Structural and functional characterization of mycobacterial PhoH2 and identification of potential inhibitor of its enzymatic activity

Mycobacterium tuberculosis is composed of a cumbersome signaling and protein network which partakes in bacterial survival and augments its pathogenesis. Mycobacterial PhoH2 (Mt-PhoH2) is a signaling element and a predictive phosphate starvation protein that works in an ATP-dependent manner. Here, we elaborated the characterization of Mt-PhoH2 through biophysical, biochemical, and computational methods. In addition to its intrinsic ATPase activity, the biochemical experiments revealed its GTPase activity and both activities are metal ion dependent. Magnesium, manganese, copper, iron, nickel, zinc, cesium, calcium, and lithium were examined for their effect on activity, and the optimum activity was found with 10 mM of Mg2+ ions. The kinetic parameters of 3 µM Mt-PhoH2 were observed as Km 4.873 ± 0.44 µM, Vmax 12.3817 ± 0.084 µM/min/mg, Kcat 0.0075 ± 0.00005 s-1, and Kcat/Km 0.0015 ± 0.000001 µM-1 s-1 with GTP. In the case of GTP as a substrate, a 20% decrease in enzymatic activity and a 50% increase in binding affinity of Mt-PhoH2 were observed. The substrates ADP and GDP inhibit the ATPase and GTPase activity of Mt-PhoH2. CD spectroscopy showed the dominance of alpha helix in the secondary structure of Mt-PhoH2, and this structural pattern was altered upon addition of ATP and GTP. In silico inhibitor screening revealed ML141 and NAV_2729 as two potential inhibitors of the catalytic activity of Mt-PhoH2. Mt-PhoH2 is essential for mycobacterial growth as its knockdown strain showed a decreased growth effect. Overall, the present article emphasizes the factors essential for the proper functioning of Mt-PhoH2 which is a participant in the toxin-antitoxin machinery and may also play an important role in phosphate starvation.

Dyakonov waves generation at uniaxial chiral-plasma interface

Numerical analysis of Dyakonov waves generation has been carried out at uniaxial chiral-plasma planar interface. The extended electromagnetic wave theory is utilized, and an impedance boundary conditions approach is employed to obtain characteristics equation. Effective mode index and attenuation under the different values of collisional frequency, plasma frequency and chirality in the THz frequency range for three cases for uniaxial chiral media are discussed. These results can be used in the field of photonics and integrated optics to fabricate nanophotonic devices in the THz frequency range.

Prevalence of anxiety, sleep bruxism and temporomandibular disorders during COVID-19 in Qatari children and adolescents: a cross-sectional study

PURPOSE

Understanding the impact of coronavirus disease-2019 (COVID-19) pandemic social restrictions on the lives of children and adolescents is of utmost importance to enable timely diagnosis and treatment. Therefore, the aim of this study was to explore the prevalence of anxiety, sleep bruxism, temporomandibular disorders (TMD) and change in dietary and brushing habits and their association with COVID-19 social restrictions.

METHODS

Parents of fit and healthy Qatari children and adolescents were recruited and interviewed by the research team, whereby validated questioners were used to assess the prevalence of children's/adolescents' anxiety, sleep bruxism and TMD. Furthermore, changes in dietary and brushing habits were also evaluated.

RESULTS

A total of 199 parents of children and adolescents (mean age = 9.3 ± 3.2 years old) were included. Overall anxiety symptoms, sleep bruxism and TMD were evident in 29.6%, 5.7% and 23.1%, respectively. An increased consumption of food, sweets and worsening of brushing habits were evident in 51.8%, 62.8% and 31.2%, respectively.

CONCLUSION

Within the limitations of this study, pandemic-related social restrictions could result in elevated levels of anxiety, specifically, social phobia, amongst children and adolescents, which could inevitably lead to unwanted dental consequences.

