Treatment of distal tibia fractures: plating versus intramedullary nailing

Background: Distal tibia shaft fractures pose significant challenge to treating surgeons. Giving more importance to anatomical reduction and ignoring often injured soft tissues has led to poor outcomes and high complication rates. Although multiple options are described to treat these fractures, there is no consensus on the best method of treatment. We hereby want to study the results of distal tibia fractures treated by expert tibia nailing and distal tibia plating.Methods: This study was undertaken in patients who were operated in between January 2012 to March 2015 at M S Ramaiah Teaching Hospital, which is a tertiary care hospital in Bangalore. Study included 52 patients with distal tibia fracture treated by surgery. All the fractures were closed distal diaphyseal fractures without articular involvement. Thirty two patients underwent expert tibia nailing whereas 20 patients were treated with open reduction and internal fixation with locking plates. Patients were followed up at 6 weeks, 3 months, 6 months and 1 year.Results: Fifty two patients included in study and they were divided into two groups as nailing group and plating group. Plating group included 20 patients whereas nailing group included 32 patients. The mode of injury was  road traffic injury in 32 cases , followed by self-fall in 17 cases and sports related injury in 3 cases. Distal tibia fracture was associated with in 29 patients (87%) of nailing group whereas in 17 patients (80) of plating group. Average distance of fracture from pilon was 6 cm in nailing group and 3cm in plating group.  The average duration of surgery in nailing was  group  was 88 minutes (range, 65-130 minutes) whereas average duration of surgery in  plating group was group  was 92 minutes (range, 70-130 minutes).  The average time for union was 16 weeks for nailing group and for plating group it was 18 weeks.  Conclusions: Both intramedullary nailing and plating are the optimal methods of treatment. Plating is preferred in cases where fracture is close to pilon whereas intramedullary nailing is preferred for fractures away from tibial pilon. There is no significant difference between union and complication rates

Recent developments in machine learning and flyrock prediction

The blasting techniques are employed in mining and underground works to loosen the rock mass and ease the excavation. The blasting practices are economical and swifter in terms of their engineering application, however, they are of major environmental and safety concerns. The major issues related to blasting are flyrock, air over pressure, and ground vibrations etc. The rock fragments of rockmass are thrown outward after blasting, which can be threat to workers and machineries involved in the work, and sometimes nearby human settlements can be its victim. Therefore, an accurate prediction of the flyrock distance is the needed by mining practitioners. Earlier, experts have developed several empirical methods based on certain known parameters to assess flyrock distance. However, with time they become irrelevant and were easily replaced with advanced machine learning algorithm. The present study reviews some of these latest publications (2019–2021) examining flyrocks through artificial intelligent technique. The study incorporates types of machine learning models employed, input parameters used and number of datasets supporting the models. The input parameters were further classified according to rock-mass properties, blast design at site, and explosives responsible for blasting. Moreover, to compare the reliability of the model coefficient of correlation of the testing data of the all the documented model were evaluated. Rock density, rock mass rating and Shmidt hammer rebound number (SHRN) were found to be uncertain parameters. Artificial Neural Network (ANN) and other hybrid models for prediction of flyrock were compared

Effect of vitamin D supplementation of low birth weight term Indian infants from birth on cytokine production at 6 months.

BACKGROUND/OBJECTIVES: Vitamin D deficiency has been associated with impaired resistance to infection, which may be mediated by alterations in cytokine responses. We investigated the effect of vitamin D supplementation to infants on whole blood in-vitro cytokine production and on the inflammatory marker, plasma C-reactive protein (CRP). SUBJECTS/METHODS: Blood samples were taken at 6 months of age from infants participating in the DIVIDS (Delhi Infant Vitamin D Supplementation) randomized controlled trial of weekly vitamin D supplements (1400 IU = recommended intake) from birth to 6 months with the aim of decreasing mortality and severe morbidity. We measured plasma CRP and whole blood in-vitro production of tumour necrosis factor-α (TNFα), interferon-γ (INFγ), interleukin (IL)-10 and IL-13 following no stimulation or stimulation with lipopolysaccharide or phytohemagglutinin. RESULTS: Although the intervention improved vitamin D status in a severely deficient population, there were no differences between treatment groups in plasma CRP or in the production of any of the cytokines in either unstimulated or stimulated cultures. Recent illness had limited association with immunological markers. Plasma 25-hydroxyvitamin D levels were not associated with CRP or production of any cytokines. CONCLUSIONS: Vitamin D supplementation did not affect plasma CRP or whole blood cytokine production of vitamin D-deficient low birth weight infants. This is consistent with the lack of effect of vitamin D on mortality and severe morbidity among infants in the DIVIDS trial