Search results for: gastrocnemius flap

Authors: Mona G. Alharbi

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A new family of methionine-sulfoxide reductase (Msr) was recently discovered and was named free methionine sulfoxide reductase (fRMsr). This family includes enzymes with a reductase activity toward the free R isomer of a methionine sulfoxide substrate. The fRMsrs have a GAF domain topology, a domain, which was previously identified as having in some cases a cyclic nucleotide phosphodiesterase activity. The classification of fRMsrs as GAF domains revealed a new function can be added to the GAF domain family. Interestingly the four members identified in the fRMsr family share the GAF domain structure and the presence of three conserved cysteines in the active site with free R methionine sulfoxide substrate specificity. This thesis presents the crystal structures of reduced, free Met-SO substrate-bound and MES-bound forms of a new fRMsr from Burkholderia pseudomallei (BPSL2418). BPSL2418 was cloned, overexpressed and purified to enable protein crystallization. The crystallization trials for reduced, Met-SO-bound and MES-bound forms of BPSL2418 were prepared and reasonable crystals of each form were produced. The crystal structures of BPSL2418MES, BPSL2418Met-SO and BPSL2418Reduced were solved at 1.18, 1.4 and 2.0Å, respectively by molecular replacement. The BPSL2418MES crystal belongs to space group P 21 21 21 while BPSL2418Met-SO and BPSL2418Reduced crystals belong to space group P 1 21 1. All three forms share the GAF domain structure of six antiparallel β-strands and four α-helices with connecting loops. The antiparallel β-strands (β1, β2, β5 and β6) are located in the center of the BPSL2418 structure flanked on one side by a three α-helices (α1, α2 and α4) and on the other side by a (loop1, β3, loop2, α3, β4 loop4) unit where loop4 forms a capping flap and covers the active site. The structural comparison of the three forms of BPSL2418 indicates that the catalytically important cysteine is CYS109, where the resolving cysteine is CYS75, which forms a disulfide bond with CYS109. They also suggest that the third conserved cysteine in the active site, CYS85, which is located in α3, is a non-essential cysteine for the catalytic function but it may play a role in the binding of the substrate. The structural comparison of the three forms reveals that conformational changes appear in the active site particularly involving loop4 and CYS109 during catalysis. The 3D structure of BPSL2418 shows strong structure similarity to fRMsrs enzymes, which further suggests that BPSL2418 acts as a free Met-R-SO reductase and shares the catalytic mechanism of fRMsr family.

Keywords: Burkholderia pseudomallei, GAF domain protein, methionine sulfoxide reductase, protein crystallization

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Authors: Daifeng Hao, Guang Feng, Jingfeng Zhao, Tao Li, Xiaoye Tuo

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Objective: To retrospectively analyze the clinical characteristics of incision infection with sternal osteomyelitis sinus tract after cardiac surgery and the operation method and therapeutic effect of filling and repairing with activated PRP gel. Methods: From March 2011 to October 2022, 142 cases of incision infection after cardiac surgery with sternal osteomyelitis sinus were retrospectively analyzed, and the causes of poor wound healing after surgery, wound characteristics, perioperative wound management were summarized. Treatment during operation, collection and storage process of autologous PRP before debridement surgery, PRP filling repair and activation method after debridement surgery, effect of anticoagulant drugs on surgery, postoperative complications and average wound healing time, etc.. Results: Among the cases in this group, 53.3% underwent coronary artery bypass grafting, 36.8% underwent artificial heart valve replacement, 8.2% underwent aortic artificial vessel replacement, and 1.7% underwent allogeneic heart transplantation. The main causes of poor incision healing were suture reaction, fat liquefaction, osteoporosis, diabetes, and metal allergy in sequence. The wound is characterized by an infected sinus tract. Before the operation, 100-150ml of PRP with 4 times the physiological concentration was collected separately with a blood component separation device. After sinus debridement, PRP was perfused to fill the bony defect in the middle of the sternum, activated with thrombin freeze-dried powder and calcium gluconate injection to form a gel, and the outer skin and subcutaneous tissue were sutured freely. 62.9% of patients discontinued warfarin during the perioperative period, and 37.1% of patients maintained warfarin treatment. There was no significant difference in the incidence of postoperative wound hematoma. The average postoperative wound healing time was 12.9±4.7 days, and there was no obvious postoperative complication. Conclusions: Application of activated PRP gel to fill incision infection with sternal osteomyelitis sinus after cardiac surgery has a less surgical injury and satisfactory and stable curative effect. It can completely replace the previously used pectoralis major muscle flap transplantation operation scheme.