Identification of G-quadruplex structures in MALAT1 lncRNA that interact with nucleolin and nucleophosmin

Nuclear-retained long non-coding RNAs (lncRNAs) including MALAT1 have emerged as critical regulators of many molecular processes including transcription, alternative splicing and chromatin organization. Here, we report the presence of three conserved and thermodynamically stable RNA G-quadruplexes (rG4s) located in the 3' region of MALAT1. Using rG4 domain-specific RNA pull-down followed by mass spectrometry and RNA immunoprecipitation, we demonstrated that the MALAT1 rG4 structures are specifically bound by two nucleolar proteins, Nucleolin (NCL) and Nucleophosmin (NPM). Using imaging, we found that the MALAT1 rG4s facilitate the localization of both NCL and NPM to nuclear speckles, and specific G-to-A mutations that disrupt the rG4 structures compromised the localization of both NCL and NPM in speckles. In vitro biophysical studies established that a truncated version of NCL (ΔNCL) binds tightly to all three rG4s. Overall, our study revealed new rG4s within MALAT1, established that they are specifically recognized by NCL and NPM, and showed that disrupting the rG4s abolished localization of these proteins to nuclear speckles.

Genome Sequence of Highly Pathogenic Avian Influenza Virus A/Chicken/North Kazakhstan/184/2020 (H5N8)

The influenza virus strain A/chicken/North Kazakhstan/184/2020 (H5N8) was isolated in North Kazakhstan during a highly pathogenic avian influenza outbreak in 2020. This study aimed to obtain the complete genome sequence of the isolate.

Biophysical Characterization of Nucleolin Domains Crucial for Interaction with Telomeric and TERRA G-Quadruplexes

Nucleolin (NCL) is a well-characterized nucleic acid-binding protein; it binds to various canonical and noncanonical structures including single- and double-stranded DNA and RNA, hairpin, loops, and G-quadruplex structures. G-quadruplex structures are majorly formed in promoter, telomeric, and untranslated regions of the genome and affect the process of replication, transcription, and translation. One of the widely studied G-quadruplex-forming regions are telomeres, as these are sites for the recruitment for various proteins providing stability or having an effect on the telomerase activity. NCL is known to bind to both single- and double-stranded telomeric regions and its transcribed telomeric RNA (TERRA). In our study, we show that the 21nt G-quadruplex-forming region of telomeric DNA and TERRA RNA binds to NCL and the domains RRM1234 destabilize the telomeric G-quadruplex structure. We also show the preferential binding of the RNA G-quadruplex over the DNA G-quadruplex by two NCL domains, RRM3 and RRM4. Our findings provide insights into the binding preferences of RRM domains toward G-quadruplex structures and their subsequent effect on the quadruplex stability.

Dorsal Wrist Ganglion: Pilot for Randomized Control Trial Comparing Aspiration Alone or Combined with Injection of Platelet-Rich Plasma

This pilot study assessed the feasibility of performing a randomized control trial (RCT) investigating injection with platelet-rich plasma (PRP) for dorsal wrist ganglion (DWG). Aspiration alone was compared with aspiration plus injection of PRP. Seventeen patients were enrolled. Nine patients received PRP and eight aspiration alone. Patients were followed up at 6 weeks and 1 year; recurrence of the ganglion and Patient Evaluation Measure scores were measured. At 6 weeks seven patients in the aspiration group had a recurrence and five in the PRP group, but by 1 year, this has increased to seven out of eight in the PRP group whereas in the aspiration group four had resolved leaving three out of eight patients with a ganglion still present. From the basis of our work an RCT would require a minimum of 46 patients per group; however, it is unlikely that PRP will be a panacea for ganglia. This is a Level II study.

Foresight methodologies to unravel the indirect health economic impact of the COVID-19 pandemic on cancer care and management in Belgium studied in the HELICON project

Background

The COVID-19 pandemic had indirect effects on segments of the population affected with non-COVID-19 diseases e.g. through delayed care and management of cancer patients. Early diagnosis and appropriate treatment are key to improving patient outcomes and reducing societal and health care costs. Tio support policymakers to anticipate these trends a public health foresight study (PHFS) was done.

Methods

The PHFS follows a structured approach provided through a compact guide and is supervised by PHIRI team members. Its evolution is measured through a template gathering data on the study's contextual information, objective, main target groups, conceptual model, indicators, driving forces, time horizon, spatial unit, identifying uncertainties, scenario logics, scenario type, stakeholders, data, tools and instruments, projection methods, communication strategy/products, and the uptake of results and evaluation.

Results

Several foresight elements were identified. Contextual information on the resources and governance structure were elucidated. The objective was made clear by identifying the topic, general issue, and sub-issues of the initial study. A conceptual model was developed to analyse the interaction of the topic with other aspects that could influence it. The main driving forces, which are factors that influence the studied topic, were then determined through the DESTEP method. Stakeholders were identified and classified through the power-interest matrix.

