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This study aims to evaluate costs associated with periprosthetic femoral fracture (PFF) treatment at a UK tertiary referral centre.This study included 128 consecutive PFFs admitted from 02/04/2014-19/05/2020. Financial data were provided by Patient Level Information and Costing Systems. Primary outcomes were median cost and margin. Secondary outcomes were length of stay, blood transfusion, critical care, 30-day readmission, 2-year local complication, 2-year systemic complication, 2-year reoperation and 30-day mortality rates. Statistical comparisons were made between treatment type. Statistical significance was set at p0.05.Across the cohort, median cost was £15,644.00 (IQR £11,031.00-£22,255.00) and median loss was £3757.50 (£599.20-£8296.20). The highest costs were ward stay (£3994.00, IQR £1,765.00-£7,013.00), theatre utilisation (£2962.00, IQR £0.00-£4,286.00) and overheads (£1705.10, IQR £896.70-£2432.20). Cost (£17,455.00 [IQR, £13,194.00-£23,308.00] versus £7697.00 [IQR £3871.00-£10,847.00], p0.001) and loss (£4890.00 [IQR £1308.00-£10,009.00] versus £1882.00 [IQR £313.00-£3851.00], p = 0.02) were greater in the operative versus the nonoperative group. There was no difference in cost (£17,634.00 [IQR £12,965.00-£22,958.00] versus £17,399.00 [IQR £13,394.00-£23,404.00], p = 0.98) or loss (£5374.00 [IQR £1950.00-£10,143.00] versus £3860.00 [IQR -£95.50-£7601.00], p = 0.21) between the open reduction and internal fixation (ORIF) and revision groups. More patients required blood transfusion in the operative versus the nonoperative group (17 [17.9%] versus 0 [0.0%], p = 0.009). There was no difference in any clinical outcome between the ORIF and revision groups (p0.05).PFF treatment costs are high with inadequate reimbursement from NHS tariff. Work is needed to address this disparity and reduce hospital costs. Cost should not be used to decide between ORIF and revision surgery.

Multiple biochemical biomarkers have been previously investigated for the diagnosis, prognosis and response to treatment of articular cartilage damage, including osteoarthritis (OA). Synovial fluid (SF) biomarker measurement is a potential method to predict treatment response and effectiveness. However, the significance of different biomarkers and their correlation to clinical outcomes remains unclear. This systematic review evaluated current SF biomarkers used in investigation of cartilage degeneration or regeneration in the knee joint and correlated these biomarkers with clinical outcomes following cartilage repair or regeneration interventions.PubMed, Institute of Science Index, Scopus, Cochrane Central Register of Controlled Trials, and Embase databases were searched. Studies evaluating SF biomarkers and clinical outcomes following cartilage repair intervention were included. Two researchers independently performed data extraction and Quality Assessment of Diagnostic Accuracy Score 2 (QUADAS-2) analysis. Biomarker inclusion, change following intervention and correlation with clinical outcome was compared.9 studies were included. Study heterogeneity precluded meta-analysis. There was significant variation in sampling and analysis. 33 biomarkers were evaluated in addition to microRNA and catabolic/anabolic ratios. Five studies reported on correlation of biomarkers with six biomarkers significantly correlated with clinical outcomes following intervention. However, correlation was only demonstrated in isolated studies.This review demonstrates significant difficulties in drawing conclusions regarding the importance of SF biomarkers based on the available literature. Improved standardisation for collection and analysis of SF samples is required. Future publications should also focus on clinical outcome scores and seek to correlate biomarkers with progression to further understand the significance of identified markers in a clinical context.PROSPERO CRD42022304298. Study protocol available on PROSPERO website.

Introduction Suspending elective surgery during the first wave of coronavirus (COVID-19) led to record-breaking numbers of patients on waiting lists. Patients in Black, Asian and minority ethnic (BAME) groups are disproportionately affected by COVID-19. This study compares the perspectives of patients from different ethnic backgrounds on the return to elective surgery. Methods Some 151 patients were sampled from cancelled operating lists at two hospitals. Semi-structured interviews focused on the impact of COVID-19, and views about resuming elective surgery. The Generalized Anxiety Disorder 7-iten Scale (GAD-7) measured anxiety. A visual analogue scale (VAS) measured pain. Data were analysed using exploratory thematic analysis. Results Fewer BAME patients were pleased about restarting surgery, compared with white patients (47.3% vs 82.6%, pConclusion The delay in surgery due to the pandemic has had a devastating impact on patients awaiting operations. The variation in pain and anxiety levels between ethnic groups must be addressed when redesigning services to avoid discrepancies in postoperative clinical outcomes. Patients in BAME groups are more likely to postpone their operation, which may lead to further health deterioration, psychosocial and socio-economic consequences, and poorer clinical outcomes following surgery. The thoughts, feelings and concerns of all must be considered when redesigning services to prevent health inequalities between patients from different backgrounds.

Introduction Diversity in the healthcare workforce is associated with improved performance and patient-reported outcomes. Gender disparity in Trauma and Orthopaedics (T&O) is well recognised. The aim of this study was to compare factors that influence career choice in T&O between male and female final-year students. Furthermore, the trend of representation of women in T&O over the last decade was also compared with other surgical specialities. Methods An online survey of final-year students who attended nationally advertised T&O courses over a 2-year period was conducted. Data from NHS digital was obtained to assess gender diversity in T&O compared with other surgical specialities. Results A total of 414 students from 13 UK medical schools completed the questionnaire. Compared with male students (34.2%), a significantly higher proportion of women (65.8%) decided against a career in T&O, pConclusion T&O remains an unpopular career choice among women. To enhance recruitment of women in T&O, future strategies should be directed toward medical students. Universities, orthopaedic departments and societies must work collaboratively to embed culture change, improve the delivery of the undergraduate curriculum, and facilitate students’ exposure to operating theatres and female role models.

