Highlighting the Benefits of Rehabilitation Treatments in Hip Osteoarthritis.

Background and objectives: Due to its frequency and possible complications, hip arthrosis or hip osteoarthritis (hip OA) has a high social impact, its advanced stages eventually leading to irreversible lesions involving major complications or surgery. In the early stages, conservative treatment plays a key role in the prophylaxis of complications and in slowing down the degenerative process. The association between an appropriate drug therapy (DT) and a rehabilitation treatment (RT)­including individualized physical therapy (PT) and adapted occupational therapy (OT)­provides good results. Our objective was to highlight the benefits of associating RT with DT in patients with hip OA. Materials and Methods: An observational follow-up study was conducted between 2018−2021, which included 100 patients with hip OA divided into two groups: the study group­group A (50 subjects who complied with RT) and the control group­group B (who did not comply with RT). To evaluate them, the evolution of the Lequesne hip index (LHI), Tinetti test (TT) and the hip joint mobility: flexion (FH) and abduction (AH) were monitored before the beginning of the study (T0) and after one-year (T1) for each patient. The mean values of the parameters, the standard deviations, the frequency intervals, as well as the tests of statistical significance were calculated using the Student method (t-test) and χ2, ANOVA (Bonferroni) being used to compare the means. Results: Compared to the evolution of group B, improvements were observed in group A, as follows: in LHI group A (p = 0.023) vs. group B (p = 0.650); in TT group A (p = 0.011) vs. group B (p < 0.001); in FH group A (p = 0.001) vs. group B (p = 0.025); in AH group A (p = 0.001) vs. group B (p < 0.001). BMI changes were non-significant in both groups A (p = 0.223) and B (p = 0.513). Evaluating group A, the most significant improvements of the studied parameters were observed in the age group 41−50 years. Conclusions: The study reveals the benefits of combining RT with DT in patients with especially early-stage hip OA, aged up to 50 years old.

L3 Skeletal Muscle Index Dynamics in Patients with HCV-Related Compensated Cirrhosis Following Sustained Virological Response after Direct Acting Antiviral Treatment.

Background and Objectives: Sarcopenia is commonly associated with liver cirrhosis and predicts clinical outcome. Our aim was to identify the changes in skeletal muscle index (SMI) on computed tomography (CT) examination, as a quantitative marker of sarcopenia, in patients with HCV-related cirrhosis after direct acting antivirals (DAAs) treatment and to assess predictive factors for the evolution of SMI. Materials and Methods: This is a single center retrospective study in patients with HCV-related compensated cirrhosis who obtained sustained virological response (SVR) after DAAs. CT examinations were performed in 52 patients before and within 5-24 months after treatment. The total muscle area (TMA) of abdominal muscle at the level of third lumbar vertebra (L3) was measured at baseline and after SVR. The L3-SMI was calculated from TMA divided by body height squared (cm2/m2). We assessed changes in L3-SMI after SVR according to baseline body mass index (BMI) and laboratory data. Predictive factors were assessed by linear regression model. Results: Patients with L3-SMI above the gender-specific cut-off value at baseline had higher values of serum creatinine (median 0.73) compared to patients with low L3-SMI (median 0.68, p = 0.031). After SVR, 14 patients showed increase of L3-SMI, and 38 patients had a decrease of L3-SMI. BMI in the decreased L3-SMI group was significantly lower (median 26.17) than those without decreased L3-SMI (median 28.84, p = 0.021). ALT values in the decreased L3-SMI group (median 66.5) were significantly lower than those without a decrease in L3-SMI (median 88, p = 0.045). Conclusions: Low creatinine serum level correlates with sarcopenia. SMI was partially influenced by the viral clearance. Lower BMI and ALT serum levels at baseline were predictive for no benefit in terms of muscle mass dynamics. Understanding all the mechanisms involved in sarcopenia and identifying the most vulnerable patients could ensure optimal adapted care strategies.

Proposal of a Preoperative CT-Based Score to Predict the Risk of Clinically Relevant Pancreatic Fistula after Cephalic Pancreatoduodenectomy.

