ABSTRACT
Over the last decades, the increased incidence of metabolic disorders, such as type two diabetes and obesity, has motivated researchers to investigate new enzyme inhibitors. Inhibition of the α-amylase enzyme is one therapeutic approach in lowering glucose levels in the blood to manage diabetes mellitus. The objective of this study was to synthesize short α-/ß-mixed peptides in the solution phase. The Boc-protected α-L-leucine was converted to ß-analogue by using Arndt-Eistert synthesis with the advantage of no racemization and retention of configuration. Three novel short peptides were successfully synthesized: N(Boc)-Gly-ß-Leu-OCH3(14), N(Boc)-O(Bz)α-Ser-ß-Leu-OCH3(16), and N(Boc)-O(Bz)-α-Tyr-α-Gly-ß-Leu-OCH3(17), characterized by FTIR and 1H NMR analysis. The synthesized peptide 16 showed highest inhibitory activity (45.22%) followed by peptide 14 (18.51%) and peptide 17 (17.05%), respectively. Intriguingly, peptide 16 showed higher inhibition on α-amylase compared with other α-/ß-mixed peptides.
Subject(s)
Peptides , alpha-Amylases , alpha-Amylases/antagonists & inhibitors , Peptides/chemistry , Peptides/chemical synthesis , Peptides/pharmacology , Enzyme Inhibitors/chemistry , Enzyme Inhibitors/chemical synthesis , Enzyme Inhibitors/pharmacologyABSTRACT
Obesity is a source of significant pathologies and deadly diseases, including heart disease, diabetes, and cancer. One of the most intriguing strategies in the hunt for new anti-obesity medications is the inhibition of pancreatic lipase (PL). This study presents a novel application of short α and ß-mixed peptides as pancreatic lipase inhibitors. These peptides were synthesized in the solution phase and characterized using FTIR and 1H-NMR. L-proline is present in a high percentage of natural anti-lipase peptides and was used as a ß-amino acid in this study to enhance anti-lipase activity and proteolytic stability. Moreover, L-α-proline was converted to ß-amino acid derivatives using the Arndt-Eistert method with the advantage of stereo control at the α-carbon. The synthesized peptides with anti-lipase activity are N-Boc-ß-Pro-Gly-OBz (93%), N-Boc-O-Bz-Tyr-ß-Pro-ß-Pro-Gly-OBz (92%), N-Boc-O-Bz-Tyr-ß-Pro-COOH (91%), N-Boc-Phe-ß-Pro-OCH3 (90%), and N-Boc-O-Bz-Tyr-ß-Pro-OCH3 (89%). These peptides may function as lead molecules for further modification to more significant molecules, which can help control obesity.
Subject(s)
Peptides , Proline , Humans , Peptides/pharmacology , Peptides/chemistry , Amino Acids , Lipase , ObesityABSTRACT
PURPOSE: To assess the use of a 2-mm miniplate as a dorsal blocking plate to stabilize the central avulsion fragment in a proximal interphalangeal joint (PIP) volar fracture dislocation. METHODS: This was a case series comprising 8 patients with volar fracture dislocation of the PIP joint. The average age of the patients was 36 years. The patients were managed by this technique within an average of 11 days following the injury. The clinical outcome measurements included the assessment of pain and range of motion of the PIP and distal interphalangeal joints. RESULTS: The average follow-up duration was 20 months. The mean visual analog scale pain score was 1.9. The average range of motion of the PIP joint was 82°, whereas the average range of motion of the distal interphalangeal joint was 43°. Reduction of the subluxation was achieved in all cases, with no articular step remaining. CONCLUSIONS: A dorsal blocking plate is a simple technique, associated with a satisfactory outcome, for volar fracture dislocation injuries of the PIP joint. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
Subject(s)
Finger Injuries , Fracture Dislocation , Fractures, Bone , Joint Dislocations , Adult , Bone Plates , Finger Injuries/diagnostic imaging , Finger Injuries/surgery , Finger Joint/diagnostic imaging , Finger Joint/surgery , Fracture Dislocation/diagnostic imaging , Fracture Dislocation/surgery , Fracture Fixation, Internal/methods , Humans , Joint Dislocations/diagnostic imaging , Joint Dislocations/surgery , Range of Motion, ArticularABSTRACT