Acute bronchiolitis is a viral respiratory illness of infants and young children that occurs in the first two years of life. It is a major cause of hospital admissions in Bangladesh. Management of bronchiolitis is a great challenge for the pediatrician both in the outpatient and inpatient department. Because mainstay of treatment options are usually supportive like cool humidified oxygen, fluids, bronchodilators, epinephrine and corticosteroids. A number of agents have been proposed as adjunctive therapies, but their effects are controversial. Nebulized hypertonic saline (3%) has been reported to have some benefit in recent studies. So the objective of this study was to compare the efficacy of nebulized 3% hypertonic saline (HS) with salbutamol and normal saline (0.9%) nebulization in children with acute bronchiolitis. A double-blind randomized controlled trial was conducted in the Department of Paediatrics, Mymensingh Medical College Hospital, Bangladesh from November 2015 to October 2016. A total of 100 children aged one month to two years with acute bronchiolitis admitted in the Pediatric wards of MMCH were included in the study and were randomly assigned to either 3% nebulized hypertonic saline (n=50) or to 0.9% nebulized isotonic saline with salbutamol solution (n=50). The main outcome variables were clinical severity score, length of hospital stay, duration of oxygen therapy and oxygen saturation (SpO2). The therapy was repeated three times on every hospitalization day and the outcome was evaluated two times daily (12 hourly) for 60 hours. Mean duration of oxygen therapy in study group was 33.6±21.7 hours and in control group was 36.8±22.5 hours. But their difference was not statistically significant (p0.05). The mean clinical severity score and mean oxygen saturation of the entire study patients in both groups decreased and increased respectively during hospital stay. There was significant difference of mean clinical severity score and oxygen saturation between admission and follow up-5 in each group (p0.001). But their difference between two groups was not statistically significant (p0.05). Mean duration of hospital stay was 2.91±1.54 days in study group and 3.09±1.85 days in control group. But their difference between two groups was not statistically significant (p0.05). So in acute bronchiolitis nebulized hypertonic saline (3%) is as effective as normal saline (0.9%) and salbutamol nebulization.

Introduction Major surgery, including major orthopaedic surgery, is a key risk factor for developing venous thromboembolism (VTE). This poses a challenge in the post-operative phase when considering initiation of therapeutic-dose anticoagulation for suspected VTE due to the risk of major bleeding. Method A search strategy was developed with inclusion criteria involving all studies relating to the treatment of suspected VTE in the post-operative orthopaedic patient. Journal articles predating 3rd June 2021 were searched for in Medline, Embase and PubMed. Titles and s were reviewed based on clinical relevance. Results 56 articles were generated using this search strategy. 22 results were excluded as conference papers and/or case reports. Title and review of the remaining 34 studies did not identify any relevant articles reporting outcomes. Conclusions No evidence is available to guide recommendations for the empirical treatment of suspected VTE in the post-operative orthopaedic patient prior to a confirmed VTE diagnosis. This is therefore a risk-benefit clinical decision to be undertaken based on individual patient factors. Current American College of Chest Physicians guidelines advise initiation of anticoagulation for suspected acute VTE in cases with a high clinical suspicion, or intermediate clinical suspicion with expected delay in diagnostic imaging for at least 4 hours. However, this does not apply to patients following recent surgery who are at increased risk of bleeding post-operatively. Empirical systemic treatment dose anticoagulation for VTE in the post-operative period should therefore only be initiated when timely image-based diagnosis cannot be achieved.

Involving research users in setting priorities for musculoskeletal research is essential to raise awareness of the unmet needs for MSK research, to ensure research outcomes are patient-centred and relevant, have a high likelihood of resulting in patient benefit, reduce research waste and increase research value and impact. In 2018, Versus Arthritis convened an MSK Disorders Research Advisory Group (RAG) which included people with arthritis, health care professionals and researchers in MSK, in order to identify and prioritise research areas with a long-term aim of improving quality and impact of MSK research. On further review, there were few previous prioritisation approaches in this area looking across discovery science to more clinical research, at important research questions which might be common to a range of disorders or approaches incorporating input at all stages of the process by a range of stakeholders including people with arthritis. The group identified that more work to define research priorities in these areas was justified and designed a research priority setting process for MSK disorders. This manuscript documents the methodology that was developed by the group for this process.MethodsFollowing a review, the Child Health and Nutrition Research Initiative (CHNRI) method for research prioritisation was selected as best aligning with the needs of this process. The group agreed on adaptations to the CHNRI approach, context, purpose and remit of the exercise and identified through consensus four priority research Domains: Mechanisms of disease; Diagnosis (including early diagnosis) and measuring the impact of these disorders; Living well with MSK disorders and Successful Translation. From all published CHNRI scoring criteria for generated research avenues or themes of research, the group identified six which were most relevant to this process. To ensure accessibility of the survey and scoring, these were refined to three: Equity (considered cross cutting, not scored but considered throughout the process), Importance (Will research in this area have potential to lead to important new knowledge) and Impact (Might research in this area make a difference). Importance and Impact were to be scored on a scale of 1-10 for each research avenue with equal weighting of these two criteria in the subsequent generation of a total score.Data collectionFollowing ethical approval, an electronic first survey asking for important research uncertainties in the four research domains and any other areas will be distributed to all stakeholders (people with arthritis, researchers in all stages of MSK disorders research, healthcare professionals, industry e.g. pharmaceutical and medical technology companies, research funders, healthcare providers, government policy makers and charities). The next step is to consolidate all the gathered research uncertainties from the first survey into finalised research domains and avenues. Uncertainties will be summarised using deductive thematic analysis and organised into possible themes which will then be considered and refined by each of four appointed subgroups within the RAG. Following group and lay review and refinement of the wording including tests of readability, the second survey including this full list of research avenues will be submitted for ethical approval. The second survey will be completed by the same range of stakeholders as the first survey, both those who previously completed and new respondents. Respondents will be invited to rate each research avenue using the two scoring criteria, with the avenues presented in a random sequence to avoid bias.Analysis PlanAll available data will be analysed, from all respondents completing the survey in full and all partial respondents. For each research avenue, a mean criterion score will be calculated for each of the two criteria from all available survey responses (considering the number of respondents in each case), and then the two mean criterion scores will be summed to create a total score. Response rates and missing data for scoring of avenues will be reported. The primary prioritisation output of this exercise will be to produce a single ranked list of these total scores of research avenues, from highest to lowest. The most highly ranked avenues will be highlighted, for example the top five to top ten overall and from each research domain, with the exact number and nature of this depending on the distribution of the data. Respondent characteristics will be summarised including self-identified stakeholder group, age group, gender and ethnic background, to describe the diversity and representation within the survey respondents as far as possible.Dissemination planFindings will be communicated in a number of formats, both written and spoken, to ensure accessibility to all stakeholders, and will also be used by the charity in internal strategy development. Dissemination will include the submission of a manuscript to a peer-reviewed journal.

