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High-energy X-ray diffraction methods can non-destructively map the 3D microstructure and associated attributes of metallic polycrystalline engineering materials in their bulk form. These methods are often combined with external stimuli such as thermo-mechanical loading to take snapshots of the evolving microstructure and attributes over time. However, the extreme data volumes and the high costs of traditional data acquisition and reduction approaches pose a barrier to quickly extracting actionable insights and improving the temporal resolution of these snapshots. This article presents a fully automated technique capable of rapidly detecting the onset of plasticity in high-energy X-ray microscopy data. The technique is computationally faster by at least 50 times than the traditional approaches and works for data sets that are up to nine times sparser than a full data set. This new technique leverages self-supervised image representation learning and clustering to transform massive data sets into compact, semantic-rich representations of visually salient characteristics (e.g. peak shapes). These characteristics can rapidly indicate anomalous events, such as changes in diffraction peak shapes. It is anticipated that this technique will provide just-in-time actionable information to drive smarter experiments that effectively deploy multi-modal X-ray diffraction methods spanning many decades of length scales.
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New stability indicating related substances and assay methods for trametinib acetic acid by RP-HPLC have been developed and validated through forced degradation and mass balance studies for the first time. In related substances (RS) method, trametinib acetic acid was successfully separated from its six related substances namely, cyclopropanamide impurity, desiodo trametinib, desacetyl trametinib, trione acetamide intermediate, trione intermediate, and trione PTSA intermediate using YMC-Triart C18 (150 × 4.6 mm, 3 µm) column. Orthophosphoric acid (0.15%) in water was used as buffer. Gradient elution was programmed using mobile phase-A (buffer and acetonitrile mixture in 80:20 v/v ratio) and mobile phase-B (buffer and acetonitrile mixture in 20:80 v/v ratio). Acetonitrile and methanol mixture (1:1 v/v) was used as diluent. Flow rate, injection volume, column temperature, and wavelengths were kept as 0.8 mL/min, 10 µL, 55 °C, and 240 nm, respectively. Desacetyl trametinib and cyclopropanamide impurity were identified as potential degradation impurities in acid and base degradation conditions, respectively. Assay method specific to above six related substances was also developed. Assay of forced degradation samples was also determined, and the mass balance was established by adding total impurities formed in RS method to assay of trametinib acetic acid.
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BACKGROUND: Chronic osteomyelitis is a debilitating bone infection, characterized by a persistent infection over months to years, poses diagnostic and therapeutic challenges due to its insidious nature and potential for severe bone and soft tissue destruction. This systematic review and meta-analysis aims to review the literature on the treatment of chronic osteomyelitis in long bones and assess cure rates in single versus two-stage surgery. METHODS: Following the PRISMA guidelines and registered with PROSPERO (ID: CRD42021231237), this review included studies that reported on the management of chronic osteomyelitis in long bones using either a planned one-stage or two-stage surgical approach in adult patients. Databases searched included Medline, Embase, Web of Science, CINAHL, HMIC, and AMED, using keywords related to osteomyelitis, long bones, and surgical management. Eligibility criteria focused on adults with chronic osteomyelitis in long bones, with outcomes reported after a minimum follow-up of 12 months. The meta-analysis utilized the random-effects model to pool cure rates. RESULTS: The analysis included 42 studies with a total of 1605 patients. The overall pooled cure rate was 91% (CI 95%) with no significant difference observed between single-stage and two-stage surgeries (X2 = 0.76, P > 0.05). Complications were reported in 26.6% of cases in single-stage procedures and 27.6% in two-stage procedures, with prolonged wound drainage noted as a common issue. Dead space management techniques varied across studies, with antibiotic-loaded calcium sulphate beads used in 30.4% of cases. CONCLUSION: This meta-analysis reveals no significant difference in cure rates between single and two-stage surgical treatments for chronic osteomyelitis in long bones, supporting the efficacy of both approaches. The current treatment strategy should include a combination of debridement, dead space management using local and systematic antibiotics and soft tissue reconstruction if necessary.
