Robotic-arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning.

PURPOSE: The primary objective of this study was to determine the surgical team's learning curve for robotic-arm assisted TKA through assessments of operative times, surgical team comfort levels, accuracy of implant positioning, limb alignment, and postoperative complications. Secondary objectives were to compare accuracy of implant positioning and limb alignment in conventional jig-based TKA versus robotic-arm assisted TKA. METHODS: This prospective cohort study included 60 consecutive conventional jig-based TKAs followed by 60 consecutive robotic-arm assisted TKAs performed by a single surgeon. Independent observers recorded surrogate markers of the learning curve including operative times, stress levels amongst the surgical team using the state-trait anxiety inventory (STAI) questionnaire, accuracy of implant positioning, limb alignment, and complications within 30 days of surgery. Cumulative summation (CUSUM) analyses were used to assess learning curves for operative time and STAI scores in robotic TKA. RESULTS: Robotic-arm assisted TKA was associated with a learning curve of seven cases for operative times (p = 0.01) and surgical team anxiety levels (p = 0.02). Cumulative robotic experience did not affect accuracy of implant positioning (n.s.) limb alignment (n.s.) posterior condylar offset ratio (n.s.) posterior tibial slope (n.s.) and joint line restoration (n.s.). Robotic TKA improved accuracy of implant positioning (p < 0.001) and limb alignment (p < 0.001) with no additional risk of postoperative complications compared to conventional manual TKA. CONCLUSION: Implementation of robotic-arm assisted TKA led to increased operative times and heightened levels of anxiety amongst the surgical team for the initial seven cases but there was no learning curve for achieving the planned implant positioning. Robotic-arm assisted TKA improved accuracy of implant positioning and limb alignment compared to conventional jig-based TKA. The findings of this study will enable clinicians and healthcare professionals to better understand the impact of implementing robotic TKA on the surgical workflow, assist the safe integration of this procedure into surgical practice, and facilitate theatre planning and scheduling of operative cases during the learning phase. LEVEL OF EVIDENCE: II.

Lateral extra-articular tenodesis with ACL reconstruction demonstrates better patient-reported outcomes compared to ACL reconstruction alone at 2 years minimum follow-up.

PURPOSE: The role for extra-articular procedures in addition to ACL reconstruction to restore rotational stability is debated. We use lateral extra-articular tenodesis (LEAT) for patients that meet criteria. Our null hypothesis was that there would be no difference between two groups of patients that were treated with ACL reconstruction alone or ACL reconstruction with LEAT according to criteria. METHODS: A prospectively collected database of patients that were treated primarily according to the presence of a high-grade pivot shift with LEAT at the time of ACL reconstruction was propensity-matched with a group of patients that underwent ACL reconstruction alone. Minimum follow-up was 2 years. Stratified variable analysis of the groups was also performed. RESULTS: There were 218 and 55 patients in the ACL reconstruction group and ACL reconstruction with LEAT group, respectively. There were 125 patients and 46 patients after propensity matching with a median follow-up of 52 months and 27 months, respectively. Post-operative Lysholm score (P = 0.005), Tegner activity index (P = 0.003) and time to return to sport (P < 0.001) favoured ACL reconstruction with LEAT compared to ACL reconstruction alone. Sports with frequent change of direction maneuvers and higher rates of ACL injury (rugby, soccer, skiing) favoured ACL reconstruction with LEAT versus ACL reconstruction alone (P = 0.001). No significant difference in re-operation rate or type of surgery was found between the two surgical groups after propensity matching but 13 patients in the ACL reconstruction-only group re-injured their ACL, 8 of whom required supplementary LEAT at the time of revision surgery. CONCLUSION: Patient-reported outcomes and return to multi-directional sports after ACL reconstruction favour LEAT at the time of ACL reconstruction when narrow inclusion criteria are applied.

Mitigating arsenic contamination in rice plants with an aquatic fern, Marsilea minuta.