A 66‐year‐old man experienced symptomatic pneumorrhachis (air within the spinal canal) following a cervical laminoplasty for the excision of meningioma. Following an uneventful intraoperative course, he suffered a fluctuating hemiparesis of varying severity. Urgent imaging demonstrated extradural and intradural air in the spinal canal. Treatment with supplemental oxygen and dexamethasone was commenced, and the patient’s symptoms improved over a period of three days with full resolution at six weeks. Pneumorrhachis can be avoided by allowing air to escape from the spinal canal through positioning, and displacement with irrigation fluid at the time of wound closure. However, if pneumorrhachis does occur, oxygen therapy, positioning of the patient to mitigate the gravitational effect of the air bubbles and supportive treatment are the central elements of management. Other possible causes of neurological deficit should be ruled out. This is particularly important as treatment options for some differential diagnoses can potentially cause harm if started based on clinical impression alone, for example, re‐exploration for suspected haematoma. Only a small number of previous reports have described symptomatic pneumorrhachis as a complication of spinal surgery. This patient was successfully managed with conservative measures following the exclusion of other spinal cord pathologies.

Most of the glaciers have been retreating and thinning globally due to climate change. Glacier velocity is one such important parameter of glacier dynamics, which helps to understand the mass balance. The variations in velocity at different areas of the glacier can be used to identify the zones of ablation and accumulation. Zones of accumulation are identified as areas with higher velocity. This data is useful to incorporate in the glacier mass balance analysis. This study aims to derive the glacier velocity, using feature tracking technique for Potsdam glacier, east Antarctica. Feature tracking is an efficient way to derive glacier velocity, which is based on a cross-correlation algorithm that seeks offsets of the maximal correlation window on repeated satellite images. In this technique, two temporally different images are acquired for the same area and a distinct feature on both images is identified and the velocity is calculated with respect to the movement of that particular feature from one image to the other. Landsat-8 data for the year 2016 was used to derive velocity. Finer resolution promotes better feature tracking so the panchromatic band (band 8) of Landsat-8 OLI with a resolution of 15 m was utilized for deriving velocity. This technique was performed using COSI-Corr module in ENVI. This tool calculates displacement between the east-west and north-south directions, and the resultant velocity is calculated using the displacement in both directions and the temporal difference of two images. The velocity map generated at a resolution of 240 m showed that the resultant velocity ranged between 18.60 and 285.28 ma−1. Bias and root mean square error (RMSE) have been calculated with respect to the point-by-point MEaSUREs data provided by National Snow and Ice Data Centre at 1000 m resolution. The RMSE was found to be 78.06 ma−1 for 2016. The velocity for Potsdam glacier was also pictorially validated with the DGPS measurements from literature.

Surface glacier facies are superficial expressions of a glacier that are distinguishable based on differing spectral and structural characteristics according to their age and inter-mixed impurities . Increasing bodies of literature suggest that the varying properties of surface glacier facies differentially influence the melt of the glacier, thus affecting the mass balance. Incorporating these variations into distributed mass balance modelling can improve the perceived accuracy of these models. However, detecting and subsequently mapping these facies with a high degree of accuracy is a necessary precursor to such complex modelling. The variations in the reflectance spectra of various glacier facies permit multiband imagery to exploit band ratios for their effective extraction. However, coarse and medium spatial resolution multispectral imagery can delimit the efficacy of band ratioing by muddling the minor spatial and spectral variations of a glacier. Very high-resolution imagery, on the other hand, creates distortions in the conventionally obtained information extracted through pixel-based classification. Therefore, robust and adaptable methods coupled with higher resolution data products are necessary to effectively map glacier facies. This study endeavours to identify and isolate glacier facies on two unnamed glaciers in the Chandra-Bhaga basin, Himalayas, using an established object-based multi-index protocol. Exploiting the very high resolution offered by WorldView-2 and its eight spectral bands, this study implements customized spectral index ratios via an object-based environment. Pixel-based supervised classification is also performed using three popular classifiers to comparatively gauge the classification accuracies. The object-based multi-index protocol delivered the highest overall accuracy of 86.67%. The Minimum Distance classifier yielded the lowest overall accuracy of 62.50%, whereas, the Mahalanobis Distance and Maximum Likelihood classifiers yielded overall accuracies of 77.50% and 70.84% respectively. The results outline the superiority of the object-based method for extraction of glacier facies. Forthcoming studies must refine the indices and test their applicability in wide ranging scenarios.

