3D-printed titanium porous prosthesis combined with the Masquelet technique for the management of large femoral bone defect caused by osteomyelitis.

BACKGROUND: The treatment of infected bone defects remains a clinical challenge. With the development of three-dimensional printing technology, three-dimensional printed implants have been used for defect reconstruction. The aim of this study was to investigate the clinical outcomes of three-dimensional printed porous prosthesis in the treatment of femoral defects caused by osteomyelitis. METHODS: Eleven patients with femoral bone defects following osteomyelitis who were treated with 3D-printed porous prosthesis at our institution between May 2017 and July 2021, were included. Eight patients were diagnosed with critical-sized defects, and the other three patients were diagnosed with shape-structural defects. A two-stage procedure was performed for all patients, and the infection was eradicated and bone defects were occupied by polymethylmethacrylate spacer during the first stage. The 3D-printed prosthesis was designed and used for the reconstruction of femoral defects in the second stage. Position of the reconstructed prostheses and bone growth were measured using radiography. The union rate, complications, and functional outcomes at the final follow-up were assessed. RESULTS: The mean length of the bone defect was 14.0 cm, union was achieved in 10 (91%) patients. All patients showed good functional performance at the most recent follow-up. In the critical-sized defect group, one patient developed a deep infection that required additional procedures. Two patients had prosthetic dislocations. Radiography demonstrated good osseous integration of the implant-bone interface in 10 patients. CONCLUSION: The 3D printed prostheses enable rapid anatomical and mechanically stable reconstruction of extreme femur bone defects, effectively shortens treatment time, and achieves satisfactory clinical outcomes.

Pretreatment of sludge with sodium iron chlorophyllin-H2O2 for enhanced biogas production during anaerobic digestion.

This study investigated a novel sodium iron chlorophyllin-H2O2 (SIC-H2O2) sludge pretreatment strategy before anaerobic digestion to enhance methane production. The efficiencies and mechanism of the proposed strategy to enhance sludge biodegradability were explored. The SIC-H2O2 pretreatment could enhance the oxidation performance for sludge floc disintegration to dissociate TB-EPS into S-EPS increased SCOD to 521.38 mg/L. The increase of solubilization and release of EPS with the pretreatment facilitate the biogas production at 702 L kg-1 VS, which was 3-folds of the control and significantly higher than other pretreatments. The result of excitation-emission matrix and parallel factor (EEM-PARAFAC) analysis showed that the SIC-H2O2 pretreatment enhanced the dissociation of TB-EPS fractions, especially the protein-like and soluble microbial by-product-like substances. Electron paramagnetic resonance (EPR) results provided evidence for homolytic catalysis H2O2 for the generation OH and the production of high-valent (Por)FeIV(O) intermediates. Synergistic effects of reactive oxygen species (OH, H2O2 and /HO2) and (Por)FeIV(O) enhanced the EPS disintegration during SIC-H2O2 pretreatment. The mixed-acid type fermentation provided continuous VFAs supply under the enrichment of Chloroflexi and Actinobacteria and multiplication Methanosaeta also promoted methane production. This research provides a feasible pretreatment strategy increase sludge biodegradability and enhance biogas production in the anaerobic digestion process.

Recirculation of reject water in deep-dewatering process to influent of wastewater treatment plant and dewaterability of sludge conditioned with Fe2+/H2O2, Fe2+/Ca(ClO)2, and Fe2+/Na2S2O8: From bench to pilot-scale study.

