The effect of medial shift of supraspinatus tendon on the glenohumeral joint motion-a cadaveric study.

PURPOSE: Full-thickness retracted massive supraspinatus tears are a challenge for arthroscopic surgeons where multiple options for treatment exist, but medializing the attachment is a relatively easy procedure for which a decision can be taken intraoperatively. We investigate the viability of MATERIAL AND METHODS: Ten freshly thawed cadavers were taken and dissected. The supraspinatus tendon was resected, and then its attachment was progressively medialized. The range of motion (abduction, internal and external rotation) was recorded and compared. As a result, we noted a statistically significant decrease in abduction, internal and external rotation with progressive medialization of the supraspinatus insertion. CONCLUSION: Medialized repair of the supraspinatus can be performed only to an extent beyond which it compromises glenohumeral motion. We noted a statistically significant decrease in ROM with even a 3 mm medialization of the tendon, but the acceptable medialization has to be determined on a case-to-case basis.

Biosynthesis of ZnO and TiO2 nanoparticles using Ipomoea carnea leaf extract and its effect on black carrot (Daucus carota L.) cv. Pusa Asita.

Nano fertilizers (NFs) are now becoming an important tool for plant nutrient management having capabilities to improve soil fertility, crop productivity and quality of agricultural products. Since, they are needed in very small amount, thus, reduces cost of crop production. Among different essential or beneficial plant nutrients, Zn and Ti are important micro nutrients having number of beneficial effect on crop growth, yield, quality and post harvest life. Present experiment was carried out to prepare ZnO and TiO2 nanoparticles (NPs) through green technology by using aqueous extract of Ipomoea carnea (morning glory) leaves. In order to investigate size, morphology, composition, and stability of selected NPs, the detailed characterization was carried out using UV-visible spectroscopy, FTIR, HRTEM, EDX, BET, X-ray diffraction, XPS and particle size distribution studies. Subsequently, the effect of foliar spray of ZnO and TiO2 NPs was evaluated in respect of vegetative growth, yield and quality of black carrot (Daucus carota L.) cv. Pusa Asita in presence of 50% Recommended dose of fertilizer (RDF) to assess their effect on fertilizer use efficiency also. There were 8 treatments viz. Control (no fertilizer), recommended dose of fertilizer (RDF), TiO2 (5, 10 and 15 ppm along with 50% RDF), ZnO (50, 75 and 100 ppm along with 50% RDF)] with 3 replications following Randomised Block Design having 24 plots (1 m × 1 m). The observations were taken for vegetative growth, edible root yield and root quality parameters. Although, the growth, yield and quality parameters were found superior (root yield 43.84 g/plant) under conventional system of recommended dose of fertilizers (RDF) of NPK, however, TiO2 NPs also showed very promising result close to RDF as compared to ZnO NPs. Among them, 5 ppm TiO2 foliar application along with 50% NPK was found to be the best in terms of vegetative growth, root yield (38.73 g/plant) and quality of black carrot. It was also found that higher concentration of TiO2 and ZnO NPs had adverse effect on the plant performance. Therefore, it can be concluded that 5 ppm TiO2 NPs along with 50% RDF was good for black carrot production.

Prediction of sodium binding energy on 2D VS2via machine learning: a robust accompanying method to ab initio random structure searching.

In this work, we employed the back-propagation neural network (BPNN) for predicting the energetics of different sodium adsorption phases on the VS2 monolayer generated via ab initio random structure searching (AIRSS). Two key adsorption features were identified as inputs: the average Na-Na distance and a defined adsorption feature marker that indicates the number of nearest-neighbor pairs within a sodium cluster. Using the stoichiometric structure Na0.5VS2 as the test system, we first generated 50 random sensible structures via AIRSS and optimized them via density functional theory (DFT) calculations to obtain the sodium binding energy per atom. From these, 30 were utilized to train 3000 BPNNs with varying numbers of neurons and types of activation functions. The remaining 20 were employed to verify the generalization of the best identified BPNN model for the considered Na0.5VS2 system. The calculated mean absolute error for the predicted sodium binding energy per atom is smaller than 0.1 eV. This suggests that the identified BPNN model was able to predict the sodium binding energy per atom on VS2 with outstanding accuracy. Our results demonstrated that with the assistance of BPNN, it is possible to perform AIRSS with hundreds of random sensible structures without relying solely on DFT calculations. The uniqueness of this method lies on the utilization of a very large number of BPNN models to be trained by a relatively small number of structures. This is particularly very useful for large systems wherein the data come from DFT calculations, which is computationally expensive. Moreover, with the assistance of machine learning, the theoretical estimation of important metal-ion battery metrics such as specific energy capacity and open circuit voltage via AIRSS could be made more accurate and reliable.

