Ankle fracture open reduction and internal fixation in patients with cerebral palsy.

AIM: To examine patients with cerebral palsy (CP) undergoing open reduction and internal fixation (ORIF) for ankle fractures. METHOD: This was a retrospective study of adult patients undergoing ankle fracture ORIF for closed, isolated ankle fractures identified in between 2010 and 2021 in the Q1 PearlDiver M151 database. Patients with CP were identified with International Classification of Diseases (ICD)-9 and ICD-10 codes, and were matched to those without 1:10 on age, sex, and Elixhauser comorbidity index (ECI). Ninety-day adverse events were assessed with multivariable logistic regression. RESULTS: A total of 148 993 patients with isolated ankle fracture ORIF were identified, of whom 407 (0.27%) had CP. After matching, 3863 without CP were compared to 389 with CP. Patients with CP were at increased odds of: 90-day urinary tract infection (odds ratios [OR] 6.26), pneumonia (OR 3.50), minor adverse events (OR 3.46), sepsis (OR 3.30), any adverse events (OR 3.04), emergency department visits (OR 2.28), serious adverse events (OR 1.77), and prolonged length of stay more than 4 days (OR 22.44) (p < 0.001 for all). INTERPRETATION: Patients with CP undergoing ORIF for isolated, closed ankle fractures are at increased odds of several 90-day adverse events and prolonged length of stay compared to matched patients without CP.

Total shoulder arthroplasty in patients with factor V Leiden.

BACKGROUND: Anatomic and reverse total shoulder arthroplasty (TSA) are effective treatment options for end-stage glenohumeral osteoarthritis. However, consideration for pre-existing conditions must be taken into account. Factor V Leiden (FVL), the most common inherited thrombophilia, is one such condition that predisposes to a prothrombotic state and may affect perioperative and longer-term outcomes following TSA. METHODS: Adult patients undergoing primary TSA for osteoarthritis indication were identified in the 2010 through October 2021 PearlDiver M157 database. Patients with or without FVL were matched at a 1:4 ratio based on age, sex, and Elixhauser Comorbidity Index. Ninety-day adverse events and 5-year revision rates were assessed and compared with multivariable logistic regression and rank-log tests, respectively. Finally, the relative use and bleeding/clotting outcomes were assessed based on venous thromboembolic (VTE) prophylactic agents used, with categories defined as (1) warfarin, heparin, or direct oral anticoagulant (DOAC) or (2) aspirin/no prescription found. RESULTS: Of 104,258 TSA patients, FVL was identified for 283 (0.27%). Based on matching, 1081 patients without FVL and 272 patients with FVL were selected. Multivariable analyses demonstrated that those with FVL displayed independently greater odds ratios (ORs) of deep vein thrombosis (DVT, OR = 9.50, P < .0001), pulmonary embolism (PE, OR = 10.10, P < .0001), and pneumonia (OR = 2.43, P = .0019). Further, these events contributed to the increased odds of aggregated minor (OR = 1.95, P = .0001), serious (OR = 6.38, P < .0001), and all (OR = 3.51, P < .0001) adverse events. All other individual 90-day adverse events, as well as 5-year revision rates, were not different between the study groups. When compared to matched patients without FVL on the same anticoagulant agents, FVL patients on warfarin, heparin, or DOAC agents demonstrated lesser odds of 90-day DVT and PE (OR = 4.25, P < .0001, and OR = 2.54, P = .0065) than those on aspirin/no prescription found (OR = 7.64 and OR = 21.95, P < .0001 for both). Interestingly, those on VTE prophylactic agents were not at greater odds of bleeding complications (hematoma or transfusion). DISCUSSION AND CONCLUSIONS: TSA patients with FVL present a difficult challenge to shoulder reconstruction surgeons. The current study highlights the strong risk of VTE that was reduced but still significantly elevated for those with stronger classes of VTE chemoprophylaxis. Acknowledging this risk is important for surgical planning and patient counseling, but also noted was the reassurance of similar 5-year revision rates for those with vs. without FVL.

Total Hip Arthroplasty in Patients Who Have Factor V Leiden: Elevated Risks Isolated to Venous Thromboembolism Events.

