The flow pattern effects of hydrodynamic cavitation on waste activated sludge digestibility.

The disintegration of raw sludge is of importance for enhancing biogas production and facilitates the degradation of substrates for microorganisms so that the efficiency of digestion can be increased. In this study, the effect of hydrodynamic cavitation (HC) as a pretreatment approach for waste activated sludge (WAS) was investigated at two upstream pressures (0.83 and 1.72 MPa) by using a milli-scale apparatus which makes sludge pass through an orifice with a restriction at the cross section of the flow. The HC probe made of polyether ether ketone (PEEK) material was tested using potassium iodide solution and it was made sure that cavitation occurred at the selected pressures. The analysis on chemical effects of HC bubbles collapse suggested that not only cavitation occurred at low upstream pressure, i.e., 0.83 MPa, but it also had high intensity at this pressure. The pretreatment results of HC implementation on WAS were also in agreement with the chemical characterization of HC collapse. Release of soluble organics and ammonium was observed in the treated samples, which proved the efficiency of the HC pretreatment. The methane production was improved during the digestion of the treated samples compared to the control one. The digestion of treated WAS sample at lower upstream pressure (0.83 MPa) resulted in higher methane production (128.4 mL CH4/g VS) compared to the treated sample at higher upstream pressure (119.1 mL CH4/g VS) and control sample (98.3 mL CH4/g VS). Thus, these results showed that the HC pretreatment for WAS led to a significant increase in methane production (up to 30.6%), which reveals the potential of HC in full-scale applications.

Modelling of high-rate activated sludge process: Assessment of model parameters by sensitivity and uncertainty analyses.

The objective of this study is to develop a mechanistic model to predict the long-term dynamic performance of High-Rate Activated Sludge (HRAS) process, including the removal of carbon (COD), nitrogen (N), and phosphorus (P). The model was formulated with inspiration from Activated Sludge Models No. 1 and 3 (ASM1 and ASM3) to incorporate essential mechanisms, such as adsorption and storage substrate, specific to HRAS systems. A stepwise protocol was followed for calibration with dynamic data from a pilot-scale HRAS plant. Sensitivity analysis identified influential model parameters, including maximum specific growth rate (µ), growth yield (YH), storage yield (YSTO), storage rate (kSTO), decay rate (b), and half saturation of the readily biodegradable substrate for growth (KS1). The calibrated model achieved prediction efficiencies above the normalized Mean Absolute Error (MAE) of 70 % for mixed liquor suspended solids (MLSS), total chemical oxygen demand (TCOD), soluble COD (SCOD), particulate COD (XCOD), total nitrogen (TN), ammonia nitrogen (SNH), total phosphorus (TP), soluble TP (STP), and particulate TP (XTP). Uncertainty analysis revealed that SCOD was underestimated. Based on the dynamic profiles of uncertainty bands and observed data, there is potential for improving the estimation of dynamic behavior in STP. The observed discrepancies may be attributed to variations in wastewater characteristics during the monitoring period, particularly concerning the phosphorus (P) fractions of the readily biodegradable substrate (SS) and soluble inerts (SI), which were not considered as dynamically changing parameters in the model.

Functional outcomes of primary subtalar arthrodesis in sanders type IV calcaneal fractures, a case series.

Background: Primary subtalar arthrodesis (PSTA) is a valid option in treating Sanders IV calcaneal fractures with few studies to assess its outcomes. Methods: Seventeen patients with Sanders IV calcaneal fractures were managed by open reduction and primary subtalar arthrodesis. Functional outcomes were measured by AOFAS-AHS and FAAM-ADL. We also documented time to return to work, union rate, wound complications and the need for second surgeries. Results: Fourteen patients were followed for two years. At final follow-up, the mean AOFAS-AHS score was 74.42 ± 1.95, while the mean FAAM- ADL score was 59.21 ± 1.6. Conclusion: PSTA is a valid option in treating these severe fractures. It may reduce the overall disability time.

Use of water treatment plant sludge in high-rate activated sludge systems: A techno-economic investigation.

