Which factor is more associated with survival of patients with hip fracture over 90 years: Type of fracture or treatment modality?

OBJECTIVE: We aimed to analyze prognostic factors affecting the mortality and to evaluate whether the fracture type (collum femoris or intertrochanteric fracture) or treatment method (proximal femoral nail or hemiarthroplasty) affects the mortality in patients with hip fractures and older than 90 years old. METHODS: In our study, we retrospectively reviewed the patients aged >90 years and operatively treated hip fractures. Patients were categorized according to fracture type and treatment method. Finally, three groups were created. Demographic values, laboratory values were analyzed for prognostic factors and determining independent factors associated with survival for each group. RESULTS: A total of 193 patients were included with an average age of 92.5±2.4 (range, 90-104) years. There were 144 women and 49 men. There were 126 (65.2%) patients with intertrochanteric fracture and 67 (34.8%) patients with collum femoris fracture. At the time of this study, 142 (73.5%) patients had deceased. Staying in intensive care unit for collum femoris group, general anesthesia for intertrochanteric fracture treated with hemiarthroplasty group and delay to surgery and preoperative albumin level for intertrochanteric fracture treated with proximal femoral nail group were associated with poor survival. CONCLUSION: Staying intensive care unit, general anesthesia, delay to surgery and preoperative albumin levels should be carefully evaluated for patients aged over 90 years with hip fractures. Our study showed that both fracture type and treatment modality were not associated with poor overall survival of the patients aged >90 years following hip fracture surgery.

Describing an old trick in posterior thoracal and lumbar implant removal surgery: follow-up results for at least 10 years.

STUDY DESIGN: Retrospective case series. OBJECTIVES: We aimed to describe with a novel surgical approach for the removal of posterior thoracolumbar implant in patients with symptomatic failure of the implant and present our preliminary results with this method. METHODS: This retrospective, single-center study was performed in the neurosurgery department of a university hospital. Data were gathered from the medical files of 314 patients (243 women, 77.39%; 71 men, 22.61%) with symptomatic thoracolumbar implant failure that underwent implant removal operation using our novel technique between 2010 and 2020. Symptoms, radiological findings, intraoperative findings as well as clinical outcomes were evaluated. RESULTS: In our series, the average age was 46.5 years (range: 21-84) with a mean follow-up duration of 7 years (range: 3 months to 10 years). Preoperatively, the most common symptoms were leg pain and numbness of the lower extremity. Postoperatively, no major complications were noted. Clinical progression of symptoms was avoided by surgery in all patients, while we came across removal difficulties due to screw-screwdriver mismatch in 15 of 314 surgeries (4.78%). Our novel approach allowed successful screw removal including these challenging cases. CONCLUSIONS: We suggest that our novel approach is a practical and effective for the removal of posterior thoracolumbar implant in cases with symptomatic failure attributed to screw-screwdriver mismatch. Further trials are warranted to assess the efficacy of this technique to overcome surgical problems associated with screw removal.

Evaluation of the Effect of Morphological Structure on Dilatational Tracheostomy Interference Location and Complications with Ultrasonography and Fiberoptic Bronchoscopy.

Background: Percutaneous dilatational tracheostomy (PDT) is the most commonly performed minimally invasive intensive care unit procedure worldwide. Methods: This study evaluated the percentage of consistency between the entry site observed with fiberoptic bronchoscopy (FOB) and the prediction for the PDT level based on pre-procedural ultrasonography (USG) in PDT procedures performed using the forceps dilatation method. The effect of morphological features on intervention sites was also investigated. Complications that occurred during and after the procedure, as well as the duration, site, and quantity of the procedures, were recorded. Results: Data obtained from a total of 91 patients were analyzed. In 57 patients (62.6%), the USG-estimated tracheal puncture level was consistent with the intercartilaginous space observed by FOB, while in 34 patients (37.4%), there was a discrepancy between these two methods. According to Bland Altman, the agreement between the tracheal spaces determined by USG and FOB was close. Regression formulas for PDT procedures defining the intercartilaginous puncture level based on morphologic measurements of the patients were created. The most common complication related to PDT was cartilage fracture (17.6%), which was proven to be predicted with maximum relevance by punctured tracheal level, neck extension limitation, and procedure duration. Conclusions: In PDT procedures using the forceps dilatation method, the prediction of the PDT intervention level based on pre-procedural USG was considerably in accordance with the entry site observed by FOB. The intercartilaginous puncture level could be estimated based on morphological measurements.

