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The importance of academic journals in second language (L2) research is evident on at least two levels. Journals are, first of all, central to the process of disseminating scientific findings. Journals are also critical on a professional level as most L2 researchers must publish articles to advance their careers. However, not all journals are perceived as equal; some may be considered more prestigious or of higher quality and may, therefore, achieve a greater impact on the field. It is therefore necessary that we understand the identity and quality of L2 research journals, yet very little research (e.g., Egbert, 2007; VanPatten & Williams, 2002) has considered these issues to date. The current study sought to explore L2 journal identity and quality, and the relationship between these constructs. In order to do so, a database was compiled based on three different types of sources: (1) a questionnaire eliciting L2 researchers' perceptions of the quality and prestige of 27 journals that publish L2 research (N = 327); (2) manual coding of different types of articles (e.g., empirical studies, review papers), data (quantitative, qualitative, mixed), research settings, and authorship patterns (K = 2,024) using the same 27 journals; and (3) bibliometric and submission data such as impact factors, citation counts, and acceptance rates. Descriptive statistics were applied to explore overall quality and prestige ratings as well as publication trends found in each journal. The relationships between those patterns and subjective ratings were also examined. In addition, regression models were built to determine the extent to which perceptions of journal quality and prestige could be explained as a function of journal and article features. We discuss the findings of the study in terms of on-going debates concerning publication practices, study quality, impact factors, journal selection, and the "journal culture" in applied linguistics.

Background. Currently, there is no consensus on postoperative risk stratification for parathyroid cancer (PC). The risk factors of disease progression are crucial for choosing the optimal treatment strategy, including adjuvant methods and patient,s follow-up. Aim. Identifying predictors of PC recurrence Materials and methods. We performed a retrospective observational study of 85 patients with verified PC divided into remission (n=61) and recurrence (n=19) groups after primary surgical treatment for the period 2004–2023. The analyzed parameters included demographic, laboratory and instrumental data of patients with PC, the presence of a mutation in the CDC73 gene, morphological and immunohistochemical characteristics of the primary tumor. Results. After adjustments for multiple comparisons, a statistically significant association of recurrence was found for preoperative calcium level (p0.001), pT4 stage (p0.001) according to TNM-classification (Tumor, Nodus, Metastasis) American Joint Committee on Cancer 2017. There was a statistical trend for calcium correction for hypoalbuminemia (p=0.002), presence of nephrolithiasis/nephrocalcinosis (p=0.021), parathyroid hormone level 6 months after primary surgery (p0.05), pT3 stage TNM (p=0.007), nuclear expression of parafibromin in tumor tissue (p0.05). We did not reveal any associations between disease recurrence and sex, age, volume of surgical treatment, germline mutation in the CDC73, parafibromin expression and Ki-67 in tumor tissue. Conclusion. Our study revealed several factors of poor prognosis, allowing to identify a risk group for recurrence, which can contribute to active dynamic monitoring and timely treatment.

Category: Ankle; Ankle Arthritis Introduction/Purpose: Infection is a serious complication of primary total ankle arthroplasty (TAA) and can lead to implant failure and revision surgery. While various patient demographics, comorbidities, and surgical factors have been associated with an increased risk of infection, evidence is limited, and further research is required to better understand infection in TAA. This study aims to analyze risk factors of infection and explore outcomes following infected TAA. Methods: A retrospective cohort study was conducted using data from a single institution from 2002 to 2022. Patients who underwent primary TAA and had subsequent infection were identified and matched using propensity-score matching (PSM) based on various demographic, comorbidity, and surgical factors. Demographics were compared between the matched groups using Mann-Whitney U test and Fisher's exact test. The outcomes following infection were identified and summarized using descriptive statistics. Results: A total of 1,863 patients who underwent primary TAA were identified, and 19 (1%) were diagnosed with an infection. After PSM, there were no significant differences in age, gender, BMI, and smoking status between the cohorts. There was a statistically significant increase in the rate of diabetes in the infected cohort (26.3 vs. 15.3; p =0.01). Subsequent surgical intervention resulted in limb salvage in 18 (94.7%) cases. Two-stage revision to total ankle replacement was performed in 7 cases (36.8%), while revision to arthrodesis and isolated polyethylene exchange were each carried out in 4 cases (21.1%). One patient had to undergo amputation, however, at the time of the most recent follow-up (5.3%). All patients were found to be free of infection. Conclusion: This study demonstrated significantly increased rates of smoking and diabetes in the infected TAA cohort. Two-stage revision to TAR and revision to arthrodesis with isolated polyethylene exchange were successful in eradicating infection. Overall, a high rate of limb salvage was reported.

Category: Ankle; Ankle Arthritis Introduction/Purpose: While the utilization of total ankle arthroplasty (TAA) for managing severe ankle osteoarthritis has become increasingly common, there has been a subsequent increase in the occurrence of revision TAA procedures due to implant failure. The INBONE II system has risen in popularity specifically for the use in revision TAA cases, however there has been limited patient performance data for this specific indication. Given the growing number of TAA revision procedures and increasing focus on motion-preserving salvage options, this study aims to comprehensively examine the clinical outcomes associated with revision TAA using the INBONE II system. Methods: A retrospective analysis was conducted on a group of 60 patients who underwent revision TAA with the INBONE II system. Detailed information was collected on patient demographics, implant characteristics, concurrent procedures, and complications. The implant survival was estimated using Kaplan-Meier analysis. Results: The study revealed high complication rates but generally fair clinical outcomes for revision TAA utilizing the INBONE II system. Complications were observed in 22 patients (36.7%), including persistent pain (n=6), nerve injury/impingement (n=5), infection (n=3), fracture (n=3), implant failure (n=3), impaired wound healing (n=2), and osteolysis (n=3). The three-year implant survivorship rate from reoperation was 92.0% [82.7%-100.0%] while the three-year survivorship rate from major complications was 90.4% [80.8%-100.0%]. Conclusion: Our study demonstrates that revision TAA is an option to preserve joint function following primary TAA failure. Although there are high complication rates associated with revision TAA, patients generally fair clinical outcomes for revision TAA using the INBONE II system. Further study with longer-term follow-up is needed to ensure that revision TAA is durable at longer time intervals and remains a favorable option for the salvage of the failed total ankle.

Abstract Research on the production and utilization of hydrogen energy is essential to overcome the environmental issues caused by fossil fuels. Herein, we anchor PtNi nanoalloy clusters (Pt‐Ni NACs) on nitrogen‐doped graphene oxide (NrGO) by a facile microwave‐assisted synthesis and analyze the variations of catalyst properties based on the PtNi composition and the presence of nitrogen. Ni inclusion in the Pt matrix can induce lattice strain and change the electronic structure, while the doped nitrogen into the graphene can enhance electron transfer and improve the durability of the catalyst through strong chemical bonding with the alloy clusters. TEM analysis discovers that the NACs are uniformly decorated in a few‐nanometer‐size on the graphene surface, and the formation of the PtNi NACs and structural changes according to composition are confirmed through XRD and XPS. In addition, the structural changes due to N‐doping and its bonding with the NACs are observed through Raman spectroscopy and XPS. Electrochemical measurements reveal that Pt2.6Ni NACs/NrGO exhibits the highest ORR onset potential (0.893 V) and the lowest HER overpotential at 10 mA cm−2 (22 mV) among other catalysts, and those activities are almost unchanged under long‐term durability tests. From these results, Pt2.6Ni NACs/NrGO is utilized in a zinc‐air battery (ZAB) system, demonstrating better battery performance than commercial Pt and Ir‐based catalysts. Moreover, it is applied to hydrogen collection, showing linear trend in hydrogen production over time, confirming the catalyst's availability in hydrogen production and utilization.

