Lateral Meniscus Zip Lesion of Knee: Classification and Repair Methods.

Lateral meniscus tears at the junction of the Wrisberg ligament and posterior horn are meniscocapsular injuries often seen with injury to the anterior cruciate ligament. Such lateral meniscus posterior horn lesions have been termed zip lesions. The lateral meniscus posterior horn is the major restraint for the pivot shift maneuver. Considering the morphology of condyles, lateral meniscus preservation and repair of unstable meniscocapsular posterior tear are needed to prevent future osteoarthritis. In this Technical Note, we aim to classify zip lesions of the posterior horn of the lateral meniscus. Zip lesions are located posteriorly and often are missed on magnetic resonance imaging and routine diagnostic arthroscopy. We recommend looking from the anteromedial portal and exploring the posterolateral compartment to identify hidden zip lesions, equivalent to medial-sided ramp lesions. We describe various all-inside techniques to repair these inaccessible tears.

Meniscus Root Tear: Extended Classification and Arthroscopic Repair Techniques.

The meniscus root is an attachment of the anterior and posterior horns of the meniscus onto the tibia, and its primary function is to prevent extrusion under axial load. Meniscus root tear constitutes 15% to 20% of meniscus tear. With the increased incidence of root tears being diagnosed commonly, many newer morphologic patterns of root tears have been detected, and the need to extend the conventional classification arises. At the same time, preserving the meniscus root necessitates novel techniques to repair this newer pattern. In this Technical Note, we describe the extended classification of root tears and arthroscopic repair techniques to achieve stable and secure fixation of meniscus roots.

Anatomical Double-Row Lateral Meniscus Root Repair Using Suture Anchors.

Posterior lateral meniscus root tear leads to extrusion of meniscus and increased instability of knee joint. This leads to loss of hoop stresses with increased and progressive wear of cartilage. Conservative management of root tear in the absence of osteoarthritis is ineffective, and meniscus root repair results in delayed progression of osteoarthritis and improved clinical outcomes. Lateral meniscus root, having a larger surface area, needs a stiffer and secure fixation. Our double-row meniscus root repair technique allows a larger contact area for healing, better biomechanics, low retear, and no tunnel interference with concomitant procedure.

Arthroscopic Ramp Repair: "No-Implant, Pass, Park, and Tie Technique" Using Knee Scorpion.

Ramp lesions play a significant role in both anteroposterior and rotational knee stability. Ramp lesions are difficult to diagnose clinically as well as on magnetic resonance imaging. Arthroscopic identification by visualizing the posterior compartment and probing via the posteromedial portal will confirm the diagnosis of ramp lesion. Failure to address this lesion properly will lead to poor knee kinematics, residual knee laxity, and increased chances of failure of reconstructed anterior cruciate ligament. Here, we describe a simple arthroscopic surgical technique to repair ramp lesion, the pass, park, and tie at the end, via 2 posteromedial portals using a knee scorpion suture passing device.

Positive Psychological Changes at High Altitude Shown by the Low Landers after the Yoga Intervention-Sudarshan Kriya Yoga (SKY).

Background: Immediate assent to high altitude affects the cognitive performance and mood of an individual, which is followed by depression and anxiety. It also affects the sleep quality, general health, and happiness quotient of an individual. Sudarshan Kriya Yoga (SKY) is a cyclical breathing technique, which has been proven successful in managing stress, depression, anxiety, and helps in the improvement of sleep quality. Purpose: The current study was to understand the role of SKY meditation on psychological parameters, happiness quotient of low landers at high altitude (Leh). Methods: It is a two-armed pre-post study with experimental and control group both are lowlanders, and their psychological parameters are being assessed when they immediately assent to high altitude (Leh). There are two groups experimental group (SKY) was from AOL SKY-AMP and has prior SKY meditation experience. The control group does not have any yoga or meditation experience. SKY-AMP is a 4 days protocol done at high altitude by the SKY group. Both groups reach Leh through air mode transportation. Results: Oxford Happiness Questionnaire (OHQ) showed a significant result in the SKY group with P ≤ .001, whereas it is nonsignificant in the control group. We also observed anthropometric and physiological changes in the participants showing significant effects on weight, BMI, waist circumference, hip circumference, and blood pressure; with no significant effect in the control group. It is one of the first studies done with both two groups, where yoga and meditation are done at high altitude and then seen the changes in the groups at physical and psychological level. Conclusion: Yogic practices can be helpful in having positive psychological change in the lowlanders at high altitude.

