Different stages of microbial community during the anaerobic digestion of food waste.

Large-scale food waste (FW) disposal has resulted in severe environmental degradation and financial losses around the world. Although FW has a high biomass energy contents and a growing large number of national projects to recover energy from FW by anaerobic digestion (AD) are being developed. AD is a promising solution for FW management and energy generation when compared to typical disposal options including landfill disposal, incineration, and composting. AD of FW can be combined with an existing AD operation or linked to the manufacture of value-added products to reduce costs and increase income. AD is a metabolic process that requires four different types of microbes: hydrolyzers, acidogens, acetogens, and methanogens. Microbes use a variety of strategies to avoid difficult situations in the AD, such as competition for the same substrate between sulfate-reducing bacteria and methane-forming bacteria. An improved comprehension of the microbiology involved in the anaerobic digestion of FW will provide new insight into the circumstances needed to maximize this procedure, including its possibilities for use in co-digestion mechanisms. This paper reviewed the present scientific knowledge of microbial community during the AD and the connection between microbial diversity during the AD of FW.

Potentially toxic elements in groundwater of the upper Brahmaputra floodplains of Assam, India: water quality and health risk.

This paper presents the groundwater quality assessment of the upper Brahmaputra floodplains of Assam on a seasonal basis. A total of 88 samples were analyzed for the presence of potentially toxic elements in two seasons. In addition, an attempt is made to identify any possible associated health risks to the residents via the drinking water pathway. The study reveals the presence of various potentially toxic elements, in particular, manganese, iron, nickel, and fluoride concentration exceeding the drinking water specifications set by BIS and WHO drinking water standards. The degree of groundwater contamination was assessed using the Water Quality Index, Heavy metal Pollution Index, Heavy metal Evaluation Index, and Degree of Contamination. The spatial distribution maps of groundwater quality were prepared using geographical information system. The non-carcinogenic health risk was evaluated using hazard quotients and hazard index as per the United States Environmental Protection Agency methodology. The hazard quotient of fluoride and manganese have values > 1, which exceeds USEPA recommended benchmark. The health risk assessment identified that the risk was highest during the pre-monsoon season, and the child population is more vulnerable to non-carcinogenic risk than the adults. Findings of cancer risk identified that pre-monsoon groundwater samples from the Golaghat District pose the highest health risks in the upper Brahmaputra floodplains. The risk is highest in the southwest of the study area, followed by the south and then by the north.

Remediation of noxious wastewater using nanohybrid adsorbent for preventing water pollution.

Removal of toxic elements from wastewater effluent has got a lot of attention because of their severe negative effects on human and environmental health. In the past few years, rapid urbanization and industrial activities in developing countries have exacerbated the destruction of the environment. Most of the wastewater effluents are discharged untreated or inadequately treated, which has become a major concern due to its impact on sustainability and the environment. This is imperative to implement, innovative and resourceful wastewater treatment technologies requiring low investment. Among the various treatment technologies, cutting-edge processes in nano-material sciences have recently piqued the interest of scientists. Nanohybrid absorbents have the potential in improving wastewater treatment and increase water supply by utilizing unconventional water resources. Carbon nanotubes, titanium oxide, manganese oxide, activated carbon (AC), magnesium oxide, graphene, ferric oxides, and zinc oxide are examples of nano-adsorbents that are used to eliminate pollutants. This also demonstrated the effective removal of contaminants along with the harmful effects of chemicals, colorants, and metals found in wastewater. The present manuscript examines potential advances in nanotechnology in wastewater treatment for the prevention of water and soil pollution. This systematic review aims to highlight the importance of nanohybrid absorbents treatment technology for wastewater treatment and to explain how nanohybrid absorbents have the potential to revolutionize industrial pollution. There are also other published review articles on this topic but the present review covers an in-depth information on nano-adsorbents and their targeted contaminants.

Outcome Analysis of Anterior Reconstruction with Rib Grafts in Tuberculosis of the Thoracic Spine.

