Instability Research Articles

Multimodal training protocols on unstable rather than stable surfaces better improve dynamic balance ability in older adults

BackgroundThere has been growing interest in using unstable devices in training protocols. This study aimed to assess the effectiveness of two multimodal exercise interventions (i.e., on stable and unstable surfaces) on dynamic balance control and lower limb strength in older adults.MethodsSixty-two older adults were randomly assigned to two intervention groups (N = 20, stable group; N = 19, unstable group), and to a control group (N = 18). In this single-blinded randomized controlled study, the two intervention groups underwent a 12-week training program twice a week for 45 min, consisting of strength and balance exercises. The stable (ST) group performed the training program over stable surfaces, while the unstable (UNST) group over unstable surfaces. Dynamic balance was assessed by computing the center of pressure (CoP) trajectory while a driven movable platform induced an unexpected perturbation of the base of support. Specifically, we considered the following CoP-related parameters within a 2.5-s temporal window from the beginning of the perturbation: displacement (Area95), mean velocity (Unit Path), anterior–posterior first peak (FP), post perturbation variability (PPV), and maximal oscillations (ΔCoPMax). The dominant quadriceps strength was measured through an isometric maximal voluntary contraction on an instrumented chair.ResultsFour out of five CoP-related parameters (i.e., Area95, Unit Path, ΔCoPMax, and PPV) significantly improved in the UNST group from a minimum of 14.28% (d = 0.44) to a maximum of 52.82% (d = 0.58). The ST group significantly improved only in two (i.e., ΔCoPMax, and PPV) out of five CoP-related parameters with an enhancement of 12.48% (d = 0.68) and 19.10% (d = 1.06). Both intervention groups increased the maximal isometric quadriceps strength (UNST:17.27%, d = 0.69; ST:22.29%, d = 0.98). The control group did not show changes in any of the parameters considered.ConclusionsStable surfaces promoted faster increments of muscular strength. Unstable surfaces were more effective in enhancing dynamic balance efficiency. These findings suggested the employment of multimodal training on unstable rather than stable surfaces to potentially lower the incidence of falls in older adults.Trial registrationNCT 05769361, retrospectively registered 13 March 2023, https://clinicaltrials.gov/study/NCT05769361?lat=45.3661864&lng=11.8209139&locStr=Padova,%20Italy&distance=50&page=11&rank=107.

Genomic instability in advanced non-small cell lung cancer (NSCLC) treated with maintenance durvalumab in the UNICANCER SAFIR02-Lung/ IFCT1301 trial.

2632 Background: Genomic instability is a hallmark of cancer that has been associated to immune evasion, cancer progression and multidrug resistance. In SAFIR02-Lung, advanced NSCLC pts were enrolled to receive a platinum-based chemotherapy. After 4 cycles, pts with no targetable alterations were oriented to the immunotherapy sub-study, and if stable or in response, were randomized between maintenance durvalumab or Standard of Care (SoC) (PMID 35802649). Durvalumab prolonged survival only in the PD-L1 ≥ 1% subgroup. In this study we investigated a genomic instability score based on somatic copy number alterations as determined by Comparative Genomic Hybridization (CGH) array as a biomarker for maintenance immunotherapy. Methods: SAFIR02-Lung (NCT02117167) is a multicentric, randomized phase 2 clinical trial. Tissue samples were obtained before induction chemotherapy. Extracted DNA from fresh frozen tumor was analyzed using high-resolution Affymetrix Cytoscan arrays, DNA from FFPE samples was analyzed using the Affymetrix Oncoscan CNV platform. The absolute copy-number (ACN) profile was generated by ASCAT v3.1 through EaCoN v0.3.6 ( https://github.com/gustaveroussy/EaCoN , PMID 36669143 ) on R v4.1.1 and then the genomic instability score was estimated as the sum of the segment length multiplied by the absolute difference between segment copy number and the ASCAT estimated sample ploidy. This sum is reported to the reference genome length. Progression Free Survival (PFS) was the primary endpoint, defined as the time from randomization until the date of objective radiological disease progression, clinical progression or death. The secondary endpoint was Overall Survival (OS). Results: CGH array data were available for 79 patients out of 183, 56 randomized to durvalumab and 23 to SoC. 47 were men, 72 had non-squamous histology and 12 had brain and 10 had liver metastasis. We divided patients in tertiles according to instability (INS) score. No correlation was seen between INS score and PD-L1 positivity (p = 0.5), or liver and brain metastasis. Pts with high INS had lower median PFS of 2.5 months (m) (95% CI 1.4 – 5.2) vs 4.3m (95% CI 2.6 – 13.7) for those with intermediate INS and 6.1m for those with low INS (95% CI 1.9 – 21.2), p 0.012. Similarly, low INS patients had longer OS of 29.6 m (95% CI 15.4 – NR) vs 17.9m for intermediate INS (95% CI 10 – NA) and 12.1m for high INS (95% CI 10.2 – 19.5), p = 0.039. No difference was seen in the control group (p=0.25 for PFS and p=0.4 for OS). A multivariable model showed that high INS was independently associated worse PFS (HR 2.60, 95% CI 1.36 - 4.98, p 0.004) and OS (HR 2.90, 95% CI 1.33 - 6.35, p 0.008). Conclusions: Genomic instability score based on CGH array-based copy number alterations profile is associated with worse PFS and OS in patients under response to chemotherapy who received durvalumab maintenance. Clinical trial information: NCT02117167 .

