A new digital technology to reduce fungicide use in vineyards.

There is a growing demand for technologies able to decrease the environmental impact of agricultural activities without penalizing quali-quantitative characteristics of productions. In the case of viticulture, one of the key problems is represented by the spray drift during fungicide treatments. The diffusion in operational farming contexts of technologies based on variable-rate and recycling tunnel sprayers is often limited by their cost and, for the latter, by their size and lower maneuverability, representing clear disadvantages especially in case of small farms or in hilly and mountain areas. We present a new digital technology implemented in a mobile app that supports the reduction of both the number of treatments and the amount of fungicide distributed per treatment. The technology is based (i) on an alert system that prevents unneeded treatments in case of no risk of infection and (ii) on the quantification of the optimal amounts of active ingredients and dilution water based on the sprayer type/settings and on leaf area index values estimated with a common smartphone. An internal database allows to adjust (in case of need) the active ingredient dose to assure full compliance with product's legal requirements. In case of heterogeneity in leaf area index values inside the vineyard, prescription maps are generated. Results from a 2-year case study in a vineyard in northern Italy are shown, where the system allowed to reduce by 26.4 % and 27.4 % (mean of two years), respectively, the seasonal amounts of fungicides and dilution water, and by 43.8 % the copper content in must. The high usability of the technology proposed (just a common smartphone is needed) and the fact that it does not require updating the farm machine park highlights the suitability of the proposed solution for operational farming conditions, including premium wine production districts often characterized by small farms in hilly areas.

May smart technologies reduce the environmental impact of nitrogen fertilization? A case study for paddy rice.

Precision agriculture is increasingly considered as a powerful solution to mitigate the environmental impact of farming systems. This is because of its ability to use multi-source information in decision support systems to increase the efficiency of farm management. Among the agronomic practices for which precision agriculture concepts were applied in research and operational contexts, variable rate (VR) nitrogen fertilization plays a key role. A promising approach to make quantitative, spatially distributed diagnoses to support VR N fertilization is based on the combined use of remote sensing information and few smart scouting-driven ground estimates to derive maps of nitrogen nutrition index (NNI). In this study, a new smart app for field NNI estimates (PocketNNI) was developed, which can be integrated with remote sensing data. The environmental impact of using PocketNNI and Sentinel 2 products to drive fertilization was evaluated using the Life Cycle Assessment approach and a case study on rice in northern Italy. In particular, the environmental performances of rice fertilized according to VR information derived from the integration of PocketNNI and satellite data was compared with a treatment based on uniform N application. Primary data regarding the cultivation practices and the achieved yields were collected during field tests. Results showed that VR fertilization allowed reducing the environmental impact by 11.0% to 13.6% as compared to uniform N application. For Climate Change, the impact is reduced from 937.3 to 832.7 kg CO2 eq/t of paddy rice. The highest environmental benefits - mainly due to an improved ratio between grain yield and N fertilizers - were achieved in terms of energy consumption for fertilizer production and of emission of N compounds. Although further validation is needed, these preliminary results are promising and provide a first quantitative indication of the environmental benefits that can be achieved when digital technologies are used to support N fertilization.

Quantifying Uncertainty Due to Stochastic Weather Generators in Climate Change Impact Studies.

Climate change studies involve complex processes translating coarse climate change projections in locally meaningful terms. We analysed the behaviour of weather generators while downscaling precipitation and air temperature data. With multiple climate indices and alternative weather generators, we directly quantified the uncertainty associated with using weather generators when site specific downscaling is performed. We extracted the influence of weather generators on climate variability at local scale and the uncertainty that could affect impact assessment. For that, we first designed the downscaling experiments with three weather generators (CLIMAK, LARS-WG, WeaGETS) to interpret future projections. Then we assessed the impacts of estimated changes of precipitation and air temperature for a sample of 15 sites worldwide using a rice yield model and an extended set of climate metrics. We demonstrated that the choice of a weather generator in the downscaling process may have a higher impact on crop yield estimates than the climate scenario adopted. Should they be confirmed, these results would indicate that widely accepted outcomes of climate change studies using this downscaling technique need reconsideration.

Estimating Crop Nutritional Status Using Smart Apps to Support Nitrogen Fertilization. A Case Study on Paddy Rice.

