Comparative study of functional outcome analysis and extent of paraspinal muscle damage between lumbar spinous process splitting decompression and conventional midline decompression for lumbar canal stenosis

INTRODUCTION Lumbar spinal canal stenosis is a clinical syndrome of back or leg pain with characteristic provocative and palliative features, which occurs due to narrowing of spinal canal, nerve root canal and the intervertebral foramen. Lumbar spinal canal stenosis has been regarded as “the forgotten spinal disease” for more than 100 years. This neglect occurred because of the association between herniated intervertebral discs and sciatica received most of the attention after it was discovered by Mixter and Barr in 1934. However, Lumbar spinal canal stenosis was not widely understood until Verbiest in 1954 described the classic finding of this syndrome. It occurs in middle aged and older adults with back pain and lower extremity pain precipitated by standing and walking and aggravated by hyperextension. The secondary degenerative changes that further narrow the lumbar spinal canal precipitated symptoms. Lumbar spinal canal stenosis now is an accepted clinical entity. The degenerative lumbar spinal canal stenosis is due to thickening of interspinous ligament, ligamentum flavum and facet joint hypertrophy. Lumbar spinal canal stenosis cause signs of intermittent neurogenic claudication, and it can lead to decreased quality of life. Conservative measures provide relief from symptoms for a shorter period only, but finally surgical decompression of the neurovascular structures will be needed. AIM OF THE STUDY: This prospective Randomised Control Study compares the the functional outcome and extent of paraspinal muscle damage between Lumbar spinous process splitting decompression (LSPSD) and Conventional Midline Decompression(CMD) by laminectomy surgical approaches in degenerative lumbar canal stenosis and their aim was whether 1) Lumbar spinous process splitting decompression (LSPSD ) approach provide sufficient decompression. 2) Preserve posterior musculoligamentous complex and reduces associated morbidity. MATERIALS AND METHODS : This randomized prospective control study was approved by the medical ethics committee of the Institutional Review Board in our hospital. Patients meeting the following inclusion criteria were enrolled for the study after obtaining written informed consent. 20 patients with degenerative lumbar canal stenosis are randomly divided into two groups and recruited into the study based on the following criterias INCLUSUION CRITERIA: Degenerative LCS affecting 3 or less levels, -Typical neurogenic claudication symptoms, - Magnetic resonance image demonstrating good clinical correlation, - Failure of conservative methods of treatment for a minimum period of 6 months. EXCLUSION CRITERIA: -Spondylolisthesis with slip grade 2 or greater (Meyerding grade). - Instability at the level of stenosis (as defined by >3-mm translation or >10° angular change on flexion extension lateral radiographs) - Associated symptomatic cervical or thoracic stenosis. - Multiple level canal stenosis. -Spinal canal stenosis due to congenital, traumatic , iatrogenic causes. - Presence of spinal disorders( ankylosing spondylitis, neoplasm ) - Comorbidities ( such as cardiopulmonary insufficiency, peripheral neuropathy, peripheral vascular disease, prior lumbar spine surgery, and severe hip or knee disease). RESULTS: 20 patients were followed up for 6-18 months with mean average follow up of 11.4 months. Data of 10 patients (5 men and 5 women) in the lumbar spinous process splitting decompression group and 10 patients (4 men and 6 women) in the Conventional Midline Decompression group were included in the final analysis. The mean age was 58.9 (range 54-65) yrs for the lumbar spinous process splitting decompression group and 60.4 (range 55-65) yrs for Conventional Midline Decompression group. Mean number of decompressed levels were 1.30 for Conventional Midline Decompression group and 1.20 for lumbar spinous process splitting decompression. CONCLUSION: In our study, Lumbar Spinous Process Splitting Decompression provides minimal exposure for decompression in lumbar canal stenosis while preserving musculoligamentous attachments of the posterior elements of spine and good postoperative results after one year with favourable outcomes of atleast 70% on the Japanese orthopaedic association score and Neurogenic claudication outcome score. With both these surgical techniques, a significant improvement in the outcome after surgical decompression could be demonstrated. There was no significant difference between the Lumbar Spinous Process Splitting decompression and Midline decompression by laminectomy techniques regarding the later outcome. But Lumbar Spinous Process Splitting decompressive approach is not suitable for cases with bilateral intervertebral disc protrusion and bilateral fac et joint arthritis with hypertrophy causing degenerative lumbar canal stenosis and foraminal stenosis

Radiation-Induced Hypomethylation Triggers Urokinase Plasminogen Activator Transcription in Meningioma Cells