Background and Objectives: Postoperative pancreatic fistula after cephalic pancreatoduodenectomy (CPD) is still the leading cause of postoperative morbidity, entailing long hospital stay and costs or even death. The aim of this study was to propose the use of morphologic parameters based on a preoperative multisequence computer tomography (CT) scan in predicting the clinically relevant postoperative pancreatic fistula (CRPF) and a risk score based on a multiple regression analysis. Materials and Methods: For 78 consecutive patients with CPD, we measured the following parameters on the preoperative CT scans: the density of the pancreas on the unenhanced, arterial, portal and delayed phases; the unenhanced density of the liver; the caliber of the main pancreatic duct (MPD); the preoperatively estimated pancreatic remnant volume (ERPV) and the total pancreatic volume. We assessed the correlation of the parameters with the clinically relevant pancreatic fistula using a univariate analysis and formulated a score using the strongest correlated parameters; the validity of the score was appreciated using logistic regression models and an ROC analysis. Results: When comparing the CRPF group (28.2%) to the non-CRPF group, we found significant differences of the values of unenhanced pancreatic density (UPD) (44.09 ± 6.8 HU vs. 50.4 ± 6.31 HU, p = 0.008), delayed density of the pancreas (48.67 ± 18.05 HU vs. 61.28 ± 16.55, p = 0.045), unenhanced density of the liver (UDL) (44.09 ± 6.8 HU vs. 50.54 ± 6.31 HU, p = 0.008), MPD (0.93 ± 0.35 mm vs. 3.14 ± 2.95 mm, p = 0.02) and ERPV (46.37 ± 10.39 cm3 vs. 34.87 ± 12.35 cm3, p = 0.01). Based on the odds ratio from the multiple regression analysis and after calculating the optimum cut-off values of the variables, we proposed two scores that both used the MPD and the ERPV and differing in the third variable, either including the UPD or the UDL, producing values for the area under the receiver operating characteristic curve (AUC) of 0.846 (95% CI 0.694-0.941) and 0.774 (95% CI 0.599-0.850), respectively. Conclusions: A preoperative CT scan can be a useful tool in predicting the risk of clinically relevant pancreatic fistula.

Liver Remodeling on CT Examination in Patients with HCV Compensated Cirrhosis Who Achieved Sustained Virological Response after Direct-Acting Antivirals Treatment.

Aims: The purpose of this study was to assess the changes in hepatic morphology evaluated by computed tomography (CT) examination in patients with hepatitis C virus (HCV)-related compensated cirrhosis who achieved sustained virologic response (SVR) after direct-acting antivirals (DAAs) treatment. Methods: CT examination was performed in 56 patients with HCV-related compensated cirrhosis before and within 6-18 months after the treatment with Ombitasvir/Paritaprevir/ritonavir + Dasabuvir. The liver CT changes were assessed by measuring liver volume, caudate-right lobe ratio (C/RL), hepatic vessels diameters, periportal widening space, and right posterior notch. Portal trunk, splenic and superior mesenteric vein diameters, as well as spleen volume were assessed as part of portal hypertension. Results: Right hepatic vein diameter was significantly wider after treatment (median: 8.12 mm; IQR: 4.20) than before treatment (median: 6.36 mm; IQR: 3.94) z = -3.894; p < 0.001. The liver volume was significantly higher prior to the treatment (median: 1786.77 mm3; IQR: 879.23) than after treatment (median: 1716.44 mm3; IQR: 840.50), z = -1.970; p = 0.049. Splenic volume was considerably higher before treatment (median: 564.79 mm3; IQR: 342.54) than after (median: 474.45 mm3; IQR: 330.00), z = -2.500; p = 0.012. The other parameters, such as C/RL, periportal space widening, and right hepatic notch showed no significant changes. Conclusions: SVR in patients with HCV-related compensated cirrhosis treated with DAAs is associated with some improvements of hepatic morphology detectable by CT, the most constant being the increase of right hepatic vein diameter.

Material flow design and simulation for a glass panel recycling installation.

