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Body Sensor Networks (BSNs) represent an emerging technology which has received much attention recently due to its enormous potential to enable remote, real-time, continuous and non-invasive monitoring of people in health-care, entertainment, fitness, sport, social interaction. Signal processing for BSNs usually comprises of multiple levels of data abstraction, from raw sensor data to data calculated from processing steps such as feature extraction and classification. This paper presents a multi-layer task model based on the concept of Virtual Sensors to improve architecture modularity and design reusability. Virtual Sensors are abstractions of components of BSN systems that include sensor sampling and processing tasks and provide data upon external requests. The Virtual Sensor model implementation relies on SPINE2, an open source domain-specific framework that is designed to support distributed sensing operations and signal processing for wireless sensor networks and enables code reusability, efficiency, and application interoperability. The proposed model is applied in the context of gait analysis through wearable sensors. A gait analysis system is developed according to a SPINE2-based Virtual Sensor architecture and experimentally evaluated. Obtained results confirm that great effectiveness can be achieved in designing and implementing BSN applications through the Virtual Sensor approach while maintaining high efficiency and accuracy. [ABSTRACT FROM PUBLISHER]

The reuse of stormwater represents a potential option for meeting water demands in water stressed regions as well as preventing and mitigating diffuse pollution of receiving water bodies. Particularly, the elaboration of a risk management plan for stormwater reuse may help to understand associated environmental and public health risks and design fit-for-purpose water treatment processes. In this work, it is presented an innovative methodology to perform quantitative microbial risk assessment (QMRA) for stormwater reuse by using data simulated by SWMM software. Particularly, 210 rain events were simulated by SWMM after qualitative and quantitative calibration of the sewer network model of the city of Cupra Maritima (Italy) to identify sewer overflows. Obtained concentrations of pathogens (i.e., E. coli, Campylobacter) in overflows from each critical spillway were fitted by theoretical distribution curves. Hence, QMRA for Campylobacter was performed by Monte Carlo simulation and by linking observed overflows to the exposure events of stormwater reuse for the scenario of 1) municipal irrigation, 2) garden irrigation and 3) toilet flushing as defined by the Australian Guideline for water recycling. Furthermore, QMRA analysis was repeated after simulation of sewer overflow treatment by nature-based solution (NBS) with and without disinfection (UV and performic acid - PFA). Stormwater treatments were simulated by applying uniform distributions of expected range of bacteria log removals. Results showed that stormwater treatment by nature-based solution and disinfections (PFA dose of 2.5-5 mg/L) were able to reduce the risk of Campylobacter infection to acceptable level for most of spillways in the three investigated reuse scenarios. In addition, produced data were elaborated to identify critical overflows discharging in bathing water according to the indications of the EU bathing directive., 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 © 2025 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: Refractory or recurrent retinoblastoma results from acquired chemoresistance and the management of these eyes often requires surgical removal. Our objective was to develop retinoblastoma models resistant to chemotherapy by exposing cancer cells to repeated chemotherapy mimicking the clinical scenario. These newly resistant cells were used to evaluate potential novel therapies., Methods: Chemoresistant cells were obtained by exposing two primary retinoblastoma cell cultures to three weekly doses of melphalan or topotecan. The sensitivity of these resistant cells to each chemotherapy was evaluated, and cross-resistance to topotecan, melphalan, and carboplatin was assessed. Genomic alterations and differential expression of efflux/influx transporters between chemoresistant and parental cells were analyzed. Subsequently, sensitivity of both resistant and parental cells to the repurposed agents digoxin, methylene blue, and gemcitabine was assessed., Results: Four chemoresistant models were successfully established, showing significantly higher half-maximal inhibitory concentration (IC50) values for melphalan and topotecan compared to their corresponding parental cells (P < 0.05). Cross-resistance between melphalan and topotecan was demonstrated, with a 3-fold increase in the IC50. Chemoresistant cells also showed reduced sensitivity to carboplatin (P < 0.05) compared to parental cells, whereas sensitivity to the evaluated repurposed agents remained unchanged. Genomic analysis revealed no selective alterations in the resistant cells, although differential expression of influx/efflux transporters was observed across all chemoresistant models., Conclusions: In vitro simulation of patient treatment was useful to establish chemoresistant retinoblastomas and to identify strategies to overcome resistance to topotecan or melphalan through drug repurposed. Our results warrant further investigation to support the clinical translation.

Specific campaigns to detect microplastics (MPs) in the urban water cycle were carried out in three drinking water plants and two wastewater treatment plants. A self-designed sampler for MPs detection in water matrices was in this study preliminary validated and then tested in long term campaigns sampling up to 1000 L. Raw drinking water and wastewater show microplastics (MPs) concentrations of 2-11 and of 480-801 MPs/m 3 , respectively, and MPs removals of 47-78 % and of 84-98 %, correspondingly. Specific roles of chemical and physical conventional processes in microplastics removals were investigated. Solid-liquid separation, flotation and filtration are the main processes for achieving high microplastics removal. Regarding concentrated matrices, MPs concentrations in sludge samples varied in the range of 5000-500,000 MPs/m 3 . Finally, shapes, size classes and polymers' typologies were investigated in the extracted MPs. The detected sizes are mainly 0.5-0.1 mm in drinking waters while 5-1 mm in wastewaters. Wastewaters were predominated by synthetic fibers (polyester type), while drinking waters were mainly characterized by fragments and the fibers were mostly of natural origin. Finally, the results of this study supported best practices and guidelines for a representative assessment of MPs in water (sampling methods, extraction procedures, characterization and quantification)., 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 B.V.)

