Post Reduction Research Articles

Effect of Moisture Content on the Ductility of Cemented Paste Backfill

The ductility of cemented paste backfill at different moisture content were researched in this paper. The cemented paste backfill specimens at three different moisture content were prepared and the uniaxial compressive tests were conducted. The results show that the compressive strength of specimen decreases with the increase of moisture content. However, the ductility of specimen increases with the increase of moisture content. The elastic modulus and the rate of post peak stress reduction decreases with the increase of moisture content. The obtained results are helpful to better understand the behavior of the cemented paste backfill under different moisture condition, which could provide guidance for safe mining.

Novel sustainable silicothermic synthesis of phase-pure TiB2 fine powder

Abstract Phase pure TiB2 powder of 100–400 nm was synthesized at 1100 °C via a novel sustainable silicothermic reduction technique using TiO2, Na2B4O7 and Si powders as starting materials. By introducing sodium salts as source of Na2O into the reactant mixture, the original water-insoluble byproduct SiO2, which is hard eliminated from resultant product in the conventional silicothermic reduction process, was transformed into water-soluble Na2Si2O5, making it much easy to remove it from the reacted mass via simple hot water washing. Consequently, a ‘‘post reduction’’ leaching process with a strong acid, generally required by the conventional metallothermic processes, was successfully avoided, and the relevant environmental concerns could be alleviated. Moreover, the aqua Na2Si2O5 could be readily recycled and used as a precursor for preparing many other types of valuable materials. Evaporation loss of silicon in the reduction process was dominated by SiO (g) resultant from the interactions between Si, SiO2 and Na2Si2O5 at test temperatures. By using 5 wt% excessive Si, TiO2 and Na2B4O7 were completely converted into TiB2 at 1100 °C.

Clinical study of fixation of unstable inter-trochanteric femoral fractures with 95⁰ angle blade plate

Background: Inter-Trochanteric hip fractures account for approximately half of the hip fractures in the elderly. By definition, these are extra-capsular fractures occurring between greater and lesser trochanters of the proximal femur, occasionally extending into sub-trochanteric region. These fractures present in bimodal age distribution. In older females these osteoporotic low energy fractures, while in young patients, usually males are affected with high energy injuries. Intertrochanteric fractures unite with conservative management also, but not without high rate of complications. Therefore, Stable reduction and rigid internal fixation is the treatment of choice for these fractures. In the present study, attempt has been made to evaluate the results of surgical management of unstable inter-trochanteric fractures with a 95 degrees angle blade plate. Materials and Methods: This study is a hospital based prospective study centered in Department of Orthopaedics at R.L Jalappa Hospital and Research Centre, Kolar, from October 2012 to October 2014 in which 30 patients with Unstable inter-trochanteric fractures are treated with open reduction and internal fixation with 95 degrees angle blade plate. Results: Patients were regularly followed-up post-operatively. Thirty cases were available for follow up. Excellent results were seen in 21 patients, good results in 7 patients, fair results in 2 patients and poor results in none. Conclusion: This study has shown that the 95 degrees angle blade plate fixation is a reliable and effective treatment of trochanteric fractures. This plate can be used for both stable and unstable intertrochanteric fractures. The final result is dependent on various other factors such as the type of fractures, lateral wall comminution and stability of the medial wall post reduction. The operative technique and final implant position also influenced the results. Over-all results also were dependent on co-morbidities of the patients. The ideal position of the implant is to keep the tip of the blade in the lower half of the femoral head and the blade should pass below the superior cortex of the neck. The 95 degrees angle blade plate is found to be a stable and acceptable implant for the fixation of intertrochanteric fractures.

