Intra-operative Safety of an Autonomous Robotic System for Total Knee Replacement: A Review of 500 Cases in India.

Background: Manual total knee arthroplasty (TKA) has been documented several times for their safety and complications data. In contrast, there is a limited evidence-based analysis for safety and complications of autonomous robotic-assisted (RA)-TKA. This study aimed to evaluate the safety features and intra-operative surgical complications associated with the use of Cuvis Joint™ autonomous robotic system for TKA. Methods: The study included 500 consecutive patients who underwent TKA using the Cuvis Joint™ autonomous robotic system from November 2020 to November 2021. All surgeries were performed by a senior surgeon. Patients in whom the surgery was abandoned midway due to technical errors, were excluded from the analysis. In case of unilateral abandonment of the robotic arm during a bilateral RA-TKA, data of the side on which the surgery was completed with robotic assistance was recorded. Results: There was no incidence of neurological injury, vascular injury, extensor mechanism disruption, or medial collateral ligament injury. There was one case of superficial abrasion of the patellar tendon; however, it did not require any intervention. There were no cases of midway abandonment due to threatened soft tissue injury. There was no intra-operative pin loosening or stress-related fractures at the pin sites. There was one case of Steinmann pin breakage and another case of drill bit breakage, which were removed without any damage to the bone. Conclusion: The Cuvis Joint™ autonomous robotic system for TKA is safe with no significant intra-operative complications.

rGO/MnO2 nanowires for ultrasonic-combined Fenton assisted efficient degradation of Reactive Black 5.

Reduced graphene oxide (rGO) coated manganese dioxide (MnO2) nanowires (NWs) were prepared by the hydrothermal method. Raman spectra confirmed the presence of rGO and the Brunauer-Emmett-Teller surface area of rGO/MnO2 NWs was found to be 59.1 m2g-1. The physico-chemical properties of prepared catalysts for the degradation of Reactive Black 5 (RB5) dye were investigated. 84% of RB5 dye in hydrogen peroxide solution was successfully degraded using rGO/MnO2 NWs, while only 63% was successfully degraded with pristine α-MnO2 NWs in 60 min owing to the smaller crystallite size and large surface area. Further, the ultrasonic-combined Fenton process significantly enhanced the degradation rate to 95% of RB5 by the catalyst rGO/MnO2 NWs due to synergistic effects. The decomposition products identified using gas chromatography-mass spectrometry revealed a higher production rate of fragments in the ultrasonic-combined Fenton process. Therefore, rGO/MnO2 NWs with the ultrasonic-combined Fenton process is an efficient catalyst for the degradation of RB5, and may be used for environmental protection.

Medial Open Wedge High Tibial Osteotomy for Varus Malunited Tibial Plateau Fractures.

PURPOSE: To analyze radiologic and functional outcomes of varus malunited tibial plateau fractures managed with medial open wedge high tibial osteotomy (MOHTO). METHODS: Eighteen patients with symptomatic varus malunited tibial plateau fractures with less than stage II arthritic changes managed from July 2009 to October 2013 were included. Patients with complex intra-articular step malunions and severe arthritic changes (stage III and IV) were excluded. Initially, diagnostic arthroscopy was performed followed by MOHTO stabilized with locking plate and tricortical autograft (n = 11, 61%) or a Puddu plate and allograft (n = 7, 39%). Patients were evaluated radiologically for union, medial proximal tibial angle, and tibial slope angle, and functional assessment was performed with a knee outcome survey based on activities of daily living. RESULTS: The mean follow-up duration was 41.7 ± 12.1 months (range 25-61); all patients achieved radiologic union by a mean duration of 4.3 ± 1.2 months (range 3-8). The mean medial proximal tibial angle improved from 75.3° ± 3.7° (range 70.5°-85.2°) to a postoperative angle of 83.8° ± 3.6° (range 77.5°-90.4°) (P < .001). In 12 patients, an abnormal mean anterior slope of -5.5° ± 3.0° (range -1.1° to -13°) was corrected to a postoperative posterior slope of 5.8° ± 4.4° (range -1.1° to 14.1°) (P < .001). In 6 patients, a mean posterior slope of 17.4° ± 10.5° (range 1.4°-33°) was corrected to a postoperative posterior slope of 14.08° ± 5.6° (range 7.4-21.3) (P = .214). The mean knee outcome survey scores preoperatively were 25% ± 9.68% (range 8%-48%) and postoperatively were 85% ± 11.18% (range -52% to 98%, P < .001). CONCLUSIONS: MOTHO for varus malunited tibial plateau fractures is safe and effective procedure that provides excellent functional outcomes, acceptable radiologic outcomes, and carries minimal complications. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Fabrication and performance evaluation of hybrid supercapacitor electrodes based on carbon nanotubes and sputtered TiO2.

