Bio-clay: Antioxidant-rich and stable for body mud scrubs

Clay is naturally occurring and poses a low risk. It is distinguished by mineral composition and ability to adsorb plant colorants and phytochemicals effectively. This study aimed to enhance the stability of bio-clay by preparing body mud scrubs through a solid-state reaction, combining volcanic clay with herbal plants, including Bougainvillea spp., Pandanus amaryllifolius Roxb., and Curcuma longa L. (bio-clay). The characterization of purification clay revealed strong stability within its mineral composition. The optimum condition for sampling was 4 °C, which reserved the total phenolic content (TPC), 2, 2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging assay. A high Trolox equivalent antioxidant capacity (TEAC; mg TEAC/g sample) and low half-maximal inhibitory concentration (IC50) indicated excellent antioxidant activity. Over a storage period of 28 d, the Bougainvillea spp., Curcuma longa L., purified clay + Bougainvillea spp., and purified clay + Curcuma longa L. samples retained their stability. Their TPC, % scavenging, TEAC, and IC50 showed dominant antioxidant activity, stable active phenolic compounds, and the maintenance of extensive amounts. This compound is widely applied as a unique cosmetic ingredient.

Make It Shine: Labelling the ER for Light and Fluorescence Microscopy

The ER is a highly dynamic network of tubules and membrane cisternae. Hence, imaging this organelle in its native and mobile state is of great importance. Here we describe methods of labelling the native plant ER using fluorescent proteins and lipid dyes as well as methods for immunolabelling on plant tissue.

Efficient and safe use of a slow-release Mn material for three sequential crops of rice in Cd-contaminated paddy soils

Traditional passivators reduce the effectiveness of Cd by ion exchange, chemisorption, and complexation in soil. However, traditional passivators have defects such as easy aging and poor durability, which not only reduce the treatment efficiency but also increase the risk of primary soil environmental pollution. For this reason, considering that Mn and Cd have physiological antagonism in rice, sepiolite-supported manganese ferrite (SMF) was prepared in this study to improve passivation persistence. The passivation mechanism, effect and duration of SMF were explored. The results showed that SMF has a dense and small pore structure and that the surface is rough, which provides abundant adsorption sites for Cd2+ adsorption. When the SMF adsorbs Cd2+, ions or functional groups in the material, such as MnOOH*, will exchange with Cd2+ to form Cd(OH)2 and other internal complexes. Indoor pure soil cultivation experiments showed that 0.1 % SMF can reduce the effective Cd content of soil by 41.32 %, demonstrating the efficiency of SMF. The three-crop rice experiments in pots showed that SMF could increase soil pH and continuously increase the content of available Mn in soil. Increasing the content of available Mn reduces the ability of rice to absorb Cd. In addition, the three-cropping rice experiments also indicated that the passivation effect of SMF materials on Cd-contaminated paddy fields was long-lasting and stable and that SMF is a more efficient and safe Cd passivation agent.

Coronary artery disease and its management in TAVI

OBJECTIVE

Aortic stenosis and coronary artery disease (CAD) are frequently associated. The preprocedural evaluation and indications for treatment in patients undergoing transcatheter aortic valve intervention (TAVI) remain controversial. This study sought to 1) determine the prevalence and angiographic characteristics of CAD in TAVI candidates, along with revascularization patterns, and 2) to evaluate the impact of the presence and complexity of CAD, as well as angiography-guided percutaneous coronary intervention, on prognosis after TAVI.

METHODS

Single-center retrospective study from a prospectively collected institutional registry that included all patients that underwent TAVI between 2009 and 2018 and pre TAVI coronary angiography (CA) in our institution in the context of pre-procedure work-up. A multivariate analysis was performed to determine the effect of CAD and PCI on 2-year mortality.

RESULTS

A total of 379 patients were included: 55 patients (14.5%) presented with normal coronary arteries, 120 (31.6%) with non-obstructive CAD, and 204 (53.8%) with obstructive CAD (the mean SxS was 8.2). Ultimately, 110 patients (29%) underwent PCI. Two-year survival after TAVI was decreased in patients with complex coronary lesions (SS > 22), while it was not affected by the overall presence of non-obstructive CAD, obstructive CAD, residual SxS, or pre-TAVI PCI of angiographically significant lesions (OR 0.631, 95%CI 0.192-1.406).

CONCLUSION

In our population, the overall presence and management of obstructive CAD did not appear to impact mortality at 2 years after TAVI. Survival was decreased in patients with baseline complex coronary anatomies.

Magnesium oxide nanoparticles improved vegetative growth and enhanced productivity, biochemical potency and storage stability of harvested mustard seeds

A field study was conducted to investigate the influence of MgO-NPs priming on growth and development of mustard. Priming of mustard seeds before sowing with MgO-NPs at concentration 10, 50, 100, and 150 μg/ml enhanced the vegetative parameters of plants, with considerable increase in leaf area. MgO-NPs exposure increased the photosynthetic pigment accumulation in mustard that led to increase in biomass, carbohydrate content, and the yield in terms of total grain yield. Increased chlorophyll has simultaneously increased the oxidative stress in plants, and hence stimulated their antioxidant potential. A consistent increase was observed in the content of mustard polyphenols and activity of SOD, CAT, and APX on MgO-NPs exposure. MgO-NPs induced oxidative stress further reduced the protein content and bioavailability in mustard. We further, evaluated the influence of MgO-NPs on the quality of mustard harvested seeds. The seeds harvested from nanoprimed mustard possessed increased antioxidant potential and reduced oxidative stress. The carbohydrate and protein accumulation was significantly enhanced in response to nanopriming. Reduced chlorophyll content in seeds obtained from nanoprimed mustard indicated their potential for disease resistance and stability on long term storage. Therefore, the seeds harvested from MgO-NPs primed mustard were biochemically rich and more stable. Therefore, MgO-NPs priming can be potentially used as a novel strategy for growth promotion in plants where leaves are economically important and a strategy to enhance the seed quality under long term storage conditions.

Addition of FFRct in the diagnostic pathway of patients with stable chest pain to reduce unnecessary invasive coronary angiography (FUSION) : Rationale and design for the multicentre, randomised, controlled FUSION trial

BACKGROUND

Coronary computed tomography angiography (CCTA) is widely used in the diagnostic work-up of patients with stable chest pain. CCTA has an excellent negative predictive value, but a moderate positive predictive value for detecting coronary stenosis. Computed tomography-derived fractional flow reserve (FFRct) is a non-invasive, well-validated technique that provides functional assessment of coronary stenosis, improving the positive predictive value of CCTA. However, to determine the value of FFRct in routine clinical practice, a pragmatic randomised, controlled trial (RCT) is required. We will conduct an RCT to investigate the impact of adding FFRct analysis in the diagnostic pathway of patients with a coronary stenosis on CCTA on the rate of unnecessary invasive coronary angiography, cost-effectiveness, quality of life and clinical outcome.

