Operative costs associated with arthroscopic assisted open reduction and internal fixation of acute ankle fractures.

BACKGROUND: Ankle fractures are a common orthopedic injury that frequently involves associated cartilage lesions, soft tissue damage, and a significant inflammatory burden. Despite studies revealing intra-articular pathology in up to 79% of ankle fractures, only 1% of open reduction and internal fixation (ORIF) procedures undergo arthroscopic evaluation. The primary purpose of this study was to determine the cost effectiveness of ankle arthroscopy performed at time of ORIF for ankle fracture. METHODS: An IRB approved retrospective review of patients who sustained ankle fractures and underwent ORIF with and without concomitant arthroscopic surgery between 2015 and 2020 were investigated. Patient demographics, fracture characteristics, outcomes, and cost data were collected and analyzed. RESULTS: There were 567 total ORIF and 28 ORIF and scope included for cost analysis purposes. Total surgical costs averaged $6,537.62 and $6,886.46 for the ORIF only and ORIF and scope procedures respectively. Total direct costs, including operating room time, for the same procedures were found to average $6,212.34 and $7,312.10 for the ORIF only and ORIF and scope procedures respectively. The cost difference between the ORIF only and with arthroscopy was not statistically significant (p = 0.1174). Twelve of the 28 arthroscopic patients (42.86%) had grade 3 or full thickness chondral lesions, and 11/28 (39.28%) arthroscopic patients were found to have grade 1-2 cartilage changes. CONCLUSION: In the acute treatment of ankle fractures, concurrent arthroscopic evaluation does not add a significant cost to the procedure and may result in improved short and long term benefits for the patient. With improved arthroscopic efficiency, the cost differential can be further reduced. LOE: IV.

Physicochemical and volatiles characterization of trans-free solid fats produced by lipase-catalyzed interesterification.

Trans-free solid fats were synthesized from fully hydrogenated soybean oil (FHSBO), olive oil (OO), and palm stearin (PS) at different substrate weight ratios (10:20:70, 10:40:50 and 10:50:40) via lipase-catalyzed interesterification. The interesterified products contained mostly TAG (98.8% to 99.0%), and small amounts of MAG and DAG as by-products. The major fatty acids were oleic acid, palmitic acid, and stearic acid in the interesterified products, and the melting points ranged from 39 to 45 degrees C. The amount of alpha-tocopherol was reduced by 75% to 92%. Volatile analysis by solid-phase microextraction indicated that OO and PS had distinct volatile profiles, in which 18 volatiles were retained in interesterified products. Furthermore, some volatiles disappeared or formed during processing. Electronic nose showed that the odors of substrates (OO and PS) were different from each other, and the odors of interesterified products were distinguishable from that of OO or PS. Among the interesterified products, the odor of blend FHSBO:OO:PS of 10:40:50 or 10:50:40 was different from that of blend FHSBO:OO:PS (10:20:70). However, no odor difference was observed between products blend FHSBO:OO:PS 10:40:50 and 10:50:40.

Compositional study on rice bran oil after lipase-catalyzed glycerolysis and solvent fractionations.

Rice bran oil (RBO) was modified through lipase-catalyzed glycerolysis. After 48 h reaction, the reactant (RBO-G, solved in hexane) containing 0.14 mg/mL of MAG, 0.19 mg/mL of DAG, and 0.93 mg/mL of TAG was obtained. Extending the reaction to 72 h resulted in 0.37 mg/mL of DAG with concomitant reduction in TAG (0.68 mg/mL). Two solvent fractionation methods, independent and sequential fractionation, were performed with acetone and hexane at 0, -8, -14, or -35 degrees C. The fraction with most unsaturated fatty acids (Sigma UFA) was liquid fraction from independent fractionation at -35 degrees C (-35 In) from hexane, showing 88.3%Sigma UFA content. Nevertheless, when yield (wt%) was considered, the highest amount of UFA was obtained from 0 In (liquid fraction from independent fractionation at 0 degrees C) with hexane, resulting in 82.3%Sigma UFA with 97.9 wt% recovery. Normal-phase HPLC was conducted for the compositional study of RBO-G. Overall, solid fractions from sequential fractionation at 0 degrees C (0 SeSo) and independent fractionation at -35 degrees C (-35 InSo) with hexane contained the high concentration of total MAG and DAG, ranging from 0.94 to 1.35 (mg/mL).

