Role of pinch in Argon impurity transport in ohmic discharges of Aditya-U Tokamak

We present experimental results of the trace argon impurity puffing in the ohmic plasmas of Aditya-U tokamak performed to study the argon transport behaviour. Argon line emissions in visible and Vacuum Ultra Violet (VUV) spectral ranges arising from the plasma edge and core respectively are measured simultaneously. During the experiments, space resolved brightness profile of Ar1+ line emissions at 472.69 nm (3p44s 2P3/2-3p44p 2D3/2), 473.59 nm (3p44s 4P5/2-3p44p 4P3/2), 476.49 nm (3p44s 2P1/2-3p44p 2P3/2), 480.60 nm (3p44s 4P5/2-3p44p 4P5/2) are recorded using a high resolution visible spectrometer. Also, a VUV spectrometer has been used to simultaneously observe Ar13+ line emission at 18.79 nm (2s22p 2P3/2-2s2p2 2P3/2) and Ar14+ line emission at 22.11 nm (2s2 1S0-2s2p 1P1). The diffusivity and convective velocity of Ar are obtained by comparing the measured radial emissivity profile of Ar1+ emission and the line intensity ratio of Ar13+ and Ar14+ ions, with those simulated using the impurity transport code, STRAHL. Argon diffusivities ~ 12 m2/s and ~ 0.3 m2/s have been observed in the edge (ρ > 0.85) and core region of the Aditya-U, respectively. The diffusivity values both in the edge and core region are found to be higher than the neo-classical values suggesting that the argon impurity transport is mainly anomalous in the Aditya-U tokamak. Also, an inward pinch of ~ 10 m/s mainly driven by Ware pinch is required to match the measured and simulated data. The measured peaked profile of Ar density suggests impurity accumulation in these discharges.

Enhanced etching characteristics of Si{100} in NaOH-based two-component solution

Silicon wet bulk micromachining is the most widely used technique for the fabrication of diverse microstructures such as cantilevers, cavities, etc. in laboratory as well as in industry for micro-electromechanical system (MEMS) application. Although, increasing the throughput remains inevitable, and can be done by increasing the etching rate. Furthermore, freestanding structure release time can be reduced by the improved undercutting rate at convex corners. In this work, we have investigated the etching characteristics of a non-conventional etchant in the form of hydroxylamine (NH2OH) added sodium hydroxide (NaOH) solution. This research is focused on Si{100} wafer as this orientation is largely used in the fabrication of planer devices (e.g., complementary metal-oxide semiconductors) and microelectromechanical systems (e.g., inertial sensors). We have performed a systematic and parametric analysis without and with 12% NH2OH in 10 M NaOH for improved etching characteristics such as etch rate, undercutting at convex corners, and etched surface morphology. 3D scanning laser microscope is used to measure average surface roughness (Ra), etch depth (d), and undercutting length (l). Morphology of the etched Si{100} surface is examined using optical and scanning electron microscopes. The addition of NH2OH in NaOH solution remarkably exhibited a two-fold increment in the etching rate of a Si{100} surface. Furthermore, the addition of NH2OH significantly improves the etched surface morphology and undercutting at convex corners. Undercutting at convex corners is highly prudent for the quick release of microstructures from the substrate. In addition, we have studied the effect of etchant age on etching characteristics. Results presented in this article are of large significance for engineering applications in both academic and industrial laboratories.

Initial results from time-resolved LaBr based hard x-ray spectrometer for ADITYA-U tokamak

Runaway electrons (REs) are passively studied by hard x-ray (HX) emissions generated by REs. A LaBr₃(Ce) detector-based HX spectroscopic diagnostic (operational within ∼75 keV to 3.5 MeV) has been set up on the ADITYA-U. The diagnostic acquisition software utility is upgraded to obtain the temporal evolution of the HX spectrum to understand the RE energy distribution in plasma during its various phases. The peak position moves to lower energy for Ohmically heated discharges (200-80 keV), indicating a relative increase in the thermal particle content in the plasma. The peak position of RE energy shows a decreasing tendency with increasing n_e with Ne gas puffing and termination of the electron cyclotron resonance pulse.

Recovery of Long Standing Neurological Deficit in Pediatric Dorsal Spinal Tuberculosis: A Single Center Experience of 13 Cases

STUDY DESIGN

Retrospective analysis of case series.

OBJECTIVE

The aim is to study the recovery of neurological deficit in pediatric spinal tuberculosis cases presenting to us more than 6 months after onset of motor weakness in lower limbs.

METHODS

This is a retrospective analysis of 13 consecutive patients of pediatric spinal tuberculosis presenting to us at least 6 months after the onset of neurologic deficit. All these patients underwent surgical intervention at our center and their neurological recovery was noted in terms of improvement in Frankel grading and spasticity improvement by modified Ashworth scale. All the patients were followed up to at least 18 months post op and final neurologic status was assessed at that time.

RESULTS

The mean age of the patients at presentation was 8.5 years. The mean duration of neurologic deficit at the time of presentation was 10.23 months (6-24 months). Seven patients had a Frankel grade B at presentation out of which 6 improved to Frankel grade D and one improved to Frankel C at final follow up. Out of the other 3 patients with Frankel A at presentation, 2 improved to Frankel grade D and 1 to Frankel grade C. The remaining 3 patients presented with Frankel grade C at presentation, 2 improved to Frankel D and one improved to Frankel E at the time of final follow up.

CONCLUSION

Neurologic recovery in patients with neurological deficit is possible even in cases of long standing deficit more than 6 months and in some cases upto 24 months as shown in our study.