METHODS

The FUSION trial is a prospective, multicentre RCT that will randomise 528 patients with stable chest pain and anatomical stenosis of ≥ 50% but < 90% in at least one coronary artery of ≥ 2 mm on CCTA, to FFRct-guided care or usual care in a 1:1 ratio. Follow-up will be 1 year. The primary endpoint is the rate of unnecessary invasive coronary angiography within 90 days.

CONCLUSION

The FUSION trial will evaluate the use of FFRct in stable chest pain patients from the Dutch perspective. The trial is funded by the Dutch National Health Care Institute as part of the research programme 'Potentially Promising Care' and the results will be used to assess if FFRct reimbursement should be included in the standard health care package.

Bacterial aerosol, particulate matter, and microclimatic parameters in the horse stables in Poland

Keeping horses in good condition requires providing them with living conditions that meet welfare requirements. These animals should be accommodated with suitable space, access to high nutritional fodder and water, and a suitable microclimate in their shelters. When it comes to the environment in the stables, a serious problem is created by particulate matter (PM), which consists of bacteria. PM concentration may be responsible for developing multiple lower respiratory tract diseases in horses, including allergies and recurrent airway obstruction (RAO). In turn, these ailments may lead to decreasing equine physical and mental fitness. Additionally, people who spend time in the stables are exposed to the same harmful factors. The study was conducted in Udórz Stud Farm located in the southern region of Poland. The study was carried out in 2 different types of stables: 3 runners (a type of stable where horses are housed together and occasionally linked up, e.g., for feeding or grooming) and 2 box stables. The research continued for 2 years and the samples were collected in each season. The bioaerosol samples were collected using a six-stage Andersen-Graseby cascade impactor to assess size distribution and concentrations of airborne bacteria. PM concentration was analyzed using the DustTrak™ II Aerosol Monitor 8530, while microclimate parameters were measured using the Kestrel 5000 Weather Meter. There are almost no studies concerning size distribution of airborne bacteria, individual PM fractions, and the impact of everyday handling on the changes in the bioaerosol and PM concentration. This preliminary study provided basic information on this subject. We have revealed a strong correlation between high PM and bacterial aerosol concentrations. Higher contamination levels were recorded in runners, as compared to box stables. The highest bacterial aerosol level was detected in the spring. The analysis of the fractions of the bacterial aerosol in the stables indicated the highest share of ultra-fine fraction (0.65-2.1 µm), while respirable fraction (below 4.7 µm) exceeded 75%. It was established that the concentration of the bacterial aerosol inside the stables was many times higher than outside. It depended significantly on everyday activities undertaken in the stables, like feeding or cleaning. Taking the above into account, a different cleaning system should be developed (a wet cleaning system, with the use of water) and excrement should be removed more frequently.

Sources of riverine mercury across the Mackenzie River Basin; inferences from a combined HgC isotopes and optical properties approach

The Arctic environment harbors a complex mosaic of mercury (Hg) and carbon (C) reservoirs, some of which are rapidly destabilizing in response to climate warming. The sources of riverine Hg across the Mackenzie River basin (MRB) are uncertain, which leads to a poor understanding of potential future release. Measurements of dissolved and particulate mercury (DHg, PHg) and carbon (DOC, POC) concentration were performed, along with analyses of Hg stable isotope ratios (incl. ∆¹⁹⁹Hg, δ²⁰²Hg), radiocarbon content (∆¹⁴C) and optical properties of DOC of river water. Isotopic ratios of Hg revealed a closer association to terrestrial Hg reservoirs for the particulate fraction, while the dissolved fraction was more closely associated with atmospheric deposition sources of shorter turnover time. There was a positive correlation between the ∆¹⁴C-OC and riverine Hg concentration for both particulate and dissolved fractions, indicating that waters transporting older-OC (¹⁴C-depleted) also contained higher levels of Hg. In the dissolved fraction, older DOC was also associated with higher molecular weight, aromaticity and humic content, which are likely associated with higher Hg-binding potential. Riverine PHg concentration increased with turbidity and SO₄ concentration. There were large contrasts in Hg concentration and OC age and quality among the mountain and lowland sectors of the MRB, which likely reflect the spatial distribution of various terrestrial Hg and OC reservoirs, including weathering of sulfate minerals, erosion and extraction of coal deposits, thawing permafrost, forest fires, peatlands, and forests. Results revealed major differences in the sources of particulate and dissolved riverine Hg, but nonetheless a common positive association with older riverine OC. These findings reveal that a complex mixture of Hg sources, supplied across the MRB, will contribute to future trends in Hg export to the Arctic Ocean under rapid environmental changes.

A prospective cohort study

BACKGROUND

The aim of this study was to evaluate the outcome after nondisplaced and stable Lisfranc injuries.

METHODS

26 patients with injuries to the Lisfranc joint complex detected on CT scans, but without displacement were tested to be stable using a fluoroscopic stress test. The patients were immobilized in a non-weightbearing short leg cast for 6 weeks. The final follow-up was 55 (IQR 53-60) months after injury.

RESULTS

All the Lisfranc injuries were confirmed to be stable on follow-up weightbearing radiographs at a minimum of 3 months after injury. Median American Foot and Ankle Society (AOFAS) midfoot score at 1-year follow-up was 89 (IQR 84-97) and at final follow-up 100 (IQR 90-100); The AOFAS score continued to improve after 1-year (P=.005). The median visual analog scale (VAS) for pain was 0 (IQR 0-0) at the final follow-up. One patient had radiological signs of osteoarthritis at 1-year follow-up.

CONCLUSION

Stable Lisfranc injuries treated nonoperatively had an excellent outcome in this study with a median follow-up of 55 months. The AOFAS score continued to improve after 1 year.

Functional bracing is a safe and cost effective treatment for isolated Weber B fracture

BACKGROUND

Despite the current recommendations that stable Weber B ankle fractures can be treated with functional bracing and weightbearing as tolerated, some reluctance exists among trauma surgeons to follow these recommendations. This paper reports on our institution's experience in managing these injuries and compare it to the national guidelines.

PATIENTS AND METHODS

This is a retrospective cohort study. Consecutive patients with isolated Weber B fractures referred to the local outpatient clinic over the period of six months were included in the study. Radiographs and clinic letters were examined, the patients were interviewed via telephone to obtain outcome scores [Olerud and Molander score]. Method of immobilisation, weight-bearing status, radiological fracture union, clinical outcomes and complications were all assessed and analysed.

