CONCENTRATION OF SOLUBLE SALTS IN COOLING WATER OF POWER PLANTS WITH BLOW DOWN RECIRCULATION

The method for calculating the dynamics of concentration of soluble salts (tracers) using the assumption of their homogeneous distribution in the water volume of the circulated cooling system (CCS) under the conditions of recirculation of part of the purge water was proposed. The assumption of homogeneity of salt distribution is substantiated by the fact that the period of mixing of cold water (CW) in CCS is equal to several hours, and the period of setting the concentration limits is calculated in tens of days. In this approximation the law of change of concentration of tracers in time from the moment of their supply in CCS in modes without and with recirculation of a part of purge water and without any processing is received. It is shown that without recirculating treatment, recirculation of purge water increases the maximum salt concentration and the time to reach it. Attention is drawn to the fact that the flow rate consists of two parts: controlled and uncontrolled. When calculating the allowable amount of purge recirculation, it is necessary to use the value of the total purge flow. It is important to understand that the relative change in total purge is always less than the controlled one. To obtain the cost of full purge, it is necessary to calculate its uncontrolled part. The procedure for calculating the uncontrolled purge is given in the paper. Since there are restrictions for of maximum allowable concentration (MAC) on the concentrations of tracers in the CCS, the expressions obtained in this work are consistent with the requirements of the MAC and allow for a given degree of concentration of salts φ, to calculate the limit of recirculation flow. It is shown that the recirculation regime can be applied without additional measures for CCS with a low initial degree of salt concentration and low concentration in the feed water. The proposed algorithm is used to predict the results of recirculation in the case of a specific CСS for thermal power plants with an electrical capacity of 1200 MW and the ratio CMAC/C0 = 5. It is shown that in this case recirculation has significant economic and environmental effects. However, at high, concentrations of tracers C0, compared to MAC, feed water recirculation is meaningless. The calculation algorithm applies to tracers, i.e. salts that do not give deposits, but only limited by the MAC requirements and the risk of corrosion or environmental considerations. Therefore, the above technique cannot be directly used for sparingly soluble salts, such as calcium carbonate. In this case, it requires significant correction. Note the convenient use in calculations of the earlier introduced by us concept of regime (dynamic) factor φ, especially when comparing the real consumption of the main flows of ССS to calculated and in determining the evaporative capacity of cooling towers, or assessing the degree of salt concentration.

Spontaneous humeral torsion deformity correction after displaced supracondylar fractures in children

Background After displaced supracondylar humerus fractures (SCHF) in children, residual deformities are common with cubitus varus (CV) being the clinically most visible. Distal fragment malrotation may lead to instability, fragment tilt and subsequent CV. Detection and assessment of malrotation is difficult and the fate of post-traumatic humeral torsion deformity is unknown. The aim of this study was to evaluate the incidence of humeral torsion differences in children with surgically treated SCHF and to observe spontaneous changes over time. Methods A cohort of 27 children with displaced and surgically treated SCHF were followed prospectively from the diagnosis until twelve months after trauma. Clinical, photographic, sonographic and radiological data were obtained regularly. Differences in shoulder and elbow motion, elbow axis, sonographic humeral torsion measurement and radiological evaluation focusing on rotational spur were administered. Results Six weeks after trauma, 67% of SCHF children had a sonographically detected humeral torsion difference of > 5° (average 14.0 ± 7.6°). Of those, 44% showed a rotational spur, slight valgus or varus on radiographs. During follow-up, an average decrease of the difference from 14° (six weeks) to 7.8° (four months) to 6.5° (six months) and to 4.9° (twelve months) was observed. The most significant correction of posttraumatic humeral torsion occurred in children < 5 years and with internal malrotation > 20°. Conclusion After displaced and surgically treated SCHF, most children had humeral torsion differences of both arms. This difference decreased within one year after trauma due to changes on the healthy side or correction in younger children with severe deformity. Level of Evidence/Clinical relevance Therapeutic Level IV

Calcaneal lengthening using ipsilateral fibula autograft in the treatment of symptomatic pes valgus in adolescents

