Target setting and performance analysis: Promoting e-waste collection in China under the collection target responsibility models.

The increasing volume of electronic waste (e-waste) poses significant challenges for efficient collection in China. Despite many measures were taken over the past two decades, the e-waste collection rate was still not high. To this end, the Chinese government issued a new policy, the collection target responsibility (CTR) policy. Under the CTR policy, however, it is essential for participants to know how to share the responsibility of collection and how much reasonable targets are set to ensure the efficiency of the collection models. Therefore, the purpose of this paper is to explore the determination of optimal collection targets and the corresponding performance from the perspective of responsibility sharing to support the successful implementation of the CTR. Firstly, the study focuses on participants including the government, manufacturers, and recyclers, and develops three CTR models, independent collection model, government cost-sharing model, and enterprise collaboration model. Secondly, collection target equations for each model are established by employing dynamic differential game analysis, and corresponding collection performances are derived. Thirdly, through practical case simulations, the evolution of collection performance is dynamically analyzed to determine reasonable collection targets for the three models, as 23.8%, 32.3%, and 34.4%, respectively. The findings highlight the effectiveness of CTR in improving e-waste collection targets and performance, with the highest levels attained when the collection responsibilities are shared by government cost-sharing and enterprise collaboration. This study provides theoretical support for setting reasonable collection targets under CTR, and assists decision-makers in developing targeted CTR implementation measures.

Critical factors for implementing collection target responsibility in e-waste collection in China: A DEMATEL-ISM analysis.

The Collection Target Responsibility (CTR) is the direction for the proper management of e-waste reuse and recycling. Despite its potential, the CTR policy is still in its infancy in China and faces significant challenges to its effective implementation. There are a few studies that have systematically identified and analyzed the factors that influence the application of CTR to e-waste collection systems in China. This study proposes a comprehensive process that considers collection targets and behaviors to develop the critical factors (CFs) involved in e-waste collection under CTR by participants including government, manufacturers and recyclers. The Decision-making Trial and Evaluation Laboratory and Interpretative Structural Modeling (DEMATEL-ISM) method was applied to analyze these CFs. The findings show that the development of policy and regulation is the root factor influencing the implementation of CTR in China, both in terms of collection targets and behaviors. Incentives and regulation of government, collection channels, and benefits of manufacturers and recyclers are important CFs that participants consider when adopting CTR and should be prioritized. This study not only contributes to the literature on e-waste collection under CTR, but also provides valuable insights for decision-makers to improve the performance of e-waste collection practices.

A hybrid technique combining intramedullary pinning with extramedullary plate fixation in unstable and comminuted radial head fractures following on-table reconstruction.

BACKGROUND: Management of comminuted radial fractures remains controversial. Currently, the emergence of on-table reconstruction technique has made fixation in comminuted radial head fractures more viable. However, the present study reported an intro-operative unstable displacement from the reconstructed radial head to the neck during plate fixation, characterized by a poor radiocapitellar contact and incongruity between the radial head and neck. A hybrid technique combining with intramedullary pining was performed in our study to restore the normal alignment and maintain the stability of fixation. Therefore, the purpose of this article aimed to prove the feasibility of unstable comminuted radial head fractures treated with the extramedullary plate and intramedullary pinning fixation using titanium elastic nails. METHODS: The clinical, functional and radiographic outcomes of the groups were compared during follow-up. The radiographic examination was conducted to evaluate the status of bone union, heterotopic ossification and post-traumatic arthritis. The functional assessment was performed to evaluate clinical effects, which included measurements of range of motion (ROM) in the elbow, Visual Analog Scale (VAS) score, Elbow Self-Assessment score (ESAS), Mayo Elbow Performance score (MEPS), and Disabilities of the Arm, Shoulder, and Hand (DASH)Outcome Measure score. RESULTS: Thirteen patients with unstable fractures were participated with an average follow-up of (38.6 ± 4.5) months for the experimental group and (32.0 ± 6.3) months for the control group, respectively. The functional outcomes in the experimental group, including MEPS and DASH, were significantly superior to the control group. However, no significant difference was observed in the elbow ROM and VAS score between two groups. In the last follow-up, one patient with post-traumatic arthritis rated as grades 1 and two with heterotopic ossifications were observed in the experimental group. In the control group, degenerative changes were observed in three cases (grade 1 in two cases and grade 2 in one case) and heterotopic ossifications rated as grade I were found in two patients. CONCLUSION: Collectively, intramedullary pinning with extramedullary plate fixation is feasible in unstable comminuted radial head fractures, which can be considered as a remedial surgery for on-table reconstruction technique.

