Surgery For Removal Research Articles

Proposal of a predictive score for the occurrence of postoperative cerebral vasospasm: analysis of a large single institution retrospective series and literature review.

Despite being uncommon, postoperative vasospasm (PoVS) present notably high morbidity and mortality rates. Our aim was to identify prognostic factors associated with this condition and introduce a scoring system to improve subsequent clinical and radiological surveillance strategies. We conducted a retrospective analysis of our institutional database covering patients aged over 18 who underwent craniotomic or transsphenoidal surgery for elective tumor removal at the Neurosurgical Unit of our institution between January 2016 and August 2023. A comprehensive search was conducted using the Cochrane Database of Systematic Reviews and PubMed database to identify the most correlated risk factors. Literature review included a final group of 32 studies (52 patients) and identified SAH, vessel encasement or vessel manipulation, hypothalamic disfunction, meningitis, younger age, tumor size > 3 cm, and long operative time as predictive factors for PoVS. Our cohort included 2132 patients, with only 13 individuals (0.61%) presenting PoVS. To predict the occurrence of PoVS, we developed a logistic multivariate regression model that identified thick (defined as Fisher grade ≥ 3) subarachnoid hemorrhage (coeff. 6.7, p < 0.001), intraparenchymal hemorrhage (coeff. 3.44, p < 0.001), lesion located in the parasellar region (coeff. 2.1, p = 0.064), and lesion size ≥ 4 cm (coeff. 2.0, p = 0.069) as potential independent predictors of PoVS. Based on statistical model for these variables was assigned a score: thick SAH 7 points, intraparenchymal hemorrhage 3 points, parasellar lesion site 2 points, and lesion size ≥ 4 cm 2 points. The cumulative scores ranged from 0 to 14. PoVS is a rare complication but its association with significant morbidity and mortality underscores the importance of early identification and treatment. In our study we proposed a stratified risk score to identify high risk patients. However, due to rarity of this condition, our score proposal should be considered as a training set a to be validated in future studies with a multicenter setting.

Self-Reinforcing Ionogel Bioadhesive Interface for Robust Integration and Monitoring of Bioelectronic Devices with Hard Tissues.

Integrating bioelectronic devices with hard tissues, such as bones and teeth, is essential for advancing diagnostic and therapeutic technologies. However, stable and durable adhesion in dynamic, moist environments remains challenging. Traditional bioadhesives often fail to maintain strong bonds, especially when interfacing with metal electrodes and hard tissues. This study introduces a self-reinforcing ionogel bioadhesive interface (IGBI) combining silk fibroin and calcium ions, designed to provide robust and conductive integration of bioelectronic devices with hard tissues. The IGBI exhibits strong adhesion (up to 186Jm-2) and undergoes mechanical self-reinforcement through a structural transition in silk fibroin under physiological conditions. In vivo experiments demonstrate the IGBI's effectiveness in repairing bone defects and reimplanting teeth, with the added capability of wireless, real-time monitoring of bone healing. This approach allows for continuous tracking of tissue regeneration without a second invasive surgery for device removal. The IGBI represents a significant advancement in bioelectronic integration, offering a durable and versatile solution for challenging environments. Such unique self-reinforcing properties make the IGBI a promising material for biomedical applications where traditional adhesives are insufficient.

Injuries from blank cartridge shots in suicide attempts within the South Korean military: a case series of five patients.