We report a simple and eco-friendly method for the fabrication of a titanium dioxide/functionalized multiwalled carbon nanotube (TiO2/FMWCNT) composite electrode for use in supercapacitors. The nanocomposite electrodes were formed by depositing titanium dioxide onto FMWCNTs using reactive magnetron sputtering, thus providing a green roue for the formation of the binder-free composite electrode. It is shown that the electrochemical performance of the fabricated electrodes can be altered by tuning the thickness of the titanium dioxide overlayer. The integrated nanocomposite electrode showed an improved specific capacitance of 90 Fg(-1) in two-electrode configuration.

Fibrodysplasia Ossificans Progressiva in a Four year Old Child.

INTRODUCTION: Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disoder characterized by bone formation within muscles tendons and ligaments. It has an incidence of one in two million. We hereby report a case of FOP in a four year male child from a tribal family in orissa. CASE REPORT: 4 yr old male child presented with gradual development of stiffness of neck and hard nodules on his body for which his parents had sought all sort of indegenous treatment and manipulations by traditional bone setters. Patient returned to our hospital at the age of four years with widespread ossification and stiffness of neck, shoulders and back. He also had upper tibial osteochondromas and scalp nodules and valgus deformity of bilateral great toes. A diagnosis of FOP was made on clinical and radiological examination. CONCLUSION: Though rare, diagnosis of Myositis ossificans progressiva should be considered in a child with heterotopic bone formation and valgus deformities of great toes. Being a rare condition, treatment guidelines are not clear and this condition need further research.

A comparative histopathological study of systemic candidiasis in association with experimentally induced breast cancer.

Systemic candidiasis is a fungal infection which coupled with solid malignancies places patients at high risk of succumbing to the disease. Few studies have shown evidence of the relationship between systemic candidiasis and malignancy-induced immunosuppression disease especially in breast cancer. At present, animal studies that exclusively demonstrate this relationship have yet to be conducted. The exact causative mechanism of systemic candidiasis is currently under much speculation. This study therefore aimed to demonstrate this relationship by observing the histopathological changes of organs harvested from female Balb/c mice which were experimentally induced with breast cancer and inoculated with systemic candidiasis. The mice were randomly assigned to five different groups (n=12). The first group (group 1) was injected with phosphate buffer solution, the second (group 2) with systemic candidiasis, the third (group 3) with breast cancer and the final two groups (groups 4 and 5) had both candidiasis and breast cancer at two different doses of candidiasis, respectively. Inoculation of mice with systemic candidiasis was performed by an intravenous injection of Candida albicans via the tail vein following successful culture methods. Induction of mice with breast cancer occurred via injection of 4T1 cancer cells at the right axillary mammary fatpad after effective culture methods. The prepared slides with organ tissues were stained with hematoxylin and eosin, periodic acidic schiff and gomori methenamine silver stains for a histopathological analysis. Grading of primary tumour and identification of metastatic deposits, as well as scoring of inflammation and congestion in all the respective organs was conducted. Statistical tests performed to compare groups 2 and 4 showed that group 4 exhibited a highly statistically significant increase in organ inflammation and congestion (p<0.01). The median severity of candidiasis in the kidneys and liver also increased in group 4 as compared to group 2. In conclusion, based on the above evidence, systemic candidiasis significantly increased in mice with breast cancer.

Expression of transforming growth factor-beta and determination of apoptotic index in histopathological sections for assessment of the effects of Apigenin (4', 5', 7'- Trihydroxyflavone) on Cyclosporine A induced renal damage.

