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BACKGROUND: Reverse total shoulder arthroplasty (rTSA) has gained popularity for the operative treatment of proximal humerus fractures (PHF). The purpose of this study was to compare racial differences in surgical management of PHF between open reduction and internal fixation (ORIF), hemiarthroplasty, and rTSA. Our hypothesis was that there would be no difference in fixation by race. METHODS: The National Surgical Quality Improvement Program (NSQIP) database was queried for ORIF, rTSA, and hemiarthroplasty between 2006 and 2020 for patients with a PHF. Race, ethnicity, age, sex, body mass index (BMI), and American Society of Anesthesiologists (ASA) class were recorded. Chi squared tests were performed to assess relationships between patient factors and operative intervention. Factors significant at the 0.10 level in univariable analyses were included in a multivariable multinomial model to predict operative intervention. RESULTS: 7,499 patients underwent surgical treatment for a PHF, including 526 (7%) undergoing hemiarthroplasty, 5,011 (67%) undergoing ORIF, and 1,962 (26%) undergoing rTSA. 27% of white patients with PHF underwent rTSA compared to 21% of Black patients, 16% of Asian patients, and 14% of Native American and Alaskan Native patients (p<0.001). In the multivariable analysis, utilization of rTSA increased over time (OR 1.2 per year since 2006, p < 0.001) and hemiarthroplasty decreased over time (OR 0.86 per year since 2006, p < 0.001). Non-white patients had significantly lower odds of undergoing rTSA versus ORIF (OR 0.75, 95% CI 0.58-0.97), as did male patients (OR 0.77, 95% CI 0.66-0.88). Patients over 65 (OR 3.86, 95% CI 3.39-4.38), patients with higher ASA classifications (ASA2: OR 3.24, 95% CI 1.86-5.66, ASA3: OR 4.77, 95% CI 2.74-8.32, ASA4: OR 5.25, 95% CI 2.89-9.54), and patients who were overweight (OR 1.33, 95% CI 1.14-1.55) or obese (OR 1.52, 95% CI 1.32-1.75) had higher odds of undergoing rTSA versus ORIF. DISCUSSION: As utilization of rTSA increases, understanding disparities in surgical treatment of PHF is crucial to improving outcomes and equitable access to emerging orthopedic technologies. While patient factors such as age, BMI, and comorbidities are known to directly impact outcomes and thus may be predictive of the type of surgical intervention, patient race should not dictate treatment.
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Polyethylenimine (PEI) has been shown to be promising for direct air capture (DAC) of carbon dioxide and has potential for commercial scale-up globally. Laboratory scale processes include multiple steps, such as mixing, solvent extraction, vacuum application, sonication, and various flushes and activation steps. It is critical to properly control these operating parameters to achieve higher capture capacity as a result of the optimized material configuration. This study adopts previously published pelletization processes for PEI-infiltrated mesoporous foam silica (mesoporous silica foam) to uncover the adsorption mechanisms and optimize the associated fabrication steps, such as sonication, to achieve higher sorbent productivity. A high capture capacity was achieved at 46 °C for 75 wt % PEI loading (2.27 mmol/g) followed by PEI_MSF 70 (1.81 mmol/g) and PEI_MSF 80 (1.44 mmol/g). As part of the optimization, sonication parameters of frequency, amplitude, and time were modified for PEI_MSF 75 sorbent, which resulted in the highest uptake capacity of 3.04 mmol/g (sonicated at 40 kHz and a wave amplitude of 50% for 30 s). These preliminary results would tend to prove that sonication energy affects carbon capture capacity, although there is still a lack of understanding regarding the exact underlying mechanism, suggesting the need for further investigation. It is important to note that the present work is focused on the adsorption mechanisms and not desorption or durability of the capture performance. Ongoing research addresses these factors. This paper is intended to establish baseline DAC behavior of a promising capture medium and begins probing the optimization spectrum by considering the effects of sonication energy on adsorption. Ongoing work intends to address potential abbreviations of the full range of process steps and furthers the understanding of kinetics by considering the desorption and resorption attributes.
