Early Term Effects of rhBMP-2 on Pedicle Screw Fixation in a Sheep Model: Histomorphometric and Biomechanical Analyses

Background: The effects of recombinant human bone morphogenetic protein-2 (rhBMP-2) on pedicle screw pullout force and its potential to improve spinal fixation have not previously been investigated. rhBMP-2 on an absorbable collagen sponge (ACS) carrier was delivered in and around cannulated and fenestrated pedicle screws in a sheep lumbar spine instability model. Two control groups (empty screw and ACS with buffer) were also evaluated. We hypothesized that rhBMP-2 could stimulate bone growth in and around the cannulated and fenestrated pedicle screws to improve early bone purchase. Methods: Eight skeletally mature sheep underwent destabilizing laminectomies at L2–L3 and L4–L5 followed by stabilization with pedicle screw and rod constructs. An ACS carrier was used to deliver 0.15 mg of rhBMP-2 within and around the cannulated and fenestrated titanium pedicle screws. Biomechanics and histomorphometry were used to evaluate the early term results at 6 and 12 postoperative weeks. Results: rhBMP-2 was unable to improve bony purchase of the cannulated and fenestrated pedicle screws compared to both control groups. Although rhBMP-2 groups had pullout forces that were less than both control groups, both rhBMP-2 groups had pullout force values exceeding 2,000 N, which was comparable to previously published results for unmodified pedicle screws. Significant differences in the percentages of bone in peri-screw tissues was not observed amongst the four treatment groups. Microradiography and quantitative histomorphometry showed that at 6 weeks, rhBMP-2 induced peri-screw remodeling regions containing peri-implant bone which was hypodense with respect to surrounding native trabeculae. A moderate correlation between biomechanical pullout variables and histomorphometry data was observed. Conclusions: The design of the cannulated and fenestrated pedicle screw was able to facilitate new bone formation to achieve high pullout forces. However, delivery of rhBMP-2 should be carefully controlled to prevent excessive bone remodeling which could cause early screw loosening

A study to evaluate the clinical outcome of drug-eluting vs. bare-metal stents for acute coronary syndrome patients during commercial use in real setting

Background: This study compared clinical outcome of Drug Eluting Stents (DES) versus Bare Metal Stents (BMS) in coronary arteries in patients with Acute Coronary Syndromes.Methods: A retrospective, observational study was carried out in an inpatient setting of the private tertiary care hospital. Patients with >18 years, diagnosed for Acute Coronary Syndromes (ACS), required intervention in coronary artery with implantation of Drug Eluting Stents (DES) or Bare Metal Stents (BMS) were recruited in the study. The data had been collected from file or database of the hospital. All subjects were followed for major adverse cardiac event.Results: A total of 202 patients who underwent percutaneous coronary intervention (PCI) were enrolled into DES group (n=101) and BMS group (n=101). All patients were followed up at 1 month, 3 months, 6 months & 12 months for Major Adverse Cardiac Events (MACE). Clinical outcomes during 12 months were compared between DES group & BMS group. Overall MACE rates were reported non-significantly high in BMS group patients (14.85%) compare to DES group patients (8.91%) (p=0.458). However, DES group had lower rates of death (0.99% vs 1.98%, p=0.57), rate of MI (3.96% vs 4.95% p=0.73), rate of revascularization (1.98% vs 3.96% p=0.42) & rate of sub acute thrombosis (1.98% vs 3.96% p=0.42) and higher rate of bleeding (1.98% vs 0.99% p=0.57) compare to cohort-II.Conclusions: The use of DES in the setting of Acute Coronary Syndrome is associated with lower Major Adverse Cardiac Event (MACE) rate compared to BMS without compromising the overall safety over the course of one-year follow-up. The long-term safety of drug-eluting stents needs to be ascertained in large, randomized trials

ECALTOOL: fuzzy logic based computer program to calibrate the Hargreaves equation for accurate estimation of evapotranspiration

