Removal of Hg from Real Polluted Sediments Using Enhanced-EK Decontamination: Verification of Experimental Methods and Batch-Test Preliminary Results

The aim of the research is to apply a biosurfactant-enhanced-EK technology to marine sediment contaminated by high level of Hg. In this work, data from batch-tests using different novel biosurfactant agents were reported. In addition, a dedicated EK bench-scale apparatus was designed and carried out. Technical test was also performed to evaluate the optimal operating features of the EK bench-scale apparatus, assessing the influence of applied voltage and treatment time on the current intensity and electroosmotic flow. Batch experiments were conducted using two sugar esters as biosurfactants and EDTA salt at different concentrations. Results showed that the maximum extraction efficiency was observed for the biosurfactant Olimpicon GC (15%), for which the Hg extraction was shown to be 3.6-fold higher than for 0.2 M EDTA. From technical tests, the observed reduction of current intensity and electroosmotic flow with time highlights the necessity of using conditioning agents during the treatment. Data demonstrates also the good working features of the experimental apparatus. Preliminary results show that EK treatment jointly with biosurfactants such as sugar esters could be a better choice for the remediation of Hg-polluted sediments. The results obtained are of scientific and practical interest and can be used for further researches

Development of a performance threshold approach for identifying the management options for stabilisation/solidification of lead polluted soils

Two soils spiked with lead at different rates were stabilised/solidified using Portland cement and fy ash at different soil:binder ratios, and tested for their setting time, unconfined compressive strength, leachability and durability. A performance threshold approach was used in order to identify optimal management options for the products of the S/S treatment. Results show that soil texture, percentage of binders and lead concentration play an important part in the treatment, significantly influencing the performance of the resulting products in terms of curing, compressive strength and durability. Pb soil concentrations higher than 15000 mg kg-1 were found to heavily reduce the applicability of the treatment requiring the maximum amount of binder in order to satisfy the performance criteria. Te performance of sandy soils was shown to be limited by setting time and UCS features due to the retardation of the hydration reactions and also by its leaching behaviour, whereas for silt-clayey soils the critical parameter is the mechanical resistance

Segond fracture with anterior cruciate ligament tear in an adolescent

The authors report a case of acute knee injury in a 14-year-old teenager. The X-ray showed a so-called Segond’s fracture: a small avulsed bone fragment, elliptical in shape, lying immediately below the external tibial plateau, a few millimeters from the lateral tibial cortex. The fracture site was in the portion of the tibial condyle which is linked to the middle third of the lateral capsule by meniscal tibial fibers. Clinical examination under anesthesia and subsequent arthroscopy revealed a total intrasubstance ACL (anterior cruciate ligament) tear close to the proximal insertion. The authors confirm Segond’s report of a possible association of this avulsion fracture with ACL injuries, even in adolescence

Effectiveness of Oral Nutritional Supplementation for Older Women after a Fracture: Rationale, Design and Study of the Feasibility of a Randomized Controlled Study

<p>Abstract</p> <p>Background</p> <p>Malnutrition is a problem for many older people recovering from a hip and other major fractures. Oral supplementation with high calorie high protein nutrients is a simple intervention that may help older people with fractures to improve their recovery in terms of rehabilitation time, length of hospital stay and mortality. This paper reports a pilot study to test the feasibility of a trial initiated in a hospital setting with an oral supplement to older people with recent fractures.</p> <p>Method</p> <p>A randomized controlled trial with 44 undernourished participants admitted to a hospital following a fracture. The intervention group (n = 23) received a high calorie high protein supplement for forty days in addition to their diet of choice. The control group (n = 21) received high protein milk during their hospital stay in addition to their diet of choice and their usual diet when discharged from hospital.</p> <p>Results</p> <p>All participants were women and their mean age was 85.3 (± 6.1) years. Twenty nine (65%) participants had a hip fracture. At baseline no differences were measured between the two groups regarding their nutritional status, their cognitive ability or their abilities in activities of daily living. There were no significant differences between the intervention and control group with reference to nutritional or functional parameters at 40 day and 4 month follow-ups. Median length of stay in hospital was 18.0 days, with 12 participants being readmitted for a median of 7.0 days.</p> <p>Conclusion</p> <p>It is feasible to perform a randomised trial in a hospital and community setting to test the effect of an oral high energy high protein supplement for older people. Due to the limited number of participants and incomplete adherence with use of the supplements no conclusion can be drawn about the efficacy or effectiveness of this intervention.</p