Conclusions

Establishing a foresight study on the indirect impact of the COVID-19 pandemic on the care and management of cancer patients allows exploring potential and unsuspected issues that may affect society, health care systems, and patients. Those groups should not be considered individually but as an ecosystem continuously interacting, where a decision may affect everyone. This type of information may be of high relevance to policy- and decision-makers in their public health interventions.

Neurocognitive Changes in Chronic Hepatitis C patients Receiving Combination Therapy of Interferon and Ribavirin: A Systematic Review

Background:

Approximately 3% of the world’s total population is affected by the Hepatitis C virus (HCV). The treatment for HCV differ widely across the countries and one of the therapy used is the combination of interferon (INF) and ribavirin (RBV). Few studies have shown that this combination increases the rate of sustained virological response in HCV patients, resulting in beneficial effects on cognition, while other studies reported that it leads to cognitive decline. Thus, this systematic review aims to assess the effects of INF+RBV therapy on neurocognitive changes of HCV patients.

Methods:

Studies reporting the effect of INF+RBV on neurocognitive changes were searched using Scopus, PubMed, Academia, Google Scholar, Science Direct, and Cochrane. The studies were retried till August 23, 2021. The quality assessment of the included studies was done using Cochrane’s bias assessment tool.

Results:

A total of 6380 articles were found in the initial search. After removing the duplicates, 619 articles were screened on the basis of titles. Further, after the screening, 54 articles were screened on the basis of abstract and finally 16 articles were included in this study. Nine studies reported decline in cognitive function post INF+RBV therapy while 7 articles reported improvement in cognitive functions.

Conclusion:

In conclusion, the combination therapy of INF and RBV may result in cognitive decline in HCV patients.

Expression and roles of GRAS gene family in plant growth, signal transduction, biotic and abiotic stress resistance and symbiosis formation-a review

The GRAS (derived from GAI, RGA and SCR) gene family consists of plant-specific genes, works as a transcriptional regulator and plays a key part in the regulation of plant growth and development. The past decade has witnessed significant progress in understanding and advances on GRAS transcription factors in various plants. A notable concern is to what extent the mechanisms found in plants, particularly crops, are shared by other species, and what other characteristics are dependent on GRAS transcription factor (TFS)-mediated gene expression. GRAS are involved in many processes that are intimately linked to plant growth regulation. However, GRAS also perform additional roles against environmental stresses, allowing plants to function more efficiently. GRAS increase plant growth and development by improving several physiological processes, such as phytohormone, biosynthetic and signalling pathways. Furthermore, the GRAS gene family plays an important role in response to abiotic stresses, e.g. photooxidative stress. Moreover, evidence shows the involvement of GRAS in arbuscule development during plant-mycorrhiza associations. In this review, the diverse roles of GRAS in plant systems are highlighted that could be useful in enhancing crop productivity through genetic modification, especially of crops. This is the first review to report the role and function of the GRAS gene family in plant systems. Furthermore, a large number of studies are reviewed, and several limitations and research gaps identified that must be addressed in future studies.

Alternative splicing modulation mediated by G-quadruplex structures in MALAT1 lncRNA

MALAT1, an abundant lncRNA specifically localized to nuclear speckles, regulates alternative-splicing (AS). The molecular basis of its role in AS remains poorly understood. Here, we report three conserved, thermodynamically stable, parallel RNA-G-quadruplexes (rG4s) present in the 3' region of MALAT1 which regulates this function. Using rG4 domain-specific RNA-pull-down followed by mass-spectrometry, RNA-immuno-precipitation, and imaging, we demonstrate the rG4 dependent localization of Nucleolin (NCL) and Nucleophosmin (NPM) to nuclear speckles. Specific G-to-A mutations that abolish rG4 structures, result in the localization loss of both the proteins from speckles. Functionally, disruption of rG4 in MALAT1 phenocopies NCL knockdown resulting in altered pre-mRNA splicing of endogenous genes. These results reveal a central role of rG4s within the 3' region of MALAT1 orchestrating AS.

Orf virus infection of the hand in a Scottish sheep farmer. A case report to increase awareness to avoid misdiagnosis

Awareness of infections which are transmitted between animals and humans have been given prominence following the (COVID-19) pandemic. The Orf infection in humans is rare. Recognition of Orf lesions avoids misdiagnosing and incorrect treatment. We present a case of a Scottish-farmer with pain and discomfort from a lesion on her finger.