Enzymatic production of infant milk fat analogs containing palmitic acid: optimization of reactions by response surface methodology.

Infant milk fat analogs resembling human milk fat were synthesized by an enzymatic interesterification between tripalmitin, coconut oil, safflower oil, and soybean oil in hexane. A commercially immobilized 1,3-specific lipase, Lipozyme RM IM, obtained from Rhizomucor miehei was used as a biocatalyst. The effects of substrate molar ratio, reaction time, and incubation temperature on the incorporation of palmitic acid at the sn-2 position of the triacylglycerols were investigated. A central composite design with 5 levels and 3 factors consisting of substrate ratio, reaction temperature, and incubation time was used to model and optimize the reaction conditions using response surface methodology. A quadratic model using multiple regressions was then obtained for the incorporation of palmitic acid at the sn-2 positions of glycerols as the response. The coefficient of determination (R2) value for the model was 0.845. The incorporation of palmitic acid appeared to increase with the decrease in substrate molar ratio and increase in reaction temperature, and optimum incubation time occurred at 18 h. The optimal conditions generated from the model for the targeted 40% palmitic acid incorporation at the sn-2 position were 3 mol/mol, 14.4 h, and 55 degrees C; and 2.8 mol/mol, 19.6 h, and 55 degrees C for substrate ratio (moles of total fatty acid/moles of tripalmitin), time, and temperature, respectively. Infant milk fat containing fatty acid composition and sn-2 fatty acid profile similar to human milk fat was successfully produced. The fat analogs produced under optimal conditions had total and sn-2 positional palmitic acid levels comparable to that of human milk fat.

Enzymatic interesterification of tripalmitin with vegetable oil blends for formulation of caprine milk infant formula analogs.

The structure of triacylglycerols in vegetable oil blends was enzymatically modified, and the blends were incorporated into skim caprine milk to produce goat milk-based infant formula analogs, homologous to human milk. A modified lipid containing palmitic, oleic, and linoleic acids, resembling the composition of human milk fat, was synthesized by enzymatic interesterification reactions between tripalmitin and a vegetable oil blend containing a 2.5:1.1:0.8 ratio of coconut, safflower, and soybean oils. A commercial sn-1,3-specific lipase obtained from Rhyzomucor miehei, Lipozyme RM IM, was used as the biocatalyst. The effects of substrate molar ratio and reaction time on the incorporation of palmitic, oleic, and linoleic acids at the sn-2 position of the triacylglycerols were investigated. The fatty acid composition and sn-2 position of the experimental formulas were analyzed using gas chromatography. Results showed that the highest incorporation of palmitic acid was obtained at 12 h of incubation at 55 degrees C with a substrate molar ratio of 1:0.4 of tripalmitin to vegetable oil blend. However, the modified milk interesterified for 12 h at a 1:1 molar ratio had a greater resemblance to human milk compared with the other formulas. The level of oleic acid incorporation at the sn-2 position increased with the molar ratio of tripalmitin to vegetable oil blend. It was concluded that, unlike the original goat milk and other formulas, the formulated caprine milk with a molar ratio of 1:1 and a 12-h incubation was similar to the fatty acid composition of human milk.

Structured Lipids-Novel Fats with Medical, Nutraceutical, and Food Applications.

Generally, structured lipids (SLs) are triacylglycerols (TAGs) that have been modified to change the fatty acid composition and/or their positional distribution in glycerol backbone by chemically and/or enzymatically catalyzed reactions and/or genetic engineering. More specifically, SLs are modified TAGs with improved nutritional or functional properties. SLs provide an effective means for producing tailor-made lipids with desired physical characteristics, chemical properties, and/or nutritional benefits. The production, commercialization outlook, medical, and food applications of SLs are reviewed here. Physical property measurements for SL in food systems and future research needs for increased industrial acceptance are also included in this review.

Enzymatic modification of high-laurate canola to produce margarine fat.