RESULTS

One hundred and twenty-three patients with isolated Weber B fractures were identified. This cohort of patients did not show clinical or radiographic evidence of instability, they were deemed stable and were initially treated non-operatively. Minimum follow-up period was six months. Sixty-two patients were treated in plaster and were non-weight bearing on the affected limb, while 61 were treated with functional bracing in a boot and were allowed early weight bearing. Three patients showed displacement requiring surgical fixation. All fractures progressed to union and patients were discharged irrespective of the method of immobilisation or weightbearing status during treatment. There was no statistically significant difference in the functional outcome measures between the two groups. The protocol of functional bracing and weightbearing was associated with fewer outpatient clinics and a reduced number of radiographs obtained in the clinic and fewer complications.

CONCLUSION

Isolated trans-syndesmotic Weber B ankle fractures, that are clinically and radiologically stable, can be safely treated with functional bracing in a boot and weightbearing as tolerated.

The thermodynamic stability, potential toxicity, and speciation of metals and metalloids in Tehran runoff, Iran

Surface runoff is the most significant source of water in dry cities like Tehran. The surface runoff is polluted by heavy metals, which their risk level is a function of their speciation. Herein, Tehran runoff quality and the speciation of metals and metalloids were investigated. The results of quality showed that oxidation-reduction potential (Eh) and pH ranged from + 186 to + 230 mV and from 7.31 to 10.29, respectively. Cluster analysis indicated that Cr, Si, Mn, Fe, Pb, Se, Th, Ba, Ni, Li, and Sr had similar behaviors and origins, and salinity played an active role in restricting their concentrations. Eh and dissolved oxygen (DO) negatively affected the concentrations of all the studied elements. The speciation model (according to HSC Chemistry program) exhibited that all the studied elements are stable; however, in two cases, they would become unstable (pH < 7, Eh <  - 480 mV or Eh > 1100 mV) and (pH > 10, Eh <  - 570 mV or Eh > 970 mV). Also, Ba, Cd, Li, Mn, Al, As, Sr, Cr, Si, and Se are present in bioavailable species and As and Cd in the runoff exist in high toxic oxidation states of + 3 and + 2, respectively. The linear regression of Cu, Co, Cd, Zn, and As with Eh provided a good fit, and all of these metals were significant at levels 1 and 5%. Finally, it is recommended to continuously monitor the Eh-pH changes for investigating the potential toxicity of metals and predicting the metal pollution by regression equations in any other stations.

Factors Associated With the Development and Prevalence of Abnormal Behaviors in Horses: Systematic Review With Meta-Analysis

Researchers believe that the development and prevalence of abnormal behaviors in horses may be caused by several environmental and biological factors, and the literature offers numerous reports that discuss the causes and effects of stereotypies in these animals. In this light, this study aimed to conduct a systematic review and meta-analysis of the scientific literature, summarizing the main risk factors associated with the development of abnormal behaviors in horses. The searches were conducted over the course of four years in Portuguese, Spanish, and English. The publications reviewed were full text research thesis or articles that addressed issues within the following criteria: (1) presentation of epidemiological information on the studied population; (2) prevalence of abnormal behaviors in equine populations; (3) factors associated with the development or prevalence of stereotypies. Data were extracted from each study and inserted into an Excel spreadsheet to be analyzed through descriptive statistics. In addition, the Mann-Whitney U test was used to verify the existence of significant differences between the methodologies (direct observation/questionnaires). The dataset was also analyzed through data mining to identify the main factors that influence the prevalence of abnormal behaviors in the studied population. The results showed a great variation in the mean prevalence of abnormal behaviors, with no significant difference between research conducted through questionnaires or direct observation, and the data mining technique identified that incorrect nutritional management may be the main factor influencing the development and prevalence of abnormal behaviors in horses.

Stable and Inducible Gene Knockdown in Primary Human Fibroblasts: A Versatile Tool to Study the Role of Human Cytomegalovirus Host Cell Factors

Human fibroblasts represent the most extensively used cell type for the investigation of lytic human cytomegalovirus (HCMV) replication. However, analyzing the function of specific proteins during infection can be challenging since primary cells are difficult to transfect. An alternative approach is the use of lentiviral transduction with vectors for stable or inducible shRNA expression. This approach provides a versatile tool to study the role of host cell factors during HCMV infection. The essential steps to achieve an efficient target protein knockdown are shRNA design, cloning, generation of transgenic lentiviral particles, and, finally, transduction of the cells. However, these steps are highly dependent on the selected vector system. Here we focus on two different vector systems and describe how to successfully generate stable and inducible knockdown fibroblasts. Additionally, we demonstrate different methods to validate the knockdown of the target protein.

Comparative Analysis of the Effect of Renal Function on the Spectrum of Coronary Artery Disease

BACKGROUND

We aim to assess the differential effect of renal impairment across the spectrum of patients with ischaemic heart disease and to study if any established risk factors may modify this risk.

METHODS

A total of 2013 patients who underwent revascularization for ST-segment elevation myocardial infarction or invasive physiology assessment were included. Renal impairment was defined as glomerular filtration rate less than 60 ml/min/1.73m². Clinical endpoints were prospectively collected, and the primary endpoint was defined as the composite endpoints of death, myocardial infarction, and unplanned revascularization.

RESULTS

593 (30%) presented with ST-segment elevation myocardial infarction, and 1362 (70%) stable patients had invasive ischaemia assessment which resulted in 37% receiving revascularization and 63% being deferred. Renal impairment was associated with increased adverse events in myocardial infarction [HR 1.77 (95% CI 1.15 to 2.74)], but not in the revascularized stable group [(HR 1.14 (95% CI 0.62 to 2.08)] or the deferred group [HR 1.31 (95% CI 0.84 to 2.03)]. There was an exponential increase in the future risk in ST-segment elevation myocardial infarction patients with severe renal dysfunction (glomerular filtration rate < 30) compared to a linear relationship in stable patients. Age and hypertension were the only two factors that had a differential impact across three groups (P<0.05 for interactions), with inconsistent directional effect of hypertension between medically managed and revascularized groups.

CONCLUSIONS

The magnitude of risk of renal impairment varies according to the clinical presentation of coronary artery disease with more weighted risk in myocardial infarction compared to stable patients.

Prevalence of depression and its association with quality of life in clinically stable patients with COVID-19

INTRODUCTION

High risk of mental health problems is associated with Coronavirus Disease 2019 (COVID-19). This study explored the prevalence of depressive symptoms (depression hereafter) and its relationship with quality of life (QOL) in clinically stable patients with COVID-19.

METHODS

This was an online survey conducted in COVID-19 patients across five designated isolation hospitals for COVID-19 in Hubei province, China. Depression and QOL were assessed with standardized instruments.

