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Fulltext Thoracic Spine Stenosis: Does Ultrasonic Osteotome Improve Outcome in Comparison to Conventional Technique?

Krishnan A, Samal P, Mayi S, Degulmadi S, Rai RR, Dave B

Malays Orthop J, 2021 Jul;15(2):62-69.
PMID: 34429824 DOI: 10.5704/MOJ.2107.010

Introduction: To investigate the efficacy of Ultrasonic Bone Scalpel (UBS) in thoracic spinal stenosis (TSS) in comparison to traditional technique.
Material and Methods: A total of 55 patients who had undergone conventional surgery (Group A) are compared with 45 patients of UBS (Group B) in TSS. The primary outcome measure of Modified Japanese Orthopaedic Association score (m JOA) with neurological complications and dural injury were assessed. Secondary outcome measures of total blood loss (TBL), time duration of surgery (ORT) and length of hospital stay (LHS) were analysed.
Results: The pre-operative mJOA score 5.00(4.00-6.00) in the group A and 5.00(4.00-6.00) in the group B improved to 7.00(7.00-8.00) in the group A and 9.00(9.00-10.00) in the group B, respectively (P<0.001) at final average follow-up of 117.55 months for group A and 75.69 months in group B. More significant grade of myelopathy improvement and mJOA recovery rate (RR) were noted in group B. The TBL, ORT and LHS were more favourable in group B as compared to group A (p<0.0001). The group A had 9 (16.36%) neurological deficits compared to 2 (4.44%) in group B (p<0.001). Dural tears occurred in both groups (A=11, B=9). It was more frequent and not repairable in group A but without significant statistical difference.
Conclusion: UBS can reduce neurological deficits and improve outcomes in TSS. Secondarily, reduced blood loss, lesser surgical time and reduced LHS are significant added advantages of this new technology.
Biochemical unravelling of the endoxylanase activity in a bifunctional GH39 enzyme cloned and expressed from thermophilic Geobacillus sp. WSUCF1

Rai R, Samanta D, Goh KM, Chadha BS, Sani RK

Int J Biol Macromol, 2024 Feb;257(Pt 2):128679.
PMID: 38072346 DOI: 10.1016/j.ijbiomac.2023.128679

The glycoside hydrolase family 39 (GH39) proteins are renowned for their extremophilic and multifunctional enzymatic properties, yet the molecular mechanisms underpinning these unique characteristics continue to be an active subject of research. In this study, we introduce WsuXyn, a GH39 protein with a molecular weight of 58 kDa, originating from the thermophilic Geobacillus sp. WSUCF1. Previously reported for its exceptional thermostable β-xylosidase activity, WsuXyn has recently demonstrated a significant endoxylanase activity (3752 U·mg-1) against beechwood xylan, indicating towards its bifunctional nature. Physicochemical characterization revealed that WsuXyn exhibits optimal endoxylanase activity at 70 °C and pH 7.0. Thermal stability assessments revealed that the enzyme is resilient to elevated temperatures, with a half-life of 168 h. Key kinetic parameters highlight the exceptional catalytic efficiency and strong affinity of the protein for xylan substrate. Moreover, WsuXyn-mediated hydrolysis of beechwood xylan has achieved 77 % xylan conversion, with xylose as the primary product. Structural analysis, amalgamated with docking simulations, has revealed strong binding forces between xylotetraose and the protein, with key amino acid residues, including Glu278, Tyr230, Glu160, Gly202, Cys201, Glu324, and Tyr283, playing pivotal roles in these interactions. Therefore, WsuXyn holds a strong promise for biodegradation and value-added product generation through lignocellulosic biomass conversion.
Early Intervention in Post-operative Infectious Spondylodiscitis: Outcome of Aggressive Transforaminal Lumbar Interbody Fusion

Krishnan A, Dave BR, Degulmadi D, Mayi S, Rai R, Bang P, et al.

