Multimodal Intraoperative Neurophysiological Monitoring in Spine Surgeries: The Experience at a Spine Centre through Years

Rajappa Deepak,Khan Mohd Mazhar,Masapu Dheeraj,Manchala Ravi,Rudrappa Satish,Gopal Swaroop,Govindasamy Ramachandran,Horasuku Sunil Kumar 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.6

Study Design: Retrospective observational study. Purpose: To share our experience of multimodal intraoperative neurophysiological monitoring (IONM) used in Sakra World Hospital, Bengaluru in various spine surgeries. Overview of Literature: The development of new onset postoperative neurological deficits can be completely avoided. In order to avoid these, IONM has become a standard of care in recent times for early detection and manipulation of the surgical procedure to prevent postoperative neurological deficits. Methods: This retrospective study was performed on 408 patients who had undergone spine surgeries with IONM during April 2014 to March 2020 at a single center. The operative report, anesthesia record, and IONM were reviewed. All the patients were reassessed for postoperative neurological deficits in the postoperative period and followed up based on the intraoperative findings and neurological deficits for 4 weeks. Signal changes in IONM were reviewed, and the obtained results were further categorized into true positive, true negative, false positive, or false negative. If changes were observed during the IONM, the patients were managed as per the algorithm. Results: Of the 408 patients being monitored continuously during the intraoperative period, 38 showed changes in recordings, 28 developed postoperative neurological deficits, and one developed neurological deficit without any change in the IONM. Nine patients had transient neurological deficits, and the other 20 had permanent neurological deficits. Overall, the multimodal IONM used in our study had a sensitivity of 96.6%, specificity of 97.4%, a positive predictive value of 73.7%, and a negative predictive value of 99.7%. Conclusions: Use of decision algorithm and multimodal neuromonitoring consisting of motor evoked potentials, somatosensory evoked potentials, and electromyography complement each other in the detection of neurological injury during the course the surgery, improve intraoperative care, and prevent further damage and morbidity in patients.

Peak mooring forces in the horizontal interlaced multi-layered moored floating pipe breakwater

Mane, Vishwanath,Rajappa, Sacchi,Rao, Subba,Vittal, Hegde A. The Society of Naval Architects of Korea 2011 International Journal of Naval Architecture and Oc Vol.3 No.2

Present study aims to investigate the influence of relative breakwater width W/L (W=width of breakwater, L=wavelength), wave steepness $H_i/gT^2$ (Hi=incident wave height, T=wave period) and relative wave height d/W (d=water depth) on forces in the moorings of horizontal interlaced multi-layered moored floating pipe breakwater (HIMMFPB) model. Studies were conducted on scaled down physical models having three layers of Poly Vinyl Chloride (PVC) pipes, wave steepness $H_i/gT^2$ varying from 0.063 to 0.849, relative width W/L varying from 0.4 to 2.65 and relative spacing S/D=2 (S=horizontal centre-to-centre spacing of pipes, D=diameter of pipes). Peak mooring forces were also measured and data collected is analyzed by plotting non-dimensional graphs depicting variation of $f_s/{\gamma}W^2$ ($f_s$=Sea side Mooring force, ${\gamma}$=specific weight of water) & $f_l/{\gamma}W^2$ ($f_l$=Lee side Mooring force) with $H_i/gT^2$ for d/W varying from 0.082 to 0.276 and also variation of $f_s/{\gamma}W^2$ and $f_l/{\gamma}W^2$ with W/L for $H_i$/d varying from 0.06 to 0.400.

IP Multimedia Subsystem—An Intrusion Detection System

Bakkiam David Deebak,Rajappa Muthaiah,Karuppusamy Thenmozhi,Pitchai Iyer Swaminathan 한국산학기술학회 2013 SmartCR Vol.3 No.1

The IP Multimedia Subsystem (IMS) amalgamates the core of telecommunication and Internet protocol (IP) network access to ease network traffic of the next-generation network (NGN). Since the coalescence of the NGN, malicious attacks can also disrupt multimedia services. This can lead to financial loss for telecom operators and loss of connection for users. This paper introduces an attack detection schema (ADS) that provides security from session initiation protocol (SIP) flooding attacks. The proposed schema is configured with the OpenOpenIMSCore to validate the accuracy of SIP session traffic. Similarly, the schema is imbedded with the OpenIMS client, which helps to detect and expose such attacks on the IMS client display. Since even a small flooding attack could clog the OpenOpenIMSCore, detection accuracy should be relatively higher to prevent OpenIMSCore from going down. The proposed schema includes a key authentication schema for proficiently analyzing SIP packets. The proposed authentication is placed between the transport and application layers. A network traffic tool, Ntop, is configured with the OpenOpenIMSCore to analyze SIP traffic, Real Time Transport Protocol (RTP) traffic and the throughput rate. Overall, the proposed schema of ADS improves reasonably well after it cuts off the attacker.