Spatial patterns of historical crop yields reveal soil health attributes in US Midwest fields

Attaining high crop yields and increasing carbon storage in agricultural soils, while avoiding negative environmental impacts on water quality, soil erosion, and biodiversity, requires accurate and precise management of crop inputs and management practices. The long-term analysis of spatial and temporal patterns of crop yields provides insights on how yields vary in a field, with parts of field constantly producing either high yields or low yields and other parts that fluctuate from one year to the next. The concept of yield stability has shown to be informative on how plants translate the effects of environmental conditions (e.g., soil, climate, topography) across the field and over the years in the final yield, and as a valuable layer in developing prescription maps of variable fertilizer rate inputs. Using known relationships between soil health and crop yields, we hypothesize that areas with measured constantly low yield will return low carbon to the soil affecting its heath. On this premises, yield stability zones (YSZ) provide an effective and practical integrative measure of the small-scale variability of soil health on a field relative basis. We tested this hypothesis by measuring various metrics of soil health from commercial farmers’ fields in the north central Midwest of the USA in samples replicated across YSZ, using a soil test suite commonly used by producers and stakeholders active in agricultural carbon credits markets. We found that the use of YSZ allowed us to successfully partition field-relative soil organic carbon (SOC) and soil health metrics into statistically distinct regions. Low and stable (LS) yield zones were statistically lower in normalized SOC when compared to high and stable (HS) and unstable (US) yield zones. The drivers of the yield differences within a field are a series of factors ranging from climate, topography and soil. LS zones occur in areas of compacted soil layers or shallow soils (edge of the field) on steeper slopes. The US zones occurring with high water flow accumulation, were more dependent on topography and rainfall. The differences in the components of the overall soil health score (SHS) between these YSZ increased with sample depth suggesting a deeper topsoil in the US and HS zones, driven by the accumulation of water, nutrients, and carbon downslope. Comparison of the field management provided initial evidence that zero tillage reduces the magnitude of the variance in SOC and soil health metrics between the YSZ.

Use of angioembolization, treatment modalities and mortality in association with blunt liver trauma in Germany — a data analysis of the TraumaRegister DGU®

