Midfoot Trauma: Let's Get It Right the First Time.

Lisfranc injuries represent a wide variety of injury patterns, from stable midfoot sprains to grossly displaced fractures and fracture-dislocations. Obtaining and maintaining an anatomic reduction is critical in the treatment of these injuries. Considerable controversy remains as to the optimal method of treatment. Beyond the type and severity of the injury pattern, treatment decisions may ultimately be defined by activity-specific criteria and patient demographics.

Transport and Burial of Microplastics in Deep-Marine Sediments by Turbidity Currents.

The threat posed by plastic pollution to marine ecosystems and human health is under increasing scrutiny. Much of the macro- and microplastic in the ocean ends up on the seafloor, with some of the highest concentrations reported in submarine canyons that intersect the continental shelf and directly connect to terrestrial plastic sources. Gravity-driven avalanches, known as turbidity currents, are the primary process for delivering terrestrial sediment and organic carbon to the deep sea through submarine canyons. However, the ability of turbidity currents to transport and bury plastics is essentially unstudied. Using flume experiments, we investigate how turbidity currents transport microplastics, and their role in differential burial of microplastic fragments and fibers. We show that microplastic fragments become relatively concentrated within the base of turbidity currents, whereas fibers are more homogeneously distributed throughout the flow. Surprisingly, the resultant deposits show an opposing trend, as they are enriched with fibers, rather than fragments. We explain this apparent contradiction by a depositional mechanism whereby fibers are preferentially removed from suspension and buried in the deposits as they are trapped between settling sand-grains. Our results suggest that turbidity currents potentially distribute and bury large quantities of microplastics in seafloor sediments.

Antibacterial activity of 2-amino-4-hydroxypyrimidine-5-carboxylates and binding to Burkholderia pseudomallei 2-C-methyl-d-erythritol-2,4-cyclodiphosphate synthase.

Enzymes in the methylerythritol phosphate pathway make attractive targets for antibacterial activity due to their importance in isoprenoid biosynthesis and the absence of the pathway in mammals. The fifth enzyme in the pathway, 2-C-methyl-d-erythritol-2,4-cyclodiphosphate synthase (IspF), contains a catalytically important zinc ion in the active site. A series of de novo designed compounds containing a zinc binding group was synthesized and evaluated for antibacterial activity and interaction with IspF from Burkholderia pseudomallei, the causative agent of Whitmore's disease. The series demonstrated antibacterial activity as well as protein stabilization in fluorescence-based thermal shift assays. Finally, the binding of one compound to Burkholderia pseudomallei IspF was evaluated through group epitope mapping by saturation transfer difference NMR.

Sediment Microstructure and the Establishment of Gas Migration Pathways during Bubble Growth.

Soft sediments exhibit complex and varied deformation behavior during in situ bubble growth; however, the sediment microstructure is often neglected when predicting bubble networking or fracture propagation dynamics. This study considers three chemically similar Mg(OH)2-rich sediments, which differ slightly in their particle size distributions and morphologies but exhibit significant differences in their porosity, stiffness, and pore throat dimensions at equivalent yield strengths. At low yield strengths, microstructure greatly influenced the size distribution and connectivity of spherical bubble populations, with narrow sedimentary pore throats promoting coarser bubbles with diminished connectivity. Increased connectivity of the bubble population appeared highly significant in limiting bed expansion, either by establishing pathways for gas release or by dissipating excess internal bubble pressure, thereby diminishing further growth. During in situ gas generation, each sediment demonstrated a critical fracture strength, which demarcated the populations with high void fractions (0.27 < ν < 0.4) of near-spherical bubbles from a fracturing regime supporting reduced void fractions (ν ≈ 0.15) of high aspect ratio cracks. However, critical fracture strengths varied significantly (in the 60-1000 Pa range) between sediments, with coarser-grained and higher porosity sediments promoting fracture at lower strengths. Fracture propagation greatly enhanced the connectivity and diminished the tortuosity of the void networks, thereby augmenting the continuous gas release flux.

Direct Monitoring Reveals Initiation of Turbidity Currents From Extremely Dilute River Plumes.