INTRODUCTION: Tricortical iliac bone is the gold standard as an autograft for the reconstruction of the anterior column in tuberculosis (TB) of the thoracic spine. However, the quantity of graft needed is significant. It creates a considerable defect in the pelvic bone, causing graft site complications, including pain, pelvic instability, fractured ilium, herniated muscle, or abdominal contents. To prevent these donor site morbidities, ribs that were removed during the versatile approach were used for anterior reconstruction. The aim of this study was to assess the clinical and radiological results of the reconstruction of the anterior column of the spine with the help of an excised rib during the versatile approach. SUBJECTS AND METHODS: This retrospective study was undertaken at a tertiary care center with a study duration of 14 years. Between January 2004 and December 2016, 52 patients with thoracic Koch's spine had anterior column reconstructed with multiple rib grafts. A single surgeon performed all operations. Indications for the surgery in these patients were the presence of neurologic deficit (49 patients) and vertebral column instability (3 patients). The preoperative kyphosis angle and visual analog scale (VAS) score were compared with postoperative values using a paired t-test. RESULTS: All patients underwent a minimum follow-up of 18 months and were evaluated clinicoradiologically. Good bony fusion with neurological recovery was achieved in all cases. The VAS score for back pain improved significantly postsurgery. There was one case of graft buckling treated conservatively. DISCUSSION: Appropriate anterior reconstruction forms the cornerstone of successful surgical management of spinal TB. The "Versatile approach" used offers anterior and posterior access in the lateral position. In these patients, we obviated the need for iliac crest graft using multiple segments of the rib for anterior column reconstruction. This meticulous rib grafting technique gives good functional outcome in terms of solid bony fusion. CONCLUSION: Meticulous rib grafting technique gives 360° bony fusion and good functional outcome in surgery for thoracic spinal TB. It has the advantage of avoiding the complications associated with a tricortical iliac crest graft.

Surgical Management of Hirayama Disease: A Rare Entity with Unusual Clinical Features.

Hirayama disease (HD) is a rare type of cervical myelopathy in young males due to neck flexion causing cervical cord atrophy and asymmetric flattening with preferential involvement of anterior horn cells of the spinal cord. This is due to forward displacement of the cord during neck flexion getting compressed between the posterior part of the vertebral body and the posterior dura. The spinal cord involvement occurs due to repeated flexion and extension motion of the neck leading to selective spinal cells injury and atrophy. Most cases report an asymmetric lower motor neuron type of weakness predominantly involving the forearm and hand muscles. We report here a case of HD in an 18-year-old male who presented to us with weakness and wasting in the right hand. The patient was progressively symptomatic over a period of 1 year before presentation. The etiology and the exact cause of HD largely remain debatable and rely on the understanding of few theories which have been put forward. The natural history of this disease reaches a plateau in terms of neurological involvement after 2-5 years and is considered a self-remitting disorder. The patient was initially managed with a cervical collar immobilization but symptoms were largely not improving which was attributed to poor brace compliance. The patient was then managed surgically with a posterior lateral mass instrumentation without fusion in a lordotic alignment at the levels of maximal dural shift anteriorly. The patient improved neurologically following the surgery and maintained the intact status at the last follow-up.

Dystopic Os Odontoideum Causing Cervical Myelopathy: A Rare Case Report and Review of Literature.

Os odontoideum (OO) was first described by Giacomini in 1886 as separation of the odontoid process from the body of the axis. Instability can consequently occurs at this level due to the failure of the transverse atlantal ligament (TAL) and this atlantoaxial instability can be a cause of progressive neurological deficits. It is considered a rare anomaly of the odontoid process. It is a disease with controversial etiology, debatable incidence, and only a partly known natural history owing to the paucity of the literature on this topic. There are insufficient demographic data about the occurrence of the disease, and most of the management is dictated by the isolated case reports and few studies which have been carried out at handful of institutes. OO is classified into two types by Fielding et al. based on the anatomic location: orthotopic and dystopic. Orthotopic OO consists of an ossicle that moves with the anterior arch of the atlas, whereas the dystopic type presents as an ossicle near the basion or one that is fused with the clivus. In one magnetic resonance imaging (MRI) study of odontoid morphology, a 0.7% (1 case of 133 patients) incidence was reported. The spectrum of the clinical presentation varies from completely asymptomatic individuals to patients presenting with features of cervical myelopathy. Here, we present a case of 35-year-old-male with dystopic OO who presented to us with features of gradually progressing cervical myelopathy without any obvious history of neck trauma. On investigations, he was found to have atlantoaxial instability with wide atlanto-dens interval. He was treated with the posterior C1-C2 stabilization and reduction of atlantoaxial instability.

