Search Results (66)

Background: Despite advances in repair techniques, the failure rates of meniscal surgery are still high. The seven most common tear types—horizontal cleavage tears (HCTs), radial tears (RTs), meniscal ramp lesions (MRLs), meniscal root tears (MRTs), longitudinal tears (LTs), bucket-handle tears (BHMTs), and complex meniscal tears (CMTs)—were reviewed. The present retrospective observational study aimed to analyze their characteristics, incidence, treatment approach and failure rates of a consecutive cohort of patients undergoing meniscal arthroscopic repair. Methods: The database of a high-volume meniscal suture center was examined for lesions managed by all-inside, inside-out, outside-in, or transtibial pull-out techniques from January 2018 to September 2022. Demographic (gender, age at surgery, laterality of the affected knee) and intraoperative data (tear type/site, repair technique, and suture number/combination) were collected in order to calculate the failure rates of the cohort and of each tear type and suture technique. Results: Altogether, 636 procedures met our criteria of having at least a 2-year follow-up. The overall failure rate was 1.98%. The most frequent lesions were HCTs (41.98%), with most injuries being in the body/posterior horn (88.52%) of the right knee (56.92%). Treatment predominantly (92.50%) included all-inside sutures. All-inside repair had the highest failure rate (2.98%), followed by inside-out (1.56%) repair (p = 1.0), whereas outside-in and pull-out techniques never failed. Failure rates by lesion included BHMTs (7.27%), HCTs (2.25%), CMTs (1.49%), and LTs (1.25%); RMT, RML, and MRT repair were always successful. Conclusions: Findings at two years suggest that 1–3 all-inside sutures minimize MRL failure, whereas three or more all-inside sutures or combined techniques seem to be effective for HCTs, LTs, and RTs but not BHMTs. Pull-out repair worked best for complete tears/avulsion types of MRTs, whereas all-inside sutures effectively managed partial lesions. Results for CMTs were inconclusive. Full article

Current αIIbβ3 antagonists are potent antithrombotic agents, their clinical use is limited by the risk of life-threatening bleeding. Emerging evidence has highlighted key mechanistic differences between thrombosis and hemostasis, opening avenues for safer antithrombotic strategies. Targeting integrin αIIbβ3 outside-in signaling has been proposed to mitigate bleeding risk; however, the short half-life of peptide-based therapeutics remains a major challenge. In this study, we developed an optimized αIIbβ3 antagonist, KGDRR—a recombinant mutant protein derived from snake venom disintegrin, incorporating an Arg55 residue within the KGD loop—through systematic structure–activity relationship (SAR) analysis. Molecular docking revealed a critical cation–π interaction between Arg55 of KGDRR and Tyr122 of the β3 subunit, stabilizing integrin αIIbβ3 in an unliganded-closed conformation. Functionally, KGDRR selectively inhibited thrombus propagation by blocking ligand binding and downstream Gα13-mediated outside-in signaling while preserving initial thrombus core formation, which is a limitation of current αIIbβ3 inhibitors. Unlike conventional antagonists, KGDRR maintained αIIbβ3 in an unliganded-closed conformation without inducing the integrin activation and conformational change that lead to immune-mediated platelet clearance and thrombocytopenia. In animal models, KGDRR effectively suppressed thrombus growth without causing thrombocytopenia or prolonging bleeding time. Furthermore, intramuscular administration of KGDRR achieved a functional half-life 3.5 times longer than that of the clinically used antithrombotic eptifibatide at equivalent antithrombotic efficacy. In conclusion, KGDRR exhibits potent antithrombotic activity with a favorable safety profile and enhanced pharmacokinetic stability. These findings position KGDRR as a promising next generation αIIbβ3 antagonist with the potential to improve clinical outcomes in antithrombotic therapy. Full article

As the digital economy progresses aggressively in the UAE, the ways in which different players in the economy interact with each other are changing. Therefore, strategic orientations that enable successful interactions have become a necessity. This study aims to investigate the impact of adaptive marketing capability on market ambidexterity in the presence of strategic orientations. It examines the outside-in and inside-out strategies that form the dynamic capabilities of firms. Furthermore, this study identifies how strategic orientations enable higher firm ambidexterity in highly competitive digital business environments as in the case of the UAE. A quantitative deductive approach using a survey is followed in order to test the proposed hypotheses. The data were collected from senior management-level individuals in 75 firms with the careful selection of demographics. Our study demonstrates a strong correlation between adaptive marketing capability and market ambidexterity. Furthermore, strategic orientations, which are characterised by a culture of proactiveness, responsiveness, and innovativeness, are found to positively mediate the relationship between adaptive marketing capability and market ambidexterity. Additionally, there exists a positive and direct relationship between adaptive marketing capability and market ambidexterity. Finally, this study provides important contributions regarding new forms of dynamic capabilities, such as adaptive marketing capability and market ambidexterity, under the specific intervention of strategic orientations, thus enhancing the body of knowledge on ambidexterity and dynamic capability, which is vital in the digital era. It also presents an enhanced empirical model reflecting the relationships between adaptive marketing capabilities, strategic orientations, and market ambidexterity from both the inside-out and outside-in perspectives. Full article