Ailanthone increases oxidative stress in CDDP-resistant ovarian and bladder cancer cells by inhibiting of Nrf2 and YAP expression through a post-translational mechanism

Chemoresistance represents one of the main obstacles in treating several types of cancer, including bladder and ovarian cancers, and it is characterized by an increase of cellular antioxidant potential. Nrf2 and YAP proteins play an important role in increasing chemoresistance and in inducing antioxidant enzymes. It has been reported that Ailanthone (Aila), a compound extracted from the Ailanthus Altissima, has an anticancer activity toward several cancer cell lines, including chemoresistant cell lines. We have examined the effect of Aila on proliferation, migration and expression of Nrf2 and YAP proteins in A2780 (CDDP-sensitive) and A2780/CP70 (CDDP-resistant) ovarian cancer cells. Furthermore, to clarify the mechanism of Aila action we extended our studies to sensitive and CDDP-resistant 253J-BV bladder cancer cells, which have been used in a previous study on the effect of Aila. Results demonstrated that Aila exerted an inhibitory effect on growth and colony formation of sensitive and CDDP-resistant ovarian cancer cells and reduced oriented cell migration with higher effectiveness in CDDP resistant cells. Moreover, Aila strongly reduced Nrf2 and YAP protein expression and reduced the expression of the Nrf2 target GSTA4, and the YAP/TEAD target survivin. In CDDP-resistant ovarian and bladder cancer cells the intracellular oxidative stress level was lower with respect to the sensitive cells. Moreover, Aila treatment further reduced the superoxide anion content of CDDP-resistant cells in correlation with the reduction of Nrf2 and YAP proteins. However, Aila treatment increased Nrf2 and YAP mRNA expression in all cancer cell lines. The inhibition of proteolysis by MG132, a proteasoma inhibitor, restored Nrf2 and YAP protein expressions, suggesting that the Aila effect was at post-translational level. In accordance with this observation, we found an increase of the Nrf2 inhibitor Keap1, a reduction of p62/SQSTM1, a Nrf2 target which leads Keap1 protein to the autophagic degradation, and a reduction of P-YAP. Moreover, UCHL1 deubiquitinase expression, which was increased in bladder and ovarian resistant cells, was down-regulated by Aila treatment.In conclusion we demonstrated that Aila can reduce proliferation and migration of cancer cells through a mechanism involving a post translational reduction of Nrf2 and YAP proteins which, in turn, entailed an increase of oxidative stress particularly in the chemoresistant lines.

Tumor Response in Esophageal Squamous Cell Carcinoma Treated With Neoadjuvant Chemotherapy Followed by Surgery.

Neoadjuvant therapy followed by surgery is the standard treatment for advanced esophageal cancer. This study aimed to evaluated the potential of 18F-fluorodeoxyglucose positron-emission tomography to predict the pathological therapeutic effect of neoadjuvant chemotherapy. We enrolled 68 patients with advanced esophageal squamous cell carcinoma who underwent 18F-fluorodeoxyglucose positron-emission tomography before and after neoadjuvant chemotherapy, followed by surgery. Retrospective analysis of the pathological therapeutic effects was performed. The pathological therapeutic effect of good responders was significantly inversely associated with the maximum standardized uptake value (SUVmax) after neoadjuvant chemotherapy and with SUVmax reduction (both p<0.0001). Univariate and multivariate analyses revealed that lower post therapy SUVmax and reduction in SUVmax were independent prognostic factors for relapse-free (p=0.02) and overall survival (p<0.0001). Post-neoadjuvant chemotherapy SUVmax and SUVmax reduction can predict the pathological therapeutic effect of neoadjuvant chemotherapy.

Multiple Lines of Evidence Identify U(V) as a Key Intermediate during U(VI) Reduction by Shewanella oneidensis MR1.

As the dominant radionuclide by mass in many radioactive wastes, the control of uranium mobility in contaminated environments is of high concern. U speciation can be governed by microbial interactions, whereby metal-reducing bacteria are able to reduce soluble U(VI) to insoluble U(IV), providing a method for removal of U from contaminated groundwater. Although microbial U(VI) reduction is widely reported, the mechanism(s) for the transformation of U(VI) to relatively insoluble U(IV) phases are poorly understood. By combining a suite of analyses, including luminescence, U M4-edge high-energy resolved fluorescence detection-X-ray absorption near-edge structure (XANES), and U L3-edge XANES/extended X-ray absorption fine structure, we show that the microbial reduction of U(VI) by the model Fe(III)-reducing bacterium, Shewanella oneidensis MR1, proceeds via a single electron transfer to form a pentavalent U(V) intermediate which disproportionates to form U(VI) and U(IV). Furthermore, we have identified significant U(V) present in post reduction solid phases, implying that U(V) may be stabilized for up to 120.5 h.

