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Lumbar Disc Height Changes in Pre and Post- Operatives of degenerative lumber disorders

Share this: Facebook Twitter Reddit LinkedIn WhatsApp Radiological Evaluation of the Lumbar Disc Height Changes in Pre and Post- Operatives of degenerative lumber disorders underwent Computer navigated MIS- TLIF Abstract: Objective: This retrospective study to assessment the disc height changes pre and post-operation for the patients with degenerative lumber disease whether the disc height improved by discectomy and cage implantation by MIS-TLIF procedure. Methods: Between the periods of January to June 2016 a retrospective study of 40 patients (21 Female, 19 Male) with mean age 52.6 years old who underwent MIS-TLIF were compared pre and postoperation of MIS-TLIF through calculating disc height by digital tool using X-ray image. Results: This study includes 56 segments of lumbar spine. The X-Ray post-operatively showed significant physiological changes in disc height with the disc height average 14.38mm compared with the disc height pre-operatively with the average disc height 9.83mm in addition the T-test result was 2.050. The disc height improve significantly after MIS-TLIF, P0>.001, There was no serious complication found after performing the operation. Conclusion: The MIS-TLIF procedure elevates the disc gap. Supported with cage and bone graft can restore the disc height to keep the normal lumber function that may play an important role in relive the symptoms of degenerative lumber disorders. Keywords: MIS-TLIF, Disc height, computer navigation system, Disc degenerative disease. Introduction: First of all, a short overview of spinal anatomy so that can understand how a lumbar herniated disc can cause lower back pain and leg pain. In between each of the vertebrae is a disc. The disc shapes look like circle and from outside is fibrous covering the gel substance disc. Herniation occur when the gel substance bulge out and press the nerve root or the spine itself. Disc degeneration disorders are the most common reason for low back pain. Many cases require operation if the conservative treatment doesn’t improve the symptoms, dynamic stabilization implant systems to fuse the vertebral bodies with or without supplementary devices. And dynamic stabilization devices are employed with the assumption that they will decrease the inter-vertebral disc loading at the treated level thereby decreasing pain and restrict more degeneration while reducing the degenerative influence on the adjacent levels. Various design concepts ranging from loaded springs to articulating type devices to the nucleus and annular repair devices have been proposed recently. The prevalence of spine surgery has steadily been on the rise over the last two decennium and this direction in prospect to spread over the next twenty-five years. In addition, the number of implanted medical devices that have been developed and the clinical indications for their use have expanded over the last ten years. Disc height is racial for the patient with the lumbar degenerative disease. Restore the disc height is important in keeping the normal structure of the lumbar spine. MIS-TLIF assisted by computer navigation system could accurately play the role in restores the disc height with the satisfied clinical outcome. This method has some obvious advantages over traditional surgeries but few kinds of literature report the disc changes after operation, so we aim in this study to declare that disc height restored and the patients symptoms disappear after MIS-TLIF. Methods: Patient’s characteristics: This retrospective study between the period of January-June 2016 included 40 patients (21 F, 19 M) with mean age 52.6 years .56 segments of lumbar vertebra were treated by MIS-TLIF divided as (12 segments L3-L4, 32 segments L4-L5, 12 segments L5-S1). 40 patients were with a clear history, no previous spinal operation, no hypertension or diabetes, none of the patients was having a disease prevent the MIS-TLIF to be performed. Operative technique: Using the minimally invasive procedure involves a two small incision in the backside. Using a portable X-ray machine, the surgeon locates the diseased vertebral levels. Making the smallest incision possible, the surgeon uses a combination of dilators and tubular re-tractors to access the vertebra and remove the degenerative disc. An implant with bone graft in place in of the degenerative disc, this procedure relieves pressure on the nerve roots. Minimally invasive transforaminal lumbar interbody fusion depends on the use of micro-tools and graduated dilators to approaches the spine, and then cut through the muscle tissue to gateway the influenced vertebras. With MIS technique, the incision is made to side the spine with minimal incision size about 4-5cm. Graduated dilators are used to aside the vertebral muscle in the stand of cutting them. MIS- TLIF needs a part of the vertebral bone to