PURPOSE: To describe a surgical approach for open repair of the triangular fibrocartilage complex foveal avulsion via ulnar styloid osteotomy, and to assess its clinical results. METHODS: We reviewed 12 patients with distal radioulnar joint (DRUJ) instability due to isolated foveal avulsion of DRUJ ligaments. Wrist arthroscopy was conducted for all patients to exclude the presence of concomitant tear of the superficial part of the triangular fibrocartilage complex and to corroborate the diagnosis with a positive hook test. Through an ulnar approach between flexor and extensor carpi ulnaris, an ulnar styloid osteotomy was performed under image intensifier control just ulnar to the fovea of the head of the ulna. The avulsed foveal attachment was anchored through transosseous sutures passing from the fovea to the neck of the ulna. The ulnar styloid was fixed by means of screws or tension band wires. Outcome measures included clinical assessment of pain (visual analog scale), grip strength, DRUJ instability, range of motion of the wrist, and modified Mayo wrist score. Radiographic assessment was done to determine union of the ulnar styloid osteotomy, DRUJ subluxation, and any hardware-related problems. RESULTS: Outcome measures were evaluated after a mean follow-up of 21 months. Healing of the osteotomy was obtained in all cases by 11 weeks. The DRUJ laxity, visual analog scale, and modified Mayo wrist score improved, while grip strength and range of motion remained unchanged. One patient had prominent hardware necessitating removal after union of the osteotomy. There were no reported cases of injury or neuropraxia of the dorsal cutaneous branch of the ulnar nerve. CONCLUSIONS: Open repair of an avulsed foveal attachment of the triangular fibrocartilage complex using an ulnar styloid osteotomy is an alternative to either open or arthroscopic repair approaches. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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OBJECTIVE: To determine the effects of Pilates exercises on pain, knee range of motion and functional disability in women with knee osteoarthritis. METHODS: The double-blind randomised controlled trial was conducted at the National Orthopaedic Hospital, Bahawalpur, Pakistan, from April to September 2018, and comprised female patients with knee osteoarthritis. The subjects were selected and randomised into control group A receiving isometrics and intervention group B receiving Pilates exercises. Both groups received one-hour sessions 3 times per week for 8 weeks. The groups were assessed at baseline and at the end of the 8th week using numeric pain rating scale and Western Ontario and McMaster Universities osteoarthritis index for pain and functionality level respectively. Data was analysed using SPSS 23. RESULTS: Of 44 patients, there were 22(50%) in each of the two groups. Mean age of group B was 57.60±6.34 years, and it was 55.65±7.28 in group B. Mean body mass index of group B was 25.812±4.16, and it was 26.93±4.4 in group A. The study was completed by 40(91%) patients; 20(50%) in each of the two groups. Both groups showed significant improvement for pain, range of motion and physical function post-intervention (p<0.05). Group B showed significantly more improvement in terms of pain and physical function compared to group A (p<0.05). CONCLUSIONS: Pilates exercises were found to be more effective in the treatment of patients with knee osteoarthritis. TRIAL REGISTRATION NUMBER: Chi CTR 2000030486.
Subject(s)
Exercise Movement Techniques , Osteoarthritis, Knee , Exercise Therapy , Female , Humans , Middle Aged , Osteoarthritis, Knee/therapy , Range of Motion, Articular , Treatment OutcomeABSTRACT
A new non-stationary (NS) geometry-based stochastic model (GBSM) is presented for developing and testing the communication systems of vehicle-to-vehicle (V2V) applications, which considers the three-dimensional (3D) scattering environments and allows 3D velocity as well. In this paper, the proposed GBSM for NS V2V channels allowed 3D velocity variations and was more suitable for actual V2V communications because it provided smoother transitions between the consecutive channel segments. The time-variant channel coefficient and the channel parameters, i.e., Doppler frequencies, path delay and power, angle of arrival (AoA), and angle of departure (AoD), were analyzed and derived. Likewise, the theoretical statistical properties as the probability density function (PDF), the auto-correlation function (ACF), and Doppler power spectral density (DPSD) were also analyzed and derived under the von Mises-Fisher (VMF) distribution. Finally, the theoretical and measured results were well coordinated alongside the implemented results, which confirmed the feasibility of the introduced model along with the theoretical expressions.
