Search

Prosthetic joint infections (PJIs) after megaprosthesis implantation are associated with high rates of treatment failure and amputation. Our study analyzed PJI treatment success rates by surgical strategy and assessed risks of reinfection and amputation. We retrospectively analyzed the outcomes of patients diagnosed with PJI after undergoing megaprosthesis implantation for oncologic indications. The 2011 Musculoskeletal Infection Society criteria were used to define PJI. Reinfection, reoperation, and amputation for PJI recurrence were assessed. A total of 67 patients with megaprosthesis PJIs were included. There were fourteen patients who were treated with debridement, antibiotics, and implant retention (DAIR), 31 with DAIR plus (DAIR with modular component exchange and stem retention), and 21 with two-stage revisions. Kaplan-Meier estimates were used for survival analyses and Cox proportional hazards for risk factor analyses. The two-year reinfection-free survival was 25% for DAIR and 60% for DAIR plus or two-stage revision (P =.049). The five-year amputation-free survival was 84% for DAIR plus or two-stage revision, and 48% for DAIR (P =.13). Reinfection-free, reoperation-free, and amputation-free survival were similar between DAIR plus and two-stage revision at the 2- and 5-year marks. Body mass index ≥30 (hazard ratio [HR] = 2.65) and chronic kidney disease (HR = 11.53) were risk factors for reinfection. Treatment with DAIR plus or two-stage revision (HR = 0.44) was a protective factor against reinfection. A DAIR was associated with high rates of treatment failure and higher amputation rates than DAIR plus or 2-stage surgery. A DAIR plus was not inferior to 2-stage revision clearing a PJI and might be performed in patients who cannot withstand two-stage revision surgery. [ABSTRACT FROM AUTHOR]

Currently, there is no universally accepted diagnostic radiology curriculum for self-studying, so diagnostic radiology residents often have a challenging time knowing where to begin their independent studying away from work. In an effort to meet the needs of today's residents, we attempted to provide structured, comprehensive self-studying suggestions in a digestible and personalized format. Each radiology division attempted to create an optimal learning resource form for the residents to use for self-studying while on each rotation. Each self-study guide included hyperlinks to easily accessible online resources. Training level-specific week-by-week recommendations were provided based on the expected types of cases a resident would typically encounter during that timeframe. All of the neuroradiology rotation forms and several of the other subspecialty forms were originally made available to the residents and faculty electronically on July 1, 2022. The forms are now distributed to newly rotating residents on a monthly basis. There is a fine balance between providing residents with comprehensive review material and promoting realistic expectations. In addition, educators must keep in mind financial limitations of their residents and institutions. Learning resources must be affordable to be accessible to all residents. As radiology and technology continuously advance, there will undoubtedly be more and more excellent resources for trainees to learn from. To optimize self-studying, retention of information, and wellness, it is imperative to provide our residents with a structured, personalized, manageable curriculum including easily accessible high-yield resources. [ABSTRACT FROM AUTHOR]

The B2 glenoid poses significant challenges for reconstruction with shoulder arthroplasty. A variety of techniques has been used to quantify the B2 glenoid and is often used for surgical decision-making. The critical B2 glenoid ratio is a novel measure and is defined as the ratio between the paleoglenoid length (original glenoid surface) and the total glenoid length. This study aims to define inter and intrarater reliability of the critical B2 ratio and to compare it to conventional methods of measurement. A convenience sample of patients with Walch B2 glenoid morphology was generated from a prospectively collected multicenter shoulder arthroplasty registry. The axes of preoperative computed tomography (CT) images were reoriented in the scapular plane. Three sports medicine surgeons experienced in arthroplasty measured the critical B2 glenoid ratio in addition to posterior humeral subluxation, version, and glenoid bone loss at 2 timepoints greater than 1 week apart. Inter-rater and intra-rater reliability were calculated for all readers and CT measures with the intraclass correlation coefficient (ICC). The critical B2 glenoid ratio was compared to conventional measurements using Spearman's rank correlation coefficients and receiver operating characteristic (ROC) curves. The critical B2 glenoid ratio demonstrated good inter-rater reliability among the 3 measurers with ICCs of 0.89 and 0.799 for the 1st and 2nd measurement sessions, respectively. The critical B2 glenoid ratio showed excellent intrarater reliability for 2 of the measurers (ICC 0.933 and 0.98) and good intrarater reliability for 1 of the measurers (ICC 0.820). A significant correlation was observed between glenoid bone loss along Friedman's line and the critical B2 ratio (P <.001). ROC curves found a B2 ratio = 0.4 was found to be an inflection point for 15° of neoglenoid (posterior erosion surface) retroversion. ROC curves to assess if humeral head subluxation >70% correlated to a threshold B2 ratio value revealed no significant threshold. The critical B2 glenoid ratio is a novel and reproducible CT-based measure that is defined as the ratio between the paleoglenoid length and the total glenoid length. It has high reproducibility based on inter and intra-rater reliability among a group of shoulder surgeons. A critical B2 ratio of less than or equal to 0.4 correlates with significant neoglenoid retroversion and may be a threshold beyond which to avoid corrective eccentric reaming for anatomic shoulder arthroplasty. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Ophthalmology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Antimicrobial resistance is an emerging global threat to public health. The resistant bacteria in food animals can be transferred to humans through the food chain. Limited information on antimicrobial usage and resistance in food animals is available in Southeast Asia due to inadequate monitoring or surveillance systems. A literature review was conducted on antimicrobial use and resistance in food animal production in Southeast Asia for the period 2011–2020, to assess the scope and extent of antibiotic use and resistance. The countries included in the study were Bangladesh, Bhutan, Democratic People's Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. The information was categorised by country, production type and findings regarding antibiotic use and resistance. A total of 108 publications were included in the review. Results showed widespread use of critically and highly important antibiotics in livestock, poultry and aquacultured fish and their products. To curb the growing threat of antibiotic resistance, Southeast Asian countries need to strengthen surveillance and regulatory controls of antimicrobial use in food animal production through "One Health" approach. [ABSTRACT FROM AUTHOR]

Autologous platelet rich fibrin (PRF), is currently being widely used and investigated across the globe by clinicians and periodontal research. The technical aspect required for the procurement of PRF includes revolution per minute (RPM), relative centrifugal force (RCF) or G-force, rotor radius, rotor angle, stability or vibration in the centrifugal machine and material of test-tube, besides the systemic health of the individual may influence the final outcome. Present technical note intends to compile these aspects for better understanding and appropriate outcome while preparing PRF in varying clinical scenarios. [Display omitted] [ABSTRACT FROM AUTHOR]

