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(MgFe 2 O 4) 100-x /(BaFe 12 O 19) x , soft/hard nanocomposites (NCs) having different hard ferrite ratio i.e. x = 0, 25, 50, 75 and 100 have been synthesized via in-situ auto-combustion sol-gel method. XRD patterns ensured the co-existence of both hexaferrite and spinel ferrite phases without any impure phase and no significant difference in average crystallite size was observed. The FTIR and Raman spectra confirmed the fabrication of desired material without any impurity. The absence of blocking peak in the ZFC measurements revealed that the blocking temperature of these NCs lie above room temperature. The M − H loops taken at different temperatures resulted into single smooth curve indicating strong interphase exchange-coupling among hard-soft ferrite phases. The occurrence of shoulder peak in dM/dH versus H curve for molar ratio x = 50 is an indication of weak exchange coupling between the two phases. From modified Block's law fitting, the Block's constant (B) exponentially declined with the addition of hard phase that revealed higher value of exchange-coupling constant J. The complex impedance analysis (Nyquist/Cole-Cole plots) and its simulation using an equivalent model circuit revealed the major contribution of both grains and grin-boundaries toward the total conduction mechanism of the NCs. These findings indicate that the higher value of impedance makes these NCs favorable candidates for numerous technological areas like electromagnetic shielding and high band-pass filters. [ABSTRACT FROM AUTHOR]

Orthopedic trauma results in the injury of bone joints and tendons of the body. A radiologist reviews and monitors large numbers of radiographs daily, which can lead to the diagnostic error. Therefore, there is a need to automate the detection of bone fractures in X-ray images, particularly humerus bone fractures. In this paper, we have proposed an ensemble model that can detect the fracture in an x-ray image. In this paper, we proposed an ensemble model designed for fracture detection in X-ray images. An ensemble model combines multiple diverse models to improve predictive accuracy and robustness by aggregating their individual predictions. The model leverages MobileNetV2, Vgg16, InceptionV3, and ResNet50, using histogram equalization for preprocessing and a Global Average Pooling layer for feature extraction. The entire humerus from the public Mura-v1.1 dataset is utilized for analysis, utilizing a single training-validation split. The dataset is divided into a ratio of 80:20 for experiments for the training and validation datasets. The proposed model outperformed the modified deep-learning models and achieved 92.96%, 91.62%, and 92.14% accuracy, recall, and F1 scores, respectively. The ensemble model presented effectively automates bone fracture detection in X-ray images of the humerus, demonstrating superior performance compared to modified deep-learning models. A comparison has been made between a novel ensemble model and state-of-the-art models, bench-marking their performance. These findings underscore its potential for enhancing diagnostic accuracy and efficiency in orthopedic radiology. • Novel technique using an ensemble model for humerus fracture detection in X-ray images. • Combines MobileNetV2, Vgg16, InceptionV3, and ResNet50 for enhanced predictive accuracy. • Uses histogram equalization before data augmentation and Global Average Pooling. • Achieved 92.96% accuracy, 91.62% recall, and 92.14% F1 score, outperforming other models. [ABSTRACT FROM AUTHOR]

Summary Background A 5-year follow-up study of 633 cutaneous squamous cell cancer (SCC) excisions was performed by collecting data on rates of local recurrence (LR) and lymph node (LN) metastasis. Methods A retrospective analysis of patients was performed across four regional plastic surgery centres (Stoke Mandeville Hospital, Aylesbury; John Radcliffe Hospital, Oxford; Salisbury District Hospital, Salisbury and Queen Alexandra Hospital, Portsmouth) assessing rates of LR and LN metastasis. Results We report 5-year outcomes from 598 SCCs (95% follow-up rate). The total recurrence rate (LR and LN metastasis) was 6.7% (n = 40) at 5 years, with 96% of these occurring within 2 years. Median time to LR was 9 months (1–57), with 76.9% (n = 20) undergoing further wide local excision. Median time to LN metastasis was 5.5 months (1–18 months). There were two cases of disease-related death. Only 15% (n = 6) of incomplete excisions recurred. Interestingly, 19.1% (n = 9) of 47 SCCs with perineural invasion on original histopathology recurred versus only 5.6% (n = 31) of the 551 SCCs without perineural invasion (p = 0.005). Conclusions This study is one of the largest studies to date following up 598 SCC excisions at 5 years with total recurrence rates comparable to those in current published literature. We report perineural invasion as a significant predictor of recurrence and that 96% of total recurrence occurred within 2 years. This is in contrast to current UK guidelines (75% at 2 years, 95% at 5 years), thus suggesting that shorter length of hospital follow-up may be reasonable. [ABSTRACT FROM AUTHOR]

