Reversing the damage: ecological restoration of polluted water bodies affected by pollutants due to anthropogenic activities

Aquatic ecosystems provide a large number of cultural, regulating, and supporting services to humans and play a pivotal role in sustaining freshwater-dependent ecosystems. However, an increase in human population coupled with economic growth in the last few decades has severely affected their functioning and ecological health. This has led to an increase in concentrations of pollutants originating from anthropogenic activities such as heavy metals, plastics, semi-volatile organic compounds, and endocrine disruptors. These pollutants provoke deleterious impacts on aquatic biodiversity and affect the water quality and functioning. In this paper, we discuss the sources and impacts of such pollutants as well as restoration techniques for reducing their impact on aquatic ecosystems. Several physical and chemical ecological restoration techniques, such as dredging, sediment capping, water diversion, adsorption, aeration, and flushing, can be employed to improve the water quality of water bodies. Additionally, biological techniques such as phytoremediation, phycoremediation, the use of biomembranes, and the construction of ecological floating beds can be employed to increase the population of aquatic organisms and improve the overall ecological health of aquatic ecosystems. Restoration techniques can effectively reduce the concentrations of suspended solids and dissolved phosphorus and increase the levels of dissolved oxygen. The restoration techniques for improving the ecological health of water bodies should not be limited to simply improving the water quality but should also focus on improving the biological processes and ecosystem functioning since it is essential to mitigate the adverse effects of pollutants and restore the vital ecosystem services provided by water bodies for future generations.

Comparison of TiO2 catalysis and Fenton's treatment for rapid degradation of Remazol Red Dye in textile industry effluent

The contamination of water bodies by toxic industrial effluents is a serious threat to environment and the exposed organisms. The treatment of carcinogenic azo dyes in wastewater of grossly polluting textile industry is a major challenge considering the persistent nature of chemical dyes against biological treatment. The present study explores efficacy of advanced oxidation processes—photocatalysis and photo-Fenton, towards degradation of Remazol Red dye in the textile industry effluent. It was observed that both processes can completely remove the colour and approximately 85% mineralization of the dye within reaction time of 60 min and 8 min, respectively. The economic analysis placed photo-Fenton as a cost-effective method with treatment cost of approx. 0.0090 US $/litre of wastewater containing Remazol Red dye. Although, Photocatalysis was relatively slow, it is substantially effective in removal/degradation of colour from textile effluent against the biological treatment. The study concludes that photo-Fenton and Photocatalysis are cost-effective and substantial treatment options for removal of toxicity arising from coloured textile effluents.

Cost effectiveness of patellofemoral versus total knee arthroplasty in younger patients

AIMS

Patellofemoral arthroplasty (PFA) has experienced significant improvements in implant survivorship with second generation designs. This has renewed interest in PFA as an alternative to total knee arthroplasty (TKA) for younger active patients with isolated patellofemoral osteoarthritis (PF OA). We analysed the cost-effectiveness of PFA versus TKA for the management of isolated PF OA in the United States-based population.

PATIENTS AND METHODS

We used a Markov transition state model to compare cost-effectiveness between PFA and TKA. Simulated patients were aged 60 (base case) and 50 years. Lifetime costs (2015 United States dollars), quality-adjusted life year (QALY) gains and incremental cost-effectiveness ratio (ICER) were calculated from a healthcare payer perspective. Annual rates of revision were derived from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. Deterministic and probabilistic sensitivity analysis was performed for all parameters against a $50 000/QALY willingness to pay.

RESULTS

PFA was more expensive ($49 811 versus $46 632) but more effective (14.3 QALYs versus 13.3 QALYs) over a lifetime horizon. The ICER associated with the additional effectiveness of PFA was $3097. The model was mainly sensitive to utility values, with PFA remaining cost-effective when its utility exceeded that of TKA by at least 1.0%. PFA provided incremental benefits at no increased cost when annual rates of revision decreased by 24.5%.

