Self-aligned passivated copper interconnects: a novel technique for making interconnections in ultra large scale integration device applications

Journal ArticleWe have developed a technique to grow self-aligned epitaxial Cu/MgO films on Si (100) using a Pulsed Laser Deposition Method. In this method we deposit a uniform film of Cu/Mg (5-7%) alloy over Si (100) at room temperature using TiN as an intermediate buffer layer. As a result of HRTEM (with spatial resolution of 0.18 nm) and STEM-Z investigations we observed that when this film is annealed at 500?C (in a controlled oxygen environment), in less than 30 minutes time, all the Mg segregates at the top and at the bottom surface of Cu. This is understood to be the consequence of lower surface energy of Mg. At 500?C Mg is quite sensitive to oxygen and a thin layer of MgO is immediately formed at the top surface, we also observed a thin layer of MgO at the Cu/TiN interface. Thickness of the upper MgO layer was found to be 15 nm while that of lower layer was 10 nm. MgO underneath layer acts as a diffusion barrier and inhibits the diffusion of Cu in the system. Upper MgO layer acts as a passivating layer and improves the quality of copper against oxidation. Electrical resistivity measurements (in the temperature range 12-300 K) showed MgO/Cu/MgO/TiN/Si (100) sample to be highly conducting. We also observed that the resistivity of the system is insensitive to ambient oxygen environment. Self-aligned MgO (100) layer also provides a means to grow several interesting materials over it. This technique can be used to integrate high temperature superconductors like YBa2Cu3O7 with silicon chip

A comparative study to assess the effect of multiple Kirschner wiring versus plating in the management and functional outcome of proximal humerus fractures

Background: Proximal humerus fractures constitute 5% of all appendicular skeletal injuries and are mainly a menace of the elderly, after hip fractures and distal radial fractures. According to the NEER’S classification, the decision regarding the treatment of such fractures is dependent on whether the four anatomical segments of the proximal humerus are fractured or displaced.Methods: A total of 50 patients admitted in orthopaedics ward satisfying the inclusion criteria were randomly divided in 2 groups with 25 patients in each group for PHILOS plating and Kirschner wiring management. Groups were compared with respect to their improvement in physical function, pain, quality of life, complications and re-operation rates.Results: Out of the total 50 cases, 20% were type I, 22% type II, 36% were type III fractures while 22% were type IV fractures. Mean DASH questionnaire was comparable between two groups at 1 month after surgery (p=0.56). During immediate post-op period and at subsequent follow ups, DASH questionnaire was better in plating group as compared to K-wiring. At 3 months and 6 months follow up, functional outcome as calculated by DASH questionnaire was comparable between two groups (p=0.17 and 0.45). Excellent to good outcome was seen in all cases of either group. No difference was observed between study groups with respect to associated complications. K-wire loosening was observed in 2 cases (8%). Plating was associated with infections (8%) and screw break out (4%).Conclusions: After comparing both the techniques, we recommend PHILOS plating for young adults and percutaneous K wire fixation for the elderly age group

Awake spinal fusion: a retrospective analysis of minimal invasive single level transforaminal lumbar interbody fusion done under spinal anaesthesia in 150 cases

Background: Spinal anaesthesia carries the advantage of having rapid onset, lesser blood loss, early recovery and hospital stay as compared to general anaesthesia. The present study evaluated outcomes of awake spinal fusion i.e., minimal invasive single level transforaminal lumbar interbody fusion (MIS-TLIF) under spinal anaesthesia. Current study is a retrospective analysis of prospectively collected data carried to assess patient related outcome benefits for a single level transforaminal lumbar interbody fusion done under spinal anaesthesia.Methods: Patients who fit deemed criteria not responding to 6 weeks of conservative treatment to lumbar degenerative pathologies underwent MIS-TLIF. The demographic data, visual analogue pain scale (VAS), Oswestry disability index (ODI), blood loss, time from entering operation theatre to time of incision, time of bandaging to exit from operation theatre, time of stay in post anaesthesia care unit (PACU), duration of surgery, nausea/vomiting, urinary retention, requirement of analgesics, duration of stay in hospital, peri-operative complications, fusion rate and satisfaction score were compiled and assessed.Results: 150 patients were operated with MISTLIF under spinal anaesthesia. VAS and ODI score improved significantly at final follow up (p<0.05). The mean duration of surgery was 148±18.24 minutes and blood loss were 109.64±110.45 ml. The average time from entering OT to incision and bandaging to exit was respectively 27.32±8.44 and 6.43±3.28 minutes. Mean PACU time was 36.74±6.32 minutes while duration of stay averaged 1.58±0.67 days. Post operative analgesia requirement was in 10.6% patients and radiographic fusion was observed in 96.6% patients. 90.6% patients were fully satisfied with spinal anaesthesia.Conclusions: Awake spinal fusion should be considered as a novel surgical approach with newer minimal invasive surgical techniques and regional anaesthesia to improve patient satisfaction and overall surgical outcome

