Comparison of acute outcomes from elective total hip replacements and after fragility femoral neck fractures in nonagenarians.

BACKGROUND: Hip hemiarthroplasty has traditionally been used to treat displaced femoral neck fractures in older, frailer patients whilst total hip replacements (THR) have been reserved for younger and fitter patients. However, not all elderly patients are frail, and some may be able to tolerate and benefit from an acute THR. Nonagenarians are a particularly heterogenous subpopulation of the elderly, with varying degrees of independence. Since THRs are performed electively as a routine treatment for osteoarthritis in the elderly, its safety is well established in the older patient. The aim of this study was to compare the safety of emergency THR to elective THR in nonagenarians. METHODS: A retrospective 10-year cohort study was conducted using data submitted to the National Hip Fracture Database (NHFD) across three hospitals in one large NHS Trust. Data was collected from 126 nonagenarians who underwent THRs between 1st January 2010 - 31st December 2020 and was categorised into emergency THR and elective THR groups. Mortality rates were compared between the two groups. Secondary outcomes were also compared including postoperative complications (dislocations, revision surgeries, and periprosthetic fracture), length of stay in hospital, and discharge destination. RESULTS: There was no significant difference in mortality between the two groups, with 1-year mortality rates of 11.4% and 12.1% reported for emergency and elective patients respectively (p = 0.848). There were no significant differences in postoperative complication rate and discharge destination. Patients who had emergency THR spent 5.56 days longer in hospital compared to elective patients (p = 0.015). CONCLUSION: There is no increased risk of 1-year mortality in emergency THR compared to elective THR, in a nonagenarian population. Therefore, nonagenarians presenting with a hip fracture who would have been considered for a THR if presenting on an elective basis should not be precluded from an emergency THR on safety grounds. TRIAL REGISTRATION: Not necessary as this was deemed not to be clinical research, and was considered to be a service evaluation.

Hierarchical Self-Assembly of Carbon Dots into High-Aspect-Ratio Nanowires.

We report a spontaneous and hierarchical self-assembly mechanism of carbon dots prepared from citric acid and urea into nanowire structures with large aspect ratios (>50). Scattering-type scanning near-field optical microscopy (s-SNOM) with broadly tunable mid-IR excitation was used to interrogate details of the self-assembly process by generating nanoscopic chemical maps of local wire morphology and composition. s-SNOM images capture the evolution of wire formation and the complex interplay between different chemical constituents directing assembly over the nano- to microscopic length scales. We propose that residual citrate promotes tautomerization of melamine surface functionalities to produce supramolecular shape synthons comprised of melamine-cyanurate adducts capable of forming long-range and highly directional hydrogen-bonding networks. This intrinsic, heterogeneity-driven self-assembly mechanism reflects synergistic combinations of high chemical specificity and long-range cooperativity that may be harnessed to reproducibly fabricate functional structures on arbitrary surfaces.

Dynamics of a single-phase natural circulation system under harmonic excitation.

A natural circulation system (NCS) has a broad application in the sector of thermal engineering, for example, in nuclear reactors due to its capability in transferring heat without any support of external power or a mechanical device. NCSs, although designed for steady operation, have been found to exhibit dynamical behavior, such as periodic oscillations, depending on the input heater power. The heater power, otherwise assumed to be steady, can be fluctuating in practice. The present study focuses on the dynamics of a single-phase square NCS, which exhibits periodic dynamics and is subjected to an external harmonic perturbation (chosen as the simplest form of fluctuation) over the steady heater power. The objective of the study is to study the dynamics of NCS under external (harmonic) disturbances using the framework of forced synchronization. Toward that, a 1D transient model of a square-shaped NCS is simulated with harmonically forced input power. The transition in the nature of synchronization between mass flux oscillations and the external forcing has been characterized by varying the frequency and amplitude of external perturbation independently. We find different nonlinear effects of the harmonic forcing, such as exhibition of quasiperiodic dynamics, frequency pulling/pushing, and frequency locking or forced synchronization. The aforementioned characterization techniques open up an avenue for detailed analysis of the more complex type of fluctuating input heat in real systems.