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Osteomielite , Osteomielite/cirurgia , Humanos , Doença Crônica , Adulto , Resultado do Tratamento , Desbridamento/métodosRESUMO
Introduction: The decision to use circular frame fixation for lower limb trauma, or elective deformity correction, often accompanies the assertion that the patient will be able to fully weight-bear through the limb immediately following surgery. Materials and methods: About 53 patients underwent retrospective review. Included in the study were current attendees of adult specialist physiotherapy, following circular frame application to the lower leg at our Institution between August 2018 and January 2020. Cases with incomplete data, cases given postoperative status of non-weight-bearing, those with physiotherapy follow-up conducted elsewhere, or cases of polytrauma were excluded from the study.Weight-bearing assessment and rehabilitation supervision were at the discretion of the physiotherapy team. The clinical concept of 'full weight-bearing' is poorly defined, but was documented in the context of displaying a stable gait using elbow crutches and subsequently without walking aids. Comparative data was analysed using an unpaired, two-tailed Welch's t-test. Results: Mean postoperative time to full weight-bearing using crutches was 28.3 days (0-159) (n = 40).Mean postoperative time to independent full weight-bearing with no walking aids was 230.6 days (35-393), or 7.1 months (0-12) (n= 34).No significant differences were seen between:Frames for open injuries (n= 5) vs closed injuries (n = 17; p > 0.4).Joint-spanning constructs (n= 18) vs non-spanning constructs (n = 21; p > 0.6), orTreatment of intra-articular injuries (n = 14) vs extra-articular injuries (n = 17; p > 0.2).Interpretation of these results should be made with caution due to sample size. Conclusion: The ability to permit patients to fully weight-bear immediately after surgery is often a distinct advantage of the circular frame over other fixation modalities, for a variety of indications. However, it does not follow that patients are capable of doing so; there is a long dependency on walking aids. This would appear to be the case irrespective of open/closed injuries, intra-/extra-articular injuries, or the use of a spanning construct across the knee or ankle. How to cite this article: Craig A, Barron E, Sharma H, et al. Do Patients Achieve "Full Weight-bearing" Immediately Following Application of Circular Frame Fixation of the Lower Limb? Strategies Trauma Limb Reconstr 2024;19(1):40-44.
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OBJECTIVE: Anxiety is among the major psychological concerns for children living with food allergy (FA). Yet research exploring the variables driving anxiety symptoms in FA remains sparse, and most studies still utilize homogeneous samples to assess anxiety symptoms. The current study seeks to evaluate the rates of clinically significant anxiety symptoms among a diverse sample of youth with FA and examine whether a heightened risk perception of FA outcomes and FA burden (vs. FA medical history) is associated with anxiety in youth. METHODS: 94 youth ages 10-14 and their parents were recruited from FA clinics at a mid-Atlantic children's hospital. Both youth and parents completed demographic and FA medical history questionnaires, the Screen for Child Anxiety Related Emotional Disorders, and the Food Allergy Independent Measure as part of a longitudinal study about FA adjustment and adherence. RESULTS: Over a third (37%) of youth scored above clinical cut-offs for overall anxiety symptoms. At least 25% of youth reported clinically significant scores on panic disorder, generalized anxiety, social anxiety, separation anxiety, and school avoidance subscales. Perception of risk of adverse FA outcomes and burden-but not FA medical history-were associated with total anxiety, generalized anxiety, panic disorder, and school avoidance symptoms, but not social anxiety and separation anxiety. Having more FAs was associated with higher social anxiety scores but not with other anxiety subscales. CONCLUSIONS: Youth with FA might benefit from psychosocial interventions that address FA risk perception management and promote appropriate FA vigilance to cope with anxiety symptoms.
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Ansiedade , Hipersensibilidade Alimentar , Humanos , Feminino , Adolescente , Masculino , Hipersensibilidade Alimentar/psicologia , Criança , Ansiedade/psicologia , Transtornos de Ansiedade/psicologia , Inquéritos e Questionários , Estudos Longitudinais , Pais/psicologiaRESUMO
Background: Varus deformity is common in medial compartment knee osteoarthritis (OA). This coronal plane malalignment is compensated for by static and dynamic adjustments in the position of the adjacent joints, principally in the hindfoot & ankle. Varus knee OA can be treated in selected patients with high tibial osteotomy (HTO) and stabilised with a fixed angle plate or circular frame, which may reverse these compensatory adjustments. The aim of this systematic review is to determine the evidence available for static and dynamic compensations with the main objectives being to improve deformity planning and optimise patient outcomes. Method: A systematic review with meta-analysis was designed using the PRISMA template to meet the research aims & objectives. Results: A total of 1006 patients (1020 knees) with acombined mean age of 54.5 years, female:male ratio of 0.9:1 were extracted from 19 included studies. The methodologies of the majority of studies were at high risk of bias according to the Newcastle-Ottawa Scale demonstrating significant heterogeneity. The combined mean change in the HKA axis was 7.7°; MPTA 7.4°; TT, 0.21°; TI 4.56° & AJLO 4° valgus. Preoperative hindfoot valgus compensation reverts towards neutral post-HTO. There is limited evidence available for a direct relationship between static alignment and dynamic gait parameters. Conclusions: An inverse relationship between ankle and hindfoot alignment in varus deformity of the knee forms the basis of this compensation theory. In cases with a stiff hindfoot which may not revert postoperatively, the reconstructive orthopaedic surgeon may consider angulation with translation HTO, in order to optimise joint alignment and minimise transference of symptoms to the foot and ankle.