Pattern of Drug Resistance in Primary Spinal Tuberculosis: A Single-Center Study From India

STUDY DESIGN

Retrospective observational analysis.

OBJECTIVES

Spinal tuberculosis accounts for about 50% of cases among extra pulmonary osteoarticular tuberculosis. Resistance to drugs in spinal tuberculosis patients is on a rise and there is inadequate literature concentrating on the precise pattern of resistance in Indian subcontinent which harbors 24% of global prevalence. The aim was to study the pattern of drug resistance in spinal tuberculosis among first- and second-line drugs. Drug resistance is common in spinal tuberculosis and we intended to find the prevalence of various drug resistance patterns.

METHODS

Patients with spinal tuberculosis visiting a tertiary center were assessed. Samples were taken from the affected vertebrae and sent for BACTEC mycobacterium growth indicator tube (MGIT) 960 culture. Patients with a positive growth in MGIT were included in the study. All previously treated patients (relapse, treatment after failure, treatment after loss to follow-up and other previously treated patients) were excluded.

RESULTS

A total of 150 patients with a positive growth in MGIT report were included in the study, of whom 43 patients had some kind of drug resistance. Seven were multidrug resistant (MDR), 9 had preextensive drug resistance (pre-XDR), and 4 had extensive drug resistance (XDR). Seventeen patients had mono-drug resistance, which was most frequently for isoniazid. Resistance among second-line drugs was common in the fluoroquinolone group.

CONCLUSION

Drug resistance in spinal tuberculosis was found to be 28.6%. Of these, MDR was in 16.2%, pre-XDR in 20.9%, and XDR in 9.3% patients.

Bilateral Transcervical Femur Neck Fracture in a Case of Pseudohypoparathyroidism: A Rare Case Report and Review of Literature

Introduction:

Pseudohypoparathyroidism (PHP) is an uncommon metabolic bone disorder characterized by biochemical hypocalcemia, hyperphosphatemia and raised parathyroid hormone (PTH), and target tissue unresponsiveness to the biological actions of PTH. In addition, many patients with PHP exhibit a distinctive constellation of developmental and skeletal defects.

Case Report:

An 11-year-old girl was brought to emergency pediatric department for the assessment of fever with generalized tonic-clonic seizure (GTCS) with inability to walk. She had hypocalcemia and hyperphosphatemia. The diagnosis of PHP was made and was started on Vitamin D3 and oral calcium. Physical examination revealed no dysmorphic features. Biochemical investigations revealed normal complete blood count, liver and renal functions, and arterial blood gas. However, serum PTH was high with slightly decreased Vitamin D3.

Conclusion:

As per our knowledge, this is the first reported case in literature of bilateral pathological transcervical neck femur fracture in a case of PHP following episode of GTCS. Multidisciplinary team approach with the involvement of pediatrician, endocrinologist, and orthopedic surgeon and devising a plan after thorough workup keeping in mind the infrequent presentations of hypoparathyroidism and adequate pre-operative optimization helps provide appropriate management of this rare presentation. This case report was prepared following the CARE guidelines.

Practical consensus recommendations on management of HR + ve early breast cancer with specific reference to genomic profiling

Breast cancer is a heterogeneous disease and patients are managed clinically based on ER, PR, HER2 expression, and key risk factors. The use of gene expression assays for early stage disease is already common practice. These tests have found a place in risk stratifying the heterogeneous group of stage I–II breast cancers for recurrence, for predicting chemotherapy response, and for predicting breast cancer-related mortality. Most guidelines for hormone receptor (HR)–positive early breast cancer recommend addition of adjuvant chemotherapy for most women, leading to overtreatment, which causes considerable morbidity and cost. Expert oncologist discussed about strategies of gene expression assays and aid in chemotherapy recommendations for treatment of HR + ve EBC and the expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

Outcome Analysis of Anterior Reconstruction with Rib Grafts in Tuberculosis of the Thoracic Spine

Introduction:

Tricortical iliac bone is the gold standard as an autograft for the reconstruction of the anterior column in tuberculosis (TB) of the thoracic spine. However, the quantity of graft needed is significant. It creates a considerable defect in the pelvic bone, causing graft site complications, including pain, pelvic instability, fractured ilium, herniated muscle, or abdominal contents. To prevent these donor site morbidities, ribs that were removed during the versatile approach were used for anterior reconstruction. The aim of this study was to assess the clinical and radiological results of the reconstruction of the anterior column of the spine with the help of an excised rib during the versatile approach.

Subjects and Methods:

This retrospective study was undertaken at a tertiary care center with a study duration of 14 years. Between January 2004 and December 2016, 52 patients with thoracic Koch's spine had anterior column reconstructed with multiple rib grafts. A single surgeon performed all operations. Indications for the surgery in these patients were the presence of neurologic deficit (49 patients) and vertebral column instability (3 patients). The preoperative kyphosis angle and visual analog scale (VAS) score were compared with postoperative values using a paired t-test.

Results:

All patients underwent a minimum follow-up of 18 months and were evaluated clinicoradiologically. Good bony fusion with neurological recovery was achieved in all cases. The VAS score for back pain improved significantly postsurgery. There was one case of graft buckling treated conservatively.

Discussion:

Appropriate anterior reconstruction forms the cornerstone of successful surgical management of spinal TB. The “Versatile approach” used offers anterior and posterior access in the lateral position. In these patients, we obviated the need for iliac crest graft using multiple segments of the rib for anterior column reconstruction. This meticulous rib grafting technique gives good functional outcome in terms of solid bony fusion.

