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Dittrichia viscosa is a perennial herb that has been used for generations in traditional medicine to address a variety of diseases, including diabetes, hypertension, cancer, microbial disorders, inflammatory conditions, and wound healing. The objective of this review is to provide an overview of existing knowledge on D. viscosa with regards to its botanical description, ethnomedicinal uses, and pharmacological properties. Databases such as Scopus, Wiley-Online, PubMed, Springer, Google Scholar, and ScienceDirect were used to select relevant articles based on their title and abstract.The reviewed studies found a strong correlation between D. viscosa's traditional uses and its observed biological effects. Pharmacological research has shown that the essential oils and extracts from D. viscosa possess a variety of biological activities, such as anti-inflammatory, anticancer, antibacterial, antifungal, analgesic, and antioxidant properties. The chemical compounds found in D. viscosa include sesquiterpenes, monoterpenes, flavonoids, and phenolic acids; some of these compounds, such as tometosin and inuviscolide, have been isolated and displayed promising cytotoxic and anti-inflammatory activity.The present review suggests that the pharmacological properties of D. viscosa align well with its ethnomedicinal uses. These findings support the traditional use of D. viscosa in treating various illnesses. Additionally, toxicological examinations of D. viscosa extracts and essential oil have demonstrated the plant's safety, which supports the need for comprehensive pharmacological studies, in vivo studies, and clinical trials to evaluate the best doses for optimal medicinal effects. This work underscores the medicinal value of D. viscosa and its potential in developing new pharmacological agents to address major health challenges like antibiotic resistance and cancers.

Introduction: Automated machine learning (AutoML) is a novel artificial intelligence (AI) strategy that enables clinicians without coding experience to develop their own AI models. This study assessed the discriminative performance of AutoML in differentiating diabetic retinopathy (DR), central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) from normal fundi using color fundus photographs (CFPs). Methods: We carried out AutoML model design using CFPs retrieved from a publicly available CFP data set (3200 labelled images). The retrieved CFPs were reviewed for quality and then uploaded to the Google Cloud Vertex AI platform for AutoML training and testing. We trained a multi-class classification model to differentiate DR, CRVO, BRVO from normal fundi using 875 CFPs and externally validated the model using 210 CFPs obtained from another dataset. Performance metrics, including area under receiver operator curve (AUROC) and sensitivity were reported. We then compared the AutoML model to state-of-the-art deep learning (DL)-based DR and RVO multi-class models identified through a literature search. Results: Our AutoML model showed high discriminative performance in the multi-class classification of DR, CRVO and BRVO based on CFPs, with an AUROC, precision and recall reaching 0.995, 95.4% and 95.4% respectively at the 0.5 confidence threshold. The per-label sensitivity and specificity, respectively, were normal fundi (97.5%, 100%), DR (100%, 93.88%), CRVO (66.67%, 100%) and BRVO (71.43%, 98.73%). Our AutoML model generally showed similar performance to the state-of-the-art DL classifiers. Conclusion: Our AutoML model can detect DR, CRVO, and BRVO in CFPs with good diagnostic accuracy and is a potentially useful screening tool.

Sinus tarsi syndrome (STS) is a clinical entity characterized by pain of the lateral hindfoot and a sense of instability especially on uneven surfaces due to chronic inflammation characterized by fibrotic tissue remnants and synovitis of the sinus tarsi, associated with both traumatic and nontraumatic causes. Arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. The purpose of this Technical Note is to report the details of arthroscopic management of STS.

Dysplasia epiphysealis hemimelica (Trevor disease) is a rare skeletal development disorder of childhood, characterized by irregular ossification centers, which may develop together or individually, leading to asymmetric epiphyseal cartilage overgrowth, affecting 1 side of the epiphyses or the epiphyses equivalents (the medial side being affected twice as often as the lateral), until skeletal maturity is reached. Trevor disease around the ankle is locally aggressive with a poor outcome, especially in tumors involving the articular surface. The purpose of this Technical Note is to describe the details of arthroscopic management of dysplasia epiphysealis hemimelica (Trevor disease) of the ankle.

The talonavicular joint is a common site for osteoarthritis of the foot. Talonavicular arthrodesis is the surgical treatment for symptomatic talonavicular osteoarthritis. Classically, this is performed via an open approach and is associated with a rate of nonunion that ranges from 3% to 37%. Arthroscopic talonavicular arthrodesis has been proposed to provide better intra-articular visualization, conserve bone blood supply to improve the union rate, and reduce soft-tissue complications such as wound dehiscence, infection, and neurovascular injury. The purpose of this Technical Note is to describe the details of arthroscopic talonavicular arthrodesis for management of talonavicular osteoarthritis.

A ganglion is the most common soft-tissue mass in the foot and can cause pain, paresthesia, or footwear problems. A ganglion can extend from the dorsum into the plantar compartment of the foot in the form of a horseshoe at the borders of the foot or in the form of an hourglass through the intermetatarsal space. Initial conservative management of a ganglion may entail observation and the use of padding for comfort, manual rupture, aspiration of the cyst contents, and steroid injection or sclerotherapy into the cyst. When the lesion is recurrent or painful, surgical excision is recommended. The purpose of this Technical Note is to describe the details of endoscopic resection of a horseshoe ganglion of the lateral midfoot. This technique has the advantages of being minimally invasive, with better cosmetic results and less surgical trauma to the soft tissue.

Cancer is one of the major leading causes of mortality globally and chemo-drug-resistant cancers pose significant challenges to cancer treatment by reducing patient survival rates and increasing treatment costs. Although the mechanisms of chemoresistance vary among different types of cancer, cancer cells are known to share several hallmarks, such as their resistance to apoptosis as well as the ability of cancer stem cells to produce metastatic daughter cells that are resistant to chemotherapy. To address the issue of chemo-drug resistance in cancer cells, a tetracistronic expression construct, Ad-MBR-GFP, encoding adenovirus-mediated expression of MOAP-1, Bax, RASSSF1A, and GFP, was generated to investigate its potential activity in reducing or inhibiting the chemo-drug resistant activity of the human breast cancer cells, MCF-7-CR and MDA-MB-231. When infected by Ad-MBR-GFP, the cancer cells exhibited round cell morphology and nuclei condensation with positive staining for annexin-V. Furthermore, our results showed that both MCF-7-CR and MDA-MB-231 cells stained positively for CD 44 and negatively for CD 24 (CD44+/CD24-) with high levels of endogenous ALDH activity whereas SNU-1581 breast cancer cells were identified as CD 44-/CD 24- cells with relatively low levels of endogenous ALDH activity and high sensitivity toward chemo-drugs, suggesting that both CD 44 and ALDH activity contribute to chemo-drug resistance. Moreover, both MCF-7-CR and MDA-MB-231 cells showed strong chemo-drug sensitivity to cisplatin when the cells were infected by Ad-MBR-GFP, leading to 9-fold and 2-fold reduction in the IC 50 values when compared to cisplatin treatment alone, respectively. The data were further supported by 3D (soft agar) and spheroid cell models of MCF-7-CR and MDA-MB-231 cells which showed a 2-fold reduction of a number of cell colonies and spheroid size when treated with both Ad-MBR-GFP and cisplatin, and compared to control. Other than chemo-sensitivity, Ad-MBR-GFP-infected cancer cells retarded cell migration. Flow cytometry analysis showed that the mechanism of action of Ad-MBR-GFP involved cell cycle arrest at the G1 phase and inhibition of cellular DNA synthesis. Taken together, our investigation showed that Ad-MBR-GFP mediated chemo-drug sensitization in the infected cancer cells involved the activation of apoptosis signaling, cell cycle arrest, and inhibition of DNA synthesis, suggesting that Ad-MBR-GFP is potentially efficacious for the treatment of chemo-drug resistant cancers.

