Outerbridge classification as a predictor for the need of patellar resurfacement in total knee arthroplasty: a prospective study

Background: Residual anterior knee pain after total knee arthroplasty is one of the common causes of early revision surgery in form of patellar resurfacing and even resurfacing the patella in these circumstances may not relieve the symptoms. So, the decision to perform patellar resurfacing during total knee arthroplasty to prevent anterior knee pain remains controversial. The purpose of this study is to determine if the outerbridge classification can predict the need for Patellar resurfacing as part of total knee arthroplasty.Methods: 100 patients with advanced osteoarthritis of knee fulfilling the inclusion and exclusion criteria were randomized into two groups of 50 patients each. In group A-patellar resurfacing done and in group B-patella was not resurfaced while carrying out TKR. Each patient was assessed intraoperatively and his/her patella classified as per Outerbridge classification. Patients were followed-up at 03, 06 and 12 months postoperatively and assessed by modified hospital for special surgery (HSS) knee scores.Results: In case of Outerbridge class III group there is a statistically significant difference (p value -0.002) in HSS score at 03 months, which becomes highly significant at 06 months (p value -0.001) and 01 year (p value <0.001). Similarly, there is statistically significant difference in HSS score (p value- 0.001) in Outerbridge class IV group at 03 months, 06 months and 01 year.Conclusions: Patellar resurfacing in patients undergoing total knee arthroplasty with patella in Outerbridge class III and IV can be safely carried out to further improve the functional outcome. There is no distinct advantage of resurfacing patella in Outerbridge class I and II in terms of functional gain. Thus, Outerbridge classification for patella can effectively guide us whether to resurface patella or not in patients undergoing total knee arthroplasty.

Comparative study of complications and final outcome between bone patellar tendon bone and hamstring auotgraft in ACL reconstruction

Background: The most common current graft choices in ACL reconstruction are the bone-patellar tendon–bone (BPTB) graft and the quadrupled Hamstring graft. Though BPTB is considered to be the gold standard; hamstring tendon (HT) grafts have increased in popularity over last decade. Our aim in this study is to assess the complications, comorbidities, difficulties and final outcome between BPTB and Hamstring grafts in ACL reconstruction.Methods: 71 male patients with isolated tear of ACL between age group of 18-45 years were included in the study. 35 patients in group A underwent ACL reconstruction using bone patellar tendon bone autograft and 35 patients in group B were managed by reconstructing ACL using quadrupled Hamstring autograft. All the patients in both the groups were followed up at 08 weeks,06 months and 01 year post surgery and evaluated by Lysholm knee scoring system.Results: The Lysholm scoring scale scores in anterior cruciate ligament reconstruction showed that BPTB group and Hamstring group have similar outcome. One case (2.8%) each of patellar fracture and graft contamination occurred in BPTB group. There were 09 cases of superficial infection of which 03 were from BPTB group and 06 were from Hamstring group. Conclusions: There is statistically no significant difference in the overall clinical outcome between bone-patellar tendon- bone and Hamstring autografts. With precise surgical techniques, meticulous attention to sterility and proper wound closure most of the complications in both the techniques can be minimized or avoided

Comparative study between proximal femoral nail and proximal femoral nail antirotation in management of unstable trochanteric fractures