RESULTS

A total of 770 participants were included. The prevalence of depression was 43.1% (95%CI: 39.6%-46.6%). Binary logistic regression analysis found that having a family member infected with COVID-19 (OR=1.51, P = 0.01), suffering from severe COVID-19 infection (OR=1.67, P = 0.03), male gender (OR=0.53, P<0.01), and frequent social media use to obtain COVID-19 related information (OR=0.65, P<0.01) were independently associated with depression. Patients with depression had lower QOL than those without.

CONCLUSION

Depression is highly prevalent in clinically stable patients with COVID-19. Regular screening and appropriate treatment of depression are urgently warranted for this population.

Retrovectors packaged in CHO cells to generate GLP-1-Fc stable expression CHO cell lines

Background

Chinese hamster ovary (CHO) cells are the most dependable mammalian cells for the production of recombinant proteins. Replication-incompetent retroviral vector (retrovector) is an efficient tool to generate stable cell lines. Multiple copies of integrated genes by retrovector transduction results in improved recombinant protein yield. HEK-293 and their genetic derivatives are principal cells for retrovector production. Retrovectors packaged in HEK-293 cells pose a risk of infectious agent transmission, such as viruses and mycoplasmas, from serum and packaging cells.

Results

In this report, retrovectors were packaged in CHO cells cultured in chemically defined (CD) media. The retrovectors were then used to transduce CHO cells. This method can block potential transmission of infectious agents from serum and packaging cells. With this method, we generated glucagon-like protein-1 Fc fusion protein (GLP-1-Fc) stable expression CHO cell lines. Productivity of GLP-1-Fc can reach 3.15 g/L. The GLP-1-Fc protein produced by this method has comparable bioactivity to that of dulaglutide (Trulicity). These stable cell lines retain 95–100% of productivity after 40 days of continuous culture (~ 48–56 generations).

Conclusions

Suspension CHO cells are clean, safe, and reliable cells for retrovector packaging. Retrovectors packaged from this system could be used to generate CHO stable cell lines for recombinant protein expression.

How to cite: Li J, Wei S, Cao C, et al. Retrovectors packaged in CHO cells to generate GLP-1-Fc stable expression CHO cell lines. Electron J Biotechnol 2019;41. https://doi.org/10.1016/j.ejbt.2019.07.002.

[Comparison of the prognostic value of different clinical, angiographic and scintigraphic scores in stable coronary patients after acute coronary syndrome]

INTRODUCTION

To date, there is no consensus regarding the follow-up of asymptomatic coronary patients with an intermediate risk of events. Indeed, most of cardiovascular events (CVE) occur in asymptomatic patients, hence the clinician's interest in establishing risk stratification scores. In asymptomatic patient, the risk assessment after acute coronary syndrome (ACS) can currently be based on 3 types of score: clinical with, for example, the REACH score; angiographic with the residual SYNTAX score; imaging with different scintigraphic scores. These scores differ widely in terms of evaluation criteria and period of analysis. The aim of our study was therefore, in stable and asymptomatic coronary patients after ACS, to compare these different predictive scores; to establish that the combination of these scores makes it possible to optimize the risk assessment during the follow-up.

METHODS

Our retrospective study included 236 revascularized patients after ACS. Three different risk scores were collected: 1) the residual SYNTAX score, calculated at the time of revascularization; 2) the scintigraphic risk score described by Sharir et al., performed 3 to 12 months after the event and taking into account the extent of ischemia (SDS) and the poststress left ventricular ejection fraction (LVEF). Patients with LVEF <50% and/or moderate to severe ischemic disease (SDS≥2) were considered with an intermediate or high scintigraphic risk; 3) the REACH clinical score calculated on the day of the scintigraphic examination. After the myocardial scintigraphic exam, patients had a 1-year follow-up and CVE were recorded. Continuous data were analyzed either by Student's t-test or non-parametric Mann-Whitney test. The dichotomous data were compared either by the χ² test or by Fisher's exact test.

RESULTS

Forty-eight patients (20.1%) had a CVE during the 1-year follow-up. Thirty patients (13.8%) had a high residual SYNTAX score (≥8) without any correlation observed between the residual SYNTAX score and CVE (P=0.359). 148 patients (57.7%) had a high REACH clinical score (≥11) with no significant correlation observed with CVE (P=0.079). Lastly, 34 patients (14.4%) had an intermediate or high scintigraphic score, this imaging score being strongly correlated with a greater number of CVE (P<0.001). Multivariate analysis revealed 3 independent factors associated with CVE: a scintigraphic score> 2 (OR [(95% CI): 5.530 [2.426-12.605] P<0.001); Peripheral Arterial Obstructive Disease (PAOD) (OR [95% CI]: 8.531 [2.540-28.660] P<0.001); diabetes (OR [95% CI]: 2.86 [1.262-6.517] P=0,012).

CONCLUSION

The combination of the scintigraphic score with two clinical factors, such as PAOD and diabetes, provides optimal prognostic value in the evaluation of asymptomatic and stable patients after ACS. Our study therefore highlights the importance of optimizing evaluation strategies in the follow-up of these patients who remain at risk of post-revascularization CVE.

Determinants of Undesirable Behaviors in American Quarter Horses Housed in Box Stalls

The objective of this study was to investigate the management practices that affect undesirable behaviors in American Quarter Horses (AQH) confined to box stalls. A total of 105 adult AQH, comprising 29 females, 22 intact males, and 54 castrated males, housed in box stalls for at least 30 days, were included in the study. Behavioral activities were recorded through visual inspection at 5-min intervals over a 24-h period by two observers who took turns in shifts of 4 hours. Parameters related to animal characteristics, stall conditions, handling, training, nutrients supplied, and feeding behaviors were considered independent variables, and the time spent in undesirable behaviors was the dependent variable. Data were subjected to exploratory factor analysis and hierarchical cluster analysis. Four principal components were extracted. Two clusters were identified based on the time spent in undesirable behaviors: low-incidence group (25 ± 13 minutes) and high-incidence group (97 ± 52 minutes). Nutritional status (P = .1447), physiological status (P = .1372), and training routine (P = .1160) had no significant effects on the dependent variable; however, the effect of feeding behavior (P = .0444) was significant. A low dry matter intake/requirement ratio (P = .0470) and a high heart rate at rest (P = .0444) indicated that inadequate nutrient supply is a determinant of the time spent in undesirable behaviors in AQH. Aspects related to management practices such as horse nutrition, feeding behaviors, and training routine should be considered to reduce undesirable behaviors in AQH.

Improved protein expression in HEK293 cells by over-expressing miR-22 and knocking-out its target gene, HIPK1

Stable cell lines can continuously produce a recombinant protein without the need to repeatedly engineer the genome. In a previous study HIPK1, Homeodomain-interacting Protein Kinase 1, was found to be a target of the microRNA miR-22 that, when repressed, improved expression of both an intracellular and a secreted protein. In this report, HEK293 cells stably over-expressing miR-22 were compared with HEK293 with knockout of HIPK1, executed by CRISPR/Cas9, for their ability to improve recombinant protein expression. In this model case of luciferase, over-expression of miR-22 improved overall activity 2.4-fold while the HIPK1 knockout improved overall activity 4.7-fold.

