Pressure injury incidence and impact on patients treated with prone positioning for COVID-19 ARDS.

OBJECTIVE: To determine the incidence of pressure injuries (PIs) and their impact on clinical outcomes in patients treated with prone positioning for COVID-19 acute respiratory distress syndrome (ARDS). METHOD: All patients with COVID-19 ARDS who were treated with prone positioning were categorised as cases and those who were not treated with prone positioning were categorised as controls. Demographics, clinical data and confounding variables affecting outcomes were recorded. Outcome variables of mortality and length of stay in intensive care units (ICUs) for both groups were recorded. Both groups' incidence of PIs were recorded and compared using statistical tests. Fisher's exact test was used for categorical variables, and Mann-Whitney U test was used for continuous variables. RESULTS: The sample included 212 patients, treated with prone position (n=104) and without prone treatment (n=108). The incidence of PIs was n=75 (35.4%). PIs were significantly higher in patients in the prone position (n=51, 49%) compared with patients who were not (n=24, 22%); p=0.001. Patients in the prone position were found to have lower APACHE-2 scores, longer stays on the ventilator, ICU and in the hospital. CONCLUSION: PIs are more prevalent in patients in the prone position and it adversely impacts clinical outcomes; it prolongs the length of stay on the ventilator, in the ICU and in the hospital.

Cardiotoxicity of Immune Checkpoint Inhibitors.

PURPOSE OF REVIEW: Immune checkpoint inhibitors (ICIs) have improved the survival of several cancers. However, they may cause a wide range of immune-related adverse events (irAEs). While most irAEs are manageable with temporary cessation of ICI and immunosuppression, cardiovascular toxicity can be associated with high rates of morbidity and mortality. As ICIs evolve to include high-risk patients with preexisting cardiovascular risk factors and disease, the risk and relevance of ICI-associated cardiotoxicity may be even higher. RECENT FINDINGS: Several cardiovascular toxicities such as myocarditis, stress cardiomyopathy, and pericardial disease have been reported in association with ICIs. Recent findings also suggest an increased risk of atherosclerosis with ICI use. ICI-associated myocarditis usually occurs early after initiation and can be fulminant. A high index of suspicion is required for timely diagnosis. Prompt treatment with high-dose corticosteroids is shown to improve outcomes. Although the overall incidence is rare, ICI cardiotoxicity, particularly myocarditis, is associated with significant morbidity and mortality, making it a major therapy-limiting adverse event. Early recognition and prompt treatment with the cessation of ICI therapy and initiation of high-dose corticosteroids are crucial to improve outcomes. Cardio-oncologists will need to play an important role not just in the management of acute cardiotoxicity but also to reduce the risk of long-term sequelae.

Selenium Alleviates the Adverse Effect of Drought in Oilseed Crops Camelina (Camelina sativa L.) and Canola (Brassica napus L.).

Drought poses a serious threat to oilseed crops by lowering yield and crop failures under prolonged spells. A multi-year field investigation was conducted to enhance the drought tolerance in four genotypes of Camelina and canola by selenium (Se) application. The principal aim of the research was to optimize the crop yield by eliciting the physio-biochemical attributes by alleviating the adverse effects of drought stress. Both crops were cultivated under control (normal irrigation) and drought stress (skipping irrigation at stages i.e., vegetative and reproductive) conditions. Four different treatments of Se viz., seed priming with Se (75 µM), foliar application of Se (7.06 µM), foliar application of Se + Seed priming with Se (7.06 µM and 75 µM, respectively) and control (without Se), were implemented at the vegetative and reproductive stages of both crops. Sodium selenite (Na2SeO3), an inorganic compound was used as Se sources for both seed priming and foliar application. Data regarding physiochemical, antioxidants, and yield components were recorded as response variables at crop maturity. Results indicated that WP, OP, TP, proline, TSS, TFAA, TPr, TS, total chlorophyll contents, osmoprotectant (GB, anthocyanin, TPC, and flavonoids), antioxidants (APX, SOD, POD, and CAT), and yield components (number of branches per plant, thousand seed weight, seed, and biological yields were significantly improved by foliar Se + priming Se in both crops under drought stress. Moreover, this treatment was also helpful in boosting yield attributes under irrigated (non-stress) conditions. Camelina genotypes responded better to Se application as seed priming and foliar spray than canola for both years. It has concluded that Se application (either foliar or priming) can potentially alleviate adverse effects of drought stress in camelina and canola by eliciting various physio-biochemicals attributes under drought stress. Furthermore, Se application was also helpful for crop health under irrigated condition.

Phytochemicals in Daucus carota and Their Health Benefits-Review Article.

