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The levels of polycyclic aromatic hydrocarbons, PAHs, were determined in the liver and salt gland of 19 loggerhead turtles (Caretta caretta Linnaeus, Cheloniidae) stranded along the coasts of the south Tyrrhenian Sea, Italy, from 2019 to 2021. The 16 EPA's priority PAHs were determined by gas chromatography coupled with mass spectrometry (GC-MS). The average values of ΣPAHs in liver, 139 ± 55.0, were exceptionally high and up to one hundred times those of literature and appeared even more worrying in salt gland, 320 ± 97.6 ng/g, w.w. Naphthalene was the predominant contributor to PAHs richness and accounted for 90.0% and 93.7% of ΣPAHs in the two matrices, highlighting the petrogenic source of exposure. An overall higher bioaccumulation of NAP, more than two-fold, was detected in salt gland and especially in female and adults. Data of PAHs richness highlighted a potential risk of neoplastic disease development and that anthropogenic activities may seriously impair healthy state conditions of C. caretta. populations in south Tyrrhenian Sea., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

The levels of six non-dioxin-like polychlorinated biphenyls (PCBs 28, 52, 101, 138, 153, and 180) were determined in the liver of 84 loggerhead turtles (Caretta caretta) stranded along the coasts of the Tyrrhenian Sea in Campania Region (Southern Italy), from 2017 to 2021. The average value of the sum (∑ 6 PCB IND ) was 28.0 ± 52.2 ng/g (w.w.). The hexachlorobiphenyls PCB 153 and PCB 138 and the heptachlorobiphenyl PCB 180 were the main contributors to the ∑ 6 PCB IND . A weak positive correlation was found between CCL and highly chlorinated PCBs, with adult females having lower PCB concentrations than juvenile females and adult males. This study provides more comprehensive information on the levels of NDL-PCB in Mediterranean loggerhead turtles and sets the basis for assessing anthropogenic impacts on this species., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

A peri-implant fracture near the volar plate of the distal radius represents a rarity and can be associated with a mechanical failure of the devices. A literature review was conducted including all fractures that occurred around a volar wrist plate, which could be associated with an ulna fracture. All articles published until December 2021 were considered according to the guidelines presented in the PRISMA Statement. The search was conducted with the PubMed electronic database, Cochrane Database of Systematic Reviews, Medline, Embase, and Google Scholar. Only nine cases of these fractures were reported in the literature. The causes could be due to delayed union/non-union of the old fracture after low energy traumas, high energy trauma in patients with poor bone quality, or hardware mechanical failure. Furthermore, the literature review of peri-implant radius fracture shows different level of radius fracture and types of implant failure. In accordance with these different cases, a new classification of peri-implant fracture of the distal radius is proposed.

The spatial distribution of trace elements in surface sediments of the Hooghly estuary was studied over the monsoons in 2014-2017. As, Cd, Ni, Pb and U were two- to sixteen-fold the crust means with increasing levels toward the estuary, with Ni peak during the post-monsoon. Pearson's correlation matrix, cluster analysis, enrichment factors and pollution index revealed the anthropic source and association of trace elements with Fe, Mn and Al and of Pb with U. Geoaccumulation index revealed for Ni an extremely contaminated situation at the estuary water during monsoon and for Cd a heavily contaminated situation at freshwater location. The potential contamination index was >6; thus, sediments were very severely contaminated by As, Cd and Ni with worst situation for As and Cd at fresh and brackish water and during post-monsoon. The overall ecological risk was severe, 300≤RI<600 at all sites and seasons, especially after the monsoon, at fluvial and brackish locations., (© 2021. The Author(s).)

Vohwinkel Syndrome, also known as Keratoderma Hereditarium Mutilans, is an extremely rare dominant autosomal keratosis. It typically presents with "starfish" keratoses on the knuckles, palmoplantar keratoderma (PPK), hearing impairment and mutilating digital constriction bands (pseudoainhum) that cause strangulation, often leading to autoamputation of the affected digit. Both medical and surgical treatment haven't shown to date consistent results, in the treatment of pseudoainhum. In this study we present the case of a woman with Vohwinkel syndrome who showed constriction bands causing ischemic changes of the 5th digit of the right hand for which she was treated with surgery. We also present a review of the literature for the management of this disease., Competing Interests: Conflict of interest: The authors declare no potential conflict of interest., (©Copyright: the Author(s).)

A peri-implant fracture near the volar plate of distal radius represent a very rare injury. The main factor of this lesion is high energy trauma on the wrist. We report a case of a 61-year-old woman with a peri-implant fracture located just proximally to the plate and a fracture of the ulnar head that occurred after a simple fall. The patient was surgically treated by plate and screws removal. The fracture was fixed using a longer volar plate for the radial fracture and a plate for the head ulnar fracture. Different factors such as osteoporosis, BMI and screw position could influence the fracture pattern. However, considering growing use of plates for distal radius fracture fixation, the frequency of these kind of fracture will probably increase., Competing Interests: All authors have disclosed all financial support for this work and other potential conflict of interests related to the publication of this manuscript., (© 2020 Published by Elsevier Ltd.)

Osteoblastoma is a relatively rare, benign, bone-forming tumor, commonly observed in the second and third decades of life. Spine and the long tubular bones are the most common sites of involvement. Osteoblastoma is infrequently seen in other sites, including the bones of hand and foot. A rare case of a 35-year-old man that presented an osteoblastoma of the cuboid bone is reported. The patient was treated with surgical resection and grafting. After the intervention, the patient recovered with no clinical and radiological evidence of recurrence after one year of follow-up. Several cases of osteoblastoma-like variant of osteosarcoma of the cuboid have been previously reported, but, to our knowledge, this is the first case of conventional and isolated osteoblastoma involving the cuboid bone reported in the literature., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Heavy metal concentrations in sediments of the Gulf of Pozzuoli, GoP, and northwest of the Gulf beyond Monte di Procida, MdP, were determined. The enrichment factor, EF, revealed in GoP strong pollution with peaks for Cr and Cu of 61.1 and 96.9. High EF Cr, Cu, and Ni values were observed for MDP. Geoaccumulation index, Igeo, rates GoP extremely polluted by Cr and Cu, Igeo > 5, and MdP heavily polluted by Cr, moderately to heavily polluted by Cu, and heavily to extremely polluted by Ni. Contamination factor, Cf, was high in GoP and varied: Cu > Cr > Ni > Cd > Hg > Zn > Pb > As, and those of Cr, Cu and Ni largely surpassed the thresholds in MdP. The ecological and comprehensive ecological risk placed Cr, Cu, Hg and Ni at high or serious risk level in the Gulf, with a peak of 465 for Cu and at a moderate level in MdP except for a very high risk for Ni., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: Massive rotator cuff tears are common in the aging population. The incidence of failed rotator cuff repairs is still quite high, especially in the treatment of full-thickness tears or revision repairs. In this context, natural and synthetic meshes can be used as augmentation scaffolds or as devices to close the gap between a retracted tendon and the bone. The purpose of this work is to evaluate the ultimate tensile strength of different tendon-patch joints in order to consider their use in the treatment of massive cuff tears., Materials and Methods: Porcine tendons and a synthetic low-density polypropylene mesh have been used. A preliminary study on the tensile strength of tendons and patches has been performed. Different patch-tendon joints have been studied by modifying the number and the layout of the sutures. For every joint, the tensile test, performed through an electromechanical machine, has been repeated at least twice to obtain reliable data., Results: Experimental tensile tests on tendons and patches have given good results with very low dispersion data. Mean values of the calculated ultimate tensile stresses are, respectively, about 34 MPa and 16 MPa for tendons and patches. As regards the sutures arrangement, the staggered layout gave, for all joints, a higher tensile strength than the regular (aligned) one. Different ultimate tensile stress values, depending on the sutures number and layout, have been calculated for the joints., Conclusion: Synthetic patches could be an interesting option to repair massive cuff tears and to improve, in a significant way, pain, range of motion and strength at time 0, so reducing the rehabilitation time. Obtained results demonstrated that joints with a suitable number and layout of sutures could ensure very good mechanical performances. The failure load of the tendon-patch joint, in fact, is higher than the working load on a healthy tendon., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Self-inflicted fractures simulating traffic accident represent a new social fraud opportunity for criminality. Recognising scams through an increase of awareness of existence of self-inflicted arm fractures for insurance fraud could help community health workers to report these injuries to the competent authorities. In this article, authors have recognised an unusual but consistent pattern of upper and lower limb fractures whose incidence does not coincide in numerical terms with what is reported in literature. The aim of the present study is to describe fracture patterns observed over the past 2 years. Further, authors describe clinical presentations of these fractures and attempt to define a possible mechanism of these types of injuries.