Apical Vertebral Column Resection with Sagittal Rotation and Controlled Anterior Opening and Posterior Closing Maneuver for the Treatment of Severe Post-Tubercular Kyphosis: Case Series and Literature Review.

STUDY DESIGN: Retrospective case series. PURPOSE: Describe the technique and evaluate the outcome of apical vertebral column resection (VCR) with sagittal rotation and anterior opening and posterior closing (AOPC) maneuver for correction of severe post-tubercular kyphosis (PTK). OVERVIEW OF LITERATURE: The surgical procedures described for the correction of PTK are VCR, pedicle subtraction osteotomy, transpedicular decancellation osteotomy, and closing-opening osteotomy. METHODS: We retrospectively evaluated 21 patients who had been operated on with single stage apical VCR with AOPC maneuver. Radiographs were obtained before surgery and at regular follow-up intervals. These were used to calculate the angle of kyphosis. Back pain was rated using the Visual Analog Scale (VAS) and neurological status was graded using Frankel grading. Radiological outcome was assessed by the improvement in the angle of kyphosis and fusion following surgery. Neurological status was assessed using Frankel grading. RESULTS: The study included eight males and 13 females with a mean age of 21.9 and average follow-up time of 30.4 months. The average number of vertebral bodies destroyed was 2.57. Kyphosis was improved from a mean of 68.42°±13.23° preoperative to 8.71°±4.58° postoperative. The average correction achieved was 87.10%. Preoperative VAS score improved from a mean of 6.38±0.92 preoperative to 1.38±0.49 postoperative. No patients had any sign of neurological deterioration. Seven out of eight patients with a preoperative neurological deficit improved following surgery. Two patients developed superficial wound maceration, one had persistent postoperative hypotension, and the other developed hemothorax. All patients recovered fully without a need for additional surgery. CONCLUSIONS: Single stage simultaneous anterior column lengthening and posterior column shortening is an effective method for surgical correction of severe PTK.

The Versatile Approach: A Novel Single Incision Combined with Anterior and Posterior Approaches for Decompression and Instrumented Fusion to Treat Tuberculosis of the Thoracic Spine.

STUDY DESIGN: Retrospective case series. PURPOSE: To describe a novel single incision that combines anterior and posterior approaches for decompression and instrumented fusion to treat tuberculosis of the thoracic spine and study the neurological and radiological outcomes. OVERVIEW OF LITERATURE: Tuberculosis of the spine remains a major health issue in many developing countries. The options for treating tuberculosis of the thoracic spine include the anterior, posterior, and combined approaches, each with its advantages and disadvantages. METHODS: Totally, 143 patients with tuberculosis of the thoracic spine were surgically treated using the "Versatile approach". Posterior fixation was performed using sublaminar wires and a Hartshill rectangle in all patients. Anterior reconstruction was accomplished using bone graft harvested from autologous rib, iliac crest, or fibula. RESULTS: The study included 45 males and 98 females, with a mean age of 33.18±18.65 years (range, 3-82 years) and a mean follow-up of 60.23±24.56 months (range, 18-156 months). Kyphosis improved from a mean value of 24.02 preoperatively to 10.25 postoperatively. A preoperative neurological deficit was observed in 131 patients, with 130 patients regaining ambulatory power. No patient had deterioration of neurological status following surgery. Fusion was achieved in all cases. The visual analogscale score improved from an average score of 7.02 preoperatively to 1.51 at final follow-up. Eight patients had superficial macerations, which healed spontaneously. One patient had buckling of the anterior graft, and one patient had implant breakage following road traffic accident. CONCLUSIONS: The "Versatile approach" is an effective, single-stage, single-incision method that combines anterior and posterior approaches for the surgically treating tuberculosis of the thoracic spine. It offers the advantage of direct visualization for decompression and reconstruction of the anterior and posterior vertebral columns, thus providing an excellent, long-lasting clinical outcome.

