Effectiveness of low frequency vibration on the rate of canine retraction: a randomized controlled clinical trial.

To investigate the effectiveness of AcceleDent Aura vibrating device on the rate of canine retraction. Thirty-two patients requiring extraction of upper first premolars and canine retraction were randomly allocated with a 1:1 ratio into either no-appliance group or the AcceleDent Aura appliance group. Canine retraction was done applying 150gm of retraction force using NiTi coil springs on 16 × 22 stainless steel archwires. The duration of the study was 4 months. Models were collected and digitized directly after extraction of upper first premolars and at monthly intervals during canine retraction for recording the monthly as well as the total distance moved by the canine. Digitized models were superimposed on the initial model and data were statistically analyzed. Anchorage loss, rotation, tipping, torque and root condition were evaluated using cone beam computed tomography imaging. Pain was evaluated by visual analog scale. No patients were dropped-out during this study. There was no statistically significant difference between both groups regarding the total distance travelled by the canine (P = 0.436), as well as the rate of canine retraction per month (P = 0.17). Root condition was the same for the two groups. Regarding the pain level, there was no statistically significant difference between the two groups at day 0 (P = 0.721), after 24 h (P = 0.882), after 72 h (P = 0.378) and after 7 days (P = 0.964). AcceleDent Aura was not able to accelerate orthodontic tooth movement. Pain level couldn't be reduced by vibrational force with an AcceleDent device during orthodontic treatment. Root condition was not affected by the vibrational forces.

Assessment of the anti-cancer potential of Ephedra foeminea leaf extract on MDA-MB-231, MCF-7, 4 T1, and MCF-10 breast cancer cell lines: Cytotoxic, apoptotic and oxidative assays.

Ephedra foeminea is traditionally used to treat breast cancer in several Arab countries. Scientific studies have reported different effects of this plant on some cancer cell lines. The current study determined the anti-cancer potential of the methanolic extract of Ephedra foeminea against four different types of breast cancer cell lines in-vitro. The extract was prepared by maceration and phytoconstituents were identified by LC-MS analysis. The IC50 value was determined against MDA-MB-231, MCF-7, 4 T1, and MCF-10 cell lines using the MTT assay. Further investigations were carried out using IC50 concentration of the extract (40.09 µg/ml) to determine live/dead cells by acridine orange/ethidium bromide staining. The effect on the expression of reactive oxygen species (ROS) was evaluated by flow cytometry. The results were analyzed using one-way ANOVA followed by Tukey's test. The LC-MS analysis revealed the presence of 34 and 30 phytoconstituents in positive and negative modes respectively. The Ephedra foeminea extract was most effective against 4 T1 cells in a dose-dependent manner (P < 0.001) with an IC50 value of 40.09 µg/ml and showed negligible effect against MCF-10 cells. It increased apoptosis in 77.84 % of 4 T1 cells, as determined by acridine orange/ethidium bromide staining. The extract also increased the ROS expression in the 39.57 % of 4 T1 cells. The study results showed that Ephedra foeminea extract possesses an anti-cancer effect against 4 T1 cells by increasing the expression of ROS and inducing apoptosis in the 4 T1 cells. The result suggests Ephedra foemenia methanolic extract possesses a reasonable anti-cancer effect due to its effect on apoptosis and oxidative pathways. The results confirm the traditional belief that Ephedra is effective against breast cancerز.

Neglected war injuries: Reconstruction versus amputation.