Rivers (on land) and turbidity currents (in the ocean) are the most important sediment transport processes on Earth. Yet how rivers generate turbidity currents as they enter the coastal ocean remains poorly understood. The current paradigm, based on laboratory experiments, is that turbidity currents are triggered when river plumes exceed a threshold sediment concentration of ~1 kg/m3. Here we present direct observations of an exceptionally dilute river plume, with sediment concentrations 1 order of magnitude below this threshold (0.07 kg/m3), which generated a fast (1.5 m/s), erosive, short-lived (6 min) turbidity current. However, no turbidity current occurred during subsequent river plumes. We infer that turbidity currents are generated when fine sediment, accumulating in a tidal turbidity maximum, is released during spring tide. This means that very dilute river plumes can generate turbidity currents more frequently and in a wider range of locations than previously thought.

Revision Open Reduction and Internal Fixation of Ankle and Syndesmosis Malunions.

Malreduction of the fibula and syndesmosis remains a common complication associated with the surgical management of ankle fractures. This malreduction leads to profound alterations in the biomechanics of the ankle, leading to chronic pain and premature degenerative changes of the ankle. It is possible to correct many fibular and syndesmotic malunions with reconstructive surgical techniques, of which there are several for revising and salvaging the malreduced ankle mortise and tibiofibular syndesmosis.

Cytidine derivatives as IspF inhibitors of Burkolderia pseudomallei.

Published biological data suggest that the methyl erythritol phosphate (MEP) pathway, a non-mevalonate isoprenoid biosynthetic pathway, is essential for certain bacteria and other infectious disease organisms. One highly conserved enzyme in the MEP pathway is 2C-methyl-d-erythritol 2,4-cyclodiphosphate synthase (IspF). Fragment-bound complexes of IspF from Burkholderia pseudomallei were used to design and synthesize a series of molecules linking the cytidine moiety to different zinc pocket fragment binders. Testing by surface plasmon resonance (SPR) found one molecule in the series to possess binding affinity equal to that of cytidine diphosphate, despite lacking any metal-coordinating phosphate groups. Close inspection of the SPR data suggest different binding stoichiometries between IspF and test compounds. Crystallographic analysis shows important variations between the binding mode of one synthesized compound and the pose of the bound fragment from which it was designed. The binding modes of these molecules add to our structural knowledge base for IspF and suggest future refinements in this compound series.

First in-situ monitoring of sponge response and recovery to an industrial sedimentation event.

Assessment of risks to seabed habitats from industrial activities is based on the resilience and potential for recovery. Increased sedimentation, a key impact of many offshore industries, results in burial and smothering of benthic organisms. Sponges are particularly vulnerable to increases in suspended and deposited sediment, but response and recovery have not been observed in-situ. We quantified the impact of sedimentation from offshore hydrocarbon drilling over ∼5 days on a lamellate demosponge, and its recovery in-situ over ∼40 days using hourly time-lapse photographs with measurements of backscatter (a proxy of suspended sediment) and current speed. Sediment accumulated on the sponge then cleared largely gradually but occasionally sharply, though it did not return to the initial state. This partial recovery likely involved a combination of active and passive removal. We discuss the use of in-situ observing, which is critical to monitoring impacts in remote habitats, and need for calibration to laboratory conditions.

Volcaniclastic density currents explain widespread and diverse seafloor impacts of the 2022 Hunga Volcano eruption.

The impacts of large terrestrial volcanic eruptions are apparent from satellite monitoring and direct observations. However, more than three quarters of all volcanic outputs worldwide lie submerged beneath the ocean, and the risks they pose to people, infrastructure, and benthic ecosystems remain poorly understood due to inaccessibility and a lack of detailed observations before and after eruptions. Here, comparing data acquired between 2015 - 2017 and 3 months after the January 2022 eruption of Hunga Volcano, we document the far-reaching and diverse impacts of one of the most explosive volcanic eruptions ever recorded. Almost 10 km3 of seafloor material was removed during the eruption, most of which we conclude was redeposited within 20 km of the caldera by long run-out seafloor density currents. These powerful currents damaged seafloor cables over a length of >100 km, reshaped the seafloor, and caused mass-mortality of seafloor life. Biological (mega-epifaunal invertebrate) seafloor communities only survived the eruption where local topography provided a physical barrier to density currents (e.g., on nearby seamounts). While the longer-term consequences of such a large eruption for human, ecological and climatic systems are emerging, we expect that these previously-undocumented refugia will play a key role in longer-term ecosystem recovery.

