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The efficacy of the removal of contaminants from wastewater depends on physico-chemical properties of pollutants and the efficiency of treatment plant. Sometimes, low amounts of toxic compounds can be still present in the treated sewage. In this work we considered the effects of contaminant residues in treated wastewaters and of temperatures on Lemna minor L. Treated effluent waters were collected, analyzed and used as duckweed growth medium. In order to better understand the effects of micropollutants and seasonal variation, the plants were grown under ambient conditions for seven days in summer and winter. Relative growth rate, pigments and phenolic compounds concentrations were determined, as well as the activities of catalase (CAT), ascorbate peroxidase (APX), guaiacol peroxidase (G-POD) and polyphenol oxidase (PPO). The pollutant concentrations varied in the two seasons, depending on the industrial and municipal activities and efficiency of treatments. Treated waters contained heavy metals, nitrogenous and phosphorus compounds, surfactants and hydrocarbons. Compared to the control, duckweed growth of treated plants decreased by 25% in summer, while in the winter due to the lower temperatures and the presence of pollutants was completely impeded. The amounts of photosynthetic pigments of treated plants were not significantly affected in the summer, while they were higher than the control in the winter when the effluent had a high nitrogen amount. High CAT activity was registered in both seasons. Treated plants had significantly lower APX activity in the summer (53%) and winter (59%) respect to the controls. The observed inhibition of the peroxidase activities in the exposed plants, confirms the controversy existing in the literature about the variability of enzymatic response in stress condition.

Acetabular offset (AO) is the distance between the centre of the femoral head and the true floor of the acetabulum. We quantified the AO in normal hips and compared the displacement of the centre of rotation of the hip (CRH) after conventional and anatomical cup implantation during THA. 100 CT-scans of normal hips were analysed before and after simulating implantation of the acetabular component.Mean AO was 30.8 mm ± 3. The medial shift of the CRH was 1.6 mm ± 1.2 with the anatomical and 4.8 mm ± 1.9 with the conventional technique (pThe concept of hip offset cannot be limited to that of the femoral offset. AO widely varies and cannot be neglected. In patients with significant AO, surgeons should pay close attention to the preparation of the acetabulum. This should be done conservatively so that the acetabular cup can be placed anatomically in order to restore the native hip biomechanics.

Background During total hip arthroplasty (THA), medialisation of the cup decreases the lever arm of body weight and is considered to be beneficial. Theoretically it should be compensated by an equivalent increase of the femoral offset in order to maintain global offset. Goal of the study We investigated via a numerical model the forces on each bundle of the abductor muscles and the loading forces at the head-cup interface. We compared THA with and without medialisation of the cup and with and without restoration of the global offset. Method A digital finite element model of the hip joint with THA was constructed. Monopodal weight-bearing was simulated with the cup positioned so that the hip centre of rotation was left unchanged. Forces in the abductors and pressure on the prosthetic head were measured and then compared with three other configurations: 1. Medialisation of the cup by 5 to 15mm with reproduction of the native femoral offset or; 2. with an increased femoral offset compensating for the cup medialisation and; 3. no medialisation of the cup with a femoral offset increased. Results Medialisation of the cup decreased stresses on the head-cup interface and on the abductor muscles, even when the global offset was not restored. Anatomical placement of the cup did not give the best results. The optimal outcome in terms of stress was observed when the cup was medialised but global offset restored. Any increase of global offset significantly increases the length and the tension in the anterior bundles of the abductor muscles.

Background: Increased femoral tunnel widening and weakness of the hamstring muscles postoperatively have been described as potential adverse events after anterior cruciate ligament (ACL) reconstruction (ACLR) with a hamstring graft. Meniscectomy and cartilage lesions are important factors for the development of degenerative osteoarthritis. Purpose: To compare 15-year follow-up data with 5-year follow-up data from the same cohort of patients after ACLR with a hamstring autograft using an outside-in technique. Study Design: Case series; Level of evidence, 4. Methods: A total of 72 patients who underwent anatomic ACLR with a quadruple hamstring graft and an outside-in technique were selected for this prospective study. Patients were reviewed at a minimum follow-up of 15 years. Results were compared with the same series of patients previously reviewed at 5 years after surgery. Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores as well as KT-1000 arthrometer measurements were obtained at final follow-up. Comparative weightbearing radiographs were obtained and analyzed according to the Fairbank, Kellgren-Lawrence, and IKDC classifications and used for the tunnel evaluation. Results: No significant difference was detected on the subjective evaluation. Objectively, patients categorized as A or B according to the IKDC score were not significantly different at 5 and 15 years ( P < .01). A KT-1000 arthrometer side-to-side manual maximum difference >5 mm, a pivot shift >2+, any giving-way episode, and ACL revision surgery were considered as failures, and these were noted in 6 patients at 5 years and 6 patients at 15 years. The radiological evaluation at 15 years showed a higher rate of osteoarthritis in 2 of 3 radiological scales used in the study compared with results at 5-year follow-up ( P < .01). At 15-year follow-up, there was a statistically significant reduction in the mean tibial tunnel diameter ( P < .01). Conclusion: Endoscopic single-bundle ACLR using hamstring grafts and an outside-in technique demonstrated good results at 15-year follow-up in terms of subjective, objective, and radiographic evaluations. As compared with 5-year follow-up, clinical results remained stable both subjectively and objectively. However, a progression of osteoarthritis changes was observed, especially in patients in whom meniscectomy had been performed.

