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Background: In this report, we describe an uncommon instance of fungating synovial sarcoma affecting the posterior aspect of the neck. Although the existing literature has documented a limited number of cases, this particular case contributes to the knowledge about it, which is scarce., Case Presentation: A total of 5 months before the examination, a Pakistani-Asian male, age 20 years, complained of a malodorous fungating swelling on the posterior aspect of his neck. An examination revealed a foul-smelling, 10 × 13 cm fungating enlargement surrounded by maggots and hemorrhaging at the site of the incision. A hemoglobin level of 6 and a total leukocyte count (TLC) of 23,000 indicated the patient's disoriented and pallid appearance. He was expeditiously admitted, and preoperatively, the general well-being of the patient was optimized. After a comprehensive discussion with the medical team, a strategy for marginal excision and coverage with a latissimus dorsi (LD) flap and grafting was devised. The tumor was successfully excised, and an LD flap with graft was conducted on the patient during surgery; however, the infection caused the failure of half of the graft. Following that, the lesion was debrided, and re-grafting was performed. The patient was subsequently administered 5 cycles of chemotherapy and 32 cycles of radiotherapy. He was diagnosed with pulmonary metastasis 2 years later. Sadly, the patient died during a follow-up visit 3.5 years later., Conclusions: The patient's unfavorable prognosis after surgical intervention, radiotherapy, and chemotherapy, despite undergoing all-encompassing treatments, underscores the importance of early detection and intervention in fungating tumor cases., (© 2024. The Author(s).)

Aflatoxin B1 (AFB 1 ) is the primary mycotoxin that is responsible for the severe issues plaguing poultry farming. The study was aimed to explore the relevant pathways connected with immunity (inflammation, oxidative stress and apoptosis) in an AFB 1 -challenged chicken by using Penthorum chinense Prush extract (PCPE) in Bursa of Fabricius (BF) of broilers. A total one hundred and eighty day-old broilers were divided into six groups: Control, AFB 1 (3 mg/kg feed), Yin-Chen-Hao Tang extract (YCHT) (10 ml/kg feed), and PCPE groups (low 1 g/kg, medium 2 g/kg, and high 3 g/kg PCPE/kg feed) respectively. The results showed that AFB 1 -challenged birds showed significant decrease in growth, BF weight index, serum antioxidant biomarkers and histopathological changes in BF tissues. The mRNA analysis showed that AFB 1 upregulated the apoptosis associated genes (caspase-3, caspase-9, Bak, Bax and p53) and downregulated BCL-2. Additionally, AFB 1 downregulated expression level of Nuclear Factor EF-2 (Nrf2) related genes (Nrf2, HO-1, NQO1 and GCLC) in the BF of broilers. The PCPE treatment showed positive impact on final weight gain, bursal index, and reversing of pathological changes in the BF of AFB 1 -challanged broilers. PCPE ameliorated oxidative stress generated by AFB 1 , as an increase in antioxidant enzyme activities, alleviated histopathological changes in BF, enhanced the Nrf2 expression levels and lowered the apoptosis gene expressions as compared to AFB 1 . The findings revealed that PCPE activated the Nrf2 pathway, antioxidant defense system and modulated the apoptosis in the BF of broiler chicken., 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 Inc. All rights reserved.)

Objective: To determine the prevalence of objectively confirmed deep vein thrombosis of lower extremities in bedridden hospitalised orthopaedic patients who received no thromboprophylaxis., Methods: The prospective cross-sectional study was conducted at Dr Ruth Pfau Civil Hospital, Karachi, from April to June 2021, and included all patients aged ≥40 years admitted for intended major lower limb surgery and expected to be confined to the bed for at least 4 days. Duplex ultrasound scanning of both legs was used to confirm deep vein thrombosis. Data was analysed using SPSS 22., Results: Of the 104 subjects, 60(57.6%) were males and 44(42.3%) were females. The overall mean age was 51.9±7.4 years. The most common type of fracture was the neck of femur 28(26.9%). The mean delay between the fracture and admission was 6.44±4.9 days. The mean length of hospital stay was 12.76±3.8 days. The overall prevalence of deep vein thrombosis was 16(15.3% and none of these patients had any symptom at all., Conclusions: There was 15.3% prevalence of deep vein thrombosis. Considering that the condition is potentially lethal, routine prophylaxis for all at-risk patients should be encouraged.

