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Purpose: Necrotizing fasciitis (NF) is a rare, but rapidly progressing bacterial infection of the subcutaneous tissues and muscular fascia with high rates of morbidity and mortality. Our study aims to determine if socioeconomic status (SES) is a predictor of outcomes in NF., Methods: A retrospective review was conducted of patients diagnosed with NF at our institution. Demographic information, insurance status, medical and surgical history, vitals, ASA score, blood laboratory values, surgical procedure information, and outcomes prior to patient discharge were collected. Patient zip codes were utilized to obtain median household incomes at the time of the patient's surgical procedure to determine SES. Patients without complete data in their medical record were excluded. Initial descriptive statistics and logistic regression models were performed., Results: We identified 196 patients (mean age 50.13 ± 13.03 years, 31.6% female) for inclusion. Mortality rate was 15.3% (n = 30) and 33.7% (n = 66) underwent amputation. Mortality rate was not significantly different across income brackets. Lower income brackets had higher rates of amputation than higher income brackets (p < 0.05). A logistic regression models showed the rate of amputation decreases by 29% for every $10,000 increment in median household income and ASA score decreased by 0.15 units for every $10,000 increase in median household income., Conclusions: Amputation rates in cases of NF are significantly higher in lower SES groups than higher SES groups. Patients with perivascular disease in lower SES groups were more likely to experience serious complications of NF than their counterparts in higher SES groups., (© 2024. The Author(s) under exclusive licence to SICOT aisbl.)

This study investigated the in vitro bioaccessibility of aluminum, copper, iron, manganese, lead, selenium, and zinc in three important species of farmed insects: the yellow mealworm (Tenebrio molitor), the house cricket (Acheta domesticus) and the migratory locust (Locusta migratoria). Results show that all three insect species constitute excellent sources of essential elements (Fe, Cu and Zn) for the human diet, contributing to the recommended dietary allowance, i.e., 10%, 50%, and 92%, respectively. A higher accumulation of Se (≥1.4 mg Se/kg) was observed with increasing exposure concentration in A. domesticus, showing the possibility of using insects as a supplements for this element. The presence of Al and Fe nanoparticles was confirmed in all three species using single particle-inductively coupled plasma-mass spectrometry and transmission electron microscopy. The results also indicate that Fe bioaccessibility declines with increasing Fe-nanoparticle concentration. These findings contribute to increase the nutritional and toxicological insights of farmed insects., 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 © 2024. Published by Elsevier Ltd.)

Stress fractures of the upper extremity are reported less often than their lower extremity counterpart. This review aims to provide a comprehensive overview of an important and often missed diagnosis in pediatric athletes: hand and wrist stress fractures., 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 Elsevier Ltd. All rights reserved.)

This study utilizes wastewater-based epidemiology (WBE) to evaluate spatiotemporal changes in the consumption of antidepressants before and during the COVID-19 pandemic in Slovenia. Composite 24-h influent wastewater samples (n = 210) were collected from six wastewater treatment plants between summer 2019 and spring 2021. The samples were extracted using 96-well solid-phase extraction and analysed by liquid chromatography-tandem mass spectrometry. The measured concentrations of target antidepressant biomarkers were then converted to population-normalised mass loads (PNMLs), taking into account flow rate and catchment population. Ten biomarkers, including amitriptyline, bupropion, bupropion-OH, citalopram, norcitalopram, normirtazapine, venlafaxine, O-desmethylvenlafaxine, trazodone, and moclobemide, were above the lower limit of quantification and were included in the spatiotemporal temporal assessment. The highest PNMLs were detected for O-desmethylvenlafaxine (mean ± SD: 82.1 ± 21.2 mg/day/1000 inhabitants) and venlafaxine (38.0 ± 10.6 mg/day/1000 inhabitants), followed by citalopram (27.0 ± 10.7 mg/day/1000 inhabitants). In addition, the mean metabolite/parent compound ratios were comparable with other WBE studies indicating consumption rather than direct disposal. Overall, the results indicated significant spatiotemporal variations depending on the location, and the PNMLs of most biomarkers increased during the first wave of the COVID-19 pandemic (spring of 2020). However, no clear spatial patterns were revealed related to the pandemic., 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 B.V. All rights reserved.)