Carrots are a multi-nutritional food source. They are an important root vegetable, rich in natural bioactive compounds, which are recognised for their nutraceutical effects and health benefits. This review summarises the occurrence, biosynthesis, factors affecting concentration, and health benefits of phytochemicals found in Daucus carota. Two hundred and fifty-five articles including original research papers, books, and book chapters were analysed, of which one hundred and thirty articles (most relevant to the topic) were selected for writing the review article. The four types of phytochemicals found in carrots, namely phenolics, carotenoids, polyacetylenes, and ascorbic acid, were summarised. These chemicals aid in the risk reduction of cancer and cardiovascular diseases due to their antioxidant, anti-inflammatory, plasma lipid modification, and anti-tumour properties. Numerous factors influence the amount and type of phytochemicals present in carrots. Genotype (colour differences) plays an important role; high contents of α and ß-carotene are present in orange carrots, lutein in yellow carrots, lycopene in red carrots, anthocyanins in the root of purple carrots, and phenolic compounds abound in black carrots. Carotenoids range between 3.2 mg/kg and 170 mg/kg, while vitamin C varies from 21 mg/kg to 775 mg/kg between cultivars. Growth temperatures of carrots influence the level of the sugars, carotenoids, and volatile compounds, so that growing in cool conditions results in a higher yield and quality of carrots, while higher temperatures would increase terpene synthesis, resulting in carrots with a bitter taste. It is worthwhile to investigate the cultivation of different genotypes under various environmental conditions to increase levels of phytochemicals and enhance the nutritional value of carrot, along with the valorisation of carrot by-products.

Complex Tears, Extrusion, and Larger Excision Are Prognostic Factors for Worse Outcomes 1 and 2 Years After Arthroscopic Partial Meniscectomy for Degenerative Meniscal Tears: A Secondary Explorative Study of the Surgically Treated Group From the Odense-Oslo Meniscectomy Versus Exercise (OMEX) Trial.

BACKGROUND: Few studies have examined morphological findings from preoperative magnetic resonance imaging (MRI) and arthroscopic findings as prognostic factors for outcomes 1 and 2 years after arthroscopic partial meniscectomy (APM). PURPOSE/HYPOTHESIS: The purpose was to evaluate prognostic factors of preoperative findings from MRI and arthroscopic evaluation on lower extremity performance at 1 year and patient-reported outcomes at 1 to 2 years after APM. The hypothesis was that medial compartment abnormalities would be prognostic for 1- and 2-year functional outcomes. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: This secondary analysis from the OMEX (Odense-Oslo Meniscectomy Versus Exercise) trial included 40 patients treated surgically. Regression analyses with adjustments for age, sex, and body mass index explored associations between MRI findings (tear complexity and extrusion), arthroscopic findings (tear length, cartilage injury, and amount of excised meniscal tissue), and the following: lower extremity performance tests and thigh muscle strength at 1 year and the 5 Knee injury and Osteoarthritis Outcome Score (KOOS) subscales at 1 and 2 years. RESULTS: A complex meniscal tear was a significant and clinically relevant prognostic factor for worse KOOS Symptoms subscores at 2 years (mean, 14.1 points [95% CI, 6.1-22.2]). Meniscal extrusion of at least 11%, 25%, and 20% were significant and clinically relevant prognostic factors for worse KOOS Activities of Daily Living (ADL) subscores at 1 year and worse KOOS Sports and Recreation (Sports/Rec) subscores at 1 and 2 years, respectively. Tear lengths of at least 7.0 mm, 6.7 mm, and 6.5 mm were significant and clinically relevant prognostic factors for better KOOS Symptoms subscores at 1 year and better KOOS Sports/Rec subscores at 1 and 2 years, respectively. A cartilage injury in the medial compartment was a significant and clinically relevant prognostic factor for worse KOOS ADL and Quality of Life (QoL) subscores at 2 years (mean, 10.4 and 19.4 points, respectively [95% CI, 3.4-17.4 and 7.7-31.1, respectively]). More than 20% meniscal tissue excised was a significant and clinically relevant prognostic factor for worse KOOS Pain, Symptoms, ADL, and Sports/Rec subscores at 1 and 2 years (mean, 8.9-41.5 points [95% CI, 2.2-15.5 to 21.0-62.0]) and worse KOOS QoL subscores at 2 years (mean, 25.3 points [95% CI, 13.6-37.0]). CONCLUSION: Complex meniscal tears, larger extrusion, cartilage injuries, and larger meniscal excision were significant and clinically relevant prognostic factors for worse outcomes 1 and 2 years after APM. REGISTRATION: NCT01002794 (ClinicalTrials.gov identifier).

Assessment of the yield loss imparted by Orobanche aegyptiaca in tomato in Pakistan.

