The complex effect of dissolved organic carbon on desorption of per- and poly-fluoroalkyl substances from soil under alkaline conditions.

Per- and poly-fluoroalkyl substances (PFASs) are contaminants of emerging concern, yet the understanding of factors that control their leaching and release from contaminated soils remains limited. This study aimed to investigate the impact of dissolved organic carbon (DOC) on the release of PFASs-specifically, perfluorohexane sulfonate (PFHxS), perfluorooctane sulfonate (PFOS), and perfluorooctanoic acid (PFOA)from soils contaminated by aqueous film forming foam (AFFF). Batch aqueous leaching experiments were conducted on AFFF-contaminated soils under alkaline solution conditions (pH 9.5, 10.5, and 12) as it enhances leaching of both PFAS and DOC. Leaching of PFOS was significantly increased under alkaline conditions. Although the leaching of PFAS generally increased with pH, PFOS appeared to be more retained under the very alkaline pH conditions used in this study. At the same solution pH, leaching of PFOS and DOC was less in Ca(OH)2 than in NaOH. The retention of PFOS under these conditions may be attributable to the shielding of the negative charge of the soil components and colloids (e.g., DOC and clay minerals) in the leachates and/or the screening of negative charges on head groups of PFOS due to the high concentration of divalent cations. Solution chemistry affected desorption of PFOS more than PFHxS and PFOA. The study highlights that the influence of DOC on PFAS leaching and transport can be very complex, and depends on leachate chemistry (e.g., pH and cation type), PFAS chemistry, the magnitude of PFAS contamination and factors that influence the solid:liquid partitioning of organic carbon in soil.

Effect of rheological models on pulsatile hemodynamics in a multiply afflicted descending human aortic network.

In the cardiovascular diseased (CVD) conditions, it is essential to choose a suitable rheological model for capturing the correct physics behind the hemodynamic in the multiply afflicted diseased arterial network. This study investigates the effect of blood rheology on hemodynamics in a blood vessel with abdominal aortic aneurysm (AAA) and right internal iliac stenosis (RIIAS). A model with AAA and RIIAS is reconstructed from a human subject's computed tomography (CT) data. Localized mesh generation and pulsatile inflow condition are considered. Non-Newtonian models such as the Power-law, Carreau, Cross, and Herschel Berkley models are used in simulations. The outcome from a validated computational model is compared with the Newtonian model to identify the suitable model for dealing with pathological complications under consideration. The capabilities and significance of various rheological models are also examined via Wall Pressure (WP), Wall Shear Stress (WSS), velocity, Global non-Newtonian importance factor (IG), Vorticity Streamlines, and Swirling Strength. It is noted that during the entire cardiac cycle, the IG factor of the cross model is found to be relatively more significant. Power Law depicts larger IG factor during peak systole and early diastole. Also, the cross model depicts larger WSS, WPS, swirling strength distribution and vorticity during the peak systolic and diastolic phases It is noted that IG ∼0.02 is an appropriate non-Newtonian blood activity cut-off value in the descending abdominal artery having AAA and RIIAS. The critical important WSS values are in the range of 0-9 Pa which is stated in WSS contour plot.

Role of Screening Lung Function Tests in a Routine Health Checkup.

