiological differences between EPCs of trauma and infection which allowed the development of an EIPS. The scores showed that 67.64% of our study patients with Modic changes had EPCs resembling infection rather than trauma suggesting the possibility of an infective aetiology and allowing us to propose an alternate theory of 'Primary Endplatitis'. [ABSTRACT FROM AUTHOR]

The analytical method development and validation of Medroxyprogesterone tablets 10mg summarizes the outcome of the results for content of Cadmium, Lead, Arsenic, Mercury, and Lithium in by ICP-MS1. The test sample was prepared with microwave assisted acid digestion and introduced into optimized instrumental parameters for use of a quadruple based Agilent 7700 inductively coupled plasma mass spectrometry instrument. This method development and validation by ICP-MS to prove that it is Specific, Precise, Accurate, Linear, Robust, Reproducible and Capable of producing reliable results. [ABSTRACT FROM AUTHOR]

Salivary gland canalicular adenoma is rare yet benign. It accounts for fewer than 1% of salivary tumors and is the third most common non-cancerous mass in the small salivary glands. A 45-year-old presented to the outpatient department with complaints of swelling in the left parotid region for the past 3 years. Examination revealed a firm swelling in the left parotid region. USG and MRI revealed features suggestive of pleomorphic adenoma. Superficial parotidectomy was planned but intra-operatively, the mass was seen between the two lobes of the parotid, which was removed, and on histopathological examination, it was diagnosed as canalicular adenoma. Post-operatively, the patient’s condition is excellent. [ABSTRACT FROM AUTHOR]

Objective: To report on the phenomenon of body drift in neurofibromatosis scoliosis and discuss its implication on surgical safety. Materials and methods: Ten dystrophic neurofibromatosis scoliosis (NF) and ten adolescent idiopathic scoliosis (AIS) were studied by radiographs, CT, and MRI. The curve characteristics and a detailed analysis of the morphology of the apical and three adjacent vertebral segments above and below were done. The coronal alignment and the presence of a drift of the vertebral body in relationship to the lamina were carefully studied in both groups and compared. Results: The mean cobb angle in the NF group was 77.6°, and 63.7° in the AIS group. All the studied vertebra in the NF group had extensive pedicle changes, which were more severe at the apical and periapical regions. Body drift was noted in 29 vertebral segments, with 9/10 of apical segments showing a significant drift. The body drift was associated with significant pedicle dystrophic changes and was independent of the curve magnitude. In comparison, in AIS, no body drift was noted despite a larger deformity and more severe vertebral rotation. Conclusion: The 'body drift' phenomenon was unique to neurofibromatosis scoliosis and was secondary to severe pedicle morphology changes. This was present even in curves less than 60° and could result in cord injury while instrumenting the concave pedicle. Therefore, a thorough preoperative assessment and planning by a 3D CT are mandatory. [ABSTRACT FROM AUTHOR]

Background Context: Patients with modic changes (MC) form a distinct clinical subset with reports of higher intensity of pain, poor clinical and surgical outcomes and higher incidence of recurrence. MC also is an independent risk factor for increased post-operative surgical site infection.Purpose: This study aimed to investigate the biological changes at molecular level, in discs with MCs. We also aim to identify biological biomarkers and potential targets for molecular therapy.Study Design: Experimental analysis MATERIALS AND METHODS: Nucleus pulposus (NP) from 24 patients undergoing microdiscectomy for disc herniation [14 discs with MC and 10 without modic changes (NMC)] were procured. The overall expression of proteins, biological processes, protein-protein and metabolite interactions were analysed and compared. Host defense response proteins (HDRPs) and immunological pathways activated in patients with MC were documented and analysed.Results: Label-free proteomic approach with stringent filters revealed a total of 208 proteins in MC and 193 in NMC groups. 45 proteins were specific to MC; 30 to NMC and 163 common to both. Downregulated proteins in MC belonged to components of extracellular matrix such as collagens (COL- 6A1, 6A2, 6A3, 11A1, 12A1, and 20A1), and proteoglycans (versican (VCAN), and biglycan (BGN)). Inflammatory molecules [plasminogen (PLG), angiogenin (ANG), fibroblast growth factor-binding protein 2 (FGFBP2), tetranectin (CLEC3B), cartilage acidic protein 1(CRTAC1), kininogen (KNG-1), chitinase-3-like protein 2 (CHI3L2), and ferritin (FTL) were expressed only in the MC group. The significantly altered pathways in MC included Fc Fragment of IgG Receptor IIIa (FCGR3A)-mediated phagocytosis, regulation of Toll-like receptors (TLR) by endogenous ligand, neutrophil and platelet degranulation. 50 HDRPs were identified in the study, 14 of which were specific to MC and included acute phase reactants, antimicrobial peptides, complement cascade proteins, inflammatory molecule and stress response proteins. Metabolite-protein interaction analysis revealed a significant interaction between 19 proteins, specifically involving ubiquitin mediating proteasome degradative pathway and an association with the metabolite-glutamic acid in the MC group. Accumulation of glutamic acid in MC discs was confirmed by quantitative amino acid analysis using High-performance liquid chromatography.Conclusion: Our study confirms that MC represents an intense inflammatory status and activation of host defense response and immunological pathways. Downstream effects leading to ubiquitin mediated proteasomal degradation of ECM proteins and the resulting metabolites such as glutamic acid could cause excessive pain and needs further investigation.Clinical Significance: We have documented the expression of inflammatory molecules, immune mechanisms and host defense response proteins which throw molecular insights into the pathological mechanisms of MC. Further, ubiquitin mediated proteasomal degradation and accumulation of glutamate in discs with MC might serve as targets for molecular therapy. [ABSTRACT FROM AUTHOR]

Otitis media is an inflammation of mucoperiosteal layer of the middle ear cleft which occurs mostly due to eustachian tube dysfunction superadded with an infective etiology. It is said that younger children are more commonly affected due to the anatomical difference of eustachian tube in children from an adult, but adults are affected as well. Usually acute otitis media may settle following a course of antibiotics, however, it can lead to persistence of infection or becoming chronic and may lead to severe intra and extracranial complications. This report is about a 16-year-old male who presented with a painful swelling in right postauricular region for two weeks duration. The right ear had a diffuse swelling of size 6x1x5 cm in the postauricular region, tender on palpation, firm in consistency, and was fluctuant. Otoscopic examination of the right ear showed bulge out and intact tympanic membrane without active discharge and congestion. High Resolution Computed Tomography (HRCT) of temporal bone showed right otomastoiditis with erosion of the lateral cortex of the right mastoid. He underwent right cortical mastoidectomy under general anaesthesia. The patient was on follow-up for six months and no recurrence was noted. [ABSTRACT FROM AUTHOR]

Purpose: There is considerable controversy on the role of genetics, mechanical and environmental factors, and, recently, on subclinical infection in triggering inflammaging leading to disk degeneration. The present study investigated sequential molecular events in the host, analyzing proteome level changes that will reveal triggering factors of inflammaging and degeneration. Methods: Ten MRI normal disks (ND) from braindead organ donors and 17 degenerated disks (DD) from surgery were subjected to in-gel-based label-free ESI-LC–MS/MS analysis. Bacterial-responsive host-defense response proteins/pathways leading to Inflammaging were identified and compared between ND and DD. Results: Out of the 263 well-established host-defense response proteins (HDRPs), 243 proteins were identified, and 64 abundantly expressed HDRPs were analyzed further. Among the 21 HDRPs common to both ND and DD, complement factor 3 (C3) and heparan sulfate proteoglycan 2 (HSPG2) were significantly upregulated, and lysozyme (LYZ), superoxide dismutase 3 (SOD3), phospholipase-A2 (PLA2G2A), and tissue inhibitor of metalloproteinases 3 (TIMP-3) were downregulated in DD. Forty-two specific HDRPs mainly, complement proteins, apolipoproteins, and antimicrobial proteins involved in the complement cascade, neutrophil degranulation, and oxidative-stress regulation pathways representing an ongoing host response to subclinical infection and uncontrolled inflammation were identified in DD. Protein–Protein interaction analysis revealed cross talk between most of the expressed HDRPs, adding evidence to bacterial presence and stimulation of these defense pathways. Conclusions: The predominance of HDRPs involved in complement cascades, neutrophil degranulation, and oxidative-stress regulation indicated an ongoing infection mediated inflammatory process in DD. Our study has documented increasing evidence for bacteria's role in triggering the innate immune system leading to chronic inflammation and degenerative disk disease. [ABSTRACT FROM AUTHOR]