Biosynthesis of Colloidal Silver Nanoparticles: Their Characterization and Potential Antibacterial Activity

Chikkapura Shekarappa Shivananda,Sangappa Asha,Rajappa Madhukumar,Sreedharamurthy Satish,Badiadka Narayana,Kullaiah Byrappa,Youjiang Wang,Yallappa Sangappa 한국고분자학회 2016 Macromolecular Research Vol.24 No.8

The colloidal silver nanoparticles (AgNPs) were synthesized in situ under white light at room temperature using aqueous silk fibroin (SF) obtained from Bombyxmori silk. The UV-visible spectroscopy revealed the formation of AgNPs by showing a typical surface Plasmon resonance (SPR) band at 422 nm from the UV-visible spectra. The transmission electron microscope (TEM) images show that the formed nanoparticles were spherical in shape with smooth surfaces. The particle diameter was around 35-40 nm. Further the X-ray diffraction (XRD) analysis confirms the nanocrystalline phase of silver with face centered cubic (FCC) crystal structure. The biogenic silver nanoparticles exhibited significant antibacterial activity against human bacterial pathogens Bacillus subtilis, Staphylococcus aureus, Salmonella typhi and Escherichia coli.

Further evaluations of Ramanujan-Weber class invariants g_n

B. R. Rakshith,R. G. veeresha,G. N. Rajappa 장전수학회 2012 Proceedings of the Jangjeon mathematical society Vol.15 No.3

The purpose of this paper is to establish further evaluations of the class invariants gn using Ramanujan's modular equations.

Further evaluations of Ramanujan-Weber class invariants $g_n$

B. R. Rakshith,Veeresha R.G.,G. N. Rajappa 장전수학회 2013 Advanced Studies in Contemporary Mathematics Vol.23 No.1

The purpose of this paper is to establish further evaluations of the class invariants gn using Ramanujan’s modular equations.

Deletion of GSTM1 and T1 Genes as a Risk Factor for Development of Acute Leukemia

Dunna, Nageswara Rao,Vure, Sugunakar,Sailaja, K.,Surekha, D.,Raghunadharao, D.,Rajappa, Senthil,Vishnupriya, S. Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.4

The glutathione S-transferases (GSTs) are a family of enzymes involved in the detoxification of a wide range of chemicals, including important environmental carcinogens, as well as chemotherapeutic agents. In the present study 294 acute leukemia cases, comprising 152 of acute lymphocytic leukemia (ALL) and 142 of acute myeloid leukemia, and 251 control samples were analyzed for GSTM1 and GSTT1 polymorphisms through multiplex PCR methods. Significantly increased frequencies of GSTM1 null genotype (M0), GSTT1 null genotype (T0) and GST double null genotype (T0M0) were observed in the both ALL and AML cases as compared to controls. When data were analyzed with respect to clinical variables, increased mean levels of WBC, Blast %, LDH and significant reduction in DFS were observed in both ALL and AML cases with T0 genotype. In conclusion, absence of both GST M & GST T might confer increased risk of developing ALL or AML. The absence of GST enzyme might lead to oxidative stress and subsequent DNA damage resulting in genomic instability, a hallmark of acute leukemia. The GST enzyme deficiency might also exert impact on clinical prognosis leading to poorer DFS. Hence GST genotyping can be made mandatory in management of acute leukemia so that more aggressive therapy such as allogenic stem cell transplantation may be planned in the case of patients with a null genotype.