The uninjured contralateral feet of consecutive patients undergoing cone-beam weightbearing computed tomography for acute Lisfranc injury between July 2017 and October 2019 were retrospectively analyzed. Of these, any cases with history or radiological evidence of trauma to the Lisfranc interval were excluded. The area of the non-weightbearing (NWBA) and weightbearing (WBA) Lisfranc joint was calculated (in mm2) using a novel technique. Area difference (AD) was calculated as WBA-NWBA. Area ratio (AR) was calculated as WBA/NWBA. A subset of cases was double-measured by 2 technologists to evaluate inter- and intraobserver variability. A total of 91 patients aged 15 to 74 years were included in the study. The measurement technique was reproducible with excellent intraobserver correlation (intraclass correlation coefficient [ICC]: 0.998, 95% confidence interval [CI]: 0.996-0.999) and high interobserver correlation (ICC: 0.964, CI: 0.939-0.979). The median NWBA was 83 (range 52-171) and median WBA was 86 (range 52-171). Median AD was 1 mm2 (range -3 to 10) and median AR was 1.01 (range 0.96-1.11). No significant difference was identified in AD or AR when adjusted for age, gender, patient-weight or weight put through the foot. Both AD and AR distributions were highly skewed toward 0 and 1, respectively. Based on 95% CI, normal reference range for AD is -1 to 7 mm2 and for AR is 0.98 to 1.09. Absolute area of the Lisfranc joint is highly variable between individuals. The Lisfranc joint is rigid with little to no physiologic widening in most subjects. The normal upper limit of widening of the Lisfranc area on weightbearing was 9%. Differences in age, sex, patient-weight or weight put through the foot were not significantly associated with the extent of joint widening. [ABSTRACT FROM AUTHOR]

[Display omitted] • Most risks increasing the susceptibility to black fungus are related to COVID-19. • Diabetes and steroid use can make COVID-19 patients prone to mucormycosis. • Vulnerability to black fungus needs to be probed beyond traditional risk factors. • Holistic study of causative factors is needed to streamline black fungus diagnosis. The deadly second wave of COVID-19 has seen an unprecedented surge in mucormycosis associated mortality in India, overwhelming the heath authorities with challenges beyond measure. Also known as black fungus, this life-threatening fungal infection usually manifests in the nose, spreads to the eyes, and in some cases also to the brain. Immune suppression, pre-existing conditions, prolonged and indiscriminate use of steroids, and unhygienic environments are some of the widely recognized risk factors for contracting black fungus in individuals recovered from COVID-19. However, diagnosis of the infection remains insufficient due to the lack a holistic understanding of the possible risks, symptoms, and exposure pathways and therefore no definite protocol exists for managing this fatal infection. Here, we synthesize the current state of knowledge on black fungus outbreak in India and identify key gaps in its understanding with respect to potential risk factors leading to the widespread infection. We looked at 3354 black fungus cases in India, enlisting ailment history (particularly diabetes) and steroid usage in COVID-19 patients as the key factors responsible for exacerbating risks associated with the disease. However, we also press on the possibilities that other less studied non-traditional risk factors may also have a role in causing the infection. Black fungus is therefore a reality of COVID-19, with or without diabetes or steroid use needs to be investigated. We believe such a review is imperative for making informed decisions specially around timely diagnosis and channelizing efforts in controlling the spread of COVID-19 associated mucormycosis. [ABSTRACT FROM AUTHOR]

The connotation of liveability varies with context. Assessing the liveability of cities is complicated by the plethora of mutually-interacting dimensions – physical, economic, social, environmental and institutional. The authors, in this paper, have attempted to address this complexity and advance the understanding of the concept of liveability to planners, and its applicability to more inclusive policymaking. By availing of the body of knowledge in extant literature, the paper fosters a systematic understanding of the concepts of liveability and its key constructs, suggests various methods to measure liveability, and highlights the need for trade-offs between liveability and sustainability outcomes in urban planning. It also contributes to the identification of the inherent social construction reflecting the values, perceptions and experiences of its inhabitants in defining and measuring liveability. The authors suggest the use of cognitive, participatory and micro-scale indicators to assess liveability, while arguing in favour of a 'pro-equity' perspective in the local context; and opine that the assessment framework suggested can unearth opportunities to formulate place-based innovative policies to create liveable, sustainable and equitable cities. Bolstered by their findings from the review, the authors have introduced a novel participatory assessment approach, abbreviated as SaRVO, which they recommend to town planners and policymakers as well as researchers in the future. [Display omitted] • Liveability is contextual with differing values and experiences of individuals. • Liveability and sustainability are complementary despite existence of tensions. • Managing trade-offs between influencing drivers can enhance city's liveability. • Equity issues needs to be addressed in defining and measuring liveability for all. • Microscale indices and cognitive approach can shape city's liveability performance. [ABSTRACT FROM AUTHOR]

One of the critical issues in detecting depression is using facial expressions with image data classification. In This research paper, we proposed Fusion Fuzzy Logic((FFL) with deep learning for identifying depressed people based on their facial expressions. Our proposed model the based on an advanced fuzzy algorithm with deep learning for unordered fuzzy rule(FR) initiation to offer appropriate and suitable opinions based on depressed people's facial expressions(FE), to allow Depression Recognition(DR) from image files and recorded video files. The primary goal of this research work was to use the fusion method to turn these facial expressions (FE) into the detection of depressed states. To elevate the performance of the Fusion Fuzzy Logic((FFL) (fuzzy logic and CNN)), delivering them entreated them several times to imitate specific facial expressions. Our proposed FFL with the CNN model produces exact and dependable results with a 94.3% overall accuracy comparable to human recognition. [ABSTRACT FROM AUTHOR]

From the perspective of the Industry 4.0 paradigm, the machine learning (ML) discipline has had a significant influence on the manufacturing sector. The industry 4.0 concept promotes intelligent sensors, gadgets, and equipment to create technology infrastructure sectors that collect information constantly. By analyzing the obtained data, machine learning approaches allow actionable insight to boost industrial productivity without dramatically altering the necessary resources. Furthermore, the capacity of machine learning applications to provide actionable analytics has facilitated the detection of complex manufacturing trends and paved the path for an integrated intelligent process in various activities in the supply chain, including smart and constant inspection, preventative maintenance, quality enhancement, process optimization, supply chain advancement, and workflow scheduling. This paper aims to present recent advances in the field of quality inspection in Industry 4.0 and develop a framework for quality inspection that can be fully utilized in the Industry 4.0 context using adaptive bilateral filtering and Feature Correlated Auto encoder (FCA) machine learning technique. The suggested approach makes full use of information from all sources along the manufacturing chain. Therefore, it complies with quality management standards within the context of Industry 4.0. The suggested model makes use of corrective measures based on data patterns discovered through predictive analysis. Result analysis was shown on some pre-trained deep learning models such as ResNet18, Vgg19, Alexnet, Squeezenet, auto encoder, and FCA and observed that the proposed FCA(Feature Correlated Auto encoder) achieved a better result. [ABSTRACT FROM AUTHOR]

