Ambulatory unicompartmental knee arthroplasty: Short outcome of 50 first cases.

INTRODUCTION: The reduction in length of stay (LOS) in orthopedic surgery has been steady for several years. For the past 3 or 4 years in France, the trend toward outpatient surgery has been growing upwards, as it is a goal for hospital administration. MATERIALS AND METHODS: This is a prospective, continuous, mono-centric, single operator study on 56 UKAs. Included were all UKAs carried out between January 2014 and December 2015, meeting the following criteria: voluntary patients, supportive family environment, absence of comorbidity (oral anticoagulants, diabetes, obesity), ASA score≤3. Preoperatively, patients received: Dexamethasone 2mg/10kg, Tranexamic acid 2g, Cefazolin 2g IV. All patients were operated on under general anesthesia with the same technique: Alpina® (Zimmer-Biomet) uni-prosthesis without tourniquet. The arthrotomy was closed after a capsular injection of a solution of 150mg Ropivacaine+30mg Bi-Profenid®. Patient discharge on the same day evening was authorized by both surgeon and anesthesiologist. Three criteria were quantified: number of patients seen before the date of the first consultation for the removal of stitches (around day 12), Visual Pain Scale (10 points scale) on the first 12 days, and the level of satisfaction at the one-month postoperative visit. RESULTS: Six patients (11%) were not included in the ambulatory program during the initial consultation. Three patients were not able to be discharged on the same day evening due to nausea and therefore remained hospitalized for one night. Eighteen patients (38%) were reviewed before D10: 13 patients were reviewed between D1 and D4 for bleeding through the dressing and 5 for pain not controlled by level 1 and 2 analgesics. The Visual Pain Scale (VPS) reached level 6±2 by the 2nd day and then dropped to 1±1 by the 12th day. At 1 month, 85% of the patients were satisfied or very satisfied with their care. There were no general or localized complications. DISCUSSION: Ambulatory UKA surgery is possible for most patients. The inclusion rate for ambulatory UKA was 88% for Berger RA in 2010, therefore very close to this study rate of 89%. Ambulatory care is not only a change in surgical and anesthetic practice but a totally new management process involving all medical and non-medical actors. Ambulatory UKA surgery is feasible and safe for most patients. LEVEL OF EVIDENCE: IV, retrospective cohort study.

Implementation of GOLD consensus report in real life: results from the Velletri-Lariano (VELA) cohort.

BACKGROUND: COPD is one of the leading causes of morbidity and mortality. Pharmacotherapy improves quality of life and reduces exacerbations although low adherence with prescribed treatments may represent a barrier to optimal disease management. The first objective of this paper is to report the distribution of COPD patients according to GOLD categories, in a sample of patients from a cohort study in an area of the Latium region in Italy. The second objective is to evaluate the agreement between the distributions of severity obtained from the HCPs and the experts included in the study board (Board). METHODS: COPD patients were given a card to collect demographic and clinical data at baseline. Information in those cards was independently evaluated by HCPs and Board to include each patient into one of the four GOLD categories. RESULTS: In a sample of 187 stable COPD patients, 59% male, mean age 70 year, the distribution of GOLD categories according to the Board was: 6% A, 34% B, 2% C, and 58% D. A discrepancy in GOLD classification was observed between the study board and field-based HCPs, regarding more than 50% of the patients, with a clear trend to underestimate the frequency of patients in D level (21%) and to overestimate the frequency in C level (21%). CONCLUSIONS: These results describe for the first time the distribution of COPD patients in an Italian cohort according to the GOLD categories, with the highest frequencies in levels B and D. The misclassification from HCPs may impact the therapeutic approach and the clinical outcomes.

Gait analysis and clinical correlations in early Parkinson's disease.

