Talus bone: normal anatomy, anatomical variations and clinical correlations.

Talus is a pivotal bone that assists in easy and correct locomotion and transfers body weight from the shin to the foot. Despite its small size, it is implicated in many clinical disorders. Familiarity with the anatomy of the talus and its anatomical variations is essential for the diagnosis of any disorder related to these variations. Furthermore, orthopedic surgeons must be fully aware by this anatomy during podiatry procedures. In this review, we attempt to present its anatomy in a simple, updated and comprehensive manner. We have also added the anatomical variations and some clinical points relevant to the unique and complex anatomy of talus. The talus has no muscle attachment. However, it does have many ligaments attached to it and others around it to keep it in place. Moreover, the bone plays a pig role in movements due to its involvement in many joints. Most of its surface is covered with articular cartilage. Therefore, its blood supply is relatively poor. This puts the talus at greater risk for poor healing as well as more complications in the event of injury than any other bone. We hope this review will make it easier for clinicians to pursue and understand the updated essential knowledge of one of the most complex bone anatomies that they need in their clinical practice.

A critical analysis of deficiencies in the quality of information contained in prostate multiparametric MRI requests and reports.

BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI) has been increasingly recognised as an important tool in the diagnosis of prostate cancer. PI-RADSv2 guidelines recommend that important clinical information including prostate-specific antigen (PSA) levels, examination findings, and biopsy information should be included in mpMRI requests. PIRADS score and PSA density (PSAD) are both independent predictors for the presence of a clinically significant prostate cancer. AIMS: This study aims to evaluate the quality of mpMRI requests and reports at our institution in accordance with these parameters. METHODS: All prostate mpMRIs performed by radiology services in Galway University Hospital between 1st September 2019 and 1st March 2020 were reviewed. Exclusion criteria were applied. Requests and reports were analysed for the presence of the following parameters: PSA-results, examination findings, biopsy information, PI-RADS score, prostate volume, and PSAD. RESULTS: A total of 586 mpMRIs were performed, and of these, 546 were included. PSA value was provided in 497 (91%) of requests, exam findings in 355 (65%), and biopsy information in 452 (82%). PIRADS score was included in 224 (41%) of reports, prostate volume in 178 (32.6%), and PSAD in 106 (19%). CONCLUSIONS: Great variation in the quality of information contained in both requests and reports for prostate mpMRIs exists within our service. We aim to improve this by collaborating with our radiology colleagues to develop a proforma for requesting and reporting of mpMRIs for our radiology systems to ensure important clinical and radiological information is provided in future.

Facile, Efficient, and Cheap Electrode based on SnO2/Activated Carbon Waste for Supercapacitor and Capacitive Deionization Applications.

Activated carbon granules present in our household filters used in water purification are significant waste. Activated carbon waste (ACW) was ground to a fine powder, then impregnation of SnO2 on ACW was performed under mild conditions followed by calcination of SnO2-ACW at 700 °C for 2 h, producing a SnO2-ACW hybrid composite. This hybrid composite material was used in the preparation of electrodes for supercapacitor and capacitive deionization applications. The electrochemical performance of the electrodes was investigated by using cyclic voltammetry, galvanostatic charge-discharge, and electrochemical impedance spectroscopy. Calcination and addition of SnO2 contributed to an obtained electrode with a high specific capacitance of 30.46 F g-1 in a solution of 1 M Na2SO4 compared to the original ACW (0.122 F g-1) and calcined-ACW (1.42 F g-1) at an actual current of 1 mA. This electrode was also investigated for water desalination through the capacitive deionization technique and exhibited an electrosorption capacity of 6.44 mg/g compared to the commercial AC (8.9 mg/g) so it is a highly promising and economic electrode.

Pathophysiology, Mechanism, and Outcome of Ischemic Stroke in Cancer Patients.

