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Introduction: The Ascend Flex short stem implant has been reported to have good early clinical outcomes and low revision rates. This retrospective study aimed to evaluate the early to mid-term radiographic and clinical outcomes of patients who underwent primary shoulder arthroplasty with this implant., Methods: All consecutive patients who underwent primary shoulder arthroplasty with short uncemented Ascend Flex stems with a minimum of 24-month follow-up were included. The primary outcomes were revision and reoperation rate. The secondary outcomes included stress shielding and Oxford Shoulder Score (OSS)., Results: Totally, 151 shoulders were eligible for inclusion. Out of which 73 were anatomic total shoulder arthroplasty, 77 were reverse geometry, and 1 was a hemiarthroplasty. Mean follow-up duration was 52 ± 17.2 months. The revision and reoperation rates were 0.6% and 2.6%, respectively. 1.3% anatomic total shoulder arthroplasty (aTSA) cases and 6.5% RSA cases demonstrated stress shielding. OSS improved from 16.1 ± 8.5 to 34.1 ± 12.3 in aTSA cases ( Z  = -3.98, p  < 0.001) and from 15.6 ± 8.4 to 30.0 ± 13.5 in RSA cases ( Z  = -3.41, p  < 0.001)., Conclusion: These findings demonstrate reassuring outcomes for this implant at a mean of 52 months. Further reports are required to document the long-term outcomes for this component., Competing Interests: RH, DS and MR have no conflicting interests in the subject matter or materials discussed in this manuscript. PM declares teaching and research consultancy from Stryker, Lima and Arthrex. Wrightington Hospital receives research funding from Stryker, however this study's design, data collection, analysis and preparation of manuscript were independent from Stryker., (© The Author(s) 2023.)

Abstract: Paget-Schroetter syndrome describes a primary thrombosis of the subclavian vein induced by effort. In most cases, the clinical presentation includes painful swelling, discoloration, and visible collateral circulation in the arm. Paget-Schroetter syndrome is treated with anticoagulation, rest, and physical therapy. In certain cases, invasive treatment such as thrombolysis and decompression surgery (first rib resection) may be necessary. We present the case of a 28-year-old healthy male patient with effort-induced deep vein thrombosis of the upper extremity after posterior shoulder subluxation. Anticoagulation, rest, and physical therapy were used to treat the patient, who became asymptomatic and was able to resume normal activities without restriction. To our knowledge, this is the first case of effort-induced upper extremity deep vein thrombosis after posterior shoulder subluxation. Paget-Schroetter syndrome is rare diagnosis that requires vigilance during musculoskeletal assessment for shoulder pain and swelling. The early detection, radiological confirmation, and prompt initiation of treatment are essential to successful management of Paget-Schroetter syndrome. The impact of associated posterior shoulder subluxation remains unclear., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Soil pollution with cadmium (Cd) poses serious health and environmental consequences. The study investigated the incubation of several soil samples and conducted quantitative soil characterization to assess the influence of biochar (BC) on Cd adsorption. The aim was to develop predictive models for Cd concentrations using statistical and modeling approaches dependent on soil characteristics. The potential risk linked to the transformation and immobilization of Cd adsorption by BC in the soil could be conservatively assessed by pH, clay, cation exchange capacity, organic carbon, and electrical conductivity. In this study, Long Short-Term Memory (LSTM), Bidirectional Gated Recurrent Unit (BiGRU), and 5-layer CNN Convolutional Neural Networks (CNNs) were applied for risk assessments to establish a framework for evaluating Cd risk in BC amended soils to predict Cd transformation. In the case of control soils (CK), the BiGRU model showed commendable performance, with an R2 value of 0.85, indicating an approximate 85.37% variance in the actual Cd. The LSTM model, which incorporates sequence data, produced less accurate results (R2=0.84), while the 5-layer CNN model had an R 2 value of 0.91, indicating that the CNN model could account for over 91% of the variation in actual Cd levels. In the case of BC-applied soils, the BiGRU model demonstrated a strong correlation between predicted and actual values with R2 (0.93), indicating that the model explained 93.21% of the variance in Cd concentrations. Similarly, the LSTM model showed a notable increase in performance with BC-treated soil data. The R2 value for this model stands at a robust R2 (0.94), reflecting its enhanced ability to predict Cd levels with BC incorporation. Outperforming both recurrent models, the 5-layer CNN model attained the highest precision with an R2 value of 0.95, suggesting that 95.58% of the variance in the actual Cd data can be explained by the CNN model's predictions in BC-amended soils. Consequently, this study suggests developing ecological soil remediation strategies that can effectively manage heavy metal pollution in soils for environmental sustainability.

Background: Navigated augmented reality (AR) through a head-mounted display (HMD) has led to accurate glenoid component placement in reverse shoulder arthroplasty (RSA) in an in-vitro setting. The purpose of this study is to evaluate the deviation between planned, intraoperative, and postoperative inclination, retroversion, entry point, and depth of the glenoid component placement during RSA, assisted by navigated AR through an HMD, in a surgical setting., Methods: A prospective, multicenter study was conducted. All consecutive patients undergoing RSA in 2 institutions, between August 2021 and January 2023, were considered potentially eligible for inclusion in the study. Inclusion criteria were as follows: age >18 years, surgery assisted by AR through an HMD, and postoperative computed tomography (CT) scans at 6 weeks. All participants agreed to participate in the study and informed consent was provided in all cases. Preoperative CT scans were undertaken for all cases and used for 3-dimensional (3D) planning. Intraoperatively, glenoid preparation and component placement were assisted by a navigated AR system through an HMD in all patients. Intraoperative parameters were recorded by the system. A postoperative CT scan was undertaken at 6 weeks, and 3D reconstruction was performed to obtain postoperative parameters. The deviation between planned, intraoperative, and postoperative inclination, retroversion, entry point, and depth of the glenoid component placement was calculated. Outliers were defined as >5° for inclination and retroversion and >5 mm for entry point., Results: Seventeen patients (9 females, 12 right shoulders) with a mean age of 72.8 ± 9.1 years (range, 47.0-82.0) met inclusion criteria. The mean deviation between intra- and postoperative measurements was 1.5° ± 1.0° (range, 0.0°-3.0°) for inclination, 2.8° ± 1.5° (range, 1.0°-4.5°) for retroversion, 1.8 ± 1.0 mm (range, 0.7-3.0 mm) for entry point, and 1.9 ± 1.9 mm (range, 0.0-4.5 mm) for depth. The mean deviation between planned and postoperative values was 2.5° ± 3.2° (range, 0.0°-11.0°) for inclination, 3.4° ± 4.6° (range, 0.0°-18.0°) for retroversion, 2.0 ± 2.5 mm (range, 0.0°-9.7°) for entry point, and 1.3 ± 1.6 mm (range, 1.3-4.5 mm) for depth. There were no outliers between intra- and postoperative values and there were 3 outliers between planned and postoperative values. The mean time (minutes : seconds) for the tracker unit placement and the scapula registration was 03:02 (range, 01:48 to 04:26) and 08:16 (range, 02:09 to 17:58), respectively., Conclusion: The use of a navigated AR system through an HMD in RSA led to low deviations between planned, intraoperative, and postoperative parameters for glenoid component placement., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