ABSTRACT
PURPOSE: To report the results of our modified technique for repair of the EWAS 1 lesion of triangular fibrocartilage complex (TFCC). METHODS: This retrospective case series reviewed 22 consecutive patients with EWAS 1 TFCC tear. Arthroscopic repair was done using our modified double-loop arthroscopic outside-in technique which is originally described by Mathoulin and Del Piñal. The repair was performed using single-strand suture and 18-gauge cannula, having three passes through the tear. Follow-ups ranged from 24 to 33 months with an average of 29.3 months. The results were evaluated by the Modified Mayo Wrist Score (MMWS), Visual Analog Score (VAS). In addition, range of motion (ROM) and power grip were compared with the contralateral side. RESULTS: The mean age was 23 years. The dominant side was affected in 16 wrists. There was postoperative improvement of the all functional outcome measures (MMWS, VAS, ROM, and power grip). All the patients returned to their previous activities with no reported intra- or postoperative complications. CONCLUSIONS: The described outside-in technique is safe and effective technique for repair of EWAS 1 TFCC tear. LEVEL OF EVIDENCE: Therapeutic, case series, level IV.
Subject(s)
Triangular Fibrocartilage , Wrist Injuries , Arthroscopy , Humans , Infant, Newborn , Retrospective Studies , Treatment Outcome , Triangular Fibrocartilage/surgery , Wrist JointABSTRACT
PURPOSE: This is a purely observational study with a literature comparison to assess the effectiveness of radial and ulnar arteries propeller perforator-based flaps in post-traumatic soft tissue reconstruction and identify the risk factors for complications. METHODS: Sixteen patients were involved with post-traumatic wrist and hand soft tissue defects not exceeding 5 × 20 cm. Defects were covered with propeller radial and ulnar arteries perforator-based flaps. Patient demographics, soft tissue defects, complications and clinical outcomes were recorded. Assessment of patients' satisfaction for donor site morbidity and aesthetic outcome of the flap were performed. RESULTS: Radial artery propeller perforator flap was performed in seven cases, and ulnar artery propeller perforator flap was done in nine cases. The size of the skin paddle ranged from 2.5 × 5 cm to 4.5 × 10.5 cm. Primary closure of the donor site was performed in all cases. One flap was lost, while superficial epidermolysis occurred in seven cases (45%). Edge necrosis ranging between 3 and 7 mm occurred in nine cases (60%). Patients' factors, mode of injury, associated injuries and interval between trauma and coverage were all correlated with complication incidence. The patients' satisfaction for donor site morbidity was very good and good in 80% of patients, while satisfaction for aesthetic outcome of the flap was very good and good in only 40%. CONCLUSION: Radial and ulnar arteries have reliable perforators for flap elevation, which produce reliable outcome for small- and medium-sized soft tissue reconstruction. Effectiveness decreases in post-traumatic reconstructions. Complications are more frequent in crushing injuries especially if associated with bony fractures. Most complications in trauma cases were attributed to venous congestion, for which supercharging with a vein if accessible to the surgeon is recommended.
