Search Results (101)

Background: Osteochondral fractures (OCFs) following acute patellar dislocation significantly influence treatment decisions and long-term prognosis, yet reliable risk stratification remains elusive. This study aimed to identify demographic and trochlear morphology predictors of fracture occurrence in a large patient cohort. Methods: This retrospective analysis included 261 skeletally mature patients with acute patellar dislocation from 2000 to 2024 (mean age 24 ± 10 years, 59% male), excluding those with previous knee surgery, additional injuries, or skeletal immaturity. A comprehensive MRI assessment evaluated trochlear morphology (Dejour classification, sulcus angle, trochlear groove depth, and facet measurements) and patellofemoral alignment parameters (TT-TG distance, Q-angle, and congruence angle). Multivariate logistic regression identified independent risk factors for the development of osteochondral fractures. Results: Osteochondral fractures occurred in 133 patients (51% [of those undergoing MRI evaluation]). Male gender emerged as the strongest predictor (OR 2.38, 95% CI: 1.30–4.42, p = 0.005), followed by right-sided dislocation (OR 2.33, 95% CI: 1.21–4.58, p = 0.013). Notably, higher-grade trochlear dysplasia (Dejour Grades 3–4) was associated with lower fracture rates, being more common in non-fracture patients (27% vs. 10%, p = 0.003). Trochlear condyle asymmetry was also significant (OR 1.14, p = 0.004). Most patellofemoral alignment parameters, including TT-TG distance and Q-angle, showed no significant predictive value. Conclusions: Male gender and right-sided dislocation are associated with higher rates of osteochondral fracture after patellar dislocation. Patients with normal trochlear anatomy have higher fracture rates than those with severe dysplasia. These findings suggest that demographic factors and trochlear morphology should be considered in the diagnostic workup of acute patellar dislocations, though prospective validation is needed before implementing screening protocols. Full article

Background and objectives: In cases of acute type A aortic dissection, including iatrogenic cases following transcatheter procedures, the choice of arterial cannulation site has a critical influence on early haemodynamics, organ protection and the risk of malperfusion. Transapical left ventricular cannulation has been suggested as a ‘central’ approach for rapidly establishing cardiopulmonary bypass with antegrade true-lumen flow. This review summarises the current evidence on TAC in acute type A dissection, focusing on indications, technical aspects and clinical outcomes. Materials and methods: We conducted a narrative review of observational studies and technical reports describing TAC for the surgical repair of acute type A aortic dissection. Particular attention was paid to patient selection, operative technique, perioperative complications, and early and mid-term results. Results: Across the published series, TAC is primarily employed in haemodynamically unstable patients or when the peripheral arteries are dissected, diseased, or unsuitable. A long arterial cannula is introduced through the left ventricular apex, crosses the aortic valve and is positioned in the true lumen of the ascending aorta under echocardiographic guidance. This configuration enables the rapid initiation of CPB, shortens skin-to-pump times, and provides reliable antegrade inflow. Early mortality and stroke rates are comparable to those associated with other cannulation strategies. Reported complications include malperfusion requiring site conversion, apical bleeding and rare local structural damage. These can be minimised through standardised technique and systematic imaging. Conclusions: TAC is a valuable bail-out option and, in selected patients, a primary cannulation option for acute type A aortic dissection when conventional arterial access is unsafe or ineffective. Although it offers fast and reproducible establishment of antegrade true-lumen flow, it requires specific expertise in apical exposure and intraoperative echocardiography. It should therefore be integrated into a structured perfusion and repair strategy. Full article

Ophiocordyceps sinensis represents a valuable medicinal resource. In this study, mechanisms underlying differences in chemical composition and antioxidant capacity among wild O. sinensis (GL), artificially cultivated O. sinensis (RG), and product of O. sinensis “Bailing” capsules (BL) were systematically investigated via in vitro antioxidant capacity assays and untargeted metabolomics. Results showed GL exhibited the highest total phenol (TPS) content and superior free radical scavenging activity. Additionally, superoxide dismutase (SOD) and peroxidase (POD) activities in RG were higher than those in BL. Correlation analysis of antioxidant indices demonstrated significant positive correlations between total phenols (TPS) and flavonoids (TF) with DPPH radical scavenging, ferric ion reducing antioxidant power (FRAP), hydroxyl radical scavenging rate, and superoxide anion radical scavenging rate (p < 0.01). A total of 6729 metabolites were detected, encompassing amino acids and their derivatives, lipids, and nucleotides and their derivatives, among other classes. Furthermore, metabolites exhibited distinct intergroup separation, indicating significant differences in metabolic profiles between O. sinensis and its substitute products. KEGG enrichment analysis showed that differential metabolites were mainly enriched in amino acid, lipid, and nucleotide metabolic pathways, among which the linoleic acid metabolic pathway was significantly downregulated. Key metabolites included γ-linolenic acid, 12(13)-EpOME-d, 9-HpODE, etc. Additionally, results of correlation analysis revealed that differential metabolites of lipids, nucleotides, and amino acids exhibited a significant positive correlation with antioxidant indices (p < 0.05). These findings suggest that the antioxidant capacity of O. sinensis and its substitutes may be regulated via linoleic acid metabolism, providing a theoretical basis for advancing targeted functional development of O. sinensis and its substitute products. Full article