Biodegradable plastic formulated from chitosan of Aristeus antennatus shells with castor oil as a plasticizer agent and starch as a filling substrate.

Biodegradable plastics are those subjected easily to a degradation process, in which they can be decomposed after disposal in the environment through microbial activity. 30 bioplastic film formulations based only on chitosan film were used in the current investigation as a positive control together with chitosan film recovered from chitin-waste of locally obtained Aristeus antennatus. Additionally, castor oil was used as a plasticizer. While the yield of chitosan was 18% with 7.65% moisture content and 32.27% ash in the shells, the isolated chitin had a degree of deacetylation (DD) of 86%. The synthesized bioplastic films were characterized via numerous criteria. Firstly, the swelling capacity of these biofilms recorded relatively high percentages compared to polypropylene as synthetic plastic. Noticeably, the FTIR profiles, besides DSC, TGA, and XRD, confirmed the acceptable characteristics of these biofilms. In addition, their SEM illustrated the homogeneity and continuity with a few straps of the chitosan film and showed the homogeneous mixes of chitosan and castor oil with 5 and 20%. Moreover, data detected the antibacterial activity of different bioplastic formulas against some common bacterial pathogens (Enterococcus feacalis, Kelbsiella pnumina, Bacillus subtilis, and Pseudomonas aeruginosa). Amazingly, our bioplastic films have conducted potent antimicrobial activities. So, they may be promising in such a direction. Further, the biodegradability efficacy of bioplastic films formed was proved in numerous environments for several weeks of incubation. However, all bioplastic films decreased in their weights and changed in their colors, while polypropylene, was very constant all the time. The current findings suggest that our biofilms may be promising for many applications, especially in the field of food package protecting the food, and preventing microbial contamination, consequently, it may help in extending the shelf life of products.

Design, Synthesis and Antibacterial Assessment of Active (4-Arylazo-3-Methyl-2-Thienyl) 4-Antipyrine Ketones.

The chemicals formed from antipyrines are flexible organic building blocks that are employed in the development of pharmaceuticals. By diazotizing (4-arylazo-3-hydroxy-2-thienyl) 4-antipyrine ketones 1a, 1b and 1c and (4-arylazo-3-methyl-2-thienyl) 4-antipyrine ketones (2a, 2b and 2c) further replaced with six other coupling components, a broad spectrum of hybrid molecules have been created. Mass spectra, NMR, FTIR, and elemental analyses have all been used to confirm the structures of the synthesised compounds. The antimicrobial screening was investigated by agar well diffusion and diluting the broth technique against both Gram-negative and positive-tested bacterial strains. (3-methyl-5-(phenylamino)-4-(4-tolylazo)-2-thienyl) 4-antipyrine ketone (2a) was found to be superior to Ciprofloxacin against test strains: Acinetobacter sp (34.33±1.15 mm), Listeria monocytogenes (29.33±1.15 mm) and Streptococcus sp. (19.33±1.15 mm). Also, good to moderate activities were expressed as minimum inhibitory concentration (MIC) and minimum bacterial concentration (MBC) which were recorded at 9±1 to 59.67±4.51 µg/mL and 16±4 to >512 µg/mL, respectively, using compounds 2a, 2b, and 2c. MBC/MIC ratio showed, that only, 2a and 2b have a bactericidal effect but other antipyrines with bacteriostatic strength. To conclude, it was suggested that the use of these novel synthesized (4-arylazo-3-methyl-2-thienyl) 4-antipyrine ketone derivatives molecules as a new chemical class of antimicrobial agents to perform new drug discovery in pharmaceutical preparations and medicinal research.