Peri-operative Management and the Role of Minimally Invasive Spine Surgery in a Case of Hemophilia B

Hemophilia A and B are rare X-chromosome-linked recessive bleeding disorders caused by mutations in the genes causing abnormalities of blood clotting factors VIII and IX, respectively. Surgery in these patients will require additional planning and interaction among the surgeon, anesthetist, and a hematologist because they inevitably result in bleeding, excessive blood loss, and other life-threatening complications. The authors present a case 62-year-old male with haemophilia B and progressive neurological claudication. On plain radiographs and MRI the patient had grade 1 spondylolisthesis with lumbar canal stenosis at L4-L5 with a VAS score of 8 and ODI score of 45 and was operated with MIS-TLIF with 22 mm diameter tubular retractor (METRx, Medtronics) and an operating microscope. Pre-operatively, the hematologist opinion was taken and the patient was optimised by maintaining the plasma factor peak level activity according to the WFH guidelines. The patient had uneventful peri-operative period. The total hospital stay is 16 days and a VAS score of 3 and ODI score of 12 after one-year follow-up and without any notable complications. Minimally invasive surgical techniques are a better option in hemophilia patients as these techniques provide the surgeon with an excellent magnification of the operative field, which enables the use of a smaller incision, better hemostasis, and facilitates less traumatic procedures

Efficiency of Spinal Anesthesia versus General Anesthesia for Minimal Invasive Single Level Transforaminal Lumbar Interbody Fusion: A Retrospective Analysis of 178 Patients

Objective To evaluate the efficacy of spinal anesthesia in patients undergoing minimal invasive single level transforaminal lumbar interbody fusion surgery (MIS TLIF) and to compare the results with that of general anesthesia. Method 178 patients were included in the study, 86 were in general anesthesia and 92 were in spinal anesthesia. Patients aged between 20 to 70 years who had undergone MIS-TLIF not responding to 6 weeks of conservative treatment were included. The routine steps of anesthesia for both general and spinal anesthesia were adhered. The VAS, blood loss, duration of surgery, time from entering operation theatre to time of incision, time of bandaging to exit from operation theatre, time of stay in Post Anesthesia Care Unit (PACU), nausea/vomiting, urinary retention, duration of stay in hospital, peri-operative complications were compiled and assessed. Appropriate statistical analysis was applied. Results The mean time for entering the operation theatre to the incision; mean time from bandaging to the exit; mean PACU time and the mean hospital stay were significantly lower in the spinal anesthesia group (p<0.05). The other parameters are comparable except, urinary retention which was significantly higher in spinal anesthesia group (p<0.05). Conclusion Spinal anesthesia offers efficient operating room functioning with decreasing overall operation theatre time. It is very efficient alternative technique to general anesthesia which can be considered for elective lumbar surgeries with a lower late of adverse events especially at lower lumbar levels

A Prospective Study of the Accidental Durotomies in Microendoscopic Lumbar Spine Decompression Surgeries. Incidence, Surgical Outcomes, Postoperative Patient Mobilization Protocol

Objective To study the incidence, risk factors, surgical outcomes of accidental durotomies (ADT) in patients of microendoscopic lumbar decompression surgeries (MLDS) and the postoperative patient mobilization protocol. Methods A total of 550 patients who underwent MLDS from January 2012 to march 2020 under single surgeon and single institute were included in the study and incidence of ADT risk factors like age, BMI, smoking status, diabetes mellitus, surgeon’s experience were studied for the same and early mobilization protocol for all the patients was followed. Results Age >60 years (p=0.0062), bilateral decompression with unilateral approach, surgeons experience in the first 3 years over next 5 years (p=0.037) were the statistically significant risk factors for increased incidence of ADT. Most of the ADT were small which did not require primary repair and managed with sealants like gelfoam and fibrin glue. Postoperative recovery in JOA and ODI scores in both ADT and non ADT cohorts were same. Conclusion MISS has low incidence of ADT and age >60 years and surgical technique of bilateral decompression with unilateral approach and surgeons expertise are the significant risk factors. MISS also has less risk of CSF leak symptoms and pseudomeningocele formation because of limited dead space formation in the soft tissue which helps in early postoperative mobilization and reduces the duration of hospital stay

combined pik3ca and fgfr inhibition with alpelisib and infigratinib in patients with pik3ca mutant solid tumors with or without fgfr alterations