Dangers of arsenic contamination are well known in human civilization. The threat increases when arsenic is accumulated in food and livestock through irrigated crops or animal food. Hence, it is important to mitigate the effects of arsenic as much as possible. This paper discusses a process for reducing the level of arsenic in different parts of rice plants with an aquatic fern, Marsilea minuta L. A pot experiment was done to study the possibility of using Marsilea minuta as a phytoremediator of arsenic. Rice and Marsilea minuta were allowed to grow together in soils. As a control, Marsilea minuta was also cultured alone in the presence and absence of arsenic (applied at 1 mg/L as irrigation water). We did not find any significant change in the growth of rice due to the association of Marsilea minuta, though it showed a reduction of approximately 58.64% arsenic accumulation in the roots of rice grown with the association of fern compared to that grown without fern. We measured a bioaccumulation factor (BF) of > 5.34, indicating that Marsilea minuta could be a good phytoremediator of arsenic in rice fields.

Hip fractures, preceding distal radius fractures and screening for osteoporosis: should we be screening earlier? A minimum 10-year retrospective cohort study at a single centre.

UNLABELLED: Both men and women who sustain a fracture of the distal forearm run an increased risk of sustaining a subsequent hip fracture. Our study implies that these patients may not necessarily constitute a group in which osteoporosis screening is warranted. INTRODUCTION: People who sustain a distal radius fracture run an increased risk of sustaining a subsequent hip fracture. However, many institutions only screen for osteoporosis at the time of a hip fracture. We aimed to determine the true incidence of preceding distal radius fractures in an Asian population of patients with a hip fracture aged 60 years or older and whether screening for osteoporosis earlier would be beneficial. METHODS: We reviewed 22 parameters of 572 patients aged 60 years or older admitted after sustaining a hip fracture over a 3-year period. This included the occurrence or absence of a distal radius fracture in the 10 years preceding their hip fracture. RESULTS: Twenty-nine patients (5 %) had a fracture of the distal radius in the preceding decade. Univariate analyses suggested that hip fracture patients who had preceding distal radius fractures were older, female, have lower mean haemoglobin levels, and right-sided hip fractures. Of these factors, only age was found to have significant predictive value in a multivariate analysis. CONCLUSIONS: A number of institutions have started to screen for osteoporosis when a patient presents with a fracture of the distal radius because these patients may have an increased risk of a subsequent hip fracture. Our study implies that this may not be warranted. Implementing such a screening service from both cost and resource utilization point of view must be studied prospectively and in greater detail considering earlier screening may only be beneficial to a very small percentage of patients.

Lack of BCG vaccination and other risk factors for bacteraemia in severely malnourished children with pneumonia.

We sought to examine the factors associated with bacteraemia and their outcome in children with pneumonia and severe acute malnutrition (SAM). All SAM children of either sex, aged 0-59 months, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh with radiologically confirmed pneumonia from April 2011 to July 2012 were enrolled (n = 405). Comparison was made between pneumonic SAM children with (cases = 18), and without (controls = 387) bacteraemia. The death rate was significantly higher in cases than controls (28% vs. 8%, P < 0·01). In logistic regression analysis, after adjusting for potential confounders, the SAM children with pneumonia and bacteraemia more often had a history of lack of bacillus Calmette-Guérin (BCG) vaccination (odds ratio 7·39, 95% confidence interval 1·67-32·73, P < 0·01). The results indicate the importance of continuation of BCG vaccination which may provide benefit beyond its primary purpose.

CNN-Based Brain Tumor Detection Model Using Local Binary Pattern and Multilayered SVM Classifier.

In this paper, an autonomous brain tumor segmentation and detection model is developed utilizing a convolutional neural network technique that included a local binary pattern and a multilayered support vector machine. The detection and classification of brain tumors are a key feature in order to aid physicians; an intelligent system must be designed with less manual work and more automated operations in mind. The collected images are then processed using image filtering techniques, followed by image intensity normalization, before proceeding to the patch extraction stage, which results in patch extracted images. During feature extraction, the RGB image is converted to a binary image by grayscale conversion via the colormap process, and this process is then completed by the local binary pattern (LBP). To extract feature information, a convolutional network can be utilized, while to detect objects, a multilayered support vector machine (ML-SVM) can be employed. CNN is a popular deep learning algorithm that is utilized in a wide variety of engineering applications. Finally, the classification approach used in this work aids in determining the presence or absence of a brain tumor. To conduct the comparison, the entire work is tested against existing procedures and the proposed approach using critical metrics such as dice similarity coefficient (DSC), Jaccard similarity index (JSI), sensitivity (SE), accuracy (ACC), specificity (SP), and precision (PR).