Conclusion:

Meticulous rib grafting technique gives 360° bony fusion and good functional outcome in surgery for thoracic spinal TB. It has the advantage of avoiding the complications associated with a tricortical iliac crest graft.

An integrated 3D fluidic device with bubble guidance mechanism for long-term primary and secondary cell recordings on multi-electrode array platform

A 3D fluidic device (3D-FD) is designed and developed with the capability of auto bubble guidance via a helical pathway in a 3D geometry. This assembly is integrated to a multi-electrode array (MEA) to maintain secondary cell lines, primary cells and primary retinal tissue explants of chick embryos for continuous monitoring of the growth and electrophysiology recording. The ability to maintain the retinal tissue explant, extracted from day 14 (E-14) and day 21 (E-21) chick embryos in an integrated 3D-FD MEA for long duration (>100 h) and study the development is demonstrated. The enhanced duration of monitoring offered by this device is due to the controlled laminar flow and the maintenance of a stable microenvironment. The spontaneous electrical activity of the retina, including the spike recordings from the retinal ganglion layer, was monitored over a long duration. Specifically, the spiking activity in embryonic chick retinas of different days (E-14 to 21) is studied, and the presence of light-stimulated firings along with a distinct electroretinogram for E-21 mature retina provides the evidence of a stable microenvironment over a sustained period.

Management of congenital craniovertebral anomalies: a single-centre experience of 71 cases by an algorithmic approach

STUDY DESIGN

Retrospective study.

OBJECTIVE

Congenital craniovertebral (CV) anomalies include a wide variety of conditions involving basilar invagination (BI), atlantoaxial dislocation (AAD), bony congenital anomalies and Chiari malformation. The management of these disorders is more surgeon dependent rather than based on clear guidelines. This study aims to provide a step-by-step algorithmic approach to the management of congenital CV anomalies to achieve good CV alignment, neural recovery and long lasting stability.

MATERIALS

The study retrospectively analyses 71 patients of congenital CV anomalies treated by our algorithmic approach. Clinical assessment was done with the help of Nurick's grading pre- and post-operatively. Radiological outcome was assessed by plain radiographs, and computed tomographic scan was done at 12-month follow-up.

RESULTS

Mean age at presentation was 17.9 years (6-41 years). Mean Nurick score pre-operatively was 3.8 which was reduced to 1.3 at a mean follow-up of 13.6 months. Sixty-one patients had type I BI, 6 had type II BI, and 4 patients had os odontoideum. Most common symptom at presentation was weakness in limbs, neck pain and difficulty in walking. Patients of isolated AAD with os odontoideum required posterior atlantoaxial fixation and fusion only. Thirty-two patients of type I BI and 4 patients of type II BI required anterior release procedures prior to occipitocervical instrumentation. Bony fusion was achieved in 96% (68) cases with the help of autologous bone grafting. Three patients of occipitocervical fusion developed pseudoarthrosis.

CONCLUSION

Our retrospective analysis demonstrates that the algorithm is effective in ensuring long lasting results in all types congenital CV anomalies.

Does kyphosis in healed subaxial cervical spine tuberculosis equate to a poor functional outcome?

Introduction:

Tuberculosis (TB) of the subaxial cervical spine has a high percentage of morbidity. It accounts for about 10% of cases with the major concerns being quadriparesis and localized kyphosis.

Aim:

The study aims to provide an insight in the management of subaxial cervical spine TB treated by multiple modalities.

Materials and Methods:

A retrospective analysis of 91 patients with subaxial cervical (C3–C7) TB was performed. Neurology was assessed by Nurick's grading and pain using the visual analog scale (VAS) (in mm). Radiological evaluation was done with standard anteroposterior and lateral view of the cervical spine at presentation and 3 monthly intervals after intervention. Magnetic resonance imaging was done in all patients. Angle of kyphosis (K angle) was calculated from plain radiographs.

Results:

Mean age of the patients was 31.5 years. Neurological status was Nurick's Grade 5 in 8, Grade 4 in 15, Grade 3 in 28, Grade 2 in 22, Grade 1 in 7, and further 11 had Nurick's Grade 0. Operative intervention was either anterior, or posterior, or a combination of both depending on extent of vertebral destruction. All patients with Nurick's 5 and 4 improved to 3 or less at final follow-up. The kyphosis angle at presentation ranged from 2° to 58° of with an average kyphosis of 16.05°. The postoperative kyphosis was graded as mild (loss of lordosis to 10° kyphosis), moderate (10°–30°), and severe (>30°). Ten patients had mild kyphosis and 6 patients had moderate kyphosis. Mean VAS score at presentation was 45.5 mm which improved to 14.48 mm at follow-up. Patients with mild and moderate kyphosis remained asymptomatic till the last follow-up.

Conclusion:

Healing of subaxial cervical TB in kyphosis does not necessitate a poor clinical outcome as most patients remain asymptomatic.

Prevalence of Vitamin D Deficiency Amongst Indian Orthopaedic Surgeons

BACKGROUND

Vitamin D deficiency is a widely prevalent condition with patients in both symptomatic and asymptomatic spectrum. With the lack of routine screening there exists an unknown population of Indian Orthopaedic surgeons who are deficient in Vitamin D and lead to an unexplained loss of quality of work and increased susceptibility to various other diseases. The easiest access to resources for supplementation is available to this group of treating physicians however its use for their personal cure is rarely recognised. This study aims to highlight this endemic disease and to find out its correlation with other parameters.

