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This article investigates the temporal analysis of billion tree tsunami forests in Garhi Chandan area of Pakistan based on three supervised methods, namely random forest algorithm (RFA), principal component analysis (PCA) combined RFA and support vector machine (SVM). As a first step, the Sentinel-2 and Landsat-8 data fusion is performed to enhance the spatial resolution of the data to 10 m. The overlapping features in the data may compromise the classification accuracy, thus, to overcome this limitation, PCA is utilized. As a second step, classification is performed using RFA, PCA-RFA and SVM methods by using the data of the years 2016 and 2023. The change map analysis is done by using the aforementioned methods. As a next step, ground data matching is performed for the classified samples using each method. Finally, by utilizing logistic regression, future prediction for the years 2028, 2030 and 2033 is performed. The PCA-RFA technique achieved the best overall accuracy of 95% with a Kappa hat score of 0.93. The second-best result is achieved by RFA classifier, with overall accuracy of 92% with a Kappa hat score of 0.92. SVM showed moderate matching with an overall accuracy of 72% with a Kappa hat score of 0.55. [ABSTRACT FROM AUTHOR]

Melatonin is considered an effective bio-stimulant that is crucial in managing several abiotic stresses including drought. However, its potential mechanisms against drought stress in fragrant roses are not well understood. Here, we aim to investigate the role of melatonin on Rosa centifolia plants cultivated under drought stress (40 % field capacity) and normal irrigation (80 % field capacity). Plant growth traits, gaseous exchange, antioxidants, osmolytes, oxidative stress, and leaf anatomical attributes were measured. All pots were arranged with a completely randomized design with two-factor factorial setup. Foliar application of melatonin was carried out on the next day of drought treatment and was repeated weekly, while normal watering was regarded as control. Drought stress significantly enhanced oxidative stress markers and reduced growth parameters in water-deficit rose plants. However, melatonin spray (100 μM) produced increased plant height (16 %), flower yield (16 %), petal fresh and dry biomass (7 % and 38 %), total chlorophyll (48 %), contents of carotenoid (54 %), and gaseous exchange traits such as stomatal conductance (25 %), photosynthetic rate (91 %), and transpiration rate (3 %), in water-deficient plants. Likewise, the accretion of catalase, superoxide dismutase, soluble protein, proline, and glycine betaine contents was recorded by 22 %, 45 %, 58 %, 7 %, and 6 %, respectively, in drought-stressed plants, due to melatonin treatment. Increment of oxidative stress indicators i.e. malondialdehyde (−37 %) and hydrogen peroxide (−27 %) was diminished by melatonin triggered by drought stress. Furthermore, leaf cortex (51 %), vascular bundle area (76 %), palisade cell area (59 %), and lamina thickness (42 %) were remarkably increased with melatonin foliar sprays in water-deficit plants. The results of this study recommend that melatonin is a protective agent against drought stress and has potential application prospects in the rose-producing regions suffering from water deficiency. Future studies should focus on molecular responses of R. centifolia to drought stress to further develop stress alleviation strategies in floricultural crops.

Chromium (Cr) toxicity hampers ornamental crops’ growth and post-harvest quality, especially in cut flower plants. Nano-enabled approaches have been developing with phenomenal potential towards improving floricultural crop production under heavy metal-stressed conditions. The current pot experiment aims to explore the ameliorative impact of silicon nanoparticles (Si-NPs; 10 mM) and indole butyric acid (IBA; 20 mM) against Cr stress (0.8 mM) in Freesia refracta. The results showed that Cr stress significantly reduced morphological traits, decreased roots-stems biomass, abridged chlorophyll (14.7%) and carotenoid contents (27.2%), limited gas exchange attributes (intercellular CO2 concentration (Ci) 24.8%, stomatal conductance (gs) 19.3% and photosynthetic rate (A) 28.8%), condensed proline (39.2%) and total protein (40%) contents and reduced vase life (15.3%) of freesia plants by increasing oxidative stress. Contrarily, antioxidant enzyme activities, MDA and H2O2 levels, and Cr concentrations in plant parts were remarkably enhanced in Cr-stressed plants than in the control. However, foliar supplementation of Si-NPs + IBA (combined form) to Cr-stressed plants increased defense mechanism and tolerance as revealed by improved vegetative and reproductive traits, increased biomass, photosynthetic pigments (chlorophyll 30.3%, carotenoid 57.2%) and gaseous exchange attributes (Ci 33.3%, gs 25.6%, A 31.1%), proline (54.5%), total protein (55.1%), and vase life (34.9%) of metal contaminated plants. Similarly, the improvement in the activities of peroxidase, catalase, and superoxide dismutase was recorded by 30.8%, 52.4%, and 60.8%, respectively, compared with Cr-stressed plants. Meanwhile, MDA (54.3%), H2O2 (32.7%) contents, and Cr levels in roots (43.3), in stems (44%), in leaves (52.8%), and in flowers (78.5%), were remarkably reduced due to combine application of Si-NPs + IBA as compared with Cr-stressed nontreated freesia plants. Thus, the hypothesis that the synergistic application of Si-NPs + IBA will be an effective approach in ameliorating Cr stress is authenticated from the results of this experiment. Furthermore, the study will be significant since it will demonstrate how Si-NPs and IBA can work synergistically to combat Cr toxicity, and even when added separately, they can improve growth characteristics both under stressed and un-stressed conditions.

Pheochromocytoma is a rare catecholamine-secreting tumours of chromaffin tissues that cause a constellation of symptoms. It is closely associated with endocrine hypertension that can be masked, sustained or paroxysmal leading to hypertensive crisis, resulting in vascular and non-vascular complications and rarely cerebral ischaemia and stroke.A healthy 22 year old male reported with acute Right upper limb(RUL) monoplegia and Motor aphasia for five days with raised blood pressure levels. hypertonia was present, deep tendon reflexes were exaggerated in RUL and Right Plantar was extensor. General and systemic findings were nonsignificant . Routine investigations showed thrombocytosis and M.R.I. Brain was suggestive of acute infarction of Left Parieto-Temporal region. Renal doppler, Carotid Intima Media Thickness, Cerebral Angiogram, 2D-E.C.H.O. and Fundoscopy were normal. AntinuclearAntibody was negative. Contrast CT of abdomen revealed right adrenal mass suggestive of isolated Pheochromocytoma. Vanyl-Mandelic Acid was positive. Patient was stabilised and managed conservatively for 4 weeks followed by adrenalectomy and appropriate medical therapy. Patient is on regular followup and does not seem to require any antihypertensives or any other intervention.Pheochromocytoma is a notorious tumor and a great masquerader specially in young adults. A keen eye, routine checkups and evaluation is the key to detecting and preventing its associated morbidity and mortality.

