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Objectives We hypothesize that in adequately resuscitated borderline polytrauma patients with long bone fractures (femur and tibia) or pelvic fractures; early (within 4 days) definitive stabilization (EDS) can be performed without an increase in post-operative ventilation and post-operative complications. Design Retrospective Cohort Study SETTING:: Level 1 Trauma Centre PATIENTS:: In total 103 patients were included in this study of which 18 (17.5%) were female and 85(82.5%) were male. These patients were borderline trauma patients who had the following parameters prior to definitive surgery, normal coagulation profile, lactate Intervention These patients were treated either according to Early Total Care (ETC), definitive surgery on day of admission, or Damage Control Orthopaedics (DCO) principles, temporizing external fixation followed by definitive surgery at a later date. Timing of definitive surgical fixation was recorded as EDS or late definitive surgical fixation (LDS) (>4 days). Main outcome measurements Primary outcome measured was duration of ventilation more than 3 days post definitive surgery and presence of post-operative complications. Results 35 (34.0%) patients received ETC, while 68 (66.0%) patients were treated with DCO. In total 51 (49.5%) of all patients had LDS while 52 (50.5%) patients had EDS. On Logistic Regression the following factors were found to be predictive of higher rates of post -operative ventilation ≥ 3 days, Units of Blood Transfused and time to definitive surgery>4 days. Increased age, Head AIS 3 or more and Time to definitive surgery were found to be associated with an increased risk of post-operative complications. Conclusions Borderline polytrauma patients with no severe soft tissue injuries such as chest or head injuries may be treated with EDS if adequately resuscitated with no increase in need for post-operative ventilation and complications. Level of evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Enhancing the enzymatic activity inside metal-organic frameworks (MOFs) is a critical challenge in chemical technology and bio-technology, which, if addressed, will broaden their scope in energy, food, environmental, and pharmaceutical industries. Here, we report a simple yet versatile and effective strategy to optimize biocatalytic activity by using MOFs to rapidly "lock" the ultrasound (US)-activated but more fragile conformation of metalloenzymes. The results demonstrate that up to 5.3-fold and 9.3-fold biocatalytic activity enhancement of the free and MOF-immobilized enzymes could be achieved compared to those without US pretreatment, respectively. Using horseradish peroxidase as a model, molecular dynamics simulation demonstrates that the improved activity of the enzyme is driven by an opened gate conformation of the heme active site, which allows more efficient substrate binding to the enzyme. The intact heme active site is confirmed by solid-state UV-vis and electron paramagnetic resonance, while the US-induced enzyme conformation change is confirmed by circular dichroism spectroscopy and Fourier-transform infrared spectroscopy. In addition, the improved activity of the biocomposites does not compromise their stability upon heating or exposure to organic solvent and a digestion cocktail. This rapid locking and immobilization strategy of the US-induced active enzyme conformation in MOFs gives rise to new possibilities for the exploitation of highly efficient biocatalysts for diverse applications.

Single-atom catalysts (SACs) exhibit unparalleled atomic utilization and catalytic efficiency, yet it is challenging to modulate SACs with highly dispersed single-atoms, mesopores, and well-regulated coordination environment simultaneously and ultimately maximize their catalytic efficiency. Here, a generalized strategy to construct highly active ferric-centered SACs (Fe-SACs) is developed successfully via a biomineralization strategy that enables the homogeneous encapsulation of metalloproteins within metal-organic frameworks (MOFs) followed by pyrolysis. The results demonstrate that the constructed metalloprotein-MOF-templated Fe-SACs achieve up to 23-fold and 47-fold higher activity compared to those using metal ions as the single-atom source and those with large mesopores induced by Zn evaporation, respectively, as well as up to a 25-fold and 1900-fold higher catalytic efficiency compared to natural enzymes and natural-enzyme-immobilized MOFs. Furthermore, this strategy can be generalized to a variety of metal-containing metalloproteins and enzymes. The enhanced catalytic activity of Fe-SACs benefits from the highly dispersed atoms, mesopores, as well as the regulated coordination environment of single-atom active sites induced by metalloproteins. Furthermore, the developed Fe-SACs act as an excellent and effective therapeutic platform for suppressing tumor cell growth. This work advances the development of highly efficient SACs using metalloproteins-MOFs as a template with diverse biotechnological applications.

