One-Stage Anatomical Revision Anterior Cruciate Ligament Reconstruction: Results According to Tunnel Overlaps.

PURPOSE: To present clinical results according to tunnel overlap in 1-stage anatomical revision anterior cruciate ligament reconstruction (ACLR). METHODS: All patients who underwent revision ACLR performed by a single surgeon (J.H.A.) from 2012 to 2017 and were followed up for >24 months were retrospectively evaluated. The exclusion criteria were concomitant ligament injury, including medial collateral ligament injury, modified Outerbridge grade ≥3 cartilage lesion, and severe meniscus defects. Tunnel overlap was measured on 3-dimensionally reconstructed computed tomography images. Patients in the nonoverlapped femoral tunnel group (group NO, n = 52) were treated with new tunnel drilling that completely avoided previous tunnels, and those in the overlapped femoral tunnel group (group O, n = 41) were treated with a new tunnel that overlapped with previous tunnels. Clinical outcomes were evaluated using the subjective International Knee Documentation Committee (IKDC) and Lysholm scores. Knee joint stability was measured using the Lachman and pivot shift tests. Patients with femoral tunnel widening of ≥14 mm underwent 2-stage ACLR. RESULTS: The mean follow-up duration of 93 patients was 46.9 months (range, 24-97 months). All preoperative subjective and objective IKDC (P<0.001) and Telos stress test scores (P = .016) were significantly improved at the last follow-up. Forty-one patients had overlapping femoral tunnels, whereas 87 had overlapping tibial tunnels. At the last follow-up, subjective IKDC and Lysholm scores (73.6 ± 15.3 vs 74.9 ± 12.1, P = .799 and 80.0 ± 19.2 vs 81.44 ± 13.5, P = .505, respectively) and objective pivot shift (IKDC grade) in the Lachman test (P = .183 and P = .450, respectively) did not differ significantly between groups NO and O, respectively. CONCLUSIONS: One-stage anatomical revision ACLR significantly improved the clinical results. Most tibial tunnels (94%) and approximately one-half (44%) of the femoral tunnels overlapped. The overlapped femoral tunnel group did not show inferior outcomes or stability. LEVEL OF EVIDENCE: Level III, cohort study.

Restoration of the inferomedial orbital strut using a standardized three-dimensional printing implant.

The inferomedial orbital strut (IOS) is the thin bony junction of the orbital medial wall and floor. Its fracture is common and leads to serious complications, including enophthalmos, globe dystopia and diplopia. However, anatomical restoration of the IOS is challenging owing to reduced structural support; sound anatomical background and accurate implants are therefore essential. The aim of the present study was to incorporate data from cadaveric orbit anatomy into three-dimensional (3D) printing technology and to reconstruct the complex orbital fracture elaborately. After averaging the data from computed tomography (CT) images of 100 adult cadavers, the dimensions of the IOS were extracted, and a tangent sphere was created using a computer-aided design program. The curves were compared with the CT data of 10 adult patients from the simulation test. Based on these data, a standardized 3D implant, 1.15 mm thick, was designed using polycaprolactone. The implant was placed in five patients with complex orbital fractures. The radius of the sphere in contact with the orbit, measuring 33.54 mm, was confirmed to be appropriate. A comparison between the normal side volume (V0) and the postoperative volume (Vpost ) showed that they were statistically similar. Furthermore, a comparison between V0 and the preoperative volume (Vpre ), and Vpost compared with Vpre also showed a statistically significant difference (P < 0.05). On follow-up, the preoperative ocular symptoms were resolved. The orbital data obtained from 100 cadavers provided standardized orbital anatomy, and 3D printed implants were created. The implants were anatomically accurate with regard to the orbital cavity and adequately covered the simulation model. The implant also showed satisfactory results when applied clinically in actual patients.

Effects of pectoralis minor length on strength improvement and pain reduction during scapular reposition test.

