INTRODUCTION:
Many conditions, including benign and malignant tumours, peripheral vascular diseases and open fracture grade 3C, have been successfully treated with limb sparing procedures. However, the same could not be said for treatment of limb infection, especially late stage diabetic foot complications.
METHODS:
This is a retrospective review of patients who underwent operations at our hospital from July 2003 to June 2005. All patients who underwent various types of limbs amputations were included. The cohort was divided according to the diagnosis leading to the amputation and the level of amputation. The number and levels of amputation were then compared with the various causes leading to the amputation.
RESULTS:
There were 203 patients who underwent amputation during the period of study. 135 (66.5 percent) of the patients were diabetic and amputations performed were related to diabetic foot conditions. 68 (33.5 percent) patients were not known to have diabetes mellitus. Among nondiabetic patients, 54 (26.6 percent) amputations were due to trauma, 11 (5.4 percent) were related to musculoskeletal tumours and 3 (1.5 percent) were due to peripheral vascular disease. Among diabetic patients, 23 (17 percent) patients underwent above knee amputation, 44 (33 percent) patients underwent below knee amputation, and 68 (50 percent) patients underwent local foot amputation. 80 of 135 (59.3 percent) patients, who underwent amputation due to diabetic complications, were less than 60 years old.
CONCLUSION:
Good diabetic control and detection of early diabetic foot complications will reduce the number of patients undergoing limb amputation as well as the number of amputees. Since the incidence of lower limb amputation is due mainly to poor diabetic control, it is important to protect this group of patients from a probable avoidable amputation.
The progress of novel sorbents and their function in preconcentration techniques for determination of trace elements is a topic of great importance. This review discusses numerous analytical approaches including the preparation and practice of unique modification of solid-phase materials. The performance and main features of ion-imprinting polymers, carbon nanotubes, biosorbents, and nanoparticles are described, covering the period 2007-2012. The perspective and future developments in the use of these materials are illustrated.
A study was carried out to determine the distribution of cockroaches in two different housing areas with central sewerage or individual septic tanks in an urban area in Kuala Lumpur, Malaysia. Six species of cockroaches were present and of these Periplaneta americana and Periplaneta brunnea were found in greater abundance. Seventeen species of bacteria were isolated and of these Escherichia coli and Klebsiella p. pneumoniae were isolated in greatest numbers. Control measures carried out using lambda cyhalothrin showed that there was no significant difference between treated and control sites.
The effect of different aeration rates on the organic matter (OM) degradation during the active phase of oil palm empty fruit bunch (EFB)-rabbit manure co-composting process under constant forced-aeration system has been studied. Four different aeration rates, 0.13 L min(-1) kg(DM)(-1),0.26 L min(-1) kg(DM)(-1),0.49 L min(-1) kg(DM)(-1) and 0.74 L min(-1) kg(DM)(-1) were applied. 0.26 L min(-1) kg(DM)(-1) provided enough oxygen level (10%) for the rest of composting period, showing 40.5% of OM reduction that is better than other aeration rates. A dynamic mathematical model describing OM degradation, based on the ratio between OM content and initial OM content with correction functions of moisture content, free air space, oxygen and temperature has been proposed.
Exploitation of renewable sources of energy such as algal biodiesel could turn energy supplies problem around. Studies on a locally isolated strain of Dunaliella sp. showed that the mean lipid content in cultures enriched by 200 mg L(-1) myoinositol was raised by around 33% (1.5 times higher than the control). Similarly, higher lipid productivity values were achieved in cultures treated by 100 and 200 mg L(-1) myoinositol. Fluorometry analyses (microplate fluorescence and flow cytometry) revealed increased oil accumulation in the Nile red-stained algal samples. Moreover, it was predicted that biodiesel produced from myoinositol-treated cells possessed improved oxidative stability, cetane number, and cloud point values. From the genomic point of view, real-time analyses revealed that myoinositol negatively influenced transcript abundance of AccD gene (one of the key genes involved in lipid production pathway) due to feedback inhibition and that its positive effect must have been exerted through other genes. The findings of the current research are not to interprete that myoinositol supplementation could answer all the challenges faced in microalgal biodiesel production but instead to show that "there is a there there" for biochemical modulation strategies, which we achieved, increased algal oil quantity and enhanced resultant biodiesel quality.
Nanobiocatalysis is a new frontier of emerging nanosized material support in enzyme immobilization application. This paper is about a comprehensive review on cellulose nanofibers (CNF), including their structure, surface modification, chemical coupling for enzyme immobilization, and potential applications. The CNF surface consists of mainly -OH functional group that can be directly interacted weakly with enzyme, and its binding can be improved by surface modification and interaction of chemical coupling that forms a strong and stable covalent immobilization of enzyme. The knowledge of covalent interaction for enzyme immobilization is important to provide more efficient interaction between CNF support and enzyme molecule. Enzyme immobilization onto CNF is having potential for improving enzymatic performance and production yield, as well as contributing toward green technology and sustainable sources.