A significant amount of energy can be produced using renewable energy sources; however, storing massive amounts of energy poses a substantial obstacle to energy production. Economic crisis has led to rapid developments in electrochemical (EC) energy storage devices (EESDs), especially rechargeable batteries, fuel cells, and supercapacitors (SCs), which are effective for energy storage systems. Researchers have lately suggested that among the various EESDs, the SC is an effective alternate for energy storage due to the presence of the following characteristics: SCs offer high-power density (PD), improvable energy density (ED), fast charging/discharging, and good cyclic stability. This review highlighted and analyzed the concepts of supercapacitors and types of supercapacitors on the basis of electrode materials, highlighted the several feasible synthesis processes for preparation of metal oxide (MO) nanoparticles, and discussed the morphological effects of MOs on the electrochemical performance of the devices. In this review, we primarily focus on pseudo-capacitors for SCs, which mainly contain MOs and their composite materials, and also highlight their future possibilities as a useful application of MO-based materials in supercapacitors. The novelty of MO's electrode materials is primarily due to the presence of synergistic effects in the hybrid materials, rich redox activity, excellent conductivity, and chemical stability, making them excellent for SC applications., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Asghar, Khan, Hakami, Alamier, Ali, Zelai, Rashid, Tareen and Al-Harthi.)

Background: Cutibacterium acnes ( C acnes ) is a commensal skin bacterium, primarily found in sebaceous glands and hair follicles, with a high prevalence in the shoulder region. It is the most common pathogenic organism in prosthetic joint infections after shoulder arthroplasty. Because of its low virulence, its diagnosis remains difficult., Purpose: To evaluate the relative effects of topical preparations in reducing C acnes in shoulder surgery., Study Design: Meta-analysis; Level of evidence, 1., Methods: We searched the MEDLINE, Embase, PsychINFO, and Cochrane Library databases in March 2022. Randomized controlled trials (RCTs) comparing any form of topical preparation in arthroscopic or open shoulder surgery were included. The primary outcome was a reduction in the number of positive C acnes cultures. Secondary outcomes were adverse events related to the application of topical preparations. We performed a network meta-analysis to facilitate simultaneous comparisons between multiple preparations across studies. We calculated differences between preparations using odds ratios and their 95% CIs. The risk of bias was assessed using the Cochrane risk-of-bias tool., Results: The search yielded 17 RCTs (1350 patients), of which 9 were suitable for the network meta-analysis (775 patients). Overall, 2 RCTs were deemed as having a low risk of bias, and 15 raised "some concerns" of bias. Preparations included benzoyl peroxide (BPO), BPO combined with clindamycin, chlorhexidine gluconate, hydrogen peroxide, povidone-iodine, and water with soap. Only BPO resulted in significantly lower odds of a positive C acnes culture compared with placebo or soap and water (odds ratio, 0.12 [95% CI, 0.04-0.36]). There was no statistically significant difference with all other topical preparations. The only adverse events were skin irritation from BPO and chlorhexidine gluconate in a small number of reported cases., Conclusion: BPO was the most effective topical agent in reducing the prevalence of C acnes in shoulder surgery. These results were limited by a combination of indirect and direct data. Future studies should focus on establishing the optimal frequency and duration of preoperative BPO to further reduce the burden of C acnes ., Registration: CRD42022310312 (PROSPERO)., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Iterative evolutions in arthroscopic rotator cuff repair aim to improve its biomechanical and biological properties. This technical note describes an arthroscopic rotator cuff repair technique that combines the advantages of a modified Mason-Allen suture technique with the advantages of an arthroscopic transosseous-equivalent construct. Two alternatives for creating this construct are described. The Mason-Allen stitch is easy to perform, is cost-effective, and increases tissue security without tendon strangulation. The arthroscopic transosseous-equivalent construct increases footprint contact pressure and coverage, aiding healing of the repaired rotator cuff., (© 2024 The Authors.)

Purpose: To determine whether non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors affect healing rate, functional outcomes, and patient satisfaction after rotator cuff repair., Methods: Medline, EMBASE, PsychINFO and the Cochrane Library were searched for randomized controlled trials (RCTs) investigating the use of NSAIDs and COX-2 inhibitors after arthroscopic rotator cuff repair. Primary outcomes included healing and retear rate, determined by radiological imaging. Secondary outcomes included shoulder-specific outcome measures and the visual analog scale (VAS). Risk of bias was graded using the Cochrane risk-of-bias v2.0 tool. The GRADE framework was used to assess certainty of findings., Results: Seven RCTs with a total of 507 patients were included (298 randomized to NSAID/COX-2 vs 209 randomized to control). NSAIDs use did not yield a difference in retear rate (P = .77). NSAIDs were shown to significantly reduce pain in the perioperative period (P = .01); however, no significant difference was present at a minimum of 6 months (P = .11). COX-2 inhibitors did not significantly reduce pain (P = .15). Quantitative analysis of ASES and UCLA scores showed NSAIDs significantly improved functional outcomes versus control (P = .004). COX-2 inhibitors did not significantly improve functional outcomes (P = .15). Two trials were deemed "low" risk of bias, four trials were graded to have "some concerns", and one trial was graded to have "high" risk of bias. Retear rate and functional PROMs were deemed to have "low" certainty. VAS pain scale was graded to have "moderate" certainty., Conclusions: This systematic review and meta-analysis indicates that NSAIDs do not affect healing rate after arthroscopic rotator cuff repair, but they do significantly improve postoperative pain and functional outcomes. No significant difference was seen in pain or functional outcomes with the use of COX-2 inhibitors., Level of Evidence: Level I, meta-analysis of randomized controlled trials., Competing Interests: Disclosure The authors report no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (Copyright © 2023 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Failure after isolated Bankart repair has led surgeons to consider when to address the Hill-Sachs lesion, which is thought to be a contributor to recurrent instability. One approach utilizes the glenoid track concept to determine whether a Hill-Sachs lesion is classified as "off-track," suggesting that the addition of a remplissage procedure may aid stability. However, the accuracy and reliability of using this approach require validation using an appropriate reference., Purpose: To determine the accuracy and reliability of using the glenoid track concept against dynamic arthroscopic assessment of Hill-Sachs lesion engagement., Study Design: Cohort study (diagnosis); Level of evidence, 3., Methods: A total of 49 patients undergoing arthroscopic Bankart repair surgery for recurrent traumatic anterior shoulder instability were enrolled in this diagnostic validation study. Shoulders were classified as on-track or off-track using 3-dimensional computed tomography (3DCT) and static arthroscopic measurements. These classifications were compared with dynamic arthroscopic assessment (engagement of the Hill-Sachs lesion on the anterior glenoid rim in the 'athletic position') to determine their accuracy and reliability., Results: The 3DCT-based measurements to determine glenoid track status had a higher positive predictive value (66% vs 42%), higher specificity (47% vs 42%), and higher accuracy (65% vs 59%) compared with static arthroscopic measurements. Static arthroscopic measurements to determine glenoid track status had a higher negative predictive value (96% vs 64%) and higher sensitivity (96% vs 81%) compared with 3DCT-based measurements. Interrater reliability (Krippendorff α) was 'fair' for determining the glenoid track status using 3DCT (0.368; 95% CI, 0.217-0.519) and 'moderate' for static arthroscopic measurements (0.523; 95% CI, 0.364-0.666). Intrarater reliability (intraclass correlation coefficient [ICC] 3, k ) was 'moderate' for 3DCT measurements (0.660; 95% CI, 0.444-0.798) and 'good' for static arthroscopic measurements (0.769; 95% CI, 0.629-0.862)., Conclusion: Determining glenoid track status using either 3DCT or static arthroscopic measurements yielded moderate accuracy and reliability. Surgeons using the glenoid track concept to aid surgical decision-making in traumatic recurrent anterior shoulder instability should utilize 3DCT or static arthroscopic measurements with caution., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: I.K.Y.L. has received fellowship support from Smith & Nephew, consulting fees from Smith & Nephew, and royalties from Smith & Nephew, Arthrex, and Wolters Kluwer. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2024.)