[Purpose] This study aimed to compare pain and shoulder elevation strength when scapular reposition test is applied to subclinical individuals with a short or long pectoralis minor. [Participants and Methods] Subclinical participants (n=34) with a positive impingement result on at least one of three tests were assigned to short (n=18) or long (n=16) pectoralis minor groups. Impingement tests were repeated with and without scapular reposition test. Visual analog scale was used to measure pain intensities under both conditions. Isometric shoulder elevation strength was measured by dynamometry. Two-way analyzes of variance and paired t-test were used to evaluate the effects of scapular reposition test in the two groups. [Results] The effects of pectoralis minor length on the frequencies of meaningful strength, pain reduction, and positive scapular reposition test result were evaluated. Repositioning reduced pain in both groups. In the short pectoralis minor group, shoulder elevation strength was significantly improved by scapular reposition test. A meaningful strength improvement and positive scapular reposition test result were reported more frequently in the short pectoralis minor group. [Conclusion] Consideration of pectoralis minor length and scapular reposition test results could aid the identification of factors contributing to scapular dyskinesis and related shoulder injuries, thereby enabling the selection of appropriate interventions.

Deep learning-based ultrasonographic classification of canine chronic kidney disease.

Objectives: In veterinary medicine, attempts to apply artificial intelligence (AI) to ultrasonography have rarely been reported, and few studies have investigated the value of AI in ultrasonographic diagnosis. This study aimed to develop a deep learning-based model for classifying the status of canine chronic kidney disease (CKD) using renal ultrasonographic images and assess its diagnostic performance in comparison with that of veterinary imaging specialists, thereby verifying its clinical utility. Materials and methods: In this study, 883 ultrasonograms were obtained from 198 dogs, including those diagnosed with CKD according to the International Renal Interest Society (IRIS) guidelines and healthy dogs. After preprocessing and labeling each image with its corresponding IRIS stage, the renal regions were extracted and classified based on the IRIS stage using the convolutional neural network-based object detection algorithm You Only Look Once. The training scenarios consisted of multi-class classification, categorization of images into IRIS stages, and four binary classifications based on specific IRIS stages. To prevent model overfitting, we balanced the dataset, implemented early stopping, used lightweight models, and applied dropout techniques. Model performance was assessed using accuracy, recall, precision, F1 score, and receiver operating characteristic curve and compared with the diagnostic accuracy of four specialists. Inter- and intra-observer variabilities among specialists were also evaluated. Results: The developed model exhibited a low accuracy of 0.46 in multi-class classification. However, a significant performance improvement was observed in binary classifications, with the model designed to distinguish stage 3 or higher showing the highest accuracy of 0.85. In this classification, recall, precision, and F1 score values were all 0.85, and the area under the curve was 0.89. Compared with radiologists, whose accuracy ranged from 0.48 to 0.62 in this experimental scenario, the AI model exhibited superiority. Intra-observer reliability among radiologists was substantial, whereas inter-observer variability showed a moderate level of agreement. Conclusions: This study developed a deep-learning framework capable of reliably classifying CKD IRIS stages 3 and 4 in dogs using ultrasonograms. The developed framework demonstrated higher accuracy than veterinary imaging specialists and provided more objective and consistent interpretations. Therefore, deep-learning-based ultrasound diagnostics are potentially valuable tools for diagnosing CKD in dogs.

DeepHealthNet: Adolescent Obesity Prediction System Based on a Deep Learning Framework.

The global prevalence of childhood and adolescent obesity is a major concern due to its association with chronic diseases and long-term health risks. Artificial intelligence technology has been identified as a potential solution to accurately predict obesity rates and provide personalized feedback to adolescents. This study highlights the importance of early identification and prevention of obesity-related health issues. To develop effective algorithms for the prediction of obesity rates and provide personalized feedback, factors such as height, weight, waist circumference, calorie intake, physical activity levels, and other relevant health information must be taken into account. Therefore, by collecting health datasets from 321 adolescents who participated in Would You Do It! application, we proposed an adolescent obesity prediction system that provides personalized predictions and assists individuals in making informed health decisions. Our proposed deep learning framework, DeepHealthNet, effectively trains the model using data augmentation techniques, even when daily health data are limited, resulting in improved prediction accuracy (acc: 0.8842). Additionally, the study revealed variations in the prediction of the obesity rate between boys (acc: 0.9320) and girls (acc: 0.9163), allowing the identification of disparities and the determination of the optimal time to provide feedback. Statistical analysis revealed that the performance of the proposed deep learning framework was more statistically significant (p 0.001) compared to the other general models. The proposed system has the potential to effectively address childhood and adolescent obesity.