Outcomes in Nonagenarians with Hip Fractures Treated Conservatively and Surgically.

INTRODUCTION: We aimed to assess the clinical outcomes in nonagenarians following a hip fracture. We also further investigated the factors that influence these outcomes, such as method of treatment (operative versus conservative), co-morbidities, and pre-morbid function. MATERIALS AND METHODS: We studied 65 nonagenarians that were identifiable from our hospital hip fracture database. We reviewed various parameters of these patients admitted after sustaining a hip fracture (neck of femur or intertrochanteric) and investigated how these parameters affected patient outcomes. The main outcomes studied were: inpatient morbidity, and mortality at one year. RESULTS: Inpatient morbidity was more likely in patients with an ASA grade of 3 to 5. Urinary tract infection was the most common medical complication. The 1-year mortality was 15.4% and was significantly influenced by advancing age. Surgically managed patients had a 1-year mortality rate (14.3%) slightly less than non-operative patients (17.4%). Post injury mobility was significantly better in those who received operative treatment with 63% of surgical cases regaining ambulatory status versus 7% of conservatively managed patients. CONCLUSIONS: We presented the outcomes of hip fractures in an extreme age group in the population. In nonagenarians with hip fractures surgery was associated with a 1-year mortality rate of 14.3% which is comparable to the general hip fracture population and less than the mortality rate of conservatively managed patients (17.4%). The primary advantage of surgery would be that two-thirds of patients return to ambulatory status. This information is useful to counsel patients and their families especially since the elderly are often more fearful of surgical intervention.

A comprehensive multi-directional exploration of phytochemicals and bioactivities of flower extracts from Delonix regia (Bojer ex Hook.) Raf., Cassia fistula L. and Lagerstroemia speciosa L.

Delonix regia (Bojer ex Hook.) Raf., Cassia fistula L. and Lagerstroemia speciosa L. are three ornamental plants that produce colorful flowers. The present study aimed to evaluate the phytochemicals and bioactivities of methanolic extracts of flowers from Delonix regia (DrFME), Cassia fistula (CfFME), and Lagerstroemia speciosa (LsFME). The presence of ten different chemical classes in varying degrees was confirmed while qualitatively screened. During quantitative determination, LsFME possesses the highest amount of total phenolic (418.0 mg/g), flavonoid (50.8 mg/g), and tannin (256.3 mg/g) contents. The extracts showed excellent antioxidant capacity in a concentration-dependent manner with the lowest IC50 value (41.51 µg/mL) displayed by LsFME. LsFME paralyzed the experimental worms at 2.95 min and killed at 3.96 min. DrFME was found to be more effective in thrombolytic (35.5% clot lysis) and anticoagulant activities. Negligible hemolytic activity (IC50 > 200 µg/mL) found for all extracts which suggest their less potential toxicity. The in vivo experiments revealed that the CfFME has the highest analgesic (64.34% pain inhibition) activity while LsFME has the highest antidiarrheal (70.27% inhibition) and antihyperglycemic (46.94% inhibition) activities at 400 mg/kg of body weight doses. This study has shown the presence of phytochemicals and potential bioactivities which indicates the possibility of these flowers to be used as a source of phytochemicals as well as safe and effective natural medicine.

Sorption and bioavailability of arsenic in selected Bangladesh soils.