Biochar (BC) has been substantiated to effectively reduce the available content of heavy metals (HMs) in soil-plant system; however, the risk of biochar (BC)derived dissolved organic matter (DOM) induced metal vertical migration has not been well documented, especially in the long-term field conditions. Therefore, this study investigated HM vertical migration ecological risks and the long-term effectiveness of the amendment of biochar in the three successive years of field trials during the rotation system. The results revealed that biochar application could increase soil pH and DOM with a decrease in soil CaCl 2 extractable pool for Pb, Cu, and Cd. Furthermore, the results indicated a significant decrease in acid phosphatase activities and an increase in urease and catalase activities in the soil. Cucumber was shown to be safe during a three-year rotation system in the field. These results suggest that BC has the potential to enhance soil environment and crop yields. BC derived DOM-specific substances were identified using parallel factor analysis of excitation-emission matrix in deep soil (0-60 cm). The study incorporated HM concentration fluctuations in deep soils, providing an additional interpretation of DOM and co-migration of HMs.The environmental risk associated with the increase in DOM hydrophobicity should not be ignored by employing BC for soil HM remediation applications. The study enhances understanding of biochar-derived DOM's migration and stabilization mechanisms on heavy metals, providing guidelines for its use as a soil amendment., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose of Review: The purpose of the review is to provide an updated overview of a relatively novel but controversial surgical device (InSpace subacromial balloon, Stryker, Kalamazoo, MI) that can be readily incorporated into the armamentarium of the shoulder surgeon. The authors review the critical clinical and surgical decision-making aspects of InSpace. A recommended surgical technique and rehabilitation protocol are outlined. The authors present a nuanced view of the balloon spacer in the continuum of care of the irreparable rotator cuff tear., Recent Findings: Within the last year, two Level I clinical trials have been published, and the data from these studies offer conflicting evidence regarding the utility of the subacromial balloon spacer. The current review contrasts these two recent studies and offers a framework by which the available evidence can be practically understood with respect to clinical decision-making. The literature currently supports a limited indication for use of InSpace: the elderly, low-demand patient with preserved active range of motion with an operatively irreparable, posterosuperior rotator cuff tear with an intact subscapularis. The InSpace subacromial balloon spacer is a simple device that can yield substantial improvements in clinical outcomes among a subset of patients with irreparable rotator cuff tears. InSpace is not a panacea for the complex, irreparable rotator cuff tear. Individualized decision-making is necessary in this diverse and challening patient population., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The beneficial utilization of potentially increasing urban green waste (UGW) is critical for sustainable urban development in China. In this study, UGW was pyrolyzed at different temperatures, and the resulting biochar was used to amend Cd-contaminated soils to grow cabbage. Our results showed that the Cd adsorption capacity of UGW-biochar was positively correlated with the surface area, O/C, and (O+N)/C value of biochar. Furthermore, UGW-biochar was incorporated into three Cd-contaminated soils, including one acidic soil and two neutral soils, to assess its impact on the availability of Cd. The most substantial reduction in the concentration of available Cd was observed in the acidic soil, of the three tested soils. In the neutral soils, a more substantial reduction was found in the heavily Cd-contaminated soil compared to the lightly Cd-contaminated soil. UGW-biochar amendments to the three Cd-contaminated soils resulted in an increase in the cabbage biomass in acidic soil, whereas in neutral soils, it increased in lightly contaminated soils but decreased in heavily contaminated soils. Additionally, the Cd bioaccumulation factor (BCF), translocation factor (TF), and removal efficiency (RE), as impacted by the biochar application, were calculated in the lightly Cd-contaminated soil-cabbage system. The BCF decreased from 5.84 to 3.80 as the dosage of the UGW-biochar increased from 0% to 3%, indicating that the UGW-biochar immobilized Cd and reduced its bioaccumulation in cabbage roots. Based on our investigations, UGW-biochar effectively immobilizes Cd by reducing its mobility and bioavailability in a lightly contaminated environment matrix.

Background: Glenoid retroversion and humeral head subluxation is a progressive disorder due to abnormal force coupling and increased contact force. In situ placement of anatomic total shoulder arthroplasty (TSA) components in this scenario results in edge loading, progressive subluxation, and early failure. Wedged glenoid components have been demonstrated to improve glenohumeral alignment, but have not been correlated with mid-term clinical outcomes., Methods: Patients undergoing TSA using a wedged all-polyethylene glenoid component for retroverted glenoid deformity were identified from a prospectively maintained database. Preoperative planning computed tomography was routinely performed and compared to postoperative correction on radiographic evaluation. Evidence of loosening was correlated to prospectively collect clinical outcome using patient-reported outcome measures. A matched group of neutrally aligned glenohumeral joints undergoing anatomic TSA was used to compare improvement in clinical outcomes., Results: Over a 5-year period, 17 patients with mean age 60 (range 43-81, standard deviation 10.5) were identified with a mean preoperative neoglenoid retroversion of 16.7° (standard deviation 4.5). At a mean follow-up of 43.8 months (range 27-60), no revision surgeries were undertaken. Improvement in the Oxford Shoulder Score was 18 points ( P  < .0001). The mean improvement was compared to a matched control group demonstrating a comparable magnitude of improvement of 20.4 points., Conclusion: Wedged polyethylene components for Walch B2-type glenoids in TSA yield acceptable correction of the joint line, excellent clinical outcomes, and survivorship is maintained in the short term. The clinical and radiological outcome demonstrated similar improvement to that seen in A type deformities., (Crown Copyright © 2023 Published by Elsevier Inc. on behalf of American Shoulder and Elbow Surgeons.)

