Flexible intramedullary nails: the panacea for paediatric femoral shaft fractures

Background: Management of pediatric femoral shaft fractures continues to evolve with time with flexible intramedullary nailing being one of the options to treat a specific age group of children. Grey zone exists concerning the cost effectiveness and appropriate timing of nail removal in treating such fractures. The objective of the study was to evaluate the treatment outcome of fracture shaft of the femur in children in the age group of 5- 12 years with flexible intramedullary nail.Methods: The study comprised of 30 consecutive cases of acute fractures of the femoral shaft in children of the age group of 5 to 12 years. Only closed fractures of the mid-diaphyseal region of the femur were included while supracondylar, subtrochanteric and pathological fractures were excluded. Flexible intramedullary nails of stainless steel (n=24) or titanium (n=6) were used for fixation of these fractures.Results: Evaluation of the results was done according to the criteria by Flynn et al. 21(70%) out of 30 patients had an excellent result and remaining 9 (30%) had a satisfactory result. All fractures united with a full range of motion at the hip and knee joint without any major complications. Conclusions: Intramedullary elastic nailing of simple diaphyseal femur fractures in children is an effective method with negligible complications. Treatment cost can be significantly lowered by using the much cheaper stainless steel flexible nails rather than the more expensive titanium nails

Nitrogen release kinetics of organic nutrient sources in two benchmark soils of Indo-Gangetic plains

An understanding of the mineralization process of organic amendments in soil is required to synchronize N release with crop demand and protect the environment from excess N accumulation. Therefore, we conducted a laboratory incubation experiment to assess nitrogen mineralization potential of crop residues (rice and wheat straw) and organic manures (poultry manure, farmyard manure, cowpea and sesbania) in two benchmark soils (Typic Haplustept and Typic Ustifluvents) of semi-arid region of Punjab, India, varying in textureat field capacity moisture level at a constant temperature of 331°C. Mineralization was faster during first 7 days of incubation in Typic Haplustept and upto 14 days in Typic Ustifluvents which subsequently declined over time. In both soils, net N mineralization continued to increase with increasing period of incubation (expect with crop residues) and was significantly higher in Typic Ustifluvents (54-231µg g-1) than Typic Haplustept (33-203 µg g-1). Compared to unamended soils, percent N mineralized was highest is sesbania (35-40 %) followed by cowpea (32-37 %) and least in wheat (10-11 %) after 42 days of incubation. Thus, sesbania and cowpea may preferably be used to meetthe large N demand during early period of plant growth. Further, mineralization rate constants (k) also indicated that availability of mineral N was significantly higher with application of organic amendments than unamended control treatments in both soils. Therefore, it may be concluded that considerable economy in the use of inorganic N fertilizer can be employed if N mineralization potential of organic inputs is taken into consideration

Internal Finishing of Aluminium Tube with Sintered Magnetic Abrasive

There has been a rapid growth in the development of harder and complex shapes to machine metals and alloys during the last few years. Conventional edged tool machining is difficult and uneconomical for such materials and degree of surface finish attainable is poor. In view of the seriousness of this problem, recently new non-conventional fine machining processes like Magnetic Abrasive Polishing, Magnetic Abrasive Flow Machining (MAFM), Magnetic Float Machining (MFM) and Magnetic Abrasive Machining (MAM), Magneto ndashRheological Machining (MRM), Chemo-Mechanical Polishing (CMP) have been developed. Among these processes lsquoMagnetic Abrasive Finishing processes are widely used for obtaining quality finish on metallic (ferrous and non ferrous) as well as non metallic (ceramics) components. MAF process has been recently used in its variant forms such as Magnetic float polishing, Magneto-rheological machining, Electrolytic magnetic polishing but the problem of development of magnetic abrasive powders is still present and efforts are in continuous progress at global to remove this problem.nbspIn the MAF method, a magnetic field is used to generate cutting force to treat the surface of a machined part. The magnetic field helps to form a flexible magnetic abrasives brush for finishing of surface.nbsp Finishing force can be controlled with magnetic field and a low surface temperature is generated during finishing operations. Magnetic abrasives are not easily available. Very few studies have been reported till date on the development of alternative magnetic abrasives. The aim of study is to evaluate the performance of developed sintered magnetic abrasives for internal finishing of aluminium tubes using MAF process. PISF is calculated nbspconsidering different variables like speed (rpm) , quantity of abrasive and gap of magnetic pole and work piece.nbsp Preparation of sintered magnetic abrasive was difficult and time consuming. The best result came at 425 rpm and quantity of abrasive used 6 gm. PISF value obtained in present case was 84 % . nbs

