Lateral Mass Screw Fixation in the Cervical Spine: Introducing a New Technique

Rathinavelu Sreeramalingam,Islam Ariful,Shivhare Pankaj,Chatterjee Sandip 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.6

Study Design: This was designed as a randomized double blind study to compare the classical Magerl technique of insertion of lateral mass screws with the authors’ technique. The observations regarding length, outcome, and radiology was done by a group blinded to the technique used. Purpose: The present study was designed with the objective of identifying the optimal technique for introducing the lateral mass screws that uses the maximum possible dimension of the lateral mass. Overview of Literature: Lateral mass screw fixation is a common surgery that is performed in the cervical spine. Various modifications for the procedure have been described, such as changes in the entry point, angulation of the screws, and modifications in the exit point. These do not allow the insertion of longer screws that can give more purchase on the bone. Methods: From January 1, 2009 to December 31, 2018, 176 patients who were scheduled to undergo lateral mass screw fixation were enrolled. They were randomized into two groups; we inserted lateral mass screws using our new technique for one group and by using the classical Magerl technique for the other group. Intraoperative measurements were used to assess the bone-screw interface length. Postoperative radiography and postoperative computed tomography were performed to assess the trajectory of the screws. Results: Total 88 patients were included in the study group, including 68 men. The control group included 65 men. The most common indication for surgery was cervical spondylotic myelopathy. The average bi-cortical length that was measured intraoperatively was 19.9 mm in the study group and 16.3 mm in the control group. This was significantly different from the average lengths of screws in the control group. Conclusions: The trajectory that involves an entry point as close as possible to the posterior inferior medial angle of the lateral mass cuboid and traverses a distance of about 20 mm to obtain a bi-cortical purchase in the diagonally opposite angle may provide a much better and firmer bony purchase in the lateral mass than conventional points of entry and trajectories.

The Extended Posterior Circumferential Decompression Technique in the Management of Tubercular Spondylitis with and without Paraplegia

Barani Rathinavelu,Justin Arockiaraj,Venkatesh Krishnan,Rohit Amritanand,Gabriel David Sundararaj 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.6

Study Design: Retrospective clinical series. Purpose: To study the clinical, functional and radiological results of patients with tuberculous spondylitis with and without paraplegia, treated surgically using the “Extended Posterior Circumferential Decompression (EPCD)” technique. Overview of Literature: With the increasing possibility of addressing all three columns by a single approach, posterior and posterolateral approaches are gaining acceptance. A single exposure for cases with neurological deficit and kyphotic deformity requiring circumferential decompression, anterior column reconstruction and posterior instrumentation is helpful. Methods: Forty-one patients with dorsal/dorsolumbar/lumbar tubercular spondylitis who were operated using the EPCD approach between 2006 to 2009 were included. Postoperatively, patients were started on nine-month anti-tuberculous treatment. They were serially followed up to thirty-six months and both clinical measures (including pain, neurological status and ambulatory status) and radiological measures (including kyphotic angle correction, loss of correction and healing status) were used for assessment. Results: Disease-healing with bony fusion (interbody fusion) was seen in 97.5% of cases. Average deformity (kyphosis) correction was 54.6% in dorsal spine and 207.3% in lumbar spine. Corresponding loss of correction was 3.6 degrees in dorsal spine and 1.9 degrees in the lumbar spine. Neurological recovery in Frankel B and C paraplegia was 85.7% and 62.5%, respectively. Conclusions: The EPCD approach permits all the advantages of a single or dual session anterior and posterior surgery, with significant benefits in terms of decreased operative time, reduced hospital stay and better kyphotic angle correction.

Hybrid Model-based Framework for Soft Sensing and Forecasting Key Process Variables in the Production of Hyaluronic Acid by Streptococcus zooepidemicus

Sivakumar Rathinavelu,Satya Sai Pavan,Senthilkumar Sivaprakasam 한국생물공학회 2023 Biotechnology and Bioprocess Engineering Vol.28 No.1

Hyaluronic acid (HA), a glycosaminoglycan polymer, is widely used in the biomedical and cosmetic industries. Due to highly viscous nature of the HA fermentation broth, it is difficult to capture the dynamics of its bioprocess with physical sensors in real-time. The goal of this study was to track non-invasively the state variables involved in HA production process and deducing the critical process parameters based on the recorded process inputs. The framework employed in this study is based on a hybrid model that predicts HA and biomass concentration using online bioreactor data (pH, DO%, %CO2 evolved, feed rate, and agitation rate) to ensure real-time tracking of HA bioprocess dynamics. A HA fermentation dataset with data from historical batches and freshly performed fedbatch runs for various specific growth rate set-points (μsp) was created. The dataset was used to train the hybrid model, which was then used to predict biomass and HA concentration for test runs, with a mean squared error of prediction ranging from 0.018 to 0.049 (g/L)2. Furthermore, recurrent neural networks were evaluated in forecasting the specific growth rate (μ) and HA productivity rate (qHA) to observe the desired process trajectory. The current study addressed the scope of application of hybrid model based soft-sensor to predict the trend of process parameters of HA fermentation.

