Accuracy of Femoral Tunnel Placement between Anteromedial and Anterolateral Visualisation Portals in Anterior Cruciate Ligament Reconstruction - Outcomes of a CT based Cross-Sectional Study.

Introduction: Anatomical femoral tunnel placement is critical for anterior cruciate ligament reconstruction (ACLR). Tunnel placement may vary with different surgical techniques. The aim of this study was to compare the accuracy of femoral tunnel placement between the Anteromedial (AM) and Anterolateral (AL) visualisation portals on post-operative CT scans among a cohort of ACLR patients. Materials and methods: This cross-sectional study was conducted from January 2018 to March 2020 after obtaining ethics clearance. Patients who went for arthroscopic ACLR in our institute were divided into an AM (group 1) and an AL (group 2) based on the visualisation portal for creating the femoral tunnel and a 3D CT scan was done. The femoral tunnel position was calculated in deep to shallow and high to low direction using the Bernard Hertel grid. Femoral tunnel angle was measured in the 2D coronal image. Statistical analysis was done with the data collected. Results: Fifty patients with an average age of 26.36 (18-55) years ±7.216 SD were enrolled in the study. In this study, the AM technique was significantly more accurate (p<0.01) than the AL technique in terms of femoral tunnel angle. Furthermore, the deep to the shallow position was significantly (p= 0.018) closer to normative values, as determined by the chi-square test. The chances of error in tunnel angle in femoral condyle are 2.6 times greater in the AL technique (minimal clinical difference). Conclusion: To conclude, in ACLR the anteromedial visualisation portal can facilitate accurate femoral tunnel placement compared to the anterolateral visualisation portal.

Accuracy of Femoral Tunnel Placement between Anteromedial and Anterolateral Visualisation Portals in Anterior Cruciate Ligament Reconstruction - Outcomes of a CT based Cross-Sectional Study

@#Introduction: Anatomical femoral tunnel placement is critical for anterior cruciate ligament reconstruction (ACLR). Tunnel placement may vary with different surgical techniques. The aim of this study was to compare the accuracy of femoral tunnel placement between the Anteromedial (AM) and Anterolateral (AL) visualisation portals on post-operative CT scans among a cohort of ACLR patients. Materials and methods: This cross-sectional study was conducted from January 2018 to March 2020 after obtaining ethics clearance. Patients who went for arthroscopic ACLR in our institute were divided into an AM (group 1) and an AL (group 2) based on the visualisation portal for creating the femoral tunnel and a 3D CT scan was done. The femoral tunnel position was calculated in deep to shallow and high to low direction using the Bernard Hertel grid. Femoral tunnel angle was measured in the 2D coronal image. Statistical analysis was done with the data collected. Results: Fifty patients with an average age of 26.36 (18-55) years ±7.216 SD were enrolled in the study. In this study, the AM technique was significantly more accurate (p<0.01) than the AL technique in terms of femoral tunnel angle. Furthermore, the deep to the shallow position was significantly (p= 0.018) closer to normative values, as determined by the chi-square test. The chances of error in tunnel angle in femoral condyle are 2.6 times greater in the AL technique (minimal clinical difference). Conclusion: To conclude, in ACLR the anteromedial visualisation portal can facilitate accurate femoral tunnel placement compared to the anterolateral visualisation portal.

Transcriptomic profiling of sporadic Alzheimer's disease patients.