Hemodialysis (HD) is a critical treatment for patients with end-stage kidney disease (ESKD). The effectiveness of conventional dialyzers used there could be compromised during extended use due to limited blood compatibility of synthetic polymeric membranes and sub-optimal dialyzer design. In fact, blood flow in the hollow fiber (HF) membrane could trigger inflammatory responses and thrombus formation, leading to reduced filtration efficiency and limiting therapy duration, a consequence of flowing the patients’ blood through the lumen of each fiber while the dialysate passes along the inter-fiber space (IOF, inside-out filtration). This study investigates the development of HF membranes for “outside-in filtration” (OIF) in HD. In OIF, blood flows through the inter-fiber space while dialysate flows within the fiber lumens, reducing the risk of fiber clogging and potentially extending treatment duration. For the OIF mode, the membrane should have a blood-compatible outer selective layer in contact with the patient’s blood. We develop HFs for OIF via liquid-induced phase separation using PES/PVP (polyethersulphone/polyvinylpyrrolidone) blends. The fibers’ surface morphology (SEM, scanning electron microscopy), chemistry (ATR-FTIR—attenuated total reflection-Fourier transform infrared spectroscopy, XPS—X-ray photoelectron spectroscopy), transport properties, and uremic toxin removal from human plasma are evaluated and compared to commercial HFs. These membranes feature a smooth, hydrophilic outer layer, porous lumen, ultrafiltration coefficient of 13–34 mL m² h⁻¹ mmHg⁻¹, adequate mechanical properties, low albumin leakage, and toxin removal performance on par with commercial membranes in IOF and OIF. They offer potential for more efficient long-term HD by reducing clogging and systemic anticoagulation needs and enhancing treatment time and toxin clearance. Full article

City image is essential for city marketing, yet the impact of “outside–in” shaping by social media in the Web 2.0 era has been largely overlooked. The decentralized and diverse Web 2.0 environment now dominates online information dissemination, influencing not just cyberspace, but also the physical urban landscape. These externally driven city images increasingly reflect and interact with traditional “inside–out” images shaped by official sources. Understanding the influence of external actors via social media compared to traditional internal sources, like government websites, is crucial. This dual analysis offers insights into city image formation, helping cities refine their marketing strategies. This study analyzed a representative social media platform alongside official government websites, using programming and a naive Bayes classifier. We developed a method to categorize the city images of selected U.S. world cities based on these two different media sources. The results are as follows: (1) We establish a city image categorization system that divides the considered U.S. world cities into four and five categories based on social media and official government website content, respectively. (2) We compare the groups and logics shaping global city images in different cyber eras based on the example of the U.S. world cities, and based on this, we explore the relative roles of groups outside the city. (3) We identify the preferences of forming different city images between external groups based on social media and internal forces based on government websites. In summary, this article takes world cities as an example to demonstrate that, in the Web 2.0 era, the image of a city depends on both internal and external groups and has varying degrees of preference. The unique urban image of each city is formed through two media content streams and quantitative preference. Full article

Background and Objectives: Although previous reports have shown that early anterior cruciate ligament (ACL) reconstruction is associated with an increased risk of stiffness, recommendations for delayed surgery are based on outdated literature. The advent of arthroscopic surgery and accelerated rehabilitation protocols warrants a reexamination of the optimal surgical timing. The purpose of this study was to investigate complications during early ACL reconstruction after injury in young athletes. Materials and Methods: A total of 87 patients (27 males and 60 females) were included in this study. Patients who underwent anatomic ACL reconstruction using hamstring autografts were evaluated. Patients under 25 years of age with a Tegner activity score greater than 6 were included and classified into three groups according to the time from injury to surgical treatment: one week from injury to surgery (early group), three to six weeks from injury to surgery (normal group), and three to six months from injury to surgery (delayed group). We evaluated the rates of various complications such as graft rupture, contralateral injury, the need for manipulation for loss of ROM, infection, and fracture around the knee up to 2 years postoperatively. In addition, we investigated postoperative muscle strength, Lysholm score, Tegner activity score, and period of the return to sport from injury. Results: Patients in the delayed group were younger than those in the other groups (p = 0.009). Patients in the early group had a lower range of motion than those in the other groups preoperationly. However, the 1-month postoperative range of motion was comparable between groups. Patients in the early group had greater postoperative Tegner activity scores than those in the other groups. The period of return to sport from injury in the delayed group was longer than in the other groups. There were no statistically significant differences in the postoperative complication rate, muscle strength, or Lysholm score. Conclusions: ACL reconstruction performed 1 week from injury to surgery in young athletic patients indicated the rate of complications were not significantly different among the groups. Early ACL reconstruction with no postoperative complications may be related to early return to sports and a high level of sports. Full article