Bitumen has been used in different forms and with various properties in pavement as a binder material. Meanwhile, the properties of soil-rubber mixtures (SRM) have been extensively examined for applications in geotechnical and highway engineering. These applications range from serving as a lightweight fill material, subgrade layers in pavement, and foundation materials for geotechnical seismic isolation (GSI). However, a research gap exists in understanding the effect of the interaction between bitumen and rubber granules on their mechanical properties under a range of confining pressures. In this paper, a series of unconfined compressive strength (UCS) and monotonic triaxial tests were conducted. The results show that a bitumen content as low as 3% of the total mass can significantly increase the shear strength and cohesion of SRM and reduce the deformability. Moreover, the increase in the elastic modulus due to a 3–5% bitumen content is notably less than the reduction obtained from 25% to 45% rubber replacement, which is favourable for GSI applications. The shear strength and elastic modulus in gravel-based mixtures were found to be more sensitive to changes in rubber and bitumen content compared to sand-based mixtures. Conversely, the effect of confining pressure was more pronounced in sandy soil than in gravelly soil.

The aims of this study are the phytochemical exploration and food valorization of Schinus molle L. (S. molle) and Schinus terebinthifolia Raddi (S. terebinthifolia) from the Rabat, Morocco. Gas chromatography (GC) and high-performance liquid chromatography (HPLC) were used to analyze the chemical composition of the oils extracted from both species by soxhlet and maceration. Moreover, physicochemical characteristics such as lipid quality indexes such as thrombogenic index (TI), atherogenic index (AI), oxidation susceptibility (OS), and calculated oxidability (Cox) were determined. These characteristics included percentage acidity, peroxide, saponification, iodine, specific extinction values, chlorophyll, and carotenoid pigments. As results, the oil yields varied from 7% (S. molle) to 13% (S. terebinthifolia). In addition, unsaturated fatty acids represented the major fraction for S. terebinthifolia (79%) and S. molle (81%). However, S. terebinthifolia contains more saturated fatty acids (20%) than S. molle (16%) with a predominance of linoleic acid (59.53% and 55%, C18,2), oleic acid (19.29% and 21.69%, C18,1), and palmitic acid (12.56% and 15.48%, C16,0) in S. molle and S. terebinthifolia, respectively. Moreover, the main sterols are β-sitosterol followed by campesterol and then Δ-5-avenasterol, while β-sitosterol varies according to the species and the extraction method. Results revealed also that campesterol is influenced by the extraction results in a content of 179.66 mg/kg (soxhlet) and 63.48 mg/kg (maceration) for S. molle, while S. terebinthifolia yeilds concentrations of 170 mg/kg and 138 mg/kg, then Δ-5-avenasterol, which present with (117 mg/kg and 136 mg/kg), (34 mg/kg and 80 mg/kg) of the total amount of sterols for the oils extracted by soxhlet and maceration, respectively. In addition, there are favorable physicochemical properties for all oils, such as chlorophylls (0.4 to 0.8 mg/kg) and carotenoids (0.7 to 2 mg/kg). However, further investigations are needed to determine other chemical compounds of both extracts as well as to evaluate their biological and health benefits.

This study aimed to explore the possibility of enriching cold-pressed Virginia (VIO) and Valencia (VAO) peanut oils with omega-3 fatty acids (FAs) from walnut oil (WO) to produce blended oils with improved nutritional value. The oxidative stability of pure and blended oils was examined under accelerated conditions (60 °C) for 28 days. The FA and tocopherol profiles, as well as nutritional quality indices, were determined. As the proportion of WO increased in the blends, the levels of linoleic and α-linolenic essential FAs increased, while oleic acid content decreased. Furthermore, γ- and δ-tocopherol levels rose, whereas α-tocopherol declined. Among the studied blends, VIO:WO blends, especially at a (70:30) ratio, were nutritionally favorable with a balanced FA profile. During storage, notable changes were observed in tocopherol levels, along with subtle alterations in the FA profile of the blended oils. Hence, the oxidative stability of pure VIO and VAO decreased with WO incorporation.

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83–0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders.

Background: The Calcium-sensing receptor (CaSR) participates in the regulation of gastrointestinal (GI) motility under normal conditions and might be involved in the regulation of GI dysmotility in patients with Parkinson's disease (PD). Methods: CaSR antagonist-NPS-2143 was applied in in vivo and ex vivo experiments to study the effect and underlying mechanisms of CaSR inhibition on GI dysmotility in the MPTP-induced PD mouse model. Findings: Oral intake of NPS-2143 promoted GI motility in PD mice as shown by the increased gastric emptying rate and shortened whole gut transit time together with improved weight and water content in the feces of PD mice, and the lack of influence on normal mice. Meanwhile, the number of cholinergic neurons, the proportion of serotonergic neurons, as well as the levels of acetylcholine and serotonin increased, but the numbers of nitrergic and tyrosine hydroxylase immunoreactive neurons, and the levels of nitric oxide synthase and dopamine decreased in the myenteric plexus in the gastric antrum and colon of PD mice in response to NPS-2143 treatment. Furthermore, the numbers of c-fos positive neurons in the nucleus tractus solitarius (NTS) and cholinergic neurons in the dorsal motor nucleus of the vagus (DMV) increased in NPS-2143 treated PD mice, suggesting the involvement of both the enteric (ENS) and central (CNS) nervous systems. However, ex vivo results showed that NPS-2143 directly inhibited the contractility of antral and colonic strips in PD mice via a non-ENS mediated mechanism. Further studies revealed that NPS-2143 directly inhibited the voltage gated Ca2+ channels, which might, at least in part, explain its direct inhibitory effects on the GI muscle strips. Interpretation: CaSR inhibition by its antagonist ameliorated GI dysmotility in PD mice via coordinated neuronal regulation by both ENS and CNS in vivo, although the direct effects of CaSR inhibition on GI muscle strips were suppressive.