Background: The acromion clavicular joint dislocations are common injuries of the shoulder. The severity is dependent upon the degree of ligamentous injury. Surgical treatment is typically performed in higher grade acromioclavicular separation with several static and dynamic operative procedures with or without primary ligament replacement., Methods: 47 patients with acute Rockwood type III, IV, and V injuries were treated surgically with LARS reconstruction. The success of technique was evaluated by radiographic outcomes for each patient at every follow-up visit (one, three, 12 months), while to assess pain reduction and clinical evaluation Visual Analogue scale score (VAS) and Constant-Murley score (CMA) was performed, respectively. An One Way Analysis of Variance (Kruskal-Wallis test), a multiple comparison Turket test, or a t-test (Mann-Whitney Rank Sum Test) were used when required., Results: Follow-up radiographs revealed maintenance of anatomical reduction in 41 patients, and no bone erosions has been identified. In short-term joint functional recovery has been observed. Indeed, after 12 months pain on the VAS-scale in all groups decreased significantly ( P < 0.05 ), and the CMS revealed a significant overall improvement ( P < 0.05 )., Conclusion: These data demonstrate that the use of the LARS allows to provide stability to the joint and especially to ensure its natural elasticity, relieving pain and improving joint function already one month post-surgery.

We studied the bioaccumulation of metals and PAHs, the pathological conditions, regressive phenomena and pathogens in wild Mytilus galloprovincialis taken along the North Pier facing the former second Italian largest steelworks of Bagnoli. There was no Cd and Pb bioaccumulation with respect to the EU role 221/2002. Metal shell index decreased as follows: Pb > Ni > Zn > Cu and correlates with the pollution state. The level of BaP was up to thirtysixfold higher the EU rule 835/2011. The sum of 4 hydrocarbons, PAH4, were up to seventeen-fold the rule. PAH levels increased toward the coast. Prevalence values of tissue necrosis and inflammatory lesions were between 50 and 100%. In May animals showed lesion like granulocytomas and inflammatory capsules. Signs of atresia, necrotic oocytes and diffused cases of hermaphroditism were detected. An appropriate localization of farming to avoid contamination from sediment turbulence and risks for consumer health is needed., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The Gulf of Pozzuoli includes the former second largest Italian steelworks of Bagnoli. The REE, Y, Th and Sc pollution in sediments of the Gulf of Pozzuoli was determined. Ce, La, Nd and Pr had the highest percentage distribution of rare earth elements normalized respect to chondrite with 31.19, 28.35, 19.51 and 8.41% individually. It was observed a marked enrichment of these elements, from west to the east from 26.39 to 111.04 mg/kg and from onshore to offshore from 31.67 to 217.74 mg/kg. The output of the principal component analysis revealed that the REE were mainly of anthropic origin being clearly linked to that of PAHs, metals and organic matter. This, together with their distribution patterns, highlighted the role of the former Bagnoli metallurgical plant in the pollution of the gulf., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: We aimed to evaluate the efficacy of the use of the electromagnetic distal targeting system in treating humeral shaft fracture., Methods: Patients were divided in: Group 1) patients that received a distal locking screw placement following the free-hand technique; Group 2) patients in which the distal locking screw was performed using the SURESHOT device., Results: No differences were noted comparing Group 1 (freehand) [71,9 range 40-135 min] to Group 2 (SURESHOT)[70, range 25-125 min]., Conclusion: The use of the EM distal targeting system doesn't reduce the overall operative time of the humeral shaft fracture fixation using IMN.

Background: Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors contributing to prolonged healing. In this prospective, multicentre, observational study, we investigated the capability of FRACTING (tibia FRACTure prediction healING days) score, calculated soon after tibia fracture treatment, to predict healing time., Methods: The study included 363 patients. Information on patient health, fracture morphology, and surgical treatment adopted were combined to calculate the FRACTING score. Fractures were considered healed when the patient was able to fully weight-bear without pain., Results: 319 fractures (88%) healed within 12 months from treatment. Forty-four fractures healed after 12 months or underwent a second surgery. FRACTING score positively correlated with days to healing: r = 0.63 ( p < 0.0001). Average score value was 7.3 ± 2.5; ROC analysis showed strong reliability of the score in separating patients healing before versus after 6 months: AUC = 0.823., Conclusions: This study shows that the FRACTING score can be employed both to predict months needed for fracture healing and to identify immediately after treatment patients at risk of prolonged healing. In patients with high score values, new pharmacological and nonpharmacological treatments to enhance osteogenesis could be tested selectively, which may finally result in reduced disability time and health cost savings.

Background: The aim of this study is to evaluate a possible correlation between specific anthropometric parameters and sizes of knee tendons commonly used for ACL reconstruction. We hypothesized that specific clinical and radiological knee measurements could be better tendon sizes predictors than age, gender, height and weight., Materials and Methods: 100 consecutive patients were enrolled and 77 patients met the inclusion criteria of the study. All patients underwent a MRI of the knee with a 1.5 T super conducting MR System. For each patient, anthropometric data such as gender, height, weight, body mass index (BMI) and knee circumference were recorded. Specific MRI knee measurements were performed on each study: patellar tendon (PT) thickness and length, quadriceps tendon (QT) thickness, semitendinosus tendon (ST) diameter, gracilis tendon (GR) diameter, the largest patella and intercondylar width., Results: The mean ST diameter, QT thickness and PT thickness were higher in males than in females. No significant differences were noted between males and females concerning GT diameter and the knee circumference. In addition, male knees had greater patellar and intercondylar width than female knees. Significant, but only weak correlations were found between patient anthropometric data and hamstrings diameter, PT length, and QT and PT thickness. Intercondylar and patellar width present a moderate correlation between PT thickness, PT length and ST diameter., Conclusion: The intercondylar and patellar width presented a moderate correlation with PT thickness, PT length and ST diameter. Further, weak correlations were found between patient anthropometric data (gender, weight, height, BMI) and GR and ST diameter, PT length, and QT and PT thickness. This results may help surgeons during preoperative planning, specifically regarding graft choice and size., Level of Evidence: III.

