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Abstract Worldwide industrialization has grown at a rapid pace, contaminating water resources, particularly with phenolic pollutants that pose a risk to aquatic systems and human health. The goal of this study is to create an inexpensive magnetic composite that can effectively remove nitrophenol (o-NP) using adsorptive means. In this instance, a nonanyl chitosan (N-Cs) derivative was synthesized and then combined with activated petroleum coke (AP-coke) and magnetic Fe3O4 to boost its adsorbability towards o-NP and to facilitate its separation. Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), X-ray diffractometer (XRD), Vibrating sample magnetometer (VSM), X-ray photoelectron spectroscopy (XPS), and zeta potential were employed to characterize the magnetic composite. The experimental results indicated that the Fe3O4/AP-coke/N-Cs composite possesses a greater affinity toward o-NP with a maximal efficiency reached 88% compared to 22.8, 31.2, and 45.8% for Fe3O4, AP-coke and N-Cs, respectively. The equilibrium adsorption data coincided with the Langmuir, Freundlich, and Temkin isotherm models, with a maximum adsorption capacity of 291.55 mg/g at pH 6, whereas the pseudo second order kinetic model offered the best fit to the experimental data. Besides, the developed adsorbent preserved satisfactory adsorption characteristics after reuse for five successive cycles. The proposed adsorption mechanism involves the H-bonding, π-π interaction, hydrophobic interactions and electron donor-acceptor interactions. These findings hypothesize that the constructed magnetic composite could efficiently remove nitrophenols from polluted water with high performance and ease-separation.

Abstract The current paper evaluated experimentally an innovative sun tracking concentrated solar still under Egyptian climatic conditions during the summer of 2022. The proposed system consists of a 120-cm-diameter parabolic reflector mirror that tracks the sun using a dual axis tracking system, a cylindrical solar still with a volume of 3.7 L positioned in its focal point, and a concentration ratio of 12.5. The performance of the concentrated solar still was investigated in the context of two critical parameters. First, three feed water salinity (17, 27, 37) ppt samples were evaluated, followed by four percentages of saline water filling ratio (26.5, 39.8, 53.1, 66.3)%. Increasing the salinity of the feed water had no effect on solar still productivity, but increasing the saline water filling ratio did. The daily cumulative productivity of the system was 6 kg/m2 with an optimal filling ratio of 53.1%, a daily efficiency of 42.88%, and an average cost of freshwater production of 0.0489 $/L. The proposed system also had the highest instantaneous efficiency of 61.77% and the highest distilled water productivity rate of 0.941 kg/h m2.

Abstract Background Type 2 Diabetes mellitus (DM) is an affliction impacting the quality of life of millions of people worldwide. An approach used in the management of Type 2 DM involves the use of the carbohydrate-hydrolyzing enzyme inhibitor, acarbose. Although acarbose has long been the go-to drug in this key approach, it has become apparent that its side effects negatively impact patient adherence and subsequently, therapeutic outcomes. Similar to acarbose in its mechanism of action, bee propolis, a unique natural adhesive biomass consisting of biologically active metabolites, has been found to have antidiabetic potential through its inhibition of α-amylase. To minimize the need for ultimately novel agents while simultaneously aiming to decrease the side effects of acarbose and enhance its efficacy, combination drug therapy has become a promising pharmacotherapeutic strategy and a focal point of this study. Methods Computer-aided molecular docking and molecular dynamics (MD) simulations accompanied by in vitro testing were used to mine novel, pharmacologically active chemical entities from Egyptian propolis to combat Type 2 DM. Glide docking was utilized for a structure-based virtual screening of the largest in-house library of Egyptian propolis metabolites gathered from literature, in addition to GC–MS analysis of the propolis sample under investigation. Thereafter, combination analysis by means of fixed-ratio combinations of acarbose with propolis and the top chosen propolis-derived phytoligand was implemented. Results Aucubin, identified for the first time in propolis worldwide and kaempferol were the most promising virtual hits. Subsequent in vitro α-amylase inhibitory assay demonstrated the ability of these hits to significantly inhibit the enzyme in a dose-dependent manner with an IC50 of 2.37 ± 0.02 mM and 4.84 ± 0.14 mM, respectively. The binary combination of acarbose with each of propolis and kaempferol displayed maximal synergy at lower effect levels. Molecular docking and MD simulations revealed a cooperative binding mode between kaempferol and acarbose within the active site. Conclusion The suggested strategy seems imperative to ensure a steady supply of new therapeutic entities sourced from Egyptian propolis to regress the development of DM. Further pharmacological in vivo investigations are required to confirm the potent antidiabetic potential of the studied combination.

Decision analysis is a key aspect in improving slums intervention strategies utilizing a variety of tools to evaluate all relevant information that support decision-making process for dealing with the complexity of slums interventions policies. This paper presents a framework integrating Multi Criterion Decision Analysis (MCDA) with (GIS) based decision support tool to quantitatively assess land suitability for site relocation of an urban slum site utilizing Analytical Hierarchy Process (AHP), which is commonly used for fastest growing decision-analytic techniques in several disciplines for the determination of various aspects weights. Herein Batn Al Baqara region (which is located in south of Cairo) was selected as study area to be relocated as it was considered among the most difficult to deal with, three proposed relocation sites were selected and analyzed using MCDA-GIS Model. Twelve different criteria were utilized to evaluate the degree of suitability of the relocation sites. A five degree of suitability were employed according to the different criteria scores for each site. The results supported that Al Asmarat is the most suitable site for the relocation of slum since it achieved the highest evaluation score (84.92 %) when the model was applied to the relocation sites.

This study aimed to investigate the potential protective effects of diminazene, an activator of angiotensin II converting enzyme (ACE2), on kidney function and structure in rats with acute kidney injury (AKI) induced by the anticancer drug doxorubicin (DOX). The impact of diminazene was compared to that of two other drugs: the ACE inhibitor lisinopril and the angiotensin II type 1 (AT1) receptor blocker valsartan. Rats were subjected to a single intraperitoneal injection of DOX (13.5 mg/kg) on the 5th day, either alone or in combination with diminazene (15 mg/kg/day), lisinopril (10 mg/kg/day), or valsartan (30 mg/kg/day) for 8 consecutive days. Various markers related to kidney function, oxidative stress, and inflammation were measured in plasma and urine. Additionally, kidney tissues were assessed histopathologically. DOX-induced nephrotoxicity was confirmed by elevated levels of plasma urea, creatinine, and neutrophil gelatinase-associated lipocalin (NGAL). DOX also led to increased urinary N-acetyl-β-D-glucosaminidase (NAG) activity and decreased creatinine clearance, albumin levels, and osmolality. Moreover, DOX caused a reduction in renal oxidative stress markers, including superoxide dismutase (SOD), glutathione reductase (GR), and catalase activities, while increasing malondialdehyde (MDA) levels. It also raised plasma inflammatory markers, tumor necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1β). Concurrently administering diminazene significantly mitigated these DOX-induced changes, including histopathological alterations like renal tubule necrosis, tubular casts, shrunken glomeruli, and increased renal fibrosis. Similar protective effects were observed with lisinopril and valsartan. These protective effects, at least in part, appear to result from the anti-inflammatory and antioxidant properties of these drugs. In summary, this study suggests that the administration of diminazene, lisinopril, or valsartan had comparable effects in ameliorating the biochemical and histopathological aspects of DOX-induced acute kidney injury in rats.

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Progressive collapsing foot deformity (PCFD), Hallux Valgus (HV), and Midfoot Arthritis (MA) are diseases that benefit from the Lapidus procedure due to its capability to provide a stable medial column while correcting the underlying deformity. However, the technique does not go without complications. First metatarsal shortening/dorsiflexion are not uncommon, which could be exacerbated by local anatomy/revision surgery settings. Restoring length and sagittal plane position (plantarflexion) of the first ray when treating these pathologies is paramount. Performing a primary distraction and plantarflexion fusion with an allograft wedge (LapiCotton) has been advocated in the literature, potentially allowing improved deformity correction, but with the risk of increased non-union rate. The objective of this study was to report medium-term follow-up results of the LapiCotton in patients with collapsed feet. Methods: This IRB-approved comparative prospective study assessed patients diagnosed with PCFD, HV, and MA undergoing a Lapidus bone-block fusion (LapiCotton) between August 2020 and November 2022. All patients were operated on by a single fellowship-trained foot and ankle surgeon after clinical evaluation and a weight-bearing computed tomography (WBCT). After adequate joint preparation and trials, a Lapidus pre-shaped wedge allograft was placed and fixed using available implants. Adjunctive procedures were carried out as needed. Patients were kept non-weight bearing for six weeks and followed clinically, performing a WBCT at three months and subsequent follow-up. Non-Union and complications were documented. Bone healing was determined by at least 50% of bone trabeculae crossing both graft interfaces at the WBCT. Forefoot arch angle (FFA), Meary’s angle, talonavicular coverage angle (TNCA), middle facet subluxation (MFS), and foot and ankle offset (FAO) were also obtained. Two fellowship-trained readers performed all assessments. P-values >0.05 were considered significant. Results: Fifty-eight patients (60 feet) were included, mean age 53.87 (range:18-77)/BMI 31.70 (SD:7.96). Twenty-four PCFD, 19 HV, and 17 MA had an average 15.47 months (4-31) follow-up. Cuneiform-Post implants were used in 62%, plates/screws in 25%, and Lapidus nails in 13%. Median allograft size was 9mm (mode:8mm,5-19mm). Minor complications were observed in 3% (two superficial dehiscences) and major in 7% (three deep infections [5%], and one EHL contracture [2%]). Healing at the 3-month WBCT occurred in 94.8% and only in 66% at the most-recent WBCT (mean:11.08 months; 6-20). The clinical non-union rate demanding reoperation was eight clinical non-unions 13%. Mean FFA (pre:6.89,SD:6.63; postop:14.21,SD:5.48; p< 0.001), Meary (pre:15.17,SD:8.12; postop:6.31,SD:5.61; p< 0.001), TNCA (pre:26.75,SD:11.77; postop:11.59,SD:7.91; p< 0.001), MFS (pre:36.3,SD:26; postop:23.49,SD:17.35; p< 0.001), and FAO (pre:6.71,SD:5.81; postop:2.2,SD:4.33; p< 0.001) improved after the interventions. Conclusion: Although the Lapidus bone-block arthrodesis (LapiCotton) restored many of the markers associated with foot collapse and alignment, non-union rated was noted in 13% what is on the top range of non-union rates reported in the literature for Lapidus arthrodesis. The use of allograft wedges in the fusion site probably explains our findings. The fact that the sample was heterogeneous and composed of considerably severe deformities should also be considered. Also, important to highlight that WBCT findings of fusion site healing was initially 94% at 3-months and only 66% at most recent follow-up). Additional studies and longer-term follow up are needed.