The bioavailability of arsenic (As) in the soil environment is largely governed by its adsorption-desorption reactions with soil constituents. We have investigated the sorption-desorption behaviour of As in four typical Bangladeshi soils subjected to irrigation with As-contaminated groundwater. The total As content of soils (160 samples) from the Laksham district ranged from <0.03 to approximately 43 mg kg(-1). Despite the low total soil As content, the concentration of As in the pore water of soils freshly irrigated with As-contaminated groundwater ranged from 0.01 to 0.1 mg l(-1). However, when these soils were allowed to dry, the concentration of As released in the pore water decreased to undetectable levels. Remoistening of soils to field moisture over a 10-day period resulted in a significant (up to 0.06 mg l(-1)) release of As in the pore water of soils containing >10 mg As kg(-1) soil, indicating the potential availability of As. In soils containing <5 mg As kg(-1), As was not detected in the pore water. A comparison of Bangladeshi soils with strongly weathered long-term As-contaminated soils from Queensland, Australia showed a much greater release of As in water extracts from the Australian soils. However, this was attributed to the much higher loading of As in these Australian soils. The correlation of pore water As with other inorganic ions (P, S) showed a strongly significant (P < 0.001) relationship with P, although there was no significant relationship between As and other inorganic cations, such as Fe and Mn. Batch sorption studies showed an appreciable capacity for both As(V) and As(III) sorption, with As(V) being retained in much greater concentrations than As(III).

Groundwater chemistry and arsenic mobilization in the Holocene flood plains in south-central Bangladesh.

A comparative study of arsenic enrichment in the Bengal Delta (BD) was carried out in three alluvial aquifers in south-central Bangladesh. Investigated sites included Sonargaon in Narayanganj, Chandina in Comilla and Sirajdikhan in Munshiganj districts. At all sites samples from different depths were collected, and water chemistry and redox status vs. depth trends were determined. The concentrations of DOC and HCO(3)(-) were highest at Sirajdikhan site, while at the Sonargaon and Chandina sites the concentrations were lower. On the contrary, the NH(4)(+) concentration was high at the Chandina site as compared to the other sites. There was a good match between dissolved As and Fe at the Sirajdikhan and Sonargaon sites, but not at the Chandina site. The dissolved aqueous concentration of Mn was low at the Chandina site, which suggested that the Mn(IV) redox buffering step was missing. Speciation modeling indicated a possibility of siderite precipitation at all sites, but precipitation of rhodochrosite only at the Sonargaon and Sirajdikhan sites. At the Sirajdikhan site, the log P(CO2) values were very high (-1.37), which revealed the production of CO(2) in redox processes. Principal component analysis (PCA) indicated an impact of sea water and redox status of different samples. These results suggest that the dissolved As is de-coupled from dissolved Mn because when released, As is re-adsorbed onto the Fe(III) minerals in solid phase, as well as from dissolved Fe when precipitation of Fe(II) minerals controls the aqueous concentrations of Fe. In addition, several other concurrent redox processes may exert kinetic constraints depending on refractory characteristics of Fe(III) minerals.

Assuring the long-term total joint arthroplasty: a triad of variables.

OBJECTIVES: The primary objective of this study was to compare accuracy in restoring the native centre of hip rotation in patients undergoing conventional manual total hip arthroplasty (THA) versus robotic-arm assisted THA. Secondary objectives were to determine differences between these treatment techniques for THA in achieving the planned combined offset, component inclination, component version, and leg-length correction. MATERIALS AND METHODS: This prospective cohort study included 50 patients undergoing conventional manual THA and 25 patients receiving robotic-arm assisted THA. Patients undergoing conventional manual THA and robotic-arm assisted THA were well matched for age (mean age, 69.4 years (sd 5.2) vs 67.5 years (sd 5.8) (p = 0.25); body mass index (27.4 kg/m2 (sd 2.1) vs 26.9 kg/m2 (sd 2.2); p = 0.39); and laterality of surgery (right = 28, left = 22 vs right = 12, left = 13; p = 0.78). All operative procedures were undertaken by a single surgeon using the posterior approach. Two independent blinded observers recorded all radiological outcomes of interest using plain radiographs. RESULTS: The correlation coefficient was 0.92 (95% confidence interval (CI) 0.88 to 0.95) for intraobserver agreement and 0.88 (95% CI 0.82 to 0.94) for interobserver agreement in all study outcomes. Robotic THA was associated with improved accuracy in restoring the native horizontal (p < 0.001) and vertical (p < 0.001) centres of rotation, and improved preservation of the patient's native combined offset (p < 0.001) compared with conventional THA. Robotic THA improved accuracy in positioning of the acetabular component within the combined safe zones of inclination and anteversion described by Lewinnek et al (p = 0.02) and Callanan et al (p = 0.01) compared with conventional THA. There was no difference between the two treatment groups in achieving the planned leg-length correction (p = 0.10). CONCLUSION: Robotic-arm assisted THA was associated with improved accuracy in restoring the native centre of rotation, better preservation of the combined offset, and more precise acetabular component positioning within the safe zones of inclination and anteversion compared with conventional manual THA.