Mild hypoglycemia is strongly associated with increased intensive care unit length of stay

Background: Hypoglycemia is associated with increased mortality in critically ill patients. The impact of hypoglycemia on resource utilization has not been investigated. The objective of this investigation was to evaluate the association of hypoglycemia, defined as a blood glucose concentration (BG) <70 mg/dL, and intensive care unit (ICU) length of stay (LOS) in three different cohorts of critically ill patients. Methods: This is a retrospective investigation of prospectively collected data, including patients from two large observational cohorts: 3,263 patients admitted to Stamford Hospital (ST) and 2,063 patients admitted to three institutions in The Netherlands (NL) as well as 914 patients from the GLUCONTROL trial (GL), a multicenter prospective randomized controlled trial of intensive insulin therapy. Results: Patients with hypoglycemia were more likely to be diabetic, had higher APACHE II scores, and higher mortality than did patients without hypoglycemia. Patients with hypoglycemia had longer ICU LOS (median [interquartile range]) in ST (3.0 [1.4-7.1] vs. 1.2 [0.8-2.3] days, P <0.0001), NL (5.2 [2.6-10.3] vs. 2.0 [1.3-3.2] days, P <0.0001), and GL (9 [5-17] vs. 5 [3-9] days, P <0.0001). For the entire cohort of 6,240 patients ICU LOS was 1.8 (1.03.3) days for those without hypoglycemia and 3.0 (1.5-6.7) days for those with a single episode of hypoglycemia (P <0.0001). This was a consistent finding even when patients were stratified by severity of illness or survivor status. There was a strong positive correlation between the number of episodes of hypoglycemia and ICU LOS among all three cohorts. Conclusions: This multicenter international investigation demonstrated that hypoglycemia was consistently associated with significantly higher ICU LOS in heterogeneous cohorts of critically ill patients, independently of severity of illness and survivor status. More effective methods to prevent hypoglycemia in these patients may positively impact their cost of car

Does high-dose metformin cause lactic acidosis in type 2 diabetic patients after CABG surgery? A double blind randomized clinical trial

Metformin is a dimethyl biguanide oral anti-hyperglycemic agent. Lactic acidosis due to metformin is a fatal metabolic condition that limits its use in patients in poor clinical condition, consequently reducing the number of patients who benefit from this medication. In a double blind randomized clinical trial, we investigated 200 type 2 diabetic patients after coronary artery bypass surgery in the open heart ICU of the Mazandaran Heart Center, and randomly assigned them to equal intervention and control groups. The intervention group received regular insulin infusion along with 2 metformin 500 mg tablets every twelve hours, while the control group received only intravenous insulin with 2 placebo tablets every twelve hours. Lactate level, pH, base excess, blood glucose and serum creatinine were measured over five 12 h periods, with data averaged for each period. The primary outcome in this study was high lactate levels. Comparison between the 2 groups was made by independent Student’s t-test. To compare changes in multiple measures in each group and analysis of group interaction, a repeated measurement ANOVA test was used

Brace technology thematic series: the progressive action short brace (PASB)