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Open tibia fractures frequently occur following high-energy trauma. Contamination of the fracture site combined with limited soft tissue coverage and blood supply means that these open fractures are associated with a high rate of complications, including fracture related infection (FRI). FRI is associated with lowered patient outcomes and requires early recognition and appropriate surgical and medical management. The current evidence on FRI after open tibial fractures largely is limited to case series, small retrospective cohort studies and expert opinion. Recent expert consensus has produced guidelines with the aim of standardising care for these patients. This review summarises the current management strategies employed in treating FRI following open tibial fractures and where possible the evidence behind them.
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BACKGROUND: Definitive treatment for food allergy reactions including anaphylaxis varies widely by reaction severity and socioeconomic status, but little data exist to characterize the relationship between severity, management, and race and ethnicity. OBJECTIVE: To analyze the differences in reaction severity, epinephrine use, and emergency room (ER) use by race and ethnicity in a large, diverse, food-allergic cohort. METHODS: We analyzed intake data from participants in the Food Allergy Outcomes Related to White and African-American Racial Differences cohort on the history of food allergy reactions, severity of the reactions, and management associated with each reaction. We used descriptive statistics as well as mixed-effects logistic and Poisson models to describe the differences in reaction severity, ER visits, and total lifetime epinephrine use by race and ethnicity. RESULTS: A total of 784 children were included in the analysis: 425 (54.2%) were non-Hispanic White, 282 (36.0%) were non-Hispanic Black, and 77 (9.8%) were Hispanic/Latino. Non-Hispanic Black children had increased odds of more severe reactions (odds ratio, 1.7; 95% CI, 1.2-2.3) and higher odds of going to the ER (odds ratio, 2.8; 95% CI, 1.4-5.4). Both non-Hispanic Black (incidence rate ratio, 0.4; 95% CI, 0.3-0.5) and Hispanic/Latino (incidence rate ratio, 0.3; 95% CI, 0.2-0.5) children had lower rates of total lifetime epinephrine use. CONCLUSIONS: There are significant disparities in the severity and treatment of food allergy reactions by race and ethnicity, resulting in increased ER use and decreased total lifetime epinephrine use. Equipping parents with resources and tools on management of food allergy reactions may result in decreased disparity in access to definitive care.
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Hipersensibilidade Alimentar , Hispânico ou Latino , Criança , Humanos , Negro ou Afro-Americano , Epinefrina/uso terapêutico , Etnicidade , Hipersensibilidade Alimentar/epidemiologia , BrancosRESUMO
OBJECTIVES: Despite significant advancements in modern medicine, effective hepatoprotective medication with minimal side effects is still lacking. In this context. Tinospora cordifolia, an Indian Ayurvedic liana, has attracted much attention. KEY FINDINGS: Traditionally, T. cordifolia has been found to be effective in the treatment of jaundice; according to the literature, T. cordifolia is a hepatoprotective agent, and the CCl4 model is the most frequently used to evaluate its potential. Its hepatoprotective effects might be attributed to alkaloids (berberine, palmatine, and jatrorrhizine) and sinapic acid. Berberine decreases inflammation by inhibiting the proinflammatory cascade triggered by TNF-α and reduces nitrosative stress by inhibiting iNOS. T. cordifolia also exhibits anticancer, anti-inflammatory, antimicrobial, antioxidant, and other activities; it is safe at concentrations up to 2000 mg/kg. Its biological action can be attributed to polyphenols, alkaloids, steroids, terpenoids, and glycosides. T. cordifolia has also been found to be an active ingredient in several polyherbal formulations used to treat chemical-mediated hepatotoxicity. CONCLUSION: T. cordifolia's hepatoprotective effects are mediated by the inhibition of lipid peroxidation, the management of oxidative stress, and other factors. T. cordifolia can be used to manage liver disorders and as a hepatoprotective supplement in the food industry. The bioprospecting of its alkaloids can lead to the development of novel formulations against hepatic ailments.