We present a thermally tunable microring resonator (MRR) implemented on a Ge-on-insulator (Ge-OI) photonic platform tailored for mid-infrared spectrometer applications. Thanks to the favorable thermo-optic effect of Ge, we characterized the optical and thermal properties of the thermally tunable Ge-OI MRR through rigorous optical and thermal numerical analyses. Building upon the simulation, a ring-shaped Au heater was successfully integrated into the Ge-OI MRR that was fabricated by using a direct wafer bonding process, followed by electron-beam lithography and dry etching techniques. Observations via thermo-reflectance microscopy revealed the temperature change within the Ge induced by heat transfer from the applied bias to the Au heater. Notably, the measured temperature change of 17 K at an applied electrical power of 181.7 mW closely aligned with the simulated values. In optical measurement, the heater-integrated Ge-OI MRR exhibited the tunability of 33.7 nm/W (0.36 nm/K) and the loaded Q factor of 21k at 4.2 µm wavelength with no bias. Hence, our demonstration of the Ge-OI tunable ring filter for mid-IR spectrometers could be a promising technology employing photonic integrated circuits for diverse applications in optical communication and spectral sensing.

A flight controller formulation based on incremental nonlinear dynamics inversion (INDI) control with nonlinear disturbance observer (NDO) is proposed. INDI control is a nonlinear controller based on incremental dynamics. Aimed to attain robustness for nonlinear dynamics inversion (NDI)-based controller, incremental dynamics are derived using the first-order Talyor series expansion to nonlinear systems. The incremental dynamics-based controller requires information on state derivative terms to strengthen the robustness property of the nonlinear controller. The proposed controller utilizes the first-order low-pass filter to obtain the state derivative estimate to implement incremental dynamics into the system. Because the incremental form creates uncertainty term which is an aftermath of the Taylor series expansion, the proposed controller adopts the NDO to eliminate this effect. The controller is applied to the generic transport model which was developed by NASA for simulation purposes. The proposed NDO-based INDI control underwent simulations, together with an INDI controller without disturbance observer, and showed that the developed method results in better performances, providing important advantages where it compensates the uncertainties, removes the steady-state error, and shows less oscillating longitudinal body rate response than the baseline controller, desirable for aerodynamics applications with faster system response.

Alkylphenols, such as nonylphenol and 4-tert-octylphenol (OP), are byproducts of the biodegradation of alkylphenol ethoxylates and present substantial ecological and health risks in aquatic environments and higher life forms. In this context, our study aimed to explore the effect of OP on reproductive endocrine function in both female and male zebrafish. Over a period of 21 days, the zebrafish were subjected to varying concentrations of OP (0, 0.02, 0.1, and 0.5 μg/L), based on the lowest effective concentration (EC10 = 0.48 μg/L) identified for zebrafish embryos. OP exposure led to a pronounced increase in hepatic vitellogenin (vtg) mRNA expression and 17β-estradiol biosynthesis in both sexes. Conversely, OP exhibits anti-androgenic properties, significantly diminishes gonadal androgen receptor (ar) mRNA expression, and reduces endogenous androgen (testosterone and 11-ketotestosterone) levels in male zebrafish. Notably, cortisol and thyroid hormone (TH) levels demonstrated concentration-dependent elevations in zebrafish, influencing the regulation of gonadal steroid hormones (GSHs). These findings suggest that prolonged OP exposure may result in sustained reproductive dysfunction in adult zebrafish, which is largely attributable to the intricate reciprocal relationship between hormone levels and the associated gene expression. Our comprehensive biological response analysis of adult zebrafish offers vital insights into the reproductive toxicological effects of OP, thereby enriching future ecological studies on aquatic systems.

Background: Long-term survival in patients who receive bone marrow transplantation (BMT) is increasing. However, osteonecrosis and secondary osteoarthritis (OA) of the hip and knee are common complications in this population due to post-transplant steroid treatment to prevent graft vs host disease. The purpose of this study was to evaluate the outcomes of total joint arthroplasty (TJA) in patients with prior BMT and compare them to those of patients undergoing TJA for primary OA. Methods: Patients with a history of BMT undergoing primary TJA from 2013 to 2021 were retrospectively reviewed. Patients were matched 1:1 by surgical site, sex, age, body mass index, American Society of Anesthesiologists score, and Elixhauser Comorbidity Index to patients undergoing TJA for primary OA. Demographics, intraoperative blood loss, perioperative transfusion requirements, hospital length of stay, 90-day emergency department visits and readmissions, all-cause revisions, and 2-year mortality were compared between cohorts. Results: There were 17 patients undergoing total knee arthroplasty (TKA) after BMT (TKA-BMT) and 43 patients undergoing total hip arthroplasty (THA) after BMT (THA-BMT). More TKA-BMT and THA-BMT patients were immunosuppressed preoperatively compared to 17 matched TKA-OA and 43 THA-OA patients (P = .018 and P < .001). There were no other significant perioperative differences between BMT and OA groups. Two-year patient and implant survivorship for TKA-BMT and THA-BMT patients were high and not statistically different from TKA-OA and THA-OA cohorts. Conclusions: TJA after BMT provides satisfactory perioperative and short-term outcomes and is a viable treatment option for patients with osteonecrosis and secondary OA after BMT treatment.

Abstract Background Higher positive end-expiratory pressure (PEEP) during laparoscopic surgery may increase oxygenation and respiratory compliance. This meta-analysis aimed to compare the impact of different intraoperative PEEP strategies on arterial oxygenation, compliance, and hemodynamics during laparoscopic surgery in non-obese patients. Methods We searched RCTs in PubMed, Cochrane Library, Web of Science, and Google Scholar from January 2012 to April 2022 comparing the different intraoperative PEEP (Low PEEP (LPEEP): 0–4 mbar; Moderate PEEP (MPEEP): 5–8 mbar; high PEEP (HPEEP): >8 mbar; individualized PEEP - iPEEP) on arterial oxygenation, respiratory compliance (Cdyn), mean arterial pressure (MAP), and heart rate (HR). We calculated mean differences (MD) with 95% confidence intervals (CI), and predictive intervals (PI) using random-effects models. The Cochrane Bias Risk Assessment Tool was applied. Results 21 RCTs (n = 1554) met the inclusion criteria. HPEEP vs. LPEEP increased PaO2 (+ 29.38 [16.20; 42.56] mmHg, p

The study data of the last two decades on primary and secondary immunodeficiency in congenital heart defects (CHD) as a cause of frequent infectious complications before and after cardiac surgery are presented. Based on screenings of various levels, data are provided on the greater severity of immunological disorders in critical and cyanotic CHD in conotruncal defects compared with those in septal defects and stenotic defects. Violations were more often related to T-cell function and immunoglobulin deficiency (especially the IgG and IgG4 subgroups). Various types of primary immunodeficiency were found in 13 genetic syndromes in combination with CHD. The review discusses the possibility of using the technique of quantitative determination of DNA TREC and KREC — by-products of maturation of T- and B-cell receptors, which allows us to judge the defects of the T- and B-cell links of the immune system to predict infectious complications in children with CHD. The data of our own study of 200 infants with CHD (in 5% of cases with syndromic forms of CHD) are presented, where a decrease in TREC was found in 23.5% of cases, including all infants with syndromic forms, more often with cyanotic and conotruncal CHD and in children admitted in critical conditions. In children with reduced TREC values, infectious complications in the postoperative period were observed significantly more often than in children with normal indicators (36 and 3.6%, respectively). The analysis of publications confirmed the importance of TREC and KREC screening for targeted preoperative preparation in order to reduce postoperative complications and reduce the risk of mortality in CHD.

