Low Back Pain: Current Surgical Approaches

Santosh Baliga,Katrina Treon,Niall John Angus Craig 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.4

Low back pain (LBP) is a worldwide phenomenon. The UK studies place LBP as the largest single cause of absence from work; up to 80% of the population will experience LBP at least once in their lifetime. Most individuals do not seek medical care and are not disabled by their pain once it is managed by nonoperative measures. However, around 10% of patients go on to develop chronic pain. This review outlines the basics of the traditional approach to spinal surgery for chronic LBP secondary to osteoarthritis of the lumbar spine as well as explains the novel concepts and terminology of back pain surgery. Traditionally, the stepwise approach to surgery starts with local anaesthetic and steroid injection followed by spinal fusion. Fusion aims to alleviate pain by preventing movement between affected spinal segments; this commonly involves open surgery, which requires large soft tissue dissection and there is a possibility of blood loss and prolonged recovery time. Established minimally invasive spine surgery techniques (MISS) aim to reduce all of these complications and they include laparoscopic anterior lumbar interbody fusion and MISS posterior instrumentation with pedicle screws and rods. Newer MISS techniques include extreme lateral interbody fusion and axial interbody fusion. The main problem of fusion is the disruption of the biomechanics of the rest of the spine; leading to adjacent level disease. Theoretically, this can be prevented by performing motion-preserving surgeries such as total disc replacement, facet arthroplasty, and non fusion stabilisation. We outline the basic concepts of the procedures mentioned above as well as explore some of the novel surgical therapies available for chronic LBP.

Bargaining and War: A Review of Some Formal Models

( Sandeep Baliga ),( Tomas Sjostrom ) 한국경제학회 2013 The Korean Economic Review Vol.29 No.2

Would perfectly rational agents always negotiate peaceful outcomes at the bargaining table, or would they sometimes fight costly wars? The Coase theorem suggests that when rational agents negotiate freely, they will reach a surplus-maximizing outcome. This seems to rule out war, since war will not in general be surplus-maximizing. However, the Coase theorem is valid only under certain assumptions, such as transferable utility (no restrictions on side-payments) and complete information. Brito and Intriligator (1985) showed how incomplete information may lead to war. An aggressor who demands concessions may simply be bluffing, so it may be rational to refuse his demands. If the aggressor is not bluffing, a war may ensue. We discuss how long such a war may last, and whether other kinds of “frictions” (such as limited commitment power and limits on side-payments) may also lead to war.

Role of dexmedetomidine in pediatric dental sedation

Mohite, Vedangi,Baliga, Sudhindra,Thosar, Nilima,Rathi, Nilesh The Korean Dental Society of Anesthsiology 2019 Journal of Dental Anesthesia and Pain Medicine Vol.19 No.2

Dexmedetomidine is a highly selective ${\alpha}2$-adrenoceptor agonist with a vast array of properties, making it suitable for sedation in numerous clinical scenarios. Its use was previously restricted to the sedation of intensive care unit patients. However, its use in pediatric dental sedation has been gaining momentum, owing to its high suitability when compared with conventional pediatric sedatives. Its properties range from sedation to anxiolysis to analgesia, due to its sympatholytic properties and minimal respiratory depression ability. Because dexmedetomidine is an efficacious and safe drug, it is gaining importance in pediatric sedation. Thus, the aim of this review is to highlight the properties of dexmedetomidine, its administration routes, its advantages over the commonly used pediatric sedatives, and especially its role as an alternative pediatric sedative.

The Evaluation of Nitric Oxide Scavenging Activity of Certain Indian Medicinal Plants In Vitro: A Preliminary Study

Ganesh Chandra Jagetia,Manjeshwar Shrinath Baliga 한국식품영양과학회 2004 Journal of medicinal food Vol.7 No.3

Effect of Alstonia scholaris in Enhancing the Anticancer Activity of Berberine in the Ehrlich Ascites Carcinoma-Bearing Mice

Ganesh Chandra Jagetia,Manjeshwar Shrinath Baliga 한국식품영양과학회 2004 Journal of medicinal food Vol.7 No.2

The chemomodulatory activity of Alstonia scholaris extract (ASE) was studied in combination with berberine hydrochloride (BCL), a topoisomerase inhibitor, in Ehrlich ascites carcinoma-bearing mice. The tumor-bearing animals were injected with various doses of ASE, and 8 mg/kg of BCL (one-fifth of the 50% lethal dose) was combined with different doses of ASE (60–240 mg/kg). The combination of 180 mg/kg of ASE with 8 mg/kg of BCL showed the greatest antitumor effect; the number of tumor-free survivors was more, and the median survival time and the average survival time increased up to 47 and 40.5 days, respectively, when compared with either treatment alone. Similarly, when 180 mg/kg of ASE was combined with different doses of BCL (2–12 mg/kg), a dose-dependent increase in the anticancer activity was observed up to 8 mg/kg of BCL. However, a further increase in the BCL dose to 10 and 12 mg/kg resulted in toxic side effects. The best effect was observed when 180 mg/kg of ASE was combined with 6 or 8 mg/kg of BCL, where an increase in the antineoplastic activity was reported. The efficacy of the combination of 180 mg/kg of ASE was also tested with 6 mg/kg body weight of BCL in various stages of tumorigenesis, and it was effective when given in the early stages, although the efficiency decreased with an increase in the tumor developmental stages.

