Understanding the impact: an investigation into the National Brain Injury Awareness Week and public interest regarding concussion in Australia

OBJECTIVES

The purpose of this study is to analyze the relationship between the occurrence of the National Brain Injury Awareness Week and public interest in the concussion topic in Australia through an analysis of Internet search activity data from Google Trends.

STUDY DESIGN

Online retrospective observational study.

METHODS

For the keyword "concussion", the search interest rate over a period of 10 years between August 2012 and August 2022 within Australia has been analyzed using the Google Trends tool. The rising related topics that contributed to the months with the highest search interest were extracted for each year and a trendline analysis was performed to capture temporal patterns.

RESULTS

There was a significant difference in the average search interest between the month of August, when the Brain Injury Awareness Week is annually held, and the rest of the year (d = 0.09, p = 0.017). Also, May and August were the two months with the overall highest search interests (mean ± SD: 73.3 ± 5.16 and mean ± SD: 70.1 ± 5.49, respectively). Trendline analysis showed a positive slope of 0.3081 with R2 = 0.4462 for search interests of concussion over the 10-year period.

CONCLUSIONS

The data suggest that there is a growing interest and potential awareness of concussion in Australia that seems highly limited to the context of sports such as football, rugby, and soccer. Major sports events, news coverage, and media exposure appear to be associated with this trend. The study highlights the importance of more investment in producing engaging media content to educate the public on concussion of different causes and improving strategies for National Brain Injury Awareness Week.

Total Hip Arthroplasty in Protrusio Acetabuli: A Systematic Review

Protrusio acetabuli, or abnormal protrusion of the femoral head into the acetabulum, requires performance of a total hip arthroplasty (THA) for which various reconstruction techniques and outcomes have been described. The aim of this systematic review is to provide a comprehensive analysis of the current evidence, evaluate treatment efficacy, compare surgical techniques, and identify topics for future research along with improving evidence-based decision-making, improving patient outcomes in the management of this condition. A thorough systematic review of the PubMed, Embase, Cochrane Library databases, and Scopus library was conducted, and articles describing techniques of THA for treatment of protrusion acetabuli were extracted. The initial search generated 751 results. After exclusion, 18 articles were included. Of these, eight were prospective studies and 10 were retrospective. Surgery was performed on 783 hips with a mean age of 60 years; 80% of females who mostly had inflammatory arthritis were followed up for 8.86 years (range, 2-15.4 years). Good outcomes have been achieved with THA using uncemented cups with bone graft; however, no conclusion could be drawn with regard to the femoral side. It can be concluded that the concept of restoration of the anatomical hip center of rotation is paramount for good outcome and better survival of the implant is important when using uncemented cups with a bone graft. In addition, screw augmentation for fixation is not recommended unless absolutely necessary. The most common complications were aseptic loosening and heterotopic ossification. While the former required revision, conservative management was administered for the latter.

Screening of Individuals with Type 2 Diabetes on Anti-Diabetic Agents for Probable Hypoglycaemia Using the Stanford Hypoglycemia Questionnaire (SHQ) in Outpatient Settings: A Cross-Sectional Study from Outpatient Diabetes Care Centres in North India

Introduction

The study was aimed at identifying the incidence of unreported probable hypoglycaemia in individuals with type 2 diabetes (T2DM) on anti-diabetic medications, using the screening Stanford Hypoglycemia Questionnaire (SHQ) in real-world situations.

Methods

It was a multicentre cross-sectional study on consecutive individuals attending 10 diabetes care centres in Lucknow, Uttar Pradesh, India. The inclusion criteria were as follows: known individuals with T2DM, literate, age greater than or equal to 18 years, on at least one anti-diabetic agent for more than a month and not engaged in regular self-monitoring of blood glucose (SMBG).

Results

This study was conducted from August 2017 to April 2018, involving 1198 participants. The mean age of the individuals enrolled was 53.45 years (±10.83), with males comprising 55.3% of the population. It was found that 63.6% of patients were on sulphonylurea (SU), 14.5% were on pioglitazone, 92.2% on metformin, 62.3% on Dipeptidyl peptidase (DPP4i) and 12.8% on Sodium-glucose cotransporter (SGLT2i). The mean SHQ score was 1.81 (±1.59). Probable hypoglycaemia was mild in 57.59%, moderate in 14.69% and severe in 1.41%. Those with diabetic neuropathy (P = <0.001), retinopathy (P = <0.001) and nephropathy (P = <0.001) had significantly higher SHQ scores. Insulin or SU use was associated with a significantly higher SHQ score. Concomitant statin use was associated with a lower incidence of mild, moderate and severe hypoglycaemia (P = 0.01). On multivariate analysis, we found that age, sex, systolic blood pressure (SBP), insulin use and fasting blood sugar were the most important factors associated with an increased risk of hypoglycaemia with an R2 cut-off of 0.7.

Conclusion

SHQ was discovered to be a simple and cost-effective screening tool for outpatient detection of hypoglycaemia in an Indian setting, and it can add value to management.

Modern implants in total knee arthroplasty are more patellofemoral joint friendly compared to their traditional design: a systematic review and meta-analysis

BACKGROUND

Implant designs for total knee arthroplasties (TKA) are continuously evolving to improve outcomes and satisfaction rates after TKA. The present systematic review and meta-analysis aimed to explore the evidence in the literature regarding the outcomes of the Attune knee system over the PFC Sigma knee design and investigate the advantage of one over the other.

METHODS

A systematic review and meta-analysis of published studies till August 2021 was performed using the defined eligibility criteria. This was a systematic review of the literature published in the Cochrane Central Register of Controlled Trials (CENTRAL) Library, PUBMED, and EMBASE. The analysis included prospective and retrospective comparative trials comparing TKA by PFC sigma or Attune posterior stabilized (PS) or cruciate-retaining (CR), fixed bearing, or rotating platform systems. Patient-reported outcome measures (PROM) and postoperative patellar complications were analysed in the studies utilizing attune knee system (modern implants) to its counterpart PFC sigma (traditional implants) for TKA. Quality assessment was conducted using NIH Quality Assessment Tool for controlled intervention studies (RCTs and case-control studies).