The article presents a literature review of the modern concept of anatomical and physiological structure and functioning of the cornea. The strict morphological structure and corneal tissue homeostasis ensure its transparency. Studying the mechanisms that regulate the constancy of the corneal tissue internal environment allows us to get closer to understanding the prospects forregenerative therapy for the corneal stroma pathology. The article discusses in detail the role and functional potential of corneal stromal cells, which are capable of reverse cytologic differentiation, which primarily ensures the maintenance of tissue homeostasis and corneal transparency. The functional activity of corneal cells can change for a number of reasons, which may be exogenous, iatrogenic (trauma, infection, etc.) or endogenous. Endogenous causes include: cell autoregulation pathologies (for example, enzyme defects); defects in transport systems leading to tissue hypoxia; disorders of the neuro-humoral regulation of trophism. The physical reason forthe violation of the corneal transparency is an increase in the light scattering. The article presents five main causes of increased light scattering in the opaque cornea, and also provides an overview of the main substances – components and products of cellular synthesis of corneal stromal cells: cytokines and growth factors (complex of the signal molecule and the SDF1/CXCR4 receptor, insulin-like growth factor 1, tumor necrosis factor alpha, intercellular adhesion molecule 1, erythropoietin, neurotrophic factors, etc.). Thus, corneal opacity can be caused by a single pathogenic mechanism or be the result of a complex effect of several factors. The main processes of tissue homeostasis regulation are aimed at maintaining the unique morphological structure of the cornea.

Abstract The bacteriophage CAP 10-3 forming plaques against Cutibacterium acnes which causes skin acne was previously isolated from human skin acne lesion. Incomplete whole genome sequence (WGS) of the bacteriophage CAP 10-3 was obtained and it had 29,643 bp long nucleotide with 53.86% GC content. The sequence was similar to C. acnes phage PAP 1-1 with a nucleotide sequence identity of 89.63% and the bacteriophage belonged to Pahexavirus. Bioinformatic analysis of the WGS predicted 147 ORFs and functions of 40 CDSs were identified. The predicted endolysin gene of bacteriophage CAP 10-3 was 858 bp long which was deduced as 285 amino acids (~ 31 kDa). The protein had the highest similarity with amino acid sequence of the endolysin from Propionibacterium phage PHL071N05 with 97.20% identity. The CAP 10-3 endolysin gene was amplified by PCR with primer pairs based on the gene sequence, cloned into an expression vector pET-15b and transformed into Escherichia coli BL21(DE3) strain. The predicted protein band (~ 33 kDa) for the recombinant endolysin was detected in an SDS-PAGE gel and western blot assay. The concentrated supernatant of cell lysate from E. coli BL21(DE3) (pET-15b_CAP10-3 end) and a partially purified recombinant CAP 10-3 endolysin showed antibacterial activity against C. acnes KCTC 3314 in a dose-dependent manner. In conclusion, the recombinant CAP 10-3 endolysin was successfully produced in E. coli strain and it can be considered as a therapeutic agent candidate for treatment of human skin acne.

Introduction Soft tissue defects are a devastating complication of prosthetic joint infections (PJI) after total knee arthroplasty (TKA). Rotational flaps are commonly utilized to address these defects with variable reports of success. This study aimed to identify predictors of poor outcomes in rotational muscle flap placement after prosthetic knee infections. The authors hypothesized that outcomes may vary based on infecting pathogen and treatment characteristics. Methods 44 cases of rotational muscle flaps for prosthetic knee infection were retrospectively evaluated at a tertiary referral hospital from 2007 to 2020. Muscle flap types included 39 medial and four lateral gastrocnemius, and one anterior tibialis. Minimum follow-up was 1 year (median: 3.4 years). Primary outcome was flap-related complications. Secondary outcomes included recurrent infection requiring additional surgery, final joint outcomes, and mortality. Results One-year complication-free flap survivorship was 83.9%, recurrent infection-free survivorship was 65.7%, and amputation-free survivorship was 79%. Multivariable cox regression revealed that rheumatoid arthritis diagnosis (HR: 3.4; p = .028) and methicillin-resistant Staphylococcus aureus -positive culture (HR: 4.0; p = .040) had increased risk, while Coagulase-negative Staphylococcus infections had reduced risk for recurrent or persistent infection (HR: 0.2; p = .023). Final joint outcome was retained TKA implant in 18 (40.9%), amputation in 15 (34.1%) patients, and definitive treatment with articulating spacer in 10 (22.7%). 5-years survivorship from death was 71.4%. Conclusion Rotational muscle flaps for soft tissue coverage of the knee are often performed in limb salvage situations with poor survivorship from flap complications, reinfections, and amputation. When considering surgical options for limb salvage, patients should be counseled on these risks.

Aqueous zinc batteries (AZBs) have garnered attention as a low-cost and safe alternative to commercial lithium-ion batteries. However, the use of aqueous electrolytes has plagued electrochemical performance of AZBs particularly at sub-zero temperatures, which has hindered the expansion of their applications. Most previous studies have focused on the weakening of hydrogen bonds between water molecules, with little attention to the underlying intermolecular interactions such as dipole−dipole, dipole−ion, and ion−ion. Here, we review the design principles of low-temperature electrolytes for practical AZBs based on the mechanistic insights into the relevant intermolecular interactions, in addition to the previously prevalent approaches of hydrogen bond regulation. The electrokinetic phenomena behind the sluggish ion transport in the bulk electrolytes and the limited charge transfer at the electrode−electrolyte interface below freezing temperatures are described together with the theoretical elucidation. Based on this understanding, key determinants for the low-temperature aqueous electrolytes and their contribution to the electrochemical performance of AZBs are discussed in terms of intermolecular interactions. Lastly, we suggest the development directions and outlook of the low-temperature aqueous electrolytes, with a focus on elucidation of atomic-scale intermolecular interactions, electrode−electrolyte interface engineering, electrolyte restructuring, and cell design and electrolyte requirements for practical energy-dense AZB applications.

Category: Ankle Arthritis; Ankle Introduction/Purpose: Although many patients with postraumatic ankle arthritis are of a younger age, studies evaluating the impact of age on outcomes of primary total ankle arthroplasty (TAA) reveal heterogenous results. The purpose of this study is to determine the effect of age on complication rates and patient reported outcomes after TAA. Methods: This was a retrospective study of 1,185 primary TAA divided into 3 age cohorts (Age < 55, n=219; Age55-70, n=688; Age>70, n=278). Patient demographics, intraoperative variables, postoperative complications, and patient reported outcome measures were compared among groups using univariable analyses. Multivariable Cox regression was performed to assess risk for implant failure by age group. Mean follow-up was 5.7 years. Results: Compared to Age55-70 and Age>70 groups, Age < 55 patients had the lowest mean ASA score (2.2 vs 2.4 vs 2.5; p< 0.001) and highest rates of all complications (33.8% vs 23.1% vs 19.8%; p=0.001), implant failure (9.1% vs 6.0% vs 3.2%; p=0.022), and component removal (5.0% vs 2.8% vs 1.1%; p=0.030). Univariable and multivariable cox regression analysis revealed decreased risk for implant failure for Age>70 compared to Age < 55 patients (HR: 0.43 [95%CI: 0.19-0.94], p=0.034; and HR: 0.42 [95%CI: 0.18-0.95], p=0.038, respectively). Across the AOFAS Hindfoot and all FAOS subscales, Age < 55 group reported the lowest (worst) mean pre and postoperative scores (p < 0.001). The age < 55 group had the highest mean VAS score at final follow-up (22 vs 14 vs 14; p< 0.001). Conclusion: Studies involving large sample sizes with mid-to long-term follow up are critical to reveal age-related impacts on outcomes after TAA. Younger patients had higher rates of complications and implant failure and fared worse on patient reported outcome measures in the largest single-institution series to date evaluating the effect of age on outcomes in TAA.

