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Simulation-based education is gaining attention worldwide as it is recognized as effective in fostering collaborative skills in healthcare students. We conducted a comprehensive review of simulation-based interprofessional education (IPE) to examine the current state of simulation-based IPE. This scoping review systematically analyzed studies on simulation-based IPE in South Korean healthcare education, following established guidelines. Relevant articles were comprehensively searched, and key data on simulation methods, implementations, and educational effectiveness were extracted for analysis. The present study included nine quantitative studies and one mixed-methods study. The majority of participants were undergraduate nursing and medical students. The duration of IPE interventions ranged from 2 hours to 2 weeks. Education methods included standardized patients, high-fidelity simulators, and role-playing. Educational outcomes focused on measuring IPE competencies and satisfaction levels, concentrating on Kirkpatrick levels 1 and 2. While most studies reported high satisfaction levels, there is a need for objective evaluation of educational effectiveness. As simulation-based IPE in Korean healthcare education evolves, there is a need for greater inclusivity of diverse roles, multidisciplinary respect, and scenario development allowing active participation across professions. Establishing institutional frameworks, community linkages, and a deep understanding of IPE’s purpose and essence among practitioners is crucial for its academic maturation.

Abstract This study presents a comprehensive investigation into a 3D simulation of magnetorheological (MR) conical bearings, focusing on considering viscous dissipation using the conjugated heat transfer approach. The behavior of MR fluids is expressed through the utilization of the Bingham-Papanastasiou constitutive equation. Notably, this study considers variations in viscosity and yield stress as functions of both magnetic field intensity and temperature. The study utilizes a multidisciplinary approach, encompassing fluid dynamics, magnetism, and heat transfer, to model and analyze the behavior of MR fluids within conical bearing geometries. The governing equations containing Cauchy momentum, energy, and Maxwell equations are solved using the finite element method. This research delves into the impacts of viscous dissipation on the functional and characteristic attributes of conical bearings. The energy equations in solid and fluid domains and extended considerations to the plug region within viscous dissipation are specifically addressed. Extensive validation is performed through a comparative analysis involving experimental, numerical, and analytical studies to ensure the validity of results. The results reveal the substantial impact of temperature on both the characteristics and functionality of magnetorheological conical bearings.

Oxide dispersion-strengthened (ODS) superalloys are usually manufactured by a hot isostatic pressing after mechanical alloying (MA-HIP). However, this process cannot produce complex-shaped parts. Here, we used an additive manufacturing product (powders produced by laser powder bed fusion, L-PBF) to address this issue. Modified ODS Ni-based superalloy powders with a similar composition to the mechanical alloy 6000 (MA6000) were manufactured using a gas atomization process. The obtained powders and L-PBF synthesized samples were analyzed by scanning electron microscopy (SEM), X-ray diffraction (XRD), LPSA, and EBSD analyses.

Powder materials strengthened by oxide dispersion are generally made by in-situ method; direct oxide dispersing in matrix powders during atomization. There is also ex-situ method; oxides dispersing by mixing with matrix powders. In this study powder mixtures (Inconel 738 matrix powder + SiO2 powder + Al2O3 powder) were mechanically manufactured by ex-situ process, a lowenergy ball milling method. Then, specimens of the as-mill powders were manufactured by laser powder bed fusion (L-PBF) method and spark plasma sintering (SPS) process. The microstructures of each prepared specimen were compared according to process variables. SEM, EDS, XRD, and Electron Backscatter Diffraction (EBSD) analyses were applied in this study.

Summary: Stem cell therapies for degenerative cartilage disease are limited by an incomplete understanding of hyaline cartilage formation and maintenance. Human bone marrow stromal cells/skeletal stem cells (hBMSCs/SSCs) produce stable hyaline cartilage when attached to hyaluronic acid-coated fibrin microbeads (HyA-FMBs), yet the mechanism remains unclear. In vitro, hBMSC/SSC/HyA-FMB organoids exhibited reduced BMP signaling early in chondrogenic differentiation, followed by restoration of BMP signaling in chondrogenic IGFBP5+/MGP+ cells. Subsequently, human-induced pluripotent stem cell (hiPSC)-derived sclerotome cells were established (BMP inhibition) and then treated with transforming growth factor β (TGF-β) −/+ BMP2 and growth differentiation factor 5 (GDF5) (BMP signaling activation). TGF-β alone elicited a weak chondrogenic response, but TGF-β/BMP2/GDF5 led to delamination of SOX9+ aggregates (chondrospheroids) with high expression of COL2A1, ACAN, and PRG4 and minimal expression of COL10A1 and ALP in vitro. While transplanted hBMSCs/SSCs/HyA-FMBs did not heal articular cartilage defects in immunocompromised rodents, chondrospheroid-derived cells/HyA-FMBs formed non-hypertrophic cartilage that persisted until at least 5 months in vivo.

Abstract The feasibility of a novel type of moss (Parkortanso No. 1 synthesized from Racomitrium japonicum, Dozy and Molk) to capture CO2 in urban areas was demonstrated. The effects of light intensity (500, 1000, and 1500 µmol/m2.s), ambient temperature (10 °C, 25 °C, and 35 °C), age (1-year-old and 3 years old), and leaf color (bright and dark green) on the CO2 removal caused by the moss concerned were investigated. It was determined that stronger light intensity resulted in higher CO2 removal by the target moss. The moss showed the best CO2 capture at 25 °C, while the CO2-capturing capacities declined when the ambient temperatures were 10 °C and 35 °C. Three years old bright green moss was found to have higher CO2-capturing capacity than 1 year old. Similarly, bright green moss exhibited the best CO2 uptake out of the mosses concerned. The highest net CO2 emission of the moss was − 1.94 ± 0.72 kgCO2/m2.year, which was comparable to other moss and plant species. Consequently, the bright green and old Parkortanso No. 1 moss are recommended for a green roof application in terms of CO2 capture. Graphical Abstract

Abstract The spatial monitoring of submicron particles has become an essential issue due to their negative effects on human health. However, the use of high-cost and high-grade measurement instruments is a challenging investment cost. Thus, a cost-effective optical particle counter (OPC), which is improved measurement quality, has become a good candidate. In this study, two cost-effective OPCs, coupled with a heated inlet tube to reduce the effect of humidity on its measurements, were applied in the field to measure ambient PM10, PM2.5, and PM1 over 1 month. Their 1-h-average and 24-h-average data were compared with those obtained from a reference-grade OPC and a beta attenuation monitor (BAM). In particular, the correlations between the measurement data obtained from them, the differences in the mean values of these data, and the relative errors were evaluated. The PM2.5 data obtained from cost-effective OPCs were comparable to those from BAM at even under high humidity conditions, except for rainy days. The data obtained from the cost-effective OPCs also showed good correlations and low relative errors (i.e.,

Abstract This paper presents a novel analytical solution for journal-bearing viscoelastic lubrication using the perturbation method. The nonlinear Giesekus model was used for the constitutive equations to study the effects of fluid elasticity, shear-thinning viscometric functions, and strain-hardening elongational viscosity of viscoelastic lubrication. The investigation focuses on the impact of characteristic parameters such as mobility factor, eccentricity ratio, and Weissenberg number on the fluid film pressure distribution, load capacity, and shear stress. Although distinguishing between the normal stress differences and extensional viscosity in mixed viscoelastic flows is complicated, we investigated the role and contribution of these two factors. By increasing the elasticity of the fluid, the portion of both mentioned parameters increases consequently. Furthermore, analyses and comparisons show the contributions of the first normal stress and elongational viscosity to the load capacity of the bearing through the stress ratio and flow type parameter for the first time. The research findings indicate that fluid elasticity enhances the load capacity of the bearing compared to a Newtonian lubricant with the same effective viscosity. Moreover, the bearing load capacity is divided into two regions. In the linear region, the mobility factor and Weissenberg numbers have minimal effects leading to a linear increase in the load distribution, and in the exponential region, the load capacity changes are considerable. This research provides valuable insights into the behavior of viscoelastic lubrication in journal-bearing systems.