METHODS

It is a prospective observational study including 150 practicing orthopaedic surgeons from entire India who visited our centre during 3 months duration for various educational meetings. Venous sample was collected after due informed consent and analysed at a single laboratory for 25-OH Cholecalciferol levels by a chemiluminescent assay. All the samples were analysed and a questionnaire was sent to the participants via google forms regarding various parameters under study.

RESULTS

The mean serum Vitamin D levels were 18.6 ± 9.67 ng/ml in the sample studied. 17 out of 150 participants (11.3%) were found to have sufficient serum levels of 25(OH) Cholecalciferol. 105 participants (70%) were having deficient levels and 28 (18.7%) had insufficient levels of Vitamin D. Overall 88.7% participants had Vitamin D deficiency among the sample studied.

CONCLUSION

This widespread prevalence of Vitamin D deficiency warrants frequent screening and routine supplementation of Vitamin D in orthopaedic surgeons thereby providing a low cost solution to improve the troublesome situation among healthcare providers.

Golden Wires and Rectangle: A Cost-Effective Treatment for Tuberculosis of the Thoracic Spine

STUDY DESIGN

This was a retrospective study.

PURPOSE

The purpose of this study was to compare the functional outcome and cost of surgery for tuberculosis (TB) of the thoracic spine between two commonly used fixation modalities "pedicular screws and rods" and "Hartshill loop rectangle and sublaminar wires."

OVERVIEW OF LITERATURE

TB is a common ailment in Asia. Surgical indications have remained almost unchanged since the middle-path regimen was advocated by Tuli. Pedicle screws and Hartshill loop rectangle with sublaminar wires are the two common fixation techniques used.

MATERIALS AND METHODS

This retrospective observational study was performed at a single tertiary center. Patients were divided into two groups depending on the method of fixation (pedicle screw rod/Hartshill loop rectangle and sublaminar wires). All patients were evaluated preoperatively by X-rays and magnetic resonance imaging. Patients were assessed clinically by preoperative and postoperative neurology and Visual Analog Scale score and radiologically assessed by the K angle. These variables were separately compared in both the groups.

RESULTS

The functional outcomes of Hartshill loop rectangle and sublaminar wire fixation and that of pedicular screw fixation were comparable. Hartshill loop rectangle and sublaminar wire fixation was found to be more cost-effective.

CONCLUSION

Hartshill loop rectangle and sublaminar wire fixation gets purchase over the posterior column structures alone when compared to pedicle screws which have a 3-column hold. However, when combined with meticulous neural decompression and skillful preparation of osteogenic bed with autologous strut grafting and additional onlay grafting, it gives overall adequate stabilization of the column with functional outcome comparable to pedicular screw and rod fixation with additional benefit of cost-effectiveness. Although Hartshill loop rectangle and sublaminar wire fixation is less commonly used now, it has a special place in the management of TB, especially in a resource-poor setting like some countries of Asia.

Dystopic Os Odontoideum Causing Cervical Myelopathy: A Rare Case Report and Review of Literature

Os odontoideum (OO) was first described by Giacomini in 1886 as separation of the odontoid process from the body of the axis. Instability can consequently occurs at this level due to the failure of the transverse atlantal ligament (TAL) and this atlantoaxial instability can be a cause of progressive neurological deficits. It is considered a rare anomaly of the odontoid process. It is a disease with controversial etiology, debatable incidence, and only a partly known natural history owing to the paucity of the literature on this topic. There are insufficient demographic data about the occurrence of the disease, and most of the management is dictated by the isolated case reports and few studies which have been carried out at handful of institutes. OO is classified into two types by Fielding et al. based on the anatomic location: orthotopic and dystopic. Orthotopic OO consists of an ossicle that moves with the anterior arch of the atlas, whereas the dystopic type presents as an ossicle near the basion or one that is fused with the clivus. In one magnetic resonance imaging (MRI) study of odontoid morphology, a 0.7% (1 case of 133 patients) incidence was reported. The spectrum of the clinical presentation varies from completely asymptomatic individuals to patients presenting with features of cervical myelopathy. Here, we present a case of 35-year-old-male with dystopic OO who presented to us with features of gradually progressing cervical myelopathy without any obvious history of neck trauma. On investigations, he was found to have atlantoaxial instability with wide atlanto-dens interval. He was treated with the posterior C1-C2 stabilization and reduction of atlantoaxial instability.

A Case Report of Aneurysmal Bone Cyst with Pathologic Fracture of Proximal Femur Managed with EnblocExcision and Autologous Non-vascularized Fibular Graft

INTRODUCTION

Aneurysmal bone cyst (ABC) is typically a benign, expansile, and cystic lesion of the bone that can be locally aggressive characterized by vascular gaps separated by fibrous septae. Treatment modalities available are sclerosing agents, arterial embolization, surgical excision, curettage with or without bone grafting, and adjuvant radiotherapy.

CASE REPORT

We report a rare case of ABC with pathologic fracture in the proximal femur in a 15-year-old female patient, treated with en blocexcision, bone grafting with non-vascularized fibular strut graft and stabilized with a 95°dynamiccondylar screw plate system. Follow-up at 24 months showed incorporation of the fibular graft and full union.

CONCLUSION

Structural support and autologous bone grafting in giant ABC in young individuals would yield adequate results.

