A Review of Minimally Invasive Surgical Techniques for the Management of Thoracic Disc Herniations

Sagar B. Sharma,김진성 대한척추신경외과학회 2019 Neurospine Vol.16 No.1

Thoracic disc herniation (TDH) is a rare, but technically challenging, disorder. Apart from their unfamiliarity with this condition, surgeons are often posed with challenges regarding the diverse methods available to address TDH, the neurological disturbances accompanying the disorder, the prospect of iatrogenic cord damage during surgical procedures, and the complications associated with various surgical approaches. In today’s era, when minimally invasive surgery has been incorporated into almost every aspect of managing spine disorders, it is necessary for surgeons to be aware of the various minimally invasive techniques available for the management of these rare and difficult conditions. In this review article, we provide a synopsis of the epidemiology, clinical features, and technical aspects of TDH, starting from level identification to intraoperative neuromonitoring and including important steps and guidance for all the minimally invasive approaches to TDH. We conclude the review by providing insights into the clinical decision-making process and outline the specific aspects of “giant” thoracic discs and indications for fusion in certain conditions. Outcomes of minimally invasive surgery for these conditions are generally favorable. The location of herniation is an important factor for surgical planning.

Radioprotective and Antioxidant Activity of Fractionated Extracts of Berries of Hippophae rhamnoides

Rakesh Kumar Sharma,Raman Chawla,Rajesh Arora,Shikha Singh,Ravinder Kumar Sagar,Raj Kumar,Ashok Sharma,Manju L. Gupta,Surender Singh,Jagdish Prasad,Haider A. Khan,Anand Swaroop,A.K. Sinha,A.K. Gupta,R 한국식품영양과학회 2007 Journal of medicinal food Vol.10 No.1

Plants are an abundant source of medicinal compounds, some of which are useful in combating free radical-1002 (flavonoid-poor fraction) of Hippophae rhamnoideswere screened on the basis of their reducing power in the aqueousphase. REC-1001 was selected for further study, since it exhibited 27.38 times higher antioxidant activity than REC-1002.REC-1001 also showed significant (P. .05) membrane protection potential at 50 .g/mL, which was attributed to its abilityto scavenge peroxyl radicals (64.82. 1.25% scavenging within 1,440 min). A significant (P. .05) difference of 67.02% infree radical scavenging activity at 1,000 ng/mL between REC-1001 and vitamin E demonstrated the extract fraction’s worthc-tion. Further, REC-1001 was found to be nontoxic up to 200 mg/kg of body weight. This research suggests that the REC-1001 fraction of H. rhamnoidesextract is a safe and effective antioxidant nutraceutical product.

Role of Wearable Technology on Chronic Liver Disease in Type 2 Diabetic Patients

( Vikas Sharma ),( Sagar Lavenia ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: New wearable sensor networks together with smartphone applications are being examined and tested for their potential to monitor and manage chronic liver disease (CLD) in type 2 diabetic patients. To develop methods for analyzes and monitor of map the intersection(s) of hepatology data in relation to CLD via wearable technology (MI band and Yu band). To study effects of daily life routine activities on data by a wearable devices that can obtain real-time CLD data, help technologists understand medical aspects, and clinicians to understand technological processes them and provides assistance based on pre-determined specifications in CLD in type 2 diabetic patients in Agra city, India. Methods: Total of 106 CLD with type 2 diabetes patients were taken as subject with an equal ratio of male and female. Wearable monitoring devices were put on the wrist of CLD patients for 30 days and a questionnaire was filled out by each patient. Both diabetes and cardiovascular disease in turn are known as important factors for developing CLD and aggravation toward once end-stage liverl disease. In all subjects, blood glucose was measured on daily basis with day to day data of their monitoring of step count (deep sleep, light sleep, wake up time), blood pressure, calorie burnt, insulin dose, motion time i.e. every time when your body was in motion, sleep monitoring, monitoring heart rate, cardiac arrhythmias to know daily routines and recording them for health purpose. Results: Present results shown that both wearable device reading showed there was a normal heart rate, more calorie burnt with better control of sugar control and average good sleep count in more physically workout, include walking in CLD patients compared to less physically workout CLD patients, identified by professional physiotherapists. Both device reading showed that after changing lifestyle routine among less physically active CLD patients, their post- CLD events normalize with less requirement of medicine and insulin injection dose. Conclusions: With this study we show that, by using, these wearable devices ensured online assistive feedback for CLD patients with type 2 diabetes is possible with their health awareness, exercising and motivate further studies.

