Novel enhancement of interfacial interaction and properties in biodegradable polymer composites using green chemically treated spent coffee ground microfiller.

This study investigates the potential of utilizing green chemically treated spent coffee grounds (SCGs) as micro biofiller reinforcement in Poly-3-hydroxybutyrate-co-3-hydroxyvalerate (PHBV) biopolymer composites. The aim is to assess the impact of varying SCG concentrations (1 %, 3 %, 5 %, and 7 %) on the functional, thermal, mechanical properties and biodegradability of the resulting composites with a PHBV matrix. The samples were produced through melt compounding using a twin-screw extruder and compression molding. The findings indicate successful dispersion and distribution of SCGs microfiller into PHBV. Chemical treatment of SCG microfiller enhanced the interfacial bonding between the SCG and PHBV, evidenced by higher water contact angles of the biopolymer composites. Field Emission Scanning Electron Microscopy (FE-SEM) confirmed the successful interaction of treated SCG microfiller, contributing to enhanced mechanical characteristics. A two-way ANOVA was conducted for statistical analysis. Mass losses observed after burying the materials in natural soil indicated that the composites degraded faster than the pure PHBV polymer suggesting that both composites are biodegradable, particularly at high levels of spent coffee grounds (SCG). Despite the possibility of agglomeration at higher concentrations, SCG incorporation resulted in improved functional properties, positioning the green biopolymer composite as a promising material for sustainable packaging and diverse applications.

A case report of two Moroccan patients with hereditary neurological disorders and molecular modeling study on the S72L de novo PMP22 variant.

Hereditary neurological disorders represent a wild group of hereditary illnesses affecting mainly the nervous system, the majority of which have a Mendelian inheritance pattern. Here we present the case of two Moroccan patients each affected by a different hereditary neurological disorder. In the first patient WES analysis revealed the presence of the p.Ser72Leu de novo mutation in the PMP22 gene reported for the first time in Africa, specifically in Morocco. This variant is predicted to be in a mutation "hot-spot" region causing Dejerine-Sottas syndrome called also Charcot-Marie-Tooth type 3. The molecular modeling study suggests an important alteration of hydrogen and hydrophobic interactions between the residue in position 72 of the PMP22 protein and its surrounding amino acids. On the other hand, the p.Ala177Thr mutation on the RNASEH2B gene, responsible of Aicardi-Goutières syndrome 2, was carried in a homozygous state by the second patient descending from a consanguineous family. This mutation is common among the Moroccan population as well as in other North African countries. The present results contributed to a better follow-up of both cases allowing better symptom management with convenient treatments.

Push out bond strength of fiber post to radicular dentin using Q-mix, lemon/garlic extract, and riboflavin activated by photodynamic therapy as a final canal irrigant.

OBJECTIVE: The aim of this study was to assess the extrusion bond values of fiber post to radicular dentin when disinfected using different final irrigants lemon garlic extract (LGE), riboflavin (RFP) activated by PDT (photodynamic therapy), and Q-mix 2-in-1. MATERIALS AND METHODS: Forty single-rooted mandibular premolar teeth were decoronated. Endodontic treatment was performed, and the canals were continually irrigated with normal saline, dried with paper points, and obturated. Post space was prepared by removing gutta-percha using peso-reamers. All specimens were randomly allocated into four groups based on the final irrigant used. Specimens in Group 1 irrigated with: 5.25% NaOCl+17% EDTA, group 2: 5.25% NaOCl+Q-mix 2-in-1, group 3: 5.25% NaOCl+RFP, and group 4: 5.25% NaOCl+LGE. Following final irrigation, a fiber post was placed in the canal space and luted. Samples were sectioned and each section was placed in a universal testing machine to assess bond values. Debonded samples were assessed for failure modes, EBS and modes of failure. For comparisons among groups, the one-way analysis of variance (ANOVA) test and the Post-Hoc Tukey HSD test were used keeping the level of significance at p=0.05. RESULTS: The cervical section of samples in group 2 (NaOCL+Qmix) (7.11±0.81 MPa) exhibited the maximum value of EBS. However, the apical section of samples in group 3 (5.25% NaOCl+RFP) (3.33±0.26 MPa) displayed minimum extrusion bond values. Group 3 specimens in which final irrigation was performed with RFP established significantly lower bond integrity values than all the other investigated groups coronal (3.77±0.13 MPa), middle (3.60±0.41 MPa), and apical (3.33±0.26 MPa) (p<0.05). Intragroup comparison analysis, the coronal and middle root sections of all the experimental groups displayed comparable outcomes of EBS (p>0.05). However, near the apical section of the root, the bond strength of all the groups declined considerably. CONCLUSIONS: Q-mix 2-in-1 as the final irrigant displayed the highest extrusion bond strength of fiber-reinforced composite to canal dentin at all three levels coronal, middle and apical. Lemon garlic extract has the potential to be used alternative to ethylene diamine tetra acetic acid as a final irrigant.

