Assessing the factors that influence a recurrence of congenital talipes equinovarus in children treated with the Ponseti method

Background: Congenital talipes equinovarus, also known as clubfoot, is one of the most common congenital malformations in pediatric orthopedics. With a checkered treatment history extending from Hippocrates' bandages to Kite's serial plaster cast application to surgical treatment, no single modality can claim to be a complete treatment. Methods: In a combined prospective and retrospective study at the Department of Orthopaedics of St. Stephen's Hospital, 192 patients with 292 clubfeet who met the inclusion criteria and received ethics committee approval were included. The purpose of the research was to identify early recurrence characteristics, undertake the Pirani scoring, and identify additional clinical characteristics to evaluate recurrence predictors. Results: In our study, out of 192 patients, 188 were successfully treated with the Ponseti casting technique combined with tendoachilles tenotomy; tenotomy was required in 177 patients (93%). Four patients were lost to follow-up. Nine out of sixty-one children in the six-month-to-one-year age group showed the maximum rate of recurrence (15%). The mean number of cast applications was 7.23. In all, 90% of children required casts ranging from four to eight in number. The syndromic association was seen in 10.4% of cases with club feet. Most common among them were neural tube defects (4.2%) and arthrogryposis (3% of cases). Fourteen out of 154 (or 9%) of the non-operated idiopathic patients had lateral border recurrence during an average follow-up of two years. According to the Pirani score, recurrence was seen in eight out of twenty (or 40% of) syndromic patients and five out of fourteen (or 35% of) operated cases. In 37% of recurrences, dynamic supination was observed. Conclusions: Even though Ponseti's approach to treating idiopathic clubfoot is widely regarded as the gold standard, recurrences are known to occur even in the best of circumstances. The most common cause of recurrence was poor brace compliance, with families citing a variety of reasons

Current scenario and challenges for bone retrieval for allograft use in North India

Bone grafts are the second most common tissue transplanted. With advances in the treatment of musculoskeletal tumors, limb salvage surgery, with its concomitant demand for bone graft, has increased significantly. This study aims to evaluate current scenario for bone donation in north India. This study was done in bone bank, Government Medical College, Kota, Rajasthan. Inclusion and exclusion criteria of bone donors were followed as per the APASTB standards of tissue banking. Bone was retrieved from deceased donor and live donors after proper consent and counselling in this institute during period 01 January 2021 to 31 January 2022. During the period of study bones were retrieved from 26 donors – 24 live donors and 2 cadavers. Out of 24 live donors 20 were femoral head, 2 tibia and fibula and 2 hemi-radius and hemi-ulna. All donors were between 28-71-year age group and mean age was 56 years. 18 males and 8 females participated in study. There is huge difference between demand and supply of bone allograft in this region of country. There is lack of initiative from government for encouraging people to donate bone along with other organ and tissue donations. Lack of infrastructure for to and fro transport of bone retrieval from deceased and live donors to storage unit results in loss of bone samples. Less trained personnel and sufficiently low coordination between various institutes. Concerns of family members and misconceptions to be addressed properly to reduce morbidity burden in society

Recent trends in photoelectrochemical water splitting: the role of cocatalysts

Environmental degradation due to the carbon emissions from burning fossil fuels has triggered the need for sustainable and renewable energy. Hydrogen has the potential to meet the global energy requirement due to its high energy density; moreover, it is also clean burning. Photoelectrochemical (PEC) water splitting is a method that generates hydrogen from water by using solar radiation. Despite the advantages of PEC water splitting, its applications are limited by poor efficiency due to the recombination of charge carriers, high overpotential, and sluggish reaction kinetics. The synergistic effect of using different strategies with cocatalyst decoration is promising to enhance efficiency and stability. Transition metal-based cocatalysts are known to improve PEC efficiency by reducing the barrier to charge transfer. Recent developments in novel cocatalyst design have led to significant advances in the fundamental understanding of improved reaction kinetics and the mechanism of hydrogen evolution. To highlight key important advances in the understanding of surface reactions, this review provides a detailed outline of very recent reports on novel PEC system design engineering with cocatalysts. More importantly, the role of cocatalysts in surface passivation and photovoltage, and photocurrent enhancement are highlighted. Finally, some challenges and potential opportunities for designing efficient cocatalysts are discussed

Emerging Copper-Based Semiconducting Materials for Photocathodic Applications in Solar Driven Water Splitting

