Double-bundle anterior cruciate ligament reconstruction using autologous hamstrings with LARS augmentation demonstrates comparable outcomes to hamstrings alone, without evidence of synovitis or early osteoarthritis.

PURPOSE: To compare the clinical and radiological outcomes in patients undergoing anterior cruciate ligament reconstruction (ACLR) with, or without, LARS augmentation. METHODS: One-hundred and thirty-six patients that underwent double-bundle ACLR with (DB Hams/LARS, n = 67), or without (DB Hams, n = 69), LARS augmentation, were assessed clinically and with Magnetic Resonance Imaging (MRI) at a minimum of 7-years post-surgery. Patients were assessed via patient-reported outcome measures (PROMs), KT-1000 (laxity), isokinetic knee extensor and flexor strength and a 4-hop test battery. Limb symmetry indices (LSIs) were calculated. The Whole-Organ Magnetic Resonance Imaging Score (WORMS) evaluated knee status via MRI. Sport participation, secondary operations, ACL re-tears and contralateral ACL tears were reported. RESULTS: No differences (n.s.) were observed in demographics, PROMs, KT-1000 scores or strength and hop LSIs. Normal (< 3 mm side-to-side differences) KT-1000 scores were observed in 64 (92.8%) and 59 (88.1%) of DB Hams and DB Hams/LARS patients, respectively. Comparative rates of satisfaction were reported. Knee flexor strength and hop test LSIs were all ˃95% in both groups, which was 94.2% and 96.7% for knee extensor strength in the DB Hams and DB Hams/LARS cohorts, respectively. While 53 (76.8%) and 52 (77.6%) of the DB Hams and DB Hams/LARS patients had returned to pivoting sports, 42 (60.9%) and 41 (61.2%) were participating in pivoting sports at the minimum 7-year review. No difference (n.s.) was observed in the WORMS (12.3 DB Hams, 16.7 DB Hams/LARS). Of the cohort assessed, 8 (11%) DB Hams and 11 (16%) DB Hams/LARS patients had undergone secondary surgery. In addition to one patient in each group that demonstrated ACL rupture on MRI, an additional cohort of patients were excluded from the current analysis due to prior re-tear (DB Hams n = 6, DB Hams/LARS n = 8) or contralateral ACL tear (DB Hams n = 4, DB Hams/LARS n = 4). CONCLUSIONS: Comparable outcomes were observed after double-bundle ACLR using autologous hamstrings with, or without, LARS augmentation. Therefore, while these outcomes do not justify the additional use of synthetic augmentation given the lack of further benefit and additional cost, higher rates of graft failure, synovitis and early osteoarthritic change previously reported were not observed. LEVEL OF EVIDENCE: III.

A comparison of XRFS and ICP-OES methods for soil trace metal analyses in a mining impacted agricultural watershed.

Field portable X-ray fluorescence spectroscopy (XRFS) has become increasingly prevalent for in situ detection of trace metals, as it is both rapid and cost effective. The accuracy of in situ XRFS analyses has been questioned due to possible interferences from elevated soil moisture and organic content. In this study, three metal analysis protocols (Cd, Pb, Zn) were compared for surface soil samples collected near the Tar Creek Superfund Site in northeastern Oklahoma. The protocols included the use of a field portable XRF spectrometer for in situ analyses and on homogenized, pulverized, air-dried soil samples sieved to < 250-µm fraction in the laboratory. A subset of soil samples was also analyzed after microwave-assisted hot HNO3 digestion followed by inductively coupled plasma-optical emission spectrometry (ICP-OES) analyses. Moisture content and loss-on-ignition (as a surrogate for organic matter) were determined for each sample. Soil moisture exceeding 10% in situ caused underreporting of field XRF readings when compared to the laboratory XRF readings. Relationships between concentrations determined by laboratory XRFS and ICP-OES for Pb (r2 = 0.96) and Zn (r2 = 0.91) were not statistically different (p < 0.025 for both analytes). A strong relationship between ICP-OES analyses of Zn and Cd (r2 = 0.93) allowed prediction of Cd concentrations for additional samples not analyzed by ICP-OES. This study recommends that XRFS field readings be used for initial screening only and that samples analyzed via field portable XRFS be homogenized, air dried, sieved and re-analyzed in the laboratory to yield the most accurate results.