Blank cartridges are designed to produce the sound and gas flare of a gunshot without firing a bullet. However, blank cartridge shots (BCS) can still cause injuries ranging from minor to life-threatening. Within the South Korean military, most BCS-related injuries have occurred during suicide attempts. This study documents a case series of patients who sustained injuries from BCS during such attempts. We examined the medical records of Korean soldiers at a military trauma center between April 2022 and April 2024 who had sustained injuries from BCS during suicide attempts. The analyzed data included general characteristics, injury site, surgical and psychiatric interventions, and length of hospitalization. The case series included five patients between 19 and 20 years old (mean age, 19.6±0.55 years). Four of these patients sustained self-inflicted gunshot wounds to the submandibular area, while one targeted the right temporal area. Although initial vital signs and laboratory findings were unremarkable, computed tomography scans revealed injuries from projectile gas and gunpowder, including burns, subcutaneous emphysema, and major structural damage. Cases 1 and 2 required emergency surgery for foreign body removal and debridement. The average length of hospitalization was 35.2±12.11 days. Patients were first admitted to the trauma surgery department for BCS injury management, and then transferred to the psychiatry department for emotional support. The average stay was 15.6±15.87 days in trauma surgery and 19.6±14.99 days in psychiatry. This study highlights the consequences of BCS from suicide attempts in the South Korean military and provides valuable insights for medical personnel who may encounter patients with BCS injuries.

Research on Diagnosis and Localization of Moles for Robotic Mole Removal Surgery Based on YOLO

Surgical treatment is often considered the first choice for mole removal. Treatments such as laser mole removal are widely performed, but intraoperative navigation remains a significant challenge, relying heavily on the experience of surgeons. Additionally, when multiple moles are required to be removed, a more repetitive workload can occur in the surgical procedures. To address these issues, this study aims to achieve precise intraoperative navigation and to achieve modes of automatic diagnosis and localization for robotic mole removal surgery. By training the YOLO model on an open-source categorical mole dataset, this study achieves the automatic diagnosis and localization of the moles during surgeries. In the evaluation of the study, a precision of 0.839 and an average precision mAP of 0.862 which are at a high level are observed. This study verifies that the YOLO can play a critical role in enabling the automatic diagnosis and localization of robotic mole removal surgery.

On the Salt Bath Cleaning Operations for Removal of Lubricants on the Surface of Titanium Alloy Aerospace Fasteners

On the Salt Bath Cleaning Operations for Removal of Lubricants on the Surface of Titanium Alloy Aerospace Fasteners

Stiffness-tunable velvet worm-inspired soft adhesive robot.

Considering the characteristics and operating environment of remotely controlled miniature soft robots, achieving delicate adhesion control over various target surfaces is a substantial challenge. In particular, the ability to delicately grasp wrinkled and soft biological and nonbiological surfaces with low preload without causing damage is essential. The proposed adhesive robotic system, inspired by the secretions from a velvet worm, uses a structured magnetorheological material that exhibits precise adhesion control with stability and repeatability by the rapid stiffness change controlled by an external magnetic field. The proposed adhesion protocol involves controlling soft-state adhesion, maintaining a large contact area, and enhancing the elastic modulus, and the mechanical structure enhances the effectiveness of this protocol. Demonstrations of the remote adhesive robot include stable transportation in soft and wet organs, unscrewing a nut from a bolt, and supporting mouse tumor removal surgery. These results indicate the potential applicability of the soft adhesive robot in biomedical engineering, especially for targeting small-scale biological tissues and organisms.

Digital design combined with endoscopic minimally invasive extraction of impacted mandibular third molars with roots in contact with the mandibular canal

