The effect of combined drug therapy in lateral fragility fractures of the femur: a prospective observational study.

OBJECTIVE: Due to a growing number of lateral fragility fractures, and their high economic and social impact, we evaluated the combined drug therapy effectiveness in lateral fragility femur fractures treated by intramedullary nailing surgery comparing the clinical and radiological results of two groups of patients. PATIENTS AND METHODS: From May 2019 to March 2020, we carried out a prospective observational study comparing the results of patients with femoral lateral fractures treated by the same intramedullary nail (PFNA Synthes®) using Clodronic acid and Vitamin D (study group, 25 patients) compared to patients with the same fractures treated with Vitamin D alone (control group, 25 patients). The evaluations were based on bone biochemical markers (serum calcium level, serum phosphate level, parathyroid hormone, Vitamin D, serum C-terminal telopeptide), Visual Analogic Scale and HHS (Harris Hip Score) score, and femur densitometric views. In order to evaluate the femur neck mineral bone density (BMD), two areas have been identified on the Anterior-Posterior view: the Region of Interest (ROI)1 (under the head screw) and the ROI2 (above the femoral screw). The BMD has been calculated using femur densitometric views at T0 (1st day post-surgery) and at T1 (12 months later). RESULTS: As far as the BMD average of ROI1 is concerned, we found a significant statistical increase at T1 in the study group (0.93±0.07 gr/cm2) vs. control group (0.88±0.08 gr/cm2), p=0.04. Both biochemical and densitometric values were statistically increased in the study group from T0 to T1 (p<0.05), while control group showed an improvement in the biochemical values only. CONCLUSIONS: Thanks to a one year follow-up, we are able to demonstrate that the administration of an adequate drug therapy after surgery can lead to a better control of the bone remodeling and reabsorption process.

An innovative in-situ DRAINage system for advanced groundwater reactive TREATment (in-DRAIN-TREAT).

The removal of groundwater contamination is a complex process due to the hydro-geochemical characteristics of the specific site, related maintenance and the possible presence of several types of pollutants, both organic and inorganic. In recent decades, there has been an increasing drive towards more sustainable treatment for contaminated groundwater as opposed to "intensive" treatments, i.e. with high requirements for onsite infrastructure, energy and resource use. In this study, a new remediation technology is proposed, combining the use of advanced drainage systems with adsorption processes, termed "In-situ reactive DRAINage system for groundwater TREATment" (In-DRAIN-TREAT). By taking advantage of the groundwater natural gradient, In-DRAIN-TREAT collects the contaminated groundwater via a drainage system and treats the polluted water directly into an active cell located downstream, avoiding external energy inputs. Preliminary results indicate the applicability and high efficiency of In-DRAIN-TREAT when compared with a permeable reactive barrier (PRB). In-DRAIN-TREAT is applied to remediate a theoretical aquifer with low permeability, contaminated by a 13 m wide hexavalent chromium (CrVI) plume. This is achieved in less than a year, via a drain DN500, 32 m long, a 30 m3 treatment cell filled with activated carbon and no energy consumption. A comparison with permeable barriers also shows a preliminary 63% volume reduction, with a related 10% decrease of remediation costs.

Bridging the gap between serum biomarkers and biomechanical tests in musculoskeletal ageing.

Musculoskeletal ageing is a major public health interesting and strain due to the significant demographic modifications in the population, and it is linked to high risk of falls, loss of autonomy in elderly individuals and institutionalization with small health outcomes. Thus, this pathological status is related to high morbidity and health care rates. Bone mass and muscle mass and strength increase during late adolescence and early adulthood but start to reduce noticeably from the fifth decade of life and are closely linked. Preclinical and clinical data strongly support the muscle-bone cross-talk showing the presence of many tissue-specific factors released by the muscle that modulate bone, such as insulin-like growth factor-1 (IGF- 1), IL-6, IL-15, myostatin and irisin. Bone and muscle tissues were increasingly recognized as endocrine target organs and endocrine organs themselves, interacting through paracrine and endocrine signals. It is then plausible that laboratory parameters could be involved in sarcopenia and osteoporosis diagnosis and treatment monitoring. This narrative review raises the possibility of whether this poor correlation between different muscle/lean mass assessment methods and muscle function tests could suggest that each parameter evaluates different aspects of "muscle status" or "muscle quality". If this is true, no one test can be used to assess muscle status but rather a battery of tests is necessary for a comprehensive assessment. More research is required to provide information for researchers to optimally design studies by using the muscle assessment method that is best associated with selected specific outcomes.

Gait analysis in the postoperative assessment of intertrochanteric femur fractures.