A Novel Method of Treatment for a Mal-United Galeazzi Fracture With Dislocation of the Distal Radioulnar Joint Using Scarf Osteotomy

The Galeazzi fracture is an unstable fracture-dislocation of the forearm. There have been reports of non-union of the radius despite rigid internal fixation with a plate. We present the case of a 25-year-old male who fell from his bicycle, sustaining a closed Galeazzi fracture-dislocation. Definitive surgical fixation involved internal fixation using a six-hole dynamic compression plate. Post-operatively, the patient noted a significant reduction in pronation. The fracture had united but with approximately 5 mm of radial shortening. The operating consultant formulated a surgical plan to resolve the complex nature of this mal-united Galeazzi fracture. A scarf-type osteotomy would correct the deformity and reduce the risk of non-union. Clinically and radiographically, the scarf osteotomy had healed by three months. The patient was very pleased that he underwent revision surgery, as the pain from the wrist resolved and the range of movement improved.

Reflectance and transmittance of terahertz waves from graphene embedded into metamaterial structures

In this work, the theoretical study of the interaction of terahertz (THz) waves with graphene embedded into two different semi-infinite metamaterials was carried out. To model the graphene, the effective surface conductivity approach based on the Kubo formalism was used. In addition, two types of metamaterials, i.e., double-positive (DPS) and double-negative (DNG), were studied in the THz regime. The numerical modeling of metamaterials was performed in the framework of causality-principle-based Kramers-Kronig relations. The reflectance and transmittance from the graphene-embedded metamaterial structures are studied for the following four different configurations: DPS-Graphene-DPS, DPS-Graphene-DNG, DNG-Graphene-DPS, and DNG-Graphene-DNG. The influence of the chemical potential and scattering rate on the reflectance and transmittance for each configuration is analyzed. It is concluded that the DPS-Graphene-DPS and DNG-Graphene-DNG configurations behave as anti-reflectors for the THz waves, while the DPS-Graphene-DNG and DNG-Graphene-DPS configurations are suitable for THz reflector applications. Moreover, a parametric study revealed that the relative permittivity of the partnering metamaterial can be used as an additional degree of freedom to control the reflectance and transmittance of THz waves. In conclusion, the transmissive and reflective characteristics of THz waves can be controlled effectively with the appropriate choice of graphene parameters, as well as the configuration of metamaterial structures. The convergence of the analytical and numerical results is found with the published results under special conditions. The present work may have potential applications in the design of THz wave controllers, reflectors, absorbers, and anti-reflectors.

Optical characterization of non-thermal plasma jet energy carriers for effective catalytic processing of industrial wastewaters

An argon plasma jet was sustained in open air and characterized for its chemical composition. The optically characterized plasma jet was used to treat industrial wastewater containing mixed textile dyes and heavy metals. Since plasma jet produces UV-radiations, the photocatalytic TiO₂ was used to enhance plasma treatment efficiency especially for degradation of dyes. Mixed anatase and rutile phases of TiO₂ (5.2-8.5 nm) were produced through surfactant assisted sol-gel approach. The emission spectrum confirmed the presence of excited argon, OH, excited nitrogen, excited oxygen, ozone and nitric oxide in the plasma jet. The spectral lines of excited Ar, NO, O₃, OH^-, N₂, [Formula: see text], O, [Formula: see text] and O⁺ species were observed at wavelength of 695-740 nm, 254.3 nm, 307.9 nm, 302-310 nm, 330-380 nm, 390-415 nm, 715.6 nm, 500-600 nm and 400-500 nm. These reactive species decompose the organic pollutants and separate the heavy metals from the water samples. The conductivity of plasma exposed water samples increased while pH and hardness decreased. The atomic absorption spectrophotometry analysis confirmed the presence of heavy metals in the samples, which were effectively removed through plasma treatment. Finally, the effect of plasma treatment on Staphylococcus aureus strains was more pronounced than Escherichia coli strains.

