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International audience; Food supply chains are nowadays perturbed by an increased supply and demand uncertainty, and more and more suffering from unexpected disruptions. In the specific context of food supply chains (FSC) for perishable products, these could be linked to natural hazards, industrial accidents or epidemics and their impact could lead to huge economic losses. The case of epidemic events has been little studied in the existing literature, although there are numerous cases reported in practice. At the strategic level, this requires a novel risk modeling approach to tackle the correlation and propagation features and advanced stochastic multi-period models to design the FSC network. Our interest in this research is to propose a comprehensive two-stage scenario-based mathematical model to design a resilient food supply chain under demand uncertainty and epidemic disruptions. In order to adequately characterize epidemic disruptions, they are modeled as a compound stochastic process and a Monte Carlo procedure is developed to generate plausible scenarios. The modeling approach covers the special characteristics of FSC, such as products perishability in time and discount prices based on product's age. In addition, a number of resiliency strategies are incorporated into the core model to enhance the resilience level of the FSC network design. The developed models are solved through an efficient solution approach relying on scenario reduction technique and Benders decomposition. Numerous problem instances are used to validate the modeling approach and to derive managerial insights.

BACKGROUND: Hamstring tendons are secondary hip extensors. Their harvest for graft in anterior cruciate ligament (ACL) reconstruction may create deleterious effect on hip extension strength. This is of particular importance in sports that need powerful hip extension force like climbing and sprinting. Due to scarcity of a comprehensive study in this area, we designed this prospective study to evaluate hip extension strength following ACL reconstruction using different types of grafts. METHODS: Fifty eight patients were enrolled in this prospective non-randomized case control study to compare isokinetic hip extension strength following ACL reconstruction with different graft types. Twenty patients in group A (both Semitendinosus and Gracilis tendons autograft (ST-G)), 14 patients in group B (Tibialis Posterior tendon allograft (Allograft)), 12 patients in group C (bone-patellar tendon-bone autograft (BPTB)) and 12 patients in group D (only semitendinosus autograft (ST)) were studied. Hip extension strength was tested post-operatively at three- and six-month periods using a Biodex isokinetic testing machine at a speed of 30 degree per second in operated (cases) and non-operated (controls) limbs. RESULTS: There was a significant increase in hip extension force between three and six month intervals in all four groups and in both operated (case) and non-operated (control) limbs (P

Normal axial alignment restoration in lower extremities is crucial for surgeons performing reconstructive surgeries. Since reference normal values of axial alignment are affected by age, sex, and ethical issues, we tried to scrutinize these parameters in Iranian adults and compare them with normal values in literatures. Through a cross-sectional design, standing axial alignment views of lower extremities were surveyed from 100 volunteers (50 males and 50 females) aged between 15-32 years. The lower extremities alignment variables were evaluated during two separate measurements. Total average values were used for comparison among genders. Tibiofemoral mechanical angle depicted mean varus of 1.5 degrees in an Iranian population that was significantly higher in male participants. The Mean angle between anatomical and mechanical axes of the femur was 5.7 ± 1.2º. The Knee joint was shown to be medially inclined 3.6 ± 1.7º in men comparing 2 ± 2º of women with a significant difference. Joint line congruence angle was medially inclined in all of the study participants with a mean of 1 ± 1.6º. To compare with anthropometric studies of western populations, Iranian participants had more varus lower limb alignment. It seemed mainly because of larger medially inclined knee joint (knee-joint obliquity). This finding along with more compensatory ankle valgus is similar to results of other Asian studies. Such racial variation should be considered in designing appropriate systems in reconstructive surgery.

Background: Various methods have been applied to prevent maternal hypotension after spinal anesthesia for cesarean delivery. We compared the efficacy of three combinational methods in this regard in the current study. Methods: In this randomized comparative trial, 150 candidates of elective cesarean delivery under spinal anesthesia were assigned to three groups: crystalloid preload and leg bandage, colloid preload and leg bandage, and ephedrine and leg bandage. Maternal hemodynamic changes during 60 minutes after spinal injection and neonatal condition were compared among the groups. Results: The cumulative incidence of hypotension was 54%, 64%, and 36% in groups 1 to 3, respectively (p = 0.018). Spinal injection to hypotension interval was similar among the groups (p = 0.828). Heart rate in group 3 was significantly lower at the most time measures after anesthesia compared with the other two groups (p < 0.05 to

Background: Women candidate for cesarean section experience a high degree of anxiety due to fear of anesthesia and its complications. On the other hand, post-operative pain induces unfavorable psychosomatic effects. Pharmaceutical and non-pharmaceutical approaches, like listening to music, use to decrease these adverse effects. Regard to the belief of Muslims to Quran sound, we assessed its effect on the grade of pain and anxiety of the patients underwent cesarean section with regional anesthesia. Methods: In a case-controlled clinical trail, 64 candidates of cesarean section were included. Cases were exposed to Quran sound but the controls did not expose. The degree of pain and anxiety were compared during and after operation between two groups. Findings: There was no statistically significant difference between the groups in sedation score, heart rate, respiratory rate and vomiting (P > 0.050). Recovery duration in controls was significantly longer (P < 0.001). Pain was significantly lower in cases at 1, 2 and 24 hours after the surgery (P < 0.050). Mean arterial pressure was significantly lower in cases before, during, and after the (P < 0.050). Anxiety score was higher in controls during and 1 hour after the surgery (P = 0.001). The level of satisfaction between the groups was statistically different (P < 0.001). Conclusion: Quran sound decreased the degree of anxiety and pain, and increased the patients’ satisfaction.

Background: Distal femur wedge osteotomies for varus or valgus alignment of the lower extremity could be done in either uniplanar or biplanar fashion.Union time and stability of the osteotomy site has been considered important in this anatomic region. In this study, clinical and radiographic findings of biplane distal femur osteotomy were reported. Methods: Clinical, functional, and radiological findings of eight patients (10 knees)underwent biplane distal femur osteotomy were evaluated. Visual analogue score (VAS) and Lysholm-Tegner knee score were used for the assessment of pain and function before and three months after surgery. Results: In this study, eight patients were included. All patients were female. The mean age was 28±6.3. The mean pre-operativemechanical anglewas 8.7±2.2˚and the post-operativeangle was 1.4±0.53˚ in patients with valgus alignment whileit was 7.0±1.0˚preoperatively and 0.66±1.2˚ postoperatively in patients with varus alignment. The mean lateral distal femoral angle (LDFA)was 85±8.0˚ before surgery and was 88±1.3˚ after surgery. According to Lysholm- Tegner knee score, in the post-operative visit, sixknees were good and four were excellent. The mean union time was 9.2±2.3 weeks. Conclusions: Biplane distal femur osteotomy is a reliable technique that creates larger surfaces and more stability at the osteotomy site with further rapid union.