Surgical Management of Bilateral Triceps Muscle Rupture: A Case Report and Literature Review.

Introduction: Triceps tendon avulsion is a rare tendinous injury that can be easily overlooked. If left untreated, such injuries can lead to a weakening of a patient's elbow extension and thereby cause significant disability; therefore, early identification and appropriate surgical intervention are important. Case Report: We report bilateral triceps tendon avulsion injuries in a 49-year-old, right-hand dominant airline pilot. The patient fell while running and injured both his elbows. X-rays of both elbows showed displaced olecranon avulsion fractures, confirming triceps tendon injuries. Bone tendons were repaired with the suture anchor technique, and a solid repair was achieved. 3 months post-surgery, the post-operative progress of the patient was satisfied with full function, a range of motion of 5-150° on the left arm, and 0-150° on the right arm and ability to return to work with no restrictions. Conclusion: Triceps tendon avulsion is a rare injury with few reported cases. Literature suggests that the successful outcome of the patient depends on early identification and timely intervention, such as surgical repair through a trans-osseous suture technique. Our report adds to the knowledge base available in the existing medical literature for future reference by healthcare professionals.

Isolated Gastrocnemius Contraction and Gastroc Recession Surgery in Case of Planter Fasciitis: A Systemic Review and Meta-Analysis.

Objective: The current systematic and meta-static review aimed to analyze the correlation between isolated gastrocnemius contracture and plantar fasciitis and the effectiveness of gastroc recession surgery in the treatment of plantar fasciitis. Methodology: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct this meta-analysis. A literature search was carried out on the following databases, including Google Scholar, PubMed, EMBASE, and the Cochrane databases with the appropriate medical subject headings (MeSH) to identify the eligible articles. Results: A total of 13 studies were included in this meta-analysis. In this study, there is a significant difference in chronic plantar fasciitis outcome when comparing experimental and control (RR: 0.02; 95% CI: 0.01 to 0.05; P < 0.001; I2 = 29%). There is a significant difference in pain scale outcome when comparing pre-treatment and post-treatment (RR: 3.25; 95% CI 1.44 to 7.32; P = 0.004 < 0.01; I2 = 0%). A significant difference in VAS scale outcome when comparing pre-treatment and post-treatment (RR: 2.58; 95% CI 1.52 to 4.38; P = 0.0004 < 0.01; I2 = 0%). Conclusion: In conclusion, the current systematic review and meta-analysis of gastrocnemius recession and proximal medial gastrocnemius release and other treatment measures for plantar fasciitis suggests that the improvement of ankle dorsiflexion, reduction in pain, and patient satisfaction are almost similar in all the treatment measures. Among the five treatment measures, gastrocnemius recession remains the best, followed by proximal medial gastrocnemius release.

Deoxyelephantopin-a novel PPARγ agonist regresses pressure overload-induced cardiac fibrosis via IL-6/STAT-3 pathway in crosstalk with PKCδ.

Pathological cardiac hypertrophy is associated with ventricular fibrosis leading to heart failure. The use of thiazolidinediones as Peroxisome Proliferator-Activated Receptor-gamma (PPARγ)-modulating anti-hypertrophic therapeutics has been restricted due to major side-effects. The present study aims to evaluate the anti-fibrotic potential of a novel PPARγ agonist, deoxyelephantopin (DEP) in cardiac hypertrophy. AngiotensinII treatment in vitro and renal artery ligation in vivo were performed to mimic pressure overload-induced cardiac hypertrophy. Myocardial fibrosis was evaluated by Masson's trichrome staining and hydroxyproline assay. Our results showed that DEP treatment significantly improves the echocardiographic parameters by ameliorating ventricular fibrosis without any bystander damage to other major organs. Following molecular docking, all-atomistic molecular dynamics simulation, reverse transcription-polymerase chain reaction and immunoblot analyses, we established DEP as a PPARγ agonist stably interacting with the ligand-binding domain of PPARγ. DEP specifically downregulated the Signal Transducer and Activator of Transcription (STAT)-3-mediated collagen gene expression in a PPARγ-dependent manner, as confirmed by PPARγ silencing and site-directed mutagenesis of DEP-interacting PPARγ residues. Although DEP impaired STAT-3 activation, it did not have any effect on the upstream Interleukin (IL)-6 level implying possible crosstalk of the IL-6/STAT-3 axis with other signaling mediators. Mechanistically, DEP increased the binding of PPARγ with Protein Kinase C-delta (PKCδ) which impeded the membrane translocation and activation of PKCδ, downregulating STAT-3 phosphorylation and resultant fibrosis. This study, therefore, for the first time demonstrates DEP as a novel cardioprotective PPARγ agonist. The therapeutic potential of DEP as an anti-fibrotic remedy can be exploited against hypertrophic heart failure in the future.

