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Summary: Background: Patients with atrial fibrillation (AF) frequently experience multimorbidity. Cluster analysis, a machine learning method for classifying patients with similar phenotypes, has not yet been used in South Asian AF patients. Methods: The Kerala Atrial Fibrillation Registry is a prospective multicentre cohort study in Kerala, India, and the largest prospective AF registry in South Asia. Hierarchical clustering was used to identify different phenotypic clusters. Outcomes were all-cause mortality, major adverse cardiovascular events (MACE), and composite bleeding events within one-year follow-up. Findings: 3348 patients were included (median age 65.0 [56.0–74.0] years; 48.8% male; median CHA2DS2-VASc 3.0 [2.0–4.0]). Five clusters were identified. Cluster 1: patients aged ≤65 years with rheumatic conditions; Cluster 2: patients aged >65 years with multi-comorbidities, suggestive of cardiovascular-kidney-metabolic syndrome; Cluster 3: patients aged ≤65 years with fewer comorbidities; Cluster 4: heart failure patients with multiple comorbidities; Cluster 5: male patients with lifestyle-related risk factors. Cluster 1, 2 and 4 had significantly higher MACE risk compared to Cluster 3 (Cluster 1: OR 1.36, 95% CI 1.08–1.71; Cluster 2: OR 1.79, 95% CI 1.42–2.25; Cluster 4: OR 1.76, 95% CI 1.31–2.36). The results for other outcomes were similar. Atrial fibrillation Better Care (ABC) pathway in the whole cohort was low (10.1%), especially in Cluster 4 (1.9%). Overall adherence to the ABC pathway was associated with reduced all-cause mortality (OR 0.26, 95% CI 0.15–0.46) and MACE (OR 0.45, 95% CI 0.31–0.46), similar trends were evident in different clusters. Interpretation: Cluster analysis identified distinct phenotypes with implications for outcomes. There was poor ABC pathway adherence overall, but adherence to such integrated care was associated with improved outcomes. Funding: Kerala Chapter of Cardiological Society of India.

Background: The split anconeus fascia transfer (SAFT) is an option for reconstruction of the lateral ulnar collateral ligament (LUCL) in chronic posterolateral rotatory instability (PLRI) of the elbow with potential advantages of using only local tissue within the surgical exposure and not requiring ulnar fixation. This study aimed to assess SAFT strength compared to a traditional free graft reconstruction in a PLRI biomechanical model. Methods: To measure biomechanical strength, eight cadaveric upper extremity pairs were utilized. Within each pair, one specimen was randomly assigned to LUCL reconstruction with autograft palmaris longus and the other to SAFT reconstruction. Torque load to failure was assessed on a load frame with the elbow in 30 degrees of flexion, 5 degrees of valgus, and 25 N axial load as the elbow was brought into external rotation. Torque load to failure was compared between the two reconstruction techniques. Results: No difference was found in the torque load to failure between SAFT specimens compared to palmaris longus autograft specimens (mean 14.6 ± 4.4 Nm vs. mean 11.3 ± 3.9 Nm; P = .16). Discussion: In this biomechanical study, the SAFT LUCL reconstruction provided torque load to failure similar to that of the traditional technique. These findings suggest that the SAFT technique warrants continued study as a biomechanically sound option for LUCL reconstruction in the setting of elbow PLRI.

The process of inclusion of carbon nanotubes as fibers in cement paste has been proved to have optimistic effect as it enhances the tensile property of cement paste composite. Coir fibers have exceptional mechanical qualities and are thus employed as reinforcement in cement composites. Epoxy resin, which has a high Young’s modulus, is an ideal component for bonding carbon nanotubes (CNTs) to coir fiber. This paper describes a novel kind of nanocomposite made of L-12 epoxy resin and CNTs at the nanolevel, along with coir fibers at the microlevel which operate as crack arrestors. To remove surface contaminants, coir fibers are first treated with sodium hydroxide (NaOH). Epoxy/CNTs polymer coatings were developed at varying CNTs fractions (0.05, 0.1, 0.15, and 0.2 wt.% of cement). Multiwalled CNTs were combined in distilled water, followed by epoxy resin and hardener (9 : 1 v/v) polymer in an ultrasonic sonicator for 90 min to ensure full dispersion of CNTs within the epoxy polymer. This blend is now coated on the treated clustered coir fiber (length 10 cm, 10 strands) and reinforced along the length of a cement composite beam 20 mm × 20 mm × 80 mm in size. Tensile and three-point tests were performed to evaluate the mechanical characteristics of the hybrid composite. The linear elastic finite element analysis is employed to distinguish their failure phenomena via fatigue or fracture behavior. The microstructure behavior and the effect of coating material on the coir fibers were investigated using scanning electron microscope and EDX analysis. The reinforcing impact of nanopolymer coated coir fiber in cement composite diminished the tensile and flexural strength after 0.1 wt.% of CNT fraction but increased the composite’s durability and Young’s modulus. Fourier transform infrared spectroscopy analysis was carried out to assess the chemical interaction between the epoxy/CNTs and the coir fibers. The simulation was performed using ANSYS workbench, and the modeling results were within an acceptable 10% range of the experimental data. Nevertheless, it can be concluded that the hybrid composite is capable of enhancing the composite’s stress and strain capacity by regulating the fracture propagation process at the crack’s end.

Background: Role of continuous infusion of local anesthetic drug in the transverse abdominal plane using a catheter inserted during the surgical closure of the wound has not been evaluated as a “sole technique” in patients undergoing open nephrectomy. Thus we designed this prospective, randomized comparative study to evaluate this aspect. Aim and Objectives: To compare the efficacy of continuous surgical transverse abdominal plane block with intravenous fentanyl infusion in open nephrectomies. The primary outcomes were post-operative tramadol consumption, pain at rest and pain while coughing. The secondary outcomes were the level of sedation, time to mobilize, and the incidence of wound infection. Material and Methods: Fifty patients undergoing elective open nephrectomy were randomly divided into two equal groups to either receive intravenous fentanyl infusion (Group A), or continuous infusion of bupivacaine in the transversus abdominis plane through a surgically inserted catheter (Group B). The independent sample t-test was applied for numerical variables, while one way Analysis of Variance (ANOVA) repeated measure was used for analyzing the continuous variables. Chi-square and Fisher's exact tests were the tools used for analyzing the dichotomical variables. Results: Tramadol consumption, pain while resting, and pain during coughing were significantly lower in Group B (p

Background: Physical activity is associated with many health benefits like maintaining weight and decreased risk factors for Non-communicable Diseases. Physical inactivity is seen as prevalent among students who have a higher workload especially students in the medical field. Lack of physical activity in students could be one of the reasons for low performance in academics as well as other day-to-day activities Objective: Among the students of a medical college in Dakshina Kannada district in April 2023: to assess levels of physical activity and to determine the barriers to physical activity. Methodology: A cross sectional study recruiting 256 medical students chosen equally from each admission year (4 years) by Stratified Random Sampling with gender. Study duration was 6 months. Global Physical Activity Questionnaire (GPAQ) was used to obtain data. Data collected were entered in Microsoft Excel and reported as frequency and proportions. METs (Metabolic Equivalents) were calculated that are used to express the intensity of physical activities. Results: Most participants were in the age group of 18-24. Less than 4 out of 5 students exhibited lower recommended WHO physical activity. Conclusion: Despite a majority falling within the 18-24 age range and diverse parental education backgrounds, a significant proportion fails to meet WHO recommendations. Identified barriers emphasize need for targeted interventions. The study highlights how critical it is to address these problems in order to encourage medical students to lead more active lives.

