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Core decompression (CD) is beneficial in the early stage of osteonecrosis of the femoral head (ONFH). Adjunctive bone marrow derived cell therapies (BMDCT) have been advocated which potentially aid the regenerative process.This study was conducted to determine potential benefit of CD + BMDCT in ONFH, in terms of disease progression, conversion to arthroplasty (primary outcomes), and functional outcomes and complication rates (secondary outcomes).A systematic review of literature was performed on 3 databases. Studies reporting CD + BMDCT (intralesional instillation) in ONFH, with a minimum follow up of 1 year and reporting the pre-defined outcome measures were included in the review. Meta-analysis consisted of two different arms: a comparative arm, to compare CD + BMDCT to CD alone, and a non-comparative meta-analysis arm, to determine pooled rates of disease progression, conversion to arthroplasty and complication rates.A total of 18 studies were included in the systematic review. CD + BMDCT had lower rates of disease progression (OR 0.19 [95% CI, 0.09, 0.40]) and conversion to arthroplasty (OR 0.20 [95% CI, 0.11, 0.40]) as compared to CD alone. Functional score (MD = -7.07 [95% CI, -12.28, -1.86]) and visual analog scale also showed better improvement with the use of CD + BMAC (MD = -10.39 [95% CI, -12.87, -7.90]). Increasing age and post-collapse stage at presentation were noted to have an adverse effect on the outcomes.CD + BMDCT was found to decrease disease progression and conversion to arthroplasty, and was noted to have better functional outcome scores as compared to CD alone.

In absence of frank purulence, wound cultures represent 'gold-standard' for diagnosis of fracture related infection (FRI). However, these are time-intensive, and may be falsely negative, necessitating the need for accurate and rapid biomarker-based diagnosis. We conducted this study to determine the accuracy of 3 wound-based biomarkers for the diagnosis of FRI.This was a prospective cohort study on adult patients who underwent an operative procedure for an upper or lower limb fracture. Wound fluid levels of alpha-defensin (AD), neutrophil elastase (NE) and IL-6 were evaluated on post-operative day 2, and patients were followed up for one month. Patients were categorized as cases (FRI) or controls (no FRI), on the basis of the consensus definition of FRI. Univariate analysis, along with receiver operating characteristic (ROC) analysis was performed.48 patients were included. AD levels showed a 2.6-fold elevation in cases (n = 26, Median = 23.74 µg/ml) as compared to controls (n = 22, Median = 8.78 µg/ml). The area under the curve for this variable was 0.71 (95% Confidence Intervals = 0.56 - 0.86). The levels of NE and IL-6 were not significantly different between cases and controls.Wound AD levels are significantly elevated in patients with FRI. However, these results need to be validated in a larger cohort of patients before it can be used as a biomarker of FRI.

Trimalleolar fractures are generally considered to have inferior outcomes among ankle injuries. Historically, emphasis was placed on the size of the posterior malleolar fracture (PMF) to guide surgical decision-making and predict outcomes. Recent studies have suggested that the morphology of the PMF fragment is more important than its size. The aim of this systematic review was to determine if the outcomes of trimalleolar fractures depend on the morphology of the PMF as per the Haraguchi classification system after surgical fixation.A systematic literature search was conducted in the electronic databases of PubMed, Embase, Scopus, and Ovid. Title and abstracts were screened, and data from eligible studies were extracted. Meta-regression and pooled analysis was performed using appropriate computer software.11 studies with 597 patients were included in the final analysis. Pooled mean AOFAS score was 87.43 (95% CI 84.24-90.62) after a mean follow-up of 31.6 months. Univariate and multivariate meta-regression analysis demonstrated that as the percentage of Haraguchi type 1 patients increased, there was a statistically significant improvement in outcome scores. A similar trend was noted for Haraguchi type 3 fractures, and a reverse trend was observed for Haraguchi type 2 injuries, although neither were statistically significant.Our review suggests that the outcomes of trimalleolar fractures after surgical fixation may depend on the morphology of the PMF, with Haraguchi type 1 fractures having overall superior functional outcomes than Haraguchi type 2 and 3 injuries. Future studies need to done to conclusively prove or refute these findings.

The role of subchondral bone as a key mediator in pathogenesis of osteoarthritis (OA) is emerging and various injectable modalities are being tried to address the subchondral pathology. Intraosseous (IO) infiltrations of PRP is biological way of addressing the pathology. This review aimed to explore the role of IO PRP in OA knees.A systematic literature search was conducted on the electronic databases of PubMed, Embase, Scopus, Web of Science and Ovid for relevant articles on IO PRP with a predefined search strategy. Data from eligible studies were extracted and was analyzed.There were only five studies on the study topic which included 112 patients (112 knees) who received IO PRP injection. IO PRP was associated with significant improvements in VAS, KOOS and WOMAC scores. The most commonly reported complication was pain at injection site. Meta-analysis revealed that combined intraarticular (IA) and IO PRP were associated with significantly better WOMAC scores, compared to only IA PRP. However, VAS and KOOS scores were equivocal.IO PRP infiltration for OA knees is safe and effective and results in improved patient-reported outcome scores based on the current limited literature. However, its added advantage over only IA PRP is not well established and clear due to limited available published data.