Subject(s)
Perforator Flap , Plastic Surgery Procedures , Soft Tissue Injuries , Humans , Reproducibility of Results , Soft Tissue Injuries/etiology , Soft Tissue Injuries/surgery , Treatment Outcome , Wrist , Wrist JointABSTRACT
Soil salinity is a major source of abiotic plant stress, adversely affecting plant growth, development and productivity. Although the physiological and molecular mechanisms that underlie plant responses to salt stress are becoming increasingly understood, epigenetic modifications, such as histone methylations and their potential regulation of the transcription of masked genes at the genome level in response to salt stress, remain largely unclear. Castor bean, an important nonedible oil crop, has evolved the capacity to grow under salt stress. Here, based on high-throughput RNA-seq and ChIP-seq data, we systematically investigated changes in genomic transcription and histone methylation using typical histone H3 lysine 4 trimethylation (H3K4me3) and histone H3 tri-methylated lysine 27 (H3K27me3) markers in castor bean leaves subjected to salt stress. The results showed that gain or loss of histone methylation was closely associated with activated or repressed gene expression, though variations in both transcriptome and histone methylation modifications were relatively narrow in response to salt stress. Diverse salt responsive genes and switched histone methylation sites were identified in this study. In particular, we found for the first time that the transcription of the key salt-response regulator RADIALIS-LIKE SANT (RSM1), a MYB-related transcription factor involved in ABA(abscisic acid)-mediated salt stress signaling, was potentially regulated by bivalent H3K4me3-H3K27me3 modifications. Combining phenotypic variations with transcriptional and epigenetic changes, we provide a comprehensive profile for understanding histone modification, genomic transcription and their associations in response to salt stress in plants.
Subject(s)
Gene Expression Regulation, Plant , Histones/metabolism , Ricinus communis/metabolism , Transcription, Genetic , Ricinus communis/physiology , Gene Expression Regulation, Plant/physiology , Histone Code , Methylation , Plant Leaves/metabolism , Plant Leaves/physiology , Salt Stress , Transcription, Genetic/physiologyABSTRACT
PURPOSE: To compare combined ulnar nerve repair with supercharged end-to-side anterior interosseous nerve to ulnar motor nerve transfer (UR+SETS) with conventional isolated ulnar repair techniques in proximal ulnar nerve transection, with respect to intrinsic muscle power recovery and claw hand deformity correction. METHODS: We conducted a comparative matched-paired series prospectively on 21 patients with proximal ulnar nerve transection injury. Eleven patients were managed by UR+SETS and 10 by isolated ulnar repair. The outcome was reported at 3, 6, 12, and 18 months using the score of Birch and Raji and Brand's criteria. RESULTS: A total of 21 patients with acute proximal ulnar nerve transection injury had completed 18 months' follow-up. We observed better results in the UR+SETS group regarding the return of intrinsic function and reduction of deformity with earlier improvement in the score of Birch and Raji and Brand's criteria. CONCLUSIONS: In the short term, UR+SETS transfer appears to result in better intrinsic muscle reinnervation and clawing deformity correction after proximal ulnar nerve transection injury. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
Subject(s)
Nerve Transfer , Ulnar Nerve , Forearm , Humans , Ulnar Artery , Ulnar Nerve/surgeryABSTRACT
After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidenced-based argument for the fundamental role of surgery and anaesthesia within cost-effective health systems strengthening global strategy. The launch of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care in 2015 has further coordinated efforts to build priority for surgical care and anaesthesia. These combined efforts culminated in the approval of a World Health Assembly resolution recognizing the role of surgical care and anaesthesia as part of universal health coverage. Momentum gained from these milestones highlights the need to identify consensus goals, targets and indicators to guide policy implementation and track progress at the national level. Through an open consultative process that incorporated input from stakeholders from around the globe, a global target calling for safe surgical and anaesthesia care for 80% of the world by 2030 was proposed. In order to achieve this target, we also propose 15 consensus indicators that build on existing surgical systems metrics and expand the ability to prioritize surgical systems strengthening around the world.
Subject(s)
Anesthesia , Health Services Accessibility , Obstetrics , Surgical Procedures, Operative , Wounds and Injuries/surgery , Capacity Building , Consensus , Global Health , Goals , HumansABSTRACT
BACKGROUND: Children with sickle cell disease (SCD) often have obstructive lung function abnormalities which could be due to asthma or increased pulmonary blood volume; it is important to determine the underlying mechanism to direct appropriate treatment. In asthmatics, exhaled nitric oxide (FeNO) is elevated. FeNO, however, can also be raised due to increased alveolar production. Our aim, therefore, was to determine if airway or alveolar NO production differed between SCD children and ethnic and age-matched controls. METHODS: Lung function, airway NO flux and alveolar NO production, and effective pulmonary blood flow were assessed in 18 SCD children and 18 ethnic and age-matched controls. RESULTS: The SCD children compared to the controls had a higher respiratory system resistance (P = 0.0008), alveolar NO production (P = 0.0224), and pulmonary blood flow (P < 0.0001), but not airway NO flux. There was no significant correlation between FeNO and respiratory system resistance in either group, but in the SCD children, there were correlations between alveolar NO production (P = 0.0006) and concentration (P < 0.0001) and pulmonary blood flow. CONCLUSION: Airway NO flux was not elevated in the SCD children nor correlated with airways obstruction, suggesting that airways obstruction, at least in some SCD children, is not due to asthma.
