bluuebunny/crossref_metadata_2025 huggingface dataset:
Static model tests on mechanical behaviour of assembled multi-step cantilever walls
Authors: Li Zhaoying , Xiao Shiguo
Published: August 2023

An assembled multi-step cantilever retaining wall is a new type of light retaining structure, which can be quickly installed in situ and is suitable for high-fill earthworks. To investigate its mechanical behaviours fully to support practical analysis and design of the novel wall, a series of laboratory model tests is conducted for three-step cantilever walls retaining cohesionless filling under various strip surcharges on the top of the backfill. Test results indicate that lateral earth pressure on the highest-step wall member increases with the depth on the upper two-thirds segment of the wall stem, whereas it presents a multi-step polyline distribution mode on the lower two steps. Except for the highest-step wall member, the earth pressure on the upper part of each member stem shows some reduction effect due to shielding action of the upper heel plate inserted in the backfill. Horizontal displacement of the whole wall takes on a unimodal profile with relatively higher values at the middle height of the wall. Increasing the bench width is helpful to reduce the lateral earth pressure on the wall stems and setting up a shear key beneath the footing plate of the lowest-step member can reduce the wall displacement by up to 51%.
"Myth" or "construct"?: What students are learning about race in the South African history classroom
Authors: Robinson N , KerswillI N
Published: August 2023

History education in post-apartheid South Africa addresses topics that are highly salient to the concept of race. To make sense of colonialism, slavery, the Holocaust, and most notably apartheid, students require an understanding of what race is, and how it has been used to justify discriminatory and unjust behaviour. The South African Curriculum and Policy Statements for Grade 9 History therefore devotes two hours to a topic on "the definition of race" (Department of Basic Education [DBE], 2011a: 43). However, what are students learning about 'the definition of race' from their history education? In this article, we draw on our experience as a history educator and history education researcher to argue that students often develop inaccurate and unhelpful understandings of race. This is partially since both the South African history curricula and textbooks describe race as a "myth" (DBE, 2011a, 43; Bottaro, Cohen, Dilley, Duffett, & Visser, 2013) with no scientific or evolutionary basis. Hence, students who learn that race is a 'myth' understandably struggle to understand discourses and policies that refer to racial identity and are at risk of misunderstanding theories of evolution. While we agree that the concept of race has no legitimate scientific basis, we nonetheless argue that students require an historical understanding of race; one that demonstrates how racial identities have been constructed in different ways and for different purposes over time. Such an approach would introduce students to the extensive historiography of the construction of race (e.g. DuBois, 1940; Dubow, 1995). By understanding race as a construct rather than a myth, we suggest that students will be better able to engage with the legacies of racialised violence as well as the ways in which racial identity is a legitimate source of meaning for many South Africans.
Attempts to (re)capture the school history curriculum? Reflections on the history ministerial task team's report
Authors: Maluleka P , Ledwaba L
Published: August 2023

The History Ministerial Task Team Report (HMTT) on the proposed compulsory school history in South Africa was made public in February 2018. Ever since, it has generated many debates and concerns among in- and pre-service history educators, History (of) Education scholars as well as the general public. Many of these concerns are premised on the fear that there is an attempt, at least by the state, through the work of the HMTT to (re)capture school history. This (re)capture, some argue, would deliver a school history that is both nationalist and patriotic in its approach, and glorifies only the African National Congress's (ANC) role in history, much in the same way as the apartheid curriculum glorified the role of the National Party (NP), Afrikaner nationalism and white supremacy thinking. However, we are convinced that there might as well be a different reading of the HMTT and its Report; thus, a different form of (re)capture. In this paper, we will explore, theorise and reflect on the HMTT's work and Report, as well as recent scholarly debates regarding the HMTT itself and its Report. This we do by employing the notion of (re)capture as our theoretical framework which is derived from the current 'state capture' discourse in South Africa. We then use this theoretical lens to review literature on the contested epistemic nature of school history, as well as to read and make sense of the HMTT and its Report. We conclude that those who argue that there are indeed attempts to (re)capture the school history for narrow nationalistic aspirations which are nativist in nature, provide us with a different reading of the HMTT and its report. We contend that the form of (re)capture advanced by the HMTT, and its Report is for a greater cause related to current calls for decolonisation and Africanisation of school history in post-apartheid South Africa - where the colonised ways of knowing and being can also take centre stage in the historical literature and where cognitive, epistemic, existential, and ontological justice is realised.
Exercise Training for autoimmune myasthenia gravis: A review of safety and effectiveness based on existing literature
Authors: Birnbaum Simone , Sharshar Tarek , Hogrel Jean-Yves
Published: August 2023

No abstract is required for a review article as per instructions
Complement inhibition in Myasthenia – from basics to RCT data
Authors: Jacob Saiju
Published: August 2023