Background: In the management of peri-trochanteric fractures, intramedullary (IM) devices have proven advantage over extramedullary devices. IM devices allow for stable anatomical fixation of more comminuted fractures without shortening the abductor lever arm or changing the proximal femoral anatomy. Between IM devices like proximal femoral nail (PFN) and proximal femoral nail antirotation (PFNA), the helical blade of latter is believed to provide stability, compression and rotational control of the fracture with higher cut out strength. The following study was undertaken in an attempt to compare these two types of Intra-medullary devices.Methods: Between January 2012 and June 2013, 50 patients with unstable intertrochanteric fractures fulfilling inclusion and exclusion criteria, were randomized into 2 groups to undergo CRIF with either standard PFN (n=25) or PFNA (n=25). They were compared in terms of demography, per-operative variables and postoperative parameters including functional evaluation till 1year postoperatively.Results: Background demographic variables, fracture type and pre-injury ambulatory status were comparable between the groups. Operative duration of surgery, amount of blood loss and number of fluoroscopic images were significantly lower in PFNA group as compared to PFN group. Post op complications like infection, non-union, cut out/z-effect, loss of reduction, re-operation and mortality rates didn’t differ significantly between the groups. Post op functional recovery as evaluated by pain, use of walking aids and Harris hip scores were similar in both groups. Conclusions: PFNA significantly reduces the operative time, amount of blood loss and fluoroscopic imaging as compared to PFN. However PFNA offers no significant benefits over PFN in terms of post-operative functional recovery or complications

Evaluation of Ponseti method in correction of congenital talipes equinovarus

Background: Congenital idiopathic clubfoot is a complex foot deformity often requires many months of treatment and frequently resulted in incomplete or defective correction by older methods. Deformity can be corrected with serial manipulation and casting with minimal or no surgery as reported by Ponseti. This study is an attempt to evaluate the effectiveness of Ponseti technique in treatment of idiopathic congenital talipes equino varus.Methods: 30 patients between age group of 01 to 24 weeks with 48 feet having congenital idiopathic clubfoot were treated using Ponseti technique. The guidelines for treatment were followed as per the Ponseti method of serial manipulation and casting at weekly intervals.Results: 43 (89.58%) cases were treated successfully by using Ponseti technique without need of extensive surgery. 42 feet required tenotomy. 38 (79.16%) feet had an excellent outcome, 5 (10.42%) feet had a fair outcome and 05 feet (10.42%) had poor outcome as measured by the Pirani scoring system. 7 (14.58%) patients had cast related complications.Conclusions: The Ponseti method is a safe, effective and reproducible method for correction of idiopathic congenital talipes equinovarus which significantly reduces the rate of extensive corrective surgeries for correction of clubfoot

Liposomal nanotheranostics for multimode targeted in vivo bioimaging and near‐infrared light mediated cancer therapy

Developing a nanotheranostic agent with better image resolution and high accumulation into solid tumor microenvironment is a challenging task. Herein, we established a light mediated phototriggered strategy for enhanced tumor accumulation of nanohybrids. A multifunctional liposome based nanotheranostics loaded with gold nanoparticles (AuNPs) and emissive graphene quantum dots (GQDs) were engineered named as NFGL. Further, doxorubicin hydrochloride was encapsulated in NFGL to exhibit phototriggered chemotherapy and functionalized with folic acid targeting ligands. Encapsulated agents showed imaging bimodality for in vivo tumor diagnosis due to their high contrast and emissive nature. Targeted NFGL nanohybrids demonstrated near infrared light (NIR, 750 nm) mediated tumor reduction because of generated heat and Reactive Oxygen Species (ROS). Moreover, NFGL nanohybrids exhibited remarkable ROS scavenging ability as compared to GQDs loaded liposomes validated by antitumor study. Hence, this approach and engineered system could open new direction for targeted imaging and cancer therapy.publishersversionpublishe

General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multi-centre observational study

There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%)

Autonomous Aerial System (UAV) for Sustainable Agriculture: A Review

Drones are now a days emerging as a component of precision agriculture along with contributing to sustainable agriculture. The use of advanced technologies such as drone in agriculture offer potential for facing several major or minor challenges. The major applications of drone in agriculture are spraying, irrigation, crop monitoring, soil and field analysis and bird control. The objective of this paper is to review the latest trends and applications of leading technologies related to agricultural UAVs equipment, and sensors development. And also, the use of UAVs in real agricultural environments. Based on the literature, found that a lots of agriculture applications can be done by using Drone. In the methodology, we used a comprehensive review from other researches in this world. Furthermore, the future development of agricultural UAVs and their challenges are considered. In this review paper, summarizes the available agricultural drones and applications of UAVs for Precision Agriculture using different sensors to evaluated agricultural parameters such as NDVI, vegetation index, NIR, nutrient disorder using sensors like RGB, digital camera, multispectral and hyperspectral sensors and to reduce the wasting of water and chemicals quadcopter, hexacopter UAVs could be used