AbstractOur previous studies have shown the role of radiation-induced urokinase plasminogen activator (uPA) expression in the progression of meningioma. In the present study, we investigated whether modulation of DNA methylation profiles could regulate uPA expression. Initially, radiation treatment was found to induce hypomethylation in meningioma cells with a decrease in DNA (cytosine-5)-methyltransferase 1 (DNMT1) and methyl-CpG binding domain protein (MBD) expression. However, oxidative damage by H2O2 or pretreatment of irradiated cells with N-acetyl cysteine (NAC) did not show any influence on these proteins, thereby indicating a radiation-specific change in the methylation patterns among meningioma cells. Further, we identified that hypomethylation is coupled to an increase in uPA expression in these cells. Azacytidine treatment induced a dose-dependent surge of uPA expression, whereas pre-treatment with sodium butyrate inhibited radiation-induced uPA expression, which complemented our prior results. Methylation-specific polymerase chain reaction on bisulfite-treated genomic DNA revealed a diminished methylation of uPA promoter in irradiated cells. Transfection with small hairpin RNA (shRNA)-expressing plasmids targeting CpG islands of the uPA promoter showed a marked decline in uPA expression with subsequent decrease in invasion and proliferation of meningioma cells. Further, radiation treatment was found to recruit SP1 transcription factor, which was abrogated by shRNA treatment. Analysis on signaling events demonstrated the activation of MAP kinase kinase (MEK)-extracellular signal-regulated kinase (ERK) in radiation-treated cells, while U0126 (MEK/ERK inhibitor) blocked hypomethylation, recruitment of SP1, and uPA expression. In agreement with our in vitro data, low DNMT1 levels and high uPA were found in intracranial tumors treated with radiation compared to untreated tumors. In conclusion, our data suggest that radiation-mediated hypomethylation triggers uPA expression in meningioma cells

Suppression of uPAR Retards Radiation-Induced Invasion and Migration Mediated by Integrin β1/FAK Signaling in Medulloblastoma

Despite effective radiotherapy for the initial stages of cancer, several studies have reported the recurrence of various cancers, including medulloblastoma. Here, we attempt to capitalize on the radiation-induced aggressive behavior of medulloblastoma cells by comparing the extracellular protease activity and the expression pattern of molecules, known to be involved in cell adhesion, migration and invasion, between non-irradiated and irradiated cells.We identified an increase in invasion and migration of irradiated compared to non-irradiated medulloblastoma cells. RT-PCR analysis confirmed increased expression of uPA, uPAR, focal adhesion kinase (FAK), N-Cadherin and integrin subunits (e.g., α3, α5 and β1) in irradiated cells. Furthermore, we noticed a ∼2-fold increase in tyrosine phosphorylation of FAK in irradiated cells. Immunoprecipitation studies confirmed increased interaction of integrin β1 and FAK in irradiated cells. In addition, our results show that overexpression of uPAR in cancer cells can mimic radiation-induced activation of FAK signaling. Moreover, by inhibiting FAK phosphorylation, we were able to reduce the radiation-induced invasiveness of the cancer cells. In this vein, we studied the effect of siRNA-mediated knockdown of uPAR on cell migration and adhesion in irradiated and non-irradiated medulloblastoma cells. Downregulation of uPAR reduced the radiation-induced adhesion, migration and invasion of the irradiated cells, primarily by inhibiting phosphorylation of FAK, Paxillin and Rac-1/Cdc42. As observed from the immunoprecipitation studies, uPAR knockdown reduced interaction among the focal adhesion molecules, such as FAK, Paxillin and p130Cas, which are known to play key roles in cancer metastasis. Pretreatment with uPAR shRNA expressing construct reduced uPAR and phospho FAK expression levels in pre-established medulloblastoma in nude mice.

A multi-biometric iris recognition system based on a deep learning approach

YesMultimodal biometric systems have been widely applied in many real-world applications due to its ability to deal with a number of significant limitations of unimodal biometric systems, including sensitivity to noise, population coverage, intra-class variability, non-universality, and vulnerability to spoofing. In this paper, an efficient and real-time multimodal biometric system is proposed based on building deep learning representations for images of both the right and left irises of a person, and fusing the results obtained using a ranking-level fusion method. The trained deep learning system proposed is called IrisConvNet whose architecture is based on a combination of Convolutional Neural Network (CNN) and Softmax classifier to extract discriminative features from the input image without any domain knowledge where the input image represents the localized iris region and then classify it into one of N classes. In this work, a discriminative CNN training scheme based on a combination of back-propagation algorithm and mini-batch AdaGrad optimization method is proposed for weights updating and learning rate adaptation, respectively. In addition, other training strategies (e.g., dropout method, data augmentation) are also proposed in order to evaluate different CNN architectures. The performance of the proposed system is tested on three public datasets collected under different conditions: SDUMLA-HMT, CASIA-Iris- V3 Interval and IITD iris databases. The results obtained from the proposed system outperform other state-of-the-art of approaches (e.g., Wavelet transform, Scattering transform, Local Binary Pattern and PCA) by achieving a Rank-1 identification rate of 100% on all the employed databases and a recognition time less than one second per person

Understanding the Biochemical Basis of Resistance in Rice to Leaffolder (Cnaphalocrocis medinalis)

Rice leaf folder has been recorded to cause major loss in rice yield. To know the relevance of biochemical factors in conferring tolerance to rice leaffolder Cnaphalocrocis medinalis, a study was conducted utilizing 196 rice accessions at Pandit Jawaharlal Nehru College of Agriculture and Research Institute, Karaikal. Standard evaluation system developed by IRRI for leaf folder complex was followed for screening the rice accessions and entries were ranked accordingly based on the leaf damage. Among these entries, top five entries along with the susceptible check (TN1) were selected for analysis of biochemical factors such as total chlorophyll, total sugars, reducing sugars, total phenols, total soluble protein and proline. Results revealed that high level of total phenols, moderate chlorophyll content, and low sugar content in leaves conferred resistance to this pest in rice