Summary: Pesticides may help safeguard food security but endanger the local ecosystem and farmer health. The globalization of the food trade is masking such impacts by separating production from consumption, and its effects on pesticide use and their related risks remain unclear. Here, we provide a map of the environmental and health risks associated with pesticide footprints along the soybean trade across 197 countries. We find that approximately 64% of soybeans were traded globally, embodying ∼55% of environmental-health risks linked to ∼108 kt of pesticide use. Notably, trade soybean pesticide footprints and their associated environmental-health risks are concentrated in a few hotspot nations, including the USA, Brazil, and Argentina. About 30 kt of future increase in soybean pesticide use and ∼6% of their related environmental-health risks can be offset by reducing 80% of soybean traded from high-pesticide-use-intensity nations to lower ones. Our results highlight the necessity of rethinking the role of agricultural trade in global pesticide management. Science for society: The widespread use of pesticides in food production systems impacts human, animal, and ecosystem health. Food trade complicates the issue, as it can separate consumption from production, shifting pesticide-related burdens from consumers to producers across regions. However, there is a lack of clarity on pesticide footprints and their associated impacts embodied in the global food trade, impeding sustainable pesticide management. Our research develops an integrated framework to assess nation-specific environmental and health burdens linked to pesticide use along the global soybean trade. Our study identifies a concentrated pattern of embodied soybean pesticide footprints and their related risks, as well as a declining contribution of trade to overall pesticide-related risks. Our findings reveal the potential of trade in reducing environmental-health risks associated with soybean pesticides and underscore the need to rethink the role of agricultural trade in global pesticide management.

Osteoarthritis in the thumb carpometacarpal joint causes pain, swelling, deformity, instability, loss of motion, and power, which seriously impairs overall hand function. Surgery is indicated if conservative treatment fails to relieve the pain. Trapeziectomy is the most popular surgical treatment choice and yields good range of motion and relieves pain with the fewest complications. Arthroscopic trapeziectomy is gaining popularity. In general, the arthroscopic procedure is performed under continuous traction with a traction tower. The purpose of this Technical Note is to describe the details of arthroscopic trapeziectomy without traction tower. This eliminates the need of a traction tower and continuous traction and provides a stable platform for the arthroscopic procedure.

Introduction: Pressure reactivity index (PRx) is used for continuous monitoring of cerebrovascular reactivity in traumatic brain injury (TBI). However, PRx has a noisy character. Oscillations in arterial blood pressure (ABP) introduced by cyclic positive end-expiratory pressure adjustment, can make PRx more reliable. However, if oscillations are introduced by the cycling process of an anti-decubitus-mattress the effect on PRx is confounding, as they affect directly also intracranial pressure (ICP). In our routine monitoring in TBI patients we noticed periods of highly regular, slow, spontaneous oscillations in ABP and ICP signals. Research question: We set out to explore the nature of these oscillations and establish if PRx remains reliable during the oscillations. Materials and methods: 10 TBI patients’ recordings with oscillations in ICP and ABP were analysed. We computed PRx, PRx variability (hourly-average of standard-deviation, SD), phase-shift and coherence between ABP and ICP in the slow frequency range. Metrics were compared between oscillation and peri-oscillation periods. Results: During oscillations (frequency 0.006± 0.002Hz), a significantly lower variability of PRx (SD 0.185vs0.242) and higher coherence ABP-ICP (0.618±0.09 vs 0.534 ±0.09) were observed. No external oscillations sources could be identified. 34 out of 48 events showed signs of 'active' transmission associated with negative PRx, indicating a potential positive impact on PRx reliability. Discussion and conclusions: Spontaneous oscillations observed in ABP and ICP signals were found to enhance rather than confound PRx reliability. Further research is warranted to elucidate the nature of these oscillations and develop strategies to leverage them for enhancing PRx reliability in TBI monitoring.

Introduction: Cerebrospinal fluid (CSF) infusion test analysis allows recognizing and appropriately evaluating CSF dynamics in the context of normal pressure hydrocephalus (NPH), which is crucial for effective diagnosis and treatment. However, existing methodology possesses drawbacks that may compromise the precision and interpretation of CSF dynamics parameters. Research question: This study aims to circumvent these constraints by introducing an innovative analysis method grounded in Bayesian inference. Material and methods: A single-centre retrospective cohort study was conducted on 858 patients who underwent a computerized CSF infusion test between 2004 and 2020. We developed a Bayesian framework-based method for parameter estimation and compared the results to the current, gradient descent-based approach. We evaluated the accuracy and reliability of both methods by analysing erroneous prediction rates and curve fitting errors. Results: The Bayesian method surpasses the gradient descent approach, reflected in reduced inaccurate prediction rates and an improved goodness of model fit. On whole cohort level both techniques produced comparable results. However, the Bayesian method holds an added advantage by providing uncertainty intervals for each parameter. Sensitivity analysis revealed significance of the CSF production rate parameter and its interplay with other variables. The resistance to CSF outflow demonstrated excellent robustness. Discussion and conclusion: The proposed Bayesian approach offers a promising solution for improving robustness of CSF dynamics assessment in NPH, based on CSF infusion tests. Additional provision of the uncertainty measure for each diagnostic metric may perhaps help to explain occasional poor diagnostic performance of the test, offering a robust framework for improved understanding and management of NPH.

Introduction: PRx can be used as surrogate measure of Cerebral Autoregulation (CA) in traumatic brain injury (TBI) patients. PRx can provide means for individualising cerebral perfusion pressure (CPP) targets, such as CPPopt. However, a recent Delphi consensus of clinicians concluded that consensus could not be reached on the accuracy, reliability, and validation of any current CA assessment method. Research question: We aimed to quantify the short-term uncertainty of PRx time-trends and to relate this to other physiological measurements. Material and methods: Intracranial pressure (ICP), arterial blood pressure (ABP), end-tidal CO2 (EtCO2) high-resolution recordings of 911 TBI patients were processed with ICM + software. Hourly values of metrics that describe the variability within modalities derived from ABP, ICP and EtCO2, were calculated for the first 24h of neuromonitoring. Generalized additive models were used to describe the time trend of the variability in PRx. Linear correlations were studied for describing the relationship between PRx variability and the other physiological modalities. Results: The time profile of variability of PRx decreases over the first 12h and was higher for average PRx ∼0. Increased variability of PRx was not linearly linked with average ABP, ICP, or CPP. For coherence between slow waves of ABP and ICP >0.7, the variability in PRx decreased (R = −0.47, p

Introduction: Electrical-equivalence mathematical models that integrate vascular and cerebrospinal fluid (CSF) compartments perform well in simulations of dynamic cerebrovascular variations and their transient effects on intracranial pressure (ICP). However, ICP changes due to sustained vascular diameter changes have not been comprehensively examined. We hypothesise that changes in cerebrovascular resistance (CVR) alter the resistance of the bulk flow of interstitial fluid (ISF). Research question: We hypothesise that changes in CVR alter the resistance of the bulk flow of ISF, thus allowing simulations of ICP in response to sustained vascular diameter changes. Material and methods: A lumped parameter model with vascular and CSF compartments was constructed and converted into an electrical analogue. The flow and pressure responses to transient hyperaemic response test (THRT) and CSF infusion test (IT) were observed. Arterial blood pressure (ABP) was manipulated to simulate ICP plateau waves. The experiments were repeated with a modified model that included the ISF compartment. Results: Simulations of the THRT produced identical cerebral blood flow (CBF) responses. ICP generated by the new model reacted in a similar manner as the original model during ITs. Plateau pressure reached during ITs was however higher in the ISF model. Only the latter was successful in simulating the onset of ICP plateau waves in response to selective blood pressure manipulations. Discussion and conclusion: Our simulations highlighted the importance of including the ISF compartment, which provides mechanism explaining sustained haemodynamic influences on ICP. Consideration of such interactions enables accurate simulations of the cerebrovascular effects on ICP.