With more than 10 times the capacity of the graphite used in current commercial batteries, lithium metal is ideal for a high-capacity battery anode; however, lithium metal electrodes suffer from safety and efficiency problems that prevent their wide industrial adoption. Their intrinsic high reactivity towards most liquid organic electrolytes leads to lithium loss and dendrite growth, which result in poor efficiency and short circuiting. However, the multitude of factors that contribute to dendrite formation make determining a nucleation mechanism extremely difficult. Here, we study the intricate science of dendrite nucleation on metallic lithium by using an array of analytical techniques that provide simultaneous ultra-high spatial sensitivity and chemical selectivity. Our results reveal a 3D picture of the chemical make-up of the native Li surface and the resulting solid electrolyte interphase (SEI) with better than 200 nm resolution. We find that, contrary to the general understanding, the initial surface chemistry, not the topography, is the dominant factor leading to dendrite nucleation. Specifically, inhomogeneously distributed organic material in the native surface leads to inhomogeneously dispersed LiF-rich SEI regions where dendrite nucleation is favored. This has significant implications for battery research as it elucidates a mechanism for inhomogeneous SEI formation, something that is accepted, but not well understood, and highlights the importance of Li surface preparation for experimental studies, which is implicit in battery research, but not directly addressed in the literature. By homogenizing the initial lithium surface composition, and thus the SEI composition, we increase the number of dendrite nucleation sites and thereby decrease the dendrite size, which significantly increases the electrode lifetime.

Glaciers play a crucial role in the study of the climate change pattern of the Earth. Remote sensing with access to large archives of data has the ability to monitor glaciers frequently throughout the year. Therefore, remote sensing is the most beneficial tool for the study of glacier dynamics. Fed by many tributaries from different sides, the Amery Ice Shelf (AIS) is one of the largest ice shelves that drains ice from the Antarctic ice sheet into the Southern Ocean. This study focuses on the eastern and the western tributaries of the AIS. The primary objective of the study was to derive the velocity of the tributary glaciers and the secondary objective was to compare variations in their velocities between the summer and winter season. This study was carried on using the European Space Agency’s (ESA) Sentinel-1 satellite’s Synthetic Aperture Radar (SAR) data acquired from the Sentinel data portal. Offset tracking method was applied to the Ground Range Detected (GRD) product of the Sentinel-1 interferometric wide (IW) swath acquisition mode. The maximum velocity in summer was observed to be around 610 m/yr in the eastern tributary glacier meeting the ice shelf near the Pickering Nunatak, and around 345 m/yr in the Charybdis Glacier Basin from the western side. The maximum velocity in the winter was observed to be 553 m/yr in the eastern side near the Pickering Nunatak whereas 323 m/yr from the western side in the Charybdis Glacier Basin. The accuracy of the derived glacier velocities was computed using bias and root mean square (RMS) error. For the analysis, the publicly available velocity datasets were used. The accuracy based on RMS error was observed to be 85-90% for both seasons with bias values up to 25 m/yr and root mean square error values up to 30 m/yr.

Stone fruits are an important temperate fruit crops and play a significant role in the food and nutritional security. Due to the increase in temperature, stone fruit cultivation is decreasing, because most of the cultivated stone fruit crop appeared to be unable to receive enough chilling in most winters. The increase in the temperature acts as a treat to its profitable cultivation. So, it became an imperative to go for hi-tech cultivation in stone fruit cultivation. Hi-tech cultivation is a precise production technique for the efficient use of inputs at the appropriate time and quantity for maximization of yield and quality of different fruit crops. The production potential of stone fruit can be enhanced through hi-tech approaches which include high-density planting (HDP), micro-irrigation, fertigation, integrated nutrient management (INM), and integrated pest management (IPM). But there are many limitations in promoting hi-tech cultivation in stone fruit industry. These issues can be overcome by using recent technologies integrated with indigenous knowledge and will have a far-reaching consequence to see that hi-tech horticulture reaches a new high.

Additional file 1: Supplementary File. Survey questions.

Glacier movement is a crucial factor for assessing cryospheric climate change. Traditional methods of field surveys for studying glacier movement and velocity are often not possible owing to inaccessibility and harsh terrains. Furthermore, as it is not feasible to physically monitor and survey many glaciers around the globe, these traditional methods are limited in their global coverage. Remote sensing is an ideal tool to study such phenomena on a global scale. Optical remote sensing employs techniques such as feature tracking and pixel tracking, whereas, microwave remote sensing uses intensity tracking, speckle tracking, Interferometric SAR and Differential InSAR (DInSAR). This study focuses on estimation of glacier velocity and its seasonal variations using the image-matching technique for optical images for the Fisher glacier, a tributary glacier of the Amery ice shelf in Antarctica. The tool used in this study is the COSI-Corr module embedded in ENVI which provides the velocity in both azimuth and range resolution. The principle of estimating velocity using this tool is pixel tracking wherein similar pixels on two images are tracked where one is the master image and the other is a slave. This technique correlates the master and slave images over a time period and generates three outputs: displacements in the East-West and North-South directions and signal-to-noise ratio (SNR) image. Landsat 8 image pairs were used for cross correlation over a time span of four years spanning 2013–2017. With a resolution of 15 m, the panchromatic band (Band 8) was the ideal choice for pixel tracking as the resolution of other bands is coarser. The initial window size for correlation was 64 while the final window size was 16. The resolution of the displacement images produced is dependent on the value assigned for the step size, which was set to 8. The resultant velocity was derived using the result of the two displacement images. The SNR image was used to remove all the pixels from the velocity output having the value of SNR less than 0.9, in order to reduce the effect of noise. The annual velocity of the Fisher glacier was estimated to be around 600 to 650 myr−1 near the tongue where it merges with the Amery Ice Shelf, which was reduced to 150 myr−1 as it recedes. The resultant velocity images have a resolution of 120 m. The seasonal variation in velocity for the year 2013–2014 is 1.8 myr−1, while in the succeeding year 2014-2015 it subdued to 1.7 myr−1. The seasonal variation for the year 2015–2016 was estimated to be 7.9 myr−1. The seasonal variation for 2016–2017 was 17.4 myr−1.