Abstract Molt is critical for birds as it replaces damaged feathers and worn plumage, enhancing flight performance, thermoregulation, and communication. In passerines, molt generally occurs on the breeding grounds during the postbreeding period once a year. However, some species of migrant passerines that breed in the Nearctic and Western Palearctic regions have evolved different molting strategies that involve molting on the overwintering grounds. Some species forego molt on the breeding grounds and instead complete their prebasic molt on the overwintering grounds. Other species molt some or all feathers a second time (prealternate molt) during the overwintering period. Using phylogenetic analyses, we explored the potential drivers of the evolution of winter molts in Nearctic and Western Palearctic breeding passerines. Our results indicate an association between longer photoperiods and the presence of prebasic and prealternate molts on the overwintering grounds for both Nearctic and Western Palearctic species. We also found a relationship between prealternate molt and generalist and water habitats for Western Palearctic species. Finally, the complete prealternate molt in Western Palearctic passerines was linked to longer days on the overwintering grounds and longer migration distance. Longer days may favor the evolution of winter prebasic molt by increasing the time window when birds can absorb essential nutrients for molt. Alternatively, for birds undertaking a prealternate molt at the end of the overwintering period, longer days may increase exposure to feather‐degrading ultra‐violet radiation, necessitating the replacement of feathers. Our study underlines the importance of the overwintering grounds in the critical process of molt for many passerines that breed in the Nearctic and Western Palearctic regions.

Abstract Bird migration is typically associated with a latitudinal movement from north to south and vice versa. However, many bird species migrate seasonally with an upslope or downslope movement in a process termed altitudinal migration. Globally, 830 of the 6,579 Passeriformes species are considered altitudinal migrants and this pattern has emerged multiple times across 77 families of this order. Recent work has indicated an association between altitudinal migration and diet, but none have looked at diet as a potential evolutionary driver. Here, we investigated potential evolutionary drivers of altitudinal migration in passerines around the world by using phylogenetic comparative methods. We tested for evolutionary associations between altitudinal migration and foraging guild and primary habitat preference in passerines species worldwide. Our results indicate that foraging guild is evolutionarily associated with altitudinal migration, but this relationship varies across zoogeographical regions. In the Nearctic, herbivorous and omnivorous species are associated with altitudinal migration, while only omnivorous species are associated with altitudinal migration in the Palearctic. Habitat was not strongly linked to the evolution of altitudinal migration. While our results point to diet as a potentially important driver of altitudinal migration, the evolution of this behavior is complex and certainly driven by multiple factors. Altitudinal migration varies in its use (for breeding or molting), within a species, population, and even at the individual level. As such, the evolution of altitudinal migration is likely driven by an ensemble of factors, but this study provides a beginning framework for understanding the evolution of this complex behavior.

The elaborate ornamental plumage displayed by birds has largely been attributed to sexual selection, whereby the greater success of ornamented males in attaining mates drives a rapid elaboration of those ornaments. Indeed, plumage elaboration tends to be greatest in species with a high variance in reproductive success such as polygynous mating systems. Even among socially monogamous species, many males are extremely colourful. In their now-classic study, Møller and Birkhead (1994) suggested that increased variance in reproductive success afforded by extra-pair paternity should intensify sexual selection pressure and thus an elaboration of male plumage and sexual dichromatism, but the relatively few measures of extra-pair paternity at the time prevented a rigorous test of this hypothesis. In the nearly three decades since that paper’s publication, hundreds of studies have been published on rates of extra-pair paternity and more objective measures of plumage colouration have been developed, allowing for a large-scale comparative test of Møller and Birkhead’s (1994) hypothesis. Using an analysis of 186 socially monogamous passerine species with estimates of extra-pair paternity, our phylogenetically controlled analysis confirms Møller and Birkhead’s (1994) early work, demonstrating that rates of extra-pair paternity are positively associated with male, but not female, colouration and with the extent of sexual dichromatism. Plumage evolution is complex and multifaceted, driven by phylogenetic, ecological, and social factors, but our analysis confirms a key role of extra-pair mate choice in driving the evolution of ornamental traits.

Climate change and the consequent alteration in agricultural circumstances enhance the susceptibility of fresh water use particularly in water-scarce regions. Marginal quality water reuse is a common alternative practice but possible perils of metal accretion in plant parts are mostly ignored. The present research aimed to probe the impact of treated wastewater (TWW) and untreated wastewater (UTWW) on metal accumulation in flower petals and their influence on essential oil contents of fragrant Rosa species (R. Gruss-an-teplitz, R. bourboniana, R. centifolia, R. damascena) in a peri-urban area of Faisalabad, Pakistan during January, 2017 to December, 2018. The mineral and chemical contents in canal water (CW) and TWW were less than recommended levels of national environmental quality standards (NEQS) for wastewater of Pakistan. The experimentally UTWW possessed higher electrical conductivity (EC), biological and chemical oxygen demand (BOD and COD), and some metals (Pb, Co, Cr) that were above the permissible levels. The experimental data revealed that except Cr other metals contents in the flower petals were less than the WHO recommended limits (for medicinal plants) under experimental irrigation regimes. Rosa centifolia and R. damascena possessed higher metal i.e. Zn, Cu, Pb, Cr, Co contents while Fe and Ni contents were higher in R. Gruss-an-Teplitz and R. bourboniana respectively. There were twelve constituents which were detected in essential oil by gas chromatography. Major constituents were phenyl ethyl alcohol, citronellol, geranyl acetate, γ- undelactone, methyl eugenol, and limonene whose share was 48.17%, 41.11%, 8.46%, 4.82%, 4.44%, and 4.15% respectively whereas concentrations of other 06 constituents were less than 3.7%. Phenyl ethyl alcohol, lion shared constituent of essential oil was found highest (48.17%) in R. Gruss-an-Teplitz whereas minimum level was recorded in R. damascena (28.84%) under CW. In contrast, citronellol (chief component of fragrance) was highest in R. damascena (41.11%) in UTWW while the lowest level was found in R. Gruss-an-Teplitz (17.41%) in CW. This study confirmed the variations in metal concentrations of Rosa species due to different absorbability of each metal in flower petals. It also indicates that wastewater did not affect the composition but there were quantitative differences in aroma constituents and chemical composition of essential oil.

Drought is a key abiotic stress that confines agriculture development worldwide. Silicon (Si) is commonly considered to be a valuable element for resistance against drought and for sustainable agriculture. To investigate the morpho-physiological and biochemical characteristics of Gerbera jamesonii plants, a pot experiment was conducted under greenhouse conditions and exposed to water stress (60% FC) and well-watered (100% FC) conditions. Foliar application of Si was carried out after ten days (48 days after sowing) of drought treatment and was repeated weekly, while well-water was regarded as control. Water deficiency significantly abridged the morphological attributes, pigments, and stress-related metabolites and negatively affected the photosynthetic apparatus in drought-stressed gerbera plants. However, Si supplementation by 40 mg L−1 produced increased leaf area (31%), stem length (25%), flower diameter (22%), plant fresh biomass (17%), total chlorophyll (48%), and concentration of carotenoids (54%) in water-stressed plants. Similarly, the accretion of a total free amino acid (41%) and the activities of peroxidase, catalase, superoxide dismutase, ascorbate peroxidase, glycinebetaine, total soluble proteins, total free proline, and malondialdehyde were enhanced by 44%, 31%, 53%, 33%, 330%, 61%, 51%, and 66%, respectively, under drought stress in comparison with control conditions. Meanwhile, the photosynthetic rate (89%), the transpiration rate (12%), and stomatal conductance (55%) were significantly enhanced in water-deficit gerbera leaves with Si supplementation. This study proposes that the foliar application of Si is a viable and convenient method of improving the performance of elegant gerbera flower plants in regions of the world that are facing severe water deficiency.