Purpose: Inappropriate use of MRI leads to increasing interventions and surgeries for low back pain (LBP). We probed the potential effects of a routine MRI report on the patient's perception of his spine and functional outcome of treatment. An alternate 'clinical reporting' was developed and tested for benefits on LBP perception. Methods: In Phase-I, 44 LBP patients were randomized to Group A who had a factual explanation of their MRI report or Group B, who were reassured that the MRI findings showed normal changes. The outcome was compared at 6 weeks by VAS, PSEQ-2, and SF-12. In Phase-II, clinical reporting was developed, avoiding potential catastrophizing terminologies. In Phase-III, 20 MRIs were reported by both routine and clinical methods. The effects of the two methods were tested on four categories of health care professionals (HCP) who read them blinded on their assessment of severity of disease, possible treatment required, and the probability of surgery. Results: Both groups were comparable initial by demographics and pain. After 6 weeks of treatment, Group A had a more negative perception of their spinal condition, increased catastrophization, decreased pain improvement, and poorer functional status(p = significant for all). The alternate method of clinical reporting had significant benefits in assessment of lesser severity of the disease, shift to lesser severity of intervention and surgery in three groups of HCPs. Conclusion: Routine MRI reports produce a negative perception and poor functional outcomes in LBP. Focussed clinical reporting had significant benefits, which calls for the need for 'clinical reporting' rather than 'Image reporting'. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effectiveness of fresh whole blood (FWB) and blood component transfusion in improving clinical outcome and serological parameters in the early postoperative period following spinal deformity surgery. Methods: Patients undergoing major spinal deformity surgeries involving ≥ 6 levels of fusion and expected blood loss ≥ 750 ml between September 2017 and August 2018 were included in the study. The patients were randomized into two groups: FWBG and CG, receiving fresh whole blood and component transfusions, respectively. Results: A total of 65 patients with spinal deformities of different etiologies were included. The mean age was 14.0 and 14.9 years in FWB and CG, respectively. All other preoperative parameters were comparable. The mean fusion levels and surgical time were 11.1 and 221.20 min in FWB, as compared with 10.70 and 208.74minutes in CG, respectively. Intraoperative blood losses were 929 ml (FWBG) and 847 ml(CG), and the mean volumes of transfusion were 1.90 (FWBG) and 1.65 units (CG). FWBG was significantly superior to CG in the following clinical and laboratory parameters: duration of oxygen dependence [36.43 (FWBG) vs. 43.45 h (CG); P = 0.0256], mean arterial pH [7.442 (FWBG) vs. 7.394 (CG); p < 0.001], interleukin-6 [30.04 (FWBG) vs. 35.10 (CG); p < 0.019], mean duration of HDU stay [40.6 hours (FWBG) vs 46.51 hours (CG); p = 0.0234] and postoperative facial puffiness [7/30 in FWBG vs. 18/35 (CG) (P < 0.02)]. Conclusion: FWB transfusion can potentially improve the immediate postoperative outcome in patients undergoing major spinal deformity surgeries by reducing the duration of intensive care unit stay and oxygen dependence. The other potential benefits of this practice, based on our study, include a reduced inflammatory response (reduced lactate and IL-6) and postoperative facial puffiness. However, further large-scale validation studies in future are necessary to precisely determine the role of FWB in spine surgeries. Level of evidence II: Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding. [ABSTRACT FROM AUTHOR]

Copper oxide (CuO) is a p‐type metal‐oxide semiconductor with a bandgap of 1.2 eV and a minimal bandgap. Solar cells, superconductors, and sensors are among the applications for which it is used. To dope transition metals, researchers use a low‐cost soft chemical process (Mn). The aim of this research is to identify CuO nanopowders using a low‐cost soft chemical method to dope transition metals (Mn). The nanopowders' structural, morphological, functional, and optical properties are investigated. X‐ray diffraction (XRD) analysis findings point to the synthesis of high purity single monoclinic phase CuO nanoparticles. The crystallite size (30 nm) and lattice parameters of Mn‐doped CuO samples are reduced. These results suggest that Mn‐doped CuO nanoparticles may be a promising candidate for optoelectronic devices and photocatalytic organic compound degradation. [ABSTRACT FROM AUTHOR]

Diagnosis of spinal tuberculosis (TB) in the early (inflammatory) stage is essential to prevent the development of spinal deformity and neurological deficit. As spinal TB is a paucibacillary disease, diagnosis is established through a combination of clinical evaluation, imaging features, acid-fast bacilli smear, mycobacterial culture, histologic and/or cytologic evaluation, and molecular methods of diagnosis. No single modality can ascertain a diagnosis in all cases. Spinal TB is a medical disease to be treated by antitubercular therapy (ATT) until healing is attained. The consensus for the definition of a healed status in bone and joint TB, and consequent length of ATT intake, remains unresolved. Children with spinal TB need to be followed until skeletal maturity as kyphotic deformity may increase with growth. The indications for surgery and type of surgery performed (decompression, instrumented stabilization, or deformity correction) are case-specific decisions. Surgical correction of spinal deformity is easier to perform in active disease than in healed disease. Drug-resistant strains present an emerging challenge. Demonstration of drug resistance is often difficult in patients with spinal TB because of the lack of bacterial growth on culture. Molecular methods of diagnosis are often useful in such patients. Establishment of treatment protocols requires further long-term and large-scale clinical trials. [ABSTRACT FROM AUTHOR]

Background Context: The true understanding of aging and disc degeneration (DD) is still elusive. MRI has not helped our attempts to understand the health and disease status of the discs as it reflects mainly the end morphologic changes and not the changes at a molecular level. Understanding degeneration at a molecular level through proteomics might allow differentiation from normal aging and also aid in the development of biomarkers for early diagnosis and preventive therapies.Purpose: To utilize proteomics to understand the molecular basis of healthy, aging, and degenerating discs and conclusively differentiate normal aging and degeneration.Study Design: Proteomic analysis of human intervertebral disc samples.Methods: L4-L5 disc samples from three groups were acquired and subjected to proteomic analysis. Samples from individuals aged in the second, third, and fourth decades were used to represent young healthy discs (Group A). Those from MRI normal donors aged in the fifth, sixth, and seventh decades represented normal aging (Group B). Five degenerated discs obtained from patients at surgery represented degeneration (Group C). The entire proteome map and alteration in protein expressions were further analyzed using bioinformatics analysis. This was a self-funded project.Results: There were 84 common proteins. Specific proteins numbered 225 in A, 315 in B, and 283 in C. By gene ontology biological process identification, Group A predominated with extracellular matrix organization, cytoskeletal structural and normal metabolic proteins. Group B differed in having additional basal expression of immune response, complement inhibitors, and senescence proteins. Group C was different, with upregulation of proteins associated with oxidative stress response, positive regulators of apoptosis, innate immune response, complement activation and defense response to gram positive bacteria indicating ongoing inflammaging.Conclusions: Our study documented diverse proteome signatures between the young, aging and degenerating discs. Inflammaging was the main differentiator between normal biological aging and DD.Clinical Significance: Multiple inflammatory molecules unique to DD were identified, allowing the possibility of developing specific biomarkers for early diagnosis and thereby provide evidence-based metrics for preventive measures rather than surgical intervention and also to monitor progress of the disease. [ABSTRACT FROM AUTHOR]

Background: The role of prophylactic pinning of the contralateral hip in unilateral SCFE is well established in patients with risk factors for developing contralateral slip. The effect of prophylactic pinning on the growth and morphology of the hip is not well documented in the literature. We aimed to study the effect of prophylactic pinning on the residual growth and morphology of the proximal femur. Materials & Methods: The institutional database was searched for all unilateral SCFE cases for the period 2011 to 2020. A total of 171 unilateral SCFE cases were identified. All the radiographs were scanned and those patients who had follow-up X-rays till skeletal maturity were included in the study. Prophylactic pinning was performed using 6.5 mm fully threaded cancellous screws in supine position on a radiolucent table. The following radiological parameters were measured on the post-operative X-rays and at skeletal maturity: (i) neck length (NL), (ii) neck-shaft angle (NSA), (iii) femoral offset (FO), (iv) articulo-trochanteric distance (ATD) and (iv) tip-apex distance (TAD) by two different observers. Results: The mean age of the cohort was 13.7 years. ATD decreased from the mean value of 25.67 mm in post-operative radiographs to 20.84 mm in final follow-up radiographs. The NL, FO, and TAD were found to be increasing with age with mean final follow-up values of 55.35 mm, 41.41 mm, and 6.19 mm respectively compared to post-operative mean values of 50.95 mm, 37.4 mm, and 4.69 mm. There was no significant change in the neck-shaft angle. The mean post-operative NSA was 132.9° and it was 131.8° at final follow-up radiographs. Conclusion: Prophylactic pinning in unilateral SCFE does not stop the growth of the proximal femur completely. The ATD decreases in all the patients with prophylactic screw fixation probably due to the discrepancy in growth between the trochanteric apophysis and proximal femoral physis. The clinical effects of this subtle change in the morphology of the proximal femur need further investigation. Level of Evidence: Level IV Case series. [ABSTRACT FROM AUTHOR]