The aim of our study was to identify and quantify spatiotemporal and kinematic gait parameters obtained by 3D gait analysis (GA) in a group of Parkinson's disease (PD) patients compared with healthy subjects in order to investigate whether early PD patients could present an abnormal gait pattern. Forty-four patients affected by early-stage PD compared with a control group were analyzed. All participants were evaluated with 3D GA in the gait laboratory. The greatest significance in temporal parameters was found in cadence (102.46 ± 13.17 steps/min in parkinsonian patients vs 113.84 ± 4.30 steps/min in control subjects), followed by stride duration (1.19 ± 0.18 seconds right limb and 1.19 ± 0.19 seconds left limb in PD patients vs 0.426 ± 0.16 seconds right limb and 0.429 ± 0.23 seconds left limb in normal subjects) and stance duration. Marked differences were also found in the swing phase and in swing duration (p<0.05), while the stance phase was not significantly different in patients compared with healthy subjects. A statistically different velocity in PD patients (0.082 ± 0.29 m/s) vs healthy subjects (1.33 ± 0.06 m/s) was shown by spatial parameter analysis. Step width, stride length and swing velocity were highly significant parameters, as was average velocity. Our study highlighted some distinguishing characteristics of gait in early PD. Ambulation disorders may be present in the early stage of PD and their detection allows for early medical treatment and possible rehabilitation.

Impact of milling, enzyme addition, and steam explosion on the solid waste biomethanation of an olive oil production plant.

Anaerobic digestion is a consolidated bioprocess which can be further enhanced by incorporating an upstream pretreatment unit. The olive oil production produces a large amount of solid waste which needs to be properly managed and disposed. Three different pretreatment techniques were evaluated in regard to their impact on the anaerobic biodegradability: manual milling of olive pomace (OP), enzyme maceration, direct enzyme addition, and thermal hydrolysis of two-phase olive mill waste. The Gompertz equation was used to obtain parameters for comparison purposes. A substrate/inoculum ratio 0.5 was found to be the best to be used in anaerobic batch test with olive pomace as substrate. Mechanical pretreatment of OP by milling increases the methane production rate while keeping the maximum methane yield. The enzymatic pretreatment showed different results depending on the chosen pretreatment strategies. After the enzymatic maceration pretreatment, a methane production of 274 ml CH4 g VS added (-1) was achieved, which represents an improvement of 32 and 71 % compared to the blank and control, respectively. The direct enzyme addition pretreatment showed no improvement in both the rate and the maximum methane production. Steam explosion showed no improvement on the anaerobic degradability of two-phase olive mill waste; however, thermal hydrolysis with no rapid depressurization enhanced notoriously both the maximum rate (50 %) and methane yield (70 %).

Adaptation of acidogenic sludge to increasing glycerol concentrations for biohydrogen production.

Hydrogen is a promising alternative as an energetic carrier and its production by dark fermentation from wastewater has been recently proposed, with special attention to crude glycerol as potential substrate. In this study, two different feeding strategies were evaluated for replacing the glucose substrate by glycerol substrate: a one-step strategy (glucose was replaced abruptly by glycerol) and a step-by-step strategy (progressive decrease of glucose concentration and increase of glycerol concentration from 0 to 5 g L(-1)), in a continuous stirred tank reactor (12 h of hydraulic retention time (HRT), pH 5.5, 35 °C). While the one-step strategy led to biomass washout and unsuccessful H2 production, the step-by-step strategy was efficient for biomass adaptation, reaching acceptable hydrogen yields (0.4 ± 0.1 molH2 mol(-1) glycerol consumed) around 33 % of the theoretical yield independently of the glycerol concentration. Microbial community structure was investigated by single-strand conformation polymorphism (SSCP) and denaturing gradient gel electrophoresis (DGGE) fingerprinting techniques, targeting either the total community (16S ribosomal RNA (rRNA) gene) or the functional Clostridium population involved in H2 production (hydA gene), as well as by 454 pyrosequencing of the total community. Multivariate analysis of fingerprinting and pyrosequencing results revealed the influence of the feeding strategy on the bacterial community structure and suggested the progressive structural adaptation of the community to increasing glycerol concentrations, through the emergence and selection of specific species, highly correlated to environmental parameters. Particularly, this work highlighted an interesting shift of dominant community members (putatively responsible of hydrogen production in the continuous stirred tank reactor (CSTR)) according to the gradient of glycerol proportion in the feed, from the family Veillonellaceae to the genera Prevotella and Clostridium sp., putatively responsible of hydrogen production in the CSTR.

Effects of focal vibration on bone mineral density and motor performance of postmenopausal osteoporotic women.

