Evaluation of sulfate rhizofiltration by Carpobrotus chilensis for treating mining waters

Chile, the world's leading copper producer, generates significant volumes of mining waters, some of which cannot be recirculated into the production process. These mining waters are characterized by elevated sulfate (SO 4 2 - ) concentrations, requiring sustainable management strategies for potential reuse. This study aims to evaluate the rhizofiltration technique using Carpobrotus chilensis for treating mining waters with a high SO 4 2 - concentration. Initially, the mining waters exhibited a pH of 7.97 ± 0.16 and a SO 4 2 - concentration of 2,743 ± 137 mg L-1, while the control water had a pH of 7.88 ± 0.08 and a SO 4 2 - concentration of 775 ± 19.0 mg L-1. The plants were hydroponically cultivated in 40 L containers with mining waters and drinking water as a control. Over an 8-week period, the pH of the mining water decreased to 3.12 ± 0.01, and the SO 4 2 - concentration declined to 2,200 ± 110 mg L-1. Notably, the fresh weight of roots was significantly higher in plants grown in mining water (22.2 ± 6.66 g) compared to those in the control treatment (14.3 ± 4.28 g). However, an undesirable increase in the acidity was observed in the mining waters after rhizofiltration, which was attributed to hydrogen sulfate (HSO4-) and/or root exudates. Despite the unexpected increase in acidity, C. chilensis effectively reduced the concentration of SO 4 2 - in mining waters by 20%. Additionally, the C. chilensis roots accumulated 4.84 ± 1.40% of sulfur (S), a level comparable to thiophore plants. This study provides evidence that this non-aquatic plant can be used in sulfate rhizofiltration.

Development of a core descriptor set for Crohn's anal fistula

AIM

Crohn's anal fistula (CAF) is a complex condition, with no agreement on which patient characteristics should be routinely reported in studies. The aim of this study was to develop a core descriptor set of key patient characteristics for reporting in all CAF research.

METHOD

Candidate descriptors were generated from published literature and stakeholder suggestions. Colorectal surgeons, gastroenterologists and specialist nurses in inflammatory bowel disease took part in three rounds of an international modified Delphi process using nine-point Likert scales to rank the importance of descriptors. Feedback was provided between rounds to allow refinement of the next ratings. Patterns in descriptor voting were assessed using principal component analysis (PCA). Resulting PCA groups were used to organize items in rounds two and three. Consensus descriptors were submitted to a patient panel for feedback. Items meeting predetermined thresholds were included in the final set and ratified at the consensus meeting.

RESULTS

One hundred and thirty three respondents from 22 countries completed round one, of whom 67.0% completed round three. Ninety seven descriptors were rated across three rounds in 11 PCA-based groups. Forty descriptors were shortlisted. The consensus meeting ratified a core descriptor set of 37 descriptors within six domains: fistula anatomy, current disease activity and phenotype, risk factors, medical interventions for CAF, surgical interventions for CAF, and patient symptoms and impact on quality of life.

CONCLUSION

The core descriptor set proposed for all future CAF research reflects characteristics important to gastroenterologists and surgeons. This might aid transparent reporting in future studies.

Feedback and Analysis System to Improve Partial Weight Bearing and Bone Healing Following Fractures and Osteotomies of the Lower Limb: Technical Note

PURPOSE OF THE STUDY After the surgical treatment of injuries of the lower extremities or osteotomies, patients are frequently asked to partially load the affected leg during the first weeks of rehabilitation. The patient's compliance to the prescribed weight bearing limit and their ability to regain a physiological gait as soon as possible are necessary for a fast rehabilitation without complications. MATERIAL AND METHODS/RESULTS To support patients during this important phase of recovery, we developed a feedback and analysis system that is able to provide feedback concerning loading and roll over behavior to the patient. The system is based on sensor insoles to measure the amount of pressure and pressure distribution and on a smartphone application to provide realtime visual and acoustic feedback. CONCLUSIONS This newly developed device has the potential to monitor the rehabilitation phase and assist patients with lower leg injuries therefore decrease the complication rate and enable faster rehabilitation. Key words: lower limb fracture osteotomy around the knee, partial weight bearing, realtime feedback, smartphone application.

Sporting activity is reduced following medial reefing performed for patellar dislocation : A retrospective case series of 144 patients with a minimum follow-up of 24 months

Background

Patellar dislocation is common in young and active patients. The purpose of this study was to determine sporting activity following the medial reefing of patellar dislocation.