Malays Orthop J, 2024 Nov;18(3):16-26.
PMID: 39691573 DOI: 10.5704/MOJ.2411.003

INTRODUCTION: Conservative and surgical approach timeline in post-operative spondylodiscitis (POS) following lumbar disc herniation (LDH) surgery is ill defined, and patients have a protracted recovery phase with social, psychological, and financial implications.
MATERIAL AND METHODS: Retrospective analysis of patients operated by transforaminal lumbar interbody fusion (TLIF) in POS was done. Confirmed clinico-radiological diagnosed POS cases, not responding within three to four weeks were included. Normalisation of CRP and radiological stable reconstruction was assessed for objective clearance of POS and bony union.
RESULTS: Ninety-five patients were included in the study with minimum follow-up period of two years. The mean age was 51.63±13.63 years. There were organisms cultured in 55 patients (57.89%). The ODI improvement of the patients was noted to improve from 88.71±5.3 to 20.80±9.7 (8 weeks) and was incremental at 2 years follow-up (10.12±6.41) and maintained further at final follow-up at 9±4.3. Bony union achieved in all with stable reconstruction. The resumption of activities of daily living (ADL) was quick (15.90±8.20 days) and job (3.67±1.31 months) was achieved in all the patients. In poor outcomes, two patients didn't respond, and one patient died due to uncontrolled infection.
CONCLUSION: Early diagnosis and intervention is the key to effective management of POS. Utilisation of aggressive TLIF yields faster ADL resumption.
Fulltext Surface Acoustic Wave Propagation of GaN/Sapphire Integrated with a Gold Guiding Layer

Jaafar MM, Mohd Razip Wee MF, Nguyen HT, Hieu LT, Rai R, Sahoo AK, et al.

Sensors (Basel), 2023 Feb 23;23(5).
PMID: 36904668 DOI: 10.3390/s23052464

Gallium nitride (GaN), widely known as a wide bandgap semiconductor material, has been mostly employed in high power devices, light emitting diodes (LED), and optoelectronic applications. However, it could be exploited differently due to its piezoelectric properties, such as its higher SAW velocity and strong electromechanical coupling. In this study, we investigated the affect of the presence of a guiding layer made from titanium/gold on the surface acoustic wave propagation of the GaN/sapphire substrate. By fixing the minimum thickness of the guiding layer at 200 nm, we could observe a slight frequency shift compared to the sample without a guiding layer, with the presence of different types of surface mode waves (Rayleigh and Sezawa). This thin guiding layer could be efficient in transforming the propagation modes, acting as a sensing layer for the binding of biomolecules to the gold layer, and influencing the output signal in terms of frequency or velocity. The proposed GaN/sapphire device integrated with a guiding layer could possibly be used as a biosensor and in wireless telecommunication applications.
Fulltext International Core Outcome Set for Acute Simple Appendicitis in Children: Results of a Systematic Review, Delphi Study, and Focus Croups With Young People

Knaapen M, Hall NJ, Moulin D, van der Lee JH, Butcher NJ, Minneci PC, et al.

Ann Surg, 2022 Dec 01;276(6):1047-1055.
PMID: 33630468 DOI: 10.1097/SLA.0000000000004707

OBJECTIVE: To develop an international core outcome set (COS), a minimal collection of outcomes that should be measured and reported in all future clinical trials evaluating treatments of acute simple appendicitis in children.
SUMMARY OF BACKGROUND DATA: A previous systematic review identified 115 outcomes in 60 trials and systematic reviews evaluating treatments for children with appendicitis, suggesting the need for a COS.
METHODS: The development process consisted of 4 phases: (1) an updated systematic review identifying all previously reported outcomes, (2) a 2-stage international Delphi study in which parents with their children and surgeons rated these outcomes for inclusion in the COS, (3) focus groups with young people to identify missing outcomes, and (4) international expert meetings to ratify the final COS.
RESULTS: The systematic review identified 129 outcomes which were mapped to 43 unique outcome terms for the Delphi survey. The first-round included 137 parents (8 countries) and 245 surgeons (10 countries), the second-round response rates were 61% and 85% respectively, with 10 outcomes emerging with consensus. After 2 young peoples' focus groups, 2 additional outcomes were added to the final COS (12): mortality, bowel obstruction, intraabdominal abscess, recurrent appendicitis, complicated appendicitis, return to baseline health, readmission, reoperation, unplanned appendectomy, adverse events related to treatment, major and minor complications.
CONCLUSION: An evidence-informed COS based on international consensus, including patients and parents has been developed. This COS is recommended for all future studies evaluating treatment ofsimple appendicitis in children, to reduce heterogeneity between studies and facilitate data synthesis and evidence-based decision-making.