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Traumatic brain injury (TBI) disproportionately affects low- and middle-income countries (LMICs). In these settings, accurate patient prognostication is both difficult and essential for high-quality patient care. With the ultimate goal of enhancing TBI triage in LMICs, we aim to develop the first deep learning model to predict outcomes after TBI and compare its performance with that of less complex algorithms. TBI patients' data were prospectively collected in Kampala, Uganda, from 2016 to 2020. To predict good versus poor outcome at hospital discharge, we created deep neural network, shallow neural network, and elastic-net regularized logistic regression models. Predictors included 13 easily acquirable clinical variables. We assessed model performance with 5-fold cross-validation to calculate areas under both the receiver operating characteristic curve and precision-recall curve (AUPRC), in addition to standardized partial AUPRC to focus on comparisons at clinically relevant operating points. We included 2164 patients for model training, of which 12% had poor outcomes. The deep neural network performed best as measured by the area under the receiver operating characteristic curve (0.941) and standardized partial AUPRC in region maximizing recall (0.291), whereas the shallow neural network was best by the area under the precision-recall curve (0.770). In several other comparisons, the elastic-net regularized logistic regression was noninferior to the neural networks. We present the first use of deep learning for TBI prognostication, with an emphasis on LMICs, where there is great need for decision support to allocate limited resources. Optimal algorithm selection depends on the specific clinical setting; deep learning is not a panacea, though it may have a role in these efforts. [ABSTRACT FROM AUTHOR]

Phytochemicals from plant extracts belong to an important source of natural products which have demonstrated excellent cytotoxic activities. However, plants of different origins exhibit diverse chemical composition and bioactivities. Therefore, discovery of plants based new anticancer agents from different parts of the world is always challenging. In this study, methanolic extracts of different parts of 11 plants from Saudi Arabia have been tested in vitro for their anticancer potential on human liver cancer cell line (HepG2). Particularly, for this study, plants from Asteraceae, Resedaceae and Polygonaceae families were chosen on the basis of locally available ethnobotanical data and their medicinal properties. Among 12 tested extract samples, three samples obtained from Artemisia monosperma stem, Ochradenus baccatus aerial parts and Pulicaria glutinosa stem have demonstrated interesting cytotoxic activities with a cell viability of 29.3%, 28.4% and 24.2%, respectively. Whereas, four plant extracts including Calendula arvensis aerial parts, Scorzonera musilii whole plant, A. monosperma leaves show moderate anticancer properties bearing a cell viability ranging from 11.9 to 16.7%. The remaining extracts have shown poor cytotoxic activities. Subsequently, GC-MS analysis of methanolic extracts of four most active plants extracts such as C. comosum , O. baccatus , P. glutinosa and A. monosperma detected the presence of 41 phytomolecules. Among which 3-(4-hydroxyphenyl) propionitrile (1) , 8,11-octadecadiynoic acid methyl ester (2) , 6,7-dimethoxycoumarin (3) and 1-(2-hydroxyphenyl) ethenone (4) were found to be the lead compounds of C. comosum , O. baccatus P. glutinosa and A. monosperma , respectively. [ABSTRACT FROM AUTHOR]

The choice of treatment for Sanders Type II and Type III calcaneal fractures remains controversial with unclear patient functional outcomes. A meta-analysis was done to compare the functional outcome of ORIF vs primary subtalar arthrodesis (PSA) according to American Orthopedic Foot and Ankle Score (AOFAS) hindfoot-ankle scores. The PubMed, Embase, and Cochrane Library Databases were searched by two independent evaluators. Fourteen studies met the eligible criteria. ORIF of 501 Type II and Type III fractures was compared to primary subtalar arthrodesis treatment of 57 Type II and Type III fractures. AOFAS for a mixed ORIF group of "Type II and III" fractures was 82.16 ± 1.58 at average follow-up of 25.3 months. For a mixed PSA group of "Type II and III" fractures, the AOFAS was 74.22 ± 2.45 at average follow-up of 28.0 months. This showed a difference between ORIF and primary subtalar arthrodesis of 7.94 points (95% confidence interval [CI] = 7.75–7.98; p value.004) favoring ORIF when adjusting for minimally invasive and percutaneous methods. Without adjustment, there was a difference of 6.54 points favoring ORIF (95% CI = 6.22–6.46; p value.017). In conclusion, while high-quality randomized controlled trials comparing ORIF to primary subtalar arthrodesis for Type II and Type III fractures would further elucidate superior treatment outcomes, this meta-analysis of available data shows a tendency for ORIF of Type II and Type III Sanders calcaneal fractures to have a better functional outcome at approximately 2 years postoperatively compared to primary subtalar arthrodesis. [ABSTRACT FROM AUTHOR]