Most of the literature reports on the impact of the former Bagnoli brownfield on the pollution of Bagnoli Bay, embedded in the Gulf of Pozzuoli (GoP). Thus, we studied concentrations, types and sources of sixteen PAHs (EPA) in sediments at 22 sites along 5 transects covering the entire area of GoP. Outstanding levels of PAHs were found, varying from 7.1μgg -1 to 2.5 E+3μgg -1 . Sediments collected at sites far away from Bagnoli were found to be polluted to a similar extent than those facing the brownfield site, with values>100μgg -1 . Total PAHs levels in the sediments of GoP were higher by thirty-eleven thousand fold than those reported by other studies from various marine sites in the world. Transit axes of fine and very fine sands and diagnostic indexes revealed a common pyrolytic PAHs pollution spreading from the Bagnoli plant to all GoP., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The distribution of metals in surface sediments of Gulf of Pozzuoli (GoP), embedding the former second Italian largest integrated steelworks of Bagnoli, was studied based on sediment dispersal, quality guidelines (SQGs) and quantitative pollution indices of the respective metals. As, Cd, Hg, Pb, Zn largely exceeded the limits. Hg had a mean of 5.8mg/kg, twentyfold higher the rule, accumulating primarily near Bagnoli site. The mean effective range quotient, m-ERM-Q, revealed a high potential for negative biological effects especially in the area nearby the Bagnoli site. The enrichment factor (EF) values were outstandingly high, >1.5 with values which were often ≥100. The geoaccumulation index, Igeo, was very critical for Cr, Cu, Hg and Ni, showing an Igeo in the range of strongly polluted (45). The principal component analysis (PCA) and Pearson's correlation matrix (CM), excluded significant contribution from weathering products., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose: To investigate the effect of applying an additional suture to enhance the biomechanical behavior of the suture-meniscus construct used during the transtibial pull-out repair technique., Methods: A total of 20 fresh-frozen porcine tibiae with intact medial menisci were used. In one half of all specimens (N = 10), two non-absorbable sutures were passed directly over the meniscal root from the tibia side of the meniscus to the femoral side (2SS). In other ten specimens, three sutures were passed over the meniscal root (3SS). All specimens were subjected to cyclic loading followed by load-to-failure testing. Displacement of the construct was recorded at 100, 500, and 1000 cycles. Further, stiffness (500-1000 cycles) and ultimate load and modes of failure of the suture-meniscus construct were also recorded., Results: There was no statistically significant difference between the Group 2SS and Group 3SS at the 1st (1.6 ± 0.7 vs 1.4 ± 0.4 mm) and the 100th cycle (2 ± 0.7 vs 1.8 ± 0.4 mm). At 500 and 1000 cycles, the 2SS fixation technique resulted in significantly more displacement than the 3SS fixation technique (2.8 ± 0.6 vs 2.3 ± 0.5 mm; 3.1 ± 0.7 vs 2.5 ± 0.5 mm) (p < 0.05). No differences between two groups were noted concerning ultimate load to failure and stiffness (500-1000 cycles)., Conclusion: Three single sutures technique provided superior biomechanical properties compared with the two single sutures technique during the conducted fatigue tests., Clinical Relevance: Applying three simple stitches during meniscal root repair might be beneficial for healing of the posterior meniscal root, potentially reducing the post-operative immobilization time.

Introduction: We conduct a systematic and qualitative review of the current literature to evaluate studies that described bilateral ruptures of the extensor mechanism of the knee., Methods: A comprehensive literature search was performed to evaluate all studies included in the literature until September 2016., Results: Fourteen studies with a total of 44 patients met the inclusion criteria. There were 14 patients with CRF (61%), 6 patients were affected by diabetes mellitus (14%) while other 6 patients were obese patients (14%)., Conclusion: CRF represents the most frequent comorbidity in patients with bilateral quadriceps/patellar tendon ruptures.

A multidisciplinary survey was carried out on the quality of water and sediments of a coastal protected marine area, embedded between the inputs from Bagnoli steel plant to the south and a sewage plant, Volturno River and Regi Lagni channel to the north. The study integrated chemical-sedimentological data with biological and ecotoxicological analyses to assess anthropogenic pressures and natural variability. Data reveal marked differences in anthropogenic pollution between southeastern and northwestern zone, with the north affected by both inorganic and organic flows and the south influenced by levels of As, Pb and Zn in the sediments above law limits, deriving from inputs of the Bagnoli brownfield site. Meiobenthic data revealed at south higher relative abundance of sensitive species to pollution and environmental stress to the south, i.e. Lobatula lobatula and Rosalina bradyi, whereas to the north relative abundance of stress tolerant Quinqueloculina lata, Quinqueloculina pygmaea and Cribroelphidium cuvilleri were determined., (Copyright © 2016. Published by Elsevier Ltd.)

Purpose: The purpose of this study was to characterize the biomechanical effect of two grasping suture techniques used during ligament reconstruction: the modified rolling-hitch (MRH) and the modified finger-trap (MFT)., Methods: Flexor profundus tendons were harvested from fresh pig hind-leg trotters. Each specimen was mounted on an electro-mechanic universal testing machine (Instron 3367). In half of all tendons (15 specimens), the suture was passed around the tendon following the MRH knot (Group 1). In the remaining half of all tendons (15 specimens), the suture was passed over a distance of 30 mm according to the MFT suture technique (Group 2). As per standard intra-operative technique, a 1 cm residual tendon stub was left free from suture in all samples. All specimens were preconditioned to a load of 50 N for 10 min, followed by three cycles loading between 50 and 120 N. At this point, each sample was cyclically tensioned between 35 and 240 N, at 1 Hz for 200 cycles. Load-to-failure test was then carried out at a rate of 200 mm/min., Results: Rupture of the suture material at the knot was the mode of failure in all specimens during the loaded to failure test. Significant difference was found between Group 1 vs Group 2 for the elongation between the 0th cycle and 10th cycle, the elongation between the 10th cycle and 200th cycle, the mean stiffness at the 10th cycle, and the mean stiffness at the 190th cycle. No significant differences were noted between Group 1 and Group 2 concerning the ultimate load-to-failure., Conclusion: This study showed that both suture methods appear to be biomechanically effective in a porcine tendon model. However, the single-knot grasping technique (MRH) provided superior biomechanical properties compared with the MFT technique.