Methods

One hundred forty-four patients with objective patellar dislocation were treated between 2004 and 2013. Three groups were analyzed retrospectively with a minimum follow-up of 24 months: (1) primary dislocation that was treated with medial reefing without a recurrent dislocation until the day of follow-up (n = 74), (2) primary dislocation that was initially treated with medial reefing but with a recurrent dislocation until the day of follow-up (n = 44), and (3) medial reefing after failed conservative treatment (n = 26). Sporting activity was assessed using a widely-used sporting activity questionnaire and the Tegner score prior to the injury and at the follow-up (58.7 ± 22.6 months after the injury). Clinical outcomes were assessed using IKDC and Kujala score.

Results

The Kujala score was 94.7 ± 9.3 for Group 1, 84.1 ± 16.6 for Group 2 and 93.4 ± 9.7 for Group 3. IKDC at the time of follow-up was 97.2 ± 9.3 for Group 1, 86.1 ± 14.6 for Group 2 and 95.1 ± 11.1 for Group 3. 91.9% of Group 1 and 92.3% of Group 3 were active in sports prior to their injuries and at the time of the follow-up. In Group 2, sporting activity reduced from 81.8 to 75.0%. In all groups, a shift from high performance to recreational sports was found.

Conclusions

Despite good clinical results, sporting activity was reduced following patellar dislocation treated with medial reefing. Also, a shift from engagement in high- to low-impact sports among the participants was noted.

No change in patellar height following open wedge high tibial osteotomy using a novel femur-referenced measurement method

BACKGROUND

Open wedge high tibial osteotomy (HTO) can influence the tibial slope and thereby the landmarks of currently used patellar height indices. The purpose of this retrospective study was to compare and validate a new femur-referenced patella height measurement method to currently used patellar height indices in a cohort of HTO patients.

METHODS

Patellar height (Caton-Deschamps, Blackburne-Peel and Insall-Salvati Indices and our newly developed Femoral Patellar Height Index) as well as tibial slope were analysed. Full-weight-bearing long-leg anteroposterior radiographs as well as anteroposterior and lateral radiographs of the knee in 0° of extension were used. Radiographs were performed preoperatively, and at six weeks, three, six, 12 and 18months postoperatively. Measurements were recorded twice by two observers. The second observation was performed after a delay of three months.

RESULTS

A total of 99 patients with a mean age of 46.2±8years were included. A statistically significant pre- to postoperative increase in tibial slope was found in all methods. Patellar height decreased according to Caton-Deschamps and Blackburne-Peel Indices. The Insall-Salvati Index as well as the novel Femoral Patellar Height Index remained unchanged. Intra-rater (interclass correlation coefficient (ICC) 0.914-0.998) and inter-rater (ICC 0.955-0.989) reliability were highest in the new index.

CONCLUSION

Detected changes of patellar height following open wedge HTO depend on the method used. Tibial slope increases following surgery. Our new index with a femoral reference for measuring patellar height was validated and good to excellent intra- and inter-rater reliability were demonstrated. Following HTO, the Femoral Patellar Height Index can be recommended as a standardized method to measure patellar height.

Early full weight-bearing versus 6-week partial weight-bearing after open wedge high tibial osteotomy leads to earlier improvement of the clinical results: a prospective, randomised evaluation

PURPOSE

Open wedge high tibial osteotomy is a widespread treatment option in patients with varus malalignment and medial compartment osteoarthritis. There is no standardised protocol for post-operative rehabilitation available. The purpose of this study was to compare two post-operative rehabilitation protocols and to evaluate the clinical outcome of early full weight-bearing after open wedge HTO.

METHODS

One hundred and twenty consecutive patients with varus malalignment and medial compartment osteoarthritis received an open wedge HTO using an angular locking plate fixation between December 2008 and December 2011. All patients were assigned randomly into one of two groups with different post-operative rehabilitation protocols (11-day vs. 6-week 20-kg partial weight-bearing). Clinical outcome was evaluated using established instruments (Lequesne, Lysholm, HSS and IKDC scores) preoperatively, 6, 12 and 18 months post-operatively. Deformity analysis was performed preoperatively and during follow-up.

RESULTS

All clinical scores showed a significant pre- to post-operative improvement. After 6 months, there was a higher improvement in the group of early full weight-bearing. The difference between preoperative and 6-month follow-up for the group with early full weight-bearing and for the group with 20-kg PWB for 6 weeks was 28 ± 26 and 18 ± 22, respectively, for the Lysholm score and -5.0 ± 5.1 and -3.0 ± 3.6, respectively, for the Lequesne score.

