Lateral extra-articular tenodesis does not enhance ACL graft healing, however, does reduce graft tunnel widening.

PURPOSE: The study hypothesized that the addition of lateral extra-articular tenodesis (LEAT) in anterior cruciate ligament reconstruction (ACLR) had a significant effect on ACL graft healing. METHODS: A total of 80 patients were divided into two cohorts matched for gender, age, body mass index, time from surgery to post-operative MRI and graft diameter. Forty patients underwent ACL reconstruction alone, while 40 underwent ACLR in addition to LEAT. Patients underwent a magnetic resonance imaging scan at 12 months post-surgery; tunnel apertures were measured using multiplanar reformation, graft healing was assessed using signal-to-noise quotient (SNQ) in three regions of interest and finally graft maturity and integration were classified using the Howell and Ge scale, respectively. In addition, clinical evaluation and patient-reported outcome measures were collected. RESULTS: The mean femoral tunnel widening at 12 months post-surgery was 39.8 ± 14.0% in the ACLR + LEAT group and 55.2 ± 12.7% in the ACLR alone group (p < 0.05). The mean tibial tunnel widening was 29.3 ± 12.7% in the ACLR + LEAT group and 44.4 ± 12.1% in the ACLR group (p < 0.05). The mean adjusted graft SNQ was 9.0 ± 14.9 in the ACLR + LEAT group and 9.5 ± 11.4 in the ACLR group (n.s.). CONCLUSION: At 1 year post-operatively, we noted significantly less femoral and tibial tunnel widening in the ACLR + LEAT group. LEAT did not result in a statistically significant effect on graft healing. LEVEL OF EVIDENCE: Level III.

Control of mRNA translation by dynamic ribosome modification.

Control of mRNA translation is a crucial regulatory mechanism used by bacteria to respond to their environment. In the soil bacterium Pseudomonas fluorescens, RimK modifies the C-terminus of ribosomal protein RpsF to influence important aspects of rhizosphere colonisation through proteome remodelling. In this study, we show that RimK activity is itself under complex, multifactorial control by the co-transcribed phosphodiesterase trigger enzyme (RimA) and a polyglutamate-specific protease (RimB). Furthermore, biochemical experimentation and mathematical modelling reveal a role for the nucleotide second messenger cyclic-di-GMP in coordinating these activities. Active ribosome regulation by RimK occurs by two main routes: indirectly, through changes in the abundance of the global translational regulator Hfq and directly, with translation of surface attachment factors, amino acid transporters and key secreted molecules linked specifically to RpsF modification. Our findings show that post-translational ribosomal modification functions as a rapid-response mechanism that tunes global gene translation in response to environmental signals.

Pseudomonas syringae addresses distinct environmental challenges during plant infection through the coordinated deployment of polysaccharides.

Prior to infection, phytopathogenic bacteria face a challenging environment on the plant surface, where they are exposed to nutrient starvation and abiotic stresses. Pathways enabling surface adhesion, stress tolerance, and epiphytic survival are important for successful plant pathogenesis. Understanding the roles and regulation of these pathways is therefore crucial to fully understand bacterial plant infections. The phytopathogen Pseudomonas syringae pv. tomato (Pst) encodes multiple polysaccharides that are implicated in biofilm formation, stress survival, and virulence in other microbes. To examine how these polysaccharides impact Pst epiphytic survival and pathogenesis, we analysed mutants in multiple polysaccharide loci to determine their intersecting contributions to epiphytic survival and infection. In parallel, we used qRT-PCR to analyse the regulation of each pathway. Pst polysaccharides are tightly coordinated by multiple environmental signals. Nutrient availability, temperature, and surface association strongly affect the expression of different polysaccharides under the control of the signalling protein genes ladS and cbrB and the second messenger cyclic-di-GMP. Furthermore, functionally redundant, combinatorial phenotypes were observed for several polysaccharides. Exopolysaccharides play a role in mediating leaf adhesion, while α-glucan and alginate together confer desiccation tolerance. Our results suggest that polysaccharides play important roles in overcoming environmental challenges to Pst during plant infection.