he main aim of this paper is to analyze how well Women’s and Children’s Directorates that successfully balance efficiency and appropriateness monitor their performances. National performance indicators (PNE data by AGENAS and SDO data by the Ministry of Health) may not be sufficient to govern the system. The study presents the literature on performance indicators in clinical directorates and then applies this framework to Italian Directorates. Data have been gathered through an online survey. The target population was identified on the basis of efficiency and appropriateness: Directorates with efficiency scores above a threshold, with less than 30% of primary cesarean sections, and a minimum of 1.000 deliveries per year were chosen. On the basis of these criteria we identified 44 structures belonging to 40 departments. Of these, 26 managers completed the questionnaire and provided results we discuss for policy recommendations.

The present study aims to review the state of the art of the organisational models of Women’s and Children’s Clinical Directorates in Italy, based on the available studies, regulations, and the data available at the national level. In addition, the study integrates these data with insights from semi-structured interview to Clinical Directorate’s Heads, in order to understand underexplored topics related to strategies, organisation, and control of activities and results.

In this paper we report about a 50-year-old patient who underwent a surgical revision procedure for rupture of the right Achilles tendon with the use of Ligastic((R)) synthetic graft in 1995, and in which a strong reactive immune response took place over the graft 11 years after. As far as we know, this is the first case described in literature of long-term follow-up inflammatory reaction after the use of such augmentation grafts in Achilles tendon repair.

In this case report, the patient experienced a stress fracture at one of the pinhole sites used for placement of the computer navigation system’s tibial trackers. Introduction The use of computer navigation systems in total knee arthroplasty (TKA) has become increasingly popular in recent years. Many authors have already documented satisfactory short- to mid-term results after using various types of software [1-3]. Bathis et al [4], as well as Decking et al [5] and Rosenberger et al [6], showed how the use of navigation systems can improve the accuracy of the femoral and tibial component placement when compared with the “traditional” techniques. Because a correct alignment of the components is one of the most important factors determining favorable long-term results of a TKA, this could lead to a higher longevity of the prosthesis. Despite these positive aspects, some authors have reported no advantages, as well as a longer operative time with the use of computer-assisted systems [7,8]. Moreover, recently three cases of stress femoral or tibial fractures have been reported as a complication of navigated TKA [9,10]. We present a case of a stress fracture of the tibial diaphysis that occurred after a TKA performed with the use of a computer navigation system. The stress fracture occurred at one of the pinhole sites used for the placement of the tibial trackers. We have been using computer navigation systems since 2005 as a standard procedure for TKA. This complication occurred after a series of 155 (0.64%) uncomplicated procedures (ie, well after the learning curve was complete).

The objective of this study is to report the clinical and radiological long-term follow-up evaluation of young patients arthroscopically treated for anterior tibial eminence fracture. Ten patients (mean age: 13.5 years) were treated between 1992 and 2006. At follow-up they were clinically and radiologically evaluated. Moreover, they underwent assessment with the International Knee Documentation Committee (IKDC) forms, Lysholm and Tegner knee scales and measurement with the KT-1000 arthrometer. At a mean follow-up of 85.8 months, all of the patients reported a subjective good-excellent outcome. Objectively, the Lachman test was negative in seven patients and positive in three patients; six patients (60%) registered a slight (+) to mild (++) pivot-glide test. The mean value of KT-1000 arthrometer measurements was 3 mm; all knee scales showed satisfactory results. Radiological exam always showed good healing of the fracture. Fractures of the tibial spine often lead to anterior and rotational knee laxity. However, despite this instrumental finding, patients usually do not report any type of restriction in their functional or sports activities.