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Context: Distal femoral osteotomy (DFO) is a joint preservation procedure that corrects genu valgum deformities and patellofemoral maltracking, thereby restoring kinematics and unloading contact pressures in the lateral tibiofemoral and patellofemoral compartments. Objective: To evaluate the rates of return to work (RTW) and return to sport (RTS) after DFO for valgus malalignment and lateral compartment osteoarthritis through a systematic review of the literature. Data Sources: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted on the PubMed, Cochrane, and Embase databases. Study Selection: The search terms femoral osteotomy AND ( sports OR work) were used. Studies in which patients underwent concomitant total knee arthroplasty were excluded. Study Design: Systematic review. Level of Evidence: Level 4 (systematic review of level 4 studies). Data Extraction: Data included the number of patients, age, gender, laterality of operation, time to follow-up, rate of RTW and RTS, time to RTS, activity level on return, and activity level scores (Tegner, Marx, Lysholm, and the International Knee Documentation Committee). Risk of bias was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Results: Seven articles with 194 patients were included. The average age ranged from 19 to 49 years with a mean postoperative follow-up range of 36 to 90 months. RTW data were available for 125 patients, of whom 42.1% to 91.3% returned by final follow-up. Data on RTS were available for 149 patients, of whom 70% to 100% returned at a range of 8.3 to 16.9 months postoperatively, and 41.6% to 100% returned to the same or greater level of sports activity. The Tegner and Marx activity level scores ranged from 3 to 4 and from 5 to 11, respectively, at final follow-up. Conclusion: Patients treated with DFO reported high rates of RTW and RTS, with most patients being able to return to recreational sport after surgery.

Purpose We present image classifiers based on Dense Convolutional Networks and transfer learning to classify chest X-ray images according to three labels: COVID-19, pneumonia, and normal. Methods We fine-tuned neural networks pretrained on ImageNet and applied a twice transfer learning approach, using NIH ChestX-ray14 dataset as an intermediate step. We also suggested a novelty called output neuron keeping, which changes the twice transfer learning technique. In order to clarify the modus operandi of the models, we used Layer-wise Relevance Propagation (LRP) to generate heatmaps. Results We were able to reach test accuracy of 100% on our test dataset. Twice transfer learning and output neuron keeping showed promising results improving performances, mainly in the beginning of the training process. Although LRP revealed that words on the X-rays can influence the networks’ predictions, we discovered this had only a very small effect on accuracy. Conclusion Although clinical studies and larger datasets are still needed to further ensure good generalization, the state-of-the-art performances we achieved show that, with the help of artificial intelligence, chest X-rays can become a cheap and accurate auxiliary method for COVID-19 diagnosis. Heatmaps generated by LRP improve the interpretability of the deep neural networks and indicate an analytical path for future research on diagnosis. Twice transfer learning with output neuron keeping improved DNN performance.

Neuromuscular disorders are often caused by heterogeneous mutations in large, structurally complex genes. Targeting compensatory modifier genes could be beneficial to improve disease phenotypes. Here we report a mutation-independent strategy to upregulate the expression of a disease-modifying gene associated with congenital muscular dystrophy type 1A (MDC1A) using the CRISPR activation system in mice. MDC1A is caused by mutations in LAMA2 that lead to nonfunctional laminin-α2, which compromises the stability of muscle fibres and the myelination of peripheral nerves. Transgenic overexpression of Lama1, which encodes a structurally similar protein called laminin-α1, ameliorates muscle wasting and paralysis in mouse models of MDC1A, demonstrating its importance as a compensatory modifier of the disease1. However, postnatal upregulation of Lama1 is hampered by its large size, which exceeds the packaging capacity of vehicles that are clinically relevant for gene therapy. We modulate expression of Lama1 in the dy2j/dy2j mouse model of MDC1A using an adeno-associated virus (AAV9) carrying a catalytically inactive Cas9 (dCas9), VP64 transactivators and single-guide RNAs that target the Lama1 promoter. When pre-symptomatic mice were treated, Lama1 was upregulated in skeletal muscles and peripheral nerves, which prevented muscle fibrosis and paralysis. However, for many disorders it is important to investigate the therapeutic window and reversibility of symptoms. In muscular dystrophies, it has been hypothesized that fibrotic changes in skeletal muscle are irreversible. However, we show that dystrophic features and disease progression were improved and reversed when the treatment was initiated in symptomatic dy2j/dy2j mice with apparent hindlimb paralysis and muscle fibrosis. Collectively, our data demonstrate the feasibility and therapeutic benefit of CRISPR-dCas9-mediated upregulation of Lama1, which may enable mutation-independent treatment for all patients with MDC1A. This approach has a broad applicability to a variety of disease-modifying genes and could serve as a therapeutic strategy for many inherited and acquired diseases.

