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The present work deals with the preparation and standardization of chitrakadi vati. All the parameters of both market formulation (MF1 & MF2) and Laboratory formulation (LF) were found to be within the limit prescribed in pharmacopoeia. Average weight and weigh variation of LF was 2057 mg and 0.2±0.1 %, disintegration time was 8±2 min, hardness was 4.6±0.2 Kg/cm2 , friability was 0.9722±0.2 %, ash values were 2.4 % (acid insoluble ash) and 2.15 % (water soluble ash), extractive values were 5.6 % (acid insoluble extractive) and 7.25 % (water soluble extractive). In order to ensure quality and stability of final product, some of the important chemical markers has been separated from the mixture and for analysis by high performance thin layer chromatography was selected for qualitative and quantitative purpose. The results of standardization parameters showed marked difference among three, which fingers to authenticity of market formulations. Even HPTLC fingerprinting showed some ingredients in market formulations were taken adulterated or inferior in quality. The HPTLC method for fingerprinting was found to be precise and accurate to quantify three chemical markers plumbagin (0.84%), piperine (0.92%), zingiberene (0.71%), and it further characterized by IR, NMR, Mass spectra.

Surveys of community based elderly patients’ shows that 2 to 9 prescription medications on average are taken per day. By survey 57% of US women aged >65 years took more than 4 prescription medication and 12% took more than 9 prescription medication. [1]On random day 8.3 % of the population were exposed to minor polypharmacy and 1.2% to major polypharmacy. The prevalence of polypharmacy increased with the age and from the age of 70 years, two third of all drug users were polypharmacy users. An elderly patient is at greater risk for adverse drug reactions and drug-drug interactions because the physiologic changes that occur with aging make the body more sensitive to the effects of medications. The burden of polypharmacy, may enhance the risk of morbidity and mortality, especially in cases of acute infections. The Middle East respiratory syndrome (MERS-CoV), severe acute respiratory syndrome (SARS-CoV), SARS- related coronavirus-2 (SARS-CoV-2), and corona virus disease (COVID-19) are members of the same family as coronavirus. Various studies reported that COVID-19 has a similar pathogenic potential to cause respiratory complications, disability, and death as SARS-CoV and MERS-CoV. Medication non-adherence includes delaying prescription fills, failing to fill prescriptions, cutting dosages, and reducing the frequency of administration. Non adherence with medication is a complex and multidimensional health care problem. The causes may be related to the patient, treatment, and/or health care provider.

Aim: This retrospective, case–control study evaluated the effect of pharmacogenomic testing (PGT) on the management of pediatrics with anxiety, major depressive disorder (MDD) and attention-deficit/hyperactivity disorder (ADHD). Methods: The authors examined psychiatric diagnoses, medication histories, CYP450 profiles, SLC6A4, HTR2A, COMT and MTHFR. Results: The authors found no difference in clinical improvement between the two groups. However, the number of medication changes was significantly larger after PGT. The treatment response in MDD and anxiety was not different between the groups, while ADHD treatment response was substantially improved in PGT and correlated with COMT status. Conclusion: PGT had some value with ADHD with doubtful benefit for MDD or anxiety disorders. Accordingly, pediatric indications must be weighed against cost, utility and clinician experience. Limitations included sample size and selection bias.

The outcome of cementless total knee arthroplasty (TKA) relies on successful bony ingrowth into the implant surfaces. Failures due to aseptic loosening are still reported, especially in younger and more active patients. The objective of this study is to quantify the micromotion of a commercially available design of cementless tibial tray under loading conditions simulating walking and stair descent.A commercially available design of cementless total knee arthroplasty was implanted in 7 cadaveric knees which were preconditioned with 500 cycles of 0°-100° flexion under a vertical load of 1050 N in a custom-built, multiaxial functional activity simulator. This was followed by application of the peak forces and moments occurring during walking and stair descent. During each loading procedure, 3-dimensional motion at the bone-prosthesis interface was measured using digital image correlation.The tray migrated 101 ± 25 μm on average during preconditioning, which was dominated by rotation in the sagittal plane (92% of total migration), combined with posterior translation (28%) and minimal rotation in the transverse plane (14%). The migration varied 2.7-fold (61-167 μm) between the 6 measurement zones. Stair descent produced significantly higher total micromotion than walking in zone #5 (62 ± 9 vs 51 ± 10 μm, P.05) and zone #6 (68 ± 17 vs 37 ± 10 μm, P.05). In addition, during stair descent, the tray exhibited significantly more tilting (anterior zones: 31 ± 17 vs -16 ± 20 μm, P.05; posterior zones: -60 ± 8 vs -40 ± 7 μm, P.05) and more anteroposterior displacement in the anterior zones (-25 ± 3 vs -13 ± 2 μm, P.05) when compared to walking.The relative motion at the bone-prosthesis interface varied substantially around the periphery of the cementless tray. Under the loading conditions evaluated, the tray primarily underwent a rocking motion in the sagittal plane. Compared with walking, stair descent produced significantly more micromotion, especially in the posterior zones.