A residual stress field was generated by a circular, flat-ended, rigid punch indenting a thick test specimen extracted from X65 grade-controlled-rolled pipeline steel. Laboratory X-ray diffraction was used to measure residual stress field the near-surface, whereas the contour method and neutron diffraction were used to quantify the through-thickness residual stress field. A numerical method was proposed to account for gauge volume variation which allowed a direct comparison of the Finite Element prediction with the experimental measurements. A good agreement between the measurements and prediction was observed, showing that the through-thickness compressive residual stress reaches the highest magnitude in the centre of the specimen. The validated results can be used with confidence for residual stress-crack interaction studies in single-edge notched bend SEN(B) and single-edge notched tension SEN(T) fracture specimens which are common in the oil and gas industry due to the inherited close level of constraint experienced in a pipe. • Measured and predicted residual stress field generated through mechanical punching. • Near-surface residual stress field and through-thickness residual stress field. • Simple approach developed to generate weld-type residual stress field. • Residual stress-crack interaction in single-edge notched bend and single-edge notched tension. • Determination of accurate, detailed residual stress fields in thick ferritic steels. [ABSTRACT FROM AUTHOR]

The analytical solutions for the free and forced vibration characteristics of all edges simply supported bimodular cross-ply laminated plates and cylindrical panels are presented using the Bert’s constitutive model and layerwise theory (LWT). The positive/negative half cycle free vibration frequencies, corresponding through the thickness distribution of modal stresses and frequency response under harmonic excitation obtained using layerwise theory are compared with those obtained using first order shear deformation theory (FSDT). The layerwise theory is computationally efficient since the number of unknowns does not depend on the number of layers and the distribution of transverse shear stresses can be predicted directly from the constitutive relations. [ABSTRACT FROM AUTHOR]

The free and forced vibration characteristics of bimodular cross-ply laminated clamped–clamped circular cylindrical shells are studied using Bert’s and a recently proposed model considering first order shear deformation theory. The free vibration frequencies in positive and negative half cycles are found to be same for all asymmetric modes and for axisymmetric modes with even number of axial half waves, and different for axisymmetric modes with odd number of axial half waves. However, the negative half cycle amplitude is significantly greater than the positive half cycle amplitude due to the local stiffness of bimodular cylindrical shells being different for positive and negative half cycles even though the natural frequencies are same for positive and negative half cycles of asymmetric vibrations. The relative difference of positive and negative half cycle frequencies is very less for single layer orthotropic shells, and it is significant for cross-ply shells for axisymmetric mode of vibration. The vibration characteristics predicted using proposed and Bert’s constitutive models are quite close except for the transverse to the fiber direction normal stress. [ABSTRACT FROM AUTHOR]

Summary Necrotising Fasciitis is a destructive infection of the skin and subcutaneous tissues associated with significant mortality and morbidity. Survival from the condition often necessitates patient referral for appropriate reconstructive surgery and supportive medical management. The aim of our study was to identify emerging patterns, characteristics and outcomes of necrotising fasciitis in Northern Ireland. A retrospective analysis of all patients referred to the Regional Plastic Surgery Service in Belfast between 2007 and 2012 was performed. Forty-six patients were identified with clinical, intraoperative and histopathological confirmation of necrotising fasciitis. Mean patient age was 59.4 years (range 32–88) with a 25:21 male to female ratio. 13 patients died from the disease. Smoking, obesity, diabetes and immunocompromise were the most prevalent co-morbidities identified. 37 patients had no identifiable mechanism of infection initiation in the history. Painful cellulitis (44/46), skin necrosis (26/46), skin blistering (8/46) and subcutaneous emphysema (3/46) were the most common presenting features. The median LRINEC score at presentation was 7 (range 2–12). The mean serum lactate at presentation was 4.0 mmol/L (range 1.6–13.5). LRINEC scores and serum lactate at presentation exhibited diagnostic sensitivities of 65% and 90% respectively. The lower extremity was the most commonly affected anatomical site (16/46). Group A Streptococcus was the most frequently isolated causative bacterium from debrided tissue cultures (16/46). The prevalence of necrotising fasciitis in the population studied is increasing, particularly in relation to patient cases caused by Group A Streptococcal infection. Increasing bacterial virulence and levels of patient immunocompromise may explain this increasing trend. The LRINEC scoring system lacked diagnostic sensitivity. Elevated serum lactate was supported as both a diagnostic and prognostic indicator. The findings of our study are somewhat limited in their application to other regions and highlight the need for a national analysis of necrotising fasciitis in the UK. [ABSTRACT FROM AUTHOR]

