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Pomegranate ( Punica granatum ) has staminate (male), androgynous (hermaphrodite), and intermediate flower types. Floral characterization is difficult for breeding efficiency across many pomegranate genotypes in Pakistan, which is essential for pomegranate cultivar enhancements. The present research focused on the floral characterization and breeding efficiency of fifteen pomegranate genotypes. Flower sex ratio, floral morphological parameters, i.e., flower length, ovary width, flower notch, flower tip and stigma with style length, and fruit set percentage were examined during the experiment. In terms of sex ratio, male flowers were found to be higher among all genotypes. Due to clear differences in flower length, width, and heterostyly facilitating visual identification of the hermaphrodite flowers, genotype Ternab-2, Kandhari White, and Kandhari Red had higher fruit set (≥70%) among all cross combinations attempted. Genotype Sava had higher flower length and heterostyly of hermaphrodite flower type, but ovary width was not very distinct, leading to average crossing success (85-34%). In conclusion, single or combination of morphological characters can be used for accurate identification of hermaphrodite flowers, which can improve hybrid efficiency and fruit set after artificial cross-pollination.

Extracellular DNA (eDNA) is a key component of many microbial biofilms including dental plaque. However, the roles of extracellular deoxyribonuclease (DNase) enzymes within biofilms are poorly understood. Streptococcus gordonii is a pioneer colonizer of dental plaque. Here, we identified and characterised SsnA, a cell wall-associated protein responsible for extracellular DNase activity of S. gordonii. The SsnA-mediated extracellular DNase activity of S. gordonii was suppressed following growth in sugars. SsnA was purified as a recombinant protein and shown to be inactive below pH 6.5. SsnA inhibited biofilm formation by Streptococcus mutans in a pH-dependent manner. Further, SsnA inhibited the growth of oral microcosm biofilms in human saliva. However, inhibition was ameliorated by the addition of sucrose. Together, these data indicate that S. gordonii SsnA plays a key role in interspecies competition within oral biofilms. Acidification of the medium through sugar catabolism could be a strategy for cariogenic species such as S. mutans to prevent SsnA-mediated exclusion from biofilms., (© 2022. The Author(s).)

The COVID-19 pandemic with multiple waves of infection has caused panic and distress globally. Cancer patients being immuno-compromised are more susceptible to infection leading to increased morbidity and unpredictability of their survival. There has been a halt in the diagnosis and treatment of patients suffering from cancer because of the COVID-19 pandemic. Oncologists have the tedious task of assessing the urgency of managing cancer patients against the risk of Coronavirus infection. Timely diagnostic services along with the treatment strategy are needed for the proper management of cancer patients. Since the laboratories are already overwhelmed with the investigations related to the COVID-19 management, there has been a compromise and delay in the diagnosis, thus leading to an overall lag in the management of cancer patients., Competing Interests: The authors declare no conflict of interest., (© 2022 The Author(s).)

Background: Localized tenosynovial giant cell tumor (GCT) or giant cell tumor of tendon sheath (GCTTS), is a benign nodular lesion that arises from the synovium of the tendon sheath of the hands and foot. GCTTS is characterized by the presence of multinucleated giant cells and proliferation of synovial-like mononuclear cells. A clinical diagnosis of GCTTS is kept as a differential when a firm, nodular mass shows decreased signal intensity on both T1-and T2-weighted MR imaging. Treatment is usually marginal excision of the mass., Material and Methods: It is a retrospective study, observed in the past 3 years at a tertiary care hospital. Those cases were included in the study in which histopathological confirmation was available or if clinico-radiological features were confirmatory of the diagnosis of GCTTS when correlated with cytological features., Results: There was a total of 24 cases, out of which 16 were females and 8 males. The tumor was located in the upper limb in 21 cases and in 3 cases the tumor was present in the lower limb. In the upper limb, 18 cases were on the right side and three cases were on the left side. In the lower limb, 1 case was present on the left and 2 on the right side. The cytomorphology consisted of mononuclear stromal cells, multinucleated giant cells, and hemosiderin-laden macrophages in variable numbers., Conclusion: It is important to accurately diagnose and categorize giant cell-containing lesions because their prognosis depends on the exact categorization of the tumor., (© 2022 Wiley Periodicals LLC.)

Pentagonal two-dimensional ternary sheets are an emerging class of materials because of their novel characteristic and wide range of applications. In this work, we use first-principles density functional theory (DFT) calculations to identify a new pentagonal SiPN, p -SiPN, which is geometrically, thermodynamically, dynamically, and mechanically stable, and has promising experimental potential. The new p -SiPN shows an indirect bandgap semiconducting behavior that is highly tunable with applied equ-biaxial strain. It is mechanically isotropic, along the x-y in-plane direction, and is a soft material possessing high elasticity and ultimate strain. In addition, its exceptional anisotropic optical response with strong UV light absorbance, and small reflectivity and electron energy loss make it a potential material for optoelectronics and nanomechanics.

With the decrease in severity of COVID-19 there is a sense of relief in the general population. However, there has been an increased incidence of cardiovascular and other organ complications post-infection, which have raised concerns about long COVID. The term "long COVID" was first used by Perego on social media to denote the persistence of symptoms weeks or months after initial SARS-CoV-2 infection and the term 'long haulers' was first described by Watson and by Yong to identify post-COVID conditions. There has been an increased incidence of sudden cardiac death and MI post-COVID-19 in healthy individuals, sports persons and prominent movie stars. Potential mechanisms contributing to the pathophysiology of post-acute COVID-19 may include 1) Damage to tissues and cells that are important for blood flow, so clotting of blood is increased. 2) Persistence of fragments of virus or its sub-particles/ protein material in a wide range of body sites and, 3) an immune system gone haywire. As the majority of countries across the globe are easing coronavirus precautionary measures, there is an urgent need by health care organizations and policymakers worldwide to generate awareness by educating the public at large, about the ill effects of long-COVID and varied types of post-acute sequelae of COVID-19., Competing Interests: Conflict of Interest We want to certify that there is no conflict of interest for the manuscript titled "Beyond COVID-19 and SARS-CoV-2, cardiovascular outcomes of “long covid” from a pathological perspective – a look back and road ahead", further there is no conflict of interest among authors., (Copyright © 2022 Elsevier GmbH. All rights reserved.)

Previous research has found support for depression and anxiety associated with social networks. However, little research has explored parents' depression and anxiety constructs as mediators that may account for children's depression and anxiety. The purpose of this paper is to test the influence of different factors on children's depression and anxiety, extending from parents' anxiety and depression in Jordan. The authors recruited 857 parents to complete relevant web survey measures with constructs and items and a model based on different research models TAM and extended with trust, analyzed using SEM, CFA with SPSS and AMOS, and ML methods, using the triangulation method to validate the results and help predict future applications. The authors found support for the structural model whereby behavioral intention to use social media influences the parent's anxiety and depression which correlate to their offspring's anxiety and depression. Behavioral intention to use social media can be enticed by enjoyment, trust, ease of use, usefulness, and social influences. This study is unique in exploring rumination in the context of the relationship between parent-child anxiety and depression due to the use of social networks.

It is well-known that hip disorders are frequently of bony origin related to an underlying pathomorphology. A fundamental understanding of morphology and biomechanics is therefore of essential importance for a targeted approach in defining treatment plans. Treatment is frequently based on altering bony morphology, for which a set of effective techniques have been proposed. Periacetabular osteotomy (PAO) allows for reorientation of the acetabulum and powerful correction of acetabular coverage. The revolutionary aspect of PAO compared to prior osteotomies lies in maintenance of the integrity of the posterior column. This allows for a substantial increase in primary stability, a larger bony surface for healing, and simple reorientation of the acetabular fragment that is free of posterior ligamentous restraints. The results for dysplasia are very promising. Indications have been refined by studies revealing that the presence of degenerative changes and age > 40 years at the time of surgery represent prognostic factors of poorer outcome. Indications have also been broadened to include acetabular retroversion (with posterolateral dysplasia) and borderline hip dysplasia. A glimpse at the future would reflect major advances related to individual planning, surgical training, and precise surgical conduction. In the era of digitalization, augmented reality may assist in performing bony cuts and act as an aid for some of the blind ischial and retro-acetabular cuts. Innovations in perioperative management will enhance recovery after the procedure and allow for early recovery programs with optimized protocols of pain management. Considering that the success of PAO in the young is comparable to the success of hip arthroplasty in the old, PAO should be considered one of the pillars of modern orthopedic surgery.