Travel-associated lineages and unique endemic antimicrobial-susceptible lineages of Neisseria gonorrhoeae predominate in Western Australia.

In Australia, gonococcal isolates are monitored for antimicrobial susceptibilities. In Western Australia (WA), gonorrhoea notification rates increased by 63 % between 2013 and 2016, with the steepest increase occurring between 2015 and 2016, before stabilizing at this higher baseline between 2017 and 2020. This increased prevalence was associated with antimicrobial-susceptible (AMS) lineages. To understand the provenance of these isolates causing gonorrhoea in WA, whether they were introduced or expanded from endogenous lineages, 741 isolates were collected in 2017 and characterized by both iPLEX typing and whole genome sequencing (WGS). Antibiograms and genocoding of the isolates revealed that AMS isolates were most prevalent in the remote regions, while the urban/rural regions were characterized by antimicrobial-resistant (AMR) isolates. iPLEX typing identified 78 iPLEX genotypes (WA-1 to WA-78) of which 20 accounted for over 88 % of isolates. WA-10 was the most frequently identified genotype in the urban/rural regions whilst WA-29 was the most frequently identified genotype in the remote regions. Genotypes WA-38, WA-52 and WA-13 accounted for 81 % (n=36/44) of the azithromycin-resistant N. gonorrhoeae (AziR) isolates. A representative isolate of each iPLEX genotype and AMR biotype was whole genome sequenced and analysed using MLST, NG-MAST and NG-STAR, and the novel core genome clustering Ng_cgc_400 typing scheme. Five predominant Bayesian population groups (termed BPG-1 to 5) were identified in the study collection. BPG-1 and BPG-2 were associated with AMS isolates from the remote regions. BPG-1 and BPG-2 were shown to be unique to the remote regions based on a minimum spanning tree against 4000 international isolates. AMS isolates in urban/rural regions were dominated by international lineages. AziR and Cef DS (decreased susceptibility to ceftriaxone) was concentrated in three urban/rural genomic groups (BPG-3, 4 and 5). Azithromycin minimum inhibitory concentrations (0.5-16 mg l-1) correlated with the accumulation of mtrR mutations or/and the fraction of 23S rRNA C2611T mutated copies. The majority of isolates in BPG-3, 4 and 5 could be correlated with known AMR lineages circulating globally and nationally. In conclusion, the surge in AMS isolates in WA in 2017 was due to importation of international AMS lineages into urban/rural regions, whilst the local AMS lineages persisted largely in the remote regions. Bridging between the urban/rural and remote regions was relatively rare, but continued surveillance is required to prevent ingress of AMR strains/lineages into the remote regions of WA.

Effect of Colostomy on Treatment Outcome in Fournier Gangrene: A Prospective Comparative Study.

Background and Aim: Value of colostomy in management of Fournier gangrene (FG) is a debatable issue. Almost all relevant studies are retrospective and included heterogeneous patients' groups. The present prospective study aimed to evaluate the role of colostomy in management of FG affecting the perianal region in 2 well-matched FG groups. Patients and Methods: The present prospective comparative study included 30 patients with FG associated with extensive involvement of the perianal region. They comprised 15 patients subjected to colostomy and other 15 patients who refused to perform the procedure. Colostomy was performed after the first debridement. Outcome parameters in the present study included time to wound healing, length of hospital stay, and inhospital mortality. Results: Comparison between the studied groups regarding the preoperative characteristics revealed no statistically significant differences. Postoperatively, patients in the colostomy group had significantly fewer number of debridements (1.3 ± 0.5 vs 2.7 ± 1.2, P < .001), shorter hospital stay (9.5 ± 3.3 vs 29.9 ± 6.2 days, P < .001), and significantly shorter time to wound healing (16.5 ± 3.9 vs 42.9 ± 6.9 days, P < .001). Also, patients in the colostomy group had significantly lower rate of wound dehiscence, wound infection, and flap ischemia. However, the difference wasn't statistically significant. Conclusions: Aggressive treatment of FG aided by colostomy after first debridement would result in better clinical outcome.

