Short-Term Results of Hybrid Closed-Wedge High Tibial Osteotomy: A Case Series with a Minimum 3-Year Follow-up

PURPOSE: High tibial valgus osteotomy (HTO) is a well-established surgical procedure for patients with medial compartment osteoarthritis (OA) of the knee. The hybrid closed-wedge HTO (CWHTO) procedure permits extensive correction in patients with severe deformities or patellofemoral joint OA. The aim of this study was to report the short-term results in a consecutive series of patients treated with hybrid CWHTO. MATERIALS AND METHODS: We retrospectively evaluated the clinical outcomes and radiographic parameters in 29 consecutive knees that underwent hybrid CWTHO to correct medial compartment OA at an average follow-up of 52.6 months. Clinical outcomes were assessed using the Lysholm score and knee scoring system of the Japanese Orthopedic Association (JOA). The Kellgren-Lawrence grading system and pre- and postoperative mechanical axis (MA), femorotibial angle (FTA), posterior tibial slope, and patella height were assessed. RESULTS: The FTA and MA significantly changed from 180.7° to 170.4° and from 22.0° to 60.2°, respectively. No significant differences were observed between the mean pre- and postoperative posterior tibial slope, Insall-Salvati ratio, or Caton-Deschamps index. The postoperative JOA and Lysholm scores significantly improved from 76.7 to 95.8 and from 58.8 to 90.2, respectively. CONCLUSIONS: Satisfactory outcomes can be achieved with hybrid CWHTO in patients with medial OA.

Personal growth and related factors among family primary caregivers after bereavement of a terminally ill cancer patient at home

<b>Purpose:</b> To identify the nature of personal growth of family primary caregivers after bereavement and to explore the association between such growth and the experience of caring for a terminally ill cancer patient at home. <b>Methods:</b> A self-administered questionnaire survey was mailed to 112 bereaved family primary caregivers who, with assistance from a palliative care service, had cared for a terminally ill cancer patient at home. The main outcomes were measured using the After Bereavement Growth Inventory, previously developed. <b>Results:</b> Responses from 73 questionnaires were analyzed (effective response rate, 66%). The post-bereavement growth score was significantly higher among the study group than among the general population who had experienced bereavement due to illness-related death. Multiple regression analysis revealed that post-bereavement growth was more likely to occur among those family members who, "at the time they chose to provide home palliative care, intended to care for a patient at home until the time of death" and when "the patient desired home palliative care", those who "felt a deepening of their bond with the patient", and those who "felt the death was peaceful". <b>Conclusion:</b> Our findings suggest that for primary family caregiver's to experience personal growth after bereavement, medical professionals should support patients' preference of place at the end of life and caregivers' preparation for the expected home death, respect the family's bond with the patient, and through appropriate symptom management in home palliative care to maintain the patient's sense of peacefulness until the end of life.

High rate partial nitrification treatment of reject wastewater.

Partial nitrification (PN) treatments on reject wastewater were carried out. Dissolved oxygen concentration was limited by controlling air flowrate, which was the main operational strategy in this study. Stable PN performance was obtained during continuous operation for 80 days, with a maximum nitrogen loading rate (NLR) of 4.2 kg-N m(-3) day(-1) and ammonium conversion rate of 2.1 kg-Nm(-3) day(-1). The production of nitrite oxidizers was assumed to be responsible for the nitrogen loss in the reactor. The ratios of NO2--N/ (NO2--N+NO3--N) were always above 99.9%, and BOD removal efficiencies were also stable at around 70% even if a sharp increase in NLR was applied during the stable period. Additionally, bacterial consortia analysis showed ammonium-oxidizing bacteria were the dominant microorganisms, which provided evidence for the long-term stable performance of this PN reactor. During the experiment, sludge setting properties deteriorated due to the absence of a biomass carrier. The stable performance of partial nitrification from reject wastewater demonstrated the feasibility of the operation strategy in this study.