Fast and destructive density currents created by ocean-entering volcanic eruptions.

Volcanic eruptions on land create hot and fast pyroclastic density currents, triggering tsunamis or surges that travel over water where they reach the ocean. However, no field study has documented what happens when large volumes of erupted volcanic material are instead delivered directly into the ocean. We show how the rapid emplacement of large volumes of erupted material onto steep submerged slopes triggered extremely fast (122 kilometers per hour) and long-runout (>100 kilometers) seafloor currents. These density currents were faster than those triggered by earthquakes, floods, or storms, and they broke seafloor cables, cutting off a nation from the rest of the world. The deep scours excavated by these currents are similar to those around many submerged volcanoes, providing evidence of large eruptions at other sites worldwide.

First source-to-sink monitoring shows dense head controls sediment flux and runout in turbidity currents.

Until recently, despite being one of the most important sediment transport phenomena on Earth, few direct measurements of turbidity currents existed. Consequently, their structure and evolution were poorly understood, particularly whether they are dense or dilute. Here, we analyze the largest number of turbidity currents monitored to date from source to sink. We show sediment transport and internal flow characteristic evolution as they runout. Observed frontal regions (heads) are fast (>1.5 m/s), thin (<10 m), dense (depth averaged concentrations up to 38%vol), strongly stratified, and dominated by grain-to-grain interactions, or slower (<1 m/s), dilute (<0.01%vol), and well mixed with turbulence supporting sediment. Between these end-members, a transitional flow head exists. Flow bodies are typically thick, slow, dilute, and well mixed. Flows with dense heads stretch and bulk up with dense heads transporting up to 1000 times more sediment than the dilute body. Dense heads can therefore control turbidity current sediment transport and runout into the deep sea.

Longest sediment flows yet measured show how major rivers connect efficiently to deep sea.

Here we show how major rivers can efficiently connect to the deep-sea, by analysing the longest runout sediment flows (of any type) yet measured in action on Earth. These seafloor turbidity currents originated from the Congo River-mouth, with one flow travelling >1,130 km whilst accelerating from 5.2 to 8.0 m/s. In one year, these turbidity currents eroded 1,338-2,675 [>535-1,070] Mt of sediment from one submarine canyon, equivalent to 19-37 [>7-15] % of annual suspended sediment flux from present-day rivers. It was known earthquakes trigger canyon-flushing flows. We show river-floods also generate canyon-flushing flows, primed by rapid sediment-accumulation at the river-mouth, and sometimes triggered by spring tides weeks to months post-flood. It is demonstrated that strongly erosional turbidity currents self-accelerate, thereby travelling much further, validating a long-proposed theory. These observations explain highly-efficient organic carbon transfer, and have important implications for hazards to seabed cables, or deep-sea impacts of terrestrial climate change.

Internal field distribution measurement in 1-D strongly anisotropic sub-wavelength periodic structures of finite length.

We report measurements of the internal field intensity distribution in finite length one dimensional strongly anisotropic sub-wavelength periodic structures in the vicinity of the photonic band gap (PBG) edge. The strong in-plane anisotropy of more than 10% index contrast is obtained via form birefringent sub-wavelength gratings. The structures have a period of less than half the wavelength. Depending on the excitation frequency, both standing wave and evanescent Bloch modes can be identified and observed experimentally. The field enhancement near the PBG edge is confirmed also but at a significantly reduced strength attributed to the small but finite material loss.

Salvage of failed total ankle arthroplasty with fusion using structural allograft and internal fixation.

BACKGROUND: The current study presents our experience with conversion of failed TAA to fusion. MATERIALS AND METHODS: A retrospective review of all failed total ankles converted to fusion from 1999 to 2009 was performed at our institution. RESULTS: Twelve total ankles were converted to isolated ankle fusions (Group I) and 12 converted to ankle-hindfoot fusions (Group II). All isolated ankle fusions were stabilized with anterior plate and screws with one nonunion. Structural bone graft was used in ten of 12. Mean outcome scores using the AOFAS-Ankle/Hindfoot score and Maryland Foot Score improved from preoperative values of 43 ± 13 and 56.7 ± 14 to 67 ± 12 and 71.2 ± 16 postoperatively, respectively (p < 0.05). All Group II ankle-hindfoot fusion patients were fixed using either anterior plate and screws, intramedullary nail, or a combination nail:plate construct. All received structural allografts. Five patients developed nonunion including four subtalar nonunions Preoperative scores on the AOFAS-AHS and MFS were 48.8 ± 14 and 58.3 ± 14. Postoperative scores were 51.2 ± 17 for the AOFAS and 64.5 ± 14 for the MFS. These changes were not statistically significant. However, the difference in nonunions was significant, p < 0.05. CONCLUSION: Failed total ankles can be successfully converted to fusion using structural bone graft and internal fixation. The primary risk appears to be nonunion of the subtalar joint when ankle-hindfoot fusion is required. We believe this risk can be decreased by using a separate approach for preparation of the subtalar joint.