Medium-term mortality after hip fractures and COVID-19: A prospective multi-centre UK study.

PURPOSE: The COVID-19 pandemic has caused 1.4 million deaths globally and is associated with a 3-4 times increase in 30-day mortality after a fragility hip fracture with concurrent COVID-19 infection. Typically, death from COVID-19 infection occurs between 15 and 22 days after the onset of symptoms, but this period can extend up to 8 weeks. This study aimed to assess the impact of concurrent COVID-19 infection on 120-day mortality after a fragility hip fracture. METHODS: A multi-centre prospective study across 10 hospitals treating 8% of the annual burden of hip fractures in England between 1st March and 30th April, 2020 was performed. Patients whose surgical treatment was payable through the National Health Service Best Practice Tariff mechanism for "fragility hip fractures" were included in the study. Patients' 120-day mortality was assessed relative to their peri-operative COVID-19 status. Statistical analysis was performed using SPSS version 27. RESULTS: A total of 746 patients were included in this study, of which 87 (11.7%) were COVID-19 positive. Mortality rates at 30- and 120-day were significantly higher for COVID-19 positive patients relative to COVID-19 negative patients (p < 0.001). However, mortality rates between 31 and 120-day were not significantly different (p = 0.107), 16.1% and 9.4% respectively for COVID-19 positive and negative patients, odds ratio 1.855 (95% CI 0.865-3.978). CONCLUSION: Hip fracture patients with concurrent COVID-19 infection, provided that they are alive at day-31 after injury, have no significant difference in 120-day mortality. Despite the growing awareness and concern of "long-COVID" and its widespread prevalence, this does not appear to increase medium-term mortality rates after a hip fracture.

Directing Group Assisted Unsymmetrical Multiple Functionalization of Arene C-H Bonds.

Multiple C-H bond functionalizations promptly install diverse groups on the molecular framework and consequently fabricate complex molecular entities. This review briefly surveys the conceptual development of directing group assisted unsymmetrical multiple functionalization of arene C(sp2 )-H bonds, which is exceedingly appealing and highly important.

Sulfoximine-Assisted Unsymmetrical Twofold C-H Functionalization of Arenes.

An unprecedented ruthenium (Ru)-catalyzed twofold unsymmetrical annulation of 3-O/N-allyl benzoic acid derivatives with isocyanates for the construction of dihydro-furan/indole-fused phthalimide scaffolds is discussed. This double-unsymmetrical functionalization of both o,o'-C-H bonds of arene moiety is explicitly viable under the influence of methylphenyl sulfoximine directing group constructing three different [C-C/C-C(O)/N-C(O)] bonds under a single catalytic system. A broad scope with all six-carbon-substituted arene motifs, control experiments, and gram-scale synthesis make the synthetic model viable and significant.

Transphyseal anterior cruciate ligament reconstruction using living parental donor hamstring graft: excellent clinical results at 2 years in a cohort of 100 patients.

PURPOSE: To determine outcomes of transphyseal ACL reconstruction using a living parental hamstring tendon allograft in a consecutive series of 100 children. METHODS: One hundred consecutive juveniles undergoing ACL reconstruction with a living parental hamstring allograft were recruited prospectively and reviewed 2 years after ACL reconstruction with IKDC Knee Ligament Evaluation, and KT1000 instrumented laxity testing. Skeletally immature participants obtained annual radiographs until skeletal maturity, and long leg alignment radiographs at 2 years. Radiographic Posterior tibial slope was recorded. RESULTS: Of 100 juveniles, the median age was 14 years (range 8-16) and 68% male. At surgery, 30 juveniles were graded Tanner 1 or 2, 21 were Tanner 3 and 49 were Tanner 4 or 5. There were no cases of iatrogenic physeal injury or leg length discrepancy on long leg radiographs at 2 years, despite a median increase in height of 8 cm. Twelve patients had an ACL graft rupture and 9 had a contralateral ACL injury. Of those without further ACL injury, 82% returned to competitive sports, IKDC ligament evaluation was normal in 52% and nearly normal in 48%. The median side to side difference on manual maximum testing with the KT1000 was 2 mm (range - 1 to 5). A radiographic PTS of 12° or more was observed in 49%. CONCLUSIONS: ACL reconstruction in the juvenile with living parental hamstring tendon allograft is a viable procedure associated with excellent clinical stability, patient-reported outcomes and return to sport over 2 years. Further ACL injury to the reconstructed and the contralateral knee remains a significant risk, with identical prevalence observed between the reconstructed and contralateral ACL between 12 and 24 months after surgery. LEVEL OF EVIDENCE: III (Cohort Study).