Management of Open Calcaneal Fractures with Medial Wounds by One-Stage Sequential Reduction and Frame Structure Fixation Using Percutaneous Kirschner Wires.

OBJECTIVE: To assess the clinical outcomes of open calcaneal fractures with medial wounds treated with one-stage management, including early modern wound care, sequential reduction, and frame structure fixation using percutaneous Kirschner wires. METHODS: A total of 19 patients with open calcaneal fractures admitted to our hospital from May 2016 to March 2019 were selected in this study. Twelve type-II and seven type-IIIA medial open injuries were identified according to the classification of Gustilo and Anderson. Fractures were stratified by Sanders classification, including nine type-II fractures, seven type-III fractures, and three type-IV fractures. All patients accepted one-stage irrigation and debridement, sequential reduction of calcaneal fractures through the open medial wound, percutaneous Kirschner wire fixation, and primary closure of wounds covered with vacuum-assisted closure (VAC) device. The Bohler angle, the Gissane angle, and the width of the calcaneus were compared before and after surgery. The functional results were evaluated according to the Paley and Hall score system, visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, Maryland Foot Score, and related complications. RESULTS: The follow-up duration for all patients ranged from 14 to 28 months (mean, 22.7 months). The angle of Bohler and Giasane was increased from (-7.6° ± 15.0°) and (96.6° ± 7.6°) before surgery to (23.7° ± 6.1°) and (124.1° ± 7.1°) postoperatively (P < 0.05), respectively. Three cases of superficial infection and two cases of wound dehiscence were observed in our study, which were then successfully treated with wound debridement, VAC replacement, appropriate use of antibiotics, and delayed closure. The last follow-up revealed three cases of lateral wall expansion and six cases of mild-to-moderate subtalar arthritis based on the Paley and Hall scoring system. According to the AOFAS ankle and hindfoot score, one case showed excellent results, 14 cases exhibited good results, and four cases displayed fair results, with the mean of 80.7 ± 6.7 points (range, 70-90). The Maryland Foot Score revealed one case of excellent outcomes, nine cases of good outcomes, and nine cases of fair outcomes with an average of 76.8 ± 8.6 points (range, 62-90). The mean VAS for pain was 1.8 ± 1.5 (range, 0-5), and a total of 14 patients complained of mild-to-moderate pain when walking for a more extended period. Severe complications, such as deep infection, osteomyelitis, and soft tissue necrosis, were not observed during follow-up. CONCLUSIONS: Collectively, one-stage management allowed the direct restoration of calcaneal morphology with a minimal invasion of soft tissues in most open calcaneal fractures with medial wounds, and the functional outcomes were comparable to previous data.

Preoperative irrigation and vacuum sealing drainage with antibiotic-containing drainage fluid of foot and ankle wounds improves outcome of reconstructive skin flap surgery.

OBJECTIVES: By observing the infection and soft tissue defect on the wound surface of the foot and ankle, this paper attempts to explore the effect of preoperative irrigation and vacuum sealing drainage with antibiotic-containing drainage fluid (abPI-VSD) on the bacterial quantity and the local inflammatory response at the flap, and further to provide a basis for applying this technique before a reconstructive skin flap surgery of foot and ankle wounds. METHODS: Seventy-five patients were randomly divided into two groups, and all surgeries were done by one physician. The flap reconstructions were done to 31 cases with the abPI-VSD being used (group A); the flap reconstructions were done to the rest 44 cases after wound cleaning using antibiotic irrigation solution without the use of the abPI-VSD (group B). Quantitative bacteriology was made to group A before and after the use of abPI-VSD; quantitative bacteriology was made to group B before and after wound cleaning. Then, the reconstructive skin flap surgery was done. After the surgeries, the time of local inflammatory response at the flap in both groups were recorded. The measured bacterial quantity was evaluated in logarithm and by t test. RESULTS: The bacterial quantity was 3.2 ± 1.9 × 107 cfu/g in group A before the use of abPI-VSD and 2.3 ± 2.0 × 107 in group B (P > 0.05) before debridement. The bacterial quantity was 1.2 ± 2.0 × 104 cfu/g in group A after abPI-VSD and was 2.9 ± 4.0 × 106 in group B after wound cleaning (P < 0.05). The time of postoperative inflammatory response in the flap was 8 ± 2.5 days in group A and 13 ± 3.4 days in group B (P < 0.05). CONCLUSIONS: abPI-VSD can distinctly reduce the bacterial quantity on the surface of the wound, provide a good condition of tissue bed for the flap reconstruction, and effectively control the local inflammatory response at the flap and hence improve the survival quality of the flap.

