Osteotomías distales de los metatarsianos menores realizadas por cirugía abierta vs cirugía percutánea en el tratamiento de las metatarsalgias.

Objetivo. Comparar los resultados clínicos y radiológicos de las osteotomías distales de los metatarsianos menores realizadas por cirugía abierta y por cirugía percutánea en el tratamiento de las metatarsalgias Material y método. Revisión retrospectiva de 44 metatarsalgias: 22 en cada grupo. Recogida de datos epidemiológicos, clínicos y medición de parámetros radiográficos. Resultados. Se consiguieron modificaciones en los parámetros radiográficos con ambas técnicas, con mayor corrección con la cirugía abierta. Las fórmulas metatarsales postoperatorias continuaron siendo no armónicas en ambos grupos. Todos los pacientes mejoraron clínicamente. La cirugía abierta tuvo más complicaciones. Conclusiones. Los resultados clínicos y radiológicos de las osteotomías percutáneas son similares a los obtenidos por cirugía abierta, pero con menos complicaciones. La obtención de una fórmula metatarsal armónica no debería ser el objetivo principal de la cirugía de las metatarsalgias, ya que, según nuestro estudio, no es una condición indispensable para lograr un buen resultado clínicoObjectives. To compare the radiographic and functional outcomes in lesser metatarsal distal osteotomies performed by percutaneous and open surgery for the treatment of metatarsalgia. Methods. A retrospective medical record review of 44 cases of discharge diagnosis of metatarsalgia: 22 patients in each group. Epidemiological data, clinical data and radiological measurements were collected. Results . Improvement of radiological parameters were obtained with both techniques, with better correction with open than with percutaneous surgery. Postoperatively metatarsal parabola continues being nonharmonious in both groups. All patients improved in clinical assessment. Open surgery had more complications than percutaneous surgery. Conclusions . Clinical and radiological outcomes of lesser metatarsal distal osteotomies performed percutaneously are similar to those obtained by open surgery, but with fewer complications. To obtain a harmonic metatarsal parabola should not be the main purpose of surgery of metatarsalgia because it is not an essential condition to achieve a good clinical outcome

Space-borne observation of methane from atmospheric infrared sounder: data analysis and distribution over Iraq

Methane (CH4) Volume Mixing Ratio (VMR) at pressure level 925hPa data extracted from Atmospheric Infrared Sounder (AIRS) with spatial resolution of 1°× 1° covering whole of Iraq and surrounding regions (28.5°–38.5°N, 37.5°–49.5°E) have been examined for the period from January 2003 to December 2013. The results show a considerable increasing of CH4 with maximum values at north and north eastern regions during autumn and the early winter, whereas the minimum values appeared at the pristine desert environment at the west and the south-west region during spring months. For more accuracy validation the trend analysis was applied on the retrieved AIRS data at three different stations are Mosul, Baghdad and Basrah. The mean and standard deviation in Mosul, Baghdad and Basrah was (1.8657 ± 0.0198, 1.8536 ± 0.0196, 1.8448 ± 0.0212) ppmv respectively for monthly long term trend analysis. Monthly trend analyses have positive trends (0.0040, 0.0039 and 0.0042) ppmv.y-1 for Mosul, Baghdad and Basrah Consecutively. These results indicate that Satellite observations efficiently present the temporal and spatial variations of the CH4 for the considered study Area

Suppressing scratch-induced brittle fracture in silicon by geometric design modification of the abrasive grits

The overarching goal of this research was to investigate the application of spherically shaped abrasive particles in achieving ductile-mode cutting. Scratching experiments were carried out to assess the differences between arbitrarily and spherically shaped diamond and tungsten carbide (WC) grits in inducing brittle fracture or ductile plasticity in single-crystal silicon. It was observed that the arbitrarily shaped particles produce brittle fracture in contrast to the spherically shaped grits. The sharp edges and corners of grits result in high tensile stress-concentrated regions causing cracking and spalling. Contrary to this, spherically shaped WC particles induce uniform cutting pressure, which suppresses the extent of the brittle fracture and the mode of material removal was completely dominated by ductile-cutting until a threshold load for ductile-to-brittle transition (the first cracks appearance). These observations are expected to provide a suitable pathway in making the Diamond Wire Sawing machining operations more robust by providing a control on brittle damage

PREPARATION AND EVALUATION OF FENTANYL TRANSDREMAL PATCHES USING LIDOCAINE AS A MODEL DRUG AND AZELAIC ACID AS A PENETRATION ENHANCER

