Quality assurance for cancer patient safety: Clinical assessment for precise angles in linac during radiation therapy.

PURPOSE: Quality assurance for stereotactic body radiation treatment requires that isocentric verification be ensured during gantry rotation at various angles. This study examined statistical parameters on Winston-Lutz tests to distinguish the deviation of angles from isocenter during gantry rotation using machine learning. METHOD: The Varian TrueBeam linac was aligned with the marked lines on the Ruby phantom. Eight images were captured while the gantry was rotating at a 45° shift. The statistical features were derived from IsoCheck EPID software. The decision tree model was applied to these Winston-Lutz tests to cluster data into two groups: precise and error angles. RESULTS: At 90° and 270° angles, the gantry exhibits isocentric stability compared to other angles. In these angles, the most statistical features were inside the range. Most variations were observed at 0° and 180° angles. In most tests, the angles 45°, 135°, 225°, and 315° showed reasonable performance and with less variation. CONCLUSION: The comprehensive statistical analyses for gantry rotation of angles assists expert radiotherapists in determining the contribution of each feature that highly affects gantry movement at specific angles. Misalignment between radiation isocenter and imaging isocenter, tuning of the beam at each angle, or a slight change in the position of the Ruby phantom can further improve the inaccuracy that causes the most variations. Better precision can effectively increase patient safety and quality during cancer treatment.

Efficient quality assurance for isocentric stability in stereotactic body radiation therapy using machine learning.

This study aims to predict isocentric stability for stereotactic body radiation therapy (SBRT) treatments using machine learning (ML), covers the challenges of manual assessment and computational time for quality assurance (QA), and supports medical physicists to enhance accuracy. The isocentric parameters for collimator (C), gantry (G), and table (T) tests were conducted with the RUBY phantom during QA using TrueBeam linac for SBRT. This analysis combined statistical features from the IsoCheck EPID software. Five ML models, including logistic regression (LR), decision tree (DT), random forest (RF), naive Bayes (NB), and support vector machines (SVM), were used to predict the outcome of the QA procedure. 247 Winston-Lutz (WL) tests were collected from 2020 to 2022. In our study, both DT and RF achieved the highest score on test accuracy (Acc. test) ranging from 93.5% to 99.4%, and area under curve (AUC) values from 90 to 100% on three modes (C, G, and T). The precision, recall, and F1 scores indicate the DT model consistently outperforms other ML models in predicting isocenter stability deviation in QA. The QA assessment using ML models can assist error prediction early to avoid potential harm during SBRT and ensure safe and effective patient treatments.

Cobalt Iron Oxide (CoFe2O4) Nanoparticles Induced Toxicity in Rabbits.

The market for nanoparticles has grown significantly over the past few decades due to a number of unique qualities, including antibacterial capabilities. It is still unclear how nanoparticle toxicity works. In order to ascertain the toxicity of synthetic cobalt iron oxide (CoFe2O4) nanoparticles (CIONPs) in rabbits, this study was carried out. Sixteen rabbits in total were purchased from the neighborhood market and divided into two groups (A and B), each of which contained eight rabbits. The CIONPs were synthesized by the co-precipitation method. Crystallinity and phase identification were confirmed by X-ray diffraction (XRD). The average size of the nanoparticles (13.2 nm) was calculated by Scherrer formula (Dhkl = 0.9 λ/ß cos θ) and confirmed by TEM images. The saturation magnetization, 50.1 emug-1, was measured by vibrating sample magnetometer (VSM). CIONPs were investigated as contrast agents (CA) for magnetic resonance images (MRI). The relaxivity (r = 1/T) of the MRI was also investigated at a field strength of 0.35 T (Tesla), and the ratio r2/r1 for the CIONPs contrast agent was 6.63. The CIONPs were administrated intravenously into the rabbits through the ear vein. Blood was collected at days 5 and 10 post-exposure for hematological and serum biochemistry analyses. The intensities of the signal experienced by CA with CIONPs were 1427 for the liver and 1702 for the spleen. The treated group showed significantly lower hematological parameters, but significantly higher total white blood cell counts and neutrophils. The results of the serum biochemistry analyses showed significantly higher and lower quantities of different serum biochemical parameters in the treated rabbits at day 10 of the trial. At the microscopic level, different histological ailments were observed in the visceral organs of treated rabbits, including the liver, kidneys, spleen, heart, and brain. In conclusion, the results revealed that cobalt iron oxide (CoFe2O4) nanoparticles induced toxicity via alterations in multiple tissues of rabbits.