Physiotherapy is a management option for the treatment of femoroacetabular impingement (FAI) syndrome. This study examines the influence of changes in pelvic tilt and hip adduction on the range of motion (ROM) of the hip.Ten FAI hips were used to simulate impingement at two positions: (1) 20° internal rotation (IR) with 100° flexion and 10° adduction and (2) 40° IR with 35° flexion and 10° adduction; the amount of IR was measured at the point of bony impingement or to the defined limit. Each simulation was performed at neutral and 5° and 10° anterior and posterior pelvic tilt. Then, the hip was placed in 10° of abduction, and all simulations were repeated.With neutral pelvic tilt, impingement occurred at 4.3 ± 8.4° of IR at the high-flexion position. An increase in anterior pelvic tilt led to a loss of IR, that is, earlier occurrence of FAI, whereas an increase in posterior pelvic tilt led to an increase in IR, that is, later occurrence of FAI. At the high-flexion position, abduction provided more IR before impingement (neutral: 9.1 ± 5.7°, P0.01; 10° anterior tilt: 14.6 ± 5.2°, P0.01; 10° posterior tilt: 4.2 ± 3.7° IR, P = 0.01). Placing the hip in abduction and posteriorly tilting the pelvis produce a combined effect that increased IR relative to the neutrally tilted pelvis (5° posterior tilt: 11.4 ± 7.6°, P = 0.01; 10° posterior tilt: 12.8 ± 7.6°, P0.01). The ROM in the mid-flexion position was not affected by any combination of pelvic tilt and hip abduction or adduction (average IR: 37.4 ± 5.0°, P0.05).Abduction and posterior pelvic tilt increased the impingement-free ROM in the hips with FAI. Thus, rehabilitation aimed at altering the tilt of the pelvis may reduce the frequency of impingement and limit further joint damage.

In current years there's a first rate growth in web purchasing for distinctive commodities like cloth, jewelry and the trade of medication had been extended thru online /internet. Online pharmacy is one of the era improvements this is approximately to create a big call for in the future days. Though it's far handy to get them. There is excessive hazard of self medicine and abuse of drug specially that get nearer below schedule H and schedule X. Online buy of medication is likewise growing constantly because of creation of numerous online pharmacies in India and those online drug shops offer the humans with numerous blessings like domestic shipping of medication, big reductions and beneficial offer. Despite those blessings to the purchaser the protection situation associated with those e- shops also are on rise. For instance, the drugs quality, irrational dispensing, loss of supervision are the high situation arisen from those e-pharmacies, however, this fashion with right guidelines is pretty famous in western international however it's been these days followed in India. Covid-19 disease is spreading everywhere in the international, mostly pharmacy act a pillar at this prevalent state of affairs for the overall community healthiness. Today’s epharmacy to be tailored due to the fact medicine may be ordered in a single click.

In this study we formulate Raloxifene hydrochloride, edicated chewing gum to overcome first pass metabolism of it so bioavability increase of drug. We take polyvinyl acetate as chewing gum base. Aspartame, mannitol and sucrose as sweetener. Glycerin as a plasticizer. Beta-cyclodextrine as solubility enhancer and taste masking agent. First we evaluate the API by its melting point after we derived its calibration curve. After this we select proper ratio of Beta-cyclodextrine and API. After we study drug and excipients compatibility by using FTIR. XRD study perform for API and formulation. After we formulate our formulation and perform post-evaluation study like hardness, weight variation, % drug content and % drug release. From all formulation F5 formulation shows best % drug release and % drug content. After we perform stability study for our formulation and after study no major change show in formulation. And in last we perform buccal permeability study. On basis of all study results we can say that our formulation is successfully formed. Keywords: Raloxifene hydrochloride, Medicated chewing gum, Buccal permeation, Osteoporosis.

