The effectiveness of exercises on fall and fracture prevention amongst community elderlies: A systematic review and meta-analysis

Objective

To analyze the effectiveness of exercise interventions on falls and fall-related fracture prevention among community-dwelling elderlies.

Methods

Literature search was conducted in Pubmed and Embase. Keywords used for literature search were “fracture” AND “fall” AND “exercise”. Randomized controlled trials involving community-dwelling elderlies older than 60 years old with physical exercises as intervention were included. A systematic review and meta-analysis was performed. The primary outcomes were falls and fractures.

Results

Twelve studies were included and 4784 participants were involved with a mean age of 75.4. The most common exercise interventions were strength and balance exercises. The results of meta-analysis of 11 studies showed that exercise intervention had beneficial effect on fall prevention (RR = 0.71, 95% CI, 0.62–0.82; I² = 24%, p < 0.0001). The effect was better when exercise intervention applied to women participants (RR = 0.64, 95% CI, 0.49–0.83; I² = 28%, p = 0.00009) compared to men and women participants (RR = 0.75, 95% CI, 0.64–0.89; I² = 24%, p = 0.001). The results of meta-analysis of seven studies showed that physical exercise had significant effect on fracture prevention (RR = 0.54, 95% CI, 0.35–0.83; I² = 25%, p = 0.005). However, the effect was significant when exercise intervention applied to women participants only (RR = 0.37, 95% CI, 0.20–0.67; I² = 0%, p = 0.001) but not significant when exercise intervention applied to both genders (RR = 0.80, 95% CI, 0.58–1.09; I² = 0%, p = 0.15).

Conclusion

Exercise interventions, especially the combination of strength and balance training, were effective in preventing falls. Resistance exercises and jumping exercises were effective for fracture prevention among community-dwelling older population. The effectiveness of exercise interventions on fracture prevention have more significant effect on women. Further studies are needed to test the effectiveness of exercise interventions in men.

Translational potential

The use of effective exercises or biophysical interventions including vibration therapy can be incorporated into Fracture Liaison Services to prevent future fall and fracture.

A metaphyseal fracture rat model for mechanistic studies of osteoporotic bone healing

Most osteoporotic fractures occur at metaphyseal regions of long bones. The present study proposed a clinically relevant animal model that satisfied: i) induction of osteoporosis, ii) unilateral complete osteotomy at metaphysis, iii) internal fixation. 6 months old female Sprague-Dawley rats (n = 64) were randomly divided into the ovariectomised-metaphyseal osteotomy (OVX, n = 32) and metaphyseal osteotomy (SHAM, n = 32) groups. The metaphyseal-osteotomy model was created with a plate-fixation of the osteotomy and assessed by X-ray, micro-computed tomography, histomorphometry and mechanical testing at weeks 1, 3 and 6. X-ray results showed complete healing of metaphyseal osteotomy at week 6. Histology showed 3 stages of metaphyseal healing. Stage 1 was characterised by fibrous tissue, consisting of disorganised orientation of collagen fibres, and infiltration of immune cells. At stage 2, a transitional zone consisting of maturing fibrous tissue and differentiating mesenchymal cells with early trabecular bone formation and disorganised woven bone were observed. During stage 3, cortical bone ends unified and woven bone underwent transformation to lamellar bone. OVX group healing was significantly delayed when compared to SHAM samples. The study demonstrated that healing of osteoporotic osteotomy at the metaphyseal region was delayed in terms of radiography, histomorphometry and mechanical strength. These quantitative evaluations, along with histological features, may provide key references for future studies. The animal model may provide additional clinical relevance as most osteoporotic fracture in humans occurs at metaphyseal regions.

The relationship between sarcopenia and fragility fracture-a systematic review

Sarcopenia is a common geriatric syndrome characterized by progressive decrease of muscle mass and function leading to an increased risk of physical disability, poor quality of life, and mortality. Increasing evidence shows that sarcopenia is related with fragility fractures. This systematic review aimed to summarize the following: (1) the prevalence of sarcopenia in patients with fragility fracture and (2) the associated risk factors for fragility fracture in patients with sarcopenia. Literature search was conducted in PubMed and Cochrane databases. Studies with the prevalence of sarcopenia in elderly patients with fragility fracture and associated risk factors in patients with sarcopenia were included. A total of 15 papers were included, with 10 reporting sarcopenia prevalence, and 5 on fracture risk in patients with sarcopenia. The prevalence of sarcopenia after fracture ranged from 12.4 to 95% in males and 18.3 to 64% in females. The prevalence of sarcopenia in elderly patients with fragility fracture was high, especially in men. Two studies showed that sarcopenia was a risk factor for fragility fracture when associated with low bone mineral density (BMD) but only in men. Caution should be taken for male patients with sarcopenia and low BMD, which is related to significantly increased risk of fractures. There is a pressing need for further research on sarcopenia and its risk on fragility fracture to better understand the relationship, pathophysiology, and mechanisms, which may shed light on potential interventions to improve clinical outcomes.