Utility of Postreduction Radiographs After Fluoroscopy-Guided Reduction and Casting of Uncomplicated Pediatric Forearm Fractures.

The aim of the study was to determine efficacy of performing postreduction radiographs in managing uncomplicated pediatric forearm fractures after reduction and casting under fluoroscopic guidance. This is retrospective analysis of consecutive cases. The study was conducted in a large urban hospital pediatric emergency department (ED). Pediatric patients presenting to the ED with a forearm fracture between the ages of 0 to 18 years. All received orthopedic manual reduction with fluoroscopic guidance and casting, then followed by performance of a dedicated 2-view radiographic series of postreduction forearm to document proper alignment and cast placement. Of 236 consecutive cases studied, there were only 5 cases (2%) in which the managing orthopedist determined that a further reduction attempt was warranted based on the postreduction radiograph results. All were mid-shaft fractures of both radius and ulna, which were angulated and/or displaced. The remaining 231 patients with an uncomplicated forearm fracture received no further ED clinical orthopedic intervention after performing postreduction radiographs. The mean ED time to ultimate discharge was prolonged an average of 89 minutes per patient after reduction and casting while awaiting performance/orthopedic review of postreduction radiographs. A calculation of postreduction radiograph cost amounted to a total of nearly US $50,000. Performance of postreduction radiographs in children with uncomplicated pediatric forearm fractures that are reduced and casted under fluoroscopy has little clinical utility and contributes to increased radiation exposure, patient health care cost, and time spent in the ED. Patients with mid-shaft forearm fractures involving both radius and ulna (especially if angulated or displaced) are at risk for unacceptable reduction after casting and may be the target group in which performing post reduction radiographs has potential benefit.

Second physician review of radiographs after wrist and ankle reductions offers limited utility to clinical management.

The purpose of this study is to determine the clinical utility of second-physician review of radiographs obtained after reduction of distal radius and ankle fractures. Fifty consecutive ankle and distal radius fractures requiring reduction were reviewed. The time from post-reduction radiograph to second-physician interpretation was obtained. The second-physicians' interpretation was evaluated for clinically influential information. Patients requiring a repeat reduction were identified, and the timing of the repeat reduction radiograph was compared with the timing of the second-physician interpretation of the initial post-reduction radiograph. The mean time of second-physician interpretation for post reduction ankle radiographs was 6h and 47min (range 4min to 43h and 3min). Eleven of 50 (22%) interpretations of post reduction ankle radiographs commented on acceptability of reduction. The mean time of second-physician interpretation for post reduction distal radius radiographs was 5h and 34min (range 8min to 22h and 59min). Seven of 50 (14%) interpretations of post reduction distal radius radiographs commented on acceptability of reduction. Three distal radius (6%) and 8 ankle fractures (16%) required repeat reduction. Repeat reductions were completed in 10/11 cases (91%) before the second-physician review of the initial post reduction radiograph was obtained. In only 1 case of repeat reduction was the second-physician review of the post reduction radiograph available before repeat reduction was attempted. The timing and quality of second-physician review of post-reduction radiographs offers little utility to the clinical management of ankle and distal radius fractures.

The Effect of Isometric Exercise Plantar Flexor on Osteoblast Activity Measured by Bone Specific Alkaline Phosphatase and Callus Formation in a Patient Post Open Reduction Internal Fixation with Non-articular Tibia Fracture.