Adult Diaphorina citri (ACP) use visual and chemical cues to locate young citrus flush shoots on which they forage and oviposit, and they use vibrational communication duetting calls as cues to help locate mates. For individual pairs, calling and mating usually peaks between 10:00 and 15:00. To explore whether call rates (calls/h) are affected by interactions with nearby conspecifics, rates were compared in small citrus trees on which either 5 or 25 ACP female and male pairs had been released at 17:00 for later recording from sunrise (06:00) to 22:00. Final ACP locations were noted 40 h after release. Call rates were similar in both treatments during normal mating hours. However, rates were significantly higher for low- than high-density treatments between 06:00 and 10:00, which suggests calling during this period may be affected by conspecific density. Both sexes aggregated on flush at both densities. We discuss the potential that ACP producing calls near sunrise, outside of normal mating hours, might benefit from gains in reproductive fitness in low-density contexts if they call not only to locate mates but also to locate preferred flush&mdash, in which case, co-opting of vibrations to disrupt both mating and foraging may be feasible.

The respiratory system is highly prone to a number of chronic disorders, which is one of the common health problems all over the world. Administration of therapeutics by oral or parenteral routes leads to minimal bioavailability at the therapeutic site, unwanted adverse events, and required frequent dosing. To overcome the limitations with respect to conventional delivery systems, advanced drug delivery systems like inhalable formulations had attained high priority. Inhalation-based formulations exhibit major challenges with particle size and the elimination of foreign particles from the lungs. The particle size of inhalable formulation has a critical role that can retain within the respiratory part and overcome the disadvantages of alveolar uptake. Micron-size particles like microparticles, microspheres, and microemulsions are found to an attractive strategy for effective delivery of drugs to the targeted sites. These particles can be settled in the deeper part of the respiratory system and overcome the disadvantages of normal powder for inhalation. The micron-size particles are modified as dry powder inhalers with good flow properties. Various techniques have been implemented for microparticle preparation, and modification is implemented to overcome alveolar macrophage uptake and mucoadhesion. The microparticulate systems can overcome the disadvantage of nanoparticles as nanoparticles can be encapsulated in microparticles. This minimizes the engulfing of nanoparticle, aggregation of nanoparticle, and exhalation of nanoparticles. The current microparticle-, microsphere-, and microemulsion-based formulation approaches are discussed to achieve better therapeutic efficacy in the treatment of respiratory disorders.

The pathophysiology of narrow complex dilated cardiomyopathy is not defined, so therapeutic options are limited. By utilising the velocity equation, the pathophysiology of narrow complex cardiomyopathy allows above normal conduction propagation velocities. There are two pathophysiological theories that allow above normal conduction velocities and failure to capture the myocardium: (1)insulating fibres of the conduction system extending beyond the apex and (2) reduction of axon branching. A patient with narrow complex cardiomyopathy was subjected to graded increase in amplitude and pulse width pacing to overcome the failure of native conduction to capture the myocardium. Peak systolic strain maps demonstrated a progressive increase in apical contractility with increasing pulse width and amplitude. Ejection fraction improved from 17% to 31%. Understanding the pathophysiology of narrow complex cardiomyopathy leads to proposed therapies. One potential pacing therapy is multi-lead pacing at high amplitude and pulse width to capture myocardial cells not captured by native conduction.