Vanishing bone disease of chest wall and spine with kyphoscoliosis and neurological deficit: A case report and review of literature.

Vanishing bone disease is an extremely rare disorder of unknown etiology characterized by idiopathic osteolysis of bone. We describe a case of vanishing bone disease of chest wall and spine with kyphoscoliosis and neurological deficit. A 17-year-old male presented with gradually progressive deformity of back and dorsal compressive myelopathy with nonambulatory power in lower limbs. Radiographs revealed absent 4th-7th ribs on the right side with dorsal kyphoscoliosis and severe canal narrowing at the apex. The patient was given localized radiotherapy and started on a monthly infusion of 4 mg zoledronic acid. Posterior instrumented fusion with anterior reconstruction via posterolateral approach was performed. The patient had a complete neurological recovery at 5 weeks following surgery. At 1 year, anterior nonunion was noted for which transthoracic tricortical bone grafting was done. Bone graft from the patient's mother was used both times. At 7 months following anterior grafting, the alignment was maintained and the patient was asymptomatic; however, fusion at graft-host interface was not achieved. Bisphosphonates and radiotherapy were successful in halting the progress of osteolysis.

Giant Cervical Osteophyte: An Unusual Cause of Dysphagia.

Dysphagia due to skeletal causes is a rare entity. A large cervical osteophyte can cause mechanical compression of the pharyngo-oesophageal segment leading to dysphagia. Large cervical osteophytes can occur in cervical spondylosis, ankylosing spondylitis or Diffuse Idiopathic Skeletal Hyperostosis (DISH). A 60-year-old female came with progressive dysphagia due to a giant cervical osteophyte anterior to C4 and C5 vertebral bodies causing compression of the pharyngo-oesophageal segment. The patient was treated by surgical excision of the osteophyte by orthopaedic surgeons. The patient had complete relief of dysphagia following excision of the osteophyte.

Neglected dislocation in sub-axial cervical spine: Case series and a suggested treatment protocol.

CONTEXT: Approaches suggested for treatment of neglected dislocations in the subaxial cervical spine (SACS) include only anterior approach (a), only posterior approach (b), posterior-anterior approach, posterior-anterior-posterior approach, and anterior-posterior-anterior-posterior approach. No protocol is suggested in literature to guide surgeons treating neglected dislocations. AIM: To describe a protocol for the treatment of neglected dislocation in the SACS. SETTINGS AND DESIGNS: Retrospective case series and review of literature. MATERIALS AND METHODS: Six consecutive patients of neglected dislocation (presenting to us more than 3 weeks following trauma) of the SACS were operated as per the protocol suggested in this paper. A retrospective review of the occupational therapy reports, patient records, and radiographs was performed. Only cases with time lapse of more than 3 weeks between the time of injury and initial management have been included in the review. RESULTS: Closed reduction (CR) was achieved in three patients following cervical traction and these were managed by anterior cervical discectomy and fusion (ACDF). Open reduction via posterior approach and soft tissue release was required to achieve reduction in two patients. Following reduction posterior instrumented fusion was done in them. One patient with preoperative neurological deficit needed a facetectomy to achieve reduction. Following short-segment fixation, ACDF was also performed in this patient. None of the patients deteriorated neurologically following surgery. Fusion was achieved in all patients. CONCLUSIONS: Preoperative and intraoperative traction have a role in the management of neglected dislocations in the cervical spine. If CR is achieved the patient may be managed by ACDF. If CR is not achieved, posterior soft tissue release may be done to achieve reduction and partial facetectomy must be reserved for cases in which reduction is not achieved after soft tissue release. A treatment protocol for management of neglected dislocation in the SACS has been suggested in this paper.

Prediction of surgical outcome in compressive cervical myelopathy: A novel clinicoradiological prognostic score.