Objective We used deep convolutional neural networks (DCNNs) to classify electroencephalography (EEG) signals in a steady-state visually evoked potentials (SSVEP) based single-channel brain–computer interface (BCI), which does not require calibration on the user. Methods EEG signals were converted to spectrograms and served as input to train DCNNs using the transfer learning technique. We also modified and applied a data augmentation method, SpecAugment, generally employed for speech recognition. Furthermore, for comparison purposes, we classified the SSVEP dataset using support-vector machines (SVMs) and filter bank canonical correlation analysis (FBCCA). Results Excluding the evaluated user's data from the fine-tuning process, we reached 82.2% mean test accuracy and 0.825 mean F1-Score on 35 subjects from an open dataset, using a small data length (0.5 s), only one electrode (Oz) and the DCNN with transfer learning, window slicing (WS) and SpecAugment's time masks. Conclusion The DCNN results surpassed SVM and FBCCA performances, using a single electrode and a small data length. Transfer learning provided minimal accuracy change, but made training faster. SpecAugment created a small performance improvement and was successfully combined with WS, yielding higher accuracies. Significance We present a new methodology to solve the problem of SSVEP classification using DCNNs. We also modified a speech recognition data augmentation technique and applied it to the context of BCIs. The presented methodology surpassed performances obtained with FBCCA and SVMs (more traditional SSVEP classification methods) in BCIs with small data lengths and one electrode. This type of BCI can be used to develop small and fast systems.

The supplementation of vitamin E on broiler chicken diets is essential to the prevention of lipid oxidation reactions in the meat and improvement of meat quality. The objective of this study was to assess the effect of different doses of dietary vitamin E on breast meat quality of broiler chickens in the finishing period. Five doses of vitamin E were used (30, 90, 150, 210, and 270 mg/kg feed) in broilers' diets from 42 to 54 d of age. A completely randomized design was conducted, followed by a split-plot, where the vitamin E dose was considered as the whole plot, and broilers’ age at slaughter was the subplot. Breast meat quality was assessed at 4 different ages (45, 48, 51, and 54 d old), using 50 birds per age, totaling 200 birds. Meat quality characteristics evaluated were: pH at 24 h post mortem, color (brightness, redness, and yellowness), water holding capacity, cooking loss, shear force, and lipid peroxidation. There was no interaction between age and dose of vitamin E for meat quality characteristics (P > 0.05). The age at slaughter had a quadratic effect (P

In recent years, the development of renewable energy from biomass has received a great deal of attention as a result of serious environmental problems, exhaustion of fossil fuels, and the growing global population. In this chapter, the use of various types of biomass for biofuel production and heat and power generation is discussed. In section one, the major types, characterizations, availability, and distribution of world biomass resources are summarized in detail, followed by Section 21.2 , with a discussion on the production of conventional biofuels including bioethanol, biobutanol, and biodiesel. In Section 21.3 , the advanced biofuels production via fast pyrolysis, microwave-assisted pyrolysis, and hydrothermal liquefaction (HTL) is covered. In addition, Section 4 reviews the use of third-generation biomass algae as the feedstock for producing biofuels, with a focus on the in situ transesterification for biodiesel, HTL for bio-oil, and anaerobic digestion for biogas. Following this, Section 5 presents the utilization of biomass for heat and power generation by combustion, gasification, and anaerobic digestion. Finally, Section 6 provides the main conclusions and recommendations for future work.

Carotenoids have been receiving increasing attention due to their potential health benefits. Microalgae are recognized as a natural source of carotenoids and other beneficial byproducts. However, the production of micro-algal carotenoids is not yet sufficiently cost-effective to compete with traditional chemical synthetic methods and other technologies such as extraction from plant based sources. This review presents the recent biotechnological developments in microalgal carotenoid production. The current technologies involved in their bioprocessing including cultivation, harvesting, extraction, and purification are discussed with a specific focus on downstream processing. The recent advances in chemical and biochemical synthesis of carotenoids are also reviewed for a better understanding of suitable and economically feasible biotechnological strategies. Some possible future directions are also proposed.

Brazil has the highest water availability of any country in the world. Nearly 20% of all the world’s rivers flow on Brazilian soil. Brazil’s herds of cattle, pigs and poultry are among the largest in the world, and the country uses irrigated agriculture extensively, which accounts for most water consumption (approximately 70% of the water consumed in the world). The Brazilian Agricultural Research Corporation (Embrapa), the largest and most important public institution of Brazilian agricultural research, has attempted to develop environmental technologies in order to minimize the impact caused by the scarcity and pollution of water resources. This paper describes the technologies this institution offers to different regions. For this purpose, a descriptive and exploratory study was conducted in various Embrapa research units. The results showed that research on the rational use of water in agriculture has intensified since the early 2000s. However, the pace of growth in agricultural activities and their impact is much greater than that of the generated technologies, demonstrating the difficulty in striking a balance in this relationship. Furthermore, it is clear that that water scarcity and the increasing pollution of shallow and deep waters are complex issues with no short-term solution.