Changes in the Spinopelvic Parameters of Elite Weight Lifters

Yang, Jae Hyuk,Barani, Rathinavelu,Bhandarkar, Amit Wasudeo,Suh, Seung Woo,Hong, Jae Young,Modi, Hitesh N.,Yang, Jae Hyuk by Lippincott Williams Wilkins 2014 Clinical journal of sport medicine Vol.24 No.4

OBJECTIVE:: To describe the changes in the spinopelvic parameters in weight lifters and evaluate the factors leading to spinal anatomical changes (eg, spondylolysis and listhesis). DESIGN:: Case–control study. SETTING:: Tertiary, institutional. PARTICIPANTS:: The study group participants were practicing weight lifters in the athletes’ village of the 2012 London Olympics. A total of 21 elite weight lifters were enrolled. Their data were compared with those of 45 healthy volunteers in the control group. INTERVENTIONS:: Comparative radiological evaluations were performed among the 21 elite weight lifters. Spinopelvic parameters (radiographic analysis), including total (TLL), upper (ULL), and lower (LLL) lumbar lordoses, sacral slope, pelvic tilt (PT) and incidence, lumbar index, and disc angles, were assessed. MAIN OUTCOME MEASURES:: The proportional ratio of ULL and LLL to TLL (ULL/TLL and LLL/TLL) was measured to describe the proportion effect. These values were compared with those of the control group. Weight lifters with and those without anatomical changes were subdivided into a deformed and nondeformed group, respectively, and further analyzed for differences. The correlation between these spinal parameters and the amount and duration of weight lifting training was also analyzed. RESULTS:: Anatomical changes in the lumbar spine were seen in 6 weight lifters (28.6%, P = 0.01). The mean TLL, ULL, and LLL values (59.8, 22.6, and 37.2 degrees, respectively) were increased, whereas PT (10.3 degrees) was decreased in the athletes compared with the volunteers (P = 0.001, 0.005, 0.07, and 0.018, respectively). The ULL/TLL was higher in the deformed group than in the nondeformed group (P = 0.036). The duration and amount of weight lifting training were not correlated with the spinopelvic parameters measured in this study. CONCLUSIONS:: The elite weight lifters had increased lumbar lordosis and decreased PT compared with the healthy volunteers. The ULL/TLL ratio may be used as a predictive marker for lumbar deformation.

A Prospective Study of Clinical and Radiological Outcomes of Zero-Profile Cage Screw Implants for Single-Level Anterior Cervical Discectomy and Fusion: Is Segmental Lordosis Maintained at 2 Years?

Saumyajit Basu,Sreeramalingam Rathinavelu 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.2

Study Design: Prospective cohort study. Purpose: To study clinicoradiological parameters of zero-profile cage screw used for anterior cervical discectomy and fusion (ACDF). Overview of Literature: Radiological parameters of various implants used for ACDF are available, but those for zero-profile cage are sparse. Methods: Patients with unilateral intractable brachialgia due to single-level cervical disc prolapse between April 1, 2011 and March 31, 2014 were included. Clinical assessment included arm and neck pain using visual analogue score (VAS) and neck disability index (NDI) scores. Radiological assessment included motion segment height, adjacent disc height (upper and lower), segmental and cervical lordosis, implant subsidence, and pseudoarthrosis. Follow-ups were scheduled at 1, 3, 6, 12, and 24 months. Results: Thirty-four patients (26 males, 8 females) aged 30–50 years (mean, 42.2) showed excellent clinical improvement based on VAS scores (7.4–0 for arm and 2.0–0.6 for neck pains). Postoperative disc height improved by 11.33% (p <0.001), but at 2 years, the score deteriorated by 7.03% (p <0.001). Difference in the adjacent segment disc height at 2 years was 0.08% (p =0.8) in upper and 0.16% (p <0.001) in lower disc spaces. Average segmental lordosis achieved was 5.59° (p <0.001) from a preoperative kyphosis of 0.88°; at 2 years, an average loss of 7.05° (p <0.001) occurred, resulting in an average segmental kyphosis of 1.38°. Cervical lordosis improved from 11.59° to 14.88° (p =0.164), and at 2 years, it progressively improved to 22.59° (p <0.001). Three patients showed bone formation and two mild protrusion of the implant at 2 years without pseudoarthrosis/implant failure. Conclusions: The zero-profile cage screw device provides good fusion and cervical lordosis but is incapable of maintaining the segmental lordosis achieved up to a 2-year follow-up. We also recommend caution when using it in patients with small vertebrae.

