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Treatment of the terrible triad injury of the elbow remains a difficult problem. There are several ways to treat the radial head and coronoid fractures; controversy still exists regarding the best way to treat each. The purpose of this meta-analysis was to compare the clinical outcomes of radial head and coronoid fractures treated using current protocols. No differences in functional outcomes were found between the different surgical techniques. There is no superior current protocol for treating these injuries. Surgical treatment should be dictated by fracture type and surgeon experience. [ Orthopedics . 2020;43(6):328–332.]

Regardless of the existing governmental and public preventive actions for surveillance and controlling the air quality in several regions of the Chennai city in India, the air quality does not meet the desired standard. In this regard, this study employs an ARMA/ARIMA modelling approach for forecasting Respirable Suspended Particulate Matter (RSPM), Sulphur dioxide (SO 2 ) and Nitrogen dioxide (NO 2 ) concentration for three most polluted sites in Chennai city. A total of nine univariate linear stochastic models have been developed, three for each of the stations which includes one for each of the specific pollutants in order to forecasts the concentration of each pollutant. The evaluation of the model statistics R 2 values and index of agreement values evince that a significant level of real-time forecasting of the pollutants can be achieved by employing the developed ARMA/ARIMA models. Moreover, the comparisons of actual air pollutant concentration have been carried out with the permissible limit as prescribed by the National ambient air quality standards (NAAQS) of India for assessing the level of pollution of all three locations.

The genetics of late-onset Alzheimer's disease (AD) is complex due to the heterogeneous nature of the disorder. APOE*4 is the strongest genetic risk factor for AD. Genome-wide association studies have identified more than 30 additional loci, each having relatively small effect size. Known AD loci explain only about 30% of the genetic variance, and thus much of the genetic variance remains unexplained. To identify some of the missing heritability of AD, we analyzed whole-exome sequencing (WES) data focusing on non-APOE*4 carriers from two WES datasets: 720 cases and controls from the University of Pittsburgh and 7,252 cases and controls from the Alzheimer's Disease Sequencing Project. Following separate WES analyses in each dataset, we performed meta-analysis for overlapping markers present in both datasets. Among the four variants reaching the exome-wide significance threshold, three were from known AD loci: APOE/rs7412 (odds ratio (OR) = 0.40; p = 5.46E-24), TOMM40/rs157581 (OR = 1.49; p = 4.04E-07), and TREM2/rs75932628 (OR = 4.00; p = 1.15E-07). The fourth significant variant, rs199533, was from a novel locus on chromosome 17 in the NSF gene (OR = 0.78; p = 2.88E-07). NSF was also significant in the gene-based analysis (p = 1.20E-05). In the GTEx data, NSF/rs199533 is a cis-eQTL for multiple genes in the brain and blood, including NSF that is highly expressed across all brain tissues, including regions that typically show amyloid-β accumulation. Further characterization of genes that are affected by NSF/rs199533 may help to shed light on the roles of these genes in AD etiology.

Graphene is a potential reinforcing material for polymeric materials due to high aspect ratio, surface area and electrical and mechanical properties. In this work, thermally reduced graphene oxide (TRGO)/acrylonitrile butadiene styrene (ABS) composites were developed using combined solution mixing and melt mixing techniques. The effect of wt% of pristine graphite and TRGO on the mechanical and thermal properties of composites was studied. Graphene oxide (GO) was prepared from graphite powder using improved Hummers’ method followed by thermal reduction to obtain TRGO. Characterization of GO, TRGO and as-developed ABS composites was performed using Fourier transmission infrared spectroscopy, scanning electron microscopy, atomic force microscopy, differential scanning calorimetry and thermogravimetric analysis. Tensile properties were determined by testing injection-molded dumbbell-shaped samples. The results showed that tensile properties of TRGO/ABS composites increased significantly at 0.2 wt% loading compared to corresponding graphite/ABS composites. However, increased content of both fillers decreased mechanical properties of the composites. TRGO, at 0.2 wt% loading, increased glass transition temperature of ABS by ca.7 °C. TRGO neither increased nor decreased thermal stability of ABS composites. This study showed that combined solution and melt mixing technique can significantly improve dispersion of TRGO in ABS matrix.

Boron nitride nanosheets (BNNS) with thickness 5–11 nm were successfully produced when pure boron powder (1–2 μm) interacted with ammonia gas in chemical vapour deposition set up. Under the optimized parameters, at 1200 °C and for uninterrupted 1 h of reaction duration, 2D BNNS with thickness of ca.11 nm were synthesized. BNNS were characterized by X-ray diffraction (XRD) for crystal structure, scanning electron microscopy for dimensions and morphology, energy dispersive X-ray analysis for chemical composition and Fourier transform infrared spectroscopy for sp2 BN bond detection. The thickness of BNNS determined from both XRD data (using Scherrer equation) and atomic force microscopic analysis confirmed the stated product thickness. The BNNS obtained at 1200 °C had high crystallinity, purity and yield.

The purpose of this study are 1) To find out the Islamic guidance method in shaping children's morals at the Al-Hakim Paya Kulbi orphanage in Aceh Tamiang District, 2) to find out the implications of Islamic guidance in shaping children's morals at the Al-Hakim Paya Kulbi in Aceh Tamiang District. This type of research is field research. This is a qualitative descriptive study conducted directly on the object under study to obtain the data needed, meaning that the individual researchers talk and directly observe the people being examined using the method of observation, interviews, and documentation. As the findings of the data obtained by researchers from primary data sources, namely orphanage children and administrators/educators of the orphanage. The results showed that the Islamic guidance method in shaping the character of children in the al-Hakim Paya Kulbi orphanage in Aceh Tamiang Regency is by using; 1) exemplary methods; 2) habituation methods; and 3) lecture methods. Furthermore, the implications of Islamic guidance in shaping the morals of children in the al-Hakim Paya Kulbi orphanage in Aceh Tamiang Regency are the formation of good behavior in the orphans, increased religious practices (praying, reciting in daily life, increasing the craft of orphans, and the formation of independence in the orphanage self orphanage.