Background: Small changes in deltoid tension and moment arm due to glenosphere lateralization may be associated with an increase in acromion or scapular spine strain in reverse shoulder arthroplasty (RSA), which can lead to stress fracture. The coracoacromial ligament (CAL) may be protective and lower the strain seen on the acromion or scapular spine. This biomechanical study investigated the impact of glenosphere lateralization and CAL integrity on acromion and scapular spine strain after RSA. Methods: Ten cadaveric specimens were tested on a custom dynamic shoulder frame. Acromial and scapular spine strain were measured at 0°, 30°, and 60° of abduction using strain rosettes fixed to the acromion (Levy Type 2) and the scapular spine (Levy Type 3). Specimens were first tested with a standard commercially available RSA implant with zero lateralization and then subsequently with the +3 and +6 lateralizing glenospheres for that implant. The CAL was then cut in each specimen and testing was repeated with the 0, +3, and +6 glenospheres. Maximal strain was recorded at both the acromion and scapular spine and analysis of variance compared strain across various abduction angles and glenospheres with and without CAL transection. Results: In the intact CAL group, maximal strain decreased significantly at the acromion with abduction from 0° to 30° and 0° to 60°, however, at the scapular spine abduction did not significantly impact strain. Maximal strain decreased significantly with increasing abduction from 0 to 30 and 0 to 60 at both the acromion and scapular spine in the cut CAL group. Average strain at the acromion was significantly higher in the cut group (844.7 με) versus the intact group (580.3 με), a difference of 31.3% (P = .0493). Average strain at the scapular spine, did not differ in the cut group (725 με) compared with the intact group (787 με) (P = .3666). There were no statistically significant differences in acromial or scapular spine strain between various levels of glenosphere lateralization in either the cut or intact state. Conclusion: In this biomechanical study, arm abduction decreased acromial and scapular spine strain following RSA. Cutting the CAL significantly increased strain at the acromion, and did not significantly alter strain at the scapular spine for all angles of abduction, differing from prior literature. Glenosphere lateralization did not have a significant effect on strain at the levels studied regardless of CAL status. Continued study of the complexion relationship between surgical and implant factors on strain following RSA is needed.

Abstract Combustion of char has conventionally been reported to be diffusion controlled. Analytically, the process is reported to follow second order initial diametric ( $$d_0$$ d 0 ) dependence $$(d_0^\beta ; \beta =2)$$ ( d 0 β ; β = 2 ) for both single-film (no CO combustion) and two-film models (CO burns in a concentric sphere over the particle). However, experimental investigations indicate deviation from classical diffusion limit with $$\beta$$ β exceeding 2.00 and going as high as 2.37. Videography investigations depict luminous film engulfing the particle for certain Temperature-Oxygen concentration-Particle diameter combinations (for which, $$\beta \ge 2$$ β ≥ 2 ). The observed deviation is hypothesized to convective resistance offered by the CO generated on the surface to motion of $$CO_2$$ C O 2 towards the surface. This results in reduced $$CO_2$$ C O 2 concentration at the surface with enhanced conversion time being the implication (hence, $$\beta >2$$ β > 2 ). Such convective resistance remains unaccounted for in the prevailing analytical models. The CO dominated film thickness is enhanced with temperature and reactant concentration, increasing the convective resistance, and further deviating from $$d_0^2$$ d 0 2 behaviour. The analytical solution shows that in presence of a convectively expanding CO film, total conversion time is a function of film diameter while also being dependent on $$d_0^2$$ d 0 2 . The hypothesis is validated by comparing analytical estimates with experimentally observed film diameter and conversion time.

The impact factor (IF) assessment of a four-span non-prismatic continuous and an equivalent integral railway bridge under the action of high-speed moving train loads is conducted in this study. Critical analysis of the full-scale three-dimensional finite element (FE) bridge models is done to investigate the differences in the IFs of all the spans of the two-track railway bridge under various loading conditions. A simplified approach is proposed to identify the dynamic IF values. The results show that for a continuous bridge, with the increase in the load on the bridge, IF coefficients reduce from 0.195 to 0.102. However, for the integral bridge, and considered loading conditions, almost similar IF coefficients (0.100) are obtained. For the intermediate spans, the resonance phenomenon for the integral bridge is achieved at lower speeds compared to the equivalent continuous bridge.

Here, a highly efficient and inexpensive technique to fabricate silver dendritic nanostructures with unique numerous lateral branches has been demonstrated. The study utilized the metal-assisted growth (MAG) technique, which is a simple, one-step technique that allows exact control over the size and morphology of the generated dendrites. The prepared dendrites are characterized using various techniques and the fabrication mechanism is well explored. The final synthesized Ag dendrites are then utilized to detect in-house cultured E. coli. cells using surface-enhanced Raman scattering (SERS) activity. The proposed reason for their superior SERS performance is due to the contribution from the large amount of plasmon-active ‘hotspots’ present in dendritic structures at the sharp edges enhancing the nearby local electromagnetic fields. The proposed work suggests Ag dendritic nanostructures as a potential candidate for SERS-based applications.

Background: Increased levels of serotonin secretion are associated with mesenteric fibrosis (MF) in small intestinal neuroendocrine tumors (SI-NETs ). However, the profibrotic potential of serotonin differs between patients, and in this study, we aimed to gain an understanding of the mechanisms underlying this vari ability. To this end, we analyzed the proteins involved in tryptophan metabolism in SI-N ETs. Methods: Proteomes of tumor and stroma from primary SI-NETs and paired mesenteric metastases of patients with MF (n = 6) and without MF (n = 6) were identified by liquid chromatography–mass spectrometry (LC-MS). The differential expression of proteins involved in tryptophan metabolism between patients with and wit hout MF was analyzed. Concurrently, monoamine oxidase A (MAO-A) expression was analyz ed in the tumor and stromal compartment by immunohistochemistry (IHC) and reported as intensity over area (I/A). Results: Of the 42 proteins involved in tryptophan metabolism, 20 were detected by LC-MS. Lower abundance of ten proteins was found in mesenteric metastases stroma in patients with MF. No differential expression was found in pri mary SI-NETs. In patients with MF, IHC showed lower MAO-A expression in the stroma of the primary SI-NETs (median 4.2 I/A vs 6.5 I/A in patients without MF, P = 0.003) and mesenteric metastases (median 2.1 I/A vs 2.8 I/A in patients without MF, P = 0.019). Conclusion: We found a decreased expression of tryptophan and serotonin-met abolizing enzymes in the stroma in patients with MF, most notably in the mesenteric stroma. This might account for the increased profibrotic potential of se rotonin and explain the variability in the development of SI-NET-associated fibrotic com plications.

Intentional ingestion of organophosphorus compound (OP) poisoning continues to be a frequent reason for critical care admission in India. For the past 6 decades, the OP compounds used in India for the poisoning had effects on cholinergic and neurogenic fibers producing the respiratory and neurologic presentation. Recently, a less frequent OP poison has appeared which acts on cardiac sympathetic fibers with bradycardia and hypotension as presenting features. The shock which was nonresponsive to dopamine/dobutamine was identified as a major cause of death in patients with dimethoate poisoning in a large prospective cohort study. Severe dimethoate poisoning in contrast to other OP compounds has a high case fatality rate. There have been case reports from outside India. We report the first two cases with successful treatment of this toxicity in India.

