Comprehensive kinetic modeling and product distribution for pyrolysis of pulp and paper mill sludge

Pyrolysis holds immense potential for clean treatment of pulp and paper mill sludge (PPMS), enabling efficient energy and chemical recovery. However, current understanding of PPMS pyrolysis kinetics and product characteristics remains incomplete. This study conducted detailed modeling of pyrolysis kinetics for two typical PPMSs from a wastepaper pulp and paper mill, namely, deinking sludge (PPMS-DS) and sewage sludge (PPMS-SS), and analyzed comprehensively pyrolysis products. The results show that apparent activation energy of PPMS-DS (169.25-226.82 kJ/mol) and PPMS-SS (189.29-411.21 kJ/mol) pyrolysis undergoes significant change, with numerous parallel reactions present. A distributed activation energy model with dual logistic distributions proves to be suitable for modeling thermal decomposition kinetics of both PPMS-DS and PPMS-SS, with coefficient of determination >0.999 and relative root mean square error <1.99 %. High temperature promotes decomposition of solid organic materials in PPMS, and maximum tar yield for both PPMS-DS (53.90 wt%, daf) and PPMS-SS (56.48 wt%, daf) is achieved at around 500 °C. Higher levels of styrene (24.45 % for PPMS-DS and 14.71 % for PPMS-SS) and ethylbenzene (8.61 % for PPMS-DS and 8.33 % for PPMS-SS) are detected in tar and could be used as chemicals. This work shows great potential to propel development of PPMS pyrolysis technology, enabling green and sustainable production in pulp and paper industry.

Green transformation of CO2 into γ-amino alcohols with continuous stereocenters

Here, we present a synthetic route towards γ-amino alcohols with continuous stereocenters based on a copper-catalyzed asymmetric conjugate addition/CO2-trapping tandem reaction of α,β-unsaturated amide, followed by a reduction of the generated α-carboxyl amide. This strategy provides a green route for the transformation of CO2 into valuable chiral organic molecules.

Long-term results of ablation index guided atrial fibrillation ablation: insights after 5+ years of follow-up from the MPH AF Ablation Registry

Background

Catheter ablation (CA) for symptomatic atrial fibrillation (AF) offers the best outcomes for patients. Despite the benefits of CA, a significant proportion of patients suffer a recurrence; hence, there is scope to potentially improve outcomes through technical innovations such as ablation index (AI) guidance during AF ablation. We present real-world 5-year follow-up data of AI-guided pulmonary vein isolation.

Methods

We retrospectively followed 123 consecutive patients who underwent AI-guided CA shortly after its introduction to routine practice. Data were collected from the MPH AF Ablation Registry with the approval of the institutional research board.

Results

Our patient cohort was older, with higher BMI, greater CHA2DS2-VASc scores, and larger left atrial sizes compared to similar previously published cohorts, while gender balance and other characteristics were similar. The probability of freedom from atrial arrhythmia with repeat procedures is as follows: year 1: 0.95, year 2: 0.92, year 3: 0.85, year 4: 0.79, and year 5: 0.72. Age >75 years (p = 0.02, HR: 2.7, CI: 1.14-6.7), BMI >35 kg/m2 (p = 0.0009, HR: 4.6, CI: 1.8-11.4), and left atrial width as measured on CT in the upper quartile (p = 0.04, HR: 2.5, CI: 1-5.7) were statistically significant independent predictors of recurrent AF.

Conclusion

AI-guided CA is an effective treatment for AF, with 95.8% of patients remaining free from atrial arrhythmia at 1 year and 72.3% at 5 years, allowing for repeat procedures. It is safe with a low major complication rate of 1.25%. Age >75 years, BMI >35 kg/m2, and markedly enlarged atria were associated with higher recurrence rates.