Coagulants such as aluminum sulfate (Al2(SO4)3 (alum)) and ferric chloride (FeCl3) used in water treatment plants (WTPs) led to the generation of sludge that is usually disposed to landfills. However, the utilization of WTP sludge is being encouraged by authorities to achieve sustainable development. This study aims to investigate WTP sludge utilization in a pilot-scale high-rate activated sludge (HRAS) system as a substitute for conventional coagulants. Based on jar tests, the iron sludge was selected for pilot-scale testing due to its superior ability to enhance the treatment efficiency of the HRAS process compared to alum sludge. Iron sludge addition (20.1 ± 1.6 mg dry sludge/L wastewater) slightly improved the removal efficiency of particulate chemical oxygen demand (pCOD) from 74 % to 81 % (p-value: 0.014). Iron sludge addition had a distinct effect on the sludge characteristics of the HRAS process. The average median particle size (d50) increased from 96 ± 3 to 163 ± 14 µm (p-value<0.00) with the addition of iron sludge, which improved the settleability of the HRAS process sludge. However, the biochemical methane potential (BMP) of the HRAS process sludge decreased by 8.9 % (p-value<0.00) after iron sludge addition. In a scenario analysis of WTP sludge use in a hypothetical HRAS plant, the effluent quality index (EQI), an indicator of environmental impact, was calculated and the cost related to the operation (the transfer and landfill disposal of WTP and HRAS process sludge, energy and chemical consumption of the HRAS plant) was estimated. As a result, using WTP sludge in the HRAS plant did not significantly affect the EQI of the plant but decreased overall cost by 11 %. The results showed that the use of WTP sludge as a coagulant in wastewater treatment could achieve mutual benefits for WTPs and WWTPs and have the potential to realize the circular economy model.

Impact of primary treatment methods on sludge characteristics and digestibility, and wastewater treatment plant-wide economics.

Biogas production from anaerobic sludge digestion plays a central role for wastewater treatment plants to become more energy-efficient or even energy-neutral. Dedicated configurations have been developed to maximize the diversion of soluble and suspended organic matter to sludge streams for energy production through anaerobic digestion, such as A-stage treatment or chemically enhanced primary treatment (CEPT) instead of primary clarifiers. Still, it remains to be investigated to what extent these different treatment steps affect the sludge characteristics and digestibility, which may also impact the economic feasibility of the integrated systems. In this study, a detailed characterization has been performed for sludge obtained from primary clarification (primary sludge), A-stage treatment (A-sludge) and CEPT. The characteristics of all sludges differed significantly from each other. The organic compounds in primary sludge consisted mainly of 40% of carbohydrates, 23% of lipids, and 21% of proteins. A-sludge was characterized by a high amount of proteins (40%) and a moderate amount of carbohydrates (23%), and lipids (16%), while in CEPT sludge, organic compounds were mainly 26% of proteins, 18% of carbohydrates, 18% of lignin, and 12% of lipids. The highest methane yield was obtained from anaerobic digestion of primary sludge (347 ± 16 mL CH4/g VS) and A-sludge (333 ± 6 mL CH4/g VS), while it was lower for CEPT sludge (245 ± 5 mL CH4/g VS). Furthermore, an economic evaluation has been carried out for the three systems, considering energy consumption and recovery, as well as effluent quality and chemical costs. Energy consumption of A-stage was the highest among the three configurations due to aeration energy demand, while CEPT had the highest operational costs due to chemical use. Energy surplus was the highest by the use of CEPT, resulting from the highest fraction of recovered organic matter. By considering the effluent quality of the three systems, CEPT had the highest benefits, followed by A-stage. Integration of CEPT or A-stage, instead of primary clarification in existing wastewater treatment plants, would potentially improve the effluent quality and energy recovery.

Imaging Real-Time Coronary Anatomy Using a Three-Dimensional Electrophysiology Mapping System.

The aim of this study is to evaluate the feasibility of creating fast three-dimensional maps of coronary arteries and to develop a bipolar coronary guidewire in vitro and determine whether it can be localised accurately within the model.A total of five patients were recruited, and EnSite Precision was utilised to create 3D coronary anatomy. A water bath to accommodate a 3D-printed coronary model was developed to test the performance of the bipolar angioplasty wire.Successful guidewire localisation and 3D reconstruction of coronary anatomy were achieved in all the cases. No complications. The bipolar wire was able to collect point clouds, and localisation of the distal tip was excellent when tested in the water bath.Our study demonstrates the feasibility and safety of utilising EAMS to collect coronary anatomy. Real-time tracking with a bipolar catheter is accurate when tested in vitro.

Safety and efficacy of interrupting dual antiplatelet therapy one month following percutaneous coronary intervention: a meta-analysis of randomized controlled trials.