PurposeAngioembolization (ANGIO) is highly valued in national and international guideline recommendations as a treatment adjunct with blunt liver trauma (BLT). The literature on BLT shows that treatment, regardless of the severity of liver injury, can be accomplished with a high success rate using nonoperative management (NOM). An indication for surgical therapy (SURG) is only seen in hemodynamically instable patients. For Germany, it is unclear how frequently NOM ±\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\pm$$\\end{document} ANGIO is actually used, and what mortality is associated with BLT.MethodsA retrospective systematic data analysis of patients with BLT from the TraumaRegister DGU® was performed. All patients with liver injury AIS ≥ 2 between 2015 and 2020 were included. The focus was to evaluate the use ANGIO as well as treatment selection (NOM vs. SURG) and mortality in relation to liver injury severity. Furthermore, independent risk factors influencing mortality were identified, using multivariate logistic regression.ResultsA total of 2353 patients with BLT were included in the analysis. ANGIO was used in 18 cases (0.8%). NOM was performed in 70.9% of all cases, but mainly in less severe liver trauma (AIS ≤ 2, abbreviated injury scale). Liver injuries AIS ≥ 3 were predominantly treated surgically (64.6%). Overall mortality associated with BLT was 16%. Severity of liver injury ≥ AIS 3, age > 60 years, hemodynamic instability (INSTBL), and mass transfusion (≥ 10 packed red blood cells/pRBC) were identified as independent risk factors contributing to mortality in BLT.ConclusionANGIO is rarely used in BLT, contrary to national and international guideline recommendations. In Germany, liver injuries AIS ≥ 3 are still predominantly treated surgically. BLT is associated with considerable mortality, depending on the presence of specific contributing risk factors.

The effect of mean flow on the intrinsic thermoacoustic instabilities in the duct and annular combustion chambers

Thermoacoustic instability in the combustion chamber of gas turbines, aero and rocket engines has become a topic concern. In this paper, a new instability phenomenon in the field of the thermoacoustic instability - Intrinsic ThermoAcoustic instabilities (ITA) is studied. The classic thermoacoustic instability is caused by the coupling among acoustic disturbances, flow fluctuations and heat release pulsations. When the influence of acoustic disturbance is removed, there is still a thermoacoustic instability phenomenon in the combustion chamber, which is known as ITA. In the previous research on ITA, the scholars found that the ITA is mainly determined by the flame response, but many scholars neglected the influence of the mean flow and entropy waves. In this paper, the influence of the mean flow on the ITA mode in the duct and annular combustion chambers is studied by constructing a low-order acoustic network model. At the same time, it also explores the influence of other parameters on the ITA mode. The mean flow greatly affects the growth rate of the ITA mode, and has little effect on its frequency in the duct combustion chamber model. This is also the main reason for neglecting the effect of mean flow on the ITA mode in previous studies. In addition, the influence of other parameters on the ITA mode is also reflected in the growth rate. In the annular combustion chamber, a new ITA mode, which does not meet the −π criterion, is found. And the increase of Mach number makes all ITA modes more unstable. The circumferential mode number has a great influence on the high frequency ITA mode. In addition, the ITA mode has a significant effect on the thermoacoustic mode of the system in the annular combustion chamber.

Quantitative assessment of the level of instability of a single-plane balance platform.

Balance training on unstable surfaces is widely used in medicine and sports. The main disadvantage of balance platforms is weakly definable assessment of the level of instability (IL) they create. To evaluate the mechanical characteristics of a suspended single-plane instability balance platform which determines quantitative instability characteristics. Three criteria influencing the IL were evaluated: 1. The displacement of the platform board by changing the position of the object on the board; 2. Amount of force required for board displacement; 3. The vibration damping of the platform. 1. 1IL the displacement of the object on the board affected 0.66 cm. the displacement of the board relative to the platform frame; 2IL - 0.79cm; 3IL - 0.91cm.; 2. A force of 2.64 is required for a board displacement of 1IL compared to 2IL and 5.76 times that of 3IL. 3. Damping factor 1IL - 0.015, 2IL - 0.006, 3IL - 0.003. 1. The longer the suspension, the change in the position of the object on the board affects the greater movement of the board relative to the platform. 2. Different IL can be compared with each other depending on how different the force required to cause the board to move. 3. The platform dampens vibrations weakly, but the damping between 1 and 3 IL differs about 5 times.

Immune Milieu and Genomic Alterations Set the Triple-Negative Breast Cancer Immunomodulatory Subtype Tumor Behavior.