Soil contamination and its subsequent impact on the food chain is a pressing challenge in the present day. The application of biochar has demonstrated a significant and positive effect on soil health, thereby enhancing plant growth and development. However, the application of biochar (BC) produced from negative pressure-induced carbonization to mitigate metal(loid) contamination is a new strategy that has been studied in current research. Results depicted that the application of biochar derived from the negative pressure carbonization (vacuum-assisted biochar (VBC) has a significant (p ≤ 0.05) positive impact on plant growth and physiological characteristics by influencing immobilization and speciation of metal(loid) in the soil system. Moreover, the interactive effect of VBC on physiological characteristics (photosynthesis, gas exchange, and chlorophyll contents) and antioxidant activities of maize (Zea mays L.) was significantly (p ≤ 0.05) positive by confining the translocation and movement of metal(loid)s to the aerial part of the maize plant. X-ray diffraction (XRD) provided information on the structural and chemical changes induced by the VBC-500 °C explaining metal(loid) adsorption onto mineral surfaces and complexation that can affect their mobility, availability, and toxicity in the contaminated soil. Fourier transform infrared spectroscopy (FTIR) further provided a more detailed understanding of the metal(loid)s and biochar complexation mechanisms influenced by VBC-based functional groups -OH, C-Hn, -COOH, CO, C-O-C, CC, C-O, C-H, OH, and C-C in the binding process. These results suggest that the application of biochar prepared at 500 °C under negative pressure-induced carbonization conditions to the soil is the most efficient way to reduce the uptake and transfer of metal(loid)s by influencing their mobility and availability in the soil-plant system., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: The purpose of this study is to report the clinical and radiologic outcomes of patients undergoing primary or revision reverse total shoulder arthroplasty using custom 3D-printed components to manage severe glenoid bone loss with a minimum of 2-year follow-up., Methods: Following ethical approval, patients were identified and invited to participate. Inclusion criteria were (1) severe glenoid bone loss necessitating the need for custom implants and (2) patients with definitive glenoid and humeral components implanted more than 2 years prior. Included patients underwent clinical assessment using the Oxford Shoulder Score (OSS), Constant-Murley score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and the quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH). Radiographic assessment included anteroposterior and axial projections. Patients were invited to attend a computed tomography (CT) scan to confirm osseointegration. Statistical analysis used descriptive statistics (mean and standard deviation [SD]) and paired t test for parametric data., Results: Eleven patients declined to participate. Five patients were deceased prior to study commencement, leaving 42 remaining patients in this analysis. Three patients had revision surgery before the 2-year follow-up; of these, 2 retained their custom glenoid components. Mean follow-up was 31.6 months from surgery (range 24-52 months). All 4 scores improved: OSS from a mean 15 (SD 8.4) to 36 (SD 12) (P < .001), Constant-Murley score from a mean 15 (SD 11.2) to 52 (SD 20.1) (P < .001), QuickDASH from a mean 70 (SD 21) to 31 (SD 24.8) (P = .004), and the ASES score from a mean 22 (SD 17.8) to 71 (SD 23.3) (P = .007). Radiologic evaluation demonstrated good osseointegration in all but 1 included patient., Conclusion: The utility of custom 3D-printed components for managing severe glenoid bone loss in primary and revision reverse total shoulder arthroplasty yields significant clinical improvements in this complex cohort. Large complex glenoid bone defects can be managed successfully with custom 3D-printed glenoid components., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Shoulder stiffness is a frequent complication after proximal humeral fractures treated with or without surgery. Shoulder stiffness is associated with high rates of absence from work and a significant financial burden for the healthcare system. Secondary stiffness is characterized by additional extracapsular adhesions, including subacromial, subcoracoid, and subdeltoid spaces, usually derived from post-fracture or post-surgical extraarticular hematomas. Several secondary causes may coexist with capsular and extracapsular adhesions decreasing the shoulder motion, such as malunion, nonunion, metalwork failure, infection, and osteoarthritis, among others. Conservative treatment, usually prescribed for primary shoulder stiffness, has shown unfavorable results in secondary stiffness, and surgical intervention may be required. Surgical interventions need to be patient-specific. Usually, open or arthroscopic fibro-arthrolysis and subacromial release are performed, together with plate removal and biceps tenotomy/tenodesis. In severe osteoarthritis, shoulder replacement may be indicated. Ruling out infection is recommended in every case.

Purpose: A number of classification systems exist for posterior malleolar ankle fractures. The user reliability of these classification systems remains unclear. The primary aim of this study was to evaluate the reliability of three commonly utilised classification systems for fractures of the posterior malleolus., Methods: Imaging of 60 patients across 2 hospitals with ankle fractures including a posterior malleolar fragment was identified. All patients had undergone plain radiographs and computed tomography of their injured ankle as part of their normal standard of care. 9 surgeons including pre-resident/registrar level, resident/registrar level, and attending/consultant level applied the Haraguchi, Bartoníček, and Mason classifications to these fractures, at two timepoints, at least 4 weeks apart. The order was randomised between assessments. Inter-rater reliability was assessed using Fleiss' κ and standard error (SE). Intra-rater reliability was assessed using Cohen's κ and standard error (SE)., Results: Inter-rater reliability (Fleiss' κ) was calculated for the Haraguchi classification as 0.588 (SE 0.023), for the Bartoníček classification as 0.626 (SE 0.019), and the Mason classification as 0.541 (SE 0.098). Intra-rater reliability (Cohen's κ) was 0.761 (SE 0.098) for the Haraguchi classification, 0.761 (SE 0.091) for the Bartoníček, classification, and 0.724 (SE 0.096) for the Mason classification., Conclusions: This study reports the inter-rater and intra-rater reliability for three classification systems for posterior malleolus fractures. Based on definitions by Landis and Koch (Biometrics 33:159-174, 1977), inter-rater reliability was rated as 'moderate' for the Haraguchi and Mason classifications and 'substantial' for the Bartoníček classification. Similarly, the intra-rater reliability was rated as 'substantial' for all three classifications., (© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

An inexpensive and environmentally friendly composite synthesized from rice husk, impregnated with montmorillonite and activated by carbon dioxide, was investigated for the removal of azithromycin from an aqueous solution. Various techniques were used to characterize adsorbents in detail. The sorption process was primarily regulated by the solution pH, pollutant concentration, contact duration, adsorbent dose, and solution temperature. The equilibrium data were best analyzed using the nonlinear Langmuir and Sips (R 2  > 0.97) isotherms, which revealed that adsorption occurs in a homogenous manner. The adsorption capacity of pristine biochar and carbon dioxide activated biochar-montmorillonite composite was 33.4 mg g -1 and 44.73 mg g -1 , respectively. Kinetic studies identified that the experimental data obeyed the pseudo-second-order and Elovich models (R 2  > 0.98) indicating the chemisorption nature of adsorbents. The thermodynamic parameters determined the endothermic and spontaneous nature of the reaction. The ion exchange, π-π electron-donor-acceptor (EDA) interactions, hydrogen-bonding, and electrostatic interactions were the plausible mechanisms responsible for the adsorption process. This study revealed that a carbon dioxide activated biochar-montmorillonite composite may be used as an effective, sustainable, and economical adsorbent for the removal of azithromycin from polluted water., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Professional societies have recommended universal first trimester screening for preeclampsia and a second or third trimester soluble fms-like tyrosine kinase-1-placental growth factor ratio test to assess for preeclampsia and its severity. However, it may not be feasible to implement the most optimal screening protocol for preeclampsia in the first trimester which uses a combination of maternal characteristics, maternal biophysical and biochemical markers due to limitations in the access to uterine artery doppler ultrasound. There are inconsistent findings on how early in the second trimester the fms-like tyrosine kinase-1-placental growth factor ratio begins to provide useful information in preeclampsia prediction., Objective: This study aimed to assess the accuracy of (1) a combination of maternal characteristics, maternal serum pregnancy-associated plasma protein A, and placental growth factor in the screening for preeclampsia in the first trimester; and (2) placental growth factor or soluble fms-like tyrosine kinase-1-placental growth factor ratio in the prediction of preeclampsia in the early second trimester., Study Design: This retrospective case-control study used frozen residual blood samples from women who had aneuploidy screening and delivered at a tertiary center. The case group included pregnancies with gestational hypertension or preeclampsia (further classified as early-onset [birth at <34 weeks' gestation] and preterm preeclampsia [birth at <37 weeks' gestation]). Each case was matched with 3 control pregnancies by date of blood sample draw, gestational age at first blood sample draw, maternal age, maternal ethnicity, type of multiple-marker screening, and amount of residual sample. Mann-Whitney U tests were used to assess the associations between serum markers and the risk of preeclampsia. Logistic regressions were used to assess if the risk of preeclampsia can be predicted using a combination of maternal characteristics and serum markers., Results: The case group included 146 preeclampsia and 295 gestational hypertension cases. Compared with the controls, preeclampsia cases had significantly lower first-trimester pregnancy-associated plasma protein A and placental growth factor. At a 20% false-positive rate, 71% of early-onset and 58% of preterm preeclampsia cases can be predicted using maternal characteristics, pregnancy-associated plasma protein A, and placental growth factor. Preeclampsia cases had lower second-trimester placental growth factor and a higher soluble fms-like tyrosine kinase-1-placental growth factor ratio. At a 10% false-positive rate, 80% and 53% of early-onset preeclampsia can be predicted using maternal characteristics and placental growth factor or soluble fms-like tyrosine kinase-1-placental growth factor ratio, respectively., Conclusion: The current first-trimester aneuploidy screening programs may be expanded to identify women at increased risk of developing preeclampsia. Early in the second trimester, placental growth factor alone provided better prediction for preeclampsia compared with the soluble fms-like tyrosine kinase-1-placental growth factor ratio., (© 2023 The Authors.)