Myasthenia gravis (MG) is the prototypic autoimmune neurological disorder causing fatiguable muscle weakness either limited to the ocular muscles or becoming generalised involving the limb and bulbar muscles. Nine out of 10 generalised MG patients have IgG1 or IgG3 antibodies against the acetylcholine receptor (AChR). AChR antibodies cause neuromuscular weakness by internalisation of AChR, receptor blockade and by activating the complement pathway. Complement activation causes formation of the membrane attack complex (MAC) leading to degradation of the neuromuscular junction (NMJ). Several animal models have confirmed the role of complement in the pathogenesis of MG, with the experimental models (EAMG) often needing complement inhibitory therapies to prevent or reverse the disease. Various molecules that target the complement system have now been developed to treat myasthenia gravis. The vast majority of the currently studied molecules target the C5 protein, thereby preventing the formation of MAC and subsequent NMJ destruction. The currently studied anti-complement therapies for MG include Eculizumab, Zilucoplan, Ravulizumab, Pozelimab, Cemdisiran, Gefurilimab, Danicopan and few others in the pipeline.  Eculizumab has been shown in clinical trials to be effective in the treatment of refractory MG, but further sub-group analysis and real-life experience have shown that this can be beneficial in various patients including those receiving regular IVIG, plasma exchange or Rituximab. It was approved for use by FDA in Oct 2017. Ravulizumab is a long-acting monoclonal antibody which has similar mechanism of action to Eculizumab and was approved for use in MG by FDA in April 2022. Zilucoplan is a macrocyclic peptide which binds to C5 and C5b thus preventing terminal complement activation, which can be given subcutaneously (FDA new drug application accepted in Nov 2022). Many of these have also been shown to have long term benefit in different sub-groups of patients with MG. Patients would need to be vaccinated against Neisseria meningitidis because of the risk of Gram-negative septicaemia, although no major safety signatures have been noted in the studies so far. Future studies may be able to identify specific biomarkers which might aid in selecting the most appropriate patients who might respond to these therapies.
Pharmacological treatment of Lambert-Eaton Myasthenic Syndrome
Authors: Bakker Wisse Roelof , Remijn-Nelissen Linda , Schimmel Kirsten , Tannemaat Martijn , Verschuuren Jan , Van Gelder Teun
Published: August 2023

Lambert-Eaton myasthenic syndrome (LEMS) is a very rare antibody-mediated autoimmune disease of the neuromuscular junction. Therapy can be divided in symptomatic treatment and immunosuppressive treatment. Symptomatic treatment with amifampridine is the only therapy currently authorized for use in LEMS patients. In the Netherlands the first choice drug is amifampridine base in an extended release formulation instead of the currently authorized amifampridine phosphate. This formulation has lower costs and is possibly safer due to lower peak concentrations. Other therapy used in LEMS patients is prescribed off-label and is based on experience in patients with myasthenia gravis. In many cases pyridostigmine is added as symptomatic treatment. In almost half of patients immunosuppressive therapy is started, mostly corticosteroids with or without azathioprine. Intravenous immunoglobulins and plasma exchange are used as emergency treatment.

Currently no randomized clinical trials with new therapies are ongoing or announced in patients with LEMS, although multiple new therapies for myasthenia gravis are being investigated. These future therapies can be differentiated in symptomatic and immunomodulating drugs. The immunomodulating drugs can be further differentiated in early stage drugs which target the B-cell, later stage drugs which target the circulating antibodies and targeted therapy which have a disease-specific target. Some early and later stage immunomodulating drugs show promising results in myasthenia gravis although high cost and uncertain long term safety may be limiting for incorporating these drugs in LEMS treatment guidelines.

Clinical trials in LEMS patients are lacking due to the rarity of the disease and we suggest the following requirements for future trials of potential new treatments: Sufficient power by performing multicenter or n-of-1 trials when appropriate, a cross-over design to reduce the number of patients and using a LEMS-specific quantitative primary outcome measure like the 3TUG score.
Congenital myasthenic syndromes: beta adrenergic receptor agonist treatment
Authors: Beeson David
Published: August 2023

Acetylcholinesterase inhibitors, such as pyridostigmine, are the standard symptomatic treatment for myasthenia gravis, and so have naturally been applied to the genetic forms of myasthenia, termed congenital myasthenic syndromes (CMS). Although effective for many CMS in others there was no clear response and in some it was positively harmful. Now, with greater understanding of the mutations and molecular mechanisms underlying CMS, treatments can be tailored for the specific syndrome and depending on diseases severity and patient response this can include utilizing different combinations of the drugs. In CMS, over the last 15-20 years b2-adrenergic receptor agonists have moved from occasional use to a mainstream medication. Many cases show life-transforming improvement both when the b2-adrenergic receptor agonists are used alone or in combination. Here we feature how the identification of DOK7-CMS first highlighted the consistent benefit of b2-adrenergic receptor agonists as medication and how it’s application to many different CMS subtypes evolved.  The molecular pathogenic mechanisms for many CMS subtypes are now established and this report will also discuss a hypothetical rationale for which forms of CMS are likely to benefit from the b2-adrenergic receptor agonists.
Perfil de dor e cinesiofobia em atletas de judô da categoria master
Authors: Sestelo Enzo Seixas , Ribeiro Gabriel Ledo , Dos Santos Clarcson Plácido Conceição , Goes Bruno Teixeira
Published: August 2023