Hydrogen production through solar-driven water splitting is a promising approach and an alternative to the conventional steam reforming of natural gas and coal gasification. The growing energy demand and environmental degradation through carbon-emitting fossil fuels urge a transition in the usage of non-renewable to renewable sources of energy. The photocathodes in a photoelectrochemical (PEC) water-splitting cell are essential for the direct evolution of hydrogen. Among the known photocathodes, Cu-based p-type semiconducting materials are the most promising photo-absorber materials owing to their low-cost, low toxicity, natural abundance, suitable bandgaps, and favorable band edges for reduction. Moreover, the chemical stability and the rate of recombination significantly limit the longevity, the PEC performance, and practical applicability of Cu-based photocathodes. To overcome these problems, it is critical to have a thorough understanding of the constraints, improvement strategies, and an assessment of current developments in order to construct and design highly stable and efficient photocathodes. Here, in this review we have summarized the development of Cu-based metal oxide and sulfide photocathodes with the significant operational challenges and strategies that have successfully been employed to enhance the PEC performance. Furthermore, the emphasis is placed on recent reports and future perspectives regarding emerging challenges

Utilizing Radiomic Feature Analysis For Automated MRI Keypoint Detection: Enhancing Graph Applications

Graph neural networks (GNNs) present a promising alternative to CNNs and transformers in certain image processing applications due to their parameter-efficiency in modeling spatial relationships. Currently, a major area of research involves the converting non-graph input data for GNN-based models, notably in scenarios where the data originates from images. One approach involves converting images into nodes by identifying significant keypoints within them. Super-Retina, a semi-supervised technique, has been utilized for detecting keypoints in retinal images. However, its limitations lie in the dependency on a small initial set of ground truth keypoints, which is progressively expanded to detect more keypoints. Having encountered difficulties in detecting consistent initial keypoints in brain images using SIFT and LoFTR, we proposed a new approach: radiomic feature-based keypoint detection. Demonstrating the anatomical significance of the detected keypoints was achieved by showcasing their efficacy in improving registration processes guided by these keypoints. Subsequently, these keypoints were employed as the ground truth for the keypoint detection method (LK-SuperRetina). Furthermore, the study showcases the application of GNNs in image matching, highlighting their superior performance in terms of both the number of good matches and confidence scores. This research sets the stage for expanding GNN applications into various other applications, including but not limited to image classification, segmentation, and registration

Surgical Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion in Elderly

Objective The purpose of this study was to compare the clinical-radiological outcome and incidence of perioperative complications of MIS-TLIF at lower lumbar levels for elderly (Age >65 years) and younger patients (Age65 years and group B<65 years). Perioperative clinical (co-morbidities, surgical time, blood loss, hospital stay, fusion level, VAS, ODI), radiological parameters (fusion, cage subsidence, implant failure), postoperative complications and satisfactory outcomes in the form of Wang’s criteria were evaluated in both the groups. A statistical analysis between two matched groups was done with logistic regression analysis, chi-square and student t-test. Results There was no statistical difference in blood loss, surgical time, mobilization and hospital stay between two groups however elderly patients took longer time to become pain free (p=0.001). Both groups showed significant improvement in ODI, VAS and Wang’s outcome score however, no statistically significant difference noted in outcome between two groups at final follow up. General complications not affecting outcome were common in elderly group but no statistically significant difference noted among neurological events between both groups. Conclusion MISS-TLIF surgery in elderly can produce successful clinical outcome and satisfaction after surgery in judiciously selected patients with proper preoperative risk assessment and optimization of medical co-morbidities. Elder age does not prove deterrent to outcome and should not be a contraindication to perform MISS-TLIF in lumbar degenerative diseases

Learning Curve of Minimally Invasive C1-C2 Trans-articular Screw Fixation (MIS-TAS): Over A Period of Five Years

Objective To evaluate the learning curve associated with minimally invasive surgery (MIS) in posterior C1-C2 trans-articular (TAS) screw fixation based on surgical and clinical parameters. Also, to report the challenges faced and measures to overcome them. Methods 84 patients who underwent C1-C2 MIS-TAS between 2009-2014 were included in the study and were divided into four quartiles (q) (21 patients each) based on the date of their surgery with each consecutive group serving as a control for prior. Pre- and post-operative clinical and perioperative parameters, technical issues and complications were evaluated. Results The mean age of the patients was 36.26±5.78 years (20-78 years) with male to female ratio of 48:36. A statistically significant difference was observed between the mean operative time and mean blood loss between second and third quartile. Inadvertent vertebral artery injury occurred in 3 cases without any post-operative sequelae. There were 6 instances of guide wire migration(q1=4, q2=2). At 2 instances (q1=2) there was guide wire breakage. Total 9 times (q1=5, q2=2, q3=1, q4=1) dorsal burst into C2 pars occurred. VAS, ODI and mJOA scores showed a significant improvement from their pre-operative values in the entire study population without any significant difference between the quartiles. Conclusion C1-C2 MIS-TAS is a very safe and effective means of treating reducible atlanto-axial instability. Pre-operative planning, detailed radiological evaluation, practice on cadavers/bone-saw models and by following the mentioned recommendations the learning curve of C1-C2 MIS-TAS can be reduced