Background: Weight loss can induce changes in appetite-regulating hormone levels, possibly linked to increases in appetite and weight regain. However, hormonal changes vary across interventions. Here, we studied levels of appetite-regulating hormones during a combined lifestyle intervention (CLI: healthy diet, exercise and cognitive behavioral therapy).Methods: We measured levels of long-term adiposity-related hormones (leptin, insulin, high-molecular-weight (HMW) adiponectin) and short-term appetite hormones (PYY, cholecystokinin, gastric-inhibitory polypeptide, pancreatic polypeptide, FGF21, AgRP) in overnight-fasted serum of 39 patients with obesity. Hormone levels were compared between T0 (baseline), T1 (after 10 weeks) and T2 (end of treatment, 1.5 years). T0-T1 hormone changes were correlated with T1-T2 anthropometric changes.Results: Initial weight loss at T1 was maintained at T2 (−5.0%, p < 0.001), and accompanied by decreased leptin and insulin levels at T1 and T2 (all p < 0.05) compared to T0. Most short-term signals were not affected. Only PP levels were decreased at T2 compared to T0 (p < 0.05). Most changes in hormone levels during initial weight loss did not predict subsequent changes in anthropometrics, except for T0-T1 decreases in FGF21 levels and T0-T1 increases in HMW adiponectin levels tended to be associated with larger T1-T2 increases in BMI (p < 0.05 and p = 0.05, respectively).Conclusion: CLI-induced weight loss was associated with changes in levels of long-term adiposity-related hormones towards healthy levels, but not with orexigenic changes in most short-term appetite signals. Our data indicates that the clinical impact of alterations in appetite-regulating hormones during modest weight loss remains questionable. Future studies should investigate potential associations of weight-loss-induced changes in FGF21 and adiponectin levels with weight regain.

A study of 43 cases of suspected congenital diseases of heart was performed in Sahyadri Hospital, Pune, over a period of 5 to 6 years with dual source computed tomography (CT) in adolescents as well as children. Only the images of anomalies of pulmonary veins are presented.

Category: Sports; Ankle; Other Introduction/Purpose: Surgical treatment of chronic lateral ankle instability (CLAI) with the Modified Brostrom-Gould (MB) procedure and suture tape ligament augmentation (+ST) has proven to be biomechanically and clinically successful. A concern regarding the MB + ST procedure is increased surgical costs and additional operating room time. To date, there are no available studies in the literature evaluating the cost-effectiveness of suture tape ligament augmentation of the Modified Brostrom-Gould procedure. The purpose of the present study is to evaluate and report the cost-effectiveness of the Modified Brostrom-Gould procedure, with and without suture tape ligament augmentation. Methods: This study followed the consensus-based recommendations made by the Panel on Cost-Effectiveness in Health and Medicine. The base case was assumed to be a healthy individual with symptomatic CLAI following recurrent ankle sprains requiring surgical intervention. The standard MB technique utilized two 2.4 mm BioComposite SutureTak anchors for direct anatomic repair of the disrupted anterior talofibular and calcaneofibular ligaments. This treatment was then compared to the Modified Brostrom-Gould procedure with the addition of suture tape ligament augmentation (MB + ST). A Markov Model was designed to evaluate the cost-effectiveness of the MB + ST procedure. Model input variables and parameters were derived from a prospective randomized clinical study which described the rate of return to previous activity level at 26 weeks postoperatively for the MB and MB + ST groups. Direct and indirect surgical costs were incorporated into the model to provide an accurate financial assessment of both procedures. Results: When only direct surgical costs were considered, the total cost of MB was $2,318.88 and the total effectiveness was 0.91 quality-adjusted-life-years (QALY) over the 26-week period. The total cost for MB + ST was $4,004.93 and the total effectiveness was 0.98 QALY's. Patients in the MB + ST group spent, on average, $1,686 more than those in the MB group, with a higher quality of life by 0.07 QALYs. To evaluate the impact of indirect surgical costs, a sensitivity analysis was performed which measured the additional costs associated with physical therapy and time off work. Patients in the MB group incurred an increased physical therapy cost of $4,212 assuming 4.2 extra weeks of treatment. Assuming those in the MB group returned to full duty work 4.2 weeks later than those in the MB + ST group, this resulted in a net loss of approximately $5,413.80 in wages. Conclusion: In the early postoperative period following lateral ligament reconstruction for CLAI, MB + ST technique yields a higher quality of life and lower overall expense despite a higher direct surgical cost when compared to MB alone. The cost effectiveness of the MB + ST technique was further supported through a sensitivity analysis which revealed that as indirect surgical costs were incorporated into the model, MB + ST became an even more cost effective option. This cost-effectiveness analysis adds to the growing literature in support of suture tape augmentation for the Modified Brostrom-Gould procedure.

Category: Ankle Arthritis; Ankle Introduction/Purpose: The availability of fourth-generation ankle replacements has burgeoned over the past several years. These ankle replacements benefit from improved surgical technique, respect for bony preservation, and increased surgeon awareness of operative indications. Documentation of implant survivability and comparison studies of the latest generation implants are limited. The purpose of this study is report on prospectively collected patient reported outcome measures (PROMs) in a multi-institutional study of a fourth-generation total ankle. Methods: Patients presenting for a total ankle replacement at 9 institutions were prospectively enrolled and implanted in both academic and private settings. Each patient received an INFINITY ankle prothesis (Stryker, Memphis, TN, USA) Patients had demographics and PROMs recorded pre-operatively and at 6 month, 12 months, and 24- month intervals. The following PROMs were collected: Ankle Osteoarthritis Score (AOS), PROMIS Global Physical Health, Foot and Ankle Outcome Score (FAOS), and satisfaction scores. The preoperative and latest follow-up scores for patients with two years of follow-up were analyzed. Results: A total of 147 patients were enrolled :(54.7% male) average age of 64.2 +- 9.4 years old, average BMI of 31.0 +- 5.2. pre- operative diagnosis for arthritis type was degenerative arthritis (48.7%), rheumatoid arthritis (2.7), post-traumatic arthritis (47.9%), and other (0.70%). Thirty-seven percent of patients had previously undergone surgery at the index joint. Eighty-eight patients had at least two years of follow-up. There were 3 (1.3%) clinical failures:(2 with aseptic tibial component loosening: at months 17 and 21, and 1 tibial subsidence at month 14). The patients improved in all PROMs domains at two years including: Mean Total AOS (17.2 +- 18.3, p

Category: Ankle Arthritis Introduction/Purpose: Fourth generation ankle replacements benefit from improved surgical technique, respect for bony preservation, and increased surgeon awareness of operative indications. In some studies, pre-operative degree of deformity has been reported to influence survivorship, pain, and functional outcomes. The purpose of this multi-institutional study was to evaluate whether pre- operative deformity affects prospectively collected patient reported outcome measures (PROMs) of a fourth-generation total ankle replacement. Methods: Patients presenting for a total ankle replacement at 9 institutions were prospectively enrolled and implanted in a variety of academic and private settings. Each patient received an INFINITY ankle prosthesis. (Styker, Memphis, TN, USA). The degree of deformity was radiographically classified pre-operatively as severe if ankle varus or valgus was greater than 10° in the coronal plane. PROMs were recorded pre-operatively and at 6 months, 12 months, and 24-month intervals. The following PROMs were collected: Ankle Osteoarthritis Score (AOS), PROMIS Global Physical Health, and Foot and Ankle Outcome Score (FAOS). The preoperative and latest follow-up scores for patients with two years of follow-up were analyzed. Results: A total of 147 patients were enrolled in the study. Fifty-two patients exhibited a pre-operative ankle deformity of greater than 10° varus or valgus. Eighty-eight patients had 24 months of follow-up. All patients with severe deformity had significant improvements in all domains of the AOS, PROMIS, and FAOS Scores (p