Subject(s)
Airway Obstruction/etiology , Airway Resistance , Anemia, Sickle Cell/complications , Lung/metabolism , Nitric Oxide/metabolism , Pulmonary Circulation , Adolescent , Airway Obstruction/diagnosis , Airway Obstruction/metabolism , Airway Obstruction/physiopathology , Anemia, Sickle Cell/diagnosis , Biomarkers/metabolism , Blood Flow Velocity , Breath Tests , Case-Control Studies , Child , Female , Humans , Lung/blood supply , Lung/physiopathology , Male , Respiratory Function Tests , Risk FactorsABSTRACT
Plant-specific GRAS transcription factors play important roles in regulating growth, development, and stress responses. Castor beans (Ricinus communis) are important non-edible oilseed plants, cultivated worldwide for its seed oils and its adaptability to growth conditions. In this study, we identified and characterized a total of 48 GRAS genes based on the castor bean genome. Combined with phylogenetic analysis, the castor bean GRAS members were divided into 13 distinct groups. Functional divergence analysis revealed the presence of mostly Type-I functional divergence. The gene structures and conserved motifs, both within and outside the GRAS domain, were characterized. Gene expression analysis, performed in various tissues and under a range of abiotic stress conditions, uncovered the potential functions of GRAS members in regulating plant growth development and stress responses. The results obtained from this study provide valuable information toward understanding the potential molecular mechanisms of GRAS proteins in castor beans. These findings also serve as a resource for identifying the genes that allow castor beans to grow in stressful conditions and to enable further breeding and genetic improvements in agriculture.
Subject(s)
Evolution, Molecular , Genome, Plant , Multigene Family , Plant Proteins/genetics , Ricinus/genetics , Stress, Physiological , Conserved Sequence , Gene Expression Regulation, Plant , Phylogeny , Plant Proteins/metabolism , Ricinus/classification , Ricinus/metabolismABSTRACT
BACKGROUND: Anterior knee pain is the most common complaint after intramedullary nail of the tibia. The incidence of anterior knee pain ranges from 10-86% and the exact ethology is unclear. Transpatellar tendon approach is commonly used for tibial intramedullary interlocking nailing but it can also be done through medial parapatellar tendon approach. The objective of the study was to compare post-operative anterior knee pain after intramedullary nailing technique by transpatellar approach compared to medial parapatellar approach. METHODS: This randomized controlled trial was carried out in Department of Orthopaedic and Spine Surgery, Ghurki trust teaching hospital, Lahore from 20th February to 19th Nov 2015. Sixty patients who presented at emergency department for the treatment of simple tibial shaft fractures were included in the study. They were divided into two groups with 30 patients in each group, Group A containing patients operated through transpatellar tendon approach while group B containing patients operated through medial parapatellar tendon approach. RESULTS: In Group A, 27 patients were male and 3 patients were female with a mean age of 28.667±9.63 while in Group B, 28 were male and 2 were female with a mean age of 34.63±15.82. The main causes of tibial shaft fractures were RTA followed by fall. In Group A mean anterior knee pain was 4.4 while in Group B, it was was 2.5 with a p-value of .000. CONCLUSIONS: This study shows that medial parapatellar tendon approach causes less pain as compared to transpatellar approach.