Stearic acid was enzymatically transesterified with high-laurate canola using a nonspecific lipase from Candida antarctica to produce structured lipids (SL) suitable for margarine application. Stearic acid levels ranged from 10 to 40 wt % of high-laurate canola oil. Differential scanning calorimetry was used to evaluate melting characteristics of the transesterified products. A stearic acid level of 30% was found to best match the melting characteristics of fat extracted from commercially available stick margarine. This SL was used to prepare nonrefrigerated and refrigerated margarine samples. Refrigerated margarine was prepared using 60% SL and 40% canola oil, whereas 100% SL was used for the nonrefrigerated margarine. Slip melting point, solid fat content, and hardness index were determined for all samples. Application of a dynamic temperature step using a dynamic stress rheometer showed complete breakdown of the commercial stick margarine and the experimental refrigerated margarine at approximately 30 degrees C and complete breakdown of the nonrefrigerated margarine at approximately 35 degrees C. Addition of canola oil to the SL improved spreadability at refrigeration temperatures and reduced the hardening effect of lauric acid in the SL. The nonrefrigerated margarine was spreadable at room temperature and exhibited no oil exudation or phase separation.

Synthesis of structured lipids by transesterification of trilinolein catalyzed by Lipozyme IM60.

Structured lipids (SL) containing caprylic, stearic, and linoleic acids were synthesized by enzymatic transesterification using Lipozyme IM60. Pure trilinolein and free fatty acids were used as substrates. Incorporation of stearic acid was higher than that of caprylic acid in all parameters. Highest incorporations of both acids were achieved at 32 h, mole ratio of 1:4:4 (trilinolein/caprylic/stearic acids), water content of 1% (wt %), temperature of 55 degrees C, and 10% (wt %) enzyme load. The maximal incorporations of caprylic and stearic acids were 23.73 and 62.46 mol %, respectively. Reaction time, water content, and enzyme load had major influences on the reaction, whereas substrate mole ratio and temperature showed less influence. Lipozyme showed good stability over six reuses. Differential scanning calorimetric analysis of SL gave a melting profile with a very low melting peak of 0-3.3 degrees C and a solid fat content of 25.21% at 0 degrees C. The melting profile and solid fat content of SL were compared with those of fats extracted from commercially available solid and liquid margarine products. The data suggest that enzymatically produced SL could be used in liquid margarine products.

Nutritional effects of enzymatically modified soybean oil with caprylic acid versus physical mixture analogue in obese Zucker rats.

Enzymatically modified soybean oil with caprylic acid (SL), a physical mixture of tricaprylin and soybean oil (PHY), and soybean oil as control were fed (20% of diet weight) to female obese Zucker rats. Both lipids (SL and PHY) have similar total fatty acid composition containing 23.4 mol % caprylic acid (C8:0) but have different lipid structures. After 21 days of feeding, the body weight gain was 36.4% in the SL-fed group and 35.2% in the PHY-fed group, respectively; whereas the body weight of the control group increased 41.6%. Significant differences in the respiratory exchange ratio were observed between the SL and PHY groups. However, the contents of glucose, total and high density lipoprotein (HDL) cholesterol, and very low density and low density lipoprotein (VLDL + LDL) cholesterol in serum were not significantly different between the SL- and PHY-fed groups or among the three dietary groups (control, SL, and PHY) (p < 0.05). On the other hand, plasma total cholesterol and plasma triacylglycerol (TAG) were significantly higher in SL- and PHY-fed groups than in the control group. In the liver and inguinal adipocyte TAG, C8:0 was found in the SL-fed group, whereas it was not observed in the liver and inguinal adipocyte TAG of the PHY-fed group, which suggests that positional distribution of C8:0 of the TAG molecule is an important consideration in the metabolism of lipids. This study showed that different positional distribution in TAG molecules lead to different metabolic fates, resulting in the change of fatty acid composition in liver and inguinal adipose TAG in female Zucker rats.

Lipase-catalyzed modification of rice bran oil to incorporate capric acid.