CONCLUSIONS

Early full weight-bearing (11-day 20-kg partial weight-bearing) after open wedge HTO without bone graft leads to earlier improvement of the clinical results and can be recommended for post-operative rehabilitation after open wedge HTO and fixation with an angular locking plate.

LEVEL OF EVIDENCE

Therapeutic study, Level I.

[Retrospective Analysis of Diabetics with Regard to Treatment Duration and Costs]

Background: The increasing incidence of diabetes mellitus is also reflected in the patient population of a trauma and orthopaedic centre. Diabetics also exhibit more comorbidities than non-diabetics. In addition to surgical problems in these patients, hospitalisation is often accompanied by complications, which can prolong treatment and increase costs. The aim of this retrospective study is to analyse hospitalisation of diabetics compared to non-diabetics, as well as differences in treatment costs, depending on associated age and comorbidities. Patients/Material and Methods: 17,185 patients were treated at a transregional trauma and orthopaedic centre and were included in this retrospective analysis between 2012 and 2015. Comorbidities and hospitalisation of diabetics and non-diabetics were recorded. All costs charged by DRG were evaluated to calculate the cost per day and per patient, on the basis of the specific case rate. In this calculation, patient-related case rates were divided by the average residence time and the means of the calculated daily rates were calculated. Inclusion criteria were treatment within the various departments and a minimum hospitalisation of one day. Statistical analysis was performed with the SPSS program (version 22.0, SPSS Inc., Chicago, USA). Results: In comparison to non-diabetics (ND), diabetics (D) exhibited significantly more comorbidities, including: obesity, arterial hypertension, coronary heart disease, myocardial infarction (in the history), peripheral arterial disease, chronic kidney disease and hyperlipidaemia. Pneumonia in hospital was considerably commoner in diabetics (2.45 % [D] vs. 1.02 % [ND], p < 0.001). Time in hospital was significantly longer in diabetics (endoprosthetics 13.52 days [D] vs. 12.54 days [ND], p < 0.001; septic surgery 18.62 days [D] vs. 16.31 days [ND], p = 0.007; traumatology 9.82 days [D] vs. 7.07 days [ND], p < 0.001). For patients aged under 60 years, time in hospital was significantly longer for diabetics than for non-diabetics (9.98 days [D] vs. 6.43 days [ND] p < 0.001). Because of the longer time in hospital, treatment costs were higher by € 1,932,929.42 during the investigated time period. Conclusion: Because of their comorbidities, diabetics need to be categorised at an early stage as high-risk patients in traumatological and orthopaedic departments. Hospitalisation and the associated increased treatment costs, as well as postoperative complications, could be minimised in patients with diabetes by implementing an interdisciplinary treatment concept.

[Malnutrition in Elderly Trauma Patients - Comparison of Two Assessment Tools]

Background: The prevalence of malnutrition in hospitalised patients is reported to be between 16 and 55 % across disciplines. Within hospital care, screening for malnutrition is required. However, in orthopaedics and trauma surgery, there is still no generally accepted recommendation for the methods for such a data survey. In the present study, the following aspects are to be investigated with the help of two established scores: (1) the prevalence of malnutrition in the patient population of geriatric trauma care, and (2) the correlation between methods of data survey. Material and Methods: Between June 2014 and June 2015, a consecutive series of hospitalised trauma patients were studied prospectively with two validated screening instruments to record nutritional status. The study was carried out at a municipal trauma surgery hospital, which is a first level interregional trauma centre as well as a university hospital. The Nutritional Risk Screening (NRS) and the Mini Nutritional Assessment (MNA Short and Long Form) were used. All patients were divided into three age groups: < 65 years, 65-80 years, and > 80 years. The prevalence of malnutrition in geriatric trauma patients and the correlation between the screening instruments were determined. For a better comparison, prescreening and main assessment were applied to all patients. For statistical evaluation, both quantitative and semi-quantitative parameters were used. Furthermore, the Kolmogorov-Smirnov test, Spearman's correlation analysis and the chi-square test were applied. These tests were two-sided and had a level of significance of 5 %. The present study was partially funded by the Oskar-Helene-Heim Foundation. Results: 521 patients (43.8 % women, 56.2 % men), with a mean age of 53.96 ± 18.13 years, were statistically evaluated within the present study. Depending on the method of the data survey, malnutrition (NRS≥3) in geriatric trauma patients varied from 31.3 % (65-80 years) to 60 % (> 80 years). With MNA, 28.8 and 54.3 % of patients were at risk of malnutrition (MNA 17-23.5), while the fractions of patients already suffering from malnutrition (MNA < 17) were 5.4 and 8.6 %, respectively. The correlation between the NRS and MNA total scores increases with the age of the patients. The correlation coefficient for patients under 65 years is r = - 0.380, while among patients aged between 65 and 80, it is r = - 0.481, and for patients over 80 years, there is a medium to strong correlation of r = - 0.638 (each with a Spearman correlation of p < 0.001). For the total population as well as the different age groups, statistically significant correlations were recorded between the categorised scores (chi-square test for linear trend, p < 0.001). Summary: The present study demonstrates high prevalence of malnutrition among the geriatric trauma patients. Because of its easy and rapid application, the NRS has an advantage in clinical use. It was shown that the two methods of data survey were highly correlated.