Background and objectives The lung function test is a gold standard, guideline-recommended test to detect obstructive airway diseases like asthma and COPD. It is of considerable value in detecting the presence and severity of airflow obstruction in patients with respiratory symptoms. However, the role of spirometry in a routine health checkup is controversial. Spirometry, when used in routine health checkup settings as a case-finding tool for all adults with persistent respiratory symptoms or having a history of exposure to risk factors, is likely to label a relatively large proportion of individuals as diseased with airflow obstruction. Conversely, spirometry is normal in a relatively large percentage of adults who report respiratory symptoms including dyspnea, the respiratory symptom having the greatest impact on quality of life. The objective of this study is to determine the utility of spirometry as a screening test to detect airflow obstruction in otherwise healthy subjects undergoing a routine health checkup. Methods This observational study was conducted with 538 health checkup individuals aged 18 and over. A brief history was taken prior to the test. Lung function tests were performed and interpreted as per the Global Initiative for Chronic Obstructive Lung Disease criteria. The anthropometric and spirometric data obtained were compared to other population-based spirometric studies to compare the prevalence of airflow limitation, the risk factors, and smoking history. Results Of the total 538 subjects incorporated in the study, 305 (57%) were males and 233 (43%) were females aged between 18 to 80 years with a mean age of 45 years. The male-to-female ratio was 1.3:1 with a mean BMI of 25.9. The overall yield from lung function tests in detecting airflow obstruction was 63 subjects (11.7%), of which 36 (11.8%) were males and 27 (11.5%) were females. Seventy-three subjects (13.5%) were classified as having a small airway obstruction, of which 34 were males (46.6%), and 39 were females (53.4%). The distribution of airflow obstruction by age was with eight subjects (5.4%) in the 18-35 group, 21 subjects (7.8%) in the 36-55 group, and 34 (25%) in the elderly (>55) age group. Although overall smoking history showed no significant association with developing airflow obstruction, significant association with smoking was found in the elderly (>55) age group. Interpretation and conclusions The results of the study suggest that lung function tests should be included in routine health checkups in the subset of individuals greater than 35 years of age with or without a history of smoking, in all age groups with a family history of asthma, in individuals with respiratory symptoms and in individuals greater than 55 years of age with a moderate history of smoking.

Effect of heavy metal co-contaminants on the sorption of thirteen anionic per- and poly-fluoroalkyl substances (PFAS) in soils.

Understanding the sorption behavior of per- and poly-fluoroalkyl substances (PFAS) in soils are essential for assessing their mobility and risk in the environment. Heavy metals often coexist with PFAS depending on the source and history of contamination. In this study, we investigated the effect of heavy metal co-contaminants (Pb2+, Cu2+ and Zn2+) on the sorption of 13 anionic PFAS with different perfluorocarbon chain length (C3-C9) in two soils with different properties. Results revealed that Pb2+, Cu2+ and Zn2+ had little effect on the sorption of most short-chain compounds, while the presence of these heavy metals enhanced the sorption of long-chain PFAS in two soils. The distribution coefficients (Kd) of several long-chain PFAS linearly increased with increasing concentrations of heavy metal, especially in the presence of Pb2+ (ΔKd/Δ [Pb2+] > 3 for PFOS and PFNA vs <1 for PFPeS and PFHxS). While several mechanisms may have contributed to the enhancement of sorption of PFAS, the heavy metals most likely contributed through enhanced hydrophobic interactions of PFAS by neutralizing the negative charge of adsorption surfaces in soils and thus making it more favorable for their partitioning onto the solid phase. Moreover, the increase in the concentrations of heavy metals led to a decrease in the pH of the system and promoted sorption of long-chain compounds, especially in soil with lower organic carbon content. Overall, this study provides evidence that the presence of co-existing heavy metal cations in soils can significantly enhance the sorption of long-chain PFAS onto soil, thereby potentially limiting their mobility in the environment.

Photoluminescence behavior of rare earth doped self-activated phosphors (i.e. niobate and vanadate) and their applications.

In the present study, the photoluminescence behaviors of rare earth doped self-activated phosphors are discussed briefly. Different techniques were used to develop these phosphor samples. We prepared pure and rare earth doped phosphor samples to look for their various applications. The structural confirmations and surface morphologies were performed using X-ray diffraction (XRD) and scanning electron microscopy (SEM) measurements, respectively. The upconversion (UC) phenomenon was investigated in Tm3+/Yb3+ and Ho3+/Yb3+ co-doped niobate and vanadate based phosphors, which gave intense blue/NIR and green/red emissions with a 980 nm diode laser as an excitation source. Pure niobate and vanadate phosphor materials are self-activated hosts which give broad blue emission under UV excitation. Upon UV excitation, intense broad blue emission along with sharp emissions due to Tm3+ and Ho3+ ions are observed via energy transfer between niobate/vanadate and rare earth ions. These self-activated hosts show prominent downshifting (DS) behavior. Broad band quantum cutting (QC) was observed in these self-activated hosts, in which a blue emitting photon is converted into two NIR photons by co-doping Yb3+ ions in it. The multimodal (upconversion, downshifting and quantum cutting) behaviors of these phosphors make them very promising in various applications, such as spectral converters to enhance the efficiency of a c-Si solar cell, security ink and color tunable materials.