OBJECTIVES: The purpose of this study is to assess the risk factors, biomarkers of stroke, mechanism, and outcomes of cerebral infarction among cancerous diseases. MATERIALS & METHODS: 156 patients presented by acute ischemic stroke were divided into two groups: the first group included 78 ischemic stroke patients associated with different types of cancer and the second group (control group) included 78 ischemic stroke patients not associated with cancer. Both groups were compared regarding the risk factors, previous thrombotic activity, subtypes, biomarkers of stroke, and outcomes. RESULTS: Cancer patients presented by acute ischemic stroke were accompanied by a significantly less incidence of diabetes mellitus, hypertension, dyslipidemia, and coronary heart disease, and atrial fibrillation than non-cancer patients (P < 0.001). While, levels of biomarkers of inflammation like erythrocyte sedimentation rate and C-reactive protein, and stroke biomarkers like fibrinogen, and D-dimer, all together were highly elevated in cancerous disease group of patients (P < 0.01). The prevalence of deep vein thrombosis, pulmonary embolism, and myocardial infarction was significantly higher in patients with cancer than in control patients without cancer (P = 0.008, P < 0.01 and P < 0.01 respectively). The most common stroke etiologies were atherosclerosis of large arteries and stroke of undetermined cause in a cancerous group of patients. Cancer patients were accompanied by significant higher mortality rate (P = 0.005), and more disability as determined by mRS (P < 0.005) CONCLUSIONS: Pathophysiology and mechanism of ischemic stroke in cancerous disease patients were due to different risk factors, biomarkers of stroke, and subtypes in comparison with non- cancerous cases.

Unusual case of absence of suprascapular notch and foramen

Identification of anatomical variations is essential to understand and perfectly manage the correlated clinical disorders. One of such disorders is shoulder pain that might result from entrapment of suprascapular nerve at the narrow supracondylar foramen. In this article, we report a rare case of absence of such foramen. With absence of the foramen, there is an increasing potentiality of nerve entrapment beneath the superior scapular transverse ligament. Therefore, investigation of such anatomical variation is suggested for proper management of cases of shoulder pain and dysfunction

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Facile Synthesis of Poly(DMAEMA-co-MPS)-coated Porous Silica Nanocarriers as Dual-targeting Drug Delivery Platform: Experimental and Biological Investigations.

Inorganic structures with functionalized polymers play essential roles in diverse biological trends. Herein, thermal and CO2 dual-stimuli nanomaterials composed of mesoporous silica nanoparticles (MSN) anchored with two grafted copolymers: poly(3-methacryloxypropyltrimethoxysilane) "PMPS" & poly(N,N-dimethylaminoethyl methacrylate) "PDMAEMA" were synthesized via one-step reaction and characterized by BET as well as BJH methods to estimate pore sizes, pore volumes, and surface areas. The smart PDMAEMA acted as an active gatekeeper to adjust the loading or in vitro release processes of a fungicidal drug-loaded inside the mesopores by altering temperature or CO2 of the tested environment. Furthermore, treating the nanomaterials by CO2 for a few minutes was found to have a bactericidal effect with promising results as indicated by the disk diffusion technique. In general, the positive biological activity against selected strains of bacteria and fungi indicates that these particles may be helpful for engineering more efficient antifungal or antibacterial agents for pharmaceutical applications.

Engineered borate ester conjugated protein-polymer nanoconjugates for pH-responsive drug delivery.

To improve the clinical efficiency of cytotoxic anticancer drugs e.g. doxorubicin (DOX), reduce the severe off-target side effects, and allow the more biocompatible and biodegradable drug penetration into tumor cells, our research efforts developed a new DOX-conjugated protein polymer nanoconjugates (PPNCs) prodrugs delivery system. Briefly, DOX was conjugated to bovine serum albumin (BSA) and the complex was treated with lactobionic acid (LA) as well as folic acid (FA) to enhance drug endocytosis and targeting selectivity. Such functionalized BSA could be conjugated with a designed phenylboronic acid functionalized poly(N-isopropylacrylamide) (PNIPAAm) via forming a pH-sensitive borate ester bond to give the functionalized PPNCs prodrugs. The potential of the PPNCs prodrugs on tumor cells therapy was systematically evaluated in dose/time-dependent effects. In vitro results showed a rapid accumulation of the prodrugs into the MDA-MB-231 tumor cell during the first 30 min and reached maximum at 24 h. Moreover, the cell-killing effect was observed quickly after 4 h incubation with an IC50 of 0.5 mg/mL (≈4 µM/L). In general, given the efficient pH-dependent DOX release of these constructed nanoconjugates, it is anticipated to contribute a potential delivery strategy for cancer therapy.

The construction of thiol-functionalized DNAsomes with small molecules response and protein release.