Preoperative CT-Based Three-Dimensional Templating in Robot-Assisted Total Knee Arthroplasty More Accurately Predicts Implant Sizes than Two-Dimensional Templating.

Patient dissatisfaction after total knee arthroplasty (TKA) is a concern. Surgical error is a common, avoidable cause of failed TKA. Correct femoral and tibial component sizing improves implant longevity, clinical outcomes, knee balance, and pain scores. We hypothesized that preoperative three-dimensional (3D) templating for robot-assisted TKA (RA-TKA) is more accurate than two-dimensional (2D) digital templating. Prospectively collected data from 31 RA-TKAs were assessed to determine accuracy pertaining to implant sizing and positioning. All cases undergoing RA-TKA undergo preoperative CT-scans as per protocol. Three blinded observers retrospectively templated these knees for TKA using standard radiographs. We compared whether 2D templating was as accurate as CT-guided templating. Postoperative radiographs were then evaluated for sizing and positioning. Intraclass correlation coefficients (ICCs) and the effect of learning curve were assessed. Preoperative femoral component 3D templating and retrospective blinded 2D templating accuracies were 96.6% and 52.9%, respectively (χ 2: 17.965; odds ratio [OR]: 24.957, 3.250-191.661; p < 0.001). Tibial component 3D and 2D templating accuracies were 93.1% and 28.7%, respectively (χ 2: 36.436; OR: 33.480, 7.400-151.481; p < 0.001). ICC for the three radiograph observers was 0.920 (95% confidence interval [CI]: 0.652-0.890; p < 0.001) for the femur and 0.833 (0.717-0.911; p < 0.001) for the tibia, showing excellent agreement. We conclude that preoperative CT-based templating for RA-TKA more accurately predicts the size of implants compared with traditional 2D digital templating. This may improve operating room efficiency and cost containment.

Assessment of concentration and toxicological (Cancer) risk of lead, cadmium and chromium in tobacco products commonly available in Bangladesh.

This study aimed to assess the concentrations of heavy metal ('lead (Pb)''cadmium (Cd)', and 'chromium (Cr)') in various brands of four types of tobacco products (zarda, gul, cigarettes, and bidi) as well as calculate toxicological risk as a lifetime cancer risk for Pb, Cd, and Cr. In smokeless tobacco products, the metal concentration ranged from 0.99 to 10.02 µg/g for Pb, 1.05-3.53 µg/g for Cd, and 1.23-7.29 µg/g for Cr, respectively. Metal concentrations in the smoke-based tobacco products ranged from 0.98 to 3.07 µg/g for Pb, 0.91-3.46 µg/g for Cd, 1.08-6.75 µg/g for Cr, respectively. When assuming a 100% transfer of these metals, the calculated lifetime cancer risk was found 'unacceptable' in 33 out of 35 tobacco samples which exceeded the U.S. Environmental Protection Agency (USEPA) benchmark of an 'acceptable' cancer risk range of 10E-4 to 10E-6. Our study demonstrated higher levels of Pb, Cd, and Cr in various tobacco products of Bangladesh compared to GOTHIATEK standard. This study shows the need for the development of industry standards and regulation for tobacco products to reduce the levels of heavy metals.

The learning curve associated with robotic-arm assisted unicompartmental knee arthroplasty: a prospective cohort study.