Broomrapes (Orobanche sp.) are root holoparasitic plants causing severe damage to various families of horticultural crops. A Preliminary survey was carried in tomato fields infested with orobanche in Potohar plateau of Pakistan. Results indicated that each planting bed comprising10-12 tomato plants contained 7-8 parasitic weeds. Overall survey indicated the 65-70% plants suffered partial or complete yield loss. Further, it was estimated that the number of weeds inhabiting plant-1 was ranged from 2-4. Yield loss was estimated at 57.17 tons/ha while in terms of financial loss, it was 2579.87 $/ha. Hence total estimated loss on the total surveyed area of 16 hectares was 41395.85 $. The high potential of tomato cultivation in Pakistan reinforces the urgent protection measures to resolve this emerging issue.

The natural course of nonoperatively treated rotator cuff tears: an 8.8-year follow-up of tear anatomy and clinical outcome in 49 patients.

BACKGROUND: The natural course of nonoperatively treated rotator cuff tears is not fully understood. We explored the long-term development of tear anatomy and assessed functional outcomes. METHODS: Eighty-nine small to medium-sized full-thickness tears of the rotator cuff, all primarily treated by physiotherapy, were identified retrospectively. Twenty-three tears needed surgical treatment later on, and 17 patients were unable to meet for follow-up. The remaining 49 still unrepaired tears were re-examined after 8.8 (8.2-11.0) years with sonography. Re-examination by magnetic resonance imaging was possible for 37 patients. Shoulder function was assessed with shoulder scores. Primary outcome measures were progression of tear size, muscle atrophy, and fatty degeneration and the Constant score (CS). RESULTS: Mean tear size increased by 8.3 mm in the anterior-posterior plane (P = .001) and by 4.5 mm in the medial-lateral plane (P = .001). Increase of tear size was -5 to +9.9 mm in 33 patients, 10 to 19.9 mm in 8 patients, and ≥20 mm in 8 patients. The CS was 81 points for tear increases <20 mm and 58.5 points for increases ≥20 mm (P = .008). Muscle atrophy and fatty degeneration progressed in 18 and 15 of the 37 patients, respectively. In tears with no progression of atrophy, the CS was 82 points compared with 75.5 points in tears with progression (P = .04). CONCLUSIONS: Anatomic tear deterioration was found in the majority of patients, but it was often moderate. Large tear size increases and progression of muscle atrophy were correlated to a poorer functional outcome.

Haemodynamic instability secondary to cardiac involvement by lymphoma.

Cardiac involvement in lymphomas is not uncommon, but it is often missed due to the variability in its presentation. We present a case of bradycardia and complete heart block resulting in haemodynamic instability in a patient with recurrent diffuse large B-cell lymphoma. Timely diagnosis and appropriate management of such patients is crucial and requires a high index of suspicion. Our patient required temporary pacemaker implantation and intravenous corticosteroid therapy. His complete heart block and bradycardia eventually resolved after a course of radiation therapy.

Humidity and temperature sensing properties of copper oxide-Si-adhesive nanocomposite.

Smart and professional humidity and temperature sensors have been fabricated by utilizing copper oxide-Si-adhesive composite and pure copper oxide nanosheets. Copper oxide nanosheets are synthesized by low temperature stirring method and characterized by field emission scanning electron microscopy, which reveals that synthesized product is composed of randomly oriented nanosheets, which are grown in high density with an average thickness of~80±10 nm. X-ray diffraction confirms that the grown nanosheets consist of well crystalline monoclinic CuO. X-ray photoelectron spectroscopy and Fourier transform infrared (FTIR) spectroscopy also confirm that the synthesized nanomaterial is pure CuO without any impurity. The fabricated sensors exhibit good temperature sensitivity of -4.0%/°C and -5.2%/°C and humidity sensitivity of -2.9%/%RH and -4.88%/%RH, respectively for copper oxide-Si-adhesive composite and pure copper oxide nanosheets. The average initial resistance of the sensors is equal to 250 MΩ and 55 MΩ for the composite and pure copper oxide based sensors, respectively.

The natural history of asymptomatic rotator cuff tears: a three-year follow-up of fifty cases.