Phycocyanin Induces Apoptosis and Enhances the Effect of Topotecan on Prostate Cell Line LNCaP

Miroslav Gantar,Sivanesan Dhandayuthapani,Appu Rathinavelu 한국식품영양과학회 2012 Journal of medicinal food Vol.15 No.12

C-phycocyanin (C-PC) from Spirulina has been previously shown to have anticancer properties. Here, we report on anticancer activity of C-PC that was isolated from the novel cyanobacterium Limnothrix sp. 37-2-1. C-PC from this organism exhibited anticancer properties in our in vitro systems; however, the required doses were well above the range of anticancer drugs normally used. Therefore, we conducted several experiments to test whether lower-than-usual doses of the anticancer drug topotecan (TPT) can offer the same level of cytotoxic effects as normal doses when combined with C-PC. For this purpose, cytotoxicities of C-PC and TPT were tested using the LNCaP (prostate cancer) cells. We found that when only 10% of a typical dose of TPT was combined with C-PC, the cancer cells were killed at a higher rate than when TPT was used alone at full dose. Similarly, we were also able to detect an increased level of radical oxygen species (ROS) generation as well as an increase in activities of caspase-9 and caspase-3 when these two compounds were used in combination. Taken together, our findings suggest that combining C-PC from Limnothrix sp. with the lower dose of TPT can induce apoptosis through generation of ROS and activation of caspases. In that respect, we suggest that C-PC can potentially improve the efficacy of the currently available anticancer drug, and therefore diminish its harsh side effects in the patient.

Apoptosis Induction by Ocimum sanctum Extract in LNCaP Prostate Cancer Cells

Sivanesan Dhandayuthapani,Hasan Azad,Appu Rathinavelu 한국식품영양과학회 2015 Journal of medicinal food Vol.18 No.7

Tulsi (Ocimum sanctum Linn), commonly known as ‘‘holy basil,’’ has been used for the treatment of a wide range of ailments in many parts of the world. This study focuses on apoptosis-inducing ability of tulsi extract on prostate cancer cells. For this purpose LNCaP prostate cancer cells were treated with different concentrations of 70% ethanolic extract of tulsi (EET) and then the cytotoxicity was determined after 24 and 48 h. After treatment with EET externalization of phosphatidyl serine (PS) from the inner membrane to outer leaflet of the plasma membrane was clearly evidenced by the results obtained from both flow cytometry analysis with Annexin V-FITC and pSIVA-IANBD binding fluorescence microscopy assay. Depolarization of the mitochondrial membrane potential was also evidenced by the presence of 5,5',6,6'-tetrachlolo-1,1',3,3'-tetraethyl benzimedazolyl carbocyanine iodide ( JC-1) monomeric form in the EET-treated cells that emitted the green fluorescence when compared with the control cells that emitted the red fluorescence due to aggregation of JC-1. Furthermore, the level of poly (ADP-ribose) polymerase (PARP) cleavage and Bcl-2 were determined using western blot analysis. When compared to the control cells the level of cleaved PARP was found to be higher with a concomitant decrease in the Bcl-2 level after 24 h of treatment of cells with EET. In addition, treatment with EET significantly elevated the activities of caspase-9 and caspase-3 in LNCaP cells compared with the control. Also, after 48 h of treatment all doses used in this study showed clear fragments of DNA, which is one of the hallmarks of apoptosis. Taken together, our findings suggest that, EET can effectively induce apoptosis in LNCaP cells via activation of caspase-9 and caspase-3 that can eventually lead to DNA fragmentation and cell death.

