Are Vascularized Fibula Autografts a Long-lasting Reconstruction After Intercalary Resection of the Humerus for Primary Bone Tumors?

BackgroundA vascularized fibula graft (VFG) is the vascular autograft most frequently used to restore large segmental long bone defects, particularly in the upper limb. Because the use of a vascularized fibula involves an operation in an uninvolved extremity with potential morbidity, it is important to document that this type of reconstruction is successful in restoring function to the humerus. However, the long-term results of VFG after intercalary resection of the humeral diaphysis for bone tumors are still unknown.Questions/purposes(1) What was the complication rate of reconstruction? (2) What was the functional result after surgical treatment, as assessed by the Musculoskeletal Tumor Society (MSTS) score, the American Shoulder and Elbow Society (ASES) score, and Constant score? (3) What was the survivorship of these grafts free from revision and graft removal at 5, 10, and 15 years?MethodsBetween 1987 and 2021, 127 patients were treated at our institution with en bloc resection for a primary malignant or an aggressive benign bone tumor of the humerus; we excluded patients treated with extra-articular resection or amputation. Of those, 14% (18 of 127) were treated with intercalary resection of the humeral diaphysis for primary bone tumors and reconstruction with VFG, with or without a bulk allograft, and were analyzed in this retrospective study. Generally, our indications for reconstruction with VFG are intercalary resection of the humerus for primary malignant or aggressive benign bone tumors in patients with long life expectancy and high functional demands, in whom adequate bone stock of the proximal and distal epiphysis can be preserved. In 13 patients, VFG was used alone, whereas in five patients, a massive allograft was used. Our policy was to use VFG combined with a massive allograft in patients undergoing juxta-articular joint-sparing resections in which proximal osteotomy was performed close to the anatomic neck of the humerus to obtain more stable fixation and better tendinous reattachment of the rotator cuff and deltoid. All 18 patients who were treated with a VFG were available for follow-up at a minimum of 2 years (median follow-up 176 months, range 26 to 275 months), and although three have not been seen in the past 5 years and are not known to have died, they had 172, 163, and 236 months of follow-up, and were included. The median age at surgery was 25 years (range 2 to 63 years), the median humeral resection length was 15 cm (range 8 to 21 cm), and the median fibular length was 16 cm (range 12 to 23 cm). Complications and functional scores were ascertained by chart review that was performed by an individual not involved in patient care. Functional results were assessed with the MSTS score (range 0 to 30), the ASES score (range 0 to 100), and the Constant score (range 0% to 100%). Survivorship was estimated using a Kaplan-Meier survivorship estimator, which was suitable because there were few deaths in this series.ResultsSeven patients underwent a revision procedure (one radial nerve transient palsy because of screw impingement, four nonunions in three patients with one humeral head avascular necrosis, treatment for screw-related pain in one patient, and two VFG fractures), and one patient underwent VFG removal. Donor site complications were observed in four patients (one ankle valgus deformity and three claw toes - the first toe in two patients and the other toes in the third). At the final clinical control, at a median follow-up of 176 months (range 26 to 275 months), the median MSTS score was 30 of 30 (range 28 to 30), the median ASES score was 98.3 (range 93 to 100), and the median Constant score was 93.5% (range 79% to 100%). Revision-free survival was 71% (95% CI 53% to 96%) at 5 years and 57% (95% CI 37% to 88%) at 10 and 15 years; VFG removal-free survival was 94% (95% CI 83% to 100%) at 5, 10, and 15 years.ConclusionVFG appears to be an effective reconstructive option after humeral intercalary resection for primary bone tumors. These are complex procedures and should be performed by an experienced team of surgeons who recognize that complications may occur frequently in the first years after the procedure. The frequency of mechanical complications observed in the first 5 years postoperatively may be lessened by using long spanning-plate fixation, and if successful, this reconstruction provides a long-term, durable reconstruction with excellent functional results.Level of EvidenceLevel IV, therapeutic study

Identification of most relevant variables and processes to assess the environmental impacts of remediation technologies along their life cycles: Focus on the waste management scenarios

The application of Life Cycle Assessment (LCA) to remediation technologies is still not a consolidated practice and it is especially lacking in the assessment of the environmental impacts associated to the management of the waste produced during remediation. This study aims at addressing these methodological gaps by identifying the typologies of waste typically generated during the remediation of a contaminated site and classifying them according to the European Waste Catalogue (EWC) codes. Thereafter, the following steps are: (i) the identification of the waste management scenarios (WMSs) applicable to the identified waste typologies, (ii) the selection of Life Cycle Assessment processes that can be used to assess the impacts of the different WMSs and (iii) the quantification and comparison of the environmental impacts caused by the different WMSs applied considering hazardousness levels to which the same waste may belong in relation to its contamination levels and characteristics: inert, non-hazardous and hazardous waste (Waste Framework Directive 2008/98/EC). As results, a matrix reporting the classes and typologies of waste, their EWC codes, their different WMSs and the suitable LCA processes from the Ecoinvent database that can be applied to each EWC within a specific WMS, has been developed. Additionally, the comparative assessment of the impacts caused by the Ecoinvent processes applicable to the same waste typology within the same WMS has been performed to support the selection of the most appropriate WMS case by case

