Vaccination governance in protracted conflict settings: the case of northwest Syria.

BACKGROUND: Effective vaccination governance in conflict-affected regions poses unique challenges. This study evaluates the governance of vaccination programs in northwest Syria, focusing on effectiveness, efficiency, inclusiveness, data availability, vision, transparency, accountability, and sustainability. METHODS: Using a mixed-methods approach, and adapting Siddiqi's framework for health governance, data were collected through 14 key informant interviews (KIIs), a validating workshop, and ethnographic observations. Findings were triangulated to provide a comprehensive understanding of vaccination governance. RESULTS: The study highlights innovative approaches used to navigate the complex health governance landscape to deliver vaccination interventions, which strengthened sub-national vaccination structures such as The Syria Immunisation Group (SIG). The analysis revealed several key themes. Effectiveness and efficiency were demonstrated through cold-chain reliability and extensive outreach activities, though formal reports lacked detailed analysis of vaccine losses and linkage between disease outbreak data and coverage statistics. Key informants and workshop participants rated the vaccination strategy positively but identified inefficiencies due to irregular funding and bureaucracy. Inclusiveness and data availability were prioritised, with outreach activities targeting vulnerable groups. However, significant gaps in demographic data and reliance on paper-based systems hindered comprehensive coverage analysis. Digitalisation efforts were noted but require further support. The SIG demonstrated a clear strategic vision supported by international organizations such as the World Health Organization, yet limited partner participation in strategic planning raised concerns about broader ownership and engagement. While the SIG was perceived as approachable, the lack of public documentation and financial disclosure limited transparency. Internal information sharing was prevalent, but public communication strategies were insufficient. Accountability and sustainability faced challenges due to a decentralized structure and reliance on diverse donors. Despite stabilizing factors such as decentralization and financial continuity, fragmented oversight and reliance on donor funding remained significant concerns. DISCUSSION: The study highlights the complexities of vaccination governance in conflict-affected areas. Comparisons with other conflict zones underscore the importance of local organisations and international support. The SIG's role is pivotal, but its legitimacy, transparency, and inclusivity require improvement. The potential transition to early recovery in Syria poses additional challenges to SIG's sustainability and integration into national programs. CONCLUSION: The governance of vaccination in northwest Syria is multifaceted, involving multiple stakeholders and lacking a legitimate government. Enhancing transparency, local ownership, and participatory decision-making are crucial for improving governance. The role of international bodies is essential, emphasising the need for structured feedback mechanisms and transparent monitoring processes to ensure the program's success and sustainability.

Intratympanic corticosteroid injection as a first-line treatment of the patients with idiopathic sudden sensorineural hearing loss compared to systemic steroid: A systematic review and meta-analysis.

OBJECTIVES: The current study aimed to investigate if there is a difference in the use of intratympanic steroid therapy (IST), compared to systemic steroid treatment (SST), as an initial treatment for patients with sudden sensorineural hearing loss (SSNHL) by a meta-analysis design performed on the mean pure-tone average (PTA) improvement and the complete recovery rate. METHODS: A systematic literature review was performed on randomized controlled trials published from 1990 to August 2020 in some databases including PubMed/MEDLINE, Scopus, Embase, Web of Science, Cochrane library/CENTRAL, Ovid, ProQuest, Google Scholar, and clinical trials.gov. The primary outcomes of interest were pure-tone average improvement and complete recovery rates. RESULTS: Six eligible studies with 496 patients (250 patients in the IST group and 246 subjects in the SST group) were included in this study. The pooled standardized mean difference of the PTAs was estimated as 0.07 (95% CI = -0.10 to 0.25; I2 = 0.0%, P = 0.668), and the pooled odds ratio of complete recovery rate was obtained as 1.00 (95% CI = 0.66 to 0.151; I2 = 31.6, P = 0.199). Moreover, the pooled standardized mean difference of pure-tone average for the intratympanic steroid treatment group compared to the patients with oral steroid treatment was 0.07 (95% CI = -0.12 to 0.26; I2 = 0.0%, P = 0.526). CONCLUSIONS: The current study demonstrated that the effect of intratympanic injection of corticosteroid, as a first-line treatment, is not statistically different from the systemic route in improving the hearing outcomes among patients with SSNHL.

