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Background: Coronal fractures of distal end femur, referred as Hoffa’s fracture are not uncommon, yet easily missed injuries lacking proper classification system and consensus for ideal treatment. While most trauma surgeons adopt different strategies based on the fracture configuration and their own experience, there are no set ways to classify these based on the most appropriate treatment strategy. Methods: Thirty cases of Hoffa fracture from tertiary care centres were studied for the fracture pattern, fragment size, comminution and possible variations to formulate a radiological classification and treatment guidelines. Additionally, a literature search was used to analyze 77 case studies based on Hoffa fracture to find out the common fracture patterns and treatment modalities adopted for varying fracture patterns in these studies. Six independent observers participated in testing the inter-observer reliability of the proposed classification. Results: A new proposed radiological classification for Hoffa fracture consists of four main types. Type 1 is with fracture fragment >2.5 cm, Type 2 with fragment

BackgroundPediatric tuberculous meningitis (TBM) commonly causes death or disability. In adults, high-dose rifampicin may reduce mortality. The role of fluoroquinolones remains unclear. There have been no antimicrobial treatment trials for pediatric TBM.MethodsTBM-KIDS was a phase 2 open-label randomized trial among children with TBM in India and Malawi. Participants received isoniazid and pyrazinamide plus: (i) high-dose rifampicin (30 mg/kg) and ethambutol (R30HZE, arm 1); (ii) high-dose rifampicin and levofloxacin (R30HZL, arm 2); or (iii) standard-dose rifampicin and ethambutol (R15HZE, arm 3) for 8 weeks, followed by 10 months of standard treatment. Functional and neurocognitive outcomes were measured longitudinally using Modified Rankin Scale (MRS) and Mullen Scales of Early Learning (MSEL).ResultsOf 2487 children prescreened, 79 were screened and 37 enrolled. Median age was 72 months; 49%, 43%, and 8% had stage I, II, and III disease, respectively. Grade 3 or higher adverse events occurred in 58%, 55%, and 36% of children in arms 1, 2, and 3, with 1 death (arm 1) and 6 early treatment discontinuations (4 in arm 1, 1 each in arms 2 and 3). By week 8, all children recovered to MRS score of 0 or 1. Average MSEL scores were significantly better in arm 1 than arm 3 in fine motor, receptive language, and expressive language domains (P

Glucuronoxylan is present mainly in the dicot of the secondary cell walls, often O‐acetylated, which stabilizes cell structure by maintaining interaction with cellulose and other cell wall components. Some members of the Golgi localized Trichome Birefringence‐Like (TBL) family function as xylan O‐acetyl transferase (XOAT). The primary XOAT in the stem of Arabidopsis is ESKIMO1/TBL29, and its disruption results in decreased xylan acetylation, stunted plant growth, and collapsed xylem vessels. To elucidate the effect on metabolic reprogramming and identify the underlying cause of the stunted growth in eskimo1, we performed transcriptomic, targeted, and untargeted metabolome analysis, mainly in the inflorescence stem tissue. RNA sequencing analysis revealed that the genes involved in the biosynthesis, regulation, and transport of aliphatic glucosinolates (GSLs) were upregulated, whereas those responsible for indolic GSL metabolism were unaffected in the eskimo1 inflorescence stem. Consistently, aliphatic GSLs, such as 4‐methylsulfinylbutyl (4MSOB), were increased in stem tissues and seeds. This shift in the profile of aliphatic GSLs in eskimo1 was further supported by the quantification of the soluble acetate, decrease in accumulation of GSL precursor, i.e., methionine, and increase in the level of jasmonic acid. [ABSTRACT FROM AUTHOR]

Background: Radiation Heart Disease (RHD) results from thoracic radiotherapy and often necessitates Cardiothoracic Surgery (CTS). This study investigates the Long-Term Survival (LTS) of cardiac surgery patients with RHD. Objective: To evaluate the LTS outcomes for patients with RHD who have undergone cardiac surgery. Materials and Methods: This cohort study involved 268 RHD patients and 400 control patients, matched by age, gender, and type/time of CTS. Most RHD patients had a history of Hodgkin lymphoma or breast cancer, with an average of 20 years to 22 years since radiation therapy. Mortality was analyzed using Multivariate Cox Proportional Hazard Analysis (MCPHA). Results: Clinical and surgical parameters, including all-cause mortality and preoperative STS score, were assessed. The mean STS score was comparable between RHD and control groups. RHD patients had a higher incidence of proximal coronary artery disease but lower rates of redo CTS compared to controls. Approximately two-thirds of patients in both groups underwent combined surgical procedures. Over an average follow-up period of 8 years, the RHD group had a significantly higher mortality rate compared to the control group. Higher mortality was linked to the absence of ß-blockers, a higher STS score, and RHD status in the MCPHA. Conclusions: RHD patients undergoing CTS have reduced LTS compared to non-RHD patients. Improved therapeutic strategies can be needed to enhance survival outcomes for RHD patients. [ABSTRACT FROM AUTHOR]