Category: Ankle Arthritis; Ankle Introduction/Purpose: Fourth generation ankle replacements benefit from improved surgical technique, respect for bony preservation, and increased surgeon awareness of operative indications. In order to better compare and stratify pre-operative ankle arthritis patients, the Canadian Orthopaedic Foot and Ankle (COFAS) pre-operative classification for end-stage ankle arthritis score was developed. The purpose of this study is report on how the COFAS scores effects prospectively collected patient reported outcome measures(PROMs) in a multi-institutional study of a fourth-generation total ankle replacement. Methods: Patients presenting for a total ankle replacement at 9 institutions were prospectively enrolled and implanted in both academic and private settings. Each patient received an INFINITY ankle prosthesis (Stryker, Memphis, TN, USA). Patients had their COFAS pre-operative classification for end-stage ankle arthritis scores, and PROMs recorded pre-operatively and at 6 months,12 months, and 24-month intervals. The following PROMs were collected: Ankle Osteoarthritis Score (AOS), PROMIS Global Physical Health, and Foot and Ankle Outcome Score (FAOS). The preoperative and latest follow-up scores for patients with two years of follow-up were analyzed. Results: A total of 147 patients were prospectively enrolled. for study participation. COFAS types; were delineated as Type 1 (42.6%, isolated ankle arthritis), Type 2 (27.0%, ankle arthritis with varus or valgus deformity, tight Achilles, ankle instability), Type 3(4.7%, ankle arthritis with hindfoot deformity, tibial malunion), and Type 4 (25.8%, Types 1-3, plus hindfoot arthritis). Eighty-eight (88) patients had at least 24 months of follow-up. COFAS Types 1, 2, 3, and 4 patients had significant improvements in all domains of the AOS, PROMIS, and FAOS Scores (p

Manish Anand, Shreya Panwar Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, IndiaCorrespondence: Manish AnandDepartment of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College, Alapakkam, Chennai, Tamil Nadu, 600056, IndiaTel +91 8056246581Email manishanand028@gmail.comAbstract: Surgeries related to the maxillofacial area deal with an intricate network of anatomical structures. With the complexity of the vital structures, it necessitates a surgical team to respect each anatomical boundary. In the past, there was an exceptionally high number of cases with surgical errors. These errors were not because of flaws in the surgeon’s skills or techniques but owing to lack of resources. Visualisation is one of the key factors that determines the precision of any surgical outcome. Advances in surgical planning have led to the introduction of a “Navigation” system that helps surgeons to see more, know more and ultimately do more for their patients. The usefulness of the navigation system in oral surgeries has been indicated by its surgical applications in craniomaxillofacial trauma, orthognathic surgeries, head and neck pathological resections, complex skull base surgeries and surgery involving temporomandibular joint. A vast majority of research literature has suggested remarkable improvement in surgical outcomes under the guidance of 3d planning and navigation. However, with such an inordinate advancement, financial expenses and a gradual learning curve are always a constraining factor in surgical navigation. This article overviews indication of navigation in craniofacial surgeries with a focus on applied aspect, planning and solution to the future problem.Keywords: navigation, computer-assisted surgeries, craniomaxillofacial, orthognathic, trauma

Introduction: Hypertension is considered as one of the major health problem worldwide and the most important risk factor for non-communicable diseases. Aims: To estimate the prevalence and the risk factors of prehypertension and hypertension. Methods and Material: A community-based cross-sectional study was conducted among adult population of rural area of Chittoor District. WHO STEPS was applied for data collection from 1,742 study participants aged 18 years and above. Chi-square test, Fisher exact, and ANOVA test applied to find out the intragroup and intergroup variable association with raised blood pressure. Results: The overall prevalence of hypertension and prehypertension in our study was 21.5% [95% CI: (19.6–23.5)] and 42.8% [95% CI: (39.5–46.3)], respectively. Males had higher prevalence when compared to females. The mean systolic and diastolic blood pressure was 118.7 ± 17.6 mmHg and 77.1 ± 9.7 mmHg, respectively. The odds of being hypertensive was higher among older age group (OR: 3.83), male study participants (OR: 1.83), either widowed or separated (OR: 2.03), unemployed (OR: 1.51), and those who belonged to upper socioeconomic status (OR: 2.01). Those who were overweight (OR: 3.15), obese (OR: 2.55) and having central obesity (OR: 1.74), and also tobacco smokers (OR: 1.53) were having higher odds of hypertension. Significant association was found between hypertension and age, gender, marital status, body mass index, abdominal obesity, tobacco smoking, and physical inactivity. Conclusion: The prevalence of prehypertension and hypertension in this study was found to be high in rural area of Andhra Pradesh. There is a need to develop a community-based program, which would aim at minimizing the risk factors of hypertension.

Mohan, Abdulhalim and Cvelbar investigated the capabilities of different plasmonic-based sensing techniques including the surface plasmon resonance (SPR), localised SPR, surface-enhanced Raman scattering (SERS), surface-enhanced fluorescence (SEF) and surface-enhanced infrared absorption spectroscopy (SEIRA) for the detection of viruses. The presented data will assist in the development of novel and versatile virus biosensors.

Background: We report patient characteristics, treatment pattern and one-year clinical outcome of nonvalvular atrial fibrillation (NVAF) from Kerala, India. This cohort forms part of Kerala Atrial Fibrillation (KERALA-AF) registry which is an ongoing large prospective study. Methods: KERALA-AF registry collected data of adults with previously or newly diagnosed atrial fibrillation (AF) during April 2016 to April 2017. A total of 3421 patients were recruited from 53 hospitals across Kerala state. We analysed one-year follow-up outcome of 2507 patients with NVAF. Results: Mean age at recruitment was 67.2 years (range 18–98) and 54.8% were males. Main co-morbidities were hypertension (61.2%), hyperlipidaemia (46.2%) and diabetes mellitus (37.2%). Major co-existing diseases were chronic kidney disease (42.1%), coronary artery disease (41.6%), and chronic heart failure (26.4%). Mean CHA2DS2-VASc score was 3.18 (SD ± 1.7) and HAS-BLED score, 1.84 (SD ± 1.3). At baseline, use of oral anticoagulants (OAC) was 38.6% and antiplatelets 32.7%. On one-month follow-up use of OAC increased to 65.8% and antiplatelets to 48.3%. One-year all-cause mortality was 16.48 and hospitalization 20.65 per 100 person years. The main causes of death were cardiovascular (75.0%), stroke (13.1%) and others (11.9%). The major causes of hospitalizations were acute coronary syndrome (35.0%), followed by arrhythmia (29.5%) and heart failure (8.4%). Conclusions: Despite high risk profile of patients in this registry, use of OAC was suboptimal, whereas antiplatelets were used in nearly half of patients. A relatively high rate of annual mortality and hospitalization was observed in patients with NVAF in Kerala AF Registry.