INTRODUCTION: War injuries are remarkably different situations with profound severity and significant contamination compared to civilian injuries. Delayed definitive management makes the situation much more complicated. This study aimed to report the outcomes of limb reconstruction of neglected war injuries with a previous decision of amputation. PATIENTS AND METHODS: From 2010 to 2021, 1104 patients with war-related fractures from conflict-zone countries were referred to our center including 589 open tibial fractures. Of these tibial fractures, amputation had already been decided in 54 cases, and the patients were looking for a trial of reconstruction and avoiding amputation. These cases were included in the current study. The treatment approach was a single-stage procedure with bone and soft tissue reconstruction. RESULTS: This study included 54 male patients with a mean age of 26.3 years. Infection was the predominant feature in 43 cases (79.6 %). CT angiography revealed a one-vessel limb in 17 patients. Peripheral nerve injuries affected 15 patients. The mean time from injury to presentation was 8.5 weeks. The bone gap (2-13 cm) was evident in 44 cases. In four cases, the contralateral limb was amputated below the knee. There were associated injuries in nine cases. Rotational flap coverage was done in the same setting for 19 legs. Gastrocnemius flap was done in two cases. The mean follow-up duration was 45.1 months. The treatment methods included bifocal management (33 cases), trifocal management (17 cases), fibular transfer (two cases), and a mono-focal approach in two cases. All fractures healed successfully. The mean external fixation period was 7.6 months. Recurrence of infection occurred in three patients. A non-displaced refracture developed in one case. Five cases had a residual angular deformity. Eventually, the ASAMI bone and functional results were good in all cases. CONCLUSIONS: Neglected war injuries constitute a complex problem where amputation may be indicated. Our approach includes one-stage limb reconstruction with the corticotomy-first technique, conservative debridement of the docking site, concomitant osteoplastic procedure, and gradual distraction to tackle all the aspects of the problem. The good results obtained in the presented series make it a valid approach to avoid amputation in neglected war injuries.

Biomonitoring of manganese metal pollution in water and its impacts on biological activities of Biomphalaria alexandrina snail and larvicidal potencies.

Metal pollution has many dangerous environmental and human health consequences due to the bioaccumulation in the tissues. The present study aims to measure the bioaccumulation factor of the manganese (Mn) heavy metal in Biomphalaria alexandrina snails' tissues and water samples. The current results showed the concentration of Mn heavy metal in water (87.5 mg/l) and its bioaccumulation factor in Helisoma duryi tissue was higher than that in tissues of Physa acuta and B. alexandrina snails. Results showed that 87.5 mg/l Mn concentration had miracidicidal and cercaricidal activities. Also, this concentration decreased the mean total number of the hemocytes after exposure for 24 h or 48 h, while increasing both the mean mortality and phagocytic indices of the hemocytes of exposed snails. It caused alterations in the cytomorphology of the hemocytes of exposed snails after 24 or 48 h, where the granulocytes had irregular cell membranes and formed pseudopodia. Besides, levels of testosterone (T) and estradiol (E) were increased after exposure to 87.5 mg/l Mn metal compared to the control group. Also, it increased MDA (malonaldehyde) and TAC (total antioxidant capacity) contents, while decreasing SOD (superoxide dismutase). Besides, it caused significant histopathological damages in both hermaphrodite and digestive glands, represented in the degeneration of the gonadal, digestive, secretory cells, and the connective tissues. Therefore, B. alexandrina might be used as a sensitive bioindicator of pollution with Mn heavy metal to avoid ethics rules; besides, they are readily available and large in number.

Honey dressing: a missed way for orthopaedic wound care.

PURPOSE: Orthopaedic-related wounds are critical situations calling for care to avoid deep infections and its consequences. The purpose of this study was to evaluate the efficacy of using honey for care of orthopaedic-related wounds with limited resources. PATIENTS AND METHODS: This prospective study included 50 cases with an average age of 38.18 (range 17-63) years with 38 males and 12 females. The most frequent wound location was the leg (41 patients; 82%), then the foot (six patients; 12%), and the ankle in three patients (6%). The aetiologies were open fractures (34 cases; 68%), infected tibial non-unions (nine cases; 18%), and post-operative infections (seven cases; 14%). Exposed tendon was present in three cases. Bone exposure was present in two cases. Deep infection was present in 29 cases (58%). Besides treating the primary cause, a ribbon of gauze soaked with honey was applied to the wounds after thorough saline washing. RESULTS: Wound sizes were variable. All cases showed improvement in all parameters with complete wound healing and full coverage of bone and tendons. Recurrence of deep infection occurred in three cases and treated by debridement. One case needed sequestrectomy of a small exposed tibial cortical fragment. Exposed tendon cases showed superficial necrosis which was treated by simple debridement. Initial mild itching occurred in five patients with spontaneous resolution. CONCLUSION: With treating the underlying aetiology and optimising the patient's general condition, honey was an effective, simple, and affordable method of wound care in different orthopaedic conditions even with exposed bone or tendons.

3E enhancement of freshwater productivity of solar still with heater, vibration, and cover cooling.