Metals retention in a net alkaline mine drainage impacted stream due to the colonization of the North American Beaver (Castor canadensis).

This study investigated two aspects of Castor canadensis (North American Beaver) colonization on a net alkaline mine drainage impacted tributary to Tar Creek (Ottawa County, OK, USA). Specifically, the retention of metals due to the presence of beaver dams, and metals contamination of sediments due to long-term loading, were examined. The Unnamed Tributary (UT) has been impacted by two mine drainage sources since at least 1979, with Cd, Fe, Pb, and Zn being the primary metals of concern. This study was conducted along a 1.6 km reach of the stream. The presence of beaver was noted in the UT in 2013, and by the end of 2014, the majority of the UT had been transformed into a series of six to eight wetlands constructed by beaver. The study found the presence of beaver impoundments resulted in a decrease in aqueous Fe and Cd concentrations, with minimal influence on Pb concentrations. The most upstream beaver pond, impounding waters with the greatest initial metals concentrations, had mean Fe and Cd removal efficiencies of 57% and 63%, respectively. Utilizing geomorphic data collected during rapid habitat assessments, this beaver pond had an approximate surface area and hydraulic retention time of 3000 m2 and 70 h, respectively, resulting in a mean Fe removal rate of 4.12 g m-2 day-1 of Fe. The sediments collected from the UT contained elevated Cd, Pb, and Zn concentrations, with many of the metals concentrations greater than five times the EPA site-specific probable effect concentrations for sediment toxicity (Cd: 11.1 mg/kg, Pb: 150 mg/kg, and Zn: 2083 mg/kg). Five sediment samples contained Fe concentrations exceeding 200,000 mg/kg. Overall, this study emphasizes the ability of beaver to modify their surroundings and the potentially important role of beaver dams to help retain metals from untreated mine drainage impacted streams.

Characterization of trace metal removal products in vertical flow bioreactor substrates at the Mayer Ranch Passive Treatment System in the Tar Creek Superfund Site.

A passive treatment system (PTS), including two parallel vertical flow bioreactors (VFBR), was constructed in 2008 for the treatment of unabated net-alkaline ferruginous mine drainage in the Tar Creek Superfund Site in northeastern Oklahoma. Water quality data collected since the PTS began operation indicate significant removal of trace metals in the VFBR. Results of a sequential extraction procedure (SEP) performed on substrate samples showed that the majority of Cd, Co, Fe, Ni, Pb, and Zn were retained in the refractory organic/sulfide fraction. Subsequent acid volatile sulfide/simultaneously extracted metals (AVS/SEM) analyses confirmed the retention of Cd, Fe, Pb, and Zn as sulfides, but Co and Ni results were less certain. The majority of trace metals were retained as insoluble products in the VFBR, while up to 20% of most of the trace metals were retained in soluble, bioavailable fractions. Nearly 70% of Mn was retained in the soluble and bioavailable exchangeable, carbonate, and labile organic fractions.

Synergistic negative effects of small-sized benthivorous fish and nitrogen loading on the growth of submerged macrophytes - Relevance for shallow lake restoration.