RESULTS

This review included 3 RCTs and the rest, 10 of which were non-RCT, including 5852 patients. ATTUNE designs suggested a statistically significant improvement in KSS over PFC Sigma designs. Other PROMs such as OKS and WOMAC scores yielded comparable results between the two groups. ATTUNE knee prosthesis did not result in better knee range of motion, patient satisfaction, or radiological outcomes than the PFC design. Regarding the complications, attune knee prosthesis demonstrated favourable results over PFC Sigma for anterior knee pain and patellofemoral (PF) crepitus.

CONCLUSIONS

The present systematic review highlights better KSS and lesser chances of PF complications favouring a modern implant design over its traditional counterpart. Other patient-reported outcome analyses at a short-term follow-up period were comparable among patients undergoing total knee replacements with two different implant designs. Radiological outcomes for component positioning also suggested similar results among the two groups.

Total Hip Replacement in Active and Inactive Tuberculosis Hip: A Systematic Review

Introduction

Tuberculosis of the hip joint is a debilitating disease that can result in severe joint destruction, eventually leading to painful arthritis of the hip. Total hip arthroplasty (THA) in patients with advanced arthritis offers a painless and mobile joint with good functional outcome but some aspects of THA in TB hip have been controversial in the past due to the concerns of disease reactivation, especially when disease activity is factored in. Various factors like timing of surgery, Antitubercular therapy (ATT) initiation timing, reactivation, complications etc needs to be evaluated very carefully before planning for such cases.

Methods

Electronic databases like MEDLINE, EMBASE, Cochrane library, Clinicaltrials gov and OpenGrey were searched. The key words used were "Tuberculosis", "Tuberculosis of hip", Hip tuberculosis, "TB", "THR", "total hip replacement", "total hip arthroplasty","THA", "ankylosed hip", "fused hip", "arthrodesis" along with boolean operators "AND" and "OR". Out of a total of 1634 articles, 38 were selected for full text review and 22 articles were finally included in the study.

Results

For the timing of surgery most authors relied on the inflammatory markers to settle down with ATT before performing THA. 15 authors advocated use of pre-operative ATT with 6 studies recommending at least 2 weeks and 3 studies advocating atleast 3 months of ATT pre surgery.Single stage THA was performed in most studies(214 hips vs 18 hips) as opposed to 2 or 3 stage surgery. In the active disease 72.8% of the hips had uncemented prosthesis, 25.6% hips underwent cemented and 1.5% hips had hybrid THA fixation. Overall reactivation of the infection was seen in 2.47% cases. All authors reported excellent clinical improvement (mean HHS improvement 37.17 to 88.62).

The cross-sectional morphology of median nerve in carpal tunnel of healthy, adult population: A systematic review and meta-analysis

The cross-section area is a crucial parameter to assess peripheral neuropathy. The ultrasonographic evaluation of cross-section area of median nerve is a low-cost and readily available tool for diagnosis and assessment. However, the intra-nerve dimensional variability and its normative reference value in a healthy subject are missing. The current meta-analysis aims to capture the median nerve cross-section area for healthy subjects and generate a comprehensive ultrasonographic reference data set for each population.

METHODS

The full text of manuscripts were collected after short-listing the abstracts collected from search strategy. A quality assurance tool was used to capture the risk of bias of each study after reviewing the included manuscripts. The pooled estimate of cross-section area was stratified according to anatomical landmarks, sex, and ancestry.

RESULTS

A total of 97 observational studies dealt with 6679 wrists of healthy subjects were included. The pooled estimate of the cross-section area of median nerve at carpal tunnel inlet was 8.54mm² [95% CI: 8.34-8.74mm²]. The same pooled estimate at carpal tunnel outlet was 8.03mm² [95% CI: 7.46-8.60mm²]. Both these pooled estimates have significant correlation with mean age of population. Age and sex were two primary predictors of the cross-section of median nerve. The flattening ratio, circularity, and wrist-forearm ratio of median nerve were also computed.

CONCLUSION

These normative data could serve as a reference for assessing median nerve pathologies, including carpal tunnel syndrome. The ethnic variation of pooled estimate and heterogeneity will guide clinician set up the reference value for diagnostic criteria.

Difference in Muscle Strength and Functional Outcome in Direct Lateral Approach versus Posterior Approach in Total Hip Arthroplasty: A Prospective Cohort Study

Background and Purpose

The choice between posterior approach (PA) and direct lateral approach (DLA) for total hip arthroplasty (THA) remains a contentious issue regarding clinical outcome optimization and restoring patient function. Previous studies have evaluated the postsurgical outcomes mostly in the form of Harris hip score (HHS), and the data to objectively measure the postoperative muscle power is scarce. We intend to objectively compare the hip abduction and extension strengths and other functional outcomes with a very simple tool in PA and DLA in the Indian population as most patients do not undergo as intensive rehabilitation in the postoperative period as in the western world.

Materials and Methods

A total of 158 patients underwent THA during the study period, of which 48 met inclusion criteria and only 42 completed 6 months follow-up. Patients were evaluated preoperatively, postoperatively at 2 weeks, 6 weeks, 3 months, and 6 months follow-up. At each visit, muscle strength was tested using a customized sling device mounted on a pulling apparatus fitted on the wall, as well as a pain score (VAS), Harris hip score (HHS), and Short Form Survey (SF-36).

Results

The study showed statistically significant better hip muscle strength at 2 weeks postoperative for leg press test and 2 weeks as well as 6 weeks postoperative for hip abduction strength in the PA. However, no differences were noted during the 3 or 6 months follow-up period among the DLA and PA. The surgical approach used has no effect on VAS, HHS, or SF-36 scorings.

Conclusion

The weak abductor mechanism at 2 and 6 weeks and extension mechanism at 2 weeks in a cohort of DLA in contrast to the PA are seen in the early postoperative period and hence are short-lived muscle weakness. However, there is no effect on VAS, HSS, and SF-36 scores. Therefore, the surgical approach is to be chosen according to the surgeon's expertise.

Assessment of determining factors for severity of NeoCOVIDiabetes in India: A pan India multicentric retrospective study

BACKGROUND AND AIMS

There is a bidirectional relationship between COVID-19 and diabetes. The primary objective of this study was to estimate the prevalence of patients newly detected to have diabetes (NDD) who recovered from COVID-19 in India whilst comparing NDD with patients without diabetes (ND) and those who have known to have diabetes (KD) in terms of glycemic status pre- and post-COVID with disease severity.