Induction of Apoptosis in HeLa Cells via Caspase Activation by Resveratrol and Genistein

Sivanesan Dhandayuthapani,Palanisamy Marimuthu,Vanessa Hormann,James Kumi-Diaka,Appu Rathinavelu 한국식품영양과학회 2013 Journal of medicinal food Vol.16 No.2

Selectively inducing apoptosis in cancer cells is a much desired strategy when tolerance toward side effects is minimal during chemotherapy. In our search for natural products that can induce apoptosis in human cervical cancer cells (HeLa), we selected resveratrol and genistein for our study. We conducted several experiments to test whether genistein can synergistically enhance the apoptotic potential of resveratrol at doses lower than the usual cytotoxic dose. Both resveratrol and genistein were able to induce apoptosis by enhancing the activities of caspase-9 and caspase-3 by themselves and also in combination. After 24 h of exposure to resveratrol and genistein, individually or in combination, lowered mitochondrial membrane potential was observed in HeLa cells. In addition, the mitochondrial membrane potential in HeLa cells was decreased, forcing JC-1 to stay in the monomeric form. The monomeric JC-1(5,5′,6,6′ -tetrachloro-1,1′,3,3′-tetraethyl benzimedazolyl carbocyanine iodide) emitted green fluorescence. In the control group, the color of the fluorescence was red due to aggregation of JC-1 in the physiological pH. The treatment groups exhibited DNA fragmentation as the hallmark of apoptotic nuclear features. We also detected an obvious decrease in the level of HDM2 gene expression after both individual and combination treatments with resveratrol and genistein. Our findings suggest that resveratrol and genistein when combined can induce apoptosis at doses lower than usual doses, through the activation of caspases cascade, and by decreasing the expression of HDM2.

Genome Organization in Coffee as Revealed by EST PCR-RFLP, SNPs and SSR Analysis

Mishra, Manoj Kumar,Tornincasa, Patrizia,Nardi, Barbara De,Asquini, Elisa,Dreos, Rene,Terra, Lorenzo Del,Rathinavelu, Rajkumar,Rovelli, Paola,Pallavicini, Alberto,Graziosi, Giorgio 한국작물학회 2011 Journal of crop science and biotechnology Vol.14 No.1

An EST-based PCR-RFLP method was employed to gain insight into genome organization in eight allopolyploid Coffea arabica cultivars and seven diploid coffee species. The PCR-amplified products at 19 EST loci were digested with 46 different restriction enzymes and size fractioned in agarose gels. Most often, the sum of the fragments length was double or more than the PCR product. In arabica, this condition could be explained by assuming the presence of duplicated loci in paralogous chromosomes and this was supported by considerable evidence of multiple loci SSR amplification. Based on the RFLP analysis, 12 EST loci were polymorphic. The level of polymorphism was higher in different species compared to the arabica varieties. Sequencing of the amplified products revealed a SNP frequency of 0.021 among diploid species and of 0.007 among arabica varieties. We propose that the involvement of two genomes in C. arabica maintains a residual level of heterozygosity in the form of paralogous chromosomes, while the self-fertilization in this species tends to drive of homozygosity. The heterozygosity of paralogous chromosomes in arabica creates valuable polymorphism essential for species diversity and survival in various ecological niches, while self-fertility tends to preserve in homozygosity many genes of functional significance.

Genome Organization in Coffee as Revealed by EST PCRRFLP, SNPs and SSR Analysis

Manoj Kumar Mishra,Patrizia Tornincasa,Barbara De Nardi,Elisa Asquini,René Dreos,Lorenzo Del Terra,Rajkumar Rathinavelu,Paola Rovelli,Alberto Pallavicini,Giorgio Graziosi 한국작물학회 2011 Journal of crop science and biotechnology Vol.14 No.1

An EST-based PCR-RFLP method was employed to gain insight into genome organization in eight allopolyploid Coffea arabica cultivars and seven diploid coffee species. The PCR-amplified products at 19 EST loci were digested with 46 different restriction enzymes and size fractioned in agarose gels. Most often, the sum of the fragments length was double or more than the PCR product. In arabica, this condition could be explained by assuming the presence of duplicated loci in paralogous chromosomes and this was supported by considerable evidence of multiple loci SSR amplification. Based on the RFLP analysis, 12 EST loci were polymorphic. The level of polymorphism was higher in different species compared to the arabica varieties. Sequencing of the amplified products revealed a SNP frequency of 0.021 among diploid species and of 0.007 among arabica varieties. We propose that the involvement of two genomes in C. arabica maintains a residual level of heterozygosity in the form of paralogous chromosomes, while the self-fertilization in this species tends to drive of homozygosity. The heterozygosity of paralogous chromosomes in arabica creates valuable polymorphism essential for species diversity and survival in various ecological niches, while self-fertility tends to preserve in homozygosity many genes of functional significance.