BACKGROUND: Total hip arthroplasty (THA) is a common procedure that requires consideration of preexisting comorbidities. Factor V Leiden (FVL), an inherited thrombophilia, is one such condition that predisposes patients to venous thromboembolism (VTE, deep vein thrombosis, and pulmonary embolism). The present study aimed to characterize the risks associated with FVL patients undergoing THA and evaluate the effect of VTE chemoprophylactic agents on these risks. METHODS: A total of 544,022 adult patients who underwent primary THA for osteoarthritis indications between 2010 and October 2021 were identified in an administrative claims database. Of these, FVL was identified in 1,138 (0.21%). Patients who had and did not have FVL were matched at a 1:4 ratio (1,131 with FVL and 4,519 without FVL) based on age, sex, and Elixhauser comorbidity index. Univariable and multivariable analyses were assessed for 90-day complications. Implant survival at 5 years was assessed and compared with log-rank tests. The relative use of different chemoprophylactic agents, including aspirin, warfarin, heparin, or direct oral anticoagulant (DOAC), was assessed. Bleeding events and VTE were compared for those prescribed either aspirin or warfarin, heparin, or DOAC. A Bonferroni correction was applied. RESULTS: On multivariable analysis, FVL patients were found to have increased odds of 90-day deep vein thrombosis (odds ratio (OR) = 9.20), pulmonary embolism (OR = 6.89), and aggregated severe and all adverse events (OR = 4.74 and 1.98, respectively), but not elevated risk of other perioperative adverse events or 5-year reoperations. More potent chemoprophylactic agents (warfarin, heparin, DOAC) reduced, but did not completely eliminate, the increased VTE risks (without increasing bleeding events). CONCLUSIONS: This study quantified the significantly elevated VTE risk associated with FVL patients undergoing THA. The lack of difference in other specific adverse events and 5-year reoperations is reassuring. Clearly, chemoprophylactic agents are important in this population and may need further attention.

Outcomes Following Total Hip Arthroplasty in Patients Who Have Von Willebrand Disease Depend on Postoperative Anticoagulation.

BACKGROUND: Von Willebrand disease (VWD) is the most common congenital bleeding disorder. This autosomal dominant condition arises from quantitative or qualitative defects of Von Willebrand factor. To our knowledge, this study leveraged a national database to characterize the largest VWD cohort of total hip arthroplasty (THA) patients to date, assessing 90-day postoperative adverse events and 5-year revision-free survival. METHODS: Adult patients who underwent primary THA for osteoarthritis were identified from January 2010 to October 2021 in a nationwide database. Patients who had and did not have VWD were matched (4:1) on age, sex, and Elixhauser Comorbidity Index and compared with multivariable logistic regression. Patients were then categorized based upon venous thromboembolism (VTE) chemoprophylaxis prescription patterns to compare bleeding and thrombotic adverse events. RESULTS: Of 544,851 THA patients, VWD was identified in 309 patients (0.06%). The matched cohorts contained 1,221 patients who did not have VWD and 306 patients who have VWD. On multivariable analysis, VWD patients had increased odds of 90-day VTE (odds ratio [OR] = 1.86) and hematoma (OR = 3.40) (P < .05 for all). No difference in 5-year revision-free survival was found. The VWD patients receiving aspirin or no prescriptions had greater odds of VTE (OR = 2.39, P = .048). Those on other chemoprophylaxis agents had greater odds of hematoma (OR = 4.84, P = .006). CONCLUSIONS: Patients with VWD undergoing THA had increased odds of 90-day VTE if using aspirin or no prescriptions, or hematoma if using other chemoprophylaxis. There is a delicate balancing act of clotting versus bleeding that must be considered in managing such patients, but it was reassuring that no difference in overall 5-year revision-free survival was found.

Influences of Partial Destruction of Ti-MOFs on Photo(electro)catalytic H2 Evolution by Dominating Role of Charge Carrier Trapping over Surface Area.