Subject(s)
Fracture Fixation, Intramedullary/methods , Pain, Postoperative/etiology , Tibial Fractures/surgery , Adult , Female , Humans , Male , Visual Analog ScaleABSTRACT
PURPOSE: To evaluate the validity of performing a static anti-claw procedure (metacarpophalangeal joint volar capsulorrhaphy and A1 and A2 pulley release) at the time of ulnar nerve repair for acute or chronic lacerations to prevent development of claw hand deformity and disability or to correct them. METHODS: We present a case series of 14 patients for whom metacarpophalangeal joint capsulorrhaphy and pulley advancement were done at the time of ulnar nerve management. Direct nerve repair was performed in 10 patients, nerve grafting in 2, neurolysis in 1, and combined direct repair and anterior interosseous nerve transfer in 1. Outcome measurements included assessment of claw hand correction and sequence of phalangeal flexion according to modified evaluation criteria of Brand and motor recovery of ulnar nerve function using the British Medical Research Council (MRC) scale. RESULTS: Average follow-up was 39 months. At 3 months, 12 patients had good and 2 had fair claw hand correction. At 6 months, 2 patients had excellent, 10 patients had good, and 2 patients had fair correction. At final follow-up, 13 patients had good to excellent correction and 1 had fair correction. Motor recovery of the intrinsic muscles was rated from 2 to 5 according to the MRC scale. CONCLUSIONS: This technique is simple and effective. It acts as an internal orthosis during recovery of sufficient strength of the intrinsic muscles. In cases of incomplete recovery of the intrinsic muscles (up to MRC grade 2), it may eliminate the need for secondary surgery to correct a claw hand deformity. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Subject(s)
Hand Deformities, Acquired/prevention & control , Hand Injuries/surgery , Joint Capsule/surgery , Lacerations/surgery , Metacarpophalangeal Joint/surgery , Ulnar Nerve/surgery , Ulnar Neuropathies/complications , Ulnar Neuropathies/surgery , Adolescent , Adult , Child, Preschool , Female , Follow-Up Studies , Humans , Male , Middle Aged , Recovery of FunctionABSTRACT
This intriguing case report explores an interesting complication following percutaneous cholecystostomy for the management of acute cholecystitis in an elderly female with multiple comorbidities. Despite initial improvement, she later presented with recurrent symptoms, due to a collection of gallstones, that had migrated through the cholecystostomy tract, requiring exploration, stone retrieval and abscess drainage. While percutaneous cholecystostomy remains an effective treatment for managing acute cholecystitis in high-risk surgical candidates, this case highlights the rare yet critical risk of extrahepatic gallstones and abscess formation. It emphasises the necessity for vigilance in detecting and managing complications associated with percutaneous transhepatic cholecystostomy, ensuring timely diagnosis and effective treatment.
Subject(s)
Cholecystitis, Acute , Cholecystostomy , Gallstones , Humans , Female , Cholecystostomy/adverse effects , Cholecystostomy/methods , Cholecystitis, Acute/surgery , Gallstones/surgery , Abscess/etiology , Drainage/methods , Postoperative Complications/etiology , Aged, 80 and over , AgedABSTRACT
Knee pain encompasses a wide array of differential diagnoses and can often pose a diagnostic challenge, as it can have traumatic or non-traumatic causes. A good clinical history, assessment and anatomical knowledge gives a strong foundation to narrow down the diagnosis, and understanding the correct imaging modality and findings further informs correct and timely management. This article reviews various disease processes including fractures, inflammatory, infective and neoplastic causes, and discusses the assessment and various imaging modalities to aid diagnosis in both primary and secondary care.
Subject(s)
Fractures, Bone , Pain , Humans , Pain/etiology , Diagnosis, Differential , Secondary CareABSTRACT
Introduction Total knee arthroplasty is the standard of care treatment for advanced knee osteoarthritis. However, patients frequently continue to have pain and disability after surgery, with one of the most common reasons being a bone-implant mismatch. Notably, there is a significant difference reported in proximal tibia morphometry between Asian and Caucasian populations, and the currently available implants do not account for the anthropometric variations observed across ethnicities. We aimed to evaluate the proximal tibia anthropometry in a Pakistani population. Materials and methods A study was conducted at The Indus Hospital, Karachi Campus, from August 2019 to July 2020. All consecutive patients fulfilling the eligibility criteria and undergoing knee replacement surgery were included in the study. Baseline characteristics and anthropometry of proximal tibia were recorded on a pre-designed proforma. Statistical analysis was done using SPSS version 24. Results A total of 30 patients were enrolled in this study, which included 17 females (56.7%) and 13 males (43.3%). The mean age was 61.6± 7.9 years and the BMI was 33±5.7 kg/m2. There was a significant difference found in the anteroposterior and mediolateral dimensions in both genders. A significant association was noted with body mass index (p-value 0.01) and occupation (p-value=0.02). Conclusion The results indicated that the anatomical profile of the proximal tibia in the Pakistani population is distinct, thus stressing the fact that it requires developing prostheses specifically tailored to this population's sizing requirements.
