Is it possible to achieve multiplanar correction of complex deformities around the knee in children and adolescents using a monolateral external fixator?

PURPOSE: To present the technique of correction of multiplanar deformities around the knee in children and adolescents using the monolateral external fixator. Also, to evaluate the results of the technique regarding radiological correction, time to union, and possible complications. METHODS: A total of 29 patients (47 limbs) were prospectively included in the study (14 males and 15 females). Their median age was 13 years (range, 7-17). All patients had at least a 2-plane deformity around the knee which was corrected using a monolateral external fixator. The primary outcome measure was deformity correction (correction of mechanical axis deviation (MAD) in both the coronal and sagittal planes with correction of rotational deformities). The secondary outcome measures included bony union, radiographic, and functional results (assessed by using the Association for the Study and Application of the Method of Ilizarov (ASAMI) score). RESULTS: The median pre-operative MAD improved from 6.3 to 0.4 cm post-operatively. According to the ASAMI scoring system, the radiographic scoring was excellent in all cases (100%), and the functional scoring was excellent in 22 cases (89.7%) and good in three cases (10.3%). CONCLUSION: The simple monolateral fixator can be an effective tool for multiplanar correction of complex deformities around the knee without limb length discrepancy.

Detection of Corona Faults in Switchgear by Using 1D-CNN, LSTM, and 1D-CNN-LSTM Methods.

The damaging effects of corona faults have made them a major concern in metal-clad switchgear, requiring extreme caution during operation. Corona faults are also the primary cause of flashovers in medium-voltage metal-clad electrical equipment. The root cause of this issue is an electrical breakdown of the air due to electrical stress and poor air quality within the switchgear. Without proper preventative measures, a flashover can occur, resulting in serious harm to workers and equipment. As a result, detecting corona faults in switchgear and preventing electrical stress buildup in switches is critical. Recent years have seen the successful use of Deep Learning (DL) applications for corona and non-corona detection, owing to their autonomous feature learning capability. This paper systematically analyzes three deep learning techniques, namely 1D-CNN, LSTM, and 1D-CNN-LSTM hybrid models, to identify the most effective model for detecting corona faults. The hybrid 1D-CNN-LSTM model is deemed the best due to its high accuracy in both the time and frequency domains. This model analyzes the sound waves generated in switchgear to detect faults. The study examines model performance in both the time and frequency domains. In the time domain analysis (TDA), 1D-CNN achieved success rates of 98%, 98.4%, and 93.9%, while LSTM obtained success rates of 97.3%, 98.4%, and 92.4%. The most suitable model, the 1D-CNN-LSTM, achieved success rates of 99.3%, 98.4%, and 98.4% in differentiating corona and non-corona cases during training, validation, and testing. In the frequency domain analysis (FDA), 1D-CNN achieved success rates of 100%, 95.8%, and 95.8%, while LSTM obtained success rates of 100%, 100%, and 100%. The 1D-CNN-LSTM model achieved a 100%, 100%, and 100% success rate during training, validation, and testing. Hence, the developed algorithms achieved high performance in identifying corona faults in switchgear, particularly the 1D-CNN-LSTM model due to its accuracy in detecting corona faults in both the time and frequency domains.

Complement C5a and Clinical Markers as Predictors of COVID-19 Disease Severity and Mortality in a Multi-Ethnic Population.

Coronavirus disease-2019 (COVID-19) was declared as a pandemic by WHO in March 2020. SARS-CoV-2 causes a wide range of illness from asymptomatic to life-threatening. There is an essential need to identify biomarkers to predict disease severity and mortality during the earlier stages of the disease, aiding treatment and allocation of resources to improve survival. The aim of this study was to identify at the time of SARS-COV-2 infection patients at high risk of developing severe disease associated with low survival using blood parameters, including inflammation and coagulation mediators, vital signs, and pre-existing comorbidities. This cohort included 89 multi-ethnic COVID-19 patients recruited between July 14th and October 20th 2020 in Doha, Qatar. According to clinical severity, patients were grouped into severe (n=33), mild (n=33) and asymptomatic (n=23). Common routine tests such as complete blood count (CBC), glucose, electrolytes, liver and kidney function parameters and markers of inflammation, thrombosis and endothelial dysfunction including complement component split product C5a, Interleukin-6, ferritin and C-reactive protein were measured at the time COVID-19 infection was confirmed. Correlation tests suggest that C5a is a predictive marker of disease severity and mortality, in addition to 40 biological and physiological parameters that were found statistically significant between survivors and non-survivors. Survival analysis showed that high C5a levels, hypoalbuminemia, lymphopenia, elevated procalcitonin, neutrophilic leukocytosis, acute anemia along with increased acute kidney and hepatocellular injury markers were associated with a higher risk of death in COVID-19 patients. Altogether, we created a prognostic classification model, the CAL model (C5a, Albumin, and Lymphocyte count) to predict severity with significant accuracy. Stratification of patients using the CAL model could help in the identification of patients likely to develop severe symptoms in advance so that treatments can be targeted accordingly.