The design of water-stable photo and electrocatalysts of metal-organic frameworks (MOFs) for its promising catalytic applications at long-term irradiations or persisted current loads is extremely necessary but still remains as challenging. A limited number of reports on Ti-MOF-based catalysts for water splitting are only available to explain and understand the correlation between the nature of materials and MOFs array. Herein, spherical Ti-MOFs and corresponding partially annealed hollow core-shell Ti-MOFs (Ti-MOF/D) are designed and the correlation with their photo(electro)catalytic water splitting performance is evaluated. The switchable valence state of Ti for the Ti-MOF as a function of molecular bonding is the possible reason behind the observed photocatalytic hydrogen generation and light-harvesting ability of the system. Besides, the defect state, solid core-shell mesoporous structure, and active sites of Ti-MOF help to trap the charge carriers and the reduction of the recombination process. This phenomenon is absent for hollow core-shells Ti-MOF/D spheres due to the rigid TiO2 outer surface although there is a contradiction in surface area with Ti-MOF. Considering the diversity of Ti-MOF and Ti-MOF/D, further novel research can be designed using this way to manipulate their properties as per the requirements.

Exact Quantum Virial Expansion for the Optical Response of Doped Two-Dimensional Semiconductors.

We introduce a quantum virial expansion for the optical response of a doped two-dimensional semiconductor. As we show, this constitutes a perturbatively exact theory in the high-temperature or low-doping regime, where the electrons' thermal wavelength is smaller than their interparticle spacing. We obtain exact analytic expressions for the photoluminescence and we predict new features such as a nontrivial shape of the attractive branch peak related to universal resonant exciton-electron scattering and an associated energy shift from the trion energy. Our theory furthermore allows us to formally unify the two distinct theoretical pictures that have been applied to this system, where we reveal that the predictions of the conventional trion picture correspond to a high-temperature and weak-interaction limit of Fermi-polaron theory. Our results are in excellent agreement with recent experiments on doped monolayer MoSe_{2} and they provide the foundation for modeling a range of emerging optically active materials such as van der Waals heterostructures.

Total Knee Arthroplasty: Variables Affecting 90-day Overall Reimbursement.

BACKGROUND: Total knee arthroplasty (TKA) is commonly considered to address symptomatically limiting knee osteoarthritis. With increasing utilization, understanding the variability and related drivers may help the healthcare system optimize delivery to the large numbers of patient to whom it is offered. METHODS: A total of 1,066,327 TKA patients who underwent primary TKA were isolated from a 2010 to 2021 PearlDiver national dataset. Exclusion criteria included patients less than 18 years old and traumatic, infectious, or oncologic indications. Overall, 90-day reimbursements and variables associated with the patient, surgical procedure, region, and perioperative period were abstracted. Multivariable linear regressions were performed to determine independent drivers of reimbursement. RESULTS: The 90-day postoperative reimbursements had an average (standard deviation) of $11,212.99 ($15,000.62), a median (interquartile range) of $4,472.00 ($13,101.00), and a total of $11,946,962,912. Variables independently associated with the greatest increase in overall 90-day reimbursement were related to admission (in-patient index-procedure [+$5,695.26] or hospital readmission [+$18,495.03]). Further drivers were region (Midwest +$8,826.21, West +$4,578.55, South +$3,709.40; relative to Northeast), insurance (commercial +$4,492.34, Medicaid +$1,187.65; relative to Medicare), postoperative emergency department visits (+$3,574.57), postoperative adverse events (+$1,309.35), (P < .0001 for each). CONCLUSION: The current study assessed over a million TKA patients and found large variations in reimbursement/cost. The largest increases in reimbursement were associated with admission (readmission or index procedure). This was followed by region, insurance, and other postoperative events. These results underscore the necessity to balance performing out-patient surgeries in appropriate patients versus the risk of readmissions and defined other areas for cost containment strategies.

Urgent Care Visits Sought After Primary Total Hip Arthroplasty: A Potentially Overlooked Resource.

BACKGROUND: Following total hip arthroplasty (THA), readmissions and emergency department (ED) visits have been studied. Urgent care utilization is not well-characterized and may represent an overlooked avenue to facilitate lesser acuity patient needs. METHODS: Primary THAs performed for osteoarthritis indications were identified from 2010 to April of 2021 from a large national database. The incidence and timing of 90-day postoperative ED and urgent care visits were determined. Univariable and multivariable analyses assessed factors associated with urgent care relative to ED utilization. Reasons and acuity of diagnoses for these visits were determined. For 213,189 THA patients, 90-day ED visits were identified for 37,692 (17.7%) and urgent care visits for 2,083 (1.0%). The greatest incidence of both ED and urgent care visits were in the first two postoperative weeks. RESULTS: Independent predictors of urgent care utilization relative to ED utilization were: procedures being performed in the Northeast or South, insurance plan being Commercial, women, and lesser comorbidity burden (P < .0001). Reason for visits to the ED was directly related to the surgical site for 25.6% but for urgent care were just 4.8% (P < .0001). Reasons for visits to the ED were classified as low-acuity for 57.4% and for urgent care 96.9% (P < .0001). CONCLUSION: Following THA, patients may need urgent evaluation. While many issues can be addressed through the office, urgent care visits may represent a viable and underused resource relative to the ED for a large percentage of patients who have lower acuity diagnoses.