[Ⅱ ]

Objective: To investigate the role and related mechanism of ubiquitin-like protein FAT10 in the angiotensin Ⅱ (AngⅡ)-induced endothelial cell inflammatory responses. Methods: The Western blot was used to detect the protein expression of FAT10 in 16-weeks old WKY rat carotid artery, thoracic aorta artery, renal artery and vascular smooth muscle cells (VSMC), human umbilical vein endothelial cells (HUVEC) and human breast cancer cells (MDA-MB-231). The optimal concentration and stimulation time of AngⅡ on inducing the highest FAT10 in HUVEC were determined. The following plasmids were constructed: control plasmid, overexpression FAT10 plasmid (Flag-FAT10), invalid interference plasmid, and interference FAT10 plasmid (sh-FAT10). These plasmids were then transfected into HUVEC cells and divided into following groups: control group, Flag-FAT10 group, invalid interference group, and sh-FAT10 group. After culturing with 100 nmol/L AngⅡ for 36 h, the control group and the Flag-FAT10 group were treated with reactive oxygen species scavenger N-acetyl-L-cysteine ​​(NAC), the protein expression levels of the inflammatory factor monocyte chemotactic protein-1 (MCP-1) and tumor necrosis factor-α (TNF-α) were measured. Laser confocal microscopy was used to detect the generation levels of reactive oxygen species in the cells of vrious groups. Results: FAT10 was expressed in carotid artery, thoracic aorta, and renal artery of normal blood pressure rats and expressed in HUVEC, VSMC, MDA-MB-231. The expression level of FAT10 gradually increased in proportion to the increase of the time and concentration of AngⅡ stimulation in HUVEC, and the expression level of FAT10 was the highest when the HUVEC was treated with 100 nmol/L AngⅡ for 36 h (P<0.01). The protein expression level of MCP-1 (P<0.001) and TNF-α (P<0.01) was higher in AngⅡ treated HUVEC with FAT10 overexpression, while the expression level of MCP-1 and TNF-α protein was lower in AngⅡ treated HUVEC with FAT10 knockdown (all P<0.01). The level of intracellular reactive oxygen species (ROS) production was significantly increased with FAT10 overexpression (P<0.001), and the level of ROS was decreased when the expression of FAT10 was interfered (P<0.05). The increased level of MCP-1 and TNF-α proteins in FAT10 overexpressed HUVEC was reversed by NAC (all P<0.05). Conclusion: FAT10 promotes the release of inflammatory factors induced by AngⅡ in endothelial cells by increasing the level of intracellular ROS production.

Impact of Surface Roughness on Partition and Selectivity of Ionic Liquids Mixture in Porous Electrode

Understanding the influence of surface roughness on the adsorption of ions from an ionic liquids (ILs) mixture is essential for designing supercapacitors. The classical density functional theory (DFT) is applied to investigate the adsorption behavior of ILs mixtures in rough nanopores. The model parameters for each ion are determined by fitting experimental data of pure IL density. The results show that the smaller anions are densely accumulated near the rough surface and are the dominant species at a high positive potential. The exclusion of larger anions is enhanced by roughness at almost all potentials. At negative potential, the surface roughness promotes the adsorption of cations, and the partition coefficient increases with roughness. The partition coefficient of smaller anions is virtually independent of roughness. At positive potential, the surface roughness only promotes the adsorption of smaller anions and raises the partition coefficient. The partition coefficient of smaller anions is far greater than one. The selectivity of smaller anions for rough surfaces is very high and increases with roughness. The surface charge of a more uneven surface is significantly higher (about 30%) at a high potential.

Neurosyphilis with a rare magnetic resonance imaging pattern confirmed by metagenomic next-generation sequencing: a case report

Background

Neurosyphilis refers to infection of the central nervous system by Treponema pallidum. The clinical presentation is variable and nonspecific. Neuroimaging findings are complex and that the diagnosis is based on clinical presentation, cerebrospinal fluid (CSF) parameters, and serologic and CSF evidence of syphilis. To date, there is no case report describing Treponema pallidum detected by metagenomic next-generation sequencing (mNGS) in CSF.