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Chronic inflammatory lesions (CIL) in the body are rare and inflammatory pseudotumor (IPT) is a subtype of CIL. Spine is an uncommon location of CIL, with most cases reported in the thoracic spine. Our objective was to review the current literature on IPT. To the best of our knowledge only about 13 cases are reported till date. A retrospective review of 13 existing cases was done. The etiopathogenesis of CIL is uncertain and total surgical excision remains the mainstay. It's a diagnosis of exclusion after ruling out commonly found lesions, both clinically and radiologically. Only histopathology can confirm the diagnosis. Total surgical resection remains the mainstay of treatment with adjuvant treatment only if there is a residue or a recurrence. CILs are rare lesions in the body with IPT being the commonest. Surgical excision remains the mainstay of treatment and a long-term follow up is warranted.
Subject(s)
Thoracic Vertebrae , Humans , Thoracic Vertebrae/pathology , Thoracic Vertebrae/diagnostic imaging , Thoracic Vertebrae/surgery , Granuloma, Plasma Cell/diagnosis , Granuloma, Plasma Cell/surgery , Granuloma, Plasma Cell/pathology , Granuloma, Plasma Cell/diagnostic imaging , Female , Male , Epidural Space/pathology , Epidural Space/diagnostic imaging , Adult , Magnetic Resonance Imaging , Middle AgedABSTRACT
In this study, a sustainable and eco-friendly method is developed to quantify azelnidipine and chlorthalidone in rabbit plasma by gradient liquid chromatography based on green chemistry principle and analytical quality by design. The separation was achieved on a Shim pack C18 (25 cm × 5 cm × 4.6 µm) column with L1 packing. The mobile phase compromised of ethanol and 50-Mm ammonium acetate buffer (pH.6) at flow rate of 0.6 mL/min with 25-min runtime. The resolution and asymmetric factor were identified as critical analytical attributes (CAAs). The screening studies employing Control Noise Experimentation revealed that mobile phase pH, flow rate and ethanol concentration at 6 and 15 min significantly affected the CAAs method. The critical method parameters were optimized using Central Composition design. Chromatogram showed peak of the drugs at retention time of 9.03 min for chlorthalidone and 16.83 min for azelnidipine. The greenness score of the analytical method was found to be 1876.43 using analytical method greenness score calculator. The validation of the developed method was done which showed linearity at the range of 16-520 ng/mL, with R2 of 0.9992 and 0.9996 for azelnidipine and chlorthalidone, respectively, furthermore accuracy, precision, recovery and stability studies are carried out.
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The novel coronavirus SARS-CoV-2 resulted in a significant worldwide health emergency known as the COVID-19 pandemic. This crisis has been marked by the widespread of various variants, with certain ones causing notable apprehension. In this study, we harnessed computational techniques to scrutinize these Variants of Concern (VOCs), including various Omicron subvariants. Our approach involved the use of protein structure prediction algorithms and molecular docking techniques, we have investigated the effects of mutations within the Receptor Binding Domain (RBD) of SARS-CoV-2 and how these mutations influence its interactions with the human angiotensin-converting enzyme 2 (hACE-2) receptor. Further we have predicted the structural alterations in the RBD of naturally occurring SARS-CoV-2 variants using the tr-Rosetta algorithm. Subsequent docking and binding analysis employing HADDOCK and PRODIGY illuminated crucial interactions occurring at the Receptor-Binding Motif (RBM). Our findings revealed a hierarchy of increased binding affinity between the human ACE2 receptor and the various RBDs, in the order of wild type (Wuhan-strain) < Beta < Alpha < Gamma < Omicron-B.1.1.529 < Delta < Omicron-BA.2.12.1 < Omicron-BA.5.2.1 < Omicron-BA.1.1. Notably, Omicron-BA.1.1 demonstrated the highest binding affinity of -17.4 kcal mol-1 to the hACE2 receptor when compared to all the mutant complexes. Additionally, our examination indicated that mutations occurring in active residues of the Receptor Binding Domain (RBD) consistently improved the binding affinity and intermolecular interactions in all mutant complexes. Analysis of the differences among variants has laid a foundation for the structure-based drug design targeting the RBD region of SARS-CoV-2.