Very short duration of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) has recently attracted a lot of attention with the introduction of newer generations stents. This is appealing, especially in patients at high bleeding risk. However, none of the trials were powered for the individual ischemic and bleeding endpoints. All randomised controlled trials (RCTs) investigating one-month versus routine duration of DAPT in patients undergoing PCI and reporting outcomes from the time of cessation of DAPT (1 month) to 1 year were eligible for inclusion in the meta-analysis. The pooled risk ratios (RR) with their 95% confidence interval (CI) were calculated with the random-effects model using the Mantel-Haenszel method. Four RCTs involving 26,576 patients were included in this meta-analysis. Cessation of DAPT after 1 month was associated with significantly less major bleeding [RR 0.70, 95%CI (0.51-0.95), P = 0.02, heterogeneity (I2) = 42%]. There was no statistically significant difference in all-cause mortality [RR 0.84 (95%CI 0.69-1.03), P = 0.10, I2 = 0%] and stroke [RR 0.71 (95%CI 0.45-1.13), P = 0.15, I2 = 42%] when compared to routine duration of DAPT. There was also no difference in myocardial infarction (MI) [RR 1.12 (95%CI 0.91-1.39), P = 0.28, I2 = 0%], and definite or probable stent thrombosis [RR 1.49 (95%CI 0.92-2.41), P = 0.11, I2 = 0%] with cessation of DAPT after 1 month. Cessation of DAPT 1 month after PCI was associated with significantly less major bleeding, but there was no difference in the rate of all-cause mortality, stroke, MI and stent thrombosis.

Nanomaterials in membrane bioreactors: Recent progresses, challenges, and potentials.

The use of nanomaterials (NMs) in the fabrication and modification of membranes as well as the coupling of nanomaterial-based processes with membrane processes have been attracted many researchers today. The NMs due to a wide range of types, different chemistry, the possibility of various kinds of functionality, different properties like antibacterial activity, hydrophilicity, and large surface area were applied to enhance the membrane properties. In the membrane bioreactors (MBRs) as a highly successful process of membrane technology in wastewater treatment, the NMs have been applied for improving the efficiency of MBR process. This review assessed the application of NMs both as the modifiers of membrane and as the effective part of hybrid techniques with MBR system for wastewater treatment. The efficiency of NMs blended membranes in the MBR process has been reviewed in terms of antifouling and antibacterial improvement and removal performance of the pollutants. Novel kinds of NMs were recognized and discussed based on their properties and advantages. The NMs-based photocatalytic and electrochemical processes integrated with MBR were reviewed with their benefits and drawbacks. In addition, the effect of the presence of mobilized NPs in the sludge on MBR performance was surveyed. As a result of this review, it can be concluded that nanomaterials generally improve MBR performance. The high flux and antifouling properties can be obtained by adding nanomaterials with hydrophilic and antibacterial properties to the membrane, and further studies are required for photocatalytic NMs applications. In addition, this review shows that the low amounts of NMs in the membrane structure could have an effective influence on the MBR process. Besides, since many studies in the literature are carried out at the laboratory scale, it is thought that pilot and real-scale studies should be carried out to obtain more reliable data.

Association between miR-196a-2 Gene Polymorphism and Ovarian Cancer Prognosis in Egyptian Females.

BACKGROUND: Ovarian cancer is the fifth leading cause of cancer-related deaths among women worldwide. Unfortunately, early detection tests are relatively lacking. Diagnosis in the late stages of the disease carries a poor prognosis. OBJECTIVE: To evaluate the relationship between miR-196a-2 rs11614913 polymorphism and ovarian cancer risk and prognosis in Egyptian females. METHODS: In this case-control study, the participants were classified into 2 groups. Group A is the control group which included 50 healthy females. Group B included 50 patients newly diagnosed with ovarian carcinoma confirmed by histopathological analysis. Immunohistochemistry for P53 and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) for miR-196a-2 genotypes detection were performed.   Results: There was a statistically significant difference among ovarian cancer cases and controls regarding genotypes (P = 0.003). However, the distribution of the T and C alleles in both studied groups showed no significant difference (P = 0.17). There was a statistically significant increase of CA 125 levels among CT and CC genotypes carriers of ovarian cancer cases (p = 0.04). Besides, there was a statistically significant correlation between miR-196a-2 polymorphism and each of tumor grade (P <0.001), p53 immunohistochemical expression (P= 0.002), and Figo classification (P <0.001). CONCLUSION: There was a statistically significant increase of CA 125 levels among C allele carriers of ovarian cancer cases. Besides, there was a statistically significant association between the miR-196a-2 polymorphism and each of tumor grade, p53 immunohistochemical expression, and Figo classification. So, miR-196a-2 polymorphism can be a possible prognostic factor in ovarian cancer.

