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Ganesan Baranidharan,1,2 Beatrice Bretherton,1,3 Richard G Feltbower,4 Jake Timothy,5 Almas Latif Khan,6,7 Ashok Subramanian,8 Mushtaq Ahmed,9 Tracey A Crowther,1,10 Helen Radford,10,11 Harun Gupta,12 Muthusamy Chandramohan,13 Douglas P Beall,14 Timothy R Deer,15 Thomas Hedman16 1Pain Management Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 2School of Medicine, University of Leeds, Leeds, UK; 3School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK; 4Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK; 5Department of Neuroscience, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 6Department of Spine Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 7Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK; 8Somerset Spinal Surgery Service, Musgrove Park Hospital, Taunton, UK; 9Department of Trauma and Orthopaedic Surgery, Dudley Group NHS Foundation Trust, Dudley, UK; 10Research & Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 11Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK; 12Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 13Radiology Department, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK; 14Comprehensive Specialty Care, Edmond, OK, USA; 15The Spine and Nerve Center of the Virginias, Charleston, WV, USA; 16Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USACorrespondence: Ganesan Baranidharan, Pain Management Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK, Email g.baranidharan@nhs.netPurpose: An early-stage, multi-centre, prospective, randomised control trial with five-year follow-up was approved by Health Research Authority to compare the efficacy of a minimally invasive, laterally implanted interspinous fixation device (IFD) to open direct surgical decompression in treating lumbar spinal stenosis (LSS). Two-year results are presented.Patients and Methods: Forty-eight participants were randomly assigned to IFD or decompression. Primary study endpoints included changes from baseline at 8-weeks, 6, 12 and 24-months follow-ups for leg pain (visual analogue scale, VAS), back pain (VAS), disability (Oswestry Disability Index, ODI), LSS physical function (Zurich Claudication Questionnaire), distance walked in five minutes and number of repetitions of sitting-to-standing in one minute. Secondary study endpoints included patient and clinician global impression of change, adverse events, reoperations, operating parameters, and fusion rate.Results: Both treatment groups demonstrated statistically significant improvements in mean leg pain, back pain, ODI disability, LSS physical function, walking distance and sitting-to-standing repetitions compared to baseline over 24 months. Mean reduction of ODI from baseline levels was between 35% and 56% for IFD (p< 0.002), and 49% to 55% for decompression (p< 0.001) for all follow-up time points. Mean reduction of IFD group leg pain was between 57% and 78% for all time points (p< 0.001), with 72% to 94% of participants having at least 30% reduction of leg pain from 8-weeks through 24-months. Walking distance for the IFD group increased from 66% to 94% and sitting-to-standing repetitions increased from 44% to 64% for all follow-up time points. Blood loss was 88% less in the IFD group (p=0.024) and operating time parameters strongly favoured IFD compared to decompression (p< 0.001). An 89% fusion rate was assessed in a subset of IFD participants. There were no intraoperative device issues or re-operations in the IFD group, and only one healed and non-symptomatic spinous process fracture observed within 24 months.Conclusion: Despite a low number of participants in the IFD group, the study demonstrated successful two-year safety and clinical outcomes for the IFD with significant operation-related advantages compared to surgical decompression.Keywords: lumbar spinal stenosis, surgical decompression, posterior lateral arthrodesis, patient reported outcomes, minimally invasive spine, interspinous fixation device

Introduction: Both knotted all suture anchors and metal anchors are used for arthroscopic Bankart repair. We retrospectively evaluated and compared clinical and functional outcomes after arthroscopic Bankart repair using the knotted all-suture anchors and knotted metal anchors. Materials and methods: In a retrospective cohort analysis, patients who underwent arthroscopic Bankart repair without any concomitant additional lesion repair using either all-suture anchors or metal anchors, between January 2015 and May 2018 were identified. Their pre- and post-operative functional and clinical outcomes were compared using Rowe and WOSI scores. The recurrence rate in the two groups was also compared. Results: A total of 41 patients in all suture anchors group and 47 in the metal anchors group were identified as per inclusion and exclusion criteria. The demographic profile of both groups was comparable. There was no significant difference in clinical and functional outcome between the two suture anchor groups as per Rowe (pre-operative 40.13+6.51 vs 38.09+6.24 and post-operative 2 years 93.28+7.09 vs 92.55+9.2) and WOSI (pre-operative 943.05+216.64 vs 977.55+165.46 and post-operative 2 years 278.21+227.56 vs 270.94+186.25) scores. There was a significant improvement in both the groups between pre-operative and post-operative ROWE and WOSI scores at 6 months and 2 years follow-up as compared to pre-operative scores (p