Postulated in 1992 and synthesized in 2004 above 2000 K and 110 GPa, the singly-bonded nitrogen cubic gauche crystal (cg-PN) is still considered to be the ultimate high energy density material (HEDM). The search however has continued for a method to synthesize cg-PN at more ambient conditions or find HEDMs which can be synthesized at lower pressure and temperature. Here, using ab initio evolutionary crystal prediction techniques, a simpler nitrogen-based molecular crystal consisting of N[Formula: see text] and N[Formula: see text] molecules is revealed to be a more favorable polynitrogen at lower pressures. The energetic gain of  534 meV/atom over cg-PN and  138 meV/atom over the N[Formula: see text] molecular crystal at zero pressure makes the N[Formula: see text]-N[Formula: see text] system more appealing. Dynamical and mechanical stabilities are investigated at 5 and 0 GPa, and vibrational frequencies are assessed for its Raman and IR spectra. The prospects of an experimental synthesis of the N[Formula: see text]-N[Formula: see text] polymeric system compared to cg-PN is higher because the C[Formula: see text] symmetry of N[Formula: see text] within this crystal would be easier to target from the readily available N[Formula: see text] azides and the observed N[Formula: see text] and N[Formula: see text] radicals., (© 2022. The Author(s).)

Objectives: Cytological examination of effusion sample is a preliminary and minimally invasive method for the diagnosis of body fluids. Recently, the International System For Reporting Serous Fluid Cytopathology (ISRSFC) and the Indian Academy of Cytologist (IAC) have published guidelines for reporting effusion cytology and calculating the risks of malignancy (ROMs) for each defined category. We report our 2 years of experience in reclassifying and assessing the feasibility of applying ISRFSC and IAC categories to effusion fluid and to provide an estimate of the risk of malignancy for each diagnostic category., Material and Methods: Cytological reports of patients from January 2019 to December 2020 were retrieved and reclassified into a five-tiered classification scheme as per ISRSFC guidelines. Cellblock and immunohistochemistry were performed in selected cases. Clinico radiological and histopathological information were obtained and correlated with the cytological findings wherever available., Results: In the study, 652 cases were included during the 2 years. Out of these, 328 (50.3%) were women and 314 (47.3%) were men. Patient's ages ranged between 2 92 years with a mean age of 47.4 years. There were 366 (56.1%) cases of ascitic fluid followed by 262 (40.1%) cases of pleural fluid and 24 (3.8%) cases of pericardial fluid in the analysis. Of all the cases, 13 (2%) were non-diagnostic (ND), 464 (71.6%) were negative for malignant (NFM) cells, 16 (2.4%) were atypia of uncertain significance, 31 (4.7%) were suspicious of malignancy, and 125 (19.3%) were malignant. Cellblock was prepared in 65 cases. Lung cancer followed by breast cancer was the most common malignancies involving the pleural effusion and ovarian cancer was the most common cause of peritoneal effusion. ROM for each diagnostic category was 23% for ND, 25% for NFM, 56% for the atypical category, 80.6% in suspicious, and 90% were for positive for malignancy category., Conclusion: The use of a five-tiered system as per the ISRFC and IAC guidelines are feasible for the standardized reporting of effusion samples, thus avoiding subjective variation of reporting., Competing Interests: There is no conflict of interest., (© 2022 Cytopathology Foundation Inc, Published by Scientific Scholar.)

Purpose: Anterior cruciate ligament (ACL) repair has been recommended as a treatment principle for ACL tears. Several authors have advocated a potential role for primary repair techniques in the ACL decision tree. However, long-term results have been controversial. This study aims to determine the survival of the primarily repaired ACL after dynamic intraligamentary stabilization (DIS) with and without augmentation., Methods: Between 2014 and 2019, 102 patients with isolated proximal ACL ruptures underwent DIS repair within 21 days from injury and were available for follow-up either clinically or telephonically after ≥5 years postoperatively. In 45 cases, DIS repair was augmented with collagen fleece wrapping, platelet-rich fibrin (PRF) or both. Failure was defined as traumatic re-rupture or conversion to ACL reconstruction. The patients being available for physical examination underwent a.-p. stability measurement with a KT-1000 device. Functional outcome was measured with the IKDC, Tegner and Lysholm scores. Kaplan-Meier survival analysis, Log-Rank Test and Binominal logistic regression were performed., Results: After a minimum 5-year follow-up, 71/102 (69.6%) DIS repairs were not re-reptured and clinically and/or subjectively stable. Augmentation did not improve survival rates (p = 0.812). The identified factors influencing failure were a younger age and a pre-injury Tegner activity level of ≥7. 95.7% of those patients with an intact ACL repair had normal or near normal knee function based on the IKDC scoring system., Conclusions: The 5-year overall survival rate of DIS was 69.6%. Collagen fleece wrapping and local PRF application did not improve survival. Patients not suffering failure of repair demonstrated high satisfaction. Nevertheless, the results are inferior to those of established ACL reconstruction procedures., Level of Evidence: Case series, Level IV., (© 2022. The Author(s).)

Using mobile applications in e-government for the purpose of health protection is a new idea during COVID-19 epidemic. Hence, the goal of this study is to examine the various factors that influence the use of SANAD App As a health protection tool. The factors were adopted from well-established models like UTAUT, TAM, and extended PBT. Using survey data from 442 SANAD App from Jordan, the model was empirically validated using AMOS 20 confirmatory factor analysis, structural equation modeling (SEM) and machine learning (ML) methods were performed to assess the study hypotheses. The ML methods used are ANN, SMO, the bagging reduced error pruning tree (RepTree), and random forest. The results suggested several key findings: the respondents' performance expectancy, effort expectancy, social influence, facilitating conditions, perceived risk, trust, and perceived service quality of this digital technology were significant antecedents for their attitude to using it. The strength of these relationships is affected by the moderating variables, including age, gender, educational level, and internet experience on behavioral intention. Yet, perceived risk did not have a significant effect on attitude towards SANAD App The study adds to literature by empirically testing and theorizing the effects of SANAD App on public health protection.

Proximal fractures of the humerus are at high risk of osteonecrosis if the medial calcar is disrupted and the metaphyseal extension of the head fragment is <8mm. Risk factors for failure of osteosynthesis include: poor bone stock, varus dislocation, head dislocation and medial comminution. During surgical treatment of distal humerus fractures, one should aim to restore the arc and stabilize the columns. Several technical rules have been outlined by O´Driscoll and are mentioned in this article in detail. In fractures of the distal radius, the length, the joint surface, and joint angles (palmar inclination ca. 11°, radial inclination ca. 22°) should be reconstructed. Several surgical factors are associated with the development of radiocarpal osteoarthritis including the sagittal depth of the articular cavity and the anterior-posterior diameter of the fossa lunata of the distal radius. When managing fractures of the proximal tibia, a four- or more column classification system should be used to plan the surgical steps and choose the appropriate approach(es). In ankle fractures, intraoperative 3-D-Scan should be considered especially in the case of syndesmotic involvement or involvement of the posterior malleolus., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2022. Published by Elsevier Ltd.)

