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Device scaling for future semiconductor technologies is driving the adoption of innovative methods for miniaturizing semiconductor chips. One promising approach that has garnered significant interest for sub-10 nm device scaling is area selective deposition (ASD). In this study, we demonstrate the feasibility of ASD of silicon dioxide (SiO2) on –OH terminated surfaces (silicon oxide: SiOx) but not on –NH terminated surfaces (silicon nitride: SiNx) for 2D blanket, 2D patterned, and 3D stacks using a novel precursor: Orthrus. To achieve this, we optimized the SiOx and SiNx layers to enhance the –OH and –NH surface bonds, respectively. Using x-ray photo spectroscopy analysis, we showed that SiO2 selectively deposits on SiOx without any nucleation delay compared to SiNx. We have demonstrated the inherent selective deposition of approximately ∼4 nm on 2D patterned structures and ∼3.7 nm on 3D stacks by fine-tuning the atomic layer deposition process. This selective thickness is >250% compared to a previously shown selective SiO2 deposition process in the literature. Finally, we also showed that the step coverage of selective SiO2 growth in 3D stacks is ∼1. This study highlights the potential pathway for performing ASD of commonly used SiO2 in 3D high-aspect-ratio stacks. [ABSTRACT FROM AUTHOR]

The area of the brain affected by a brain tumour can be identified using the tumour's shape, size, location, and border. This study seeks to develop a novel system of classification for brain tumours through pre-processing, segmentation, feature extraction, and tumour classification. An improved median filter will be applied to the input image in this initial phase to improve it. In this step, the image is segmented using a U-net model. Then, characteristics based on the Median Binary Pattern (MBP), the loop, the modified Local Gabor Directional Pattern (LGDiP), and the tumour size are retrieved. A hybrid model that fuses DBN and Bi-LSTM is presented to classify cancers. The optimal weights for both classifiers will be tuned during training to improve the classification performance. For this, BMEBEO (Blue Monkey Extended Bald Eagle Optimization) is proposed, which is a hybrid optimization technique. The suggested model obtains the maximum F-measure of 96.16%%. [ABSTRACT FROM AUTHOR]

The co-precipitation approach was used to synthesize zinc oxide (ZnO) nanopowders with varying pH values of the starting solution. The structural, optical, and morphological features of ZnO nanopowders synthesized were investigated. The hexagonal structure is confirmed by X-ray diffraction (XRD) patterns, which show a minor shift in crystallite size and strain values with pH. Raman Spectra showed the characteristic peaks of wurtzite structure with strong E2 high vibrational mode. FTIR confirms the ZnO functional groups, and there is a change in the wave number position of groups, which is analyzed with the Zn–O bond length studies of XRD patterns. Field emission scanning electron microscopy studies confirm the change in morphological properties from nanoflakes to spherical and then mixed morphology with increased pH value. The band gap energy of all the samples is measured using the UV–Vis spectra, and it is around 3.20 eV; a very minute change in the band gap is observed with the pH value. Defects and rate of recombination of electron and hole pair were analyzed using photoluminescence spectra and the concentration of defects and recombination is explained using the deconvolution peak analysis. It slightly changes with the pH value. The room-temperature magnetic hysteresis loops confirm the ferromagnetic nature of the samples and with an increase of pH, the required magnetic field to saturate the loop is more. The change in the magnetic properties is explained based on the defects in the samples. The observed results confirmed that the pH value influences the structural, morphological, and magnetic properties, and there is not much difference in the optical properties. This implies that manipulating process parameters allows the preparation of pure ZnO with varied morphological nanostructures, potentially improving its optical and sensing capabilities. [ABSTRACT FROM AUTHOR]

Introduction: Increased time to surgery has been previously associated with poorer clinical outcomes after surgical treatment of proximal hamstring ruptures, though the etiology remains unclear. The purpose of this study was to evaluate whether degree of muscle atrophy, as assessed using the Goutallier classification system, is associated with worse outcomes following surgical treatment of chronic proximal hamstring ruptures. Materials and methods: This was a retrospective case series of patients who underwent repair of proximal hamstring ruptures from 2012 to 2020 with minimum 2-year follow-up. Patients were included if they underwent primary repair of a proximal hamstring rupture ≥ 6 weeks after the date of injury and had accessible preoperative magnetic resonance imaging (MRI). Exclusion criteria were allograft reconstruction, endoscopic repair, or prior ipsilateral hip surgery. Patients were administered validated surveys: the modified Harris Hip Score (mHHS) and Perth Hamstring Assessment Tool (PHAT). Fatty atrophy on preoperative MRI was independently graded by two musculoskeletal radiologists using the Goutallier classification. Multivariate regression analysis was performed to evaluate associations of preoperative characteristics with muscle atrophy, as well as mHHS and PHAT scores. Results: Complete data sets were obtained for 27 patients. A majority of this cohort was male (63.0%), with a mean age of 51.5 ± 11.8 years and BMI of 26.3 ± 3.8. The mean follow-up time was 62.6 ± 23.1 months, and the mean time from injury-to-surgery was 20.4 ± 15.3 weeks. The Goutallier grading inter-reader weighted kappa coefficient was 0.655. Regression analysis demonstrated that atrophy was not significantly associated with PHAT (p = 0.542) or mHHS (p = 0.574) at latest follow-up. Increased age was significantly predictive of muscle atrophy (β = 0.62, p = 0.005) and was also found to be a significant predictor of poorer mHHS (β = − 0.75; p = 0.037). Conclusions: The degree of atrophy was not found to be an independent predictor of clinical outcomes following repair of chronic proximal hamstring ruptures. Increasing age was significantly predictive of increased atrophy and poorer patient-reported outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to determine whether significant differences exist when comparing posterior tibial slope (PTS) measurements using increasing lengths of the tibia to determine the anatomical axis. Methods: Patients with full-length weightbearing tibial radiographs were retrospectively identified from 2014-2022 at a single institution. Patients were excluded if there was any previous history of lower extremity fracture or osteotomy. The anatomical axis of the tibia was determined using the full length of tibial radiographs, and the "reference PTS" was measured using this axis. Using the same radiograph, the PTS was measured using four different anatomical axes at standardized tibial lengths. While the center of the proximal circle remained constant at 5-cm below the tibial plateau, the center of the distal circle was drawn at four points: a) overlapping circles; b) 10-cm distal to the tibial plateau; c) 15-cm distal to the tibial plateau; d) half the length of the tibia, measured from the tibial plateau to the tibial plafond. Bivariate correlation and frequency distribution analysis (measurements >2-degrees from reference PTS) were performed between the reference PTS and PTS measured at each of the four other lengths. Results: A total of 154 patients (39.8±17.4 years old, 44.2% male) were included in the final analysis. Measurements at each of the four tibial lengths were all significantly different from the reference PTS (p<0.001). The correlation strength improved with increasing tibial length (overlapping: R=0.681, 10-cm: R=0.821, 15-cm: R=0.937, and half-tibia: R=0.963). The number of PTS measurements >2-degree absolute difference from the reference PTS decreased with increasing tibial length (overlapping: 40.3%, 10-cm: 24.0%, 15-cm: 26.0%, and half-tibia: 18.8%). Conclusions: Assessment of PTS is dependent on the length of the tibia utilized to obtain the anatomical axis. Accuracy and precision of PTS measurements improved with increasing length of tibia used to determine the anatomical axis. [ABSTRACT FROM AUTHOR]