<p>Abstract</p> <p>Background</p> <p>The Progressive Action Short Brace (PASB) is a custom-made thoraco-lumbar-sacral orthosis (TLSO), devised in 1976 by Dr. Lorenzo Aulisa (Institute of Orthopedics at the Catholic University of the Sacred Heart, Rome, Italy). The PASB was designed to overcome the limits imposed by the trunk anatomy. Indeed, the particular geometry of the brace is able to generate internal forces that modify the elastic reaction of the spine. The PASB is indicated for the conservative treatment of lumbar and thoraco-lumbar scoliosis. The aim of this article is to explain the biomechanic principles of the PASB and the rationale underlying its design. Recently published studies reporting the results of PASB-based treatment of adolescent scoliotic patients are also discussed.</p> <p>Description and principles</p> <p>On the coronal plane, the upper margin of the PASB, at the side of the curve concavity, prevents the homolateral bending of the scoliotic curve. The opposite upper margin ends just beneath the apical vertebra. The principle underlying such configuration is that the deflection of the inferior tract of a curved elastic structure, fixed at the bottom end, causes straightening of its upper tract. Therefore, whenever the patient bends towards the convexity of the scoliotic curve, the spine is deflected. On the sagittal plane, the inferior margins of the PASB reach the pelvitrochanteric region, in order to stabilize the brace on the pelvis. The transverse section of the brace above the pelvic grip consists of asymmetrical ellipses. This allows the spine to rotate towards the concave side only, leading to the continuous generation of derotating moments. On the sagittal plane, the brace is contoured so as to reduce the lumbar lordosis. The PASB, by allowing only those movements counteracting the progression of the curve, is able to produce corrective forces that are not dissipated. Therefore, the brace is based on the principle that a constrained spine dynamics can achieve the correction of a curve by inverting the abnormal load distribution during skeletal growth.</p> <p>Results</p> <p>Since its introduction in 1976, several studies have been published supporting the validity of the biomechanical principles to which the brace is inspired. In this article, we present the outcome of a case series comprising 110 patients with lumbar and thoraco-lumbar curves treated with PASB brace. Antero-posterior radiographs were used to estimate the curve magnitude (C_M) and the torsion of the apical vertebra (T_A) at 5 time points: beginning of treatment (t₁), one year after the beginning of treatment (t₂), intermediate time between t₁and t₄(t₃), end of weaning (t₄), 2-year minimum follow-up from t₄(t₅). The average C_Mvalue was 29.3°Cobb at t₁and 13.0°Cobb at t₅. T_Awas 15.8° Perdroille at t₁and 5.0° Perdriolle at t₅. These results support the efficacy of the PASB in the management of scoliotic patients with lumbar and thoraco-lumbar curves.</p> <p>Conclusion</p> <p>The results obtained in patients treated with the PASB confirm the validity of our original biomechanical approach. The efficacy of the PASB derives not only from its unique biomechanical features but also from the simplicity of its design, construction and management.</p

Treatment of thoraco-lumbar curves in adolescent females affected by idiopathic scoliosis with a progressive action short brace (PASB): assessment of results according to the SRS committee on bracing and nonoperative management standardization criteria

<p>Abstract</p> <p>Background</p> <p>The effectiveness of conservative treatment of scoliosis is controversial. Some studies suggest that brace is effective in stopping curve progression, whilst others did not report such an effect.</p> <p>The purpose of the present study was to effectiveness of Progressive Action Short Brace (PASB) in the correction of thoraco-lumbar curves, in agreement with the Scoliosis Research Society (SRS) Committee on Bracing and Nonoperative Management Standardisation Criteria.</p> <p>Methods</p> <p>Fifty adolescent females (mean age 11.8 ± 0.5 years) with thoraco-lumbar curve and a pre-treatment Risser score ranging from 0 to 2 have been enrolled. The minimum duration of follow-up was 24 months (mean: 55.4 ± 44.5 months). Antero-posterior radiographs were used to estimate the curve magnitude (C_M) and the torsion of the apical vertebra (T_A) at 5 time points: beginning of treatment (t₁), one year after the beginning of treatment (t₂), intermediate time between t₁and t₄(t₃), end of weaning (t₄), 2-year minimum follow-up from t₄(t₅). Three situations were distinguished: curve correction, curve stabilisation and curve progression.</p> <p>The Kruskal Wallis and Spearman Rank Correlation tests have been used as statistical tests.</p> <p>Results</p> <p>C_Mmean value was 29,30 ± 5,16 SD at t₁and 14,67 ± 7,65 SD at t₅. T_Awas 12.70 ± 6,14 SD at t₁and 8,95 ± 5,82 at t₅. The variation between measures of Cobb and Perdriolle degrees at t_1,2,3,4,5and between C_Mt₅-t₁and T_At₅-t₁were significantly different.</p> <p>Curve correction was accomplished in 94% of patients, whereas a curve stabilisation was obtained in 6% of patients.</p> <p>Conclusion</p> <p>The PASB, due to its peculiar biomechanical action on vertebral modelling, is highly effective in correcting thoraco-lumbar curves.</p