Historique et objectif: L'intérêt de la colostomie pour prendre en charge la maladie de Fournier (MF) n'est pas consensuel. Presque toutes les études pertinentes sont rétrospectives et portent sur des groupes de patients hétérogènes. La présente étude prospective visait à évaluer le rôle de la colostomie pour prendre en charge la MG qui touche la région périanale dans deux groupes bien appariés de patients atteints de la MF. Patients et méthodologie: La présente étude comparative prospective portait sur 30 patients atteints de la MF associés à une atteinte importante de la région périanale. Elle était composée de 15 patients soumis à une colostomie et à 15 patients qui avaient refusé l'intervention. La colostomie a été effectuée après le premier débridement. Le temps jusqu'à la guérison de la plaie, la durée du séjour hospitalier et la mortalité en milieu hospitalier étaient les résultats primaires de la présente étude. Résultats: La comparaison des caractéristiques préopératoires des groupes à l'étude n'a révélé aucunes différences statistiquement significatives. Après l'opération, les patients du groupe ayant subi une colostomie présentaient beaucoup moins de débridements (1,3 ± 0,5 par rapport à 2,7 ± 1,2, p<0,001) et avaient été hospitalisés moins longtemps (9,5 ± 3,3 par rapport à 29,9 ± 6,2 jours, p <0,001) et leur plaie avait guéri plus vite (16,5 ± 3,9 par rapport à 42,9 ± 6,9 jours, p <0,001). De plus, les patients qui faisaient partie du groupe ayant subi une colostomie présentaient un taux beaucoup plus bas de déhiscences ou d'infections de la plaie et d'ischémies du lambeau. Cependant, cette différence n'était pas statistiquement significative. Conclusions: Un traitement énergique de la MF assisté par colostomie après le premier débridement de meilleurs résultats cliniques.

Current concepts in the management of radial head fractures: a national survey and review of the literature.

INTRODUCTION: This study aims to report on current practice in the management of radial head fractures (RHFs) in the United Kingdom and to review the literature to identify areas for future investigation. METHODS: A 12-question online survey was sent to 500 surgeon members of the British Elbow and Shoulder Society in 2021. Questions focused on clinical assessment, indications for surgical treatment and willingness to participate in future studies. Descriptive statistical analysis summarised the responses. RESULTS: The response rate was 20.4% (n = 102). For minimally displaced RHFs, non-operative management with immediate mobilisation was reported by 90.2% (n = 92) as opposed to 9.8% (n = 10) for initial immobilisation in plaster or brace. The most cited indication for radial head arthroplasty as opposed to fixation was increased patient age or low functional demand in 69.9% of responses (n = 71). In total, 41.2% (n = 42) indicated the need for a future randomised controlled trial (RCT) concerning the management of RHF. Only five RCTs were returned by the literature review. DISCUSSION: There is considerable variability in the management of RHF among an experienced cohort of surgeons. With the interest declared by the participating surgeons, there is a call for a well-designed sufficiently powered RCT.

Rhythm abnormalities among hospitalised children in Lagos: a case series.

Arrhythmias refer to disturbances in heart rate or rhythm which leads to heart rates that are abnormally fast, slow or irregular. Rhythm abnormalities may be common among Nigerian children but there are only a few reports. The current write up is a clinical review of eight patients in various age groups including neonates, infants and older children. It is presented to highlight the different forms of arrhythmias that can occur in children, with varying underlying aetiology, thus, stressing the need for early recognition of arrhythmias in children, appropriate early intervention and challenges involved in their care.

RANDOMIZED COMPARATIVE STUDY OF DEFINITIVE EXTERNAL FIXATION VERSUS ORIF IN PILON FRACTURES: AN EARLY CLINICAL OUTCOME REPORT.