Case presentation

In this report, we describe a case of neurosyphilis in a HIV-negative, 29-year-old man, who was admitted to our hospital with an epileptic seizure and progressive cognitive impairment. Brain magnetic resonance imaging (MRI) revealed fluid-attenuated inversion recovery (FLAIR) high signal intensities in bilateral medial and anterior temporal lobes, insula, right pulvinar of the thalami, precuneus, frontal and temporo-occipital lobes. Laboratory examination showed positive results by means of nontreponemal or specific treponemal test in serum and CSF. mNGS of the CSF was also performed to identify Treponema pallidum for the first time.

Conclusions

This case underscores the importance of considering neurosyphilis as a potential cause of mesiotemporal abnormality. In addition, the rapid improvement and wide usability of mNGS technology will bring new breakthroughs in the clinical diagnosis of neurosyphilis.

Degradation of hexavalent chromium and methyl orange by the synergistic system of graphitic carbon nitride and electron beam irradiation

Hexavalent chromium (Cr(VI)) and methyl orange (MO) are highly toxic and difficult to treat. Electron beam irradiation (EB) can produce ·OH, H·, ·O₂^-, hydrated electron (e_aq^-) and other active substances, which have strong redox ability to pollutants. However, the penetration capacity of EB is limited (the penetration depth of water is 10 cm). Therefore, the photocatalytic method of graphitic carbon nitride (CN) was used as the synergistic method of EB in this project to degrade Cr(VI) and MO. The results showed that the maximum treatment efficiency of 100 mg L^-1 Cr(VI) and 50 mg L^-1 MO with liquid surface height of 5 cm was 95.0% and 99.1%, respectively, which was much higher than that of single photocatalytic method (39.5%, 23.4%) and EB (79.6%, 92.1%), and the efficiency of synergistic treatment was higher under acidic condition. When the liquid depth increased to 30 cm, the efficiency of synergistic system decreased by 14.7% and 15.2% for the degradation of Cr(VI) and MO, respectively, less than the single EB treatment (47.2%, 45.7%). Additionally, the performance of the morphology, the light absorption performance, and the separation of photogenerated electron-hole pairs of the CN were evaluated before and after the synergistic system. Lastly, the mechanism illustrates that the electron and thermal effects of EB, e_aq^-, photogenerated electrons played key roles for the Cr(VI) reduction, and the electron and thermal effects of EB, ·O₂^-, photogenerated holes played key roles for the MO degradation. This study provides a new opportunity for the synergistic system of photocatalyst and EB in the treatment of pollutants.

Brain-mimicking phantom for biomechanical validation of motion sensitive MR imaging techniques

Motion sensitive MR imaging techniques allow for the non-invasive evaluation of biological tissues by using different excitation schemes, including physiological/intrinsic motions caused by cardiac pulsation or respiration, and vibrations caused by an external actuator. The mechanical biomarkers extracted through these imaging techniques have been shown to hold diagnostic value for various neurological disorders and conditions. Amplified MRI (aMRI), a cardiac gated imaging technique, can help track and quantify low frequency intrinsic motion of the brain. As for high frequency actuation, the mechanical response of brain tissue can be measured by applying external high frequency actuation in combination with a motion sensitive MR imaging sequence called Magnetic Resonance Elastography (MRE). Due to the frequency-dependent behavior of brain mechanics, there is a need to develop brain phantom models that can mimic the broadband mechanical response of the brain in order to validate motion-sensitive MR imaging techniques. Here, we have designed a novel phantom test setup that enables both the low and high frequency responses of a brain-mimicking phantom to be captured, allowing for both aMRI and MRE imaging techniques to be applied on the same phantom model. This setup combines two different vibration sources: a pneumatic actuator, for low frequency/intrinsic motion (1 Hz) for use in aMRI, and a piezoelectric actuator for high frequency actuation (30-60 Hz) for use in MRE. Our results show that in MRE experiments performed from 30 Hz through 60 Hz, propagating shear waves attenuate faster at higher driving frequencies, consistent with results in the literature. Furthermore, actuator coupling has a substantial effect on wave amplitude, with weaker coupling causing lower amplitude wave field images, specifically shown in the top-surface shear loading configuration. For intrinsic actuation, our results indicate that aMRI linearly amplifies motion up to at least an amplification factor of 9 for instances of both visible and sub-voxel motion, validated by varying power levels of pneumatic actuation (40%-80% power) under MR, and through video analysis outside the MRI scanner room. While this investigation used a homogeneous brain-mimicking phantom, our setup can be used to study the mechanics of non-homogeneous phantom configurations with bio-interfaces in the future.