Antarctica and Greenland are two major Earth’s continental ice shelves which play an important role in influencing Earth’s energy balance through their high albedo. The ice sheets comprise of grounded ice or the continental glaciers and their associated ice shelves. Surface velocity is an important parameter that needs to be monitored to understand the glacier dynamics. Marine terminating glaciers have higher velocity than land terminating glaciers. Therefore, ice shelves are generally observed to have higher velocity as compared to continental glaciers. The focus of this study is Amery ice shelf (AIS) which is the third largest ice shelf located in east Antarctica terminating into the Prydz Bay on the eastern Antarctica. The surface ice-flow velocity of AIS is very high compared to its surrounding glaciers which flows at a rate of 1400 m a−1 and drains about 8% of the Antarctic ice sheet. AIS is fed by different glaciers and ice streams at the head, as well as from the western and eastern side of the ice shelf before it terminates into the ocean. The primary objective of this study was to compute velocity of the eastern tributary glaciers of AIS using SAR from Sentinel-1 data. The secondary objective was to compare the winter and summer velocities of the glaciers for 2017–2018. The offset tracking method has been applied to the ground range detected (GRD) product obtained from Sentinel-1 satellite. This method is suitable for regions with higher glacier velocity where interferometry is generally affected by the loss of coherence. The offset tracking method works by tracking the features on the basis of another feature and calculates the offset between the two features in the images. Two tributary glaciers near the Clemence massif and another glacier near the Pickering Nunatak feed into this ice shelf from the eastern glacial basin region that drains ice from the American Highland, east Antarctica. The glaciers near the Clemence massif showed low annual velocity which ranged from 100 m a−1 at the head to ∼300 m a−1 near the end of the glacier, where it merges with AIS. The glaciers flowing near the Pickering Nunatak exhibited moderate velocity ranging from 150 m a−1 at its head and reaching up to 450 m a−1 near the tongue. The summer velocity (March 2018) was observed to be higher than the velocity in winter (July 2017) and the difference between the summer and the winter velocities was found to be between 50 m a−1 and 130 m a−1. The results for the velocity were obtained at 120 m resolution and were compared with the previous MEaSUREs (Making Earth System Data Records for Use in Research Environments) yearly velocity at 450 m and 1 km resolution provided by National Snow and Ice Data Center portal. The results were evaluated using statistical measure- bias and the accuracy was derived using the root mean square error. The bias did not exceed 20 m a−1 for the three glaciers and the accuracy was observed to be more than 85% for most of the regions. The accuracy of the results suggests that the offset tracking technique is useful for future velocity estimation in the regions of high glacier velocity.

Casualty, in relation to personnel, any person who is lost to his organization; by reason of being declared dead, wounded, diseased, detained, captured or missing. Casualty service or department is not well organized in the hospitals of our country. We have recently started functioning casualty department to manage casualties properly in spite of the increasing workload and emerging needs of this department. This study was conducted in the Casualty department, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh to analyze the number of patients and pattern of casualties. A total number of 17435 patients were enrolled in this retrospective observational study. Data was collected from hospital records of all patients attending in the Casualty Department, MMCH between November 19, 2017 and May 18, 2018 and patients were categorized on the basis of their mode of injury. The demographic characteristics of patients with mode of Casualty were analyzed. Male were 75% and female 25%. Avergae per day patient attended in the Casualty department was 96, maximum was 176 and minimum 33. According to age sub-division, 11-20 years age group attended maxiumum was 48. One day attended Road traffic accident (RTA) maximum was 65 and minimum was 3, Non-RTA maximum was 83 and minimum 25, physical assaults maximum was 48 and minimum 1. Injury due to fall and RTA were the common mode of casualty especially in the young population in the study area. Study showed that injury caused by fall was 44% among the all patients. Patients due to fall from tree was highest (35%) in April-May. Incidents of fall were followed by RTA which was 25%. Physical assaults (17%), machinery injury (9%) and others were 5%.