Calcaneal Fractures Management, Change of Clinical Practice in Recent Years from ELA to STA: A Systematic Review and Meta-Analysis.

Background: Calcaneal fractures are serious injuries that mainly affect young, active people. As a result, these fractures may cause long-term impairment and have a major socioeconomic impact. The current updated systematic review and meta-analysis were conducted to evaluate the functional outcomes, re-operative risk, and complications associated with the treatment of displaced intra-articular calcaneal. Methodology: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct this meta-analysis. The literature search was carried out using PubMed, Cochrane, MEDLINE, Google Scholar, and the EMBASE databases with the appropriate keywords. Results: A total of 13 studies were included in this review. The follow-up months were diverse, ranging between 12 and 65 months in sinus tarsi approach (STA) and 12 to 76 months in extended lateral approach (ELA) methods. Time to surgery was shorter for the STA when compared to ELA (MD: 3.48; 95% CI 2.43 to 4.53; p < 0.00001). No significant difference was observed in functional outcomes between STA and ELA (MD: 0.34; 95% CI: -0.37 to 1.04; p = 0.35 > 0.05; I2 = 88%). In comparison to the ELA, the STA has significantly less wound healing complications (RR: 0.20; 95% CI 0.11 to 0.36; p 0.00001; I2 = 0%). Conclusion: In conclusion, the STA technique in treating calcaneal fractures was significantly safer and more effective when compared to the ELA methods. The STA method of treatment was found to have a lower risk of complications and an infection rate, as well as a shorter operating and recovery time.

Symptomatic Os Subtibiale Following Injury: A Case Report of Failed Conservative Treatment, Leading to Differential Diagnosis Made Intraoperatively.

INTRODUCTION: Os subtibiale is a rare accessory bone found adjacent to the distal tibia and is mostly asymptomatic. Differentiating it from a medial malleolar fracture is challenging. Most cases of acute ankle trauma that presents with an Os subtibiale are initially diagnosed as fractures by treating physicians at emergency centers. It is therefore critical for an orthopedic surgeon who gets referral for such cases to consider complete history of such patients to understand the cause of their symptoms. The goal is to avoid unnecessary surgical treatment and to realize that a symptomatic Os subtibiale can be successfully managed by conservative means. Nonetheless, certain cases may require surgical treatment if conservative treatment options fail. This is a case report of a patient that was diagnosed as a case of symptomatic Os subtibiale intraoperatively, after conservative options were unsuccessful. CASE PRESENTATION: An 18-year-old patient with an injured right ankle was referred to our clinic after failed attempts to resolve his symptoms conservatively. Based on our initial clinical and radiographic examination, the patient was continued on a conservative treatment plan assuming, it was a case of unsuccessful fracture union. After almost a year of failed conservative treatments, surgery was offered to the patient, with the understanding that the bone fragment might either be fused or completely removed based on intraoperative diagnosis. At surgery, it was observed that the bone fragment had the characteristic of an Os subtibiale. It presented as a round, smooth structure with well-formed cortical boundaries, and minimal attachment to the distal tibia. A diagnosis of symptomatic Os subtibiale was made intraoperatively, which was then successfully excised using standard orthopedic instrumentation. The patient healed uneventfully and reported a pain free, normal ankle range of motion at latest follow-up of 18 months. CONCLUSION: Accurate diagnosis of Os subtibiale continues to present a learning challenge for most orthopedic physicians as these cases are extremely rare and often asymptomatic. Our patient failed to respond to conservative treatment, which led to surgery and intraoperative diagnosis of Os subtibiale that was the pain causing agent.