Background Evans calcaneal lengthening osteotomy is used to treat symptomatic flexible flatfoot when conservative treatment fails. Grafts such as autologous iliac bone grafts, allografts, and xenografts are implanted at the osteotomy site to lengthen the lateral column of the hindfoot. This study aimed to present the outcomes of an autologous mid-fibula bone graft used for calcaneal lengthening in symptomatic pes valgus in adolescents. Methods We retrospectively examined 23 ft of 13 adolescents who underwent surgery between July 2014 and January 2018. The radiological and clinical outcomes (American Orthopaedic Foot and Ankle Society ankle-hindfoot scale scores) were assessed during a mean follow-up of 49.7 (range, 30.9–73.4) months. The mean distance of the lengthening site was measured to evaluate graft sinking or collapse. The Goldberg scoring system was used to determine the degree of union at the donor and recipient sites. Results The calcaneal pitch and the anteroposterior and lateral talo-first metatarsal (Meary) angles showed significant correction, from 14.4 to 19.6 (p < 0.001), and from 14.5 to 4.6 (p < 0.001) and 13.5 to 8.5 (p < 0.001), respectively. The mean distance of the lengthening site showed no significant change (p = 0.203), suggesting no graft sinking or postoperative collapse. The lateral distal tibial angle showed no significant difference (p = 0.398), suggesting no postoperative ankle valgus changes. Healing of the recipient and donor sites occurred in 23 and 21 ft, respectively. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scores improved significantly, from 68.0 to 98.5 (p < 0.001). Conclusions Evans calcaneal lengthening using an ipsilateral mid-fibula bone autograft resulted in significant improvement in clinical and radiological outcomes without ankle valgus deformity. Hence, it could be a treatment option for lateral column calcaneal lengthening in adolescents.

When can we expect global sagittal alignment to reach a stable value following cervical deformity surgery?

OBJECTIVE Cervical deformity (CD) is a complex condition with a clear impact on patient quality of life, which can be improved with surgical treatment. Previous study following thoracolumbar surgery demonstrated a spontaneous and maintained improvement in cervical alignment following lumbar pedicle subtraction osteotomy (PSO). In this study the authors aimed to investigate the complementary questions of whether cervical alignment induces a change in global alignment and whether this change stabilizes over time. METHODS To analyze spontaneous changes, this study included only patients with at least 5 levels remaining unfused following surgery. After data were obtained for the entire cohort, repeated-measures analyses were conducted between preoperative baseline and 3-month and 1-year follow-ups with a post hoc analysis and Bonferroni correction. A subanalysis of patients with 2-year follow-up was performed. RESULTS One-year follow-up data were available for 121 of 168 patients (72%), and 89 patients had at least 5 levels remaining unfused following surgery. Preoperatively there was a moderate anterior cervical alignment (C2–7, −7.7° [kyphosis]; T1 slope minus cervical lordosis, 37.1°; cervical sagittal vertebral axis [cSVA], 37 mm) combined with a posterior global alignment (SVA, −8 mm) with lumbar hyperextension (pelvic incidence [PI] minus lumbar lordosis [LL] mismatch [PI-LL], −0.6°). Patients underwent a significant correction of the cervical alignment (median ΔC2–7, 13.6°). Simultaneously, PI-LL, T1 pelvic angle (TPA), and SVA increased significantly (all p < 0.05) between baseline and 3-month and 1-year follow-ups. Post hoc analysis demonstrated that all of the changes occurred between baseline and 3 months. Subanalysis of patients with complete 2-year follow-up demonstrated similar results, with stable postoperative thoracolumbar alignment achieved at 3 months. CONCLUSIONS Correction of cervical malalignment can have a significant impact on thoracolumbar regional and global alignment. Peak relaxation of compensatory mechanisms is achieved by the 3-month follow-up and tends to remain stable. Subanalysis with 2-year data further supports this finding. These findings can help to identify when the results of cervical surgery on global alignment can be best evaluated.