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Minimally invasive surgery (MIS) Chevron-osteotomy for HV treatment offers a surgical alternative to open surgery with minimal surgical dissection and a hypothetical decreased risk for soft-tissue complications. During this procedure, there is a concern regarding the injury to the blood supply of the 1st-metatarsal-head. The objective of this study was to assess the incidence of injuries: (1) to the soft-tissue envelope around the first metatarsal head complex and, (2) to the blood supply of the first metatarsal head and also by using Micro-CT, (3) looking for safe zones close to the first metatarsal head to perform MIS Chevron osteotomy. We hypothesized that the MIS Chevron-type osteotomy procedure would preserve the soft-tissue envelope of the first-metatarsal-head complex and the blood supply of the 1st-metatarsal-head. Methods: Sixteen HV deformity cadaveric specimens were used to perform MIS Chevron-type osteotomy of the first metatarsal head. Anatomical dissection of all specimens was then performed to assess macroscopic injury to the first metatarsal head complex soft-tissue structures, including Extensor Hallucis Longus (EHL) tendon, Extensor Hallucis Brevis (EHB) tendon, Flexor Hallucis Longus (FHL) tendon, Flexor Hallucis Brevis (FHB) tendon, Abductor Hallucis tendon, Adductor Hallucis tendon, Sesamoid complex, Dorsolateral and Dorsomedial digital branches of the first toe and the Dorsomedial digital branch to the second. Macroscopic injuries were classified using a calibrated digital caliper. Any chondral damage to the first metatarsal head was quantified in mm². To assess the amount of first metatarsal head blood supply, specimens were perfused with 200 ml of a low viscosity radiopaque polymer, MV 117 (Flowtech), preoperatively, followed by Micro-CT assessment. Descriptive statistics and percentages were utilized for categorical data. Results: We did not find injuries in the EHL, EHB, FHL, Abductor-Hallucis, and Adductor-Hallucis tendons. We found a 2mm injury in the FHB tendon in one specimen. No injuries were found in the Dorsomedial and Dorsolateral nerves of the first-toe, the Dorsomedial-nerve of the second-toe, and Medial branch of the dorsomedial-nerve of the first-toe. In 3 cases, we found an injury on first-metatarsal-head (1mm) due to the passage of the K-wire and, in 1 case, due to the inadvertent passage of the drill (4.41mm). Macroscopically and using Micro-CT, we did not observe injuries in the First-Dorsal-Metatarsal-Artery (FDMA), Lateral-Dorsal-Branch of FDMA, and Plantar-Metatarsal-Artery. Micro-CT helped estimate a safe distance to finish the proximal exit of Chevron-osteotomy (25mm from the most distal point of the first metatarsal head). Conclusion: In this study, the minimally invasive Chevron osteotomy for treating HV seems to be a technically safe procedure, presenting a low rate of iatrogenic injuries with a low degree of severity. In addition, using Micro-CT promoted a better visualization of the microvasculature that nourishes the first metatarsal head. We observed that a proximal distance of 25 mm from the most distal part of the first metatarsal head could be a safe place to finalize the Chevron osteotomy, minimizing the risk of injury to the blood supply of the first metatarsal head.

Category: Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Women wearing high heels for 20 years without Hallux valgus angle alterations make it debatable that causes Hallux valgus deformation. A recent systematic review determined that 4.13 ± 0.34 cm of heel height would improve foot weight-bearing . Wearing high heels would realign the foot, causing an inversion of the foot, which locked the navicular-cuneiform and cuneo-metatarsal joints rather than primarily rotate the metatarsophalangeal joint. Nowadays, weight-bearing scans could favor understanding the alignment mechanism involved in the foot and ankle with different shoe heights. Therefore, we aimed to determine the acute foot alignment in non-frequent HH users without Hallux valgus during stand posture. Here, we hypothesize that high heels studied by weight-bearing scans shows radiology changes linked to hindfoot alignment rather than primary forefoot rotation. Methods: This comparative cross-sectional study, participants were randomly submitted to a tridimensional weight-bearing CT. Foot alignment for barefoot and wearing custom high heels of 3, 6, and 9 cm. Forty-one feet from twenty-one participants (11 males and 10 females, aged 30.8 ± 8.9 years, and Body Mass Index 25.5 ± 2.0 m kg-2) were submitted to a tridimensional weight- bearing scan in barefoot and wearing high heels of 3, 6, and 9 cm. The inclusion criteria were: Aged between 20 and 50 years, and no regular wearing of heels.Participants were instructed to bear weight in their regular standing upright posture, dispensing the body weight uniformly between the lower limbs with the feet set at shoulder width. Declination talar, forefoot arch, foot ankle offset, 1st, 2nd, and 3rd metatarsophalangeal dorsiflexion, and metatarsal rotation and sesamoid rotation angles were compared with repeated measurement analysis and multiple comparisons as well as the raters intraclass coefficient. Results: When height increases, the declination talar angle decrease (p < 0.001), the foot ankle offset decreases (p < 0.001), the 1st, 2nd, and 3rd dorsiflexion angle increases (p < 0.001), and metatarsal rotation angle (p=0.696) and sesamoid rotation angles (p=0.649) did not change. The forefoot arch for 6 cm was higher than 3 cm (p < 0.001) and then 9 cm (p=0.001), and the forefoot arch for 9 cm was higher than 3 cm (p=0.049). Conclusion: The main finding was that increased forefoot arch, lower ankle offset, no metatarsal rotation angle, and no sesamoid rotation angle strongly suggest an acute primary hindfoot alignment adaptation mechanism rather than forefoot rotation with increase of heel heigth. The most critical mechanism combines the activation of the windlass mechanism together with a stiffer alignment of Hindfoot. Our interpretation here is supported by the lower FAO, and increased forefoot arch and metatarsophalangeal joints, giving insight into pathology foot deformation like Hallux valgus. Thus, our findings suggest that it is debatable that wearing high heels can trigger forefoot deformity,

Category: Hindfoot; Other Introduction/Purpose: The use of bio-integrative implants in orthopedic surgery is growing exponentially. Advantages, such as reduced implant-related artifact production, lower removal rates, and superior bone interaction, have been advocated. However, while many biomechanical and histological reports could sustain its structural and biological properties, only some clinical studies were produced that could support its use. Therefore, this trial intended to determine the bio-integrative screws' capacity to reach the same clinical and radiographical outcomes of current metallic screws in calcaneus osteotomies. Our main hypothesis was that metallic and bio-integrative screws would not present differences when comparing bone healing and complications. Methods: This was a single center, in parallel groups, randomized non-inferiority clinical trial (NCT05018130) that included patients undergoing a calcaneal sliding osteotomy from November 2021 to January 2023. Patients were randomized in a 1 to 1 ratio by software in the metallic or bio-integrative groups, and allocation occurred after anesthesia was carried out. Surgeries were performed by a single surgeon respecting the same technique, using two canulated 4mm screws, either titanium or fiber, according to the treatment group. The primary outcome was determined by bone using weight-bearing computed tomography (WBCT) in the 6th postoperative week. At least 50% of bone trabeculae crossing the osteotomy site needed to be observed to be considered positive. Secondary outcomes included minor and major complications and bone healing, assessed in the 2nd, 4th, 6th, 12th, 24th, and 48th weeks of follow-up. Two assessors performed readings. Between-group differences were measured with ANOVA and chi-square tests. Results: After twenty-nine patients were assessed initially, 22 subjects were found eligible and included in the study. Groups were similar demographically (ps>0.37), with ten patients allocated to the bio-integrative and 12 to the metallic group. The mean follow- up was 31.64 weeks (min 6; max 48) with no losses through the endpoints. Considering WBCT bone healing at six weeks, the bio (80%) and the metallic (75%) groups had similar rates (p=0.58). At 12 weeks, bone healing was slightly higher in the bio-integrative group (100% vs. 92%; p=0.004). No major complications were observed. Minor complications were similar between groups (10% in bio; 16% in metallic; p=0.56) and composed of superficial infections (one bio, one metallic) and delayed wound healing (one metallic), all resolved by six weeks. Conclusion: Bio-integrative screws presented similar results to metallic screws when used in calcaneus osteotomies, considering bone healing and complications. No differences were found in a medium to long-term follow-up, and no major complications were reported. This non-inferiority clinical trial could contribute to the body of literature supporting the use of bio-integrative screws in clinical practice. Larger and longer trials are necessary to determine the superiority of any implant and its impact on orthopedic surgery.

