Drug eluting bioactive glass ceramics for fusion in spondylodiscitis: a pilot study

Retrospective observational study. To determine the efficacy and safety of bioactive glass ceramics mixed with autograft in the treatment of spondylodiscitis. Thirty-four patients with spondylodiscitis underwent surgery using autologous bone graft augmented by antibiotic loaded bioactive glass ceramic granules. Twenty-five patients aging 6 to 77, completed 1-year follow-up. The lumbosacral junction was affected in 3, lumbar spine in 13, one each in the dorso-lumbar junction and sacrum, and 7 dorsal spines. The organism isolated was Mycobacterium tuberculosis in 15, Methicillin sensitive Staphylococcus aureus (MSSA) in 4, Pseudomonas aeruginosa in 4, Klebsiella pneumoniae in one, Burkholderia pseudomallei in 1, and mixed infections in 2. All patients had appropriate antibiotic therapy based on culture and sensitivity. Clinical and radiological evaluation of all the patients was done at 6 weeks, 3 months, 6 months, and 12 months after the surgery. Twenty-three patients improved clinically and showed radiographic fusion between 6 and 9 months. The patient with Burkholderia infection died due to fulminant septicemia with multi organ failure while another patient died at 9 months due to an unrelated cardiac event. The mean Visual Analogue Score (VAS) at the end of 1-year was 2 with radiological evidence of fusion in all patients. There were no re-infections or discharging wounds, and the 30-day re-admission rate was 0. Bioactive glass ceramics is a safe and effective graft expander in cases of spondylodiscitis. The absorption of antibiotics into the ceramic appears to help the elimination of infection.

Case Reports and their impact on Journal Metrics, Researcher's Indices, and other sundry issues

Case reports (CR) are essential for documentation, particularly for managing rare diseases, presenting a new/emerging disease, reporting adverse reactions to a medication, or sometimes sharing novelty among medical professionals [1]. However, they are a matter of impugn between the journal editors on one side and the researcher and the clinician on the other. The advent of impact factor (IF) as a tool to determine the academic status of journals and the evolution of the evidence-based pyramid has pushed many journals into the muddy rat race of claiming supremacy over other journals. CR is less cited and, therefore, reduces the total IF of the journal [2]. Additionally, the perception that CR and case series form the lowest rung of the evidence pyramid has progressively led to most journals shying away from CR. The result is the burgeoning numbers of armchair researchers replacing hard-worked original clinical and basic science studies with meta-analysis and systematic reviews, often concluding in ambiguous statements like “more studies are required to…”. Some journals have an ornamental CR section allowing 1-2 CRs, while many have already done away with this section. Some even have mentioned in the author’s guidelines that CR is no longer accepted in their journal. This might appear paradoxical in an era where most journals are published online, often solely so, and the number of submissions is (at least theoretically) unlimited. But do CRs negatively influence the IF of a journal? Interestingly, Erivan et al. did a bibliometric study of the effect of the CR on the IF of journals. The authors found that mean IF would have improved from 2.013 to 2.072 (p-value- 0.00001 and therefore statistically significant) without CR. Academicians have long debated “questionable editorial policies that affect the IF of journals,” like manipulating the denominator, coercive citations, etc. The real question is – Are the journals truly meant to compete for IF in the name of publishing high-quality original research only? Clearly, the core purpose of disseminating scientific/medical knowledge amongst peers may be lost in this battle, and the journals would be restricted to a handful of select contributors and readers (the elite club). A researcher has to be perceived as an ever-evolving entity. In their formative years, most clinical students start reading CR as they search for similar cases for diagnosis, investigations, and management, all of which are given in precise detail. CR is also an initial article for many of them as they enter the publishing world. Unfortunately, several academic institutions and organizations have shunned CR for one reason or another. CR is typically not even counted as a publication for authors. Therefore, many authors move away from CR while only a few hold on to the old passion and keep publishing CR, often at considerable financial expense. Can a CR contribute to a researcher or author? The h-index and I-10 index are the recent critical parameters for measuring the research abilities of authors and journals. Here is an example of the author’s (MJ) Google profile (Fig. 1). The figure clearly illustrates that CRs are high in citation and have contributed substantially to the author’s higher indices. One can argue that CR, having higher citations, was published long ago. The journey of every researcher progresses from CR to the original articles and studies higher up in the evidence pyramid. The IF considers two or five years into the calculation, but CRs are also frequently cited in the long run and are beneficial for journals. A clinician, meanwhile, is a mute spectator in this ongoing transformation. The publishing world conundrum is snatching away his opportunity for scientific knowledge in the form of CR. CR is a valuable learning resource to enhance his clinical knowledge and analytical skills that ultimately affect patient care [3]. A medical undergraduate or post-graduate student who is a new entrant to the “world of research” would first dive into the CR section as they are most easily relatable to their daily life. Even there is a paradigm shift in medical education from traditional teaching to case-based and problem-solving scenarios. CR is a complete package to give intricate details to any situation. For example, if a CR discusses the differential diagnosis of a disease. It will include the commoner to the rarest possibility. Originally meant to disseminate knowledge among medical professionals, journals have de facto become a staggeringly profitable business model rivalling the film and music industries. This trend, in turn, unfortunately, reflects the global career imperatives to publish or perish. The need for objective criteria to monitor the quality of such outputs is, therefore, increasingly necessary to stratify the players in the market. But in the bargain, are they losing the wide readership once enjoyed to select “intellectuals”? Many journals have issued a death sentence to CR, but few journals (JOCR is one of them) have given a fresh lease of life by exclusively publishing CRs. JOCR articles are archived in PubMed, and being an open access journal, they give easy opportunity for reading and citations.