Intraoperative infusion of 0.6-0.9 µg·kg(-1)·min(-1) remifentanil induces acute tolerance in young children after laparoscopic ureteroneocystostomy.

BACKGROUND: Intraoperative infusion of opioids has been associated with increased postoperative pain and analgesic requirements, but the development of tolerance in young children is less clear. This prospective, randomized, double-blinded study was designed to test the hypothesis that the intraoperative administration of remifentanil results in postoperative opioid tolerance in a dose-related manner in young children. METHODS: We enrolled 60 children (aged 1-5 yr) who were undergoing elective laparoscopic ureteroneocystostomy. Patients were randomized and received an intraoperative infusion of 0, 0.3, 0.6, or 0.9 µg·kg·min remifentanil. Postoperative pain was managed by a parent/nurse-controlled analgesia pump using fentanyl. The primary outcome included the total fentanyl consumptions at 24 and 48 h postsurgery. Secondary outcomes were the postoperative pain scores and adverse effects. RESULTS: The children who received 0.6 and 0.9 µg·kg·min remifentanil required more postoperative fentanyl than the children who received saline or 0.3 µg·kg·min remifentanil (all P < 0.001) for 24 h after surgery. The children who received 0.3-0.9 µg·kg·min intraoperative remifentanil reported higher pain scores at 1 h after surgery than the children who received saline (P = 0.002, P = 0.023, and P = 0.006, respectively). No significant intergroup differences in recovery variables were observed, but vomiting was more frequent in the 0.9 µg·kg·min remifentanil group than in the other groups (P = 0.027). CONCLUSIONS: The intraoperative use of 0.3 µg·kg·min remifentanil for approximately 3 h (range: 140-265 min) did not induce acute tolerance, but the administration of 0.6 and 0.9 µg·kg·min remifentanil to young children resulted in acute tolerance for 24 h after surgery in an apparently dose-related manner.

Chitosan cross-linked ß-cyclodextrin polymeric adsorbent for the removal of perfluorobutanesulfonate from aqueous solution: adsorption kinetics, isotherm, and mechanism.

The existence of per- and polyfluoroalkyl substances (PFASs) in water is of serious interest due to their toxic, bioaccumulative, and persistent nature, and adsorption is an effective approach for the PFASs removal. In the present study, we developed a polymeric adsorbent by cross-linking chitosan and ß-cyclodextrin using glutaraldehyde (Chi-Glu-ß-CD) and evaluated its removal performance for perfluorobutanesulfonate (PFBS) from water. The results indicate that the performance was highly affected by solution pH; under a more acidic condition (e.g., pH 2.0), a higher removal efficiency was detected, and faster adsorption kinetics was observed with the rate constant (k2) of 0.001 ± 3×10-4 g mg-1 min-1. Adsorption isotherm data agreed to the Sips model with a maximum heterogeneous adsorption capacity of 135.70 ± 25.70 mg g-1, probably due to protonated amine (NH+) and electron-deficient ß-CD cavities. The adsorption mechanism was confirmed using energy dispersive X-ray and Fourier transform infrared (FTIR) spectroscopy, showing the role of electrostatic attractions between the protonated amine and the negatively charged PFBS molecule (especially, with sulfonate side (N-H--O-S)) and host-guest inclusion formations with ß-CD cavity in adsorption. Additionally, the synthesized adsorbent was recovered using methanol without any significant decline in adsorption efficiency even after four continuous adsorption/desorption cycles. All these findings suggested that the Chi-Glu-ß-CD composite could be a promising adsorbent in the removal of PFBS from water.

Evaluation of vertical distribution characteristics of microplastics under 20 µm in lake and river waters in South Korea.