Arthrofibrosis of the first metatarsophalangeal joint may cause significant limitation of sport and daily activities. Surgical release is indicated if conservative management fails. Open release may have a high recurrence rate of joint stiffness because the surgical trauma will induce fibrous tissue formation and the presence of lengthy surgical wounds may hinder early joint mobilization. Arthroscopic release of the first metatarsophalangeal joint is a minimally invasive approach that may be the treatment of choice for arthrofibrosis of the joint. The purpose of this Technical Note is to describe the details of the 3-portal approach of arthroscopic release of the first metatarsophalangeal joint.

Cyanobacteria and microalgae contain various phytochemicals, including bioactive components in the form of secondary metabolites, namely flavonoids, phenolic acids, terpenoids, and tannins, with remarkable anticancer effects. This review highlights the recent advances in bioactive compounds, with potential anticancer activity, produced by cyanobacteria and microalgae. Previous in vitro investigations showed that many of these bioactive compounds exhibit potent effects against different human cancer types, such as leukemia and breast cancers. Multiple mechanisms implicated in the antitumor effect of these compounds were elucidated, including their ability to target cellular, subcellular, and molecular checkpoints linked to cancer development and promotion. Recent findings have highlighted various mechanisms of action of bioactive compounds produced by cyanobacteria and microalgae, including induction of autophagy and apoptosis, inhibition of telomerase and protein kinases, as well as modulation of epigenetic modifications. In vivo investigations have demonstrated a potent anti-angiogenesis effect on solid tumors, as well as a reduction in tumor volume. Some of these compounds were examined in clinical investigations for certain types of cancers, making them potent candidates/scaffolds for antitumor drug development.

Purpose: Scar assessment tools can be utilized during the post-operative period to monitor scar progress. The primary aim of this systematic review was to evaluate current subjective scar assessment scales utilized in orthopaedic surgery. The secondary aim was to identify determinants of patients’ satisfaction with their scars and evaluate current measurement scales. Methods: The preferred reporting items for systematic reviews and meta-analyses checklist was followed. Electronic databases, currently registered studies, conference proceedings and the reference lists of included studies were searched. There were no constraints based on language or publication status. A narrative synthesis provided a description and evaluation of scales utilized in orthopaedic surgery. Determinants of patient satisfaction were identified along with the scales used to measure satisfaction. Results: A total of 6059 records were screened in the initial search. Twenty-six articles satisfied the inclusion criteria, assessing 7130 patients. In the literature, six validated subjective scar scales were identified, including the Vancouver scar scale, patient and observer scar assessment scale, Manchester scar scale, Stony Brook scar evaluation scale, visual analogue scale, and Hollander wound evaluation scale. Studies utilizing these scales to evaluate scars following orthopaedic procedures did so successfully. These were total hip arthroplasty, total knee arthroplasty, and limb reconstruction. The scales demonstrated satisfactory validity. Functional outcomes such as restoration of movement ranked among patients' highest concerns. Scar cosmesis was found to be amongst patients’ lowest priorities. Conclusions: Subjective scar assessment scales identified in the literature were not designed specifically for orthopaedic surgery. However, these were able to appropriately assess scars in the studies identified in this review. Current evidence suggests the effect of scar cosmesis on patient satisfaction with orthopaedic procedures is limited.

Objectives: This study aimed to assess the feasibility of the home-based kyphosis-specific exercises among Chinese older adults with different exercise habits and explore its potential effects on reducing the kyphosis angle and improving physical performance. Methods: A single-group, pre-and post-test design was conducted according to CONSORT 2010 statement: extension for pilot and feasibility trials. A total of 20 participants aged ≥60 with thoracic hyperkyphosis and rehabilitation potential were recruited from four local communities in Wuhan, China. Participants underwent a six-week home-based kyphosis-specific exercises intervention that included warm-up, muscle strengthens, spinal alignment, spinal mobility and flexibility, and cool down five sections (22 exercises). The intervention involved seven 1-h group classes and 35 times daily home practice with identical content. At pre- and post-intervention, the participants' kyphosis angle in two standing postures, static balance, dynamic balance, cardiopulmonary function, dynamic gait assessment, pain, and self-image were assessed and compared. Feasibility was assessed by group class attendance, home practice adherence, and participant evaluations. Results: All participants completed group classes and >75% home practice. Post-intervention, the participant’s kyphosis angle in relaxed and best-standing postures was changed by −12.0° (−15.5°, −4.0°) (Z = − 3.98, P

Deep-seated lipomas can be intramuscular, intermuscular, and rarely, parosteal lipomas. Intramuscular lipoma can be divided into infiltrative, well-circumscribed, and mixed types. Marginal excision is the treatment of choice for well-circumscribed intramuscular lipoma, and histopathology eliminates diagnosis of well-differentiated liposarcoma. The purpose of this technical note is to describe the details of endoscopic en-bloc resection of intramuscular lipoma of the flexor digitorum profundus. This minimally invasive approach allows en-bloc resection of the lipoma for histopathological study, with minimal risk to the surrounding neurovascular structures.

A supervised deep learning network like the UNet has performed well in segmenting brain anomalies such as lesions and tumours. However, such methods were proposed to perform on single-modality or multi-modality images. We use the Hybrid UNet Transformer (HUT) to improve performance in single-modality lesion segmentation and multi-modality brain tumour segmentation. The HUT consists of two pipelines running in parallel, one of which is UNet-based and the other is Transformer-based. The Transformer-based pipeline relies on feature maps in the intermediate layers of the UNet decoder during training. The HUT network takes in the available modalities of 3D brain volumes and embeds the brain volumes into voxel patches. The transformers in the system improve global attention and long-range correlation between the voxel patches. In addition, we introduce a self-supervised training approach in the HUT framework to enhance the overall segmentation performance. We demonstrate that HUT performs better than the state-of-the-art network SPiN in the single-modality segmentation on Anatomical Tracings of Lesions After Stroke (ATLAS) dataset by 4.84% of Dice score and a significant 41% in the Hausdorff Distance score. HUT also performed well on brain scans in the Brain Tumour Segmentation (BraTS20) dataset and demonstrated an improvement over the state-of-the-art network nnUnet by 0.96% in the Dice score and 4.1% in the Hausdorff Distance score.