Tunable negative group index in metamaterial structures with large form birefringence.

We experimentally verify the anomalous phase behavior in metamaterial structures with birefringent materials predicted by Mandatori, et. al. using form birefringent structures. Large birefringence as much as Deltan/n = 0.7 has been achieved by surface-treated form birefringent discs, making compact single layer Mandatori structures viable. With a reduced model of a single layer birefringent structure, the relationship between design parameters (thickness and orientation angle) and device operation and performance parameters (such as the center operation frequency, bandwidth, effective negative index, negative group index of refraction, and the transmission throughput) are derived and verified experimentally. Tunable group index of refraction from strong slow light of ng = 29.6 to fast light of ng = -1.1 are measured experimentally.

Switch control pocket inhibitors of p38-MAP kinase. Durable type II inhibitors that do not require binding into the canonical ATP hinge region.

Switch control pocket inhibitors of p38-alpha kinase are described. Durable type II inhibitors were designed which bind to arginines (Arg67 or Arg70) that function as key residues for mediating phospho-threonine 180 dependant conformational fluxing of p38-alpha from an inactive type II state to an active type I state. Binding to Arg70 in particular led to potent inhibitors, exemplified by DP-802, which also exhibited high kinase selectivity. Binding to Arg70 obviated the requirement for binding into the ATP Hinge region. X-ray crystallography revealed that DP-802 and analogs induce an enhanced type II conformation upon binding to either the unphosphorylated or the doubly phosphorylated form of p38-alpha kinase.

Aminopyridinecarboxamide-based inhibitors: Structure-activity relationship.

Series of aminopyridinecarboxamide-based inhibitors were synthesized and tested against human recombinant IKK-2 and in IL-1beta stimulated synovial fibroblasts. The 2-amino-5-chloropyridine-4-carboxamides were identified as the most potent inhibitors with improved cellular activity.

Seafloor microplastic hotspots controlled by deep-sea circulation.

Although microplastics are known to pervade the global seafloor, the processes that control their dispersal and concentration in the deep sea remain largely unknown. Here, we show that thermohaline-driven currents, which build extensive seafloor sediment accumulations, can control the distribution of microplastics and create hotspots with the highest concentrations reported for any seafloor setting (190 pieces per 50 grams). Previous studies propose that microplastics are transported to the seafloor by vertical settling from surface accumulations; here, we demonstrate that the spatial distribution and ultimate fate of microplastics are strongly controlled by near-bed thermohaline currents (bottom currents). These currents are known to supply oxygen and nutrients to deep-sea benthos, suggesting that deep-sea biodiversity hotspots are also likely to be microplastic hotspots.

Author Correction: Rapidly-migrating and internally-generated knickpoints can control submarine channel evolution.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Rapidly-migrating and internally-generated knickpoints can control submarine channel evolution.

Submarine channels are the primary conduits for terrestrial sediment, organic carbon, and pollutant transport to the deep sea. Submarine channels are far more difficult to monitor than rivers, and thus less well understood. Here we present 9 years of time-lapse mapping of an active submarine channel along its full length in Bute Inlet, Canada. Past studies suggested that meander-bend migration, levee-deposition, or migration of (supercritical-flow) bedforms controls the evolution of submarine channels. We show for the first time how rapid (100-450 m/year) upstream migration of 5-to-30 m high knickpoints can control submarine channel evolution. Knickpoint migration-related changes include deep (>25 m) erosion, and lateral migration of the channel. Knickpoints in rivers are created by external factors, such as tectonics, or base-level change. However, the knickpoints in Bute Inlet appear internally generated. Similar knickpoints are found in several submarine channels worldwide, and are thus globally important for how channels operate.