ANTIOXIDANT PROFILE AND PHYTOCHEMICAL CONTENT OF DIFFERENT PARTS OF SUPER RED DRAGON FRUIT (HYLOCEREUS COSTARICENSIS) COLLECTED FROM WEST JAVA-INDONESIA

Objectives: The goals of this research were to observe antioxidant properties from different parts of super red dragon fruit (Hylocereus costaricensis) using two antioxidant testing methods which were 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2'-azino-bis (3-ethylbenzthiazoline-6-sulfonic acid) (ABTS).Methods: Antioxidant activities were determined using DPPH and ABTS assays, total phenolic content (TPC) using Folin–Ciocalteu reagent, flavonoid content by Chang's method.Results: Inhibitory concentration 50% (IC50) of DPPH scavenging activity of all of the extracts in the range of 2.69 μg/ml was −94.17 μg/ml. The ethyl acetate peel extract of super red dragon fruit expressed the highest TPC (4.56 g GAE/100 g) and the highest total flavonoid content (12.63 g QE/100 g). TPC in flesh extract of super red dragon fruit had a negative and significant correlation with their IC50 of ABTS. The IC50 of DPPH and IC50 of ABTS of flesh extract of super red dragon fruit showed positive and significant correlation.Conclusion: All different parts extracts of super red dragon fruit (except n-hexane flesh extract) were categorized as a very strong antioxidant by DPPH method. Phenolic compounds in flesh extract of super red dragon fruit were the major contributor in antioxidant activities by ABTS method. DPPH and ABTS showed linear results in antioxidant activities of super red dragon fruit flesh extract

Anamnèse et examen clinique du rachis

Le diagnostic est défini comme l’ensemble des mesures réalisées afin d’identifier la nature et la cause des pathologies. Cette recherche est par essence imparfaite et tout thérapeute visera, autant que faire se peut, à s’approcher au plus près du diagnostic. Dans ce processus, plusieurs modalités (anamnèse, examen clinique et examens complémentaires) seront nécessaires tout en restant insuffisantes - ou pour le moins imprécises - lorsqu’elles seront considérées de manière isolée. Au final, c’est la synthèse de ces données qui nous offrira la meilleure vision d’une pathologie nécessairement spécifique et individuelle. La médecine se trouve à mi-distance entre les sciences exactes et les sciences humaines. Certains la définissent aussi comme un art, c’est-à-dire comme une capacité individuelle qu’aurait chaque médecin à soigner. En partie en réaction avec cette idée, depuis une trentaine d’années, l’Evidence Based Medicine s’est progressivement imposée dans les parcours thérapeutiques en même temps qu’une multitude de nouveaux examens complémentaires. Cette évolution vers davantage de science se voit aujourd’hui modérée par un retour progressif à une prise en charge plus globale des patients et c’est probablement à mi-chemin que se trouvera la meilleure stratégie. L’avantage de cette méthode est appuyé par la littérature scientifique actuelle qui montre, chaque jour un peu plus, l’interconnexion des différentes pathologies là-même où nous aurions pensé les séparer par une frontière bien nette. La prise en charge du patient dans sa globalité est garantie par un interrogatoire et un examen clinique bien conduits. Eux seuls peuvent efficacement orienter la nécessité d’examens complémentaires dont la précision extrême reste limitée soit dans l’espace (une IRM lombaire ne couvre que quelques vertèbres…) soit par leur technologie (faible résolution spatiale de la scintigraphie...). La pathologie rachidienne est décrite, à cause de sa prévalence, comme la pathologie du siècle. Elle constitue un des premiers motifs de consultation. Son impact est important sur le plan socio-économique et sur le plan de la santé publique. En effet, en termes d’invalidité, les problèmes lombaires sont au premier plan, suivis par la dépression et les autres affections musculo-squelettiques. Le vieillissement de nos populations s’accompagne d’une augmentation des pathologies dégénératives - y compris rachidiennes - associant des symptômes d’enraidissement, de douleur, de déformation ou de déficit neurologique. Dans ce chapitre, nous nous efforcerons de mettre en lumière les éléments fondamentaux à recueillir dans le cadre d’une consultation en pathologie rachidienne. Il ne s’agit donc pas d’une description exhaustive de l’ensemble des techniques d’interrogatoire et d’examen clinique mais plutôt d’un recueil d’étapes nécessaires pour pouvoir s’orienter correctement et parler un même langage