Accurate nitrogen (N) management is crucial for the economic and environmental sustainability of cropping systems. Different methods have been developed to increase the efficiency of N fertilizations. However, their costs and/or low usability have often prevented their adoption in operational contexts. We developed a diagnostic system to support topdressing N fertilization based on the use of smart apps to derive a N nutritional index (NNI; actual/critical plant N content). The system was tested on paddy rice via dedicated field experiments, where the smart apps PocketLAI and PocketN were used to estimate, respectively, critical (from leaf area index) and actual plant N content. Results highlighted the system's capability to correctly detect the conditions of N stress (NNI < 1) and N surplus (NNI > 1), thereby effectively supporting topdressing fertilizations. A resource-efficient methodology to derive PocketN calibration curves for different varieties-needed to extend the system to new contexts-was also developed and successfully evaluated on 43 widely grown European varieties. The widespread availability of smartphones and the possibility to integrate NNI and remote sensing technologies to derive variable rate fertilization maps generate new opportunities for supporting N management under real farming conditions.

Proposal of a therapeutic protocol for selected patients with patellofemoral knee osteoarthritis: arthroscopic lateral retinacular release followed by viscosupplementation.

BACKGROUND: Lateral retinacular release has been demonstrated to reduce articular patellofemoral pressures, while intra-articular injection of hyaluronic acid can improve the biological and rheological knee pathway. We evaluated whether treatment protocol consisting on combination of these two therapies can provide significant symptomatic improvement in patients with patellofemoral osteoarthritis (PFO) and patellar tilt. MATERIALS AND METHODS: We retrospectively analyzed the clinical and radiological data of 28 knees (25 patients with anterior knee pain) who underwent arthroscopic lateral retinacular release followed by viscosupplementation for isolated patellofemoral osteoarthritis without clinical or radiological signs of patellar instability. Clinical evaluation was performed at a mean follow-up of 32.4 months (range 24-47 months) by an independent surgeon using the Kujala score, visual analog scale (VAS), and patient satisfaction scale. Univariate and multivariate analysis was used to identify best determinants to have a good clinical outcome. RESULTS: Mean Kujala score improved from 45.8 points before surgery (range 33-65 points) to 82.7 points after treatment protocol (range 52-100 points). VAS improved of 68.5 % from preoperative and all patients except one were satisfied. Linear multiple regression modeling showed that younger age (OR 1.134, 95 % CI 1.018-1.263, p = 0.022) and short time delay between the onset of symptoms and treatment (OR 1.207, 95 % CI 0.982-1.484, p = 0.007) were the best determinants for a good final outcome. CONCLUSIONS: Arthroscopic lateral retinacular release followed by viscosupplementation is an effective treatment protocol for PFO, simple and minimally invasive with respect to other therapeutic options.

The role of active immunization therapy as preoperative treatment for chronic osteomyelitis.

BACKGROUND: This retrospective study was performed to assess the effectiveness of active immunostimulation therapy with bacterial immunotherapy (BIT) in treatment for chronic osteomyelitis (COM). MATERIALS AND METHODS: We analyze 154 patients affected by COM and treated with BIT from 1995 to 2009 at our Institution. Using Cierny and Mader classification, patients were divided according to their clinical status and anatomic nature of septic process. The data were analyzed considering several confounding factors, such as antibiotic therapy and hyperbaric oxygen therapy combined with the administration of BIT. According to clinical and radiographic parameters, patients were considered as unchanged, improved, or healed. RESULTS: After a mean follow-up of 40.4 months (median 38 months), healing was achieved in 41.6 % of cases. Multivariate statistical analysis showed that patient's clinical status is the most important prognostic factor of responding (p < 0.0005) and healing (p = 0.008) after therapy. The best healing rate (62 % of cases) was achieved in patients with a normal clinical condition (Cierny-Mader group A); it was worse (20 % of cases) in those patients with a compromised clinical status (Cierny-Mader group B). There was no healing case in group C. CONCLUSIONS: The results show the effectiveness of BIT in treatment of patients affected by COM with uncompromised clinical status. The use of this therapy must be assessed critically in patients with alterations in clinical conditions.

Dislocations of the elbow in children: long-term follow-up.

BACKGROUND: Dislocation of the elbow in children is considered to be a benign injury in most cases. The aim of this paper is to evaluate whether this condition has late sequelae in the adult age. The study consisted of a retrospective evaluation of patients under 15 years old at the time of injury. METHODS: 40 patients were selected for the follow-up evaluation. The mean age of the children at the time of injury was 10.9 years old (range 5-14 years). Four patients were lost to follow-up, so they were not considered for final clinical evaluation. For the other 36 patients, the follow-up examination was undertaken after an average of 15 years (range 7-22 years). The average age of the patients at the follow-up was 26 (range 18-34 years). RESULTS: At the end of follow-up period, there were few subjective complications. No redislocations occurred. None of the patients had been influenced by their elbow injury in their choice of occupation. X-rays were available for 27 patients. These were graded using Linscheid and Wheeler criteria and were excellent in 14 patients, good in 10 and fair in 3. CONCLUSIONS: Dislocation of the elbow in children is a benign injury in the majority of cases and has a good prognosis in the adult age too in spite of extensive damage to the periarticular structures. Ectopic ossifications are a common finding, but only large periarticular ectopic ossifications were associated with a decrease in range on motion. Extension loss is the most common sequelae. Level of evidence IV.