be removed. This is the lamina of the vertebra-and a part of the phacet joint. Through this opening can do the discectomy so the fusion can take place. Minimally invasive TLIF usually depend on using the pedicle screws and rods to fix the vertebral bodies. A cage is placed in the inter-body space and packed with bone graft to help stimulate bone growth. It restores the height of the spine and stabilizes the vertebrae as they fuse together. In a successful fusion, the bone grows around and through the cage over time, making it the only place in the body where a material is implanted and active in the reparative process which elevates the disc height after the MIS-TLIF procedure. In other words, the cage and the material it is made out of play an active role in the growth of the bone that forms the fusion. Bone graft material come in many kinds often, the patient’s bone is taken from the hip bone, and sometimes the surgeon will use the allograft to reduce the recovery time for the patient. Bone morphogenetic protein can also be used. Radiological assessment: Radiographic examinations were performed pre and postoperative, Radiographic data were collected and evaluated by the same observer. In all patients, X-Ray performed in our radiology department in order to calculate the inter vertebral height index (DHI) preoperative and postoperative using digital tools. The inter vertebral disc height is expressed as an average of the sum of the measurements at the anterior and posterior regions of the disc (anterior line posterior line/2). This X-Ray showing the disc height pre and post MIS-TLIF : Secondary spinal stenosis due to lumbar disc herniation L5-S1 Disc height pre=(5.6 11.1)/2=8.35mm Disc height post=(7.4 22.2)/2=14.8mm MIS-TLIF operation of 2 segments (L3-L4, L4-L5( Disc height is calculated by using digital tool (Anterior line posterior line)/2 Statistical analysis: For comparing the differences between the preoperative and postoperative disc height we use the T-test. Statistical significance was set at a P value < 0.001. The statistical analysis was performed using SPSS software. RESULTS: All the cases showed improvement on the disc height after MIS-TLIF. Though the average of the posterior line pre-post (6.76mm – 10.61mm), and the anterior disc line average was pre-post (12.9mm – 18.16mm), and the mean of disc height pre- MIS-TLIF was 9.83mm compared with the disc height post MIS-TLIF with average 14.38 the patient’s complaints improved after MIS-TLIF with no complication .the postoperative X-ray showed no subsidence or collapse of the cage or bars, and none of the pedicle screws show a sign of loosening position‏. PLA: posterior line after the operation. PLB: posterior line before the operation. ALA: anterior line after the operation. ALB: anterior line before the operation. DHB: disc height before the operation. DHA: disc height after the operation. DHA DHB ALA ALB PLA PLB 10 8.95 14.3 12.4 5.7 5.5 11.75 5 16.8 5.6 6.7 4.4 14.1 8.45 16.7 12.8 11.5 4.1 14.8 8.35 22.2 11.1 7.4 5.6 13.25 10.7 14.9 9.3 11.6 12.1 12.5 9.1 15 10.3 10 7.9 15.75 11.45 23.5 13.5 8 9.4 15.75 11.35 18.9 14.5 12.6 8.2 14.4 8.7 17.7 10 11.1 7.4 12.15 10.7 15.1 12.5 9.2 8.9 8.5 4.45 10.4 5.5 6.6 3.4 11.4 2.75 13.2 3.2 9.6 2.3 13.9 6.3 14.6 10.2 13.2 2.4 11.6 10.65 12.6 15.8 10.6 5.5 14.75 11.7 19.6 16.7 9.9 6.7 17.6 13.2 23.5 19.9 11.7 6.5 14.95 10.85 16.6 10 13.3 11.7 13.7 9.4 18.4 15.1 9 3.7 13.3 12.1 17.4 16.6 9.2 7.6 12.8 9.45 15.8 11.7 9.8 7.2 10.55 7.7 13.2 11.1 7.9 4.3 17.4 11.65 19.5 15.6 15.3 7.7 11.6 10.2 13.1 11.4 10.1 9 18.95 11.55 27.2 17.4 10.7 5.7 15.2 9.75 17.6 12.4 12.8 7.1 16.85 9.15 23.2 14.8 10.5 3.5 12.95 4.6 18.9 5.4 7 3.8 12.65 9.7 13 7.9 12.3 11.5 11.85 7.2 14.6 8.7 9.1 5.7 13.35 9.25 17.6 11.4 9.1 7.1 12.15 10.85 15.8 14.7 8.5 7 14.05 12.35 19.3 18.5 8.8 6.2 14.95 9.7 15.5 13.4 14.4 6 12.5 7.3 16.5 10.4 8.5 4.2 14.4 10.4 18 14.9 10.8 5.9 17 11.75 19.3 13.7 14.7 9.8 12.35 7.7 15.9 12.3 8.8 3.1 16.6 11.25 20.6 13 12.6 9.5 14.75 9.1 19.1 11.3 10.4 6.9 17.6 11.15 19.9 11.1 15.3 11.2 10.3 6.5 13.8 10 6.8 3 16.25 12.1 18.8 18.1 13.7 6.1 18.95 5.9 25.7 7.2 12.2 4.6 19.5 14.5 25.1 20.2 13.9 8.8 16.5 11.4 22.2 17.1 10.8 5.7 14.5 13.4 17.3 18.4 11.7 8.4 19.55 13.35 23.4 16.4 15.7 10.3 18.2 12.65 21.1 17.1 15.3 8.2 17.45 12.65 24.1 15 10.8 10.3 11.8 10.55 15 14 8.6 7.1 12.2 9.55 15.4 14.8 9 4.3 16.6 10.25 21.3 15 11.9 5.5 15.3 9.05 20.2 12.3 10.4 5.8 13.35 7.5 19.1 10.3 7.6 4.7 14.5 11.55 18.6 12.7 10.4 10.4 Discussion: Inter vertebral discs undergo age-related degenerative changes that contribute to some of the most common causes of impairment and disability for middle aged and older people: spine stiffness, neck pain, and back pain. Potential causes of the age-related degeneration of inter vertebral discs. Most of the reason for disc loses is the disc aging. Disc aging lead to overall loss of water content and conversion to fibrocartilage especially there is a decrease in the water content, nutritional support, proteoglycans