Objectives: Liquid-based cytology (LBC) is becoming a useful method in evaluating both gynecological and nongynecological preparations. Many studies have been conducted these days to see the quality of LBC in diagnosing thyroid lesions and its role is yet to be standardized. This study has been done to pick the cytomorphological features of thyroid lesions on LBC and to compare them with the conventional cytology of these lesions.The objective of the study is to evaluate the efficacy of thyroid fine-needle aspiration cytology processed by LBC as compared to conventional smears., Material and Methods: A prospective study has been done on 53 cases of thyroid lesions using standard conventional and LBC techniques., Results: In most of the cases, the cytological features are similar in conventional cytology smears and LBC, but the colloid film and the lymphocytic component show a clear picture on direct smears, whereas nuclear and cytoplasmic details are better evaluated in LBC slides. The preservative solution used in LBC could be efficiently used for the application of immunocytochemical and molecular techniques., Conclusion: LBC does not represent as a valid alternative to conventional cytology but it can be considered as a diagnostic utility process especially due to the possibility of applying additional techniques which enhance the efficacy of the cytological diagnosis of thyroid lesions., Competing Interests: The authors have no conflicts of interest to declare., (© 2022 Cytopathology Foundation Inc, Published by Scientific Scholar.)

We present two cases of Isolated complex pulmonary arteriovenous malformations in two children presenting with cyanosis and exercise intolerance. We present the anatomical features and the management of each case. One patient was treated with surgical ligation of the draining vein, and one patient was treated percutaneously by closure of the feeding segmental artery.

Purpose: Cataract surgery combined with excimer laser trabeculotomy (phaco-ELT) leads to a significant reduction in intraocular pressure by enhancing trabecular outflow. The aim of this study is to compare two laser systems for ELT (AIDA vs. ExTra)., Methods: In this retrospective chart review, inclusion criteria were a diagnosis of glaucoma and phaco-ELT between 07/17/2010 and 07/17/2018. Data were collected preoperatively and postoperatively up to 1 year. Success was defined as IOP reduction of ≥ 20% compared to baseline plus an IOP of < 21 mmHg with no hypotony, no loss of light perception vision, and no subsequent glaucoma surgery., Results: Three hundred and fourteen eyes (mean age 75.9 ± 8.6 years) were included. Baseline intraocular pressure (IOP) for the ExTra group (94 eyes) was 20.3 ± 5.9 mmHg on 2.0 ± 1.3 anti-glaucoma drugs (AGD) and a best-corrected visual acuity (BCVA, logMar) of 0.5 ± 0.4. For The AIDA group (220 eyes), baseline IOP was 18.7 ± 6.3 mmHg on 2.0 ± 1.3 AGD and a BCVA of 0.3 ± 0.3. In the ExTra group, IOP was reduced to 12.8 ± 2.5 mmHg (-37%) and in the AIDA group to 14.7 ± 3.9 (-21%, p = 0.14) at 1 year. AGD reduction in the ExTra group was 1.3 ± 1.5 and 1.8 ± 1.4 in the AIDA group (p = 0.14). Success rates were 80% (ExTra) and 70% (AIDA), respectively (p = 0.552). Thirty-one eyes (10.0%) required a subsequent glaucoma surgery during the follow-up., Conclusion: Both laser platforms, the ExTra and the AIDA laser, used for Phaco-ELT lead to a significant reduction in intraocular pressure and anti-glaucoma drugs with no statistically significant difference in success rates during the follow-up of 12 months., Trial Registration Swissethics: 2018-01,791., (© 2022. The Author(s).)

Background: Partner involvement in maternal health services utilization remains a major public challenge in the developing world. Strategies of involving men in maternal health services are a critical and proven intervention for reducing maternal and neonatal mortality by ensuring safe delivery and reducing complications during childbirth. Moreover, the husbands' involvement during pregnancy helps their spouses to make timely decisions and avoid maternal delays, especially first and second delays. Although birth and complication readiness have been studied in developing countries such as Ethiopia, almost all previous researchers were focused primarily on women participants. Therefore, we aimed to investigate factors associated with husband involvement in birth preparedness and complication readiness plan in Haramaya Health and Demographic Surveillance site, Eastern Ethiopia., Methods: A community-based cross-sectional study was conducted from March 1 to 30, 2020 among men whose wives were pregnant in Haramaya Health and Demographic Surveillance (HDSS) site in Eastern Ethiopia. The calculated sample size was 653, however while contacting 653 husbands only 630 had given the full interview, hence 630 respondents were remained in the analysis. Participants were approached through a systematic sampling technique. Data were collected using a pre-tested structured questionnaire through a face-to-face interview, and entered into Epidata version 3.1 and analyzed using SPSS version 22 (IBM SPSS Statistics, 2013). The prevalence was reported using proportion with 95% Confidence Interval (CI) and summary measures. Predictors were assessed using a multivariable logistic regression analysis model and reported using an adjusted odds ratio (AOR) with 95%CI. Statistical significance was declared at p < 0.05., Results: Overall, the prevalence of the husband's plan to participate in birth preparedness and complication readiness was 59.6% (95%CI:56-64%). In the final model of multivariable analysis, predictors like husband's knowledge of birth preparedness and complication readiness [AOR = 4.18, 95%CI:2.05, 8.51], having a discussion with spouse on the place of delivery [AOR = 6.84, 95% CI: 4.17, 11.22], husband's knowledge of danger signs during labor and delivery [AOR = 3.19, 95 % CI: 1.52, 6.71], and making a postpartum plan[AOR = 2.30, 95 % CI: 1.38, 3.85] were factors statistically associated with husband's plan to participate in birth preparedness., Conclusions: This study pointed out that two in every five husbands failed to plan birth preparedness and complication readiness. As a result, all stakeholders should emphasize male partners' education in terms of birth preparedness and complication readiness, as well as knowledge of danger signs during labor and delivery. They should also encourage male partners to discuss a place of delivery and have a postpartum plan in place to reduce potential complications related to labor and delivery., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Sufian, Kure, Dheresa, Debella, Balis and Roba.)

Background and Objective: Various fixation devices and surgical techniques are available for the management of proximal femur fractures. Recently, the femoral neck system (FNS) was introduced, and was promoted on the basis of less invasiveness, shorter operating time, and less fluoroscopy time compared to previous systems. The aim of this study was to compare two systems for the internal fixation of femoral neck fractures (FNF), namely the dynamic hip screw (DHS) with an anti-rotation screw (ARS) and an FNS. The outcome measures included operating room time (ORT), dose−area product (DAP), length of stay (LOS), perioperative changes in haemoglobin concentrations, and transfusion rate. Materials and Methods: A retrospective single-centre study was conducted. Patients treated for FNF between 1 January 2020 and 30 September 2021 were included, provided that they had undergone closed reduction and internal fixation. We measured the centrum-collum-diaphyseal (CCD) and the Pauwels angle preoperatively and one week postoperatively. Results: In total, 31 patients (16 females), with a mean age of 62.81 ± 15.05 years, were included. Fracture complexity assessed by the Pauwels and Garden classification did not differ between groups preoperatively. Nonetheless, the ORT (54 ± 26.1 min vs. 91.68 ± 23.96 min, p < 0.01) and DAP (721 ± 270.6 cGycm² vs. 1604 ± 1178 cGycm², p = 0.03) were significantly lower in the FNS group. The pre- and postoperative CCD and Pauwels angles did not differ statistically between groups. Perioperative haemoglobin concentration changes (−1.77 ± 1.19 g/dl vs. −1.74 ± 1.37 g/dl) and LOS (8 ± 5.27 days vs. 7.35 ± 3.43 days) were not statistically different. Conclusions: In this cohort, the ORT and DAP were almost halved in the patient group treated with FNS. This may confer a reduction in secondary risks related to surgery.

