Biomechanical evaluation of a modified intramedullary nail for the treatment of unstable femoral trochanteric fractures

Background

The Proximal Femoral Nail Antirotation (PFNA) device is the most commonly used implant to fix unstable femoral trochanteric fractures (UFTFs), but it has a relatively high incidence of complications. Due to this factor, the modified intramedullary nail (MIN) was created to treat patients with UFTFs. The aim was to exhibit the MIN and make a comparison with PFNA and InterTAN using biomechanical methods.

Methods

An adult UFTF model was developed using Mimics software. The PFNA, InterTAN nail, and MIN models were drawn referring to the corresponding parameters and installed in the fracture models. Vertical, anteroposterior (AP) bending, and torsion loads of the femoral head were set in advance and loaded onto the fracture models. The value of maximal displacement and von Mises stress was evaluated via finite element analysis (FEA).

Results

The MIN model had smaller values for maximal displacement than that of the PFNA model, and the increase in displacement was less pronounced for the MIN compared to PFNA under increasing vertical loads. For the indicator of von Mises stress, the MIN model showed lower stress compared with the PFNA model in vertical loads ranging from 300 N to 2100 N. Except for the maximal stress at implants under AP bending loads, the MIN demonstrated the most superior biomechanical properties under AP bending and torsional loads.

Conclusion

The MIN offered obvious advantages in terms of mechanical stability and stress distribution among the three studied implants, providing a promising implant option for patients with UFTFs.

Modified Retzius-sparing robot-assisted radical prostatectomy for cases with anterior tumor: a propensity score-matched analysis

OBJECTIVE

To compare the outcomes between a modified Retzius-sparing robot-assisted radical prostatectomy (mRS-RARP) technique and conventional robot-assisted radical prostatectomy (Con-RARP) technique for cases with anterior prostate cancer (PCa), especially positive surgical margin (PSM) rates and urinary continence (UC).

PATIENTS AND METHODS

We retrospectively included 193 mRS-RARP and 473 Con-RARP consecutively performed by a single surgeon for anterior PCa. Perioperative complications, pathology, and continence were compared after propensity score matching using 9 variables.

RESULTS

After matching (n = 193 per group), PSM were not significantly different in the two groups (16.1% in mRS-RARP group vs. 15.0% in Con-RARP group, p = 0.779). The UC at catheter removal and at 1-month was significantly higher in the mRS-RARP (24.9% vs. 9.8%, p < 0.001; 29.0% vs. 13.5%, p < 0.001, respectively), but not at 3-, 6-, and 12-month follow-ups (p = 0.261, 0.832, and 0.683, respectively).

CONCLUSION

mRS-RARP seems to be an oncologically safe approach for patients with anterior PCa. Compared with the conventional approach, mRS-RARP approach shows benefits in the short-term postoperative UC recovery.

Structural, physicochemical and functional properties of high-pressure modified white finger millet starch

The effect of high-pressure processing (HPP) modification (200, 400, and 600 MPa for 10 min) on the physico-chemical, functional, structural, and rheological properties of white finger millet starch (WFMS) was studied. Measured amylose content, water, and oil absorption capacity, alkaline water retention, and pasting temperature increased significantly with the intensity of pressure. All color parameters (L, a, b values, and ΔC) were affected by HPP treatment, and paste clarity of modified starch decreased significantly with an increase in storage time. The samples' least gelation concentration (LGC) is in the range of 8-14 %. An increasing solubility and swelling power are noted, further intensifying at the elevated temperature (90 °C). The structural changes of WFMS were characterized by XRD, SEM, and FTIR spectroscopy. Starch modified at 600 MPa showed a similar pattern as 'B'-type crystalline, and the surfaces of starch deformed because of the gelatinization. Applied pressure of 600 MPa affected the FTIR characteristic bands at 3330, 2358, and 997 cm-1, indicating a lower crystallinity of the HPP-600 modified sample. According to DSC analysis, even at 600 MPa, WFMS is only partially gelatinized. This work provides insights for producing modified WFM starches by a novel physical modification method.

Utilizing different types of biomass materials to modify steel slag for the preparation of composite materials used in the adsorption and solidification of Pb in solutions and soil

This study utilized discarded steel slag (SS) as raw material and prepared modified steel slag materials (SS-SBC, SS-NBC, SS-BHA) through modification with biomass materials such as straw biochar (SBC), nutshell biochar (NBC), and biochemical humic acid (BHA). These materials were then applied for the removal of Pb from both solution and soil. The physical and chemical properties of the materials were analyzed using characterization techniques such as SEM, EDS, XRD, and BET. The specific surface area of the modified materials increased from the original 3.8584 m2/g to 34.7133 m2/g, 181.7329 m2/g, and 7.7384 m2/g, respectively. The study then explored the influence of different adsorption conditions on the adsorption capacity of Pb in solution, determining the optimal conditions as follows: initial concentration of 200 mg/L, adsorbent mass of 0.04 g, temperature of 15 °C, and pH = 2. To further investigate the adsorption process, kinetic and isotherm models were established. The results indicated that the adsorption process for all three materials followed a pseudo-second-order kinetic model and Freundlich isotherm model, suggesting a multi-layer chemical adsorption. Thermodynamic analysis revealed that the adsorption process was an exothermic spontaneous reaction. Soil cultivation experiments were conducted to explore the effects of different material addition amounts and cultivation times on the passivation of Pb-polluted soil. Analysis of heavy metal forms in the soil revealed that the addition of modified materials reduced the acid-extractable form of Pb in the soil and increased the residual form, which is beneficial for reducing the migration of Pb in the soil. FT-IR and XPS analyses were employed to study the functional groups, element composition, and valence states before and after adsorption passivation of Pb by the three materials. The results confirmed that the adsorption mechanisms of SS-SBC, SS-NBC, and SS-BHA mainly involved electrostatic adsorption, ion and ligand exchange, and surface precipitation. This study not only provides a new material for adsorbing and immobilizing heavy metals in soil and water but also offers a new approach for the resource utilization of steel slag waste.

Use of a modified microvascular plug to modify fenestration flow in a rapidly failing Fontan

We report a case of an alternative transcatheter use of the modified Medtronic microvascular plug to modify fenestration stent flow in a patient with a rapidly deteriorating clinical condition. This four-year-old boy developed severe cyanosis following fenestration stent insertion, initially placed due to prolonged drainage post-Fontan with extra-cardiac conduit. In April 2023, he underwent urgent cardiac catheterisation and had partial occlusion of fenestration stent with a modified 9Q microvascular plug. His oxygen saturations improved from 50 to 89% in room air with no re-emergence of raised cavopulmonary pressures.

The physical-mechanical behavior and chemical bonding nature of poly-N-vinylpyrrolidone modified cement concrete

In this study, the various amounts of poly-N-vinylpyrrolidone (PVPr) were added to the cement paste, and some parameters - flowing, initial and final setting points, water absorption, compressive strength, and flexural strength were determined. The concrete containing 0.8% PVPr exhibited high water absorption, specifically, at 14 and 28 days, increased from 15.65% to 20.71% and from 16.74% to 21.67%, respectively. The final setting time increased from 238 min to 261 min. It was determined that the compressive strength of the cement mortar increased from 54.8 MPa to 58.5 MPa when the PVPr content was 0.8-1.0%. The flexural strength also improved due to the presence of PVPr, increasing from 11.58 MPa to 14.27 MPa. According to the FTIR characterization, the PVPr macromolecule interacts with Ca2+ and Al3+ ions. TGA analysis reveals that the chemical interaction of PVPr with calcium and aluminum ions limits its mass loss up to 4-5% until 400 °C.

Development of bio-based PLA/cellulose antibacterial packaging and its application for the storage of shiitake mushroom

This study presents the extraction of cellulose from water bamboo byproducts to prepare polylactic acid (PLA)/cellulose antibacterial packaging material. The cellulose was modified using a silane coupling agent, which improved the interfacial compatibility between cellulose and PLA. Upon coating the PLA onto the modified cellulose sheet, the water contact angle of the composite material increased from 11.42° to 132.12° and the water absorption rate decreased from 182.52% to 55.71%, which improved the water resistance performance of the material. The addition of cinnamaldehyde in the PLA layer imparted antibacterial activity to the PLA/cellulose packaging material. This packaging material effectively inhibited the mycelial growth and spore germination of Aspergillus niger and Trichoderma harzianum isolated from shiitake mushroom. Additionally, the study investigated the effects of the composite on the postharvest quality of shiitake mushroom. Overall, the packaging material contributed to shiitake mushroom storage and can be applied to other perishable food products.