Deep dewatering of sewage sludge pretreated with advanced oxidation processes (AOPs) is a strategy for efficient sludge reduction and subsequent disposal. The pretreatment and dewatering performance of sludge conditioned with three types of AOPs (Fe2+/H2O2, Fe2+/Ca(ClO)2, and Fe2+/Na2S2O8), compared with sludge conditioned with traditional conditioner (Fe3+/CaO), were investigated in both bench and pilot-scale tests. All of those conditioner systems could reduce the water content of dewatered sludge cake to below 60 wt% in bench-scale (about 16 kg raw sludge per round) and pilot-scale (approximate 800 kg raw sludge per round) diaphragm filter press dewatering. Compared with raw sludge, the deep-dewatering filtrate after different conditioning and dewatering processes had higher ammonia nitrogen (NH4+-N) and chemical oxygen demand (COD) contents due to the degradation of organic matter, and much lower total phosphorus (TP) content due to the formation of iron phosphate precipitate. A better biodegradability (i.e. higher BOD5/COD ratio) was found in the deep-dewatering filtrate of sludge conditioned with Fe2+/H2O2 (25.2 %) and Fe2+/Ca(ClO)2 (17.4 %). Most of the heavy metals (Cr, Cu, Ni, and Pb) (>79 wt%) have remained in the dewatered sludge cake, and most of the Cl element (>90 wt%) in the sludge pretreated by Fe2+/Ca(ClO)2 and Fe3+/CaO was kept in the filtrate, rather than the dewatered sludge cake. Based on the pilot-scale experimental results, if all the filtrate in the deep-dewatering process returned to the influent of WWTP, the loading ratios of TP, NH4+-N, COD in the four conditioner systems were less than 3 wt%. The above results proved that the AOPs conditioned sludge could achieve deep-dewatering in pilot-scale and the direct recirculation of deep-dewatering filtrate to the influent of wastewater treatment plant was feasible.

Repair of critical diaphyseal defects of lower limbs by 3D printed porous Ti6Al4V scaffolds without additional bone grafting: a prospective clinical study.

The repair of critical diaphyseal defects of lower weight-bearing limbs is an intractable problem in clinical practice. From December 2017, we prospectively applied 3D printed porous Ti6Al4V scaffolds to reconstruct this kind of bone defect. All patients experienced a two-stage surgical process, including thorough debridement and scaffold implantation. With an average follow-up of 23.0 months, ten patients with 11 parts of bone defects were enrolled in this study. The case series included three females and seven males, their defect reasons included seven parts of osteomyelitis and four parts of aseptic nonunion. The bone defects located at femur (five parts) and tibia (six parts), with an average defect distance of 12.2 cm. Serial postoperative radiologic follow-ups displayed a continuous process of new bone growing and remodeling around the scaffold. One patient suffered tibial varus deformity, and he underwent a revision surgery. The other nine patients achieved scaffold stability. No scaffold breakage occurred. In conclusion, the implantation of 3D printed Ti6Al4V scaffold was feasible and effective to reconstruct critical bone defects of lower limbs without additional bone grafting. Graphical abstract.

Enhancing waste activated sludge dewaterability by reducing interaction energy of sludge flocs.

How to efficiently improve waste activated sludge (WAS) dewaterability is a common challenge in WAS treatment and management throughout world. The interaction energy of sludge flocs is of great importance for sludge dewaterability. In this study, the relationship among the repulsive force of sludge flocs, hydrophilic/hydrophobic characteristics of sludge flocs, and sludge dewaterability have been quantitatively and qualitatively investigated based on extended Derjaguin-Landau-Verwey-Overbeek theory for the first time. The energy barrier of sludge flocs has good correlations with sludge dewaterability (p < 0.05). Trivalent cations (Al3+ and Fe3+) and Fenton's reagent reduced the interfacial free energy (ΔG) from 9.4 mJ/m2 of raw sludge to -34.2 (Al3+), -60.5 (Fe3+), and -63.2 (Fenton) mJ/m2, respectively, indicating that the hydrophilic surfaces of the sludge flocs converted to hydrophobic (△G < 0), and decreasing Lewis acid-base interaction energy (WAB) of sludge flocs. In addition, most of the trivalent cations (Al3+ and Fe3+) were attached to sludge flocs, leading to neutralize negative charges and mitigate electrostatic interaction energy (WR) of sludge flocs. The reduction of WAB and WR eliminated energy barrier of sludge flocs and repulsive force between sludge flocs. In comparison, monovalent (Na+ and K+) and bivalent (Ca2+ and Mn2+) cations cannot completely change the hydrophilic surface characteristic and negative charge of sludge flocs. The existed energy barrier prevented sludge flocs to agglomerate with each other, thus resulting in a worse dewaterability. This study illustrated that reducing interaction energy of sludge flocs played a critical role to improve sludge dewaterability.