Endoscopic lumbar discectomy (ELD) is a key advancement in minimally invasive spinal surgery, particularly for lumbar disc herniation. Interlaminar endoscopic lumbar discectomy (IELD) and transforaminal endoscopic lumbar discectomy (TELD) are the two major methods used for FED. TELD, while less familiar to spine surgeons inexperienced in endoscopic surgery, presents challenges in visualizing the dura mater, a crucial aspect for reducing surgical complications. The hand down outside-in (HDOI) technique introduced by Dezawa enhances this visualization by positioning the cannula tip dorsally on the intervertebral disc and maneuvering it between the dura mater and disc to the spinal canal’s midpoint. The cannula is then flipped to directly visualize the dura mater, enabling safe removal of the prolapsed disc material. A comparative study involving 20 patients treated from April 2020 to April 2022 examined the efficacy of the HDOI technique against conventional TELD. Each group, comprising ten patients, underwent ELD for lumbar disc herniation. While both groups showed similar improvements in clinical outcomes, as assessed using the Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) for pain, the HDOI group exhibited a 100% success rate for dura mater visualization, and this rate is significantly higher than the 60% observed in the conventional TELD group. Additionally, the time required for dura mater visualization was notably shorter for the HDOI technique. These results indicate that the HDOI technique not only enhances the safety and efficacy of TELD but may also encourage its wider use in clinical settings. Full article

Adrenaline has recently been found to trigger phosphatidylserine (PS) exposure on blood platelets, resulting in amplification of the coagulation process, but the mechanism is only fragmentarily established. Using a panel of platelet receptors’ antagonists and modulators of signaling pathways, we evaluated the importance of these in adrenaline-evoked PS exposure by flow cytometry. Calcium and sodium ion influx into platelet cytosol, after adrenaline treatment, was examined by fluorimetric measurements. We found a strong reduction in PS exposure after blocking of sodium and calcium ion influx via Na⁺/H⁺ exchanger (NHE) and Na⁺/Ca²⁺ exchanger (NCX), respectively. ADP receptor antagonists produced a moderate inhibitory effect. Substantial limitation of PS exposure was observed in the presence of GPIIb/IIIa antagonist, phosphoinositide-3 kinase (PI3-K) inhibitors, or prostaglandin E₁, a cyclic adenosine monophosphate (cAMP)-elevating agent. We demonstrated that adrenaline may develop a procoagulant response in human platelets with the substantial role of ion exchangers (NHE and NCX), secreted ADP, GPIIb/IIIa-dependent outside-in signaling, and PI3-K. Inhibition of the above mechanisms and increasing cytosolic cAMP seem to be the most efficient procedures to control adrenaline-evoked PS exposure in human platelets. Full article

The direct integration of membrane distillation and solar energy collection in a single module is a promising technology for autonomous seawater desalination in remote regions; however, the modeling and design of such modules are challenging because of the coupling of the radial and longitudinal heat and mass transfers. In a previous study, we provided as a first modeling approach a hollow fiber solar collector vacuum membrane distillation (VMD) module, considering a constant temperature at the shell side and a pure water feed. Here, a full model is developed to describe the coupled effects of the solar collector and a hollow fiber VMD module operating in an outside/in mode with saline water. The model considers all the main phenomena (membrane distillation, temperature and concentration polarization, absorption of solar radiation and energy balances over the solar collector, radial and longitudinal heat and mass transfer, seawater properties, and more than 30 variables). Applied to simulate the behavior of a semi-industrial-scale module, it allows the influence of solar radiation on the performance/limits of the integrated module to be discussed based on the radial and longitudinal profiles and heat flows. The model can be used to identify key points in the module design to better utilize solar radiation and manage heat flows. Full article