Introductory paragraphIdentification of protective and/or pathogenic genetic modifiers provides important insight into the heterogeneity of disease presentations in individuals affected by neuromuscular disorders (NMDs), despite having well-defined pathogenic variants. Targeting modifier genes to improve disease phenotypes could be especially beneficial in cases where the causative genes are large, structurally complex and the mutations are heterogeneous. Here, we report a mutation-independent strategy to upregulate expression of a compensatory disease-modifying gene in Congenital Muscular Dystrophy type 1A (MDC1A) using a CRISPR/dCas9-based transcriptional activation system. MDC1A is caused by nonfunctional Laminin α2, which compromises muscle fibers stability and axon myelination in peripheral nerves 1. Transgenic overexpression of Lama1, encoding a structurally similar protein Laminin α1, ameliorates muscle wasting and paralysis in the MDC1A mouse models, demonstrating its role as a protective disease modifier 2. Yet, upregulation of Lama1 as a postnatal gene therapy is hampered by its large size, which exceeds the current genome packaging capacity of clinically relevant delivery vehicles such as adeno-associated viral vectors (AAVs). In this study, we sought to upregulate Lama1 using CRISPR/dCas9-based transcriptional activation system, comprised of catalytically inactive S. aureus Cas9 (dCas9) fused to VP64 transactivation domains and sgRNAs targeting the Lama1 promoter. We first demonstrated robust upregulation of Lama1 in myoblasts, and following AAV9-mediated intramuscular delivery, in skeletal muscles of dy2j/dy2j mouse model of MDC1A.We therefore assessed whether systemic upregulation of Lama1 would yield therapeutic benefits in dy2j/dy2j mice. When the intervention was started early in pre-symptomatic dy2j/dy2j mice, Lama1 upregulation prevented muscle fibrosis and hindlimb paralysis. An important question for future therapeutic approaches for a variety of disorders concerns the therapeutic window and phenotypic reversibility. This is particularly true for muscular dystrophies as it has long been hypothesized that fibrotic changes in skeletal muscle represent an irreversible disease state that would impair any therapeutic intervention at advanced stages of the disease. Here, we demonstrate that dystrophic features and disease progression were significantly improved and partially reversed when the treatment was initiated in symptomatic 3-week old dy2j/dy2j mice with already-apparent hind limb paralysis and significant muscle fibrosis.Collectively, our data demonstrate the feasibility and therapeutic benefit of CRISPR/dCas9-mediated modulation of a disease modifier gene, which opens up an entirely new and mutation-independent treatment approach for all MDC1A patients. Moreover, this treatment strategy provides evidence that muscle fibrosis can be reversible, thus extending the therapeutic window for this disorder. Our data provide a proof-of-concept strategy that can be applied to a variety of disease modifier genes and a powerful therapeutic approach for various inherited and acquired diseases.

Although dental implant placements have high success rates and a low incidence of morbidity, post-operative pain and complications with the healing process have been reported. There is little guidance available regarding optimal pre- and post-operative management of dental implant placement. This first paper discusses the mechanisms of pain associated with dental implant placement and offers guidance to clinicians on optimal pre- and post-operative pain management regimes. The second paper aims to discuss pre- and post-operative means of reducing the risk of early healing complications.

Biodiesel usage as in the environment as an alternative to fossil fuels or in biodiesel/diesel blends requires an understanding of the potential effects of its addition on the integrity of the infrastructure used for fuel storage. Polyethylene is one of the most common materials for the manufacturing of fuel storage tanks. Due to the insoluble nature of polyethylene, biofilm formation on its surface boosted by the presence of biodiesel could potentially contribute to its degradation. In this study, the effect of biodiesel concentration on biofilm development on linear low-density polyethylene (LLDPE), cross-linked polyethylene (XLPE) and a bilayer construction of linear-low density polyethylene and polyamide-11 (LLDPE/PA) was studied. Polymers were exposed to biodeterioration conditions during a 200 days in a simulated fuel storage tank. Excess of water and blends of diesel/biodiesel (0%, 25%, 50%, 75% and 100%) as a carbon source were employed to simulate the conditions found in the bottom of fuel storage tanks, where the presence of water is common as result of condensation. Microorganisms obtained from a diesel storage facility were used as inoculum. Biofilm growth and viability were quantified by a crystal violet assay and hydrolysis of fluorescein diacetate, respectively. Results show that although there is greater accumulation of biofilm material in pure biodiesel samples metabolic activity is higher in pure diesel ones. Microbial community structure and composition were studied by community level physiological profiling (CLPP) and 16s rDNA sequencing. Principal component analysis of CLPP revealed that both biodiesel concentration and polymer type affect the structure and metabolic capabilities of biofilm communities. These results were confirmed by comparison of libraries of 16s rDNA for different polymers growing at different biodiesel concentrations. Genera isolated in the biofilm were characterized either by their ability to degrade hydrocarbons, produce surfactants or degrade polyethylene or polyamide-11. The results of this study may lead to a better understanding of microbial effects on storage materials for diesel/biodiesel blends.

Objectifs La chirurgie de l’incontinence urinaire masculine fait appel a la mise en place du sphincter urinaire artificiel (SUA) AMS800 depuis plus de 35 ans. Usuellement realise en hospitalisation complete (HC) en France, la chirurgie ambulatoire (CA) s’est imposee et modifie les pratiques professionnelles. L’objectif est de revoir l’experience immediate au sein d’une structure hospitalo-universitaire ambulatoire dediee recemment ouverte (1/4/2018). Methodes Du 1er avril 2018 au 1er avril 2019 tous les patients devant etre implantes d’un SUA ont ete proposes a une hospitalisation ambulatoire sous reserve de l’absence de contre-indications anesthesiques ou sociales. L’etude reprend le descriptif de la population, le taux d’hospitalisation complete secondaire jusqu’a activation, la morbidite perioperatoire et les taux de retention postoperatoire immediats. La preparation a la chirurgie comprenait un ECBU preoperatoire, une antibioprophylaxie peroperatoire exclusive et le rasage a domicile. Resultats Vingt-cinq patients (69,5 ans, DS 9) selectionnes pour leur recevabilite a la CA ont ete operes par deux operateurs, 19/25 pour IUE apres PT, 5/25 post chirurgie d’HBP, 1/25 post-radiotherapie et cryotherapie. Un patient est passe en HC pour non-reveil de rachianesthesie (24/25 anesthesies generales) et repose de sonde urinaire (ablation j2). Quatre-vingt pour cent etaient des premieres poses, 20 % des revisions completes ; 25 manchettes bulbaires dont 4 trans-caverneuses. Aucune transfusion n’a ete realisee, 3/25 etant sous anticoagulants actifs stoppes pour la chirurgie. Deux pompes se sont mal positionnees (hematomes postoperatoire, Clavien 1) ayant impose un geste de reprise pour realignement des tubulures dans les 6 mois. Vingt-deux sur 25 etaient socialement continents (≤ 1 protection). 1 infection de cicatrice (Clavien 1). Conclusion Si aucune comparaison n’est actuellement faite a l’experience passee en hospitalisation complete, la faisabilite parait acceptable et pouvoir soutenir les programmes de reduction des durees d’hospitalisation pour cette chirurgie prothetique. La rachianesthesie doit etre exceptionnelle et les protocoles d’auto-suivi a domicile optimises. Une etude de vecu de ces sejours reduits et contraignants pour les patients devra etre mise en place.