Propolis, particularly those produced by stingless bees, is known to have a broad range of medicinal benefits due to its antioxidant properties. However, its strong and unpleasant flavour and sticky texture make it less palatable. This study aimed to improve the oral administration of stingless bee propolis extract for nutraceutical use by formulating it into a microemulsion. The microemulsion was created using a water titration method and a pseudo-ternary phase diagram to determine the optimal surfactant: co-surfactant ratio. The formulation was then characterized for its globule size, pH, viscosity, and phenolic content, and subjected to stability tests under ambient and accelerated conditions. Anti-microbial and antioxidant activity were evaluated through the disk diffusion method and the ABTS assay. The microemulsion had an average droplet size of 229.2 nm, a pH of 4.78 ± 0.18, and a viscosity of 0.149 Pa, which falls within the typical range for oral formulations. The microemulsion successfully preserved the antioxidant and antibacterial properties of the propolis extract. Long-term and accelerated stability studies indicated that the microemulsion's pH, appearance, and viscosity remained stable for up to 12 months, although there was a 24 % loss in phenolic activity over the same period. Overall, a stable and potent propolis microemulsion was successfully developed using pharmaceutical and food-grade ingredients, providing a safe and effective way to orally deliver propolis.

Propolis, a valuable resin from beehives has many potential health benefits. In this study, we examine the effects of addition of L-Leucine (LL) on the properties of propolis powder produced by spray and freeze drying. Gum Arabic (GA) with LL at different ratios were used as wall materials. Adding LL increases the yield of spray dried (SD) propolis powders, while hygroscopicity, flowability and reconstitution characteristics were affected by both drying method and LL concentration. Freeze dried (FD) powders were more porous as evident by the scanning electron micrographs and showed release of >90 % of compounds within 15 min in both gastric and intestinal media. SD powders were spherical and showed a sustained release of compounds in both media. The best powders were produced with a GA to LL ratio of 8:2 dried by spray drying at 120 °C or 150 °C and by freeze drying. These three optimized formulations showed greater yields (> 50 %), lower hygroscopicity (< 10 %) and moderate antioxidant and antibacterial activities. The formulations remained stable for up to 6 months at ambient temperature, but instability was observed at 40 °C. In conclusion, leucine addition facilitates the formation of SD and FD propolis powders with good properties.

Lavandula stoechas, a Mediterranean plant, renowned in traditional medicine for its health benefits, is also arousing strong interest associated with its essential oils (EOs) with promising therapeutic properties. The aim of this study was to analyze the chemical composition of the plant, as well as to study its major activities, including antioxidant, anti-diabetic, dermatoprotective, anti-inflammatory, and antibacterial effects, focusing on its major molecules. Using the GC-MS method, the main compounds identified in L. stoechas EO (LSEO) were fenchone (31.81 %) and camphor (29.60 %), followed by terpineol (13.14 %) and menthone (8.96 %). To assess their antioxidant activity, three in vitro methods were used (DPPH, FRAP, and ABTS). The results revealed that LSEO exhibited the best antiradical property (54 ± 62 μg/mL) according to the DPPH test, while fenchone demonstrated the highest antioxidant capacity (87 ± 92 μg/mL) in the FRAP test, and camphor displayed the highest antioxidant capacity (96 ± 32 μg/mL) in the ABTS test. However, these results were lower than those obtained by Trolox used as a reference. In addition, study also explored the anti-diabetic potential of LSEO and its major compounds by evaluating their inhibitory activity towards two digestive enzymes, α-glucosidase and α-amylase. Camphor (76.92 ± 2.43 μg/mL) and fenchone (69.03 ± 2.31 μg/mL) exhibited the best inhibitory activities for α-amylase and α-glucosidase assays, respectively. Interestingly, all elements of the study exerted activities superior to those of acarbose, regardless of the test performed. In contrast, the evaluation of the dermatoprotective potential was carried out in vitro by targeting two enzymes involved in cutaneous processes, tyrosinase and elastase. In this light, fenchone (53.14 ± 3.06 μg/mL) and camphor (48.39 ± 1.92 μg/mL) were the most active against tyrosinase and elastase, respectively. It should be noted that the effect of both molecules, as well as that of LSEO, ranged between 53.14 ± 3.06 and 97.45 ± 5.22 μg/mL, which was significantly lower than the standard, quercetin (IC50 of 246.90 ± 2 0.54 μg/mL) against tyrosinase. Furthermore, the anti-inflammatory potential of these elements has been studied by evaluating their ability to inhibit lipooxygenase (LOX), a class of enzymes involved in the inflammatory process in the human body. As a result, the LSEO demonstrated a remarkable effect with an IC50 of 6.34 ± 1.29 μg/mL, which was almost comparable to the standard, quercetin (IC50 = 3.93 ± 0.45 μg/mL). Concerning the antibacterial potential, we carried out a quantitative analysis of the various products tested, revealing a bactericidal activity of the LSEO against the strain L. monocytogenes ATCC 13932 at a minimum effective concentration (MIC = CMB = 0.25). Overall, LSEOs offer significant potential as a source of natural antioxidants, and antidiabetic and anti-inflammatory agents, as well as dermatoprotective and antibacterial compounds. Its major molecules, fenchone and camphor, showed promising activity in these areas of study, making it a valuable candidate for future research and development in the field of natural medicine.

With WHO announcing COVID-19 no longer as a public health emergency of international concern (PHEIC) on May 5, 2023, coupled with the fact that the majority of the countries of the world have dropped strict city lockdown or border closure, this perhaps signals the end of the COVID-19 crisis caused by the SARS-CoV-2 virus. However, the COVID-19 pandemic has resulted in far-reaching effects affecting nearly every aspect of our lives and society. Notably, the food industry including agriculture, food manufacturers, food logistics, distributors and retailers have all felt the profound impact and had experienced significant stress during the pandemic. Therefore, it is essential to retrospect the lessons that can be learned from this pandemic for the food industry. This short review aims to address the food safety issues related to the COVID-19 pandemic by focusing on its foodborne transmission potential, innovations of virus detection strategies suitable for food industry; development of phathogenicaidal methods and devices to inactivate SARS-CoV-2 virus (particularly in industrial scale); and the set-up of related food regulations and guidelines as preventive and control measures for preventing the spread of SARS-CoV-2 virus through the food supply chain during the pandemic. This article may provide useful references for the food industry to minimize the food safety impact of COVID-19 (as well as other respiratory virus) and allows them to better prepare for similar future challenges.

