Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall; a randomised controlled trial

Purpose

There is no consensus about the best option of internal fixation for unstable intertrochanteric fractures. The aim of the present study was to compare proximal femoral nail (PFN) with contralateral reverse distal femoral locking compression plate (reverse-DFLCP) in the management of unstable intertrochanteric fractures with compromised lateral wall.

Method

In a randomized controlled study, from November 2011 to October 2012, 40 patients with unstable intertrochanteric fractures with compromised lateral wall (AO 31A 2.2 to 3.3) had osteosynthesis by PFN (n = 20) or reverse-DFLCP (n = 20). Intra-operative variables compared were duration of surgery, blood loss during surgery, fluoroscopy time and surgeons perception of the surgery. Patients were followed up clinically for a minimum of one year. Functional outcome was assessed by Parker Palmer mobility score (PPMS), Harris hip score (HHS), and Short Form-12. Failure was defined as any condition which would necessitate revision surgery with change of implant.

Results

Duration of surgery (p = 0.022), blood loss during surgery (p = 0.008) and fluoroscopy time (p = 0.0001) were significantly less in the PFN group than in the reverse-DFLCP group. No significant difference was found in type of reduction, difficulty in reduction and surgeon’s perception of surgery. The PFN group had better functional outcome than the reverse-DFLCP group. HHS for the PFN group was 81.53 ± 13.21 and for the reverse-DFLCP group it was 68.43 ± 14.36 (p = 0.018). SF-12 physical (p = 0.002) and mental component (p = 0.007) scores in the PFN group was significantly better than in the reverse-DFLCP group. There was one failure in the PFN group as compared to six in the reverse-DFLCP group (p = 0.036).

Conclusion

Due to favourable intra-operative variables, better functional outcome and lower failure rates, we conclude that PFN is a better implant than reverse-DFLCP for intertrochanteric fractures with compromised lateral wall.Keyword: Unstable intertrochanteric fractures, Lateral wall, Proximal femoral nail, Reverse distal femoral locking compression plate     

Role of cytokines in the clinical manifestation of exophthalmia in newborn calves with tropical theileriosis

The present study aimed to evaluate the pathology of the exophthalmia and the host-immune response in naturally Theileria annulata-infected calves. The newborn calves detected positive for theileriosis were grouped into calves with theileriosis and absence of exophthalmia (n = 30), and calves with theileriosis and the presence of exophthalmia (n = 13). Sixteen healthy calves, free from any haemoprotozoal infection, were kept as healthy controls. A significantly (P ≤ .001) higher circulating levels of tumour necrosis factor-α (TNF-α) and interleukin-10 (IL-10) were estimated in diseased calves with and without exophthalmia as compared to healthy controls. Contrarily, significantly (P ≤ .01) lower interferon-γ (IFN-γ) level was estimated in diseased calves. The diseased calves with exophthalmia revealed significantly higher levels of TNF-α (P ≤ .001) and IL-10 (P ≤ .006) as compared to the diseased calves without exophthalmia. The diseased calves were not found to have an elevated intraocular pressure; rather they had significantly (P ≤ .001) lower intraocular pressure compared to the healthy controls. An elevated systemic TNF-α level might be attributed to the exophthalmia in calves with tropical theileriosis. The elevated circulatory IL-10 and reduced IFN-γ levels could be one of the strategies of Theileria annulata to escape the host immunity.     

Peripheral Neurectomy: Minimally Invasive Surgical Modality for Trigeminal Neuralgia in Indian Population: A Retrospective Analysis of 20 Cases

Objective

To evaluate the efficacy of peripheral neurectomy in 20 cases of trigeminal neuralgia as minimally invasive surgical treatment modality.

Materials and methods

Twenty (12 males and 8 females) patients with trigeminal neuralgia aged between 35 and 68 years (mean 48 years), who had undergone peripheral neurectomy, were retrospectively analyzed for relief of pain, complications, recurrence of pain, and any additional procedure required to treat recurrence, in a follow-up period of 36 months postoperatively.

Results

There was no significant intra-operative and post-operative complications. There was recurrence of pain in two patients (10 %) in 24 and 28 months post-operative follow-up respectively, whereas, rest of the 18 patients were symptom free during 36 months follow-up.