Synthesis and biological evaluation of new coumarin derivatives as cytotoxic agents.

New coumarin derivatives 9a-f, 10a-e, and 11a-f were synthesized and evaluated for their cytotoxic activity against a human breast cancer cell line (MCF-7). All compounds exhibited good activity in the nanomolar range, using doxorubicin and erlotinib as positive controls. The most active compound 9d with IC50 of 21 nM was tested against the HCT-116, HepG-2, A549, and SGC-7901 cell lines, with IC50 values of 0.021, 0.170, 0.028, and 0.11 µM, respectively. Compound 9d was further investigated for its ability to suppress the expression of epidermal growth factor receptor (EGFR). Compound 9d decreased the concentration of EGFR by 87%, using erlotinib as a positive control. A docking study revealed similar or higher scores than for erlotinib and similar binding poses providing interactions with the hinge region of the tyrosine kinase (TK). Besides the effect on expression, this in silico investigation predicts the possibility of direct binding between the new coumarin derivatives and the EGFR TK. Moreover, computational calculation for ADME properties for the most active compounds 9d, 9e, 10c, and 11c revealed the expected high gastrointestinal tract absorption, moderate water solubility with no central nervous system toxicity, and druglikeness.

An Equivalent Constitutive Model of Cancellous Bone With Fracture Prediction.

To simulate the mechanical and fracture behaviors of cancellous bone in three anatomical directions and to develop an equivalent constitutive model. Microscale extended finite element method (XFEM) models of a cancellous specimen were developed with mechanical behaviors in three anatomical directions. An appropriate abaqus macroscale model replicated the behavior observed in the microscale models. The parameters were defined based on the intermediate bone material properties in the anatomical directions and assigned to an equivalent nonporous specimen of the same size. The equivalent model capability was analyzed by comparing the micro- and macromodels. The hysteresis graphs of the microscale model show that the modulus is the same in loading and unloading; similar to the metal plasticity models. The strength and failure strains in each anatomical direction are higher in compression than in tension. The microscale models exhibited an orthotropic behavior. Appropriate parameters of the cast iron plasticity model were chosen to generate macroscale models that are capable of replicating the observed microscale behavior of cancellous bone. Cancellous bone is an orthotropic material that can be simulated using a cast iron plasticity model. This model is capable of replicating the microscale behavior in finite element (FE) analysis simulations without the need for individual trabecula, leading to a reduction in computational resources without sacrificing model accuracy. Also, XFEM of cancellous bone compared to traditional finite element method proves to be a valuable tool to predict and model the fractures in the bone specimen.

Complete manuscript Title: Changes in RANKL during the first two years after cART initiation in HIV-infected cART naïve adults.

BACKGROUND: By assessing the changes in concentration of soluble receptor activator of nuclear factor κ B ligand (RANKL) and osteoprotegrin (OPG) after initiation of combination antiretroviral therapy (cART) in treatment-naïve HIV-infected patients we aimed to evaluate whether the initial accelerated bone loss could be mediated by increased soluble RANKL (sRANKL) levels associated with CD4+ T cell recovery. METHODS: We used multiplex immunoassays to determine sRANKL and OPG concentrations in plasma from 48 HIV patients at baseline and 12, 24, 48 and 96 weeks after cART initiation. RESULTS: Soluble RANKL changed significantly over time (overall p = 0.02) with 25% decrease (95% CI: -42 to -5) at week 24 compared to baseline and stabilized at a lower level thereafter. We found no correlation between CD4+ T cell count increment and changes in sRANKL or between percentage change in BMD and changes in sRANKL. CONCLUSION: In this study there was no indication that the accelerated bone loss after cART initiation was mediated by early changes in sRANKL due to CD4+ T cell recovery. Future studies should focus on the initial weeks after initiation of cART. TRIAL REGISTRATION: Clinical-Trial.gov . id NCT00135460 , August 25, 2005. The study was approved by the Danish Data Protection Agency, Danish Medicines Agency and Regional Ethics Committee.