Process temperature-dependent interface quality and Maxwell-Wagner interfacial polarization in atomic layer deposited Al2O3/TiO2 nanolaminates for energy storage applications.

Considering the excellent tunability of electrical and dielectric properties in binary metal oxide based multi-layered nanolaminate structures, a thermal atomic layer deposition system is carefully optimized for the synthesis of device grade Al2O3/TiO2 nanolaminates with well-defined artificial periodicity and distinct interfaces, and the role of process temperature in the structural, interfacial, dielectric and electrical properties is systematically investigated. A marginal increase in interfacial interdiffusion in these nanolaminates, at elevated temperatures, is validated using X-ray reflectivity and secondary ion mass spectrometry studies. With an increase in deposition temperature from 150 to 300 °C, the impedance spectroscopy measurements of these nanolaminates exhibited a monotonic increment in dielectric constant from ∼95 to 186, and a decrement in dielectric loss from ∼0.48 to 0.21, while the current-voltage measurements revealed a subsequent reduction in leakage current density from ∼2.24 × 10-5 to 3.45 × 10-7 A cm-2 at 1 V applied bias and an improvement in nanobattery polarization voltage from 100 mV to 700 mV, respectively. This improvement in dielectric and electrical properties at elevated processing temperature is attributed to the reduction in impurity content along with the significant enhancement in sublayer densities and the conductivity contrast driven Maxwell-Wagner interfacial polarisation. Additionally, the devices fabricated at 300 °C exhibited a higher capacitance density of ∼22.87 fF µm-2, a low equivalent oxide thickness of ∼1.51 nm, and a low leakage current density of ∼10-7 A cm-2 (at 1 V bias), making this nanolaminate a promising material for high-density energy storage applications. These findings highlight the ALD process temperature assisted growth chemistry of Al2O3/TiO2 nanolaminates for superior dielectric performance and multifaceted applications.

Physical and chemical properties of carbon-based sorbents that affect the removal of per- and polyfluoroalkyl substances from solution and soil.

Removal of per- and polyfluoroalkyl substances (PFASs) from water or their immobilization in soil using carbon-based sorbents is one of the cost-effective techniques. Considering the variety of carbon-based sorbents, identifying the key sorbent properties responsible for PFASs removal from solution or immobilization in the soil can assist in the selection of the best sorbents for management of contaminated sites. This study evaluated the performance of 28 carbon-based sorbents including granular and powdered activated carbon (GAC and PAC), mixed mode carbon mineral material, biochars, and graphene-based materials (GNBs). The sorbents were characterized for a range of physical and chemical properties. PFASs' sorption from an AFFF-spiked solution was examined via a batch experiment, while their ability to immobilize PFASs in soil was tested following mixing, incubation and extraction using the Australian Standard Leaching Procedure. Both soil and solution were treated with 1 % w/w sorbents. Comparing different carbon-based materials, PAC, mixed mode carbon mineral material and GAC were the most effective in sorbing PFASs in both solution and soil. Among the different physical characteristics measured, the sorption of long-chain and more hydrophobic PFASs in both soil and solution was best correlated with sorbent surface area measured using methylene blue, which highlights the importance of mesopores in PFASs sorption. Iodine number was found to be a better indicator of the sorption of short-chain and more hydrophilic PFASs from solution but was found to be poorly correlated with PFASs immobilization in soil for activated carbons. Sorbents with a net positive charge performed better than those with a net negative charge, or no net charge. This study showed that surface area measured by methylene blue and surface charge are the best indicators of sorbent performance with respect to sorption/reducing leaching of PFASs. These properties may be helpful in selecting sorbents for PFASs remediation of soils/waters.