Slurry erosion usually results in the form of damage to the materials of different components having underwater working domain. Numerous industries have suffered due to this kind of wear resulting in frequent breakdowns demanding repeated financial assistance and poor productivity. Properties and tribo-performance of materials related to distinct slurry applications play a significant role in arresting the slurry erosion wear. Slurry erosion depends on different parameters such as impact velocity, impingement angle, shape and size of erodent, slurry concentration and so on. These parameters differ from one application to another and accordingly, specific materials are selected knowing the extent and severity of slurry erosion wear. In the last decade, many authors studied parametrically the tribo-slurry erosion performance of materials, few of them correlated their investigations to the actual in situ conditions of applications. Various authors have analyzed the effect of operating parameters on the mechanism of erosion and conducted the comparative studies of different materials. Many of the investigators attempted to improve the properties and tribo-slurry erosion performance of materials through surface modification techniques; coating, reinforcement, heat treatment, thermo-mechanical process etc. This review is an effort to covers all such kind of explorations.

Objectives: Bibliometrics is being used to assess the quantity and quality of scientific research output. This study is aimed to evaluate the worldwide research productivity in the field of platelet-rich plasma (PRP) use in osteoarthritis (OA) knee. Materials and Methods: Scopus and PubMed databases were searched to identify published articles on PRP and OA knee. The contributions of authors, countries, institutions, and collaborations across the world were analyzed. The top journals publishing in this field were analyzed for the citations and other parameters. Results: Total publications on this topic were 1309 in Scopus and 921 in PubMed, and the yearly average of publication numbers has seen a steady increase over the past 10 years. Top journal in terms of number of articles and citations was Arthroscopy and AJSM, respectively. Osteoarthritis and Cartilage published the maximum preclinical studies. Kon E emerges to be the leading author in both the databases. Original clinical research articles (15.31% and 22.15%) are less compared to review articles (34.6% and 28.3%) in both PubMed and Scopus, respectively. The largest number of articles in this field was from the USA and six of the top 10 productive universities were also from the USA. Conclusion: There has been a rapid increase in the scientific research productivity in the past 10 years and this topic has gained attention in the recent past. There is a need for more clinical trials in this field.

We empirically study whether firms improve their quality based on online customer reviews in a dynamic quality environment. We do so by analyzing the U.S. hotel industry using data from two major online review platforms: Tripadvisor and Expedia. Using management response as a proxy for whether hotels pay attention to consumer reviews and a difference-in-differences strategy, we find that hotels that are more likely to pay attention to reviews increase their ratings more than hotels that do not do so. Moreover, we show that low-rated hotels experience larger gains as they have more margin of improvement than high-rated hotels. We reinforce these findings by using natural language processing algorithms and show that hotels that respond to reviews improve on issues that are frequently mentioned in their reviews. Overall, our results suggest that online reviews provide a useful source of information for firms that can help them improve their quality.

Diverse mouse strains have different health and life spans, mimicking the diversity among humans. To capture conserved aging signatures, we studied long-lived C57BL/6J and short-lived NZO/HILtJ mouse strains by profiling transcriptomes and epigenomes of immune cells from peripheral blood and the spleen from young and old mice. Transcriptional activation of the AP-1 transcription factor complex, particularly Fos, Junb, and Jun genes, was the most significant and conserved aging signature across tissues and strains. ATAC-seq data analyses showed that the chromatin around these genes was more accessible with age and there were significantly more binding sites for these TFs with age across all studied tissues, targeting pro-inflammatory molecules including Il6. Age-related increases in binding sites of Jun/Fos factors were also conserved in human peripheral blood ATAC-seq data. Single-cell RNA-seq data from the mouse aging cell atlas Tabula Muris Senis showed that the expression of these genes increased with age in B, T, NK cells, and macrophages, with macrophages from old mice expressing these molecules more abundantly than other cells. Functional data showed that upon myeloid cell activation via poly(I:C), the levels of c-JUN protein and its binding activity increased more significantly in spleen cells from old mice compared to cells from young mice. In addition, upon activation, old cells produced more IL6 compared to young cells. In sum, we showed that the aging-related transcriptional activation of Jun/Fos members of the AP-1 complex is conserved across immune tissues and long- and short-living mouse strains, possibly contributing to increased inflammation with age.

Introduction: Dysplasia epiphysealis hemimelica, also known as Trevor disease, is a rare skeletal development disorder of childhood, characterized by asymmetric growth of the epiphyseal cartilage in childhood. The disease can be locally aggressive at the ankle, and can result in deformity or instability. We present a case of Trevor disease involving the lateral aspect of distal tibia and talus in a 9-year-old patient, and of highlight its clinical and radiological presentation, treatment, and outcomes. Case Report: A 9-year-old male presented with a painful swelling over the lateral aspect of the dorsum of right ankle and foot swelling for the past 1.5 years. Radiographs and computed tomography scan revealed exostoses arising from the lateral distal tibial epiphysis and talar dome. Skeletal survey revealed cartilaginous exostoses in distal femoral epiphyses, confirming the diagnosis. Wide resection was done, and the patients were asymptomatic and recurrence-free at 8 months follow-up. Conclusion: Trevor disease around the ankle can have an aggressive course. Prompt recognition and timely surgical excision can prevent morbidity, instability, and deformity.