In this work, a poly(N-isopropylacrylamide) polymer (PNIPAAm) was prepared via the photoinduced reversible addition-fragmentation chain transfer (RAFT) polymerization using Ru(bpy)3Cl2·6H2O as photoinitiator. The design and spontaneous assembly of thiol-functionalized DNA-Thiol/PNIPAAm polymeric capsule (DNAsomes) by water-in-oil Pickering emulsion method and effective response with small molecules (Sybr green and phenanthrene) were described. The intermediate product, DNA-Thiol/PNIPAAm conjugates and DNAsomes were characterized by using 1H NMR, dynamic light scattering (DLS), SEM, TEM and UV-vis methods. The obtained results indicated that DNA-Thiol/PNIPAAm constructs assembled in a Pickering emulsion could produce DNA-based spherical DNAsomes with typically 3.3-267.7 µm in diameter. The DNAsomes showed a vesicle formation approximately 2 µm in diameter, resulting in phenanthrene molecule intercalating with DNAsomes. The phenomenon indicated that the DNA-Thiol/PNIPAAm conjugates may have potential applications in recognition polycyclic aromatic hydrocarbon molecules. The membrane of the DNAsomes could effective response toward small molecules such as Sybr green or phenanthrene, and DNAsomes has release capability of protein (BSA) under reductive agent glutathione (GSH). Our results highlight the potential of integrating aspects of supramolecular and polymer chemistry into the design and construction of DNA-polymeric capsule, guest molecule encapsulation, control delivery of drugs, recognition organic polycyclic aromatic hydrocarbon molecules and gene-directed capsule synthesis.

A facile approach for the reduction of 4­nitrophenol and degradation of congo red using gold nanoparticles or laccase decorated hybrid inorganic nanoparticles/polymer-biomacromolecules vesicles.

Catalytic reduction of toxic 4­nitrophenol to 4­aminophenol and dye wastewater treatment over rapid, convenient gold nanoparticles or laccase decorated hybrid vesicles catalysts has attracted much attention. In current work, a stable building block was designed with inorganic gold nanoparticles and nano-conjugates; and a hybrid giant vesicles (AuNPs@vesicles) was self-assembled by using Pickering emulsion method. The vesicles were characterized by SEM, TEM, UV-vis and DLS measurements. The results showed that a temperature-responsive multifunctional building block based on BSA-PNIPAAm and gold nanoparticles was obtained. DLS results also indicated that the length of chains on the surface of AuNPs could change shorter with increasing of temperature (>32 °C) and also obtain an average diameter to ~190 nm. A substrate-rich (high concentration of 4­nitrophenol) microenvironment can be created around AuNPs, which can dramatically accelerate the interfacial AuNPs-catalyzed reactions. The AuNPs@vesicles as catalyst in the presence of freshly prepared NaBH4 has excellent catalytic performance for reduction of 4­nitrophenol (almost 100%). After laccase was capsulated into AuNPs@vesicles, the obtained active hybrid laccase⊂AuNPs@vesicles demonstrated high catalytic decolouration efficiency (>98.5%, nearly 2.3 times higher than that of free laccase) and excellent reusability. The possible mechanisms of reduction of 4­nitrophenol and dye decolouration was proposed. These novel giant vesicles could provide some new opportunities in wastewater treatment, bottom-up synthetic biology, bioinspired microstorage/microreactor and drug/gene delivery.

Multifunctional and Programmable Modulated Interface Reactions on Proteinosomes.

A multiresponsive microcapsule has been synthesized by incorporating photoswitchable spiropyran units and the thermoresponsive monomer N-isopropylacrylamide into membrane lumens. By using functionalized light or thermoresponsive groups, this multifunctional microcapsule can modulate programmed release and interface reactions between lipase and fluorescein diacetate, alkaline phosphatase and fluorescein diphosphate, and others. Exposing this multifunctional microcapsule in a programmed controlled way allowed us to develop schematics to understand complicated interface interactions on protocells.

Gold modified polydopamine coated mesoporous silica nano-structures for synergetic chemo-photothermal effect.

Near infrared (NIR) responsive agents have attracted a great attention in nanomedicine due to their efficient photothermal effect (PTE) and eco-friendly nature. In our study, a novel kind of nanostructure were developed based on mesoporous silica nanoparticles (MSN) loaded doxorubicin(DOX) core and polydopamine-gold nanoparticles shell (PDA-AuNPs), the system was designed for combined chemo and photothermal therapy into one system. The designed nanostructure were thoroughly characterized to confirm their structure and to ensure their efficiency as cargo delivery system (DDS). The pH controlled release behavior of DOX from the designed nanostructures was investigated, approximately 60% of DOX was released over 48 h. Under NIR irradiation, the nanoparticles exhibited good photothermal stability and a high photothermal conversion efficiency of approximately 49%. Importantly, the MSN@DOX-PDA-AuNPs nanostructures showed a synergetic photo and chemotherapeutic effect, with the enhanced DOX release by 19% over 15 h and 15.42% over 250 min with 4 cycles of NIR laser irradiation. The combined chemo-photothermal in an acidic environment and under NIR irradiation was successfully proved.

Synthesis and evaluation of water soluble pH sensitive poly (vinyl alcohol)-doxorubicin conjugates.