Simple SummaryTriple-negative breast cancer (TNBC) is an aggressive and highly heterogeneous breast cancer subtype, both molecular and transcriptomic. Gene expression patterns identified seven TNBC subtypes; basal-like 1 (BL1), basal-like 2 (BL2), immunomodulatory (IM), mesenchymal (M), mesenchymal stem-like (MSL), luminal androgen receptor (LAR), and unstable (UNS). Herein, we contrasted the IM subtype with non-IM TNBC, including clinical, histopathological, and molecular variables. Our results showed that the IM subtype featured an increased FOXP3+ TILs infiltration and a higher CTLA-4 and PD-L1 expression compared with non-IM tumors. Long intergenic non-coding RNAs associated with the immune response through transcriptomic and enrichment analyses characterized the IM-subtype enriched by the β-catenin signaling pathway. Additionally, DNA sequencing identified differences in mutation rates as well as some specific mutations. These results should motivate the design of future clinical trials in which the benefit of immune-based therapy in this subgroup of patients could be evaluated.Triple-negative breast cancer (TNBC) is an aggressive and heterogeneous disease. Seven subtypes have been described based on gene expression patterns. Herein, we characterized the tumor biology and clinical behavior of the immunomodulatory (IM) subtype. Methods: Formalin-fixed paraffin-embedded tumor samples from 68 high-risk (stage III-IV) TNBC patients were analyzed through microarrays, immunohistochemistry, and DNA sequencing. Results: The IM subtype was identified in 24% of TNBC tumor samples and characterized by a higher intratumoral (intT) and stromal (strml) infiltration of FOXP3+ TILs (Treg) compared with non-IM subtypes. Further, PD-L1+ (>1%) expression was significantly higher, as well as CTLA-4+ intT and strml expression in the IM subtype. Differential expression and gene set enrichment analysis identified biological processes associated with the immune system. Pathway analysis revealed enrichment of the β-catenin signaling pathway. The non-coding analysis led to seven Long Intergenic Non-Protein Coding RNAs (lincRNAs) (6 up-regulated and 1 down-regulated) that were associated with a favorable prognosis in the TNBC-IM subtype. The DNA sequencing highlighted two genes relevant to immune system responses: CTNNB1 (Catenin β-1) and IDH1. Conclusion: the IM subtype showed a distinct immune microenvironment, as well as subtype-specific genomic alterations. Characterizing TNBC at a molecular and transcriptomic level might guide immune-based therapy in this subgroup of patients.

Расслаивающая аневризма аорты как одна из ведущих причин летальности при синдроме Марфана на примере клинического случая

Синдром Марфана наряду с другими наследственными заболеваниями соединительной ткани занимает второе место среди причин аневризмы аорты. Прогноз пациентов с аневризмой аорты зависит от ранней диагностики и, соответственно, раннего хирургического лечения. В нашей статье представлен клинический случай пациентки с поздно диагностированным синдромом Марфана, осложнившимся к моменту диагностики расслоением аневризмы аорты и впоследствии (на фоне нестабильных цифр артериального давления) — разрывом восходящего отдела аорты.

The New FA₂ST Stroke Screening Score: An Expanding Recognition to Posterior Circulation Stroke

Background: Rapid screening and intervention are the keys to successful early treatment of stroke. Generally, the conventional FAST stroke screening score has been used by triage nurses to promptly detect acute stroke. However, the conventional FAST score has a limitation in detecting posterior circulation stroke, which results in high mortality rates. Previous studies have shown that adding ataxia could increase the sensitivity of posterior circulation stroke detection. Objective: To introduce and evaluate the diagnostic performance of a new stroke screening score, FA₂ST score, by adding ataxia to the conventional FAST score. Materials and Methods: The present study was a cross-sectional study. The new FA₂ST and conventional FAST scores were used by triage nurses in patients presented with acute neurological symptoms within seven days at the emergency department of three different types of hospitals in Thailand. Patients with Glasgow Coma Score less than 9 and those having unstable vital signs were excluded. Final diagnosis was made by a neurologist using clinical and neuroimaging information. The diagnostic performance of the new FA₂ST score was calculated using ROC curve in comparison to the conventional FAST score. The rate of posterior circulation stroke detection was calculated as percentage. Results: One hundred forty-six patients were studied. Of these, 127 (86%) had acute ischemic stroke and 19 (14%) had other diagnoses. The overall diagnostic performance of the new FA₂ST score was not statistically different with conventional FAST score in terms of area under the curve (0.642 versus 0.684, p=0.221). However, after in-depth analysis, the rate of posterior circulation stroke detection of the new FA₂ST score was higher compared with the conventional FAST score (94.12% versus 82.35%). Conclusion: The present study introduces the new FA₂ST stroke screening score and emphasizes the importance of posterior circulation stroke detection in acute stroke screening. Future studies should be considered before implementation of this score. Keywords: Screening score; Acute stroke treatment; Stroke; Emergency neurology