Background: A giant cell tumour (GCT) is a locally invasive benign tumour of bone in young adults. Treatment includes surgical resection as first-line or denosumab pharmacotherapy in inoperable patients. However, surgical resection of distal radius GCT has produced debatable functional outcomes. Here we study the use of fibular grafts for reconstruction of surgically resected GCT of the distal radius. Methods: A total of 11 patients having Grade III GCT of the distal radius were recruited for a retrospective single-centred study. Five underwent arthrodesis with fibular shaft graft and six received arthroplasty with the proximal fibula. Functional outcomes at 6 weeks, 6 and 12 months were measured by Mayo wrist score (MWS) (>51% = good) and Revised Musculoskeletal tumor society (MSTS) score (>15 = good). Results: At 6 weeks, mean MSTS score and MWS were 23.64 and 58.64% respectively, and the length of the fibular graft was a predictor for both MSTS score ( p = 0.014) and MWS ( p = 0.006). At 6 months, the mean MSTS and MWS were 26.36 and 76.82%, respectively. At 6 months, the surgical procedure was a predictor in MSTS score ( p = 0.02) while MWS was predicted by length of graft ( p = 0.02). At 12 months, MSTS score was 28.73, and MWS remained 91.82%. Length of the fibular graft was an insignificant predictor, but a significant risk factor was surgical procedure for MWS ( p = 0.04) at 12 months. No variable was found significant for MSTS score. Conclusions: Resection along with reconstruction of Grade III GCT of the radius with fibular graft was found an optimal treatment option. Also, use of the fibular head grafts and shorter length grafts are predictors for better outcomes after surgery. Level of Evidence: Level IV (Therapeutic).

Background: Giant cell tumors (GCT) of the proximal humerus are rarely reported case that requires complex surgeries due to involvement of the shoulder joint. Therefore, we report the first retrospective comparative study where the postoperative functional outcomes, recurrence rate and complications in patients who underwent arthrodesis of shoulder after resection of grade III GCT with and without neoadjuvant denosumab are compared., Methods: A retrospective review of eight cases of grade III GCT of proximal humerus receiving resection and fibular strut graft and arthrodesis between January 2014 and December 2019 is performed. They were stratified into two groups: one group of four patients received once-weekly denosumab 120 mg for 4-weeks before resection and reconstruction, while the other group of four patients did not receive denosumab before surgery. Primary outcomes included the functional outcomes assessed by revised Musculoskeletal tumor society (MSTS) score and shoulder pain and disability index (SPDI) at 6-weeks and 12-months postoperatively while secondary outcomes included complications and recurrences., Results: There was no significant difference in terms of SPDI at 6 weeks and 12 months, MSTS at 12 months, complications, recurrence among denosumab and non-denosumab groups. At 6-weeks follow-up, a significantly better pain score in SPDI and MSTS was acquired in the denosumab group., Conclusions: Resection and reconstruction with or without neoadjuvant denosumab for Grade III GCT of proximal humerus had similar functional outcomes and with no major differences in recurrence and complications. Hence, postoperative pain relief while long-term benefits were not discovered with the use of neoadjuvant denosumab., (© 2021. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