Identification of allele-specific KIV-2 repeats and impact on Lp(a) measurements for cardiovascular disease risk

The abundance of Lp(a) protein holds significant implications for the risk of cardiovascular disease (CVD), which is directly impacted by the copy number (CN) of KIV-2, a 5.5 kbp sub-region. KIV-2 is highly polymorphic in the population and accurate analysis is challenging. In this study, we present the DRAGEN KIV-2 CN caller, which utilizes short reads. Data across 166 WGS show that the caller has high accuracy, compared to optical mapping and can further phase ~50% of the samples. We compared KIV-2 CN numbers to 24 previously postulated KIV-2 relevant SNVs, revealing that many are ineffective predictors of KIV-2 copy number. Population studies, including USA-based cohorts, showed distinct KIV-2 CN, distributions for European-, African-, and Hispanic-American populations and further underscored the limitations of SNV predictors. We demonstrate that the CN estimates correlate significantly with the available Lp(a) protein levels and that phasing is highly important.

The prevalence of Schmorl's nodes in osteoporotic vs normal patients: a Middle Eastern population study

The study was conducted to establish the association of Schmorl's nodes and osteoporosis in a Middle Eastern cohort. The prevalence of SN in this sample was 41.1%. It was most frequent in the lumbar spine typically solitary central lesions. Over 88% Schmorl's node cases were osteoporotic/osteopenic and only 11.6% normal.

INTRODUCTION

This study aims to identify the prevalence of Schmorl's nodes (SNs) in a cohort of Omani nationals, and also to determine any relation between osteoporosis and Schmorl's nodes.

METHODS

This retrospective observational study was conducted on Omani nationals. One thousand three hundred and forty-eight DEXA scan patients were included. Of these, 545 patients had complete X-rays and MRI scans that would help determine the SN status. The X-rays and sagittal, coronal, and axial T2-weighted MR images were used to identify the presence and exact location of the Schmorl nodes by one orthopedic trainee and confirmed by the senior author. The correlation of each parameter with the presence of SN was analyzed by the independent-samples T test and one-way ANOVA.

RESULTS

The overall prevalence of SN in this population sample appeared to be 41.1%. Over 88% of the SN-positive cases were either osteopenic or frankly osteoporotic by the WHO definition. Vast majority of SNs (87.1%) occurred in the lumbar spine and were central in location and mostly solitary. Statistical analysis of the data revealed significant correlation between osteopenia or osteoporosis and the presence of SNs.

CONCLUSIONS

The prevalence of SN in the sample of Omanis studied was 41.1% and was most frequently seen in older men in the lumbar spine. It is strongly associated with osteoporosis/osteopenia (88.4%) and frequently presents as solitary central lesions.

Screw-Related Complications After Instrumentation of the Osteoporotic Spine: A Systematic Literature Review With Meta-Analysis

STUDY DESIGN

Systematic literature review with meta-analysis.