Type 2 diabetes remission 2 years post Roux-en-Y gastric bypass and sleeve gastrectomy: the role of the weight loss and comparison of DiaRem and DiaBetter scores

AIMS

The comparative efficacy of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy on Type 2 diabetes remission and the role of weight loss are unclear. The DiaRem diabetes remission prediction score uses HbA_1c , age and diabetes medications but not diabetes duration. The aim of this study was to compare the DiaRem with the DiaBetter score that includes diabetes duration, upon combined (complete plus partial) 2-year post-surgery diabetes remission in people following RYGB and sleeve gastrectomy, and to investigate the relationship between weight loss and diabetes remission.

METHODS

A retrospective single-centre cohort study of obese people with diabetes who underwent RYGB (107) or sleeve gastrectomy (103) and a validation cohort study (173) were undertaken. Diabetes remission, % weight loss, DiaRem, DiaBetter scores and areas under receiving operator characteristic (ROC) curves were calculated. The relationship between % weight loss and diabetes remission was investigated using logistic regression.

RESULTS

The proportion of people achieving diabetes remission was highest for those with the lowest DiaBetter and DiaRem scores. Areas under the ROC curves were comparable [DiaBetter: 0.867 (95%CI: 0.817-0.916); DiaRem: 0.865 (95%CI: 0.814-0.915), P=0.856]. Two-year % weight loss was higher post RYGB [26.6 (95%CI: 24.8-28.4)] vs post-sleeve gastrectomy [20.6 (95%CI: 18.3-22.8), P<0.001]. RYGB had 151% higher odds of diabetes remission [OR 2.51 (95%CI: 1.12-5.60), P=0.025]. This association became non-significant when adjusted for % weight loss.

CONCLUSION

DiaBetter and DiaRem scores predict diabetes remission following both procedures. Two-year % weight loss plays a key role in determining diabetes remission.

The effect of whole body vibration on fracture healing - a systematic review

This systematic review examines the efficacy and safety of whole body vibration (WBV) on fracture healing. A systematic literature search was conducted with relevant keywords in PubMed and Embase, independently, by two reviewers. Original animal and clinical studies about WBV effects on fracture healing with available full-text and written in English were included. Information was extracted from the included studies for review. In total, 19 articles about pre-clinical studies were selected. Various vibration regimes are reported; of those, the frequencies of 35 Hz and 50 Hz show better results than others. Most of the studies show positive effects on fracture healing after vibration treatment and the responses to vibration are better in ovariectomised (OVX) animals than non-OVX ones. However, several studies provide insufficient evidence to support an improvement of fracture healing after vibration and one study even reports disruption of fracture healing after vibration. In three studies, vibration results in positive effects on angiogenesis at the fracture site and surrounding muscles during fracture healing. No serious complications or side effects of vibration are found in these studies. WBV is suggested to be beneficial in improving fracture healing in animals without safety problem reported. In order to apply vibration on fractured patients, more well-designed randomised controlled clinical trials are needed to examine its efficacy, regimes and safety.

Chemical torrefaction as an alternative to established thermal technology for stabilisation of sugar cane bagasse as fuel

Dry and chemical torrefaction of sugar cane bagasse was examined in this study with the aim of stabilising and upgrading the fuel properties of bagasse. Dry torrefaction was conducted at temperatures from 160°C to 300°C under inert conditions, whilst chemical torrefaction incorporated a H₂SO₄ pre-treatment of bagasse. Chemical torrefaction imparted superior chemical and physical properties inducing morphological transformation and textural development with the potential to address issues in handling, feeding and processing bagasse. It increased the energy density of the chars with maximum HHV_mass 21.5 MJ/kg and maximum HHV_volume of 7.4 GJ/m³. Chemically torrefied bagasse demonstrated resistance against microbiological attack for 18 months. These features demonstrate the practical value of chemical torrefaction in advancing the utilisation of bagasse as fuel.

How well are we managing fragility hip fractures? A narrative report on the review with the attempt to setup a Fragility Fracture Registry in Hong Kong

INTRODUCTION

In setting up a disease registry for fragility fractures in Hong Kong, we conducted a retrospective systematic study on the management of fragility hip fractures. Patient outcomes were compared with the standards from our orthopaedic working group and those from the British Orthopaedic Association that runs a mature fracture registry in the United Kingdom.

METHODS

Clinical data on fragility hip fracture patients admitted to six acute major hospitals in Hong Kong in 2012 were captured. These included demographics, pre- and post-operative assessments, discharge details, complications, and 1-year follow-up information. Analysis was performed according to the local standards with reference to those from the British Orthopaedic Association.

RESULTS

Overall, 91.0% of patients received orthopaedic care within 4 hours of admission and 60.5% received surgery within 48 hours. Preoperative geri-orthopaedic co-management was received by 3.5% of patients and was one of the reasons for the delayed surgery in 22% of patients. Only 22.9% were discharged with medication that would promote bone health. Institutionalisation on discharge significantly increased by 16.2% (P<0.001). Only 35.1% of patients attended out-patient follow-up 1 year following fracture, and mobility had deteriorated in 69.9% compared with the premorbid state. Death occurred in 17.3% of patients within a year of surgery compared with 1.6% mortality rate in a Hong Kong age-matched population.