Objective: To study the clinical efficacy of digital design combined with three-dimensional (3D) printing model minimally invasive extraction of complex impacted mandibular third molars. Methods: Eight patients who visited the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from April 2023 to March 2024 were included, including 3 males and 5 females, aged from 27 to 57 years old. The impacted mandibular third molars of all patients were closely related to the mandibular canal, and part of the dental tissue entered the mandibular canal. Preoperative digital design was used to simulate the intraoperative tooth segmentation and bone removal operation of the power system and the segmented tooth dislocation path, and analyze the tooth extraction resistance. The mandibular teeth, mandibular canal and mandibular model were three-dimensionally printed using light-curing resin inkjet. During the operation, an endoscope was used combined with the 3D printed model to minimally invasively extract the impacted mandibular third molar. Quantitative sensory testing of the patient's lower lip skin on the operated side was performed before surgery, 2 days after surgery, and 7 days after surgery. Clinical data such as operation time were collected. A paired sample t test was performed on the 2 and 7 days postoperative data and the preoperative data to compare the data differences. Results: All 8 patients successfully completed preoperative design, model printing and minimally invasive surgery. The number of teeth segmented in the preoperative design was (4.4±1.3), and the number of teeth segmented in the actual operation was (4.0±1.1). The operation time was (33.3±13.0) min. None of the patients had postoperative numbness of the lower lip or other postoperative complication. It was observed endoscopically that the inferior alveolar neurovascular bundle was exposed in the extraction socket during the operation. The patient's pressure pain threshold 2 days after surgery (0.601±1.170) was significantly lower than before surgery (1.251±1.109) (t=2.83, P=0.025). Conclusions: For complicated impacted mandibular third molars, digital design combined with 3D printing model can be used to perform minimally invasive extraction with the assistance of an endoscope.

Clinical Analysis of Transoral Approach Surgery for Removal of Migrating Pharyngeal Foreign Bodies.

Objective: To present our experience in the diagnosis and treatment of the migrating pharyngeal foreign bodies. Methods: Seven patients with migrating pharyngeal foreign bodies were retrospectively reviewed. The following data were collected: symptoms, time of onset, examination methods, buried sites of foreign bodies, methods of removal, and clinical outcomes. Results: All the 7 patients were diagnosed by computed tomography (CT) scan or ultrasound and then underwent foreign body removal through the transoral approach surgery under laryngoscope. The transoral removal of foreign bodies failed in 2 cases, in which the foreign bodies were removed via the transcervical approach subsequently. No complications were observed during the follow-up of 1 month. Conclusions: Migrating pharyngeal foreign bodies can be found and located by CT scan or ultrasound preoperatively. It is feasible and minimally invasive to remove migrating pharyngeal foreign bodies with radiofrequency coblation or CO2 laser through transoral approach surgery under laryngoscope.

Multiphysics simulation of liposome release from hydrogels for cavity filling following patient-specific breast tumor surgery

Several studies have recommended the use of hydrogels for localized targeted delivery of chemotherapeutic drugs following tumor removal surgery. This approach aims to both fill the cavity and prevent cancer recurrence. The use of Multiphysics-based simulation emerges as a valuable strategy for minimizing experimental work, providing detailed insights into how drug release occurs in the tissue, and enabling the optimization of the design.In this study, we introduced a mathematical model, utilizing experimental data, to investigate the transport of liposomes carrying MZ1 from a thermosensitive hydrogel and their impact on the viability of breast cancer cells. The proposed comprehensive model considers not just the transport within the interstitial tissue, represented as a porous medium, but also the uptake by cells and its influence on cell viability, along with the potential lymphatic drainage.The six real patient-specific tumor shapes extracted from MRI scans were used to investigate how the size and form of the tumor can modify the transport pattern. The computational results revealed that the concentration of liposomes in the tissue is significantly influenced by their release from the hydrogel, which proved to be the limiting step. Liposome concentrations of approximately 0.1 % weight were found to be sufficient in ensuring minimal cell survival in the vicinity of the tumor.

Integrative Korean Medicine Treatment for Temporomandibular Disorder and Facial Paresthesia after Tumor Removal Surgery: A Case Report (Case Report Guidelines-Compliant)

Integrative Korean Medicine Treatment for Temporomandibular Disorder and Facial Paresthesia after Tumor Removal Surgery: A Case Report (Case Report Guidelines-Compliant)

Evaluation of Knowledge and Perception of the Third Molar Extraction Procedure Among Patients in the Eastern Province, Saudi Arabia: A Cross-Sectional Study