The soluble urokinase plasminogen activator receptor (suPAR) has been implicated in a wide range of pathological conditions including primary nephrotic syndromes and acute kidney injuries. suPAR can trigger transduction cascades in podocytes by outside-in activation of αVβ3-integrin, but there is evidence that the functional cell surface response element is actually a complex of different types of receptors, which may also include the receptor for advanced glycation end-products (RAGE) and formyl peptide receptors (FPRs). Here we observed that ROS accumulation and Src activation could be evoked by continuous 24 h exposure to either suPAR or the FPR agonist fMLF. Responses to suPAR and fMLF were completely blocked by either the FPR antagonist WRW4 or by the αV-integrin inhibitor cilengitide. Moreover, endogenous podocyte mouse Fpr1 co-immunoprecipitates with β3-integrin, suggesting that these receptors occur as a complex on the cell surface. suPAR- and fMLF-evoked activation of Src and ROS differed in time course. Thus, robust pertussis toxin (PTX)-sensitive responses were evoked by 60 min exposures to fMLF but not to suPAR. By contrast, responses to 24 h exposures to either suPAR or fMLF were PTX-resistant and were instead abolished by knockdown of β-arrestin-1 (BAR1). FPRs, integrins, and RAGE (along with various Toll-like receptors) can all function as pattern-recognition receptors that respond to “danger signals” associated with infections and tissue injury. The fact that podocytes express such a wide array of pattern-recognition receptors suggests that the glomerular filter is designed to change its function under certain conditions, possibly to facilitate clearance of toxic macromolecules. Full article

The topic of cultural heritage is the subject of many interdisciplinary studies. So far, these studies have focused on the issues of classifying particular types of heritage, their functions and benefits, components and determinants. However, relatively less attention was paid to the dimension of a methodical approach to education and rebuilding cultural identity through heritage. Meanwhile, generational changes, especially in the dimension of knowledge perception, indicate such a need. The aim of this article is to present the perspective of using open innovations in the transfer of cultural heritage used in shaping cultural identity and education. Our review and conceptual article is an attempt to draw attention to the problem of changes in the perception of cultural heritage by generations born in the era of the digital revolution and the need to take these changes into account in heritage education. Taking these conditions into account allowed the authors to develop a model for generating open innovation in the outside-in process and then to develop a model for making it available through the inside-out process. The role of education in this process was also emphasized. Full article

Boarding time constitutes a critical element of turnaround time, which is used to measure the efficiency of airline operations. Therefore, to reduce boarding time, it is imperative to reconsider traditional passenger boarding strategies to make them more efficient. In this sense, this study seeks to analyze the impact of different strategies on boarding times using discrete event simulation on an Airbus 320. Seven boarding strategies have been identified and considered in our study, as follows: random, back-to-front, outside-in, reverse pyramid, blocks, Steffen, and modified optimal. The impact of carrying hand luggage and the presence of priority passengers has been considered, as well as the impact of having a continuous arrival of passengers during the boarding process versus having all passengers available at boarding time. In general, simulation results have pointed out that the outside-in and reverse pyramid strategies are the most effective, improving boarding time by up to 15%, when compared to the random strategy. Moreover, the back-to-front strategy, which is generally implemented by airline companies, has been shown to be the most inefficient strategy. Efficient boarding strategies are expected to contribute to the sustainability of air travel by minimizing the turnaround time, improving operational efficiency, and reducing emissions. Full article

To ensure the safety of passengers concerning virus propagation, such as COVID-19, and keep the turnaround time at low levels, airlines should seek efficient aircraft boarding strategies in terms of both physical distancing and boarding times. This study seeks to analyze the impact of different boarding strategies in the context of the International Air Transport Association’s recommendations during the pandemic to reduce interference and physical contact between passengers in airplanes. Boarding strategies such as back-to-front, outside-in, reverse pyramid, blocks, Steffen, and modified optimal have been tested in this context. This study extends the previous literature using discrete event simulation to evaluate the impact of the occupation of the middle seat by family members only. This study also analyses the impact of having passengers carrying hand luggage and priority passengers on the performance of these strategies concerning boarding times. In general, the simulation results revealed a 15% improvement in boarding times when the reverse pyramid strategy is used compared to a random strategy, which essentially results from a reduction in the boarding interferences between passengers. The results also show that Steffen’s strategy is the best performing, while the blocks strategy results in the worst performance. This study has practical implications for airline companies concerning both operation efficiency and passenger safety. Full article

