Reliability of the CURL classification for proximal ulna fracture-dislocations of the elbow

Background

Proximal ulna fracture-dislocations are challenging injuries with a myriad of existing classification systems. The Coronoid, proximal Ulna, Radius, and Ligaments classification (CURL) is a simple framework designed to focus attention on the key components affecting outcome and guide surgical management. This study evaluates interobserver and intraobserver reliability of this new classification.

Methods

Four observers independently reviewed plain radiographs and computed tomography (CT) scans of patients with proximal ulna fracture-dislocations. Each observer scored the Coronoid (C), proximal Ulna (U), and Radius (R) components for each fracture on 2 occasions. The osseous components were subclassified as 'intact', 'simple', or 'complex'. The Ligament component (L) was not rated as this requires intraoperative classification. Interobserver and intraobserver reliability was calculated using Cohen's weighted kappa coefficients. X-ray and CT were compared for patients with both imaging modalities. The Landis and Koch criteria were used to interpret the strength of the kappa statistics.

Results

One hundred seventy seven patients had plain X-rays; 58 patients had both X-ray and CT scans. Overall, in the X-ray only cohort, there was 'almost perfect' interobserver reliability for the radial head (k = 0.94) and coronoid (k = 0.83), and 'substantial' reliability (k = 0.68) for the proximal ulna. For the X-ray and CT cohort, interobserver reliability was 'almost perfect' across both modalities for the radial head (k = 0.88 and k = 0.93, respectively) and 'moderate' for the proximal ulna (k = 0.48 and k = 0.52, respectively). For the coronoid, interobserver reliability for X-ray interpretation was 'substantial' (k = 0.74) and for CT was 'almost perfect' (k = 0.89). Intraobserver reliability was 'almost perfect' for all components, other than CT assessment of the proximal ulna which demonstrated 'substantial' reliability (k = 0.74).

Conclusion

The Coronoid, proximal Ulna, Radius, and Ligaments classification demonstrates strong interobserver and intraobserver reliability, supporting use of the classification for proximal ulna fracture-dislocations. CT is recommended for improved characterization of any fracture with a coronoid component.

Let-Us Investigate; A Meta-Analysis of Influencing Factors on Lettuce Crop Yields within Controlled-Environment Agriculture Systems

Climate change-related impacts have hampered the productivity of agricultural lands in recent times, affecting food security globally. Novel technology-based agricultural production systems such as controlled-environment agriculture (CEA) are a way to reduce the impact of climatic variation and pests that harm current global crop production and ensure consistent crop development. These systems often use artificial lighting and soilless mediums to produce crops. This meta-analysis has investigated the key influencing factors on crop production within these systems, using previous studies on lettuce (the most cultivated crop in these systems) to understand what affects yield within CEA. This analysis has found that on average, CEA systems yield twice that of field-based agriculture (3.68 kg m^-2 vs. 1.88 kg m^-2), with the most influencing factors being the variety of cultivars grown, the season, the nutrient delivery method, and the lighting type. The cultivation time for this study was 40 days, with 94% of papers having trial periods of 70 days or less, much lower than field-based agriculture (60-120 days). Vertical farming (stacked vertical CEA cultivation) studies were found to especially drive up yield per area (6.88 kg m^-2). The results of this meta-analysis are useful for starting to understand the key influencing factors on CEA growth and highlight the breadth of research ongoing in the CEA industry.

Coronal shear fractures of the distal humerus managed according to the Modified Dubberley Classification System

BACKGROUND

Coronal shear fractures of the capitellum and trochlea are relatively uncommon and can be challenging to treat because of variable articular comminution and poor bone stock. Classification is valuable to help guide surgical decision making and prognosis. The aim of this study was to present a large series of coronal shear fractures treated according to the Modified Dubberley Classification System (MDCS).

METHODS

Forty-five patients with a coronal shear fracture were followed up (12-93 months, mean: 28 months) after surgical intervention. Fractures were classified according to the MDCS by 3 observers, and outcome data collected included Oxford elbow score (OES), visual analog pain score (VAS), range of motion, complications, and radiographic findings.

RESULTS

There were 10 type 1, 12 type 2, 8 type 3, and 15 type 4 fractures. There were 26 subtype B fractures (posterior comminution). A total of 37 patients underwent open reduction and internal fixation (ORIF) and 8 primary arthroplasty. The median OES and VAS were 43(16-48) and 2 (0-9), respectively. Median flexion extension arc was 125° (range, 70°-140°). There was no significant difference in OES, VAS, or range of motion according to fracture type (types 1-4), subtype (type a or b), or treatment method (arthroplasty vs. ORIF). The overall complication and reoperation rates were 31% and 33%, respectively. A total of 75% of complications occurred in type 3 and 4 fractures, and there was a nonsignificant trend toward higher complication rate in type B fractures than type A fractures (34% vs. 16%, P = .19). Patients with a type B fracture who underwent screw-only fixation had a significantly lower OES and higher complication rate compared with when they had combined plating with screws (OES, P = .03; complications P = .04) and compared with when an arthroplasty was performed (OES, P = .05; complications P = .04).

CONCLUSION

Consistently good outcomes can be achieved by classification and management according to the MDCS. It is recommended that type B fractures undergo combined plate and screw fixation and that type 4 fractures should be considered for arthroplasty because of the higher risk of complications with ORIF.

Comparison of Cellular Responses to TGF-β1 and BMP-2 Between Healthy and Torn Tendons

BACKGROUND

Tendons heal by fibrotic repair, increasing the likelihood of reinjury. Animal tendon injury and overuse models have identified transforming growth factor beta (TGF-β) and bone morphogenetic proteins (BMPs) as growth factors actively involved in the development of fibrosis, by mediating extracellular matrix synthesis and cell differentiation.

PURPOSE

To understand how TGF-β and BMPs contribute to fibrotic processes using tendon-derived cells isolated from healthy and diseased human tendons.

STUDY DESIGN

Controlled laboratory study.

METHODS

Tendon-derived cells were isolated from patients with a chronic rotator cuff tendon tear (large to massive, diseased) and healthy hamstring tendons of patients undergoing anterior cruciate ligament repair. Isolated cells were incubated with TGF-β1 (10 ng/mL) or BMP-2 (100 ng/mL) for 3 days. Gene expression was measured by real-time quantitative polymerase chain reaction. Cell signaling pathway activation was determined by Western blotting.

RESULTS

TGF-β1 treatment induced ACAN mRNA expression in both cell types but less in the diseased compared with healthy cells (P < .05). BMP-2 treatment induced BGN mRNA expression in healthy but not diseased cells (P < .01). In the diseased cells, TGF-β1 treatment induced increased ACTA2 mRNA expression (P < .01) and increased small mothers against decapentaplegic (SMAD) signaling (P < .05) compared with those of healthy cells. Moreover, BMP-2 treatment induced ACTA2 mRNA expression in the diseased cells only (P < .05).

CONCLUSION

Diseased tendon-derived cells show reduced expression of the proteoglycans aggrecan and biglycan in response to TGF-β1 and BMP-2 treatments. These same treatments induced enhanced fibrotic differentiation and canonical SMAD cell signaling in diseased compared with healthy cells.

CLINICAL RELEVANCE

Findings from this study suggest that diseased tendon-derived cells respond differently than healthy cells in the presence of TGF-β1 and BMP-2. The altered responses of diseased cells may influence fibrotic repair processes during tendon healing.

Evaluation of the Circles Measurement and the ABC Classification of Acromioclavicular Joint Injuries

BACKGROUND

Acromioclavicular joint (ACJ) injuries are common. Despite this, it remains unclear how best to assess, classify, and manage these cases. A simple, reliable, valid, and accurate radiographic parameter to measure ACJ displacement would allow improved consistency of diagnosis and subsequent treatment pathways.

