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Background Ultrasound-guided supra-inguinal fascia iliaca block (FIB) provides effective analgesia after total hip arthroplasty (THA) but is complicated by high rates of motor block. The erector spinae plane block (ESPB) is a promising motor-sparing technique. In this study, we tested the analgesic superiority of the FIB over ESPB and associated motor impairment. Methods In this randomized, observer-blinded clinical trial, patients scheduled for THA under spinal anesthesia were randomly assigned to preoperatively receive either the ultrasound-guided FIB or ESPB. The primary outcome was morphine consumption 24 h after surgery. The secondary outcomes were pain scores, assessment of sensory and motor block, incidence of postoperative nausea and vomiting and other complications, and development of chronic post-surgical pain. Results A total of 60 patients completed the study. No statistically significant differences in morphine consumption at 24 h (P = 0.676) or pain scores were seen at any time point. The FIB produced more reliable sensory block in the femoral nerve (P = 0.001) and lateral femoral cutaneous nerve (P = 0.018) distributions. However, quadriceps motor strength was better preserved in the ESPB group than in the FIB group (P = 0.002). No differences in hip adduction motor strength (P = 0.253), side effects, or incidence of chronic pain were seen between the groups. Conclusions ESPBs may be a promising alternative to FIBs for postoperative analgesia after THA. The ESPB and FIB offer similar opioid-sparing benefits in the first 24 h after surgery; however, ESPBs result in less quadriceps motor impairment.

Special‐shaped concrete‐filled steel tubes (CFSTs) have been used in modern structures like high‐rise commercial and residential buildings due to their superior structural performance compared to steel and reinforced concrete members. Various shapes of special‐shaped CFSTs might be necessary to meet architectural and aesthetic needs. Cross‐shaped CFSTs could be used where two orthogonal walls cross in high‐rise buildings. However, at present, the research on the compressive performance of cross‐shaped CFSTs is limited, consequently, the unavailability of design guidelines and design‐oriented strength prediction models. Therefore, in this study, a finite element (FE) model of cross‐shaped CFSTs was developed following the past experimental data, and the model's accuracy was verified by the failure modes and load–strain curves of specimens. Sensitivity analysis was performed for some parameters of the concrete damaged plasticity model besides imperfections and residual stress. The parametric analysis was conducted considering various study parameters such as the width‐to‐thickness ratio, width‐to‐depth ratio, and steel and concrete strengths. The compressive strength of cross‐shaped CFSTs was predicted by different design codes and available design formulas, which gave unsatisfactory results necessitating the development of new strength prediction models. Finally, a new design formula was developed by performing a linear regression of FE and test results. The proposed formula predicted the strength of cross‐shaped CFSTs with great accuracy and can be used for design purposes. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of Subacromial Steroid Injection (SAI) and Hydrodilatation in treating adhesive capsulitis (frozen shoulder). Study Design: Observational study. Setting: Department of Orthopedic, Dr. Ziauddin Hospital, Located in North Nazimabad, Karachi, Pakistan. Period: March 2023 to September 2023. Methods: Included 138 participants with primary adhesive capsulitis. Participants were divided into two groups: one received hydrodilatation and the other received SAI. The Disability of Arm, Shoulder, and Hand (DASH) Score and Visual Analogue Scale (VAS) were used for pre and post-treatment assessments at intervals of 2 weeks, 6 weeks, and 6 months. SPSS version 23 was used to analyze the data. Results: Both groups show significant reductions in pain scores and DASH scores over time (p-value<0.05 for changes within each group). There are significant differences in pain scores and DASH scores between the groups at 6 weeks, 12 weeks, and 6 months (p-value<0.05), with the hydrodilatation group showing better outcomes. Moreover, the mean reduction in pain scores and DASH scores from pre-treatment to 6 months is significantly greater in the hydrodilatation group compared to the SAI group (p-value<0.05). Conclusion: While both Hydrodilatation and SAI are effective in reducing pain and improving functionality in patients with adhesive capsulitis, Hydrodilatation appears to be more effective in achieving these outcomes, particularly in terms of pain management and functional improvement. [ABSTRACT FROM AUTHOR]

The current study focuses on the importance of Protein–Protein Interactions (PPIs) in biological processes and the potential of targeting PPIs as a new treatment strategy for diseases. Specifically, the study explores the cross-links of PPIs network associated with obesity, type 1 diabetes mellitus (T1DM), and cardiac disease (CD), which is an unexplored area of research. The research aimed to understand the role of highly connected proteins in the network and their potential as drug targets. The methodology for this research involves retrieving genes from the NCBI online gene database, intersecting genes among three diseases (type 1 diabetes, obesity, and cardiovascular) using Interactivenn, determining suitable drug molecules using NetworkAnalyst, and performing various bioinformatics analyses such as Generic Protein–Protein Interactions, topological properties analysis, function enrichment analysis in terms of GO, and Kyoto Encyclopedia of Genes and Genomes (KEGG), gene co-expression network, and protein drug as well as protein chemical interaction network. The study focuses on human subjects. The results of this study identified 12 genes [VEGFA (Vascular Endothelial Growth Factor A), IL6 (Interleukin 6), MTHFR (Methylenetetrahydrofolate reductase), NPPB (Natriuretic Peptide B), RAC1 (Rac Family Small GTPase 1), LMNA (Lamin A/C), UGT1A1 (UDP-glucuronosyltransferase family 1 membrane A1), RETN (Resistin), GCG (Glucagon), NPPA (Natriuretic Peptide A), RYR2 (Ryanodine receptor 2), and PRKAG2 (Protein Kinase AMP-Activated Non-Catalytic Subunit Gamma 2)] that were shared across the three diseases and could be used as key proteins for protein-drug/chemical interaction. Additionally, the study provides an in-depth understanding of the complex molecular and biological relationships between the three diseases and the cellular mechanisms that lead to their development. Potentially significant implications for the therapy and management of various disorders are highlighted by the findings of this study by improving treatment efficacy, simplifying treatment regimens, cost-effectiveness, better understanding of the underlying mechanism of these diseases, early diagnosis, and introducing personalized medicine. In conclusion, the current study provides new insights into the cross-links of PPIs network associated with obesity, T1DM, and CD, and highlights the potential of targeting PPIs as a new treatment strategy for these prevalent diseases. [ABSTRACT FROM AUTHOR]