Pre-trial detention is intended to be a measure of last resort, yet it is excessively applied across jurisdictions worldwide. This paper examines its use, with particular emphasis on its application to women and its incompatibility with international human rights law, standards, and norms. We demonstrate that the inappropriate and widespread use of custodial remand violates fundamental human rights, while exposing the gendered and intersectional barriers that impede women’s access to bail. We further underscore the far-reaching social, economic, and emotional consequences of women’s incarceration. Drawing on a limited but expanding body of research, we argue that pre-trial detention operates as a form of gendered punishment that reflects and reinforces structural inequalities, producing enduring harms for women, their families, and communities. The paper concludes by calling for investment in gender-sensitive, non-custodial, and community-based alternatives that advance women’s decarceration. These measures must be underpinned by reforms that give practical effect to human rights law, standards, and norms, while also addressing the structural conditions that lead to women’s involvement in the criminal-legal system, and ending the unnecessary imprisonment of those who are legally innocent. Full article

Background: Despite the high prevalence of anterior cruciate ligament (ACL) surgeries, standardized, evidence-based rehabilitation protocols remain lacking. Digital medical devices (DMDs) like the “Orthelligent” system have gained relevance as adjuncts to traditional physiotherapy, offering continuous, objective monitoring of functional recovery. Methods: A retrospective cohort analysis included 335 patients who underwent ACL reconstruction and used the “Orthelligent home” system between August 2022 and December 2024. In total, 5675 recorded test and exercise events were analyzed. Functional recovery was assessed using the Limb Symmetry Index (LSI) across five defined rehabilitation phases (0–4). All patients followed a structured rehabilitation program aligned with current clinical practice guidelines, supplemented by Orthelligent as a home-based digital tool for daily monitoring. Results: Significant functional improvement was observed during early rehabilitation phases, with the LSI increasing from 0.64 ± 0.02 in phase 0 to 0.81 ± 0.01 in phase 2 (p < 0.001). Time since surgery was a significant positive predictor (p = 0.034), while pain showed a strong negative impact on performance (p < 0.001). Anthropometric factors had no significant effect. Exercises associated with high rates of drop-out, pain, or difficulty were identified and linked to specific rehab phases. Conclusions: This study demonstrates that digital rehabilitation monitoring can reliably reflect patient progress after ACL reconstruction. The early postoperative period (first 3 months) is critical for functional gains, highlighting the need for individualized, pain-sensitive rehabilitation strategies. Full article

In this study, we used liquid chromatography–tandem mass spectrometry (LC-MS/MS) combined with multivariate statistical analysis to conduct comprehensive qualitative and quantitative profiling of amino acids and their derivatives in wild Ophiocordyceps sinensis (O. sinensis) samples from Naqu (NQ) and Xiaojin (XJ), cultivated O. sinensis (RG), and Bailing Capsules (BL). The objective was to systematically characterize amino acid metabolism and assess its correlation with antioxidant functionality. A total of 82 amino acids and their derivatives were identified. XJ had the highest essential amino acids, while BL had significantly lower content (except lysine) (p < 0.05). Antioxidant assays revealed that NQ and XJ samples exhibited superior antioxidant activity in 2,2′-azino-bis (3-ethylbenzothiazoline-6-sulfonate) (ABTS), 2,2-diphenyl-1-picrylhydrazyl (DPPH), and ferric ion reducing antioxidant power (FRAP) assays, and this activity showed a correlation to the contents of bioactive components such as total phenols (TPS), total polysaccharide (TPE), and total flavonoids (TF). Further pathway analysis using the Kyoto Encyclopedia of Genes and Genomes (KEGG) suggested that arginine and proline metabolism, aromatic amino acid biosynthesis, and tryptophan metabolism may be critical pathways that could underpin regional differences in O. sinensis quality, while variation in tyrosine metabolism may account for differences in antioxidant activity. This study provides a systematic comparison of amino acid profiles and antioxidant capacities across O. sinensis and its substitutes, offering a robust theoretical foundation for the development and functional evaluation of these bioresources. Full article