Patellar thickness is an important consideration for resurfacing in total knee arthroplasty. A patella of 25 mm in thickness is not suitable for resurfacing using the currently available total knee systems. A cross sectional study on patellar thickness using plain radiographs was undertaken on 56 patients. It was observed that the average thickness of the bony part of the patella was 20.05 mm (range 17-23 mm). The actual thickness of cartilage varies from 2.0 to 5.5 mm (mean 3.2 mm). Thus the mean thickness of the patella was 23.2 mm (range 20.2-26.2 mm). The majority of our patients (73%) had patellar thickness of 24 mm or less. The patellar thickness had a significant correlation with the patient's height (R=0.5). Since the majority of our patients have thin patella, we are of the opinion that majority of our patients are not suitable for patellar resurfacing.
We report a case of the Antley-Bixler syndrome in an 11-year-old girl. She presented with bilateral proximal femoral focal deficiency, right clubfoot, left radiohumeral synostosis, bilateral ear hypoplasia, cleft palate, tongue tie, missing teeth, congenital heart disease, a pelvic kidney with hydronephrosis, and mental retardation. Proximal femoral focal deficiency has never been reported before as a manifestation of Antley-Bixler syndrome. Her mother was exposed to radiation during an intravenous urogram done in the first trimester of pregnancy. Exposure to radiation has not been implicated as a cause of Antley-Bixler syndrome.
Distraction osteogeneis over intramedullary nail has a benefit of decreasing the time for external fixation thus reducing the rate of associated complications. However, risk of panosteomyelitis is still the major worry. We are reporting two patients who underwent the procedure. The first case was a 13-year-old girl requiring 6 cm of femoral lengthening and the second case was a 17-year-old girl who required 5 cm of tibial lengthening. The healing index was 19.5 days/cm and 14.8 days/cm respectively, compared favorably to 30 days/cm with traditional method of distraction osteogenesis. There were mild pin tract infections and joint stiffness which responded to non-operative treatment.
Resection and reconstruction using a vascularised fibular graft is a viable alternative treatment for congenital pseudarthrosis of the tibia, although distal junctional nonunion and residual deformity are known complications that are difficult to treat. We illustrate 2 cases in which bony union was achieved following a technique using fibular grafting and intramedullary nailing, without additional bone grafting. This technique was feasible because of hypertrophy of the fibular graft.
The use of 'spare part' tissue from an amputated segment to cover a stump with soft tissue deficiency is a viable option for augmenting the shape of the stump and preserving functional length of the stump without additional donor morbidity. The procedure requires no microsurgical skill if the tissues are used as pedicle fillet flaps transfer. This concept of fillet flap makes the amputation distal to an unfavourable definitive amputation site such as in congenital constriction band possible. We report herein a case of amputation distal to constriction ring to illustrate the application of fillet flap in reconstruction surgery.
The reconstruction of hallux varus deformity involves the release of contracted medial structure and realignment of the phalange, leaving a significant skin defect which requires cover. Farmer described proximal based rotational skin flap from the first web space to cover the defect. This technique may compromise the circulation to the flap and risk to the lateral digital vessels. We modified his technique to address these issues. We report a successful reconstruction using the Farmer's technique on one patient and a modified technique on three patients. We used the excess skin from the extra digit to cover the medial defect. We found this modified technique of skin cover safe without risk of injuring the neurovascular bundle. There was no recurrence of deformity at last foolow-up. All patients were able to wear normal shoes.
Post-traumatic severe patella infera and intra-articular adhesion may lead to a severe knee stiffness. We report a 29-year-old man, a muslim prayer leader, who had a previous knee injury. He presented with knee movement from ten degrees to 30 degrees, patellar infera with a length of patella to length of patellar tendon ratio of 2:5, and severe knee arthrofibrosis. He underwent incision of the patella ligament and open arthrofibrosis release, leaving a tendon gap and skin defect of 5 cm. Reconstruction was successfully done using a free vascularised composite tensor fascia lata flap. He regained full range of knee motion with normal strength quadriceps mechanism at five months after surgery, and remained in full function at 18 months follow-up.