Background: The purpose of the present study was to compare the operative time for graft preparation using different techniques for graft suturing., Material and Methods: Flexor profundus tendons were harvested from fresh pig hind-leg trotters. Three different suture techniques were investigated: the Krackow stitch (K), the Whipstitch (W), and the Modified Finger-Trap suture (MFT). Tendons were sutured starting at 10 mm from the distal free end of the tendon. The suture configurations of the Krackow stitch and Whipstitch were completed with five suture throws. According to the MFT technique, the suture was wrapped five times around the tendon over a distance of 30 mm. The time required to perform a complete suture on each tendon was measured. Five independent examiners of different levels of training measured the time required for graft preparation during 3 separate occasions to determine intraobserver repeatability and interobserver reproducibility., Results: The mean time required for graft preparation following the Krackow technique was 69.1 seconds ± 18.3 SD (range 31.8-120). The Whipstitch technique took an average of 59.9 seconds ± 21.2 SD (range 27-93). The MFT suture required a mean of 29.3 seconds ± 11.4 SD for completing the suture (range 21.6-33). In all examiners the time required to complete the MFT suture was significantly less than the other suture techniques (p < 0.05). Intraobserver intraclass correlation coefficients for each examiner ranged from 0.72 to 0.83., Conclusion: Low graft preparation time is required to complete a MFT suture in a porcine tendon model. Further, time required for graft preparation using the MFT was shorter than other suturing techniques such as the Krackow and Whipstitch techniques., Clinical Relevance: The MFT suture could be used for graft set-up with the main advantage of reducing the time required in comparison with other suture techniques.

The distribution, inventory, and potential risk of organochlorine pesticides (OCPs), including Hexachlorocyclohexanes (HCHs) and Dichlorodiphenyltrichloroethanes (DDTs), and their correlation with soil properties and anthropogenic factors were investigated in soils of the Campanian Plain. The total concentrations of HCHs and DDTs ranged from 0.03 to 17.3 ng/g (geometric mean: GM = 0.05 ng/g), and 0.08-1231 ng/g (GM = 14.4 ng/g), respectively. In general, the concentration of OCPs in farmland and orchards was higher than on land used for non-agricultural purposes. There are significant differences in the concentration of OCPs in the soils across the region, more specifically, the Acerra-Marigliano conurbation (AMC) and Sarno River Basin (SRB) are recognized as severely OCP-contaminated areas. The recent application of technical HCHs and DDTs in large quantities appears unlikely in light of the ratio of α-HCH/β-HCH and p,p'-DDT/p,p'-DDE, and the prohibition of the use of these chemicals in Italy nearly forty years ago. The clear correlation between the concentration of DDTs and organic carbon suggests a typical secondary distribution pattern. The mass inventory of OCPs in soils of the Campanian Plain is estimated to have a GM of 17.3 metric tons. There is no clear evidence linking the impact of geographical distribution of OCPs on the incidence of cancer, and the 95% confidence interval of total incremental lifetime cancer risk (TILCR) data falls below the internationally accepted benchmark value of 1 × 10(-5)., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Purpose: The purpose of the present study was to assess the risk of femoral tunnel collisions between the medial collateral ligament (MCL) and the posterior cruciate ligament (PCL) tunnels during a simultaneous PCL and MCL reconstruction., Methods: Fourth generation medium and large synthetic femur bones were used. On each femur, a MCL tunnel and a PCL tunnel were reamed. The MCL tunnel was drilled at 0°, 20° and 40° of axial and coronal angulations. The PCL femoral tunnel was reamed to simulate two different tunnel directions that could be obtained through an inside-out and outside-in technique. Tunnels were filled with epoxy resin augmented with BaSO4, and a multidetector CT examination of each specimen was performed., Results: High rate of tunnel collision (62.5 %) was found when the MCL femoral tunnel was reamed with a coronal angulation of 0° and 20°. The rate of tunnel collision significantly decreased (0 %) when the MCL tunnel was reamed proximally with a coronal angulation of 40°. No differences were found between the two PCL tunnel directions in terms of tunnel collision., Conclusion: The results of this study can help surgeons to better direct the femoral MCL tunnel in order to avoid a collision between femoral tunnels during a combined MCL and PCL reconstruction. In order to minimize such potential complications, the MCL tunnel should be created limiting the axial angulation and it should be drilled with a proximal angulation from 20° to 40°, depending on the medial condyle width.

Fahr's syndrome, also known as "Bilateral Striopallidodentate Calcinosis" (BSPDC) primitive, is a rare neurological disease characterized by the presence of idiopathic, bilateral, symmetrical and abnormal deposition of calcium in areas of the brain that control movements including the basal ganglia, dentate nuclei of the cerebellum, nuclei of thalamus and semi-oval center. We describe a case of a 76-year-old male patient underwent reduction and fixation of a subtrochanteric fracture with intramedullary nail. During post-operative rehabilitation therapists's patient management was difficult due to obvious extrapyramidal symptoms characterized by dysarthria, rigidity, bradykinesia, postural instability. A CT scan, performed for the onset of stiffness and confusion before the operation, showed: IV ventricle eumorphic and in axis; expansion in atrophic sense of supratentorial ventricular system; bilateral, diffuse and coarse calcifications of the basal ganglia in the cerebellar and occipital cortex, elements compatible with Fahr's syndrome. The patient presented repeated postural instability episodes in the upright position, with loss balance tendency and recurrent falls. Fahr's syndrome patient is a "weak" patient, which requires a multi-disciplinary approach in order to prevent the mobility reduction, to improve the condition of postural instability, thus reducing the risk of fractures using preventive measures in domestic environment.

Introduction: Despite good clinical outcome proposals, there has been relatively little published regarding the use of non-metallic implant for patellar fracture fixation. The purpose of the study was to perform a systematic literature review to summarize and evaluate the clinical studies that described techniques for treating patella fractures using non-metallic implants., Methods: A comprehensive literature search was systematically performed to evaluate all studies included in the literature until November 2015. The following search terms were used: patellar fracture, patella suture, patella absorbable, patella screw, patella cerclage. Two investigators independently reviewed all abstracts and the selection of these abstracts was then performed based on inclusion and/or exclusion criteria., Results: A total of 9 studies involving 123 patients were included. Patients had a mean age of 33.7 years and were followed up for a mean of 18.9 months. The most common method for fracture fixations included the use of suture material. Good clinical outcomes were reported among all studies. Thirteen patients (10.5%) presented complications, while 4 patients (3.2%) required additional surgery for implant removal., Conclusion: There is a paucity of literature focused on the use of non-metallic implant for patellar fracture fixation. However, this systematic review showed that non-metallic implants are able to deliver good clinical outcomes reducing the rate of surgical complications and re-operation. These results may assist surgeons in choosing to use alternative material such as sutures to incorporate into their routine practice or to consider it, in order to reduce the rate of re-operation., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background : Infection remains among the main reasons for joint prosthesis failure. Preclinical reports have suggested that antibacterial coatings of implants may prevent bacterial adhesion and biofilm formation. This study presents the results of the first clinical trial on an antibiotic-loaded fast-resorbable hydrogel coating (Defensive Antibacterial Coating, DAC ® ) in patients undergoing hip or knee prosthesis. Methods: In this multicenter, randomized prospective study, a total of 380 patients, scheduled to undergo primary (n=270) or revision (n=110) total hip (N=298) or knee (N=82) joint replacement with a cementless or a hybrid implant, were randomly assigned, in six European orthopedic centers, to receive an implant either with the antibiotic-loaded DAC coating (treatment group) or without coating (control group). Pre- and postoperative assessment of clinical scores, wound healing, laboratory tests, and x-ray exams were performed at fixed time intervals. Results: Overall, 373 patients were available at a mean follow-up of 14.5 ± 5.5 months (range 6 to 24). On average, wound healing, laboratory and radiographic findings showed no significant difference between the two groups. Eleven early surgical site infections were observed in the control group and only one in the treatment group (6% vs. 0.6%; p=0.003). No local or systemic side effects related to the DAC hydrogel coating were observed, and no detectable interference with implant osteointegration was noted. Conclusions: The use of a fast-resorbable, antibiotic-loaded hydrogel implant coating can reduce the rate of early surgical site infections, without any detectable adverse events or side effects after hip or knee joint replacement with a cementless or hybrid implant., Competing Interests: Competing Interests: The authors have declared that no competing interest exists.

