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Background A balloon spacer is a relatively simple addition to an arthroscopic debridement procedure for irreparable rotator cuff tears. Objective To evaluate the clinical and cost-effectiveness of a subacromial balloon spacer for individuals undergoing arthroscopic debridement for irreparable rotator cuff tears. Design A multicentre participant-and assessor-blinded randomised controlled trial comparing arthroscopic debridement with the InSpace® (Stryker, Kalamazoo, MI, USA) balloon to arthroscopic debridement alone, using a novel adaptive design. Pretrial simulations informed stopping boundaries for two interim analyses, using outcome data from early and late time points. Setting A total of 24 NHS centres. Participants Adults with a symptomatic, irreparable rotator cuff tear for whom conservative management had been unsuccessful. Interventions Arthroscopic debridement of the subacromial space plus insertion of the InSpace balloon compared with arthroscopic debridement alone. Main outcome measures Oxford Shoulder Score at 12 months. Results A predefined stopping boundary was met at the first interim analysis. Recruitment stopped with 117 participants randomised. We obtained primary outcome data on 114 participants (97%). The mean Oxford Shoulder Score at 12 months was 34.3 in the debridement-only group (59 participants of 61 randomised) and 30.3 in the debridement with balloon group (55 participants of 56 randomised; mean difference: −4.2; 95% confidence interval −8.2 to −0.26; p = 0.037). There was no difference in safety events. In the cost-effectiveness analysis, debridement-only dominated with a probability of

Recent efforts to identify disadvantaged communities (DACs) on a census tract level have evoked possibilities of attaining transportation justice and vision zero goals in these areas. To identify DACs, the United States Department of Transportation (USDOT) has developed six comprehensive indicators: economy, environment, equity, health, resilience, and transportation access. The indicators are used to explore the associations between DACs (in 71,728 census tracts) and five years of fatal crashes, providing a comprehensive understanding of safety risks. Specifically, using data on DACs and linking it with census and crash data, this study aims to understand the complex connections between safety (captured through fatal crashes) and disadvantages that communities confront due to a convergence of multiple challenges and burdens using Zero-Hurdle Negative Binomial models. The results reveal that health, resilience, and transportation-disadvantaged tracts are associated with more fatal crashes. The study also found the presence of a higher percentage of the population with bachelor's degrees and increased use of public transportation are correlated with fewer fatal crashes. Also, a higher fatal crash rate is observed in disadvantaged census tracts where a high proportion of the Hawaiian or other Pacific Islander, and American Indian or Alaska Native populations live. This implies that targeted interventions can be explored further in tracts that show high correlations with fatal crashes. The findings contribute to traffic safety by highlighting the risks in DACs, which can help design and implement traffic safety interventions. The insights gained from this study can inform decision-making and help to guide the development of more equitable traffic safety programs in disadvantaged communities., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Coronary catheterization is usually performed using the transfemoral approach but trans-radial has been increasingly used as an alternative to transfemoral approach due to less vascular complications, earlier ambulation time and improved patient comfort. The aim of the study was to compare the safety and feasibility of trans-radial and transfemoral PCI in the elderly ACS patients. This prospective observational study was conducted in the NICVD, Dhaka from October 2017 to September 2018. Total 80 patients were categorized into two groups according to the approach of PCI. Group I consists 40 patients who underwent trans-radial PCI and Group II consists 40 patients who underwent transfemoral PCI. Patients with abnormal Allen's test, history of CABG, CKD were excluded. Patient's demographics were same in both groups. The mean procedural time in min (37.44±5.13 vs. 34.42±4.42, p=0.004) and fluoroscopy time in min (21.6±4.11 vs. 17.55±2.78, p=0.02) were more in Group I but the mean hemostasis time in min (7.58±1.11 vs. 15.59±3.33, p=0.005) and the ambulation time in hour (0.00±0.00 vs. 15.59±3.33, p=0.001) were more in Group II. Significant arterial spasm following puncture (10.0% vs. 0.0%, p=0.01) were more in Group I. Post procedural major bleeding (0.0% vs. 10.0%, p=0.004), minor bleeding (10.0% vs. 20.0%, p=0.004) were significant in Group II but vessel occlusion (5.0% vs. 0.0%, p=0.02) were significant in Group I. Transradial PCI is safe in respect of procedural and post procedural vascular complications. Transradial procedure leads to improved quality of life after the procedure and thus gives much comfort to the patient. It also shortened mean duration of hospital stay. So transradial approach is an attractive alternative to conventional transfemoral approach in the elderly.