Strigolactones, a new group of phytohormones, are reported to improve plant tolerance to multiple abiotic stresses. A pot experiment was conducted to investigate the impact of synthetic strigolactone (GR24 at 0.001, 0.01 and 0.1 mg L−1) application on ornamental sunflowers (Helianthus annuus cv. Vincent’s Choice) grown under salt stress (150 mM NaCl). Salt stress was applied after 14 days, and SL was applied 25 days seed sowing. The results showed that amongst various GR24 concentrations, 0.01 mg L−1 proved to be superior, as it enhanced the photosynthetic rate (9.29%), transpiration rate (0.76%), stomatal conductance (77.5%), total soluble protein (0.55%) and K+ (14.63% in roots; 14.87% in shoots) and Ca2+ (12.63% in roots; 11.48% in shoots) contents under control conditions. Similarly, the leaf turgor potential (Ψp), osmotic potential (Ψs) and free proline, glycinebetaine (GB), superoxide dismutase (SOD), catalase (CAT) and peroxide (POD) contents increased by 58.17, 89.95, 159.04, 101.54, 74.42, 175.68 and 53.62%, respectively, under salt stress conditions. The leaf water potential (Ψw) decreased (−0.14%) and the malondialdehyde (MDA) content increased (16.65%) when treated with the 0.001 mg L−1 GR24 level. Meanwhile, hydrogen peroxide (H2O2) and Na+ concentrations in roots and shoots increased by 62.53%, 74.66% and 38.55% under saline conditions with a GR24 level of 0 mg L−1. Regarding the plant biomass, a GR24 level of 0.01 mg L−1 with salt stress greatly decreased the root (−47.27% and −50.45%) and shoot (−44.79% and −59.42%) fresh and dry weights, respectively, compared to control conditions. These results reveal that exogenously applied GR24 might be an effective way to mitigate the perilous impacts of salt stress in ornamental sunflower production. It is suggested that the use of molecular techniques to study different processes in which GR24 could play a vital part in various commercial floricultural crops is extremely imperative and can open novel horizons for future investigations in this exhilarating field of plant hormones.

Persistent organic pollutants (POPs) are known to be silent killers due to their bioaccumulative and long-lasting existence. These pollutants are present everywhere in our environment, including plants, animals, and humans. POPs can be stored in several aquatic environmental matrices and biomagnified by the food web, thus presenting a danger to aquatic habitats and human health. During recent decades, they have gained substantial attention considering their possible persistent threats. In the aquatic environment, legacy POPs, such as organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), were widely found and recorded. A complete description of OCPs and PCBs amounts and their distribution in the aquatic environment is necessary for a detailed understanding of the activities and threats of POPs in aquatic ecosystems.

Abstract Background The infant gut is rapidly colonized by microorganisms soon after birth, and the composition of the microbiota is dynamic in the first year of life. Although a stable microbiome may not be established until 1 to 3 years after birth, the infant gut microbiota appears to be an important predictor of health outcomes in later life. Methods We obtained stool at one year of age from 173 white Caucasian and 182 South Asian infants from two Canadian birth cohorts to gain insight into how maternal and early infancy exposures influence the development of the gut microbiota. We investigated whether the infant gut microbiota differed by ethnicity (referring to groups of people who have certain racial, cultural, religious, or other traits in common) and by breastfeeding status, while accounting for variations in maternal and infant exposures (such as maternal antibiotic use, gestational diabetes, vegetarianism, infant milk diet, time of introduction of solid food, infant birth weight, and weight gain in the first year). Results We demonstrate that ethnicity and infant feeding practices independently influence the infant gut microbiome at 1 year, and that ethnic differences can be mapped to alpha diversity as well as a higher abundance of lactic acid bacteria in South Asians and a higher abundance of genera within the order Clostridiales in white Caucasians. Conclusions The infant gut microbiome is influenced by ethnicity and breastfeeding in the first year of life. Ethnic differences in the gut microbiome may reflect maternal/infant dietary differences and whether these differences are associated with future cardiometabolic outcomes can only be determined after prospective follow-up.

BackgroundThe global prevalence of childhood eczema has increased over the last few decades, with a marked increase in high-income countries. Differences in prevalence of childhood eczema between countries and ethnicities suggest that genetic and early modifiable environmental factors, such as dietary intake, may underlie this observation. To investigate the association between pregnancy diet and infant eczema in a consortium of prospective Canadian birth cohorts predominantly comprised of white Europeans and South Asians.MethodsWe evaluated the association of maternal dietary patterns reported during pregnancy (assessed at 24-28 weeks gestation using a semi-quantitiative food-frequency questionnaire) with parent-reported physician-diagnosed infant eczema at 1-year from 2,160 mother-infant pairs. Using three dietary patterns ("Western", "plant-based", and "Balanced") previously derived in this cohort using principal component analysis, we used multivariable logistic regression to determine the association of these dietary patterns with infant eczema, adjusted for potential confounders.ResultsWe observed a lower odds of eczema in the full sample combining white Europeans and South Asians with greater adherence to a plant-based (OR = 0.65; 95% CI: 0.55, 0.76; ConclusionA plant-based diet during pregnancy is associated with a lowered odds of infant eczema at 1 year in all participants. Future studies of the components of plant-based diet which underlie the lower risk of eczema are needed.

Mitogen-activated protein kinase (MAPK) cascades are the universal signal transduction networks that regulate cell growth and development, hormone signaling, and other environmental stresses. However, their essential contribution to plant tolerance is very little known in the potato (Solanum tuberosum) plant. The current study carried out a genome-wide study of StMAPK and provided a deep insight using bioinformatics tools. In addition, the relative expression of StMAPKs was also assessed in different plant tissues. The similarity search results identified a total of 22 StMAPK genes in the potato genome. The sequence alignment also showed conserved motif TEY/TDY in most StMAPKs with conserved docking LHDXXEP sites. The phylogenetic analysis divided all 22 StMAPK genes into five groups, i.e., A, B, C, D, and E, showing some common structural motifs. In addition, most of the StMAPKs were found in a cluster form at the terminal of chromosomes. The promoter analysis predicted several stress-responsive Cis-acting regulatory elements in StMAPK genes. Gene duplication under selection pressure also indicated several purifying and positive selections in StMAPK genes. In potato, StMAPK2, StMAPK6, and StMAPK19 showed a high expression in response to heat stress. Under ABA and IAA treatment, the expression of the total 20 StMAPK genes revealed that ABA and IAA played an essential role in this defense process. The expression profiling and real-time qPCR (RT-qPCR) exhibited their high expression in roots and stems compared to leaves. These results deliver primary data for functional analysis and provide reference data for other important crops.