Background Third molar extraction is one of the most common oral surgical procedures globally. This study assessed patients’ knowledge of third molar extraction procedures. Methods A self-administered questionnaire was administered to patients (N=384) of the dental hospital at Imam Abdulrahman bin Faisal University in the eastern province. The questionnaire covered demographic data, knowledge of third molar extraction, and patients’ perception questions. SPSS Version 24 was used for statistical analysis. Chi-square and Fisher’s Exact test were used. P-values less than or equal to 0.05 were considered statistically significant. Results According to the demographical characteristics of the patient who received 3rd molar removal surgery. As per the history of the extraction, 45% had previous 3rd molar extraction experience, whereas 55% had no previous dental surgical experience. There was no significant difference between the groups with the knowledge about the extraction (p-0.187). Patients with no previous history were more aware of the correct time for 3rd molar extraction at 27% vs 19%, respectively (P=0.046*). Patients with a previous history of third molar extraction showed significant results of knowledge in terms of taking medication prior to 3rd molar surgical procedure. Conclusion The patient with previous experience with third molar extraction showed low misconceptions. However, further studies should consider increasing the knowledge and correcting the patients’ perceptions.

Anaesthesia during surgery of a unilateral external vein aneurysm in a young dog

AbstractA female Swedish Elkhound was presented by the breeder at a referring clinic due to a swelling in the left mandibular area. The mass continued to grow, and at the age of 2 months the dog was referred to the hospital. Computed tomography was used for diagnostics of a unilateral external aneurysm of the left vena facialis and vena lingualis with a suspected centrally mineralised thrombus was made. One month later, the dog underwent surgery for removal of the aneurysm. This case describes the diagnostics, the perioperative anaesthetic considerations and anaesthetic management for surgery to remove the aneurysm where concerns regarding the young age and the risk of intraoperative haemorrhage were addressed. Premedication consisted of methadone and dexmedetomidine, general anaesthesia was induced using propofol and ketamine as co‐induction agents and maintained using isoflurane. There were no intraoperative anaesthetic complications; however, a postoperative surgical complication in the form of a seroma developed.

Combined laparoscopic nephroureterectomy with transurethral approach to the ureter in renal tuberculosis treatment

BACKGROUND: Tuberculosis of the genitourinary system is a common cause of organ removal surgeries. Despite the improvement of medical technologies, kidney and urinary tract surgeries for urogenital tuberculosis are traditionally performed using the open method. AIM: To assess the findings of laparoscopic and open combined nephroureterectomy with transurethral resection of the distal ureter in patients with renal tuberculosis. MATERIALS AND METHODS: The findings of 61 nephroureterectomies with transurethral resection of the distal ureter performed for destructive renal tuberculosis were analyzed. Open nephroureterectomy was performed in 31 patients, and laparoscopic approach was used in 30 patients. Patients in both groups were comparable by gender and age. RESULTS: The surgery duration, volume of intraoperative blood loss, rate and severity of postoperative complications were lower in patients who had laparoscopic interventions. When examined 1 month after surgery, patients in both groups showed the improvement of clinical parameters. The following changes were reported: a significant decrease in the nighttime urination rate, a decrease in IPSS scores, and an increase in the functional bladder capacity without significant differences depending on the surgical approach. After the surgery, a significant improvement in the quality of patients’ life was observed. In patients who had laparoscopic surgery, improvements were detected in all the SF-36 questionnaire domains. However, in patients after open surgery with a positive effect on most of assessed parameters no significant improvement of parameters in section “General Physical Health” was found. CONCLUSIONS: Irrespective of the selected approach, combined nephroureterectomy with transurethral resection of the distal ureter is an effective method of surgical treatment of patients with destructive renal tuberculosis. Moreover, the laparoscopic technique has shown a number of significant advantages over open surgery.

Dynamics in Quality of Life of Breast Cancer Patients Following Breast-Conserving Surgery Versus Mastectomy: Protocol for Systematic Review and Meta-Analysis.

