Dynamic hip screw and fibular strut graft for fixation of fresh femoral neck fracture with posterior comminution.

INTRODUCTION: Posterior comminution of the femoral neck fracture is a major cause of delayed and non-union owing to the loss of the buttressing effect against the posterior rotation. When a femoral neck fracture with posterior comminution is anatomically reduced, only the anterior portions of the femoral neck fracture surfaces are brought into contact leaving a posterior defect. The purpose of this study was to evaluate the use of fibular strut grafting and dynamic hip screw (DHS) for fresh femoral neck fractures with posterior comminution in young patient less than 50 years. MATERIALS AND METHODS: Between October 2012 and March 2016, 35 patients aged 20-50 years, 30 men and 5 women underwent fixation using DHS and fibular strut grafts for Garden grades III (25 patients) and IV (10 patients) femoral neck fractures with posterior comminution. All fractures were reduced by closed methods, and no hip was aspirated. Clinical and radiological outcomes were evaluated. RESULTS: All patients were in the age group of 20-50 years (mean 37 years). The mean delay in presentation after injury was 1 day. The mean final follow-up for these 35 patients was 27.2 months. Healing of the femoral neck was attained in 34 cases, with an average time to union of 4.8 months (range 4-8 months). One patient underwent arthroplasty due to failure of fixation. According to the Harris hip score, outcome was good to excellent in 30 patients, fair in 4, and poor in 1. CONCLUSIONS: In our study, only one patient developed non-union and no patients had avascular necrosis of the femoral head. Closed reduction, fibular strut grafts, and DHS fixation is a reliable procedure for femoral neck fractures with posterior comminution in young adults.

Diagnostic accuracy of a screening electronic alert tool for severe sepsis and septic shock in the emergency department.

BACKGROUND: Early recognition of severe sepsis and septic shock is challenging. The aim of this study was to determine the diagnostic accuracy of an electronic alert system in detecting severe sepsis or septic shock among emergency department (ED) patients. METHODS: An electronic sepsis alert system was developed as a part of a quality-improvement project for severe sepsis and septic shock. The system screened all adult ED patients for a combination of systemic inflammatory response syndrome and organ dysfunction criteria (hypotension, hypoxemia or lactic acidosis). This study included all patients older than 14 years who presented to the ED of a tertiary care academic medical center from Oct. 1, 2012 to Jan. 31, 2013. As a comparator, emergency medicine physicians or the critical care physician identified the patients with severe sepsis or septic shock. In the ED, vital signs were manually entered into the hospital electronic heath record every hour in the critical care area and every two hours in other areas. We also calculated the time from the alert to the intensive care unit (ICU) referral. RESULTS: Of the 49,838 patients who presented to the ED, 222 (0.4%) were identified to have severe sepsis or septic shock. The electronic sepsis alert had a sensitivity of 93.18% (95% CI, 88.78% - 96.00%), specificity of 98.44 (95% CI, 98.33% - 98.55%), positive predictive value of 20.98% (95% CI, 18.50% - 23.70%) and negative predictive value of 99.97% (95% CI, 99.95% - 99.98%) for severe sepsis and septic shock. The alert preceded ICU referral by a median of 4.02 hours (Q1 - Q3: 1.25-8.55). CONCLUSIONS: Our study shows that electronic sepsis alert tool has high sensitivity and specificity in recognizing severe sepsis and septic shock, which may improve early recognition and management.

Development and evaluation of a live attenuated camelpox vaccine from a local field isolate of the virus.

A strain of camelpox virus (CMLV) isolated in the Sudan was attenuated by serial passage in Vero cell monolayers for use as a future vaccine strain. The safety and potency of passage 115 virus (designated Sudan CMLV/115) was tested. Camels inoculated with CMLV/115 showed no clinical disease or skin lesions, developed low-level antibodies and cell-mediated immune response and resisted challenge with virulent wild-type CMLV. Field testing of the candidate vaccine showed that the developed vaccine induces immune response and is safe for young and pregnant camels.

Hydrogen energy systems: Technologies, trends, and future prospects.