Subject(s)
COVID-19 , Spike Glycoprotein, Coronavirus , Humans , Spike Glycoprotein, Coronavirus/genetics , SARS-CoV-2/genetics , Molecular Docking Simulation , Pandemics , Mutation , Protein BindingABSTRACT
A sustainable approach for pharmaceutically important pyrimidine derivatives is achieved by using biogenically produced single-phase δ-MnO2 NPs under external ligand-free conditions. The phytochemicals that comprise the extract of Areca Nut Husk (ANH) have been discovered to serve as reducing agents. The role of phytochemicals is not only to aid in the reduction of Mn(VII) into Mn(IV), but they also have an important role in stabilizing the catalyst. The establishment of δ-MnO2 NPs was confirmed inveterate by FE-SEM, p-XRD, ICP-OES (Mn content = 43.17% w/w), EDX, and with an active Mn content of 43.17% w/w. A series of pyrimidine derivatives were prepared in good yields using a one-pot multicomponent synthesis approach under atmospheric conditions. In addition, hot filtration tests, control experiments, gram-scale synthesis, and mechanistic investigations were demonstrated. Additionally, antimicrobial activity studies of δ-MnO2 NPs and pyrimidine derivatives against the Gram-negative bacteria E. coli, growth curve and minimum inhibitory concentration were studied.
Subject(s)
Anti-Infective Agents , Nanoparticles , Escherichia coli , Manganese Compounds/pharmacology , Oxides , Nanoparticles/therapeutic use , Pyrimidines/pharmacology , Anti-Infective Agents/pharmacologyABSTRACT
Many methods have been proposed for the remediation of dye-contaminated soils, a widespread form of environment pollution. Bioremediation, it is hoped, can combine ecological benefits with efficiency of dye decontamination. We review the types and sources of dye contaminants; their possible effects on plant, animal, and human health; and emerging strategies for microbial bioremediation. Challenges, limitations, recommendations for future research, and prospects for large-scale commercialization of microbial bioremediation are discussed.
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Soil Pollutants , Animals , Humans , Biodegradation, Environmental , Soil Pollutants/analysis , Plants , Coloring Agents , SoilABSTRACT
A sustainable method to reduce the use of natural resources and the negative effects of the concrete industry on the environment is to use waste lateritic aggregate in self-compacting concrete and evaluate its fresh, mechanical and durability characteristics. Using RSM's central composite design (CCD), Thirteen different SCC mixtures have been designed with varying input factor combinations (LA: 0-100%, PPF: 0-2%) and tested for eight responses (rheological properties, like slump flow, V-funnel time, and T500; mechanical properties, like compressive, split-tensile, and flexural strengths, and durability properties like drying shrinkage and rapid chloride penetration test). The analysis of variance (ANOVA) test was performed to determine the accuracy of the mathematical models developed following the experimental results. ANOVA was used to verify eight response models (seven quadratic and one linear). The inclusion of laterite aggregate has been found to linearly reduce the workability of fresh concrete. Self-compacting concrete will have a lower V-funnel value if any combination of components falls below these two limit values (31% LA and 1.12% PPF). The area bounded by the 760-mm contour line and the graph axes recorded the highest slump flow at (28% LA and 1.26% PPF). Similarly, SCC with a lower T500 value will be produced by any combination of components below these two limit values (25% LA and 1.11% PPF). By replacing 28.5% of the granite aggregate with laterite aggregate and adding 1.24% polypropylene fiber, the compressive strength of M30 grade self-compacting concrete increased by 12.33% after 28 days. A similar strength gain of 7.89% was seen in the splitting tensile by replacing 28% of the granite aggregate with laterite aggregate and adding 1.46% polypropylene fiber over the control mix, and a flexural strength gain of 14.46% was seen by replacing 31.4% of laterite aggregate and adding 1.2% polypropylene fiber, respectively. The low drying shrinkage values are related to a combination of LA concentration (34.4% replacement) and PPF (1.31%) and minimum chloride ingress is located in the region with a LA concentration (30.5% replacement) and a PPF content (1.26%), The projected optimal data were verified experimentally with an error rate of less than 5%. Thus, it is highly recommended that the created model be adequate and capable of optimizing both the experimental and analytical values. It is recommended that the utilization of 25% LA and 1% PPF in lateritic self-compacting concrete provides optimum outcomes for the construction industry in the field of civil engineering.