MATERIALS & METHODOLOGY

There were 2212 participants enrolled from 15 sites, with 1630 active participants after the respective execution of selection criteria. Data collection was done using a specialized Case Record Form (CRF). Planned statistical analysis and descriptive statistics were concluded for significance between patient groups on various parameters.

RESULT

The differences in age between the study groups were statistically significant. The average blood glucose at COVID-19 onset was significantly higher in KD than in NDD. Significantly more proportion of NDD (83%) had been hospitalized for COVID management when compared to KD (45%) and ND (55%). The NDD group received higher doses of steroids than the other two groups. On average, patients in the NDD group who received at least one vaccination (one dose or two doses) had a higher High-Resolution Computed Tomography (HRCT) score. Patients who had not been vaccinated in ND and KD groups experienced a higher HRCT score.

CONCLUSION

Prospective metabolism studies in post-acute COVID-19 will be required to understand the etiology, prognosis, and treatment opportunities.

An Exceedingly Rare Case of Nodular Fasciitis of Tongue in an Infant

Introduction/Objective

Nodular fasciitis is a rapidly growing but benign self-limited myofibroblastic/fibroblastic tumor of unknown etiology. It was first described in the literature by Konwaler in 1955 and can occur in any location. Nodular fasciitis of the tongue is a rare entity in infancy with only one case reported so far. Accurate diagnosis of this entity is crucial to avoid a possible misdiagnosis of malignancy leading to radical resections.

Methods/Case Report

A 6-month old, previously heathy full term male presented to pediatric otolaryngology clinic with a rapidly growing painless mass on the right tongue. The mass was associated with feeding difficulty. There was no history of trauma to the area, no personal and family history of cancer was noted. Computed tomography scan demonstrated a 1.5 x 1.4 x 1.5 cm mass confined to the right anterior undersurface of tongue. Biopsy of the mass showed ulcerated mucosa with an underlying spindle cell lesion composed of reactive-appearing myofibroblasts arranged in a variably fascicular to "tissue-culture" pattern, intermixed with inflammatory cells and scattered extravasated erythrocytes. These morphologic features in conjunction with immunohistochemistry and demonstration of fusion of SRSF3 [serine and arginine rich splicing factor 3] and USP6 [ubiquitin specific peptidase 6] by Targeted next-generation RNA sequencing confirmed the diagnosis of nodular fasciitis. On follow up, spontaneous regression of the mass occurred in 3 months.

Results (if a Case Study enter NA)

NA.

Conclusion

Nodular fasciitis of tongue in infancy is an exceedingly rare entity and this case demonstrates the importance of including this unique entity in the differential diagnosis of a rapidly-growing tongue lesion. Because it can simulate malignancy both clinically and histologically, awareness and familiarity with this benign proliferative lesion is crucial in effective management.

Prediction of collapse in femoral head osteonecrosis: role of volumetric assessment

PURPOSE

The purpose of this study was to evaluate and compare the accuracy of three different techniques of measuring the extent of osteonecrosis involvement of the femoral head on MRI to determine the best predictor of collapse and to identify the size of the lesion volume which best predicts collapse.

METHODS

We prospectively enrolled 48 hips of osteonecrosis femoral head (ONFH) with stage 1 or 2 osteonecrosis and the enrolled patients were followed up for 1 year. Angular measurements (modified Kerboul Angle and modified index of necrotic extent) were compared with the 3D volumetric measurement of necrotic lesion based on MRI in predicting the collapse of the head. ROC analysis was done to evaluate the diagnostic performance of the 3 indices in predicting collapse. Survival analysis of all the hips in the collapsed and non-collapsed group were interpreted using Kaplan Meir survival analysis.

RESULTS

In lesion sizes larger than 25% of femoral head volume - 90.6% (29/32) of hips collapsed within 1 year as compared to 31.3% (5/16) hips collapsed in lesion volume <25% of femoral head (Log-rank test p = 0.001). There was good inter-observer (ICC, 0.94; 95% CI, 0.89-0.97) and intra-observer reliability (ICC, 0.93; 95% CI, 0.88-0.96).

CONCLUSIONS

The Volumetric method assessed the severity of lesion size with the future collapse better and more predictably than angular measurements. Necrotic lesion volume of 25% is a potential cut off beyond which future collapse of early ONFH can be predicted and aid in the further management. This study can help in solving the mystery behind prediction of collapse in ONFH.

AB1456 CLINICAL IMPACT OF THE INTERSTITIAL LUNG DISEASE MULTIDISCIPLINARY SERVICE

Background

Interstitial lung diseases (ILD) are a diverse group of pulmonary diseases for which accurate diagnosis is critical for optimal management and outcomes. Diagnosing ILD, both idiopathic pulmonary fibrosis (IPF) and connective-tissue-disease-associated interstitial lung disease (CTD-ILD), has become critically important, as the disease has a devastating prognosis with poor survival.There are also management implications, as patients with ILD can now potentially be treated with new antifibrotic therapies such as pirfenidone and nintedanib, both of which have been approved. Certain types of CTD – ILD may benefit from systemic immunomodulatory therapies. Diagnosis of ILD can be challenging and a multidisciplinary team (MDT) approach is recommended in current guidelines. Several studies have reported that MDT diagnosis is associated with higher levels of diagnostic confidence and better interobserver agreement (1-3).

Objectives

We describe the benefits of an ILD multidisciplinary service on the diagnosis and management of patients with suspected ILD.

Methods

We performed a single-centre retrospective review of consecutive patients referred to the ILD clinic with subsequent discussions in ILD MDTs over a 36-month period from 2016 to 2019. We compared changes in ILD diagnosis and management at referral to those following the ILD-MDT. We collected data on the demographics, occupation, age at ILD onset, smoking status, imaging, blood tests including autoimmune serology, MDT recommendations, change in diagnosis after MDT, tertiary referral, serial PFTs, medications and outcomes. Cases of suspected ILD that were not fully characterised and those with complex management issues were presented at our monthly ILD MDT.