Repairing Pilon fractures remains challenging. ORIF allows direct anatomical reduction, but at the expense of soft tissues dissection which are associated with recovery. On the other hand, External Fixation allows indirect reduction and causes less soft tissue damage. However, a few studies conclude that External Fixation is associated with high rates of malunion.The objectives were to evaluate and compare: primary outcome measure: ankle hindfoot function (AOFAS at 9 months) and secondary outcome measures: quality of reduction, bone union, arthritic changes, other potential complications and ultimately the optimum management for pilon fractures.A prospective randomized comparative clinical study. 40 Patients were included in the study with comminuted closed Pilon fracture. Patients were randomized by closed envelope technique into two groups: Group (1) Included 20 patients managed by external fixation with limited internal fixation. Group (2) Included 20 patients managed by open reduction and internal fixation. Skeletally immature, type 43A AO/OTA, Open fractures, compartment syndrome, Pathological fractures were excluded.There was no significant difference between External fixation and ORIF as methods of fixation for Pilon fracture in the functional activity of the patient after 9 months as evidenced by AOFAS score (P=0.547) and the development of complications (P=0.227). However, there was statistically significant difference (P<0.001) regarding the time to weight bearing between both groups, and statistically significant difference (P=0.042) regarding time to union.The best surgical modality to treat Pilon fractures is still debatable. While external fixation is used by many to avoid major complications, it has been associated with high rates of malunion, and osteoarthritis.

Use of photosensitizers activated by photodynamic therapy on the canal disinfection of radicular dentin bonded to Dimethacrylate-based glass fiber post: an assessment of pushout bond strength.

OBJECTIVE: The present lab-based investigation aimed at evaluating the canal disinfectants using photodynamic therapy (PDT) using different photosensitizers, conventional NaOCl, a mixture of doxycycline, citric acid, and a detergent (MTAD) and their impact on the bond strength of glass fiber post to radicular dentin. MATERIALS AND METHODS: Forty extracted human premolars were gathered and disinfected. The decoration was performed up to the cementoenamel junction. Using the crown down technique cleaning of the canal was done following rinse with distilled water. All canals were dried with paper points and obturated with gutta-percha. Post space was prepared using peso reamers and samples were randomly allocated into four groups following different disinfection regimes: Group 1 - Methylene blue photosensitizer (MBP) + MTAD; Group 2 - RBP (Rose Bengal photosensitizer) + MTAD; Group 3 - CP (curcumin photosensitizer) + MTAD and Group 4 - 2.25% NaOCl + MTAD (control). Following disinfection, the canals were dried and the post was placed and cemented within the canal. Samples were dissected at coronal, middle, and apical third and placed in a universal testing machine for push-out bond strength (PBS). Debonded surfaces were evaluated for failure modes. PBS was examined using a one-way analysis of variance (ANOVA). The means of PBS were compared using Tukey multiple comparison tests with a significance threshold of (p<0.05). RESULTS: Group 3 canals disinfected with CP and MTAD had the highest PBS at two levels: cervical (9.57±1.21 MPa), middle (6.37±0.79 MPa), and group 2 canal space disinfected by RBP and MTAD had the maximum PBS in apical portion (5.35±0.42 MPa). No significant difference at all root levels between group 2 (RBP + MTAD) and group 3 (p>0.05). Canal irrigation with group 1 (MBP + MTAD) and group 4 control (2.25% NaOCl + MTAD) exhibited comparable PBS at all three levels of the root. CONCLUSIONS: CP, MTAD, RBP and MTAD for canal disinfection and bonding of glass fiber post to radicular dentin demonstrated comparable bond values at all three root levels and can be recommended in clinical settings after further investigations.

Effects of the COVID-19 lockdown and recovery on People's mobility and air quality in the United Arab Emirates using satellite and ground observations.

The stringent COVID-19 lockdown measures in 2020 significantly impacted people's mobility and air quality worldwide. This study presents an assessment of the impacts of the lockdown and the subsequent reopening on air quality and people's mobility in the United Arab Emirates (UAE). Google's community mobility reports and UAE's government lockdown measures were used to assess the changes in the mobility patterns. Time-series and statistical analyses of various air pollutants levels (NO2, O3, SO2, PM10, and aerosol optical depth-AOD) obtained from satellite images and ground monitoring stations were used to assess air quality. The levels of pollutants during the initial lockdown (March to June 2020) and the subsequent gradual reopening in 2020 and 2021 were compared with their average levels during 2015-2019. During the lockdown, people's mobility in the workplace, parks, shops and pharmacies, transit stations, and retail and recreation sectors decreased by about 34%-79%. However, the mobility in the residential sector increased by up to 29%. The satellite-based data indicated significant reductions in NO2 (up to 22%), SO2 (up to 17%), and AOD (up to 40%) with small changes in O3 (up to 5%) during the lockdown. Similarly, data from the ground monitoring stations showed significant reductions in NO2 (49% - 57%) and PM10 (19% - 64%); however, the SO2 and O3 levels showed inconsistent trends. The ground and satellite-based air quality levels were positively correlated for NO2, PM10, and AOD. The data also demonstrated significant correlations between the mobility and NO2 and AOD levels during the lockdown and recovery periods. The study documents the impacts of the lockdown on people's mobility and air quality and provides useful data and analyses for researchers, planners, and policymakers relevant to managing risk, mobility, and air quality.

