Simple bone cysts of the proximal humerus presented with limb length discrepancy: A case report.

BACKGROUND: Simple bone cysts (SBC) are benign tumor-like bone lesions typically identified in children. While SBC may lead to growth disturbances or growth arrest, such cases are uncommon. The mechanisms behind these observations remain unclear. Additionally, research on the etiology of SBC remains inconclusive, and there has been no consensus on the appropriate timing and methodology for treatment. CASE SUMMARY: Here, we present our experience in the successful surgical management of a 10-year-old girl with SBC, who presented with a pathological fracture complicated by malunion of the displaced fracture, varus deformity, and limb length discrepancy. We hypothesized two possible etiologies for the patient's growth arrest and subsequent humerus varus deformity: (1) Direct disruption of the physis by fluid from the cyst itself; and (2) damage to the epiphysis due to repetitive pathological fractures associated with SBC. In addressing this case, surgical intervention was undertaken to correct the proximal humerus varus deformity. This approach offered the advantages of simultaneously correcting angular abnormalities, achieving mild limb lengthening, providing definitive SBC treatment, and reducing the overall treatment duration. CONCLUSION: As per current literature, acute correction of acute angular deformity in proximal humeral SBC is not well comprehended. However, in this specific case, acute correction was considered an optimal solution.

Biobased polyester versus synthetic fiberglass casts for treating stable upper limb fractures in children: a randomized controlled trial.

BACKGROUND: Stable upper limb fractures, such as radius, ulna, or distal humerus fractures, are common pediatric orthopedic traumas that are traditionally managed with cast immobilization. The commonly used synthetic fiberglass cast is light and water resistant but may promote skin itchiness during casting, which is a common complaint of patients. In addition, these diisocyanate-based casts have been proven to be toxic and may cause asthma. Herein, we introduce a novel biobased polyester cast to compare its clinical outcomes and patient satisfaction with conventional synthetic fiberglass casts. METHODS: From Feb 2022 to Nov 2022, we undertook a single-center prospective randomized trial involving 100 children with cast-immobilized stable upper limb fractures. These patients were randomized into either biobased polyester or synthetic fiberglass groups. All patients were regularly followed up till the cast removal which occurred approximately 3-4 weeks after immobilizing. Objective clinical findings and subjective patient questionnaire were all collected and analyzed. RESULTS: According to the radiographs taken on the day of cast removal, there was no loss of reduction in both groups. The incidence of skin problems was 3.4 times higher in the synthetic fiberglass group than in the biobased polyester group. For the subjective questionnaire, the biobased polyester cast was preferred in every sub-item. CONCLUSIONS: Our study strongly suggested that the novel biobased polyester cast provides matching stability to conventional fiberglass casts and improves patient satisfaction in an eco-friendlier and safer way. TRIAL REGISTRATION: ClinicalTrials.gov Protocol Registration and Results System ( https://www. CLINICALTRIALS: gov/ ; ID: NCT06102603; Date: 26/10/2023).

Polymer Packaging through the Blending of Biowaste Oyster Shell and Low-Density Polyethylene: A Sustainable Approach for Enhanced Food Preservation.

This research delves into the impact of incorporating thermally treated oyster shell powder (TOS), a biowaste filler, into low-density polyethylene (LDPE) to develop a LDPE/TOS blend, aiming at enhancing food packaging materials. The LDPE/TOS blend portrays advantageous characteristics such as augmented mechanical strength, thermostability, crystallinity, water absorption, and improved hydrophobicity with TOS content up to 50%. Microstructure analysis reveals a transition from a sparse to a more interconnected structure, contributing to the amplified tensile strength. The blend demonstrates increased barrier properties against water vapor transmission, which is attributed to elongated diffusion paths induced by the TOS particles. Application of the blend material in vegetable preservation trials manifested a substantial reduction in water loss compared to pure LDPE or no packaging. This biowaste-based blend film extends the shelf-life of chicken significantly when compared to that of pure LDPE. Importantly, the LDPE/TOS blend exhibits excellent antibacterial properties against both Escherichia coli and Staphylococcus aureus.