The application of nanomotors for cancer diagnosis and therapy is a new and exciting area of research, which when combined with precision nanomedicine, promises to solve many of the issues encountered by previous development of passive nanoparticles. The goal of this article is to introduce nanomotor and nanomedicine researchers to the deep pool of knowledge available regarding cancer cell biology and biochemistry, as well as provide a greater appreciation of the complexity of cell membrane compositions, extracellular surfaces, and their functional consequences. We first provide a short description of the nanomotor state-of-art for cancer therapy and diagnosis, as well as recommendations for future directions of the field. Then, a biomolecular targeting toolbox has been collated for researchers looking to apply their nanomaterial of choice to a biological setting, as well as providing a glimpse into currently available clinical therapies and technologies. This toolbox contains an overview of different classes of targeting molecules available for high affinity and specific targeting and cell surface targets to aid researchers in the selection of a clinical disease model and targeting methodology. Biological systems are complex, and there is a steep learning curve for material scientists applying their skills to the fields of biochemistry and immunology. It is hoped that this review will provide biological context, inspiration, and direction to future nanomotor and nanomedicine research. This article is protected by copyright. All rights reserved.

The aim of this study was to investigate rates, causes, and risk factors of unplanned hospital readmissions (UHR) within 30 days, 90 days, 1 year and 2 years after metastatic spine tumour surgery (MSTS) to augment multi-disciplinary treatment planning and improve patient education. We retrospectively reviewed 272-patients who underwent MSTS between 2005 and 2016. Hospital records were utilised to obtain demographics, oncological, procedural details, and postoperative outcomes. All UHR within 2 years were reviewed. Primary outcomes were rates, causes, and risk factors of UHR. Risk factors for UHR were evaluated utilising multivariate logistic regression analysis. Thirty-day, 90 day, 1 year, and 2 year UHR-rates after MSTS were 17.2%, 31.1%, 46.2%, and 52.7%, respectively. Lung cancer primaries had the highest UHR-events (24.7%) whilst renal/thyroid displayed the least (6.6%). Disease-related causes (16.2%) were the most common reason for readmissions across all timeframes, followed by respiratory (13.7%) and progression of metastatic spine disease (12.7%). Urological conditions accounted for majority of readmissions within 30-days; disease-related causes, symptomatic spinal metastases, and respiratory conditions represented the most common causes at 30–90 days, 90 days–1 year, and 1–2 years, respectively. An ECOG >1 (p = 0.057), CCI >7 (p = 0.01), and primary lung tumour (p = 0.02) significantly increased UHR-risk on multivariate analysis. Seventy-four percent of patients had at least one UHR within 2 years of MSTS and majority were secondary to disease-related causes. Majority of first UHR occurred between 30 and 90 days post-surgery. Local disease progression and overall disease progression account for the highest UHR-events at 90 days–1 year and 1–2 year timeframes, respectively. We define UHR in specific timeframes, thus enabling better surveillance and reducing unnecessary morbidity.

Metastatic spine tumour surgeries (MSTS) are indicated for preservation or restoration of neurological function, to provide mechanical stability and pain alleviation. The goal of MSTS is to improve the quality of life of the patients with spinal metastases and rarely for oncological control which is usually achieved by adjuvant therapies. Hence outcome measures such as length of stay (LOS) and rate of complications after MSTS are important indicators of quality but there is limited literature evidence for the same. We carried out a retrospective study to determine the incidence and the factors influencing normal (nLOS) and extended length of stay (eLOS) after MSTS. Data of 220 consecutive patients who underwent MSTS between 2005 and 2015 were retrieved from hospital electronic records. The preoperative, intraoperative and postoperative variables, discharge destinations as well as socioeconomic factors were analyzed. eLOS defined as positive when the LOS exceeded the 75th percentile for this cohort, was the key outcome indicator. Univariate and multivariate logistic regression analyses were performed to determine the predictive factors of eLOS. The overall median LOS was 7 days (1-30 days) and 55 patients had eLOS (LOS ≥ 11 days). Multivariate analysis revealed that significant variables independently associated with eLOS were instrumentation9 spinal segmental levels (OR 2.89, 95% CI 1.1-7.5, p = 0.032) and presence of postoperative complications (OR 3.68, 95% CI 1.85-7.30, p 0.001). Metastatic tumours other than breast, prostate and lung have lesser risk of eLOS (OR 0.31, 95% CI 0.14-0.70, p = 0.004). Survival estimates show that patients with eLOS have shorter survival than patients with nLOS (Crude HR 1.81, 95% CI 1.13-2.89, p = 0.003).