Purpose: Aneurysmal bone cysts (ABC) form 1 % of primary bone tumors. Reported incidence rates are no more than 1.4 to 1,00,000. ABC of spine frequently involves posterior elements and commonly affects the lumbar spine (45 %). We present a case of C2 ABC for the challenges it poses due to the rarity of the lesion, tedious to access location, dilemmas relating to the suitable approach for tumor resection and technically demanding stabilization and reconstruction strategy post resection.Methods: Clinical data analysis was performed to discuss a method of novel anterior column reconstruction following resection of a C2 aneurysmal bone cyst in a 8 year old child with anterior and posterior elements being involved.Results: An 8-year-old girl with an aneurysmal bone cyst of the C2 vertebra underwent staged surgery following pre-operative embolisation. First a posterior approach tumor excision with posterior instrumented fusion was performed. Following which, using a modified anterior retropharyngeal approach anterior tumor excision and fibular graft reconstruction between the C1 lateral mass and C2 body was performed. Complete tumor clearance and stable reconstruction was successfully achieved in our patient. Patient showed excellent clinical outcome with radiological fusion.Conclusions: Preoperative embolisation in the treatment of ABC has supplemental advantage by reducing blood loss. Modified anterior retropharyngeal approach allows satisfactory clearance for C1-2 lesion and fibular strut graft between the C1 lateral mass and C2 body can provide a stable graft placement with good chance of fusion. Instability and spinal deformity, whether preexisting or post-excision, should be corrected with reconstruction and stabilization to offer best chance of cure in such cases. [ABSTRACT FROM AUTHOR]

Purpose: To develop a classification based on the technical complexity encountered during pedicle screw insertion and to evaluate the performance of AIRO® CT navigation system based on this classification, in the clinical scenario of complex spinal deformity.Materials and Methods: 31 complex spinal deformity correction surgeries were prospectively analyzed for performance of AIRO® mobile CT-based navigation system. Pedicles were classified according to complexity of insertion into five types. Analysis was performed to estimate the accuracy of screw placement and time for screw insertion. Breach greater than 2 mm was considered for analysis.Results: 452 pedicle screws were inserted (T1-T6: 116; T7-T12: 171; L1-S1: 165). The average Cobb angle was 68.3° (range 60°-104°). We had 242 grade 2 pedicles, 133 grade 3, and 77 grade 4, and 44 pedicles were unfit for pedicle screw insertion. We noted 27 pedicle screw breach (medial: 10; lateral: 16; anterior: 1). Among lateral breach (n = 16), ten screws were planned for in-out-in pedicle screw insertion. Among lateral breach (n = 16), ten screws were planned for in-out-in pedicle screw insertion. Average screw insertion time was 1.76 ± 0.89 min. After accounting for planned breach, the effective breach rate was 3.8% resulting in 96.2% accuracy for pedicle screw placement.Conclusion: This classification helps compare the accuracy of screw insertion in range of conditions by considering the complexity of screw insertion. Considering the clinical scenario of complex pedicle anatomy in spinal deformity AIRO® navigation showed an excellent accuracy rate of 96.2%. [ABSTRACT FROM AUTHOR]

Background: There is a lack of a classification system providing uniformity in description and guiding management decisions for kyphotic spinal deformities. We developed such a classification based on column deficiency, flexibility of disc spaces, curve magnitude, and correlation with the corrective osteotomy required.Methods: A classification was developed based on analysis of 180 patients with thoracolumbar kyphosis requiring osteotomy. The deformity was classified as Type I if the anterior and posterior columns were intact (IA indicated mobile disc spaces and IB, ankylosed segments). Type II indicated deficiency of only 1 column (IIA = anterior column and IIB = posterior column). Type III indicated deficiency of both columns (IIIA = kyphosis of ≤60°, IIIB = kyphosis of >60°, and IIIC = buckling collapse). A prospective analysis of 76 patients was performed to determine interobserver variability and the ability of the classification to guide selection of osteotomies of increasing complexity, including the Ponte osteotomy, pedicle subtraction osteotomy, disc bone osteotomy, single vertebrectomy, multiple vertebrectomies, and anterior in situ strut fusion procedure.Results: The mean age of the 76 patients was 21.2 years, the mean kyphosis was 69.9° (range, 26° to 120°), and the mean follow-up duration was 30 months. Six deformities were classified as IA, 5 as IB, 5 as IIA, 2 as IIB, 13 as IIIA, 35 as IIIB, and 10 as IIIC. Four surgeons classifying the deformities had a high agreement rate (kappa = 0.83), with the highest agreement for Types IA, IB, and IIIB. A correlation between the type of deformity and the osteotomy performed demonstrated that the classification could indicate the type of osteotomy required. All 18 patients with Type-I or II kyphosis were treated with Ponte, pedicle subtraction, or disc bone osteotomy. Forty-three (90%) of the 48 patients with Type IIIA or IIIB underwent vertebrectomy (single in 27 [56%] and multiple in 16 [33%]), and only 5 (10%) underwent disc bone osteotomy. Seven of the 10 patients with Type-IIIC kyphosis were treated with multiple vertebrectomies, with 5 of them needing preoperative halo gravity traction; the other 3 patients underwent an anterior in situ strut fusion procedure.Conclusions: The proposed classification based on the morphology of column deficiency, flexibility, and curve magnitude demonstrated a high interobserver agreement and ability to guide selection of the appropriate osteotomy.Clinical Relevance: A novel classification system for kyphosis based on spinal column deficiency, flexibility of disc spaces, and curve magnitude would bring uniformity in management and help guide surgeons in the choice of the appropriate corrective osteotomy. [ABSTRACT FROM AUTHOR]

Epithelioid hemangioma is an uncommon benign vascular lesion which most commonly appears as a nodular lesion in the head and neck area. Here, we present a rare case of nodular swelling in the dorsal aspect of the tongue in a 30 year old male for the past 3 months. Excision of growth was done and histopathological examination revealed epithelioid hemangioma of the tongue. Patient is on regular follow up and there is no evidence of recurrence. [ABSTRACT FROM AUTHOR]

This study was conducted to evaluate the outcomes of closed reduction of different types of nasal bone fractures depending on time between onset of injury and reduction and comparing the outcomes of early closed reduction (within 6 h) of nasal bone fracture with late closed reduction (after 2 weeks). A hospital based Prospective cohort type of study was conducted among cases of nasal bone fracture attending the outpatient department of Otorhinolaryngology at Chettinad Hospital and Research Institute, Chennai during the months of August 2021 to January 2022. A total of 54 participants were included in the study. Primary outcome was to assess the effectiveness of closed reduction of different types of nasal bone fractures postoperatively. The second objective was to compare the outcomes of early closed reduction (within 6 h) of nasal bone fracture with late closed reduction (after 2 weeks). Using chi square test, the association of factors such as age, sex, mode of injury, external framework deformity, type of fracture and treatment was analyzed with outcome measures such as post op degree of deviation, arch irregularity, malalignment, bony irregularity, bony displacement, olfactory disturbances and result. We analyzed the sample data statistically and measured the outcomes which showed that post operatively after undergoing closed reduction, some degree of deviation was present in 17(31.48./.), arch irregularity present in 12(22.2./.), malalignment in 11(20.37./.), bony irregularity in 24(44.44./.), bony displacement in 19(35.19./.), olfactory disturbances in 2(3.70./.). Comparing the outcome factors between early and late reduction, we found that the outcome was better in early closed reduction when compared with late closed reduction. Among the 54 patients studied, the results of closed reduction were found to be excellent in 27(50./.), Fair in 16(29.63./.), Good in 10(18.52./.) and poor in 1(1.85./.) We could thus conclude from this study that early closed reduction of nasal bone fracture gave better results than a late closed reduction in terms of post operative deformity, arch irregularity, malalignment, bony irregularity, bony displacement and olfactory disturbances. [ABSTRACT FROM AUTHOR]

Unconventional superconductivity in the cuprates coexists with other types of electronic order. However, some of these orders are invisible to most experimental probes because of their symmetry. For example, the possible existence of superfluid stripes is not easily validated with linear optics, because the stripe alignment causes interlayer superconducting tunneling to vanish on average. Here we show that this frustration is removed in the nonlinear optical response. A giant terahertz third harmonic, characteristic of nonlinear Josephson tunneling, is observed in La1.885Ba0.115CuO4 above the transition temperature Tc = 13 kelvin and up to the charge-ordering temperature Tco = 55 kelvin. We model these results by hypothesizing the presence of a pair density wave condensate, in which nonlinear mixing of optically silent tunneling modes drives large dipole-carrying supercurrents. [ABSTRACT FROM AUTHOR]

