Clinical effect of day case arthroscopic surgery in tibial-eminence fracture in adults using button plates.

Background: The tibial-eminence fracture (TEF) is an anterior cruciate-ligament avulsion fracture with a low incidence. Many surgical techniques have been described, but none of them allow early functional exercise, and there are many postoperative complications. Purposes: This study aimed to evaluate the early clinical efficacy and complications of day case arthroscopic-surgery treatment of adult TEF with button plates. Methods: We retrospectively analyzed patients with TEF treated with arthroscopic surgery. Clinical subjective evaluation included International Knee Documentation Committee (IKDC) subjective score, Lysholm Knee Score, and Visual Analog Scale (VAS) score. Knee joint scores were evaluated by Lysholm score. Clinical objective assessment included the Lachman test, anterior-drawer test (ADT), IKDC, and range of motion. We assessed patient quality of life using a life summary table. Assessment of fracture healing and internal fixation was based on lateral x-rays of the knee joint. We measured and evaluated patient satisfaction at the last follow-up in accordance with Marsh criteria. Results: At final follow-up (average follow-up time, 28.23 ± 3.14 months), we evaluated results from 22 patients (22 knees). Average patient age during surgery was 33.64 ± 6.96 years. Average time from injury to surgery was 6.59 ± 1.47 h. Postoperative function was better than pre-operative function in all patients. IKDC subjective score, Lysholm score, and VAS score were better at final follow-up than before surgery. Differences in Lachman test and ADT scores before and after surgery were statistically significant. According to Intra-articular button position classification, 6 patients (6 knees) showed ideal position (A), 16 patients (16 knees) showed nearly ideal position (B), and none of the patients had nonideal position (C). The fractures of 22 patients healed completely; 2 patients had a 5°-10° knee joint dysfunction, and 1 had an abnormal knee sound. According to intra-articular button position classification, the rate of ideal position was 100%. Patient satisfaction rate was 81.8%. Conclusion: Day surgery using double-button plates to treat TEF could achieve anatomical reduction, power and stability, as well as good clinical efficacy.

Medium-Term Clinical Results of High-Flexion Knee Prostheses in Patients with Rheumatoid Arthritis.

OBJECTIVE: This study was performed to evaluate the function and satisfaction outcome of patients with rheumatoid arthritis (RA) who underwent total knee arthroplasty (TKA) with high-flexion prostheses. MATERIALS AND METHODS: Twenty-two patients (35 knees) using high-flexion prostheses (Zimmer, Warsaw, IN) were followed up for a period of 7-11 years from February 2007 to December 2009. Clinical and radiographic follow-up was performed using Hospital for Special Surgery (HSS), Short-Form 36 scores (SF-36), American Knee Society score (KSS), and Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Patient satisfaction assessments took place at the final follow-up sessions using the Marsh Satisfaction Questionnaire. RESULTS: The average ROM improved from preoperative 68.43° ± 33.78° to 95.54° ± 7.03° at the final follow-up. The HSS score and KSS score for pain improved from (46.49 ± 12.73) points to (85.46 ± 3.90) points and from 20.57 ± 5.91 points to 47.43 ± 3.51 points at the follow-up evaluation, respectively. Physical Component Summary(PCS) and Physical Component Summary (MCS) scores were 45.38 and 52.56, respectively by the end of follow-up. Deep venous thrombosis developed in one patient and one patient required surgical revision due to infection. There were no instances of prosthetic loosening. The satisfaction rate of patients was 95.5%. CONCLUSION: Although this particular model of TKA did not yield high-flexion angles (ie, 140°) required for kneeling, squatting, or rising from the floor, significant clinical and radiographic gains were evident in these patients with RA.

Study of sludge conditioning using organic acids chelated ferrous ion catalyzed NaClO oxidation: Evolution of extracellular polymeric substances and floc structure.

In previous studies, we interestingly found that several ligands (e.g., nitrilotriacetate and humic acid) could significantly accelerate the oxidation of NaClO by ferrous ion, via complexing with Fe(II). This inspired us to hypothesis that organic acids (OA) chelated Fe(II) might enhance the NaClO oxidation for improving sludge dewaterability. In this work, the OA chelated ferrous ions activated NaClO (OA-Fe(II)-NaClO) process was utilized for sludge conditioning, which exhibited significantly improved dewatering performance, as evidenced by capillary suction time (CST), specific resistance to filtration (SRF) and cake moisture of sludge. The normalized CST (CSTn) and SRF decreased to 1.22 s × L/g and 3.24 × 108 m/kg, when ratio dosage of [ClO-]/[Fe2+] (NaClO: 0.75%(v/v)) was 1 at pH of 2. During the NaClO activation by Fe(II), tightly bound extracellular polymeric substances (TB-EPS) was cracked into soluble EPS (S-EPS), followed by oxidizing into smaller molecular organic matters due to the production of hydroxyl radicals. Meanwhile, OA complexed to ferrous ion inhibited hydrolysis of ferric ions, leading to better catalytic performance of NaClO under neutral pH conditions. In addition, the molecular structure of OA determined the low complexing ability and steric hindrance for OA-Fe(II). When molar ratio of [Oxalic acid]/[Fe2+] was 1, oxalic acid-Fe(II)-NaClO improved sludge dewaterability significantly due to the coagulation and skeleton builder properties of formed iron oxalate precipitates. This work provides an eco-friendly and cost-effective method for improving sludge dewaterability.

Insight into effect of high-level cephalexin on fate and driver mechanism of antibiotics resistance genes in antibiotic wastewater treatment system.

In the study, antibiotic resistance genes (ARGs) were examined in wastewater and sludge samples to explore the effect of cephalexin (CFX) on the spreading and removal of ARGs in the Expanded Granular Sludge Bed (EGSB) reactor treating antibiotics wastewater. The result showed that the addition of CFX in the wastewater affected the removal amount of ß-lactam ARGs and other types ARGs. Besides, the addition of CFX in the wastewater had no obviously effect on total concentration of targeted ARGs in the sludge, but it was related to the accumulation of some typical ARGs. Based on gene cassette array libraries analysis, the diversity of gene cassettes carried by intI1 gene was increased by the addition of CFX in the wastewater. Furthermore, the co-occurrence patterns between ARGs and bacterial genus were also investigated. The results showed the CFX in the wastewater not only affected the number of potential host bacteria of ARGs, but also changed the types of potential host bacteria of ARGs. The correlation analysis of ARG in influent, effluent and sludge showed that, for blaCTX-M, sul2, qnrS and AmpC genes, their removal amount in EGSB reactor treating antibiotic wastewater system might be enhanced by reducing their concentration in the sludge.