Objectives: High Tibial Osteotomy (HTO) and Distal Femoral Osteotomy (DFO) have long been utilized in the treatment of symptomatic osteoarthritis as well as malalignment with instability, meniscal deficiency or chondral defects. There remains a paucity of literature on the clinical and patient reported outcomes following HTO and DFO procedures in high level athletes. The purpose of this study is to present the outcomes in high-level athletes following HTO and DFO surgery at a large academic institution. Methods: High-level athletic patients (defined as Tegner score over 5) undergoing HTO/DFO from January 2010 to August 2023 were eligible for inclusion. Patients were excluded if they were less than 18 years old, had a Tegner score below 5 prior to symptom onset or had less than 2 years of follow-up. Demographic data including sex, age at time of surgery, and body mass index (BMI) at time of surgery was obtained from the EMR. Outcomes were assessed using follow-up questionnaires that consisted of symptom resolution, patient satisfaction, Tegner Activity Scale, IKDC, KOOS, Lysholm, and return to sports. Patients with concomitant meniscus allograft transplantation, osteochondral allograft transplantation and anterior cruciate ligament reconstruction were included. Results: There were 52 patients that met inclusion criteria, with 39 (75.0%) of patients undergoing HTO and 13 (25.0%) patients undergoing DFO. The mean age at the time of surgery was 39.5 ± 11.1 years, mean follow-up was 5.6 ± 3.1 years (2.0-12.2 years). The cohort was 71.2% male with average BMI of 26.8 ±4.1 Complete symptomatic resolution was reported by 46.2% of patients. When asked about their overall physical ability after surgery, 41.2% patients said they were "much better", with 27.5% patients saying they were "better". The mean VAS satisfaction score at final follow-up was 73.7 and 64.7% patients would choose to undergo the operation again if given the option. There was a significant decrease in the value of VAS pain score from the patient's pre-operative level after knee injury versus their current pain level (73.6 vs. 29.5, p<0.0001). Furthermore, 3/51 (5.9%) patients eventually underwent total knee arthroplasty with an average time of 2.9 ± 0.2 years form HTO/DFO procedure. The mean Tegner score before injury was 6.4, before surgery was 2.7 and a significant increase to 4.3 (p<0.0001) after the procedure at follow up. Following surgery 82.7% of patients met the threshold for patient acceptable symptom state (PASS) for IKDC. 44 percent returned to sports after surgery and only 12 (25.0%) were able to return to sport to the same level from before their injury. The average time to return to sport was 47.3 ±27.0 weeks. There was a significant difference between male and female patients undergoing HTO/DFO procedures with respect to IKDC (p=0.027), KOOS symptom (p=0.048), KOOS activities of daily living (p=0.050), KOOS pain (p=0.050), KOOS QoL (p=0.039) and KOOS sports (p=0.016). Additionally, there was no significant difference in any of the clinical or patient reported outcomes studied between patients who underwent HTO/DFO procedures for degenerative joint disease versus instability aside from IKDC (72.8 vs. 61.1, p=0.046) and KOOS ADL (92.1 vs. 81.0, p=0.037). Conclusions: In high level-athletes, HTO and DFO procedures lead to high satisfaction rates and significant increases in Tegner scores following surgery compared to their symptomatic baseline, with low conversion rates to total knee arthroplasty at mid-term follow up, with male patients having better outcomes. The majority of patients did not return to sport following these procedures and even fewer were able to return to sport at their pre-injury activity level. Surgeons can use the findings from this study to educate high-level athletes that HTO/DFO procedures provide reliable improvements in clinical and patient reported outcomes with high patient satisfaction but may not allow them to return to sport at their pre-injury level. [ABSTRACT FROM AUTHOR]

Pure and metal‐doped ZnO nanopowders with composition formula M0.04Zn0.96O (where M = Al, Mg, Sm, and Cu) are synthesized using the coprecipitation method. The structural characterization of synthesized powders is investigated using X‐ray diffraction and the results confirm the hexagonal wurtzite structure without any additional phases. The change in structural parameters of ZnO with dopants is estimated using X‐ray peak profile analysis. The structural characterization is further analyzed by Fourier‐transform infrared spectroscopy. The size and morphology of the synthesized powders are analyzed by a field‐emission scanning electron microscope, which also evidences the formation of uniform nanostructures with quasi‐spherical and hexagonal shapes. Moreover, the elemental composition of these metal‐doped nanotructures is determined by energy‐dispersive X‐ray measurements. UV–vis spectroscopy is used to determine the energy bandgap of ZnO nanopowders. A vibration sample magnetometer is employed to measure the samples' magnetic properties, and dopants are found to induce distinct magnetic behaviors in ZnO. The antimicrobial activity of the synthesized powders is measured using the well diffusion method. It is observed that the introduction of dopant metals leads to increased microbial activity. Among the doped ZnO variants, Al‐doped ZnO exhibits the highest level of microbial activity compared to pure ZnO and other samples. [ABSTRACT FROM AUTHOR]

Introduction: The relationship between elevated uric acid levels and pre-eclampsia has been a subject of considerable research, highlighting its potential role as a biomarker for the disease and its complications. This observational study aimed to assess perinatal risks associated with elevated uric acid levels in pregnant women diagnosed with pre-eclampsia. Material and Methods: Seventy-five pregnant women with pre-eclampsia were included in the study. Baseline demographics, clinical parameters (including blood pressure, proteinuria, and uric acid levels), and perinatal outcomes (such as gestational age at delivery, birth weight, Apgar scores, preterm birth incidence, NICU admissions, and fetal distress) were collected. Statistical analysis included means, standard deviations, and p-values to assess differences and associations. Results: Maternal age (28.5 ± 4.2 years), parity (1.8 ± 1.2), and gestational age at pre-eclampsia diagnosis (30.4 ± 2.5 weeks) showed significant variations (p < 0.05). Perinatal outcomes demonstrated lower gestational age at delivery (36.2 weeks ± 2.1), reduced birth weight (2750 grams ± 350), and Apgar scores at 1 and 5 minutes (7.8 ± 1.2 and 8.5 ± 1.0, respectively), indicating the impact of preeclampsia on neonatal health. The study revealed a high incidence of preterm birth (32%), NICU admissions (25%), and fetal distress (15%). Conclusion: Elevated uric acid levels in pre-eclampsia are associated with adverse perinatal outcomes, including preterm birth, low birth weight, and increased neonatal care requirements. Early detection, vigilant monitoring, and appropriate interventions are essential in managing pre-eclampsia and improving neonatal outcomes. [ABSTRACT FROM AUTHOR]

Scaling semiconductor devices necessitates the fabrication of high-aspect-ratio narrow features through the precise etching of multiple layers comprising alternating materials, each with sub-20 nm thickness. However, etching dissimilar materials, such as alternating metal and oxide layers, pose significant challenges due to inherent discrepancies in vertical and lateral etch rates. This study demonstrates the feasibility of etching a stack comprising 10 layers of silicon dioxide (SiO2) and molybdenum (Mo) using an Oxford Instruments ICP RIE tool operating at a low power regime (bias < 250 V). We evaluated different etch chemistries, including Cl2/CHF3 and CF4/CHF3, and the role of CH4 as a passivation gas to control the lateral etch rates. Mask encapsulation with Ru was employed to protect the hardmask during the etching process, enabling successful etching of 10 layers without lateral recess. Experimental results were validated using Sentaurus™ TCAD software to investigate the impact of gas chemistry on the stack etch rate. Our findings provide valuable insights into the performance of various etch chemistries, demonstrating the effectiveness of the evaluated chemistries and the role of CH4 in improving profile characteristics. The integration of experimental and computational approaches facilitates the optimization of process parameters for advanced integrated circuit fabrication. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the effect of concomitant open distal clavicle excision (DCE) on postoperative clinical outcomes and incidence of acromial and scapular stress fractures (ASFs) in patients with symptomatic acromioclavicular joint osteoarthritis (ACJ OA) undergoing reverse total shoulder arthroplasty (RTSA). Methods: A single-surgeon retrospective cohort study was conducted including patients who underwent primary elective RTSA with or without DCE from 2015 to 2019 with a minimum 6-month follow-up period. Shoulder active range of motion (AROM) and visual analog scale (VAS) pain were recorded preoperatively and postoperatively. ASFs and other adverse events were identified using postoperative notes and/or radiographs. Characteristics and outcomes were compared between the RTSA and RTSA-DCE groups. Results: Forty-six RTSA patients (mean age, 67.9±8.7 years; 60.9% male; mean follow-up, 24.9±16.6 months) and 70 RTSA-DCE patients (mean age, 70.2±8.9 years; 20.0% male; mean follow-up, 22.7±12.9 months) were included. There were no significant intergroup differences in rates of ASF (RTSA, 0.0% vs. RTSA-DCE, 1.4%; P=1.00), stress reactions (RTSA, 8.7% vs. RTSA-DCE, 11.4%; P=0.76), reoperation, revision, or infection (all P>0.05), or in pre-to-postoperative reduction in VAS pain (P=0.17) at latest follow-up. However, the RTSA-DCE group had greater pre-to-postoperative improvement in flexion AROM (RTSA, 43.7°±38.5° vs. RTSA-DCE, 59.5°±33.4°; P=0.03) and internal rotation (IR) AROM (P=0.02) at latest follow-up. Conclusions: Concomitant DCE in RTSA improves shoulder flexion and IR AROM, alleviates shoulder pain, and does not increase the risk of ASFs. [ABSTRACT FROM AUTHOR]

