Investigation of gadolinium doped manganese nano spinel ferrites via magnetic hypothermia therapy effect towards MCF-7 breast cancer

Magnetic spinel ferrite nanoparticles (MSF-NPs) are potential candidates for biomedical applications, especially in cancer diagnosis and therapy due to their excellent physiochemical and magnetic properties. In the current study, MSF-NPs were fabricated by sol-gel auto combustion method. The crystal structure and surface morphology were confirmed by X-ray diffraction (XRD) and scanning electron microscopy (SEM). The magnetic properties were studied by VSM (vibrating sample magnetometer). As increasing Gd3+ concentration, the saturation magnetization values decreased from (17.8-2.3) emu/g, while the coercivity decreased from (499-133) Oe at room temperature. Finally, the fabricated MSF-NPs were tested against anticancer activity by MTT assay. The IC50 = 21.27 μg/mL value was observed, showing the strong antiproliferative activity of these nanoparticles. These results suggested that the obtained MSF-NPs would be useful for remote-controlled hyperthermia therapy for cancer treatment and MRI application due to their excellent magnetic properties. These distinct properties make MSF-NPs most suitable for cancer treatment and bright Contrast Agents (T1-MRI).

Evaluation of in vitro anticancer potential of pharmacological ethanolic plant extracts Acacia modesta and Opuntia monocantha against liver cancer cells

Abstract Acacia modesta (AM) and Opuntia monocantha (OM) are distributed in Pakistan, Afghanistan and India. Both of these plants have different pharmacological properties. This study was designed to evaluate anticancer potential of Acacia modesta (AM) and Opuntia monocantha (OM). Liver cancer cell line HepG2 was used for assessment of anticancer activity. For the evaluation of anti-proliferative effects, cell viability and cell death in all groups of cells were evaluated via MTT, crystal violet and trypan blue assays. For the evaluation of apoptosis ELISA of p53 performed. Furthermore, LDH assay to find out the ability of malignant cells to metabolize pyruvate to lactate and antioxidant enzymes activity (GSH, CAT and SOD) at the end HPLC was performed to find active compound of AM and OM. Cytotoxicity (MTT), Viability assays (trypan blue, crystal viability, MUSE analysis) showed more dead, less live cells in plant treated groups with increase of concentration. Scratch assay for the anti-migratory effect of these plants showed treated groups have not ability to heal scratch/wound. ELISA of p53 for cellular apoptosis showed more release of p53 in treated groups. Antioxidant assay via glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) showed less anti-oxidative potential in treated cancer groups. LDH assay showed more lactate dehydrogenase release in treated groups compared with untreated. HPLC analysis showed the presence of phytochemicals such as steroids, alkaloids, phenols, flavonoids, saponins, tannins, anthraquinone and amino acids in AM and OM plant extracts. Based on all these findings, it can be concluded that ethanolic extracts of Acacia modesta and Opuntia monocantha have promising anti-cancer potential.

The effect of smoking on union rates following corrective osteotomies around the knee: A systematic review and meta-analysis

BACKGROUND

Distal femur osteotomies (DFO) and high tibial osteotomies (HTO), are well-established treatment options for joint preservation in active patients with uni-compartmental osteoarthritis. Optimal outcomes are contingent on adequate preoperative evaluation of patient-specific factors. This systematic review and meta-analysis aims to explore the difference in union rates between smokers and non-smokers following corrective osteotomies around the knee.

METHODS

A systematic search of the MEDLINE and EMBASE databases was performed in accordance with the PRISMA guidelines to identify studies reporting smoking status in adults who developed delayed and/or non-union following HTO or DFO. Studies were pooled using a random effect model [Review Manager (RevMan) software, V.5.4] and heterogeneity was estimated using I2.

RESULTS

Data for meta-analysis was available for 1,406 osteotomies from 10 studies, performed in patients with mean age ranging from 38-54 years, and 65% were male. The union rate among non-smokers was 97.3% (1100/1131) compared with 89.5% (246/275) among smokers; OR 4.59 [95% CI 1.99 to 10.62], p-value < 0.001. Subgroup analysis revealed that the risk of non-union in smokers after opening wedge osteotomy was almost double (OR 4.8) that of closing wedge osteotomies (OR 2.9).

CONCLUSION

Smoking increases the risk of non-union during elective knee osteotomy surgery. Our findings also suggest that smokers have a better chance of achieving union with closing wedge osteotomy compared to open wedge osteotomy.

Primary Malignant Peripheral Nerve Sheath Tumor of the Breast: A Rare Case Report

Introduction/Objective

Primary breast sarcomas are uncommon and primary mammary malignant peripheral nerve sheet tumors (MPNST) are exceptionally rare. MPNST’s are malignant variants of peripheral nerve sheath tumors. These neoplasms are often associated neurofibromatosis type I (NF-I) but can also occur sporadically. They tend to occur in the deeper soft tissues, trunk, and extremities.

Methods/Case Report

A 60-year-old female was referred to our University Hospital for evaluation of an abnormal mammogram. Patient noticed a mass in the left breast 3 months ago and mammogram showed a large solid mass located at the left superior breast. Subsequent biopsy of the left breast lesion showed high grade malignant neoplasm with differential diagnosis of malignant phyllodes tumor, primary sarcoma, and metaplastic carcinoma. The tumor was non-responsive to the initial neoadjuvant therapy. The patient underwent modified radical mastectomy. The excised tumor was well-circumscribed, tan-white, firm, measuring 9.6 x 6.1 x 4.3 cm. The neoplastic cells were positive for CD99, S-100, SOX-10, neuron specific enolase, p53, Vimentin, focally positive for neurofilament, D2-40, p63, and negative for epithelial, melanoma and other sarcoma markers. The tumor was triple negative ER, PR, HER-2, with Ki- 67 at 61%. A diagnosis of primary high grade malignant peripheral nerve sheath tumor of the breast was rendered. The patient does not have a history of NF-1. There was no lympho-vascular or perineural invasion. After the surgery, the patient followed up without complications.

Results (if a Case Study enter NA)

N/A

Conclusion

An accurate diagnosis of this rare entity is necessary because it plays a crucial role in the therapeutic options and prognosis. In our case the patient was treated with neo-adjuvant chemotherapy followed by modified radical mastectomy. The purpose of presenting this unique case is to provide awareness of the existence of this entity among pathologists and clinicians for better patient care.