Measurement of Distance Between Femoral Insertion of Fibular Collateral Ligament and Popliteus: A Cadaveric Study in Indian Population.

Background: Injuries to posterolateral corner (PLC) of knee are often neglected. The three key components of PLC are lateral collateral ligament (LCL), popliteofibular ligament (PFL) and popliteus tendon (PT). For adequate reconstruction, anatomic location of these ligaments should be well understood. Material and methods: Twenty formalin fixed cadaveric knees were dissected. PT and LCL identified. Circumference of the two structures marked with pen just after cutting them close to bone surface. Distance between the centre of LCL and PT was measured along with the measurement of distal femoral medio-lateral dimension (MLD) and Anteroposterior dimension (ALD) of lateral condyle. Result: The mean distance between PT and LCL measured in 20 specimens was 8.3 ± 0.84 mm, with a range of 7 mm to 10 mm. MLD was 81.0 ± 3.6 mm and APD was 62.7 ± 3.2 mm. Conclusion: The distance in Indian population is significantly smaller compared to the western. This has clinical implication in drilling the tunnels for PLC reconstruction.

Microscopic Proof of Photoluminescence from Mechanochemically Synthesized 1-Octene-Capped Quantum-Confined Silicon Nanoparticles: Implications for Light-Emission Applications.

Silicon nanoparticles (SiNPs) have been explored intensively for their use in applications requiring efficient fluorescence for LEDs, lasers, displays, photovoltaic spectral-shifting filters, and biomedical applications. High radiative rates are essential for such applications, and theoretically these could be achieved via quantum confinement and/or straining. Wet-chemical methods used to synthesize SiNPs are under scrutiny because of reported contamination by fluorescent carbon species. To develop a cleaner method, we utilize a specially designed attritor type high-energy ball-mill and use a high-purity (99.999%) Si microparticle precursor. The mechanochemical process is used under a continuous nitrogen gas atmosphere to avoid oxidation of the particles. We confirm the presence of quantum-confined NPs (<5 nm) using atomic force microscopy (AFM). Microphotoluminescence (PL) spectroscopy coupled to AFM confirms quantum-confined tunable red/near-infrared PL emission in SiNPs capped with an organic ligand (1-octene). Using micro-Raman-PL spectroscopy, we confirm SiNPs as the origin of the emission. These results demonstrate a facile and potentially scalable mechanochemical method of synthesis for contamination-free SiNPs.

Correlation between height and semitendinosus tendon length, prediction of minimum semitendinosus tendon length based on height-an easy and accurate method.

Purpose: To find out an easy method to predict tendon length on the basis of patient height. Methods: A prospective study which included 256 patients. All patients underwent ligament reconstruction using semitendinosus graft. Pre-operatively age, gender, height and weight were noted. Harvested semitendinosus graft's length and diameter was measured. Results: Both the patient height as well as weight correlated with tendon diameter and tendon length (p-value < 0.05). A simple equation was also derived to pre-operatively predict tendon length. Conclusion: To predict graft size, surgeon should consider anthropometric variables. If we divide height of the patient with six, we get the approximate length of the tendon and by subtracting three from the obtained value we are more than 90% sure that ST would not be shorter than this. Level of evidence: level 4.

Sacha inchi (Plukenetia volubilis L.): An emerging source of nutrients, omega-3 fatty acid and phytochemicals.

Sacha inchi (Plukenetia volubilis) (SI) is an oleaginous plant producing oil and protein-rich seeds. It has been cultivated for centuries and is native to the tropical rainforest of the Amazon region of South America including parts of Peru and northwestern Brazil. At present, SI seeds are emerging as a potential source of macro- and micronutrients, α-linolenic acid and phytochemicals. This review attempts to elucidate the nutrients, phytonutrients, safety, toxicity, health benefits and food applications of SI seed. Recent scientific studies have associated the consumption of SI seed/oil with reduced risk of chronic inflammatory diseases. However, lack of awareness and in-depth understanding has resulted in it being neglected both at the consumer and industrial level. In all, SI is an underutilized and undervalued oleaginous crop which not only has the potential to mitigate food and nutritional insecurity but also offers humongous opportunities for the development of novel value-added food products.