Antibacterial substances produced by pathogen inhibitory gut bacteria in Labeo rohita: Physico-chemical characterization, purification and identification through MALDI-TOF mass spectrometry.

Application of antibiotics to combat bacterial diseases in fish has been criticized due to likely emergence of drug resistance. Therefore, investigation of new bioactive compounds from natural sources has been taken into account. This study was designed to purify and characterize the bioactive compound in the cell free supernatant (CFSs) of autochthonous gut bacteria (Bacillus methylotrophicus KU556164, B. amyloliquefaciens KU556165, Pseudomonas fluorescens KU556166 and B. licheniformis KU556167) isolated from rohu, Labeo rohita. CFSs were antagonistic to fish pathogenic Aeromonas spp., moderately thermo-tolerant and active in wide range of pH (5-11). Antibacterial activity of the CFSs was reduced by the action of proteases (e.g., Proteinase K and Trypsin), indicating proteinaceous nature of the bioactive compound like the bacteriocins. Three-step purification procedure resulted in recovery of 16.97%, 18.04%, 33.33% and 6.38% activity of the antimicrobial protein produced by B. methylotrophicus, B. amyloliquefaciens, P. fluorescens and B. licheniformis, respectively. Purification at each step revealed decrease in protein content with gradual increase in the specific activity of the antimicrobial protein. The purified antibacterial compound ranged between 18.2 and 25.6 kDa. Identification through MALDI-TOF MS/MS and database search through Mascot search engine predicted that the bactericidal compound belonged to either alkaline proteases, or, transcriptional regulator and some hypothetical proteins. Apart from potential technological application of the antibacterial compound, the present study might show promise for application of gut-associated bacteriocinogenic bacteria to control diseases in fish caused by pathogenic bacteria.

A metallo-biopolymer conjugate of elastin-like polypeptide: photoluminescence enhancement in the coacervate microenvironment.

An optically active metallo-polymer assembly is demonstrated via conjugation of a genetically engineered elastin-like polypeptide (ELP) and a ruthenium(II) polypyridyl complex. By taking advantage of the phase transition of ELPs in water, photophysical properties of the resultant conjugate are investigated for both phases, below and above the critical transition temperature. Upon coacervation, the luminescence of the metallo-ELP is greatly enhanced as a consequence of local effects on the metal-ligand luminophore. These findings open a possibility to harness the temperature control of stimuli-responsive properties of biopolymers.

Sulfoximine-Assisted One-Pot Unsymmetrical Multiple Annulation of Arenes: A Combined Experimental and Computational Study.

Discussed herein is an unprecedented Ru-catalyzed one-pot unsymmetrical C-H difunctionalization of arenes comprising intramolecular hydroarylation of olefins and intermolecular annulation of alkynes. This unprecedented 2-fold C-H functionalization is validated on the basis of experimental and density functional theory (DFT) study. The transformation readily occurs with the assistance of methylphenyl sulfoximine (MPS) directing group in the presence of Ru catalyst forming two C-C and one C-N bonds in a single operation. The overall process is atom economical and step-efficient and provides unusual dihydrofuran-fused isoquinolone heterocycles. Further annulation of NH and the proximal o-C-H-arene of isoquinolone with alkynes build highly conjugated novel polycyclic compounds. Overall, three independent annulations in arene motifs are visualized and thoughtfully executed; finally, 5 ring-fused structural entities are constructed forming three C-C and two C-N bonds.