In this paper, the effect of two parametric elastic foundations on the stability and free vibration behaviour of functionally graded (FG) Euler (EB) and Timoshenko beams (TB) in the presence of conservative axial loads is examined. In Timoshenko beam, both shear deformation and rotary inertia effects are taken into account. The governing equations and boundary conditions are derived using the variational principles and presented in a matrix form. Differential Quadrature Element Method of fist order (DQEM) is used to solve the equations. Many examples and comparisons are presented in order to emphasize the influence of elastic foundation, beam taper, boundary conditions and the material properties. Finally the results are compared with the results given by the other authors using the closed form and other numerical techniques. [ABSTRACT FROM AUTHOR]

Study Design: Proteomic and 16S rDNA analysis of disc tissues obtained in vivo.Objective: To address the controversy of infection as an aetiology for disc disorders through protein profiling. There is raging controversy over the presence of bacteria in human lumbar discs in vivo, and if they represent contamination or infection. Proteomics can provide valuable insight by identifying proteins signifying bacterial presence and, also host defence response proteins (HDRPs), which will confirm infection.Methods: 22 discs (15-disc herniations (DH), 5-degenerate (DD), 2-normal in MRI (NM) were harvested intraoperatively and immediately snap frozen. Samples were pooled into three groups and proteins extracted were analysed with liquid chromatography-tandem mass spectrometry (LC-MS/MS). Post identification, data analysis was performed using Uniprotdb, Pantherdb, Proteome discoverer and STRING network. Authentication for bacterial presence was performed by PCR amplification of 16S rDNA.Results: LC-MS/MS analysis using Orbitrap showed 1103 proteins in DH group, compared to 394 in NM and 564 in DD. 73 bacterial specific proteins were identified (56 specific for Propionibacterium acnes; 17 for Staphylococcus epidermidis). In addition, 67 infection-specific HDRPs, unique or upregulated, such as Defensin, Lysozyme, Dermcidin, Cathepsin-G, Prolactin-Induced Protein, and Phospholipase-A2, were identified confirming presence of infection. Species-specific primers for P. acnes exhibited amplicons at 946 bp (16S rDNA) and 515 bp (Lipase) confirming presence of P. acnes in both NM discs, 11 of 15 DH discs, and all five DD discs. Bioinformatic search for protein-protein interactions (STRING) documented 169 proteins with close interactions (protein clustering co-efficient 0.7) between host response and degenerative proteins implying that infection may initiate degradation through Ubiquitin C.Conclusion: Our study demonstrates bacterial specific proteins and host defence proteins to infection which strengthen the hypothesis of infection as a possible initiator of disc disease. These results can lead to a paradigm shift in our understanding and management of disc disorders. [ABSTRACT FROM AUTHOR]

In this paper, elastic buckling of tapered Euler Bernoulli nano columns for tip load and self weight using non-local theory of elasticity is studied using matrix based Chebyshev spectral collocation method (MBCSC). I he size effect is taken into consideration using Eringen's non-local elasticity theory. Detailed numerical analyses about the effects of boundary conditions and load types are conducted and the influence of non-local parameter on the static buckling response of tapered or uniform nano tubes and rods is discussed. It is hoped that the results in this paper may present a bench mark in the study of buckling of tapered nano rods and tubes. [ABSTRACT FROM AUTHOR]

Single Electron Transistor (SET) is a nanoelectronic device that operates under the controlled mode of tunnelled individual electrons. In this paper, a comparative analysis was performed employing SET based D-Flip flop with conventional logic D-flip flop. SET is eminent nanoscale devices that have low power dissipation, high speed and performance. The flip flop design was simulated using SIMON simulator and the stability of its operation was analysed applying the Monte-Carlo method that represented stability with low power dissipation and matched the functionality of traditional CMOS devices. [ABSTRACT FROM AUTHOR]

Study Design: Prospective observational cohort study.Objective: The aim of this study was to analyze the efficacy of diffusion tensor imaging (DTI) anisotropy indices in predicting the postoperative recovery in cervical spondylotic myelopathy (CSM) patients and to describe postoperative changes in the DTI indices based on neurological recovery after surgery.Summary Of Background Data: Surgical results of CSM are unpredictable and cannot be estimated based on preoperative MRI. DTI indices were found to have good sensitivity to detect changes in CSM, but their efficacy in predicting postoperative recovery and postoperative changes in DTI indices has not been studied before.Methods: Thirty-five patients who underwent surgical decompression for cervical spondylotic myelopathy underwent DTI evaluation preoperatively and postoperatively at 12 months. DTI indices-fractional anisotropy, apparent diffusion coefficient (ADC), relative anisotropy, volume ratio, and eigen vectors (E1, E2, and E3)-were obtained and clinical evaluations were made preoperatively and 12 months postoperatively.Results: Twenty-six patients were available for final follow-up at 12 months. Twenty patients showed improvement by at least 1 Nurick grade, five maintained the preoperative Nurick grade status and one patient was noted to have deterioration by 1 grade. The preoperative DTI values could not predict neurological recovery patterns postoperatively. Although conventional MRI showed adequate decompression in all patients irrespective of the clinical outcome, DTI indices showed variable results. There were significant improvements in postoperative DTI indices for ADC (P = 0.002), E1 (P < 0.001), and E2 (P = 0.012) values in patients who showed neurological recovery at 12 months. Postoperative DTI indices for coefficients ADC, E1, and E2 in neurologically static/worsened individuals remained unchanged or insignificant (P = 0.05) CONCLUSION.: The DTI indices were sensitive enough to indicate postoperative neurological recovery observed following surgery. Preoperative DTI evaluation could not predict postoperative recovery for patients with cervical spondylotic myelopathy.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Element based Differential Transform method (EDTM) and Finite Element methods (FEM) are applied to analyze the free vibration and stability of isotropic Levy's rectangular plates resting on Winkler foundation. Two opposite edges of the plate are assumed to be simply supported and the other two may be of any type of boundary conditions. To develop an analytical approach for buckling and free vibration of stepped and multi-span plates, Levy' solution that satisfies equilibrium and compatibility conditions at the interfaces is used. In this paper, an exact buckling in-plane loads and natural frequencies are determined for many cases and compared with the published results and using other method such as FEM developed by the author. [ABSTRACT FROM AUTHOR]

Study Design: Prospective genetic association study.Objective: The aim of this study was to document the variations in the genetic associations, when different magnetic resonance imaging (MRI) phenotypes, age stratification, cohort size, and sequence of cohort inclusion are varied in the same study population.Summary Of Background Data: Genetic associations with disc degeneration have shown high inconsistency, generally attributed to hereditary factors and ethnic variations. However, the effect of different phenotypes, size of the study population, age of the cohort, etc have not been documented clearly.Methods: Seventy-one single-nucleotide polymorphisms (SNPs) of 41 candidate genes were correlated to six MRI markers of disc degeneration (annular tears, Pfirmann grading, Schmorl nodes, Modic changes, Total Endplate Damage score, and disc bulge) in 809 patients with back pain and/or sciatica. In the same study group, the correlations were then retested for different age groups, different sample, size and sequence of subject inclusion (first 404 and the second 405) and the differences documented.Results: The mean age of population (M: 455, F: 354) was 36.7 ± 10.8 years. Different genetic associations were found with different phenotypes: disc bulge with three SNPs of CILP; annular tears with rs2249350 of ADAMTS5 and rs11247361 IGF1R; modic changes with VDR and MMP20; Pfirmann grading with three SNPs of MMP20 and Schmorl node with SNPs of CALM1 and FN1 and none with Total End Plate Score.Subgroup analysis based on three age groups and dividing the total population into two groups also completely changed the associations for all the six radiographic parameters.Conclusion: In the same study population, SNP associations completely change with different phenotypes. Variations in age, inclusion sequence, and sample size resulted in change of genetic associations. Our study questions the validity of previous studies and necessitates the need for standardizing the description of disc degeneration, phenotype selection, study sample size, age, and other variables in future studies.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