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Flattening of the longitudinal arch of the foot (Flatfoot) can represent a normal spectrum of foot morphology and alignment. The issue comes when the foot is collapsing progressively, what is now termed Progressive Collapsing Foot Deformity (PCFD). Literature on asymptomatic flatfoot is scarce since asymptomatic patients do not seek medical attention. Alignment differences between asymptomatic flatfoot and PCFD have not been established and might represent a key-step in understanding predictors of PCFD. The objective of this prospective study was to compare established PCFD measures in a cohort of asymptomatic flatfoot, PCFD patients and healthy controls. We hypothesized that asymptomatic flatfeet alignment would differ from both symptomatic PCFD patients and healthy controls. Methods: In this prospective comparative study, patients with asymptomatic flatfeet were recruited to undergo a weight-bearing CT (WBCT) scan. This cohort (22 feet, 10 males, 12 females) was compared to two other prospective cohorts (22 symptomatic PCFD and 22 healthy controls). Along with demographic data, PCFD measurements performed include Foot and Ankle Offset (FAO), Forefoot Arch Angle (FAA), Middle Facet Uncoverage, and the Transverse Arch Plantar (TAP) angle. Normality of variables was assessed using the Shapiro-Wilk test. Chi-squared or analysis of variance (ANOVA) test was performed to compare each parameter between the three groups. A post-hoc Bonferroni test was then performed to assess significance between each group pairing. P-values of >0.05 were considered significant. Results: All three groups were comparable on BMI (p=0.10), Age (p=0.75) and Gender (p=0.78). All measurements taken differed significantly between the symptomatic PCFD and healthy controls (Table 1). FAO was significantly different between controls vs asymptomatic (p < 0.001) and asymptomatic vs symptomatic (p < 0.001). FAA was also significantly different between asymptomatic and both symptomatic (p=0.001) and control groups (p=0.001). Middle facet uncoverage differed between the asymptomatic and control group (p=0.001) but the asymptomatic and symptomatic group were similar (p=0.106). While the TAP angle was significantly different between asymptotic and symptomatic groups (p=0.013), the asymptomatic and control groups failed to reach significance (p=0.061) (Table 1). On average, deformity measurements for asymptomatic flatfeet were in between the values for healthy controls and symptomatic PCFD (Figures 1-3). Conclusion: To our knowledge this is the first prospective study to compare healthy controls, asymptomatic flatfoot and symptomatic PCFD patients. We observed that asymptomatic flatfoot patients usually had measurements of PCFD that would fall in between normal alignment asymptomatic controls and symptomatic PCFD patients. Further, the asymptomatic group differed significantly from both other groups on every measure but two. Our data supports the idea that asymptomatic flatfoot should be considered a risk factor for Progressive Collapsing Foot Deformity. Our data can hopefully shine light in finding predictive markers for the development of PCFD.

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Hallux valgus (HV) and progressive collapsing foot deformity (PCFD) are very common foot and ankle conditions in the adult population. Both could potentially disrupt the tripod construct of the foot which leads to chronic pain and arthritis. Several procedures were described to address HV deformity depending on deformity characteristics. PCFD could alter the management plan for HV if they occur simultaneously. The aim of this study was to detect the prevalence of PCFD in HV patients and study the frequency of individual PCFD classes. Methods: In this retrospective IRB approved study, patients > 18 years old who were evaluated for symptomatic hallux valgus and had a weight bearing computed tomography (WBCT) imaging were included. Patients were considered for further analysis if they have a hallux valgus angle (HVA) > 15° or inter-metatarsal angle (IMA) > 9°. All relevant demographic data were extracted. Two fellowship trained foot and ankle orthopaedic surgeon measured the following parameters: foot and ankle offset (FAO%) (Class A), talo-navicular coverage angle (TNCA) (Class B), Meary’s angle (Class C) and middle facet subluxation (MFS%) (Class D). Cases that showed FAO% > 4.6% and MFS% > 28.7% were diagnosed as PCFD. The prevalence of PCFD classes (A,B,C and D) was calculated using threshold values for its respective radiographic marker. Descriptive statistics were performed. Results: Thirty-four cases were included. 16 cases were females (46.06%) and 16 (46.06%) were right side. The average age was 52.51 years (SD ± 17.75), the average BMI was 30.14 (SD ± 7.15). The average HVA was 26.82 (SD ± 9.98) and the average IMA was 15.41 (SD ± 3.53). 13 patients (38.24%) had MFS% and FAO% above the threshold values. The average FAO was 4.75% (SD ± 4.92) and the average MFS was 29.17% (SD ± 15.89). Prevalence of Class A (FAO%) was 20 (58.82%), Class B (TNCA) was 12 (35.29%), Class C (Meary’s angle) was 15 (44.12%) and Class D (MFS%) was 16 (47.06%). Conclusion: Progressive collapsing foot deformity is prevalent in the hallux valgus population (38.24%). Class C which indicates medial column instability was prevalent in 44.12% of the cases. Given this high prevalence of PCFD, we believe that in addition to the classic hallux valgus parameters, PCFD classes evaluation could favor a surgical approach over another such as first tarsometatarsal joint procedures over isolated distal first metatarsal procedures to correct the HV deformity and simultaneously halt PCFD progression.

Category: Hindfoot Introduction/Purpose: Progressive collapsing foot deformity (PCFD) is a complex three-dimensional foot deformity that is characterized, in part, by peritalar subluxation (PTS). The subtalar joint has been analyzed in PCFD using distance mapping as a measure of subfibular impingement (Figure 1). However, the progression of PCFD from healthy to asymptomatic to symptomatic and painful, specifically within the subtalar joint, is largely unknown. Therefore, investigating asymptomatic PCFD may offer clinical insight into both the pathology of PCFD within the subtalar joint and how the disease progresses. The objective of this study was to use a three-dimensional distance mapping algorithm of the subtalar joint for asymptomatic PCFD patients to describe and compare this stage of the deformity with a previously described cohort of symptomatic PCFD patients and healthy controls. Methods: In this prospective comparative study, patients with asymptomatic flatfeet were recruited to undergo a weight-bearing CT (WBCT) scan. This cohort (20 feet, 8 male, 12 female) was compared to a previously described cohort of both control (n=10, 4 male, 6 female) and symptomatic PCFD (n=20, 8 male, 12 female). Using a commercially available software package (Disior Bonelogic), models of the talus and calcaneus were created and analyzed. Distance mapping was then used to measure the distance along the normal direction of vectors projected from the calcaneal subchondral surface to the opposing talar surface. In this manner, the subtalar joint was objectively measured across the entire peritalar surface, including articular and nonarticular regions (Figure 1). Mean distances over the described articulations of the subtalar joint were compared using an analysis of variance (ANOVA) test to compare each parameter between the three groups. Results: Regarding mean distance values, the asymptomatic group was significantly higher than symptomatic measures in 10/13 articular surfaces and 3/4 sinus tarsi regions. Asymptomatic distances were also significantly greater than control measures in 11/13 articular surfaces (Table 1, Table 2) but were smaller and without significance in the sinus tarsi region. (Table 3). When looking at the sinus tarsi as a whole, asymptomatic distances (mean 3.21mm) were greater than both control (mean 2.73mm, p=0.01,) and symptomatic distances (mean 2.63, p=0.002) (Table 1). More specifically, asymptomatic distances were different than both symptomatic and control distances in the anteromedial, posteromedial and posterolateral regions of the sinus tarsi (Table 3). Conclusion: To our knowledge, this is the first study to examine the asymptomatic flatfoot within the subtalar joint. Asymptomatic distances were found to be largely greater than both symptomatic and control distances. This suggests that the bones are unstable and moving in patients who have flatfeet but no symptoms. When PTS, in an unstable asymptomatic foot, produces sinus tarsi impingement, that may be the trigger to further collapse and subsequent pain. Our data supports the idea that asymptomatic flatfoot should be considered a risk for progression to PCFD and represents a step toward finding predictors for development painful flatfoot.