Background: Quality of life (QoL) may change in female patients with breast cancer over time due to its dynamic construct. Recent studies have provided statistics on the diverse predictors of QoL in breast cancer patients. Still, the literature findings on the prognostication of QoL are scarce. Objectives: With this meta-analysis, we aim to describe the dynamics of overall QoL and its dimensions: mental status, physical functioning, and social interactions. Methods: To reach this aim, we will systematically evaluate the peer-reviewed literature on QoL of women who have undergone either mastectomy or breast-conserving surgery. The proposed study will focus on, but not be limited to, the analysis of BIRS, FACT-B, and EORTC QLQ-C30 questionnaires, which are most commonly used in the assessment of the quality of life of cancer patients. Then, we will extract the following outcome measures: The participants' age, time since surgery, type of tumor removal procedure (mastectomy or breast-conserving surgery), breast reconstruction technique, mean value, and standard deviation in a QoL score. A random-effects model will then compute the pooled QoL and construct the trend lines for scores received from each diagnostic tool. The findings will be adjusted according to the reconstruction techniques and tumor removal surgery. Finally, we will model the QoL dynamics with a set of predictors identified in the extracted studies. Conclusions: The study findings may serve as a tool for stratifying female patients with breast cancer by the risk of significant reduction in QoL.

Residual Elbow Instability Treated with a Submuscular Internal Joint Stabilizer: Prospective and Consecutive Series with a Minimum Follow-Up of 12 Months.

Background: The management of residual elbow instability is a challenging and compelling issue for treating physicians. To overcome inherent drawbacks of dynamic external fixators, the internal joint stabilizer (IJS) has been developed, achieving successful results, but it can sometimes cause local tenderness or anesthetic concerns in the subcutaneous layer. In addition, a bulky anconeus can pull the hardware away from the axis of rotation with an increase in the lever arm and potential issues. To address these issues, an alternative approach has been recently described in which the internal device is covered by the anconeus muscle, becoming submuscular, rather than subcutaneous. The aim of this study was to evaluate the effectiveness of this alternative approach to the IJS application in maintaining a concentric elbow during and after device removal in both acute and chronic scenarios. Methods: Prospective data collection was performed with consecutive patients who had residual elbow instability treated with an IJS (Skeletal Dynamics, Miami, FL) covered by the anconeus from January 2022 and with a minimum follow-up of 12 months. Results: At a medium follow-up of 16 months, the 16 patients selected had a mean arc of flexion-extension of 123° (range: 0-140°) and a mean pronation-supination arc of 150° (range: 80-80°). The mean MEPS and DASH scores were 90.3 ± 6.2 and 6.3 ± 5.3, respectively. At the last follow-up, elbow stability and concentric reduction were confirmed with radiographic and clinical examinations. Conclusions: With a minimum follow-up of 12 months, the present study supports the safety and efficacy of the internal device in a submuscular layer. The clinical outcomes and the rate of recurrent instability are comparable to those achieved with a classic subcutaneous position. Similarly, the complication rate is not affected, and removal surgery is no more aggressive than the classic approach.

Ear Reconstruction following Mohs Micrographic Surgery

AbstractRelative to other regions of the body, the ear has a high risk of developing cutaneous malignancies that often necessitate Mohs micrographic surgery (MMS) for removal. This procedure can create defects that are immediately noticeable if left untreated. Reconstructive techniques are often needed to restore the appearance of the affected ear and its symmetrical relationship to the contralateral ear. However, achieving optimal aesthetic results can be challenging due to the subtle intricacies of the external ear. Therefore, careful planning and execution should be implemented prior to managing the acquired defect. Additionally, depending on the size and location of the defect, various options aligning with the reconstructive ladder can provide desired outcomes. The purpose of this article was to highlight and discuss the different techniques used in ear reconstruction following MMS.

Successful use of single-port laparoscopic surgery for ovarian cyst removal on postpartum day two after vaginal delivery.