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ABSTRACT: Median arcuate ligament (MAL) syndrome or celiac artery (CA) compression syndrome previously treated mainly by vascular surgeons using the open approach is now being increasingly performed by general surgeons with training in advanced laparoscopy. Although this approach has all the advantages of minimal access surgery, the procedure is fraught with serious complications like injury to major vascular structures during dissection. Vascular injury by far is the major cause of conversion to open procedure. Herein, we report a laparoscopic repair of iatrogenic CA injury by intra-corporeal suturing during MAL release. We also elaborate the causes, the preventive measures that can be applied to avoid such catastrophic occurrences in future. To the best of our knowledge, this is the first report of a laparoscopic repair of CA bleed during MAL release.
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OBJECTIVES: To compare the efficacy of laparoscopic transabdominal cerclage (TAC) pre-pregnancy and laparoscopic TAC in pregnancy in treating cervical insufficiency. METHOD: A retrospective analytical study comparing outcomes of laparoscopic TAC pre-pregnancy with laparoscopic TAC in pregnancy. A total of 178 patients who underwent laparoscopic TAC at our hospital were enrolled in the study. In total, 122 patients underwent interval cerclage, and 56 patients underwent cerclage during pregnancy. RESULTS: A total of 178 patients who met the inclusion criteria were included in the analysis. Second-trimester abortions decreased by 50%, with an overall increase in full-term live births (32.53%) in patients undergoing laparoscopic TAC pre-pregnancy. The fetal survival rate was around 90% and 85% with laparoscopic TAC pre-pregnancy and laparoscopic TAC in pregnancy, respectively. Although the obstetric outcomes of laparoscopic TAC pre-pregnancy and in pregnancy were comparable, laparoscopic TAC pre-pregnancy was safer than laparoscopic TAC in pregnancy due to the complications associated with the procedure during pregnancy. CONCLUSIONS: Laparoscopic TAC pre-pregnancy yielded better reproductive outcomes than laparoscopic TAC in pregnancy and was associated with fewer perioperative complications.
Subject(s)
Cerclage, Cervical , Laparoscopy , Uterine Cervical Incompetence , Pregnancy , Female , Humans , Pregnancy Outcome , Retrospective Studies , Cerclage, Cervical/methods , Laparoscopy/methods , Term Birth , Uterine Cervical Incompetence/surgeryABSTRACT
When plants are exposed to water stress, photosynthesis is downregulated due to enhanced reactive oxygen species (ROS) and nitric oxide (NO). In contrast, photorespiratory metabolism protected photosynthesis and sustained yield. Modulation of photorespiration by ROS was established, but the effect of NO on photorespiratory metabolism was unclear. We, therefore, examined the impact of externally added NO by using S-nitrosoglutathione (GSNO), a natural NO donor, in leaf discs of pea (Pisum sativum) under dark or light: moderate or high light (HL). Maximum NO accumulation with GSNO was under high light. The presence of 2-4-carboxyphenyl-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide (cPTIO), a NO scavenger, prevented the increase in NO, confirming the release of NO in leaves. The increase in S-nitrosothiols and tyrosine-nitrated proteins on exposure to GSNO confirmed the nitrosative stress in leaves. However, the changes by GSNO in the activities and transcripts of five photorespiratory enzymes: glycolate oxidase, hydroxypyruvate reductase, catalase, glycerate kinase, and phosphoglycolate phosphatase activities were marginal. The changes in photorespiratory enzymes caused by GSNO were much less than those with HL. Since GSNO caused only mild oxidative stress, we felt that the key modulator of photorespiration might be ROS, but not NO.