The impact of COVID-19 pandemic lockdown on smoking habits and lifestyle: A cross-sectional study.

Background and Aims: Throughout the COVID-19 lockdown, the resultant psychological disturbances led to more tobacco consumption and deteriorated smoking behaviors among smokers. In this study, we aimed to investigate the impact of the COVID-19 pandemic on the smoking behaviors of the Jordanian population. Methods: A cross-sectional online survey was designed using the Google Forms service and distributed by social media platforms. Responses were collected starting from November 12, 2020, until November 24, 2020. Results: A total of 2511 respondents completed the survey, 77.3% were females. Males were significantly smoking more than females (p < 0.0001). Smoking was significantly more common among respondents who were older than 18 years old, married, held master's and PhD degrees, and working in non-health-related fields (p < 0.0001). Participants who smoke were more likely to adopt an unhealthy lifestyle during the pandemic. Females who started smoking last year were 2.6-fold more than males (p < 0.0001). We also noticed that there is a significant relationship between those who started smoking and are <18 years, living in a family consisting of seven members or more, being unemployed, having a diploma or bachelor's degree in a health-related major, having no chronic illnesses, increasing of daily meals or night meals, almost daily sugar intake, starting to follow social media account concerning physical activity, exercising once or twice a week, and sleeping more hours per day since the beginning of the pandemic (p < 0.01). Conclusion: The results of our study showed that the lockdown had a significant impact on people's lifestyles including smoking habits. Most of our sample's smoker participants experienced a change in their smoking level mostly, an increase. While those who had a decrease in their smoking level experienced a somehow healthier lifestyle regarding nutrition and other aspects.

One-pot hydrothermal synthesis of a carbon quantum dot/CaFe2O4 hybrid nanocomposite for carcinogenic Congo red dye degradation.

Semiconductor materials show a restricted degradation response to organic pollutants due to limited photocatalytic activity under visible light. Therefore, researchers have devoted much attention to novel and effective nanocomposite materials. For the first time, herein, a novel nano-sized semiconductor calcium ferrite modified by carbon quantum dots (CaFe2O4/CQDs) photocatalyst is fabricated via simple hydrothermal treatment for the degradation of aromatic dye using a visible light source. The crystalline nature, structure, morphology, and optical parameters of each of the synthesized materials were investigated using X-ray diffraction spectroscopy (XRD), Fourier transform infrared spectroscopy (FT-IR), scanning electron microscopy (SEM), and UV-visible spectroscopy. The nanocomposite exhibits excellent photocatalytic performance (90% degradation) against Congo red (CR) dye. In addition, a mechanism for CaFe2O4/CQDs improving photocatalytic performance has been proposed. The CQDs in the CaFe2O4/CQD nanocomposite are considered to act as an electron pool and transporter, as well as a strong energy transfer material, during photocatalysis. CaFe2O4/CQDs appear to be a promising and cost-effective nanocomposite for dye-contaminated water purification, according to the findings of this study.

Iron enriched quinoa biochar enhances Nickel phytoremediation potential of Helianthus annuus L. by its immobilization and attenuation of oxidative stress: implications for human health.

The present study was performed to assess Ni-immobilization and the phytoremediation potential of sunflower by the application of quinoa stalks biochar (QSB) and its magnetic nanocomposite (MQSB). The QSB and MQSB were characterized with FTIR, SEM, EDX, and XRD to get an insight of their surface properties. Three-week-old seedlings of sunflower were transplanted to soil spiked with Ni (0, 15, 30, 60, 90 mg kg-1), QSB and MQSB (0, 1, and 2%) in the wire house under natural conditions. The results showed that increasing Ni levels inhibited sunflower growth and yield due to the high production of reactive oxygen species (ROS) and lipid peroxidation. Enzyme activities like superoxide dismutase (SOD), catalase (CAT), ascorbate peroxidase (APX), and peroxidase (POX) also increased as Ni levels increased. However, the application of QSB and MQSB reduced Ni uptake, root-shoot, and shoot-seed translocation and decreased the generation of ROS, and lowered the activity of SOD, CAT, APX, and POX, leading to improved growth and yield, especially with MQSB. This was verified through SEM, EDX, XRD, and FTIR. It can be concluded that QSB and MQSB can effectively enhance Ni-tolerance in sunflowers and mitigate oxidative stress and human health risks.