Drug (ab)use among young people is a serious issue, negatively impacting their well-being and prospects. The emergence of new psychoactive substances (NPS) further complicates the situation as they are easily accessible (e.g., online), but users are at high risk of intoxication as their chemical identity is often unknown and toxicity poorly understood. While surveys and drug testing are traditionally used in educational institutions to comprehend drug use trends and establish effective prevention programs, they are not without their limitations. Accordingly, we investigated the occurrence of NPS in educational institutions through wastewater analysis and critically evaluated the viability of the approach. The study included eight wastewater samples from primary schools (ages 6-15 years), six from secondary schools (ages 15-19 years), three from institutions for both secondary and higher education (ages 15+), and six from higher educational institutions (ages 19+). Samples were obtained mid-week and evaluated in two Slovenian municipalities; the capital Ljubljana and a smaller one (M1). Samples were screened using liquid chromatography-ion mobility-high-resolution mass spectrometry (LC-IMS-HRMS), and NPS identified at three levels of confidence (Level 1: unequivocal, Level 2: probable, Level 3: tentative) from a suspect list containing over 5600 entries. NPS were identified in all types of educational institutions. Most were synthetic stimulants, with 3-MMC, ephedrine, 4-chloro-α-PPP, and ethcathinone being unequivocally identified. Also, NPS were present in wastewater from all educational institution types revealing potential spatial but no inter-institutional trends. Although specific groups cannot be targeted, the study, as a proof-of-concept, demonstrates that a suspect screening of wastewater employing LC-IMS-HRMS can be used as a radar for NPS in educational institutions and potentially replace invasive drug testing., 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.)

This study investigated the occurrence and potential sources of residues of drugs of abuse in an urban aquifer beneath the City of Ljubljana using water analysis and a solute transport model designed to predict nitrogen distribution. Samples were collected from three sources: 28 wastewater samples (24-h composites), 4 aquifer-recharging river samples (grab), and 22 groundwater samples. The samples were analysed for residues of commonly (ab)used licit drugs (nicotine and alcohol), medications of abuse (morphine, methadone, codeine, and ketamine), and illicit drugs (tetrahydrocannabinol - THC, cocaine, amphetamines, and heroin) using liquid-liquid (alcohol residue) and solid-phase extraction, followed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Additionally, we used solute transport modelling to predict the spatial distribution of drug residues in the aquifer and their potential sources. Nicotine (up to 45,7 ng/L), cotinine (up to 5.86 ng/L), trans-3'-hydroxycotinine (up to 0.528 ng/L) and benzoylecgonine (up to 0.572 ng/L) were the most commonly detected drug residues in groundwater, followed by cocaine (

Bisphenols are widely recognised as toxic compounds that potentially threaten the environment and public health. Here we report the use of cold atmospheric pressure plasma (CAP) to remove bisphenol A (BPA) and bisphenol S (BPS) from aqueous systems. Additionally, methanol was added as a radical scavenger to simulate environmental conditions. After 480 s of plasma treatment, 15-25 % of BPA remained, compared to > 80 % of BPS, with BPA being removed faster (-k t = 3.4 ms -1 , half-life = 210 s) than BPS (-k t = 0.15 ms -1 , half-life 4700 s). The characterisation of plasma species showed that adding a radical scavenger affects the formation of reactive oxygen and nitrogen species, resulting in a lower amount of ˙OH, H 2 O 2 , and NO 2 - but a similar amount of NO 3 - . In addition, a non-target approach enabled the elucidation of 11 BPA and five BPS transformation products. From this data, transformation pathways were proposed for both compounds, indicating nitrification with further cleavage, demethylation, and carboxylation, and the coupling of smaller bisphenol intermediates. The toxicological characterisation of the in vitro HepG2 cell model has shown that the mixture of transformation products formed during CAP is less toxic than BPA and BPS, indicating that CAP is effective in safely degrading bisphenols., 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. Published by Elsevier B.V.)