Utilization of random vector functional link integrated with manta ray foraging optimization for effluent prediction of wastewater treatment plant.

An innovative predictive model was employed to predict the key performance indicators of a full-scale wastewater treatment plant (WWTP) operated with an activated sludge treatment process. The data-driven model was obtained using data gathered from Cairo, Egypt. The proposed model consists of Random Vector Functional Link (RVFL) Networks incorporated with Manta Ray Foraging Optimizer (MRFO). RVFL is used as an advanced Artificial Neural Network (ANN) that avoids the common conventional ANN problems such as overfitting. MRFO is employed to determine the best RVFL parameters to maximize the prediction accuracy of the model. The developed MRFO-RVFL is compared with conventional RVFL to figure out the role of MRFO as an optimization tool to enhance model performance. Both models were trained and tested using experimental data measured during a long period of 222 days. This study aims to provide an accurate prediction of the most widely treated effluent indicators of BOD5 and TSS in the wastewater treatment plants. In this study, ten well-known influent wastewater parameters, BOD5, TSS, and VSS, influent flow rate, pH, ambient temperature, F/M ratio, SRT, WAS, and RAS, the output BOD5 and TSS were modeled and predicted using the integrated MRFO-RVFL algorithms and compared with the standalone RVFL model. The performance of the models was evaluated using different assessment measures such as R2, RMSE, and others. The obtained results of R2 and RMSE for the MRFO-RVFL model were 0.924 and 3.528 for BOD5 and 0.917 and 6.153 for TSS, which were much better than the results of conventional RVFL with 0.840 and 6.207 for BOD5 and 0.717 and 10.05 for TSS. Based on the obtained results, the selective model (MRFO-RVFL) exhibited a higher performance and validity to predict the TSS and optimal BOD5.

Enhanced quorum sensing of anode biofilm for better sensing linearity and recovery capability of microbial fuel cell toxicity sensor.

MFC toxicity sensor has major hindrances that limit its practical application, such as the poor concentration-response relationship and inferior recovery capability after high toxicity shock. Till now, the direct influence of intrinsic properties on the performance of MFC toxicity sensor has not been well understood. Quorum sensing (QS) is a cell-to-cell communication strategy that indirectly affects the intrinsic properties of electroactive biofilms. In this work, commercially available QS autoinducers (AHLs) were applied to MFC toxicity sensor to manipulate anode biofilm for better sensing performance. The results showed that the addition of AHLs (C6-HSL, 3-OXO-C12-HSL) led to higher sensing linearity to a wider range of Pb2+. The voltage of MFC sensors with AHLs addition fully recovered even after 10 mg/L Cu2+ shock, indicating an enhanced recovery capability of MFC toxicity sensor. It was found that higher live/dead cells ratio and increased exoelectrogen Geobacter abundance were responsible for the superior sensing linearity and recovery capability of MFC toxicity sensor. Our work presented a novel and effective way to advance the process of MFC toxicity sensor application from the perspective of EABs.

Improvement of sludge dewaterability by ammonium sulfate and the potential reuse of sludge as nitrogen fertilizer.