Capric acid (C10:0) was incorporated into rice bran oil with an immobilized lipase from Rhizomucor miehei as the biocatalyst. Effects of incubation time, substrate mole ratio, enzyme load, and water addition on mole percent incorporation of C10:0 were studied. Transesterification was performed in an organic solvent, hexane, and under solvent-free condition. Pancreatic lipase-catalyzed sn-2 positional analysis and tocopherol analysis were performed before and after enzymatic modification. Products were analyzed by gas-liquid chromatography (GLC) for fatty acid composition. After 24 h of incubation in hexane, there was an average of 26.5 +/- 1.8 mol % incorporation of C10:0 into rice bran oil. The solvent-free reaction produced an average of 24.5 +/- 3.7 mol % capric acid. In general, as the enzyme load, substrate mole ratio, and incubation time increased, the mole percent of capric acid incorporation also increased. Time course reaction indicated C10:0 incorporation increased up to 27.0 mol % at 72 h, for the reaction in hexane, and up to 29.6 mol % at 12 h, for the solvent-free reaction. The highest C10:0 incorporations (53.1 and 43.2 mol %) for the mole ratio experiment occurred at a mole ratio of 1:8 for solvent and solvent-free reactions, respectively. The highest C10:0 incorporation (27.9 mol %) for the reaction in hexane occurred at 10% enzyme load, and the highest incorporation (34.4 mol %) for the solvent-free reaction occurred at 20% enzyme load. Incorporation of C10:0 into rice bran oil declined with the addition of increasing amounts of water after reaching 30.3 mol % at 2% water addition in hexane, and in the solvent-free reaction after reaching 35.9 mol %.

Synthesis of structured triacylglycerols by lipase-catalyzed acidolysis in a packed bed bioreactor.

Structured triacylglycerols (ST) from canola oil were produced by enzymatic acidolysis in a packed bed bioreactor. A commercially immobilized 1,3-specific lipase, Lipozyme IM, from Rhizomucormiehei, was the biocatalyst and caprylic acid the acyl donor. Parameters such as substrate flow rate, substrate molar ratio, reaction temperature, and substrate water content were examined. High-performance liquid chromatography was used to monitor the reaction and product yields. The study showed that all of the parameters had effects on the yields of the expected di-incorporated (dicaprylic) ST products. Flow rates below 1 mL/min led to reaction equilibrium, and lower flow rates did not raise the incorporation of caprylic acid and the product yield. Incorporation of caprylic acid and the targeted di-incorporated ST was increased by approximately 20% with temperature increase from 40 to 70 degrees C. Increasing the substrate molar ratio from 1:1 to 7:1 increased the incorporation of caprylic acid and the product yield slightly. Water content in the substrate also had a mild influence on the reaction. Water content at 0.08% added to the substrate gave the lowest incorporation and product yield. The use of solvent in the medium was also studied, and results demonstrated that it did not increase the reaction rate at 55 degrees C when 33% hexane (v/v) was added. The main fatty acids at the sn-2 position of the ST were C(18:1), 54. 7 mol %; C(18:2), 30.7 mol %; and C(18:3), 11.0 mol %.

Optimized enzymatic synthesis of geranyl butyrate with lipase AY from Candida rugosa.

Response surface methodology (RSM) and five-level, five-variable central composite rotatable design (CCRD) were used to evaluate the effects of synthetic variables, such as reaction time (1-9 h), temperature (25-65 degrees C), enzyme amount (10-50%), substrate molar ratio of geraniol to tributyrin (1:0.33-1:1), and added water amount (0-20%) on molar percent yield of geranyl butyrate, using lipase AY from Candida rugosa. Reaction time and temperature were the most important variables and substrate molar ratio had no effect on percent molar conversion. Based on contour plots, optimum conditions were: reaction time 9 h, temperature 35 degrees C, enzyme amount 50%, substrate molar ratio 1:0.33, and added water 10%. The predicted value was 100% and actual experimental value was 96.8% molar conversion. (c) 1996 John Wiley & Sons, Inc.

Lipid-based fat substitutes.