Recent trends in semiconductor process engineering have resulted in significant adoption of new materials and processes to enable new paradigms in device manufacturing. One such emerging process is area selective deposition where a material can be selectively deposited on an area of interest. In this work, we have demonstrated selective deposition of ruthenium (Ru) on amorphous (a-Si) and polycrystallized silicon (p-Si) to silicon dioxide (SiO2) on both 2D blanket films as well as 3D annealed SiO2–Si multilayer stacks. Amorphous Si once crystallized using high temperature annealing exhibits reduced surface hydrogen content (–Si–H), yet we observed Ru growth on p-Si films that were annealed under multiple conditions (800, 900, and 1000 °C). We have used a combination of Fourier transform-infrared spectroscopy and x-ray photoelectron spectroscopy (XPS) to show that both –Si–H and film crystallinity impact the selective growth of Ru. We have also demonstrated selective deposition of ∼10 nm Ru on p-Si layers and ∼0 nm Ru on SiO2 layers of the annealed 3D SiO2–Si multilayer stack. Additionally, by using a combination of XPS and transmission electron microscopy, we have demonstrated that Ru growth is higher on nongrowth surfaces in 2D substrates than on 3D stacks. Finally, we have shown that this process technology can be further advanced using a combination of selective and nonselective conformal atomic layer deposition processes to develop a novel 3D annealed SiO2–Si multilayer stack, thereby demonstrating a 3D device with low –H content p-Si films. This study can help us to realize new integration schemes for innovative 3D device structures. [ABSTRACT FROM AUTHOR]

Miniaturization and scaling of semiconductor devices require development of innovative techniques to sustain advancements. A promising trend is the migration from 2D to 3D device architectures that necessitate fabrication of high-aspect-ratio narrow features through layers of different materials. Reactive ion etching can achieve this but poses unique challenges due to the requirement of etch chemistries capable of etching dissimilar materials with varying etch rates while maintaining high productivity. The choice of hardmask is also crucial, as it plays a critical role in determining efficacy of the etch process and the final shape of the feature being etched. To address these challenges, we introduce a new concept of hardmask engineering that involves a bilayer hardmask scheme consisting of a patterned conventional hardmask encapsulated with a thin layer of etch-resistant ruthenium (Ru) layer. Experimental results for etching multilayer stacks consisting of alternating pairs of SiO2 and Mo show that this engineered hardmask results in improved hardmask remaining and etch profile with smaller critical dimensions (CDs). Technology computer-aided design simulations with the Ru encapsulation layer on conventional carbon hardmask demonstrate increased poly-Si etch depth with reduced bow CD. This concept can be extended to any semiconductor nanofabrication step involving high-aspect-ratio etching where precise control of CDs is essential in the vertical direction. [ABSTRACT FROM AUTHOR]

Purpose: The indications for surgical treatment of proximal hamstring ruptures are continuing to be refined. The purpose of this study was to compare patient-reported outcomes (PROs) between patients who underwent operative or nonoperative management of proximal hamstring ruptures. Methods: A retrospective review of the electronic medical record identified all patients who were treated for a proximal hamstring rupture at our institution from 2013 to 2020. Patients were stratified into two groups, nonoperative or operative management, which were matched in a 2:1 ratio based on demographics (age, gender, and body mass index), chronicity of the injury, tendon retraction, and number of tendons torn. All patients completed a series of PROs including the Perth Hamstring Assessment Tool (PHAT), Visual Analogue Scale for pain (VAS), and the Tegner Activity Scale. Statistical analysis was performed using multi-variable linear regression and Mann–Whitney testing to compare nonparametric groups. Results: Fifty-four patients (mean age = 49.6 ± 12.9 years; median: 49.1; range: 19–73) with proximal hamstring ruptures treated nonoperatively were successfully matched 2:1 to 27 patients who had underwent primary surgical repair. There were no differences in PROs between the nonoperative and operative cohorts (n.s.). Chronicity of the injury and older age correlated with significantly worse PROs across the entire cohort (p < 0.05). Conclusions: In this cohort of primarily middle-aged patients with proximal hamstring ruptures with less than three centimeters of tendon retraction, there was no difference in patient-reported outcome scores between matched cohorts of operatively and nonoperatively managed injuries. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

Background: The current study aims to determine the expression of trefoil factor 2 (TFF2), trefoil factor 3 (TFF3), and adrenomedullin (ADM) in salivary samples of periodontitis patients with and without coronary heart disease (CHD). Methods: A total of 75 patients were selected based on the inclusion and exclusion criteria and divided into three groups of 25 patients each: generalized periodontitis (GP) only; GP+CHD; and CHD only. Demographic, periodontal, and cardiac parameters were recorded, and unstimulated saliva samples were collected and analyzed for the expression of TFF2, TFF3, and ADM. Results: Among the demographic variables, the means for age,weight, and body mass indexwere significantly different between the groups on statistical analysis. Plaque index, bleeding on probing, probing pocket depth, clinical attachment level, and the expression of TFF2 were highest in the GP+CHD group, and ADM was highest in the CHD group, with P values of < 0.01 as compared to the other groups. TFF2, TFF3, and ADM were also correlated with the demographic and periodontal parameters. Conclusions: The study demonstrates significantly elevated levels of TFF2 in CHD and GP patients, and a higher expression of ADM in CHD patients only, suggesting the possibility of an underlying inflammatory mechanism. [ABSTRACT FROM AUTHOR]