Background: Symptomatic hardware represents the most frequent complication reported following surgical treatment of patellar fracture. For this reason, some authors suggested using nonabsorbable sutures to fix the fracture with various techniques. The aim of this study was to evaluate clinical and radiological results of patients treated following a modified Pyriford technique using a FiberWire suture (Arthrex, Naples, FL, USA)., Materials and Methods: We retrospectively evaluated a case series of seventeen patients with displaced patellar fractures treated by open reduction and internal fixation with a modified tension band using FiberWire sutures. Clinical and radiological outcome were evaluated. Union time, complications, and reoperation rate were observed and recorded., Results: All fractures healed (time to union 9.2 ± 2 weeks), and no fixation failure was observed. Slight losses of reduction (<4 mm) were noted in two patients at 4 weeks postoperatively. The average Lysholm and Bostman scores at the final follow-up were 91 ± 5.7 (range 83-100) and 28.3 ± 1.6 (range 26-30), respectively., Conclusion: Modified tension band using FiberWire sutures showed satisfactory clinical results, with a low incidence of complications and reoperations. FiberWire tension bands could be used in place of metal-wire tension bands to treat patellar fracture, reducing the rate of symptomatic hardware., Level of Evidence: 4.

A vertical engineered barrier (VEB) coupled with a water treatment plant was surveyed in the framework of a vast remedial action at the brownfield site of the former ILVA of Bagnoli steel making facility located in western Naples, Italy. The VEB was put in place to minimize contaminant migration from the brownfield site toward the sea at the shorelines sites of Bagnoli and Coroglio. The efficiency of the VEB was monitored through 12 piezometers, 8 at the Bagnoli shoreline and 4 at the Coroglio shoreline. Concentrations of inorganic and organic pollutants were examined in upstream and downstream groundwater relative to the VEB. The mean levels of Al, As, Fe, and Mn largely exceeded the legal limits, 10-15-fold, whereas that of Hg was up to 3-fold the rules. The VEB decreased the outlet concentrations only at certain specific location of the barrier, four times for Al, 6-fold for Hg, and by 20% for Mn with means largely exceeding the rules. At the other sites, the downstream water showed marked increases of the pollutants up to 3-fold. Outstanding levels of the hydrocarbons > 12 were detected in the inlet water with means of some hundred times the limits at both sites. Likewise most of screened inorganic pollutants, the downstream water showed marked increases of the hydrocarbons up to ~113%. The treatment plant was very effective, with removal efficiencies >80% for As, Al, Fe, and Mn. The study evidenced the need to put alternative groundwater remedial actions.

Background: Reduction of tibial plateau fractures and maintain a level of well aligned congruent joint is key to a satisfactory clinical outcome and is important for the return to pre-trauma level of activity. Stable internal fixation support early mobility and weight bearing. The augmentation with bone graft substitute is often required to support the fixation to mantain reduction. For these reasons there has been development of novel bone graft substitutes for trauma applications and in particular synthetic materials based on calcium phosphates and/or apatite combined with calcium sulfates. Injectable bone substitutes can optimize the filling of irregular bone defects. The purpose of this study was to assess the potential of a novel injectable bone substitute CERAMENT™|BONE VOID FILLER in supporting the initial reduction and preserving alignment of the joint surface until fracture healing., Methods: From June 2010 through May 2011 adult patients presenting with acute, closed and unstable tibial plateau fractures which required both grafting and internal fixation, were included in a prospective study with percutaneous or open reduction and internal fixation (ORIF) augmented with an injectable ceramic biphasic bone substitute CERAMENT™|BONE VOID FILLER (BONESUPPORT™, Lund, Sweden) to fill residual voids. Clinical follow up was performed at 1, 3, 9 and 12 months and any subsequent year; including radiographic analysis and Rasmussen system for knee functional grading., Results: Twenty four patients, balanced male-to-female, with a mean age of 47 years, were included and followed with an average of 44 months (range 41-52 months). Both Schatzker and Müller classifications were used and was type II or 41-B3 in 7 patients, type III or 41-B2 in 12 patients, type IV or 41-C1 in 2 patients and type VI or 41-C3 in 3 patients, respectively. The joint alignement was satisfactory and manteined within a range of 2 mm, with an average of 1.18 mm. The mean Rasmussen knee function score was 26.5, with 14 patients having an excellent result and the remaining 10 with a good result., Conclusion: It can be concluded that radiological and clinical outcome was satisfactory and obtained in all cases without complications. This injectable novel biphasic hydroxyapatite and calcium sulfate ceramic material is a valuable armamentarium in the treatment of trauma where bone graft is required.

We studied the contamination level of the soils of the Sarno River basin in southwestern Italy by combined acute toxicity test with Dapnia magna and chemical extraction of polycyclic aromatic hydrocarbons (PAHs) and organochlorine pesticides (OCPs). For the ecotoxicological assessment, 188 samples were taken and coincided with those of a previous study (2013) where heavy metals were surveyed. For the organics assessment, 21 samples were selected nearby representative areas of elevated anthropic pressure. About 10.1 % of the samples showed noticeable sign of D. magna mortality, 61-100 %, and fall along the potentially floatable areas of Sarno and Solofrana basins with high degree of contamination by Cr, As, Zn, and Hg. High levels of ecotoxicity, 61-100 %, were determined in the lower Sarno River basin in areas of moderate or low degree of contamination by Cd, Cu Hg, Pb, Sb, Sn, and Zn. Benzo(a)pyrene, indenopyrene, and benzo(g,h,i)perylene were present at concentrations of 0.32, 0.23, and 0.18 mg kg(-1), respectively, 2- to 3-fold the law limits with most of the samples falling nearby the points where the ecotoxicity output was close to 100 %. Among OCPs, pp'-DDT had a mean of 0.225 mg kg(-1) and hence about more than 200- and 2-fold the residential, 0.01 mg kg(-1), and commercial/industrial limits, 0.1 mg kg(-1) and determined mainly in the central Sarno valley in an area where elevated concentrations of benzopyrene and D. magna mortality were also observed. The study evidenced the high rate of contamination by PAHs and OCPs of the soils and the need of urgent remediation actions.

Dislocations of a total knee arthroplasty (TKA) are an uncommon injury and only few cases of anterior dislocations have been reported. We report a rare case of anterior dislocation of a 10-year-old posterior stabilized total knee arthroplasty in a 74-year-old woman. The patient was successfully treated by close reduction of the dislocation followed by immobilization in full extension with a long leg cast. Because of a high risk of neurovascular complications, a high index of suspicion for vascular injury must be maintained. For this reason, a proper diagnosis is required and immediate reduction is recommended.