Subject(s)
Pisum sativum , S-Nitrosoglutathione , Nitric Oxide/metabolism , Nitric Oxide Donors/metabolism , Plant Leaves/metabolism , Reactive Oxygen Species/metabolism , S-Nitrosoglutathione/pharmacology , S-Nitrosoglutathione/metabolismABSTRACT
Hamstring tendons are a very commonly used autograft for anterior cruciate ligament (ACL) reconstruction. Given that larger hamstring graft diameter has been shown to positively affect outcomes after ACL reconstruction, several techniques have been developed to optimize this variable. In this technical note, we describe the operative technique for generation of a 5-strand hamstring autograft via tripling of the semitendinosus tendon and doubling of the gracilis tendon, which can serve to maximize graft diameter, especially in patient populations with undersized hamstring tendons at baseline.
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Introduction: LNG-IUD although used extensively for its non-contraceptive indications like abnormal uterine bleeding (AUB), dysmenorrhoea and fibroid uterus, one of the major drawbacks is the high expulsion rates, especially among adenomyotic and fibroid uterus. Material and Methods: Altius Hospitals, Bangalore have developed a new technique of LNG-IUD fixation, which employs hystero-laparoscopy and usage of a long port closure needle with delayed absorbable sutures. Conclusion: It ensures proper placement and fixation of the LNG-IUD to the uterine cavity, reduces the expulsion rates and has the advantages of being a day care procedure. Supplementary Information: The online version contains supplementary material available at 10.1007/s13224-023-01788-2.
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We herein report a rare case of duodeno-duodenal intussusception (IS) presenting with obstruction caused by tubulovillous adenoma in an adult with malrotation that was managed by a novel laparoendoscopic hybrid technique. This was done by passing transjejunal nasogastric tube (NG) through one of the ports and manoeuvring it towards the IS. Two hundred and fifty millilitre of saline was flushed by aseptosyringe with pressure connected to the NG. This hydrostatic reduction technique resulted in distension of the jejunal and duodenal loop achieving reduction of IS. Intraoperative endoscopy was performed to exactly localise the mass lesion. The duodenum was kocherised and was delivered through a 4-cm transverse incision. Anterior duodenotomy was performed; the mass was excised; and duodenotomy was closed transversely. An extensive literature search did not show any case report of duodenoduodenal IS being managed by this technique. The combination of novel retrograde decompression and intraoperative endoscopy helped us to manage this rare case by this novel technique.
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An efficient, unique, and eco-friendly biogenic synthesis of single-crystalline δ-phase manganese oxide nanoparticles (MnO2 NPs) using Gliricidia sepium leaves (GSL) extract at room temperature has been revealed for the first time. The active chemicals present in the GSL extract were found to serve as both reducing and stabilizing agents. The catalyst shows an excellent surface area of 301.13 m2 g-1, a mean pore diameter of 4.01 nm, and 39.97% w/w of active metal content. The reactivity of the synthesized catalyst was demonstrated by achieving a one-pot synthesis of benzimidazoles and quinoxalines via an acceptorless dehydrogenative coupling strategy utilizing biorenewable alcohols. The release of hydrogen gas was observed as the only side product and proven by its successful utilization for alkene reduction which supports the mechanistic elucidation. The release of hydrogen gas as a useful byproduct highlights the scientific importance of the present methodology. Additionally, gram-scale synthesis and catalyst recyclability studies are deliberated. Importantly, the δ-MnO2 NP catalyst exhibited superior catalytic activity and high durability toward hydrogen evolution reaction in alkaline media, highlighting the dual use of the catalyst. The δ-MnO2 NPs attain the current density of 10 mA/cm2 at an overpotential of 154 mV with a Tafel slope of 119 mV/dec.