Background:Patients with knee osteoarthritis (OA) who do not achieve adequate pain relief and functional improvement with a combination of non-pharmacologic and pharmacologic therapies are recommended an arthroplasty as an effective option to relieve severe pain and functional limitations. However, some patients are reluctant to undergo surgical interventions, and clinicians may choose to avoid or delay surgery due to safety risks and/or the financial cost. It is of interest to understand if the use and perception of surgery differs between countries, however, few published data exist.Objectives:To demonstrate how surgery and the use of surgical procedures differs across Japan, United States of America (US) and 5 major European countries (EU5) and to evaluate patient perception towards surgery.Methods:Data were drawn from the Adelphi OA Disease Specific Programme (2017-18), a point-in-time survey of primary care physicians (PCP), rheumatologists (rheums), orthopaedic surgeons (orthos) and their OA patients. Patients with physician-diagnosed knee OA were included and segmented into two categories: had previous surgery (PS) and never had surgery (NS). A Fisher’s exact test was performed on the two groups. Physicians reported on patient demographics; whether patients had undergone surgery; type of surgery; success of surgery; how success was defined; and reasons for wanting to delay surgery. Patients reported their willingness to undergo surgery; reasons for not wanting surgery; how successful their surgery was; and how they defined this success.Results:Physician/patient reported data were available for 302,230 (Japan), 527,283 (US) and 1487,726 (EU5) patients with diagnosed knee OA. Patients were categorised by their physicians as mild (40% Japan; 34% US; 24% EU5), moderate (49% Japan; 49% US; 56% EU5) or severe (9% Japan; 17% US; 19% EU5). Patients in Japan were more likely to be female (78% vs 54% US; 58% EU5), older (73 vs 65 US; 66 EU5) and have a lower BMI than patients in the US and EU5. Obesity and diabetes were much less prevalent among patients in Japan. One in ten patients in Japan had undergone a surgery (10%), far fewer than in the US (22%) or EU5 (17%). When surgery was performed, this was more likely to be a total joint replacement (TJR) in Japan, whereas in the EU and US, arthroscopic washout was more commonly performed.For over half of Japanese patients (56%), successful surgery was more likely to be defined as having no more pain (vs. 35% US; 14% EU5). Improved mobility and a reduction in pain were also commonly reported reasons. Physicians (in each region) were more likely to suggest pain reduction, rather than no pain, and improved mobility as markers of success. Patients in Japan were much more likely to say they would not agree to surgery if recommended by their doctor, or were unsure (84% vs. 68% US; 62% EU5). The main reason for patient reluctance in Japan was fear of surgery, whereas in the US and EU5 the main reason given was that surgery was not needed. This finding was also evident among physicians in Japan, who frequently reported that patient reluctance was a key reason for delaying surgery. Physicians in Japan, do however, report that patient request was one of their main triggers for recommending surgery (45% vs 20% US; 16% EU5).Conclusion:Although surgery can be an effective option for those with OA who have exhausted other treatment options, some patients are reluctant to undergo surgery out of fear, especially in Japan, possibly due to the higher patient age. Physicians aiming to delay surgery were driven by patient reluctance in Japan, whereas cost to patient was a bigger factor in the US and EU5. The higher level of TJR vs. other surgery options among patients in Japan may suggest physicians are looking for higher levels of efficacy.Disclosure of Interests:Naoshi Fukui Speakers bureau: Pfizer, Consultant of: Pfizer, Philip G Conaghan Speakers bureau: Abbvie, Novartis, Consultant of: AstraZeneca, BMS, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, Gilead, Novartis, Pfizer, Kanae Togo Shareholder of: Pfizer, Employee of: Pfizer, Nozomi Ebata Shareholder of: Pfizer, Employee of: Pfizer, Lucy Abraham Shareholder of: Pfizer, Employee of: Pfizer, James Jackson: None declared, Jessica Jackson: None declared, Mia Berry: None declared, Hemant Pandit Paid instructor for: Bristol Myers Squibb, Consultant of: Johnson and Johnson, Grant/research support from: GSK

Study Objective To show that Laparoscopic approach is beneficial for surgical repair of uterine inversion cases. Design A case report. Setting Pandit Hospital and Laparoscopy centre, Ahmednagar, India. Patients or Participants A 26 year female presented with subacute uterine inversion in January 2020. Interventions Laparoscopic Haultain's repair for subacute uterine inversion. Measurements and Main Results Although in modern era, endoscopy has replaced abdominal or vaginal surgeries, there is hardly any case report of laparoscopic management of uterine inversion. Here, we report a case of successful management of subacute uterine inversion by Laparoscopic approach by Haultain's technique, which is done for the first time as per our knowledge and no such case of laparoscopic repair is been mentioned in the literature. A 26 year old P2L2, presented on seventh day postpartum with complaints of continuos bleeding per vaginum and fever. Patient was febrile with temperature of 99 F with tachycardia. On per abdominal examination, uterus was much below the umbilicus and indentation was felt at the level of fundus. On per speculum examination, endometrium was seen protruding outside, so inversion of uterus was suspected which was confirmed on ultrasonography of pelvis. Before going for the Laparoscopy, manual reposition of uterus was tried under general anaesthesia but was not successful. During Laparoscopic Haultan's repair, posterior wall of uterus was incised at the rim. By continuous upward traction on bilateral round ligament, inversion was corrected. Uterine incision was closed in double layer. Patient was asymptomatic on discharge and on fallow up examination after seven days and one month. Conclusion Uterine inversion cases can be managed laparoscopically without any harmful effects and with added benefits of laproscopic route as for any other procedure.

The present study was carried out at Experimental Farm of Division of Fruit Science, SKUAST-Kashmir during2016-2017 and 2017-2018. During the investigation programme, ten hilling materials were applied viz., Vermiculite (T1), Saw dust(T2), FYM(T3),Vermicompost(T4), Vermiculite+ Saw dust+ Pseudomonas (T5), Vermicultite + Saw dust +Azotobacter (T6), FYM + Vermicompost + Pseudomonas (T7), FYM + Vermicompost+ Azotobacter (T8), Pseudomonas+ Azotobacter+ Soil (T9), Control(T10) (only soil was used as a hilling material). The rootstocksused during the research programme consist of M-9 T337(S1), M-27(S2), MM-106(S3), P-22(S4), MM-111(S5). Theexperimental results showed that maximum shoot diameter (12.22mm), fresh leaf weight (33.33g), dry leaf weight(16.23g) and relative water content(87.16 per cent) were recorded under FYM + Vermicompost+ Azotobacter while as maximum annual production of rooted layers (8.62) was found under saw dust as a hilling media. Theminimum shoot diameter (7.12mm), fresh leaf weight (21.83g), dry leaf weight (7.50g), relative water content (70.47 per cent) and annual production of rooted layers (6.81) were recorded under control (only soil was used a hilling material). Among the various propagation techniques it was observed that propagation technique P2 (trench layering) had a significant effect over P1 (mound layering) with regard to shoot diameter, fresh leafweight, dry leaf weight, relative water content and annual production of rooted layers.