Successful modified implantation of insertable cardiac monitor in a very young paediatric patient

Insertable cardiac monitors are minimally invasive devices designed for implantation in the chest wall of patients to record heart rhythms and relate them to symptoms over prolonged periods. The Jot Dx™ (Abbott Laboratories, Abbott Park, IL, USA) is the latest Food and Drug Administration-cleared insertable cardiac monitor that is Bluetooth™ enabled allowing for near-immediate transmission of data from patients to physicians. We report on the first paediatric patient, in a patient weighing 11.7 kg, to undergo a modified, vertical, parasternal implantation of a Jot Dx™.

Maleic anhydride-modified xylanase and its application to the clarification of fruits juices

At presently, the catalytic activity of xylanase is sub-optimal, and the required reaction conditions are harsh. To improve its catalytic activity and stability, xylanase (XY) was chemically modified with maleic anhydride (MA). The enzymatic properties of this maleic anhydride-modified xylanase (MA-XY) were then evaluated and analyzed spectroscopically. The results showed that the thermal stability, use of organic solvents, storage stability and the pH range of 3.0 to 9.0 for MA-XY were better than that for XY alone. The kinetic parameters of the enzyme (Km values) decreased from 40.63 to 30.23 mg/mL. Spectroscopic analysis showed that XY had been modified by the acylation reaction to become a tertiary structure. An assay based on clarifying fruit juices showed that the clarification capacity and reducing sugar content using MA-XY increased compared with those using XY. Overall, this study provides a theoretical basis for improving the application of XY in the food industry.

Modified Technique of Setting Capsulotomy Thickness in Reducing Capsulotomy-Related Complications During Femtosecond Laser-Assisted Cataract Surgery: A Prospective, Comparative Cohort Study

INTRODUCTION

Although uncommon, incomplete capsulotomy, anterior capsule tags and anterior capsule tears are still encountered during femtosecond laser-assisted cataract surgery (FLACS), resulting in surgical complications. This highlights the need to improve femtosecond laser-assisted capsulotomy technique to reduce capsulotomy-related complications. Therefore, the purpose of this study was to investigate the efficacy of a newly developed, modified technique of setting capsulotomy irradiation thickness in lowering the incidence of capsulotomy-related complications in FLACS.

METHODS

This open-label prospective, comparative cohort study included 440 eyes (220 patients) treated with FLACS using the LenSx laser system (Alcon Laboratories, Inc. Fort Worth, TX, USA). Varying capsulotomy irradiation thicknesses were applied in each eye of the same patient. In Group 1, capsulotomy irradiation thickness was set between the upper edge of the highest point of the anterior capsule and the lower edge of the lowest point of the anterior capsule (modified technique). In Group 2, this was set between the center of the highest point of the anterior capsule and the center of the lowest part of the anterior capsule (conventional technique). Incidence rates of incomplete capsulotomy, anterior capsule tags and tears, and posterior capsule tears were compared.

RESULTS

Preoperative baseline characteristics showed no significant differences. Mean total of the irradiation thicknesses was 877.1 ± 81.9 µm in Group 1 and 808.9 ± 80.0 in Group 2, with a statistically significant difference (P < 0.001). Incidences of incomplete capsulotomy were 1.8% and 7.7%, anterior capsule tags were 2.3% and 8.6%, and anterior capsule tears were 0% and 3.2% in Groups 1 and 2, respectively. These differences were statistically significant (P = 0.006, 0.005, and 0.015, respectively). No posterior capsule tears were reported in either group.

CONCLUSION

The modified technique for capsulotomy in FLACS may significantly reduce the occurrence of capsulotomy-related complications, maximizing the benefits of FLACS.

A Pilot Randomised Control Trial Exploring the Feasibility and Acceptability of Delivering a Personalised Modular Psychological Intervention for Anxiety Experienced by Autistic Adults: Personalised Anxiety Treatment-Autism (PAT-A)

Anxiety is commonly experienced by autistic people and impacts on quality of life and social participation. New anxiety interventions are required to effectively meet the needs of autistic people. Personalised Anxiety Treatment-Autism (PAT-A©) is a bespoke, modular approach to treating anxiety in up to 12 sessions. This study explored the feasibility and acceptability of delivering PAT-A© in the UK National Health Service (NHS). A single-blind randomised controlled trial design. Thirty-four autistic adults were recruited via clinical services and randomised to receive either PAT-A© or enhanced treatment as usual (CCSP). Outcome assessments relating to anxiety, quality of life and related constructs were completed at baseline, immediately post intervention; and at 3 and 12 months. Seventy-one percent of the PAT-A© group and 65% of the CCSP met diagnostic threshold for at least three anxiety disorders. Retention was good across both groups, with 82% (N = 14/17) completing the full course of PAT-A© and 71% (N = 12/17) attending both psychoeducational sessions in CCSP. 94% in PAT-A© and 82% in CCSP completed some follow up assessment 3 months post-intervention. Thematic analysis of interview data revealed that many participants valued the personalised approach, developed transferable skills and experienced positive changes to their anxiety. Participants were willing to be recruited and randomised, PAT-A© was feasible to deliver in the NHS and the trial methods and materials were acceptable. Our findings indicate that a fully powered clinical and cost-effectiveness trial of PAT-A© is warranted.

Efficacy of modified time of flight magnetic resonance venography in diagnosis of iliac vein compression syndrome

OBJECTIVE

We investigated the diagnostic efficacy of modified time of flight magnetic resonance venography (mTOF-MRV) for iliac vein compression syndrome diagnosis by optimizing the scanning parameters and improving image quality.

METHODS

A retrospective study was conducted on 69 patients who underwent routine time of flight magnetic resonance venography (TOF-MRV) and 85 patients who received mTOF-MRV. Assessment of image quality of the two methods was performed by two radiologists using a four-point method. The sensitivity, specificity, positive and negative predictive values of TOF-MRV and mTOF-MRV in the diagnosis of significant iliac vein compression (stenosis >50%) were analyzed by calculating the iliac vein stenosis rates of the two methods and using digital subtraction angiography (DSA) as the gold standard.

RESULTS

Inter-observer assessment of objective data measurement revealed excellent agreement {ICC [95% confidence interval (CI)]: 0.972 (0.953 to 0.983) for TOF-MRV and 0.979 (0.965 to 0.988) for m-TOF MRV, 0.976 (0.960 to 0.986) for DSA}. The mean error of stenosis rate of mTOF-MRV was markedly smaller than that of TOF-MRV (p < 0.05). Sensitivity, specificity, positive and negative predictive values of TOF-MRV in the diagnosis of significant stenosis were 100%, 95%, 67% and 100%, respectively. The sensitivity, specificity, positive and negative predictive values of mTOF-MRV were 100%. The mean image score for the mTOF-MRV was 3.63 ± 0.59, which was significantly higher compared with that of TOF-MRV (2.19 ± 0.42).

CONCLUSION

mTOF-MRV has better image quality and can accurately diagnose venous stenosis. Therefore, it can be used for the detection of iliac vein compression syndrome and further assessment after endovascular interventions.

Relevance of Zearalenone and its modified forms in bakery products

Zearalenone is a frequently occurring and well-known mycotoxin developed in cereals before and during the harvest period by Fusarium spp. mainly in maize and wheat. In addition to the main form, various modified forms (phase I and II metabolites) were detected, in some cases in high amounts. These modified forms can be harmful for human health due to their different toxicity, which can be much higher compared to the parent toxin. In addition, the parent toxin can be cleaved from the phase I and II metabolites during digestion. A risk of correlated and additive adverse effects of the metabolites of ZEN phase I and II in humans and animals is evident. ZEN is considered in many studies on its occurrence in grain-based foods and some studies are dedicated to the behavior of ZEN during food processing. This is not the case for the ZEN phase I and II metabolites, which are only included in a few occurrence reports. Their effects during food processing is also only sporadically addressed in studies to date. In addition to the massive lack of data on the occurrence and behavior of ZEN modified forms, there is also a lack of comprehensive clarification of the toxicity of the numerous different ZEN metabolites detected to date. Finally, studies on the fate during digestion of the relevant ZEN metabolites will be important in the future to further clarify their relevance in processed foods such as bakery products.