Proximal femur fractures (PFFs) are an increasing public health concern. Improving gait and mobility after surgical fixation of intertrochanteric femur fractures (IFFs) is the most important target of research efforts. The purpose of this study is to investigate the role of gait analysis in the functional assessment of over-65 patients with stable and unstable IFFs, at a minimum 6-month follow-up. Fourteen patient's over-65 with IFFs (AO/OTA 31-A) treated with intramedullary nailing (EBA-2, Citieffe Srl, Italy) were enrolled. The patients were divided into two groups according to the fracture stable or unstable pattern, according to AO/OTA classification. At follow-up appointments, clinical outcomes [Harris Hip Score (HHS)], Western Ontario and McMaster University (WOMAC) and gait parameters were assessed. Radiographs were analyzed at the time of surgery and at each follow-up visit. At 3-month follow-up, both groups showed a significantly different gait patterns, compared with control subjects. At 6-month follow-up, a significant improvement of both mean HHS score (p=0.43) and mean WOMAC score was observed (p=0.43) within groups. Nonetheless, patients with stable fractures showed a comparable gait pattern, compared with control subjects, while patients with unstable fractures still presented a worse gait pattern, compared with control subjects. Therefore, in presence of an unstable IFF, a more aggressive rehabilitative program is needed. The data provided by postoperative gait analysis, therefore, could be useful to customize the patients' rehabilitative protocol, to quickly improve their walking ability and autonomy, thus reducing the post-operative re-fall risks.

Experimental investigations and numerical modelling of in-situ reactive caps for PAH contaminated marine sediments.

The present study compared numerical modelling and experimental investigations to evaluate the effectiveness of in-situ reactive capping for marine sediments contaminated by polycyclic aromatic hydrocarbons (PAHs). As a case study, sediment samples from Mar Piccolo (Italy) were analyzed and experiments were undertaken using batch columns. Two types of capping amendments were tested: AquaGate® + 5 % of powdered activated carbon (AG PAC) and Organoclay Reactive Core Mat (OC RCM). The column tests were carried out for 20 days, obtaining a short-term PAH distribution for three cases analysed, which compared the application of the two caps with no intervention. In parallel, in order to evaluate the intervention long term efficacy, an ad-hoc multilayered model predicting PAH concentrations into the sediments and the overlying water column was developed and validated with the experimental results. Both capping systems considerably reduced PAH concentrations in the overlying water, with the highest performance seen in AG PAC for benzo[a]pyrene (99 %) and anthracene (72 %); results also confirmed in the model predictions. In addition, the numerical simulations indicated a good efficiency of both caps over time, obtaining PAH values below the threshold limit in the long term. Although further experiments need to be developed accounting for multiple contamination competitiveness.

Experimental and simulation study of the restoration of a thallium (I)-contaminated aquifer by Permeable Adsorptive Barriers (PABs).

Permeable Adsorptive Barriers (PABs), filled with a commercial activated carbon, are tested as a technique for the remediation of a thallium (I)-contaminated aquifer located in the south of Italy. Thallium adsorption capacity of the activated carbon is experimentally determined through dedicated laboratory tests, allowing to obtain the main modelling parameters to describe the adsorption phenomena within the barrier. A 2D numerical model, solved by using a finite element approach via COMSOL Multi-physics®, is used to simulate the contaminant transport within the aquifer and for the PAB design. Investigations are carried out on an innovative barrier configuration, called Discontinuous Permeable Adsorptive Barrier (PAB-D). In addition, an optimization procedure is followed to determine the optimum PAB-D parameters, and to evaluate the total costs of the intervention. A PAB-D made by an array of wells having a diameter of 1.5m and spaced at a distance of 4m from each other, is shown to be the most cost-effective of those tested, and ensures the aquifer restoration within 80years. The simulation outcomes demonstrate that the designed PAB-D is an effective tool for the remediation of the aquifer under analysis, since the contaminant concentration downstream of the barrier is below the thallium regulatory limit for groundwater, also accounting for possible desorption phenomena. Finally, the best PAB-D configuration is compared with a continuous barrier (PAB-C), resulting in a 32% saving of adsorbing material volume, and 36% of the overall costs for the PAB-D.

Permeable Adsorptive Barrier (PAB) for the remediation of groundwater simultaneously contaminated by some chlorinated organic compounds.