56 A Quality Improvement Project to Assess and Refine the Handover Process at Morning Trauma Meetings

Aim

Poor handover and inadequate transmission of clinical information between shifts can result in patient harm. This study was designed to evaluate the impact of implementing a handover protocol on the quality of information exchanged in the trauma handover meetings in a UK district general hospital.

Method

A prospective single centre observational study was performed at an acute NHS trust, using the define, measure, analyse, improve and control (DMAIC) methodology. Ten consecutive weekday trauma meetings, involving 43 patients, were observed to identify poor practices in handover. This data was used in conjunction with the Royal College of Surgeon’s recommendations for effective handover (2007) to create a standard operating protocol (SOP). Following the implementation of the SOP, a further eight consecutive weekday trauma meetings, involving a further 47 patients, were observed. The data collection was performed by five trained independent observers. The data was analysed using t-test for quantitative variables and chi-square or Fisher’s exact tests for categorical variables.

Results

An improvement in the trauma handover was demonstrated in multiple aspects of handover including patient’s past medical history, injury date, results, diagnosis, consent, mark and starvation status (all p &lt; 0.001). Subgroup analyses showed that handover of neck of femur patients including information on mobility (p = 0.04), Nottingham Hip Fracture Score (p = 0.01), next of kin discussion (p = 0.075) and resuscitation status (p = 0.001) all improved following our interventions.

Conclusions

These results demonstrate that the implementation of a well-structured handover protocol can improve the transmission of critical information in trauma meetings.

1091 Assessment of Cauda Equina Syndrome Referrals to The Tertiary Spinal Service for Compliance with National Standards

Introduction

Urgent assessment/investigation and appropriate referral of Cauda Equina Syndrome (CES) is important in preventing morbidity and avoiding litigation. A recent GIRFT review outlined a series of guidelines on the management of patients with suspected CES. This audit aimed to assess whether CES referrals to a tertiary spinal service are compliant with GIRFT recommendations and SBNS/BASS guidelines.

Method

Retrospective review of an electronic referral system at a tertiary spinal centre over 4 months, examining CES referrals from surrounding peripheral hospitals. General Practice referrals were excluded. Data collected included patient demographics, symptoms/examination findings, timing of MRI and outcomes of the referral.

Results

A total of 48 referrals were included for analysis, mean age was 46.7 and 64% were female. 27% had no ‘red' or ‘yellow' flag signs/symptoms and were inappropriately referred. Majority did not perform pre/post void bladder scans prior to referring. 58% of all referrals were made without an MRI. 22% of those referred within ‘working hours’ were referred without MRI scan. There were significant variations in time taken to perform MRI at the referring hospital; median delay 11.1 hours (3-21hrs).

Conclusions

SBNS/BASS standards are currently not being met, which may adversely impact patient outcomes. Cost implications of patients being transferred to tertiary spinal centres who are found to have no abnormality, must be balanced against the cost of missed CES. This audit highlights the need for improvement in the quality of referrals through education and training at the referring centres.

POS0537 TRENDS AND PREDICTORS OF INPATIENT MORTALITY IN PATIENTS WITH CLOSTRIDIODES DIFFICILE INFECTION AMONG THOSE WITH AND WITHOUT RHEUMATOID ARTHRITIS: A NATIONWIDE ANALYSIS

Background:

People with rheumatoid arthritis (RA) have a higher risk of serious infections. The most common nosocomial infection in the United States (US) is Clostridioides difficile infection (CDI) and yet, little is known regarding the impact of comorbid RA on outcomes in persons hospitalized with CDI.

Objectives:

To evaluate the trends over time and predictors of inpatient mortality in hospitalized patients with CDI comparing those with and without RA.

Methods:

We used the National Inpatient Sample (NIS) database, the largest available all-payer database of inpatient hospitalizations in the US. Patients aged ≥18 years admitted with CDI from 2006-2018 were included. Patients with RA were identified using the International Classification of Diseases (ICD) 9 and 10 codes. Categorical variables between CDI patients with and without RA were compared using Chi-squared test. Temporal trends of hospitalization charges, length of stay (LOS) and inpatient mortality were assessed using the Cochrane Armitage test. Predictors of inpatient mortality were assessed using multivariable logistic regression adjusting for: age ≥65, sex, race, presence of RA, and Elixhauser comorbidity index.

Results:

There were 4,396,945 hospitalizations with a discharge diagnosis of CDI in the study period, of which 111,336 (2.5%) had a coexisting diagnosis of RA. Over the study period, the proportion of CDI patients with a diagnosis of RA increased from 1.7% in 2006 to 3.3% in 2018 with a statistically significant trend of rise (p trend<0.001). There were significantly more females in the RA group (78.2%) than without RA (57.5%), p <0.001. RA group was significantly younger (68.0 vs 70.7, P<0.001). Races were similar between the groups.

The inflation-adjusted average charge for hospitalization for CDI without RA was significantly higher than for CDI with RA ($95,863 vs $73,025, p<0.001). There was an increasing trend in inflation-adjusted average charge for hospitalization for both CDI without RA ($76,966 in 2006 to $104,552 in 2018, p<0.001) and CDI with RA ($55,689 in 2006 to $77,295 in 2018, p<0.001). Patients with or without RA had the same median length of stay (LOS) of 7 days. But when trended over time, for patients without RA, the median LOS decreased from 8 days in 2006-08 to 6 days in 2016-18 whereas for patients with RA, the median LOS fluctuated between 6 and 7 days over the course of study period.

CDI patients without RA had a significantly higher mortality over the study period than those with RA (7.8% vs 6.1%, p<0.001). Among non-RA CDI patients, mortality decreased from 9.3% in 2006 to 6.3% in 2018 (p trend <0.001). Hospitalizations of people with CDI and comorbid RA showed an overall decreasing trend (p trend <0.001).

The multivariable analyses found age≥65 was associated with increased inpatient mortality (adjusted odds ratio [aOR], 1.77, 95% confidence interval [CI], 1.73-1.80), whereas a diagnosis of RA was associated with a decreased mortality (aOR 0.86, 95% CI, 0.81-0.91) (Table 1).

Table 1.