Objective This study aimed to describe the relationship between sex and survival in patients experiencing unintentional trauma. Methods This retrospective, national population–based observational, case-control study involved a cohort of Korean trauma patients who were transferred to an emergency department by a Korean emergency medical service from January 1 to December 31, 2018. Propensity score matching was used. The primary outcome was survival until hospital discharge. Results Of 25,743 patients with severe unintentional trauma, 17,771 were male and 7,972 were female. Prior to propensity score matching, there was no significant difference in survival among male and female patients (92.6% vs. 93.1%, P=0.105). After using propensity score matching to adjust for confounders, there was still no sex difference in survival (male, 93.6% vs. female, 93.1%; P=0.270). Conclusion Survival after severe trauma was not influenced by the sex of the patient. Further studies with patients of reproductive age and a larger study population are needed to analyze the effects of sex on survival in patients with trauma.

Sargassum horneri (SH) and Ulva australis (UA) are marine waste resources that cause environmental and economic problems when entering or multiplying the coastal waters of Jeju Island. We analyzed their anti-diabetic efficacy to assess their reusability as functional additives. The alpha-glucosidase inhibitory activity of SH and UA extracts was confirmed, and the effect of UA extract was higher than that of SH. After the induction of insulin-resistant HepG2 cells, the effects of the two marine extracts on oxidative stress, intracellular glucose uptake, and glycogen content were compared to the positive control, metformin. Treatment of insulin-resistant HepG2 cells with SH and UA resulted in a concentration-dependent decrease in oxidative stress and increased intracellular glucose uptake and glycogen content. Moreover, SH and UA treatment upregulated the expression of IRS-1, AKT, and GLUT4, which are suppressed in insulin resistance, to a similar degree to metformin, and suppressed the expression of FoxO1, PEPCK involved in gluconeogenesis, and GSK-3β involved in glycogen metabolism. The oral administration of these extracts to rats with streptozotocin-induced diabetes led to a higher weight gain than that in the diabetic group. Insulin resistance and oral glucose tolerance are alleviated by the regulation of blood glucose. Thus, the SH and UA extracts may be used in the development of therapeutic agents or supplements to improve insulin resistance.

Abstract Background Oncologic impact of genetic alteration across synchronous colorectal cancer (CRC) still remains unclear. This study aimed to compare the oncologic relevance according to genetic alteration between synchronous and solitary CRC with performing systematic review. Methods Multicenter retrospective analysis was performed for CRC patients with curative resection. Genetic profiling was consisted of microsatellite instability (MSI) testing, RAS (K-ras, and N-ras), and BRAF (v-Raf murine sarcoma viral oncogene homolog B1) V600E mutation. Multivariate analyses were conducted using logistic regression for synchronicity, and Cox proportional hazard model with stage-adjusting for overall survival (OS) and disease-free survival (DFS). Results It was identified synchronous (n = 36) and solitary (n = 579) CRC with similar base line characteristics. RAS mutation was associated to synchronous CRC with no relations of MSI and BRAF. During median follow up of 77.8 month, Kaplan–meier curves showed significant differences according to MSI-high for OS, and in RAS, and BRAF mutation for DFS, respectively. In multivariable analyses, RAS and BRAF mutation were independent factors (RAS, HR = 1.808, 95% CI = 1.18–2.77, p = 0.007; BRAF, HR = 2.417, 95% CI = 1.32–4.41, p = 0.004). Old age was independent factor for OS (HR = 3.626, 95% CI = 1.09–12.00, p = 0.035). Conclusion This study showed that oncologic outcomes might differ according to mutation burden characterized by RAS, BRAF, and MSI between synchronous CRC and solitary CRC. In addition, our systematic review highlighted a lack of data and much heterogeneity in genetic characteristics and survival outcomes of synchronous CRC relative to that of solitary CRC.

Abstract This study investigates the effect of fluid elasticity on axisymmetric droplets colliding with pre-existing liquid films, using both numerical and experimental approaches. The numerical simulations involve solving the incompressible flow momentum equations with viscoelastic constitutive laws using the finite volume method and the volume of fluid (VOF) technique to track the liquid’s free surface. Here, the Oldroyd-B model is used as the constitutive equation for the viscoelastic phase. Experiments are also performed for dilute viscoelastic solutions with 0.005% and 0.01% (w/w) polyacrylamide in 80:20 glycerin/water solutions, in order to ensure the validity of the numerical solution and to investigate the elasticity effect. The formation and temporal evolution of the crown parameters are quantified by considering the flow parameters, including the fluid’s elasticity. The results indicate that the axisymmetric numerical solutions reasonably agree with the experimental observations. Generally, the fluid’s elasticity can enlarge the crown dimension at different thicknesses of the fluid film. Moreover, at intermediate values of the Weissenberg number, the extensional force in the crown wall can control the crown propagation. Furthermore, the results reveal that the effects of the Weber number and the viscosity ratio on this problem are more significant at higher values of the Weissenberg number.

Background: Platelets play a modulatory role in inflammatory response by secreting a vast array of granules and disintegrating into membrane-bound microparticles upon activation. The interplay between eosinophils and platelets is postulated to be implicated in the pathology of allergic airway inflammation. In this study, we investigated whether activated platelets can induce eosinophil extracellular trap (EET) formation, a cellular process by which activated eosinophils release net-like DNA fibers. Methods: Platelets were stimulated with the calcium ionophore, A23187, and the platelet agonists, thrombin and adenosine diphosphate (ADP). Platelet cultures were fractionated into conditioned medium (CM) and pellet, which were then overlaid on eosinophils to examine EET formation. Results: The CM and pellet from A23187-activated platelets stimulated eosinophils to generate EET, whereas those from thrombin- or ADP-activated platelets failed to induce such generation. The EET-inducing activity of the A23187-activated platelet culture was linearly proportional to the number of activated platelets. Interestingly, while EET formation induced by the direct stimulation of eosinophils with A23187 was NADPH oxidase (NOX)-dependent, EET formation induced by A23187-activated platelets was NOX-independent and significantly inhibited by necroptosis pathway inhibitors. Conclusions: Activated platelets and their products may induce EET formation, thereby potentiating their role in eosinophilic airway inflammation.

Background: Escalating evidence shows that ginseng possesses an antiaging potential with cognitive enhancing activity. As mountain cultivated ginseng (MCG) is cultivated without agricultural chemicals, MCG has emerged as a popular herb medicine. However, little is known about the MCG-mediated pharmacological mechanism on brain aging. Methods: As we demonstrated that glutathione peroxidase (GPx) is important for enhancing memory function in the animal model of aging, we investigated the role of MCG as a GPx inducer using GPx-1 (a major type of GPx) knockout (KO) mice. We assessed whether MCG modulates redox and cholinergic parameters, and memory function in aged GPx-1 knockout KOmice. Results: Redox burden of aged GPx-1 KO mice was more evident than that of aged wild-type (WT) mice. Alteration of Nrf2 DNA binding activity appeared to be more evident than that of NFκB DNA binding activity in aged GPx-1 KO mice. Alteration in choline acetyltransferase (ChAT) activity was more evident than that in acetylcholine esterase activity. MCG significantly attenuated reductions in Nrf2 system and ChAT level. MCG significantly enhanced the co-localization of Nrf2-immunoreactivity and ChAT-immunoreactivity in the same cell population. Nrf2 inhibitor brusatol significantly counteracted MCG-mediated up-regulation in ChAT level and ChAT inhibition (by k252a) significantly reduced ERK phosphorylation by MCG, suggesting that MCG might require signal cascade of Nrf2/ChAT/ERK to enhance cognition. Conclusion: GPx-1 depletion might be a prerequisite for cognitive impairment in aged animals. MCG-mediated cognition enhancement might be associated with the activations of Nrf2, ChAT, and ERK signaling cascade.