Due to their inexpensive and eco-friendly nature, and existence of manganese in various oxidation states and their natural abundance have attained significant attention for the formation of Mn 3 O 4 nanoparticles (Mn 3 O 4 NPs). Herein, we report the preparation of Mn 3 O 4 nanoparticles using manganese nitrate as a precursor material by utilization of a precipitation technique. The as-prepared Mn 3 O 4 nanoparticles (Mn 3 O 4 NPs) were characterized by using X-ray powder diffraction (XRD), UV–Visible spectroscopy (UV–Vis), High-Resolution Transmission electron microscopy (HRTEM), Field emission scanning electron microscopy (FESEM), Thermal gravimetric analysis (TGA) and Fourier-transform infrared spectroscopy (FT-IR). The antimicrobial properties of the as-synthesized Mn 3 O 4 nanoparticles were investigated against numerous bacterial and fungal strains including S. aureus, E. coli , B. subtilis, P. aeruginosa, A. flavus and C. albicans. The Mn 3 O 4 NPs inhibited the growth of S. aureus with a minimum inhibitory concentration (MIC) of 40 μg/ml and C. albicans with a MIC of 15 μg/ml. Furthermore, the Mn 3 O 4 NPs anti-cancer activity was examined using MTT essay against A549 lung and MCF-7 breast cancer cell lines. The Mn 3 O 4 NPs revealed significant activity against the examined cancer cell lines A549 and MCF-7. The IC 50 values of Mn 3 O 4 NPs with A549 cell line was found at concentration of 98 µg/mL and MCF-7 cell line was found at concentration of 25 µg/mL. [ABSTRACT FROM AUTHOR]

Osteochondral defects in the young active patient remain a difficult issue to treat. Autograft cartilage implantation is a procedure that was originally devised as a difficult 2-stage process, with disadvantages including donor-site morbidity and the need for multiple procedures. Recently, a technique for a single stage autograft cartilage transfer, also known as AutoCart using the GraftNet device for autograft harvest and BioCartilage in addition to bone marrow concentrate to aid in graft incorporation and healing, has been described. In this article, we discuss a modification of this autograft cartilage transfer procedure using a minimally invasive single incision for lesion preparation, microfracture, graft harvest, and graft delivery using visualization from the NanoScope. Video 1 The patient is placed supine in a standard knee arthroscopy position. The operative extremity is placed into a leg holder with a tourniquet applied to the thigh and the nonoperative extremity is placed on a well-padded leg pillow. Before the tourniquet is inflated, a small stab incision is made just lateral to the tibial tubercle. You can see an aspiration needle and central sharp trocar are inserted proximally at approximately a 10° angle. A mark is made on the needle at 30 mm to avoid overinsertion. Then, 60 cc of bone marrow is aspirated into heparinized syringes. This aspiration is the concentrated using the Arthrex Angel System to 5 cc of bone marrow concentrate. The leg is exsanguinated, and a tourniquet is placed to 250 mm Hg. With the operative knee in flexion, a spinal needle is placed in the standard anterolateral portal location. A nitinol wire is inserted through the spinal needle and the needle is removed. Next, the 3.4-mm high-flow NanoScope cannula (Arthrex) is inserted and the NanoScope (Arthrex) is inserted into the cannula after flow is attached. A standard diagnostic arthroscopy is then performed with the NanoScope. The lesion on the medial femoral condyle is then identified. A spinal needle is used to establish a standard portal at the location of the medial lesion. The lesion is prepared and debrided with a shaver and then using a small curet. After the lesion has been prepared, a standard microfracture technique is performed with a small drilling device (PowerPick; Arthrex). First, circumferential perforations are created and then central perforations to a bleeding base. While viewing from the lateral portal with the NanoScope (Arthrex) and the knee in full extension, a shaver with the GraftNet (Arthrex) applied is placed through the medial portal. It is important to debride as much synovium from the areas of harvesting before harvesting to increase the amount of pure cartilage harvested. This shaver then is used to harvest the nonarticulating portion of cartilage from the medial femur. The shaver and NanoScope (Arthrex) are switched and in similar fashion autograft cartilage is harvested from the lateral nonarticulating cartilage of the femur. This autograft cartilage is then removed from the graft net on the back table as you can see. Then, 1 cc of BioCartilage (Arthrex) is added to the BioCartilage mixing cannula with the autograft cartilage and 1 cc of bone marrow concentrate is also added and mixed with the graft until a toothpaste-like consistency is obtained. The delivery cannula is then applied to the mixing cannula and this is placed on the back table. The arthroscopy fluid is turned off at this point, and sponges can be used through the lateral portal to dry the lesion. The composite graft is then carefully delivered through the lateral portal and a small bone tamp can be used to impact the graft in place. After the graft is properly placed into the lesion, EVICEL glue (Ethicon) is delivered onto the graft. It is important to start the glue superiorly as it will run inferiorly. Care is taken to not deliver too much glue, and suction can be used to remove excess. The glue will need at least 7 to 8 minutes to set up and fix the graft in place. [ABSTRACT FROM AUTHOR]