In this paper, a Permeable Reactive Barrier (PRB) made with activated carbon, namely a Permeable Adsorptive Barrier (PAB), is put forward as an effective technique for the remediation of aquifers simultaneously contaminated by some chlorinated organic compounds. A design procedure, based on a computer code and including different routines, is presented as a tool to accurately describe mass transport within the aquifer and adsorption/desorption phenomena occurring inside the barrier. The remediation of a contaminated aquifer near a solid waste landfill in the district of Napoli (Italy), where Tetrachloroethylene (PCE) and Trichloroethylene (TCE) are simultaneously present, is considered as a case study. A complete hydrological and geotechnical site characterization, as well as a number of dedicated adsorption laboratory tests for the determination of activated carbon PCE/TCE adsorption capacity in binary systems, are carried out to support the barrier design. By means of a series of numerical simulations it is possible to determine the optimal barrier location, orientation and dimensions. PABs appear to be an effective remediation tool for the in-situ treatment of an aquifer contaminated by PCE and TCE simultaneously, as the concentration of both compounds flowing out of the barrier is everywhere lower than the regulatory limits on groundwater quality.

Increased risk of osteoporosis in postmenopausal women with type 2 diabetes mellitus: a three-year longitudinal study with phalangeal QUS measurements.

Type 2 diabetes mellitus (T2DM) is associated with a higher risk of fractures even in presence of normal or increased bone mineral density. The purpose of this three-year longitudinal study was to evaluate the risk of osteoporotic fractures by assessing the changes of Quantitative Ultrasound (QUS) parameters in a group of postmenopausal women with type 2 diabetes mellitus (T2DM) compared with non-diabetic controls. The measurements were taken on a group of 18 postmenopausal women affected by T2DM and 18 healthy age-matched controls, aged 55-70 years, referring to the Osteolab laboratory at the ISBEM Research Institute (Brindisi, Italy) between 2009 and 2013. Subjects had baseline and 3-year follow-up measurements with phalangeal QUS carried out by a DBM Sonic Bone Profiler 1200 (Igea®); medical history, current drug therapies and risk factors for fractures were recorded for each patient. The analyzed phalangeal QUS parameters were Amplitude-Dependent Speed of Sound (AD-SoS), Bone Transmission Time (BTT), Fast Wave Amplitude (FWA) and Signal Dynamic (SDy). At the baseline visit we found no statistically significant difference between T2DM and non-diabetic patients when looking at phalangeal QUS parameters. At the three-year follow-up visit, a significantly higher decrease of both BTT (P<0.001) and AD-SoS (P<0.001) parameters was found in the T2DM group. On the contrary, the decrease of FWA was significantly higher in non-diabetic controls (P<0.001). Our data confirm the ability of phalangeal QUS to detect differences in the risk of osteoporotic fractures in T2DM postmenopausal women compared to non-diabetic controls. The study suggests that T2DM women present a higher cortical porosity and increased trabecular bone density compared to non-diabetic controls, respectively shown by the higher decrease of both AD-SoS and BTT and the lower decrease of FWA.

Remediation of an aquifer polluted with dissolved tetrachloroethylene by an array of wells filled with activated carbon.

In this work, an array of deep passive wells filled with activated carbon, namely a Discontinuous Permeable Adsorptive Barrier (PAB-D), has been proposed for the remediation of an aquifer contaminated by tetrachloroethylene (PCE). The dynamics of the aquifer in the particular PAB-D configuration chosen, including the contaminant transport in the aquifer and the adsorption onto the barrier material, has been accurately performed by means of a computer code which allows describing all the phenomena occurring in the aquifer, simultaneously. A PAB-D design procedure is presented and the main dimensions of the barrier (number and position of passive wells) have been evaluated. Numerical simulations have been carried out over a long time span to follow the contaminant plume and to assess the effectiveness of the remediation method proposed. The model results show that this PAB-D design allows for a complete remediation of the aquifer under a natural hydraulic gradient, the PCE concentrations flowing out of the barrier being always lower than the corresponding Italian regulation limit. Finally, the results have been compared with those obtained for the design of a more traditional continuous barrier (PAB-C) for the same remediation process.

A procedure to design a Permeable Adsorptive Barrier (PAB) for contaminated groundwater remediation.

A procedure to optimize the design of a Permeable Adsorptive Barrier (PAB) for the remediation of a contaminated aquifer is presented in this paper. A computer code, including different routines that describe the groundwater contaminant transport and the pollutant capture by adsorption in unsteady conditions over the barrier solid surface, has been developed. The complete characterization of the chemical-physical interactions between adsorbing solids and the contaminated water, required by the computer code, has been obtained by experimental measurements. A case study in which the procedure developed has been applied to a tetrachloroethylene (PCE)-contaminated aquifer near a solid waste landfill, in the district of Napoli (Italy), is also presented and the main dimensions of the barrier (length and width) have been evaluated. Model results show that PAB is effective for the remediation of a PCE-contaminated aquifer, since the concentration of PCE flowing out of the barrier is everywhere always lower than the concentration limit provided for in the Italian regulations on groundwater quality.