The correction of severe post-tubercular kyphosis (PTK) is complex and has the disadvantage of being multiple staged with a high morbidity. Here, we describe the procedure and results of closing-opening osteotomy for correction of PTK which shortens the posterior column and opens the anterior column appropriately to correct the deformity without altering the length of the spinal cord. Seventeen patients with PTK (10 males; 7 females) with an average age of 18.3 +/- 10.6 years (range 4-40 years) formed the study group. There were ten thoracolumbar, one lumbar and six thoracic deformities. The number of vertebrae involved ranged from 2 to 5 (average 2.8). Preoperative kyphosis averaged 69.2 degrees +/- 25.1 degrees (range 42 degrees -104 degrees ) which included ten patients with deformity greater than 60 degrees . The average vertebral body loss was 2.01 +/- 0.79 (range 1.1-4.1). The neurological status was normal in 13 patients, Frankel's grade D in three patients and grade C in one. Posterior stabilization with pedicle screw instrumentation was followed by a preoperatively calculated wedge resection. Anterior column reconstruction was performed using rib grafts in four, tricortical iliac bone graft in five, cages in six, and bone chips alone and fibular graft in one patient each. Average operating time was 280 min (200-340 min) with an average blood loss of 820 ml (range 500-1,600 ml). The postoperative kyphosis averaged 32.4 degrees +/- 19.5 degrees (range 8 degrees -62 degrees ). The percentage correction of kyphosis achieved was 56.8 +/- 14.6% (range 32-83%). No patient with normal preoperative neurological status showed deterioration in neurology after surgery. The last follow-up was at an average of 43 +/- 4 months (range 32-64 months). The average loss of correction at the last follow-up was 5.4 degrees (range 3 degrees -9 degrees ). At the last follow-up, the mean preoperative pain visual analogue scale score decreased significantly from 9.2 (range 8-10 points) to 1.5 (range 1-2 points). There was also a significant decrease in mean preoperative Oswestry's Disability Index from 56.4 (range 46-68) to 10.6 (range 6-15). Complications were superficial wound infections in two, neurological deterioration in one, temporary jaundice in one and implant failure requiring revision in one. Single-stage closing-opening wedge osteotomy is an effective method to correct severe PTK. The procedure has the advantage of being a posterior only, single-stage correction, which allows for significant correction with minimal complications. [ABSTRACT FROM AUTHOR]

Degenerative disc disease (DDD) is still a poorly understood phenomenon because of the lack of availability of precise definition of healthy, ageing and degenerated discs. Decreased nutrition is the final common pathway for DDD and the status of the endplate (EP) plays a crucial role in controlling the extent of diffusion, which is the only source of nutrition. The vascular channels in the subchondral plate have muscarinic receptors but the possibility of enhancing diffusion pharmacologically by dilation of these vessels has not been probed. Although it is well accepted that EP damage will affect diffusion and thereby nutrition, there is no described method to quantify the extent of EP damage. Precise definitions with an objective method of differentiating healthy, ageing and degenerated discs on the basis of anatomical integrity of the disc and physiological basis of altered nutrition will be useful. This information is an urgent necessity for better understanding of DDD and also strategizing prevention and treatment. Seven hundred and thirty endplates of 365 lumbar discs from 73 individuals (26 healthy volunteers and 47 patients) with age ranging from 10-64 years were evaluated by pre-contrast and 10 min, 2, 4, 6 and 12 h post contrast MRI after IV injection of 0.3 mmol/kg of Gadodiamide. End plates were classified according to the extent of damage into six grades and an incremental score was given for each category. A total endplate score (TEPS) was derived by adding the EP score of the two endplates for each concerned disc. The base line value (SI(base)) and the signal intensity at particular time periods were used to derive the enhancement percentage for each time period (Enhancement (%) = SI(tp) - SI(base)/SI(base) x 100). The enhancement percentage for each time period, the time for peak enhancement (T-max) and the time intensity curve (TIC) over 12 h were used to study and compare the diffusion characteristics. The differences in pattern of diffusion were obvious visually at 4 h which was categorized into five patterns-Pattern A representing normal diffusion to Pattern E representing a total abnormality in diffusion. Degeneration was classified according to Pfirrmann's grading and this was correlated to the TEPS and the alterations in diffusion patterns. The relationship of TEPS on the increase in DDD was evaluated by a logistic curve and the cut point for severe DDD was found by ROC curve. The influence of the variables of age, level, Modic changes, instability, annulus fibrosis defect (DEBIT), TEPS and diffusion patterns on DDD was analyzed by multiple and stepwise regression analysis. Oral nimodipine study: Additional forty lumbar end-plates from four young healthy volunteers were studied to document the effect of oral nimodipine. Pre-drug diffusion levels were studied by pre and post contrast MRI (0.3 mmol/kg of gadodiamide) at 10 min, 2, 4, 6, 12 and 24 h. Oral nimodipine was administered (30 mg QID) for 5 days and post-contrast MRI studies were performed similarly. Enhancement was calculated at vertebral body-VB; subchondral bone-SCB; Endplate Zone-EPZ and at superior and inferior peripheral nucleus pulposus-PNP and central nucleus pulposus-CNP, using appropriate cursors by a blinded investigator. Paired sample t test and area under curve (AUC) measurements were done.The incidence of disc degeneration had a significant correlation with increasing TEPS (Trend Chi-square, P < 0.01). Only one out of 83 (1.2%) disc had either Pfirrmann Grade IV or V when the score was 4 or below when compared to 34/190 (17.9%) for scores 5-7; 41 of 72 (56.9%) for scores 8-10 and 18 of 20 (90%) for scores 11 and 12 (P < 0.001 for all groups). Pearson's correlation between TEPS and DDD was statistically significant, irrespective of the level of disc or different age groups (r value was above 0.6 and P < 0.01 for all age groups). Logistic curve fit analysis and ROC curve analysis showed that the incidence of DDD increased abruptly when the TEPS crossed six. With a progressive increase of end plate damage, five different patterns of diffusion were visualized. Pattern D and E represented totally altered diffusion pattern questioning the application of biological method of treatment in such situations. Four types of time intensity curves (TIC) were noted which helped to differentiate between healthy, aged and degenerated discs. Multiple and stepwise regression analysis indicated that pattern of disc diffusion and TEPS to be the most significant factors influencing DDD, irrespective of age. Nimodipine increased the average signal intensity for all regions-by 7.6% for VB, 8% for SCB and EPZ and 11% for CNP at all time intervals (P < 0.01 for all cases). Although the increase was high at all time intervals, the maximum increase was at 2 h for VB, SCB and EPZ; 4 h for PNP and 12 h for CNP. It was also interesting that post-nimodipine, the peak signal intensity was attained early, was higher and maintained longer compared to pre-nimodipine values. Our study has helped to establish that EP damage as a crucial event leading to structural failure thereby precipitating DDD. An EP damage score has been devised which had a good correlation to DDD and discs with a score of six and above can be considered 'at risk' for severe DDD. New data on disc diffusion patterns were obtained which may help to differentiate healthy, ageing and degenerated discs in in-vivo conditions. This is also the first study to document an increase in diffusion of human lumbar discs by oral nimodipine and poses interesting possibility of pharmacological enhancement of lumbar disc nutrition. [ABSTRACT FROM AUTHOR]

We prospectively followed 61 children under 15 years of age at the time of diagnosis to identify the risk factors for deformity progression. The children had 63 lesions and a minimum of 15 years followup. All exhibited an increase in deformity during the active disease phase, but 26 of 63 (41%) continued to progress during the quiescent phase until the growth was complete. In 21 of those 26, there was an increase in angular kyphosis with a final deformity < 90 degrees. In the other five, the deformity resembled a buckling collapse analogous to failure of an axially loaded slender column; the deformity was more than 100 degrees and associated with facet dislocation at multiple levels. These patients' vertebral segments above the level of destruction underwent severe sagittal rotation resulting in horizontal vertebrae with vertical growth plates, which resulted in longitudinal overgrowth of the vertebral segments. Risk factors for buckling collapse included an age of less than 7 years at the time of the disease, thoracolumbar involvement, loss of more than two vertebral bodies, and presence of radiographic spine-at-risk signs. Children at risk for buckling collapse must be carefully watched and the spine stabilized to avoid a massive increase in deformity. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness of Riluzole as a pharmacotherapeutic treatment option for early cervical myelopathy using clinical parameters and DTI analysis.Methods: Early cervical myelopathy cases with MJOA scores ≥13, were recruited for the double-blinded, placebo-controlled randomised control trial. Thirty cases with fifteen cases each in the test and placebo group were studied. Analysis was done using diffusion tensor imaging (DTI) and clinical evaluation, pre- and post-institution of sodium channel blocker Riluzole for a period of 1 month (50 mg twice daily). Placebo group was treated with Vitamin B complex tablets. Diffusion co-efficient fractional anisotrophy (FA), apparent diffusion co-efficient (ADC), volume ratio (VR), relative anisotrophy (RA) and Eigen vectors were calculated. Outcomes analysis was based on clinical scores of MJOA, Nurick grading, SF-12, NDI, and statistical analysis of DTI datametrics.Results: The mean MJOA score was 15.6 (13-17) with no significant change in the test and control groups. The mean ADC, FA values were 1533.36 (1238-1779) and 494.36 (364-628) and changed to 1531.57 (1312-2091) and 484.86 (294-597), respectively, in the Riluzole group. However, the changes in the values of ADC, FA, and other co-efficients including VR, RA and eigenvectors in the two groups were not statistically significant. The functional scores in the SF-12 and NDI questionnaires did not change significantly.Conclusions: Our study did not show a significant change in the clinical outcome and DTI Indices with the use of Riluzole as a standalone pharmacotherapeutic agent for early cervical myelopathy. More studies may be needed to confirm the usefulness of Riluzole as a treatment option for cervical myelopathy. [ABSTRACT FROM AUTHOR]