The structure of biochar produced at various pyrolysis temperatures influences metal geochemical behavior. Here, the impact of wheat straw-derived biochar (300, 500, and 700 °C) on the immobilization and transformation of metals in the contaminated soil-plant system was assessed. The findings of the sequential extraction revealed that biochar additives had a substantial influence on the speciation of Cr, Ni, Pb, and Zn in the contaminated soil. The lowest F1 (exchangeable and soluble fraction) + F2 (carbonate fraction) accounted for Cr (44%) in WB-300, Ni (43.87%) in WB-500, Pb (43.79%), and Zn (49.78%) in WB-700 with applied amendments of their total amounts. The characterization results indicated that high pyrolysis temperatures (300-700 °C) increased the carbon-containing groups with the potential to adsorb metals from the soil-plant environment. The bioconcentration and translocation factors (BCF and TF) were less than 1, indicating that metal concentration was restricted to maize roots and translocation to shoots. Reactive oxygen species (ROS) intracellularly influence metal interactions with plants. Electron paramagnetic resonance (EPR) was performed to determine hydroxyl radical generation (•OH) in plant segments to assess the dominance of free radicals (FRs). Consequently, the formation of •OH significantly depends on the pyrolysis temperature and the interaction with a contaminated soil-plant environment. Thus, metal transformation can be effectively decreased in the soil-plant environment by applying WB amendments., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Potentially toxic metals have become a viable threat to the ecosystem due to their carcinogenic nature. Biochar has gained substantial interest due to its redox-mediated processes and redox-active metals. Biochar has the capacity to directly adsorb the pollutants from contaminated environments through several mechanisms such as coprecipitation, complexation, ion exchange, and electrostatic interaction. Biochar's electron-mediating potential may be influenced by the cyclic transition of surface moieties and conjugated carbon structures. Thus, pyrolysis configuration, biomass material, retention time, oxygen flow, and heating time also affect biochar's redox properties. Generally, reactive oxygen species (ROS) exist as free radicals (FRs) in radical and non-radical forms, i.e., hydroxyl radical, superoxide, nitric oxide, hydrogen peroxide, and singlet oxygen. Heavy metals are involved in the production of FRs during redox-mediated reactions, which may contribute to ROS formation. This review aims to critically evaluate the redox-mediated characteristics of biochar produced from various biomass feedstocks under different pyrolysis conditions. In addition, we assessed the impact of biochar-assisted FRs redox-mediated processes on heavy metal immobilization and mobility. We also revealed new insights into the function of FRs in biochar and its potential uses for environment-friendly remediation and reducing the dependency on fossil-based materials, utilizing local residual biomass as a raw material in terms of sustainability., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Studies of color perception have led to mechanistic models of how cone-opponent signals from retinal ganglion cells are integrated to generate color appearance. But it is unknown how this hypothesized integration occurs in the brain. Here we show that cone-opponent signals transmitted from retina to primary visual cortex (V1) are integrated through highly organized circuits within V1 to implement the color opponent interactions required for color appearance. Combining intrinsic signal optical imaging (ISI) and 2-photon calcium imaging (2PCI) at single cell resolution, we demonstrate cone-opponent functional domains (COFDs) that combine L/M cone-opponent and S/L + M cone-opponent signals following the rules predicted from psychophysical studies of color perception. These give rise to an orderly organization of hue preferences of the neurons within the COFDs and the generation of hue "pinwheels". Thus, spatially organized neural circuits mediate an orderly transition from cone-opponency to color appearance that begins in V1., (© 2022. The Author(s).)

Objectives: The comparative clinical effectiveness of common surgical techniques to address long head of biceps (LHB) pathology is unclear. We synthesised the evidence to compare the clinical effectiveness of tenotomy versus tenodesis., Design: A systematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation approach., Data Sources: EMBASE, Medline, PsycINFO and the Cochrane Library of randomised controlled trials were searched through 31 October 2021., Eligibility Criteria: We included randomised controlled trials, reporting patient reported outcome measures, comparing LHB tenotomy with tenodesis for LHB pathology, with or without concomitant rotator cuff pathology. Studies including patients treated for superior labral anterior-posterior tears were excluded. No language limits were employed. All publications from database inception to 31 October 2021 were included., Data Extraction and Synthesis: Screening was performed by two authors independently. A third author reviewed the article, where consensus for inclusion was required. Data were extracted by two authors. Data were synthesised using RevMan. Inverse variance statistics and a random effects model were used., Results: 860 patients from 11 RCTs (426 tenotomy vs 434 tenodesis) were included. Pooled analysis of patient-reported functional outcome measures data demonstrated comparable outcomes (n=10 studies; 403 tenotomy vs 416 tenodesis; standardised mean difference (SMD): 0.14, 95% CI -0.04 to 0.32, p=0.13). There was no significant difference for pain (Visual Analogue Scale) (n=8 studies; 345 tenotomy vs 350 tenodesis; MD: -0.11, 95% CI -0.28 to 0.06, p=0.21). Tenodesis resulted in a lower rate of Popeye deformity (n=10 studies; 401 tenotomy vs 410 tenodesis; OR: 0.29, 95% CI 0.19 to 0.45, p<0.00001). Tenotomy demonstrated shorter operative time (n=4 studies; 204 tenotomy vs 201 tenodesis; MD 15.2, 95% CI 1.06 to 29.36, p<0.00001)., Conclusions: Aside from a lower rate of cosmetic deformity, tenodesis yielded no significant clinical benefit to tenotomy for addressing LHB pathology., Prospero Registration Number: CRD42020198658., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

