Single-stage long-stem total knee arthroplasty in severe arthritis with stress fracture: a systematic review

( Shubhankar Shekhar ),( Alok Rai ),( Saket Prakash ),( Tarun Khare ),( Rajesh Malhotra ) 대한슬관절학회 2023 대한슬관절학회지 Vol.35 No.-

Purpose Proximal tibia stress fractures present a challenge when performing total knee arthroplasty (TKA) in knee arthritis (KA). The literature on treatment modalities for stress fractures with arthritis is varied and not systematically reviewed. We aimed to answer the questions: (1) Is long-stem TKA sufficient for stress fractures in arthritic knees? (2) Should stress fracture and KA be addressed simultaneously? (3) What is the role of augmentative procedures in stress fractures with knee arthritis? (4) Can a unified algorithm be established? Methods The PubMed and Cochrane databases were searched for keywords such as stress fracture, knee arthritis and total knee arthroplasty, published from January 1995 to 29 May 2022. A total of 472 records were screened down to 13 articles on the basis of our selection criteria. Ten data items were recorded from the included studies. The methodological index for non-randomised studies (MINORS) score for the included studies was 17 ± 3. Results We found long-stem TKA to be sufficient for most cases and advocated for single-stage treatment of stress fractures and arthritis. Augmentative procedures play a role in the treatment, and a unified algorithm was drafted to guide treatment. Conclusion Single-stage management of advanced KA with a stress fracture causes less morbidity than a staged procedure. Long-stem TKA, with or without an augmentative procedure, is an excellent option.

Single-stage long-stem total knee arthroplasty in severe arthritis with stress fracture: a systematic review

( Shubhankar Shekhar ),( Alok Rai¸ Saket Prakash ),( Tarun Khare ),( Rajesh Malhotra ) 대한슬관절학회 2023 대한슬관절학회지 Vol.35 No.-

Purpose Proximal tibia stress fractures present a challenge when performing total knee arthroplasty (TKA) in knee arthritis (KA). The literature on treatment modalities for stress fractures with arthritis is varied and not systematically reviewed. We aimed to answer the questions: (1) Is long-stem TKA sufficient for stress fractures in arthritic knees? (2) Should stress fracture and KA be addressed simultaneously? (3) What is the role of augmentative procedures in stress fractures with knee arthritis? (4) Can a unified algorithm be established? Methods The PubMed and Cochrane databases were searched for keywords such as stress fracture, knee arthritis and total knee arthroplasty, published from January 1995 to 29 May 2022. A total of 472 records were screened down to 13 articles on the basis of our selection criteria. Ten data items were recorded from the included studies. The methodological index for non-randomised studies (MINORS) score for the included studies was 17 ± 3. Results We found long-stem TKA to be sufficient for most cases and advocated for single-stage treatment of stress fractures and arthritis. Augmentative procedures play a role in the treatment, and a unified algorithm was drafted to guide treatment. Conclusion Single-stage management of advanced KA with a stress fracture causes less morbidity than a staged procedure. Long-stem TKA, with or without an augmentative procedure, is an excellent option.

Limit elastic speed analysis of rotating porous annulus functionally graded disks

Royal Madan,Shubhankar Bhowmick,Lazreg Hadji,Abdelouahed Tounsi 국제구조공학회 2022 Steel and Composite Structures, An International J Vol.42 No.3

In this work, limit elastic speed analysis of functionally graded porous rotating disks has been reported. The work proposes an effective approach for modeling the mechanical properties of a porous functionally graded rotating disk. Four different types of porosity models namely: uniform, symmetric, inner maximum, and outer maximum distribution are considered. The approach used is the variational principle, and the solution has been achieved using Galerkin's error minimization theory. The study aims to investigate the effect of grading indices, aspect ratio, porosity volume fraction, and porosity types on limit angular speed for uniform and variable disk geometries of constant mass. To validate the current study, finite element analysis has been used, and there is good agreement between the two methods. The study yielded a decrease in limit speed as grading indices and aspect ratio increase. The porosity volume fraction is found to be more significant than the aspect ratio effect. The research demonstrates a range of operable speeds for porous and non-porous disk profiles that can be used in industries as design data. The results show a significant increase in limit speed for an exponential disk when compared to other disk profiles, and thus, the study demonstrates a range of FG-based structures for applications in industries that will not only save material (lightweight structures) but also improve overall performance.