Results

A total of 208 patients were referred to the ILD clinic over a 36-month period. Of these, 106 cases were discussed at the ILD MDT and the remaining 102 cases did not require discussion at the MDT as these deemed to be clear cut, which included RA and CTD ILD. The mean age of the total cohort was 74 (min age 32, max age 97) and 120 (58 %) were males. Overall, evaluation by the ILD service (i.e. ILD clinic and MDT) resulted in a change in diagnosis in 106(51%) patients. Of those, 49(46%) didn’t have ILD. In the remaining 57 patients with suspected ILD, the majority of the diagnoses were ILD with an uncertain classification (24, 23%). The other diagnoses included CTD-ILD (4, 3.7%), ILD with autoimmune serology 11(10.4%), IPF 10(9.4%), Drug-induced-ILD 3(2.8%), Hypersensitivity Pneumonitis 5(4.7%), Eosinophilic pneumonitis 1 (0.94%), Cryptogenic Pneumonitis 1(0.94%), PPFE with IPF 1 (0.94%), PPFE 1 (0.94%), CPFE 4 (0.94%), EAA 2 (0.94%), RB-ILD 2 (1.88%), Langerhans Histiocytosis 2 (1.88%).16/57(28%) were referred to a tertiary centre for further management. Serology was positive in 11 patients (ANA 6, CCP 3, and ANCA 2). Of the 57 patients with other diagnoses, the main recommendations included steroids (28), anti-fibrotic therapy (4), immunomodulatory therapy (6) and ambulatory Oxygen (1). Further analysis will be carried out on survival and treatment outcomes of the cohort.

Conclusion

Dedicated ILD-MDT service has an important clinical impact on the care of the ILD patient, with frequent changes in ILD diagnosis and subsequent management and outcomes. Multidisciplinary approach to the management of these patients should be standard of care for these patients.

References

[1]Flaherty KR, King TE Jr, Raghu G, et al. Idiopathic interstitial pneumonia: what is the effect of a multidisciplinary approach to diagnosis? Am J Respir Crit Care Med 2004; 170:904-10.

[2]Lynch DA, Sverzellati N, Travis WD, et al. Diagnostic criteria for idiopathic pulmonary fibrosis: a Fleischner Society White Paper. Lancet Respir Med 2018; 6:138-53.

[3]Ryerson CJ, Corte TJ, Lee JS, et al. A standardized diagnostic ontology for fibrotic interstitial lung disease. An international working group perspective. Am J Respir Crit Care Med 2017; 196:1249-54.

Disclosure of Interests

None declared

Transfer learning application of a novel frequency shift convolutional neural network method for atrial fibrillation classification

Funding Acknowledgements

Type of funding sources: None.

Background

There has been a proliferation of machine learning (ML) electrocardiogram (ECG) classification algorithms reaching &gt;85% accuracy for various cardiac pathologies. Despite the high accuracy at individual institutions, challenges remain with cross-institutional algorithm evaluation. Transfer learning (TL) is a technique in which a model trained for a specific task is repurposed for another related task, in this case ECG ML model trained at one institution used to classify ECGs at another institution. Models trained at one institution, however, might not be generalizable for accurate classification when deployed broadly due to differences in type, time, and sampling rate of traditional ECG acquisition. TL would thus require additional ECG signal processing which inherently introduces noise and has high computational costs. Our previous work has shown that frequency domain (FD) convolutional neural networks (CNN) outperform traditional time domain (TD) CNN methods in detecting atrial fibrillation (Afib) and are more robust against noise and sampling variations.

Purpose

In this study, we explore ECG transfer learning by comparing performance of TD and FD CNN ECG classification models. Examine the hypothesis that FD signal analysis can overcome limitations inherent to TD and demonstrate application for Afib classification in three different publicly available datasets.

Methods

PTB-XL ECG dataset was used to train TD and FD CNN models for Afib classification. TL on the two data sets, Lobachevsky University Electrocardiography Database (LUDB) and KURIAS-ECG database (KURIAS), was performed with portions of each dataset added to PTB-XL training data before test runs on the remaining ECGs. The models were also tested directly on the two datasets (cross-testing) for comparison.

Results

Results of TL are summarized in Fig. 1. Panels (a) and (b) show TD and FD performance on PTB-XL dataset, with FD outperforming TD. Panels (c) and (d) show TL of PTB-XL trained TD and FD models applied on LUDB Afib data with FD outperforming TD. Panels (e) and (f) show TL of PTB-XL trained models applied to KURIAS Afib ECGs, with FD again outperforming TD. Table 1 summarizes results of TL and direct cross-testing with TL outperforming cross-testing.

Conclusions

FD models were superior to TD models in Afib classification, both in cross-testing and TL. TL technique, in which a pre-trained model is used as starting point for novel dataset training, outperformed direct cross-testing. TL with FD CNN has the capacity to leverage models trained on a particular set of ECGs to classify ECGs with varying signal acquisition properties. FD CNN may be robust to inter-institutional variability and has potential for widespread application with no compromise to ECG classification power. A potential application of these findings is deployment of ECG classification CNN models trained at institutions with large ECG databases to hospitals with smaller datasets.

Comparison of functional outcomes and complications of cemented vs uncemented total hip arthroplasty in the elderly neck of femur fracture patients: A systematic review and meta-analysis

PURPOSE

The neck of femur fractures in the elderly is a global concern. These fractures impair the quality of living and add to morbidity and mortality. A Multitude of treatment options for the same. This systematic review focuses on evaluating outcomes between cemented and uncemented total hip replacement in the elderly population with neck of femur fractures.

MATERIAL AND METHODS

The search was conducted in databases PubMed, Embase, Scopus, open grey, and Cochrane following PRISMA guidelines. The studies fulfilling the inclusion criteria were included, scrutinized for data analysis, and also quality appraisal of all the included studies was conducted to be included in this article.

RESULTS

A total of 7 studies were included (2 RCT, 5 retrospective studies) comprising 1171 THRs. Data analysis showed a higher HHS in cemented compared to uncemented(p < 0.001). The uncemented group had a significantly higher rate of revision, dislocation, and periprosthetic fracture compared to cemented group(p < 0.001). However, VAS score, loosening rates, and heterotopic ossification were similar in both statistically insignificant groups.