AIM: This randomized double blind controlled study is aimed at determining the effect of repeated vibratory stimuli focally applied to the contracted quadriceps muscles (repeated muscle vibration=rMV) on bone mineral density, leg power and balance of postmenopausal osteoporotic women. METHODS: The study has been conducted on 40 voluntary postmenopausal osteoporotic women, randomised at 2 groups for rMV treatment and for control. The treatment group underwent rMV (100Hz, 300-500 µm; three applications per day, each lasting 10-minutes, for 3 consecutive days) applied to voluntary contracted quadriceps (VC=vibrated and contracted group). The control group, received a sham stimulation on contracted quadriceps (NV=non vibrated group). Bone mineral density T-score of proximal femur of the participants, was evaluated in two weeks before and 360 days after intervention; body balance and explosive leg power were measured 1 day before, 30 days and 360 days after treatment. RESULTS: VC group T-score at one year didn't change significantly relative to baseline values (pretreatment: -2.61±0.11, post-treatment -2.62±0.13); conversely in NV subjects T-score decreased significantly from -2.64 ± 0.15 SD down to -2.99 ± 0.28 SD. A significant improvement of balance and explosive leg power was observed only in VC group at 30 and 360 days after the intervention. CONCLUSION: We conclude that rMV is a safe, short-lasting and non-invasive treatment that can significantly and persistently improve muscle performance and can effectively counteract progressive demineralisation in postmenopausal and osteoporotic women.

Hypotonic stress-induced calcium signaling in Saccharomyces cerevisiae involves TRP-like transporters on the endoplasmic reticulum membrane.

Saccharomyces cerevisiae cells respond to hypotonic stress (HTS) by a cytosolic calcium rise, either generated by an influx of calcium from extracellular medium, when calcium is available, or by a release from intracellular stores in scarcity of extracellular calcium. Calcium release from intracellular compartments is peculiarly inhibited by external calcium in a calcineurin-independent and Cch1-, but not Mid1-, driven manner. HTS-induced calcium release is also negatively regulated by the ER protein Cls2 and involves a poorly characterized protein, FLC2/YAL053W gene product, previously proposed to be required for FAD transport in the ER, albeit, due to its molecular features, it was also previously classified as an ion transporter. A computational analysis revealed that this gene and its three homologs in S. cerevisiae, together with previously identified Schizosaccharomyces pombe pkd2 and Neurospora crassa calcium-related spray protein, belong to a fungal branch of TRP-like ion transporters related to human mucolipin and polycystin 2 calcium transporters. Moreover, disruption of FLC2 gene confers severe sensitivity to Calcofluor white and hyper-activation of the cell wall integrity MAPK cascade, suggesting a role in cell wall maintenance as previously suggested for the fission yeast homolog. Perturbation in cytosolic resting calcium concentration and hyper-activation of calcineurin in exponentially growing cells suggest a role for this transporter in calcium homeostasis in yeast.

Relationship between phenol degradation efficiency and microbial community structure in an anaerobic SBR.

Phenol is a common wastewater contaminant from various industrial processes, including petrochemical refineries and chemical compounds production. Due to its toxicity to microbial activity, it can affect the efficiency of biological wastewater treatment processes. In this study, the efficiency of an Anaerobic Sequencing Batch Reactor (ASBR) fed with increasing phenol concentrations (from 120 to 1200 mg L(-1)) was assessed and the relationship between phenol degradation capacity and the microbial community structure was evaluated. Up to a feeding concentration of 800 mg L(-1), the initial degradation rate steadily increased with phenol concentration (up to 180 mg L(-1) d(-1)) and the elimination capacity remained relatively constant around 27 mg phenol removed∙gVSS(-1) d(-1). Operation at higher concentrations (1200 mg L(-1)) resulted in a still efficient but slower process: the elimination capacity and the initial degradation rate decreased to, respectively, 11 mg phenol removed∙gVSS(-1) d(-1) and 154 mg L(-1) d(-1). As revealed by Denaturing Gradient Gel Electrophoresis (DGGE) analysis, the increase of phenol concentration induced level-dependent structural modifications of the community composition which suggest an adaptation process. The increase of phenol concentration from 120 to 800 mg L(-1) had little effect on the community structure, while it involved drastic structural changes when increasing from 800 to 1200 mg L(-1), including a strong community structure shift, suggesting the specialization of the community through the emergence and selection of most adapted phylotypes. The thresholds of structural and functional disturbances were similar, suggesting the correlation of degradation performance and community structure. The Canonical Correspondence Analysis (CCA) confirmed that the ASBR functional performance was essentially driven by specific community traits. Under the highest feeding concentration, the most abundant ribotype probably involved in successful phenol degradation at 1200 mg L(-1) was affiliated to the Anaerolineaceae family.

