Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft with Fixation Using Endobutton at Femoral End and Bioabsorbable Screw at Tibial End

Anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. It can be repaired and reconstructed by open and endoscopic method, the gold standard is, however, endoscopic reconstruction. It is usually reconstructed using bone patellar tendon bone (BPTB) or Hamstring autograft. The graft is supported using endobutton at the femoral end while bioabsorbable interference screw at the tibial end. This study aimed to determine how a certain fixation procedure for quadrupled hamstring autografts worked out. This prospective observational study duration period was 1 year in which 40 patients with ACL injury were treated with arthroscopic reconstruction using hamstring autograft from January 2020 to December 2020 with 6 months follow up after surgery. On the femoral side, an endobutton was used to secure the graft, while the tibial end was secured using a bioabsorbable screw. The International Knee Documentation Committee (IKDC) scoring system was used for prospective evaluation. According to subjective IKDC scoring, 20(50.0%) results were very good, 14(35.0%) were good, 4(10.0%) were satisfactory and 2(5.0%) were bad. In 95.0% patients the state of knee joint is very good compared to preoperative state. Of all the 40 patients underwent ACL reconstruction, 38(95.0%) patients are satisfied with the results of the operation.

Escobar Syndrome with Monodactyly: A Rare Case Report

Escobar syndrome (nonlethal type of multiple pterygium syndrome) is a very rare genetic disorder. The central manifestations of Escobar syndrome are the presence of multiple pterygia, fixed joint contractures, and characteristic facies. Here, we report a case of Escobar syndrome with additional features such as monodactyly and hypoplastic pectoralis muscle.

Bioequivalence of a hybrid pegylated liposomal doxorubicin hydrochloride injection and Caelyx®: A single-dose, randomized, multicenter, open-label, two-period crossover study in patients with advanced ovarian cancer

OBJECTIVE

To evaluate the bioequivalence of a hybrid pegylated liposomal doxorubicin (PLD) hydrochloride injection with reference product Caelyx®.

METHODS

This multicenter, open-label, balanced, randomized, two-treatment, two-period, two-sequence, single-dose, crossover, bioequivalence study was conducted in female patients aged ≥18 years and ≤75 years with ovarian cancer, whose disease progressed or recurred after platinum-based chemotherapy, and who were scheduled to start PLD therapy. Patients were intravenously infused drugs over 1 h at 50 mg/m² dose two hours after breakfast on the first day of the chemotherapy cycle in period-I and crossed over to the other arm in period-II (day 29). Pharmacokinetic (PK) analyses were performed using two separate, validated liquid chromatography-mass spectrometry methods for encapsulated and unencapsulated doxorubicin.

RESULTS

Both the test and reference formulations were well-tolerated and safe. The pharmacokinetic analysis for both encapsulated and unencapsulated doxorubicin was conducted in 50 patients and PK parameters were found to be comparable between test and reference products. The geometric mean ratios (90% confidence interval) of hybrid PLD/Caelyx® were; maximum measured plasma concentration (C_max): 91.94-97.28%, area under the plasma concentration versus time from time 0 to t (AUC_0-t): 95.19-103.67%_, AUC from time 0 to ∞ (AUC_0-∞): 95.13-103.66% for encapsulated doxorubicin and for unencapsulated doxorubicin C_max: 92.08-116.46%_, AUC_0-t: 91.91-108.28%_, AUC_0-∞: 93.45-110.05%.

CONCLUSION

The PLD formulation was found to be bioequivalent to Caelyx®.