Hyperbranched Copolymers Forming Polymersome-like Structures Used for Encapsulation and Controlled Release of α-Tocopherol Succinate (TOS): Drug Transport Modeling.

Trimesic acid (TMA) and ethyelene diamine (ED) were reacted in various molar proportions to yield several branched/hyperbranched copolymers which formed polymersome-like structures, and they were used for encapsulation and release of a model drug, α-tocopherol succinate (TOS). The branched topology of the copolymers was established from spectroscopy, viscometry, and rheological measurements. Hydrodynamic size and transmission electron microscopy revealed the self-aggregated polymersome-like features of the copolymers with a dense core. Zeta potential studies unveiled pH-sensitive features of the aggregates. Both hydrodynamic size and viscosity were found to decrease with more branching, whereas the encapsulation efficiency displayed a drastic increase from 68 to 89.5% from the least branched (30%) to mostly branched grade (68%). The hydrophobic drug was primarily accommodated within the macromolecular voids inside the core and was released slowly following the diffusion mechanism. An indigenous model was established to explain the release kinetics from such a pH-sensitive and highly branched core-shell matrix which yielded a unique parameter called effective diffusivity or ED that took account of those parameters affecting the release rate. The copolymers were found to be biologically viable through a series of in vitro tests, thus inviting in vivo trials for future experimentation.

An elastic semi IPN polymer hybrid for enhanced adsorption of heavy metals.

An elastic semi IPN from guar gum (GG), xanthan gum (XG) and poly(acrylic acid) (PAA) was developed and used as a bioadsorbent for soluble Pb(II) and Hg(II) from water. The IPNs were developed using a photo-initiated crosslinking cum polymerization approach (benzophenone was used as an initiator) with a variable composition of the biopolymers (GG:XG fixed at 20:80 by mass) to PAA by mass (Biopolymers: PAA as 90:10, 80:20, 70:30 and 50:50, respectively). The hybrids were extensively characterized for microstructure, morphology, swelling, porosity and rheological behavior, both in dry and swelled conditions. Three grades of biosorbents namely 90:10, 80:20 and 70:30 showed an enhanced adsorption efficiency compared to the remaining ternary grades as well as the crosslinked binary grade of GG:XG (20:80 mass composition, used as a control), respectively. It was primarily due to high network strength (elasticity) cum flexibility (more liquid like behavior) of those three ternary grades under swollen condition followed by their higher swelling capacity and strongly negative zeta potential to attract the positively charged Pb(II) and Hg(II), respectively. The 80:20 grade (80 parts was the mass composed of XG:GG in 80:20 mass ratio and 20 parts was the mass of PAA) exhibited the maximum molecular effect and thus recorded the highest adsorption efficiency (93 % for Pb(II) with an adsorption capacity of 111.6 and 72 % of Hg(II) with an adsorption capacity of 86.4). Nevertheless, all the hybrids showed a strong pH dependant adsorption as the -COOH unit present in the network displayed a pH sensitive ionization. The adsorption was lower below the pH level of 4.0 (pKa of PAA at 4.5) while drastically improved beyond that. On additional note, the adsorbate dose was also found to affect the adsorption efficiency whereby a maximum dose of 300 ppm of both Pb(II) and Hg(II) was found to be most effective for adsorption.

Aquasorbent guargum grafted hyperbranched poly (acrylic acid): A potential culture medium for microbes and plant tissues.