This review critically examines hydrogen energy systems, highlighting their capacity to transform the global energy framework and mitigate climate change. Hydrogen showcases a high energy density of 120 MJ/kg, providing a robust alternative to fossil fuels. Adoption at scale could decrease global CO2 emissions by up to 830 million tonnes annually. Despite its potential, the expansion of hydrogen technology is curtailed by the inefficiency of current electrolysis methods and high production costs. Presently, electrolysis efficiencies range between 60 % and 80 %, with hydrogen production costs around $5 per kilogram. Strategic advancements are necessary to reduce these costs below $2 per kilogram and push efficiencies above 80 %. Additionally, hydrogen storage poses its own challenges, requiring conditions of up to 700 bar or temperatures below -253 °C. These storage conditions necessitate the development of advanced materials and infrastructure improvements. The findings of this study emphasize the need for comprehensive strategic planning and interdisciplinary efforts to maximize hydrogen's role as a sustainable energy source. Enhancing the economic viability and market integration of hydrogen will depend critically on overcoming these technological and infrastructural challenges, supported by robust regulatory frameworks. This comprehensive approach will ensure that hydrogen energy can significantly contribute to a sustainable and low-carbon future.

Evaluation of small hydropower turbines installed downstream of Nile River branches (Egypt).

The current study proposes a new strategy for using small hydroelectric turbines in downstream river branches with the least amount of construction and the lowest cost by comparing two different methods of installing the turbines, the first by installing the turbines at the river's bottom and the second by installing the turbines on floating boats. The methodology of this article is based on predicting the distribution of velocities through the watercourse using experimental data collected at various points in the river's depth, and then predicting the resulting electrical power for different sizes of turbines, as well as estimating the number of turbines for each row and the number of rows along the river. Therefore, Investigate the proposed systems. The proposed small hydropower system's economic viability and environmental impact are investigated in this article. According to the nature of the waterway, the best diameter of a turbine that can be used is 1.5 m based on water velocities and river depths. The proposed power plant generated 25.8 kW per single turbine row, with an estimated cost of produced power (0.035 USD/kWh) of approximately 20 turbines installed per row. Compared to other renewable energy sources, the proposed hydropower system is cost-effective and environmentally friendly, as generating electricity with the proposed small hydropower plant could reduce annual carbon dioxide emissions by 368 tones of CO2 per single turbine row.

In/Ga inter-diffusion in InAs quantum dot in InGaAs/GaAs asymmetric quantum well.

The Photoluminescence spectra (PL), their temperature and power dependence were investigated for the ground state in InAs quantum dots (QDs) embedded in InGaAs asymmetric quantum well (Asym. QW). In-atom segregation is well known phenomena in such structures, which result in altering the inter-atomic distances; as a consequence the thermo-dynamical parameters change as well, namely Debye temperature. The bigger value of Debye temperature for the studied sample with respect to the corresponding bulk value is attributed to In/Ga inter-diffusion during growth. The inter-diffusion process causes non-radiative defects in the sample. As a consequence, rapid decrease in the QDs integrated emission intensity as the temperature increases was occurred.

Peculiar temperature-power dependence of AlGaAs/GaAs multi quantum well.

The dependence of the integrated photoluminescence on the excitation power intensity in Al(0.3)Ga(0.7)As/GaAs multi quantum well is studied. Four peaks are found in the photoluminescence spectra, which are corresponding to the four quantum wells in the sample. The temperature dependence of the exponent alpha of the power law shows peculiar behavior for the quantum well of width 11.2 nm (peak C). The value of the exponent alpha exceeds the quadratic value predicted by the steady state model near room temperature. All other peaks shows linear dependence in the low temperature range which switches to super linear in the high temperature range with values of alpha less than 2. Carriers thermal capture and re-trapping is discussed. The presented results are a sign of thermal dissociation of exciton in quantum well near room temperature. The peculiar behavior is attributed to the excess flow of the charge carriers to this QW by thermal escape from other QWs, and also due to excess free carriers because of exciton dissociation.

Applicability of steady state model to carrier thermodynamics in InAs quantum dot.

The carrier thermodynamics of InAs self assembled quantum dot (QD) are investigated. The investigated parameters include the dependence of quantum dot photoluminescence on temperature and the photoluminescence (PL) dependence on the excitation power density. Results are discussed on the basis of steady state model. The model predicts that the photoluminescence integrated intensity has linear dependence on the excitation power density in low temperature range, and super linear in the high temperature range. Our data matches the prediction of the steady state model. In our sample the super linearity starts to take place at T = 150 K and the super linear behavior of the photoluminescence on excitation power density proves that the carrier dynamics in our quantum dot sample are dominated by uncorrelated electron hole pair in the high temperature region.

Dataset for transient 3D simulations of turbulent premixed flames of Gas-to-Liquid (GTL) fuel.