Purpose: The current investigation evaluated the relationship between the synovial fluid cytokine microenvironment at the time of isolated anterior cruciate ligament (ACL) reconstruction and the presence of subsequent chondral wear and radiologic evidence of osteoarthritis (OA) on cartilage-specific MRI sequences at a minimum of 5-year follow-up. Methods: Patients who underwent primary ACL reconstruction with no baseline concomitant cartilage or meniscal defects and had synovial fluid samples obtained at the time of surgery were retrospectively identified. Patients with a minimum of 5 years of postoperative follow-up were contacted and asked to complete patient-reported outcome (PRO) measures including Visual Analog Scale (VAS) for pain, Lysholm Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Tegner Activity Scale, along with postoperative magnetic resonance imaging (MRI). The concentration of ten biomarkers that have previously been suggested to play a role in cartilage degradation and inflammation in the joint space was measured. Linear regression controlling for age, sex, and body mass index (BMI) was performed to create a model using the synovial fluid concentrations at the time of surgery to predict postoperative semiquantitative cartilage lesion size and depth on MRI at a minimum of 5 years follow up. Results: The patients were comprised of eight males (44.4%) and ten females (55.6%) with a mean age at the time of surgery of 30.8 ± 8.7 years (range 18.2–44.5 years). The mean follow-up time was 7.8 ± 1.5 years post-operatively (range 5.7–9.7 years). MCP-1, VEGF, and IL-1Ra were found to have significant associations with the presence of postoperative cartilage wear (p < 0.05). No correlations were demonstrated among the biomarker concentrations at the time of injury with PRO scores at final follow-up (NS). Conclusion: Synovial fluid inflammatory biomarker concentrations at the time of injury can predict progression of early-stage post-traumatic osteoarthritis at a mean of almost 8 years post-operatively. Findings from this study may help identify treatment targets to alter the natural history of cartilage loss following anterior cruciate ligament injury. Level of evidence: Level III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine whether point-of-care ultrasound performed during the Pavlik method treatment of developmental dysplasia of the hip predicts acetabular morphology at 12 months of age. Methods: We reviewed the medical records, ultrasounds, and radiographs of patients treated successfully with the Pavlik method between 2017 and 2019. We performed sonographic measurements on point-of-care ultrasound at the initial presentation, the Pavlik discontinuation, and an additional sonographic follow-up. We measured the acetabular index on a plain anteroposterior radiograph of the pelvis obtained at a minimum of 12 months of age. Spearman's rank correlation coefficient was used to analyze for correlation between sonographic measurements and the acetabular index. Results: A total of 72 patients were included in the final analysis. There were no residual or late dysplasia cases at the last radiographic follow-up (mean age = 14.8 ± 2.7 months). Sonographic parameters at the initial presentation significantly correlated with the acetabular index at the final radiographic follow-up (p < 0.001). Patients with worsening degrees of developmental dysplasia of the hip based on stability on sonographic testing (stable, unstable, or dislocated) had higher acetabular indices at the final radiographic follow-up (p < 0.05). Conclusion: Point-of-care ultrasound at initial presentation and the Pavlik discontinuation significantly correlate with acetabular morphology at 1–1.5 years of age. At initial presentation, hips that were unstable or dislocated on point-of-care ultrasound had significantly greater acetabular indices than stable hips at the final follow-up. Level of evidence: level IV case series. [ABSTRACT FROM AUTHOR]

Introduction: Prior studies of hamstring tendon tears have reported varied findings on whether increased delay from injury to surgery is associated with worse outcomes. The purpose of this study was to determine whether increased time from injury to surgical repair is associated with worse clinical outcomes in patients with proximal hamstring ruptures. Materials and methods: Patients who underwent surgical repair of a proximal hamstring rupture from 2010 to 2019 were followed for a minimum of 24 months from surgery. A cutoff of 6 weeks from injury to the time of surgery was used to distinguish between acute and chronic ruptures. All patients completed patient-reported outcome measures (PROs) at the final follow-up. Multiple factors were analyzed for their effects on PROs including time to surgery, amount of tendon retraction, and demographics such as sex and age. Results: Complete data sets were obtained for 38 patients at a mean follow-up of 4.9 years. All data is reported as a mean ± standard deviation. Patients who underwent acute repair of proximal hamstring ruptures had significantly greater Perth Hamstring Assessment Tool (PHAT) scores than those who underwent chronic repair (76.9 ± 18.8 vs 60.6 ± 18.2, p = 0.01). Increased time to surgery was significantly correlated with worse PHAT scores (ρ = − 0.47, p = 0.003). There was no difference in PROs based on the amount of tendon retraction, number of tendons torn, sex, smoking status, or BMI. Conclusions: This study found that acute repair performed within 6 weeks of injury appears to yield improved PROs compared to chronic repair. These data highlight the importance of timely and accurate diagnosis of proximal hamstring ruptures and early operative intervention for surgical candidates. [ABSTRACT FROM AUTHOR]

Trends in device miniaturization have driven the adoption of new materials that, in turn, have enabled significant advancements in the field of process engineering and integration for semiconductor technology. Continued progress for device scaling is necessary and can be enabled by advances in lithographic techniques and deposition schemes. Thin-film deposition for spacers and etch stop layers has become a mainstay to enable and extend traditional 2D scaling into the 3D realm for fabricating advanced semiconductor devices. For processing 3D structures, controlled film deposition with subnanometer resolution in high aspect ratio features is desired. Area selective deposition (ASD) can be a powerful response to such a challenge. ASD is a type of thin-film deposition technique scheme that can be used to eliminate the need for several expensive and time-consuming lithography steps with fewer performance penalties. In this work, we show ASD of ruthenium (Ru) on 3D molybdenum (Mo)–silicon oxide (SiO2) stacks by utilizing the inherent substrate preference of the Ru precursor to a H-terminated surface. In the best selectivity condition, our results show growth of ∼5 nm Ru on Mo, with no film growth on SiO2. Changes in Ru growth kinetics were observed after dilute hydrofluoric acid (DHF) treatment for both surfaces. Post-DHF treatment, the Ru growth rate on Mo was reduced by 5%. However, on SiO2 (after incubation delay), the growth rate was reduced by 94% compared to untreated surfaces. This translates to a very high difference in the growth rate of Ru on Mo vs SiO2, even after considering the incubation delay. Finally, by using 3D topologies with high aspect ratio holes, we have highlighted that it is important to deconvolute the effects of precursor depletion and selectivity. To the best of our knowledge, this is the first demonstration of ASD of Ru on 3D structures without the use of any blocking layers. Therefore, these results demonstrate a new paradigm for ASD in 3D features. [ABSTRACT FROM AUTHOR]

Objectives: This study was conducted to evaluate the levels of salivary uric acid and arginase in patients with periodontitis, generalized gingivitis, and in healthy individuals. Then, the effects of non-surgical periodontal therapy on levels of salivary arginase and uric acid were also investigated. Methods: A total of 60 subjects were divided into three groups based on periodontal health: group I comprised 20 healthy individuals; group II comprised 20 subjects who had generalized gingivitis; group III comprised 20 subjects who had generalized periodontitis. On day 0, the clinical examination of periodontal status was recorded, following which saliva samples were collected. Group II and group III subjects underwent non-surgical periodontal therapy. These patients were recalled on day 30 to collect saliva samples. The periodontal parameters were reassessed on day 90, and saliva samples were collected for analysis of salivary arginase and uric acid levels. Results: Group II and group III showed improvement in clinical parameters following non-surgical periodontal therapy on the 90th day. The MGI score, PPD, and CAL showed improvement. On day 0, at baseline, salivary arginase levels in group III and group II were higher than those in healthy subjects, whereas on day 0, salivary uric acid levels in group III and group II were lower than those in healthy subjects. Both on day 0 and day 90, the salivary arginase level showed a positive correlation with the periodontal parameters, whereas the salivary uric acid level was positively correlated with the periodontal parameters on day 90. Conclusion: the level of salivary arginase was a pro-inflammatory marker and a raised level of salivary uric acid was an anti-inflammatory marker following periodontal therapy, suggesting their pivotal role in assessing periodontal status and evaluation of treatment outcome. [ABSTRACT FROM AUTHOR]

Regional blocks are being increasingly utilized for anesthesia for various orthopedic procedures. Several studies have shown that regional anesthesia has fewer side effects and improved postoperative pain relief compared to general anesthesia, but regional blocks are not without risks. We present case reports of 2 patients who experienced posterior shoulder instability, one of whom had a posterior shoulder dislocation, immediately in the postanesthesia care unit after undergoing hand surgery with regional anesthesia. This paper highlights the importance of being aware that patients might be at increased risk of shoulder instability after upper extremity regional anesthesia, and appropriate perioperative precautions should be taken. [ABSTRACT FROM AUTHOR]

