Effect of multilevel open-door laminoplasty and laminectomy on flexibility of the cervical spine: an experimental investigation

STUDY DESIGN.: A biomechanical comparison of 2 commonly used posterior surgical procedures for spinal cord decompression in the cervical spine: laminoplasty (open door) and laminectomy. OBJECTIVE.: To delineate differences in cervical motion after laminoplasty (2-level and multilevel) and laminectomy. SUMMARY OF BACKGROUND DATA.: Cervical spondylotic myelopathy is a common spinal cord disorder in persons aged 55 years or older. Laminectomy and laminoplasty are the 2 common posterior-based techniques used for decompression of spinal cord. There is lack of adequate literature data on the intersegmental rotations at the operated and adjacent levels. METHODS.: Five human cadaveric specimens were tested sequentially as follows: (1) intact, (2) laminoplasty at C5-C6, (3) laminoplasty at C3-C6, and (4) laminectomy at C3-C6, each subjected to 2 N·m moments in flexion/extension, right/left lateral bending, and right/left axial rotation. For laminoplasty, the laminae of the involved vertebrae were stabilized with standard 10-mm plates and screws. The total and segmental motions of the specimens were measured before and after the surgical procedures. Statistical analysis was performed using repeated measures analysis of variance, with P < 0.05 as the level of significance. RESULTS.: Two-level laminoplasty led to minimal decrease (<7% in the 3 loading modes) in C2-T1 motion. Multilevel laminoplasty resulted in a minimal increase during lateral bending (4%) and axial rotation (6%). During flexion/extension, both C4-C5 and C2-C3 showed a decrease of 20% (P > 0.05) and 17% (P > 0.05) after 2-level and multilevel laminoplasty, respectively. Laminectomy resulted in a statistically significant (P < 0.05) increase in the C2-T1 range of motion compared with the intact condition during the 3 loading modes (21% in flexion/extension, 8% in lateral bending, and 15% in axial rotation). CONCLUSION.: Both 2-level and multilevel laminoplasty preserved the C2-T1 range of motion. Laminectomy resulted in a significant increase in C2-T1 motion due to the loss of the posterior structures.     

Tissue-engineered provisional matrix as a novel approach to enhance diabetic wound healing

Inherent pathologies associated with diabetic wound microenvironment including increased proteolysis, inflammatory dysregulation, and impaired neovascularization prevent timely resolution of chronic diabetic ulcers. It is hypothesized that augmentation of local wound microenvironment with a stable provisional matrix formed by proteolysis-resistant angiogenic peptide nanofibers (NFs) will create permissive environment for attenuated inflammation, enhanced neovascularization, and improved diabetic wound healing. Using murine excisional wound healing models, full-thickness dorsal skin wounds were treated with either NFs or control solutions (phosphate buffered saline; hyaluronic acid) and analyzed for morphology, inflammatory response, neovascularization, and biomechanical properties. NF treatment of diabetic wounds stimulated formation of a robust pro-angiogenic in situ tissue-engineered provisional matrix leading to a significant decrease in wound inflammatory cell infiltration and proinflammatory interleukin-6 levels, a significant increase in endothelial and endothelial progenitor cell infiltration, vascular endothelial growth factor levels, and neovascularization (day 7), as well as improved wound morphology, accelerated wound closure, and significantly stronger repair tissue (day 28). These results suggest that appropriate design of provisional matrix may compensate for some of the complex disruptions in diabetic wound microenvironment and provide missing cues to cells and direct in situ responses toward improved healing, which is promising for future development of new therapies for diabetic ulcers.     

In silico identification of potential antigenic proteins and promiscuous CTL epitopes in Mycobacterium tuberculosis

Cell-mediated immunity is critical for the control of Mycobacterium tuberculosis infection. We hypothesized that those proteins of M. tuberculosis (MTB) that do not have homologs in humans as well as human gut flora, would mount a good antigenic response in man, and employed a bioinformatics approach to identify MTB antigens capable of inducing a robust cell-mediated immune response in humans. In the first step we identified 624 MTB proteins that had no homologs in humans. Comparison of this set of proteins with the proteome of 77 different microbes that comprise the human gut flora narrowed down the list to 180 proteins unique to MTB. Twenty nine of the 180 proteins are known to be associated with dormancy. Since dormancy associated proteins are known to harbor CTL epitopes, we selected four representative unique proteins and subjected them to epitope analysis using ProPred1. Nineteen novel promiscuous epitopes were identified in the four proteins. Population coverage for 7 of the 19 shortlisted epitopes including Rv3852 (58-KPAEAPVSL, 112-VPLIVAVTL, 118-VTLSLLALL and 123-LALLLIRQL), Rv2706c (66-RPLSGVSFL) Rv3466 (8- RIVEVFDAL and 38-RSLERLECL) was >74%. These novel promiscuous epitopes are conserved in other virulent MTB strains, and can therefore be further investigated for their immunological relevance and usefulness as vaccine candidates.     