The demand for telemedicine has been increasing over the past several years with the growth of technology and digital connectivity in our daily lives. With the impact of the global coronavirus disease 2019 pandemic, telemedicine implementation has become a necessity for many specialties because social distancing measures have greatly affected access to routine medical care. This article presents a detailed and systematic approach to conducting a hand physical examination during a video telemedicine encounter. Although the telemedicine physical examination has limitations, most components of the normal physical examination can be completed remotely with a systematic approach. We enumerate modifications to maximize examination remotely and present considerations for improved delivery of telemedicine care. These methods may be beneficial to providers incorporating telemedicine into their practice.

Background: Scapholunate (SL) ligament injuries can occur concomitantly with distal radius fractures (DRFs), and the management of acute SL injury in the setting of DRFs remains controversial. The purpose of the study is to identify the radiographic incidence of SL widening in DRF treated with volar plate fixation and to determine the functional outcomes of DRF with concomitant radiographic SL-widening. Methods: One hundred and seventeen patients with DRFs, with and without radiographic SL-widening, and treated with volar locked plating, were prospectively enrolled. No SL ligament repairs or reconstructions were performed in any cases. Patients with DRFs with radiographic criteria for SL widening were compared to those without. Patients were evaluated at 3 months and 1 year postoperatively with Quick Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation (PRWE) questionnaires. Results: Thirty-one patients (26.5%) were found to have radiographic evidence of SL widening. Patients with concomitant SL widening had less wrist extension at 3 months (52.4 degrees vs 60.8, P = .034) and at 1 year (64.5 degrees vs 71.8, P = .023). The group with SL widening had greater articular step off at 3 months (0.33 vs 0.06, P = .042), but no difference at 1 year (0.11 vs 0.05, P = .348). There were no differences in wrist flexion, supination, pronation, volar tilt, radial inclination, radial height, ulnar variance, PRWE scores, and Quick Dash scores at 3 months and 1 year. Conclusions: Radiographic SL-widening is a common finding associated with DRFs undergoing surgical repair. There are similar clinical outcomes between those with untreated SL widening compared to those without an SL widening at 1-year postoperatively.

Background: To determine the prevalence of prosthetic joint infections (PJIs) after elective clean hand surgery in order to determine whether prophylactic antibiotics are warranted in patients who have previously undergone total joint arthroplasty (TJA). Methods: All patients undergoing elective clean hand surgery between 2012 and 2018 were retrospectively cross-referenced with patients who had previously undergone a TJA at the same urban academic medical center. Inclusion criteria were any patients who underwent clean hand surgery during the study period who were an adult between the ages of 30 and 90, had a previous TJA, and did not have a previous history of a PJI. All charts were reviewed to collect data on patient demographics, co-morbidities, the type of TJA and hand surgery performed, whether prophylactic antibiotics were used prior to the hand surgery, and whether a PJI occurred within 3 months of the hand surgery. Results: Total of 331 patients (181 females and 150 males) were identified over the 6-year period that met inclusion criteria. In total, 13% of the patients received prophylactic antibiotics prior to their hand surgery and 87% had not. Only 1 case of a PJI occurred within 3 months of a hand surgery. No relationship was identified between the PJI and the hand surgery, nor the need for preoperative antibiotic prophylaxis. Conclusions: Incidence of PJI after clean hand surgery is very low. We do not recommend the routine use of antibiotic prophylaxis in patients undergoing clean elective hand surgery with a history of prior TJA in order to prophylax against a PJI.

Background: Rates of opioid addiction and overdose continue to climb in the United States, increasing pressure on prescribers to identify solutions to decrease postoperative opioid consumption. Hand and upper extremity surgeries are high-volume surgeries with a predilection for inadvertent overprescribing. Recent investigations have shown that preoperative opioid counseling may decrease postoperative opioid consumption. In order to test this hypothesis, a prospective randomized trial was undertaken to determine the effect of preoperative opioid counseling on postoperative opioid consumption. Methods: Eligible patients undergoing outpatient upper extremity surgery were randomized to either receive preoperative opioid counseling or to receive no counseling. Surgeons were blinded to their patient’s counseling status. Preoperatively, patient demographics, surgical and prescription details were recorded. Postoperatively, patients’ pain experience including opioid consumption, pain levels, and satisfaction was recorded. Results: There were 131 total patients enrolled, with 62 in the counseling group and 69 in the control group. Patients receiving counseling consumed 11.8 pills compared to 17.4 pills in the control group ( P = .007), which translated to 93.7 Morphine Equivalent Units (MEU) in the counseling group compared to 143.2 MEU in the control group ( P = .01). There was no difference in pain scores at any time point between groups. Among all study patients a total of 3767 opioid pills were prescribed with approximately 50% left unused. Conclusion: Patients receiving preoperative counseling consumed significantly fewer opioids postoperatively. Inadvertant overprescribing remains high. Routine use of preoperative counseling should be implemented along with prescribing fewer opioids overall to prevent overprescribing.

This paper explores spherically symmetrical dynamical traversable wormhole solutions for an anisotropic fluid configuration in the context of f(R) gravity. We construct the corresponding field equations and investigate the wormhole solutions by specifying the redshift and shape functions for three models of f(R) gravity. Graphical analysis shows that ordinary matter satisfies the null as well as weak energy conditions against the time and radial coordinates for each model. It is concluded that dynamical traversable wormholes are supported by this theory.