Following the alarming reports of microplastic pollution in the marine environment, increased attention has been given to microplastics in other environmental media. Despite the attention, there is limited research available on the depth-distribution of microplastics in freshwater. Specifically, in the case of water sources used for drinking or tap, the height of intake facilities varies, and it is highly likely that there is a correlation between the vertical distribution of microplastics and these water intake structures. Further, because the size of microplastics varies widely in the environment, the commonly used sampling devices are not suitable for selectively extracting microplastics without causing cross-contamination. Thus, we developed a suitable device for microplastics of size 5-20 µm and studied microplastic distribution in freshwater at various depths by considering various types of microplastics and aqueous systems. Lake and river, two major water sources, were selected for the study of microplastics distribution in water system. The microplastic distribution characteristics in both water systems showed that polypropylene and polyethylene were the most abundant across all depths because of their production volume. Plastic types with higher density were found only at the lower layers, and polystyrene was found in the upper layers because of the environmental effects on its buoyancy caused pore diameter and surface area. The lake and river had higher microplastic distribution in the lower layer and upper layer, respectively. This was because the flow rate in river was higher than that of lake. The higher flow rate reduced the settling velocity in river. Thus, hydrodynamic stability influences the vertical distribution and concentrations of microplastics in the water systems. These results are expected to be used for understanding the behavioral characteristics of microplastics in water systems and to manage water sources.

Bio-oil and biochar production from Ageratum conyzoides using triple-stage hydrothermal liquefaction and utilization of biochar in removal of multiple heavy metals from water.

Production of low-cost biomass and its utilization for producing cost effective and eco-friendly bioenergy as well as for removing heavy metals from water can be explored as an approach to meet the sustainable development goals. In light of the above-mentioned study, hydrothermal liquefaction (HTL) of Billy goat weed (BGW; Ageratum conyzoides) was carried out to produce bio-oil. In addition, the residual biochar from the HTL process was activated to obtain Act-BC and was further modified to produce MnO2-loaded biochar (Act-BC@MnO2-25%). The HTL of BGW was done at three different temperatures, i.e., 250 °C, 350 °C and 450 °C in a high-pressure batch reactor to maximize the bio-oil yield. Also, two different HTL methods i.e., single-stage HTL and triple-stage HTL of BGW were compared and discussed in detail. The bio-oil obtained via the triple-stage HTL was rich in carbon, hydrogen, and nitrogen. It also showed a higher heating value (HHV) and bio-oil yield (46%) than the single-stage. The residual biochar obtained at 450 °C (Act-BC) and MnO2 modified (Act-BC@MnO2-25%) were then tested to adsorb multiple heavy metal (i.e., Pb(II), Cd(II), Cu(II), and Ni(II)) from water. The kinetics data obtained from the adsorption experiment with Act-BC@MnO2-25% were well fitted to PSO kinetics model. The isotherm data were well aligned with the Langmuir model; the adsorption capacity of Act-BC@MnO2-25% was estimated to be 198.70 ± 11.40 mg g-1, 93.70 ± 6.60 mg g-1, 78.90 ± 7.20 mg g-1 and 30.50 ± 2.10 mg g-1 for Pb(II), Cd(II), Cu(II), and Ni(II), respectively. Furthermore, Act-BC@MnO2-25% remained active for metal ions absorption even after six consecutive uses. The result obtained from this study clearly demonstrates that the triple-stage HTL of BGW is a promising technology to achieve both remediation of metal-contaminated water and production of bioenergy.

Hydrogenotrophs-Based Biological Biogas Upgrading Technologies.

Biogas produced from anaerobic digestion consists of 55-65% methane and 35-45% carbon dioxide, with an additional 1-2% of other impurities. To utilize biogas as renewable energy, a process called biogas upgrading is required. Biogas upgrading is the separation of methane from carbon dioxide and other impurities, and is performed to increase CH4 content to more than 95%, allowing heat to be secured at the natural gas level. The profitability of existing biogas technologies strongly depends on operation and maintenance costs. Conventional biogas upgrading technologies have many issues, such as unstable high-purity methane generation and high energy consumption. However, hydrogenotrophs-based biological biogas upgrading offers an advantage of converting CO2 in biogas directly into CH4 without additional processes. Thus, biological upgrading through applying hydrogenotrophic methanogens for the biological conversion of CO2 and H2 to CH4 receives growing attention due to its simplicity and high technological potential. This review analyzes the recent advance of hydrogenotrophs-based biomethanation processes, addressing their potential impact on public acceptance of biogas plants for the promotion of biogas production.

