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In this retrospective study we compared clinicoradiologic outcomes and complication profiles of the traditional 2-rod construct versus the 4-rod construct in patients with adult spinal deformity (ASD) who underwent pedicle subtraction osteotomy (PSO). We performed a retrospective review of 208 ASD patients at 2 referral centers who underwent lumbar PSO and long fusion from thoracic to the pelvis. Two different techniques, including the 4-rod construct and the traditional 2-rod technique, were used at the PSO level. Clinicoradiologic outcomes and complication profiles of the patients were documented and compared statistically between the groups. The 4-rod construct was associated with statistically lower rates of rod fracture (44.8% vs. 26.4%, P < 0.01), pedicular screw loosening at the PSO level (25.3% vs. 14.0%, P = 0.04), and reoperation (49.4% vs. 33.9%, P = 0.02). Radiologically, the 4-rod construct was associated with higher degree of lumbar lordosis (LL) (–37.4°vs. –26.8°; P < 0.01) and improved pelvic tilt (PT) (–17.2° vs. –9.9°; P < 0.01) and sacral vertical axis (SVA) corrections (–211.5° vs. –192.2°; P = 0.04). Overall, the 4-rod construct was associated with improved quality of life (P = 0.04) and statistically lower Oswestry Disability Index score at 12 months postoperatively (P < 0.01). Our results showed that the 4-rod construct was associated with statistically lower rates of rod fracture and pedicular screw loosening at the osteotomy level, higher degree of LL correction and improved PT and SVA than the 2-rod technique. The 4-rod construct was also associated with improved quality of life and Oswestry Disability Index and lower complication profiles. [ABSTRACT FROM AUTHOR]

To compare short-term clinical and radiological outcomes and complication profiles between bilateral dual sacral-2-alar-iliac (S2AI) screw and bilateral single S2AI screw fixation techniques in patients who underwent grade 3 or 4 spinal osteotomies. A retrospective review of 83 patients treated with bilateral dual S2AI screws and 32 patients treated with bilateral single S2AI screws was conducted between 2018 and 2020 with a minimum 1-year follow-up. Clinical and radiological outcomes of patients and incidence of perioperative complications, including rod breakage, screw dislodgment, proximal junctional kyphosis, proximal junctional failure, need for reoperation, and systemic adverse effects, were collected and statistically compared between the groups. With a mean follow-up of 18.2 months, rod fracture (6.0% vs. 18.7%, P = 0.03), screw dislodgment (0 vs. 12.5%, P < 0.01), and S2AI screw loosening (1.2% vs. 18.7%, P < 0.01) were significantly lower in the dual S2AI screws group than in the single S2AI screws group. However, the reoperation rate was similar between the 2 groups (24.1% vs. 34.3%, P = 0.26). No significant differences in clinical and radiological outcomes as well as proximal junctional kyphosis (10.8% vs. 18.7%, P = 0.25) and proximal junctional failure (9.6% vs. 18.7%, P = 0.18) were identified between the 2 groups. The dual S2AI screw fixation technique showed more advantages over the single S2AI screw fixation technique with reduced incidence of screw dislodgment, rod fractures, and sacral-alar-iliac screw loosening. [ABSTRACT FROM AUTHOR]

• BituSul improved the moisture susceptibility of the HMA mixture. • Pure mode I/II fracture behavior of BituSul-modified HMA under 0 and 1 Freeze-thaw cycle (FTC) was evaluated. • Effect of New Jig Coal Tailings (NJCT) on fracture behavior of BituSul-modified HMA under 0 and 1 FTC was evaluated. • Aging was an efficient method to improve the performance of BituSul-modified HMA compared to the addition of NJCT. Moisture susceptibility and cracking resistance of asphalt pavement made with sulfur additive are two important failures of this type of asphalt mixture that should be considered. Recently, researchers have been trying to improve the mechanical performance of sulfur asphalt mixtures by modifying the asphalt mixture manufacturing method, modifying sulfur manufacturing technology, and applying laboratory conditioning. In this laboratory work, an attempt was made to improve the mechanical properties of an asphalt mixture made with a type of sulfur material called BituSul by different methods. The first method was the moisture susceptibility test and the second method was the fracture test. In the first step, 30 % of PG70-10 bitumen was replaced with BituSul, and a moisture susceptibility test was performed. After estimating the minimum moisture susceptibility of the BituSul-reinforced asphalt mixture, the fracture test was performed on the asphalt mixture without additives, BituSul-reinforced asphalt mixture, and BituSul-reinforced asphalt mixture containing New Jig Coal Tailings (NJCT) (with a replacement ratio of 50 % filler). To compare the fracture behavior of the mixtures over time, two conditions, including one freeze–thaw cycle (FTC) and about fifty-six hours of the aging period, which was equivalent to four years of failure, were applied to the mentioned samples separately. Finally, the samples were tested under mixed mode I/II at −12 °C and + 24 °C. The findings showed that the manufacturing technology used in this research, including how to design and manufacture the samples, the type of bitumen used, and the type of sulfur used (BituSul), caused a 2 % decrease in moisture susceptibility compared to the base sample. The fracture resistance results showed that the application of 0 and one cycle of FTC decreased the fracture indices of the mixture reinforced with BituSul at −12 °C and + 24 °C. Also, the results showed that the fracture stiffness improved for samples containing BituSul at −12 °C and + 24 °C. Finally, the results showed that applying aging to BituSul mixtures and BituSul mixtures reinforced with NJCT improved fracture resistance, fracture flexibility, and fracture stiffness. However, NJCT could not compensate for the improvement of fracture indices of asphalt mixture caused by the presence of BituSul; therefore, the application of aging was reported to be a suitable option to improve the fracture indices of BituSul-reinforced mixtures. [ABSTRACT FROM AUTHOR]