Hidradenitis Suppurativa (HS) is a relatively common chronic debilitating skin condition characterized by recurrent abscesses and sinuses formation on apocrine sweat glands bearing areas. Although immune modulating therapies have been popular lately but definitive surgery with wide excision and reconstruction can provide permanent cure for the involved areas. Here we are reporting an unfortunate case of a 47 years old male who has been suffering from HS in the buttocks and perineum since adolescence. Patient was first seen 8 years back and he was advised to consider wide surgical excision and skin grafting. Patient did not accept this solution and kept undergoing alternative treatments with prolonged courses of antibiotics as well as steroids. Eventually he presented with fungating areas in the gluteal region which proved to be moderately differentiated squamous cell carcinoma (SCC). Sacrum was already invaded with the disease and has metastasized to regional lymph nodes, liver and lungs. Patient was treated as palliative including conservative surgical debulking and skin grafts. He received further oncologic treatment in a different center overseas. Unfortunately developed brain metastasis and expired two years following diagnosis of Marjolin’s ulcer (MU). Patients with chronic HS, recurrant infections and sinuses must be encouraged to seriously consider definitive surgical treatment to eliminate the risk of such long term fatal complication of their disease.

Introduction Radial nerve palsies with humeral shaft fractures have historically been treated with expectant management. A previous systematic review by Shao et al, based on studies published from 1964 to 2004, purported no difference in the rate of recovery between patients treated with early surgical intervention versus expectant treatment. However, the authors combined expectant treatment to include patients treated nonsurgically and those with delayed surgery. To better understand the effect of surgery and its timing on radial nerve recovery, an updated analysis was performed with stricter treatment definitions. Methods An updated systematic review of the published literature was undertaken. An electronic database search was performed to identify publications that met specific inclusion criteria. A total of 23 articles published since 2000 met our eligibility requirements. Data were abstracted from these articles and analyzed in conjunction with the results of the systematic review by Shao et al. RESULTS:: The overall prevalence of radial nerve palsy was 12.3% (890/7,262). Patients with radial nerve palsy treated nonsurgically had a rate of spontaneous radial nerve recovery of 77.2%. Patients who failed nonsurgical management and underwent nerve exploration more than 8 weeks after their injury had a rate of recovery of 68.1%. Patients treated with early (within 3 weeks of the injury) surgical exploration and fracture repair had a rate of recovery of 89.8%. Discussion From the published data from 1964 to 2017, patients who underwent surgical exploration within 3 weeks of injury had a significantly higher likelihood of regaining radial nerve function than patients who underwent nonsurgical management with or without late surgical exploration.

Background: Surgical treatment of basal joint arthritis commonly consists of trapeziectomy followed by various suspensionplasty techniques to provide stability to the thumb ray. Our study goal was to assess the motion and stability of the thumb ray after trapeziectomy and placement of a suture button (Mini TightRope®, Arthrex, Naples, Florida) in a high- or low-angle trajectory. We hypothesized that a low-angle trajectory would yield the greatest stability while providing maximal motion of the thumb. Methods: Eleven fresh-frozen cadaver arms were imaged fluoroscopically in anterior-posterior and lateral views before and after trapeziectomy, and after placement of low- and high-angle suture buttons. The intermetacarpal angle between the thumb and index metacarpals was measured after application of a standard force. Radial abduction, opposition, subsidence, palmar abduction, adduction, and subsidence were measured. Results: Compared to posttrapeziectomy constructs, low- and high-angle TightRope constructs demonstrated less subsidence, low-angle TightRopes had less palmar abduction, and high-angle TightRope constructs had less radial abduction and adduction. High-angle TightRopes allowed more palmar abduction than low-angle constructs. The high-angle TightRopes trended toward more subsidence than low-angle constructs, although it was not significant. Conclusions: Both TightRope constructs provided improved axial stability after trapeziectomy while not excessively limiting any one motion of the thumb. Compared to the high-angle trajectory, the low-angle TightRope placement provided a more stable construct with respect to subsidence and angular motion. Given the concern for excessive motion of the first metacarpal base with the high-angle construct, we recommend a low-angle trajectory TightRope placement.

Metode muraja’ah merupakan suatu cara yang dipergunakan untuk mencapai tujuan yang telah ditetapkan dengan cara mengulang kembali hafalan yang sudah pernah dihafalkan untuk menjaga dari lupa dan salah. Kegiatan mengulang hapalan sangat penting dalam menjaga hapalan agar tidak mudah hilang dan terlepas karena lupa, sifat lupa adalah sesuatu yang wajar pada diri manusia. Maka disinilah perlunya muraja’ah dalam menjaga hafalan al-qur’an. setiap orang yang menghafal Al-Qur’an sebenarnya tahu betul bahwa jika dia tidak me-muraja’ah secara terus-menerus maka hafalannya akan hilang. Perlu disadari bahwa Al-Qur’an dengan me-muraja’ahnya adalah sebagai penjaga keamanan dalam perjalanan yang sangat sangat menolong seseorang dalam melakukan muraja’ah secara efisien dengan izin Allah Swt. Rumusan masalah yaitu; apa kiat–kiat mudah menjaga hafalan al-Qur’an, metode muraja’ah, macam-macam muraja’ah dalam hafalan al-Qur’an, teknik ber-muraja’ah al-Qur’an, langkah-langkah muraja’ah hafalan al-Qur’an, tips muraja’ah (Mengulang).