Synthesis of EDTA-functionalized graphene oxide-chitosan nanocomposite for simultaneous removal of inorganic and organic pollutants from complex wastewater.

Discharging of inorganic and organic pollutants creates a serious threat to the human health and the environment. In the current work, we have synthesized Ethylenediaminetetraacetic acid (EDTA) functionalized graphene oxide-chitosan nanocomposite (GO-EDTA-CS) for simultaneous removal of inorganic (i.e., mercury (Hg(II) and copper (Cu(II)) and organic pollutants (i.e., methylene blue (MB) and crystal violet (CV)) from wastewater via adsorption process. The structural, functional, morphological, elemental compositions, surface area and thermal properties of the synthesized nanocomposite were identified using powder X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), field scanning electron microscopy (FESEM), energy dispersive spectroscopy (EDS), Brunauer-Emmett-Teller (BET), and thermogravimetric analyzer (TGA), respectively. Different batch adsorption experiments such as pH effect, contact time, initial pollutants concentration, reusability etc. were studied in monocomponent system to optimize the results. The adsorption process apparently followed pseudo-second-order (PSO) kinetics for both pollutants, however the adsorption kinetics was also explained by the intra-particle diffusion model. The isotherm data for both metals ions and dyes were well fit by the Langmuir isotherm model. The maximum adsorption capacities of the adsorbent were determined 324 ± 3.30 130 ± 2.80, 141 ± 6.60, and 121 ± 3.50 mg g-1 for Hg(II), Cu(II), MB, and CV, respectively. The excellent adsorption capacity was attributed to the availability of various active functional groups (e.g., -COOH, -OH, -NH2, etc.) on the adsorbent. The EDS, elemental mapping and FTIR analysis performed before and after the adsorption of heavy metals and dyes by GO-EDTA-CS confirmed the simultaneous adsorption of the pollutants. Moreover, GO-EDTA-CS could maintain its adsorption capacity for both inorganic and organic pollutants even after seven cycles of adsorption-desorption, indicating itself a promising adsorbent for practical wastewater treatment containing both inorganic and organic toxic pollutants.

Multifunctional ß-Cyclodextrin-EDTA-Chitosan polymer adsorbent synthesis for simultaneous removal of heavy metals and organic dyes from wastewater.

Heavy metals and organic dyes are the major source of water pollution. Herein, a trifunctional ß-cyclodextrin-ethylenediaminetetraacetic acid-chitosan (ß-CD-EDTA-CS) polymer was synthesized using an easy and simple chemical route by the reaction of activated ß-CD with CS through EDTA as a cross-linker (amidation reaction) for the removal of inorganic and organic pollutants from aqueous solution under different parameters such as pH, time effect, initial concentration, reusability, etc. The synthesized adsorbent was characterized using powder X-ray diffraction, Fourier transform infrared spectroscopy, field scanning electron microscopy, energy dispersive spectroscopy, Brunauer-Emmett-Teller (BET), thermogravimetric analyzer techniques to investigate their structural, functional, morphological, elemental compositions, surface area and thermal properties, respectively. Two types of heavy metals, i.e., mercury (Hg2+) and cadmium (Cd2+), and three organic dyes, i.e., methylene blue (MB), crystal violet (CV) and safranin O (SO) were chosen as inorganic and organic pollutants, respectively, to study the adsorption capacity of ß-CD-EDTA-CS in aqueous solution. The ß-CD-EDTA-CS shows monolayer adsorption capacity 346.30 ± 14.0 and 202.90 ± 13.90 mg g-1 for Hg2+ and Cd2+, respectively, and a heterogeneous adsorption capacity 107.20 ± 5.70, 77.40 ± 5.30 and 55.30 ± 3.60 mg g-1 for MB, CV and SO, respectively. Kinetics results followed pseudo-second order (PSO) kinetics behavior for both metal ions and dyes, and higher rate constants values (0.00161-0.00368 g mg-1 min-1) for dyes confirmed the cavitation of organic dyes (physisorption). In addition, we have also demonstrated the performance of ß-CD-EDTA-CS for the of four heavy metals Hg2+, Cd2+, Ni2+, and Cu2+ and three dyes MB, CV, and SO in secondary treated wastewater. Findings of this study indicate that ß-CD-EDTA-CS simple and essay to synthesize and can be use in wastewater treatment.