Complications en chirurgie du rachis

Ce chapitre aborde les complications « locales » de la chirurgie de la colonne cervicale, thoracique et lombaire. Il n’aborde pas les complications générales de cette chirurgie (AVC, problème cardiaque, thrombo-embolique, etc.). Il n’aborde pas non plus l’échec chirurgical qui est fréquent en chirurgie de la colonne et que les patients confondent souvent avec la notion de complication. Seront abordés : la brèche durale, l’hématome péridural, l’infection du site opéra¬toire, les complications neurologiques et les problèmes liés aux implants. D’autres complications non abordées ici sont la récidive herniaire, fréquente et survenant le plus souvent dans le « lit » de la hernie opérée, et les complications neurologiques tardives, fibrose épidurale et arachnoïdite adhésive

IN VITRO ANTIOXIDANT ACTIVITIES, TOTAL FLAVONOID, PHENOLIC AND CAROTENOID CONTENT FROM VARIOUS EXTRACTS OF FOUR SPECIES ASTERACEAE HERB

Objectives: The objectives of this research were to study antioxidant activities from various extracts of Asteraceae herbs using two methods of antioxidant assays which were DPPH (2,2-diphenyl-1-picrylhidrazyl) and FRAP (Ferric Reducing Antioxidant Power); and correlation of total flavonoid, phenolic, and carotenoid content in various extracts of Asteraceae herbs with DPPH antioxidant activities and FRAP antioxidant capacities.Methods: Extraction was performed by reflux apparatus using different polarity solvents. The extracts were evaporated using the rotary evaporator. Antioxidant capacities were tested using DPPH and FRAP assays. Determination of total flavonoid, phenolic, and carotenoid content was performed by spectrophotometer UV-visible and their correlation with DPPH antioxidant activities and FRAP antioxidant capacities were analyzed by Pearson's method.Results: Methanolic extract of Bidens pilosa herbs (BP3) had the highest DPPH scavenging activity with IC50 76.25 µg/ml, while ethyl acetate extract of B. pilosa herbs (BP2) had the highest FRAP capacity with EC50 33.50 µg/ml. Ethyl acetate extract of B. pilosa (BP2) had the highest total flavonoid (14.66 g QE/100 g), BP3 had the highest phenolic content (7.61 g GAE/100 g), and ethyl acetate extract of Sonchus arvensis (SA2) had the highest carotenoid content (11.92 g BE/100 g).Conclusions: There was a positively high correlation between total phenolic with their antioxidant activity using FRAP and DPPH assays. The FRAP capacities in Artemisia vulgaris, Bidens pilosa, Ageratum conyzoides, and Sonchus arvensis herbs extracts had linear result with DPPH scavenging activities.Â

Myélopathie cervicarthrosique

La myélopathie cervicarthrosique désigne - comme son nom l’indique - une pathologie où le cordon médullaire est en souffrance à cause de l’arthrose cervicale. On utilise aussi le terme de myélopathie cervico-arthrosique ; en anglais le terme consacré est cervical spondylotic myelopathy ou degenerative cervical myelopathy. Le terme myélopathie désigne littéralement une « pathologie de la moelle épinière ». Ce chapitre n’aborde que la souffrance liée à la compression sur arthrose cervicale (y compris les hernies discales molles, qui sont par nature dégénératives) et ne couvre pas les causes tumorales, inflammatoires, infectieuses ou vasculaires de myélopathie