Stabilisation of PFAS in soils: Long-term effectiveness of carbon-based soil amendments.

Immobilisation/stabilisation is one of the most developed and studied approaches for treating soils contaminated with per- and poly-fluoroalkyl substances (PFAS). However, its application has been inhibited by insufficient understanding of the effectiveness of added soil sorbents over time. Herein, we present results on the effectiveness of select carbon-based sorbents, over 4 years (longevity) and multiple laboratory leaching conditions (durability). Standard batch leaching tests simulating aggressive, worst-case scenario conditions for leaching (i.e., shaking for 24-48 h at high liquid/solid ratios) were employed to test longevity and durability of stabilisation in clay-loam and sandy-loam soils historically contaminated with PFAS (2 and 14 mg/kg ∑28 PFAS). The different sorbents, which were applied at 1-6% (w/w), reduced leaching of PFAS from the soils to varying degrees. Among the 5 sorbents tested, initial assessments completed 1 week after treatment revealed that 2 powdered activated carbon (PAC) sorbents and 1 biochar were able to reduce leaching of PFAS in the soil by at least 95%. Four years after treatment, the performance of the PAC sorbents did not significantly change, whilst colloidal AC improved and was able to reduce leaching of PFAS by at least 94%. The AC-treated soils also appeared to be durable and achieved at least 95% reduction in PFAS leaching under repetitive leaching events (5 times extraction) and with minimal effect of pH (pH 4-10.5). In contrast, the biochars were affected by aging and were at least 22% less effective in reducing PFAS leaching across a range of leaching conditions. Sorbent performance was generally consistent with the sorbent's physical and chemical characteristics. Overall, the AC sorbents used in this study appeared to be better than the biochars in stabilising PFAS in the long term.

Role of C and B4C barrier layers in controlling diffusion propagation across the interface of Cr/Sc multilayers.

The optical performance of low-bilayer-thickness metallic multilayers (ML) can be improved significantly by limiting the intermixing of consecutive layers at the interfaces. Barrier layers are supposed to exhibit a decisive role in controlling diffusion across the interfaces. The element-specific grazing incidence extended X-ray absorption fine structure technique using synchrotron radiation has been used in conjunction with grazing incidence X-ray reflectivity and diffuse X-ray scattering measurements to study the impact of the two most common barrier layers, viz., C and B4C, at the interfaces of Cr/Sc MLs. The diffusion propagation is reduced by both the barrier layers; however, it is found that the improvement is more significant with the B4C barrier layer. It is seen that C forms an intermixed layer with Sc and leads to carbide formation at the interface, which then acts as shielding and prevents further interdiffusion, while B4C hardly penetrates into Sc and stops the overlap between Sc and Cr directly by wetting the corresponding interface. Thus, the above measurements reveal crucial and precise information regarding the elemental diffusion kinetics at the interfaces of Cr/Sc MLs in a non-destructive way, which is very important for technological applications of these MLs as X-ray optical devices.

Patient-reported outcomes of laparoscopic versus robotic primary ventral and incisional hernia repair: a systematic review and meta-analysis.