Alzheimer's disease (AD) manifested before age 65 is commonly referred to as early-onset AD (EOAD) (Reitz et al. Neurol Genet. 2020;6:e512). While the majority (> 90%) of EOAD cases are not caused by autosomal-dominant mutations in PSEN1, PSEN2, and APP, they do have a higher heritability (92-100%) than sporadic late-onset AD (LOAD, 70%) (Wingo et al. Arch Neurol. 2012;69:59-64, Fulton-Howard et al. Neurobiol Aging. 2021;99:101.e1-101.e9). Although the endpoint clinicopathological changes, i.e., Aß plaques, tau tangles, and cognitive decline, are common across EOAD and LOAD, the disease progression is highly heterogeneous (Neff et al. Sci Adv Am Assoc Adv Sci. 2021;7:eabb5398). This heterogeneity, leading to temporally distinct age at onset (AAO) and stages of cognitive decline, may be caused by myriad combinations of distinct disease-associated molecular mechanisms. We and others have used transcriptome profiling in AD patient-derived neuron models of autosomal-dominant EOAD and sporadic LOAD to identify disease endotypes (Caldwell et al. Sci Adv Am Assoc Adv Sci. 2020;6:eaba5933, Mertens et al. Cell Stem Cell. 2021;28:1533-1548.e6, Caldwell et al. Alzheimers Demen. 2022). Further, analyses of large postmortem brain cohorts demonstrate that only one-third of AD patients show hallmark disease endotypes like increased inflammation and decreased synaptic signaling (Neff et al. Sci Adv Am Assoc Adv Sci. 2021;7:eabb5398). Areas of the brain less affected by AD pathology at early disease stages-such as the primary visual cortex-exhibit similar transcriptomic dysregulation as those regions traditionally affected and, therefore, may offer a view into the molecular mechanisms of AD without the associated inflammatory changes and gliosis induced by pathology (Haroutunian et al. Neurobiol Aging. 2009;30:561-73). To this end, we analyzed AD patient samples from the primary visual cortex (19 EOAD, 20 LOAD) using transcriptomic signatures to identify patient clusters and disease endotypes. Interestingly, although the clusters showed distinct combinations and severity of endotypes, each patient cluster contained both EOAD and LOAD cases, suggesting that AAO may not directly correlate with the identity and severity of AD endotypes.

Lime activated flyash-phosphogypsum blend as a low-cost alternative binder.

This study investigates the potential of a blended binder formulated from two industrial solid wastes viz. phosphogypsum and fly ash in combination with lime. Three mix proportions of phosphogypsum and fly ash were investigated, and the minimum lime contents required for activation were determined using the Eades and Grim pH test. The lime-fly ash-phosphogypsum blends were then cast into cubes, both in their paste form as well as mortar form, mixed with sand in the ratio of 1:3. They were cured for a period of seven days, and afterwards, their compressive strength was determined. Ordinary Portland cement and lime mortar blocks were also cast as control specimens for comparative evaluation of the strength. The optimal lime-fly ash-phosphogypsum blend was identified and used to construct a masonry prism, and the strengths of the masonry prisms were also evaluated. The optimal lime-fly ash-phosphogypsum blend mortar was also subjected to an X-ray diffraction analysis to determine the reaction products formed during hydration. The study revealed that 5% lime mixed with fly ash:phosphogypsum in the ratio of 3:1 was the optimal proportion which gave the maximum strength to the cubes. The optimal lime-fly ash-phosphogypsum blend mortar developed strength that was higher than conventional Portland cement and lime mortar. The optimal lime-fly ash-phosphogypsum blend mortar masonry prisms developed strength that was comparable to that of Portland cement mortar masonry. The X-ray diffraction analysis revealed the formation of calcium silicate hydrate minerals as well as ettringite and portlandite which were responsible for strength gain.

Adsorption of Rare Earth Ce3+ and Pr3+ Ions by Hydrophobic Ionic Liquid.

This study reports the use of hydrophobic ionic liquid (IL) based on D-galactose for the recovery of Ce (III) and Pr (III) ions from solutions. The equilibrium data were obtained by optimization of batch parameters, and various isotherms and kinetic models were utilised to predict the mechanistic process of sequestration of ions. The Arrhenius activation energies are found to be between 5-40 kJ, suggesting the physisorption process of ions onto IL. The present process is understood to be rapid and exothermic in nature according to thermodynamic experiments. The loading capacity was found to be 179.3 g L-1 and 141.5 g L-1, respectively, for Ce (III) and Pr (III) ions at pH 5 with a contact time of 30 min and dose being 0.1 g L-1. The higher uptake capacity is attributed to the presence of a highly electronegative fluorine atom in the IL. These results highlight the potential application of IL in the sequestration of Ce (III) and Pr (III) ions from any water sources.