CONCLUSIONS

The efficiency and quality of acute care for fragility hip fracture patients was documented. Regular geri-orthopaedic co-management can enhance acute care. Much effort is needed to improve functional recovery, prescription of bone health medications, attendance for follow-up, and to decrease institutionalisation. A Fracture Liaison Service is vital to improve long-term care and prevent secondary fractures.

Emergency Critical Care Service in Emergency Medicine Ward: The Experience in North Lantau Hospital

With the increased demand of critical care, emergency physicians often provide a significant proportion of critical care for the critically ill patients apart from their primary roles in resuscitation and initial stabilisation. The dual training pathway of emergency medicine and intensive care medicine enables the Accident and Emergency Departments (AEDs) to be staffed with emergency intensivist to provide care of critically ill patients in the AEDs beyond the initial resuscitation. North Lantau Hospital is a community hospital located in central Tung Chung of Lantau Island. Transporting critically ill patients to the nearest tertiary hospital requires a significant amount of time which poses high risk to them. An “Emergency Critical Care Management” pilot program was created under these circumstances. In this pilot program, up to 2 beds in the Emergency Medicine Ward (EMW) are used for managing critically ill patients. The experience and preliminary outcomes of implementing critical care service in the EMW are shared in this article.

Combustion of thermochemically torrefied sugar cane bagasse

This study compared the upgrading of sugar bagasse by thermochemical and dry torrefaction methods and their corresponding combustion behavior relative to raw bagasse. The combustion reactivities were examined by non-isothermal thermogravimetric analysis. Thermochemical torrefaction was carried out by chemical pre-treatment of bagasse with acid followed by heating at 160-300°C in nitrogen environment, while dry torrefaction followed the same heating treatment without the chemical pretreatment. The results showed thermochemical torrefaction generated chars with combustion properties that are closer to various ranks of coal, thus making it more suitable for co-firing applications. Thermochemical torrefaction also induced greater densification of bagasse with a 335% rise in bulk density to 340kg/m³, increased HHV_mass and HHV_volume, greater charring and aromatization and storage stability. These features demonstrate the potential of thermochemical torrefaction in addressing the practical challenges in using biomass such as bagasse as fuel.

Mechanical stimulation enhanced estrogen receptor expression and callus formation in diaphyseal long bone fracture healing in ovariectomy-induced osteoporotic rats

Estrogen receptor (ER) in ovariectomy-induced osteoporotic fracture was reported to exhibit delayed expression. Mechanical stimulation enhanced ER-α expression in osteoporotic fracture callus at the tissue level. ER was also found to be required for the effectiveness of vibrational mechanical stimulation treatment in osteoporotic fracture healing.

INTRODUCTION

Estrogen receptor(ER) is involved in mechanical signal transduction in bone metabolism. Its expression was reported to be delayed in osteoporotic fracture healing. The purpose of this study was to investigate the roles played by ER during osteoporotic fracture healing enhanced with mechanical stimulation.

METHODS

Ovariectomy-induced osteoporotic SD rats that received closed femoral fractures were divided into five groups, (i) SHAM, (ii) SHAM-VT, (iii) OVX, (iv) OVX-VT, and (v) OVX-VT-ICI, where VT stands for whole-body vibration treatment and ICI for ER antagonization by ICI 182,780. Callus formation and gene expression were assessed at 2, 4, and 8 weeks postfracture. In vitro osteoblastic differentiation, mineralization, and ER-α expression were assessed.

RESULTS

The delayed ER expression was found to be enhanced by vibration treatment. Callus formation enhancement was shown by callus morphometry and micro-CT analysis. Enhancement effects by vibration were partially abolished when ER was modulated by ICI 182,780, in terms of callus formation capacity at 2-4 weeks and ER gene and protein expression at all time points. In vitro, ER expression in osteoblasts was not enhanced by VT treatment, but osteoblastic differentiation and mineralization were enhanced under estrogen-deprived condition. When osteoblastic cells were modulated by ICI 182,780, enhancement effects of VT were eliminated.

CONCLUSIONS

Vibration was able to enhance ER expression in ovariectomy-induced osteoporotic fracture healing. ER was essential in mechanical signal transduction and enhancement in callus formation effects during osteoporotic fracture healing enhanced by vibration. The enhancement of ER-α expression by mechanical stimulation was not likely to be related to the increased expression in osteoblastic cells but rather to the systemic enhancement in recruitment of ER-expressing progenitor cells through increased blood flow and neo-angiogenesis. This finding might explain the observed difference in mechanical sensitivity of osteoporotic fracture to mechanical stimulation.