This report describes a single-port laparoscopic approach for giant ovarian cystectomy tailored for postpartum patients. For asymptomatic giant ovarian cysts reaching full term, timely postpartum single-port laparoscopic surgery may confer benefits by utilizing physiological alterations to mitigate risks and enhance surgical outcomes.

Civilian ballistic spinal cord injuries versus blunt trauma: comparative analysis of clinical characteristics, management, and outcomes

BACKGROUND CONTEXTThere are no current guidelines for the management of civilian gunshot wound injuries (GSW) to the spine and patient management often relies on algorithms derived from blunt trauma (BT). However, spinal cord injury due to GSW or blunt trauma mechanism may have significantly different clinical presentation, management, and outcomes. To ensure improved and evidence-based treatment, we need to understand the outcome determining characteristics of civilian GSW to the spine and identify the differences to the well-studied BT. PURPOSEThe aim of this study was to compare clinical characteristics, management, functional outcomes, and mortality associated with GSW to the spine versus BT. DESIGNRetrospective single-center analysis. PATIENT SAMPLEOne thousand nine hundred thirty-nine unique patients admitted to a level 1 trauma center with spinal cord injuries due to GSW or BT between the years 2003–2022. OUTCOME MEASURESPrimary outcome measure was the progression in American Spinal Injury Association (ASIA) motor score. METHODSClinical characteristics were compared followed by age-matched analysis (<45years) of neurological injury, the need for surgery, neurological outcomes and mortality. Stratification by neurological injury allowed for more homogenous subgroups for outcome analysis. RESULTSOf the 1939 patients with spinal cord injury, 566 were included in GSW group, and 1373 patients in BT group. Most patients in the GSW group were males (94.9% GSW vs. 83.5% BT; p<0.001) and younger (28.2 (range 13-62) years vs. 37.9, (range 12-91) years, p<0.001). The age-matched dataset comprised 1536 patients, with 540 in GSW group, and 996 in BT group. There were significantly more complete neurological injuries at admission in GSW group compared with BT (63.5% GSW vs. 34.4% BT, p<0.001). The ASIA motor Score at admission was significantly lower in GSW group (p<0.001), and changed without significant difference between the groups from admission to discharge (p<0.001, p=0.222). Subgroup analysis based on spinal cord injury showed that a higher proportion of patients with incomplete injuries improved neurologically, opposed to complete injuries, with significantly more patients improving in GSW group compared to BT (incomplete 58.9% GSW vs. 44.3% BT, p<0.001). Likewise, a higher proportion of paraplegic patients improved, opposed to quadriplegic patients, and in the paraplegic subgroup GSW patients improved rather than BT (paraplegic 65.1% GSW vs. 35.3%BT, p<0.001). In GSW group significantly less patients were managed operatively compared to BT group (12.2% GSW vs 76.8% BT, p<0.001). Most surgeries were bullet removals (81,4%) and involved the lumbar spine: 38.6% lumbar surgeries (of all GSW surgeries) and 31.4% surgery rate of all lumbar GSW patients. There was no significant difference in ASIA motor and sensory score improvement between patients who underwent surgery for bullet removal compared to nonoperatively managed patients in GSW group (p=0.199). The incidence rate of surgery showed a downwards trend over the study period. GSW group showed significantly less complications than BT group (22.8% GSW vs 27.0% BT, p<0.001). There was no significant difference in mortality rates (p ≥ 0.289). ConclusionTo our knowledge, this is the largest single-center dataset of civilian ballistic spinal cord injuries compared to BT. GSW affect mostly young males and result in significantly more severe, complete neurologic injuries compared with BT at similar mortality rates. Nevertheless, the present data suggest a greater potential for neurological improvement for paraplegic patients and incomplete injuries in GSW group. Patients with spinal cord injuries due to GSW undergo surgery less frequently compared to BT. Operated GSW cases primarily involved the lumbar spine. This study revealed differences between spinal cord injuries due to GSW and BT. In clinical application, this means that guidelines based on BT may not directly be transferable to civilian ballistic spinal cord injuries.