Explicit temperature-based model for anaerobic digestion: application in domestic wastewater treatment in a UASB reactor.

Temperature is an important environmental variable that can strongly affect the performance of anaerobic reactors working at ambient temperatures. This study presents a mechanistic mathematical model which depends in an explicit way on the operating temperature. The cardinal temperature model function is proposed to describe the temperature dependence of the kinetic parameters and the experimental data from an UASB-degasification system was used to calibrate and validate the model. The performance of the model is compared with the classic Arrhenius approach. The results showed that the temperature-based model of the anaerobic digestion is able to reproduce a long-term reactor operation in terms of biogas production and the concentration of organic matter at fluctuating ambient temperature.

Focal vibration of quadriceps muscle enhances leg power and decreases knee joint laxity in female volleyball players.

AIM: This double-blind randomized controlled study aims at determining the effect of repeated muscle vibration (rMV) on explosive and reactive leg power and on knee laxity of female volleyball players. METHODS: Eighteen voluntary volleyball athletes, belonging to the same senior regional level team (age=22.7 ± 3 years, height=180.3 ± 5 cm, mass= 64 ± 4 kg) were assigned to three groups (N.=6) for vibration on contracted quadriceps (VC), vibration on relaxed muscle (VR), and sham vibration (NV), respectively. Intervention consisted in 3 rMV sessions performed in 3 consecutive days. In each session, 100 Hz, 300-500 µm amplitude vibratory stimuli were bilaterally delivered to the quadriceps in three consecutive 10-minutes applications. Explosive and reactive leg power and knee joint laxity were evaluated 1 day before, and 1, 30, and 240 days after intervention. RESULTS: In VC group, explosive and reactive leg power increased respectively by ~16% and ~9% at 1 day, by ~19% and ~11% at 30 days and by ~26% and ~13% at 240 days, concomitantly knee laxity decreased by ~6%, ~15% and ~18% at the same times. These changes were significantly larger than in the other groups, in which leg power increment and knee joint laxity reduction remained close to ~3%, ~5% and ~10% at 1, 30 and 240 days, respectively. CONCLUSION: Combined bilateral voluntary contraction and rMV of the quadriceps muscles is a short-lasting, non-invasive technique that can significantly and persistently improve muscle performance and knee laxity in volleyball women players.

Performance of an in-situ rotating biological contactor in a recirculating aquaculture system.

The start-up and activation of a nitrifying rotating biological contactor (RBC) and its performance inside a culture tank of rainbow trout were studied. First, in a lab-scale operation, the system was fed with a synthetic medium containing a high ammonia concentration (567 mg NH(4)(+)-N L(-1)) and operated at a high hydraulic retention time (HRT) (6.5 days) to minimize the wash-out of the biomass and promote the biofilm formation. Then, both inlet ammonia concentration and HRT were decreased in order to obtain operational conditions similar to those of the culture tank. During this period, the RBC was able to treat an ammonia loading rate (ALR) of 0.64 g N-NH(4)(+) L(-1) d(-1) with a removal efficiency within 70-100%. Pilot-scale experiments were carried out in culture tanks of rainbow trout. The operation of a recirculating system with the RBC unit was compared with a recirculating system without biological treatment and with a flow-through system. The use of this in-situ nitrifying unit allowed working at a recirculation ratio of 90% without negative effects on either growth or the condition factor of fishes. Up to 70% of ammonia generated was removed and a removal rate of 1.41 g NH(4)(+)-N m(-2) d(-1) was reached.

Influence of temperature on the hydrolysis, acidogenesis and methanogenesis in mesophilic anaerobic digestion: parameter identification and modeling application.

