A focus on melorheostosis disease: a literature review and case report of femoral-acetabular impingement due to melorheostosis treated with surgical hip osteoplasty

OBJECTIVE

Melorheostosis is a rare, non-hereditary, benign bone disease characterized by abnormal bone growth. Generally, melorheostosis develops during childhood or adolescence and progresses gradually over time. This disease represents a true challenge to the physician because of its variability due to location, extension of the affected bone, and involvement of associated soft tissue. Pain management, physical therapy, and surgery may be recommended, depending on the individual case. This review aims to get an overview of the latest evidence relating to epidemiology, clinical and radiographic characteristics, diagnosis, and possible therapeutic strategies for melorheostosis and describe our experience through a clinical case.

METHODS

We designed a comprehensive literature search on melorheostosis in MEDLINE (via Pubmed) up to April 2023 and reviewed reports published in international journals.

RESULTS

The purpose is to highlight the importance of a multidisciplinary approach in the management of a rare disease such as melorheostosis. We discuss the role of different physicians, including genetists, rheumatologists, physiatrists, physical therapists, and orthopedic surgeons, in providing accurate diagnoses and effective treatments. We conducted a comprehensive review of the literature on the treatment of melorheostosis to support these findings. In addition, the article presents a case study of a patient suffering from melorheostosis, focusing on difficulties in reaching a correct diagnosis and attempts towards conservative and surgical interventions. The patient underwent hip arthroplasty, and the final result was an improvement in function and a reduction in pain.

CONCLUSIONS

Managing melorheostosis can be challenging, and there is no standardized treatment for this condition at the moment.

Electrodialysis with Bipolar Membranes for the Sustainable Production of Chemicals from Seawater Brines at Pilot Plant Scale

Environmental concerns regarding the disposal of seawater reverse osmosis brines require the development of new valorization strategies. Electrodialysis with bipolar membrane (EDBM) technology enables the production of acid and base from a salty waste stream. In this study, an EDBM pilot plant with a membrane area of 19.2 m² was tested. This total membrane area results much larger (i.e., more than 16 times larger) than those reported in the literature so far for the production of HCl and NaOH aqueous solutions, starting from NaCl brines. The pilot unit was tested both in continuous and discontinuous operation modes, at different current densities (200-500 A m^-2). Particularly, three different process configurations were evaluated, namely, closed-loop, feed and bleed, and fed-batch. At lower applied current density (200 A m^-2), the closed-loop had a lower specific energy consumption (SEC) (1.4 kWh kg^-1) and a higher current efficiency (CE) (80%). When the current density was increased (300-500 A m^-2), the feed and bleed mode was more appropriate due to its low values of SEC (1.9-2.6 kWh kg^-1) as well as high values of specific production (SP) (0.82-1.3 ton year^-1 m^-2) and current efficiency (63-67%). These results showed the effect of various process configurations on the performance of the EDBM, thereby guiding the selection of the most suitable process configuration when varying the operating conditions and representing a first important step toward the implementation of this technology at industrial scale.

Electrodialysis with Bipolar Membranes for the Generation of NaOH and HCl Solutions from Brines: An Inter-Laboratory Evaluation of Thin and Ultrathin Non-Woven Cloth-Based Ion-Exchange Membranes

The SEArcularMINE project aims to recover critical raw materials (CRMs) from brines from saltworks, thus facing a CRM shortage within Europe. To promote a fully circular scheme, the project valorises concentrated brines using electrodialysis with bipolar membranes (EDBM) to generate the required amounts of reactants (i.e., acids and bases). Regarding the performances of new non-woven cloth ion-exchange membranes (Suez): (i) an ultra-thin non-woven polyester cloth and (ii) a thin polypropylene cloth acting as the support structures were assessed. Additionally, the anion layer includes a catalyst to promote the water dissociation reaction. The effect of current density (100, 200, and 300 A m^-2) on the performance of two combinations of membranes in an inter-laboratory exercise using 2 M NaCl was evaluated. According to statistical analysis ANOVA, there was an agreement on the results obtained in both laboratories. NaOH/HCl solutions up to 0.8 M were generated working at 300 A m^-2 using both combinations of membranes. Regarding the performance parameters, stack set-ups incorporating thin polypropylene membranes showed lower specific energy consumption (SEC) and higher specific productivity (SP) than ultra-thin polypropylene ones. Hence, for ultra-thin polypropylene membranes, SEC was reported to be between 2.18 and 1.69 kWh kg^-1_NaOH and SP between 974 and 314 kg m^-2 y^-1.