Background:In recurrent urinary tract infections (UTIs) usual prophylactic antibiotic regimes do not change the long-term risk of recurrence. Our aim was to evaluate the efficacy of D-mannose in the treatment and prophylaxis of recurrent UTIs.Methods:In this randomized cross-over trial female patients were eligible for the study if they had an acute symptomatic UTI and three or more recurrent UTIs during the preceding 12 months. Suitable patients were randomly assigned to antibiotic treatment with trimethoprim/sulfamethoxazole or to a regimen of oral D-mannose 1 g 3 times a day, every 8 hours for 2 weeks, and subsequently 1 g twice a day for 22 weeks. They received the other intervention in the second phase of the study, with no further antibiotic prophylaxis. The primary endpoint was evaluation of the elapsed time to recurrence; secondary endpoints were evaluation of bladder pain (VASp) and urinary urgency (VASu).Results:The results for quantitative variables were expressed as mean values and SD as they were all normally distributed (Shapiro–Wilk test). In total, 60 patients aged between 22 and 54 years (mean 42 years) were included. Mean time to UTI recurrence was 52.7 days with antibiotic treatment, and 200 days with oral D-mannose ( p < 0.0001).Conclusions:Mean VASp, VASu score, and average numbers of 24-hour voidings decreased significantly. D-mannose appeared to be a safe and effective treatment for recurrent UTIs in adult women. A significant difference was observed in the proportion of women remaining infection free versus antibiotic treatment.

Understanding changes in microbial structure due to biodiesel storage is important both for protecting integrity of storage systems and fuel quality management. In this work a simulated storage system was used to study the effect of biodiesel (0%, 25%, 50%, 75% and 100%) on a microbial population, which was followed by community level physiological profiling (CLPP), 16s rDNA analysis and plating in selective media. Results proved that structure and functionality were affected by biodiesel. CLPP showed at least three populations: one corresponding to diesel, one to biodiesel and one to blends of diesel and biodiesel. Analysis of 16s rDNA revealed that microbial composition was different for populations growing in diesel and biodiesel. Genera identified are known for degradation of hydrocarbons and emulsifier production. Maximum growth was obtained in biodiesel; however, microbial counts in standard media were lower for this samples. Acidification of culture media was observed at high biodiesel concentration.

The fabrication of dry ultrathin photoelectric layers is described in this paper. The self-assembled monolayer of oriented purple membrane (PM) patches from bacteriorhodopsin (bR) is created on a bio-functionalized gold (Au) surface using a biotin molecular recognition technique. The biotin enables the extracellular side of the bR PMs to be accurately labeled. During the biochemical immobilization process, the biotinylated alkylthiols modify the Au surface using HS terminals of the thiols and affix the labeled bR to the functionalized surface using streptavidin-biotin interactions. An optically transparent indium tin oxide (ITO) electrode is then placed on top of the finished assembly to complete the circuit of the photocell for testing and performance verification. An experimental study shows that the proposed self-assembly method can produce a 12.33 nm thick photoelectric layer that generates nearly 0.54 mV/(mW ·cm2) when exposed to a 568-nm laser beam. In contrast, other immobilization techniques such as electric field sedimentation produce dry bR films that are more than 10 μm thick. These ultrathin photoelectric layers can be used to create nanoscale light sensors and photocells.

Proteins are one of the fundamental building blocks for the sustainability of life. They catalyze the reactions in every form of life, including microorganisms, plants, and animals. They provide structural support to tissues and collaborate in energy storage. From an industrial perspective, proteins are a big and attractive market, and they lead to significant profit margins. However, when these proteins end as part of the waste after an industrial process, they represent pollution challenges, for example, by decreasing water quality. Attention has been attracted to the recovery of the proteins from waste streams so economical profit can be obtained from materials that otherwise would be just pollutants. This chapter reviews a compilation of state-of-the-art research on this field. Different potential sources for protein recovery are described, and also some of the interesting applications that can be found for waste-derived proteins are detailed. In addition, different techniques for protein separation are presented and supported with examples from previous and ongoing research.

Brazilian agricultural and livestock represent 22.54% of the Brazilian Gross Domestic Product. The Brazilian Agricultural and Livestock Research Company aims to develop technologic solutions for this sector. It has an approximate annual budget of 2.5 million dollars and 2,440 researchers. The researches target audience diversity makes more challenging the Technology Transfer process for the institution. The objective of this article was the proposal and validation, under the perception of the broiler productive chain agents, of a Technology Transfer model to optimize the public-private interaction for the institution. Were interviewed 142 agents, with a statistically significant sample, higher than 95%. The results demonstrated the contribution of Embrapa for the technological development of the chain is perceived as low, but the Technology Transfer model presented was considered essential by 96.77% of the respondents to optimize the Technology Transfer of Embrapa Pigs and Poultry to the chain.

