Total knee arthroplasty and periprosthetic distal femoral fracture: looking beyond the osteoporosis to previous osteoporotic fracture.

Osteoporosis increases the risk of periprosthetic distal femoral fractures after TKA, especially in patients with a history of osteoporotic fractures. Therefore, careful assessment and proper treatment of osteoporosis need and the importance of taking osteoporotic medication needs to be recognized by the patients following primary TKA. PURPOSE: Osteoporosis is a risk factor for fractures, including those of the hip, vertebrae, and distal radius; however, the association between osteoporosis and periprosthetic fractures after total knee arthroplasty (TKA) has not been much investigated. Therefore, we aimed to investigate the association of the presence of systemic osteoporosis with periprosthetic fractures after TKA. METHODS: This study included 34 patients with periprosthetic fractures following primary TKA and 106 controls matched for age and sex. Bone mineral density was evaluated at the femoral neck, total hip, and lumbar spine using dual X-ray absorptiometry. Medical records were reviewed for age; sex; body mass index; smoking; rheumatoid arthritis, endocrine diseases, and cardiovascular diseases; history of glucocorticoid use; medication for osteoporosis; and history of previous osteoporotic fracture. In addition, anterior femoral notching after TKA was evaluated. Univariable and multivariable logistic regression analysis were used to determine factors associated with periprosthetic fracture. RESULTS: The prevalence of osteoporosis in the fracture group was higher than that in the control group (61.8% vs. 40.6%, p=0.045). The rate of medication for osteoporosis was significantly low in the fracture group (47.6 % vs 76.7%, p=0.026). History of previous osteoporotic fracture (odds ratio [OR], 9.1; p=0.015) and osteoporosis (OR, 3.6; p=0.013) were significant risk factors for periprosthetic fractures after TKA. Medication for osteoporosis could decrease the risk of periprosthetic fracture (OR 0.3; p=0.020). CONCLUSION: Osteoporosis is a major risk factor for periprosthetic distal femoral fractures after TKA. Therefore, careful assessment and proper treatment of osteoporosis need and the importance of taking osteoporotic medication needs to be recognized to the patients following primary TKA, especially in patients with a history of osteoporotic fracture. LEVEL OF EVIDENCE: Prognostic study, level III.

Search for Boosted Dark Matter in COSINE-100.

We search for energetic electron recoil signals induced by boosted dark matter (BDM) from the galactic center using the COSINE-100 array of NaI(Tl) crystal detectors at the Yangyang Underground Laboratory. The signal would be an excess of events with energies above 4 MeV over the well-understood background. Because no excess of events are observed in a 97.7 kg·yr exposure, we set limits on BDM interactions under a variety of hypotheses. Notably, we explored the dark photon parameter space, leading to competitive limits compared to direct dark photon search experiments, particularly for dark photon masses below 4 MeV and considering the invisible decay mode. Furthermore, by comparing our results with a previous BDM search conducted by the Super-Kamionkande experiment, we found that the COSINE-100 detector has advantages in searching for low-mass dark matter. This analysis demonstrates the potential of the COSINE-100 detector to search for MeV electron recoil signals produced by the dark sector particle interactions.

Search for a Dark Matter-Induced Annual Modulation Signal in NaI(Tl) with the COSINE-100 Experiment.

We present new constraints on the dark matter-induced annual modulation signal using 1.7 years of COSINE-100 data with a total exposure of 97.7 kg yr. The COSINE-100 experiment, consisting of 106 kg of NaI(Tl) target material, is designed to carry out a model-independent test of DAMA/LIBRA's claim of WIMP discovery by searching for the same annual modulation signal using the same NaI(Tl) target. The crystal data show a 2.7 cpd/kg/keV background rate on average in the 2-6 keV energy region of interest. Using a χ-squared minimization method we observe best fit values for modulation amplitude and phase of 0.0092±0.0067 cpd/kg/keV and 127.2±45.9 d, respectively.

First Direct Search for Inelastic Boosted Dark Matter with COSINE-100.

A search for inelastic boosted dark matter (IBDM) using the COSINE-100 detector with 59.5 days of data is presented. This relativistic dark matter is theorized to interact with the target material through inelastic scattering with electrons, creating a heavier state that subsequently produces standard model particles, such as an electron-positron pair. In this study, we search for this electron-positron pair in coincidence with the initially scattered electron as a signature for an IBDM interaction. No excess over the predicted background event rate is observed. Therefore, we present limits on IBDM interactions under various hypotheses, one of which allows us to explore an area of the dark photon parameter space that has not yet been covered by other experiments. This is the first experimental search for IBDM using a terrestrial detector.

Studies on the Interactions of 2-Hydroxyoleic Acid with Monolayers and Bilayers Containing Cationic Lipid: Searching for the Formulations for More Efficient Drug Delivery to Cancer Cells.

Drug delivery in cationic liposomes seems to be a promising therapeutic approach in cancer treatment. The rational design of the positively charged lipid vesicles as anticancer drug carriers should be supported by a detailed analysis of the interactions of the carrier components with anticancer drugs. In the present work, 2-hydroxyoleic acid (2OHOA; Minerval), a membrane lipid therapy drug, was incorporated into positively charged mono- and bilayer membranes containing 1-palmitoyl-2-oleoyl- sn-glycero-3-ethylphosphocholine (EPOPC), the synthetic cationic lipid, and 1,2-dioleoyl- sn-glycero-3-phosphocholine (DOPC). The intermolecular interactions, fluidity, and miscibility of the studied monolayers were analyzed by utilizing Langmuir balance experiments. The morphology of two-dimensional films was inspected using a Brewster angle microscopy technique. The properties of the liposomes were investigated by dynamic light scattering (DLS) and zeta potential measurements, steady-state fluorescence anisotropy experiments, and the spectrofluorimetric titration of calcein-encapsulated vesicles with a lysis-inducing agent. According to the collected results, 2OHOA intercalation into films of pure phospholipids or a binary EPOPC/DOPC film is thermodynamically favorable. Surprisingly, no significant effect of the presence of unsaturated 2OHOA chains on the EPOPC/DOPC monolayer order was observed. The experiments carried out for 2OHOA-inserted cationic EPOPC/DOPC (1:4) liposomes indicate effective incorporation of the drug into the liposome bilayer and the formation of stable vesicles without affecting their properties markedly. On the basis of the obtained results, EPOPC/DOPC/2OHOA cationic liposomes with 15% 2OHOA content in the phospholipid bilayer seem to be the most suitable for potential biomedical applications.

[Intrafamilial disruptive behaviour disorders in children and adolescents: Present data and treatment prospects]. / Troubles disruptifs intrafamiliaux : données actuelles et perspectives de traitement.

Child-to-parent violence is a form of family violence that is still a well-kept secret. Abused parents can be victims of different types of abuse. Children can use both physical and psychological violence such as financial threats to take control of the home. In this situation, parents often no longer dare to contradict their children by fear of triggering uncontrollable violence. Although the phenomenon recently drew the attention of the media, there is still little knowledge about its prevalence and clinical characteristics. Most families remain isolated for a long time and, even in case of consulting in a mental health setting, disclosure of the nature of the difficulties is often delayed. This article presents the specificities of these children and their clinical characteristics. It also studies the victimized parents, the entire family, and their relation to the external environment. When observing these young offenders oppositional defiant disorder, conduct disorder and attention deficit hyperactivity disorder are frequently found. The diagnosis of "conduct disorder confined to family context" defined in the ICD 10 is the most appropriate to describe them. But it is regrettable that there has currently been no study to validate it and to determine its specificity. Compared with other young children who have "classic" disruptive disorders, children involved in violence against their parents have more difficulties with affect regulation, impulse control, and interpersonal skills. These children also frequently have low self-esteem and difficulties interacting with their peers. They may be isolated and bullied. They feel more sadness than these other young people and use violence as a way to express their emotions. Within the family both girls and boys commit violence against their parents. Girls will mostly use psychological violence but can also be involved in physical aggression. The first victim of child-to-parent violence is the mother. As mothers are often more present at home and seen by their children as weaker than the father, they are seen as an "easy target". If the "classic" conduct disorder is most frequently encountered in low social status families, intra familial disruptive behavior can be observed in families from all socio economic status. With respect to the parent-child relationship in those families, there are some relevant specificities. First, the quality of communication is bad, parents and children are not intimate and the tension is permanent. Furthermore, children do not respect their parents' authority. They perceive parenting style as permissive and negligent without enough support and control, and they may want to restore a coherent authority in the family. It is important to mention that potential vulnerability factors such as older age, a history of mental illness and social isolation have been described in parents of these children. Thereby, victimized parents have all the more difficulty to stand up against their children or to cleverly adapt their authority to their behavior. Other types of inappropriate education can be the origin of the child-to-parent violence. There is a direct correlation between the high frequency of punishments and violent attitude of the children towards their parents. So, the family dynamic is characterized by an inversion of the family hierarchy, the parents' fear of violent behavior from their child, and shame expressed by the parents with regards to the nature of familial relationships. Their fear and their shame will contribute to ensuring that their child's behavior is kept secret. Finally, several factors can therefore be at the source of the development of child-to- parent violence ; this study aims to raise awareness of clinicians of this impairing and frequently hidden condition. Due to the absence of specific studies, management of intra-familial disruptive disorder is likely to be less than optimal and heterogeneous. The development of a group of targeted parental psychoeducation is a promising management technique. We will describe the basic principles of « active parental control¼, a programme using techniques of « non-violent resistance¼ to help parents cope with violence and control children's behavior. The results of this programme are still being evaluated, but preliminary results seem promising since the parents included in the pilot group have described a significant improvement in the feeling of parental competence and, notably, self-control.

Single-stage cell-based cartilage repair in a rabbit model: cell tracking and in vivo chondrogenesis of human umbilical cord blood-derived mesenchymal stem cells and hyaluronic acid hydrogel composite.

OBJECTIVE: Human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) have gained popularity as a promising cell source for regenerative medicine, but limited in vivo studies have reported cartilage repair. In addition, the roles of MSCs in cartilage repair are not well-understood. The purpose of this study was to investigate the feasibility of transplanting hUCB-MSCs and hyaluronic acid (HA) hydrogel composite to repair articular cartilage defects in a rabbit model and determine whether the transplanted cells persisted or disappeared from the defect site. DESIGN: Osteochondral defects were created in the trochlear grooves of the knees. The hUCB-MSCs and HA composite was transplanted into the defect of experimental knees. Control knees were transplanted by HA or left untreated. Animals were sacrificed at 8 and 16 weeks post-transplantation and additionally at 2 and 4 weeks to evaluate the fate of transplanted cells. The repair tissues were evaluated by gross, histological and immunohistochemical analysis. RESULTS: Transplanting hUCB-MSCs and HA composite resulted in overall superior cartilage repair tissue with better quality than HA alone or no treatment. Cellular architecture and collagen arrangement at 16 weeks were similar to those of surrounding normal articular cartilage tissue. Histological scores also revealed that cartilage repair in experimental knees was better than that in control knees. Immunohistochemical analysis with anti-human nuclear antibody confirmed that the transplanted MSCs disappeared gradually over time. CONCLUSION: Transplanting hUCB-MSCs and HA composite promote cartilage repair and interactions between hUCB-MSCs and host cells initiated by paracrine action may play an important role in cartilage repair.

Diamine Functionalized Cubic Mesoporous Silica for Ibuprofen Controlled Delivery.

A diamine functionalized cubic mesostructured KIT-6 (N-KIT-6) has been prepared by post-synthetic method using calcined mesoporous KIT-6 with a diamine source, i.e., N-'[3-(tri methoxysilyl)- propyl]'ethylenediamine. The KIT-6 mesoporous silica used for N-KIT-6 was synthesized under weak acidic hydrothermal method using bitemplates, viz., Pluronic P123 and 1-butanol. The synthesized mesoporous materials, KIT-6 and N-KIT-6, have been characterized by the relevant instrumental techniques such as SAXS, N2 sorption isotherm, FT-IR, SEM, TEM and TGA to prove the standard mesoporous materials with the identification of diamine groups. The characterized mesoporous materials, KIT-6 and N-KIT-6, have been extensively used in the potential application of controlled drug delivery, where ibuprofen (IBU) employed as a model drug. The rate of IBU adsorption and release was monitored by UV vis-spectrometer. On the basis of the experimental results of controlled drug delivery system, the results of IBU adsorption and releasing rate in N-KIT-6 are higher than those of KIT-6 because of the higher hydrophobic nature as well as rich basic sites on the surface of inner pore wall silica.

The impact of hepatitis B virus (HBV) infection on clinical outcomes of patients with diffuse large B-cell lymphoma.

We performed a retrospective study to analyse the characteristics and clinical outcomes of diffuse large B-cell lymphoma (DLBCL) patients with hepatitis B virus (HBV) infection and compare with those without HBV infection. The occurrence of hepatitis after withdrawal of prophylactic antiviral treatment on completion of chemotherapy was also assessed. The HBsAg-positive patients were given prophylactic antiviral treatment until 6 months after finishing chemotherapy. A total of 81 patients were recruited with 16 in the HBsAg-positive group and 65 in the HBsAg-negative group. The clinical characteristics were similar in both groups of patients. There was no significant difference in complete remission rate between the two groups (63% in HBsAg-positive group vs. 54% in HBsAg-negative group, P = 0.59). There was also no statistically significant difference in overall survival between the two groups (P = 0.23). Four of the 16 HBsAg-positive patients (25%) had hepatitis after cessation of chemotherapy and prophylactic lamivudine. The mean time of onset of hepatitis was 3 months after stopping lamivudine. In conclusion, HBV infection did not appear to affect the prognosis of DLBCL patients given antiviral prophylaxis. It is reasonable to consider prophylactic antiviral therapy to extend to at least one year on completion of chemotherapy.

Prevalence of thoracic spine pain in a surveillance network.

BACKGROUND: Back pain has long been identified as a major occupational health issue, but there are few prevalence studies on thoracic spine pain (TSP). The epidemiological surveillance of musculoskeletal disorders implemented in 2002 by the French Institute for Public Health Surveillance in the Pays de la Loire region provided the opportunity to study the prevalence of TSP in a large, representative sample of workers. AIMS: To assess the prevalence of TSP across a week in a regional workforce according to age, occupational category and industry sector in men and women separately. METHODS: A random sample of workers aged 20-59 years, representative of the regional workforce, was constituted between 2002 and 2005. Medical and occupational data were gathered by questionnaire. RESULTS: The sample consisted of 3710 workers (58% men). The prevalence of TSP was higher in women (17%) than in men (9%). Lower grade male white-collar workers were more likely to report TSP (17%) than male workers in other occupational categories, whereas upper grade female white-collar and professional workers were more likely to report TSP. No significant difference in the prevalence of TSP was noted in either men or women according to industry sector. CONCLUSIONS: Although TSP is less frequent than low back and neck pain, the results of this study indicate that 1 in 10 men and 1 in 5 women suffer from TSP.

Difference in post-surgical reproductive prognosis between transcervical resection and transcervical incision of the septum.

OBJECTIVE: This study aims to determine the difference between transcervical resection of septum (TCRS) and transcervical incision of septum (TCIS) in the improvement of reproductive prognosis. STUDY DESIGN: Women with uterine septum in the Affiliated Hospital of Ningxia Medical University were retrospectively analyzed. A statistical method was used according to operative time, postoperative menstruation, postoperative pregnancy rate, postoperative term delivery rate, and so on. RESULTS: Compared with TCRS, the TCIS method decreased operative time, blood loss, and consumption of uterus distension medium. No statistical difference was observed in operative complications between the two methods. After TCIS, the incidence of uterine adhesion was low and the degree of endometrial epithelialisation was high by hysteroscopy review. No statistical difference was observed in residual septum after the operation. The total pregnancy rate after TCIS was higher than that of TCRS. However, no statistical difference was observed in early and late pregnancy loss rates, preterm birth rate, and term birth rate. CONCLUSION: TCIS exhibits advantages of decreasing operative time, blood loss, and consumption of uterus distension medium. TCIS can reduce the incidence of uterine adhesion and can promote endometrial epithelialisation, which are the key factors to increase pregnancy rate after operation.

Betaproteobacteria are a key component of surface water biofilters that maintain sustained manganese removal in response to fluctuations in influent water temperature.

The health risks associated with manganese (Mn) in drinking water, and an improved understanding of Mn accumulation within, and subsequent release from, distribution systems, have increased the need for robust, sustainable treatment options to minimize Mn concentrations in finished water. Biofiltration is an established and effective method to remove Mn in groundwater however, Mn removal in surface water biofilters is an emerging treatment process that has not been extensively studied. Seasonal variations in water temperature can present an operational challenge for surface water biofilters which may see reduced Mn removal under colder conditions. This study examined the microbiomes of surface water biofilters at three utilities (ACWD WTP, WTP B, and WTP D) which all experienced similar seasonal fluctuations in influent water temperature. High Mn removal was observed at the ACWD WTP for much of the year, but Mn removal decreased with a concurrent decrease in the influent water temperature (58% ± 22%). In contrast, both WTP B and WTP D achieved year-round Mn removal (84% ± 5% and 93% ± 8% respectively). Marker gene (16S rRNA) sequencing analysis of the biofilter microbiomes identified a high abundance of Betaproteobacteria in WTP B and WTP D (37% ± 12% and 21% ± 3% respectively), but a low abundance of Betaproteobacteria in the ACWD WTP (2% ± 2%). The microbiomes of new bench-scale biofilters, in operation at the ACWD WTP, were also investigated. The abundance of Betaproteobacteria was significantly greater (p < 0.05) after the biofilters had acclimated than before acclimation, and differential abundance analysis identified 6 genera within the Betaproteobacteria class were enriched in the acclimated microbiome. Additionally, the acclimated biofilters were able to maintain high Mn removal performance (87% ± 10%) when the influent water temperature decreased to 10 °C or less. Further analysis of previously published studies found the abundance of Betaproteobacteria was also significantly greater (p < 0.001) in biofilters with sustained Mn removal than in biofilters which did not treat for Mn as a contaminant, despite differences in design scale, source water, and media type. Microbiome network analysis identified multiple co-occurrence relationships between Betaproteobacteria and Mn oxidizing bacteria in the WTP B and WTP D biofilters, suggesting indirect contributions by Betaproteobacteria to biological Mn oxidation. These co-occurrence relationships were not present in the full-scale ACWD WTP microbiome. Whether the role of Betaproteobacteria in biological Mn oxidation is direct, indirect, or a combination of both, they are consistently present at a high abundance in both groundwater and surface water biofilters with sustained Mn removal, and their absence may contribute to the seasonal fluctuations in Mn removal observed at the ACWD WTP. This new insight to Betaproteobacteria and their role in Mn biofiltration could contribute to water innovation and design that would improve the reliability of Mn removal.

Optical band gaps and spectroscopy properties of Bi m+/Eu n+/Yb3+ co-doped (m = 0, 2, 3; and n = 2, 3) zinc calcium silicate glasses.

In this study, the indirect/direct optical band gaps and spectroscopy properties of Bi m+/Eu n+/Yb3+ co-doped (m = 0, 2, 3; and n = 2, 3) zinc calcium silicate glasses under different excitation wavelengths were investigated. Zinc calcium silicate glasses with the main compositions of SiO2-ZnO-CaF2-LaF3-TiO2 were prepared by the conventional melting method. EDS analysis was performed to determine the elemental composition existing in the zinc calcium silicate glasses. Visible (VIS)-, upconversion (UC)-, and near-infrared (NIR)-emission spectra of Bi m+/Eu n+/Yb3+ co-doped glasses were also investigated. Indirect optical band gaps and direct optical band gaps of Bi m+-, Eu n+- single-doped, and Bi m+-Eu n+ co-doped SiO2-ZnO-CaF2-LaF3-TiO2-Bi2O3-EuF3-YbF3 zinc calcium silicate glasses were calculated and analyzed. CIE 1931(x, y) color coordinates for VIS and UC emission spectra of Bi m+/Eu n+/Yb3+ co-doped glasses were determined. Besides, the mechanism of VIS-, UC-, NIR-emissions, and energy transfer (ET) processes between Bi m+ and Eu n+ ions were also proposed and discussed.

Prevalence of knee bursitis in the workforce.

BACKGROUND: Knee bursitis (KB) is a common disorder in specific occupations requiring frequent and/or sustained kneeling postures. AIMS: To assess the prevalence of KB in the general working population. METHODS: Between 2002 and 2005, a total of 3710 workers of a French region were randomly included in the study. A standardized physical examination of the knee was performed when knee pain was reported by the worker during the preceding 12 months. The criteria for diagnosis of KB were (i) the presence of pain and/or tenderness in the anterior face of the knee at the date of the examination (or for at least 4 days in the preceding week) and (ii) the presence of swelling and/or pressure-induced pain of the pre- or infra-patellar bursa. Occupational risk factors were assessed by a self-administered questionnaire. RESULTS: The prevalence of uni- or bilateral cases of knee bursitis was low: 0.6% [0.2-0.9] in men and 0.2% [0.0-0.6] in women. The highest prevalence was observed in the construction sector (2.3% [0.8-5.4]) and in the food and meat processing industries (1.4% [0.4-3.5)]. More blue-collar workers were affected than other occupation categories (0.8% [0.3-1.2] versus 0.1% [0.0-0.4]). CONCLUSIONS: The study showed a concentration of cases among male workers exposed to heavy workloads and frequent kneeling.

Working in temporary employment and exposure to musculoskeletal constraints.

BACKGROUND: In recent years, temporary work (TW) has increased in European countries due to the greater uncertainty in the economy. AIMS: To compare the prevalence of non-specific musculoskeletal symptoms of the upper extremities (UEMSDs) and their main risk factors in blue-collar workers employed through temporary agencies (TW) and in those in permanent employment (PE). METHODS: UEMSDs occurring during the preceding 7 days were assessed using a Nordic questionnaire completed by 1493 blue-collar workers randomly included in a surveillance programme for UEMSDs (171 in TW and 1322 in PE) in a large French region. Personal factors and work-related risk factors for UEMSDs were assessed by self-administered questionnaires. RESULTS: The prevalence of UEMSDs during the preceding 7 days did not significantly differ between workers in TW or PE. However, after adjustment for age and gender, TW had a higher risk of symptoms of the wrist/hand region (OR = 1.6, 95% CI 1.04-2.6). TW was characterized by higher exposure to paced work (OR = 2.0, 95% CI 1.4-3.0), repetitive work (OR = 2.3, 95% CI 1.6-3.4), awkward postures of the wrist (OR = 1.6, 95% CI 1.2-2.4) and intensive use of vibrating hand tools (OR = 1.7, 95% CI 1.1-2.3). Workers in TW suffered from a lack of autonomy (OR = 2.5, 95% CI 1.7-3.6) and skill discretion at work (OR = 2.0, 95% CI 1.3-3.1) more frequently, but there was no difference in relation to psychological demands of the task or social support. CONCLUSIONS: Temporary workers were more frequently exposed to working time constraints, repetitive work and biomechanical constraints of the wrist/hand region when compared to permanent workers and may represent a subpopulation at particularly high risk of UEMSDs.

Biological and physico-chemical mechanisms accelerating the acclimation of Mn-removing biofilters.

This study investigated treatment strategies which accelerated the acclimation of new Mn-removing biofilters to help utilities respond to changing Mn regulations, such as the recent introduction of a health-based maximum acceptable concentration and a reduction in the aesthetic objective for Mn in drinking water by Health Canada. Bench-scale filters of either GAC or anthracite media were fed with applied water containing Mn (17-61 µg/L) from a full-scale plant over 294 days. Treatment strategies included the addition of H2O2 (1 mg/L) and/or an increase in pH from 6.8 to 7.5 through the addition of NaOH. The potential physico-chemical and biological mechanisms responsible for accelerated biofilter acclimation under the various redox conditions were investigated through thermodynamic modelling, to predict homogeneous Mn oxide formation, and 16S rRNA gene amplicon sequencing, to characterize the microbial community within the filters. GAC filters treated with NaOH, and both H2O2 and NaOH, were the first to acclimate (< 20 µg/L Mn in filter effluent) after 59 and 63 days respectively, while the ambient GAC filter took almost 3 times as long to acclimate (168 days), and the anthracite filters which received the same chemically adjusted water took almost 4 times as long (226 and 251 days, respectively). The accelerated acclimation in the treated GAC filters was likely due to physico-chemical oxidation via three potential mechanisms: (1) homogeneous oxidation of dissolved Mn(II) to Mn(III)/Mn(IV) oxides and the subsequent removal of oxides from solution through adherence to the GAC surface, (2) adsorption of dissolved Mn(II) to GAC and subsequent homogeneous or biological oxidation, or (3) formation of colloidal Mn(III)/Mn(IV) oxides and subsequent adsorption of dissolved Mn(II) to the Mn colloids. In the untreated GAC filter and all anthracite filters, which did not benefit from improved redox conditions or an active surface, physico-chemical mechanisms alone were insufficient for consistent Mn removal to less than 20 µg/L. Acclimation in these filters was delayed until a microbiome enriched with bacteria capable of biological nitrification and Mn oxidation evolved within the filters. The acclimated microbiome was consistent between GAC and anthracite filters and was significantly different from the non-acclimated microbiome (p < 0.001) initially formed during the early operation of the filters. Interestingly, treatment with NaOH, and NaOH and H2O2, which accelerated physico-chemical oxidation in GAC filters, was observed to delay the development of biological oxidation in anthracite filters, and thus deferred acclimation. Although some filters took longer to acclimate than others, once acclimation was reached all filters had a similar microbiome and were able to consistently remove Mn to below 20 µg/L.

A novel approach to spinal anaesthesia to avoid aerosol-generating procedures in a patient with COVID-19 presenting for laser prostate surgery.

General anaesthesia involves aerosol-generating procedures which, in the context of the coronavirus 2019 (COVID-19) pandemic, increases the risk of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) transmission from patients to staff. This risk can be minimised by performing spinal or regional anaesthesia instead of general anaesthesia where possible. We report the successful management of a patient utilising spinal anaesthesia in a patient with COVID-19 undergoing urgent holmium laser enucleation of prostate for symptomatic benign prostatic hyperplasia. A combination of bupivacaine, diamorphine and midazolam was administered intrathecally which provided adequate anaesthesia despite the prolonged surgical duration. Nebulised lidocaine was also given to prevent coughing during the procedure. This report demonstrates that it is possible and safe to use spinal anaesthesia to perform prolonged surgical procedures that are normally conducted under general anaesthesia using a combination of intrathecal adjuncts to facilitate effective block duration. In addition, the novel use of nebulised lidocaine for its antitussive effects in a patient with COVID-19 is highlighted.