PURPOSE

To evaluate "the circles measurement" and associated "ABC classification" as a tool for assessing ACJ displacement and injury classification.

STUDY DESIGN

Descriptive laboratory study.

METHODS

The circles measurement is taken from a lateral Alexander radiograph of the shoulder. The measurement is the center-to-center distance between 2 circles drawn to define the lateral extent of the clavicle and the anteromedial extent of the acromion; it is independent of the displacement plane, judging total ACJ displacement in any direction rather than trying to quantify vertical and/or horizontal displacement. When utilized clinically, the circles measurement is a single measurement calculated as the difference between values recorded for the injured and uninjured sides. Validation of the circles measurement was performed using lateral Alexander radiographs (including ±20° projection error in all planes) and computed tomography of standardized ACJ injury simulations. We assessed inter- and intrarater reliability, convergent validity, and discriminant validity of the circles measurement and subsequently generated a classification of ACJ injury based on displacement.

RESULTS

Reliability and validity of the circles measurement was excellent throughout. Interrater reliability (ICC [intraclass correlation coefficient] [2,1], 95% CI; n = 78; 4 observers) was 0.976 (0.964-0.985). Intrarater reliability (ICC [2,1]; 95% CI; n = 78; 2 measures) was 0.998 (0.996-0.998). Convergent validity (Pearson correlation coefficient, r) was 0.970 for ideal radiographs and 0.889 with ±20° projection error in all planes. Discriminant validity, with 1-way analysis of variance, showed a P value of <.0001 and effect size (η²) of 0.960, with the ability to distinguish between the previously defined stable (Rockwood IIIA) and unstable (Rockwood IIIB) injuries. The results permitted objective, statistically sound parameters for the proposed ABC classification system.

CONCLUSION

The circles measurement is a simple, reliable, valid, accurate, and resilient parameter for assessing ACJ displacement and can be used in conjunction with the proposed ABC classification to define ACJ injuries more accurately and objectively than previously described.

CLINICAL RELEVANCE

This novel parameter has the potential to standardize the initial assessment and possibly the subsequent clinical management of ACJ injuries, in addition to providing a standardized measure for future research.

Utility of bedside leucocyte esterase testing to rule out septic arthritis

INTRODUCTION

Suspected septic arthritis is a common presentation to EDs. The underlying diagnosis is often non-infective pathology. Differentiating between aetiologies is difficult. A bedside test with high negative predictive value (NPV) may allow safe discharge of patients, reduce the time in the ED, hospital admission and associated costs. This study aims to evaluate the NPV of bedside leucocyte esterase (LE) in the assessment of these patients.

METHODS

A prospective multicentre observational study of ED adult patients referred to orthopaedics with suspected native joint septic arthritis between October 2015 and April 2016. At three hospital sites in the Bristol region, the results of the LE test exposed to aspirated synovial fluid were recorded along with Gram stain, culture, haematinics and length of stay. A positive LE test was considered 2+ or 3+ leucocytes based on the test strip colour. Data were analysed to establish sensitivity, specificity, NPV and positive predictive value (PPV) against the gold standard 48-hour culture. We determined the potential number of inpatient bed-days that might be avoided using this bedside test.

RESULTS

Eighty patients underwent joint aspiration. Five cases had positive 48-hour culture. All (5/5) infected cases showed ≥2+ LE, sensitivity of 100% (95% CI 47.8% to 100%) while the Gram stain was positive in only one case (sensitivity 20%, 95% CI 0.51% to 71.6%). Twenty-three LE were read negative or 1+, all with negative 48-hour culture results, resulting in an NPV of 100% (95% CI 82.1% to 1.00%) for a negative LE test. Specificity of a positive LE test was 30.7% (95% CI 20.5% to 42.45%) with PPV of 8.77% (95% CI 7.64% to 10.1%). It was calculated that 57 orthopaedic bed-days could have potentially been saved by immediately discharging those with a negative LE test.

CONCLUSIONS

LE point-of-care testing for suspected septic arthritis of native joints has a high NPV. Implementation of LE may facilitate more rapid discharge of patients with negative results. This test has the potential to reduce diagnostic uncertainty and costs to the healthcare system.

BiPOD arthroscopically assisted bidirectional stabilisation technique for high-grade acromioclavicular joint injury: two-year clinical and radiological outcomes

PURPOSE

The purpose of this study was to evaluate the intermediate-term clinical and radiological outcomes for acute, unstable acromioclavicular joint (ACJ) injuries treated with the arthroscopically assisted BiPOD stabilisation technique.

METHODS

Twenty-three patients who sustained acute, unstable ACJ injuries were included in this prospective study. We recorded demographics, injury classification, time to surgery, clinical scores, radiological outcomes and complications; each patient completed a minimum of 2 years post-operative observation.

RESULTS

Mean follow-up was 26 months (range, 24-34). Clinical outcomes scores demonstrated good 2-year results: relative Constant score, 97.9/100; ACJ Index, 89.4/100; Subjective Shoulder Value, 92.4/100 and Taft = 11.1/12. Final C-C distance showed a mean of 0.7 mm (SD ± 1.8 mm) at 2 years. Complication rate was 9%.

CONCLUSION

The BiPOD technique shows excellent, reliable intermediate-term results with a favourable complication rate compared to existing techniques; it provides a comprehensive surgical option for the stabilisation of acute ACJ injuries restoring both vertical and horizontal stability.

Biogenicity of Spicular Geyserite from Te Kopia, New Zealand: Integrated Petrography, High-Resolution Hyperspectral and Elemental Analysis

Hyperspectral and micro X-ray fluorescence (μXRF) imagery were used to derive maps of mineralogy and elemental chemistry from a sample of a siliceous hot spring deposit, or sinter, collected from a landslide breccia deposit at the base of the Paeroa fault, which bounds the eastern Taupo Rift at Te Kopia, Taupo Volcanic Zone, New Zealand. The sample is of a known biogenic sinter layer from a paleo-vent area of a recently extinct alkali chloride hot spring. The aim of the study was to distinguish it from other horizons derived from nonbiogenic sources, which is of relevance to early and extraterrestrial life research, specifically to help assess the potential reliability of morphology as an indicator of biology in the geological record. In particular, the distribution of opal, a common mineral in hot springs deposits that is known to preserve microbial features, and the relative abundances of Al-OH clay and water (OH and H₂O) were mapped from hyperspectral imagery and element distributions defined by μXRF element mapping. Layers within the sinter sample composed of spicular geyserite-a type of micro-columnar stromatolite-showed contrasting mineralogy and water content in comparison with interspicular clastic sediment. Whereas clay was found to be concentrated in the interspicular sediment, high water contents characterized the spicules. μXRF imagery also showed differences in the composition of the two components of the spicule-bearing layers, with interspicular sediment being enriched in K, Ti, Fe, and Rb relative to the spicules, which are enriched in Ga. The contrasting nature of the mapped components highlights the detailed upward-branching nature of the spicules, identical to those found in living microstromatolites. These discriminants show that the spicular component can be discerned from the geological background through hyperspectral and μXRF mapping and used to define morphological features that may survive burial diagenesis and metamorphism as a biosignature in deep time rocks.