Rapid recruitment of small fish after biomanipulation in warm lakes may delay the reestablishment of submerged macrophytes, not least at high nutrient concentrations. Success has recently been obtained in controlling phosphorus (P) loading to many lakes, but nitrogen (N) inputs often remain high. To determine the interactive effects of N loading and the abundance of small-sized fish on the growth of the submerged macrophyte Vallisneria natans, we conducted an outdoor mesocosm experiment with a factorial design on the north shore of Lake Taihu, China. The experiment involved two densities of small crucian carp - low (10gm-2) and high (40gm-2) - crossed with two levels of N loading - present-day external nutrient loading (P: 5µgL-1day-1, N: 130µgL-1day-1) and P: 5µgL-1day-1 with a three times higher N loading (N: 390µgL-1day-1). The results showed that nitrogen-fish interactions significantly hindered the growth of V. natans, particularly at the high N loading. At low N loading, high densities of fish decreased the relative growth rate, mean leaf length, leaf mass and root mass of V. natans by 16%, 5%, 8%, and 23%, respectively, compared with these measures at low fish densities. The effect of fish was even stronger when N loading was high, with decreases of 232%, 32%, 57%, and 47% for the respective plant growth measures. The stronger effect at high N loading was attributed to higher turbidity due to enhanced phytoplankton biomass and to increased consumption or damage of plants by the fish in response to the more nutrient-enriched plant tissue. Our results indicate that high abundance of small crucian carp in warm lakes may reduce the resilience of submerged macrophytes to external N loading, thereby lowering the chances of successful restoration by biomanipulation.

A Midterm Evaluation of Postoperative Platelet-Rich Plasma Injections on Arthroscopic Supraspinatus Repair: A Randomized Controlled Trial.

BACKGROUND: Platelet-rich plasma (PRP) has been applied as an adjunct to rotator cuff repair to improve tendon-bone healing and potentially reduce the incidence of subsequent tendon retears. PURPOSE: To investigate whether the midterm clinical and radiographic outcomes of arthroscopic supraspinatus repair are enhanced after repeated postoperative applications of PRP. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 60 patients (30 control; 30 PRP) were initially randomized to receive 2 ultrasound-guided injections of PRP to the tendon repair site at 7 and 14 days after double-row arthroscopic supraspinatus repair or not. A total of 55 patients (91.7%) underwent a clinical review and magnetic resonance imaging (MRI) at a mean of 3.5 years after surgery (range, 36-51 months). Patient-reported outcome measures (PROMs) included the Constant score, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, Oxford Shoulder Score (OSS), and visual analog scale (VAS) for pain. Global rating of change (GRC) scale and patient satisfaction scores were evaluated. Structural integrity of the surgical repair was assessed via MRI using the Sugaya classification system. RESULTS: At the midterm review, there was no difference between the groups for any of the PROMs. No differences between the groups were demonstrated for the subjective and range of motion subscales of the Constant score, although a significantly higher Constant strength subscale score was observed in the PRP group (3.3 points; 95% CI, 1.0-5.7; P = .006). There was no evidence for any group differences in MRI scores or retear rates, with 66.7% of PRP patients and 64.3% of control patients rated as Sugaya grade 1. Two control patients had symptomatic retears (both full thickness) within the first 16 weeks after surgery compared with 2 PRP patients, who suffered symptomatic retears (both partial thickness) between 16 weeks and a mean 3.5-year follow-up. CONCLUSION: Significant postoperative clinical improvements and high levels of patient satisfaction were observed in patients at the midterm review after supraspinatus repair. While pain-free, maximal abduction strength was greater in the midterm after PRP treatment, repeated applications of PRP delivered at 7 and 14 days after surgery provided no additional benefit to tendon integrity.

Metal-contaminated potato crops and potential human health risk in Bolivian mining highlands.