Measurement of spinopelvic parameters in healthy adults of Indian origin - A cross sectional study

BACKGROUND

Restoration of spinopelvic balance during spinal surgery is very important to ensure a good outcome. Many studies have been conducted to define the normal ranges, examining the correlation between these individual parameters and their relation with spinal parameters of thoracic kyphosis and lumbar lordosis. The ranges, specific to individual ethnicities, is very essential to restore the sagittal balance in patients suffering from spinal degenerative conditions. Hence this study aims to define the average ranges of relevant spinopelvic parameters in the adult population of Indian origin.

METHODS

A observational cross sectional study was conducted in 130 healthy volunteers in Mumbai without having any spine, hip or pelvis pathology. Spinopelvic parameters like Pelvic Incidence(PI), Sacral Slope(SS) and Pelvic Tilt(PT) were studied and compared between various other similar studies with patients of different ethnicities. The correlation of those parameters with each other was also evaluated.

RESULTS

The mean value of PI was 51.50(±6.85°), that of SS was 39.17° (±6.26°) and for PT it was 12.32°(±5.41°). These values were statistically significant between both sexes for PI and PT. The strongest positive correlation among the parameters was between pelvic incidence and sacral slope, with a r-value of 0.668. Comparison of our study with similar studies within the country (Chennai, Delhi and Surat) showed statistically significant differences in PT and SS of all three studies while PI was not significant when compared with the Surat study.

CONCLUSION

There appears to be considerable variation of the values of the spinopelvic parameters as determined by various studies due to ethnic variations. Further studies should be done with larger samples and directed towards early detection of individuals at risk of developing degenerative spinal disorders with sagittal imbalance, so that interventions can be made at an earlier stage.

A rare case of posterior interosseous nerve palsy due to ganglion cyst arising from supinator muscle

Here we present a rare case of ganglion cyst of the elbow joint arising from supinator muscle causing posterior interosseous nerve (PIN) palsy in a 40-year-old female who presented with weakness in finger extension and carrying out routine activities with right hand since 2 weeks. Patient had pain over the right forearm radiating to the right hand since 3 months. She also noted a swelling in the right forearm, which was gradually increasing in size since last 1 month. Atraumatic PIN compression is uncommon and is usually caused by compression of PIN in the arcade of Frohse, by radial recurrent artery, and fibrous band around the radiocapitellar joint. Reports of PIN palsy caused by ganglionic cyst in the elbow joint are rare and case reports regarding the same are sparingly reported. Here we report a case of PIN palsy secondary to ganglion cyst arising from supinator muscle, which recovered completely after excision of the ganglion cyst.

Blocking FcRn in humans reduces circulating IgG levels and inhibits IgG immune complex-mediated immune responses

The neonatal crystallizable fragment receptor (FcRn) functions as an intracellular protection receptor for immunoglobulin G (IgG). Recently, several clinical studies have reported the lowering of circulating monomeric IgG levels through FcRn blockade for the potential treatment of autoimmune diseases. Many autoimmune diseases, however, are derived from the effects of IgG immune complexes (ICs). We generated, characterized, and assessed the effects of SYNT001, a FcRn-blocking monoclonal antibody, in mice, nonhuman primates (NHPs), and humans. SYNT001 decreased all IgG subtypes and IgG ICs in the circulation of humans, as we show in a first-in-human phase 1, single ascending dose study. In addition, IgG IC induction of inflammatory pathways was dependent on FcRn and inhibited by SYNT001. These studies expand the role of FcRn in humans by showing that it controls not only IgG protection from catabolism but also inflammatory pathways associated with IgG ICs involved in a variety of autoimmune diseases.

Computed Tomography Scan-Based Morphometric Analysis of Lateral Masses of Atlas Vertebrae in Normal Indian Population

Study Design

A cross-sectional observational study involved the analysis of computed tomography (CT) scan data from 125 Indian subjects of 18 years or older with normal imaging findings. Scans were obtained from patients with head injuries as a part of the screening process along with brain CT scans.

Purpose

To establish the dimensions of lateral masses of the atlas vertebrae in normal disease-free Indian individuals.

Overview of Literature

Lateral mass fixation has become the standard of care in fixation of the supra-axial cervical spine. Many studies have investigated the dimensions of lateral masses in cadaveric specimens; however, studies involving the radiological morphometric analysis of the lateral masses of the atlas vertebra in living patients are lacking.

Methods

Subjects underwent craniovertebral junction CT scans during evaluations of head injury. All had normal radiology reports. The CT scans were obtained using a CT Philips Brilliance 64 machine (Philips, Amsterdam, Netherlands) with a slice thickness of 1 mm and then analyzed using Horos software ver. 2.0.2 (Horos Project, Annapolis, MD, USA) on a MacBook.

Results

Lateral masses of the atlas vertebrae were found to be larger in males than females and larger on the right than the left side. The angle of permissible medialization was found to be larger on the right side. The analysis of the average dimensions indicated the conventionally described screw positions to be safe.

Conclusions

The present study provides information that may help to establish standard dimensions of lateral masses of the atlas vertebrae among the normal Indian population. We demonstrate that there is no significant difference when compared with the Western population. The results presented here will be of use to clinicians as they may inform preoperative planning for lateral mass fixation surgeries.

Role of Additional Coronal Magnetic Resonance Imaging in Decompression and Reconstruction with or without Segment Salvage in Thoracic Spine Tuberculosis

Study Design

Retrospective and observational study.

Purpose

The present study aimed to develop guidelines for segment salvage or sacrifice based on the amount and status of the remnant portion of the vertebra as assessed by coronal magnetic resonance imaging (MRI) in addition to sagittal and axial images in thoracic spine tuberculosis (TB).