BACKGROUND:Post-operative non-articular tibia fracture several problems that can occur include; pain, muscles atrophy, muscles weakness, joint stiffness, delayed union, and non-union that makes patients limited in their daily activities. Several factors that play a role in the process of fracture healing include osteoblast activity and exercise. Isometric exercises plantar flexor might effectively prevent the problem. Markers of osteoblast activity are bone-specific alkaline phosphatase (BSAP) levels and Hummer scale callus formation. Not yet known the effect isometric exercise of plantar flexor on osteoblast activity in the post open reduction internal fixation of non-articular tibia fractures, due to the lack of studies in this field.AIM:This research was conducted to investigate the effect of isometric plantar flexor on osteoblast activity and callus formation in patients post open reduction internal fixation nonarticular tibial fractures.HYPOTHESIS:There are differences in osteoblast activity and callus formation between groups that do isometric exercises of plantar flexor muscles with those that without isometric exercises plantar flexor.ANALYSIS:Hypothesis test used a paired t-test with a value of α 0.05 and a confidence level of 95%.METHODS:This clinical trial was true experimental with pre-post test control group design divided into two groups, group I obtained treatment of isometric exercises of the plantar flexor muscle, range of motion knee joint, and ankle while group II obtained the range of motion knee joints and ankle. Osteoblast activity measured with bone-specific alkaline phosphatase level and callus formation.RESULTS:The result of the study found to increase mean bone-specific alkaline phosphatase group I; 15.6 and group II; 5.2. A paired t-test of independent samples with α of 0.05 and confidence interval 95% was obtained p-value = 0.000, there is a significant difference in increased levels of bone-specific alkaline phosphatase group I obtained isometric exercises plantar flexor with group II without isometric exercises plantar flexor in patients post open reduction internal fixation of a non-articular tibia fracture. Radiographic examination of Hummer scale callus in group I who carried out isometric exercises plantar flexor had an average value of 2.63, whereas group II without isometric exercises plantar flexor average of 3.06. Wilcoxon test with α 0.05 and 95% confidence interval obtained p-value = 0.000, there is a significant difference in callus image in both groups of patients post open reduction internal fixation non-articular tibia fracture. The linear regression calculated of callus assessment with bone-specific alkaline phosphatase obtained the value of R quadrat = 0.793, which showed that the formation of callus Hummer classification could predict the change in bone-specific alkaline phosphatase value by 79%.CONCLUSION:The research found isometric exercise plantar flexor in patients post open reduction internal fixation non-articular tibia fracture enhances osteoblast activity and callus formation that will likely short the healing process time and prevent delayed union or non-union.

A study of greenstick fractures in forearm bones in children

Background and objectives: Definition: A fracture in which one side of a bone is broken and the other is bent John Insall, a British-American orthopedist and Michal Slupecki, a Polish-American orthopedist, described the fracture like that of a breakage of green wood, which simply breaks outer side when bent. Ligaments and Tendons are stronger than bone when young. Bone is more likely to be injured than soft tissue. Periosteal is biologically active in children and often stays intact with injury. This stabilizes fractures and promotes healing. Force to side of bone may cause break in only one cortex–Greenstick fracture. The outer cortex only bends. In very young children none of the cortex may break–Plastic deformation. Methods: Out of 35 cases treated in our instate 23 were male and 12 female child. Patients pre and post reduction serial follow up x-rays were studied. Follow up period ranges from 3 months to 3 year. In greenstick fracture reduction done according to angulation of fracture. When the apex of the fracture is towards dorsum of the forearm (apex dorsal- pronation injury), the forearm supinated to achieve reduction. When the apex of the fracture is towards volar aspect of the forearm (apex volar- supination injury), the forearm pronated to achieve reduction. Results: Out of twenty patients treated, overall good to excellent results were obtained in 96% patients. The results was fair in one patient each. There were no intraoperative complications. Interpretation and conclusion: Maximum fractures were in age group of 5-10 year with predominance in males. Most of the fractures were on subordinate side. Average union time in greenstick fracture was 6 week. In this series the highest degree of angulation (at final follow up) which got corrected was in radius 18° and in ulna 13°. Remodeling and returning of final range of motion is excellent.