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Nanotechnology is a new science and business endeavour with worldwide economic benefits. Growing knowledge of nanomaterial fabrication techniques has increased the focus on nanomaterial preparation for various purposes. Nanofibers are one-dimensional nanomaterials having distinct physicochemical properties and characteristics. Nanofibers are nanomaterial types with a cross-sectional dimension of tens to hundreds of nanometres. They may create high porosity mesh networks with significant interconnections among pores, making them suitable for advanced applications. Electrospinning stands out for its ease of use, flexibility, low cost, and variety among the approaches described in the literature. The most common method for making nanofibers is electrospinning. This article extensively describes and summarizes the impact of various process variables on the fabrication of nanofibers. Special attention has been given to scientific and patent prospection to confirm the research interests in nanofibers.
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[This corrects the article DOI: 10.1039/D3RA04277D.].
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AlCl3-loaded ZnO nanoparticles have been explored as an efficient catalyst for 1,4-dihydropyridine synthesis under ambient temperature and solvent-free conditions. For this purpose, ZnO nanoparticles were synthesized by a simple solution-based precipitation technique using a stoichiometric amount of zinc sulfate and oxalic acid. The AlCl3@ZnO nanocrystalline catalyst was prepared by loading 20% AlCl3 on ZnO nanoparticles by a simple wet-impregnation technique. This catalyst efficiently performed Hantzsch pyridine reactions with various aromatic aldehydes, ethyl acetoacetate and ammonium acetate. The nanostructured AlCl3-loaded ZnO catalyst was characterized by UV-DRS, XRD, FESEM, EDS, FETEM-STEM-EDS and XPS techniques. The comprehensive characterization reveals the formation of AlCl3-loaded ZnO catalysts with an average particle size of 70-80 nm. The loading of AlCl3 on the ZnO surface was confirmed by minor shifts in the XPS and XRD peaks. FETEM-STEM-EDS also indicates reasonable AlCl3 loading on ZnO nanoparticles. The 20% AlCl3-loaded ZnO nanocatalyst (AlCl3@ZnO) confers 92% yield for the synthesis of 1,4-dihydropyridine under solvent-free and ambient temperature conditions. The synthesized 1,4-dihydropyridines were characterized by 1H-NMR, 13C-NMR, HRMS and FT-IR spectroscopic techniques. The reported catalyst is highly efficient, environmentally friendly and could become an alternative to homogenous and heterogenous catalytic reactions.
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Background: Glenoid wear secondary to primary osteoarthritis or rotator cuff arthropathy is an obstacle commonly encountered by surgeons performing reverse shoulder arthroplasty, with numerous techniques devised to address this finding. The most recent of such techniques is the introduction of augmented glenoid baseplates to fill these glenoid defects. The objectives of this systematic review are to analyze clinical outcomes of augmented baseplates in patients with glenoid wear, including pain, range of motion, patient-reported functional scores, radiographic outcome measures, complication rates, and revision rates. Methods: Three online databases (Ovid Medline, EMBASE, Pubmed) were searched for studies publishing clinical and functional outcomes of augmented baseplates in primary reverse shoulder arthroplasty. Findings were aggregated and frequency-weighted means of these variables were calculated when applicable. Results: Seven studies comprising 810 patients were included in this review. The mean patient age was 72.1 ± 8.1 years with an average follow-up time of 41.4 months. Frequency-weighted means of improvement in forward elevation, abduction, and active external rotation were 53°, 47°, and 19°, respectively. Patients experienced American Shoulder and Elbow Surgeons, Simple Shoulder Test, and Constant score improvements of 45.9, 5.9, and 33.7, respectively. Pooled complicated rate was 6.4%, with 10 cases of baseplate loosening and 3 cases of instability. Five (0.6%) patients required reoperation. Subdividing among augment type (posterior, superior, posterosuperior), there were no apparent differences in outcomes or complication rates between directional augments. Conclusion: This systematic review demonstrates that augmented baseplates for reverse shoulder arthroplasty provide positive outcomes both clinically and functionally at early follow-up. Complications are within an acceptable range for primary reverse shoulder arthroplasty, with a low rate of revision. Augmented baseplates should serve as a viable option for surgeons seeking to address glenoid wear during reverse shoulder arthroplasty.