Dengue, a vector-borne acute febrile illness caused by members of the Flavivirus genus, has dramatically increased its occurrence worldwide. Neurological complications of dengue range from 2.63 to 40%, and subarachnoid hemorrhage is a rare, but significant manifestation. Hemophagocytic lymphohistiocytosis is a life-threatening hyperinflammatory syndrome, sometimes secondary to infections such as dengue. This report presents a rare case of severe dengue with subarachnoid hemorrhage and hemophagocytic lymphohistiocytosis. A 19-year-old male presented with a 7-day history of fever and myalgia, followed by severe headache and vomiting. Initial examination revealed high fever, hepatosplenomegaly, and pancytopenia. Lumbar puncture confirmed via computed tomography showed a Fisher Grade 2 subarachnoid hemorrhage with a small aneurysm at the junction of the left anterior coronary and anterior communicating arteries. Secondary hemophagocytic lymphohistiocytosis was diagnosed based on the criteria from 2004, with elevated inflammatory markers, hypertriglyceridemia, and hyperferritinemia. The patient was treated conservatively with intravenous fluids, osmotic diuretics, antiepileptics, steroids, and nimodipine. The patient showed clinical improvement and was discharged on the 11th day. Isolated subarachnoid hemorrhage is rare in dengue. The hyperinflammatory state in hemophagocytic lymphohistiocytosis, which is often overlooked due to nonspecific symptoms, can lead to aneurysm formation and rupture. Persistent fever, cytopenia, and hyperferritinemia should raise suspicion of hemophagocytic lymphohistiocytosis in cases of severe dengue with neurological complications. In patients with severe dengue and intracranial hemorrhage, clinicians should remain cautious for hemophagocytic lymphohistiocytosis to reduce the associated morbidity and mortality.

Genome editing has emerged during the past few decades in the scientific research area to manipulate genetic composition, obtain desired traits, and deal with biological challenges by exploring genetic traits and their sequences at a level of precision. The discovery of Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) as a genome editing tool has offered a much better understanding of cellular and molecular mechanisms. This technology emerges as one of the most promising candidates for genome editing, offering several advantages over other techniques such as high accuracy and specificity. In the microbial world, CRISPR/Cas technology enables researchers to manipulate the genetic makeup of micro-organisms, allowing them to achieve almost impossible tasks. This technology initially discovered as a bacterial defense mechanism, is now being used for gene cutting and editing to explore more of its dimensions. CRISPR/Cas 9 systems are highly efficient and flexible, leading to its widespread uses in microbial research areas. Although this technology is widely used in the scientific community, many challenges, including off-target activity, low efficiency of Homology Directed Repair (HDR), and ethical considerations, still need to be overcome before it can be widely used. As CRISPR/Cas technology has revolutionized the field of microbiology, this review article aimed to present a comprehensive overview highlighting a brief history, basic mechanisms, and its application in the microbial world along with accessing the opportunities and challenges., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Minimally invasive surgery (MIS) continues to develop as a viable alternative to traditional open surgery for various foot and ankle pathologies. The neuropathic foot is one area where MIS can be very beneficial to surgeons and their patients. Improving wound healing and decreasing the surgical footprint and thus reducing complications associated with soft tissue in this population is advantageous. Further research is necessary; however, the early successful outcomes in neuroarthropathy reconstruction via MIS are encouraging., Competing Interests: Disclosure S. Mateen and M. Greenblatt have no financial disclosures or conflicts of interest. N.A. Siddiqui is a consultant for Arthrex. The following organizations supported the institution of M. Greenblatt, S. Mateen, and N.A. Siddiqui: DePuy Synthes, United States, NuVasive Specialized Orthopedics, United States, Orthofix, United States, OrthoPediatrics, Paragon 28, Pega Medical, Smith & Nephew, United Kingdom, Stryker, United States, Turner Imaging Systems, and WishBone Medical., (Copyright © 2024 Elsevier Inc. All rights reserved.)

As a natural progression from educational pamphlets to the worldwide web, and now artificial intelligence (AI), OpenAI chatbots provide a simple way of obtaining pathology-specific patient information, however, little is known concerning the readability and quality of foot and ankle surgery information. This investigation compares such information using the commercially available OpenAI ChatGPT Chatbot and FootCareMD®. A list of common foot and ankle pathologies from FootCareMD® were queried and compared with similar results using ChatGPT. From both resources, the Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL) scores were calculated for each condition. Qualitative analysis of each query was performed using the JAMA Benchmark Criteria Score and the DISCERN Score.The overall ChatGPT and FootCareMD® FRES scores were 31.12 ± 7.86 and 55.18 ± 7.27, respectively (p < .0001). The overall ChatGPT and FootCareMD® FKGL scores were 13.79 ± 1.22 and 9.60 ± 1.24 respectively (p < .0001), except for the pilon fracture FKGL scores (p = .09). The average JAMA Benchmark for all information obtained through ChatGPT and FootCareMD® were 0 ± 0 and 1.95 ± 0.15 (p < .001), respectively. The DISCERN Score for all information obtained through ChatGPT and FootCareMD® were 52.53 ± 5.39 and 66.93 ± 4.57 (p < .001), respectively. AI-assisted queries concerning common foot and ankle pathologies are written at a higher grade level and with less reliability and accuracy compared to similar information available on FootCareMD®. With the ease of use and increase in AI technology, consideration should be given to the nature and quality of information being shared with respect to the diagnosis and treatment of foot and ankle conditions., (Published by Elsevier Inc.)

Background: Sheehan syndrome is the infarction of a pituitary gland that has been physiologically enlarged as a result of postpartum bleeding. Agalactorrhea and amenorrhea are classic symptoms, but a constellation of manifestations occurs in both the acute and chronic forms. These manifestations can remain largely nonemergent unless Sheehan syndrome is complicated by severe adrenal dysfunction secondary to an inciting event such as dengue. We present a case of Sheehan syndrome that was uncovered in a patient with a dengue infection presenting as adrenal crisis. Case Report: A 45-year-old female presented with symptoms of acute gastroenteritis and severe dehydration. Her medical history was significant for secondary amenorrhea for 14 years after her last delivery followed by symptoms of endocrine dysfunction. At presentation, the patient was in adrenal crisis with hypotension, hypoglycemia, and hyperthermia. Dengue nonstructural protein 1 antigen was positive, along with signs of plasma leakage. Bloodwork showed bicytopenia with abnormal liver enzymes. Ultrasonography and computed tomography of the abdomen were suggestive of serositis with acalculous cholecystitis. Magnetic resonance imaging of the brain revealed an empty sella. Anterior pituitary hormone levels were significantly decreased with low serum cortisol, and the patient's thyroid profile analysis suggested secondary hypothyroidism. The final diagnosis was Sheehan syndrome presenting as adrenal crisis precipitated by severe dengue fever. The patient was managed conservatively and discharged on hormone supplement therapy. Conclusion: Sheehan syndrome is an important cause of panhypopituitarism in the developing world. Knowledge of Sheehan syndrome is important to help prevent its occurrence and reduce its resultant multifactorial effects., (©2024 by the author(s); Creative Commons Attribution License (CC BY).)