Signatures of Quantum Chaos in an Out-of-Time-Order Tensor.

Motivated by the famous ink-drop experiment, where ink droplets are used to determine the chaoticity of a fluid, we propose an experimentally implementable method for measuring the scrambling capacity of quantum processes. Here, a system of interest interacts with a small quantum probe whose dynamical properties identify the chaoticity of the system. Specifically, we propose a fully quantum version of the out-of-time-order correlator-which we term the out-of-time-order tensor-whose correlations offer clear information theoretic meanings about the chaoticity of a process. We illustrate the utility of the out-of-time-order tensor as a signature of chaos using random unitary processes as well as in the quantum kicked rotor, where the chaoticity is tunable.

Monitoring bioaccessibility of iron and zinc in pearl millet grain after sequential milling.

The present study was to understand the effect of sequential milling on the distribution of inhibitory factors and their relation to iron-zinc bioaccessibility in the two pearl millet cultivars differing in grain shape and size. The studies revealed that the yield of decorticated grain and bran fractions differed between the cultivars. The initial bran fractions had lower iron content, which increased on increase of decortication duration (2.33-25.14 mg/100 g), while zinc did not follow this pattern. Among the inhibitory factors, polyphenols and phytic acid were low in the initial stages of milling and subsequently increased as the milling duration increased. Microscopic studies further confirmed that iron-zinc and inhibitory factors coexist in the same tissues of the grain. The ß- carotene was more concentrated in the middle layers of the pericarp. It was observed that iron bioaccessibility was the highest in the 4 min milling bran (7.7%, 3.34%) and final decorticated grain fractions (13.79%, 18.45%) of both the cultivars. Iron bioaccessibility could not be related to any particular inhibitory factors, in bran insoluble fibre and phytic acid were prominent while in decorticated grain galloyls, catechols and phytic acid were the maxima. In both the cultivars, zinc bioaccessibility was high in fractions with low phytic acid and insoluble fibre. The data presented suggest that 6 min decortication that removed around 10-15% of the bran had the highest iron and zinc bioaccessibility. The iron-rich bran fraction after appropriate processing can also be used in speciality food and thereby addresses the problem of micronutrient deficiency. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13197-021-05072-x.

SERS and DFT studies of 2-(trichloroacetyl)pyrrole chemisorbed on the surface of silver and gold coated thin films: In perspective of biosensor applications.

The adsorption and orientations of 2-(trichloroacetyl)pyrrole (TCAP) adsorbed on a fabricated silver-coated thin film (SCF), and gold-coated thin film (GCF) were investigated using surface-enhanced Raman scattering (SERS) studies and compared with the normal Raman scattering (nRs) spectrum of TCAP. The observed nRs and SERS spectra of TCAP were validated theoretically using DFT quantum chemical calculations. Initially, the molecular structure of TCAP, TCAP-Ag3 , and TCAP-Au4 molecular systems were optimized and analyzed. The fabricated SCF and GCF are characterized using FESEM analysis, which confirms that the silver and gold nanoparticles of the corresponding films are spherical in shape. The obtained significant red-shift in UV-visible spectra of TCAP added on SCF and GCF surfaces reveal that the TCAP strongly adsorbed on SCF and GCF surfaces. The frontier molecular orbitals analysis authenticates the charge-transfer interaction from Ag3 and Au4 metal clusters to the TCAP molecule, leading to the adsorption of TCAP molecule on Ag3 and Au4 metal clusters, which validates the UV-vis results. SERS spectral analysis confirms that the TCAP chemisorbed on SCF and GCF surfaces with tilted orientation and the corresponding results were validated theoretically. The calculated SERS enhancement factor values illustrate that the GCF surface exhibits a higher SERS signal enhancement than the SCF surface. Therefore, the present investigation will be useful for the development of active SERS substrates and pyrrole-related biosensors.

