Hallux valgus surgery in children with cerebral palsy: A systematic review.

BACKGROUND: Children with cerebral palsy are highly likely to develop foot deformities, some of which may require surgical intervention. Hallux valgus is a common forefoot deformity which can cause issues with pain, footwear, orthotic splints and soft tissues. It remains unclear what the optimal surgical treatment is for children with cerebral palsy and hallux valgus deformity. OBJECTIVE: To systematically review studies reporting the clinical and radiological outcomes of surgical correction of hallux valgus deformity in children with cerebral palsy. METHODS: A systematic review of studies published in electronic databases (Medline, Embase, Pubmed and Cochrane library) from inception until January 2021. Keywords related to hallux valgus and cerebral palsy were included. RESULTS: 58 studies were identified of which 7 met the criteria for inclusion. 200 feet in 134 patients with a mean age of 13.5 years were included, with a mean follow up period of 43 months. A range of clinical and radiographic outcomes were assessed. A treatment framework for the assessment and management of hallux valgus in children with cerebral palsy based on the published evidence is presented. CONCLUSION: Non-ambulant children with cerebral palsy with symptomatic hallux valgus should primarily undergo first MTPJ arthrodesis whilst those who are ambulant should undergo first metatarsal osteotomy± soft tissue correction.

Can virtual reality headsets be used safely as a distraction method for paediatric orthopaedic patients? A feasibility study.

INTRODUCTION: Virtual reality (VR) has been shown to decrease pain and anxiety in clinical areas. The purpose of this study was to assess the feasibility of 'Rescape DR.VR Junior' headset as a distraction method for paediatric orthopaedic patients. METHODS: An internal risk assessment by medical engineers to determine its safety deemed the device safe to be used only in the venepuncture and plaster rooms, while further investigation is needed to establish its safety in the operating theatre/anaesthetic room. A total of 32 children (age range: 2-15 years) took the option to use the device while they underwent venepuncture or a cast procedure. Anxiety scores, measured on a Likert scale, were collected pre and postprocedure. Participants were asked if they would use the device again. Subjective feedback was also collated from the supervising clinical staff. RESULTS: A total of 66% (21) showed a reduction in anxiety scores, 28% (9) had no change in score; all scores being mild, 1-3 on the Likert scale; 6% (2) showed an increase in postprocedure score. All participants stated they would use the device again. One patient declined the device. Health professionals also gave positive subjective feedback and they would all use it again with their paediatric patients. No adverse events were recorded. CONCLUSION: The 'Rescape DR.VR Junior' headset has been found to be a safe and feasible distraction method for use in children in the venepuncture and plaster room. Further research is required to assess its safety and effectiveness in other clinical areas, including the paediatric orthopaedic operating theatre.

Can virtual reality headsets be used safely as a distraction method for paediatric orthopaedic patients? A feasibility study.

INTRODUCTION: Virtual reality (VR) has been shown to decrease pain and anxiety in clinical areas. The purpose of this study was to assess the feasibility of 'Rescape DR.VR Junior' headset as a distraction method for paediatric orthopaedic patients. METHODS: An internal risk assessment by medical engineers to determine its safety deemed the device safe to be used only in the venepuncture and plaster rooms, while further investigation is needed to establish its safety in the operating theatre/anaesthetic room. A total of 32 children (age range: 2-15 years) took the option to use the device while they underwent venepuncture or a cast procedure. Anxiety scores, measured on a Likert scale, were collected pre and postprocedure. Participants were asked if they would use the device again. Subjective feedback was also collated from the supervising clinical staff. RESULTS: A total of 66% (21) showed a reduction in anxiety scores, 28% (9) had no change in score; all scores being mild, 1-3 on the Likert scale; 6% (2) showed an increase in postprocedure score. All participants stated they would use the device again. One patient declined the device. Health professionals also gave positive subjective feedback and they would all use it again with their paediatric patients. No adverse events were recorded. CONCLUSION: The 'Rescape DR.VR Junior' headset has been found to be a safe and feasible distraction method for use in children in the venepuncture and plaster room. Further research is required to assess its safety and effectiveness in other clinical areas, including the paediatric orthopaedic operating theatre.