This study assessed metals in irrigation water, soil and potato crops impacted by mining discharges, as well as potential human health risk in the high desert near the historic mining center of Potosí, Bolivia. Metal concentrations were compared with international concentration limit guidelines. In addition, an ingested average daily dose and minimum risk level were used to determine the hazard quotient from potato consumption for adults and children. Irrigation water maximum concentrations of Cd, Pb and Zn in mining-impacted sites were elevated 20- to 1100-fold above international concentration limit guidelines. Agricultural soils contained total metal concentrations of As, Cd, Pb and Zn that exceeded concentration limits in agricultural soil guidelines by 22-, 9-, 3- and 12-fold, respectively. Potato tubers in mining-impacted sites had maximum concentrations of As, Cd, Pb and Zn that exceeded concentration limits in commercially sold vegetables by 9-, 10-, 16- and fourfold, respectively. Using conservative assumptions, hazard quotients (HQ) for potatoes alone were elevated for As, Cd and Pb among children (range 1.1-71.8), in nearly all of the mining-impacted areas; and for As and Cd among adults (range 1.2-34.2) in nearly all of the mining-impacted areas. Only one mining-impacted area had a Pb adult HQ for potatoes above 1 for adults. Toxic trace elements in a major regional dietary staple may be a greater concern than previously appreciated. Considering the multitude of other metal exposure routes in this region, it is likely that total HQ values for these metals may be substantially higher than our estimates.

MDM2/CDK4 gene amplification in large/deep-seated 'lipomas': incidence, predictors and clinical significance.

This study of 140 cases assessed the incidence of MDM2/CDK4 gene amplification in lipomatous neoplasms with histological features of a lipoma but which were of clinical concern due to large size (≥50 mm) and/or deep-seated (subfascial) location. Univariate and multivariate statistical analyses were used to identify clinical, radiological and pathological predictors of gene amplification. Differences in local recurrence rates between amplified and non-amplified cases were assessed using survival analysis. The findings indicate that the incidence of MDM2/CDK4 amplification in this setting is low at 5% (95%CI 1.4-8.6%). Variables associated with amplification on univariate analysis were tumour site (thigh, p = 0.004), size (>100 mm, p = 0.033) and presence of equivocal atypia (p = 0.001). Independent predictors on multivariate analysis were size (OR 3.9, 95%CI 1.4-11.3, p = 0.012) and presence of equivocal atypia (OR 12.5, 95%CI 1.9-80.3, p = 0.008). There was no significant difference in local recurrence rates between amplified and non-amplified cases (p = 0.461) based on a median follow-up time of 31 months. Assessment for MDM2/CDK4 amplification, therefore, should be considered in 'lipomas' which are >100 mm in size, show equivocal atypia and arise in the thigh. However, the clinical significance of gene amplification in this setting is unclear and requires confirmation in larger studies.

Evaluation of a universal flow-through model for predicting and designing phosphorus removal structures.

Phosphorus (P) removal structures have been shown to decrease dissolved P loss from agricultural and urban areas which may reduce the threat of eutrophication. In order to design or quantify performance of these structures, the relationship between discrete and cumulative removal with cumulative P loading must be determined, either by individual flow-through experiments or model prediction. A model was previously developed for predicting P removal with P sorption materials (PSMs) under flow-through conditions, as a function of inflow P concentration, retention time (RT), and PSM characteristics. The objective of this study was to compare model results to measured P removal data from several PSM under a range of conditions (P concentrations and RT) and scales ranging from laboratory to field. Materials tested included acid mine drainage residuals (AMDRs), treated and non-treated electric arc furnace (EAF) steel slag at different size fractions, and flue gas desulfurization (FGD) gypsum. Equations for P removal curves and cumulative P removed were not significantly different between predicted and actual values for any of the 23 scenarios examined. However, the model did tend to slightly over-predict cumulative P removal for calcium-based PSMs. The ability of the model to predict P removal for various materials, RTs, and P concentrations in both controlled settings and field structures validate its use in design and quantification of these structures. This ability to predict P removal without constant monitoring is vital to widespread adoption of P removal structures, especially for meeting discharge regulations and nutrient trading programs.

Mushroom tyrosinase: A model system to combine experimental investigation of enzyme-catalyzed reactions, data handling using R, and enzyme-inhibitor structural studies.