Quantum Behavior of a Heavy Impurity Strongly Coupled to a Bose Gas.

We investigate the problem of an infinitely heavy impurity interacting with a dilute Bose gas at zero temperature. When the impurity-boson interactions are short-ranged, we show that boson-boson interactions induce a quantum blockade effect, where a single boson can effectively block or screen the impurity potential. Since this behavior depends on the quantum granular nature of the Bose gas, it cannot be captured within a standard classical-field description. Using a combination of exact quantum Monte Carlo methods and a truncated basis approach, we show how the quantum correlations between bosons lead to universal few-body bound states and a logarithmically slow dependence of the polaron ground-state energy on the boson-boson scattering length. Moreover, we expose the link between the polaron energy and the spatial structure of the quantum correlations, spanning the infrared to ultraviolet physics.

Enhanced Scattering between Electrons and Exciton-Polaritons in a Microcavity.

The interplay between strong light-matter interactions and charge doping represents an important frontier in the pursuit of exotic many-body physics and optoelectronics. Here, we consider a simplified model of a two-dimensional semiconductor embedded in a microcavity, where the interactions between electrons and holes are strongly screened, allowing us to develop a diagrammatic formalism for this system with an analytic expression for the exciton-polariton propagator. We apply this to the scattering of spin-polarized polaritons and electrons, and show that this is strongly enhanced compared with exciton-electron interactions. As we argue, this counterintuitive result is a consequence of the shift of the collision energy due to the strong light-matter coupling, and hence this is a generic feature that applies also for more realistic electron-hole and electron-electron interactions. We furthermore demonstrate that the lack of Galilean invariance inherent in the light-matter coupled system can lead to a narrow resonancelike feature for polariton-electron interactions close to the polariton inflection point. Our results are potentially important for realizing tunable light-mediated interactions between charged particles.

Severe Thrombocytopenia in COVID-19: A Conundrum in Dengue-endemic Areas.

Thrombocytopenia in coronavirus disease-2019 (COVID-19) can be attributed to multiple factors. Most often it is disease related. It is usually mild and if severe often associated with severe COVID-19 disease. It can also be due to drugs (Remdesivir, Tocilizumab) or coinfection with other viruses. Here we report two cases of severe thrombocytopenia in COVID-19 due to dengue coinfection. Most often the thrombocytopenia in dengue is self-resolving, and a careful "wait and watch" should suffice unlike COVID-19, where steroids can help if the cytopenia is due to cytokine storm or immune-mediated effects. HOW TO CITE THIS ARTICLE: Adarsh MB, Abraham A, Kavitha P, Nandakumar MM, Vaman RS. Severe Thrombocytopenia in COVID-19: A Conundrum in Dengue-endemic Areas. Indian J Crit Care Med 2021;25(4):465-466.

Radio-Frequency Response and Contact of Impurities in a Quantum Gas.

We investigate the radio-frequency spectroscopy of impurities interacting with a quantum gas at finite temperature. In the limit of a single impurity, we show using Fermi's golden rule that introducing (or injecting) an impurity into the medium is equivalent to ejecting an impurity that is initially interacting with the medium, since the "injection" and "ejection" spectral responses are simply related to each other by an exponential function of frequency. Thus, the full spectral information for the quantum impurity is contained in the injection spectral response, which can be determined using a range of theoretical methods, including variational approaches. We use this property to compute the finite-temperature equation of state and Tan contact of the Fermi polaron. Our results for the contact of a mobile impurity are in excellent agreement with recent experiments and we find that the finite-temperature behavior is qualitatively different compared to the case of infinite impurity mass.

Quasiparticle Lifetime of the Repulsive Fermi Polaron.