The role of tacit knowledge in communication and decision-making during emerging public health incidents

Strong communication systems for knowledge exchange are required to prevent, respond to and mitigate the effects of emerging public health incidents (EPHIs). The objective of this paper is to examine how "tacit knowledge" - implicit knowledge used to guide everyday practice - is employed in professional relationships and communication processes between public health and acute care settings. A qualitative study design was used to explore the experiences of key informants from public health and acute care settings in Ontario, Canada, to examine how specific dimensions of tacit knowledge are employed in communications about EPHIs. Twenty-six in-depth interviews were conducted from 2014 to 2015. The results describe the way in which participants employ discretion and knowledge of local context, and rely on relationships built on trust and credibility, to facilitate decision-making and communication during EPHIs. Given the uncertainty characterizing most EPHIs, communicators rely a great deal on their informal knowledge and networks which allow them to remain flexible and respond quickly to changing situations. The results reveal that communication about public health guidance during emergencies is a complex and active process that draws from past experiences of the individuals involved, and is shaped by the requirements of local circumstances. The broader implications of these findings for building resilient and responsive health systems are considered. In particular, for rethinking the authority of standardized forms of evidence in public health decision-making, and the importance of knowledge which is grounded in the uniqueness of specific local contexts.

Electromagnetic surface waves supported by a resistive metasurface-covered metamaterial structure

This study examines the analytical and numerical solution of electromagnetic surface waves supported by a resistive metasurface-covered grounded metamaterial structure. To simulate the metamaterial, the Kramers-Kronig relation based on the causality principle is used, while the modeling of the resistive metasurface has been done by implementing the impedance boundary conditions. The analytical expressions for the field phasors of surface waves are developed for the transverse magnetic (TM) polarized mode and transverse electric (TE) polarized mode. The characteristic equations are computed for both modes, and the unknown propagation constant is evaluated numerically in the kernel. After computation, the dispersion curves, electric field profiles, effective mode index ([Formula: see text]), and phase speeds ([Formula: see text]) are presented for both the TM and TE polarized modes. To study the tunability of surface waves, the influence of the thickness of the metamaterial slab ([Formula: see text]), effective permittivity of the metamaterial ([Formula: see text]), thickness of the resistive metasurface ([Formula: see text]), and effective permittivity of the metasurface ([Formula: see text]) on all the numerical results has been studied. However, the geometrical parameters are found to be more sensitive to the effective mode index ([Formula: see text]) and phase speed ([Formula: see text]) of the surface waves. The results are consistent with the published results, which reflects the accuracy of the work. It is concluded that the appropriate choice of parameters can be used to achieve surface waves with the desired characteristics in the GHz range. The present work may have potential applications in surface waveguide design, surface wave speed controllers, surface communication devices, and light trapping configurations.

Supra-patellar nailing for isolated closed tibial shaft fractures: Medium term functional outcomes from an Academic Level 1 Trauma centre

Aims The aim of this study was to assess functional outcome, at medium-term follow up, in patients undergoing intra-medullary nailing of tibial shaft fractures, using the supra-patellar approach. Materials and methods The study included patients with intra-medullary nailing, for diaphysial tibia fractures, between March 2013 to August 2015. An initial audit compared short-term functional outcomes at 15 months, between the supra and infra-patellar approaches, using a cohort of 20 patients (10 in each group). Subsequently, a larger cohort of 22 patients with supra-patellar nailing, were reviewed for medium term assessment of their functional outcomes at average 60 months (50 - 78 months) and the results between all 3 groups were compared. All patients were assessed using the Kujala and Oxford Knee Scores. Results The mean age of the cohorts was 38 years (18-87years). The mean follow-up was 15 months for the initial audit and 60 months for the medium-term results. The initial audit showed that the supra-patellar group had statistically significantly better Oxford and Kujala scores when compared to infra-patellar group (p < 0.05). At 5 years following supra-patellar nailing, the medium-term cohort showed improved outcome scores compared to the infra-patellar group at 1 year (p < 0.01) but showed no difference with the supra-patellar group at 1 year (p value >0.1). Conclusion Our study suggests that patients undergoing supra-patellar tibial nailing have better outcomes at 15 months compared to traditional infra-patellar nailing and more importantly, they continue to do well even at 5 years, despite perceived risks associated with this technique.

Tubercular granuloma mimicking pyogenic liver abscess

Hepatic Tuberculosis (TB) is extremely rare without miliary involvement in immunocompetent patients. Even in countries like India where TB is a major public health problem only few cases have been diagnosed and treated. We report a case of an immunocompetent patient who presented with undiagnosed pyrexia of 11 days, was initially diagnosed as pyogenic liver abscess, he did not responded to treatment and on liver biopsy was diagnosed as hepatic tuberculoma. Antitubercular treatment (ATT) was started and the patient responded well. We concluded that though hepatic TB is rare in immunocompetent patient, it is important to keep it as a differential diagnosis in patients of liver abscesses who are not responding to treatment in order to avoid needless investigations.

