Functional and union outcome of combined column tibial plateau fracture treated with hybrid external fixator.

Objective: To determine the combined column tibial plateau fracture treated with a hybrid external fixator in terms of knee functionality, union outcome and complications. METHODS: The quasi-experimental study was conducted at the Department of Orthopaedic Surgery, Mayo Hospital, Lahore, Pakistan, from July 5, 2019, to December 31, 2021, and comprised patients of either gender aged 20-50 years who presented with 2-column or 3-column fractures of proximal tibia classified according to the 3-column classification system after being diagnosed using radiographs and three-dimensional computed tomography scan. Knee function, union and complications, like neural, vascular, infection, delayed union, nonunion, malunion and implant failure, were evaluated. The Knee Society Score was used to assess knee function, and modified Rasmussen score for the union, while complications were assessed clinically on the 2nd, 6th, 12th, 16th, 24th, 36th weeks and one year post-operatively. Data was analysed using SPSS 26. RESULTS: Of the 113 patients, 91(80.53%) were males and 22(19.47%) were females. The overall mean age was 35.56±9.00 years. From the 12th week to the 24th week 45(39.83%) patients had good and 59(52.21%) patients had excellent functional outcomes. Union outcome in the 16th and 24th week was good in 57(50.44%) patients and excellent in 47(41.59%) patients. No neurovascular injury was observed. Superficial pin tract infection was observed in 21(18.6%) cases that healed with wound debridement and antibiotics. No delayed union, malunion and implant failure was observed. CONCLUSIONS: Good to excellent functional and union outcomes with minimum complications were observed with the hybrid external fixator.

Comparison of Clopidogrel Versus Ticagrelor for Percutaneous Coronary Intervention (PCI) Patients Managed with Therapeutic Hypothermia: A Systematic Review and Meta-Analysis.

Various antiplatelet drugs, such as clopidogrel and ticagrelor, are available on the market for use after percutaneous coronary intervention (PCI). However, the efficacy of such drugs in patients being managed with therapeutic hypothermia (TH) has always been debated. In light of this controversy, this systematic review and meta-analysis was performed to enhance existing literature. Various databases were searched for potentially relevant studies from inception to April 2023, including PubMed, Cochrane Library, and Scopus. The risk of bias was assessed using the Newcastle-Ottawa scale for cohort studies and the Cochrane risk of bias tool for randomized controlled trials. Outcomes of interest included risk of bleeding, stent thrombosis, and all-cause mortality. Five studies were shortlisted for inclusion into the meta-analysis, featuring a total of 245 patients receiving either clopidogrel or ticagrelor. Overall, no significant differences were noted when the use of clopidogrel and ticagrelor was compared in PCI patients being managed with TH. To the best of our knowledge, this is the most comprehensive meta-analysis comparing the outcomes of clopidogrel and ticagrelor in PCI patients being managed with TH. Despite existing studies claiming an altered efficacy of clopidogrel in such conditions, our meta-analytic findings could not prove this relationship. Due to the limited sample size, further comprehensive and randomized studies are encouraged to arrive at a robust conclusion.

A mega study of antibiotics contamination in Eastern aquatic ecosystems of China: occurrence, interphase transfer processes, ecotoxicological risks, and source modeling.

Understanding the occurrence, sources, transfer mechanisms, fugacity, and ecotoxicological risks of antibiotics play a pivotal role in improving the sustainability and ecological health of freshwater ecosystems. Therefore, in order to determine the levels of antibiotics, water and sediment samples were collected from multiple Eastern freshwater ecosystems (EFEs) of China, including Luoma Lake (LML), Yuqiao Reservoir (YQR), Songhua Lake (SHL), Dahuofang Reservoir (DHR), and Xiaoxingkai Lake (XKL), and were analyzed using Ultra Performance Liquid Chromatography/Tandem Mass Spectrometry (UPLC-MS/MS). EFEs regions are particularly interesting due to higher urban density, industrialization, and diverse land use in China. The findings revealed that a collective total of 15 antibiotics categorized into four families, which included sulfonamides (SAs), fluoroquinolones (FQs), tetracyclines (TCs), and macrolides (MLs), exhibited high detection frequencies, indicating widespread antibiotic contamination. The pollution levels in the water phase were in the order of LML > DHR > XKL > SHL > YQR. The sum concentration of individual antibiotics for each water body ranged from not detected (ND) to 57.48 ng/L (LML), ND to 12.25 ng/L (YQR), ND to 57.7 ng/L (SHL), ND to 40.50 ng/L (DHR), and ND to 26.30 ng/L (XKL) in the water phase. Similarly, in the sediment phase, the sum concentration of individual antibiotics ranged from ND to 15.35 ng/g, ND to 198.75 ng/g, ND to 1233.34 ng/g, ND to 388.44 ng/g, and ND to 862.19 ng/g, for LML, YQR, SHL, DHR, and XKL, respectively. Interphase fugacity (ffsw) and partition coefficient (Kd) indicated dominant resuspension of antibiotics from sediment to water, causing secondary pollution in EFEs. Two groups of antibiotics, namely MLs (erythromycin, azithromycin, and roxithromycin) and FQs (ofloxacin and enrofloxacin), showed a medium-high level of adsorption tendency on sediment. Source modeling (PMF5.0) identified wastewater treatment plants, sewage, hospitals, aquaculture, and agriculture as the major antibiotic pollution sources in EFEs, contributing between 6% and 80% to different aquatic bodies. Finally, the ecological risk posed by antibiotics ranged from medium to high in EFEs. This study offers valuable insights into the levels, transfer mechanisms, and risks associated with antibiotics in EFEs, enabling the formulation of large-scale policies for pollution control.