NH2-MIL-125(Ti) doped CdS/Graphene composite as electro and photo catalyst in basic medium under light irradiation.

The development of active electrocatalysts and photocatalysts for hydrogen evolution reaction (HER) and for environmental remediation is a huge challenge. Research is still underway on the development of low-cost catalytic materials with appreciable efficiency for HER. In the present study, a composite of metal organic framework (MOF) with CdS and graphene (NH2-MIL-125(Ti)/CdS-graphene) composites were developed with different loadings of graphene material via solvothermal technique. Further the electrocatalytic activity of the synthesized catalysts were investigated for HER and photocatalytic degradation of dye. Results show that the synthesized catalyst with a less amount of graphene was more active. HER results showed a less Tafel slope of 70.8 and 61.9 mVdec-1 with 15.6 mA/cm2 and 15.46 mA/cm2 current densities under light on and off conditions. Further the dye degradation activity of the synthesized catalysts was tested with Rhodamine B dye and results showed that the catalyst showed excellent activity for low weight loading of graphene with a degradation efficiency of 95 % and followed pseudo first order kinetic model. Overall results showed that the synthesized composites are promising for HER and photocatalytic applications.

Gabapentin controlled substance status.

Gabapentin is approved to treat postherpetic neuralgia and epilepsy with partial-onset seizures. The large majority of gabapentin prescribing is off label. Gabapentin may be abused for euphoria, potentiating the high from opiates, reduction of alcohol cravings, a cocaine-like high, as well as sedation or sleep. Individuals at the highest risk for abusing gabapentin include those with opioid abuse, mental illness, or previous history of prescription drug abuse. States are now taking action to track gabapentin use through prescription monitoring programs, and some states have reclassified it as a Schedule V controlled substance. This commentary summarizes gabapentin's abuse potential, identifies state-level actions regarding gabapentin monitoring, and discusses possible clinical implications and ways to enhance patient safety when prescribing gabapentin.

Current hip cartilage regeneration/repair modalities: a scoping review of biologics and surgery.

PURPOSE: The rapidly growing and emerging nature of biologics have made indications for regenerative and reparative hip therapies ever changing, with at times only early-stage evidence for their use. The purpose of this study was to review and summarize the currently available data on the management of hip cartilage injuries and osteoarthritis. METHODS: A scoping review of the available scientific literature for hip biologics was performed, with available evidence for hyaluronic acid (HA), platelet rich plasma (PRP), stem/stromal cells, microfracture, mosaicplasty, osteochondral allograft, and cell-based therapies investigated. RESULTS: To date, there exist better guidelines and further consensus concerning knee joint biologic treatments than the hip due to a greater number of studies as well as the more recent emergence of hip preservation approaches. However, increasing evidence is available for the selective implementation of biologics on an individualized basis with attention to lesion size and location. CONCLUSION: Orthopedic surgeons are at an exciting crossroads in medicine, where hip biologic therapies are evolving and increasingly available. Timetested interventions such as arthroplasty have shown good results and still have a major role to play but newer, regenerative approaches have the potential to effectively delay or reduce the requirement for such invasive procedures.

Role of Platelet-rich Plasma in the Healing of Impacted Third Molar Socket: A Comparative Study on Central India Population.