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: The current classification system of progressive collapsing foot deformity (PCFD) is comprised of 5 possible classes. PCFD is understood to be a complex, three-dimensional deformity occurring in many regions along the foot and ankle. The question remains whether a deformity in one area impacts other areas. The objective of this study is to assess how each one of the classes is influenced by other classes by evaluating each associated angular measurement. We hypothesized that positive and linear correlations would occur for each class with at least one other class and that this influence would be high. Methods: We retrospectively assessed weight-bearing computed tomography (WBCT) measurements of 32 feet with PCFD diagnosis. The classes and their associated radiographic measurements were defined as follows: class A (hindfoot valgus) measured by the hindfoot moment arm (HMA), class B (midfoot abduction) measured by the talonavicular coverage angle (TNCA), class C (medial column instability) measured by Meary’s angle, class D (peritalar subluxation) measured by the medial facet uncoverage (MFU), and class E (ankle valgus) measured using the talar tilt angle (TTA). Multivariate analyses were completed comparing each class measurement to the other classes. A p-value < 0.05 was considered significant. Results: Class A showed a substantial positive correlation with class C (ρ=0.71; R2=0.576; p 0.001). Class B was substantially correlated with class D (ρ=0.74; R2=0.613; p 0.001). Class C showed a substantial positive correlation with class A (ρ=0.71; R2=0.576; p 0.001) and class D (ρ=0.75; R2=0.559; p 0.001). Class D showed a substantial positive correlation with class B and class C (ρ=0.74; R2=0.613; p 0.001), (ρ=0.75; R2=0.559; p 0.001) respectively. Class E did not show correlation with class B, C, or D (ρ=0.24; R2=0.074; p=0.059), (ρ=0.17; R2=0.071; p=0.179), and (ρ=0.22; R2=0.022; p=0.082) respectively. The average values of each class radiographic markers are listed in Figure 1. Conclusion: This study was able to find relations between components of PCFD deformity with exception of ankle valgus deformity (Class E). Measurements associated with each class were influenced by others, and in some instances, with pronounced strength such as between class A and C as well as between Class B and D. Surgical procedures to address certain class deformities could indirectly address other classes as well, which ultimately decreases surgical procedures numbers or complexity. The presented data may support the notion that PCFD is a three-dimensional complex deformity and suggests a possible relation among its ostensibly independent features.

Category: Ankle; Hindfoot Introduction/Purpose: Foot and Ankle Offset (FAO) is a clinically relevant measurement technique used to objectively evaluate the foot and ankle that has been shown to be reliable and validated in common mild foot deformities. It represents a measurement of the offset between the body weight vector and the ground reaction force vector, thus making it a biomechanically relevant measurement. However, FAO has not been validated in the setting of severe ankle deformity. The goal of this paper was to evaluate the validity of FAO measurements in the setting of severe foot and ankle deformities by utilizing a novel rotational FAO measurement technique to account for the deformity. Methods: This study included 57 feet (36 patients) that had a history of severe cavovarus deformity. Each participant received a Weightbearing CT (WBCT) scan that was then used to measure FAO. This measurement was taken three times, once using the traditional measurement technique and two additional times using a modified technique with a 15-day washout period between each measurement. This modified technique allowed for alignment of the talus in a neutral position through rotational correction in the axial, coronal, and sagittal planes to identify the most proximal and central point of the talus. Patients were broken into three groups based on the alignment of their foot and ankle. Normal alignment was defined as a FAO of 2.3% ± 2.9%, varus alignment as -11.6% ± 6.9%, and valgus alignment as 11.4% ± 5.7%. The measurements from the different techniques were compared to identify validity between them and the intraobserver reliability was assessed. Results: The mean traditional FAO was 2.37 ± 4.65% (95% CI=1.16–3.59) and modified FAO was 2.51 ± 4.6 (95% CI=1.3–3.71). The mean modified FAO values between the different alignment groups were found to be significantly different (p

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: The first-ray and the medial column play a crucial role in preserving the tripod of the foot. Changes to structural properties of the first-ray, along with collapse of the medial-longitudinal-arch, have been associated with hallux valgus (HV). Thus, restoring the first-ray plays an important role when correcting the mechanical function of the foot tripod in the setting of HV combined with medial-longitudinal-arch collapse. The LapiCotton technique combines the mechanical advantages of Cotton osteotomy and modified Lapidus procedures by maintaining the length of the first-ray and preserving the medial- longitudinal-arch by plantar inclination of the distal part of first-ray. The aim of this study was to evaluate the effectiveness of the LapiCotton procedure in correcting selected radiographic parameters in patients with combined VH with medial-longitudinal arch collapse. Methods: Preoperative and postoperative Weight Bearing CT (WBCT) scans were obtained from HV patients who underwent unilateral LapiCotton procedure. Postoperative scans were obtained roughly three months after the date of surgery. Semi- automatic measurements were applied to 22 WBCT images across a total of 11 patients enrolled into the study using the Disior ® Bonelogic ® Software. Measurements of the hallux valgus angle (HVA), meary sagittal measurement, and intermetatarsal angles were taken from preoperative and postoperative scans. These scans were then compared using intraclass correlation coefficients and paired t-tests to evaluate the efficacy of the Lapicotton technique in treating HV with P-valus < 0.05 being significant. Results: HVA was found to be significantly larger (p=.026) in the preoperational group (Mdn = 27.52) than the postoperational group (Mdn = 20). In addition, the Meary sagittal measurement was found to be significantly different between groups (p=.033), with a larger value seen in the preoperational group (Mdn = -14.28) compared to the post-operational group (Mdn = -11.15). It was also observed that the IMA was significantly larger (p=.003) in the preoperative group (Mdn = 15.68) compared to the postoperative group (Mdn = 11.26). The sesamoid rotation was found to be higher in the preoperative group (Mdn = -17.71) than the post operative group (Mdn = -24.98), however, these values were not significantly different from one another (p=.203). Conclusion: The LapiCotton procedure proved to be effective in correcting radiographic parameters in patients with HV combined with collapse of the medial longitudinal arch. Reliable correction of HV, along with correction of medial longitudinal arch collapse, was quantified based on semi-automated WBCT measurements of HVA, IMA and Meary angle. LapiCotton produced significantly different measurements for both HVA and IMA postoperatively, providing evidence that the LapiCotton procedure can successfully correct medial longitudinal arch collapse in patients with HV, as well as radiographically reduce the severity of the deformity.

Category: Ankle Arthritis; Hindfoot Introduction/Purpose: Tibio-talo-calcaneal (TTC) arthrodesis is usually a salvage procedure to address several hindfoot and ankle conditions. Non-union rate after TTC fusion is variably reported 3.4% - 48%. The aims of this study were to describe the outcomes and complications of this procedure and to determine potential risk factors associated with non-union. Methods: In this IRB-approved retrospective cohort study, we used the following codes (28705,28725 and 27870) to search the medical records for all patients who underwent TTC fusion between 2006-2022. All relevant demographic data, surgical indications, surgery details (type of the graft, type of the implant, and surgical approach, associated procedures), post-operative course (complications and union rate) and follow-up duration were extracted. Descriptive statistics were performed, and continuous variables were described using median (interquartile range) and categorical variables were described using frequency (%) and mean (standard deviation, SD). Patients and surgery characteristics were compared between united and non-united cases using Wilcoxon Rank Sum Tests for continuous variables and Chi-squared or exact tests, as appropriate, for categorical variables. Analyses were performed using SAS statistical software version 9.4 (SAS Institute Inc., Cary, NC). Results: Fifty-one patients (53 feet) were included in the study. Long hindfoot fusion nails were used in 51 cases.Ten cases were routinely dynamized 8-10 weeks after surgery. In 24 (45.3%) patients, morselized allograft was combined with infuseTM and reamer irrigation aspiration autograft (RIA). In 20 (37.7%) patients, morselized allograft was combined with infuseTM only. There were 6 non-union cases (11.3%). When comparing patients and surgery characteristics between non-union versus union group, smoking (P = 0.0150) and routine dynamization (P= 0.0297) were higher in the non-union group. No difference in union rates between different types of graft. Frequency of other complications is listed in (Figure 1). Follow up duration was 27.2 months (range 4-108 months). Conclusion: TTC fusion achieves good union rate (88.68%), however it carries a relatively high risk of complications. Routine dynamization of the TTC nail at 8-10 weeks could be a risk factor for non-union. Smoking was also associated with a high non- union rate.

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Evidence in the literature suggests the negative effects of using High Heels (HH), becoming a challenge for clinicians and researchers since they are welcomed by women worldwide, mainly due to the subjective power of attractiveness given to them. Although some people blame HH as one of the causes of Hallux Valgus (HV), until now, there are no studies in the literature that effectively prove a cause-effect relationship between HH and HV. The objectives of this study are: (1) to analyze whether the increase in heel height can lead to HV and (2) to evaluate whether HV can increase in severity with increasing heels. We hypothesized that an increase in heel height could cause and increase the severity of HV deformity radiographically. Methods: Comparative cross-section4-one feet from twenty-one participants (11 males and 10 females, aged 30.8 ± 8.9 years, and with Body Mass Index 25.5 ± 2.0 m kg2) were recruited. HH shoes were designed for this study with three heights for each participant: 3, 6, and 9 cm. The inclusion criteria were: no regular wearing of heels. The exclusion criteria were: Hallux Valgus diagnosis and/or any orthopedic conditions that affect the Foot and Ankle joints. Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), First-Metatarsal Phalangeal Angle, 1st-to-5th Intermetatarsal Angle, First Tarsometatarsal Angle (axial), Second tarsometatarsal angle (axial), Hindfoot Moment Arm (HMA) (mm), Saltzman 45 angle and, Foot Ankle Offset (FAO) were measurement using semiautomated software analysis. Multiple comparisons were performed (Bonferroni's for normal distributions and Wilcoxon test for no normal distributions) when there was a main effect on an outcome (p < 0.05). Results: With the increase in HH, we noticed a progressive increase in HVA (p < 0.001), IMA (p < 0.001), First-Metatarsal Phalangeal Angle (p < 0.001), First Tarsometatarsal Angle (axial) (p < 0.001), and the Second tarsometatarsal angle (axial) (p < 0.001). The Hindfoot Moment Arm (HMA) (mm), Saltzman 45 angle, and Foot Ankle Offset (FAO) had hindfoot varus behavior. When we stratified the groups and compared them, we noticed that an increase of 3 cm in heels slightly increased HVA and IMA (p > 0.05). However, heel increases above 6 cm significantly increased HVA and IMA (p > 0.001). Based on Coughlin's classification, a 3 cm heel increase promoted a mild HV, and increases above 6 cm caused a moderate HV. Conclusion: Based on data from our study with patients without Hallux Valgus through analysis with WBCT versus High Heels, we conclude that increasing heel height can radiographically lead to Hallux Valgus deformity and progressively increase the severity. High heels above 6 cm can lead to radiographically moderate Hallux Valgus. These findings may be an essential step toward a better understanding the effects of increasing high heels on Hallux Valgus pathology. More studies are needed to support this data clinically.