Innovative approaches in cloud-point extraction

Cloud-point extraction (CPE) is a pre-treatment technique for the extraction and preconcentration of different chemical compounds, such as metal ions, pesticides, drugs, phenols, vitamins etc., from various samples. CPE is based on the phenomenon of two phases (micellar and aqueous) forming after the heating of an aqueous isotropic solution of a non-ionic or zwitterionic surfactant above the cloud-point temperature. If analytes are added to the surfactant solution under suitable conditions, they should be extracted into the micellar phase, also called the surfactant-rich phase. Recently, the traditional CPE procedure is being increasingly replaced by improved CPE procedures. In this study, recent advances in CPE over the last three years (2020 - 2022), including the application of various innovative approaches, are reviewed. In addition to the basic principle of CPE, alternative extraction media in CPE, CPE supported by various auxiliary energies, a different modified CPE procedure and the use nanomaterials and solid-phase extraction in combination with CPE are presented and discussed. Finally, some future trends for improved CPE are presented.

Carbon Fibers for Bioelectrochemical: Precursors, Bioelectrochemical System, and Biosensors

Abstract

Carbon fibers (CFs) demonstrate a range of excellent properties including (but not limited to) microscale diameter, high hardness, high strength, light weight, high chemical resistance, and high temperature resistance. Therefore, it is necessary to summarize the application market of CFs. CFs with good physical and chemical properties stand out among many materials. It is believed that highly fibrotic CFs will play a crucial role. This review first introduces the precursors of CFs, such as polyacrylonitrile, bitumen, and lignin. Then this review introduces CFs used in BESs, such as electrode materials and modification strategies of MFC, MEC, MDC, and other cells in a large space. Then, CFs in biosensors including enzyme sensor, DNA sensor, immune sensor and implantable sensor are summarized. Finally, we discuss briefly the challenges and research directions of CFs application in BESs, biosensors and more fields.

Highlights

CF is a new-generation reinforced fiber with high hardness and strength.Summary precursors from different sources of CFs and their preparation processes.Introduction of the application and modification methods of CFs in BESs and biosensor.Suggest the challenges in the application of CFs in the field of bio-electrochemistry.Propose the prospective research directions for CFs.

Graphical abstract

Treatment of unstable spinopelvic fractures: outcome of three surgical techniques-a retrospective single-center case series

PURPOSE

The aim of our retrospective study is to analyze how spinopelvic dissociations (SPDs) were treated in a single center trying to better understand how to improve surgical and non-surgical options.

METHODS

Twenty patients of a single center surgically treated for SPDs between 2013 and 2021 were retrospectively included in this study. Three surgical techniques have been used: modified triangular stabilization, triangular stabilization and double iliac screws stabilization. Follow-up was assessed for up to 11.6 ± 9.9 months through ODI, MRS, NRS, IIEF or FSFI, a CT scan and whole spine X-ray examination.

RESULTS

Twenty patients were admitted to our ER for traumatic spinopelvic dissociation. Surgical treatment for spinopelvic dissociation has been performed on average 11.5 ± 6.7 days after the trauma event. Eighteen fractures were C3 type and two C2 types. Neurological examination showed nerve root injury (N2) in 5 patients, incomplete spinal cord injury (N3) in 4 patients and cauda equina syndrome in two patients (N4). In case of neurologic deficits, routinary nerve decompression was performed. Three different surgical techniques have been used: 8 triangular fixations (Group 1), 6 modified triangular stabilization (Group 2) and 6 double iliac screws triangular fixation (Group 3).

CONCLUSION

In patients with post-traumatic neurological deficit, decompression surgery and fracture reduction seem to be associated with clinical improvement; however, sexual disorders seem to be less responsive to the treatment. Some open stabilization techniques, such as the double iliac screw, could help in restoring the sagittal balance in case of severe deformities.

Anterolateral versus modified posterolateral approach for tibial plateau fractures with involvement of the posterior column: a cadaveric study

INTRODUCTION

The aim of this study was to compare the reduction quality of the anterolateral (AL) and modified posterolateral approach (PL) in lateral tibial plateau fractures involving the posterior column and central segments.

METHODS

Matched pairs of pre-fractured cadaveric tibial plateau fractures were treated by either AL approach (supine position) or PL approach (prone position). Reduction was controlled by fluoroscopy and evaluated as satisfying or unacceptable. Afterwards, the reduction was examined by 3D scan.

RESULTS

10 specimens (3 pairs 41B3.1, 2 pairs 41C3.3) were evaluated. PL approach achieved significantly (p 0.00472) better fracture reduction results (0.4 ± 0.7 mm) of the posterior column compared to the AL group (2.1 ± 1.4 mm). Fracture steps involving the central area of the lateral plateau were insufficiently reduced after fluoroscopy using both approaches.

CONCLUSION

Optimal reduction of displaced tibial plateau fractures involving the posterolateral column necessitates a posterior approach, which can be conducted in prone or lateral positioning. The anterolateral approach is indicated in fractures with minor displacement of the posterolateral rim but fracture extension in the latero-central segments. In these cases, an additional video-assisted reduction or extended approaches are helpful.

Evaluation of Fluoride Release in Chitosan-Modified Glass Ionomer Cements

OBJECTIVE

This study assessed the influence of chitosan nanoparticles on the fluoride-releasing ability of 4 glass ionomer cement (GIC) through an in vitro analysis.

METHODS

Four types of GIC (type II light cure universal restorative, type II universal restorative, GC Fuji VII, and type IX) were modified with nanochitosan particles; 10% chitosan was added to the glass ionomer liquid. Six specimens for each of the 4 groups were created, using expendable Teflon moulds. Discs of each type of GIC (n = 6) were immersed in deionised water at various time intervals. Electrodes selective for fluoride ions were employed to analyse the amount of released fluoride at 1, 7, 14, 21, and 28 days.

RESULTS

Chitosan-modified GICs showed greater fluoride release than conventional GICs at all time points. All samples showed an initial high release of fluoride that tapered off with time. The total amount of fluoride released increased from the 1st day to the 28th day on adding chitosan to all the 4 types of GIC. Amongst those, type IX high-strength posterior extra with chitosan released a considerably higher quantity of fluoride at all time intervals.

CONCLUSIONS

In all the experimental groups, adding chitosan to the glass ionomer liquid had an accelerating effect on its fluoride-releasing property.

Recycling of municipal sewage sludge incineration fly ash based on (NH4) 2SO4 roasting-acid leaching and filling PP matrix process

Sludge incineration is one of the most efficient sludge treatment methods. The fly ash produced by incineration must be handled further since it has a significant number of heavy metals. In this study, the chemical composition of sewage sludge incineration fly ash (SSA) generated from Zhejiang in various months was identified by XRD, X-ray fluorescence spectrometer (XRF), and SEM analyzes. The SSA were treated by a (NH₄)₂SO₄ roasting-acid leaching process to determine its effect on the elimination performance of heavy metals. The SSA content on the mechanical properties and heavy metal leaching of modified SSA-filled PP composite were also studied. Results show (NH₄)₂SO₄ roasting-acid leaching process has a good effect of eliminating heavy metals, with the highest leaching of Zn of 86.4%. The presence of sodium stearate modifier increases activation index of SSA and then improves the compatibility of SSA particles in PP, resulting for the composites have relatively excellent mechanical properties. For the toxicity characteristic leaching procedure (TCLP) test, modified SSA particles can be effectively encapsulated with PP resins, which have a considerable inhibitory effect on heavy metal leaching. This process from this study provides a reference for sewage sludge treatment by using modified SSA as a polymer filler to achieve the immobilization of heavy metals and the resource recycling.

Evaluation of the conventional and modified aerosol boxes during tracheal intubation in normal and difficult airways: a randomized, crossover, manikin simulation study

The aim of this study was to evaluate conventional and modified aerosol boxes in terms of intubation time, first-pass intubation success, and mouth-to-mouth distance between the laryngoscopist and patient during tracheal intubation in simulated patients with normal and difficult airways. Sixteen anesthesiologists performed tracheal intubations with direct laryngoscope or three different videolaryngoscopes (McGRATH MAC videolaryngoscope, C-MAC videolaryngoscope, and Pentax-AWS) without an aerosol box or with a conventional or a modified aerosol boxes in simulated manikins with normal and difficult airways. Intubation time, first-pass intubation success, and mouth-to-mouth distance during tracheal intubation were recorded. Compared to no aerosol box, the use of a conventional aerosol box significantly increased intubation time in both normal and difficult airways (Bonferroni-corrected P-value (P_corrected) = 0.005 and P_corrected = 0.003, respectively). Intubation time was significantly shorter with the modified aerosol box than with the conventional one for both normal and difficult airways (P_corrected = 0.003 and P_corrected = 0.011, respectively). However, no significant differences were found in intubation time between no aerosol box and the modified aerosol box for normal and difficult airways (P_corrected = 0.336 and P_corrected = 0.112, respectively). The use of conventional or modified aerosol boxes significantly extended the mouth-to-mouth distances compared to not using an aerosol box during tracheal intubation with each laryngoscope (all P_corrected < 0.05), and the distances were not different between the conventional and modified boxes in normal and difficult airways. The use of modified aerosol box did not increase intubation time and could help maintain a distance from the simulated patients with normal and difficult airways.