Fast and automatic periacetabular osteotomy fragment pose estimation using intraoperatively implanted fiducials and single-view fluoroscopy

Accurate and consistent mental interpretation of fluoroscopy to determine the position and orientation of acetabular bone fragments in 3D space is difficult. We propose a computer assisted approach that uses a single fluoroscopic view and quickly reports the pose of an acetabular fragment without any user input or initialization. Intraoperatively, but prior to any osteotomies, two constellations of metallic ball-bearings (BBs) are injected into the wing of a patient's ilium and lateral superior pubic ramus. One constellation is located on the expected acetabular fragment, and the other is located on the remaining, larger, pelvis fragment. The 3D locations of each BB are reconstructed using three fluoroscopic views and 2D/3D registrations to a preoperative CT scan of the pelvis. The relative pose of the fragment is established by estimating the movement of the two BB constellations using a single fluoroscopic view taken after osteotomy and fragment relocation. BB detection and inter-view correspondences are automatically computed throughout the processing pipeline. The proposed method was evaluated on a multitude of fluoroscopic images collected from six cadaveric surgeries performed bilaterally on three specimens. Mean fragment rotation error was 2.4 ± 1.0 degrees, mean translation error was 2.1 ± 0.6 mm, and mean 3D lateral center edge angle error was 1.0 ± 0.5 degrees. The average runtime of the single-view pose estimation was 0.7 ± 0.2 s. The proposed method demonstrates accuracy similar to other state of the art systems which require optical tracking systems or multiple-view 2D/3D registrations with manual input. The errors reported on fragment poses and lateral center edge angles are within the margins required for accurate intraoperative evaluation of femoral head coverage.

Improved identification of unstable acromioclavicular joint injuries in a clinical population using the acromial center line to dorsal clavicle radiographic measurement

BACKGROUND

Accurate classification and subsequent management of acromioclavicular (AC) joint injuries remains a contentious topic. The updated Rockwood classification acknowledges "stable IIIA" and "unstable IIIB" injuries, a watershed accepted by ISAKOS and important in guiding clinical management. Traditionally, the coracoclavicular distance is used to classify these injuries, despite well-documented limitations. This study aimed to evaluate displacement in AC joint injuries by measuring both coracoclavicular (CC) distance and the newly proposed acromial center line to dorsal clavicle (AC-DC) distance, in a cohort of patients, and correlate the results between the 2 measurements and relationship to Rockwood grade.

MATERIALS AND METHODS

Ninety consecutive cases of AC joint injury were evaluated radiographically for Rockwood classification, CC distance on anteroposterior radiographs, and AC-DC distance on Alexander view radiographs. Inter- and intraobserver reliability for each measurement was calculated as well as correlation between the 2 measurement types and the degree to which each measurement accurately represented the Rockwood classification.

RESULTS

Although both CC and AC-DC measurements showed very high inter- and intraobserver reliability, the CC distance systematically underestimated the degree of AC joint displacement when compared with the AC-DC measurement as the severity of injury increased, particularly in the presence of posterior horizontal displacement such as that seen in Rockwood IV injuries.

CONCLUSION

The AC-DC measurement and use of the Alexander view provides the clinician with a more realistic appreciation of true AC joint displacement, especially in defining watershed cases (ie, IIIA/IIB/IV) and may better inform the decision-making process regarding management options and recommendations.

Nanomaterials Derived from Fungal Sources-Is It the New Hype?

Greener alternatives to synthetic polymers are constantly being investigated and sought after. Chitin is a natural polysaccharide that gives structural support to crustacean shells, insect exoskeletons, and fungal cell walls. Like cellulose, chitin resides in nanosized structural elements that can be isolated as nanofibers and nanocrystals by various top-down approaches, targeted at disintegrating the native construct. Chitin has, however, been largely overshadowed by cellulose when discussing the materials aspects of the nanosized components. This Perspective presents a thorough overview of chitin-related materials research with an analytical focus on nanocomposites and nanopapers. The red line running through the text emphasizes the use of fungal chitin that represents several advantages over the more popular crustacean sources, particularly in terms of nanofiber isolation from the native matrix. In addition, many β-glucans are preserved in chitin upon its isolation from the fungal matrix, enabling new horizons for various engineering solutions.

Impact of high latitude, urban living and ethnicity on 25-hydroxyvitamin D status: A need for multidisciplinary action?

The effects of urban living on health are becoming increasingly important, due to an increasing global population residing in urban areas. Concomitantly, due to immigration, there is a growing number of ethnic minority individuals (African, Asian or Middle Eastern descent) living in westernised Higher Latitude Countries (HLC) (e.g. Europe, Canada, New Zealand). Of concern is the fact that there is already a clear vitamin D deficiency epidemic in HLC, a problem which is likely to grow as the ethnic minority population in these countries increases. This is because 25-hydroxyvitamin D (25(OH)D) status of ethnic groups is significantly lower compared to native populations. Environmental factors contribute to a high prevalence of vitamin D deficiency in HLC, particularly during the winter months when there is no sunlight of appropriate wavelength for vitamin D synthesis via the skin. Also, climatic factors such as cloud cover may reduce vitamin D status even in the summer. This may be further worsened by factors related to urban living, including air pollution, which reduces UVB exposure to the skin, and less occupational sun exposure (may vary by individual HLC). Tall building height may reduce sun exposure by making areas more shaded. In addition, there are ethnicity-specific factors which further worsen vitamin D status in HLC urban dwellers, such as low dietary intake of vitamin D from foods, lower production of vitamin D in the skin due to increased melanin and reduced skin exposure to UVB due to cultural dress style and sun avoidance. A multidisciplinary approach applying knowledge from engineering, skin photobiology, nutrition, town planning and social science is required to prevent vitamin D deficiency in urban areas. Such an approach could include reduction of air pollution, modification of sun exposure advice to emphasise spending time each day in non-shaded urban areas (e.g. parks, away from tall buildings), and advice to ethnic minority groups to increase sun exposure, take vitamin D supplements and/or increase consumption of vitamin D rich foods in a way that is safe and culturally acceptable. This review hopes to stimulate further research to assess the impact of high latitude, urban environment and ethnicity on the risk of vitamin D deficiency.

A Physics-Based Deep Learning Approach to Shadow Invariant Representations of Hyperspectral Images

This paper proposes the Relit Spectral Angle-Stacked Autoencoder, a novel unsupervised feature learning approach for mapping pixel reflectances to illumination invariant encodings. This work extends the Spectral Angle-Stacked Autoencoder so that it can learn a shadow-invariant mapping. The method is inspired by a deep learning technique, Denoising Autoencoders, with the incorporation of a physics-based model for illumination such that the algorithm learns a shadow invariant mapping without the need for any labelled training data, additional sensors, a priori knowledge of the scene or the assumption of Planckian illumination. The method is evaluated using datasets captured from several different cameras, with experiments to demonstrate the illumination invariance of the features and how they can be used practically to improve the performance of high-level perception algorithms that operate on images acquired outdoors.

Further testing of Melatonin Receptor 1a for out-of-season reproduction in the Cornell flock and allelic frequencies compared with Romney sheep

Sheep are seasonally polyestrous breeders, meaning they breed when day length shortens in the autumn. Ewes respond to changing day length through chemical pathways involving melatonin receptors. Some breeds, such as Dorset, are known to be less seasonal with many ewes able to breed and lamb year-round. The Melatonin Receptor 1a () gene was identified as a candidate gene controlling out-of-season lambing. The first studies in the Cornell STAR accelerated lambing flock found that a allele was associated with a shorter time to first lambing and a shorter period between lambings. The favorable allele was denoted the allele and the unfavorable allele, the allele. This study evaluated additional data for the effect of the polymorphism on sheep reproduction. Genotypic frequencies among the 320 sheep in this study differed between Romney and breeds selected for accelerated lambing ( < 0.02), but they did not deviate from Hardy-Weinberg equilibrium. Using 228 ewes from the Cornell University flock, we found no association ( > 0.05) between the allele and success for out-of-season lambing and no significant differences were observed in several production measures, such as number of lambs delivered per yr or number of lambs weaned ( > 0.05). With few ewes in the flock, these results may be due to the high level of selection for accelerated lambing. This study shows that the allele may not be a beneficial marker for use within flocks seeking to improve production and the ability to lamb out-of-season. These findings warrant additional research on the genetics of aseasonality in sheep.