The accuracy of spatiotemporal control cargo delivery and release are primordial to enhance the therapeutic efficiency and decrease the undesirable effects, in this context a novel prodrug were developed based on biocompatible polyvinyl alcohol (PVA) substrate. PVA was conjugated to doxorubicin (PVA-DOX) via an acid-labile hydrazone linkage. PVA was first functionalized with acidic groups, then reacted with hydrazine hydrate to form an amide bond. The amine group of PVA hydrazide was linked to carbonyl group (C = O) of DOX to form a pH sensitive hydrazone bond. The molecular structure of the PVA-DOX was confirmed by FTIR, XPS, and 1H-NMR analysis methods. The degree of grafting were evaluated by TGA and confirmed by XPS, which reveals the successful bond attachment of DOX to PVA. Our findings confirm pH dependent DOX release from PVA-DOX prodrug with faster release rate in acidic environment (pH 5.0, pH 6.0) and slower release rate in neutral pH environment (pH 7.4). Compared to the primary DOX, our synthesized PVA-DOX conjugates could exhibit a promising therapeutic effect, high biocompatibility and zero premature release. The results prove the successful synthesis of PVA-DOX conjugates with high efficiency.

Interictal electrocardiographic and echocardiographic changes in patients with generalized tonic-clonic seizures.

Partial and generalized seizures often affect autonomic functions during seizures, and interictal and postictal periods. We investigated possible interictal electrocardiographic abnormalities in patients with generalized tonic-clonic seizures (GTCS), together with evaluating any structural heart changes by echocardiography in these patients in comparison with healthy controls. We studied 120 definite GTCS patients (76 males and 44 females) who are neither diabetic nor under any medical treatment, and 60 healthy controls with a mean age of 25.2 ± 9.3 and 27.3 ± 7.5 years; respectively. Resting systolic and diastolic arterial blood pressures were measured, and standard 12-lead electrocardiograms and a 2-dimensional echocardiographic examination were performed. In univariate analysis, GTCS patients (compared to controls) had significantly lower means of PR interval (147.2 ± 18.6 versus 153.8 ± 22.6 msec; P = 0.037), QT interval (362.8 ± 22.9 versus 379.9 ± 29.3 msec; P < 0.001), and QTc interval (425.5 ± 20.7 versus 441.6 ± 19.9 msec; P < 0.001) but significantly higher mean left atrial diameter (3.49 ± 0.64 versus 3.09 ± 0.45 cm; P < 0.001). After adjusting for age, gender, and body mass index in a multivariate adjusted logistic regression model, left atrial diameter (OR = 3.941 [1.739 - 8.932]) and QTc (OR = 0.924 [0.895 - 0.954]) were significantly and independently associated with GTCS. In conclusion, patients with epilepsy may be predisposed to disturbances of autonomic functions with subsequent cardiac arrhythmias due to the effects of recurrent seizures on cardiac microstructure. Further work is needed to stratify the risk of sudden unexplained cardiac death (SUDEP) on the basis of interictal autonomic parameters to improve prognosis.

Preparation of Some Eco-friendly Corrosion Inhibitors Having Antibacterial Activity from Sea Food Waste.

Chitosan is one of the important biopolymers and it is extracted from exoskeletons of crustaceans in sea food waste. It is a suitable eco-friendly carbon steel corrosion inhibitor in acid media; the deacetylation degree of prepared chitosan is more than 85.16 %, and the molecular weight average is 109 kDa. Chitosan was modified to 2-N,N-diethylbenzene ammonium chloride N-oxoethyl chitosan (compound I), and 12-ammonium chloride N-oxododecan chitosan (compound II) as soluble water derivatives. The corrosion inhibition efficiency for carbon steel of compound (I) in 1 M HCl at varying temperature is higher than for chitosan and compound (II). However, the antibacterial activity of chitosan for Enterococcus faecalis, Escherichia coli, Staphylococcus aureus, and Candida albicans is higher than for its derivatives, and the minimum inhibition concentration and minimum bacterial concentration of chitosan and its derivatives were carried out with the same strain.

Clinical and biochemical aspirin resistance in patients with recurrent cerebral ischemia.