Although sound exposure from personal listening devices (PLDs) could potentially lead to noise-induced hearing loss (NIHL), the actual hearing risk associated with the use of these devices is still unclear. In this study, early hearing effects related to PLD usage were evaluated in 35 young adult PLD users (listening for >1 h/day, at >50% of the maximum volume setting of their devices) and their age- and sex-matched controls using a combination of conventional and extended high-frequency audiometry as well as transient-evoked otoacoustic emission (TEOAE) and distortion product of otoacoustic emission (DPOAE) measurements. The mean listening duration of the PLD users was 2.7 ± 1.0 h/day while their estimated average listening volume was 81.3 ± 9.0 dBA (free-field corrected). Typical signs of NIHL were not detected in the audiogram of PLD users and their audiometric thresholds at most of the conventional test frequencies (0.25-8 kHz) were comparable with those obtained from controls. However, compared with the controls, mean hearing thresholds of PLD users at many of the extended high-frequencies (9-16 kHz) were significantly higher. In addition, TEOAE and DPOAE amplitudes in users were reduced compared with controls. The deterioration of extended high-frequency thresholds and the decrease in DPOAE amplitudes were more evident in the users' right ears. These results indicate the presence of an early stage of hearing damage in the PLD user group. Preventive steps should be taken as the initial hearing damage in these users could eventually progress into permanent NIHL after many years of PLD use.
In this era of digitization, most hardcopy documents are being transformed into digital formats. In the process of transformation, large quantities of documents are stored and preserved through electronic scanning. These documents are available from various sources such as ancient documentation, old legal records, medical reports, music scores, palm leaf, and reports on security-related issues. In particular, ancient and historical documents are hard to read due to their degradation in terms of low contrast and existence of corrupted artefacts. In recent times, degraded document binarization has been studied widely and several approaches were developed to deal with issues and challenges in document binarization. In this paper, a comprehensive review is conducted on the issues and challenges faced during the image binarization process, followed by insights on various methods used for image binarization. This paper also discusses the advanced methods used for the enhancement of degraded documents that improves the quality of documents during the binarization process. Further discussions are made on the effectiveness and robustness of existing methods, and there is still a scope to develop a hybrid approach that can deal with degraded document binarization more effectively.
Worldwide, apple juice is the second most popular juice, after orange juice. It is susceptible to enzymatic browning spoilage by polyphenoloxidase, an endogenous enzyme. In this study, Royal Gala apple juice was treated by thermosonication (TS: 1.3 W/mL, 58 ℃, 10 min), pulsed electric field (PEF: 24.8 kV/cm, 60 pulses, 169 µs treatment time, 53.8 ℃) and heat (75 ℃, 20 min) and stored at 3.0 ℃ and 20.0 ℃ for 30 days. A sensory analysis was carried out after processing. The polyphenoloxidase activity, antioxidant activity and total color difference of the apple juice were determined before and after processing and during storage. The sensory analysis revealed that thermosonication and pulsed electric field juices tasted differently from the thermally treated juice. Apart from the pulsed electric field apple juice stored at room temperature, the processed juice was stable during storage, since the pH and soluble solids remained constant and fermentation was not observed. Polyphenoloxidase did not reactivate during storage. Along storage, the juices' antioxidant activity decreased and total color difference increased (up to 6.8). While the antioxidant activity increased from 86 to 103% with thermosonication and was retained after pulsed electric field, thermal processing reduced it to 67%. The processing increased the total color difference slightly. No differences in the total color difference of the juices processed by the three methods were registered after storage. Thermosonication and pulsed electric field could possibly be a better alternative to thermal preservation of apple juice, but refrigerated storage is recommended for pulsed electric field apple juice.
Strawberry puree was processed for 15 min using thermal (65 ℃), high-pressure processing (600 MPa, 48 ℃), and ultrasound (24 kHz, 1.3 W/g, 33 ℃). These conditions were selected based on similar polyphenoloxidase inactivation (11%-18%). The specific energies required for the above-mentioned thermal, high-pressure processing, and power ultrasound processes were 240, 291, and 1233 kJ/kg, respectively. Then, the processed strawberry was stored at 3 ℃ and room temperature for 30 days. The constant pH (3.38±0.03) and soluble solids content (9.03 ± 0.25°Brix) during storage indicated a microbiological stability. Polyphenoloxidase did not reactivate during storage. The high-pressure processing and ultrasound treatments retained the antioxidant activity (70%-74%) better than the thermal process (60%), and high-pressure processing was the best treatment after 30 days of ambient storage to preserve antioxidant activity. Puree treated with ultrasound presented more color retention after processing and after ambient storage than the other preservation methods. For the three treatments, the changes of antioxidant activity and total color difference during storage were described by the fractional conversion model with rate constants k ranging between 0.03-0.09 and 0.06-0.22 day - 1, respectively. In resume, high-pressure processing and thermal processes required much less energy than ultrasound for the same polyphenoloxidase inactivation in strawberry. While high-pressure processing retained better the antioxidant activity of the strawberry puree during storage, the ultrasound treatment was better in terms of color retention.