Climate-Resilient Technologies for Enhancing Productivity of Soybean in India

Soybean (Glycine max [L.]) contributes 25% of the global edible oil. Globally, soybean area and production in 2020 were 127.9 million ha and 379.8 million tons, respectively. Soybean has got early acceptance as an important oilseed crop in India in with approximately 10–11 million ha area. Now, it has become a major crop by replacing the traditional and contemporary popular crops in nearly all parts of India. Climate change effects, like change in Monsoon pattern, increase in dry spell frequencies, heavy rainfall event during crop growth period, extended monsoon at harvesting stage, has drastically influenced the productivity of soybean, which needs attention to identify the constraints and accordingly adapt the climate-resilient technologies. The recent research conclusions revealed that the climate-resilient technologies like selecting suitable varieties, sowing within proper sowing window, broad bed furrow (BBF) method of sowing, dry spell management practices to reduce moisture stress, rainwater harvesting, and soil conservation through BBF method of planting, reuse of harvested and stored rainwater during moisture stress conditions, the adaptation of micro-irrigations systems for protective irrigation, intercropping in soybean, resource conservation techniques can mitigate the effects of climate change and enhance the productivity of soybean in a sustainable manner

Use of response surface method for maximizing the production of arginine deiminase by Pseudomonas putida

Statistically designed experiments were used to optimize the production of arginine deiminase (ADI) by Pseudomonas putida KT2440 in batch culture. A Plackett-Burman design involving eleven factors showed that ADI production was most influenced by the initial pH and the initial concentrations of glucose and yeast extract. A central composite experimental design showed that the optimal values of these factors were 8.0, 10 g/L and 12.5 g/L, respectively. The other components of the optimal culture medium were bacto peptone 7.5 g/L, Triton X–100 0.30% (v/v), and arginine 3 g/L, for a culture temperature of 25 °C. Compared with the basal medium, the ADI activity in the optimized medium had nearly 4.5-fold increase (4.31 U/mL). The optimized medium was then used for a further study of ADI production in a 14 L stirred tank bioreactor. The agitation speed and the aeration rates were varied to determine suitable values of these variables

Comparative study of complications and final outcome between bone patellar tendon bone and hamstring auotgraft in ACL reconstruction

Background: The most common current graft choices in ACL reconstruction are the bone-patellar tendon–bone (BPTB) graft and the quadrupled Hamstring graft. Though BPTB is considered to be the gold standard; hamstring tendon (HT) grafts have increased in popularity over last decade. Our aim in this study is to assess the complications, comorbidities, difficulties and final outcome between BPTB and Hamstring grafts in ACL reconstruction.Methods: 71 male patients with isolated tear of ACL between age group of 18-45 years were included in the study. 35 patients in group A underwent ACL reconstruction using bone patellar tendon bone autograft and 35 patients in group B were managed by reconstructing ACL using quadrupled Hamstring autograft. All the patients in both the groups were followed up at 08 weeks,06 months and 01 year post surgery and evaluated by Lysholm knee scoring system.Results: The Lysholm scoring scale scores in anterior cruciate ligament reconstruction showed that BPTB group and Hamstring group have similar outcome. One case (2.8%) each of patellar fracture and graft contamination occurred in BPTB group. There were 09 cases of superficial infection of which 03 were from BPTB group and 06 were from Hamstring group. Conclusions: There is statistically no significant difference in the overall clinical outcome between bone-patellar tendon- bone and Hamstring autografts. With precise surgical techniques, meticulous attention to sterility and proper wound closure most of the complications in both the techniques can be minimized or avoided