Nanoporous biochar with high specific surface area based on rice straw digestion residue for efficient adsorption of mercury ion from water

The unreasonable disposal of residue after anaerobic digestion seriously affects the stability of the ecosystem, and the preparation of adsorbent is an effective way to value-added utilization of the residue. In this study, a high adsorption capacity (209.65 mg/g) biochar-based adsorbent was prepared by hydrothermal carbonization and alkali modification using rice straw biogas residue. The lignocellulosic structure was destroyed after anaerobic digestion, forming porous biochar with larger specific surface area (2372.51 m²/g) and richer pore structure. Besides, the mercury ion complexed on the adsorbent surface in monovalent and divalent forms and possessed favorable selectivity in the presence of other examples of interference. The adsorption process is consistent with pseudo second-order kinetics and the Langmuir isotherm, indicating a predominance of chemisorption. This study provides a methodology for use of rice straw biogas residue and treatment of mercury containing wastewater, which offers a fresh direction for resource utilization of biogas residue.

Callnudoids A-H: Highly modified labdane diterpenoids with anti-inflammation from the leaves of Callicarpa nudiflora

Eight undescribed 3,4-seco-norlabdane diterpenoids, callnudoids A-H, as well as two known analogues were isolated from the leaves of Callicarpa nudiflora. The structures were elucidated using spectroscopic methods and were compared with published NMR spectroscopic data. The absolute configurations of callnudoids D and E were defined based on ECD data or single-crystal X-ray diffraction. Callnudoids A-C are the highly modified labdane diterpenoids featuring rearranged 3,4-seco-ring and the formation of an undescribed cyclohexene moiety via C2-C18 cyclization. They only contain 15 carbon atoms on the carbon skeleton. Callnudoid D represents the unusual 3,4-seco-15,16-norlabdane diterpenoid with C13-C17 cyclization, and a putative biosynthesis pathway for callnudoids A, B, D, and E was proposed. All compounds were evaluated for their anti-inflammatory activities by inhibiting the lipopolysaccharide (LPS)-induced nitric oxide (NO) released in RAW264.7 cells; callnudoids A-E and H, and methylcallicarpate obviously inhibited pro-inflammatory cytokines TNF-α and IL-1β in a dose-dependent manner.

Novel elimination method of iron and manganese ions from drinkable groundwater in Assiut, Egypt, by using sodalite-bearing modified illite

The world's interest now is focusing on the applying of the principles of sustainable development in managing natural resources, especially in managing freshwater, which is one of the greatest challenges the whole world face. In this paper, the illite ore was tested to remove the excess of iron and manganese from groundwater which is used for drinking and household purposes in Assiut. To accomplish this goal, the study was based on two directions. The first direction focused on achieving a physicochemical analytical survey for all the groundwater produced by wells in Assiut governorate, and its averages are plotted on GIS maps, to illustrate the difference in the concentrations of iron and manganese. However, the second direction focused on the preparation and examination of the modified illite ore, and it was characterized by using XRD, SEM, FT-IR, and XRF techniques. The results showed that the sodalite-bearing modified illite (SBMI) was able to remove the excess of iron and manganese from raw groundwater with the efficiency of 99% and 97%, respectively.

Predictive accuracy of the modified SOFA score, SIRS criteria, and qSOFA score for uroseptic shock after mini-percutaneous nephrolithotomy

The purpose of this study was to determine the plausibility and utility of utilizing a modified SOFA (mSOFA) score for predicting uroseptic shock after mini-percutaneous nephrolithotomy. A cohort of 707 patients who received mini-PCNL from August 2019 to December 2020 was retrospectively evaluated. The area under receiver operating characteristic curve (AUROC) was used to compare the predictive value of septic shock between mSOFA, systemic inflammatory response syndrome (SIRS) and qSOFA. Among 707 patients, 24 patients experienced uroseptic shock after mini-PCNL. Compared with the no uroseptic shock group, the proportion of females and rates of preoperative urine culture, renal pelvis urine culture and stone culture positivity were higher in the uroseptic shock group, with high levels of preoperative C-reactive protein (CRP) and postoperative procalcitonin (PCT). In the uroseptic shock group, the mSOFA score increased by two or more points in 83.3%; 79.2% had at least two SIRS criteria, and 100% had a qSOFA score of at least one point. mSOFA score (AUROC = 0.866, 95% CI: 0.779-0.954) exhibited greater discrimination for uroseptic shock after PCNL than SIRS (AUROC = 0.838, 95% CI: 0.742-0.943) and qSOFA (AUROC = 0.851, 95% CI: 0.811-0.892). In conclusion, the predictive value of the modified SOFA score for uroseptic shock after mini-PCNL was greater than that of the qSOFA score or SIRS.

Muscle-Sparing Skin Crease Incision Posterolateral Thoracotomies in Pediatric Patients: Our Experience

Context

Standard posterolateral muscle cutting thoracotomies in pediatric patients are associated with morbidities in terms of poor motor and esthetic outcomes and also more postoperative analgesia requirement, when compared with muscle-sparing technique.

Aims

The aim of this study is to evaluate the outcomes of muscle-sparing skin crease incision posterolateral thoracotomies in pediatric patients in terms of abovementioned variables.

Settings and Design

This prospective observational study was conducted over a period from January 2016 to July 2020 in a tertiary care teaching institute.

Materials and Methods

All patients of stage 3 empyema and pulmonary hydatidosis were included in the study.

Results

Thirty-nine patients fulfilled the inclusion criteria. There were 38 children with organized (Stage 3) empyema and one patient with bilateral lung hydatid. There were 24 males and 15 females; age ranging from 6 months to 15 years. Right thoracotomy was performed in 28, left in 10, and bilateral in one patient with lung hydatid. Adequate exposure was achieved in all cases. Decortication with complete excision of thickened parietal pleura with stripping of the visceral peel and release of the entrapped lung was performed in all 38 patients. In 5 children along with decortication, repair of bronchopleural fistula due to necrotizing pneumonia was performed. Bilateral thoracotomies with pericystectomies were performed with a gap of 3 weeks for lung hydatid. Lung expansion assessment at 3 months was satisfactory. Ultrasound assessment of the latissimus dorsi muscle and serratus anterior muscle at 4 weeks revealed complete integrity in all the cases. Most of the patients achieved satisfactory motor and esthetic outcomes.

Conclusions

Muscle-sparing skin crease incision posterolateral thoracotomy is a viable alternative to standard posterolateral muscle cutting thoracotomy, especially in a resource-challenged setting. The technique is easy to perform with satisfactory exposure.

Physician-modified stent graft with inner branches for treating ruptured thoracoabdominal aortic aneurysm

Thoracoabdominal aortic aneurysm (TAAA) repair remains challenging in patients with high surgical risk. We report a case of TAAA in an 84-year-old woman with type Ib endoleak after thoracic endovascular aortic repair with coeliac artery coverage due to impending ruptured TAAA. A stent graft was assembled to create 3 fenestrations and sew 3 inner grafts for the superior mesenteric artery (SMA) and bilateral renal arteries. This stent graft system was inserted into the thoraco-abdominal aorta and partially unsheathed until the first inner branch endograft fully expanded. The wire was used to catheterize the stent graft, inner branch, and SMA from the left upper limb, and a bridge stent was deployed from the inner branch to the SMA. A similar procedure was performed for bilateral renal arteries. The stent graft system was fully unsheathed. Postoperative computed tomography angiography revealed no endoleak and good flow of the visceral artery. The use of the physician-modified inner branched endograft system described is feasible and can make TAAA endovascular repair simpler and safer.

Effects of ultrasonic treatment and homogenization on physicochemical properties of okara dietary fibers for 3D printing cookies

This paper presents a means to modify the attributes of okara fiber using ultrasonic and high-speed shearing treatment. The results of scanning electron microscopy and differential scanning calorimetry reveal that the modified okara fiber demonstrates small particle size and high thermal stability. When the 500 W-15,000 rpm combination is used for okara-fiber treatment, the latter exhibits excellent swelling (SC) as well as water- and oil-holding capacities. When 6% of modified okara fiber is added to the dough, the resulting cookies demonstrate the best printing performance. Subsequently, the printing parameters can be optimized to obtain the best filling rate of 30%. The corresponding nozzle diameter and printing speed equal 0.8 mm and 50 mm/s, respectively. Finally, the 3D-printed cookies containing okara fiber are compared against those commonly available in the market via sensory evaluation. As observed, the 3D-printed cookies were more acceptable to people. Therefore, the addition of the okara dietary fiber to the cookie dough not only improves the okara utilization rate but also increases the dietary-fiber content in the cookie, thereby alleviating the occurrence of obesity in modern society.

Modified double guiding catheter 'Ping Pong' technique to treat large coronary perforation: a case report

Background 

Despite improvement in available tools and techniques, procedural complications like coronary perforation can occur during percutaneous coronary intervention (PCI). Severe proximal coronary perforations are usually caused by balloon and vessel size mismatch but can also occur with appropriately sized balloons or stents if the coronary vessel has very eccentric calcification or if there is negative remodelling of the vessel.

Case summary 

A 74-year-old man with a history of type II diabetes mellitus, hypertension, and chronic coronary syndrome (previous PCI 10 years before) presented with unstable angina of 2 weeks of duration. Coronary angiography revealed a patent stent in left anterior descending artery, significant disease in left circumflex artery and diffuse calcified lesion in dominant right coronary artery (RCA). During angioplasty of RCA, the patient developed severe Ellis grade III perforation, which was successfully managed with modified double guiding catheter ‘Ping Pong’ technique. In this technique, the already engaged 7 French (F) Amplatz Left 1 guide catheter was used to deliver the bulky covered stent in highly tortuous and calcified RCA while a second 6F guide catheter (Judkin Right) introduced through contralateral femoral access was used for introducing the balloon, which initially sealed the perforation and subsequently acted as a distal anchor to provide strong support to deliver the covered stent.

Conclusion 

In a case of severe coronary perforation, modified Ping Pong technique using a small-sized second guide catheter complimentary to the first guide catheter, can be used to deploy bulky covered stent.

Modified ypTNM Staging Classification for Gastric Cancer after Neoadjuvant Therapy: A Multi-Institutional Study

BACKGROUND

The benefits of neoadjuvant therapy for patients with locally advanced gastric cancer (GC) are increasingly recognized. The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual first proposed ypTNM staging, but its accuracy is controversial. This study aims to develop a modified ypTNM staging.

PATIENTS AND METHODS

Clinicopathological data of 1,791 patients who underwent curative-intent gastrectomy after neoadjuvant therapy in the Surveillance, Epidemiology, and End Results database, as the development cohort, were retrospectively analyzed. Modified ypTNM staging was established based on overall survival (OS). We compared the prognostic performance of the AJCC 8th edition ypTNM staging and the modified staging for patients after neoadjuvant therapy.

RESULTS

In the development cohort, the 5-year OS for AJCC stages I, II, and III was 58.8%, 39.1%, and 21.6%, respectively, compared with 69.9%, 54.4%, 34.4%, 24.1%, and 13.6% for modified ypTNM stages IA, IB, II, IIIA, and IIIB. The modified staging had better discriminatory ability (C-index: 0.620 vs. 0.589, p < .001), predictive homogeneity (likelihood ratio chi-square: 140.71 vs. 218.66, p < .001), predictive accuracy (mean difference in Bayesian information criterion: 64.94; net reclassification index: 35.54%; integrated discrimination improvement index: 0.032; all p < .001), and model stability (time-dependent receiver operating characteristics curves) over AJCC. Decision curve analysis showed that the modified staging achieved a better net benefit than AJCC. In external validation (n = 266), the modified ypTNM staging had superior prognostic predictive power (all p < .05).

CONCLUSION

We have developed and validated a modified ypTNM staging through multicenter data that is superior to the AJCC 8th edition ypTNM staging, allowing more accurate assessment of the prognosis of patients with GC after neoadjuvant therapy.

IMPLICATIONS FOR PRACTICE

The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual first proposed ypTNM staging, but its accuracy is controversial. Based on multi-institutional data, this study developed a modified ypTNM staging, which is superior to the AJCC 8th edition ypTNM staging, allowing more accurate assessment of the prognosis of patients with gastric cancer after neoadjuvant therapy.

Modified homodigital dorsolateral proximal phalangeal island flap for the reconstruction of finger-pulp defects

BACKGROUND

Reconstruction of finger-pulp defects remains a challenge, although the treatment varies widely. The homodigital island flap based on dorsal branches of the proper digital artery (PDA) is one of the most popular methods for repair of finger-pulp defects. The aim of this study was to introduce our experiences of using modified dorsolateral proximal phalangeal island flaps for reconstruction of finger-pulp defects.

METHODS

From July 2016 to November 2018, 16 modified dorsolateral proximal phalangeal (MDPP) island flaps were performed for finger-pulp reconstruction. The comparison group included 11 patients treated with homodigital dorsal perforator (HDP) flaps. Flap survivals were assessed and active range of motion (ROM) of the joints, time to return to work, static 2-point discrimination and hand performance were analysed at final follow-up.

RESULTS

Both the Group MDPP and the Group HDP had similar satisfactory flap survival. There were no differences in static 2-point discrimination, time to return to work and the ROM of the injured fingers. However, the Michigan Hand Outcomes Questionnaire (MHQ) summary scores of the satisfaction and aesthetics were much better in Group MDPP.

CONCLUSIONS

The modified homodigital dorsolateral proximal phalangeal island flap is a reliable alternative for finger-pulp reconstruction with good functional and cosmetic outcome.

Reliability, internal consistency, and concurrent validity of a modified version of the dynamic gait index in people with vestibular disorders

BACKGROUND

People with vestibular disorders often have abnormalities in gait and balance. The Dynamic Gait Index (DGI) is a relatively effective clinical gait measure that has been validated for use in patients with vestibular disorders. The modified version of the DGI (M-DGI) is based on the original DGI.

RESEARCH QUESTION

The objective of this study was to refine and test the clinical application of the M-DGI, and to investigate whether it is an effective indicator of dynamic gait in patients with vestibular disorders.

METHODS

A reliability and validity study. All raters reviewed the instructions and scoring criteria for each M-DGI item prior to the initial test. The raters simultaneously scored two M-DGI tasks for the 75 subjects, and the two tasks were completed with an interval of two hours in-between. Reliability of total M-DGI scores was assessed using intraclass correlation coefficients (2,1). Internal consistency of the M-DGI was evaluated using Cronbach's alpha. Concurrent validity of the M-DGI with Dizziness Handicap Inventory (DHI) and Timed "Up & Go" Test (TUG) was assessed using Spearman's rank order correlation coefficient.

RESULTS AND SIGNIFICANCE

Interrater and intrarater reliability of the total M-DGI scores were reflected by ICCs of 0.99 and 0.97. Internal consistency of the M-DGI score was 0.9975. Spearman's rank order correlation coefficient of the M-DGI score with the Dizziness Handicap Inventory (DHI) and the Timed "Up & Go" Test (TUG) was 0.72 and 0.65, respectively.The M-DGI demonstrates acceptable reliability, internal consistency, and concurrent validity for use as a clinical gait measurement for patients with vestibular disorders.

Modified pararectus approach for treatment of atypical acetabular anterior wall fracture: A case report

BACKGROUND

Acetabular anterior wall fracture with preservation of the pelvic brim is extremely rare. It is different from anterior wall fracture classified by Judet and Letournel. Few studies have reported cases treated by open reduction and internal fixation via the Smith-Petersen or iliofemoral approach.

CASE SUMMARY

We report a 48-year-old Chinese woman who had difficulty moving her right hip from abduction and external rotation after falling from 3 m. Pelvic radiograph and three-dimensional reconstruction of computed tomography revealed acetabular anterior wall fractures combined with fractures of the anterior inferior iliac spine and the iliac wing but not involving the pelvic brim. First, the patient underwent interim management by closed reduction of the hip dislocation and skin traction for 6 d. Then, we used a modified pararectus approach for treatment to fix the acetabular fractures with a reconstruction plate and nonlocking T-shape plate. At the 9-mo follow-up, the patient could walk painlessly without necrosis of the femoral head or heterotopic ossification, and the X-rays and computed tomography scan reconstructions showed good bone union.

CONCLUSION

The modified pararectus approach described here can facilitate exposure, reduction, and osteosynthesis for atypical acetabular fracture with less invasiveness.

Efficient removal of formaldehyde by polyethyleneimine modified activated carbon in a fixed bed

Polyethyleneimine modified activated carbon (PEI-AC) was prepared through a treatment of immersion, and used for the adsorption of formaldehyde. The adsorption capacity of formaldehyde by unmodified AC is 190.1 mg g^-1, and the adsorption capacity of formaldehyde can reach to 317.6 mg g^-1 after 10 g L^-1 of PEI modified, being about 1.67 times than unmodified activated carbon (AC: 191.2 mg g^-1). And the 10 g L^-1 of PEI modified AC (PAC-30) has the highest adsorption capacity of formaldehyde, reached to 650 mg g^-1, with an increasing magnitude of 240% in comparison with that without modified AC. This is mainly due to changes in the pore structure and surface functional groups after modification. However, as the PEI concentration increases, the adsorption performance is inhibited. Through kinetic studies, it was found that all adsorption curves follow the second-order kinetics, and the breakthrough curves follow the Boltzmann model, and the adsorption process can also be described by the intraparticle diffusion model.

Minimally invasive versus conventional fixation of tracer in robot-assisted pedicle screw insertion surgery: a randomized control trial

BACKGROUND

This study evaluated the minimal invasiveness, safety, and accuracy of robot-assisted pedicle screw placement procedure using a modified tracer fixation device.

METHODS

Patients were randomly assigned to conventional fixation group (25 patients) and modified fixation group (27 patients).

RESULTS

No baseline statistical difference was observed between the groups (P > 0.05). The length of unnecessary incision, amount of bleeding, and fixation duration for tracer fixation respectively were 6.08 ± 1.02 mm, 1.46 ± 0.84 ml, and 1.56 ± 0.32 min in the modified fixation group and 40.28 ± 8.52 mm, 12.02 ± 2.24 ml, and 5.08 ± 1.06 min in the conventional group. The difference between both groups was significant (P < 0.05). However, no significant difference between the two groups was observed in terms of the accuracy of pedicle screw placement (P > 0.05).

CONCLUSIONS

The modified minimally invasive procedure for tracer fixation results in minimal trauma and is simple, reliable, and highly safe. Additionally, the procedure does not compromise the accuracy of pedicle screw placement. Thus, it has great clinical applicable value.

TRIAL REGISTRATION

Chinese Clinical Trial Registry: Registration number, ChiCTR1800016680; Registration Date, 15/06/2018.

A Systematic Review of Jailed Balloon Technique for Coronary Bifurcation Lesion: Conventional-Jailed Balloon Technique vs Modified-Jailed Balloon Technique

BACKGROUND

In this systematic review, we aim to evaluate the latest evidence on the efficacy and safety of conventional jailed balloon technique and modified jailed balloon technique for bifurcation lesion, and also whether the former or latter is more effective for preventing side branch occlusion during main branch stenting in bifurcation lesions.

METHODS

We performed comprehensive search on studies assessing the efficacy and safety of conventional jailed balloon and modified jailed balloon technique for bifurcation lesion from several electronic databases.

RESULTS

There were 908 patients from six studies comprising of 615 in conventional jailed balloon technique group and 293 in modified jailed balloon technique group. Side branch loss was lower in modified jailed balloon technique group, however, the proportion of lesions with TIMI flow <3 in the final percutaneous coronary intervention result was somewhat higher in the modified jailed balloon technique group. The efficacy issue regarding side branch dissection was reported as high as 3.4%, especially at proximal stent edge in conventional jailed balloon technique group, but not quantitatively described in the modified jailed balloon technique group. Zero percent major adverse cardiovascular events at 9-12 months follow up was demonstrated in modified jailed balloon technique group, and 1-5% in the conventional jailed balloon group at a longer observation period up to 2.7 years.

CONCLUSION

Our study showed that modified jailed balloon technique is potentially better compared to conventional jailed balloon in terms of side branch loss, dissection, and major adverse cardiovascular events. Further controlled studies are warranted for definite conclusion.

4-aminoantipyrine modified carbon dots and their analytical applications through response surface methodology

A sensitive and selective nanoprobe for detection of hypochlorite (OCl^-) based on 4-aminoantipyrine (AAP) modified carbon dots (CDs-AAP) has been prepared. The CDs-AAP exhibit an emission peak at 484 nm when the excitation wavelength is 370 nm, accompanying 36 nm red shift compare with the pristine CDs. The addition of OCl^- lead to the AAP on the surface of CDs experience a process of hydrazide hydrolysis and double bond addition, causing the singlet and triplet electrons of the excited state more closer in energy (ie, the energy difference between the two is reduced), eventually quenching the fluorescence of CDs due to heavy atomic effects. Central composite design (CCD) and response surface method (RSM) were used to optimize the detection variables of pH, incubation time and temperature. The designed model study indicated that the optimum detection conditions was pH 7.0, temperature 30 °C and incubation time 20 min, respectively. Under optimal conditions, the fluorescent intensity of the nanoprobe linearly responded to the OCl^- concentration from 3 μM to 36 μM and the limit of detection was 40 nM. The proposed nanoprobe was successfully used to the detection of OCl^- in tap water and pool water, and the recovery were in the range of 94% - 103%. In addition, the nanoprobe was also applied in imaging of VMSCs cells and labeling E.coli.

Unraveling sorption of Cr (VI) from aqueous solution by FeCl3 and ZnCl2-modified corn stalks biochar: Implicit mechanism and application

A novel functionalized biochar was prepared using corn stalks for efficiently removal and mobility control of Cr(VI). Compared to single modified biochar, iron/zinc biochar (Fe@Zn@HBC) displayed a better removal property and the maximum adsorption capacity of Fe@Zn@HBC reached 138.89 mg·g^-1 at pH = 2 and 260 ± 10 Lux illumination. The positive charge on biochar might be the main reason promoting the rapid adsorption of Cr(VI) by electrostatic interaction. Reduction functional groups and photocatalysis (derived from ZnFe₂O₄ and B-H functional group) provided electrons for Cr(VI) reduction. And the SiO₂ could enhance the reduction process by improving electrons transfer. Finally, FeCr₂O₄ and ZnFeCrO₄ were formed by coprecipitation and ion exchange. Meanwhile, Fe@Zn@HBC showed a high solid-liquid magnetic separation potential due to the Fe₃O₄ and ZnFe₂O₄. In soil column experiment, Fe@Zn@HBC displayed a superior mobility control on biochar particles and Cr(VI) solution under the external magnetic field.

Reconstruction of elbow flexion with a modified Oberlin procedure: A comparative study

INTRODUCTION

In upper brachial plexus injuries (C5-C6-C7), selective nerve transfers appear as a favourable technique. For this purpose, transfer of an ulnar nerve fascicle to the biceps motor branch (Oberlin's procedure) is often used. In this paper we present our modified Oberlin technique, as well as a comparison of this method with the classic Oberlin procedure.

MATERIALS AND METHODS

We present two groups of patients that where operated by two different surgeons. The first group, consisting of 16 patients was treated with the classic Oberlin procedure. The second group included 5 patients treated with a modified Oberlin procedure, where two fascicles from the ulnar nerve were transferred to both the motor branch of the biceps and the motor branch of the brachialis muscles.

RESULTS

In the last follow-up of the 16 patients from the first group with the classic Oberlin procedure, 15 patients (93.75%) had Medical Research Council (MRC) grade of biceps strength 4 and 1 patient (6.25%) had MRC grade 3, whereas in the group where the modified Oberlin procedure was used the muscle strength was very durable with 4 out of 5 the patients reached MRC grade of 4+ and one MRC grade of 4, and with a mean elbow strength at 5.4 kg (3-8 kg). No sensitivity or motor problems were encountered on the ulnar territories for both groups.

CONCLUSION

With the modified Oberlin technique, the median nerve is reserved and both elbow flexors are innervated. The results of this technique compare favourably with those of other methods. Thus, we propose using the double fascicle transfer from the ulnar nerve to both elbow flexors in order to restore a strong elbow flexion in patients with upper brachial plexus injuries.

Modified dose of melphalan-prednisone in multiple myeloma patients receiving bortezomib plus melphalan-prednisone treatment

BACKGROUND/AIMS

Bortezomib plus melphalan-prednisone (VMP) is a standard treatment for multiple myeloma, particularly for patients who are ineligible for high-dose therapy. However, early discontinuation or treatment modification is often needed owing to adverse events. The aim of this study was to investigate the clinical outcomes of modifying the dose of melphalan-prednisone (MP) in patients receiving VMP.

METHODS

We examined 67 patients who received a modified dose of MP, and 38 patients who received the regularly planned dose of MP. We then analyzed clinical differences between the groups.

RESULTS

Although there was no difference in the proportion of discontinuation due to adverse events between dose groups, more patients in the planned-dose group experienced earlier discontinuation in general. The overall response rate (ORR) was 81.0% and complete response (CR) rate was 30.5%. After a median 15.7 months of follow-up, the median progression-free survival (PFS) and overall survival (OS) were 25.0 and 47.8 months, respectively. There was no significant difference in the ORR, CR, PFS, and OS of the two dose groups. A median of four cycles were delivered, and the median cumulative bortezomib dose was 41.6 mg/m2 . The median PFS in patients with doses ≥ 41.6 mg/m2 was longer than that in patients with doses < 41.6 mg/m2 (35.1 months vs. 9.6 months). However, when MP was < 50% of the planned dose, PFS and OS were poor.

CONCLUSION

Modifying the dose of MP might be a feasible and effective therapeutic approach for multiple myeloma patients receiving VMP treatment.

Biomechanical comparison of conventional versus modified technique in distal chevron osteotomies of the first metatarsal: A cadaver study

BACKGROUND

Distal chevron osteotomy can be performed using a conventional or a modified technique. The aim of this biomechanical study was to compare the stability of the two techniques.

METHODS

Eighteen first metatarsals from nine pairs of fresh frozen human cadaver feet were used. A distal chevron osteotomy was performed using the conventional technique in group 1 (n=9) and using the modified technique in group 2 (n=9). The head of the first metatarsals was loaded in two different configurations (cantilever and physiological), using a materials testing machine.

RESULTS

In the cantilever configuration, the relative stiffness of the osteosynthesis in comparison with intact bone was 60% (±21%) in group 1 and 65% (±25%) in group 2 (p=0.61). In the physiological configuration, it was 47% (±29%) in group 1 and 47% (±21%) in group 2 (p=0.98). The failure strength in the cantilever configuration was 235N (±128N) in group 1 and 210N (±107N) in group 2 (p=0.47).

CONCLUSIONS

The conventional and the modified technique for distal chevron osteotomy in the treatment of hallux valgus show a comparable biomechanical loading capacity in this cadaver study.

The Utility of Strap Muscle in Complex Type I Thyroplasties

INTRODUCTION

Type I thyroplasty is a common procedure used to improve dysphonia secondary to glottic insufficiency caused by vocal fold paralysis, paresis, or bowing. Revision often involves more complex procedures that can be complicated by mucosal violation, hemorrhage, infection, and shifted or extruded implants. Intraoperative challenges can be managed successfully using autologous strap muscle rotation flaps.

OBJECTIVES

Review vocal fold medialization with strap muscle as a viable option for thyroplasty, particularly operations with inadvertent mucosal disruption.

METHODS

All operative records of the senior author's 30-year experience were queried for modified, complex, or revision type I thyroplasties. Each of these was reviewed, and only those utilizing autologous strap muscle rotation flaps for vocal fold medialization were included. Changes in voice quality were assessed using strobovideolaryngoscopic assessment of glottic closure and Voice Handicap Index-10 (VHI-10) scores when available.

RESULTS

Seven patients were found to have undergone eight type I thyroplasty using autologous strap muscle flaps. Improved glottic closure was seen in all patients except one. This patient, complicated by a laryngeal fracture of unknown origin discovered at the time of surgery, had worse voice with strap muscle implantation intraoperatively; therefore, the patient's fracture was reduced, and medialization was postponed. All other patients reported improved voice quality both intra- and postoperatively. Pre- and postoperative VHI-10 scores were available for two of the seven cases with successfully implanted strap muscles. A decrease in VHI-10 was observed in both cases (mean = 11). No postoperative complications occurred in any patient.

CONCLUSION

Although revision thyroplasties are relatively rare, they can be challenging. The seven cases presented herein illustrate the successful and safe use of autologous strap muscle rotation flaps for complex, revision type I thyroplasty procedures. They are particularly helpful in cases requiring additional soft tissue between the thyroid cartilage and mucosa in preparation for possible future medialization after Gore-Tex or Silastic implants, and for inadvertent mucosal disruption in which using a foreign implant might pose a risk of infection. Future studies should be performed with larger populations and longer follow-up to confirm the efficacy and safety of this procedure.

Modified PUMC classification for adolescent idiopathic scoliosis

BACKGROUND

The original Peking Union Medical College (PUMC) classification of adolescent idiopathic scoliosis (AIS) is one system to combine each type with corresponding surgical fusion guidance, presenting comparable interobserver reliability, and reproducibility with Lenke classification. However, during its application in previous over 10 years, we found 2 main problems of this classification, which required modification.

PURPOSE

(1) To evaluate the interobserver and intraobserver reliability, (2) to assess the effects of the added fusion criteria of proximal thoracic (PT) curve on improving postoperative shoulder balance of the modified PUMC classification of AIS.

STUDY DESIGN/SETTING

Retrospective analysis of our AIS cohort and prospective validation of its effectiveness.

PATIENT SAMPLE

Fifty sets of preoperative radiographs of AIS patients were randomly chosen from our AIS database. Furthermore, 46 consecutive AIS cases with PT curve were enrolled who underwent surgeries in our center from July 2007 to July 2013, with at least 2-year follow-up.

OUTCOME MEASURES

The classification results of 50 sets of preoperative radiographs by 5 surgeons. The shoulder balance was evaluated using radiographic shoulder height.

METHODS

Five surgeons independently evaluated and classified presurgical radiographs of 50 AIS patients based on the modified PUMC classification. Inter- and intraobserver reliabilities were calculated. Furthermore, the post-op shoulder balance was investigated in 46 consecutive cases of AIS with PT curve who were treated strictly based on the modified PUMC classification.

RESULTS

The Kappa coefficients of inter- and intraobserver reliability of the overall modified PUMC classification are 0.889 and 0.865, respectively. The Kappa coefficients of inter- and intraobserver reliability for the type II are 0.791 and 0.746, respectively. In addition, the shoulder balance rate of the 46 AIS patients with PT curve at the final follow-up was 95.7%.

CONCLUSIONS

Modified PUMC classification presents incremental improvement compared to our original published version, with high interobserver and intraobserver reliability and better performance of postoperative shoulder balance. Furthermore, the modified PUMC classification provides corresponding surgical fusion guidance for each subtype. Multicenter prospective studies with larger samples are still needed to further improve this system.

Modified mussel shell powder for microalgae immobilization to remove N and P from eutrophic wastewater

In this work, calcined mussel shell powder (CMSP) was activated by K₂CO₃ (K-CMSP), and this porous K-CMSP surface was modified by L-arginine (L-ARG) to render porous biomass a positively charged surface, which was innovatively utilized as a carrier to immobilize microalgae by adsorption via electrostatic interactions. The pore and the surface structures of CMSP and K-CMSP were characterized by XRD, FTIR, BET and SEM. The surface morphology of immobilized microalgae was visualized via using inverted optical microscope and SEM. It was found that microalgae could survive for 60 days, and the loss rate of chlorophyll-a preserved at -24 °C was the lowest, 44.73%. The microalgae could revive to normal growth level within 10 days and the cell content of microalgae was the highest at 25 °C, 2.8022 × 10⁶ cell/mL. At 25 °C, the highest removal rate of N and P was obtained about 95.0% and 88.63%, respectively.

MODIFIED STOPPA APPROACH FOR PELVIC AND ACETABULAR FRACTURE TREATMENT

OBJECTIVE

A retrospective review aims to investigate the operative methods and therapeutic effects of the modified Stoppa approach for treating pelvic and acetabular fractures.

METHODS

18 patients with acetabular fracture of the anterior column and pelvic anterior ring fracture underwent surgical treatment using the modified Stoppa approach. Some of the treatment was combined with the iliac fossa approach or rear K-L approach. Fracture reduction and postoperative function were evaluated using the Matta scoring standard and the Majeed scoring system. The Oxford Centre for Evidence-Based Medicine system was used to grade the literature review and create graded B recommendations.

RESULTS

Incision length was 6-12 cm (mean, 10 cm), operative duration was 50-150 minutes (mean, 85 minutes), and intraoperative blood loss volume was 400-1,000 ml (mean, 500 ml). 18 patients were followed up for 12-36 months post-operation. In the results of X-ray films, 12 cases were anatomical reductions and the remaining cases were satisfactory reductions. According to Majeed standard, 13 patients were excellent and five patients were good.

CONCLUSIONS

Treatment using the modified Stoppa approach was suitable for anterior approaches, in which pelvic and acetabular fractures were sufficiently exposed, the fracture was conveniently reduced, less complications occurred, and curative effect was satisfactory. Level of evidence III, Retrospective comparative study.

Modified internal fixator for anterior pelvic ring fractures versus conventional two-screw fixation

PURPOSE

The present study aims to evaluate the short-term clinical effects and complications of modified three-screw fixation and conventional two-screw fixation for treating anterior pelvic ring fractures.

METHODS

A retrospective study of 51 patients with type B fractures was performed. 25 patients (modified group) were treated with modified three-screw fixation and the other 26 patients (conventional group) with conventional two-screw fixation. Outcome measures included operation time, intraoperative blood loss, hospital stays, postoperative complications and the Majeed score at postoperatively 2 months, 3 months, 1 year and the time of implant removal.