Purpose: A suture passed along the part of the graft that will be inserted into the femoral tunnel is widely used by surgeons, because it could prevent the graft sliding on the femoral fixation device during pulling from the tibial side. The aim of this study was to evaluate the biomechanical effects of suturing the intratunnel femoral part of the graft during an anterior cruciate ligament (ACL) reconstruction., Methods: Bovine digital extensor tendons and tibias were harvested from 20 fresh-frozen mature bovine knees ranging in age from 18 to 24 months. Quadruple-strand bovine tendons were passed through the tibial tunnel and secured distally with a bioabsorbable interference screw. In one half of all grafts (N = 10), the looped-over part of the graft was sutured in a whipstitch technique over a distance of 30 mm (Group 1). In one half of all grafts (N = 10), the looped-over part was left free from any suture (Group 2). The grafts were preconditioned at 50 N for 10 min, followed by cyclic loading at 1 Hz between 50 N and 250 N for 1,000 cycles. Load-to-failure test was then carried out at a rate of 1 mm/s., Results: There was no statistically significant difference between mean stiffness at pullout and yield load between the two groups. In all specimens on Group 1, failure occurred following to partial breaking and then slipping of the tendons between the screw and the tunnel. Concerning Group 2, in six cases failure occurred as described for Group 1 specimens. In the remaining four cases, failure occurred entirely through the ligament mid-substance., Conclusions: Suturing in a whipstitch fashion the femoral portion of the graft doesn't affect the mechanical proprieties of the ACL graft. When suspension fixation device is used, suturing the looped-over part of the graft could be helpful in order to provide equal tension in all of the strands of the graft at time of tibial fixation.

Introduction: Osteoarthritis (OA) is considered to be a multifactorial and polygenic disease and diagnosis is mainly clinical and radiological. Correlation between radiographic data and clinical status has been reported. However, very few studies, especially in Caucasian people, describe the association between the Kellgren and Lawrence OA grading scale (KL) and genetic alterations to better understand OA etiopathogenesis and susceptibility. In order to update the knee OA grading, in this study we assessed the associations between KL grade, clinical features such as American Knee Society Score (AKSS), age, and polymorphisms in the principal osteoarthritis susceptibility (OS) genes in Sicilian individuals., Methods: In 66 Sicilian individuals affected by primary knee OA, the clinical and radiographic evaluation was performed using 2 sub-scores of AKSS (knee score (KS) and function score (FS)) and KL. The patients were also classified according to age. Online Mendelian Inheritance in Man (OMIM) and Database of Single Nucleotide Polymorphisms (dbSNP) Short Genetic Variations databases were used to select gene regions containing the following polymorphisms to analyze: FRZB rs288326 and rs7775, MATN3 rs77245812, ASPN D14 repeats, PTHR2 rs76758470, GDF5 rs143383 and DVWA rs11718863. Patient genotypes were obtained using Sanger DNA sequencing analysis., Results: In our cohort of patients a statistical association between the variables analyzed was reported in all associations tested (KL versus KS, FS and age). We observed that a mild to severe OA radiographic grade is related to severe clinical conditions and loss of articular function and that the severity of symptoms increases with age. Concerning the genotyping analysis, our results revealed a significant statistical association between KL grading and GDF5 rs143383 and DVWA rs11718863 genetic alterations. The latter was also associated with a more severe radiographic grade, displaying its predictive role as OA marker progression. Statistically significant association between clinical, radiographic and genetic signs observed, suggests extending the actual grading of knee OA based mainly on X-ray features., Conclusions: This work represents a multidisciplinary and translational medicine approach to study OA where clinical, radiological, and OS5 and OS6 SNPs evaluation could contribute to better define grading and progression of OA and to the development of new therapies.

Two olive mill wastewaters (OMW) samples, OMWa and OMWb, containing different polyphenolic loads were used for decontaminating an unauthorized dump site in the Campania region, south Italy. In a bench-scale experiment, OMWa at pH 6.0 (OMWapH6.0) and 4.7 (OMWapH4.7), OMWb at pH 4.7 (OMWbpH4.7) and OMWa free of the polyphenolic moiety polyphenol-free OMWa (PF-OMWa) were added to the soil for a 96 h contact time. At 96 h, OMWapH4.7 was more effective than OMWapH6.0, with Cd, Cu, Pb and Zn removal percentages of 30.7-68.1. Cd and Pb levels were 6.0 and 915 mg kg(-1), respectively, decreasing below the regulatory limits for industrial and commercial areas (15.0 and 1 × 10(3) mg kg(-1), respectively). A threefold decrease in Zn levels was also observed from 13.5 × 10(3) to 4.3 × 10(3) mg kg(-1). The metal removal efficiency of PF-OMWa dropped from 30.7 % to 15.6 % for Cd and from 37.9 % to 1.3 % for Pb. OMWbpH4.7 at 96 h was more efficient than OMWapH4.7, with mean removal percentages of 32.5 versus 7.8, respectively.

Background: Symptomatic severe osteoarthritis and hip osteoporotic fractures are the main conditions requiring total hip arthroplasty (THA), whereas total knee arthroplasty (TKA) is mainly performed for pain, disability or deformity due to osteoarthritis. After surgery, some patients suffer from "painful prosthesis", which currently represents a clinical problem., Methods: A systematic review of scientific literature has been performed. A panel of experts has examined the issue of persistent pain following total hip or knee arthroplasty, in order to characterize etiopathological mechanisms and define how to cope with this condition., Results: Four major categories (non infective, septic, other and idiopathic causes) have been identified as possible origin of persistent pain after total joint arthroplasty (TJA). Time to surgery, pain level and function impairment before surgical intervention, mechanical stress following prosthesis implant, osseointegration deficiency, and post-traumatic or allergic inflammatory response are all factors playing an important role in causing persistent pain after joint arthroplasty. Diagnosis of persistent pain should be made in case of post-operative pain (self-reported as VAS ≥3) persisting for at least 4 months after surgery, or new onset of pain (VAS ≥3) after the first 4 months, lasting ≥2 months. Acute pain reported as VAS score ≥7 in patients who underwent TJA should be always immediately investigated., Conclusions: The cause of pain needs always to be indentified and removed whenever possible. Implant revision is indicated only when septic or aseptic loosening is diagnosed. Current evidence has shown that peri-and/or post-operative administration of bisphosphonates may have a role in pain management and periprosthetic bone loss prevention.

The long-term variability of total Cu content from fungicides applied in a certified wine region of Spain (La Rioja) and of other metals (Cd, Cr, Ni, Pb, and Zn) was evaluated in three young vineyard soils and subsoils unamended and amended with spent mushroom substrates (SMS) over a 3-year period (2006-2008). SMS is a promising agricultural residue as an amendment to increase the soil organic matter content but may modify the behaviour of metals from pesticide utilisation in vineyards. Fresh and composted SMS was applied each year at a rate of 25 t ha(-1) (dry-weight). Copper concentrations in the three unamended soils were 21.2-88.5, 25.5-77.1, and 29.4-78.4 mg kg(-1). They exceeded natural Cu concentrations of the region and reference sub-lethal hazardous concentration for soil organism. The concentrations of Cd, Ni, Pb, and Zn were largely below the sub-lethal limits. Thus, although Cu levels were lower than those of established vineyards, vine performance, and productivity might be affected. The variation in behaviour between different amendments for each soil was high, so a generic conclusion could not be drawn. The amendment practice seemed to have caused temporarily Cu mobilization respect to untreated soils. Total zinc concentrations fall within the range of the natural soil of La Rioja and were significantly affected (p < 0.05) especially by fresh state SMS addition, with increasing up to 75% respect to untreated specimen. The results indicated a build-up of fresh sites for metal retention at both surface and subsurface level, although no accumulation of metals was observed in the short-term period. However, the benefit for soils and the negative effects need to be monitored in the long run.