Background: The demographic transition leads to a continuously growing number of elderly patients who receive therapeutic anticoagulation by reason of several comorbidities. Though therapeutic anticoagulation may reduce the number of embolic complications in these patients, major complications such as bleeding complications need to be kept in mind when considering such therapy. However, evidence regarding the choice of anticoagulation agents in chronic kidney disease patients of higher age is limited. In this report, a guideline-based anticoagulation treatment which led to a fulminant atraumatic bleeding complication is discussed., Case Presentation: We present the case of an 85-year-old female stage V chronic kidney disease patient who suffered from a diffuse arterial, subcutaneous bleeding in her lower left leg due a therapeutic anticoagulation using low molecular weight heparin (LMWH). Anticoagulation was started in accordance with general recommendations for patients with atrial fibrillation, and the dosage was adapted for the patient's renal function. Nevertheless, the above-mentioned complication occurred, and the bleeding led to a hemorrhagic shock and an acute kidney injury on top of a chronic kidney disease. The hematoma required surgical evacuation and local coagulation in the operating room. In the further course, the patient underwent additional four surgical interventions due to a superinfected skin necrosis, including skin grafting. Furthermore, the patient needed continuous renal replacement therapy, as well as intensive care unit treatment, for a total of 47 days followed by 36 days of geriatric rehabilitation. Afterwards, she was discharged from the hospital to her previous nursing home., Discussion and Conclusions: Although therapeutic anticoagulation may sufficiently protect patients at cardiovascular risk, major complications such as bleeding complications may occur at any time. Therefore, physicians need to regularly re-evaluate any prior indication for therapeutic anticoagulation. With this case report, we hope to draw attention to the cohort of geriatric patients and the need for more and well differentiated study settings to preferably prevent any potentially avoidable complications., (© 2022. The Author(s).)

Background: Open wedge high tibial osteotomy is a standard procedure for frontal realignment. It is indicated in varus knee with reduced mechanical medial proximal tibia angle. Overcorrection producing a mechanical medial proximal tibia angle out of the normal range (85-90°) is not recommended because this would lead to unphysiological joint-line orientation. Osteotomies around the knee also influence the adjacent ankle and hip joints. For the hip, it is known that frontal alignment of the leg influences the ischiofemoral space. A decreased ischiofemoral space can lead to painful impingement between the ischial bone and the lesser trochanter., Case Presentation: A 53-year-old German woman presented with severe ischiofemoral impingement symptoms and valgus malalignment of the left leg after open wedge high tibial osteotomy, which was indicated and performed by an orthopedic surgeon with intention to treat medial knee pain due to degenerative arthritis of the medial compartment years after medial meniscectomy. The mechanical medial proximal tibia angle was 100.5°. We performed closed wedge high tibial osteotomy producing a mechanical medial proximal tibia angle of 90.0° and normal joint-line orientation. The hip pain was gone immediately after the surgery, and the patient had no signs of ischiofemoral impingement or hip pain at last follow-up 12 months after closed wedge high tibial osteotomy., Conclusions: Frontal realignment osteotomy around the knee can create problems at adjacent joints. Overvalgization of the proximal tibia made the patient compensate by hyperadduction of the hip to enable full foot sole contact with the floor. Hyperadduction of the hip decreased the ischiofemoral space, leading to severe impingement. Therefore, meticulous planning of osteotomies is important not to produce unphysiological situations or unwanted negative effects at the level of an adjacent joint., (© 2022. The Author(s).)

Background: Assessing and improving quality of care should be of paramount importance to health care systems and providers. This study aimed to evaluate the quality of surgical records at the Jordan University Hospital., Methods: We used the previously validated Surgical Tool for Auditing Records (STAR) to retrospectively evaluate the quality of surgical records of patients who underwent surgery in the general surgery department from 2016 to 2021. Total STAR and section-specific STAR scores were compared using the two independent sample Student's ttest on SPSS Statistics, version 23 (IBM Corp, Armonk, NY)., Results: A total of 488 records were selected and evaluated using the STAR. The total STAR scores significantly improved steadily throughout the years compared to the baseline in 2016, reaching the highest in 2021. All domains had improved compared to the baseline except for anesthesia records that did not change from an already high baseline. The highest improvements between STAR domains were observed in Initial Clerking and Consent domains., Conclusion: Our study demonstrates that significant improvements in the quality of surgical records can be achieved by simply using an electronic record entry system, personnel education, and systematic auditing., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Alqudah et al.)

Total knee arthroplasty (TKA) is the gold standard for treating advanced knee osteoarthritis. Among the postoperative complications of TKA are true patella infera (TPI) and pseudo patella infera (PPI), which should be differentiated since TPI exhibits significantly worse clinical outcomes. Multiple radiological patella height indices (PHI) exist; some were modified or originally designed for knees with implanted endoprostheses. However, there is no consensus on measuring and comparing patella height. Due to the lack of established, simple, reliable, and reproducible concepts for assessing patella height for arthroplasty, measuring patella height and the change of patella height by or after TKA have been challenging tasks for clinicians and researchers. This is a review of the current literature on methods for measuring patella height, with special attention to the ability to differentiate between the TPI and PPI after TKA. All literature on the topic was retrieved, and references from relevant articles were investigated until the end of April 2022., (© The Authors, published by EDP Sciences, 2022.)

Introduction: The exact evaluation of hip morphology is essential for surgical planning. A wide range of morphometric measures of the acetabulum is deduced from conventional anterior-posterior (ap) pelvic radiographs. Full-length weight-bearing radiographs (FLWBR) also depict the acetabulum and are commonly used for osteotomy planning of the lower limb. This study aimed to determine whether FLWBR can be used to evaluate acetabular morphology., Methods: Radiographs of patients receiving a hip workup that included a conventional ap pelvic X-ray and FLWBR were utilized for radiographic measurements. The following parameters were measured: extrusion index of the femoral head, anterior wall index, posterior wall index, lateral center edge angle (LCE), acetabular index, pubic arc angle (subpubic angle), and centrum-collum-diaphyseal angle (CCD)., Results: FLWBR depicted a significantly reduced anterior coverage (p = 0.049) and increased posterior coverage (p < 0.001), higher acetabular index (p = 0.015), and higher pubic-arc angle (p = 0.02) compared to conventional ap pelvic radiographs. There were no significant differences regarding the CCD angle (p = 0.28), extrusion index (p = 0.31), and LCE (p = 0.16)., Discussion: The CCD angle of the femur can be measured on conventional ap radiographs and full-length weight-bearing X-rays for lower limb deformity analysis. However, FLWBR will depict an anteverted acetabular morphology, rendering conventional ap radiographs necessary for planning pelvic osteotomies., (© The Authors, published by EDP Sciences, 2022.)

Since the emergence of yellow fever in the Americas and the devastating 1918 influenza pandemic, biologists and clinicians have been drawn to human infecting viruses to understand their mechanisms of infection better and develop effective therapeutics against them. However, the complex molecular and cellular processes that these viruses use to infect and multiply in human cells have been a source of great concern for the scientific community since the discovery of the first human infecting virus. Viral disease outbreaks, such as the recent COVID-19 pandemic caused by a novel coronavirus, have claimed millions of lives and caused significant economic damage worldwide. In this study, we investigated the mechanisms of host-virus interaction and the molecular machinery involved in the pathogenesis of some common human viruses. We also performed a phylogenetic analysis of viral proteins involved in host-virus interaction to understand the changes in the sequence organization of these proteins during evolution for various strains of viruses to gain insights into the viral origin's evolutionary perspectives., Competing Interests: The authors have declared that no competing interests exist.