Modeling wastewater treatment parameters such as concentrations of components and particle size distribution of solid particles, viable biomass and dead biomass requires the simulation of several processes within various wastewater plant layouts. Although the software is not a specialized tool for the simulation of the UV disinfection unit, it predicts parameters critical for such purpose. Multi-purpose flexible software was thus developed with the ability to simulate several key processes used in the municipal and industrial wastewater treatment processes. A special feature is the ability of the software to predict particle size distribution at the clarifier-thickener unit outputs. A presented case study showed a simulation of the typical biological and settler processes usually located upstream of the UV disinfection unit.

We ultrasonographically evaluated the prenatal development in cats, from the early phases to Day 30 of pregnancy, subjecting a group of pregnant cats (n = 12) to a daily ultrasonographic exam. The ultrasonographic images allowed us to measure the minor diameter of the gestational sac and the crown-rump length of the embryo/fetus. Ten subjects underwent ovariohysterectomy at specific intervals during the pregnancy, with the aim of comparing the ultrasonographic data with real data; only two subjects brought their pregnancy to term. The earliest ultrasonographic observation of the gestational sac was on Day 10 after mating, while the embryo could be measured only beginning with Day 18. This study allowed to gather useful new data in order to clinically monitor the normal course of pregnancy in cats and to date the gestational age.

Despite morbidity factors that include pain and complications with healing, there is currently little available guidance regarding optimal pre-and post-operative protocols for dental implant placement. While the first paper of this two-part series discussed the management of post-operative pain, the second instalment reviews pre- and post-operative means of managing early complications associated with dental implant placement.

The lymphomas are a group of lymphoproliferative disorders that can be divided histologically in the two main groups of Hodgkin's and non-Hodgkin's lymphoma. They sometimes present in the head and neck, and the diagnosis and management require a multidisciplinary approach. An unusual case is described presenting at an advanced stage because of patient delay in seeking medical help.

Una delle cause più frequenti di sofferenza dei nervi cranici (n.c.), V,VII e VIII è un conflitto neurovascolare che si determina a livello dell'angolo pontocerebellare. La metodica diagnostica di elezione è la risonanza magnetica. Scopo di questo studio è stato quello di valutare l'utilità della sequenza 3D-FT CISS per la diagnosi di tale patologia. Le immagini ottenute con questa metodica sono state in grado di identificare situazioni di conflitto neurovascolare in 5 casi su 16 di nevralgia trigeminale e nell'unico caso di emispasmo del facciale. Nei 69 pazienti con sofferenza dell'ottavo n.c. un conflitto era presente in 13 casi in cui era presente ipoacusia, variamente associata ad acufeni e vertigini; in 2 casi caratterizzati da acufeni e in 1 che lamentava solo vertigini. In 2 pazienti con sofferenza del VII n.c. ed in 24 di quelli con sofferenza dell'VIII era presente una situazione di contiguità tra il nervo ed un vaso, generalmente un'ansa vascolare della PICA o dell'AICA. Tuttavia solo nel 48% dei casi la condizione di contiguità si associava a manifestazioni cliniche a carico del 8° nervo cranico. Alla luce dei dati clinici e neuroradiologici si può concludere che la sequenza 3D-FT CISS, grazie al suo elevato potere di risoluzione spaziale, è un valido ausilio diagnostico nel documentare una situazione di conflitto neurovascolare.

Focal spinal cord lesions have been present in all previously reported cases of MRI appearances in myelopathy complicating vitamin B12 deficiency. We describe two further cases showing mild atrophy only and review the salient features of the previous 11 publications. MRI findings reflect quite closely the known pathological changes in this condition.

A case of growing skull fracture associated with unrecognized extradural haematoma is presented together with the relevant radiology. The pathophysiology of growing skull fracture is reviewed in light of this previously unreported case.

Penetrating injuries involving the spinal cord are not common. The incidence is, however, much higher in armed conflict. In a civilian population, gunshot wounds and stabbings account for the majority of such injuries. A pencil causing penetrating injury involving the spinal cord is very rare. We present the case of a young boy who accidentally suffered a penetrating injury involving the spinal cord from a pencil in his coat pocket.

At the one‐stop carpal tunnel syndrome clinic, patients undergo neurophysiological studies followed by clinical assessment by the orthopaedic consultant on the same day. Patients with paraesthesia or numbness in the median nerve distribution for greater than three months duration without a history of a previous soft tissue neck injury were selected for assessment in the one‐stop carpal tunnel syndrome clinic based on a proforma completed by their general practitioners. Data of patients attending the one‐stop carpal tunnel syndrome clinic over a ten‐month period were compared with that over the same period from a conventional hand clinic. A total of 77 patients attended the one‐stop carpal tunnel syndrome clinic over a ten‐month period. The mean time from referral to surgery was 23 weeks in this group compared to 44 weeks for a conventional clinic. On average, the one‐stop carpal tunnel syndrome clinic reduced the time from referral to surgery by 21 weeks. The one‐stop carpal tunnel syndrome clinic is convenient and cost effective for patients and hospitals.