PURPOSE Concurrent PIK3CA mutations and fibroblast growth factor receptor (FGFR) alterations occur in multiple cancer types, including estrogen receptor–positive breast cancer, bladder cancer, and endometrial cancer. In this first-in-human combination trial, we explored safety and preliminary efficacy of combining the PI3Kα selective inhibitor alpelisib with the FGFR1-4 selective inhibitor infigratinib. PATIENTS AND METHODS Patients with PIK3CA-mutant advanced solid tumors, with or without FGFR1-3 alterations, were enrolled in the dose escalation or one of three molecular-defined dose-expansion cohorts. The primary end point was the maximum tolerated dose. Secondary end points included safety, pharmacokinetics, and response. Archival tumor samples were sequenced to explore genomic correlates of response. RESULTS In combination, both agents were escalated to full, single-agent recommended doses (alpelisib, 300 mg per day continuously; infigratinib, 125 mg per day 3 weeks on followed by 1 week off). The toxicity profile of the combination was consistent with the established safety profile of each agent, although 71% of all patients required at least one treatment interruption or dose reduction. Molecularly selected dose expansions in breast cancer and other solid tumors harboring PIK3CA mutations, alone or in combination with FGFR alterations, identified sporadic responses, predominately in tumor types and genotypes previously defined to have sensitivity to these agents. CONCLUSION The combination of alpelisib and infigratinib can be administered at full single-agent doses, although the high rate of dose interruption or reduction suggests long-term tolerability may be challenging. In exploratory signal-seeking cohorts of patients harboring dual PIK3CA and FGFR1-3 alterations, no clear evidence of synergistic activity was observed

What do we know about chronic kidney disease in India: first report of the Indian CKD registry

<p>Abstract</p> <p>Background</p> <p>There are no national data on the magnitude and pattern of chronic kidney disease (CKD) in India. The Indian CKD Registry documents the demographics, etiological spectrum, practice patterns, variations and special characteristics.</p> <p>Methods</p> <p>Data was collected for this cross-sectional study in a standardized format according to predetermined criteria. Of the 52,273 adult patients, 35.5%, 27.9%, 25.6% and 11% patients came from South, North, West and East zones respectively.</p> <p>Results</p> <p>The mean age was 50.1 ± 14.6 years, with M:F ratio of 70:30. Patients from North Zone were younger and those from the East Zone older. Diabetic nephropathy was the commonest cause (31%), followed by CKD of undetermined etiology (16%), chronic glomerulonephritis (14%) and hypertensive nephrosclerosis (13%). About 48% cases presented in Stage V; they were younger than those in Stages III-IV. Diabetic nephropathy patients were older, more likely to present in earlier stages of CKD and had a higher frequency of males; whereas those with CKD of unexplained etiology were younger, had more females and more frequently presented in Stage V. Patients in lower income groups had more advanced CKD at presentation. Patients presenting to public sector hospitals were poorer, younger, and more frequently had CKD of unknown etiology.</p> <p>Conclusions</p> <p>This report confirms the emergence of diabetic nephropathy as the pre-eminent cause in India. Patients with CKD of unknown etiology are younger, poorer and more likely to present with advanced CKD. There were some geographic variations.</p

Receptor tyrosine kinases: Characterisation, mechanism of action and therapeutic interests for bone cancers

Bone cancers are characterised by the development of tumour cells in bone sites, associated with a dysregulation of their environment. In the last two decades, numerous therapeutic strategies have been developed to target the cancer cells or tumour niche. As the crosstalk between these two entities is tightly controlled by the release of polypeptide mediators activating signalling pathways through several receptor tyrosine kinases (RTKs), RTK inhibitors have been designed. These inhibitors have shown exciting clinical impacts, such as imatinib mesylate, which has become a reference treatment for chronic myeloid leukaemia and gastrointestinal tumours. The present review gives an overview of the main molecular and functional characteristics of RTKs, and focuses on the clinical applications that are envisaged and already assessed for the treatment of bone sarcomas and bone metastases