Background: There is minimal literature on the use of suture tape augmentation in the treatment of chronic lateral ankle instability (CLAI), prompting an investigation on its use and effect during surgery of the lateral ankle. Purpose: To evaluate the evidence for the use of suture tape augmentation in the treatment of CLAI and the outcomes after this procedure. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they evaluated the use of suture tape for CLAI. Outcome measures included the Foot and Ankle Ability Measure, American Orthopaedic Foot and Ankle Society (AOFAS) score, return to play, and radiological improvement in anterior talar translation and talar tilt angle. Quantitative and qualitative analyses were performed. Results: There were 11 studies (2 with level 2 evidence, 1 with level 3, and 8 with level 4) including 334 patients (334 ankles) that underwent suture-tape augmentation. The mean age was 27.3 years, 67.3% were women, and the mean follow-up was 27.6 months (range, 11.5-38.5 months). The mean weighted postoperative AOFAS score was 95, and 87.7% were able to return to sports. Overall, 9 recurrent instability events (4.1%) were reported. In 3 studies that compared Broström repair and suture tape augmentation, there were no significant differences between the procedures in recurrent instability (mean difference [MD], 0.81 [95% CI, 0.19 to 3.50]; I 2 = 0%; P =.78), Foot and Ankle Ability Measure (MD, 1.24 [95% CI, –3.73 to 6.21]; I 2 = 66%; P =.63), talar tilt angle improvement (MD, –0.07 [95% CI, –0.68 to 0.54]; I 2 = 0%; P =.42), or anterior talar translation improvement (MD, –0.06 [95% CI, –0.69 to 0.56]; I 2 = 0%; P =.77). Conclusion: Suture tape augmentation did not significantly improve clinical or radiological outcomes in the setting of modified Broström repair for CLAI. There is currently insufficient evidence to recommend suture tape augmentation for all patients at this time. [ABSTRACT FROM AUTHOR]

Background: MET exon 14 skipping mutation (MET ex14) is observed in ~3% of non-small cell lung cancer (NSCLC) cases and has been shown to be an independent poor prognostic factor associated with shorter overall disease-specific survival. Broad molecular testing can identify this biomarker in patients with advanced NSCLC (aNSCLC) and allow patients to be matched with the appropriate targeted therapy. This study examines biomarker testing patterns and clinical outcomes of chemotherapy and immuno-oncology (IO) monotherapy in aNSCLC patients with MET ex14. Methods: A descriptive retrospective study was conducted using the Flatiron Health–Foundation Medicine Inc. (FMI) clinico-genomic database. Patients with MET ex14 aNSCLC treated with systemic therapies were included in the biomarker testing analysis. The duration from specimen collection to reported results was assessed for PD-L1– and MET ex14-tested patients. Clinical outcomes were assessed in patients treated with chemotherapy or IO monotherapy. First-line (1L) and second-line (2L) real-world progression-free survival (rw-PFS) were estimated using Kaplan-Meier analysis. Results: Of 91 MET ex14 patients eligible for the biomarker testing analysis, 77% and 60% received PD-L1 and FMI next-generation sequencing (NGS) testing within 3 months post aNSCLC diagnosis. Of those assessed for both PD-L1 and MET ex14 (n=9), the median duration between specimen collection and reporting was 1 week shorter for PD-L1 than for FMI NGS. Median 1L rw-PFS was 5.7 months (95% CI, 4.6-7.1) and 2.4 months (95% CI, 1.4-3.2) in patients receiving 1L chemotherapy (n=59) and IO monotherapy (n=18), with 3-month 1L rw-PFS rates of 78% and 33%. Median 2L rw-PFS was 3.5 months (95% CI, 1.9-11.1) and 4.7 months (95% CI, 2.8-12.9) in patients receiving 2L chemotherapy (n=16) and IO monotherapy (n=23), with 3-month 2L rw-PFS rates of 54% and 67%. Conclusions: The median time from biopsy to test results appears 1 week shorter for PD-L1 than for FMI NGS. Chemotherapy and IO monotherapy were the most common regimens utilized but with limited PFS. [ABSTRACT FROM AUTHOR]

Background: Carbapenem-resistant (CR) Acinetobacter baumannii is a concerning pathogen in the USA and worldwide.Methods: To assess the comparative burden of CR vs carbapenem-susceptible (CS) A. baumannii, this retrospective cohort study analyzed data from adult patients in 250 US hospitals from the Premier HealthCare Database (2014-2019). The outcomes analyzed included hospital length of stay (LOS), intensive care unit (ICU) utilization, discharge status, in-hospital mortality, readmission rates and hospital charges. Logistic regression was used for univariate and multivariable assessment of the independent relationship between relevant covariates, with a focus on CR status, and in-hospital mortality.Results: 2047 Patients with CR and 3476 patients with CS A. baumannii infections were included. CR A. baumannii was more commonly isolated in respiratory tract infections (CR 40.7% and CS 27.0%, P < 0.01), whereas CS A. baumannii was more frequently associated with bloodstream infections (CS 16.7% and CR 8.6%, P < 0.01). Patients with CR A. baumannii infections had higher in-hospital (CR 16.4% vs CS 10.0%; P < 0.01) and 30-day (CR 32.2% vs CS 21.6%; P < 0.01) mortality compared to those with CS infections. After adjusting for age, sex, admission source, infection site, comorbidities, and treatment with in vitro active antibiotics within 72 h, carbapenem resistance was independently associated with increased mortality (adjusted odds ratio 1.42 [95% confidence interval 1.15; 1.75], P < 0.01). CR infections were also associated with increases in hospital length of stay (CR 11 days vs CS 9 days; P < 0.01), rate of intensive care unit utilization (CR 62.3% vs CS 45.1%; P < 0.01), rate of readmission with A. baumannii infections (CR 17.8% vs CS 4.0%; P < 0.01) and hospital charges.Conclusions: These data suggest that the burden of illness is significantly greater for patients with CR A. baumannii infections and are at higher risk of mortality compared with CS infections in US hospitals. [ABSTRACT FROM AUTHOR]

Background: Cataracts are one of the leading causes of blindness in the world and disproportionately affect the elderly people and women. Sex- and race-related differences in cataract formation are not well understood. Furthermore, race and socioeconomic factors can play a role in developing systemic diseases. Earlier studies have supported a link between certain systemic diseases and cataract formation. Our study examined race-related differences in ocular and systemic comorbidities and analyzed differences among races and insurance types for cataract surgery visual outcomes among female patients with cataracts. Materials and Methods: Data were collected retrospectively and patients were grouped by race and insurance classifications. Female patients at a large tertiary center with an International Classification of Disease, 9th Edition (ICD-9) or ICD-10 cataract diagnosis or cataract extraction procedure code between January 2013 and June 2018 were included. A total of 909 female patients were included in the study. Frequency of systemic and ocular comorbidities was analyzed. Demographic factors were also compared among races. Finally, characteristics of cataract surgery patients, such as age at surgery, preoperative best-corrected visual acuity (BCVA), and visual outcomes among races and insurance types were analyzed. Results: There are differences among races for frequency of smoking, hemoglobin A1c, hypertension, and diabetes mellitus in female patients with cataracts and differences among races and insurance types for preoperative BCVA for patients who underwent cataract surgery (p < 0.001 for all). Conclusions: Female minority and non-minority patients with cataracts have a high frequency of systemic and ocular comorbidities at our county hospital. Patients with no insurance and white and Hispanic patients had worse preoperative BCVA. [ABSTRACT FROM AUTHOR]

