Reclamation of wastewater in wetlands using reed plants and biochar.

To cope with water crisis, wastewater reuse has been introduced as a potential source for irrigation. On the other hand, irrigation with wastewater may negatively affect the surroundings. In this study, reed plant (Phragmits australis) and its biochar were tested as low-cost treatments to enhance the efficiency of wastewater reclamation in wetlands within only 72 h. The investigated water was of low irrigation quality and exhibited high contents of BOD5 and fecal coliform. Moreover, this water contained high levels of soluble cations and anions; besides, being marginally contaminated with Cu, Mn and Cd. After 2 days in the sedimentation unit, wastewater was subjected to three reclamation treatments in parallel (each lasted for 24 h): (1) a "sand & gravel bed", (2) "reed plants grown on a sand & gravel bed" and (3) "biochar + a sand & gravel bed". The results showed that all treatments decreased BOD5, fecal coliform, total cations and anions, with superiority for the second and third treatments. The levels of the potentially toxic elements also decreased to values within the permissible levels. Although the aforementioned wastewater treatment processes upgraded the quality of this water, it remained in the poor grade. Biochar or reed plants grown on sand and gravel beds significantly improved wastewater quality to the medium quality grade, with superiority for biochar treatment. In conclusion, investigated treatments are guaranteed in wetlands for wastewater reclamation; yet, further protocols should be followed to achieve safe handling of this water and attain the sustainable goals.

Charcot Arthropathy of Foot and Ankle: Radiographic and Clinical Patterns with Related Outcomes.

PURPOSE: Our aim is to retrospectively review and evaluate the patterns of affection of Charcot arthropathy of foot and ankle. METHODS: Two hundred twenty-eight patients (235 feet) with post-acute Charcot were reviewed and classified anatomically through plain radiographs into type I and type II based on single or multiple regions affected, respectively. Type I included ankle, Lisfranc (tarsometatarsal), naviculocuneiform, forefoot, and hindfoot which includes one of the following: talonavicular joint, calcaneocuboid joint, or calcaneus. Type II included peritalar, perinavicular, mid-tarsal Charcot, or any other combination. Both types were further classified into four stages (A, stable with no deformity; B, stable with deformity; C, unstable; and D, deformity/instability with associated mechanical ulcers). RESULTS: The most common type was type IIC (27.2%) followed by type IID (18.3%), while types IA and IIA represented the least common types (3.4% and 3.8%, respectively). Types IA and IIA were managed conservatively. All patients in types IC, ID, IIB, IIC, and IID and the majority of type IB received fusion surgery to achieve stability and correction of deformity. Type II D had the highest complication rate (30%). Five patients ended up with amputation, and all were stage IID. CONCLUSION: Affection of single region has better prognosis than affection of two or more regions. Stage A has the best prognosis and can be managed conservatively provided good diabetes control. Surgery is indicated in all cases of types IC, ID, IIB, IIC, and IID to achieve stability and correction of deformity and prevent complications. Mechanical ulcer (stage D) carries the worst prognosis and highest complication rate.

Comparing the gender diversity and affiliation trends of the authors for two orthopaedics journals from the Arab world.

OBJECTIVES: Authorship trends, female authors' contributions, and the collaboration among institutions have been a concern in the medical field. This study primarily aims to report and compare the number of authors per article and the prevalence of female authors by comparing two orthopaedics journals from the Arab world. The secondary objective of this study is to evaluate the characteristics of the authors' affiliations and the pattern in institutions' collaborations and contributions to the published articles. METHODS: This cross-sectional study reviewed all articles (until July 2020) published in the Archives of the Egyptian Orthopaedic Journal (EOJ) (the official journal of the Egyptian Orthopaedic Association) and the Journal of Musculoskeletal Surgery and Research (JMSR) (the official journal of the Saudi Orthopaedic Association). RESULTS: We evaluated 383 and 122 articles from the EOJ and JMSR, respectively. The average number of authors per article was significantly higher for JMSR (4.3 ± 1.7) than EOJ (2.0 ± 1.0); p = 0.000. There was a significantly larger number of contributions by female authors in JMSR (75, 14.2%) than EOJ (2, 0.3%); p = 0.000. The average number of institutions per article was significantly larger for JMSR (2.1 ± 1.2) than EOJ (1.1 ± 0.3); p = 0.000. For the JMSR, the incidence of national institutions' cooperation (27.9%) and international institutions' contributions (53.3%) were significantly higher than their counterparts for the EOJ-6% and 4.7%, respectively; p = 0.000. CONCLUSION: The JMSR showed superiority regarding the number of authors per article and the prevalence of female authors. The incidence of national institutions' cooperation and international contributions were higher in the JMSR compared with the EOJ.