Balloon Catheter Technique for Prevention of Vascular Injuries During Arthroscopic Posterior Cruciate Ligament Reconstruction.

Arthroscopic posterior cruciate ligament (PCL) reconstruction is a technically demanding procedure and is associated with several intraoperative and postoperative complications, although less-common but intraoperative iatrogenic popliteal artery injuries have been reported. At our center, we developed a simple and effective technique using a Foley balloon catheter that ensures a safe surgery to avoid possible neurovascular complications. Through a lower posteromedial portal, this inflated balloon acts as protective mechanism between the PCL and posterior capsule. Betadine or methylene blue dye is used to inflate this bulb, which provides easy identification if balloon ruptures, as evidenced by leakage of this solution in posterior compartment. This balloon increases significant distance, equivalent to the diameter of the balloon, between the PCL and popliteal artery by pushing the capsule more posteriorly. This balloon catheter protection technique combined with other methods will ensure a greater level of safety when performing an anatomical PCL reconstruction.

Effects of glenohumeral corticosteroid injection on stiffness following arthroscopic rotator cuff repair: a prospective, multicentric, case-control study with 18-month follow-up.

BACKGROUND: This study aimed to analyze the efficacy of single-dose corticosteroid injection (CSI) administered at 6 weeks postoperative to treat stiffness following arthroscopic rotator cuff repair (ARCR). METHODS: In this prospective, multicentric, case-control study, post-ARCR stiffness at 6 weeks was treated with either a single dose of intra-articular CSI (CSI group) or physical therapy with oral analgesics (non-CSI group). Pain intensity according to visual analog scale (VAS), functional outcome using the Constant Murley Shoulder Score, time to return to activities of daily living (ADLs), and retear rate were recorded at 6 weeks, 9 weeks, 12 weeks, 6 months, 12 months, and 18 months postoperatively in both groups. RESULTS: A total of 149 patients (54.5%) in the CSI group and 124 patients (45.5%) in the non-CSI group were included in this study. Pain and function were significantly better in the CSI group at 9-week, 12-week, and 6-month (P<0.001) follow-up, whereas they were not significantly different when the groups were compared at 12- and 18-month follow-up. The mean duration to return to ADLs was significantly shorter (P<0.001) in the CSI group. The incidence of retears was not significantly different (P=0.36) between groups at the end of 18 months of follow-up. CONCLUSIONS: Single-dose intra-articular CSI administered at 6 weeks postoperative to treat post-ARCR stiffness significantly improved pain, function, and duration of return to ADLs without increasing the risk of retears compared to patients who did not receive intra-articular CSI.

Reconstruction of Superficial Medial Collateral Ligament: Modified Danish Technique with Dual Adjustable Loop Suspensory Fixation.

Injury to the superficial medial collateral ligament (MCL) is treated conservatively for low-grade injury and with surgery for high-grade injury, especially in association with cruciate ligament injury. Acute injuries are treated with MCL repair, and chronic injury requires reconstruction. Anatomic MCL reconstruction can be done using free allograft or autograft and fixed using screws or suspensory fixation. We describe here an anatomic technique that is a modification of a Danish technique in which we reroute the semitendinosus, keeping its tibial attachment intact. The semitendinosus is rerouted anatomically in the tibial tunnel, and a graft is then passed anatomically in the femoral tunnel. The graft is fixed in both tunnels with adjustable loop suspensory fixation, which gives the unique advantage of controlled tensioning of the graft for MCL reconstruction. In this technique further re-tensioning is possible if the knee is unstable in valgus stress, even after final fixation.