Red Disperse Azo Dye Side Chains Influence on Polyethylene Terephthalate Dyeing Performances in Supercritical Carbon Dioxide Media.

Supercritical carbon dioxide dyeing (SDD) as a dyeing media not only provides a friendly dyeing environment but also significantly increases polymeric dyeing performances ascribed to strong azo dye affinity. Disperse azo dyes have shown to be highly efficient dyeing agents due to their facile coupling synthesis, side chains position, and length tunability to optimize absorption properties. Herein, we first synthesize two series of disperse red azo dyes via a coupling chemical route. Further, we investigate the position of the electron withdrawing group and alkyl chains length impact onto the absorption and color fastness properties. Upon synthesis, 1H NMR and mass spectroscopy were used to characterize our newly synthesized series dye structure. Also, according to spectroscopic characterization, the functional group positions as well as the alkyl chains length have a major impact on the dye series maximum light absorption wavelength and performance. We have performed SDD dyeing of polyethylene terephthalate woven and determined each dye color fastness, we find that a reduced electron withdrawing effect and alkyl chains increase reduce color-fastness performances. Overall, our dyes exhibited a good resistance against detergent water, perspiration, abrasion, and friction.

Synthesis of Azo Disperse Dyes with High Absorption for Efficient Polyethylene Terephthalate Dyeing Performances in Supercritical Carbon Dioxide.

Supercritical carbon dioxide dyeing (SCDD) not only enables strong dyeing performance for a versatile range of polymer material but is also regarded as a green chemical media due to its low environmental impact as well as low risk of product denaturation. Over the decades, azo disperse dyes have been revealed to be efficient dyes and represent the wide majority of dyeing material. Azo dyes possess a wide variety of functional groups to optimize dye synthesis and tune the light absorption properties. Using SCDD, end-chain of different lengths, and functional group exhibiting various electronic affinity, six disperse red azo dyes were synthesized to investigate dyeing performances as woven fabric type, color strain, and color fastness after dyeing are discussed. Dye structure synthesized through a coupling reaction was confirmed by 1H NMR and mass spectroscopy. We found that the light absorption wavelength and absorption coefficient value variation are associated to the nature of the functional group. From the color strength values of the polyethylene terephthalate woven after dyeing, we find that the fiber host and dye dopant chemical structure greatly influence the dyeing process by providing enhanced woven, color strain, and color fastness. In comparison with commercial products, our approach not only improves the dyeing process but also guarantees a strong resistance of the dyed product against water, detergent, perspiration, abrasion, and friction.

Radiographic outcomes of the treatment of complex femoral shaft fractures (AO/OTA 32-C) with intramedullary nailing: a retrospective analysis of different techniques.

OBJECTIVES: To assess the results of open versus closed reduction in intramedullary nailing (IMN) for complex femoral fractures (Arbeitsgemeinschaft für Osteosynthesefragen Foundation/Orthopaedic Trauma Association [AO/OTA]: 32-C) and to determine the factors involved in bone healing. METHODS: This retrospective study involved 47 consecutive patients with complex femoral diaphyseal fractures who underwent reduction and fixation. RESULTS: All open-reduction and 12 closed-reduction patients (52.17%) had an anatomical-to-small gap. The closed-small group had the highest bone union rate (100%), followed by the open-reduction (79.17%) and closed-large groups (72.73%); intergroup differences were significant. The closed-small group had the shortest mean union time (7.31 months), followed by the open-reduction group (7.58 months). The closed-large group had a significantly longer union time (9.75 months) than those in the closed-small and open-reduction groups. Femoral radiographic union scores in the closed-small and open-reduction groups were similar at three timepoints; scores were higher than those in the closed-large group, with a significant difference 6 and 9 months post-operatively. CONCLUSION: IMN with closed reduction for complex femoral shaft fractures had better outcomes and fewer complications versus open reduction. For unsatisfactory closed reduction outcomes (i.e., residual gap >10 mm), minimally invasive techniques or open reduction with minimal stripping should be considered.