Bacterial melanin production by heterologous expression of 4 hydroxyphenylpyruvate dioxygenase from Pseudomonas aeruginosa

Pyomelanin is a reddish-brown pigment produced by bacteria of different genera and plays a variety of physiological roles. Proposals have been regarding the use of pyomelanin in various environmental, industrial and, more recently, cosmetic applications. In Pseudomonas aeruginosa, the enzyme 4\u2011hydroxyphenylpiruvate dioxygenase (Hpd) converts 4-hydroxyphenylpiruvate into homogentisic acid, which represents the key intermediate for melanin biosynthesis. This work aimed to obtain Escherichia coli cells overexpressing hpd gene from the PAO1 strain to produce large amounts of pyomelanin for biotechnological purposes. The recombinant dioxygenase expression gave E. coli JM109 the ability to produce pyomelanin. A series of biotransformations led us to choose the best experimental conditions for pyomelanin production. Cells were grown at the mid-exponential phase in a mineral medium with added glucose 10 mM as carbon and energy sources and casamino acid 0.2% w/v as an amino acid source. The administration of tyrosine 1 mM after 30 min of exposure to arabinose 1% w/v made it possible to purify 213 mg/L of pyomelanin after 6 days of biotransformation. In addition to the interesting biotechnological outcomes, the resulting expression system supports the correlation between the hpd gene from P. aeruginosa PAO1 and pyomelanin synthesis

Lizards and snakes Warmth-loving sunbathers

This chapter includes the most recent advances about the study of lizards and snakes recovered in the Messel Pit (Middle Eocene), Germany.Fil: Smith, Krister T.. Senckenberg Research Institute and Natural History Museum Frankfurt. Department of Messel Research and Mammalogy. Section Palaeoherpetology; AlemaniaFil: Cernansky, Andrej. Comenius University in Bratislava. Department of Ecology; EslovaquiaFil: Scanferla, Carlos Agustín. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Bio y Geociencias del Noroeste Argentino. Universidad Nacional de Salta. Facultad de Ciencias Naturales. Instituto de Bio y Geociencias del Noroeste Argentino; ArgentinaFil: Schaal, Stephan F. K.. Senckenberg Research Institute and Natural History Museum Frankfurt. Department of Messel Research and Mammalogy; Alemani

Fixed combination of manidipine and delapril in the treatment of mild to moderate essential hypertension: evaluation by 24-hour ambulatory blood pressure monitoring

This present study assessed the antihypertensive efficacy of the fixed combination of manidipine and delapril by ambulatory blood pressure monitoring in patients with hypertension inadequately controlled by monotherapy with either component. After a 2-week placebo period, 55 mild to moderate hypertensive patients were randomized to manidipine 20 mg o.d. or delapril 30 mg b.i.d. for 4 weeks. After this period, 30 patients, aged 30-76 years (18 males and 12 females) whose diastolic blood pressure was not adequately controlled (> or = 90 mmHg) by monotherapy were treated with the fixed combination of manidipine 10 mg plus delapril 30 mg o.d. for 8 weeks. A 24-h ambulatory blood pressure monitoring recording was performed at the end of the placebo washout, of the monotherapy and of the combination therapy. Blood pressure control over the 24 h was quantified by the trough-to-peak ratio and the smoothness index. As compared to placebo, the fixed combination of manidipine and delapril produced a statistically significant (p<0.01) decrease in sitting clinic (18 +/- 9/14 +/- 5 mmHg) and 24-h blood pressure (12 +/- 7/10 +/- 5 mmHg) without affecting heart rate. This reduction was greater than that observed with single components. At the end of the 8-week combination treatment period, the rate of normalilized patients was 73%. Treatment with the fixed combination was associated with a positively high smoothness index (1.2 +/- 0.7/13.8 +/- 0.8) and with a relatively good trough-to-peak ratio (0.46/0.60). The combination of manidipine and delapril produced significant and smooth reductions in blood pressure values, which persisted over the 24-h dosing interval. These results support the use of fixed manidipine-delapril combination in the treatment of mild to moderate hypertensive patients inadequately controlled by monotherap