BACKGROUND: Little is known about the clinical and anatomic progression of asymptomatic rotator cuff tears. The purpose of our study was to assess if deterioration in rotator cuff tear anatomy would be correlated to the development of symptoms. METHODS: Fifty patients with initially asymptomatic full-thickness rotator cuff tears were followed clinically, sonographically, and by magnetic resonance imaging over three years. Changes of tear size, muscle atrophy, fatty degeneration, and condition of the long head of the biceps tendon were compared between tears that developed symptoms and those that did not. RESULTS: Eighteen of fifty tears developed symptoms during follow-up. There was a significantly larger increase (p = 0.02) in the mean tear size in the newly symptomatic group (10.6 mm) when compared with the still-asymptomatic group (3.3 mm). The rate of progressing to advanced muscle atrophy was higher (p = 0.08) in the newly symptomatic group (35% [six of seventeen subjects]) when compared with the still-asymptomatic group (12% [three of twenty-five subjects]). The rate of fatty degeneration was significantly higher (p = 0.02) in the newly symptomatic group (35% [six of seventeen subjects]) when compared with the still-asymptomatic group (4% [one of twenty-five subjects]). The rate of pathology of the long head of the biceps tendon was significantly higher (p = 0.02) in the newly symptomatic group (33% [six of eighteen subjects]) when compared with the still-asymptomatic group (6% [two of thirty-two subjects]). CONCLUSIONS: During a relatively short-term follow-up, a substantial percentage of asymptomatic rotator cuff tears became symptomatic and underwent anatomic deterioration. Increase in tear size and decrease of muscle quality were correlated to the development of symptoms. Subjects diagnosed with an asymptomatic rotator cuff tear should be informed about the natural history of the condition and follow-up with repeated imaging may be indicated to monitor tear progression.

MRI of symptomatic and asymptomatic full-thickness rotator cuff tears. A comparison of findings in 100 subjects.

BACKGROUND AND PURPOSE: Why some full-thickness rotator cuff tears are symptomatic and others are asymptomatic is not understood. By comparing MRI findings in symptomatic and asymptomatic tears, we wanted to identify any tear characteristics that differed between groups. PATIENTS AND METHODS: 50 subjects with asymptomatic and 50 subjects with symptomatic full-thickness tears were examined by MRI. Tear characteristics including tear size, tear location, the condition of the long head of the biceps, atrophy, and fatty degeneration of the muscles were compared between groups. RESULTS: Single factor logistic regression analysis showed that there were statistically significant associations between symptoms and tear size exceeding 3 cm in the medial-lateral plane, positive tangent sign, and fatty degeneration exceeding grade 1 of the supraspinatus and infraspinatus muscles. INTERPRETATION: We found associations between the symptomatic status of a rotator cuff tear and MRI-derived tear characteristics. The causal relationships are unclear.

Hydrodilatation, corticosteroids and adhesive capsulitis: a randomized controlled trial.

BACKGROUND: Hydrodilatation of the glenohumeral joint is by several authors reported to improve shoulder pain and range of motion for patients with adhesive capsulitis. Procedures described often involve the injection of corticosteroids, to which the reported treatment effects may be attributed. Any important contribution arising from the hydrodilatation procedure itself remains to be demonstrated. METHODS: In this randomized trial, a hydrodilatation procedure including corticosteroids was compared with the injection of corticosteroids without dilatation. Patients were given three injections with two-week intervals, and all injections were given under fluoroscopic guidance. Outcome measures were the Shoulder Pain and Disability Index (SPADI) and measures of active and passive range of motion. Seventy-six patients were included and groups were compared six weeks after treatment. The study was designed as an open trial. RESULTS: The groups showed a rather similar degree of improvement from baseline. According to a multiple regression analysis, the effect of dilatation was a mean improvement of 3 points (confidence interval: -5 to 11) on the SPADI 0-100 scale. T-tests did not demonstrate any significant between-group differences in range of motion. CONCLUSION: This study did not identify any important treatment effects resulting from three hydrodilatations that included steroid compared with three steroid injections alone. TRIAL REGISTRATION: The study is registered in Current Controlled Trials with the registration number ISRCTN90567697.

MRI diagnosis of occult hip fractures.

BACKGROUND: Most fractures of the proximal femur are easily diagnosed by conventional radiography. When the images are judged to be negative or equivocal and a clinical suspicion of fracture persists, another approach is to use magnetic resonance imaging (MRI) to help reach a diagnosis. METHODS: In a prospective study running from November 1998 to December 2001, we registered all patients being examined by MRI who had had a negative or equivocal radiograph and where there was continued clinical suspicion of hip fracture. RESULTS: 100 consecutive patients (67 women) were included, with an average age of 80 (37-100) years. The MRI examinations corresponded to 4% of the 2,350 patients admitted with hip trauma during the study period. 46 patients had a femoral neck or intertrochanteric fracture on MRI. 27 patients had other fractures. 18 had other findings on MRI, and 10 were interpreted as being negative, although one of these was a false negative. In a separate interobserver analysis, two experienced radiologists agreed on the diagnoses in 19/23 cases (kappa value 0.78). They agreed with a less experienced radiologist in 17/23 and 19/23 cases, respectively (kappa values 0.66 and 0.76). INTERPRETATION: MRI is a useful tool for demonstration of occult hip fractures. In the absence of a hip fracture, another explanation for the patient's pain and disability will often be given.