Stroke is leading cause of death world wide, after coronary artery disease and cancer. A high proportion of patients suffering from an acute stress such as stroke or myocardial infarction may develop hyperglycemia, even in the absence of a preexisting diagnosis of diabetes. An observational comparative study was carried out at the Department of Neurology and Medicine, Mymensingh Medical College, Mymensingh, Bangladesh from July 2011 to June 2013 among purposively selected ninety-three patients with a view to assess the outcome of stress hyperglycemia on acute stroke. Data were collected through interview, physical examinationslaboratory investigations by using case record form. Statistical analysis was performed using SPSS (Statistical package for social science) version 17. The mean age of this study was 59.04±15.01 years in the hyperglycemic group and 62.06±13.81 years in the normoglycemic group. The male female ratio in the Hyperglycemic and normoglycemic group was 2.12:1 and 2.44:1 respectively. Smoker was 48.8% in the hyperglycemic group and 52% in the normoglycemic group. 70% of the Hyperglycemic group and 66% of the normoglycemic were found hypertensive. Mean±SD blood glucose level was found 11.86±0.58mmol/L in the Hyperglycemic group and 6.50±1.55mmol/L in the normoglycemic group. Mean HbAlc were 6.14±0.56 in hyperglycemic group and 5.29±0.54 in normoglycemic group. Stroke severity score were 21.79±11.85 in Hyperglycemic and 28.64±9.53 in normoglycemic group on admission. Functional outcome was measured on dischargeat the end of 4th weeks of every patient by Glasgo Outcome Scale (GOS). The study also suggests that stress hyperglycemia is an important risk factor of poor stroke outcome.

Blue Ice Areas (BIAs) or bare ice areas are zones of glacier where surface mass balance is negative, sublimation forms the major ablation process and surface albedo is relatively small. Exceptionally dry and windy meteorological conditions over Antarctica favor the formation of large areas of net ablation on the ice sheet leading to formation of BIRs (Schytt, 1961). BIAs are major source of drinking water to research stations and serve as runways for airplanes in Antarctica. This study has been conducted on the Polar Record Glacier (PRG), Princess Elizabeth Land, East Antarctica, where more than 30% of area is covered by BIAs. The BIAs are extracted and estimated using the value of albedo which is the fraction of solar energy reflected from the surface back to space. A surface having a higher (lower) reflectivity occupies higher (lower) albedo. With an average value of blue ice albedo (also known as bare ice) of 0.55, it ranges from 0.52 to 0.66, due to its geographical area, katabatic wind and wind patterns, the direction of ice flow, rate of sublimation and ablation, surface temperature, etc. The extent of BIAs also depends upon climate and seasonal changes. Albedo is calculated using the Level-1 product of Landsat, this data product (images) is processed according to standard parameters such as Geo-referencing, re-sampling, re-projection and north-up image re-orientation. These data (Digital Numbers) were further calibrated to standard pixel value using multiplicative and additive rescaling factors from metadata provided with the Level-1 product and scaled for absolute reflectance. A further algorithm was applied to get albedo from Landsat-8 dataset. After processing the data, we detected some error in a few pixels, (∼20) which was normalized by using band math. Our result indicates that the range of albedo for the BIAs is decreasing (more surface absorption of solar radiation), which subsequently could promote warming of surface due to increase in the surface temperature. The decreasing rate of albedo suggest the possibility of less reflection of radiation to the atmosphere, more melting which leads to depletion in the BIAs. The carry home message is that the variation in different parameters like albedo of the glacier causes significant variation in the surface area and spatial extent of BIAs.

Stroke is one of the leading causes of death and disability in developed as well as developing countries like Bangladesh. There is a crucial need to identify additional risk factors that are easily measurable and treatable in general population. Role of serum lipids, lipoproteins and lipoprotein related variables in the prediction of stroke is less clear. Abnormalities in plasma lipoproteins are the most firmly established and best understood risk factors for atherosclerosis and they are probable risk factors for ischaemic stroke, largely by their link to atherosclerosis. High serum apolipoprotein-B (Apo-B) levels may predict an increased risk for ischaemic stroke. Aim of the study was to evaluate the association between serum Apo-B level and acute ischaemic stroke and to measure and compare serum Apo-B level in ischaemic stroke and normal subjects. A cross-sectional comparative study was carried out in the department of Neurology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2013 to June 2015. A total number of 100 subjects within 18-70 years were considered for the study. Fifty (50) subjects with stroke (both clinically as well as CT scan of head or MRI of brain proven) were taken as the cases and 50 age and sex matched nearly healthy individuals without stroke were taken as the controls by using non-probability sampling procedure. Total cholesterol, HDL cholesterol and triglycerides were estimated by enzymatic method using Semiautoanalyser. LDL cholesterol was estimated by Friedewald formula. Apo-B was estimated by immunoturbidimetric method using Semiautoanalyser. Finally collected data were analyzed by using SPSS software Version 20. Student 't' test was used to compare the data between cases and controls. P value was set0.05. Diagnostic validity tests were conducted to assess the diagnostic efficiency of Apo-B. Total cholesterol, LDL cholesterol and triglycerides are significantly increased in cases compared to controls. HDL-cholesterol was significantly decreased in cases compared to controls. Apo-B was significantly increased in cases compared to controls. The result was statistically significant. Apo-B may be used as predictors of ischaemic stroke components.