Fats and oils account for 38% of the total calories in the diet of Western populations, especially in the U.S. They provide the most concentrated source of energy, 9 kcal/g of a triacylglycerol molecule compared with 4 kcal/g provided by carbohydrate and protein. In response to consumer demands for low-calorie or calorie-free fats and their reluctance to give up the taste of fat, current research efforts have been directed toward the development of lipid-like fat substitutes. These fat substitutes contain the fatty acids found in conventional fats and oils, with all the physical and organoleptic properties of fats, but provide few or no calories in the diet. Some of the fat substitutes are modified triacylglycerols (glycerol backbone) with reduced digestion and absorption; others are digestible and nondigestible carbohydrate fatty acid esters and polyesters, respectively. Sucrose polyester (Olestra), a sucrose molecule esterified with six to either fatty acids, is the most studied of the lipid-based fat substitutes containing a carbohydrate backbone. If approved by the FDA, sucrose polyester will find application in almost all fat-containing foods. Specialty fats or fat substitutes targeted to certain individuals with special needs are being developed. Among these are the medium-chain triacylglycerols and structured lipids (glycerol backbone), or ¿nutraceuticals¿ with reduced absorption and medical applications. Enzyme biotechnology is another tool available to lipid chemists to selectively modify, esterify, transform, transesterify, and interesterify fats and oils or synthesize new lipids such as structured lipids of food, nutritional, and medical importance. These designer fats may be the trend in the future to produce medical lipids that do not occur normally in nature. The different types of lipid-based fat substitutes are reviewed with respect to their synthesis, analysis, metabolism, potential applications/uses, and the future of fat substitutes.

Effects of a fat substitute, sucrose polyester, on food intake, body composition, and serum factors in lean and obese Zucker rats.

Sucrose polyester, a fat substitute, has shown promise in reducing blood cholesterol and body weight of obese individuals. Effects of this compound in the Zucker rat, a genetic model of obesity, are unknown. Thus, we examined food intake, body weight, body composition, and several metabolic parameters in sera of lean and obese female Zucker rats. Eight-week-old lean and obese animals were given a choice between a control diet (15% corn oil) and fat substitute diet (5% corn oil and 10% sucrose polyester) for 2 days. Next, one-half of the lean and obese groups received control diet; the remaining lean and obese rats received fat substitute diet for 18 days. Cumulative food intake was depressed in fat substitute groups relative to control-fed animals; however, this effect was more predominant in obese animals. Obese rats consuming fat substitute diet (O-FS) gained less weight as compared to obese control-fed animals (O-C). Lean rats given fat substitute (L-FS) did not have significantly different body weights as compared to the L-C group. Fat substitute groups, combined, had lower body fat and higher body water as compared to controls. The O-FS group had lower serum glucose and insulin and higher fatty acid levels compared to the O-C group. There were no differences in serum cholesterol, HDL, or triglyceride levels due to fat substitute diet. These data suggest that the obese Zucker rat is unable to defend its body weight when dietary fat is replaced with sucrose polyester.

Influence of dietary n-3 fatty acids on macrophage glycerophospholipid molecular species and peptidoleukotriene synthesis.

The study examined the ability of dietary n-3 fatty acids to modify mouse peritoneal macrophage glycerophospholipid molecular species and peptidoleukotriene synthesis. After a 2-week feeding period, fish versus corn oil feeding significantly (P less than 0.01) lowered n-6 polyunsaturated fatty acid (PUFA) mol % levels, i.e., arachidonic acid (20:4n-6) in diacylphosphatidylserine (PtdSer), diacylphosphatidylinositol (PtdIns), diacylglycerophosphoethanolamine (PtdEtn), alkenylacylglycerophosphoethanolamine (PlsEtn), and diacylglycerophosphocholine (PtdCho). A notable exception was alkylacylglycerophosphocholine (PakCho), where only moderate decreases in 16:0-20:4n-6 and 18:0-20:4n-6 species were observed after fish oil supplementation. The predominant n-3 PUFA in macrophage phospholipid subclasses was docosapentaenoic acid (22:5n-3). The major n-3 species were 18:0-22:5n-3 in PtdIns, PtdSer, glycerophosphoethanolamines (EtnGpl) and 16:0-22:5n-3 in PtdCho and PlsEtn. The major n-3-containing species in PakCho were 16:0-20:5n-3 and 18:1-22:6n-3. These findings indicate that n-3 PUFA are differentially incorporated into macrophage phospholipid subclasses after dietary fish oil supplementation, and suggest that phospholipid remodeling enzymes selectively discriminate between substrates based on compatibility of sn-1 covalent linkage and the composition of the sn-1 and sn-2 aliphatic chains. Macrophage peptidoleukotriene synthesis was also strongly influenced after fish oil feeding; the LTC5/LTC4 ratio was significantly higher (P less than 0.01) in fish oil-fed animals than in corn oil-fed animals, 0.85 versus 0.01, respectively. These ratios were subsequently compared to phospholipid molecular species 20:5n-3/20:4n-6 ratios in order to determine potential sources of eicosanoid precursors.