Aims: The aim of this study was to determine the association between knee alignment and the vertical orientation of the femoral neck in relation to the floor. This could be clinically important because changes of femoral neck orientation might alter chondral joint contact zones and joint reaction forces, potentially inducing problems like pain in pre-existing chondral degeneration. Further, the femoral neck orientation influences the ischiofemoral space and a small ischiofemoral distance can lead to impingement. We hypothesized that a valgus knee alignment is associated with a more vertical orientation of the femoral neck in standing position, compared to a varus knee. We further hypothesized that realignment surgery around the knee alters the vertical orientation of the femoral neck., Methods: Long-leg standing radiographs of patients undergoing realignment surgery around the knee were used. The hip-knee-ankle angle (HKA) and the vertical orientation of the femoral neck in relation to the floor were measured, prior to surgery and after osteotomy-site-union. Linear regression was performed to determine the influence of knee alignment on the vertical orientation of the femoral neck., Results: The cohort included 147 patients who underwent knee realignment-surgery. The mean age was 51.5 years (SD 11). Overall, 106 patients underwent a valgisation-osteotomy, while 41 underwent varisation osteotomy. There was a significant association between the orientation of the knee and the coronal neck-orientation. In the varus group, the median orientation of the femoral neck was 46.5° (interquartile range (IQR) 49.7° to 50.0°), while in the valgus group, the orientation was 52.0° (IQR 46.5° to 56.7°; p < 0.001). Linear regression analysis revealed that HKA demonstrated a direct influence on the coronal neck-orientation ( β = 0.5 (95% confidence interval (CI) 0.2 to 0.7); p = 0.002). Linear regression also showed that realignment surgery was associated with a significant influence on the change in the coronal femoral neck orientation ( β = 5.6 (95% CI 1.5 to 9.8); p = 0.008)., Conclusion: Varus or valgus knee alignment is associated with either a more horizontal or a more vertical femoral neck orientation in standing position, respectively. Subsequently, osteotomies around the knee alter the vertical orientation of the femoral neck. These aspects are of importance when planning osteotomies around the knee in order to appreciate the effects on the adjacent hip joint. The concept may be of even more relevance in dysplastic hips. Cite this article: Bone Jt Open  2021;2(12):1057-1061.

This study explored the roles of activins and follistatin in colorectal cancers. Paired malignant and normal colonic tissues were collected from archived paraffin-embedded ( n = 90 patients) alongside fresh ( n = 40 patients) specimen cohorts. Activin β-subunits, follistatin and Smad4 mRNAs and proteins were measured by real-time PCR and immunohistochemistry (IHC). Mature activin-A, -B, -AB and follistatin proteins were measured by ELISA. Cancer tissues having ≤ the 20th percentile of the Smad4 IHC score were considered as low (L-S4) group. The Smad4-intact SW480 and Smad4-null HT29 colon cancer cell lines were treated with activins and follistatin, and cell cycle was analysed by flow cytometry. The cell cycle inducing (CCND1/CCND3) and inhibitory (p21/p27) proteins alongside the survival (survivin/BCL2) and pro-apoptosis (Casp-8/Casp-3) markers were measured by immunofluorescence. Thirty-nine patients had right-sided cancers (30%) and showed higher rates of L-S4 tumours ( n = 17; 13.1%) alongside worse clinicopathological characteristics relative to left-sided cancers. The βA-subunit and activin-A increased, whilst βB-subunit and activin-AB decreased, in malignant sites and the late-stage cancers revealed the greatest abnormalities. Interestingly, follistatin declined markedly in early-stage malignant tissues, whilst increased significantly in the advanced stages. All activin molecules were comparable between the early stage right- and left-sided tumours, whereas the late-stage right-sided cancers and L-S4 tumours showed more profound deregulations. In vitro , activin-A increased the numbers of the SW480 cells in sub-G1 and G0/G1-phases, whereas reduced the HT29 cell numbers in the sub-G1 phase with simultaneous increases in the G0/G1 and S phases. The p21/p27/Casp-8/Casp-3 proteins escalated, whilst CCND1/CCND3/BCL2/survivin declined in the SW480 cells following activin-A, whereas activin-A only promoted p21 and p27 alongside reduced CCND3 in the HT29 cells. By contrast, activin-AB increased the numbers of SW480 and HT29 cells in Sub-G1 and G0/G1-phases and promoted the anti-cancer and reduced the oncogenic proteins in both cell lines. In conclusion, activins and follistatin displayed stage-dependent dysregulations and were markedly altered during the advanced stages of right-sided and L-S4 cancers. Moreover, the activin-A actions in CRC could be Smad4-dependent, whereas activin-AB may act as a Smad4-independent tumour suppressor protein., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Refaat, Zekri, Aslam, Ahmad, Baghdadi, Meliti, Idris, Sultan, Alardati, Saimeh, Alsaegh, Alhadrami, Hamid, Naeem and Elsamany.)

Background: We previously reported that chronic venous insufficiency treatment of Medicare-eligible patients achieved outcomes similar to those for non-Medicare-eligible patients. The goal of the present investigation was to assess the long-term treatment outcomes and the effect of race in a larger patient cohort., Methods: From January 2015 to December 2019, we retrospectively reviewed the data from 131,268 patients who had presented for a lower extremity venous evaluation. We divided the patients into two groups by age: group A was aged ≥65 years and group B, <65 years. The treatments analyzed in each group were axial thermal ablation (TA), axial Varithena ablation (VA), TA plus phlebectomy, VA plus phlebectomy, and TA or VA with phlebectomy and ultrasound-guided foam sclerotherapy (UGFS). The treatment outcomes were assessed using the revised venous clinical severity score (rVCSS) and Chronic Venous Insufficiency Quality of Life 20-item questionnaire (CIVIQ-20) scores at the initial consultation and 1, 6, and 12 months after completion of the treatment plan., Results: Of the 131,268 patients, 40,020 were in group A and 91,248 in group B, with an average age of 74.4 ± 6.6 and 49.9 ± 10.6 years, respectively. Of the 40,020 patients in group A, 15,697 (n = 25,234 limbs) had undergone TA and 1910 (n = 3222 limbs) had undergone VA. Of the 91,248 patients in group B, 35,220 (n = 53,717 limbs) had undergone TA and 2178 (n = 3672 limbs) had undergone VA. For the TA subgroups, all rVCSSs had significantly improved after treatment at each evaluation point (P ≤ .001). For the TA and VA plus phlebectomy with or without UGFS subgroup, the older patients (group A) required 6 months to develop the same degree of improvement as the younger patients (group B) at 1 month. When subdivided by race, all initial and 6-month rVCSSs and CIVIQ-20 scores within a race had improved and were better in group B, except for Asian and Hispanic patients (P ≤ .001). After TA or VA plus phlebectomy, with or without UGFS, the CIVIQ-20 outcomes had improved by 1 month in both groups, although the rVCSS lagged by 6 months in group A. No differences in the rVCSSs or CIVIQ-20 scores were observed between the groups treated with TA or VA., Conclusions: Medicare-eligible beneficiaries demonstrated improved outcomes similar to those of non-Medicare-eligible beneficiaries after ablation. When TA or VA plus phlebectomy with or without UGFS were examined, group A required 6 months to demonstrate rVCSSs equivalent to those of group B at 1 month. The CIVIQ-20 scores had improved by 1 month in both groups, regardless of the treatment modality. The difference in rVCSSs appeared to be driven by African American and white patients because Hispanic and Asian patients demonstrated equivalent results regardless of age. Patients treated with TA or VA demonstrated equivalent results., (Copyright © 2021. Published by Elsevier Inc.)

Objective: Description of a reproducible surgical technique for single-bundle anterolateral reconstruction of the posterior cruciate ligament (PCL) based on a septum-sparing approach. This technique is less traumatic than the trans-septum approach. The article illustrates surgical steps to simplify the technical aspects of the procedure., Indications: A complete grade III symptomatic tear of the PCL associated with instability and often discomfort (deceleration, stairs) or subsequent gonalgia arising from the medial compartment or patellofemoral joint. Injury of the peripheral joint stabilizers alongside the PCL including the posterolateral corner or a complete medial knee injury. The procedure is indicated in chronic cases, but also in acute cases of posterior instability > 10 mm, if it is an intraligamentous tear with dislocated PCL stumps., Contraindications: Bony avulsions of the PCL suitable for refixation, soft tissue compromise, infection, advanced osteoarthritic disease., Surgical Technique: After diagnostic arthroscopy of the knee, the ipsilateral semitendinosus and gracilis tendons are harvested and prepared as a 6-strand graft for PCL reconstruction. One high anterolateral viewing portal, one low anterolateral portal, one anteromedial portal, and a posteromedial portal are used for single-bundle reconstruction via one femoral and one tibial bone tunnel and hybrid graft fixation., Postoperative Management: Weight bearing is restricted to 20 kg for 6 weeks. PCL brace with tibial support for a period of 12 weeks. Flexion is limited to 30° in the first 2 postoperative weeks, then 60° for 2 weeks, and 90° for 2 further weeks. Passive flexion in prone position is performed. Active focused muscle strengthening exercise is begun after 6 weeks postoperatively and participation in competitive sports is not recommended before full muscle strength and coordination is re-established, at the earliest 9-12 months postoperatively., Results: Two isolated and 19 combined PCL injuries were treated. Mean patient age was 27.4 years, and the minimal follow-up was 12 months. On average, we found good clinical outcome with slight degree of posterior laxity (4.1 mm) after PCL reconstruction in comparison with the contralateral knee. No patient showed signs of effusion at follow-up. Range of motion was fully restored in 19 of 21 patients. One patient suffered failure due to persistent posterior instability and persistence of symptoms., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