Accuracy of Pedicle screw insertion using a new intraoperative cone-beam ct imaging technique: retrospective analysis of 586 screws

INTRODUCTION Pedicle screw placement is a widely used procedure for the treatment of spine pathologies including trauma, scoliotic deformities, infection, degenerative and malignant diseases. Inaccurate screw placement with a pedicle breach can lead to spinal cord, visceral and vascular injuries, with complications in terms of patient survival. Clinical studies have demonstrated the feasibility of achieving clinically accurate placement of pedicle screws with the aid of assistive technologies including intraoperative imaging systems, navigation systems, robots, and 3D-printed mechanical guides (Tian 2011). Assessment of pedicle screw placement accuracy is usually carried out in postoperative CT scans (Motiei-Langroudi 2015), thereby making it impossible to detect pedicle breach intraoperatively. New techniques have been adapted to detect pedicle breach intraoperatively and to allow for direct re-positioning of these misplaced screws (Santos 2012), thereby helping to reduce the radiation dose by eliminating the need for postoperative CT scans. This retrospective study aims to assess accuracy of pedicle screw placement using a new intra-operative cone-beam CT (CBCT) imaging technique, and to compare the efficacy of this technique with conventional postoperative CT scans for pedicle breach detection. MATERIALS AND METHODS In 102 patients, 586 pedicle screws were inserted over a 21 month period. The new intraoperative CBCT imaging technique consisted of a robotic interventional angiography system (Artis Zeego, Siemens Healthcare, Forchheim, Germany) equipped with CBCT software applications (DynaCT, Siemens Healthcare, Forchheim, Germany) which has been recently adapted for spine surgeries. In all patients, intraoperative CBCT scans (Fig. 1) were acquired after all screws were inserted, and retrospectively reviewed by the orthopaedic surgeons for pedicle breach detection and grading. Of the 586 inserted screws, placement assessment of 239 screws were also carried out in conventional postoperative CT scans using the same grading system. Reliability tests computing Cohen’s Kappa coefficient and Gwet’s coefficient were performed to compare the CBCT imaging technique with the conventional postoperative CT scans for assessing screw placement accuracy and detecting pedicle breach. Sensitivity, specificity, positive and negative predictive values of the CBCT imaging technique to assess screw placement accuracy were measured, assuming that postoperative CT scans are the gold standard for assessing such accuracy. RESULTS Of the 586 inserted pedicle screws (Fig. 2), 496 (84.6%) were placed within the pedicle without any breach, 24 (4.1%) were in-out-in screws with a lateral breach but with the screw tip inside the vertebral body, 21 (3.6%) had a medial breach 4 mm, 5 (0.9%) had a lateral breach, and 26 (4.4%) had an anterior breach. Seventeen screws (2.9%) were revised intraoperatively. Kappa and Gwet’s coefficients on screw placement assessment carried out in intraoperative CBCT and in conventional postoperative CT scans were 0.80 and 0.93, respectively. Sensitivity and specificity of the intraoperative CBCT imaging technique, considering that the postoperative CT imaging is the gold standard, were 0.77 and 0.98, respectively. Positive and negative predictive values were 0.91 and 0.96, respectively. DISCUSSION This study is the first to assess accuracy of pedicle screw placement using the new intraoperative Artis Zeego CBCT imaging system. Screws placed within the pedicle without any breach were considered accurate. In-out-in screws with a lateral breach but with the screw tip inside the vertebral body can also be considered accurate thanks to relevant mechanical stability (Husted 2004). The cumulative rate of “accurate” screws in the present study is consistent with the findings of clinical and cadaveric studies that investigated the accuracy of pedi

Radiation dose reduction in thoracic and lumbar spine instrumentation using navigation based on an intraoperative cone beam CT imaging system: a prospective randomized clinical trial

