Comparing immobilisation devices in gynaecological external beam radiotherapy: improving inter-fraction reproducibility of pelvic tilt.

INTRODUCTION: The aim was to determine which immobilisation device improved inter-fraction reproducibly of pelvic tilt and required the least pre-treatment setup and planning interventions. METHODS: Sixteen patients were retrospectively reviewed, eight immobilised using the BodyFIX system (BodyFIX®, Elekta, Stockholm, Sweden) and eight using the Butterfly Board (BB) (Bionix Radiation Therapy, Toledo, OH, USA). The daily pre-treatment images were reviewed to assess setup variations between each patient and groups for pelvic tilt, pubic symphysis, sacral promontory and the fifth lumbar spine (L5). RESULTS: Compared with the planning CT, pelvic tilt for most patients was within ±2° using the BodyFIX and ± 4° for the BB. The Butterfly Board had a slightly higher variance both for patient-to-patient (standard deviation of the systematic error) and day-to-day error (standard deviation of the random error). Variance in position between individual patients and the two stabilisation devices were minimal in the anterior-posterior (AP) and superior-inferior (SI) direction for the pubic symphysis, sacral promontory and L5 spine. Re-imaged fractions due to pelvic tilt reduced by about half when BodyFIX was used (39.1% BB, 19.4% BodyFIX). One patient treated with the BB required a re-scan for pelvic tilt. Three patients required a re-scan for body contour variations (two using BodyFIX and one with the BB). CONCLUSIONS: BodyFIX resulted in a more accurate inter-fraction setup and efficient treatment and is used as the standard stabilisation for gynaecological patients at our centre. It reduced the pelvic tilt variance and reduced the need for re-imaging pre-treatment by half.

Rehabilitation guidelines following arthroscopic shoulder stabilisation surgery for traumatic instability - a Delphi consensus.

BACKGROUND: There is no consistent approach to rehabilitation following arthroscopic shoulder stabilisation surgery (ASSS) in the UK. The aim of this study was to agree a set of post-operative guidelines for clinical practice. METHOD: Expert stakeholders (surgeons, physiotherapists and patients) were identified via professional networks and patient involvement and engagements groups. A three-stage online Delphi study was undertaken. Consensus was defined by the OMERACT threshold of 70% agreement. RESULTS: 11 surgeons, 22 physiotherapists and 4 patients participated. It was agreed patients should be routinely immobilised in a sling for up to 3 weeks but can discard earlier if able. During the immobilisation period, patients should move only within a defined "safe zone." Permitted functional activities include using cutlery, lifting a drink, slicing bread, using kitchen utensils, wiping a table, light dusting, pulling up clothing, washing/drying dishes. Closing car doors or draining saucepans should be avoided. Through range movements can commence after 4 weeks, resisted movements at 6 weeks. Patients can resume light work as they feel able and return to manual work after 12 weeks. Return to non-contact sports when functional markers for return to play are met was agreed. Return to contact sport is based on function & confidence after a minimum of 12 weeks. Additional factors to consider when determining rehabilitation progression: functional/physical milestones, patient's confidence and presence of kinesiophobia. The preferred outcome measure is the Oxford Instability Shoulder Score. CONCLUSION: This consensus provides expert recommendations for the development of rehabilitation guidelines following ASSS. CONTRIBUTION OF THE PAPER.

Nutrition policy or price stabilisation policy: which policy is more effective for nutrition outcomes?

