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Introduction: Chronic cervical radiculopathy is a common condition characterised by neck and arm pain, numbness and weakness. Both neck muscle activation and strengthening exercises are widely recognised treatments for cervical radiculopathy, but there is a research gap on the efficacy of neck muscle activation versus strengthening. This protocol will determine the efficacy of neck muscle activation alongside conventional care versus strengthening exercise and conventional care for cervical radiculopathy. Methods and analysis: We planned a 5-week parallel, two-arm randomised clinical trial on 80 participants with chronic cervical radiculopathy (lasting over 3 months) between July and December 2023. Participants will be recruited from Dhaka's Agrani Specialised Physiotherapy Centre in Bangladesh and randomly assigned to two groups in a 1:1 ratio. Both groups will receive 14 sessions, each lasting 30-45 min. Post-treatment evaluations will be employed on Brief Pain Inventory (BPI), range of motion, craniovertebral angle (CVA), strength, endurance and Neck Disability Index (NDI) after 5 weeks and follow-up after 12 weeks of post-test analysis. Primary outcomes (strength, endurance and CVA) will be measured using a handheld dynamometer, digital inclinometer and goniometer. Secondary outcomes (pain, range of motion and disability) will be assessed through the BPI scale, digital inclinometer and NDI. Ethics and dissemination: The Institute of Physiotherapy Rehabilitation and Research of Bangladesh Physiotherapy Association has approved the study. All participants will provide informed consent, and data will be anonymised and accessible only to authorised personnel. The study's findings will be disseminated in peer-reviewed journals and conferences. Clinical trial registry India: CTRI/2023/09/057587 (13/09/2023).

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BACKGROUND: COVID-19 infection caused by the SARS-Cov-2 virus may result in severe acute respiratory failure and require respiratory support in the ICU. OBJECTIVE: The present study was designed to evaluate the role of the respiratory rate oxygenation (ROX) index in the assessment of the adequacy of non-invasive respiratory support the COVID-19 patients with acute respiratory failure and observe its outcome. MATERIALS AND METHODS: This cross-sectional, observational study was conducted between October 2020 and September 2021 in the Department of Anaesthesia, Analgesia, and Intensive Care Medicine of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. A total of 44 patients with a confirmed diagnosis of COVID-19 with acute respiratory failure were enrolled in this study based on inclusion and exclusion criteria. Informed written consent was taken from the patient/patient's guardian. Each patient underwent detailed history taking through physical examination and relevant investigations. All necessary information were recorded in a separate case record form. All the patients receiving high-flow nasal cannula (HFNC) were assessed at two hours, six hours, and 12 hours for variables of the ROX Index. The team of respective physicians was applied responsibly for determining HFNC failure to discontinue or deescalate respiratory support as a part of continuous positive airway pressure (CPAP) ventilation success. Each selected patient was observed for the duration of different types of respiratory support. CPAP failure or success, progression to mechanical ventilation, and data were collected from individual medical records. The patients who were successfully weaned from CPAP were recorded. The diagnostic accuracy of the ROX index was determined. RESULTS: The mean age of the patients was 65±8.80 years with a majority in the age group 61-70 years (36.4%). A male predominance was observed with 79.5% male and 20.5% female. Of all, HFNC failure was observed in 29.5% of patients. Oxygen saturation (SpO2), respiratory rate (RR), and ROX index were statistically worse at the sixth and 12th hour of initiation of HFNC (P<0.05). At a cut-off value of 3.90, the ROC curve showed 90.3% sensitivity and 76.9% specificity in predicting HFNC success (the area under the curve (AUC) was 0.909). Similarly, 46.2% of patients had CPAP failure. SpO2, RR, and ROX index were found statistically worse among those patients at the sixth and 12th hour of CPAP therapy (P<0.05). The ROC curve showed 85.7% sensitivity and 83.3% specificity at a cut-off value of 2.64 in predicting CPAP success (the AUC was 0.881). CONCLUSION: The ROX index's clinical score form, which does not require lab findings or sophisticated computation techniques, is its key benefit. The study findings recommend the use of the ROX index to predict the outcome of respiratory support in acute respiratory failure in COVID-19 patients.

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Large scale cortical allografts suffer from poor incorporation and healing and often end in graft failure 5-10 years after implantation. To reduce these failures we have developed a growth-factor loaded cortical allograft capable of delivering one or two factors with a degree of temporal control and precision that permits the early release of one growth factor followed by the later and more sustained release of the other. We have loaded vascular endothelial growth factor (VEGF) and bone morphogenetic protein-2 (BMP-2), both critical components of bone formation and repair, onto cortical long bone allografts such that the VEGF is released first and followed shortly by BMP-2. Coated and factor-loaded allografts were placed into a critical sized rat femoral segmental defect and allowed to heal for either 4 or 8 weeks. Healing at each time point was compared to allografts loaded with only BMP-2 and allografts containing no growth factors. Results indicate statistically significant increases in new bone formation from 4 to 8 weeks around allografts loaded with both VEGF and BMP-2 over allografts with no growth factor, suggesting that factor-loaded polymer-coated allografts delivering multiple factors with temporal precision may provide a new off-the-shelf tool to the orthopedic surgeon for management of large-scale orthopedic bone defects. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1002-1010, 2019.