ABSTRACT
Aim: This study aimed to assess the impact of routine histological examination of stapled colorectal anastomotic doughnuts in patients undergoing rectal cancer surgery (RCS). Justification of biopsy examination could form part of the strategies of NHS net zero practice with effort to reduce wastage and carbon footprint. Method: A data analysis of all patients undergoing RCS during 2019-2021 at our institute was performed. We also analysed the cost of preparing and reviewing histology slides. Results: 52 patients underwent anterior resection during the aforementioned period. Doughnuts were sent in 37 (71%) patients. 23 (62%) patients were male, and 14 (38%) were female. The median age at diagnosis was 68 (range 54-84) years. All resected specimens were adenocarcinomas. Of the 37 patients, 18 (49%) underwent low anterior resection and 19 (51%) underwent high anterior resection. Proximal doughnuts were sent in 26 (70%) patients, whereas distal doughnuts were sent in all cases. Mean distal microscopic resection margin from tumour was 22 mm (range 6-45 mm). Each doughnut required 3 slides, each costing £50 and requiring 82 minutes to fix and read. This incurred a cost of £13,650 and required 19,656 hours of preparation time. All of the doughnuts as well as resection margins were negative for malignancy. Conclusion: Routine histopathological examination of doughnuts is time and cost-intensive however provides little or no clinical value (particularly analysis of the proximal doughnut). Distal doughnuts should only be sent for histological examination in exceptional circumstances.
Subject(s)
Cost-Benefit Analysis , Rectal Neoplasms , Humans , Female , Male , Middle Aged , Aged , Aged, 80 and over , Rectal Neoplasms/surgery , Rectal Neoplasms/pathology , Rectal Neoplasms/economics , Adenocarcinoma/surgery , Adenocarcinoma/pathology , Adenocarcinoma/economics , Margins of Excision , Retrospective Studies , Anastomosis, Surgical/economicsABSTRACT
Worldwide environmental challenges pose critical problems with the growth of the global economy. Addressing these issues requires the development of an eco-friendly and sustainable catalyst for degrading organic dye pollutants. In this study, copper-doped magnesium aluminates (CuxMg1-xAl2O4) with x = 0.0-0.8 were synthesized using a citrate-based combustion route. The inclusion of Cu(II) significantly impacted the structural, microstructural, optical, and photocatalytic activity of the catalyst. Rietveld analysis of X-ray diffraction powder profiles revealed single-phase spinels crystallized in the face-centered cubic unit cell with Fd 3 ¯ m space group. Chemical states of the ions, surface morphology, and elemental investigation were analyzed by X-ray photoelectron spectroscopy, field-emission scanning electron microscopy, and energy-dispersive X-ray spectroscopy, respectively. UV-visible and diffuse reflectance spectroscopies confirmed the reduction of the band gap due to Cu(II) doping, validated by first-principle investigations using the WIEN2k code. The catalyst with x = 0.8 showed higher photocatalytic efficacy (90% and 93%) for removing two azo organic dye pollutants, rhodamine B and methyl orange, respectively, within 120 min. Degradation kinetics followed a pseudo-first-order mechanism. The doped (0.8) sample was structurally and morphologically stable and reusable under visible irradiation, retaining performance after three runs. Scavenger studies confirmed hydroxyl and superoxide radicals' involvement in the degradation. This work presents an effective approach to enhancing CuxMg1-xAl2O4 catalysts' photodegradation performance, with potential applications in pharmaceuticals and wastewater remediation.