Online physician ratings and reviews prove useful among patients when selecting a provider. Analyzing such reviews across medical and surgical specialties to determine their emotional tone through sentiment analysis yielded varying levels of positivity, negativity, and neutrality. To provide insight into what patients are saying, this study similarly analyzes the sentiment of physician ratings and reviews among foot and ankle surgeons. Healthgrades ratings and reviews, entered as of February 2024, were collected among the American College of Foot and Ankle Surgeons (ACFAS) fellows along with each surgeon's demographic information. ChatGPT was used to perform a sentiment analysis to describe the positivity, negativity, and neutrality of online physician reviews. Ratings and review sentiment were described among the sample and between sexes. Among 268 fellows, men received higher average rating scores than women (p = .02), From the 2339 reviews, women received a greater proportion of negative reviews compared to men (p < .001). The overall sentiment scores among men were higher than women (p < .001). There existed a very weak inverse relationship between ratings and years in practice (R = -0.16; p = .01). Fellowship-trained foot and ankle surgeons received predominantly positive reviews. When comparing sexes, males received higher ratings with higher sentiment scores. As patients place high credence in online reviews when selecting their provider, surgeons should remain mindful of and monitor or manage their online reputation., (Published by Elsevier Inc.)

Chronic inflammatory diseases, such as arthritis have been linked to a higher risk of developing cardiovascular disease. The present study examined the association between carotid intima-media thickness (CIMT) and coronary artery calcium (CAC), as well as the cardiovascular risk in patients with rheumatoid arthritis (RA). Additionally, the present study used 28 measures to calculate the disease activity score (DAS). To compare healthy controls with patients with RA, a case-control study was conducted that assessed CAC and CIMT in patients with the disease. A total of 45 healthy individuals and 45 patients with a diagnosis of RA were included in the study. With an average age of 50.66±12.35 years, the ages of the participants varied from 24 to 80 years. In both the control and RA patient groups, the sex ratio was 60%. The RA patient group had 53.3% female participants. There were significant variations in the levels of serum urea, potassium, magnesium, serum alkaline phosphatase, serum glutamic pyruvic transaminase, total leucocyte count, erythrocyte sedimentation rate, C-reactive protein (CRP) and lipids [apart from triglycerides and very low-density lipoprotein (VLDL)]. There was a substantial difference in the scores between patients with RA and the controls as regards CAC. A mild-severe risk of coronary artery disease was observed in 55.6% of RA cases and 4.4% of the controls (all mild). Both CIMT thickness and the CAC score exhibited a significant correlation with CRP, serum cholesterol, serum triglycerides, serum low-density lipids and serum VLDL. The DAS of patients ranged between 4.4 and 8.2 (mean, 5.81±0.91). A moderate disease activity was noted in the remaining patients, whereas 66.7% exhibited a high disease activity (DAS >5.2). On the whole, the present study demonstrates that conventional risk factors for cardiovascular disease, such as dyslipidemia, are consistent with both CIMT and CAC. The risk of developing atherosclerosis may be substantially increased by chronic inflammation, as the DAS score corresponds with CIMT and CAC., Competing Interests: The authors declare that they have no competing interests., (Copyright: © 2024 Fatima et al.)

Background Elderly individuals have higher rates of morbidity, death, and financial burden due to community-acquired pneumonia (CAP). Objectives The study aimed to assess the outcomes of geriatric pneumonia patients and the prediction of mortality based on the pneumonia severity index (PSI), CURB-65 (confusion, urea, respiratory rate, blood pressure, and 65-year-old score), frailty index (frailty index), and FI-Lab21 (21-item frailty index based on laboratory) scores. Methods A prospective observational study was conducted on 100 elderly patients (≥ 65 years) with CAP. PSI, CURB-65, FI, and FI-Lab21 scores were determined. The outcome measures were 30-day mortality and the risk factors of mortality. The mortality predictive value of scores were compared. Results The mean age of the study subjects was 72.14 ± 6.1 years. Specifically, 76 (76%) were male, and 24 (24%) were females. During the follow-up, there was a 30-day mortality rate of 57%. On performing multivariate regression, the PSI score and severely frail were significant independent risk factors of mortality, with an odds ratio of 1.046 and 52.213, respectively. Area under the ROC curve (AUC) showed that the performance of the PSI score (AUC: 0.952; 95% CI: 0.910-0.994), CURB-65 score (AUC: 0.936; 95% CI: 0.893-0.978), and severely frail (AUC: 0.907; 95% CI: 0.851-0.962) was outstanding, while FI-Lab21 (AUC: 0.515; 95% CI: 0.400-0.631) was non-significant. Among all the parameters, the PSI score was the best predictor of mortality at the cutoff points of >121 with a diagnostic accuracy of 92%. Conclusion CAP in the elderly carries a high mortality rate. Out of PSI, CURB-65, FI, and FI-Lab21 scores, the PSI holds the best predicting ability for mortality., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee issued approval RCell/IEC/2021/75-Extension. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Jabeen et al.)

Introduction Myocardial bridge is a rare, benign, normal anatomical variant of the coronary artery that puts the patient at risk for significant cardiac symptoms, resulting in myocardial ischemia, arrhythmia, and sudden cardiac death. The aim of the study was to assess the prevalence and characteristics of myocardial bridging (MB) in patients with chest pain undergoing coronary angiography. Methodology A total of 1301 patients presenting with chest pain suggestive of acute coronary syndrome with associated non-invasive supportive cardiac evaluation were subjected to coronary angiography by Philips Allura Xper FD10 Cath Lab (Philips Healthcare, Andover, MA) and evaluated. Results Out of 1301 patients, the mean age was 54.70 ± 11.41 years with a male-to-female ratio of 1.9:1. Tobacco use and diabetes mellitus were the most common associated risk factors (49% and 44%, respectively). MB was seen in 51 patients, making the prevalence 3.9%, with male predominance over females in the ratio of 3.9:1. The most common clinical presentation was unstable angina (UA) (n = 22, 43.1%), followed by stable angina (SA) (n = 11, 21.6%), non-ST-elevation myocardial infarction (NSTEMI) (n = 10, 19.6%), and ST-elevation myocardial infarction (STEMI) (n = 8, 15.7%). Myocardial bridges were more common among patients with stable coronary artery disease. The left anterior descending artery (n = 51, 3.9%) was involved in all the cases and the middle segment was affected in all patients with MB. Among patients with myocardial bridge, 26 patients (51%) had atherosclerosis and 25 patients had a normal artery. Among patients with myocardial bridge with atherosclerosis, 17 patients (65%) had atherosclerosis in the same artery in which the myocardial bridge was present. Among patients with myocardial bridge with atherosclerosis, nine patients (52%) had atherosclerosis proximal to the bridge, three patients (17%) had atherosclerosis distal to the bridge, and five patients (31%) had atherosclerosis both proximal and distal to the bridge. Conclusion The prevalence of MB in the Indian population is significantly lower than in the Western populations, and it is significantly higher in the male population with patients diagnosed as normal coronaries on coronary angiography., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mishra et al.)