Role of ACE Polymorphism in Acute Ischemic Stroke.

BACKGROUND: Stroke is one of the leading causes of death and disability in India. Angiotensin-converting enzyme (ACE) is involved in the development of hypertension, atherosclerosis, cardio, and cerebrovascular disease and is a plausible genetic candidate for stroke. The role of ACE polymorphism is still uncertain and requires further investigation. OBJECTIVE: The aim of this study was to study the role of ACE insertion/deletion polymorphism in acute ischemic stroke (AIS). MATERIALS AND METHODS: One hundred thirty AIS cases and 130 age and sex matched healthy controls were recruited. Ten milliliters venous blood was drawn and 6 mL of blood was used for routine hematological, biochemical tests. Remaining 4 mL of EDTA blood was used for DNA extraction, PCR amplification, and restriction digestion. Three genotypes (II, ID, and DD) were visualized on 3% agarose gel. Association between genotypes among stroke case was done by Chi-square test with P value <0.05 taken as significant. RESULTS: DD genotype was significantly associated with the risk of stroke with P value of 0.0001. Both the dominant and recessive models showed that the DD genotype was independently associated with an increased risk of ischemic stroke (OR = 20.732; 95% CI: 2.7241-157.7864; P value = 0.003 for the recessive model and OR = 2.848; 95% CI: 1.5127-5.3649; P value = 0.001 for dominant model). CONCLUSIONS: Our study showed a strong association between ACE polymorphism and the risk of AIS. This study paves the way for further studies to confirm the role of ACE polymorphism as genetic risk factors for AIS.

Is Revision Bankart Repair with Remplissage a Viable Option for Failed Bankart Repair in Non-contact Sports Person Aiming to Return to Sports?

PURPOSE: Failure of a well-executed Bankart repair in non-contact athletes is difficult to predict and its management is a lesser investigated area with uncertain outcome in terms of return to sports (RTS). This study analyses effectiveness of revision Bankart repair with remplissage for failed Bankart repair in non-contact athletes, focusing on time and level of RTS. MATERIALS AND METHODS: Fifty-five consecutive non-contact athletes with evidence of instability after primary arthroscopic Bankart repair having glenoid loss < 25% and off-track Hill-Sachs lesion were included in the study according to algorithm mentioned. All cases underwent revision arthroscopic Bankart repair with remplissage and followed-up for 24 months. Rowe, UCLA, WOSI and Quick-DASH scores were recorded preoperative and at 24 months. RTS was allowed after unilateral seated shot-put test. RESULTS: Out of 55 cases, 6 were excluded because of poor tissue quality, 7 were lost to follow-up. Forty-two cases with a mean age of 28.2 ± 5.2 years were included. Mean duration between primary surgery and failure was 7.3 ± 1.4 months with a mean 1.9 redislocations. The mean Rowe, WOSI, UCLA, Quick-DASH scores improved from 37 to 89, 39.3 to 83.7%, 18.4 to 30.5, 45.3 to 18.7 at 24 months. Thirty-five cases could RTS in a mean time 15.4 ± 1.4 months. Out of seven cases who could not RTS, four had instability, one had pain and two voluntarily quit sports. CONCLUSION: Revision Bankart repair with remplissage is a feasible option for failed primary Bankart repair in non-contact athletes who have glenoid bone loss < 25% with off-track Hill-Sachs. LEVEL OF EVIDENCE: Level IV.

Endothelial Nitric Oxide Synthase (Glu298Asp) Polymorphism is Associated Significantly with Ischemic Stroke Presenting with Seizures and Altered Sensorium.