Effect of copper on multiple successional stages of a marine fouling assemblage

Copper based paints are used to prevent fouling on the hulls of ships. The widely documented effect of copper on hull assemblages may be primarily due to direct effects on the invertebrates themselves or indirect effects from copper absorbed into the microbial biofilm before settlement has commenced. Artificial units of habitat were exposed to varied regimes of copper to examine (1) the photosynthetic efficiency and pigments of early-colonising biofilms, and (2) subsequent macroinvertebrate assemblage change in response to the different regimes of copper. Macroinvertebrate assemblages were found to be less sensitive to the direct effects of copper than indirect effects as delivered through biofilms that have been historically exposed to copper, with some species more tolerant than others. This raises further concern for the efficacy of copper as a universal antifoulant on the hulls of ships, which may continue to assist the invasion of copper-tolerant invertebrate species.

Incorporating Spatial Information and Endmember Variability Into Unmixing Analyses to Improve Abundance Estimates

Incorporating endmember variability and spatial information into spectral unmixing analyses is important for producing accurate abundance estimates. However, most methods do not incorporate endmember variability with spatial regularization. This paper proposes a novel 2-step unmixing approach, which incorporates endmember variability and spatial information. In step 1, a probability distribution representing abundances is estimated by spectral unmixing within a multi-task Gaussian process framework (SUGP). In step 2, spatial information is incorporated into the probability distribution derived by SUGP through an a priori distribution derived from a Markov random field (MRF). The proposed method (SUGP-MRF) is different to the existing unmixing methods because it incorporates endmember variability and spatial information at separate steps in the analysis and automatically estimates parameters controlling the balance between the data fit and spatial smoothness. The performance of SUGP-MRF is compared with the existing unmixing methods using synthetic imagery with precisely known abundances and real hyperspectral imagery of rock samples. Results show that SUGP-MRF outperforms the existing methods and improves the accuracy of abundance estimates by incorporating spatial information.

Complex patterns in fossilized stromatolites revealed by hyperspectral imaging (400-2496 nm)

Hyperspectral imaging (400-2496 nm) was used to quantitatively map surface textures and compositional variations in stromatolites to determine whether complexity of textures could be used as evidence to support biogenicity in the absence of preserved biomarkers. Four samples of 2.72-2.4 Ga stromatolites from a variety of settings, encompassing marine and lacustrine environments, were selected for hyperspectral imaging. Images of the sawn surfaces of samples were processed to identify reflectance and mineral absorption features and quantify their intensity (as an index of mineral abundance) using automated feature extraction. Amounts of ferrous iron were quantified using a ratio of reflectance at 1650 and 1299 nm. Visible near infrared imagery (400-970 nm) did not reveal additional textural patterns to those obtained from visual inspection. Shortwave infrared imagery (1000-2496 nm), however, revealed complex laminar and convoluted patterns, including a distinctive texture of sharp peaks and broad, low troughs in one sample, similar to living tufted microbial mats. Spectral analysis revealed another sample to be composed of dolomite. Two other samples were dominated by calcite or chlorite ± illite. Large variations in amounts of ferrous iron were found, but ferric iron was exclusively located in the oxidation crust. Hyperspectral imaging revealed large differences between parts of a sample of biogenic and non-biogenic origin. The former was characterized by calcite with varying amounts of ferrous iron, distributed in lenticular, convoluted patterns; the latter by Mg-Fe chlorite with large amounts of aluminium silicate, distributed as fine laminar layers. All minerals identified by hyperspectral imaging were confirmed by thin section petrography and XRD analyses. Spatial statistics generated from quantitative minerals maps showed different patterns between these different parts of the sample. Thus, hyperspectral imaging was shown to be a powerful tool for detecting structures in stromatolites that could be used, together with other lines of evidence, to support biogenicity.

A limited legacy effect of copper in marine biofilms

The effects of confounding by temporal factors remains understudied in pollution ecology. For example, there is little understanding of how disturbance history affects the development of assemblages. To begin addressing this gap in knowledge, marine biofilms were subjected to temporally-variable regimes of copper exposure and depuration. It was expected that the physical and biological structure of the biofilms would vary in response to copper regime. Biofilms were examined by inductively coupled plasma optical emission spectrometry, chlorophyll-a fluorescence and field spectrometry and it was found that (1) concentrations of copper were higher in those biofilms exposed to copper, (2) concentrations of copper remain high in biofilms after the source of copper is removed, and (3) exposure to and depuration from copper might have comparable effects on the photosynthetic microbial assemblages in biofilms. The persistence of copper in biofilms after depuration reinforces the need for consideration of temporal factors in ecology.

Differences in glutamate receptors and inflammatory cell numbers are associated with the resolution of pain in human rotator cuff tendinopathy

INTRODUCTION

The relationship between peripheral tissue characteristics and pain symptoms in soft tissue inflammation is poorly understood. The primary aim of this study was to determine immunohistochemical differences in tissue obtained from patients with persistent pain and patients who had become pain-free after surgical treatment for rotator cuff tendinopathy. The secondary aim was to investigate whether there would be differences in glutaminergic and inflammatory gene expression between disease-derived and healthy control cells in vitro.

METHODS

Supraspinatus tendon biopsies were obtained from nine patients with tendon pain before shoulder surgery and from nine further patients whose pain had resolved completely following shoulder surgery. Histological markers relating to the basic tendon characteristics, inflammation and glutaminergic signalling were quantified by immunohistochemical analysis. Gene expression of glutaminergic and inflammatory markers was determined in tenocyte explants derived from painful rotator cuff tendon tears in a separate cohort of patients and compared to that of explants from healthy control tendons. Dual labelling was performed to identify cell types expressing nociceptive neuromodulators.

RESULTS

Tendon samples from patients with persistent pain demonstrated increased levels of metabotropic glutamate receptor 2 (mGluR2), kainate receptor 1 (KA1), protein gene product 9.5 (PGP9.5), CD206 (macrophage marker) and CD45 (pan-leucocyte marker) versus pain-free controls (p <0.05). NMDAR1 co-localised with CD206-positive cells, whereas PGP9.5 and glutamate were predominantly expressed by resident tendon cells. These results were validated by in vitro increases in the expression of mGluR2, N-methyl-D-aspartate receptor (NMDAR1), KA1, CD45, CD206 and tumour necrosis factor alpha (TNF-α) genes (p <0.05) in disease-derived versus control cells.

CONCLUSIONS

We conclude that differences in glutamate receptors and inflammatory cell numbers are associated with the resolution of shoulder pain in rotator cuff tendinopathy, and that disease-derived cells exhibit a distinctly different neuro-inflammatory gene expression profile to healthy control cells.