Saphenous Artery-based Posteromedial Leg Fasciocutaneous Flap for Knee Reconstruction.

Soft tissue knee defects are frequently seen in surgical practice. The saphenous artery (SA)-based flap is a management option with variable suggested donor sites. The present study describes the use of an SA-based flap harvested from the posteromedial aspect of the leg in management of soft tissue knee defects. Methods: The present study recruited 30 patients with soft tissue knee defects due to miscellaneous causes. All patients were treated with an SA-based flap harvested from the posteromedial aspect of the leg. All patients were followed up for 6 months. Outcome parameters included flap survival, flap complications, and restoration of knee function. Results: After 6 months of follow-up, all flaps survived; the reported complications were distal flap necrosis (6.7%), wound dehiscence (6.7%), seroma (3.3%), and small contracture band (3.3%). All patients restored normal range of motion around the knee. Conclusion: An SA-based flap harvested from the posteromedial aspect of the leg is a feasible, safe, and effective option for management of soft tissue knee defects.

Prevalence and determinants of peripheral arterial disease in children with nephrotic syndrome.

Peripheral arterial disease (PAD) is the least studied complication of nephrotic syndrome (NS). Risk factors which predispose children with NS to developing PAD include hyperlipidaemia, hypertension and prolonged use of steroids. The development of PAD significantly increases the morbidity and mortality associated with NS as such children are prone to sudden cardiac death. The ankle brachial index (ABI) is a tool that has been proven to have high specificity and sensitivity in detecting PAD even in asymptomatic individuals. We aimed to determine the prevalence of PAD in children with NS and to identify risk factors that can independently predict its development. A comparative cross-sectional study was conducted involving 200 subjects (100 with NS and 100 apparently healthy comparative subjects that were matched for age, sex and socioeconomic class). Systolic blood pressures were measured in all limbs using the pocket Doppler machine (Norton Doppler scan machine). ABI was calculated as a ratio of ankle to arm systolic blood pressure. PAD was defined as ABI less than 0.9. The prevalence of PAD was significantly higher in children with NS than matched comparison group (44.0% vs 6.0%, p < 0.001). Average values of waist and hip circumference were significantly higher in subjects with PAD than those without PAD (61.68± 9.1cm and 67.6± 11.2 cm vs 57.03 ± 8.3cm and 65.60± 12.5cm respectively, p< 0.005). Serum lipids (triglyceride, very low density lipoprotein, total cholesterol and low density lipoprotein) were also significantly higher in subjects with PAD than those without PAD [106.65mg/dl (67.8-136.7) vs 45.72mg/dl (37.7-61.3), 21.33mg/dl (13.6-27.3) vs 9.14mg/dl (7.5-12.3), 164.43mg/dl (136.1-259.6) vs 120.72mg/dl (111.1-142.1) and 93.29mg/dl (63.5-157.3) vs 61.84mg/dl (32.6-83.1), respectively p< 0.05]. Increasing duration since diagnosis of NS, having a steroid resistant NS and increasing cumulative steroid dose were independent predictors of PAD in children with NS; p< 0.05 respectively. With these findings, it is recommended that screening for PAD in children with NS should be done to prevent cardiovascular complications before they arise.

Waste to energy spatial suitability analysis using hybrid multi-criteria machine learning approach.

Municipal solid waste is typically managed in developing countries through various disposal methods, such as sanitary landfills or dumpsites. Alternatively, waste to energy (WTE) systems have been recently adopted to provide sustainable waste management and diversify the energy mix. The abundance of remotely sensed datasets and derivatives, along with the rapid development of artificial intelligence, can offer an effective solution for WTE site selection. In this study, an analytical hierarchy process (AHP)-based framework supported by multiple machine learning algorithms (gradient boosted tree (GBT), decision tree (DT), and support vector machines (SVMs)) was established to explore the optimum location for WTE facilities. Various social, legal, environmental, economic, morphological, and land cover parameters were considered under 11 thematic geospatial raster layers. The proposed framework was applied to the 1.5-million-capita city of Sharjah, United Arab Emirates. A novel approach was developed to incorporate Gaussian dispersion modeling for the expected air pollution emissions from a WTE facility. The results showed that the accuracy performance sequence of the algorithms was 94.6, 93.9, and 91.8% for GBT, DT, and SVM, respectively. It was found that the distance from existing landfills had the most critical impact on the optimum location of the WTE facility, followed by the distance from coastline and elevation. The AHP consistency check revealed an acceptable overall criteria consistency index and the ratio of 0.0344 and 0.019, respectively. The results showed that 16.6% of Sharjah was considered extremely highly suitable areas. This research supports decision-makers in developing local guidelines for siting WTE facilities and determining the most suitable locations for such projects.