The effect of temperature on the kinetic parameters involved in the main reactions of the anaerobic digestion process was studied. Batch tests with starch, glucose and acetic acid as substrates for hydrolysis, acidogenesis and methanogenesis, respectively, were performed in a temperature range between 15 and 45 degrees C. First order kinetics was assumed to determine the hydrolysis rate constant, while Monod and Haldane kinetics were considered for acidogenesis and methanogenesis, respectively. The results obtained showed that the anaerobic process is strongly influenced by temperature, with acidogenesis exerting the highest effect. The Cardinal Temperature Model 1 with an inflection point (CTM1) fitted properly the experimental data in the whole temperature range, except for the maximum degradation rate of acidogenesis. A simple case-study assessing the effect of temperature on an anaerobic CSTR performance indicated that with relatively simple substrates, like starch, the limiting reaction would change depending on temperature. However, when more complex substrates are used (e.g. sewage sludge), the hydrolysis might become more quickly into the limiting step.

Development and validation of a simplified model for the anaerobic degradation of phenol.

The anaerobic treatment of phenolic wastewater has demonstrated to be a suitable biological system, for that reason, a large number of systems have been implemented in a lab/pilot scale, several industrial plants have also been developed. Despite of this, there is a lack of modeling applications within these systems. In order to enhance the anaerobic treatment of this kind of water, a simplified model of 2 populations and 3 reactions was developed and implemented. The parameter calibration and the model validation were carried out with experimental data obtained from an Anaerobic Sequencing Batch Reactor treating phenolic wastewater through two different operational strategies: sequential batches with a co-substrate and sequential fed-batches without a co-substrate. The model predicted the reactors performance accurately for the different experimental conditions tested. Therefore, the theoretical basis of the model is, in general terms, valid, and its utilization to predict the reactors performance or in control purposes is feasible.

Effectiveness of masking agents: outcome of a three-year study at pilot and full scales.

Commercial products used as masking or neutralizing agents against odour emissions from solid waste activities were investigated both at pilot scale and at three full scale sites. Twenty-six products were first characterized and classified as potential masking or neutralizing agents. Four of the products tested at pilot scale revealed a masking efficiency and a significant decrease of the discomfort index. No evidence of neutralization effect was observed during the field tests.

Winery effluent treatment at an anaerobic hybrid USBF pilot plant under normal and abnormal operation.

A 1.1 m3 hybrid USBF fully instrumented pilot plant has been used for the treatment of diluted wine for four years. In this work, the performance of the wastewater treatment plant (WWTP) during start up and operation (normal operation and overload experiments) is shown. A complete description of the treatment process behaviour (gas and liquid phase composition and anaerobic sludge characteristics) is given by on-line and off-line monitoring of 28 process variables. The results presented here demonstrate the reliability of this technology for the treatment of wastewater from seasonal processes, such as winery wastewaters, during a long period of time (four years). Furthermore, the USBF reactor presented very short start up periods after short and long shut down of the WWTP and rapidly turned back to normal operation after suffering a complete destabilization due to organic overload. Both effluent and biogas were of good quality. Dissolved organic carbon concentration in the effluent was always lower than 100 mg DOC l(-1) under normal operation, while methane concentration in the biogas was in the range 70-74%, making it suitable for energy recovering.

Selected experiences in Chile for the application of UASB technology for vinasse treatment.

One of the research areas is the agricultural use of treated wastewaters, because it represents a unique opportunity to solve the problem of water supply for irrigation and at the same time the disposal of treated water. Anaerobic digestion appears as an interesting alternative, since anaerobically treated wastewaters can be used for irrigation purposes. These considerations are applied to the Chilean pisco industry (a traditional alcoholic drink, prepared by distillation of wine made mainly from Muscatel grapes), where high concentrated wastewaters are produced: vinasses originate as a residue from the distillation operation. Two laboratory reactors fed with wine vinasses, a UASB and an EGSB, were used in order to study the anaerobic treatability of the wastewater. Then, a pilot reactor was built (60 m3 UASB digester) and treated water was used to irrigate eucalyptus trees. Finally a 300 m3 reactor, including biogas treatment for its reuse, was developed. Results showed, both at laboratory and full scale, that anaerobic treatment is suitable for pisco's wastewaters, and also that the nutrient content of treated water can be beneficial for plant growth, reducing the need for fertilizers. Another kind of investigation was carried out in order to study the stability of anaerobic granules and how it can be recovered. UASB and EGSB were fed with low, medium and high load wastewaters, in order to evaluate possible fluctuations in the productive process. From these results, it was possible to propose and to apply recovery techniques to the digesters when they are destabilized.