Category: Ankle Arthritis; Other Introduction/Purpose: Utilization rates of total ankle arthroplasty (TAA) have greatly increased in recent years. For patients with rheumatoid arthritis (RA) undergoing TAA, conflicting data have been reported regarding risk of complications and patient reported outcome (PRO) improvement when compared to patients with osteoarthritis. The purpose of this study is to compare complication rates and PROs of patients with RA to patients with osteoarthritis and posttraumatic arthritis. Methods: This was a retrospective study of 1,071 primary TAA performed at a single institution between 2001 and 2020. Minimum follow-up was two years. Patients were stratified by indication for TAA (osteoarthritis, n=372; posttraumatic arthritis, n=642; RA, n=57). Patient demographics, intraoperative variables, postoperative complications, and PRO measures were compared between groups using univariable statistics. Multivariable Cox regression was performed to assess risk for implant failure. Mean follow-up was 5.6 years (SD: 3.1). Results: Compared to the osteoarthritis and posttraumatic arthritis groups, the RA cohort had the lowest mean age (p < 0.001), lowest percentage of males (p < 0.001), and highest ASA score (p < 0.001). Univariate analysis showed no statistically significant difference for infection rates among groups (p=1.0). The RA cohort had the highest rate of heterotopic ossification postoperatively (2/57, 3.5%, p< 0.001). Multivariable regression analysis showed no increased risk of implant failure for the RA cohort (p=0.23). For the SMFA, SF-36, AOFAS-hindfoot, FAOS-symptoms, and FAOS-ADL the RA group reported the worst scores at final follow-up (p < 0.001). However, the RA cohort demonstrated the largest improvements from preoperative to postoperative scores on the FADI, SF-36, and the symptoms and ADL subscales of the FAOS (p=0.04, 0.01, 0.03, 0.03). Conclusion: In the largest single institution study to date, patients with RA had the worst PRO scores compared to the osteoarthritis and posttraumatic arthritis groups. However, they experienced significantly higher improvements in functional outcomes from their preoperative baseline. Large patient samples with mid- to long-term follow up such as a presented in this series are imperative to fully understand the risk-benefit of TAA in various patient cohorts.

Category: Ankle Arthritis Introduction/Purpose: End stage arthritis is a debilitating condition that significantly affects patients’ quality of life. Ankle arthritis differs from arthritis of the hip and knee in that ankle arthritis is often posttraumatic in nature and affects a younger patient population. Historically, younger age was a contraindication to total ankle arthroplasty (TAA) and ankle arthrodesis was the mainstay of treatment. Advances in TAA implant design and revision implants has expanded indications and increased usage of TAA. Despite this, many surgeons remain hesitant due to the lack of long term data on patient outcomes and survivorship in these patients. The purpose of our study was to evaluate patient reported outcome measures and survivorship after primary TAA in patients < 50 years of age at the time of surgery. Methods: A retrospective chart review was conducted of patients < 50 years of age who underwent primary TAA at a single institution from 2010-2020. Patient demographics, outcome measures, and complications were recorded. All patients had a minimum clinical follow up of 5 years. Patient reported outcome (PRO) measures collected included FADI, VAS, SMFA SF-36, AOFAS hindfoot scores, and FAOS scores. Outcome measures were evaluated preoperative, 1 year postoperative, and at final clinical follow up. Paired t-tests were performed to compare individual patients’ changes in PRO from preoperative to postoperative timepoints. Multiple comparisons correction was performed using the Bonferroni method. Implant survivorship was evaluated based on need for revision of either the tibial or talar component. Results: A total of 59 patients were included in the study. The average age at time of surgery was 43.2 years. All patients had a minimum follow up of 5 years with a mean follow up time of 8.8 years. Mean FADI improved from 53.3 (sd:14.1) preoperatively to 16.1 (sd:11.4) (p < 0.001) at 1-year postoperatively. Mean VAS and SMFA also improved from preoperative to 1-year postoperative timepoints [VAS: 68.2 (sd:27.0) to 10.3(sd:13.1) (p < 0.001); SMFA: 36.1 (sd:12.2) to 14.8 (sd:13.7) (p < 0.001)]. A total of 5 patients required revision of components during the follow up period. Three patients required complete revision of both tibial and talar components, 2 due to aseptic loosening and 1 due to deep infection requiring explant of components. Conclusion: Patients < 50 years undergoing TAA for end stage ankle arthritis have improved patients reported outcomes greater than 5 years after surgery. Despite the increased demands of the younger population, survivorship of total ankle implants in our study was 85% at a mean of 8.8 years postoperative. We believe that TAA is a safe and reliable option for young patients with high patient satisfaction at mid term follow up.

Category: Ankle; Sports Introduction/Purpose: A growing body of evidence favors the use of dynamic fixation techniques such as suture endo button over rigid screw fixation for syndesmotic injuries. However, specific dynamic fixation techniques have been poorly evaluated. The purpose of this study was to compare single suture-endobutton fixation (single) to double fixation with suture-endobuttons placed one centimeter (cm) apart (double 1 cm) and double fixation with suture-endobuttons placed three cm apart (double 3 cm). Methods: Twenty-four lower leg specimens from twelve cadavers were tested using a custom biaxial apparatus. Internal rotation, external rotation, and anterior and posterior translation of the tibia and fibula were examined using motion tracking systems after transection of deltoid and syndesmotic ligaments to compare three syndesmotic repair techniques: 1) a single suture-endobutton placed 1 cm above the joint line, 2) two suture suture-endobuttons placed 2 and 3 cm above the joint line, and 3) two suture- endobuttons placed 1 and 4 cm above the joint line. Results: All three endobutton constructs improved the stability of the syndesmosis by reducing aberrant motion after transection. There was no clear superiority of either single suture-endobutton (SEB), double suture-endobuttons placed 2 and 3 cm above the joint line (DSEB 1), or double suture-endobuttons placed 1 and 4 cm above the joint line (DSEB 3). DSEB 3 and DSEB 1 showed equal median laxity for tibia internal rotation (2.7 degrees, DSEB 1 (2.0 – 3.2) degrees, DSEB 3 (2.3 – 2.8) degrees), tibia external rotation (-0.2 degrees, DSEB 1 (-0.4 - 0.4) degrees, DSEB 3 (-0.4 - 0.3) degrees), and fibula external rotation (-0.3 degrees, DSEB 1 (-0.7 - 0.3) degrees, DSEB 3 (-0.7 - 0.7) degrees). Conclusion: Cadaveric biomechanical studies are critical to evaluate various suture-endobutton constructs prior to widespread use in patients. Our results demonstrate that the added cost of a second suture-endobutton may not confer substantial additional stability to the syndesmosis. Likewise, increased spread between suture-endobuttons appears to have minimal impact of syndesmotic stability.