Purpose: Thumb basal joint arthritis is a common degenerative condition of the hand that is often managed with thumb basal joint arthroplasty (BJA). This procedure generally results in a high level of patient satisfaction; however, the rate and cause of early unplanned reoperation after thumb BJA are not well-understood. Therefore, we performed a review to better understand the rate and cause of early reoperation. Methods: A retrospective review of all thumb BJA cases performed at a single private academic center between 2014 and 2016 yielded 637 patients and 686 primary thumb BJAs with a minimum 1-year follow-up (mean, 2.4 years). Data collection included patient demographics, surgical technique and type of thumb BJA performed, time to reoperation, reason for early reoperation (within 2 years), and type of reoperation. Results: Of 686 patients undergoing thumb BJAs, 10 had unplanned early reoperation (1.5%). Mean duration between the index procedure and reoperation was 5.2 months (range, 0.5–14.3 months). Of the 10 unplanned early reoperations, 4 thumbs in 4 patients required revision arthroplasties owing to persistent pain. Time to reoperation for revision arthroplasty was 9.6 months (range, 3.9–14.3 months). Three of 10 reoperations resulted from early infection, 2 from unplanned early removal of symptomatic K-wires, and one from radial sensory neuritis. Conclusions: In this series of nearly 700 consecutive cases, we identified an unexpected early reoperation rate of 1.5%, with only a 0.6% reoperation rate specifically for painful subsidence requiring a revision arthroplasty. Mean time to revision was 9.6 months. These rates are lower than those published previously and should be considered by patients and surgeons when planning thumb BJA. Type of study/level of evidence: Prognostic IV. Key words: Basal joint arthroplasty, Reoperation, Revision, Thumb, Trapeziometacarpal arthritis

Important insights into the early pathogenesis of Alzheimer's disease can be provided by studies of autosomal dominant Alzheimer's disease and Down syndrome. However, it is unclear whether the timing and spatial distribution of amyloid accumulation differs between people with autosomal dominant Alzheimer's disease and those with Down syndrome. We aimed to directly compare amyloid changes between these two groups of people.In this cross-sectional study, we included participants (aged ≥25 years) with Down syndrome and sibling controls who had MRI and amyloid PET scans in the first data release (January, 2020) of the Alzheimer's Biomarker Consortium-Down Syndrome (ABC-DS) study. We also included carriers of autosomal dominant Alzheimer's disease genetic mutations and non-carrier familial controls who were within a similar age range to ABC-DS participants (25-73 years) and had MRI and amyloid PET scans at the time of a data freeze (December, 2020) of the Dominantly Inherited Alzheimer Network (DIAN) study. Controls from the two studies were combined into a single group. All DIAN study participants had genetic testing to determine PSEN1, PSEN2, or APP mutation status. APOE genotype was determined from blood samples. CSF samples were collected in a subset of ABC-DS and DIAN participants and the ratio of amyloid β42 (Aβ42) to Aβ40 (Aβ42/40) was measured to evaluate its Spearman's correlation with amyloid PET. Global PET amyloid burden was compared with regards to cognitive status, APOE ɛ4 status, sex, age, and estimated years to symptom onset. We further analysed amyloid PET deposition by autosomal dominant mutation type. We also assessed regional patterns of amyloid accumulation by estimated number of years to symptom onset. Within a subset of participants the relationship between amyloid PET and CSF Aβ42/40 was evaluated.192 individuals with Down syndrome and 33 sibling controls from the ABC-DS study and 265 carriers of autosomal dominant Alzheimer's disease mutations and 169 non-carrier familial controls from the DIAN study were included in our analyses. PET amyloid centiloid and CSF Aβ42/40 were negatively correlated in carriers of autosomal dominant Alzheimer's disease mutations (n=216; r=-0·565; p0·0001) and in people with Down syndrome (n=32; r=-0·801; p0·0001). There was no difference in global PET amyloid burden between asymptomatic people with Down syndrome (mean 18·80 centiloids [SD 28·33]) versus asymptomatic mutation carriers (24·61 centiloids [30·27]; p=0·11) and between symptomatic people with Down syndrome (77·25 centiloids [41·76]) versus symptomatic mutation carriers (69·15 centiloids [51·10]; p=0·34). APOE ɛ4 status and sex had no effect on global amyloid PET deposition. Amyloid deposition was elevated significantly earlier in mutation carriers than in participants with Down syndrome (estimated years to symptom onset -23·0 vs -17·5; p=0·0002). PSEN1 mutations primarily drove this difference. Early amyloid accumulation occurred in striatal and cortical regions for both mutation carriers (n=265) and people with Down syndrome (n=128). Although mutation carriers had widespread amyloid accumulation in all cortical regions, the medial occipital regions were spared in people with Down syndrome.Despite minor differences, amyloid PET changes were similar between people with autosomal dominant Alzheimer's disease versus Down syndrome and strongly supported early amyloid dysregulation in individuals with Down syndrome. Individuals with Down syndrome aged at least 35 years might benefit from early intervention and warrant future inclusion in clinical trials, particularly given the relatively high incidence of Down syndrome.The National Institute on Aging, Riney and Brennan Funds, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the German Center for Neurodegenerative Diseases, and the Japan Agency for Medical Research and Development.

In this paper, we employed a hyperbolic viable model in the [Formula: see text] gravity to inspect the presence of wormhole geometries combined with the configurations of relativistic matter. In this regard, the static form of spherically symmetric spacetime was taken into account and the validity of energy conditions was verified by considering a particular form of matter and a combination of shape functions. The equilibrium background of wormhole models was analyzed by using the concept of an anisotropic fluid and explored our findings graphically. These nonstandard astrophysical wormhole models were further supported by the gravitational entity resulting from the [Formula: see text] gravity in the form of extra-curvature quantities. Furthermore, in the presence of an anisotropic fluid and [Formula: see text] gravity, it was demonstrated that the wormhole models might actually exist in a couple of zones in the parameter space without the requirement of exotic matter.