and PH. Many ligaments and muscle attack to the back of the spine to provide power movement which will help the disc tissue to stand longer any disorder will affect the anatomical structure will lead to more pressure on the disc tissue and end with disc degeneration. Degenerative disc disease can occur in any place in the spinal cord, but mainly its happen in the low back and it’s a condition more than disease cause the disc will lose their flexibility of courser age related to disc tissue include the disc dry and shrink small tears occur in the annulus, bone spurs appear and the disc became thinner in addition to spinal cord stenosis. Degenerative disc disease develops as a result of the effects of aging on your spine and specifically on your inter vertebral discs. It can also be associated with an injury to the back, but even in that scenario, your discs have usually become weak because, with age, discs lose water content, may become thinner; both of which can alter the strength and shape of one or more discs. Before you can feel the result of Degenerative disc disease, pain and other symptoms your discs and other spine structures are changing. This is simply the natural result of the stress and strain each of us puts our backs through every day. In this prospective study used forty patients pre and post MIS-TLIF and after calculating the disc height it’s clear that MIS-TLIF is a success procedure to treat the patients complain of low back pain and the disc height showed significant improvable Some of the spine degenerative disorders that require surgical intervention such as degenerated discs. The surgical process providing a solution to remove the problem of lower-back pain only more than fix it. The perfect treatment technique would include returning the physical and mechanical functionality of the disc. However, current research has been able to identify only MIS-TLIF to solve this complaint. MIS-TLIF is also an effective method to treat lumbar spine deformity and avoid complications compare with TLIF, provide pleasant clinical outcomes. This method has some clear advantages over convention surgeries. It is a technique with more advantages than other procedure treats spinal disorders. In the treatment of patients with spinal disorders the cage can be placed between the vertebral bodies which prevent the pressure on the nerve root. After inducing the supplementary instrumentation, it can result in convenient postoperative stability. For surgical procedures in lumbar spine disorders, MIS-TLIF has the advantages over other surgeries with minimum blood loss and short time surgical procedure and early discharge from the hospital. MIS-TLIF is important surgery in reconstructing spinal stenosis to attain a considerable surgical outcome. The MIS-TLIF can achieve significant post-operation results; most of the authors support the use of MIS-TLIF in the treatment of the lumbar spinal disorders results in significant improvement of disc height. Advantages of the minimally invasive TLIF procedure over traditional spine surgery include short time hospital stay, smaller incision and less damage to the tissue. Most patients can return home directly after the operation with some exceptions which need more time for examination, many patients will show improvement on their symptoms directly after the operation. Patients will need to start the exercise and TLIF is a beneficial procedure that can provide an improvement in spinal stability and reduce pain. Disc degenerative diseases are one of the main problems which can be treated by MIS-TLIF and the disc height will show improvement, and the symptoms will decrease. In this prospective study we hypothesized not to find any subsidence or collapse, and any worse outcome, any complication during the operation, the patients who performed the MIS-TLIF have shown improvements after the operation and the symptoms disappear and they get back to their normal life after a short hospital stay. The drawback of MIS are prolonged learning period, it demands a specialist with considerable experience, the medical instruments which are used in the operation is very expensive not every hospital can have it, short the time compare with the open procedure and increase the risk of surgery failure from this all points we can find the MIS-TLIF is more convenient for the patients and that’s what we are looking for improving it. There is a criteria before the operation room. If the patients will not improve with the conservative treatments, there was no improvement of the patient’s symptoms and need surgical intervention, the surgical procedures for all the patients were transforaminal lumbar inter body fusion. Conclusion: The MIS-TLIF procedure evaluate the disc gap sported with cage and bone graft can restore the disc height to keep the normal lumber function .MIS-TLIF operation is highly safe procedure in treating the disc degenerative d conditions, and improve the patients symptoms with less blood loss during the operation, less pain, short healing time, and the patient can get back to his normal life after short period, MIS-TLIF is a successful procedure for primary cases as well as for revision cases with expressive increase in disc height and reduce in patients complaints. Abbreviations: MIS: minimal invasive Surgery, Tlif: transforaminal interbody fusion DHI: intervertebral height index. References: 1-Does minimally invasive fusion technique influence surgical outcomes in isthmic spondylolisthesis? Ryu DS, Ahn SS, Kim KH, Park JY, Kuh SU, Chin DK, Kim KS, Cho YE. Minim Invasive Ther Allied Technol. 