Comparative validity of microalbuminuria versus clinical mortality scores to predict pediatric intensive care unit outcomes

Nismath, Shifa,Rao, Suchetha S.,Baliga, B.S.,Kulkarni, Vaman,Rao, Gayatri M. The Korean Pediatric Society 2020 Clinical and Experimental Pediatrics (CEP) Vol.63 No.1

Background: Predicting the prognosis of patients admitted to the pediatric intensive care unit (PICU) is very important in determining further management and resource allocation. The prognostication of critically ill children can be challenging; hence, accurate methods for predicting outcomes are needed. Purpose: To evaluate the role of microalbuminuria at admission as a prognostic marker in comparison to standard Pediatric Risk of Mortality (PRISM) and Pediatric Logistic Organ Dysfunction (PELOD) mortality scores in children admitted to the PICU. Methods: This cross-sectional study was conducted from January 2015 to October 2016. Eighty-four patients aged 1 month to 18 years admitted to the PICU of teaching hospitals for more than 24 hours were enrolled by convenience sampling method. Microalbuminuria was estimated by spot urinary albumin-creatinine ratio. PRISM and PELOD scores were calculated using an online calculator. Outcome measures were PICU length of stay, inotrope usage, multiorgan dysfunction, and survival. ACR was compared with mortality scores for predicting survival. Results: Microalbuminuria was present in 79.8% with a median value of 85 mg/g (interquartile range, 41.5-254 mg/g). A positive correlation was found between albumin-creatinine ratio and PICU length of stay (P=0.013, r=0.271). Albumin-creatinine ratio was significantly associated with organ dysfunction (P=0.004) and need for inotropes (P=0.006). Eight deaths were observed in the PICU. The area under the curve for mortality for albumin-creatinine ratio (0.822) was comparable to that for PRISM (0.928) and PELOD (0.877). Albumin-creatinine ratio >109 mg/g predicted mortality with a sensitivity of 87.5% and specificity of 63.2%. Conclusion: Microalbuminuria is a good predictor of PICU outcomes comparable with mortality scores.

Midazolam use in pediatric dentistry: a review

Jain, Shreyans Aditya,Rathi, Nilesh,Thosar, Nilima,Baliga, Sudhindra The Korean Dental Society of Anesthsiology 2020 Journal of Dental Anesthesia and Pain Medicine Vol.20 No.1

Behaviour management and dental procedures performed in very young, pre-cooperative, highly anxious, or medically disabled children are challenging tasks. Various drugs and methods have, however, been introduced to facilitate treatment for this patient population. Midazolam is a benzodiazepine used as an adjunct to behavior management techniques in the dental treatment of pediatric patients. Midazolam can be used as a safe and effective drug for conscious sedation, general anesthetic premedication, and treatment of seizures during dental procedures. Nevertheless, further research involving pediatric patients would be beneficial.

Retraction: Midazolam use in pediatric dentistry: a review

Jain, Shreyans Aditya,Rathi, Nilesh,Thosar, Nilima,Baliga, Sudhindra The Korean Dental Society of Anesthsiology 2020 Journal of Dental Anesthesia and Pain Medicine Vol.20 No.2

A simple technique for imaging of anterior cruciate ligament graft after anterior cruciate ligament reconstruction surgery in the immediate post-operative period

Tunglut Pausiam,Prashant Arya,Sunil Baliga,Manabendra N. Basu Mallick 대한정형외과 스포츠의학회 2021 Arthroscopy and Orthopedic Sports Medicine Vol.8 No.1

Post-operative radiography performed after anterior cruciate ligament (ACL) reconstruction surgery only shows the position of the tunnels; however, no information about the ACL graft, the actual focus of the surgery, is revealed. Videography during surgery and magnetic resonance imaging (MRI) after surgery is rarely documented in the immediate post-operative period. Here, we describe a simple technique for visualization of ACL graft and tunnels immediately after the surgery. For this, the graft is soaked in an iodine-containing radio-opaque dye iohexol injection after harvesting and before implantation into the joint. A radiograph of the knee is taken immediately after the surgery and the iodine-soaked graft shows up clearly. This technique is easy, reproducible, does not prolong the surgical duration, does not alter the graft properties, and does not pose any risk to the patient.

A systems level predictive model for global gene regulation of methanogenesis in a hydrogenotrophic methanogen

Yoon, Sung Ho,Turkarslan, Serdar,Reiss, David J.,Pan, Min,Burn, June A.,Costa, Kyle C.,Lie, Thomas J.,Slagel, Joseph,Moritz, Robert L.,Hackett, Murray,Leigh, John A.,Baliga, Nitin S. Cold Spring Harbor Laboratory Press 2013 Genome research Vol.23 No.11

<P>Methanogens catalyze the critical methane-producing step (called methanogenesis) in the anaerobic decomposition of organic matter. Here, we present the first predictive model of global gene regulation of methanogenesis in a hydrogenotrophic methanogen, <I>Methanococcus maripaludis</I>. We generated a comprehensive list of genes (protein-coding and noncoding) for <I>M. maripaludis</I> through integrated analysis of the transcriptome structure and a newly constructed Peptide Atlas. The environment and gene-regulatory influence network (EGRIN) model of the strain was constructed from a compendium of transcriptome data that was collected over 58 different steady-state and time-course experiments that were performed in chemostats or batch cultures under a spectrum of environmental perturbations that modulated methanogenesis. Analyses of the EGRIN model have revealed novel components of methanogenesis that included at least three additional protein-coding genes of previously unknown function as well as one noncoding RNA. We discovered that at least five regulatory mechanisms act in a combinatorial scheme to intercoordinate key steps of methanogenesis with different processes such as motility, ATP biosynthesis, and carbon assimilation. Through a combination of genetic and environmental perturbation experiments we have validated the EGRIN-predicted role of two novel transcription factors in the regulation of phosphate-dependent repression of formate dehydrogenase—a key enzyme in the methanogenesis pathway. The EGRIN model demonstrates regulatory affiliations within methanogenesis as well as between methanogenesis and other cellular functions.</P>