Effect of breathing intervention in patients with COVID and healthcare workers.

Background: Regulated breathing facilitates ventilation and reduces breathlessness. However, the effect of Yogic breathing on patients with COVID remains unclear. We aimed to evaluate the efficacy of two breathing protocols, i.e., short breathing technique (SBT) and long duration breathing technique (LBDT). Methods: Three groups including COVID-positive patients, COVID-recovered patients, and healthcare workers (HCWs) were included in the study and segregated into Yoga and control groups. SBT was administered to COVID-positive patients. Both SBT and LBDT were administered to COVID-recovered patients and HCWs. A total of 18 biochemical parameters, a 6-min walk test (6MWT), and a 1-min sit-stand test (1MSST) were assessed on 0th, 7th, and 15th days, where biochemical parameters were the primary outcome. Pre-post estimation of neuropsychological parameters (nine questionnaires) and heart rate variability (HRV) were carried out. The paired t-test or Wilcoxon rank test was applied for pre-post comparison and the Student's t-test or Mann-Whitney U test was used for group comparison. Repeated measures test was applied for data recorded at three time points. Results: A significant elevation in white blood cell (WBC) count was observed in COVID-positive intervention (p < 0.001) and control groups (p = 0.003), indicating no role of intervention on change in WBC number. WBC count (p = 0.002) and D-dimer (p = 0.002) significantly decreased in the COVID-recovered intervention group. D-dimer was also reduced in HCWs practicing Yogic breathing as compared to controls (p = 0.01). D-dimer was the primary outcome, which remained below 0.50 µg/ml (a cutoff value to define severity) in the COVID-positive yoga group (CYG) and decreased in the COVID-recovered yoga group (RYG) and the HCW yoga group (HYG) after intervention. A 6-min walk test (6MWT) showed an increase in distance covered among the COVID-positive patients (p = 0.01) and HCWs (p = 0.002) after intervention. The high-frequency power (p = 0.01) was found to be reduced in the COVID-positive intervention group. No significant change in neuropsychological parameters was observed. Conclusion: Yogic breathing lowered D-dimer, which is helpful in reducing thrombosis and venous thromboembolism in patients with COVID-19 besides lowering the chances of vaccine-induced thrombotic thrombocytopenia in vaccinated individuals. The breathing intervention improved exercise capacity in mild to moderate cases of COVID-19. Further studies can show if such breathing techniques can influence immunity-related genes, as reported recently in a study. We suggest that Yogic breathing may be considered an integrative approach for the management of patients with COVID. Trial registration: http://ctri.nic.in/Clinicaltrials/login.php, identifier: CTRI/2020/10/028195.

Role of debulking mucoid ACL in unicompartmental knee arthroplasty: a prospective multicentric study.

BACKGROUND: Mucoid degeneration of the anterior cruciate ligament (ACL) has been shown to cause restricted terminal range of motion and rest pain. If present in a patient undergoing unicompartmental knee arthroplasty, it can deteriorate the final outcome. This study aims to compare functional and clinical outcomes of debulking the mucoid ACL in patients undergoing mobile-bearing unicompartmental knee arthroplasty (UKA). METHODS: Patients with mucoid ACL undergoing mobile-bearing UKA at five different centres by five different arthroplasty surgeons were included. They were segregated into two groups matched for all demographic and pre-operative values: group A did not undergo debulking; group B underwent open debulking by a 15-number blade prior to UKA. Patient-related outcome measures, rest pain, clinical outcomes, and subjective patient satisfaction were recorded and compared at 2 years follow-up. RESULTS: A total of 442 patients (226 patients underwent debulking, 216 patients did not undergo debulking) were included. Both groups showed overall improvement after surgery, however, patients who underwent debulking performed better at 2 years follow-up in terms of Knee Society functional score, International Knee Documentation Committee scores, range of motion, rest pain and overall patient satisfaction (p < 0.05) as compared with their counterparts. CONCLUSIONS: Debulking of mucoid ACL in patients undergoing unicompartmental knee arthroplasty significantly reduces the rest pain and improves the final range of motion of the knee joint, subsequently improving the overall functional and clinical outcome of the patient and resulting in greater patient satisfaction.