Overview of Literature

Indications for surgery have not changed significantly since the ‘middle path regimen’ was proposed by Tuli. Goals of modern surgical management of spinal TB include debridement of diseased vertebrae, spinal cord decompression, deformity correction, and spine stabilization. However, the extent of decompression has not been defined previously. Too less decompression will lead to compromised neurological recovery, whereas large extent of decompression is associated with increased surgical morbidity and longer segment to reconstruct.

Methods

Sixty-five patients with thoracic spine TB were divided into two groups (segment salvage/sacrifice) based on the thickness of the subchondral bone and endplate morphology of the vertebra as seen on MRI. The operative procedure in the form of instrumentation with Hartshill loop rectangle and sublaminar wire using the simultaneous anterior posterior approach in lateral position (versatile approach) was performed. The patients were analyzed for postoperative fusion, improvement in kyphosis angle, and followed up for development of complications.

Results

This method of deciding the level of fixation and segment salvage based on coronal MRI in addition to the sagittal and axial images provided good result in 64 of 65 patients, except for one patient in the segment sacrifice group who had graft buckling and resultant kyphosis.

Conclusions

For segment salvage, having a clear three-dimensional idea about the viable remnant bone is important. Viable salvaged segment reduces the morbidity of the procedure, length of the construct, and unnecessary debridement without compromising on the neural recovery and fusion rate. Hence, additional cone down coronal cuts must be required when MRI is suggestive for spinal TB because it will help in the decision making.

Apical Vertebral Column Resection with Sagittal Rotation and Controlled Anterior Opening and Posterior Closing Maneuver for the Treatment of Severe Post-Tubercular Kyphosis: Case Series and Literature Review

Study Design

Retrospective case series.

Purpose

Describe the technique and evaluate the outcome of apical vertebral column resection (VCR) with sagittal rotation and anterior opening and posterior closing (AOPC) maneuver for correction of severe post-tubercular kyphosis (PTK).

Overview of Literature

The surgical procedures described for the correction of PTK are VCR, pedicle subtraction osteotomy, transpedicular decancellation osteotomy, and closing-opening osteotomy.

Methods

We retrospectively evaluated 21 patients who had been operated on with single stage apical VCR with AOPC maneuver. Radiographs were obtained before surgery and at regular follow-up intervals. These were used to calculate the angle of kyphosis. Back pain was rated using the Visual Analog Scale (VAS) and neurological status was graded using Frankel grading. Radiological outcome was assessed by the improvement in the angle of kyphosis and fusion following surgery. Neurological status was assessed using Frankel grading.

Results

The study included eight males and 13 females with a mean age of 21.9 and average follow-up time of 30.4 months. The average number of vertebral bodies destroyed was 2.57. Kyphosis was improved from a mean of 68.42°±13.23° preoperative to 8.71°±4.58° postoperative. The average correction achieved was 87.10%. Preoperative VAS score improved from a mean of 6.38±0.92 preoperative to 1.38±0.49 postoperative. No patients had any sign of neurological deterioration. Seven out of eight patients with a preoperative neurological deficit improved following surgery. Two patients developed superficial wound maceration, one had persistent postoperative hypotension, and the other developed hemothorax. All patients recovered fully without a need for additional surgery.

Conclusions

Single stage simultaneous anterior column lengthening and posterior column shortening is an effective method for surgical correction of severe PTK.

Treatment of Chronic Simple Elbow Dislocation by Two Separate Incisions - A Case Report

INTRODUCTION

Chronic elbow dislocation is a highly disabling condition to be treated and to provide a successful functional outcome. Surgical treatment of such conditions might result in persisting instability or stiffness of the elbow joint due to associated shortening and contracture of the soft tissues and articular incongruity. Most of the described open reduction techniques are through an extensile posterior approach which might result in increased post-operative stiffness. We report the treatment of such a case with separate medial and lateral incisions with the excellent functional outcome at 1-year follow-up.

CASE REPORT

A 45-year-old lady with 2-month-old elbow dislocation was planned for open reduction of the joint through two separate incisions, medial and lateral. Surgical details and difficulties faced will be analyzed in this paper. The patient currently has 30-140°flexion with complete pronation-supination movements at 1-year follow-up.

CONCLUSION

Chronic dislocation of the elbow is a highly disabling condition and has a very unpredictable outcome. By combining an understanding in the anatomy and biomechanics of the elbow with a proper surgical technique tailored to the individual patient, it is possible to achieve a functional and painless elbow in the majority of cases. By accessing medial and lateral elbow separately, the morbidity and wound complications of an extensile posterior approach can be reduced and also it has similar, if not better, functional results.

A Case Report of Aneurysmal Bone Cyst with Pathologic Fracture of Proximal Femur Managed with EnblocExcision and Autologous Non-vascularized Fibular Graft

INTRODUCTION

Aneurysmal bone cyst (ABC) is typically a benign, expansile, and cystic lesion of the bone that can be locally aggressive characterized by vascular gaps separated by fibrous septae. Treatment modalities available are sclerosing agents, arterial embolization, surgical excision, curettage with or without bone grafting, and adjuvant radiotherapy.

CASE REPORT

We report a rare case of ABC with pathologic fracture in the proximal femur in a 15-year-old female patient, treated with en blocexcision, bone grafting with non-vascularized fibular strut graft and stabilized with a 95°dynamiccondylar screw plate system. Follow-up at 24 months showed incorporation of the fibular graft and full union.