BACKGROUND: Malnutrition remains a global problem and is increasing with the emergence of the COVID-19 pandemic. In Madagascar, half of the children under five years of age suffer from stunting. However, since 2006, vitamin A supplementation campaigns, deworming and free vaccinations have been implemented within the framework of the Mother and Child Health Week (MCHW) to strengthen the fight against micronutrient deficiencies and reduce mortality. On the other hand, rice, the staple food of the Malagasy population, can provide some of the micronutrients necessary for good nutrition. However, the country's rice production is still insufficient, and the price has been rising steadily in recent years. This has led the government to resort to the policy of stabilizing rice prices through imported rice in 2017 and 2018. The aim of this paper is therefore to analyse the effects of these policies on the prevalence of malnutrition among children under five years of age in Madagascar. Which policy would be more effective: the nutrition policy or the price stabilisation policy? METHODS: Data from the Multiple Indicator Cluster Survey conducted by the National Institute of Statistics in 2018 are used, and logistic regressions for the analysis of the effects of nutrition policies on nutrition outcomes are performed. For the effect of price stabilisation policy, panel data on 22 regions of Madagascar from 2016 to 2019 are considered, and a fixed effect model is used. RESULTS: We found that the effects of the nutrition policy are not immediately visible. Only participation in the 2016 MCHW contributes to a lower probability of malnutrition occurrence. The odds ratios of the effects of this participation on stunting are 0.69 (p-value: 0.05); on underweight: 0.70 (p-value < 0.01); and on wasting: 0.57 (p-value < 0.01). However, the participation rate remains very low. Then, there is no effect of the rice price stabilization policy on nutrition outcomes (0.00; p-value = 0.11). CONCLUSIONS: Price stabilisation policy is not sufficient to fight against malnutrition, due to a lack of food diversification. These results suggest the need for a policy to ensure nutritional intake and to sensitize the population to participate in the MCHW. TRIAL REGISTRATION: Not applicable.

Unveiling the potential of cellulose, chitosan and polylactic acid as precursors for the production of green carbon nanofibers with controlled morphology and diameter.

Carbon nanofibers (CNFs) are very promising materials with application in many fields, such as sensors, filtration systems, and energy storage devices. This study aims to explore the use of eco-friendly biopolymers for CNF production, finding novel, suitable and sustainable precursors and thus prioritising environmentally conscious processes and ecological compatibility. Polymeric nanofibers (PNFs) using cellulose acetate, polylactic acid, and chitosan as precursors were successfully prepared via electrospinning. Rheological testing was performed to determine suitable solution concentrations for the production of PNFs with controlled diameter and appropriate morphology. Their dimensions and structure were found to be significantly influenced by the solution concentration and electrospinning flow rate. Subsequently, the electrospun green nanofibers were subject to stabilisation and carbonisation to convert them into CNFs. Thermal behaviour and chemical/structural changes of the nanofibers during stabilisation were investigated by means of thermogravimetric analysis and Fourier-transform infrared spectroscopy, while the final morphology of the fibers after stabilisation and carbonisation was examined through scanning electron microscopy to determine the optimal stabilisation parameters. The optimal fabrication parameters for cellulose and chitosan-based CNFs with excellent morphology and thermal stability were successfully established, providing valuable insight and methods for the sustainable and environmentally friendly synthesis of these promising materials.

Together is better - RibScore and SCARF in the prediction of pulmonary complications and association with SSRF.

BACKGROUND: Optimal treatment of patients with rib fractures requires identification of those patients at risk of pulmonary complications. It is also important to determine which patients would benefit from Surgical Stabilisation of Rib Fractures (SSRF). This study aims to validate two scoring systems (RibScore and SCARF score) in predicting complications and association with SSRF in an Australian trauma population. Clinical observation suggests that complications and criteria for SSRF is associated with anatomical and physiological factors. Therefore it is hypothesized that utilisation of an anatomical (RibScore) and physiological (SCARF) in conjunction will have improved predictive ability. METHOD: Retrospective cohort study of rib fracture patients admitted to an Australian Level I trauma centre from Jan 2017 to Jan 2021. RibScore and SCARF score were calculated. Multivariate logistic regression was performed to determine risk factors associated with complications and SSRF, as well the scoring systems' ability via ROC AUC. RESULTS: 1157 patients were included. Higher median RibScore (1vs0; p < 0.001) and SCARF score (3vs1, p < 0.001) was associated with development of complications. Similarly for SSRF, RibScore (3vs0; p < 0.001), SCARF score (3vs1; p < 0.001) were higher. On multivariate analysis, increasing RibScore and SCARF score were associated with an increased risk of respiratory failure, pneumonia, death, and SSRF. The sensitivity for a patient with a high risk score in either RibScore or SCARF increased to 96.3 % in identifying pulmonary complications (from 66.7 % in RibScore and 88 % in SCARF, when used individually) and 91.9 % in identifying association with SSRF (from 86.5 % in RibScore and 70.3 % in SCARF). CONCLUSION: RibScore and SCARF score demonstrate predictive ability for complications and SSRF in an Australian trauma rib fracture population. Combining a radiological score with a clinical scoring system demonstrates improved sensitivity over each score individually for identifying patients at risk of complications from rib fractures, those who may require SSRF, and those who are low risk. STUDY TYPE: Retrospective Cohort Study LEVEL OF EVIDENCE: Level III.