Effect of season and housing system on hematochemical attributes in rabbits of Southern Punjab, Pakistan

ABSTRACT The present study was conducted to investigate the effect of season and housing system on hematochemical attributes of rabbits in Southern Punjab, Pakistan. Adult healthy rabbits (n=30) were divided into two groups of equal size (n=15). Group I was housed in a modern cage system and group II in traditional colony system for a period of one year. Blood samples of rabbits from both groups were collected in the summer and the winter seasons and analyzed for various hematochemical attributes. Hematochemical attributes including red blood cell (RBC) count, hematocrit (HCT), mean corpuscular volume (MCV), total white blood cell (WBC) count, mixed cells (MID), granulocytes (GRA), glucose and alanine aminotransferase (ALT) were lowered significantly (P<0.05) in the summer in relation to the winter, while mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), creatinine, and cholesterol level were significantly (P<0.05) higher during the summer season. Biochemical attributes as cholesterol, triglycerides and globulin were significantly (P<0.05) lower in the caged rabbits. In conclusion, the summer season caused a significant decrease in most of the hematochemical attributes whereas housing system did not affect most of the hematochemical attributes of the rabbits under the climatic conditions of Southern Punjab, Pakistan.

Apportionment of heavy metals in a soil-water-plant system via brick kiln emissions in heavily industrialized city of Pakistan

One of the major environmental problems is the fast accumulation of brick kiln emissions near the peripheries of almost all urban centers. An enormous quantity of substandard coal, wood, rubber tires, or saw wood is used as fuel in these brick kilns, creating environmental pollution through carbon and heavy metals present in the emissions. The present study was designed to determine the distribution pattern of heavy metals in a soil-water-plant system under the influence of brick kiln emissions. Ash, soil (0-15 cm), water, and plant samples were collected from the adjacent areas of the brick kilns. Geo-accumulation index and contamination factors were used to assess the toxicity of metals to soil and plants. It was found that the concentrations of Cd in water, soil, coal, and plant samples were found in the range of 0.004-0.024 mg L^-1, 0.02-0.66, 0.002-0.042, and 0.06 to 0.07 mg kg^-1, respectively, while Pb concentration was found within the range of 0-0.08 mg L^-1, 0.30-8.60, 0.011-0, and 0.01-0.08 mg kg^-1 in water, soil, and plant samples, respectively. The concentration of Cd in brick kilns ash was in the range of 0-0.04 mg kg^-1 while Pb was found within the range of 0.01-0.05 mg kg^-1 for ash. Geo-accumulation index and contamination factor values for Cd were found higher suggesting proper pollution prevention measures to be implemented. Based on the results, it was concluded that Cd concentrations in soil, plants, and water samples were higher in the subject area due to brick kiln emissions and higher Cd concentrations in the fuel material.

Role of Early Enteral Glutamine Supplementation in Reducing Infectious Morbidity in Burn Patients: A Case-Control Study

Severe burn injury is more challenging to sustain life than a preburn status. The situation changes drastically in terms of energy demands/ expenditure and the great degree of susceptibility to infections due to the loss of amino acids. Glutamine stimulates the immune system and prevents catabolism. The bacterial translocation from the gut can be decreased by glutamine supplementation, thereby suppressing the inflammatory response. In acute burn injury, plasma and muscle glutamine depletion is observed to contribute to muscle wasting, weight loss, and infection. Patients with 20%–50% TBSA burns presenting within 24 hours of injury to the emergency department or outpatient department were included in the study. The patients were divided into two groups randomly. In group 1 (Cases), all patients were given enteral glutamine supplementation at the dose of 0.5 mg/kg/day either orally or through a nasogastric tube started within 24 hours of injury. Group 2 (Control) had all the patients in whom enteral glutamine supplementation was not given. In both groups, blood analysis for total leucocyte count (TLC) and total serum proteins (TSP) was done upon admission. On Day 4, followed by analysis every fourth day, after that, till healing occurred or the patient was taken up for grafting. Blood and wound swab cultures were done on the third day of admission, then the first week, followed by weekly cultures for 4 weeks or till healing occurred or the patient was taken up for grafting. A total of 123 patients were studied. There was a decreasing trend in the mean values of the TLC and an increasing trend in TSP in both groups. The difference became statistically significant from Day 20 onwards. The pattern of wound cultures was found to be statistically significant in Week 3 and Week 4, whereas the difference in blood culture positivity among the groups was statistically significant in Week 3. We noted, in our study, that the glutamine supplementation to the early enteral nutrition increased the TSP levels and decreased the TLC, wound, and blood culture positivity rates in the study group. Glutamine supplementation can contribute to improved immunity and reduce burn wound sepsis and bacteremia. All these combined can lead to decreased morbidity, improved wound healing, and better outcomes with lesser costs.

