Structural evaluation and animal implantation of porous eggshell wastederived hydroxyapatite graft as bone substitution

The development of hydroxyapatite graft with high economically value is needed for orthopedic practice in developing countries. Eggsell waste is well known as natural substance for calcium resource. It has been used as raw material in producing hydroxyapatite. This study was conducted to synthesize porous hydroxyapatite from eggshell waste and evaluate its activity as bone substitution. The porous hydroxyapatite graft was manufactured from eggshell and sugar as a raw material using hydrothermal process. The porous eggshell waste-derived hydroxyapatite (EW-HAP) graft was characterized using X ray difractometer (XRD) and analytical scanning electron microscope (SEM) and compared with commercial hydroxyapatite (HAP) JCPDS 09-432 graft (Bangros®) as standard. The porous EW-HAP graft obtained was then implanted on critically sized femoral defects surgically created in the right thigh of male Wistar rats (Rattus norvegicus) with Bangros® as control. Radiological examination using XRD and histological examination using hematoxyline-and-eosin staining of the bone femour were performed at 28 days after implantation. The results showed that the XRD pattern for EW-HAP was likely similar with the HAP standard. However, the SEM examination showed that the pasticle size of EW-HAP graft (2.5-3 μm) was higher than those HAP standard graft (1.5-2 μm). Radiographs according to the International of Limb Salvage (ISOLS) radiological evaluation system between EW-HAP graft (6.1 ± 1.45) and HAP control graft (6.9 ± 2.10) was not significantly different (p>0.05). Moreover, histological examination according to Lane and Shandu scoring system between the both graft (4.0 ± 0.94 versus 4.4 ± 0.92) was also not significantly different (p>0.05). It can be concluded that the structure EW-HAP graft is similar with HAP graft standard. The both grafts have also equal outcome as bone substitution

Trajectory and Determinant of Functional Independence among Patient with Traumatic and Non-Traumatic Spinal Cord Injury

The level of functional independence was directly proportional to life satisfaction and quality of life in patients with spinal cord injury. By knowing the determinants that predict changes in functional independence, medical treatment and rehabilitation can be better planned to improve the patient’s quality of life. We conducted a prospective cohort study on 49 patients with spinal cord injury at Dr. Sardjito general hospital Yogyakarta from April to June 2016. The data were taken before patient underwent surgery, before discharged from the hospital, and 3 months after underwent surgery. We found that most common spinal cord injury was at the level of lumbar vertebra with 28 patients (58%). There was a positive trajectory of the patients with spinal cord injury with ASIA grade B-E classification. However, patients with spinal cord injury with ASIA classification grade A have a neutral trajectory.We conclude there was a positive trajectory between functional independence and traumatic or non-traumatic spinal cord injury except in patients with ASIA grade A classification spinal cord injury. The determinants that affected the trajectory of patients with spinal cord injury were the level of the injured vertebra and severity of the neurological deficit.

Correlation between vascular endothelial growth factor (VEGF) expression with histopathological findings in osteosarcoma

Vascular endothelial growth factor (VEGF) expression is associated with malignancy progression, metastasis, and poor prognosis in many malignancies, including osteosarcoma. However, studies concerning correlations between VEGF expression and histopathological prognostic factors ofosteosarcoma are limited. This study aimed to evaluate the correlations between VEGF expression and histopathological findings in osteosarcoma’spatients.This was a cross-sectional study using formalin-fixed paraffin embedded (FFPE) samples of 32 osteosarcoma’s patients from Dr. Sardjito General Hospital, Yogyakarta. Histopathological findings of specimens were re-evaluated by two independent observers, recorded for the subtypes, invasiveness, grading, mitotic counts, and tumor infiltrating lymphocytes (TIL). Expression of VEGF was determined based on immunostaining and evaluated using immunoreactivity score (IRS).Chi-square and Spearman correlation test were used to analyze the association between variables. Range of VEGF expression score was 0 to 11, with mean 5.09. Significant negative correlation between the VEGF expression and TIL was observed (p=0.046). However, there was no significant correlations between the VEGF expression and osteosarcomas subtypes, invasion, grading or mitotic counts (p> 0.05). In conclusion, the VEGF expression is associated with TIL. Further study is needed to evaluate the roles of VEGF and lymphocytes in osteosarcoma development dan progression in order to better understand of the role of VEGF in immunotherapy of osteosarcoma

Evaluasi Struktur dan Aplikasi pada Hewan Coba Graft Hydroxyapatite Berpori dari Limbah Cangkang Telur sebagai Substitusi Tulang (uji komparasi dengan graft hydroxyapatite komersial berpori)

Introduction The development of economically affordable hydroxyapatite graft is needed for orthopaedic practice in developing country. Materials and Methods This study comprise of graft manufacturing process using egg shell waste as calcium resource for hydroxyapatite production with consecutive development of interconnecting porous structure using sugar, material and structural evaluation of the graft using X Ray Diffractometer (XRD) and Scanning Electron Microscope (SEM), and followed with animal implantation procedure on critical size defect of Rattus Novergicus femur. Result After thermal heating process up to 900°C and subsequent hydrothermal synthesis procedure, we have managed to form hydroxyapatite crystals that match to JCPDS standard with interconnecting pore diameter of 50 � 500μm based on XRD and SEM examination, consecutively. The following animal implantation also showed no significant difference on radiologic (ISOLS) and histological (Lane and Shandu modified by Heiple et.al) score compare to the commercial graft based on Mann Whitney U test with p = 0,364 and p = 0,338 (p > 0, 05). Conclusion Porous � egg shell waste derived hydroxyapatite graft has the material characteristic as standard with comparable structural porosity and equal outcome on bone healing with regards to the commercial porous hydroxyapatite graft