INTRODUÇÃO: Atletas de contato estão sujeitos a lesões musculoesqueléticas devido às técnicas repetitivas aplicadas durante treinos e campeonatos. Isso pode levá-los a apresentar dores agudas e crônicas, e, a depender da técnica aplicada, diferentes regiões do corpo podem ser acometidas.  Estudos nesta área focam na descrição da lesão ou trauma, no entanto, a presença de cinesiofobia nesta população é uma lacuna a ser investigada.  OBJETIVO: Descrever o perfil de dor e cinesiofobia em atletas de Judô da categoria master. MÉTODO: Estudo observacional, descritivo, de corte transversal, realizado com 29 atletas de judô master inscritos na Federação Baiana. Para descrição da dor, foram utilizados o Inventário Breve de Dor (IBD) e Doleur Neuropathique Questionnaire (DN4) e a Escala de Cinesiofobia de Tampa (ECT). Os dados foram tabulados e analisados descritivamente através do software Excel for Windows® utilizando valor absoluto ou média (desvio padrão). RESULTADOS: Os dados do IBD mostraram que a média geral de dor foi de 5,1 ± 1,8, o tratamento optado foi majoritariamente o farmacológico e a região mais acometida foi a face anterior do joelho. Dos 29 participantes, 9 (31%) apresentavam o escore ≥3, indicando presença de dor neuropática e cinesiofobia leve com média geral de 33,8 ± 6,7 no escore da ECT. CONSIDERAÇÕES FINAIS: Os atletas apresentaram dor moderada com pouco impacto na vida pessoal e as regiões com maior incidência foram os joelhos. Cinesiofobia leve esteve presente em mais da metade dos participantes e um terço apresentou dor neuropática.
Refining PD-1/PD-L1 assessment for biomarker-guided immunotherapy - a review
Authors: Zdrenka Marek , Kowalewski Adam , Ahmadi Navid , Sidiqi Rizwanullah , Chmura Łukasz , Borowczak Jędrzej , Maniewski Mateusz , Szylberg Łukasz
Published: August 2023

Anti-programmed cell death ligand 1 (Anti-PD-L1)  immunotherapy is an increasingly crucial in cancer treatment. To date, the Federal Drug Administration has approved four PD-L1 immunohistochemistry (IHC) staining protocols, commercially available in the form of "kits", facilitating testing for PD-L1 expression. These kits comprise four PD-L1 antibodies on two separate IHC platforms, each utilizing distinct, non-interchangeable scoring systems. Several factors, including tumor heterogeneity and the size of the tissue specimens assessed, can lead to PD-L1 status misclassification, potentially hindering the initiation of therapy. Therefore, the development of more accurate predictive biomarkers to distinguish between responders and non-responders prior to anti-PD-1/PD-L1 therapy warrants further research. Achieving this goal necessitates refining sampling criteria, enhancing current methods of PD-L1 detection, and deepening our understanding of the impact of additional biomarkers. In this article, we review potential solutions to improve the predictive accuracy of PD-L1 assessment in order to more precisely anticipate patients' responses to anti-PD-1/PD-L1 therapy, monitor disease progression and predict clinical outcomes.
Evaluation of Anti-SARS-CoV-2 IgG antibody response following COVISHEILD vaccination: A comparison between previously infected and non-infected cohorts
Authors: Md Shakeel Ahmed , Md Zakir Hossain , Md Mamunur Rashid , Istiak Ahmad , Md Zahirul Islam , Meherab Hossain , Hasan Rabbi
Published: August 2023

Background: The Coronavirus disease-2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a significant global health threat. In this study, we investigated the antibody response in five-time intervals following the COVISHEILD first, second, and booster doses vaccination in previously infected and previously non-infected individuals. Methods: The study was a cross-sectional prospective study that took place at the Bangladesh Institute of Tropical and Infectious Diseases (BITID), Fouzderhat, Chittagong, in 46 individuals who received the COVISHEILD vaccine from February 2021 to January 2022. Blood samples were collected from vaccine recipients at five different time points (Baseline: Day 0 before 1st vaccine dose, 3 weeks, 2 months (before 2nd dose), 6 months, and 1 year after a booster dose) to measure the levels of S-RDB IgG antibodies using the EUROIMMUN Anti-S-Rose Disease Bioinfection assay test kits (Lübeck, Germany). Results: The study reveals that individuals with prior SARS-CoV-2 infection showed a significant increase in antibody levels after receiving the first vaccine dose, reaching 145.51 units at 3 weeks post-vaccination. This response remained stable at 117.6 units at 3 months and slightly declined to 103.26 units at 6 months, indicating a sustained immune response. For previously non-infected individuals, vaccination induced a strong immune response, with antibody levels of 159.62 units at 3 weeks, increasing to 150 units at 3 months, and then slightly declining to 87.84 units at 6 months. Despite the decline, antibody levels at 6 months and 1 year were notably higher than the pre-vaccination baseline of 0 units, indicating the development of a durable immune response following vaccination. In the <40 years age group, individuals with prior SARS-CoV-2 infection showed a substantial boost in antibody levels after receiving the first vaccine dose, reaching 198.61 units at 3 weeks post-vaccination. The response remained stable at 122.22 units at 3 months and declined to 73.7 units at 6 months, followed by a rise to 263.85 units at 1 year. Conclusion: Our findings highlight that tailoring vaccination approaches based on gender differences and considering vaccination in both previously and non-infected individuals will aid in optimizing immune responses and combatting the COVID-19 epidemic effectively.
Effects of sprouted soybeans and ginger on soymilk quality attributes via a developed dual-powered milk pasteurizer
Authors: Saheed Sanusi Mayowa , Olushola Sunmonu Musliu , Sani Rafat , Adeola Adesanya Al Ameen , Gegele Hammed Ameen , Tolulope Abodunrin
Published: August 2023