A novel method to enhance sludge dewaterability with ammonium sulfate ((NH4)2SO4) was proposed, and the potential reuse of dewatered sludge cake and filtrate as nitrogen fertilizers was evaluated. Compared with raw sludge, 87.91% reduction of capillary suction time (CST) and 88.02% reduction of specific resistance to filtration (SRF) after adding 80% (m/m) (NH4)2SO4 were achieved, with 38.49% of protein precipitated simultaneously. The (NH4)2SO4 dose destroyed cell membrane, resulting in the release of intracellular water by converting bound water into free water, thus enhancing sludge dewaterability. In the solid phase, the content of protein-N increased, and larger protein aggregates were formed. The (NH4)2SO4 dose destroyed the hydration shell, making proteins to exhibit hydrophobic interactions, and to be aggregated, and precipitated from the liquid phase. When incubated Pennisetum alopecuroides L. with the dewatered sludge cake and filtrate after dewatering and conditioning with (NH4)2SO4, the germination rate of grass seed and shoot lengths both increased while compared with those incubated with dewatered sludge cake and filtrate of the raw sludge. This study might provide insights into sustainable sludge treatment by integrating sludge dewatering and the potential reuse of dewatered sludge cake and filtrate as nitrogen fertilizer via treatment with (NH4)2SO4.

Radiological indicators to predict the application of assistant intubation techniques for patients undergoing cervical surgery.

BACKGROUND: We aimed to distinguish the preoperative radiological indicators to predict the application of assistant techniques during intubation for patients undergoing selective cervical surgery. METHODS: A total of 104 patients were enrolled in this study. According to whether intubation was successfully accomplished by simple Macintosh laryngoscopy, patients were divided into Macintosh laryngoscopy group (n = 78) and Assistant technique group (n = 26). We measured patients' radiographical data via their preoperative X-ray and MRI images, and compared the differences between two groups. Binary logistic regression model was applied to distinguish the meaningful predictors. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to describe the discrimination ability of indicators. The highest Youden's index corresponded to an optimal cut-off value. RESULTS: Ten variables exhibited significant statistical differences between two groups (P <  0.05). Based on logistic regression model, four further showed correlation with the application of assistant techniques, namely, perpendicular distance from hard palate to tip of upper incisor (X2), atlanto-occipital gap (X9), angle between a line passing through posterior-superior point of hard palate and the lowest point of the occipital bone and a line passing through the anterior-inferior point and the posterior-inferior point of the second cervical vertebral body (Angle E), and distance from skin to hyoid bone (MRI 7). Angle E owned the largest AUC (0.929), and its optimal cut-off value was 19.9° (sensitivity = 88.5%, specificity = 91.0%). the optimal cut-off value, sensitivity and specificity of other three variables were X2 (30.1 mm, 76.9, 76.9%), MRI7 (16.3 mm, 69.2, 87.2%), and X9 (7.3 mm, 73.1, 56.4%). CONCLUSIONS: Four radiological variables possessed potential ability to predict the application of assistant intubation techniques. Anaesthesiologists are recommended to apply assistant techniques more positively once encountering the mentioned cut-off values.

An innovative strategy to treat large metaphyseal segmental femoral bone defect using customized design and 3D printed micro-porous prosthesis: a prospective clinical study.

Five patients with segmental irregular-shaped bone defect of the femur were recruited in this study from 2017.12 to 2018.11. All patients were treated by customized design and 3D printed micro-porous prosthesis. And the procedure was divided into stages: radical debridement and temporary fixation (the first stage); the membrane formation and virtual surgery (intervening period for 6-8 weeks); definite reconstruction the defects (the second stage). Routine clinical follow-up and radiographic evaluation were done to assess bone incorporation and complications of internal fixation. The weight-bearing time and the joint function of the patients were recorded. The patients were followed up for an average of 16.4 months. The average length of bone defect and the distal residual bone was 12 cm and 6.5 cm. The average time of partial weight-bearing and full weight-bearing was 12.7 days and 2.6 months. X-ray demonstrated good osseous integration of the implant/bone interface. No complications occurred such as implant loosening, subsidence, loss of correction and infection. At the last follow-up, Harris score of hip joint was excellent in 2 cases, good in 2 cases, fair in 1 case; HSS score of knee joint was good in 4 cases, middle in 1 case. From our study, we concluded that meticulous customized design 3D printed micro-porous prosthesis combined with intramedullary nail may be a promising and an alternative strategy to treat metaphyseal segmental irregular-shaped femoral bone defect, especially for cases with massive juxta-articular bone loss.