With the advancement in the concrete technology, the application of precast concrete elements in the buildings and road infrastructures is increasing very rapidly. One of such applications is the use of precast hollow concrete elements in the bridge construction. As the conventional steel reinforcement is highly susceptible to corrosion, the use of non‐corrosive reinforcement in precast hollow concrete piers and piles of bridges could be a good option for the durability of bridge structures., In this regard, hollow concrete columns reinforced with fiber‐reinforced polymer (FRP) have been considered as a potential solution to overcome the structural deterioration due to corrosion. In the past, limited studies have been carried out on hollow concrete columns reinforced with FRP, consequently, the behavior of such columns is not fully understood. Therefore, to comprehensively evaluate the behavior of hollow concrete columns for various design parameters, a finite element model (FEM) was developed in this study using the commercial tool "Abaqus". The model was developed and verified based on the experimental results of studies conducted by two independent research groups on circular concrete columns. The proposed model well predicted the peak loads with an error less than 10% and the failure modes of the tested columns. The verified constitutive relation and establishing method were further employed to conduct parametric evaluations to observe the influence of different parameters, such as inner‐to‐outer diameter ratio, longitudinal reinforcement ratio, lateral reinforcement ratio, and concrete strength, on the behavior of hollow concrete columns. Parametric analyses show that reduced inner‐to‐outer diameter ratio and larger longitudinal or lateral reinforcement may lead to higher peak load and confined concrete strength. Finally, based on the experimental and FEM evaluations, the strength prediction equations were developed for the analysis and design of hollow concrete columns reinforced with GFRP bars. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of prophylactic intravenous tramadol alone versus a combination of tramadol and ketamine in preventing shivering during spinal anesthesia for lower segment caesarean section. Methods: This double-blind randomized controlled trial was conducted at Ziauddin Hospital, North Nazimabad, Karachi, Pakistan from August 2023 to October 2023. Pregnant women aged between 18 to 40 years meeting American Society of Anesthesiologist physical status I and II admitted in hospital for lower segment caesarian section were enrolled. One group received an injection tramadol 0.5mg/kg whereas the other group received an injection of tramadol 0.25mg/Kg plus an injection ketamine 0.25 mg/Kg. The primary outcomes were incidence of shivering and severity of shivering. Time to shiver and complications were secondary outcomes. Results: Of total 190 patients, the mean age was 25.95 ±3.63 years. Shivering was reported in 96 (50.5%) patients. The incidence of shivering was found significantly lower in tramadol plus ketamine group as compared to tramadol group i.e., 18 (18.7%) vs. 78 (81.3%) (p-value <0.001). Severity of shivering was found significantly lower in tramadol plus ketamine group as compared to tramadol group (p-value <0.001). Mean duration of shivering found significantly lower in tramadol plus ketamine group as compared to tramadol group i.e., 4.78 ±0.73 minutes vs. 8.46 ±1.02 minutes (p-value <0.001) respectively. Conclusion: The incidence of shivering was significantly lower in the group receiving the combination therapy compared to those receiving tramadol alone. Notably, the severity and duration of shivering were also markedly reduced in the tramadol plus ketamine group. [ABSTRACT FROM AUTHOR]

The Pantothenate synthetase (PS) from the Mycobacterium tuberculosis ( Mtb ) holds a crucial role in the survival and robust proliferation of bacteria through its catalysis of coenzyme A and acyl carrier protein synthesis. The present study undertook the PS drug target in complex with a co-crystallized ligand and subjected it to docking and virtual screening approaches. The experimental design encompassed three discrete datasets: an active dataset featuring 136 compounds, an inactive dataset comprising 56 compounds, and a decoys dataset curated from the zinc library, comprising an extensive compilation of approximately 53,000 compounds. The compounds' binding energies were observed to be in the range of -5 to ∼-14 kcal/mol. Additionally, binding energy results were further refined through Enrichment Factor analysis (EF). EF is a new statistical approach which uses the scores obtained from docking-based virtual screening and predicts the precision of the scoring function. Remarkably, the Enrichment Factor (EF) analysis produced exceptionally favorable outcomes, attaining an EF of approximately 49% within the uppermost 1% fraction of the compound distribution. Finally, a total of eight compounds, evenly distributed between the active dataset and the decoys dataset, emerged as potent inhibitors of the Pantothenate synthetase (PS) enzyme. The analysis of inhibition constants and binding energy revealed a notable correlation, with an r-squared value ( r 2 ) of 0.912 between the two parameters. Furthermore, the shortlisted compounds were subjected to 100 ns MD simulation to determine their stability and dynamics behavior. The decoy compounds that have been identified, exhibiting properties comparable to the active compounds, are postulated as potential candidates for targeting the Pantothenate synthetase (PS) enzyme to treat Mtb infection. Nevertheless, in the pursuit of a comprehensive investigation, it is advisable to undertake additional experimental validation as a component of the subsequent study.Communicated by Ramaswamy H. Sarma.