Fractures of the distal radius are common injuries, with an annual incidence of 27 per 10,000 per year. As many as two-thirds of these fractures are displaced, necessitating reduction to restore wrist function and avoid neurovascular compromise. When adequate reduction cannot be achieved by closed reduction alone, closed reduction and percutaneous pinning versus open reduction and internal fixation is considered. Here we present the case of a middle aged female presenting with a dorsally displaced and angulated fracture of the distal radius after a fall on the outstretched hand. The fracture was treated by open reduction and internal fixation with a volar locking plate. We outline the natural history, preoperative care, intraoperative technique, and postoperative considerations of distal radial fractures.

Background Osteoarthritis (OA) can result in significant pain, requiring pain management with opioids. Medical cannabis (MC) has the potential to be an alternative to opioids for chronic pain conditions. This study investigates whether MC used in the management of OA-related chronic pain can reduce opioid utilization. Methods Forty patients with chronic OA pain were certified for MC. Average morphine milligram equivalents (MME) per day of opioid prescriptions filled within the six months prior to MC certification was compared to that of the six months after. Visual analog scale (VAS) for pain and Global Health scores were measured at baseline, three, and six months post MC certification. Results Average MME/day decreased from 18.2 to 9.8 (n=40, p0.05). The percentage of patients who dropped to 0 MME/day was 37.5%. VAS scores decreased significantly at three and six months, and Global Physical Health score increased significantly by three months. Conclusions MC reduces opioid prescription for patients with chronic OA pain and improves pain and quality of life.

We assessed the rate of periprosthetic joint infection (PJI) following hand surgery in patients with prosthetic joints, and determined the efficacy of prophylactic antibiotics for preventing PJI in this patient subset.A systematic review of PubMed (MEDLINE) and Scopus (EMBASE, MEDLINE, COMPENDEX) from 1968 to 2021 was conducted. Primary articles that studied PJIs following hand surgery in patients with prosthetic joints (hip, knee, shoulder, elbow, or ankle) and/or the use of prophylactic antibiotics prior to hand surgery in patients with prosthetic joints were included.A total of 3 studies (439,080 patients) met our inclusion criteria. Of the total study population, 9,070 patients (2.1%) had a prior total joint arthroplasty treated and subsequently underwent soft-tissue hand surgery. A single study reported a 0.2% prevalence of PJI secondary to hand surgery. The remaining 2 studies found no cases of PJI following hand surgery in patients with a history of total joint arthroplasty. On average, 16% (1,214 of 7,374) of patients with prosthetic joints received antibiotics prior to hand surgery. No significant relationships were found between hand surgery, antibiotic prophylaxis, and PJI risks.There is a very low reported incidence of PJI following hand surgery in patients with existing prosthetic joints, with or without the use of prophylactic antibiotics. Therefore, the authors do not recommend the routine use of prophylactic antibiotics in this patient subgroup. The decision to use prophylaxis should be made on a case-by-case basis, accounting for patient-specific comorbidities and risk factors. Further research on hand surgery-associated PJI is warranted.Therapeutic III.

In this paper, we consider the flat Friedmann Lematre Robertson-Walke metric in the presence of perfect fluid models and extended $f(R,G,T)$ gravity (where $R$ is the Ricci scalar, $G$ is the Gauss Bonnet invariant and $T$ stands for trace of energy momentum tensor). In this context, we assume some specific realistic $f(R,G,T)$ models configuration that could be used to explore the finite-time future singularities that arise in late-time cosmic accelerating phases. In this scenario, we choose the most recent estimated values for the Hubble, deceleration, snap and jerk parameters to develop the viability and bounds on the models parameters induced by different energy conditions., Comment: texts modified, typos corrected, version accepted for publication/published in Physica Scripta

Background: Alzheimer’s disease (AD) is a complex disease influenced by the environment and genetics; however, much of the genetic component remains unaccounted for. Objective: The purpose of this work was to use genome-wide association analyses to detect genetic associations with incident AD in a sample of older adults aged 75 and above. Methods: We performed a genome-wide association study (GWAS) on genome-wide genotyped and imputed data (14,072,053 variants) on the Gingko Evaluation of Memory (GEM) study sample consisting of 424 incident dementia (mean age = 84.46±3.91) and 2,206 non-demented (mean age = 84.55±3.23) subjects. Results: The established association of APOE*4 carriers with AD was confirmed in this community-based sample of older subjects (odds ratio (OR) = 2.22; p = 9.36E-14) and was stronger in females (OR = 2.72; p = 1.74E-10) than in males (OR = 1.88; p = 2.43E-05). We observed a novel genome-wide significant (GWS) locus on chromosome 12 near ncRNA LOC105369711/rs148377161 (OR = 3.31; p = 1.66E-08). In addition, sex-stratified analyses identified two novel associations in males: one near ncRNA LOC729987/rs140076909 on chromosome 1 (OR = 4.51; p = 3.72E-08) and the other approaching GWS near ncRNA LOC105375138/rs117803234 on chromosome 7 (OR = 3.76; p = 6.93E-08). Conclusion: The use of community-based samples of older individuals and incident dementia as a phenotype may be a helpful approach for the identification of novel genes for AD, which may not be detected in standard case-control studies. Replication of these signals and further studies of these regions and genes will help to provide a clearer picture for their role in AD.