Endoscopic Treatment of Extraforaminal Entrapment of L5 Nerve Root (Far Out Syndrome) by Unilateral Biportal Endoscopic Approach: Technical Report and Preliminary Clinical Results

허동화,Sagar Sharma,박춘근 대한척추신경외과학회 2019 Neurospine Vol.16 No.1

Objective: Far out syndrome is compression and entrapment of the L5 nerve root in the extraforaminal area between the hypertrophied L5 transverse process and the sacral ala. The purpose of this study was to describe the technique of unilateral biportal endoscopic decompression for far out syndrome and to analyze early clinical results after endoscopic decompression. Methods: The authors consecutively performed operative treatments for 16 patients with unilateral extraforaminal entrapment of the L5 nerve root (far out syndrome) using percutaneous biportal endoscopies. We included only patients who were followed more than six months after surgery. Demographic characteristics, operative time, concomitant herniated disc, and surgical complications were investigated. Clinical outcomes were evaluated using modified MacNab criteria, the visual analogue scale (VAS) for legs, and the Oswestry Disability Index (ODI). Results: Among 16 patients, a total of 14 cases with 4 males and 10 females were included in the study. The mean leg VAS and the ODI were significantly improved after unilateral biportal endoscopic surgery. Concomitant extraforaminal disc herniation was associated with a favorable outcome (p<0.05). Abdominal pain in the immediate postoperative period occurred in 2 patients. Abdominal pain was completely resolved with conservative management in both patients. Conclusion: We were able to achieve successful decompression of unilateral extraforaminal entrapment of the L5 nerve root using unilateral biportal endoscopic surgery. A unilateral biportal endoscopic approach may be considered as an alternative surgical treatment for far out syndrome.

Hepatoprotective Evaluation of the Effects of The Hydroalcoholic Extract of Liv.52 Ds on Paracetamol Induced Liver Toxicity in Rats

( Pardeep Kumar ),( Sagar Lavenia ),( Vk Sharma ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Oxidative stress induced by toxicants is known to cause various complications in the liver. Herbal drug such as Liv.52 is found to have hepatoprotective effect. However, the biochemical mechanism involved in the Liv.52 DS mediated protection against toxicity is not well elucidated using suitable in vivo models. Paracetamol causes oxidative stress and dysfunction of the liver. This study was undertaken to evaluate the effects of the hydroalcoholic extract of Liv.52 DS on some biochemical and histopathological parameters of liver tissue in against paracetamol induced hepatic damage in rats. Methods: Wistar rats were orally administered with 2g/kg body weight Paracetamol. Vehicle (distilled water) and silymarin (50 mg/kg body weight) were used as the negative and positive control groups, respectively. Paracetamol -administered groups were treated with Liv 52 DS extract (100, 200, and 400 mg/kg). After 15 days of treatment, the blood specimens and liver samples were examined. Alteration in the levels of biochemical markers of hepatic damage like AST, ALT, ALP and lipid peroxides were tested, and phytochemical tests were also performed. Results: In Paracetamol -treated group, the levels of serum urea, high density lipoprotein (HDL), and liver superoxide dismutase (SOD), catalase (CAT), and vitamin C significantly decreased (P<0.05) compared to control. Also, in this group, serum triglyceride (TG), total cholesterol (TC), very low density lipoprotein cholesterol (VLDL), protein carbonyl (PC), malondialdehyde, tumor necrosis factor-alpha (TNF-α), and TNF-α gene expression significantly increased (P<0.05) as compared to the control (vehicle-treated rats). Treatment with Liv. 52 DS extract in a significant increase (P<0.05) in CAT, SOD, vitamin C, HDL and a significant decrease (P<0.05) in the level of urea, MDA, PC, TG, TC, VLDL, TNF-α protein, and the gene expression of TNF-α compared with test without treatment group. Histopathological evidence demonstrated that treatment with Liv.52 DS extract could decrease liver lymphocyte infiltration. Conclusions: The present study suggests that Liv. 52 DS extract possesses hepatoprotective activity. It could be an effective and promising preventive agent against Paracetamo-induced hepatotoxicity.