Keywords: platelet-rich plasma, negative-pressure wound therapy, sternal osteomyelitis, cardiac surgery

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Authors: Anis Al-Yakhiri

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Introduction: The World Health Organization (WHO) classifies malignant epithelial thyroid tumors into four major groups (papillary, follicular, medullar and undifferentiated) . Papillary thyroid carcinoma (PTC) is the most common type, for about eight out of ten thyroid cancers belong to this histological type. Radioactive iodine (RAI) is considered effective for patients with total or nearly total thyroidectomy, but the beneficial effects of RAI are still controversial. War conditions forced us to study alternative methods of using radioactive iodine in the treatment of patients with PTC. Material and methods: Between January 2014 and June 2021, in Al-Yakhiri hospital, 57 Total Thyroidectomy with Radical BilateralNeckDissection (RBND) were performed, 50 for malignant disease,7 for false positive cytology.RBND involves surgical clearance of Levels II-VI. Mean age was 40.7 years old and 92% of the patients were female. 7(14%) patients had hypothyroidism which required preoperative thyroid hormone treatment. The Thyroid Stimulating Hormone- Suppression Therapy (TSH-ST) immediately started after RBND for mostpatients on the first day. It consisted in reducing the level of TSH< 0.1 mIU/L. Results: The Apron flap was used on most operations (40)80% and with lateral extensions had 10(20%). RBND involves surgical clearance of Levels II-VI performed in all operated patients, besides that, 4(8%) of them had resection of sternocleidomastoid muscle (SCM) and accessory nerve (XIn) and internal jugular vein (IJV) withclearance of Levels IB. The PTC was the most common 80.9% (38 patients from 47)by histopathological report. and 4(8%) patients of 50 had resection of sternocleidomastoid muscle (SCM) and accessory nerve (XIn) and internal jugular vein (IJV). The postoperative mortality rate not observed (0%). The postoperative morbidity rate was 22.8% (n =13).Seroma(8.7%),Hypocalcimia(7%), Wound infection(5.3%), Bleeding(1.8%). To suppress TSH and growth of any residual thyroid theTSH-ST (levothyroxine150 – 600mcg)was performed in all patients 57(100%) on the first day afterRBND. We tracked the results of treatment for two years in 30 patients with PTC, only 3 of them received radioactive iodine abroad. Biennial Recurrence rate for PTC appeared in one woman (2%), who had RAI postoperatively in the form of neck lymph nodes metastasis. Conclusion: For patients with PTC, thyroidectomy plus prophylacticRBND is a safe and efficient procedure and it results in lower recurrence rate. Postoperative treatment with exogenous thyroid hormone in doses sufficient to suppress TSH (not less than 150mcg), decreases incidence of recurrence. Total Thyroidectomy with RBND followed by TSH-ST, in our opinion, applicable optimal treatment scheme care for this patient population.

Keywords: thyroid cancer, Yemen war, absence of radioactive iodine, neck dissection, surgery results

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Authors: Drew Commandeur, Ryan Brodie, Sandra Hundza, Marc Klimstra