Toxicity bioassay of waste cooking oil-based biodiesel on marine microalgae.

The world biodiesel production is increasing at a rapid rate. Despite its perceived safety for the environment, more detailed toxicity studies are mandatory, especially in the field of aquatic toxicology. While considerable attention has been paid to biodiesel combustion emissions, the toxicity of biodiesel in the aquatic environment has been poorly understood. In our study, we used an algae culture growth-inhibition test (OECD 201) for the comparison of the toxicity of B100 (pure biodiesel), produced by methanol transesterification of waste cooking oil (yellow grease), B0 (petroleum diesel fuel) and B20 (diesel-biodiesel blended of 20% biodiesel and 80% petroleum diesel fuel by volume). Two marine diatoms Attheya ussuriensis and Chaetoceros muelleri, the red algae Porphyridium purpureum and Raphidophyte Heterosigma akashiwo were employed as the aquatic test organisms. A sample of biodiesel from waste cooking oil without dilution with petroleum diesel (B100) showed the highest level of toxicity for the microalgae A. ussuriensis, C. muelleri and H. akashiwo, compared to hexane, methanol, petroleum diesel (B0) and diluted sample (B20). The acute EC50 in the growth-inhibition test (96 h exposure) of B100 for the four species was in the range of 3.75-23.95 g/L whereas the chronic toxicity EC50 (7d exposure) was in the range of 0.42-16.09 g/L.

Morphological and chemical composition of particulate matter in buses exhaust.

This research article investigates the particulate matter originated from the exhaust emissions of 20 bus models, within the territory of Vladivostok, Russian Federation. The majority of evaluated buses (17 out of 20) had emissions of large particles with sizes greater than 400 µm, which account for more than 80% of all measured particles. The analysis of the elemental composition showed that the exhaust emissions contained Al, Cd, Cu, Fe, Mg, Ni, Pb, and Zn, with the concentration of Zn prevailing in all samples by two to three orders of magnitude higher than the concentrations of the other elements.

Prognostic factors for premature growth plate arrest as a complication of the surgical treatment of fractures of the medial malleolus in children.

McFarland fractures of the medial malleolus in children, also classified as Salter-Harris Type III and IV fractures, are associated with a high incidence of premature growth plate arrest. In order to identify prognostic factors for the development of complications we reviewed 20 children with a McFarland fracture that was treated surgically, at a mean follow-up of 8.9 years (3.5 to 17.4). Seven children (35%) developed premature growth arrest with angular deformity. The mean American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale for all patients was 98.3 (87 to 100) and the mean modified Weber protocol was 1.15 (0 to 5). There was a significant correlation between initial displacement (p = 0.004) and operative delay (p = 0.007) with premature growth arrest. Both risk factors act independently and additively, such that all children with both risk factors developed premature arrest whereas children with no risk factor did not. We recommend that fractures of the medial malleolus in children should be treated by anatomical reduction and screw fixation within one day of injury.

Hair nicotine/cotinine concentrations as a method of monitoring exposure to tobacco smoke among infants and adults.

In this pilot study, we examined the validity and usefulness of hair nicotine-cotinine evaluation as a biomarker of monitoring exposure to tobacco. Head hair samples were collected from 22 infants (<2 years of age) and 44 adults with different exposures to tobacco (through either active or passive smoking) and analyzed by liquid chromatography-mass spectrometry (LC-MS) for nicotine and cotinine. Hair samples were divided into three groups, infants, passive smoker adults and active smoker adults, and into eight subgroups according to the degree of exposure. The limit of quantification (LOQ) was 0.1 ng/mg for nicotine and 0.05 ng/mg for cotinine. Mean recovery was 69.15% for nicotine and 72.08% for cotinine. The within- and between-day precision for cotinine and nicotine was calculated at different concentrations. Moreover, hair nicotine and cotinine concentrations were highly correlated among adult active smokers (R (2) = 0.710, p < 0.001), among adult nonsmokers exposed to secondhand smoke (SHS; R (2) = 0.729, p < 0.001) and among infants (R (2) = 0.538, p = 0.01). Among the infants exposed to SHS from both parents the noted correlations were even stronger (R (2) = 0.835, p = 0.02). The above results identify the use of hair samples as an effective method for assessing exposure to tobacco, with a high association between nicotine and cotinine especially among infants heavily exposed to SHS.