The activity of mushroom tyrosinase can be measured by monitoring the conversion of phenolic compounds into quinone derivatives using spectrophotometry. This article describes a series of experiments which characterize the functional properties of tyrosinase, the analysis of the resulting data using R to determine the kinetic parameters, and the exploration of the structural properties of tyrosinase-inhibitor complexes. Tyrosinase assay development and subsequent activity measurements, in the presence of varying pH, substrate concentration and inhibitors, offers the opportunity to learn the enzyme characterization skills relevant to a research laboratory setting. Combining the activity studies with an exploration of the nature of the tyrosinase-inhibitor interactions enables a structural understanding of the experimental observations.

Incidence, degree, and development of graft hypertrophy 24 months after matrix-induced autologous chondrocyte implantation: association with clinical outcomes.

BACKGROUND: Graft hypertrophy is a common occurrence after periosteal, collagen-covered and matrix-induced autologous chondrocyte implantation (MACI). PURPOSE/HYPOTHESIS: The purpose of this study was to investigate the incidence, development, and degree of graft hypertrophy at 24 months after MACI. The hypothesis was that graft hypertrophy would not be associated with clinical outcome at 24 months. STUDY DESIGN: Case series, Level of evidence, 4. METHODS: This study was undertaken in 180 consecutive patients (113 male, 67 female) after MACI in the knee. All patients were assessed clinically using the Knee injury and Osteoarthritis Outcome Score (KOOS) and underwent magnetic resonance imaging (MRI) at 3, 12, and 24 months after surgery. The incidence of hypertrophy relevant to anatomic graft site was investigated, as was the progressive change in hypertrophic studies postoperatively. The degree of tissue overgrowth in hypertrophic cases was investigated, as was its association with patient clinical outcome at 24 months after surgery. RESULTS: Of the 180 patients, 50 demonstrated a hypertrophic graft at 1 or more postoperative time points. This included 9 grafts (5.0%) at 3 months and 32 grafts (18.7%) at 12 months. At 24 months, 47 grafts (26.1%)-43 (32.1%) tibiofemoral and 4 (8.7%) patellofemoral-were hypertrophic. Patients with hypertrophic grafts at 24 months (n = 47) were younger (P = .051), they had a lower body mass index (BMI; P = .069), and significantly fewer of them had patellofemoral grafts (P = .007) compared with patients who had grafts with full (100%) tissue infill (n = 61). There were no significant differences in any of the KOOS subscales between patients with graft hypertrophy or full (100%) tissue infill at 24 months after surgery, while the severity of graft hypertrophy was not associated with KOOS subscales at 24 months. CONCLUSION: Hypertrophic grafts after MACI were common and continued to develop through to 24 months after surgery. Hypertrophic growth was associated with being younger and having a lower BMI, was more common on the femoral condyles, and overall was not associated with clinical outcome at 24 months after surgery. However, further research with longer term follow-up is required to evaluate the effect of persistent hypertrophy on graft stability and to assess the use of early surgical intervention to prevent such failure.

Translational research will fail without surgical leadership: SCOTRRCC a successful surgeon-led Nationwide translational research infrastructure in renal cancer.

BACKGROUND: High quality human biosamples with associated high quality clinical data are essential for successful translational research. Despite this, the traditional approach is for the surgeon to act as a technician in the tissue collection act. Biomarker research presents multiple challenges and the field is littered with failures. Tissue quality, poor clinical information, small sample numbers and lack of validation cohorts are just a few reasons for failure. It is clear that the surgeon involved in tissue acquisition must be fully engaged in the process of biosampling for a specific condition, as this will negate many of the issues for translational research failure due to an inadequate bioresource. APPROACH: In this Matter for Debate paper, the Scottish Collaboration On Translational Research into Renal Cell Cancer (SCOTRRCC) is discussed as an example of a urological surgery lead bioresource which has resulted in a National collection of renal cancer tissue and blood (from over 900 patients to date), negating all of the traditional issues with biobanks because of close enagagement and acknowledgement of urologists and uropathologists from seven centres around Scotland. SCOTRRCC has leveraged renal cancer research in Scotland resulting in several high impact publications and providing a springboard for future research in this disease in Scotland and beyond. CONCLUSIONS: The SCOTRRCC model presented here can be transferred to other surgical disciplines for success in translational research.