Category: Ankle Arthritis Introduction/Purpose: The Vantage total ankle arthroplasty (TAA) features a design based on careful study of arthritic ankles and current ankle biomechanics, with theoretical advantages of a vertically-oriented tibial fixation and a fully congruent talar dome bone-implant interface. In this design-team, single-institution investigation, we report early-to-intermediate term clinical and radiographic outcomes, implant survivorship, and complications of the Vantage TAA. Methods: We retrospectively reviewed prospectively collected data for 278 consecutive patients undergoing Vantage fixed-bearing TAA. Ankles with coronal plane deformity > 25 degrees and suspected poor bone quality were prospectively excluded. Prospectively collected data includes: PROMIS, SF-36, SMFA, VAS and AOFAS hindfoot-ankle scores. Using previously published and commonly accepted evaluation methods, independent radiographic analysis, performed by a non-design surgeon investigator, included pre-operative, 1-year, and most recent follow-up assessments of 2-plane alignment, component position, and the bone- implant interface. A non-design surgeon investigator with dedicated training in statistics performed the statistical analysis using descriptive statistics to report PROM and radiographic measures and Kaplan-Meier survivorship analysis. Results: Mean patient age was 64.8yrs (range:33-86), 44.2% were female, and mean follow-up was 3.1yrs (2.0-5.5). Mean preoperative and postoperative PROMs were as following: PROMIS-Depression 50.3+/-4.2 and 45.6+/-9.8, PROMIS-Physical Function 39.0+/-3.4 and 45.0+/-7.8, SF-36 total score 55.8+/-15.3 and 73.2+/-20.0, SMFA-Function 29.0+/-13.5 and 15.9+/-5.4, VAS 15.8+/-24.8 and 3.1+/-10.1, and AOFAS hindfoot-ankle 46.3+/-16.5 and 81.1+/-16.3 (Table 1). Radiographic lucency at the bone- implant interface was noted in 33 (18.5%) TAAs at final follow-up; 20 (11.2%) were progressive. Lucency was almost exclusive to the tibial component. Implant survivorship was 99.6% [98.9-100.0] at 1-year and 93.3% [88.7-98.2] at the 5-year mark (Table 2, Figure 1). We identified suboptimal bone preparation, initial component alignment and/or component position in all 11 implant failures (Table 3). Conclusion: At early-to-intermediate followup, we observed favorable clinical outcomes, radiographic results and implant survivorship for the fixed-bearing Vantage TAA, especially with optimal bone preparation and component position. Tibial component lucency remains a concern and warrants further investigation. Suboptimal bone preparation, initial component alignment and/or component position was observed in all implant failures.

Category: Ankle Arthritis; Ankle Introduction/Purpose: Younger age remains at the forefront of discussion when deciding between total ankle arthroplasty (TAA) and the ankle arthrodesis (AA) for treatment of end stage ankle arthritis. Unlike in the hip and knee, ankle arthritis is typically post-traumatic and presents at a much younger patient age. With the goal of preserving ankle motion, improving function and limiting adjacent joint degeneration, TAA has been shown to be safe and effective in patients < 55 years of age. However, it is not uncommon for debilitating ankle arthritis to occur in individuals within their fourth or even third decade of life resulting in significant patient comorbidity. The purpose of our study was to evaluate patient reported outcome measures and survivorship after primary TAA in patients < 35 years old. Methods: A retrospective chart review was conducted of patients < 35 years old who underwent primary TAA at a single institution from 2007-2020. Patient demographics, outcome measures, and complications were recorded. All patients had a minimum clinical follow up of 2 years. Patient reported outcome measures collected included VAS, SMFA dysfunction index, SF-36 and AOFAS hindfoot scores. Outcome measures were evaluated preoperative, 1 year postoperative, and at final follow up. Paired t-tests were performed to compare individual patients’ changes in PRO from preoperative to postoperative timepoints. Implant survivorship was evaluated as well as complications related to the index procedure. Implant survivorship based on need for complete revision of either the tibial or talar component Results: Twelve patients were included in the study. Average age at surgery was 28.5 years. Mean follow-up was 7.2 years. Mean VAS improved from 53.8 preoperatively to 14.7 (p= 0.152) at 1-year and 12.5 (p= 0.045) at final follow up, respectively. Mean SMFA improved from 40.0 preoperatively to 27.1 (p= 0.018) at 1-year and 24.0 (p= 0.006) at final follow up, respectively. SF-36 and AOFAS hindfoot scores also improved at 1 year and final follow-up compared to preoperative values [SF-36: 45.3 to 60.2 (p=0.06) and 67.0 (p=0.016); AOFAS: 40.6 to 70 (p= 0.08) and 68.9 (p=0.068)]. One patient required talar component revision due to aseptic loosening. One patient required subsequent removal of heterotopic bone due to impingement. No patients developed infection requiring surgical intervention. Conclusion: The onset of ankle arthritis typically occurs at a much younger age compared with that of the hip and knee and has a detrimental impact on patient quality of life. Despite a young age and increased activity demands, our results demonstrated that patients < 35 with end-stage ankle arthritis undergoing TAA demonstrated improved patient-reported outcomes greater than 2 years after surgery. Survivorship of TAA in our study was 91.7% at a mean follow-up of 7.2 years. We believe that TAA is a safe, effective and durable option for very young patients with high patient satisfaction at early to mid-term follow up.

Category: Ankle Arthritis Introduction/Purpose: Obesity is a well-established risk factor for complications after total hip and knee arthroplasty. The incidence of total ankle arthroplasty (TAA) continues to grow, but few studies have evaluated TAA outcomes in patients with obesity. The present study sought to measure the impact of obesity on TAA outcomes using a national database. Methods: The 2012-2020 National Surgical Quality Improvement Program (NSQIP) database was queried for primary TAA (CPT:27002). 1,610 patients were identified and stratified by preoperative body mass index (BMI): non-obese (18 5-29.9kg/m 2 , n=760), obesity class I (30.0-34.9kg/m 2 , n=455), and class II and III (>35.0kg/m 2 , n=395). Preoperative and perioperative patient data, operative time, hospital length of stay (LOS), and 30-day complications were compared using univariable statistics. Multivariable analyses controlling for patient characteristics were employed to measure the effect of obesity on operative time and LOS. Results: Compared to the non-obese group, obesity class II and III patients were younger (61.9 versus 65.6 years;p < 0.001), more female (57.2% versus 42.0%;p < 0.001), higher ASA class (p < 0.001) and had more comorbidities such as hypertension, diabetes, and dyspnea (p < 0.001). Mean preoperative albumin was lower (p=0.013) and white blood count was higher (p < 0.001) in the obesity class II and III group. Home discharge rate was lowest in class II and III patients (88.6%;p=0.017). Multivariable regression revealed longer hospital LOS for obesity class II and III (μ=0.21; p=0.005) relative to the non-obese group. Obesity group was not associated with operative time or 30-day readmissions and reoperations. Conclusion: Obesity class II and III patients undergoing TAA had more comorbidities and longer hospital LOS compared to lower BMI patients. Despite the well-established association between obesity and postoperative complications after hip and knee arthroplasty, the present NSQIP analysis of 1,610 TAA patients did not find a greater burden of acute complications among patients with obesity.