BACKGROUND: Patient-Reported Outcome Measures (PROM's) are increasingly used to assess surgical outcomes in low-risk surgeries such as minimally invasive primary ventral and incisional hernia repair. The purpose of this meta-analysis was to systematically summarize the available evidence for the effect of laparoscopic versus robotic primary ventral and incisional hernia repair on PROM's. METHODS: A systematic review and meta-analysis were performed in accordance with PRISMA guidelines. Randomised control trials, retrospective and prospective studies were included. Medline, Embase, SCOPUS, Web of Science, and Cochrane CENTRAL, and two trial registers were searched. Pooled effect sizes and 95% confidence intervals were calculated using the Mantel-Haenszel method. The overall quality of evidence was assessed using GRADE. RESULTS: Of the 2728 titles screened, eight studies involving 41,205 participants were included. Return to activities of daily living, return to work day and recurrence rate were statistically better in the robotic group. Length of stay, readmission, postoperative pain, quality of life, body image, and patient satisfaction were similar in both groups. The GRADE rating of the quality of evidence was moderate for postoperative pain and low to very low for the quality of life, length of stay, recurrence and readmission. CONCLUSION: The available data of PROM's of laparoscopic and robotic primary ventral and incisional hernia repair is scarce and highly heterogeneous, thus making it difficult to assess the superiority of the laparoscopic technique over the robotic technique. Further studies with uniform reporting of PROM's in laparoscopic and robotic primary ventral and incisional hernia repair are needed.

Formation of disinfection by-products from microplastics, tire wear particles, and other polymer-based materials.

Disinfection by-products (DBPs) are formed through the disinfection of water containing precursors such as natural organic matter or anthropogenic compounds (e.g., pharmaceuticals and pesticides). Due to the ever increasing use of plastics, elastomers, and other polymers in our daily lives, polymer-based materials (PBMs) are detected more frequently and at higher concentrations in water and wastewater. The present review provides a comprehensive and systematic analysis of the contribution of PBMs - including elastomers, tire waste, polyelectrolytes, and microplastics - as precursors of DBPs in water and wastewater. Literature shows that the presence of PBMs can lead to the leaching of dissolved organic matter (DOM) and subsequent formation of DBPs upon disinfection in aqueous media. The quantity and type of DBPs formed strongly depends on the type of polymer, its concentration, its age, water salinity, and disinfection conditions such as oxidant dosage, pH, temperature, and contact time. DOM leaching from elastomers and tire waste was shown to form N-nitrosodimethylamine up to concerning levels of 930 ng/L and 466,715 ng/L, respectively upon chemical disinfection under laboratory conditions. Polyelectrolytes can also react with chemical disinfectants to form toxic DBPs. Recent findings indicate trihalomethanes formation potential of plastics can be as high as 15,990 µg/L based on the maximum formation potential under extreme conditions. Our analysis highlights an overlooked contribution of DOM leaching from PBMs as DBP precursors during disinfection of water and wastewater. Further studies need to be conducted to ascertain the extent of this contribution in real water and wastewater treatment plants.

Surgical outcomes of T4b oral cancers: assessment of prognostic factors and a need to re-evaluate the current staging system.

T4b oral cancer is a broad umbrella term for all advanced oral cancers, the prognosis of which varies drastically for disease of the same stage, according to the extent of the masticator space involvement. This was a retrospective observational study including all consecutive T4b oral squamous cell carcinoma patients treated surgically between January 2015 and January 2016 and followed up until January 2020. The disease was classified as upper disease or lower disease based on the anatomical location in relation to an imaginary plane passing through the base of the retromolar trigone. The prime objective was to evaluate overall survival and prognostic factors affecting overall survival. The projected 5-year overall and disease-free survival rates were 40.7% and 35.6%, respectively. The assessment of prognostic factors revealed that lower disease (lower anatomical subsites), bone invasion, and lymph nodal spread significantly affected survival. Patients with disease in an upper anatomical location without bone and nodal involvement can achieve fairly good survival (projected 5-year overall survival of 64.2%) when compared to the other subsets of patients. We propose a re-evaluation of the current staging system based on the prognostic features, so that all patients are not considered under a single stage, since their survival differs significantly.

The pulsatile 3D-Hemodynamics in a doubly afflicted human descending abdominal artery with iliac branching.