A fan-stirred combustion vessel is used to study the premixed turbulent combustion of diesel, Gas to Liquids (GTL) and 50/50 diesel-GTL and to generate these datasets. A numerical simulation approach is implemented for modelling the premixed combustion of the three fuels under different thermodynamics and turbulence initial conditions, using Zimont Turbulent Flame Speed Closure (Zimont TFC) model. Different parameters are obtained from these simulation runs such as turbulent eddy viscosity (µ), turbulent kinetic energy (k), Damkohler number (Da), Reynolds number (ReT) and turbulent flame speed (St). The raw, filtered and pre-processed data are imported from ANSYS Fluent and then listed on filtered tables for the ease of accessibility. These datasets can be then used to perform research in different related areas such as chemical kinetic mechanisms, ignition delay time, flame ignition mechanisms and flame extinction and diffusion. Also, they can be employed to further understand trends, patterns, and anomalies in data. In addition, they can be compared with other numerical models to establish a robust knowledge about the modelling of premixed turbulent combustion. For more information and discussion of the dataset creation, the reader is directed to the full-length article, "Abdellatif M. Sadeq, Samer F. Ahmed, Ahmad K. Sleiti, Transient 3D simulations of turbulent premixed flames of gas-to-liquid (GTL) fuel in a fan-stirred combustion vessel, Fuel, Volume 291, 2021, 120,184, ISSN 0016 2361, https://doi.org/10.1016/j.fuel.2021.120184" [1].

Adenoviral delivery of E2F-1 directs cell cycle reentry and p53-independent apoptosis in postmitotic adult myocardium in vivo.

Irreversible exit from the cell cycle precludes the ability of cardiac muscle cells to increase cell number after infarction. Using adenoviral E1A, we previously demonstrated dual pocket protein- and p300-dependent pathways in neonatal rat cardiac myocytes, and have proven that E2F-1, which occupies the Rb pocket, suffices for these actions of E1A. By contrast, the susceptibility of adult ventricular cells to viral delivery of exogenous cell cycle regulators has not been tested, in vitro or in vivo. In cultured adult ventricular myocytes, adenoviral gene transfer of E2F-1 induced expression of proliferating cell nuclear antigen, cyclin-dependent protein kinase 4, cell division cycle 2 kinase, DNA synthesis, and apoptosis. In vivo, adenoviral delivery of E2F-1 by direct injection into myocardium induced DNA synthesis, shown by 5'-bromodeoxyuridine incorporation, and accumulation in G2/M, by image analysis of Feulgen-stained nuclei. In p53(-)/- mice, the prevalence of G1 exit was more than twofold greater; however, E2F-1 evoked apoptosis and rapid mortality comparably in both backgrounds. Thus, the differential effects of E2F-1 on G1 exit in wild-type versus p53-deficient mice illustrate the combinatorial power of viral gene delivery to genetically defined recipients: E2F-1 can override the G1/S checkpoint in postmitotic ventricular myocytes in vitro and in vivo, but leads to apoptosis even in p53(-)/- mice.

A novel Rb- and p300-binding protein inhibits transactivation by MyoD.

The retinoblastoma protein (Rb) regulates both the cell cycle and tissue-specific transcription, by modulating the activity of factors that associate with its A-B and C pockets. In skeletal muscle, Rb has been reported to regulate irreversible cell cycle exit and muscle-specific transcription. To identify factors interacting with Rb in muscle cells, we utilized the yeast two-hybrid system, using the A-B and C pockets of Rb as bait. A novel protein we have designated E1A-like inhibitor of differentiation 1 (EID-1), was the predominant Rb-binding clone isolated. It is preferentially expressed in adult cardiac and skeletal muscle and encodes a 187-amino-acid protein, with a classic Rb-binding motif (LXCXE) in its C terminus. Overexpression of EID-1 in skeletal muscle inhibited tissue-specific transcription. Repression of skeletal muscle-restricted genes was mediated by a block to transactivation by MyoD independent of G(1) exit and, surprisingly, was potentiated by a mutation that prevents EID-1 binding to Rb. Inhibition of MyoD may be explained by EID-1's ability to bind and inhibit p300's histone acetylase activity, an essential MyoD coactivator. Thus, EID-1 binds both Rb and p300 and is a novel repressor of MyoD function.

A Ras-dependent pathway regulates RNA polymerase II phosphorylation in cardiac myocytes: implications for cardiac hypertrophy.