High-throughput kinome-RNAi screen identifies protein kinase R activator (PACT) as a novel genetic modifier of CUG foci integrity in myotonic dystrophy type 1 (DM1)

Myotonic Dystrophy Type 1 (DM1) is the most common form of adult muscular dystrophy (~1:8000). In DM1, expansion of CTG trinucleotide repeats in the 3’ untranslated region of the dystrophia myotonica protein kinase (DMPK) gene results in DMPK mRNA hairpin structures which aggregate as insoluble ribonuclear foci and sequester several RNA-binding proteins. The resulting sequestration and misregulation of important splicing factors, such as muscleblind-like 1 (MBNL1), causes the aberrant expression of fetal transcripts for several genes that contribute to the disease phenotype. Previous work has shown that antisense oligonucleotide-mediated disaggregation of the intranuclear foci has the potential to reverse downstream anomalies. To explore whether the nuclear foci are, to some extent, controlled by cell signalling pathways, we have performed a screen using a small interfering RNA (siRNA) library targeting 518 protein kinases to look at kinomic modulation of foci integrity. RNA foci were visualized by in situ hybridization of a fluorescent-tagged (CAG)10 probe directed towards the expanded DMPK mRNA and the cross-sectional area and number of foci per nuclei were recorded. From our screen, we have identified PACT (protein kinase R (PKR) activator) as a novel modulator of foci integrity and have shown that PACT knockdown can both increase MBNL1 protein levels; however, these changes are not suffcient for significant correction of downstream spliceopathies.

Outcomes following surgical management of femoroacetabular impingement: a systematic review and meta-analysis of different surgical techniques

Outcomes following different types of surgical intervention for femoroacetabular impingement (FAI) are well reported individually but comparative data are deficient. The purpose of this study was to conduct a systematic review (SR) and meta-analysis to analyze the outcomes following surgical management of FAI by hip arthroscopy (HA), anterior mini open approach (AMO), and surgical hip dislocation (SHD). This SR was registered with PROSPERO. An electronic database search of PubMed, Medline, and EMBASE for English and German language articles over the last 20 years was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We specifically analyzed and compared changes in patient-reported outcome measures (PROMs), α-angle, rate of complications, rate of revision, and conversion to total hip arthroplasty (THA). A total of 48 articles were included for final analysis with a total of 4,384 hips in 4,094 patients. All subgroups showed a significant correction in mean α angle postoperatively with a mean change of 28.8° (95% confidence interval (CI) 21 to 36.5; p < 0.01) after AMO, 21.1° (95% CI 15.1 to 27; p < 0.01) after SHD, and 20.5° (95% CI 16.1 to 24.8; p < 0.01) after HA. The AMO group showed a significantly higher increase in PROMs (3.7; 95% CI 3.2 to 4.2; p < 0.01) versus arthroscopy (2.5; 95% CI 2.3 to 2.8; p < 0.01) and SHD (2.4; 95% CI 1.5 to 3.3; p < 0.01). However, the rate of complications following AMO was significantly higher than HA and SHD. All three surgical approaches offered significant improvements in PROMs and radiological correction of cam deformities. All three groups showed similar rates of revision procedures but SHD had the highest rate of conversion to a THA. Revision rates were similar for all three revision procedures.

Poor Correction Capacity of Preexisting Ankle Valgus Deformity after Total Knee Arthroplasty

This study investigated the differences in ankle alignment changes after TKA in patients with varying preexisting ankle deformities. We retrospectively examined 90 knees with osteoarthritis and varus deformity in 78 patients who underwent TKA. Preoperative and postoperative radiographic parameters were analyzed. According to their preexisting ankle deformity, patients were assigned to the valgus or varus group. Overall, 14 (15.6%) cases were of preoperative valgus ankle deformity; the remainder were of preoperative varus ankle deformity. Hip–knee–ankle angle (HKA), tibial plafond–ground angle (PGA), and talus–ground angle (TGA) all exhibited significant correction in both groups; however, tibial plafond–talus angle (PTA) and superior space of ankle joint (SS) only changed in the varus group. The median PTA and SS significantly decreased from 1.2° to 0.3° (p < 0.001) and increased from 2.5 to 2.6 mm (p = 0.013), respectively. Notably, ∆PTA positively correlated with ∆HKA in the varus group (r = 0.247, p = 0.032) but not in the valgus group. Between-group differences in postoperative PTA (p < 0.001) and ∆PTA (p < 0.001) were significant. The degree of ankle alignment correction after TKA differed between patients with preexisting varus and valgus ankle deformities. TKA could not effectively correct the preexisting ankle valgus malalignment.