Low-magnitude high-frequency vibration enhanced mesenchymal stem cell recruitment in osteoporotic fracture healing through the SDF-1/CXCR4 pathway

Low-magnitude high-frequency vibration (LMHFV) has been proven to promote osteoporotic fracture healing. Mechanical stimulation was reported to enhance SDF-1/CXCR4 signalling in mesenchymal stem cells (MSCs). We hypothesised that LMHFV promoted osteoporotic fracture healing by enhancing MSC migration through the SDF-1/CXCR4 pathway. 152 ovariectomised SD-rats received closed femoral fracture in groups of vibration+MSC (VMG) (20 min/d, 5 d/week), vibration+MSC+AMD3100 (VMAG; AMD, a CXCR4 inhibitor) (1 mg/kg/d, intraperitoneal), MSC (MG) (1 × 106 MSC, intracardiac) or control (CG) for a treatment duration of 2, 4 or 8 weeks. MSC migration was evaluated by ex-vivo green fluorescent protein signal in the callus; and fracture healing was examined by weekly radiographs, endpoint computed-tomography and mechanical test. At week-2 and week-4, ex-vivo callus GFP intensity of VMG was significantly higher than other groups (p < 0.05). From week-2 to week-3, both callus width and callus area in VMG were significantly larger; and from week-7 to week-8, smaller than other groups (p < 0.05). At week-8, high-density bone volume fraction, bone volume fraction, bone mineral density and stiffness in VMG were significantly higher than other 3 groups (p < 0.05). This study demonstrated that LMHFV promoted MSC migration and fracture healing in osteoporotic rats. This effect was attenuated by CXCR4 inhibitor, providing strong evidence that SDF-1-mediated MSC migration was one of the important mechanisms through which LMHFV enhanced fracture healing.

Feasibility and Impact of a Combined Supervised Exercise and Nutritional-Behavioral Intervention following Bariatric Surgery: A Pilot Study

BACKGROUND

Lifestyle intervention programs after bariatric surgery have been suggested to maximise health outcomes. This pilot study aimed to investigate the feasibility and impact of an 8-week combined supervised exercise with nutritional-behavioral intervention following Roux-en-Y gastric bypass and sleeve gastrectomy.

METHODS

Eight female patients (44 ± 8 years old, BMI = 38.5 ± 7.2 kg m(-2)) completed the program. Before and after intervention, anthropometric measures, six-minute walk test (6MWT), physical activity level, eating behavior, and quality of life (QoL) were assessed. Percentage weight loss (%WL) outcomes were compared with a historical matched control group.

RESULTS

The program significantly improved functional capacity (mean increment in 6MWT was 127 ± 107 meters, p = 0.043), increased strenuous intensity exercise (44 ± 49 min/week, p = 0.043), increased consumption of fruits and vegetables (p = 0.034), reduced consumption of ready meals (p = 0.034), and improved "Change in Health" in QoL domain (p = 0.039). The intervention group exhibited greater %WL in the 3-12-month postsurgery period compared to historical controls, 12.2 ± 7.5% versus 5.1 ± 5.4%, respectively (p = 0.027).

CONCLUSIONS

Lifestyle intervention program following bariatric surgery is feasible and resulted in several beneficial outcomes. A large randomised control trial is now warranted.

Effects of 18-month low-magnitude high-frequency vibration on fall rate and fracture risks in 710 community elderly--a cluster-randomized controlled trial

This study is a prospective cluster-randomized controlled clinical trial involving 710 elderly subjects to investigate the long-term effects of low-magnitude high-frequency vibration (LMHFV) on fall and fracture rates, muscle performance, and bone quality. The results confirmed that LMHFV is effective in reducing fall incidence and enhancing muscle performance in the elderly.

INTRODUCTION

Falls are direct causes of fragility fracture in the elderly. LMHFV has been shown to improve muscle function and bone quality. This study is to investigate the efficacy of LMHFV in preventing fall and fractures among the elderly in the community.

METHODS

A cluster-randomized controlled trial was conducted with 710 postmenopausal females over 60 years. A total of 364 participants received daily 20 min LMHFV (35 Hz, 0.3 g), 5 days/week for 18 months; 346 participants served as control. Fall or fracture rate was taken as the primary outcome. Also, quadriceps muscle strength, balancing abilities, bone mineral density (BMD), and quality of life (QoL) assessments were done at 0, 9, and 18 months.

RESULTS

With an average of 66.0% compliance in the vibration group, 18.6% of 334 vibration group subjects reported fall or fracture incidences compared with 28.7% of 327 in the control (adjusted HR = 0.56, p = 0.001). The fracture rate of vibration and control groups were 1.1 and 2.3 % respectively (p = 0.171). Significant improvements were found in reaction time, movement velocity, and maximum excursion of balancing ability assessment, and also the quadriceps muscle strength (p < 0.001). No significant differences were found in the overall change of BMD. Minimal adverse effects were documented.

CONCLUSION

LMHFV is effective in fall prevention with improved muscle strength and balancing ability in the elderly. We recommend its use in the community as an effective fall prevention program and to decrease related injuries.

Imaging techniques for the assessment of fracture repair

Imaging of a healing fracture provides a non-invasive and often instructive reproduction of the fracture repair progress and the healing status of bone. However, the interpretation of this reproduction is often qualitative and provides only an indirect and surrogate measure of the mechanical stability of the healing fracture. Refinements of the available imaging techniques have been suggested to more accurately determine the healing status of bone. Plain radiographs provide the ability to determine the degree of bridging of the fracture gap and to quantify the amount of periosteal callus formation. Absorptiometric measures including dual X-ray absorptiometry and computed tomography provide quantitative information on the amount and the density of newly formed bone around the site of the fracture. To include the effect of spatial distribution of newly formed bone, finite element models of healing fracture can be employed to estimate its load bearing capacity. Ultrasound technology not only avoids radiation doses to the patients but also provides the ability to additionally measure vascularity in the surrounding soft tissue of the fracture and in the fracture itself.