Sustainable utilisation of calcium-rich industrial wastes in soil stabilisation: Potential use of calcium carbide residue.

Calcium carbide residue (CCR), a by-product of the acetylene industry, is generated at a rate of 136 million tonnes per year, posing significant environmental risks. This review examines the potential utilisation of CCR in soil stabilisation, focusing on its stabilisation mechanism, performance in improving mechanical properties, environmental safety, and sustainability. The aim is to identify future research directions for CCR-based stabilisation to promote its broader application, and to provide references for managing similar Ca-rich wastes. CCR-based materials demonstrate promising benefits in enhancing various soil properties, such as uniaxial strength, swelling properties, triaxial shear behaviour, compressibility, and dynamic responses, while also reducing the mobility of contaminants. Compared to conventional stabilisers, CCR-based materials exhibit comparable performance in soil improvement, environmental impact and safety, and economic feasibility. However, further research is required to delve deeper into stabilisation mechanisms, mechanical properties, and stability of contaminants for the soil treated with CCR-based materials under diverse conditions.

Metaizeau Technique for Treatment of Paediatric Isolated Radial Neck Fracture - Clinical and Radiological Outcomes - Case Control Study.

BACKGROUND: Radial neck fractures account for 5-17% of elbow fractures and about 1% of all fractures in children. The subject of the presented research is assesment of clinical and radiological outcomes of the Metaizeau technique for treatment of isolated radial neck fractures in children. MATERIAL AND METHODS: Retrospective analysis of clinical and radiological data of patients treated with the Metaizeau technique in our Department between 2015 and 2020. Twenty children with isolated radial neck fracture met the inclusion criteria. RESULTS: Excellent outcomes of operative treatment were achieved in 95% of children. None of the complications described in the literature (e.g. avascular necrosis of radial head (AVN), malunion, nonunion) were observed in our case series. CONLCUSIONS: 1. The Metaizeau technique for reduction and stabilisation of the radial neck fracture using a TEN is a safe and effective method in the paediatric population and produces good clinical and radiological results. 2.Furthermore, the minimal demands it places on surgical equipment make it possible for this technique to be recommended to orthopaedic surgeons managing paediatric trauma patients.

Rehabilitation following shoulder arthroscopic stabilisation surgery: A survey of UK practice.

Background: Optimal rehabilitation following arthroscopic shoulder stabilisation for traumatic anterior instability is unknown. The purpose of this study was to establish current UK practice for this patient group. Methods: A self-administered online questionnaire was developed and distributed to UK surgeons and physiotherapists. Results: 138 responses were received. Routine immobilisation was reported in 79.7% of responses with a cross-body sling being the preferred position (63.4%). Duration of immobilisation and timescales to initiate movement were highly variable. Return to light work was advised when patients felt able (25.4%) or after 6 weeks (26.1%). 58.7% recommended waiting for 12 weeks to return to manual work. 56% recommended non-contact sport could be resumed after 12 weeks. For contact sport, recommendations varied from 6 weeks (3.8%) to 6 months (5.8%). Psychological readiness was the most frequently cited criteria for return to play (58.6%). Factors such as hyperlaxity (40.6%), age (32.6%) and kinesiophobia (28.3%) were not considered as relevant as reported quality of surgical fixation (50%). Conclusion: There is no clear consensus regarding optimal post-operative rehabilitation following arthroscopic shoulder stabilisation. Further work is required to establish high value, personalised pathways for this patient group.

Evaluating the stability of external fixators following pelvic injury: A systematic review of biomechanical testing methods.