The natural history of focal non-infected lesions of the abdominal aorta (fl-AA) remains unclear and largely depends on their aetiology. These lesions often involve a focal “tear” or partial disruption of the arterial wall. Penetrating aortic ulcers (PAUs) and intramural hematomas (IMHs) are examples of focal tears in the aortic wall that can either progress to dilatation (saccular aneurysm) or fail to fully propagate through the medial layers, potentially leading to aortic dissection. These conditions typically exhibit a morphology consistent with eccentric saccular aneurysms. The management of focal non-infected pathologies of the abdominal aorta remains a subject of debate. Unlike fusiform abdominal aortic aneurysms, the inconsistent definitions and limited information regarding the natural history of saccular aneurysms (sa-AAAs) have prevented the establishment of universally accepted practice guidelines for their management. As emphasized in the latest 2024 ESVS guidelines, the focal nature of these diseases makes them ideal candidates for endovascular repair (class of evidence IIa—level C). Moreover, the Society for Vascular Surgery just referred to aneurysm diameter as an indication for treatment suggesting using a smaller diameter compared to fusiform aneurysms. Consequently, the management of saccular aneurysms is likely heterogeneous amongst different centres and different operators. Endovascular repair using tube stent grafts offers benefits like reduced recovery times but carries risks of migration and endoleak due to graft rigidity. These complications can influence long-term success. In this context, the use of endovascular bifurcated grafts may provide a more effective solution for treating these focal aortic pathologies. It is essential to achieve optimal sealing regions through anatomical studies of aortic morphology. Additionally, understanding the anatomical characteristics of focal lesions in challenging necks or para-visceral locations is indeed crucial in device choice. Off-the-shelf devices are favoured for their time and cost efficiency, but new endovascular technologies like fenestrated endovascular aneurysm repair (FEVAR) and custom-made devices enhance treatment success and patient safety. These innovations provide stent grafts in various lengths and diameters, accommodating different aortic anatomies and reducing the risk of type III endoleaks. Although complicated PAUs and focal saccular aneurysms rarely arise in the para-visceral aorta, the consequences of rupture in this segment might be extremely severe. Experience borrowed from complex abdominal and thoracoabdominal aneurysm repair demonstrates that fenestrated and branched devices can be deployed safely when anatomical criteria are respected. Elective patients derive the greatest benefit from a fenestrated graft, while urgent cases can be treated confidently with off-the-shelf multibranch systems, reserving other types of repairs for emergent or bail-out cases. While early outcomes of these interventions are promising, it is crucial to acknowledge that limited aortic coverage can still impede effective symptom relief and lead to complications such as aneurysm expansion or rupture. Therefore, further long-term studies are essential to consolidate the technical results and evaluate the durability of various graft options. Full article

Background/Objectives: Proximal interphalangeal joint (PIJ) arthrodesis is a common surgical intervention for patients with PIJ osteoarthritis or trauma-related joint destruction. The objective of this study was to evaluate the biomechanical stability of various arthrodesis techniques under forces comparable to activities of daily living (ADL) to assess their suitability for early active movement protocols. Methods: In this in vitro study, composite cylinders simulating PIJ arthrodesis were subjected to standardized fusion angles of 40° using different fixation techniques, including crossed K-wires, compression screws, cerclage wires, tension band wiring, anatomical fixation plates, and locking grid plates. Forces representing ADLs such as typing, holding a pencil, carrying weight, and opening a jar were applied using a universal testing machine in a four-point bending setup. Micromotion and gap clearance were calculated and analyzed. Results: Techniques involving compression, such as compression screws, tension bands, and cerclage wires, exhibited lower micromotion and gap clearance under forces up to 17 N, suggesting potential suitability for early active movement protocols. In contrast, fixation plates demonstrated structural failure or excessive clearance during early active motion ADLs. K-wires showed intermediate results with moderate gap clearance and micromotion. Conclusions: Compression-based fixation techniques for PIJ arthrodesis may permit early active movement without external stabilization, while fixation plates are prone to failure under ADL forces. Further dynamic biomechanical testing and clinical studies are recommended to confirm these findings. Full article