What constitutes a "good osteosynthesis"? Although the question seems trivial, on closer inspection there are manifold influencing factors that affect fracture healing, so that this question is ultimately not that easy to answer. The first steps are already set with taking the patient history and initial diagnostics. An adequate analysis of the fracture with a coherent preoperative concept for stabilization based on the latest scientific findings and a subsequent adequate implementation of the planning in the operating room make the success of an osteosynthesis and thus a "good osteosynthesis". Digital support is playing an increasingly important role in this field. This review article deals with the topic in depth and summarizes the most important elements of the necessary cascade., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Purpose: The aim of this study is to evaluate the long-term efficacy of a novel minimally invasive glaucoma surgery technique (MIGS), Ab interno Canaloplasty (AbiC)., Material and Methods: For this retrospective cohort study, we analysed the data of 25 eyes of 23 patients with open angle glaucoma who underwent an AbiC (6 eyes) or in case of an additional cataract, a combined cataract-AbiC procedure ("phacocanaloplasty ab interno", 19 eyes), respectively. Postoperatively, we investigated the intraocular pressure (IOP) and the number of still required IOP-lowering medication, as well as surgery-related complications., Results: Overall, the mean baseline IOP of 20.24 mmHg ± 5.92 (n = 25) was reduced to 10.64 mmHg ± 2.77 (n = 25, p < 0.001), 12.55 mmHg ± 3.33 (n = 22, p < 0.001) and 13.67 mmHg ± 2.15 (n = 21, p < 0.001) at 1 day, 1 year and 2 year follow-up visit, respectively. Compared to baseline, this implies a reduction in IOP of 47.4, 37.9 and 32.5%. An average glaucoma medication usage of 1.92 ± 1.04 was registered at baseline visit and was reduced to 0,05 ± 0,23 after 2 years of follow-up. 80% of patients were off medication. In 5 eyes (20%) further antiglaucomatous eye drops or surgical treatment were administered. The only surgical complications were hyphema in 5 eyes (20%) and a localized peripheral detachment of the Descemet's membrane in one eye (4%) with no late sequelae., Conclusion: AbiC performed independently or combined with cataract surgery seems to be a safe and effective MIGS-technique with good long-term regulation of IOP and low risk profile., Competing Interests: The authors declare that they have no conflict of interest./Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: A binary triage system based on infectivity and facilitated by departmental restructuring was developed to manage suspected COVID-19 patients with an aim to provide effective prevention and control of infection among health care workers (HCWs) in the emergency department. This study analyses the effectiveness of the new triage system and structural reorganization in response to the COVID-19 pandemic., Methods: A cross-sectional observational study was conducted in the Emergency and Trauma Department, Hospital Kuala Lumpur (ETDHKL). The implementation of a binary triage system separates patients with risk of COVID-19 who present with fever and respiratory symptoms from other patients. Data on exposed HCWs to COVID-19 patients were captured pre-restructuring and post-restructuring of the emergency department and analysed using descriptive statistics., Results: A total of 846 HCWs were involved in this study. Pre-restructuring reported 542 HCWs exposed to COVID-19 patients while post-restructuring reported 122. Using the four categorical exposure risks for HCWs which are no identifiable risk, low risk, medium risk, and high risk, the number of HCWs exposed during pre-restructuring were 15(1.8%), 504 (59.6%), 15 (1.8%), and 8 (0.9%), respectively, while post-restructuring the numbers were 122 (14.4%), 8 (0.9%), 109 (12.9%), and 5 (0.1%), respectively. There was a 77.5% reduction in the number of exposed HCWs after our implementation of the new system (542 vs 122)., Conclusion: A binary triage system based on severity and infectivity and supported with structural reorganization can be effective in reducing HCWs COVID-19 exposure., (© 2021. The Author(s).)

No thermal process, even the biological systems, can escape from the long arms of the second law. All living things preserve entropy since they obtain energy from the nutrition they consume and gain order by producing disorder. The entropy generation in a biological and thermally isolated system is the main subject of current investigation. The aim is to examine the entropy generation during the convective transport of a ciliated nano-liquid in a micro-channel under the effect of a uniform magnetic field. Joint effects of electroosmosis and thermal radiation are also brought into consideration. To attain mathematical simplicity, the governing equations are transformed to wave frame where the inertial parts of the transport equations are dropped with the use of a long-wavelength approximation. This finally produces the governing equations in the form of ordinary differential equations which are solved numerically by a shooting technique. The analysis reports that the cilia motion contributes to enhance the flow and heat transfer phenomena. An enhancement in the flow is observed near the channel surface for higher cilia length and for smaller values of the electroosmotic parameter. The entropy generation in the ciliated channel is observed to be lessened by intensifying the thermal radiation and decreasing the Ohmic heating. The extended and flexible cilia structure contributes to augment the volumetric flow rate and to drop the total entropy generation in the channel.