A reference evapotranspiration rate (ET0) is vital information for irrigation scheduling as well as plant growth modeling.  Estimation of evapotranspiration using environmental variables is a convenient approach compare to direct measurement.  Several mathematical models have been proposed for the estimation of ET0.  Among all these, the Hargreaves equation has received maximum attention of the agricultural fraternity as it needs minimum weather data.  However, requirement of minimal weather data in the Hargreaves equation makes it a simple and pragmatic model for estimation of ET0.  The minimalist approach makes the equation incapable to estimate ET0 accurately under extreme weather conditions.  The calibration or adjustment of the Hargreaves equation parameter CH and EH for different climate conditions is well accepted approach to accomplish error free estimation from the equation.  The establish calibration methods are empirical and time consuming.  Further, the results obtained by these methods are valid only for the restricted area and season only.  This paper presents Evapotranspiration CALibration TOOL (ECALTOOL), which is a fuzzy based universal computer program developed on the platform of NI LabVIEW to calibrate CH and EH.  The key features of the tool are its ability to provide calibration of ET0 for 1100 locations of 190 countries, and its user friendliness.  The performance of the tool is compared and validated against the benchmark Penman-Monteith equation as well as the experimentally calibrated values for various locations with diverse climate conditions.  Mean Absolute Error (MAE) and Mean Absolute Percentage Error (MAPE) is in the range of 0.4856 – 1.1562 and 1.21%– 2.06% respectively.  The calibrated values of CH and EH are proved to be accurate in comparison with experimentally carried out calibration.  The developed tool eliminates the need of location specific experimental calibration process for the Hargreaves equation.Keywords: evapotranspiration, fuzzy logic, Hargreaves equation, LabVIE

A Study to Compare Major Adverse Cardiac Event in Patient Undergoing PCI with Drug Eluting Stents Vs Bare Metal Stents

This study compared Major Adverse Cardiac Event in patient with Acute Coronary Syndromes undergoing PCI with Drug Eluting Stents Vs Bare Metal Stents. A retrospective, observational study was carried out in an inpatient setting of the private tertiary care hospital. Patients with >18 years, diagnosed for Acute Coronary Syndromes (ACS), required intervention in coronary artery with implantation of Drug Eluting Stents (DES) or Bare Metal Stents (BMS) were recruited in the study. The data had been collected from file or database of the hospital. All subjects were followed for major adverse cardiac event. Result. A total of 202 patients who underwent percutaneous coronary intervention (PCI) were enrolled into DES group (N=101) and BMS group (N=101).  All patients were followed up at 1 month, 3 months, 6 months & 12 months for Major Adverse Cardiac Events (MACE). Clinical outcomes during 12 months were compared between DES group & BMS group. There was no significant difference in baseline parameters including demographic, risk factors of ACS, diagnosis, angiographic parameters between both groups. Overall MACE rates were reported non-significantly high in BMS group patients (14.85%) compare to DES group patients (8.91%) (P=0.458). However, DES group had lower rates of death (0.99% vs 1.98%, P=0.57), rate of MI (3.96% vs 4.95% P=0.73), rate of revascularization (1.98% vs 3.96% p=0.42) & rate of sub acute thrombosis (1.98% vs 3.96% P=0.42) and higher rate of bleeding (1.98% vs 0.99% p=0.57) compare to cohort-II. Conclusion. The use of DES in the setting of Acute Coronary Syndrome is associated with lower Major Adverse Cardiac Event (MACE) rate compared to BMS without compromising the overall safety over the course of one-year follow-up. The long-term safety of drug-eluting stents needs to be ascertained in large, randomized trials.DOI: http://dx.doi.org/10.11591/ijphs.v1i2.125

A CommonKADS Model Framework for Web Based Agricultural Decision Support System

Increased demand of farm products and depletion of natural resources compel the agriculture community to increase the use of Information and Communication Technology (ICT) in various farming processes. Agricultural Decision Support Systems (DSS) proved useful in this regard. The majority of available Agricultural DSSs are either crop or task specific. Less emphasis has been placed on the development of comprehensive DSS, which are non-specific regarding crops or farming processes. The crop or task specific DSSs are mainly developed with rule based or knowledge transfer based approaches. The DSSs based on these methodologies lack the ability for scaling up and generalization. The Knowledge engineering modeling approach is more suitable for the development of large and generalized DSS. Unfortunately the model based knowledge engineering approach is not much exploited for the development of Agricultural DSS. CommonKADS is one of the popular modeling frameworks used for the development of Knowledge Based System (KBS). The paper presents the organization, agent, task, communication, knowledge and design models based on the CommonKADS approach for the development of scalable Agricultural DSS. A specific web based DSS application is used for demonstrating the multi agent CommonKADS modeling approach. The system offers decision support for irrigation scheduling and weather based disease forecasting for the popular crops of India. The proposed framework along with the required expert knowledge, provides a platform on which the larger DSS can be built for any crop at a given location