Purpose: Although the exact mechanisms that lead to degenerative disc disease (DDD) are not well understood, a significant genetic influence has been found. Focusing on DDD that occurs in young adults can be valuable in determining the exact role of genetic predisposition to DDD. Methods: Patients (<40 years) with lumbar disc degeneration were evaluated with MRI imaging (1.5 Tesla) and genetic association analysis for 58 single nucleotide polymorphism (SNP) of 35 candidate genes was performed. Disc degeneration of individual discs of lumbar spine from L1 to S1 was graded by Pfirrmann's grading. The subjects were stratified into two groups based on Total Disc Degenerative Score (TDDS). Based on TDDS, the severity of DDD was classified as mild (Group A: TDDS <10) and severe (Group B: TDDS >10). Results: 695 Indian subjects including 308 with mild TDDS and 387 with severe TDDS were studied. The mean age of the patients was 29.6 ± 6.9 years in group A and 31.7 ± 6.1 in group B ( p < 0.05). Five of the 35 candidate genes viz., rs1337185 of COL11A ( p = 0.02), rs5275 ( p = 0.03) and rs5277 ( p = 0.05) of COX2, rs7575934 of IL1F5 ( p = 0.04), rs3213718 of CALM1 ( p = 0.04) and rs162509 of ADAMTS5 ( p = 0.04) were found to be significantly associated with severe TDDS. Conclusion: The study identifies specific SNP associations of five genes in young adults with severe lumbar disc degeneration. These five genes ( COL11A1, ADAMTS5, CALM1, IL1F5and COX2) have different functions in the matrix metabolism, intracellular signalling and inflammatory cascade. This shows that disc degeneration is a complex disease with an intricate interplay of multiple genetic polymorphisms. [ABSTRACT FROM AUTHOR]

Patients with Modic changes form a distinct clinical subset with reports of higher intensity of pain, poor clinical and surgical outcomes and higher incidence of recurrence. MC also is an independent risk factor for increased postoperative surgical site infection. This study aimed to investigate the biological changes at molecular level, in discs with Modic changes. Experimental analysis. Nucleus pulposus (NP) from 24 patients undergoing microdiscectomy for disc herniation [14 discs with Modic changes and 10 without Modic changes] were procured. The overall expression of proteins, biological processes, protein-protein and metabolite interactions were analyzed and compared. Host defense response proteins (HDRPs) and immunological pathways activated in patients with Modic changes were documented and analyzed. Label-free proteomic approach with stringent filters revealed a total of 208 proteins in Modic changes and 193 in non-Modic change groups. Forty-five proteins were specific to Modic changes; 30 to non-Modic changes and 163 common to both. Downregulated proteins in Modic changes belonged to components of extracellular matrix such as collagens (COL- 6A1, 6A2, 6A3, 11A1, 12A1, and 20A1), and proteoglycans (versican [VCAN], and biglycan [BGN]). Inflammatory molecules [plasminogen (PLG), angiogenin (ANG), fibroblast growth factor-binding protein 2 (FGFBP2), tetranectin (CLEC3B), cartilage acidic protein 1(CRTAC1), kininogen (KNG1), chitinase-3-like protein 2 (CHI3L2), and ferritin (FTL) were expressed only in the Modic changes group. The significantly altered pathways in Modic changes included Fc Fragment of IgG Receptor IIIa (FCGR3A)-mediated phagocytosis, regulation of Toll-like receptors (TLR) by endogenous ligand, neutrophil and platelet degranulation. 50 HDRPs were identified in the study, 14 of which were specific to Modic changes and included acute phase reactants, antimicrobial peptides, complement cascade proteins, inflammatory molecule and stress response proteins. Metabolite-protein interaction analysis revealed a significant interaction between 19 proteins, specifically involving ubiquitin mediating proteasome degradative pathway and an association with the metabolite-glutamic acid in the Modic changes group. Accumulation of glutamic acid in Modic changes discs was confirmed by quantitative amino acid analysis using High-performance liquid chromatography. Our study confirms that Modic changes represent an intense inflammatory status due to activation of host defense response and immunological pathways. Downstream effects leading to ubiquitin mediated proteasomal degradation of ECM proteins and the resulting metabolites such as glutamic acid could cause excessive pain and needs further investigation. Clinical Significance: We have documented the expression of inflammatory molecules, immune mechanisms and host defense response proteins which throw molecular insights into the pathological mechanisms of Modic changes. Further, ubiquitin mediated proteasomal degradation and accumulation of glutamate in discs with Modic changes might serve as targets for molecular therapy. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Thyroglossal duct cysts are most commonly occurring congentinal midline swellling of the neck. Usually carcinomas in thyroglossal duct cysts is extremely rare, commonly being papillary carcinomas. However, the diagnosis is only made postoperatively after excision of the cyst. Although the Sistrunk procedure is often regarded as adequate but controversies exist, the need for thyroidectomy based on histopathological findings. This is a case report of 43-year-old male presented with swelling in the midline of the neck for one year. On examination, a cystic swelling was present in the midline of the anterior aspect of the neck. USG neck revealed heteroechoic cystic lesion with solid component and microcalcifications present within the cyst suggestive of thyroglossal duct cyst probably neoplastic. The mass was surgically excised and sent for histopathological examination and reported as Thyroglossal duct cyst with papillary carcinoma of thyroid. Appropriate history, clinical examination and investigation leads to the correct diagnosis and treatment. Incomplete removal of the mass leads to recurrence. Histopathological examination is must postoperatively. The patients is still on follow-up and no recurrence have been noted. [ABSTRACT FROM AUTHOR]

Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficit. Controversies exist regarding the appropriate radiological investigations, the indications for surgical management and the timing, approach and type of surgery. This review provides an overview of the epidemiology, biomechanical principles, radiological and clinical evaluation, classification and management principles. Literature review of all relevant articles published in PubMed covering thoracolumbar spine fractures with or without neurologic deficit was performed. The search terms used were thoracolumbar, thoracic, lumbar, fracture, trauma and management. All relevant articles and abstracts covering thoracolumbar spine fractures with and without neurologic deficit were reviewed. Biomechanically the thoracolumbar spine is predisposed to a higher incidence of spinal injuries. Computed tomography provides adequate bony detail for assessing spinal stability while magnetic resonance imaging shows injuries to soft tissues (posterior ligamentous complex [PLC]) and neurological structures. Different classification systems exist and the most recent is the AO spine knowledge forum classification of thoracolumbar trauma. Treatment includes both nonoperative and operative methods and selected based on the degree of bony injury, neurological involvement, presence of associated injuries and the integrity of the PLC. Significant advances in imaging have helped in the better understanding of thoracolumbar fractures, including information on canal morphology and injury to soft tissue structures. The ideal classification that is simple, comprehensive and guides management is still elusive. Involvement of three columns, progressive neurological deficit, significant kyphosis and canal compromise with neurological deficit are accepted indications for surgical stabilization through anterior, posterior or combined approaches. [ABSTRACT FROM AUTHOR]

The antiepileptic activity of ethanolic extract from the roots of Parthenium hysterophorus L. on maximal electroshock (MES) or pentylenetetrazole (PTZ) in male mice examined in this study. This medicinal plant belongs to the Asteraceae family and the roots are popularly used in the treatment of bitter tonic, febrifuge, emmenagogue, antidyscentric, etc The extract of Parthenium hysterophorus (orally) was administered in mice at the doses of 250 and 500 mg/kg. The Extract suppressed hind limb tonic extensions (HLTE) induced by MES and also exhibited protector effect in PTZinduced seizures, at 500 mg/kg dose. Since the ethanolic extract of Parthenium hysterophorus delayed the occurrence of MES and PTZ convulsions, it is concluded that it interfere with gabaergic mechanism(s) to exert their anticonvulsant effect. The levels of biogenic amines such as dopamine, serotonin and nor-adrenaline in the fore brain region were also estimated and a significant level of restoration was observed in the extract treated animals. Significant results were observed in the estimated parameters thereby justifying the use of these medicinal plants in the treatment of epilepsy. [ABSTRACT FROM AUTHOR]

