Adequate Reduction Research Articles

Evinacumab-dgnb (Evkeeza-REGN1500), A Novel Lipid-Lowering Therapy for Homozygous Familial Hypercholesterolemia.

Chronically elevated low-density lipoprotein (LDL) has harmful effects on the vasculature including increased vasoconstriction and the formation of plaques which may rupture, causing coronary heart disease and stroke. In patients with familial hypercholesterolemia, adequate reduction of LDL is especially challenging. Although HMG-CoA reductase inhibitors (statins) are the mainstays for LDL lowering, other treatments such as proprotein convertase subtilisin/kexin type 9 inhibitors, bempedoic acid, incliseran, lomitapide, and apheresis have been employed in an effort to achieve adequate LDL reduction in these patients. Despite these available therapies, many patients with familial hypercholesterolemia do not meet the LDL targets suggested in current guidelines. Evinacumab is a novel lipid-lowering therapy that exerts its LDL-lowering effect through inhibition of angiopoietin-like protein 3 (ANGPTL3). ANGPTL3 inhibits the breakdown of triglyceride-rich lipoproteins, such as very low-density lipoprotein and chylomicrons. By inhibiting ANGPTL3, evinacumab allows these lipoproteins to be degraded, ultimately leading to reductions in LDL, high-density lipoprotein, and triglycerides. Clinical trials have demonstrated evinacumab to be safe and effective in reducing LDL. However, data are lacking regarding its potential to reduce risk of atherosclerotic cardiovascular disease. Evinacumab is generally well tolerated with the primary adverse effects comprising infusion reactions, nasopharyngitis, influenza-like illness, dizziness, rhinorrhea, and nausea. While evinacumab is an interesting therapy, until it is proven to reduce cardiovascular events, its high cost leaves its anticipated role in therapy somewhat ambiguous. In the meantime, it may be a useful therapy for those with homozygous familial hypercholesterolemia.

Effect of heat treatment on microbiological safety of supermarket food waste as substrate for black soldier fly larvae (Hermetia illucens)

Supermarket food waste, constituting 13% of global food waste, can be upcycled as substrate for black soldier fly larvae (BSFL) and converted into larval biomass. Since presence of food pathogens in supermarket food waste is likely, microbiological safety should be ensured when using waste as insect substrate. Heat treatment provides a suitable pre-treatment to reduce microbiological contaminations. This study investigated the effect of different temperature–time combinations on the microbiological safety of supermarket food waste as BSFL substrate. Artificial supermarket food waste without meat and fish (SFW) was inoculated with both Salmonella and Staphylococcus aureus (7.0log cfu/g) and treated at 50 and 60 °C for 10, 20 and 30 min. While 50 °C was insufficient for adequate pathogen reduction, 60 °C only required 10 min to reduce the Enterobacteriaceae and S.aureus counts to < 1.0logcfu/g and for absence of Salmonella in 25 g. Heat-treated SFW could be stored for two days at ambient temperature or refrigerated without pathogen growth. Treatment of supermarket food waste containing meat and fish at 60 °C for 10 min caused similar results as for SFW, but S.aureus persisted (2.4logcfu/g), possibly by protective effects of fat and/or proteins. Finally, BSFL rearing experiments on SFW revealed significantly higher larval mass, bioconversion efficiency and waste reduction than on Gainesville diet, with no notable differences between untreated and heat-treated SFW. Rearing BSFL on supermarket food waste is possible, and unsafe food waste can be heated to obtain safety without eliminating nutrients necessary for rearing.