A Comparison Between Two Methods of Face-Lift Surgery in Nine Cadavers: SMAS (Superficial Musculo-Aponeurotic System) Versus MACS (Minimal Access Cranial Suspension).

BACKGROUND: This study aimed to compare the average amounts of facial skin and muscle lifting in two different face-lift methods, superficial musculo-aponeurotic system (SMAS) plication and minimal access cranial suspension (MACS), to evaluate the effectiveness of each method in facial excursion. METHODS: Thirty-six face-lift surgeries were performed on nine cadavers between October and December 2010. Both SMAS and MACS surgeries were done on each side of the cadaver faces. The average amounts of skin and muscle lifting up and out in three defined anatomical landmarks were compared between the two methods, SMAS plication and MACS lift procedure. RESULTS: Nine fresh cadavers with the mean age of 53 ± 6.7 years entered the study. Seven (77.8 %) were males and two (22.2 %) were females. The average amounts of lifting of the anatomical landmarks up and out were significantly greater in the SMAS plication method compared to the MACS lift procedure (P values <0.05), whereas facial symmetry was not significantly different between the two methods. CONCLUSION: The overall amounts of facial skin and muscle lifting by the SMAS plication method were greater than the MACS lift procedure. However, it does not justify ignoring the benefits of the MACS lift procedure in terms of less invasiveness and quicker recovery. NO LEVEL EVIDENCE: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Muramyl dipeptide responsive pathways in Crohn's disease: from NOD2 and beyond.

Crohn's disease (CD) is one of main disease entities under the umbrella term chronic inflammatory bowel disease. The etiology of CD involves alterations in genetic, microbiological, and immunological factors. This review is devoted to the role of the bacterial wall compound muramyl dipeptide (MDP) for the activation of inflammatory pathways involved in the pathogenesis of CD. The importance of this molecule is underscored by the fact that (1) MDP, which is found in most Gram-negative and -positive bacteria, is able to trigger several immunological responses in the intestinal system, and (2) that alterations in several mediators of the MDP response including-but not restricted to-nucleotide oligomerization domain 2 (NOD2) are associated with CD. The normalization of MDP signaling is one of several important factors that influence the intestinal inflammatory response, a fact which emphasizes the pathogenic importance of MDP signaling for the pathogenesis of CD. The important aspects of NOD2 and non-NOD2 mediated effects of MDP for the development of CD are highlighted, as well as how alterations in these pathways might translate into the development of new therapeutic strategies.

Evaluating of Supraglottic Subunits in Swallowing Function in Supraglottic Cancer Patients Pre- and Post-Transoral Laser Microsurgery.

BACKGROUND AND AIM: This study aims to assess the impact of supraglottic cancer on swallowing functionality and its anatomical correlations before and after laser surgery. The study seeks to determine the extent of score changes post-surgery, pinpoint the most influential anatomical component in swallowing, predict post-surgery outcomes, and ascertain the effect on patients' quality of life. METHODS: Patients with supraglottic cancer and dysphagia were identified through stroboscopy and indirect laryngoscopy. Exclusion criteria encompassed a history of prior radiotherapy, chemotherapy, or distant metastases. Demographic data, tumor stage, comorbidities, risk factors, and treatment details were documented. Swallowing evaluation employed the translated EAT10 self-assessment questionnaire, administered before and after transoral laser microsurgery (TLM) at baseline and 6 months later. Additional treatments, rehabilitation duration, NG tube use, and post-surgery complications were recorded. RESULTS: At the six-month follow-up, 9 patients had EAT-10 scores ≥ 3, while 7 patients scored < 3. Five patients underwent post-TLM additional therapies, and 9 patients had neck dissections. Involved subunits were epiglottis (11 patients), arytenoid (5 patients), FVC (13 patients), and TVC (3 patients). Seven patients received dysphagia treatment. Analysis revealed significant associations between follow-up EAT-10 scores and dysphagia treatment (p = 0.04), smoking (p = 0.02), and FVC involvement (p = 0.02). CONCLUSION: Our study on supraglottic cancer treatment with transoral laser microsurgery (TLM) revealed variable EAT-10 scores after a six-month follow-up. Adjunctive therapies and neck dissections were administered to some patients. Significant associations were found between follow-up scores, dysphagia treatment, smoking history, and FVC involvement, highlighting the complex interplay between interventions and patient factors. Further research is needed for optimization.