Study Design. A prospective observational analysis of diffusion tensor imaging (DTI) datametrics collected from control and patients with cervical spondylotic myelopathy (CSM). Objective. The aims were to study the use of DTI in CSM and to probe whether DTI datametrics and tractography will correlate with magnetic resonance imaging and clinical findings. Summary of Background Data. Magnetic resonance imaging is the current "gold standard" in the assessment of cord status in CSM; however, various parameters such as extent of compression and presence of signal intensity changes do not correlate well with clinical status. DTI is a novel investigation tool with proven applications in brain pathologies but is not routinely used in spinal cord evaluation. Methods. Patients with CSM (n = 35) who required surgical decompression (mean age = 48 yr) and 40 normal individuals (mean age = 38 yr) were included. Diffusion Tensor Imaging of the cervical spine was obtained using a 1.5T magnetic resonance image. Apparent diffusion coefficient, fractional anisotropy, and eigenvalues (E1, E2, and E3) were obtained at each cervical level. The DTI datametrics of CSM patients were compared with normal volunteers and correlated with individual and grouped Nurick grades, which indicate the neurological status of patients. Results. There was significant difference in DTI datametrics between patients with myelopathy and control (P < 0.05), with decrease in fractional anisotropy (0.49 ± 0.081 vs. 0.53 ± 0.07) and increase in apparent diffusion coefficient (1.8 ± 0.31 5 vs. 1.44 ± 0.145) and eigenvalues (El: 2.82 ± 0.395 vs. 2.37 ± 0.221, E2: 1.64 ± 0.39 vs. 1.1 8 ± 0.198, E3: 0.956 ± 0.277 vs. 0.76 ± 0.142). There was also a significant difference between increasing grades of myelopathy when individuals were grouped as--control, self-ambulant (Nurick grades 1 and 2), and dependent (Nurick grades 3, 4, and 5). Conclusion. The study shows that DTI is a promising and useful investigational tool in evaluation of CSM. There was a significant difference in all DTI values between control and patients with CSM, and there was a significant trend of change in values between control, self-ambulant, and dependent patients. Our results encourage further investigation of this important modality. [ABSTRACT FROM AUTHOR]

Introdutcion: Idiopathic palsy of facial nerve is an acute disease which causes lower motor neuron palsy characterised by facial asymmetry leads to psychological effects and limits one's social life. Steroids are very effective in the management of Bell's palsy. The usage of antiviral is still in debate due to the idiopathic aetiology of Bell's palsy. Aim: To evaluate the efficacy of acyclovir with steroid and steroid alone in the management of Bell's palsy with respect to the recovery time. Materials and Methods: The randomised double-blinded study was conducted in the Department of Otorhinolaryngology, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India, from September 2021 to February 2022 among 100 patients with idiopathic facial nerve palsy. Patients were divided into two groups, 50 patients in each. One group treated with acyclovir (400 mg oral five times daily) and methylprednisolone (1 mg/kg/ day), and other group treated with steroid alone. Both the groups received physiotherapy in the Department of Physiotherapy and taught about home facial exercises. The patients were on regular follow-up for 6 months to monitor the time of the recovery. House-Brackmann grading system was used for initial assessment and monitor the recovery of the patient. The improvement of House-Brackmann grade to I or II was considered a satisfactory recovery. The association between two groups were assessed by Chi-square test (χ²), repeated measures and paired t-test. The statistical significance was considered when p-value<0.05. Results: Out of 100 patients, 52 patients were male and 48 were female, while the age range was 19-58 years. At 2 months, 43 (86%) patients recovered in the combination group and 41 (82%) in the steroid alone group (p-value=0.0038). At 6 months, 48 (96%) patients recovered in the combination group and 42 (84%) in the steroid alone group (p-value=0.178). The overall recovery rate was higher in the combination group (96%) compared to steroid alone group (84%). Conclusion: The combination of acyclovir with steroids in the treatment of Bell's palsy has better recovery compared to steroid alone therapy. [ABSTRACT FROM AUTHOR]

The present study was designed to investigate the hypolipidemic effect of Acalypha indica Linn . Leaves extracts in Atherogenic diet induced hyperlipidemia. Aqueous and ethanolic extracts of leaves of Acalypha indica Linn. were administered in doses of 400mg/kg /day p.o. each for 10 days. Simultaneous administration of Acalypha indica Linn. leaves extracts significantly (p<0.001) prevent the rise in serum levels of total cholesterol, triglyceride, LDL-C,VLDL-C and Atherogenic index whereas significant (p<0.01) increases in the level of HDL-C. [ABSTRACT FROM AUTHOR]

Study Design. A prospective randomized controlled trial. Objective. To assess the ability of local vancomycin powder in controlling postoperative infection in spine surgery. Summary of Background Data. Despite improvements through the use of prophylactic systemic antibiotics, surgical site infections remain a significant problem in spine surgical procedures. Various retrospective and prospective studies have reported the efficacy of local application of vancomycin powder in reducing the infection in animal and human studies. However, there were no randomized control trials that reported on its efficacy. Methods. Prospective randomized controls of 907 patients with various spinal pathologies were treated surgically during a period of 18 months. The control group received standard systemic prophylaxis only, whereas the treatment group received vancomycin powder in the surgical wound in addition to systemic prophylaxis. Patient demographics, comorbidities, level of spinal pathology, estimated blood loss, nutritional status, and hemoglobin were recorded. Incidence of infection was the primary outcome evaluated. Results. There were 8 infections (1.68%) in the control group (6 instrumented and 2 noninstrumented, 6 deep and 2 superficial) with bacteria cultured in 3 (1 Escherichia coil and 2 Staphylococcus aureus). In the treatment group, 7 infections (1.61 %) were observed (6 instrumented and 1 noninstrumented surgical procedures, 6 deep and 1 superficial) with bacteria cultured in 3 (1 Staphylococcus aureus and 2 Klebsiella). No adverse effects were observed from the use of vancomycin powder. Statistically no significant difference was seen in infection rate between the treatment group and control group. Conclusion. The local application of vancomycin powder in surgical wounds did not significantly reduce the incidence of infection in patients with surgically treated spinal pathologies. The use of vancomycin powder may not be effective when incidence of infection is low. [ABSTRACT FROM AUTHOR]

Abstract: Background context: Although the influence of genetics on the process of disc degeneration is well recognized, in recently published studies, there is a wide variation in the race and selection criteria for such study populations. More importantly, the radiographic features of disc degeneration that are selected to represent the disc degeneration phenotype are variable in these studies. The study presented here evaluates the association between single nucleotide polymorphisms (SNPs) of candidate genes and three distinct radiographic features that can be defined as the degenerative disc disease (DDD) phenotype. Purpose: The study objectives were to examine the allelic diversity of 58 SNPs related to 35 candidate genes related to lumbar DDD, to evaluate the association in a hitherto unevaluated ethnic Indian population that represents more than one-sixth of the world population, and to analyze how genetic associations can vary in the same study subjects with the choice of phenotype. Study design: A cross-sectional, case-control study of an ethnic Indian population was carried out. Methods: Fifty-eight SNPs in 35 potential candidate genes were evaluated in 342 subjects and the associations were analyzed against three highly specific markers for DDD, namely disc degeneration by Pfirrmann grading, end-plate damage evaluated by total end-plate damage score, and annular tears evaluated by disc herniations and hyperintense zones. Genotyping of cases and controls was performed on a genome-wide SNP array to identify potential associated disease loci. The results from the genome-wide SNP array were then used to facilitate SNP selection and genotype validation was conducted using Sequenom-based genotyping. Results: Eleven of the 58 SNPs provided evidence of association with one of the phenotypes. For annular tears, rs1042631 SNP of AGC1 and rs467691 SNP of ADAMTS5 were highly significantly associated (p<.01) and SNPs in NGFB, IL1B, IL18RAP, and MMP10 were also significantly associated (p<.05). The rs4076018 SNP of NGFB was highly significant (p<.01) and rs2292657 SNP of GLI1 was significantly (p<.05) correlated to disc degeneration. For end-plate damage, the rs2252070 SNP of MMP 13 showed a significant association (p<.05). Previously associated genes such as COL 9, SKT, CHST 3, CILP, IGFR, SOXp, BMP, MMP 2-12, ADH2, IL1RN, and COX2 were not significantly associated and new associations (NGFB and GLI1) were identified. The validity of all the associations was found to be phenotype dependent. Conclusions: For the first time, genetic associations with DDD have been performed in an Indian population. Apart from identifying new associations, the highlight of the study was that in the same study population with DDD, SNP associations completely changed when different radiographic features were used to define the DDD phenotype. Our study results therefore indicate that standardization of the phenotypes chosen to study the genetics of disc degeneration is essential and should be strongly considered before planning genetic association studies. [Copyright &y& Elsevier]