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The amplitude of raw electromyography (EMG) is affected by recording conditions and often requires normalization to make meaningful comparisons. Bioelectric methods normalize with an EMG signal recorded during a standardized task or from the experimental protocol itself, while biomechanical methods often involve measurements with an additional sensor such as a force transducer. Common bioelectric normalization techniques for treadmill walking include maximum voluntary isometric contraction (MVIC), dynamic EMG peak (EMGPeak) or dynamic EMG mean (EMGMean). There are several concerns with using MVICs to normalize EMG, including poor reliability and potential discomfort. A limitation of bioelectric normalization techniques is that they could result in a misrepresentation of the absolute magnitude of force generated by the muscle and impact the interpretation of EMG between functionally disparate groups. Additionally, methods that normalize to EMG recorded during the task may eliminate some real inter-individual variability due to biological variation. This study compared biomechanical and bioelectric EMG normalization techniques during treadmill walking to assess the impact of the normalization method on the functional interpretation of EMG data. For the biomechanical method, we normalized EMG to a target torque (EMGTS) and the bioelectric methods used were normalization to the mean and peak of the signal during the walking task (EMGMean and EMGPeak). The effect of normalization on muscle activation pattern, EMG amplitude, and inter-individual variability were compared between disparate cohorts of OLD (76.6 yrs N=11) and YOUNG (26.6 yrs N=11) adults. Participants walked on a treadmill at a self-selected pace while EMG was recorded from the right lower limb. EMG data from the soleus (SOL), medial gastrocnemius (MG), tibialis anterior (TA), vastus lateralis (VL), and biceps femoris (BF) were phase averaged into 16 bins (phases) representing the gait cycle with bins 1-10 associated with right stance and bins 11-16 with right swing. Pearson’s correlations showed that activation patterns across the gait cycle were similar between all methods, ranging from r =0.86 to r=1.00 with p<0.05. This indicates that each method can characterize the muscle activation pattern during walking. Repeated measures ANOVA showed a main effect for age in MG for EMGPeak but no other main effects were observed. Interactions between age*phase of EMG amplitude between YOUNG and OLD with each method resulted in different statistical interpretation between methods. EMGTS normalization characterized the fewest differences (four phases across all 5 muscles) while EMGMean (11 phases) and EMGPeak (19 phases) showed considerably more differences between cohorts. The second notable finding was that coefficient of variation, the representation of inter-individual variability, was greatest for EMGTS and lowest for EMGMean while EMGPeak was slightly higher than EMGMean for all muscles. This finding supports our expectation that EMGTS normalization would retain inter-individual variability which may be desirable, however, it also suggests that even when large differences are expected, a larger sample size may be required to observe the differences. Our findings clearly indicate that interpretation of EMG is highly dependent on the normalization method used, and it is essential to consider the strengths and limitations of each method when drawing conclusions.

Keywords: electromyography, EMG normalization, functional EMG, older adults

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Authors: Vilas Warudkar, Dinkar Janghel, Siraj Ahmed

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Rapid development experienced by India requires huge amount of energy. Actual supply capacity additions have been consistently lower than the targets set by the government. According to World Bank 40% of residences are without electricity. In 12th five year plan 30 GW grid interactive renewable capacity is planned in which 17 GW is Wind, 10 GW is from solar and 2.1 GW from small hydro project, and rest is compensated by bio gas. Renewable energy (RE) and energy efficiency (EE) meet not only the environmental and energy security objectives, but also can play a crucial role in reducing chronic power shortages. In remote areas or areas with a weak grid, wind energy can be used for charging batteries or can be combined with a diesel engine to save fuel whenever wind is available. India according to IEC 61400-1 belongs to class IV Wind Condition; it is not possible to set up wind turbine in large scale at every place. So, the best choice is to go for small scale wind turbine at lower height which will have good annual energy production (AEP). Based on the wind characteristic available at MANIT Bhopal, rotor for small scale wind turbine is designed. Various Aero foil data is reviewed for selection of airfoil in the Blade Profile. Airfoil suited of Low wind conditions i.e. at low Reynold’s number is selected based on Coefficient of Lift, Drag and angle of attack. For designing of the rotor blade, standard Blade Element Momentum (BEM) Theory is implanted. Performance of the Blade is estimated using BEM theory in which axial induction factor and angular induction factor is optimized using iterative technique. Rotor performance is estimated for particular designed blade specifically for low wind Conditions. Power production of rotor is determined at different wind speeds for particular pitch angle of the blade. At pitch 15o and velocity 5 m/sec gives good cut in speed of 2 m/sec and power produced is around 350 Watts. Tip speed of the Blade is considered as 6.5 for which Coefficient of Performance of the rotor is calculated 0.35, which is good acceptable value for Small scale Wind turbine. Simple Load Model (SLM, IEC 61400-2) is also discussed to improve the structural strength of the rotor. In SLM, Edge wise Moment and Flap Wise moment is considered which cause bending stress at the root of the blade. Various Load case mentioned in the IEC 61400-2 is calculated and checked for the partial safety factor of the wind turbine blade.