Potential of cannabinoids as treatments for autism spectrum disorders

Current treatments for autism spectrum disorders (ASD) are limited in efficacy and are often associated with substantial side effects. These medications typically ameliorate problem behaviors associated with ASD, but do not target core symptom domains. As a result, there is a significant amount of research underway for development of novel experimental therapeutics. Endocannabinoids are arachidonic acid-derived lipid neuromodulators, which, in combination with their receptors and associated metabolic enzymes, constitute the endocannabinoid (EC) system. Cannabinoid signaling may be involved in the social impairment and repetitive behaviors observed in those with ASD. In this review, we discuss a possible role of the EC system in excitatory-inhibitory (E-I) imbalance and immune dysregulation in ASD. Novel treatments for the core symptom domains of ASD are needed and phytocannabinoids could be useful experimental therapeutics for core symptoms and associated domains.

Untargeted metabolite profiling of petal blight in field-grown Rhododendron agastum using GC-TOF-MS and UHPLC-QTOF-MS/MS

Petal blight caused by fungi is among the most destructive diseases of Rhododendron, especially Rhododendron agastum. Nonetheless, the metabolite changes that occur during petal blight are unknown. We used untargeted gas chromatography time-of-flight mass spectrometry (GC-TOF-MS) and ultra-high performance liquid chromatography quadrupole time-of-flight tandem mass spectrometry (UHPLC-QTOF-MS/MS) to compare the metabolite profiles of healthy and petal blight R. agastum flowers. Using GC-TOF-MS, 571 peaks were extracted, of which 189 metabolites were tentatively identified. On the other hand, 364 and 277 metabolites were tentatively identified in the positive and negative ionization modes of the UHPLC-QTOF-MS/MS, respectively. Principal component analysis (PCA) and orthogonal projections to latent structures-discriminant analysis (OPLS-DA) were able to clearly discriminate between healthy and petal blight flowers. Differentially abundant metabolites were primarily enriched in the biosynthesis of specialized metabolites. 17 accumulated specialized metabolites in petal blight flowers have been reported to have antifungal activity, and literature indicates that 9 of them are unique to plants. 3 metabolites (chlorogenic acid, medicarpin, and apigenin) are reportedly involved in resistance to blight caused by pathogens. We therefore speculate that the accumulation of chlorogenic acid, medicarpin, and apigenin may be involved in the resistance to petal blight. Our results suggest that these metabolites may be used as candidate biocontrol agents for the control fungal petal blight in Rhododendron.

[Prevalence of CYP2C19 gene mutations in patients with coronary heart disease and its biological activation effect in clopidogrel antiplatelet response]