This paper presents an analytical solution for fluid flow and heat transfer inside arbitrarily-shaped triangular ducts for the first time. The former analytical solutions are limited to the special case of isosceles triangular ducts. The literature has no report about the analytical solution for the general case of arbitrarily-shaped triangular ducts. Due to the significant role of fluid flow through non-circular channels in industry and the large number of triangular shapes, a method for solving the heat transfer problem for all triangular shapes is needed. The heat transfer of a fluid flow through a channel with an arbitrary triangular cross-section for the case of constant heat flux at the walls is solved in this work for the first time, considering viscous dissipation. Here, the functionals of flow and heat transfer equations are derived, and the resulting Euler–Lagrange equations are solved using the Ritz method. The effect of the duct geometry on the velocity profile and friction coefficient is studied in detail. The effect of the Brinkman number on the temperature distribution and Nusselt number is investigated for both cooling and heating cases. The results reveal that the critical Brinkman Number distinguishes between the cooling and heating cases and represents the critical point at which the Nusselt number approaches infinity. The value of the Nusselt number decreases with the increase of the Brinkman number in both the wall cooling and heating modes. It is also found that the equilateral triangle exhibits the minimum friction coefficient and the maximum value of the Poiseuille number.

Category: Ankle; Trauma Introduction/ Purpose: Previous studies identified a link between increased hindfoot valgus and distal tibiofibular syndesmosis (DTFS) widening in patients with flatfoot deformity using foot-ankle offset (FAO). However, it is not known what the impact of 3D foot alignment is on the DTFS in the presence of a known syndesmotic injury, particularly in varus. Weight-bearing Computed Tomography (WBCT) has emerged as a highly precise tool for diagnosing deformities of the foot and ankle. Under weight-bearing, it is possible to precisely detect deviations in DTFS stability. The objective of this cadaveric study was to determine the relationship between hindfoot alignment, measured by FAO, and DTFS widening in specimens with complete DTFS ligamentous injury. We hypothesized that DTFS widening would be significantly greater in specimens with increased hindfoot valgus. Methods: Two WBCT scans of the foot and ankle were obtained for each of 17 matched pairs (34 legs) of through-knee cadaveric specimens in a radiolucent frame under 80lbs of load to simulate double legged stance, a baseline scan with intact syndesmotic ligaments and a second after surgical ligament sectioning. All syndesmotic ligaments were released through a direct lateral approach to the distal fibula. Models of the bones were created from scans using Disior Bonelogic. Distance mapping was used to evaluate DTFS widening over the entire DTFS interface, as well as the anterior/posterior sections, in the first 1cm, 3cm, and 5cm from the joint after injury. Post-injury distance maps were compared to the contralateral baseline normal scan as a control. FAO was measured post-injury and compared to the difference in DFTS widening between the injured leg and its contralateral, healthy control. Linear regression and Spearman’s correlations were used to evaluate relationships. Results: Significant correlations between hindfoot alignment and DTFS widening were identified at every level in the syndesmosis. The Spearman’s rho values for the entire DTFS interface at 1cm, 3cm, and 5cm were 0.393 (p = 0.0316), 0.458 (p = 0.0101), and 0.369 (p = 0.0446), respectively. Anterior Spearman’s rho values at 1cm and 3cm were 0.453 (p = 0.0119) and 0.420 (p = 0.0209), respectively. Inter-observer variability of the FAO measurements showed no statistical difference (p = 0.4248). Extremely varus FAO measurements (FAO < -10%) showed negligible changes in syndesmotic opening. Linear regression also demonstrates a positive trend. The R2 values for the entire interface at 1cm, 3cm, and 5cm were 0.127, 0.213, and 0.158. Anterior R2 values at 1cm and 1cm were 0.133 and 0.1583. Conclusion: In this cadaveric study, we confirmed our hypothesis showing that valgus FAO was correlated with syndesmosis opening from an uninjured to an injured site. These data are in accord with prior findings relating FAO and DTFS opening in flatfeet and additionally demonstrate a stronger positive trend in the presence of known injury with smaller changes in tibiofibular distances after injury for extreme varus alignments. This study provides important context to the clinically relevant comparison of contralateral feet. The trend in our data allows for predictable results for the degree of injury in patients with valgus foot alignment.

Category: Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Women wearing high heels for 20 years without Hallux valgus angle alterations make it debatable that causes Hallux valgus deformation. A recent systematic review determined that 4.13 ± 0.34 cm of heel height would improve foot weight-bearing . Wearing high heels would realign the foot, causing an inversion of the foot, which locked the navicular-cuneiform and cuneo-metatarsal joints rather than primarily rotate the metatarsophalangeal joint. Nowadays, weight-bearing scans could favor understanding the alignment mechanism involved in the foot and ankle with different shoe heights. Therefore, we aimed to determine the acute foot alignment in non-frequent HH users without Hallux valgus during stand posture. Here, we hypothesize that high heels studied by weight-bearing scans shows radiology changes linked to hindfoot alignment rather than primary forefoot rotation. Methods: This comparative cross-sectional study, participants were randomly submitted to a tridimensional weight-bearing CT. Foot alignment for barefoot and wearing custom high heels of 3, 6, and 9 cm. Forty-one feet from twenty-one participants (11 males and 10 females, aged 30.8 ± 8.9 years, and Body Mass Index 25.5 ± 2.0 m kg-2) were submitted to a tridimensional weight- bearing scan in barefoot and wearing high heels of 3, 6, and 9 cm. The inclusion criteria were: Aged between 20 and 50 years, and no regular wearing of heels.Participants were instructed to bear weight in their regular standing upright posture, dispensing the body weight uniformly between the lower limbs with the feet set at shoulder width. Declination talar, forefoot arch, foot ankle offset, 1st, 2nd, and 3rd metatarsophalangeal dorsiflexion, and metatarsal rotation and sesamoid rotation angles were compared with repeated measurement analysis and multiple comparisons as well as the raters intraclass coefficient. Results: When height increases, the declination talar angle decrease (p < 0.001), the foot ankle offset decreases (p < 0.001), the 1st, 2nd, and 3rd dorsiflexion angle increases (p < 0.001), and metatarsal rotation angle (p=0.696) and sesamoid rotation angles (p=0.649) did not change. The forefoot arch for 6 cm was higher than 3 cm (p < 0.001) and then 9 cm (p=0.001), and the forefoot arch for 9 cm was higher than 3 cm (p=0.049). Conclusion: The main finding was that increased forefoot arch, lower ankle offset, no metatarsal rotation angle, and no sesamoid rotation angle strongly suggest an acute primary hindfoot alignment adaptation mechanism rather than forefoot rotation with increase of heel heigth. The most critical mechanism combines the activation of the windlass mechanism together with a stiffer alignment of Hindfoot. Our interpretation here is supported by the lower FAO, and increased forefoot arch and metatarsophalangeal joints, giving insight into pathology foot deformation like Hallux valgus. Thus, our findings suggest that it is debatable that wearing high heels can trigger forefoot deformity,

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: The current classification system of progressive collapsing foot deformity (PCFD) is comprised of 5 possible classes. PCFD is understood to be a complex, three-dimensional deformity occurring in many regions along the foot and ankle. The question remains whether a deformity in one area impacts other areas. The objective of this study is to assess how each one of the classes is influenced by other classes by evaluating each associated angular measurement. We hypothesized that positive and linear correlations would occur for each class with at least one other class and that this influence would be high. Methods: We retrospectively assessed weight-bearing computed tomography (WBCT) measurements of 32 feet with PCFD diagnosis. The classes and their associated radiographic measurements were defined as follows: class A (hindfoot valgus) measured by the hindfoot moment arm (HMA), class B (midfoot abduction) measured by the talonavicular coverage angle (TNCA), class C (medial column instability) measured by Meary’s angle, class D (peritalar subluxation) measured by the medial facet uncoverage (MFU), and class E (ankle valgus) measured using the talar tilt angle (TTA). Multivariate analyses were completed comparing each class measurement to the other classes. A p-value < 0.05 was considered significant. Results: Class A showed a substantial positive correlation with class C (ρ=0.71; R2=0.576; p 0.001). Class B was substantially correlated with class D (ρ=0.74; R2=0.613; p 0.001). Class C showed a substantial positive correlation with class A (ρ=0.71; R2=0.576; p 0.001) and class D (ρ=0.75; R2=0.559; p 0.001). Class D showed a substantial positive correlation with class B and class C (ρ=0.74; R2=0.613; p 0.001), (ρ=0.75; R2=0.559; p 0.001) respectively. Class E did not show correlation with class B, C, or D (ρ=0.24; R2=0.074; p=0.059), (ρ=0.17; R2=0.071; p=0.179), and (ρ=0.22; R2=0.022; p=0.082) respectively. The average values of each class radiographic markers are listed in Figure 1. Conclusion: This study was able to find relations between components of PCFD deformity with exception of ankle valgus deformity (Class E). Measurements associated with each class were influenced by others, and in some instances, with pronounced strength such as between class A and C as well as between Class B and D. Surgical procedures to address certain class deformities could indirectly address other classes as well, which ultimately decreases surgical procedures numbers or complexity. The presented data may support the notion that PCFD is a three-dimensional complex deformity and suggests a possible relation among its ostensibly independent features.