Cadmium (Cd) toxicity is a form of soil contamination that causes losses in plant growth and yield. Understanding the effects of Cd-induced changes in physiological and cellular processes will help scientists develop better scientific strategies for sugar beet plant improvement. Cd toxicity triggered a substantial decrease in morphological parameters and total soluble protein in sugar beets, as well as membrane damage and cell death. Furthermore, the SPAD score and photosynthetic OJIP parameters in leaves were severely affected due to Cd stress. This was correlated with the decreased FCR activity and BvIRT1 expression in roots, suggesting the adverse effect of Cd in Fe acquisition in sugar beet. Our findings also revealed that BvHMA3 and BvNRAMP3 were upregulated in Cd-exposed roots, indicating that these genes might be involved in Cd uptake in sugar beet. In silico analysis of BvHMA3 and BvNRAMP3 proteins showed close partnerships with several Arabidopsis genes mainly linked to metal tolerance protein, cation diffusion facilitator, vacuolar metal transporter, and vacuolar Fe transporter. Subsequently, Cd-exposed sugar beet showed severe sensitivity to oxidative damages resulted in elevated H 2 O 2 and O 2 .- without possessed efficient antioxidant defense. Finally, growth retardation in Cd-exposed sugar beets is linked to photosynthetic inefficiency caused by low Fe levels and oxidative stress in cells. These results may be used to improve Cd-sensitive sugar beet plants by breeding or transgenic programs., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Coronary heart disease (CHD) is the most common cause of heart disease and serious cause of early death in developed countries around the world. Stress hyper-glycaemia has a bad prognostic implication in hospital outcomes in acute ST elevated myocardial infarction patients. It serves as a marker of myocardial damage, provides information about complications of acute MI and bad prognosis. The aim of this cross-sectional descriptive study was to find out prognostic implications of Stress hyper-glycaemia in non diabetic patients with first attack of acute ST elevated myocardial infarction underwent thrombolysis and conducted in the department of Cardiology in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from June 2017 to May 2018. Total 249 first attack of Acute STEMI patients were included considering inclusion and exclusion criteria. The sample population was divided into two groups: Group I: Patients with first attack of acute STEMI underwent thrombolysis with non diabetic stress hyper-glycaemia (Blood sugar >7.8mmol/L and HbA1c <6.5), Group II: Patients with first attack of acute STEMI underwent thrombolysis with non diabetic normo-glycaemia (Blood sugar <7.8mmol/L and HbA1c <6.5). In this study, in non diabetic Stress hyperglycemic patients' death was 5.7% and in non diabetic normo-glycemic patients death was 0.6%. It was statistically significant (p<0.05). In non diabetic stress hyperglycemic patients, heart failure was 78.31% patients and in non diabetic normo-glycemic patients, it was 21.6%. It was statistically significant (p<0.01). Echocardiography showed that patients with non diabetic Stress hyper-glycaemia had mean ejection fraction (LVEF) was 44.01±4.93 and patients with non diabetic normo-glycaemia had mean ejection fraction (LVEF) was 47.70±5.71. It was statistically significant (p<0.01). In this study, in non diabetic Stress hyperglycaemic patients, cardiogenic shock was 16.1% and in non diabetic normo-glycemic patients, it was 3.7%. It was statistically significant (p<0.05). Mean duration of hospital stay, in non diabetic Stress hyperglycaemic patients was 5.07±0.566 and in non diabetic normo-glycemic patients, it was 3.52±0.850. It was statistically significant (p<0.001). In conclusion, the incidence of death, heart failure, cardiogenic shock and hospital stay were higher in non diabetic Stress hyperglycaemic patients than non diabetic normo-glycemic patients who admitted with first attack of acute ST elevated myocardial infarction.

Dental implants need to support good osseointegration into the surrounding bone for full functionality. Interconnected porous structures have a lower stiffness and larger surface area compared with bulk structures, and therefore are likely to enable better bone-implant fixation. In addition, grading of the porosity may enable large pores for ingrowth on the periphery of an implant and a denser core to maintain mechanical properties. However, given the small diameter of dental implants it is very challenging to achieve gradations in porosity. This paper investigates the use of Selective Laser Melting (SLM) to produce a range of titanium structures with regular and graded porosity using various CAD models. This includes a novel 'Spider Web' design and lattices built on a diamond unit cell. Well-formed interconnecting porous structures were successfully developed in a one-step process. Mechanical testing indicated that the compression stiffness of the samples was within the range for cancellous bone tissue. Characterization by scanning electron microscopy (SEM) and X-ray micro-computed tomography (μCT) indicated the designed porosities were well-replicated. The structures supported bone cell growth and deposition of bone extracellular matrix., (Copyright © 2018. Published by Elsevier Ltd.)

Ethanolamine plasmalogen (PlsEtn), a major phospholipid in neuronal membranes [60-90 mol% of ethanolamine glycerophospholipid (EtnGpl)], is specifically decreased in brains from patients with Alzheimer's disease (AD). The present study investigated how PlsEtn administration affects cognitive deficits and lipid composition in an animal model of AD. AD model rats were infused with amyloid-β (Aβ) into the cerebral ventricle and divided into three groups. Control, Egg, and Ascidian groups were then orally administered vehicle, egg yolk EtnGpl (260 μmol as EtnGpl/kg BW/day; 10 μmol as PlsEtn/kg BW/day), or ascidian viscera EtnGpl (260 μmol as EtnGpl/kg BW/day; 209 μmol as PlsEtn/kg BW/day), respectively. After 4 weeks of dosing, Aβ-infused rats were tested for learning ability in an 8-arm radial maze. The administration of ascidian viscera EtnGpl improved both reference and working memory-related learning abilities. In lipid analysis, the Ascidian group showed higher levels of PlsEtn species in the plasma, erythrocytes, and liver when compared to other groups. In addition, although there were no differences at levels of total plasmalogen including choline plasmalogen, the Ascidian group had significantly higher levels of 18:0ol/22:6-PlsEtn in the cerebral cortex. These levels of 18:0ol/22:6-PlsEtn in the cerebral cortex were correlated with working memory-related learning ability. Moreover, 18:0ol/22:6-PlsEtn levels in the cerebral cortex showed positive correlations with those in the erythrocytes and liver. In summary, dietary PlsEtn, especially that with 22:6n-3 (docosahexaenoic acid, DHA), may ameliorate learning deficiencies in AD by altering lipid composition in the brain.

This communication reports a novel enzymatic Ag-deposition scheme combined with chemical-chemical redox cycling by reduced β-nicotinamide adenine dinucleotide. This novel scheme allows a higher Ag-deposition rate than a scheme using only enzymatic Ag deposition. Therefore, it can be applied for the highly sensitive detection of a cardiac biomarker, creatine kinase-MB.