Study Design. Prospective, randomized controlled study. Objective. To compare the functional outcomes and extent of paraspinal muscle damage between 2 decompressive techniques for lumbar canal stenosis. Summary of Background Data. Lumbar spinous process splitting decompression (LSPSD) preserves the muscular and ligamentous attachments of the posterior elements of the spine. It can potentially avoid problems such as paraspinal muscle atrophy and trunk extensor weakness that can occur after conventional midline decompression. However, large series prospective randomized controlled studies are lacking. Methods. Patients with lumbar canal stenosis were randomly allocated into 2 groups: LSPSD (28 patients) and conventional midline decompression (23 patients). The differences in operative time, blood loss, time to comfortable mobilization, and hospital stay were studied. Paraspinal muscle damage was assessed by postoperative rise in creatine phosphokinase and C-reactive protein levels. Functional outcome was evaluated at 1 year by Japanese Orthopaedic Association score, neurogenic claudication outcome score, and visual analogue scale for back pain and neurogenic claudication. Results. Fifty-one patients of mean age 56 years were followed-up for a mean 14.2 ± 2.9 months. There were no significant differences in the operative time, blood loss, and hospital stay. Both the groups showed significant improvement in the functional outcome scores at 1 year. Between the 2 groups, the Japanese Orthopaedic Association score, neurogenic claudication outcome score improvement, visual analogue scale for back pain, neurogenic claudication visual analogue scale, and the postoperative changes in serum C-reactive protein and creatine phosphokinase levels did not show any statistically significant difference. On the basis of the Japanese Orthopaedic Association recovery rate, it was found that 73.9% of conventional midline decompression group had good outcomes compared with only 60.7% after LSPSD. Conclusion. The functional outcome scores, back pain, and claudication pain in the immediate period and at the end of 1 year are similar in both the techniques. More patients had better functional outcomes after conventional decompression than the LSPSD technique. On the basis of this study, the superiority of one technique compared with the other is not established, mandating the need for further long-term studies. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: A prospective multimodal study including clinical, radiological, serial postcontrast magnetic resonance imaging, intraoperative findings, and histopathological study. OBJECTIVE: To document in vivo, the site of anatomical failure in lumbar disc herniation (LDH). SUMMARY OF BACKGROUND DATA: Although in vitro mechanical disruption studies have implicated both the endplate junction (EPJ) and the annulus fibrosus (AF) as the site of failure in LDH, there are no in vivo human studies to document the exact anatomy of failure. METHODS: One hundred eighty-one consecutive patients requiring microdiscectomy at a single level formed the study group. The status of the endplate and AF in the operated level (study discs) and the other discs (control) were evaluated by plain radiograph, thin slice computed tomographic scan, plain and contrast magnetic resonance imaging, intraoperative examination, and histopathological analysis. RESULTS: LDH due to EPJ failure (EPJF- type I herniation) was more common (117; 65%) than annulus fibrosis rupture. Herniated discs had a significantly higher incidence of EPJF than control discs (P < 0.0001). The EPJF was evident radiologically as vertebral corner defect in 30 patients, rim avulsion in 46, frank bony avulsions in 24, and avulsion at both upper and lower EP in 4. Thirteen discs with normal EP radiologically had cartilage or bone avulsion intraoperatively. Sixty-four discs (35%) had intact EP of which annular high intensity zone was found in 21 (11%), suggesting a disruption of AF (type II herniation). Postcontrast magnetic resonance image of 20 patients showed dye leak at the EPJ proving EPJF as main cause of LDH. CONCLUSION: Our study provides the first in vivo evidence that LDH in humans is more commonly the result of EPJF than AF rupture and offers clinical validation of previous in vitro mechanical disruption studies. Future research must focus on the EPJ as a primary area of interest in LDH.Level of Evidence: N/A. [ABSTRACT FROM AUTHOR]

Study Design. A prospective multimodal study including clinical, radiological, serial postcontrast magnetic resonance imaging, intraoperative findings, and histopathological study. Objective. To document in vivo, the site of anatomical failure in lumbar disc herniation (LDH). Summary of Background Data. Although in vitro mechanical disruption studies have implicated both the endplate junction (EPJ) and the annulus fibrosus (AF) as the site of failure in LDH, there are no in vivo human studies to document the exact anatomy of failure. Methods. One hundred eighty-one consecutive patients requiring microdiscectomy at a single level formed the study group The status of the endplate and AF in the operated level (study discs) and the other discs (control) were evaluated by plain radiograph, thin slice computed tomographic scan, plain and contrast magnetic resonance imaging, intraoperative examination, and histopathological analysis Results. LDH due to EPJ failure (EPJF-type I herniation) was more common (117; 65%) than annulus fibrosis rupture. Herniated discs had a significantly higher incidence of EPJF than control discs (P < 0.0001). The EPJF was evident radiologically as vertebral corner defect in 30 patients, rim avulsion in 46, frank bony avulsions in 24, and avulsion at both upper and lower EP in 4. Thirteen discs with normal EP radiologically had cartilage or bone avulsion intraoperatively. Sixty-four discs (35%) had intact EP of which annular high intensity zone was found in 21 (11%), suggesting a disruption of AF (type II herniation). Postcontrast magnetic resonance image of 20 patients showed dye leak at the EPJ proving EPJF as main cause of LDH. Conclusion. Our study provides the first in vivo evidence that LDH in humans is more commonly the result of EPJF than AF rupture and offers clinical validation of previous in vitro mechanical disruption studies. Future research must focus on the EP/as a primary area of interest in LDH. [ABSTRACT FROM AUTHOR]

Histopathological examination was suggestive of pyocele with calcification.{Figure 1}{Figure 2}{Figure 3} Conflicts of Interest: None. X-ray showed enlarged right testis with bilateral testicular peripheral rim calcification [Figure 1]. A 78 yr old male† patient came to the department of General Surgery, Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India, in August 2019, with complaints scrotal swelling of the right side for the past five years with initial size of 3 × 3 cm which gradually increased to 8 × 6 cm. The swelling was hard in consistency and the testis was not palpable skin rugosity was also present. [Extracted from the article]

Although the discovery of effective anti-tuberculosis drugs has made uncomplicated spinal tuberculosis a medical disease, the advent of multi-drug-resistant Mycobacterium tuberculosis and the co-infection of HIV with tuberculosis have led to a resurgence of the disease recently. The principles of drug treatment of spinal tuberculosis are derived from our experience in treating pulmonary tuberculosis. Spinal tuberculosis is classified to be a severe form of extrapulmonary tuberculosis and hence is included in Category I of the WHO classification. The tuberculosis bacilli isolated from patients are of four different types with different growth kinetics and metabolic characteristics. Hence multiple drugs, which act on the different groups of the mycobacteria, are included in each anti-tuberculosis drug regimen. Prolonged and uninterrupted chemotherapy (which may be 'short course' and 'intermittent' but preferably 'directly observed') is effective in controlling the infection. Spinal Multi-drug-resistant TB and spinal TB in HIV-positive patients present unique problems in management and have much poorer prognosis. Failure of chemotherapy and emergence of drug resistance are frequent due to the failure of compliance hence all efforts must be made to improve patient compliance to the prescribed drug regimen. [ABSTRACT FROM AUTHOR]

The natural history of Pott's kyphosis is different from that of other spinal deformities. After healing of the spinal infection, the post-tubercular kyphosis in adults is static but in children variable progression of the kyphosis is seen. The changes occurring in the spine of children, after the healing of the tubercular lesion, are more significant than the changes that occur during the active stage of infection. During growth, there is a decrease in deformity in 44 % of the children, an increase in deformity in 39 % of the children and no change in deformity in 17 % of the children. The critical factor leading to the progress of the deformity is dislocation of the facets. This can be identified on radiographs by the "Spine-at-risk" signs. Dislocation of facets at more than two levels can lead to the "Buckling collapse" of the spine, which is characteristically seen only in severe tubercular kyphosis in children. Age below 10 years, vertebral body loss of more than 1-1.5 pre-treatment deformity angle of greater than 30° and involvement of cervicothoracic or thoracolumbar junction are the other risk factors for deformity progression. In children, the kyphosis can progress even after healing of the spinal infection and hence children with spinal tuberculosis must be followed-up till skeletal maturity. [ABSTRACT FROM AUTHOR]