INTRODUCTION: This systematic review aims to identify previously used techniques in biomechanics to assess pelvic instability following pelvic injury, focusing on external fixation constructs. METHODS: A systematic literature search was conducted to include biomechanical studies and to exclude clinical trials. RESULTS: Of an initial 4666 studies found, 38 met the inclusion criteria. 84% of the included studies were retrieved from PubMed, Scopus, and Web of Science. The studies analysed 106 postmortem specimens, 154 synthetic bones, and 103 computational models. Most specimens were male (97% synthetic, 70% postmortem specimens). Both the type of injury and the classification system employed varied across studies. About 82% of the injuries assessed were of type C. Two different fixators were tested for FFPII and type A injury, five for type B injury, and fifteen for type C injury. Large variability was observed for external fixation constructs concerning device type and configuration, pin size, and geometry. Biomechanical studies deployed various methods to assess injury displacement, deformation, stiffness, and motion. Thereby, loading protocols differed and inconsistent definitions of failure were determined. Measurement techniques applied in biomechanical test setups included strain gauges, force transducers, and motion tracking techniques. DISCUSSION AND CONCLUSION: An ideal fixation method should be safe, stable, non-obstructive, and have low complication rates. Although biomechanical testing should ensure that the load applied during testing is representative of a physiological load, a high degree of variability was found in the current literature in both the loading and measurement equipment. The lack of a standardised test design for fixation constructs in pelvic injuries across the studies challenges comparisons between them. When interpreting the results of biomechanical studies, it seems crucial to consider the limitations in cross-study comparability, with implications on their applicability to the clinical setting.

In Vitro Assessment of Wound-Healing Efficacy of Stabilized Basic Fibroblast Growth Factor (FGF-2) Solutions.

Chronic tympanic membrane perforations (TMP) pose a significant clinical challenge, but basic fibroblast growth factor (FGF-2) shows promise for their treatment, despite its instability in aqueous solutions which hampers the sustained delivery crucial for the healing process. Addressing this, our research focused on the development of stabilized FGF-2 formulations, F5 and F6, incorporating dual, generally regarded as safe (GRAS) excipients to enhance stability and therapeutic efficacy. F5 combined FGF-2 (1600 ng/mL) with 0.05% w/v methylcellulose (MC) and 20 mM alanine, while F6 used FGF-2 with 0.05% w/v MC and 1 mg/mL human serum albumin (HSA). Our findings demonstrate that these novel formulations not only significantly improve the cytoproliferation of human dermal fibroblasts but also exhibit the most potent chemoattractant effects, leading to the highest fibroblast monolayer closure rates (92.5% for F5 and 94.1% for F6 within 24 h) compared to other FGF-2 solutions tested. The comparable performance of F5 and F6 underscores their potential as innovative, less invasive, and cost-effective options for developing otic medicinal products aimed at the effective treatment of chronic TMP.

Pyrolysed sewage sludge for metal(loid) removal and immobilisation in contrasting soils: Exploring variety of risk elements across contamination levels.

Efficient treatment of sewage sludge may transform waste into stable materials with minimised hazardous properties ready for secondary use. Pyrolysed sewage sludge, sludgechar, has multiple environmental benefits including contaminant sorption capacity and nutrient recycling. The properties of five sludgechars were tested firstly for adsorption efficiency in laboratory solutions before prospective application to soils. A wide variety of metal(loid)s (As, Cd, Co, Cr, Cu, Ni, Pb, Sb, and Zn) was involved. Secondly, the sludgechars (3 % v/v) were incubated in five soils differing in (multi)-metal(loid) presence and the level of contamination. The main aim was to evaluate the metal(loid) immobilisation potential of the sludgechars for soil remediation. Moreover, nutrient supply was investigated to comprehensively assess the material's benefits for soils. All sludgechars were efficient (up to 100 %) for the removal of metal cations while their efficiency for metal(loid) anions was limited in aqueous solutions. Phosphates and sulphates were identified crucial for metal(loid) capture, based on SEM/EDS, XRD and MINTEQ findings. In soils, important fluctuations were observed for Zn, being partially immobilised by the sludgechars in high-Zntot soils, while partially solubilised in moderate to low-Zntot soils. Moreover, pH showed to be crucial for material stability, metal(loid) adsorption ability and their immobilisation in soils. Although metal(loid) retention was generally low in soils, nutrient enrichment was significant after sludgechar application. Long-term evaluation of the material sorption efficiency, nutrient supply, and ageing in soil environments will be necessary in future studies.

Immobilisation of arsenic in contaminated soil by electrokinetics in an outdoor experiment.