Cyclosporine A (CsA), a calcineurin inhibitor produced by the fungi Trichoderma polysporum and Cylindrocarpon lucidum, is an immunosuppressant prescribed in organ transplants to prevent rejection. Its adverse effect on renal dysfunction has limited its use in a clinical setting. Apigenin (4',5',7'-Trihydroxyflavone), a herbal extract, with anti-inflammatory and anti-tumour properties, has been investigated for properties to reverse this adverse effect. This research was conducted to establish a standard protocol for immunohistochemical estimation of Transforming Growth Factor beta (TGF-beta) expression, as an indicator of Cyclosporine A induced damage, and to observe whether apoptotic index and TGF-beta expression can be used to assess effects of Apigenin on CsA induced renal dysfunction. Six groups of 5 male Sprague-Dawley albino rats each were dosed once daily for 21 days, as follows: (1) negative control--oral corn oil, (2) positive control--Cyclosporine A (25 mg/kg), (3) Group 3--Apigenin (20 mg/kg), (4) Group 4--Cyclosporine A (25 mg/kg) +Apigenin (10 mg/kg), (5) Group 5--Cyclosporine A (25 mg/kg) +Apigenin (15 mg/kg) and (6) Group 6--Cyclosporine A (25 mg/kg) +Apigenin (20 mg/kg). Cyclosporine A was administered intra-peritoneally while Apigenin was given orally. The rat kidneys were harvested and examined microscopically to assess the apoptotic index, and stained by immunohistochemistry for multifunctioning polypeptide TGF-beta expression. A high apoptotic index and TGF-beta intensity was observed in the Cyclosporine A group. Apigenin significantly reduced the both apoptotic index and TGF-beta intensity. The apoptotic index correlated with TGF-beta intensity, especially in glomeruli. This study indicates that Cyclosporine A can enhance the TGF-beta expression in rat kidney, signifying accelerated apoptosis. TGF-beta and apoptotic index may be used to assess Apigenin and its effect on Cyclosporine A induced renal damage.

Protective antioxidant effect of Centella asiatica bioflavonoids on lead acetate induced neurotoxicity.

Lead (Pb) is a neurotoxic heavy metal and children in the developmental stage are particularly susceptible to toxic effects of lead exposure. The brain is the key organ involved in interpreting and responding to potential stressors. Epidemiological investigations have established the relationship between chronic lead exposure and cognitive impairments in young children. Excessive production of radical species plays an important role in neuronal pathology resulting from excitotoxic insults, therefore one plausible neuroprotective mechanism of bioflavonoids is partly relevant to their metal chelating and antioxidant properties. Centella asiatica (CA) is a tropical medicinal plant enriched with bioflavonoids and triterpenes and selenium, reported to rejuvenate the cells and promote physical and mental health. Bioflavonoids are claimed to be exert antimutagenic, neurotrophic and xenobiotics ameliorating and membrane molecular stabilizing effects. The objective of the present work is to study the protective antioxidant effect of pretreatment of CA extract (CAE) on lead acetate induced changes in oxidative biomarkers in the central nervous system (CNS) of mice.

Forced swimming stress induced alterations in ingestive behavior in rats.

The effects of forced swimming stress (15 minutes per day) on body weight, food intake, blood sugar, water intake, and urine output were studied in adult male Wistar rats on the first, seventh, fourteenth and 21st days in different subgroups. There was a significant initial decrease in the body weight up to 14 days followed by a regain in the body weight, which was sustained until 21 days. Though there was no change in the food intake initially for 7 days, after 14 days a significant increase in the food intake was observed. A significant hypoglycemia was observed throughout the entire period of stress. More significant fall in the blood sugar level was observed in the initial period of exposure of stress (1-7 days). There was a significant reduction in the water intake in the stressed animals. Urine output decreased significantly up to 7 days of stress, though it got marginally increased later. Thus, repeated stress may produce a reduction in body weight only initially, which is accompanied with an initial decrease in food and water intake also. The peak response to stress was seen after 7 days of stress exposure. There was a gradual recovery back to normal in the body weight, food intake, and water intake and urine output when stress period was prolonged to 14-21 days. This is suggestive of the adaptation of the organism to repeated exposure of similar kind of stress.

Effect of acute and chronic conditions of over-crowding on free choice ethanol intake in rats.