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Autografts have been shown to stimulate osteogenesis, osteoclastogenesis, and angiogenesis, and subsequent rapid graft incorporation. Large structural allografts, however, suffer from limited new bone formation and remodeling, both of which are directly associated with clinical failure due to non-unions, late graft fractures, and infections, making it a priority to improve large structural allograft healing. We have previously shown the osteogenic ability of a polymer-coated allograft that delivers bone morphogenetic protein-2 both in vitro and in vivo through both burst release and sustained release kinetics. In this study, we have demonstrated largely sequential delivery of bone morphogenetic protein-2 and vascular endothelial growth factor from the same coated allograft. Release data showed that loading both growth factors onto a polymeric coating with two different techniques resulted in short-term (95% release within 2 weeks) and long-term (95% release within 5 weeks) delivery kinetics. We have also demonstrated how released VEGF, traditionally associated with angiogenesis, can also provide a stimulus for allograft remodeling via resorption. Bone marrow derived mononuclear cells were co-cultured with VEGF released from the coated allograft and showed a statistically significant (p < 0.05) and dose dependent increase in the number of tartrate-resistant acid phosphatase-positive multinucleated osteoclasts. Functionality of these osteoclasts was assessed quantitatively and qualitatively by evaluating resorption pit area from both osteo-assay plates and harvested bone. Data indicated a statistically significant higher resorption area from the cells exposed to VEGF released from the allografts over controls (p < 0.05). These results indicate that by using different loading protocols temporal control can be achieved when delivering multiple growth factors from a polymer-coated allograft. Further, released VEGF can also stimulate osteoclastogenesis that may enhance allograft incorporation, and thus mitigate long-term clinical complications. © 2017 Orthopedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1086-1095, 2017.

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INTRODUCTION: The purpose of this study was to examine the safety and feasibility of laparoscopically assisted vaginal hysterectomy for uteri weighing more than 500 g as compared to uteri weighing less than 500 g in benign gynecological diseases. METHODS: This was a retrospective study. Patients were admitted through the outpatient department. They were divided into two groups: uterine weight ≥500 g (group 1) and uterine weight >500 g (group 2). There were no exclusion criteria based on the size, number, or location of leiomyomas. The patient characteristics for the two groups were compared in terms of demographic and socioeconomic details, operating time, amount of blood loss, requirement of blood transfusion, need for analgesia, and length of hospital stay. RESULTS: The characteristics age and BMI were well balanced between the two groups. Uterine weight was 267.2 ± 97.6 g in group 1 and 740.0 ± 371.4 g in group 2 (P < 0.001). Length of operation and amount of blood loss were greater in group 2 than in group 1 (operation: 89.1 ± 26.7 vs 73.3 ± 24.6 min, P < 0.01; blood loss: 570.5 ± 503.6 vs 262.5 ± 270.0 mL, P < 0.001). However, there was no significant difference in hospital stay or incidence of operative complications between the two groups. No patients were switched from laparoscopy to laparotomy during operation. The rate of blood transfusion was lower in group1 than in group 2 (4.9% vs 32.6%; P < 0.001). CONCLUSION: This study demonstrated that despite the increased operating time and blood loss, laparoscopy should be considered instead of laparotomy in cases of large uteri. Laparoscopically assisted vaginal hysterectomy can be performed safely for a large uterus.

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According to 5- and 10-year clinical follow-up studies large-scale bone allografts have a high failure rate, largely due to poor allograft incorporation with adjacent bone and subsequent poor remodeling. The goal of this study was to develop a methodology to deliver growth factors from large-scale bone allografts in a temporally controlled manner. Intact long bone allografts were coated with a micron-scale thick layer of degradable polymer that maintained inherent pore structures and acted as a delivery vehicle for bone morphogenetic protein-2 and vascular endothelial growth factor. VEGF was loaded onto the surface of the polymer to produce rapid release, to encourage initial vascularization at the defect site, while BMP-2 was encapsulated within the polymer layer to promote a more sustained release, to encourage bone formation over time. Release kinetics from factor-loaded polymer-coated allografts show an early burst release of VEGF over the first 7 days followed by a more sustained release of BMP-2 over the second and third week. In vitro cell studies using human mesenchymal stem cells confirm the bioactivity of the released BMP-2. In-vivo results show robust bone formation over the first 8 weeks of healing in femoral segmental defects in rats implanted with BMP-2 loaded polymer-coated allografts. A microscale thin coating of degradable polymer on a large-scale bone allograft provides temporal control over the delivery of growth factor loaded onto one allograft, while maintaining its microscale pore structure. Enhancing the incorporation and subsequent remodeling of allografts would reduce the incidence of allograft failure over time, and potentially speed healing at the earliest stages after implantation.

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