Uncertainty Quantification in Water Retention Characteristic Curve of Fly Ash Using Copulas

Abstract Water retention characteristic curve (WRCC) is a primary input for modeling the unsaturated behavior of geomaterials. The inadequacy of measurement methodologies in capturing the measurable range of the suction of geomaterials along with material variability induce uncertainties in the quantification of WRCC. The goal of this study is to demonstrate the usefulness of copulas for quantifying the uncertainties in WRCC attributed to the aforementioned reasons. Four instruments measuring different ranges of suction of four fly ashes were used to generate 54 combinations of measured data that would represent possible cases of data-induced uncertainties. van Genuchten WRCC equation parameters (a and n) were determined for these combinations. Statistical analysis of the parameters determined from the 54 combinations indicates a negative correlation with each other; therefore, they represent a bivariate random vector. Four commonly used copulas, Gaussian, Frank, Plackett, and No. 16, were utilized to construct the bivariate density function of the parameters, among which the Gaussian copula was found to be the best fit. The impact of the copula-based model developed in this study on two important unsaturated functions, the suction stress characteristic curve (SSCC) and hydraulic conductivity function (HCF) of fly ash, was investigated and found to be significant. The dispersion in SSCC ranges from monotonically increasing to sharp post peak reduction in the suction range of 20–50 kPa. The limiting state of suction required to reach the theoretical minimum permeability was found to vary widely in the range of 300–9,000 kPa. The study shows that a Gaussian copula with lognormal marginals can adequately capture the significant range of uncertainties associated with WRCC.

A PROSPECTIVE STUDY ON RADIOLOGICAL AND FUNCTIONAL OUTCOME OF UNSTABLE DISPLACED ACETABULAR FRACTURES TREATED BY OPEN REDUCTION AND INTERNAL FIXATION

We reviewed the radiological and functional outcome of open reduction and internal fixation of 18 unstable acetabular fractures in our institution from July 2009 to November 2011. Pre operative evaluation was done with Letournel and Judet views, Axial CT scan and 3D reconstruction scans. The factors affecting the radiological and functional outcome of surgically treated patients were analyzed. The anatomical reduction is found to be the most important and consistent factor affection the outcome. The relationship between the factors such as age, initial displacement, associated injuries, and the time interval between injury and surgery were also evaluated. The radiological outcome was assessed using Matta’s criteria while the functional outcome was assessed using Merle d’ Aubign and Postel modified score. The post operative fracture reduction as measured on the three plain radiographs were graded as anatomical in 7(39%), imperfect in 6 (34%) and poor in 5(28%) cases. The functional outcome which was evaluated with Merle d’ Aubigne’ and Postel modified score was found to be excellent in 4 patients, good in 6 patients, fair in 4 patients and poor in 4 patients. The radiological outcome was strongly associated with the functional outcome (p-0.0044) which strongly supports the point that achieving anatomical reduction is the most important aspect. The findings in our study suggest that the achievement of anatomical reduction is the most important factor affecting the outcome. None of our patients had iatrogenic nerve injury. We encountered complications such as infection (3 out of 18), posterior dislocation of hip (1 out of 18) and plate breakage (1 out of 18). To conclude, it involves a long learning curve and the treatment should be done in a specialized tertiary care centre which has a specialized team for managing the acetabular fractures. The goal of the surgical treatment should be to produce a functional mobile painless joint that continues to function till the rest of life for the patient. Keywords: Acetabular fractures, anatomical reduction, Letournel and Judet views, Kocher Langenbeck, posterior wall.