Category: Ankle; Hindfoot Introduction/Purpose: Foot and Ankle Offset (FAO) is a clinically relevant measurement technique used to objectively evaluate the foot and ankle that has been shown to be reliable and validated in common mild foot deformities. It represents a measurement of the offset between the body weight vector and the ground reaction force vector, thus making it a biomechanically relevant measurement. However, FAO has not been validated in the setting of severe ankle deformity. The goal of this paper was to evaluate the validity of FAO measurements in the setting of severe foot and ankle deformities by utilizing a novel rotational FAO measurement technique to account for the deformity. Methods: This study included 57 feet (36 patients) that had a history of severe cavovarus deformity. Each participant received a Weightbearing CT (WBCT) scan that was then used to measure FAO. This measurement was taken three times, once using the traditional measurement technique and two additional times using a modified technique with a 15-day washout period between each measurement. This modified technique allowed for alignment of the talus in a neutral position through rotational correction in the axial, coronal, and sagittal planes to identify the most proximal and central point of the talus. Patients were broken into three groups based on the alignment of their foot and ankle. Normal alignment was defined as a FAO of 2.3% ± 2.9%, varus alignment as -11.6% ± 6.9%, and valgus alignment as 11.4% ± 5.7%. The measurements from the different techniques were compared to identify validity between them and the intraobserver reliability was assessed. Results: The mean traditional FAO was 2.37 ± 4.65% (95% CI=1.16–3.59) and modified FAO was 2.51 ± 4.6 (95% CI=1.3–3.71). The mean modified FAO values between the different alignment groups were found to be significantly different (p

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: The first-ray and the medial column play a crucial role in preserving the tripod of the foot. Changes to structural properties of the first-ray, along with collapse of the medial-longitudinal-arch, have been associated with hallux valgus (HV). Thus, restoring the first-ray plays an important role when correcting the mechanical function of the foot tripod in the setting of HV combined with medial-longitudinal-arch collapse. The LapiCotton technique combines the mechanical advantages of Cotton osteotomy and modified Lapidus procedures by maintaining the length of the first-ray and preserving the medial- longitudinal-arch by plantar inclination of the distal part of first-ray. The aim of this study was to evaluate the effectiveness of the LapiCotton procedure in correcting selected radiographic parameters in patients with combined VH with medial-longitudinal arch collapse. Methods: Preoperative and postoperative Weight Bearing CT (WBCT) scans were obtained from HV patients who underwent unilateral LapiCotton procedure. Postoperative scans were obtained roughly three months after the date of surgery. Semi- automatic measurements were applied to 22 WBCT images across a total of 11 patients enrolled into the study using the Disior ® Bonelogic ® Software. Measurements of the hallux valgus angle (HVA), meary sagittal measurement, and intermetatarsal angles were taken from preoperative and postoperative scans. These scans were then compared using intraclass correlation coefficients and paired t-tests to evaluate the efficacy of the Lapicotton technique in treating HV with P-valus < 0.05 being significant. Results: HVA was found to be significantly larger (p=.026) in the preoperational group (Mdn = 27.52) than the postoperational group (Mdn = 20). In addition, the Meary sagittal measurement was found to be significantly different between groups (p=.033), with a larger value seen in the preoperational group (Mdn = -14.28) compared to the post-operational group (Mdn = -11.15). It was also observed that the IMA was significantly larger (p=.003) in the preoperative group (Mdn = 15.68) compared to the postoperative group (Mdn = 11.26). The sesamoid rotation was found to be higher in the preoperative group (Mdn = -17.71) than the post operative group (Mdn = -24.98), however, these values were not significantly different from one another (p=.203). Conclusion: The LapiCotton procedure proved to be effective in correcting radiographic parameters in patients with HV combined with collapse of the medial longitudinal arch. Reliable correction of HV, along with correction of medial longitudinal arch collapse, was quantified based on semi-automated WBCT measurements of HVA, IMA and Meary angle. LapiCotton produced significantly different measurements for both HVA and IMA postoperatively, providing evidence that the LapiCotton procedure can successfully correct medial longitudinal arch collapse in patients with HV, as well as radiographically reduce the severity of the deformity.

Category: Hindfoot; Sports Introduction/Purpose: Zadek's procedure is a surgical option to treat insertional Achilles tendinopathy(IAT). This procedure consists of a closing wedge osteotomy of the calcaneus with biomechanical consequences. Great modifications in the hindfoot alignment can result in poor functional outcomes for athletes. Additionally, some authors stated that Zadek osteotomy is a good choice for patients with IAT associated with cavovarus foot. This study aims to analyze the hindfoot alignment and the parameters related to Haglund's syndrome after Zadek's osteotomy using a virtual surgical simulation by specific software. The authors hypothesize that the Zadek is an effective technique to decompress the Achilles tendon against the Haglund deformity without major modifications in the alignment. Methods: A total of 20 WBCT scans of patients with IAT were included. The WBCT images were run through the Foot & Ankle module of Disior's BonelogicTM software, creating a 3D virtual model. With this 3D model built into this software, 20 virtual Zadeck osteotomies standardized with a 10 mm resection wedge were performed using the virtual osteotomy module of Bonelogic®. The Calcaneal Inclination angle (sagittal view)7; Talocalcaneal angle (sagittal view)8; Talocalcaneal angle (axial view)8; Saltzman angle (45 degrees view)9; Saltzman angle (20 degrees view)9; Hindfoot moment arm angle;10 Hindfoot angle10; Fowler Philips angle11 and the calcaneal length7 were measured before and after the virtual osteotomy. These results were compared and statistically analyzed. Results: A virtual Zadek osteotomy was realized in 20 WBCT from patients with an insertional Achilles tendinopathy. Most of the patients were female, and the mean age was 55 years. There were significant statistical differences in the average of the calcaneal length (79 mm to 73 mm), Fowler Philips angle (57º to 43º), calcaneal pitch ( 24º to 20º ), sagittal talocalcaneal angle (55º to 47º ), and the hindfoot moment arm angle (20 º to 21,8º). The axial talocalcaneal angle, Saltzman view 45 º and 20 º, and Hindfoot moment arm showed subtle modifications. Conclusion: The virtual analysis of Zadek's osteotomy decreased the Fowler Philips angle, shortened the calcaneus, and modified the alignment in the sagittal view. It suggests that Zadek's procedure reduces the bone impingement with Achilles and the Achilles push. The effect of this osteotomy in Hindfoot Alignment was subtle, modifying only the sagittal plane.