CONCLUSION

Structural support and autologous bone grafting in giant ABC in young individuals would yield adequate results.

Improved design for Heliotron J soft X-ray diagnostic for tomographic reconstruction studies

Identifications of the plasma boundary shape and mode structure are important problems for the studies of the magnetohydrodynamics equilibrium and stability studies. Imaging diagnostics have the possibility to measure the plasma boundary shape and mode structure directly. The soft X-ray (SX) tomography is an imaging diagnostic for offering these direct measurements. However, SX tomography is by nature a limited angle tomography and provides a challenge as an ill-condition inverse problem. The reconstructed profiles depend heavily on the quality of measurements along with the employed inversion algorithm. This paper provides a detailed description of tomographic reconstruction of simulated SX measurements from the current SX diagnostic design of Heliotron J (H-J), which is a medium size heliotron device. Heliotron J has a unique magnetic geometry, and the quantitative identification of the plasma boundary and mode structure is a critical problem. The Phillip-Tikhonov regularization is employed to address the inversion problem. Finally, a new design for Heliotron J soft X-ray diagnostic is discussed which holds enhanced capabilities for tomographic reconstructions especially for the high poloidal number perturbations.

Vulnerabilities and risks of HIV infection among migrants in the Thane district, India

OBJECTIVES

To explore the vulnerabilities and risks of HIV infection among female migrants compared with male migrants in the Thane district of Maharashtra, India.

STUDY DESIGN

This is a cross-sectional epidemiological study.

METHODS

Data from 35,841 migrants (men 96.2% and women 3.8%) were collected using the web-based 'Migrant Service Delivery System.' The data were then analysed in SPSS, version 23.0. Statistical analysis, including Chi-squared test and multivariate logistic regression, was used to identify factors influencing HIV infection for both male and female migrants.

RESULTS

It was observed that 2.96% of female migrants had HIV infection compared with 0.77% of male migrants. We found that 12.1% of women consumed alcohol compared with 41.9% of men, and access to bars was 1.5% among women and 3.5% in men. We observed an even larger difference between men and women in their previous history of using brothels for sex; only 5.9% of female migrants reported previously having used brothels for sex, compared with 62.9% of male migrants. Approximately 12.3% of married women and 93.6% of married men had sex with someone other than their spouse. We found that 67.0% of married women and 73.9% of married men reported using a condom during their last sexual act compared with 60.9% of unmarried women and 68.1% of unmarried men.

CONCLUSIONS

In Thane, female migrants faced higher vulnerabilities and risks of HIV infection than male migrants. Consequently, innovative strategies are required to address these particular needs of female migrants.

Paratesticular Paraganglioma with Metastasis to D1 Vertebra- A Case Report and Review of Literature

INTRODUCTION

Paragangliomas are relatively rare tumors, accounting for only about 0.3% of all neoplasms. Most paragangliomas are defined as benign in nature, but 10-% possess metastatic potential. There have been scattered reports of metastatic paraganglioma in the literature, but in rare circumstances, paragangliomas can metastasize to the spinal column causing destruction or compression of the spinal cord, clinically manifesting as pain or neurological deficit.

CASE REPORT

We present a case of a 43-year-old man who presented with paresthesia and paraparesis and was found to have pathologic fracture involving D1 vertebra as a manifestation of metastasis from a non-secretory right paratesticular paraganglioma.

CONCLUSIONS

We will review the literature on the topic of metastatic paraganglioma, management of paragangliomas involving spine, and touch on the importance of angioembolization, staged procedures, and a team approach.

Iatrogenic Pseudo-aneurysm of Profunda Femoris Artery Following Fixation of Intertrochanteric Femur Fracture - A Case Report and Review of Literature

The Profunda Femoris is a common site for arterial pseudo-aneurysms and these have been described in literature following fractures as well as orthopaedic procedures of the femur and hip region. These are an uncommon complication and a high index of suspicion is required for correct diagnosis and prompt management. We present a case of pseudo-aneurysm of the Profunda Femoris in an operated case of Intertrochanteric femur fracture with acute presentation. The case was managed successfully by angiographic coil embolization.

Quantification and localization of mast cells in periapical lesions

Background:

Periapical lesions occur in response to chronic irritation in periapical tissue, generally resulting from an infected root canal. Specific etiological agents of induction, participating cell population and growth factors associated with maintenance and resolution of periapical lesions are incompletely understood. Among the cells found in periapical lesions, mast cells have been implicated in the inflammatory mechanism.

Aim:

Quantifications and the possible role played by mast cells in the periapical granuloma and radicular cyst. Hence, this study is to emphasize the presence (localization) and quantification of mast cells in periapical granuloma and radicular cyst.

Materials and Methods:

A total of 30 cases and out of which 15 of periapical granuloma and 15 radicular cyst, each along with the case details from the previously diagnosed cases in the department of oral pathology were selected for the study. The gender distribution showed male 8 (53.3%) and females 7 (46.7%) in periapical granuloma cases and male 10 (66.7%) and females 5 (33.3%) in radicular cyst cases. The statistical analysis used was unpaired t-test.

Results:

Mean mast cell count in periapical granuloma subepithelial and deeper connective tissue, was 12.40 (0.99%) and 7.13 (0.83%), respectively. The mean mast cell counts in subepithelial and deeper connective tissue of radicular cyst were 17.64 (1.59%) and 12.06 (1.33%) respectively, which was statistically significant. No statistical significant difference was noted among males and females.

