Evaluating the utility of inflammatory markers in the diagnosis of soft tissue abscesses of the forearm and hand.

Upper extremity abscesses frequently present to the acute care setting with inconclusive physical examination and imaging findings. We sought to investigate the diagnostic accuracy of inflammatory markers including white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). A retrospective cohort study was performed to identify subjects ≥ 18  years treated with surgical debridement of upper extremity abscesses at our institution between January 2012 and December 2015. In this study, 188 patients were screened, and 72 met the inclusion criteria. A confirmed abscess as defined by culture positivity was present in 67 (93.1 %) cases. The sensitivity of WBC, ESR, or CRP individually was 0.45, 0.71, and 0.81. The specificity of WBC, ESR, or CRP individually was 0.80, 0.80, and 0.40. In combination all three markers when positive had a sensitivity of 0.26 and specificity of 1.0. These values were similar among patients with diabetes and those with obesity. With the highest sensitivity and lowest specificity, CRP exhibited the most utility as a screening test (level IV).

Spine or Hip First? Outcomes in Patients Undergoing Sequential Lumbar Spine or Hip Surgery.

BACKGROUND: Lumbar spine pathology frequently coexists in patients who have hip arthrosis. There is controversy on whether lumbar or hip pathology should be first addressed. The purpose of this study was to evaluate the outcomes of sequential lumbar spine (LSP) or hip arthroplasty (THA). METHODS: Using a large national database from 2010 to 2020, we reviewed the records of 241,279 patients who had concurrent hip arthritis and lumbar spine disease defined as spinal stenosis, lumbar radiculopathy, or degenerative disc disease. During the study period, 6,458 (2.7%) patients with concurrent hip/spine disease underwent sequential operative treatment of either the hip joint or lumbar spine within 2 years. The rates of subsequent surgery in either the hip or the spine, opioid requirements, and rates of hip dislocation were determined and analyzed using compared Chi-squared analyses. RESULTS: Patients undergoing THA first had lower risk of subsequent spinal procedure compared to patients who had spinal procedures first (5.7 versus 23.7%, P < .001). This disparity was maintained up to 5 years (P < .001). Opioid requirements at 1 year were highest in patients who underwent spinal procedures only (836 pills/patient) compared to any other group THA only (566 pills/patient), LSP and then THA (564 pills/patient), THA and LSP (586 pills/patient). Also, THA following LSP was associated with significantly higher rates of dislocation compared to patients undergoing THA first (3.2 versus 1.9%, P < .001). CONCLUSION: Total hip arthroplasty first in patients who have concurrent spine disease was associated with lower risk of subsequent surgery, opioid requirement, and risk of postoperative instability compared to patients having lumbar procedure first.

Valorisation of mine waste - Part II: Resource evaluation for consolidated and mineralised mine waste using the Central African Copperbelt as an example.

Mine waste can create long-term and occasionally catastrophic environmental degradation. Due diligence of mine waste in the form of monitoring and maintenance requires a constant supply of societal resources. Furthermore, mine waste is unlikely to disappear with current mining methods and instead, it is more likely to accumulate at a faster rate due to decreasing primary ore grades and increasing societal demands. However, mine waste can be a societal asset, as it can offer an alternative source of partly critical raw materials (CRMs) that can augment primary sources and provide an opportunity to mitigate supply-risk while ensuring sustainability and easing geopolitical tensions. Cobalt is a critical raw material that is largely a by-product of mining of copper, nickel and platinum-group element ores. It is an element that the renewable energy and high-tech sectors critically depend on and for which no reasonable substitutes currently exist. The majority of the global cobalt production stems from the Central African Copperbelt. Published cobalt production figures for the Central African Copperbelt were used to evaluate cobalt tailings from the Central African Copperbelt. As part of a waste valorisation framework that focuses on primarily on the technical aspects of mine waste valorisation, this study assesses the application of key geostatistical methods, such as kriging and conditional simulation, followed by uniform conditioning, to evaluate the resource potential in a hypothetical copper-cobalt tailing deposit from the Central African Copperbelt. The results indicate that methods such as traditional algorithmic kriging, sequential Gaussian simulation and uniform conditioning are highly effective tools in resource modelling of mine waste. The resource assessment framework component developed in this study makes it possible to systematically characterise, profile and model any mine waste storage facility and thus supplements other framework components discussed in an accompanying paper to maximise mine waste utilization.