Effect of film thickness and filler properties on sulphuric acid permeation in various commercially available epoxy mortar coatings

The performance of various commercially available epoxy mortar coatings was compared by measuring their sulphuric acid diffusivity. Apparent diffusivities, which were measured gravimetrically, were found to be dependent on coating tortuosity. In composite materials like epoxy mortars, the tortuosity was determined by filler properties and polymer alignment. Tortuosity was found to depend on the filler size, their dispersion, filler aspect ratio and concentration. The order and greater alignment of polymer aggregates, which characterises thinner coatings effects higher tortuosity and thus lower permeabilities. The result is that sulphuric acid diffusivities were observed to increase with coating thickness, which challenges the notion that greater coating thicknesses provide greater protection or environmental barrier. The effect of film thickness and filler properties observed in this study has significant implications to the current selection of coatings and sewer protection.

Dye adsorption onto char from bamboo

Experiments have been carried out to prepare char from waste bamboo scaffolding for wastewater treatment. Carbonisation parameters such as temperature, holding time, heating rate and particle size were investigated. When the material was heated to 1173 K for 2h, surface area S(BET-N(2)) and total pore volume (V(total)) were 327 m(2)/g and 0.185 cm(3)/g, respectively. Particle size and heating rate appear less influential to the yield and textural characteristics of the resultant chars. Bamboo char obtained in this study did not show very high adsorption capacities for two acid dyes (Acid Blue 25 and Acid Yellow 117) but exhibited significant uptake of Methylene Blue. The equilibrium data were modelled by three different isotherms, namely, Langmuir, Freundlich and Redlich-Peterson model. Comparing the predicted data using optimised parameters from each model based on the SSE error function, the Redlich-Peterson isotherm appears the 'best' model to correlate experimental data.

Compensation effect during the pyrolysis of tyres and bamboo

Pyrolysis parameters (e.g. pre-exponential factor A, and activation energy E) of two waste materials, namely, tyre rubber and bamboo scaffolding, based on the Arrhenius equation were obtained from weight loss data via thermogravimetry at different heating rates. The compensation effect, which suggests that the linear variation in the pre-exponential factor and the activation energy, was observed for these materials. This can be attributed to the variety of active sites over the reactant surface in the course of decomposition. The calculated data from several revised, first-order models were compared with similar models in the literature. It has been shown that both literature and our calculated data exhibit high linearity in terms of lnA and E, revealing that the latter agree well with other researchers' work.

Tyre char preparation from waste tyre rubber for dye removal from effluents

A number of chars from waste tyre rubber were prepared by carbonisation at 673-1173 K. The effects of holding time, heating rate and particle size on the textural characteristics and elemental composition of the resultant chars were investigated. It was demonstrated that temperatures over 773 K did not have a significant improvement on the total surface area but resulted in lower char yields following increased aromatisation. Modelling of dye adsorption isotherms showed that the Redlich-Peterson expression yields the best-fit between experimental and predicted data. Furthermore, for a larger sized dye like Acid Yellow 117 (MW=848 g/mol), the amount adsorbed by the tyre char is not directly proportional to the total surface area when compared with a commercial carbon, revealing that factors other than total surface area are involved in the adsorption potential of the tyre chars.

Design and application of a high-temperature microfurnace for an in situ X-ray diffraction study of phase transformation

Thermal treatment of mineral ores such as ilmenite can initiate phase transformations that could affect their activation or deactivation, subsequently influencing their ability to dissolve in a leaching agent. Most laboratory-based X-ray diffraction (XRD) studies were carried out ex situ in which realistic diffraction patterns could not be obtained simultaneously with occurring reactions and were time-consuming. The availability of synchrotron-radiation-based XRD not only allows in situ analysis, but significantly shortens the data recording time. The present study details the design of a robust high-temperature microfurnace which allows thermal processing of mineral ore samples and the simultaneous collection of high-resolution synchrotron XRD data. In addition, the application of the manufactured microfurnace for in situ study of phase transformations of ilmenite ore under reducing conditions is demonstrated.

Enhancing the adsorption capacities of acid dyes by chitosan nano particles

In the present study, nanochitosan emulsion has been produced in a suspension form by adding tripolyphosphate solution into a chitosan solution drop-wise. The adsorption capacities of four acid dyes, namely, Acid Orange 10 (AO10), Acid Orange 12 (AO12), Acid Red 18 (AR18) and Acid Red 73 (AR73) on nanochitosan, have been determined to be 1.77, 4.33, 1.37 and 2.13 mmol l(-1), respectively. The nanochitosan dye capacities were compared with normal chitosan capacities which were 1.54, 2.66, 1.11 and 1.25 mmol l(-1) for AO10, AO12, AR18 and AR73, respectively. In all cases, the nanochitosan has a higher capacity. The mechanism of acid dye adsorption and the effect of pH are also discussed.