CONCLUSIONS

Recent improvements in rates of implant of survival have made PFA an economically beneficial joint-preserving procedure in younger patients, delaying TKA until implant failure or tibiofemoral OA progression. The present study quantified the minimum required marginal benefit for PFA to be cost-effective compared with TKA and identified survivorship targets for PFA to become both less expensive and more effective. These benchmarks might be used to assess clinical outcomes of PFA from an economic standpoint within the United States healthcare system. Cite this article: Bone Joint J 2017;99-B:1028-36.

Early functional outcome after lateral UKA is sensitive to postoperative lower limb alignment

PURPOSE

The predictive role of patient-specific characteristics and radiographic parameters on medial unicompartmental knee arthroplasty (UKA) outcomes is well known, but knowledge of these predictors is lacking in lateral UKA. Therefore, purpose of this study was to assess the predictive role of these parameters on short-term functional outcomes of lateral UKA.

METHODS

In this retrospective cohort study, Western Ontario and McMaster Universities Arthritis Index scores were collected at 2-year follow-up (median 2.2 years, range 2.0-4.0 years) in 39 patients who underwent lateral UKA. Patient-specific characteristics included age, BMI and gender, while radiographic parameters included osteoarthritis severity of all three compartments and both preoperative and postoperative hip-knee-ankle alignment.

RESULTS

BMI, gender, age and preoperative valgus alignment were not correlated with functional outcomes, while postoperative valgus alignment was correlated with functional outcomes (0.561; p = 0.001). Postoperative valgus of 3°-7° was correlated with better outcomes than more neutral (-2° to 3° valgus) alignment (96.7 vs. 85.6; p = 0.011). Postoperative alignment was a predictor when corrected for patient-specific characteristics (regression coefficient 4.1; p < 0.001) and radiological parameters (regression coefficient 3.8; p = 0.002).

CONCLUSIONS

Postoperative valgus alignment of 3°-7° was correlated with the best short-term functional outcomes in lateral UKA surgery, while patient-specific parameters and preoperative alignment were not correlated with functional outcomes. Based on these findings, a surgeon should aim for valgus alignment of 3°-7° when performing lateral UKA surgery for optimal functional outcomes.

LEVEL OF EVIDENCE

Prognostic study, Level II.

Why do patellofemoral arthroplasties fail today? A systematic review

BACKGROUND

Historically poor results of patellofemoral arthroplasty (PFA) were reported in the setting of isolated patellofemoral osteoarthritis (OA). In order to lower PFA failure rates, it is important to identify failure modes using a standardized method. In this systematic review, PFA failure modes were assessed and compared in early vs. late failures and older vs. recent studies.

METHODS

Databases of PubMed, Embase and Cochrane and annual registries were searched for studies reporting PFA failures. Failure modes in studies with mean follow-up <5years were classified as early failures while >5years were classified late failures. Cohorts started before 2000 were classified as older studies and started after 2000 as recent studies.

RESULTS

Thirty-nine cohort studies (10 level II and 29 level III or IV studies) and three registries were included with overall low quality of studies (GRADE criteria). A total of 938 PFA failures were included and were caused by OA progression (38%), pain (16%), aseptic loosening (14%) and patellar maltracking (10%). Pain was responsible for most early failures (31%), while OA progression was most common in late failures (46%). In older studies, OA progression was more commonly reported as failure mode than in more recent studies (53% vs. 39%, p=0.005).

CONCLUSION

This level IV systematic review with low quality of studies identified OA progression and pain as major failure modes. Reviewing these studies, appropriate patient selection could prevent PFA failures in select cases. Future studies assessing the role of PFA in isolated patellofemoral OA are necessary.

Patients with isolated lateral osteoarthritis: Unicompartmental or total knee arthroplasty?