BackgroundThe incidence of intertrochanteric femur fracture (IFF) in the elderly has increased with increased life expectancy globally. These fractures require surgeries at the earliest to bring them out of bed and minimize the complications of recumbency, like decubitus ulcers, decreased cardiopulmonary reserves, and thromboembolic events. Dynamic hip screws and Cephalomedullary nails (CMN) are both considered adequate for the internal fixation of the stable IFF with comparable stability and outcomes. However, CMNs are considered to have better results in unstable IFF fixation.ObjectiveTo compare the outcomes of internal fixation of short CMN versus long CMN of IFF in the elderly by analyzing the evidence from the current literature.MethodsA systematic review and meta-analysis will be performed in accordance with the PRISMA guidelines. A primary search of Medline, Embase, Scopus, and Cochrane Library databases will be conducted using a pre-defined search strategy. The studies of any design in the English language will be included, which have compared the outcomes of the internal fixation of short CMN versus long CMN of the IFF and reported at least one primary or secondary outcome of interest.Studies that did not compare the outcomes of the internal fixation of short CMN versus long CMN of the IFF, conference abstracts, posters, case reports, book chapters, technical tips, review articles, biomechanical studies, cadaveric studies, and the articles not in the English language will be excluded.Both qualitative and quantitative analyses will be performed. A qualitative analysis will be performed using appropriate tables and diagrams. Wherever feasible, quantitative analysis will be done with the appropriate software. The risk-of-bias assessment for non-randomized comparative studies will be done using the MINORS tool, and the Cochrane Collaboration’s risk-of-bias tool will be used for randomized control trials (RCT).

Involvement of toe phalanges by giant cell tumor (GCT) is extremely rare; tumors in these locations tend to be aggressive. Whereas aggressive GCTs of the distal phalanx may be managed successfully by en-bloc resection without reconstruction or amputation, management of these lesions, when they involve the proximal phalanx, can be challenging. We present a Campannaci grade III GCT of the hallucal proximal phalanx in a 14-year old girl that had breached into the dorsal soft tissues and the metatarso-phalangeal joint. Wide local resection of the proximal phalanx along with reconstruction arthrodesis with an autologous, non-vascularized fibular strut graft was performed. There was no recurrence at 3 years of follow-up. The patient had an excellent functional outcome. To the best of our knowledge, this is the first case reporting the outcomes of fibular strut arthrodesis for salvage of GCT of the hallucal proximal phalanx.

Background Intraoperative imaging is frequently made use of in Orthopaedic surgery. Historically, conventional 2-dimensional fluoroscopy has been extensively used for this purpose. However, 2D imaging falls short when it is required to visualise complex anatomical regions such as pelvis, spine, foot and ankle etc. Intraoperative 3D imaging was introduced to counter these limitations, and is increasingly being employed in various sub-specialities of Orthopaedic Surgery. Objectives This review aims to outline the clinical and radiological outcomes of surgeries done under the guidance of intraoperative 3D imaging and compare them to those done under conventional 2D fluoroscopy. Methods Three electronic databases (PubMed, Embase and Scopus) were searched for relevant studies that directly compared intraoperative 3D imaging with conventional fluoroscopy. Case series on intraoperative 3D imaging were also included for qualitative synthesis. The outcomes evaluated included accuracy of implant placement, mean surgical duration and rate of revision surgery due to faulty implants. Results A total of 31 studies from sub-specialities of spine surgery, pelvi-acetabular surgery, foot and ankle surgery and trauma surgery, having data on a total of 658 patients were analysed. The study groups which had access to intraoperative 3D imaging was found to have significantly increased accuracy of implant positioning (Odds Ratio 0.35 [0.20, 0.62], p = 0.0002) without statistically significant difference in mean surgical time (p = 0.57). Analysis of the studies that included clinical follow up showed that the use of intraoperative 3D imaging led to a significant decrease in the need for revision surgeries due to faulty implant placement. Conclusion There is sufficient evidence that the application of intraoperative 3D imaging leads to precise implant positioning and improves the radiological outcome. Further research in the form of prospective studies with long term follow up is required to determine whether this superior radiological outcome translates to better clinical results in the long run.

Access to a platform's services often requires consumers to use a complementary hardware product or service, e.g., Internet service is needed to access the YouTube platform. Typically, such access products are provided by third-party firms. More recently, however, some major platforms like Google have themselves ventured into providing these access products. For example, Google Fiber provides access to YouTube. In this paper, we examine the effect of a platform's entry into an access product market when the profits from the platform's advertising business depend upon the quality of the access products. We develop a theoretical model to study this context and find that such an entry by the platform (i) can lead the platform to provide a higher quality access product than the third-party firms at a lower price, (ii) may, in contrast to the entry by a third-party firm, lead to higher-quality access product by both the platform as well as the firms, (iii) improves the platform's profits due to increased advertising revenue and/or additional profits from the access product sales, and (iv) increases consumer surplus even though the platform becomes more dominant due to its entry into the access product market. All the results are driven by the positive association between the platform's advertising profits and the quality of access products in the market.