PURPOSE: Spine surgery still remains a challenge for every spine surgeon, aware of the potential serious outcomes of misplaced instrumentation. Though many studies have highlighted that using intraoperative cone beam CT imaging and navigation systems provides higher accuracy than conventional freehand methods for placement of pedicle screws in spine surgery, few studies are concerned about how to reduce radiation exposure for patients with the use of such technology. One of the main focuses of this study is based on the ALARA principle (as low as reasonably achievable). METHOD: A prospective randomized trial was conducted in the hybrid operating room between December 2015 and December 2016, including 50 patients operated on for posterior instrumented thoracic and/or lumbar spinal fusion. Patients were randomized to intraoperative 3D acquisition high-dose (standard dose) or low-dose protocol, and a total of 216 pedicle screws were analyzed in terms of screw position. Two different methods were used to measure ionizing radiation: the total skin dose (derived from the dose-area product) and the radiation dose evaluated by thermoluminescent dosimeters on the surgical field. RESULTS: According to Gertzbein and Heary classifications, low-dose protocol provided a significant higher accuracy of pedicle screw placement than the high-dose protocol (96.1 versus 92%, respectively). Seven screws (3.2%), all implanted with the high-dose protocol, needed to be revised intraoperatively. The use of low-dose acquisition protocols reduced patient exposure by a factor of five. CONCLUSION: This study emphasizes the paramount importance of using low-dose protocols for intraoperative cone beam CT imaging coupled with the navigation system, as it at least does not affect the accuracy of pedicle screw placement and irradiates drastically less

PMMA-cement anterior column reconstruction in surgical treatment of spondylodiscitis.

INTRODUCTION AND RESEARCH QUESTION: This paper explains how antibiotic loaded cement can be used in surgical treatment of spondylodiscitis to reconstruct the anterior column of the spine. MATERIAL AND METHODS: 35 consecutive surgical procedures performed for spondylodiscitis were collected over a 11-year period and charts were reviewed. Most infections were caused mainly by staphylococcus spp (n = 16), streptococcus spp (n = 8) and pseudomonas spp (n = 4). Most patients had long standing but unsuccessful antibiotic therapy (median 42 days). Other indications included instability, neurologic deficit, abscess, and patients were generally in very poor medical condition. RESULTS: Anterior debridement was followed by a partial cavity filling with surgical high viscosity PMMA cement in all cases. Cement was a high viscosity gentamycin loaded cement, that was placed in the cavity created by debridement under the direct eye control. In 25 cases, a part of the cavity was filled with freeze dried cancellous bone allograft rehydrated in rifampicin. Spine was further stabilized with an anterior plate in 15 cases, with short (+1/+1) posterior instrumentation in 5 cases, and a long (≥ +2/+2) posterior instrumentation in 11 cases. In four patients, spine was left un-instrumented. Immediate, unrestricted mobilization was always authorized after surgery. None of the patients were reoperated neither for mechanical failure nor for infection relapse. CONCLUSION: This report supports the idea that surgical bone cement is an efficient gap filler when used through anterior approach. For small as well as for large defects, it can help to reconstruct the anterior column and locally control the infection in combination with additional stabilization and optimal intravenous and oral antibiotic treatment

Correction des scolioses par modulation de croissance. État des lieux

La scoliose idiopathique est une pathologie qui survient pendant la croissance. Lorsqu’elle évolue au-delà d’un certain angle, elle peut, à moyen et long terme, retentir sévèrement sur la qualité de vie par évolution arthrosique et diminution de la fonction respiratoire. Cela justifie un dépistage précoce, un suivi régulier, la mise en place d’un traitement par corset si la scoliose évolue et, lorsque la scoliose est trop sévère, un traitement chirurgical. Le traitement chirurgical de référence est l’arthrodèse vertébrale. Il permet de redresser la colonne vertébrale mais fusionne définitivement les vertèbres scoliotiques entre elles. [...