With an increase in aging population, osteoporosis has become one of the major public health issues nowadays, affecting over 200 million people worldwide. Since current medications are associated with various side effects, there is a clear clinical need to develop alternative therapeutics for managing osteoporosis. Selenium is an essential trace mineral, which has been proved to play important role in bone health. However, the narrow therapeutic window of selenium has greatly hindered its further development. Recently, selenium nanoparticles (SeNPs) have become a new selenium source due to its promising bioactivity and low toxicity. Nevertheless, scientific research concerning their effects on bone health is still very limited. By using the mushroom polysaccharide-protein complex isolated from Cordyceps sinensis, we have successfully prepared novel SeNPs (“Cs4-SeNPs”) with well-characterized structure and high stability. Interestingly, Cs4-SeNPs (10 μM) were found to markedly induce proliferation, differentiation, and mineralization of the pre-osteoblast murine MC3T3-E1 cells. Further mechanistic study discovered that after cellular internalization via endocytosis, Cs4-SeNPs would trigger Nox4-derived intracellular ROS generation in the MC3T3-E1 cells followed by promoting downstream BMP-2 gene transcription and activating BMP signaling via both Smad dependent and Smad independent p38 MAPK pathways. More importantly, Cs4-SeNPs (25–500 μg/kg BW/d) exhibitedpromising in vivo bone protective efficacy against OVX-induced osteoporosis by promoting bone formation, inhibiting bone resorption, and improving bone microarchitecture after oral gavage for 6 weeks. Findings of this study collectively suggested that Cs4-SeNPs is of great potential to be further developed into a safe and evidence-based nano-mineral for managing postmenopausal osteoporosis.

Lipoma is benign soft-tissue tumor that consists entirely of mature fat and can occur in a superficial or deep location. Lipoma of the foot and ankle can even develop within a tendon sheath or joint. Classically, lipoma is resected via open approach, which may result in a lengthy disfiguring surgical scar. Endoscopic en-bloc tumor resection is a minimally invasive approach and can provide a whole block specimen for histologic examination. The purpose of this Technical Note is to describe the details of endoscopic en-bloc resection of lipoma of the tibialis anterior tendon.

Neurilemmoma (schwannoma) is a benign, slow-growing, encapsulated tumor originating from the Schwann cells of the peripheral nerve sheath. The purpose of this technical note is to describe the technique of endoscopic en-bloc resection of neurilemmoma of the foot dorsum. This has the advantage of better cosmetic result and less postoperative perineural fibrosis.

Ulnar bursa of the hand invaginates the flexor digitorum superficialis and flexor digitorum profundus tendons of the little, ring, long, and index fingers. Distension of this bursa can have an inflammatory or infective cause. It can also originate from pathology of another site (e.g., degenerative wrist joint). Because of the tough overlying palmar aponeurosis, distended ulnar bursa can have swelling at a remote site. The distended ulnar bursa can also have compressive neuropathy to the ulnar nerve and median nerve. The purpose of this Technical Note is to describe the technical details of the 2 ulnar portals technique involving endoscopic resection of the ulnar bursa. This is indicated for symptomatic distension of the ulnar bursa, especially with hypothenar extension.

Hallux valgus is one of the most common forefoot deformities faced by foot and ankle surgeons. Symptomatic deformity usually needs surgical correction. Endoscopic techniques of hallux valgus correction have been reported that are based on the same principle of the classic distal soft tissue procedure. Recently, the technique has been modified to include reconstruction of the medial metatarsosesamoid ligament and augmentation of the intermetatarsal ligament. In severe deformity or the presence of hypermobility or painful degeneration of the first tarsometatarsal joint, Lapidus arthrodesis of the joint is indicated. Arthroscopic Lapidus arthrodesis has been reported to reduce the complications associated with open procedure, including first metatarsal shortening, metatarsal elevatus, and nonunion. In this technical note, the technical details of a combined modified endoscopic distal soft tissue procedure and arthroscopic Lapidus arthrodesis is described. This is a minimally invasive approach for correction of severe hallux valgus deformity, especially that associated with ligamentous laxity.

Propolis, a substance produced by bees for hive construction, has piqued major interests for decades due to its potential biological properties including antimicrobial and antioxidant effects. These properties are contributed by its high polyphenol content which can vary based on the botanical origin of propolis. In this study, A. mangium and G. mangostana derived propolis were extracted using supercritical fluid extraction and the chemical species composition, total phenols, flavonoids, and antioxidant activities were compared. Through untargeted mass spectrometry, we found the active compounds present within both propolis samples such as flavonoids, coumarins, terpenes, terpenoids, sugar alcohols and fatty acids. When compared, G. mangostana propolis showed higher antioxidant activity measured by superoxide dismutase enzyme, and had higher antibacterial effect against gram positive S. aureus. This correlated with its higher content of flavonoids compared to A. mangium derived propolis. Our study demonstrates how the difference in chemical composition of propolis derived from A. mangium and G. mangostana can affect their antioxidant and antibacterial properties and highlights its potential for use in nutraceuticals.

Alzheimer's disease (AD) poses a significant challenge to healthcare systems and economics worldwide in the 21st century. It is characterised by progressive memory dysfunction and is a leading cause of dementia. Literature suggests that the involvement of neuroinflammation plays a critical role in the progression of neuropathological changes in AD. Currently, available drugs for AD management primarily focus on symptomatic treatment. There is a need for safe adjunctive agents with a specific target and explicit mechanism of action. Swietenia macrophylla (SM) has been traditionally used as a food source and for pain relief in folk medicine. Recent studies have highlighted the neuroprotective properties of SM, including its anti-inflammatory, antioxidant, anti-acetylcholinesterase, and anti-mitochondrial dysfunction effects. In light of these considerations, this review aims to explore the potential neuroprotective role of SM by examining the existing literature to elucidate its potential mechanisms of action in addressing the complex challenges presented by AD.

The use of oral agents that can modify the gut microbiota (GM) could be a novel preventative or therapeutic option for Parkinson’s disease (PD). Maslinic acid (MA), a pentacyclic triterpene acid with GM-dependent biological activities when it is taken orally, has not yet been reported to be effective against PD. The present study found both low and high dose MA treatment significantly prevented dopaminergic neuronal loss in a classical chronic PD mouse model by ameliorating motor functions and improving tyrosine hydroxylase expressions in the substantia nigra pars compacta (SNpc) and increasing dopamine and its metabolite homovanillic acid levels in the striatum. However, the effects of MA in PD mice were not dose-responsive, since similar beneficial effects for low and high doses of MA were observed. Further mechanism studies indicated that low dose MA administration favored probiotic bacterial growth in PD mice, which helped to increase striatal serotonin, 5-hydroxyindole acetic acid, and γ-aminobutyric acid levels. High dose MA treatment did not influence GM composition in PD mice but significantly inhibited neuroinflammation as indicated by reduced levels of tumor necrosis factor alpha and interleukin 1β in the SNpc; moreover, these effects were mainly mediated by microbially-derived acetic acid in the colon. In conclusion, oral MA at different doses protected against PD via distinct mechanisms related to GM. Nevertheless, our study lacked in-depth investigations of the underlying mechanisms involved; future studies will be designed to further delineate the signaling pathways involved in the interactive actions between different doses of MA and GM.