To share our experience of establishing a bone bank in Pakistan, and the clinical use of these indigenously produced bone grafts. We retrospectively reviewed our experience of the procurement, processing, and storage of bone grafts at a bone bank in Karachi, Pakistan, the first bone bank to be established in a public sector hospital in Pakistan. The bone bank was established at Sindh Institute of Urology and Transplantation (SIUT), Karachi, in collaboration with Department of Orthopaedic Surgery, Dow University of Health Sciences/Civil Hospital, Karachi (CHK) in May, 2015. Since then, a large number of bone grafts from the tissue bank have been used for various orthopedic procedures. This paper describes the problems and challenges faced in establishing and running a tissue bank in a Muslim and a developing country and the progress of the bone bank over the first 4 years. A total of 93 bone grafts were retrieved and preserved in the bone bank over the 4-year period. Among these, 56 (60.2%) bones were retrieved from male donors and 37 (39.8%) from females. The mean age of all donors was 55.9 ± 15.34 years (range: 16-90 years). All bone donors were living patients. No c bones were obtained from deceased donors. Types of bone grafts included: femoral heads, 68; head with neck of femur, 19; radius and ulna, 1; lower femur, knee joint, lower leg and foot bones, 4; and skull bone, 1. All grafts were subjected to aerobic and anaerobic bacterial cultures, as well as fungal cultures. Microbiological contamination was observed in 18/93 (19.35%). All culture positive bones were discarded. Bone grafts issued from the bank and transplanted were 51/93 (54.8%) in all. Bone grafts were used in a variety of tumor and non-tumor orthopaedic procedures in CHK. Nine bone grafts were donated to the other hospitals to be used for revision total hip replacement and tumor surgeries. There were no service charges. Two patients (3.92%) developed infections postoperatively, one superficial and one deep. No other complications were noted. This is the preliminary report on the establishment and functioning of a bone bank in a public sector hospital in Pakistan. The favorable outcome has inculcated confidence in orthopedic surgeons for greater use of bone allografts for a variety of indications in this country., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Objective  This is the first study to establish the utility of extended curettage with or without bone allograft for Grade II giant cell tumors GCTs around the knee joint with the aim of exploring postoperative functional outcomes. Methods  We retrospectively reviewed 25 cases of Campanacci grade II GCTs undergoing extended curettage between January 2014 and December 2019. The participants were divided into two groups: one group of 12 patients underwent extended curettage with bone allograft and bone cement, while the other group of 13 patients underwent extended curettage with bone cement only. Quality of life was assessed by the Revised Musculoskeletal Tumor Society Score and by the Knee score of the Knee Society; recurrence and complications were assessed for each cohort at the last follow-up. The Fisher test and two-sample t-tests were used to compare the categorical and continuous outcomes, respectively. Results  The mean age was 28.09 (7.44) years old, with 10 (40%) males and 15 females (60%). The distal femur and the proximal tibia were involved in 13 (52%) and in 12 (48%) patients, respectively. There was no significant difference in the musculoskeletal tumor society score (25.75 versus 27.41; p  = 0.178), in the knee society score (78.67 versus 81.46; p  = 0.33), recurrence (0 versus 0%; p  = 1), and complications (25 versus 7.69%; p  = 0.21). Conclusions  Extended curettage with or without bone allograft have similar functional outcomes for the knee without any major difference in the incidence of recurrence and of complications for Grade II GCTs. However, surgical convenience and cost-effectiveness might favor the bone cement only, while long-term osteoarthritis prevention needs to be investigated to favor bone allograft., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses., (Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Background: Denosumab has been approved by Food and Drug Authority in 2013 for use in surgically unresectable Giant cell tumor (GCT) to achieve resectable tumor margins. The aim of this study is to investigate the functional outcome and surgical convenience with the use of neoadjuvant denosumab before resection and reconstruction in Campanacci grade III GCT., Methods: We retrospectively reviewed 70 cases of Campanacci grade III GCT receiving resection and reconstruction between January 2014 and December 2019. They were stratified into two groups: one group of 29 patients received once-weekly denosumab 120 mg for 4-weeks before resection and reconstruction, while the other group of 41 patients did not receive denosumab before resection and reconstruction. Quality of life by musculoskeletal tumor society score where 0-7 means poor, 8-14 means fair, 15-22 means good; above 22 means excellent, incidence of tumor recurrence, intraoperative duration in minutes and postoperative positive margins were assessed for each cohort after 12 months follow-up., Results: There was no significant difference in musculoskeletal tumor society score (25.75 vs. 27.41; P  = 0.178), incidence of recurrence (3.45% vs. 4.88%; P  < 0.001), and postoperative positive margins (10.34% vs. 4.88%; P  = 0.38) for both groups. However, the intraoperative duration (133.38 vs. 194.49; P  < 0.001) was significantly higher in the non-denosumab group compared with denosumab group., Conclusions: Neoadjuvant denosumab is equally effective considering postoperative functional outcomes and surgical convenience except intraoperative duration where it is highly helpful in saving the operating time duration. Easier identification, resection and lesser reconstruction are the key surgical convenience offered by neoadjuvant denosumab., (© 2021. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: One of the methods of stabilizing the stump of the ulna following resection of the distal ulna is tenodesis of the extensor carpi ulnaris (ECU). Some studies have recommended stabilization, whereas others have not found it useful. Most of these studies have a mix of different pathologies and often do not have a control group. The aim of this study is to compare the outcomes of ECU tenodesis versus no tenodesis after resection of the distal ulna in patients with grade III giant cell tumor (GCT) of the distal ulna. Methods: The retrospective study included 10 patients with Campanacci grade III GCT of the distal ulna treated by resection of the distal ulna between 2014 and 2019. Patients were stratified into two groups based on whether they underwent ECU tenodesis ( n = 5) or no tenodesis ( n = 5). The patients were assessed at 6 weeks, 6 months, and 12 months for complications and outcomes using the Mayo wrist score (MWS) and the revised musculoskeletal tumor society score (MSTS). Results: The MWS and the MSTS were significantly better in the ECU tenodesis group at 6 weeks. At 6 months, MWS was similar in both groups, but MSTS continued to be significantly better in ECU tenodesis group. At 12 months, both groups reported similar MWS and MSTS. There were no recurrences in either groups. One patient in the ECU tenodesis group developed ECU tendonitis that resolved with conservative treatment. Conclusions: The outcomes of ECU tenodesis were better in the short term (6 months), although both groups reported similar outcomes at 12 months. Level of Evidence: Level III (Therapeutic).