Predictors of inpatient mortality

aOR95% C.I. for aORP-valueLowerUpperAge ≥ 651.7651.7301.801<0.001Hospitalization years -Years 2006-2011Ref -Years 2011-20140.7070.6930.721<0.001 -Years 2015-20180.5820.5690.594<0.001Elixhauser Comorbidity Index1.0561.0551.056<0.001Rheumatoid Arthritis0.8590.8100.911<0.001Female0.8700.8550.885<0.001Race -WhiteRef -African American1.0711.0441.099<0.001 -Hispanic1.1441.1081.180<0.001 -Asian/Pacific Islander1.2671.2001.337<0.001 -Native American1.0220.9101.1470.716 -Other races1.2631.2011.329<0.001

aOR = Adjusted Odds Ratio; C.I.= confidence interval

Conclusion:

In this nationwide study, among hospitalized patients with CDI, those with comorbid RA had significantly decreased odds of inpatient mortality than those without RA. Further studies are needed to understand this association.

Figure 1.

Disclosure of Interests:

None declared

600 The Use of a Wide-Awake Local Anaesthesia No Tourniquet (WALANT) Technique in Foot and Ankle Procedures - A Randomised Control Trial

Introduction

Wide awake local anaesthesia no tourniquet (WALANT) is a widely used technique in upper limb procedures that has gained increasing popularity during the coronavirus pandemic. The benefit of WALANT for foot and ankle surgeries is less clear, especially in patients with multiple comorbities. The primary aim of this study was to compare post-operative pain levels in patients undergoing ankle fracture fixation. Secondary objectives included comparison of intra-operative patient experiences, clinical outcomes, and patient satisfaction 1-year post-procedure.

Method

129 patients presenting with ankle fractures were enrolled in a multicenter randomised control trial from February 2016 to January 2020. Patients with medial malleolar, lateral malleolar, bimalleolar or trimalleolar fractures received either WALANT (62 patients) or spinal anaesthesia (67 patients). A 5ml solution of 0.9% saline and 2% lidocaine with 1: 100,000 adrenaline was used for WALANT.

Results

Compared to patients who received spinal anaesthesia, those in the WALANT group experienced less post-operative discomfort and were more satisfied 1-year post-procedure (p-value = 0.003). Surgical outcomes were similar for both groups. Cost analysis revealed that WALANT is significantly more economical.

Conclusions

WALANT is an effective and safe anaesthetic for foot and ankle procedures. Without use of a tourniquet, it reduces post-operative pain and so, eases patient recovery.

49 A Quality Improvement Project to Assess and Refine the Handover Process at Morning Trauma Meetings

Introduction

Poor handover between shifts can result in patient harm. This study was designed to evaluate the impact of implementing a handover protocol on the quality of information exchanged in the trauma handover meetings in a UK hospital.

Method

A prospective single-centre observational study was performed at an NHS Trust. Ten consecutive weekday trauma meetings, involving 43 patients, were observed to identify poor practices in handover. This data was used in conjunction with the Royal College of Surgeons’ recommendations for effective handover (2007) to create and implement a standard operating protocol (SOP). Following its implementation, a further 8 consecutive meetings, involving a further 47 patients, were observed. The data was analysed using t-test for quantitative variables and chi-square or Fisher’s exact tests for categorical variables.

Results

An improvement was demonstrated in multiple aspects of trauma handover including past medical history, injury date, results, diagnosis, consent, mark, and starvation status (all p &lt; 0.001). Subgroup analyses showed that handover of neck-of-femur fracture patients including information on baseline mobility (p = 0.04), Nottingham-Hip-Fracture Score (p = 0.01), next-of-kin discussion (p = 0.075) and resuscitation status (p = 0.001) all improved following the intervention.

Conclusions

These results demonstrate that the implementation of a well-structured handover protocol can improve the transmission of critical information in trauma meetings.

175 Open vs MIS Lumbar Surgery: A Systematic Review of Cost Effectiveness

Introduction

Minimally invasive surgery has benefits over open surgery for lumbar decompression and/or fusion but there is no established consensus regarding its cost effectiveness.

Method

A systematic electronic search of databases (MEDLINE, EMBASE and Cochrane Library) and manual search from the Cost Effectiveness Analysis (CEA) database and NHS Economic Evaluation Database (NHS EED). Two authors reviewed abstracts against exclusion criteria. Studies including adult populations undergoing surgery for degenerative changes (lumbar stenosis, lumbar radiculopathy, spondylolisthesis) of the lumbar spine, reporting outcomes of costing analysis, CEA or Incremental cost effectiveness ratio (ICER) were included.

Results

Two of the 5 studies comparing open vs single level MIS fusion surgery (TLIF) reported a statistically significant reduction in direct cost for MIS compared to open surgery. The mean non-inflation adjusted cost was $31,626, and $34757 for the MIS and open TLIF groups respectively.

One paper comparing open versus MIS two level TLIF reported a statistically significant difference in costing but not in QALYs.

Conclusions

Generally, studies reported a reduced cost associated with MIS versus open surgery. One study reported a statistically significant change in QALY. The majority had a high risk of bias. This review was unable to recommend MIS over open surgery from a cost effectiveness perspective.

383 An International Comparison of Competency-Based Orthopaedic Curricula and Minimum Operative Numbers

Introduction

The requirements for completion of surgical training can vary across different countries. This review aims to assess key differences among orthopaedic curricula in selected high-income countries, focusing on their criteria for assessing technical competence for completion of training.

Method

Current orthopaedic training curricula in the UK, USA, Canada, Australia, and Germany were reviewed. Data extracted included training duration, minimum or desirable operative experience requirements, methods, and timing of in-training assessments.

Results

The overall training duration ranged between 9-10 years in the UK and Australia, compared to 5-6 years in all other countries. While operative logbook was an essential component of formative and end-of-training reviews in all countries, minimum indicative numbers in index operations were a requirement only in the UK (minimum total required; 1800, index operations; 365) and USA (minimum total required; 1000, index operations; 455). On average, USA residents performed 1,700 procedures compared to German residents performing 730 procedures before completion of training.

Conclusions

There is a lack of robust data describing the operative experiences of orthopaedic trainees outside of the UK and USA. Contrary to common perception, surgeons exiting training and entering independent practice in the above countries are not trained to the same minimum standard.