We investigate the metastable repulsive branch of a mobile impurity coupled to a degenerate Fermi gas via short-range interactions. We show that the quasiparticle lifetime of this repulsive Fermi polaron can be experimentally probed by driving Rabi oscillations between weakly and strongly interacting impurity states. Using a time-dependent variational approach, we find that we can accurately model the impurity Rabi oscillations that were recently measured for repulsive Fermi polarons in both two and three dimensions. Crucially, our theoretical description does not include relaxation processes to the lower-lying attractive branch. Thus, the theory-experiment agreement demonstrates that the quasiparticle lifetime is dominated by many-body dephasing within the upper repulsive branch rather than by relaxation from the upper branch itself. Our findings shed light on recent experimental observations of persistent repulsive correlations, and have important consequences for the nature and stability of the strongly repulsive Fermi gas.

Spectroscopic Signatures of Quantum Many-Body Correlations in Polariton Microcavities.

We theoretically investigate the many-body states of exciton polaritons that can be observed by pump-probe spectroscopy in high-Q inorganic microcavities. Here, a weak-probe "spin-down" polariton is introduced into a coherent state of "spin-up" polaritons created by a strong pump. We show that the ↓ impurities become dressed by excitations of the ↑ medium, and that they form new polaronic quasiparticles that feature two-point and three-point many-body quantum correlations that, in the low density regime, arise from coupling to the vacuum biexciton and triexciton states, respectively. In particular, we find that these correlations generate additional branches and avoided crossings in the ↓ optical transmission spectrum that have a characteristic dependence on the ↑-polariton density. Our results thus demonstrate a way to directly observe correlated many-body states in an exciton-polariton system that go beyond classical mean-field theories.

Variational Approach for Impurity Dynamics at Finite Temperature.

We present a general variational principle for the dynamics of impurity particles immersed in a quantum-mechanical medium. By working within the Heisenberg picture and constructing approximate time-dependent impurity operators, we can take the medium to be in any mixed state, such as a thermal state. Our variational method is consistent with all conservation laws and, in certain cases, it is equivalent to a finite-temperature Green's function approach. As a demonstration of our method, we consider the dynamics of heavy impurities that have suddenly been introduced into a Fermi gas at finite temperature. Using approximate time-dependent impurity operators involving only one particle-hole excitation of the Fermi sea, we find that we can successfully model the results of recent Ramsey interference experiments on ^{40}K atoms in a ^{6}Li Fermi gas. We also show that our approximation agrees well with the exact solution for the Ramsey response of a fixed impurity at finite temperature. Our approach paves the way for the investigation of impurities with dynamical degrees of freedom in arbitrary quantum-mechanical mediums.

Cereal by-products as an important functional ingredient: effect of processing.

Cereal is a staple food and major nutrition source throughout the world. The cereal bran obtained from milling as by-product contains multiple benefits and health-promoting components such as dietary fiber, minerals, vitamins, polyphenols, and phytosterols. However, these by-products are usually undervalued and used in animal feed. To increase the functional and food value, processing techniques linked to improving nutritional characteristics, sensory properties and reducing the inhibitory factors have been developed. These processing techniques include mechanical, enzymatic and thermal processing. It aims to improve the functional properties, enhance the extractability of beneficial food ingredients, reduce the complex structure of the bran and improve solubility, decrease the content of inhibitory factors and improve the bio-accessibility of micronutrients. This review highlights the various technological interventions and application of appropriate processing techniques to process cereal bran for the isolation of functional food ingredient and thus utilizing the nutritious by-product of cereal processing industry.

Impurity-Induced Multibody Resonances in a Bose Gas.

We investigate the problem of N identical bosons that are coupled to an impurity particle with infinite mass. For noninteracting bosons, we show that a dynamical impurity-boson interaction, mediated by a closed-channel dimer, can induce an effective boson-boson repulsion which strongly modifies the bound states consisting of the impurity and N bosons. In particular, we demonstrate the existence of two universal "multibody" resonances, where all multibody bound states involving any N emerge and disappear. The first multibody resonance corresponds to infinite impurity-boson scattering length, a→+∞, while the second corresponds to the critical scattering length a^{*}>0 beyond which the trimer (N=2 bound state) ceases to exist. Crucially, we show that the existence of a^{*} ensures that the ground-state energy in the multibody bound-state region, ∞>a>a^{*}, is bounded from below, with a bound that is independent of N. Thus, even though the impurity can support multibody bound states, they become increasingly fragile beyond the dimer state. This has implications for the nature of the Bose polaron currently being studied in cold-atom experiments.