To assess the repeatability and comparability of the Galilei G4 versus the Cassini topographer in post-refractive eyes and in normal eyes, including older patients representative of an initial cataract evaluation. Simulated keratometric (simK), total corneal and posterior corneal power and astigmatism were evaluated in both post-refractive and normal eyes. Repeatability was measured by calculating within-subject standard deviation (Sw), coefficient of variation (CoV), and intraclass correlation coefficient (ICC). Vector analyses and Bland–Altman plots were employed to assess agreement between devices. We studied 32 subjects with a history of refractive surgery and 32 subjects without a history of refractive surgery undergoing cataract surgery. The mean age was 55 ± 18.5 years and the age range was 21.5–91.5 years. In non-refractive and post-refractive eyes, the ICC was > 0.9 (P < 0.001) for all corneal powers and for simK and total corneal astigmatism for both analyzers. The ICC for posterior corneal astigmatism magnitude using the Galilei was 0.62 and 0.67 and for the Cassini 0.55 and 0.38 in normal and post-refractive eyes, respectively. In both post-refractive and normal eyes, the Galilei G4 and Cassini analyzers have high repeatability in simK, total, and posterior corneal power and low repeatability for posterior corneal astigmatism. [ABSTRACT FROM AUTHOR]

Background: The BYLieve trial (NCT03056755) confirmed efficacy and safety of alpelisib with fulvestrant for hormone receptor–positive (HR+), human epidermal growth factor receptor‐2–negative (HER2−), PIK3CA‐mutated advanced breast cancer (ABC), after cyclin‐dependent kinase 4/6 inhibitor (CDK4/6i) with an aromatase inhibitor (AI) as immediate prior therapy. Further analyses were performed to compare efficacy from BYLieve with effectiveness of standard treatment in the real‐world setting. Materials and Methods: Patients who progressed on a CDK4/6i plus AI and were treated with alpelisib with fulvestrant in BYLieve were matched with a real‐world patient cohort who received standard‐of‐care from a deidentified clinico‐genomics database (CGDB). Primary and secondary endpoints were to compare progression‐free survival (PFS), estimated by the Kaplan‐Meier method, and the proportion of patients remaining progression‐free at 6 months, respectively, between the two cohorts. Results: A total of 855 patients with PIK3CA‐mutant disease who had prior CDK4/6i plus hormone therapy were selected from the CGDB; further matching to 120 patients from BYLieve selected 95 patients without exposure to HER2‐targeting agents, clinical study drug, or alpelisib. In unadjusted and postmatching results, primary and secondary endpoints favored treatment with alpelisib with fulvestrant in BYLieve more than standard treatments in the real‐world cohort. Postadjustment, median PFS for patients treated with alpelisib in BYLieve was 7.3 versus 3.7 months in the real‐world cohort, and 6‐month PFS was 54.6% versus 40.1%, respectively. Conclusion: Matched/weighted analysis comparing BYLieve with the real‐world setting further supports the clinical benefit of alpelisib with fulvestrant for treatment of HR+, HER2−, PIK3CA‐mutant ABC after CDK4/6i treatment. Implications for Practice: Approximately 40% of patients with hormone receptor–positive (HR+), human epidermal growth factor receptor‐2–negative (HER2−) advanced breast cancer (ABC) have PIK3CA‐mutated tumors, which have been associated with endocrine therapy resistance. Alpelisib, an α‐selective phosphatidylinositol‐3‐kinase inhibitor, demonstrated significantly improved progression‐free survival in SOLAR‐1 and demonstrated clinical efficacy in BYLieve when combined with fulvestrant. Data are limited in comparing the efficacy of alpelisib combined with fulvestrant with effectiveness of standard therapy after CDK4/6i treatment. Using real‐world data, this is the first analysis comparing alpelisib combined with fulvestrant with standard treatments for HR+, HER2−, PIK3CA‐mutant ABC in the post‐CDK4/6i setting. This article reports the efficacy of treatment with alpelisib combined with fulvestrant in a cohort of patients with PIK3CA‐mutated breast cancer compared with the effectiveness of real‐world standard treatments in the post‐CDK4/6i setting using data from a deidentified clinico‐genomics database (CGDB). [ABSTRACT FROM AUTHOR]

Background: Urinary tract infections (UTIs) are the most common infections caused by Gram-negative bacteria and represent a major healthcare burden. Carbapenem-resistant (CR) strains of Enterobacterales and non-lactose fermenting pathogens further complicate treatment approaches.Methods: We conducted a retrospective analysis of the US Premier Healthcare Database (2014-2019) in hospitalised adults with a UTI to estimate the healthcare burden of Gram-negative CR UTIs among patients with or without concurrent bacteraemia.Results: Among the 47,496 patients with UTI analysed, CR infections were present in 2076 (4.4%). Bacteraemia was present in 24.5% of all UTI patients, and 1.7% of these were caused by a CR pathogen. The most frequent CR pathogens were Pseudomonas aeruginosa (49.4%) and Klebsiella pneumoniae (14.2%). Patients with CR infections had a significantly longer hospital length of stay (LOS) (median [range] 8 [5-12] days vs 6 [4-10] days, P < 0.001), were less likely to be discharged home (38.4% vs 51.0%, P < 0.001), had a higher readmission rate (22.6% vs 13.5%, P < 0.001), and had greater LOS-associated charges (mean US$ 91,752 vs US$ 66,011, P < 0.001) than patients with carbapenem-susceptible (CS) infections, respectively. The impact of CR pathogens was greater in patients with bacteraemia (or urosepsis) and these CR urosepsis patients had a significantly higher rate of mortality than those with CS urosepsis (10.5% vs 6.0%, P < 0.001).Conclusions: Among hospitalised patients with UTIs, the presence of a CR organism and bacteraemia increased the burden of disease, with worse outcomes and higher hospitalisation charges than disease associated with CS pathogens and those without bacteraemia. [ABSTRACT FROM AUTHOR]

Sickle cell disease affects more than 30 million people worldwide, including 0.1% of the population in Lebanon. It is characterized by unpredictable and painful vaso-occlusive crises (VOCs) that may lead to serious complications. This study describes the clinical burden of sickle cell disease in a cohort of patients treated at a comprehensive sickle cell disease referral center in Tripoli, Northern Lebanon. Patient demographics, clinical events, treatment, and survival were evaluated from a local, hospital-based registry of 334 sickle cell disease patients treated at the Nini Hospital, Tripoli, Lebanon, between 2009 and 2019. Mean age at sickle cell disease diagnosis and at first clinic visit was 2.9 and 8.5 years, respectively. Pain was the most common clinical event observed among all patients. Over the 10-year follow-up period, 15 (4.5%) patients died. Hydroxyurea (HU) and red blood cell (RBC) transfusions were the most commonly used therapies. One hundred and thirty-one (39.0%) patients were diagnosed with sickle cell disease at the Nini Hospital; the remaining patients were referred to and subsequently followed-up at the Nini Hospital. Eighty-seven (66.0%) Nini Hospital-diagnosed patients experienced a VOC. Seventy-four (85.0%) of these patients with a VOC event required HU during follow-up. Patients with a VOC required more RBC transfusions, cholecystectomy, and splenectomy than non-VOC patients. The high disease burden observed in this population of sickle cell disease patients illustrates a continued, unmet need to both prevent and manage VOC events and other sickle cell disease-associated complications. [ABSTRACT FROM AUTHOR]

Giant cell arteritis (GCA) is a condition that can cause irreversible visual loss if untreated. While corticosteroids remain the mainstay of treatment to prevent visual loss, the type, dose, route, and duration of corticosteroid treatment of GCA remain controversial. Our study surveyed neuro-ophthalmologists to determine commonly prescribed dosages of corticosteroids for the treatment of GCA with or without visual loss. For patients with acute visual loss, 52% would use intravenous (IV), 46% would use IV or oral and 2% would use oral corticosteroids. Seventy-three per cent would use 500 to 1000 mg IV methylprednisolone in this group. For patients with GCA without acute visual loss, 67% would use the oral route, 30% would use IV or oral, and 3% indicated they would use IV route of treatment. Seventy-five per cent would use 1.0 to 1.5 mg/kg oral prednisone in this group. Our results suggest a majority but not a complete consensus for route and dose of corticosteroid treatment in GCA and confirm conventional recommendations for high dose IV corticosteroids for GCA with visual loss and lower dose oral regimens for GCA without visual loss. [ABSTRACT FROM AUTHOR]