333 Management of Distal Radius Fractures During The COVID-19 Crisis

Introduction

Distal radius fractures are common. Treatment depends on a multitude of factors including the pattern / displacement of the fracture, patient age, pre-morbid function, and surgeon preference. We aim to investigate the effect of the pandemic on the management and short-term outcomes of patients with DRF’s.

Method

Retrospective review of all adult DRF’s two months before and after BOA released emergency standards on trauma management. The primary outcome measure was the proportion of patients managed non-operatively before and during COVID-19. Data extracted: demographics, comorbidities, cognitive baseline, treatment, and follow-up. Radiographs were reviewed for displacement [dorsal tilt (>10^o), ulnar variance (>3mm), intra-articular step (>2mm)].

Results

Pre-COVID (n = 29), COVID (n = 35). Characteristics were comparable in terms of median age (66 and 72 years, p = 0.41), %aged ≤65 (48% and 37%, p = 0.37), dominant side fracture (36% and 40%, p = 0.52), presence ≥ 2 co-morbidities (41% and 43%, p = 0.91). More patients were managed non-operatively during COVID (86% vs. 69%, p = 0.11), 2 of whom had unstable fracture pattern and developed malunion, compared to none in pre-COVID period.

Conclusions

Management of DRF’s remains a controversial topic, particularly in age <65 years. Long term follow up of patients with significant fracture displacement managed conservatively during COVID pandemic could help guide future practice.

Effects of Bacillus sp. MR-1/2 and magnetite nanoparticles on yield improvement of rice by urea fertilizer under different watering regimes

AIMS

The present research aimed to examine the use of magnetite nanoparticles (MNPs) in combination with phyto-beneficial rhizobacterium (PhBR) for improvement of applied N recovery (ANR) from urea fertilizer in rice grown under deficient and optimum watering conditions.

METHODS AND RESULTS

The Bacillus sp. MR-1/2 was positive for acetylene reduction, phosphate solubilization and ACC deaminase activity at temperature ranges 35-45°C. In a pot experiment, urea, MNPs and Bacillus sp. MR-1/2 were applied either alone or in combination to rice plants grown in pots under water deficit and optimal watering conditions. Combined application of urea, MNPs and Bacillus sp. MR-1/2 increased the plant N content and ANR by 27 and 65%, respectively, over their respective control values in rice grown under optimum watering conditions, whereas these increases were 27 and 41%, respectively, in rice grown under water deficit conditions. This treatment also increased the kernel weight and plant dry matter by 36 and 60%, respectively, over control (urea alone) values in rice grown under water deficit conditions, whereas these increases were 31 and 21·8%, respectively, in rice grown under optimum watering conditions. Values of malondialdehyde (MDA) contents, ascorbate peroxidase (APX), catalase and ethylene concentration were higher in control treatment under both the watering regimes. The application of Bacillus sp. MR-1/2 either alone or in combination with MNPs and urea reduced MDA contents, APX, catalase and ethylene production in the rice plants.

CONCLUSION

The combined application of MNPs+Bacillus sp. MR-1/2 reduced the N losses from applied urea, increased N uptake and ANR in rice, decreased MDA contents, APX and catalase activity and ethylene level in rice grown under deficit and optimum water conditions.

SIGNIFICANCE AND IMPACT OF THE STUDY

The application of MNPs together with Bacillus sp. MR-1/2 may help to increase ANR and rice productivity under water deficit conditions with low cost of production.

“Clots and Failures” A Case of COVID-19 Causing STEMI and Persistent Cardiogenic Shock Ultimately Requiring LVAD

Introduction

We present a case of COVID-19 causing hypercoagulability and inflammatory stress leading to STEMI in a patient who went on to develop persistent cardiogenic shock requiring LVA) implantation.

Case Report

57-year-old lady developed COVID-19 infection in May 2020. In June 2020, she presented with chest pain, was noted to have STEMI on EKG, complicated by cardiac arrest with ROSC in 14 minutes. She was in cardiogenic shock as well and was started on veno-arterial ECMO. She underwent left anterior descending artery stent placement. Further hospitalization was complicated by persistent cardiogenic shock and complete heart block and underwent pacemaker and cardiac-defibrillator implantation. She developed pulmonary edema, acute kidney injury requiring hemodialysis, shock liver, and persistent cardiogenic shock. She was weaned off VA-ECMO after 4 days but continued to have severely reduced cardiac function. RHC revealed severe volume overload, pulmonary venous hypertension, low cardiac output, and right heart dysfunction. Echo showed severe LV dysfunction with an EF of 15%. A femoral intra-aortic balloon pump(IABP) was placed on July 7, 2020. An attempt was made to wean her off of IABP on July 10^th,however, it was unsuccessful and she was transitioned to axillary intra-aortic balloon pump. She remained IABP dependent thereafter and on July 15th, given persistent cardiogenic shock, decision was made to pursue advanced heart failure therapies. After multi-disciplinary discussion, the decision to pursue LVAD implantation was made. She underwent a successful LVAD implantation on July 20^th . She failed an extubation trial and underwent tracheostomy on July 23^rd . Post LVAD, she developed atrial fibrillation and was started on digoxin and amiodarone. Her symptoms improved and she was subsequently discharged to rehabilitation in late August on amiodarone, digoxin, metoprolol, prasugrel, warfarin, spironolactone and lisinopril. The detailed timeline is shown in figure 1.

Summary

Hypercoagulability and severe inflammatory stress leading to life-threatening illness is a significant complication of COVID-19 infection. A low threshold for suspecting and treating hypercoagulability and inflammatory induced myocardial ischemia and injury and cardiogenic shock is a reasonable strategy to decrease acute as well as chronic morbidity and mortality.