Screw versus suture button in treatment of syndesmosis instability: Comparison using weightbearing CT scan.

BACKGROUND: The superiority of screw or suture button fixation for syndesmotic instability remains debatable. Our aim is to compare radiographic outcomes of screw and suture button fixation of syndesmotic instability using weight bearing CT scan (WBCT). METHODS: Twenty patients with fixation of unilateral syndesmotic instability were recruited and divided among two groups (screw = 10, suture button = 10). All patients had WBCT of both ankles ≥12 months postoperatively. RESULTS: In suture button group, injured side measurements were significantly different from normal side for syndesmotic area (P = 0.003), fibular rotation (P = 0.004), anterior difference (P = 0.025) and direct anterior difference (P = 0.035). In screw group, syndesmotic area was the only significantly different measurement (P = 0.006). CONCLUSION: While both screw and suture button didn't completely restore the syndesmotic area as compared to the contralateral uninjured ankle, external malrotation of the fibula was uniquely associated with suture button fixation. LEVEL OF EVIDENCE: III Retrospective Cohort Study.

Eighth-order virial equation of state and speed-of-sound measurements for krypton.

An eighth-order virial equation of state (VEOS) for krypton, valid for temperatures up to 5000 K, was developed using the accurate potential functions proposed by Jäger et al. [J. Chem. Phys. 144, 114304 (2016)] for the pair interactions and nonadditive three-body interactions between krypton atoms. While the second and third virial coefficients were already calculated by Jäger et al., the fourth- to eighth-order coefficients were determined in the present work. A simple analytical function was fitted individually to the calculated values of each virial coefficient to obtain the VEOS in an easy-to-use analytical form. To enable a stringent test of the quality of the new VEOS, we measured the speed of sound in krypton in the temperature range from 200 K to 420 K and at pressures up to 100 MPa with a very low uncertainty (at the 0.95 confidence level) of 0.005%-0.018% employing the pulse-echo technique. In order to verify that the isotopic composition of the krypton sample conforms to that of natural krypton in air, high-precision measurements of krypton isotope ratios using a high-sensitivity noble gas mass spectrometer were performed. The extensive comparison with the new speed-of-sound data as well as with experimental p-ρ-T and speed-of-sound data from the literature indicates that pressures and speeds of sound calculated using our new VEOS have uncertainties (at the 0.95 confidence level) of less than 0.1% at state points at which the VEOS is sufficiently converged.

Evaluation of Syndesmosis Reduction on CT Scan.

BACKGROUND: Computed tomography (CT) imaging has traditionally been considered the gold standard for evaluation of syndesmostic reduction, but there is no uniformly accepted method to assess reduction. The aim of this study was to evaluate the intra- and interobserver reliability of published measurement techniques for evaluation of syndesmotic reduction on weightbearing CT scan (WBCT) in hopes of determining which method is best. METHODS: Medical records were reviewed to identify patients who underwent operative stabilization of unilateral syndesmotic injuries. Exclusion criteria included patients younger than 18 years, ipsilateral fractures extending to the tibial plafond, any contralateral ankle fracture or syndesmotic injury, and body mass index greater than 40 kg/m2. Twenty eligible patients underwent WBCT evaluation of both ankles at an average of 3 years after syndesmotic fixation. The anatomic accuracy of syndesmotic reduction was evaluated by 2 observers using axial CT images at a level 1 cm proximal to the tibial plafond using 9 previously published radiological measurement techniques. Inter- and intraobserver reliability were assessed for each evaluation method. RESULTS: The syndesmotic area calculation showed the highest interobserver reliability (0.96), the highest intraobserver reliability for observer 2 (0.97), and the second highest intraobserver reliability for observer 1 (0.92). Fibular rotation had the second highest interobserver reliability in our results (0.84), with intraobserver reliability of 0.91 and 0.8 for first and second observers, respectively. The intraobserver reliability of the side-by-side method was 0.49 and 0.24 for the first and second observers, respectively, and the interobserver reliability was 0.26. CONCLUSION: Qualitatively assessing syndesmotic reduction via side-by-side comparison with the uninjured ankle had the least intra- and interobserver reliability and should not be relied on to determine syndesmotic reduction quality. In contradistinction, syndesmotic area calculation demonstrated the highest reliability when evaluating syndesmotic reduction, followed by fibular rotation. Given that syndesmotic area measurement techniques are not readily available on standard image viewers, technologically updating image viewers to allow such calculation would make this approach more accessible in clinical practice. LEVEL OF EVIDENCE: Level IV, case series.