Solar power is one of the consideration for many oil & gas platform operators who are going for renewable energy to provide power. However for solar power, continuous power has been an issue especially during the Northeast monsoon (October – March) where the sun is frequently blocked by rain clouds. By using a hybrid of Photovoltaic (PV) modules and wind turbines to harvest both solar and wind power, power generation will be more stable and reliable. The results of this can be concluded by the results taken from a Malaysia offshore platform which had installed a wind turbine to their solar system in March 2018. The results show more consistent power generation with the hybridization of solar and wind power.

To review the current status of salvaged blood transfusion (SBT) in metastatic spine tumour surgery (MSTS), with regard to its safety and efficacy, contraindications, and adverse effects. We also aimed to establish that the safety and adverse event profile of SBT is comparable and at least equal to that of allogeneic blood transfusion. MEDLINE and Scopus were used to search for relevant articles, based on keywords such as “cancer surgery,” “salvaged blood,” and “circulating tumor cells.” We found 159 articles, of which 55 were relevant; 20 of those were excluded because they used other blood conservation techniques in addition to cell salvage. Five articles were manually selected from reference lists. In total, 40 articles were reviewed. There is sufficient evidence of the clinical safety of using salvaged blood in oncological surgery. SBT decreases the risk of postoperative infections and tumour recurrence. However, there are some limitations regarding its clinical applications, as it cannot be employed in cases of sepsis. In this review, we established that earlier studies supported the use of salvaged blood from a cell saver in conjunction with a leukocyte depletion filter (LDF). Furthermore, we highlight the recent emergence of sufficient evidence supporting the use of intraoperative cell salvage without an LDF in MSTS.

BACKGROUND Metastatic Spine Tumour Surgery (MSTS) is often complex and extensive leading to significant blood loss. Allogeneic blood transfusion (ABT) is mainstay of blood replenishment but with immune-mediated post-operative complications. Alternative blood management techniques (salvaged blood transfusion (SBT)) allow us to overcome such complications. Despite widespread use of intra-operative cell salvage (IOCS) in oncological and non-oncological surgeries, surgeons remain reluctant to employ IOCS in MSTS. OBJECTIVE This study will analyse the safety of IOCS-LDF processed blood transfusion to patients undergoing MSTS by assessing clinical outcomes – disease progression: tumour progression and overall survival (OS). We will also evaluate whether reinfusion of IOCS-LDF processed blood can reduce the ABT rates in patients undergoing MSTS by comparing the proportion of MSTS patients requiring ABT in those patients who consent to receive SBT, and those who do not consent for SBT. METHODS We aim to recruit 90-patients (minimum)-30 SBT, 30 ABT and 30 with no blood transfusion (NBT). SBT and ABT form the two experimental arms, while NBT forms the control cohort. All available patient data will be reviewed to determine tumour burden secondary to metastasis and post-operative survival and/or disease progression, improvement in pain, neurology and ambulatory status. Collected data will be studied at 3, 6, 12 and 24 months post-operatively, or until demise, whichever occurs first. Collected outcomes of the experimental groups will be compared with that of the control group. Statistical Analysis: Outcomes will be analysed using one-way ANOVA and Fisher’s exact test. OS will be studied by Kaplan-Meier curve and log rank test. Multivariate and competing risk analysis will be used to study the association between blood transfusion type and tumour progression. All statistical analyses will be done using STATA/SE14.0 RESULTS This is the first clinical study on the use of IOCS in MSTS from various primary malignancies. It will provide major clinical evidence regarding safety and applicability of IOCS in MSTS. It will help reduce ABT usage; thus improving overall blood management of MSTS patients. However, limitation of this study is that not all patients undergoing MSTS will survive for the total follow-up period (two years), thereby theoretically leading to under-reporting of disease progression. CONCLUSIONS Results will be disseminated via peer-reviewed publications and will pave the way for future studies CLINICALTRIAL This study did not involve a healthcare intervention and hence, did not need to be registered

Organelles, or subcellular structures, are the fundamental functional units in almost all eukaryotic cells. Consequently, they play a critical role in the development of various biomedical applications, such as targeted drug delivery, biosensing, imaging, and biomimetics. Many efforts are devoted to developing nanosystems that can target specific organelles in a controlled manner. A series of nanomaterials with high porosity, stability, and easy‐to‐tailor properties, named metal–organic frameworks (MOFs), have shown to be a promising new class of nanocarriers and bioprotective exoskeletons for biomedical and biocatalytical platforms at the subcellular level. Herein, the recent state‐of‐the‐art progress of MOF nanomaterials for bioapplications at the subcellular level is highlighted. In the first section, MOF‐derived biomimetics organelles and subcellular structures are highlighted. Then, the strategies of organelle‐targeted MOF therapy and biosensing are illustrated. Next, MOF‐based biopreservation of organelles is introduced. Finally, a personal perspective about the challenges and future innovative designs is discussed.