This study investigated the bio-degradation kinetics of tetramethyl bisphenol F (TMBPF), a non-estrogenic alternative to bisphenol A (BPA). Batch biotransformation experiments were performed whereby samples were inoculated with activated sludge and analysed using liquid chromatography-Orbitrap-tandem mass spectrometry (LC-Orbitrap-MS) utilising two non-targeted workflows (commercial and freely available online) for biotransformation products (BTP) identification. The degradation of TMBPF followed single first-order reaction kinetics and depended on the initial concentration (c i ) with faster degradation -k t  = 0.16, (half-life = 4.4 days) at lower concentrations c i  = 0.1 mg L -1 , compared with -k t  = 0.02 (half-live = 36.4 days) at c i  = 10.0 mg L -1 . After 18 days, only 8% of the original TMBPF remained at the lowest tested concentration (0.1 mg L -1 ). Twelve BTPs were identified, three of which were workflow and one condition-specific. The highest relative quantities of BTPs were observed in nutrient-mineral and mineral media after ten days, while after 14 days, 36 and 31% of TMBPF (c i  = 1 mg L -1 ) remained in the nutrient-mineral and mineral media, respectively. Also, the kinetics of TMBPF and its BTPs were the same with and without an additional carbon source. A newly proposed biodegradation pathway for TMBPF involves cleavage of the methylene bridge, hydroxylation with further oxidation, sulphation, nitrification, nitro reduction with further oxidation, acetylation, and glycine conjugation, providing a deeper insight into the fate of TMBPF during biological wastewater treatment., 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.)

As population growth and climate change add to the problem of water scarcity in many regions, the argument for using treated wastewater for irrigation is becoming increasingly compelling, which makes understanding the risks associated with the uptake of harmful chemicals by crops crucial. In this study, the uptake of 14 chemicals of emerging concern (CECs) and 27 potentially toxic elements (PTEs) was studied in tomatoes grown in soil-less (hydroponically) and soil (lysimeters) media irrigated with potable and treated wastewater using LC-MS/MS and ICP-MS. Bisphenol S, 2,4 bisphenol F, and naproxen were detected in fruits irrigated with spiked potable water and wastewater under both conditions, with BPS having the highest concentration (0.034-0.134 µg kg -1 f. w.). The levels of all three compounds were statistically more significant in tomatoes grown hydroponically (-1 f. w.) than in soil (-1 f. w.). Their elemental composition shows differences between tomatoes grown hydroponically or in soil and tomatoes irrigated with wastewater and potable water. Contaminants at determined levels showed low dietary chronic exposure. When the health-based guidance values for the studied CECs are determined, results from this study will be helpful for risk assessors., 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 B.V. All rights reserved.)

Reduced carbon monoxide diffusing capacity (DL CO ) is common after recovery from severe COVID-19 pneumonitis. The extent to which this relates to alveolar membrane dysfunction as opposed to vascular injury is uncertain. Simultaneous measurement of nitric oxide diffusing capacity (DL NO ) and DL CO can partition gas diffusion into its two components: alveolar-capillary membrane conductance (D mCO ) and capillary blood volume (V C ). We sought to evaluate D mCO and V C in the early and later recovery periods after severe COVID-19. Patients attended for post-COVID-19 clinical review and lung function testing including DL NO /DL CO . Repeat testing occurred when indicated and comparisons made using t-tests. Forty-nine (eight female) subjects (mean ± SD age: 58 ± 13, BMI: 34 ± 8) who had severe COVID-19 pneumonitis, WHO severity classification of 6 ± 1, and prolonged (21 ± 22 days) hospital stay, were assessed 2 months (61 ± 35 days) post discharge. DL CO adj (z-score -1.70 ± 1.49, 25/49 < lower limit of normal [LLN]) and total lung capacity (z-score -1.71 ± 1.30) were both reduced. D mCO and V C and were reduced to a similar extent (z-score -1.19 ± 1.05 and -1.41 ± 1.20, p = 0.4). Seventeen (one female) patients returned for repeat testing 4 months (122 ± 61 days) post discharge. In this subgroup with more impaired lung function, DL CO adj improved but remained below LLN (z-score -3.15 ± 0.83 vs. -2.39 ± 0.86, p = 0.01), 5/17 improved to >LNN. D mCO improved (z-score -2.05 ± 0.89 vs. -1.41 ± 0.78, p = 0.01) but V C was unchanged (z-score -2.51 ± 0.55 vs. -2.29 ± 0.59, p = 0.16). Alveolar membrane conductance is abnormal in the earlier recovery phase following severe COVID-19 but significantly improves. In contrast, reduced V C persists. These data raise the possibility that persisting effects of acute vascular injury may contribute to gas diffusion impairment long after severe COVID-19 pneumonitis., (© 2023 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)