Functional pedal construct achieved by combined operative treatment in peritalar complex Charcot arthropathy: A prospective study of 38 feet.

BACKGROUND: Charcot arthropathy of the peritalar complex carries a high risk of amputation if not properly managed. Our aim is to assess the functional outcome of severe Charcot arthropathy of the peritalar complex following enblock resection of the ulcer, massive debridement and stabilizing all the elements of the peritalar complex. METHODS: We prospectively studied 38 feet in 35 patients with peritalar complex Charcot arthropathy. All Feet underwent intense debridement and fusion using a combination of (Ilizarov) external fixation, and (plate and locked nail) internal fixation. Thirty two feet were graded as Eichenholtz 2, and six feet were graded as Eichenholtz 3. The mean follow up was 35.9months. RESULTS: The mean AOFAS score was significantly elevated from 25.4±9.1 preoperatively to 67.6±5.7 at the most recent follow-up (p<0.001). Complete bony fusion was achieved in 28 feet. Unsound bony fusion occurred in 8 feet. Two feet required below knee amputation. CONCLUSION: Peritalar complex Charcot arthropathy is not uncommon variety. Such cases carry high risk of complications and amputation is not excluded. The proper timing of surgery is crucial. Massive debridement and rigid fixation with strict follow up is mandatory to achieve the ultimate goal of obtaining a plantigrade, stable, mechanically sound, painless and infection free pedal construct.

Hybrid Fixation for Ankle Fusion in Diabetic Charcot Arthropathy.

BACKGROUND: Ankle fusion is difficult to achieve in the diabetic Charcot ankle Brodsky type 3a because of the poor quality of the bone and the inability to achieve a stable biomechanical construct. The aim of this study was to report the outcome of ankle fusion using a combination of an intramedullary nail and a circular external fixator in patients with diabetic Charcot arthropathy. METHODS: We prospectively studied 24 patients with diabetic Charcot arthropathy of the ankle who were treated by fusion of the tibiotalar joint using a combined retrograde intramedullary nail and Ilizarov external fixator. Their mean age was 50.7 ± 6.9 (range, 43-62) years. The mean follow-up after surgery was 36.4 ± 5.8 (range, 24-98) months. RESULTS: Twenty-two patients (92%) achieved clinical and radiographic solid bony fusion. No patients in this series needed amputation. All the patients were pain free, and the mean American Orthopaedic Foot & Ankle Society Score (AOFAS) improved significantly from 34.6 ± 6.8 to 66.4 ± 4.5 at the last follow-up. Two patients developed an ulcer over the heel due to a prominent nail. The ulcer healed after nail removal. Eight patients developed pin tract infection. CONCLUSION: We report a successful outcomes of ankle fusions using combined intramedullary nail locked only proximally and ring external fixator (hybrid fixation) in patients with diabetic Charcot arthropathy. LEVEL OF EVIDENCE: Level IV, case series.

Comparison of in-stent neoatherosclerosis and tissue characteristics between early and late in-stent restenosis in second-generation drug-eluting stents: an optical coherence tomography study.

Optical frequency domain imaging (OFDI) was utilized to compare the prevalence of neoatherosclerosis (NA) and morphological characteristics of the neointimal tissue in second generation drug eluting stent (G2-DES)-treated lesions between early (<1 year, E-ISR) and late (>1 year, L-ISR) in-stent restenotic phases. Data comparing NA and in vivo tissue characteristics between early and late in-stent restenosis (ISR) after implantation of G2-DES is limited. An OFDI analysis was performed in 50 G2-DESs {35 everolimus-eluting stent [22 cobalt-chromium (CoCr), 13 platinum-chromium (PtCr)], and 15 biolimus-eluting stent [BES]} ISR lesions (46 consecutive patients) undergoing target lesion revascularization, classified as E-ISR (n = 22 lesion) and L-ISR (n = 28 lesion). NA, defined as a neointima formation containing lipids or calcification was observed in fewer than half (24/50) of all ISR lesions with no significant difference between E-ISR and L-ISR lesions (50 vs. 46.4%, p = 0.8). There were also no significant differences in the morphological appearance and tissue characteristics between E-ISR and L-ISR lesions. ISR was more likely to occur earlier [median 8.6 (8.3-8.9) months] after PtCr-EES implantations (12 lesions vs. 1, p < 0.001), while 3/4 of the BES ISR lesions and more than 2/3 of the CoCr-EES ISR lesions were observed after 1 year of implantation [median 21.3 (20.7-27.5) months, p < 0.001]. Acknowledging some limitations, our observations may suggest that the prevalence of neoatherosclerosis and the morphological appearance, and tissue characteristics of G2-DESs restenotic lesions are similar between the early and late restenotic phases. Certain platforms (PtCr-EESs) may have preferentially presented with early ISR.

