Functional outcome of an arthroscopic anatomical single bundle anterior Cruciate Ligament (ACL) reconstruction using Semi-tendinosus graft with fixation using Endo-button on femoral side and Suture Disc on Tibial side- A prospective clinical study

Background: Injury to the anterior cruciate ligament (ACL) is one of the most frequent injuries of the knee during different sports activities. Arthroscopic surgical reconstruction is the current standard of care for treatment of ACL injuries in young and active patients. The widespread adoption of ACL reconstruction over primary repair was based on early perception of the limited healing capacity of the ACL. Hamstring tendon is most favoured graft for ACL reconstruction. We wanted to study the outcomes particular method of fixation for fixing the hamstring tendon.Methods: In this study 30 patient with ACL injury were treated arthroscopically for the fixation of graft in bone tunnel we use endobutton for femur and suture disc for tibia as suspensor implant and prospective assessment of functional outcome using Tegner Lysholm knee scoring system.Results: The preoperative activity level could be maintained in 70% of the patients. The Lysholm score showed very good and good results in 80%. Functional and stability results in about 70% of the patients.Conclusions:This surgical technique can be recommended for the active patient with ACL deficiency. The functional outcome of anterior cruciate ligament reconstruction with quadrupled semitendinosus tendon autograft using Endobutton and suture disc is good. This method of fixation will help the graft to facilitate graft tunnel healing and also maintain its strength until there is a good graft to bone healing occurs completely

Plating as an operative management of intra articular fractures of the upper end of tibia: a prospective clinical study

Background: Tibial plateau fracture management is challenging because of the severe displacement of the bony fragments, the concomitant depression and impaction of the cancellous subchondral bone, and the inevitable associated cartilage injury.Methods: A prospective cohort study of 25 patients who suffered high energy intra-articular fractures of proximal tibia was done and they were diagnosed and classified according to Schatzker’s classification. The study was done to study the outcomes of surgical management of high energy tibial plateau fractures with buttress plate, to achieve anatomical reduction and absolute stable internal fixation to prevent malunion, to achieve early mobilisation, to prevent post-operative knee stiffness and also to determine timing of operation after trauma and sequence of fixation of bicondylar fractures. All patients were treated with open reduction and internal fixation with a buttress plate either a lateral, medial or bicondylar plating.Results: Average radio-graphic bony union time was 12 weeks. Average full weight bearing time was 13 weeks. Knee stiffness improved with physiotherapy and full range was achieved on an average in 8 weeks, mean range of movement 0-124.5º was achieved. 4 patients (16%) developed infection. Conclusions: Fractures of upper end of tibia can be treated with the plating technique, to achieve anatomical reduction and stable internal fixation with 82% good functional outcome. The plating technique facilitates early mobilisation of injured joint and attains good range of movements. Minimal mal reduction does not seem to vitiate the results. The infection rate of 16% is of concern with this procedure, but responds well to antibiotics and surgical debridement

Circular economy adoption challenges in the food supply chain for sustainable development

Food loss and waste are major issues in the food industry, and they affect all stages of the food supply chain (FSC). Food loss and waste are linked to environmental deterioration, economic loss, and an increase in hunger. Therefore, the food industry requires sustainable consumption and production (SCP) to reduce losses and waste. The circular economy (CE) concept has become a popular strategy for reducing food waste and boosting sustainability. Therefore, with efficient reverse logistics in the FSC, food producers can help achieve sustainable development goals (SDGs) like SCP and zero hunger. In literature, minimal research has been available in identifying the CE adoption challenges in FSC. This research identifies 15 critical challenges from the literature and discussion with the panel of experts. The relationship between the challenges has been established through an interpretive structural modeling (ISM) technique. The challenges were characterized in cause–effect according to their relational intensity obtained using the grey decision-making trial and evaluation laboratory (DEMATEL) technique. Grey's relational theory is applied in DEMATEL to minimize uncertainty and vagueness of the expert judgment. The findings of this study suggest that creating policy from the government, providing incentives, and strictly enforcing environmental regulations are the most critical challenge. Hence, by focusing on the above, the effective adoption of the CE principle is achieved. This result also suggests that by addressing the challenges of CE, corporate social responsibility (CSR) can be performed. This study provides some recommendations for the practitioners to adopt CE towards sustainable development targets

Hypofractionated radiotherapy in post mastectomy locally advanced breast cancer: a study from a regional cancer center in North East India

Background: Adjuvant radiotherapy has increased local-regional and overall survival rates in breast cancer. Conventional fractionation delivering 50-60 Gray (Gy) over 5-6weeks is a standard approach. A shorter duration of hypofractionated treatment will be more convenient for patients and treatment providers if found safe and equally effective.Methods: Around 50 high risk breast cancer patients who underwent mastectomy were enrolled and randomized into the study arms- CF (Conventional Fractionation) Arm (50Gy/25 Fr @ 2 Gy/fraction/day 5 days a week over 5weeks) and HF (Hypo-Fractionation) arm (40.05 Gy/15 Fr @ 2.67 Gy/fraction/day 5 days a week over 3weeks). Treatment related acute and late toxicities, loco-regional recurrence; distant metastasis and survival rates were recorded for comparison.Results: Twenty-five patients were enrolled in each arm with baseline characters well matched. At median follow up of 44 months, OS was 80% in HF arm against 64% in CF arm (p-value: 0.292). HF arm also showed better DFS at 4 years of 76% compared to 64% in CF arm (p-value: 0.411). Although the difference was not significant statistically, the Hazard Ratio of 1.543 (95% CI: 0.549-4.339) for DFS and 1.801 (95% CI: 0.603-5.377) for OS indicated trends towards better outcomes in HF arm in terms of disease control and survival. Acute and late toxicities were also lesser in HF arm, though not statistically significant (all p-values >0.05).Conclusions: In post mastectomy setting, HFRT is comparable to CFRT in terms of safety and efficacy, will be more convenient for patients and care givers and hence can be a routine standard practice