A Study to Compare Major Adverse Cardiac Event in Patient Undergoing PCI with Drug Eluting Stents Vs Bare Metal Stents

This study compared Major Adverse Cardiac Event in patient with Acute Coronary Syndromes undergoing PCI with Drug Eluting Stents Vs Bare Metal Stents. A retrospective, observational study was carried out in an inpatient setting of the private tertiary care hospital. Patients with >18 years, diagnosed for Acute Coronary Syndromes (ACS), required intervention in coronary artery with implantation of Drug Eluting Stents (DES) or Bare Metal Stents (BMS) were recruited in the study. The data had been collected from file or database of the hospital. All subjects were followed for major adverse cardiac event. Result. A total of 202 patients who underwent percutaneous coronary intervention (PCI) were enrolled into DES group (N=101) and BMS group (N=101). All patients were followed up at 1 month, 3 months, 6 months & 12 months for Major Adverse Cardiac Events (MACE). Clinical outcomes during 12 months were compared between DES group & BMS group. There was no significant difference in baseline parameters including demographic, risk factors of ACS, diagnosis, angiographic parameters between both groups. Overall MACE rates were reported non-significantly high in BMS group patients (14.85%) compare to DES group patients (8.91%) (P=0.458). However, DES group had lower rates of death (0.99% vs 1.98%, P=0.57), rate of MI (3.96% vs 4.95% P=0.73), rate of revascularization (1.98% vs 3.96% p=0.42) & rate of sub acute thrombosis (1.98% vs 3.96% P=0.42) and higher rate of bleeding (1.98% vs 0.99% p=0.57) compare to cohort-II. Conclusion. The use of DES in the setting of Acute Coronary Syndrome is associated with lower Major Adverse Cardiac Event (MACE) rate compared to BMS without compromising the overall safety over the course of one-year follow-up. The long-term safety of drug-eluting stents needs to be ascertained in large, randomized trials

MRI Evaluation of Lumbar Disc Degenerative Disease

Introduction: Lower back pain secondary to degenerative disc disease is a condition that affects young to middle-aged persons with peak incidence at approximately 40 y. MRI is the standard imaging modality for detecting disc pathology due to its advantage of lack of radiation, multiplanar imaging capability, excellent spinal soft-tissue contrast and precise localization of intervertebral discs changes. Aims and Objective: To evaluate the characterization, extent, and changes associated with the degenerative lumbar disc disease by Magnetic Resonance Imaging. Study Design: Cross-sectional and observational study. Materials and Methods: A total 109 patients of the lumbar disc degeneration with age group between 17 to 80 y were diagnosed & studied on 1.5 Tesla Magnetic Resonance Imaging machine. MRI findings like lumbar lordosis, Schmorl’s nodes, decreased disc height, disc annular tear, disc herniation, disc bulge, disc protrusion and disc extrusion were observed. Narrowing of the spinal canal, lateral recess and neural foramen with compression of nerve roots observed. Ligamentum flavum thickening and facetal arthropathy was observed. Result: Males were more commonly affected in Degenerative Spinal Disease & most of the patients show loss of lumbar lordosis. Decreased disc height was common at L5-S1 level. More than one disc involvement was seen per person. L4 – L5 disc was the most commonly involved. Annular disc tear, disc herniation, disc extrusion, narrowing of spinal canal, narrowing of lateral recess, compression of neural foramen, ligamentum flavum thickening and facetal arthropathy was common at the L4 –L5 disc level. Disc buldge was common at L3 – L4 & L4 – L5 disc level. Posterior osteophytes are common at L3 - L4 & L5 –S1 disc level. L1- L2 disc involvement and spondylolisthesis are less common. Conclusion: Lumbar disc degeneration is the most common cause of low back pain. Plain radiograph can be helpful in visualizing gross anatomic changes in the intervertebral disc. But, MRI is the standard imaging modality for detecting disc pathology due to its advantage of lack of radiation, multiplanar imaging capability, excellent spinal soft-tissue contrast and precise localization of intervertebral discs changes

The effect of combined renal and pancreatic transplantation on diabetic retinopathy

This case report describes the effect of simultaneous pancreas kidney transplant (SPK) on the diabetic retinopathy (DR) of two male type 1 diabetic patients. The literature on the effect of SPK on DR is reviewed and the evidence surrounding visual function outcomes is discussed