The current paper presents the design of a glass panels recycling flow and the method used for establishing the optimal processing installation architecture. In the solution provided in the current research, a novel approach centred on applying digital twinning in the design of the requested processing architecture is presented. It involves designing the virtual prototype of the diffused processing architecture and modelling the glass waste flow as a hybrid material flow. Dedicated analysis and simulation software is then used for establishing installation architecture and the specific parameters for each processing and transport capacity. The assessment of different processing scenarios by virtual modelling and simulations can also be used for exploring options to increase productivity and profit for other different recycling architectures. The main practical value of the study consists of creating the means to improve the waste recycling of automotive windshields, float glass or construction glass panels with metallic meshes, all representing categories of waste insufficiently recycled in Romania. The simulation results of the study were validated by tests made on the glass panel recycling installation. Also, a recovery glass rate of minimum 85% of the amount of waste loaded into the recycling system was achieved, obtaining a waste recycling quantity three times higher than initially anticipated.

Macro and microplastic pollution in Romania: addressing knowledge gaps and potential solutions under the circular economy framework.

Background: This review reveals the role of linear economy prevalence and mismanagement practices in plastic pollution of aquatic and terrestrial environments and related knowledge gaps in Romania while outlining downstream and upstream solutions to reduce plastic pollution and adopt circular economy strategies. Thus, the major aim of this study is the investigation of the stage of scientific knowledge concerning all these demands in the Romanian context. Methodology: This work integrates two main approaches: (i) a bibliometric analysis fed by Web of Science and Scopus databases to reveal the current coverage of peer-reviewed literature related to plastic waste in Romania and (ii) a subject-based review to underline the main themes related to plastic waste management, plastic pollution, and mitigating options in Romania in line with circular economy principles. Results: Reducing plastic pollution requires scientific knowledge, multi-sectoral cooperation, and societal awareness. Following this, the topics of plastic waste and plastic pollution appeared to be under-investigated in the literature considering Romania as a case study and concentrated around the 2020 year, emphasizing, in this way, the trendiness of plastic waste concerns and their management in the current research landscape. Our analysis points out that: (i) Romania is facing massive plastic pollution requiring solid improvements in waste management performances; (ii) few peer-reviewed research studies are performed in Romania for both macro and microplastic concerns with unknown pollution levels in most of its geographical regions; (iii) the plastic waste management is still understudied here, while waste statistics are poorly available at local levels; (iv) the perspectives of circular economy transition are still limited, feeding the plastic pollution in the coming years. Conclusions: Several knowledge gaps are identified and must be covered by future research such as (i) adjusting mismanaged plastic waste levels to regional waste management performances and determining littering rates in urban and rural areas to improve the plastic pollution modeling inputs; (ii) examining plastic pollution associated with landfill sites and waste imports; (iii) assessing the sectoral contributions to macro and microplastic pollution of aquatic environments related to municipalities, tourist destinations, agriculture, etc.; (iv) determining retention levels of plastic in river basins and role of riparian vegetation; (v) analyzing microplastics presence in all types of freshwater environments and interlinkage between macroplastic fragmentation and microplastic; (vi) assessing the plastic loads of transboundary rivers related to mismanagement practices; (vii) determining concentrations of microplastics in air, soil, and other land use ecosystems.

Review of microplastics and chemical risk posed by plastic packaging on the marine environment to inform the Global Plastics Treaty.

Plastic overproduction and the resulting increase in consumption has made plastic pollution ubiquitous in all ecosystems. Recognizing this, the United Nations (UN) has started negotiations to establish a global treaty to end plastic pollution, especially in the marine environment. The basis of the treaty has been formulated in terms of turning off the tap, signaling the will to prevent plastic pollution at its source. Based on the distribution of plastic production by sector, the plastic packaging sector consumes the most plastic. The volume and variety of chemicals used in plastic packaging, most of which is single-use, is a major concern. Single-use plastics including packaging is one of the most dominant sources of plastic pollution. Plastic waste causes pollution in water, air and soil by releasing harmful chemicals into the environment and can also lead to exposure through contamination of food with micro- and nano-plastic particles and chemicals through packaging. Marine life and humans alike face risks from plastic uptake through bioaccumulation and biomagnification. While the contribution of plastics ingested to chemical pollution is relatively minor in comparison to other pathways of exposure, the effect of plastic waste on marine life and human consumption of seafood is beyond question. To reduce the long-term impact of plastic, it is crucial to establish a global legally binding instrument to ensure the implementation of upstream rather than downstream solutions. This will help to mitigate the impact of both chemicals and microplastics, including from packaging, on the environment.