Background: Osteoarthritis is the most common degenerative disease of the synovial joints in the elderly population with hip osteoarthritis as the second most commonly affected joint. A multitude of conservative treatments is used for pain relief and functional improvement including acetaminophen, NSAID, intra-articular corticosteroid, and viscosupplementation (VS). Different preparations of VS based on different molecular weights are commercially available. No systematic review or meta-analysis regarding the use of intra-articular high molecular weight hyaluronic acid (HMWHA) injection for the hip joint was published before. This review analyzes the efficacy of intra-articular HMWHA for hip osteoarthritis., Methods: PubMed, Google Scholar, Cochrane Library for randomized trials describing the efficacy of HMWHA for hip osteoarthritis was searched. The search terms were osteoarthritis, hip joint, outcomes, viscosupplementation, and high molecular weight hyaluronic acid in different combinations. Standardized mean difference (SMD) in VAS for pain relief and Lequesne index for functional outcomes while risk ratio (RR) for complications was used for data pooling., Results: Four studies comprising 185 and 189 patients in HMWHA and control groups were included, respectively. SMD for VAS and Lequesne index was -0.056 and -0.114, respectively while RR for complication was 0.879., Conclusions: Intra-articular HMWHA injection provided pain relief, functional improvement, and no severe complications on immediate short term basis. However, the results do not favor treatment with HMWHA over other treatment methods. Randomized trials are further necessary to provide data regarding comparisons between HMWHA for hip osteoarthritis concerning clinicians' convenience, compliance, duration of relief, and cost-effectiveness.

Tilmicosin (TMS) is widely used to treat bacterial infections in veterinary medicine, but the clinical effect is limited by its poor solubility, bitterness, gastric instability, and intestinal efflux transport. Nanostructured lipid carriers (NLCs) are nowadays considered to be a promising vector of therapeutic drugs for oral administration. In this study, an orthogonal experimental design was applied for optimizing TMS-loaded NLCs (TMS-NLCs). The ratios of emulsifier to mixed lipids, stearic acid to oleic acid, drugs to mixed lipids, and cold water to hot emulsion were selected as the independent variables, while the hydrodynamic diameter (HD), drug loading (DL), and entrapment efficiency (EE) were the chosen responses. The optimized TMS-NLCs had a small HD, high DL, and EE of 276.85 ± 2.62 nm, 9.14 ± 0.04%, and 92.92 ± 0.42%, respectively. In addition, a low polydispersity index (0.231 ± 0.001) and high negative zeta potential (-31.10 ± 0.00 mV) indicated the excellent stability, which was further demonstrated by uniformly dispersed spherical nanoparticles under transmission electron microscopy. TMS-NLCs exhibited a slow and sustained release behavior in both simulated gastric juice and intestinal fluid. Furthermore, MDCK-chAbcg2/Abcb1 cell monolayers were successfully established to evaluate their absorption efficiency and potential mechanism. The results of biodirectional transport showed that TMS-NLCs could enhance the cellular uptake and inhibit the efflux function of drug transporters against TMS in MDCK-chAbcg2/Abcb1 cells. Moreover, the data revealed that TMS-NLCs could enter the cells mainly via the caveolae/lipid raft-mediated endocytosis and partially via macropinocytosis. Furthermore, TMS-NLCs showed the same antibacterial activity as free TMS. Taken together, the optimized NLCs were the promising oral delivery carrier for overcoming oral administration obstacle of TMS.