Most massive rotator cuff tears (MCTs) are often successfully treated with nonoperative treatment; however, various surgical treatment options are available if conservative management fails. Several joint preserving techniques for MCT are commonly used, but the options are limited if an MCT is irreparable. Reverse total shoulder arthroplasty (RTSA) is gaining popularity over hemiarthroplasty as a treatment option for irreparable MCT, especially if glenohumeral degenerative changes are present. RTSA has been shown to have improved functional outcomes and range of motion postoperatively, particularly in the elderly and patients with pseudoparalysis. [ABSTRACT FROM AUTHOR]

Authentication and Authorization are the base of security for all the Technologies present in this world today. Starting from your smartphone where a user authenticates himself before he could access the data inside to Entering into the White House, you must authenticate yourself, and based on that you are authorized. In this digital world where every Business, MNC, Government Body, Companies, Users, etc. needs a website to inform the world about their presence on the internet, provide services online and become a "Brand", the risk of leaking user's sensitive information increases. It could be dangerous to the users of the hacked website because their sensitive information like a credit card, bank account details, etc. could be sold in the black market of the "dark web". The role of the dark web is described in the paper and how the data is sold there and what becomes of it. The paper helps to understand how a secure website is developed that promises the user to keep the sensitive information safe, increases the bond of trust between a client and server which results in a long-term relationship. The aim behind developing an authentication system is to keep users' sensitive information safe so that hackers cannot steal and sell the information on the dark web's back market. To perform this, the developer needs to understand how to implement authentication. NodeJS, with the help of its framework expressJS and some other packages, is used to develop the authentication and authorization system of the website by the research. Previous papers on this field covered the authentication topic in general. This paper overcame that by going deeper into the field and being server-side language specific. The common types of authentication methods used in different types of websites are discussed in detail and the best methods are purposed for the developer to be implemented for a more secure website. This research put light on Artificial Intelligence and blockchain as the future of security of big data. [ABSTRACT FROM AUTHOR]

Exercise training is a well-established intervention for patients with heart failure with reduced and preserved ejection fraction. Still, the evidence of its effects on mortality, hospitalization, and quality of life needs to be more conclusive. We aim to evaluate exercise training clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). We searched five databases and three clinical trial registries for RCTs that compared exercise training plus usual care versus usual care alone in congestive heart failure (CHF) patients. We extracted data on all-cause mortality, hospital admission, heart failure hospitalization, and health-related quality of life measured by the Minnesota Living with HF questionnaire (MLHFW) and other scales. We pooled the data using random-effects or fixed-effects models, depending on the heterogeneity of the outcomes. We performed subgroup analyses for patients with heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). We included 61 RCTs with 9062 participants. There was no mortality benefit, but exercise training improved health-related quality of life, reduced hospital admission at 12 months and longer follow-up, and reduced heart failure hospitalization. We observed substantial enhancement in health-related quality of life and a greater decrease in hospital admissions in the HFpEF group compared to the HFrEF group. Despite the lack of mortality benefit, exercise training is a beneficial intervention for CHF patients, improving health-related quality of life and reducing hospitalization. [ABSTRACT FROM AUTHOR]

Unstable ankle fractures are traditionally treated with open reduction and internal fixation. An alternative surgical option is primary tibio-talar-calcaneal fusion. Our aims were to determine the indication, complication rates, and functional outcomes, of tibio-talar-calcaneal nailing when used as the primary treatment of ankle fractures. A multidatabase literature search was performed on December 14, 2019 according to PRISMA guidelines. All studies in the English language reporting complications and outcomes involving tibio-talar-calcaneal nailing for primary treatment of ankle fractures were included. Ten studies with 252 ankle fractures were included. Mean age of patients was 75.5 (32-101) years. Mean follow-up duration was 79 weeks (36-104 weeks). Surgical site infection occurred in 11.2% (95% confidence interval [CI] 6.3%-19%) of patients, implant failure occurred in 8.1% (95% CI 5%-12.8%) of patients, and unplanned return to operating room occurred in 10.1% (95% CI 6.1%-16.2%) of patients. There were no cases of wound dehiscence. All-cause mortality rate at the end of follow-up was 26.6% (95% CI 19.7%-34.9%). Average reduction in Olerud-Molander Ankle Score after surgery was 7.9 points (5.0-11.8). Eighty-one point five percent (95% CI: 67.4%-90.4%) of patients were able to return to similar preoperative mobility aid after surgery. Tibio-talar-calcaneal nailing is an alternative procedure for patients who have sustained fractures unsuitable for nonoperative management, but have low functional demands and at increased risks of complications after open reduction and internal fixation. About 81.5% (95% CI 67.4%-90.4%) of patients were able to return to a similar preinjury mobility status after tibio-talar-calcaneal nailing. [ABSTRACT FROM AUTHOR]

With the increase in digital communication, images have become indispensable media for carrying obscured communication these days. Unraveling the presence or details of obscured transmission also known as steganography is termed as steganalysis. Passive steganalysis focuses only on classification of object as clean or adulterated. Finding the length of payload and regions where the message is hidden, in a stego object is a challenging task and forms a part of Active or Forensic Steganalysis. Many researchers have worked towards finding the length of message, but not much work has been done on finding region where message is hidden. This motivated us to work towards finding the region of payload in stego images. Hence this paper proposes a novel technique for detection of payload regions in a stego image combining Denoising Autoencoder with Local Binary Pattern (LBP) Operator. Denoising Autoencoder is used to learn inter relationships between pixels of an image for estimating cover image from the given stego image. LBP operator capable of capturing local inter-relationships within neighborhood coordinates, have been used to compare corresponding blocks in input stego image and estimated cover image for unraveling payload locations. The major advantage of the proposed technique is that it is universal and it does not require cover image or knowledge about steganographic algorithm used. Accuracy of 96.5% and 97.7% respectively was achieved in the experimental study conducted with spatial and JPEG domain images from BOSSBase dataset. [ABSTRACT FROM AUTHOR]

We provide our algorithm for tissue augmentation of rotator cuff repairs based on the current available evidence regarding rotator cuff healing. A variety of factors are associated with healing following rotator cuff repair. Increasing tear size and retraction as well as severe fatty degeneration have been associated with worsening rates of tendon healing. Given the correlation between tendon healing and postoperative outcomes, it is important to identify patients at high risk for failure and to modify their treatment accordingly to minimize the risk of early biomechanical failure and maximize the potential for structural healing. One approach that may be used to improve healing is tissue augmentation. Tissue augmentation is the use of tissue patches and scaffolds to provide rotator cuff reinforcement. Surgical management for rotator cuff tears (RCTs) continues to be a challenging task in orthopaedic surgery today. Appropriate treatment measures require an in depth understanding and consideration of the patient's prognostic factors such as age, fatty infiltration of the rotator cuff muscles, bone mineral density, rotator cuff retraction, anteroposterior tear size, work activity, and degenerative changes of the joint. Using these factors within the Rotator Cuff Healing Index, we can determine a patient's surgical treatment that will yield the maximum healing rate. For nonarthritic RCTs, joint-preserving strategies should be first-line treatment options. For young, active patients with a reparable RCT and minimal fatty infiltration, a complete repair can be effective. For young patients with irreparable RCTs, superior capsular reconstructions, and tendon transfers are viable options. For elderly patients with low work activity, an irreparable RCT and significant fatty infiltration, a partial repair with or without graft augmentation can be attempted if minimal to no arthritic changes are seen. LEVEL OF EVIDENCE: Level V, expert opinion. [ABSTRACT FROM AUTHOR]