Knee arthroscopy has evolved greatly from its inception in the 20th century. Arthroscopic synovectomy is performed in the case of infection or significant synovitis. We continue to develop more minimally invasive procedures, and the NanoScope (Arthrex, Naples, FL) has provided a new generation of possibilities. The system does not require the use of a standard incision or portal, and using the GraftNet (Arthrex), we can harvest tissue with a standard shaver for further evaluation. This technique provides an option to perform a synovial and bone biopsy in a painful total knee arthroplasty without the use of standard arthroscopy portals through an incisionless approach. This technique provides distinct advantages over a more open approach in the setting of a prosthetic joint. Specifically, this technique is useful for a difficult-to-diagnose painful total knee arthroplasty. Video 1 Incisionless synovial and bone biopsy technique. A spinal needle is inserted into the superolateral joint space while the left knee is in full extension. A nitinol wire is inserted into the needle, and the needle is removed. A high-flow 3.4-mm cannula is then inserted over the wire, and the wire is removed. Care should be taken when inserting the 3.4-mm cannula because it can cause damage during insertion. Inflow is then placed onto the cannula, and the NanoScope is inserted for visualization of the joint. A standard diagnostic arthroscopy is performed in the patellofemoral joint. The other portals will be established in the anterolateral joint space and anteromedial joint space and in a similar fashion, with the knee in flexion. Next, with the NanoScope through the superolateral portal and the left knee in extension, the patellofemoral synovium is examined and found to be hypertrophic, hyper-vascularized, and inflamed. Then, we place the NanoScope through the anterolateral joint space through the high-flow cannula, and the patellofemoral joint is viewed and examined. Viewing through the anterolateral joint space with the knee in extension, we place a shaver through the superolateral joint space. The GraftNet is attached to the shaver, and as shown, synovial biopsy specimens are obtained. Care is taken to obtain samples from the medial aspect, lateral aspect, and superior aspect. Next, a shaver with the GraftNet is placed through the anteromedial portal, and further biopsy specimens can be obtained. The left knee is then brought into flexion, and after use of the anteromedial portal as the working portal, the shaver is placed through the anterolateral portal and the anterior synovium is biopsied. Care is taken to view the tibia-cement interface and anterior compartment. With the NanoScope placed through the anterolateral portal and the shaver placed through the superolateral portal, areas on the lateral bone interface and anterior flange–bone interface are shaved down to bone. Then, the GraftNet is applied to the shaver, and as shown, the bone biopsy specimens are obtained. First, we take a biopsy specimen from the lateral femur; then, the anterior bone is biopsied. Care must be taken not to resect too much bone. [ABSTRACT FROM AUTHOR]

A new series of coumarin-yl-chalcone derivatives (3a-m) had been designed and synthesized through different reactions such as aromatic addition, cyclization and Claisen-Schmidt reactions in good yields (54–78%). 5-acetyl-4-(2-hydroxyphenyl) -6-methyl-3, 4-dihydropyrimidin-2(1H) -one (1) has been synthesized by multi-component one pot reaction of salicylaldehyde, methyl acetoacetate and urea, which was further reacted with malonic acid employing ZnCl 2 catalyst to yield 5-acetyl-4-(4-hydroxy-2-oxo-2 H -chromen-8-yl) -6-methyl-3, 4-dihydropyrimidin-2(1 H) -one (2). The title compounds (3a-m) were synthesised by reacting 5-acetyl-4-(4-hydroxy-2-oxo-2 H -chromen-8-yl) -6-methyl-3, 4-dihydropyrimidin-2(1 H)-one (2) with different aromatic aldehydes in the presence of potassium hydroxide. In silico studies, a preliminary screening method for predicting the anti-cancer activity was performed for the synthesized compounds (3a-m) against Src, Alb tyrosine kinase and homology model protein (PDB ID: 4csv). The derivatives 3h and 3m showed moderate binding energies. The in vitro cytotoxic activity was evaluated for the compounds 3h and 3m by using human cancer cell-line morphology and MTT assay against three human cell-lines A549 (Lung), Jurkat (Leukemia) and MCF-7 (Breast). The results indicate that the derivatives 3h and 3m display significant anti-cancer activity, however it was found to be less cytotoxic when compared to the standard used i.e. Imatinib. [ABSTRACT FROM AUTHOR]