The unknown fate of macroplastic in mountain rivers.

Mountain rivers are typically seen as relatively pristine ecosystems, supporting numerous goods (e.g., water resources) for human populations living not only in the mountain regions but also downstream from them. However recent evidence suggests that mountain river valleys in populated areas can be substantially polluted by macroplastic (plastic item >25 mm). It is unknown how distinct characteristics of mountain rivers modulate macroplastic routes through them, which makes planning effective mitigation strategies difficult. To stimulate future works on this gap, we present a conceptual model of macroplastic transport pathways through mountain river. Based on this model, we formulate four hypotheses on macroplastic input, transport and mechanical degradation in mountain rivers. Then, we propose designs of field experiments that allow each hypothesis to be tested. We hypothesize that some natural characteristics of mountain river catchments can accelerate the input of improperly disposed macroplastic waste from the slope to the river. Further, we hypothesize that specific hydromorphological characteristics of mountain rivers (e.g., high flow velocity) accelerate the downstream transport rate of macroplastic and together with the presence of shallow water and coarse bed sediments it can accelerate mechanical degradation of macroplastic in river channels, accelerating secondary microplastic production. The above suggests that mountain rivers in populated areas can act as microplastic factories, which are able to produce more microplastic from the same amount of macroplastic waste inputted into them (in comparison to lowland rivers that have a different hydromorphology). The produced risks can not only affect mountain rivers but can also be transported downstream. The challenge for the future is how to manage the hypothesized risks, especially in mountain areas particularly exposed to plastic pollution due to waste management deficiencies, high tourism pressure, poor ecological awareness of the population and lack of uniform regional and global regulations for the problem.

Mountains of plastic: Mismanaged plastic waste along the Carpathian watercourses.

Plastic waste poses numerous risks to mountain river ecosystems due to their high biodiversity and specific physical characteristics. Here, we provide a baseline assessment for future evaluation of such risks in the Carpathians, one of the most biodiverse mountain ranges in East-Central Europe. We used high-resolution river network and mismanaged plastic waste (MPW) databases to map MPW along the 175,675 km of watercourses draining this ecoregion. We explored MPW levels as a function of altitude, stream order, river basin, country, and type of nature conservation in a given area. The Carpathian watercourses below 750 m a.s.l. (142,282 km, 81 % of the stream lengths) are identified as significantly affected by MPW. Most MPW hotspots (>409.7 t/yr/km2) occur along rivers in Romania (6568 km; 56.6 % of all hotspot lengths), Hungary (2679 km; 23.1 %), and Ukraine (1914 km; 16.5 %). The majority of the river sections flowing through the areas with negligible MPW (< 1 t/yr/km2) occur in Romania (31,855 km; 47.8 %), Slovakia (14,577 km; 21.9 %), and Ukraine (7492; 11.2 %). The Carpathian watercourses flowing through the areas protected at national level (3988 km; 2.3 % of all watercourses studied) have significantly higher MPW values (median = 7.7 t/yr/km2) than those protected at regional (51,800 km; 29.5 %) (median MPW = 1.25 t/yrkm2) and international levels (66 km; 0.04 %) (median MPW = 0 t/yr/km2). Rivers within the Black Sea basin (88.3 % of all studied watercourses) have significantly higher MPW (median = 5.1 t/yr/km2, 90th percentile = 381.1 t/yr/km2) than those within the Baltic Sea basin (median = 6.5 t/yr/km2, 90th percentile = 84.8 t/yr/km2) (11.1 % of all studied watercourses). Our study indicates the locations and extent of riverine MPW hotspots in the Carpathian Ecoregion, which can support future collaborations between scientists, engineers, governments, and citizens to better manage plastic pollution in this region.

Life Cycle Assessment of River Sand and Aggregates Alternatives in Concrete.