The ice flow velocity is a critical variable in understanding the glacier dynamics. The Synthetic Aperture Radar Interferometry (InSAR) is a robust technique to monitor Earth’s surface mainly to measure its topography and deformation. The phase information from two or more interferogram further helps to extract information about the height and displacement of the surface. We used this technique to derive glacier velocity for Polar Record Glacier (PRG), East Antarctica, using Sentinel-1 Single Look Complex images that were captured in Interferometric Wide mode. For velocity estimation, Persistent Scatterer interferometry (PS-InSAR) method was applied, which uses the time coherent of permanent pixel of master images and correlates to the same pixel of the slave image to get displacement by tracking the intensity of those pixels. C-band sensor of European Space Agency, Sentinel-1A, and 1B data were used in this study. Estimated average velocity of the PRG is found to be approximately ≈400 ma−1, which varied from ≈100 to ≈700 ma−1. We also found that PRG moves at ≈700 and 200 ma−1 in the lower part and the upper inland area, respectively.

Gastroesophageal reflux disease (GERD) is defined as symptoms or complications associated with regurgitation from the stomach and/or the duodenum to the esophagus. Patients with type II diabetes mellitus (DM) were known to have higher prevalence of GERD in the Western countries, but data on the impact of GERD on DM patients in our country are scarce. The aim of this cross-sectional study was to evaluate the presence of GERD in type II DM patients admitted at the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from April 2015 to September 2015. A total of 137 type II DM cases were purposively collected. Reflux Disease Questionnaire (RDQ) was used to check the presence of GERD. Patient's characteristics, laboratory data, face-to-face interview data were analyzed. Out of 137 type 2 DM patients 108 were suffering from GERD giving a prevalence rate of 78.8% which is quite high. Pathophysiological factors like age, sex, duration of DM, weight, waist circumference (WC) had no significant difference between GERD-DM and non-GERD-type II DM patients. Only hypertension and frequent eating fatty food were found to have significant differences between the two groups. From the study findings it could be said that the higher rate of GERD in patients with type II DM may be associated with lifestyle factor and some pathophysiological factors like hypertension. Psychiatric factors may also play role in contributing GERD. Further in-depth and large scale studies are necessary in our country in this regard.

Cementless fixation is an alternative to cemented unicompartmental knee replacement (UKR), with several advantages over cementation. This study reports the ten-year survival and seven-year clinical outcome of cementless Oxford unicompartmental knee replacement (OUKR).This prospective study describes the clinical outcome and survival of the first 1000 consecutive cementless medial OUKRs implanted at two centres for recommended indications.The 10-year survival was 97% (CI 95%: 92-100%), with 25 knees being revised. The commonest reason for revision was progression of arthritis laterally, which occurred in nine knees, followed by primary dislocation of the bearing, which occurred in six knees. There were two dislocations secondary to trauma and a ruptured ACL, and two tibial plateau fractures. Although there were no definite cases of aseptic loosening, two early revisions were related to tibial fixation: one for pain and a radiolucent line and one for incomplete seating of the component with a radiolucent line. There were four revisions for pain, but the cause of the pain was uncertain: in one there was tibial overhang and in two there was patellofemoral degeneration, which possibly contributed to the pain. There were no deep infections. The mean OKS improved from 23 (SD 8) to 42 (SD 7) at a mean follow-up of 7.0 years (p 0.001). There was no significant difference in survival or clinical outcome between the designer and independent centre.The cementless OUKR is a safe and reproducible procedure with excellent 10-year survival and clinical results in the hands of both designer and independent surgeons.

Inflammatory pseudotumours occasionally occur after metal-on-metal hip resurfacing and often lead to revision. Our aim was to determine the severity of this complication by assessing the outcome of revision in these circumstances and by comparing this with the outcome of other metal-on-metal hip resurfacing revisions as well as that of matched primary total hip replacements. We identified 53 hips which had undergone metal-on-metal hip resurfacing and required revision at a mean of 1.59 years (0.01 to 6.69) after operation. Of these, 16 were revised for pseudotumours, 21 for fracture and 16 for other reasons. These were matched by age, gender and diagnosis with 103 patients undergoing primary total hip replacement with the Exeter implant. At a mean follow-up of three years (0.8 to 7.2) the outcome of metal-on-metal hip resurfacing revision for pseudotumour was poor with a mean Oxford hip score of 20.9 (sd 9.3) and was significantly worse (p < 0.001) than the outcome for fracture with a mean Oxford hip score of 40.2 (sd 9.2) or that for other causes with a mean Oxford hip score of 37.8 (sd 9.4). The clinical outcome of revision for pseudotumour was also significantly worse (p < 0.001) than the outcome of matched primary total hip replacements. By contrast, the outcome for fracture and other causes was not significantly different from that of matched primary total hip replacements (p = 0.065). After revision for pseudotumour there were three cases of recurrent dislocation, three of palsy of the femoral nerve, one of stenosis of the femoral artery and two of loosening of the component. Five hips required further revision. In three of these there was evidence of recurrent pseudotumour, and one is currently awaiting further revision. The incidence of major complications after revision for pseudotumour (50%) was significantly higher (p = 0.018) than that after revision for other causes (14%). The outcome of revision for pseudotumour is poor and consideration should be given to early revision to limit the extent of the soft-tissue destruction. The outcome of resurfacing revision for other causes is good.

The present investigation was carried out with the aim of selecting chestnut types that have superior nut and yield characteristics in Srinagar district of Kashmir province, India. Bearing habit, number of nuts per burr, number of plump nuts per burr, nut weight, nut size, pellicle adhesion and intrusion, and cropping efficiency were evaluated as per FAO Corporate Document Repository and UPOV (1989). The following selections were identified for their special quality scores: HSC032, HSC025, HSC040, HSC018, and HSC022.