Geospatial Analysis On Stunting Prevalence And Strategies

Stunting is a condition in which children under the age of five fail to thrive due to chronic malnutrition, resulting in the child being too short for his age. The issue of short children reflects the community's socioeconomic conditions because the nutritional problems displayed by short children are chronic. Stunting is influenced by environmental factors and geographical conditions (population density, climatic conditions, and inadequate sanitation) in addition to maternal characteristics and child-rearing patterns, so spatial analysis is critical in overcoming this problem at the rural level. Various stunting prevention programs have been implemented, but they have not been effective, and there has not been an adequate reduction. This research aims to determine the relationship between geographical conditions and the distribution of stunting sufferers, as well as stunting prevention strategies, in Bulukumba Regency. Secondary data were obtained from reports of stunting cases at the Bulukumba District Health Office, and interviews were used in this study. The chi-square test was used in data analysis to determine the relationship between variables, specifically the incidence of stunting and geographical conditions. Meanwhile, the empirical bayesian smoothing rates developed by Clayton and Kaldor (1987) are used in the Geoda software program version 1.6.7 to identify the distribution of cases because stunting cases are not fully representative if they occur in a larger population but are not densely populated due to a larger area. This study was carried out in Bulukumba Regency with a population of 24-59-month-old children. The findings indicate that there is a link between population density and stunting distribution. This research serves as the foundation for decision-makers to develop relevant strategic policies to accelerate stunting prevention in Bulukumba Regency.

A Comparative Study Between Plate Osteosynthesis and Intramedullary Nailing for Diaphyseal Fracture of Radius and Ulna in Adults.

In this era of active living, industrial growth, increasing automobile accidents, and athletic activities, fractures of the forearm bones are becoming more frequent. The incidence of diaphyseal fractures of both bone forearms is reported to be approximately 10 per 10,000 persons per year, although rates may vary according to age and sex. If not properly treated, a fracture of the forearm bones might cause a serious loss of function. Therefore, to restore function, these fractures require adequate anatomical reduction and internal fixation. The majority of forearm fractures in adults are treated surgically, and various modes of internal fixation are available. In this study, we evaluated and compared the clinical, functional, and radiological outcomes of both bone forearm diaphyseal fractures treated with plate osteosynthesis and intramedullary nailing. This prospective and comparative study was conducted in a tertiary care medical teaching hospital in southern Rajasthan, India. Forty patients with diaphyseal fractures of the radius and ulna bones who presented to the casualty or orthopedic outpatient departments of our institute were included. Patients were divided into two groups, 20 patients in each group and treated by intramedullary nailing (group A) and plate osteosynthesis (group B), and regularly followed up and evaluated for clinical, functional, and radiological outcomes. Final results were calculated according to the modified Grace-Eversmann scoring system. In group A, out of 20 cases excellent score was seen in six cases (30%), good score in nine cases (45%), fair score in three cases (15%), and at last, two cases (10%) showed poor results. In group B, excellent score was in eight cases (40%), good score was in eight cases (40%), fair score was in three cases (15%), and at last, one case (5%) was poor in our study. Based on our findings, we conclude that for the treatment of diaphyseal fractures of the radius and ulna, both treatment modalities provide equally satisfactory results.

EVALUATION OF CLINICAL AND RADIOLOGICAL OUTCOME OF INTERTROCHANTERIC FRACTURES OF FEMUR TREATED WITH PROXIMAL FEMORAL NAIL : A PROSPECTIVE STUDY

Background: With purpose to evaluate the outcome of proximal femur nail procedure ,we carried out a prospective observational study in which 40 patients, underwent Proximal Femoral nailing for intertrochanteric fracture femur at Govt. R.D.B.P Jaipuria Hospital, Jaipur, Rajasthan. Materials and Methods: Patients were included as per the inclusion and exclusion criteria in the study. All patients were followed up at 4 weeks, 6 weeks, 8 weeks, 12 weeks, 16weeks and 24 weeks and later depending on the fracture healing status. X ray of the operated hip with femur –anteroposterior and lateral views were taken during follow up. Kyle's criteria and Harris hip score was measured at 6 months follow up. Results:The Kyle's criteria was Excellent in 22 patients (55%), Good in 13 patients (32.5%), Fair in 4 patients (10%) and poor in 1 patient (2.5%) Conclusion: proximal femoral nail (PFN) is a good minimally invasive implant for stable and unstable proximal femoral fractures. It's particularly benecial in elderly and osteoporotic population. Adequate fracture reduction is critical in management of the intertrochanteric fractures. Achieving good anatomical reduction and maintaining the tip apex distance less than 25mm will avoid the implant related complications

Hypertensive Emergencies: Common Presentations and Pharmacological Interventions.