Coconut-Water-Mediated Carbonaceous Electrode: A Promising Eco-Friendly Material for Bifunctional Water Splitting Application.

The organic and eco-friendly materials are extended to prevail over the worldwide energy crisis where bio-inspired carbonaceous electrode materials are being prepared from biogenic items and wastes. Here, coconut water is sprayed over three-dimensional (3D) nickel foam for obtaining a carbonaceous electrode material, i.e., C@Ni-F. The as-prepared C@Ni-F electrode has been used for structural elucidation and morphology evolution studies. Field emission scanning electron microscopy analysis confirms the vertically grown nanosheets of the C@Ni-F electrode, which is further employed in the oxygen evolution reaction (OER) and hydrogen evolution reaction (HER), where excellent OER and HER performances with small overpotentials of 219 and 122 mV and with stumpy Tafel slopes, i.e., 27 and 53 mV dec-1, are respectively obtained, suggesting a bifunctional potential of the sprayed electrode material. Moreover, sustainable bifunctional performance of C@Ni-F proves considerable chemical stability and moderate mechanical robustness against long-term operation, suggesting that, in addition to being a healthy drink to mankind, coconut water can also be used for water splitting applications.

Predictors of Functional Outcome in Unstable Ankle Fractures Treated Surgically - A Prospective Cohort Study.

INTRODUCTION: Unstable ankle injuries require anatomical reduction and stabilisation for optimal outcome. In spite of adequate care, a few patients have poor outcome. In this study, we assessed the risk factors that predict the clinical outcomes in surgically treated unstable ankle fractures. MATERIAL AND METHODS: This prospective cohort study was conducted on 68 patients who underwent surgical management for an unstable ankle injury. Demographic details, fracture type and associated medical comorbidities were recorded. Pre-operative radiographic assessment was done for all patients. At the end of one year follow-up, clinical (American Orthopaedic foot and ankle society-AOFAS and Olerud-Molander ankle - OMAS) scores and radiological parameters were assessed and analysed. RESULTS: Fracture dislocation (0.008), diabetes mellitus (0.017), level of alchohol consumption (0.008) and pre-operative talocrural angle (TCA) > 100° (0.03) were significant predictors of poor outcomes as per AOFAS. Fracture dislocation (0.029), diabetes mellitus (0.004), pre-operative TCA > 100° (0.009), female gender (0.001), age more than 60 years (0.002) and open injuries (0.034) had significantly poor outcome as per OMAS. Other parameters (smoking, hypertension, classification, syndesmotic injury, medial clear space and tibiofibular overlap) did not affect the outcome significantly. CONCLUSION: Our study showed that poor outcome predictors in unstable ankle fractures are age >60 years, female gender, diabetes mellitus, alcohol consumption, fracture dislocation, open fractures and pre-op TCA >100°.

Recasting Ni-foam into NiF2 nanorod arrays via a hydrothermal process for hydrogen evolution reaction application.

A promising electrode for hydrogen evolution reaction (HER) has been prepared via a reduction process to form NiF2 nanorod arrays directly grown on a 3D nickel foam. We reveal NiF2@Ni nanorod arrays for a stable hydrogen evolution reaction (HER) application. The computational analysis for H2O, OH and H and experimentally in aqueous KOH endow considerable shift in Fermi levels for Ni (111) unlike for NiF2 (110) on account of an effective coalition of p-orbitals of fluorine and d-orbitals of Ni in NiF2, NiF2 under pinning the reduced overpotential of 172 mV at 10 mA cm-2 compared to Ni (242 mV) in same electrolyte. The electrocatalytic mechanism has been proposed using density functional theory (DFT) and is found in well accordance with the experimental findings of the present study. The preparation of self-grown porous nanostructured electrodes on the 3D nickel foam via a displacement reaction is possibly valuable for other metal halides for energy storage and conversion applications as these materials have inherently smaller overpotentials.

Porous metal-graphene oxide nanocomposite sensors with high ammonia detectability.