AIM: The aim of the study was to compare the healing and osseous regeneration of mandibular third molar extraction sockets with and without platelet-rich plasma (PRP) with the evaluation of clinical objectives such as pain, swelling, trismus, soft tissue healing, pocket depth distal to second molar and radiological evaluation of the bony density in the postextracted third molar socket. MATERIALS AND METHODS: In this prospective study, 100 patients were selected by the random sampling method from the outpatient department of oral and maxillofacial surgery in the year 2016-2017. Patients were equally allocated into intervention (transalveolar extraction followed by PRP placement) and nonintervention (transalveolar extraction without PRP placement) group as group I and group II, respectively, and evaluation parameters were considered accordingly. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 (IBM, USA) statistical analysis software. RESULTS: The pain score of patients of group I (non-PRP) was found to be higher as compared to group II (with PRP). Mean trismus of patients of group II was found to be higher than that of group I at postoperative day 7, but this difference was not found to be statistically significant. Swelling at T-Sn (Tragus-Subnasale) and T-Pog (Tragus-Pogonion) was higher among patients of group I as compared to group II. Healing in group II was two to three times faster than group I. Healing among patients of group I and group II was found to be statistically significant. The mean pocket depth of patients of group I was found to be significantly higher than that of group II at follow-up of 1 and 2 months. The bone density of patients of group II was found to be significantly higher than that of group I at 3 months and 6 months follow-up. CONCLUSION: The procedure of PRP preparation is simple and cost-effective, and can be prepared at the point of care. It had a significant impact on the postoperative healing of the third molar socket. CLINICAL SIGNIFICANCE: The use of PRP application increases the bone density, healing process, and improvement in the pain and swelling, and there was a definite reduction in trismus and periodontal probing depth after the impacted mandibular wisdom teeth extraction.

Prevalence of goiter and its association with iodine status among the women of reproductive age group in coastal villages of Udupi Taluk, Karnataka, India.

BACKGROUND: Iodine deficiency is one of the most prevalent micronutrient deficiencies globally. Women in reproductive age group are vulnerable to develop iodine deficiency as there is an increase in demand for iodine, especially during pregnancy. OBJECTIVES: The objective is to assess the prevalence of goiter and its association with iodine status and salt usage practices among the women of reproductive age group. METHODS: A community-based cross-sectional study was conducted from August 2015 to July 2017 among 1500 women of reproductive age group in five villages of Udupi Taluk. Stratified sampling design and proportion to population size of the reproductive age women in the study area was used to select the study participants. A pretested semi-structured questionnaire was used for data collection. Goiter was assessed clinically and graded as per the recommended criteria of the WHO. Salt samples from every household were collected for iodine estimation. Blood and urine samples were collected from subsample to estimate thyroid-stimulating hormone levels and urinary iodine excretion levels, respectively. RESULTS: The overall prevalence of goiter was 13% with 11.5% being Grade 1 and 1.5% being Grade 2. No significant association of goiter with urinary iodine, salt iodine levels, and salt usage practices was found. CONCLUSIONS: Median urinary iodine among the women with goiter indicates iodine sufficiency and no significant difference observed in urinary iodine levels between women with and without goiter.

Indian Antimicrobial Prescription Guidelines in Critically Ill Immunocompromised Patients.

How to cite this article: Kulkarni AP, Sengar M, Chinnaswamy G, Hegde A, Rodrigues C, Soman R, Khilnani GC, Ramasubban S, Desai M, Pandit R, Khasne R, Shetty A, Gilada T, Bhosale S, Kothekar A, Dixit S, Zirpe K, Mehta Y, Pulinilkunnathil JG, Bhagat V, Khan MS, Narkhede AM, Baliga N, Ammapalli S, Bamne S, Turkar S, Bhat KV, Choudhary J, Kumar R, Divatia JV. Indian Journal of Critical Care Medicine 2019;23(Suppl 1): S64-S96.

Safe Veress Needle Intraperitoneal Placement and Safer Laparoscopic Entry.