Category: Ankle; Sports Introduction/Purpose: Syndesmotic injuries and residual chronic subtle distal tibiofibular syndesmotic instability (DTFSI) are relatively common injuries, especially in athletes prone to suffering high ankle sprains. The diagnosis of subtle DTFSI remains challenging, with a high prevalence of false-negative results using conventional non-invasive clinical-radiographical diagnostic tools. The current gold standard for diagnosis, arthroscopy, is a surgical operation, which is invasive and, therefore, not ideal. Weightbearing Computed-Tomography (WBCT) has emerged as a possible dynamic non-invasive alternative diagnostic option, with proven high diagnostic accuracy for syndesmotic incisura area measurements in major DTFSI. Our study aimed to assess the capability of semiautomatic weight-bearing computed tomography (WBCT) syndesmotic incisura area in diagnosing subtle chronic syndesmotic instability. Methods: In this diagnostic case-control study, patients with suspected unilateral chronic subtle DTFSI underwent bilateral standing weight-bearing CT (WBCT) before surgical treatment. All patients had gold-standard arthroscopic assessment for DTFSI, introducing a 3mm diameter arthroscopic sphere into the syndesmotic incisura for diagnosis. Bilateral syndesmotic incisura areas were measured 10mm proximally to the apex of the distal tibia articular dome using a semiautomatic measurement algorithm. Two tangent lines marked the anterior and posterior borders of the syndesmotic incisura to the anterior and posterior edges of the distal tibia and fibula. Once borders were marked, the incisura area was automatically calculated by the software based on a Hounsfield units (HU) contrast algorithm. A HU threshold of 200HU was utilized. Measurements were done independently by two fellowship-trained readers. Comparisons between injured and control ankles were made using Student T-test or Wilcoxon, according to normality. Measurements' reliability was assessed with the Intraclass Correlation Coefficient (ICC). Results: From an initial sample of 32 patients, 20 patients (12 female) with arthroscopically confirmed DTFSI (11 right sides) with a mean age of 31.7 years (range 18 to 55 years) and a mean BMI of 30.35kg/m² (SD +/-8.29 kg/m²) were included in the study. All patients had a history of an old ankle sprain 6 to 182 months before the assessment, and athletic lesions were reported in 53% of the population. ICCs were above 0.98 for both intra and interobserver reliability. The average syndesmotic area was 96.91mm 2 (SD +/-27.9mm 2 ) in injured ankles compared to 84.61mm 2 (SD +/-26.9 mm 2 ) in uninjured ankles. The difference between injured and non-injured tibiofibular areas was 12.31mm 2 (95%CI: 9.04-15.58mm 2 ), which was shown statistically significant (p < 0.001; effect size: 1.43). Conclusion: In this case-control study, we assessed the accuracy of semiautomatic WBCT syndesmotic incisura area measurements in diagnosing subtle chronic DTFSI. We found an increased syndesmotic area in injured ankles that reached statistical significance. Due to the minimal differences between injured and uninjured contralateral ankles, larger cohorts would likely solidify this study's findings further. The use of external rotation stress, volumetric assessment, distance, and coverage maps could increase the diagnostic accuracy in DTFSI. However, automatic area measurements have a higher overall reproducibility and applicability in the clinical setting, which could help providers make therapeutic decisions.

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Interpositional arthroplasty (IPA) is a motion-preserving surgery in patients with advanced hallux rigidus. Literature displays several complications after the procedure including transfer metatarsalgia, cock-up deformity and infection. In a finite element model, shortening of the first metatarsal was associated with increased plantar pressure on lateral rays during gait. Additionally, there are reports of a positive correlation between first metatarsal shortening after hallux valgus surgery and transfer metatarsalgia of the second, third and fourth metatarsophalangeal joints. The goals of this study were to report the outcomes and complications of IPA using acellular dermal allograft (IPA-ADA) as well as study the changes in the length of the proximal phalanx of the hallux (P1) and the first metatarsal (M1) following the procedure. Methods: In this IRB-approved retrospective study, we assessed patients who underwent IPA-ADA in a single academic institute during the period 2019-2022. All patients’ demographic data, surgical details, complications, and patient-reported outcomes (PROs) were extracted. On standing conventional anteroposterior (AP) foot views, we measured the lengths of the first metatarsal (M1), the second metatarsal (M2), the proximal phalanx of the big toe (P1) and the entire length of the hallux (HX). The ratio of M1/M2 and P1/HX were calculated. The first metatarsophalangeal joint space was measured at the medial and lateral aspects of the joint on the AP view. All measurements were recorded pre-operatively, at six weeks follow-up and at the final follow-up. Descriptive statistics were performed, comparison between groups was performed using analysis of variance (ANOVA) or Kruskal Wallis test according to data normality. The Dunn-Bonferroni test was then performed for pairwise group comparisons.A p-value < 0.05 was considered significant. Results: Eleven patients were included, 9 being females (81.81%). Six were hallux rigidus Coughlin grade III (54.55%) and 5 were grade IV (45.45%). The average age was 59 years (SD±6.78) and the body mass index (BMI) was 26 (SD±4.79). At the final follow- up, there was significant shortening of the first ray in comparison to the pre-operative length evidenced by lower M1/M2 (82.63 SD±2.29 versus 75.42 SD±5.1; p=0.001) and P1/HX ratio 53.38 ± 2.29 versus 48.98 SD ± 7.92; p=0.001). Although there was no significant difference between M1/M2 at 6 weeks and at the final follow-up (p=0.716), there was a significant negative correlation between follow-up length and M1/M2 (r= -0.76, p=0.003). Follow-up was (19.95 months; range 3-39). Complications and PROs are listed in Figure 1. Conclusion: Interposition arthroplasty using dermal allograft for HR is associated with progressive shortening of the first ray at the level of the first metatarsal as well as the proximal phalanx. Although the study did show shortening of the first ray, the small sample size didn't allow for a correlation between this shortening and complications such as transfer metatarsalgia and cock-up toe deformity. The potential shortening should be considered in the selection of patients, particularly in the setting of an already short first metatarsal or when simultaneous Akin/Moberg osteotomy is planned.

The pressing demand for clean water worldwide has increased attention to developing innovative desalination processes. In this work, the second law of thermodynamics is used to examine and assess two coupled desalination systems: a separation-based reverse osmosis (RO) system and a thermal desalination-based humidification–dehumidification (HDH) system. The HDH unit configuration used here is based on the working principle of the heat pump, where the process is open-air, open-water, and air-heated. The RO system is equipped with a pressure exchanger (PX) and has been examined under various operating circumstances, such as different feed water pressures, salinities, and flow rates. To improve the system’s sustainability, a solar photovoltaic system (PV) was integrated. An exergy model was used to precisely evaluate the system components and the hybrid systems by employing a proper exergy efficiency definition. The evaluation of the second law of thermodynamics for the RO–HDH–PX and RO–HDH–PX–PV systems indicated maximum efficiencies of 23% and 23.25%, respectively. A cost analysis was also performed on the hybrid RO–HDH–PX–PV desalination system using two approaches: the first included a battery storage system, whereas, in the second, the battery was not considered. When a battery storage system is included, the cost per cubic meter varies from USD 3.22 to USD 5.10. In contrast, it varies from USD 3.96 to USD 7.12 without a battery storage system.

Chronic kidney disease (CKD) is a global health challenge, with a reported prevalence of around 10%. Prescribing for patients receiving hemodialysis (HD) is challenging and complicated by polypharmacy, comorbidities, and changes in clearance of medications. The aim of this study was to evaluate antibiotics utilization patterns and dosage appropriateness in patients receiving HD at a tertiary hospital. A retrospective study was carried on 287 adult inpatients, who received HD and at least one antibiotic in a tertiary hospital in Oman. Data were extracted using the hospital’s electronic patient information system. Dosage appropriateness was assessed by identifying the dosage and frequency of prescribed antibiotics and comparing them with international guidelines. The main outcome measures were antibiotics utilization patterns and dosing inappropriateness. The most commonly prescribed parenteral antibiotic was piperacillin + tazobactam (20%), while the most common prescribed oral antibiotic was azithromycin (41.7%). For prophylaxis, cefazolin (54.6%) was the main antibiotic prescribed. The most commonly used antibiotic for external use was mupirocin ointment (38.5%). The overall dosing inappropriateness was 29.5%. Vancomycin was the most common parenteral antibiotic subjected to dosing inappropriateness (19.8%). However, trimethoprim + sulfamethoxazole was more inappropriately prescribed among the oral route (28.6%).In conclusion, the most utilized antibiotic was piperacillin + tazobactam followed by vancomycin. The study reported some inappropriate dosing of antibiotics. Such a study opens the door for the establishment of local guidelines for the improved practice of antibiotics use in HD patients.