The study of patient-specific human arterial flow dynamics is well known to face challenges like a) apt geometric modelling, b) bifurcation zone meshing, and c) capturing the hemodynamic prone to variations with multiple disease complications. Due to aneurysms and stenosis in the same arterial network, the blood flow dynamics get affected, which needs to be explored. This study develops a new protocol for accurate geometric modelling, bifurcation zone meshing and numerically investigates the arterial network with abdominal aortic aneurysms (AAA) and right internal iliac stenosis (RIIAS). A realistic arterial model is reconstructed from the computed tomography (CT) data of a human subject. To understand the combined effect of the aneurysm and aortoiliac occlusive diseases in a patient, an arterial network with AAA, RIIAS, multiple branches tapering, and curvature has been considered. Clinically significant pulsatile blood flow simulations have been carried out to trace the alteration in the flow dynamics with multiple pathological complications under consideration. The transient blood flow dynamics are investigated via wall shear stress, wall pressure, velocity contour, streamlines, vorticity, and swirling strength. During the systolic deceleration phase, the rhythmic nested rapid secondary oscillatory WSS, adverse pressure gradients, high WSS, and high WP bands are noticed. Also, the above studies will help researchers, clinicians, and doctors understand the influence of morphological changes on hemodynamics in cardiovascular studies.

Retrospective analysis and risk of progression of partial anterior cruciate ligament injuries in a young population.

BACKGROUND: The anterior cruciate ligament (ACL) is a common knee ligament injury. Partial ACL tears are common, and at least 10-27% of isolated ACL tears are diagnosed as partial tears. Patients with partial tears have high risk of progression of tears to complete tears, which may require surgical reconstruction. The risk factors associated with the progression to a complete tear are poorly understood. METHODS: The present case-control study assessed the incidence and risk factors for the progression of conservatively treated partial ACL tears to complete tears in 351 patients younger than 45 years. The diagnosis of partial ACL tears was based on clinical evaluation, side-to-side difference on Rolimeter, and magnetic resonance imaging. These patients were managed conservatively and followed up for a mean of 17.5 months or until the progression of the tear into a complete tear, requiring surgery. The patients in whom the tear progressed to complete tear (group P) were compared with those in whom the tear remained stable for a minimum of 18-month follow-up period (group S). RESULTS: Of the 351 partial ACL tear patients, 166 (47.3%) patients progressed to a complete tear at a mean duration of 17.5 months, whereas the tear in 185 (52.7%) patients remained stable and did not progress to a complete tear. Group P had mean international knee documentation committee (IKDC) scores and Tegner scores of 95.7 ± 3.7 and 7.6 ± 1.6, respectively, before the injury, and scores decreased to 52.4 ± 4.1 and 5.7 ± 2.2, respectively, at the 24-month follow-up. CONCLUSION: Partial ACL tear progressed to a complete tear in 47.3% of evaluated patients. The associated risk factors were age less than 35 years, rigorous physical activities, high ACL-Return to Sport after Injury score during early rehabilitation days, early return to activity, and pivoting contact sports.

The efficacy of soil washing for the remediation of per- and poly-fluoroalkyl substances (PFASs) in the field.

This paper aims to describe the performance of a soil washing plant (SWP) for remediating a per- and poly-fluoroalkyl substances (PFASs)-contaminated soil with a high clay content (61%). The SWP used both physical and chemical processes; fractionation of the soil particles by size and partitioning of PFASs into the aqueous phase to remove PFASs from the soil. Contaminated water was treated in series with granulated activated carbon (GAC) and ion-exchange resin and reused within the SWP. Approximately 2200 t (dry weight) of PFAS-contaminated soil was treated in 25 batches of 90 t each, with a throughput of approximately 11 t soil/hr. Efficiency of the SWP was measured by observed decreases in total and leachable concentrations of PFASs in the soil. Average removal efficiencies (RE) were up to 97.1% for perfluorocarboxylic acids and 94.9% for perfluorosulfonic acids. REs varied among different PFASs depending on their chemistry (functional head group, carbon chain length) and were independent of the total PFAS concentrations in each soil batch. Mass balance analysis found approximately 90% of the PFAS mass in the soil was transferred to the wash solution and > 99.9% of the PFAS mass in the wash solution was transferred onto the GAC without any breakthrough.