دراسة وتحليل واقع هشاشة النظام المالي في العراق للمدة (2003-2018)

The analysis of the reality of the financial fragility of the financial system especially the banking system side of it is recent and it has become an increasingly important goal in the context of macroeconomic policy-making especially its financial and monetary parts and among the reasons that have made attention towards the issue of the fragility of the financial system and that it has priority within The concerns of financial monetary and economic policymakers around the world are the need for sudden financing operations especially investment which necessitated the study and analysis of the impact of the state of the fragility of the financial system in Iraq on the state potential or ability of the country's financial and banking system to face the necessary financing operations especially domestic investment The fragility of the financial system expresses a state of deterioration and instability of the financial system whether the banking side of it (the financial and banking institutions) or the financial market side in a manner in which it does not perform its functions efficiently especially the allocation of resources directing them or making them ready for any sudden financing that could aid the economic situation in the country

The interaction between ion transit-time and electron drift instabilities and their effect on anomalous electron transport in Hall thrusters

Recent simulations and experiments have observed a transition from short to long-wavelength azimuthal instabilities that leads to enhanced electron transport in Hall thrusters. Here we make the hypothesis that this phenomenon stems directly from the interaction between the axial ion transit-time instabilities (ITTI), and the azimuthal electron drift instability (EDI). This interaction is studied using 2D axial-azimuthal self-consistent particle-in-cell simulations which include a 1D neutral dynamics solver. It is found that a short to long-wavelength transition only occurs if the breathing-mode and ITTI are captured in the simulation, and two distinct instability regions can be distinguished depending on the local ion Mach number. Upstream of the ion sonic point the EDI exhibits an ion-acoustic behaviour, and the associated instability-enhanced electron transport is well described by a previously developed model based on kinetic theory. Downstream of the ion sonic point however, the ITTI significantly changes the local plasma parameters, and this modifies the EDI while increasing the electron transport.

Genome instability and lymphoma.

Lymphoma is one of the most common malignant tumor of the hematologic system. The genome instability is not only an important molecular basis for the development of lymphoma, but also has important value in the diagnosis and prognosis of lymphoma. There are 2 types of genome instability: Microsatellite instability (MSI/MIN) at gene level and chromosomal instability at chromosome level. Through the study on genes associated with lymphoma, the unstable genes associated with lymphoma could be found, meanwhile the mechanism of its occurrence and development of lymphoma could be explored, and the important basis of molecular biology could also be provided in the field of current hot lymphoma precision medical research.

Successful Rescue Intervention of Internal Mammary Artery Anastomotic Site Acute Graft Failure With Direct New Generation Covered Stenting

Acute, perioperative myocardial infarction (MI) from acute left internal mammary artery (LIMA) to left anterior descending (LAD) graft failure immediately following coronary artery bypass grafting (CABG) surgery is associated with significantly increased in-hospital mortality. The leading etiology of such acute graft failure is acute thrombosis, dissection, spasm, anastomosis failure or no-reflow phenomenon. Repeat bypass surgery carries incremental risk and may not be feasible in hemodynamically unstable patients. Traditional percutaneous coronary intervention (PCI), with or without stent placement is sometimes used in such cases; however, graft anatomy and lesion location increase procedural complexity and challenge technical feasibility. This is particularly true of the LIMA to LAD graft anastomosis, where PCI carries the risk of anastomotic site perforation or avulsion. Therefore, the best revascularization strategy for such a lesion involving the LIMA to LAD graft anastomosis in the immediate perioperative period remains unknown. We present a case of 75-year-old male who suffered an acute MI complicated by cardiogenic shock less than 24 h after two-vessel CABG. Selective angiography revealed acute LIMA to LAD anastomotic site closure, posing a risk for perforation if treated with traditional angioplasty or stenting. We successfully performed rescue PCI, by directly deploying a PK Papyrus covered stent (Biotronik, Berlin, Germany) across the anastomosis. Our case report describes the upfront (rather than a bail out) use of the new covered stent as a novel revascularization strategy to treat “perforation prone” LIMA to LAD anastomotic site acute graft failure. J Med Cases. 2021;12(7):271-274 doi: https://doi.org/10.14740/jmc3695