OBJECTIVE

Osteoporosis is common in elderly patients, who frequently suffer from spinal fractures or degenerative diseases and often require surgical treatment with spinal instrumentation. Diminished bone quality impairs primary screw purchase, which may lead to loosening and its sequelae, in the worst case, revision surgery. Information about the incidence of spinal instrumentation-related complications in osteoporotic patients is currently limited to individual reports. We conducted a systematic literature review with the aim of quantifying the incidence of screw loosening in osteoporotic spines.

METHODS

Publications on spinal instrumentation of osteoporotic patients reporting screw-related complications were identified in 3 databases. Data on screw loosening and other local complications was collected. Pooled risks of experiencing such complications were estimated with random effects models. Risk of bias in the individual studies was assessed with an adapted McHarm Scale.

RESULTS

From 1831 initial matches, 32 were eligible and 19 reported screw loosening rates. Studies were heterogeneous concerning procedures performed and risk of bias. Screw loosening incidences were variable with a pooled risk of 22.5% (95% CI 10.8%-36.6%, 95% prediction interval [PI] 0%-81.2%) in reports on nonaugmented screws and 2.2% (95% CI 0.0%-7.2%, 95% PI 0%-25.1%) in reports on augmented screws.

CONCLUSIONS

The findings of this meta-analysis suggest that screw loosening incidences may be considerably higher in osteoporotic spines than with normal bone mineral density. Screw augmentation may reduce loosening rates; however, this requires confirmation through clinical studies. Standardized reporting of prespecified complications should be enforced by publishers.

Mechanically Relevant Anatomy of the Axis Vertebra and Its Relation to Hangman's Fracture: An Illustrated Essay

To describe the biomechanically relevant anatomy of the Axis vertebra and the load transfer patterns within the bone, and on that basis, to postulate its mechanism of injury, a literature review was conducted of the anatomy and biomechanics of Axis fractures. Two hypotheses have been presented: the internal gear hypothesis and the leaf spring hypothesis. Both are based on the trabecular anatomy of the vertebra and its load transmission patterns. The relationship of the Axis with Hangman’s injury is also discussed. According to the leaf spring hypothesis, the C2 pedicle corresponds to the shackle in the assembly and constitutes the weak link. The trabecular architecture of the Axis is such that the primary compression of the trabeculae is directed from the superior facet to the C2–3 endplate, with few trabeculae directed to the inferior facet. Along with the trabecular void in this area, this renders the isthmus vulnerable to trauma. The isthmus of the Axis is biomechanically susceptible to injury due to its unique anatomy in relation to the whole cervical spine and the internal load transmission patterns of the bone. The author suggests that in the flexion type of Hangman’s injury, the C1–2 posterior ligaments are disrupted and need to be addressed.

Scoliosis in Dandy-Walker syndrome: a case report and review of literature

This submission presents a case of scoliosis in a patient with established Dandy-Walker anomaly of the brain. A retrospective review of the patient's case notes was undertaken and the limited literature on this subject reviewed. The 13-year-old girl presented with a stiff right thoracic scoliosis typical of adolescent idiopathic scoliosis. The scoliotic segment also presented with significant lordosis. She had facial and truncal dysmorphism characteristic of Dandy-Walker complex and her brain images confirmed the diagnosis. She underwent scoliosis surgery by the posterior approach uneventfully. In conclusion scoliosis is hitherto unreported in the Dandy-Walker complex. The results of intervention appear satisfactory.

Early Versus Late Tracheostomy for Patients with High and Low Cervical Spinal Cord Injuries

OBJECTIVES

This study aimed to evaluate the effects of early versus late tracheostomies among patients with cervical spinal cord injuries (CSCIs).

METHODS

This retrospective study included 69 adult CSCI patients who underwent bedside percutaneous tracheostomies at the Intensive Care Unit of Khoula Hospital, Muscat, Oman, between January 2011 and October 2015. The tracheostomy was considered early if the procedure took place within one week of the CSCI. The impact of an early tracheostomy on patient outcomes was analysed in terms of duration of mechanical ventilation and intensive care unit (ICU) stay among patients with high (C1-C2 vertebrae) and low (C3-C7 vertebrae) CSCIs. Ventilator dependence, bradycardia episodes and surgical intervention outcomes were also examined.