Integrated model for genomic prediction under additive and non-additive genetic architecture.

Using data from genome-wide molecular markers, genomic selection procedures have proved useful for estimating breeding values and phenotypic prediction. The link between an individual genotype and phenotype has been modelled using a number of parametric methods to estimate individual breeding value. It has been observed that parametric methods perform satisfactorily only when the system under study has additive genetic architecture. To capture non-additive (dominance and epistasis) effects, nonparametric approaches have also been developed; however, they typically fall short of capturing additive effects. The idea behind this study is to select the most appropriate model from each parametric and nonparametric category and build an integrated model that can incorporate the best features of both models. It was observed from the results of the current study that GBLUP performed admirably under additive architecture, while SVM's performance in non-additive architecture was found to be encouraging. A robust model for genomic prediction has been developed in light of these findings, which can handle both additive and epistatic effects simultaneously by minimizing their error variance. The developed integrated model has been assessed using standard evaluation measures like predictive ability and error variance.

Hypoplastic femur with pathologic femoral shaft fracture associated with extensive arteriovenous malformations. A series of five cases.

Introduction: Extremities arteriovenous malformations are uncommon vascular lesions that usually go unnoticed until a fracture occurs or imaged for other medical problems. The lesion is invariably quiescent, infiltrative in nature, and leads to the destruction of soft tissue and bone. Worldwide 20-30 % incidence of arteriovenous malformations has been noted in bones. This arteriovenous malformation greatly affects bone growth as compared to the normal side and leads to pathological fracture. However, few reports on the management of such pathologic fractures associated with AVM have been published in the literature.The main problem is to decide the types of implants and whether open or closed reduction. Here, we present a case series of pathologic femoral shaft fracture associated with multiple hemangiomas in the thigh that was treated successfully by minimally invasive distal femoral locking plate fixation and teriparatide. Case Presentation: We are describing our one index case. A 39-year-old woman, otherwise healthy, sustained a fall and developed a left femoral shaft fracture. At the time of admission, she had swelling and venous varicosities and non-itchy, blanchable violet patches over the left thigh. Plain radiography of the left thigh revealed Hypoplastic femoral shaft with a markedly obliterated medullary canal with distal 1/3 rd fracture with calcification of soft tissue. We planned open reduction and distal locking femoral plating because medullary canal was very small to accommodate intramedullary nail following embolization of the feeding artery. While performing open reduction, a considerable amount of bleeding (1300 ml) after incision of subcutaneous tissue occurred. After successful fracture fixation, union was achieved with administration of teriparatide 12 months postoperatively. At present patient is able to walk using elbow support. Conclusion: We present the five cases of pathologic fracture associated with large AVMs that achieved fracture union using minimally invasive distal femoral locking plate fixation and teriparatide.

On the universality of medical device regulations: the case of Benin.

BACKGROUND: Regulatory frameworks surrounding medical devices (MDs) and medical locations are of utter importance for safeguarding patients and users, and for granting a universal access to healthcare. Currently, as the main existing regulatory frameworks are drafted by high-income countries, they pretend to be general and applicable globally, but fail to understand particular contexts, specifically those in low-resource settings (LRSs), resulting, therefore, inapplicable. In particular, LRSs present a varied situation, with legal transplants of guidelines from their previous colonial regimes. This apparently theoretical issue, is, effectively, a tangible and rising matter of concern, given the ever-increasing number of MD patent applications per year, as well as the appearance of low- and middle-income countries (LMICs) on the MD market itself. This article will focus on the European Regulation on MDs 745/2017 and its applicability in LRSs, specifically presenting the case of Benin, a Sub-Saharan African country. METHODS: This work is based on a field study conducted in 2019 in Benin, which is particularly exemplar to show the complexity of the "legal transplantation" concept. A multidisciplinary approach, comprising the standard tools and methods of ethics, law, and biomedical engineering, was used to draft a heuristic hermeneutic framework, and to analyse related bioethical issues concerning Medical Device Regulations (MDRs) in LRSs, the role of Maintenance, and other sociological questions; as well as the rural population's perception on MDs and health technologies, and the role of ethics in the hospitals of LRSs. RESULTS: The definition of these themes helped approach the local perspective and define the research questions. Downstream of the analysis of the Medical Devices Regulations, the Maintenance and other bioethical issues in Benin, the heuristic hermeneutic framework was created to guide a shift in the paradigm of law and regulation making, so as to make them more contextualised and inclusive, globally. CONCLUSION: This article proposes a framework that will help policymakers take into account the particularism of each context, especially those of the most vulnerable countries, when drafting and issuing regulatory frameworks, promoting an ever-evolving model of universalism.