CONCLUSION

Choosing between cemented and uncemented techniques had been a controversy with lesser data due to higher morbidity and mortality. This systematic review provides information regarding functional outcomes and complications in both groups. The cemented group had better outcomes and lesser complications which should be preferred in elderly patients as the conclusion of this study. However, a larger RCT with better follow-up is still required.

LEVEL OF EVIDENCE

Level I, systematic review and meta-analysis.

Prophylactic effects of dietary ascorbic acid on oxidative stress indices, physiological and behavioural responses of domestic pigeons exposed to road transport stress

Transport disturbs birds' welfare and health status which lead to oxidative stress and dietary ascorbic acid mitigates the adverse effects of transport stress. The present study was aimed to evaluate the impacts of ascorbic acid administration on oxidative stress indices, cortisol, H/L ratio, tonic immobility reaction and rectal temperature of pigeons exposed to road transport. A total of 80 clinically healthy pigeons were selected and randomly divided to eight equal groups as follow: (1) Ctrl- : fed by basal diet and no subjected to transport stress; (2) Ctrl+: fed by the basal diet and subjected to transport stress; (3, 4) 1DBS10 and 1DBS16: received ascorbic acid from 1 day before transport stress at doses of 10 g/100 L and 16 g/100 L of drinking water, respectively; (5, 6) 3DBS10 and 3DBS16: treated with ascorbic acid from 3 consecutive days before transport stress at doses of 10 g/100 L and 16 g/100 L, respectively and (7, 8) 7DBS10 and 7DBS16: received ascorbic acid from 7 consecutive days before the transport at doses 10 g/100 L and 16 g/100 L, respectively. Birds were transported for 3 h over a distance of about 200 km. The total antioxidant capacity, malondialdehyde and cortisol were measured before transport and at 6, 24 and 72 h post-transportation. The rectal temperature and tunic immobility reactions were recorded. Dietary ascorbic acid led to a decrease in tonic immobility response, hetrophil to lymphocyte ratio, circulating cortisol and total antioxidant capacity, and an increase in circulating malondialdehyde in pigeons exposed to transport stress compare to Ctrl+ group. In conclusion, ascorbic acid administration at dose 16 g/100 L of drinking water from 3 and 7 days before exposure to stress helps attenuate undesirable effects of oxidative stress in pigeons.

Antibacterial and Osteoinductive Implant Surface Using Layer-by-Layer Assembly

Osseointegration of dental, craniofacial, and orthopedic implants is critical for their long-term success. Multifunctional surface treatment of implants was found to significantly improve cell adhesion and induce osteogenic differentiation of dental-derived stem cells in vitro. Moreover, local and sustained release of antibiotics via nanolayers from the surface of implants can present unparalleled therapeutic benefits in implant dentistry. Here, we present a layer-by-layer surface treatment of titanium implants capable of incorporating BMP-2-mimicking short peptides and gentamicin to improve their osseointegration and antibacterial features. Additionally, instead of conventional surface treatments, we employed polydopamine coating before layer-by-layer assembly to initiate the formation of the nanolayers on rough titanium surfaces. Cytocompatibility analysis demonstrated that modifying the titanium implant surface with layer-by-layer assembly did not have adverse effects on cellular viability. The implemented nanoscale coating provided sustained release of osteoinductive peptides with an antibacterial drug. The surface-functionalized implants showed successful osteogenic differentiation of periodontal ligament stem cells and antimicrobial activity in vitro and increased osseointegration in a rodent animal model 4 wk postsurgery as compared with untreated implants. Altogether, our in vitro and in vivo studies suggest that this approach can be extended to other dental and orthopedic implants since this surface functionalization showed improved osseointegration and an enhanced success rate.

Risk Factors for CKD Progression: Overview of Findings from the CRIC Study

The Chronic Renal Insufficiency Cohort (CRIC) Study is an ongoing, multicenter, longitudinal study of nearly 5500 adults with CKD in the United States. Over the past 10 years, the CRIC Study has made significant contributions to the understanding of factors associated with CKD progression. This review summarizes findings from longitudinal studies evaluating risk factors associated with CKD progression in the CRIC Study, grouped into the following six thematic categories: (1) sociodemographic and economic (sex, race/ethnicity, and nephrology care); (2) behavioral (healthy lifestyle, diet, and sleep); (3) genetic (apoL1, genome-wide association study, and renin-angiotensin-aldosterone system pathway genes); (4) cardiovascular (atrial fibrillation, hypertension, and vascular stiffness); (5) metabolic (fibroblast growth factor 23 and urinary oxalate); and (6) novel factors (AKI and biomarkers of kidney injury). Additionally, we highlight areas where future research is needed, and opportunities for interdisciplinary collaboration.

Harnessing Dental Stem Cell Immunoregulation Using Cell-Laden Biomaterials

Successful tissue engineering therapies rely on the appropriate selection of the cell source, biomaterial, and regulatory factors. To be applied in a wide range of clinical applications, the ideal cell source needs to be easily accessible and abundant. Human orofacial tissues and teeth harbor several populations of mesenchymal stem cells (MSCs) with self-renewal and multilineage differentiation capabilities. The ease of access, relative abundance, and minimally invasive isolation procedures needed to harvest most types of the dental-derived MSCs render them a promising cell source for tissue engineering applications. A growing body of evidence has reported the profound immunoregulatory potential of dental-derived MSCs as compared with their bone marrow counterparts. Biomaterials can act as a physical barrier protecting the MSCs from the invasion of the immune system by hindering penetration of proinflammatory cells/cytokines, leading to higher viability of the encapsulated MSCs and improved tissue regeneration. Besides their protective capabilities, biomaterials can actively contribute to the immunoregulatory potential of the MSCs through their physical and chemical properties, including porosity and elasticity. However, despite recent advancement, the therapeutic capability of biomaterials to regulate the MSC-host immune system crosstalk and the mechanism underlying this immunoregulation has been poorly understood. It has been reported that biomaterials can regulate the viability and determine the fate of the encapsulated MSCs through modulation of the NF-kB pathway and the caspase-3 and caspase-8 proapoptotic cascades. Additionally, the physiomechanical properties of the encapsulating biomaterial have been shown to modulate clustering of TNF-α receptors on the encapsulated MSCs while regulating the production of anti-inflammatory factors such as indoleamine 2,3-dioxygenase (IDO) and prostaglandin E2 (PGE₂) through activation of the P38 MAPK pathway. In the current review, we sought to provide a thorough overview of the immunomodulatory functions of dental-derived MSCs and the role of biomaterials in their interplay with the host immune system.