Effect of lumbar disc replacement on the height of the disc space and the geometry of the facet joints: a cadaver study.

In a study on ten fresh human cadavers we examined the change in the height of the intervertebral disc space, the angle of lordosis and the geometry of the facet joints after insertion of intervertebral total disc replacements. SB III Charité prostheses were inserted at L3-4, L4-5, and L5-S1. The changes studied were measured using computer navigation software applied to CT scans before and after instrumentation. After disc replacement the mean lumbar disc height was doubled (p < 0.001). The mean angle of lordosis and the facet joint space increased by a statistically significant extent (p < 0.005 and p = 0.006, respectively). By contrast, the mean facet joint overlap was significantly reduced (p < 0.001). Our study indicates that the increase in the intervertebral disc height after disc replacement changes the geometry at the facet joints. This may have clinical relevance.

Determination of dialkyl phosphates in human hair for the biomonitoring of exposure to organophosphate pesticides.

A new, simple, fast and sensitive method that enables the measurement of four dialkyl phosphates (DAPs) in human head hair is presented in the current study. The dialkyl phosphates, dimethyl phosphate (DMP), diethyl phosphate (DEP), diethyl thiophosphate (DETP) and diethyl dithiophosphate (DEDTP) are non-selective metabolites of the organophosphate pesticides (OPs). The extraction of DAPs from hair matrix was achieved by one step methanolic extraction. Head hair samples from general population and population occupationally exposed to OPs were analysed using gas chromatography-mass spectrometry (GC-MS) after derivatization with pentafluorobenzylbromide. The recovery of the target compounds was estimated at 84.3% for DMP, 116.1% for DEP, 109.0% for DETP and 91.5% for DEDTP. The limit of quantitation (LOQ) and detection (LOD) was 20 and 6 pg/mg for DMP, 10 and 5 pg/mg for DEP and DETP and 5 and 3 pg/mg for DEDTP, respectively. With-run and between-run precision as well as accuracy was estimated. The percentage of positive hair samples for DMP, DEP, DETP and DEDTP for the group of general population was 63.0%, 96.3%, 66.7%, and 70.4% respectively. The samples from the group with occupational exposure were positive for all dialkyl phosphates analysed. The median concentrations for DMP were 165.0 and 181.7 pg/mg, for DEP were 51.2 and 812.9 pg/mg, for DETP were 54.0 and 660.1 pg/mg, and for DEDTP were 40.0 and 60.6 pg/mg for the general population group and the group with occupational exposure respectively. Significant differences in the levels of the total dialkyl phosphates amongst exposed and not exposed groups were observed (p<0.001). More specifically, the total ethyl phosphate (DEPs) and DAPs median concentrations were 119.5 and 301.5 pg/mg for the general population group and 1498.8 and 1694.4 pg/mg for the group with occupational exposure.

Haematogenous infection of a resurfacing hip replacement after transurethral resection of the prostate.

A 66-year-old man presented with an infected resurfacing hip replacement in the immediate post-operative period following an uneventful transurethral resection of the prostate. Prophylactic antibiotics had been administered on induction of anaesthesia. The hip prosthesis had been inserted seven years previously and had been hitherto asymptomatic. The hip was washed out and microbiological examination identified Enterococcus faecalis as the infecting micro-organism. Despite current recommendations, clinicians undertaking invasive procedures which can lead to bacteraemia in patients with prosthetic joint replacements should be aware of the risk of haematogenous seeding in such prostheses, which although low, has potentially disastrous consequences.