Takedown of Ankle Arthrodesis and Conversion to Total Ankle Arthroplasty: A Systematic Review.

Management of the nonunited or painful ankle arthrodesis remains a difficult challenge. The aim of this systematic review was to investigate the clinical outcomes and complications of conversion of an ankle fusion to a total ankle replacement (TAR). The PRISMA statement guidelines were followed. A literature search was performed in PubMed, Science Direct and Cochrane Central Register of Controlled Trails (CENTRAL) from their inception up to October 10th, 2023. The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal tool and the Methodological Index for NonRandomized Studies (MINORS). Seven studies with 220 patients (223 ankles) with a mean follow-up of 64.9 months were included. Takedown of an ankle fusion and conversion to a TAR led to a significant improvement in all functional and clinical scores and with an acceptable range of motion. Most common complications were malleolar fractures (12.8%) and arthrofibrosis (5.6%). The revision rate was 8% and 4 cases resulted in a below-knee amputation. Cases with an insufficient fibula had a good outcome when a fibular reconstruction was performed. In conclusion, takedown of an ankle fusion and conversion to a TAR has satisfactory clinical outcomes and with a limited number of complications. Future well-designed studies are needed to validate the results of the present study.

Sustainability of phytoremediation: Post-harvest stratagems and economic opportunities for the produced metals contaminated biomass.

Heavy metals (HMs) are indestructible and non-biodegradable. Phytoremediation presents an opportunity to transfer HMs from environmental matrices into plants, making it easy to translocate from one place to another. The ornate features of HMs' phytoremediation are biophilia and carbon neutrality, compared to the physical and chemical remediation methods. Some recent studies related to LCA also support that phytoremediation is technically more sustainable than competing technologies. However, one major post-application challenge associated with HMs phytoremediation is properly managing HMs contaminated biomass generated. Such a yield presents the problem of reintroducing HMs into the environment due to natural decomposition and release of plant sap from the harvested biomass. The transportation of high yields can also make phytoremediation economically inviable. This review presents the design of a sustainable phytoremediation strategy using an ever-evolving life cycle assessment tool. This review also discusses possible post-phytoremediation biomass management strategies for the HMs contaminated biomass management. These strategies include composting, leachate compaction, gasification, pyrolysis, torrefaction, and metal recovery. Further, the commercial outlook for properly utilizing HMs contaminated biomass was presented.

Preoperative Expectations Versus Reality: A Patient Experience Study Following Scarf Osteotomy for Hallux Valgus Correction.

The relationship between managing patient expectations and postoperative functional outcomes has been studied widely in other areas of orthopedics, but there is a paucity of information in the foot and ankle literature. The primary objective of the study was to identify the most common patient "expectations" from hallux valgus surgery and establish over what time period postsurgery they would meet those goals. A prospective study of 45 consecutive patients was performed at a single center. This included adult patients (>18 years old) that underwent a scarf osteotomy for primary hallux valgus correction. Patients were followed up for 6 months and completed pre- and postoperative Manchester-Oxford Foot Questionnaire and Visual Analogue Scale scores. A separate "expectations" questionnaire was designed and completed assessing the patient's preoperative rehabilitation expectations compared to the actual time taken to achieve those goals. These included 5 domains: pain improvement, return to walking unaided, return to normal foot sensation, return to normal footwear, and return to driving. The postoperative functional scores demonstrated statistically significant improvement postsurgery (p < .001). It also highlighted the overall time frame over which the above expectations were met. On average, patients achieved satisfactory pain improvements 1.4 weeks earlier than expected (p < .001) along with trends toward an earlier return to driving function of patient expectation (p < .05). Patients can thus be reliably informed that their pain symptoms are likely to settle within one month of surgery. This should allow patients to prepare for their rehabilitation more informed, thus facilitating earlier weightbearing and return to function.

Multi-step short-term [Formula: see text] forecasting for enactment of proactive environmental regulation strategies.