RESULTS

The mean operative times and mean blood loss for modified three-screw fixation versus conventional two-screw fixation bilateral were 54.8 ± 10.7 min versus 32.3 ± 9.9 min, and 153.3 mL versus 550.0 mL (p < 0.001), respectively. However, the Majeed score was better in modified group at postoperatively 2 months (75.6 ± 9.5 vs. 69.7 ± 8.3, p = 0.008) and 3 months (80.3 ± 10.7 vs. 75.1 ± 11.9, p = 0.014). There was no statistical difference between two groups at the time of implant removal (82.1 ± 9.3 vs. 80.9 ± 8.8, p = 0.272) and postoperatively 1 year (83.5 ± 7.8 vs 82.6 ± 8.2, p = 0.723). No patients experienced surgical wound infection, deep vein thrombosis, delayed union or nonunion, implant loosening or rupture. One patient complained of tardive unilateral thigh pain at postoperatively 4 months in conventional group.

CONCLUSIONS

Both modified three-screw fixation and conventional two-screw fixation could ultimately afford satisfactory clinical and radiological outcomes with less complication for anterior pelvic ring fractures. The modified three-screw fixation might have better biomechanical strength and faster pelvic rehabilitation.

Reduced Facial Swelling and Incision Numbness After Q-Modified Eversion Carotid Endarterectomy in Patients with Severe Carotid Stenosis

BACKGROUND

Carotid endarterectomy, especially eversion carotid endarterectomy (ECEA), is a standard treatment of carotid artery stenosis but continues to have deficiencies. We have described a modified ECEA technique that focuses on the quality of life (QoL), called Q-modified eversion carotid endarterectomy (QCEA). The modifications mainly include the skin incision, surgical approach, and arterial anastomosis. The purpose of the present study was to evaluate the clinical efficacy of QCEA and the QoL of patients after QCEA.

METHODS

We performed a retrospective study of 109 patients were had undergone ECEA or QCEA from October 2016 to December 2017. The data from all interventions were prospectively collected in a dedicated database. The primary efficacy outcome was the composite of any stroke, myocardial infarction, or death through the 1-year follow-up period. The secondary endpoint was the QoL of patients after ECEA or QCEA on the seventh postoperative day, including incision hematoma, incision numbness, facial swelling, and scar length.

RESULTS

QCEA was performed in 41 patients and ECEA in 45 patients. No statistically significant differences were found in operating or clamping time between the 2 groups. The incidence of facial swelling (4.9% vs. 28.9%; P = 0.040) and incision numbness (4.9% vs. 24.4%; P = 0.011) in the QCEA group was significantly lower than that in the ECEA group. The average scar length of the QCEA group was significantly shorter than that of the ECEA group (5.1 ± 1.4 cm vs. 7.6 ± 2.1 cm; P < 0.001). No transient ischemic attack, stroke, myocardial infarction, or mortality occurred in either group during the 1-year follow-up.

CONCLUSIONS

Our results suggest that QCEA can reduce incision numbness, facial edema, and scar length, thereby improving the QoL of patients.

Reliability of Modified Harris Hip Score as a tool for outcome evaluation of Total Hip Replacements in Indian population

BACKGROUND

Standard Harris Hip Score (HHS) is a validated tool, to measure the functional status of an individual and has been traditionally used to assess the condition of a patient with hip pathologies. Harris hip score in its standard form includes a physician's physical examination component which has a high inter-observer variability. A modified version of HHS (MHHS) was devised and brought into use, but has not been validated as an outcome measure, post total hip replacement (THR) in Indian population.

METHODS

101 patients with 122 hips for whom THR was done, were followed up, and HHS and MHHS were recorded at a minimum followup of 6 months.

RESULTS

The mean MHHS was 78.97 with a standard deviation of 15.017. There was positive correlation between the two functional outcome scores with a p value of 0.001. MHHS was found to be reliable with a significant intraclass correlation coefficient (p = 0.001).

CONCLUSION

MHHS is a reliable and valid tool to measure functional outcome in patients undergoing Total Hip Replacements.

Treatment results for acetabulum fractures using the modified Stoppa approach

Objectives

The aim of this study was to evaluate the clinical and radiological results of the surgical treatment of acetabular fractures using modified Stoppa approach.

Methods

A total of 57 patients (mean age 37.8 years; range 15–84) who underwent surgical treatment for acetabular fracture with modified Stoppa approach from February 2013 to June 2016 were included into the study. The mean follow-up time was 28.1 months (range 24–35). The records were reviewed for fracture patterns, time to surgery, operative time, blood loss, reduction quality, and perioperative complications. Reduction quality was graded as anatomic, imperfect, or poor. The Harris Hip Score (HHS) and Merle d'Aubigné score were used for functional evaluation.

Results

Among the 63 acetabulum fractures of the 57 patients, 27 were associated with both columns, 12 were T-type fractures, 10 were transverse, 7 were anterior column/posterior hemitransverse, 5 were anterior column, and 2 were anterior wall fracture. A single surgeon performed all operations. Pfannenstiel incision was used in the first 19 cases while vertical midline incision in the remaining 38 cases. Average time to operation was 5.5 days, and supplemental lateral windows were used in 17 (29.8%) patients. Average blood loss and operation times were 660 mL and 152 min, respectively. Radiological outcomes were anatomic, imperfect, and poor in 52 (82.5%), 9 (14.2%), and 2 (3.2%) of the acetabulum fractures, respectively. Clinical outcomes at 2 years with HHS and Merle d’Aubigné scores were mean 86.6 (range 66–96) (Excellent in 27, good in 23, fair in 4, poor in 3 patient) and 16.7 (range 10–18) (Excellent in 25, very good in 18, good in 6, fair in 5, poor in 3 patient), respectively. There was a significant relation between the reduction quality and clinical outcome (p < 0.001), while there was no significant relation between the clinical outcome and the fracture type (p > 0.05). Iatrogenic external iliac vein damage was noted in 2 patients. Obturator nerve palsy was noted in 3 patients, who recovered spontaneously at mean time of 3.7 months (range 3–5). Rectus abdominus paralysis was noted in 2 of the 19 (10.5%) Pfannenstiel-incision patients but not in the vertical-incision patients.

Conclusion

Our experience in 57 patients shows that satisfactory results can be obtained, even in bilateral fractures with vertical midline incision.

Level of evidence

Level IV Therapeutic Study

Traumatic Spino-pelvic Dissociation with Bilateral Triangular Fixation

OBJECTIVE

To evaluate the clinical outcomes of traumatic spino-pelvic dissociation (TSD) treated with modified bilateral triangular fixation.

METHODS

Eighteen consecutive patients of TSD were included in the study from March 2011 to March 2015, and the medical records of patients were reviewed retrospectively. There were 14 men and 4 women with an average age of 33.1 ± 1.4 years (range, 18-55 years). A total of 16 cases were caused by falling, and 2 cases were caused by traffic accident. All sacral fractures had associated injuries. According to the morphology of sacral fracture, U-shaped fractures were present in 10 cases, H-shaped fractures in 6 cases, and Y-shaped fractures in 2 cases. According to Roy-Camille classification, there were 12 cases of type II and 6 cases of type III. All patients received surgical treatment with modified bilateral triangular fixation, and the sacral plexus decompression was performed simultaneously on 6 cases whose scores were more than 2 according to Gibbons classification and were found having traumatic canal stenosis or sacral nerve compression detected by preoperative imaging examination. Mears' radiological evaluation criterion was applied to evaluate the reduction quality of fractures; Gibbons score was applied as the index of neurological deficiency healing, and the clinical outcome of fracture was evaluated with Majeed function assessment at last follow-up.

RESULTS

All patients were followed up continuously within an average of 32.4 ± 3.6 months (range, 22-48 months). All sacral fractures were healed in an average time of 11.3 ± 2.8 months (range, 8-28 months). According to the Majeed function evaluation, 12 cases were classified as excellent, 4 cases as good, and 2 cases as fair. Meanwhile, the anatomical reduction was obtained in 11 cases, satisfactory reduction in 6 cases, and unsatisfactory reduction in 1 case according to Mears' radiological evaluation criterion. The average Gibbons score changed from 2.5 ± 0.2 preoperatively to 1.4 ± 0.5 24 months postoperatively, which had a significant difference (t = 2.15, P < 0.05).

CONCLUSION

Modified triangular fixation combined with internal fixations shows satisfactory clinical outcomes in the treatment of TSD, which is recommended as an effective and advanced surgical choice.