Although landfilling is environmentally and economically unsustainable, it is the dominant soil remediation method in EU member states. This paper describes part of a study on mixed contaminants that investigated the stabilisation of arsenic (As) in contaminated soil in an outdoor box experiment with electrokinetic treatment (EK). The experiment was conducted in two 1 m3 boxes, each containing a 20 cm bottom layer of sand, overlaid with 20 cm of peat. In EK, a pulsating, low-voltage current was applied with the intention of corroding the zerovalent iron (Fe) electrodes, migrating ionic Fe species, and forming secondary iron minerals, thereby immobilizing As. Porewater samples were collected over two seasons to determine whether the treatment decreased the concentration of dissolved As. Sequential extraction was performed on the soil samples to determine whether the fraction of Fe-bound As increased. Reed canary grass was planted in one of the boxes during the second season and analysed for As uptake. The results showed that the treatment decreased the porewater As concentration in sand by 50-54 %, while the concentration of Fe increased. The sequential extraction of sand showed that the fraction of As bound to poorly crystalline Fe oxides increased during this time. This treatment effect was less visible in the peat. Moreover, the exchangeable As fraction increased in both peat and sand, most likely because of the decrease in redox potential at the end of the experiment. The plants grown in treated soil accumulated less As than those grown in untreated soil, indicating that the phytoavailable As fraction decreased. This study showed that EK remediation can be a suitable in situ remediation technique, mostly in sand. Future research should focus on redox control to further optimise EK remediation and ensure long-term As stability in treated soils.

Refractive stability and timing of spectacle prescription following cataract surgery in myopic eyes.

PURPOSE: To investigate the post-operative refractive stabilisation time and provide evidence for the optimal timing of a spectacle prescription in myopic post-cataract surgery patients. METHODS: A total of 116 consecutive myopic cataract patients were recruited from the Zhongshan Ophthalmic Center in this prospective study. Post-operative subjective refraction was assessed after 1 week and 1 month (4-6 weeks), with the interval for the new spectacle acquisition being recorded. Visual Function Index-14 (VF-14) questionnaires were used to assess the vision-related quality of life. RESULTS: There was no significant difference in spherical (p = 0.33), cylindrical (p = 0.65) or spherical equivalent refractions (p = 0.45) obtained 1 week and 1 month post-operatively, indicating that subjects achieved refractive stability within 1 week. In subgroups having differing age and axial lengths, there were also no significant differences between the 1 week and 1 month findings. The spherical equivalent refractive shift between 1 week and 1 month was significantly correlated with the post-operative prediction error (R = 0.35; p < 0.001). Only five (4.3%) out of 116 patients obtained new spectacles 1 week post-surgery. The VF-14 values improved from 85.77 ± 7.24 to 90.45 ± 5.39 after acquiring new spectacles (p < 0.01). CONCLUSIONS: The stabilisation of subjective refraction occurred within 1 week in myopic cataract patients. Shortening the interval before prescribing a new spectacle prescription is recommended for myopic patients following cataract surgery to improve their vision-related quality of life.

Determinants of outcomes for patients with chronic low back pain and fear-avoidance beliefs following treatment with specific stabilisation exercises.

BACKGROUND: Specific stabilisation exercises (SSE) can combat the debilitating effects of chronic non-specific low back pain (CLBP), improve disability, pain and fear-avoidance beliefs (FAB). OBJECTIVE: To elicit the determinants of outcome in patients with CLBP with associated FABs after treatment with SSE. METHOD: Twenty-nine patients (20 females) with CLBP were classified using FAB questionnaire into high or low Work and Physical Activity (PA) subscales. After 4-week treatment, evaluations were done for pain, disability and lumbar spine active range of motion (AROM). Data was analysed exploratory-descriptively with a significance level set at p< 0.05. RESULTS: Participants were aged 55.24 ± 11.91 years. They scored 19 (65.5%) and 5 (17.2%) respectively on Work and PA subscales. The post-intervention evaluation showed significant differences in all outcomes, but no significant difference between patients with high or low FAB scores for both subscales. PA scores correlated significantly with pain while work scores correlated significantly with disability. Participants' gender predicted disability, pain and AROM with moderate to large effect sizes. CONCLUSION: SSE can potentially improve disability, pain and range of motion for patients with chronic low back pain regardless of FABQ status. Gender and baseline patient status are potential determinants of outcome of treatment using SSE.

Physiological-based cord clamping stabilised cardiorespiratory parameters in very low birth weight infants.