Particulate matter is one of the key contributors of air pollution and climate change. Long-term exposure to constituents of air pollutants has exerted serious health implications in both humans and plants leading to a detrimental impact on economy. Among the pollutants contributing to air quality determination, particulate matter has been linked to serious health implications causing pulmonary complications, cardiovascular diseases, growth retardation and ultimately death. In agriculture, crop yield is also negatively impacted by the deposition of particulate matter on stomata of the plant which is alarming and can cause food security concerns. The deleterious impact of air pollutants on human health, agricultural and economic well-being highlights the importance of quantifying and forecasting particulate matter. Several deterministic and deep learning models have been employed in the recent years to forecast the concentration of particulate matter. Among them, deep learning models have shown promising results when it comes to modeling time series data and forecasting it. We have explored recurrent neural networks with LSTM model which shows potential to predict the particulate matter ([Formula: see text]) based on multi-step multi-variate data of two of the most polluted regions of South Asia, Beijing, China and Punjab, Pakistan effectively. The LSTM model is tuned using Bayesian optimization technique to employ the appropriate hyper-parameters and weight initialization strategies based on the dataset. The model was able to predict [Formula: see text] for the next hour with root-mean-square error (RMSE) of 0.1913 (91.5% accuracy) and this error gradually increases with the number of time steps with next 24 hours steps prediction having RMSE of 0.7290. While in case of Punjab dataset with data recorded once a day, the RMSE for the next day forecast is 0.2192. These multi-step short-term forecasts would play a pivotal role in establishing an early warning system based on the air quality index (AQI) calculated and enable the government in enacting policies to contain it.

Ornamental plants for the phytoremediation of heavy metals: Present knowledge and future perspectives.

Environmental matrices are polluted with the plethora of contaminants, and among these, the concerns related to heavy metals (HMs) are also included. Due to the low cost in a long-term application and environmental friendliness, the use of biological remediation has gained significant attention in recent decades. The use of ornamental plants (OPs) in the field of phytoremediation is scarcely reported, and the impacts of HMs on OPs have also not been investigated in great depth. The OPs mediated HMs remediation can simultaneously remove contaminants and bring improvement in aesthetics of the site. The biomass of OPs produced after such activities can be used and sold as pot plants, cut flowers, essential oils, perfumes, air fresheners production, metal phytomining, and feedstock in silk production. The OPs also present a lower risk of HMs bioaccumulation compared to crop plants. This review focuses on the current knowledge of HMs toxicity to OPs, their applicability advantages, methods to improve the tolerance of OPs with incremented HMs uptake, challenges in the field, and future application perspectives. The case studies realted to practical application of OPs, from China, Iran, India, Oman, Pakistan, and Turkey, were also discussed. This work fetches the inter-disciplinary features and understanding for the sustainable treatment of HMs in a new novel way, to which no previous review has focused.

The timing of closed unstable ankle fracture fixation and major wound complications - an observation from a UK major trauma centre.

OBJECTIVE: A retrospective cohort study was performed at a UK major trauma centre to identify whether timing of surgical fixation of closed unstable ankle fracture affected the rate of major wound complications. METHODS: Consecutive cases of unstable ankle fractures treated with open reduction internal fixation (ORIF) between March 2014 to December 2016 were included in this retrospective cohort study. Data were collected from 2018 onwards allowing a minimum follow-up of 2 years. Patients under the age of 18, polytrauma, open fractures and those requiring external fixation were excluded. Timing of ORIF were categorised into early (within 24 hours of injury) and delayed (after 24 hours of injury). Primary outcome was major soft tissue complications (defined as deep wound infections or wound breakdown that required further surgery). Secondary outcomes included fixation failure, and symptomatic metal work requiring removal. RESULTS: A total of 235 consecutive cases were included. There were 108(46%) patients in the early fixation group, and 127(54%) patients in the delayed fixation group. Seven major wound complications were identified. Five of which were in the early group, and 2 in the late group. There was no statistically significant difference in the major wound complication rates between the early and delayed surgery groups (p = 1.000). CONCLUSIONS: No significant difference was observed in the rate of major soft tissue complications between early and delayed fixation for isolated unstable ankle fractures.

Environmental risk assessment of diclofenac residues in surface waters and wastewater: a hidden global threat to aquatic ecosystem.