Intra-articular Partial Acetabular Resection and Allograft Reconstruction for Synovial Sarcoma

Introduction:

The aim of this case report is to present an option of reconstruction in tumors involving the posterior wall and column of the acetabulum with sparing of the anterior column and the weight-bearing dome.

Case Report:

We are reporting a case of a 25-year-old female with histopathologically proven synovial sarcoma involving the left inferior pubic ramus, ischium, and posterior wall of the acetabulum, along with a large soft-tissue extension in the posterior and medial thigh. Wide local excision involving partial acetabular resection and reconstruction using a femoral head allograft was carried out. The patient was allowed full weight-bearing mobilization after 6 weeks. At 3 months’ follow-up, the patient was able to walk without support and was able to do active straight leg raising. There were no radiological signs of joint degeneration at the 12-month follow-up.

Conclusion:

Reconstruction with non-articular femoral head allograft can be a viable alternative after resection of tumor involving acetabulum. This procedure is expected to support the hip joint and restore function in the short term and recreate bone stock for future arthroplasty if the need arises.

Competition between Allowed and First-Forbidden β Decay: The Case of ^{208}Hg→^{208}Tl

The β decay of ^{208}Hg into the one-proton hole, one neutron-particle _{81}^{208}Tl_{127} nucleus was investigated at CERN-ISOLDE. Shell-model calculations describe well the level scheme deduced, validating the proton-neutron interactions used, with implications for the whole of the N>126, Z<82 quadrant of neutron-rich nuclei. While both negative and positive parity states with spin 0 and 1 are expected within the Q_{β} window, only three negative parity states are populated directly in the β decay. The data provide a unique test of the competition between allowed Gamow-Teller and Fermi, and first-forbidden β decays, essential for the understanding of the nucleosynthesis of heavy nuclei in the rapid neutron capture process. Furthermore, the observation of the parity changing 0^{+}→0^{-}β decay where the daughter state is core excited is unique, and can provide information on mesonic corrections of effective operators.

Use of Acetate Templates Over Digital Radiographs for Templating in Total Hip Arthroplasty: Technique and Its Validation

PURPOSE

Acetate templates were commonly used for templating for total hip arthroplasty. With digital radiographs having replaced conventional analogue radiographs, newer techniques are required. We describe a method for templating images of digital radiographs using conventional acetate templates, which is independent of a magnification marker or PACS system.

METHODS

Fifty-one patients (64 hips) who were treated with primary THA were prospectively evaluated. Templating was done by keeping the acetate template directly over the digital image of the radiograph on a liquid crystal display (LCD) monitor, after calibrating the linear scale generated by the digital radiography machine. The size of prosthesis predicted on this templating technique was compared with the actual sizes used during the surgery. Inter-observer and intra-observer reliabilities were assessed. Our calibration method was further validated by comparing the size of the cup calculated on postoperative radiograph using digital templating software (mediCAD Hectec GmbH) and the actual size used during surgery.

RESULTS

Accurate size was predicted for 36.7% of the acetabular cup and 35.9% of femoral stems. The accuracy within ± one size was 89.9% for acetabular cups and 91.4% for femoral stems. Excellent inter-observer and intra-observer reliability were seen for both femoral and acetabular components.

CONCLUSION

The method described provides an accurate, reproducible, convenient and low-cost technique of preoperative templating. It combines the ease of using acetate templates with the convenience of being able to use digital images, without the need for expensive software.

A mathematical model for the evaluation of iron transport across the blood-cerebrospinal fluid barrier in neurodegenerative diseases

Iron plays important roles in healthy brain but altered homeostasis and concentration have been correlated to aging and neurodegenerative diseases. Iron enters the central nervous system by crossing the brain barrier systems: the Blood- Brain Barrier separating blood and brain and the Blood-Cerebrospinal Fluid Barrier (BCSFB) between blood and CSF, which is in contact with the brain by far less selective barriers. Herein, we develop a two-compartmental model for the BCSFB, based on first-order ordinary differential equations, performing numerical simulations and sensitivity analysis. Furthermore, as input parameters of the model, experimental data from patients affected by Alzheimer's disease, frontotemporal dementia, mild cognitive impairment and matched neurological controls were used, with the aim of investigating the differences between physiological and pathological conditions in the regulation of iron passage between blood and CSF which can be possibly targeted by therapy.

Role of 3D printing in the management of complex acetabular fractures: a comparative study

PURPOSE

The aim of this study is to assess the role of 3D printing of actual size pelvis in the management and outcome of acetabular fractures.

METHODS

Retrospective study with inclusion of acetabular fractures which were divided into two groups (traditional and 3D printing) was done over a 1 year period. The indices for comparison of both groups in this study were (a) operative time (from skin incision to suture), (b) intraoperative blood loss (noted from the anaesthetist notes), (c) times of intraoperative fluoroscopy, (d) postoperative complications, (e) quality of fracture reduction (good =  < 2 mm displacement, fair =  > 2 mm displacement) and (f) Harris hip score at final follow-up.

RESULTS

27 cases (traditional group = 15, 3D printing group = 12) meeting the study criteria were included in the study with a mean follow-up of 26.3 ± 11.2 months. There was a significant difference in the operative time, intraoperative blood loss and number of intraoperative fluoroscopy images. The mean operative time was shorter in the 3D printing group by 62 min. No difference was noted in the quality of reduction in either of the groups (p > 0.05).

CONCLUSION

3D imaging and printing helps in better understanding of the anatomy of acetabular fractures. It leads to reduced operative time, blood loss as well as exposure to radiation intraoperatively. There is no difference in functional outcome at final follow-up between 3D printing and traditional groups.