BACKGROUND

Lateral unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) are both reliable treatment options for patients with isolated lateral osteoarthritis (OA). However, studies comparing both procedures are scarce. Aims of this study were to (I) compare short-term functional outcomes following lateral UKA and TKA and (II) assess the role of patient characteristics on outcomes as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

METHODS

In this retrospective cohort study, 82 patients (48 undergoing lateral UKA and 34 undergoing TKA) were identified that presented with lateral OA and completed the WOMAC. Independent t-tests were used to compare outcomes following lateral UKA and TKA.

RESULTS

Mean follow-up was 2.8 years (range: 2.0 - 5.0 years). Preoperatively, no differences between lateral UKA and TKA were seen (50.1±13.5 and 53.3±17.1, respectively, p=0.551). Postoperatively, lateral UKA patients reported better overall outcomes than TKA (90.5±11.7 vs. 81.8±17.9, p=0.017). Subgroup analysis showed better outcomes following lateral UKA than TKA in patients younger than 75 years (92.1±9.9 vs. 81.3±19.6, p=0.014) and in females (91.6±9.9 vs. 81.0±18.2, p=0.014).

CONCLUSION

These findings indicate that lateral UKA has superior short-term functional outcomes compared to TKA in patients with isolated lateral OA. Better outcomes were especially seen in younger patients and females. These findings may help orthopedic surgeons choose treatment for patients presenting with lateral OA and optimize treatment for individual patients.

Results of small incision extracapsular cataract surgery using the anterior chamber maintainer without viscoelastic

AIMS

To assess the efficacy of extracapsular cataract surgery using the anterior chamber maintainer (ACM) without the use of viscoelastic. To compare the effects of this surgical technique on non-diabetic and diabetic patients.

METHODS

A prospective single armed clinical trial of 46 eyes in 46 patients undergoing cataract surgery using the ACM without viscoelastic. Patients were assessed preoperatively and at 3 weeks, 3 months, and 12 months postoperatively. The main outcome variables included visual acuity, surgically induced astigmatic change (SIAC), changes in endothelial cell density (ECD), and morphology affecting the central and superior regions of the cornea.

RESULTS

Postoperatively, 56% and 70% of patients had unaided visual acuities of 6/12 or better at 3 weeks and 3 months respectively. Even after excluding those patients with pre-existing maculopathy (including diabetic maculopathy), there remains a significant difference between the non-diabetic and diabetic groups in terms of the proportion of patients attaining an unaided visual acuity of 6/12 or better at both 3 weeks (p = 0.003) and 3 months (p = 0.001). Three months postoperatively, the SIAC based upon the keratometric and refractive data was 1.1 dioptres (D) and 1.3 D respectively. There was no statistically significant difference in the SIAC when the non-diabetic and diabetic groups were compared. The mean central and superior endothelial cell losses at 3 months postoperatively were 16% and 22% respectively and at 12 months postoperatively were 20% and 25% respectively. The diabetic group demonstrated greater endothelial cell losses and a more marked and protracted deviation of endothelial cell morphology from normality when compared with the non-diabetic group; however, the differences did not reach statistical significance.

CONCLUSIONS

The efficacy of small incision cataract surgery using the ACM in terms of visual outcome and induced astigmatism is comparable with the results obtained using other techniques that utilise a similar size of incision. However, in view of the magnitude and range of the endothelial cell losses associated with this technique the concurrent use of viscoelastic is suggested. There does not appear to be a statistically or clinically significant difference between non-diabetic and diabetic patients in terms of the magnitude of the endothelial cell losses or in the wound healing response in the 12 months after cataract surgery using the ACM.

Electromyogram-triggered neuromuscular stimulation for improving the arm function of acute stroke survivors: a randomized pilot study

OBJECTIVE

To assess the efficacy of electromyogram (EMG)-triggered neuromuscular stimulation (EMG-stim) in enhancing upper extremity motor and functional recovery of acute stroke survivors.

DESIGN

A pilot randomized, single-blinded clinical trial.

SETTING

Freestanding inpatient rehabilitation facility.