Depending on end-organ involvement, hypertensive crisis is classified as hypertensive urgency or hypertensive emergency. The recognition of a hypertensive crisis will lead to the adequate reduction of blood pressure to ameliorate the incidence of end-organ damage. Hypertensive crises result from dysfunction in the renin-angiotensin-aldosterone system and damage to the vascular bed. They occur commonly in the emergency department setting and can lead to increased mortality rates if not treated. Registered nurses play a vital role in assessing patients and administering medications during hypertensive crises. This article will outline the assessment strategies that registered nurses should implement in critical care units while patients are receiving antihypertensive drugs. We will also underscore the significance of monitoring specific laboratory values to mitigate the potential side effects of these drugs and exclude them when contraindicated.

Pathogen inactivation methods to prevent transfusion-transmissible arboviruses: A systematic review and meta-analysis.

Arboviruses are emerging as a relevant threat to transfusion safety. Pathogen inactivation methods (PIMs) may reduce the risk of transmission through transfusion, as long as they meet minimum standards for effectiveness. This study aims to assess the log reduction of viral load achieved with different PIMs, according to the blood product they are used on and the arbovirus targeted. Systematic literature review and meta-analysis. Searches were conducted in MEDLINE and Embase. The study protocol was registered in PROSPERO CRD42022312061. We selected records reporting the log reduction of viral load achieved with the main PIMs (amotosalen + UVA light [INTERCEPT], riboflavin + UV light [Mirasol], methylene blue + visible light/UVC light [THERAFLEX], solvent detergent, amustaline [INTERCEPT] and PEN110 [Inactine]), applied to any blood product (plasma, platelets, red blood cells or whole blood) and for any arbovirus. The log reduction of viral loads was assessed by obtaining the mean log reduction factor (LRF). We compared and classified the LRF of different techniques using statistical methods. We included 59 publications reporting LRF results in 17 arboviruses. For 13 arboviruses, including Chikungunya virus, Dengue virus, West Nile virus and Zika virus, at least one of the methods achieves adequate or optimal log reduction of viral load-mean LRF ≥4. The LRF achieved with riboflavin + UV light is inferior to the rest of the techniques, both overall and specifically for plasma, platelets preserved in platelet additive solution (PAS)/plasma, and red blood cells/whole blood. The LRF achieved using Mirasol is also lower for inactivating Chikungunya virus, Dengue virus and Zika virus. For West Nile virus, we found no significant differences. In plasma, the method that achieves the highest LRF is solvent/detergent; in platelets, THERAFLEX and INTERCEPT; and in red blood cells/whole blood, PEN110 (Inactine). Not all PIMs achieve the same LRF, nor is this equivalent between the different arboviruses or blood products. Overall, the LRFs achieved using riboflavin + UV light (Mirasol) are inferior to those achieved with the rest of the PIMs. Regarding the others, LRFs vary by arbovirus and blood product. In light of the threat of different arboviruses, blood establishments should have already validated PIMs and be logistically prepared to implement these techniques quickly.

POINT-OF-CARE ULTRASOUND FOR GUIDANCE OF CLOSED REDUCTION OF FIFTH METACARPAL NECK (BOXER'S) FRACTURE

BackgroundUltrasound has been used previously in fracture identification, analgesia delivery, and fracture reduction for patients in the emergency department. It has not been previously described as a tool for the guidance of closed fracture reduction in fifth metacarpal neck fractures (“boxer's fractures"). Case ReportA 28-year-old man presented with hand pain and swelling after punching a wall. Point-of-care ultrasound revealed a significantly angulated fifth metacarpal fracture, which was confirmed with a subsequent hand x-ray study. After an ultrasound-guided ulnar nerve block, closed reduction was performed. Ultrasound was used to assess reduction and ensure improvement in bony angulation during the closed reduction attempts. Post-reduction x-ray study confirmed improved angulation and adequate alignment. Why Should an Emergency Physician Be Aware of This? Point-of-care ultrasound has previously had efficacy in fracture diagnosis and anesthesia delivery for fifth metacarpal fractures. Ultrasound can also be used at the bedside to assist in the determination of adequate fracture reduction when performing closed reduction of a boxer's fracture.