Continuous consumption combined with incomplete removal during wastewater treatment means residues of psychoactive substances (licit drugs, medications of abuse and illicit drugs) are constantly introduced into the aquatic environment, where they have the potential to affect non-target organisms. In this study, 17 drug residues of psychoactive substances were determined in wastewater influent, effluent and in receiving rivers of six Slovene municipal wastewater treatment plants employing different treatment technologies. Variations in removal efficiencies (REs) during spring, summer and winter were explored, and ecotoxic effects were evaluated using in silico (Ecological Structure-Activity Relationships software-ECOSAR) and in vivo (algal growth inhibition test) methods. Drug residues were detected in influent and effluent in the ng/L to μg/L range. In receiving rivers, biomarkers were in the ng/L range, and there was good agreement between measured and predicted concentrations. On average, REs were highest for nicotine, 11-nor-9-carboxy-∆9-tetrahydrocannabinol (THC-COOH), cocaine residues, and amphetamine (>90 %) and lowest for methadone residues (<30 %). REs were comparable between treatments involving activated sludge and membrane bioreactors, while the moving biofilm bed reactor (MBBR) removed cotinine, cocaine, and benzoylecgonine to a lesser extent. Accordingly, higher levels of nicotine and cocaine residues were detected in river water receiving MBBR discharge. Although there were seasonal variations in REs and levels of drug residues in receiving rivers, no general pattern could be observed. No significant inhibition of algal growth (Chlamydomonas reinhardtii) was observed for the tested compounds (1 mg/L) during 72 h and 240 h of exposure, although effects on aquatic plants were predicted in silico. In addition, environmental risk assessment revealed that levels of nicotine, methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), morphine, and 3,4-methylenedioxymethamphetamine (MDMA) pose a risk to aquatic organisms. Since nicotine and EDDP can have acute and chronic effects, the authors support regular monitoring of receiving surface waters, followed up by regulatory actions., 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 B.V. All rights reserved.)

Developing novel, fast and efficient ecologically benign processes for removing organic contaminants is important for the continued development of water treatment. For this reason, this study investigates the implementation of Cold Atmospheric pressure Plasma (CAP) generated in ambient air as an efficient tool for the removal of Bisphenol A (BPA) and Bisphenol S (BPS)-known endocrine disrupting compounds in water and wastewater, by monitoring degradation kinetics and its transformation products. The highest removal efficiencies of BPA (>98%) and BPS (>70%) were obtained after 480 s of CAP exposure. A pseudo-first-order kinetic revealed that BPA (-k t = 4.4 ̶ 9.0 ms -1 ) degrades faster than BPS (-k t = 0.4 ̶ 2.4 ms -1 ) and that the degradation is also time- and CAP power-dependent, while the initial concentration or matrix type had a negligible effect. This study also tentatively identified three previously reported and one novel transformation product of BPA and four novel transformation products of BPS. Their postulated structures suggested similar breakdown mechanisms, i.e., hydroxylation followed by ring cleavage. The results demonstrate that CAP technology is an effective process for the degradation of both BPA and BPS without the need for additional chemicals, indicating that CAP is a promising technology for water and wastewater remediation worthy of further investigation and optimization., 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 The Author(s). Published by Elsevier B.V. All rights reserved.)