Background: Periodontitis is conventionally treated with both surgical and nonsurgical methods. Various adjuncts have been used previously with compromised efficacy. Recently omega-3(ώ-3) polyunsaturated fatty acids (PUFA) including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) were shown to have therapeutic anti-inflammatory and protective actions in inflammatory diseases including periodontitis. The purpose of the present study was to evaluate and compare the clinical efficacy of ώ-3 fatty acids as an adjunct to scaling and root planing in the treatment of periodontitis. Methods: 110 Patients were selected for the study out of which 20 were excluded (12 not meeting the inclusion criteria and 8 refused to participate). 90 patients (48 in test and 42 in the control group) after randomisation through a coin toss method were enrolled in a single-blind randomised controlled trial conducted in the Periodontics department of a dental college. Full mouth subgingival scaling and root planing and ώ-3 fatty acid 500 mg (EPA/DHA 180/120 mg), BD daily for 1 month was given to the test group and subgingival scaling and root planing only was given to the control group. Clinical parameters like probing pocket depth, clinical attachment level, plaque index and gingival index were recorded at baseline, 1 and 3 months and were compared. Results: Statistical analyses demonstrated a significant reduction in probing pocket depth (t = 65.56, P = 0.000) and (t = 51.69, P = 0.000) at 1 and 3 months, respectively, in test group compared to baseline and control group. There was a significant gain in clinical attachment level (t = 63.29, P = 0.000) and (t = 31.03, P = 0.000) at 1 and 3 months, respectively, in test group compared to baseline and control group. The gingival index shows an appreciable reduction in both groups, and in test group, it is statistically significant at 3 months (t = 2.15, P = 0.03). There was no statistical significant reduction in plaque index at 3 months (t = 0, P = 0.997). Conclusion: The present study showed that adjunctive use of ώ-3 fatty acids proved to be beneficial over scaling and root planing alone in the treatment of chronic moderate periodontitis. The beneficial effects were in terms of significant improvements in clinical parameters, probing pocket depth, and clinical attachment level and gingival index. Dietary modulation is now emerging as an adjunct to periodontal therapy. Hence, omega-3 fatty acid may be used routinely in the management of chronic periodontitis.

Introduction: Japanese encephalitis (JE) is a vector-borne, viral illness caused by the Japanese Encephalitis Virus. Permanent neurologic or psychiatric sequelae can occur in 30%–50% of those with encephalitis; hence, JE is a cause of major public health concern. For the ease of diagnosis and facilitation of surveillance, National Vector Borne Disease Control Programme uses the term Acute Encephalitis Syndrome (AES). In this study, an attempt has been made to ascertain the status and trends of AES and JE in Uttar Pradesh, India. Methodology: This is a record-based retrospective study. The data were obtained from the Directorate of Medical and Health Services of Uttar Pradesh and analyzed using software SPSS version 24.0. Results: In Uttar Pradesh, there were 47,509 reported cases of AES from 2005 to 2018,. With yearly fluctuations, the average Case Fatality Rate of AES was 17.49% with highest in 2005 (24.76%) and lowest in 2018 (8%). Among the patients with AES, 9.98% were found positive for JE. The most commonly affected age group is 1-5 years for both AES and JE, closely followed by the age group of 5-10 years. Peak occurrence of both AES and JE was recorded in month of September. Among the AES-affected patients 53.8% were males and 46.2% were females. Conclusion: The most commonly affected age group was 1-5 years with peak occurrence in the month of September. Though there was a downward trend in CFR, awareness activities like “Dastak” campaign and intersectoral preventive activities, needs to be strengthened.

The primary objective of the research was to investigate the ideal resin coating on the mild steel surface among various resin coatings which are in use. These resin coatings are used as an anti-corrosive material for mild steel surfaces with enhanced mechanical properties. The resins (epoxy, polyurethane, polyester, and phenolic) on mild steel surface were applied by the pneumatic spray coating method. In addition, immersion test and salt spray test methods were followed using sodium chloride (NaCl) solution. Furthermore, the rate of corrosion and mechanical properties of mild steel coated with different resins was evaluated by conducting various experiments (immersion test, salt spray test, tensile strength test, and scratch hardness test) and was compared with a bare mild steel surface. The results of the current research showed that the mild steel surface coated with epoxy resin was found to be the most effective corrosion resistance material with better mechanical properties compared to other tested mild steel resin-coated surfaces.

Ellipsometric Surface Plasmon Resonance (SPR) sensors are known for their relatively simple optical configuration compared to interferometric and optical heterodyne phase interrogation techniques. However, most of the previously explored ellipsometric SPR sensors based on intensity measurements are limited by their real-time applications because phase or polarization shifts are conducted serially. Here we present an ellipsometric SPR sensor based on a Kretschmann–Raether (KR) diverging beam configuration and a pixelated microgrid polarization camera. The proposed methodology has the advantage of real-time and higher precision sensing applications. The short-term stability of the measurement using the ellipsometric parameters tanψ and cos(Δ) is found to be superior over direct SPR or intensity measurements, particularly with fluctuating sources such as laser diodes. Refractive index and dynamic change measurements in real-time are presented together with Bovine Serum Albumin (BSA)–anti-BSA antibody binding to demonstrate the potential of the developed sensor for biological sensing applications with a resolution of sub-nM and down to pM with additional optimization. The analysis shows that this approach may provide the ultimate detection limit for SPR sensors.

Abstract Armed conflicts are a pervasive global threat, but their implications for wildlife conservation remain unclear. Using a 30‐year spatial dataset of armed conflicts in conjunction with species range maps, we found that conflicts during 1989–2018 occurred within at least 4291 (78%) and 9056 (85%) terrestrial mammal and bird species ranges, respectively. For 4% overall and 5–7% of threatened species, conflicts within ranges have been both widespread (≥50% of range) and frequent (≥15 years). Further, an examination of International Union for Conservation of Nature Red List assessments revealed that ranges overlap with armed conflicts is associated with declining population trends of threatened species and distinct species threat portfolios in which hunting and habitat loss and degradation are more prominent. Our findings call for greater recognition and understanding of direct and indirect threats from armed conflicts in species conservation assessments and underscore the importance of addressing conflict resiliency in conservation plans for a wide suite of species.

Analysis of pulmonary function tests (PFTs) is an area where machine learning (ML) may benefit clinicians, researchers, and the patients. PFT measures spirometry, lung volumes, and carbon monoxide diffusion capacity of the lung (DLCO). The results are usually interpreted by the clinicians using discrete numeric data according to published guidelines. PFT interpretations by clinicians, however, are known to have inter-rater variability and the inaccuracy can impact patient care. This variability may be caused by unfamiliarity of the guidelines, lack of training, inadequate understanding of lung physiology, or simply mental lapses. A rules-based automated interpretation system can recapitulate expert’s pattern recognition capability and decrease errors. ML can also be used to analyze continuous data or the graphics, including the flow-volume loop, the DLCO and the nitrogen washout curves. These analyses can discover novel physiological biomarkers. In the era of wearables and telehealth, particularly with the COVID-19 pandemic restricting PFTs to be done in the clinical laboratories, ML can also be used to combine mobile spirometry results with an individual’s clinical profile to deliver precision medicine. There are, however, hurdles in the development and commercialization of the ML-assisted PFT interpretation programs, including the need for high quality representative data, the existence of different formats for data acquisition and sharing in PFT software by different vendors, and the need for collaboration amongst clinicians, biomedical engineers, and information technologists. Hurdles notwithstanding, the new developments would represent significant advances that could be the future of PFT, the oldest test still in use in clinical medicine.