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Berberina , Tinospora , Extratos Vegetais/farmacologia , Antioxidantes/farmacologia , Suplementos NutricionaisRESUMO
Non-equilibrium magneto-transport properties of a quantum dot dimer transistor are studied in the presence of electron-electron and electron-phonon interactions and the interaction of the dimer phonons with the substrate phonon bath that gives rise to dissipation. The entire system is modeled by the Anderson-Holstein-Caldeira-Leggett Hamiltonian where the Caldeira-Leggett term takes care of the damping. The electron-phonon interaction is dealt with the Lang-Firsov transformation and the electron-electron interaction is treated at the mean-field level. The transport problem is studied using the Keldysh non-equilibrium Green function theory and the effects of electron-electron interaction, external magnetic field, electron-phonon interaction and damping on spectral function, tunneling current and differential conductance of the dimer transistor are calculated.
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BACKGROUND: The management of failed tibial fracture fixation remains a challenge for orthopaedic surgeons. This study investigate the utility and outcomes of circular external fixation in the management of failed internal fixation of tibial fractures. METHODS: Retrospective review of a prospectively collected database of a complex limb reconstruction unit at a major trauma centre was done during December 2022. Patients with failed internal fixation of tibial fracture who underwent revision surgery with circular external fixation frame were included. RESULTS: 20 patients with a mean age of 47.8 ± 16.5 years (range: 15-69) were included. Fourteen (70.0%) patients had failed plate and screws fixations, and the remaining six (30.0%) failed intramedullary nail fixation. The most common indication for revision surgery was development of early postoperative surgical site infection (5 patients; 25.0%). The mean duration of frame treatment was 199.5 ± 80.1 days (range = 49-364), while the mean follow-up duration following frame removal was 3.2 ± 1.8 years (range = 2-8). The overall union rate in this series was 100%; and all infected cases had complete resolution from infection. The total number of complications was 11, however, only two complications required surgical intervention. The most common complications reported were pin site infection (6; 30.0%) and limb length discrepancy of 2 cm (2; 10.0%). CONCLUSIONS: Circular external fixation is a reliable surgical option in the treatment of failed internal fixation of tibia fractures. This technique can provide limb salvage in complex infected and noninfected cases with a high union rate and minimal major complications.
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Tíbia , Fraturas da Tíbia , Humanos , Adulto , Pessoa de Meia-Idade , Tíbia/cirurgia , Fixação de Fratura/efeitos adversos , Fixação de Fratura/métodos , Fixadores Externos , Resultado do Tratamento , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas da Tíbia/cirurgia , Estudos RetrospectivosRESUMO
Allergic disease management for adolescents and young adults requires consideration of unique psychosocial challenges and opportunities. Erik Erikson's model for the Stages of Psychosocial Development is a useful lens through which we can understand adolescent and young adult experiences with allergic and immunologic disease, particularly with regard to identity and relationship development. It is important to provide anticipatory guidance for patients who are transitioning environments (eg, home to college), with attention to the anxiety-provoking demands for increased responsibility on top of new stressors such as academic and vocational demands. It is critical that health care professionals use an empathetic, shared decision-making approach regarding the emotional impact of allergy on a patient's social engagement. A patient's ability to develop positive lifelong habits is also shaped by their environment's "culture of wellness," and clinicians can encourage habits to promote healthy choices and effective disease management. Social media provides opportunities and challenges as a conduit for both social connection and possible misinformation. Overall, allergic disease management in adolescents and young adults is a "high-risk, high-reward" period of time-and with awareness, anticipation, and proactive action, health care professionals can better serve patients by leveraging this transitional period to promote positive approaches to management of allergies and asthma, trusting relationships, and personal responsibility.