Selection of Response Reduction Factor Considering Resilience Aspect

The selection of an adequate response reduction factor (R) in the seismic design of a reinforced concrete building is critical to the building’s seismic response. To construct a robust structure, the R factor should be chosen based on the building’s resilience performance. Since no background was provided for the selection of R factors, the study focuses on the right selection of R factors in relation to the building’s functionality, performance level, and resilience. In this study, a high-rise building with multiple R factors (R = 3, 4, 5, and 6) is developed. Five potential recovery paths (RP-1 to RP-5) that matched the realistic scenario were used to estimate the building’s functionality. The building was subjected to uni and bi-directional loadings, and two design levels, Design Basic Earthquake (DBE) and Maximum Considered Earthquake were used to monitor the building’s response. According to the findings, a decrease in the lateral design force with the highest R results in a high ductility requirement and a substantial loss of resilience. The maximum R factor can be recommended under uni-directional loading up to 6, in which the building’s resilience is almost 50%, whereas under bi-directional loading and taking the recommended R factor decreased from 6 to 4.

Routine postoperative computed tomography (CT) scans following acetabulum open reduction internal fixation (ORIF): A survey of orthopaedic traumatologists

ObjectiveThe purpose of this study was to assess the practices related to obtaining postoperative pelvic CT scans following acetabular ORIF and revision surgery rates. DesignA 20-question survey published on the Orthopaedic Trauma Association (OTA) website assessed each surgeon's preference and rationale for or against the routine use of postoperative CT scans for acetabular fractures. ParticipantsFellowship-trained orthopaedic traumatologists. Main outcome measurementsWe examined the percentage of surgeons ordering routine postoperative CT scans, surgeon demographics, and revision surgery rates based on these routine CT scan results. ResultsResponses were received from 57 surgeons. Practices varied regarding postoperative CT scans, with 16 surgeons (28%, Group A) routinely ordering them and 41 surgeons (72%, Group B) not ordering them on all patients. No significant difference in surgeon demographics were found between the groups. Majority of Group A report a revision surgery rate of <1% based on the results of the postoperative CT.Group A report routine postoperative scans were obtained to assess reduction, hardware placement, identify intra-articular fragments, and for educational purposes. Group B did not obtain routine postoperative CTs due to the following: unlikely to change postoperative treatment, adequate reduction and instrumentation placement assessed intraoperatively and by postoperative radiographs, and increased radiation exposure and cost to patients. Group B did report obtaining postop CT scans on select patients, with inadequate intraoperative imaging and postoperative neurological changes being the most common indications. ConclusionThe routine use of postoperative CTs following open reduction internal fixation of acetabular fractures is a controversial topic. While we recognize the role for postoperative CT scans in select patients, our study questions the clinical utility of these scans in all patients and in conclusion do not recommend this protocol.

Squeezing flow of aqueous CNTs-Fe3O4 hybrid nanofluid through mass-based approach: Effect of heat source/sink, nanoparticle shape, and an oblique magnetic field

Here, the squeezing unsteady 2-dimensional incompressible hybrid nanofluid flow between two collateral sheets has been investigated numerically, considering the influences of magnetic field and the mutable thermal conductivity. The solid-particles are the magnetite (Fe3O4) and the carbon nanotubes (CNTs) inserted in the base liquid (water). To give a complete development investigation of the present problem, the influences of a heat source/sink have also been analyzed. The technique used is pursuant to the Tiwari-Das nanofluid method which nanoparticle weights are considered instead of the volumetric concentration of the solid-particles. At first, the controlling dimensional PDEs, including continuity, momentum conservation, and energy conservation, are changed to a non-dimensional ODEs system applying adequate similarity reduction. The Runge–Kutta–Fehlberg (RK4) approach and shooting procedure is utilized to solve nonlinear ODEs system numerically. The impression of the controlling parameters on the temperature and velocity of working fluid as well as the Nusselt number, and the skin friction has been studied and analyzed. The mass-based manner gives trustable results for the flow and heat transfer analysis in the presence heat generation source and also an oblique magnetic ground. The results demonstrate that the entity of temperature-dependent thermal conductivity and the oblique magnetic ground reduces heat transfer. Furthermore, the greatest temperature distribution was related to spherical solid-particles in the presence of a horizontal magnetic ground.