The article focuses on enhancing the phytoremediation remediation potential of Helianthus annuus by using the quinoa stalks biochar (QSB) and magnetic quinoa stalks biochar (MQSB) by immobilization of Ni in soil and ultimately attenuation of oxidative stress in plants and human health risk. Iron enrichment of biochar improves the surface characteristics (surface area, functional groups, porosity, etc.) which help to immobilize metals ions. To the best of our knowledge, QSB and MQSB has never been used before to study the Ni dynamics and for enhancing sunflower phytoremediation potential.

Pharmacological properties and therapeutic potential of honey bee venom.

Honey bee venom (BV) is a valuable product, and has a wide range of biological effects, and its use is rapidly increasing in apitherapy. Therefore, the current study, we reviewed the existing knowledge about BV composition and its numerous pharmacological properties for future research and use. Honey bee venom or apitoxin is produced in the venom gland in the honey bee abdomen. Adult bees use it as a primary colony defense mechanism. It is composed of many biologically active substances including peptides, enzymes, amines, amino acids, phospholipids, minerals, carbohydrates as well as some volatile components. Melittin and phospholipase A2 are the most important components of BV, having anti-cancer, antimicrobial, anti-inflammatory, anti-arthritis, anti-nociceptive and other curative potentials. Therefore, in medicine, BV has been used for centuries against different diseases like arthritis, rheumatism, back pain, and various inflammatory infections. Nowadays, BV or its components separately, are used for the treatment of various diseases in different countries as a natural medicine with limited side effects. Consequently, scientists as well as several pharmaceutical companies are trying to get a new understanding about BV, its substances and its activity for more effective use of this natural remedy in modern medicine.

Multivariate characterization of biochemical and physiological attributes of quinoa (Chenopodium quinoa Willd.) genotypes exposed to nickel stress: implications for phytoremediation.

Nickel (Ni) is an essential element for plants; however, excessive uptake of Ni causes phytotoxicity in plants. The phytotoxic effects of Ni on the growth of quinoa and the underlaying mechanisms for Ni tolerance and phytoremediation are unknown. Hence, the present study investigated Ni tolerance and accumulation potential of two quinoa genotypes (Puno and Vikinga). Both genotypes were exposed to Ni (0, 100, 200, 300, and 400 µM) in half-strength Hoagland nutrient solution for three weeks. Results revealed that shoot and root lengths, biomass, stomatal conductance, and chlorophyll contents were decreased with the increase of Ni concentration. Excessive uptake of Ni resulted in the limited uptake of K by root and its translocation to shoot. Ni caused oxidative stress in plants by overproduction of H2O2 leading to lipid peroxidation of cell membranes. Genotype Puno showed greater tolerance to Ni than Vikinga based on tolerance index, lower bioconcentration factor, and translocation factor. Greater tolerance of Puno was mainly attributed to improved physiological responses and amelioration of oxidative stress by induction of antioxidant enzymes such as peroxidase (POD), catalase (CAT), superoxide dismutase (SOD), and ascorbate peroxidase (APX). It was revealed through multivariate analysis that Ni had strong negative correlations with growth and physiological attributes and positive associations with oxidative stress attributes. The study demonstrated genotypic variation in response to varying Ni concentrations and Puno performed better than Vikinga for phytostabilization of Ni-contaminated soils.

Salinity mitigates cadmium-induced phytotoxicity in quinoa (Chenopodium quinoa Willd.) by limiting the Cd uptake and improved responses to oxidative stress: implications for phytoremediation.