Performance evaluation of microbial fuel cell for landfill leachate treatment: Research updates and synergistic effects of hybrid systems.

Over half of century, sanitary landfill was and is still the most economical treatment strategy for solid waste disposal, but the environmental risks associated with the leachate have brought attention of scientists for its proper treatment to avoid surface and ground water deterioration. Most of the treatment technologies are energy-negative and cost intensive processes, which are unable to meet current environmental regulations. There are continuous demands of alternatives concomitant with positive energy and high effluent quality. Microbial fuel cells (MFCs) were launched in the last two decades as a potential treatment technology with bioelectricity generation accompanied with simultaneous carbon and nutrient removal. This study reviews capability and mechanisms of carbon, nitrogen and phosphorous removal from landfill leachate through MFC technology, as well as summarizes and discusses the recent advances of standalone and hybrid MFCs performances in landfill leachate (LFL) treatment. Recent improvements and synergetic effect of hybrid MFC technology upon the increasing of power densities, organic and nutrient removal, and future challenges were discussed in details.

Facile and Cost-Effective Approach for Copper Recovery from Waste Printed Circuit Boards via a Sequential Mechanochemical/Leaching/Recrystallization Process.

The recovery of copper (Cu0) from waste printed circuit boards (WPCBs) is a great challenge as a result of its heterogeneous structural properties, with a mixture of metals, epoxy resin, and fiberglass. In this study, a three-step sequential process, including mechanochemical processing, water leaching, and recrystallization, for Cu0 recovery from WPCB powder is reported. Potassium persulfate (K2S2O8), instead of acid/alkali reagents, was employed as the sole reagent in the cupric sulfate (CuSO4) regeneration process. Complete oxidation of Cu0 in the WPCBs to copper oxide (CuO) and CuSO4 was first achieved during mechanochemical processing with K2S2O8 as the solid oxidant, and the K2S2O8 was simultaneously converted to sulfate compounds [K3H(SO4)2] via a solid-solid reaction with epoxy resin (C nH mO y) as the hydrogen donator under mechanical force. The rapid leaching of Cu species in the forms of CuO and CuSO4 was therefore easily realized with pure water as a nontoxic leaching reagent. The kinetics of the leaching process of Cu species was confirmed to follow the shrinking nucleus model controlled by solid-film diffusion. Finally, CuSO4·5H2O was successfully separated by cooling crystallization of the hot saturated solution of sulfate salt [K2Cu(SO4)2·6H2O]. An efficient conversion of Cu0 to CuSO4·5H2O product, for WPCB recycling, was therefore established.

A micromilled microgrid sensor with delaminated MXene-bismuth nanocomposite assembly for simultaneous electrochemical detection of lead(II), cadmium(II) and zinc(II).

A delaminated MXene-bismuth (Bi@d-Ti3C2) nanocomposite was synthesized for the construction of a microgrid electrochemical sensor via mechanical milling. The Bi@d-Ti3C2 nanocomposite was synthesized by accumulation of Bi(III) on the surface of delaminated Ti3C2 nanosheets through electrostatic attraction and subsequent in-situ growth of bismuth nanorods. Under optimized experimental conditions, the sensor exhibits (a) linear responses to Pb(II), Cd(II) and Zn(II) in the concentration range from 1 to 20 µg L-1, (b) well separated peak potentials at -0.54 V, -0.76 V and - 1.15 V vs. Ag/AgCl, (c) sensitivities of 0.98, 0.84 and 0.60 µA L µg-1, and (d) detection limits of 0.2, 0.4 and 0.5 µg L-1, respectively. This performance is attributed to the uniform dispersion of Bi nanorods on electrically conductive delaminated Ti3C2 MXene, and to the enhanced diffusion due to the microgrid structure. Graphical abstractSchematic representation of a microgrid sensor based on delaminated MXene-bismuth (Bi@d-Ti3C2) nanocomposite for the simultaneous electrochemical determination of Pb(II), Cd(II) and Zn(II).