BACKGROUND AND AIM: Stroke recurrence is an important public health concern. One half of survivors remain disabled, and one seventh requires institutional care. Aspirin remains the cornerstone of primary and secondary stroke prevention; meanwhile, aspirin resistance is one of the possible causes of stroke recurrence. We aimed to evaluate the clinical and biochemical aspirin resistance in patients with recurrent ischemic stroke. PATIENTS AND METHODS: We studied demographic characteristics, vascular risk factors, stroke subtypes, radiologic findings and biochemical aspirin resistance tests using both arachidonic acid (AA) and adenosine diphosphate (ADP)-induced light transmittance aggregometry (LTA) on admission and 24 h after observed aspirin ingestion. RESULTS: Of the 82 patients with recurrent cerebral ischemia included in this study, 37 (45%) patients were poor compliant with aspirin. There were no statistically significant differences between the two groups regarding the demographic characteristics, stroke severity, laboratory tests, radiological findings or vascular risk factors. On admission, 19.6% and 4.8% of patients showed aspirin resistance, while 24 h after supervised 300 mg single aspirin dose ingestion, it was 9.8% and 2.4% using ADP and AA-induced LTA respectively. Of the eight aspirin resistant patients, two only showed resistance using both AA and ADP. Aspirin resistance was statistically significantly higher in the male gender, older age, hyperlipidemia, smokers and in all lacunar strokes using AA. CONCLUSION: Biochemical aspirin resistance in one's series was rather rare (2.4%) and was more prevalent in patients with lacunar strokes. Clinical aspirin failure may often be contributed to poor compliance with aspirin intake.

Can we put a simplified algorithm for reconstruction of large scalp defects following tumor resection?

BACKGROUND: Reconstruction of large scalp defects after tumor resection is a challenging problem. We aimed at putting an algorithm for reconstruction of those defects. METHODS: Forty-two patients with scalp malignancies were enrolled in this study. Tumors were resected to a 1 cm negative margin and defects were reconstructed according to their size and to patient general condition. RESULTS: No peri-operative mortality was encountered. Usage of free flaps was superior in cosmoses and function with an acceptable rate of complications. CONCLUSION: for scalp defects wider than 100 cm2, the best tool of reconstruction is free flaps. Pedicled distant flaps are reserved if free flaps are not feasible or failed. Split thickness skin grafts are cosmetically inferior and not suitable for recurrent and irradiated tumours and better reserved for patients who cannot tolerate major operations.

Single level cervical arthroplasty with the Discocerv prosthesis: a preliminary report.

The authors conducted a prospective nonrandomised study about a new cervical disc prosthesis: the Discocerv Cervidisc Evolution. Fourteen patients (10 men and 4 women) were treated at a single mobile level, between July 2006 and November 2008. Their mean age was 40.8 years (range 31-56), and the mean clinical follow-up period was 12.8 months (range 9-18). Diagnosis was disc herniation (n = 12) and stenosis (n = 2). The VAS for neck pain, the VAS for radiating pain and the Neck Disability Index decreased significantly at last followup (p <0.05). According to Odom's criteria 81.6% of the patients had a good or excellent outcome. The range of movement of the cervical spine as a whole and of the treated functional segmental unit were preserved at final follow-up, which suggests that the disc prosthesis might prevent osteoarthritis at adjacent levels. The neutral sagittal alignment of the cervical spine as a whole and of the functional spinal unit showed kyphosis shortly after surgery, but lordosis was practically restored at final follow-up.

Neurophysiologic changes in live related kidney transplant children and adolescents.

Uremic neuropathy is one of the most debilitating symptoms associated with end stage renal disease. In adults the only potential cure for uremic neuropathy is renal transplantation. No studies have investigated the neurophysiologic abnormalities among pediatric renal transplant recipients. The objective of this study is to describe the incidence, nature and factors affecting neurophysiologic abnormalities in young renal transplant recipients. Neurophysiologic study was performed for 31 of our live related pediatric renal transplant recipients; they were 21 males and 10 females. The mean age at transplantation was 13.2 +/- 3.1 yr. The neurophysiologic studies were performed at different time points after transplantation (range 12-60 months), with a mean period of follow-up after transplantation 3.2 +/- 1.1 yr. Electromyography of the following muscles was tested: abductor pollicis brevis of the thenar eminence, biceps brachii, extensor digitorum brevis and rectus femoris. The median and lateral popliteal nerves were tested for estimating the motor conduction velocity. Neuropathic changes were found in 19% of our cases with more affection of the distal muscles of lower limbs. Motor conduction velocities were reduced, distal latencies were lengthened, and motor unit action potentials were reduced or dispersed. The predictors for development of neuropathy by multivariate analysis were the cumulative steroid dose and graft dysfunction. These results suggest that neuropathy is prevalent among young pediatric renal transplants. The independent predictors for development of neuropathy are graft dysfunction and anemia. It is unclear how significant these findings are in view of absent clinical signs and symptoms. This may represent an early stage of a disease that is still silent.