Pharmaceuticals are chemical compounds employed as medicinal drugs. They have severe physic-chemical properties which make them destructive for non-target species. Consequently, their continuous addition in the environment may pose hazardous effects. Among these, diclofenac (DCF), a non-steroidal anti-inflammatory drug (NSAID), is extensively used in Pakistan which may lead to its accumulation in both terrestrial and aquatic environment. Present study aims to assess the presence and concentration of pharmaceutically active drug (DCF) in surface water and wastewater of twin cities of Pakistan (Rawalpindi and Islamabad). For this purpose, a validated high-performance liquid chromatography (HPLC) method was adopted involving solid-phase extraction procedure. Wastewater samples were collected from various sites of Rawalpindi and Islamabad. Results of HPLC analysis revealed that DCF was extant with considerably high concentration, not only in wastewater but also in surface water samples. Concentrations as high as 216 µg L-1 was detected in Rawat industrial area and low as 8 µg L-1 was detected in dairy farm wastewater samples collected from Taramri. However, maximum DCF levels in residential wastewater and hospital wastewater were detected to be 105 µg L-1 and 34 µg L-1, respectively. Moreover, the highest detected level (116 µg L-1) was found in surface water of Sawan River. Further, results of ecological risk assessment revealed its possible toxic effects of DCF on various aquatic organisms.

Soil amendments enhanced the growth of Nicotiana alata L. and Petunia hydrida L. by stabilizing heavy metals from wastewater.

Due to the non-degradable nature of heavy metals (HMs), the industrial effluent, whether treated or untreated, carrying HMs, eventually end up into the water bodies, soil, and sediments. Numerous countermeasures were applied, but the use of ornamental plants for the stress mitigation associated with HMs on the environment is a neglected research domain. The composition of wastewater influences bioremediation strategies. As the wastewater is contaminated with multiple HMs, many lab studies, with the plants, failed in the industrial field. This work focuses on the potential of Nicotiana alata L. and Petunia hydrida L. against multiple HMs contaminated synthetic wastewater. To improve plant tolerance, soil amendments (biochar, compost, and moss, each at 5% v/v in soil) were used, individually and in combination. After 6 weeks of the exposure, plant physiological, biochemical and enzymatic parameters, as well as the distribution of HMs, (Cd, Cr, Cu, Pb, Mn, Ni, and Zn) in the plant (flower, leaves, root, and shoot) and soil, were measured. The HMs uptake positivity influenced the malondialdehyde content, hydrogen peroxide content and electrolyte leakage, while negatively to photosynthetic pigments, and resulted in increased catalase, guaiacol peroxidase, glutathione s-transferase, ascorbate peroxidase, while reduced superoxide dismutase activity. It was found that all amendments improved the plant growth by metal stabilization, and best results were obtained with the combined application of biochar + compost + moss. So, HMs stabilization can be achieved by growing ornamental plants, like Nicotiana alata L. and Petunia hydrida L. along with soil amendments.

Temperature drives the assembly of endophytic communities' seasonal succession.

Endophytic microorganisms asymptomatically colonise plant tissues. Exploring the assembly dynamics of bacterial endophytic communities is essential to understand the functioning of the plant holobiont and to optimise their possible use as biopesticides or plant biostimulants. The variation in endophytic communities in above and below-ground organs in Vitis vinifera in the field were studied. To understand the specific effect of temperature on endophytic communities, a separate experiment was set up where grapevine cuttings were grown under controlled conditions at three different temperatures. The findings revealed the succession of endophytic communities over the year. Endophytic communities of roots and stems differ in terms of composition and dynamic response to temperature. Noticeably, compositional differences during the seasons affected bacterial taxa more in stems than in roots, suggesting that roots offer a more stable and less easily perturbed environment. Correlation abundance networks showed that the presence of several taxa (including Bradyrhizobium, Burkholderia, Dyella, Mesorhizobium, Propionibacterium and Ralstonia) is linked in both the field and the greenhouse.

Role of nutrients and illuminance in predicting the fate of fungal mediated petroleum hydrocarbon degradation and biomass production.

Biodegradation and biomass production are affected by numerous environmental factors including pH, oxygen availability and presence of pollutants. The present study, for the first time, elucidated the effects of nutrients and light on mycodegradation of petroleum hydrocarbons in diesel oil. Seven fungal strains (Aspergillus terreus FA3, Aspergillus niger FA5, Aspergillus terreus FA6, Penicillium chrysogenum FP4, Aspergillus terreus FP6, Aspergillus flavus FP10, and Candida sp. FG1) were used for hydrocarbon degradation under static conditions, in four combinations of nutrient media and illuminance for 45 days. Highest degradation was achieved by Aspergillus terreus FA6 and Candida sp. FG1 under both conditions of light and dark, with nutrient deprived HAF (Hydrocarbon adopted fungi) broth. Under HAF/Dark diesel oil degradation by FA6 and FG1 was 87.3% and 84.3% respectively, while under HAF/Light both FA6 and FG1 performed 84.3% biodegradation. The highest biomass was produced by Aspergillus flavus FP10 in PDB (Potato dextrose broth)/Dark (109.3 mg). Fungal degradation of petroleum hydrocarbons was negatively affected by the presence of other simpler-to-degrade carbon sources in the medium. The biomass production was enhanced by improved nutrient availability and diminished by illuminance.