Soymilk market has achieved tremendous progress in consumption and sales due to its inexpensiveness and soymilk protein content. However, due to the present global health crisis, there is a need to further devise means of enriching the quality of soymilk. This study aimed to evaluate the effects of sprouted soybeans and ginger on soymilk quality and sensory attributes. A developed dual -powered milk pasteurizer was used to produce the soymilk. Soybeans, a mixture of soybeans and sprouted soybeans, and sprouted soybeans were interacted with peeled ginger and whole ginger rhizome using Taguchi experimental design to produce nine soymilk samples. The proximate composition, calorific value, total phenolic content and phytic acid content of the soymilk samples were determined using standard procedures. The moisture content of the soymilk samples ranged from 80.85 to 83.78%, crude protein content (7.47 – 9.54%), ash content (0.72 – 1.27%), fibre content (0.24 – 0.73%), crude fat (0.24 - 5.44%), carbohydrate content (1.29 -6.82%) and calorific value (67.6 kcal/g - 91.58 kcal/g). The total phenolic content and phytic acid content ranged from 4.81 mg/l to 11.88 GAE mg/l and 26.77 to 41.86 mg/l, respectively. The soymilk produced from the mixture of sprouted soybeans and un-sprouted soybeans with the addition of either whole or peeled ginger significantly increased the crude protein content, ash content, calorific value and total phenolic content to 9.54%, 1.27%, 91.58 kcal/g and 11.88 GAE mg/l, respectively. In addition, it increased the overall sensory acceptability of soymilk. Conclusively, the use of sprouted soybeans and the addition of ginger should be encouraged to promote a more enriched soymilk beverage. Also, the developed dual-powered milk pasteuriser could be adopted for soymilk production.
Searching for Reconnection: Environmental Challenges and Course Changes in Spatial Development Along Shanghai’s Shipping Channels
Authors: Den Hartog Harry
Published: August 2023

Waterways played a crucial role in the emergence of Shanghai as a cosmopolitan city and world port. Over the years the spatial and functional relationships between the city and ports and hinterland have been changing continuously. In Shanghai, like other port cities, almost all ports and related industries are placed out beyond the urban fringes, to form decentralized regional clusters, while former docklands are quickly transformed into attractive urban waterfronts. Simultaneously there is a growing physical and socio-economic gap with the rural hinterland. During Shanghai’s brutal lockdown in Spring 2022, due to China’s rigid zero-Covid policy, citizens were without food and other supplies while fully loaded ships were lined up waiting in the port. Also, deliveries from surrounding rural areas were temporarily halted. This article focuses on recent developments but is based on experiences in previous centuries from a long durée perspective. It elaborates on how the Yangtze River Delta urbanized along shipping channels and examines changing relationships between city and port, between urban and rural, and between man and nature. What role did shipping channels play and how to rebalance various spatial claims: urban, rural, port interests, and environmental concerns?
InSAR Observations Reveal Variations in Shallow Creep on the Kangding Segment of the Xianshuihe Fault
Authors: Huang Xing , Li Yanchuan , Shan Xinjian , Zhao Dezheng , Gao Zhiyu , Gong Wenyu , Qu Chunyan
Published: August 2023

Investigating the spatiotemporal characteristics of aseismic shallow creep provides insights into interseismic steady-state and/or postseismic transient behavior of faults. In this study, we focus on the Kangding segment of the Xianshuihe fault in eastern Tibet, where the 2014 Mw 5.9 Kangding earthquake occurred. Previous geodetic observations in 1999–2021 identified apparent shallow creep along this segment; however, whether the aseismic slip is secular creep, afterslip of the 2014 Kangding earthquake, or the combined effect remains unresolved. We process descending and ascending Interferometric Synthetic Aperture Radar data in the 2014–2021 period and investigate the creep rate variations on the fault plane. Our results reveal an ∼55-km-long aseismic slip section between Huiyuan Temple and Kangding Airport, of which the ∼15-km-long section between Huiyuan Temple and Jinlong Temple is in steady creep at a rate of 13 ± 2.0 mm/yr. Along the remaining ∼40-km-long section that overlaps the rupture of the Kangding earthquake, the creep rate decays from ∼40 to 0 mm/yr between 2014 and 2019, implying that the aseismic slip here is most likely the postseismic afterslip. We also identify a northwestward migration of aseismic creep from Huiyuan Temple to Longdengba during 2017–2021, which might be related to fluid diffusion. On the basis of the aseismic slip distribution, we quantitatively calculate the moment budget on the Kangding segment. The results show that the Huiyuan Temple-Longdengba section can produce an Mw 6.9 earthquake. Despite the 2014 Kangding earthquake, which ruptured the ∼40-km-long Jinlong Temple-Kangding Airport section, the accumulated seismic moment since the last major earthquake in 1748 is still sufficient for an Mw 7.0 earthquake.
Dynamic Rupture Modeling and Ground-Motion Simulations of the 2022 Mw 6.6 Luding Earthquake
Authors: Gu Yuhao , Zhang Zhenguo , Wang Wenqiang , He Zhongqiu
Published: August 2023