Gastric environment-stable oral nanocarriers for in situ colorectal cancer therapy

Colorectal cancer (CRC) is a prevalent and fatal cancer. Oral administration provided the potential for in situ treatment of the colorectal cancer. However, drugs couldn't be well-absorbed mainly due to its degradation in the gastric area and poor intestinal permeability. In this study, we synthesized deoxycholic acid and hydroxybutyl decorated chitosan nanoparticles (DAHBC NPs) as oral curcumin (CUR) delivery system for colorectal cancer treatment. DAHBC with lower critical solution temperature (LCST) below 37 °C (27-33 °C) was obtained. DAHBC NPs were correspondingly stable in simulated gastric conditions (pH 1.2, 37 °C), due to the offset of size change between pH-responsive expansion and thermo-responsive shrinkage. In simulated intestinal tract (pH 7.0-7.4, 37 °C), DAHBC NPs exhibited burst release of CUR owing to the onefold effect of thermo-responsive shrinkage. DAHBC27 NPs showed the minimum CUR leakage (~10%) in simulated gastric conditions, because a furthest temperature-sensitive shrinkage caused by the lowest LCST offset the expansion in acid environment. DAHBC27 NPs induced ~10-fold increased (P < 0.05) CUR absorption by paracellular transport pathway, compared to the free CUR. Thus, DAHBC NPs stabilized in the gastric environment may be a promising oral drugs delivery system for effective in situ colorectal cancer therapy.

Sustainable synthesis of novel carbon microwires for the modification of a Ti mesh anode in bioelectrochemical systems

Herein, an effective method was developed to integrate carbon microwires on Ti mesh (denoted as CM/TiM) to fabricate high-performance anodes with long-time stability in microbial fuel cell. CM/TiM was synthesized by colonizing filamentous fungi on the bread modified Ti mesh followed by carbonization, which could convert the attached mycelium into carbon microwires (denoted as CM). Benefiting from the biocompatibility and 3D interlaced structure of carbon microwires, the biomass accumulation (1027 ± 83 μg cm^-2) of CM/TiM have been significantly improved nearly 3 folds, thus the fabricated CM/TiM demonstrated 2-fold higher current density (12.19 ± 0.07 A m^-2) with significantly increased stability compared with TiM. Therefore, the present high power output, chemical stability and hydrophilic carbon microwires make CM/TiM stable, scalable and environmentally sustainable anodes in bioelectrochemical systems.

Transformation improvement with the Standardized Pressure Agrobacterium Infiltration Device (SPAID)

OBJECTIVE

The treatment of plant tissue with Agrobacterium tumefaciens is often a critical first step to both stable and transient plant transformation. In both applications bacterial suspensions are oftentimes physically introduced into plant tissues using hand-driven pressure from a needleless syringe. While effective, this approach has several drawbacks that limit reproducibility. Pressure must be provided with the syringe perfectly perpendicular to the tissue surface. The researcher must also attempt to provide even and consistent pressure, both within and between experimental replicates. These factors mean that the procedures do not always translate well between research groups or biological replicates.

RESULTS

We have devised a method to introduce Agrobacterium suspensions into plant leaves with greater reproducibility. Using a decommissioned dissecting microscope as an armature, a syringe body with the bacterial suspension is mounted to the nosepiece. Gentle, even pressure is applied by rotating the focus knob. The treatment force is measured using a basic kitchen scale. The development of the Standardized Pressure Agrobacterium Infiltration Device (SPAID) provides a means to deliver consistent amounts of bacterial suspensions into plant tissues with the goal of increasing reproducibility between replicates and laboratories.

A High-Throughput System for Transient and Stable Protein Production in Mammalian Cells

Recombinant protein expression and purification is an essential component of biomedical research and drug discovery. Advances in automation and laboratory robotics have enabled the development of highly parallel and rapid processes for cell culture and protein expression, purification, and analysis. Human embryonic kidney (HEK) cells and Chinese hamster ovary (CHO) cells have emerged as the standard host cell workhorses for producing recombinant secreted mammalian proteins by using both transient and stable production strategies. In this chapter we describe a fully automated custom platform, Protein Expression and Purification Platform (PEPP), used for transient protein production from HEK cells and stable protein production from CHO cells. Central to PEPP operation is a suite of custom robotic and instrumentation platforms designed and built at GNF, custom cell culture ware, and custom scheduling software referred to as Runtime. The PEPP platform enables cost-effective, facile, consistent production of proteins at quantities and quality useful for early stage drug discovery tasks such as screening, bioassays, protein engineering, and analytics.

Treatment of smuggled cigarette tobacco by composting process in facultative reactors

This paper presents a study on the degradation of smuggled cigarette tobacco combined with domestic organic waste and sawdust or wood chips, using facultative reactor. Four reactors with different amounts of residue were assembled. For the study of the quality of the compost obtained, physicochemical, phytotoxicity and microbiological analyses were carried out. The mixture with wood chips presented the best temperature conditions and pH variation optimizing the degradation. The final germination index (GI) values of all treatments were above the recommended GI value (50%) and the final C/N ratio between 8 and 13 indicated a mature compost. The concentration of metals under study was below the limit allowed for the commercialization. The composting carried out in all facultative reactors provided ideal conditions for the total sterilization of the final compost. Therefore, the treatment of smuggled cigarettes through facultative reactors was efficient to produce stable and mature compost.

Agrobacterium-mediated transformation systems of Primula vulgaris

BACKGROUND

Genetic transformation is a valuable tool and an important procedure in plant functional genomics contributing to gene discovery, allowing powerful insights into gene function and genetically controlled characteristics. Primulaceae species provide one of the best-known examples of heteromorphic flower development, a breeding system which has attracted considerable attention, including that of Charles Darwin. Molecular approaches, including plant transformation give the best opportunity to define and understand the role of genes involved in floral heteromorphy in the common primrose, Primula vulgaris, along with other Primula species.

RESULTS

Two transformation systems have been developed in P. vulgaris. The first system, Agrobacterium-mediated vacuum infiltration of seedlings, enables the rapid testing of transgenes, transiently in planta. GUS expression was observed in the cotyledons, true leaves, and roots of Primula seedlings. The second system is based on Agrobacterium tumefaciens infection of pedicel explants with an average transformation efficiency of 4.6%. This transformation system, based on regeneration and selection of transformants within in vitro culture, demonstrates stable transgene integration and transmission to the next generation.