Lisfranc injuries may occur in the form of fracture-dislocations or pure ligamentous dislocations or subluxations. These innocuous appearing injuries have the potential for significant morbidity and long-term sequelae resulting in permanent deformities. Ligamentous subluxations account for 20% of these injuries and cases with partial incongruity are amenable to percutaneous fixation. In this article, we present step-by-step percutaneous fixation of these injuries as well as the post-operative management.

Calcaneus malunion is a common sequela to calcaneal fractures and is a cause of pain and discomfort. Multiple approaches have been described to address the subtalar joint and the lateral wall. Type 2 malunion is the most commonly encountered problem, and is usually addressed by the sinus tarsi approach. This has some limitations, as exposure for lateral wall excision beneath the peroneal tendons maybe a problem. We have slightly modified the sinus tarsi approach by a more horizontal skin incision, which may even be extended proximally by 1–2 cm; this allows access to the lateral wall on either side of the peroneal tendons. The approach is described in detail.

Severe coronavirus disease 2019 (COVID-19) is characterized by systemic inflammation and can result in protracted symptoms. Robust systemic inflammation may trigger persistent changes in hematopoietic cells and innate immune memory through epigenetic mechanisms. We reveal that rare circulating hematopoietic stem and progenitor cells (HSPC), enriched from human blood, match the diversity of HSPC in bone marrow, enabling investigation of hematopoiesis and HSPC epigenomics. Following COVID-19, HSPC retain epigenomic alterations that are conveyed, through differentiation, to progeny innate immune cells. Epigenomic changes vary with disease severity, persist for months to a year, and are associated with increased myeloid cell differentiation and inflammatory or antiviral programs. Epigenetic reprogramming of HSPC may underly altered immune function following infection and be broadly relevant, especially for millions of COVID-19 survivors.One Sentence SummaryTranscriptomic and epigenomic analysis of blood reveal sustained changes in hematopoiesis and innate immunity after COVID-19.Graphical Abstract

BackgroundPosterior malleolus (PM) fractures have historically been classified according to the size of the fragment, to study the need for surgical fixation and to assess clinical outcomes. Recent research has suggested that the morphology of the PM fragment is of more relevance than its size.ObjectivesThis systematic review aims to determine if the size of the PM fragment influences clinical outcomes of trimalleolar fractures after surgical fixation, and if so, to find out which fracture type has the best outcomes.MethodsThis systematic review will be conducted according to the PRISMA guidelines. A literature search will be conducted on the electronic databases of PubMed, Embase, Scopus and Ovid with a pre-determined search strategy. A manual bibliography search of included studies will also be done. Original articles in English that have relevant data on the outcomes of PM fractures and its morphology will be included. Data will be extracted from included studies and analysis carried out with the help of appropriate software.

Increased inflammation with age (i.e., inflammaging) is a hallmark of aging conserved in human and mice, but the underlying mechanisms are poorly understood, partially because a systematic comparative study of mouse and human immune system aging is lacking. We uncovered epigenomic/transcriptomic signatures of aging in spleen and peripheral blood lymphocytes from young (3 months) and old (18 months) mice in two strains: C57BL/6J (long-lived) and NZO/HILtJ (short-lived) and compared these to the aging signatures of human peripheral blood cells. The most predominant and conserved genomic signature of aging in human and mice tissues studied here was the epigenetic activation of several AP-1 complex members (Fos, Fosl2, Junb, Jund). Footprinting analyses showed that these transcription factors ‘bind’ more frequently with age and target pro-inflammatory and effector molecules, including the pro-inflammatory Il6. Analysis of single cell RNA-seq data from the mouse aging cell atlas (Tabula Muris Senis) revealed that AP-1 activation with age is a common feature across all immune cell types within spleens, yet macrophages express these molecules more often than other cells. Functional assays confirmed that spleen cells from older animals have increased c-JUN protein binding and increased IL6 production upon myeloid cell activation using poly(I:C) via TLR3. Western blot data revealed that c-JUN activation with age is not post-transcriptional since its phosphorylation levels were similar between young and old mice. Together, these data established that Jun and Fos families in the AP-1 complex are transcriptionally activated with age and target pro-inflammatory molecules and aging-related increases in the binding of these proteins likely modulate increased inflammation with age.