The 2022 Mw 6.6 Luding earthquake occurred on the Xianshuihe fault, one of China’s most active faults. Revealing the rupture process of the Luding earthquake and exploring the distribution of high intensities is important for earthquake hazard reduction around the active Xianshuihe fault in the future. Therefore, we modeled the dynamic rupture and ground motions of the Luding earthquake. The dynamic rupture modeling demonstrates that the maximum slip of the fault plane is ∼1.34 m, and the ground-motion simulations show the highest intensity attained is IX. In addition, we conducted a comparative analysis between synthetic data and station observation records, illustrating that our simulation results are compatible with the seismic station observations. We investigated the influence of geometric complexities on the Xianshuihe fault rupture and found that varying the dip angle of the southern segment may lead to premature rupture termination and constrain the rupture propagation. Our study provides insights into the complex geometry’s effect on the physical process of large earthquakes on the Xianshuihe fault.
Developing a Long-Term Strategy for Volunteer Retention in Open-Source Project Teams
Authors:   , Wright Allison , Koltick Nicole
Published: August 2023

Open Source Design Practices (OSDP) have value in contributing knowledge to the design community. OSDP allows information to freely flow without the limitations of traditional academic practices. The most vital component of OSPD is the people who come together to create the projects: the volunteers. Volunteers can derive many benefits from participating in OPSD, such as social networking and skill building. This paper looks at the systemic issues that have challenged the wider adaptation of open source into the practice of the mainstream design community. One reason that Open Source projects may fail to generate momentum to completion is the lack of acknowledgment that volunteers receive for their participation and contribution to given projects. Open Source projects often lack financial incentives and require other forms of recognition such as intangible value for social interactions among members. Literature in direct relation to Open Source is new and limited in scope. The project goal is to test and experiment with tools that will assist in building community and connections that can be sustained in the OSDP community. The approach to this problem began with the analysis of process value in relation to the field of Industrial and Organizational Psychology. A group of dedicated Industrial and Organizational psychologists, (Allee, 2015) have written extensively on the importance of identifying value in group participation. Their research emphasizes that projects must build strong value networks in the form of social capital and knowledge exchange. The project approach, building on the literature examined, is to develop an interactive tool to assist project leaders in the identification of the skills each project participant brings to an Open Source development team. Susan Leigh Star defines boundary objects as "scientific objects which both inhabit several communities of practice and satisfy the informational requirements of each of them. Boundary objects are thus objects which are both plastic enough to adapt to local needs and constraints of the several parties employing them, yet robust enough to maintain a common identity across sites" (Star, 2015). The goal is to develop knowledge into a social network web through the development of a collaborative tool or boundary object. Through an analytical process, active participant skills are mapped to create a formal Social Network Analysis (SNA). This process could uncover possible unidentified social and knowledge capital. Once identified and represented, I anticipate that project leads will be able to use this information to match participants who have knowledge of a particular skill with those who want to acquire those skills. Over the course of a project, this will help build a social network, which will strengthen group cohesion and sustain volunteer engagement.
Aortic valve replacement using interrupted pledgeted non everting suture technique versus simple suture technique in small aortic annulus, does it influence patient prosthetic mismatch
Authors: Kothari Ankur , Jadhav Uday E.
Published: August 2023

Background: This study aims at comparing post-op outcome and incidence of patient prosthetic mismatch (PPM) post aortic valve replacement (AVR) using pledgeted versus simple suture technique in isolated aortic stenosis patients with small aortic annulus undergoing AVR with 18-21 mm mechanical bi-leaflet valve in Indian population.
Methods: A retrospective study, conducted in KEM Hospital, Mumbai in patients who underwent AVR between January 2015 to December 2018. Pre-operative data and 1-year post-op hemodynamic data of patients undergoing AVR using interrupted non everting pledgeted and interrupted simple suture technique were compared.
Results: 68 patients were selected for study after applying exclusion criteria (pledgeted 44, simple 24). Both groups were comparable in terms of age (p=0.46), sex (p=0.41), and valve pathologies. Incidence of severe PPM was higher in pledgeted group in patients with valve size 18-19 mm (p=0.20) but similar in valve size 20-21 mm group (p=0.30). Patients with severe and moderate PPM had poor post-operative LV function.
Conclusions: PPM is a common and alterable entity. Severe PPM is responsible for adverse hemodynamic function and congestive heart failure among patients with small sized aortic valve implantation (18-21 mm). Use of simple suture technique had a slight benefit over pledgeted technique in reducing incidence of severe PPM (not statistically significant) and better recuperation during short term follow up.
Comparative study of Alvarado score and RIPASA score in the diagnosis of acute appendicitis
Authors: Jaiswal Anand K. , Mathur Sujeet K. , Kumar Santosh , Tripathi Durgesh K. , Kumari Sudha
Published: August 2023