Removal of Less Commonly Addressed Metals via Passive Cotreatment.

The viability of removing less commonly addressed metals (e.g., Cd, Cu, Ni, and Pb) in a passive cotreatment concept was tested using a microcosm-scale, three-stage batch reactor system in which acid mine drainage from an abandoned adit on Cerro Rico de Potosí and raw municipal wastewater from Potosí, Bolivia, were introduced at a 5:1 ratio. The acid mine drainage had pH 3.58, acidity 1080 mg L as CaCO equivalent, and elevated concentrations of dissolved Al, Fe, Mn, Zn, Cd, Cu, Ni, and Pb, among other metals/metalloids. The municipal wastewater had pH 9.05 and alkalinity 418 mg L as CaCO equivalent, with 5.6 and 38 mg L of nitrate and phosphate, respectively. Previous analyses noted substantial pH increase, phosphate removal, denitrification, and removal of Al, Fe, Mn, and Zn. Prompted by these results, subsequent analyses were conducted for the current study, which noted that dissolved concentrations of Cd, Cu, Ni, and Pb decreased by 78.5, 18.3, 25.5, and 45.9%, respectively. Additionally, concentrations of Ce, Cr, Gd, and La decreased throughout the system. The study revealed the broader applicability of passive cotreatment of acid mine drainage and municipal wastewater, specifically for removing metals that are often difficult to address with conventional passive treatment approaches, such as Cd, Cu, Ni, and Pb. Results could be applicable for treatment alternatives in developing and developed countries where these waste streams occur in close proximity.

Reliability of a 3 T MRI protocol for objective grading of supraspinatus tendonosis and partial thickness tears.

BACKGROUND: Partial thickness supraspinatus tears and tendonosis can be managed either nonoperatively or by various arthroscopic techniques. New biologic treatment approaches are currently being investigated. MRI is commonly used for objective imaging outcome evaluation but there is a lack of reliability studies. We propose a novel MRI classification of partial supraspinatus tears and tendonosis and evaluate its inter-observer and intra-observer reliability. METHODS: Digital MRI scans (3 Tesla) of 65 patients investigated for assessment of supraspinatus pathology or subacromial impingement were evaluated by three independent and experienced musculoskeletal (MSK) radiologists. Tendonosis (absent, focal, generalized), partial thickness (PT) tears (absent, 0%-25% PT, 25%-50% PT, 50%-100% PT, and full thickness tears), and anteroposterior extent of tears (less than 5 mm, 5-10 mm, greater than 10 mm) were scored by each radiologist on two separate occasions (t1, t2), 2 months apart. The inter-observer and intra-observer agreement and weighted kappa values for each parameter were calculated. RESULTS: The range of weighted intra-observer kappa (IAK) was 0.84-0.93 for evaluation of tendonosis; 0.84 (all raters) for depth of partial thickness, 0.74-0.84 for AP tear size, and 0.83-0.85 for the total score. The range of weighted inter-observer kappa (IEK) over two time points (t1, t2) was 0.55-0.74 for tendonosis, 0.69-0.84 for depth for partial thickness tears, 0.57-0.80 for AP tear size, and 0.63-0.80 for the total score. CONCLUSION: A comprehensive MRI grading protocol is proposed and is reliable for the evaluation of supraspinatus tendonosis and partial thickness tears with good to excellent kappa values. This rotator cuff MRI protocol can be applied to evaluate morphological tendon outcomes after different treatment modalities.

Anatomic repair of the distal biceps tendon cannot be consistently performed through a classic single-incision suture anchor technique.