Fabrication of carbon black nanoparticles from green algae and sugarcane bagasse.

There are several industrial uses for carbon black (CB), an extremely fine powdered form of elemental carbon that is made up of coalesced particle aggregates and almost spherical colloidal particles. Most carbon black is produced from petroleum-derived feedstock, so there is a need to find an alternative method to produce CB, which relies on renewable resources such as algae and agricultural waste. A process involving hydrolysis, carbonization, and pyrolysis of green algae and sugarcane bagasse was developed, as the optimal hydrolysis conditions (16N sulfuric acid, 70 °C, 1 h, 1:30 g/ml GA or SC to sulfuric acid ratio), a hydrolysis ratio of 62% for SC and 85% for GA were achieved. The acidic solution was carbonized using a water bath, and the solid carbon was then further pyrolyzed at 900 °C. The obtained carbon black has a high carbon content of about 90% which is confirmed by EDX, XRD, and XPS analysis. By comparison carbon black from sugar cane bagasse (CBB) and carbon black from green algae Ulva lactuca (CBG) with commercial carbon black (CCB) it showed the same morphology which was confirmed by SEM analysis. The BET data, showed the high specific surface area of prepared CB, which was 605 (m2/g) for CBB and 424 (m2/g) for CBG compared with commercial carbon black (CBB) was 50 (m2/g), also the mean pore diameter of CBB, CBG and CCB indicated that CBB and CBG were rich in micropores, but CCB was rich in mesoporous according to IUPAC classification. This study might have created a technique that can be used to make carbon black from different kinds of biomass.

Fabrication of date palm kernel biochar-sulfur (DPKB-S) for super adsorption of methylene blue dye from water.

A novel form of biochar was created by dehydration of Date palm kernel with 85% sulfuric acid. It was examined how the newly produced biochar (DPKB-S) affected the aqueous solution's capacity to extract Methylene Blue (MB) dye. The prepared DPKB-S was categorized by BET, BJH, FT-IR, SEM, EDX, DSC, and TGA analyses. The ideal pH for the MB dye adsorption by DPKB-S is 8. With 0.75 g L-1 of DPKB-S and an initial concentration of 50 ppm MB dye, Date Palm Kernel Biochar-Sulfur (DPKB-S) had the highest removal percentage of 100%. The Langmuir and Freundlich isotherm models were used to investigate the collected data. Freundlich model is the model that best covers MB dye adsorption in DPKB-S at low concentrations (0.75-1.25 g L-1) and the Langmuir model at high concentrations (1.5-1.75 g L-1). The Langmuir model maximum adsorption capacity (Qm) of the DPKB-S was 1512.30 mg g-1. Furthermore, a variety of error function models were applied to investigate the isotherm models derived data, including Marquardt's percent standard deviation (MPSD), the sum of absolute errors (EABS), the sum of the errors squared (ERRSQ), root mean square errors (RMS), Chi-square error (X2), the average relative error (ARE), average percent errors (APE), and hybrid error function (HYBRID). Kinetic data were calculated by intraparticle diffusion (IPD), pseudo-second-order (PSO), pseudo-first-order (PFO), and film diffusion (FD) models. A PSO rate model with a strong correlation (R2 = 1.00) largely regulated the adsorption rate. The removal mechanism of MB dye by DPKB-S is based on the principle that these positively charged dyes are attracted by electrostatic attraction forces due to the growth in the number of negatively charged regions at basic pH value. According to the results, DPKB-S shows promise as an affordable and competent adsorbent for the adsorption of MB dye. It can be used frequently without experiencing a discernible decrease in adsorption efficiency.

Vertebral Hemangiomas: Yucesoy-Yilmaz Classification System with Corresponding Therapeutic Options.

