"Meniscal" scar as a landmark for the joint line in revision total knee replacement

$\textbf{AIM}$: To determine whether tissue identified at the joint line was actually remnant "meniscal" scar tissue or not. $\textbf{METHODS}$: Nine patients undergoing revision knee surgery following informed consent had meniscal scar tissue sent to the histology department for analyses. All revisions were performed where joint line had been raised or lowered at earlier surgery. Although preoperative radiographic evaluations suggested that the joint line had been altered, intraoperatively there was scar tissue at the level of the recreated joint line. This scar tissue has traditionally been described as meniscal scar, and to identify the origins of this tissue, samples were sent for histological analyses. The tissue samples were stored in formalin, and embedded and sectioned before undergoing histochemical staining. All samples underwent macroscopic and microscopic examination by a histopathologist who was blind to the study aims. The specific features that were examined included tissue organisation, surface and central composition, cellular distribution including histiocytes, nuclear ratio and vasculature. Atypical and malignant features, inflammation and degeneration were specifically looked for. A statistical review of the study was performed by a biomedical statistician. $\textbf{RESULTS}$: The histological findings for the nine patients showing the macroscopic and microscopic findings, and the conclusion are outlined in a Table. The histological analyses were reviewed to determine whether the tissue samples were likely to be meniscal scar tissue. The response was yes (2, 22%), no (6, 67%) and maybe (1, 11%) based on the conclusions. The results were "yes" when on macroscopy, firm cream tissue was identified. In these two "yes" samples, microscopic analyses showed organised fibrous tissue with focal degenerative areas with laminated pattern associated with histiocytes peripherally but no inflammation. The "no" samples were assessed macroscopically and microscopically and were deemed to have appearances representing fibrous synovial tissue and features in keeping with degenerate scar tissue or connective tissue. One sample was indeterminate and microscopically contained fibro-collagenous tissue with synovial hyperplasia. It also contained some degenerate hyalinised tissue that may represent cartilage, but the appearances were not specific. $\textbf{CONCLUSION}$: Based on our pilot study, we recommend reliance on a number of markers to identify the joint line as outlined above, and to exercise caution in using the "meniscal" scar

Covid-19 and herbal practice: A United Kingdom practitioner survey

Objectives: To identify the effect of the Covid-19 pandemic on UK herbal medicine practice and how herbal medicine practitioners are supporting people with Covid-19. / Design: Mixed-methods e-survey. / Methods: The survey link was distributed through professional associations and social media. Quantitative data were descriptively summarised and qualitative data were analysed using content analysis. / Results: Results from 59 responses indicated a profound effect of the pandemic on herbal medicine practice, with a move to remote working and a reduction in client numbers. Practitioners reported prescribing a wide range of medicinal plants, chiefly Glycyrrhiza glabra L. and Echinacea spp. alongside providing information and advice. Few reported inter-professional collaboration. / Conclusions: Herbal practitioners need to build on current collaborations, research and experience to develop consistent approaches to support people with mild-moderate Covid-19 symptoms. More systematic exploration of herbal medicine practice during and as a consequence of the pandemic is needed

Chondromyxoid fibroma management: a single institution experience of 22 cases

Background: Several different strategies have been reported for the treatment of chondromyxoid fibromas, all with variable outcomes and high recurrence rates. Methods: We report on 22 consecutive cases of chondromyxoid fibromas treated by intralesional curettage, four of which had adjuvant cementation at our institution between 2003 and 2010. We assessed the functional outcome using the Musculoskeletal Tumour Society (MSTS) scoring system. Results: Nine males and 16 females with a mean age of 36.5 years (range 11 to 73) and a mean follow-up of 60.7 months were included in the study. Local recurrence occurred in two patients (9%) within the first 2 years following the index procedure. This was treated by re-curettage only of the residual defect. Two postoperative complications occurred: a superficial wound infection in one patient and a transient deep peroneal nerve neurapraxia in the other. The mean postoperative MSTS score was 96.7%. Conclusions: Intralesional curettage and cementation is as an effective treatment strategy for chondromyxoid fibromas, providing satisfactory functional results with a low recurrence rate. Careful case selection with stringent clinical and radiographic follow-up is recommended

Challenges in applying human factors approaches to health service design

A participatory systems approach is a fundamental characteristic of the human factors and ergonomics discipline. However, the appropriate application of relevant methods is challenging in healthcare, since there is very limited time for staff to participate and their knowledge on design methods is usually very limited. An action research was carried out in a health service design project commissioned by a local health service commissioner. The aim of this paper is to examine and discuss challenges in applying the participatory systems approach

Critical materials supply and risk

Rare earth Elements (REEs) are a subset of Critical materials (CMs) and are found in numerous modern electronic products and advanced technologies where, due to their unique physical and chemical properties, they cannot be substituted. Disruption in their supply chain has the potential to cause devastating impacts on production and consumers. To help manage such disruptions, this research focusses on the areas of critical materials, supply chain resilience, and supply chain risk. Research has established the challenges that can occur from disruptions caused by up-stream suppliers, necessitating supply-side resilience strategies. Supply-side risk factors associated with CMSs differ from conventional material supply chain risk, and it is advocated that they cannot be effectively managed through traditional material supply risk management practices. This study investigates the research on CMs that appears around the periphery of the OM (operations management) field by adopting a systematic literature review. Findings show a dearth of research work directly focused on REEs and CMs from within the OM field. Importantly, a call is made for OM researchers to investigate REEs and CMs based on the imperative that geopolitics, resource scarcity and environmental issues present