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Interpositional arthroplasty (IPA) is a motion-preserving surgery in patients with advanced hallux rigidus. Literature displays several complications after the procedure including transfer metatarsalgia, cock-up deformity and infection. In a finite element model, shortening of the first metatarsal was associated with increased plantar pressure on lateral rays during gait. Additionally, there are reports of a positive correlation between first metatarsal shortening after hallux valgus surgery and transfer metatarsalgia of the second, third and fourth metatarsophalangeal joints. The goals of this study were to report the outcomes and complications of IPA using acellular dermal allograft (IPA-ADA) as well as study the changes in the length of the proximal phalanx of the hallux (P1) and the first metatarsal (M1) following the procedure. Methods: In this IRB-approved retrospective study, we assessed patients who underwent IPA-ADA in a single academic institute during the period 2019-2022. All patients’ demographic data, surgical details, complications, and patient-reported outcomes (PROs) were extracted. On standing conventional anteroposterior (AP) foot views, we measured the lengths of the first metatarsal (M1), the second metatarsal (M2), the proximal phalanx of the big toe (P1) and the entire length of the hallux (HX). The ratio of M1/M2 and P1/HX were calculated. The first metatarsophalangeal joint space was measured at the medial and lateral aspects of the joint on the AP view. All measurements were recorded pre-operatively, at six weeks follow-up and at the final follow-up. Descriptive statistics were performed, comparison between groups was performed using analysis of variance (ANOVA) or Kruskal Wallis test according to data normality. The Dunn-Bonferroni test was then performed for pairwise group comparisons.A p-value < 0.05 was considered significant. Results: Eleven patients were included, 9 being females (81.81%). Six were hallux rigidus Coughlin grade III (54.55%) and 5 were grade IV (45.45%). The average age was 59 years (SD±6.78) and the body mass index (BMI) was 26 (SD±4.79). At the final follow- up, there was significant shortening of the first ray in comparison to the pre-operative length evidenced by lower M1/M2 (82.63 SD±2.29 versus 75.42 SD±5.1; p=0.001) and P1/HX ratio 53.38 ± 2.29 versus 48.98 SD ± 7.92; p=0.001). Although there was no significant difference between M1/M2 at 6 weeks and at the final follow-up (p=0.716), there was a significant negative correlation between follow-up length and M1/M2 (r= -0.76, p=0.003). Follow-up was (19.95 months; range 3-39). Complications and PROs are listed in Figure 1. Conclusion: Interposition arthroplasty using dermal allograft for HR is associated with progressive shortening of the first ray at the level of the first metatarsal as well as the proximal phalanx. Although the study did show shortening of the first ray, the small sample size didn't allow for a correlation between this shortening and complications such as transfer metatarsalgia and cock-up toe deformity. The potential shortening should be considered in the selection of patients, particularly in the setting of an already short first metatarsal or when simultaneous Akin/Moberg osteotomy is planned.

Background: Ginseng contains three active components: ginsenosides, gintonin, and polysaccharides. After the separation of 1 of the 3 ingredient fractions, other fractions are usually discarded as waste. In this study, we developed a simple and effective method, called the ginpolin protocol, to separate gintonin-enriched fraction (GEF), ginseng polysaccharide fraction (GPF), and crude ginseng saponin fraction (cGSF). Methods: Dried ginseng (1 kg) was extracted using 70% ethanol (EtOH). The extract was water fractionated to obtain a water-insoluble precipitate (GEF). The upper layer after GEF separation was precipitated with 80% EtOH for GPF preparation, and the remaining upper layer was vacuum dried to obtain cGSF. Results: The yields of GEF, GPF, and cGSF were 14.8, 54.2, and 185.3 g, respectively, from 333 g EtOH extract. We quantified the active ingredients of 3 fractions: L-arginine, galacturonic acid, ginsenosides, glucuronic acid, lysophosphatidic acid (LPA), phosphatidic acid (PA), and polyphenols. The order of the LPA, PA, and polyphenol content was GEF > cGSF > GPF. The order of L-arginine and galacturonic acid was GPF >> GEF = cGSF. Interestingly, GEF contained a high amount of ginsenoside Rb1, whereas cGSF contained more ginsenoside Rg1. GEF and cGSF, but not GPF, induced intracellular [Ca2+]i transient with antiplatelet activity. The order of antioxidant activity was GPF > GEF = cGSF. Immunological activities (related to nitric oxide production, phagocytosis, and IL-6 and TNF-α release) were, in order, GPF > GEF = cGSF. The neuroprotective ability (against reactive oxygen species) order was GEF > cGSP > GPF. Conclusion: We developed a novel ginpolin protocol to isolate 3 fractions in batches and determined that each fraction has distinct biological effects.

Abstract Sustained drug delivery strategies have many potential benefits for treating a range of diseases, particularly chronic diseases that require treatment for years. For many chronic ocular diseases, patient adherence to eye drop dosing regimens and the need for frequent intraocular injections are significant barriers to effective disease management. Here, we utilize peptide engineering to impart melanin binding properties to peptide-drug conjugates to act as a sustained-release depot in the eye. We develop a super learning-based methodology to engineer multifunctional peptides that efficiently enter cells, bind to melanin, and have low cytotoxicity. When the lead multifunctional peptide (HR97) is conjugated to brimonidine, an intraocular pressure lowering drug that is prescribed for three times per day topical dosing, intraocular pressure reduction is observed for up to 18 days after a single intracameral injection in rabbits. Further, the cumulative intraocular pressure lowering effect increases ~17-fold compared to free brimonidine injection. Engineered multifunctional peptide-drug conjugates are a promising approach for providing sustained therapeutic delivery in the eye and beyond.

Objective This study investigated the characteristics and survival rates of patients with unintentional severe trauma who visited a regional trauma center (TC) or a non-TC. Methods This retrospective, national, population-based, observational, case-control study included patients with abnormal Revised Trauma Score from January 2018 to December 2018. We divided hospitals into two types, TC and non-TC, and compared several variables, including in-hospital mortality. Propensity score matching was used to reduce the effect of confounding variables that influence survival outcome variables. Results Of the 25,743 patients, 5,796 visited a TC and 19,947 visited a non-TC. Compared to patients treated at non-TCs, patients treated at TCs were more likely to have a higher Injury Severity Score (TC, 11.5; non-TC, 7.4; P

Ejectors have emerged as a viable solution for handling Boil-Off-Gas (BOG) generated by cryogenic storage tanks. The efficiency of ejector-based systems plays is highly dependent on the ejector's performance which is influenced by various factors including the geometry of the ejector and the boundary conditions. In this study, an axisymmetric supersonic ejector was designed, optimized, and evaluated for BOG removal. The baseline geometric dimensions design of the ejector was obtained via theoretical analysis. Subsequently, computational fluid dynamics (CFD) simulations were employed to optimize the boundary conditions and geometrical parameters. Experimental investigations were conducted to validate the design and evaluate the ejector's performance. The results highlighted the significant influence of two key parameters, namely, the mixing chamber diameter (Dm) and the nozzle exit position (NXP), on the ejector's performance. Optimized Dm showed an increase of about 12.5% compared with the baseline geometry. By operating the ejector within its on-design geometric and boundary conditions, the maximum entrainment ratio (ER) was achieved. The CFD models successfully identified and validated various flow phenomena, including double choke, single choke, and backflow, which were consistent with the experimental observations. Both the numerical models and experimental findings demonstrated that the modified ejector achieved an entrainment ratio of 1.06 under its design condition showing a 33.66% increase compared with that obtained using the baseline geometry. These results indicate the potential of the supersonic ejector as an alternative solution for BOG applications, emphasizing its efficacy in handling this industrial challenge.

IntroductionAntisense oligonucleotides (ASOs) with therapeutic potential have recently been reported to target the SARS-CoV-2 genome. Peptide nucleic acids (PNAs)-based ASOs have been regarded as promising drug candidates, but intracellular delivery has been a significant obstacle. Here, we present novel modified PNAs, termed OPNAs, with excellent cell permeability that disrupt the RNA genome of SARS-CoV-2 and HCoV-OC43 by introducing cationic lipid moiety onto the nucleobase of PNA oligomer backbone.MethodsHCT-8 cells and Caco-2 cells were treated with 1 μM antisense OPNAs at the time of viral challenge and the Viral RNA levels were measured by RT-qPCR three days post infection.ResultsNSP 14 targeting OPNA 5 and 11, reduced the viral titer to a half and OPNA 530, 531 and 533 lowered viral gene expression levels to less than 50% of control by targeting the 5’ UTR region. Several modifications (oligo size and position, etc.) were introduced to enhance the efficacy of selected OPNAs. Improved OPNAs exhibited a dose-dependent reduction in viral replication and nucleoprotein (NP) protein. When a mixture of oligomers was applied to infected cells, viral titer and NP levels decreased by more than eightfold.DiscussionIn this study, we have developed a modified PNA ASO platform with exceptional chemical stability, high binding affinity, and cellular permeability. These findings indicate that OPNAs are a promising platform for the development of antivirals to combat future pandemic viral infections that do not require a carrier.