CONCLUSION

The two transformation systems reported here will aid fundamental research into important traits in Primula. Although, stable integration of transgenes is the ultimate goal for such analyses, transient gene expression via Agrobacterium-mediated DNA transfer, offers a simple and fast method to analyse transgene functions. The second system describes, for the first time, stable Agrobacterium-mediated transformation of Primula vulgaris, which will be key to characterising the genes responsible for the control of floral heteromorphy.

Should they stay or should they go now? Exploring the impact of team familiarity on interprofessional team training outcomes

INTRODUCTION

Although simulation is an effective method for enhancing team competencies, it is unclear how team familiarity impacts this process. We examined how team familiarity impacted team competencies.

METHODS

Trainees were assigned to stable or dynamic teams to participate in three simulated cases. Situation awareness (SA) data was collected through in-scenario freezes. The recorded performances were assessed for clinical effectiveness (ClinEff) and teamwork. All data are reported on a 1-100% (100% = perfect performance) scale.

RESULTS

Forty-six trainees (23 General Surgery; 23 Emergency Medicine) were randomized by specialty into stable (N = 8) or dynamic (N = 7) groups. Overall changes from Sim 1 to Sim3 were 12.2% (p < 0.01), -1.1% (ns), and 7.1% (p < 0.01) for SA, ClinEff, and Teamwork, respectively. However, improvements differed by condition, with stable teams reflecting improvements in ClinEff (15.2%; p < 0.05), whereas dynamic team ClinEff improvement (8.7%) was not significant. Both groups demonstrated improvements in teamwork (stable = 9%, p < 0.05; dynamic = 4.9%, p < 0.05).

CONCLUSIONS

Teams who continued to work together demonstrated increased improvements in clinical effectiveness and teamwork, while dynamic teams only demonstrated improvements in teamwork.

American lobster Cathepsin D, an aspartic peptidase resistant to proteolysis and active in organic solvents, non-ionic detergents and salts

Suitable peptidases for biotechnological applications are those active at low temperature, in organic solvents, detergents or proteolytic additives. American lobster cathepsin D1 (CD1) is an enzyme highly efficient at 5-50°C and at pH 2.5-5.5. We assessed the effect of common industrial additives on CD1 activity. CD1 was isolated from lobster gastric fluid by chromatography. The proteolytic activity was measured using a fluorogenic specific substrate and the conformation by intrinsic fluorescence. Non-ionic detergents Tween-20 and Triton X-100 stabilize the peptidase activity. Ethanol, methanol and isopropanol [5-15% (v/v)] increased the enzyme activity up to 80%. The enzyme is active until 2.5M urea and is resistant to proteolysis by papain and renin. In this work, a crustacean peptidase that remains active when exposed to different chemical and proteolytic additives is reported, evincing that crustaceans are a good model for discovery of novel stable peptidases for future pharmaceutical, cosmetic and alimentary applications.

Treatment of stable slipped capital femoral epiphysis: systematic review and exploratory patient level analysis

Background

Several aspects of slipped capital femoral epiphysis (SCFE) treatment remain controversial. Loder’s work has been instrumental in changing our understanding and approach to the management of the condition when he introduced the concept of “slip instability” and showed that avascular necrosis (AVN) developed in 47% of unstable slips but none of the stable slips. As the two types of SCFE behave differently in terms of presentation, progress and complications, we approached them as two different conditions to highlight these differences. This paper focuses on treatments of stable SCFE.

Materials and methods

An extensive literature search was carried out from multiple databases. One thousand six hundred and twenty-three citations were screened. Three hundred and sixteen full publications were obtained for further scrutiny. Fifty-eight studies (2262 hips) were included in the review. These studies evaluated 6 interventions. AVN was chosen as a surrogate for bad outcome. Secondary outcomes were chondrolysis (CL), femoro-acetabular impingement (FAI), osteoarthritis (OA) and patients’ reported outcomes. The latter were pooled when they met our predefined criteria.

Results

The type of surgical intervention was an important risk factor. Pinning in situ (PIS) was associated with the lowest AVN rate (1.4%). Moreover, the CL, FAI and OA rates were relatively low in patients who underwent PIS. These were not translated into high patient satisfaction rates among these patients, with only 47% reporting an “excellent” outcome. In contrast, 87% of patients who underwent Ganz surgical dislocation reported an “excellent” outcome. The Ganz surgical dislocation was associated with an AVN rate of 3.3%; double that observed in pinning in situ.

Conclusion

Pinning in situ is the best treatment for mild and moderate stable slip. Ganz surgical dislocation gives higher patient satisfaction for severe stable slip but the risk of AVN is doubled compared with pinning in situ. Devices that allow continued growth may be better than standard screws.

Level of evidence

Level III.

Improvement of Subjective Well-Being by Ranolazine in Patients with Chronic Angina and Known Myocardial Ischemia (IMWELL Study)

Introduction

We aimed to assess if ranolazine would improve angina symptoms among patients with documented myocardial ischemia.

Methods

Eligible subjects had chronic stable angina and at least one coronary stenosis with fractional flow reserve (FFR) ≤0.80 or at least one chronic total occlusion (CTO) without attempted revascularization. Subjects were randomized to oral ranolazine 500 mg twice daily for 1 week, then ranolazine 1000 mg twice daily for 15 weeks versus matching placebo. The primary end point was change in angina at 16 weeks as assessed by the Seattle Angina Questionnaire (SAQ).

Results

Between September 2014 and January 2016, 25 subjects were randomized to ranolazine versus 25 to placebo. The most common reason for eligibility was CTO (72%), while the remainder had myocardial ischemia documented by low FFR. The mean FFR was 0.57 ± 0.12. Sixty-eight percent of subjects were on two or more anti-angina medications at baseline. Study medication was discontinued in 32% (eight of 25) of the ranolazine group versus 36% (nine of 25) of the placebo group. By intention-to-treat, 46 subjects had baseline and follow-up SAQ data completed. Ranolazine was not associated with an improvement in angina compared with placebo at 16 weeks. The results were similar among 33 subjects that completed study medication. The incidence of ischemia-driven hospitalization or catheterization was 12% (three of 25) of the ranolazine group versus 20% (five of 25) in the placebo group (p > 0.05).

Conclusions

In subjects with chronic stable angina and documented myocardial ischemia, ranolazine did not improve angina symptoms at 16 weeks.

Funding

Gilead.

Clinical trial registration

The study was registered at ClinicalTrials.gov (NCT02265796).