While distant metastases in primary bone sarcomas have been extensively studied, the impact of isolated regional lymph node (LN) metastasis on survival remains unknown. In patients with primary bone sarcomas, we sought to assess the prevalence of isolated regional LN metastasis and the survival of this population. A total of 6651 patients with histologically-confirmed high-grade osteosarcoma, Ewing sarcoma, or chondrosarcoma were retrieved from the SEER database. We defined four subgroups for our analysis: localized disease (N0 M0), isolated regional LN metastasis (N1 M0), isolated distant metastasis (N0 M1), and combined regional LN and distant metastasis (N1 M1). Disease-specific survival (DSS) was assessed using the Kaplan-Meier method. Prevalence of isolated regional LN metastasis (N1 M0) was highest in Ewing sarcoma (27/1097; 3.3 %), followed by chondrosarcoma (18/1702; 1.4 %) and osteosarcoma (26/3740; 0.9 %). In all three histologies, patients with isolated regional LN metastasis had a worse 2-year, 5-year, and 10-year DSS than those with localized disease. Chondrosarcoma patients with isolated regional LN (N1 M0) metastasis had a significantly higher DSS in comparison to those with only distant metastasis (N0 M1) at the 5- and 10-year marks; for osteosarcoma and Ewing sarcoma, only a pattern towards higher survival was seen. Risk factors for presenting isolated regional LN metastasis included tumor location in lower-limb (OR = 2.01) or pelvis (OR = 2.49), diagnosis of Ewing sarcoma (OR = 2.98), and tumor >10 cm (OR = 1.96). Isolated regional LN metastases in primary bone sarcomas is an infrequent presentation associated with worse survival than localized disease. III. [ABSTRACT FROM AUTHOR]

• Rapid assessment of persistent symptoms after 12-14 weeks of recovery among 1001 participants in a metropolitan city in India. • One in four reported at least one symptom 12-14 weeks post recovery • Hospitalisation for severe infection, having at least one morbidity were associated with persistent symptoms. • Hospitalisation for severe infection was independently associated with severe limitation of activities of daily living post COVID-19 recovery. [ABSTRACT FROM AUTHOR]

The American Board of Radiology (ABR) developed the international medical graduate alternate pathway to give foreign trained radiologists an alternate route to independent radiology practice without having to undergo radiology residency in the United States. After 4 years of fellowship/faculty experience in the same training institution, the foreign trained radiologist becomes eligible to sit for the radiology board examinations conducted by the ABR. As this pathway is not offered at every radiology training program, many training institutions are unfamiliar with the fundamentals of this pathway. At the same time, both the training institutions and the applying foreign-trained physicians face a plethora of confusing choices on the state and federal level. In this paper, we review the main factors which both the international medical graduate radiologists and training programs must consider before embarking on the diagnostic radiology ABR Alternate Pathway, namely, eligibility, visa options, state medical licensure requirements, their costs and implications for future employment opportunities. [ABSTRACT FROM AUTHOR]

The incidence of breast cancer in the UK continues to increase; however, the death rates continue to decline. Mortality rates have reduced by 19% in the UK in the last decade and are projected to fall by a further 26% in 2014–2035. Cancer research UK reports 55,176 new cases in 2015–2017 with 11,547 deaths from breast cancer reported from 2016 to 2018. Ten-year survival for all comers is reported at 76%. Largely, the improvements in outcomes is felt to be multi factorial in nature with earlier detection of cancers, increased axial imaging and the rapidly progressing and expanding radiotherapy and systemic therapy treatment options available. Irrespective of this, there are still a number of patients diagnosed with more advanced disease. Between 13% and 21% of patients are diagnosed with stage III/IV disease, with 7% of patients having metastatic disease at diagnosis. The following review discusses the treatment options available to patients with locally recurrent or metastatic breast cancer (MBC). [ABSTRACT FROM AUTHOR]

There remains limited data as to the feasibility, safety, and efficacy of higher doses of elective radiation therapy to the pelvic lymph nodes in men with high-risk prostate cancer. We conducted a phase II study to evaluate moderate dose escalation to the pelvic lymph nodes using a simultaneous integrated boost to the prostate. Patients were eligible with biopsy-proven adenocarcinoma of the prostate, a calculated lymph node risk of at least 25%, Karnofsky performance scale ≥70, and no evidence of M1 disease. Acute and late toxicity were prospectively collected at each follow-up using Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4.0). The pelvic lymph nodes were treated to a dose of 56 Gy over 28 fractions with a simultaneous integrated boost to the prostate to a total dose of 70 Gy over 28 fractions using intensity-modulated radiation therapy. Thirty patients were prospectively enrolled from October 2010 to August 2014. Median patient age was 70 years (57-83), pretreatment prostate-specific antigen was 11.5 ng/mL (3.23-111.5), T stage was T2c (T1c-T3b), and Gleason score was 9 (6-9). CTCAE v4.0 rate of any grade 1 or 2 genitourinary and gastrointestinal toxicity were 55% and 44%, respectively, and there was 1 reported acute grade 3 genitourinary and gastrointestinal toxicity, both unrelated to protocol therapy. With a median follow-up of 6.4 years, the biochemical failure free survival rate was 80.2%, and mean biochemical progression free survival was 8.3 years (95% confidence interval [CI], 7.2-9.4). The prostate cancer specific survival was 95.2%, and mean prostate cancer specific survival was 8.7 years (95% CI, 8.0-9.4). Five-year distant metastases free survival was 96%. Medians were not reached. In this single arm, small, prospective feasibility study, nodal radiation therapy dose escalation was safe, feasible, and seemingly well tolerated. Rates of progression free survival are highly encouraging in this population of predominately National Comprehensive Cancer Network very high-risk patients. [ABSTRACT FROM AUTHOR]