Minimally Invasive Treatment of Mason Type II Radial Head Fracture by Intramedullary Pinning.

OBJECTIVE: To evaluate the outcome of Mason type II radial head fractures treated by intramedullary pinning. METHODS: From May 2013 to March 2017, we respectively reviewed 25 patients affected by Mason type II radial head fractures. A total of 12 patients who met criteria for inclusion and exclusion were collected and analyzed. They were all isolated displaced partial articular radial head fractures and treated with intramedullary pinning using titanium elastic nails (TEN). The patients comprised eight men and four women with the mean age of 40 years (range, 21-58 years). The clinical evaluation included the range of motion (ROM) in the elbow, the shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH), the visual analogue scale (VAS) for pain rating, and the Mayo Elbow Performance Score (MEPS). Follow-up radiographs to monitor related complications were evaluated as well. RESULTS: All patients were followed-up with a mean of 21.8 months (range, 12-28 months). The average range of elbow flexion-extension was barely unaffected in the injured side when compared to the uninjured side (139.08° ± 3.14° vs 140.16° ± 3.01°, P = 0.398) as were pronation of the forearm (86.50° ± 2.75° vs 87.83° ± 2.12°, P = 0.197) and supination of the forearm (87.41° ± 2.53° vs 88.17° ± 1.95°, P = 0.425). The MEPS was 93.75 ± 5.28 points (range, 85-100), the QuickDASH revealed good to excellent results with 2.33 ± 4.56 points (range, 0-14), and the VAS for pain was 0.33 ± 0.78 (range, 0-2). Only two patients had a minor complication with constant affection of the superficial branch of radial nerve. CONCLUSION: Intramedullary pinning technique in the treatment of Mason type II radial head fractures is minimally traumatic and effective and represents good to excellent results in adults.

[Closed reduction and internal fixation with elastic nail for Mason type â ¡ radial head fracture in adults].

OBJECTIVE: To investigate the effectiveness of closed reduction and internal fixation with elastic nails in treatment of Mason type Ⅱ radial head fracture in adults. METHODS: A clinical data of 28 patients with Mason type Ⅱ radial head fractures between May 2013 and March 2017 was retrospectively analyzed. Thirteen patients were treated with closed reduction and internal fixation with elastic nails (trial group); 15 patients were treated with open reduction and internal fixation with Herbert screws (control group). There was no significant difference in gender, age, cause of injury, side of fracture, and the time from injury to operation between the two groups ( P>0.05). The operation time, blood loss, and fluoroscopy times in the two groups were recorded and compared. Postoperative X-ray films were used to evaluate the bone healing, heterotopic ossification, and necrosis of radial head. The effectiveness was evaluated according to Mayo score criteria of the elbow at last follow-up. RESULTS: All patients were followed up 12-30 months (mean, 21.9 months). The operation time and blood loss were significantly less in the trial group than in the control group ( P<0.05), while the fluoroscopy times significantly increased in the trial group than in the control group ( P<0.05). X-ray films showed that all fractures healed with the bone healing time of (2.85±0.69) months in the trial group and (3.35±0.88) months in the control group. There was no significant difference in bone healing time between the two groups ( t=1.654, P=0.110). Heterotopic ossification occurred in 2 cases in the control group. At last follow-up, there was no significant difference in the Mayo scores between the trial group (90.6±5.3) and the control group (86.4±7.1) ( t=1.750, P=0.092). CONCLUSION: Closed reduction and internal fixation with elastic nails, as a minimally invasive technique, has advantages of short operation time and less bleeding in the treatment of Mason type Ⅱ radial head fracture.

Fabrication and biocompatibility of poly(l-lactic acid) and chitosan composite scaffolds with hierarchical microstructures.