AIM: We investigated the influence of physiological-based cord clamping (PBCC) on cardiorespiratory stability in very low birth weight (VLBW) infants during the first 72 h of life. METHODS: This retrospective study comprised VLBW infants born at <32 + 0 weeks of gestation and admitted to the neonatal intensive care unit of the Medical University of Graz, Austria, from December 2014 to April 2021. VLBW infants delivered with PBCC were matched by gestational age and birth weight to delayed cord clamping controls. The PBCC group was stabilised after birth with an intact cord. Routine monitoring parameters were compared between the groups. RESULTS: We included 54 VLBW infants. The mean gestational ages of the PBCC group and controls were 27.4 ± 1.9 versus 27.4 ± 1.8 weeks (p = 0.87), and the mean birth weights were 912 ± 288 versus 915 ± 285 g (p = 0.96), respectively. The mean cord clamping time was 191 ± 78 s in the PBCC group. Heart rate was lower in the PBCC group during the first 3 days after birth, reaching significance by 10 h. Other monitoring parameters did not reveal any differences between the two groups. CONCLUSION: PBCC stabilised cardiorespiratory parameters in VLBW infants. The lower heart rate in the PBCC group suggested higher blood volume following intact cord resuscitation.

Multi-objective property optimisation of a phosphoserine-modified calcium phosphate cement for orthopaedic and dental applications using design of experiments methodology.

Phosphoserine is a ubiquitous molecule found in numerous proteins and, when combined with alpha-tricalcium phosphate (α-TCP) powder, demonstrates the ability to generate an adhesive biomaterial capable of stabilising and repairing bone fractures. Design of Experiments (DoE) approach was able to optimise the composition of phosphoserine-modified calcium phosphate cement (PM-CPC) demonstrating that the liquid:powder ratio (LPR) and quantity of phosphoserine (wt%) significantly influenced the handling, mechanical, and adhesion properties. Subsequently, the DoE optimisation process identified the optimal PM-CPC formulation, exhibiting a compressive strength of 29.2 ± 4.9 MPa and bond/shear strength of 3.6 ± 0.9 MPa after a 24 h setting reaction. Moreover, the optimal PM-CPC composition necessitated a mixing time of 20 s and displayed an initial setting time between 3 and 4 min, thus enabling homogenous mixing and precise delivery within a surgical environment. Notably, the PM-CPC demonstrated a bone-to-bone bond strength of 1.05 ± 0.3 MPa under wet conditions, coupled with a slow degradation rate during the first five days. These findings highlight the ability of PM-CPC to effectively support and stabilise bone fragments during the initial stages of natural bone healing. The developed PM-CPC formulations fulfil the clinical requirements for working and setting times, static mechanical, degradation properties, and injectability, enabling surgeons to stabilise complex bone fractures. This innovative bioinspired adhesive represents a significant advancement in the treatment of challenging bone injuries, offering precise delivery within a surgical environment and the potential to enhance patient outcomes. STATEMENT OF SIGNIFICANCE: This manuscript presents a noteworthy contribution to the field of bone fracture healing and fixation by introducing a novel phosphoserine-modified calcium phosphate cement (PM-CPC) adhesive by incorporating phosphoserine and alpha-TCP. This study demonstrates the fabrication and extensive characterisation of this adhesive biomaterial that holds great promise for stabilising and repairing complex bone fractures. Design of Experiment (DoE) software was used to investigate the correlations between process, property, and structure of the adhesive, resulting in a cost-effective formulation with desirable physical and handling properties. The PM-CPC adhesive exhibited excellent adhesion and cohesion properties in wet-field conditions. This research offers significant potential for clinical translation and contributes to the ongoing advancements in bone tissue engineering.

Comparison of intra-operative outcomes following internal fixation with trochanteric stabilisation plate or intramedullary nail in intertrochanteric fractures.

PURPOSE: Intertrochanteric fractures can be classified as stable (AO-OTA 31-A1) or unstable (AO-OTA 31-A2/3). For A3 fractures there is no recommended treatment, often fixed with either an intramedullary nail (IMN) or a dynamic hip screw and trochanteric stabilisation plate (DHS/TSP). This study retrospectively reviews peri-operative outcomes of patients treated with either fixator. METHODS: Pre-operative demographics, operative information and patient outcome data from 213 patients who suffered intertrochanteric fractures and were treated with either DHS/TSP or IMN at a major trauma centre from 01/2015 to 01/2022 was collected. Unpaired T tests were performed to assess levels of significance between peri-operative outcomes. RESULTS: The mean age for DHS/TSP-treated patients was 2.63 years greater than IMN-treated (P = 0.039). There were no other significant differences in pre-operative characteristics. We found a significantly shorter mean operative time in the DHS/TSP group (88.05 min, 95% CI: 82.1-94.0) compared to IMN counterparts (100.8 min, 95% CI: 92.7-109.0, P = 0.012), but no statistically significant difference in length of hospital stay or patient mortality, blood transfusion, re-operation or complication rates. When A3 fractures were analysed, a statistically significant greater proportion of IMN patients required blood transfusions (DHS/TSP: 35.90%, IMN: 65.00%, P = 0.0093). All other factors were found to have no significant differences. CONCLUSION: This study provides evidence to support the national guidelines regarding A1 fractures and suggests that DHS/TSP is a valid alternative to the IMN in A3 intertrochanteric fractures, with reduced blood loss. With the flexibility to add the TSP intraoperatively to prevent femoral head medialisation, and cheaper implant costs, the DHS/TSP may become the preferred method of internal fixation.