Aims: The primary aim of this study was to determine the surgical team's learning curve for introducing robotic-arm assisted unicompartmental knee arthroplasty (UKA) into routine surgical practice. The secondary objective was to compare accuracy of implant positioning in conventional jig-based UKA versus robotic-arm assisted UKA. Patients and Methods: This prospective single-surgeon cohort study included 60 consecutive conventional jig-based UKAs compared with 60 consecutive robotic-arm assisted UKAs for medial compartment knee osteoarthritis. Patients undergoing conventional UKA and robotic-arm assisted UKA were well-matched for baseline characteristics including a mean age of 65.5 years (sd 6.8) vs 64.1 years (sd 8.7), (p = 0.31); a mean body mass index of 27.2 kg.m2 (sd 2.7) vs 28.1 kg.m2 (sd 4.5), (p = 0.25); and gender (27 males: 33 females vs 26 males: 34 females, p = 0.85). Surrogate measures of the learning curve were prospectively collected. These included operative times, the Spielberger State-Trait Anxiety Inventory (STAI) questionnaire to assess preoperative stress levels amongst the surgical team, accuracy of implant positioning, limb alignment, and postoperative complications. Results: Robotic-arm assisted UKA was associated with a learning curve of six cases for operating time (p < 0.001) and surgical team confidence levels (p < 0.001). Cumulative robotic experience did not affect accuracy of implant positioning (p = 0.52), posterior condylar offset ratio (p = 0.71), posterior tibial slope (p = 0.68), native joint line preservation (p = 0.55), and postoperative limb alignment (p = 0.65). Robotic-arm assisted UKA improved accuracy of femoral (p < 0.001) and tibial (p < 0.001) implant positioning with no additional risk of postoperative complications compared to conventional jig-based UKA. Conclusion: Robotic-arm assisted UKA was associated with a learning curve of six cases for operating time and surgical team confidence levels but no learning curve for accuracy of implant positioning. Cite this article: Bone Joint J 2018;100-B:1033-42.

Physiographical variability in arsenic dynamics in Bangladeshi soils.

Rice plants grown on soils with elevated arsenic have been shown to have increased arsenic content in their grains. To gain a better understanding of the likelihood of high grain arsenic in rice grown in different soils, it is important to understand the factors affecting the bioavailability and mobility of arsenic. Paddy soils from six different physiographic regions of Bangladesh were collected, and diffusive gradients in thin-films (DGT) were used to assess the porewater and solid phase arsenic. While significant differences were identified in total soil arsenic (1.4-9.8mg/kg), porewater arsenic (AsCsoln) (5.6-64.7µg/l), labile arsenic (AsCDGT) (6.3-77.6µg/l), and solid phase pool of arsenic (AsKd) (52-1057l/kg), importantly arsenic resupply capacity was not different between the physiographic regions. All soils had a high ratio of DGT to porewater arsenic (~1), this in conjunction with the porewater arsenic values and the high AsKd values suggesting a large solid phase pool of arsenic capable of contributing towards the resupply/transport of the labile pool of arsenic in the soil porewater. This indicates that there is less difference in soil arsenic availability than might be predicted based solely on total soil arsenic content between the physiographic regions.

Ion trap mass spectrometry on a comet nucleus: the Ptolemy instrument and the Rosetta space mission.

In May 2014, the Rosetta spacecraft is scheduled to rendezvous with the comet Churyumov-Gerasimenko ('67P'). One of the instruments on board the 'Lander' which will descend on to the surface of the comet is a miniaturised GC/MS system that incorporates an ion trap mass spectrometer, specially developed for isotope ratio analysis. This article describes the development and optimisation of the ion trap for this unique application, and presents a summary of the range of pre-programmed experiments that will contribute to the characterisation of the solid and volatile cometary materials.

Osmotic demyelination syndromes: central and extrapontine myelinolysis.

Osmotic demyelination syndromes are often progressive disorders, with clinical features ranging from a mild tremor or dysarthria to a progressive quadraparesis. Although rapid correction of serum sodium is known to be a potent causative factor, additional pathogenic factors exist, which appear critical in predisposing pontine and extrapontine glia to osmotic stress. Interestingly, several cases of osmotic demyelination have emerged where serum sodium was found to be within normal limits and minimal or no correction of a hypo or hypernatraemic state was implemented. We describe two cases--one of extra pontine and another of central-pontine myelinolysis, both of which have occurred in the context of relatively normal serum sodium. The first case illustrates the association of extrapontine myelinolysis with the traditional risk factor of alcoholic cirrhosis and intravenous fluid resuscitation, while the second, more unusual case, describes a patient who developed central pontine myelinolysis possibly in association with alpha interferon therapy.