This study examines the role of artificial intelligence (AI) in judicial decision-making, focusing on bail and sentencing contexts. We examined public perceptions of judges who use AI tools compared to those who rely solely on expertise. Using an experimental design, participants (N = 1800; stratified by race/ethnicity and gender) were presented with vignettes depicting judges using varying levels of AI assistance. Key outcomes included perceptions of judicial legitimacy, procedural justice, and trust in AI, with analyses stratified by racial groups (Black, Hispanic, White). The results revealed that judges relying on expertise were generally rated higher in legitimacy than those using AI; however, significant racial differences emerged. Black participants showed greater trust and perceived fairness in AI-augmented decisions compared to White and Hispanic participants. Open-ended responses further highlighted social psychological themes regarding the symbolic meaning of AI in judicial processes. These findings underscore the complexity of integrating AI in the judiciary, emphasizing the need for transparent and equitable implementation strategies to maintain public trust and fairness. Future research should explore underlying factors influencing these perceptions to inform policies that address racial disparities and enhance trust in AI-assisted legal decision-making. Full article

This paper studies the impact of crisis management mechanisms (bailouts and bail-ins) on moral hazard. Through an econometric study of financial crises in emerging countries since 1993, the results indicate that recurrent bailouts exacerbate moral hazard, while bail-ins have only a minor impact due to their perceived lack of credibility. The results highlight the impact of crisis management measures on financial stability and the scale of the mobilised resources. Analysed in the context of efforts to support sustainable development, the study recommends reassessing the fundamentals of the bailout approach, developing a robust and sustainable bailout framework that aligns immediate interventions with sustainability objectives towards sustainable recovery strategies. Full article

Background: Complications due to frailty and injury after falls are a significant problem for people living in residential aged care. This can lead to a range of negative outcomes including poor physical, social, and psychological well-being. The Australian Royal Commission into Aged Care Quality and Safety highlighted many aspects of care in residential aged care homes requiring improvement, leading to specific recommendations aimed at improving the outcomes in this area. This contributed to four recommendations calling for increased allied health interventions to meet the unmet needs in residential aged care. This intervention aims to implement and evaluate evidence-based allied health interventions for people living in residential aged care specifically relating to frailty, preventing falls, and maintaining engagement in everyday activities. Method: This is a pragmatic, non-randomised, pre–post design study where six groups of up to 10 residents of an aged care home will start the intervention at staggered times. The EAHOP intervention is an integrated application of a suite of allied health services (occupational therapy, physiotherapy, dietetics, speech pathology, pharmacy, and optometry), with general practitioner involvement, using allied health assistants in an integrated transdisciplinary model of care. The baseline period is 6 weeks, and intervention is a maximum of 36 weeks with follow-up at 12 and 24 weeks. Primary outcomes measure changes in falls, frailty, and quality of life. A qualitative program evaluation will be completed as well as an economic analysis. Conclusion: The results of the study will provide information about the clinical, implementation, and effectiveness outcomes of this integrated, transdisciplinary allied health service model for people living in residential aged care. The results will be used to develop evidence-informed guidelines for residential aged care providers on the delivery of allied health services. Full article

This article discusses key aspects of deposit–refund system design in Poland, highlighting the importance of energy-sustainable collection logistics. The main role in this system is played by the operator responsible for collecting and transporting packaging to metering centers and recycling plants. The research focused on the optimal placement of logistics facilities to minimize energy expenditures, using the balanced center of gravity method. It took into account the distribution of collection points and the intensity of material flows to develop an efficient and environmentally friendly reverse logistics model. The most important results of the research are the development of a model for the layout of logistics facilities that minimizes energy consumption, the identification of key factors such as the location of collection points and material flows, the development of a methodology for green logistics, and practical recommendations for system designers. The proposed solutions, although innovative in Poland, are universal in nature and can be applied in other countries. The article makes an important contribution to the development of sustainable bail logistics and promotes a balanced energy transition. Full article