STUDY OBJECTIVE: Fifty percent of laparoscopic bowel and vascular injuries occur at the time of entry. These serious complications can lead to significant morbidity and even mortality. This video demonstrates 3 techniques that have been developed to minimize the risk of these injuries during entry. DESIGN: Step-by-step description of 3 techniques that can be used as a highly reliable and safe method of obtaining intraperitoneal entry during laparoscopy. MEASUREMENTS AND MAIN RESULTS: Caudal displacement of the umbilicus before insertion of the veress needle allows for a median displacement of 6 cm between the site of entry and the common iliac vessels. An entry pressure of less than 9 mm Hg is suggestive of successful intraperitoneal entry. The left upper quadrant should be used in specific cases instead of the umbilicus as the point of entry for the veress needle. The use of a visualized trocarless cannula instead of a conventional primary trocar for entry after insufflation allows for real-time recognition of injury and converts linear penetrating force to radial torque. CONCLUSION: These 3 techniques can help decrease the risk and improve intraoperative recognition of serious bowel and vascular injuries during laparoscopy.

Heredity, Genetics and Orthodontics - How Much Has This Research Really Helped?

Uncovering the genetic factors that correlate with a clinical deviation of previously unknown etiology helps to diminish the unknown variation influencing the phenotype. Clinical studies, particularly those that consider the effects of an appliance or treatment regimen on growth, need to be a part of these types of genetic investigations in the future. While the day-to-day utilization of "testing" for genetic factors is not ready for practice yet, genetic testing for monogenic traits such as Primary Failure of Eruption (PFE) and Class III malocclusion is showing more promise as knowledge and technology advances. Although the heterogeneous complexity of such things as facial and dental development, the physiology of tooth movement, and the occurrence of External Apical Root Resorption (EARR) make their precise prediction untenable, investigations into the genetic factors that influence different phenotypes, and how these factors may relate to or impact environmental factors (including orthodontic treatment) are becoming better understood. The most important "genetic test" the practitioner can do today is to gather the patient's individual and family history. This would greatly benefit the patient, and augment the usefulness of these families in future clinical research in which clinical findings, environmental, and genetic factors can be studied.

The role of ambient ice-like water adlayers formed at the interfaces of graphene on hydrophobic and hydrophilic substrates probed using scanning probe microscopy.

In this work, we report the role of ice-like water adlayers (IWLs) formed under ambient conditions in between mechanically exfoliated as-prepared and patterned few layer graphene (FLG) and multi-layer graphene (MLG) on hydrophobic Si and hydrophilic SiO2/Si substrates. The growth of the IWL is probed by measuring the height changes in graphene using intermittent contact atomic force microscopy (IC-AFM) and their electrostatic effect is studied using electrostatic force microscopy (EFM) over time. It is found that more IWLs are formed within a shorter period of time, when both as-prepared graphene and underlying substrates are either hydrophobic or hydrophilic in nature. In contrast, AFM voltage nanolithographically patterned trenches on FLG and MLG on the Si substrate show quick formation of IWLs. The effect of IWL formed, on the dimensions of trenches, is correlated with the variation of the measured EFM phase shift over time. This study demonstrates the dependence of the formation of IWLs under ambient conditions on the affinity towards water, at the interface of graphene on hydrophobic and hydrophilic substrates, which has important implications for the performance of graphene-based nanoelectronic devices.

Thrombophilia testing in pregnancy: should we agree to disagree?

The value of testing for inherited thrombophilia in pregnancy has been debated in literature with regard to its utility in preventing adverse obstetrical outcomes or identifying women at risk for it. In this commentary, an evidence based approach is used to investigate the strength of association between thrombophilias and recurrent pregnancy loss and stillbirth. Several studies and meta-analyses have shown that there is only a weak association with recurrent pregnancy loss. However, many of these studies were underpowered, and there was significant heterogeneity-issues that are addressed in this paper. The evidence for association with stillbirth is lacking, but the few studies that are available seem to suggest a stronger correlation than for recurrent pregnancy loss. Further, the benefit of treating thrombophilias with anticoagulation in order to prevent these outcomes is discussed. While there is a lack of evidence looking at whether anticoagulation prevents stillbirth, there is strong evidence to show that anticoagulation does not prevent recurrent pregnancy loss. Finally, guidelines put out by various obstetrical and hematological societies regarding this topic are summarized.