A representative assessment of the management of open fractures of the lower limb within UK orthoplastic centres: A two-centre audit of compliance with national standards.

BACKGROUND: Open fractures of the lower limb represent a complex and varied array of injuries. The BOAST 4 document produced by BAPRAS and the BOA provides standards on how to manage these patients, and NICE have recently produced additional guidance. We aimed to assess concordance with these standards in a large cohort representative of UK orthoplastic centres. METHODS: Patients admitted to the orthoplastic units at Norfolk and Norwich University Hospital and Royal Stoke University Hospital with open lower limb fractures between 2009 and 2014 were included. Data was gathered from notes and endpoints based on the BOAST 4 document. RESULTS: In total, 84 patients were included across the two sites, with 83 having their initial debridement within 24h (98.8%). Forty-two patients had a documented out-of-hours initial surgery. Of these, 10 (23.8%) had an indication for urgent surgery. This pattern was consistent across both hospitals. A plastic surgeon was present at 33.3% of initial operations. Of 78 patients receiving definitive soft tissue cover, 56.4% had cover within 72h and 78.2% within 7days. Main reasons for missing these targets were transfer from other hospitals, plastic surgeons not present at initial operation and intervening critical illness. CONCLUSIONS: This study has identified key areas for improving compliance with the national BOAST 4 and NICE standards. Out-of-hours operating is occurring unnecessarily and time targets are being missed. The development of dedicated referral pathways and a true orthoplastic approach are required to improve the management of this complex set of injuries.

Arsenic in Bangladeshi soils related to physiographic region, paddy management, and mirco- and macro-elemental status.

While the impact of arsenic in irrigated agriculture has become a major environmental concern in Bangladesh, to date there is still a limited understanding of arsenic in Bangladeshi paddy soils at a landscape level. A soil survey was conducted across ten different physiographic regions of Bangladesh, which encompassed six types of geomorphology (Bil, Brahmaputra floodplain, Ganges floodplain, Meghna floodplain, Karatoya-Bangali floodplain and Pleistocene terrace). A total of 1209 paddy soils and 235 matched non-paddy soils were collected. The source of irrigation water (groundwater and surface water) was also recorded. The concentrations of arsenic and sixteen other elements were determined in the soil samples. The concentration of arsenic was higher in paddy soils compared to non-paddy soils, with soils irrigated with groundwater being higher in arsenic than those irrigated with surface water. There was a clear difference between the Holocene floodplains and the Pleistocene terraces, with Holocene floodplain soils being higher in arsenic and other elements. The results suggest that arsenic is most likely associated with less well weathered/leached soils, suggesting it is either due to the geological newness of Holocene sediments or differences between the sources of sediments, which gives rise to the arsenic problems in Bangladeshi soils.

Arsenic contamination in food-chain: transfer of arsenic into food materials through groundwater irrigation.

Arsenic contamination in groundwater in Bangladesh has become an additional concern vis-à-vis its use for irrigation purposes. Even if arsenic-safe drinking-water is assured, the question of irrigating soils with arsenic-laden groundwater will continue for years to come. Immediate attention should be given to assess the possibility of accumulating arsenic in soils through irrigation-water and its subsequent entry into the food-chain through various food crops and fodders. With this possibility in mind, arsenic content of 2,500 water, soil and vegetable samples from arsenic-affected and arsenic-unaffected areas were analyzed during 1999-2004. Other sources of foods and fodders were also analyzed. Irrigating a rice field with groundwater containing 0.55 mg/L of arsenic with a water requirement of 1,000 mm results in an estimated addition of 5.5 kg of arsenic per ha per annum. Concentration of arsenic as high as 80 mg per kg of soil was found in an area receiving arsenic-contaminated irrigation. A comparison of results from affected and unaffected areas revealed that some commonly-grown vegetables, which would usually be suitable as good sources of nourishment, accumulate substantially-elevated amounts of arsenic. For example, more than 150 mg/kg of arsenic has been found to be accumulated in arum (kochu) vegetable. Implications of arsenic ingested in vegetables and other food materials are discussed in the paper.