Valorisation of mine waste - Part I: Characteristics of, and sampling methodology for, consolidated mineralised tailings by using Witwatersrand gold mines (South Africa) as an example.

The quest for steady primary supplies of critical raw materials (CRMs) creates significant waste, which is inevitably generated at each phase of mining and mineral processing. Waste from extraction, separation and refinement of non-renewable natural resources is accumulated globally and creates not only environmental hazards but also economic possibilities. Mine waste management is an expensive and prolonged task but unavoidable. Mine tailings, especially historical ones, can contain economically feasible resources, and given the right condition, such tailings could be reutilised through a waste valorisation concept. A prominent example are the Witwatersrand gold mine tailings in South Africa, which have been reused in small-scale projects. Tailing reutilisation is only possible if a sound classification, sampling and resource modelling framework is established to thoroughly and accurately profile the economic, environmental, health and geometallurgical aspects. Our study on valorisation of mine waste is presented in two parts: Here, in Part I, we focus on the essential components of a mine waste valorisation framework that includes the characterization and development of a systematic sampling framework for consolidated mineralised tailings. The development of a mine waste valorisation framework will hopefully enable worldwide reduction and reutilisation of mine waste.

Cost-Minimization Analysis and Treatment Trends of Surgical and Nonsurgical Treatment of Proximal Humerus Fractures.

PURPOSE: Recent evidence demonstrated similar outcomes between nonsurgical and surgical management of displaced proximal humerus fractures. We analyzed treatment trends and performed a cost-minimization analysis comparing nonsurgical treatment, open reduction and internal fixation, reverse total shoulder arthroplasty, and hemiarthroplasty. We hypothesized that rates of surgical treatment have increased and that the costs associated with surgery are greater compared with nonsurgical management of proximal humerus fractures. METHODS: We used a US private-payer claims database of 22 million patient records from 2007 to 2016 to compare (1) cost for the episode of care from the payer perspective between each surgical group and nonsurgical treatment of proximal humerus fractures, and (2) annual trends and complication rates of each group. Cost data, including facility fees, physician fees, physical therapy, and clinic visits, were used to complete a cost-minimization analysis. RESULTS: Nonsurgical treatment was associated with lower average total costs compared with surgical intervention. Facility and physician fees accounted for most of this difference. Physical therapy costs and number of physical therapy visits were higher in each surgical group compared with nonsurgical treatment. Surgical treatment was associated with higher complications, revision rates, and length of stay. There was a small but statistically significant decrease in nonsurgical management of proximal humerus fractures between 2007 and 2016. No change was observed in rates of open reduction and internal fixation, whereas rates of reverse total shoulder arthroplasty increased and rates of hemiarthroplasty decreased. CONCLUSIONS: Nonsurgical management of proximal humerus fractures decreased during the study period. In the setting of treatment equipoise, cost-minimization analysis favors nonsurgical management of proximal humerus fractures. Surgical management is associated with higher complication rates, revision rates, and length of stay. TYPE OF STUDY/LEVEL OF EVIDENCE: Economic Decision Analysis IV.

The paradoxical effects of SKF83959, a novel dopamine D1-like receptor agonist, in the rat acoustic startle reflex paradigm.

While the benzazepine SKF83959 elicits classical behavioral responses associated with dopamine D1 receptors, it also acts as a D1 receptor antagonist biochemically. The paradoxical properties of this agent remain an enigma. In the present study, we sought to determine the behavioral effects of SKF83959 in the rat acoustic startle reflex test. Systemic administration of SKF83959 produced a dose-related increase in the startle amplitude with a stimulus of 105 dB, and a significant group difference was observed between animals treated with 1 mg/kg SKF83959 and vehicle controls. SKF83959 also significantly reduced the latency to startle response to stimuli of 95 dB and 105 dB in a dose-dependent manner. However, unlike classical dopamine D1-like receptor agonists, SKF83959 failed to disrupt prepulse inhibition (PPI) of either the startle amplitude or the latency to startle response; rather, the agent dose-dependently increased the PPI latency to startle response of 105 dB stimulus. These results suggest that the behavioral effects of SKF83959 in the rat acoustic startle reflex paradigm are paradoxical, and these paradoxical effects may be associated with its distinct pharmacological properties.