CONTEXT: Preoperative severity of myelopathy, age, and duration of symptoms have been shown to be highly predictive of the outcome in compressive cervical myelopathy (CCM). The role of radiological parameters is still controversial. AIMS: Define the prognostic factors in CCM and formulate a prognostic score to predict the outcome following surgery in CCM. SETTINGS AND DESIGN: Retrospective. MATERIALS AND METHODS: This study included 78 consecutive patients with CCM treated surgically. The modified Japanese Orthopaedic Association (mJOA) scale was used to quantify severity of myelopathy at admission and at 12-month follow-up. The outcome was defined as good if the patient had mJOA score ≥16 and poor if the score was <16. Age, sex, duration of symptoms, comorbidities, intrinsic hand muscle wasting (IHMW), diagnosis, surgical technique, Torg ratio, instability on dynamic radiographs, and magnetic resonance imaging (MRI) signal intensity changes were assessed. STATISTICS: Statistical Package for the Social Sciences (SPSS) (version 20.0) was used for statistical analysis. The association was assessed amongst variables using logistic regression analysis. Parameters having a statistically significant correlation with the outcome were included in formulating a prognostic score. RESULTS: Severity of myelopathy, IHMW, age, duration, diabetes, and instability on radiographs were predictive of the outcome with a P value <0.01. Genders, diagnosis, surgical procedure, Torg ratio, and intensity changes on MRI were not significantly related to the outcome. A 8-point scoring system was devised incorporating the significant clinicoradiological parameters, and it was found that nearly all patients (97.82%) with a score below 5 had good outcome and all patients (100%) with a score above 5 had poor outcome. The outcome is difficult to predict with a score of 5. CONCLUSIONS: Clinical parameters are better predictors of the outcome as compared to radiological findings, following surgery in CCM. A simple scoring system based on clinicoradiological parameters is suggested in this paper to predict the outcome following surgery in cases of CCM.

Congenital Absence of Posterior Elements of C2 Vertebra with Atlanto-Axial Dislocation and Basilar Invagination: A Case Report and Review of Literature.

Developmental anomalies of the axis are commonly encountered, especially anomalies involving the odontoid process. Anomalies of the posterior elements are uncommon. We describe a unique case of agenesis of posterior elements of C2 with basilar invagination and atlanto-axial dislocation. An obese 8-year-old boy presented with symptoms of cervical myelopathy. Radiological workup revealed a craniovertebral junction anomaly with occipitalised atlas, absent posterior elements of axis, and hypertrophied C3 spinous process. Atlanto-axial instability and basilar invagination was present. Magnetic resonance angiography revealed hypoplastic left vertebral artery. Traction with cervical tongs failed to improve the alignment and symptoms. Anterior trans-oral release, followed by posterior decompression and custom-made instrumentation, was done. The patient recovered completely and was asymptomatic at the end of two years. X-ray and computed tomography scan demonstrated reduction of basilar invagination and maintenance of alignment. This is the first case to be reported of agenesis of posterior elements of axis associated with basilar invagination. One should look for this condition in patients with hypertrophied spinous process of C3. Utilization of hypoplastic pedicle of axis serves as an additional fixation point to increase the stability of the construct.

Single-stage anterior release and posterior instrumented fusion for irreducible atlantoaxial dislocation with basilar invagination.

