Moving bed biofilm reactor as an alternative wastewater treatment process for nutrient removal and recovery in the circular economy model.

Over the last years, an increasing concern has emerged regarding the eco-friendly management of wastewater. Apart from the role of wastewater treatment plants (WWTPs) for wastewater and sewage sludge treatment, the increasing need of the recovery of the resources contained in wastewater, such as nutrients and water, should be highlighted. This would allow for transforming a wastewater treatment plant (WWTP) into a sustainable technological system. The objective of this review is to propose a moving bed biofilm reactor (MBBR) as a novel technology that contributes to the circularity of the wastewater treatment sector according to the principles of circular economy. In this regard, this paper aims to consider the MBBR process as the initial step for water reuse, and nutrient removal and recovery, within the circular economy model.

Advanced methods for the elimination of microorganisms in industrial treatments: potential applicability to wastewater reuse.

Because of the growing need to eliminate undesirable microorganisms in different industrial treatments, mainly in the food and agricultural sector and the pharmaceutical industry, a number of increasingly effective systems for disinfection to eliminate microorganisms have been devised. This article analyzes different methods to eliminate and/or significantly reduce the number of microorganisms in industrial contexts and in environmental engineering. Although, in the past, thermal treatments had been used most frequently for microbial elimination, the method is costly and has the disadvantage of modifying the organoleptic and/or physicochemical properties of the food products. For this reason, new technologies rapidly are being developed, such as high-intensity pulsed electric fields, high-pressure systems, ultrasounds, and irradiation, which effectively eliminate microorganisms without deteriorating the properties of the product. These emerging technologies are potentially applicable in the field of environmental engineering.

Steroids and gunshot wounds to the spine.

OBJECTIVE: The second National Acute Spinal Cord Injury Study demonstrated that there were neurological benefits from "spinal cord injury" doses of methylprednisolone for blunt spinal cord injuries. In this review, we examined the relative risk/benefit ratio of intravenously treating spinal gunshot wound victims with steroids. METHODS: A retrospective review was conducted of 254 consecutive patients who were treated between 1979 and 1994 for gunshot wounds to the spine (C1-L1) and a spinal cord injury. Three subgroups were established based on the administration of the steroids methylprednisolone (National Acute Spinal Cord Injury Study 2 protocol), dexamethasone (initial dose, 10-100 mg), and no steroids. All patients who received steroids were initially treated at another hospital and then transferred. No patients received steroids at our institution. The data analyzed included neurological outcome and infectious and noninfectious complications. RESULTS: No statistically significant neurological benefits were demonstrable from the use of steroids (methylprednisolone, dexamethasone). Infectious complications were increased in both groups receiving steroids (not statistically significant). Gastrointestinal complications were significantly increased in the dexamethasone group (P = 0.021), and pancreatitis was significantly increased in the methylprednisolone group (P = 0.040). The mean duration of follow-up was 56.3 months. CONCLUSION: In this retrospective, nonrandomized review, no neurological benefits were detectable from intravenously administered steroids after a gunshot wound to the spine. Both infectious and noninfectious complication rates were higher in the groups receiving steroids. Patients who sustain a spinal cord injury secondary to a gunshot wound to the spine should not be treated with steroids until the efficacy of such treatment is proven in a controlled study.

Relationship between polyethylene wear, pelvic osteolysis, and clinical symptomatology in patients with cementless acetabular components. A framework for decision making.

The purpose of this study is to assess the relationship between acetabular component polyethylene wear, pelvic osteolysis, and clinical symptoms to determine when operative intervention should occur and to predict the degree of difficulty of the revision. Fifty-four revisions of failed cementless acetabular components were performed in 52 patients. All cases demonstrated polyethylene wear radiographically, and in 43 cases (80%), osteolysis of the pelvis was seen. Symptoms of groin or buttock pain were seen in 45 of 54 cases (83%). Preoperative staging of the disease process included one patient with wear radiographically but neither symptoms nor lysis (stage I), 10 patients with wear and pain (stage IIA), 8 patients with wear and lysis but no pain (stage IIB), and 35 patients with wear, lysis, and pain (stage III). Patients in stages I and IIA could be revised with cementless components without structural allograft. Patients in stages IIB and III required structural allograft in 79% and cemented components in 53%. Cemented components were used when there was less than 50% contact between host-bone and prosthesis. Polyethylene wear alone (stage I) is an indication of impending failure, and when symptoms develop (stage IIA), revision should be undertaken. The development of radiographic lysis is a critical event, and as soon as osteolysis develops (stage IIB or III), revision should be undertaken immediately. From the perspective of the revision surgeon, there is great value in the early intervention for polyethylene wear and pelvic osteolysis.