ECMO for Critically Ill COVID-19 with ARDS: A Case Series

Introduction

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) as bridge to recovery in critically ill COVID-19 continues to be commonly utilized strategy in cases with persistent respiratory failure refractory to traditional ventilation support

Case Report

We report 5 cases of severe acute respiratory syndrome coronavirus-2 infection (SARS-CoV-2) who were treated with ECMO (Table 1). All 5 cases presented with fever, cough and shortness of breath and a positive nasopharyngeal swab for SARS-CoV-2 on admission. Case 1, 2, 3 and 5 patients were hypoxemic with saturation less than 90% on admission and decompensated rapidly, whereas Case 4 decompensated after day 14. Mechanical ventilation failed to provide adequate oxygenation in all 5 cases; case 2,3 and 5 were started on recruitment measures with proning while it was not possible for case 1 owing to morbid obesity. Proning was not possible in the case 4 as patient became severely hypoxemic while patient was undergoing mechanical thrombectomy. The case 1-4 remained on ECMO for 19, 17, 17 and 2 days respectively. All except case 2 had improvement in APACHEII and SOFA score after ECMO initiation. All 5 patients had elevated inflammatory markers of serum ferritin, D-dimer, Lactate dehydrogenase (LDH), C-reactive protein (CRP) which trended down after a few days of ECMO initiation All 5 patients received high dose steroids during their stay in the ICU. Case 4 and 5 passed away after compassionate extubation. Case 1-3 had prolonged hospital course with complication of hospital acquired pneumonia requiring multiple courses of broad-spectrum antibiotics.

Summary

Our observational report of 5 patients reports the use of ECMO in critically ill SARS-CoV-2 with ARDS and difficult to maintain saturation despite mechanical ventilation and proning with recovery for 3 patients. However, given the lack of ECMO centers; this is not a readily available option. Further studies are warranted to investigate the role of ECMO in SARRS-CoV-2 and careful identification of appropriate candidates.

Using caputo-fabrizio derivative for the transmission of mathematical model epidemic Corona Virus

Just in a week a rapidly spreading corona virus which was originated in Wuhan, city of China, infected more than 20,000 people and also killed at least 427 people in that week worldwide. Corona virus is transmissible and spreading from person to person, while the Chinese commanded authorities are scrambling to treat a flood of new patients in Chines successfully. The said Corona virus has been spread from an initial outbreak in Wuhan, city of China, and invade 25 other worldwide countries. In this article, we considered the mathematical model (Chen et al. Infect Dis Poverty, https://doi.org/10.1186/s40249-020-00640-3) in which Bats-Hosts-Reservoir-People and their transmission was taken, while we introduced the population of susceptible Bats and visitors to Wuhan city or any country in same mathematical model. Now we studying two types of populations first Bats-Hosts-Reservoir-People (Chen et al. Infect Dis Poverty, https://doi.org/10.1186/s40249-020-00640-3, also introducing susceptible Bats and second visitors to Wuhan city, china or any country in the same model. We used Caputo-Fabrizio derivative with provided result that the addition of susceptible Bats and visitors are not responsible in spread of infection. The numerical result also supported our model.

Is implantable loop recorder the answer to reduce the increased risk of stroke in cancer patients?

Introduction

Recent epidemiologic data suggests increased risk of ischaemic stroke in cancer patients. The etiology of increased ischaemic stroke is unknown. Atrial fibrillation (AF) is among the potential etiologies. The risk of AF has not been studied among cancer patients in the United States.

Purpose

Ascertain the association of AF in cancer patients in the USA by using the largest database i.e. National Inpatient Sample (NIS).

Methods

Patients ≥18 years old were selected in the NIS database for years 2010 to 2014 and stratified based on presence or absence of any of four cancers (lung, colon, breast and prostate; 4CA) using ICD 9 codes. Atrial fibrillation and stroke/TIA were also identified using ICD 9 codes. Components of CHADS2 score (CHF, hypertension, Age&gt;75, diabetes and stroke/TIA) were identified using ICD 9 codes. χ2 tests performed for prevalence of AF in patients with or without these cancers stratified by CHADS2 score. Binary logistic regression was used to analyze individual components of CHADS2 score.

Results

AF and stroke/TIA were significantly higher among 4CA than non-4CA group (18.7% vs 12.0%, P&lt;0.001 and 5.4% vs 4.8%, P&lt;0.001 respectively). AF prevalence increased with CHADS2 and was significantly higher in 4CA group with CHADS2 score 0 to 4 (Table 1 and Figure 1). Logistic regression for the outcome of AF showed “Age &gt;75” OR (3.0), CHF (2.8), CVA (1.2), HTN (1.3) and DM (1.1).

Conclusion

This is the first study using a national database of USA patients to estimate prevalence of AF in cancer patients compared to non-cancer patients and reaffirms the higher burden of AF in cancer patients. Prevalence of both AF and stroke were greater in cancer patients when stratified by CHADS2 score. This may indicate not just an increased risk of AF but an increased risk of stroke/TIA for the same CHADS2 score. Stroke incidence was also higher in the 4CA group (5.4% vs. 4.8% P&lt;0.001). Cancer patients with CHADS2 score &gt;1 may benefit from screening with loop recorder to identify previously undetected AF and initiate anticoagulation therapy. Prospective longitudinal studies are needed to validate this retrospective study.

Funding Acknowledgement

Type of funding source: None

Principal components analysis of Raman spectral data for screening of Hepatitis C infection

In the current study, Raman spectroscopy is employed for the identification of the biochemical changes taking place during the development of Hepatitis C. The Raman spectral data acquired from the human blood plasma samples of infected and healthy individuals is analysed by Principal Components Analysis and the Raman spectral markers of the Hepatitis C Virus (HCV) infection are identified. Spectral changes include those associated with nucleic acidsat720 cm^-1, 1077 cm^-1 1678 (CO stretching mode of dGTP of RNA), 1778 cm^-1 (RNA), with proteins at 1641 cm^-1(amide-I), 1721 cm^-1(CC stretching of proteins) and lipids at 1738 cm^-1(CO of ester group in lipids). These differences in Raman spectral features of blood plasma samples of the patients and healthy volunteers can be associated with the development of the biochemical changes during HCV infection.

Outcomes and costs of single-step hepatitis C testing in primary care, Birmingham, United Kingdom

OBJECTIVES

In UK laboratories, the diagnostic algorithm for chronic hepatitis C (HCV) infection commonly requires two serological assays to confirm anti-HCV-antibody positivity in a serum sample followed by HCV RNA detection in a second whole-blood sample (two-step testing algorithm). A single-step algorithm (both anti-HCV antibodies and RNA tested on an initial serum specimen) has been advocated to reduce attrition rates from the care pathway.