Insights into nitrogen allocation and recycling from nitrogen elemental analysis and 15N isotope labelling in 14 genotypes of willow

Minimizing nitrogen (N) fertilization inputs during cultivation is essential for sustainable production of bioenergy and biofuels. The biomass crop willow (Salix spp.) is considered to have low N fertilizer requirements due to efficient recycling of nutrients during the perennial cycle. To investigate how successfully different willow genotypes assimilate and allocate N during growth, and remobilize and consequently recycle N before the onset of winter dormancy, N allocation and N remobilization (to and between different organs) were examined in 14 genotypes of a genetic family using elemental analysis and (15)N as a label. Cuttings were established in pots in April and sampled in June, August and at onset of senescence in October. Biomass yield of the trees correlated well with yields recorded in the field. Genotype-specific variation was observed for all traits measured and general trends spanning these sampling points were identified when trees were grouped by biomass yield. Nitrogen reserves in the cutting fuelled the entirety of the canopy establishment, yet earlier cessation of this dependency was linked to higher biomass yields. The stem was found to be the major N reserve by autumn, which constitutes a major source of N loss at harvest, typically every 2-3 years. These data contribute to understanding N remobilization in short rotation coppice willow and to the identification of traits that could potentially be selected for in breeding programmes to further improve the sustainability of biomass production.

Effect of tear size, corticosteroids and subacromial decompression surgery on the hierarchical structural properties of torn supraspinatus tendons

OBJECTIVES

The effects of disease progression and common tendinopathy treatments on the tissue characteristics of human rotator cuff tendons have not previously been evaluated in detail owing to a lack of suitable sampling techniques. This study evaluated the structural characteristics of torn human supraspinatus tendons across the full disease spectrum, and the short-term effects of subacromial corticosteroid injections (SCIs) and subacromial decompression (SAD) surgery on these structural characteristics.

METHODS

Samples were collected inter-operatively from supraspinatus tendons containing small, medium, large and massive full thickness tears (n = 33). Using a novel minimally invasive biopsy technique, paired samples were also collected from supraspinatus tendons containing partial thickness tears either before and seven weeks after subacromial SCI (n = 11), or before and seven weeks after SAD surgery (n = 14). Macroscopically normal subscapularis tendons of older patients (n = 5, mean age = 74.6 years) and supraspinatus tendons of younger patients (n = 16, mean age = 23.3) served as controls. Ultra- and micro-structural characteristics were assessed using atomic force microscopy and polarised light microscopy respectively.

RESULTS

Significant structural differences existed between torn and control groups. Differences were identifiable early in the disease spectrum, and increased with increasing tear size. Neither SCI nor SAD surgery altered the structural properties of partially torn tendons seven weeks after treatment.

CONCLUSIONS

These findings may suggest the need for early clinical intervention strategies for torn rotator cuff tendons in order to prevent further degeneration of the tissue as tear size increases. Further work is required to establish the long-term abilities of SCI and SAD to prevent, and even reverse, such degeneration. Cite this article: Bone Joint Res 2014;3:252-61.

Glucocorticoids induce specific ion-channel-mediated toxicity in human rotator cuff tendon: a mechanism underpinning the ultimately deleterious effect of steroid injection in tendinopathy?

BACKGROUND

Glucocorticoid injection (GCI) and surgical rotator cuff repair are two widely used treatments for rotator cuff tendinopathy. Little is known about the way in which medical and surgical treatments affect the human rotator cuff tendon in vivo. We assessed the histological and immunohistochemical effects of these common treatments on the rotator cuff tendon.

STUDY DESIGN

Controlled laboratory study.

METHODS

Supraspinatus tendon biopsies were taken before and after treatment from 12 patients undergoing GCI and 8 patients undergoing surgical rotator cuff repair. All patients were symptomatic and none of the patients undergoing local GCI had full thickness tears of the rotator cuff. The tendon tissue was then analysed using histological techniques and immunohistochemistry.

RESULTS

There was a significant increase in nuclei count and vascularity after rotator cuff repair and not after GCI (both p=0.008). Hypoxia inducible factor 1α (HIF-1α) and cell proliferation were only increased after rotator cuff repair (both p=0.03) and not GCI. The ionotropic N-methyl-d-aspartate receptor 1 (NMDAR1) glutamate receptor was only increased after GCI and not rotator cuff repair (p=0.016). An increase in glutamate was seen in both groups following treatment (both p=0.04), while an increase in the receptor metabotropic glutamate receptor 7 (mGluR7) was only seen after rotator cuff repair (p=0.016).

CONCLUSIONS

The increases in cell proliferation, vascularity and HIF-1α after surgical rotator cuff repair appear consistent with a proliferative healing response, and these features are not seen after GCI. The increase in the glutamate receptor NMDAR1 after GCI raises concerns about the potential excitotoxic tendon damage that may result from this common treatment.

Temporal trends and geographical variation in the use of subacromial decompression and rotator cuff repair of the shoulder in England

We explored the trends over time and the geographical variation in the use of subacromial decompression and rotator cuff repair in 152 local health areas (Primary Care Trusts) across England. The diagnostic and procedure codes of patients undergoing certain elective shoulder operations between 2000/2001 and 2009/2010 were extracted from the Hospital Episode Statistics database. They were grouped as 1) subacromial decompression only, 2) subacromial decompression with rotator cuff repair, and 3) rotator cuff repair only. The number of patients undergoing subacromial decompression alone rose by 746.4% from 2523 in 2000/2001 (5.2/100 000 (95% confidence interval (CI) 5.0 to 5.4) to 21 355 in 2009/2010 (40.2/100 000 (95% CI 39.7 to 40.8)). Operations for rotator cuff repair alone peaked in 2008/2009 (4.7/100 000 (95% CI 4.5 to 4.8)) and declined considerably in 2009/2010 (2.6/100 000 (95% CI 2.5 to 2.7)). Given the lack of evidence for the effectiveness of these operations and the significant increase in the number of procedures being performed in England and elsewhere, there is an urgent need for well-designed clinical trials to determine evidence of clinical effectiveness.

Bioethanol from poplar: a commercially viable alternative to fossil fuel in the European Union

BACKGROUND

The European Union has made it a strategic objective to develop its biofuels market in order to minimize greenhouse gas (GHG) emissions, to help mitigate climate change and to address energy insecurity within the transport sector. Despite targets set at national and supranational levels, lignocellulosic bioethanol production has yet to be widely commercialized in the European Union. Here, we use techno-economic modeling to compare the price of bioethanol produced from short rotation coppice (SRC) poplar feedstocks under two leading processing technologies in five European countries.

RESULTS

Our evaluation shows that the type of processing technology and varying national costs between countries results in a wide range of bioethanol production prices (€0.275 to 0.727/l). The lowest production prices for bioethanol were found in countries that had cheap feedstock costs and high prices for renewable electricity. Taxes and other costs had a significant influence on fuel prices at the petrol station, and therefore the presence and amount of government support for bioethanol was a major factor determining the competitiveness of bioethanol with conventional fuel. In a forward-looking scenario, genetically engineering poplar with a reduced lignin content showed potential to enhance the competitiveness of bioethanol with conventional fuel by reducing overall costs by approximately 41% in four out of the five countries modeled. However, the possible wider phenotypic traits of advanced poplars needs to be fully investigated to ensure that these do not unintentionally negate the cost savings indicated.

CONCLUSIONS

Through these evaluations, we highlight the key bottlenecks within the bioethanol supply chain from the standpoint of various stakeholders. For producers, technologies that are best suited to the specific feedstock composition and national policies should be optimized. For policymakers, support schemes that benefit emerging bioethanol producers and allow renewable fuel to be economically competitive with petrol should be established. Finally, for researchers, better control over plant genetic engineering and advanced breeding and its consequential economic impact would bring valuable contributions towards developing an economically sustainable bioethanol market within the European Union.