Background The coronavirus disease 2019 (COVID-19) since the beginning has been a reason of fear among healthcare workers (HCWs) due to the increased mortality, especially in the HCWs themselves. In this survey study, we aimed to explore the predictive factors associated with fear faced by HCWs during the COVID-19 pandemic and to identify the areas which need to be addressed to reduce it. Methods On May 14, 2020, we conducted an observational, cross-sectional survey using a self-administered questionnaire, consisting of the following two parts: (1) focused on factors associated with HCWs' fear of getting an infection and being a source of carrying the infection to whom they care, and (2) focused on factors associated with HCWs' fear of uncertainty and lack of support from concerned health authorities. Results The mean age of the participants was 40.04 ± 12.92 years with 79.3% being males. More than half (51.1%) of the participants were consultants. The most important factors associated with fear included getting infected (84.8%), quarantined (69.6%), not getting medical treatment (62%), losing a life (56.8%), and infecting family members (94.2%). Another major factor associated with HCWs' fear was lack of support from concerned health authorities, 80.2% thought of solatium, and 71.7% believed that the job should be given to eligible family members of the deceased. More than 82.2% were concerned about health expenses and around 97.6% felt an additional health risk allowance should be given. Conclusion Our results indicate that the risk of getting infection to themselves and their families, along with a lack of support from concerned health authorities, was strongly associated with fear among HCWs. We hope through these findings that the concerned health authorities will take notice and do something in this regard by developing appropriate policies and measures to make sure that HCWs and their families are cared for if they get infected., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Kumar et al.)

Introduction Many countries including Pakistan are currently using face masks in their pandemic control plans. Being highly prevalent, the correct use of these masks is particularly important, as an incorrect use and disposal may actually increase the rate of transmission. The purpose of this study was to investigate the knowledge, attitude, and practices of healthcare workers (HCWs) in wearing a surgical face mask to limit the spread of the new coronavirus disease 2019 (COVID-19). Materials and Methods This survey was conducted by interviewing HCWs using a questionnaire consisting of the basic demographic characteristics, and the knowledge, attitude, and practices regarding the use of surgical face mask to limit the new COVID-19 exposure. Each correct answer was scored 1 and each incorrect answer scored 0. The total number of questions was 16, and the final score was calculated and then labeled according to the percentage (out of 16) of correct responses as good (>80%), moderate (60-80%), and poor (<60%). Results A total of 392 participants with a mean age of 42.37 ± 13.34 years (341 males and 51 females) were included in the study. The overall final results were good in 138 (35.2%), moderate in 178 (45.4%), and poor in 76 (19.3%). Around 43.6% of participants knew about the correct method of wearing the masks, 68.9% knew that there are three layers, 53% stated that the middle layer act as a filter media barrier, and 75.5% knew the recommended maximum duration of wearing it. The majority (88.2%) of participants knew that a cloth face mask is not much effective, around 79.8% knew that used face mask cannot be re-used, and 44.8% knew about the yellow-coded bag for disposal. Conclusions Knowledge, attitude, and practice of HCWs regarding the use of face masks were found to be inadequate. Studied HCWs had a positive attitude but moderate-to-poor level of knowledge and practice regarding the use of face mask. HCWs and general public awareness campaigns regarding the proper use of face mask by utilizing all social media available resources would be helpful during this pandemic., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Kumar et al.)