In this manuscript, phosphate grains were used as energy storage materials at different concentrations to improve the performance of solar hemispherical distillation. For the aim of verifying the best concentration of phosphate grains to achieve the highest performance of the hemispherical distillers, twelve different concentrations of phosphate grains 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 60 and 70 g/L were studied. Additionally, three hemispherical distillers were designed and built; the first is a traditional hemispherical distillation device (THSS), the second and third are hemispherical distillates (HSS) containing phosphate grains with different concentrations. The pilot test was carried out on six days. The experimental results showed that the phosphate grains concentration of 30 g/L represents the optimum concentration of energy storage materials to achieve the highest performance of hemispherical distillates. The utilization of 30 g/L phosphate grains (HSS-PG30) gave a cumulative yield of 6 L/m2/day with an improvement of 57.9 % compared to THSS. Also, the daily efficiency of HSS-PG30 was 60 % with an improvement of 23 % compared to THSS. It is recommended to fasten the concentration of phosphate grains up to 30 g/L for maximum performance gain.

Abstract Artificial intelligence (AI) is looked upon nowadays as the potential major catalyst for the fourth industrial revolution. In the last decade, AI use in Orthopaedics increased approximately tenfold. Artificial intelligence helps with tracking activities, evaluating diagnostic images, predicting injury risk, and several other uses. Chat Generated Pre‐trained Transformer (ChatGPT), which is an AI‐chatbot, represents an extremely controversial topic in the academic community. The aim of this review article is to simplify the concept of AI and study the extent of AI use in Orthopaedics and sports medicine literature. Additionally, the article will also evaluate the role of ChatGPT in scientific research and publications. Level of evidence: Level V, letter to review.

In this study, we apply the commutative hyper complex algebraic method to solve analytically the Doubly Dispersive Equation (DDE) in (1+1)-D, for the strain waves propagating in a cylindrical circular rod in complex polymer systems, within the framework of analytical mechanics. Relying on the stability of the solutions via phase portrait analysis, the resulting solitary waves obtained by applying the complex Jacobi elliptic function method, show the compression characters in the non-linearly elastic materials tackled in our article. The estimated Lagrangian density confirms the potential well criterion of the physical situation. Some comparisons are made with recent models conducted by several authors.

All living beings depend on energy for survival, and modern civilizations will continue to thrive only if existing sources of energy can be developed to meet the growing demand. With the universal urge to reduce power usage in the building environment, there are broad discrepancies between energy efficiency intention and the realistic operation of buildings. Implementing current mitigation strategies tends to be gradual and requires a ‘whole-system’ approach to the issue.In Egyptian buildings, energy demand increased dramatically with the increasing necessity to acquire indoor thermal comfort conditions. Simultaneous growth in residential and commercial developments necessitate increasing power production to face new demands. Energy needs in facilities are growing annually due to the expansion in HVAC (Heating, Ventilation & Air Conditioning) systems operating hours. Minimizing power demand and encouraging the use of green energy sources, protecting the planet from global warming impacts, and depleting the ozone layer is beneficial.High temperatures and high humidity levels in hot and humid climate zones such as Alexandria in Egypt cause human discomfort, resulting in high HVAC energy consumption. Apart from medical equipment, power, and infection controls, hospitals utilize substantial amounts of HVAC energy. To clarify Egyptian hospitals ' energy consumption, the on-going case study is conducted on a hospital accessible to the researcher at Alexandria, Egypt. The purpose of this study is to explore medical facilities' energy requirements and to assess the possible energy savings of present buildings in Egypt. Using the DesignBuilder simulator platform, a prototype was built for medical institution underdevelopment. Depending on the hospital’s construction, mechanical consultants’ documentation, and EUI, the model is validated. Firstly, the initial model is adjusted to the latest outdoor design conditions and weather database information endorsed by ASHRAE (American Heating, Refrigeration, and Air Conditioning Engineers Society) and NREL (National Renewable Energy Laboratory). Analysis of energy-efficient methods influencing yearly HVAC power utilization and total building power is examined. The analysis gives information about the increase in energy efficiency in medical institutions achieving thermal comfort in Alexandria that would allow designers to sufficiently limit buildings ' energy consumption.For the autonomous temperature and moisture control and influence on the HVAC system, a DOAS (Dedicated Outdoor Air Systems) was introduced asserting substantial energy-savings for both HVAC and the entire building electricity utilization.The study reveals that about 67% energy savings and operating costs can be achieved through efficient retrofitting and systems right sizing.Through economic analysis, this study provides new energy opportunities for new medical facilities in hot-humid climatic regions.

The associated production of Higgs and W bosons via vector-boson fusion is highly sensitive to the relative sign of the Higgs boson couplings to W and Z bosons. In this Letter, two searches for this process are presented, using 140  fb−1 of proton-proton collision data at s=13  TeV recorded by the ATLAS detector at the LHC. The first search targets scenarios with opposite-sign couplings of the W and Z bosons to the Higgs boson, while the second targets standard model-like scenarios with same-sign couplings. Both analyses consider Higgs boson decays into a pair of b quarks and W boson decays with an electron or muon. The data exclude the opposite-sign coupling hypothesis with a significance beyond 5σ, and the observed (expected) upper limit set on the cross section for vector-boson fusion WH production is 9.0 (8.7) times the standard model value at 95% confidence level. © 2024 CERN, for the ATLAS Collaboration 2024 CERN

Abstract: The ratio of branching ratios of the W boson to muons and electrons, $$R^{\,\mu /e}_W={{\mathcal {B}}(W\rightarrow \mu u )}$$ R W μ / e = B ( W → μ ν ) /$${{\mathcal {B}}(W\rightarrow eu )}$$ B ( W → e ν ) , has been measured using $$140\,\text{ fb}^{-1}\,$$ 140 fb - 1 of pp collision data at $$\sqrt{s}=13$$ s = 13  $$\text {T}\text {e}\hspace{-1.00006pt}\text {V}$$ Te V collected with the ATLAS detector at the LHC, probing the universality of lepton couplings. The ratio is obtained from measurements of the $$t\bar{t}$$ t t ¯ production cross-section in the ee, $$e\mu $$ e μ and $$\mu \mu $$ μ μ dilepton final states. To reduce systematic uncertainties, it is normalised by the square root of the corresponding ratio $$R^{\,\mu \mu /ee}_Z$$ R Z μ μ / e e for the Z boson measured in inclusive $$Z\rightarrow ee$$ Z → e e and $$Z\rightarrow \mu \mu $$ Z → μ μ events. By using the precise value of $$R^{\,\mu \mu /ee}_Z$$ R Z μ μ / e e determined from $$e^+e^-$$ e + e - colliders, the ratio $$R^{\,\mu /e}_W$$ R W μ / e is determined to be $$\begin{aligned} R^{\,\mu /e}_W&= 0.9995\pm 0.0022\,\mathrm {(stat)}\,\pm 0.0036\,\mathrm {(syst)}\\ &\quad \pm 0.0014\,\mathrm {(ext)} . \end{aligned}$$ R W μ / e = 0.9995 ± 0.0022 ( stat ) ± 0.0036 ( syst ) ± 0.0014 ( ext ) . The three uncertainties correspond to data statistics, experimental systematics and the external measurement of $$R^{\,\mu \mu /ee}_Z$$ R Z μ μ / e e , giving a total uncertainty of 0.0045, and confirming the Standard Model assumption of lepton flavour universality in W-boson decays at the 0.5% level.

Abstract: Pixel sensors in 3D technology equip the outer ends of the staves of the Insertable B Layer (IBL), the innermost layer of the ATLAS Pixel Detector, which was installed before the start of LHC Run 2 in 2015. 3D pixel sensors are expected to exhibit more tolerance to radiation damage and are the technology of choice for the innermost layer in the ATLAS tracker upgrade for the HL-LHC programme. While the LHC has delivered an integrated luminosity of  ≃ 235 fb-1 since the start of Run 2, the 3D sensors have received a non-ionising energy deposition corresponding to a fluence of ≃ 8.5 × 1014 1 MeV neutron-equivalent cm-2 averaged over the sensor area. This paper presents results of measurements of the 3D pixel sensors' response during Run 2 and the first two years of Run 3, with predictions of its evolution until the end of Run 3 in 2025. Data are compared with radiation damage simulations, based on detailed maps of the electric field in the Si substrate, at various fluence levels and bias voltage values. These results illustrate the potential of 3D technology for pixel applications in high-radiation environments.