In the absence of a specific marker for renal cell carcinoma (RCC), we evaluated the tumour-associated trypsin inhibitor (TATI) in patients with RCC. Between November 1990 and November 1993, 63 patients with RCC and 23 patients with benign renal disease underwent a competitive radioimmunoassay of TATI. The cutoff value was defined on a series of serum samples of 96 healthy subjects (normal n < 20 micrograms/l, then 25 micrograms/l after April 1993). We related the value of TATI to the tumour stage and compared the sensitivities of TATI and other markers (CEA, CA 15-3, CA 125, CA 19-9, ferritin). In 24 patients the TATI assay was repeated 3-12 months after radical nephrectomy. 15 patients with benign disease had a normal value of TATI (specificity: 65%). 44 of the 63 patients had a value of TATI above the cutoff point (sensitivity: 69%). Sensitivities of CEA, CA 15-3, CA 125, CA 19-9 and ferritin were 5, 10, 13, 5, 35%, respectively. The TATI value was correlated with the stage of the disease. Among the 15 patients without metastasis, the mean preoperative value was 112 micrograms/l (14-760) versus 46 micrograms/l (24-180) postoperatively. In the 9 patients with metastasis, the preoperative mean value was 100 micrograms/l (20-434) versus 240 micrograms/l (22-544) postoperatively. TATI showed a better sensitivity than other markers for RCC but its specificity is limited. Nevertheless it can be useful for a postoperative follow-up. TATI remains one of the best serum markers for RCC.

In recent years, the not too distant exhaustion of fossil fuels is becoming apparent. Apart from this, the combustion of fossil fuels leads to environmental concerns, the emission of greenhouse gases and issues with global warming and health problems. Production of biodiesel from microalgae may represent an attractive solution to the above mentioned problems, and can offer a renewable source of fuel with fewer pollutants. This review presents a compilation of engineering challenges related to microalgae as a source of biodiesel. Advantages and current limitations for biodiesel production are discussed; some aspects of algae cells biology, with emphasis on cell wall composition, as it represents a barrier for fatty acid extraction and lipid droplets are also presented. In addition, recent advances in the different stages of the manufacturing process are included, starting from the strain selection and finishing in the processing of fatty acids into biodiesel.

Obtaining a satisfactory outcome for a patient with a severely resorbed maxilla can be extremely challenging. This clinical report describes the treatment of a patient with a history of multiple implant failures in the maxilla. A conventional upper complete denture had poor retention and so did not fulfil the patient's needs. Further surgery was not considered appropriate. A new upper complete denture was made with a fitting surface covered in multiple suction cups to attempt to improve the retention without surgery and resulted in a pleasing outcome for both the patient and authors.

This anatomic study of the lumbar region (as defined by Rouvière [11]) applied to multiplanar imaging techniques was carried out both in the cadaver and in vivo. The cadaver study (5 cases) consisted of anatomic sections (transverse, sagittal, frontal and oblique) and computerised three-dimensional reconstructions after CT studies on subjects injected with colored and radio-opaque latex. The in vivo study (4 cases) used MRI sections and three-dimensional ultrasound sections coupled with the pulsed doppler. The spatially referenced oblique vertical sections revealed the structures from unusual aspects, situating them amidst the retroperitoneal area with the maximum of topographic landmarks. The transposition of these results (obtained by sectional anatomy of the retroperitoneal region) to the new techniques of multiplanar formatting after MRI, ultrasound or CT data acquisition should optimise the investigation of certain retroperitoneal structures by specifying the ideal planes of section for each organ, while diminishing certain artefacts specific to acquisitions in the traditional planes of section. Oblique vertical sections seem eminently suitable for ultrasound location of the suprarenal compartments, study of the renal pedicles and topographic retroperitoneal location. This oblique vertical visualisation constitutes a fundamental resource for the development of video-monitored surgical procedures as it corresponds exactly to the axes of the access routes in percutaneous surgery of the kidney and the adjacent anatomic structures.

A new class of switching architectures for broadband packet networks, called shuffleout, is described and analyzed. Shuffleout is basically an output-queued architecture with a multistage interconnection network built out of unbuffered b/spl times/2b switching elements. Its structure is such that the number of cells that can be concurrently switched from the inlets to each output queue equals the number of stages in the interconnection network. The switching element operates the cell self-routing adopting a shortest path algorithm which, in case of conflict for interstage links, is coupled with deflection routing. The basic version of this architecture is called open-loop shuffleout. This paper describes the closed-loop shuffleout architecture with 2/spl times/4 switching elements in which cells that have crossed the whole interconnection network re-enter the network as long as they are not successfully routed to the addressed switch outlet. This result is accomplished by adding to the basic open-loop structure recirculation paths so that each packet can cross several times the interconnection network. Two different solutions are proposed to implement such functionality, the buffered closed-loop shuffleout and the expanded closed-loop shuffleout architecture. Both these solutions aim at reducing the number of stages in the network, compared to the open-loop structure, so as to reduce the complexity of the switch internal wiring and to simplify the output queue interface. >

The success of metal stents in the urethra led us to implant flexible metal stents unilaterally in the ureter in four patients. Radiographic and endoscopic controls during follow-up showed an obstruction in three cases. We describe the different aspects of these unfavorable outcomes and propose changes to be made in metal stents for use in the upper urinary tract.