Ultrafast Two-Color X-Ray Emission Spectroscopy Reveals Excited State Landscape in a Base Metal Dyad.

Effective photoinduced charge transfer makes molecular bimetallic assemblies attractive for applications as active light-induced proton reduction systems. Developing competitive base metal dyads is mandatory for a more sustainable future. However, the electron transfer mechanisms from the photosensitizer to the proton reduction catalyst in base metal dyads remain so far unexplored. A Fe─Co dyad that exhibits photocatalytic H2 production activity is studied using femtosecond X-ray emission spectroscopy, complemented by ultrafast optical spectroscopy and theoretical time-dependent DFT calculations, to understand the electronic and structural dynamics after photoexcitation and during the subsequent charge transfer process from the FeII photosensitizer to the cobaloxime catalyst. This novel approach enables the simultaneous measurement of the transient X-ray emission at the iron and cobalt K-edges in a two-color experiment. With this methodology, the excited state dynamics are correlated to the electron transfer processes, and evidence of the Fe→Co electron transfer as an initial step of proton reduction activity is unraveled.

COVID-19-induced immune thrombocytopenia management approach: A case report and literature review.

Key Clinical Message: Vincristine therapy can be effective in refractory Immune thrombocytopenia (ITP) following COVID-19 vaccination. Our case report highlights the need for further research to establish standard management guidelines for COVID-19-vaccine-associated ITP. Abstract: Adult immune thrombocytopenia (ITP) can occur as a rare complication following several viral infections or a rare adverse event or complication of vaccination. In this paper, we report a case of a 39-year-old male patient with severe refractory ITP that began 4-weeks after receiving his third (booster) dose of the COVID-19 vaccine (BNT162b2, Pfizer-BioNTech). He was given oral dexamethasone 40 mg daily for 4 days followed by prednisone at 1 mg/kg (85 mg daily) for 10 days. In the following weeks, we attempted several other lines of therapy to treat his ITP, including anti-RhD immunoglobulin, which, unfortunately, caused moderate hemolysis requiring packed red blood cell transfusion, intravenous immunoglobulin (given at a subtherapeutic dose of 0.4 g/kg for only 1 day since it was not available), rituximab, and eltrombopag. The patient, unfortunately, showed no response to any of these treatments. This was an indicator to initiate salvage therapy with vincristine 2 mg weekly for 3 weeks. The patient's platelet count started to increase remarkably during the third week of vincristine and normalized after 4 weeks. We review the findings, clinical characteristics, and management approaches that were reported in the literature regarding COVID-19-vaccine-induced ITP. More in-depth research is needed to delineate standard guidelines for the management of such cases. This report underscores the importance of resorting to vincristine and eltrombopag as great options for severe and refractory ITP related to the COVID-19 vaccine.

Involvement of JAK/STAT signaling in the pathogenesis of inflammatory bowel disease.

The Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway constitute the fulcrum in many vital cellular processes, including cell growth, differentiation, proliferation, and regulatory immune functions. Various cytokines, growth factors, and protein tyrosine kinases communicate through the JAK/STAT pathway and regulate the transcription of numerous genes. In addition to their critical roles in a plethora of key cellular activities, the JAK/STAT signaling pathways also have been implicated in the pathogenesis of several diseases, including inflammatory bowel disease (IBD), especially since a JAK inhibitor recently has been shown to be effective in the treatment of ulcerative colitis. The aim of this review is to highlight the recent findings on the regulatory mechanism of JAK/STAT signaling pathways and to reveal the evolving comprehension of their interface which might be of interest for clinicians involved in IBD therapy. Further, it is described how these signaling pathways have been exploited for the development of promising novel JAK inhibitors with anti-inflammatory effects verified in clinical trials.