Traditional studies of hip kinematics have not identified which anatomic structures limit the range of motion (ROM) when the hip is placed in different maneuvers. In this study, we attempted to answer two questions: (a) During which maneuvers is the motion of the hip limited by bony impingement between the femur and pelvis? (b) When is hip ROM determined by the constraint of soft tissues and to what extent? ROM of eight cadaveric hips was measured in 17 maneuvers using a motion capture system. The maneuvers were recreated in silico using 3D CT models of each specimen to detect the occurrence of bony impingement. If bony impingement was not detected, the variable component of 3D hip motion was increased until a collision was detected. The difference between the virtual ROM at the point of bony impingement and the initial ROM measured experimentally was termed as the soft-tissue restriction. The results showed that bony impingement was present in normal hips during maneuvers consisting of high abduction with flexion, and high flexion combined with adduction and internal rotation. At impingement-free maneuvers, the degree of soft tissue restriction varies remarkably, ranging from 4.9° ± 3.8° (internal rotation) at 90° of flexion to 80.0° ± 12.5° (internal rotation) at maximum extension. The findings shed light on the relative contributions of osseous and soft tissues to the motion of the hip in different maneuvers and allow for a better understanding of physical exams of different purposes in diagnosing bone- or soft tissue-related diseases.

INTRODUCTION AND OBJECTIVES:Venous thromboembolism (VTE) is a common cause of morbidity and mortality in urologic surgery. Appropriate risk stratification and administration of prophylaxis can help...

Objectives Completing training is a rite of passage common to all physicians, yet our knowledge of the components in postgraduate paediatric education that equip learners for successful transition to practice is limited. In order to optimally design training programs, it is critical to develop a better sense of what early career paediatricians (ECPs) experience as they navigate this time of transition. Methods We created and distributed a 23-question survey via e-mail to 481 Canadian ECPs in September 2017, specifically to those who received Royal College certification in 2011 or later. Survey responses were obtained confidentially through an online platform (Survey Monkey). Descriptive statistics and thematic analysis were used to analyze responses to closed-ended and free text questions, respectively. Results Response rate was 42% with nearly 70% of the respondents self-identifying as general paediatricians. Factors facilitating transition to practice included: dedicated mentorship; supportive new colleagues and workplace environment; and ease of finding work. Identified challenges included: billing, finances, and practice management; adjusting to a different scope of practice and learning local resources; managing comfort level; and achieving work–life balance. Nearly half of the respondents expressed interest in mentoring new ECP colleagues. Conclusions Our findings suggest that ECPs find clear value in mentorship, but desire further support to adapt to new practice contexts and activities. As a result, we must consider strategies in both individual programs and nationally that effectively prepare learners prior to transition and align with needs in the first years of independent practice.

Knee osteoarthritis (OA) is a degenerative process that slowly destroys the joints producing pain and loss of function, and diminishes the quality of life. Current treatments alleviate this symptomatology but do not stop the disease, being total knee arthroplasty the only definitive solution. Among the emerging treatments, Platelet-Rich Plasma (PRP) has shown promising results in the treatment of OA. However, to improve its effectiveness, it is necessary to approach this pathology targeting the whole joint, not only the cartilage, but including other tissues such as subchondral bone. The pathological processes that occur in the subchondral bone have influence of the cartilage loss, aggravating the disease. The combination of intraarticular infiltrations with intraosseous infiltrations regulates the biological processes of the tissues, reducing the inflammatory environment and modulating the overexpression of biomolecules that generate an aberrant cellular behavior. Although the first clinical results using this technique are promising, further research and developing adequate protocols are necessary to achieve good clinical results.

Tibial stems are frequently used in revision total knee arthroplasty (TKA). We investigated the effect of tibial stems on final component alignment and tray position. Thirty 3D reconstructed cadaveric tibial models were classified according to canal bow angle. After virtual implantation of 120 mm and 200 mm stemmed tibial components, deviation from native mechanical axis was measured. Tibial alignment valgus malposition of up to three degrees occurred and most pronounced with 120 mm stems. Canal alignment using 200 mm stems deviated tray position medially and posteriorly. Mild to moderate valgus bowing of the tibial canal is not uncommon (57% in our series) possibly leading to valgus malalignment. Anatomic conflict between the tibial mechanical axis and intramedullary canal can exist, with alignment and tray placement implications.