Despite extensive evidence implicating Ras in cardiac muscle hypertrophy, the mechanisms involved are unclear. We previously reported that Ras, through an effector-like function of Ras GTPase-activating protein (GAP) in neonatal cardiac myocytes (M. Abdellatif et al., J. Biol. Chem. 269:15423-15426, 1994; M. Abdellatif and M. D. Schneider, J. Biol. Chem. 272:527-533, 1997), can up-regulate expression from a comprehensive set of promoters, including both cardiac cell-specific and constitutive ones. To investigate the mechanism(s) underlying these earlier findings, we have used recombinant adenoviruses harboring a dominant negative Ras (17N Ras) allele or the N-terminal domain of GAP (nGAP), responsible for the Ras-like effector function. Inhibition of endogenous Ras reduced basal levels of [3H]uridine and [3H]phenylalanine incorporation into total RNA, mRNA, and protein, with parallel changes in apparent cell size. In addition, 17N Ras markedly inhibited phosphorylation of the C-terminal domain (CTD) of RNA polymerase II (pol II), known to regulate transcript elongation, accompanied by down-regulation of its principal kinase, cyclin-dependent kinase 7 (Cdk7). In contrast, nGAP elicited the opposite effects on each of these parameters. Furthermore, cotransfection of constitutively active Ras (12R Ras) with wild-type pol II, rather than a truncated mutant lacking the CTD, demonstrated that Ras activation of transcription was dependent on the pol II CTD. Consistent with a potential role for this pathway in the development of cardiac myocyte hypertrophy, alpha1-adrenergic stimulation similarly enhanced pol II phosphorylation and Cdk7 expression, where both effects were inhibited by dominant negative Ras, while pressure overload hypertrophy led to an increase in both hyperphosphorylated and hypophosphorylated pol II in addition to Cdk7.

Application of Failure Mode Effect Analysis to Improve the Care of Septic Patients Admitted Through the Emergency Department.

BACKGROUND: Failure mode effect analysis (FMEA) is a proactive multistep tool used to analyze risks, identify failures before they occur, and prioritize preventive measures. METHODS: A multidisciplinary team trained on FMEA methodology analyzed the process of treatment of septic patients and recorded processes under 3 major phases (recognition of severe sepsis, referral, and resuscitation). The team identified potential failure modes in each process; assigned severity, occurrence, and detection scores for each; and calculated the risk priority numbers (RPNs). Finally, higher-priority failure modes (RPN of ≥300) were analyzed to redesign the care process. RESULTS: We identified 27 processes and 48 failure modes with a mean RPN of 270. Twenty-two high-risk failures were identified by RPN of 300 or higher. All identified critical processes were related to phase 1 (recognition of sepsis) and phase 3 (resuscitation). The most critical process seemed to be related to the initial workup and treatment of septic patients, with 4 potential failure modes and a total RPN of 1485. CONCLUSIONS: Patient safety and care reliability issues are a major concern in health care. This study suggests that tools such as FMEA can enable a detailed analysis of the care process of septic patients by outlining potential failure modes and guiding improvement efforts.

The impact of a multifaceted intervention including sepsis electronic alert system and sepsis response team on the outcomes of patients with sepsis and septic shock.

BACKGROUND: Compliance with the clinical practice guidelines of sepsis management has been low. The objective of our study was to describe the results of implementing a multifaceted intervention including an electronic alert (e-alert) with a sepsis response team (SRT) on the outcome of patients with sepsis and septic shock presenting to the emergency department. METHODS: This was a pre-post two-phased implementation study that consisted of a pre-intervention phase (January 01, 2011-September 24, 2012), intervention phase I (multifaceted intervention including e-alert, from September 25, 2012-March 03, 2013) and intervention phase II when SRT was added (March 04, 2013-October 30, 2013) in a 900-bed tertiary-care academic hospital. We recorded baseline characteristics and processes of care in adult patients presenting with sepsis or septic shock. The primary outcome measures were hospital mortality. Secondary outcomes were the need for mechanical ventilation and length of stay in the intensive unit and in the hospital. RESULTS: After implementing the multifaceted intervention including e-alert and SRT, cases were identified with less severe clinical and laboratory abnormalities and the processes of care improved. When adjusted to propensity score, the interventions were associated with reduction in hospital mortality [for intervention phase II compared to pre-intervention: adjusted odds ratio (aOR) 0.71, 95% CI 0.58-0.85, p = 0.003], reduction in the need for mechanical ventilation (aOR 0.45, 95% CI 0.37-0.55, p < 0.0001) and reduction in ICU LOS and hospital LOS for all patients as well as ICU LOS for survivors. CONCLUSIONS: Implementing a multifaceted intervention including sepsis e-alert with SRT was associated with earlier identification of sepsis, increase in compliance with sepsis resuscitation bundle and reduction in the need for mechanical ventilation and reduction in hospital mortality and LOS.

Investigation of High-Energy Ion-Irradiated MA957 Using Synchrotron Radiation under In-Situ Tension.