Intraparticle diffusion processes during acid dye adsorption onto chitosan

The adsorption of five acid dyes onto chitosan was studied. The equilibrium capacities based on the Langmuir analysis were 1.54, 2.66, 1.11, 1.25 and 1.03 mmol/g chitosan for Orange 10 (AO10), Acid Orange 12 (AO12), Acid Red 18 (AR18), Acid Red 73 (AR73) and Acid Green 25 (AG25) respectively. The batch adsorption rate for the five systems based on an intraparticle diffusion rate parameter derived from the plots of dye adsorbed versus the square root of time indicated that the adsorption mechanism was predominantly intraparticle diffusion but there was also a dependence on pore size as the dye diffuses through macropore, mesopore and micropore respectively.

Role of heteroatoms in activated carbon for removal of hexavalent chromium from wastewaters

Heteroatoms are elements including sulfur, nitrogen, oxygen and hydrogen which are found on the surface of activated carbons. This study investigated the surface modification arising from heteroatoms bonding to carbon aromatic rings within the activated carbon and their corresponding influence on the chromium adsorption process. Activated carbons were prepared from bagasse by physical. Chromium removal capacities of these activated carbons by adsorption and reduction were determined. Models which related the chromium adsorption and reduction capacities of activated carbons to carbon acidity and heteroatom site concentrations were established using multi-variable linear regression method. It was found the individual heteroatoms contributed separately to the basicity of the carbon which in turn determined the mechanism by which chromium was removed from solution. The surface areas of the carbons were also observed to influence the adsorption and reduction of chromium. These understandings provide the fundamental method of optimising chromium removal through suitable control of carbon surface chemistry and textural properties.

Roles of the textural and surface chemical properties of activated carbon in the adsorption of acid blue dye

This study has demonstrated the use of empirical modeling in resolving the effects of individual carbon properties on acid blue dye adsorption. Acid blue dye adsorption tests were conducted on activated carbons prepared from bagasse by physical (CO2) and chemical (ZnCl2, MgCl2 and CaCl2) techniques. Empirical models based on the carbon textural (surface area and pore size) properties and the surface chemistry inferred from heteroatom (C,H, N, and S) concentration and carbon surface pH were used to resolve the effects of individual carbon properties on acid blue dye adsorption. This form of analysis was conducted to optimize carbon preparation properties, forming the foundation for tailor-making adsorbents from bagasse suitable for acid dye adsorption. A series of statistical analyses (partial F-tests to establish the parameter significance) measured variants including the mean square error, r2 and adjusted r2, normality, and randomness of residuals, and formed the basis for testing the adequacy of these models. The empirical models suggest that a combination of suitable pore structure and distinct basic surface chemistry generated by sulfur- and nitrogen-based groups, which were also elucidated by Fourier transform infrared spectroscopy, is necessary to promote acid dye adsorption.

Roles of physical and chemical properties of activated carbon in the adsorption of lead ions

Elucidation of the roles of chemical and physical properties of activated carbons is an important basis for the systematic development of adsorbents with optimal properties specific for certain applications. Such an understanding has challenged most researchers and this has been attributed with the difficulty in decoupling the effect of chemical and physical properties that characterize activated carbons. This study proposed empirical modeling in resolving the effects of individual carbon properties in lead adsorption. A model based on lead adsorption and carbon properties including total surface area, mean pore size and heteroatom concentrations has been shown to adequately describe the lead adsorption onto activated carbons prepared from bagasse. To support this investigation a series of activated carbons were prepared from bagasse by physical and by chemical activation techniques. The surface chemical properties of the carbons were inferred from carbon pH and heteroatom concentrations. The physical characterizations of the carbons included total surface area by the BET technique and mean pore size measured using the Horvath-Kawazoe equation. Adsorption tests were conducted using a low concentration of lead (5 ppm) and the solution pH was maintained at 1.0 to maintain lead speciation to the un-complexed Pb(2+) ion. The adequacy of the proposed empirical models was statistically assessed. This form of analysis was shown to provide valuable information in tailor making adsorbents and selecting appropriate adsorbents for lead adsorption.

Removal of batteries from solid waste using trommel separation

This paper describes the design and testing of a trommel for separation of batteries from solid waste. A trommel is a cylindrical separation device that rotates and performs size separation. It has also been used in areas such as municipal solid waste (MSW) processing, classifying construction and demolition debris, screening mass-burn incinerator ash and compost processing. A trommel has been designed based on size separation to separate household batteries from solid waste, which can then be used as feedstock for alternative applications of solid waste combustion, particularly where the metal content of the product is also a critical parameter, such as the Co-Co process for integrated cement and power production. This trommel has been tested with batches of university office and restaurant wastes against various factors. The recovery efficiency of batteries increases with decreasing inclination angle of the trommel and decreasing rotational speed. A physical characterization of the university solid waste has been performed with a 20-kg sample of the tested waste. It was found that there is a trend of decreasing recovery of batteries with increasing paper composition, and a trend of increasing recovery of batteries with increasing organic materials composition.