Purpose: The purpose of this study was to evaluate the risk of tunnel collisions of the fibular collateral ligament (FCL) and posterolateral bundle anterior cruciate ligament (PLB-ACL) tunnels during a combined FCL and double-dundle (DB) ACL reconstruction., Methods: Thirty-six 4th-generation synthetic femurs (Sawbones, Pacific Research Laboratories, Vashon, WA) were utilized, and two different femur sizes were used. A FCL tunnel and a PLB-ACL tunnel were reamed on each femur. The tunnels of synthetic specimens that did not have a collision were filled with an epoxy resin augmented with BaSO(4) and radiographic evaluation, and Multidetector CT exams of the specimens were performed., Results: The rate of tunnel collision when the FCL tunnel was reamed to a depth of 30 mm was 75 and 69.4% for the 25 mm depth. There was a significantly increased risk of tunnel collision when the FCL tunnel was reamed proximally with coronal angulations of 20° and 40°. No collisions were noted when the FCL tunnel was reamed parallel to the distal condylar line and with axial angulations of 20° and 40°., Conclusion: This study provides new insight into tunnel positioning during a combined FCL and DB-ACL reconstruction. The results show that a concomitant FCL injury do not represent a contraindication to perform a DB-ACL reconstruction as long as the FCL tunnel is reamed with no proximal angulation and is directed anteriorly with an axial angulation between 20° and 40°.

Background: Fractures of the distal extremity of the radius are the most common bone lesions of the superior extremity of the body, representing 17% of the fractures treated in First Aid facilities. The restoration of anatomical relationships in the radiocarpal joint is considered to be a prerequisite for good functional recovery. There are numerous methods of treatment of these fractures. The Epibloc system is a percutaneous endomedullary synthesis alternative to the plaster cast in wrist fracture treatment., Materials and Methods: The authors describe their experience with 81 fractures (63 type A2-3 fractures and 18 type C1) of the wrist treated with the Epibloc System (ES). The results were evaluated clinically, functionally and radiographically on the 7th, 14th, 35th, 90th day. The Gartland and Werley score modified by Sarmiento was used for the functional assessment of the wrist injuries, Results: Twenty-nine patients (35.8%) had excellent results, 43 (53.1%) had good results. Forty-seven of the patients (58%) had a ROM of 100% of normal, with a dorsiflexion-palmar flexion (DF-PF) arc of 120 degrees or more. Seven (8.6 %) of the patients developed Sudeck's osteodystrophy. A "very moderate" or "moderate" malunion was observed in 19 cases (23.4%, Conclusion: 1. The ES is a surgical technique for the treatment of numerous wrist fractures. These fractures can result in excellent mobility as well as a low rate of complications and secondary loss of reduction. 2. This method enables early functional recovery with low incidence of rigidity and algodystrophy. 3. This technique is best indicated for AO type A2-3 and type C1. 4. The ES is inadequate for patients with severe osteopaenia and markedly comminuted intra-articular fractures.

High energy trauma is often responsible for acute bleeding. Long bone and pelvis fractures are correlated with increased blood loss. Hypovolaemia could become a life threatening complication especially in elderly patients because of the reduced physiological response. Furthermore it could compromise the course of associated morbidities. Haemorrage is also associated in both comminuted fractures and osteoporosis. An increased intraoperative bleeding often occurs when a prolonged surgical time is required to obtain an appropriate ostheosynthesis. The final consequence of a mayor bleeding is hypovolaemic shock. The reduced oxygen tension of the tissue may be responsible for heart attack, arrhythmia, stroke, multi organ deficiency. For these reasons, it is important to immediately recognize and correct all potential bleeding in order to avoid complications.

Background: Isolated posterolateral corner (PLC) tears are relatively rare events. Various surgical techniques to treat posterolateral knee instability have been described; because surgical results are linked to cruciate reconstructions it has been difficult to date to define whether one surgical procedure has better prognosis than another. The goal of this study is to determine the clinical outcome of PLC reconstruction following fibular-based technique., Materials and Methods: We retrospectively evaluated a case series of patients who received isolated PLC reconstruction between March 2005 and January 2007. Ten patients were surgically treated for isolated injuries and were available for follow-up; average patient age was 27.4 years (range 16-47 years). All patients were treated following the fibular-based technique: double femoral tunnel was performed in six patients, while in the remaining four patients, the reconstruction of the PLC was performed with a single femoral tunnel. Six patients had semitendinosus allograft and four had semitendinosus autograft. All patients had the same evaluation and the same rehabilitation protocol., Results: Mean follow-up was 27.5 months (range 18-40 months). Mean range of motion (ROM) was 143.5 degrees for flexion (range 135-150 degrees) and 0.5 degrees for extension (range 0-3 degrees). Three patients showed 1+ on varus stress test, while on Dial test another three patients showed 10 degrees reduction of external rotation compared with contralateral knee. The average Lysholm score was 94 points (range 83-100), and the mean International Knee Documentation Committee (IKDC) subjective result was 88.48 (range 74-96.5). Based on Lysholm score, the results were excellent in eight knees and good in two knees. On IKDC evaluation, two patients were grade A and eight were grade B. No significant difference in clinical results was observed between single and double femoral tunnel., Conclusion: Fibular-based technique showed good results in terms of clinical outcome, restoring varus and rotation stability of knees in treatment of chronic isolated PLC injury.

Introduction: We aimed to assess the incidence and hospitalization rate of hip and "minor" fragility fractures in the Italian population., Methods: We carried out a 3-year survey at 10 major Italian emergency departments to evaluate the hospitalization rate of hip, forearm, humeral, ankle, and vertebral fragility fractures in people 45 years or older between 2004 and 2006, both men and women. These data were compared with those recorded in the national hospitalizations database (SDO) to assess the overall incidence of fragility fractures occurring at hip and other sites, including also those events not resulting in hospital admissions., Results: We observed 29,017 fractures across 3 years, with hospitalization rates of 93.0% for hip fractures, 36.3% for humeral fractures, 31.3% for ankle fractures, 22.6% for forearm/wrist fractures, and 27.6% for clinical vertebral fractures. According to the analyses performed with the Italian hospitalization database in year 2006, we estimated an annual incidence of 87,000 hip, 48,000 humeral, 36,000 ankle, 85,000 wrist, and 155,000 vertebral fragility fractures in people aged 45 years or older (thus resulting in almost 410,000 new fractures per year). Clinical vertebral fractures were recorded in 47,000 events per year., Conclusions: The burden of fragility fractures in the Italian population is very high and calls for effective preventive strategies.