Two-stage reimplantation for periprosthetic knee infection: Influence of host health status and infecting microorganism.

BACKGROUND: Two-stage revision is the gold standard treatment of TKA infection; nevertheless various factors may influence the success rate. The aim of our study was to assess the impact of the number of patient comorbidities together with virulence of infectious organism on prognosis of two-stage revision procedure in chronic peri-prosthetic knee infection; moreover we tried to demonstrate correlation between the presence of positive culture during re-implantation and re-infection rate. METHODS: Thirty-eight cases of two-staged revision procedures for infected total knee arthroplasty were prospectively followed. The presence of high virulence microorganisms on the culture result and the number (more than three) of comorbidities were used as major risk factors. All cases were divided into three groups: Group 1 (10 patients without major risk factors), Group 2 (18 patients with only one major risk factor), Group 3 (10 patients with both of major risk factors). RESULTS: After a mean follow-up of 65months (range 24-139months), there was infection recurrence in nine cases: four re-infections occurred with the same organism while five patients had re-infection with a different organism. Recurrence was higher in Group 3 (33% of the cases), lower in Group 2 (12% of the cases), whereas no infection occurred in Group 1. Finally in case of positive intraoperative cultures recurrence rate was 83%, whereas when specimens were negative we had only 12.5% of re-infections. CONCLUSIONS: Even if standard protocol of two-stage revision has demonstrated good results when treating low-virulence infections or patients without associated risk factors, its application to more challenging condition cannot be assumed. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

Factors predicting blood transfusion in different surgical procedures for degenerative spine disease.

BACKGROUND AND OBJECTIVES: Spine surgery frequently needs allogeneic blood transfusions to compensate for great blood loss. Autologous blood donations often are indicated to reduce homologous transfusions. In last decades interbody spinal fusion has gained popularity, being frequently performed in many spine procedures. Nevertheless, there are few studies evaluating the risk factors of additional blood transfusions in the postoperative course of degenerative spine surgery and no one concerning patients who underwent interbody fusion. MATERIALS AND METHODS: In 15 consecutive months, in the same Department of Spine Surgery 40 different elective spine surgeries were performed, divided into four groups: laminectomy alone, laminectomy with an instrumented posterolateral fusion, laminectomy with an instrumented posterolateral and interbody fusion, extensive instrumented fusion. All patients surgery-related data were respectively recorded: patient age, gender, diagnosis, preoperative hemoglobin rate, autologous blood availability, number of spinal level decompressed and fused, duration of surgery, type of surgical procedure, duration of hospital stay. These data were statistically analysed to determine whether variables could determine higher risk of blood transfusion. RESULTS: In an univariate analysis of factors influencing the need of blood transfusion, significantly greater risk of blood transfusions was observed in the female, in case of low preoperative Hb rate, longer surgical times, multiple spinal level decompressed or fused and longer duration of hospital stay. Our linear multiple regression modeling showed that patients gender and increased number of levels decompressed and levels surgically fused were significant determinants of need of blood transfusion. CONCLUSIONS: The practical value of this work can be particularly appreciated by those who are used to consider blood predonation. According to our findings blood predonation should preferably be proposed to women supposed to undergo spine instrumented fusion or a more than three levels spine decompression.

Surgical treatment of Sprengel's shoulder: experience at the Rizzoli Orthopaedic Institute 1975-2010.

The outcome of 56 children (61 shoulders) treated surgically at the Rizzoli Institute between April 1975 and June 2010 for congenital elevation of the scapula is reported. There were 31 girls and 25 boys with a mean age at surgery of 6.4 years (2 to 15). The deformity involved the right shoulder in 20 cases, the left in 31 and was bilateral in five. The degree of the deformity was graded clinically and radiologically according to the classifications of Cavendish and Rigault, respectively. All patients underwent a modified Green procedure combined, in selected cases, with resection of the superomedial portion of the scapula and excision of any omovertebral connection. After a mean follow-up of 10.9 years (1 to 29.3), there was cosmetic improvement by at least one Cavendish grade in 54 shoulders (88.5%). The mean abduction of the shoulder improved from 92° (50° to 155°) to 112° (90° to 170°) and the mean flexion improved from 121° (80° to 160°) to 155° (120° to 175°). The unsatisfactory cosmetic result in seven shoulders was due to coexistent scoliosis in two cases and insufficient reduction of the scapular elevation in the other five. An incomplete upper brachial plexus palsy occurred post-operatively in three patients but resolved within seven months. We suggest that a modified Green procedure combined with resection of the superomedial portion of the scapula provides good cosmetic and functional results in patients with Sprengel's shoulder.

