Engineering-geological study of relationships between soil and rock workability, type and volume of excavated materials, and earthwork costs (six case studies).

The engineering-geological study deals with the study of significance and relationship of soil and rock workability (factor representing the engineering-geological structure of rock massif) and the remaining earthwork parameters influencing the cost of construction work, such as excavation type and its technology, and excavated cubic volume. The comparative tool was the cost of earthwork as it reflects the real value of the given parameters during the implementation of earthwork. Soil and rock workability is the most important parameter of rock massif engineering-geological structure during any earthwork. The investor pays the contractor for earthwork based on workability classes which have their accounting value expressed as a volume unit of earthwork per particular project. The research results arise from a comparison of 6 sewer system construction project case studies in the north-east of the Czech Republic. The research shows that the most important factor during the implementation of earthwork is the specific engineering-geological structure (52%), which reflects in the parameter of soil and rock workability classes, using which all earthwork is priced. The second most important factor (33%) is the type of excavation and its technology. The least important is the excavated cubic volume (15%), which means the overall cubic volume of earthwork. The results were obtained within three evaluation approaches, where the comparison unit was one cubic meter of excavated volume during earthwork.

Suitability of Engineering-Geological Environment on the Basis of Its Permeability Coefficient: Four Case Studies of Fine-Grained Soils.

The aim of the article is to compare two classifications systems of engineering-geological environment sustainability in terms of its permeability evaluated on the basis of permeability coefficient. The first evaluated classification assumes a permeable environment to be a positive characteristic in the engineering-geological assessment, while the other considers an impermeable environment as favourable. The four fine-grained soil materials were selected, as they had very similar, almost identical grains-size distribution, but different microstructure characterized by grains sphericity, angularity, and roughness. At the same time, the influence of changes in the density of soil materials (density index 10%, 30%, 60%, 90%) was analysed. Permeability coefficient was determined using six methods (empirical formulae, laboratory and microscopic analysis). The laboratory method falling head test (FHT) was taken as a reference test that reflected the actual water flow through the soil. It was found that with an increase in grain angularity and roughness (and a decrease in sphericity), the permeability coefficient was decreasing and this trend culminated along with gradual compaction. Moreover, the research shows that unsuitable methods may classify soil materials into wrong engineering-geological permeability classes, which may have negative consequences during engineering-geological or geotechnical assessment and cause subsequent problems in foundation engineering.

Demographics and rates of surgical arthroscopy and postoperative rehabilitative preferences of arthroscopists from the Arthroscopy Association of North America (AANA).

Survey of 869 arthroscopists regarding joint-specific arthroscopic procedures and postoperative rehabilitative preferences revealed comparable support for use of supervised physical therapy (SPT) and home exercise programs (HEPs) but stronger preference for joint-specific HEP applications (wrist, knee). Among respondents utilizing HEPs, modality of delivery (verbal/handout/web-based) didn't differ by joint, yet only 2.9% utilized web-based HEPs. This is the first known study to identify postoperative rehabilitation preferences. With 1.77 million estimated arthroscopic procedures annually (mean: 325.4 procedures/respondent), this study highlights under-utilization of web-based HEPs. Reliable, web-based HEPs can improve post-arthroscopic outcomes for patients, arthroscopic surgeons, and rehabilitative specialists while being cost efficient.

Occurrence of pneumonitis following radiotherapy of breast cancer - A prospective study.

AIM: of this study is to determine the temporal resolution of therapy-induced pneumonitis, and to assess promoting factors in adjuvant treated patients with unilateral mammacarcinoma. PATIENTS AND METHODS: A total of 100 post-surgery patients were recruited. The cohort was treated by 2 field radiotherapy (2FRT; breast and chest wall, N = 75), 3 field radiotherapy (3FRT; + supraclavicular lymphatic region, N = 8), or with 4 field radiotherapy (4FRT; + parasternal lymphatic region, N = 17). Ninety-one patients received various systemic treatments prior to irradiation. Following an initial screening visit post-RT, two additional visits after 12 and 25 weeks were conducted including radiographic examination. In addition, general anamnesis and the co-medication were recorded. The endpoint was reached as soon as a pneumonitis was developed or at maximum of six months post-treatment. RESULTS: A pneumonitis incidence of 13% was determined. Of 91 patients with prior systemic therapy, 11 patients developed pneumonitis. Smoking history and chronic obstructive pulmonary disease (COPD) appeared to be positive predictors, whereas past pneumonia clearly promoted pneumonitis. Further pneumonitis-promoting predictors are represented by the applied field extensions (2 field radiotherapy [2FRT] < 3 field radiotherapy [3FRT] < 4 field radiotherapy [4FRT]) and the type of combined initial systemic therapies. As a consequence, all of the three patients in the study cohort treated with 4FRT and initial chemotherapy combined with anti-hormone and antibody protocols developed pneumonitis. A combination of the hormone antagonists tamoxifen and goserelin might enhance the risk for pneumonitis. Remarkably, none of the 11 patients co-medicated with statins suffered from pneumonitis. CONCLUSIONS: The rapidly increasing use of novel systemic therapy schedules combined with radiotherapy (RT) needs more prospective studies with larger cohorts. Our results indicate that contribution to pneumonitis occurrence of various (neo)adjuvant therapy approaches followed by RT is of minor relevance, whereas mean total lung doses of >10 Gy escalate the risk of lung tissue complications. The validity of potential inhibitors of therapy-induced pneumonitis as observed for statin co-medication should further be investigated in future trials.

Gitelman syndrome as a cause of psychomotor retardation in a toddler.

INTRODUCTION: Gitelman syndrome (GS) is a very rare autosomal recessive tubulopathy due to loss-of-function or mutation in solute carrier family12, member 3 gene (SLC12A3 gene) encoding thiazide-sensitive NaCl co-transporter in the distal convoluted tubule, leading to hypokalemia, metabolic alkalosis, hypomagnesemia, hypocalciuria and low-to-normal blood pressure. Clinical signs are mostly secondary to chronic hypokalemia and include dizziness, fatigue, constipation and weakness. Patients can also present with muscle cramps, tetany, fatigue and convulsions due to severe metabolic alkalosis or hypomagnesemia. Manifestations of GS are rarely apparent before the age of five, and the syndrome is usually diagnosed during adolescence or adulthood. Here we describe a case of GS presenting in infancy with hypokalemia and psychomotor retardation. CASE REPORT: We present an 18-month-old boy who presented with psychomotor retardation and failure to thrive. Investigations revealed hypokalemia at 2.7 mmol/L, metabolic alkalosis, hypocalciuria and normal serum magnesium level. The diagnoses of Barter syndrome (BS) and Gitelman syndrome (GS) were considered. Genetic studies confirmed the diagnosis of GS and three different mutations of in SLC12A3 gene were detected. Two mutations (c.2576T>C and c.2929C>Ty) were considered as causal ones, with the patient´s parents being the heterozygous carriers. Oral potassium supplementation resulted in normalisation of the hypokalemia and psychomotor improvement. CONCLUSION: We report a rare case of psychomotor retardation occurring at an early age in genetically confirmed GS. In spite of being a rare disorder, GS has to be considered in children with developmental delay and muscle weakness. With adequate treatment, GS patients have an excellent prognosis.