Objective: The purpose of this study was to investigate the effects of CYP2C19 gene mutations on clopidogrel antiplatelet activity in the patients with coronary heart disease treated by percutaneous coronary intervention. Methods: Patients with coronary heart disease, who hospitalized in the Second Affiliated Hospital of Nanchang University from March 2011 to June 2019, and healthy individuals with matching genetic background, gender, and age as controls were included in this study. Basic clinical data were analyzed and blood samples of all research subjects were obtained for extraction of DNA, and Sanger first-generation sequencing method was used to detect CYP2C19 gene mutation from full exon and exon and intron junction. CYP2C19 gene variations in patients with coronary heart disease were compared with the 1000 Genomes Browse database and the sequencing results of healthy controls to determine whether the gene variation was a genetic mutation or a genetic polymorphism. After that, PolyPhen-2 prediction software was used to analyze the harmfulness of gene mutations to predict the effect of mutations on protein function. The same dose of CYP2C19 wild-type plasmid and the CYP2C19 gene mutant plasmids were transfected into human normal liver cells HL-7702. After transfection of 24 h, the expression of CYP2C19 protease in each group was detected. The liver S9 protein was incubated with clopidogrel, acted on platelets to detect the platelet aggregation rate and the activity of human vasodilator-activated phosphoprotein (VASP). Results: A total of 1 493 patients with coronary heart disease (59.36%) were enrolled, the average age was (64.5±10.4) years old, of which 1 129 were male (75.62%). Meanwhile, 1 022 healthy physical examination volunteers (40.64%) were enrolled, and the average age was (64.1±11.0) years old, of which 778 were male (76.13%). A total of 5 gene mutations of CYP2C19 gene were identified in 12 patients (0.80%), namely, 4 known mutations T130K (1 case), M136K (6 cases), N277K (3 cases), V472I (1 case) and one new mutation G27V (1 case), no corresponding gene mutation was found in healthy controls. It was found that T130K and M136K were probably damaging, G27V was possibly damaging, and N277K and V472I were benign mutations. In vitro, we demonstrated that the platelet aggregation rate of the M136K gene mutation group was 24.83% lower than that of the wild type (59.58% vs. 34.75%; P<0.05), and the phosphorylated VASP level was 23.0% higher than that of the wild type (1.0 vs. 1.23; P<0.05). However, the platelet aggregation rate and phosphorylated VASP level were similar between of G27V, T130K, N277K, V472I gene mutation groups and wild type group (P>0.05). Conclusions: In this study, 5 gene mutations are defined in patients with coronary heart disease, namely G27V, T130K, M136K, N277K, V472I. In vitro functional studies show that CYP2C19 gene mutation M136K, as a gain-of-function gene mutation, can enhance the activation of CYP2C19 enzyme on clopidogrel, thereby inhibiting the platelet aggregation rate.

Apical sparing strain pattern observed in danon disease: insights from a global registry

Background

Danon Disease (DD) is a rare X-linked autophagic disorder due to mutations in the Lysosomal Associated Membrane Protein 2 (LAMP-2) gene and causes severe cardiac manifestations. Measurement of longitudinal strain (LS) has been shown to provide diagnostic insights into different etiologies of hypertrophic cardiomyopathies compared to conventional echocardiographic parameters.

Purpose

The aim of this study was to describe the pattern of global and regional LS in DD.

Methods

A retrospective, international registry, using medical records provided by patients, was formed to describe the natural history of DD. Complete echocardiogram images were available for review and LS was analyzed globally and regionally (basal, mid, apex).

Results

A total of eighteen DD patients (male 72%, mean age 17.2±10 years) had sufficient quality echocardiographic images for both traditional and myocardial strain evaluation. Notable traditional echocardiographic parameters included a mean EF of 60±11%, LV mass index 200±159 g/m2, intraventricular septal diameter 17.7±10.3 mm, LV posterior wall diameter 16.1±7.7 mm, LA volume index 21.9±13 mL/m2. Global longitudinal strain was reduced with a mean of −12.1±4.9% with an observed regional strain gradient: apex (−16.6±6.6%), mid (−10.9±4.7%) and basal (−9.2±4.5%). Bull's eye plot patterns reflected an apical sparing pattern that was similar to that described in cardiac amyloidosis.

Conclusion

In this DD cohort, we describe for the first time a strain pattern characterized by reduction in global longitudinal strain with apical sparing, which was originally pathognomonic for cardiac amyloidosis. This strain pattern in conjunction with a paradoxically normal LA volume may discriminate patients with DD from other hypertrophic conditions.

