Relevance of posterior malleolar fracture fixation to ankle syndesmotic reduction, a comparative study

Background: Appropriate distal tibiofibular syndesmotic reduction is crucial to restore ankle stability, guard against future arthrosis with worse functional outcome. Optimal technique for syndesmotic reduction has been a matter of debate. This study aimed at radiological evaluation of syndesmotic integrity following two methods of reduction (posterior malleolar fixation and trans-syndesmotic screw fixation), additionally, correlating the posterior malleolus size to the radiological results of both techniques.Methods: Syndesmotic integrity was compared after each technique as per translational and rotational fibular positions. Utilizing, preoperative and postoperative computed tomography scans of injured ankle, the fibular antero-posterior and Medio-lateral translation distances were measured. Additionally, the fibular rotation angle was calibrated. Incidence of inadequate reduction in each group was reported. Preoperative and postoperative radiological findings were compared and correlated to posterior malleolus size in relation to tibial articular distance.Results: A significant difference between both techniques was noted in term of fibular rotation. In patients with PM ˂ 10% of tibial articular surface, a significant difference was obvious in postoperative AP-translational and rotational findings between both techniques. Overall malreduction incidence rate of 68.9% was reported in this study, with 84.7% rate in patients managed with SS-fixation, whilst 51.2% rate in those managed via PM-fixation.Conclusions: Posterior malleolar fixation could limit syndesmotic malreduction risk whatsoever it’s size. Approaching CT reference values for syndesmotic reduction might benefit preoperative planning and detect intraoperative malreduction. Further future clinical studies correlating these findings to clinical outcome would be more helpful

Peer Social Acceptance of Students with Special Needs

The purpose of this research is to investigate how kids with ASD are accepted socially by their peers. Peer social acceptability may be seen in the manner in which autistic kids are treated by their peers as well as in how they show and demonstrate their desire to participate in various activities. In addition, the many kinds of connections that may be seen between ordinary students and pupils who have ASD. This research is a qualitative study that focuses on description. The participants in this research were classmates and their respective professors. Interviews and observations were the methods of data collection that were employed for this investigation. The method of data analysis that was employed was called descriptive analysis, and it included reducing the amount of data, presenting the data, and deriving conclusions from the data. Verifying the accuracy of the authors claims by using methods such as triangulation, extended observations, and consultation with others. Students who have ASD spectrum disorder may participate in social activities with their peers. The classroom instructors support and understanding helps ordinary students better appreciate the condition of students with ASD. The teacher also understands children with ASD when they have tantrums and may be an aid when students with ASD are having problems. Social interactions and group relations are the types of relationships that may develop between children with ASD and their typical classmates. Regular students are able to create group interactions with students who have ASD with the assistance of the class teachers promotion of the formation of study groups

Tremor in cervical dystonia

Background: Cervical dystonia (CD) is the most common form of focal dystonia encountered in the clinic. Approximately one-third of CD patients have co-existing tremor in the head and hands. Assessment of tremor as regular or irregular in context of its oscillation trajectory, frequency, and amplitude is a major clinical challenge and can confound the diagnosis of CD. The misdiagnosis may lead to therapeutic failures, poor quality of life, and poor utilization of medical and financial resources.Methods: We analyzed the largest cohort of CD patients (n = 3117) available to date, collected from 37 movement disorder centers in North America, Europe, and Asia. We used machine learning to determine what clinical features from clinician reports predicted the presence of tremor as well as its regular or irregular appearance.Results: Out of 3,117 CD patients, 1,367 had neck tremor. The neck tremor was interpreted as irregular in 1,022, regular in 345, and mixed (both irregular and regular) in 442. A feature importance analysis determined that greater severity of CD, longer disease duration, and older age, in descending order, predicted the presence of neck tremor. The probability of neck tremor was reduced if the dystonia affected other body parts in addition to the neck. We also found a significantly heightened risk for developing neck tremor in women. An additional feature importance analysis indicated that increased severity of dystonia affecting other body parts, severity of CD, and prolonged disease duration was associated with a lower likelihood of regular neck tremor while increased age predicted a higher likelihood.Conclusion: Machine learning recognized the most relevant clinical features that can predict concurrent neck tremor and its irregularity in a large multi-center dystonia cohort. These results may facilitate a more accurate description of neck tremor and improved care path in CD

Selecting Key Drivers for a Successful Lean Construction Implementation Using Simos’ and WSM: The Case of Egypt

Despite the use of numerous new and advanced technologies in construction projects, the industry’s efficiency remains low. This business has faced significant challenges for a long time, such as non-value-added activities, also known as waste. Lean construction (L.C.) is one method for improving the situation by reducing waste and increasing value for the client. This study provides an in-depth literature review to provide a comprehensive list of all critical drivers and groups all these drivers into one research paper in order to determine the importance (weights) of these drivers and their relative importance, and to propose an innovative methodology for ranking them using Simos’ approach. Seven construction project case studies were proposed. Their lean status was assessed, the key-list was verified using a Weighted-Sum Model as a multi-criteria decision-making technique to rank them, the best one in terms of lean implementation was found. Subsequently, a sensitivity analysis was conducted to determine the most critical criterion for the key list. The following are some of the study’s main findings: 18 key drivers were identified and ranked, a clear definition of the client’s requirements was the most global weight between factors, and the case studies demonstrated that more than 60% of the lean drivers are implemented in Egypt. Day-to-day observation and standardized work were the top two most widely used lean practices in Egypt

Morphology, differentiation and matrix production of liver cells in organoid cultures high density cultures of fetal rat livers

Tlie aim of this study \\as to dcn~ons t ratetl ie morpl~ologya nd matrix synthesis of ernl~ryonicr at liver cc.11\ (clay IS of gestation) in organoid cultures (high densit!, cultures) with electron microscopic and imm~~nomorphologictaelc hniclues. For this purpose tlie cells of embryonic rat livers were isolated enzyniaticall! and g r o ~i1~1 ;iin organoid culture (high clensit!, c ~ ~ l t u r e ) l'or .; weeks in n Trowell systern. During the first 48 h n sor t ing-o~~ptr ocess took place. i.e. liver and bloodforming cells met to form aggregates. In between mescncliynial cells were seen. Vessel-like cavities cleceloped. Electron microscopic inspection of the hepatocytes did not reveal any lesions of the cell organelles after 14 days in culture. As late as after a 3-week culture period niitochondrial s\~cllings ancl an increasecl number of autopliagic cacuole\ \\.ere ohse~.vccl. A rim of collagenous fibrils or fibrillar hun~llcs ancl granular matrix structul-es uas perceptible ;I\ earl! as after 7 days in culture. Immunofluoresccnce microscopic t e c h n i q~~eresv ealed collagen types 111. IV and V1 as well as laminin. nidogen. lieparansulfateproteoglycan and fibronectin in these areas. Thus, the composition of the matrix in this c u l t ~ ~ rsey stem corresponds (apart from the absence of collagen type 1 ) to tlie embryonic situation. Therefore. the organoid culture appears to be a n appropriate technicl~let o stuciy the l > c l i a ~ i oo~f~ lri epatocytes in \,itro. It is especially suited to clenionstrate the formation of matrix coliiponents in liver cells and their extracellular occurrence