Abstract: In this paper, a constitutive model is proposed for analysis of bimodular composite laminated structures. In case of already existing Bert’s model, the material properties are assigned according to the nature (tensile/compressive) of only fiber direction strain. In the proposed model, the material properties are assigned according to the nature of fiber direction and transverse to fiber direction normal strains. The proposed model is used for free vibration analysis of cylindrical and conical panels. First order shear deformation theory based finite element is employed to obtain the free vibration frequencies and through the thickness modal stress distributions. The free vibration frequencies predicted from the two models for the parameters considered are found to be very close to each other but transverse to the fiber direction normal stress distribution using both the models is significantly different. [Copyright &y& Elsevier]

Abstract: Familial breast cancer accounts for 5–10% of all breast cancers. Due to BRCA1/2 tumour suppressor gene mutation, hereditary breast and ovarian syndrome is the most common form. Risk-reducing gynaecological and breast surgery is offered to such patients in ever-increasing numbers. Hence, the development of a multi-specialty combined treatment approach is called for. Twenty-two BRCA gene-mutation carrier women underwent one-stage gynaecological and breast risk-reducing surgery and immediate reconstruction between January 2005 and December 2011 at the Belfast City Hospital. Their mean age was 41.2 years (median 41 years). Nearly half of the patients were BRCA2 and a quarter were BRCA1 carriers. The rest were positive for both genes. Hormone-replacement therapy was initiated in 14 women. Average theatre time and stay in the hospital were three hours and two and a half days, respectively. Two patients developed complications unrelated to combining the procedures. Both were treated conservatively and recovered. The one-stage approach logically proves economical by limiting the time the patients are in the hospital and away from work. We describe our multidisciplinary team service that is offering safe and economical one-stage risk-reducing surgery and reconstruction to young BRCA gene-mutation carrier women in Northern Ireland. [Copyright &y& Elsevier]

Abstract: Background: The pathophysiology of Crohn's disease (CD) is related to immune dysregulation making it unique among indications for intestinal transplants (ITx). We examined whether outcomes of ITx for CD are any worse than the overall ITx population. Methods: United Network for Organ Sharing Standard Transplant Analysis and Research files were analyzed. Adult ITx recipients from 1987 to 2009 were included. Results: Of 86 primary ITx for CD, 61 (70%) had isolated ITx and 25 (30%) had liver-ITx (L-ITx). The 1-, 3-, and 5-year patient survival for isolated ITx was 85%, 67%, and 54%; for L-ITx, 63%, 47%, and 41% (P = .04). The graft survival at 1, 3, and 5 years was 85%, 55%, and 45% for isolated ITx recipients and 63%, 47%, and 41% for L-ITx recipients (Wilcoxon's test, P = .04). Patient and graft survival was better in era 2 (January 2001 through August 2009) than in era 1 (October 1987 through December 2000). In the regression analysis of long-term outcome of adults undergoing ITx, recipient age > 40 years and hospitalization prior to transplantation were negative predictors of outcome. Conclusion: Patient and graft survival for CD patients is not inferior to other indications for ITx. [Copyright &y& Elsevier]

Summary: The buccinator musculo-mucosal island or Zhao flap can be used to reconstruct a wide range of intra-oral defects including floor of mouth, tonsillar fossa and lateral tongue. We describe our experience with the inferiorly based facial artery buccinator musculo-mucosal flap for a novel use in the reconstruction of oropharyngeal tumours at the tongue base and lateral pharyngeal wall. We prospectively reviewed all patients who underwent buccinator musculo-mucosal island flap reconstruction examining indication, operative details, and post-operative outcomes. We describe our technique for its novel use in lateral pharynx/tongue base reconstruction through neck dissection access. Deeper flaps were adequately visualised and monitored using flexible nasoendoscopy. There were no flap failures with all patients achieving primary healing with minimal complications. All donor sites closed directly with minimal scarring. Two patients reported mild tightness on mouth opening and two patients reported transient weakness of the mandibular branch of the facial nerve. In our experience the buccinator musculo-mucosal island flap is an extremely versatile ‘like for like’ local flap option due to its long arc of rotation. As inset can be achieved via neck dissection access, this avoids lip/jaw split as per conventional oropharyngeal surgical management further minimising morbidity. We present the first series of its effective use in oropharyngeal reconstruction. [Copyright &y& Elsevier]