Cadmium (Cd) contamination and soil salinity are the main environmental issues reducing crop productivity. This study aimed to examine the combined effects of salinity (NaCl) and Cd on the physiological and biochemical attributes of quinoa (Chenopodium quinoa Willd.). For this purpose, 30-day-old plants of quinoa genotype "Puno" were transplanted in Hoagland's nutrient solution containing diverse concentrations of Cd: 0, 50, 100, 200 µM Cd, and salinity: 0, 150, and 300 mM NaCl. Results demonstrated that plant growth, stomatal conductance, and pigment contents were significantly lower at all Cd concentrations than the control plants. Quinoa plants exhibited improved growth and tolerance against Cd when grown at a lower level of salinity (150 mM NaCl) combined with Cd. In contrast, the elevated concentration of salinity (300 mM NaCl) combined with Cd reduced shoot and root growth of experimental plants more than 50%. Combined application of salinity and Cd increased Na (25-fold), while lessened the Cd (twofold) and K (1.5-fold) uptake. A blend of high concentrations of Na and Cd caused overproduction of H2O2 (eightfold higher than control) contents and triggered lipid peroxidation. The activities of antioxidant enzymes: ascorbate peroxidase (APX), catalase (CAT), peroxidase (POD), and superoxide dismutase (SOD) were 13, 12, 7 and ninefold higher than control to mitigate the oxidative stress. Due to restricted root to shoot translocation, and greater tolerance potential against Cd, the quinoa genotype, Puno, is suitable for phytostabilization of Cd in saline soils.

Genomic and Epigenomic Features of Glioblastoma Multiforme and its Biomarkers.

Glioblastoma multiforme is a serious and life-threatening tumor of central nervous system, characterized by aggressive behavior, poor prognosis, and low survival rate. Despite of the availability of aggressive antitumor therapeutic regimen for glioblastoma (radiotherapy followed by chemotherapeutic dose), recovery rate, and patients' survival ratio is attributed to the lack of selectivity of therapeutic drugs and less advancement in cancer therapeutics over last decade. Moreover, tools employed in conventional diagnosis of glioblastoma are more invasive and painful, making the process excruciating for the patients. These challenges urge for the need of novel biomarkers for diagnosis, prognosis, and prediction purpose with less invasiveness and more patient compliance. This article will explore the genetic biomarkers isocitrate dehydrogenase mutation, MGMT mutations, and EGFR that can be deployed as an analytical tool in diagnosis of disease and prognosis of a therapeutic course. The review also highlights the importance of employing novel microRNAs as prognostic biomarkers. Recent clinical advancements to treat GBM and to prevent relapse of the disease are also discussed in this article in the hope of finding a robust and effective method to treat GBM.

Machine vision-based Statistical texture analysis techniques for characterization of liver tissues using CT images.

OBJECTIVE: To characterize human liver tissues by demonstrating the ability of machine vision, and to propose a new auto-generated report based on texture analysis that may work with co-occurrence matrix statistics. METHODS: The retrospective study was conducted at Bahawal Victoria Hospital (BVH), Bahawalpur, Pakistan, and comprised clinically verified computed tomography imaging data between October 2018 and September 2020. The image samples and related data were used to segregate classes 1-4. Appropriate image classes belonging to the same disease were trained to confirm the abnormalities in liver tissues using supervised learning methods, principal component analysis, linear discriminant analysis, and non-linear discriminant analysis. Robust and reliable texture features were investigated by generating testing classes. Overall performance of the presented machine vision approach was analyzed using four parameters; precision, recall/sensitivity, F1-score, and accuracy. Statistical analysis was done using B11 software. RESULTS: There were 312 image samples from 71 patients; 51(71.8%) males and 20(28.2%) females. Among the patients, 19(26.7%) had abscess, 15(21.1%) had metastatic disease, 23(32.4%) had tumour necrosis, 6(8.5%) had vascular disorder, and 8(11.3%) were normal. Principal component analysis, linear discriminant analysis, and non-linear discriminant analysis showed high >97.86% values, but the discrimination rate was 100% for class 4. CONCLUSIONS: Abnormalities in the human liver could be discriminated and diagnosed by texture analysis techniques using second-order statistics that may assist the radiologist and medical physicists in predicting the severity and proliferation of abnormalities in liver diseases.

Cytotoxic effects of extracts and isolated compounds from Ifloga spicata (forssk.) sch. bip against HepG-2 cancer cell line: Supported by ADMET analysis and molecular docking.