This guideline provides evidence-based recommendations addressing the indications for radiation therapy (RT), sequencing of local therapies, and appropriate dose and planning techniques for management of primary, operable, localized, soft tissue sarcoma (STS) in adults. The American Society for Radiation Oncology convened a task force to address 5 key questions focused on the use of RT for management of STS. These questions included indications for RT for STS of the extremity and superficial trunk; considerations for sequencing of RT with respect to surgery, dose of RT, appropriate treatment volumes and techniques; and the role of RT in management of retroperitoneal sarcoma. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. Multidisciplinary evaluation and decision making are recommended for all cases of STS. RT is recommended for patients in whom there is increased risk of local recurrence of resected STS, particularly if close or microscopically positive margins are anticipated or have occurred. When RT is indicated, preoperative RT is strongly recommended over postoperative RT. Postoperative RT is conditionally recommended in specific clinical circumstances (eg, uncontrolled pain or bleeding) or when the risk of wound complications outweighs that of late toxicity from RT. Routine use of RT in addition to oncologic resection for retroperitoneal sarcoma is conditionally not recommended. When RT is used for retroperitoneal sarcoma, preoperative RT is recommended, whereas postoperative RT is not recommended. Based on currently published data, the American Society for Radiation Oncology task force has proposed evidence-based recommendations regarding the use of RT for STS in adults. Future studies will ascertain whether alterations in dosing and sequencing may optimize outcomes and quality of life. [ABSTRACT FROM AUTHOR]

This paper is devoted to discuss Hilfer fractional evolution equations through its controllability and stability in a Banach space. We achieve our claims and conclusions by first demonstrating the nature and uniqueness of the suggested set of equations with their mild solutions. The outcomes of existence and uniqueness are obtained with the aid of the propagation family theory, non-compactness calculation methods and the fixed point technique. An example is also provided for the description of our main results. [ABSTRACT FROM AUTHOR]

Objectives: Pharmacist collaboration in transitions of care (TOC) programs is integral to increase patient education and adherence after discharge. This study aimed to conduct a qualitative evaluation of stakeholder perspectives to inform the design and implementation of a TOC program between an emergency department (ED) and regional supermarket chain pharmacies.Methods: Pharmacies from a regional supermarket chain were identified for inclusion on the basis of geographic proximity to a local community hospital ED. Semistructured, one-on-one interviews with the primary investigator were conducted. Interview questions were based on the Consolidation Framework for Implementation Research (CFIR). The following 5 CFIR domains were used: (1) intervention characteristics, (2) outer setting, (3) inner setting, (4) characteristics of individuals, and (5) process. Interviews were audio-recorded and transcribed. Two investigators coded each transcript independently. A thematic analysis was performed.Results: A total of 19 interviews were conducted, and the following 7 major themes emerged on analysis: (1) enhance real-time interprofessional communication, (2) establish data sharing between the ED and the community pharmacy, (3) provide timely resolution of prescription insurance issues for new therapies post-ED discharge, (4) use off-site pharmacy resources to support community pharmacy workflow, (5) increase patient education to prevent primary medication nonadherence, (6) reinforce discharge care plans, and (7) focus on community-dwelling older adult patients in an ED care transition program.Conclusion: Health care providers including pharmacists, physicians, nurses, and care managers, view an ED-to-community pharmacy TOC program as a valuable service to increase patient education on new medications and discharge planning. Establishment of data sharing and reimbursement is integral to the development, implementation, and sustainability of such programs. There is an untapped opportunity for community pharmacists to bridge the gap in care after ED discharge. [ABSTRACT FROM AUTHOR]

YouTube, the most commonly used free video-sharing platform globally, is increasingly being used as an educational tool in Radiology. Trainees worldwide now have the opportunity to learn about medical imaging at their own pace in the comfort of their homes, without geographical and financial constraints. Unfortunately, because YouTube is an easily accessible platform, it also incurs the risk of disseminating erroneous medical information or low-quality educational content. This article outlines the primary considerations when creating educational content on YouTube, including technical aspects, best practices, and measures to maximize effectiveness and success. Additionally, we discuss the current usage of the platform for Radiology education and its advantages and disadvantages and list some of the most popular Radiology YouTube channels. [ABSTRACT FROM AUTHOR]

Stock market plays a vital role in a country's economy, serving as a platform for companies to raise capital and enabling investors to share in their growth and success. The market is very unpredictable, characterized by non-linear variations and sudden fluctuations driven by a multitude of external factors. In the past, several traditional, deep learning, machine learning-based, and hybrid solutions have been put forth to estimate stock trends accurately. The existing techniques fail to achieve the desired accuracy due to the complex, non-linear, and random behavior of the stock time series. Moreover, the hybrid approaches in this domain have several shortcomings, such as shifting procedure dependency, optimal component count, computationally expensive, and many more. To address these challenges, and improve both accuracy and reliability, the current approach proposes a hybrid approach integrating association rule mining with deep learning models. The association rule mining aims to quantify the impact of a critical external factor (other companies' stock trends) on a target company stock. The identified associated companies define the data to be fed to the neural models. The current approach implements a multivariate long short-term memory neural architecture for the stock price prediction task. Through performance analysis conducted on the National Stock Exchange (NIFTY50) dataset focusing on four well-known companies, the proposed hybrid approach demonstrates significantly improved prediction accuracy compared to benchmark methods. The proposed approach has demonstrated an average 8%–10% improvement in the prediction results of the benchmark approach. Moreover, the prediction performance of the proposed approach is statistically verified using the T-test. • Proposed a novel approach for financial time-series forecasting. • Association Rule Mining with Regression is employed for Feature Selection. • Identified Strong Association among stocks is utilized to perform future estimates. • Performance estimation on NIFTY50 shows prediction superiority of proposed approach. [ABSTRACT FROM AUTHOR]

Patients with hostile chests are often precluded from the use of left ventricular assist device therapies for advanced heart failure. We describe a technique for left ventricular assist device implantation using a left thoracotomy approach with outflow graft anastomosis to the left subclavian artery and placement of a distal band to the left subclavian artery. Distal banding of the left subclavian artery prevents over-circulation to the left upper extremity. This technique provides an alternative approach for left ventricular assist device implantation in patients who otherwise would be deemed inoperable because of hostile chest. [ABSTRACT FROM AUTHOR]

Background: Globally, more than 12 million people have been infected with COVID -19 infection till date with more than 500,000 fatalities. Although, Covid-19 commonly presents with marked respiratory symptoms in the form of cough and dyspnoea, a neurotropic presentation has been described of late as well.Objective: In this brief communication we report four cases of Covid-19 who presented to our hospital with features suggestive of Guillain-Barre Syndrome (GBS).Discussion: The mechanisms by which SARS-CoV-2 causes neurologic damage are multifaceted, including direct damage to specific receptors, cytokine-related injury, secondary hypoxia, and retrograde travel along nerve fibres. The pathogenesis of GBS secondary to Covid-19 is not well understood. It is hypothesised that viral illnesses related GBS could be due to autoantibodies or direct neurotoxic effects of viruses.Conclusion: Nervous system involvement in Covid-19 may have been grossly underestimated. In this era of pandemic, it is very important for the physicians to be aware of association of GBS with Covid-19, as early diagnosis and treatment of this complication could have gratifying results. To the best of our knowledge, this is the first such case series of Guillain-Barre Syndrome associated with Covid-19 to be reported from India. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has forced the transition of the traditional residency interview to a virtual format. This new interview format creates additional challenges and opportunities for both programs and applicants. The specific challenges of the virtual interview format are described, as well as means to mitigate those challenges. In addition, opportunities to improve residency selection from the program end are described. [ABSTRACT FROM AUTHOR]