Urbanization processes in Asia are still ongoing; thus, aggregate demand is expected to increase in following years. Even though construction and demolition waste is a source for secondary building materials in industrialized countries, it is not yet an alternative construction material source in Vietnam as the urbanization process is still ongoing. Thus, there is a need for river sand and aggregates alternatives in concrete, namely manufactured sand (m-sand) from primary solid rock materials and secondary waste materials. The focus in the present study for Vietnam was on m-sand sand as alternative for river sand, and different ashes as alternatives for cement in concrete. The investigations comprised concrete lab tests according to the formulations of concrete strength class C 25/30 in accordance with DIN EN 206, followed by a lifecycle assessment study in order to identify the environmental impact of the alternatives. In total 84 samples were investigated, consisting of 3 reference samples, 18 samples with primary substitutes, 18 samples with secondary substitutes, and 45 samples with cement substitutes. This kind of holistic investigation approach comprising material alternatives and accompanying LCA was the first study for Vietnam, and even for Asia, and represents a substantial added value for future policy development in order to cope with resource scarcity. The results show that with the exception of metamorphic rocks, all m-sands meet the requirements for quality concrete. In terms of cement replacement, the mixes showed that a higher percentage of ash reduces the compressive strength. The compressive strength values of the mixes with up to 10% coal filter ash or rice husk ash were equivalent to the C25/30 standard concrete formulation. Higher ash contents up to 30% lead to the reduction of the concrete quality. The LCA study's results highlighted the better environmental footprints across environmental impact categories in the 10% substitution material in comparison to the use of primary materials. The LCA analysis results showed that cement as a component in concrete holds the highest footprint. The use of secondary waste as alternative for cement provides significant environmental advantage.

Recent trends and advances in composting and vermicomposting technologies: A review.

Composting technologies have come a long way, developing from static heaps and windrow composting to smart, artificial intelligence-assisted reactor composting. While in previous years, much attention has been paid to identifying ideal organic waste streams and suitable co-composting candidates, more recent efforts tried to determine novel process-enhancing supplements. These include various single and mixed microbial cultures, additives, bulking agents, or combinations thereof. However, there is still ample need to fine-tune the composting process in order to reduce its impact on the environment and streamline it with circular economy goals. In this review, we highlight recent advances in integrating mathematical modelling, novel supplements, and reactor designs with (vermi-) composting practices and provide an outlook for future developments. These results should serve as reference point to target adjusting screws for process improvement and provide a guideline for waste management officials and stakeholders.

In-depth bibliometric analysis and current scientific mapping research in the context of rheumatoid arthritis pharmacotherapy.

Rheumatoid arthritis (RA) is a chronic multifactorial disorder of autoimmune etiology with a complex pathophysiological mechanism that is not yet fully elucidated. RA pharmacotherapy includes active molecules of chemical or biological nature that offer symptomatic relief and a slowing of progression, but still in a context of incurability. Therefore, the development of continuous research and multidisciplinary collaboration is essential. Although the management of RA is a topic of significant scientific relevance, existing bibliometric analyses are insufficient to assess this vast field. Consequently, the present study examines numerous manuscripts indexed in the Web of Science database using the VOSviewer software to provide through statistical interpretation of the data a comprehensive description of RA pharmacotherapy in terms of scientific impact, current state of research, number and frequency of citations, most prolific journals, authors, and countries, along with their relationships and other useful data for the literature search/publication process. Furthermore, the use of bubble maps of term occurrence has applicability in identifying current research trends in the field of RA pharmacotherapy as well as their evolution over the years. The leader in this field in terms of published papers is the United States, and the most prolific journal is Annals of the rheumatic diseases. The global management of RA, which is characterized by extensiveness and depth due to many variables, suggests the need for a conceptual framework based on pharmacotherapy coupled with comprehensive bibliometric studies, and the results may be useful for researchers in setting specific objectives that contribute to improving RA outcomes.

Assessment of COVID-19 Waste Flows During the Emergency State in Romania and Related Public Health and Environmental Concerns.