BACKGROUND: Endothelial nitric oxide synthase (eNOS) is an enzymatic marker whose genetic polymorphism might predispose to acute ischemic stroke (AIS) via vascular endothelial dysfunction. It has a potential role in atherosclerosis, making it a plausible risk factor for stroke. Prior studies have failed to prove a conclusive relationship between eNOS polymorphism and AIS. OBJECTIVE: The aim of this study is to find an association between the presence of eNOS polymorphism (Glu298Asp) and the risk of developing AIS. MATERIALS AND METHODS: We recruited 307 subjects including 153 AIS cases and 154 healthy controls. The eNOS (Glu298Asp) polymorphism was identified in EDTA blood by PCR amplification of the target region followed by restriction enzyme digestion, and genotyping on Agarose gel. GG, GT and TT genotypes were obtained. Statistical analysis was done using SPSS software version 20. RESULTS: A significant association was found between the presence of TT genotype and the risk of AIS (Odd's ratio (OR): 2.43, P-value = 0.038). There was no significant association between the TT genotype and the traditional stroke risk factors. However, the TT genotype was significantly associated with the presence of altered consciousness (OR: 5.27, 95% CI: 1.59-17.04, P-value = 0.003) and with the occurrence of seizures at presentation (OR: 7.98, 95% CI: 1.99-32.09, P-value = 0.007). CONCLUSIONS: There is a significant association between the presence of eNOSpolymorphism (Glu298Asp) and the risk of AIS, and the TT genotype may predispose to a more severe initial presentation of ischemic stroke.

Is in-vivo 80 N tensioned quadrupled hamstring graft better than conventional unmeasured pull for arthroscopic ACL reconstruction.

PURPOSE: To find clinical outcome of in-vivo standard 80 N tensioning of quadrupled hamstring graft during arthroscopic single bundle ACL reconstruction in comparison to traditional graft tensioning. METHODS: Sixty cases of isolated ACL tears were included in this study. All cases underwent Arthroscopic ACL reconstruction with Tibial attachment sparing quadrupled hamstring graft. Cases were divided into group I and group II (30 cases each). Graft Tensioning in group 1 was conventional one-handed unmeasured pull and in group II it was measured tension of 80 N with tensionometer during graft fixation. Pre-operative and post-operative (12 months) Anterior tibial translation (ATT) was measured with KT-1000 arthrometer. Clinical outcome was measured using Lysholm knee scoring system at 6weeks, 3months, 6months, 12 months and compared statistically among both groups. RESULTS: The mean pre-op ATT of 10.6 ± 2.04 mm (group I) & 10.83 ± 2 mm (group II) improved to 3.63 ± 1.16 mm (group I) & 3.63 ± 0.92 (group II) respectively at one year without significant difference (p value 1). The mean pre-op Lysholm score was 46.73 ± 6.77 (group I) and 45.97 ± 8.68 (group II). The mean Lysholm score at 6 weeks was 91.5 ± 2.78 (group I) and 93.43 ± 3.02 (group II) with significant difference (p value 0.014). At 3 months it was 95.4 ± 2.99 (group I) and 97.07 ± 2.07 (group II) with significant difference (p value 0.025). At 6 months it was 95.53 ± 2.46 (group I) and 97.5 ± 1.2 (group II) with significant difference (p value 0.0002). At 1 year it was 95.73 ± 2.22 (group I) and 97.8 ± 0.979 (group II) with significance (p value 0.0001). CONCLUSION: The clinical score of ACL reconstruction is better when in-vivo 80 N tension is applied using tensionometer during graft fixation in comparison to conventional manual tensioning but there is no difference in ATT.

Comparison of semitendinosus tendon length and diameter in sports and non-sports group for ACL reconstruction.

Different anthropometric parameters such as weight, height, body mass index, thigh circumference, and thigh length have been extensively studied and their correlation assessed with hamstring graft length and diameter. This study is to analyse the difference of semitendinosus graft characteristics with sports activity of the patient. METHODS: 110 patients undergoing any ligament reconstruction with semitendinosus were included, 55 in sports and 55 in non-sports group. Height, weight, BMI, sports activity were noted pre-operatively. Semitendinosus harvested and graft length and diameter measured. RESULTS: 98 patients completed the study. The mean length of the harvested semitendinosus tendons was 28.45 ± 2.54 cm in non-sports group and 28.06 ± 4.18 cm in sports group. The mean diameter of semitendinosus was 6.29 ± 0.61 mm in non-sports group and 6.35 ± 0.6 mm in sports group. Positive correlation was found between height and graft length. No statistically significant difference between tendon length (p = 0.994) and diameter (p = 0.549) of sports and non-sports group was found. CONCLUSION: Patient height should be considered for preoperative prediction of tendon length and thickness without any difference in sports or non-sports group. A taller patient has a longer and thicker graft.

Management of Peri-Implantitis Lesions without the Use of Systemic Antibiotics: A Systematic Review.