Bipolar membrane reverse electrodialysis for the sustainable recovery of energy from pH gradients of industrial wastewater: Performance prediction by a validated process model

The theoretical energy density extractable from acidic and alkaline solutions is higher than 20 kWh m^-3 of single solution when mixing 1 M concentrated streams. Therefore, acidic and alkaline industrial wastewater have a huge potential for the recovery of energy. To this purpose, bipolar membrane reverse electrodialysis (BMRED) is an interesting, yet poorly studied technology for the conversion of the mixing entropy of solutions at different pH into electricity. Although it shows promising performance, only few works have been presented in the literature so far, and no comprehensive models have been developed yet. This work presents a mathematical multi-scale model based on a semi-empirical approach. The model was validated against experimental data and was applied over a variety of operating conditions, showing that it may represent an effective tool for the prediction of the BMRED performance. A sensitivity analysis was performed in two different scenarios, i.e. (i) a reference case and (ii) an improved case with high-performance membrane properties. A Net Power Density of ~15 W m^-2 was predicted in the reference scenario with 1 M HCl and NaOH solutions, but it increased significantly by simulating high-performance membranes. A simulated scheme for an industrial application yielded an energy density of ~50 kWh m^-3 (of acid solution) with an energy efficiency of ~80-90% in the improved scenario.

Is kinesiophobia a predictor of early functional performance after total hip replacement? A prospective prognostic cohort study

Background

Considerable attention has been paid to the role of kinesiophobia with respect to knee prosthesis but it has not yet been studied as a prognostic factor of short-term functional performance following total hip replacement. The main purpose of the present study is to examine the possible predictors of early functional performance of patients undergoing total primary hip arthroplasty, including demographics as age, sex and body mass index, preoperative functional ability, type of anaesthesia, level of haemoglobin, pain and level of kinesiophobia before surgery. Secondly, we want to describe the main characteristics of the population with the highest levels of kinesiophobia.

Methods

A prospective, prognostic cohort study was carried out. Patients undergoing primary hip replacement were recruited consecutively. The main outcome is the early functional performance achieved by patients after surgery and measured using the Iowa Level of Assistance (ILOA) scale on the fifth postoperative day. Preoperative kinesiophobia was measured by the Tampa Scale and the preoperative functional ability by the Western Ontario and McMaster Osteoarthritis Index (WOMAC). The multivariate analysis was performed by the General Linear Model. The analysis of the population with high levels of kinesiophobia was conducted by identifying a cut-off of 40 compared to the Tampa Scale.

Results

Statistical analysis was performed on 269 patients. The average ILOA score recorded was 19.5 (DS 8.3). The levels of kinesiophobia, showed an average score of 35.1 (7.8) and it was not associated with early functional performance. The independent predictive factors include age, sex and body mass index. Kinesiophobia high levels were recorded in 30% of the population and this population had a higher level of pre-operative WOMAC score.

Conclusions

Early functional performance after hip replacement surgery was not correlated with the level of kinesiophobia. Three significant factors that describe a population most at risk of not achieving optimal functional performance are increased age, being female and increase in body mass index. In the preoperative phase, high levels of kinesiophobia were associated with more impaired preoperative functional ability.

Trial registration

Current Controlled Trials NCT02786121, May 2016. Retrospectively registered.