Treatment of perioperative swelling by rest, ice, compression, and elevation (RICE) without and with additional application of negative pressure (RICE+) in patients with a unilateral ankle fracture: study protocol for a monocentric, evaluator-blinded randomized controlled pilot trial

Background Edema is commonly seen after surgical fixation of ankle fractures. Rest, ice, compression, and elevation (RICE) is an established combination to prevent swelling but hardly able to stimulate lymphatic resorption. Recently, an epicutaneously applied negative pressure suction apparatus (LymphaTouch®) has been introduced to stimulate lymphatic flow. While postoperative recovery, soft tissue, and osseous healing as well as functional outcome are probably linked to the amount of postoperative swelling, estimates on this relative to prevention (RICE) or prevention + stimulated resorption (RICE + ) of fluid are scarce. Methods and analysis This is a single-center, evaluator-blinded randomized pilot trial to investigate postoperative swelling in adults requiring surgical fixation of a closed unilateral ankle fracture. A total of 50 patients will be recruited and randomly assigned to RICE or RICE + prior to surgery. All patients will undergo evaluator-blinded measurements of the ankle volume the day before surgery and subsequently from the evening of the 2nd postoperative day every 24 h until discharge. RICE will be initiated right after surgery and continued until discharge from the hospital in all patients. Additional application of negative pressure therapy (RICE + ) will be initiated on the morning of the 2nd postoperative day and repeated every 24 h until the time of discharge from the hospital. Outcome measures are (i) the relative amount and the time course of the postoperative swelling, (ii) the demand for analgesic therapy (type and amount) together with the perception of pain, (iii) the rate of complications, and (iv) mobility of the ankle joint and the recovery of walking abilities during a 12-weeks follow-up period. Serum and urine samples taken prior to sugery and during postoperative recovery will allow to evaluate the ratio of naturally occurring stable calcium isotopes (δ 44/42 Ca) as a marker of skeletal calcium accrual

Multiple injections of energetic electrons associated with the flare and CME event on 9 October 2021

Context. We study the solar energetic particle (SEP) event observed on 9 October 2021 by multiple spacecraft, including Solar Orbiter. The event was associated with an M1.6 flare, a coronal mass ejection, and a shock wave. During the event, high-energy protons and electrons were recorded by multiple instruments located within a narrow longitudinal cone. Aims. An interesting aspect of the event was the multi-stage particle energisation during the flare impulsive phase and also what appears to be a separate phase of electron acceleration detected at Solar Orbiter after the flare maximum. We aim to investigate and identify the multiple sources of energetic electron acceleration. Methods. We utilised SEP electron observations from the Energetic Particle Detector (EPD) and hard X-ray (HXR) observations from the Spectrometer/Telescope for Imaging X-rays (STIX) on board Solar Orbiter, in combination with radio observations at a broad frequency range. We focused on establishing an association between the energetic electrons and the different HXR and radio emissions associated with the multiple acceleration episodes. Results. We find that the flare was able to accelerate electrons for at least 20 min during the non-thermal phase, observed in the form of five discrete HXR pulses. We also show evidence that the shock wave contributed to the electron acceleration during and after the impulsive flare phase. The detailed analysis of EPD electron data shows that there was a time difference in the release of low- and high-energy electrons, with the high-energy release delayed. Also, the observed electron anisotropy characteristics suggest a different connectivity during the two phases of acceleration.ISSN:0004-6361ISSN:1432-074