Tilmicosin (TMS) is widely applied to treat porcine bacterial respiratory diseases in veterinary medicine. However, oral administration of TMS is greatly limited due to its physicochemical properties, such as poor water solubility, gastric acid sensitivity and bitterness. Therefore, nanostructured lipid carriers (NLCs) were developed as an oral delivery system for TMS by the high shear method combined with ultrasonic techniques in this study. The results showed that TMS-NLCs were approximately spherical with a hydrodynamic diameter of 283.03 nm and a zeta potential of -30.04 mV. TMS was almost entirely encapsulated in the NLCs by interacting with the lipid matrix, as characterized by differential scanning calorimetry and fourier transform infrared spectroscopy. Thus, TMS-NLCs had an excellent encapsulation efficiency and loading capacity with values of 93.46% and 9.23%, respectively. TMS-NLCs maintained good stability not only during storage at 4 ℃, 25 ℃ and 40 ℃ for 90 days but also in stimulated gastrointestinal (GI) fluids at 37 ℃ for 7 days. Therefore, TMS-NLCs displayed low and sustained release in vitro without an initial burst release in stimulated GI fluids. Furthermore, TMS-NLCs showed higher oral bioavailability in piglets compared to the API suspension. Subsequently, Caco-2 cell monolayers were utilized to analyze the mechanism of NLC-enhanced oral adsorption of TMS. The data revealed that NLCs not only increased cellular uptake of TMS but also inhibited the efflux of P-gp in Caco-2 cells. Additionally, TMS-NLCs mainly entered Caco-2 cells via the caveolae/lipid raft-mediated endocytosis pathway. Moreover, nanoparticles were transported across Caco-2 cell monolayers in the intact form to the basolateral side, as identified by transmission electron microscopy, indicating that TMS-NLCs escape lysosome degradation. Taken together, these results indicate that NLCs are a potential delivery carrier for improving the solubility, permeability and oral bioavailability of TMS., Competing Interests: Declaration of Competing Interest These authors declare no conflict of interest., (Copyright © 2019 Elsevier B.V. All rights reserved.)

(1) Background: The effects of a high-concentrate (HC) diet in inducing mammary epithelial cell apoptosis in dairy cows via the NOD1/Caspase-8 pathway have never been investigated before the current study. (2) Methods: Twelve Holstein Frisian cows at mid-lactation were selected to conduct this research. The animals were randomly allocated to two groups (n = 6), and both groups received one of two diets: a low-concentrate (LC) (forage: concentrate 6:4) or a high-concentrate (HC) (forage: concentrate 4:6) diet. Furthermore, an enzyme activity assay, tunnel cell assay, RT-qPCR, western blotting, and an immunofluorescence antibody (IFA) assay were performed to elucidate the effect of an HC diet in the mammary gland of dairy cows. (3) Results: The tunnel cell assay revealed a significant number of apoptotic cells in HC group, and the concentration of Caspase-3, and Caspase-8 was higher in the HC group than in the LC group. NOD1, Rip-2, Caspase-3, Caspase-8, Caspase-9, and Bax mRNA expressions, and NOD1, Caspase-3, Caspase-8, and Bax protein expressions, in the HC group were markedly higher than those in the LC group. Furthermore, Bcl-2 mRNA and protein expressions were markedly decreased in the HC compared to those in the LC group. (4) Conclusions: A HC diet fed to dairy cows incites subacute ruminal acidosis (SARA), which increases the iE-DAP concentration and induces apoptosis in the mammary gland via the NOD1/Caspase-8 pathway.

This study aimed to develop nanostructured lipid carriers (NLCs) for improved oral absorption of tilmicosin (TMS) in broilers. Thus, palmitic acid, lauric acid, and stearic acid were selected as solid lipids to formulate TMS-pNLCs, TMS-lNLCs, and TMS-sNLCs, respectively. They showed similar physicochemical properties and meanwhile possessed excellent storage and gastrointestinal stability. The TMS interacted with the lipid matrix and was encapsulated efficiently in NLCs in an amorphous structure. NLCs could enhance oral absorption of TMS compared to 10% tilmicosin phosphate solution in broilers, among which the TMS-sNLCs were the most efficient drug delivery carriers, with a relative oral bioavailability of 203.55%. NLCs could inhibit the efflux of P-glycoprotein (P-pg) toward TMS, which may be involved with improved oral absorption. Taken together, these types of solid lipids influenced the enhanced level of NLCs toward oral bioavailability of TMS, and the sNLCs proved to be the most promising oral delivery carriers of TMS.