Soft tissue sarcomas are a heterogenous group of neoplasms without well-validated biomarkers. Cancer-related inflammation is a known driver of tumor growth and progression. Recent studies have implicated a high circulating neutrophil-lymphocyte ratio as a surrogate marker for the inflammatory tumor microenvironment and a poor prognosticator in multiple solid tumors, including colorectal and pancreatic cancers. The impact of circulating neutrophil-lymphocyte ratio in soft tissue sarcomas has yet to be elucidated. We performed a retrospective analysis of patients undergoing curative resection for primary or recurrent extremity soft tissue sarcomas at academic centers within the US Sarcoma Collaborative. Neutrophil-lymphocyte ratio was calculated retrospectively in treatment-naïve patients using blood counts at or near diagnosis. A high neutrophil-lymphocyte ratio (≥4.5) was associated with worse survival on univariable analysis in patients with extremity soft tissue sarcomas (hazard ratio 2.07; 95% confidence interval, 1.54–2.8; P <.001). On multivariable analysis, increasing age (hazard ratio 1.03; 95% confidence interval, 1.02–1.04; P <.001), American Joint Committee on Cancer T3 (hazard ratio 1.89; 95% confidence interval, 1.16–3.09; P =.011), American Joint Committee on Cancer T4 (hazard ratio 2.36; 95% confidence interval, 1.42–3.92; P =.001), high tumor grade (hazard ratio 4.56; 95% confidence interval, 2.2–9.45; P <.001), and radiotherapy (hazard ratio 0.58; 95% confidence interval, 0.41–0.82; P =.002) were independently predictive of overall survival, but a high neutrophil-lymphocyte ratio was not predictive of survival (hazard ratio 1.26; 95% confidence interval, 0.87–1.82; P =.22). Tumor inflammation as measured by high pretreatment neutrophil-lymphocyte ratio was not independently associated with overall survival in patients undergoing resection for extremity soft tissue sarcomas. [ABSTRACT FROM AUTHOR]

The management of glenoid deformity during anatomic total shoulder arthroplasty remains controversial. In this study, we evaluate variable correction of glenoid deformity by eccentric reaming. We hypothesize that partial correction of modified Walch B/C-type glenoid deformities can achieve 75% bone-implant contact area (BICA) with a reduced vault perforation risk compared with complete correction. Fifty shoulder computed tomographic scans with glenohumeral osteoarthritis were retrospectively evaluated. The Tornier BluePrint v2.1.5 software simulated 3 eccentric reaming scenarios including no, partial, and complete deformity correction. Each scenario was evaluated at 4 BICAs and using 3 implant fixation types. Three-dimensional surface representations were used to evaluate medialization and vault perforation. The patients had mean glenoid retroversion and inclination of 18.5° and 8.8°, respectively, and mean posterior humeral head subluxation of 76%. With 75% BICA, the 3 fixation types had glenoid vault perforation in 6%-26% and 26%-54% of cases for partial and complete glenoid deformity correction, respectively. The central and posterior-inferior implant components were most likely to perforate across all scenarios. Eccentric reaming for glenoid deformity correction increases the risk of vault perforation. Severe glenoid deformity required increased medialization to achieve 75% BICA. Pegged implants have increased chances of perforation compared with a keeled design; the central and posterior-inferior components were most likely to perforate during deformity correction. Partial deformity correction of modified Walch B/C-type glenoid deformities can achieve 75% BICA while reducing the risk of vault perforation compared with complete correction at the time of anatomic total shoulder arthroplasty. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare the percentage of native femoral anterior cruciate ligament (ACL) footprint covered by the 2 most clinically relevant bone plug/graft orientations used with interference screw fixation in ACL reconstruction. A secondary purpose was to assess whether a transtibial or tibia-independent drilling technique would affect this outcome.Methods: Five matched pairs of cadaver knees were used. Each matched pair had 1 knee assigned to a 10-mm femoral socket prepared via a transtibial (TT) drilling technique and the other via an anteromedial (AM) drilling technique. The bone plug of each graft was press-fitted into the femoral socket with the graft collagen in 2 distinct clinically relevant orientations (collagen inferior or posterior). The digitized graft collagen cross-sectional area (CSA) in each orientation was overlaid onto the native femoral ACL footprint CSA to generate a percentage of native ACL footprint covered by graft collagen.Results: The average native ACL femoral footprint CSA was 110.5 ± 9.1 mm2, with no difference between knees assigned to TT or AM drilling (112.6 ± 2.7 vs 108.4 ± 13.0 mm2, P = .49). The average femoral socket CSA was 95.4 ± 8.7 mm2, with no difference between TT and AM tunnels (95.5 ± 9.9 vs 95.3 ± 8.4 mm2, P = .96). There was no difference between the percentage of native footprint covered between TT and AM sockets (76.8% ± 7.8% vs 82.2% ± 13.7%, P = .47). Irrespective of drilling technique, there was significantly greater native ACL footprint covered by graft collagen when the bone plug was oriented with graft collagen inferior rather than posterior (75.6% ± 6.3% vs 65.4% ± 11.4%, P = .02).Conclusion: Orienting the femoral bone plug such that the graft collagen is inferior rather than posterior significantly increases native ACL femoral footprint coverage in bone-patellar tendon-bone ACL reconstruction. This effect is consistent across AM and TT drilling techniques.Clinical Relevance: Surgeons attempting to restore an anatomic ACL footprint should consider bone plug-graft orientation when performing ACL reconstruction.Study Design: Controlled laboratory study. [ABSTRACT FROM AUTHOR]

Syndesmotic injuries are common, but only a subset of these injuries are unstable. A noninvasive tool for identifying instability would aid in the selection of patients for surgery. Weightbearing computed tomography (CT) data have been reported for healthy patients, but there are limited data on unstable syndesmoses. We evaluated the syndesmotic area of arthroscopically proven unstable ankles after acute injury. This is a prospective comparative study of consecutive patients recruited to a weightbearing CT database. Thirty-nine patients were included for analysis with arthroscopically proven unstable syndesmoses and an uninjured contralateral ankle. The syndesmosis area was measured for both ankles, in non-weightbearing and weightbearing positions, and compared. Syndesmosis area of the unstable ankle was significantly greater than the uninjured ankle of the same patient, by a mean of 22.9 ± 10.5 mm2. This was a significantly greater difference than that observed with non-weightbearing CT (9.8 ± 10.2 mm2, p <.001). Dynamic change in area, from non-weightbearing to weightbearing, of the unstable ankle (13.7% [16.6 ± 9.9 mm2]) was significantly greater than that of the uninjured ankle (3.1% [3.4 ± 6.7 mm2], p <.001). The intraobserver and interobserver correlations were good with intraclass correlation coefficients of 0.983 and 0.970, respectively. Weightbearing CT demonstrated significantly greater diastasis in unstable ankles than did conventional non-weightbearing CT. Syndesmosis area measurement was reliable and reproducible. Dynamic change in area and weightbearing comparison with the contralateral uninjured ankle are 2 parameters that may prove useful in the future for predicting syndesmotic instability. [ABSTRACT FROM AUTHOR]