84 Folate-methionine cycle and folate transport in developing buffalo embryos

Periconceptional folic acid is known to have a major role in the prevention of neural tube defects, leading to global recommendations for folic acid supplementation before and in early pregnancy. Maternal folate throughout pregnancy may have other roles in offspring health, including neurodevelopment and cognitive performance in childhood. Folate and folic acid (vitamin B9) act as a co-enzyme essential for single carbon metabolism, a network of pathways involved in several biological processes including nucleotide synthesis, DNA repair, and methylation reactions. In general, rapidly growing and multiplying cells require an adequate supply of folate. A primary deficiency of natural folate resulting in an increase of the total homocysteine concentration may be detrimental to the quality of the oocyte, subsequent fertilisation, embryogenesis, implantation, and fetal development. However, to date, folate-methionine metabolism and folate transport have not been studied in developing buffalo embryos. The present study details transcript expression for genes encoding key enzymes in the linked folate-methionine cycles in the ovary tissue, cumulus cells, immature oocytes, IVM oocytes, and pre-implantation embryos and also estimates the folate concentration in follicular fluid (FF) of buffalo. The FF was pooled and collected by aspiration of different sizes of surface follicles (2-8mm diameter). The total number of analysed samples was three, with different dilutions and estimation of folate in FF of buffalo done by chemiluminescence assay. Total RNA was extracted from oocytes, cumulus cells, ovarian tissue, and embryos produced from IVF. RT-PCR was performed to analyse the expression of folate-methionine cycle enzymes and folate transporters. Transcripts for all the enzymes of the folate-methionine cycle (i.e. SHMT, MTR, MTRR, MAT1A, MAT2B, GNMT, AHCY, CBS, and DHFR) and folate transporters (FOLR1, FOLR2) and reduced folate carrier (SLC19A1) were expressed in ovarian tissue, cumulus cells, oocytes, and pre-implantation embryos. Immunocytochemical analysis revealed FOLR2 and SLC19A1 protein expression on the plasma membrane and/or cytoplasm of the oocytes and embryos, and FOLR1 in the nucleus of pre-implantation embryos. The folate concentration in FF was 24ngmL−1. This is the first report to examine the concentration of folate in FF and revealed the identification of transcripts in different samples of buffalo species. The presence of these enzymes could have a profound effect on single-carbon metabolism within the ovary and pre-implantation embryo, therefore indicating that folate from FF is being disseminated through folate receptors within oocytes and embryos to participate in the folate pathway. This study advocates the necessity for examination of the result of folate supplementation throughout invitro embryo production for improving the quality and quantity of transferable blastocysts and subsequently live calf births in buffalo.

220 Exploring the use of mesenchymal stem cells for treatment of mastitis and metritis in cattle

The present study was carried out to isolate mesenchymal stem cells (MSCs) from adipose tissue of cattle (Bos indicus), characterise them, and apply them for the treatment of mastitis and metritis in the cow. Cattle MSCs were isolated from adipose tissue near the loin region of cow. Isolated adipose tissue was subjected to enzymatic digestion using 2% collagenase with agitation at regular intervals. The cells obtained after digestion were resuspended in cell culture flasks containing growth enriched medium and cultured under standard culture conditions. Alkaline phosphatase staining was used as one of the parameters to confirm cultured putative MSCs. Bovine Ad-MSCs were further characterised using real time-PCR by amplification of MSC-specific markers: CD73, CD90, and CD105 as positive markers and CD34, CD45, and CD79a as negative markers. Immunocytochemistry showed the presence of CD73, CD90, and CD105 on the cell surface. Three groups-control (C), local (L), and intravenous (IV)-with 6 cows suffering from mastitis were taken in each group and subjected to MSC transplantation through local and intravenous routes. Control group animals were subjected to antibiotic treatment only. Similarly, another three groups were taken with 6 cows in each group suffering from metritis. Post-transplantation wound healing, tissue repair, and reduction in inflammation were monitored for 26 days, at different time intervals; that is, after Days 1, 3, 7, and 15. Blood samples were also collected from animals at the same time intervals for real time-PCR. A similar examination was also done in metritis groups along with the analysis of the reduction in turbidity of cervical fluid at the abovementioned time intervals. Real time-PCR was performed to determine relative expression of genes for proliferative factors, anti-inflammatory cytokines, and antimicrobial peptides on cells isolated from blood collected at different time intervals. Gene expression in the local group of mastitis subjected to MSC injection was significantly higher than that of the IV and control group. The somatic cell count declined in both local and IV groups compared with the control group. Whereas the expression of the same genes in the IV group of metritis was significantly higher than that of the local and control groups of cows. The turbidity of cervical fluid and mucus was reduced in the IV group compared with the local group. In conclusion, we demonstrated the healing potential of MSCs in a cow model via MSC injection. Promising results were obtained in curing mastitis in both local and IV groups, whereas healing in the case of metritis was significantly higher in the IV group compared with both the control and local groups of cows. The study indicates the potential use of MSc for treatment of mastitis and metritis in cattle through wound healing and decreasing microbial infection.

The first case of fingernail onychomycosis due to Neoscytalidium novaehollandiae, molecular identification and antifungal susceptibility

Onychomycosis is considered a fungal nail infection caused mainly by dermatophytes, yeasts and non-dermatophyte molds including dematiaceous fungi. Onychomycosis caused by non-dermatophyte molds is a health problem in the medical environment as the patients frequently return to outpatient clinics seeking new therapeutic modalities. Here, we report the first case of onychomycosis caused by a black fungus, Neoscytalidium novaehollandiae, in the right hand finger nail of a 52-year-old Iranian female with no history of immunodeficiency and underlying disease. The pattern of nail involvement was recognized as total dystrophic onychomycosis. Examination of nail scrapings with potassium hydroxide revealed brown, septate and branching sub-hyaline to dark-colored hyphae. The black fungus isolated in culture was identified as Neoscytalidium novaehollandiae by molecular analysis. The patient received oral terbinafine plus ciclopirox nail lacquer twice a week and began responding to the treatment three months after initial antifungal therapy. Additional four weeks' use of terbinafine plus ciclopirox nail lacquer completely resolved the clinical manifestations of onychomycosis. After four months, both microscopy and culture were negative.