Calcaneal lengthening using ipsilateral fibula autograft in the treatment of symptomatic pes valgus in adolescents.

BACKGROUND: Evans calcaneal lengthening osteotomy is used to treat symptomatic flexible flatfoot when conservative treatment fails. Grafts such as autologous iliac bone grafts, allografts, and xenografts are implanted at the osteotomy site to lengthen the lateral column of the hindfoot. This study aimed to present the outcomes of an autologous mid-fibula bone graft used for calcaneal lengthening in symptomatic pes valgus in adolescents. METHODS: We retrospectively examined 23 ft of 13 adolescents who underwent surgery between July 2014 and January 2018. The radiological and clinical outcomes (American Orthopaedic Foot and Ankle Society ankle-hindfoot scale scores) were assessed during a mean follow-up of 49.7 (range, 30.9-73.4) months. The mean distance of the lengthening site was measured to evaluate graft sinking or collapse. The Goldberg scoring system was used to determine the degree of union at the donor and recipient sites. RESULTS: The calcaneal pitch and the anteroposterior and lateral talo-first metatarsal (Meary) angles showed significant correction, from 14.4 to 19.6 (p < 0.001), and from 14.5 to 4.6 (p < 0.001) and 13.5 to 8.5 (p < 0.001), respectively. The mean distance of the lengthening site showed no significant change (p = 0.203), suggesting no graft sinking or postoperative collapse. The lateral distal tibial angle showed no significant difference (p = 0.398), suggesting no postoperative ankle valgus changes. Healing of the recipient and donor sites occurred in 23 and 21 ft, respectively. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scores improved significantly, from 68.0 to 98.5 (p < 0.001). CONCLUSIONS: Evans calcaneal lengthening using an ipsilateral mid-fibula bone autograft resulted in significant improvement in clinical and radiological outcomes without ankle valgus deformity. Hence, it could be a treatment option for lateral column calcaneal lengthening in adolescents.

Unilateral biportal endoscopic decompression for degenerative lumbar canal stenosis.

BACKGROUND: Unilateral biportal endoscopic (UBE) decompression is a minimally invasive (MI) approach to treat degenerative lumbar canal stenosis (DLCS). Decompression can be performed in a clear and magnified surgical field with proper control of normal saline inflow and outflow. METHODS: Clinical and radiographic data of 81 consecutive patients of DLCS treated between July 2018 and Feb 2019 using UBE techniques were reviewed. They were 38 males and 43 females with an average age of 70.2. Sixty-nine had pure canal stenosis and 12 patients had associated spondylolisthesis. Bilateral decompression via unilateral laminotomy was performed from the side on patients with more severe neurological symptoms. This is a retrospective study from chart review and image analysis. Therefore, we don't have formal ethical information for this study, and it is not mandatory in our hospital. RESULTS: At the final follow-up, the mean VAS for low back pain was improved from 4.3±3.0 to 1.2±1.0 and the VAS for leg symptoms was improved from 7.3±2.2 to 0.9±0.7. The mean JOA score and ODI was significantly improved from 13.3±7.9 to 25.3±5.0 and from 54.6±16.9 to 14.6±12.6, respectively. Modified Macnab criteria were excellent in 47 patients (58.0%), good in 29 (35.8%), fair in 5 (6.2%). The average hospital stay was 3.6±2.4 days. MRI before and after the operation showed the cross-sectional dural area (CSDA) was significantly increased from 71.4±36.5 to 177.3±59.2 mm2, corresponding to a 201.9%±188.0% increase. The percentage of facet joint preservation was 84.2% on the approach side and 92.9% on the contralateral side. Complications included 4 dural tears, 1 transient motor weakness, 1 inadequate decompression, and 1 epidural hematoma. CONCLUSIONS: With UBE techniques, decompression for DLCS can be performed safely and effectively. The soft tissue and facet joint destruction are minimized; therefore, it is possible to avoid spinal fusion as well as to preserve the segmental stability.