PATIENTS

Nine subjects who were within 6 weeks of their first unifocal, nonhemorrhagic stroke were randomly assigned to either the EMG-stim (n = 4) or control (n = 5) group. All subjects had a detectable EMG signal (>5 microV) from the surface of the paretic extensor carpi radialis and voluntary wrist extension in synergy or in isolation with muscle grade of <3/5.

INTERVENTION

All subjects received two 30-minute sessions per day of wrist strengthening exercises with EMG-stim (experimental) or without (control) for the duration of their rehabilitation stay.

MAIN OUTCOME MEASURES

Upper extremity Fugl-Meyer motor assessment and the feeding, grooming, and upper body dressing items of the Functional Independence Measure (FIM) were assessed at study entry and at discharge.

RESULTS

Subjects treated with EMG-stim exhibited significantly greater gains in Fugl-Meyer (27.0 vs 10.4; p = .05), and FIM (6.0 vs 3.4; p = .02) scores compared with controls.

CONCLUSION

Data suggest that EMG-stim enhances the arm function of acute stroke survivors.

Modulation of chloride secretion in the rat ileum by intracellular bicarbonate

Increasing intracellular bicarbonate concentration ([HCO3-]i) inhibits calcium-mediated Cl- secretion in rat distal colon and T84 cells. We investigated the effect of [HCO3-]i on Cl- secretion in rat ileum. Segments of intact ileum from Sprague-Dawley rats were studied in Ussing chambers and villus and crypt intracellular pH and [HCO3-]i were determined using BCECF. A range of crypt and villus [HCO3-]i from 0 to 31 mM was obtained by varying Ringer's composition. Basal serosal-to-mucosal Cl- flux (JsmCl) averaged 8.5 +/- 0.2 mu eq.h-1.cm-2 and was unaffected by changing [HCO3-]i or serosal bumetanide. Carbachol increased JsmCl by 3.9 +/- 0.5 mu eq.h-1.cm-2 at [HCO3-]i = 0 mM but only by 1.0 +/- 0.3 mu eq.h-1.cm-2 at high crypt and villus [HCO3-]i. Dibutyryl-cAMP increased JsmCl by 2.5 +/- 0.2 mu eq.h-1.cm-2 at all [HCO3-]i. Carbachol and db-cAMP showed mutual antagonism at low [HCO3-]i and near-additivity at high [HCO3-]i. We conclude that like rat colon and T84 cells, calcium-mediated but not cAMP-mediated Cl- secretion in the ileum is inhibited by increasing [HCO3-]i. Mutual antagonism between carbachol and db-cAMP at low [HCO3-]i was present in ileum and distal colon but not in T84 cells.

Immune complex glomerulonephritis in patients coinfected with human immunodeficiency virus and hepatitis C virus

Human immunodeficiency virus-associated nephropathy (HIVAN), characterized by heavy proteinuria, rapidly progressive renal failure, "collapsing" glomerulopathy, and tubulointerstitial abnormalities, is the most common finding in HIV-infected patients undergoing a renal biopsy and predominantly affects blacks. We describe the clinical features and renal pathologic findings of 12 intravenous drug users (IVDUs) coinfected with HIV and hepatitis C virus (HCV) who were selected for renal biopsy because they presented with features different from typical HIVAN, including hypertension, microscopic hematuria, and cryoglobulinemia. There were seven black and five Hispanic patients. Eleven patients had immune complex glomerulonephritis (ICGN); one had glomerulosclerosis with immune complex deposits. Ten individuals had evidence of past hepatitis B viral infection, but none had persistent hepatitis B surface antigenemia. No other underlying cause for immune complex glomerulonephritis was identified. Renal biopsy showed membranoproliferative glomerulonephritis in five patients, mesangial proliferative glomerulonephritis in five, membranous nephropathy in one, and "collapsing" glomerulopathy with immune complex deposits in one. Hepatitis C virus RNA was detected by reverse transcription-polymerase chain reaction (RT-PCR) in the renal tissue and/or serum of nine of the 11 patients tested, and also in the renal biopsy tissue of four of eight patients with clinical and pathologic features of typical HIVAN without immunofluorescence evidence of immune complex deposits. One patient presented with renal failure, five patients developed end-stage renal disease (ESRD) requiring hemodialysis (mean time, 6.5 months), and six had stable renal function after a mean follow-up of 29.1 months (range, 2 to 72 months). Liver function abnormalities were present in seven of the 12 individuals, including four of the six patients who developed renal failure. These findings indicate that in some patients coinfected with HIV and HCV, the development of ICGN may dominate the clinical course of the disease. The occurrence of ICGN among black patients at risk for HIVAN may be related to the relatively high prevalence of HCV infection among IVDUs in this group.