Enantiomeric profiling can supplement wastewater-based epidemiology (WBE) by providing additional information on drug origin (licit or illicit), improving consumption estimates, i.e., differentiating between disposal and consumption, and offering an insight into the potency of drugs available on the illicit drug market. We report on the enantiomeric profiling of amphetamines in wastewater using R(-)-α-methoxy-α-(trifluoromethyl) phenylacetyl chloride (R-MTPCl), a chiral derivatising agent and GC-MS/MS. The method performed well when evaluated against the SANTE/12682/2019 guidelines in terms of recovery (81-99%), accuracy (99-111%), repeatability (1-8%RSD) and linearity (LOQ-1000 ng/mL). The LOD and LOQ were 120 ng/L and 400 ng/L, respectively. The method was applied to samples of raw wastewater from two Slovene municipalities with unusual levels of amphetamines: Ljubljana (LJ1) and Velenje (VE1). LJ1 had an anomalously high mass load of MDMA (3,4-methylenedioxymethamphetamine) identified during SCORE 2020, and VE1 is a representative sample of the consistently high mass load of amphetamine. A second Ljubljana sample (LJ2) was chosen as a representative sample. The presence of racemic MDMA (EF = 0.511) in LJ1 indicated the disposal of the unused drug into the sewer, while the enrichment of R-MDMA (EF = 0.666) in the combined extract sample from Ljubljana (LJ2) indicated consumption. In the case of Velenje and Ljubljana, it is impossible to distinguish between the direct disposal and consumption of amphetamine and methamphetamine. Also, since amphetamine/methamphetamine-based prescription medications are unavailable in Slovenia, racemic amphetamine in VE1 (EF = 0.514) and LJ2 (EF = 0.459) indicate racemic and the more potent S-amphetamine are sold on the illicit drug market. Only S-methamphetamine was detected in wastewater (LJ2: EF = 0), indicating the presence of only the more potent S-methamphetamine on the illicit drug market. Overall, enantiomeric profiling provided useful information on amphetamine residues. In addition, chiral derivatisation can be a cost-effective alternative to using chiral chromatographic columns for the enantiomeric profiling of amphetamines in wastewater., 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 The Authors. Published by Elsevier B.V. All rights reserved.)

The geographical classification and authentication of strawberries were attempted using discriminant and class-modelling methods applied to stable isotopes of light elements and elemental composition. The work involved creating a database of 92 authentic Slovenian strawberry samples and 32 imported samples. All samples were harvested between 2018 and 2020. A good geographical classification of Slovenian and non-Slovenian strawberries was obtained despite different production years using discriminant approaches. However, for verifying compliance with a given specification (geographical indications), a class-modelling approach was used to build an unbiased verification model. Class models generated by data-driven soft independent modelling of class analogy (DD-SIMCA) had high sensitivity (96% to 97%) and good specificity (81% to 91%) on a yearly basis, while a more generalised model combining total yearly data gave a lower specificity (63%). Of the 33 commercially available samples (test samples) with declared Slovenian origin, 39% were from outside of Slovenia., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Regenerative medicine requires better pre-clinical tools in order to increase the efficiency of novel therapies transitioning to the clinic. Current monolayer cell culture methods are suboptimal for effectively testing new therapies and live mouse models are expensive, time consuming and require invasive procedures. Fetal organ culture, organoids, microfluidics and culture of thick sections of adult organs all aim to fill the knowledge gap between monolayer culture and live mouse studies. Here we report on an ex vivo organ perfusion system that can support whole adult mouse organs. Ex vivo perfusion of healthy and diseased mouse organs allows for real-time analysis that provides immediate feedback and accurate data collection throughout the experiment. Having a suitable normothermic ex vivo perfusion system for mouse organs provides a tool that will help contribute to our understanding of kidney physiology and disease and can take advantage of the many mouse models of human disease that already exist. Furthermore, an ex vivo kidney perfusion system can be used for testing novel cell therapies, drug screening, drug validation and for the detection of nephrotoxic substances. Critical to the success of mouse ex vivo organ perfusion is having a suitable bioreactor to maintain the organ. Here we have focused on the mouse kidney and mathematically modeled, built and validated a bioreactor that can maintain a kidney for 7 days. The long duration of the ex vivo perfusion will help to advance studies on kidney disease and can rapidly test for new regenerative medicine therapies compared to whole animal studies.

VEXAS is a newly recognised adult-onset autoinflammatory syndrome resulting from a somatic mutation in the UBA1 gene. Herein, we present three cases of VEXAS syndrome in Sydney, Australia, that capture key clinical features and the refractory nature of the condition. They highlight the importance of multidisciplinary collaboration for early diagnosis and the need for new therapeutic options., (© 2022 Royal Australasian College of Physicians.)

Echinococcosis is a neglected zoonosis that uses dogs and sheep as its main hosts in Chile. The Eg95 vaccine against sheep infection has been included in some control programs. Here, we assess the efficacy of the vaccination program in the hyperendemic Alto Biobío commune after 3 years of execution. Fisher’s test and generalized linear models were used in the assessment. The program tried to offer a first dose at 2 months of age, a booster 1 month later, and yearly vaccination. Given logistic difficulties, important delays in vaccination occurred, and most animals did not receive the first booster. Dog deworming was not included in the program. Likely due to the aforementioned factors, the overall frequency of infection was not lower, but the proportion of large (>5 mm) cysts and fertile cysts was smaller after the program. The frequency of infection and/or the number of cysts were lower when the age at first dose was younger and the first booster was administered 1 month after the first dose. The results suggest that vaccination affects both cyst development after the larvae reach the target organs, as well as the development of the protoscolex once the cysts start developing.