Pediatric multifocal histiocytic sarcoma- a fatal diagnosis not to miss!

Histiocytic sarcoma (HS) is a rare hematolymphoid malignant neoplasm with an aggressive clinical course. It can arise de novo or from low-grade B-cell lymphoma. We describe the case of a 16-year-old boy referred to our hospital with generalized lymphadenopathy, weight loss, and decreased appetite for one month. The patient died undiagnosed on the 7th day of hospitalization. Lymph node and bone marrow biopsies were performed one day before the patient died. The lymph node biopsy revealed an architectural effacement with a diffuse proliferation of large pleomorphic neoplastic cells containing large, multilobulated nuclei, coarse vesicular chromatin, prominent nucleoli, and a moderate amount of eosinophilic cytoplasm. The bone marrow aspiration smears and biopsy also showed evidence of infiltration by these above-mentioned cells. Based on the morphology, along with the exclusion of many differential diagnoses by an extensive panel of immunohistochemical markers, a diagnosis of HS was made. This case report aims at evaluating all the clinical and immunophenotypic features of a case of HS with multifocal presentation and an aggressive clinical course in order to give a correct and definite diagnosis at the proper time

Enablers to achieve zero hunger through IoT and blockchain technology and transform the green food supply chain systems

Food security necessitates a multifaceted strategy, ranging from social protection to providing healthy food. Change in existing food systems is needed to create a more equitable and sustainable society. Hunger is one of the significant challenges in the world that arise due to food insecurity, bad quality, food waste, and losses that leads to damage of public health. The implementation of green food supply chain management (GFSCM) practices in the food supply chain helps in lowering food wastage, carbon emissions, food quality, and safety. To strengthen food security/safety and quality, digital transformation of the supply chain is required, and IoT and blockchain can help in achieving this. Digital transformation of GFSCM has helped to improve food security, safety and quality control. This study identifies modern enablers of food security, safety and quality that transform the GFSCM through Internet of things (IoT) and blockchain to reduce hunger. Zero hunger goal is far behind in India as India reported 117th rank in hunger index, indicating an urgent need to study the digital transformation in green food supply chain towards achieving food quality and security. In this study twelve enablers out of 16 suggested in earlier literatures has been selected and reconfirmed with the feedback of seventeen academia and Industrial experts from Indian food supply chain. We used a two-step combined Interpretive Structural Modeling (ISM) and Analytical Network Process (ANP) technique to examine the enablers contextual interrelationships and significance weights. Findings reveal that IoT and blockchain technologies are the main actuators of the contemporary GFSCM enabling system. ISM provides eight core enablers system that can transform the GFSCM digitally to achieve food quality and security along with achieving zero hunger (SDG2). Inventory management is the least ranked enabler, whereas IoT and blockchain are the top two. Towards achieving zero hunger, some management, theoretical, and policy implications have been suggested

Standard-dose versus high-dose radiotherapy with concurrent chemotherapy in esophageal cancer: A prospective randomized study

Objective: The objective of this study is comparision of local and distant control rates with high-dose versus standard-dose radiotherapy along with concurrent chemotherapy in esophageal cancer – a prospective randomized study. Materials and Methods: Histologically proven Stage I–III patients with carcinoma esophagus were randomized into two groups. One group has been treated with standard-dose radiotherapy, i.e., a total dose of 50.4 Gy (1.8 Gy/day, 28#, 5 days/week). The other group (study arm) has received high-dose radiotherapy, i.e. a total dose of 64.8 Gy (1.8 Gy/day, 36#, 5 days/week). Both groups have received 2 cycles of 3 weekly concurrent chemotherapy (cisplatin 75 mg/m[2] on day 1 and 5-fluorouracil 750 mg/m[2] continuous intravenous infusion over 24 h on day 1–4). Follow-up response evaluation was done by both endoscopy and computed tomography scan after 6–8 weeks and after 2 months thereafter. Results: Out of a total of 28 patients, 68% showed a complete response, 14% showed partial response, and 18% patients developed progressive disease at first and subsequent follow up (median follow-up of 21 months). Among the complete response patients, rates were higher in high-dose group compared to standard-dose radiotherapy group (71% vs. 64%, P = 0.38). Treatment-related toxicities were acceptable in both groups. Conclusion: High-dose radiotherapy with concurrent chemotherapy seems to be more effective with acceptable toxicity in our study. However, further follow-up and large sample size may be required to validate the current study conclusion