Transdermal drug delivery offers numerous advantages over the conventional routs of administration; however, poor permeation of most drug across the skin barrier constitutes a major limitation of this rout. Objective: The possibility of utilizing azelaic acid as penetration enhancer was investigated. And then development of a new transdermal controlled-release device using of non-medicated and lidocaine transdermal patches and then testing the feasibility of loading fentanyl patch. Methods: DSC, FTIR, X-ray diffraction analysis and skin permeability measurements were done for both skin sample untreated and treated with azelaic acid to prove the possibility of utilizing it as permeation enhancer. Multilayered lidocaine transdermal patches were prepared by solvent/evaporation casting technique using Eudragit® E100 as transdermal adhesive polymer, and ethyl vinyl acetate as impermeable backing layer. The flexibility of films required for a good compliance and optimum transdermal adhesion of the Eudragit E films was achieved by employing triethyl citrate or dibutylphthalate at concentration of 25% (w/w) of polymer. A physicochemical interaction between azelaic acid and Eudragit E100 (cationic polymer) has been evaluated using FTIR and DSC. Lidocaine as well as fentanyl bilayerd transdermal patches containing triethylcitrate at concentration of 25% (w/w) of Eudragit E100 with and without azelaic acid were selected for further permeation studies Results: The obtained results indicated that fluorescien permeation through epidermal human skin treated with overnight exposure to saturated aqueous solution of azelaic acid was increased by 8.6 folds while, its permeation through rat skin was increased by 10.89 folds. Additional analysis by FTIR, X-ray diffraction, SEM, and DSC showed that azelaic acid disrupted stratum corneum lipid, which supported its action as promising penetration enhancer.Plasticizers as triethyl citrate or dibutylphthalate at concentration of 25% (w/w) of polymer reduced Tg of Eudragit E100 polymer to about 15.50C and 26.20C respectively. A physicochemical interaction between azelaic acid and Eudragit E100 was proven by FTIR study which indicated the present of ionic bonding between them, while DSC showed that azelaic acid may act as non-traditional plasticizer through its reduction in Tg by 7.30 C.The results of permeation studies indicated that the presence of azelaic acid was significantly increased (P < 0.05) the drug flux as the concentration of azelaic acid increased. As well as; fentanyl transdermal permeability studies revealed similar behavior to lidocaine as drug flux increased by 4.82 folds at AZ concentration of 2mg/cm2. Conclusion: the overall obtained data revealed the feasibility of preparing a controlled release fentanyl transdermal patches containing azelaic acid as penetration enhancer

Surface defects incorporated diamond machining of silicon

Abstract This paper reports the performance enhancement benefits in diamond turning of the silicon wafer by incorporation of the surface defect machining (SDM) method. The hybrid micromachining methods usually require additional hardware to leverage the added advantage of hybrid technologies such as laser heating, cryogenic cooling, electric pulse or ultrasonic elliptical vibration. The SDM method tested in this paper does not require any such additional baggage and is easy to implement in a sequential micro-machining mode. This paper made use of Raman spectroscopy data, average surface roughness data and imaging data of the cutting chips of silicon for drawing a comparison between conventional single-point diamond turning (SPDT) and SDM while incorporating surface defects in the (i) circumferential and (ii) radial directions. Complementary 3D finite element analysis (FEA) was performed to analyse the cutting forces and the evolution of residual stress on the machined wafer. It was found that the surface defects generated in the circumferential direction with an interspacing of 1 mm revealed the lowest average surface roughness (Ra) of 3.2 nm as opposed to 8 nm Ra obtained through conventional SPDT using the same cutting parameters. The observation of the Raman spectroscopy performed on the cutting chips showed remnants of phase transformation during the micromachining process in all cases. FEA was used to extract quantifiable information about the residual stress as well as the sub-surface integrity and it was discovered that the grooves made in the circumferential direction gave the best machining performance. The information being reported here is expected to provide an avalanche of opportunities in the SPDT area for low-cost machining solution for a range of other nominal hard, brittle materials such as SiC, ZnSe and GaAs as well as hard steels.</jats:p

Mutations in PYCR2, Encoding Pyrroline-5-Carboxylate Reductase 2, Cause Microcephaly and Hypomyelination

Despite recent advances in understanding the genetic bases of microcephaly, a large number of cases of microcephaly remain unexplained, suggesting that many microcephaly syndromes and associated genes have yet to be identified. Here, we report mutations in PYCR2, which encodes an enzyme in the proline biosynthesis pathway, as the cause of a unique syndrome characterized by postnatal microcephaly, hypomyelination, and reduced cerebral white-matter volume. Linkage mapping and whole-exome sequencing identified homozygous mutations (c.355C>T [p.Arg119Cys] and c.751C>T [p.Arg251Cys]) in PYCR2 in the affected individuals of two consanguineous families. A lymphoblastoid cell line from one affected individual showed a strong reduction in the amount of PYCR2. When mutant cDNAs were transfected into HEK293FT cells, both variant proteins retained normal mitochondrial localization but had lower amounts than the wild-type protein, suggesting that the variant proteins were less stable. A PYCR2-deficient HEK293FT cell line generated by genome editing with the clustered regularly interspaced short palindromic repeat (CRISPR)-Cas9 system showed that PYCR2 loss of function led to decreased mitochondrial membrane potential and increased susceptibility to apoptosis under oxidative stress. Morpholino-based knockdown of a zebrafish PYCR2 ortholog, pycr1b, recapitulated the human microcephaly phenotype, which was rescued by wild-type human PYCR2 mRNA, but not by mutant mRNAs, further supporting the pathogenicity of the identified variants. Hypomyelination and the absence of lax, wrinkly skin distinguishes this condition from that caused by previously reported mutations in the gene encoding PYCR2’s isozyme, PYCR1, suggesting a unique and indispensable role for PYCR2 in the human CNS during development