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The reaction between the Grignard reagent formed from Mg and 2-bromobenzylmethyl ether and SnCl4 produced four products: [2-(MeOCH2 )C6 H4 ]3 SnBr (1), [2-(MeOCH2 )C6 H4 ]2 SnX2 (2, X2 =Br2 (a) and BrCl (b)), [{2-(MeOCH2 )C6 H4 }3 Sn]2 (3), and [{2-(MeOCH2 )C6 H4 }2 SnBr]2 O (4). In the case of 1, two of the three dangling arm O atoms coordinate to the central tin atom with O-Sn internuclear distances of 2.53 (O1) and 2.91 (O2) Å, the shorter interaction being trans to the Br atom, the other trans to a phenyl carbon atom. In the case of 2a the resulting hexacoordinate structure exhibits two very short O-Sn interactions of 2.42 and 2.50â Å, well below the sum of the VdW radii of O and Sn, 3.69â Å. The sterically crowded ditin compound 3 was obtained in trace amounts and the structure demonstrates no dangling O-Sn interactions. General changes in structure compared to other distannane systems are reflective of the great steric crowding. Distannoxane 4, has a Sn-O-Sn bond angle of 148.1(2)° which is larger compared to other distannoxane structures. The intermolecular interactions between Sn-O 2.470(3) and 2.521(3)Å and 2.665(3) and 2.629(3)Å for Sn1 and Sn2 respectively are responsible for a distorted octahedral geometry around the two tin atoms. The various 119 Sn, 13 C and 1 H NMR spectra are in accord with their structural analysis for 1 and 2, and in the solid state 13 C NMR spectrum of 1 the dangling methylene group is observable whereas is solution there is a rapid dynamic equilibrium resulting in a single resonance for all methylene groups.
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BACKGROUND: The composition of the gut microbiome has been associated with development of atopic conditions such as food allergy (FA) and asthma. African American or Black children with FA have higher rate of asthma compared to their White counterparts. OBJECTIVE: We sought to investigate whether the diversity and relative abundance (RA) of gut microbiota is different between children with FA from different racial backgrounds living in the same cities. Furthermore, we aimed to understand whether the difference in the gut microbiota is associated with asthma in children with FA. METHODS: We analyzed and compared the stool microbiome of a cohort of Black and White children with FA by shotgun genomic sequencing. RESULTS: A total of 152 children with IgE-mediated FA enrolled onto FORWARD (Food Allergy Outcomes Related to White and African American Racial Differences); 30 Black and 122 White children were included. The RA of several bacteria was associated with race and asthma. Most notably the RA of Bacteroides thetaiotaomicron, Chlamydia thrachomatis, Parabacteroides goldsteinii, and Bacteroides eggerthii were significantly higher, while the RA of Bifidobacterium sp CAG:754, Parabacterium johnsonii, Bacteroides intestinalis, and Bifidobacterium breve were significantly lower in stool samples of Black children compared to White children. Asthma was associated with lower RA of B breve, Bifidobacterium catenulatum, Prevotella copri, Veilloella sp CAG:933, and Bacteroides plebius, and higher RA of 3 Bacteroides species. CONCLUSIONS: The observed variations in the gut microbiota of Black and White children such as differences in the Bacteroides and Bifidobacterium species along with their association to history of asthma in our cohort is indicative of their potential role in the higher rate of asthma observed among Black children with FA.
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Asma , Hipersensibilidade Alimentar , Microbioma Gastrointestinal , Microbiota , Criança , Humanos , Microbioma Gastrointestinal/genética , Fezes/microbiologiaRESUMO
The COVID-19 pandemic increased stress and reduced wellness for patients and physicians alike. The uncertainty, frequent changes, fear of illness and death, and supply chain issues taxed an already broken health care system. The pandemic undermined the factors that allow for a healthy workplace: control, predictability, and certainty. During this time, rates of depression, suicidality, and anxiety all increased among physicians and the community at large. These challenges were aggravated by disagreements regarding masking and vaccinations. These factors, as well as the degree to which people felt valued or not also contributed to burnout. Some changes such as the transition to telemedicine, although initially stressful, led to patient satisfaction and allowed clinical care to continue. Other changes, such as trying to homeschool, or watching young children while also trying to work were less desirable. Patients and physicians did their best to combat isolation, fear, anxiety, and the numerous societal changes. Burnout fluctuated throughout the pandemic related to local and systemic factors such as rates of infection, vaccination, supply chain issues, and individual support. The pandemic highlighted problems with our health care system, including structural racism, health care disparities, and how easily the system can be overwhelmed. Physicians may have been thrown into roles they did not feel comfortable filling and may have had insufficient staff to practice in the way they wanted. These factors led to frustration among patients and physicians alike. The National Plan for Health Workforce Well-Being outlines the need for health care reform to allow for effective and safe health care while protecting clinicians from burnout.