Rapid and inexpensive phytotoxicity bioassays for winery wastewater (WW) are important when designing winery wastewater treatment systems involving constructed wetlands. Three macrophyte wetland species (Phragmites australis, Schoenoplectus validus and Juncus ingens) were tested using a pot experiment simulating a wetland microcosm. The winery wastewater concentration was varied (0.5%, 5%, 10%, 25%, 50%, 75% and 100%) and pH was corrected for some concentrations using lime as an amendment. The tolerance of the three aquatic macrophytes species to winery wastewater was studied through biomass production, total chlorophyll and nitrogen, phosphorous and potassium tissue concentrations. The results showed that at greater than 25% wastewater concentration all the macrophytes died and that Phragmites was the least hardy species. At less than 25% wastewater concentration the wetland microcosms were effective in reducing chemical oxygen demand, phenols and total soluble solids. We also evaluated the performance of two laboratory phytotoxicity assays; (1) Garden Cress (Lepidium sativum), and (2) Onion (Allium coepa). The results of these tests revealed that the effluent was highly toxic with effective concentration, EC(50), inhibition values, as low as 0.25%. Liming the WW increased the EC(50) by 10 fold. Comparing the cress and onion bioassays with the wetland microcosm results indicated that the thresholds for toxicity were of the same order of magnitude. As such we suggest that the onion and cress bioassays could be effectively used in the wine industry for rapid wastewater toxicity assessment.

A subtalar dislocation of the foot is an uncommon injury, and cases of posterior subtalar dislocation are even rarer. This injury is characterized by a simultaneous dislocation of talocalcaneal and talonavicular joints while tibiotalar and calcaneocuboid articulations remain intact. Subtalar dislocation is commonly accompanied by fractures of the malleoli, talus, or fifth metatarsal and by a rotational component of the subtalar joint. Subtalar dislocation can occur in any direction and produces significant deformity. This article presents a case of pure posterior subtalar dislocation in an 80-year-old man who presented with pain and deformity in his left ankle following a motorcycle accident. Radiographs demonstrated dislocation of both the talonavicular and talocalcaneal joints. The calcaneus was displaced posteriorly without medial or lateral displacement. No rotational component of the calcaneus was noted, suggesting the trauma was in pure hyperplantar flexion. We hypothesize that pure hyperplantar flexion could lead to a progressive subtalar ligament weakening that may result in a complete ligament rupture if the plantar flexion force is prolonged. This could be observed in the presence of good bone quality and if the force is applied distally at the navicular bone.

Luxatio erecta is an uncommon form of glenohumeral dislocation. Cases of bilateral inferior shoulder dislocation (luxatio erecta) are very rare, and only ten cases have been described in literature. We describe a case of a woman with bilateral luxatio erecta of the shoulders treated with close reduction, immobilization and rehabilitation. The patient had fallen downstairs while clinging to both lateral banisters.

A pilot-scale winery wastewater treatment system was developed to treat wastewater produced by a small winery (approximately 1200 metric tons of grapes crushed). The pilot system consisted of a sedimentation/aerobic process combined with a bioremediation wastewater cell planted with Juncus ingens. The main design specifications, detailed descriptions of the plant, and analysis of the influent and effluent characteristics (pH, electrical conductivity, total suspended solids, chemical oxygen demand [COD], etc.) are reported for each segment of the system. Over the study period, the mean winery wastewater flowrate was 3.5 m3/d at organic loads of 5000 to 14 000 mg-COD/L. The study measured average removal rates of 72% for COD and 65% for total organic carbon and dissolved carbon. The application of wastewater to the soil increased the soil salinity in the top 30 cm, but remained stable below this. The system also seemed to be effective at neutralizing the pH of the acidic winery wastewater and at removing the phosphorus pool (65%) in the wastewater, whereas the levels of nitrogen and most of the cations increased in the treated effluent. The absorbing/adsorbing and degradation capacity of the soil of the wastewater bioremediation cell did not appear to be exhausted after one vintage. Juncus ingens appeared to grow moderately well, until the end of the vintage, when dieback began to occur. An infilling with organic matter of the surface soil layer under the root zone was observed, which reduced water infiltration and hence system treatment capacity. The data provide evidence that this is a potentially effective wastewater treatment approach for small wineries located in rural areas.

The 5-day biological oxygen demand (BOD(5)) remains a key indicator for proof of compliance with environmental regulators in the monitoring and management of winery effluent. Inter-conversion factors from alternative tests that are more rapid, accurate and simpler to perform have been determined that allow prediction of BOD(5) in winery wastewaters, generally, and at different stages of production and treatment. Mean values obtained from this dataset offer rule of thumb inter-conversion factors: BOD(5) = 0.7 Chemical Oxygen Demand (COD), BOD(5) = 2.3 Total Organic Carbon (TOC) and BOD(5) = 2.7 Dissolved Organic Carbon (DOC). Specific predictive linear relationships are also provided. Out of the relationships between BOD(5) vs COD, TOC and DOC, in winery wastewater, irrespective of vintage or non-vintage production periods and stage of treatment, TOC offered the most reliable prediction of BOD(5). Ethanol, glucose and fructose were evaluated in untreated wastewater as predictors of BOD(5) due to their high specificity in winery effluent. A significant relationship was determined between BOD(5) and (ethanol + glucose + fructose; R(2) = 0.64, n = 19; p<0.05), but relationships between BOD(5) and ethanol and BOD(5) vs (glucose + fructose) were weak (R(2) = 0.45 and 0.34; n = 19; p<0.05 respectively,). There was a very strong linear correlation (y = 0.9767x + 52.8; R(2) = 0.97; n = 23; p<0.05) in COD data in winery effluents when using a commercially available mercury free test kit compared with using a traditional COD test kit that contained mercury. This suggests that mercury free COD test kits could be used by the wine industry for organic pollution assessment with associated reductions to user and environmental risk, as well as reducing the costs of kit waste disposal.

Previous studies indicate that Cucurbita pepo can phytoextract highly weathered persistent organic pollutants (POPs) from soil and translocate large quantities to aerial tissues. To investigate intraspecific variability in uptake potential, a field study was conducted to quantify the phytoextraction of weathered p,p'-DDE by 21 cultivar varieties of summer squash from two distinct subspecies, C. pepo ssp texana and C. pepo ssp pepo. Significant differences exist between the two subspecies, with average root and stem to soil bioconcentration factors (BCF, dry weight ratio of contaminant concentration in the vegetation to that in the soil) of 7.22 and 5.40 for ssp pepo and of 2.37 and 0.454 for spp texana, respectively. The amounts of weathered p,p-DDE extracted from the soil by ssp pepo and ssp texana were 0.301 and 0.065%, respectively, with maximum values within each subspecies of 0.780 and 0.182%, respectively. The quantities of 14 inorganic elements were determined in both the soil and tissues (roots, stems, leaves, and fruit) of all 21 cultivar varieties. Phosphorus concentrations in the tissues of ssp pepo were 14 (fruit)-73% (stems) greater than those of ssp texana. These data support our hypothesis that the unique ability of certain cultivars of C. pepo to phytoextract highly weathered POPs from soil is the result of low molecular weight organic acid exudation as a unique phosphorus acquisition mechanism.