Insurance Fraud Detection using Spiking Neural Network along with NormAD Algorithm

General automobile insurance in recent years, has seen a huge escalation of fraud cases. The requirement of utilizing well organised and coherent technique to check on or determine user those are potential frauds. Thus, the deployment of the NormAD algorithm with less delay to enhance the safety and authorized in the operative process. The paper here describes attribute extrication method and Spiking Neural Network structure to resolve the issue of identification of automobile insurance fraud. The attribute second-level extrication algorithm coined in this paper can efficiently derive key attributes and enhance the identification accuracy of succeeding algorithms. So as to achieve to resolve the issue of unstable simulation allotment in the automobile insurance fraud identification scheme, an exemplary distributed method established on the plan of small unit proportion balance is presented. Formulated on the above techniques of attributes extrication and sample division, a model established on Spiking Neural Network with NormAD Algorithm is proposed. This method utilizes the complete goal of implementation of the Spiking Neural Network model algorithm that rely on Spiking Neuron, and ultimately accomplishes in enhancing the exactness of the detection of Automobile Insurance Fraud.

Trace elements and the carotid plaque: the GOOD (Mg, Zn, Se), the UGLY (Fe, Cu), and the BAD (P, Ca)?

Multiple epidemiological studies have suggested that industrialization and progressive urbanization should be considered one of the main factors responsible for the rising of atherosclerosis in the developing world. In this scenario, the role of trace metals in the insurgence and progression of atherosclerosis has not been clarified yet. In this paper, the specific role of selected trace elements (magnesium, zinc, selenium, iron, copper, phosphorus, and calcium) is described by focusing on the atherosclerotic prevention and pathogenesis plaque. For each element, the following data are reported: daily intake, serum levels, intra/extracellular distribution, major roles in physiology, main effects of high and low levels, specific roles in atherosclerosis, possible interactions with other trace elements, and possible influences on plaque development. For each trace element, the correlations between its levels and clinical severity and outcome of COVID-19 are discussed. Moreover, the role of matrix metalloproteinases, a family of zinc-dependent endopeptidases, as a new medical therapeutical approach to atherosclerosis is discussed. Data suggest that trace element status may influence both atherosclerosis insurgence and plaque evolution toward a stable or an unstable status. However, significant variability in the action of these traces is evident: some - including magnesium, zinc, and selenium - may have a protective role, whereas others, including iron and copper, probably have a multi-faceted and more complex role in the pathogenesis of the atherosclerotic plaque. Finally, calcium and phosphorus are implicated in the calcification of atherosclerotic plaques and in the progression of the plaque toward rupture and severe clinical complications. In particular, the role of calcium is debated. Focusing on the COVID-19 pandemia, optimized magnesium and zinc levels are indicated as important protective tools against a severe clinical course of the disease, often related to the ability of SARS-CoV-2 to cause a systemic inflammatory response, able to transform a stable plaque into an unstable one, with severe clinical complications.

Completely glaciated Cumulus mediocris during an unstable westerly

Completely glaciated Cumulus mediocris during an unstable westerly

Outcomes of simultaneous anterior cruciate ligament and medial collateral ligament reconstruction

Multiligamentous knee injuries (MLKI) are rare orthopedic injuries with involvement of two or more ligaments in the knee. There are variety of combinations of MLKI and one such relatively common and important injury pattern is anterior cruciate ligament (ACL) plus medial collateral ligament (MCL) injury. Though MCL grade 1 and 2 does not warrant surgical management, grade 3 defintely needs reconstruction or repair according to past studies so as to avoid valgus instability. A retrospective study was conducted evaluating the outcomes of combined ACL and MCL injuries in 22 patients at our centre. Road traffic accidents (RTA) accounted for 45.5% of the total cases as the most common mechanism of injury. Out of 22 patients operated with simultaneous ACL and MCL reconstruction, 14 (63.6%) had good results based on Lyscholm scoring system, 5 (22.8%) had excellent results, and 3(13.6%) had fair result and none of our patients had poor results. Simultaneous single stage management of ACL and MCL injury has advantages like early rehabilitation, reduced number of hospital stay as well as absence of necessity for getting admitted and operated for each ligament separately which also brings down the cost to the patient. Keywords: Reconstruction, ACL, MCL, Lyscholm.