One of the possible potential candidates for describing the universe's rapid expansion is modified gravity. In the framework of the modified theory of gravity $f(R,G)$, the present work features the materialization of anisotropic matter, such as compact stars. Specifically, to learn more about the physical behavior of compact stars, the radial, and tangential pressures as well as the energy density of six stars namely $Her X-1$, $SAXJ1808.4-3658$, $4U1820-30$, $PSR J 1614 2230$, $VELA X-1$, and $Cen X-3$ are calculated. Herein, the modified theory of gravity $f(R,G)$ is disintegrated into two parts i.e. the $\tanh$ hyperbolic $f(R)$ model and the three different $f(G)$ model. The study focuses on graphical analysis of compact stars wherein the stability aspects, energy conditions, and anisotropic measurements are mainly addressed. Our calculation revealed that, for the positive value of parameter n of the model $f(G)$, all the six stars behave normally., Comment: Some changes have been made. " To appear in International Journal of Geometric Methods in Modern Physics"

Infeksi corona virus merupakan penyakit yang disebabkan oleh virus corona dan menimbulkan gejala utama berupa gangguan pernapasan. Penyakit ini menjadi sorotan karena kemunculannya di akhir taun 2019 pertama kali di wuhan, china. Penyebab corona virus merupakan virus single stranded RNA yang berasal dari kelompok corona viridae. Dinamakan corona virus karena permukaannya yang berbentuk seperti mahkota. Virus lain yang termasuk dalam kelompok yang serupa adalah virus yang menyebabkan Middle East Respiratory Syndrome (MERS-Cov) dan Severe Acute Respiratory Syndrome (SARS-Cov) beberapa tahun silam. Namun virus corona wuhan ini merupakan virus baru yang belum pernah teridentifikasi pada manusia sebelumnya. Karena itu, virus ini juga disebut sebagai 2019 Novel Corona Virus atau Covid-19. Salah satu hal yang dapat mencegah penyebaran Virus Covid-19 ini adalah dengan melakukan penanganan Virus Covid-19. Sebagai upaya penanganan Covid-19 di tingkat mikro Satuan Tugas (Satgas) Covid-19 melalui Surat Edaran nomor 9 tahun 2021 memaparkan tentang langkah dan unsur pembentukan Posko Covid-19 Desa/Kelurahan. Posko Covid-19 Desa/Kelurahan sendiri adalah tempat dan perangkat pelaksana sebagai pusat perencanaan, koordinasi, pengendalian dan evaluasi kegiatan penanganan Covid-19 di suatu wilayah desa/kelurahan melalui fungsi pencegahan, fungsi penanganan, fungsi pembinaan, dan fungsi pendukung. Pembentukan Posko Covid-19 di Desa Kalimporo dilakukan berdasarkan inisiatif kepala desa Kalimporo. Maka dari itu, kami dari mahasiswa KKN PPL-Reguler Angkatan XXII Universitas Negeri Makassar, turut membantu dalam pembuatan posko penanganan Covid-19 di Desa Kalimporo Kecamatan Bangkala Kabupaten Jeneponto.

BACKGROUND: Dementia is multifactorial with Alzheimer (AD) and vascular (VaD) pathologies making the largest contributions. There have been over 40 genetic loci associated with AD but genome-wide associations (GWA) underlying VaD remain incompletely identified. The proportion of VaD differs across studies based on study-specific definitions. We hypothesize that common forms of dementia (AD, VaD) will share genetic risk factors. We conducted the largest GWAS to date of VaD and examined the genetic overlap with "all-cause dementia" (ACD). METHOD: A total of 293,544 participants from 9 population-based CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology) cohorts, 2 national case-control consortia (ADGC, MEMENTO) and the UKBB contributed 23,986 and 2,935 cases of ACD and VaD, respectively. We ran study-specific analyses adjusting for age, sex, and population structure and meta-analyzed summary statistics using the sample size weighted method implemented in METAL, followed by conditional analyses, fine-mapping and bioinformatic exploration of loci. RESULT: Genome-wide associations with VaD were identified at the APOE locus and at 5 additional loci. One locus has been previously associated with hippocampal volume, verbal memory and CSF amyloid levels (ASTN2); others were near genes associated with hypertension, diabetes and hyperlipidemia (Figures 1 and 2). In addition to previously identified AD loci, we identified novel variants associated with ACD. VaD-related loci also showed sub-threshold associations with ACD that were congruent in direction of effect, thus suggesting additional biological targets underlying ACD. We will additionally present results of an ongoing multiethnic GWAS and insights from pathway analyses and bioinformatic parsing of the identified loci. CONCLUSION: Although VaD is the second most common cause of dementia, the identification of associated genetic loci has been hindered by the heterogeneity of its definition, which necessitates a large sample size to reach genome-wide significance. The newly identified loci could provide novel insights into the pathophysiological mechanisms of dementia and point to new prevention and treatment strategies.

Ulnar collateral ligament (UCL) injuries of the thumb are among the most common injuries of the hand. Whether the injury is acute or chronic, a complete rupture of the ligament is usually managed with operative repair to restore thumb stability with pinch and grip, as well as to avoid arthritic changes. Here we present a patient who underwent UCL repair. We will discuss the natural history, preoperative care, intraoperative technique, and postoperative considerations.