STUDY DESIGN

To investigate the feasibility, clinical impact and relative costs of switching from a two-step to single-step testing algorithm in the laboratory, a pilot study on unselected primary care requests was undertaken.

METHODS

All primary care patients tested for HCV infection from December 2013 to April 2016 were included. The single-step testing algorithm was introduced in March 2015. Before this, the two-step algorithm was used. Patients were followed up until August 2016.

RESULTS

RNA quantitation in plasma was within one log of serum values for 21 paired samples. Although all patients in the single-step algorithm received an RNA test, only 70% completed the two-step testing algorithm; differences in referral rates to specialist care was due to 30% of HCV antibody-positive patients in the two-step algorithm not having follow-up whole-blood sampling for HCV RNA testing. Costs per new diagnosis and new diagnosis referred to specialist care were lower in single-step testing by £94.32 and £144.25, respectively.

CONCLUSION

This study provides further evidence that a single-step testing algorithm, as recommended in the UK Standards for Microbiology Investigation, works in practice and should be the standard of care for screening for chronic HCV.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Alectinib (Alecensa)-induced reversible grade IV nephrotoxicity: a case report and review of the literature

BACKGROUND

Lung cancer is among the top causes of cancer-related mortality in men and is the second most common cancer after breast cancer in women. There are approximately 234,030 new cases of lung cancer and 154,050 deaths from lung cancer in 2018 as per the latest American Cancer Society's report. Alectinib, a more potent orally active tyrosine kinase inhibitor which was approved by the US Food & Drug Administration for anaplastic lymphoma kinase-positive lung adenocarcinoma, has been shown to have a reasonable safety profile when compared with other anaplastic lymphoma kinase-targeted therapy. As per research studies, grade 1 or 2 renal impairment has been reported but grade 4 renal toxicity due to alectinib has not been reported so far. We report a case of acute renal failure caused by alectinib which necessitated emergency dialysis. This is the first case report describing the severe renal toxicity of alectinib.

CASE PRESENTATION

We describe a case of 72-year-old Taiwanese man diagnosed with stage IV anaplastic lymphoma kinase-positive adenocarcinoma of the lung initially treated with crizotinib for over a year, which was switched to alectinib due to disease progression with brain metastasis. Within 6 weeks of starting alectinib, he developed acute renal failure needing emergency dialysis support. His renal failure was secondary to acute tubular necrosis and had a complete reversal within 7-10 days on withdrawing the medication. When he was re-challenged with alectinib, his creatinine started to worsen again which confirmed the renal toxicity of alectinib.

CONCLUSIONS

This case emphasizes the uncommon adverse effect of the anaplastic lymphoma kinase-targeted therapy alectinib causing acute renal failure manifesting as acute tubular necrosis. Recognition of alectinib nephropathy requires a thorough drug history and knowledge of risk factors that lessen its margin of safety at therapeutic ingestions. Frequent monitoring of renal functions and early nephrology referral significantly reduce the mortality and morbidity of these patients.

Rubber contact mechanics: adhesion, friction and leakage of seals

We study the adhesion, friction and leak rate of seals for four different elastomers: Acrylonitrile Butadiene Rubber (NBR), Ethylene Propylene Diene (EPDM), Polyepichlorohydrin (GECO) and Polydimethylsiloxane (PDMS). Adhesion between smooth clean glass balls and all the elastomers is studied both in the dry state and in water. In water, adhesion is observed for the NBR and PDMS elastomers, but not for the EPDM and GECO elastomers, which we attribute to the differences in surface energy and dewetting. The leakage of water is studied with rubber square-ring seals squeezed against sandblasted glass surfaces. Here we observe a strongly non-linear dependence of the leak rate on the water pressure ΔP for the elastomers exhibiting adhesion in water, while the leak rate depends nearly linearly on ΔP for the other elastomers. We attribute the non-linearity to some adhesion-related phenomena, such as dewetting or the (time-dependent) formation of gas bubbles, which blocks fluid flow channels. Finally, rubber friction is studied at low sliding speeds using smooth glass and sandblasted glass as substrates, both in the dry state and in water. The measured friction coefficients are compared to theory, and the origin of the frictional shear stress acting in the area of real contact is discussed. The NBR rubber, which exhibits the strongest adhesion both in the dry state and in water, also shows the highest friction both in the dry state and in water.

Commensurability oscillations in a periodically modulated phosphorene

The recent experimental realization of high-quality phosphorene leads to novel electronic and optical properties with possible new device applications due to its huge direct band gap. We study the commensurability or Weiss oscillations in monolayer phosphorene in the presence of a weak perpendicular magnetic field B and a weak and periodic, electric or magnetic one-dimensional modulation. Either modulation broadens the Landau levels into bands, whose width oscillates with B, and the oscillations appear in the electrical conductivity perpendicular to the modulation taken along the direction (x) of the smaller effective mass. Compared with the oscillations of the diffusive conductivity in a two-dimensional electron gas (2DEG) for typical electron densities [Formula: see text], the ones in phosphorene, with typical [Formula: see text], have approximately similar height but a period significantly smaller when plotted versus [Formula: see text] while plotted versus B they occur at significantly higher fields. The Shubnikov-de Haas oscillations exhibit a similar behaviour. When the modulation is taken along the direction (y) of the larger effective mass, the oscillation period is close to that of a 2DEG. For equal modulation strengths the bandwidth due to a magnetic modulation is one order of magnitude larger than that due to an electric one and the amplitude of the oscillations in the diffusive conductivity about 50 times larger. Numerical results are presented for experimentally relevant parameters.