Purpose: To report preoperative anatomy, patient-related outcomes measures, and return to dance rates in a cohort of competitive dancers undergoing an arthroscopic hip procedure.Methods: Competitive dancers who underwent an arthroscopic hip procedure between 2008 and 2016 were included. Specific types of dance performed, morphology, and radiographic parameters were documented. Outcomes were evaluated with Modified Harris Hip Score (mHHS), the 12-Item Short Form Health Survey, visual analog scale, and Hip Disability and Osteoarthritis Outcome Scores (HOOS).Results: There were 63 competitive dancers (77 hips) with a mean age 21.2 years in the current study. Specific types of dance performed included 57 studio dance and 41 high-kick dance, and 28 dancers (44%) were professional-level. Morphology included cam-type femoroacetabular impingement (95%), pincer-type femoroacetabular impingement (40%), anterior inferior iliac spine impingement (subspine) (83%), and mild (borderline) dysplasia (11%). Procedures performed included 95% labral repairs, 5% labral debridements, 99% femoral resections, 49% rim resections, 88% subspine decompressions, and 66% capsular plications. At mean 36 months' follow-up post-arthroscopy, the mean outcome improvements were 25.6 points (mHHS), 18.9 points (HOOS-activities of daily living), 29.9 points (HOOS-Sports), 8.7 points (12-Item Short Form Health Survey), and 3.7 points (visual analog scale) (P < .01 for each). Scores were significantly improved from preoperatively to most recent follow-up for mHHS (60.0 vs 85.6 points), HOOS-activities of daily living (72.5 vs 91.5 points), and HOOS-Sports (49.7 vs 79.6) (P < .01). Sixty-three percent of dancers returned to their previous level of competitive dance, 21% returned to limited or modified dance, and 16% were unable to return to dance, including 1 retirement.Conclusions: A careful arthroscopic approach to address cam-type pathomorphology, highly prevalent subspine impingement, and capsular laxity in competitive dancers can achieve a modest rate of return to sport and good-to-excellent patient-reported outcomes at short- to mid-term (3-year) follow-up. Eighty-four percent of dancers ultimately returned to competitive dance, although only 63% returned to their preinjury competitive level.Level Of Evidence: IV, case series. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effect of independent suture tape reinforcement on the dynamic elongation and stiffness behavior as well as ultimate strength of tripled smaller-diameter and quadrupled soft-tissue grafts for anterior cruciate ligament reconstruction (ACLR) with tibial screw fixation in a biomechanical in vitro study.Methods: Tripled smaller-diameter (8 mm) and quadrupled (9 mm) bovine tendon grafts with and without suture tape reinforcement (n = 8 in each group) were tested using femoral suspensory and tibial interference screw fixation. The suture tape was femoral sided and fixed independent from the graft by passing it through the suspensory button and securing the 2 open tibial strands with a secondary interference screw. Dynamic testing was performed in position and force control at 250 N and 400 N, followed by pull to failure with the mode of failure noted. Dynamic elongation, stiffness, and ultimate strength were analyzed.Results: Tripled constructs showed a significantly worse structural performance than quadrupled constructs at higher loads. Reinforcement of tripled and quadrupled grafts substantially decreased total elongation by 56% (4.54 ± 0.75 mm vs 2.01 ± 0.50 mm, P < .001) and 39% (3.25 ± 0.49 mm vs 1.98 ± 0.51 mm, P < .001), respectively, by significantly increasing dynamic stiffness. No statistical significance was found between the reinforced groups. Failure loads of reinforced tripled (1,074 ± 148 N vs 829 ± 100 N, P = .003) and quadrupled (1,125 ± 157 N vs 939 ± 76 N, P = .023) grafts were also significantly improved.Conclusions: Independent reinforcement of soft-tissue grafts with suture tape strengthened the performance especially of tripled smaller-diameter grafts for ACLR with tibial screw fixation by significantly improving dynamic elongation at increased stiffness and ultimate strength. Quadrupled reinforced grafts showed no over-constraining and structurally behaved similarly to tripled grafts with reinforcement.Clinical Relevance: Independent reinforcement for ACLR may provide an option for protecting autografts or allografts against irreversible lengthening during the maturation and remodeling phases of healing. [ABSTRACT FROM AUTHOR]

Paternally inherited alterations in epigenetic programming are emerging as relevant factors in numerous disease states, including the growth and metabolic defects observed in fetal alcohol spectrum disorders. In rodents, chronic paternal alcohol use induces fetal growth restriction, as well as sex-specific alterations in insulin signaling and lipid homeostasis in the offspring. Based on previous studies, we hypothesized that the observed metabolic irregularities are the consequence of paternally inherited alterations liver x receptor (LXR) activity. Male offspring of alcohol-exposed sires were challenged with a high-fat diet and the molecular pathways controlling glucose and lipid homeostasis assayed for LXR-induced alterations. Similar to findings in studies employing LXR agonists we found that the male offspring of alcohol-exposed sires display resistance to diet-induced obesity and improved glucose homeostasis when challenged with a high-fat diet. This improved metabolic adaptation is mediated by LXRα trans-repression of inflammatory cytokines, releasing IKKβ inhibition of the insulin signaling pathway. Interestingly, paternally programmed increases in LXRα expression are liver-specific and do not manifest in the pancreas or visceral fat. These studies identify LXRα as a key mediator of the long-term metabolic alterations induced by preconception paternal alcohol use. • Chronic paternal alcohol use induces up-regulation of LXRα in the male offspring. • Male offspring of alcohol-exposed fathers are protected from diet-induced obesity. • Paternally-inherited up-regulation of LXRα only manifests in the liver. • Improved metabolic adaptation is linked to LXRα suppression of cytokine production. • Male offspring exhibit the same phenotypes observed in studies of LXR agonists. [ABSTRACT FROM AUTHOR]