BACKGROUND: This systematic review aims to assess the current evidence on the efficacy of surgical and non-surgical debridement techniques in the treatment of peri-implantitis lesions without the use of any antimicrobials. METHOD: Five electronic databases (MEDLINE, Pubmed, Scopus, CINAHL and Cochrane) were used, alongside hand searches, to find relevant articles. Full-text articles that were randomised controlled trials, published in the English language from 2011 onwards without pre-operative, peri-operative and post-operative antibiotic usage were included. The study was conducted according to the latest Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-P protocols, the latest Cochrane Risk of Bias tool and each investigated intervention was evaluated using the grading of recommendation, assessment, development and evaluation (GRADE) system. RESULTS: The search yielded 2718 results. After initial screening, 38 full-text articles were assessed for eligibility. From these, 11 studies satisfied all inclusion criteria. These 11 articles described six non-surgical and five surgical debridement therapies. Most articles were classified as having either a high risk of bias or presenting with some concerns. Small sample sizes, in combination with this risk of bias, meant that all interventions were adjudged to be of either low or very low quality of evidence. CONCLUSION: While all investigated modalities displayed some sort of efficacy, this review suggests that a surgical approach may be best suited to treating peri-implantitis lesions in the absence of antibiotic therapy. Despite this weak indication, further research is required in this field.

Long term outcome of early single stage surgery in multi-ligamentous injuries of knee.

BACKGROUD: Multi-ligamentous knee injuries have been a grey area due to unavailability of large scale control trials with a long term follow up. Several studies have documented good results with different protocols of management regarding time of treatment, repair versus reconstruction, choice of graft and sequence of repair. The author wishes to put forward long-term results of early (<6 weeks) single-stage surgery in multi ligamentous injuries. METHODS: The prospective trial included 29 patients diagnosed with three or more ligaments involved. Patients having fractures involving proximal tibia, distal femur, patella, patients with history of compound trauma to knee, osteochondral lesions, associated neuro-vascular injury & poly-trauma patients were excluded from the study. The patients also underwent AP, lateral & stress skiagrams in addition to a standard 3T MR scan for pre-operative planning and confirmation of diagnosis. The pre & post-operative outcomes were assessed using KSS & Lysholm score. The patients were followed up for two years with clinical examination and stress skiagrams. RESULTS: The mean increase in knee scores was statistically significant at both 12 months and 24 months (p < 0.05) with mean ROM of 132.8° at final follow-up. Three patients required manipulation under anaesthesia. All patients could carry out their activities of daily living at mean period of 8.2 months. Osteoarthritis was most common complication at 2 years follow-up. CONCLUSION: The most important aspect of a single stage reconstruction lies in earlier restoration of function with a tremendous decrease in loss of medical expenses, improvement of quality of life and early & improved function in terms of both physical and psychological factors. Better restoration of kinematics from early rehabilitation is probably the factor responsible for the results. Osteoarthritis remains an important follow-up finding.

Evaluation of existing knowledge, attitude, perception and compliance of hand hygiene among health care workers in a Tertiary care centre in Uttarakhand.

BACKGROUND AND AIMS: To evaluate existing knowledge, attitude and perception and compliance of hand hygiene activity among various healthcare workers in a tertiary care centre in Uttarakhand. METHODS: A cross sectional study was done for a period of two months. WHO hand hygiene and compliance form with slight modification were used to study knowledge, attitude, perception and compliance (overt and covert) by direct observational technique. Statistical analysis was done using Microsoft Excel 2010 and IBM SPSS 23.0 version software. RESULTS: A total of 220 participants were given questionnaire out of which 172 participated in study. 159 (92.4%) had already received training in HH in the past 3 years and were using alcohol based hand rub routinely. The overall correct knowledge score of various professional categories of HCW was good i.e. 71.6% Most of the healthcare workers knew the importance of adhering to this simple practice in prevention of healthcare associated infections. Most of them were aware of the conditions before or after when HH activity has to be performed. Poor compliance of hand hygiene was noted among healthcare workers on covert observation. For given hand hygiene opportunities the HH was started in 53.2% and 15.7% of overt and covert observations, respectively. However, HH compliance decreased drastically among HCW, which was 15.7% and 1.6% of overt and covert observations, respectively. INTERPRETATION AND CONCLUSIONS: The acceptance of the fact by most of the HCW that direct vigilance over this activity helped them performed better, suggested the demand of regular surveillance and several other promotional activities in the centre.