Effect of sex and surgical incision on survival after isolated primary mitral valve operations.

OBJECTIVES: Multiple studies have suggested that women have worse outcomes than men following mitral valve (MV) surgery-most of those studies reported on conventional sternotomy (CS) MV surgery. Therefore, we aimed to explore whether or not the minimally invasive mitral valve surgery (MIMVS) approach might mitigate a worse survival in women following MV surgery. METHODS: We identified patients with isolated primary MV operations with or without tricuspid valve repair performed between 2007 and 2019. Patients were propensity score-matched across the MIMVS and CS surgical approaches. Sex was excluded from the matching process to discern whether female patients had a different likelihood of receiving minimally invasive surgery than males. A Cox proportional hazards model was fitted in the matched cohort and adjusted for the imbalance in baseline characteristics using the propensity score. RESULTS: Of 956 patients (417 MIMVS, 539 CS; 424 females), the matched set comprised 342 pairs (684 patients; 296 females) of patients who were well balanced across MIMVS and CS groups with regard to preoperative clinical characteristics. We observed a 47/53% female/male ratio in the CS group and a 39/61% in the MIMVS group, P = 0.054. In both matched groups, women were older than males. A Cox model adjusted for propensity scores showed no survival difference with sex, surgical type or interaction. CONCLUSIONS: Women present to the surgical team at an older age. They appear less likely to be considered for a MIMVS approach than men. Neither sex nor surgical approach was associated with worse survival in a matched sample.

Primary and A-sludge treatment by anaerobic membrane bioreactors in view of energy-positive wastewater treatment plants.

Energy-rich sludge can be obtained from primary clarifiers preceding biological reactors. Alternatively, the incoming wastewater can be sent to a very-high-loaded activated sludge system, i.e., a so-called A-stage. However, the effects of applying an A-stage instead of a primary clarifier, on the subsequent sludge digestion for long-term operation is still unknown. In this study, biogas production and permeate quality, and filterability characteristics were investigated in a lab-scale anaerobic membrane bioreactor for primary sludge and A-stage sludge (A-sludge) treatment. A higher specific methane yield was obtained from digestion of A-sludge compared to primary sludge. Similarly, specific methanogenic activity was higher when the anaerobic membrane bioreactor was fed with A-sludge compared to primary sludge. Plant-wide mass balance analysis indicated that about 35% of the organic matter in wastewater was recovered as methane by including an A-stage, compared to about 20% with a primary clarifier.

One-year outcomes of percutaneous coronary intervention in native coronary arteries versus saphenous vein grafts in patients with prior coronary artery bypass graft surgery.

BACKGROUND: Patients with prior coronary artery bypass graft (CABG) surgery often require percutaneous coronary intervention (PCI). Data are still limited in regards to the outcomes of native saphenous vein graft (SVG) PCI after CABG. METHODS: We performed a retrospective study in a tertiary reference cardiac center of consecutive patients who underwent PCI after CABG. The data were collected for patients who underwent either native or graft PCI from January 2008 to December 2018. Arterial graft PCIs were excluded. Multivariable Cox regression analysis with propensity matching was performed, and major adverse cardiac events (MACE) outcomes including death or myocardial infarction (MI) or revascularization were assessed at 1-year after each index procedure. RESULTS: A total of 435 PCI were performed in 401 patients (209 had native PCI and 192 had graft PCI). Target lesions were classified as following: 235 (54%) native coronary arteries and 200 (46%) SVG. Propensity matching resulted in 167 matched pairs. In multivariable Cox regression graft PCI relative to native PCI was an independent risk factor for MACE (hazard ratio [HR] 1.725, 95% confidence interval [CI] 1.049-2.837) which was primarily driven by increased incidence in revascularization (HR 2.218, 95% CI 1.193-4.122) and MI (HR 2.248, 95% CI 1.220-4.142) and with no significant difference in mortality (HR 1.118, 95% CI 0.435-2.870). CONCLUSIONS: Compared with native coronary PCI, bypass graft PCI was significantly associated with higher incidence of MACE at 1-year and this was mainly driven by MI and revascularization.