Simultaneous capturing of mixed contaminants from wastewater using novel one-pot chitosan functionalized with EDTA and graphene oxide adsorbent.

The emergence of inorganic and organic contaminants has raised great concerns owing to their adverse impact on human health and ecological security. Herein, first time one-pot process was applied for chitosan (CS) functionalization using graphene oxide (GO) and ethylenediaminetetraacetic acid (EDTA) for simultaneous capturing of toxic inorganic (lead (Pb2+) and cadmium (Cd2+)) and organic (ciprofloxacin (CIP) and sildenafil (SDF)) contaminants from wastewater. In this approach, we believe that CS would work as a backbone, GO would capture both inorganic and organic contaminants via electrostatic interactions, while EDTA would make complexation with heavy metals. Various parameters including pH, reaction time, concentration, reusability etc. were evaluated to achieve the best experimental result in monocomponent system. The prepared adsorbent displayed an excellent monolayer adsorption capacity of 351.20 and 264.10 mg g-1 for Pb2+ and Cd2+, respectively, while a heterogeneous sorption capacity of 75.40 and 40.90 mg g-1 for CIP and SDF, respectively. The kinetics data fitted well to Pseudo-second order (PSO) kinetics model for both types of contaminants and gave faster interaction towards metal ions (higher k2) than organic contaminants. Experimental results showed excellent adsorption efficiencies at environmental levels in the capturing of both inorganic and organic contaminants at the same time from polluted water. The capturing mechanism of both types of contaminants was explained by elemental mapping, EDS, and FT-IR spectra. Overall, easy synthesis, excellent capturing capacity, and reusability imply that the prepared adsorbent has a sufficient potential for the treatment of co-existing toxic contaminants in water.

miRNA-Based Early Healing Mechanism of Extraction Sockets: miR-190a-5p, a Potential Enhancer of Bone Healing.

Objective: Tooth extraction causes a wound with hard and soft tissue defects in the alveolar ridge. Few studies have reported the function of microRNAs (miRNAs) in the healing of extraction sockets. This study used bioinformatics analysis to reveal the possible relevance and role of miRNAs during the early stages following tooth extraction. Materials and Methods: Socket tissues from beagle dogs (Canis familiaris; two males and two females) were collected 1 and 12 hours after extraction of premolars on both sides of the mandible. miRNA expression was profiled through miRNA sequencing, and hub miRNAs showing characteristic expression patterns were selected and subjected to target enrichment analysis. Alkaline phosphatase (ALP) activity analysis and reverse transcription-quantitative polymerase chain reaction (RT-qPCR) were performed to verify the effect of hub miRNA on osteoblast differentiation and bone regeneration in vivo. Results: Five miRNAs were identified to have consistently high expression levels, with cfa-miR-451 showing the highest expression. Additionally, 20 hub miRNAs were selected as candidates expected to play an important role in the healing process. Pathways, such as the MAPK, axon guidance, TGF-ß, and Wnt signaling, were significantly enriched. Among hub miRNAs, miR-190a-5p increased ALP activity and mRNA expression of osteogenic markers and increased new bone formation in vivo. Conclusions: Our findings suggest that miRNAs may be involved in the earliest stages of socket healing after tooth extraction and can play an important role in moderating the entire socket healing mechanism in the extraction socket.

Drug-induced Hyperprolactinemia Results in Atypical Atypical Fracture.