2018 Sep 28:1-8. doi: 10.1080/13645706.2018.1457542. [Epub ahead of print]PMID: 30265165. 2-Variation of facet joint orientation and tropism in lumbar degenerative spondylolisthesis and disc herniation at L4-L5: A systematic review and meta-analysis. Liu Z, Duan Y, Rong X, Wang B, Chen H, Liu H. Clin Neurol Neurosurg. 2017 Oct;161:41-47. doi: 10.1016/j.clineuro.2017.08.005. Epub 2017 Aug 18. Review. 3-Minimally,invasive,transforaminal lumber interbody,fusion and degenerative lumbar spine disease. Tsahtsarlis A, Wood M. Eur Spine J. 2012 Nov;21(11):2300-5. doi: 10.1007/s00586-012-2376-y. Epub 2012 Jun 13.PMID:22692557 4-Evaluation of the discal height gain and lumbar lordosis variation obtained by the techniques of transforaminal and posterior lumbar intersomatic fusion. Martinelli TC, Effgen EA, Brazolino MAN, Cardoso IM, Maia TC, Jacob Junior C. Rev Bras Ortop. 2018 Feb 23;53(5):527-531. doi: 10.1016/j.rboe.2018.02.005. eCollection 2018 Sep-Oct.PMID: 30245989 5-Microendoscopic Decompression for Lumbar Spinal Stenosis With Degenerative Spondylolisthesis: The Influence of Spondylolisthesis Stage (Disc Height and Static and Dynamic Translation) on Clinical Outcomes. Minamide A, Simpson AK, Okada M, Enyo Y, Nakagawa Y, Iwasaki H, Tsutsui S, Takami M, Nagata K, Hashizume H, Yukawa Y, Yamada H, Yoshida M. Clin Spine Surg. 2018 Sep 15. doi: [Epub ahead of print]PMID: 30222618 6-Intervertebral disc degeneration induced by long-segment in-situ immobilization: a macro, micro, and nanoscale analysis. Che YJ, Li HT, Liang T, Chen X, Guo JB, Jiang HY, Luo ZP, Yang HL. BMC Musculoskelet Disord. 2018 Aug 28;19(1):308. doi: 10.1186/s12891-018-2235-z. PMID:3015382 7-Adequate Restoration of Disc Height and Segmental Lordosis by Lumbar Interbody Fusion Decreases Adjacent Segment Degeneration. Tian H, Wu A, Guo M, Zhang K, Chen C, Li X, Cheng X, Zhou T, Murray SS, Sun X, Zhao J.World Neurosurg. 2018 Oct;118:e856-e864. doi: 10.1016/j.wneu.2018.07.075. Epub 2018 Jul 18.PMID:30031179 8- Minimally invasive transforaminalinterbody fusion versus open transforamianl lumber interbodyfusion.kulkarni,AG (kulkarni , Arvind G),Bohra, H (Bohra , Hussain) ;Dhruv , A (Dhruv , Abhilash) ; sarraf, Abhishek) ; Bassi , A(Bassi, Anupreel); Patil,VM (Patil, Vishwanath M).50:5:464-472,10.4103/0019-5413.189607.SEP.OCT 2016. 9- Wang J, zhou Y, zhong ZF , Li CQ, zheng WJ, liu J , comparison of one level minimally invasive and open transforaminal lumber interbody fusion in degenerative and isthmic sponylolythesis grades 1 and 2 .Eur Spine J .2010:19(10):178-0-4. 10- Selznick LA,shamji MF, Isaacs RE . minimally invasive interbody fusion for revision lumber surgery: technical feasibility and safety .J spinal disord Tech. 2009: 22(3):207- 11- Selznick LA,shamji MF, Isaacs RE . minimally invasive interbody fusion for revision lumber surgery: technical feasibility and safety .J spinal disord Tech. 2009: 22(3):207- 12- Kim JS, lee KY, Lee SH .which lumber interbody fusion with reduction of spondylolithesis :technique and outcome after minimum of 2 years follow up.Neurosurg focus .2008:25(2),E16. 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Write a Case Study – Term Paper (APA 10 pages) for Toys “R” Us which covers the company’s (No Plagiarism – Turn It In) History and Toy industry (Overview), Analysis (SWOT, PESTEL, Five Forces, Key Factors for Success or Failures, and Use of Operations and Supply Chain Management) Format (Example): Title Page, ABSTRACT, Executive Summary, Introduction, Literature Review, Methodology, Study, Conclusions and Recommendations, and References (TEXT and Five (5) others minimum), Appendix (If necessary) TEXT – Collier: Operations and Supply Chain Management, 2nd Edition Areas of Coverage per Text: Operations Strategy and Measurement or Performance in Operations and Value Chains Goods, Service, and Supply Chain Design Process Selection, Design, and Improvement Facility and Work Design Forecasting, Demand Planning, and Capacity Management Process Analysis And Resource Utilization Managing Inventories in Supply Chains Supply Chain Management and Logistics Cont. Resource Management Operations Scheduling and Sequencing Quality Management, including Quality Control and SPC Lean Operating Systems and Project Management
BADM 475 Colorado Technical University Unit 5 Small Business Environment Paper.