Transition metal oxides as a cathode for indispensable Na-ion batteries.

The essential requirement to harness well-known renewable energy sources like wind energy, solar energy, etc. as a component of an overall plan to guarantee global power sustainability will require highly efficient, high power and energy density batteries to collect the derived electrical power and balance out variations in both supply and demand. Owing to the continuous exhaustion of fossil fuels, and ever increasing ecological problems associated with global warming, there is a critical requirement for searching for an alternative energy storage technology for a better and sustainable future. Electrochemical energy storage technology could be a solution for a sustainable source of clean energy. Sodium-ion battery (SIB) technology having a complementary energy storage mechanism to the lithium-ion battery (LIB) has been attracting significant attention from the scientific community due to its abundant resources, low cost, and high energy densities. Layered transition metal oxide (TMO) based materials for SIBs could be a potential candidate for SIBs among all other cathode materials. In this paper, we discussed the latest improvement in the various structures of the layered oxide materials for SIBs. Moreover, their synthesis, overall electrochemical performance, and several challenges associated with SIBs are comprehensively discussed with a stance on future possibilities. Many articles discussed the improvement of cathode materials for SIBs, and most of them have pondered the use of Na x MO2 (a class of TMOs) as a possible positive electrode material for SIBs. The different phases of layered TMOs (Na x MO2; TM = Co, Mn, Ti, Ni, Fe, Cr, Al, V, and a combination of multiple elements) show good cycling capacity, structural stability, and Na+ ion conductivity, which make them promising cathode material for SIBs. This review discusses and summarizes the electrochemical redox reaction, structural transformations, significant challenges, and future prospects to improve for Na x MO2. Moreover, this review highlights the recent advancement of several layered TMO cathode materials for SIBs. It is expected that this review will encourage further development of layered TMOs for SIBs.

Correction: Transition metal oxides as a cathode for indispensable Na-ion batteries.

[This corrects the article DOI: 10.1039/D2RA03601K.].

Physical and mental health at high altitude of individuals doing yogic practices.

Objectives: There is an increase trend in the past few years, in the number of people traveling to high altitude for recreational activities such as pilgrims, mountaineering, and climbing and for occupational purposes such as defense and mining which have resulted in increasing in hypoxia conditions and anxiety-related medical problems at high altitude. As it is known that mental stress affects brain and heart functions, a recent research performed on Sudarshan Kriya Yoga (SKY) further validated the effectiveness of SKY on participants (practicing SKY) as compared to control after quantifying mental stress. To study the physiological effect of SKY advance breathing technique when immediately ascends to high altitude, we wanted to study the level of stress and mental well-being of lowlanders at high altitude. Materials and Methods: It is an interventional study performed at high altitudes, with low landers as participants where their biochemical and psychological parameters are being assessed. Results: The result for biochemical parameter cholesterol, triglycerides, low-density lipoproteins (LDLs), high-density lipoproteins (HDLs), very low-density lipoproteins, LDL-HDL ratio, and cholesterol-HDL ratio showed a significant decrease in the pre- and post-analyses values with P ≤ 0.001. Acute mountain sickness (AMS), Warwick-Edinburgh Mental Well-being Scale, and State and Trait Anxiety Inventory (STAI) also show a decreasing trend with significant result in AMS, mental well-being, and non-significant in STAI p value is P = 0.016, P = 0.055, and P = 0.125, respectively. Conclusion: We observed positive outcome both in for biochemical and stress-related parameters with SKY advance program practitioners who have rapidly ascend to high altitude.