Conclusion

Peripheral neurectomy is one of the minimally invasive and expeditious forms of surgical modality for the treatment of trigeminal neuralgia. This treatment option is cost effective and provides long term relief from neuralgic pain.     

BiOCl/WS2 hybrid nanosheet (2D/2D) heterojunctions for visible-light-driven photocatalytic degradation of organic/inorganic water pollutants

This report presents the superior visible-light-driven photocatalytic response of novel 2D/2D BiOCl/WS₂ (BW_X) hybrid nanosheet heterojunctions prepared by a simple solution based sonochemical technique. These BW_X hybrid nanosheets are composed of 2D transition metal dichalcogenide material WS₂ and BiOCl nanosheets. The comparative study of photocatalytic activity of BiOCl and BiOCl/WS₂ hybrid nanosheets is carried out via photodegradation of Malachite Green (MG) and photoreduction of heavy metal ion Cr(vi) under visible light irradiation. The quantum efficiency of the samples is estimated in terms of the incident photon to electron conversion efficiency (IPCE) measurements. Nearly 98.4% of the MG degradation was achieved over BiOCl/WS₂ (2%) photocatalyst in 45 min of irradiation. BiOCl/WS₂ (2%) hybrid nanosheet catalyst showed the highest external quantum efficiency (EQE) in both the UV and visible regimes. This accomplishment demonstrated the promise of commercial application of the 2D/2D BiOCl/WS₂ (2%) hybrid nanosheet photocatalyst.

Achieved highest photocatalytic performance of 2D/2D BiOCl/WS₂ (2%) hybrid nanosheets for MG degradation (∼98.4% in 45 min) and Cr(vi) reduction.     

Viral hepatitis: A brief introduction,review of management,advances and challenges

Viral hepatitis represents a major public health hazard and is associated with significant global mortality. Over the last decade, there have been significant developments in the prevention and treatment of viral hepatitis. These changes have led to a situation whereby global elimination has become a realistic goal, fully endorsed by the World Health Organization (WHO). By 2030, the WHO aims to reduce viral hepatitis mortality by 65% and reduce new infections by 90% by 2030. These are ambitious targets and will only be met through a sustained programme. This will require expertise from hepatologists and virologists and the fields of public health and primary care. In this article, we review the causes of viral hepatitis, its management through prevention and treatments, and the most pressing challenges and recent advances.     

Menopausal hormone therapy use and risk of primary liver cancer in the clinical practice research datalink

Primary liver cancer occurs less commonly among women than men in almost all countries. This discrepancy has suggested that hormone levels and/or exogenous hormone use could have an effect on risk, although prior studies have reached inconsistent conclusions. Thus, the current study was conducted to examine the relationship between menopausal hormone therapy (MHT) use and development of liver cancer. A nested case‐control study was conducted within the United Kingdom's Clinical Practice Research Datalink (CPRD). Controls were matched, at a 4‐to‐1 ratio, to women diagnosed with primary liver cancer between 1988 and 2011. A second match, based on whether the cases and controls had diabetes, was also conducted. Odds ratios (OR) and 95% confidence intervals (95%CI) for associations of MHT with liver cancer were estimated using conditional logistic regression adjusted for known risk factors. In the overall match, 339 women with liver cancer were matched to 1318 controls. MHT use was associated with a significantly lower risk of liver cancer (OR_adj = 0.58, 95%CI = 0.37–0.90) especially among users of estrogen‐only MHT (OR_adj = 0.44, 95%CI = 0.22–0.88) and among past users (OR_adj = 0.53, 95%CI = 0.32–0.88). Among the matched cases (n = 58) and controls (n = 232) with diabetes, the odds ratios were similar to the overall analysis (OR_adj = 0.57, 95%CI = 0.09–3.53), but did not attain statistical significance. In the current study, MHT use, especially estrogen‐only MHT use, was associated with a significantly lower risk of liver cancer. These results support the need of further investigation into whether hormonal etiologies can explain the variation in liver cancer incidence between men and women.     