RESULTS

Patients with a high CSCI who underwent an early tracheostomy spent significantly fewer days on mechanical ventilation compared to those who underwent a late tracheostomy (9.3 ± 7.2 days versus 13.7 ± 3.2 days; P = 0.041). Low CSCI patients who received an early tracheostomy also experienced significantly fewer days on mechanical ventilation compared to those undergoing a late tracheostomy (12.1 ± 10.4 days versus 25.2 ± 17.7 days; P = 0.035). Moreover, ICU mortality was significantly lower for high CSCI patients who underwent an early tracheostomy (P = 0.015). However, there was no association between length of ICU stay and either type of CSCI or timing of the tracheostomy procedure.

CONCLUSION

An early tracheostomy is beneficial in reducing the duration of mechanical ventilation among patients with CSCIs, irrespective of the level of injury.

Imaging findings of flexion type of hangman's fracture; an attempt for a more objective evaluation with newly introduced scoring system

OBJECTIVE

To identify the flexion type of hangman's fracture on imaging studies.

METHODS

38 cases of hangman's fracture were retrospectively studied and categorized into flexion and non-flexion groups. Plain radiograph, CT and MRI of these patients were evaluated; 13 radiological parameters that might define flexion injuries were measured. The data were statistically analyzed to identify good criteria and to rank them according to their importance in predicting flexion.

RESULTS

Seven radiological criteria that have the highest correlation with flexion injury were identified. These are C2-3 lower end-plate angle, C2-3 posterior body angle, interspinous angle, disc disruption (MRI), widening of interspinous distance, disruption of the posterior ligamentous complex (MRI) and angle at the fracture site. Scoring 1 point for each positive criterion, a total score of 4 predicts flexion injury with 100% sensitivity and 96.9% specificity. Score of 5 has 83.3% sensitivity and 100% specificity.

CONCLUSION

Flexion hangman's injury can be diagnosed by the presence of four out of seven radiological criteria in the newly introduced scoring system. The authors believe that this method may help spinal surgeons in their selection of therapeutic strategy. Advances in knowledge: This study introduces fast, simple and more objective imaging criteria for the diagnosis of flexion hangman's injury and separates it from the non-flexion pattern.

Fracture of the acetabulum with femoral artery injury presenting late: A case report

This study reports a rare case of both column acetabulum fracture with femoral artery injury that presented late and was managed with arterial reconstruction and fracture fixation.

A thirty-one year old man sustained both column acetabular fracture on the left in a motor vehicle accident. On admission there was no obvious neuro-vascular deficit. During surgery for the fracture after 7 days of the injury the femoral artery was found to be severely crushed with no blood flow. The anterior column of the acetabulum was stabilised followed by resection and reconstruction of the femoral artery. The post-operative period was uneventful and he was discharged normally. At 6 months from injury the fractures had united well with excellent limb circulation and good lower limb function.

Femoral artery injury with acetabular fracture is rare and late presentations are unreported hitherto. The results of fracture stabilisation and vessel reconstruction seem to be excellent. Literature of similar injuries is reviewed.

One-stage biopsy, debridement, reconstruction, and stabilization of pyogenic vertebral osteomyelitis

Study Design Retrospective cohort study. Objective To evaluate whether the proposed one-stage biopsy, culture, debridement, and reconstruction with stabilization strategy is a viable option for pyogenic vertebral osteomyelitis (PVO). PVO is increasing in frequency globally, particularly in immunologically compromised individuals. Typically, biopsy and culture sensitivity followed by staged surgery and long-term antibiotic therapy is the mainstay of therapy. Methods This is a study of a group of 32 consecutive cases of PVO (spondylodiskitis) treated in our institution from 2010 to 2012. All cases had one-stage biopsy, culture sensitivity, debridement, reconstruction with iliac bone graft, and stabilization with titanium implants. The mean age in this series was 51 years, and the male-to-female ratio was 2.2:1. Approximately 50% of the patients had impaired immunity status. The commonest organism isolated was Pseudomonas aeruginosa. Culture-specific antibiotics were given for a minimum of 6 weeks to all patients. The follow-up period ranged from 6 months to a maximum of 2 years. All patients were assessed for wound healing, recurrence of infection, deformity progression, pain, and healing by radiologic and biochemical parameters. No generic or disease-specific outcome tools were used for this study. Results All patients had good wound healing, although there was one case of superficial infection that was resolved with debridement. There were two implant failures with pseudarthrosis and one localized kyphosis in this series. Conclusions The one-stage technique of biopsy, debridement, bone grafting, and stabilization can be recommended for most cases of PVO.