We report a case of a patient operated for shoulder rotator cuff injury under interscalene brachial plexus block and general anesthesia, who developed neurological deficit in the nonoperative upper limb in the immediate postoperative period. As our patient developed neurological deficit on the nonoperative side, it was clear from the beginning that neither the nerve block nor the operative procedure was responsible for it. However, had he developed neurological symptoms on the operative side after having a peripheral nerve block, it would have possibly delayed the timely investigation and diagnosis. This case report underlines the need to keep an open mind when investigating neurological symptoms arising in the perioperative period, rather than assuming it to be secondary to either nerve block or as a complication of surgical procedure.

Tuberous sclerosis complex (TSC) is a rare multi-system genetic disorder characterized by a high incidence of epilepsy and neuropsychiatric manifestations known as tuberous-sclerosis-associated neuropsychiatric disorders (TANDs), including autism spectrum disorder (ASD) and intellectual disability (ID). MicroRNAs (miRNAs) are small regulatory non-coding RNAs that regulate the expression of more than 60% of all protein-coding genes in humans and have been reported to be dysregulated in several diseases, including TSC. In the current study, RNA sequencing analysis was performed to define the miRNA and isoform (isomiR) expression patterns in serum. A Receiver Operating Characteristic (ROC) curve analysis was used to identify circulating molecular biomarkers, miRNAs, and isomiRs, able to discriminate the development of neuropsychiatric comorbidity, either ASD, ID, or ASD + ID, in patients with TSC. Part of our bioinformatics predictions was verified with RT-qPCR performed on RNA isolated from patients’ serum. Our results support the notion that circulating miRNAs and isomiRs have the potential to aid standard clinical testing in the early risk assessment of ASD and ID development in TSC patients.

The electrocatalytic CO2 reduction reaction (CO2RR) is considered as one of the most promising approaches to synthesizing carbonaceous fuels and chemicals without utilizing fossil resources. However, current technologies are still in the early phase focusing primarily on identifying optimal electrode materials and reaction conditions. Doped graphene-based materials are among the best CO2RR electrocatalysts and in the present work we have performed a computational screening study to identify suitable graphene catalysts for CO2RR to CO under alkaline conditions. Several types of modified-graphene frameworks doped with metallic and non-metallic elements were considered. After establishing thermodynamically stable electrodes, the electrochemical CO2RR to CO is studied in the alkaline media. Both concerted proton-coupled electron transfer (PCET) and decoupled proton and electron transfer (ETPT) mechanisms were considered by developing and using a generalization of the computational hydrogen electrode approach. It is established that the CO2 electrosorption and associated charge transfer along the ETPT pathway are of utmost importance and significantly impact the electrochemical thermodynamics of CO2RR. Our study suggests an exceptional performance of metal-doped nitrogen-coordinated graphene electrodes, especially 3N-coordinated graphene electrodes.

Category: Sports; Ankle; Arthroscopy Introduction/Purpose: The modified Brostrom (MB) procedure has long been the mainstay for the treatment of chronic lateral ankle instability (CLAI) despite concerns about the strength of the repair. Recently, the InternalBrace TM (IB) has emerged as augmentation for this repair. The clinical benefit of such augmentation has yet to be established. The purpose of this study is to determine whether or not IB augmentation provides an advantage over the traditional MB. The preliminary results of this study are presented. Methods: Patients were identified for inclusion in the study based on indications for primary lateral ligament reconstruction for CLAI, age over 18, and able to provide informed consent. Exclusion criteria included pregnancy, cognitive disability, concomitant bony correction, inadequate soft tissue for MB, or prior ankle surgery affecting the lateral ligament complex. Preliminary outcome measures included complication rates, ability to participate in an accelerated rehabilitation protocol, and time to return to pre- injury level of activity. Complications were identified during post-operative clinical evaluations. Conversion from accelerated to traditional rehabilitation protocol was determined by patient’s self-reported ability to participate or VAS >= 5 per the physical therapist. Patients were contacted every 2 weeks from 6 to 26 weeks post-operatively to determine return to pre-injury level of activity. Results: 119 patients with CLAI who met criteria were enrolled in the study and randomized to the MB (59 patients) or IB (60 patients) treatment arm. At six months 11 patients (18.6%) of the MB arm and 4 patients (6.7%) of the IB arm were lost to follow up. 6/48 patients in the MB group and 2/56 patients in the IB group had not returned to preinjury activity level (p =.115). The complication rate was 8.5% in the MB group versus 1.7% in the IB Group. 4 patients in the MB group failed to complete the accelerated rehabilitation protocol versus 1 in the IB group. Average time to return to pre-injury level of activity was 17.6 weeks after MB and 13.2 weeks after IB (p

Category: Hindfoot; Ankle Arthritis Introduction/Purpose: Screw prominence in the heel following calcaneal fixation has resulted in unacceptably high rates of symptomatic hardware and subsequent screw removal. The hardware removal rate following calcaneal screw fixation ranges from 11-50%. We are unaware of any cost analysis comparing headed screw fixation vs. headless screw fixation in the foot and ankle literature. Furthermore, there is no literature comparing the rate of subtalar arthrodesis following headed screw fixation vs. headless screw fixation. Methods: CPT codes were used to identify all patients that had a subtalar arthrodesis or displacement calcaneal osteotomy (with screw fixation) performed by a single orthopedic foot and ankle surgeon between 2010 and 2016. The cohort was divided into two groups by the type of screw fixation, 7.0 mm headless screw or 6.7 mm headed screw. Exclusion criteria included

Category: Ankle; Sports; Trauma Introduction/Purpose: Non-operative treatment is regarded as the standard of care for the management of acute, uncomplicated lateral ankle sprains. As diagnostic and treatment options evolve, there is intermittently renewed interest in early surgical treatment of these acute injuries. Wider availability of magnetic resonance imaging (MRI) has made advanced imaging of acute ankle sprains more commonplace. One entity commonly seen on MRI is the ‘bone marrow lesion’ (BML). Recently, a procedure termed ‘Subchondroplasty’ (Zimmer, Warsaw, Indiana) has been developed to address chronic bone marrow lesions that have failed conservative management. We present a series of five cases referred from outside institutions in which patients developed rapid osteonecrosis of their tali after undergoing acute lateral ligament reconstruction with talar Subchondroplasty. Methods: We retrospectively evaluated the charts and available imaging of five patients who had developed osteonecrosis after undergoing a Subchondroplasty procedure in the setting of acute lateral ligament injury at outside institutions. Outside radiology reports, x-rays and magnetic resonance images, clinic notes, and operative reports were collected and analyzed. Patient demographics, comorbidities, and secondary interventions (after the index procedure) were recorded. Results: Average patient age was 23 (range 16-31). All patients were healthy. The patients were taken care of by different outside providers. All patients had pre-operative MRI demonstrating ATFL signal changes and bony edema within the talus in a distribution expected after ankle sprain. All patients were taken to the OR within 4 weeks of injury. Three underwent isolated talar Subchondroplasty; two underwent Subchondroplasty and an open Broström procedure. Within 6 months, radiographs and MRI in all patients demonstrated diffuse sclerosis of the tali, and diffuse talar hyperintensity on MRI scans, consistent with osteonecrosis. Two patients additionally had talar fragmentation and collapse. Currently, one patient has subsequently undergone total ankle replacement, two have had arthroscopy with bone marrow stimulation, and two are considering arthrodesis. Conclusion: We present 5 cases from outside institutions in which patients with acute ankle sprains and associated acute talar bone marrow lesions developed osteonecrosis after Subchondroplasty with or without lateral ligament repair. Although Subchondroplasty was likely not well-indicated in these acute cases, it raises a question of whether Subchondroplasty may be harmful to the talar blood supply. There is currently a lack of evidence to support Subchondroplasty for use in the foot and ankle. Practitioners should exercise caution when performing Subchondroplasy for the talus.