This study reports the synthesis of an unprecedented bio-based aquasorbent guargum-g-hyperbranched poly (acrylic acid); bGG-g-HBPAA by employing graft-copolymerization and "Strathclyde methodology" simultaneously in emulsion and its possible use as a sustainable nutrient bed for the effective growth of Anabaena cylindrica and Vigna radiata seedlings. The formation of bGG-g-HBPAA and the presence of hyperbranched architectures was confirmed from XRD, FTIR, 13C NMR, solubility, intrinsic viscosity, BET surface area/ pore size, SEM and rheology analyses. The synthesized grade with a branching percent of 65.4% and a swelling percentage of 13,300% facilitated maximum growth of the cultured species as compared to guargum and its linear graft. Semi synthetic bGG-g-HBPAA culture medium was optically transparent, dried at a controlled rate, held a huge amount of water for growth, provided sufficient space for unhindered growth and featured dimensional stability.

Carbohydrate and collagen-based doubly-grafted interpenetrating terpolymer hydrogel via N-H activated in situ allocation of monomer for superadsorption of Pb(II), Hg(II), dyes, vitamin-C, and p-nitrophenol.

Herein, guar gum (GG)-g-(acrylic acid (AA)-co-3-acrylamido propanoic acid (AMPA)-co-acrylamide (AM))-g-cow buffing dust (CBD)/(GGTPCBD), a smart carbohydrate and protein-based doubly-grafted interpenetrating terpolymer hydrogel showing excellent physicochemical properties and recyclability was synthesized by in situ strategic allocation of AMPA during solution polymerization of AA and AM through systematic optimization of the amounts of components and reaction temperature for superadsorption of Hg(II), Pb(II), methyl violet (MV), methylene blue (MB), p-nitrophenol (PNP), and vitamin-C (vit.C). The in situ strategic protrusion of AMPA, grafting of both GG and CBD into AA-co-AMPA-co-AM, and ligand-selective superadsorption was inferred by advanced microstructural analyses of unadsorbed- and/or adsorbed-GGTPCBD using FTIR, 1H/13C NMR, O1s-/N1s-/C1s-/Pb4f7/2,5/2-/Hg4f7/2,5/2-XPS, UV-vis, TGA, DSC, XRD, DLS, SEM, EDX, % gel content, % -COOH, and pHPZC. The prevalence of covalent, ionic, and variegated interactions was rationalized by FTIR, fitting of kinetics data to the pseudosecond order model, and activation energies of adsorption. The BET and Langmuir isotherms fitted the best to MB and Hg(II)/Pb(II)/MV, respectively. Thermodynamically spontaneous chemisorption processes showed the maximum adsorption capacities (ACs) of 976.64, 859.23, 116.80, and 58.52 mg g-1 for Pb(II), Hg(II), MV, and MB, respectively, at 303 K, adsorbent dose = 0.01 g, and initial concentration of metal ions/dyes = 800/30 ppm.

A polyester with hyperbranched architecture as potential nano-grade antibiotics: An in-vitro study.

A potential nanograde antibiotic with hyperbranched architecture was synthesized from melt esterification of poly(ethylene glycol) or PEG and Citric acid or CA with 1:1 mol composition. PEG of different molecular weights, c.a. 4000, 6000 and 20,000 were used during the polyesterification. The polyester molecules of nanometric size were highly water soluble and showed a melting point between 55 and 60 °C. The branching status was established from spectroscopy, flow behaviour (viscosity) and rheological evidences. The extent of branching and flowability, both were reduced as the molecular weight of PEG was increased. During in-vitro pathological study, all the grades showed reasonably strong antibacterial affect (both with gram positive and negative bacteria), high selectivity, biocompatibility and controlled generation of reactive oxygen species or ROS, however, the grade with maximum level of branching and functional chain ends displayed highest therapeutic efficiency, may that be considered further as a potential agent for next level investigation.

Adsorption of soluble Pb(II) by a photocrosslinked polysaccharide hybrid: A swelling-adsorption correlation study.

A biosorbent for adsorption of soluble, inorganic Pb(II) was prepared through a photocrosslinking of a mixture of xanthan gum and guar gum at various mass ratios. The polysaccharide mixes were irradiated using UV A in presence of benzophenone. Chemical crosslinks were formed which led to a controlled swelling of the polysaccharide mix (swelling ratio <20%), referred as crosslinked hybrid in the text. The hybrids were characterized for microstructure, rheology, surface area and surface charge behavior. Interesting changes in crystallographic pattern, both in the pre and the post adsorption stages, was investigated using x-ray diffraction technique. Adsorption efficiency was estimated in respect of blend composition, adsorbate-adsorbent concentration and pH under competitive and non-competitive conditions. A correlation between the swelling of the crosslinked hybrid and the metal adsorption was drawn at various pH to elucidate an interaction between the two phenomena.

