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Background: Rotation of the femoral component in total knee replacement (TKR) is very important for good long-term results. Malrotation of the femoral component usually requires subsequent reimplantation. We performed X-ray projections of the knee at 90° to determine proper rotation of the femoral component without use of computed tomography. Methods: The axial projection of the distal femur was measured in post-TKR cases. During the TKR operation, Whiteside’s method had been used to provide symmetrical flexion space. The exact outer rotation of the femoral component was measured by x-ray determination of the middle condylar twist angle, from the central epicondylar axis and posterior condylar axis. Results: The middle condylar twist angle was in outer rotation, with an average of 3.36° (range: 1-7.6), similar to the literature. Six of the patients underwent bilateral TKR. In total, the case series included 18 women and 15 men, with average age of 71.34 years-old (range: 56-85). As a clinical evaluation we used Knee Society Score (2011). From results 2 patients were not very satisfied with the instability TKR. Axially X-ray seemed to be only which could distribute these patients. Summary: X-ray values have the same evaluation as computed tomography. The results were 2 patients in pattern of 48, which were sufficient to extrapolate to whole population according to the statistical methods. This corresponds to 4% which we can add to evaluate satisfaction of all patients after TKR and eventually lower the total of unsatisfactory patients which is total of ¼ of total. It is also forensic reason for all patients. Our recommendation to have good results and patient satisfaction in TKR is to do x-rays before and after operation. Important are x-rays antero-posterior, lateral, and Kanekasu projection to know the rotation after TKR. Other cases without stability in flexion are nor very rarely planed for revision surgery, which is much more expensive, and burdens overall health system. 

In this work, α-induced 59Co reactions in the energy range from 11- 41MeV were used in order to study the role of pre-equilibrium emission. The experimentally measured excitation functions for residues populated via (α, n),(α, 2n),(α,3n),(α,2p),(α, 3n 2p) and (α, 4n 2p) channels in the interaction of  + 59Co system available in the literature [13] were compared with theoretical predictions obtained using the statistical model code COMPLET. It was observed that at higher energy points the pure compound nucleus predictions, in general, failed to reproduce the measured data at projectile energies ~11-41MeV, this shows significant contributions from pre-equilibrium emission. The study signified both equilibrium and pre-equilibrium emissions were required to reproduce the presently measured excitation functions. An attempt was made to deduce the contribution coming from pre-equilibrium emission. It was found that the pre-equilibrium contribution increases with increasing projectile energy. Furthermore, the present result revealed a strong correlation between pre-equilibrium contribution and particle multiplicity.

The Myeloproliferative Neoplasms (MPN) of trilinear polycythemia vera (PV) and megakaryocytic leukemia (ML = primary megakaryocytic granulocytic myeloproliferation: PMGM) and Essential Thrombocythemia (ET) in the studies of Dameshek and Michiels are caused by the MPN driver mutations JAK2V617F, JAK2exon12, CALR and MPL515 discovered by Constantinescu-Vainchenker, Green and Kralovics. The JAK2V617F mutated trilinear myeloproliferative neoplasms (MPN) include a broad spectrum of clinical laboratory and bone marrow features in essential thrombocythemia (ET), prodromal PV and erythrocythemic PV, classical PV and advanced stages of masked PV and PV complicated by splenomegaly and secondary myelofibrosis (MF). Heterozygous JAK2V617F mutated ET is associated with low JAK2 allele and MPN disease burden and normal life expectance. In combined heterozygous and homozygous or homozygous JAK2V617F mutated trilinear PV, the JAK2 mutation load increases from less than 50% in prodromal PV and classical PV to above 50% up to 100% in hypercellular PV, advanced PV and PV with MF. Bone marrow histology show diagnostic features of eryhrocytic, megakaryocytic and granulocytic (EMG) myeloproliferation in JAK2V617F mutated trilinear MPN, which clearly differs from monolinear megakaryocytic (M) myelproliferation in MPL and CALR thrombocythemia and dual megakaryocytic granulocytic (MG) myeloproliferation in CALR mutated thrombocythemia. The morphology of clustered large pleomorphic megakaryocytes with hyperlobulated nuclei are similar in JAK2V617F thrombocythemia, prodromal PV and classical PV patients. Monolinear megakaryocytic (M) myeloproliferation of large to giant megakaryocytes with hyperlobulated staghorn-like nuclei is the hallmark of MPL515 mutated normocellular thrombocythemia. CALR mutated thrombocythemia usually presents with high platelet count around 1000x109/l and normocellular megakaryocytic (M) proliferation of immature megakaryocytes with cloud-like hyperchromatic nuclei followed by dual megakaryocytic granulocytic (MG) myeloproliferation followed by various degrees of bone marrow fibrosis. Natural history and life expectancy of MPN patients are related to the response to treatment and the degree of anemia, splenomegaly, myelofibrosis and constitutional symptoms. The acquisition of epigenetic mutations at increasing age on top of MPN disease burden independently predict unfavorable outcome in JAK2V617F, MPL515 and CALR mutated myeloproliferative neoplasms (MPNs, which mutually exclude each other).