Like most real-life processes, the operation of liquid-solid circulating fluidized bed (LSCFB) system for continuous protein recovery is associated with several objectives such as maximization of production rate and recovery of protein, and minimization of amount solid ion-exchange resin requirement, all of which need to be optimized simultaneously. In this article, multiobjective optimization of a LSCFB system for continuous protein recovery was carried out using an experimentally validated mathematical model to find the scope for further improvements in its operation. Elitist non-dominated sorting genetic algorithm with its jumping gene adaptation was used to solve a number of bi- and tri-objective function optimization problems. The optimization resulted in Pareto-optimal solution, which provides a broad range of non-dominated solutions due to conflicting behavior of the operating parameters on the system performance indicators. Significant improvements were achieved, for example, the production rate at optimal operation increased by 33%, using 11% less solid compared to reported experimental results for the same recovery level. The effects of operating variables on the optimal solutions are discussed in detail. The multiobjective optimization study reported here can be easily extended for the improvement of LSCFB system for other applications.

A photoreceptor array that exploits the light sensitive bacteriorhodopsin (bR) films has been manufactured on a flexible indium-tin-oxide (ITO) coated plastic film using electrophoretic sedimentation technique (EPS). The effective sensing area of each photoreceptor is 2 x 2 mm (2), separated by 1 mm and arranged in a 4 x 4 array. A switched integrator with gain on the order of 10(10) is used to amplify the signal to a suitable level. When exposed to light, the differential response characteristic is attributed to charge displacement and recombination within bR molecules, as well as loading effects of the attached amplifier. The peak spectral response occurs at 568 nm and is linear over the tested light power range of 200 mu W to 12 mW. The response remains linear at other tested wavelengths, but with reduced amplitude. Initial tests have indicated that responsivity among all photoreceptors is greater than 71% of the average value, 465.25 mV/mW. The differential nature of the signal generated by bR makes it a suitable sensing material for vision applications such as motion detection. The prototype array demonstrates this property by employing Reichardt's delay-and-correlate algorithm. Furthermore, fabricating sensor arrays on flexible substrates introduces a new design approach that enables non-planar imaging surfaces.

The stringent new regulations to lower sulfur content in fossil fuels require new economic and efficient methods for desulfurization of recalcitrant organic sulfur. Hydrodesulfurization of such compounds is very costly and requires high operating temperature and pressure. Biodesulfurization is a non-invasive approach that can specifically remove sulfur from refractory hydrocarbons under mild conditions and it can be potentially used in industrial desulfurization. Intensive research has been conducted in microbiology and molecular biology of the competent strains to increase their desulfurization activity; however, even the highest activity obtained is still insufficient to fulfill the industrial requirements. To improve the biodesulfurization efficiency, more work is needed in areas such as increasing specific desulfurization activity, hydrocarbon phase tolerance, sulfur removal at higher temperature, and isolating new strains for desulfurizing a broader range of sulfur compounds. This article comprehensively reviews and discusses key issues, advances and challenges for a competitive biodesulfurization process.

The Acclaim total elbow replacement is a modular system which allows implantation in both unlinked and linked modes. The results of the use of this implant in primary total elbow replacement in 36 patients, operated on between July 2000 and August 2002, are presented at a mean follow-up of 36 months (24 to 49). Only one patient did not have good relief of pain, but all had improved movement and function. No implant showed clinical or radiological loosening, although one had a lucent area in three of seven humeral zones. The short-term results of the Acclaim total elbow replacement are encouraging. However, 11 patients (30.5%) suffered an intra-operative fracture of the humeral condyle. This did not affect the outcome, or the requirement for further surgery, except in one case where the fracture failed to unite. This problem has hopefully been addressed by redesigning the humeral resection guide. Other complications included three cases of ulnar neuropathy (8.3%) and one of deep infection (2.8%).

Voice over IP and video applications continue to increase the amount of real-time traffic over the Internet. These applications utilize the UDP protocol because TCP is not suitable for streaming applications since its congestion control mechanism can change the connection's transmission rate drastically, affecting the user-perceived quality of the transmission. Nonetheless, the use of end-to-end flow and congestion control mechanisms for streaming applications has been acknowledged as an important measure to ease or eliminate the congestion collapse problem in the Internet, and the unfairness problem that exist when TCP and UDP share the same congested bottleneck link. In this paper, we propose the smooth fair TCP SACK-based (SF-SACK) protocol to address these problems. SF-SACK implements the well-known end-to-end window-based congestion control algorithm of TCP but uses an additive increase smooth decrease (AISD) strategy that considers history in the evolution of the congestion window. Through simulations and experimentation, we show that if SF-SACK is used by both streaming and data-oriented applications, streaming applications receive a smooth service, and fairness is achieved. If SF-SACK is used for streaming applications only, it is unfair to TCP (not TCP-friendly) but substantially fairer and beneficial than UDP.

The performance of wide field-of-view (FOV) and omni-directional sensors are often limited by the complex optics used to project three-dimensional world points onto the planar surface of a charged-couple device (CCD) or CMOS array. Recent advances in the design and development of a spherical imaging system that exploits the fast photoelectric signals generated by dried bacteriorhodopsin (bR) films are described in this paper. The bendable, lightweight and durable bR-based photocell array is manufactured on an indium-tin-oxide (ITO) coated plastic film using Electrophoretic Sedimentation technique (EPS). The effective sensing area of each pixel in the preliminary prototype is 2x2 mm 2 , separated by 1mm and arranged in a 4x4 array. When exposed to light, the differential response characteristic is attributed to charge displacement and recombination within the bR molecule, as well as loading effects of the attached amplifier. The peak spectral response occurs at 568nm and is linear over the tested light power range of 200μW to 12mW. Response remains linear at the other tested wavelengths, but at reduced signal amplitude. Excess material between the bR sensing elements can be cut from the plastic substrate to increase structure flexibility and permit the array of photodetectors to be wrapped around the exterior, or adhered to the interior, of a sphere.