Design of a Robust Five-Phase Ferrite-Assisted Synchronous Reluctance Motor With Low Demagnetization and Mechanical Deformation

This study presents the design of a robust five-phase ferrite (Fe) permanent-magnet-assisted synchronous reluctance motor (PMaSynRM) to mitigate two major design challenges: irreversible demagnetization and mechanical deformation. Recently, rare-earth magnet-based five-phase PMaSynRMs have been proposed for vehicular applications due to their better fault tolerance, higher torque density, and low torque ripple compared to their three-phase counterparts. However, rare-earth magnets are expensive and, their supplies were disrupted multiple times in past few years. Therefore, to avoid rare-earth magnets in traction motors, this study proposes a five-phase PMaSynRM with Fe magnet. Special attention is paid to avoid irreversible demagnetization and deformation as these are two major concerns in any Fe-based machine. The rotor structure is uniquely optimized with additional geometrical parameters to reduce the risk of irreversible demagnetization. To increase the structural stability of the rotor, optimal center post and weight reduction notches are adopted. The proposed Fe-based five-phase PMaSynRM has been comparatively studied over a rare-earth magnet-based PMaSynRM. The lumped parameter model and finite element model have been utilized for design optimization and performance analysis. Finally, A 3 kW prototype of the proposed five-phase Fe PMaSynRM has been fabricated, experimentally tested, and compared with the benchmark rare-earth PMaSynRM to validate the proposed design and simulations results.

1152-P: Erbium-Yttrium Aluminum Garnet (YAG) Laser Accelerates Healing in Indolent Diabetic Foot Ulcers

Aim: The objective of the study was to evaluate the effect of the Erbium-Yttrium aluminum garnet (YAG) laser on diabetic foot ulcer that had not responded to standard care. Methods: We retrospectively evaluated 23 patients with c non-healing diabetic foot ulcers that received at least four weeks of standard wound care, demonstrated poor healing response, and were subsequently treated with YAG laser. We measure the percent wound area reduction (PWAR) for the 4 weeks prior to initiating laser therapy and the PWAR for 4 weeks following the initiation of laser therapy. YAG laser treatment consisted of two components: debridement and re-surfacing. The laser settings were the same for all treatments. We used pair t-test to compare pre versus post wound area reduction. Results: During the 4-week period prior to the initiation of laser therapy, the average PWAR was -32.1%. During this time, the diabetic foot ulcers increased in area. After treatment with YAG laser, after 4 weeks the average PWAR was 63.5% (p&amp;lt;0.01), 66.7%% of patients had &amp;gt; 50% PAR at 4 weeks and 45.8% of patients healed by 12 weeks. Conclusion: YAG laser therapy accelerated DFU healing in a cohort of patients with ulcers that had been unresponsive to standard of care therapy. Disclosure M.J. Johnson: None. L.A. Lavery: Consultant; Self; Bayer US, Boehringer Ingelheim Pharmaceuticals, Inc., Medline Industries, Inc. Research Support; Self; Cardinal Health, EO2 Concepts, Integra LifeSciences, MedImmune, Osiris Therapeutics, Inc.

SUN-290 Responsiveness of Growth Hormone Therapy in a Patient with Complex Chromosome 4 q Interstitial Deletion

Background Information: Chromosome 4 q interstitial deletion is a rare chromosomal disorder characterized by post natal growth retardation, developmental delay, craniofacial dysmorphism and behavioral problems. Not only are the characteristics of growth failure in these patients ill defined, but their responsiveness to growth hormone (GH) treatment is also lacking in the literature. An index case of a 7 year old male with unique interstitial deletion of chromosome 4 q deletion at q13.3 and q22.12 with a normal segment in between presented with significant growth failure in early infancy and was treated with growth hormone as described below. Case Report: He was born at 36 weeks gestation with a birth weight of 4 pounds 6 ounces (3rd percentile) and a birth length of 19 inches (50th percentile). Pregnancy was complicated by oligohydraminos. Post natal course was complicated by feeding difficulties and jaundice. He grew along the 5th percentile till age 6 months and then started faltering off below the 3rd percentile in both height and weight. He was started on dense caloric formula but his growth parameters continued to decline. His intake was reported good and had no diarrhea or vomiting. A TFT obtained demonstrated a slightly elevated TSH of 9.4 mcIU/ml (reference range 0.4-9.2) and marginally low Free T4 of 0.76 ng/dl (reference range 0.89-1.48). He was started on a small dose of 12.50 mcg thyroxin daily which did not improve his growth (thyroxin was discontinued at age 4 ½ year). His chemistry panel, IGF-1 and IGFBP-3 obtained were all normal. A bone age was concordant with his chronological age. Karyotype was 46 XY. Comparative genomic hybridization (CGH) array revealed a de novo 2.2 Mb deletion at 4q 13.3 and 2.2 Mb deletion at 4q22.1-q22.3. Deletions were separated by 18.3 Mb of normal copy number sequence. Other tests obtained demonstrated a normal pituitary gland on brain MRI and no tethered cord on the spinal MRI. He was started on GH for small for gestational age indication at age 13 month. His height and weight percentile improved significantly from <1% at age 13 month to 5th% by age 2 year and has continued to grow along 10-12 % since age 4 year. His other associated medical problems include improving developmental delay (attends special class with IEP and speech therapy), sleep disturbances (on melatonin and clonidine), mild hypotonia (received OT and PT, now resolved), poor dental enamel (has needed 8 crowns), obstructive sleep apnea with high arched palate (status post turbinate reduction and CPAP), clinodactyly, hyperopia with astigmatism (wears glasses) and sacral dimple. His behavior problems include high anxiety and obsessive/perseveration behavior. Conclusions: Growth failure is a characteristic feature in patients with chromosome 4 q deletion. These patients with growth retardation when treated with GH may respond with improved growth velocity and weight gain and hence should be considered.