Interkingdom transfer of the acne-causing agent, Propionibacterium acnes, from human to grapevine.

Here, we report the surprising and, to our knowledge, unique example of horizontal interkingdom transfer of a human opportunistic pathogen (Propionibacterium acnes) to a crop plant (the domesticated grapevine Vitis vinifera L.). Humans, like most organisms, have established a long-lasting cohabitation with a variety of microbes, including pathogens and gut-associated bacteria. Studies which have investigated the dynamics of such associations revealed numerous cases of bacterial host switches from domestic animals to humans. Much less is, however, known about the exchange of microbial symbionts between humans and plants. Fluorescent in situ hybridization localized P. acnes in the bark, in xylem fibers, and, more interestingly, inside pith tissues. Phylogenetic and population genetic analyses suggest that the establishment of the grapevine-associated P. acnes as obligate endophyte is compatible with a recent transfer event, likely during the Neolithic, when grapevine was domesticated.

Patient-reported and radiological outcomes of short Scarf osteotomy fixed with a single screw: A prospective study of 271 osteotomies.

The Scarf osteotomy involves inherent risks and technical challenges. The short scarf osteotomy with single screw fixation has emerged as an alternative approach. This study aims to evaluate the patient-reported outcome measures (PROMs), radiological outcomes, and complications associated with the short scarf osteotomy fixed with a single screw for hallux valgus correction. A prospective cohort study was conducted between October 2018 and October 2023 at a single center, encompassing 271 osteotomies. PROMs were collected prospectively preoperatively and at various postoperative intervals. Radiographic data, including hallux valgus angle (HVA) and intermetatarsal angle (IMA), were measured preoperatively and six weeks postoperatively. Complications were also documented. Statistically significant improvements were observed in all PROMs and were sustained up to 24 months postoperatively. The Visual Analog Scale (VAS) pain score demonstrated a significant reduction from 46.97 at baseline to 12.52 at 24 months (p < 0.001). Likewise, the EQ-5D score improved notably from 0.73 preoperatively to 0.81 at 24 months (p = 0.002). Analysis of the Manchester-Oxford Foot Questionnaire (MOXFQ) revealed substantial improvements across its pain, walking/standing, and social interaction domains over the same period, with all changes showing statistical significance (all p < 0.001). Radiographically, the mean HVA improved significantly from 31.33° preoperatively to 13.33° postoperatively (p < 0.001). Similarly, the mean IMA improved significantly from 14.67° to 7.66° (p < 0.001). The most common complication was superficial wound infection, effectively managed with oral antibiotics. The were no cases of avascular necrosis or fracture. In conclusion, the short Scarf osteotomy fixed with a single screw demonstrates favorable outcomes. These findings support its efficacy and safety as a treatment option, with potential advantages over the conventional technique. Further prospective studies are warranted to validate these findings.

Hallux Flexion Deformity Secondary to Fibula Harvesting in a 10-Year-Old Patient With Neurofibromatosis.

Hallux interphalangeal joint (IPJ) flexion contracture is an uncommon deformity with various underlying causes, including trauma, neurological disorders, and connective tissue pathologies. We present a unique case of a 10-year-old female patient with neurofibromatosis type 1 (NF1) and a history of fibula transposition surgery, resulting in a hallux IPJ flexion contracture. We believe that the loss of the proximal fibular attachment of the extensor hallucis longus (EHL) following fibula harvesting resulted in EHL weakness and unopposed flexor hallucis longus (FHL) pull that eventually led to the contracture. The patient underwent various diagnostic assessments, ruling out other potential causes of the deformity. This case emphasizes the importance of considering previous surgical interventions when encountering flexion contractures of the toes.

Are foot and ankle corticosteroid injections safe during the COVID-19 pandemic? A single center prospective observational study.