Comparison of primers for the detection of genogroup II noroviruses in India

PURPOSE

Noroviruses (NoV) are increasingly recognized as an important cause for acute gastroenteritis, worldwide. Reverse transcription polymerase chain reaction (RT-PCR) and sequencing are the methods of choice for the detection of NoVs, but there is currently no consensus about the primers to be used in these assays.

MATERIALS AND METHODS

In this study, five published primer sets were evaluated for the detection of genogroup II (GII) NoVs in India. The primers target different regions of the NoV genome. Three primer sets detect an NoV in a single round RT-PCR platform, while the remaining two primer sets are based on a nested RT-PCR platform.

RESULT

A panel of 100 samples from previous studies on norovirus diarrhoea in children were tested by all five primer sets. Of them, 74 samples were identified as positive for NoV, by at least one primer set. Subsets of positive amplicons were sequenced to check for specificity.

CONCLUSION

The most sensitive primer set was Girish 2002, which detected GII NoV by nested RT-PCR, and was modified from the previously published primers. This study demonstrates that higher detection can be obtained by either using multiple primer sets or using a sensitive nested RT-PCR assay. It also demonstrates the differences in primer sensitivity for detection of Genogroup II (GII) NoVs in India.

Adolescent idiopathic scoliosis: Retrospective analysis of 235 surgically treated cases

BACKGROUND

The surgical treatment of adolescent idiopathic scoliosis (AIS) has taken great strides in the last two decades. There have been no long term reported studies on AIS from India with documented long term followup. In this study we review a single surgical team's series of 235 surgically treated cases of AIS with a follow-up from two to six years.

MATERIALS AND METHODS

Pre operative charts, radiographs and MRI scans for 235 patients were collected for this study. The patients were grouped into three groups where anterior correction and fusion (n=47), posterior correction and fusion (n=123) and combined anterior release and posterior instrumentation (n=65) was performed. Each group was divided into two subgroups based on the surgical approach and instrumentation strategy (all screw construct or hybrid construct) used. Patients were followed up for coronal and saggital plane corrections, apical vertebral translation (AVT), trunk balance and back pain. The percentage of correction was calculated in each group as well as sub groups.

RESULTS

The incidence of MRI detected intraspinal anomaly in this series is 5.9% with 3.4% of them requiring neurosurgical procedure along with scoliosis correction. Average coronal major curve correction was 66% in the all screw group and 58.5% in the hybrid group. The coronal plane correction was better when the all screw constructs were employed. Also, the AVT and trunk balance was better with the all screw constructs. The anterior corrections resulted in better correction of the AVT and trunk balance as compared to the posterior correction. There were eight (3.4%) complications in this series. The coronal and saggital plane correction paralleled the published international standards.

CONCLUSION

The coronal plane correction was better when all screw constructs were employed. Use of all pedicle screw systems obviated the need for costoplasty in most cases. The increased incidence of intraspinal anomaly may warrant a routine pre operative MR imaging of all adolescent scoliosis needing surgical treatment.

Astrogliosis in culture. IV. Effects of basic fibroblast growth factor

Previous studies have shown that the mechanical wounding of 3-week-old cultured rat astrocytes results in cell proliferation and hypertrophy resembling astrocyte responses to a brain injury in vivo. We now report the effects of basic fibroblast growth factor (bFGF) and an anti-bFGF antibody on astrocyte morphology, proliferation, and migration following in vitro wounding of confluent secondary cultures. Addition of bFGF (20 ng/ml) to wounded cultures induced morphological changes characteristic of differentiation in wounded and nonwounded areas of the culture. Combined treatment with bFGF and an anti-bFGF antibody (100 micrograms/ml) prevented this effect. Astrocyte proliferation along the edges of a scratch wound was at maximum 24 hr after wounding in cells growing in Eagle's minimum essential medium (EMEM) containing 10% serum. Low serum concentration and treatment with dibutyryl cyclic adenosine monophosphate (dbc-AMP) reduced injury-associated astrocyte proliferation. Addition of bFGF to cultures in EMEM with serum increased astrocyte proliferation at 18 and 24 hr after wounding. This effect was reduced considerably by treatment of cultures with bFGF in combination with an anti-bFGF antibody. The combined treatment and the antibody alone reduced cell division to a level lower than in control cultures. Twenty-four hr following wounding, astrocytes along the edges of the wound exhibited extension of thick, flat processes into the wound area. At 3 and 5 days after wounding, a bodily migration of astrocytes into the wounded area was observed. Addition of bFGF significantly increased astrocyte migration 1 day after wounding, with maximum effect on day 3 and no subsequent increase on day 5. A combination of bFGF and anti-bFGF antibody as well as the antibody alone reduced astrocyte migration to a level lower than in controls. Immunohistochemical localization and isoform pattern of bFGF in astrocytes did not change with dbc-AMP treatment or wounding. We conclude that mechanically wounded confluent astrocytes respond to bFGF added to the culture medium by enhancing cell division, differentiation, and migration. In addition, the results of the antibody treatment also suggest a role for endogenous bFGF in astrocyte proliferation and migration elicited by wounding in vitro. These results support the notion that in vivo, both bFGF released by injury and endogenous bFGF synthesized by astrocytes, contribute to the cellular responses that lead to astrogliosis.