Arthroscopic versus open ankle arthrodesis.

BACKGROUND: It is thought that arthroscopic ankle fusion offers improved outcomes over open fusion in terms of functional outcomes, time to fusion, length of stay and fewer complications. However, there are doubts about whether correction of established severe deformity can be achieved using the arthroscopic approach. METHODS: A retrospective review of medical records and radiographs at our hospital identified consecutive tibio-talar ankle fusions between April 2009 and March 2014 with minimum 1 year follow up. Records were scrutinised for type of arthrodesis, demographics, length of stay (LOS), time to fusion (TTF), pre- and postoperative deformity, complications and unplanned procedures. Significant factors in the complication group were then compared, using multivariate binary logistic backward stepwise regression to see if any factors were predictive. RESULTS: There were 29 open and 50 arthroscopic ankle fusions (2 converted to open). Mean LOS was 1.93 versus 2.52 days (p=0.590). TTF was shorter after arthroscopic fusion 196d versus 146d (p=0.083). Severe deformity (>10°) was correctable to within 5° of neutral in the majority of cases (97% versus 96%, p=0.903). Union occurred in 83% versus 98% (p=0.0134). The open arthrodesis group had 9 (31%) complications (1 death-PE, 1 SPN injury, 5 non-unions, 1 delayed union and 1 wound infection) and 6 (25%) screw removals. The arthroscopic arthrodesis group had 4 (8%) complications (1 non-union, 1 reactivation of osteomyelitis and subsequent BKA, 1 wound infection, 1 delayed union) with 11 (24%) screw removals. After multi-variant regression analysis of all ankle fusions, low BMI was shown to be associated with complications (p=0.064). CONCLUSIONS: Open arthrodesis was associated with a higher rate of complications and a lower rate of fusion. However, there was no significant difference in terms of LOS and ability to correct deformity compared to arthroscopic arthrodesis. Overall, low BMI was also associated with more complications.

Ruthenium-Catalyzed Intramolecular Hydroarylation of Arenes and Mechanistic Study: Synthesis of Dihydrobenzofurans, Indolines, and Chromans.

A ruthenium-catalyzed, amide-directed intramolecular hydroarylation of alkene-tethered benzamide derivatives is discussed. This method proficiently constructs dihydrobenzofuran, indoline, and chroman skeletons of biological significance in good to excellent yields; the overall process is atom-economical and step-efficient. The reaction exhibits broad scope, tolerating common functional groups, labile protecting units, and heteroaryl motifs. The use of a catalytic amount of base suffices the need. Deuterium scrambling and kinetic studies offer valuable facts for understanding the reaction mechanism.

Ruthenium-Catalyzed Hydroarylation and One-Pot Twofold Unsymmetrical C-H Functionalization of Arenes.

A methyl phenyl sulfoximine (MPS) is used as a directing group in the ruthenium-catalyzed intramolecular hydroarylation of alkene-tethered benzoic acid derivatives to afford dihydrobenzofurans and indolines in good to excellent yields. A one-pot, unsymmetrical, twofold C-H functionalization involving intramolecular C-C and intermolecular C-C/C-N bond formations is successfully demonstrated by using a single set of catalytic reaction conditions, which is unprecedented thus far. A novel isoquinolone-bearing dihydrobenzofuran is constructed through an unsymmetrical twofold C-H functionalization.

Polythiophenes in biological applications.

Polythiophene and its derivatives have shown tremendous potential for interfacing electrically conducting polymers with biological applications. These semiconducting organic polymers are relatively soft, conduct electrons and ions, have low cytotoxicity, and can undergo facile chemical modifications. In addition, the reduction in electrical impedance of electrodes coated with polythiophenes may prove to be invaluable for a stable and permanent connection between devices and biological tissues. This review article focuses on the synthesis and some key applications of polythiophenes in multidisciplinary areas at the interface with biology. These polymers have shown tremendous potential in biological applications such as diagnostics, therapy, drug delivery, imaging, implant devices and artificial organs.