Total knee arthroplasty for post-traumatic proximal tibial bone defect: three cases report.

Bone stock deficiency in primary as well as in revision total knee arthroplasty (TKA) represents a difficult problem to surgeon with regard to maintaining proper alignment of the implant components and in establishing a stable bone-implant interface. Different surgical procedures are available in these situations, for instances the use of bone cement, prosthetic augments, custom implant, and wire mesh with morsellized bone grafting and structural bone allograft. Structural allograft offers a numerous advantages as easy remodeling and felling cavitary or segmental defects, excellent biocompatibility, bone stock restoration and potential for ligamentous reattachment. In this article we report a short term result of three cases affected by severe segmental medial post/traumatic tibial plateau defect in arthritic knee, for which massive structural allograft reconstruction and primary total knee replacement were carried. The heights of the bone defect were between 27-33 mm and with moderate medio-lateral knee instability. Pre-operative AKS score in three cases was 30, 34 and 51 points consecutively and improved at the last follow-up to 83, 78 and 85 consecutively. No acute or chronic complication was observed. Last radiological exam referred no signs of prosthetic loosening, no secondary resorption of bone graft and well integrated graft to host bone. These results achieved in our similar three cases have confirmed that the structural bone allograft is a successful biological material to restore hemi-condylar segmental tibial bone defect when total knee replacement is indicated.

Total knee arthroplasty in stiff knee compared with flexible knees.

This retrospective study was done to evaluate the results of total knee arthroplasty performed on 32 patients with stiff knee, having a preoperative arc of movement between 0° and 50° (average 30°). This group of patients were matched with a group of 32 flexible knees, randomly selected from the same cohort of patients who underwent knee arthroplasty in our ward. At a mean follow-up of 4.5 years (min 2, max 11 years), seven patients of the stiff group reported complications (21.8% overall): four prosthetic infection that successively underwent removal of the implant, one skin necrosis 4 months after the intervention, one early contracture and one late stiffness of the knee. In the control group, in two cases, there was substitution of the implant due to periprosthetic infection. At the end of the study period, the clinical evaluation was not possible in four patients of the stiff and in two patients of the control group who underwent revision of the prosthetic components. An excellent or good clinical result was obtained in 92% of stiff group and in 96% of the control group patients. Although the final results achieved in these patients are worse than those of patients with flexible knee due to disadvantageous preoperative conditions and high complication rate, our results demonstrate the efficacy of the arthroplasty procedure as treatment of stiff knee.

Knee arthrodesis with the Ilizarov external fixator as treatment for septic failure of knee arthroplasty.

BACKGROUND: The authors report the results of femoral-tibial fusion with an Ilizarov circular external fixator following septic loosening of knee prosthesis. MATERIALS AND METHODS: The series included 17 patients with a mean age of 62.9 years, treated from 1990 to 2007 with femoral-tibial fusion. The Cierny-Mader classification was used for clinical and anatomopathological evaluation; the Engh classification was used to assess the bone defect. Surgical treatment differed according to these criteria. RESULTS: Healing was achieved in 13 out of 17 patients at the first surgical attempt in a mean time of 9.3 months. Mean follow-up was 30 months. Of the four complications, two patients had an intolerance to the external fixator that led to its early removal, and the other two had a septic intraarticular nonunion. CONCLUSIONS: The Ilizarov circular external fixator is a very reliable fixation system due to its low cost, versatility, stability under load, and low risk of septic dissemination. Nevertheless, an appropriate patient selection and a good surgeon's experience are necessary.

Total knee arthroplasty in patients with poliomyelitis.

We performed a retrospective chart and radiograph review of 10 patients with a history of poliomyelitis involving a limb that subsequently underwent primary total knee arthroplasty between 2000 and 2008. One posterior stabilized (PS), two condylar constrained (CCK), and seven rotating hinge (RHK) prostheses belonging to the same system were implanted. Eight patients were followed for a minimum of 2 years (mean 4.3 years, range 2 to 8.5 years); one patient required revision for prosthesis infection. The last patient was followed for just six months reporting excellent pain relief, and without complications. American Knee Society Score (AKSS) improved postoperatively in all eight patients with at least 2 years follow-up. The improvement was more marked for the knee score, which increased from a mean of 37 points preoperatively (range 20 to 51) to 75.7 points postoperatively (range 50 to 92); for the functional score the mean increase was only 15.8 points, from a mean of 38.5 points (range 20 to 70) to 54.3 points (range 20 to 80) after the intervention. One patient had a recurrence of the recurvatum deformity after implanting a CCK prosthesis. We found that a rotating hinge prosthesis that allowed hyperextension was suitable treatment for patients with knee osteoarthritis and polio as this compensated for loss of quadriceps power.