Prediction of fracture initiation and propagation in pelvic bones.

The objective is developing an XFEM model that is capable of predicting different types of fracture in the pelvic bone under various loading conditions. Previously published mechanical and failure characteristics of cortical and cancellous tissues were implemented and assigned to an intact pelvic bone with specified cortical and cancellous tissues. Various loading conditions, including combined load directions, were applied to the acetabulum to model different types of fracture (e.g., anterior/posterior wall fracture and transverse fracture) in the pelvic bone. The predicated types of fracture and the maximum force at fracture were compared to those acquired from previously published experimental tests. Anterior/posterior wall fracture and transverse fracture were the most common types of fractures determined in the simulations. The XFEM simulations were able to predict similar fractures to those reported in the experimental tests. The maximum fracture force in the XFEM model was found to be 18.6 kN compared to 8.85 kN reported in the previous experimental tests. The results revealed that different types of fracture in the pelvic bones can be caused by the various loading conditions in unstable high-rate impact loads. Using proper mechanical and failure behaviors of cortical and cancellous tissues, XFEM modeling of pelvic bone is capable of predicting bone fracture. In future work, the XFEM models of cancellous and cortical tissues can be assigned to other bones in human body skeleton so that the failure mechanism in such bones can be investigated.

Evaluation of Nanofiltration Membranes for Pure Lactic Acid Permeability.

Lactic acid (LA) is an organic acid produced by fermentation or chemical synthesis. It plays a crucial role in the pharmaceutical, food and plastic industries. In the fermentation of, for example, grass silage, LA and different compounds are produced. To purify lactic acid, researchers have tried to investigate membrane technology to achieve a high yield of lactic acid permeance. This study tested four commercially available nanofiltration membranes (NF270, MPF-36, Toray NF, and Alfa Laval NF). Nanofiltration experiments were performed to investigate the rejection levels of lactic acid from a binary solution by using distinct molecular weight cut off membranes. All of the experiments were conducted with a lab-scale cross-flow membrane unit. Different operating conditions (pH, temperature) were studied for each membrane; the optimal process condition was found at 25 °C and pH 2.8. With higher temperatures and pH, an increase in LA rejection was observed. The MPF-36 membrane shows the lowest lactic acid rejection yield of 7%, while NF270 has the highest rejection yield of 71% at 25 °C and pH 2.8. These results will be helpful in the future to understand both the interaction of lactic acid permeance through nanofiltration membranes and process scale-up.

Inflammatory Cytokine Profiles Do Not Differ Between Patients With Idiopathic Cytopenias of Undetermined Significance and Myelodysplastic Syndromes.

Immune dysregulation has been highlighted as a key player in the pathogenesis of myelodysplastic syndromes (MDS), but little is known about cytokine profiles in patients with unexplained cytopenia with or without mutations in MDS-associated genes (clonal cytopenias of undetermined significance [CCUS] and idiopathic cytopenias of undetermined significance [ICUS], respectively), which often precede MDS. Here, we study the cytokine profiles in 111 patients with ICUS (N = 41), CCUS (N = 30), lower-risk MDS (LR-MDS; N = 22) and higher-risk MDS (HR-MDS; N = 18), and in healthy elderly controls (N = 21). Twenty cytokines were examined in blood plasma at time of diagnosis using Luminex assays and enzyme linked immunosorbent assays. The cytokine levels were compared between patient groups, and in patients versus controls. Associations between cytokines and MDS-associated mutations were evaluated. An aberrant cytokine profile was observed in all patient groups relative to healthy elderly controls. Patients had significantly higher levels of IL-6 (P< 0 .001), tumor necrosis factor α (P < 0.001), IL-10 (P < 0.001), and C-X-C motif chemokine 10 (P < 0.001) and lower levels of transforming growth factor beta 1 (P < 0.001), CCL5/regulated on activation normal T-cell expressed and secreted (P < 0.001), and S100A4 (P < 0.001) compared with healthy controls. Survival was significantly shorter in CCUS and MDS patients with a high systemic inflammatory cytokine load (median overall survival [OS] 21 months) compared with those with low-moderate systemic inflammatory cytokine load (median OS 64 months; P < 0.0001). These data suggest that patients with ICUS and CCUS have cytokine levels as abnormal as in LR-MDS. Indeed, high cytokine levels are present before MDS is diagnosed and cytokine levels are elevated irrespective of the presence or size of the myeloid clones. Cytokines may have a prognostic impact at a very early premalignant stage of myeloid disorders.