Effect of germicidal short wavelength ultraviolet light on the polyphenols, vitamins, and microbial inactivation in a highly opaque apple juice

AbstractThe aim of this investigation was to study the efficacy of UV‐C light emitting diode (LED) system operating at 263 nm for the inactivation of Listeria monocytogenes and Escherichia coli O157:H7. UV‐C irradiation was applied to stirred 5 ml samples, using a collimated beam LED system operating at a 263 nm wavelength. UV irradiation doses ranging from 0 to 160 mJ/cm2 were also delivered to apple juice (AJ) and polyphenols and vitamins were profiled. Liquid chromatography–mass spectrometry (LC–MS/MS) analysis was conducted to assess the stability of polyphenols or vitamins in UV‐C exposed AJ. The polyphenol and vitamin results demonstrated that UV‐C irradiation in AJs at relevant commercial UV doses induced significant reductions in the concentrations of selected polyphenols and vitamins, p &lt; .05. Ascorbic acid was reduced to 32%, at 160 mJ/cm2 whereas 17% reduction was observed at 40 mJ/cm2. Riboflavin was observed to be relatively stable. Epicatechin and chlorogenic were significantly reduced at high exposure doses. In contrast, minor changes were observed at 40 mJ/cm2. Results show that UV‐C irradiation effectively inactivated pathogenic microbes in AJ. Inactivation levels of all organisms were proportional to UV‐C dose. The log reduction kinetics of microorganisms followed log‐linear and with higher R2 (&gt;0.95). The decimal reduction dose (D10) values of 4.16 and 3.84 mJ/cm2 were obtained from the inactivation of E. coli and L. monocytogenes in AJ. The results from this study imply that adequate log reduction of pathogens is achievable in AJ and suggests significant potential for UV‐C treatment of other opaque liquid foods.

The Use of Montage Bone Putty in Assisting in the Maintenance of Reduction in Comminuted Distal Radius Fractures.

Background The distal radius fracture is the most common fracture in the United States. Achieving stable reduction and fixation of complex fracture patterns can be challenging. In order to help maintain reduction of comminuted fracture to simplify plating, the calcium phosphate-based bone putty Montage has been developed. Questions/Purposes Does Montage assist in achieving stable reduction and fixation of complex distal radius fractures with an acceptable complication profile? Patient and Methods We retrospectively analyzed all patients who were treated intraoperatively with Montage bone putty along with volar plate fixation at a large-volume urban county hospital. Preoperative, intraoperative, and postoperative measurements of radiographic features were recorded at 2 and 6 months, as were any complications. Statistical analysis was then performed on these values. Results Preoperative and postoperative radiographs demonstrated significant improvement in standard distal radius fracture measurements, reflecting adequate reduction with the use of Montage intraoperatively. Critically, radiographs demonstrated maintenance of reduction compared to intraoperative fluoroscopy images at 2 months, showing short-term stability of the use of Montage in these fracture patterns as well as long-term stability at 6 months in a subset of patients. There were no major complications in this study. Conclusion In this study, we demonstrate the utility of Montage bone putty for complex distal radius fractures with short-term follow-up and limited long-term follow-up. This initial study underlines its efficacy in maintaining reduction without major complications. Level of Evidence IV, Therapeutic.

How do actions to decarbonise the energy and mobility sectors affect consumption-based carbon footprints? A case of historic and predicted actions in a suburb in Finland

Household consumption accounts for 72% of the global greenhouse gas (GHG) emissions. To obtain consumption-based emissions in accordance with the 1.5-degree target, the carbon footprint of individuals should be reduced to 2.5 t CO2e a−1 by 2030, which means at least a 70% reduction in high-emitting countries. The decrease in consumption-based GHG emissions can be achieved through both technological and behavioural changes. Currently, climate measures are largely dependent on technological efficiency, although behavioural changes are also needed. In this paper, we study how technological actions to decarbonise the energy and mobility sectors affect consumption-based carbon footprints in the years 2010–2030 in a suburb in Finland. Based on the results, emissions from the mobility sector decreased by 50%, and those from the energy sector decreased by 68% in 2010–2030, when only technology development and society-level actions are considered. These emission reductions affected the carbon footprint of an average Finnish suburb by decreasing it by 37%. This study demonstrates that technological actions to decarbonise the energy and mobility sectors do not guarantee adequate emission reduction by 2030 to achieve the 1.5-degree target; therefore, a change in lifestyle and consumption habits is also needed. Further research should take behavioural changes into account when assessing the development of a consumption-based carbon footprint.