Background: Intramedullary fixation with k-wires is a surgical option in the management of fractures of the shaft and neck of central metatarsals. The current study aimed at investigating the clinical outcomes of closed antegrade/retrograde intramedullary pinning technique.Patients and Methods: A total of 34 patients (26 males and eight females) with 58 metatarsal neck and shaft fractures (28 shaft and 26 neck fractures) were operated using the antegrade/retrograde intramedullary fixation technique. At the final follow-up visit, pain intensity was assessed using the visual analog scale (VAS) and foot function was evaluated by the American Orthopedic Foot and Ankle Society (AOFAS) forefoot scoring system.Results: Mean follow-up period was 18 months, ranged 12 to 34. Mean time to clinical fracture healing was 6.5 weeks, ranged 5 to 9. Bony union was occurred in all the cases. No surgical site infection was noted. Mean VAS score at the final follow-up visit was 0.28, ranged 0 to 3. At the final follow-up, the mean AOFAS score was 95.2, ranged 81 to 100.Conclusion: Closed antegrade/retrograde intramedullary pinning is a minimally invasive technique to manage central metatarsal fractures. Using this technique, metatarsal alignment can be restored and good clinical outcome is achieved. [ABSTRACT FROM AUTHOR]

Nonalcoholic steatohepatitis (NASH), the severe stage of nonalcoholic fatty liver disease (NAFLD), is defined as the presence of hepatic steatosis with inflammation, hepatocyte injury, and different degrees of fibrosis. Although NASH affects 2–5% of the global population, no drug has been specifically approved to treat the disease. Fibroblast growth factor 21 (FGF21) and its analogs have emerged as a potential new therapeutic strategy for the treatment of NASH. In fact, FGF21 deficiency favors the development of steatosis, inflammation, hepatocyte damage, and fibrosis in the liver, whereas administration of FGF21 analogs ameliorates NASH by attenuating these processes. We review mechanistic insights into the beneficial and potential side effects of therapeutic approaches targeting FGF21 for the treatment of NASH. No drug has yet been approved specifically for treating NASH, the necroinflammatory form of NAFLD which confers a higher risk of progression to advanced fibrosis, cirrhosis, and hepatocellular carcinoma. Targeting FGF21, a hormone with insulin-sensitizing and hepatoprotective properties, has emerged as an option for NASH therapy. FGF21 analogs have demonstrated efficacy in both animal models and humans with NASH, although some concerns have been raised about the safety of FGF21 analogs in humans. Strategies other than the use of FGF21 analogs that potentiate the effects of FGF21 and might be useful in the treatment of NASH are also being developed. [ABSTRACT FROM AUTHOR]

System reliability and life-cycle cost are significantly influenced by preventive maintenance (PM). PM is commonly classified into two categories: time-based maintenance (TBM) and condition-based maintenance. Another PM approach referred to as inspection-based maintenance (IBM) incorporates condition-based activities within periodic inspections and tests. Determining the optimal maintenance rate for both TBM and IBM plans, and scheduling them effectively, poses a crucial challenge. Traditional methods assess equipment importance and condition within a reliability-centered maintenance framework. Mathematical models are commonly employed to devise robust plans, but accurate modeling based on practical conditions of the system equipment remains a key challenge. This two-part paper series introduces a novel model based on the Markov chain theory, that establishes the relationship between equipment status transition rates and the risk indices. The proposed model can be used alone or in combination with risk analysis outcomes to overcome data and budget limitations. To demonstrate its efficacy, the proposed method is implemented to optimize the PM rate of high-voltage equipment within a real-world sub-transmission substation, where the results can aid in cost estimation, equipment replacement decisions, and inventory management. • A failure rate estimation method for maintenance analysis of large-scale systems. • A probabilistic model to optimize dynamically the rate of inspections/routine tests. • Derived relations between the transition rates. • A new method for classification and analysis of failures and defects. [ABSTRACT FROM AUTHOR]