Keywords: annual energy production, Blade Element Momentum Theory, low wind Conditions, selection of airfoil

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Authors: T. N. Goh, M. Hashmi, O. Hussain

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Temporomandibular joint (TMJ) dysfunction (TMD) is a condition that may affect patients via restricted mouth opening, significant pain during normal functioning, and/or reproducible joint noise. TMD includes myofascial pain, TMJ functional derangements (internal derangement, dislocation), and TMJ degenerative/inflammatory joint disease. Internal derangement (ID) is the most common cause of TMD-related clicking and locking. These patients are managed in a stepwise approach, from patient education (homecare advice and analgesia), splint therapy, physiotherapy, botulinum toxin treatment, to arthrocentesis. Arthrotomy is offered when the aforementioned treatment options fail to alleviate symptoms and improve quality of life. The aim of this prospective study was to review the outcomes of jaw joint open surgery in TMD patients. Patients who presented from 2015-2022 at the Oral and Maxillofacial Surgery Department in the Doncaster NHS Foundation Trust, UK, with a Wilkes classification of III -V were included. These patients underwent either i) discopexy with bone-anchoring suture (9); ii) intrapositional temporalis flap (ITF) with bone-anchoring suture (3); iii) eminoplasty and discopexy with suturing to the capsule (3); iii) discectomy + ITF with bone-anchoring suture (1); iv) discoplasty + bone-anchoring suture (1); v) ITF (1). Maximum incisal opening (MIO) was assessed pre-operatively and at each follow-up. Pain score, determined via the visual analogue scale (VAS, with 0 being no pain and 10 being the worst pain), was also recorded. A total of 18 eligible patients were identified with a mean age of 45 (range 22 - 79), of which 16 were female. The patients were scored by Wilkes Classification as III (14), IV (1), or V (4). Twelve patients had anterior disc displacement without reduction (66%) and six had degenerative/arthritic changes (33%) to the TMJ. The open joint procedure resulted in an increase in MIO and reduction in pain VAS and for the majority of patients, across all Wilkes Classifications. Pre-procedural MIO was 22.9 ± 7.4 mm and VAS was 7.8 ± 1.5. At three months post-procedure there was an increase in MIO to 34.4 ± 10.4 mm (p < 0.01) and a decrease in the VAS to 1.5 ± 2.9 (p < 0.01). Three patients were lost to follow-up prior to six months. Six were discharged at six month review and five patients were discharged at 12 months review as they were asymptomatic with good mouth opening. Four patients are still attending for annual botulinum toxin treatment. Two patients (Wilkes III and V) subsequently underwent TMJ replacement (11%). One of these patients (Wilkes III) had improvement initially to MIO of 40 mm, but subsequently relapsed to less than 20 mm due to lack of compliance with jaw rehabilitation device post-operatively. Clinical improvements in 89% of patients within the study group were found, with a return to near normal MIO range and reduced pain score. Intraoperatively, the operator found bone-anchoring suture used for discopexy/discoplasty more secure than the soft tissue anchoring suturing technique.

Keywords: bone anchoring suture, open temporomandibular joint surgery, temporomandibular joint, temporomandibular joint dysfunction

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Authors: P. J. Sweeney, T. Ahtoniemi, J. Puoliväli, T. Laitinen, K. Lehtimäki, A. Nurmi, D. Wells