Integrative Approach to COVID-19: An Indian Facebook Recipe for Mental Health.

Background: The COVID-19 pandemic has given the world a big blow and has forced the entire world to develop a new thought process. To cope with the stress of lockdown, it was important for people to indulge in educational and health activities to save them from the threats being caused by the news and social media. Summary: A Facebook page named Yoga scholars Post Graduate Institute of Medical Education and Research (PGIMER) was created where three sessions were held per day for 225 days regularly. This activity resulted in people adopting an integrative approach towards alternative medicine. Key message: This also made possible a trial of Ashwagandha for COVID-19 treatment by the Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy (AYUSH) ministry.

In silico method for identification of novel copper and iron metabolism proteins in various neurodegenerative disorders.

Copper (Cu) and Iron (Fe) has been the subject of intensive research over several decades as numerous seminal studies robustly support the involvement of Cu and Fe metabolism dyshomeostasis as a common denominator in several neurodegenerative disorders (particularly Alzheimer's disease and Parkinson's disease); however, till date, the exact "cause-effect" association has not been elucidated. Thus, there is urgent need to look for newer association/pathways of these redox active elements in different neuropathological conditions. Therefore, in this study, we have used bioinformatics based approach to identify novel Cu and Fe metabolism proteins in neurodegenerative disorders using Cytoscape software. The network biology data demonstrated the association of secreted protein acidic and rich in cysteine (SPARC/osteonectin) protein with Alzheimer's disease, Parkinson's disease, Huntington's disease and neurodegeneration with brain iron accumulation (NBIA) disease, whereas Coagulation factor V may have a role in Brunner Syndrome, Obsessive-Compulsive Disorder, Febrile seizures and Schizophrenia diseases. Further analysis revealed Coagulation factor VII possible role in L1 Syndrome and Congenital hydrocephalus disorders. In conclusion, the present study shows the first evidence in silico that SPARC/osteonectin, Coagulation factor V and VII proteins may have plausible role in the pathogenesis of various neurodegenerative diseases.

Extra precision glide docking, free energy calculation and molecular dynamics studies of 1,2-diarylethane derivatives as potent urease inhibitors.

For the latter half of the twentieth century, most medical professionals considered bacterial infection to be a primary cause of gastrointestinal ulcers in human beings. In 1994, the World Health Organization (WHO) recognized Helicobacter pylori, the bacterium most closely linked to ulcer development, as a type I carcinogen. Biological research has shown that there is a positive correlation between the number of species in the Helicobacter genus and the number of medical conditions associated with Helicobacter infection, both of which are increasing rapidly. N-Benzylaniline derivatives, frequently used in industrial manufacturing, are being considered as a strong candidate for ongoing drug modeling in search of novel therapies. The basic goal behind this study was to determine the potency of experimentally proved data, and to determine favorable substituents to enhance potency, and thereafter to support this finding through theoretical modification of the existing base skeleton by addition of suitable substituents. Ligands were investigated thoroughly by paying attention to the urease-inhibitory properties present in the selected series. Initially, docking was performed on ligands with protein to produce efficient docking poses. Molecular dynamics (MD) simulations were also performed to precisely understand the interactions between ligands and proteins. Thereafter, MM-GBSA was used in order to validate the methods and results. Good interaction was observed with amino acids Arg338, Ala169, Asp223, His322, and Asn168. This study also revealed that the electron rich hydroxyl group (-OH) substituent plays an important role during bond formation. In addition, various hydrogen bonds, ionic bonds, and pi-pi stacking bonds make significant contributions towards urease inhibition. Therefore, further research utilizing electron-rich moieties may lead to novel and efficacious urease inhibitors.