Previous comparisons of hip range of motion (ROM) after THA and surface replacement arthroplasty (SRA) are inconclusive due to the lack of soft tissue considerations and dissimilar control groups. The normal ROMs of 8 intact cadaveric hips were determined by placing specimens in 6 discrete, predefined positions of rotation at a standard torque. In each position, the limiting factor of ROM, either bony impingement or soft tissue restriction, could be determined. Total hip arthroplasty and SRA components were virtually implanted, and ROM until impingement was determined. With a THA, the ROM was comparable to that of the intact hip. With an SRA, flexion (111° ± 13°) was less than for the intact hip (131° ± 6°). Surface replacement arthroplasty, but not THA, significantly decreases the ROM compared to intact hips.

Cronkhite-Canada syndrome (CCS), first described in 1955, is a rare clinical syndrome of unknown etiology. CCS is diagnosed clinically, and the presenting symptoms include alopecia, cutaneous hyperpigmentation, gastrointestinal polyposis, and onychodystrophy, often accompanied by diarrhea, weight loss, and abdominal pain. We describe a unique case of CCS that presented with eosinophilic infiltrate on gastric and duodenal biopsies and review the literature pertaining to this rare syndrome.

ORBIS International has provided a web-based ophthalmic disease consultation service, Cyber-Sight, for developing nations since 2003. The system connects partner physicians with mentor physicians. We have reviewed consultations concerning retinal cases submitted from June 2003 to December 2011. Of 943 retinal consultations reviewed, 117 were excluded, mainly for reasons of technical limitations at the partner sites. Of the 826 included cases, 504 patients were male and 322 were female. The average age of the patients was 43 years (range 2 months to 86 years). Cases were submitted from partner physicians in 30 countries, with five countries accounting for 82% of the cases (India, Vietnam, Indonesia, China, Jordan). There was a rise in the case submission rate to a peak of 251 cases in 2010. The mean consultant response time was 5 days (SD 9). The mean time to case closure was 19 days (SD 92). The most common diagnoses were diabetic retinopathy (n = 101), retinal vascular occlusion (n = 75) and retinal detachment (n = 61). The working diagnosis submitted by the partner did not match the mentor's diagnosis in 153 cases (19%). The number of incorrect initial partner diagnoses demonstrates that the teleretinal programme serves a useful diagnostic role for partner physicians. The Cyber-Sight programme is a viable method of delivering advanced retinal expertise to partner institutions and increasing capacity for partner doctors in the developing world.

Liver biopsy continues to play a critical role in the evaluation and management of patients with liver disease. Although history, physical examination, and serological markers often obviate the need for a diagnostic liver biopsy, it is still considered the criterion standard, especially when the etiology of liver disease remains obscure. Even with a thorough history and laboratory workup, significant fibrosis and/or cirrhosis can be missed in as many as 32% of patients without a liver biopsy. 1 In fact, results of a liver biopsy have been shown to alter diagnosis in as many as 14% of patients with chronically elevated liver enzymes and significantly affect patient management in as many as 18% of such patients. 1,2 Moreover, current noninvasive imaging and serological markers of hepatic fibrosis remain investigational and have not been shown to be as accurate as liver biopsy. EUS has an established and integral role in the diagnosis, management, and treatment of several GI, liver, and pancreaticobiliary diseases. New indications and techniques for EUS continue to emerge as experience grows with this technology. Although there are reports of EUSguided FNA of the liver for evaluation of discrete hepatic lesions, there is only limited information on the role of EUS in assisting with diagnostic liver biopsy. Only 1 study to date has evaluated the histological adequacy of liver tissue obtained with EUS guidance; this particular study used the 19-gauge Tru-Cut core biopsy needle. 3 There are no data regarding histological adequacy when EUS-guided liver biopsy is performed by using a 19-gauge FNA needle. It is presumed that use of such a needle may limit the histological adequacy of the specimen obtained. 4 It remains uncertain whether EUS-guided liver biopsy by using a 19-gauge aspiration needle can acquire an adequate tissue specimen to provide a histological diagnosis. Therefore, the primary aim of this study was to evaluate the histological adequacy of liver tissue specimens obtained using a 19-gauge aspiration needle via a EUSguided approach. Specifically, we analyzed the length of the biopsy specimen, the number of complete portal tracts (CPTs), and the ability of the pathologist to make a diagnosis with the obtained specimen.

