Tranexamic acid increases early perioperative functional outcomes after total knee arthroplasty.

Background: The purpose of this study was to investigate the influence of tranexamic acid (TXA) on functional outcomes in the immediate postoperative period after total knee arthroplasty (TKA). We hypothesized that the known benefits of TXA would confer measurable clinical improvements in physical therapy (PT) performance, decrease pain, and decrease hospital length of stay (LOS). Methods: We retrospectively analyzed 560 TKA patients, including 280 consecutive patients whose surgery was performed before the initiation of a standardized TXA protocol and the first 280 patients who received TXA after protocol initiation. Outcome measurements included postoperative changes in hemoglobin and hematocrit, LOS, pain scores, destination of discharge, and steps ambulated with PT over 5 sessions. Results: TXA administration resulted in less overall drops in hemoglobin ( Conclusions: It is well known that TXA reduces postoperative anemia, but this study also demonstrates that it confers early perioperative functional benefits for TKA patients. Potential mechanisms for this benefit include reduced rates of postoperative anemia and reduced rates of hemarthroses

Risk of hospitalization for heart failure in patients with type 2 diabetes newly treated with DPP-4 inhibitors or other oral glucose-lowering medications: A retrospective registry study on 127,555 patients from the Nationwide OsMed Health-DB Database

Aims Oral glucose-lowering medications are associated with excess risk of heart failure (HF). Given the absence of comparative data among drug classes, we performed a retrospective study in 32 Health Services of 16 Italian regions accounting for a population of 18 million individuals, to assess the association between HF risk and use of sulphonylureas, DPP-4i, and glitazones. Methods and results We extracted data on patients with type 2 diabetes who initiated treatment with DPP-4i, thiazolidinediones, or sulphonylureas alone or in combination with metformin during an accrual time of 2 years. The endpoint was hospitalization for HF (HHF) occurring after the first 6 months of therapy, and the observation was extended for up to 4 years. A total of 127 555 patients were included, of whom 14.3% were on DPP-4i, 72.5% on sulphonylurea, 13.2% on thiazolidinediones, with average 70.7% being on metformin as combination therapy. Patients in the three groups differed significantly for baseline characteristics: age, sex, Charlson index, concurrent medications, and previous cardiovascular events. During an average 2.6-year follow-up, after adjusting for measured confounders, use of DPP-4i was associated with a reduced risk of HHF compared with sulphonylureas [hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.62-0.97; P = 0.026]. After propensity matching, the analysis was restricted to 39 465 patients, and the use of DPP-4i was still associated with a lower risk of HHF (HR 0.70; 95% CI 0.52-0.94; P = 0.018). Conclusion In a very large observational study, the use of DPP-4i was associated with a reduced risk of HHF when compared with sulphonylureas

Candida parapsilosis complex water isolates from a haemodialysis unit: biofilm production and in vitro evaluation of the use of clinical antifungals

Candida parapsilosis, currently divided into three distinct species, proliferates in glucose-rich solutions and has been associated with infections resulting from the use of medical devices made of plastic, an environment common in dialysis centres. The aims of this study were (i) to screen for Candida orthopsilosis and Candida metapsilosis (100 environmental isolates previously identified as C. parapsilosis), (ii) to test the ability of these isolates to form biofilm and (iii) to investigate the in vitro susceptibility of Candida spp biofilms to the antifungal agents, fluconazole (FLC) and amphotericin B (AMB). Isolates were obtained from a hydraulic circuit collected from a haemodialysis unit. Based on molecular criteria, 47 strains were re-identified as C. orthopsilosis and 53 as C. parapsilosis. Analyses using a formazan salt reduction assay and total viable count, together with microscopy studies, revealed that 72 strains were able to form biofilm that was structurally similar, but with minor differences in morphology. A microtitre-based colorimetric assay used to test the susceptibility of fungal biofilms to AMB and FLC demonstrated that the C. parapsilosis complex displayed an increased resistance to these antifungal agents. The results from these analyses may provide a basis for implementing quality controls and monitoring to ensure the microbiological purity of dialysis water, including the presence of yeast

Elbow Arthroscopy for Treatment of Valgus Extension Overload

Valgus extension overload syndrome (VEO) is the result of supraphysiologic stresses placed across the posterior elbow during pitching. Following failure of nonoperative measures, surgical options consist of arthroscopic or limited incision posteromedial decompression. Although technically challenging, arthroscopic treatment offers many advantages over open treatment, including improved joint visualization, decreased soft-tissue dissection, decreased postoperative pain, and quicker rehabilitation. Arthroscopic treatment of VEO consists of soft tissue and bony debridement, loose body removal, and osteophyte resection. This technique report details the steps of arthroscopic treatment of VEO in a patient with a subluxating ulnar nerve

A rigorous procedure for the design of adsorption units for the removal of cadmium and nickel from process wastewaters

The contamination of water bodies by heavy metals is one of the main concerns for environmental protection, due to the intrinsic toxicity and long lifetime of these compounds. Consequently, there is a pressing need to reduce emissions of heavy metals in wastewater, using efficient and cost-effective remediation techniques, which at the same time will not produce toxic residues, e.g. adsorption on activated carbon. The present work deals with the optimal design and operation of adsorption columns for the removal of cadmium and nickel from synthetic aqueous solutions, both in single-compound and binary systems. Thermodynamic experimental tests were carried out on activated carbon samples (GAC), produced starting from a commercial carbon by chemical oxidation with either nitric acid or hydrogen peroxide, to support the dynamic study and to identify the sample with higher adsorption capacity. Subsequently, the dynamic behavior of Cd and Ni adsorption was studied by means of software simulations in order to attain an optimized column design. Several working configurations were explored, investigating the effects of GAC physical and chemical properties, pollutant concentration and flow rate, for a wide application in process operations. Moreover, the intertwining between thermodynamic and dynamic parameters in the performance of a fixed-bed was highlighted. All the transport phenomena that can affect the overall performance, i.e. axial dispersion, external film diffusion and intraparticle mass transport were considered. In particular, for the internal transport, both pore and surface diffusions were taken into account and considered to occur in parallel; moreover the contribution of pollutant surface diffusivity, which is usually neglected in the commonly adopted model because difficult to estimate, was isolated and its influence on the overall adsorption rate was elucidated. The general formulation of the kinetic model allowed estimating the contribution of each adsorption rate controlling parameter and the effect exerted by the main fluid dynamic parameters, hence representing a fundamental tool for the design and optimization of an adsorption column. \ua9 2013 Elsevier Ltd. All rights reserved