Characterization of network bonding created by intercalated functionalized graphene and polyvinyl alcohol in nanocomposite films for reinforced mechanical properties and barrier performance.

Graphene that consists of less than 10 layers is expensive; moreover, it tends to agglomerate. These disadvantages restrict its utility. In this regard, the present study aimed to reduce the number of layers of a functionalized graphene (FG) with 10-30 layers to less than 10 layers by using an ultrasonic processor. We prepared nanocomposite films of polyvinyl alcohol (PVA) incorporated with FG by a simple hydrothermal method and ultrasonic dispersion. Oxygen transmission rate and water vapor permeability were considerably increased on account of modifying PVA with FG. Furthermore, the mechanical properties, thermostability, and barrier properties were improved. The barrier efficiency of the nanocomposites at different temperatures remained high for long periods of operation because of the network bonding. A simple procedure involving relatively low-cost nanomaterials could unlock the potential of nanocomposite FG/PVA films in the fields of coating, packaging, and semiconductor materials.

Adult Idiopathic Bilateral Coxa Vara with Hip Osteoarthritis Treated with Bilateral Proximal Femur Osteotomy: A Case Report.

CASE: We reported a case of a 25-year-old woman with idiopathic bilateral coxa vara who had initial presentation of hip osteoarthritis. She was later treated with bilateral subtrochanteric valgus osteotomy. A good functional outcome was recorded without nonunion or deformity recurrence. The arthritis of the hips also decelerated. CONCLUSIONS: Coxa vara first diagnosed in adulthood was relatively uncommon, and the cause in this present case was uncertain. Subtrochanteric valgus osteotomy seemed to be a suitable treatment for this case.

Neglected Pediatric Osteochondral Fracture Dislocation of the Patella.

Pediatric osteochondral fracture dislocation of the patella is sometimes difficult to diagnose on the basis of physical examination or plain film radiography. Magnetic resonance imaging plays an important role in its early diagnosis, and early treatment can prevent damage to the articular cartilage as well as decrease the dislocation rate. Currently, many treatment choices have been reported with good results, but there is no consensus on which treatment option may lead to the best outcome. Herein, we describe the case of a 14-year-old girl with neglected osteochondral fracture dislocation of the patella. The outcome was optimal on the basis of a 2-year postoperative follow-up; thus, we believe that fixation with headless screws is a simple and effective method if the fracture fragment is large enough.

Pneumocephalus with Conscious Disturbance After Full Endoscopic Lumbar Diskectomy.

BACKGROUND: Pneumocephalus is a rare complication after an elective lumbar spine surgery. Full endoscopic lumbar diskectomy (FELD) is an evolving minimally invasive surgical procedure gaining its popularity in the past decade. Although seizure was recognized as a possible complication, organic injury to the central nervous system such as pneumocephalus has not yet been reported after FELD. CASE DESCRIPTION: A 63-year-old man with L3-4 intervertebral disk herniation received FELD via the transforaminal approach under general anesthesia. A small dural tear about 2 mm was encountered. After the operation, the patient was unable to recover from anesthesia and failed to be extubated due to tachypnea and generalized tonic-clonic seizures. Emergent brain computed tomography (CT) revealed pneumocephalus in the subdural and subarachnoid space. Pure oxygen was given, and hyperbaric oxygen therapy (HBO2) was arranged immediately. Fortunately, he started to regain his consciousness 8 hours after the operation and had full recovery of consciousness on the next day. Follow-up brain CT showed nearly complete resolution of the pneumocephalus. He had no neurologic deficits at final follow-up. CONCLUSIONS: This case report highlights the risk of pneumocephalus with conscious disturbance when a dural tear occurs during FELD under general anesthesia. FELD is safer when performed under local anesthesia because the patient is awake to report his discomfort and thus possible to prevent serious neurologic sequels. An emergent brain CT is critical to obtain a prompt diagnosis and HBO2 is probably helpful for resolving the mass effect caused by the pneumocephalus.