Techno-economic potential of bioethanol from bamboo in China

BACKGROUND

Bamboo is potentially an interesting feedstock for advanced bioethanol production in China due to its natural abundance, rapid growth, perennial nature and low management requirements. Liquid hot water (LHW) pretreatment was selected as a promising technology to enhance sugar release from bamboo lignocellulose whilst keeping economic and environmental costs to a minimum. The present research was conducted to assess: 1) by how much LHW pretreatment can enhance sugar yields in bamboo, and 2) whether this process has the potential to be economically feasible for biofuel use at the commercial scale. Pretreatments were performed at temperatures of 170-190°C for 10-30 minutes, followed by enzymatic saccharification with a commercial enzyme cocktail at various loadings. These data were then used as inputs to a techno-economic model using AspenPlus™ to determine the production cost of bioethanol from bamboo in China.

RESULTS

At the selected LHW pretreatment of 190°C for 10 minutes, 69% of the initial sugars were released under a standardised enzyme loading; this varied between 59-76% when 10-140 FPU/g glucan of commercial enzyme Cellic CTec2 was applied. Although the lowest enzyme loading yielded the least amount of bioethanol, the techno-economic evaluation revealed it to be the most economically viable scenario with a production cost of $0.484 per litre (with tax exemption and a $0.16/litre subsidy). The supply-chain analysis demonstrated that bioethanol could be economically competitive with petrol at the pump at enzyme loadings up to 60 FPU/g glucan. However, in a prospective scenario with reduced government support, this enzyme loading threshold would be reduced to 30 FPU/g glucan.

CONCLUSIONS

Bioethanol from bamboo is shown to be both technically and economically feasible, as well as competitive with petrol in China. Alternative approaches to reduce bioethanol production costs are still needed however, to ensure its competitiveness in a possible future scenario where neither tax exemptions nor subsidies are granted to producers. These measures may include improving sugar release with more effective pretreatments and reduced enzyme usage, accessing low cost bamboo feedstock or selecting feedstocks with higher/more accessible cellulose.

Kite aerial photography for low-cost, ultra-high spatial resolution multi-spectral mapping of intertidal landscapes

Intertidal ecosystems have primarily been studied using field-based sampling; remote sensing offers the ability to collect data over large areas in a snapshot of time that could complement field-based sampling methods by extrapolating them into the wider spatial and temporal context. Conventional remote sensing tools (such as satellite and aircraft imaging) provide data at limited spatial and temporal resolutions and relatively high costs for small-scale environmental science and ecologically-focussed studies. In this paper, we describe a low-cost, kite-based imaging system and photogrammetric/mapping procedure that was developed for constructing high-resolution, three-dimensional, multi-spectral terrain models of intertidal rocky shores. The processing procedure uses automatic image feature detection and matching, structure-from-motion and photo-textured terrain surface reconstruction algorithms that require minimal human input and only a small number of ground control points and allow the use of cheap, consumer-grade digital cameras. The resulting maps combine imagery at visible and near-infrared wavelengths and topographic information at sub-centimeter resolutions over an intertidal shoreline 200 m long, thus enabling spatial properties of the intertidal environment to be determined across a hierarchy of spatial scales. Results of the system are presented for an intertidal rocky shore at Jervis Bay, New South Wales, Australia. Potential uses of this technique include mapping of plant (micro- and macro-algae) and animal (e.g. gastropods) assemblages at multiple spatial and temporal scales.

Glucocorticoids induce senescence in primary human tenocytes by inhibition of sirtuin 1 and activation of the p53/p21 pathway: in vivo and in vitro evidence

Cellular senescence is an irreversible side effect of some pharmaceuticals which can contribute to tissue degeneration.

OBJECTIVE

To determine whether pharmaceutical glucocorticoids induce senescence in tenocytes.

METHODS

Features of senescence (β-galactosidase activity at pH 6 (SA-β-gal) and active mammalian/mechanistic target of rapamycin (mTOR) in cell cycle arrest) as well as the activity of the two main pathways leading to cell senescence were examined in glucocorticoid-treated primary human tenocytes. Evidence of senescence-inducing pathway induction in vivo was obtained using immunohistochemistry on tendon biopsy specimens taken before and 7 weeks after subacromial Depo-Medrone injection.

RESULTS

Dexamethasone treatment of tenocytes resulted in an increased percentage of SA-βgal-positive cells. Levels of phosphorylated p70S6K did not decrease with glucocorticoid treatment indicating mTOR remained active. Increased levels of acetylated p53 as well as increased RNA levels of its pro-senescence effector p21 were evident in dexamethasone-treated tenocytes. Levels of the p53 deacetylase sirtuin 1 were lower in dexamethasone-treated cells compared with controls. Knockdown of p53 or inhibition of p53 activity prevented dexamethasone-induced senescence. Activation of sirtuin 1 either by exogenous overexpression or by treatment with resveratrol or low glucose prevented dexamethasone-induced senescence. Immunohistochemical analysis of tendon biopsies taken before and after glucocorticoid injection revealed a significant increase in the percentage of p53-positive cells (p=0.03). The percentage of p21-positive cells also tended to be higher post-injection (p=0.06) suggesting glucocorticoids activate the p53/p21 senescence-inducing pathway in vivo as well as in vitro.

CONCLUSION

As cell senescence is irreversible in vivo, glucocorticoid-induced senescence may result in long-term degenerative changes in tendon tissue.

Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012

In September 2010, the first International Scientific Tendinopathy Symposium (ISTS) was held in Umeå, Sweden, to establish a forum for original scientific and clinical insights in this growing field of clinical research and practice. The second ISTS was organised by the same group and held in Vancouver, Canada, in September 2012. This symposium was preceded by a round-table meeting in which the participants engaged in focused discussions, resulting in the following overview of tendinopathy clinical and research issues. This paper is a narrative review and summary developed during and after the second ISTS. The document is designed to highlight some key issues raised at ISTS 2012, and to integrate them into a shared conceptual framework. It should be considered an update and a signposting document rather than a comprehensive review. The document is developed for use by physiotherapists, physicians, athletic trainers, massage therapists and other health professionals as well as team coaches and strength/conditioning managers involved in care of sportspeople or workers with tendinopathy.

End-of-life of starch-polyvinyl alcohol biopolymers

This study presents a life cycle assessment (LCA) model comparing the waste management options for starch-polyvinyl alcohol (PVOH) biopolymers including landfill, anaerobic digestion (AD), industrial composting and home composting. The ranking of biological treatment routes for starch-PVOH biopolymer wastes depended on their chemical compositions. AD represents the optimum choice for starch-PVOH biopolymer containing N and S elements in global warming potential (GWP(100)), acidification and eutrophication but not on the remaining impact categories, where home composting was shown to be a better option due to its low energy and resource inputs. For those starch-PVOH biopolymers with zero N and S contents home composting delivered the best environmental performance amongst biological treatment routes in most impact categories (except for GWP(100)). The landfill scenario performed generally well due largely to the 100-year time horizon and efficient energy recovery system modeled but this good performance is highly sensitive to assumptions adopted in landfill model.

Reaction wood - a key cause of variation in cell wall recalcitrance in willow

BACKGROUND

The recalcitrance of lignocellulosic cell wall biomass to deconstruction varies greatly in angiosperms, yet the source of this variation remains unclear. Here, in eight genotypes of short rotation coppice willow (Salix sp.) variability of the reaction wood (RW) response and the impact of this variation on cell wall recalcitrance to enzymatic saccharification was considered.

RESULTS

A pot trial was designed to test if the 'RW response' varies between willow genotypes and contributes to the differences observed in cell wall recalcitrance to enzymatic saccharification in field-grown trees. Biomass composition was measured via wet chemistry and used with glucose release yields from enzymatic saccharification to determine cell wall recalcitrance. The levels of glucose release found for pot-grown control trees showed no significant correlation with glucose release from mature field-grown trees. However, when a RW phenotype was induced in pot-grown trees, glucose release was strongly correlated with that for mature field-grown trees. Field studies revealed a 5-fold increase in glucose release from a genotype grown at a site exposed to high wind speeds (a potentially high RW inducing environment) when compared with the same genotype grown at a more sheltered site.