We report a case of bilateral femur fracture which may have resulted in part from long-term administration of antipsychotic agents. A 43-year-old female patient with pain in both thighs visited our clinic. We conducted X-ray and magnetic resonance imaging (MRI) examinations which revealed bilateral femur fractures. The right proximal femur had a complete fracture, and the left proximal femur had an incomplete fracture, both of which were in the subtrochanteric area. The patient was treated by intramedullary nailing in the right femur. Laboratory analysis showed hyperprolactinemia and hypogonadism. Bone mineral density analysis showed osteoporosis. Antipsychotic drug-induced hyperprolactinemia is a well-known phenomenon. Despite concerns about hyperprolactinemia induced osteoporotic fracture in patients treated with only prolactin-elevating medications, the issue has not been extensively studied. If hyperprolactinemia patients suffer from uncontrolled pain, we recommend MRI examination as surgeons should be aware of the possibility of osteoporotic fracture induced by hyperprolactinemia.

Process optimization for the synthesis of ceramsites in terms of mechanical strength and phosphate adsorption capacity.

Red mud (RM), an industrial waste of bauxite refinery, shows great potential in adsorptive phosphate immobilization but granulation of RM enables the ease for field application. Red-mud-based ceramsites with 12 compositions that blended Korean red mud, American red mud, ocher, and bentonite were synthesized through firing process (600-1000 °C). The porosity, bulk density, mechanical strength, mineralogical composition, and phosphate adsorption capacity of granulated RM were characterized and analyzed. The crystallization of plagioclases, nepheline and gehlenite was observed in the ceramsites with high alkali flux content, which enhanced both porosity and phosphate adsorption capacity. The characteristics of the ceramsites without phase transition were highly correlated with porosity. The mechanical strength of ceramsites was governed by crack population, describable by the Weibull distribution model, and thus the maximal tensile stress correlated negatively with porosity. Results showed that 32 wt % of KRREM and USREM treated at 1000 and 900 °C, respectively, yielded the best performing ceramites in terms of mechanical strength and phosphate adsorption capacity. Ultimately, the phosphate adsorption capacity, as affected by initial phosphate concentration, contact time, and temperature, of the optimized ceramsites was studied.

Simultaneous Removal of Heavy Metals and Ciprofloxacin Micropollutants from Wastewater Using Ethylenediaminetetraacetic Acid-Functionalized ß-Cyclodextrin-Chitosan Adsorbent.

The current study pertains to the synthesis of an EDTA-functionalized ß-cyclodextrin-chitosan (ß-CD-CS-EDTA) composite via a two-step process for the adsorptive removal of toxic heavy metallic ions (i.e., Pb(II), Cu(II), and Ni(II)) and antibiotic micropollutant, i.e., ciprofloxacin (CIP), from water. Different batch adsorption experiments such as pH, reaction time and initial pollutant concentration effects were carried out to identify the adsorption condition to attain the maximum removal efficiency. Kinetics results fit well with the pseudo-second order (PSO) kinetics model for both inorganic and organic pollutants. However, adsorption of heavy metal ions to the adsorbent was faster than that of CIP. Isotherms results showed excellent monolayer adsorption capacities of 330.90, 161, and 118.90 mg g-1 for Pb(II), Cu(II), and Ni(II), respectively, with a heterogeneous adsorption capacity of 25.40 mg g-1 for CIP. The adsorption mechanism was investigated using energy dispersive X-ray (EDX), elemental mapping, and Fourier transform infrared (FTIR) techniques. More significantly, the synthesized adsorbent gave good removal efficiencies when it was applied to simultaneously adsorb metal ions and CIP from real wastewater. Furthermore, excellent reusability could be obtained, making it a viable alternative to remove the inorganic and organic micropollutants for wastewater treatment.

Contribution of sewage to occurrence of phosphodiesterase-5 inhibitors in natural water.