Category: Ankle Arthritis Introduction/Purpose: Total joint arthroplasty is increasingly being performed in younger individuals across the United States. While age-specific outcomes have been evaluated in total hip and knee replacements, the data are not as clear for total ankle arthroplasty (TAA). The purpose of this study was to analyze TAA outcomes and complications by age to improve shared decision-making when considering ankle replacements. Methods: A total of 1,619 primary and revision TAAs from 2012-2020 were collected and included from the National Surgical Quality Improvement Program. Patients were stratified by age into groups less than 55, between 55-70, and greater than 70 years of age. Demographics, medical comorbidities, ASA class, operative time, 30-day complications, and comorbid conditions were compared by univariable analysis. Multivariable analysis was used to analyze readmission rates, reoperation rates, operative time, and hospital length of stay. Results: By univariable analysis, patients greater than 70 have significantly more comorbidities when compared to patients younger than 55. Younger patients have a significantly longer hospital stay, with an average of 1.64 days for those younger than 55 compared to patients 55-70 (1.50 days) and patients older than 70 (1.38 days, p< 0.001). Younger patients also have a significantly longer operative time and a higher risk of still being in the hospital after 30 days (p < 0.001, p=0.034). By multivariable analysis, patients 55-70 have a statistically lower risk of readmission compared to the other two cohorts (p = 0.043). Conclusion: As the incidence of total ankle arthroplasty increases across all ages, it is important to understand specific risks for each age group. Patients younger than 55 experience higher operative times and longer lengths of stay. Patients between 55-70 have a significantly lower risk of reoperation but longer hospital stays. Patients older than 70 tend to have lower reoperation rates, lower readmission rates, and shorter operative times.

Category: Ankle; Other Introduction/Purpose: The Invision talar component was launched in 2018 as a revision total ankle arthroplasty (TAA) specific option geared towards avoiding further subsidence when poor talar bone stock is present. Due to the recency of the market- availability of the Invision, studies evaluating the efficacy of the implant, even in the short-term, are lacking. Thus, the purpose of this study was to present the early-term outcomes of a series of patients undergoing revision TAA with the use of the Invision talar component. Methods: This was a single-center, retrospective review of 28 patients undergoing revision TAA with the Invision talar component and Inbone II tibial component (Wright Medical; Memphis, Tennessee) performed between 2007 and 2022. Mean follow-up was 1.3 ± 0.93 years. Data on patient preoperative characteristics, postoperative complications, and survivorship were collected. The primary outcome measures were time to major complication, reoperation, and infection. Results: The most common concurrent procedures performed with revision TAA with the Invision talar component were gastrocnemius recession (n=14, 50%), subtalar arthrodesis (n=3, 10.7%) and cotton osteotomy (n = 1, 3.6%). The mean preoperative coronal deformity off the tibia was 4.07 ± 3.06 degrees for varus and 3.67 ± 4.36 degrees for valgus deformities, respectively, and postoperatively, was 1.67 ± 2.16 degrees for varus and 2.00 ± 3.48 degrees for valgus. The mean preoperative coronal plane deformity off the talus was 4.83 ± 6.68 degrees for varus and 4.22 ± 4.21 degrees for valgus, respectively, and postoperatively, was 1.23 ± 2.45 degrees for varus and 2.32 ± 3.93 degrees for valgus. The survivorship from any complication, major complication, reoperation, and infection is shown in Table 2. Conclusion: In a series of 28 patients undergoing revision TAA with the Invision talar component and Inbone II tibial component, we demonstrate a survivorship of 92.7% at 1-year follow up. The Invision appears to have a reasonable safety profile in this non- designer series. The implant compares favorably with others utilized in the revision TAA setting at the early-term, but further studies evaluating mid-and long-term outcomes are required to fully assess the efficacy of the Invision.

Category: Ankle Arthritis Introduction/Purpose: As total ankle arthroplasty (TAA) rises in popularity nationwide, the incidence of major complications and need for revision TAA will continue to increase. A better understanding of the ability to durably correct deformity and improve patient reported outcomes (PROs) in the TAA revision setting is paramount for surgeons facing the impending wave of failed TAA. Thus, the purpose of this study was to present the largest single-center case series of revision TAA to date and to evaluate improvement in PROs and maintenance of correction of coronal plane deformity in patients undergoing this procedure. Methods: This was a single-center, retrospective review of 87 revision TAAs performed between 2007 and 2022. Reoperations for cyst formations only or without metallic component exchange were excluded. The two most common implants used for revision TAA were Inbone II (n=65) and Inbone I (n=14). Mean follow-up was 2.8 ± 2.9 years. Data on patient preoperative characteristics, concurrent procedures, and postoperative complications were collected. The primary outcome measures were time to major complication, reoperation, and infection. Secondary outcomes included PROs and correction of coronal plane deformity measured from both the tibial plafond and talar articulating surface from pre- to post-operatively. Cox regression analyses were performed to compute survivorship. Results: The most common concurrent procedures performed concomitantly with revision TAA were gastrocnemius recession (n=31, 35.6%), subtalar arthrodesis (n=18, 20.7%), and talonavicular arthrodesis (n=5, 5.7%). Mean preoperative coronal plane deformity measured off both the tibial plafond and talar articular surface improved after revision TAA. 1- and 5-year survivorship from major complication, reoperation, and infection is shown in Table 2. Fourteen patients underwent subsequent revision, including TAA (n= 6, 6.9%), arthrodesis (n= 4, 4.6%), below-the-knee amputation (n= 2, 2.3%), or implantation of an antibiotic spacer (n= 2, 2.3%). At one-year postoperatively, mean VAS pain score, SF36, and AOFAS Hindfoot score was 18.2 ± 16.0, 73.0 ± 13.3, and 68.8 ±:9.3, respectively, representing an improvement in PROs after revision TAA. Conclusion: In the largest single-center series of patients undergoing single or double component exchange revision TAA, we demonstrate durable improvements in coronal plane deformity measured off both the tibial plafond and talar articular surface. We also noted 63.0% survivorship with regards to reoperation and improvements in average PROs across the cohort. Overall, revision TAA is a successful procedure, but is associated with higher failure rates at 5 years than primary TAA.

Category: Ankle Arthritis Introduction/Purpose: There is limited data evaluating the effect of obesity on outcomes following total ankle arthroplasty (TAA), especially in adequate sample sizes to detect impacts on patient reported outcomes (PROs). The purpose of this study was to assess the effect of obesity on complication rates and PROs. Methods: This was a single-institution, retrospective study of 1,093 primary TAA performed between 2001 and 2020. Minimum follow-up was 2 years. Patients were stratified by body mass index (BMI) into Control (BMI=18.5-29.9; n=615), Obesity Class I (BMI=30.0-34.9; n=285), and Obesity Class II (BMI>35.0; n=193) groups. Patient information, intraoperative variables, postoperative complications, PRO measures were compared between groups using univariable statistics. Multivariable Cox regression was performed to assess risk for implant failure. Mean follow-up was 5.6 years (sd:3.1). Results: Compared to Control and Class I, Class II patients had the lowest mean age (p=0.001), highest mean ASA score (p < 0.001), and greatest proportion of female sex (p < 0.001) and Black/African American race (p=0.005). There were no statistically significant differences in postoperative complications (infection, implant failure, or impingement) across the BMI classes (p>0.05). Preoperatively, Class II had lower (worse) mean scores for FAOS Pain and ADL subscales than Controls (posthoc pairwise p< 0.001 for both). At final follow-up, both Class II and Class I had lower (worse) mean SMFA (posthoc pairwise p< 0.001 and p=0.030, respectively) and SF36 scores (posthoc pairwise p< 0.001 and p=0.005, respectively) than Controls. Conclusion: At midterm follow-up, obesity was not associated with increased rates of complications after TAA. Patients with obesity reported worse musculoskeletal function and overall quality of life after TAA but there was no differential improvement in PROs across BMI classes. To our knowledge, this is the largest single institution study to date examining the effect of obesity on outcomes after primary TAA.