Surgical outcome of tibial condyle fracture with MIPPO technique

Background: Tibial condylar fractures are very common in road traffic accidents; however, sports injury, fall and other trivial trauma can frequently produce these fractures. These are unstable fractures and quite challenging to manage. This study was undertaken to evaluate locking compression plate (LCP) fixation in proximal intra articular tibia fractures by MIPPO (minimally invasive percutaneous plate osteosynthesis) technique. Materials and Methods: The study was conducted from 0ctober 2016 to 2018. 20 cases who had sustained tibial plateau fractures (Schatzker type 1- VI) and operated with LCP fixation using MIPPO technique were included in this study after obtaining informed consent. Follow-up was done at 6 weeks, 12 weeks, 18 weeks and 24 weeks after the surgery and they were evaluated in accordance with modified Rasmussen knee scoring system. Results: Modified Rasmussen functional knee scoring system and modified Rasmussen criteria for radiological assessment was used to analyse the functional outcome among the cases. After evaluation it was observed that 90% of the patients had good to excellent performance. Conclusion: MIPPO technique enables soft tissue stripping via a small surgical incision and provides a rigid fracture reduction. There is also a reduced chance of post traumatic soft tissue injury. Proximal Tibial locking plate is a good device to stabilize the fractures of Tibial plateau (intra articular), especially when used in conjunction with meticulous intraoperative handling of the soft tissues and active participation of the patients in the rehabilitation programme is ensured. Keywords: Proximal tibia, MIPPO, Intra – articular, Tibia plateau, Locking compression plate.

Morphological variations in proximal femoral nails in Indian scenario and its clinical application

Background: There is an increasing trend of use of cephalomedullary nail for the management of both stable and unstable intertrochanteric and subtrochanteric femoral fractures. Various western and Indian proximal femoral nails with different morphologies are available in Indian market that sometimes creates confusion amongst orthopedic surgeons about which nail to be preferred in different clinical scenarios for accurate outcomes. Material and Methods: Ten different types of long femoral nails with 10 mm diameter (5 Western and 5 Indian) available in Indian market were taken and the morphology of these were studied and compared for 9 parameters. Results: A lot of variation was seen amongst the Indian nails and western nails in proximal diameter, shape of proximal part of nail, distance of lag screw from tip, distance at which actual size of nail becomes 10mm, M-L angle (medio lateral angle), shape of nail shaft, configuration of distal screws, morphology of neck screw and centrum-collum –diaphyseal (CCD) angle. Conclusion: Design of a nail may prove to be superior in some type of patients and fractures but may not be suitable for others. Pre-operative templating is must and surgeons need to consider all the factors in unison while deciding the type of nail to be used. Keywords: Intertrochantric fractures, Proximal femoral nail.

El papel de las políticas activas de empleo en las trayectorias laborales inestables de la población joven

La situación del colectivo de jóvenes en relación con su inserción en el mercado de trabajo es una constante en las agendas institucionales y de investigación en el marco de la Unión Europea. Las recientes crisis económicas y sanitarias no han hecho más que aumentar la preocupación por la inserción de dicho colectivo. Las políticas activas de empleo han sido uno de los instrumentos utilizados para mejorar la inserción laboral de las personas jóvenes. Sin embargo, la orientación de dichas políticas ha sido puesta en entredicho a tenor de la escasa efectividad que a menudo han mostrado. La perspectiva longitudinal adoptada en el artículo permite profundizar en la comprensión del papel que las políticas activas de empleo pueden tener en las trayectorias o itinerarios de inestabilidad laboral del colectivo de jóvenes. Los resultados apuntan a una escasa capacidad de dichas políticas a la hora de modificar las trayectorias juveniles y a la baja percepción que las personas jóvenes tienen de ellas como instrumentos correctores o de mejora de sus trayectorias.