Recurrence of Anterior Vaginal Prolapse After Robotic Sacrocolpopexy: Does Cervical Preservation Affect Outcome?

Anterior vaginal prolapse (AVP) is the most common site of recurrence after sacrocolpopexy (SCP). Supracervical hysterectomy helps to prevent mesh exposure, but it is unclear if cervical preservation (CP) affects adequate reduction of AVP. Our primary objective was to determine the difference in AVP recurrence rates in patients who have undergone SCP with or without CP. Secondary outcomes were composite failure and complications rates. This was a retrospective cohort analysis of women who underwent robotic SCP between 2012 and 2019 at Kaiser Permanente Southern California. The first cohort included women with CP (prior or concomitant supracervical hysterectomy). The second included women without CP (prior or concomitant total hysterectomy). Primary outcome was defined as recurrent AVP beyond the hymen. Patients without 12-month follow-up were included in demographic and surgical data analysis only. The charts of 373 patients with CP and 175 without CP were reviewed. Women with CP were more likely to undergo concomitant anterior repair at the time of SCP (14% vs 6%, P < 0.01); however, rates of AVP recurrence were not significantly different between groups (5% vs 3%, P = 0.26). Median follow-up time was 26 months (interquartile range, 14-38 months). Composite failure was similar between groups (17% vs 11%, P = 0.12). Women with CP were more likely to experience asymptomatic apical failure (6% vs 1%, P = 0.03). Cervical preservation at the time of SCP is associated with an increased need for concomitant anterior repair but is not associated with higher rates of AVP recurrence or composite failure.

Open Acromioclavicular Repair With a Suture Cerclage Tensioning System: A Case Series.

Introduction Numerous surgical techniques to address a type III and type V acromioclavicular (AC) joint separation have been described in the literature, but a preferred standard approach is still in debate.Current approaches include anatomic reduction, coracoclavicular (CC) ligament reconstruction, and anatomic reconstruction of the joint.In this case series, subjects received a surgical approach that avoids metal anchors and utilizes a suture cerclage tensioning system to achieve adequate reduction. Surgical technique An AC joint repair was achieved with a suture cerclage tensioning system, which allows the surgeon to apply a specific amount of force on the clavicle to achieve adequate reduction.This technique repairs the AC and CC ligaments, restoring the anatomy of the AC joint while avoiding some of the common risks and disadvantages associated with metal anchors. Methods From June 2019 to August 2022, 16 patients underwent repair of the AC joint with a suture cerclage tension system.Inclusion criteria included the diagnosis of type III or type V AC joint separation with another concomitant injury, acute and chronic injury, and patients who attended all their postoperative visits.Exclusion criteria included patients who lost to follow-up or patients who missed any of their postoperative visits.Radiographic images were taken during each subject's preoperative and postoperative visits, and the CCdistance was measured to determine the integrity of the all-suture cerclage repair. Results Of the 16 patients included in this case series, radiographic images taken during each subject's postoperative visit showed a stable construct with little changes in the CC distance.The average change in CC distance when comparing the two-week and one-month postoperative follow-up is 0.2mm. The average change in CC distance when comparing the two-week and two-month postoperative follow-up is 1.45mm.The average change in CC distance when comparing the two-week and four-month postoperative follow-up is 2.6mm. Conclusion Overall, an AC joint repair with the suture cerclage tension system can be a viable, cost-effective technique for restoring vertical and horizontal stability.Although follow-up, larger-scale studies are required to determine the biomechanical integrity of the construct with an all-suture approach, this case series presents 16 subjects whose postoperative radiographic images showed only a small change in CC distance at two to four months after surgery.