Stable and episodic/bolus patterns of methylmercury exposure on mercury accumulation and histopathologic alterations in the nervous system

The main purpose of the present study was to compare the blood and brain mercury (Hg) accumulation and neurological alterations in adult male and pregnant female/fetal rats following stable and episodic/bolus patterns of methylmercury (MeHg) exposure. In addition, MeHg accumulation in the human body was estimated by a one-compartment model using three different patterns of MeHg exposure. In the adult male rat experiment, doses of 0.3 and 1.5mg MeHg/kg/day were orally administered to the stable groups for 5 weeks, while 7-fold higher doses of 2.1 and 10.5mg MeHg/kg/once a week were administered to the bolus groups. The blood Hg levels increased constantly in the stable groups, but increased with repeated waves in the bolus groups. At completion of the experiment, there were no significant differences in the brain Hg concentrations or neurological alterations between the stable and bolus groups, when the total doses of MeHg were the same. In the pregnant female rat experiment, a dose of 1mg MeHg/kg/day was administered orally to the stable group for 20 days (until 1day before expected parturition), while a 5-fold higher dose of 5mg MeHg/kg/once every 5 days was administered to the bolus group. In the brains of the maternal/fetal rats, there were no significant differences in the Hg concentrations and neurological alterations between the stable and bolus groups. The mean Hg concentrations in the fetal brains were approximately 2-fold higher than those in the maternal brains for both stable and bolus groups. Using the one-compartment model, the Hg accumulation curves in humans at doses of 7µg MeHg/day, 48µg MeHg/once a week, and 96µg MeHg/once every 2 weeks were estimated to be similar, while the bolus groups showed dose-dependent amplitudes of repeated waves. These results suggest that stable and episodic/bolus patterns of MeHg exposure do not cause differences in Hg accumulation in the blood and brain, or in neurological alterations, when the total doses are the same.

In Vitro Transfection with and Expression of CCN Family of Genes

The ability to engineer cells to express a protein of interest in an inducible manner and stably for a long period is a valuable tool in molecular biology and also one that holds promise for regenerative medicine in the future. CCN proteins have been suggested to be involved in tissue regeneration. In this chapter, we describe an in vitro method for stable and inducible expression of CCN protein in a chondroprogenitor cell line and in chondrocytes in primary culture that does not involve the use of any viral vector.

The anatomical reduction of a moderate or severe stable slipped capital femoral epiphysis by modified Dunn subcapital osteotomy using the Ganz approach: functional and radiological outcomes

AIMS

This study analysed the clinical and radiological outcome of anatomical reduction of a moderate or severe stable slipped capital femoral epiphysis (SCFE) treated by subcapital osteotomy (a modified Dunn osteotomy) through the surgical approach described by Ganz.

PATIENTS AND METHODS

We prospectively studied 31 patients (32 hips; 16 females and five males; mean age 14.3 years) with SCFE. On the Southwick classification, ten were of moderate severity (head-shaft angle > 30° to 60°) and 22 were severe (head-shaft angle > 60°). Each underwent open reduction and internal fixation using an intracapsular osteotomy through the physeal growth plate after safe surgical hip dislocation. Unlike the conventional procedure, 25 hips did not need an osteotomy of the apophysis of the great trochanter and were managed using an extended retinacular posterior flap.

RESULTS

Clinical outcome was assessed using the range of movement and the Harris Hip (HHS), Western Ontario and McMaster Universities Osteoarthritis (WOMAC), and Merle d'Aubigné scores, while radiological measurements included slip and alpha angles. The mean duration of follow-up was 24.1 months (12 to 40). There was a significant improvement in all clinical and radiological measurements after treatment (p < 0.001). Post-operative major complications were one deep infection and one case of femoral head collapse.

CONCLUSION

These findings suggest that a modified Dunn osteotomy carried out through Ganz approach is a safe and effective method of treating the stable SCFE with a high degree of slip. Cite this article: Bone Joint J 2016;98-B:1283-8.

In Silico Molecular Modeling and Docking Studies on Novel Mutants (E229V, H225P and D230C) of the Nucleotide-Binding Domain of Homo sapiens Hsp70

In this study, we explored the possibility of determining the synergistic interactions between nucleotide-binding domain (NBD) of Homo sapiens heat-shock 70 kDa protein (Hsp70) and E1A 32 kDa of adenovirus serotype 5 motif (PNLVP) in the efficiency of killing of tumor cells in cancer treatment. At present, the protein interaction between NBD and PNLVP motif is still unknown, but believed to enhance the rate of virus replication in tumor cells. Three mutant models (E229V, H225P and D230C) were built and simulated, and their interactions with PNLVP motif were studied. The PNLVP motif showed the binding energy and intermolecular energy values with the novel E229V mutant at -7.32 and -11.2 kcal/mol. The E229V mutant had the highest number of hydrogen bonds (7). Based on the root mean square deviation, root mean square fluctuation, hydrogen bonds, salt bridge, secondary structure, surface-accessible solvent area, potential energy and distance matrices analyses, it was proved that the E229V had the strongest and most stable interaction with the PNLVP motif among all the four protein-ligand complex structures. The knowledge of this protein-ligand complex model would help in designing Hsp70 structure-based drug for cancer therapy.

Fabrication of a flexible and conductive lyocell fabric decorated with graphene nanosheets as a stable electrode material

Textile electrodes are highly desirable for wearable electronics as they offer light-weight, flexibility, cost effectiveness and ease of fabrication. Here, we propose the use of lyocell fabric as a flexible textile electrode because of its inherently super hydrophilic characteristics and increased moisture uptake. A highly concentrated colloidal solution of graphene oxide nanosheets (GONs) was coated on to lyocell fabric and was then reduced in to graphene nanosheets (GNs) using facile chemical reduction method. The proposed textile electrode has a very high surface conductivity with a very low value of surface resistance of only 40Ωsq(-1), importantly without use of any binding or adhesive material in the processing step. Atomic force spectroscopy (AFM) and Transmission electron microscopy (TEM) were conducted to study the topographical properties and sheet exfoliation of prepared GONs. The surface morphology, structural characterization and thermal stability of the fabricated textile electrode were studied by field emission scanning electron microscopy (FE-SEM), Fourier transform infrared spectroscopy (FT-IR), X ray photon spectroscopy (XPS), Raman spectroscopy, Wide angle X ray diffraction spectroscopy (WAXD) and Thermogravimetric analysis (TGA) respectively. These results suggest that the GONs is effectively adhered on to the lyocell fabric and the conversion of GONs in to GNs by chemical reduction has no adverse effect on the crystalline structure of textile substrate. The prepared graphene coated conductive lyocell fabric was found stable in water and electrolyte solution and it maintained nearly same surface electrical conductivity at various bending angles. The electrical resistance results suggest that this lyocell based textile electrode (L-GNs) is a promising candidate for flexible and wearable electronics and energy harvesting devices.