BACKGROUND: Distal biceps tendon ruptures commonly occur in active men, and surgical repair through a single-incision technique using suture anchors has become common. The current study assessed whether an anatomic repair of the biceps to the radial tuberosity can be consistently achieved through a single-incision technique. METHODS: Acute distal biceps tendon repairs using the single-incision technique were retrospectively reviewed. Computed tomography (CT) scans were obtained to investigate tuberosity dimensions and the position of the suture anchors. An isokinetic dynamometer was used to obtain flexion and supination strength. Disabilities of the Arm, Shoulder and Hand (DASH) scores were collected. RESULTS: CT scans were performed in 27 patients, of which, 21 underwent strength testing. The suture anchor placement averaged 50° radial to the apex of the tuberosity. Strength testing showed flexion strength of the repaired side was equal (97%-106%) to the normal side. Supination strength (80%-86%) and work (66%-75%) performed were both weaker on the repaired side (66%-75%; P < .05). The average DASH score was 10.7. CONCLUSIONS: Ideal suture anchor placement, in the ulnar aspect of the tuberosity, could not be reliably achieved through this single-incision technique. This could have clinical importance because supination strength was not fully restored in this group of patients.

Dermoid cyst of the testis with neural tissue in an adult.

Although some authors question the validity of the diagnosis of dermoid cyst of the testis, it does seem to be identical to tumors seen in the ovary and is distinct from a mature teratoma of the testis. Previous cases have described variants of the "classical" dermoid cyst, including noncutaneous teratomatous elements: bone, cartilage, respiratory epithelium, intestinal mucosa. We describe a unique case demonstrating a testicular dermoid cyst containing mature neural tissue, which has previously not been described in an adult. It has been suggested that these tumors are persistent prepubertal teratomas that are known to behave in a benign manner.

Current perspectives on percutaneous vertebroplasty: current evidence/controversies, patient selection and assessment, and technique and complications.

Osteoporotic-associated vertebral compression fractures are a major public health concern, dwarfing even hip fractures in incidence in the United States. These fractures carry a significant morbidity and mortality burden and also represent a major growing source of consumption of scarce heath resources. Percutaneous vertebroplasty remains a commonly used and safe technique for the symptomatic treatment of vertebral compression fractures, both osteoporotic- and neoplastic-induced. By carefully selecting appropriate patients who are referred promptly, vertebroplasty can provide significant and durable pain relief over traditional conservative therapy. Recent controversies surrounding the evidence for vertebroplasty in osteoporotic-associated vertebral compression fractures are reviewed. A comprehensive step-by-step practical guide to performing vertebroplasty is then described. A brief description of patient selection, workup, as well as complications is also provided.

Novel passive co-treatment of acid mine drainage and municipal wastewater.

A laboratory-scale, four-stage continuous-flow reactor system was constructed to test the viability of high-strength acid mine drainage (AMD) and municipal wastewater (MWW) passive co-treatment. Synthetic AMD of pH 2.6 and acidity of 1870 mg L(-1) as CaCO3 equivalent containing a mean 46, 0.25, 2.0, 290, 55, 1.2, and 390 mg L(-1) of Al, As, Cd, Fe, Mn, Pb, and Zn, respectively, was added at a 1:2 ratio with raw MWW from the City of Norman, OK, to the system which had a total residence time of 6.6 d. During the 135-d experiment, dissolved Al, As, Cd, Fe, Mn, Pb, and Zn concentrations were consistently decreased by 99.8, 87.8, 97.7, 99.8, 13.9, 87.9, and 73.4%, respectively, pH increased to 6.79, and net acidic influent was converted to net alkaline effluent. At a wasting rate of 0.69% of total influent flow, the system produced sludge with total Al, As, Cd, Cr, Cu, Fe, Pb, and Zn concentrations at least an order of magnitude greater than the influent mix, which presents a metal reclamation opportunity. Results indicate that AMD and MWW passive co-treatment is a viable approach to use wastes as resources to improve water quality with minimal use of fossil fuels and refined materials.