Funding Acknowledgement

Type of funding source: None

Giant isotope effect on phonon dispersion and thermal conductivity in methylammonium lead iodide

Lead halide perovskites are strong candidates for high-performance low-cost photovoltaics, light emission, and detection applications. A hot-phonon bottleneck effect significantly extends the cooling time of hot charge carriers, which thermalize through carrier-optic phonon scattering, followed by optic phonon decay to acoustic phonons and finally thermal conduction. To understand these processes, we adjust the lattice dynamics independently of electronics by changing isotopes. We show that doubling the mass of hydrogen in methylammonium lead iodide by replacing protons with deuterons causes a large 20 to 50% softening of the longitudinal acoustic phonons near zone boundaries, reduces thermal conductivity by ~50%, and slows carrier relaxation kinetics. Phonon softening is attributed to anticrossing with the slowed libration modes of the deuterated molecules and the reduced thermal conductivity to lowered phonon velocities. Our results reveal how tuning the organic molecule dynamics enables control of phonons important to thermal conductivity and the hot-phonon bottleneck.

In-situ synthesis of Fe7S8 nanocrystals decorated on N, S-codoped carbon nanotubes as anode material for high-performance lithium-ion batteries

Fe₇S₈ has emerged as an attractive anode material for lithium-ion batteries (LIBs) due to its outstanding features such as low cost, high theoretical capacity, as well as environmental benignity. However, the rapid capacity fading derived from the tremendous volume change during the charging/discharging process hinders its practical application. Nanostructure engineering and the combination with carbonaceous material are essential to address this issue. In this work, Fe₇S₈ nanocrystals decorated on N, S-codoped carbon nanotubes (Fe₇S₈-NSC) were synthesized through a facile one-step pyrolysis of Fe-containing polypyrrole (PPy) nanotubes with sulphur powders under nitrogen atmosphere. When evaluated as anode of LIBs, Fe₇S₈-NSC demonstrates excellent cycling stability (718.8 mAh g^-1 at 100 mA g^-1 after 100 cycles) and superior rate ability (290.8 mAh g^-1 at 2000 mA g^-1). Moreover, Fe₇S₈-NSC shows a typical specific capacity recovery phenomenon, an extraordinary capacity of 744.4 mAh g^-1 at 2000 mA g^-1 after 1000 cycles can be achieved, which outperforms most of the Fe₇S₈-based anode materials reported before. The Fe₇S₈-NSC should be a promising anode material for high-performance LIBs.

Theoretical study of aromatic hydroxylation of the [Cu2(H-XYL)O2]2+ complex mediated by a side-on peroxo dicopper core and Cu-ligand effects

In this work, the aromatic hydroxylation mechanism of the [Cu₂(H-XYL)O₂]²⁺ complex mediated by a peroxo dicopper core and Cu-ligand effects are investigated by using hybrid density functional theory (DFT) and the broken symmetry B3LYP method. Based on the calculated free-energy profiles, we proposed two available mechanisms. The first reaction steps of both mechanisms involve concerted O-O bond cleavage and C-O bond formation and the second step involves the Wagner-Meerwein rearrangement of the substrate by a [1,2] H shift (H_A shift from C_A to C_C) or (H_A shift from C_A to O_A) across the phenyl ring to form stable dienone intermediates, and this is followed by the protonation of bridging oxygen atoms to produce the final hydroxylated dicopper(ii) product. The H_A shift from C_A to C_C mechanism is the energetically most favorable, in which the first reaction step is the rate-limiting reaction, with a calculated free-energy barrier of 19.0 kcal mol^-1 and a deuterium kinetic isotope effect of 1.0, in agreement with experimental observations. The calculation also shows that the reaction started from the P-type species of [Cu₂(H-XYL)O₂]²⁺ which is capable of mediating the direct hydroxylation of aromatic substrates without the intermediacy of an O-type species. Finally, we designed some new complexes with different Cu-ligands and found the complex that computationally possesses a higher activity in mediating the hydroxylation of the ligand based aromatic substrate; here, Cu loses a pyridyl ligand donor by dissociation, compared to the [Cu₂(H-XYL)O₂]²⁺ complex.