Composition of mouse peritoneal macrophage phospholipid molecular species.

The individual molecular species composition of diacyl, alkylacyl and alkenylacyl glycerophospholipids was determined in mouse peritoneal macrophages. A marked heterogeneity in the relative composition (mol%) of macrophage ether and ester phospholipid individual species was noted. High concentrations of 16:0-20:4 were found in ether phospholipids such as alkenylacyl glycerophosphoethanolamine (GPE; 27.5 mol%) and alkylacyl glycerophosphocholine (GPC; 16.6%) as compared to mol% levels of 16:0-20:4 in diacyl GPE (5.7%) and diacyl GPC (8.1%), respectively. Interestingly, alkenylacyl GPE was highly enriched in 1-ether (16:0) relative to alkylacyl GPC. The predominant diacyl molecular species in glycerophosphoinositol (GPI) and glycerophosphoserine (GPS) were 18:0-20:4 (59.1%) and 16:0-18:1 (41.1%), respectively. It is noteworthy that the level of 18:0-20:4 was several times higher in diacyl GPI (59.1%) than in diacyl GPS (11.1%), diacyl GPE (25.7%), and diacyl GPC (3.7%). The most abundant molecular species in diacyl GPC and diacyl GPE were 16:0-18:1 (29.9%) and 18:0-20:4 (25.7%), respectively. The abundance of 20:4 in ether phospholipids, specifically 16:0-20:4 and 18:0-20:4, in alkylacyl GPC is significant in view of the role these antecedents play in the biosynthesis of platelet-activating factor (PAF) and 20:4-derived eicosanoids in stimulated macrophages. The unique molecular species composition of the peritoneal macrophage distinguishes this cell type from others.

Biosynthesis of the sesquiterpene patchoulol from farnesyl pyrophosphate in leaf extracts of Pogostemon cablin (patchouli): mechanistic considerations.

Several mechanistic alternatives have been proposed for the enzyme-catalyzed, electrophilic cyclization of farnesyl pyrophosphate to the tricyclic sesquiterpene alcohol patchoulol, which is the characteristic component of the essential oil of Pogostemon cablin (patchouli). These alternatives include schemes involving deprotonation-reprotonation steps and the intermediacy of the monocyclic and bicyclic olefins germacrene and bulnesene, respectively, and involving a 1,3-hydride shift with only tertiary cationic intermediates and without any deprotonation-reprotonation steps. Analytical studies, based on analyses of P. cablin leaf oil at different stages of plant development, and in vivo time-course investigations, using 14CO2 and [14C]sucrose, gave no indication that germacrene and bulnesene were intermediates in patchoulol biosynthesis. A soluble enzyme system from P. cablin leaves was prepared, which was capable of converting farnesyl pyrophosphate to patchoulol, and isotopic dilution experiments with both labeled and unlabeled olefins were carried out with this system to confirm that sesquiterpene olefins did not participate as fre intermediates in the transformation of the acyclic precursor to patchoulol. Patchoulol derived biosynthetically from [12,13-14C;1-3H]farnesyl pyrophosphate was chemically degraded to establish the overall construction pattern of the product. Similar studies with [12,13-14C;6-3H]farnesyl pyrophosphate as a precursor eliminated deprotonation steps to form bound olefinic intermediates in the biosynthesis of patchoulol, while providing supporting evidence for the hydride shift mechanism.