Introduction: Of 2.5 million newborn deaths each year, serious neonatal infections are a leading cause of neonatal death for which inpatient treatment is recommended. However, manysick newborns in sub-Saharan Africa and south Asia do not have access to inpatientcare. A World Health Organization (WHO) guideline recommends simplified antibiotic treatment atan outpatient level for young infants up to two months of age with possible serious bacterial infection (PSBI), when referral is not feasible.We implemented this guidelinein Ethiopia to increase coverage of treatment and to learn about potential facilitating factors and barriers for implementation., Methods: We conducted implementation research in two districts (Tiro Afata and Gera) in Jimma Zone, Ethiopia, to learn about the feasibility of implementing the WHO PSBI guideline within a programme setting using the existing health care structure. We conducted orientation meetings and policy dialogue with key stakeholders and trained health extension workers and health centre staff to identify and manage sick young infants with PSBI signs at a primary health care unit. We established a Technical Support Unit (TSU) to facilitate programme learning, built health workers' capacity and provided support for quality control, monitoring and data collection.We sensitized the community to appropriate care-seeking and supported the health care system in implementation. The research team collected data using structured case recording forms., Results: From September 2016 to August 2017, 6185 live births and 601 sick young infants 0-59 days of age with signs of PSBI were identified. Assuming that 25% of births were missed (total births 7731) and 10% of births had an episode of PSBI in the first two months of life, the coverage of appropriate treatment for PSBI was 77.7% (601/773). Of 601 infants with PSBI, fast breathing only (pneumonia) was recorded in 432 (71.9%) infants 7-59 days of age; signs of clinical severe infection (CSI) in 155 (25.8%) and critical illnessin 14 (2.3%). Of the 432 pneumonia cases who received oral amoxicillin treatment without referral, 419 (97.0%) were successfully treated without any deaths. Of 169 sick young infants with either CSI or critical illness, only 110 were referred to a hospital; 83 did not accept referral advice and received outpatient injectable gentamicin plus oral amoxicillin treatment either at a health post or health centre. Additionally, 59 infants who should have been referred, but were not received injectable gentamicin plus oral amoxicillin outpatient treatment. Of infants with CSI, 129 (82.2%) were successfully treated as outpatients, while two died (1.3%). Of 14 infants with critical illness, the caregivers of five accepted referral to a hospital, and nine were treated with simplified antibiotics on an outpatient basis. Two of 14 (14.3%) infants with critical illness died within 14 days of initial presentation., Conclusion: In settings where referral to a hospital is not feasible, young infants with PSBI can be treated on an outpatient basis at either a health post or health centre, which can contribute to saving many lives. Scaling-up will require health system strengthening including community mobilization., Registration: Trial is registered on Australian New Zealand Clinical Trials registry (ANZCTR) ACTRN12617001373369., Competing Interests: Rajiv Bahl and Yasir Bin Nisar are staff members of the World Health Organization. The expressedviews and opinions do not necessarily express the policies of the World Health Organization. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Purpose: The ischiofemoral distance (IFD), defined as the distance between the ischial tuberosity and the lesser trochanter of the femur, is gaining recognition as an extra-articular cause of hip pain. It is unknown whether the IFD is influenced by the frontal knee alignment. The aim of this study was to determine the influence of realignment surgery around the knee on the IFD. It was hypothesized that valgisation osteotomy around the knee is associated with reduction of the IFD., Methods: A consecutive series of 154 patients undergoing frontal realignment procedures around the knee in 2017 were included in this study. Long-leg standing radiographs were obtained before surgery and postoperatively. The IFD was measured between the ischium and the lesser trochanter at three different levels (proximal, middle and distal margins of the lesser trochanter parallel to the horizontal orientation of the pelvis) on standardized long-leg radiographs with the patient in upright standing position. The knee alignment was determined by measuring the hip knee ankle angle, mechanical lateral distal femur angle and the medial mechanical proximal tibia angle. Linear regression was performed to determine the influence of the change of frontal knee alignment on the IFD., Results: Linear regression showed a direct influence of the overall change in frontal knee alignment on the IFD of the hip, regardless of the site of the osteotomy (β-0.4, confidence-interval - 0.5 to - 0.3, p < 0.001). Valgisation osteotomy around the knee induced a significant reduction of the ipsilateral IFD (p < 0.001), while varisation osteotomy induced a significant increase (p < 0.001). The amount of ISD change was 0.4 mm per corresponding degree of change in frontal knee alignment., Conclusion: These findings are relevant to both the hip and knee surgeons when planning an osteotomy or arthroplasty procedure. Correction of a malalignment of the knee may resolve an ischiofemoral conflict in the hip. The concept deserves inclusion in the diagnostic workup of both the hip and knee joints., Level of Evidence: IV., (© 2021. The Author(s).)

The production of cement contributes to 10% of global carbon dioxide (CO 2 ) pollution and 74 to 81% towards the total CO 2 pollution by concrete. In addition to that, its low strength-to-weight ratio, high density and thermal conductivity are among the few limitations of heavy weight concrete. Therefore, this study was carried out to provide a solution to these limitations by developing innovative eco-friendly lightweight foamed concrete (LFC) of 1800 kg/m 3 density incorporating 20-25% palm oil fuel ash (POFA) and 5-15% eggshell powder (ESP) by weight of total binder as supplementary cementitious material (SCM). The influence of combined utilization of POFA and ESP on the fresh state properties of eco-friendly LFC was determined using the J-ring test. To determine the mechanical properties, a total of 48 cubes and 24 cylinders were prepared for compressive strength, splitting tensile strength and modulus of elasticity each. A total of 24 panels were prepared to determine the thermal properties in terms of surface temperature and thermal conductivity. Furthermore, to assess the environmental impact and eco-friendliness of the developed LFC, the embodied carbon and eco-strength efficiency was calculated. It was determined that the utilization of POFA and ESP reduced the workability slightly but enhanced the mechanical properties of LFC (17.05 to 22.60 MPa compressive strength and 1.43 to 2.61 MPa tensile strength), thus satisfies the ACI213R requirements for structural lightweight concrete and that it can be used for structural applications. Additionally, the thermal conductivity reduced ranging from 0.55 to 0.63 W/mK compared to 0.82 W/mK achieved by control sample. Furthermore, the developed LFC showed a 16.96 to 33.55% reduction in embodied carbon and exhibited higher eco-strength efficiency between 47.82 and 76.97%. Overall, the combined utilization of POFA and ESP as SCMs not only enhanced the thermo-mechanical performance, makes the sustainable LFC as structural lightweight concrete, but also has reduced the environmental impacts caused by the disposal of POFA and ESP in landfills as well as reducing the total CO 2 emissions during the production of eco-friendly LFC., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

With the commencement of the COVID19 pandemic, following its 1st case reported in Wuhan in China, the knowledge about the virus as well as the symptoms produced by the disease have drastically increased to this day. The manifestations of COVID19 is now known to affect multiple organ systems of the body, which have shown to have acute as well as chronic complications. Histopathological analysis of the biopsies from the affected organs have implied a direct cytopathic effect of the virus but at the same time not ruling out other causes like hypoxia metabolic changes etc., occurring during the course of the disease. In this review article, we have highlighted the histopathological changes in various organs as reported by various studies throughout the world for a better understanding of the etiopathogenesis of COVID19., (Copyright © 2021. Published by Elsevier GmbH.)

Development of strategies for removing heavy metals from aquatic environments is in high demand. Cadmium is one of the most dangerous metals in the environment, even under extremely low quantities. In this study, kenaf and magnetic biochar composite were prepared for the adsorption of Cd 2+ . The synthesized biochar was characterized using (a vibrating-sample magnetometer VSM), Scanning electron microscopy (SEM), X-ray powder diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), and X-ray photoelectron spectroscopy (XPS). The adsorption batch study was carried out to investigate the influence of pH, kinetics, isotherm, and thermodynamics on Cd 2+ adsorption. The characterization results demonstrated that the biochar contained iron particles that help in improving the textural properties (i.e., surface area and pore volume), increasing the number of oxygen-containing groups, and forming inner-sphere complexes with oxygen-containing groups. The adsorption study results show that optimum adsorption was achieved under pH 5-6. An increase in initial ion concentration and solution temperature resulted in increased adsorption capacity. Surface modification of biochar using iron oxide for imposing magnetic property allowed for easy separation by external magnet and regeneration. The magnetic biochar composite also showed a higher affinity to Cd 2+ than the pristine biochar. The adsorption data fit well with the pseudo-second-order and the Langmuir isotherm, with the maximum adsorption capacity of 47.90 mg/g.

Synthetic cilia-regulated transports through micro and nanofluidic devices guarantee an efficient delivery of drugs and other biological substances. Entropy analysis of cilia stimulated transport of thermally radiated hybrid nanofluid through an electroosmotic pump is conducted in this study. Joint effects of applied Lorentz force and Ohmic heating on the intended stream are also studied. Metachronal arrangements of cilia field coating channel inner side, are liable to generate current in the fluid. After using the lubrication and the Debye-Huckel estimations, numerical solutions of the envisioned problem are obtained. For pressure rise per metachronal wavelength, the pressure gradient is numerically integrated. The analysis reveals that high electric potential results in reducing the heat transfer effects in the flow system. The enhancement of flow is noticed near the channel surface for higher electroosmotic parameters. The irreversibility in the channel decreases when the Helmholtz-Smoluchowski velocity is applied in the opposite direction of the flow and thus produces the fluid friction irreversibility.