Hepatoprotective Effects of 17β Estradiol on Glucose Transporter and Oxidative Stress in Aging Female Rat Liver

( Pardeep Kumar ),( Sagar Lavenia ),( Vk Sharma ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Free radical production and oxidative stress are known to increase in liver during aging, and may contribute to the oxidative damage. These changes increase during menopausal condition in females when the level of estradiol is decreased. The objective of this study was to observe the changes in activities of membrane linked ATPases antioxidant enzymes, hepatic enzymes, lipid peroxidation levels and glucose transporters 2 (GLUT 2) expression occurring in livers of female rats of 3, 12 and 24 months age groups, and to see whether these changes are restored to 3 months control levels rats after exogenous administration of 17-ß-estradiol (E2). Methods: The aged female rats (12 and 24 months old) (n=8 for each group) were given subcutaneous injection of 17ß estradiol (0.1 μg/g body weight) daily for one month. Controls animals received an equal volume of vehicle. After 30 days of hormone treatment, experimental animals of all the groups were sacrificed and livers were isolated for further study. Biochemical parameters including serum transaminases [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)] and alkaline phosphatase (ALP) in serum were analyzed. A detailed study was carried on membrane linked enzymes (Na⁺ / K⁺ ATPase, Ca²⁺ ATPase), antioxidant enzymes (superoxide dismutase, glutathione-S-transferase) and GLUT2 expression with immunohistochemistry to identify the antiaging role of E2 using biochemical, molecular and histochemical study. Results: The results obtained in the present work revealed that normal aging was associated with significant decrease in the activities of membrane linked ATPases, antioxidant enzymes, GLUT 2 expression and an increase in lipid peroxidation and hepatic enzymes in livers of aging female rats. Our data showed that exogenous administration of E2 brought these changes to near normalcy in aging female rats. Conclusions: The present study showed that E2 treatment reversed the changes to normal levels. E2 treatment may be beneficial in preventing some of the age related changes in the liver by increasing antioxidant defenses.

Inhibition of Quorum Sensing Regulated Virulence Factors and Biofilm Formation by Eucalyptus globulus against Multidrug-Resistant Pseudomonas aeruginosa

Pankaj Kumar Sagar,Poonam Sharma,Rambir Singh 대한약침학회 2022 Journal of pharmacopuncture Vol.25 No.1

Objectives: The quorum-sensing–inhibitory and anti-biofilm activities of the methanol extract of E. globulus leaves were determined against clinically isolated multidrug-resistant Pseudomonas aeruginosa. Methods: The preliminary anti-quorum–sensing (AQS) activity of eucalyptus was investigated against a biosensor strain Chromobacterium violaceum ATCC 12472 (CV12472) by using the agar well diffusion method. The effect of sub-minimum inhibitory concentrations (sub-MICs) of the methanol extract of eucalyptus on different quorum-sensing–regulated virulence factors, such as swarming motility, pyocyanin pigment, exopolysaccharide (EPS), and biofilm formation, against clinical isolates (CIs 2, 3, and 4) and reference PA01 of Pseudomonas aeruginosa were determined using the swarm diameter (mm)-measurement method, chloroform extraction method, phenol (5%)-sulphuric acid (concentrated) method, and the microtiter plate assay respectively, and the inhibition (%) in formation were calculated. Results: The preliminary AQS activity (violacein pigment inhibition) of eucalyptus was confirmed against Chromobacterium violaceum ATCC 12472 (CV12472). The eucalyptus extract also showed concentration-dependent inhibition (%) of swarming motility, pyocyanin pigment, EPS, and biofilm formation in different CIs and PA01 of P. aeruginosa. Conclusion: Our results revealed the effectiveness of the E. globulus extract for the regulation of quorum-sensing–dependent virulence factors and biofilm formation at a reduced dose (sub-MICs) and suggest that E. globulus may be a therapeutic agent for curing and controlling bacterial infection and thereby reducing the possibility of resistance development in pathogenic strains.