Thalamic versus midbrain tremor; two distinct types of Holmes' Tremor: a review of 17 cases.

INTRODUCTION: Holmes Tremor (HT) is a unique and debilitating movement disorder. It usually results from lesions of the midbrain and its connection but can also result from posterior thalamic injury. Clinical examination can help lesion localization between these two areas. We studied the clinical features and their radiological correlations to distinguish midbrain HT (HT-m) from thalamic HT (HT-t). METHODS: Retrospective review of 17 patients with a HT-type presentation was conducted. Tremor characteristics, associated clinical signs and radiological findings were studied. RESULTS: Eleven patients had a myorythmic rest tremor, large amplitude proximal tremor with goal-directed worsening, with or without mild distal dystonic posturing, representing HT-m. Six patients had slow, large amplitude proximal tremors and distal choreathetoid movements, significant proximal/distal dystonic posturing, associated with proprioceptive sensory loss, representing HT-t. Haemorrhagic lesions were the predominant cause of HT-m; whereas, ischaemia was more commonly associated with HT-t. CONCLUSION: When assessing patients with HT, attentiveness to the presence of associated signs in the affected limb, such as a proprioceptive sensory deficits and additional movement disorders, can aid lesion localisation, which can have implications for management.

Management of peri-prosthetic joint infection and severe bone loss after total hip arthroplasty using a long-stemmed cemented custom-made articulating spacer (CUMARS).

BACKGROUND: There is little evidence on techniques for management of peri-prosthetic infection (PJI) in the context of severe proximal femoral bone loss. Custom-made articulating spacers (CUMARS) utilising cemented femoral stems as spacers was described providing better bone support and longer survival compared to conventional articulating spacers. We retrospectively report our experience managing PJI by adaptation of this technique using long cemented femoral stems where bone loss precludes use of standard stems. METHODS: Patients undergoing 1st stage revision for infected primary and revision THA using a cemented long stem (> 205 mm) and standard all-polyethylene acetabulum between 2011 and 2018 were identified. After excluding other causes of revision (fractures or aseptic loosening), Twenty-one patients remained out of total 721 revisions. Medical records were assessed for demographics, initial microbiological and operative treatment, complications, eradication of infection and subsequent operations. 2nd stage revision was undertaken in the presence of pain or subsidence. RESULTS: Twenty-one patients underwent 1st stage revision with a cemented long femoral stem. Mean follow up was 3.9 years (range 1.7-7.2). Infection was eradicated in 15 (71.4%) patients. Two patients (9.5%) required repeat 1st stage and subsequently cleared their infection. Three patients (14.3%) had chronic infection and are on long term suppressive antibiotics. One patient (4.8%) was lost to follow up before 2 years. Complications occurred in seven patients (33%) during or after 1st stage revision. Where infection was cleared, 2nd stage revision was undertaken in 12 patients (76.5%) at average of 9 months post 1st stage. Five (23.8%) CUMARS constructs remained in-situ at an average of 3.8 years post-op (range 2.6-5.1). CONCLUSIONS: Our technique can be used in the most taxing of reconstructive scenarios allowing mobility, local antibiotic delivery, maintenance of leg length and preserves bone and soft tissue, factors not afforded by alternative spacer options.

Inter- and intra-observer reliability of the new AO/OTA classification of proximal femur fractures.