OBJECTIVE: Vertebral hemangiomas (VHs) are relatively common, symptomatic benign tumors of the spine with a reported estimated incidence up to 11%. They usually appear in the body of the vertebrae; however, they can extend into pedicles, laminae, and epidural space. They may cause pain, neurologic deficits. and fractures. METHODS: In this retrospective, single-center study, we reviewed our cases with VH and we propose the novel classification system that evaluates these lesions per their views on magnetic resonance imaging and clinical findings under 4 main categories. RESULTS: Our novel classification system proposes that grade I lesions occupy less than 50% of the vertebral body, whereas grade II lesions occupy more than 50% and grade III lesions occupy the whole corpus. Grade IV lesions show an epidural and pedicular extension. We propose that grade I lesions may not be worthwhile for follow-up, whereas asymptomatic grade II (a) lesions to be worthy for a biannual imaging and symptomatic thoracolumbar grade II (b) and thoracolumbar grade III lesions to be considered for percutaneous vertebroplasty. We imply that decompression, posterior spinal instrumentation, and open vertebroplasty may be performed for thoracolumbar grade IV lesions. We further consider cervical grade IIb, III, and grade IV lesions as operable because of the disadvantages of percutaneous vertebroplasty. CONCLUSIONS: We suggest that our novel classification system may be useful for the determination of diagnostic and therapeutic procedures in the management of VH. Further multicentric trials on larger series are warranted to validate this system and popularize its utility in larger populations.

FGF2 gene's antisense protein, NUDT6, plays a depressogenic role by promoting inflammation and suppressing neurogenesis without altering FGF2 signalling.

Fibroblast growth factor-2 (FGF2) is involved in the regulation of affective behaviour and shows antidepressant effects through the Akt and extracellular signal regulated kinase (ERK) 1/2 pathways. Nudix hydrolase 6 (NUDT6) protein is encoded from FGF2 gene's antisense strand and its role in the regulation of affective behaviour is unknown. Here, we overexpressed NUDT6 in the hippocampus and investigated its behavioural effects and the underlying molecular mechanisms affecting the behaviour. We showed that increasing hippocampal NUDT6 results in depression-like behaviour in rats without changing FGF2 levels or activating its downstream effectors, Akt and ERK1/2. Instead, NUDT6 acted by inducing inflammatory signalling, specifically by increasing S100 calcium binding protein A9 (S100A9) levels, activating nuclear factor-kappa B-p65 (NF-κB-p65), and elevating microglia numbers along with a reduction in neurogenesis. Our results suggest that NUDT6 could play a role in major depression by inducing a proinflammatory state. This is the first report of an antisense protein acting through a different mechanism of action than regulation of its sense protein. The opposite effects of NUDT6 and FGF2 on depression-like behaviour may serve as a mechanism to fine-tune affective behaviour. Our findings open up new venues for studying the differential regulation and functional interactions of sense and antisense proteins in neural function and behaviour, as well as in neuropsychiatric disorders. KEY POINTS: Hippocampal overexpression of nudix hydrolase 6 (NUDT6), the antisense protein of fibroblast growth factor-2 (FGF2), increases depression-like behaviour in rats. Hippocampal NUDT6 overexpression triggers a neuroinflammatory cascade by increasing S100 calcium binding proteinA9 (S100A9) expression and nuclear NF-κB-p65 translocation in neurons, in addition to microglial recruitment and activation. Hippocampal NUDT6 overexpression suppresses neurogenesis. NUDT6 exerts its actions without altering the levels or downstream signalling pathways of FGF2.

Evaluation of the relationship between computed tomography angiography collateral scores and clinical outcome.