Alzheimer’s disease (AD) is a complex and multifactorial neurodegenerative disease. Due to its long clinical course and lack of an effective treatment, AD has become a major public health problem in the USA and worldwide. Due to variation in age-at-onset, AD is classified into early-onset (APP, PSEN1, and PSEN2 genes, AD is genetically heterogeneous, especially the late-onset form having a polygenic or oligogenic risk inheritance. Since the identification of APOE as the most significant risk factor for late-onset AD in 1993, the path to the discovery of additional AD risk genes had been arduous until 2009 when the use of large genome-wide association studies opened up the discovery gateways that led the identification of ~ 95 additional risk loci from 2009 to early 2022. This article reviews the history of AD genetics followed by the potential molecular pathways and recent application of functional genomics methods to identify the causal AD gene(s) among the many genes that reside within a single locus. The ultimate goal of integrating genomics and functional genomics is to discover novel pathways underlying the AD pathobiology in order to identify drug targets for the therapeutic treatment of this heterogeneous disorder.

Background There has been an increasing utilization of end-to-end (ETE) and reverse “supercharged” end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar nerve transfers (NTs) for treatment of high ulnar nerve injury. This study aimed to review the potential indications for, and outcomes of, ETE and SETS AIN–ulnar NT. Methods A literature review was performed, and 10 articles with 156 patients who had sufficient follow-up to evaluate functional outcomes were included. English studies were included if they reported the outcome of patients with ulnar nerve injuries treated with AIN to ulnar motor NT. Outcomes were analyzed based on the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores, grip and key pinch strength, and interosseous Medical Research Council–graded motor strength. Comparisons were made using the independent t-test and the chi-square test. No nerve graft control group was required for eligibility. Ulnar nerve injury types varied. Results NT resulted in 77% of patients achieving M3+ recovery, 53.7 ± 19.8 lb grip strength recovery, 61 ± 21% key pinch recovery, and a mean DASH score of 33.4 ± 16. In this diverse group, NT resulted in significantly greater M3+ recovery and grip strength recovery measured in pounds than in the nerve graft/conventional treatment group, and ETE repairs had significantly better outcomes compared with SETS repairs for grip strength, key pinch strength, and DASH scores, but heterogeneity limits interpretation. Conclusion ETE and SETS AIN–ulnar NTs produce significant restoration of ulnar nerve motor function for high ulnar nerve injuries. For ulnar nerve transection injuries at or above the elbow, ETE NT results in superior motor recovery compared with nerve grafting/conventional repair. However, further research is needed to determine the best treatment for other types of ulnar nerve injury and the role of SETS NT.

We present a case of Darier disease which is a rare autosomal-dominant genodermatosis. It is clinically manifested by hyperkeratotic papules primarily affecting seborrheic areas. A 30-year-old male came with complaints of papules that were restricted to the lateral aspect of the trunk on the right side and right underarm area. Histopathological examination showed the acanthosis of the epidermis with premature keratosis and suprabasal acantholysis. Darier’s disease must be distinguished histologically from other acantholytic dyskeratoses. It has been observed that biopsy is fundamental to make the final diagnosis. However, a multidisciplinary approach is required to treat affected patients.

Prescription opioid abuse remains an ongoing public health crisis, especially in orthopaedic surgery. The purpose of the present study is to analyze opioid-prescribing patterns and investigate risk factors for prolonged opioid use after common outpatient orthopaedic surgical procedures.After institutional review board approval, a review of 1,384 patients undergoing common elective outpatient orthopaedic procedures from January 2018 to June 2019 was conducted. Data on controlled substance prescriptions were obtained from the prescription drug monitoring program website. Statistical analysis was done to identify predictors for a second opioid prescription and prolonged opioid use (6 months).Over 10% (150/1,384) of patients were still using opioids beyond 6 months. Of the opioid exposed patients, 60.4% (174/288) filled at least 1 additional opioid prescription postoperatively, and 29.2% (84/288) filled prescriptions beyond 6 months, compared with 26.4% (289/1,096) and 6.0% (66/1,096) of opioid-naive patients, respectively. Following multivariate analysis, significant predictors for filling a second opioid prescription included preoperative opioid use, current smoker status, benzodiazepine use, psychiatric disorder, and advanced age.This study revealed risk factors for prolonged opioid use after orthopaedic surgery. Surgeons should be mindful of these risk factors and counsel patients regarding postoperative pain management.

BackgroundFollowing recent findings from our group that curcumin preconditioning augments the therapeutic efficacy of adipose-derived stem cells in the healing of diabetic wounds in rats, we aimed to investigate the regenerative effects of curcumin preconditioned adipose-derived mesenchymal stem cells (ASCs) for better recovery of acid inflicted burns in this study.MethodsASCs were preconditioned with 5 μM curcumin for 24 hours and assessed for proliferation, migration, paracrine release potential and gene expression comparative to naïve ASCs. Subsequently, the healing capacity of curcumin preconditioned ASCs (Cur-ASCs) versus naïve ASCs was examined using acidic wounds in rats. For this, acid inflicted burns of 20 mm in diameter were made on the back of male Wistar rats. Then, 2 × 106 cells of Cur-ASCs and naïve ASCs were intradermally injected in the wound periphery (n = 6) for comparison with an untreated saline control. Post-transplantation, wounds were macroscopically analysed and photographed to evaluate the percentage of wound closure and period of re-epithelization. Healed wound biopsies were excised and used for histological evaluation and expression analysis of wound healing markers at molecular level by quantitative PCR and western blotting.ResultsWe found that Cur-ASCs exhibited greater proliferation, migration and paracrine potential in vitro. Further, Cur-ASCs showed more effective recovery than naïve ASCs as exhibited by gross morphology, faster wound closure and earlier re-epithelialization. Masson’s trichrome and hematoxylin and eosin staining demonstrated the improved architecture of the healing burns, as evidenced by reduced infiltration of inflammatory cells, compact collagen and marked granulation in Cur-ASC treated rats. Corroborating these findings, molecular assessment showed significantly reduced expressions of pro-inflammatory factors (interleukin-1 beta, interleukin-6, tumor necrosis factor alpha) a with striking upsurge of an oxidative marker (superoxide dismutase 1), pro-angiogenic factors (vascular endothelial growth factor, hepatocyte growth factor, hypoxia-inducible factor-1 alpha) and collagen markers (transforming growth factor beta 1, fibroblast growth factor-2, collagen type 1 alpha 1), verifying that Cur-ASCs modulate the regulation of pro-inflammatory and healing markers at burn sites.ConclusionsTreatment with Cur-ASCs resulted in faster re-epithelization of acid inflicted burns compared to the treatment with naïve ASCs. Based on observed findings, we suggest the transplantation of Cur-ASCs is a valuable therapy for the potent clinical management of acidic burns.