Objective: To identify the impact of marijuana use on fracture healing in surgically treated pediatric patients., Design: Retrospective review., Setting: Level 1 trauma center, single-center study., Patients/participants: Surgically treated pediatric patients 10-18 years with extremity fractures from 2010 to 2020. Conservatively treated patients and patients with nonunions were excluded from the study. Three hundred thirty-nine patients were included in the study, 21 of which were confirmed marijuana users by toxicology screening., Intervention: Surgical treatment of extremity fractures by any type of fixation., Main Outcome Measurements: Time to union was the primary outcome and was defined as radiographic evidence of bridging callus on all sides of the fracture and absence of the previous fracture line. Analysis of covariance, logistic regression analysis, and Fisher exact tests were used to establish the relationship between all collected variables and time to radiographic union., Results: The average time to union for marijuana users (159.1 ± 69.5 days, 95% confidence interval) was significantly longer than for nonusers (80.3 ± 7.8 days), P < 0.001. The odds of having a time to union of greater than 4 months and greater than 6 months were 4.17 (P = 0.00192) and 6.19 (P = 0.000159), respectively, for marijuana users compared with nonusers., Conclusion: Marijuana users demonstrated longer time to union in surgically treated pediatric fracture patients., Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: The authors report no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: To determine whether obesity affects time to radiographic union in surgically treated pediatric extremity fractures., Methods: A retrospective review of pediatric patients with extremity fractures at a Level 1 trauma center from 2010 to 2020. Those treated conservatively and patients with nonunions were excluded. Union was defined as radiographic evidence of bridging callus on all sides of the fracture and absence of the previous fracture line., Results: Obese patients had a markedly increased time to union when compared with others, even when age, sex, fracture type, race, and ethnicity were controlled for. The mean time to union for obese and nonobese patients were 152 and 93.59 days, respectively (P < 0.001). Obese patients had 3.39 times increased odds of having increased time to union. Obese patients had 6.64 times increased odds of having fractures with delayed union of 4 months or greater (P < 0.001)., Conclusions: There is a positive correlation between obesity and time to union in surgically treated pediatric fracture patients., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Wastewater analysis was used to investigate drug prevalence in primary and secondary schools and institutes of higher education located in urban and non-urban areas of six municipalities in Slovenia. Seven-hour composite raw wastewater samples from 44 educational institutions, including 19 primary schools (6-15 yrs.), ten secondary schools (15-19 yrs.), nine higher education institutions (19+ yrs.) and six mixed secondary and higher education institutions (15+ yrs.), were collected at the end of the 2018/2019 academic year. Metabolic residues of licit drugs (nicotine and alcohol), medications of abuse (morphine, codeine and methadone) and illicit drugs (cannabis, cocaine, amphetamine, methamphetamine, ecstasy and heroin) were targeted in the study. The analysis was carried out using solid-phase extraction and direct injection combined ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Biomarkers of nicotine, alcohol and cannabis intake were the most frequently detected, indicating a high prevalence of these drugs. Morphine and codeine were also detected, while among the stimulants, benzoylecgonine had the highest detection frequency. Drug differences were found between different levels of educational institution, geographic location (inter-municipality comparison) and degree of urbanization. However, t-distributed stochastic neighbour embedding (t-SNE) revealed that the level of educational institution was the main factor influencing the differences in drug prevalence. Although a good agreement between data from this study and other studies implementing wastewater analysis was observed, there was a discrepancy with Slovenian epidemiological survey data. Finally, despite certain drawbacks of the method, its application to detect drug residues in educational institutions provides a non-invasive insight into drug use trends., 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 © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Metabolic residue concentration data for two licit drugs (nicotine and alcohol), three medications of abuse (morphine, methadone and codeine) and six illicit drugs (cannabis, cocaine, amphetamine, methamphetamine, ecstasy and heroin) were obtained from raw wastewater samples collected from 44 Slovenian educational institutions are presented. Also, concentrations obtained at one secondary school during a preliminary study is provided. The wastewater samples were collected at the end of the 2018/2019 academic year using time proportional sampling and analysed for 16 drug residues, extracted using solid-phase extraction and analysed using ultra-performance liquid chromatography hyphenated to tandem mass spectrometry (UPLC-MS/MS). Residues of nicotine and alcohol were determined by direct injection of filtered wastewater onto the UPLC. Concentrations data were studied based on educational level (primary, secondary and tertiary) and institution type (secondary schools: gymnasiums, vocational and technical schools, multi-programme schools; higher education institutions: natural sciences and social sciences), geographic location (municipalities) and degree of urbanisation (urban and non-urban areas). Due to the large number of different educational institutions included in the study, provided datasets are valuable for further studies on drug consumption patterns among young people. Drug presence and prevalence data for primary schools (6-15 years) offer an objective insight into drugs present in the early stage of a young person's development and help establish effective prevention programs. More details on the study can be found in [1]., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships which have or could be perceived to have influenced the work reported in this article., (© 2021 The Author(s).)