Mortality and Survival Analysis of Burn Patients Admitted in a Critical Care Burn Unit, Saudi Arabia.

Background: Burn injury is associated with a high mortality risk. Recent epidemiological data on burn injury and mortality rate from Saudi Arabia is lacking. Objective: This study aimed to analyze the survival rates and its predictability using the Baux score in patients with burn injury at a tertiary care hospital in Saudi Arabia. Materials and Methods: This retrospective study included all patients admitted to the burn unit at King Fahd Hospital of the University, Al Khobar, between March 2014 and February 2020. Patients' burn characteristics and calculated revised Baux scores were collected. The age, burn wound size, type of burn, burn extension, and Baux score of the survivors and non-survivors were compared. Results: A total number of 102 patients were included, and their mean age was 24.2 years (range: 9 months to 78 years). The mean affected total body surface area was 26.4%. Ninety patients (88%) suffered from flame/scald burn. The mortality rate was 17.6% (18 patients); all these patients had flame burns. No patient with a revised Baux score ≥110 survived (n = 14; 77% of the total deaths), while there was no mortality at score <36. Inhalational injuries were reported in 18 patients, of which 13 (72%) died. Patients with patent airway and no inhalation injury were 19 times more likely to survive than those with a compromised airway (P < 0.001). In terms of the depth of burn, partial thickness increased the likeliness of survival by 10 times compared with full thickness (P < 0.003). Conclusion: Inhalational injury and burn size were the most prognostic factors of burn injury in this study. As all cases of mortality were from flame burns, regulation on flammable materials and safety measures should be promoted to the public.

Interferon regulatory factor-7 modulates experimental autoimmune encephalomyelitis in mice.

BACKGROUND: Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS) with unknown etiology. Interferon-ß (IFN-ß), a member of the type I IFN family, is used as a therapeutic for MS and the IFN signaling pathway is implicated in MS susceptibility. Interferon regulatory factor 7 (IRF7) is critical for the induction and positive feedback regulation of type I IFN. To establish whether and how endogenous type I IFN signaling contributes to disease modulation and to better understand the underlying mechanism, we examined the role of IRF7 in the development of MS-like disease in mice. METHODS: The role of IRF7 in development of EAE was studied by immunizing IRF7-KO and C57BL/6 (WT) mice with myelin oligodendrocyte glycoprotein using a standard protocol for the induction of EAE. We measured leukocyte infiltration and localization in the CNS using flow cytometric analysis and immunohistochemical procedures. We determined levels of CD3 and selected chemokine and cytokine gene expression by quantitative real-time PCR. RESULTS: IRF7 gene expression increased in the CNS as disease progressed. IRF7 message was localized to microglia and infiltrating leukocytes. Furthermore, IRF7-deficient mice developed more severe disease. Flow cytometric analysis showed that the extent of leukocyte infiltration into the CNS was higher in IRF7-deficient mice with significantly higher number of infiltrating macrophages and T cells, and the distribution of infiltrates within the spinal cord was altered. Analysis of cytokine and chemokine gene expression by quantitative real-time PCR showed significantly greater increases in CCL2, CXCL10, IL-1ß and IL17 gene expression in IRF7-deficient mice compared with WT mice. CONCLUSION: Together, our findings suggest that IRF7 signaling is critical for regulation of inflammatory responses in the CNS.

Successful Elbow Flexion Reconstruction Using Latissimus Dorsi Muscle Transfer Following a Road Traffic Accident and Upper Limb Trauma.