I’m working on a management case study and need support to help me study.

BADM475 Small Business Management & Entrepreneurship – UNIT5: The Small Business Environment Key Assignment Final DraftPart 1 Tasks (Deliverable length: approximately 1,000 words)Finalize your business plan, and include the following to your current Business Plan Business description Marketing plan Management plan – (employees, organizational chart, tax flow projections, etc.)Financial plan Appendices Part 2 Tasks (deliverable length 300 words) Create a memo introducing yourself and your business plan to a prospective resource. Be sure to use the following steps:Introduce yourself and your venture. Explain your purpose in sending the business plan. Detail the next steps and the potential for your business. Give the intended audience reasons for taking interest in your venture.***Write this memo as if you were presenting your business plan to investors seeking money (fund) and your memo should explain how the investors can benefit from your business. You must convince your investors with this memo.***APA Style + references and citations (minimum of 3 references) + will provide the business plan.
BADM 475 Colorado Technical University Unit 5 Small Business Environment Paper

Need engineering help with the Optimization of Traffic Signal Settings Mixed-Integer Linear Programming

Need engineering help with the Optimization of Traffic Signal Settings Mixed-Integer Linear Programming.

In this project, you are to solve the example problem (as shown in Fig. 9 and Table 1) presented in Optimization of Traffic Signal Settings Mixed-Integer Linear Programming by Garnter, N.H., Little, J.D.C., and Gabbay, H. using the procedure and methodology discussed in the same paper 1- Prepare the model input data. Notice that the background cycle length of the example network is set as 80 seconds. Therefore this task mainly includes the green splits of each signal. As there is no sufficient information on this in the paper, you can assume 1) all signals are two phases (i.e. all left turns are permissive); and 2) green splits are proportional to the critical lane volume (i.e. the so-called Webster equation), you can assume the lost time per phase is 4.5 seconds. You can also design more sophisticated phases by making appropriate assumptions on the left or right turn volumes.
Need engineering help with the Optimization of Traffic Signal Settings Mixed-Integer Linear Programming

Think about the role of women in society and how our roles have changed over the years. Discuss the ways in which story- telling has reflected the changing roles of women over time.

essay writer free Think about the role of women in society and how our roles have changed over the years. Discuss the ways in which story- telling has reflected the changing roles of women over time.. Need help with my English question – I’m studying for my class.

Literary Analysis Essay
You will construct a Literary Analysis essay that assesses the skills of:
· Ability to synthesize history and literature in a thoughtful way
·Ability to discuss various genres and specific pieces we have studied in a formal essay
·Development of a thesis statement
·Text support, commentary and analysis that is unique and insightful
·Essay organization
·Grammar and mechanics for a formal essay
·Proper MLA format
·Proper embedded citations for the works we have read in class (No Works Cited page is required)
-must have a minimum of 2 quotes in each body paragraph
I have attached slides/readings that we have read and that you can refer to for context and details!!!!
We have discussed the Anglo Saxon Period: (these are the books we’ve read)
The Seafarer by Ezra Pound
The Wife’s Lament by anonymous author (translated by Ann Stanford)
Beowulf by anonymous author (translated by Burton Raffel)
We have discussed the Middle Ages:(these are the books we’ve read):
The Canterbury Tales by Geoffrey Chaucer
We have discussed the Renaissance period: (these are the books we’ve read):
Macbeth by Shakespeare
Page count does not matter! Just make sure it is 5 paragraphs-1 intro, 3 body, conclusion!!!
Think about the role of women in society and how our roles have changed over the years. Discuss the ways in which story- telling has reflected the changing roles of women over time.

BUS 3310 Amberton University Communicating Analysis Results Questions

BUS 3310 Amberton University Communicating Analysis Results Questions.

I’m working on a business question and need an explanation to help me learn.