Aim: There is a shortage of high-level evidence regarding periarticular fractures affect outcomes after MLKIs. The purpose of this study was to determine whether concomitant periarticular fractures with mutliligament knee injuries (MLKIs) predict worse patient-reported outcomes (PROMs) when compared to MLKIs without concomitant periarticular fractures after surgical repair and/or reconstruction. Materials and methods: Medical records of patients who sustained MLKIs from January 1, 2009 to June 1, 2014 were retrospectively reviewed. All patients aged 18–65 years with grade III injuries of two or more knee ligaments and 1-year minimum follow-up were included. Patients with injuries or surgeries to either knee before their MLKIs were excluded. Radiographs and computed tomography imaging obtained at the time of injury were used to detect concomitant periarticular fractures. Patients with and without concomitant periarticular fractures were matched on a 1:2 basis, respectively. Multiple PROMs were collected, including the IKDC Subjective Knee Form (IKDC-SKF), and Knee Injury and Osteoarthritis Outcome Score (KOOS). The independent t-test was used to compare PROMs between patients with and without periarticular fractures. Results: Eighteen patients (10 males, 8 females) with a mean follow-up of 4.0 years (range 1.1–8.6 years) were included in the final analysis, with six patients having MLKIs and concomitant periarticular fractures. Compared to patients with isolated ligamentous MLKIs (n = 12), patients with concomitant periarticular fracture (n = 6) demonstrated significantly worse outcomes on the IKDC-SKF (54.2 ± 13.3 vs. 74.0 ± 19.6, p = 0.04) and KOOS-Sports and Recreation subscale (41.2 ± 32.4 vs. 70.8 ± 19.4, p = 0.03). Conclusion: The presence of a periarticular fracture predicted significantly worse clinical outcomes in the setting of MLKI. These findings may be useful in determining the prognosis of MLKI with concomitant periarticular fractures treated with surgical repair and/or reconstruction. [ABSTRACT FROM AUTHOR]

Background: Serious bloodstream infections (BSIs) are often caused by Gram‐negative (GN) bacteria in hospitalized patients. Treatment of these infections has been further complicated by the continued rise and spread of drug‐resistant pathogens, including carbapenem resistant (CR) strains of Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Methods: This retrospective cohort analysis used real‐world data from a large United States hospital‐based database to examine the association between key clinical outcomes and different lengths of time to appropriate treatment between October 2010 and September 2015. Results: Of 40,549 patients with GN‐BSIs who were identified, 1117 (2.8%) had a CR GN‐BSI. Overall, outcomes of hospitalized adult patients with GN‐BSIs incrementally worsened the longer appropriate therapy was delayed. Patients with CR GN‐BSIs had a median infection‐associated length of stay (LOS) of 8, 9, 10, and 13 days, whereas patients with CS GN‐BSIs had a median infection‐associated LOS of 6, 7, 8, and 11 days for patients with days to appropriate therapy of 0, 1–2, 3–4, and ≥ 5 days, respectively. Among patients with CR GN‐BSIs, the percentage of patients discharged home was 38%, 33%, 35%, and 31%, whereas in patients with CS GN‐BSIs, the percentage of patients discharged home was 58%, 53%, 48%, and 43% for patients with days to appropriate therapy of 0, 1–2, 3–4, and ≥ 5 days, respectively. Conclusion: The findings from this study highlight the clear need to deliver appropriate therapy more expeditiously in patients with CS and CR GN‐BSIs. [ABSTRACT FROM AUTHOR]

There are limited data available regarding the management of oligometastatic squamous cell carcinoma of the head and neck (SCCHN) patients, and no consensus guidelines are available. The objective is to review the available literature for the management of oligometastatic SCCHN. Articles were selected from English Medline literature between 1995 and 2018, searched by using the keywords: oligometastatic SCCHN/metastasectomy/stereotactic body radiation treatment (SBRT). With the available data, oligometastatic SCCHN patients appear to behave differently and tend to have a better prognosis than those with widespread metastases. Retrospective evidence suggests that the aggressive treatment of the primary disease and local treatment of the metastatic sites improves survival in oligometastatic SCCHN at diagnosis. The definitive treatment of the distant metastatic sites using metastasectomy or SBRT correlates with better survival in oligorecurrent patients. Oligometastatic SCCHN patients may have a better prognosis if treated aggressively. [ABSTRACT FROM AUTHOR]

Gamma Knife Icon is the latest version of the Gamma Knife - a stereotactic radiosurgery instrument known for its accuracy and efficiency in treating disorders and lesions of the brain. As an alternative to surgery the Icon device enables the treatment of patients immobilized not only in a traditional frame but also in a customized "face mask." Mask-based treatments are convenient and permit delivery of multifraction treatments that are suitable for larger lesions (>3cm/10cc) and lesions abutting critical brain structures, which would otherwise be unsuited for single-fraction treatment. Also, on-board cone beam CT capability and infra-red camera incorporation increase confidence in the precision of treatment deliver): The Icon increases the flexibility of the treatment process while ensuring the same level of daily accuracy. In this article, we discuss the unique capabilities of the Icon that make it a complete intracranial stereotactic radiation treatment solution and share our experience with its use at the University of Mississippi Medical Center (UMMC) over the past two years. [ABSTRACT FROM AUTHOR]

Object: To compare the consistency of the agreement between the Convolution and TMR10 algorithms using a homogeneous phantom and to identify target characteristics that lead to large changes in target isodose coverage when the Convolution algorithm is used in GammaPlan as opposed to the TMR10 algorithm. Methods: The IROC phantom end-to-end test was performed and RTDose for both the TMR10 and Convolution algorithm were submitted for comparison to the measurement. Treatment plans for 16 patients and 26 different targets were retrospectively re-calculated with the Convolution algorithm when originally planned with the TMR10 algorithm. Multivariate regression was used to find statistically significant predictors of loss in target prescription isodose coverage. Results: Both algorithms agreed well with the IROC TLD measurement (within 1%) and slightly better agreement was seen in the film analysis for the Convolution algorithm. After multivariate regression, small target volumes, < 1cm from air cavity, and minimum dose to target were potential predictors of large percentage loss of prescription isodose coverage (p = 0.049, 0.026, and 0.002, respectively). Conclusion: Convolution and TMR10 appear to be equivalent in homogeneous situations. Some target characteristics have been identified that might be indications for use of the Convolution algorithm in clinical practice. [ABSTRACT FROM AUTHOR]

Probiotics are defined as live microorganisms which, when administered in appropriate amounts, confer a health benefit to the host. Although these organisms are naturally present in food and water, they can also be deliberately added to some foods because of their beneficial effects for human health. The potential application of probiotics for oral health has recently attracted the attention of several teams of researchers. However, only a few clinical studies have been conducted so far, and the results to date suggest that probiotics could be useful in preventing and treating oral infections, including dental caries, periodontal disease and halitosis. This article summarises the currently available data on the potential benefits of probiotics for oral health. [ABSTRACT FROM AUTHOR]

Probiotics are defined as live microorganisms which, when administered in appropriate amounts, confer a health benefit to the host. Although these organisms are naturally present in food and water, they can also be deliberately added to some foods because of their beneficial effects for human health. The potential application of probiotics for oral health has recently attracted the attention of several teams of researchers. However, only a few clinical studies have been conducted so far, and the results to date suggest that probiotics could be useful in preventing and treating oral infections, including dental caries, periodontal disease and halitosis. This article summarises the currently available data on the potential benefits of probiotics for oral health. [ABSTRACT FROM AUTHOR]