The summary of experience of abdominal vascular injury related to posterior lumbar surgery.

PURPOSE: To study the clinical and pathophysiologic characteristics and summarize the experience of treatment of abdominal vascular injury related to lumbar surgery. METHODS: We analyzed patients who suffered abdominal vascular injury during lumbar surgery in our hospital retrospectively and reviewed related literature in the PUBMED database from 2002 to 2017. Combined with the existing treatment options and outcomes, we investigated further and summarized our findings. RESULTS: With the data from our hospital, four cases of injuries were included, i.e., left common iliac artery and vein (CIA and CIV), left internal iliac artery, and inferior vena cava. Almost all of the patients (one exception) manifesting unstable haemodynamics were primarily treated by traditional vessel suture. After treatment, two patients died eventually, while the others recovered well at follow-up. With the reported data, 77 patients with the most frequently type of laceration (58.4%) were included. For vascular laceration, unstable haemodynamics was diagnosed in most of the patients (88.9%); CIA and CIV accounted for the all the most common patients (78.7%). Extracted from these data, traditional surgical method was selected to repair laceration prevalently (86.7%), while arteriovenous fistula and pseudoaneurysm were treated with an interventional procedure. Negative outcomes included two deaths, two suffered lower limb deep vein thrombosis, and two suffered graft infection. CONCLUSIONS: Different treatment choices should be conducted depending on different injury characteristics and patients' condition. Moreover, early recognition and prompt treatment are critical components to successful rescue. When a vascular injury is suspected, ultrasonography and positive abdominal exploration are recommended together with unified leadership in the rescue team.

An Emission-Free Vacuum Chlorinating Process for Simultaneous Sulfur Fixation and Lead Recovery from Spent Lead-Acid Batteries.

Spent lead-acid battery recycling by using conventional technologies is usually accompanied by releases of lead-containing wastewater as well as emissions of sulfur oxides and lead particulates that may potentially cause secondary pollution. This study developed a vacuum chlorinating process for simultaneous sulfur fixation and high-purity lead chloride (PbCl2) recovery from spent lead paste by using calcium chloride (CaCl2) and silicon dioxide (SiO2) as reagents. The process train includes pretreatment, simultaneous PbCl2 production and sulfur fixation, and PbCl2 volatilization. The pretreatment eliminated chlorine emission from direct chlorinating reaction of PbO2 in the initial S-paste (PbSO4/PbO2/PbO/Pb). During the subsequent PbCl2 production and sulfur fixation step, lead compounds in the P-paste (PbSO4/PbO) was converted to volatile PbCl2, and sulfur was simultaneously fixed to the solid residues in the form of CaSO4 to eliminate the emission of sulfur oxides. The final step, PbCl2 volatilization under vacuum, is a physical phase-transformation process of ionic crystals, following a zeroth-order kinetic model. A cost estimate indicates a profit of USD $ 8.50/kg PbCl2. This process offers a novel green lead recovery alternative for spent lead-acid batteries with environmental and economic benefits.

Simulation on flow field and gas hold-up of a pilot-scale oxidation ditch by using liquid-gas CFD model.

