Comparison of functional outcomes of pertrochanteric fractures of the femur managed with dynamic hip screw with a locking side plate versus proximal femoral nail

Background: In current practice, proximal femoral nail (PFN) and dynamic hip screw (DHS) with locking side plate are the implant of choice in stable trochanteric fractures. Most of the deficiencies of the standard DHS have been addressed by the introduction of the Locking side plate. There are plenty of studies comparing standard DHS and PFN. But studies comparing locking DHS and PFN are scarce in current literature. This study aimed to compare the outcomes of both implants in stable pertrochanteric fractures. Methods: The objective of this study was to assess and compare the clinical outcomes of using locking DHS and PFN for fixation in 40 patients who were admitted to SUT Academy of Medical Sciences between October 2017 and April 2019. The modified Harris hip score was used to evaluate the patients' progress, and regular follow-up was conducted to compare their outcomes. Results: Among the DHS group, the mean Harris hip score was 83.05, with excellent results observed in 2 patients (10%), good results in 12 patients (60%), fair results in 5 patients (25%), and poor results in 1 patient (5%). In comparison, the PFN group had a mean Harris hip score of 85.50, with excellent results seen in 6 patients (30%), good results in 10 patients (50%), fair results in 3 patients (5%), and poor results in 1 patient (5%). Conclusions: The DHS group had more patients with good and fair outcomes, while the PFN group had more patients with excellent and good outcomes. Based on these findings, we can conclude that both the PFN and DHS with locking side plate are similarly effective in treating stable intertrochanteric fractures.

Analysis of results of huge segmental bone loss of tibia treated with Ilizarov external fixator: our experience in Indian population

Background: Orthopaedic surgeons face challenges in treating complex tibial fractures with bone loss due to complications like infection, repeat surgeries, and patient psychological burden. The Ilizarov external fixator approach offers better clinical and radiological results, addressing these issues. The purpose of this study was to examine the outcome of tibial segmental loss treated with the Iliazrov external fixator. Methods: The study was done between January 2015 to December 2021. It’s a prospective as well as retro-prospective study. The age group of 18-65 years was considered. Patients were monitored monthly, up to nine months post-surgery, or until bone union. Functional and bone outcomes of the patients were evaluated using ASAMI criteria, knee society score, and St. Pierre ankle scoring system. Results: The study included 20 patients, all of them were male and had a mean age of 34.1±10.1. Bone union was achieved in all cases. After ilizarov application, the average bone defect was 82.6±42.9 mm. The final regeneration attained was 75.1±47.5 mm. The average limb length difference was 20.41±6.55 mm after achieving union. Out of 20 patients, 13 and 4 had good and fair ASAMI score, 1, 4, and 13 had fair, good, and excellent knee society score, and17 had fair St. Pierre score and 3 patients were lost to follow-up. Conclusions: Ilizarov technique is an excellent way for treating complicated tibial fractures. The difficulties, challenges, and complications associated with Ilizarov external fixation are negligible compared to the significant difficulties associated with open techniques

MOSAIC: Multi-Object Segmented Arbitrary Stylization Using CLIP

Style transfer driven by text prompts paved a new path for creatively stylizing the images without collecting an actual style image. Despite having promising results, with text-driven stylization, the user has no control over the stylization. If a user wants to create an artistic image, the user requires fine control over the stylization of various entities individually in the content image, which is not addressed by the current state-of-the-art approaches. On the other hand, diffusion style transfer methods also suffer from the same issue because the regional stylization control over the stylized output is ineffective. To address this problem, We propose a new method Multi-Object Segmented Arbitrary Stylization Using CLIP (MOSAIC), that can apply styles to different objects in the image based on the context extracted from the input prompt. Text-based segmentation and stylization modules which are based on vision transformer architecture, were used to segment and stylize the objects. Our method can extend to any arbitrary objects, styles and produce high-quality images compared to the current state of art methods. To our knowledge, this is the first attempt to perform text-guided arbitrary object-wise stylization. We demonstrate the effectiveness of our approach through qualitative and quantitative analysis, showing that it can generate visually appealing stylized images with enhanced control over stylization and the ability to generalize to unseen object classes.Comment: Camera ready, New Ideas in Vision Transformers workshop, ICCV 202

Predicting postoperative systolic dysfunction in mitral regurgitation: CT vs. echocardiography