Intralesion injection of basic fibroblast growth factor alters glial reactivity to neural trauma

A traumatic injury to the rat brain is known to induce astrocyte proliferation and hypertrophy leading to astrogliosis. In addition, trauma also induces microglial proliferation in the brain. Since basic fibroblast growth factor (bFGF) is believed to play a role in mediating glial responses to brain injury, we examined the effects of bFGF administration on astrocyte and microglial proliferation and astrocyte hypertrophy resulting from a traumatic injury to the rat brain. Intracerebroventricular infusion of bFGF for 2 days prior to and following injury failed to alter glial reactivity. In contrast, a single intralesion injection of bFGF immediately after injury increased total cell division 2 and 5 days later, with an exclusive effect on glial fibrillary acidic protein-negative glia which consisted mostly of cells of macrophage-microglial phenotype. In addition, bFGF also enhanced injury-induced astrocyte hypertrophy. These results support a role for bFGF in macrophage-microglia proliferation and astrocyte hypertrophy following brain injury. They also suggest that alteration of injury responses of nonneuronal cells of the brain may be a potential side effect of intracerebral administration of bFGF.

A rapid procedure for the isolation of phycobilisomes from cyanobacteria

This paper describes a method for the rapid isolation of phycobilisomes using a cationic detergent, CTAB (cetyltrimethylammonium bromide). The method has distinct advantages over those currently in use in that (i) release of intact phycobilisomes from cells in the presence of CTAB occurs in 40 s (as compared to 40-60 min of incubation required with Triton X-100), thereby reducing the chances of proteolysis of the component phycobiliproteins; and (ii) these phycobilisome preparations have reduced chlorophyll contamination in the initial stages. In addition this method also helps retain the structural and functional properties, as evidenced by spectroscopy and sodium dodecyl sulfate-polyacrylamide gel analysis.

Scapular reactivity to contact irritants: application-time and area variations

Twenty-two diurnally active, fair-skinned, male volunteers were repeatedly patch tested with 10, 15 and 20% lapyrium chloride (LC) and 0.3 and 0.5% sodium lauryl sulfate (SLS) for 5 consecutive days. A series of 5 patches containing SLS and LC were placed vertically once daily for 6 h on different sites of the scapula: paravertebral, lateral and medial. The sites of application were randomized over subjects for patch testing once a day per area at either 08%, 16% or 00%. Each patch was left in place 6 h; scoring of each site, using a 13-point scale, was done 2, 10 and 18 h after removal. The cutaneous reactivity varied in a statistically significant manner according to the time and area of patch application. For each day except the first, LC scores exhibited highest and lowest responses at 16% and 00%, respectively. For SLS, a statistically significant application-time difference in reactivity was detected only for the readings of day 2 when scores were highest at 00% and lowest at 16%. Intraregional variations in scapular reactivity were also exhibited. Strongest reactions to LC occurred in the center of each scapula; weakest reactions were elicited on either the lateral or paravertebral sites. For SLS, statistically significant intraregional differences in reactivity were detected only for the second day of patching, with strongest responses near the spinal column and weakest near the axilla.

Adenosine 5'-triphosphate sulphurylase from Spirulina platensis

ATP-sulphurylase from an unicellular blue-green alga, Spirulina platensis was localized in the soluble fractions of cell-free homogenate, and it was stable for over 3 weeks at -6 degrees C.