Characterization, management and treatment of wastewater from white wine production.

During a 16 months period, the characteristics of the wastewaters generated in a Rias Baixas winery (Spain) producing white wine were determined: The characterization study showed that white wine wastewater had an average CODt and TSS values of 7.3 and 5.2 kg/m3, respectively being the ratio wastewater/wine produced of about 1.6-2.0 L/L and the ratio between load pollution and produced wine of 9.7 kg(CODt)/m3(WINE). A strategy for the management of wastes and wastewaters allowed for an important reduction of a 55% of wastewater generation to be achieved. In order to select a suitable technology for the treatment of wastewaters two configurations were tested at pilot scale: i) An Anaerobic Filter (AF) of 430 L followed by an activated sludge unit of 510 L and: ii) one activated sludge unit of 510 L. The results showed that the anaerobic/aerobic configuration was more flexible as it adapted quickly to the different loads and flows produced during the different phases through the year. Besides it allowed higher COD removals (98.5-99.2%) to be achieved and proved to permit a quicker re-start up after starvation periods.

Selection of variables using factorial discriminant analysis for the state identification of an anaerobic UASB-UAF hybrid pilot plant, fed with winery effluents.

Anaerobic wastewater treatment has become a widely used method for wastewater depuration, and has been applied in a wide range of situations, from urban wastewater to highly toxic industrial wastewater. Particularly it has been successfully applied to the treatment of the beverage industries effluents. To avoid the destabilization of the system a monitoring diagnosis and control system of the depuration processes is necessary. The cost of this system is an important issue, that depends on the number of parameters that must be controlled for an adequate performance of a wastewater plant control system. This work shows how the classic statistical classification techniques can be applied to determine the number variables that must be monitored to achieve an adequate performance of anaerobic UASB-UAF hybrid Pilot Plant monitoring and control system. The obtained results had not been unique, so different combinations of variables can be selected for a good wastewater treatment process control. Economic or technical criteria may be considered to determine the final variables set in each particular situation.

Characterisation of odour masking agents often used in the solid waste industry for odour abatement.

Odours from waste management facilities, wastewater treatment plants and composting areas have become a major nuisance issue for operators. In addition to facing regulations which tend to become more stringent, operators are also facing increased public pressure due to complaints from neighbours resulting in the temporary shutdown of such plants, therefore the elimination of atmospheric odours is becoming a major industrial objective. Many commercial odour control products are available on the market, however, very little is known concerning their real efficiency and mechanism of action. This paper will present the results from the study of 19 agents collected in various countries. The products were first characterised both in terms of their chemical composition and sensory properties. Selected products with different modes of application were then submitted to a study of their efficiency at the pilot-scale level. The results from one product test showed no significant difference in their odour removal efficiency as determined by olfactory and chemical analysis of the emission before and after application of the odour control product.

Improvement of posture stability by vibratory stimulation following anterior cruciate ligament reconstruction.

Surgical reconstruction of the anterior cruciate ligament (ACL) may reduce, but it does not always eliminate, knee and body instability because of a persisting proprioceptive deficit. In order to enhance body stability, a new protocol of treatment has been proposed consisting of mechanical vibration (100 Hz frequency and < 20 microm amplitude) of the quadriceps muscle in the leg that has undergone ACL reconstruction. In our trials, stimulation was performed when the quadriceps muscle was kept isometrically contracted. Treatment was started one month after surgery. Vibration was applied for short periods over three consecutive days. Nine months after treatment, postural stability was re-evaluated with the subjects standing on one leg with open and with closed eyes. The postural stability of the subjects having undergone vibration treatment, standing on the operated leg was significantly improved one day after treatment when evaluated as mean of speed and elliptic area of the center of pressure. The improvement persisted and increased during the following weeks. Peak torques of the operated leg extensor muscles also increased and reached values close to that of the leg, which had not been operated. Conversely, the balance of the untreated subjects standing on the operated leg did not improve and the restoration of the extensor muscle peak torque was poor. It is concluded that short lasting proprioceptive activation by vibration may lead to a faster and more complete equilibrium recovery probably by permanently changing the network controlling knee posture.