A liquid-gas two-phase computational fluid dynamics (CFD) model was developed to simulate flow field and gas hold-up in a pilot-scale oxidation ditch (OD). The volume of fluid (VOF) model and the mass flow inlet boundary condition for gas injection were introduced in this model. The simulated values of the flow velocities and the gas hold-up were verified by experimental measurements in the pilot-scale OD. The results showed that the gas hold-up at test-site 3, immediately downstream of the surface aerator, was the highest among all three test-sites. Most of the gas existed in the upper portion of the ditch and was close to the inner side of the channel. Based on the liquid-gas two-phase CFD model, three operating conditions with different setting height ratios of the submerged impellers were simulated. The simulated results suggested that the setting heights of the submerged impellers have significant impacts on the flow velocity distribution. Lowering the setting height could increase the flow velocity in the pilot-scale OD. An optimal setting height ratio of 0.273 was proposed, which would be beneficial for minimizing sludge sedimentation, especially near the inner side of the curve bend.

Remove legacy perfluoroalkyl acids and emerging per- and polyfluoroalkyl ether acids by single-use and regenerable anion exchange resins: Rapid small-scale column tests and model fits.

Rapid small-scale column tests (RSSCT) are used to study the removal of per- and polyfluoroalkyl substances (PFAS) for drinking water treatment by ion exchange. Breakthroughs of 15 emerging per- and perfluoroalkyl ether acids and six legacy perfluoroalkyl acid analogs are studied using a single-use PFAS-selective anion exchange resin (AER1) and a regenerable, generic anion exchange resin (AER2). The Bohart-Adams model was used to describe and predict breakthrough, with the modeled results reasonably aligned with RSSCT results in most cases, enabling shorter RSSCT duration for future applications. AER1 exhibited high uptake capacity with no breakthrough for 11 of the 21 tested PFAS during the 144,175 BV continuous operation, allowing compliance with the new National Primary Drinking Water Regulation in many application scenarios. AER2 exhibited much faster breakthroughs for most PFAS and is not a promising option for drinking water treatment. However, the summed PFAS capacity via model fit and total PFAS adsorbed via measurement were only <0.01 % of both resin capacities at full breakthrough, suggesting PFAS could only occupy a tiny portion of the ion exchange sites even for the PFAS-selective AER1. Ether group insertion in the PFAS group leads to later breakthrough, and linear isomers were better captured by the resins than the branched isomers. Overall, PFAS uptake capacity increases and kinetics decrease when the PFAS molecular volume increases. Regeneration using 10 % NaCl solutions partially released PFAS from AER2 but not from AER1, with more short-chain PFAS released than long-chain ones. Ether group insertion decreased the PFAS recoveries during the regeneration of AER2. The regenerated resins showed much faster breakthroughs than the pristine resins, making them unfavorable for drinking water treatment applications. Adsorption displacement of short-chain PFAS by long-chain PFAS was observed in pristine AER1, and post-regeneration leaching occurred for both resins, both phenomena making the resins a possible PFAS source in long-term use.

Machine learning models to predict osteonecrosis in patients with femoral neck fractures undergoing internal fixation.

OBJECTIVE: This study aimed to use machine learning (ML) to establish risk factor and prediction models of osteonecrosis of the femoral head (ONFH) in patients with femoral neck fractures (FNFs) after internal fixation. METHODS: We retrospectively collected clinical data of patients with FNFs who were followed up for at least 2 years. Only intracapsular FNFs were included. In total, 437 patients and 24 variables were enrolled. The entire dataset was divided into training (89.5 %) and test (10.5 %) datasets. Six models-logistic regression, naive Bayes, decision tree, random forest, multilayer perceptron, and AdaBoost-were established and validated for predicting postoperative ONFH. We compared the area under the receiver operating characteristic curve (AUC), accuracy, recall, and F1 score of different models. In addition, a confusion matrix, density curve, and learning curve were used to evaluate the model performance. RESULTS: The logistic regression model performed best at predicting ONFH in patients with FNFs undergoing internal fixation surgery, with an AUC, accuracy, recall, F1 score, and prediction value of 0.84, 0.89, 1.00, 0.94, and 89.1 %, respectively. The learning and density curves demonstrated a good prediction fitting degree and distinct separation. When establishing the ML models, the reduction quality, internal fixation removal, American Society of Anesthesiologists classification, injury mechanism, and displacement distance of the medial cortex were the top five risk factors positively correlated with the occurrence of ONFH. CONCLUSIONS: The logistic regression model had excellent performance in predicting ONFH in patients with FNFs after internal fixation and could provide valuable guidance in clinical decision-making. When choosing treatment options for patients with FNFs, doctors should identify the risk factors and consider using the presented models to help anticipate outcomes and select individualised treatment.