In-stent neoatherosclerosis and tissue characteristics of restenotic lesions following implantation of second generation drug-eluting stents in unrestricted coronary lesions: Optical frequency domain imaging study.

BACKGROUND: Differences in stent platform, polymer coatings, and antirestenotic drugs among the current in use second-generation drug-eluting stents (G2-DESs) may induce significant variations in neointimal response and vascular healing, which may impact the prevalence of neoatherosclerosis (NA) and morphological appearance of the restenotic tissue. METHODS AND RESULTS: Utilizing Optical frequency domain imaging, two independent reviewers, retrospectively compared the prevalence of neoatherosclerosis (NA), and the morphological differences, and tissue characteristics of 50 G2-DESs in-stent restenosis (ISR) lesions (35 everolimus-eluting stent [22 cobalt-chromium (CoCr), 13 platinum-chromium (PtCr)], and 15 biolimus-eluting stent [BES]) implanted liberally in unrestricted coronary lesions. More than half of the stents were implanted in type C lesions, while 40% of the stents were implanted primarily in lesions with recanalized chronic total occlusion. NA, defined as a neointima formation with the presence of lipids or calcification, was observed in fewer than half (24/50) of all ISR lesions with no significant in-between group differences (41%, 69%, and 40% in CoCr, PtCr, and BES respectively, P = 0.22), nor were there any significant differences in the morphological appearance or tissue characteristics between all G2-DESs subtypes. CONCLUSIONS: Acknowledging some limitations, our results may suggest that the prevalence of NA and the morphological appearance of restenotic lesions might not differ when G2-DESs are implanted in unrestricted, rather complex, coronary lesions.

The management of tibial pilon fractures with the Ilizarov fixator: The role of ankle arthroscopy.

BACKGROUND: Pilon fractures usually result from high energy trauma, and are commonly associated with extensive soft tissue damage which prevents the use of open reduction and internal fixation. PURPOSE: This study was designed to evaluate the use of the Ilizarov external fixator in the treatment of pilon fractures of the ankle, and to determine whether arthroscopy of the ankle could improve the outcome. METHODS: From February 2011 to May 2013 a total of 23 patients with unilateral closed pilon fractures were divided into two groups treated with and without arthroscopy during fixation with the Ilizarov external fixator. The fractures were classified according to the AO Rüdi and Allgower classification. Follow up ranged from 10 to 37 months with a mean of 18 months. RESULTS: All cases were evaluated at follow up by the AOFAS and the Bone et al. grading system. According to Bone et al. there were 3 cases excellent, 4 cases good, 2 cases fair, and 2 cases poor in Group A (without arthroscopy), whereas there were 4 cases excellent, 6 cases good, 2 cases fair in Group B (with arthroscopy). The AOFAS score for Group A was 77.8±5.8, and for Group B was 78.4±6.9. CONCLUSION: We concluded that the Ilizarov external fixator is an excellent method in treating pilon fractures as it minimizes the need for extensive surgery. We also conclude that the use of arthroscopy during pilon fracture fixation did not add statistically significant improvement to our results and it needs longer term investigation to assess its advantage - if any - to the final outcome. LEVEL OF EVIDENCE: level 2.

Intra- and periarticular osteoid osteoma: Percutaneous destruction and alcoholisation.