This paper provides a rapid assessment method of potentially infectious waste flow related to the coronavirus disease (COVID-19) pandemic in Romania focusing on the emergency state (from 16 March to 14 May 2020) where a national lockdown was in force with restrictive and social distancing measures concerning population mobility and economic activities. Medical and municipal waste management systems are critical services in combating the virus spread in the community. This assessment is useful due to poor available data of medical waste flow in environmental reports and it covers COVID-19 patients, quarantined, and self-isolated persons as the main potential infectious waste sources. The proposed model estimates that COVID-19 related waste flow is 4312 t at the national level from 25 February to 15 June of which 2633 t in the emergency state period. This assessment is correlated with deficiencies of medical and municipal waste management systems in Romania before the COVID-19 pandemic as stress factors of public health and environment. This study points out the main challenges of waste operators and reveals some best practices during this pandemic crisis. Based on the results and discussion section, several recommendations are proposed to COVID-19 waste-related issues and points out the crucial role of the reliable medical and municipal waste database in managing such biologic hazards at national and EU levels. Monitoring of COVID-19 waste flow through such models are important for decision-makers, particularly in low and middle-income countries which are facing waste management deficiencies and gaps in waste statistics, to reduce other contamination risks or related environmental threats.

Ulcerated intussuscepted jejunal lipoma-uncommon cause of obscure gastrointestinal bleeding: A case report.

BACKGROUND: Intestinal lipomas are rare benign gastrointestinal (GI) tumors, usually asymptomatic, but may become symptomatic as the result of some complications such as intussusception, intestinal obstruction, volvulus or bleeding. They can occur at any site along the entire GI tract, more frequent in colon and rarely in small intestine. The patient reported here is a very rare case of jejunal lipoma, ulcerated and intussuscepted, diagnosed in an adult investigated for a chronic iron deficiency anemia (IDA), and successfully managed by segmental jejunal resection. CASE SUMMARY: A 63-year-old male was referred to "St. Spiridon" Hospital, Institute of Gastroenterology and Hepatology, Iasi, to investigate an obscure GI bleeding with an IDA. After upper GI endoscopy and colonoscopy were performed, excluding potentially bleeding lesions, videocapsule endoscopy was then carried out, revealing fresh blood and a protruding lesion in proximal jejunum, findings confirmed by a single-balloon enteroscopy. Multiple biopsies were taken from the lesion, but histological results were inconclusive. Then, contrast - enhanced computed tomography was performed showing jejunal polypoid mass with homogenous fat density, suggestive for lipoma. A week later a laparotomy was performed revealing the intussuscepted jejunal segment which was resected en bloc, and sent for further histopathologic analysis. The patient made an uneventful recovery and was discharged seven days later, and at six months follow-up he had no complains and his hemoglobin returned to normal value. CONCLUSION: Lipomas are very rarely located in the jejunum, usually asymptomatic, but they may lead to complications such as intussusception and bleeding. Surgical resection remains the treatment of choice.

Rural plastic emissions into the largest mountain lake of the Eastern Carpathians.

The lack of proper waste collection systems leads to plastic pollution in rivers in proximity to rural communities. This environmental threat is more widespread among mountain communities which are prone to frequent flash floods during the warm season. This paper estimates the amounts of plastic bottles dumped into the Izvoru Muntelui lake by upstream rural communities. The plastic pollution dimension between seasonal floods which affected the Bistrita catchment area during 2005-2012 is examined. The floods dumped over 290 tonnes of plastic bottles into the lake. Various scenarios are tested in order to explain each amount of plastic waste collected by local authorities during sanitation activities. The results show that rural municipalities are responsible for 85.51% of total plastic bottles collected during 2005-2010. The source of plastic pollution is mainly local. The major floods of July 2008 and June 2010 collected most of the plastic bottles scattered across the Bistrita river catchment (56 villages) and dumped them into the lake. These comparisons validate the proposed method as a reliable tool in the assessment process of river plastic pollution, which may also be applied in other geographical areas. Tourism and leisure activities are also found to be responsible for plastic pollution in the study area. A new regional integrated waste management system should improve the waste collection services across rural municipalities at the county level when it is fully operational. This paper demonstrates that rural communities are significant contributors of plastics into water bodies.