Evidence for a protective role of the CX3CL1/CX3CR1 axis in a model of amyotrophic lateral sclerosis

Aberrant microglial activation and neuroinflammation is a pathological hallmark of amyotrophic lateral sclerosis (ALS). Fractalkine (CX3CL1) is mostly expressed on neuronal cells. The fractalkine receptor (CX3CR1) is predominantly expressed on microglia. Many progressive neuroinflammatory disorders show disruption of the CX3CL1/CX3CR1 communication system. But the exact role of the CX3CL1/CX3CR1 in ALS pathology remains unknown. F1 nontransgenic/CX3CR1+/- females were bred with SOD1G93A/CX3CR1+/- males to produce F2 SOD1G93A/CX3CR1-/-, SOD1G93A/CX3CR1+/+. We analyzed end-stage (ES) SOD1G93A/CX3CR1-/- mice and progression-matched SOD1G93A/CX3CR1+/+ mice. Our study showed that the male SOD1G93A/CX3CR1-/- mice died sooner than male SOD1G93A/CX3CR1+/+ mice. In SOD1G93A/CX3CR1-/- mice demonstrated more neuronal cell loss, more microglial activation and exacerbated SOD1 aggregation at the end-stage of ALS. The NF-κB pathway was activated; the autophagy-lysosome degradation pathway and the autophagosome maturation were impaired. Our results indicated that the absence of CX3CR1/CX3CL1 signaling in the central nervous system (CNS) may worsen neurodegeneration. The CX3CL1/CX3CR1 communication system has anti-inflammatory and neuroprotective effects and plays an important role in maintaining autophagy activity. This effort may lead to new therapeutic strategies for neuroprotection and provide a therapeutic target for ALS patients.

Effect of abduction on avascular necrosis of the femoral epiphysis in patients with late-detected developmental dysplasia of the hip treated by closed reduction: a MRI study of 59 hips

PURPOSE

The purpose of this study was to explore whether increasing the hip abduction angle would increase the incidence of avascular necrosis (AVN) in patients with late- detected developmental dysplasia of the hip (DDH) treated by closed reduction (CR) and spica cast immobilization.

METHODS

A total of 55 patients (59 hips) with late-detected DDH underwent MRI after CR. Hip abduction angle and hip joint distance were measured on postoperative MRI transverse sections. The acetabular index and centre-edge angle were measured on plain radiographs at the last follow-up. The presence of AVN according to Kalamchi and McEwen's classification was assessed. We retrospectively analyzed the associations among abduction angles, hip joint distances, radiographic parameters, AVN and final outcomes, exploring the relationship between hip joint abduction angle and AVN rate.

RESULTS

The mean age at the time of CR was 14.4 months SD 5.5 (6 to 28), and the mean follow-up was 26.2 months SD 8.1 (12.4 to 41.7). The mean hip abduction angle was 70.2° SD 7.2° (53° to 85°) on the dislocated side and 63.7° SD 8.8° (40° to 82°) on the normal side; the mean hip joint distance was 5.1 mm SD 1.9 (1.3 to 9.1) on the dislocated side and 2.2 mm SD 0.6 on the normal side (1.3 to 3.3). Eight of 59 hips (13.6%) developed AVN. Neither the amount of abduction nor hip joint distance increased the AVN rate (p = 0.97 and p = 0.65, respectively) or the dislocation rate (p = 0.38 and p = 0.14, respectively).

CONCLUSION

Abduction angle up to 70.2° following CR did not increase the AVN rate in children aged six to 28 months with late-detected DDH treated by CR.

LEVEL OF EVIDENCE

III.