Intra- or periarticular osteoid osteoma (00) is uncommon, and therefore a diagnostic challenge. Symptoms are: chronic synovitis, decreased range of motion, joint effusion, and joint contracture. Radiographically, the classical perifocal sclerotic margin is often absent, which leads to a significant delay in diagnosis. The authors retrospectively studied 50 cases of intra- and peri-articular OO, treated with percutaneous destruction and alcoholisation. The mean follow-up period was 8.7 years (range, 1 to 15 years). The diagnosis was only made after +/-14 months (range, 8 to 18 months), due to atypical symptoms (nightly pain absent in 38%) and uselessness of plain radiographs (in 100%). CT-scan, contrast enhanced MRI and bone scan brought the solution. The technique was successful in 48 out of 50 cases (96%): incomplete excision occurred in 2 patients. The diagnosis of intra- or periarticular OO should be considered in case of unexplained joint pain where conservative treatment is inefficient.

Double calcaneal osteotomy and percutaneous tenoplasty for adequate arch restoration in adult flexible flat foot.

Treatment of adult acquired flexible flat foot deformity can be problematic. Triple arthrodesis for structural correction has been the standard of care, thus sacrificing hind foot motion. The objective of this study was to assess the value of double calcaneal osteotomies in improving structural alignment while maintaining hind foot motion, which may further protect the function of adjacent motion segments. Double calcaneal osteotomies (Evans osteotomy and posterior calcaneal displacement osteotomy) were performed on 17 feet of 14 patients. Postoperative follow-up showed significant improvement in clinical foot and ankle scores.

Impact of bifurcation lesions on clinical outcome and prognosis of primary angioplasty in acute myocardial infarction.

AIMS: The aim of this study was to determine the impact of bifurcation lesions on outcomes after primary percutaneous intervention (PCI) for acute myocardial infarction. METHODS AND RESULTS: We retrospectively reviewed a single-centre database of 646 patients admitted for primary angioplasty within 12 hours after AMI. We compared baseline characteristics and outcomes between bifurcation and non-bifurcation lesions. Bifurcation lesions were found in 23% of patients. They predominantly involved the left anterior descending artery. Provisional T-stenting was used in 89.3% of patients (with stenting of the main branch in 82% and of both branches in 7.3%), side-branch protection in 54.6%, and final kissing balloon inflation in 33%. The procedural success rate was 92% for the main branch of bifurcation lesions compared with 93% for non-bifurcation lesions (P=0.65). Major adverse cardiac event (MACE) rates were comparable in the two groups: in-hospital MACE was 13.3% in the bifurcation group versus 11.4% in the non-bifurcation group (P=0.72), and the 1-year total MACE rate was 22.6% in the bifurcation group versus 19.5% in the non-bifurcation group (P=0.56). CONCLUSIONS: Bifurcation lesions are common in patients with AMI. In a population with AMI, immediate and mid-term outcomes of primary PCI were similar in patients with and without bifurcation lesions.

Comparison of real-time coherent contrast imaging to dipyridamole thallium-201 single-photon emission computed tomography for assessment of myocardial perfusion and left ventricular wall motion.

Real-time coherent contrast imaging (CCI) echocardiography has the ability to evaluate wall motion and myocardial perfusion simultaneously, but its clinical applicability in the diagnosis of coronary artery disease (CAD) remains to be determined. This study examines the level of agreement between real-time CCI echocardiography and thallium-201 single-photon emission computed tomography (SPECT) following stress vasodilation. Forty-two patients with known or suspected CAD underwent real-time CCI using octafluoropropane-filled microspheres infusion before and after dipyridamole and thallium-201 injections. The apical 4- and 2-chamber views were each divided into 6 segments to assess wall motion and perfusion. Real-time CCI and SPECT were interpreted independently. Thirty-eight patients successfully completed tests, and 4 had suboptimal contrast images. Each vascular territory was classified as normal or abnormal by CCI perfusion, wall motion, and SPECT at baseline and at stress. Of the 114 territories (3 in each of the 38 patients), 3 (3.5%) were not analyzed; however, all territories corresponding to the left anterior descending artery were suitable for analysis. Concordance between CCI echocardiography and thallium-201 SPECT perfusion for left anterior descending, left circumflex, and right coronary artery territories were 91%, 86%, and 69%, respectively; between CCI perfusion and wall motion, the correlations were 93%, 93%, and 91%, respectively. When CCI perfusion and wall motion analysis were combined, their concordance to thallium-201 SPECT uptake improved to 94%, 89%, and 79%, respectively. In conclusion, real-time CCI echocardiography agrees very closely with thallium-201 SPECT in assessing myocardial perfusion following vasodilatory stress. Assessment of myocardial perfusion, in addition to segmental wall motion analysis, during stress echocardiography may be a significant contribution to the noninvasive evaluation of patients with ischemic heart disease.