Molecular and Circulatory Expression of Insulin Growth Factors in Indian Females with Advanced Cervical Cancer

Sharma, Manoj,Satyam, Abhigyan,Abhishek, Ashu,Khan, Rehan,Rajappa, Medha,Sharma, Alpana Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.12

Background: Recent studies have demonstrated an association between insulin growth factor (IGF) and insulin growth factor binding protein-3 (IGFBP-III) serum levels and increased risk for various cancers. However, little information is available on clinical implications of the IGF system in Indian patients with cervical cancer. This study explored associations by analyzing their expression profiles in cervical cancer cases. Materials and Methods: Totals of 50 patients with advanced cervical cancer and 40 healthy controls were enrolled. Human papillomavirus (HPV) and cervical biopsy sample were obtained from all participating women. Circulatory levels were estimated by ELISA and the tissue expression was assessed using RT-PCR and Western blotting. Results: Levels of IGF-I and II showed significant increase whereas IGFBP-III showed significant decline in all patients as compared to controls. Spearman correlation analysis between IGFs and HPV status showed significant correlations. Conclusions: We demonstrated elevated circulating levels and tissue expression of IGF-I and IGF-II in advancer cancer cervix patients, as compared with controls, with a converse trend being apparent for IGFBP-III. In future, associations of the IGF system and clinical outcome of cervical cancer patients in post treatment samples might point to significance in disease mapping as a prognostic marker after validation with a larger patient series.

Primary Extra Nodal Non Hodgkin Lymphoma: A 5 Year Retrospective Analysis

Padhi, Somanath,Paul, Tara Roshni,Challa, Sundaram,Prayaga, Aruna K.,Rajappa, Senthil,Raghunadharao, D.,Sarangi, Rajlaxmi Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.10

Background and Aim: The incidence of extra nodal non Hodgkin lymphoma (ENL) is rising throughout the world. However, data regarding ENL as a group is limited. The aim was to study the epidemiological and histomorphological trends of primary ENL (pENL) in India. Material and Methods: The biopsy materials from sixty eight patients with pENL (45 male, 23 female, M:F= 1.9:1), diagnosed over a five year period (2005-2009), were analysed and pathologically reclassified according to the World Health Organization (WHO) classification, 2008 criteria. Results: Primary extra nodal non Hodgkin lymphomas constituted 22.0% (68/308) of all non Hodgkin lymphomas (NHL). The mean age at presentation for pENL and primary nodal NHL was 43 years and 58 years, respectively with a male predilection (M: F=2:1). Central nervous system (CNS) constituted the most common extranodal site (20/68, 29.5%) followed by gastrointestinal tract (17/68, 25%), and nose/nasopharynx (8/68, 11.8%). Diffuse large B-cell lymphoma (DLBCL, not otherwise specified), extranodal marginal lymphoma of mucosa associated lymphoid tissue (MALT) type, and B cell NHL unclassified (U) were the three most common histological types observed. T-cell phenotype was rarely noted (4%). Follicular lymphomas and anaplastic large cell lymphoma, seen among nodal NHL, were absent at extra nodal sites. Majority (41/68, 60%) of the patients with pENL were immunocompetent and 55% were in stage I-II with favorable prognosis. Conclusion: Central nervous system was the most common site of ENL, followed by gastrointestinal tract. Majority of pENL occurred in immunocompetent hosts with a favorable prognosis.

TP53 Codon 72 Polymorphism and Risk of Acute Leukemia

Dunna, Nageswara Rao,Vure, Sugunakar,Sailaja, K.,Surekha, D.,Raghunadharao, D.,Rajappa, Senthil,Vishnupriya, S. Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.1

TP53 is the mostly commonly mutated gene in many cancers and the P53 tumor suppressor protein is involved in multiple cellular processes, including transcription, DNA repair, genomic stability, senescence, cell cycle control and apoptosis. A common single nucleotide polymorphism located within the proline rich region of TP53 gene at codon 72 in exon 4 encodes either proline or arginine. TP53 Arg 72 is more active than TP53 Pro 72 in inducing apoptosis. The aim of this study was to understand the association of the 72 codon polymorphism with acute leukemia development and prognosis. A total of 288 acute leukemia cases comprising 147 acute lymphocytic leukemia (ALL) and 141 acute myeloid leukemia (AML), as well as 245 controls were recruited for analysis of the TP53 72 polymorphism using PCR-RFLP method. Significant association of homozygous arginine genotype with AML was observed (${\chi}^2$- 133.53; df-2, p < 0.001. When data were analyzed with respect to clinical variables, elevation in mean WBC, blast %, LDH levels and slight reduction in DFS in ALL cases with the arginine genotype was observed. In contrast, AML patients with Pro/Pro had elevated WBC, Blast%, LDH levels with slightly reduced DFS. Our study indicates that Arg/Arg genotype might confer increased risk to development of acute myeloid leukemia.