NeuroSAFE PROOF: study protocol for a single-blinded, IDEAL stage 3, multi-centre, randomised controlled trial of NeuroSAFE robotic-assisted radical prostatectomy versus standard robotic-assisted radical prostatectomy in men with localized prostate cancer

BACKGROUND

Robotic radical prostatectomy (RARP) is a first-line curative treatment option for localized prostate cancer. Postoperative erectile dysfunction and urinary incontinence are common associated adverse side effects that can negatively impact patients' quality of life. Preserving the lateral neurovascular bundles (NS) during RARP improves functional outcomes. However, selecting men for NS may be difficult when there is concern about incurring in positive surgical margin (PSM) which in turn risks adverse oncological outcomes. The NeuroSAFE technique (intra-operative frozen section examination of the neurovascular structure adjacent prostate margin) can provide real-time pathological consult to promote optimal NS whilst avoiding PSM.

METHODS

NeuroSAFE PROOF is a single-blinded, multi-centre, randomised controlled trial (RCT) in which men are randomly allocated 1:1 to either NeuroSAFE RARP or standard RARP. Men electing for RARP as primary treatment, who are continent and have good baseline erectile function (EF), defined by International Index of Erectile Function (IIEF-5) score > 21, are eligible. NS in the intervention arm is guided by the NeuroSAFE technique. NS in the standard arm is based on standard of care, i.e. a pre-operative image-based planning meeting, patient-specific clinical information, and digital rectal examination. The primary outcome is assessment of EF at 12 months. The primary endpoint is the proportion of men who achieve IIEF-5 score ≥ 21. A sample size of 404 was calculated to give a power of 90% to detect a difference of 14% between groups based on a feasibility study. Oncological outcomes are continuously monitored by an independent Data Monitoring Committee. Key secondary outcomes include urinary continence at 3 months assessed by the international consultation on incontinence questionnaire, rate of biochemical recurrence, EF recovery at 24 months, and difference in quality of life.

DISCUSSION

NeuroSAFE PROOF is the first RCT of intra-operative frozen section during radical prostatectomy in the world. It is properly powered to evaluate a difference in the recovery of EF for men undergoing RARP assessed by patient-reported outcome measures. It will provide evidence to guide the use of the NeuroSAFE technique around the world.

TRIAL REGISTRATION

NCT03317990 (23 October 2017). Regional Ethics Committee; reference 17/LO/1978.

Feasibility and safety of radical prostatectomy for oligo-metastatic prostate cancer: the Testing Radical prostatectomy in men with prostate cancer and oligo-Metastases to the bone (TRoMbone) trial

OBJECTIVES

To test the feasibility of randomisation to radical prostatectomy (RP) plus pelvic lymphadenectomy in addition to standard-of-care (SOC) systemic therapy in men with newly diagnosed oligo-metastatic prostate cancer.

PATIENTS AND METHODS

A prospective, randomised, non-blinded, feasibility clinical trial with an embedded QuinteT Recruitment Intervention (QRI) to optimise recruitment was conducted in nine nationwide tertiary care centres undertaking high-volume robotic surgery. We aimed to randomise 50 men with synchronous oligo-metastatic prostate cancer within an 18-month recruitment period to SOC systemic therapy vs SOC plus RP (intervention arm). The main outcome measures were: ability to randomise patients, optimised by a QRI; EuroQoL five Dimensions five Levels (EQ-5D-5L) questionnaires to capture quality-of-life (QoL) data at baseline and 3 months post-randomisation; routine clinicopathological assessment to capture adverse events and prostate-specific antigen in both arms, plus standard perioperative parameters in the surgical arm.