Continuous In-Stream Assimilatory Nitrate Uptake from High-Frequency Sensor Measurements.

Recently developed in situ NO3­ sensors provide new opportunities to measure changes in stream concentration at high temporal frequencies that historically have not been feasible. In this study, we used multiparameter sensor measurements to relate assimilatory NO3­ uptake to metabolic rates and calculate continuous uptake rates for two stream reaches and a whole stream network. Two years of continuous 15 min data from a forest and agricultural reach of the Selke river (456 km2) revealed a strong correlation between assimilatory NO3­ uptake and growth primary production (GPP) for the forest (r2 = 0.72) and agricultural (r2 = 0.56) stream reach. The slopes of these regressions were in agreement with predicted assimilatory N-uptake based on additional metabolic data. Mean yearly assimilatory NO3­ uptake rates (Ua) were 7.4 times higher in the agricultural stream reach (mean 78.3 mg N m­2 d­1, max 270 mg N m­2 d­1) than in the forest stream reach (mean 10.7 mg N m­2 d­1, max 97.5 mg N m­2 d­1). Nitrate uptake velocities (Vf,a) tended to decrease with increasing nitrate concentrations for periods with high light availability. Percentage daily assimilatory NO3­ uptake peaked at 47.4% of the daily NO3­ loading input to the stream network across the entire watershed, whereas the percentage yearly assimilatory NO3­ uptake was 9.0% of nitrogen loading to the stream network. This is a maximum because uptake can be revered by mineralization processes. The percentage yearly assimilatory NO3­ uptake was lower in the forest-dominated upstream subwatershed (4.8%) than in the lower agriculture dominated subwatershed (13.4%).

Satiety drinking tests: effects of caloric content, drinking rate, gender, age, and body mass index.

OBJECTIVE: To compare the maximum tolerated volumes (MTVs) of drinking water and a nutrient liquid at different rates of drinking and to assess the best drinking test correlating with the symptom scores. MATERIAL AND METHODS: Healthy volunteers were requested to drink water at a rate of 10 ml/min or a nutrient liquid drink at 100 and 20 ml/min on three separate occasions. Symptoms of bloating, nausea, and abdominal pain were assessed 30 min after the cessation of drinking using visual analogue scales. RESULTS: The MTV of water was 1595 +/- 405 in males and 1327 +/- 308 in females (p<0.05). In rapid nutrient drinking, the MTV was 945 +/- 376 ml in males, whereas females tolerated 760 +/- 174 ml (p<0.05). In slow nutrient drinking, the MTV was 692 +/- 184 ml in males and 594 +/- 131 ml in females (p=0.051). Multiple regression analysis showed no influence of body mass index (BMI), age, or gender in slow nutrient drinking. However, drinking capacity was significantly influenced by gender, age, and BMI in rapid water drinking and by gender in rapid nutrient drinking. When the tolerated volumes for satiety drinking tests were compared, only males showed some significant positive correlations. Symptom scores were higher after slow nutrient drinking compared to the other two drinking tests. CONCLUSIONS: The rate of drinking and the caloric content affect the MTVs in satiety drinking tests. Slow nutrient drinking appears to be the best choice among the different satiety drink tests, as MTV in this test was not influenced by BMI or age and was associated with higher symptom scores.

Acceptability and outcomes of the Percutaneous Endoscopic Gastrostomy (PEG) tube placement--patients' and care givers' perspectives.

BACKGROUND: Percutaneous endoscopic gastrostomy tube has now become a preferred option for the long-term nutritional support device for patients with dysphagia. There is a considerable debate about the health issues related to the quality of life of these patients. Our aim of the study was to assess the outcome and perspectives of patients/care givers, about the acceptability of percutaneous endoscopic gastrostomy tube placement. METHODS: This descriptive analytic study conducted in patients, who have undergone percutaneous endoscopic gastrostomy tube placement during January 1998 till December 2004. Medical records of these patients were evaluated for their demographic characteristics, underlying diagnosis, indications and complications. Telephonic interviews were conducted till March 2005, on a pre-tested questionnaire to address psychological, social and physical performance status, of the health related quality of life issues. RESULTS: A total of 191 patients' medical records were reviewed, 120 (63%) were males, and mean age was 63 years. Early complication was infection at PEG tube site in 6 (3%) patients. In follow up over 365 +/- 149 days, late complications (occurring 72 hours later) were infection at PEG tube site in 29 (15 %) patient and dislodgment/blockage of the tube in 26 (13.6%). Interviews were possible with 126 patients/caretakers. Karnofsky Performance Score of 0, 1, 2, 3 and 4 was found in 13(10%), 18(14%), 21(17%), 29(23%) and 45(36%) with p-value < 0.001. Regarding the social and psychological aspects; 76(60%) would like to have the PEG tube again if required, 105(83 %) felt ease in feeding, and 76(60%) felt that PEG-tube helped in prolonging the survival. Regarding negative opinions; 49(39 %) felt that the feeding was too frequent, 45(36 %) felt apprehensive about dependency for feeding and 62(49%) were concerned about an increase in the cost of care. CONCLUSION: PEG-tube placement was found to be relatively free from serious immediate and long- term complications. Majority of caregivers and patient felt that PEG-tube helped in feeding and prolonging the survival. Studies are needed to assess the real benefit in terms of actual nutritional gain and quality of life in such patients.