Return to Activity After Patellofemoral Osteochondral Fracture: A Comparison of Metallic Screw and Bioabsorbable Fixation.

Patellofemoral osteochondral fractures (OCFs) have the potential to hinder patients' function and quality of life. Several fragment fixation techniques have been described, with both metallic screw and bioabsorbable fixation showing favorable functional outcomes. Despite the promising results associated with both fixation methods, no study has directly compared their functional outcomes. To compare the functional and radiographic outcomes between bioabsorbable and metallic screw patellofemoral OCF fixation in an adolescent cohort. Cohort study; Level of evidence, 2. A retrospective review was conducted identifying surgically treated pediatric patients (<18 years of age) with OCFs of the patellofemoral joint. Inclusion criteria were treatment with metallic screw or bioabsorbable fixation (bioabsorbable compression screw, suture bridge, or chondral darts), with preoperative radiographs and operative notes available for review. Patient information, injury characteristics, treatments, and outcomes were collected with a specific focus on return-to-activity time and postoperative complications. Univariate analyses were conducted to compare radiographic and functional outcomes between groups. According to the study criteria, 37 knees in 37 patients (84% male), with a mean age of 14.2 ± 1.8 years, were identified. A total of 24 patients were injured during sports participation, with basketball and football being the most common sports. OCF fixation cohorts consisted of 12 patients treated with metallic screw fixation and 25 with bioabsorbable fixation. No statistically significant differences were appreciated when comparing median time to full activity between the fixation groups (P = .427). However, time to full activity was unequally distributed, with 66.7% of the metallic screw fixation group returning to activity later than the total cohort's median, compared with 42.9% of the bioabsorbable fixation group (P = .04). Two-thirds (8/12) of patients treated with metallic screws required return to the operating room for hardware removal compared with no patient treated with bioabsorbable fixation (P < .001). Two complications occurred with no significant differences appreciated between groups (P = .202). However, both postoperative complications were recorded in the metallic screw fixation group: 1 patient with osteochondral malunion and another with arthrofibrosis. This study demonstrated that pediatric patellofemoral OCFs had good outcomes with high healing and low complication rates regardless of fixation type. Because of the high rate of secondary hardware removal procedures, metallic screw constructs delayed the return to sports and activity time. Patients treated with bioabsorbable fixation did not require a secondary operation for hardware removal and thus were more likely to recover sooner. Future studies are necessary to assess the potential outcome differences between different types of bioabsorbable fixation methods. Based on these findings, surgeons can consider bioabsorbable fixation as an option for the management of OCF lesions.

Efficient nitrogen removal and stable operation of a dynamic membrane bioreactor (DMBR) for landfill leachate treatment

This study proposed a novel anoxic/4-stage aerobic/self-forming dynamic membrane bioreactor (DMBR) process for treating landfill leachate with low carbon-to-nitrogen ratio (COD/N). When the influent COD and NH4+-N were 3689 ± 425 and 1042 ± 96 mg/L, high removal efficiencies of 87 % for COD and 79 % for TN can be achieved. The mature dynamic membrane (DM) was rapidly established within 1 h, allowing one operational cycle to last over 20 days with the permeate turbidity below 5 NTU. The primary cause of biofouling was identified as the accumulation of small particles, proteins, polysaccharides, and inorganic components such as Ca2+ and Mg2+ in the DM layer. In addition, significant up-regulation of genes associated with quorum sensing signaling molecules (such as pac, trpE, dgcB), extracellular polymeric substances secretion (exoP, exoQ, algA), and biofilm formation (lasA) were observed in the DM layer, while some genus, like Thauera, Anaerolinea and Caldilinea were highly enriched in DM layer. These findings indicate that DMBR offers cost-effective and technically advantageous operations, making it a promising candidate for the treatment of high-strength landfill leachate.