BACKGROUND Several surgical procedures to restore elbow flexion have been reported in the literature. Multiple factors direct the selection of appropriate procedures for each patient, including hand dominance, neurovascular injury, and comorbidities. Traumatic damage to the anterior compartment of the arm is an indication for latissimus dorsi transfer, which can restore elbow flexion. Bipolar pedicled latissimus dorsi (LD) flap is a design used very rarely to simultaneously reconstruct biceps brachii soft-tissue defects and regain complete flexion function. We report the case of a 30-year-old man who underwent successful elbow flexion reconstruction using latissimus dorsi muscle transfer following a road traffic accident and upper limb trauma. CASE REPORT A 30-year-old man presented with acute compartment syndrome caused by a road traffic accident and impact trauma to the left arm. The surgical evaluation revealed proximal biceps tendons rapture; therefore, immediate repair and therapeutic fasciotomy were done. Subsequently, unsuccessful repair resulted in total necrosis of the biceps muscle, which necessitated debridement of the biceps muscle. Delayed reconstruction with an LD flap was successfully done after stabilization of the patient's condition. The flap was harvested as free-pedicled, then modified into a tube-like shape to resemble the biceps muscle. CONCLUSIONS This report has shown that the surgical procedure of latissimus dorsi muscle transfer can successfully restore elbow function following upper limb trauma; however, preoperative planning and postoperative follow-up are crucial for functional reconstruction of the upper extremity. In addition, carefully selecting reconstructive surgery considering patient factors, degree of injury, and the institution's capacity are essential factors in achieving optimal function restoration with minimal complications.

Metabolomic profiling and biological investigation of Tabebuia Aurea (Silva Manso) leaves, family Bignoniaceae.

Both ethyl acetate and aqueous fractions of Tabebuia aurea leaves exhibited noteworthy antioxidant and nephroprotective activities against carbon tetrachloride (CCl4)-induced nephrotoxicity in rats, as evidenced by the remarkable improvements of renal serum biomarkers and histopathological features. Additionally, the ethyl acetate fraction displayed a prominent in vitro antitrypanosomal activity against Trypanosoma brucei; consequently, the leaves were subjected to LC-HR-ESI-MS metabolomic profiling to discover the constituents that possibly underlie their bioactivities. Therefore, ten metabolites were characterized, mostly dominated by flavonoids. Interestingly, two identified constituents viz., 3,9,12,15-octadecatetraenoic acid (9) and 9,11,13-octadecatrienoic acid (10) are reported firstly herein from the genus Tabebuia. Furthermore, among the dereplicated constituents, rutin (5) and kaempferol 3-O-rutinoside (6) exhibited the highest docking scores as effective antitrypanosomal compounds.

Prediction of failure in cancellous bone using extended finite element method.

The objective of our study is to develop extended finite element method models of cancellous bone specimens that are capable of accurately predicting the onset and propagation of cracks under mechanical loading. In order to do so, previously published three-point bending test results of a single trabecula were replicated using two different extended finite element method approaches, namely, elastic-plastic-fracture and elastic-fracture that considered different configurations of the elasto-plastic properties of bone from which the best approach to fit the experimental data was identified. The behavior of a single trabecula was then used in 2D extended finite element method models to quantify the strength of the trabecular tissue of the forearm along three perpendicular anatomical axes. The results revealed that the elastic-plastic-fracture model better represented the experimental data in the model of a single trabecula. Considering the 2D trabecular specimens, the elastic fracture model predicted higher strength than the elastic-plastic-fracture model and there was no difference in stiffness between the two models. In general, the specimens exhibited higher failure strain and more ductile behavior in compression than in tension. In addition, strength and stiffness were found to be higher in tension than compression on average. It can be concluded that with proper parameters, extended finite element method is capable of simulating the ductile behavior of cancellous bone. The models are able to quantify the tensile strength of trabecular tissue in the various anatomical directions reporting an increased strength in the longitudinal direction of forearm cancellous bone tissue. Extended finite element method of cancellous bone proves to be a valuable tool to predict the mechanical characteristics of cancellous bones as a function of the microstructure.