INTRODUCTION: Hip fractures are a global health burden, with an incidence that is projected to increase from 66,000/year currently in the United Kingdom to 100,000/year by 2033. The classification of intertrochanteric fractures is key to the treatment algorithms advising on their surgical management. The AO/OTA classification is the most commonly used system, initially published in 1990 and subsequently shown to have poor inter- and intra-observer reliability, it was revised in 2018 with the main aim of re-classifying and further defining the 31-A2 group. METHODS: 150 plain film anteroposterior and lateral plain film radiographs of intertrochanteric fractures from three hospitals were classified using the 2018 AO/OTA classification of intertrochanteric fractures by six Orthopaedic Surgeons (2 Consultants, 4 Trainees), all were blinded to the definitive surgical treatment for patients. Radiographs were re-classified after a minimum of 3-months, Cohen's Kappa for inter-observer reliability was calculated from first round classifications and intra-observer reliability from first and second classifications. RESULTS: Mean Kappa for inter-observer reliability for AO group classification (e.g. 31-A1) was 0.479 (0.220 - 0.771, for sub-group classification (e.g. 31-A1.1) reliability reduced to 0.376 (0.276 - 0.613). Intra-observer reliability was comparable for both group and sub-group classifications, 0.661 and 0.587 respectively. CONCLUSIONS: The revised 2018 AO/OTA classification aimed to simply the classification of intertrochanteric fractures, however it remains unreliable with only a "moderate" inter-observer reliability at group level with this falling to "fair" when sub-group classifications are made. Identification of stable and unstable injuries using the new AO/OTA system remains fraught with difficulties and appears difficult to apply with consistent accuracy.

In vitro haemostatic efficacy of aqueous, methanol and ethanol plant extracts of three medicinal plant species in Palestine / Eficácia hemostática in vitro de extratos aquosos, metanólicos e etanólicos de três espécies de plantas medicinais na Palestina

Abstract The haemostatic efficacy of different extract types of Satureja thymbra L., Thymbra spicata L. (Lamiaceae) and Verbascum fruticulosum Post. (Scrophulariaceae) was evaluated in this study via the Prothrombin time (PT) and Activated partial thromboplastin time (aPTT) analysis. Aqueous, methanol and ethanol extracts of the examined plant species leaves were prepared to a final concentration 50 mg/mL. In vitro PT and aPTT assays were conducted on normal platelet poor plasma blood samples by a digital coagulation analyzer. The obtained results revealed anticoagulation activity of all investigated plant species with observed variations among them. The aqueous and ethanol extracts of T. spicata as well as the aqueous extract of S. thymbra prolonged PT values significantly (p < 0.05). While, all V. fruticulosum extract types have had no significant effect on the PT values. The recorded aPTT data showed that all aqueous extracts have had a significant effect on the blood haemostasis as they increased aPTT values in all plant species under study. Out of which, both the ethanol and methanol extracts of T. spicata and methanol extract of S. thymbra showed similar effect. Of great concern, it was clearly noticed that the aqueous and ethanol extract of T. spicata and the aqueous extract of S. thymbra possess the strongest anticoagulation effect as they increased both PT and aPTT values significantly relative to the control (p < 0.05). The variable anticoagulation bioactivity among the studied plant species could be referred to the various solvents degrees of solubility of different phyto-constituents. Thus, the efficacy of the plant species extracts evaluation as anticoagulants or coagulants were related to the plant species and to the solvent of extraction.

Resumo A eficácia hemostática de diferentes tipos de extrato de Satureja thymbra L., Thymbra spicata L. (Lamiaceae) e Verbascum fruticulosum Post. (Scrophulariaceae) foi avaliada neste estudo pelo tempo de protrombina (TP) e tempo de tromboplastina parcial ativada (TTPa). Os extratos aquosos, metanólicos e etanólicos das folhas das espécies de plantas examinadas foram preparados para uma concentração final de 50 mg/mL. Os ensaios de TP e TTPa in vitro foram realizados em amostras normais de sangue, pobre em plaquetas, por um analisador de coagulação digital. Os resultados obtidos revelaram atividade anticoagulante de todas as espécies de plantas investigadas, com variações observadas dentre elas. Os extratos aquosos e etanólicos de T. spicata e o extrato aquoso de S. thymbra prolongaram significativamente os valores de TP (p <0,05). Entretanto, todos os tipos de extratos de V. fruticulosum não tiveram efeito significativo sobre os valores de TP. Os dados registrados do TTPa mostraram que todos os extratos aquosos tiveram um efeito significativo na hemostase do sangue, pois aumentaram os valores de TTPa em todas as espécies de plantas em estudo. Dos quais, ambos os extratos etanólicos e metanólicos de T. spicata e o extrato metanólico de S. thymbra mostraram efeito semelhante. De grande preocupação, notou-se claramente que os extratos aquoso e etanólico de T. spicata e o extrato aquoso de S. thymbra apresentam efeito anticoagulante mais forte, aumentando os valores de TP e TTPa significativamente em relação ao controle (p <0,05). A variável bioatividade anticoagulante dentre as espécies vegetais estudadas pôde ser referida aos vários graus de solventes de solubilidade de diferentes fitoconstituintes. Assim, a eficácia da avaliação de extratos de espécies vegetais como anticoagulantes ou coagulantes foi relacionada às espécies vegetais e ao solvente de extração.