Introduction Hypertension is a leading risk factor for the development of cardiovascular and metabolic derangements. In patients with metabolic syndrome (MetS), hypertension is one of the cornerstones showing high variability which is detected in ambulatory blood pressure monitoring. Fragmented ventricular complexes on ECG are seen as hypertensives and are a viable and easy measure of myocardial fibrosis even in the absence of obvious hypertrophy. Aim The present study was undertaken to study the blood pressure variability in patients of MetS with fragmented QRS (fQRS) versus normal ventricular complexes (QRS). Results Out of 100 patients, 22 (22%) had fQRS complexes. Hypertension and diabetes were the most prevalent associated in both groups but a difference was seen with coronary artery disease, which was significantly associated in the fQRS group (8.97% vs 95.45%, p<0.001) as compared to the non-fQRS group. Significant differences were observed in waist circumference (p=0.019), triglyceride (p=0.006) and left ventricular ejection fraction (p<0.001) between the two groups. There was a marked difference (p<0.05) between heart rate variability during day and night time between normal and fQRS sub-groups, being higher in the latter. A similar pattern of change was observed for systolic and diastolic blood pressures and associated dipping. Conclusion Significant differences exist between heart rate and blood pressure changes in patients with fQRS of MetS, thus making fQRS a potent indicator of cardiovascular status., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mishra et al.)

Various serum proteins, like Human Serum Albumin (HSA) and others, are susceptible to glycation and the formation of Advanced Glycation End Products (AGEs). Diabetes and other diseases are associated with AGE development. Recently, isoflavones have been studied for their therapeutic benefits. In the present study, we glycated HSA with Methylglyoxal (MGO) with and without the test compound, i.e., Biochanin A (BCA), to test its antiglycating capacity. We studied the biochemical and biophysical effects of glycation on HSA with and without BCA and also took the help of the in silico technique. Analytical methods included intrinsic and extrinsic fluorescence, polyacrylamide gel electrophoresis (PAGE), UV spectroscopy, far UV circular dichroism, and others. For structural comprehension, TEM and SEM were used. Molecular docking and simulation were employed to observe BCA-HSA's site-specific interaction. Since HSA is a therapeutically relevant protein involved in many disorders, this study's findings are important.Communicated by Ramaswamy H. Sarma.

Background: Calcium is an essential electrolyte with critical physiological functions. Recently, it has been implicated in the pathogenesis and outcomes of COVID-19. This retrospective study was conducted to estimate serum ionic calcium and its correlation with clinical severity, inflammatory markers, and in-hospital outcomes in moderate to severe COVID-19 patients., Methods: We retrospectively analyzed data from 377 COVID-19 patients, aged between 23 and 79 years, with a mean age of 54.17±11.53 years. Severity of the disease was determined using ICMR criteria. Parameters including age, gender, inflammatory markers, calcium levels, and clinical outcomes were assessed., Results: The study showed a prevalence of moderate and severe COVID-19 in 58.1% and 41.9% patients, respectively. Severity was significantly associated with younger age, higher mean inflammatory markers, notably IL-6, procalcitonin, D-Dimer, and lower ionic and total calcium levels, as well as vitamin D levels. Mortality and referral rate were significantly higher in the severe group. Hypocalcemia was prevalent in 39% of the patients and was significantly associated with disease severity, ARDS, and mortality. On multivariate assessment, only age and ionic calcium were significantly associated with COVID-19 severity., Conclusion: Lower serum ionic calcium levels are associated with increased severity and poor outcomes, including higher mortality in COVID-19 patients, underscoring the potential role of calcium as a diagnostic and prognostic marker in COVID-19 pneumonia and may be an important factor in various other forms of pneumonia., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Background: Acute chest pain is a common presentation in emergency departments worldwide. Differentiating between cardiac and non-cardiac chest pain is crucial for patient management and resource allocation., Methods: This study analyzed 714 patients presenting with acute chest pain in a tertiary care hospital in North India. We investigated demographic characteristics, chief complaints, risk factors, ECG findings, and final diagnoses to identify patterns associated with cardiac (CCP) and non-cardiac chest pain (NCCP)., Results: CCP was diagnosed in 53.7% (n=383) and NCCP in 46.3% (n=331). Significant predictors of CCP included age (OR=1.05, p<0.001), smoking (OR=2.22, p<0.001), diabetes (OR=1.57, p=0.003), hypertension (OR=1.82, p<0.001), and family history of ischemic heart disease (IHD) (OR=1.42, p=0.01). Central chest pain was more common in CCP (60% vs. 40%, p<0.001), as were abnormal ECG findings such as ST-segment depression (35% vs. 10%, p<0.001) and elevation (29% vs. 6%, p<0.001). Normal ECG was more prevalent in NCCP (60%, p<0.001)., Conclusion: Traditional cardiovascular risk factors remain strongly associated with CCP. Smoking has a particularly high odds ratio, suggesting the need for targeted interventions. ECG findings significantly aid in differentiating CCP from NCCP. This study underscores the importance of a comprehensive approach in evaluating acute chest pain to ensure accurate diagnosis and effective treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mateen et al.)

Charcot reconstruction with static external fixation provides stability in deformity correction. Concern for pin site health remains forefront to prevent premature fixator removal should infection develop. While previous investigations examined a spectrum of pin care protocol with a similar variation in outcomes, this study assesses results following a "no care pin care" routine. A retrospective analysis of patients with Charcot neuroarthropathy treated with static external fixation was performed where all pin sites were dressed using a chlorhexidine-soaked sponge without postoperative maintenance. Demographics, reconstruction-specific, and postoperative variables including pin site irritation, pin site infection, and pin tract infection were collected through frame removal. A comparison between uncomplicated and complicated pin sites was made. Statistical significance was set as p ≤ .05. Among 85 patients and their respective pin holes that posed potential spots of infection, 6 (7%) experienced pin site irritation and 5 (6%) experienced pin site infection. Moreover, 2 (2%) experienced a pin tract infection requiring removal. Out of the 768 wires/half-pins 2 (0.3%) were removed. There existed no statistically significant predictors of pin site irritation/infection other than age (p = .03). "No care pin care" proves an effective means at pin site care following static external fixation in Charcot reconstruction. Limited maintenance reduces the postoperative burden on providers and patients., (Copyright © 2023 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Brachymetatarsia consists of a shortened metatarsal resulting in a shorter toe. Pain with shoe wear and cosmetic concerns are the main reasons for surgical intervention. Surgical techniques to increase metatarsal length include acute lengthening with interpositional bone grafting or gradual lengthening with callus distraction. We performed a retrospective cohort study for 1 surgeon's patients at 1 institution over 10 years. Twenty-nine feet in 22 patients met inclusion criteria for acute correction; 16 feet in 11 patients were included for gradual correction. Mean ages were 26.3 ± 12.1 and 27 ± 10.8 in the acute and gradual groups, respectively (p = .79). Most patients were female: 95.4% of acute cases and 90.1% of gradual cases. Most involved lengthening the fourth metatarsal: 86.7% and 100% of acute and gradual groups, respectively (p = .54). Correction obtained amounted to 14.4 ± 2.97 mm (range, 10-22 mm) in acute cases and 14.8 ± 2.39 mm (range, 10-20 mm) in gradual cases (p = .81). The mean percent increase in metatarsal length was 21.1 ± 14% for acute and 22.6 ± 12.4% for gradual (p = .72). Mean consolidation was 8.9 ± 2.51 weeks for acute and 21.4 ± 10.8 weeks for gradual (p = <.001). Nonunions were most common in the gradual group (37.5%) with need for more revisional surgery (43.5%) compared with the acute group; both were statistically significant. We conclude that acute brachymetatarsia correction can obtain correction similar to the gradual technique with fewer postoperative complications and less osseous consolidation time., (Copyright © 2023 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Hammertoe deformity is a common forefoot pathology, characterized by a progressive deformity with dorsiflexion of the proximal phalanx on the metatarsal head at the metatarsal phalangeal joint (MTPJ) and plantarflexion of the intermediate phalanx on the proximal phalanx at the proximal interphalangeal joint (PIPJ). While there is literature available discussing open techniques for hammertoe correction, there is a lack of publications discussing minimally invasive techniques, therefore the objective of this retrospective comparative study is to evaluate minimally invasive versus open hammertoe surgery in terms of time to osseous union, complications, recurrence, and return to full activity. Sixty eight feet among 41 patients met the inclusion criteria and were surveyed. Among the 68 feet, 54 feet (124 toes) underwent minimally invasive hammertoe correction and 14 feet (22 toes) underwent open hammertoe correction. Time to osseous union (weeks) in the MIS group was 8.76 ± 2.31 weeks with similar outcomes to the open group with union at 8.42 ± 2.31 (p = .65). Return to activity (weeks) was 10.47 ± 3.45 in the MIS group and 9.92 ± 3.03 in the open group with no statistical significance (p = .62). There was 4 recurrent hammertoe deformities in the MIS group (3.23%) with no recurrent hammertoes in the open group (0%). In the MIS group 5 hammertoes had unplanned hardware removal (4.03%) compared to 0 in the open group. There was no statistical significance for both recurrence and unplanned hardware removal (p = 1). Overall, we concluded that both techniques are equivocal with no detectable statistical difference., (Copyright © 2023 the American College of Foot and Ankle Surgeons. All rights reserved.)