Biologic therapies in stress fractures: Current concepts.

Stress fractures, a common overuse injury in physically active individuals, present a significant challenge for athletes and military personnel. Patients who sustain stress fractures have demanding training regimes where periods of rest and immobilisation have unacceptable negative consequences on sports goals and finances. Aside from being an overuse injury, there are various contributing risk factors that put certain individuals at risk of a stress fracture. The main two being nutritional deficiencies and hormonal variations, which have significant effects on bone metabolism and turnover. Historically, treatment of stress fractures focused on conservative strategies such as rest and immobilisation. Calcium and vitamin D deficiencies have been closely linked to stress fractures and so over time supplementation has also played a role in treatment. With the introduction of biologics into orthopaedics, newer treatment strategies have been applied to accelerate fracture healing and perhaps improve fracture callus quality. If such therapies can reduce time spent away from sport and activity, it would be ideal for treating stress fractures. This article aims to offer insights into the evolving landscape of stress fracture management. It investigates the pre-clinical evidence and available published clinical applications. Though fracture healing is well understood, the role of biologics for fracture healing is still indeterminate. Available literature for the use of biologic therapies in stress fractures are restricted and most reports have used biologics as a supplement to surgical fixation in subjects in studies that lack control groups. Randomised control trials have been proposed and registered by a few groups, with results awaited. Assessing individuals for risk factors, addressing hormonal imbalances and nutritional deficiencies seems like an effective approach to addressing the burden of stress fractures. We await better designed trials and studies to accurately determine the clinical benefit of adding biologics to the management of these injuries.

Comparative evaluation of efficacy of physics forcep and conventional forceps for extraction of maxillary molars.

BACKGROUND: Tooth extraction is one of the most commonly performed procedures in dentistry. It is usually a traumatic procedure often resulting in immediate destruction and loss of alveolar bone and surrounding soft tissues. It is the only dental procedure which was carried out by dentists in the previous centuries and various instruments have evolved for this procedure over time. Atraumatic extraction is one of the essential dental procedures, as atraumatic extraction leads to proper wound healing and appropriate bone healing. Physics forceps have got a new role in extraction technique, that it makes just one contact point with the tooth as a unique benefit. Physics forceps depends on the physics of rotational power, lever and torque much like a bottle top removal. A study was conducted to evaluate the efficacy of physics forceps and conventional forces in the extraction of maxillary molar. METHODS: Eligible participants were adults aged 18-50 diagnosed with grossly decayed maxillary molars with poor endodontic prognosis and willing to participate in the study. Exclusion criteria were as follows: patients with dilacerate roots; patients with systemic diseases like hypertension, diabetes mellitus, thyroid, tuberculosis, epilepsy seizures, COVID-19 positive; patients' non-acceptance to voluntarily participate in research a refusal to sign the informed consent. Parameters such as a crown fracture or root fracture; buccal bone fracture; time taken for extraction and operator ease on the VAS scale are assessed. RESULTS: Results showed that with the use of physics forces, there was very less incidence of crown fracture and no incidence of buccal bone fracture, whereas with the conventional forceps the result showed that in almost all the time taken for extraction was much more in conventional forcep and the operator ease rating was more with conventional forceps. CONCLUSIONS: Hence, oral surgeons as well as general practitioner should adapt the use of physics forceps in routine extractions.

No Child's Play: Under-five Child Feces Management in a Rural Area of Bengaluru Urban District, India.