INTRODUCTION: An increased tibial tuberosity-trochlear groove (TTTG) distance is used for deciding a treatment plan in patello-femoral instability (PFI). The centre of the patellar tendon and the chondral trochlear groove can be directly visualised on MRI, and measured, giving the patellar tendontrochlear groove (PTTG) distance. A study was designed to compare the inter-rater and the test-retest reliabilities of PTTG and TTTG measurements in MRI of patients without PFI and in a group with PFI. MATERIALS AND METHODS: This cross-sectional reliability study was done on archival MRI films of 50 patients without patellar instability and 20 patients with patellar instability. TTTG and PTTG distances were independently measured by two orthopaedic surgeons and two radiologists. A hybrid PTTG measurement with bony landmarks on the femoral side and the patellar tendon landmark on the tibial side, was used to estimate the influence of the differences in the femoral and tibial landmarks on the difference in reliabilities. The intra-class correlation coefficient (ICC) was calculated for all four raters, as well as separately for each rater. RESULTS: The PTTG distance had a higher inter-rater reliability (ICC=0.86, 95% CI=0.79-0.92) compared to the TTTG distance (ICC=0.70, 95% CI=0.59-0.80) in patients without PFI. Similar trends were seen in patients with PFI (0.83 vs 0.66). The inter-rater reliability for the hybrid PTTG distance was found to lie in between the TTTG and PTTG. CONCLUSION: The MRI-based PTTG distance had better inter-rater reliability compared with the MRI-based TTTG distance.

Oleg F Sharifov,1 Thomas S Denney Jr,2 J Michael Wells,1,3,4 Gregory A Payne,1,4 Swati Gulati,1,3 Himanshu Gupta,5 Mark T Dransfield,1,3,4 Steven G Lloyd1,4 1Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA; 2Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA; 3UAB Lung Health Center, Birmingham, AL, USA; 4Birmingham VA Medical Center, Birmingham, AL, USA; 5Advanced Cardiovascular Imaging, Valley Medical Group, Paramus, NJ, USACorrespondence: Steven G LloydDepartment of Medicine, University of Alabama at Birmingham, 1808 7th Avenue South, BDB 201, Birmingham, AL 35294-0012, USATel +1 205 934 9736Fax +1 205 934 9730Email slloyd@uabmc.eduPulmonary hypertension (PH) is an important prognostic indicator in patients with chronic obstructive pulmonary disease (COPD); however, PH in these patients is typically mild-to-moderate severity and invasive testing is not typically utilized.1 Though echocardiography can be used to screen for PH, it has limited accuracy in measuring pulmonary artery (PA) pressure and often hindered by window limitations in COPD patients.2 Cardiovascular magnetic resonance (CMR) does not have window limitations and can accurately evaluate the right ventricular (RV) and PA function. Therefore, there is a growing interest in the use of CMR for the diagnosis and management of PH, including patients with lung diseases. Recently, we have validated a novel non-invasive CMR-derived parameter that, similar to impedance, reflects pulsatile and resistive properties of the PA.3 This approach relies on the principle that compliant PA vessel walls cause changes in the velocity profile as it travels through the PA over the cardiac cycle. The frequency-dependent relationship between the input and output velocity profiles is described by a velocity transfer function (VTF), which is the relationship between the frequency spectra of input and output velocity.3 In suspected PH patients who underwent right heart catheterization, we found that VTF correlates with invasive PA impedance and the mean high-frequency modulus (MHFM) of VTF correlates with the pulmonary vascular resistance (PVR) and RV remodeling.3 Moreover, MHFM >1 accurately predicted an increased PVR.3 We hypothesized that elevated MHFM of VTF, reflecting increased PVR and pulmonary vascular disease, would be associated with reduced exercise capacity measured by 6-mins walk distance (6MWD) in a COPD cohort.

The molecular underpinnings of HER2-low and HER2-0 (IHC 0) breast tumors remain poorly defined. Using genomic findings from 1039 patients with HER2-negative metastatic breast cancer undergoing next-generation sequencing from 7/2013-12/2020, we compare results between HER2-low (n = 487, 47%) and HER2-0 tumors (n = 552, 53%). A significantly higher number of ERBB2 alleles (median copy count: 2.05) are observed among HER2-low tumors compared to HER2-0 (median copy count: 1.79; P = 2.36e-6), with HER2-0 tumors harboring a higher rate of ERBB2 hemideletions (31.1% vs. 14.5%). No other genomic alteration reaches significance after accounting for multiple hypothesis testing, and no significant differences in tumor mutational burden are observed between HER2-low and HER2-0 tumors (median: 7.26 mutations/megabase vs. 7.60 mutations/megabase, p = 0.24). Here, we show that the genomic landscape of HER2-low and HER2-0 tumors does not differ significantly, apart from a higher ERBB2 copy count among HER2-low tumors, and a higher rate of ERBB2 hemideletions in HER2-0 tumors. HER2-low breast cancer has recently emerged as a targetable subset of breast tumors, for which the molecular landscape remains incompletely understood. Here, the authors use genomic data from 1039 patients to unveil and compare the genomic landscape of HER2-low and HER2-0 breast cancer. [ABSTRACT FROM AUTHOR]