Clinical Candidate VT-1161's Antiparasitic Effect In Vitro,Activity in a Murine Model of Chagas Disease,and Structural Characterization in Complex with the Target Enzyme CYP51 from Trypanosoma cruzi

A novel antifungal drug candidate, the 1-tetrazole-based agent VT-1161 [(R)-2-(2,4-difluorophenyl)-1,1-difluoro-3-(1H-tetrazol-1-yl)-1-{5-[4-(2,2,2-trifluoroethoxy)phenyl]pyridin-2-yl}propan-2-ol], which is currently in two phase 2b antifungal clinical trials, was found to be a tight-binding ligand (apparent dissociation constant [K_d], 24 nM) and a potent inhibitor of cytochrome P450 sterol 14α-demethylase (CYP51) from the protozoan pathogen Trypanosoma cruzi. Moreover, VT-1161 revealed a high level of antiparasitic activity against amastigotes of the Tulahuen strain of T. cruzi in cellular experiments (50% effective concentration, 2.5 nM) and was active in vivo, causing >99.8% suppression of peak parasitemia in a mouse model of infection with the naturally drug-resistant Y strain of the parasite. The data strongly support the potential utility of VT-1161 in the treatment of Chagas disease. The structural characterization of T. cruzi CYP51 in complex with VT-1161 provides insights into the molecular basis for the compound''s inhibitory potency and paves the way for the further rational development of this novel, tetrazole-based inhibitory chemotype both for antiprotozoan chemotherapy and for antifungal chemotherapy.     

Cortical visual loss in posterior reversible encephalopathy syndrome in late postpartum eclampsia: Case series

The purpose of this study was to determine the prevalence of visual disturbances in patients with posterior reversible encephalopathy syndrome (PRES) associated with late postpartum eclampsia. We retrospectively reviewed the clinical records of late postpartum eclampsia patients with features of PRES for the presence of visual disturbances and location of radiological abnormalities. We found a higher prevalence of cortical visual loss in patients with PRES associated with late postpartum eclampsia. Bilateral symmetrical vasogenic edema of the parieto-occipital lobe was the most common magnetic resonance imaging (MRI) abnormality noted. No significant differences were observed in the extent of edema in patients with and without visual loss.     

Prostate cancer detection using combined auto-fluorescence and light reflectance spectroscopy: ex vivo study of human prostates

This study was conducted to evaluate the capability of detecting prostate cancer (PCa) using auto-fluorescence lifetime spectroscopy (AFLS) and light reflectance spectroscopy (LRS). AFLS used excitation at 447 nm with four emission wavelengths (532, 562, 632, and 684 nm), where their lifetimes and weights were analyzed using a double exponent model. LRS was measured between 500 and 840 nm and analyzed by a quantitative model to determine hemoglobin concentrations and light scattering. Both AFLS and LRS were taken on n = 724 distinct locations from both prostate capsular (n_c = 185) and parenchymal (n_p = 539) tissues, including PCa tissue, benign peripheral zone tissue and benign prostatic hyperplasia (BPH), of fresh ex vivo radical prostatectomy specimens from 37 patients with high volume, intermediate-to-high-grade PCa (Gleason score, GS ≥7). AFLS and LRS parameters from parenchymal tissues were analyzed for statistical testing and classification. A feature selection algorithm based on multinomial logistic regression was implemented to identify critical parameters in order to classify high-grade PCa tissue. The regression model was in turn used to classify PCa tissue at the individual aggressive level of GS = 7,8,9. Receiver operating characteristic curves were generated and used to determine classification accuracy for each tissue type. We show that our dual-modal technique resulted in accuracies of 87.9%, 90.1%, and 85.1% for PCa classification at GS = 7, 8, 9 within parenchymal tissues, and up to 91.1%, 91.9%, and 94.3% if capsular tissues were included for detection. Possible biochemical and physiological mechanisms causing signal differences in AFLS and LRS between PCa and benign tissues were also discussed.OCIS codes: (170.1610) Clinical applications, (170.3650) Lifetime-based sensing, (170.6935) Tissue characterization, (170.4580) Optical diagnostics for medicine, (170.6510) Spectroscopy, tissue diagnostics