Surfactant mediated synthesis of poly(acrylic acid) grafted xanthan gum and its efficient role in adsorption of soluble inorganic mercury from water.

Noble copolymers from xanthan gum (XG) and poly(acrylic acid) (PAA) were synthesised through surfactant mediated graft copolymerization. The copolymers were applied as a biosorbent for inorganic Hg(II) at higher concentration level (300ppm). The copolymers were characterized using different analytical techniques which showed, the grafting principally occurred across the amorphous region of XG. Measurement of zeta potential and hydrodynamic size indicated, the copolymers were strong polyanion and possessed greater hydrodynamic size (almost in all cases) than XG, despite a strong molecular degradation that took place simultaneously during grafting. In the dispersed form, all grades of the copolymer displayed higher adsorption capability than XG, however, the grade with maximum grafting produced the highest efficiency (68.03%). Manipulation produced further improvement in efficiency to 72.17% with the same copolymer after 75min at a pH of 5.0. The allowable biosorbent dose, however, was 1000ppm as determined from the experimental evidences.

Polyelectrolytic aqueous guar gum for adsorptive separation of soluble Pb(II) from contaminated water.

The article introduces the concept of homophase adsorption of soluble Pb(II) from contaminated water using aqueous guar gum (GG). The process appears to be extremely handy since it avoids hectic sample preparation and adsorbent recovery stages. The results show that, addition of only 1000 ppm GG removes 56.72% of the contaminated Pb(II) within 150 min at 303 K. The best working pH has been found to be at 4.5. At this point GG molecules show greatest balance between negative zeta potential and high molecular size. Mechanistically, the adsorption follows Langmuir model since on formation of a monolayer, the positive Pb(II) prevent subsequent adsorption through strong electrostatic repulsion. The adsorption kinetics follows pseudo second order model. Both kinetics and thermodynamics of the process complies with the conventional hetero facial adsorption models despite huge procedural differences.

A carboxy methyl tamarind polysaccharide matrix for adhesion and growth of osteoclast-precursor cells.

Remodeling of bone by tissue engineering is a realistic option for treating several bone-related pathophysiological ailments such as osteoporosis, bone tumor, bone cancer or abnormal bone development. But, these possibilities are hindered due to lack of proper natural and biodegradable surface on which bone precursor cells can adhere efficiently and grow further. Here we describe the synthesis and characterization of a new hydrogel as an effective surface which can acts as a material for bone tissue engineering. This hydrogel has been prepared by chemically grafting a semi-synthetic polymer with a synthetic monomer, namely hydroxyethyl methacrylate (HEMA). Carboxy methyl tamarind (CMT) was selected as the semi-synthetic polymer. The hydrogel was prepared at different mole ratios and at the ratio of 1:10 (CMT:HEMA) yielded the best hydrogel as characterized by several physico-chemical analysis such as UV spectroscopy, FT-IR spectroscopy and swelling properties. We further demonstrate that this material is suitable for effective adhesion, growth and further clustering of bone precursor cells (RAW 264.7). This material is also compatible for growing other sensitive cells such as neuronal cells (Neuro2a) and human umbilical vein endothelial cells (HUVEC) demonstrating that this surface does not possess any cytotoxicity and is compatible for primary human cells too. We conclude that the hydrogel made of CMT:HEMA at a ratio of 1:10 can be suitable for bone tissue engineering and thus may have clinical as well as commercial application in future.

Scintigraphic scoring system for grading severity of gastro-esophageal reflux on 99mTc sulfur colloid gastro-esophageal reflux scintigraphy: A prospective study of 39 cases with pre and post treatment assessment.