Biocompatibility and characterization of polylactic acid/styrene-ethylene-butylene-styrene composites.

Polylactic acid (PLA)/styrene-ethylene-butylene-styrene (SEBS) composites were prepared by melt blending. Differential scanning calorimetry (DSC) and wide angle X-ray diffraction (WXRD) were used to characterize PLA and PLA/SEBS composites in terms of their melting behavior and crystallization. Curves from thermal gravimetric analysis (TGA) illustrated that thermostability increased with SEBS content. Further morphological analysis of PLA/SEBS composites revealed that SEBS molecules were not miscible with PLA molecules in PLA/SEBS composites. The tensile testing for PLA and PLA/SEBS composites showed that the elongation at the break was enhanced, but tensile strength decreased with increasing SEBS content. L929 fibroblast cells were chosen to assess the cytocompatibility; the cell growth of PLA was found to decrease with increasing SEBS content. This study proposes possible reasons for these properties of PLA/SEBS composites.

Bioabsorbable fish scale for the internal fixation of fracture: a preliminary study.

Fish scales, which consist of type I collagen and hydroxyapatite (HA), were used to fabricate a bioabsorbable bone pin in this study. Fresh fish scales were decellularized and characterized to provide higher biocompatibility. The mechanical properties of fish scales were tested, and the microstructure of an acellular fish scale was examined. The growth curve of a myoblastic cell line (C2C12), which was cultured on the acellular fish scales, implied biocompatibility in vitro, and the morphology of the cells cultured on the scales was observed using scanning electron microscopy (SEM). A bone pin made of decellularized fish scales was used for the internal fixation of femur fractures in New Zealand rabbits. Periodic X-ray evaluations were obtained, and histologic examinations were performed postoperatively. The present results show good cell growth on decellularized fish scales, implying great biocompatibility in vitro. Using SEM, the cell morphology revealed great adhesion on a native, layered collagen structure. The Young's modulus was 332 ± 50.4 MPa and the tensile strength was 34.4 ± 6.9 MPa for the decellularized fish scales. Animal studies revealed that a fish-scale-derived bone pin improved the healing of bone fractures and degraded with time. After an 8-week implantation, the bone pin integrated with the adjacent tissue, and new extracellular matrix was synthesized around the implant. Our results proved that fish-scale-derived bone pins are a promising implant material for bone healing and clinical applications.

Preparation and Characterization of Bioplastic-Based Green Renewable Composites from Tapioca with Acetyl Tributyl Citrate as a Plasticizer.

Granular tapioca was thermally blended with poly(lactic acid) (PLA). All blends were prepared using a plasti-corder and characterized for tensile properties, thermal properties and morphology. Scanning electron micrographs showed that phase separation occurred, leading to poor tensile properties. Therefore, methylenediphenyl diisocyanate (MDI) was used as an interfacial compatibilizer to improve the mechanical properties of PLA/tapioca blends. The addition of MDI could improve the tensile strength of the blend with 60 wt% tapioca, from 19.8 to 42.6 MPa. In addition, because PLA lacked toughness, acetyl tributyl citrate (ATBC) was added as a plasticizer to improve the ductility of PLA. A significant decrease in the melting point and glass-transition temperature was observed on the basis of differential scanning calorimetry, which indicated that the PLA structure was not dense after ATBC was added. As such, the brittleness was improved, and the elongation at break was extended to several hundred percent. Therefore, mixing ATBC with PLA/tapioca/MDI blends did exhibit the effect of plasticization and biodegradation. The results also revealed that excessive plasticizer would cause the migration of ATBC and decrease the tensile properties.

A new fish scale-derived scaffold for corneal regeneration.