Background: Acute appendicitis is one of the most common surgical emergencies. Immediate and accurate diagnosis, mainly based on clinical assessment and laboratory results, is of paramount importance in order to reduce complications and mortality rates. Challenging diagnosis and fears of missing an inflamed appendix may lead to a negative appendectomy. Many scoring systems have been developed to reduce ambiguities in the diagnosis of appendicitis. The aim of the present study was to compare the efficacy of Alvarado score and RIPASA score in the diagnosis of acute appendicitis.
Methods: This study was conducted in the Department of Surgery, Nehru Hospital, BRD Medical College, over a period of 12 months. A total number of 50 cases with a clinical diagnosis of acute appendicitis were studied. Informed consent was obtained from all registered cases.
Results: 48% were male and 52% were females in the study. 70% belonged to <40 years and 30% belonged to >40 years. Among 50 patients, in patients ≥40 years of age, appendicitis was diagnosed in 10 patients and in patients <40 years of age, 24 were diagnosed with appendicitis. Among 50 patients, 24 were males out of which 19 were diagnosed with appendicitis compared to 15 out of 26 females. Anorexia and tenderness in RLQ were present in 100% patients. 100% patients had anorexia, RIF pain and tenderness. Alvarado and RIPASA score showed sensitivity 64.7% and 88.2% respectively.
Conclusions: The difference in the diagnostic accuracy between Alvarado and RIPASA scoring system is significant indicating that the RIPASA score is a much better diagnostic tool for the diagnosis of acute appendicitis. When the ROC curve was observed the area under the curve is high for RIPASA scoring system.
Hepato biliary pancreatic ascariasis: a rare case report
Authors: A. Siva Subramanian K. , Jayaraman Chandrabose A. M. , Thangasamy Selvaraj , Sathyanesan Jeswanth
Published: August 2023

Ascariasis is an infection caused by Ascaris lumbricoides. Most of these infections are in the gastrointestinal tract. Its extraluminal infestations involving the liver, pancreas and biliary tract are rare and its complications are usually morbid. This aspect of extra intestinal manifestation is termed hepato biliary and pancreatic ascariasis. We report a 65 years old female with history of recurrent abdominal pain and on evaluation found to have Ascarial infection with complications involving liver, biliary and pancreas. She was optimized and taken up for surgery and she recovered well. The ascarial infections are generally seen in the paediatric populations and most of them are intestinal. Here we presented an adult with extraintestinal Ascariasis who had complications of hepatobiliary and pancreatic system which was managed successfully and she was presented for its rarity.
A rare case of duodenal Dieulafoy’s lesion managed by endoscopic band ligation
Authors: Urabinahatti Kiran , Devakumar Murugesan Satish , Selvaraj Thangasamy , Sathyanesan Jeswanth
Published: August 2023

Dieulafoy's lesion is an uncommon but important cause of recurrent upper gastrointestinal bleeding. Extragastric location of Dieulafoy's lesion is rare. We report a case of duodenal Dieulafoy's lesion which was successfully managed by banding. Fifty-year-old presented with recurrent upper gastrointestinal (GI) bleed and severe anemia with history of multiple blood transfusions and OGD scope showed dieulafoy’s lesion in the second part of duodenum (D2), which was successfully managed by banding. Endoscopic diagnosis of extragastric Dieulafoy's lesion can be difficult because of the small size and obscure location of the lesion. Increased awareness and careful and early endoscopic evaluation following the bleeding episode are the key to accurate diagnosis. Banding is one of the safest, cost effective endoscopic modalities for control of bleeding.
A review of the role of liver resection in the treatment of human immuno-deficiency virus-positive patients with hepatocellular carcinoma
Authors: Coelho Marcio B. , Teixeira Uira F. , Waechter Fabio L. , Fontes Paulo R. O. , Rodrigues Pablo D.
Published: August 2023

Patients with human immune-deficiency virus (HIV) have increased risk of developing hepatocellular carcinoma (HCC); this neoplasm apparently behaves more aggressively in this population, leading to worse outcomes. Questions remain regarding the best treatment of HCC in these patients, mainly related to the role of surgical resection. Some studies show that, after transplantation, this group of patients has an overall survival rate comparable to that of uninfected patients. This integrative review assesses and summarize the survival outcome of resection in the treatment of HIV-positive patients with HCC. Integrative review of articles published in English, in PubMed and Scielo databases until October 2021, using the terms: HIV, HCC, and resection. Four publications were analyzed in relation to their content and relevance to the research question. We identified 54 patients who underwent surgical resection, with great variability in overall survival between studies (median between 18 and 72 months); only one study demonstrated disease-free survival. There was also great variability in morbidity and mortality rates after the procedure. All studies were non-comparable. Data regarding the impact of surgical resection on survival in HIV-positive patients with HCC are scarce, and questions remain about the best treatment options with curative intent. Further studies on the topic are needed, given the practical implications for decision-making. Therefore, we suggest that the treatment of these patients should still be conducted similarly to that indicated by the main guidelines on the treatment of patients with HCC, without distinction to HIV serology.
Knee stiffness post anterior cruciate ligament reconstruction- factors to worry about
Authors: A. Yamani Al-Muthana M. , Shari Naser F. , Abushahot Mohammad A. , Omor Ashraf F. , A. Alannaz Nizar A.
Published: August 2023