This study focused on experimentally increasing the productivity of freshwater from solar stills. The performance of a single solar still system could be augmented with the combination of an electric heater, vibration motion, and thermoelectric cooling. The study investigated the effects of combining two of these components and finally combining all of them on freshwater productivity. The electric heater and vibration motion are used to enrich the evaporation rate, while thermoelectric coolers are used to enhance the condensation rate, leading to high freshwater productivity. The proposal, construction, and testing of two identical solar stills were performed under the local climate conditions of the city of Alexandria in northwestern Egypt during the summer and winter times. The two solar stills had a 1-m2 base area. An electric heater of 450 W was placed inside the modified solar still. The modified solar still was fixed on four coiled springs. A 1-hp power DC motor, an inverter, a control unit, and two 330-W photovoltaic solar panels were attached to the modified solar still. Eccentric masses were mounted on the rotating disk attached to the DC motor to generate the vibration. Under the same climate conditions, the daily output of freshwater was measured experimentally for the modified case and the conventional solar. The daily rates of freshwater productivity in summer were investigated for four cases and the conventional one. Results showed that the peak daily freshwater productivity achieved with the solar heater, thermoelectric coolers, and vibration motion was 12.82 kg/day, with a maximum estimated cost of 0.01786 $/L/m2.The exergoeconomic of the modified solar still with heater, vibration, and thermoelectric cooler was greater than that of conventional ones. The highest CO2 mitigation of the case (5) and that of the conventional solar desalination were about 160 tons and 28 tons, respectively.

Allogeneic platelet-derived growth factors local injection in treatment of tennis elbow: a prospective randomized controlled study.

PURPOSE: The purpose of this study aimed to evaluate the efficacy of local injection of allogeneic platelet-derived growth factors in treatment of patients with tennis elbow. PATIENTS AND METHODS: This study included 120 tennis elbow patients randomly divided into two groups. The patients were locally injected with allogeneic growth factors (treatment group) or with normal saline (control group). The outcomes were assessed using Patient-Related Tennis Elbow Evaluation (PRTEE) and quick Disabilities of the Arm, Shoulder and Hand (qDASH) scales. The clinical outcomes were accordingly classified as excellent, good and poor. The patient's satisfaction and adverse effects were also recorded. RESULTS: There was no statistically significant difference between the two groups regarding the age, gender, dominant arm or the pre-injection scores. At three month follow-up, the reductions in the mean PRTEE and qDASH scores were 88.7% and 70.6% in the treatment group versus 21.8% and 14.9% in the control group, respectively. At the last follow-up, the outcomes in the treatment group were excellent in 85% of patients and good in 15%, versus 8% and 32% in the control group. Overall, 95% were satisfied in the treatment group compared to 25% in control group. Forty patients in the treatment group experienced mild transient post-injection pain. CONCLUSION: This study strongly suggests that local injection of allogeneic platelet-derived growth factors could be a promising safe treatment option for tennis elbow with significant pain relief, functional improvement and patient's satisfaction. Yet, additional larger studies are needed to assess the durability of these outcomes.

Neglected infected floating knee injury: evaluation of closed reduction techniques.

PURPOSE: Floating knee injury is uncommon yet challenging problem. The situation is more complicated by presence of infection, open comminuted fractures, and late presentation. The aim of this study was to evaluate the closed reduction techniques by circular external fixation in a single stage to treat patients having infected neglected floating knee injuries. METHODS: This retrospective study included 19 patients with a mean age of 34.4 years. The average duration from trauma to surgery was 51.1 days. All patients had at least one infected open fracture. According to Fraser's classification, ten injuries were type I, one case was type IIa, four were type IIb, and four were type IIc. Patients were treated by closed reduction techniques using the Ilizarov principles. Orthoplastic procedures were done in four cases in the same surgical setting. RESULTS: Closed reduction and union were achieved in all cases with control of infection in 17 cases. The follow-up period averaged 41 months. The mean knee flexion was 97.4°. The complications included 5° extension lag (two cases), malunion (three cases), refracture (two cases), and DVT (four cases). The bone results were excellent (12 cases), good (5 cases), and poor (2 cases). The functional results were excellent (two cases), good (seven cases), acceptable (seven cases), and poor (three cases). CONCLUSIONS: Closed reduction techniques using a circular frame provided a valid treatment option for infected neglected floating knee injuries in one stage without bone grafting. However, the high rate of complications and the diminished knee range of motion should be considered.

