Does bariatric surgery prior to total hip or knee arthroplasty reduce post-operative complications and improve clinical outcomes for obese patients? Systematic review and meta-analysis.

AIMS: Our aim was to determine whether, based on the current literature, bariatric surgery prior to total hip (THA) or total knee arthroplasty (TKA) reduces the complication rates and improves the outcome following arthroplasty in obese patients. METHODS: A systematic literature search was undertaken of published and unpublished databases on the 5 November 2015. All papers reporting studies comparing obese patients who had undergone bariatric surgery prior to arthroplasty, or not, were included. Each study was assessed using the Downs and Black appraisal tool. A meta-analysis of risk ratios (RR) and 95% confidence intervals (CI) was performed to determine the incidence of complications including wound infection, deep vein thrombosis (DVT), pulmonary embolism (PE), revision surgery and mortality. RESULTS: From 156 potential studies, five were considered to be eligible for inclusion in the study. A total of 23 348 patients (657 who had undergone bariatric surgery, 22 691 who had not) were analysed. The evidence-base was moderate in quality. There was no statistically significant difference in outcomes such as superficial wound infection (relative risk (RR) 1.88; 95% confidence interval (CI) 0.95 to 0.37), deep wound infection (RR 1.04; 95% CI 0.65 to 1.66), DVT (RR 0.57; 95% CI 0.13 to 2.44), PE (RR 0.51; 95% CI 0.03 to 8.26), revision surgery (RR 1.24; 95% CI 0.75 to 2.05) or mortality (RR 1.25; 95% CI 0.16 to 9.89) between the two groups. CONCLUSION: For most peri-operative outcomes, bariatric surgery prior to THA or TKA does not significantly reduce the complication rates or improve the clinical outcome. This study questions the previous belief that bariatric surgery prior to arthroplasty may improve the clinical outcomes for patients who are obese or morbidly obese. This finding is based on moderate quality evidence. Cite this article: Bone Joint J 2016;98-B:1160-6

Dinâmica de O2, CO2 e CH4 em leiras estáticas de compostagem.

bitstream/item/98028/1/Dinamica-O2-leiras-compostagem-1.pd

Caracterização de dois fungos causadores de mildio pulverulento em Senna e Desmodium no Brasil.

Resumo 1755. Edição dos resumos do 44º Congresso Brasileiro de Fitopatologia, 2011, Bento Gonçalves

Precipitação de estruvita em lixiviado de compostagem para uso como fertilizante.

Nutrient recovery from agro-industrial effluents as precipitate minerals for use as fertilizers in agriculture is a promising strategy to reach sustainability. Struvite precipitation (MgNH4PO4.6H2O) is one of the most studied methods for phosphorus (P) recovery from waste waters; its use as a slow-release fertilizer has been often tested. This method also allowed the potassium (K) recovery as K-struvite (MgKPO4 .6H2O). The leachate has been considered as a major threat of composting facilities to the environment - due to its high biochemical oxygen demand and nutrient content (K, N e P). The leachate from a composting of horse bedding manure and left vegetables from an agro-processing industry showed high content of K (2,256 mg L -1), and low levels of ammoniacal nitrogen (217 mg L-1) and P (83 mg L-1). Adding soluble sources of phosphorus (H 3PO4) and magnesium (MgCl2) followed by pH adjusting (8 to 10), we reached the simultaneous formation of NH 4-struvite and K-struvite, as evidenced by X-ray diffraction. Besides composting leachate, struvite precipitation might be a feasible route to other agro-industrial waste waters with high K and N. Este estudo objetivou avaliar a composição de nutrientes do lixiviado da compostagem de esterco de cavalo e sobras de hortaliças de uma agroindústria de processamento mínimo e o potencial para a recuperação de nitrogênio amoniacal (NH 4+) e potássio (K) na forma de estruvita em condições de laboratório.On-line first

Femoral revision knee Arthroplasty with Metaphyseal sleeves: the use of a stem is not mandatory of a structural point of view

Purpose Metaphyseal sleeves are an option for patients with severe metaphyseal bony defects requiring TKA revision. Although sleeves are usually used with stems, little is known about the exact contribution/need of the stem for the initial sleeve-bone interface stability, particularly in the femur, if the intramedullary canal is deformed or bowed. It is hypothesised that diaphyseal-stem addition increases the sleeve-femur interface stability and the strain-shielding effect on the metaphyseal femur relatively to the stemless condition. Material and methods Synthetic-femur was used to measure cortex strain behaviour and implant cortex micromotions for three techniques: only femoral-component, stemless-sleeve and stemmed-sleeve. Paired t-tests were performed to evaluate the statistical significance of the difference between mean principal strains and implant-cortex micromotions. Finite-element models were developed to assess the cancellous-bone strain behaviour and sleeve-bone interface micromotions; these models were validated against the measurements. Results Cortex strains are reduced significantly (p<0.05) in 83% of strain gauges on stemmed-sleeve, which compares with 33% in stemless condition. Both techniques presented a cancellous bone strain reduction of 50% at the distal region and an increase of nearly four times at the sleeve proximal region relative to the model only with the femoral component. Both techniques presented sleeve-bone micromotions amplitude below 50-150μm, suitable for bone ingrowth. Conclusions The use of a supplemental diaphyseal-stem potentiates the risk of cortex bone resorption compared with the stemless-sleeve condition; however, the stem is not vital for increasing the initial sleeve-bone stability and has a minor effect on the cancellous-bone strain behaviour. Of a purely structural point view, appears that the use of a diaphyseal-femoral-stem with the metaphyseal sleeve is not mandatory in the revision TKA which is particularly relevant in cases where the use of stems is impracticable.publishe