A retrospective study of all patients with histologically confirmed breast cancer spinal metastases presenting to a single institution between May 2001 and April 2012.The aim of this study was to investigate whether the 2014mT is more accurate than the 2005mT.The commonly used 2005 modified Tokuhashi score (2005mT) has become more inaccurate as oncologists move toward treating tumors according to their molecular and genomic profile, rather than their tissue-of-origin. In attempts to improve the accuracy of the 2005mT, a revised score (2014mT) was published, suggesting that hormone receptor negative and triple-negative breast cancer patients be given a modified Tokuhashi histological score of 3 rather than 5.Demographic characteristics, tumor receptor status, clinical findings in relation to the primary tumor and its metastases, and actual survival time were collated. The 2005mT was compared with the 2014mT. Univariate and multivariate Cox regression analyses were used to evaluate the influence of each parameter on survival, and receiver operating characteristic curves were used to determine predictive values of each score version.Of the 185 patients included, 32 underwent operative treatment, while 153 were managed nonoperatively for their spinal metastases. The overall cohort had a median survival time of 24 months following the diagnosis of spinal metastases, with a 6-month survival rate of 90%. Hormone, HER2 and triple-negative receptor statuses were significant predictors of poorer survival upon multivariate analysis (P = 0.004, P = 0.007, P 0.001, and P 0.001, respectively). Age, the original Tokuhashi score components, previous breast surgery for cancer, previous radiotherapy to the breast, previous radiotherapy to the spine, previous chemotherapy, and previous immunotherapy were not significant. At 6 months, the 2005mT AUROC was 0.62, while that of the 2014mT was 0.64 (P = 0.5394).Tumor histological subtype is crucial when prognosticating the survival of patients with breast cancer spinal metastases. Although the 2014mT was marginally more accurate than the 2005mT, its predictive ability remains poor.3.

This study examines the hostile media effect in relation to partisans’ perception of the slant of news coverage in a highly regulated press environment—Singapore. We found that partisans in Singapore perceived unbiased news to be in favor of the other side, while the nonpartisans perceived the same news to be neutral. Our findings show that hostile media effects can persist in a restricted press environment where people are aware of the government's control of media coverage. We also found that partisans’ awareness of the government's control of media information contributed to their perception of the article slant as well.

Use of long-term care (LTC) services among older adults in Asia has emerged as an important issue in light of rapidly aging countries and changing family structures. Simply building more LTC facilities will not result in higher usage rates, and more insight is needed on the usage of existing services. Few studies have been conducted among Asian populations outside Western settings on this topic. The multi-ethnic population in Singapore is useful for understanding the factors influencing the use of long-term care services in Asia. We present our qualitative findings on long-term care service usage in the older population (50+ years) over time. We highlight caregivers’ needs as an important determinant of LTC use. Although preferences of the care recipients were considered, caregiver needs, the availability of formal and informal care support, attitudes, perceived control, and social norms surrounding family caregiving governed the use of formal LTC services in Singapore.

Background: The Agency for Integrated Care (AIC) conducted a survey to determine the specific areas in which the agency could work with General Practitioners (GPs) to enhance mental illness management in Singapore. This survey was conducted as part of AIC’s engagement strategy and because the Primary Care Surveys 2010 and 2005 noted that a sizeable number of mental health cases are seen by GPs. Methodology: An interviewer-administered questionnaire was conducted among a random sample of 849 group and non-group GPs practicing in four geographical districts of Singapore. The response rate was 64%. Findings: About 70% of the respondent GPs indicated that they were seeing patients with mental illness. Anxiety and depression were the most commonly seen mental conditions. The lack of available drugs and facilities in the clinic, and unfamiliarity with mental health patient management were the main reasons that GPs do not see patients with mental illness. About 39% of the GPs referred patients to a psychologist. About 36% of the GPs referred patients to a counsellor. Availability of additional allied health services in the neighbourhood was crucial in encouraging GPs to see more patients with mental illness. General geriatrics, dementia, general mental health and major depression were the top four areas of interest for further training. Conclusions: The role of GPs in managing mental illnesses remains crucial. There is more pressing need to address their perceived difficulties in managing such patients. The results of the GP Landscape Survey provided evidential bases to enhance the National Mental Health Blueprint in three areas: (i) extension of GP consultation subsidies to middle-income patients, (ii) expansion of allied mental health services to support GPs, and (iii) development of training programmes for GPs in mental illnesses that are commonly encountered by and of interest to GPs.