Powering Implantable and Ingestible Electronics.

Implantable and ingestible biomedical electronic devices can be useful tools for detecting physiological and pathophysiological signals, and providing treatments that cannot be done externally. However, one major challenge in the development of these devices is the limited lifetime of their power sources. The state-of-the-art of powering technologies for implantable and ingestible electronics is reviewed here. The structure and power requirements of implantable and ingestible biomedical electronics are described to guide the development of powering technologies. These powering technologies include novel batteries that can be used as both power sources and for energy storage, devices that can harvest energy from the human body, and devices that can receive and operate with energy transferred from exogenous sources. Furthermore, potential sources of mechanical, chemical, and electromagnetic energy present around common target locations of implantable and ingestible electronics are thoroughly analyzed; energy harvesting and transfer methods befitting each energy source are also discussed. Developing power sources that are safe, compact, and have high volumetric energy densities is essential for realizing long-term in-body biomedical electronics and for enabling a new era of personalized healthcare.

A Case Control Study on Serum Levels of Potential Biomarkers in Male Breast Cancer Patients.

The global incidence of breast cancer among men is steadily growing. Despite this, compared to female breast cancer patients, there are very few studies on biomarkers in male breast cancer patients. A cross-sectional case control study was carried out to determine the serum levels of melatonin, ghrelin, dopamine, serotonin, epinephrine, and GABA in male breast cancer. All the recruited patients were obese, old, and had recently been diagnosed with the disease. They had not received any treatment for the cancer until the time of the study. Melatonin and epinephrine serum levels were significantly higher in breast cancer patients compared to their age-matched controls, whereas ghrelin, dopamine, GABA, and serotonin serum levels were lower in patients compared to the control group. The serum levels of most of the studied biomarkers in male breast cancer patients were similar to those observed in female breast cancer patients, except for serum melatonin levels.

Triboelectric Nanogenerator versus Piezoelectric Generator at Low Frequency (<4 Hz): A Quantitative Comparison.

Triboelectric nanogenerators (TENGs) and piezoelectric generators (PGs) are generally considered the two most common approaches for harvesting ambient mechanical energy that is ubiquitous in our everyday life. The main difference between the two generators lies in their respective working frequency range. Despite the remarkable progress, there has been no quantitative studies on the operating frequency band of the two generators at frequency values below 4 Hz, typical of human motion. Here, the two generators are systematically compared based on their energy harvesting capabilities below 4 Hz. Unlike PGs, the TENG demonstrates higher power performance and is almost independent of the operating frequency, making it highly efficient for multi-frequency operation. In addition, PGs were shown to be inapplicable for charging capacitors when a rectifier was attached to the system. The results of this work reveal the tremendous potential of flexible TENGs for harvesting energy at low frequency.

Paediatric infected femoral nonunion; mid-term results of a rare problem with a single-stage treatment and up to eleven and half years follow-up.

PURPOSE: Nonunion of femur fractures is a devastating disabling complication which is rare in children. The purpose of this study was to report the outcomes of treating infected femur nonunions in children by the Ilizarov fixator in one stage. PATIENTS AND METHODS: The study included 13 patients with unilateral infected nonunion of the femur with an average age of 9.1 years. The nonunion duration averaged 10.69 months. Ten cases were draining nonunions, and three patients had quiescent sinuses. Associated problems include shortening in all cases (mean 3.5 cm), joint stiffness (9 cases), and angular deformity (7 cases). The quiescent cases were treated by bloodless monofocal compression-distraction. Four draining cases were treated by debridement and compression with relengthening through nonunion site. The remaining six cases were treated by bifocal technique. RESULTS: The mean follow-up duration was 60.15 months. External fixation period averaged 5.3 months. Successful union was achieved in all patients. Recurrences of infection occurred in two cases including one with refracture and another one with late pathological fracture. Other complications included pin tract infections, one delayed union, two residual angular deformities, and 6 cm residual shortening in one patient. ASAMI bone results were excellent (8 patients), good (3 patients), fair (one patient), and poor (one patient). The functional results were excellent (9 cases), good (3cases), and fair (one case). CONCLUSIONS: The Ilizarov method provided a viable treatment option for treating paediatric infected femur nonunions in single stage of management with infection control in most cases and satisfactory outcomes.