Intercalation of Anthraquinone-2-Sulphonate into Magnesium- Aluminum Layered Double Hydroxide and its Calcined Products by Ion Exchange and Memory Effect Properties

<p>Layered double hydroxide of Mg-Al-nitrate system (LDH) was prepared and its heat<strong>-</strong>treated products (LDHTs) were obtained by calcining the LDH at 250–750 °C, for 5 hours at atmospheric condition. The LDH and the LDHTs were used as an inorganic host for the intercalation of AQ2 via ion exchange or memory effect property by exposing the LDH and LDHTs in aqueous solution containing an anion, anthraquinone-2-sulfonate (AQ2) for the formation of an organic-inorganic layered nanohybrid materials. X-ray diffractograms showed that the layered structure of LDH collapsed when it was heated at around 350 °C, and an oxide phase, MgAl₂O₄ appeared. Due to the memory effect property, the regeneration of LDH from LDHT was observed and at the same time the AQ2 was intercalated when LDHT was treated with the aqueous solution containing AQ2. As a result, formation of an organic-inorganic layered nanohybrid material was also observed. Similarly, the same material can be formed by ion exchange of LDH with AQ2. The basal spacing of LDH was found expanded from 8.1 Å to around 20 Å in the resulting nanohybrid. This is to accommodate a bigger size of the AQ2 moiety with specific orientation inside the interlamella of the inorganic layered structure that warrants the layer expansion. Incomplete intercalation and ion exchange process resulted in a mixed LDH and a nanohybrid phase as observed in the PXRD pattern of the resulting material.</p>

The effect of surface roughness and viscoelasticity on rubber adhesion

Adhesion between silica glass or acrylic balls and silicone elastomers and various industrial rubbers is investigated. The work of adhesion during pull-off is found to strongly vary depending on the system, which we attribute to the two opposite effects: (1) viscoelastic energy dissipation close to an opening crack tip and (2) surface roughness. Introducing surface roughness on the glass ball is found to increase the work of adhesion for soft elastomers, while for the stiffer elastomers it results in a strong reduction in the work of adhesion. For the soft silicone elastomers a strong increase in the work of adhesion with increasing pull-off velocity is observed, which may result from the non-adiabatic processes associated with molecular chain pull-out. In general, the work of adhesion is decreased after repeated contacts due to the transfer of molecules from the elastomers to the glass ball. Thus, extracting the free chains (oligomers) from the silicone elastomers is shown to make the work of adhesion independent of the number of contacts. The viscoelastic properties (linear and nonlinear) of all of the rubber compounds are measured, and the velocity dependent crack opening propagation energy at the interface is calculated. Silicone elastomers show a good agreement between the measured work of adhesion and the predicted results, but carbon black filled hydrogenated nitrile butadiene rubber compounds reveal that strain softening at the crack tip may play an important role in determining the work of adhesion. Additionally, adhesion measurement under submerged conditions in distilled water and water + soap solutions are also performed: a strong reduction in the work of adhesion is measured for the silicone elastomers submerged in water, and a complete elimination of adhesion is found for the water + soap solution attributed to an osmotic repulsion between the negatively charged surface of the glass and the elastomer.

Molecular diversity of Pakistani mango (Mangifera indica L.) varieties based on microsatellite markers

Understanding the genetic diversity of different Pakistani mango varieties is important for germplasm management and varietal characterization. Microsatellites are efficient and highly polymorphic markers for comparative genome mapping, and were used in the present study to determine the genetic relatedness and variability among 15 indigenous mango cultivars (Mangifera indica L.). Overall, 181 bands were produced using 12 simple sequence repeat (SSR) primers. Out of the 12 primers used, 10 were polymorphic and two were monomorphic. Genetic relatedness among cultivars was assessed by constructing a dendrogram using the unweighted pair group method of arithmetic means. The accessions exhibited coefficients of similarity ranging from 75 to 100%, indicating the frequent use of only a few parent cultivars and the presence of inbreeding. The primers used in the present study were found to be valuable for identifying genetic relationships among mango cultivars.

Unconventional quantum Hall effect in Floquet topological insulators

We study an unconventional quantum Hall effect for the surface states of ultrathin Floquet topological insulators in a perpendicular magnetic field. The resulting band structure is modified by photon dressing and the topological property is governed by the low-energy dynamics of a single surface. An exchange of symmetric and antisymmetric surface states occurs by reversing the light's polarization. We find a novel quantum Hall state in which the zeroth Landau level undergoes a phase transition from a trivial insulator state, with Hall conductivity [Formula: see text] at zero Fermi energy, to a Hall insulator state with [Formula: see text]. These findings open new possibilities for experimentally realizing nontrivial quantum states and unusual quantum Hall plateaus at [Formula: see text].

Floquet edge states in germanene nanoribbons

We theoretically demonstrate versatile electronic properties of germanene monolayers under circularly, linearly, and elliptically polarized light. We show for the high frequency regime that the edge states can be controlled by tuning the amplitude of the light and by applying a static electric field. For circularly polarized light the band gap in one valley is reduced and in the other enhanced, enabling single valley edge states. For linearly polarized light spin-split states are found for both valleys, being connected by time reversal symmetry. The effects of elliptically polarized light are similar to those of circularly polarized light. The transport properties of zigzag nanoribbons in the presence of disorder confirm a nontrivial nature of the edge states under circularly and elliptically polarized light.

Neutrophil proteomic analysis reveals the participation of antioxidant enzymes, motility and ribosomal proteins in the prevention of ischemic effects by preconditioning

Intestinal ischemia and reperfusion injury are widely used models, which result into tissue injury and multiple organ failure also observed after trauma and surgery. Ischemic preconditioning (IPC) preceding ischemia and reperfusion (IR) was shown to attenuate this injury and has a potential therapeutic application; however the exact underlying mechanism is not clear. Neutrophils play an important role in the mechanism of injuries caused by ischemia and reperfusion while IPC led to a decrease in neutrophil stimulation and activation. The effect of preconditioning on the neutrophil proteome is unclear. Proteomic analysis has been ratified as an appropriate tool for studying complex systems. In order to evaluate the effect of IPC preceding 45min of ischemia on the proteome of neutrophils we used Wistar rats divided in four experimental groups: Control, sham laparotomy, intestinal ischemia reperfusion and ischemic preconditioning. After neutrophil separation, proteins were extracted, trypsin digested and the resulting peptides were iTRAQ labeled followed by HILIC fractionation and nLC-MS/MS analysis. After database searches, normalization and statistical analysis our proteomic analysis resulted in the identification of 2437 protein groups that were assigned to five different clusters based on the relative abundance profiles among the experimental groups. The clustering followed by statistical analysis led to the identification of significantly up and downregulated proteins in IR and IPC. Cluster based KEGG pathways analysis revealed up- regulation of actin cytoskeleton, metabolism, Fc gamma R mediated phagocytosis, chemokine signaling, focal adhesion and leukocyte transendothelial migration whereas downregulation in ribosome, spliceosome, RNA transport, protein processing in endoplasmic reticulum and proteasome, after intestinal ischemic preconditioning. Furthermore, enzyme prediction analysis revealed the regulation of some important antioxidant enzymes and having their role in reactive oxygen species production. To our knowledge, this work describes the most comprehensive and detailed quantitative proteomic study of the neutrophil showing the beneficial role of ischemic preconditioning and its effects on the neutrophil proteome. This data will be helpful to understand the effect of underlying protective mechanisms modulating the role of PMNs after IPC and provide a trustworthy basis for future studies.