Evaluation of anaerobic digestion post-treatment options using an integrated model-based approach

The objective of this paper is to present the main results of an engineering-research project dealing with model-based evaluation of waste streams treatment from a biotech company. This has been extensively done in domestic treatment systems, but is equally important, and with different challenges in industrial wastewater treatment. A new set of biological (activated sludge, anaerobic digestion), physicochemical (aqueous phase, precipitation, mass transfer) process models and model interfaces are required to describe removal of organics in an upflow anaerobic sludge blanket (UASB) reactor plus either traditional nitrification/denitrification (A1) or partial nitritation (PN)/anammox (ANX) (A2) processes. Model-based analysis shows that option A1 requires a decrease in digestion energy recovery (Erecovery) in order to have enough organic substrate for subsequent post NO3 reduction treatment (95 kWh.kg N−1). In contrast, A2 in an aerobic granular sludge reactor allows for higher UASB conversion since N removal is carried out autotrophically. The study also reveals that the addition of an aerated pre-treatment unit prior to the PN/ANX (A2) reactor promotes COD and H2S oxidation, CO2 and CH4 stripping, a pH increase (up to 8.5) and a reduction of the risk of intra-granular precipitation as well as sulfide inhibition. Simulations indicate clear differences regarding the microbial distribution/abundance within the biofilm in A2 when comparing the two operational modes. Final results show the effects of different loading and operational conditions; dissolved oxygen (DO), Total Suspended Solids (TSSop), energy recovery (Erecovery); on the overall process performance; N removal, aeration energy (Eaeration), net energy production (Erecovery); using response surfaces, highlighting the need of integrated approaches to avoid sub-optimal outcomes. The study shows the benefits of virtual plant simulation and demonstrates the potential of model-based evaluation when process engineers in industry have to decide between competing options.

Influence of screw to joint distance on articular subsidence in tibial-plateau fractures.

Tibial-plateau fractures with depressed osteochondral fragments have a high incidence of articular subsidence post reduction. Locking plates aim to prevent this via 'raft' screws below the subchondral bone. However, differences in plate design and patient anatomy result in variability of screw position in relation to the fragments they are designed to support. We evaluate the effect of screw placement and articular subsidence with this fracture pattern. A retrospective cohort study of operatively treated tibial-plateau fractures with free osteochondral fragments was performed to determine if screw placement was correlated with articular subsidence. Primary outcome was the relationship between screw to joint distance and articular subsidence. Secondary outcomes were whether bicortical fixation, presence of bone graft, fracture characteristics and patient age was correlated with articular subsidence. Sixty-eight of 309 tibial-plateau fractures had depressed osteochondral fragments (22%). The average thickness of these fragments was 10.2 mm. Fractures with raft screws placed closer to the joint than the thickness of the osteochondral fragment were less likely to subside (1.8 versus 3.4 mm; P = 0.02). The proportion of fractures with no radiographic subsidence was also greater in this cohort versus fractures with distal screw placement (33% versus 8%; P = 0.02). Articular comminution (P = 0.04) and female patients aged over 65 years (P = 0.03) were associated with increased articular subsidence. Fractures fixed with screws closer to the joint than the thickness of the osteochondral fragment were correlated with less articular subsidence. The 'screw-joint distance' may help guide screw placement intra-operatively.