Abstract The Advanced Mo-based Rare process Experiment (AMoRE)-Pilot experiment is an initial phase of the AMoRE search for neutrinoless double beta decay of $$^{100}$$ 100 Mo, with the purpose of investigating the level and sources of backgrounds. Searches for neutrinoless double beta decay generally require ultimately low backgrounds. Surface $$\alpha $$ α decays on the crystals themselves or nearby materials can deposit a continuum of energies that can be as high as the Q-value of the decay itself and may fall in the region of interest (ROI). To understand these background events, we studied backgrounds from radioactive contaminations internal to and on the surface of the crystals or nearby materials with Geant4-based Monte Carlo simulations. In this study, we report on the measured $$\alpha $$ α energy spectra fitted with the corresponding simulated spectra for six crystal detectors, where sources of background contributions could be identified through high energy $$\alpha $$ α peaks and continuum parts in the energy spectrum for both internal and surface contaminations. We determine the low-energy contributions from internal and surface $$\alpha $$ α contaminations by extrapolating from the $$\alpha $$ α background fitting model.

Abstract In tauopathy conditions, such as Alzheimer's disease (AD), highly soluble and natively unfolded tau polymerizes into an insoluble filament; however, the mechanistic details of this process remain unclear. In the brains of AD patients, only a minor segment of tau forms β‐helix‐stacked protofilaments, while its flanking regions form disordered fuzzy coats. Here, it is demonstrated that the tau AD nucleation core (tau‐AC) sufficiently induced self‐aggregation and recruited full‐length tau to filaments. Unexpectedly, phospho‐mimetic forms of tau‐AC (at Ser324 or Ser356) show markedly reduced oligomerization and seeding propensities. Biophysical analysis reveal that the N‐terminus of tau‐AC facilitates the fibrillization kinetics as a nucleation motif, which becomes sterically shielded through phosphorylation‐induced conformational changes in tau‐AC. Tau‐AC oligomers are efficiently internalized into cells via endocytosis and induced endogenous tau aggregation. In primary hippocampal neurons, tau‐AC impaired axon initial segment plasticity upon chronic depolarization and is mislocalized to the somatodendritic compartments. Furthermore, it is observed significantly impaired memory retrieval in mice intrahippocampally injected with tau‐AC fibrils, which corresponds to the neuropathological staining and neuronal loss in the brain. These findings identify tau‐AC species as a key neuropathological driver in AD, suggesting novel strategies for therapeutic intervention.

Association of Cardiovascular Surgeons of Russia Russian Society of Cardiology (RSC)Association of Pediatric Cardiologists of RussiaRussian Scientific Society of Specialists in X-Ray Endovascular Diagnostics and TreatmentAll-Russian Public Organization for the Promotion of Radiation Diagnostics and Therapy "Russian Society of Radiologists and Radiologists".Task Force members declared no financial support/conflicts of interest. If conflicts of interest were reported, the member(s) of the working group was (were) excluded from the discussion of the sections related to the area of conflict of interest.

A persistent sciatic artery (PSA) is a rare embryologic variant that usually presents with aneurysmal degeneration. This report describes a 66-year-old man with severe comorbidities who presented with right forefoot gangrene and severe acute respiratory syndrome coronavirus 2 infection. Imaging revealed a unilateral PSA with a chronic occlusion at the level of the knee joint with no aneurysm. After coronavirus disease 2019 resolution, he underwent CO2 angiography with successful recanalization of the PSA, followed by transmetatarsal amputation that healed uneventfully. At follow-up after 16 months, he was noted to have asymptomatic thrombosis of his stent and, hence, no intervention was performed.

An efficient development of competency-based educational process requires lecturers with high scientific and innovative potential. In order to increase considerably such competencesof senior lecturers and teaching assistants Far Eastern State Technical Fisheries University implements Master’s programme for their training, which provides a noticeable increase in academic potential as well as creation of methodically self-developing environment at theacademic department while lecturers-candidates for Master’s degree are working on their pedagogical theses.

Purpose To assess how resident and attending ophthalmologists perceive and evaluate ethically controversial scenarios regarding mentorship, authorship, and ethics compliance that may occur during research involving residents.

Background: Planar scintigraphy has long been indicated in patients receiving I-131 therapy for thyroid cancer to determine the anatomic location of metastases. We studied our experience upon implementing additional single-photon emission (SPECT)-CT scanning in these patients. Method: We performed a retrospective study of consecutive adult patients with newly diagnosed thyroid cancer treated with I-131 between 2011 and 20 17. Radiologic findings detected with planar scintigraphy alone vs those identified with SPECT-CT scanning were primary endpoints. Result: In this study, 212 consecutive patients with thyroid cancer were analyzed in two separate cohorts (107 planar scintigraphy alone and 105 planar scintigraphy with SPECT-CT). The addition of SPECT-CT resulted in more findings, b oth thyroid-related and incidental. However, we identified only 3 of 21 cases in whi ch SPECT-CT provided an unequivocal additional benefit by changing clinical managemen t beyond planar scintigraphy alone. No difference in the detection of distant me tastatic disease or outcome was identified between cohorts. Conclusion: Synergistic SPECT-CT imaging in addition to planar nuclear scintigraphy adds limited clinical value to thyroid cancer patients harboring a low risk of distant metastases, while frequently identifying clinically insignificant findings. These data from a typical cohort of patients receiving standard thyroid cancer care provide insight into the routine use of SPECT-CT in such patients.

For the first time, the content of heavy metals in the river ice in the lower Amur River has been analyzed, taking into account the stratigraphic heterogeneity of the ice structure in the river channel. According to the conditions of origin and duration of formation, the main varieties of ice were identified – layered frozen ice, naled-type (icing) ice, and hummocky ice. The most widespread in the Amur ice cover is ice consisting of layers forming hummocky-frozen, hummocky-naled and homogeneous frozen ice sequences. The aim of the study was to determine the content of heavy metals in different ice varieties and the possibility of using this data to assess river pollution during the winter period. The highest content of heavy metals was found in the naled ice, which is due to its formation on the ice surface contaminated during the winter. The minimum content was found in the layered frozen ice, which is formed throughout the winter due to accretion from below. In the layers of hummocked ice formed for several days during the autumn ice drift, metals have average content and uniform distribution within the entire thickness. Influence of Khabarovsk city in winter period is most noticeable by the content of metals in the frozen variety of Amur river ice near its right bank, where the city is located. High concentrations were noted for Pb and Zn, and less pronounced for Cu and Ni. Ice is more informative object than water under the ice, and its chemical composition can serve as an indicator of the ecological state of the river during the freezing period.