Applying 3D-Printed Porous Ti6Al4V Prostheses to Repair Osteomyelitis-Induced Partial Bone Defects of Lower Limbs: Finite Element Analysis and Clinical Outcomes.

OBJECTIVE: The clinical management of partial bone defects in lower limbs, particularly those resulting from osteomyelitis, remains a significant challenge. This study aimed to systematically evaluate the effectiveness of 3D-printed porous Ti6Al4V prostheses in addressing osteomyelitis-induced partial bone defects. METHODS: We established a comprehensive protocol for utilizing 3D-printed prostheses for bone defect repair, encompassing 3D simulation of prosthesis implantation and internal fixation, finite element analysis (FEA), and clinical implementation. Mimics software facilitated simulation of fixation patterns and screw lengths. FEA modeled bone defects in the distal metaphyseal femur and distal diaphyseal tibia to assess changes in stress conduction pre- and post-prosthesis implantation. The clinical study involved eight patients (average age: 56.3 years) with an average defect length of 14.9 cm. Postoperative outcomes were evaluated using X-rays and the Lower Extremity Functional Scale (LEFS). RESULTS: FEA demonstrated that the implanted prostheses effectively shared stress and reduced the load on residual bone in both models, thus lowering the risk of fractures under external forces. The average follow-up period was 24.5 months, with patients initiating weight-bearing activities on average 7.8 days post-surgery. Serial postoperative X-rays demonstrated long-term stability of the prostheses, with progressive bone regeneration around and integration with the prostheses. While two patients experienced infection recurrence requiring prosthesis removal and debridement, the remaining six showed significant improvement in LEFS scores, increasing from 31.5 preoperatively to 61.0 at the last follow-up. CONCLUSIONS: 3D-printed porous Ti6Al4V prostheses effectively restore anatomical integrity and optimize stress conduction in lower limbs, resulting in substantial functional recovery. This innovative approach shows promise for wider clinical adoption and warrants further investigation in medical practice.

Data-Driven Based Characterization of Anisotropic Mechanical Properties for Cancellous Bone From Low-Resolution CT Images.

OBJECTIVES: Exploring the anisotropic mechanical behavior of cancellous bone is crucial for in-vivo bone biomechanical analysis. However, it is challenging to characterize anisotropic mechanical behaviors under low-resolution (LR) clinical CT images due to a lack of microstructural information. The data-driven method proposed in this article accurately characterizes the anisotropic mechanical properties of cancellous bone from LR clinical CT images. METHODS: The trabecular bone cubes of sheep are used to obtain a high-resolution (HR) micro-CT and an LR clinical CT image dataset. First, an auto-encoder model is trained using HR image data. Microstructural features are extracted by the encoder. A fast super-resolution (FSR) model is trained to map LR bone cubes to the features extracted from corresponding HR samples. The pretrained FSR model is used to convert LR clinical CT images to encoded microstructural features. The features are later used to predict target histomorphological parameters, anisotropic elastic tensors, and fabric tensors based on a fully connected neural network. RESULTS: The data-driven model accurately predicts the elastic tensor and fabric tensor of trabecular bones with LR CT images with 0.6 mm/pixel spatial resolution. It was verified that LR clinical CT images could generate microstructural information using a generative deep-learning model and an up-sampling operation. SIGNIFICANCE: This study proves that clinical medical images of cancellous bone can be used for analysis of complex mechanical properties using a data-driven method, which is useful for real-time bone defect diagnosis and personalized bone prosthesis design in clinical application.