149 Reducing Complications and Improving Outcomes Following Total Hip Arthroplasty

Aim

Neck of femur (NOF) fractures are increasing, and the need to improve mobility and reduce complications whilst improving discharge time is an ongoing challenge. Hip fracture fixation and arthroplasty are essential in improving pain and mobility. NOF patients often undergo a fascia iliaca block (FIB) to improve outcomes. Guay J’s Cochrane systematic review confirms that FIBs reduce pain pre and postoperatively, decrease hospital-acquired pneumonia risk and improve mobility. Patients on anticoagulants are typically refused bedside blocks, however we are unsure if they truly impact adverse outcomes in FIBs for NOF patients.

Method

A retrospective observational study was undertaken to assess complication rates in 53 NOF patients who had a FIB at St Mary’s Hospital between 07/01/2020 and 26/06/2020. Patients whose NOF was the result of an inpatient fall were excluded. Pre-existing anticoagulant and antiplatelet use were noted, as were the A&E admission blood coagulation results. Local complications which may have arisen post-FIB were closely screened for in documentation until the patient’s discharge date.

Results

There were no local complications in all 53 patients. Interestingly, one patient had a documented thigh haematoma pre-nerve block, but did not have any evolution of the haematoma and achieved good pain relief from the block.

Conclusions

FIBs appear to be a safe and effective analgesic tool in the perioperative NOF patient and use has been reported to reduce early complications in those who undergo hip fracture treatment. We aim to implement these findings and increase the rate of nerve block procedures in NOF fractures.

Efficient second-harmonic and terahertz generation from single BiB3O6crystal using nanosecond and femtosecond lasers

The paper reports the efficient UV and terahertz generation from a 1.29 mm thick and Type I, θ=28.9^∘ cut BiB₃O₆ (bismuth triborate, BIBO) crystal using femtosecond and nanoseconds laser pulses. We have employed 800 nm wavelength pulses of 50 and 140 fs obtained from a Ti:sapphire laser amplifier and oscillators at 1 kHz and 80 MHz repetition rates, respectively. The conversion efficiency of second-harmonic generation (SHG) was ∼50% while that obtained for terahertz (THz) generations was of the order of 1.85×10^-5%. In addition, LDS-698 dye laser radiation tunable between 650-700 nm was also used as a source for SHG between the 325-350 nm range. The dye laser was pumped by SHG (532 nm) radiation from an electro-optically Q-switched Nd:YAG laser having a pulse repetition rate of 10 Hz and a pulse width of 10 ns. A conversion efficiency of 4.01% was obtained for generation of UV at 343.5 nm. Finally, we have measured the transmission, refractive index, absorbance, and conductivity properties of BIBO crystal in the THz domain. We also ascertained the coherence length, relative permittivity and reflectivity of the crystal.

A comparative study of thermal stability of TNT, RDX, CL20 and ANTA explosives using UV 266 nm-time resolved photoacoustic pyrolysis technique

The paper reports the potential use of UV based pulsed photoacoustic spectroscopy to study the thermal stability of some well-known premier explosives such as TNT, RDX, CL20, and ANTA between 30 and 350 °C range. The thermal PA spectra of samples were recorded using fourth harmonic wavelength i.e. 266 nm of pulse duration 7 ns and repetition rate 10 Hz obtained from Q-switched Nd: YAG laser system. Under the influence of UV radiation, the explosive molecules in vapor phase follow the photodissociation process and converted into their byproducts such as NO, NO₂ and N₂O etc. due to π* ← n transitions, which are responsible for the generation resultant PA signal at 266 nm wavelength. The results obtained from PA spectra as a function of temperature are cross verified with Thermo gravimetric-differential thermal analysis (TG-DTA) to ascertain the thermal stability of these samples. The comparative PA spectra of samples were analyzed and shown the behavior of acoustic modes with respect to incident laser energy, and data acquisition time. Finally, the thermal quality factor "Q" is measured to test the stability of reported explosives.

Impact of Superoxide Dismutase Mimetic AEOL 10150 on the Endothelin System of Fischer 344 Rats

Endothelin-1 is a potent vasoconstrictor and mitogenic peptide involved in the regulation of vasomotor tone and maintenance of blood pressure. Oxidative stress activates the endothelin system, and is implicated in pulmonary and cardiovascular diseases including hypertension, congestive heart failure, and atherosclerosis. Superoxide dismutase mimetics designed with the aim of treating diseases that involve reactive oxygen species in their pathophysiology may exert a hypotensive effect, but effects on the endothelin system are unknown. Our objective was to determine the effect of the superoxide dismutase mimetic AEOL 10150 on the basal endothelin system in vivo. Male Fischer-344 rats were injected subcutaneously with 0, 2 or 5 mg/kg body weight of AEOL 10150 in saline. Plasma oxidative stress markers and endothelins (bigET-1, ET-1, ET-2, ET-3) as well as lung and heart endothelin/nitric oxide system gene expressions were measured using HPLC-Coularray, HPLC-Fluorescence and RT-PCR respectively. AEOL 10150 reduced (p<0.05) the circulating levels of isoprostane (-25%) and 3-nitrotyrosine (-50%) measured in plasma 2h and 24h after treatment, confirming delivery of a physiologically-relevant dose and the potent antioxidant activity of the drug. The reduction in markers of oxidative stress coincided with sustained 24h decrease (p<0.05) of plasma levels of ET-1 (-50%) and ET-3 (-10%). Expression of preproET-1 and endothelin converting enzyme-1 mRNA were not altered significantly in the lungs. However preproET-1 (not significant) and ECE-1 mRNA (p<0.05) were increased (10-25%) in the heart. Changes in the lungs included decrease (p<0.05) of mRNA for the ET-1 clearance receptor ETB and the vasoconstriction-signaling ETA receptor (-30%), and an early surge of inducible nitric oxide synthase expression followed by sustained decrease (-40% after 24 hours). The results indicate that interception of the endogenous physiological flux of reactive nitrogen species and reactive oxygen species in rats impacts the endothelin/nitric oxide system, supporting a homeostatic relationship between those systems.