CONCLUSIONS

Our findings provide evidence for a new concept concerning variation in the recalcitrance to enzymatic hydrolysis of the stem biomass of different, field-grown willow genotypes (and potentially other angiosperms). Specifically, that genotypic differences in the ability to produce a response to RW inducing conditions (a 'RW response') indicate that this RW response is a primary determinant of the variation observed in cell wall glucan accessibility. The identification of the importance of this RW response trait in willows, is likely to be valuable in selective breeding strategies in willow (and other angiosperm) biofuel crops and, with further work to dissect the nature of RW variation, could provide novel targets for genetic modification for improved biofuel feedstocks.

LCA data quality: sensitivity and uncertainty analysis

Life cycle assessment (LCA) data quality issues were investigated by using case studies on products from starch-polyvinyl alcohol based biopolymers and petrochemical alternatives. The time horizon chosen for the characterization models was shown to be an important sensitive parameter for the environmental profiles of all the polymers. In the global warming potential and the toxicity potential categories the comparison between biopolymers and petrochemical counterparts altered as the time horizon extended from 20 years to infinite time. These case studies demonstrated that the use of a single time horizon provide only one perspective on the LCA outcomes which could introduce an inadvertent bias into LCA outcomes especially in toxicity impact categories and thus dynamic LCA characterization models with varying time horizons are recommended as a measure of the robustness for LCAs especially comparative assessments. This study also presents an approach to integrate statistical methods into LCA models for analyzing uncertainty in industrial and computer-simulated datasets. We calibrated probabilities for the LCA outcomes for biopolymer products arising from uncertainty in the inventory and from data variation characteristics this has enabled assigning confidence to the LCIA outcomes in specific impact categories for the biopolymer vs. petrochemical polymer comparisons undertaken. Uncertainty combined with the sensitivity analysis carried out in this study has led to a transparent increase in confidence in the LCA findings. We conclude that LCAs lacking explicit interpretation of the degree of uncertainty and sensitivities are of limited value as robust evidence for decision making or comparative assertions.

A Life Cycle Assessment (LCA) comparison of three management options for waste papers: bioethanol production, recycling and incineration with energy recovery

This study uses Life Cycle Assessment (LCA) to assess the environmental profiles and greenhouse gas (GHG) emissions for bioethanol production from waste papers and to compare them with the alternative waste management options of recycling or incineration with energy recovery. Bioethanol production scenarios both with and without pre-treatments were conducted. It was found that an oxidative lime pre-treatment reduced GHG emissions and overall environmental burdens for a newspaper-to-bioethanol process whereas a dilute acid pre-treatment raised GHG emissions and overall environmental impacts for an office paper-to-bioethanol process. In the comparison of bioethanol production systems with alternative management of waste papers by different technologies, it was found that the environmental profiles of each system vary significantly and this variation affects the outcomes of the specific comparisons made. Overall, a number of configurations of bioethanol production from waste papers offer environmentally favourable or neutral profiles when compared with recycling or incineration.

Eco-innovation of a wooden childhood furniture set: an example of environmental solutions in the wood sector

The environmental profile of a set of wood furniture was carried out to define the best design criteria for its eco-design. A baby cot convertible into a bed, a study desk and a bedside table were the objects of study. Two quantitative and qualitative environmental approaches were combined in order to propose improvement alternatives: Life Cycle Assessment (LCA) and Design for Environment (DfE). In the first case Life Cycle Assessment (LCA) was applied to identify the hot spots in the product system. As a next step, LCA information was used in eco-briefing to determine several improvement alternatives. A wood products company located in Catalonia (NE Spain) was assessed in detail, dividing the process into three stages: assembly, finishing and packaging. Ten impact categories were considered in the LCA study: abiotic depletion, acidification, eutrophication, global warming, ozone layer depletion, human toxicity, fresh water aquatic ecotoxicity, marine aquatic ecotoxicity, terrestrial ecotoxicity and photochemical oxidant formation. Two processes can be considered the key environmental factors: the production of the wooden boards and electricity, with contributions of 45-68% and 14-33% respectively depending on the impact categories. Subsequently, several improvement alternatives were proposed in the eco-design process (DfE) to achieve reductions in a short-medium period of time in the environmental impact. These eco-design strategies could reduce the environmental profile of the setup by 14%. The correct methodological adaptation of the concept of eco-briefing, as a tool for communication among environmental technicians and designers, the simplification of the analytical tool used and the LCA, could facilitate the environmental analysis of a product. The results obtained provide information that can help the furniture sector to improve their environmental performance.

Influence of agro-ecosystem modeling approach on the greenhouse gas profiles of wheat-derived biopolymer products

An approach is presented to include a wider range of factors involved in the nitrogen and carbon cycles in agro-ecosystems than is typical of many Life Cycle Assessments (LCAs) of agriculture-based products. This use results from the process-oriented Denitrification-Decomposition (DNDC, modified version) model. Here we evaluate the effects of using site-specific N(2)O emissions derived from the DNDC model rather than the values derived from the commonly used Intergovernmental Panel on Climate Change (IPCC) Tier 1 empirical model on the results of whole life cycle greenhouse gas (GHG) profiles for wheat-based biopolymer products. Statistical methods were also used to analyze the quality of the DNDC and IPCC outputs and to characterize the uncertainty in the GHG results. The results confirm that the GHG profiles of the wheat-derived biopolymer products are sensitive to how the agricultural system is modeled and uncertainty analyses indicate that DNDC is preferred over the IPCC Tier 1 approach for site-specific LCAs. The former allows inclusion of a wider range of important site-specific agricultural parameters in the LCA, provides for improved quality in the LCA data, and permits better calibration of uncertainty in the LCA inventory.

Anaerobic digestion of starch-polyvinyl alcohol biopolymer packaging: biodegradability and environmental impact assessment

The digestibility of a starch-polyvinyl alcohol (PVOH) biopolymer insulated cardboard coolbox was investigated under a defined anaerobic digestion (AD) system with key parameters characterized. Laboratory results were combined with industrial operational data to develop a site-specific life cycle assessment (LCA) model. Inoculated with active bacterial trophic groups, the anaerobic biodegradability of three starch-PVOH biopolymers achieved 58-62%. The LCA modeling showed that the environmental burdens of the starch-PVOH biopolymer packaging under AD conditions on acidification, eutrophication, global warming and photochemical oxidation potential were dominated by atmospheric emissions released from substrate degradation and fuel combustion, whereas energy consumption and infrastructure requirements were the causes of abiotic depletion, ozone depletion and toxic impacts. Nevertheless, for this bio-packaging, AD of the starch-PVOH biopolymer combined with recycling of the cardboard emerged as the environmentally superior option and optimization of the energy utilization system could bring further environmental benefits to the AD process.

Biofuels carbon footprints: Whole-systems optimisation for GHG emissions reduction

A modelling approach for strategic design of ethanol production systems combining lifecycle analysis (LCA) and supply chain optimisation (SCO) can significantly contribute to assess their economic and environmental sustainability and to guide decision makers towards a more conscious implementation of ad hoc farming and processing practices. Most models applications so far have been descriptive in nature; the model proposed in this work is "normative" in that it aims to guide actions towards optimal outcomes (e.g. optimising the nitrogen balance through the whole supply chain). The modelling framework was conceived to steer strategic policies through a geographically specific design process considering economic and environmental criteria. Results shows how a crop management strategy devised from a whole systems perspective can significantly contribute to mitigate global warming even in first generation technologies.