Introduction: Haglund's deformity is a posterosuperior calcaneal prominence often associated with a painful bursa and insertional Achilles tendinopathy. Endoscopic debridement has been previously described; however, the aim of this cadaveric study is to describe landmarks of a minimally invasive surgical (MIS) approach to Haglund's deformity., Methods: Twelve specimens were dissected to identify medial and lateral portals for minimally invasive burr placement and anchor placement. A standard ruler was used to measure the distance in millimeters from the medial and lateral neurovascular structures in relation to medial and lateral portals. A separate 7-cm longitudinal incision posterior to the lateral malleolus and a separate 7-cm longitudinal incision posterior to the medial malleolus were made to identify at-risk neurovascular structures., Results: The average distance from the sural nerve to the lateral portal was 25.7 mm (23-26). The mean distance from the lateral calcaneal branch of the sural nerve to lateral portal was 11.4 mm (10-12). The mean distance from the tibial nerve to the medial portal was 35.3 mm (35-36). Both the medial and lateral incisions were 9.3 mm from the calcaneal tuberosity., Conclusion: The results indicate that the MIS approach to Haglund's deformity resection can be performed reliably without neurovascular compromise., Levels of Evidence: Level IV., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: SM and AJ have no financial disclosures to report. JC and NAS are consultants for Arthrex. The following organizations supported the institution of SM and NAS: DePuy Synthes, NuVasive Specialized Orthopedics, Orthofix, OrthoPediatrics, Paragon 28, Pega Medical, Smith & Nephew, Stryker, Turner Imaging Systems, and WishBone Medical.

Competing Interests: There are no conflicts of interest.

Minimally invasive surgery (MIS) has gained popularity for hallux valgus correction in the adult population. The advantage of reproducibility of this procedure can aid in lower operating room costs, quicker recovery, and fewer complications. The purpose of this retrospective study was to compare preoperative versus postoperative foot widths in patients that underwent MIS hallux valgus correction. The average preoperative foot width was 101.1 ± 5.67 mm and postoperatively the foot width measured at 12-month follow-up was 95.9 ± 4.92 mm, which was statistically significant (p < .001). Overall, there was a 5.03 ± 3.71% reduction in foot width, with a statistically significant linear relationship between preoperative foot width and percent change in width following the procedure (R = -0.46; p = .003). Based on our results, we can conclude that MIS bunion surgery can effectively narrow the foot postoperatively, particularly in patients with a wider forefoot, adding cosmetic benefit to the procedure., (Copyright © 2023 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Hyperglycaemia accelerates the aging process significantly. Diabetes problems can be mitigated by inhibiting glycation. To learn more about glycation and antiglycation mediated by methyl glyoxal and baicalein, we studied human serum albumin as a model protein. A Methylglyoxal (MGO) incubation period of seven days at 37 degrees Celsius induced glycation of Human Serum Albumin.s Hyperchromicity, decreased tryptophan and intrinsic fluorescence, increased AGE-specific fluorescence, and reduced mobility were all seen in glycated human serum albumin (MGO-HSA) in sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). Fourier transform infrared spectroscopy (FT-IR) and then far ultraviolet dichroism were used to detect secondary and tertiary structural perturbations (CD). The Congo red assay (CR), scanning electron microscopy (SEM), and transmission electron microscopy (TEM) all verified the presence of amyloid-like clumps. Structure (carbonyl groups on ketoamine moieties) (CO), physiological problems including diabetes mellitus, and cardiovascular disease, etc. are linked to the structural and functional changes in glycated HSA, as proven by these studies.Communicated by Ramaswamy H. Sarma.

Charcot neuroarthropathy (CNA) is a progressive disease affecting the bones and joints of the foot that can lead to instability, breakdown, and collapse. Minimally invasive surgery (MIS) techniques are becoming a popular option within musculoskeletal surgery of the foot and ankle and may be an alternative to aggressive dissection seen during corrective surgery. An MIS approach minimizes vascular disruption, provides structural stability at an osteotomy or arthrodesis site, and encourages early mobilization if indicated. This retrospective study compares 17 patients who underwent an open approach for midfoot CNA reconstruction with 17 patients who underwent an MIS approach for midfoot CNA reconstruction. Preoperative and postoperative radiographic parameters were measured: lateral talus-first metatarsal, anteroposterior (AP) talus-first metatarsal, calcaneal pitch, and cuboid height. Difficulties that occurred during treatment were gathered and sorted into postoperative problems (stage I), obstacles (stage II), and complications (stage III). Changes from preoperative to postoperative radiographic lateral talus-first metatarsal and AP talus-first metatarsal angles were statistically significant (p < .001) for both the MIS and open approach. No true postoperative complications (stage III) were observed at last follow-up. The most common difficulty encountered was pin-site infection (stage I; in 23.5% of patients) in the MIS group. In the open group, the most common complications were wound development (stage I; 23.5%) and nonunions (stage II; 23.5%). Our findings suggest that midfoot CNA reconstruction with MIS methods offers similar outcomes to the open approach., (Copyright © 2023 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Charcot neuroarthropathy (CNA) is a progressive disease that affects the bones and joints of the foot. To prevent collapse and loss of stability within the pedal architecture, CNA should be diagnosed and managed early. The objective of this retrospective study was to review patients who underwent midfoot CNA reconstructive surgery and evaluate subsequent rates of minor and major amputations. Secondary objectives include identifying patients that underwent midfoot CAN with and without a subtalar joint (STJ) arthrodesis. Out of the 72 patients, 4 (5.6%) underwent minor (digital, ray) amputation, 2 (2.8%) underwent proximal amputations (either below or above the knee), and none underwent midfoot amputation (transmetatarsal, Lisfranc, Chopart). A Fisher's exact test was employed to compare the outcomes of minor and major amputation rates in our CNA cohort with those who underwent midfoot CNA reconstruction with STJ arthrodesis and found no statistical significance (p = .15). Overall, a total progression to amputation was 8.4% following midfoot CNA reconstruction, with 2.8% of patients undergoing major amputation (below knee or above knee). Despite no statistical significance, we recommend surgeons to consider including an STJ arthrodesis in addition to midfoot CNA reconstruction to establish a stable and plantigrade foot., (Copyright © 2023 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