Abstract: Purpose: Daidzein (Daid) has been implicated in bone health for its estrogen-‘like’ effects but low bioavailability, unfavorable metabolism and uterine estrogenicity impede its clinical potential. This study was aimed at assessing isoformononetin (Isoformo), a naturally occurring methoxydaidzein, for bone anabolic effect by overcoming the pitfalls associated with Daid. Methods: Sprague-Dawley ovariectomized (OVx) rats with established osteopenia were administered Isoformo, 17β-oestradiol (E2) or human parathyroid hormone. Efficacy was evaluated by bone microarchitecture using microcomputed tomography and determination of new bone formation by fluorescent labeling of bone. Osteoblast apoptosis was measured by co-labeling of bone sections with Runx-2 and TUNEL. Biochemical markers of bone metabolism were measured by ELISA. Plasma and bone marrow levels of Isoformo and Daid were determined by LC–MS–MS. Rat bone marrow stromal cells were harvested to study osteoblastic differentiation by Isoformo and Daid. New born rat pups were injected with Isoformo and Daid to study the effect of the compounds on the expression of osteogenic genes in the calvaria by real time PCR. Results: In osteopenic rats, Isoformo treatment restored trabecular microarchitecture, increased new bone formation, increased the serum osteogenic marker (procollagen N-terminal propeptide), decreased resorptive marker (urinary C-terminal teleopeptide of type I collagen) and diminished osteoblast apoptosis in bone. At the most effective osteogenic dose of Isoformo, plasma and bone marrow levels were comprised of ∼90% Isoformo and the rest, Daid. Isoformo at the concentration reaching the bone marrow achieved out of its most effective oral dosing induced stromal cell mineralization and osteogenic gene expression in the calvaria of neonatal rats. Isoformo exhibited uterine safety. Conclusions: Our study demonstrates that Isoformo reverses established osteopenia in adult OVx rats likely via its pro-survival effect on osteoblasts. Given its bone anabolic and anti-catabolic effects accompanied with safety at uterine level we propose its potential in the management of postmenopausal osteoporosis. [Copyright &y& Elsevier]

Summary: We present a case of hypersensitivity to a breast implant in a 57-year old female with breast cancer and hypersensitivity to adhesive dressings. A mastectomy, axillary node clearance, latissimus dorsi flap and silicone implant-based reconstruction were performed. The mammary wound dehisced within three weeks and the implant required removal. No pus was present, and cultures were negative. Three years later, a further silicone implant was inserted. Within three weeks from insertion, the patient required readmission with serous discharge from the wound, flu-like symptoms, low-grade pyrexia and painful swelling at the operative site. The implant was removed. Capsule biopsies demonstrated a large lymphoid cell reaction, in keeping with a delayed hypersensitivity reaction. Patch testing to samples of the implant was positive. [Copyright &y& Elsevier]

Abstract: Ankylosing spondylitis presents challenges for the obstetric anesthesiologist in administering neuraxial anesthesia or managing the airway. A pregnant patient with ankylosing spondylitis, cardiomyopathy and preeclampsia requiring cesarean delivery was managed with an awake nasotracheal fiberoptic intubation. The use of topical cocaine, epinephrine, phenylephrine, and oxymetazoline to produce nasal vasoconstriction is discussed. Selective alpha-2 agonists that can potentially provide nasal mucosa vasoconstriction and placental vasculature vasodilation are also discussed. [Copyright &y& Elsevier]

An official consensus statement on sports injuries by the International Olympic Committee is presented.