Sorption, degradation and microbial toxicity of chemicals associated with hydraulic fracturing fluid and produced water in soils.

Spills of hydraulic fracturing (HF) fluids and of produced water during unconventional gas extraction operations may cause soil contamination. We studied the degradation and microbial toxicity of selected HF chemical components including two biocides (methylisothiozolinone- MIT, chloromethylisothiozolinone- CMIT), a gel-breaker aid (triethanolamine -TEA), and three geogenic chemicals (phenol, m-cresol and p-cresol) in ultrapure water, HF fluid and produced water in five different soil types (surface and subsurface soils). The degradation of the two biocides (in soils treated with HF fluid or ultrapure water) and of the three geogenic chemicals (in soils treated with produced water) was rapid (in all cases DT50 values < 2 days in surface soils). In contrast, the loss of TEA was much slower in soils, especially in those treated with HF fluid (DT50 > 30 days). Sorption coefficients (Koc in L/Kg) in these soils ranged from 71 to 733 for TEA, 64-408 for MIT and 11-72 for CMIT. In terms of soil microbial toxicity, exposure to HF fluid and produced water reduced microbial respiration, albeit temporarily. The overall microbial activities in surface soils contaminated with produced water had fully recovered in most soils. In contrast, the HF fluid addition to soils completely inhibited the nitrification in all soils, with little recovery over the 60 day experimental period. In the case of produced water exposure, three out of five surface soils showed complete recovery in nitrification during the study period. The functional genes for nitrogen fixation (nifH) and carbon cycling (GA1) and microbial community composition (16 S rRNA) were significantly affected by HF fluid in some soils. Overall, the study shows that the HF fluid can have significant detrimental impact on soil microbial functions, especially on nitrogen cycling. More work is needed to identify the exact cause of microbial toxicity in soils contaminated with HF fluid.

Assessment of Mobilization Potential of Per- and Polyfluoroalkyl Substances for Soil Remediation.

This study investigated the mobilization of a wide range of per- and polyfluoroalkyl substances (PFASs) present in aqueous film-forming foams (AFFFs) in water-saturated soils through one-dimensional (1-D) column experiments with a view to assessing the feasibility of their remediation by soil desorption and washing. Results indicated that sorption/desorption of most of the shorter-carbon-chain PFASs (C ≤ 6) in soil reached greater than 99% rapidly─after approximately two pore volumes (PVs) and were well predicted by an equilibrium transport model, indicating that they will be readily removed by soil washing technologies. In contrast, the equilibrium model failed to predict the mobilization of longer-chain PFASs (C ≥ 7), indicating the presence of nonequilibrium sorption/desorption (confirmed by a flow interruption experiment). The actual time taken to attain 99% sorption/desorption was up to 5 times longer than predicted by the equilibrium model (e.g., ∼62 PVs versus ∼12 PVs predicted for perfluorooctane sulfonate (PFOS) in loamy sand). The increasing contribution of hydrophobic interactions over the electrostatic interactions is suggested as the main driving factor of the nonequilibrium processes. The inverse linear relationship (R2 = 0.6, p < 0.0001) between the nonequilibrium mass transfer rate coefficient and the Freundlich sorption coefficient could potentially be a useful means for preliminary evaluation of potential nonequilibrium sorption/desorption of PFASs in soils.