Formation and degradation of strongly reducing cyanoarene-based radical anions towards efficient radical anion-mediated photoredox catalysis

Cyanoarene-based photocatalysts (PCs) have attracted significant interest owing to their superior catalytic performance for radical anion mediated photoredox catalysis. However, the factors affecting the formation and degradation of cyanoarene-based PC radical anion (PC•‒) are still insufficiently understood. Herein, we therefore investigate the formation and degradation of cyanoarene-based PC•‒ under widely-used photoredox-mediated reaction conditions. By screening various cyanoarene-based PCs, we elucidate strategies to efficiently generate PC•‒ with adequate excited-state reduction potentials (Ered*) via supra-efficient generation of long-lived triplet excited states (T1). To thoroughly investigate the behavior of PC•‒ in actual photoredox-mediated reactions, a reductive dehalogenation is carried out as a model reaction and identified the dominant photodegradation pathways of the PC•‒. Dehalogenation and photodegradation of PC•‒ are coexistent depending on the rate of electron transfer (ET) to the substrate and the photodegradation strongly depends on the electronic and steric properties of the PCs. Based on the understanding of both the formation and photodegradation of PC•‒, we demonstrate that the efficient generation of highly reducing PC•‒ allows for the highly efficient photoredox catalyzed dehalogenation of aryl/alkyl halides at a PC loading as low as 0.001 mol% with a high oxygen tolerance. The present work provides new insights into the reactions of cyanoarene-based PC•‒ in photoredox-mediated reactions.

Scarless Modified Approach to Subcondylar Fracture Bypassing the Parotid Gland- A Case Report

Subcondylar fractures contribute about 19-29% amongst all the mandibular fractures worldwide, yet the treatment paradigm remains slightly controversial. Subcondylar fractures are pivotal in maxillofacial surgery for diverse reasons, as they can result in number of complications, whether treated or not. Initial clinical outcomes may appear pragmatic but complications such as pain, restrictions of jaw movements, muscle spasm, mandibular deviation, malocclusion, and facial asymmetry may become apparent. Fracture of tympanic part, mandibular fossa of temporal bone, may or may not be escorted by dislocation of condylar segment into middle cranial fossa, damage to blood vessels, arteriovenous fistula are some additional complications. Choosing right surgical strategy is a for minimising postoperative complications management of subcondylar fractures and it should be taken in account that, perioperative, functional, and patient-reported outcomes. The majority of studies that have been published describe the use submandibular, retromandibular, or preauricular incisions have drawbacks such as poor visibility, accessibility, and the potential to harm facial nerve and complications related to the parotid gland. Hereby, the authors present a case report of left subcondylar fracture in a 55-year-old, male patient, where a modified percutaneous approach was taken, to access the fracture, and aid in adequate reduction and proper fixation without any postoperative complications. In this approach, parotid gland is bypassed and masseter muscle fibres are excised to reach the fractured site at subcondylar region. It is small, straight forward, elementary, safe, reliable and scarless approach for the management of subcondylar fractures that ensures adequate exposure of the fractured site, osteosynthesis and minimal potential postoperative complications.

Talar Arthroscopic Reduction and Internal Fixation (TARIF): A Novel All-Inside Soft-Tissue-Preserving Technique.

Talar Arthroscopic Reduction and Internal Fixation (TARIF): A Novel All-Inside Soft-Tissue-Preserving Technique.

Abscesso renal em pediatria - desafios para o diagnóstico e manejo: relato de caso

OBJECTIVE: To discuss the diagnostic difficulties of renal abscess in the pediatric age and warn pediatrics about the possible complications of urinary tract infections. CASE DESCRIPTION: A 16-year-old boy with autism spectre disorder and Duchenne muscular dystrophy presented at the emergency care unit with persistent fever despite the use of antibiotics to treat an urinary tract infection. Although there was leukocyturia, the urine culture was negative. Ultrassound of the urinary tract showed no significant findings. Computed tomography showed multiple renal abscesses in the right kidney. A puncture guided by ultrasound was performed. The culture of the liquid resulted in growth of ESBL Klebsiella pneumoniae. A 21 day course of intravenous antibiotic after the procedure resulted in complete resolution of signs and symptoms. COMMENTS: Renal abscess is a rare condition in the pediatric population. However, it must be considered in the differential diagnosis of prolonged fever and when there is a non-favorable evolution of urinary tract infection, mainly in recurrent episodes. The early diagnosis of this condition is essential for the adequate treatment and reduction of complications.