As one of the most common ways to get rid of municipal waste, landfill leachate, waste with complicated compositions and high levels of contaminants, has become a significant threat to the world's environment. Here, the impact of sewage sludge (SS) and derived-biochar (SSB) amendments on the immobilization and potential mobility of heavy metals in a contaminated soil-plant system was investigated. The sequential fractionation findings showed that using SS-2%, SSB-2%, and SSBC-1% reduced the potential mobility of heavy metals while increasing the residual fraction in polluted soils. The translocation and bioconcentration factors showed that heavy metals were slightly transferred into shoots from roots and lowered accumulation in roots from contaminated soils. Fourier transform infrared (FTIR) and X-ray photoelectron spectrum (XPS) comprehensive characterization results indicated the significant role of applied amendments for heavy metals transformation from the exchangeable-soluble fractions to the least available form by lowering their mobility to confirm the adsorption-based complexes, which results in the surface adsorption of heavy metals with functional groups. The electron paramagnetic resonance (EPR) results indicated the dominance of reactive oxygen species (ROS) in the intracellular formation of hydroxyl radicals (•OH) in maize plant roots and shoots. ROS (•OH) generation plays a critical influence in the interaction between the physiological processes of plants and heavy metals. Moreover, all the amendments increased maize growth and biomass production. Our study suggests that alone and combined application of SS and SSB have great potential to remediate heavy metals contaminated soil for environmental sustainability., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Introduction: Propionibacterium acnes is a gram-positive anaerobe that is found on the dermis and epidermis of the shoulder and is the most commonly identifiable cause of periprosthetic shoulder joint infection. Various topical strategies have been investigated to reduce the prevalence of P acnes , with several demonstrating efficacy in reducing the positive culture. The aim of this systematic review and meta-analysis is to review the literature to assess the effectiveness of topical preparations in reducing the prevalence of P acnes in shoulder surgery., Methods: The study protocol was designed and registered prospectively on PROSPERO (International prospective register for systematic reviews). Databases used for the literature search will include MEDLINE, EMBASE, PsycINFO, and The Cochrane Library. Randomised controlled trials (RCTs) evaluating the use of any topical preparation against placebo, in all types of shoulder surgery, will be included. Our primary outcome is the number of colony forming units of P acnes. Secondary outcomes will include adverse events such as skin irritation, wound dehiscence, and the incidence of revision surgery due to infection. The Cochrane Risk of Bias Tool 2.0 and Jadad score will be used to assess the quality of methodology of the studies. Statistical analysis will be used to assess inconsistency and bias across included studies. Comparable outcome data will be pooled and analysed quantitatively or qualitatively as appropriate., Ethics and Dissemination: No ethical clearances required for this study. This systematic review and meta-analysis will be published in a peer-reviewed journal., Highlights: Various topical strategies have been investigated to reduce the prevalence of P acnes, the most common identifiable cause of periprosthetic shoulder joint infection, with several demonstrating efficacy in reducing the positive culture.This systematic review and meta-analysis evaluates the effectiveness of topical preparations in reducing the prevalence of P acnes in shoulder surgery.Our primary outcome is the number of colony forming units of P acnes., Registration: PROSPERO 2022 CRD42022310312., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2022 The Author(s).)

Erythromycin (ERY), designated as a risk-prioritized macrolide antibiotic on the 2015 European Union watch list, is the third most commonly used antibiotic, most likely due to its ability to inhibit the protein. ERY has revealed record-high aquatic concentrations threatening the entire ecosystem and hence demands priority remedial measures. The inefficiency of various conventional ERY degradation methodologies opened up a gateway to advanced technologies. The conventional approach comprising of a chemically formulated, single photocatalyst has a major drawback of creating multiple environmental stresses. In this context, photocatalysis is grabbing tremendous attention as an efficient and cost-effective antibiotic treatment approach. Several studies have ascertained that ZnO, TiO 2 , Fe 3 O 4 , and rGO nanoparticles possess remarkable pollution minimizing operational capabilities. Additionally, composites are found much more effective in antibiotic removal than single nanoparticles. In this review, an attempt has been made to provide a comprehensive baseline for efficient reactive radical production by a phyto-mediated composite kept under a certain source of irradiation. Considerable efforts have been directed towards the in-depth investigation of rGO-embedded, phyto-mediated ZnO/TiO 2 /Fe 3 O 4 photocatalyst fabrication for efficient ERY degradation, undergoing green photocatalysis. This detailed review provides photocatalytic nanocomposite individualities along with a hypothetical ERY degradation mechanism. It is assumed that derived information presented here will provoke innovative ideas for water purification incorporating green photocatalysis, initiating the construction of high-performance biogenic hierarchical nanocatalysts., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Component positioning is a key factor for avoiding complications and improving functional outcomes in reverse shoulder arthroplasty. Preoperative planning can improve component positioning. However, translating the preoperative plan into the surgical procedure can be challenging. This is particularly the case for the glenoid component positioning in severe deformity or limited visualization of the scapula. Different computational-assisted techniques have been developed to aid implementation of the preoperative plan into the surgical procedure. Navigated augmented reality (AR) refers to the real world augmented with virtual real-time information about the position and orientation of instruments and components. This information can be presented through a head-mounted display (HMD), which enables the user to visualize the virtual information directly overlaid onto the real world. Navigated AR systems through HMD have been validated for shoulder arthroplasty using phantoms and cadavers. This article details a step-by-step guide use of a navigated AR system through HMD, in the placement of the glenoid bony-augmented component., (© 2022 The Authors.)

The patient with diabetes mellitus (DM) and its complication is increasing in our country and all over the world. Fibrinogen is a renowned factor of progressive atherosclerotic lesions and a predictor of cardiovascular events. Level of fibrinogen is increases in patients with diabetes mellitus (DM) may accelerate thromboembolic risk for cardiovascular disease (CVD). This study was carried out to assess plasma fibrinogen level in subjects with type 2 diabetes mellitus. It was a cross sectional analytic study and conducted in the Department of Physiology, Dhaka Medical College, Dhaka, Bangladesh from July 2013 to June 2014. A total number of 200 adult male subjects were selected with age ranging from 40-60 years. Among them, 100 subjects with type 2 diabetes mellitus were included in the study group (Group B) and 100 healthy subjects with same age range were considered as controls (Group A) for comparison. The subjects were selected from BIRDEM hospital Dhaka and personal contact from different areas of Dhaka city on the basis of exclusion and inclusion criteria. The study parameter was plasma fibrinogen level, and was measured in the Department of Microbiology and Immunology of BIRDEM hospital, Dhaka, Bangladesh. The data were collected and recorded in pre-designed structured questionnaire by the researcher herself. For statistical analyses unpaired Student's 't' test and Pearson's correlation coefficient (r) test were performed as applicable using SPSS for windows version 19.0. In this study plasma fibrinogen level was significantly (p<0.001) higher in the study group than that of control group. From this study, it may be concluded that estimation of plasma fibrinogen level might be beneficial for prediction of future cardiovascular risk in adult diabetic male.