BACKGROUND CONTEXT: The options available for treatment of irreducible atlantoaxial dislocation (IAAD) with basilar invagination are odontoidectomy, posterior decompression, and posterior atlantoaxial joint distraction. In 2006, Wang et al. described that most IAAD can be reduced following anterior release of contracted soft tissues. Anterior release may be done by transoral (TO) or retropharyngeal (RP) approach. Posterior instrumented fusion provides stability and helps in achieving further reduction. PURPOSE: This study aimed to study the neurologic and radiological outcome following treatment of basilar invagination associated with IAAD by anterior release and posterior instrumented fusion. STUDY DESIGN: A retrospective case series was carried out. PATIENT SAMPLE: The patient sample comprised 19 patients with IAAD. OUTCOME MEASURE: Patients were assessed for neurologic recovery by Benzel modified Japanese Orthopaedic Association (mJOA) score and radiologically by assessing reduction on lateral radiographs and comparing clivus-canal angle (CCA) on preoperative and postoperative computed tomography scan. METHODS: Nineteen consecutive patients with IAAD were surgically treated. Anterior release was done via TO approach in 12 patients and RP approach in 7. Following anterior release, all patients underwent posterior instrumented fusion. RESULTS: This study included 15 men and 4 women with mean follow-up of 18 months. Pathology included occipitalization of atlas in 16 patients, os odontoideum in 2, and missing posterior elements of axis in 1. All patients had cervical myelopathy. Occipitocervical fixation was done in 18 patients and C1-C2 transarticular screw fixation in 1. Fifteen patients had anatomical reduction whereas four had partial reduction. The CCA improved from a mean preoperative angle of 111.47° to mean postoperative angle of 142.84°. The mJOA improved from preoperative mean mJOA of 12.89 to a postoperative mean mJOA of 16.84. Fusion was achieved in all patients. Maceration of posterior wound which healed by daily cleaning and dressing was noted in three patients. Implant breakage on one side was noted in 1 patient at 3 months post operation; however, the patient remained asymptomatic. CONCLUSION: This series reinforces the safety and efficacy of both TO and RP anterior release for reduction of IAAD. Posterior fixation helps in achieving further reduction and provides stability. Anterior release followed by instrumented posterior fusion is a safe and effective modality of treatment for IAAD associated with basilar invagination.

Neglected hangman fracture.

Acute management of hangman fracture is well described; however the surgical management of neglected hangman fracture has not been described in literature. We report the surgical management of an untreated hangman's fracture. A 30-year-old male had fallen from a tree 12 weeks back. Patient presented with cervical myelopathy and restricted neck movements. Radiographs and computed tomography (CT) scan revealed fracture of pars interarticularis of axis with Grade III C2-C3 spondylolisthesis with localized kyphosis of 33°. Gentle reduction under general anesthesia (GA) failed to improve the alignment. Patient was operated in three stages in a single setting. In Stage I, release of contracted anterior structures and C2-C3 discectomy was done in supine position followed by C2-C3 posterior fixation and fusion in Stage II. C2-C3 interbody bone grafting and anterior plating completed the third stage. C2-C3 interbody fusion was seen at 5 months and a CT scan at 18 months postoperative confirmed fusion and maintenance of alignment. The satisfactory outcome in our patient leads us to believe that anterior-posterior-anterior is the appropriate surgical approach for treatment of such patients.

Evidence for the presence of novel ß-melatonin receptors along with classical α-melatonin receptors in the fish Rasbora daniconius (Ham.).

The effects of melatonin (MT) were examined on the isolated scale melanophores from dorso-lateral (D-L) and band regions of a tropical fish Rasbora daniconius. Our study primarily aimed for further depiction of the signaling receptors involved in MT mediated pigment translocations in the fish. Melanophore Size Index (MSI) was employed as a recording parameter for the responses of melanophores to MT and various antagonists. MT has induced aggregation as well as dispersion in D-L region and aggregation in band region melanophores during summer season. During winter, MT-induced responses were only of aggregatory type in D-L region, while in the band region there was an increase in the sensitivity. The responses of the melanophores to MT were reversible. The aggregation of innervated melanophores induced by MT on the D-L and band regions was partially mediated through the neurotransmitters released under the influence of MT and partially by the specific MT receptors. Luzindole and K185 have completely blocked the aggregatory responses of D-L and band region melanophores. Aggregatory receptors may be of the conventional α-MT type. Dispersion of D-L and band region melanophores induced by MT in the presence of various antagonists and on denervated band region could be the result of activation of ß-MT receptors of dispersive nature. Presence of α and ß MT receptors is thus indicated in this fish melanophores.

Responses of isolated scale melanophores of a fresh water carp, Cirrhinus mrigala (Ham.) to zidovudine.

Zidovudine (AZT) induced concentration related aggregation in C. mrigala melanophores. Denervated melanophores failed to respond to AZT. Specific and nonspecific alpha adrenoceptor antagonists completely blocked the responses of fish melanophores to AZT. Histamine and prostaglandin antagonists also inhibited aggregation of the melanophores induced by AZT. The results suggest that AZT may release a mixture of neurotransmitter like substances, which cause the aggregation of this fish melanophores.