In this study, a biological photoelectric transducer based on bacteriorhodopsin (bR) is described. Purple membrane (PM) containing bR are deposited on a TiO₂ electrode surface and electrically oriented. The dried bR purple membrane film is then utilized to investigate the photoelectric response. The latter is induced by charge displacement of bR molecules in the purple membranes. The response is affected by both the wavelength and intensity of the incident light sources. The experimental results indicate that the generated photo-voltage is proportional to the intensity of the illumination light, and the photo-voltage measured under different wavelengths correspond to the absorption spectrum of bR.

A bendable photocell array that exploits bioelectronic photoreceptors based on bacteriorhodopsin (bR) is described in this paper. Fabricating such a sensor array on a flexible plastic substrate introduces a new design approach that enables lightweight and durable non-planar sensing devices to be created with curved or spherical geometries. In this research, purple membrane patches obtained from wild-type bR are deposited onto a polyethylene terephthalate (PET) substrate coated with a patterned ITO layer using Electrophoretic Sedimentation (EPS) technique. The current prototype consists of a flexible 4x4 pixel array and an amplification circuit that magnifies the small electrical signal arising from the charge displacement and recombination within the dried bR film. Each individual pixel is a 2mm x 2mm square separated by a 1mm distance between neighboring elements. The measured photoelectric response of an individual pixel is approximately linear over the light power range between 200μW and 12mW. These bR photocells respond primarily to visible light with a spectral peak response at 568nm. The response times of the photoelectric signals can reach up to the microsecond range. Preliminary tests have demonstrated that photoresponse characteristics are maintained while the flexible substrate is deformed up to a 10mm bending radius. Unfortunately, dried bR photocells are inherently susceptible to electrical noise because of their extremely high film resistance, necessitating the employment of a noise-filtering amplifier. The image processing capabilities of bR are demonstrated in a motion detection application. Specifically, Reichardt's delay-and-correlate algorithm is implemented and is used to detect both the speed and direction of a moving light spot.

A high-speed motion detection system that utilizes bioelectronic photocells is described in this paper. Each individual photocell consists of a sandwich-structural device with an ITO (indium tin oxide) electrode/bR film/ITO electrode configuration. During illumination, the molecules in the thin bacteriorhodopsin (bR) film undergo a multi-state photocycle followed by a proton transport from the cytoplasmic side to the extracellular side of the cell membrane. Both the wavelength and intensity of the impinging light source influence the charge displacement and, thereby, the current flow. Experimental studies show that the bR photodetector measured by the current mode exhibits a wide dynamic range and very fast response time. The photoelectric response is approximately linear over the light power range of muW to W. The response time is related to the bR photocycle kinetics and has been measured in mus. The responsivity of the experimental photocell is ISO mV/mW at 570nm. In addition, the device exhibits a high degree of differential photosensitivity to change in incident light intensity. These photoelectric properties make bR film a viable material for designing spatio-temporal motion detection systems. Issues related to the design and fabrication of a high-resolution and high-speed motion detection system for machine vision applications are discussed

Bacteriorhodopsin (bR) thin films have been investigated in recent years as a viable biomaterial for constructing micro- or nanoscale optical devices. During illumination, the bR molecules in the thin film undergo a photocycle that is followed by a proton transport from the cytoplasmatic side to the extracellular side of the cell membrane. The photoelectric response induced by the charge displacement can be influenced by both the wavelength and intensity of the impinging light sources. A photocell based on the photoelectric properties of a thin bR film is described in this paper. The bR-based photocell is built as a sandwich-structural device with an ITO (Indium Tin Oxide) electrode/bR film/ITO electrode configuration. The photocell is fabricated by depositing the oriented bR film onto the grounded ITO electrode. The cytoplasmic side of the bR membrane is attached to the ITO conductive surface and the extracelluar side is placed in contact with the second ITO electrode that provides the signal input to the instrumentation circuit. A polyester thin film was used as the spacer separating the two ITO electrodes. The size of the active area of the photocell is about 10×10 mm. A HeNe laser coupled with an acoustic-optical scanning system is used as the light source. Experimental results confirm that the photoelectric response generated by the bR-photocell prototype is durable, stable, and highly sensitive to changes in light intensity. The sensitivity of the proposed signal transducer is 10.25mV/mW. The wavelength dependence of the photoelectric responses is similar to the optical absorption spectrum of bR membrane.

The average of three consecutive measurements is the most frequently used method for grip strength assessment. The purpose of this study was to compare the consistency of the maximum value with that of the average value of three consecutive measurements of grip strength. One hundred healthy volunteers participated in this study. Three measurements of grip strength were taken on two occasions separated by 2 weeks. For each hand, two average values and two maximum values were obtained. Ninety-five per cent limits of agreement for the average method were – 8.3 (−23%) to +7.2 (+20%) kg and for the maximum method were – 8.8 (−23%) to + 8 (+21%) kg. Both methods of grip strength assessment were found to be highly consistent with no statistically significant difference.