Objectives To identify the volumes of contrast material needed to reach specific landmarks during lumbar transforaminal epidural injections (L-TFEIs). Design Prospective, nonrandomized, observational human study. Setting Academic/private pain management practice. Patients Sixty-nine patients undergoing L-TFEIs were investigated. Sixty patients were included in this study. Interventions L-TFEIs were performed with the use of contrast-enhanced fluoroscopic visualization. Main Outcome Measurements After the appropriate spinal needle position was confirmed, up to 5.0 mL of nonionic contrast material was slowly injected. Under biplanar fluoroscopic guidance, contrast volumes were recorded as flow reached specific anatomic landmarks: ipsilateral neural foramen, ipsilateral disks superior and inferior to the injected level, and across the midline of the spinous process. Results After 1.1 mL of contrast was injected, 100% of L-TFEIs spread to the medial aspect of the superior pedicle (PED) of the corresponding level of injection. After 2.8 mL of contrast was injected, 95% of L-TFEIs spread to the superior aspect of the superior intervertebral disk (IVD) of the corresponding level of injection. After 3.6 mL of contrast was injected, 95% of L-TFEIs spread to the inferior aspect of the inferior IVD of the corresponding level of injection. After 3 mL of contrast was injected, 88% of L-TFEIs spread to cover both the superior and inferior IVDs of the corresponding level of injection. After 4 mL of contrast was injected, 93% of L-TFEIs spread to cover both the superior and inferior IVDs of the corresponding injection. After 4 ml of contrast was injected, 55% of L-TFEIs spread beyond the midline of the spinous process, but barely. Conclusion This study demonstrates injectate volumes needed to reach specific anatomic landmarks in L-TFEIs. A volume of 4.0 mL of injectate reaches both the superior aspect of the superior IVD and the inferior aspect of the inferior IVD 93% of the time.

We explored the mechanical factors leading to the formation of labral tears and the effect of these lesions on hip kinematics at the extremes of joint motion. Using a 3D motion analysis system, the stability of six cadaveric hips was measured during loading maneuvers known to impose anterior loads on the joint margin. These measurements were repeated following venting of the capsule, and after creation of a 15-mm tear in the intact labrum. Compared to the intact hip, 43% and 60% less force was required to distract the femur by 3 mm after venting and creation of a tear. An ER torque of 177 in-lbf in 30 degrees of flexion caused the vented and torn specimens to rotate 1.5 degrees +/- 2.7 degrees and 7.1 degrees +/- 4.7 degrees more than the intact specimen, and the femoral head to displace 1.21 +/- 0.53 mm and 0.67 +/- 0.35 mm, respectively. A breach of the integrity of labral function is shown to lead to decreased femoral stability relative to the acetabulum during extreme ranges of motion.

Background context Patient factors (diabetes, osteoporosis, cardiopulmonary problems, previous surgery, smoking, worker's compensation, litigation) and surgeon factors (operative experience, patient selection, technical skill, setting) are known to significantly impact outcomes of spinal surgery. The impact of these factors is difficult to assess clinically given the volume of patients required to obtain statistically significant information, the costs involved, and ethical/equipoise considerations. Computer simulation offers a viable and useful alternative. Purpose To establish a computer simulation for randomized trials (randomized controlled clinical trials)/registries and to examine the impact of surgeon and patient factors on surgical outcomes. Study design Computer simulation of randomized controlled trials and nonrandomized trials (registries). Methods On the basis of an extensive review of the literature regarding surgical outcomes (lumbar disectomy and decompression) and patient/surgeon factors affecting such outcomes, hazard functions were developed to model the distribution of relative outcome as a function of the risk profile of individual patients and surgeons. An iterative algorithm was used to randomly or nonrandomly pair patients and surgeons to create simulated randomized controlled clinical trials/registries encompassing 10,000 performed procedures per run. Results When fully randomized, outcomes were as expected with 80% of patients obtaining a satisfactory result. When the best surgeons were paired with the best patients, success rates approached 98%; and when the worst surgeons were paired with the worst patients, success rates dropped to 53%. Other nonrandom combinations were also assessed. Conclusions The computer simulation obtains expected outcomes for randomized controlled clinical trials and closely mirrors the range of outcomes seen in available case-series/registry data—a very useful model allowing assessment of the impact of patient/surgeon factors on surgical outcomes. Multiple patient/surgeon combinations are assessed and the implications of findings discussed.