Sleep is an essential biological phase of our daily life cycle and is necessary for maintaining homeostasis, alertness, metabolism, cognition, and other key functions across the animal kingdom. Dysfunctional sleep leads to deleterious effects on health, mood, and cognition, including memory deficits and an increased risk of diabetes, stroke, and neurological disorders. Sleep is regulated by several brain neuronal circuits, neuromodulators, and neurotransmitters, where cannabinoids have been increasingly found to play a part in its modulation. Cannabinoids, a group of lipid metabolites, are regulatory molecules that bind mainly to cannabinoid receptors (CB1 and CB2). Much evidence supports the role of cannabinoid receptors in the modulation of sleep, where their alteration exhibits sleep-promoting effects, including an increase in non-rapid-eye movement sleep and a reduction in sleep latency. However, the pharmacological alteration of CB1 receptors is associated with adverse psychotropic effects, which are not exhibited in CB2 receptor alteration. Hence, selective alteration of CB2 receptors is also of clinical importance, where it could potentially be used in treating sleep disorders. Thus, it is crucial to understand the neurobiological basis of cannabinoids in sleep physiology. In this review article, the alteration of the endocannabinoid system by various cannabinoids and their respective effects on the sleep-wake cycle are discussed based on recent findings. The mechanisms of the cannabinoid receptors on sleep and wakefulness are also explored for their clinical implications and potential therapeutic use on sleep disorders.

An enchondroma is a benign tumor in the medullary cavity of bone, which is composed of mature hyaline cartilage. It has a predilection for the ulnar-sided tubular bones of the hand and occurs most commonly in the proximal phalanx, and less commonly in the middle phalanx and metacarpals, and rarely in the distal phalanx. The treatment options for enchondromas include conservative regular follow-up or surgery. Operation is indicated in symptomatic enchondroma or lesions larger than 3 to 4 cm. The purpose of this Technical Note is to report the technical details of endoscopic curettage and bone grafting of enchondroma of proximal phalanx of finger. This minimally invasive approach can preserve the cortical integrity and periosteum of the involved phalanx.

Hallux valgus is one of the most common foot and ankle conditions faced by orthopaedic surgeons. Surgical correction of hallux valgus is frequently indicated for symptomatic deformity. Recently, the endoscopic technique of hallux valgus correction has been reported, which is basically an endoscopic approach to the classic distal soft tissue procedure. In this technical note, the technical details of the modified endoscopic distal soft tissue procedure with medial metatarsosesamoid ligament and intermetatarsal ligament augmentation is described. In this modified technique, the intact intermetatarsal ligament, plantar capsule of the first metatarsophalangeal joint (including the sesamoid apparatus), and medial metatarsosesamoid ligament form a soft tissue envelop that can wrap around the first metatarsal head to stabilize the first metatarsal in the reduced position.

Rationale and objective: Demographic data collected about Canadian radiologists and trainees has been limited primarily to binary gender and geographic location. The purpose of this study was to investigate: (1) demographic characteristics of Canadian radiologists and trainees; (2) types of diversity important to radiologists; (3) relationship of radiologist demographics to practice characteristics; and (4) relationship of radiologist demographics to years in practice, (YIP). Materials and methods: French and English surveys were distributed via email through radiology associations and social media. Frequency counts of demographic variables were calculated, and chi-square and Fisher's Exact tests were performed to explore the relationships between demographic characteristics and role. Results: 611 individuals responded to the survey. 573 respondents were included in the analysis. 454 (78.8%) were practicing radiologists and 119 (20.7%) were residents/fellows. Half identified as women (50.4%). English was the primary language for most respondents. There was an association between role and sexual orientation (p = 0.02), visible minority (χ2 = 4.79, p

Background: Apple watch-derived electrocardiogram (awECG) may help identify prolongation of corrected QT (QTc) interval. This study aimed to determine its usefulness for assessment of prolongation of QTc interval in children and adolescents with long QT syndrome (LQTS). Methods: Children and adolescents with and without LQTS were recruited for measurement of QTc intervals based on standard 12-lead (sECG) and awECG lead I, II and V5 tracings. Bland-Altman analysis of reproducibility, concordance assessment of T wave morphologies, and receiver operating characteristic (ROC) analysis of sensitivity and specificity of awECG-derived QTc interval for detecting QTc prolongation were performed. Results: Forty-nine patients, 19 with and 30 without LQTS, aged 3–22 years were studied. The intraclass correlation coefficient was 1.00 for both intra- and inter-observer variability in the measurement of QTc interval. The awECG- and sECG-derived QTc intervals correlated strongly in all three leads (r = 0.90–0.93, all p

Synovial osteochondromatosis is a benign process that most commonly affects the knee joint (70%). It is characterized by proliferative metaplasia of synovial membrane into chondrocytes, resulting in the formation of multiple cartilaginous nodules, which can detach from the synovium to become multiple intra-articular loose bodies. It usually involves the anterior compartment, including infrapatellar fat pad, suprapatellar pouch, and anterior interval, and rarely involves the posterior compartment of the knee. Treatment for synovial osteochondromatosis usually involves surgery, especially in the presence of locking symptoms or decreased range of motion. Arthroscopy has gradually replaced a traditional open approach, resulting in low morbidity, low postoperative pain, better cosmetic results, early recovery of range of motion, short rehabilitation course, and an early return to previous function. In case of involvement of the posterior compartment of the knee joint, arthroscopic access may be difficult. In this Technical Note, the technical details of arthroscopic synovectomy and removal of loose bodies in synovial osteochondromatosis of the knee is described. This arthroscopic technique can deal with the disease, involving both the anterior and posterior compartments of the knee joint.

Rheumatoid arthritis is characterized by hypertrophic synovitis destroying the involved joints. If medical treatment fails to control the synovitis, synovectomy is a worthwhile prophylactic procedure that might help to delay further distention of the joint capsule and ligament. Synovitis of the proximal interphalangeal joint is usually performed by an open approach. The major complication is scar development around the interphalangeal joint, leading to considerable joint contracture. Arthroscopy of the proximal interphalangeal joint is a minimally invasive technique that can eliminate the risk of joint contracture associated with open surgery. The purpose of this Technical Note is to report the technical details of arthroscopic complete synovectomy of the proximal interphalangeal joint of the finger. This procedure is indicated in patients with rheumatoid synovitis of the proximal interphalangeal joint of the finger recalcitrant to medical treatment. It is contraindicated in case of an established boutonniere or swan-neck deformity, the presence of large dorsal synovial cysts, advanced degeneration of the joint, the presence of joint instability, or a fresh skin lesion near portals.

Chronic lateral ankle instability is a common orthopaedic problem. The continuous stress applied by the lateral instability may affect the superficial deltoid ligament. The combination of lateral ankle instability and injury to the most anterior fascicles of the deltoid ligament contributes to rotational ankle instability. The purpose of this Technical Note is to describe the details of arthroscopic deltoid ligament reconstruction in rotational ankle instability. This minimally invasive approach allows other associated lesions to be detected and managed arthroscopically.