Is 2D Fluoroscopy Reliable in Minimal Invasive Spine Surgery? Evaluation of Perforation Indices in MIS-TLIF

Objective The aim of this study is to assess reliability of 2D Fluoroscopy in Minimal Invasive Surgery Transforaminal Lumbar Interbody Fusion (MIS-TLIF) through evaluation of perforation indices in 1,200 percutaneous pedicle screw instrumentation. Methods It is a single center retrospective study of 300 consecutive patients undergoing single level minimal invasive lumbar interbody fusion surgery (MIS-TLIF) under 2D Fluoroscopy. Percutaneous pedicle screws were analyzed with post-operative CT scan to assess accuracy of pedicle screw placement, Grades of perforation, Critical vs. Non critical Nature, Location of violation. Neurological implications of misplaced screws, Demographic, Clinical Parameters, outcome scores viz. Visual Analogue Score (VAS), Oswestry Disability Index (ODI) were also assessed. Results Overall rate of screw perforation was 5% (60/1,200) with different grades of perforation(Medial=24, Lateral=30, Inferior=1, Superior=5, Anterior=0) (Grade 1=42, Grade 2=18, Grade 3=0). Critical perforations were noted in 18 patient but none of the patients with critical and non critical perforation developed any neurological complications or post-operative leg pain. Conclusion This study showed overall pedicle perforation rate of 5% (60/1,200) in lower lumbar single level MIS-TLIF for grade 1 degenerative spondylolisthesis including grade 1 perforations are 3.5% and grade 2 perforation are 1.5%. 2D Fluoroscopy guided percutaneous pedicle screws placement with appropriate technique in MIS-TLIF is an acceptable and reliable procedure with low rates of screw related complications and revisions

Investigations on Binding Pattern of Kinase Inhibitors with PPAR γ

Peroxisome proliferator-activated receptor gamma (PPARγ) is a potential target for the treatment of several disorders. In view of several FDA approved kinase inhibitors, in the current study, we have investigated the interaction of selected kinase inhibitors with PPARγ using computational modeling, docking, and molecular dynamics simulations (MDS). The docked conformations and MDS studies suggest that the selected KIs interact with PPARγ in the ligand binding domain (LBD) with high positive predictive values. Hence, we have for the first time shown the plausible binding of KIs in the PPARγ ligand binding site. The results obtained from these in silico investigations warrant further evaluation of kinase inhibitors as PPARγ ligands in vitro and in vivo

Integrated p-n Junctions for Efficient Solar Water Splitting upon TiO2/CdS/BiSbS3 Ternary Hybrids for Improved Hydrogen Evolution and Mechanistic Insights

The development of efficient and novel p-n heterojunctions for photoelectrochemical (PEC) water splitting is still a challenging problem. We have demonstrated the complementary nature of (p-type) BiSbS3 as a sensitizer when coupled with (n-type) TiO2/CdS to improve the photocatalytic activity and solar to hydrogen conversion efficiency. The as-prepared p-n heterojunction TiO2/CdS/BiSbS3 exhibits good visible light harvesting capacity and high charge separation over the binary heterojunction, which are confirmed by photoluminescence (PL) and electrical impedance spectroscopy (EIS). The ternary heterojunction produces higher H-2 than the binary systems TiO2/CdS and TiO2/BiSbS3. This ternary heterojunction system displayed the highest photocurrent density of 5 mA center dot cm(-2) at 1.23 V vs. reversible hydrogen electrode (RHE) in neutral conditions, and STH of 3.8% at 0.52 V vs. RHE is observed. The improved photocatalytic response was due to the favorable energy band positions of CdS and BiSbS3. This study highlights the p-n junction made up of TiO2/CdS/BiSbS3, which promises efficient charge formation, separation, and suppression of charge recombination for improved PEC water splitting efficiency. Further, no appreciable loss of activity was observed for the photoanode over 2500 s. Band alignment and interfaces mechanisms have been studied as well