Laminoplasty Techniques for the Treatment of Multilevel Cervical Stenosis

Laminoplasty is one surgical option for cervical spondylotic myelopathy. It was developed to avoid the significant risk of complications associated with alternative surgical options such as anterior decompression and fusion and laminectomy with or without posterior fusion. Various laminoplasty techniques have been described. All of these variations are designed to reposition the laminae and expand the spinal canal while retaining the dorsal elements to protect the dura from scar formation and to preserve postoperative cervical stability and alignment. With the right surgical indications, reliable results can be expected with laminoplasty in treating patients with multilevel cervical myelopathy

The effect of aging on cervical parameters in a normative North American population

Study Design: Retrospective cohort study. Objectives: To investigate age-based changes in cervical alignment parameters in an asymptomatic population. Methods: Retrospective review of a prospective study of 118 asymptomatic subjects who underwent biplanar imaging with 3-dimensional capabilities. Demographic and health-related quality of life data was collected prior to imaging. Patients were stratified into 5 age groups: &lt;35 years, 35-44 years, 45-54 years, 55-64 years, and ≥65 years. Radiographic measurements of the cervical spine and spinopelvic parameters were compared between age groups. The normal distribution of parameters was assessed followed by analysis of variance for comparison of variance between age groups. Results: C2-C7 lordosis, C0-C7 lordosis, and T1 slope demonstrated significant increases with age. C0-C7 lordosis was significantly less in subjects &lt;35 years compared with ≥55 years. Significant differences in T1 slope were identified in patients &lt;35 versus ≥65, 35-44 versus ≥65, and 45-54 versus ≥65 years. T1 slope demonstrated a positive correlation with age. Horizontal gaze parameters did not change linearly with age and mean averages of all age groups were within 10° of one another. Cervical kyphosis was present in approximately half of subjects who were &lt;55 compared with approximately 10% of subjects ≥55 years. Differences in pelvic tilt, pelvic incidence-lumbar lordosis, and C7-S1 sagittal vertical axis were identified with age. Conclusions: C0-C7 lordosis, C2-C7 lordosis, and T1 slope demonstrate age-based changes while other cervical and horizontal gaze parameters remain relatively constant with age. </jats:sec

Relationship between pressure and output parameters in belt grinding of steels and nickel alloy

Belt grinding of flat surfaces of typical parts made of steel and alloys, such as grooves, shoulders, ends, and long workpieces, is a good alternative to milling. Several factors can influence the belt grinding process of flat surfaces of metals, such as cutting speed and pressure. In this work, the importance of pressure in the belt grinding was investigated in terms of technological and experimental aspects. The grinding experiments were performed on structural alloy steel 30KhGSN2/30KhGSNA, structural carbon steel AISI 1045, corrosion-resistant and heat-resistant stainless steel AISI 321, and heat-resistant nickel alloy KHN77TYuR. The performance of the grinding belt was investigated in terms of surface roughness, material removal rate (MRR), grinding belt wear, performance index. Estimated indicators of the belt grinding process were developed: cutting ability; reduced cutting ability for belt grinding of steels and heat-resistant alloy. It was found that with an increase in pressure p, the surface roughness of the processed surface Ra decreased while the tool wear and MRR increased. With a decrease in plasticity and difficulty of machinability, the roughness, material removal rate, reduced cutting capacity (Performance index), material removal decreased, and the tool wear increased. The obtained research results can be used by technologists when creating belt grinding operations for steels and alloys to ensure the required performance is met

Cellulosic ethanol production via consolidated bioprocessing by a novel thermophilic anaerobic bacterium isolated from a Himalayan hot spring

BackgroundCellulose-degrading thermophilic anaerobic bacterium as a suitable host for consolidated bioprocessing (CBP) has been proposed as an economically suited platform for the production of second-generation biofuels. To recognize the overall objective of CBP, fermentation using co-culture of different cellulolytic and sugar-fermenting thermophilic anaerobic bacteria has been widely studied as an approach to achieving improved ethanol production. We assessed monoculture and co-culture fermentation of novel thermophilic anaerobic bacterium for ethanol production from real substrates under controlled conditions.ResultsIn this study, Clostridium sp. DBT-IOC-C19, a cellulose-degrading thermophilic anaerobic bacterium, was isolated from the cellulolytic enrichment cultures obtained from a Himalayan hot spring. Strain DBT-IOC-C19 exhibited a broad substrate spectrum and presented single-step conversion of various cellulosic and hemicellulosic substrates to ethanol, acetate, and lactate with ethanol being the major fermentation product. Additionally, the effect of varying cellulose concentrations on the fermentation performance of the strain was studied, indicating a maximum cellulose utilization ability of 10 g L&minus;1 cellulose. Avicel degradation kinetics of the strain DBT-IOC-C19 displayed 94.6% degradation at 5 g L&minus;1 and 82.74% degradation at 10 g L&minus;1 avicel concentration within 96 h of fermentation. In a comparative study with Clostridium thermocellum DSM 1313, the ethanol and total product concentrations were higher by the newly isolated strain on pretreated rice straw at an equivalent substrate loading. Three different co-culture combinations were used on various substrates that presented two-fold yield improvement than the monoculture during batch fermentation.ConclusionsThis study demonstrated the direct fermentation ability of the novel thermophilic anaerobic bacteria on various cellulosic and hemicellulosic substrates into ethanol without the aid of any exogenous enzymes, representing CBP-based fermentation approach. Here, the broad substrate utilization spectrum of isolated cellulolytic thermophilic anaerobic bacterium was shown to be of potential utility. We demonstrated that the co-culture strategy involving novel strains is efficient in improving ethanol production from real substrate.<br /

Comparison of Best Versus Worst Clinical Outcomes for Adult Cervical Deformity Surgery.

Study Design: Retrospective cohort study. Objective: Factors that predict outcomes for adult cervical spine deformity (ACSD) have not been well defined. To compare ACSD patients with best versus worst outcomes. Methods: This study was based on a prospective, multicenter observational ACSD cohort. Best versus worst outcomes were compared based on Neck Disability Index (NDI), Neck Pain Numeric Rating Scale (NP-NRS), and modified Japanese Orthopaedic Association (mJOA) scores. Results: Of 111 patients, 80 (72%) had minimum 1-year follow-up. For NDI, compared with best outcome patients (n = 28), worst outcome patients (n = 32) were more likely to have had a major complication ( Conclusions: Factors distinguishing best and worst ACSD surgery outcomes included patient, surgical, and radiographic factors. These findings suggest areas that may warrant greater awareness to optimize patient counseling and outcomes

Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

BACKGROUND: Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. METHODS AND FINDINGS: We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6-9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2-<6 year olds ranged from 2.9% (95% CI 1.6-5.5) to 18.7% (95% CI 14.7-23.6), and for any of nine NDDs in the 6-9-year-old children, from 6.5% (95% CI 4.6-9.1) to 18.5% (95% CI 15.3-22.3). Two or more NDDs were present in 0.4% (95% CI 0.1-1.7) to 4.3% (95% CI 2.2-8.2) in the younger age category and 0.7% (95% CI 0.2-2.0) to 5.3% (95% CI 3.3-8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5-11.2) and 13.6% (95% CI 11.3-16.2) in children of 2-<6 and 6-9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6-9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population. CONCLUSIONS: The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Optimization of machining parameters for turning AISI 4340 steel using Taguchi based grey relational analysis

679-685<span style="font-size:9.0pt;mso-bidi-font-size: 12.0pt" lang="EN-US">In metal cutting, the choice of cooling method influences the deformation mechanism, which is related to the cutting forces, tool wear and surface finish of the parts. The deformation mechanism of AISI 4340 steels machining conditions is known to be very different from that of commonly used industrial materials. Therefore, the effect of cutting parameters and cooling methods on cutting forces, tool wear and surface roughness in machining of AISI 4340 steel is of particular interest. This paper investigates experimentally and analytically the influence of various process parameters, given as cutting speed (v), feed rate (f) and different cooling conditions (i.e. dry, wet and cryogenic in which liquid nitrogen used as a coolant) using uncoated tungsten carbide insert tool on three major characteristics (cutting force, tool wear and surface roughness) of a turned AISI 4340 steel part. The Taguchi’s L9 orthogonal array, analysis of variance (ANOVA) and grey relational analysis (GRA) are executed to study the effects, significance, percentage contribution and optimum settings of given process parameters. The results obtained show that the machining performance can be improved by this approach. </span

Surface roughness measurements in NFMQL assisted turning of titanium alloys: An optimization approach

Abstract The prediction and optimization of surface roughness values remain a critical concern in nano-fluids based minimum quantity lubrication (NFMQL) turning of titanium (grade-2) alloys. Here, we discuss an application of response surface methodology with Box–Cox transformation to determine the optimal cutting parameters for three surface roughness values, i.e., R a, R q, and R z, in turning of titanium alloy under the NFMQL condition. The surface roughness prediction model has been established based on the selected input parameters such as cutting speed, feed rate, approach angle, and different nano-fluids used. Then the multiple regression technique is used to find the relationship between the given responses and input parameter. Further, the experimental data were optimized through the desirability function approach. The findings from the current investigation showed that feed rate is the most effective parameter followed by cutting speed, different nano-fluids, and approach angle on R a and R q values, whereas cutting speed is more effective in the case of R z under NFMQL conditions. Moreover, the predicted results are comparatively near to the experimental values and hence, the established models of RSM using Box-Cox transformation can be used for prediction satisfactorily