CircIRAK3 exerts negative feedback regulation on inflammation by binding to HNRNP U and destabilizing proinflammatory cytokine mRNA in osteoarthritis and chondrogenesis.

Osteoarthritis (OA) is the most prevalent age-related and degenerative joint disease with limited treatment options. Previous studies have identified the therapeutic effects of mesenchymal stem cells (MSCs) therapy. Nevertheless, chronic inflammation impedes MSCs therapeutic effect. There have been reports suggesting that circular RNAs (circRNAs) are involved in OA and chondrogenesis. The combination of MSCs and circRNAs in therapies appears to be a promising option. In this study, we identified circIRAK3 as a significant regulator in cartilage degeneration and chondrogenesis through high-throughput sequencing analyses. We observed increased circIRAK3 in OA cartilage and during MSCs chondrogenesis. Knockdown of circIRAK3 resulted in excessive apoptosis, inhibited proliferation, and degradation of chondrocytes, along with the inhibition of MSCs chondrogenesis. Mechanistically, circIRAK3 bound to HNRNP U and competitively prevented its binding to IL-1ß, TNFα, and IL6 mRNA, thereby promoting mRNA degradation. Notably, circIRAK3 expression in plasma increased with higher OARSI scores. Intra-articular injection of adeno-associated virus-circIRAK3 delayed cartilage degeneration and reduced inflammation in DMM mouse model. Our study highlights a compensatory regulation network of circIRAK3 in chondrocytes in response to inflammation. CircIRAK3 has the potential to serve as a new therapeutic target for OA. Furthermore, therapies targeting circIRAK3 combined with MSCs hold promise.

The vocal cords are predominantly closed in preterm infants <30 weeks gestation during transition after birth; an observational study.

AIM: Studies in animals have shown that vocal cords (VCs) close during apnoea before and after birth, thereby impairing the effect of non-invasive ventilation. We tested the feasibility of visualising VCs using ultrasonography (US) and investigated the position and movement of the VCs during non-invasive respiratory support of preterm infants at birth. METHODS: In an observational study, VCs were visualised using US in infants <30 weeks gestation during both stabilisation after birth and at one hour after birth. Respiratory efforts were simultaneously recorded. The percentage of time the VCs were closed in the first ten minutes was determined from videoframes acquired at 15 Hz and compared with respiratory flow patterns measured using a respiratory function monitor. RESULTS: US of the VCs could be performed in 20/20 infants included (median (IQR) gestational age 27+6 (27+1-28+6) weeks) without interfering with stabilisation, of whom 60% (12/20) were initially breathing and 40% (8/20) were apnoeic at birth. In breathing infants, the VCs closed between breaths and during breath holds, which accounted for 57% (49-66) of the time. In apnoeic infants receiving positive pressure ventilation, the VCs were closed for 93% (81-99) of the time. US at one hour after birth could be performed in 14/20 infants, VCs were closed between breaths and during breath holds, accounting for 46% (27-52) of the time. CONCLUSION: Visualising VCs in preterm infants at birth using US is feasible. The VCs were closed during apnoea, in between breaths and during breath holds, impairing the effect of ventilation given.

Screening for molecular glues - Challenges and opportunities.

Molecular glues are small molecules, typically smaller than PROTACs, and usually with improved physicochemical properties that aim to stabilise the interaction between two proteins. Most often this approach is used to improve or induce an interaction between the target and an E3 ligase, but other interactions which stabilise interactions to increase activity or to inhibit binding to a natural effector have also been demonstrated. This review will describe the effects of induced proximity, discuss current methods used to identify molecular glues and introduce approaches that could be adapted for molecular glue screening.