Nickel oxide-graphene oxide (NiO-GO), zinc oxide-graphene oxide (ZnO-GO) and bismuth oxide-graphene oxide (Bi2O3-GO) metal oxide-graphene oxide nanocomposite (MO-GO NC) sensors, operable at room temperature, were synthesized via a simple and cost-effective microwave-assisted combustion method for chemiresistive gas sensor applications. From the measured structural, morphological, and elemental detection properties, the sensors are found capable of detecting various gases. The Bi2O3-GO NC sensor exhibited excellent response over NiO-GO (~20 at 50 ppm) and ZnO-GO NC (~60 at 50 ppm) sensors for detecting NH3. The response of the Bi2O3-GO NC sensor at 50 ppm NH3 in just 14 s operation duration was ~81.23, which is improved 25-fold and 13-fold compared to pristine GO sensors. Additionally, the as-developed Bi2O3-GO NC sensor demonstrates outstanding repeatability and recovery kinetics, attributed to porosity and the combined effects of MO and GO. The sensing mechanism of the Bi2O3-GO NC gas sensors is proposed herein. The superior sensing performance, including quick response and recovery of the Bi2O3-GO NC sensor is attributed to favorable charge transfer across the Bi2O3 and GO interface. The significance of relative humidity on sensing potential of the Bi2O3-GO NC sensor has also been studied and the sensor is confirmed to be unaffected by relative humidity.

Endovascular Trapping of a Giant Splenic Artery Aneurysm by Liquid Embolic in a Case of EHPVO with Hypersplenism with a Complicated Post Procedure Course.

Case of extrahepatic portovenous obstruction (EHPVO) with giant splenic artery aneurysm and concomitant hypersplenism. The presence of bicytopenia and venous collaterals around the giant splenic aneurysm made splenectomy risky, and endovascular trapping of the giant aneurysm with partial splenic embolization was planned. Due to high flow, intraprocedural crossing of the giant aneurysm was not possible, and large coils were unstable. The aneurysm was successfully embolized with liquid embolic glue: lipiodol 50% mixture. Although the patient did not have septic complications despite large splenic infarct, the patient had secondary thrombocytosis leading to significant thrombotic complications akin to postsplenectomy syndrome. These were all successfully managed medically, and splenectomy was avoided.

Predictors of Functional Outcome in Unstable Ankle Fractures Treated Surgically – A Prospective Cohort Study

@#Introduction: Unstable ankle injuries require anatomical reduction and stabilisation for optimal outcome. In spite of adequate care, a few patients have poor outcome. In this study, we assessed the risk factors that predict the clinical outcomes in surgically treated unstable ankle fractures. Material and methods: This prospective cohort study was conducted on 68 patients who underwent surgical management for an unstable ankle injury. Demographic details, fracture type and associated medical comorbidities were recorded. Pre-operative radiographic assessment was done for all patients. At the end of one year follow-up, clinical (American Orthopaedic foot and ankle societyAOFAS and Olerud-Molander ankle - OMAS) scores and radiological parameters were assessed and analysed. Results: Fracture dislocation (0.008), diabetes mellitus (0.017), level of alchohol consumption (0.008) and preoperative talocrural angle (TCA) > 100° (0.03) were significant predictors of poor outcomes as per AOFAS. Fracture dislocation (0.029), diabetes mellitus (0.004), preoperative TCA > 100° (0.009), female gender (0.001), age more than 60 years (0.002) and open injuries (0.034) had significantly poor outcome as per OMAS. Other parameters (smoking, hypertension, classification, syndesmotic injury, medial clear space and tibiofibular overlap) did not affect the outcome significantly. Conclusion: Our study showed that poor outcome predictors in unstable ankle fractures are age >60 years, female gender, diabetes mellitus, alcohol consumption, fracture dislocation, open fractures and pre-op TCA >100°.

Shewanella algae and Microbulbifer elongatus from marine macro-algae - isolation and characterization of agar-hydrolysing bacteria.