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Duchenne muscular dystrophy (DMD) is caused by an X linked mutation in the dystrophin gene; lack of dystrophin causes a progressive muscle necrosis which leads to a progressive decrease in mobility in those suffering from the disease. The MDX mouse, a mutant mouse model which displays a frank dystrophinopathy, is currently widely employed in pre clinical efficacy models for treatments and therapies aimed at DMD. In general the end-points examined within this model have been based on invasive histopathology of muscles and serum biochemical measures like measurement of serum creatine kinase (sCK). It is established that a “critical period” between 4 and 6 weeks exists in the MDX mouse when there is extensive muscle damage that is largely sub clinical but evident with sCK measurements and histopathological staining. However, a full characterization of the MDX model remains largely incomplete especially with respect to the ability to aggravate of the muscle damage beyond the critical period. The purpose of this study was to attempt to aggravate the muscle damage in the MDX mouse and to create a wider, more readily translatable and discernible, therapeutic window for the testing of potential therapies for DMD. The study consisted of subjecting 15 male mutant MDX mice and 15 male wild-type mice to an intense chronic exercise regime that consisted of bi-weekly (two times per week) treadmill sessions over a 12 month period. Each session was 30 minutes in duration and the treadmill speed was gradually built up to 14m/min for the entire session. Baseline plasma creatine kinase (pCK), treadmill training performance and locomotor activity were measured after the “critical period” at around 10 weeks of age and again at 14 weeks of age, 6 months, 9 months and 12 months of age. In addition, kinematic gait analysis was employed using a novel analysis algorithm in order to compare changes in gait and fine motor skills in diseased exercised MDX mice compared to exercised wild type mice and non exercised MDX mice. In addition, a morphological and metabolic profile (including lipid profile), from the muscles most severely affected, the gastrocnemius muscle and the tibialis anterior muscle, was also measured at the same time intervals. Results indicate that by aggravating or exacerbating the underlying muscle damage in the MDX mouse by exercise a more pronounced and severe phenotype in comes to light and this can be picked up earlier by kinematic gait analysis. A reduction in mobility as measured by open field is not apparent at younger ages nor during the critical period, but changes in gait are apparent in the mutant MDX mice. These gait changes coincide with pronounced morphological and metabolic changes by non-invasive anatomical MRI and proton spectroscopy (1H-MRS) we have reported elsewhere. Evidence of a progressive asymmetric pathology in imaging parameters as well as in the kinematic gait analysis was found. Taken together, the data show that chronic exercise regime exacerbates the muscle damage beyond the critical period and the ability to measure through non-invasive means are important factors to consider when performing preclinical efficacy studies in the MDX mouse.

Keywords: Gait, muscular dystrophy, Kinematic analysis, neuromuscular disease

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Authors: Petr Daniel Kovarik, Matt Kennedy, James Adams, Ajay Wilson, Andy Burns, Charles Kelly, Malcolm Jackson, Rahul Patil, Shahid Iqbal

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Introduction: Osteoradionecrosis (ORN) is a recognised toxicity of radiotherapy (RT) for head and neck cancer (HNC). Existing literature lacks any generally accepted definition and staging system for this toxicity. Objective: The objective is to analyse the outcome of the surgical and nonsurgical treatments of ORN. Material and Method: Data on 2303 patients treated for HNC with radical or adjuvant RT or RT-chemotherapy from January 2010 - December 2021 were retrospectively analysed. Median follow-up to the whole group of patients was 37 months (range 0–148 months). Results: ORN developed in 185 patients (8.1%). The location of ORN was as follows; mandible=170, maxilla=10, and extra oral cavity=5. Multiple ORNs developed in 7 patients. 5 patients with extra oral cavity ORN were excluded from treatment analysis as the management is different. In 180 patients with oral cavity ORN, median follow-up was 59 months (range 5–148 months). ORN healed in 106 patients, treatment failed in 74 patients (improving=10, stable=43, and deteriorating=21). Median healing time was 14 months (range 3-86 months). Notani staging is available in 158 patients with jaw ORN with no previous surgery to the mandible (Notani class I=56, Notani class II=27, and Notani class III=76). 28 ORN (mandible=27, maxilla=1; Notani class I=23, Notani II=3, Notani III=1) healed spontaneously with a median healing time 7 months (range 3–46 months). In 20 patients, ORN developed after dental extraction, in 1 patient in the neomandible after radical surgery as a part of the primary treatment. In 7 patients, ORN developed and spontaneously healed in irradiated bone with no previous surgical/dental intervention. Radical resection of the ORN (segmentectomy, hemi-mandibulectomy with fibula flap) was performed in 43 patients (all mandible; Notani II=1, Notani III=39, Notani class was not established in 3 patients as ORN developed in the neomandible). 27 patients healed (63%); 15 patients failed (improving=2, stable=5, deteriorating=8). The median time from resection to healing was 6 months (range 2–30 months). 109 patients (mandible=100, maxilla=9; Notani I=3, Notani II=23, Notani III=35, Notani class was not established in 9 patients as ORN developed in the maxilla/neomandible) were treated conservatively using a combination of debridement, antibiotics and Pentoclo. 50 patients healed (46%) with a median healing time 14 months (range 3–70 months), 59 patients are recorded with persistent ORN (improving=8, stable=38, deteriorating=13). Out of 109 patients treated conservatively, 13 patients were treated with Pentoclo only (all mandible; Notani I=6, Notani II=3, Notani III=3, 1 patient with neomandible). In total, 8 patients healed (61.5%), treatment failed in 5 patients (stable=4, deteriorating=1). Median healing time was 14 months (range 4–24 months). Extra orally (n=5), 3 cases of ORN were in the auditory canal and 2 in mastoid. ORN healed in one patient (auditory canal after 32 months. Treatment failed in 4 patients (improving=3, stable=1). Conclusion: The outcome of the treatment of ORN remains in general, poor. Every effort should therefore be made to minimise the risk of development of this devastating toxicity.