Molecular identification of non-Cryptococcus yeasts associated with pigeon droppings in Shiraz, Southern Iran

BACKGROUND

Birds are considered as a reservoir for pathogenic and non-pathogenic fungi. Pigeon droppings have the potential for spreading these fungi to the environment. Cryptococcus species are important fungi associated with pigeon droppings. In this regard, there are many types of yeast associated with guano that is important for human and animal health.

AIMS

The main objective of this study is the identification of non-Cryptococcus yeasts isolated from pigeon dropping in Shiraz, Southern Iran.

METHODS

A total of 100 unknown yeasts, which were previously screened and identified as non-Cryptococcus from pigeon guano through the conventional methods, were used in this study. Identification of the isolates was performed based on conventional methods and DNA sequence analysis of internal transcribed spacer (ITS) rDNA gene region. The sequence results were deposited in NCBI database using the Basic Local Alignment Search Tool (BLAST).

RESULTS

A total of 16 species belonging to 7 genera were identified as Candida spp. 51% (8 species), Rhodotorula sp. 24%, Trichosporon spp. 21% (3 species), Rhodosporidium 2%, Saccharomyces 1%, Rhizoctonia 1%, and Meyerozyma 1%. The predominant isolates were Rhodotorula rubra (24%), Candida famata (20%), and Trichosporon asahii (13%). The other species were Rhodosporidium kratochvilovae 2 (2%), Saccharomyces cerevisiae 1 (1%), Rhizoctonia solani 1 (1%), and Meyerozyma caribbica 1 (1%).

CONCLUSION

Pigeon excreta examined in this study were associated with several kinds of opportunistic yeasts which could cause diseases in prone human and animals.

Molecular epidemiology of environmental Cryptococcus species isolates based on amplified fragment length polymorphism

OBJECTIVE

Cryptococcosis is a major opportunistic fungal infection caused by members of the genus Cryptococcus, mainly those belonging to the Cryptococcus neoformans/Cryptococcus gattii species complexes. Here, we report a comprehensive molecular epidemiological study of the environmental distribution of Cryptococcus isolates in Shiraz, Iran with review of litreature.

METHOD

A total of 406 samples were obtained from Eucalyptus trees and 139 samples from pigeon droppings. Cryptococcus species identification and genotyping were performed by amplified fragment length polymorphism (AFLP) fingerprinting sequencing and sequencing of the ITS rDNA region.

RESULTS

Majority of the isolates belonged to the Naganishia taxon (n=69) including N. albida (formerly C. albidus, n=62), N. globosa (formerly C. saitoi, n=4), N. adeliensis (formerly C. adeliensis, n=2), N. diffluens (formerly C. diffluens, n=1), and the identified C. neoformans isolates (n=25) belonged to genotype AFLP1/VNI (n=22) and AFLP1B/VNII (n=3).

CONCLUSION

More research efforts should be employed to isolate C. gattii species complex from environmental niches in Iran and provide additional evidence related to novel molecular types.

Lifetime measurement in neutron-rich A~100 nuclei

Lifetimes of excited states of the 98;100;102Zr nuclei were measured by using the Generalized Centroid Difference Method. The nuclei of interest were populated via neutron-induced fission of 241Pu and 235U during the EXILL-FATIMA campaign. The obtained lifetimes were used to calculate the B(E2) transition strengths and β deformation parameters which were then compared with the recent theoretical predictions obtained with Monte Carlo Shell Model.

Physician perceptions about living organ donation in patients with Amyotrophic Lateral Sclerosis

OBJECTIVES

Patients with Amyotrophic Lateral Sclerosis (ALS) have expressed desire to become living organ donors but are unable to do so with current organ donation policies. Our objective is to assess ALS patient's interest in organ donation, and perceived concerns of this practice by ALS neurologists.

PATIENTS AND METHODS

An electronic survey was administered to ALS neurologists across the United States regarding living organ donation in ALS patients prior to respiratory failure.

RESULTS

52 complete responses were received from 121 invites. 67% (35/52) of neurologists expressed no concerns about living organ donation in ALS patients, and 33% had concerns. The concerns related to respiratory failure, anesthesia exposure and renal dysfunction. With their concerns addressed, 71% of neurologists reported that they would endorse living organ donation. 49% of neurologists reported being asked by a patient for information regarding living organ donation. ALS neurologists felt that 22.8% of ALS patients (median 19%) would be interested in learning more about organ donation, while only 6% of neurologists broach this subject with their patients.

CONCLUSION

Our results indicate that 1 in every 4 ALS patients may be interested in exploring options for living organ donation, and this topic is not routinely addressed by ALS clinics. These results indicate an unexplored area of patient interest. To honor a patient's wishes to donate, the transplant community will have to accommodate living organ donation from terminally ill patients, and address neurologist concerns. Such a practice could benefit two groups of patients.

Erratum to: Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)

[This corrects the article DOI: 10.1186/s13017-016-0089-y.].

Is human Dectin-1 Y238X gene polymorphism related to susceptibility to recurrent vulvovaginal candidiasis?

Background and Purpose:

Vulvovaginal candidiasis is a frequent disease affecting approximately more than %75 of all childbearing women at least once in their lifetime by overgrowth of opportunistic Candida species. Recurrent vulvovaginal candidiasis (RVVC) is common in otherwise healthy individuals. Several risk factors were reported to contribute to RVVC susceptibility. A polymorphism in Dectin-1 (Y238X, rs16910526 ) was identified in patients with RVVC and hypothesized that genetic factors play an important role in susceptibility to RVVC. Herein, we aimed to survey the polymorphisms in the Dectin-1 gene, linked to susceptibility to RVVC.

Materials and Methods:

In the current study, blood samples were obtained from 25 patients who had frequent vulvovaginal candidiasis relapses and were diagnosed as RVVC. In addition, blood cultures were obtained from control group comprising of healthy individuals (n=25) with no history of RVVC, vaginal discharge, or itching on the day of examination. Dectin-1 Y238X gene polymorphism was investigated using Bi-PASA and DNA sequencing.

Results:

The analysis revealed that all of the patients were wild-type homozygous for Dectin-1 Y238X polymorphisms. None of the individuals showed heterozygous or mutant homozygous Dectin-1 polymorphism.

Conclusion:

No significant correlations were observed between the susceptibility to RVVC and Dectin-1 Y238X polymorphism in the Iranian population, which was not previously studied.