Determination of cocaine usage in pregnant women by a urinary EMIT drug screen and GC-MS analyses

In mothers who had no prenatal care and in their newborns, the presence of cocaine and benzoylecgonine (BE) was determined in urine, hair, and meconium. Samples of urine and hair were obtained from pregnant women who entered the hospital for delivery. Cocaine usage was assessed by a urinary enzyme-multiplied immunoassay technique (EMIT) and by gas chromatography-mass spectrometry (GC-MS). GC-MS was used to detect the presence of cocaine and BE in maternal urine and hair and in meconium and hair obtained from their newborns. In this study of 40 women, the EMIT assay for urinary BE identified 17 (42.5%) of the women as having used cocaine. Of these 17 women, all of their newborns were exposed to cocaine during gestation, based on the analysis of neonatal hair and meconium for cocaine or BE. From the maternal samples that were assayed for cocaine and BE by GC-MS, it appears that hair analysis identified the most cocaine users (70%) of the 40 women who participated in the study. When GC-MS was used to analyze the various samples from mothers and their newborns, 80% of the neonates showed exposure to cocaine. This study shows that women with no prenatal care who have a positive urinary drug screen by EMIT for BE have exposed their newborns to cocaine. The data from pregnant women with a negative drug screen for BE show that 52.2% of their newborns had prior fetal exposure to cocaine.

Necrotizing enterocolitis in infants of multiple gestation

We examined the records of ten pairs of twins and one set of triplets among whom one or more infants had necrotizing enterocolitis (NEC). Perinatal asphyxia and respiratory distress were less common in the firstborn infants. It might, therefore, be anticipated that necrotizing enterocolitis was less common in this group. We found the reverse to be true. In all of the twin pairs twin A had NEC, and in no case did only twin B have NEC. The disease developed in triplet B but not in triplets A or C. Examination of associated risk factors revealed that the firstborn infants were more stable, were fed sooner, and had feedings advanced somewhat more rapidly than their counterparts. We re-emphasize that there are unrecognized risk factors in the pathogenesis of NEC and that a high index of suspicion should be maintained for all premature infants despite their apparent stability.

A comparison of neurotic and psychotic depression using a standardized schedule

Forty-five patients of psychotic depression have been compared with 22 neurotic depressives, on SADD schedule regarding the socioderaographic and clinical variables. Two groups of these patients have differed on variables like age, duration of present attack, past history and family history of psychiatric illness and the precipitating factors.

Acute pneumonia in the newborn: changing picture

Pneumonia is one of the most serious infections in the neonate and is responsible for a large percentage of neonatal mortality. Pneumonia in a premature or term infant who is debilitated by an underlying problem such as hyaline membrane disease carries an extremely high morbidity and mortality. Since most of the bacterial pneumonias are treatable, early recognition and diagnosis and vigorous treatment are essential. X-ray findings, though helpful, serve only as a guideline. Prognosis is adversely affected if pneumonia results in generalized sepsis, leading to meningitis, disseminated intravascular coagulation, and osteomyelitis. Prompt antibiotic treatment should be begun before the etiologic agent or drug susceptibility is known.