Aims: The follow-up interval of a study represents an important aspect that is frequently mentioned in the title of the manuscript. Authors arbitrarily define whether the follow-up of their study is short-, mid-, or long-term. There is no clear consensus in that regard and definitions show a large range of variation. It was therefore the aim of this study to systematically identify clinical research published in high-impact orthopaedic journals in the last five years and extract follow-up information to deduce corresponding evidence-based definitions of short-, mid-, and long-term follow-up., Methods: A systematic literature search was performed to identify papers published in the six highest ranked orthopaedic journals during the years 2015 to 2019. Follow-up intervals were analyzed. Each article was assigned to a corresponding subspecialty field: sports traumatology, knee arthroplasty and reconstruction, hip-preserving surgery, hip arthroplasty, shoulder and elbow arthroplasty, hand and wrist, foot and ankle, paediatric orthopaedics, orthopaedic trauma, spine, and tumour. Mean follow-up data were tabulated for the corresponding subspecialty fields. Comparison between means was conducted using analysis of variance., Results: Of 16,161 published articles, 590 met the inclusion criteria. Of these, 321 were of level IV evidence, 176 level III, 53 level II, and 40 level I. Considering all included articles, a long-term study published in the included high impact journals had a mean follow-up of 151.6 months, a mid-term study of 63.5 months, and a short-term study of 30.0 months., Conclusion: The results of this study provide evidence-based definitions for orthopaedic follow-up intervals that should provide a citable standard for the planning of clinical studies. A minimum mean follow-up of a short-term study should be 30 months (2.5 years), while a mid-term study should aim for a mean follow-up of 60 months (five years), and a long-term study should aim for a mean of 150 months (12.5 years). Level of Evidence: Level I. Cite this article: Bone Jt Open  2021;2(5):344-350.

Purpose: Osteotomies represent well-established treatment-options for the redistribution of loads and forces within and around the knee-joint. Effects of these osteotomies on the remaining planes and adjacent joints are not fully understood. The aim of this study was to determine the influence of a distal-femoral-rotation-osteotomy on the coronal alignment of the ankle. It was hypothesized that supracondylar-external-rotation-osteotomy of the distal femur leads to a change in the coronal orientation of the ankle joint., Methods: Long-leg standing radiographs and CT-based torsional measurements of 27 patients undergoing supracondylar-rotational-osteotomy of the femur between 2012 and 2019 were obtained and utilized for the purpose of this study. Postoperative radiographs were obtained after union at the osteotomy-site. The hip-knee-ankle-angle (HKA), the mechanical-lateral-distal-femur-angle (mLDFA), and Tibia-Plafond-Horizontal-Orientation-Angle (TPHA) around the ankle were measured. Comparison between means was performed using the Wilcoxon-Mann-Whitney test., Results: Twenty-seven patients with high femoral antetorsion (31.3° ± 4.0°) underwent supracondylar-external-rotation-osteotomy. The osteotomy led to a reduced antetorsion (17.4 ± 5.1; p < 0.001) and to a valgisation of the overall limb-alignment. The HKA decreased by 2.4° ± 1.4° (p < 0.001). The TPHA decreased by 2.6° (p < 0.001)., Conclusions: Supracondylar external rotation osteotomy of the femur leads to lateralization of the weight bearing line at the knee and ankle due to valgisation of the coronal limb alignment. The mobile subtalar joint has to compensate (inversion) for the resulting valgus orientation of the ankle to ensure contact between the foot and the floor. When planning a rotational osteotomy of the lower limb, this should be appreciated - especially in patients with a preexisting valgus alignment of the lower extremities or restricted mobility in the subtalar joint.

Purpose: To compare the 12-month efficacy of intravitreous aflibercept (IVA) injection between eyes with pachychoroid neovasculopathy and neovascular age-related macular degeneration (AMD)., Methods: Retrospective, comparative case series analysis. Twenty-seven eyes with pachychoroid neovasculopathy and sixty-three eyes with neovascular AMD. All patients received three initial monthly, followed by bimonthly, IVA injections., Results: Twelve months after initial treatment, the mean best-corrected visual acuity (BCVA) had improved both in pachychoroid neovasculopathy (from 0.28 to 0.14 logMAR; P = 0.001) and neovascular AMD (from 0.40 to 0.29 logMAR; P < 0.001). Twelve months after initial treatment, eyes with pachychoroid neovasculopathy exhibited decreased mean central retinal thickness (CRT) and subfoveal choroidal thickness (both, P < 0.001) and presence of polyps ( P = 0.039) and improved integrity of external limiting membrane (ELM) ( P = 0.008) and ellipsoid zone band ( P = 0.001). At the 12-month follow-up, 77% and 68% of eyes with pachychoroid neovasculopathy and neovascular AMD, respectively, exhibited dry macula ( P = 0.30). Baseline CRT was correlated with 12-month BCVA in eyes with pachychoroid neovasculopathy ( P = 0.02). In eyes with neovascular AMD, CRT ( P = 0.005) and presence of intact ELM ( P = 0.007) were significant predictors of 12-month BCVA., Conclusion: Periodic IVA injection leads to anatomical and functional improvement in eyes with pachychoroid neovasculopathy and in eyes with neovascular AMD., Competing Interests: None of the authors has a proprietary interest in any of the products described herein. Dr Manabu Miyata reports personal fees from Santen Pharmaceutical, personal fees from HOYA, grants from Alcon Japan, grants from Novartis Pharma, outside the submitted work. Dr Hiroshi Tamura reports personal fees from Novartis, grants from Findex, and personal fees from Suntory, outside the submitted work. Dr Akio Oishi reports personal fees from Bayer and non-financial support from Tokai Optical, outside the submitted work. The authors report no other conflicts of interest in this work., (© 2021 Elfandi et al.)

[Formula: see text] is the first successfully synthesized salt that has a polymeric nitrogen moeity ([Formula: see text]). Although 12 other [Formula: see text] salts followed, with [Formula: see text] and [Formula: see text] being the most stable, the crystal structure of [Formula: see text] remains unknown. Currently, it is impossible to experimentally determine the structures of [Formula: see text] due to its marginal stability and explosive nature. Here, following an ab initio evolutionary prediction and using only the stoichiometry of [Formula: see text] as a starting point, we were able to reveal the crystal structure of this high energy density material (HEDM). The [Formula: see text] symmetry of the [Formula: see text] cation, as suggested from earlier investigations, is confirmed to be the symmetry adopted by this polymeric nitrogen within the crystal. This result gave full confidence in the validity of this crystal prediction approach. While stability of the [Formula: see text] within the crystal is found to be driven by electronic considerations, the marginal stability of this HEDM is found to be related to a partial softening of its phonon modes.

Objective: Sternocleidomastoid tumor of infancy (SCMI) is a rare, benign self-limiting condition which occurs in the perinatal period. The goal of our study is to highlight clinicoradiological and cytopathological findings in these cases., Material and Methods: A study was done at a tertiary level hospital, from January 2016 to December 2019. Thirteen cases were studied, out of which 11 were clinically suspected cases of SCMI tumor and two cases were clinically suspected as cervical lymph node tuberculosis which were finally diagnosed as SCMI on fine needle aspiration cytology (FNAC) evaluation. Drs. N. K., S. Z., S. S. K., and S. R. independently reviewed the original diagnosis. Clinical, ultrasonographical, and cytopathological features are highlighted along with follow-up of the cases., Results: There were a total of 13 cases, out of which 11 cases were neonates and two cases were more than 1 month of age (2 months and 2.5 months). Male: female ratio was 10:3 and swelling was present more commonly on the right side of the neck. Ultrasonography predominantly showed non-cystic, bulky, and heterogenous echotexture of the sternocleidomastoid muscle. Smears were moderately cellular showing mainly singly scattered oval to spindle shaped fibroblasts along with degenerating and regenerating muscle fibers., Conclusion: FNAC along with adequate clinic-radiological correlation aids in early and reliable diagnosis and can help curtail complications., (© 2020 Wiley Periodicals LLC.)

The impact of lateral walls and partial slip with different waveforms on peristaltic pumping of couple stress fluid in a rectangular duct with different waveforms has been discussed in the current article. By means of a wave frame of reference the flow is explored travelling away from a fixed frame with velocity c. Peristaltic waves generated on horizontal surface walls of rectangular duct are considered using lubrication technique. Mathematical modelling of couple fluid for three-dimensional flow are first discussed in detail. Lubrication approaches are used to simplify the proposed problem. Exact solutions of pressure gradient, pressure rise, velocity and stream function have been calculated. Numerical and graphical descriptions are displayed to look at the behaviour of diverse emerging parameters.