Background: This is the first study to evaluate the pattern of adverse events related to medical devices in India. We aimed to evaluate medical device adverse events (MDAEs) reported at a tertiary level teaching hospital in northern India.Methods: This descriptive study was conducted ambispectively at PGIMER, Chandigarh. We used the medical device risk classification given by the Indian regulatory authority which was framed in line with the recommendation of the Global Harmonization Task Force. The prospective study (PS) was done from January 2020 to December 2020 with a concurrent retrospective study (RS) proceeding to three years so as to learn more about the reporting culture, demographics, risk class of devices and the type of adverse events.Result. We obtained 224 MDAE in the prospective study and identified 413 MDAE in retrospective study. Reporting culture of retrospective adverse events to the national materiovigilance programme of India (MvPI) was negligible. Marginally increased incidence of MDAE reported among male patients (PS; 52%, RS; 57%) and age group between 21-30 years (PS; 19.1%, RS; 23.2%) in both studies. Fewer number of MDAEs were also reported from infants (7.5%) and the elderly (6.9%) population. Regarding risk class, MDAEs were frequent in low to moderate risk devices (Class B: 66%) in the prospective study, while it was documented only for high-risk devices (Class C: 51% & Class D: 49%) in the retrospective study. However, serious adverse events (SAEs) were equally prevalent among moderate to high-risk devices (Class B: 33%, C: 34% &D: 33%). An increased frequency of SAE was observed among non-notified medical devices (60.4%). Concerning reporting culture, nurses reported the majority of MDAEs (65%). Overall 14% of the incidents were documented as near-miss events.Conclusion: Medical devices elicit adverse events irrespective of their risk class, notification status and patient demographic factors. Escalated reporting of MDAEs by surgeons and biomedical engineers is recommended at India.

Type 1 diabetes is the prototypical CD4 T cell–mediated autoimmune disease. Its genetic linkage to a single polymorphism at position 57 of the HLA class II DQβ chain makes it unique to study the molecular link between HLA and disease. However, investigating this relationship has been limited by a series of anatomical barriers, the small size and dispersion of the insulin-producing organ, and the scarcity of appropriate techniques and reagents to interrogate antigen-specific CD4 T cells both in man and rodent models. Over the past few years, single-cell technologies, paired with new biostatistical methods, have changed this landscape. Using these tools, we have identified the first molecular link between MHC class II and the onset of type 1 diabetes. The translation of these observations to man is within reach using similar approaches and the lessons learned from rodent models.

Unstable intertrochanteric femoral fractures in the elderly require either fixation or joint sacrificing surgery; proximal femoral nail (PFN) and bipolar hemiarthroplasties (BPH) are the most common interventions. PFN is considered to be the ideal construct for these fractures; however, the usage of hemiarthroplasties to facilitate earlier mobilization has been on a rise. Currently there is no consensus on the superiority of one of these two techniques over the other and the present review was done to determine this. Is PFN a better alternative to BPH for unstable intertrochanteric femur fractures in the elderly? The present systematic review and meta-analysis was conducted to determine the superiority of PFN over BPH by comparing the primary outcomes like mortality, Harris Hip scores (HHS), complications, and re-operations. Additionally, secondary outcomes like blood loss, duration of surgery, and period of hospital stays were also compared. Three databases of PubMed, EMBASE, and SCOPUS were searched for relevant articles that directly compared PFN and BPH in unstable intertrochanteric femur fractures in the elderly. We analyzed a total of seven studies published between the years 2005 to 2017. There were four retrospective and three prospective randomized controlled studies. The number of patients in these studies ranged from 53 to 303. There was a significant difference in HHS between two groups with standard mean difference of − 0.51 (range − 0.67 to −0.36), favouring the PFN group. The rate of mortality was higher in the BPH group with odds ratio of 2.07 (range 1.40–3.08). Implant-related complications like fractures and subsidence were more in BPH group but this was not significant. Mean surgical time (standard mean difference 2.19) and blood loss (3.75) were significantly less in the PFN group. The duration of hospital stay was also found to be significantly less in the PFN group (2.66). Proximal femoral nails are superior to bipolar hemiarthroplasties for unstable intertrochanteric femoral fractures in the elderly. PFN imparts better functional outcomes and has lower rates of overall mortality. Additionally it is faster surgery, with lesser blood loss contributing to better results.

We performed bibliometric analysis of the research papers published on clinical cervical spondylotic myelopathy (CSM) in the last 50 years. We extracted bibliometric data from Scopus and PubMed from 1970 to 2020 pertaining to clinical studies of CSM. The predominant journals, top cited articles, authors, and countries were identified using performance analysis. Science mapping was also performed to reveal the emerging trends, and conceptual and social structures of the authors and countries. Bibliometrix R-package was deployed for the study. The total numbers of clinical studies available in PubMed and Scopus were 1,302 and 3,470, respectively. The most cited article was published by Hilibrand AS, as observed in Scopus. Regarding the conceptual structure of the research, two main research themes were identified, one involving symptomatology, scientific-scale-based objective evaluation of symptoms, and surgical removal of the offending culprit, while the other was based on patho-etiology, relevant diagnostic modalities, and the surgery commonly performed for CSM. In terms of emerging trends, in recent times there is an increasing trend of scale-based objective evaluations, along with investigations of advanced nonoperative management. The United States is the most productive country, whereas Canada tops the list for inter-country collaboration. The trend of research showed a shift toward noninvasive procedures.