The purpose of this study is to develop a novel scaffold, derived from fish scales, as an alternative functional material with sufficient mechanical strength for corneal regenerative applications. Fish scales, which are usually considered as marine wastes, were acellularized, decalcified and fabricated into collagen scaffolds. The microstructure of the acellularized scaffold was imaged by scanning electron microscopy (SEM). The acellularization and decalcification treatments did not affect the naturally 3-dimentional, highly centrally-oriented micropatterned structure of the material. To assess the cytocompatibility of the scaffold with corneal cells, rabbit corneal cells were cultured on the scaffold and examined under SEM and confocal microscopy at different time periods. Rapid cell proliferation and migration on the scaffold were observed under SEM and confocal microscopy. The highly centrally-oriented micropatterned structure of the scaffold was beneficial for efficient nutrient and oxygen supply to the cells cultured in the three-dimensional matrices, and therefore it is useful for high-density cell seeding and spreading. Collectively, we demonstrate the superior cellular conductivity of the newly developed material. We provide evidences for the feasibility of the scaffold as a template for corneal cells growth and migration, and thus the fish scale-derived scaffold can be developed as a promising material for tissue-engineering of cornea.

Morphology and characterization of 3D micro-porous structured chitosan scaffolds for tissue engineering.

This research studies the morphology and characterization of three-dimensional (3D) micro-porous structures produced from biodegradable chitosan for use as scaffolds for cells culture. The chitosan 3D micro-porous structures were produced by a simple liquid hardening method, which includes the processes of foaming by mechanical stirring without any chemical foaming agent added, and hardening by NaOH cross linking. The pore size and porosity were controlled with mechanical stirring strength. This study includes the morphology of chitosan scaffolds, the characterization of mechanical properties, water absorption properties and in vitro enzymatic degradation of the 3D micro-porous structures. The results show that chitosan 3D micro-porous structures were successfully produced. Better formation samples were obtained when chitosan concentration is at 1-3%, and concentration of NaOH is at 5%. Faster stirring rate would produce samples of smaller pore diameter, but when rotation speed reaches 4000 rpm and higher the changes in pore size is minimal. Water absorption would reduce along with the decrease of chitosan scaffolds' pore diameter. From stress-strain analysis, chitosan scaffolds' mechanical properties are improved when it has smaller pore diameter. From in vitro enzymatic degradation results, it shows that the disintegration rate of chitosan scaffolds would increase along with the processing time increase, but approaching equilibrium when the disintegration rate reaches about 20%.

Release properties on gelatin-gum arabic microcapsules containing camphor oil with added polystyrene.

In this study, gelatin blended with arabic gum microcapsules containing camphor oil with added polystyrene were fabricated by a compound coacervation method. The parameters of oil/wall volume ratio, emulsification stirring speed, concentration of cross-linking agent, treated time and oil release properties were investigated. In order to improve the constant release effect of camphor oil, oil-soluble polystyrene (PS) was used as a sustained release agent. The camphor oil release curves were expressed by the exponential equation: psi(t)=C(eq)(1-e(-t/tau)), where psi(t) represent the variant of camphor oil concentration in the operation environment, C(eq) as the equilibrium state, t as the release time and tau as time constant. C(eq) and tau are significant factors pertaining to the camphor oil release properties. The results indicated that, for the microcapsules, the optimal oil/wall volume ratio was 0.75 to achieve the encapsulation efficiency of 99.6 wt.%. The average particle size were 294.7+/-14.2 microm, 167.2+/-11.2 microm, 85.7+/-8.7 microm at the homogenization stirring speed of 500, 1000, and 2000 rpm, respectively. The effect of sustained oil release will increase whereas the stirring speed decreases and the concentration of glutaraldehyde (GA) and treated time increases. Along with the increasing of quantity of polystyrene added, C(eq) decreased and tau increased, indicating that the sustained oil release amount and the release rate depend on the quantity of PS considerably.