Introduction: Cardiovascular diseases are the leading cause of death in the world, headed by coronary artery disease, which is secondary to atherosclerosis. The latter recognizes classic risk factors such as diabetes, high blood pressure, tobacco, and dyslipidemia and other less classic factors such as chronic inflammation of rheumatoid arthritis. Many studies have highlighted the correlation between this chronic inflammation and clinical coronary disease but very few have focused on the anatomical correlation. Objective: To describe the correlation between the chronic biological inflammation of rheumatoid arthritis and anatomical coronary lesions on angiography. Method: This observational, retrospective, single-center study, including over 10 years, of patients with rheumatoid arthritis, confirmed the EULAR 2010 criteria and presented with coronary artery disease requiring coronary angiography. Patients with missing data or in whom coronary angiography was not done were excluded (n = 14). We divided then the patients according to the existence or not of chronic inflammation to study the impact of the latter on the existence (Stenosis < 50% vs. stenosis ≥ 50%), the extent (single vs. multivessel disease), and the severity of the coronary lesions (syntax score < 32 vs. ≥ 32). Results: 202 patients (49♂/153♀) aged between 30-75 years with a history of rheumatoid arthritis have had a coronary event requiring coronary angiography, were included; The mean ejection fraction at baseline was 57.3% +/- 5.8 (37 vs.-65%). 75% of them were ≥ 65 years old. 55% were diabetics, 61% with hypertension, 38% with dyslipidemia, and 19% were smokers. Chronic inflammation was diagnosed in 70% of them on non-specific parameters (ESR, CRP, fibrinogen, anemia, and rheumatoid factor). All patients had coronary angiography, which made it possible to identify the coronary lesions according to their existence (Stenosis < 50%: 51 patients vs. stenosis ≥ 50%: 151 patients), the extent (single: 86 patients vs. multivessel disease: 116 patients) and the severity of the coronary lesions (syntax score < 32: 142 patients vs. ≥ 32: 60 patients). Chronic inflammation of rheumatoid arthritis was correlated in bivariate and multivariate analysis (after excluding the impact of other risk factors) with the existence and extent of coronary lesions (p < 0.05) but not with their severity (p > 0.05). Discussion: The two limitations of this work are the monocentric nature of the study and the absence of specific inflammatory parameters such as anti-CCP antibodies. Strengths are anatomical correlations and multivariate analysis. Chronic inflammation apart from any influence of the various risk factors predisposes to the existence and extent of coronary lesions (p < 0.05). The severity of coronary lesions assessed by Syntax Score was not correlated with chronic inflammation, although other studies suggest that this inflammation is the cause of complex lesions.Interpretation: Rheumatoid arthritis is associated with an increase in cardiac morbidity and mortality. Atheromatous lesions are more frequent in those patients than the existence of classic cardiovascular risk factors would suggest. Several explanations could account for this risk: the inflammatory syndrome and its impact on the cardiovascular risk factors and the vessel and the deleterious effect of the treatments. This requires stricter screening and management of risk factors in rheumatoid arthritis.

Background: Effective medication to manage diabetes mellitus-related organ complications with minimal adverse drug toxicity is still in pursuit by scientists worldwide. This study investigated the cardio-protective of Rida herbal bitter (RHB) in a high-fat diet/streptozotocin (STZ)-induced diabetic rats.Methods: Thirty-two matured male Wistar rats (250 ± 20g) were used. The animals were fed with high-fat diet (HFD) for 6 weeks before diabetes induction. A single dose of (35 mg/kgb.wt) freshly prepared STZ was injected intraperitoneally to induce diabetes. The animals were allocated into four groups, 8rats/group. Group I: control; Group II: HFD/STZ-induced diabetic rats; Groups III & IV: HFD/STZ-induced diabetic rats treated with 0.3 ml RHB & 200 mg/kgb.wt metformin respectively. At the end of the experiment, the animals were sacrificed, blood was sample collected via cardiac puncture and the heart was excised and homogenized. The blood samples and cardiac homogenates tissue were centrifuged to retrieve clear supernatant plasma for biochemical assay.Results: Diabetic rats exhibited significant (p < 0.05) elevated blood glucose, insulin, glycated hemoglobin (HbA1c), cardiac biomarkers, lipid profile, malondialdehyde (MDA), pro-inflammatory cytokines, food, and water intake levels with a reduction in body weight, cardiac antioxidant activity, and total protein. RHB administration significantly (p < 0.05) diminished the blood glucose, insulin, HbA1c, cardiac biomarkers, MDA, pro-inflammatory cytokines, lipid profile, food, and water intake, and improved the body weight cardiac antioxidant activity, and total protein.Conclusion: Rida herbal bitter possesses a cardio-protective effect from this study and could be a better alternative medication for managing diabetes and its related cardiovascular complications.