Objective: To identify an optical coherence tomography (OCT) pattern predictive of visual outcome in patients with diabetic macular edema (DME) who underwent a single dose of intravitreal triamcinolone. Design: Retrospective case analysis with prospective data collection for controls. Participants: Ninety-three cases and 25 controls. Methods: Two independent masked observers retrospectively examined preoperative macular OCTs of 93 eyes of 93 patients who were given a single dose (4 mg in 0.1 ml) of intravitreal triamcinolone for DME and categorized them as belonging to 2 groups: 1, comprised of eyes with high reflectivity (bright colors) from inner retinal layers, and 2, comprised of eyes that had low reflectivity (darker colors) from inner retinal layers. Logarithm of the minimum angle of resolution visual acuity (VA) and macular thickness measured by OCT were assessed preoperatively and postoperatively at 1 and 3 months. Main Outcome Measures: Optical coherence tomographic appearance of inner retinal layers. Results: All patients completed 3 months of follow-up. In group 1, 45 of 51 eyes (88%) experienced visual improvement of ≥2 lines on an Early Treatment Diabetic Retinopathy Study (ETDRS) chart at 1 month of follow-up. Forty-four of 51 patients (86%) experienced visual improvement of ≥2 lines on an ETDRS chart at 3 months of follow-up. In group 2, 18 of 42 patients (43%) experienced visual improvement of ≥1 lines on an ETDRS chart at 1 and 3 months of follow-up. For the remaining patients, VA remained unchanged during the postoperative course of 3 months. Conclusions: Patients in whom OCT demonstrated the high reflectivity of inner retinal layers achieved greater VA though macular thickness decreased significantly after intravitreal triamcinolone in both groups. It may be hypothesized that a lower optical reflectivity of inner retinal layers is related to the atrophy of the inner retinal layers, thus resulting in a failure of VA recovery in these patients. The level of reflectivity from inner retinal layers on OCT may provide objective criteria in predicting the response of DME to intravitreal triamcinolone and help in preoperative counseling of patients with DME. [Copyright &y& Elsevier]

OBJECTIVE: To determine the diagnostic yield versus complications from endoscopy in children after hematopoietic stem cell transplantation (HSCT). DESIGN: Data from 191 patients were reviewed, then separated into procedures within the first 100 days after HSCT (when the risks for complications and prevalence of acute graft-versus-host disease [GVHD] are highest) and those performed beyond 100 days. RESULTS: Visible endoscopic lesions were found in 63 of 198 (32%) esophagogastroduodenoscopies (EGDs) and 36 of 220 (16%) sigmoidoscopies. Acute GVHD was present in 38 of 121 (31%) biopsy specimens from EGDs within the first 100 days, 15 of 73 (21%) samples from EGDs after 100 days, 52 of 136 (38%) sigmoid biopsy specimens before 100 days, and in 25 of 82 (31%) samples after 100 days. Non-GVHD histologic abnormalities were present in 36 of 124 (29%) biopsy samples from EGDs before 100 days, 32 of 74 (43%) specimens after 100 days, 14 of 136 (10%) sigmoid specimens before 100 days, and 11 of 84 (13%) samples beyond 100 days. COMPLICATIONS: Complications occurred in 13 procedures (3.1%): 8 (4.2%) EGDs, 4 (2.0%) sigmoidoscopies, and 1 (5.5%) colonoscopy. Intestinal bleeding occurred in 12 of the 13 procedures. Thrombocytopenia was a statistically significant association (p < 0.01). One death occurred after splenic flexure perforation. CONCLUSIONS: GI abnormalities other than acute GVHD occurred in children after HSCT. Acute GVHD was diagnosed most commonly on sigmoid biopsy. Postprocedure hemorrhage was related to thrombocytopenia. [ABSTRACT FROM AUTHOR]

When a child with a thermal injury suddenly becomes unwell, it is often difficult to obtain an accurate diagnosis in the early stages of the illness. Out of 71 children admitted to our burns unit over a 15-month period, 13 became acutely toxic. Most of the cases had relatively small burns and the exact reason for their sudden deterioration was not apparent in the immediate stages. Several children required admission to the intensive therapy unit and there was one death. The number of children experiencing this significant morbidity over a relatively short period of time prompted us to perform a detailed retrospective study to ascertain the exact cause of the deterioration and to identify any patterns in their presenting signs and symptoms. There was considerable variation in the clinical picture of the children who developed the toxicosis, however, several features were frequently observed which resembled those seen in the toxic shock syndrome (TSS). In order to be more specific, we applied the criteria for TSS as defined by the Centres for Disease Control (CDC) to each of the 13 children. All of the criteria were noted in six children and the majority in the other seven. This was a much higher incidence than we would normally have expected. The clinical features of children with TSS are not always easy to distinguish from those observed in other illnesses. We therefore explored the possibility of alternative diagnoses that may have caused the toxicosis in these children. The mortality associated with TSS can be high, especially if there is a delay in recognition and subsequent management of the disease. Clinicians should be alerted to the fact that TSS is probably more prevalent than previously thought and should practise with a high index of suspicion in any child with a burn whose clinical condition suddenly deteriorates. [ABSTRACT FROM AUTHOR]