RESULTS

A total of 51 men were randomised within 14 months (one was subsequently deemed ineligible), with 60-83% accrual rate in centres that recruited at least two patients. All patients completed the trial follow-up; one patient in the intervention arm subsequently did not undergo the surgical intervention and one in the SOC arm refused all therapies. The QRI positively impacted recruitment. QoL data showed similarly high functioning in both study arms. Surgery for men with oligo-metastatic prostate cancer was found to be safe and had similar impact on early functional outcomes as surgery for standard indication.

CONCLUSION

It is feasible to randomise men with synchronous oligo-metastatic prostate cancer to a surgical intervention in addition to standard systemic therapies. While surgery appeared safe with no substantial impact on QoL in this feasibility study, a large randomised controlled trial is now warranted to examine treatment effectiveness of this additional component in the multimodality management of oligo-metastatic prostate cancer.

Spectrum of germline pathogenic variants using a targeted next generation sequencing panel and genotype-phenotype correlations in patients with suspected hereditary breast cancer at an academic medical centre in Pakistan

BACKGROUND

Breast cancer is the most common malignancy in women, affecting over 1.5 million women every year, which accounts for the highest number of cancer-related deaths in women globally. Hereditary breast cancer (HBC), an important subset of breast cancer, accounts for 5-10% of total cases. However, in Low Middle-Income Countries (LMICs), the population-specific risk of HBC in different ethnicities and the correlation with certain clinical characteristics remain unexplored.

METHODS

Retrospective chart review of patients who visited the HBC clinic and proceeded with multi-gene panel testing from May 2017 to April 2020. Descriptive and inferential statistics were used to analyze clinical characteristics of patients. Fisher's exact, Pearson's chi-squared tests and Logistic regression analysis were used for categorical variables and Wilcoxon rank-sum test were used for quantitative variables. For comparison between two independent groups, Mann-Whitney test was performed. Results were considered significant at a p value of < 0.05.

RESULTS

Out of 273 patients, 22% tested positive, 37% had a VUS and 41% had a negative genetic test result. Fifty-five percent of the positive patients had pathogenic variants in either BRCA1 or BRCA2, while the remaining positive results were attributed to other genes. Patients with a positive result had a younger age at diagnosis compared to those having a VUS and a negative result; median age 37.5 years, IQR (Interquartile range) (31.5-48). Additionally, patients with triple negative breast cancer (TNBC) were almost 3 times more likely to have a positive result (OR = 2.79, CI = 1.42-5.48 p = 0.003). Of all patients with positive results, 25% of patients had a negative family history of breast and/or related cancers.

CONCLUSIONS

In our HBC clinic, we observed that our rate of positive results is comparable, yet at the higher end of the range which is reported in other populations. The importance of expanded, multi-gene panel testing is highlighted by the fact that almost half of the patients had pathogenic or likely pathogenic variants in genes other than BRCA1/2, and that our test positivity rate would have only been 12.8% if only BRCA1/2 testing was done. As the database expands and protocol-driven referrals are made across the country, our insight about the genetic architecture of HBC in our population will continue to increase.

Effect of Robot-Assisted Radical Cystectomy With Intracorporeal Urinary Diversion vs Open Radical Cystectomy on 90-Day Morbidity and Mortality Among Patients With Bladder Cancer: A Randomized Clinical Trial

Importance

Robot-assisted radical cystectomy is being performed with increasing frequency, but it is unclear whether total intracorporeal surgery improves recovery compared with open radical cystectomy for bladder cancer.

Objectives

To compare recovery and morbidity after robot-assisted radical cystectomy with intracorporeal reconstruction vs open radical cystectomy.

Design, Setting, and Participants

Randomized clinical trial of patients with nonmetastatic bladder cancer recruited at 9 sites in the UK, from March 2017-March 2020. Follow-up was conducted at 90 days, 6 months, and 12 months, with final follow-up on September 23, 2021.