Results from a wide range of searches targeting different experimental signatures with and without missing transverse momentum (ETmiss) are used to constrain a Two-Higgs-Doublet Model (2HDM) with an additional pseudo-scalar mediating the interaction between ordinary and dark matter (2HDM+a). The analyses use up to 139 fb-1 of proton-proton collision data at a centre-of-mass energy s=13 TeV recorded with the ATLAS detector at the Large Hadron Collider during 2015-2018. The results from three of the most sensitive searches are combined statistically. These searches target signatures with large ETmiss and a leptonically decaying Z boson; large ETmiss and a Higgs boson decaying to bottom quarks; and production of charged Higgs bosons in final states with top and bottom quarks, respectively. Constraints are derived for several common and new benchmark scenarios in the 2HDM+a.

This paper presents a search for exotic decays of the Higgs boson into a pair of new pseudoscalar particles, H→aa, where one pseudoscalar decays into a b-quark pair and the other decays into a τ-lepton pair, in the mass range 12≤ma≤60  GeV. The analysis uses pp collision data at s=13  TeV collected with the ATLAS detector at the LHC, corresponding to an integrated luminosity of 140  fb−1. No significant excess above the Standard Model (SM) prediction is observed. Assuming the SM Higgs boson production cross section, the search sets upper limits at 95% confidence level on the branching ratio of Higgs bosons decaying into bb¯τ+τ−, B(H→aa→bb¯τ+τ−), between 2.2% and 3.9% depending on the pseudoscalar mass. © 2024 CERN, for the ATLAS Collaboration 2024 CERN

Abstract: This paper presents a measurement of the production cross-section of a Z boson in association with b- or c-jets, in proton–proton collisions at $$\sqrt{s} = 13$$ s = 13 TeV with the ATLAS experiment at the Large Hadron Collider using data corresponding to an integrated luminosity of 140 $$\hbox {fb}^{-1}$$ fb - 1 . Inclusive and differential cross-sections are measured for events containing a Z boson decaying into electrons or muons and produced in association with at least one b-jet, at least one c-jet, or at least two b-jets with transverse momentum $$p_\text {T} > 20$$ p T > 20 GeV and rapidity $$|y| < 2.5$$ | y | < 2.5 . Predictions from several Monte Carlo generators based on next-to-leading-order matrix elements interfaced with a parton-shower simulation, with different choices of flavour schemes for initial-state partons, are compared with the measured cross-sections. The results are also compared with novel predictions, based on infrared and collinear safe jet flavour dressing algorithms. Selected $$Z + \ge 1~c$$ Z + ≥ 1 c -jet observables, optimized for sensitivity to intrinsic-charm, are compared with benchmark models with different intrinsic-charm fractions.

This Letter presents results from a combination of searches for Higgs boson pair production using 126-140  fb^{-1} of proton-proton collision data at sqrt[s]=13  TeV recorded with the ATLAS detector. At 95% confidence level (CL), the upper limit on the production rate is 2.9 times the standard model (SM) prediction, with an expected limit of 2.4 assuming no Higgs boson pair production. Constraints on the Higgs boson self-coupling modifier κ_{λ}=λ_{HHH}/λ_{HHH}^{SM}, and the quartic HHVV coupling modifier κ_{2V}=g_{HHVV}/g_{HHVV}^{SM}, are derived individually, fixing the other parameter to its SM value. The observed 95% CL intervals are -1.2

This Letter presents the first study of the energy dependence of diboson polarization fractions in WZ→ℓνℓ′ℓ′(ℓ,ℓ′=e,μ) production. The dataset used corresponds to an integrated luminosity of 140  fb−1 of proton-proton collisions at a center-of-mass energy of 13 TeV recorded by the ATLAS detector. Two fiducial regions with an enhanced presence of events featuring two longitudinally polarized bosons are defined. A nonzero fraction of events with two longitudinally polarized bosons is measured with an observed significance of 5.3 standard deviations in the region with 100200  GeV, where pTZ is the transverse momentum of the Z boson. This Letter also reports the first study of the radiation-amplitude-zero effect. Events with two transversely polarized bosons are analyzed for the ΔY(ℓWZ) and ΔY(WZ) distributions defined respectively as the rapidity difference between the lepton from the W boson decay and the Z boson and the rapidity difference between the W boson and the Z boson. Significant suppression of events near zero is observed in both distributions. Unfolded ΔY(ℓWZ) and ΔY(WZ) distributions are also measured and compared to theoretical predictions. © 2024 CERN, for the ATLAS Collaboration 2024 CERN

A search is presented for the pair production of heavy vectorlike quarks (VLQs) that each decay into a W boson and a light quark. This study focuses on events where one W boson decays into leptons and the other into hadrons. The search analyzed 140  fb−1 of pp collision data with s=13  TeV, recorded by the ATLAS detector from 2015 to 2018 during run 2 of the Large Hadron Collider. The final state is characterized by a high-transverse-momentum isolated electron or muon, large missing transverse momentum, multiple small-radius jets, and a single large-radius jet identified as originating from the hadronic decay of a boosted W boson. With higher center-of-mass energy and integrated luminosity than in the run 1 search, and improved analysis tools, this analysis excludes VLQs (Q) with masses below 1530 GeV at 95% confidence level for the branching ratio B(Q→Wq)=1, an improvement of 840 GeV on the previous ATLAS limit. © 2024 CERN, for the ATLAS Collaboration 2024 CERN

A search for heavy Majorana neutrinos in scattering of same-sign W boson pairs in proton–proton collisions at s=13 TeV at the LHC is reported. The dataset used corresponds to an integrated luminosity of 140 fb−1, collected with the ATLAS detector during 2015–2018. The search is performed in final states including a same-sign ee or eμ pair and at least two jets with large invariant mass and a large rapidity difference. No significant excess of events with respect to the Standard Model background predictions is observed. The results are interpreted in a benchmark scenario of the Phenomenological Type-I Seesaw model. New constraints are set on the values of the |VeN|2 and |VeNVμN⁎| parameters for heavy Majorana neutrino masses between 50 GeV and 20 TeV, where VℓN is the matrix element describing the mixing of the heavy Majorana neutrino mass eigenstate with the Standard Model neutrino of flavour ℓ=e,μ. The sensitivity to the Weinberg operator is investigated and constraints on the effective ee and eμ Majorana neutrino masses are reported. The statistical combination of the ee and eμ channels with the previously published μμ channel is performed.

Charged particle reconstruction in the presence of many simultaneous proton–proton (pp) collisions in the LHC is a challenging task for the ATLAS experiment’s reconstruction software due to the combinatorial complexity. This paper describes the major changes made to adapt the software to reconstruct high-activity collisions with an average of 50 or more simultaneous pp interactions per bunch crossing (pile-up) promptly using the available computing resources. The performance of the key components of the track reconstruction chain and its dependence on pile-up are evaluated, and the improvement achieved compared to the previous software version is quantified. For events with an average of 60pp collisions per bunch crossing, the updated track reconstruction is twice as fast as the previous version, without significant reduction in reconstruction efficiency and while reducing the rate of combinatorial fake tracks by more than a factor two.

We assessed the effect of treatment with the dipeptidyl peptidase-4 inhibitor, sitagliptin, on adenine-induced chronic kidney disease (CKD). Six equal groups of rats were given either normal food or food mixed with adenine (0.25% w/w for five weeks) to induce CKD. Some of these groups were also simultaneously treated with sitagliptin (2.5 and 10 mg/kg/day, by gavage). Rats given adenine showed elevation of blood pressure, decreased body weight and increased relative kidney weight. Adenine also significantly increased plasma urea, creatinine, cystatin C, liver-type fatty acid–binding protein concentrations and neutrophil gelatinase-associated lipocalin activity by 404%, 354%, 667%, 91% and 281% respectively and reduced plasma α-Klotho by 50%. In addition, adenine significantly increased albumin/creatinine ratio and N-acetyl-β-d-glucosaminidase activity by 3553% and 400% respectively and reduced creatinine clearance by 91%. Adenine feeding also significantly elevated the plasma concentration of inflammatory cytokines (plasma tumor necrosis factor-alpha, interleukin-1beta and transforming growth factor beta-1) and significantly reduced antioxidant indices (catalase, glutathione reductase and superoxide dismutase). Histopathologically, adenine caused renal fibrosis, inflammation and atrophy. When given concomitantly with adenine, sitagliptin ameliorated all the measured adenine-induced physiological and biochemical changes but not the histopathological changes. Sitagliptin (10 mg/kg/day) reduced plasma urea and creatinine by 32% and 25% respectively and increased creatinine clearance by 248%. These findings suggest a renoprotective action of sitagliptin on adenine-induced CKD.

Even though the ad-hoc on-demand distance vector (AODV) is a broadly used routing protocol for mobile ad-hoc networks (MANETs), it is vulnerable to a blackhole attack. Lu et al. developed a secure MANET routing protocol called SAODV to address the security weakness associated with the original AODV protocol and to remedy the blackhole attack. Specifically, the SAODV protocol can protect against blackhole attack performed by a malicious node during the routing process. However, it cannot resist the cooperative blackhole attack, in which two nodes are participating together to mount such attack. Therefore, this paper proposes a secure MANET routing protocol called BP-AODV to overcome the security breaches related to the SAODV protocol along with the original AODV protocol. In addition, the BP-AODV is able to protect against a cooperative blackhole attack launched during the routing process and guards against the blackhole attack that might take place during the forwarding process. The BP-AODV is developed by extending the functionality of the AODV protocol along with utilizing the chaotic map features. The experimental results assure that the BP-AODV protocol is more secure than the SAODV protocol and can effectively fight the blackhole attack achieved by a malicious node or cooperative malicious nodes during the routing process. The results also reveal that the BP-AODV can strongly guard against the blackhole attack that occurs during the forwarding process.