Background: Inappropriate feces disposal leads to environmental contamination, and increases the risk of exposure to children. We aimed to estimate the proportion of rural households with knowledge and practice of safe management of feces (SMoF) among under-five children and to identify associated factors. Materials and Methods: A cross-sectional study was conducted in eight villages in Bengaluru Urban district over 2 months, using a face-validated semi-structured interview schedule. SMoF was defined based on five criteria - defecation site, transport tool, feces disposal, cleaning of transport tool, and hand washing. Results: Out of 320 under-five children surveyed, 15.7% were pre-ambulatory and 84.3% were ambulatory. The majority of the caregivers (92.5%) felt that children should defecate in the latrine and only 23.7% were aware that child feces were more infectious than adult feces. SMoF was only practiced by caregivers of ambulatory children (52.6%). Households with older caregivers (P = 0.01) and those living in a pucca house (P = 0.02) with a latrine inside (P = 0.04) were found to practice SMoF. Children of households that practiced unsafe disposal of child feces experienced more diarrheal episodes (P = 0.04). Caregivers >20 years were found to have better odds of SMoF [20-25 years (adjusted odds ratio, aOR: 9.02), 26-30 years (aOR: 12.17), >30 years (aOR: 8.93)] compared to those <20 years. Conclusion: The proportion of households with knowledge and practice of SMoF was low. Awareness of SMoF is essential to reduce the incidence of diarrheal diseases and improve sanitation. Our findings also call for awareness building at schools and colleges.

The fate of the joint space in Legg-Calvé-Perthes' disease.

OBJECTIVE: This study was undertaken to identify variations in the hip joint space in patients with healed Legg-Calvé-Perthes' disease (LCPD) and to correlate these changes with the radiological outcome of treatment. METHODS: The width of the joint space was measured on radiographs of 121 skeletally mature individuals with healed LCPD. The joint space width at the stage of healing in 79 patients was compared with the joint space at skeletal maturity. The hips were graded by the Stulberg classification and the femoral head radius was measured. Associations between the joint space width, the Stulberg class and the femoral head radius were tested. The reproducibility of measurement was tested by measuring 30 radiographs twice and computing the intra-class correlation coefficient (ICC). The joint space width was measured on radiographs of 25 patients taken both while recumbent and standing, to determine if the joint space alters on weight-bearing. RESULTS: The reproducibility of measurements was satisfactory; no difference was noted in the joint space in recumbent and weight-bearing films. Increased joint space was noted both at healing of the disease and at skeletal maturity; the width was minimally increased in Stulberg Class I hips and considerably increased in Class III, IV and V hips. There was a significant correlation between the increase in joint space and enlargement of the femoral head. CONCLUSIONS: An increase in joint space width occurs quite frequently following LCPD; the increase is most evident in hips with a poor outcome. The implications of this observation need to be elucidated.

Total Knee Arthroplasty in Paget's Disease using 3D-Printed Patient-Specific Femoral Jig - A Case Report.

Introduction: Patients with Paget's disease develop abnormal bony anatomy which can result in significantly altered lower limb alignment predisposing them to early secondary osteoarthritis. Due to the severe extra-articular deformity, total knee arthroplasty (TKA) in these patients is challenging. Conventional knee arthroplasty using intramedullary guides is not an option and can lead to erroneous limb alignment postoperatively. Patient-specific instrumentation (PSI) is a simple solution in such complex primary knee arthroplasty. Case Report: A 70-year-old male patient presented with a severe left femur deformity and left knee pain. He was diagnosed to have monostotic Paget's disease of the left femur with tricompartmental osteoarthritis of the left knee. After reduction in pathological bone turnover, the patient was planned for a total knee replacement. As a standard intramedullary femoral jig was not applicable due to the femoral deformity, a computed topography-based 3D-printed patient-specific instrument was used. This custom jig was used to define and perform the distal femur cut at 90 degrees to the mechanical axis of the femur in the coronal and sagittal plane. Postoperatively, the patient did well and achieved good function and pain relief. Conclusion: The use of a 3D-printed PSI for complex primary knee arthroplasty is an excellent option with no additional operative time than a conventional knee arthroplasty. Although a robotic or computer-navigated TKA would be an excellent option in this case, we restored the limb alignment using a cost-effective patient-specific femoral jig. This could be a viable option in centers without navigation or robotic arthroplasty.