Abstract The insertion of a self-expandable metal stent (SEMS) has been proposed as an alternative to emergent surgery (ES) for obstructive colorectal cancer (CRC). We aimed to evaluate the perioperative and oncologic outcomes of SEMS as a bridge to surgery in obstructive CRC, as compared with ES. We retrospectively reviewed the medical records of patients who underwent curative resection of obstructive CRC at four Hallym University-affiliated hospitals between January 2010 and December 2019. All patients were analyzed overall colon, then according to the side of obstruction (overall, right or left). Of 167 patients, 52 patients underwent ES and 115 underwent SEMS insertion and surgery (SEMS group). The postoperative hospital stay and time to soft diet were shorter in the SEMS group than in the ES group for overall and both sided cancer. The SEMS group had lower rates of stoma formation and severe complications for overall and for left-sided cancer. The 5-year overall survival (P = 0.682) and disease-free survival (P = 0.233) rates were similar in both groups. SEMS insertion as a bridge to surgery was associated with faster recovery, a lower rate of stoma formation with similar oncologic outcomes to those of ES.

Abstract A study on monitoring PM2.5 concentrations at an underground subway station using light scattering and beta attenuation methods was conducted. Six optical particle counters (OPCs), which were representative of the light scattering method and had 16 size channels, were installed at different sampling sites in the waiting room and platforms to compare PM2.5 concentrations, determine PM2.5 /PM10 ratios, and characterize the size distribution based on particle number. In terms of the beta attenuation method, a beta-ray attenuation monitor (BAM) was set up at the platform to compare it with OPCs for one month. It was found that 1h-average PM2.5 concentrations varied at different sampling sites depending on PM composition, while 24h-average PM2.5 concentrations were independent of the sampling sites. There was a significant difference between the means of 1h-average PM2.5 concentrations observed by the BAM and OPC when PM2.5 contributed to less than 50% or higher than 80% of PM10. In contrast, the 24h-average PM2.5 concentrations observed by the BAM and OPC showed the same patterns as each other with an insignificant difference. Therefore, an OPC can be used to monitor the 24h-average PM2.5 concentration in an underground subway station. However, the use of OPC to measure the 1h-average PM2.5 concentration should consider PM composition and other factors. In addition, more frequent calibration is needed on a regular basis.

Abstract Background Cytoplasmic mislocalization and aggregation of TAR DNA-binding protein-43 (TDP-43) is a hallmark of the amyotrophic lateral sclerosis and frontotemporal dementia (ALS/FTD) disease spectrum, causing both nuclear loss-of-function and cytoplasmic toxic gain-of-function phenotypes. While TDP-43 proteinopathy has been associated with defects in nucleocytoplasmic transport, this process is still poorly understood. Here we study the role of karyopherin-β1 (KPNB1) and other nuclear import receptors in regulating TDP-43 pathology. Methods We used immunostaining, immunoprecipitation, biochemical and toxicity assays in cell lines, primary neuron and organotypic mouse brain slice cultures, to determine the impact of KPNB1 on the solubility, localization, and toxicity of pathological TDP-43 constructs. Postmortem patient brain and spinal cord tissue was stained to assess KPNB1 colocalization with TDP-43 inclusions. Turbidity assays were employed to study the dissolution and prevention of aggregation of recombinant TDP-43 fibrils in vitro. Fly models of TDP-43 proteinopathy were used to determine the effect of KPNB1 on their neurodegenerative phenotype in vivo. Results We discovered that several members of the nuclear import receptor protein family can reduce the formation of pathological TDP-43 aggregates. Using KPNB1 as a model, we found that its activity depends on the prion-like C-terminal region of TDP-43, which mediates the co-aggregation with phenylalanine and glycine-rich nucleoporins (FG-Nups) such as Nup62. KPNB1 is recruited into these co-aggregates where it acts as a molecular chaperone that reverses aberrant phase transition of Nup62 and TDP-43. These findings are supported by the discovery that Nup62 and KPNB1 are also sequestered into pathological TDP-43 aggregates in ALS/FTD postmortem CNS tissue, and by the identification of the fly ortholog of KPNB1 as a strong protective modifier in Drosophila models of TDP-43 proteinopathy. Our results show that KPNB1 can rescue all hallmarks of TDP-43 pathology, by restoring its solubility and nuclear localization, and reducing neurodegeneration in cellular and animal models of ALS/FTD. Conclusion Our findings suggest a novel NLS-independent mechanism where, analogous to its canonical role in dissolving the diffusion barrier formed by FG-Nups in the nuclear pore, KPNB1 is recruited into TDP-43/FG-Nup co-aggregates present in TDP-43 proteinopathies and therapeutically reverses their deleterious phase transition and mislocalization, mitigating neurodegeneration. Graphical Abstract

Callus suspension techniques have been considered attractive for improving bioactive metabolite productivity; methyl jasmonate (MeJA) is a widely used elicitor for stimulating synthetic pathways. In this study, a multivariate analysis-based metabolomics approach was employed to investigate the primary and specialized metabolites in the leaves, unelicited calli, and 100 or 200 μM MeJA elicited calli of Damnacanthus major. Rubiadin, a powerful anthraquinone with various therapeutic properties, was only identified in D. major calli, accumulating in a MeJA elicitation concentration-dependent manner. Callus cultures also contained high levels of amino acids, sugars, and phenolic compounds, indicating energy metabolism and metabolic adaptation responses for proliferation and stabilization. Regarding MeJA application, elicited calli contained higher amounts of quinic acid, kaempferol, and glucose with lower amounts of sucrose and raffinose than those in the unelicited control, which were closely related to protective mechanisms against MeJA. Moreover, excessive elicitation increased the asparagine, fructose, and raffinose levels and decreased the glucose and sucrose levels, which was ascribed to increased activation of the aminoacyl-tRNA biosynthesis pathway and wider utilization of glucose than of fructose after sucrose degradation. These results will be useful for optimizing plant cell culture techniques to achieve high production rates for valuable specialized metabolites.

Abstract Background It has been demonstrated that reactive astrocytes can be polarized into pro-inflammatory A1 phenotype or anti-inflammatory A2 phenotype under neurotoxic and neurodegenerative conditions. Microglia have been suggested to play a critical role in astrocyte phenotype polarization by releasing pro- and anti-inflammatory mediators. In this study, we examined whether trimethyltin (TMT) insult can induce astrocyte polarization in the dentate gyrus of mice, and whether protein kinase Cδ (PKCδ) plays a role in TMT-induced astrocyte phenotype polarization. Methods Male C57BL/6 N mice received TMT (2.6 mg/kg, i.p.), and temporal changes in the mRNA expression of A1 and A2 phenotype markers were evaluated in the hippocampus. In addition, temporal and spatial changes in the protein expression of C3, S100A10, Iba-1, and p-PKCδ were examined in the dentate gyrus. Rottlerin (5 mg/kg, i.p. × 5 at 12-h intervals) was administered 3–5 days after TMT treatment, and the expression of A1 and A2 transcripts, p-PKCδ, Iba-1, C3, S100A10, and C1q was evaluated 6 days after TMT treatment. Results TMT treatment significantly increased the mRNA expression of A1 and A2 phenotype markers, and the increased expression of A1 markers remained longer than that of A2 markers. The immunoreactivity of the representative A1 phenotype marker, C3 and A2 phenotype marker, S100A10 peaked 6 days after TMT insult in the dentate gyrus. While C3 was expressed evenly throughout the dentate gyrus, S100A10 was highly expressed in the hilus and inner molecular layer. In addition, TMT insult induced microglial p-PKCδ expression. Treatment with rottlerin, a PKCδ inhibitor, decreased Iba-1 and C3 expression, but did not affect S100A10 expression, suggesting that PKCδ inhibition attenuates microglial activation and A1 astrocyte phenotype polarization. Consistently, rottlerin significantly reduced the expression of C1q and tumor necrosis factor-α (TNFα), which has been suggested to be released by activated microglia and induce A1 astrocyte polarization. Conclusion We demonstrated the temporal and spatial profiles of astrocyte polarization after TMT insult in the dentate gyrus of mice. Taken together, our results suggest that PKCδ plays a role in inducing A1 astrocyte polarization by promoting microglial activation and consequently increasing the expression of pro-inflammatory mediators after TMT insult.