Assignment:Oneof the most difficult challenge for modern business analysts is to effectively communicate the results of their analysis to key decision makers who need to understand the insights generated from that analysis to make high quality, relevant decisions.Questions for Discussion:
1. Review news stories from the last few weeks. Try to identify at
least two examples where analytical information was presented to
decision makers effectively or poorly. You may find examples in
business news, social news, political news, sports news, etc. Describe
how the communication either positively or negatively affected the
decision outcome.2.
Select a company or organization that you are familiar with and
identify & describe how they might have failed to accurately
communicate analytical information in making business decision(s).
(… or vice versa, might have successfully communicated analytical information in making business decision(s).
Examples might have been Blockbuster, Tesla, Starbucks, Apple, Coca
Cola, Uber, Yellow Pages, Southwest Airlines, Macys, Neiman Marcus, etc.Guidelines for Your Discussion Forum Response:undefined on the two questions above, post a new discussion topic (using the “Add new discussion topic” button) consisting of a 150 word (minimum) discussion.
BUS 3310 Amberton University Communicating Analysis Results Questions

Functional Groups of Lisinopril

Functional Groups of Lisinopril. The IR spectra of pure showed peaks at which are consistent with the presence of the functional groups of lisinopril (Fig.no.12) Furthermore, the calibration curve of lisinopril obeyed Beer’s law in the range of 10-60 g/ml (Fig.no.11) An IR spectrum of the drug-polymer (methylcellulose) mixture was taken to study and check the drug- polymer interaction. The spectrum revealed that not much interaction between the drug and polymer (Fig.no.13). In TLC studies, the prepared lisinopril microspheres (M4, M7) showed (Table.no.9) the same Rf (0.5512, 0.5769) value as pure compound (0.5897) and no additional spots were detected. TLC studies (Fig.no15) thus indicated no interaction between lisinopril and polymer (methylcellulose) in the floating microspheres prepared. This observation also indicated that lisinopril was not decomposing during the preparation of floating microspheres. Differential Scanning Colorimetry: The thermal behavior of floating microspheres of lisinopril was studying using DSC are shown in (Fig no.16). The DSC thermogram of pure drug lisinopril exhibited an exothermic peak at corresponding to its melting point. For formulation (M7) this peaks are at respectively. The characteristic exothermic peak is slightly shifted to lower temperature, indicating that there is no interaction between drug and carrier. Percentage yield: Percentage yield of different batches of the prepared floating microspheres were determined by weighing the floating microspheres after drying. All batches of methylcellulose floating microspheres showed a percentage yield of greater than 75%, the percentage yields of all the prepared formulations (M1-M9) were in the range of 76.8 to 92.16% (Table.no.11). Percentage yield is found to be higher with formulation M7 (92.16%). Scanning Electron Microscopy: The surface morphology of the prepared floating microsphere (M7) was shown to be spherical by the SEM photography (Fig.no.19). Particle size analysis: The particle size analysis was carried out using an optical microscope. The arithmetic mean particle size of the methylcellulose floating microspheres significantly increased with increasing polymer concentration were shown in (Table.no.18).The particle size distribution of the methylcellulose floating microspheres ranged between 163.125 to 252.375µm. Micromeritic properties of the floating microspheres 61 The various micromeritic properties of the prepared floating microspheres were studied. Acceptable range of angle of repose is between 20ο-40ο and angle of repose for methylcellulose floating microspheres (M1-M9) was between 24.44 to 35.53ο (Table no. ), thus indicating good flow property for methylcellulose floating microspheres. Acceptable range of Hausner’s ratio is up to 1.25 and Hausner’s ratio for methylcellulose floating microspheres(M1-M9) was between 1.085 to 1.181(Table.no.21) ,all the prepared floating microspheres had a value less than 1.25 thereby exhibiting good flow properties. Acceptable range of Carr,s index (%)is up to 5-21%, and carr’s index for methylcellulose floating microspheres(M1-M9) was between 7.910 to 15.379 % (Table.no.21) all the formulations showed an Carr,s index (%) less than 16% and hence had a flow properties. Percentage drug content of the floating microspheres The percentage drug content of different batches of floating microspheres was found in the range of 55.33 to 88%.All batches of the methylcellulose floating microspheres formulation shown percentage drug content more than 55% (Table no.23) and it is found that percentage drug content increases with an increase in the polymer concentration (except M2,M6). Formulation M5 has shown maximum percentage drug content (88.0%). Buoyancy percentage: (Floating ability) The buoyancy test was carried out to investigate the buoyancy percentage (floating ability) of the prepared methylcellulose floating microspheres. The buoyancy percentage of the different batches of floating microspheres was found in the range of 48.0 