Clinical and Social Outcomes of Cochlear Implantation in Older Prelinguals

Tyagi Pragya,Chauhan Divya,Singh Anup,Bhutada Mayank,Sikka Kapil,Chaudhary Tanvi,Sharma Sonam,Agarwal Shivani,Verma Hitesh,Sagar Prem,Kumar Rakesh,Thakar Alok 대한청각학회 2023 Journal of Audiology & Otology Vol.27 No.2

Background and Objectives: Cochlear implantation in late implanted prelinguals necessitates a complex decision-making process for clinicians and patients due to the uncertainty of achieving adequate benefit in auditory and speech perception. This study longitudinally evaluated clinical and social outcomes of prelingually deaf children with implantation in their late childhood.Subjects and Methods: A total of 113 (49 females and 64 males) participants, with an age range of 5-15 years, were assessed for the pre-implant parameters such as hearing loss etiology, aided responses, anatomical aspects, and psychological evaluation. The Category of Auditory Performance, Speech Awareness Threshold, Speech Reception Threshold, and Speech Discrimination Score were administered to assess the patient’s auditory skills. Further, the Speech Intelligibility Rating scale was administered to evaluate the patient’s speech intelligibility at 3, 6, 9, 12, 18, and 24 months post-surgery. Subjectively perceived benefits were evaluated using the satisfaction rating scale and a questionnaire.Results: The statistical results showed a significant impact of cochlear implantation in all domains. Positive impact and improvement post-implantation were noted in all the spheres, including auditory, linguistic, social, and educational.Conclusions: The study highlighted that the outcomes of a cochlear implant at a later age might not parallel with the implantation at a younger age. However, this still provides measurable benefits even after a longer period of auditory deprivation.

A 30-Year Worldwide Research Productivity of Scientific Publication in Full-Endoscopic Decompression Spine Surgery: Quantitative and Qualitative Analysis

Yanting Liu,Vit Kotheeranurak,Javier Quillo-Olvera,Van Isseldyk Facundo,Sagar Sharma,Siravich Suvithayasiri,Khanathip Jitpakdee,Guang-Xun Lin,Akaworn Mahatthanatrakul,Hussam Jabri,Ashwinkumar Vasant K 대한척추신경외과학회 2023 Neurospine Vol.20 No.1

Objective: The ever-growing number of articles related to full-endoscopic spine surgery published in the last few decades presents a challenge which is perplexing and time-consuming in identifying the current research status. The study aims to identify and analyze the most cited works related to full-endoscopic decompression spine surgery, compare the articles published by different publishers and area, and show the current publication status of full-endoscopic research. Methods: Using Bibliometrix, CiteSpace, and VOSviewer, we analyzed the bibliometric data selected from the Web of Science database between 1992 and 2022. Spine has the highest H-index with the most-cited journal in the field of full-endoscopic decompression spine surgery. China ranked as the most productive country, whereas the most cited with high H-index papers came from South Korea. For the author analysis, Yeung AT, Ruetten S, Hoogland T, Ahn Y, Choi G, and Mayer HM were the most impactful authors in the global and local citations. The most productive organization is Wooridul Spine Hospital. Conclusion: The bibliometric study showed a growing trend of research on full-endoscopic decompression spine surgery over the past 30 years. It has demonstrated that there is a significant increase in the number of authors, institutions, and internationally collaborated countries. However, the quality of studies is still low, and the lack of high-quality clinical evidence and the trend of general journal submissions has somewhat affected the quality of endoscopy journals in recent years.