Conclusion:

Mast cells were more in number in radicular cyst. Based on the concept that mast cells play a critical role in the induction of inflammation, it is logical to use therapeutic agents to alter mast cell function and secretion, to thwart inflammation at its earliest phases. These findings may suggest the possible role of mast cells in the pathogenesis of periapical lesions.

Quantification and localization of mast cells in periapical lesions

BACKGROUND

Periapical lesions occur in response to chronic irritation in periapical tissue, generally resulting from an infected root canal. Specific etiological agents of induction, participating cell population and growth factors associated with maintenance and resolution of periapical lesions are incompletely understood. Among the cells found in periapical lesions, mast cells have been implicated in the inflammatory mechanism.

AIM

Quantifications and the possible role played by mast cells in the periapical granuloma and radicular cyst. Hence, this study is to emphasize the presence (localization) and quantification of mast cells in periapical granuloma and radicular cyst.

MATERIALS AND METHODS

A total of 30 cases and out of which 15 of periapical granuloma and 15 radicular cyst, each along with the case details from the previously diagnosed cases in the department of oral pathology were selected for the study. The gender distribution showed male 8 (53.3%) and females 7 (46.7%) in periapical granuloma cases and male 10 (66.7%) and females 5 (33.3%) in radicular cyst cases. The statistical analysis used was unpaired t-test.

RESULTS

Mean mast cell count in periapical granuloma subepithelial and deeper connective tissue, was 12.40 (0.99%) and 7.13 (0.83%), respectively. The mean mast cell counts in subepithelial and deeper connective tissue of radicular cyst were 17.64 (1.59%) and 12.06 (1.33%) respectively, which was statistically significant. No statistical significant difference was noted among males and females.

CONCLUSION

Mast cells were more in number in radicular cyst. Based on the concept that mast cells play a critical role in the induction of inflammation, it is logical to use therapeutic agents to alter mast cell function and secretion, to thwart inflammation at its earliest phases. These findings may suggest the possible role of mast cells in the pathogenesis of periapical lesions.

Silicon drift detector based X-ray spectroscopy diagnostic system for the study of non-thermal electrons at Aditya tokamak

Silicon drift detector based X-ray spectrometer diagnostic was developed to study the non-thermal electron for Aditya tokamak plasma. The diagnostic was mounted on a radial mid plane port at the Aditya. The objective of diagnostic includes the estimation of the non-thermal electron temperature for the ohmically heated plasma. Bi-Maxwellian plasma model was adopted for the temperature estimation. Along with that the study of high Z impurity line radiation from the ECR pre-ionization experiments was also aimed. The performance and first experimental results from the new X-ray spectrometer system are presented.

One-stage long-stem total knee arthroplasty for arthritic knees with stress fractures

PURPOSE. To evaluate the outcome of one-stage long-stem total knee arthroplasty (TKA) for patients with arthritic knees and tibiofemoral stress fractures. METHODS. Records of 11 men and 18 women aged 47 to 78 (mean, 66) years who underwent fixed-bearing posterior-stabilised TKA for osteoarthritis or rheumatoid arthritis of the knee with tibial (n=31) and femoral (n=3) stress fractures were reviewed. All the tibial fractures involved the proximal half. There were 7 associated fibular stress fractures. Of the 31 knees with tibial stress fractures, 26 and 5 manifested varus and valgus deformity, respectively. RESULTS. The mean follow-up period was 51 (range, 24-96) months. The mean tibiofemoral angle improved from 23.2 to 1.9 degrees varus. The mean Knee Society knee score improved from 38.5 (range, 15- 63) to 89.6 (range, 80-95) [p<0.05]. The mean Knee Society functional score improved from 25.5 (range, 0-40) to 86.5 (range, 60-100) [p<0.05]. All fractures were united at the last follow-up. No complications were encountered. CONCLUSION. One-stage long-stem TKA restores limb alignment and facilitates fracture healing, with excellent outcome.

Occurrence and surgical repair of third degree perineal lacerations in adult female camels (Camelus dromedarius) by one-stage (Goetz) technique

Retrospective analysis of third degree perineal lacerations in 7 female camels (6-17 yrs of age) that were surgically corrected by one stage repair (Goetz technique) is presented. Majority (3/7) of the camels was primiparous and all parturitions had a history of calving assistance. Six (6/7) camels recovered by first intention of healing. Dehiscence of perineal structure occurred in only one camel due to infection and healed by second intention. Subsequent matings resulted in pregnancy in four camels and one camel died due to unrelated causes. We conclude that perineal lacerations can occur in primiparous camels with difficult assisted deliveries and that one stage repair of perineal lacerations in camels improves the perineal conformation and such camels may easily regain normal fertility.

Ankyloglossia and its surgical correction by frenuloplasty in a she-camel calf (Camelus dromedarius)

A rare case of ankyloglossia in a one-humped camel and its successful surgical correction by horizontal to vertical frenuloplasty is reported. Seven-month-old she-camel calf, with a history of excessive salivation and inability to chew and swallow hay, was referred to Al Qattara veterinary hospital. Solid food was regurgitated, whereas milk and water could be swallowed. On examination; the animal could not protrude its tongue which was attached by a thin tissue band between the ventral surface of the tongue and the floor of the oral cavity. The tissue band was corrected by frenuloplasty and the incisions were sutured. The animal recovered well as the salivation and regurgitation stopped and the animal became able to chew and swallow solid food including hay. It was concluded that ankyloglossia can occur in one-humped camel in which a horizontal to vertical frenuloplasty may improve full function of tongue movement.