Background Crescent fracture-dislocation of sacroiliac joint is a type of lateral compression pelvic injury associated with instability. These fractures comprise 12% of lateral compression fractures. Objective The objective of this study is to share the experience and to assess the functional outcome of fixation in crescent fracture-dislocation. Methods We analyzed a descriptive case series with clinical data of 15 patients at the Department of Orthopedics Surgery at the Dr. Ruth K.M. Pfau Civil Hospital at Dow University of Health Sciences in Karachi, Pakistan, from January 2016 to August 2018. The patients were treated by closed and open fracture reduction and fixed with percutaneous screws and reconstruction plates. Results A total of 15 patients were included in this study with age ranging from 20 to 60 years (11 men [73%]; four women [27%]). According to the mechanism of injury, five (33%) had motorcycle accidents; four (27%) had collision while sitting in a car; three (20%) were pedestrians hit by a vehicle; four (27%) were injured while sitting in van; two (13%) had bus-related injury, and one (6.5%) presented with a history of wall collapse. Five (33%) patients had type I fractures, seven (47%) had type II fractures, and three (20%) had type III fractures Associated injuries were midshaft femur fracture in two patients, contralateral superior and inferior rami fracture in three patients, and open tibia fracture in one patient. All fractures were fixed with reconstruction plates and screws. Patients were kept as non-weight-bearing on the injured joint for three weeks, mobilized non-weight-bearing on the contralateral leg after three weeks, and partial weight-bearing was started at eight weeks; full weight-bearing was started after three months. Nine patients (60%) had excellent outcomes, three (20%) had a good outcome, and three (20%) had a poor outcome. Conclusion Crescent fracture-dislocations are unstable injuries. These fractures should have proper reduction and fixation that will reduce pain, malunion, and shortening., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Jatoi et al.)

Objective: To assess the Ponsetti technique's effectiveness in the treatment of talipes equinovarus., Methods: The cross-sectional study was conducted from January 2013 to March 2018in Naushehero Feroze disctrict of the province of Sindh, Pakistan, and data was assessed at the Department of Orthopaedic Surgery, Dow University of Health Sciences / Civil Hospital, Karachi. Children with talipes equinovarus were treated with Ponsetti casting., Results: Of the 86 patients, 53(68%) were boys and 33(32%) were girls. There were a total of 111 feet in the study. Once the foot reached neutral, percutaneous tenotomy of tendo achilles was done in 86)85%) of 111 feet. Seven (8%) patients had recurrence because of non-compliance in the maintenance phase. Overall, 17(19.7%) patients were lost to follow-up., Conclusion: Ponsetti casting was found to be a simple, effective and acceptable method of treatment for talipes equinovarus.

It is conceivable that early developing germ cells must across the basal to the luminal region of seminiferous tubules (STs) during spermatogenesis is associated with extensive restructuring of junctional complex. However, very limited information is documented about these junctional complexes in reptiles. In the present study we have determined the localization of inter-Sertoli cell tight junctions (TJ's), protein CLDN11 and gap junction protein Cx43 during spermatogenesis in the testis. In early spermatogenesis, weak immunoreactivity of CLDN11and focal localization of Cx43 was observed around the Sertoli cell in the luminal region, but completely delaminated from the basal compartment of STs. In late spermatogenesis, strong focal to linear localization of CLDN11and Cx43 was detected at the points of contact between two Sertoli cells and around the early stages of primary spermatocytes in the basal compartment of STs. In late spermatogenesis, localization of CLDN11and Cx43 was drastically reduced and seen only around Sertoli cells and spermatogonia near the basal lamina. However, transmission electron microscopy revealed that inter-Sertoli cell tight junctions were present within the basal compartment of STs, leaving the spermatogonia and early primary spermatocytes in the basal region during mid spermatogenesis. Gap junctions were observed between Sertoli cells, and Sertoli cells with spermatogonia and primary spermatocytes throughout spermatogenesis. Moreover, adherens and hemidesmosomes junctions were observed during spermatogenesis. The above findings collectively suggest that the intensity and localization of TJ's and gap junctions vary according to the spermatogenetic stages that might be protected the developing germ cells from own immune response., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Metallosis is serious condition that comes about when metallic debris builds up in the soft tissues of the body. This condition is seen in individuals undergoing joint replacement surgery, like those of the hip, knee and elbow. Incidence of metallosis is not common. Here we present a case of 61 year-old male, who had undergone right-sided total hip replacement 20 years earlier due to avascular necrosis. He presented to us with one-year history of massive swelling of right thigh and mild pain and discomfort in September 2013. He was unable to carry weight on the affected limb and had been bed-ridden for the preceding three months. On surgery, we found that the femur had eroded on the medial side, and the whole illium had been destroyed except the iliac crest. We removed the stem, some metal particles and the fibrous tissue. After 2 months of surgery, he died of myocardial infarction.