COVID-19 and herbal practice: A United Kingdom practitioner survey

Objectives: To identify the effect of the COVID-19 pandemic on UK herbal medicine practice and how herbal medicine practitioners are supporting people with COVID-19. Design: Mixed-methods e-survey. Methods: The survey link was distributed through professional associations and social media. Quantitative data were descriptively summarised and qualitative data were analysed using content analysis. Results: Results from 59 responses indicated a profound effect of the pandemic on herbal medicine practice, with a move to remote working and a reduction in client numbers. Practitioners reported prescribing a wide range of medicinal plants, chiefly Glycyrrhiza glabra L. and Echinacea spp. alongside providing information and advice. Few reported inter-professional collaboration. Conclusions: Herbal practitioners need to build on current collaborations, research and experience to develop consistent approaches to support people with mild-moderate COVID-19 symptoms. More systematic exploration of herbal medicine practice during and as a consequence of the pandemic is needed. What is already known about the topic: • The COVID-19 pandemic has had a large impact on all types of healthcare • The impact on herbal medicine practice is unclear What this paper adds: • The COVID-19 pandemic has substantially affected UK herbal medicine practice • A wide range of medicinal plants are currently used by herbal practitioners to support people with COVID-19 • Herbal practitioners need to develop consistent holistic approaches to support people with mild-moderate symptoms of COVID-1

A pH-responsive, endosomolytic liposome functionalized with membrane-anchoring, comb-like pseudopeptides for enhanced intracellular delivery and cancer treatment

Low intracellular delivery efficiency and multidrug resistance are among major barriers to effective cancer therapy. Herein, we report a novel, virus-mimicking, endosomolytic liposomal drug-delivery platform to address these two key challenges. The pH-responsive, comb-like pseudopeptides were prepared by grafting relatively long alkyl side chains onto a polyamide, poly(L-lysine isophthalamide), to mimic fusogenic peptides in viral spikes. The cholesterol-containing liposome, which mimics the viral envelope, was readily coated with these pseudopeptides due to their hydrophobic side chains acting as membrane anchors. These endosomolytic pseudopeptides displayed high adsorption onto the liposomal membrane and enabled the significantly higher cellular uptake. The virus-mimicking system showed a pH-triggered content-release profile which could be manipulated by varying the structure and concentration of the adsorbed polymers. The endosomolytic ability of the multifunctional liposome and its use for efficient intracellular delivery of the widely used anticancer drug doxorubicin (DOX) were demonstrated. The virus-mimicking liposomal system with DOX encapsulation exhibited considerably higher potency against HeLa cervical cancer cells, A549 lung cancer cells, MES-SA uterus cancer cells, and MES-SA/DX5 multidrug-resistant cancer cells than DOX-loaded bare liposomes and free DOX. These results suggest its potential applications for enhanced cytoplasmic delivery and cancer treatment

Prion propagation is dependent on key amino acids in Charge cluster 2 within the prion protein

To dissect the N-terminal residues within the cellular prion protein (PrPC) that are critical for efficient prion propagation, we generated a library of point, double, or triple alanine replacements within residues 23-111 of PrP, stably expressed them in cells silenced for endogenous mouse PrPC and challenged the reconstituted cells with four common but biologically diverse mouse prion strains. Amino acids (aa) 105-111 of Charge Cluster 2 (CC2), which is disordered in PrPC, were found to be required for propagation of all four prion strains; other residues had no effect or exhibited strain-specific effects. Replacements in CC2, including aa105-111, dominantly inhibited prion propagation in the presence of endogenous wild type PrPC whilst other changes were not inhibitory. Single alanine replacements within aa105-111 identified leucine 108 and valine 111 or the cluster of lysine 105, threonine 106 and asparagine 107 as critical for prion propagation. These residues mediate specific ordering of unstructured CC2 into β-sheets in the infectious prion fibrils from Rocky Mountain Laboratory (RML) and ME7 mouse prion strains

A participatory systems approach to design for safer integrated medicine management

It is recognised that whole systems approaches are required in the design and development of complex healthcare services. Application of a systems approach benefits from the involvement of key stakeholders. However, participation in the context of community based healthcare is particularly challenging due to busy and geographically distributed stakeholders. This study used action research to investigate what processes and methods were needed to successfully employ a participatory systems approach. Three participatory workshops planned and facilitated by method experts were held with 30 representative stakeholders. Various methods were used with them and evaluated through an audit of workshop outputs and a qualitative questionnaire. Findings on the method application and participation are presented and methodological challenges are discussed with reference to further research. Practitioner Summary: This study provides practical insights on how to apply a participatory systems approach to complex healthcare service design. Various template-based methods for systems thinking and risk-based thinking were efficiently and effectively applied with stakeholders