Keywords: head and neck cancer, radiotherapy, osteoradionecrosis, treatment outcome

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Authors: Krzysztof Skiba, Zbigniew Czyz, Ksenia Siadkowska, Piotr Borowiec

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The article presents selected concepts of technologies that use intelligent materials in aircraft in order to improve their performance. Most of the research focuses on solutions that improve the performance of fixed wing aircraft due to related to their previously dominant market share. Recently, the development of the rotorcraft has been intensive, so there are not only helicopters but also gyroplanes and unmanned aerial vehicles using rotors and vertical take-off and landing. There are many different technologies to change a shape of the aircraft or its elements. Piezoelectric, deformable actuator systems can be applied in the system of an active control of vibration dampening in the aircraft tail structure. Wires made of shape memory alloys (SMA) could be used instead of hydraulic cylinders in the rear part of the aircraft flap. The aircraft made of intelligent materials (piezoelectrics and SMA) is one of the NASA projects which provide the possibility of changing a wing shape coefficient by 200%, a wing surface by 50%, and wing deflections by 20 degrees. Active surfaces made of shape memory alloys could be used to control swirls in the flowing stream. An intelligent control system for helicopter blades is a method for the active adaptation of blades to flight conditions and the reduction of vibrations caused by the rotor. Shape memory alloys are capable of recovering their pre-programmed shapes. They are divided into three groups: nickel-titanium-based, copper-based, and ferromagnetic. Due to the strongest shape memory effect and the best vibration damping ability, a Ni-Ti alloy is the most commercially important. The subject of this work was to prepare a conceptual design of a rotor blade with SMA actuators. The scope of work included 3D design of the supporting rotor blade, 3D design of beams enabling to change the geometry by changing the angle of rotation and FEM (Finite Element Method) analysis. The FEM analysis was performed using NX 12 software in the Pre/Post module, which includes extended finite element modeling tools and visualizations of the obtained results. Calculations are presented for two versions of the blade girders. For FEM analysis, three types of materials were used for comparison purposes (ABS, aluminium alloy 7057, steel C45). The analysis of internal stresses and extreme displacements of crossbars edges was carried out. The internal stresses in all materials were close to the yield point in the solution of girder no. 1. For girder no. 2 solution, the value of stresses decreased by about 45%. As a result of the displacement analysis, it was found that the best solution was the ABS girder no. 1. The displacement of about 0.5 mm was obtained, which resulted in turning the crossbars (upper and lower) by an angle equal to 3.59 degrees. This is the largest deviation of all the tests. The smallest deviation was obtained for beam no. 2 made of steel. The displacement value of the second girder solution was approximately 30% lower than the first solution. Acknowledgement: This work has been financed by the Polish National Centre for Research and Development under the LIDER program, Grant Agreement No. LIDER/45/0177/L-9/17/NCBR/2018.

Keywords: aircraft, helicopters, shape memory alloy, SMA, smart material, unmanned aerial vehicle, UAV

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