Reducing Test Anxiety Through Mind Relaxation in Undergraduate Nursing Students

BACKGROUND:&#x0D; Anxiety and stress are feelings often experienced during nursing course exams. According to the Yerkes-Dodson Law, enhanced performance occurs at mid-levels of anxiety while low and high levels hinder optimum performance. &#x0D; PURPOSE:&#x0D; The purpose of this study was to identify the effect of a Tai Chi (mind relaxation) intervention on test anxiety. &#x0D; Approach:&#x0D; Test Anxiety was measured utilizing the Westside Test Anxiety Scale, Zero-to-Ten Self-Anxiety Scale, and pulse rates.&#x0D; Outcomes:&#x0D; Thirty-eight undergraduate nursing students enrolled in Health and Illness II during the fall and spring semesters participated in the study. An average of 15 students participated consistently in the Tai Chi intervention. Results demonstrated a significant difference in students’ anxiety scores before and after the Tai Chi intervention and with a post Tai Chi intervention anxiety scores reduction to a mid-level (M=4.73).&#x0D; CONCLUSION:&#x0D; This study supports Tai Chi as an effective intervention before examinations in reducing nursing students’ anxiety levels.

Liver Macrophage Depletion Ameliorates The Effect of Mesenchymal Stem Cell Transplantation in a Murine Model of Injured Liver

Mesenchymal stem cells (MSCs) therapy show different levels of effectiveness in the context of different types of liver damage, suggesting that the microenvironment of the injured liver is a key determinant for effective stem cell therapy. The objective was to assess the modulatory effect of hepatic stem cell niche components on the transplanted MSCs during liver injury induced by carbon tetrachloride (CCl4). Superparamagnetic iron oxide (SPIO)-labeled human MSCs were injected intravenously into mice treated with CCl4 and subjected to hepatic macrophage-depletion. Liver tissues were collected at different intervals post transplantation for subsequent histopathological, morphometric, immunohistochemical, gene expression and ultrastructural studies. The homing of the transplanted MSCs was evidenced by tracing them within the niche by iron staining and immunohistochemical studies. MSCs differentiated into hepatocyte-like cells and intimal smooth muscle cells as evidenced by their expression of human albumin and α-smooth muscle actin with a concomitant increase in the level of mouse hepatocyte growth factor. A post transplantation reduction in the liver fibro-inflammatory reaction was found and was promoted by liver macrophages depletion. Thus, it could be concluded from the present study that prior manipulation of the microenvironment is required to improve the outcome of the transplanted cells.

Results of technique of intrafocal pinning in the management of distal radius fractures

Background and Objectives: Fractures of distal end of the radius are the most common fractures that orthopedic surgeons have to treat. Range of fracture extends from simple extraarticular to highly communited intraarticular fractures. Our objective was to to assess the outcome of intra focal pinning in distal radius fractures in terms of functional recovery and radiological union and to assess the complications associated with the procedure. Materials and Methods: The present prospective study was conducted between January 2016 and September 2017. 30 patients were enrolled for the study and follow up for a period of 6 months. Closed reduction and percutaneous pinning with K wire were done. The radiological parameters were assessed for pre-reduction, post reduction, 4 weeks, 3 months and at 6 months. The data from the radiological parameters was analyzed using students t-test, Bonferroni comparison test and chi-square test. The values were normally distributed (normality test P= 0.3) and significance was assessed using a paired t-test. The statistical significance was defined as p