Introduction: Orthopedic surgical procedures (OSPs) are known to generate bioaerosols, which could result in transmission of infectious diseases. Hence, this review was undertaken to analyse the available evidence on bioaerosols in OSPs, and their significance in COVID-19 transmission. Methods: A systematic review was conducted by searching the PubMed, EMBASE, Scopus, Cochrane Library, medRxiv, bioRxiv and Lancet preprint databases for studies on bioaerosols in OSPs. Random-effects metanalysis was conducted to determine pooled estimates of key bioaerosol characteristics. Risk of bias was assessed by the RoB-SPEO tool; overall strength of evidence was assessed by the GRADE approach. Results: 17 studies were included in the systematic review, and 6 in different sets of meta-analyses. The pooled estimate of particle density was 390.74 µg/m3, Total Particle Count, 6.08 × 106/m3, and Microbial Air Contamination, 8.08 CFU/m3. Small sized particles (

BackgroundIntraoperative 3D imaging is a valuable tool to visualise complex anatomical structures and position implants optimally. This is an emerging technology and there is a paucity in literature of articles describing the same.ObjectivesThis systematic review aims to compare the outcome of surgeries done under 3D imaging to those done under 2D fluoroscopy by analysing the evidence in literature.MethodsA systematic review will be conducted adhering to the PRISMA guidelines. Electronic databases of PubMed, Embase and Scopus will be searched with a pre-defined search string. A manual search will also be conducted on the references of the included articles. Original research articles published in English that directly compare the outcomes of intraoperative 3D imaging with fluoroscopy will be included. Review articles, conference abstracts and animal studies will be excluded. Outcome measures will be extracted from the selected studies and analysed with the help of appropriate software.

Background: Assessment of mortise stability is paramount in determining appropriate management of ankle fractures. Although instability is readily apparent in bimalleolar or trimalleolar ankle fractures, determination of instability in the isolated Weber B fibula fracture often requires further investigation. Prior authors have demonstrated poor predictive value of physical examination findings such as tenderness, ecchymosis, and swelling with instability. The goal of this study is to test the validity of a new clinical examination maneuver, the lateral drawer test, against the gravity stress view (GSV) in a cohort of patients with Weber B fibula fractures. Secondary goals included assessing pain tolerability of the lateral drawer test, as well as testing interobserver reliability. Methods: Sixty-two patients presenting with isolated fibula fractures were prospectively identified by an orthopaedic nurse practitioner or resident. Three nonweightbearing radiographic views of the ankle as well as a GSV were obtained. Radiographs were not visualized before conducting the lateral drawer test. Two foot and ankle fellowship–trained orthopaedic surgeons performed and graded the lateral drawer test. Radiographs were then examined and medial clear space (MCS) was measured. Visual analog scale (VAS) pain scores were obtained before and after testing. The results of the lateral drawer test were compared with radiographic measurements of MCS on GSV. A cadaveric experiment was devised to assess interobserver reliability of the lateral drawer test. Results: Thirty (48%) of 62 consecutively enrolled patients demonstrated radiographic instability with widening of the MCS ≥5 mm on GSV. When correlated with MCS measurement, the lateral drawer test demonstrated a sensitivity of 83%, specificity of 97%, positive predictive value (PPV) of 96%, and negative predictive value (NPV) of 86%. There was a strong correlation between the lateral drawer test grade and amount of MCS widening (Spearman correlation ρ = 0.82, P < .005). Patients tolerated the maneuver well with an average increase of 0.7 on the VAS pain scale. Testing of 2 observers utilizing the cadaveric model demonstrated a Cohen’s Kappa coefficient of 0.7 indicating moderate interobserver agreement. Conclusion: The lateral drawer test demonstrates high sensitivity, specificity, PPV, and NPV with moderate interobserver reliability compared with the MCS on GSV in patients presenting with Weber B fibula fractures. Although further external validation is required, the lateral drawer test may offer an adjunct tool via physical examination to help determine mortise stability. Level of Evidence: Level II, Prospective Cohort Study.

Supplemental material, sj-pdf-1-taw-10.1177_20420986211019309 for Attitudes of ambulatory care older Nepalese patients towards deprescribing and predictors of their willingness to deprescribe by Shakti Shrestha, Roshan Giri, Hari Prasad Sapkota, Siddhartha Sharma Danai, Ahsan Saleem, Shreeshab Devkota, Sagar Shrestha, Bhojraj Adhikari and Arjun Poudel in Therapeutic Advances in Drug Safety

Supplemental material, sj-pdf-1-taw-10.1177_20420986211019309 for Attitudes of ambulatory care older Nepalese patients towards deprescribing and predictors of their willingness to deprescribe by Shakti Shrestha, Roshan Giri, Hari Prasad Sapkota, Siddhartha Sharma Danai, Ahsan Saleem, Shreeshab Devkota, Sagar Shrestha, Bhojraj Adhikari and Arjun Poudel in Therapeutic Advances in Drug Safety

We are in the twenty-first century, and live in a technologically very advanced, culturally sophisticated and globalized world. In the world of business and investment however, half of humanity still doesn’t receive their fair share of trust and financial backing when pitching their business proposals. Still, men are preferred when it comes to VC and other funding. Research shows that there is an immense gender investment gap, still and again placing women at a backseat. This chapter takes a close look at that gap, exploring the historic dimension behind it, and diving into gender roles, the role of perception and of our economic system rewarding and incentivizing “male” qualities. It outlines good reasons to invest in women and offers recommendations for best practices to close the gender investment gap. Not only as an act of justice by giving women a fair chance and a greater share of market and power—it’s a change in mindset that could well determine our future quality of life or even survival on this planet.