In this paper, a novel mixed Tutton salt (K_0.86Na_0.14)₂Ni(SO₄)₂(H₂O)₆ was successfully synthesized as a single crystal and evaluated as a thermochemical heat storage material. Its thermal and thermochemical properties were correlated with the structure, which was determined by powder X-ray diffraction using the Le Bail and Rietveld methods. The elemental ratio between the K⁺ and Na⁺ monovalent cations was established by energy-dispersive X-ray spectroscopy. Similar compounds such as Na₂Ni(SO₄)₂(H₂O)₄ and K₂Ni(SO₄)₂(H₂O)₆ were also synthesized and used for structural comparisons. The (K_0.86Na_0.14)₂Ni(SO₄)₂(H₂O)₆ salt crystallizes in monoclinic symmetry with the P2₁/c-space group, typical of hexahydrate crystals from the Tutton salt family. The lattice parameters closely resemble those of K₂Ni(SO₄)₂(H₂O)₆. A comprehensive analysis of the intermolecular contacts, based on Hirshfeld surfaces and 2D fingerprint mappings, revealed that the primary interactions are hydrogen bonds (H···O/O···H) and ion-dipole interactions (K/Na···O/O···Na/K). The unit cell exhibits minimal void space, accounting for only 0.2%, indicative of strong atomic packing. The intermolecular molecular and atomic packing are important factors influencing crystal lattice stabilization and thermal energy supplied to release crystallographic H₂O. The thermal stability of mixed Tutton salt ranges from 300 K to 365 K. Under the dehydration of its six H₂O molecules, the dehydration reaction enthalpy reaches 349.8 kJ/mol, yielding a thermochemical energy storage density of 1.79 GJ/m³. With an H₂O desorption temperature ≤393 K and a high energy storage density ≥1.3 GJ/m³ (criteria established for applications at the domestic level), the (K_0.86Na_0.14)₂Ni(SO₄)₂(H₂O)₆ shows potential as a thermochemical material for small-sized heat batteries. Full article

Background: Osteoarthritis (OA) of the knee is the most common joint disease, characterized by the degeneration of joint cartilage. Intra-articular hyaluronic acid (IAHA) injections are a well-established non-surgical treatment. Methods: This retrospective study analyzed knee OA patients receiving IAHA combined with niacinamide injections, assessing pain reduction in relation to patient data, the number of injections, and radiological findings. Results: IAHA injections led to significant pain reduction on the numeric rating scale (NRS) (0–10), with a mean decrease of 3.34 ± 1.65. Pain relief was greater with multiple injections. A comparison of subgroups by injection frequency (1, 2, or >2) showed significant pain reduction between 1 and 2 injections (p = 0.027) and between 1 and >2 injections (p = 0.032). The OA grade measured using the Kellgren–Lawrence (p = 0.95) and Vallotton MRI classifications (p = 0.50) did not correlate with pain reduction. However, patients with meniscal damage (p = 0.02) showed a greater benefit. A strong positive correlation was found between baseline pain intensity and pain reduction (p < 0.001; r = 0.61). Conclusions: IAHA with niacinamide significantly reduces knee OA pain, with more injections enhancing pain relief. Greater benefits were observed in patients with higher baseline pain and meniscal damage. The favorable safety profile and potential for repeated treatments make IAHA a valuable option in knee OA management. Full article

As a key strategy for achieving a circular economy, remanufacturing involves bringing end-of-use (EoU) products or cores back to a ‘like new’ condition, providing more affordable and sustainable alternatives to new products. Despite the potential for substantial resources and energy savings, the industry faces operational challenges. These challenges arise from uncertainties surrounding core quality and functionality, return times, process variation required to meet product specifications, and the end-of-use (EoU) product values, as well as their new life expectancy after extended use as a ‘market product’. While remanufacturing holds immense promise, its full potential can only be realized through concerted efforts towards resolving the inherent complexities and obstacles that impede its operations. Machine learning (ML) and data-driven models emerge as transformative tools to mitigate numerous challenges encountered by manufacturing industry. Recently, the integration of cutting-edge technologies, such as sensor-based product data acquisition and storage, data analytics, machine health management, artificial intelligence (AI)-driven scheduling, and human–robot collaboration (HRC), in remanufacturing procedures has received significant attention from remanufacturers and the circular economy community. These advanced computational technologies help remanufacturers to implement flexible operation scheduling, enhance quality control, and streamline workflows for EoU products. This study embarks on a comprehensive review and in-depth analysis of state-of-the-art algorithms across various facets of remanufacturing processes and operations. Additionally, it identifies key challenges to advancing remanufacturing practices through data-driven and ML methods and uncovers research opportunities in synergy with smart manufacturing techniques. The study aims to offer guidelines for stakeholders and to reinforce the industry’s pivotal role in circular economy initiatives. Full article