The purpose of this study was to determine the anticancer potential of Ifloga spicata (I. spicata) against HepG-2 cell line. To assess I. spicata cytoxicity, brine shrimp lethality and MTT assays were performed. In the brine shrimp bioassay, the ethyl acetate fraction had a significant impact with an IC50 of 10 µg/ml. The ethyl acetate and chloroform fractions inhibited HepG-2 cell line effectively (IC50 values 5.54 and 6.52 µg/ml, respectively). The isolated compound, heptadecyl benzoate inhibited growth significantly (IC50, 8.92 µg/ml) while methyl dihydroxybenzoate had modest activity (25.66 µg/ml) against the cell line. Both compounds displayed acceptable pharmacokinetic parameters in the ADME study. In the docking study, the methyl dihydroxybenzoate was involved in two hydrogen bonds with two different residues Thr830 and Asp831. The heptadecyl benzoate carbonyl oxygen exhibited a single hydrogen bond with Lys692. Both showed good interactions with the active site of the (EGFR) tyrosine kinase. Our findings suggest that I. spicata might be a viable source of anticancer natural agents. This discovery raises the prospect of the future development of a new medication for the treatment of liver cancer.

Gelatin nanoparticles with tunable mechanical properties: effect of crosslinking time and loading.

Tuning the elastic properties of nanoparticles intended to be used in drug delivery is of great interest. To this end, different potential formulations are developed since the particle elasticity is affecting the in vitro and in vivo performance of the nanoparticles. Here we present a method to determine the elasticity of single gelatin nanoparticles (GNPs). Furthermore, we introduce the possibility of tuning the elastic properties of gelatin nanoparticles during their preparation through crosslinking time. Young's moduli from 5.48 to 14.26 MPa have been obtained. Additionally, the possibility to measure the elasticity of single nanoparticles revealed the influence of loading a macromolecular model drug (FITC-dextran) on the mechanical properties, which decreased with raising amounts of loaded drug. Loaded particles were significantly softer, with Young's moduli between 1.06 and 5.79 MPa for the same crosslinking time, than the blank GNPs. In contrast to this, lysozyme as a crosslinkable macromolecule did not influence the mechanical properties. A good in vitro cell compatibility was found investigating blank GNPs and FITC-dextran-loaded GNPs in viability assays with the cancer cell line A549 and the human primary cell-derived hAELVi cell line.

Formulation Development and Characterization of pH Responsive Polymeric Nano-Pharmaceuticals for Targeted Delivery of Anti-Cancer Drug (Methotrexate).

Oral administration of pH sensitive/stimuli responsive nanoparticles are gaining importance because of the limited side effects, minimum dose and controlled drug release. The objective of this study was to develop and evaluate pH sensitive polymeric nanoparticles for methotrexate with the aim to maximize the drug release at target site. In the presented study, pH sensitive polymeric nanoparticles of methotrexate were developed through modified solvent evaporation technique using polymer Eudragit S100. Different process parameters like drug to polymer ratio, speed of sonication, concentration of surfactant and time of sonication were optimized by evaluating their effects on particle size, PDI, zeta potential, entrapment/encapsulation efficiency. The developed formulations were evaluated for their size, polydispersity (PDI), zeta potential, encapsulation efficiency, XRD, scanning electron microscopy, in-vitro drug release and stability studies. Best results were obtained with poloxamer-407 and PVA and were selected as surfactants. Physicochemical characterization of the developed formulations showed that the particle size lies in the range 165.7 ± 1.85-330.4 ± 4.19, PDI 0.119 ± 0.02-0.235 ± 0.008, zeta potential -0.163 ± 0.11--5.64 ± 0.36 mV, and encapsulation efficiency more than 61%. The results of scanning electron microscopy revealed that nanoparticles have regular geometry with spherical shape. Initially the drug release occur through diffusion followed by erosion. The present studies showed that MTX-ES100 nanoparticles prepared during this study have the desired physicochemical properties, surface morphology and release characteristics used to target the desired organs.

Design and Characterization of Paclitaxel-Loaded Polymeric Nanoparticles Decorated With Trastuzumab for the Effective Treatment of Breast Cancer.