Investigation of tension wood formation and 2,6-dichlorbenzonitrile application in short rotation coppice willow composition and enzymatic saccharification

BACKGROUND

Short rotation coppice willow is a potential lignocellulosic feedstock in the United Kingdom and elsewhere; however, research on optimising willow specifically for bioethanol production has started developing only recently. We have used the feedstock Salix viminalis × Salix schwerinii cultivar 'Olof' in a three-month pot experiment with the aim of modifying cell wall composition and structure within the stem to the benefit of bioethanol production. Trees were treated for 26 or 43 days with tension wood induction and/or with an application of the cellulose synthesis inhibitor 2,6-dichlorobenzonitrile that is specific to secondary cell walls. Reaction wood (tension and opposite wood) was isolated from material that had received the 43-day tension wood induction treatment.

RESULTS

Glucan content, lignin content and enzymatically released glucose were assayed. All measured parameters were altered without loss of total stem biomass yield, indicating that enzymatic saccharification yield can be enhanced by both alterations to cell wall structure and alterations to absolute contents of either glucan or lignin.

CONCLUSIONS

Final glucose yields can be improved by the induction of tension wood without a detrimental impact on biomass yield. The increase in glucan accessibility to cell wall degrading enzymes could help contribute to reducing the energy and environmental impacts of the lignocellulosic bioethanol production process.

Shoulder pain

INTRODUCTION

Shoulder pain is a common problem with an estimated prevalence of 4% to 26%. About 1% of adults aged over 45 years consult their GP with a new presentation of shoulder pain every year in the UK. The aetiology of shoulder pain is diverse and includes pathology originating from the neck, glenohumeral joint, acromioclavicular joint, rotator cuff, and other soft tissues around the shoulder girdle. The most common source of shoulder pain is the rotator cuff, accounting for over two-thirds of cases.

METHODS AND OUTCOMES

We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral drug treatment, topical drug treatment, local injections, non-drug treatment, and surgical treatment? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

RESULTS

We found 71 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

CONCLUSIONS

In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, arthroscopic subacromial decompression, autologous whole blood injection, corticosteroids (oral, subacromial injection, or intra-articular injection), electrical stimulation, excision of distal clavicle, extracorporeal shock wave therapy, ice, laser treatment, manipulation under anaesthesia, suprascapular nerve block, non-steroidal anti-inflammatory drugs (oral, topical or intra-articular injection), opioid analgesics, paracetamol, physiotherapy (manual treatment, exercises), platelet-rich plasma injection, rotator cuff repair, shoulder arthroplasty, and ultrasound.

Biodegradable and compostable alternatives to conventional plastics

Packaging waste forms a significant part of municipal solid waste and has caused increasing environmental concerns, resulting in a strengthening of various regulations aimed at reducing the amounts generated. Among other materials, a wide range of oil-based polymers is currently used in packaging applications. These are virtually all non-biodegradable, and some are difficult to recycle or reuse due to being complex composites having varying levels of contamination. Recently, significant progress has been made in the development of biodegradable plastics, largely from renewable natural resources, to produce biodegradable materials with similar functionality to that of oil-based polymers. The expansion in these bio-based materials has several potential benefits for greenhouse gas balances and other environmental impacts over whole life cycles and in the use of renewable, rather than finite resources. It is intended that use of biodegradable materials will contribute to sustainability and reduction in the environmental impact associated with disposal of oil-based polymers. The diversity of biodegradable materials and their varying properties makes it difficult to make simple, generic assessments such as biodegradable products are all 'good' or petrochemical-based products are all 'bad'. This paper discusses the potential impacts of biodegradable packaging materials and their waste management, particularly via composting. It presents the key issues that inform judgements of the benefits these materials have in relation to conventional, petrochemical-based counterparts. Specific examples are given from new research on biodegradability in simulated 'home' composting systems. It is the view of the authors that biodegradable packaging materials are most suitable for single-use disposable applications where the post-consumer waste can be locally composted.

Biomass characterization of Buddleja davidii: a potential feedstock for biofuel production

A compositional analysis was performed on Buddleja davidii to determine its general biomass characteristics and provide detailed analysis of the chemical structures of its cellulose and lignin using NMR. B. davidii is a new potential lignocellulosic bioresource for producing bioethanol because it has several attractive agroenergy features. The biomass composition of B. davidii is 30% lignin, 35% cellulose, and 34% hemicellulose. Solid-state CP/MAS (13)C NMR showed that 33% of the cellulose is para-crystalline and 41% is at inaccessible surfaces. Both quantitative (13)C and (31)P NMR were used to examine the structure of lignin. The lignin was determined to be guaiacyl and syringyl with an h:g:s ratio of 0:81:19.

Are routine postoperative X-rays needed following surgery for hallux valgus? An evaluation of their use after scarf osteotomy

INTRODUCTION

Postoperative X-rays, following a scarf osteotomy, are generally carried out as routine. The aim of this study was to assess the value of performing such investigations.

PATIENTS AND METHODS

Retrospective data were collected regarding all scarf osteotomies performed by three consultant orthopaedic surgeons at a large teaching hospital. A review of routine postoperative X-rays was carried out.

RESULTS

A total of 274 scarf osteotomies were included in the study. Of these, 95% were followed by at least one routine postoperative X-ray. In total, 412 X-rays were performed of which 11% were not commented upon by a radiologist or a surgeon. Of the X-rays with comments from both specialists, only one case was reported as abnormal by both radiologist and surgeon, with no change in management made as a result of these reports. In two cases, changes to standard management were made on the basis of the routine postoperative X-rays and only one of these was implemented solely on the basis of the routine postoperative images.

CONCLUSIONS

The value of postoperative X-rays following a scarf osteotomy is questionable. We propose, on the basis of this study, that, unless clinically indicated, the routine use of postoperative X-rays following a scarf osteotomy should be abandoned.

Fungicides affect the production of extracellular mucilaginous material (ECMM) and the peripheral growth unit (PGU) in two wood-rotting basidiomycetes

This study shows the effect of two fungicides on the production of extracellular mucilaginous material (ECMM) in two wood-rotting basidiomycetes and identifies a mechanism that might be responsible for the variation observed. Increasing concentrations of the fungicides copper sulphate (CuSO4) and cyproconazole in the growth medium increased the proportion of ECMM in the biomass of Trametes versicolor and Gloeophyllum trabeum. These fungicides also caused a reduction in the length of the peripheral growth unit (PGU) of the mycelia leading to a more highly branched morphology and a larger number of hyphal tips, the sites for active secretion of ECMM, per unit length of mycelium. It is postulated that both in T. versicolor and G. trabeum this change in growth leads to the increases observed in the proportion of ECMM in the total biomass. The implications of these results are discussed with a view to a potential protective role of ECMM against stress and toxic environments.

Monitoring losses of copper based wood preservatives in the Thames estuary

Field trials were conducted at two sites in the Thames estuary to monitor losses of copper, chromium and arsenic from wood preservative treated timbers of varying sizes and treatment regimes. Results indicated that leaching tests conducted under standard laboratory conditions might overestimate losses compared to losses resulting from real environmental exposures. Amine copper treated wood was noted to leach higher levels of copper compared to chromated copper arsenate treated wood, and was therefore considered an inappropriate replacement biocide for fresh and marine construction purposes on this basis. Increases in copper concentrations in the outer sections of amine copper treated posts may have represented re-distribution of this component in this timber. No accumulation of metals was found in sediments surrounding field trial posts.