The objective of this article is to review the etiology and pathophysiology of Charcot neuroarthropathy as it contributes to the breakdown of the midfoot. The article will also discuss the emerging techniques in minimally invasive surgery and how this is applied to Charcot reconstructive surgery as well as reflect on a newer thought processes to surgical intervention., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The supramalleolar osteotomy (SMO) is a joint-preserving surgical procedure that allows realignment of the ankle joint in severe deformity secondary to arthritis. This osteotomy realigns the mechanical axis to provide better weight distribution through the ankle joint. With an aligned mechanical axis, the overloaded asymmetric ankle joint will shift toward the preserved joint area in a valgus or varus ankle joint. The SMO also can be used via a staged approach to correct severe deformity in an end-stage arthritic ankle before total ankle arthroplasty to optimize the implant's longevity and improve overall functional outcomes., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Molecular targeting strategies have been used for years in order to control cancer progression and are often based on targeting various enzymes involved in metabolic pathways. Keeping this in mind, it is essential to determine the role of each enzyme in a particular metabolic pathway. In this review, we provide in-depth information on various enzymes such as ceramidase, sphingosine kinase, sphingomyelin synthase, dihydroceramide desaturase, and ceramide synthase which are associated with various types of cancers. We also discuss the physicochemical properties of well-studied inhibitors with natural product origins and their related structures in terms of these enzymes. Targeting ceramide metabolism exhibited promising mono- and combination therapies at preclinical stages in preventing cancer progression and cemented the significance of sphingolipid metabolism in cancer treatments. Targeting ceramide-metabolizing enzymes will help medicinal chemists design potent and selective small molecules for treating cancer progression at various levels.

Advanced glycation end products (AGEs) are formed through non-enzymatic glycation, that have been linked to various diseases, including polycystic ovarian syndrome (PCOS) playing a critical role leading to secondary comorbidities such as diabetes-related problems, cardiovascular complications, infertility, etc. As a result, there has been a lot of research into AGE-inhibiting phytochemicals for the remediation and obstruct progression of glycation-related illnesses. The current study is based on in-vitro protein model, in which human serum albumin have been used to investigate the cumulative effect of chlorogenic acid (CGA) and cholecalciferol (vitamin D) on glycation and evaluate their inhibitory impact on AGEs production in the presence of methylglyoxal. Through the application of several biochemical and biophysical techniques, we were able to examine the synergistic impact of both the compounds on albumin structure and its biochemical properties during different stages of glycation. According to Nitro-blue tetrazolium assay results indicate that CGA and vitamin D inhibited fructosamine (early glycation product) production. Moreover, free thiol and lysine residues were significantly increased whereas protein carbonyl levels were significantly decreased. Additive effect of CGA and vitamin D were associated with reduced AGEs fluorescence and increased tryptophan and tyrosine fluorescence. Amadori-albumin after treatment showed some evidence of regaining its alpha-helicity as measured by far-UV CD spectrum. Furthermore, secondary structural alterations were confirmed by Fourier transform infrared spectroscopy (FTIR). ANS (1-anilinonaphthalene-8-sulfonic acid) fluorescence spectra also displayed less revelation of hydrophobic patches. Bilirubin binding capacity was also restored which showed functional recovery of HSA. The electrophoretic mobility was also restored which is portrayed by SDS-PAGE. Additionally, to predict the anti-aggregation potential of CGA and vitamin D, congo red assay and ThT fluorescence was performed which reveal low aggregate formation after treatment. These results corroborated with scanning electron microscopy and confocal microscopy. Docking and simulation results also reveal spontaneous binding of CGA and vitamin D on subdomain IIA of HSA favoring their binding thermodynamically. All the findings suggest that chlorogenic acid and cholecalciferol given in combination might help in prevention of PCOS progression and its related complications., Competing Interests: Declaration of competing interest The authors have no relevant financial or non-financial interests to disclose., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Charcot neuroarthropathy (CNA) is a disabling and progressive disease that affects the bones and joints of the foot. Successful Charcot reconstruction focuses on restoring anatomic alignment, obtaining multiple joint arthrodesis, selecting stable fixation, preserving foot length, and creating a foot suitable for community ambulation in supportive shoegear. Intramedullary fixation arthrodesis of the medial and lateral columns has been previously reported to produce improvement in midfoot Charcot reconstruction. More recently, a growing trend of stabilization of the subtalar joint (STJ) has been incorporated alongside the medial and lateral column fusion. Our objectives were to retrospectively review patients who underwent midfoot Charcot reconstructive surgery, whether with or without accompanying STJ arthrodesis, and establish which patients progressed to ankle CNA. Of the 72 patients who underwent midfoot Charcot reconstruction, 28 (38.9%) underwent STJ arthrodesis, and 22 converted to ankle CNA (30.6%). Fourteen (63.6%) of 22 ankle CNA cases had not undergone STJ arthrodesis; 8 patients (36.4%) had it. A Fisher exact test was performed to identify the relationship between those without STJ arthrodesis and those progressing to ankle CNA; it revealed statistical significance (p = .001). Performing an STJ arthrodesis with midfoot Charcot reconstructive surgery may be beneficial to aiding in hindfoot stability, establishing a plantigrade foot, and providing further insight into the management of midfoot Charcot., (Copyright © 2023 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Heparin-induced thrombocytopenia (HIT) is a prothrombotic state caused by the buildup of platelet factor 4 antibodies with decreased platelet count caused by heparin therapeutic or prophylactic therapy. It is important to detect this complication, especially in critically ill patients and cardiac patients. Detection of HIT can be demonstrated by positive antibodies in a HIT panel. Based on clinical and laboratory findings, heparin use should be discontinued with immediate transition to alternative anticoagulation therapies. Thromboembolic events can be an adverse effect of HIT and can cause local tissue necrosis, especially in the lower extremity. This case is a retrospective medical record review of a 52-year-old man who was initially admitted as an outpatient for coronary artery bypass grafting and mitral valve replacement who developed digital gangrene from HIT. This case emphasizes the rare adverse effects of HIT and the need for timely consultation for surgical treatment of limb ischemia/gangrene.

The objective of this article was to review the deltoid ligament and spring ligament specifically as they pertain to ligament insufficiency and adult-acquired flatfoot deformity. Discussion includes the normal and abnormal biomechanical forces that extend through these ligaments in normal and flatfoot deformity. Current literature related to spring ligament repair as part of the flatfoot deformity reconstruction is also reviewed., (Copyright © 2022 Elsevier Inc. All rights reserved.)