Introduction: Acute acromioclavicular joint separation is a common injury to the shoulder. Various surgical reconstruction methods exist when operative management is required, but the optimal procedure is not known. The aim of this systematic review and meta-analysis is to review the literature to assess the clinical effectiveness of various surgical reconstruction modalities used for acute ACJ separation., Methods: The study protocol was designed and registered prospectively on PROSPERO (International prospective register for systematic reviews). Literature search will include MEDLINE, EMBASE, PsycINFO, and The Cochrane Library electronic databases. Randomised controlled trials (RCTs) evaluating surgical procedures for acute acromioclavicular joint (ACJ) separation will be included. Our primary outcome is any functional patient-reported outcome measure related to the shoulder. Secondary outcomes may include radiological measurements, objective measurements of strength testing, range of motion, other patient-reported outcome measures not specific to the shoulder such as the Visual-Analog Scale (VAS) for pain, timelines for return to sport or work, and rate of complications. Risk of bias will be assessed within each study using The Cochrane Risk of Bias Tool 2.0 and the Jadad score. Inconsistency and bias across included studies will be assessed statistically. Comparable outcome data will be pooled and analysed quantitatively or qualitatively as appropriate., Ethics and Dissemination: This study did not require ethical clearance. We plan to publish this systematic review and meta-analysis in a peer-reviewed journal and present the results at various national and international conferences., Highlights: There is currently variation in surgical synthetic ligament reconstruction techniques for acute acromioclavicular separation, with no clear consensus established.This systematic review evaluates the clinical effectiveness of various surgical reconstruction modalities used for acute ACJ separation.Our primary outcome is any functional patient-reported outcome measure related to the shoulder., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2022 The Author(s).)

Despite the advances in treatment strategies, cancer is still the second leading cause of death in the USA. A majority of the currently used cancer drugs have limitations in their clinical use due to poor selectivity, toxic side effects and multiple drug resistance, warranting the development of new anticancer drugs of different mechanisms of action. Here we describe the design, synthesis and initial biological evaluation of a new class of antimitotic agents that modulate tubulin polymerization. Structurally, these compounds are chalcone mimics containing a 1-(1H-imidazol-2-yl)ethan-1-one moiety, which was initially introduced to act as a metal-binding group and inhibit histone deacetylase enzymes. Although several analogues selectively inhibited purified HDAC8 with IC 50 values in low micromolar range, tissue culture studies suggest that HDAC inhibition is not a major mechanism responsible for cytotoxicity. The compounds demonstrated cell growth inhibition with GI 50 values of upper nanomolar to low micromolar potency with significant selectively for cancer over normal cells. Interestingly, several compounds arrested HeLaM cells in mitosis and seem to target tubulin to cause mitotic arrest. For example, when combined with inhibitors of Aurora B kinase, they led to dramatic disassembly of the mitotic spindle. In-vitro tubulin polymerization studies showed that the compounds reduced the rate of polymerization of microtubules during the elongation phase and lowered the amount of polymerized tubulin during the plateau phase. Finally, in silico docking studies identified binding of IPE-7 to the colchicine site with similar affinity as the test compound D64131. These compounds represent a new antimitotic pharmacophore with limited HDAC inhibitory activity., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The contamination of soil by toxic metal(oid)s has emerged as a major concern worldwide, particularly in developing countries. A metals behavior in the soil environment is influenced by organic matter, mineral phases, and oxidation states in which a particular metal exists. However, the spectroscopic evidence of metal(oid)s interactions in soil with organic matter and mineral phases can induce an extensive understanding. The surface and sub-surface soils (0-50 cm) from four sites of upper Indus basin, Pakistan, were collected and analyzed by using FTIR (Fourier-transform infrared spectroscopy), XRD (X-ray diffraction) and XPS (X-ray photoelectron spectroscopy) in addition to ICP-MS (inductively coupled plasma mass spectrometry) and geochemical fractionation. Geochemical fractionation of metal(oid)s indicated that As, Cu, Ni, Pb, and Zn were mostly found in the potentially bioavailable fractions. However, an increase in the residual fraction was observed from top to bottom. The absorption bands of FTIR spectra were divided into three spectral regions 700-400, 1700-800, and 3700-2800 cm -1 . The soil was found rich in organic matter and capable of retaining metals as abundant peaks were observed in the mid-infrared region. The mineralogical analysis of soil samples testified silicon oxides and zeolite as major mineral phases. The XPS spectra showed broad peaks of As(III), As 2 O 3 , As 4 S 4 , PbO 2 , and PbCo 3 . The study concludes that the source identification of metal(oid)s in the upper Indus is crucial to find out the particular source of contamination in the soil., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Tranexamic acid (TXA) is widely used across surgical specialties to reduce perioperative bleeding. It has been shown to be effective in spinal surgery and lower limb arthroplasty. Among all languages, there are no systematic reviews or meta-analyses investigating its clinical effectiveness for all types of shoulder surgery., Purpose: To investigate the clinical effectiveness of TXA in all types of shoulder surgery, including open and arthroscopic procedures. To investigate the effect of TXA on bleeding and non-bleeding-related outcomes., Study Design: Systematic review and meta-analysis., Methods: A protocol for the study was designed and registered with PROSPERO (CRD42020185482). The literature search included the MEDLINE, Embase, PsycINFO, and Cochrane Library databases. All randomized controlled trials evaluating the use of TXA against placebo, in all types of shoulder surgery, were included. Assessments were undertaken for risk of bias and certainty of evidence. The primary outcome was total blood loss. Secondary outcomes included those not directly related to bleeding. Data from comparable outcomes were pooled and analyzed quantitatively or descriptively, as appropriate., Results: Eight randomized controlled trials were included in the systematic review, and data from 7 of these studies were pooled in the meta-analysis. Pooled analysis demonstrated a significant reduction in 2 of 3 outcomes measuring perioperative bleeding with TXA compared with controls: estimated total blood loss (mean difference, -209.66 mL; 95% CI, -389.11 to -30.21; P = .02) and postoperative blood loss as measured by drain output (mean difference, -84.8 mL; 95% CI, -140.04 to -29.56; P = .003). Hemoglobin reduction was reduced but not statistically significant (mean difference, -0.33 g/dL; 95% CI -0.69 to 0.03; P = .07). This result became significant with sensitivity analysis excluding arthroscopic procedures., Conclusion: This systematic review and meta-analysis indicated that TXA was effective in reducing blood loss in shoulder surgery. Larger randomized controlled trials with low risk of bias for specific surgical shoulder procedures are required., Clinical Relevance: TXA can be used across shoulder surgery to reduced perioperative blood loss. The use of TXA may have other beneficial features, including reduced postoperative pain and reduced operative time.