High green index electromagnetic interference shields with semiconducting Bi2S3 fillers in a PEDOT:PSS matrix.

Conventional metallic electromagnetic interference (EMI) shields, as well as the emerging 2D material-based shields, meet the shielding effectiveness (SE) needs of most applications. However, their shielding performance is dominated by the reflection of incoming radiation due to their high electrical conductivity, which leads to secondary pollution. This problem is getting exacerbated with the proliferation of electronics and communication networks in modern society. Thus, EMI shields that function dominantly by the absorption of incoming radiation are highly desirable. Such shields would be characterized by a green index, which is the ratio of absorbance over reflectance, close to or greater than one. For nonmagnetic materials, the best way to reduce the undesirable large impedance mismatch is to reduce the effective permittivity of the shield material. Here, we present a new EMI shield with a semiconductor Bi2S3 filler in a conducting PEDOT:PSS polymer matrix, instead of the conventional conductive fillers, to reduce the effective permittivity and demonstrate that even a light loading of only 10% Bi2S3 provides high SE of over 40 dB with a green index value of 0.75. Increasing the filler content to 15 wt% increases the green index close to unity while dropping the SE to 30 dB. The shielding mechanism is explained through electromagnetic parameter measurements and supplemented by density functional theory calculations. This work lays the foundation for the advancement of lightweight and ultrathin green EMI shields with minimum secondary pollution.

A High-Resolution Digital Bathymetric Elevation Model Derived from ICESat-2 for Adam's Bridge.

This data descriptor elaborates the details of a high-resolution digital bathymetric elevation model generated for the region, namely, Adam's Bridge, which encompasses a chain of shoals between Rameswaram Island, off the southeastern coast of Tamil Nadu, India, and Mannar Island, off the northwestern coast of Sri Lanka. The proposed dataset has taken advantage of the photon penetrability in the shallow waters by the green laser of ICESat-2 LiDAR to derive the seabed topography. Seafloor depths from ~0.2 million geolocated photons of ICESat-2 for the study area were accrued and interpolated to generate a 10 m digital bathymetric elevation model. Adam's Bridge, an isthmus and submerged reefal assemblage in shallow and super-shallow waters, is a feature of scientific curiosity. Our dataset has the potential to enhance the understanding of Adam's Bridge structure by providing substantial information to reconstruct its evolution.

Visible-light-induced direct C-H alkylation of polycyclic aromatic hydrocarbons with alkylsulfones.

Polycyclic aromatic hydrocarbons (PAHs) are fragments of graphene that have attracted considerable attention as a new class of carbon-based materials. The functionalization of edge positions in PAHs is important to enable the modulation of physical and chemical properties essential for various applications. However, straightforward methods that combine functional group tolerance and regioselectivity remain sought after. Here we report a photochemical approach for the direct alkylation of carbon-hydrogen bonds in PAHs that takes place in a regiospecific manner, an outcome that has never been achieved in related thermal reactions. A reaction mechanism involving a single electron transfer process from photo-excited PAHs to sulfones, and a rationale for the origin of regioselectivity are proposed on the basis of spectroscopic analyses and theoretical calculations.

Physical features of Adam's Bridge interpreted from ICESat-2 based high-resolution digital bathymetric elevation model.