The analysis of the SIRS alcoholism models with relapse on weighted networks

Two SIRS alcoholism models with relapse on networks with fixed and adaptive weight are introduced. The spread of alcoholism threshold [Formula: see text] is calculated by the next generation matrix method. For the model with fixed weight, we prove that when [Formula: see text] the alcohol free equilibrium is globally asymptotically stable, then the drinking crowd gradually disappear. When [Formula: see text], the alcoholism equilibrium is global attractivity, then the density of alcoholics will remain in a stable value. For the model with adaptive weight, we only make some numerical simulations. We also give two effective strategies. Our results show that the treatment of recuperator for stopping relapsing and preventing the susceptible people to drink are two effective measures to eliminate alcoholism problem, and preventing the susceptible people to drink is more effective when the proportion of recuperator to accept treatment is equal to the proportion of susceptible people to refuse drinking alcohol.

Cow hair allergen concentrations in dairy farms with automatic and conventional milking systems: From stable to bedroom

Bovine hair and dander are considered to be a notable risk factor for sensitization and allergic symptoms in occupationally exposed cattle farmers due to various IgE binding proteins. Farmers are suspected not only to be exposed during their work inside the stables but also inside their homes as allergens could be transferred via hair and clothes resulting in continued bovine allergen exposure in private areas. In recent years a new sensitive sandwich ELISA (enzyme linked immunosorbent assay) test has been developed to measure the cow hair allergen (CHA) concentration in dust. The aim of the present study was to determine the CHA concentration in airborne and settled dust samples in stables and private rooms of dairy cattle farms with automatic milking systems (AM) and conventional milking systems (CM), also with respect to questionnaire data on farming characteristics. For this purpose different sampling techniques were applied, and results and practicability of the techniques were compared. Dust sampling was performed in the stable, computer room (only AM), changing room, living room and bedroom (mattress) of 12 dairy farms with automatic milking systems (AM group) and eight dairy farms with conventional milking systems (CM group). Altogether, 90 samples were taken by ALK filter dust collectors from all locations, while 32 samples were collected by an ion charging device (ICD) and 24 samples by an electronic dust fall collector (EDC) in computer rooms (AM) and/or changing and living rooms (not stables). The dust samples were extracted and analyzed for CHA content with a sandwich ELISA. At all investigated locations, CHA concentrations were above the limit of detection (LOD) of 0.1 ng/ml dust extract. The median CHA concentrations in dust collected by ALK filters ranged from 63 to 7154 μg/g dust in AM farms and from 121 to 5627 μg/g dust in CM farms with a steep concentration gradient from stables to bedrooms. ICD sampling revealed median CHA contents of 112 μg/g airborne dust in the computer rooms of the AM farms and median CHA loads of 5.6 μg/g (AM farms) and 19.8 μg/g (CM farms) in the living rooms. Passive dust sampling by EDC was performed only at two locations in the AM group resulting in median CHA values of 116 μg/m(2) (computer room) and 55.0 μg/m(2) (changing room). Except for the stable samples the median CHA load was lower in AM farms compared to CM farms. The CHA contents of ALK filter samples were significantly correlated in most locations. Differences between the farming types were not significant. Although allergen transfer to the private area of the farmers has been found and results from several locations were correlated, differences in CHA concentrations were not significant with respect to questionnaire data such as the wearing of stable clothes in living room, free access of pets to stable and home, frequency of hair washing. All sampling techniques seem to being practicable for simple and effective CHA measurement.

The effects of shared decision making in the conservative management of stable ankle fractures

INTRODUCTION

The majority of ankle fractures seen in clinic are stable, will not displace and do not require plaster casting to achieve union in a good position. Nevertheless, many patients with stable ankle fractures are advised that they need a cast. In this study we counseled patients regarding the different options for conservative management of their stable ankle fracture. We then encouraged them to make an informed decision on which method of treatment they would like to pursue.

MATERIALS AND METHODS

We analyzed eight years of a single consultant's fracture clinic. 163 patients were offered a choice of: a weight bearing below knee cast; a functional ankle brace; or a regime of rest, ice, compression bandage and elevation ("RICE" regime). All patients were advised to mobilize on the injured ankle as their pain allowed.

RESULTS

163 patients were suitable for all 3 treatment options. 82% (133/163) chose an ankle brace, 15% (25/163) opted for a RICE regime and 3% (5/163) chose a below knee cast. Of these only one returned to clinic complaining of increased pain, however after further discussion the patient opted to continue with his RICE regime as planned.

DISCUSSION

A conservative approach to these injuries is now common practice; however there is a wide variation in what type of conservative management is given. Recent studies suggest orthopedic surgeons are still treating the majority of these injuries with a weight-bearing cast despite risks of stiffness, skin damage and thromboembolism. This study showed when the patient is given opportunity to make an informed choice the vast majority opt not to have a cast. The study suggests management of these injuries should be decided via a two-way conversation between patient and practitioner.

CONCLUSIONS

Using a shared decision making approach to these injuries is a useful method of providing patients with the most suitable treatment for their personal treatment goals.

Management of slipped capital femoral epiphysis: results of a survey of the members of the European Paediatric Orthopaedic Society

AIM

To determine current practice recommendations for the treatment of slipped capital femoral epiphysis (SCFE) among members of the European Paediatric Orthopaedic Society (EPOS).

MATERIALS AND METHODS

A questionnaire with 4 case vignettes of a 12-year-old boy presenting with a stable and unstable SCFE. Each, stable and unstable slips, was of mild (20° epiphyseal-shaft angle) and of severe (60° epiphyseal-shaft angle) degree was sent to all members of EPOS in 2009 in order to ascertain their views on the best management of SCFE. Specifically, respondents were asked about the role of reduction, methods of fixation, prophylactic fixation of the non-affected hip, postoperative management and their view on the anticipated need for secondary surgery.

RESULTS

The response rate was 25% (72/287). The participating surgeons' average workload was 76% in paediatric orthopaedics, with mean 16 years of experience. Surgeons were most consistent in their advice for stable slips, where around 90% of the respondents did not recommend a reduction of the slip regardless of severity of slip. Seventy per cent of the respondents recommended the use of only one screw for fixation of a stable slip and for mild unstable slips. For severe unstable slips, 46% of surgeons recommended reduction only by positioning of the hip on the fracture table, 35% by manipulation and 11% advised open reduction. Responders were less consistent in their advice on the anticipated need for secondary osteotomies (in mild slips about 40% and about 60% in severe slips would advise an osteotomy) and on treatment of the contralateral hip (with 32% of surgeons recommending prophylactic fixation of the contralateral hip).

CONCLUSION

Within members of EPOS, there is controversy on several aspects of the management of SCFE particularly on aspects of the treatment of unstable SCFE.

SIGNIFICANCE

Members of EPOS predominantly use traditional means of treatment for patients with SCFE. In contrast, the more modern treatment concepts, such as open reduction via surgical dislocation, are rarely used.