to 85.0% at the end of 12 hrs (Table.no.25). All the formulated floating microspheres of lisinopril showed buoyancy (floating ability) more than 48%. Amongst the batches of prepared methylcellulose floating microspheres, batch M5 showed highest buoyancy (85%). Floating ability of different formulations was found to be differed according to the increase polymer concentration and it is found that percentage of buoyancy increases with an increase in the amount of polymer. In-vitro release studies Lisinopril release from the all formulated floating microspheres were studied in SGF (0.1N HCl) for 12 hrs.The floating microspheres showed sustained release of the lisinopril (drug) in acidic environment and the drug release was found to be approximately linear (fig no. ). The drug release from methylcellulose floating microspheres was found to be 82.35, 78.75, 74.25, 71.55, 66.15, 83.70, 90.45, 94.5 and 97.65% at the end of 12 h for M1,M2,M3,M4,M5,M6,M7,M8 and M9 respectively (Table.no.27). The sustained release pattern was observed for the prepared floating microspheres (M1-M9) clearly exhibiting an increase in the polymer concentration results decrease in-vitro drug release of lisinopril. Amongst the batches of prepared methylcellulose floating microspheres, batch M5 showed higher drug entrapment efficiency 88.0% and the minimal in-vitro drug release 66.15% at the end of the 12 hrs with compared to the other prepared methylcellulose floating microspheres. Drug release kinetics The results for the mathematic modeling of the in-vitro drug release data for the methylcellulose floating microspheres have been complied and the R2 values shown in the table no. The in-vitro drug release profile for the formulations M1-M9 were subjected to various drug release kinetic studies and are depicted in the following figures. (Fig.no.30-38) The release profile for the formulations M1-M9 exhibiting a maximum R2 values (0.9613, 0.9421, 0.9386, 0.9446, 0.9382, 0.9546, 0.9520, 0.9599 and 0.9660) was found to obey that particular kinetics. From the results it is apparent that the regression coefficient value closer to unity as in the case of the Zero orders plots. The Zero order plots of different formulation were found to be fairly linear, as indicated by their high regression values. Thus, it seems that drug release from the floating microspheres followed Zero order kinetics. The data indicates a lesser amount of linearity when plotted by the First order equation. Hence it can be concluded that the major mechanism of drug release follows Zero order kinetics. Further, the conversion of the data from the dissolution studies suggested possibility of understanding the mechanism of drug release by configuring the data into various mathematical modeling such as Higuchi’s and Korsemeyer’s -peppas plots. The mass transfer with respect to square root of time has been plotted, revealed a linear graph with regression value close to one stating that the release from the matrix was through diffusion. Data based on the Higuchi model usually provide a evidence to the diffusion mechanism of drug release from matrix systems such as the methylcellulose floating microspheres developed in this work. R2 values based on the Higuchi’s model ranged from 0.8882, 0.8578, 0.8507, 0.8603, 0.8542, 0.8773, 0.8708, 0.8858 and 0.8978. (Table.no.29). As these values were close to 1.0, the drug release mechanism of the developed floating microspheres can be said to be Higuchian and, therefore, matrix diffusion-controlled. CHITOSAN FLOATING MICROSPHERES IR Spectra of chitosan floating microspheres An IR spectrum of the drug-polymer (chitosan) mixture was taken to study and check the drug- polymer interaction. The spectrum revealed that not much interaction between the drug and polymer (Fig.no.14). Thin Layer Chromatography: In TLC studies, the prepared lisinopril microspheres (C4, C7) showed the same Rf (0.5384, 0.5000) value as pure compound (0.5897) and no additional spots were detected(Fig.no.15). TLC studies thus indicated no interaction between lisinopril and polymer (chitosan) in the floating microspheres prepared. This observation also indicated that lisinopril was not decomposing during the preparation of floating microspheres. Differential Scanning Colorimetry: The thermal behavior of floating microspheres of lisinopril was studying using DSC are shown in Fig.no.17. The DSC thermogram of pure drug lisinopril exhibited an exothermic peak at corresponding to its melting point. For formulation (C7) this peaks are at respectively. The characteristic exothermic peak is slightly shifted to lower temperature, indicating that there is no interaction between drug and carrier. Percentage yield: Percentage yield of different batches of the prepared floating microspheres were determined by weighing the floating microspheres after drying. All batches of methylcellulose floating microspheres showed a percentage yield of greater than 75%, The percentage yields of all the prepared formulations (C1-C9) were in the range of 78.0 -93.66% (Table.no.12). Percentage yield is found to be higher with formulation C7 (93.66%). Scanning Electron Microscopy: The surface morphology of the prepared floating microsphere (C7) was shown to be spherical by the SEM photography (Fig.no.20). Particle size analysis: The particle size analysis was carried out using an optical microscope. The arithmetic mean particle