Marijuana is considered illicit in much of the world, and is classified as a drug for recreational use, in recent decades the medicinal use of Cannabis sativa L. has grown and diversified, being considered the only therapeutic alternative in the control of serious and incurable diseases such as syndrome of Dravet. The world panorama has shown a more liberal position, since in several countries such as the United States of America, Holland, Australia, Italy, and more recently in Canada, the use of medications, or even the recreational use of this plant, have been regulated. In this context, the investigation of the modifying effects on physical activity of empirically used cannabinoids is fundamental nowadays, mainly due to the regulatory recognition of Cannabis sativa L. as a medicinal plant in a large part of the world. Therefore, the objective of this review was to verify the evidence related to the effect of cannabis on physical performance and to identify and highlight the challenges in the interpretation of information regarding the performance of practitioners of physical activity, as well as athletes, presenting new trends in this area of research to be addressed. To carry out the systematic review, a bibliographic survey of case reports was obtained through Pubmed, Science Direct and Google Academic databases. The following keywords were used to perform the research: cannabis, performance, pain, competition. The following filters were used as inclusion criteria a languages used english; species: humans; types of articles: original articles and reviews and period of publication of articles: 1981 to 2021.

I have recently described the origin of the second Ca2+ binding in the triggering of contractile activity in cardiac myofibrils that is the origin of the Ca2+ Hill coefficient of 2 for the ATPase. This site is not a simple protein binding site and cannot be measured by 45Ca2+ binding. The myofibril protein unit requirements are described by me and so are the consequences of disruption of the function of these units and the related medical outcomes. The purpose of this paper is to review the topic and extend the reasoning to the function of skeletal muscle and cite the literature that supports this.

Presently Packaging plays a significant role for Biosimilar product. The process of selecting materials and the type of packaging also offers an opportunity for the Packaging scientist to look for new biological delivery choices. Most injectable protein products were supplied in some sort of glass vial, prefilled syringe, and cartridge. Those product having high Ph content there is a chance of “delamination “from inner surface of glass vial. With protein-based drugs, the biggest issue is the effect of packaging derivatives on the protein’s three-dimensional and surface structure. These are any effects that relate to denaturation or aggregation of the protein due to oxidation or interactions from contaminants or impurities in the preparation. The potential for these effects needs to be carefully considered in choosing the container and the container closure system to avoid putting patients in jeopardy.

Background: Perinatal asphyxia (PA) which may result in hypoxic ischaemic encephalopathy (HIE) affects four million neonates worldwide and accounts for the death of one million of affected babies. The science of metabolomics has become an area of growing interest in neonatal research, with a potential role in identifying useful biomarkers that can accurately predict injury severity in perinatal asphyxia and HIE.The aim of this review is to look at the evidence of the usefulness of urine metabolomics in predicting outcome in PA/HIE. Methods: The key words used in the advanced search ‘urine metabolomics’ AND ‘perinatal asphyxia’ OR ‘hypoxic ischaemic encephalopathy’, yielded 13 articles. Results: Of the selected thirteen studies, 38% (n = 5) were human studies, 31% (n = 4) were animal studies and 31% (n = 4) were review articles. The studies confirmed the involvement of known pathways in the development of PA/HIE, primarily the Krebs cycle evidenced by accumulation of TCA cycle intermediates (citrate, α-ketoglutarate, succinate) and anaerobic pathways indicated by increased lactate. Other pathways involved include amino acid and carbohydrate pathways. Conclusion: Metabolomic studies so far are promising in highlighting potential biomarker profiles in PA/HIE. Further research is necessary to further clarify the role of identified metabolites in predicting outcome and prognosis in neonates affected by PA/HIE.

Introduction: Suicidal behavior in teenagers constitutes a health problem that, given the necessary measures of social isolation taken by the global emergency of the COVID-19 pandemic, must generate timely actions for its prevention and control from the public health services. Objective: To propose an action plan for the prevention of suicide in teenagers of the Remedios municipality, subjected to voluntary home confinement during the COVID-19 pandemic. Methods: an observational, descriptive, cross-sectional study was carried out in the “XXX Anniversary” Teaching Community Polyclinic of the municipality Remedios. We worked with the population of 25 teenagers between 12 and 19 years old who made suicide attempts in the period 2019-2021. The empirical methods used were: bibliographic and documentary review, participant observation, focus group, semi-structured interview and questionnaire. Results: The suicide attempt was common in female teenagers aged 17 to 19 years not identified as risk, the lack of motivation due to the study activity and the previous suicide attempts by ingesting psychotropic drugs without serious intention of dying predominated. The most frequent psychological disorders were emotional disorders, stress, depression, irritability, apathy and insomnia. Actions are presented for the prevention of suicide and promote behaviors that contribute to mental health in the context of COVID-19. Conclusion: The prevention of suicidal behavior in teenagers in conditions of social isolation due to COVID-19, must include actions that facilitate the coping with stress, intra-family communication and resilience.