Platelet activation during hemostasis and thrombosis is facilitated by agonist-induced inside–out and integrin α_IIbβ₃-initiated outside–in signaling via protein kinases and phosphatases. Pharmacological inhibitor studies suggest that the serine/threonine protein phosphatase 1 (PP1) promotes platelet activation. However, since phosphatase inhibitors block all the isoforms of the catalytic subunit of PP1 (PP1c), the role of specific PP1c isoform in platelet signaling remains unclear. Here, we employed a platelet-specific PP1cα^−/− mice to explore the contribution of a major PP1 isoform in platelet functions. Loss of PP1cα moderately decreased activation of integrin α_IIbβ₃, binding of soluble fibrinogen, and aggregation to low-dose thrombin, ADP, and collagen. In contrast, PP1cα^−/− platelets displayed increased adhesion to immobilized fibrinogen, fibrin clot retraction, and thrombus formation on immobilized collagen. Mechanistically, post-fibrinogen engagement potentiated p38 mitogen-activated protein kinase (MAPK) activation in PP1cα^−/− platelets and the p38 inhibitor blocked the increased integrin-mediated outside–in signaling function. Tail bleeding time and light-dye injury-induced microvascular thrombosis in the cremaster venules and arterioles were not altered in PP1cα^−/− mice. Thus, PP1cα displays pleiotropic signaling in platelets as it amplifies agonist-induced signaling and attenuates integrin-mediated signaling with no impact on hemostasis and thrombosis. Full article

Background: Effective 1 January 2017, single-level endoscopic lumbar discectomy received a Category I Current Procedural Terminology (CPT^®) code 62380. However, no work relative value units (wRVUs) are currently assigned to the procedure. A physician’s payment needs to be updated to commensurate with the work involved in the modern version of the lumbar endoscopic decompression procedure with and without the use of any implants to stabilize the spine. In the United States, the American Medical Association (AMA) and its Specialty Society Relative Value Scale Update Committee (RUC) proposes to the Centers for Medicare and Medicaid Services (CMS) what wRVUs to assign for any endoscopic lumbar surgery codes. Methods: The authors conducted an independent survey between May and June 2022 which reached 210 spine surgeons using the TypeForm survey platform. The survey link was sent to them via email and social media. Surgeons were asked to assess the endoscopic procedure’s technical and physical effort, risk, and overall intensity without focusing just on the time required to perform the surgery. Respondents were asked to compare the work involved in modern comprehensive endoscopic spine care with other commonly performed lumbar surgeries. For this purpose, respondents were provided with the verbatim descriptions of 12 other existing comparator CPT^® codes and associated wRVUs of common spine surgeries, as well as a typical patient vignette describing an endoscopic lumbar decompression surgery scenario. Respondents were then asked to select the comparator CPT^® code most reflective of the technical and physical effort, risk, intensity, and time spent on patient care during the pre-operative, peri- and intra-operative, and post-operative periods of a lumbar endoscopic surgery. Results: Of the 30 spine surgeons who completed the survey, 85.8%, 46.6%, and 14.3% valued the appropriate wRVU for the lumbar endoscopic decompression to be over 13, over 15, and over 20, respectively. Most surgeons (78.5%; <50th percentile) did not think they were adequately compensated. Regarding facility reimbursement, 77.3% of surgeons reported that their healthcare facility struggled to cover the cost with the received compensation. The majority (46.5%) said their facility received less than USD 2000, while another 10.7% reported less than USD 1500 and 17.9% reported less than USD 1000. The professional fee received by surgeons was <USD 1000 for 21.4%, <USD 2000 for 17.9%, and <USD 1500 for 10.7%, resulting in a fee less than USD 2000 for 50% of responding surgeons. Most responding surgeons (92.6%) recommended an endoscopic instrumentation carveout to pay for the added cost of the innovation. Discussion and Conclusions: The survey results indicate that most surgeons associate CPT^® 62380 with the complexity and intensity of a laminectomy and interbody fusion preparation, considering the work in the epidural space using the contemporary outside-in and interlaminar technique and the work inside the interspace using the inside-out technique. Modern endoscopic spine surgery goes beyond the scope of a simple soft-tissue discectomy. The current iterations of the procedure must be considered to avoid undervaluing its complexity and intensity. Additional undervalued payment scenarios could be created if technological advances continue to replace traditional lumbar spinal fusion protocols with less burdensome, yet no less complex, endoscopic surgeries that necessitate a high surgeon effort in terms of time required to perform the operation and its intensity. These undervalued payment scenarios of physician practices, as well as the facility and malpractice expenses, should be further discussed to arrive at updated CPT^® codes reflective of modern comprehensive endoscopic spine care. Full article