In this paper, we empirically study whether firms improve their quality based on reviews left by their customers in a dynamic quality environment. We do so by analyzing the US hotel industry using data from two major online review platforms: TripAdvisor and Expedia. Using management response as a proxy for whether hotels read and listen to consumer reviews, and a difference-in-differences strategy, we demonstrate that hotels make improvements in quality by paying attention to the reviews they receive. Moreover, we show that these improvements are primarily made by low-rated hotels that have more room for improvement, and by chain hotels likely because of their lower operational marginal cost. To pin down the underlying mechanism, we analyze the text of reviews and responses using novel tools for natural language processing, and show that: (i) hotels that listen to customers improve on issues that are frequently mentioned in their reviews, and (ii) hotels that use canned responses are less likely to see improvements in quality. Overall, our results suggest that online user-generated reviews form a feedback mechanism through which consumers make themselves heard by businesses and contribute to changes in the quality of those businesses.

Objectives To identify epigenetic and transcriptional factors controlling osteoclastogenesis (OCG), that have been shown to play a role in the pathogenesis of skeletal diseases. Methods A systematic review was conducted in accordance with the PRISMA guidelines. The PubMed and EMBASE databases were searched up to 30th April 2020; references of included articles and pertinent review articles were also screened to identify eligible studies. Studies were included if they described epigenetic and/or transcriptional regulation of OCG in a specific skeletal disorder, and quantified alterations in OCG by any well-described experimental method. Risk of bias was assessed by a previously described modification of the CAMARADES tool. Results The combined searches yielded 2265 records. Out of these, 24 studies investigating 12 different skeletal disorders were included in the review. Osteoporosis, followed by osteopetrosis, was the most commonly evaluated disorder. A total of 22 different epigenetic and transcriptional regulators of OCG were identified; key epigenetic regulators included DNA methylation, histone methylation, histone acetylation, miRNAs and lncRNAs. In majority of the disorders, dysregulated OCG was noted to occur at the stage of formation of committed osteoclast from preosteoclast. Dysregulation the stage of formation of the preosteoclast from late monocyte was noted in rheumatoid arthritis and fracture, whereas dysregulation at stage of formation of late monocyte from early monocyte was noted in osteopetrosis and spondyloarthritis. Quality assessment revealed a high risk of bias in domains pertaining to randomization, allocation concealment, blinding of outcome assessors and determination of sample size. Conclusions A variety of epigenetic and transcriptional factors can result in dysregulated osteoclastogenesis in different skeletal disorders. Dysregulation can occur at any stage; however, the formation of committed osteoclasts from preosteoclasts is the most common target. Although the published literature on this subject seems promising, the overall strength of evidence is limited by the small number of studies evaluating individual skeletal disorders, and also by deficiencies in key aspects of study design.

The difficulty of studying small tissue samples and rare cell populations have been some of the main limitations in performing efficient translational studies of immune mediated diseases. Many of these conditions are grouped under the name of a single disease whilst there are strong suggestions that disease heterogeneity leads to variable disease progression as well as therapeutic responses. The recent development of single cell techniques, such as single cell RNA sequencing, gene expression profiling, or multiparametric cytometry, is likely to be a turning point. Single cell approaches provide researchers the opportunity to finally dissect disease pathology at a level that will allow mechanistic classifications and precision therapeutic strategies. In this review, we will give an overview of the current and developing repertoire of single cell techniques, the benefits and limitations of each, and provide an example of how single cell techniques can be utilized to understand complex immune mediated diseases and their translation from mouse to human.

Background A number of surgical approaches have been described for open reduction and internal fixation (ORIF) of intra-articular distal humerus (IDH) fractures in adults. However, there is no consensus as to which approach is better in terms of functional outcomes and complications. The purpose of this study was to determine whether the functional outcomes and types and rates of complications are influenced by the choice of surgical approach for ORIF of IDH fractures (AO/OTA types 13 B & C). Methods A systematic review of literature was performed using the PubMed, EMBASE and Cochrane Database of Systematic Reviews databases. Studies, both prospective and retrospective and comparative or non-comparative, dealing with surgical approaches for ORIF of IDH fractures in adult patients were included. Conference abstracts, studies looking primarily at the results of internal fixation rather than the surgical approach, those including extra-articular distal humeral fractures, pediatric distal humeral fractures ( Results 11 studies were included in the qualitative analysis, of which 5 were comparative studies and 6 were non-comparative. Quantitative analysis was performed on two sets of two studies, each set comparing the Bryan and Morrey or the triceps-split approach to the olecranon osteotomy approach, and revealed no significant differences in the Mayo Elbow Performance Score, range of motion and rates of complications. The overall methodological quality of the studies included in the review was low. Conclusions High-quality evidence on surgical approaches for ORIF of IDH fractures in adults is lacking. Evidence from low-quality studies indicates that there is no difference in the functional outcomes or complication rates when comparing the Bryan and Morrey or triceps-split to the olecranon osteotomy approach. Future research in the form of high-quality randomized controlled trials is needed to determine which approach is superior in terms of functional outcomes and complications.