Male albino rats of Wistar strain were exposed to overcrowding stress in two different groups for a period of seven days. One group of rats was kept under stress for six hours per day (acute stressed group) and the other group rats was kept under stress continuously (chronic stressed group). The effect of these acute and chronic stresses on voluntary alcohol (2% w/v) intake was monitored during the 7 days of stress exposure, and ethanol preference and total ethanol intake in terms of g/kg body weight were also studied. A significant increase in ethanol preference and ethanol intake was observed in one-day and 7 days chronic stressed group. No significant increase in ethanol intake was observed in acute stress. Thus a short lasting stressor may not increase ethanol-drinking behavior, whereas when animals were exposed to more intense stressor continuously for 7 days, an increase in voluntary drinking behavior may be seen.

Voluntary alcohol drinking & caloric intake in rats exposed to crowding stress.

BACKGROUND & OBJECTIVES: Alcohol intake in animals is regulated in much the same way as intake of food. The effect of alcohol on feeding behaviour is not well documented. The objective of this study was to test whether alcohol was ingested as a source of calories after crowding stress in rats. METHODS: Male albino rats were exposed to crowding stress continuously for two weeks and the effect of stress on the body weight, food intake, voluntary alcohol consumption and caloric intake in terms of food and alcohol was studied. RESULTS: A significant decrease in the body weight was seen after one (P < 0.05), 7 and 14 days (P < 0.01) of stress compared to controls. Food intake decreased significantly (P < 0.01) after one day of stress and there was recovery after 7 days stress. Absolute alcohol intake (g/kg body weight) increased significantly (P < 0.001) after one day of stress. Prolonged stress for two weeks significantly (P < 0.01) increased the alcohol consumption. Total caloric intake in stressed rats decreased significantly (P < 0.001) after acute stress. After 14 days, stressed rats showed significant (P < 0.001) increase in total caloric intake compared to day one. INTERPRETATION & CONCLUSION: Crowding stress decreased the body weight gain throughout the period of stress. Chronic stress for two weeks increased the voluntary alcohol consumption and total caloric intake. Food intake alone seemed insufficient to provide the extra demand of energy due to prolonged stress and hence, the rats may be drinking increasing amounts of alcohol (when provided) to supply the extra energy required to combat stress.

Influence of different types of stress on selected cardiovascular parameters in rats.

Wistar strain male albino rats were exposed to different types of stressors like isolation, immobilization, overcrowding and forced swimming, for a duration of one day, 7 days, 15 days and 30 days and the effect on heart weight, adrenal weight, heart rate, P-R interval and serum transaminase levels were studied. There was a significant increase in the heart weight and adrenal weight in most of the stress subgroups. Tachycardia was seen in all the types of stress upto 7 days, except in the case of overcrowding stress. Serum transaminase level increased significantly in all the types of stress. Among the different types of stress, immobilization and forced swimming had greater effect on the heart weight and heart rate. Increase in the heart rate and heart weight was observed only in the initial period of exposure to a stressor and when the animals were exposed to a prolonged stressor like 15 days and 30 days, there was no further increase in the heart weight and heart rate which may be due to the adaptation of the animal to a chronic stressor.

FORCED SWIMMING STRESS-INDUCED CHANGES IN THE PHYSIOLOGICAL AND BIOCHEMICAL PARAMETERS IN ALBINO RATS.

The effects of fresh water swimming and cold water swimming for one day, 7 days and 15 days were studied on the total body weight, weight of the heart, kidney, adrenals, blood sugar level, serum cholesterol level, total leucocyte count, absolute neutrophil count and absolute eosinophil count in albino rats. The stress session in each day lasted for 45 min. Though the body weight of the animals decreased significantly during the initial period, when the stress period was prolonged, there was recovery in the body weight. There was a significant increase in the weight of the heart, kidney and adrenal glands after both types of stress. A significant leucopenia, eosinopenia and neutropenia along with significant hypoglycemia and hypocholesterolemia was observed in all the subgroups. A maximum stress response was seen upto a period of 7 days and the stress response decreased when the stress period was prolonged to 15 days in the physiological parameters studied. This could be due to the adaptation or habituation for the continued stress. There was no sign of adaptation in the case of biochemical parameters studied. A statistically significant physiological and biochemical changes were observed even after one day of forced swimming stress.