This study reports how adding a membrane filter (0.45-μm cellulose nitrate filter) between a glass fibre filter and the solid phase extraction (SPE) cartridge affected the GC/MS analysis of 48 emerging organic micropollutants in wastewater. Most of them are widely used as active pharmaceuticals, cosmetic and packaging material ingredients including classes of parabens, benzophenones and bisphenols among other chemicals tested. A high artificial organic carbon (OC) content in wastewater (DOC = 280 ± 14 mg/L) was investigated to gain insight into micropollutants/colloidal OC filter cake interactions. The results show that even with the use of matrix-matched calibration, the introduction of a second (membrane) filtration step can affect the analysis. Both positive, negative and no effects on the theoretical concentrations calculated from the calibration curves with and without additional filtration were observed. Positive effects on the concentration for the same analyte peak area relative to its surrogate standard were the consequence of a reduced signal for the same concentration, while the negative effects are the consequence of increasing signal for the same concentration. Effect types were dependent on the concentration and the nature of the analytes. Results show that bisphenols and parabens significantly interact with colloidal OC. Statistical analysis of molecular descriptor distribution with effect type showed that micropollutants that have a stronger interaction with colloidal OC have significantly higher ability to act as hydrogen bond donors (HBD) and have larger molar volume (MV). All compounds that experienced either positive or negative effects have a significantly higher median logD. However, further exploration within a single class of compounds (parabens, benzophenones and bisphenols) revealed that selected descriptors are unrelated to an effect type. Pearson's correlations showed that a correlation exists for certain concentration levels and groups of compounds between a negative effect and MV and logD and a positive effect with MV, MW and rotatable bond (RB) count., (© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The rate of medial meniscus tear (MMT) in professional soccer players is high. There are no studies on objective performance metrics following medial meniscus repair in these athletes., Purpose: Examine the impact of MMT treated with surgical repair on performance metrics and career longevity in Major League Soccer (MLS) players., Methods: MLS players who sustained an MMT between 1993 and 2019 were identified via publicly available databases. These players were each matched to 2 uninjured controls by debut date, experience, position, race, ethnicity, height, weight, and body mass index (BMI). Demographic data and performance metrics were then collected for both groups. Matches, minutes, goals, assists, shots, shots on target, duels, and duel percentage won are collectively referred to as performance metrics. Statistical analysis compared demographic distributions and performance metrics between the MMT and control groups., Results: Thirty-three MLS players who had undergone medial meniscus repair were identified and matched to 66 controls. All performance metrics decreased in the MMT group when compared to their controls in the first year after injury. This difference remained significant even when the performance metrics were normalized with respect to time, indicating that the injured players both played less and were not as productive. At 2 years after injury, performance metrics returned to pre-injury levels and were equivalent to those of the healthy controls. Career length was found to be significantly different between the two groups at 8.81 ± 3.9 years for the MMT group and 12.63 ± 3.51 years for the control group ( P < 0.001)., Conclusion: MLS players undergoing medial meniscus repair had decreased performance metrics in the first year after injury but returned to baseline levels of play at the second year after injury. Their careers were also shorter than those of their uninjured controls., Competing Interests: The authors report no conflict of interest regarding the publication of this manuscript., (© 2021 Heath et al.)