Analysis of structure-function relationship in porcine rotavirus A enterotoxin gene

Sharad Saurabh,Shubhankar Sircar,Jobin J. Kattoor,Souvik Ghosh,Nobumichi Kobayashi,Krisztian Banyai,Obli R. VinodhKumar,Ujjwal K. De,Nihar R. Sahoo,Kuldeep Dhama,Yashpal S. Malik 대한수의학회 2018 Journal of Veterinary Science Vol.19 No.1

Rotavirus (RV)-infected piglets are presumed to be latent sources of heterologous RV infection in humans and other animals. In RVs, non-structural protein 4 (NSP4) is the major virulence factor with pleiotropic properties. In this study, we analyzed the nsp4 gene from porcine RVs isolated from diarrheic and non-diarrheic cases at different levels of protein folding to explore correlations to diarrhea-inducing capabilities and evolution of nsp4 in the porcine population. Full-length nsp4 genes were amplified, cloned, sequenced, and then analyzed for antigenic epitopes, RotaC classification, homology, genetic relationship, modeling of NSP4 protein, and prediction of post-translational modification. RV presence was observed in both diarrheic and non-diarrheic piglets. All nsp4 genes possessed the E1 genotype. Comparison of primary, secondary, and tertiary structure and the prediction of post-translational modifications of NSP4 from diarrheic and non-diarrheic piglets revealed no apparent differences. Sequence analysis indicated that nsp4 genes have a multi-phyletic evolutionary origin and exhibit species independent genetic diversity. The results emphasize the evolution of the E9 nsp4 genotype from the E1 genotype and suggest that the diarrhea-inducing capability of porcine RVs may not be exclusively linked to its enterotoxin gene.

A n-order refined theory for free vibration of sandwich beams with functionally graded porous layers

Lazreg Hadji,Royal Madan,Shubhankar Bhowmick,Abdelouahed Tounsi 국제구조공학회 2021 Structural Engineering and Mechanics, An Int'l Jou Vol.79 No.3

In this paper, a simple n-order refined theory is developed for free vibration of a simply supported sandwich beam with functionally graded porous layers. The present theory is variationally consistent, uses the n-order polynomial term to represent the displacement field, and does not require a shear correction factor. The variation of shear stress is parabolic across the thickness and the condition at the top and bottom surface are shear stress-free. Equations of motion are derived from Hamilton’s principle. In the solution of the governing equations, the Navier procedure is implemented. For porosity effect, four different porosity distributions namely O, X, V, and homogeneous distribution types are modelled; power-law variation of functionally graded face sheets is considered. Results show the effects of varying gradients, thickness to length ratios, effects of the porosity parameters and porosity types on free vibration of functionally graded sandwich beams for simply supported boundary conditions. The results of the present method were validated with existing literature for both hard (ceramic) core material and soft (metal) core material, and good agreement with the benchmarks is seen. The effect of hard-core and soft-core material on natural frequency is found to be contrasting in nature.

Is 6 Months of Antitubercular Chemotherapy as Effective as More Than 6 Months Regimen in Spinal Tuberculosis? A Systematic Review and Meta-analysis

Aryal Aayush,Garg Bhavuk,Mehta Nishank,Shekhar Shubhankar,Gupta Vivek 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.5

Historically, osteoarticular tuberculosis (TB), including spinal TB, was treated with prolonged course of antitubercular therapy (ATT). Due to various challenges, there has been reluctance to explore the use of short-course ATT in spinal TB. However, with the success of short-course ATT being demonstrated in other forms of extrapulmonary TB, the subject is open for debate again. Therefore, we systematically reviewed various published literature to determine whether short-course treatment regimen (6 months) of ATT provides equivalent results in terms of disease healing as long-course treatment regimen (≥9 months) in the management of spinal TB. Five electronic databases (PubMed, MEDLINE, EMBASE, CENTRAL, and Web of Science) and their reference lists were searched to identify relevant randomized controlled trials with at least 1 year of follow-up that compared short-course with standard-course ATT for treatment of spinal TB. The methodological quality of included studies was assessed, and their data were extracted. A meta-analysis was used to calculate pooled effect sizes and 95% confidence interval (CI). The outcome measure was healed status of the disease at the final follow-up. Of 331 publications identified through literature search, eight publications describing six randomized studies were included. Moreover, 375 of 414 patients (90.58%) who received 6 months of ATT had healed status at their final follow-up compared to 404 of 463 patients (87.26%) who received ≥9 months of ATT. Overall, the healed status of spinal TB was equivalent in patients in both groups (pooled relative risk, 0.98; 95% CI, 0.92–1.04; <i>p</i> =0.439). However, there was considerable heterogeneity among the trials (I2=40.8%, <i>p</i> =0.149). The results suggest that the use of short-course (6 months) chemotherapy may be considered for the treatment of spinal TB in view of the similarity in the healing response achieved compared to treatment regimens of longer duration.

Thermal performance of functionally graded parabolic annular fins having constant weight

Vivek Kumar Gaba,Anil Kumar Tiwari,Shubhankar Bhowmick 대한기계학회 2014 JOURNAL OF MECHANICAL SCIENCE AND TECHNOLOGY Vol.28 No.10

The proposed work reports the performance of parabolic annular fins of constant weight made of functionally graded materials. Thework involves computation of temperature gradient, efficiency and effectiveness of such fins and compares the performances for differentfunctionally graded parabolic fin profiles obtained by varying grading parameters and profile parameters respectively keeping theweight of the fins constant. The functional grading of thermal conductivity is based on a power function of radial co-ordinate which consistsof parameters, namely grading parameters, varying which different grading combinations are studied. A general second order ordinarydifferential equation has been derived for all the profiles and material grading. The efficiency and effectiveness of the annular fins ofdifferent profile and grading combinations have been calculated and plotted and the results reveal the dependence of fin performance onprofile and grading parameter.