[Lateral hinge fractures in open wedge high tibial osteotomy]

BACKGROUND

Open wedge high tibial osteotomy (HTO) is an increasingly more common surgical method. A typical problem of this procedure is fracture of the lateral hinge.

OBJECTIVES

The aims of this article are to present the special issue of fractures of the lateral hinge after HTO and to discuss surgical hints on how to prevent and treat this problem.

METHODS

The results of recently published clinical studies are summarized and tips from own clinical experiences are given.

RESULTS

Type II fractures of the lateral hinge are unstable and can create a major problem. Using short spacer plates results in a problem of stability for all types of fractures.

CONCLUSION

The classification into Takeuchi grades I-III has been proven to be suitable for fractures of the lateral hinge. The TomoFix plate is a safe implant to stabilize the osteotomy in type I and III fractures with which healing can be achieved with no problems. Type II fractures can be stabilized with the TomoFix plate; however, an autologous bone graft has to be taken into consideration. For fractures of the lateral hinge short spacer plates are not recommended due to stability issues.

Detecting localized proton currents in photophosphorylation by procaine inhibition of the transthylakoid pH-gradient

The relationship between the transthylakoid pH-gradient, delta pH, and the velocity of photophosphorylation, Vp, in thylakoid membranes from spinach was investigated using the local anesthetic amine procaine as inhibitor of delta pH. When delta pH was driven by Photosystem (PS) II+I-dependent electron flow, passing through the cytochrome b6/f complex, inhibition by procaine was accompanied by an increase of ATP formation. It appeared that procaine allowed for values of Vp similar to those in controls (without procaine) at a significantly lower delta pH than in the controls. In contrast, when delta pH was driven by cyclic electron flow around PS I or by PS-II+I-dependent electron flow via a bypass around the cytochrome b6/f complex, or by PS II alone, procaine simultaneously caused an inhibition of delta pH and a decrease of ATP formation. Inhibition of delta pH by procaine did not induce an electrical membrane potential gradient that otherwise may have energetically compensated for the observed decline of delta pH. The electron flow capacity was unaffected by procaine. However, inhibition of delta pH did not significantly relax pH-dependent control of electron flux. Procaine accelerated ATP hydrolysis by pre-activated thylakoid ATPase to rates which were observed in the presence of uncouplers and had no direct effect on the activation state of the ATPase. The shift in the relationship between delta pH and Vp towards lower delta pH persisted in thermodynamic equilibrium between the phosphorylation potential and delta pH. The data indicated that the unconventional effect of procaine on photophosphorylation may be related to effects on proton translocation at the cytochrome b6/f complex and that a localized protonic coupling may occur between cytochrome b6/f and thylakoid-ATP-synthase complexes.

[Propafenon and propranolol in the management of cardiac extrasystoles (author's transl)]

The anti-arrhythmic effectiveness of propafenon (3 x 150 mg daily) combined with propranolol (3 x 20 mg daily) was compared with that of each drug alone in 15 patients with stable ventricular and (or) supraventricular extrasystoles. The frequency of extrasystoles decreased on propafenon alone by 70% (P less than 0.05), without further decrease on additional propranolol administration. Propranolol alone on average caused no significant decrease infrequency (35%). The most important ECG changes with the combined treatment consisted of a definite increase in P-Q interval by an average of 25% (P less than 0.01) while with propafenon alone it was 13%, with propranolol alone 19% . Propafenon plus propranolol decreased heart rate by a mean of 17% (P less than 0.01). The additive effect of both substances can lead to an inhibition of atrioventricular conduction and of sinus node function.