BACKGROUND: The relationship between collateral circulation and prognosis after endovascular treatment in anterior circulation strokes has been reported in many studies. OBJECTIVE: In this study, we aimed to compare the predictive power of clinical outcome by comparing five different collateral scores that are frequently used. METHODS: Among the patients who underwent endovascular treatment in our clinic between November 2019 and December 2021, patients with premorbid mRS < 3, intracranial ICA and/or MCA M1 occlusion, and a pre-procedural multiphase CTA examination were included in the study. Demographic, technical, and duration information about the procedure, major events after the procedure, and clinical outcomes at 3 months were recorded. The mCTA, Tan, Maas, Miteff, and rLMC collateral scores of the patients were evaluated. RESULTS: Clinical outcome at 3 months were good in 37 of the 68 patients included in the study (mRS ≤ 2). Only the mCTA and rLMC collateral scores were statistically significantly higher in those with a good clinical outcome. Significant correlation with 3-month mRS was detected only in mCTA and rLMC scores. Although rLMC and mCTA collateral scores showed a statistically significant association with prognosis, they were not sufficient to be an independent predictor of prognosis. CONCLUSION: mCTA and rLMC were found to have the highest predictive power of clinical outcome and the highest correlation with the 3-month clinical outcome. Our study suggests that it would be beneficial to develop a new scoring system over multiphase CTA, which combines regional and temporal evaluation, which are the strengths of both collateral scoring.

ANTECEDENTES: A relação entre circulação colateral e prognóstico após tratamento endovascular em acidentes vasculares cerebrais de circulação anterior tem sido relatada em muitos estudos. OBJETIVO: Neste estudo, nosso objetivo foi comparar o poder preditivo do desfecho clínico comparando cinco escores colaterais diferentes que são frequentemente utilizados. MéTODOS: Entre os pacientes submetidos a tratamento endovascular em nossa clínica entre novembro de 2019 e dezembro de 2021, foram incluídos no estudo pacientes com mRS pré-mórbido < 3, oclusão intracraniana de ICA e/ou MCA M1 e exame de CTA multifásico pré-procedimento. Foram registradas informações demográficas, técnicas e de duração sobre o procedimento, eventos importantes após o procedimento e resultados clínicos em três meses. Foram avaliados os escores colaterais mCTA, Tan, Maas, Miteff e rLMC dos pacientes. RESULTADOS: Os resultados clínicos aos três meses foram bons em 37 dos 68 pacientes incluídos no estudo (mRS ≤ 2). Apenas os escores colaterais mCTA e rLMC foram estatisticamente significativamente maiores naqueles com boa evolução clínica. Correlação significativa com mRS de três meses foi detectada apenas nos escores mCTA e rLMC. Embora os escores colaterais de rLMC e mCTA tenham mostrado uma associação estatisticamente significativa com o prognóstico, eles não foram suficientes para serem um preditor independente de prognóstico. CONCLUSãO: Verificou-se que mCTA e rLMC têm o maior poder preditivo do resultado clínico e a maior correlação com o resultado clínico de três meses. Nosso estudo sugere que seria benéfico desenvolver um novo sistema de pontuação em vez de CTA multifásico, que combinasse avaliação regional e temporal, que são os pontos fortes de ambas as pontuações colaterais.

Synthesis and characterization of iron oxide-commercial activated carbon nanocomposite for removal of hexavalent chromium (Cr6+) ions and Mordant Violet 40 (MV40) dye.