Dapagliflozin Versus Placebo on Left Ventricular Remodeling in Patients With Diabetes and Heart Failure:The REFORM Trial

OBJECTIVE To determine the effects of dapagliflozin in patients with heart failure (HF) and type 2 diabetes mellitus (T2DM) on left ventricular (LV) remodeling using cardiac MRI. RESEARCH DESIGN AND METHODS We randomized 56 patients with T2DM and HF with LV systolic dysfunction to dapagliflozin 10 mg daily or placebo for 1 year, on top of usual therapy. The primary end point was difference in LV end-systolic volume (LVESV) using cardiac MRI. Key secondary end points included other measures of LV remodeling and clinical and biochemical parameters. RESULTS In our cohort, dapagliflozin had no effect on LVESV or any other parameter of LV remodeling. However, it reduced diastolic blood pressure and loop diuretic requirements while increasing hemoglobin, hematocrit, and ketone bodies. There was a trend toward lower weight. CONCLUSIONS We were unable to determine with certainty whether dapagliflozin in patients with T2DM and HF had any effect on LV remodeling. Whether the benefits of dapagliflozin in HF are due to remodeling or other mechanisms remains unknown

A randomized controlled trial of metformin on left ventricular hypertrophy in patients with coronary artery disease without diabetes:the MET-REMODEL trial

Aim We tested the hypothesis that metformin may regress left ventricular hypertrophy (LVH) in patients who have coronary artery disease (CAD), with insulin resistance (IR) and/or pre-diabetes. Methods and results We randomly assigned 68 patients (mean age 65 ± 8 years) without diabetes who have CAD with IR and/or pre-diabetes to receive either metformin XL (2000 mg daily dose) or placebo for 12 months. Primary endpoint was change in left ventricular mass indexed to height1.7 (LVMI), assessed by magnetic resonance imaging. In the modified intention-to-treat analysis (n = 63), metformin treatment significantly reduced LVMI compared with placebo group (absolute mean difference −1.37 (95% confidence interval: −2.63 to −0.12, P = 0.033). Metformin also significantly reduced other secondary study endpoints such as: LVM (P = 0.032), body weight (P = 0.001), subcutaneous adipose tissue (P = 0.024), office systolic blood pressure (BP, P = 0.022) and concentration of thiobarbituric acid reactive substances, a biomarker for oxidative stress (P = 0.04). The glycated haemoglobin A1C concentration and fasting IR index did not differ between study groups at the end of the study. Conclusion Metformin treatment significantly reduced LVMI, LVM, office systolic BP, body weight, and oxidative stress. Although LVH is a good surrogate marker of cardiovascular (CV) outcome, conclusive evidence for the cardio-protective role of metformin is required from large CV outcomes trials

Research into the effect Of SGLT2 inhibition on left ventricular remodelling in patients with heart failure and diabetes mellitus (REFORM) trial rationale and design

Background Heart failure (HF) and diabetes (DM) are a lethal combination. The current armamentarium of anti-diabetic agents has been shown to be less efficacious and sometimes even harmful in diabetic patients with concomitant cardiovascular disease, especially HF. Sodium glucose linked co-transporter type 2 (SGLT2) inhibitors are a new class of anti-diabetic agent that has shown potentially beneficial cardiovascular effects such as pre-load and after load reduction through osmotic diuresis, blood pressure reduction, reduced arterial stiffness and weight loss. This has been supported by the recently published EMPA-REG trial which showed a striking 38 and 35 % reduction in cardiovascular death and HF hospitalisation respectively. Methods The REFORM trial is a novel, phase IV randomised, double blind, placebo controlled clinical trial that has been ongoing since March 2015. It is designed specifically to test the safety and efficacy of the SLGT2 inhibitor, dapagliflozin, on diabetic patients with known HF. We utilise cardiac-MRI, cardio-pulmonary exercise testing, body composition analysis and other tests to quantify the cardiovascular and systemic effects of dapagliflozin 10 mg once daily against standard of care over a 1 year observation period. The primary outcome is to detect the change in left ventricular (LV) end systolic and LV end diastolic volumes. The secondary outcome measures include LV ejection fraction, LV mass index, exercise tolerance, fluid status, quality of life measures and others. Conclusions This trial will be able to determine if SGLT2 inhibitor therapy produces potentially beneficial effects in patients with DM and HF, thereby replacing current medications as the drug of choice when treating patients with both DM and HF

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease