Degradation and metabolism of synthetic plastics and associated products by Pseudomonas sp.: capabilities and challenges.

Synthetic plastics, which are widely present in materials of everyday use, are ubiquitous and slowly-degrading polymers in environmental wastes. Of special interest are the capabilities of microorganisms to accelerate their degradation. Members of the metabolically diverse genus Pseudomonas are of particular interest due to their capabilities to degrade and metabolize synthetic plastics. Pseudomonas species isolated from environmental matrices have been identified to degrade polyethylene, polypropylene, polyvinyl chloride, polystyrene, polyurethane, polyethylene terephthalate, polyethylene succinate, polyethylene glycol and polyvinyl alcohol at varying degrees of efficiency. Here, we present a review of the current knowledge on the factors that control the ability of Pseudomonas sp. to process these different plastic polymers and their by-products. These factors include cell surface attachment within biofilms, catalytic enzymes involved in oxidation or hydrolysis of the plastic polymer, metabolic pathways responsible for uptake and assimilation of plastic fragments and chemical factors that are advantageous or inhibitory to the biodegradation process. We also highlight future research directions required in order to harness fully the capabilities of Pseudomonas sp. in bioremediation strategies towards eliminating plastic wastes.

Hybrid monolateral-ring fixator for bone transport in post-traumatic femoral segmental defect: a technical note.

Bone transport for large femoral segmental bone defects is a technically challenging task. We describe a patient with a 14 cm bone loss at the metaphyseal/diaphyseal junction of the distal femur, treated with a monolateral/ring fixator hybrid. We propose that such combination can provide sufficient stability for bone tranport to be successfully completed.

Assessment of mechanical stability of a parallel wire bone transport system for use with an Ilizarov frame.

A novel fine wire bone transport system for use with Ilizarov frames has been used in Bristol. It uses parallel wires instead of crossed wires. Its stiffness has been tested and compared with a crossed wire construct. In its basic form it is not as stiff to bending and shear loading, however, by modification it can be made at least as stiff. A parallel wire construct does not transfix as much soft tissue as a crossed wire construct when used in the leg. This is advantageous, because soft tissue transfixion causes pain and limb swelling, which impair patient mobilization.

The use of bone morphogenic protein-7 (OP-1) in the management of resistant non-unions in the upper and lower limb.

The aim of the present study was to investigate the safety and efficacy of local implantation of BMP-7 for the treatment of resistant non-unions in the upper and lower limb. Fifty-two patients (30 males, mean age 52.8 years; range 20-81) were treated with local BMP-7 implantation in a bovine bone-derived collagen paste with or without revision of fixation. Thirty-six patients had closed injuries, ten had open injuries and six had infected non-unions. Patients had undergone a mean of 2 (1-5) operations prior to implantation of BMP-7. Clinical and radiological union was achieved in 94% at a mean time of 5.6 months (3-19). Two patients with subtrochanteric femoral fractures failed to achieve union secondary to inadequate fracture stabilisation, persistent unfavourable biological environment and systemic co-morbidities. One patient developed synostosis attributed to the BMP-7 application. This study demonstrates BMP-7 implanted in a bovine-derived collagen paste is an effective adjunctive treatment for resistant non-unions in the upper and lower limb.

Supporting limb reconstruction patients: a fine-wire circular fixator support group.

INTRODUCTION: External fixator frames are widely used in limb reconstruction surgery. They are used for relatively long periods and the multidimensional impact on patients is documented. We examined the role of a nurse-led specialist group when supporting patients both pre-operatively and postoperatively. PATIENTS AND METHODS: All patients with external fixators were contacted via postal questionnaire. Questions asked covered regularity of attendance at the specialist group, information received and problems with the frames. RESULTS: Thirty-seven patients replied. Twenty-one had attended the clinic and nearly all (32) had been offered the opportunity to attend. Most reported being well prepared for surgery and felt that the information given was satisfactory. Problems were generally addressed within the group and patients attended the group with frame-related problems before attending their general practitioner or the accident and emergency department. All patients found the group environment supportive. CONCLUSIONS: We describe a unique patient support group. To our knowledge, it is the first in the country. It is a valuable resource in equipping patients prior to surgery as well as dealing with problems that arise with the frame in situ. We recommend it to other limb reconstruction units.

Improving osteoporosis assessment in the fracture clinic.

INTRODUCTION: The aim of this study was to compare the effectiveness of different ways of referring patients to an osteoporosis assessment service at an orthopaedic fracture clinic of a hospital in the UK. PATIENTS AND METHODS: Three methods of identifying and referring to an osteoporosis assessment service were evaluated. RESULTS: Relying on doctors for such a referral gave a catchment rate of only 1.6%. Involving patients themselves, asking them to self-refer, increased the catchment rate to 63% (P < 0.0001). Having a specialist osteoporosis and fracture liaison nurse present in clinic and reviewing the notes of patients checking in, to see if they match criteria for osteoporosis assessment, further increased catchment to 77% (P = 0.036). CONCLUSIONS: Simply having an osteoporosis assessment service and strict criteria to identify which patients should be referred to such a service will not necessarily increase catchment rate for osteoporosis patients. A nurse physically present in the clinic provided the best result, and supports the need of investing in an osteoporosis and fracture liaison nurse.

Scapular and clavicular osteotomy for malunion: case report.

Fractures of the clavicle and scapula are usually treated conservatively. After malunion functional results are usually good, however, function and shoulder contour can be improved by corrective osteotomies.

Fracture and nonunion of the proximal tibia below an osteoarthritic knee: treatment by long stemmed total knee replacement.

Proximal tibial fractures below an osteoarthritic knee have a greater risk of nonunion. Treatment by cast immobilization alone is problematic. Internal fixation alone means the patient will remain handicapped because of the knee. Total knee replacement with a long-stemmed prosthesis treats both the fracture and the arthritic knee.