The aim of this study was to utilize a Recurrent Neural Network with long short-term memory (LSTM) units to forecast PM 2.5 levels in Delhi. Four monitoring stations in Delhi were used to gather the PM 2.5 data required for training and evaluating the models. The models used in the study included four different combinations of variables: (i) PM 2.5 data only, (ii) PM 2.5 data combined with meteorology, (iii) PM 2.5 data combined with gaseous pollutants, and (iv) PM 2.5 data combined with gaseous pollutants and meteorology. The results revealed that the models incorporating PM 2.5 data with gaseous pollutants and PM 2.5 data with gaseous pollutants and meteorology provided more accurate forecasts of daily and hourly PM 2.5 levels compared to the other models. To further enhance the prediction of PM 2.5 during critical episodes, outlier identification methods were employed to examine the models. The episodes analyzed in the study included dust storms, stubble burning, unfavorable meteorological conditions, and Diwali. The analysis showed that events at one monitoring station occurred before similar events in other regions due to wind direction and non-local PM 2.5 sources. During these episodes, the models incorporating gaseous pollutants performed better due to the dominance of secondary components in PM 2.5 for which the gaseous pollutants act as precursor components. The study provides confidence in the accuracy and effectiveness of the models in aiding regulators to implement prompt interventions in cities facing severe pollution issues. [Display omitted] • Developed LSTM models with four feature combinations for PM 2.5 forecasts in Delhi. • Identified air pollution episodes by outlier detection with MAD and IQR. • Evaluated the models using identified episodic events. • Models with pollutant concentrations outperformed the other models. [ABSTRACT FROM AUTHOR]

To prepare a novel nanoemulsion- Carbopol® 934 gel for Eugenol, in order to prevent the periodontitis. Spontaneous emulsification method was used for the preparation of nanoemulsion in which it contain Eugenol (oil phase), Tween-80 (surfactant), and PEG (co-surfactant). To the development of best nanoemulsion, three-factor three-level central composite design was used in which %oil; %S mix and % water were optimized as independent variables. An optimized–nanoemulsion were converted to nanoemulsion–Carbopol® 934 gel. 5.5% oil, 35.5% S mix and 59.0% water were optimized as independent and dependent variables. Finally dependent variables optimized as a particle size (nm), PDI and %transmittance were observed 79.92 ± 6.33 nm, 0.229 ± 0.019, and 98.88 ± 1.31% respectively. The values of final results for dependent variables like particle size (nm), PDI and % transmittance were evaluated as 79.92 ± 6.33 nm, 0.229 ± 0.019, and 98.88 ± 1.31%, respectively. TEM and SEM showed a spherical shape of developed nanoemulsion with refractive index (1.63 ± 0.038), zeta potential (−19.16 ± 0.11), pH (7.4 ± 0.06), viscosity (34.28 ± 6 cp), and drug content of 98.8 ± 0.09%. After that a final optimized EUG–NE–Gel was assessed on the basis of their pH measurement, drug content, syringeability, and mucoadhesion on the goat buccal mucosa. Optimized EUG-NE-Gel (Tween-80 and Carbopol® 934 used) showed the results, to improve the periodontal drug delivery of EUG in future. EUG-NE-Gel showed a significant role in anti-inflammatory activity, analgesic, and anesthetic, antibacterial, and treatment of periodontal disease. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate radiographic and clinical outcomes after arthroscopic femoroacetabular impingement (FAI) correction in symptomatic adolescent athletes with open physes.Methods: We retrospectively reviewed radiographic and clinical outcomes in patients treated with a non-physeal-sparing arthroscopic approach for symptomatic FAI with open physes and a minimum 1-year follow-up. Specific plain radiographic and computed tomography parameters were determined, and preoperative and postoperative outcomes were prospectively evaluated with modified Harris Hip Score (mHHS), 12-Item Veterans-Rand, and pain on a visual analog scale.Results: Thirty-seven hips (28 patients; 75% male) with a mean age of 15.9 years (range, 12.8-18.3 years) had imaging studies consistent with open femoral neck and iliac crest physes. The ischial tuberosity and greater trochanteric physes were open in 95% and 54% of the hips, respectively. All patients participated in organized athletics, and 50% were in multiple sports year-round. Mean follow-up was 39.8 months post-arthroscopic FAI correction. There was a mean 27.7-point improvement in the mHHS (P < .001), a 4.8-point decrease in the visual analog scale for pain (P < .001), and a 15.2-point improvement in the 12-Item Veterans-Rand physical component (P < .001). Ninety-three percent of patients returned to their preinjury level of sports participation without limitations. Thirty (81.1%) patients demonstrated improvements in mHHS greater than the minimally clinically important difference (of mHHS 8 points). Two patients could not reach minimally clinically important difference because of a preoperative mHHS of > 92. There were no postoperative physeal growth arrests, growth disturbances, physeal instability, or avascular necrosis.Conclusions: A non-physeal-sparing arthroscopic approach for FAI in adolescents with open physes is safe and effective with no evidence of clinically relevant complication of growth arrest-related deformity or physeal instability in patients with a minimum of 1 year (mean, 39.8 months) of follow-up after surgery. Young, highly athletic adolescent patients with larger FAI deformities demonstrated greater outcomes improvement after arthroscopy.Level Of Evidence: Level IV, therapeutic case series. [ABSTRACT FROM AUTHOR]

Background and Aims: Markedly increased liver chemistries in patients presenting with acute calculous cholecystitis (AC) often prompt an evaluation for concomitant choledocholithiasis (CDL). However, current guidelines directing the workup for CDL fail to address this unique population. The aims of this study are to define the range of presenting laboratory values and imaging findings in AC, develop a model to predict the presence of concurrent CDL, and develop a management algorithm that can be easily applied on presentation. Methods: We conducted a retrospective review of patients presenting with AC to a large tertiary hospital over a 3.5-year period. CDL was defined as common bile duct (CBD) stone(s), sludge, or debris seen on any of the following studies: US, CT, magnetic resonance intaging/MRCP, EUS, ERCP, or intraoperative cholangiogram. A multivariable model to predict CDL was developed on 70% of the patients and validated on the remaining 30%. Results: A total of 366 patients were identified and 65 (17.8%) had concurrent CDL. Univariable analysis was used to predict CDL and demonstrated statistically significant odds ratios for transaminases >3 times the upper limit of normal, alkaline phosphatase (AlkPhos) above normal, lipase >3 times the upper limit of normal, total bilirubin ≥1.8 mg/dL, and CBD diameter >6 mm. In the validation cohort, an optimal model containing alanine transaminase (ALT) >3 times the upper limit of normal, abnormal AlkPhos, and CBD diameter >6 mm was found to have an area under the receiver operating curve of 0.91. When 0 or 1 risk factors were present, 98.6% of patients did not have CDL. When all 3 risk factors were present, 77.8% were found to have CDL. Conclusions: The prevalence of CDL is high among patients with AC. When a validated model is used, application of cutoffs for ALT, AlkPhos, and CBD diameter can effectively triage patients with low and high likelihood for CDL to surgery or ERCP, respectively. [ABSTRACT FROM AUTHOR]