Integrated Triboelectric Nanogenerators in the Era of the Internet of Things.

Since their debut in 2012, triboelectric nanogenerators (TENGs) have attained high performance in terms of both energy density and instantaneous conversion, reaching up to 500 W m-2 and 85%, respectively, synchronous with multiple energy sources and hybridized designs. Here, a comprehensive review of the design guidelines of TENGs, their performance, and their designs in the context of Internet of Things (IoT) applications is presented. The development stages of TENGs in large-scale self-powered systems and technological applications enabled by harvesting energy from water waves or wind energy sources are also reviewed. This self-powered capability is essential considering that IoT applications should be capable of operation anywhere and anytime, supported by a network of energy harvesting systems in arbitrary environments. In addition, this review paper investigates the development of self-charging power units (SCPUs), which can be realized by pairing TENGs with energy storage devices, such as batteries and capacitors. Consequently, different designs of power management circuits, supercapacitors, and batteries that can be integrated with TENG devices are also reviewed. Finally, the significant factors that need to be addressed when designing and optimizing TENG-based systems for energy harvesting and self-powered sensing applications are discussed.

Treatment of open intraarticular distal femur fractures by Ilizarov fixator; an approach to improve the outcome with mid-term results.

PURPOSE: Open comminuted intraarticular distal femur fracture represents a formidable challenge for the orthopaedic surgeon for the inherent fracture complexity, soft tissue damage, and contamination. The purpose of this study was to evaluate the mid-term outcome results and safety of using the Ilizarov fixator to treat these fractures. PATIENTS AND METHODS: The study included 22 fractures treated by debridement with reduction and stabilization by Ilizarov external fixator. The mean age was 35 years. Gustilo grade of open fracture was III-A (19 cases), III-B (2 cases), and III-C (1 case). Six fractures were AO-OTA type 33C2, and 16 cases were type 33C3. Eight patients had associated injuries. Bone and functional results were evaluated by Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria, and Neer knee score. The statistical analysis was done using the IBM SPSS Statistics for Windows. RESULTS: Seven cases had autogenous bone grafting. The frame crossed the knee in 8 patients. The fixator was removed after a mean of 7 months with union in all cases, and without any malalignment >5°. Deep infection occurred in two cases. Quadriceps-plasty was needed for 3 cases. After a mean of 44 months, the last follow-up results showed full knee extension and a mean flexion of 107.59°. The ASAMI functional and bone results were good to excellent in all cases. Neer knee score averaged 86.59. CONCLUSIONS: Ilizarov fixator was an effective treatment modality of open comminuted distal femur fractures with high union rate, adequate alignment and satisfactory functional outcomes.

Preliminary Outcomes of Calcaneal Lengthening in Adolescent Flatfoot in Müller-Weiss Disease.

BACKGROUND: Müller-Weiss disease (MWD) remains a controversial painful foot condition without consensus on its pathogenesis or a gold standard treatment modality. The aim of the study was to evaluate the outcomes of calcaneal lengthening in adolescent patients with symptomatic MWD with flatfoot. METHODS: The study included 13 feet of 7 patients including 5 females and 2 males who were treated from March 2012 until June 2015 by calcaneal lengthening. The mean age was 15.6 years. The mean duration of symptoms was 13.5 months. The body mass index (BMI) averaged 28.9 kg/m2 at presentation. The patients were followed up for a mean of 37.8 months. RESULTS: The osteotomy healed in all cases after a mean of 7.2 weeks. The second foot was operated on after an average of 11.5 months. The mean talometatarsal-1 angle improved from 39.8 degrees preoperatively to 5.9 degrees. The mean preoperative calcaneal pitch angle of 7.5 degrees increased to an average of 17.8 degrees postoperatively. The mean American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score was improved from 61.9 preoperatively to 94.2 postoperatively. Four patients had occasional exertional pain. Four feet had mild residual forefoot abduction. Arthrodesis was not needed in any case by the last follow-up. CONCLUSION: Early diagnosis of MWD with flatfoot was important and allowed for nonfusion treatment options. Calcaneal lengthening osteotomy in selected MWD cases achieved satisfactory outcomes with pain control, deformity correction, and improvement of the functional results. LEVEL OF EVIDENCE: Level IV, retrospective case series.