Background: Gintonin is a ginseng-derived exogenous G-protein-coupled lysophosphatidic acid (LPA) receptor ligand. Gintonin exerts its neuronal and non-neuronal in vitro and in vivo effects through LPA receptor subtypes. However, it is unknown whether gintonin can bind to the plasma membrane of cells and can transactivate the epidermal growth factor (EGF) receptor. In the present study, we examined whether gintonin-biotin conjugates directly bound to LPA receptors and transactivated the EGF receptor. Methods: We designed gintonin-biotin conjugates through gintonin biotinylation and examined whether gintonin-biotin conjugate binding sites co-localized with the LPA receptor subtype binding sites. We further examined whether gintonin-biotin transactivated the EGF receptor via LPA receptor regulation via phosphor-EGF and cell migration assays. Results: Gintonin-biotin conjugates elicit [Ca2+]i transient similar to that observed with unbiotinylated gintonin in cultured PC3 cells, suggesting that biotinylation does not affect physiological activity of gintonin. We proved that gintonin-biotin conjugate binding sites co-localized with the LPA1/6 receptor binding sites. Gintonin-biotin binding to the LPA1 receptor transactivates the epidermal growth factor (EGF) receptor through phosphorylation, while the LPA1/3 receptor antagonist, Ki16425, blocked phosphorylation of the EGF receptor. Additionally, an EGF receptor inhibitor AG1478 blocked gintonin-biotin conjugate-mediated cell migration. Conclusions: We observed the binding between ginseng-derived gintonin and the plasma membrane target proteins corresponding to the LPA1/6 receptor subtypes. Moreover, gintonin transactivated EGF receptors via LPA receptor regulation. Our results suggest that gintonin directly binds to the LPA receptor subtypes and transactivates the EGF receptor. It may explain the molecular basis of ginseng physiology/pharmacology in biological systems.

Gintonin, newly extracted from ginseng, is a glycoprotein that acts as an exogenous lysophosphatidic acid (LPA) receptor ligand. This study aimed to demonstrate the in vivo preventive effects of gintonin on gastric damage. ICR mice were randomly assigned to five groups: a normal group (received saline, 0.1 mL/10 g, p.o.); a control group (administered 0.3 M HCl/ethanol, 0.1 mL/10 g, p.o.) or indomethacin (30 mg/kg, p.o.); gintonin at two different doses (50 mg/kg or 100 mg/kg, p.o.) with either 0.3 M HCl/ethanol or indomethacin; and a positive control (Ranitidine, 40 mg/kg, p.o.). After gastric ulcer induction, the gastric tissue was examined to calculate the ulcer index. The expression of gastric damage markers, such as tumor necrosis factor (TNF)-α, cyclooxygenase 2 (COX-2), and LPA2 and LPA5 receptors, were measured by Western blotting. Interleukin-6 (IL-6) and prostaglandin E2 (PGE2) levels were measured by enzyme-linked immunosorbent assay. The platelet endothelial cell adhesion molecule (PECAM-1), Evans blue, and occludin levels in gastric tissues were measured using immunofluorescence analysis. Both HCl/ethanol- and indomethacin-induced gastric ulcers showed increased TNF-α, IL-6, Evans blue permeation, and PECAM-1, and decreased COX-2, PGE2, occludin, and LPA5 receptor expression levels. However, oral administration of gintonin alleviated the gastric ulcer index induced by HCl/ethanol and indomethacin in a dose-dependent manner. Gintonin suppressed TNF-α and IL-6 expression, but increased COX-2 expression and PGE2 levels in mouse gastric tissues. Gintonin intake also increased LPA5 receptor expression in mouse gastric tissues. These results indicate that gintonin can play a role in gastric protection against gastric damage induced by HCl/ethanol or indomethacin.

In Jeju-native Citrus, flavonoids are the main contributors to the various types of biological activity, such as antioxidant, antitumor, and anti-inflammatory activity. Thus, we developed simultaneous quantification methods for the analysis of ten bioactive flavonoids in Jeju Citrus fruits (Dangyuja, Gamja, Jigak, Sadugam, and Soyuja) harvested at six different time points using a high-performance liquid chromatography–diode array detector (HPLC-DAD). Separation was performed using a flow rate of 0.8 mL/min, a column temperature of 40 °C, a mobile phase buffer of 0.5% acetic acid, and a detection wavelength of 278 nm. The established analytical method showed good linearity (R2 ≥ 0.9997), precision (inter-day < 0.599%, intra-day < 0.055%), and accuracy (recoveries 92.30–108.80%). The HPLC–DAD method was subsequently applied to analyze flavonoids in Citrus samples. Overall, the quantification results indicated that the compositions and content of flavonoids differed for each Citrus species. The harvesting period also influenced the changes in flavonoid content within each Citrus species. The analytical results with chemometrics revealed that higher flavonoid levels in early-harvested Citrus were derived from the improved fruit size and reduced flavonoid synthesis during maturation. This study provides a practical and reliable method for the analysis of ten flavonoids that can be further utilized in the quality assessment of Jeju Citrus.

Background: Transumbilical laparoscopic appendectomy (TULA) may be a feasible alternative to conventional laparoscopic appendectomy. However, a transumbilical incision may increase incisional surgical site infections (SSIs) compared to conventional laparoscopic appendectomy. This study aimed to investigate the relationship between the morphology of the umbilicus and the incidence of SSIs in patients who underwent TULA. Patients and Methods: This retrospective study analysed the medical records of consecutive patients who underwent surgery for acute appendicitis at our institution from June 2016 to October 2020. The patients were assigned to the SSI group (those with an SSI) or the non-SSI group. The morphology of the umbilicus was calculated by measuring its width and depth on preoperative computed tomography images and was compared between the SSI and non-SSI groups. Results: The SSI group included 23 patients, while the non-SSI group included 252 patients. The width of the umbilicus was significantly shorter in the SSI group than in the non-SSI group (29 ± 10 mm vs. 34 ± 9 mm, P = 0.027). The umbilicus was slightly deeper in the SSI group than in the non-SSI group; however, the difference was not significant (16 mm vs. 15 mm, P = 0.384). Conclusions: This was the first study investigating the correlation between the morphology of the umbilicus and SSI development in TULA. SSIs tended to occur more commonly in a narrow and deep umbilicus. An extension of the umbilical incision may help prevent SSI in patients with this umbilical morphology.

Category: Hindfoot; Midfoot/Forefoot Introduction/ Purpose: Peritalar subluxation (PTS) is a crucial feature of Progressive Collapsing Foot Deformity (PCFD). Surrounding structures assume distinct behaviors, contributing to different disease deformities (classes). One of its most traditional aspects is the midfoot abduction (class B), usually noted by a lateral deviation of distal structures at the talonavicular joint. This finding commonly leads surgeons to perform a lateral column lengthening osteotomy for abduction correction, a complex surgery with potential complications. The first ray's ability to reestablish the tripod and restore the hindfoot by derotating structures under the talus was previously theorized. This study aimed to test the capability of the Lapidus and the Cotton procedures in conjunction with a calcaneus displacement osteotomy (MDCO) to improve midfoot abduction in the setting of a collapsed foot. Methods: In this IRB-approved, prospective cohort study, we analyzed patients undergoing medial column instability surgery and evaluated preoperatively with a weight-bearing CT (WBCT). We included individuals receiving a Lapidus bone block procedure or a Cotton for PCFD or Hallux Valgus (HV). Patients having a lateral column lengthening procedure of any type were excluded. Talonavicular coverage angle (TNCA) was measured as a marker of midfoot abduction. Medial arch collapse and forefoot varus were evaluated by the sagittal talus-first metatarsal angle (TFMA), and the forefoot arch angle (FFA) was measured. Associated procedures and the correction amount (displacement or wedge size) were recorded. Normality was estimated by the Shapiro- Wilk test and comparison among timelines by the one-way ANOVA. A multivariate regression analysis was executed to evaluate which of the measurements influenced abduction improvement. Statistical significance was considered for p-values of less than 0.05. Results: A total of 20 patients (age: 43.85 [19-72], BMI 30.98 [SD: 5.95]) were included, 11 PCFD (55%) and 9 HV (45%) with a mean follow-up of 7.5 months (3-12). Bone block Lapidus was performed in most subjects (90%), and the median wedge used was 9mm (5-12mm). MDCO occurred in 55% of patients. All measured variables had improvement with surgery (TNCA: 23.74 to 10.66, p< 0.0001; FFA: 6.27 to 12.67, p< 0.0001; TFMA: 11.73 to 4.22, p=0.0003). A correlation was found between TNCA improvement and FFA improvement (rs=0.46, p=0.0407), but not among TNCA improvement and TFMA improvement (rs=0.43, p=0.06). The size of the wedge did not strongly influence the TNCA correction (R2=0.016, p=0.0036), an improvement moderately explained by the MDCO amount (R2=0.186, p< 0.0001). Conclusion: This study demonstrated correction of midfoot abduction, translated by the TNCA, in the absence of lateral column lengthening procedures. When evaluating patients submitted to first ray procedures (bone block Lapidus and Cotton) in conjunction with MDCO, an enhancement on the talar head coverage was noted. Variables associated with arch height and forefoot varus (FFA and TFMA) were correlated with the TNCA improvement. Nevertheless, only the MDCO displacement amount and not the size of the used allograft wedge could explain changes in TNCA. The provided data might support surgeons when planning treatment in the PCFD scenario.