Background: Knee stability is affected by integrity of anterior cruciate ligament (ACL). Knee stiffness is a worrying postoperative complication, preventing patients from returning back to pre-injury sport level. In this study, we analyzed incidence of knee stiffness post ACL reconstruction and possible associated risk factors.
Methods: This is retrospective study, was held in Royal Medical Services/Jordan–Queen Alia Military hospital/Arthroscopic and Sport injuries division. We analyzed 250 patients’ data using computerized patients record system (CPRS) called Hakeem complaining of knee stiffness post ACL reconstruction between July 2022 and July 2023, whom ACL reconstructive surgeries were performed between March and September 2022.
Results: Incidence of knee stiffness post ACL reconstruction is about 1.5% (4 out of 250). All of those 4 patients were males,3 of them had limited flexion (75%), while 1 of them had limited extension (25%). All of the 3 patients having extension contracture had an associated medial meniscus tear, repaired at time of ACL reconstruction, while flexion contracture patient had an isolated ACL tear.
Conclusions: Incidence of knee stiffness post ACL reconstruction is about 1.5%. 75% of patients were associated with medial meniscus tear, who underwent meniscus repair and hinged knee brace was applied. We conclude that ACL patients having an associated meniscus tear managed by meniscus repair and hinge knee brace are at higher risk to develop knee stiffness. Therefore, we recommend limiting the usage of knee brace for ACL reconstruction with meniscus repair only.
Radiographic and functional outcome of operated closed intra-articular fractures of calcaneum: a retrospective analysis
Authors: Kerketta Abhay H. , Mittal Shivanshu , Rahul Kumar , Laik Jayanta Kumar
Published: August 2023

Background: The present study aims to analyse the results of surgical outcome of the operated calcaneal fractures using either plates or cannulated cancellous screws. Recently there has been considerable shift of treatment of calcaneal fractures from conservative to operative owing to better understanding of fracture pattern. However, reduction of long-term functional outcome of such patients is always questionable and remains unanswered.
Methods: A 25 fractures were operated with locking plates or cannulated screws after proper assessment. Functional assessment was done using AOFAS scoring system. Radiological outcome was assessed using restoration of Bohler and Gissane angle.
Results: The results were extrapolated as excellent in 20 patients, good in 3 patient's and poor result in 2 patients. Statistical analysis revealed better outcomes in percutaneous cannulated screw fixation as compared to open plate fixation.  6 patients had to undergo implant exit of which 5 were cannulated screw backout, prominence irritating the soft tissue and 1 plate removal had to be done because of infection. None of the patients had subtalar arthritis, heel pad problems, peroneal tendinitis or implant failure.
Conclusions: Surgical management in the treatment of choice for intra articular calcaneal fractures after thorough evaluation. The choice of implant depends upon the communition of fracture, soft tissue compromise, joint surface incongruity and surgical expertise. Radiological maintenance of Bohler and Gissane angle intraoperatively and at follow up is a good indicator for predicting functional outcomes score.
Study of functional outcome of muller type C distal femur fracture treated with locking compression plate
Authors: Hathiwale Mohammed Ismail , Sasnur Prakash A. , Thimmarayappa Sharath Gowda
Published: August 2023

Background: To evaluate the functional outcome of Muller type C distal femur fracture treated with locking compression plate (LCP).
Methods: This prospective study was carried out at Al-Ameen medical college and hospital, Vijayapura. Forty patients (24 males and 16 females) with Muller type C distal femur fractures were enrolled in our study. Patients were treated with open reduction and internal fixation with LCP. They were followed up for 9 months with clinical examination and serial x-rays. The functional outcome was evaluated using Neer’s scoring system.
Results: Forty patients who completed follow up of 9 months were included. There were 18 muller type C1, 14 muller type C2 and 8 Muller type C3 fractures. The functional evaluation with Neer’s scoring system was excellent in 8 patients, good in 20 patients, fair in 8 patients and poor in 4 patients. Complications observed were difficulty in reduction, superficial infections, knee stiffness and limb length discrepancy.
Conclusions: The LCP is a safe and effective tool to manage these difficult fractures as we had no incidence of implant failure, delayed union, non-union and revision surgery except that we had knee stiffness as commonest complication which can be tackled by early surgery, surgical expertise, meticulous soft tissue handling and vigorous early knee mobilisation.
Determination of various etiological factors for diagnosis of non traumatic scapulo costal syndrome
Authors: Kushwah Kundan , Mahajan Pranav , Rajoria Vikalp
Published: August 2023

Background: Scapulocostal syndrome, also known as "snapping scapula," is an under-recognized problem involving overhead or throwing motion of the upper extremities. It is often described as a snapping or grinding sensation accompanied with pain as the scapula touches the chest wall and an audible or palpable click near the anteromedial scapula.
Method: A prospective observational study was performed at one of the biggest tertiary care centres of central India from September 2021 to March 2023. A total of 50 patients were included in this study. Patient were evaluated clinically in OPD for pain in Scapulothoracic region. All the suspected patients underwent various investigations like X-ray, ultrasonography, electromyography, nerve conduction velocity study, magnetic resonance imaging (MRI) depending on the condition to reach a diagnosis. The data was recorded and evaluated.
Results: A total of 50 patients were included in the study, 30 were females and 20 males, 50 % of our patients were diagnosed with supraspinatus tendinosis, 8 patients were found to have bicipital tendinitis, 3 patients had acromioclavicular joint arthritis, 2 patients developed pain because of glenohumeral joint arthropathy, subscapularis tendinitis. There were some other conditions as well diagnosed in few patients with the help of various investigations.
Conclusions: It was found that there were various reasons for pain in patients diagnosed clinically with scapulocostal syndrome. Dominant hand affection was more common. The clinical investigations play a major role in diagnosing these conditions and planning the treatment.
Radiological and functional outcomes of anterior bridge plating with minimally invasive plate osteosynthesis technique for humerus diaphyseal fractures in adults
Authors: Dave Harshit , Modi Nihar , Pawar Eknath , Gavhale Sandeep , Topno Rohit , Shet Vipul
Published: August 2023