An Ultra-Shapeable, Smart Sensing Platform Based on a Multimodal Ferrofluid-Infused Surface.

The development of wearable, all-in-one sensors that can simultaneously monitor several hazard conditions in a real-time fashion imposes the emergent requirement for a smart and stretchable hazard avoidance sensing platform that is stretchable and skin-like. Multifunctional sensors with these features are problematic and challenging to accomplish. In this context, a multimodal ferrofluid-based triboelectric nanogenerator (FO-TENG), featuring sensing capabilities to a variety of hazard stimulus such as a strong magnetic field, noise level, and falling or drowning is reported. The FO-TENG consists of a deformable elastomer tube filled with a ferrofluid, as a triboelectric layer, surrounded by a patterned copper wire, as an electrode, endowing the FO-TENG with excellent waterproof ability, conformability, and stretchability (up to 300%). In addition, The FO-TENG is highly flexible and sustains structural integrity and detection capability under repetitive deformations, including bending and twisting. This FO-TENG represents a smart multifaceted sensing platform that has a unique capacity in diverse applications including hazard preventive wearables, and remote healthcare monitoring.

Infected tibial nonunion in children: Is radical debridement mandatory?

Nonunion is a devastating complication of tibial fractures with a debilitating effect. Several studies reporting tibial nonunions in adults are available; however, the reports on infected nonunions in children are scarce. The purpose of this study was to evaluate the results of treating paediatric infected tibial nonunion using Ilizarov fixator without radical resection. MATERIALS AND METHODS: The study included 36 cases with infected nonunion of the tibia with 31 males and 5 females, and an average age of 11.4 years. The mean number of previous operations was 3.5. The duration before presentation averaged 10.4 months. At presentation, 24 cases were draining nonunions, while 12 patients had quiescent sinuses. Preoperative shortening was evident in 31 patients ranging from 1 to12 cm. Six cases had equinus foot deformity. Stiffness of the ankle and/or knee was present in 11 cases. Angular deformity of more than 10° was evident in 13 nonunions. The monofocal compression-distraction was used for 10 cases managed by bloodless technique, and four draining cases managed by limited debridement and compression distraction. Limited debridement and bone transport was used in the remaining cases including proximal chondrodiastasis (two cases), proximal tibial corticotomy (17 cases), and partial osteotomy (three cases). RESULTS: The mean follow-up duration was 51.9 months. The external fixation period averaged 5.3 months. Delayed union occurred in three cases treated by repeating compression-distraction. Eventually, union was achieved in all cases. Two cases suffered refracture. Four cases had residual angular deformity of about 5-7°. Infection recurred in one case. ASAMI bone results were excellent in 29 patients, good in three patients, fair in two patients, and poor in two patients. The ASAMI functional results were excellent in 27 cases, good in 5 cases, fair in two cases, and poor in two cases. CONCLUSION: The Ilizarov method provides a viable treatment method for treating paediatric infected nonunions in a single stage of management. Limited debridement was enough to control infection and achieved good results without radical resection.

All printable snow-based triboelectric nanogenerator.

The development of power generators that can function in harsh snowy environments and in contact with snow can be beneficial but challenging to accomplish. Herein, we introduce the first snow-based triboelectric nanogenerator (snow-TENG) that can be used as an energy harvester and a multifunctional sensor based on the principle of snow-triboelectrification. In this work, we used a 3D printing technique for the precise design and deposition of the electrode and triboelectric layer, leading to flexible, stretchable and metal-free triboelectric generators. Based on the single electrode mode, the device can generate an instantaneous output power density as high as 0.2 mW/m2, an open circuit voltage up to 8 V, and a current density of 40 µA/m2. In addition, the snow-TENG can function as a miniaturized weather station to monitor the weather in real time to provide accurate information about the snowfall rate, snow accumulation depth, wind direction, and speed in snowy and/or icy environments. In addition, the snow-TENG can be used as a wearable power source and biomechanical sensor to detect human body motions, which may prove useful for snow-related sports. Unlike conventional sensor platforms, our design works without the need for batteries or image processing systems. We envision these devices could potentially be integrated into solar panels to ensure continuous power supply during snowy weather conditions.