Preparation of activated carbon using low temperature carbonisation and physical activation of high ash raw bagasse for acid dye adsorption

Activated carbons were prepared from bagasse through a low temperature (160 degrees C) chemical carbonisation treatment and gasification with carbon dioxide at 900 degrees C. The merit of low temperature chemical carbonisation in preparing chars for activation was assessed by comparing the physical and chemical properties of activated carbons developed by this technique to conventional methods involving the use of thermal and vacuum pyrolysis of bagasse. In addition, the adsorption properties (acid blue dye) of these bagasse activated carbons were also compared with a commercial activated carbon. The results suggest that despite the high ash content of the precursor, high surface areas (614-1433 m2 g(-1)) and microporous (median pore size from 0.45 to 1.2 nm) activated carbons can be generated through chemical carbonisation and gasification. The micropore area of the activated carbon developed from chars prepared by the low temperature chemical carbonisation provides favourable adsorption sites to acid blue dye (391 mg g(-1) of carbon). The alkalinity of the carbon surface and total surface area were shown to have complementary effects in promoting the adsorption of acid blue dye. Adsorption of the anionic coloured component of the acid dye was shown to be promoted in carbon exhibiting alkaline or positively charged surfaces. This study demonstrates that activated carbons with high acid dye adsorption capacities can be prepared from high ash bagasse based on low temperature chemical carbonisation and gasification.

A study of trabecular bones in ovariectomized goats with micro-computed tomography and peripheral quantitative computed tomography

Osteoporotic fractures occur most frequently in trabeculae-rich skeletal sites. The purpose of this study was to use a high-resolution micro-computed tomography (micro-CT) to investigate the changes in trabecular bone microarchitecture and to use a peripheral quantitative computed tomography (pQCT) to study changes in volumetric bone mineral density (BMD) in a large animal model resulted from ovariectomy (OVX). Ten adult goats were used for this study. The first iliac crest biopsy was harvested before OVX and served as baseline; the second biopsy was collected 6 months later from the opposite side for both pQCT and micro-CT measurements. Results showed that after 6 months of OVX, the BMD of the iliac crest biopsies decreased significantly by 16.3% (P < 0.05). The bone volume density (BV/TV), trabecular number (Tb.N), and connectivity density (Conn.D) measured with micro-CT decrease significantly after OVX, with an average decrease of 8.34%, 8.51%, and 18.52% (P < 0.05 each), respectively. The trabecular plate separation (Tb.Sp) was 8.26% (P < 0.05) greater than baseline after OVX. Significant correlations were found between the reduction of BMD and the decreases of BV/TV and Tb.N (r = 0.839 and 0.719, respectively; P< 0.001 both), as well as the increase of Tb.Sp (r = -0.758, P< 0.001) and SMI (r = -0.697, P< 0.001). In conclusion, this was the first experimental study in goat model to show that OVX-induced bone loss in goats was attributed by deterioration of trabecular microarchitecture.

Low intensity pulsed ultrasound stimulates osteogenic activity of human periosteal cells

The effect of low intensity pulsed ultrasound on human periosteal cells was investigated. Normal human periosteum was obtained to culture the periosteal cells. After characterization, cultures of periosteal cells at Days 2 and 4 were treated with ultrasound for 5, 10, and 20 minutes respectively. Assessments were done to assess total number of viable cells, cell proliferation, alkaline phosphatase activity, osteocalcin secretion, vascular endothelial growth factor expression, and calcium nodule formation. With the cells not treated with ultrasound as the control, the results showed that ultrasound did not affect the total number of viable cells. It stimulated cell proliferation at the early phase of cell culture. The activity of alkaline phosphatase was increased significantly in the culture at Day 4. A similar effect was seen with osteocalcin secretion and the responses were dose-dependent. The vascular endothelial growth factor secretion increased in Day 2 and Day 4 cultures with the dose-dependent effect. Formation of calcium nodules was significantly higher with ultrasound treatment. We think that low intensity pulsed ultrasound stimulated periosteal cell proliferation and differentiation toward osteogenic lineage. The dose-dependent effect on osteogenic activities may modify the existing treatment regimen. Ultrasound treatment should be started from the beginning of fracture healing.

Equilibrium studies for the sorption of lead from effluents using chitosan

The sorption of lead ions from aqueous solution onto chitosan has been studied. Equilibrium studies have been carried out to determine the capacity of chitosan for lead ions. The effects of solution pH and chitosan particle size on the sorption capacity have been studied.The experimental data were analyzed using three equilibrium isotherm correlations, namely, Langmuir, Freundlich and Redlich-Peterson equations. The linear correlation coefficients were determined for each isotherm and the Freundlich provided the best fit. In addition, error functions have been used to determine the alternative single component equilibrium isotherm parameters by non-linear regression due to the inherent bias in using the correlation coefficient from the linearization. This technique enables the "best fit" isotherm parameters to be used in the equilibrium equations for the sorption of lead ions on chitosan within the limits and assumptions of the various error analysis methods.

Equilibrium studies of the sorption of Cu(II) ions onto chitosan

Chitosan is a polymer that can be obtained from the shells of seafood such as prawns, crabs, and lobsters. Chitosan has free amino groups, which can attract metal ions, and has been used as an adsorbent for the removal of metal ions from effluents. In this research, the sorption of copper ions from solution onto chitosan at two pHs has been investigated. DSC, TGA, surface area, SEM, and NMR studies have been used to report the pure physical states of chitosan and the chitosan-copper complex. The experimental isotherm data were analyzed using the Langmuir, Freundlich, and Redlich-Peterson equations. Correlation coefficients were determined for each isotherm analysis. Error functions have been used to determine the alternative single component parameters by nonlinear regression due to the inherent bias in using the correlation coefficient resulting from linearization. The error function method provided the best parameters for the isotherm equations in this system and is demonstrated for error comparison purposes.