Macro-algae are a good source of agar oligosaccharides, which can be obtained through bacterial enzymatic hydrolysis. The agarase enzyme secreted by the micro-organisms cleaves the cell wall of the algae and releases agar oligosaccharides as degradation products with various applications. Agarolytic bacteria were isolated from the marine algae Kappaphycus sp., and Sargassum sp., and studied for their agar-degrading properties. Among the 70 isolates, 2 isolates (A13 and Sg8) showed agarase activity in in vitro assays. The maximum agarolytic index was recorded in the isolate Sg8 (3.75 mm and 4.29 µg ml-1 agarase activity), followed by the isolate A13 (2.53 mm and 2.6 µg ml-1 agarase activity). Optimum agarase production of isolate Sg8 was observed at pH7 and at a temperature of 25 °C in 24-48 h, whereas for isolate A13 the optimum production was at pH7 and at a temperature of 37 °C in 48 h. The identities of the agarolytic isolates (Sg8 and A13) were confirmed based on microscopy, morphological, biochemical and molecular analysis as Shewanella algae [National Center for Biotechnology Information (NCBI) GenBank accession number MK121204.1] and Microbulbifer elongatus [NCBI GenBank accession number MK825484.1], respectively.

Modified Lateral Position for Achilles Tendon Surgeries: A Technical Tip.

Most Achilles tendon surgeries are performed with the patient in the prone position. Some advocate supine position but the access to the tendon is compromised. We describe an innovative technique wherein the patient is positioned lateral but the surgeon has full access to the Achilles tendon as if the patient were positioned prone. We consider that this technique could be easily reproduced and hence widely adopted.

Delayed Onset Sciatic Nerve Palsy Secondary to Wound Hematoma following Anticoagulant Therapy Post-Bipolar Hemiarthroplasty - an Uncommon Complication: A Case Report.

A 58-year old female patient presented to us with a three months' old fracture of the neck of femur. She underwent bipolar hemiarthroplasty. In the immediate postoperative period, she developed deep vein thrombosis for which she was started on anticoagulant therapy. Patient had persistent discharge from the wound since then and underwent regular dressings. On the eighth post-op day, she developed sciatic nerve palsy secondary to wound haematoma. The haematoma was decompressed immediately and she had a dramatic improvement in pain but her neurological deficit persisted. The wound healed completely without any complications. At three months follow up, she had recovered completely with grade 5/5 power in ankle and foot and full sensory recovery in the sciatic nerve distribution. She was ambulating comfortably with a walker. At final follow up around 20 months post-operation, she was pain-free and walking without any support. The wound had healed completely.

Author Correction: Low-Temperature Ionic Layer Adsorption and Reaction Grown Anatase TiO2 Nanocrystalline Films for Efficient Perovskite Solar Cell and Gas Sensor Applications.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

Microbiome digital signature of MCR genes - an in silico approach to study the diversity of methanogenic population in laboratory-developed and pilot-scale anaerobic digesters.

The production of biogas by anaerobic digestion (AD) of organic/biological wastes has a firm place in sustainable energy production. A simple and cost-effective anaerobic jar at a laboratory scale is a prerequisite to study the microbial community involved in biomass conversion and releasing of methane gas. In this study, a simulation was carried out using a laboratory-modified anaerobic-jar-converted digester (AD1) with that of a commercial/pilot-scale anaerobic digester (AD2). Taxonomic profiling of biogas-producing communities by means of high-throughput methyl coenzyme-M reductase α-subunit (mcrA) gene amplicon sequencing provided high-resolution insights into bacterial and archaeal structures of AD assemblages and their linkages to fed substrates and process parameters. Commonly, the bacterial phyla Euryarchaeota , Chordata, Firmicutes and Proteobacteria appeared to dominate biogas communities in varying abundances depending on the apparent process conditions. Key micro-organisms identified from AD were Methanocorpusculum labreanum and Methanobacterium formicicum . Specific biogas production was found to be significantly correlating to Methanosarcinaceae . It can be implied from this study that the metagenomic sequencing data was able to dissect the microbial community structure in the digesters. The data gathered indicates that the anaerobic-jar system could throw light on the population dynamics of the methanogens at laboratory scale and its effectiveness at large-scale production of bio-methane. The genome sequence information of non-cultivable biogas community members, metagenome sequencing including assembly and binning strategies will be highly valuable in determining the efficacy of an anaerobic digester.