BIOLOGICAL SIGNIFICANCE

Preconditioning is a relevant strategy to overcome clinical implications from ischemia and reperfusion. Such implications have the neutrophil as a major player. Although many publications describe specific biochemical and physiological roles of the neutrophil in such conditions, there is no report of a proteomic study providing a broader view of this scenario. Here we describe a group of proteins significantly regulated by ischemia and reperfusion being such regulation prevented by preconditioning. Such finding may provide relevant information for a deeper understanding of the mechanisms involved, as well as serve as basis for future biomarker or drug target assays.

Electrically tunable magnetoplasmons in a monolayer of silicene or germanene

We theoretically study electrically tunable magnetoplasmons in a monolayer of silicene or germanene. We derive the dynamical response function and take into account the effects of strong spin-orbit coupling (SOC) and of an external electric filed E(z) perpendicular to the plane of the buckled silicene/germanene. Employing the random-phase approximation we analyze the magnetoplasmon spectrum. The dispersion relation has the same form as in a two-dimensional electron gas with the cyclotron and plasma frequencies modified due to the SOC and the field E(z). In the absence of SOC and E(z), our results agree well with recent experiments on graphene. The predicted effects could be tested by experiments similar to those on graphene and would be useful for future spintronics and optoelectronic devices.

Four-month outbreak of invasive meningococcal disease caused by a rare serogroup B strain, identified through the use of molecular PorA subtyping, England, 2013

Molecular PorA subtyping provides information that increasingly requires the adaptation of standard public health approaches to outbreak management. We report an outbreak of a rare subtype of meningococcal infection not previously identified in the United Kingdom (UK). The outbreak occurred in the Warwickshire area in England between February and June 2013. Molecular subtyping allowed the identification of additional cases, prompting an enhanced public health response that included efforts to identify potential social networks that might benefit from chemoprophylaxis. It also prompted swabbing to define nasopharyngeal carriage in the focal nursery and helped explain the unusual epidemiological pattern. Without subtyping to identify a link, the additional cases would have been managed as sporadic cases in accordance with current UK guidance.

18-β Glycyrrhetinic acid alleviates 2-acetylaminofluorene-induced hepatotoxicity in Wistar rats

2-Acetylaminofluorene (2-AAF) is a known hepatic carcinogen which leads to tumour formation in rodents. 18-β Glycyrrhetinic acid (18 β-GA) derived from liquorice plant has various pharmacological properties such as anti-ulcer, anti-inflammatory, antiviral, hepatoprotective and antioxidant. This study is designed to elucidate the chemopreventive properties of 18 β-GA against 2-AAF-induced liver toxicity in Wistar rats and evaluated its effect on inflammatory and tumour promotion marker and activities of different oxidative stress enzymes. Administration of 2-AAF at the dose of (50 mg/kg body weight (b.w.) intraperitoneally (i.p.)) for five consecutive days induces hepatic toxicity, inflammation, oxidative stress and hyperproliferation. Pretreatment with 18 β-GA at two different doses (45 and 75 mg kg−1 b.w.) significantly ameliorates 2-AAF-induced increased lipid peroxidation, alanine transaminase and aspartate transaminase, xanthine oxidase activities and activities of phase-II detoxifying enzymes along with the levels of glutathione content. Administration of 18 β-GA also significantly restored the expressions of proliferating cell nuclear antigen, cyclooxygenase 2, inducible nitric oxide synthase and nuclear factor κB. Furthermore, histological observations also support the preventive effects of 18 β-GA. Our findings suggest that pretreatment with 18 β-GA showed potential hepatoprotective effects via attenuation of oxidative stress, inflammation and hyperproliferation.

Segmental neck of femur fractures: A unique case report of an ipsilateral subcapital, greater trochanteric and intertrochanteric fracture and proposed management algorithm

INTRODUCTION

Neck of femur fractures are now increasingly common in an ageing population. The management is well known and has been described in great detail. Concomitant ipsilateral segmental fractures of the neck of femur (SFNOF) however are rare and their investigation and management is poorly described.

PRESENTATION OF CASE

We present the surgical management of a unique and complex case of an ipsilateral subcapital, greater trochanteric and intertrochanteric fracture sustained in an 87-year-old female following a low trauma injury. This fracture configuration has not been described in the literature to date, neither has our method of reconstruction for this fracture, namely hemiarthorplasty, trochanteric stabilising plate and cerclage wires.

DISCUSSION

15 cases from 1989 to 2011 managed by 8 different fixation devices and followed up for an average of 17 months (2-58 months). There was an initial mortality rate of 13% (n=2). All associated with low energy trauma occurred in female (n=8), and most with high energy trauma occurred in males (83%; n=5). The diagnosis was delayed or missed in 20% of cases, and the most common pattern was a concomitant undisplaced subcapital and intertrochanteric fracture (37.5%, n=6). The overall risk of avascular necrosis was 20%, with a greater risk in patients greater than 65 years of age (33%).

CONCLUSION

Ipsilateral SFNOF are rare injuries with a bimodal distribution, and carry a greater risk of AVN. We advise that all SFNOF should have pre-operative CT planning and propose an algorithm to treat these patients with a standardised surgical approach.

Novel spectral features of nanoelectromechanical systems

Electron transport through a quantum dot or single molecule coupled to a quantum oscillator is studied by the Keldysh nonequilibrium Green's function formalism to obtain insight into the quantum dynamics of the electronic and oscillator degrees of freedom. We tune the electronic level of the quantum dot by a gate voltage, where the leads are kept at zero temperature. Due to the nonequilibrium distribution of the electrons in the quantum dot, the spectral function becomes a function of the gate voltage. Novel spectral features are identified for the ground and excited states of nanomechanical oscillators that can be used to enhance the measurement sensitivity.