Induction of chromosomal and DNA damage and histological alterations by graphene oxide nanoparticles in Swiss mice.

The unique physicochemical properties of graphene oxide (GO) nanoparticles increase their uses in a wide range of applications that increase their release into the environment, and thus human exposure. However, the in vivo clastogenicity and genotoxicity of GO nanoparticles have not been well investigated. The current study was, therefore, designed to investigate the possible induction of chromosomal and DNA damage by GO nanoparticles and their impact on the tissue architecture in mice. Oral administration of GO nanoparticles for one or five consecutive days at the three dose levels 10, 20 or 40 mg/kg significantly increased the micronuclei and DNA damage levels in a dose-dependent manner in mice bone marrow cells, as well as caused, histological lesions including apoptosis, necrosis, inflammations and cells degeneration in the mice liver and brain tissue sections compared to the normal control mice. Thus, we concluded that oral administration of GO nanoparticles induced chromosomal and DNA damage in a dose-dependent manner as well as histological injuries in both acute and subacute treatments.

Avoiding Anchoring Bias in the Times of the Pandemic!

COVID-19 has a broad spectrum of clinical presentations, including central nervous system manifestations that are not uncommon. The high pretest probability of COVID-19 in pandemic can lead to anchoring. We present a patient of COVID-19 pneumonia who presented with dyspnea and acute confusional state. His initial workup was suggestive of tuberculous meningoencephalitis with lymphocytic pleocytosis, high protein in CSF analysis, and suspicious MRI findings, which was later confirmed with a positive CSF culture. To the best of our knowledge, it is the first such case. Anchoring to the diagnosis of COVID-19 may deter clinicians from considering other concurrent diagnoses and a poor outcome consequently.

Retrograde femoral nails for emergency stabilization in multiply injured patients with haemodynamic instability.

INTRODUCTION: The purpose of this study is to retrospectively evaluate the immediate effect of retrograde intramedullary femoral nail (RIMFN) fixation technique on patient's hemodynamic status as documented by vital signs (blood pressure and pulse) intraoperatively in all patients with femoral shaft fractures with multiple injuries and hemodynamic instability who were treated with RIMFN at our institution on emergency basis as part of damage control orthopaedics. PATIENTS AND METHODS: A retrospective review of intra operative vital signs obtained from patient records was completed at a Level 1 trauma center in a university hospital.In all, 11 multiply injured patients with (14) femur fractures with hemodynamic instability were identified. Of those, 3 had bilateral femur fractures. Closed reduction and retrograde femoral nailing without proximal locking was performed to achieve immediate skeletal and haemodynamic stability. Pulse rate and BP measurements were noted for all patients starting from the time patient would enter the operating room till the patient was shifted back to the recovery ward. RESULTS: The average cohort age was 28 years (20-36 years). The average Injury Severity Score was 28 (16-50). Statistically significant improvement in pulse rate and blood pressure was noted following femoral fracture fixation with intramedullary nail. No cases of infection or symptomatic fat or pulmonary embolism were encountered. One patient required exchange nailing for non-union and one femur underwent later lengthening. CONCLUSIONS: Retrograde Intramedullary femoral nail can be an effective alternative to external fixator as damage control device and is associated with immediate improvement in vital signs (pulse and blood pressure) intra operatively.

Estimation of genomic instability and mutation induction by graphene oxide nanoparticles in mice liver and brain tissues.

The rapidly growing interest in using graphene-based nanoparticles in a wide range of applications increases human exposure and risk. However, very few studies have investigated the genotoxicity and mutagenicity of the widely used graphene oxide (GO) nanoparticles in vivo. Consequently, this study estimated the possible genotoxicity and mutagenicity of GO nanoparticles as well as possible oxidative stress induction in the mice liver and brain tissues. Nano-GO particles administration at the dose levels of 10, 20, or 40 mg/kg for one or five consecutive days significantly increased the DNA breakages in a dose-dependent manner that disrupts the genetic material and causes genomic instability. GO nanoparticles also induced mutations in the p53 (exons 6&7) and presenilin (exon 5) genes as well as increasing the expression of p53 protein. Positive p53 reaction in the liver (hepatic parenchyma) and brain (cerebrum, cerebellum, and hippocampus) sections showed significant increase of p53 immunostaining. Additionally, induction of oxidative stress was proven by the significant dose-dependent increases in the malondialdehyde level and reductions in both the level of reduced glutathione and activity of glutathione peroxidase observed in GO nanoparticles administered groups. Acute and subacute oral administration of GO nanoparticles induced genomic instability and mutagenicity by induction of oxidative stress in the mice liver and brain tissues.