Experimental investigation of homogeneous charge compression ignition combustion of biodiesel fuel with external mixture formation in a CI engine

In parallel to the interest in renewable fuels, there has also been increased interest in homogeneous charge compression ignition (HCCI) combustion. HCCI engines are being actively developed because they have the potential to be highly efficient and to produce low emissions. Even though HCCI has been researched extensively, few challenges still exist. These include controlling the combustion at higher loads and the formation of a homogeneous mixture. To obtain better homogeneity, in the present investigation external mixture formation method was adopted, in which the fuel vaporiser was used to achieve excellent HCCI combustion in a single cylinder air-cooled direct injection diesel engine. In continuation of our previous works, in the current study a vaporised jatropha methyl ester (JME) was mixed with air to form a homogeneous mixture and inducted into the cylinder during the intake stroke to analyze the combustion, emission and performance characteristics. To control the early ignition of JME vapor-air mixture, cooled (30 °C) Exhaust gas recirculation (EGR) technique was adopted. The experimental result shows 81% reduction in NOx and 72% reduction in smoke emission.

Influence of certain forces on evolution of synonymous codon usage bias in certain species of three basal orders of aquatic insects

Forces that influence the evolution of synonymous codon usage bias are analyzed in six species of three basal orders of aquatic insects. The rationale behind choosing six species of aquatic insects (three from Ephemeroptera, one from Plecoptera, and two from Odonata) for the present analysis is based on phylogenetic position at the basal clades of the Order Insecta facilitating the understanding of the evolution of codon bias and of factors shaping codon usage patterns in primitive clades of insect lineages and their subtle differences in some of their ecological and environmental requirements in terms of habitat-microhabitat requirements, altitudinal preferences, temperature tolerance ranges, and consequent responses to climate change impacts. The present analysis focuses on open reading frames of the 13 protein-coding genes in the mitochondrial genome of six carefully chosen insect species to get a comprehensive picture of the evolutionary intricacies of codon bias. In all the six species, A and T contents are observed to be significantly higher than G and C, and are used roughly equally. Since transcription hypothesis on codon usage demands A richness and T poorness, it is quite likely that mutation pressure may be the key factor associated with synonymous codon usage (SCU) variations in these species because the mutation hypothesis predicts AT richness and GC poorness in the mitochondrial DNA. Thus, AT-biased mutation pressure seems to be an important factor in framing the SCU variation in all the selected species of aquatic insects, which in turn explains the predominance of A and T ending codons in these species. This study does not find any association between microhabitats and codon usage variations in the mitochondria of selected aquatic insects. However, this study has identified major forces, such as compositional constraints and mutation pressure, which shape patterns of codon usage in mitochondrial genes in the primitive clades of insect lineages.

Primary biliary cirrhosis (PBC), PBC autoantibodies, and hepatic parameter abnormalities in a large population of systemic sclerosis patients

OBJECTIVE

To investigate the diagnostic accuracy of antimitochondrial antibodies (AMA), sp100, and gp210 antibodies for primary biliary cirrhosis (PBC) in a large population of patients with systemic sclerosis (SSc); to examine concordance of these antibodies with subsets of SSc. Further, to assess the association of SSc-related antibodies with hepatic parameter abnormalities.

METHODS

We obtained medical records to verify the diagnoses of SSc and PBC. Sera from all participants were examined for the presence of SSc- and PBC-related antibodies, as well as for abnormalities in hepatic parameters.

RESULTS

We examined 817 patients with SSc, of whom 16 (2%) had confirmed PBC. The sensitivity and specificity of AMA by a MIT3 ELISA for PBC were 81.3% and 94.6%, respectively. Sp100 had a sensitivity and specificity of 31.3% and 97.4%, respectively, while gp210 had an even lower sensitivity. We were able to detect all PBC cases using AMA(MIT3) and sp100 as a combined marker, resulting in a significantly improved sensitivity of 100% (p = 0.042) with an incremental decrease in specificity to 92.6%. Independent of AMA or sp100 status, there was an association of anticentromere B (CENP-B) and anti-topoisomerase antibodies (ATA) with higher alkaline phosphatase levels (p = 0.051 and p = 0.003, respectively) while anti-RNA polymerase III (anti-RNAP) was associated with lower alkaline phosphatase levels (p = 0.019) among the patients with SSc.

CONCLUSION

Utilization of AMA(MIT3) and sp100 antibodies as a combined diagnostic marker leads to an improved detection of PBC in patients with SSc. CENP-B and ATA are associated with alkaline phosphatase elevation.