Comparison of insertion time, pull-out strength, and screw-media interface area of customized pedicle screw with different core and thread design against commercial pedicle screw: a pilot study on Indonesian Population

Objective: This research aimed to developing customized pedicle screw based on Indonesian vertebral anatomy and compare the insertion time, pull-out strength, and screw-media interface area of different screw design. We have developed 3 different types of pedicle screws (v-thread cylinder-core, square-thread cylinder-core and square-thread conical-core). The thread diameter was calculated from pedicle width of Indonesian population (6 mm). We used commercially available pedicle screw as control group (6.2 mm). Result: The insertion time were significantly difference between v-thread cylinder-core pedicle screw (22.94 s) with commercially available pedicle screw (15.86 s) (p < 0.05). The pull-out strength was significantly difference between commercially available pedicle screw (408.60 N) with square-thread conical pedicle screw (836.60 N) (p < 0.05). The square-thread conical-core group have the highest interface area (1486.21 mm2). The data comparison showed that the square-thread conical-core customized pedicle screw group has comparable insertion time and has better pull-out strength than commercially available pedicle screw

Trajectory and Determinant of Functional Independence among Patient with Traumatic and Non-Traumatic Spinal Cord Injury

The level of functional independence was directly proportional to life satisfaction and quality of life in patients with spinal cord injury. By knowing the determinants that predict changes in functional independence, medical treatment and rehabilitation can be better planned to improve the patient’s quality of life. We conducted a prospective cohort study on 49 patients with spinal cord injury at Dr. Sardjito general hospital Yogyakarta from April to June 2016. The data were taken before patient underwent surgery, before discharged from the hospital, and 3 months after underwent surgery. We found that most common spinal cord injury was at the level of lumbar vertebra with 28 patients (58%). There was a positive trajectory of the patients with spinal cord injury with ASIA grade B-E classification. However, patients with spinal cord injury with ASIA classification grade A have a neutral trajectory.We conclude there was a positive trajectory between functional independence and traumatic or non-traumatic spinal cord injury except in patients with ASIA grade A classification spinal cord injury. The determinants that affected the trajectory of patients with spinal cord injury were the level of the injured vertebra and severity of the neurological deficit.

Pelvic parameter improvement following deformity correction in adolescence idiopathic scoliosis: A case series

Introduction: Scoliosis is defined as 3-dimensional deformity of the spine with lateral deviation more than 10◦ and rotation of the vertebrae. Adolescence idiopathic scoliosis (AIS) is scoliosis that affect children between the age of 11–18 years old without any identifiable cause or underlying disease. Presentation of case: This study will compare the pelvic parameters and functional score of the patients before and after the procedure. Pelvic parameters are represented by 3 angles: pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) of 5 adolescence idiopathic scoliosis patients. Functional outcomes were evaluated using Indonesian SF-36 questionnaire and also pain scale of preoperative and postoperative. Discussion: An important outcome of this study was a statistically significant improvement in coronal alignment, functional capacity, pain, and role of limitation due to physical health. Coronal angle deformity correction of AIS patients is correlated with sagittal improvement which caused by compensatory alteration of pelvic parameter. Conclusion: This finding correlates with the improvement of functional outcome of the patients

Occipitocervical fixation: A case report of our techniques and results

Introduction: Occipitocervical fixation (OCF) can provide good fusion rate to treat various craniovertebral junction (CVJ) pathologies. Biomechanically it gives rigid fixation, good fusion rate, and allows for effective decompression. However, rigid fixation on the mobile occipitocervical junction has shortcomings that affect the post-operative clinical functional outcomes and range of motion. This study aimed to evaluate and elaborate the functional outcomes, range of motions, and radiographic findings in our patients underwent OCF. Case report: We presented a report of 3 patients underwent posterior decompression procedure followed by occipitocervical fixation. All three patients' clinical outcome was assessed clinically by, Japanese Orthopaedic Association (JOA) score and grading, Karnofsky, range of motion and radiographic cervical alignment evaluation parameters. Result: All patients have seen improvement (minimal 1 grade in JOA and >30 points of Karnofsky score) in 3 months after the procedure, had a tolerable range of motion limitation, normal range of cervical lordotic and cervical brow vertebral angle (CBVA). Unfortunately, one patient with loss of cranial fixation may be related to history of infection and lack of post-operative wound care. Conclussion: Our cases conclude that Occipitocervical fixation is a safe technique that provides excellent fusion rate with good functional outcome and tolerable range of motion limitation. Due to its unique anatomy and technically demanding, serial post-operative monitoring evaluation of this procedure is paramou

Neglected cervical spondyloptosis of the 5TH – 6TH cervical spine following cervical manipulation: A case report

A 16-year-old boy was diagnosed with spondyloptosis of the cervical spine at the C5–6 level with a neurologic deficit following cervical manipulation. He could not move his upper and lower extremities, but the sensory and autonomic function was spared. The pre-operative American Spinal Cord Injury Association (ASIA) Score was B with SF-36 being 25%, and Karnofsky's score was 40%. The patient was disabled and required special care and assistance. We performed anterior decompression, cervical corpectomy at the level of C6 and lower part of C5, deformity correction, cage insertion, bone grafting, and stabilization with an anterior cervical plate. The patient's objective functional score had increased after six months follow up and assessed objectively with the ASIA Impairment Scale (AIS) E or Excellent, SF-36 score 94%, and Karnofsky score was 90%. The patient could carry on regular activity with minor signs or symptoms of the disease. This case report highlights severe complications following cervical manipulation, a summary of the clinical presentation, surgical treatment choices, and a review of the relevant literature. In addition, the sequential improvement of the patient's functional outcome after surgical correction will be discussed. © 2022 The Author