Removal of micropollutants from municipal wastewater by membrane bioreactors: Conventional membrane versus dynamic membrane.

In this study, fate of micropollutants was investigated in a membrane bioreactor (MBR) having dynamic membrane (DM) and ultrafiltration (UF) membrane for the treatment of raw municipal wastewater. Removal efficiencies of different micropollutants including sulfamethoxazole, ciprofloxacin, trimethoprim, caffeine and acetaminophen were assessed. A commercial hollow fiber UF membrane was used in parallel with a DM that was formed on a low-cost hollow fiber support material, made of polyester. MBR was operated at a flux of 10 L/m2·h. High total suspended solids (>99%) and chemical oxygen demand (>91%) removal efficiencies were achieved with each membrane. Besides, high removal efficiencies of micropollutants (>68.3->99.7%) were achieved. Morphological analyses were conducted for each membrane in order to get insight to the cake (dynamic) layer that was accumulated on the membrane. DM technology provides an effective alternative to the conventional membrane systems for micropollutant removal from municipal wastewater.

Contemporary Management of Patent Foramen Ovale: A Multinational Survey on Cardiologists' Perspective.

OBJECTIVES: The purpose of our survey is to analyze the clinical approach used by interventional and imaging cardiologists to diagnose, treat, and follow-up patients with PFO-related left circulation thromboembolism in different parts of the world with particular emphasis on adherence to current guidelines. BACKGROUND: Firm guidelines do not cover many aspects of PFO-related patient care. Consequently, very disparate approaches exist among clinicians in the real-world. METHODS: A 24-item electronic questionnaire was sent directly to experienced cardiology specialists practicing at consultant/attending positions directly involved in PFO closure management in the United States, United Kingdom, Gulf countries, and other countries. There were no unanswered questions. Responses were recorded between October 2019 and July 2020. RESULTS: Seventy-one responses were obtained: 31 from the UK, 19 from the US, 16 from Gulf countries, 2 from Poland, and 1 response from Australia, Italy, and Switzerland. The overall response rate was 76%. Significant differences between regions were noted in the duration of ECG monitoring during the diagnostic process, PFO closure for left circulation thromboembolism other than stroke/transient ischemic attack, and intraoperative use of intracardiac echocardiography. A similar pattern was noted in the lack of routine screening for thrombophilia and the use of the long-term single antiplatelet therapy. CONCLUSIONS: The study shows a vast spectrum of opinions on the optimal approach to PFO closure with significant differences between the US, UK, and Gulf countries. The results stress the need for systematic, high-quality data on the diagnostic work-up and follow-up strategies to inform the standardized approach.

Use of dalbavancin in infective endocarditis: a case series.

BACKGROUND: Infective endocarditis, typically caused by Gram-positive organisms such as viridans group streptococci and Staphylococcus aureus, is associated with high mortality and morbidity and requires aggressive, prolonged antimicrobial treatment and sometimes surgery. Dalbavancin, a lipoglycopeptide active against Gram-positive pathogens, has a long half-life, which allows IV treatment as one dose or two doses with a prolonged interval, offering personalized treatment for complex psychosocial situations or facilitating early discharge. In the absence of randomized controlled trials in infective endocarditis, current evidence derives from real-world case series involving off-licence use. The Austrian Society for Infectious Disease and Tropical Medicine includes dalbavancin as an option for infective endocarditis. OBJECTIVES: This retrospective case series reports use of dalbavancin in a small cohort of patients with infective endocarditis treated at Lancashire Cardiac Centre, Blackpool Teaching Hospitals Foundation Trust, UK. RESULTS: The pharmacy database included 11 patients in whom dalbavancin was used to address either complex psychosocial circumstances or the need for early discharge. The endocarditis multidisciplinary team selected dalbavancin from available treatment options. Structures affected by infective endocarditis included aortic, mitral and tricuspid valves; aortic composite grafts; implantable cardioverter defibrillator leads; and prosthetic aortic valves. Eight patients underwent surgery; three were managed conservatively with antibiotics. Dalbavancin was curative in all but one patient, whose signs and symptoms of infection improved. No patients developed adverse reactions. CONCLUSIONS: Dalbavancin is an alternative treatment option at hospital discharge when conventional antibiotics may not be suitable due to complex psychosocial issues or early discharge is required.

Mental Health Outcomes Among British Healthcare Workers-Lessons From the First Wave of the Covid-19 Pandemic.