Background: Retrotransposons with long terminal repeats (LTR retrotransposons) are widespread in all groups of eukaryotes and are often both the cause of new mutations and the source of new sequences. Apart from their high activity in generative and differentiation-stage tissues, LTR retrotransposons also become more active in response to different stressors. The precise causes of LTR retrotransposons’ activation in response to stress, however, have not yet been thoroughly investigated. Methods: We used RT-PCR to investigate the transcriptional profile of LTR retrotransposons and piRNA clusters in response to oxidative and chronic heat stresses. We used Oxford Nanopore sequencing to investigate the genomic environment of new insertions of the retrotransposons. We used bioinformatics methods to find the stress-induced transcription factor binding sites in LTR retrotransposons. Results: We studied the transposition activity and transcription level of LTR retrotransposons in response to oxidative and chronic heat stress and assessed the contribution of various factors that can affect the increase in their expression under stress conditions: the state of the piRNA-interference system, the influence of the genomic environment on individual copies, and the presence of the stress-induced transcription factor binding sites in retrotransposon sequences. Conclusions: The main reason for the activation of LTR retrotransposons under stress conditions is the presence of transcription factor binding sites in their regulatory sequences, which are triggered in response to stress and are necessary for tissue regeneration processes. Stress-induced transposable element activation can function as a trigger mechanism, triggering multiple signal pathways and resulting in a polyvariant cell response.

Abstract P-type point contact (PPC) HPGe detectors are a leading technology for rare event searches due to their excellent energy resolution, low thresholds, and multi-site event rejection capabilities. We have characterized a PPC detector’s response to $$\alpha $$ α particles incident on the sensitive passivated and p $$^+$$ + surfaces, a previously poorly-understood source of background. The detector studied is identical to those in the Majorana Demonstrator experiment, a search for neutrinoless double-beta decay ( $$0\nu \beta \beta $$ 0 ν β β ) in $$^{76}$$ 76 Ge. $$\alpha $$ α decays on most of the passivated surface exhibit significant energy loss due to charge trapping, with waveforms exhibiting a delayed charge recovery (DCR) signature caused by the slow collection of a fraction of the trapped charge. The DCR is found to be complementary to existing methods of $$\alpha $$ α identification, reliably identifying $$\alpha $$ α background events on the passivated surface of the detector. We demonstrate effective rejection of all surface $$\alpha $$ α events (to within statistical uncertainty) with a loss of only 0.2% of bulk events by combining the DCR discriminator with previously-used methods. The DCR discriminator has been used to reduce the background rate in the $$0\nu \beta \beta $$ 0 ν β β region of interest window by an order of magnitude in the Majorana Demonstrator and will be used in the upcoming LEGEND-200 experiment.

The obesity epidemic has led to the growing number of bariatric operations and the expansion of indications for this operation as the most effective method of treatment, that’s why endocrinologists are increasingly faced the challenge of late complications, including postbariatric hypoglycemia. Postbariatric hypoglycemia is a rare but severe metabolic disorder that occurs months or years after upper gastrointestinal surgery. Postbariatric hypoglycemia can be accompanied by severe clinical symptoms and lead to disability and decreasing of the life’s quality. It is difficult to assess the prevalence of hypoglycemia after bariatric surgery due to the lack of clear diagnostic criteria, often a hidden clinical picture and ignorance of doctors and patients about this complication. Hypoglycemia in this case has postprandial and hyperinsulinemic nature. The mechanisms of development of this complication have recently been actively discussed. The exchange of incretins and dysregulation of insulin secretion are the subject of constant research in this area. Understanding the mechanisms of development of this condition makes it possible to develop optimal methods of diagnosis and treatment. The issues of pathophysiology, basic principles of diagnosis and treatment of post-bariatric hypoglycemia will be considered in this review.

Purpose: To report a series of 8 phakic eyes of 8 patients with open angle glaucoma with uncontrolled intraocular pressure on maximum tolerable medical therapy receiving Hydrus Microstent implants combined with concomitant OMNI Surgical System ab interno canaloplasty. Observations: 8 phakic eyes underwent Hydrus Microstent implantation with OMNI Surgical System ab interno canaloplasty. 2 patients underwent concurrent Kahook Dual Blade goniotomy and 1 patient underwent a concurrent micropulse transscleral cyclophotocoagulation. 6 out of 8 eyes achieved successful intraocular pressure reduction. Only 1 achieved success without the need for additional medical therapy. 1 required Neodymium-doped yttrium aluminum garnet laser to clear iris obstruction of the Hydrus inlet and 1 required selective laser trabeculoplasty for additional intraocular pressure lowering. 2 out of 8 eyes required subsequent incisional glaucoma surgery for unacceptable intraocular pressure levels despite maximum tolerable medical therapy. Conclusions and Importance: The Hydrus Microstent combined with OMNI Surgical System ab interno canaloplasty can safely and successfully reduce intraocular pressure in phakic patients with open-angle glaucoma with uncontrolled intraocular pressure on maximum tolerable medical therapy with a low complication rate and rapid visual recovery.

Background: Two-stage revision arthroplasty is the gold standard for treating chronic prosthetic joint infection (PJI), but there has been limited analysis of the costs incurred beyond the index procedure and how additional complications and/or surgeries impact the cost of care. Methods: The electronic health record was queried for patients who underwent a total hip arthroplasty complicated by PJI and then underwent removal of the prosthesis with implantation of an antibiotic-impregnated articulating cement spacer. Patient demographics, surgical variables, hospital readmissions, emergency department (ED) visits, and postoperative complications were recorded. Data on total costs were collected with an internal accounting database. The average follow-up duration was 3.35 years. Results: Univariate analyses showed statistically significant differences between outcome groups (reimplantation, reimplantation requiring later revision, retained spacer, and Girdlestone resection arthroplasty) in total overall costs, ED visit costs, and postoperative costs at 1 and 2 years after the initial spacer placement. The median total cost at 2 years for each group was $38,865 ($29,144-49,471) (reimplantation), $79,223 ($53,442-100,152) (reimplantation with revision), $54,096 ($20,872-73,903) (retained spacer), $62,134 ($52,135-101,546) (Girdlestone). Patients who underwent successful reimplantation requiring no further surgery had significantly lower total costs than patients who needed revision surgeries after reimplantation ($38,865 [$29,144-49,471] vs $79,223 [$53,442-100,152], P = .007). Patients with a Girdlestone resection arthroplasty had higher total costs at 1 year ($59,708 [$41,781-80,916] vs $33,093 [$27,237-40,429], P = .043) and higher costs attributable to ED visits at 2 years than the reimplantation group ($23,581 [$14,029-41,519] vs $15,307 [$6291-29,119], P = .009). Conclusions: A significant variation exists among total costs for the 2-stage treatment of hip PJI when stratified by the final outcome.

While most patients with follicular lymphoma (FL) have excellent outcomes with frontline chemoimmunotherapy (CIT), a subset of patients will experience early progression, which is associated with poor subsequent outcomes. Novel biomarkers are needed to identify high-risk patients earlier. We hypothesized that interim positron emission tomography (PET) would predict progression-free survival (PFS) in this population. We retrospectively identified 128 patients with grade 1–3A FL who had an interim PET after 2–4 cycles of frontline CIT at 2 academic centers. PET scans were analyzed using Deauville score (DS) and change in maximum standardized uptake value (ΔSUVmax). Interim PET DS was a significant predictor of PFS (P < 0.003). Patients with a DS of 3 had outcomes similar to those of patients with a DS of 4, so were categorized as PET-positive for additional analyses. Interim PET remained a strong predictor of PFS (DS 3-5, hazard ratio [HR] 2.4, P = 0.006) in a multivariable analysis and was also an early predictor of both a positive end-of-treatment PET (P < 0.001) and progression of disease within 24 months (POD24) (P = 0.006). An optimal ΔSUVmax cutoff of 75% was selected using the bootstrap method. ΔSUVmax