Adam's Bridge is a submerged ridge connecting India and Sri Lanka, generally regarded as a chain of shoals extending for ~ 29 km from Dhanushkodi on the Indian side to Talaimannar Island of Sri Lanka. A high-resolution digital bathymetric elevation model generated using the seafloor returned photons of ICESat-2 was used to understand the intricate details of Adam's Bridge structure. Photons emanating from ICESat-2's green laser have the potential to detect the seafloor up to a depth of ~ 40 m; taking a cue from this potentiality, in our research, we have accrued ~ 0.2 million photons representing the depth information and generated a 10 m resolution bathymetric data for the extent of Adam's Bridge. Visual interpretations made from this bathymetric data through 3D perspectives with multi-directional lighting effects, and also with the derived parameters like contours, slope, and volumetric analysis, enabled us to recognize the current form of Adam's Bridge's physical features. The results from our research confirm that, in its entirety, Adam's Bridge is a submarine continuation of Dhanushkodi and Talaimannar Island. Throughout the crest line of Adam's Bridge, approximately 1.5 km on either side is highly undulating within the super-shallow water with occurrences of sudden depths. There is an asymmetry of transverse slopes to the base on both sides of Adam's Bridge, indicating dominant transgression of material energy from the waters of the Gulf of Mannar compared to the Palk Strait. The volume of Adam's Bridge computed in our research yielded a value of ~ 1 km3; interestingly, only 0.02 percent of this volume is above the mean sea level, and in general, the same is visible in optical satellite imagery-in total ~ 99.98 percent of the Adam's Bridge is submerged in shallow and super-shallow waters.

Road accidents on Indian National highways, ambulance reachability and transportation of injured to trauma facility: Survey-based introspection of golden hour.

Background: The transportation system plays a crucial role in the context of socioeconomic development, whereas the highway infrastructure acts as a base for the transportation system. In recent years, a rich impetus has been given to the development of road infrastructure by Indian governance. There is a need to introspect how well the prevailing highway infrastructure is equipped with emergency rescue management during road accidents. Lack of ambulance service and trauma facilities along the highways results in a steady loss of lives and injuries and increases people's exposure to risks. Objective: This study aims to determine the response time of ambulance reachability to the accident spot on Indian national highways associated with heavy commercial transportation. Also, determining the time to transport the injured to the nearest trauma facility is another factor included as an objective in this investigation. Methods: The study adopted survey-based research, whereby the variables in the questionnaire were designed to record and assess the time for an ambulance to reach the accident spot and, from there, to transport the injured to the trauma management facility on Indian highways. Two hundred twenty-five participants who were either victims/relatives of victims or those involved in the rescue of the injured have participated in the survey. The dates of the accident events were 2017 and 2022. Results: The survey resulted in the identification of two categories of highway accidents. The first category of accidents happened on the highways near city limits/dense settlements, and the second category occurred on the core highways. The percentage of accidents caused on the highways either adjacent to or passing through the city limits/dense settlements was reported to be higher than the accidents on the core highways. Ninety percent of the participants reported successful contact with the ambulance call/service centre, but only ~75% success rate exists for ambulances to reach the accident scene. On the core highways, the time taken for the ambulance to arrive at the accident scene is 25-35 minutes. The results from the survey ascertained that the patients were prioritised for treatment in the nearest hospitals (irrespective of having a trauma facility) at a distance of ~12-20 km, for which the time taken is ~15-25 minutes. Importantly, from the interviews, it is understood that in many cases, these hospitals have further referred to specialty hospitals located in nearby cities or trauma centres with greater facilities. Occasions exist where the injured were taken directly to hospitals 30-40 km from the accident spot, for which the time was more than 40 minutes. Conclusions: The results provide evidence that in either of the accident cases on the highways that are adjacent to/passing through the city limits or on the core highways, the total time for emergency care accessibility is nearly 60 minutes or greater; this implies that in the majority of cases, there is very meagre time left to provide emergency medical care to the needy and injured on the Indian highways to abide by the concept of golden hour. Plausible reforms backed by technology for enabling highways into 'emergency rescuable highways' are highly needed to guarantee a safer and more sustainable transportation system in India.

A robust depolymerization route for polysiloxanes.

A versatile, robust, and stable tetrabutylammonium difluorotriphenylsilicate (TBAT) catalyst has been deployed for efficient depolymerization of silicones. This catalyst is soluble in a variety of organic solvents and is stable up to 170 °C, enabling a wide range of reaction conditions under which F--catalysed siloxane bond cleavage can be initiated. This effort offers significant advancement overcoming the traditional limitations of silicone depolymerization, such as high catalyst loading, storage and handling, and few viable reaction media.