Abstract A liquid droplet oscillating between two plane electrodes was visualized, and the electrical power generation based on the reverse-electrowetting-on-dielectric (REWOD) phenomenon was measured. For the upper plate, a hydrophobic surface treated by PTFE was used, and the lower plate was tested using the hydrophilic surface properties of ITO glass. To analyze the dynamic behavior of an oscillating liquid bridge, a modeling study was carried out using the phase field method based on the finite element method. The dynamic contact angle of the oscillating liquid bridge was modeled based on advancing and receding contact angles. The variable interfacial areas between the liquid and solid surfaces were calculated and agreed well with the experimental results within a 10% error band. Furthermore, experimental and analytical studies were carried out to examine the REWOD energy harvesting characteristics of the glycerol-water mixtures in various concentrations. As a result, the peak voltage output was obtained at a specific concentration of the glycerol mixture, and the power density of the oscillating liquid bridge at this point was up to 2.23 times higher than that of pure water.

Objective: The objective of the study was to assess the efficacy of the LapiCotton procedure on patients with hallux valgus (HV) combined with medial longitudinal arch collapse. Methods: Preoperative and postoperative weight-bearing computed tomography (WBCT) scans were obtained from patients with HV submitted to the LapiCotton procedure. Semi-automatic measurements were applied to 22 WBCT images across 11 patients enrolled in the study using a software package (Bonelogic, Disior™, Helsinki, Finland). Significance level was set at 0.05. Results: The hallux valgus angle (HVA) was significantly larger (p=0.026) in the preoperative group (Mdn = 27.52) than in the postoperative group (Mdn = 20). In addition, the Meary sagittal measurement was found to be significantly increased (p=0.033) in the preoperative group (Mdn = -14.28) when compared to the postoperative group (Mdn = -11.15). It was also observed that the intermetatarsal angle was significantly larger (p=0.003) in the preoperative group (Mdn = 15.68) compared to the postoperative group (Mdn = 11.26). Conclusion: The LapiCotton procedure effectively corrected radiographic parameters in patients with HV combined with the medial longitudinal arch collapse. Level of Evidence III; Therapeutic Studies; Comparative Retrospective Study.

Objective: The goal of this paper was to evaluate the validity of foot and ankle offset (FAO) measurements in the setting of severe foot and ankle deformities. Methods: This study included 57 feet (36 patients) that had a history of severe cavovarus deformity. Each participant received a weight-bearing computed tomography (WBCT) scan that was then used to measure FAO. This measurement was performed once using the traditional measurement technique and two additional times using a modified technique that allows for rotational correction of the images to align the talus. Results: Traditional FAO (TFAO) and modified FAO (MFAO) were found to have a significant correlation with one another (r (54)=0.92, p

Objective: This cadaveric pilot study was to develop a weight bearing computed tomography (WBCT) three-dimensional (3D) distance mapping algorithm that would allow for detection of syndesmotic instability. Methods: Pilot study, two cadaveric specimens. Syndesmotic instability was induced by release of all syndesmotic ligaments through a conventional lateral ankle approach. WBCT imaging under simulated weight bearing was acquired before and after syndesmotic destabilization. Syndesmotic incisura and ankle gutter distances were assessed using a 3D distance mapping WBCT algorithm. Results: We found increases in the overall mean syndesmotic distances in the injured syndesmosis when compared to pre-injury state, and color coded distance maps allowed easy interpretation of the syndesmotic widening following ligament sectioning and destabilization of the syndesmotic joint. Conclusion: The WBCT 3D distance mapping algorithm has the potential to allow detection of mild syndesmotic instability with a relatively ease of interpretation by using color-coded distance maps. Level of Evidence V; Cadaveric Study.

A 56-year-old male was admitted to an outpatient clinic five months after feeling a snap in his right heel while walking in the yard. Clinical and imaging evaluation demonstrated a discontinuity of Achilles tendon (AT). The measured gap between the insertion and the proximal stump was 13cm. The patient underwent reconstruction using a bio-absorbable synthetic graft associated with a Flexor Hallucis Longus (FHL) transfer. Good functional outcomes were noted. Achilles tendon reconstruction with the biosynthetic flexible band proved feasible for massive tendon defects by inserting a biological scaffold for native tendon healing, improving postoperative recovery and strength. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Background: Gintonin, isolated from ginseng, acts as a ginseng-derived lysophosphatidic acid (LPA) receptor ligand and elicits the [Ca2+]i transient through six LPA receptor subtypes (LPARSs). However, the long-term effects of gintonin-enriched fraction (GEF) on the gene expression of six LPARSs remain unknown. We examined changes in the gene expression of six LPA receptors in the mouse whole brain, heart, lungs, liver, kidneys, spleen, small intestine, colon, and testis after long-term oral GEF administration. Methods: C57BL/6 mice were divided into two groups: control vehicle and GEF (100 mg/kg, p.o.). After 21-day saline or GEF treatment, total RNA was extracted from nine mouse organs. Quantitative-real-time PCR (qRT-PCR) and western blot were performed to quantify changes in the gene and protein expression of the six LPARSs, respectively. Results: qRT-PCR analysis before GEF treatment revealed that the LPA6 RS was predominant in all organs except the small intestine. The LPA2 RS was most abundant in the small intestine. Long-term GEF administration differentially regulated the six LPARSs. Upon GEF treatment, the LPA6 RS significantly increased in the liver, small intestine, colon, and testis but decreased in the whole brain, heart, lungs, and kidneys. Western blot analysis of the LPA6 RS confirmed the differential effects of GEF on LPA6 receptor protein levels in the whole brain, liver, small intestine, and testis. Conclusion: The LPA6 receptor was predominantly expressed in all nine organs examined; long-term oral GEF administration differentially regulated LPA3, LPA4, and LPA6 receptors in the whole brain, heart, lungs, liver, kidneys, small intestine, and testis.

Abstract In the wake of the SARS-CoV-2 pandemic, inactivating bioaerosols became a pivotal issue which helps to prevent the transmittance of SARS-CoV-2. Thus, the current study was conducted to investigate a potential inactivating method using both ozone (O3) and ultraviolet C (UVC). Individual and integrated effects of O3 and UVC were compared. A solution containing approximately 4~7.3×106 CFU/mL of Salmonella typhimurium bacteria was used to produce bacteria droplets. These droplets were exposed to O3 and UVC to determine the reduction rate of bacteria. The exposure times were set as 1 and 30 minutes. Ozone concentrations were 100 and 200 ppmv. UVC-LEDs were used as a UVC source. Peak wavelength of the UVC-LED was 275 nm and the irradiation dose was 0.77 mW/cm2. In terms of O3 and UVC-LED interaction, 194 ppmv styrene was used as a target compound to be removed. Considering the O3 and UVC-LED interaction, the presence of O3 could reduce the performance of the UVC-LED, and UVC-LED could also reduce significant amount of O3. The sequence of O3 and UVC-LED treatment was as follows: O3 was exposed at first, then UVC-LED, and this order showed the best reduction ratio (>99.9%). Therefore, if O3 and UVC-LED is used to disinfect Salmonella typhimurium bacteria contained in droplets, bacteria should be separately exposed to O3 and UVC-LED in order to improve the inactivation efficiency.