Delayed Onset Sciatic Nerve Palsy Secondary to Wound Hematoma following Anticoagulant Therapy Post-Bipolar Hemiarthroplasty - an Uncommon Complication: A Case Report

@#A 58-year old female patient presented to us with a three months’ old fracture of the neck of femur. She underwent bipolar hemiarthroplasty. In the immediate postoperative period, she developed deep vein thrombosis for which she was started on anticoagulant therapy. Patient had persistent discharge from the wound since then and underwent regular dressings. On the eighth post-op day, she developed sciatic nerve palsy secondary to wound haematoma. The haematoma was decompressed immediately and she had a dramatic improvement in pain but her neurological deficit persisted. The wound healed completely without any complications. At three months follow up, she had recovered completely with grade 5/5 power in ankle and foot and full sensory recovery in the sciatic nerve distribution. She was ambulating comfortably with a walker. At final follow up around 20 months post-operation, she was pain-free and walking without any support. The wound had healed completely.

Low-Temperature Ionic Layer Adsorption and Reaction Grown Anatase TiO2 Nanocrystalline Films for Efficient Perovskite Solar Cell and Gas Sensor Applications.

A low-temperature (90 °C) and directly grown anatase titanium dioxide (TiO2) nanocrystalline film using successive ionic layer adsorption and reaction (SILAR) for perovskite solar cell and gas sensor applications. TiO2 nanocrystalline electron transfer layer (ETL) improves the power conversion efficiency (PCE) of perovskite solar cells due to faster charge transport kinetics as well as slower charge recombination process. The optimized TiO2 nanocrystalline ETL (15 L) demonstrates as high as ~10% PCE with a short circuit current density of 18.0 mA/cm2, open circuit voltage of 0.81 V and fill factor of 66.3% in perovskite solar cells. Furthermore, room-temperature ammonia sensing characteristics of TiO2 nanocrystalline film (25 L) were  demonstrated for various concentration levels of ammonia in dry air conditions. A high room-temperature response of 80% was achieved at 100 ppm of ammonia with rapid response and recovery signatures of 30 and 85 s, and nearly fifteen days stability, respectively. The response of the sensor to other gases such as formaldehyde, petrol, ethanol acetone, and ammonia etc, indicated a high selectivity towards volatile organic compounds of ammonia gas. The room temperature operation, with high selectivity, repeatability and fast transition times, suggests potentially useful in flexible and cost-effective production in optoelectrochemical device technology.

Drug resistant Skeletal Tuberculosis in a tertiary care centre in South India.

BACK GROUND: Drug resistant tuberculosis is alarmingly on the rise especially in developing countries. Skeletal tuberculosis accounts up to 10% of all extra pulmonary tuberculosis. World Health Organisation (WHO) has not formulated guidelines for the management of Multi-drug resistant skeletal tuberculosis. RESULTS: A retrospective analysis of patients treated for musculoskeletal tuberculosis was done, to study drug resistance patterns. The outcome was assessed both clinically and radiologically.898 patients were treated for skeletal tuberculosis during the period of 2006-2013 (96 months). 478 (53.2%) patients were treated for tubercular spondylitis and 420 (46.8%) for extra-spinal skeletal tuberculosis. Ninety two patients (10.2%) had documented resistance to the anti-tubercular drugs. There were 42 mono resistant tuberculosis cases (4.7%), 13 poly resistant cases (1.4%), 33 multi-drug resistant cases (MDR TB) (3.7%) and 4 (0.4%) extremely drug resistant tuberculosis cases (XDR). All the patients were treated medically as per drug susceptibility patterns and protocols. Surgery was performed when indicated in 59 (66%) cases. 85% completed their course of treatment and were successfully healed as per pre-set clinical, biochemical and radiological criteria. The remaining were lost to follow up. One patient died as a result of post op respiratory infection. CONCLUSIONS: The prevalence of Multi-drug resistant tuberculosis patients in our centre was 3.7% and that of Extremely drug resistant tuberculosis cases was 0.4%. A Multi-disciplinary approach with drug susceptibility tests, sensitive drugs, and surgery if required is essential. Health education is essential to improve awareness among health care professionals about the danger of drug resistance in tuberculosis.