IntroductionVolume overload from mitral regurgitation can result in left ventricular systolic dysfunction. To prevent this, it is essential to operate before irreversible dysfunction occurs, but the optimal timing of intervention remains unclear. Current echocardiographic guidelines are based on 2D linear measurement thresholds only. We compared volumetric CT-based and 2D echocardiographic indices of LV size and function as predictors of post-operative systolic dysfunction following mitral repair.MethodsWe retrospectively identified patients with primary mitral valve regurgitation who underwent repair between 2005 and 2021. Several indices of LV size and function measured on preoperative cardiac CT were compared with 2D echocardiography in predicting post-operative LV systolic dysfunction (LVEFecho <50%). Area under the curve (AUC) was the primary metric of predictive performance.ResultsA total of 243 patients were included (mean age 57 ± 12 years; 65 females). The most effective CT-based predictors of post-operative LV systolic dysfunction were ejection fraction [LVEFCT; AUC 0.84 (95% CI: 0.77–0.92)] and LV end systolic volume indexed to body surface area [LVESViCT; AUC 0.88 (0.82–0.95)]. The best echocardiographic predictors were LVEFecho [AUC 0.70 (0.58–0.82)] and LVESDecho [AUC 0.79 (0.70–0.89)]. LVEFCT was a significantly better predictor of post-operative LV systolic dysfunction than LVEFecho (p = 0.02) and LVESViCT was a significantly better predictor than LVESDecho (p = 0.03). Ejection fraction measured by CT demonstrated significantly greater reproducibility than echocardiography.DiscussionCT-based volumetric measurements may be superior to established 2D echocardiographic parameters for predicting LV systolic dysfunction following mitral valve repair. Validation with prospective study is warranted

NALP3 inflammasome upregulation and CASP1 cleavage of the glucocorticoid receptor cause glucocorticoid resistance in leukemia cells

Glucocorticoids are universally used in the treatment of acute lymphoblastic leukemia (ALL), and resistance to glucocorticoids in leukemia cells confers poor prognosis. To elucidate mechanisms of glucocorticoid resistance, we determined the prednisolone sensitivity of primary leukemia cells from 444 patients newly diagnosed with ALL and found significantly higher expression of CASP1 (encoding caspase 1) and its activator NLRP3 in glucocorticoid-resistant leukemia cells, resulting from significantly lower somatic methylation of the CASP1 and NLRP3 promoters. Overexpression of CASP1 resulted in cleavage of the glucocorticoid receptor, diminished the glucocorticoid-induced transcriptional response and increased glucocorticoid resistance. Knockdown or inhibition of CASP1 significantly increased glucocorticoid receptor levels and mitigated glucocorticoid resistance in CASP1-overexpressing ALL. Our findings establish a new mechanism by which the NLRP3-CASP1 inflammasome modulates cellular levels of the glucocorticoid receptor and diminishes cell sensitivity to glucocorticoids. The broad impact on the glucocorticoid transcriptional response suggests that this mechanism could also modify glucocorticoid effects in other diseases

Magnetically Maneuvered Bioceramic Nanostructures Cures Dental Hypersensitivity

Dental hypersensitivity is an acute pain triggered by everyday stimuli, like extremes of temperature or pH, affecting more than one billion people worldwide. The condition occurs when dentinal tubules are exposed through enamel loss or cementum erosion of the tooth, stimulating nerves located in the peripheral odontoblast zone of the pulp. Existing treatments, such as sensitive toothpastes and adhesive resins, offer short-term relief and are often ineffective, leaving patients reliant on continuous interventions. Here, we demonstrate a new approach to cure dental hypersensitivity using nanoparticles made of magnetic bioactive glass called "CalBots." These sub-micron particles can be maneuvered up to 300 µm deep inside the dentinal tubules for both human and murine teeth, thereafter, triggering the formation of a biocompatible seal and thus preventing response of the exposed tubules and their nerve fibers to external stimuli. We demonstrate CalBots to be non-toxic to animals, at least up to a dosage of 550 mg/kg bodyweight of the animal. Our controlled animal trial experiments, featuring various control groups, demonstrated a remarkable 100% recovery from dental hypersensitivity within the treatment group. In contrast, none of the other groups, encompassing four control groups and one negative control group, exhibited any signs of recovery. The temporal efficacy of our CalBot-based treatment protocol surpasses that of current toothpaste-based solutions available in the market by providing pain relief for a duration orders of magnitude more than the standard 24-48 hours

Percutaneous Removal of Left Atrial Myxoma

Surgical resection has been the treatment of choice for cardiac myxomas, but older age and comorbidities relegate many patients to observation. Pure percutaneous removal of left atrial myxomas is both intriguing and challenging. We report a successful percutaneous technique for removal of left atrial cardiac myxoma in a nonsurgical candidate. (Level of Difficulty: Advanced.