Arthrodesis of the first metatarsophalangeal joint is indicated for severe hallux valgus deformity. Open arthrodesis requires extensive soft-tissue dissection. Recently, a technique of arthroscopic first metatarsophalangeal arthrodesis in hallux valgus deformity has been reported. This approach includes endoscopic lateral release of the first metatarsophalangeal joint via the plantar and toe web portals, followed by arthroscopic arthrodesis of the joint via the medial and dorsolateral portals. Endoscopic lateral release of the first metatarsophalangeal joint can convert the fixed hallux valgus deformity into a flexible one and reduce the stress over the screws and risk of loss of reduction and nonunion. The purpose of this Technical Note is to report a modified technique of arthroscopic first metatarsophalangeal arthrodesis in hallux valgus deformity. In this modified technique, the arthrodesis is performed via the medial and toe web portals and creation of the dorsolateral portal is not needed. A 2.7-mm arthroscope is used for the arthrodesis procedure instead of a 1.9-mm arthroscope. This can improve fluid inflow and visualization.

Objective: The frameless linear accelerator (LINAC) based stereotactic radiosurgery (SRS) has been evolving with a reduction in patient discomfort. However, there was limited evidence comparing frame-based and frameless SRS for intracranial arteriovenous malformations (AVM). We aimed to compare the treatment outcomes between frame-based and frameless LINAC SRS. Materials and Methods: This retrospective cohort compared the outcomes of frame-based LINAC SRS (1998–2009) with frameless LINAC SRS (2010–2020). The primary outcome was the obliteration rate. The other outcomes included the neurological, radiological, and functional outcomes after SRS. A matched cohort was identified by propensity scores for further comparisons. Results: A total of 65 patients were included with a mean follow-up time of 13.2 years (158.5 months). There were 40 patients in the frame-based group and 25 patients in the frameless group. The overall obliteration rate was comparable (Frame-based 82.5% vs Frameless 80.0%, p = 0.310) and not significantly different over time (log-rank p = 0.536). The crude post-SRS hemorrhage rate was 1.5% and the incidence was 0.3 per 100 person-years. There were 67.7% of patients with AVM obliteration without new persistent neurological deficits at the last visit and 56.9% of patients with AVM obliteration without any deficits (transient or persistent) during the entire follow-up period. Four patients (8.0%) developed late onset persistent adverse radiation effects (more than 96 months after SRS) among 50 patients with more than 8-year surveillance. In the propensity-matched cohort of 42 patients, there was no significant difference in AVM obliteration (Frame-based vs Frameless, log-rank p = 0.984). Conclusion: Frameless and frame-based LINAC SRS have comparable efficacy in intracranial AVM obliteration. A longer follow-up duration may further characterize the rate of late adverse radiation effects in frameless SRS.

Background: Systemic inflammation is a significant mechanism underpinning adverse cognitive changes. Sleep quality is a crucial factor associated with systemic inflammation and neurocognitive health. Elevated levels of pro-inflammatory cytokines in the periphery help mark inflammation. With this background, we examined the relationship between systemic inflammation, subjective sleep quality, and neurocognitive performance in adults. Method & Results: In 252 healthy adults, we measured the systemic inflammation reflected by serum levels of IL-6, IL-12, IL-18, TNF-α and IFN-γ, subjective sleep quality reflected by the global scores of the Pittsburgh Sleep Quality Index, and their neurocognitive performance measured by the Hong Kong Montreal Cognitive Assessment. We observed that neurocognitive performance was negatively related to IL-18 (p = 0.046) and positively related to sleep quality (p = 0.006). We did not observe significant associations between other cytokines and neurocognitive performance. Furthermore, we found that sleep quality as a mediator explained the relationship between IL-18 and neurocognitive performance depending on the levels of IL-12 (index of moderated mediation: 95% CI = [0.0047, 0.0664]). Better subjective sleep quality buffered the negative effect of IL-18 on neurocognitive performance when IL-12 was low (bootstrapping 95% CI: [- 0.0824, - 0.0018]). On the contrary, poor subjective sleep quality mediated the association between higher IL-18 and poorer neurocognitive performance when IL-12 was elevated (bootstrapping 95% CI: [0.0004, 0.0608]). Conclusion & Implications: Our findings indicate that systemic inflammation was negatively associated with neurocognitive performance. Sleep quality regulated by IL-18/IL-12 axis activation could be a potential mechanism underpinning neurocognitive changes. Our results illustrate the intricate relationships between immune functioning, sleep quality and neurocognitive performance. These insights are essential to understand the potential mechanisms underpinning neurocognitive changes, paving the way for the development of preventive interventions for the risk of cognitive impairment.

A large quantity of end-of-life tire (ELT) rubber is being blended with thermoplastic polyurethane to provide a durable and ecologically friendly material for flexible surfaces, while a significant quantity of thermoplastic elastomeric waste (left-over and cut-outs) is also generated. These waste materials can be used efficiently for seismic isolation and vibration damping at a minimal cost, a process known as frugal innovation. In this regard, waste thermoplastic elastomeric (TPE) material, which is also known as polyurethane-coated rubber (PUcR), obtained from the tire rubber recycling industry, is explored in this study. Herein, we targeted to evaluate the stiffness and energy dissipation capabilities of waste TPE or PU-coated rubber, which, to the best of our knowledge, has never been reported before. To that end, a series of cyclic triaxial tests were carried out on PU-coated rubber-soil mixtures. In comparison to untreated rubber-soil mixtures, the shear modulus of PU-coated rubber-soil mixtures reduces by 5.5–12.7%, while the damping ratio increases by up to 12.6%.

Background: The efficacy and safety profiles of prone ventilation among intubated Coronavirus Disease 2019 (COVID-19) patients remain unclear. The primary objective was to examine the effect of prone ventilation on the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) in intubated COVID-19 patients. Methods: Databases of MEDLINE, EMBASE and CENTRAL were systematically searched from inception until March 2021. Case reports and case series were excluded. Results: Eleven studies (n = 606 patients) were eligible. Prone ventilation significantly improved PaO2/FiO2 ratio (studies: 8, n = 579, mean difference 46.75, 95% CI 33.35‒60.15, p < 0.00001; evidence: very low) and peripheral oxygen saturation (SpO2) (studies: 3, n = 432, mean difference 1.67, 95% CI 1.08‒2.26, p < 0.00001; evidence: ow), but not the arterial partial pressure of carbon dioxide (PaCO2) (studies: 5, n = 396, mean difference 2.45, 95% CI 2.39‒7.30, p = 0.32; evidence: very low), mortality rate (studies: 1, n = 215, Odds Ratio 0.66, 95% CI 0.32‒1.33, p = 0.24; evidence: very low), or number of patients discharged alive (studies: 1, n = 43, Odds Ratio 1.49, 95% CI 0.72‒3.08, p = 0.28; evidence: very low). Conclusion: Prone ventilation improved PaO2/FiO2 ratio and SpO2 in intubated COVID-19 patients. Given the substantial heterogeneity and low level of evidence, more randomized- controlled trials are warranted to improve the certainty of evidence, and to examine the adverse events of prone ventilation.