Category: Other Introduction/Purpose: Patients are often made weight-bearing as tolerated (WBAT) in a controlled ankle motion (CAM) boot for the management of various foot and ankle conditions. The CAM boot causes a leg-length discrepancy (LLD) between the booted (longer) and contralateral (shorter) lower extremities. This discrepancy can potentially cause balance problems, undue strain on joints, and discomfort in patients. We hypothesized that a leg-length evening orthotic placed on the plantar aspect of the contralateral shoe improves balance among patients who are WBAT in a CAM boot. Methods: Patients made WBAT in a CAM boot were randomized to either the leg-length-evening orthotic intervention group or to a control group in which patients wore a normal shoe of their choice. Patients were followed for two weeks and asked a series of questions pertaining to balance and pain experienced at their knees, hips, and back. Balance was the primary outcome and was scored from 0 (no difficulty with balance) to 10 (great difficulty with balance). Results: Out of 107 subjects enrolled and randomized, 95 (88.8%) completed the study, satisfying the a priori sample size requirement of 94 patients. There were no differences in baseline characteristics between groups (p>0.05 for each). Intervention patients reported less difficulty with balance than control patients (intention-to-treat analysis: 2.0+-1.5 versus 3.2+-1.8, p=0.001; as-treated analysis: 2.1+-1.7 versus 3.0+-1.7, p=0.009). Intervention and control patients did not differ with respect to pain experienced at their knees, hips, or back, or in a composite total pain score (p>0.05 for each). Conclusion: This multicenter randomized controlled trial found that adding a limb-length-evening orthotic to the plantar aspect of the contralateral shoe in a patient that is WBAT in a CAM boot improves balance. The trial was powered to identify a difference in the primary outcome measure of balance and may have been insufficiently powered to identify differences in knee, hip, back, or total pain.

Category: Ankle; Sports Introduction/Purpose: The surgical techniques for primary repair of acute Achilles tendon ruptures have evolved from large open incisions to mini-open and percutaneous techniques. Studies have demonstrated that lesser invasive surgical techniques may reduce the risk of post-operative wound complications. Knotless surgical repair of acute Achilles tendon ruptures can be performed through a mini-incision, but still permits a robust re-approximation of the tendon stumps and decreases suture burden through distal anchor fixation in the calcaneus. However, stress shielding and subsequent tendinosis of the distal tendon stump is a theoretical concern with this surgical technique. We hypothesize that our surgical technique allows for a durable repair through a minimally invasive approach, permitting a safe and accelerated rehabilitation protocol, excellent functional outcomes, and absence of distal stump tendinosis. Methods: A multicenter retrospective chart review was performed to identify all patients that underwent primary Achilles tendon repair using a knotless surgical technique with a minimum of one-year follow-up from three orthopedic foot and ankle surgeons’ practices. Exclusion criteria included: age 4 weeks), insertional Achilles tendon ruptures, revision Achilles surgery, peripheral neuropathy, and systemic inflammatory disease. All patients were contacted by phone and asked to return to the office for an MRI, clinical examination, and completion of functional outcome questionnaires. The primary outcome measure was the validated Achilles Tendon Total Rupture Score (ATRS). Secondary outcomes included the Visual Analog Score (VAS), postoperative complications, ankle range of motion, calf circumference, and single-heel rise. MRI was used to assess tendon continuity and healing, tendinosis, muscle atrophy, and bone marrow edema/stress fracture associated with anchor fixation in the calcaneus. MRI interpretation was performed by a single, blinded musculoskeletal radiologist. Results: Forty-three patients were identified with acute Achilles tendon ruptures. There were 36 patients (36/43, 84%) who underwent knotless Achilles tendon repair and agreed to participate in the study. The average time to clinical follow-up was 23.5 months (SD±16.3). The mean postoperative ATRS was 84.6 (SD±19.7). There was no significant difference in calf circumference (p=0.22), dorsiflexion (p=0.07), and plantarflexion (p=0.11) between the unaffected and surgical extremity at latest follow-up. One patient (1/36, 2.8%) experienced a re-rupture. There were no wound complications or neuritis. MRI was obtained in 26 patients (26/36, 72.2%) at an average of 17.5 months (SD±10.1). There were no MRI findings of distal stump tendinosis or calcaneal stress fractures. Thirty-two patients (32/36, 88.8%) returned to the same athletic activities one-year after surgery. Conclusion: There is paucity in the literature on functional outcomes following knotless Achilles tendon repair. In this multicenter study, we found that validated functional outcome scores and return to activity were similar to historical controls, with a low rate of surgical complications. MRI obtained in twenty-six patients (72.2%) at 17.5 months demonstrated an intact tendon without distal tendon stump stress shielding or calcaneal stress fracture. The knotless Achilles tendon repair is a unique surgical technique, minimizing suture burden and postoperative complications, while offering excellent functional outcomes and return to activity at two-year follow-up. The excellent clinical outcomes are corroborated by MRI.

Background: Patients are often made weightbearing as tolerated (WBAT) in a controlled ankle motion (CAM) boot for the management of various foot and ankle conditions. The CAM boot causes a leg length discrepancy (LLD) between the booted (longer) and contralateral (shorter) lower extremities. This discrepancy can potentially cause balance problems, undue strain on joints, and discomfort in patients. We hypothesized that a leg length–evening orthotic placed on the plantar aspect of the contralateral shoe improves balance among patients who are WBAT in a CAM boot. Methods: Patients made WBAT in a CAM boot were randomized to either the leg length–evening orthotic intervention group or to a control group in which patients wore a normal shoe of their choice. Patients were followed for 2 weeks and asked a series of questions pertaining to balance and pain experienced at their knees, hips, and back. Balance was the primary outcome and was scored from 0 (no difficulty with balance) to 10 (great difficulty with balance). Of 107 subjects enrolled and randomized, 95 (88.8%) completed the study, satisfying the a priori sample size requirement of 94 patients. There were no differences in baseline characteristics between groups ( P > .05 for each). Results: Intervention patients reported less difficulty with balance than control patients (intention-to-treat analysis: 2.0±1.5 vs 3.2±1.8, P = .001; as-treated analysis: 2.1±1.7 vs 3.0±1.7, P = .009). Intervention and control patients did not differ with respect to pain experienced at their knees, hips, or back, or in a composite total pain score ( P > .05 for each). Conclusion: This multicenter randomized controlled trial found that adding a limb length–evening orthotic to the plantar aspect of the contralateral shoe in a patient that is WBAT in a CAM boot improved patient-reported self-assessment of balance. The trial was powered to identify a difference in the primary outcome measure of balance and may have been insufficiently powered to identify differences in knee, hip, back, or total pain. Level of Evidence: Level II, prospective comparative study.