We investigated the effect of levosimendan on cisplatin (Cis)-induced nephrotoxicity. Rats were divided into four groups (n = 6). The first and second groups received normal saline (control) and intraperitoneal (i.p.) cisplatin (6 mg/kg) on day 7, respectively. The third and fourth groups received a single intraperitoneal (i.p.) injection of Cis on day 7 and levosimendan (1 mg/kg/day, orally) or vehicle for 10 days, respectively. At day 11, animals were anaesthetized and blood collected and kidneys removed. Another four groups were treated the same as the previous four groups to measure renal blood flow. Cis induced nephrotoxicity as evidenced by biochemical, histopathological and hemodynamic changes. Levosimendan partially reduced Cis-induced increase in plasma urea, creatinine and neutrophil gelatinase-associated lipocalin (NGAL) levels and decrease in creatinine clearance. Levosimendan partially reduced Cis-induced increase in urinary albumin/creatinine ratio, N-Acetyl-β-D-Glucosaminidase (NAG) and kidney Injury Molecule-1 (KIM-1). Levosimendan significantly attenuated the effect of Cis on plasma concentration of plasma tumor necrosis factor–alpha (TNF-α), antioxidant indices [catalase and superoxide dismutase (SOD)] and lipid peroxidation. Cis induced acute tubular necrosis with tubular dilatation, interstitial edema and congestion. Levosimendan attenuated the remarkable renal damage and reduced renal blood flow induced by Cis. In conclusion this study shows that levosimendan has a partial protective effect on Cis-induced nephrotoxicity. The protective effect of levosimendan is shown to be related to its anti-inflammatory, antioxidant and vasodilator effects. Keywords: Cisplatin, Levosimendan, Nephrotoxicity, Inodilator, Anti-inflammatory

Bioethanol-derived biomass is a green sustainable source of energy that is highly recommended as an efficient alternative to the replacement of fossil fuels. However, this type of bioethanol production is always expensive with very low bioethanol concentration. Therefore, this work aims to represent a facile and green approach for bioethanol production with high concentration and purity as well as reasonable cost from corn stover (CS). The goal of this study is to characterize CS and its treated samples with maleic acid (CSM) using various characterization analyses, such as proximate and ultimate analysis, HHV, TGA, FTIR, SEM, and CHNS. The bioethanol production stages: Pretreatment, enzymatic degradation, fermentation, and finally bioethanol separation and purification via the pervaporation process, which have been investigated and optimized are associated with the economic analysis. The optimum operating condition of the pretreatment process was 2% maleic acid, 1:20 solid-to-liquid ratio at 45 psi, 120 °C, and 1 h of operation in the autoclave. This process contributes to 53 and 45% lignin and hemicellulose removal, 98% cellulose recovery, and a glucose yield of 741 mg/dL. The yeast isolate succeeded in the production of 1230 mg/dL of bioethanol. This isolated yeast strain was close to Pichia nakasei with a similarity of 98%, and its amplified 18S rRNA gene sequence was deposited in GenBank with the accession number MZ675535. Poly (MMA-co-MA) membrane was synthesized, characterized, and its efficiency for increasing the bioethanol concentration was evaluated using the integrated pervaporation technique. The techno-economic analysis is presented in detail to evaluate the process profitability, which achieves a considerable profit for the whole duration of the project without any losses as it reaches a net profit of USD 1 million in 2023, reaching USD 2.1 million in 2047 for a company with a capacity of 32 thousand tons per year. The sequential strategy offers a promising approach for efficient bioethanol production under mild and environmentally friendly conditions that enable its implication industrially.

Several processes studied by the ATLAS experiment at the Large Hadron Collider produce low-momentum b-flavored hadrons in the final state. This paper describes the calibration of a dedicated tagging algorithm that identifies b-flavored hadrons outside of hadronic jets by reconstructing the soft secondary vertices originating from their decays. The calibration is based on a proton-proton collision dataset at a center-of-mass energy of 13 TeV corresponding to an integrated luminosity of 140  fb−1. Scale factors used to correct the algorithm’s performance in simulated events are extracted for the b-tagging efficiency and the mistag rate of the algorithm using a data sample enriched in tt¯ events. Several orthogonal measurement regions are defined, binned as a function of the multiplicities of soft secondary vertices and jets containing a b-flavored hadron in the event. The mistag rate scale factors are estimated separately for events with low and high average numbers of interactions per bunch crossing. The results, which are derived from events with low missing transverse momentum, are successfully validated in a phase space characterized by high missing transverse momentum and therefore are applicable to new physics searches carried out in either phase space regime. © 2024 CERN, for the ATLAS Collaboration 2024 CERN

A search for the nonresonant production of Higgs boson pairs in the HH→bb¯τ+τ− channel is performed using 140  fb−1 of proton-proton collisions at a center-of-mass energy of 13 TeV recorded by the ATLAS detector at the CERN Large Hadron Collider. The analysis strategy is optimized to probe anomalous values of the Higgs boson self-coupling modifier κλ and of the quartic HHVV (V=W,Z) coupling modifier κ2V. No significant excess above the expected background from Standard Model processes is observed. An observed (expected) upper limit μHH

Abstract: The identification of top quark decays where the top quark has a large momentum transverse to the beam axis, known as top tagging, is a crucial component in many measurements of Standard Model processes and searches for beyond the Standard Model physics at the Large Hadron Collider.Machine learning techniques have improved the performance of top tagging algorithms, but the size of the systematic uncertainties for all proposed algorithms has not been systematically studied.This paper presents the performance of several machine learning based top tagging algorithms on a dataset constructed from simulated proton-proton collision events measured with the ATLAS detector at √ s = 13 TeV.The systematic uncertainties associated with these algorithms are estimated through an approximate procedure that is not meant to be used in a physics analysis, but is appropriate for the level of precision required for this study.The most performant algorithms are found to have the largest uncertainties, motivating the development of methods to reduce these uncertainties without compromising performance.To enable such efforts in the wider scientific community, the datasets used in this paper are made publicly available.

A search for leptoquark pair production decaying into te-t¯e+ or tμ-t¯μ+ in final states with multiple leptons is presented. The search is based on a dataset of pp collisions at s=13TeV recorded with the ATLAS detector during Run 2 of the Large Hadron Collider, corresponding to an integrated luminosity of 139 fb-1. Four signal regions, with the requirement of at least three light leptons (electron or muon) and at least two jets out of which at least one jet is identified as coming from a b-hadron, are considered based on the number of leptons of a given flavour. The main background processes are estimated using dedicated control regions in a simultaneous fit with the signal regions to data. No excess above the Standard Model background prediction is observed and 95% confidence level limits on the production cross section times branching ratio are derived as a function of the leptoquark mass. Under the assumption of exclusive decays into te- (tμ-), the corresponding lower limit on the scalar mixed-generation leptoquark mass mLQmixd is at 1.58 (1.59) TeV and on the vector leptoquark mass mU~1 at 1.67 (1.67) TeV in the minimal coupling scenario and at 1.95 (1.95) TeV in the Yang–Mills scenario.

A search is performed for localized excesses in the low-mass dijet invariant mass distribution, targeting a hypothetical new particle decaying into two jets and produced in association with either a high transverse momentum photon or a jet. The search uses the full Run 2 data sample from LHC proton-proton collisions collected by the ATLAS experiment at a center-of-mass energy of 13 TeV during 2015–2018. Two variants of the search are presented for each type of initial-state radiation: one that makes no jet flavor requirements and one that requires both of the jets to have been identified as containing b-hadrons. No excess is observed relative to the Standard Model prediction, and the data are used to set upper limits on the production cross section for a benchmark Z′ model and, separately, for generic, beyond the Standard Model scenarios which might produce a Gaussian-shaped contribution to dijet invariant mass distributions. The results extend the current constraints on dijet resonances to the mass range between 200 and 650 GeV. © 2024 CERN, for the ATLAS Collaboration 2024 CERN

A measurement of the Standard Model Higgs boson produced in association with a W or Z boson and decaying into a pair of τ-leptons is presented. This search is based on proton-proton collision data collected at s=13 TeV by the ATLAS experiment at the LHC corresponding to an integrated luminosity of 140 fb−1. For the Higgs boson candidate, only final states with at least one τ-lepton decaying hadronically (τ→hadrons+ντ) are considered. For the vector bosons, only leptonic decay channels are considered: Z→ℓℓ and W→ℓνℓ, with ℓ=e,μ. An excess of events over the expected background is found with an observed (expected) significance of 4.2 (3.6) standard deviations, providing evidence of the Higgs boson produced in association with a vector boson and decaying into a pair of τ-leptons. The ratio of the measured cross-section to the Standard Model prediction is μVHττ=1.28−0.29+0.30(stat.)−0.21+0.25(syst.). This result represents the most accurate measurement of the VH(ττ) process achieved to date.