Background. This article examines the feasibility of complete conversion from conventional coronary artery operation to routine off-pump coronary bypass operation. Methods. Data on our first 285 off-pump procedures using the Octopus system (Medtronic Inc, Minneapolis, MN) represent our learning curve. This is a complete experience in coronary bypass surgery over 16 months. Results. The cohort was nonselected. All patients had at least two-vessel disease. Eight hundred seven grafts were performed (mean, 2.8 per patient) of which 647 grafts (84%) were arterial (mean, 2.3 per patient). One hundred seventy nine patients (63%) underwent total arterial revascularization. Eight patients required cardiopulmonary bypass; all other operations were completed off-pump. Complications were: mortality, 3 patients (1.5%); renal failure, 24 patients (8%); stroke, 2 patients (< 1%); and atrial fibrillation, 60 patients (21%). The morbidity data and frequency of arterial grafting did not differ from that of 355 patients who underwent coronary bypass operations in a preceding 18-month period. Conclusions. Complete shift from routine use of cardiopulmonary bypass to nonselective off-pump coronary bypass operation is possible with a low conversion rate and without an apparent increase in morbidity or change in technique. Whereas short-term safety and efficacy seem certain, studies of long-term outcome are necessary before the eventual role of off-pump coronary bypass in myocardial revascularization can be defined.

Reconstruction of critical size defects in the load-bearing area has long been a challenge in orthopaedics. In the past, we have demonstrated the feasibility of using a biodegradable load-sharing scaffold fabricated from poly(propylene fumarate)/tricalcium phosphate (PPF/TCP) loaded with bone morphogenetic protein-2 (BMP-2) to successfully induce healing in those defects. However, there is limited osteoconduction observed with the PPF/TCP scaffold itself. For this reason, 13-93 bioactive glass scaffolds with local BMP-2 delivery were investigated in this study for inducing segmental defect repairs in a load-bearing region. Furthermore, a recent review on BMP-2 revealed greater risks in radiculitis, ectopic bone formation, osteolysis and poor global outcome in association with the use of BMP-2 for spinal fusion. We also evaluated the potential side effects of locally delivered BMP-2 on the structures of adjacent bones. Therefore, cylindrical 13-93 glass scaffolds were fabricated by indirect selective laser sintering with side holes on the cylinder filled with dicalcium phosphate dehydrate as a BMP-2 carrier. The scaffolds were implanted into critical size defects created in rat femurs with and without 10 μg of BMP-2. The x-ray and micro-CT results showed that a bridging callus was found as soon as three weeks and progressed gradually in the BMP group while minimal bone formation was observed in the control group. Degradation of the scaffolds was noted in both groups. Stiffness, peak load and energy to break of the BMP group were all higher than the control group. There was no statistical difference in bone mineral density, bone area and bone mineral content in the tibiae and contralateral femurs of the control and BMP groups. In conclusion, a 13-93 bioactive glass scaffold with local BMP-2 delivery has been demonstrated for its potential application in treating large bone defects.

Background MRI has proven to be an extremely valuable tool in the assessment of normal and pathological spinal anatomy. Accordingly, it is commonly used to assess containment of discal material by the outer fibers of the anulus fibrosus and posterior longitudinal ligaments. Determination of such containment is important to determine candidacy for intradiscal techniques and has prognostic significance. The accuracy of MRI in detecting containment has been insufficiently documented. Methods The MRI's of fifty consecutive patients undergoing open lumbar microdiscectomy were prospectively evaluated for disc containment by a neuroradiologist and senior spinal surgeon using criteria available in the literature and the classification of Macnab/McCulloch. An independent surgeon then performed the surgery and documented the actual containment status using the same methods. Statistical evaluation of accuracy was undertaken. Results MRI was found to be 72% sensitive, 68% specific, and 70% accurate in detecting containment status of lumbar herniated discs. Conclusion MRI may be inaccurate in assessing containment status of lumbar disc herniations in 30% of cases. Given the importance of containment for patient selection for indirect discectomy techniques and intradiscal therapies, coupled with prognostic significance; other methods to assess containment should be employed to assess containment when such alternative interventions are being considered.