Iron Oxide-commercial activated carbon nanocomposite (CAC-IO) was prepared from commercial activated carbon (CAC) by the co-precipitation method, and the resulting nanocomposite was used as an adsorbent to remove hexavalent chromium (Cr6+) ions and Mordant Violet 40 (MV40) dye from wastewater. The produced materials (CAC, CAC after oxidation, and CAC-IO) were comparatively characterized using FTIR, BET, SEM, EDX TEM, VSM, and XRD techniques. The adsorption mechanism of Cr6+ ions and MV40 dye on CAC-IO was examined using Langmuir and Freundlich isotherm models.. Different models were applied to know the adsorption mechanism and it was obtained that Pseudo-second order fits the experimental data better. This means that the adsorption of the adsorbate on the nanocomposite was chemisorption. The maximum removal percent of Cr6+ ions by CAC-IO nanocomposite was 98.6% determined as 2 g L-1 adsorbent concentration, 100 mg L-1 initial pollutant concentration, solution pH = 1.6, the contact time was 3 h and the temperature was room temperature. The maximum removal percentage of Mordant Violet 40 dye (C.I. 14,745) from its solutions by CAC-IO nanocomposite was 99.92% in 100 mg L-1 of initial dye concentrations, 1.0 g L-1 of adsorbent concentration, solution pH = 2.07, the contact time was 3 h. The MV40 dye adsorption on CAC-IO was the most fitted to the Freundlich isotherm model. The maximum adsorption capacity was calculated according to the Langmuir model as 833.3 mg g-1 at 2 g L-1 of adsorbent concentration and 400 mg L-1 of initial MV40 dye concentration. The Cr6+ ions adsorption on CAC-IO was more fitted to the Freundlich model with Qmax, equal to 312.50 mg g-1 at 1 g L-1 adsorbent concentration and 400 mg L-1 of Cr6+ ions initial concentrations.

Effect of tranexamic acid on fracture healing in rats / Efeito do ácido tranexâmico na cura de fratura em ratos

ABSTRACT Introduction In this study we investigated the effect of tranexamic acid (TXA) on fracture healing in an established animal model, when used to stop bleeding in orthopedic trauma surgery. Materials and Methods This study was a randomized, controlled, laboratory study. Eighteen Sprague-Dawley rats were randomly assigned to three groups, either receiving TXA intravenously (Group 1), TXA topically (Group 2), or isotonic TXA intravenously and TXA topically in the same amounts for the control group (Group 3). First, a Kirschner wire was inserted retrogradely into the femoral intramedullary canal. Then the femurs were fractured at the midshaft region with blunt guillotine. After 4 weeks, the rats were sacrified and the femurs harvested. Cortical bone volume, callus volume, and bone mineral density were calculated using computer tomography scans. Torsion tests were performed. Groups were compared by maximum torque to failure and callus stiffness. Results There were no statistical differences in torque to failure and stiffness between the 3 groups. There were no differences in mean total bone volume, callus volume, percent bone volume, or callus density between the groups. Conclusions A single dose of topical or intravenous TXA has no negative effect on fracture healing when used in traumatic femur fracture surgery in an animal model. Evidence level II; Randomized controlled experimental study.

RESUMO Introdução Neste estudo, investigamos o efeito do ácido tranexâmico (TXA) sobre a consolidação de fraturas em um modelo animal estabelecido, quando é usado para estancar o sangramento em cirurgias de trauma ortopédico. Materiais e Métodos Trata-se de estudo de laboratório randomizado e controlado. Dezoito ratos Sprague-Dawley foram atribuídos randomicamente em três grupos, que receberam TXA por via intravenosa (Grupo 1), TXA tópico (Grupo 2) ou isotônico por via intravenosa e tópico na mesma quantidade como grupo controle (Grupo 3). Primeiro, foi inserido um fio de Kirschner por via retrógrada no canal intramedular femoral. Em seguida, o fêmur dos animais foi fraturado na região média do corpo do fêmur com guilhotina romba. Depois de quatro semanas, os ratos foram sacrificados e os fêmures foram retirados. O volume do osso cortical, o volume do calo e a densidade mineral óssea foram calculados por meio de tomografia computadorizada e foram realizados testes de torção. Os grupos foram comparados de acordo com o torque máximo até a falha e a rigidez do calo. Resultados Não houve diferença estatística no torque até a falha e rigidez entre os três grupos nem diferenças entre os grupos quanto ao volume médio total do osso, volume e densidade do calo e percentual de volume ósseo. Conclusões Uma dose única de TXA tópico ou intravenoso não tem efeito negativo sobre a consolidação da fratura quando usada em cirurgia de fratura traumática de fêmur em modelo animal. Nível de evidência II; Estudo experimental controlado randomizado.