In this study, an MA957 oxide dispersion-strengthened (ODS) alloy was irradiated with high-energy ions in the Argonne Tandem Linac Accelerator System. Fe ions at an energy of 84 MeV bombarded MA957 tensile specimens, creating a damage region ~7.5 µm in depth; the peak damage (~40 dpa) was estimated to be at ~7 µm from the surface. Following the irradiation, in-situ high-energy X-ray diffraction measurements were performed at the Advanced Photon Source in order to study the dynamic deformation behavior of the specimens after ion irradiation damage. In-situ X-ray measurements taken during tensile testing of the ion-irradiated MA957 revealed a difference in loading behavior between the irradiated and un-irradiated regions of the specimen. At equivalent applied stresses, lower lattice strains were found in the radiation-damaged region than those in the un-irradiated region. This might be associated with a higher level of Type II stresses as a result of radiation hardening. The study has demonstrated the feasibility of combining high-energy ion radiation and high-energy synchrotron X-ray diffraction to study materials' radiation damage in a dynamic manner.

The impact of implementing multifaceted interventions on the prevention of ventilator-associated pneumonia.

BACKGROUND: Ventilator-associated pneumonia (VAP) is a frequent hospital acquired infections among intensive care unit patients. The Institute for Healthcare Improvement has suggested a "care bundle" approach for the prevention of VAP. This report describes the effects of implementing this strategy on VAP rates. METHODS: All mechanically ventilated patients admitted to the intensive care unit between 2008 and 2013 were prospectively followed for VAP development according to the National Healthcare Safety Network criteria. In 2011, a 7-element care bundle was implemented, including head-of-bed elevation 30°-45°, daily sedation vacation and assessment for extubation, peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, oral care with chlorhexidine, endotracheal intubation with in-line suction and subglottic suctioning, and maintenance of endotracheal tube cuff pressure at 20-30 mmHg. The bundle compliance and VAP rates were then followed. RESULTS: A total of 3665 patients received mechanical ventilation, and there were 9445 monitored observations for bundle compliance. The total bundle compliance before and after initiation of the VAP team was 90.7% and 94.2%, respectively (P < .001). The number of VAP episodes decreased from 144 during 2008-2010 to only 14 during 2011-2013 (P < .0001). The rate of VAP decreased from 8.6 per 1000 ventilator-days to 2.0 per 1000 ventilator-days (P < .0001) after implementation of the care bundle. CONCLUSIONS: This study suggests that systematic implementation of a multidisciplinary team approach can reduce the incidence of VAP. Further sustained improvement requires persistent vigilant inspections.

Simvastatin induces regression of cardiac hypertrophy and fibrosis and improves cardiac function in a transgenic rabbit model of human hypertrophic cardiomyopathy.

BACKGROUND: Hypertrophic cardiomyopathy is a genetic disease characterized by cardiac hypertrophy, myocyte disarray, interstitial fibrosis, and left ventricular (LV) dysfunction. We have proposed that hypertrophy and fibrosis, the major determinants of mortality and morbidity, are potentially reversible. We tested this hypothesis in beta-myosin heavy chain-Q(403) transgenic rabbits. METHODS AND RESULTS: We randomized 24 beta-myosin heavy chain-Q(403) rabbits to treatment with either a placebo or simvastatin (5 mg. kg(-1). d(-1)) for 12 weeks and included 12 nontransgenic controls. We performed 2D and Doppler echocardiography and tissue Doppler imaging before and after treatment. Demographic data were similar among the groups. Baseline mean LV mass and interventricular septal thickness in nontransgenic, placebo, and simvastatin groups were 3.9+/-0.7, 6.2+/-2.0, and 7.5+/-2.1 g (P<0.001) and 2.2+/-0.2, 3.1+/-0.5, and 3.3+/-0.5 mm (P=0.002), respectively. Simvastatin reduced LV mass by 37%, interventricular septal thickness by 21%, and posterior wall thickness by 13%. Doppler indices of LV filling pressure were improved. Collagen volume fraction was reduced by 44% (P<0.001). Disarray was unchanged. Levels of activated extracellular signal-regulated kinase (ERK) 1/2 were increased in the placebo group and were less than normal in the simvastatin group. Levels of activated and total p38, Jun N-terminal kinase, p70S6 kinase, Ras, Rac, and RhoA and the membrane association of Ras, RhoA, and Rac1 were unchanged. CONCLUSIONS: Simvastatin induced the regression of hypertrophy and fibrosis, improved cardiac function, and reduced ERK1/2 activity in the beta-myosin heavy chain-Q(403) rabbits. These findings highlight the need for clinical trials to determine the effects of simvastatin on cardiac hypertrophy, fibrosis, and dysfunction in humans with hypertrophic cardiomyopathy and heart failure.