Phosphodiesterase-5 inhibitors (PDE-5i, such as Sildenafil, Tadalafil and Vardenafil, mainly prescribed to treat erectile dysfunction) and their generic drug equivalents have been widely marketed and consumed in Korea. From the concentrations detected in wastewater, we could deduce that relatively large amounts of PDE-5i were consumed without a legal prescription. Thus, PDE-5i's presence in the environment via sewage is unavoidable, and their environmental fate within a sewage treatment plant (STP) should be evaluated. In this study, we investigated the occurrence of three PDE-5i analogs in the influent and effluent of two STPs and the receiving water bodies. The PDE-5i concentration in total reached 62 ± 12 (STP#1) and 88 ± 37 ng L-1 (STP#2) in the sewage influent; about 70% of it was Sildenafil in both STPs. However, they were hardly removed by the STPs as the removal efficiency of the STPs was less than 10% ± 5%. Therefore, the pharmaceuticals were detected in the receiving water (lower than 7 ng L-1as a total amount) and the concentration slightly increased downstream of the STPs. A simple mass balance model applied for the compounds in the STP effluent and receiving water bodies also confirmed that the discharged PDE-5i were quite persistent. Lastly, we identified temporal and regional patterns in the consumption of the drugs from daily variations of PDE-5i in the influent to these two STPs. For instance, the levels of PDE-5i in the sewage significantly increased on weekends (from Friday to Saturday), and especially in the area where adult-entertainment businesses are common. We estimated that the amount of PDE-5i consumption in this area was 31% higher than that in the area with fewer nightlife spots. Considering that they are pharmaceutically active and resistant to treatment processes within an STP, it is advised that a regular monitoring and management program for PDE-5i should be developed to prevent the discharge of the pharmaceuticals into the water environment.

Why do subchondral cysts occur at the medial aspect of the femoral head in hip dysplasia?

INTRODUCTION: Osteoarthritis in dysplastic hips should develop from the lateral side of the acetabulum and the femoral head just below. However, the existence of subchondral cysts located more on the medial side contradicts the weight-loading theory. The aim of this study was to confirm the presence of medial cysts at the femoral head and to investigate the relationship between medial cysts and injuries of the ligamentum teres in hip dysplasia. METHODS: A retrospective analysis was conducted on 257 cases of hip dysplasia. All patients had x-rays and 3-dimensional computed tomographies (3D CT) preoperatively and 123 patients had magnetic resonance arthrographies. A comparison was performed between cases with and without medial cysts according to the severity of damage to the ligamentum teres, the presence of bony spurs around the fovea capitis, and the Tönnis grade. RESULTS: Medial subchondral cysts around the fovea capitis were found in 100 cases. Mild osteoarthritis (Tönnis grade 0 or 1) was present in 89% of cases in the medial cyst group. A significant difference between the groups was observed in the incidence of bony spurs around the fovea capitis (p < 0.05) and injuries of the ligamentum teres (p < 0.05). CONCLUSIONS: The formation of subchondral cysts at the medial femoral head in hip dysplasia may be related to damage in the ligamentum teres. Considering that subchondral cysts develop in early osteoarthritis, the progression of arthritis in hip dysplasia appears to correlate with damage to the ligamentum teres, as well as compressive pressure on the joint.

Comparison of hip subregion bone mineral density to the type of proximal femur fracture.

Beta values of the intertrochanteric fracture group were about twice as high as those of the femoral neck fracture group. These results can be used to increase the awareness of proximal hip fracture among physicians and improve treatments and outcomes. PURPOSE: To compare the BMD of the femoral neck region and the intertrochanteric region between the femoral neck fracture group and the intertrochanteric fracture group. METHODS: We did a retrospective review of radiographs of the proximal femoral fractures in patients registered from 2010 to 2017. A total of 329 patients were classified into the femoral neck fracture group (group A, n = 162) and the femur intertrochanteric fracture group (group B, n = 167). We did intergroup comparisons of age, sex, BMI (body mass index), and bone mineral density (BMD) of the neck and intertrochanteric region, adjusting for age. We did multiple logistic regression analysis among these parameters. RESULTS: The BMD of the femoral neck and intertrochanteric was statistically significantly different between the two groups (p < 0.001), and the BMD of the femur intertrochanteric was also significantly different between the two groups (p < 0.001). BMD of both regions in the intertrochanteric fracture group was lower than that of the femoral neck fracture group. In linear regression analysis, the beta values of the intertrochanteric fracture group were about twice as high as those of the femoral neck fracture group. CONCLUSION: In linear regression analysis, the beta values of the intertrochanteric fracture group were about twice as high as those of the femoral neck fracture group.