Limit speeds and stresses in power law functionally graded rotating disks

Madan, Royal,Saha, Kashinath,Bhowmick, Shubhankar Techno-Press 2020 Advances in materials research Vol.9 No.2

Limit elastic speed analysis of Al/SiC-based functionally graded annular disk of uniform thickness has been carried out for two cases, namely: metal-rich and ceramic rich. In the present study, the unknown field variable for radial displacement is solved using variational method wherein the solution was obtained by Galerkin's error minimization principle. One of the objectives was to identify the variation of induced stress in a functionally graded disk of uniform thickness at limit elastic speed using modified rule of mixture by comparing the induced von-Mises stress with the yield stress along the disk radius, thereby locating the yield initiation. Furthermore, limit elastic speed has been reported for a combination of varying grading index (n) and aspect ratios (a/b).Results indicate, limit elastic speed increases with an increase in grading indices. In case of an increase in aspect ratio, limit elastic speed increases up to a critical value beyond which it recedes. Also, the objective was to look at the variation of yield stress corresponding to volume fraction variation within the disk which later helps in material tailoring. The study reveals the qualitative variation of yield stress for FG disk with volume fraction, resulting in the possibility of material tailoring from the processing standpoint, in practice.

Study of Patients with Bilateral Knee Osteoarthritis Undergoing Total Knee Replacement Procedure with Coexisting Lumbar Spondylosis Symptoms

Londhe Sanjay Bhalchandra,Shah Ravi Vinod,Patwardhan Meghana,Doshi Amit Pankaj,Londhe Shubhankar Sanjay,Subhedar Kavita,Kundnani Vishal G.,Patel Jwalant Y. 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.6

Study Design: This is a prospective cohort study involving patients who were followed for 2 years after total knee replacement (TKR) to determine changes in lumbar spine and knee symptoms. Purpose: The objectives of this study were to determine the percentage of patients undergoing bilateral TKR who present with coexisting lumbar spine problems and determine if TKR relieves lumbar spine symptoms. Overview of Literature: No studies quantify the percentage of TKR patients who experience relief of lumbar spine symptoms after TKR surgery. Methods: The study included 200 patients (164 females, 36 males) undergoing primary TKR. Follow-up was performed at 4 weeks, 3, 6, 12, and 24 months. Lumbar spine and knee symptom improvements were assessed using the Oswestry Disability Index (ODI) and Oxford Knee Score, respectively. Results: All 200 patients undergoing bilateral TKR presented with radiographic lumbar spine degenerative pathology; 60% (n=120) of the patients presented with moderate to severe clinical symptoms of lumbar spondylosis, including 54% (n=108) with degenerative lumbar spondylosis and lumbar canal stenosis and 6% (n=12) with degenerative spondylolisthesis. Of the 120 patients who presented with lumbar spine problems, 90% (n=108) reported improvement in their symptoms; the ODI score improved from 42.5%±4.1% preoperative score to 15.6%±2.3% postoperative score (p-value<0.001). Of the 12 patients with no improvement, 10 patients underwent percutaneous procedures for their lumbar spine pathology with good results, one patient underwent surgery, and one declined any intervention. Conclusions: A significant number of patients (60%) undergoing bilateral TKR also present with symptomatic lumbar spine problems. Patients with mild to moderate lumbar spine degenerative symptoms and no associated severe radiating pain on activity are more likely to experience relief of their symptoms post-TKR.

An Artificial Tongue Fluorescent Sensor Array for Identification and Quantitation of Various Heavy Metal Ions

Xu, Wang,Ren, Changliang,Teoh, Chai Lean,Peng, Juanjuan,Gadre, Shubhankar Haribhau,Rhee, Hyun-Woo,Lee, Chi-Lik Ken,Chang, Young-Tae American Chemical Society 2014 ANALYTICAL CHEMISTRY - Vol.86 No.17

<P>Herein, a small-molecule fluorescent sensor array for rapid identification of seven heavy metal ions was designed and synthesized, with its sensing mechanism mimicking that of a tongue. The photoinduced electron transfer and intramolecular charge transfer mechanism result in combinatorial interactions between sensor array and heavy metal ions, which lead to diversified fluorescence wavelength shifts and emission intensity changes. Upon principle component analysis (PCA), this result renders clear identification of each heavy metal ion on a 3D spatial dispersion graph. Further exploration provides a concentration-dependent pattern, allowing both qualitative and quantitative measurements of heavy metal ions. On the basis of this information, a “safe-zone” concept was proposed, which provides rapid exclusion of versatile hazardous species from clean water samples based on toxicity characteristic leaching procedure standards. This type of small-molecule fluorescent sensor array could open a new avenue for multiple heavy metal ion detection and simplified water quality analysis.</P><P><B>Graphic Abstract</B> <IMG SRC='http://pubs.acs.org/appl/literatum/publisher/achs/journals/content/ancham/2014/ancham.2014.86.issue-17/ac501953z/production/images/medium/ac-2014-01953z_0006.gif'></P><P><A href='http://pubs.acs.org/doi/suppl/10.1021/ac501953z'>ACS Electronic Supporting Info</A></P>