The aim of the study was to design and formulate an antibody-mediated targeted, biodegradable polymeric drug delivery system releasing drug in a controlled manner to achieve a therapeutic goal for the effective treatment of breast cancer. Antibody-mediated paclitaxel-loaded PLGA polymeric nanoformulations were prepared by the solvent evaporation method using different experimental parameters and compatibility studies. The optimized formulations were selected for in vitro and in vivo evaluation and cytotoxicity studies. The in vitro drug release studies show a biphasic release pattern for the paclitaxel-loaded PLGA nanoparticles showing a burst release for 24 h followed by an extended release for 14 days; however, a more controlled and sustained release was observed for antibody-conjugated polymeric nanoparticles. The cytotoxicity of reference drug and paclitaxel-loaded PLGA nanoparticles with and without antibody was determined by performing MTT assay against MCF-7 cells. Rabbits were used as experimental animals for the assessment of various in vivo pharmacokinetic parameters of selected formulations. The pharmacokinetic parameters such as Cmax (1.18-1.33 folds), AUC0-t (39.38-46.55 folds), MRT (10.04-12.79 folds), t1/2 (3.06-4.6 folds), and Vd (6.96-8.38 folds) have been increased significantly while clearance (4.34-4.61 folds) has been decreased significantly for the selected nanoformulations as compared to commercially available paclitaxel formulation (Paclixil®). The surface conjugation of nanoparticles with trastuzumab resulted in an increase in in vitro cytotoxicity as compared to plain nanoformulations and commercially available conventional brand (Paclixil®). The developed PLGA-paclitaxel nanoformulations conjugated with trastuzumab have the desired physiochemical characteristics, surface morphology, sustained release kinetics, and enhanced targeting.

Hematobiochemical, Oxidative Stress, and Histopathological Mediated Toxicity Induced by Nickel Ferrite (NiFe2O4) Nanoparticles in Rabbits.

From the past few decades, attention towards the biological evaluation of nanoparticles (NPs) has increased due to the persistent and extensive application of NPs in various fields, including biomedical science, modern industry, magnetic resonance imaging, and the construction of sensors. Therefore, in the current study, magnetic nickel ferrite (NiFe2O4) nanoparticles (NFNPs) were synthesized and evaluated for their possible adverse effects in rabbits. The crystallinity of the synthesized NFNPs was confirmed using X-ray diffraction (XRD) technique. The saturation magnetization (46.7 emug-1) was measured using vibrating sample magnetometer (VSM) and 0.35-tesla magnetron by magnetic resonance imaging (MRI). The adverse effects of NFNPs on blood biochemistry and histoarchitecture of the liver, kidneys, spleen, brain, and heart of the rabbits were determined. A total of sixteen adult rabbits, healthy and free from any apparent infection, were blindly placed in two groups. The rabbits in group A served as control, while the rabbits in group B received a single dose (via ear vein) of NFNPs for ten days. The blood and visceral tissues were collected from each rabbit at days 5 and 10 of posttreatment. The results on blood and serum biochemistry profile indicated significant variation in hematological and serum biomarkers in NFNP-treated rabbits. The results showed an increased quantity of oxidative stress and depletion of antioxidant enzymes in treated rabbits. Various serum biochemical tests exhibited significantly higher concentrations of different liver function tests, kidney function tests, and cardiac biomarkers. Histopathologically, the liver showed congestion, edema, atrophy, and degeneration of hepatocytes. The kidneys exhibited hemorrhages, atrophy of renal tubule, degeneration, and necrosis of renal tubules, whereas coagulative necrosis, neutrophilic infiltration, and severe myocarditis were seen in different sections of the heart. The brain of the treated rabbits revealed necrosis of neurons, neuron atrophy, and microgliosis. In conclusion, the current study results indicated that the highest concentration of NPs induced adverse effects on multiple tissues of the rabbits.

Delay in Initial Debridement for Open Tibial Fractures and Its Possible Impact on Patient Outcomes: A Single-Center Prospective Cohort Study.