Railway big data technologies are transforming the existing track inspection and maintenance policy deployed for railroads in North America. This paper develops a data-driven condition-based policy for the inspection and maintenance of track geometry. Both preventive maintenance and spot corrective maintenance are taken into account in the investigation of a 33-month inspection dataset that contains a variety of geometry measurements for every foot of track. First, this study separates the data based on the time interval of the inspection run, calculates the aggregate track quality index (TQI) for each track section, and predicts the track spot geo-defect occurrence probability using random forests. Then, a Markov chain is built to model aggregated track deterioration, and the spot geo-defects are modeled by a Bernoulli process. Finally, a Markov decision process (MDP) is developed for track maintenance decision making, and it is optimized by using a value iteration algorithm. Compared with the existing maintenance policy using Markov chain Monte Carlo (MCMC) simulation, the maintenance policy developed in this paper results in an approximately 10% savings in the total maintenance costs for every 1 mile of track.

Background Pathological conditions with ongoing inflammatory processes result in specific heat signatures at the affected body parts; infrared thermography (IRT) detects these changes and can be utilised in screening such conditions. The modern devices are advanced and their non contact, convenient and precise readings can aid in multiple medical sub fields. Orthopaedics as a broad entity has witnessed utilisation of this technology in different indications and the present scoping review was done to assess these established indications and further scope of its utility. Method ology : A Medline search was done on 26.4.2021 with specific keywords for studies of any design in English language discussing the usage of thermography in Orthopaedics. Animal studies, conference abstracts, systematic reviews, e-posters, case reports, book chapters, and studies describing the use of thermography in non-Orthopaedic patients were excluded. Results Total number of hits were 1380.43 studies including case series and case control studies were included in the review. The subfields or indications described were pain/arthritis, Charcot's foot/neuropathic ulcers, infections associated with diabetic feet and arthroplasties, reflex sympathetic dystrophy, carpal tunnel syndrome, sports medicine, paediatric orthopaedics, spine, ergonomics and compartment syndrome. Conclusion IRT has been described to be effective in orthopaedic conditions with specific heat signatures and this can assess the trend of the ongoing inflammatory process as well as response to a particular treatment. Additionally, it can specifically determine the exact loci of the pathology for targeted interventions.

Type 2 diabetes mellitus (T2DM) adversely affects the normal functioning, intrinsic material properties, and structural integrity of many tissues, including bone. It is well known that the clinical utility of areal bone mineral density (aBMD) is limited to assess bone strength in individuals with T2DM. Therefore, there is a need to explore new diagnostic techniques that can better assist and improve the accuracy of assessment of bone tissue quality. The present study investigated the link between bone and fingernail material/compositional properties in type 2 diabetes mellitus (T2DM). For that, femoral head and fingernail samples were obtained from twenty-five adult female patients (with/without T2DM) with fragility femoral neck fractures undergoing hemi/total hip arthroplasty. Cylindrical cores of trabecular bone were subjected to micro-CT, and lower bone volume fraction was observed in the diabetic group than the non-diabetic group due to fewer and thinner trabeculae in individuals with T2DM. The material and compositional properties of bone/fingernail were estimated using nanoindentation and Fourier Transform Infrared Spectroscopy, respectively. Both bone/fingernails in T2DM had lower reduced modulus (Er), hardness (H), lower Amide I and Amide II area ratio (protein content), higher sugar-to-matrix ratio, and relatively high carboxymethyl-lysine (CML) content compared with non-diabetic patients. Sugar-to-matrix ratio and relative CML content were strongly and positively correlated with HbA1c for both bone/fingernail. There was a positive correlation between bone and fingernail glycation content. Our findings provide evidence that the degradation pattern of bone and fingernail properties go hand-in-hand in individuals with T2DM. Hence, the fingernail compositional/material properties might serve as a non-invasive surrogate marker of bone quality in T2DM; however, further large-scale studies need to be undertaken.

Computed tomography (CT) scans are often used for postoperative imaging in orthopedics. In the presence of metallic hardware, artifacts are generated, which can hamper visualization of the CT images, and also render the study ineffective for 3-D printing. Various solutions are available to minimize metal artifacts, and radiologists can employ these before or after processing the CT study. However, the orthopedic surgeon may be faced with situations where the metal artifacts were not addressed. To counter such problems, we present three do-it-yourself (DIY) techniques that can be used to manage metal artifacts.

Pediatric femoral shaft fractures account for less than 2% of all fractures in children. However, these are the most common pediatric fractures necessitating hospitalization and are associated with prolonged hospital stay, prolonged immobilization and impose a significant burden on the healthcare system as well as caregivers. In this paper, the authors present a comprehensive review of epidemiology, aetiology, classification and managemement options of pediatric femoral shaft fractures.