Head-neck modularity for total hip arthroplasty. Is it necessary?

Although modular head-neck combinations for femoral components are convenient and useful, theoretical concerns make them less attractive. In a consecutive series of 100 primary cementless total hip arthroplasties, the neck length chosen for the broach trial reduction was compared with the final neck length chosen after the actual femoral component had been impacted. In 19%, the neck length was changed after insertion of the femoral component. As a result, leg-length inequality or wastage of these femoral components would have resulted. For cementless femoral components, the ability to adjust neck length after component impaction remains important.

Health outcome assessment before and after lumbar laminectomy for radiculopathy.

STUDY DESIGN: Forty-one patients undergoing lumbar laminectomy for radiculopathy resulting from herniated discs assessed their health status using a generic health outcome instrument (Medical Outcomes Study Short Form 36) before surgery and at an average of 2 years after surgery. OBJECTIVES: To assess whether lumbar laminectomy for herniated nucleus pulposus is a useful intervention when patients evaluate their own perception of health. SUMMARY OF BACKGROUND DATA: The medical Outcomes Study Short Form 36 has been used in multiple studies assessing various medical conditions. It is brief, generic, and reliable. Although surgical treatment for radiculopathy by lumbar laminectomy has been shown to be successful using specific criteria for patient selection and an algorithmic approach, the authors are not aware of any study using a patient-based health outcome assessment to evaluate the results of this type of surgery. METHODS: Forty-one patients (82% completed follow-up evaluation; average follow-up period, 2.08 years) completed Medical Outcomes Study Short Form 36 before and after surgery. Scores from before and after surgery were compared. RESULTS: Statistically significant improvements (P < 0.01) were seen in eight of the nine health scores comparing scores from before and after surgery at follow-up evaluation. These included physical function, social function, role function resulting from physical limitations, role function resulting from emotional limitations, mental health, vitality, pain, and perceived health change. No significant change was seen in the patients' health perception after surgery. CONCLUSIONS: This study shows that the patients' self-reported health outcomes after lumbar laminectomy correlate with the excellent results previously seen using physician-driven outcome measures in an appropriately selected population with radiculopathy. The excellent results shown here did not deteriorate with age (> 40 years compared with < 40 years) or with complications after surgery.

Thoracolumbar infections in penetrating injuries to the spine.

A detailed review of the TJUH experience and the published literature on gunshot and stab wounds to the spine has been presented. The following statements are supported. (1) Military (high-velocity) gunshot wounds are distinct entities, and the management of these injuries cannot be carried over to civilian (low-velocity) handgun wounds. (2) Gunshot wounds with a resultant neurologic deficit are much more common than stab wounds and carry a worse prognosis. (3) Spinal infections are rare following a penetrating wound of the spine and a high index of suspicion is needed to detect them. (4) Extraspinal infections (septic complications) are much more common than spinal infections following a gunshot or stab wound to the spine. (5) Steroids are of no use in gunshot wounds to the spine. In fact, there was an increased incidence of spinal and extraspinal infections without a difference in neurologic outcome compared with those who did not receive steroids. (6) Spinal surgery is rarely indicated in the management of penetrating wounds of the spine. The recommendations for treatment at TJUH of victims of gunshot or stab wounds with a resultant neurologic deficit are as follows. (1) Spine surgery is indicated for progressive neurologic deficits and persistent cerebrospinal fluid leaks (particularly if meningitis is present), although these situations rarely occur. (2) Consider spine surgery for incomplete neurologic deficits with radiographic evidence of neural compression. Particularly in the cauda equina region, these surgeries may be technically demanding because of frequent dural violations and nerve root injuries/extrusions. These cases must be evaluated in an individual case-by-case manner. The neurologic outcomes of patients with incomplete neurologic deficits at TJUH who underwent acute spine surgery (usually for neural compression secondary to a bullet) were worse than the outcomes for the patients who did not have spine surgery. A selection bias against the patients undergoing spine surgery was likely present as these patients had evidence of ongoing neural compression. (3) A high index of suspicion is necessary to detect spinal and extraspinal infections. (4) Do not use glucorticoid steroids for gunshot wound victims. (5) Conservative (nonoperative) treatment with intravenous broad spectrum antibiotics and tetanus prophylaxis is the sole therapy indicated in the majority of patients who sustain a penetrating wound to the thoracic or lumbar spines.