Biallelic loss of function variants in PPP1R21 cause a neurodevelopmental syndrome with impaired endocytic function

Next‐generation sequencing (NGS) has been instrumental in solving the genetic basis of rare inherited diseases, especially neurodevelopmental syndromes. However, functional workup is essential for precise phenotype definition and to understand the underlying disease mechanisms. Using whole exome (WES) and whole genome sequencing (WGS) in four independent families with hypotonia, neurodevelopmental delay, facial dysmorphism, loss of white matter, and thinning of the corpus callosum, we identified four previously unreported homozygous truncating PPP1R21 alleles: c.347delT p.(Ile116Lysfs*25), c.2170_2171insGGTA p.(Ile724Argfs*8), c.1607dupT p.(Leu536Phefs*7), c.2063delA p.(Lys688Serfs*26) and found that PPP1R21 was absent in fibroblasts of an affected individual, supporting the allele's loss of function effect. PPP1R21 function had not been studied except that a large scale affinity proteomics approach suggested an interaction with PIBF1 defective in Joubert syndrome. Our co‐immunoprecipitation studies did not confirm this but in contrast defined the localization of PPP1R21 to the early endosome. Consistent with the subcellular expression pattern and the clinical phenotype exhibiting features of storage diseases, we found patient fibroblasts exhibited a delay in clearance of transferrin‐488 while uptake was normal. In summary, we delineate a novel neurodevelopmental syndrome caused by biallelic PPP1R21 loss of function variants, and suggest a role of PPP1R21 within the endosomal sorting process or endosome maturation pathway

Recurrent post-partum coronary artery dissection

Coronary artery dissection is a rare but well-described cause for myocardial infarction during the post-partum period. Dissection of multiple coronary arteries is even less frequent. Here we present a case of recurrent post-partum coronary artery dissections. This unusual presentation poses unique problems for management. A 35 year-old female, gravida 3 para 2, presented with myocardial infarction 9 weeks and 3 days post-partum. Cardiac catheterization demonstrated left anterior descending (LAD) dissection but an otherwise normal coronary anatomy. The lesion was treated with four everolimus eluting stents. Initially the patient made an unremarkable recovery until ventricular fibrillation arrest occurred on the following day. Unsynchronized cardioversion restored a normal sinus rhythm and repeat catheterization revealed new right coronary artery (RCA) dissection. A wire was passed distally, but it was unclear whether this was through the true or false lumen and no stents could be placed. However, improvement of distal RCA perfusion was noted on angiogram. Despite failure of interventional therapy the patient was therefore treated conservatively. Early operation after myocardial infarction has a significantly elevated risk of mortality and the initial dissection had occurred within 24 hours. This strategy proved successful as follow-up transthoracic echocardiography after four months demonstrated a preserved left ventricular ejection fraction of 55-60% without regional wall motion abnormalities. The patient remained asymptomatic from a cardiac point of view

Excess Risk of Maternal Death from Sickle Cell Disease in Jamaica: 1998–2007

Background: Decreases in direct maternal deaths in Jamaica have been negated by growing indirect deaths. With sickle cell disease (SCD) a consistent underlying cause, we describe the epidemiology of maternal deaths in this population. Methods: Demographic, service delivery and cause specific mortality rates were compared among women with (n = 42) and without SCD (n = 376), and between SCD women who died in 1998–2002 and 2003–7. Results: Women with SCD had fewer viable pregnancies (p: 0.02) despite greater access to high risk antenatal care (p: 0.001), and more often died in an intensive care unit (p: 0.002). In the most recent period (2003–7) SCD women achieved more pregnancies (median 2 vs. 3; p: 0.009), made more antenatal visits (mean 3.3 vs. 7.3; p: 0.01) and were more often admitted antenatally (p:,0.0001). The maternal mortality ratio for SCD decedents was 7–11 times higher than the general population, with 41 % of deaths attributable to their disorder. Cause specific mortality was higher for cardiovascular complications, gestational hypertension and haemorrhage. Respiratory failure was the leading immediate cause of death. Conclusions: Women with SCD experience a significant excess risk of dying in pregnancy and childbirth [MMR: (SCD) 719/ 100,000, (non SCD) 78/100,000]. MDG5 cannot be realised without improving care for women with SCD. Tertiary services (e.g. ventilator support) are needed at regional centres to improve outcomes in this and other high risk populations. Universal SCD screening in pregnancy in populations of African and Mediterranean descent is needed as are guidelines fo