Cubital tunnel syndrome is one of the most common compression neuropathies affecting the upper extremity. Physical exam findings include loss of sensation, muscle weakness, and clawing of the fingers. More severe cases also show irreversible muscle atrophy, hand contractures, and loss of function. There are several approaches to treating cubital tunnel syndrome. Here, a subcutaneous anterior transposition was performed on this patient. The patient’s ulnar nerve subluxed upon elbow flexion and extension upon physical examination, which was a primary indication for choosing this surgical approach over other techniques. This procedure not only decompresses the affected nerve but also transposes the nerve anterior to the medial epicondyle so as to relieve strain on the nerve upon the full range of motion of the elbow.

Background: The opioid epidemic has hit all corners of the United States but has disproportionately affected geographical areas to varying extents over the last thirty years. Rural areas have had higher rates of opioid prescribing than urban areas. However, urban counties have higher rates of opioid overdose deaths than rural counties. This study aims to outline the trends in opioid prescribing between rural and urban counties in the state of Pennsylvania since the implementation of a statewide prescription drug monitoring program (PDMP).Methods: Data pertaining to opioid prescribing habits as listed below were obtained from the Pennsylvania Department of Health who administers the PDMP in Pennsylvania. Study data that were of interest and provided by the PDMP were: Drug name, quantity of prescriptions, average daily morphine milligram equivalents (MME), and days supplied. Urban and Rural categorizations were provided by The Center for Rural Pennsylvania, a legislative agency of the Pennsylvania General Assembly. The timeline for this study analyses began from Q1 2017 through Q1 2020. T-tests were used to compare the county informationResults: Opioid prescriptions from 2017 to 2020 decreased on average by 35% (SD= 0.13) in rural counties and 33% (SD= 0.10) in urban counties (P= 0.114). Change in average daily MME was 0.13 (SD=0.06) in the rural group and 0.14 (SD=0.03, p=0.229). Days supplied per prescription showed no significant changes between rural and urban counties with regards to; less than 3 days, 4-7 days, 8-21 days, and 31+ days. A significant decrease was seen in the 22–30-day subgroup between the rural (0.36 SD=0.08) and urban counties (0.31 SD=0.04 p=0.003).Conclusion: No significant changes were seen in the decline of opioid prescribing habits between rural and urban counties in Pennsylvania from 2017 to 2020. This compounds on similar state-specific studies showing no significant difference in the rate of decline between rural and urban counties.

Background The opioid epidemic is a multifactorial issue, which includes pain mismanagement. A recent study has shown that residents have received little training for opioid related patient care. Therefore, resident physician education is essential in addressing this issue. We aimed to analyze the effects of an educational intervention on the knowledge and potential prescribing habits of emergency medicine, general surgery, and internal medicine residents. Methods Resident physicians were provided with educational materials and were given pre- and posttests to complete. Descriptive statistics were used to analyze pre- and posttest responses. Chi-squared analysis was used to identify changes between the pre and posttests. A p

Background: Opioid abuse persists as a significant public health issue in the United States; many states are implementing education and monitoring programs in response. This study examined opioid prescribing patterns and trends after implementing a prescription drug monitoring program in Pennsylvania from 2016 to 2020.Methods: A cross-sectional data analysis using de-identified data from Pennsylvania's PDMP delivered by the Pennsylvania Department of Health was undertaken.Results: In 2016, nearly 2 million opioid prescriptions were given to patients across the state. However, by the end of the study period in 2020, there was a 38% decrease in opioid prescriptions written. Specifically, over 700,000 fewer prescriptions in the first quarter of 2020 compared to the third quarter in 2016. The opioids that were most frequently prescribed were oxycodone, hydrocodone, and morphine.Conclusion: While fewer prescriptions were being prescribed overall, the breakdown of drug type being prescribed remained similar in 2020 compared to 2016. Fentanyl and hydrocodone saw the largest decrease between 2016 and 2020.

Jersey finger, also known as rugby finger, is an avulsion to the flexor digitorum profundus at its insertion on the base of the distal phalanx (zone I). It is frequently caused by forceful extension of the distal interphalangeal joint while actively flexing the flexor digitorum profundus. The tendon may tear from the distal phalanx independently or may avulse with a bony fragment. A classification system has been developed to categorize distinct injury patterns based upon the level to which the flexor digitorum profundus tendon retracted and the presence or absence of a bony avulsion fracture. Flexor digitorum profundus tendon rupture has been reported in all age groups but is most common in athletes. The injury frequently occurs during contact sports, notably American football and rugby, when grabbing the jersey of an opposing player as the player pulls or runs away. Surgical repair is the definitive treatment for all cases of complete rupture of the flexor digitorum profundus tendon. This video demonstrates a surgical approach using the suture anchor technique to repair a jersey finger injury.