BACKGROUND: Intra-articular corticosteroid injections (ICSI) are commonly used in orthopedic practice. Due to concerns about their immunosuppressive effects, we conducted a prospective observational audit, to monitor for COVID-19 infection amongst a group of foot and ankle patients who received an ICSI during the pandemic. PATIENTS AND METHODS: Included were 68 patients (25 males - 43 females, mean age 59.1 years, SD 15.0, range 19 - 90 years) who received a fluoroscopy-guided ICSI within a two-month period during the pandemic. The American Society of Anaesthesiologists (ASA) grade was I in 35 % of patients, II in 58 % and III in 7 %. 16 % of patients had black, Asian or minority ethnic (BAME) background. The dose of methylprednisolone injected was 20 mg for 28 % of the patients, 40 mg for 29 % and 80 mg for 43 %. RESULTS: All patients were available for follow up at one and four weeks post-injection. None reported COVID-19 infection symptoms within this period. The only complication was a flare-up of joint pain. CONCLUSION: Our study showed that the risk of COVID-19 infection to patients receiving foot or ankle ICSI is low. The limitations of this work must be considered, but our findings support the judicious use of corticosteroid injections during the current crisis.

Fungal endophytic communities in grapevines (Vitis vinifera L.) respond to crop management.

We studied the distribution of fungal endophytes of grapevine (Vitis vinifera L.) plants in a subalpine area of northern Italy, where viticulture is of high economic relevance. We adopted both cultivation-based and cultivation-independent approaches to address how various anthropic and nonanthropic factors shape microbial communities. Grapevine stems were harvested from several locations considering organic and integrated pest management (IPM) and from the cultivars Merlot and Chardonnay. Cultivable fungi were isolated and identified by internal-transcribed-spacer sequence analysis, using a novel colony-PCR method, to amplify DNA from fungal specimens. The composition of fungal communities was assessed using a cultivation-independent approach, automated ribosomal intergenic spacer analysis (ARISA). Multivariate statistical analysis of both culture-dependent and culture-independent data sets was convergent and indicated that fungal endophytic communities in grapevines from organically managed farms were different from those from farms utilizing IPM. Fungal communities in plants of cv. Merlot and cv. Chardonnay overlapped when analyzed using culture-dependent approaches but could be partially resolved using ARISA fingerprinting.

Soil conditioners improve rhizodegradation of aged petroleum hydrocarbons and enhance the growth of Lolium multiflorum.

Bioremediation and phytoremediation have demonstrated potential for decontamination of petroleum hydrocarbon-impacted soils. The total petroleum hydrocarbons (TPHs) are known to induce phytotoxicity, reduce water retention in soil, associate hydrophobic nature and contaminants' in situ heterogeneous distribution, limit soil nutrient release and reduce soil aeration and compaction. The ageing of TPHs in contaminated soils further hinders the degradation process. Soil amendments can promote plant growth and enhance the TPH removal from contaminated aged soil. In the present experiment, remediation of TPH-contaminated aged soil was performed by Italian ryegrass, with compost (COM, 5%), biochar (BC, 5%) and immobilized microorganisms' technique (IMT). Results revealed that significantly highest hydrocarbon removal (40%) was noted in mixed amendments (MAA) which contained BC + COM + IMT, followed by COM (36%), compared to vegetative control and other treatments. The higher TPH removal in aged soil corresponds with the stimulated rhizospheric effects, as evidenced by higher root biomass (85-159% increase), and bacterial count compared to NA control. Phyto-stimulants actions of biochar and IMT improved seed germination of Italian ryegrass. The compost co-amendment with other treatments showed improvement in plant physiological status. These results suggested that plant growth and TPH removal from aged, contaminated soils using BC, COM and IMT can improve bioremediation efficiency.

Interactive effect of biochar and compost with Poaceae and Fabaceae plants on remediation of total petroleum hydrocarbons in crude oil contaminated soil.