Understanding Rare Earth Elements concentrations, anomalies and fluxes at the river basin scale: The Moselle River (France) as a case study.

Anthropogenic activities linked to various new technologies are increasingly disrupting REEs biogeochemical cycles. A catchment-based perspective is therefore necessary to distinguish between natural (i.e., changes in lithology) and human-related sources of REEs variability. In the present study, REEs patterns, anomalies and fluxes were investigated in the French part of the Moselle River basin (Moselle River itself and some of its headstreams and tributaries). The REEs patterns in the headstream waters were highly variable and mostly related to the complex underlying lithology (granite, sandstone, tuff and graywacke). Along the Moselle River, the presence of positive Gd anomalies and a regular LREEs depletion/HREEs enrichment pattern on sandstone/limestone substrates were the most distinctive features. The Gd anomaly varied from 1.8 to 8.7, with anthropogenic Gd representing 45 to 88% of the total Gd. A linear relationship was obtained between the anthropogenic Gd flux and the cumulative population along the watershed. However, the magnitude of the Gd anomalies was shown to depend on the methodological approach chosen for their calculation. The use of a threshold value to identify the presence of an anthropogenic Gd anomaly may therefore be basin (and lithology) dependent, and care has to be taken in comparing results from different rivers or lithologies. Concentration of anthropogenic Gd in the Moselle River and its tributaries were close to, or above, the value of 20 ng/L reported in literature to elicit adverse biological effects in laboratory cell cultures. The ecotoxicological significance of Gd anomalies deserves further investigation because concentrations of anthropogenic Gd may also vary depending on the methodological approach used for calculating Gd anomalies.

Are positive-pressure ventilation lobby rooms effective for protective and source isolation?

High-efficiency particulate air supplied to a positive-pressure ventilation lobby (PPVL) in isolation rooms offers the dual advantage of protective and source isolation. This study demonstrates the in-use validity of PPVL rooms for protective isolation of patients. Of the 48 PPVL air samples investigated, Aspergillus fumigatus was detected from only one (2%) sample. Local and remote monitoring of the PPVL rooms is essential for the safety of patients and healthcare workers. Remote and point-of-use engineering controls are essential for ongoing ventilation monitoring, but this should be complemented by visual inspection of the isolation suite. Periodic microbiological monitoring should also be considered with other control measures.

Meningococcal Disease-Associated Prophage-Like Elements Are Present in Neisseria gonorrhoeae and Some Commensal Neisseria Species.

Neisseria spp. possess four genogroups of filamentous prophages, termed Nf1 to 4. A filamentous bacteriophage from the Nf1 genogroup termed meningococcal disease-associated phage (MDA φ) is associated with clonal complexes of Neisseria meningitidis that cause invasive meningococcal disease. Recently, we recovered an isolate of Neisseria gonorrhoeae (ExNg63) from a rare case of gonococcal meningitis, and found that it possessed a region with 90% similarity to Nf1 prophages, specifically, the meningococcal MDA φ. This led to the hypothesis that the Nf1 prophage may be more widely distributed amongst the genus Neisseria. An analysis of 92 reference genomes revealed the presence of intact Nf1 prophages in the commensal species, Neisseria lactamica and Neisseria cinerea in addition to the pathogen N. gonorrhoeae. In N. gonorrhoeae, Nf1 prophages had a restricted distribution but were present in all representatives of MLST ST1918. Of the 160 phage integration sites identified, only one common insertion site was found between one isolate of N. gonorrhoeae and N. meningitidis. There was an absence of any obvious conservation of the receptor for prophage entry, PilE, suggesting that the phage may have been obtained by natural transformation. An examination of the restriction modification systems and mutated mismatch repair systems with prophage presence suggested that there was no obvious preference for these hosts. A timed phylogeny inferred that N. meningitidis was the donor of the Nf1 prophages in N. lactamica and N. gonorrhoeae. Further work is required to determine whether Nf1 prophages are active and can act as accessory colonization factors in these species.