OBJECTIVE: To ascertain the level of psychological distress, using validated psychology tools, among British National healthcare workers (HCW) during the first wave of the Covid-19 crisis. METHODS: A multi-centre, anonymized, all-comer staff survey across 3 hospitals in Lancashire, England during the Covid-19 first wave (April to June 2020), consisting of Patient Health Questionnaire (PHQ-9), Perceived Stress Scale-10 (PSS-10), Generalized Anxiety Disorder-7 (GAD-7), and Impact of Events Scale (IES-6). RESULTS: Among 1113 HCW, median (IQR) PHQ-9, GAD-7, PSS-10, and IES-6 score was 7 (3 to 11), 6 (3 to 11), 19 (13 to 24), and 9 (5 to 14), respectively. Potential predictors of higher levels of psychological distress included living alone, disabled dependents, history of depression/anxiety, and being female. CONCLUSIONS: The study indicates a high prevalence of psychological distress during the acute Covid-19 period among HCW, identifies groups at risk and areas of future research.

Meta-Analysis Comparing Direct Oral Anticoagulants to Vitamin K Antagonists for The Management of Left Ventricular Thrombus.

Introduction: To compare vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) treatment in patients with left ventricular (LV) thrombus. The primary outcome was stroke or systemic embolism (SSE). Secondary outcomes were thrombus resolution, bleeding, and death.Areas covered: Five observational studies were included (total n = 700; VKAs n = 480; DOACs n = 220). There was a trend toward less SSE with VKAs compared to DOACs (5.2% vs. 9%; odds ratio [OR] = 0.54, 95% confidence interval [CI] = 0.29-1.01, p = 0.05). No significant difference between VKAs and DOACs in rates of thrombus resolution (61.6% vs. 56.8%; OR = 1.00, 95% CI = 0.58-1.73, p = 0.99), bleeding (8.2% vs. 4.4%; OR = 1.62, 95% CI = 0.69-3.77, p = 0.27), or death (12.7% vs. 11.8%; OR = 1.09, 95% CI = 0.59-2.0, p = 0.79) was noted. In non-primary percutaneous coronary intervention setting, VKAs were associated with less SSE in prespecified analysis (5.2% vs.10.6%; OR = 0.48, 95% CI = 0.25-0.93, p = 0.03).Expert opinion: The current meta-analysis suggests a trend toward higher SSE with the use of DOACs compared to VKAs. Our recommendation is for VKAs to retain the preferred management of LV thrombus with cautious off-label use of DOACs.

Association between pre-operative right ventricular impairment on transthoracic echocardiography and outcomes after conventional and minimally invasive mitral valve surgery.

BACKGROUND: Right ventricular (RV) impairment may have prognostic value in patients undergoing mitral valve surgery. It is unclear whether RV dysfunction predicts long-term mortality, especially in the era of minimally invasive mitral surgery. METHODS: We performed a retrospective analysis of consecutive patients referred for conventional (via sternotomy) and minimally invasive mitral valve surgery (MIMVS) between 01 January 2013 and 29 August 2018 in a tertiary cardiac centre. We truncated follow-up times at 25 March 2020. RV impairment was defined by reduced RV longitudinal function (TAPSE <17 mm) and/or dilated basal RV diameter (RVD1 > 42 mm). Primary outcome was all-cause mortality. RESULTS: The study cohort included 359 patients followed up for a median period of 4.2 (1.8) years. MIMVS approach was performed in 127 (35.4%) and conventional approach in 232 (64.6%) patients of whom 36 (28%) and 45 (19%), respectively, had RV impairment. EuroSCORE II was significantly higher in patients with RV impairment compared with patients with preserved RV function, irrespective of the surgical approach. Consequently, in both groups, patients with RV impairment had significantly higher mortality compared to patients with preserved RV function. RV impairment adjusted for EuroSCORE II predicted mortality in the whole cohort (HR 2.139, 95% CI 1.249-3.663) and in conventional approach (HR 2.361, 95% CI 1.249-4.465) in contrast to MIMVS (HR 1.570, 95% CI 0.493-4.997). CONCLUSION: In this real world cohort, patients with RV impairment and/or dilation had reduced long-term survival following both conventional surgery and MIMVS. Patients should be referred to surgery prior to worsening of RV function.

Anatomical and functional outcomes of subthreshold micropulse laser versus intravitreal ranibizumab injection in treatment of diabetic macular edema.