Interventions

Participants were randomized to receive robot-assisted radical cystectomy with intracorporeal reconstruction (n = 169) or open radical cystectomy (n = 169).

Main Outcomes and Measures

The primary outcome was the number of days alive and out of the hospital within 90 days of surgery. There were 20 secondary outcomes, including complications, quality of life, disability, stamina, activity levels, and survival. Analyses were adjusted for the type of diversion and center.

Results

Among 338 randomized participants, 317 underwent radical cystectomy (mean age, 69 years; 67 women [21%]; 107 [34%] received neoadjuvant chemotherapy; 282 [89%] underwent ileal conduit reconstruction); the primary outcome was analyzed in 305 (96%). The median number of days alive and out of the hospital within 90 days of surgery was 82 (IQR, 76-84) for patients undergoing robotic surgery vs 80 (IQR, 72-83) for open surgery (adjusted difference, 2.2 days [95% CI, 0.50-3.85]; P = .01). Thromboembolic complications (1.9% vs 8.3%; difference, -6.5% [95% CI, -11.4% to -1.4%]) and wound complications (5.6% vs 16.0%; difference, -11.7% [95% CI, -18.6% to -4.6%]) were less common with robotic surgery than open surgery. Participants undergoing open surgery reported worse quality of life vs robotic surgery at 5 weeks (difference in mean European Quality of Life 5-Dimension, 5-Level instrument scores, -0.07 [95% CI, -0.11 to -0.03]; P = .003) and greater disability at 5 weeks (difference in World Health Organization Disability Assessment Schedule 2.0 scores, 0.48 [95% CI, 0.15-0.73]; P = .003) and at 12 weeks (difference in WHODAS 2.0 scores, 0.38 [95% CI, 0.09-0.68]; P = .01); the differences were not significant after 12 weeks. There were no statistically significant differences in cancer recurrence (29/161 [18%] vs 25/156 [16%] after robotic and open surgery, respectively) and overall mortality (23/161 [14.3%] vs 23/156 [14.7%]), respectively) at median follow-up of 18.4 months (IQR, 12.8-21.1).

Conclusions and Relevance

Among patients with nonmetastatic bladder cancer undergoing radical cystectomy, treatment with robot-assisted radical cystectomy with intracorporeal urinary diversion vs open radical cystectomy resulted in a statistically significant increase in days alive and out of the hospital over 90 days. However, the clinical importance of these findings remains uncertain.

Trial Registration

ISRCTN Identifier: ISRCTN13680280; ClinicalTrials.gov Identifier: NCT03049410.

Recent advances and challenges in 2D/2D heterojunction photocatalysts for solar fuels applications

Although photocatalytic technology has emerged as an effective means of alleviating the projected future fuel crisis by converting sunlight directly into chemical energy, no visible-light-driven, low-cost, and highly stable photocatalyst has been developed to date. Due to considerably higher interfacial contact with numerous reactive sites, effective charge transmission and separation ability, and strong redox potentials, the focus has now shifted to 2D/2D heterojunction systems, which have exhibited effective photocatalytic performance. The fundamentals of 2D/2D photocatalysis for different applications and the classification of 2D/2D materials are first explained in this paper, followed by strategies to improve the photocatalytic performance of various 2D/2D heterojunction systems. Following that, current breakthroughs in 2D/2D metal-based and metal-free heterojunction photocatalysts, as well as their applications for H₂ evolution via water splitting, CO₂ reduction, and N₂ fixation, are discussed. Finally, a brief overview of current constraints and predicted results for 2D/2D heterojunction systems is also presented. This paper lays out a strategy for developing efficient 2D/2D heterojunction photocatalysts and sophisticated technology for solar fuel applications in order to address the energy issue.