Measuring biopsychosocial risk for back pain disability in chiropractic patients using the STarT back screening tool: a cross-sectional survey

Background

The Keele STarT Back Screening Tool (SBT), a 9-item questionnaire, screens for pain, physical functioning, fear-avoidance beliefs, catastrophizing, anxious thoughts, low mood, and bothersomeness in persons with back pain. SBT scores designate low, medium, or high risk for developing persistent disabling back pain. The primary study aim was to report the prevalence of SBT-calculated risk for back pain disability in US patients seeking chiropractic care.

Methods

The SBT questionnaire was administered to patients ≥18 years in 3 Chiropractic College outpatient teaching clinics in Iowa and Illinois (May 2017). Descriptive statistics were used to analyze respondent characteristics and prevalence of SBT-calculated risk subgroups. Binary logistic regression analysis was used to examine the relationship between respondent characteristics and SBT scores (including psychological subscores).

Results

Of 550 respondents, 496 completed the SBT; 392 (79%) scored low-risk, 81 (16%) medium-risk, and 23 (5%) high-risk. Mean (SD) age was 44.8 (15.9), 56.9% were female, 88.2% white, 62.6% employed, mean current pain was 2.9 (2.1) out of 10, and 62% reported symptom duration > 3 months. Eighteen percent of respondents reported anxious thoughts, 32% low mood, 41% ≥ 1 and 21% ≥ 3 SBT psychological risk factors. Respondents reporting higher average pain (OR = 1.8 [1.4, 2.3]) and pain severity (OR = 1.3 [1.0 to 1.6]) were more likely to score with medium or high risk. Respondents reporting mid back versus low back pain (OR = 0.2 [0.1, 0.7]), and those employed less than full-time versus full-time (0.2 [01, 0.5]) were less likely to score with medium or high risk. Respondents reporting higher average pain were more likely to report ≥1 psychological factor (OR = 1.8 [1.5, 2.0]). Respondents employed part-time were less likely to report ≥1 psychological factor than those employed full-time (OR = 0.4 [0.2, 0.7]).

Conclusion

The sample surveyed was less likely to score with medium or high risk for back pain disability than previous samples studied, perhaps due to differences in study design and sample characteristics. Rates of low mood and anxious thoughts indicate a need for future research to explore psychological factors among persons seeking chiropractic care.

The STarT back tool in chiropractic practice: a narrative review

Background

The Keele STarT Back Tool was designed for primary care medical physicians in the UK to determine the risk for persistent disabling pain in patients with musculoskeletal pain and to tailor treatments accordingly. In medical and physical therapy settings, STarT Back Tool’s tailored care plans improved patients’ low back pain outcomes and lowered costs.

Objective

Review studies using the STarT Back Tool in chiropractic patient populations.

Methods

PubMed, The Cochrane Library, Index to Chiropractic Literature, and Science Direct databases were searched. Articles written in English, published in peer-reviewed journals, that studied the STarT Back Tool in patients seeking chiropractic care were included.

Results

Seven articles were selected based on inclusion and exclusion criteria. The STarT Back Tool was feasibly incorporated into 19 chiropractic clinics in Denmark. Total STarT Back 5-item score correlated moderately with total Bournemouth Questionnaire score. Two studies reported that the STarT Back Tool’s predictive ability was poor, while another reported that the tool predicted outcomes in patients scoring in the medium and high risk categories who completed the STarT Back 2 days after their initial visit. A study examining Danish chiropractic, medical and physical therapy settings revealed that only baseline episode duration affected STarT Back’s prognostic ability across all care settings. The tool predicted pain and disability in chiropractic patients whose episode duration was at least 2 weeks, but not in patients with an episode duration <2 weeks.

Conclusion

While the STarT Back Tool can be incorporated into chiropractic settings and correlates with some elements of the Bournemouth Questionnaire, its prognostic ability is sometimes limited by the shorter low back pain episodes with which chiropractic patients often present. It may be a better predictor in patients whose episode duration is at least 2 weeks. Studies examining outcomes of stratified care in chiropractic patients are needed.