The inter-relationship between periodontal and endodontic disease has aroused much speculation, confusion and controversy. Pulpal and periodontal problems are responsible for more than 50% of tooth loss today. The prognosis of a true combined lesion is often poor or even hopeless, especially when there is extensive periodontal destruction. The present report describes the use of platelet-rich fibrin (PRF) gel and membrane in combination with a bone graft for treating a tooth with a combined periodonticendodontic lesion. The tooth was endodontically and periodontally treated. Clinical and radiographic follow-up was performed after 6 and 12 months. After 1 year, the absence of a interradicular lesion, pain and swelling along with tooth stability and adequate radiographic bone fill indicated a successful outcome. The success of treating a combined periodontic-endodontic lesion depends on patient cooperation, restorability and economics, which help in acting on treatment decisions. [ABSTRACT FROM AUTHOR]

Introduction: Although it is well known from cadaveric and biomechanical studies that transtibial femoral tunnel (TT) positioning techniques are associated with non-anatomic tunnel positions, controversial data exist as so far no clinical differences could have been found, comparing transtibial with anteromedial techniques (AM). The purpose of the study was to analyze if graft failure following TT ACL reconstruction was more commonly associated with non-anatomic tunnel position in comparison with the AM technique. We hypothesized that, compared to AM techniques, non-anatomic tunnel positions correlate with TT tunnel positioning techniques.Materials and Methods: A total of 147 cases of ACL revision surgery were analyzed retrospectively. Primary ACL reconstructions were analyzed regarding the femoral tunnel drilling technique. Femoral and tibial tunnel positions were determined on CT scans using validated radiographic measurement methods. Correlation analysis was performed to determine differences between TT and AM techniques.Results: A total of 101 cases were included, of whom 64 (63.4%) underwent the TT technique and 37 (36.6%) the AM technique for primary ACL reconstruction. Non-anatomic femoral tunnel positions were found in 77.2% and non-anatomical tibial tunnel positions in 40.1%. No correlations were found comparing tunnel positions in TT and AM techniques, revealing non-anatomic femoral tunnel positions in 79.7 and 73% and non-anatomic tibial tunnel positions in 43.7 and 35.1%, respectively (p > 0.05).Conclusions: Considerable rates of non-anatomic femoral and tibial tunnel positions were found in ACL revisions with both transtibial and anteromedial femoral drilling techniques. Despite the potential of placing tunnels more anatomically using an additional AM portal, this technique does not ensure anatomic tunnel positioning. Consequently, the data highlight the importance of anatomic tunnel positioning in primary ACL reconstruction, regardless of the applied drilling technique. [ABSTRACT FROM AUTHOR]

Purpose: In medial patellofemoral ligament (MPFL) reconstruction, it remains controversial whether more accurate femoral tunnel positioning is correlated with improved clinical outcomes. The purpose was to verify the accuracy of methods for evaluating tunnel positioning, one of which is the use of postoperative radiographs, in determining the femoral tunnel position following MPFL reconstruction and to compare the variability of tunnel positions to the intraoperatively documented positions on a true-lateral view.Methods: Seventy-three consecutive MPFL reconstructions were prospectively enrolled. Femoral tunnel positions were intraoperatively determined using fluoroscopy to obtain true-lateral radiographs. Postoperatively, lateral radiographic images were taken. Seven independent radiologists and seven independent orthopaedic knee surgeons evaluated the femoral tunnel position and amount of malrotation for each radiograph. Deviations from the Schoettle's point were measured and repeated after 4 weeks. Intraobserver and interobserver analyses of variance were calculated to determine the reliability of measurements on both intraoperative and postoperative radiographs.Results: Fifty-six patients were included in the final analysis. Tunnel positions were unable to be identified on postoperative radiographs in 14% of cases on average, independent of the degree of radiograph rotation. Intraoperative images showed mean deviations from the tunnel position to the centre of Schoettle's point of 1.9 ± 1.4 mm and 1.6 ± 1.0 mm in anterior-posterior and proximal-distal direction, respectively. Postoperative radiographs showed mean anterior-posterior and deviations of 7.4 ± 4.4 mm and 8.9 ± 5.8 mm assessed by orthopaedic surgeons and 10.6 ± 6.3 mm and 11.6 ± 7.1 mm assessed by radiologists at first and repeated measurement, respectively. The mean proximal-distal deviations were 4.8 ± 4.4 mm and 6.5 ± 6.0 mm and 7.2 ± 6.3 mm and 8.1 ± 7.1 mm, respectively. Measurement of tunnel position on intraoperative fluoroscopic images was significantly different compared to postoperative radiographs for each of the 14 observers (p < 0.05). Significant intraobserver and interobserver differences between the first and repeat measurements for both orthopaedic surgeons and radiologists were observed (p < 0.05).Conclusion: Measurement of the femoral tunnel position on postoperative lateral radiographs is not an accurate or reliable method for evaluating tunnel position after MPFL reconstruction due to exposure, contrast, and malrotation of the radiograph from a true-lateral image. In contrast, intraoperative fluoroscopic control allows for a precise lateral view and correct tunnel positioning. Thus, postoperative radiographic images may be unnecessary for the evaluation of femoral tunnel positions, particularly when intraoperative fluoroscopy has been used.Study Design: Level II, prospective cohort study. [ABSTRACT FROM AUTHOR]

Object: The purpose of this study was to compare two methods of stereotactic localization in Gamma Knife treatment planning: cone beam computed tomography (CBCT) or fiducial. While the fiducial method is the traditional method of localization, CBCT is now available for use with the Gamma Knife Icon. This study seeks to determine whether a difference exists between the two methods and then whether one is better than the other regarding accuracy and workflow optimization. Methods: Cone beam computed tomography was used to define stereotactic space around the Elekta Film Pinprick phantom and then treated with film in place. The same phantom was offset known amounts from center and then imaged with CBCT and registered with the reference CBCT image to determine if measured offsets matched those known. Ten frameless and 10 frame‐based magnetic resonance imaging (MRI) to CBCT patient fusions were retrospectively evaluated using the TG‐132 TRE method. The stereotactic coordinates defined by CBCT and traditional fiducials were compared on the Elekta 8 cm Ball phantom, an anthropomorphic phantom, and actual patient data. Offsets were introduced to the anthropomorphic phantom in the stereotactic frame and CBCT's ability to detect those offsets was determined. Results: Cone beam computed tomography defines stereotactic space well within the established limits of the mechanical alignment system. The CBCT to CBCT registration can detect offsets accurately to within 0.1 mm and 0.5°. In all cases, some disagreement existed between fiducial localization and that of CBCT which in some cases was small, but also was as high as 0.43 mm in the phantom domain and as much as 1.54 mm in actual patients. Conclusion: Cone beam computed tomography demonstrates consistent accuracy in defining stereotactic space. Since both localization methods do not agree with each other consistently, the more reliable method must be identified. Cone beam computed tomography can accurately determine offsets occurring within stereotactic space that would be nondiscernible utilizing the fiducial method and seems to be more reliable. Using CBCT localization offers the opportunity to streamline workflow both from a patient and clinic perspective and also shows patient position immediately prior to treatment. [ABSTRACT FROM AUTHOR]

It has been widely accepted that periodontitis is a result of the host immune inflammatory response caused by various periodontal microorganisms leading to tissue degradation and bone resorption. One important mechanism of the inflammatory mediators present in periodontal tissue is the stimulation and formation of osteoclasts that are believed to be the major cell type responsible for bone resorption. This review article comprehensively explains the various molecular activities of osteoclasts and their role in periodontitis. [ABSTRACT FROM AUTHOR]