MANAGEMENT OF GARBHODAKAVRIDDHI W.S.R. TO POLYHYDRAMNIOS THROUGH AYURVEDA - A CASE REPORT

Introduction: Polyhydramnios is a relatively common clinical presentation in pregnancy with a varying incidence of 1-2% of cases. There is yet no data suggestive of improvement in perinatal outcome with antenatal fetal surveil- lance. Since it is associated with significant perinatal morbidity and mortality, fixing up a standard treatment pro- tocol for its management is needed. Case Description: A 28-year-old female patient consulted Prasutitantra and Streeroga OPD, NIA Hospital, Jaipur complaining of difficulty in breathing, palpitations, hyperacidity for 15 days with 8 months of amenorrhea. Diagnosis: Based on abdominal examination and radiological findings, the case was diagnosed with polyhydramnios. On the correlation of symptoms as stated by Acharya Sushruta, Ayurvedic diag- nosis of Garbhavriddhi was made. Intervention: As in the management of garbhavriddhi, practices involving appropriate samshodhana (purifying) and sanshamana (suppressive) yet kshaya-avirodhi karma (not causing loss of dosha or dhatu below optimal range) are prescribed. Hence, an intervention of Ksheerabasti with Punar- navashtaka Kwatha was done along with the oral medication in the present study. Outcome: USG done after 7 days of treatment course showed significant correction in AFI as well relief from clinical symptoms. Conclusion: This case illustrates that Polyhydramnios can be managed effectively and safely with Punarnavashtaka kwatha ksheera basti. Mutrajanana, Srotoshodhana, Kledapachana, and Shothaghna are the main actions essential in its manage- ment. Keywords: Garbhavriddhi, Polyhydramnios, Punarnavashtaka kwatha, Ksheera basti

Use of torso orthoses in the treatment of congenital spinal deformities: A literature review

BACKGROUND: Congenital malformations of the spine require urgent treatment, despite the popularity of this problem. The choice of the term and method of surgical treatment of congenital spinal deformities with vertebral malformations does not have diametrically opposed views in the domestic and foreign literature, but the scientific discussion continues regarding the use of orthotics. Currently, several designs of orthoses on the trunk are known worldwide, which can be used not only for idiopathic but also for congenital scoliosis. А unified view of the use of this type of complex treatment is necessary, but there are opposite opinions in the scientific literature. AIM: This study aimed to analyze publications that present the use of torso orthoses in the treatment of congenital malformations of the spine. MATERIALS AND METHODS: We searched for data in the open electronic databases of PubMed and e-LIBRARY using the following keywords and phrases: congenital deformity of the spine, congenital scoliosis, orthosis, and effectiveness of orthosis. The search covered 30 years of literature. RESULTS: Several authors have reported a significant correction of the congenital curves using orthotics, but this issue has not been sufficiently studied and is still at the research stage. Some specialists consider the formation or progression after the operation of compensatory counter-curve above or below the established metal structure, which can be corrected not only by repeated surgery, but also by using orthoses. CONCLUSIONS: There is a clear trend toward complex treatment of children with isolated congenital malformations of the spine, including a reasonable combination of surgical treatment and orthotics. In Europe and Russia, preference is given to the Rigo system Cheneau brace.

Inhibition of Adenylate Cyclase of Regeneration-Competent Cells of Nervous Tissue: a Novel Approach for the Treatment of Alcoholic Encephalopathy

Researching new pharmacological targets and developing highly effective drugs to treat ethanol-induced encephalopathy is an urgent task of neuroscience and pharmacology. The work aimed to study the neuroprotective and neuroregenerative effects of adenylate cyclase (AC) inhibitors in modeling alcoholic encephalopathy in experimental animals. The morphofunctional repair of the brain and the functioning of progenitors (neural stem cells (NSC) and neuronal-committed progenitors (NCP)) and neuroglial cells (astrocytes, oligodendrocytes, microglial cells) of the subventricular zone of the cerebral hemispheres (SVZ) have been investigated. A significant correction of brain morphological changes, disorders of exploratory behavior, and conditioned reflex activity in laboratory animals under the influence of the AС inhibitor were revealed. Increased proliferation of both types of progenitor cells and accelerated differentiation of the NSC were observed when AC inhibitors were administered to mice with neurodegeneration. Improved neurotrophin secretion by astrocytes and microglia was also identified. The findings show the promise of developing a novel approach to treating alcohol-induced encephalopathy with AC inhibitors.