The world we live in, is becoming more and more dependent on electrical energy, which, sadly, still heavily relies on outdated techniques involving the burning of fossil fuels. Fortunately, more and more people are accepting the fact that this system simply isn’t sustainable in the longer-run. Even if air pollution wasn’t a huge factor, the shortage of these resources is something that is bound to happen in the nearest future, and it would pose an impassable obstacle towards the future growth of mankind. Hence, importance of renewable energy is such an important trend for the future of mankind. At present, net AC meters are available for measurement of four quadrant energy, which is used at output of both on grid and off grid solar inverter. This meter can measure both, energy fed into the grid and energy utilize from the grid. However Energy generated by solar panel cannot be measured directly. Even in off grid inverter the present net meter cannot measure energy generated by solar panel. In case of DC micro grid, where DC energy is used/ consumed directly by the load, the present net meter cannot be used as they can be used in AC energy measurement only. With the launch and implementation of national energy saving and emission reduction policies in relation to distributed power supply by renewable power generation, the DC energy metering technology will become an inevitable trend, breaking the landscape dominated by AC in the field of electric energy metering. This paper describes introduction, block diagram [1], Hardware and software description for development of dc energy meter.

Renal allograft rupture (RAR) is a rare but lethal complication of renal transplantation. It potentially threatens graft and patient survival. Mostly graft nephrectomy is required, but graft repair can also be attempted in selected cases to salvage the graft. The exact pathogenesis of RAR is still not clear. Acute cellular rejection causes inflammatory reaction that leads to interstitial edema. Capsule tension due to edema leads to tension and tearing and may lead to RAR. COVID‑19 infection in patient on immunosuppression like post‑renal transplant is a worrisome disease with high morbidity and mortality. This posttransplant patient developed fever and decreased urine output, for which biopsy was done. On exploration, the graft was found to be ruptured. Graft salvage was tried with argon beam laser, surgical glue, and pressure but failed. The renal graft was then salvaged using buttressing rectus sheath graft in this COVID‑19 patient. [ABSTRACT FROM AUTHOR]

To determine the incidence and determinants of delayed graft function due to post-transplant acute tubular necrosis in live related donor renal transplantation. This is a retrospective study of 337 recipients of live related donor renal graft performed between1986 and 2006. Of these recipients, 24 (7.1%) subjects developed delayed graft function with no evidence of acute rejection, cyclosporin toxicity, vascular catastrophe or obstructive cause and had evidence of acute tubular necrosis (ATN Group). These subjects were compared with recipients (n= 313, 92.9%) who had no clinical or biochemical evidence of ATN. Mean age, and gender distribution of recipients was similar in the two groups (ATN group 35.7 ± 8.3, non-ATN group 34.3 ± 7.5, P= 0.43). Gender distribution of the recipients (men 279, 89.1% vs. 21, 87.5%, P= 0.80) as well as donors (women 221, 70.6% vs. 18, 75.0%, P= 0.75) was also similar. In ATN group as compared with non-ATN group the donor age was significantly greater (56.6 ± 8.3 vs. 46.6 ± 11.2 years, P< 0.0001). There was marginal difference in pre-operative systolic BP (154.5 ± 18.3 vs. 147.4 ± 20.2 mm Hg, P= 0.077) and significant difference in diastolic BP (87.8 ± 9.5 vs. 83.4 ± 11.4 mmHg, P= 0.041). Incidence of multiple renal arteries was similar (16.7% vs. 7.3%, P= 0.22). The warm ischemia time was significantly greater in ATN group (33.3 ± 6.2 min) as compared to non-ATN group (30.4 ± 5.7 min, P= 0.042). Duration of hospital stay was more in ATN group (19.9 ± 6.7 vs. 16.8 ± 8.4 days, P= 0.04) but there was no difference in 1 year survival (284 subjects, 90.7% vs. 21 subjects, 87.5%, P= 0.873). This study shows that greater donor age, higher baseline diastolic BP and greater warm ischemia time are major determinants of delayed graft function due to acute tubular necrosis after related donor renal transplantation.