TGF-beta1 is the factor secreted by proliferative chondrocytes to inhibit neo-angiogenesis

Growth plate is an avascular tissue, which has been reported to be capable of retarding tumor spread. It is believed that angiogenic inhibitor(s) exist to inhibit the neo-vascularization of tumor, thus impeding the tumor growth. In this study, growth plate chondrocyte-derived TGFbeta1 was identified to be anti-angiogenic. It was found that growth plate chondrocytes (GPC) secreted TGFbeta1 mostly in latent form as demonstrated by gel filtration and immunoblotting. Enzyme-linked immunosorbent assay (ELISA) was followed to quantify TGFbeta1 in GPC conditioned medium (CM), in which 866 pg/ml of TGFbeta1 was found. Besides, the angiogenesis inhibitory effect of GPC CM was abolished by the addition of anti-TGFbeta1 antibody in the in vitro culture system and the in vivo chick chorioallantoic membrane (CAM) assay. This confirmed the anti-angiogenic properties of chondrocyte-derived TGFbeta1. TGFbeta1 was expressed predominantly in the proliferative zone of porcine growth plate. This explains the low incidence of tumor invasion across the entire growth plate. Also, this helps to explain the observation that tumor invasion across the physis increases with age as the proliferative zone gradually disappears. J. Cell. Biochem. Suppl. 36: 79-88, 2001.

Growth plate chondrocytes inhibit neo-angiogenesis -- a possible mechanism for tumor control

Clinically, tumors seldom grow across the articular cartilage and physeal plate. It is believed that avascular cartilage may inhibit the neo-vascularization of tumor spread. The conditioned medium of growth plate chondrocytes resisted the migration of ECV304 by approximately 41% in invasion assay. Growth plate chondrocytes were shown by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay to have an insignificant effect on the viability of human endothelial cells and fibroblasts. However, the proliferation of human endothelial cells was significantly inhibited by growth plate chondrocytes. The inhibitory activity was up to 35% and specific to endothelial cells. Inhibition of blood vessel formation was also demonstrated in the chick chorioallantoic membrane (CAM) assay. These findings demonstrated that growth plate chondrocytes secrete anti-angiogenesis factor(s) which specifically inhibit both the migration and proliferation of endothelial cells.

Methods for enumerating Escherichia coli in subtropical waters

The standard membrane filtration method of the UK has been modified in order to improve its specificity for enumerating Escherichia coli in the subtropical waters of Hong Kong. This involves incorporating into the membrane lauryl sulphate (mLS) method either an in situ urease test (the mLS-UA method), or an in situ beta-glucuronidase test (the mLS-GUD method). The false-positive errors of the mLS-UA and mLS-GUD methods are low, ranging from 3-5%. A comparison between the membrane filtration (mLS-UA) method and the multiple tube technique in testing E. coli in subtropical beach-waters has demonstrated that the former can give much more precise counts, and is the method of choice for such a purpose. The mLS-GUD method, for which automated counting of E. coli colonies is possible, is a good alternative to mLS-UA in routine enumeration of this bacterial indicator in environmental waters.

Variations in microbial indicator densities in beach waters and health-related assessment of bathing water quality

Daily and hourly variations in microbial indicators densities in the beach-waters of Hong Kong have been described. The levels of Escherichia coli at a number of beaches was observed to be influenced by tide, and for staphylococci, by bather numbers. The tidal influence was most obvious during spring tides; and for the effect of bathers, during neap tides. Both organisms are present in high densities in external sources of faecal pollution of bathing beaches, with the average staphylococci to E. coli ratios being 0.04-3. Staphylococci may serve as an indicator of bather density and the risk of cross-infection amongst bathers (rather than as another indicator of faecal contamination) when the average staphylococci to E. coli ratio for a bathing beach is considerably higher than 3. The variability of microbial indicator densities means the routine sampling of bathing beaches should be carried out on weekend days with maximum numbers of swimmers exposed to the water, and spread throughout the bathing season.

Health effects of beach water pollution in Hong Kong

Prospective epidemiological studies of beach water pollution were conducted in Hong Kong in the summers of 1986 and 1987. For the main study in 1987, a total of 18741 usable responses were obtained from beachgoers on nine beaches at weekends. The study indicated the overall perceived symptom rates for gastrointestinal, ear, eye, skin, respiratory, fever and total illness were significantly higher for swimmers than non-swimmers; and the swimming-associated symptom rates for gastrointestinal, skin, respiratory and total illness were higher at 'barely acceptable' beaches than at 'relatively unpolluted' ones. Escherichia coli was found to be the best indicator of the health effects associated with swimming in the beaches of Hong Kong. It showed the highest correlation with combined swimming-associated gastroenteritis and skin symptom rates when compared with other microbial indicators. A linear relationship between E. coli and the combined symptom rates was established. Staphylococci were correlated with ear, respiratory and total illness, but could not be used for predicting swimming-associated health risks. They should be used to complement E. coli. The setting of health-related bathing-water quality standards based on such a study is discussed.