The scaffold microstructure is crucial to reconstruct tissue normal functions. In this article, poly(l-lactic acid) and chitosan fiber (PLLA/CTSF) composite scaffolds with hierarchical microstructures both in fiber and pore sizes were successfully fabricated by combining thermal induced phase separation and salt leaching techniques. The composite scaffolds consisted of a nanofibrous PLLA matrix with diameter of 50-500nm, and chitosan fibers with diameter of about 20µm were homogenously distributed in the PLLA matrix as a microsized reinforcer. The composite scaffolds also had high porosity (>94%) and hierarchical pore size, which were consisted of both micropores (50nm-10µm) and macropores (50-300µm). By tailoring the microstructure and chemical composition, the mechanical property, pH buffer and protein adsorption capacity of the composite scaffold were improved significantly compared with those of PLLA scaffold. Cell culture results also revealed that the PLLA/CTSF composite scaffolds supported MG-63 osteoblast proliferation and penetration.

Intramuscular innervations of lower leg skeletal muscles: applications in their clinical use in functional muscular transfer.

PURPOSE: This study aims to investigate nerve distribution patterns of human lower leg skeletal muscles using a modified Sihler's staining method. METHODS: Sixteen lower leg from eight fresh adult cadavers were used in this study and all the skeletal muscles were dissected. The muscle specimens were classified according to Lim's classification. The specimens were then stained by further modified Sihler's staining technique. Data were analyzed according to research results. RESULTS: After the staining, we found four patterns of nerve distribution in human lower leg muscles: (1) Type 1: single nerve pattern in which the nerve branches into two either running parallel to each other or radiating in a spray pattern (such as the extensor digitorum longus, extensor hallucis longus, fibularis brevis and flexor hallucis longus). (2) Type 2: double nerve pattern, one being proximal and the other being distal (such as the extensor digitorum longus, flexor digitorum longus, flexor hallucis longus). (3) Type 3: multiple branch pattern (such as the tibialis anterior, fibularis longus, gastrocnemius, soleus, tibialis anterior and popliteus). CONCLUSION: Our modified Sihler's staining method is useful for research of large muscles and intramuscular nerves in human. These findings might provide guidance for clinicians for muscle reconstruction surgery.

Germinal center kinases in immune regulation.

Germinal center kinases (GCKs) participate in a variety of signaling pathways needed to regulate cellular functions including apoptosis, cell proliferation, polarity and migration. Recent studies have shown that GCKs are participants in both adaptive and innate immune regulation. However, the differential activation and regulatory mechanisms of GCKs, as well as upstream and downstream signaling molecules, remain to be fully defined. It remains unresolved whether and how GCKs may cross-talk with existing signaling pathways. This review stresses the progresses in research of GCKs relevant to the immune system.

[Application of modified superficial peroneal neuro-fasciocutaneous flap in repairing soft tissue defect of forefoot].

OBJECTIVE: To investigate the operative procedures and clinical outcomes of the modified superficial peroneal neuro-fasciocutaneous flap in repairing soft tissue defect of forefoot. METHODS: From May 2006 to May 2009, 5 male patients (aged 40-63 years) with soft tissue defect of forefoot were treated with the modified superficial peroneal neuro-fasciocutaneous flap. Tendons and bones were exposed in all cases. Defect was caused by object crash (4 cases) and traffic accident (1 case). The sizes of soft tissue defects of forefoot were 4 cm x 2 cm-8 cm x 4 cm. Rotating point of the modified superficial peroneal neuro-fasciocutaneous flap pedicled with the peripheral vessels network of ankle joint was at the level of tibiotalar joint. The flaps ranging from 5 cm x 4 cm to 10 cm x 6 cm were adopted to repair soft tissue defects of forefoot. The donor sites were either sutured directly or covered with intermediate split thickness skin grafts. RESULTS: All flaps survived and all wounds healed by first intention. Skin graft at donor site survived completely in all cases. All patients were followed up 6-18 months (mean 11 months). The appearance, texture, and function of the flap were satisfactory. There was a protective sensibility in all flaps without abrasion or ulceration, and the two-point discrimination of the flaps was 10-13 mm. The walking pattern was normal. No obvious discomfort was observed at the skin-graft donor sites. CONCLUSION: With reliable blood supply, no sacrifice of vascular trunks, favorable texture, and thickness, the modified superficial peroneal neuro-fasciocutaneous flap pedicled with the peripheral vessels network of ankle joint is useful to repair skin soft tissue defect of the forefoot.