A Phase I Trial to Determine the Safety and Tolerability of Autophagy Inhibition Using Chloroquine or Hydroxychloroquine in Combination With Carboplatin and Gemcitabine in Patients With Advanced Solid Tumors

Background

Autophagy is a catabolic process that is triggered in cells during periods of metabolic or hypoxic stress, which enables their survival during this challenge. Autophagy may also impart survival advantage to tumors cells undergoing attack from chemotherapy or radiation. Inhibition of early-stage autophagy can rescue cancer cells, while inhibition of late-stage autophagy enhances cell death due to accumulation of damaged organelles. The antiparasitic drugs chloroquine (CQ) and hydroxychloroquine (HCQ) inhibit late-phase autophagy. We assessed the safety, tolerability, and efficacy of combining CQ or HCQ with carboplatin and gemcitabine (CG) in patients with refractory advanced solid tumors.

Methods

This single institution phase 1 dose-escalation study was designed to evaluate the maximum tolerated dose (MTD) of CQ/HCQ, in combination with CG, in patients with advanced solid tumors. Secondary objectives were to determine overall response rate (ORR), progression-free survival (PFS), and overall survival (OS). A starting dose of CQ or HCQ 50 mg was used in conjunction with standard starting doses of CG and increased in increments of 50 mg in each patient dose cohort. Grade 3 or greater toxicity that is treatment related, and was not self-limited, or not controlled in <7 days was considered dose-limiting toxicity (DLT).

Results

Twenty-two patients were enrolled. All patients had at least one prior treatment, and 11 of them had 3 prior regimens. CQ/HCQ 100 mg daily was found to be the MTD in combination with CG with thrombocytopenia and/or neutropenia dose limiting. The median overall (OS) was 11 months, and the 1- and 3-year OS were 30% and 7%, respectively. Median progression-free survival was 5 months, and the 6-, 12-, and 18-month progression-free survivals were 48%, 21%, and 14%, respectively.

Conclusion

The MTD identified for CQ/HCQ was lower than previously reported with concomitant use of chemotherapeutic regimes likely due to the myelosuppressive nature of CG in previously treated patients.

Modulation of myeloid cell functions by long noncoding RNAs RN7SK and HCG11

Objective

Expressional dynamics of long noncoding RNAs (lncRNA)” regulates a gamut of biological processes including immunity. Role of lncRNA in response to oral pathogens and their regulatory impact on the innate immune functions of myeloid cells remain poorly explored. Therefore, we hypothesize that periodontal pathogens may cause the alteration of lncRNA profiles in myeloid cells and modulate their innate immune functions.

Method

CD14+ monocytes sorted from human PBMCs were differentiated into macrophages (MΦ) or dendritic cells (DC), and challenged with periopathic bacteria (A. actinomycetemcomitans [Aa] and P. gingivalis [Pg] for 4, 12 or 24 h. lncRNA expression was done at these time points by RT-qPCR array. Differentially expressed lncRNAs were assessed for: 1) cell migration , 2) phagocytosis, and 3) antigen uptake/processing in . Cell surface markers were analysed by flow-cytometry.

Result

Challenge of DCs with Pg, Pg LPS, Aa, and Aa LPS separately result in the differential expression of 21 lncRNAs (19 up, 2 down). Knockdown of LncRNA, SNHG11, NUTM2A-AS1, MCM3AP-AS1, JPX, and HCG11 (upregulated) and RN7SK (downregulated) were used to evaluate myleoid cell functions. HCG11 knockdown revealed attenuation of cell migration, while RN7SK significantly enhanced antigen uptake/processing in APCs . Importantly, RN7SK knockdown results in downregulation of M2 Mϕ surface markers (CD163, CD206 or Dectin) and concomitant increase in M1 Mϕ markers (MHC II or CD32) suggesting its critical role in macrophage polarization.

Conclusion

Our results show that periodontal pathogens alter lncRNA profiles and impair innate immune functions in myeloid cells, thereby suggesting critical roles of lncRNAs in periodontopathogenesis.

Supported by NIH/NIDCR R03 DE027147, R01DE027980, and R21DE026259 to AN.