AIM: The study aimed at developing a scoring system for scintigraphic grading of gastro-esophageal reflux (GER), on gastro-esophageal reflux scintigraphy (GERS) and comparison of clinical and scintigraphic scores, pre- and post-treatment. MATERIALS AND METHODS: A total of 39 cases with clinically symptomatic GER underwent 99mTc sulfur colloid GERS; scores were assigned based on the clinical and scintigraphic parameters. Post domperidone GERS was performed after completion of treatment. Follow up GERS was performed and clinical and scintigraphic parameters were compared with baseline parameters. RESULTS: Paired t-test on pre and post domperidone treatment clinical scores showed that the decline in post-treatment scores was highly significant, with P value < 0.001. The scintigraphic scoring system had a sensitivity of 93.9% in assessing treatment response to domperidone, specificity of 83.3% i.e., 83.3% of children with no decline in scintigraphic scores show no clinical response to Domperidone. The scintigraphic scoring system had a positive predictive value of 96.9% and a negative predictive value of 71.4%. CONCLUSION: GERS with its quantitative parameters is a good investigation for assessing the severity of reflux and also for following children post-treatment.

Uniquely different PVA-xanthan gum irradiated membranes as transdermal diltiazem delivery device.

This paper reports interesting differences between physical and mechanical properties of various membranes prepared from high and low molecular weight poly (vinyl alcohol) (PVA) and xanthan gum (XG) blends irradiated under low dose electron beam. The membranes were designed for sustained delivery of diltiazem hydrochloride through skin. Electron beam irradiation produced crosslinks and turned PVA into crystalline phase from its amorphous organization in the unirradiated state. PVA crystals were fibrillar at low XG content (1 wt.%) when the molecular weight was high while similar orientation at higher XG content (5 wt.%) when the molecular weight was low. Low molecular weight PVA-XG membranes showed equivalent physical properties under dry condition but wet-mechanical properties were superior for high molecular weight PVA-XG hybrids. Both of them showed slow and sustained diltiazem release but the later induced slightly slower release despite low drug encapsulation efficiency due to its better wet mechanical strength.

Guar gum and guar gum-oligomeric poly(vinyl alcohol) blends as novel flocculants for kaolinated waste water.

This is probably the first report on kaolin flocculation done with aqueous guar gum (GG) at various pH. Dynamic light scattering and reduced viscosity proved the polyelectrolytic feature (zeta potential) of aqueous GG which changed on changing pH. Interestingly, the molecular size of GG did not always increased with rising zeta potential due to strong intermolecular repulsion leading to macromolecular recoiling. Best pH range for settling was 4.0-5.0 which included isoelectric point (IEP) of kaolin. Post-settling turbidity was also acceptable at that range. Optimized GG was further blended with oligomeric poly (vinyl alcohol) (PVA) (Mn 14,000) to prepare a new set of flocculant. Oligomeric PVA was previously optimized at similar pH as excellent kaolin flocculant in our earlier investigation. All GG-PVA blends including neat GG exhibited faster settling than neat PVA. However, settling times of all blend compositions were slightly greater than that of neat GG except for few cases where the post settling turbidity was found significantly lower than all our previous investigations.

Efficient micropropagation and chlorocholine chloride induced stevioside production of Stevia rebaudiana Bertoni.

A promising method of micropropagation of Stevia rebaudiana Bertoni has been developed with an aim to increase the biomass, survivability of the plantlets and stevioside production, using chlorocholine chloride (CCC). Microshoots transferred to the MS medium containing different combinations CCC and IBA were found to be most effective in terms of growth pattern, hardening ability of the plantlets and stevioside content, compared to MS medium containing either IBA or CCC. Among other combinations tested, MS medium supplemented with 3 mg/l CCC and 3 mg/l IBA was found most effective in inducing significant changes like reduced shoot length, increased number of roots, higher leaf size, increased biomass and chlorophyll retaining capacity, higher survival percentage and most importantly the elevated stevioside content. Collectively, the major observations of this research indicate that application of CCC in micropropagation of S. rebaudiana Bertoni is a promising approach and has commercial prospects.