The current consensus regarding the management of open fracture indicates that the initial debridement should be performed within the first 6 hours after injury. Unfortunately, in Pakistan, the emergency medical services are not well-established and patient arrival at the hospital is delayed the majority of the time. In this study, we present our experience with delayed surgical management of open tibial fractures. METHODS: A prospective study of patients who presented to the accident and emergency department of the authors' institution was performed. The duration of the study was 4 years. All patients ≥18 years of age with an isolated open fracture of the tibia were included in the study. Open fractures were graded using the Gustilo-Anderson (GA) classification. The study participants were divided into 3 groups based on the timing of the surgery. Infection and nonunion rates were compared using chi-square analysis. P < 0.05 was considered significant. RESULTS: A total of 1,896 patients were included in the study. There was no significant difference between the results of surgery performed before 48 hours and those of surgery performed after 48 hours with regard to the infection rates associated with GA type-I (p = 0.48), type-II (p = 0.70), or type-III (p = 0.87) fractures or the nonunion rates associated with type-I (p = 0.6338), type-II (p = 0.4030), or type-III (p = 0.4808) fractures. A higher GA classification was associated with higher rates of infection and nonunion independent of the timing of the surgery (95% confidence interval [CI] = 1.24 to 1.89, p < 0.01). CONCLUSIONS: Our study indicates that the risks of infection and nonunion remain acceptable despite delays in the management of open tibial fractures within a 24 to 96-hour window. A delay in the initial time to debridement is acceptable only when early care cannot be provided. Prompt initial debridement remains the best possible treatment for open tibial fractures. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Colo-colic intussusception secondary to colon lipoma: A case report.

INTRODUCTION AND IMPORTANCE: Intestinal intussusception is rare in adults and it is associated with lead points affecting the colon in around 17% of patients. Lipomas are very rare benign tumors which may act as lead points for intestinal intussusception. Indeed, the incidence of intestinal intussusception is much rare when caused by lipomas. CASE PRESENTATION: Our patient is a 29-year-old male, previously healthy and admitted for severe right lower quadrant abdominal pain of 2-day duration. Computed tomography (CT) scan of the abdomen and pelvis showed large mass of fat consistency containing colon structure. CLINICAL DISCUSSION: Urgent laparotomy was opted during which colo-colic intussusception was diagnosed and right hemicolectomy with primary ileocolic anastomosis was performed. Pathology report showed that intussusception was induced by a colon lipoma. Patient had an uneventful hospital stay and was discharged on post-operative day 5. CONCLUSION: Thus we recommend that colo-colic intussusception caused by lipoma be considered in the differential when diagnosing adults with right lower quadrant pain.

Effects of arsenite on physiological, biochemical and grain yield attributes of quinoa (Chenopodium quinoa Willd.): implications for phytoremediation and health risk assessment.

The objectives of this study were to investigate the effects of arsenic (As) on physiological and biochemical attributes of quinoa, and human health risks associated with the consumption of As contaminated grains of quinoa. Quinoa genotype, Puno was grown on soil contaminated with various levels of arsenite; 0, 10, 20, 30, and 40 mg As kg-1 soil. Results revealed that plant growth, photosynthetic pigments, stomatal conductance, and grain yield of As treated plants were significantly less as compared to control plants. Plants exposed to elevated levels of 30 and 40 mg As kg-1 of soil could not survive until maturity. Plant roots retained higher concentration of As than shoot indicating As phytostabilizing behavior of quinoa. Arsenic toxicity caused oxidative stress in quinoa plants, which elevated the H2O2 and TBARS contents and decreased membrane stability. This oxidative stress was partly mitigated by the induction of antioxidant enzymes (SOD, CAT, POD, APX). Perhaps, our results regarding As availability might be an overestimate of the typical natural conditions, As accumulation in quinoa grains posed both carcinogenic and non-carcinogenic health risks to humans. It was concluded that quinoa is sensitive to As and the consumption of quinoa grains from plants grown on As concentration ≥20 mg kg-1 of soil was not safe for humans. Novelty statement: The tolerance potential of quinoa (Chenopodium quinoa Willd.) against the trivalent form of arsenic (arsenite), and the health risks due to the consumption of arsenic-contaminated grains has not been explored yet. This is the first study in which we have explored the effects of arsenite on physiological, biochemical and phytoremedial attributes of quinoa. Moreover, human health risks associated with the consumption of As contaminated grains of quinoa has have been investigated. The findings of the present study would be helpful for farmers who intend to grow quinoa on arsenic-contaminated soils.