BACKGROUND: To compare the therapeutic effects of subthreshold micropulse laser (SML) versus intravitreal injection of ranibizumab in treatment of diabetic macular edema (DME) both anatomically using optical coherence tomography (OCT) and functionally using best corrected visual acuity (BCVA) and multifocal electroretinogram (mfERG). METHODS: his study was an interventional prospective randomized comparative study. The study included 120 eyes classified into 3 groups: Group 1 included 40 eyes of 28 patients treated by SML laser, group 2 included 40 eyes of 32 patients treated by intravitreal injection of ranibizumab, and group 3 (control group for mfERG) included 40 eyes of 20 patients with diabetes mellitus (DM) of more than 10 year duration with no signs of diabetic retinopathy (DR). BCVA measurements, OCT and mfERG were done for the cases before and after interference and were followed up for 6 months RESULTS: By the end of the follow up period, BCVA significantly improved by 31% in group 1 vs 93% in group 2 with a statistically highly significant difference between the two groups (p value < 0.001). There was also a significant decrease in central subfield thickness in both groups with more reduction in group 2 compared with group 1 (p value < 0.001). There was a significant improvement in P1 amplitude of mf-ERG in group 2 (p value < 0.002) with no significant improvement in group 1. There was a significant decrease in P1 implicit time in group 2 (p value < 0.001) while there was no significant decrease in group1. CONCLUSIONS: Intravitreal injection of ranibizumab is a superior treatment modality for DME compared with SML regarding both anatomical and functional outcomes. TRIAL REGISTRATION:  This study has been approved by the local ethical committee of faculty of medicine of Minia University and retrospectively registered at the clinical trial gov. with Identifier: NCT04332133.

Arthroscopic Bankart repair with remplissage versus Latarjet procedure for management of engaging Hill-Sachs lesions with subcritical glenoid bone loss in traumatic anterior shoulder instability: a systematic review and meta-analysis.

BACKGROUND: A large engaging Hill-Sachs lesion (HSL) with subcritical glenoid bone loss (GBL) is approached through either increasing the glenoid arc by the Latarjet procedure or converting the HSL to an extra-articular defect by arthroscopic Bankart repair with remplissage (BRR). Until now, there has been no evidence-based consensus about which of these 2 most appropriate procedures is the better surgical choice. The purpose of this study was to analyze the current literature comparing results of BRR vs. the Latarjet procedure in the treatment of engaging HSLs with subcritical GBL. METHODS: A comprehensive review of the PubMed and Cochrane databases was completed for studies that compared the clinical outcomes and complications of BRR vs. the Latarjet procedure with minimum follow-up of 2 years. The outcome measures analyzed included postoperative Rowe score, visual analog scale pain score, postoperative range of motion (ROM), and rates of recurrent instability and other complications. RESULTS: Overall, 4 articles (level III evidence in 3 and level II in 1) were included from an initial 804 abstracts. The study population consisted of a total of 379 patients, of whom 194 underwent BRR and 185 underwent the Latarjet procedure. There were no unacceptable differences in baseline characteristics between the 2 groups. For the rate of recurrent instability, both groups had comparable risk ratios (RRs) (N = 379; RR, 0.72; 95% confidence interval [CI], 0.37-1.41). The risk of other complications was significantly increased with the Latarjet procedure (by about 7 times) relative to the the BRR procedure (N = 379; RR, 7.37; 95% CI, 2-27). Both groups had comparable postoperative Rowe scores (n = 190; mean difference [MD], -0.9; 95% CI, -3.45 to 1.7) and visual analog scale pain scores (n = 347; MD, -0.2; 95% CI, -0.6 to 0.2). Moreover, both groups had comparable postoperative external rotation ROM (MD, -1.7°; 95% CI, -9.4° to 6°) and internal rotation ROM (MD, 1.95°; 95% CI, -5.35° to 9.25°). There was substantial heterogeneity in the effect of both procedures on postoperative pain and ROM (external rotation and internal rotation). CONCLUSION: Both the BRR and Latarjet procedures are effective for the management of engaging HSLs with subcritical GBL and give comparable clinical outcomes. However, given the fewer overall postoperative complications, remplissage may be safer. The results of the included studies were adequately consistent for most analyzed outcomes. However, for the intervention effect on postoperative pain and ROM, there was a small body of evidence, limiting the strength of the reported conclusions.