Background: We conducted a study to evaluate radiological, functional outcomes and complications of internal fixation of humerus diaphyseal fractures by anterior bridge plating (ABP) with minimally invasive plate osteosynthesis technique.
Methods: 40 patients with humerus diaphyseal fractures operated by ABP with MIPO between August 2017 and January 2020 were included in the study. All patients were evaluated verbally, clinically, and radiologically for a minimum of 1 year.
Results: Mean time to radiological union was 13.75 weeks. Disabilities of the arm, shoulder and hand score improved from a mean of 23.45 to a mean of 5.04 at 6 months. All patients except one had an excellent Mayo Elbow Performance Score score at 6 months. The variation of mean shoulder range of motion between normal and operated side was within 5 degrees at 6 months. Visual Analogue Scale score improved from a preoperative mean of 8 to a postoperative mean of 0.5 at 6 months. Mean intraoperative blood loss was 147 ml. Two patients had a superficial wound infection, one patient had a postoperative radial nerve palsy, and one patient had a delayed union, all of which recovered without any surgical intervention.
Conclusions: ABP with MIPO technique for humerus diaphyseal fractures is a safe and effective treatment modality yielding high rates of union, excellent functional recovery, minimal biological disruption, better cosmesis, and superior patient satisfaction. Therefore, we recommend that ABP with MIPO should be considered as an alternative treatment option in patients with humerus diaphyseal fractures.
Isolated traumatic dislocation of the cuboid
Authors: De P. T. Alves Marcelo , F. C. Nunes Catia , M. X. Modesto Gonçalo , A. S. Madeira Sofia
Published: August 2023

The cuboid bone stabilizes the lateral column of the foot. It articulates with the midtarsal and tarsometatarsal joints and this anatomically proportionates marked stability to the cuboid. Isolated dislocations of the cuboid a rare ocurrence. The authors present a rare case of an isolated traumatic dislocation of the cuboid bone without fracture and present a short review of the pertinent literature.
When prosthetic joint infection may lead to premalignant colorectal lesion detection
Authors: R. Posse Julie , D. A. B. Werly Thayná , Souza Fabio , T. Cavanellas Naasson , A. Matos Juliana , B. G. Barbato Kelly
Published: August 2023

Osteoarthritis (OA) is a common musculoskeletal disorder that affects millions of people worldwide, and total knee arthroplasty (TKA) is a common treatment for advanced OA. However, joint replacement surgeries may lead to complications such as deep vein thrombosis (DVT), surgical site infection, and prosthetic joint infection (PJI). Our objective is to discuss a Streptococcus bovis group (SBG) PJI case after TKA and its possible consequences in clinical practice. We describe a 67-year-old female who underwent TKA and developed initial complications including wound hematoma, symptomatic anemia, and acute DVT. Further investigations because of knee pain persistence and inflammatory signs post TKA revealed the presence of Staphylococcus aureus in the synovial and scar tissues from the knee and SBG in the periprosthetic membrane from the revision surgery, as well as mitral infective endocarditis and a large stenosing villous polypoid lesion in the ascending colon. SBG osteoarticular infection post TKA is a rare condition, but it may be associated with severe diseases. This article highlights the link between SBG and colorectal cancer (CRC) and emphasizes the importance of an echocardiogram and a colonoscopy for early detection and prompt treatment of infective endocarditis and CRC. This diagnostic workup should be performed even in the absence of symptoms, for early diagnosis and increased chance of cure. A multidisciplinary approach, involving orthopedists, infectious disease specialists, cardiologists, and gastroenterologists, among others, is advised to effectively manage SBG infections and improve patient outcomes.
State of School Feeding in Latin America and the Caribbean: 2022
Authors:   Inter American Development Bank,   World Food Programme
Published: August 2023

This joint publication by the Inter-American Development Bank (IDB) and the World Food Programme (WFP) presents the state of school feeding programmes in Latin America and the Caribbean (LAC) as of 2022. Amidst the challenges posed by the COVID-19 pandemic and compounding challenges, the publication highlights the critical role of school feeding programs to build human capital in the region. The publication offers comprehensive insights into the state of school feeding in LAC: scale, coverage, components, and impacts. It emphasizes the need to reach vulnerable children to prevent dropouts and promote holistic development. The publication emphasizes the importance of integrating health and nutrition interventions along with school meals programmes via multisectoral approaches. Key findings indicate that 80.3 million children across the region received school meals in 2022. Political commitment and investment in these initiatives is high with at least 19 countries having either a specific school feeding or school nutrition policy or law. Coverage ranges from 30 to 100 percent across the countries in the region. The publication recommends strengthening coverage and programme quality as well as regulatory frameworks, implementing local food procurement, investing in intercultural approaches, and enhancing multisectoral collaboration and partnerships. Moreover, it underscores the significance of crisis preparedness for school feeding programs, which were proven to beresilient and indispensable during the pandemic. The publication offers specific recommendations to support countries to effectively tackle challenges and ensure that school feeding programs continue to contribute to children's development, education, and overall wellbeing.