size of floating microspheres significantly increased with increasing polymer concentration were shown in Table. No. 19. The particle size distribution of the chitosan floating microspheres ranged between 32.50 to 55.80µm. Micromeritic properties of the floating microspheres 61 The various micromeritic properties of the prepared floating microspheres were studied. Acceptable range of angle of repose is between 20ο-40ο and angle of repose for chitosan floating microspheres (C1-C9) was between 19.02 to 23.49ο (Table.no.22), thus indicating good flow property for chitosan floating microspheres. Acceptable range of Hausner’s ratio is up to 1.25 and Hausner’s ratio for chitosan floating microspheres(C1-C9) was between 1.100 to 1.230 (Table.no.22) ,all the prepared floating microspheres had a value less than 1.25 thereby exhibiting good flow properties. Acceptable range of Carr,s index (%)is up to 5-21%, and carr’s index for chitosan floating microspheres(C1-C9) was between 9.090 to 18.746% (Table.no.22) all the formulations showed an Carr,s index (%) less than 18% and hence had a flow properties. Percentage drug content of the floating microspheres The percentage drug content of different batches of floating microspheres was found in the range of 50.66 to 88.0%.All batches of the chitosan floating microspheres formulation shown percentage drug content more than 50% (Table.no.24) and it is found that percentage drug content increases with an increase in the polymer concentration. Formulation C5 shown maximum percentage drug content (88.0%). Buoyancy percentage: (Floating ability) The buoyancy test was carried out to investigate the buoyancy percentage (floating ability) of the prepared chitosan floating microspheres. The buoyancy percentage of the different batches of floating microspheres was found in the range of 46.0 to 82.0% at the end of 12 hrs (Table.no.26). All the formulated floating microspheres of lisinopril showed buoyancy (floating ability) more than 46%. Amongst the batches of prepared chitosan floating microspheres, batch C5 showed highest buoyancy (85%). Floating ability of different formulations was found to be differed according to the increase polymer concentration and it is found that percentage of buoyancy increases with an increase in the amount of polymer. In-vitro release studies Lisinopril releases from the all formulated floating microspheres were studied in SGF (0.1N HCl) for 12 hrs.The floating microspheres showed sustained release of the lisinopril (drug) in acidic environment and the drug release was found to be approximately linear (Fig.no.29). The drug release from chitosan floating microspheres was found to be 66.6, 61.65, 58.95, 57.15, 52.2, 69.3, 71.55, 74.7 and 78.75% at the end of 12 h for C1,C2,C3,C4,C5,C6,C7,C8 and C9 respectively (Table.no.28). The sustained release pattern was observed for the prepared floating microspheres (C1-C9) clearly exhibiting an increase in the polymer concentration results decrease in-vitro drug release of lisinopril. Amongst the batches of prepared chitosan floating microspheres, batch C5 showed higher drug entrapment efficiency 88.0% and the minimal in-vitro drug release 52.2% at the end of the 12 hrs with compared to the other prepared chitosan floating microspheres. Drug release kinetics The results for the mathematic modeling of the in-vitro drug release data for the methylcellulose floating microspheres have been complied and the R2 values shown in the table no. The in-vitro drug release profile for the formulations C1-C9 were subjected to various drug release kinetic studies and are depicted in the following figures. (Fig.no.39-47) The release profile for the formulations C1-C9 exhibiting a maximum R2 values (0.9834, 0.9646, 0.9556, 0.9244, 0.9305, 0.9656, 0.9655, 0.9646, and 0.9759) were found to obey that particular kinetics. From the results it is apparent that the regression coefficient value closer to unity as in the case of the Zero orders plots. The Zero order plots of different formulation were found to be fairly linear, as indicated by their high regression values .Thus, it seems that drug release from the floating microspheres followed Zero order kinetics. The data indicates a lesser amount of linearity when plotted by the First order equation. Hence it can be concluded that the major mechanism of drug release follows Zero order kinetics. Further, the conversion of the data from the dissolution studies suggested possibility of understanding the mechanism of drug release by configuring the data into various mathematical modeling such as Higuchi’s and Korsemeyer’s -peppas plots. The mass transfer with respect to square root of time has been plotted, revealed a linear graph with regression value close to one stating that the release from the matrix was through diffusion. Data based on the Higuchi model usually provide a evidence to the diffusion mechanism of drug release from matrix systems such as the chitosan floating microspheres developed in this work. R2 values based on the Higuchi’s model ranged from 0.9238, 0.8905, 0.8751, 0.8295, 0.8392, 0.8955, 0.8993, 0.8986 and 0.9236. (Table.no.30). As these values were close to 1.0, the drug release mechanism of the developed floating microspheres can be said to be Higuchian and, therefore, matrix diffusion-controlled. Functional Groups of Lisinopril

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