Characterization of Linum usitatissimum L. oil obtained from different extraction technique and in vitro antioxidant potential of supercritical fluid extract

Aim:

Present investigation was aimed to characterize the fixed oil of Linum usitatissimum L. using five different extraction methods: Supercritical fluid extraction (SFE), ultrasound-assistance, soxhlet extraction, solvent extraction, and three phase partitioning method.

Materials and Methods:

The SFE conditions (temperature, pressure, and volume of CO₂) were optimized prior for better yield. The extracted oils were analyzed and compared for their physiochemical parameters, high performance thin layer chromatography (HPTLC), gas chromatography-mass spectrometry (GC-MS), and Fourier-transformed infrared spectroscopy (FT-IR) fingerprinting. Antioxidant activity was also determined using 1,1-diphenyl-2-picrylhydrazyl and superoxide scavenging method.

Result:

The main fatty acids were α-linolenic acid, linoleic acid, palmitic acid, and stearic acid as obtained by GC-MS. HPTLC analysis revealed the presence of similar major components in chromatograms. Similarly, the pattern of peaks, as obtained in FT-IR and GC-MS spectra of same oils by different extraction methods, were superimposable.

Conclusion:

Analysis reported that the fixed oil of L. usitatissimum L. is a good source of n-3 fatty acid with the significant antioxidant activity of oil obtained from SFE extraction method.

The cost of adverse events from knee surgery in the United Kingdom: an in-depth review of the National Health Service Litigation Authority database

BACKGROUND

There has been a significant rise in the number and value of claims against the National Health Service (NHS), with limited studies on litigation in orthopaedic surgery and none in knee surgery alone. We aimed to examine claims against the NHS involving all aspects of knee surgery with respect to costs and trends.

CLINICAL RELEVANCE

To raise awareness of the reasons for litigation in knee surgery, thus potentially improve patient care and reduce future claims.

METHODS

We analysed the NHS litigation authority (NHSLA) database for all orthopaedic surgery claims reported to the NHSLA between 2005 and 2010, with calculation of litigation success rates and odds ratios for those relating to knee surgery.

RESULTS

There were 515 cases identified from the 4609 orthopaedic cases in the NHSLA database (11.2%): 298 (58%) involving total knee replacements (TKRs), 11 (2%) involving unicondylar knee replacements, and 90 cases (30%) remaining open. The total pay out for closed cases was £10.45 million and amputation following TKR resulted in the highest single pay out. Litigation success rates for claimants were highest for retained drains (100%), incorrect prosthesis/prosthesis size (78%), renal failure (75%), poor outcome requiring further surgery (74%) and malalignment (71%). There were also 60 cases of delayed diagnosis which resulted in pay outs totalling £2.90 million. Based on these data, projected future pay out costs for the open TKR cases were estimated to be £2.71 million.

CONCLUSION

Litigation success rates for TKR were highest following technical errors such as malalignment compared to events less under the surgeon's control, such as infection. The number of claims involving incorrect prosthesis/size continues to be of concern. Despite the increased availability of imaging modalities, missed diagnosis also resulted in substantial pay outs.

Five to eight years follow-up for trapeziectomy and Weilby ligament reconstruction for the treatment of trapeziometacarpal osteoarthritis

Trapeziectomy and Weilby ligament reconstruction is a recognized treatment for osteoarthritis of the trapeziometacarpal joint. Studies published using this procedure have limited follow-up post-surgery. In this series of 24 cases assessed objectively and 36 subjectively with a minimum follow-up of five years, patients continue to have pain relief and function comparable to the opposite non-operated hand. Patient satisfaction is high at 92% and the rate of complications is low. Despite these encouraging results the need for interposition arthroplasty and/or ligament reconstruction in addition to trapeziectomy alone is discussed.

The use of individually wrapped presterilized small orthopaedic implants increase operating time: a prospective experimental study

Objective

There have been concerns about the potential increases in operating time associated with the use of individually wrapped presterilized small orthopaedic implants compared with our traditional method of screw banks. We set out to quantify this theory.

Design

Prospective experimental study.

Setting

Theatre.

Participants

Orthopaedic Surgical Trainees and Theatre Scrub team.

Main outcome measure

The time taken to complete the operation.

Results

The use of prepacked and sterilized implants added 2 min 56 s to the use of a bank with a full complement of normal screws that required tapping and 3 min 58 s if self-tapping screws were used (P < 0.001).

Conclusion

Using individually wrapped presterilized small orthopaedic implants increases operating time.