Talar osteonecrosis is a well-described phenomenon following talar neck fracture, but is a rarely described complication after procedures about the foot and ankle. Here we describe the clinical course of 5 cases of talar osteonecrosis following injection of calcium phosphate into the talus (subchondroplasty) with or without acute lateral ligament repair after acute lateral ankle ligament injuries performed at an outside institution. Practitioners should be aware of this potentially devastating complication. Future research is indicated to determine the safety and efficacy of subchondroplasty for the talus. Level of Evidence: Level V, case series.

Abstract A lack of spatial congruence between carbon storage and biodiversity in intact forests suggests limited cobenefits of carbon‐focused policies for conserving tropical biodiversity. However, whether the same applies in tropical human‐dominated landscapes (HDLs) is unclear. In India's Western Ghats Biodiversity Hotspot, we found that while HDL forests harbor lower tree diversity and aboveground carbon stocks than relatively intact forests, positive diversity–carbon correlations are more prevalent in HDLs. This is because anthropogenic drivers of species loss in HDLs consistently reduce carbon storing biomass volume (lower basal area), and biomass per unit volume (fewer hardwood trees). We further show, using a meta‐analysis spanning multiple regions, that these patterns apply to tropical HDLs more generally. Thus, while complementary strategies are needed for securing the irreplaceable biodiversity and carbon values of intact forests, ubiquitous tropical HDLs might hold greater potential for synergizing biodiversity conservation and climate change mitigation.

The mammalian and avian assemblages of intact tropical forests are among the most diverse vertebrate communities on Earth and influence the structure, composition, and functioning of these forests in myriad ways. Over recent centuries, however, increasing human domination of the tropics has led to widespread defaunation, or the decline, local-, or global extinction of tropical animal species. Defaunation is one of the defining features of the Anthropocene and is best documented for vertebrate species, especially mammals and birds. Defaunation is driven by several direct (e.g., hunting) and indirect (e.g., habitat alteration) anthropogenic threats, but how these threats differ in the nature and magnitude of their impacts on tropical mammal and bird species remains unclear. Using a meta-analysis of 82 studies on 254 mammal and 1,640 bird species from across the tropics, we assess the effects of three major regional-scale drivers of tropical defaunation, namely hunting, forest degradation and forest conversion, on measures of abundance for tropical mammal and bird species belonging to different dietary guilds and IUCN conservation status groups. Mammal species across dietary guilds either declined or did not change, on average, in response to the three drivers, with hunting having the most consistent negative impacts on abundances of carnivores, frugivores, herbivores/granivores, large-bodied species, and species of high conservation importance. By contrast, bird species declined most strongly in response to forest conversion, with responses varying widely across different dietary and conservation importance groups, and not consistently related to body size. Our results reveal that hunting, forest degradation and conversion are associated with distinct types of defaunation of mammal and bird species, and are therefore likely to have distinct implications for animal-mediated interactions and processes, ecosystem functions, and conservation of tropical forests. Addressing major gaps in our empirical understanding of defaunation effects—e.g., hunting impacts on smaller-bodied mammals and birds, and responses of species in southeast Asian forests—is key to better understanding, predicting, and mitigating the impacts of this pervasive global threat.

Point-of-care and in-vivo bio-diagnostic tools are the current need for the present critical scenarios in the healthcare industry. The past few decades have seen a surge in research activities related to solving the challenges associated with precise on-site bio-sensing. Cutting-edge fiber optic technology enables the interaction of light with functionalized fiber surfaces at remote locations to develop a novel, miniaturized and cost-effective lab on fiber technology for bio-sensing applications. The recent remarkable developments in the field of nanotechnology provide innumerable functionalization methodologies to develop selective bio-recognition elements for label free biosensors. These exceptional methods may be easily integrated with fiber surfaces to provide highly selective light-matter interaction depending on various transduction mechanisms. In the present review, an overview of optical fiber-based biosensors has been provided with focus on physical principles used, along with the functionalization protocols for the detection of various biological analytes to diagnose the disease. The design and performance of these biosensors in terms of operating range, selectivity, response time and limit of detection have been discussed. In the concluding remarks, the challenges associated with these biosensors and the improvement required to develop handheld devices to enable direct target detection have been highlighted.

Background: Fixed orthodontic treatment is time-consuming procedure. Pain is usually associated with orthodontic treatment. The aim of the present study was to evaluate the role of low-level laser therapy (LLLT) on orthodontic tooth movement (OTM) duration and pain perception. Materials and Methods: This randomized double-blind splint-mouth controlled clinical study includes 20 (8 males and 12 females) orthodontic patients requiring bilateral canine retraction. Time taken for canine retraction with LLLT (Group A) over control (Group B) quadrant on the same patient was assessed along with pain experience using facial pain scale. The data were tabulated and statistically evaluated using SPSS 20 for windows (Microsoft, Chicago, IL, USA) and t-test with P < 0.05. The difference in pain was evaluated with Wilcoxon signed-rank test. Results: There was no difference in values for age and sex of patient for tooth movement and pain (P > 0.05). There was statistically significant decrease in rate of canine retraction in Group A compared to Group B. There was statistically significant difference for maxillary and mandibular arches in Group A whereas it was not significant in Group B. Pain experience was statistically significant till 2nd day, and after 3rd day, it was not significant between the groups. Conclusion: LLLT can reduce the fixed OTM timing and pain experience.

Tuberous sclerosis complex (TSC) is a rare, genetic disease caused by loss-of-function mutations in either TSC1 or TSC2. Patients with TSC are neurologically characterized by the presence of abnormal brain structure, intractable epilepsy and TSC-associated neuropsychiatric disorders. Given the lack of effective long-term treatments for TSC, there is a need to gain greater insight into TSC-related pathophysiology and to identify and develop new treatments.In this work we show that homozygous tsc2−/− mutant zebrafish larvae, but not tsc2+/− and WT larvae, display enlarged brains, reduced locomotor behavior and epileptiform discharges at 7dpf. In addition, we pharmacologically validated the TSC model by demonstrating the dramatic rescue effect of pericardially injected rapamycin, a well-known mTOR inhibitor, on selected behavioral read-outs and at the molecular level.By means of trancriptome profiling we also acquired more insight into the neuropathology of TSC, and as a result were able to highlight possible new treatment targets. The gene expression profiles of WT and tsc2+/− larvae revealed 117 differentially expressed genes (DEGs), while between WT and tsc2−/− larvae and tsc2+/− and tsc2−/− larvae there were 1414 and 1079 DEGs, respectively. Pathway enrichment analysis from the WT and tsc2−/− DEGs, identified 14 enriched pathways from the up-regulated genes and 6 enriched pathways from the down-regulated genes. Moreover, genes related to inflammation and immune response were up-regulated in the heads of tsc2−/− larvae, in line with the findings in human brain tissue where inflammatory and immune responses appear to be major hallmarks of TSC.Taken together, our phenotypic, transcriptomic and pharmacological analysis identified the tsc2−/− zebrafish as a preclinical model that mirrors well aspects of the human condition and delineated relevant TSC-related biological pathways. The model may be of value for future TSC-related drug discovery and development programs.