Response of L V Prasad Eye Institute to COVID-19 outbreak in India: experience at its tertiary eye care centre and adoption to its Eye Health Pyramid

AIM:To summarize the experience of response to COVID-19 outbreak at a tertiary eye care institute and its network of health facilities in India.METHODS:Our responses are based on the principles of social distancing,hand hygiene,respiratory etiquettes,surface disinfection protocol,and rational use of appropriate personal protective equipment(PPE).We describe our response in terms of administrative controls,clinical protocols,staff protection,environmental controls,and social distancing measures.We also discuss our communication strategies and monitoring systems,to ensure compliance to protocols.RESULTS:Administrative control is mainly related to formation of task force and its functions.Clinical protocols are related to patient triaging methods and clinical examination guidelines in Outpatient,Inpatient and Operating Room.Staff protection is focused on training staff on the protocols to be followed in hospital as well as at home,and use of PPE.Environmental protocol is focused on cleaning and disinfectant methods to be used in the hospital.In addition,there are systems for communication as well as monitoring compliance to protocols.CONCLUSION:We hope that these protocols and our experience would help the ophthalmic community globally and serve as a guide to protect ophthalmologists and ophthalmic care personnel,and their patients across the world.     

Glycodelin A triggers mitochondrial stress and apoptosis in T cells by a mechanism distinct and independent of TCR signaling

Glycodelin A is one of the progesterone inducible endometrial factors that protect the fetal semiallograft from maternal immune rejection. Our previous studies demonstrate that glycodelin A induces apoptosis in activated T lymphocytes. Here, we report that glycodelin A initiates the intrinsic apoptotic program in T cells. Glycodelin A treatment triggers a stress response leading to mitochondrial membrane permeabilization and activation of initiator caspase 9. The kinetics of mitochondrial depolarization precede onset of DNA fragmentation in both Jurkat cells and peripheral blood T cells treated with glycodelin A. Overexpression of the antiapoptotic protein Bcl-2 is sufficient to protect from glycodelin A-induced cell death. It has been reported earlier that glycodelin A desensitizes T cell receptor (TCR) signaling, probably by its association with the tyrosine phosphatase CD45. Here, we provide evidence that the apoptogenic activity of glycodelin A is not a consequence of this phenomenon. Glycodelin A-induced apoptosis does not depend on components of the TCR signal cascade, including CD45. We observe that glycodelin A is inhibitory to T cells even upon phorbol ester and ionophore stimulation which bypasses the TCR-proximal signaling events, and that glycodelin A treatment does not interfere with T cell activation as evidenced from induction of the activation marker CD69. Thus, glycodelin A initiates mitochondrial stress-mediated apoptosis in T cells by a pathway that is distinct and independent from the TCR signaling pathway.     

Updated consensus guidelines on the management of Phelan–McDermid syndrome

Phelan–McDermid syndrome (PMS) is a genetic condition caused by SHANK3 haploinsufficiency and characterized by a wide range of neurodevelopmental and systemic manifestations. The first practice parameters for assessment and monitoring in individuals with PMS were published in 2014; recently, knowledge about PMS has grown significantly based on data from longitudinal phenotyping studies and large-scale genotype–phenotype investigations. The objective of these updated clinical management guidelines was to: (1) reflect the latest in knowledge in PMS and (2) provide guidance for clinicians, researchers, and the general community. A taskforce was established with clinical experts in PMS and representatives from the parent community. Experts joined subgroups based on their areas of specialty, including genetics, neurology, neurodevelopment, gastroenterology, primary care, physiatry, nephrology, endocrinology, cardiology, gynecology, and dentistry. Taskforce members convened regularly between 2021 and 2022 and produced specialty-specific guidelines based on iterative feedback and discussion. Taskforce leaders then established consensus within their respective specialty group and harmonized the guidelines. The knowledge gained over the past decade allows for improved guidelines to assess and monitor individuals with PMS. Since there is limited evidence specific to PMS, intervention mostly follows general guidelines for treating individuals with developmental disorders. Significant evidence has been amassed to guide the management of comorbid neuropsychiatric conditions in PMS, albeit mainly from caregiver report and the experience of clinical experts. These updated consensus guidelines on the management of PMS represent an advance for the field and will improve care in the community. Several areas for future research are also highlighted and will contribute to subsequent updates with more refined and specific recommendations as new knowledge accumulates.     

Evaluation of anti-inflammatory and anti-arthritic property of ethanolic extract of Clitoria ternatea

Objective: Clitoria ternatea is a well-known bioactive plant used to treat several inflammatory ailments in Ayurvedic system of medicine in India. The present investigation aimed to determine the anti-inflammatory and anti-arthritic activity of ethanolic extract of Clitoria ternatea roots (EECT) in animal models. Methods: The anti-inflammatory activity of the EECT was evaluated by carrageenan and histamine-induced paw edema. Results: EECT showed a significant reduction in mean paw edema volume in both carrageenan and histamine-induced inflammation. The efficacy of EECT in rheumatoid arthritis was tested against Freund’s complete adjuvant (CFA) induced arthritic models in Wistar rats. The anti-arthritic effect of EECT was determined by systematic scoring of arthritis symptoms and measuring paw edema. A considerable decrease in paw diameter was observed in the EECT (200 and 400 mg/kg) and diclofenac (10 mg/kg) treated groups after day 7. Diclofenac (10 mg/kg) and EECT (400 mg/kg) showed a significant reduction in paw diameter from day 14 compared with CFA control (P < 0.001). The anti-arthritic activity was also confirmed from the altered biochemical, haematological (Hb, RBC and WBC) and anti-oxidant parameters (SOD, MDA, CAT, and GSH). EECT (400 and 200 mg/kg) also showed a marked inhibition of joint destruction. Conclusion: This study provides a pharmacological rationale for the traditional use of C. ternatea against inflammation and rheumatoid arthritis in India.