Acute kidney injury in Pediatric Intensive Care Unit: Incidence, risk factors, and outcome.

OBJECTIVE: To determine incidence, risk factors, and outcome of acute kidney injury (AKI) in Pediatric Intensive Care Unit (PICU). MATERIALS AND METHODS: This is a prospective, observational study conducted in PICU of Department of Paediatrics, S.P. Medical College, Bikaner, from October 2013 to May 2014. In this study, 536 patients of aged 29 days to 16 years were screened for AKI according to the Pediatric Risk, Injury, Failure, Loss, End-stage Renal Disease (pRIFLE) criteria. Their clinical and biochemical data were recorded and followed up to their discharge/death. RESULTS: During the study period, 230 (42.9%) out of 536 patients developed AKI. Younger age (<5 years) and females (P ≤ 0.013) were more prone to develop AKI. Most common etiologies were septicemia, multiple organ dysfunction syndrome (MODS), gastroenteritis, and severe malaria (P ≤ 0.05). The maximal stage of AKI was stage "R" (49.1%), followed by "I" (29.5%) and "F" (21.3%). Major PICU-related risk factors were use of vasoactive drug (VD) and nephrotoxic drug (ND) and need of mechanical ventilation (MV) (P ≤ 0.05). Length of stay was significantly longer than non-AKI patients (P ≤ 0.05). Mortality in AKI (47.5%) was higher (P ≤ 0.05%) in comparison to non-AKI (25.56%). CONCLUSION: AKI is common in critically sick children, especially in younger age and in females with septicemia and MODS. Use of VD and ND and need of MV are common risk factors. AKI is associated with longer hospital stay and higher mortality. pRIFLE is better diagnostic criteria in early detection of AKI and reduction of their morbidity and mortality.

Retention of nutrients in green leafy vegetables on dehydration.

The objective of the study was to investigate the influence of dehydration on nutrient composition of Amaranthus gangeticus, Chenopodium album, Centella asiatica, Amaranthus tricolor and Trigonella foenum graecum. The green leafy vegetables (GLV) were steam blanched for 5 min after pretreatment and dried in an oven at 60 °C for 10-12 h. The fresh and dehydrated samples were analyzed for selected proximate constituents, vitamins, minerals, antinutrients and dialyzable minerals. Dehydration seems to have little effect on the proximate, mineral and antinutrient content of the GLV. Among the vitamins, retention of ascorbic acid was 1-14%, thiamine 22-71%, total carotene 49-73% and ß-carotene 20-69% respectively, of their initial content. Dialyzable iron and calcium in the fresh vegetables ranged between 0.21-3.5 mg and 15.36-81.33 mg/100 g respectively, which reduced to 0.05-0.53 mg and 6.94-58.15 mg/100 g on dehydration. Dehydration seems to be the simplest convenient technology for preserving these sources of micronutrients, especially when they are abundantly available. Irrespective of the losses of vitamins that take place during dehydration, dehydrated GLV are a concentrated natural source of micronutrients and they can be used in product formulations. Value addition of traditional products with dehydrated GLV can be advocated as a feasible food-based approach to combat micronutrient malnutrition.

Influence of organic acids on rheological and bread-making characteristics of fortified wheat flour.

Flour was fortified with premix containing ferrous fumarate and folic acid. Organic acids such as citric acid, malic acid and tartaric acid, which are promoters of iron bioavailability, were added at three levels and their influence on rheological and bread-making characteristics was studied. Farinograph water absorption increased with fortificants, but with addition of organic acids there was a decrease. Maximum pressure was 77 mm in control, which increased to 78-88 mm with the addition of different acids to the fortified flour. Addition of organic acids to fortified flour brought about a decrease in peak viscosity, hot paste viscosity, cold paste viscosity and setback values. The L, a and b values of fortified breads were similar to that of control. Sensory analysis revealed marginal differences in the overall quality of breads prepared with fortified flour with the addition of organic acids.