Interior settled dust is one of the greatest threats of potentially toxic metal(oid)s (PTMs) exposure to the children, especially in the school environment. Therefore, it is more worthy of having in-depth knowledge of compositional characteristics of school dust. Forty schools were selected of Lahore city for dust sampling. The school dust was analyzed to determine the PTMs (As, Cd, Cr, Cu, Ge, Mo, Ni, Pb, Sb, Sn, Sr, V, and Zn) concentrations using ICP-MS. The morphological characteristics, PTMs speciation, and mineralogy of school dust were examined using SEM with EDS, XPS, and XRD, respectively. Moreover, the geo-accumulation index (I geo ), potential ecological risk index (PERI), and multivariate statistical analysis were employed to assess the pollution levels, ecological risk, and source identification of PTMs, respectively. The I geo indicated a heavily-extreme pollution level of Cd (I geo  = 4.92), moderate-heavy pollution of Zn (I geo  = 3.22), and Pb (I geo  = 2.78), and slight-moderate pollution of Cr (I geo  = 1.62), and Cu (I geo  = 1.53). The ecological risk has been found extremely high for Cd and moderately high for Pb and As, while potential ecological risk found extremely high posed by cumulatively all selected PTMs. Multivariate statistical analysis showed that sources of PTMs comprise of natural processes as well as several anthropogenic processes like vehicular emissions, agricultural and industrial activities. The SEM, XRD, and XPS analyses demonstrated the presence of airborne particles and PTMs containing minerals with several toxic chemical species in school dust. This study can help to develop strategies to reduce school indoor pollution and hence to establish an eco-friendly learning environment for children., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: The long head of biceps tendon is a common source of anterior shoulder pain and impaired function. Multiple surgical procedures are available as treatment options, but the optimal procedure is not known. The aim of this systematic review and meta-analysis is to review the literature to assess the clinical effectiveness of various surgical procedures to treat pain arising from the long head of biceps., Methods: The study protocol was designed and registered prospectively on PROSPERO (International prospective register for systematic reviews). Electronic databases used for the literature search will include MEDLINE, EMBASE, PsycINFO, and The Cochrane Library. Randomised controlled trials (RCTs) evaluating surgical procedures on the long head of biceps will be included. Our primary outcome is any functional patient-reported outcome measure related to the shoulder. Secondary outcomes will include the rate of 'Popeye' deformity, the rate of biceps cramping pain, the rate of complications, objective measurements of strength testing such as dynamometer, and other patient-reported outcome measures not specific to the shoulder such as the Visual-Analog Scale (VAS) for pain. Methodological quality of included studies will be assessed using The Cochrane Risk of Bias Tool 2.0 and the Jadad score. Inconsistency and bias across included studies will be assessed statistically. Comparable outcome data will be pooled and analysed quantitatively or qualitatively as appropriate., Ethics and Dissemination: No ethical clearances required for this study. We plan to publish this systematic review and meta-analysis in a peer-reviewed journal. It will also be presented at various national and international conferences., Highlights: Evaluating the clinical effectiveness of surgical procedures for long head of biceps pathology.Randomised controlled trials.Biceps tenodesis and biceps tenotomy.Systematic review compliant with the PRISMA guideline., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2021 The Author(s).)

Purpose: COVID-19 pandemic has created havoc all over the globe and spared no one regardless of status, gender, location and ethnicity. There were questions raised if trauma and orthopaedic (T&O) procedures actually generated aerosols? The need for a review of literature highlighting the nature and impact of aerosol generation within T&O surgery was noted., Methods: A comprehensive online search was performed for all published articles in the English language, evaluating AGPs in T&O surgery and the relevant personal protection equipment used., Results: The search strategy populated 43 studies. Six studies were identified as duplicates. The shortlisted 37 studies were screened and nine studies were included in the review. An additional four studies were included from the bibliography review., Conclusion: Most orthopaedic procedures are high-risk aerosol generating procedures (AGPs). Conventional surgical masks do not offer protection against high-risk AGPs. In the current era of COVID-19 pandemic, there is a significant risk to the transmission of infection to the theatre staff. For protection against airborne transmission, appropriate masks should be used. These need proper fitting and sizing to ensure full protection when used., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2020 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)

Low intensity pulsed ultrasound (LIPUS) therapy has demonstrated clinical effectiveness in achieving union in a variety of fracture situations.Few studies have investigated the effectiveness of LIPUS therapy in foot and ankle surgery.The overall rate of union in all published studies relating to the use of LIPUS in a variety of foot and ankle fracture and fusion situations is 95%.Some studies suggest lower healing rates (~ 67%) when LIPUS therapy is used to treat hindfoot fusion nonunion.A well-powered, high-quality, randomized controlled trial is needed to demonstrate the clinical and cost effectiveness of LIPUS therapy in foot and ankle surgery. Cite this article: EFORT Open Rev 2021;6:217-224. DOI: 10.1302/2058-5241.6.200045., Competing Interests: ICMJE Conflict of interest statement: YT reports being a speaker/consultant for Arthrex and In2Bones, being a speaker for Stryker and receipt of royalties from Stryker, all outside the submitted work. The other authors declare no conflict of interest relevant to this work., (© 2021 The author(s).)

Background: Partial-thickness rotator cuff tears are likely at least as common as full-thickness rotator cuff tears, and it is critical for surgeons to have knowledge of the tear progression rate of partial-thickness rotator cuff tears when determining surgical or nonsurgical treatment. However, a systematic review investigating the rate of tear progression of partial-thickness rotator cuff tears has not been performed. Therefore, the purpose of this study was to systematically review the literature and determine the rate of full-thickness progression in nonoperatively treated partial-thickness rotator cuff tears., Methods: A systematic review of the literature was performed following the PRISMA guidelines and checklist using the PubMed, MEDLINE, and Cochrane Library databases. English-language studies of Level I through IV evidence examining partial-thickness rotator cuff tears with description of the change in tear size were included. Studies using imaging modalities other than magnetic resonance imaging (MRI) or ultrasonography (US) for serial imaging and studies without description of the number of tears that progressed to full-thickness tears were excluded. The primary outcome was to determine the per-month progression rate from a partial-thickness tear to a full-thickness tear confirmed on either MRI or US. The progression rates, which were divided into 3 groups-symptomatic, asymptomatic and combined (asymptomatic + symptomatic)-were calculated using a random effects model with binomial within-study variance., Results: Four studies were included, and 257 tears were analyzed statistically for tear progression. The average follow-up was 34 months (standard deviation, 19 months). The overall rate of progression to a full-thickness tear was 0.26% per month (95% confidence interval [CI], 0.15%-0.36% per month). In the symptomatic and asymptomatic groups, the rates were 0.22% per month (95% CI, 0.09%-0.34% per month) and 0.32% per month (95% CI, 0.15%-0.49% per month), respectively, which showed no significant difference (P =.341)., Conclusions: This study demonstrated that partial-thickness tears progress to full-thickness tears over time but at a relatively low rate at short- to intermediate-term follow-up. There was no significant difference in the per-month rates of full-thickness progression between symptomatic and asymptomatic tears., (Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Arthur Sidney Blundell Bankart was a London-based orthopedic surgeon who discovered the essential lesion in recurrent anterior shoulder instability in 1923. He pioneered a technique, the Bankart repair, to re-establish stability to the glenohumeral joint, without sacrificing native joint motion. In this article, the original Bankart repair is compared to the modern arthroscopic Bankart repair, accompanied by a surgical video of Blundell Bankart performing the Bankart repair in 1951, shortly before his death. Bankart's original description included an open repair with a coracoid osteotomy and subscapularis tenotomy and repair. The history of the technique, its utility in present day, and the future of the Bankart repair are discussed., (Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)