The current study was dedicated to finding the effect of soil amendments (biochar and compost) on plants belonging to Poaceae and Fabaceae families. Plants selected for the phytoremediation experiment included wheat (Triticum aestivum), maize (Zea mays), white clover (Trifolium repens), alfalfa (Medicago sativa), and ryegrass (Lolium multiflorum). The physiological and microbial parameters of plants and soil were affected negatively by the 4 % TPHs soil contamination. The studied physiological parameters were fresh and dried biomass, root and shoot length, and chlorophyll content. Microbial parameters included root and shoot endophytic count. Soil parameters included rhizospheric CFUs and residual TPHs. Biochar with wheat, maize, and ryegrass (Fabaceae family) and compost with white clover and alfalfa (Poaceae family) improved plant growth parameters and showed better phytoremediation of TPHs. Among different plants, the highest TPH removal (68.5 %) was demonstrated by ryegrass with compost, followed by white clover with biochar (68 %). Without any soil amendment, ryegrass and alfalfa showed 59.55 and 35.21 % degradation of TPHs, respectively. Biochar and compost alone removed 27.24 % and 6.01 % TPHs, respectively. The interactive effect of soil amendment and plant type was also noted for studied parameters and TPHs degradation.

Experience of Using Telehealth for Foot and Ankle Examination During The SARS-COV-2 Crisis.

The era of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is rapidly evolving. To comply to the guidelines for social distancing and reducing travel to prevent the spread of disease, many centers made rapid adjustments to conduct follow-up appointments through telehealth mediums. We explore our center's adaptation to the pandemic, reflecting on how we formulated telehealth clinics for our patients. We share our experience, discuss the challenges encountered, the feedback received, as well as consider the future role of telehealth in everyday orthopaedic practice.Levels of Evidence: Level V.

Influence of Pseudomonas japonica and organic amendments on the growth and metal tolerance of Celosia argentea L.

In this study, a pot experiment was piloted in a greenhouse to evaluate the potential of Celosia argentea var. cristata L. for tolerating/accumulating heavy metals in synthetic wastewater in the presence of Pseudomonas japonica and organic amendment, i.e., moss and compost. Two-week-old seedlings were transferred to pots, and after 4 weeks, the bacterial strain was inoculated, then watered with synthetic wastewater for 5 weeks and harvested after 9 weeks. After harvesting, physiological and biochemical parameters, as well as metal contents of plants, were quantified. The results indicated highest growth and biomass production in moss- and compost-associated plants while highest metal uptake has been found in the presence of P. japonica and synthetic wastewater-irrigated plants. Synthetic wastewater-irrigated plants have shown highest Pb uptake of 2899 mg kg-1 DW, while with P. japonica in soil those plants have shown highest Cd, Cu, Ni, and Cr uptake of 962, 1479, 1042, and 956 mg kg-1 DW, respectively. The production of antioxidant enzymes, i.e., catalase (CAT), ascorbate peroxidase (APX), guaiacol peroxidase (GPX), and glutathione-s-transferase (GST), was high in P. japonica-amended plants because of increased uptake of metals. It is concluded that moss and compost have improved growth while P. japonica improved metal accumulation and translocation to aerial parts with little involvement in plant growth.

Reduced growth response of ornamental plant Nicotiana alata L. upon selected heavy metals uptake, with co-application of ethylenediaminetetraacetic acid.

The use of ornamental plant will increase with the improvement in living standards in green and blue-green infrastructure of urban settings. Nicotiana alata is an ornamental plant, frequently grown as a model plant for horticulture, medicine, and scientific research studies throughout the world. Despite its popularity, little is known about the response of N. alata against heavy metals (HMs). This work is based on the hydroponic study to identify the impacts of selected HMs (Cd, Cr, Cu, Ni and Pb) on N. alata, at 0, 50 and 100 µM concentration, with the co-application of EDTA, at 0 and 2.5 mM in hydroponics system. The HMs uptake was found to be dose dependent, with significant higher uptake at 100 µM of respective HM. Highest cumulative uptake (mg kg-1 of HMs in root, shoot, and leaf dried weight) noted were 767.50 ±â€¯50.83, 862.30 ±â€¯23.83, 271.29 ±â€¯18.68, 1117.49 ±â€¯46.10 and 2166.81 ±â€¯102.09, for Cd, Cr, Cu, Ni, and Pb at 100 µM, respectively. It was identified that EDTA co-application with HMs resulted in boosted HMs uptake, with cumulative uptake percentage increment of 41.62, 54.67, 53.98, 34.48 and 19.92% for 100 µM of Cd, Cr, Cu, Ni, and Pb, respectively. Higher uptake led to negative impact on plant physiology, photosynthetic pigments, and higher lipid peroxidation, H2O2 contents, and electrolyte leakage that increased the stress. Higher HMs uptake induced higher antioxidant enzymatic response. It is recommended to incorporate appropriate soil modification to grow N. alata in sustainable infrastructures.