Introduction The aim of this study was to investigate whether the morphology of the acromion and the inclination of the glenoid are associated with the risk of supraspinatus (SSP) tendon ruptures. Materials and methods A total of 106 patients were enrolled in this study between August 2012 and February 2014, including 55 symptomatic patients with an SSP tendon rupture (ruptured group) and 51 patients with an intact SSP (control group). MRI of the shoulder was performed for all patients in both groups. All MR images were analyzed by two blinded observers to measure the acromiohumeral interval (AHI), critical shoulder angle (CSA), acromial slope (AS), acromial tilt (AT), lateral acromial angle (LAA), acromion index (AI), and glenoid inclination (GI). Furthermore, both observers analyzed tendon integrity and quality on all MRIs in both groups. The results of the radiological examination concerning acromial and glenoidal morphology were compared between the control group with intact SSP tendons and the rupture group. Results Patients with an SSP tendon rupture had a narrower AHI (9.1 ± 1.4 mm vs. 7.8 ± 2.1 mm; p < 0.01), a greater AT (36.0 ± 5.4° vs. 39.7 ± 5.9°; p < 0.01), and a lower LAA (81.1 ± 7.2° vs. 76.2 ± 5.0°; p < 0.01). Patients with an AHI smaller than 8.2 mm (OR 1.88 [95% CI 1.2 to 2.7]; p < 0.01) or an AT greater than 36.5° (OR 3.56 [95% CI 1.57 to 8.01]; p = 0.03) or a LAA lower than 80.5° (OR 4.04 [95% CI 2.04 to 7.90]; p < 0.01) had higher risk for an SSP tendon rupture. No differences between either group were found in relation to the AS, CSA, AI, or glenoid inclination. Conclusions The results of this study showed that the AHI, LAA and AT correlated with SSP tendon rupture. It should be noted that the preoperative AHI less than 8.2 mm, AT greater than 36.5° or LAA less than 80.5° may be associated with SSP tendon ruptures., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. University of Ulm issued approval 104/17. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Caffard et al.)

By implementing advanced wastewater treatment technologies coupled with digital tools, high-quality water is produced to be reused within the industry, enhancing process efficiency and closing loops. This paper investigates the impact of three innovation tools (process, circular and digital) in a Solvay chemical plant. Four technologies of the wastewater treatment plant "WAPEREUSE" were deployed, predicting their performance by process modelling and simulation in the PSM Tool. The environmental impact was assessed using Life Cycle Assessment and compared to the impact of the current industrial effluent discharge. The circularity level was assessed through three alternative closed-loop scenarios: (1) conventional treatment and discharge to sea (baseline), (2) conventional and advanced treatment by WAPEREUSE and discharge to sea, (3) conventional and advanced treatment by WAPEREUSE and industrial water reuse through cross-sectorial symbiotic network, where effluents are exchanged among the process industry, municipality and a water utility. Scenario 1 has the lowest pollutants' removal efficiency with environmental footprint of 0.93 mPt/m 3 . WAPEREUSE technologies decreased COD by 98.3%, TOC by 91.4% and nitrates by 94.5%. Scenario 2 had environmental footprint of 1.12 mPt/m 3 . The cross-sectorial symbiotic network on the industrial value chain resulted in higher industrial circularity and sustainability level, avoiding effluents discharge. Scenario 3 is selected as the best option with 0.72 mPt per m 3 , reducing the environmental footprint by 21% and 36% compared to Scenarios 1 and 2, respectively., 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 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction While several studies have compared tenotomy and tenodesis, few studies have examined whether performing a tenodesis of the long head of the biceps (LHB), when indicated, in patients who have undergone rotator cuff reconstruction has a detrimental impact on clinical and radiological postoperative outcomes. The present study aimed to investigate whether performing a tenodesis of the LHB has a damaging effect on the clinical and radiological outcome after rotator cuff reconstruction. Material and methods Fifty-one patients surgically treated for supraspinatus (SSP) tendon tears were included. All included patients received a reconstruction of the SSP, depending on the LHB surgery performed, patients were divided into two groups: 1) with concomitant tenodesis of the LHB and 2) without surgery of the LHB. Western Ontario Rotator Cuff Index (WORC), American Shoulder and Elbow Surgeons Shoulder Score (ASES), Constant, Oxford, and LHB scores were assessed at 2.3 ± 0.3 years postoperatively. All patients underwent clinical examination, including range of motion and force measurements. Furthermore, patients received an MRI scan of the operated shoulder two years postoperatively. Two blinded observers independently analyzed the integrity and quality of the rotator cuff on postoperative MRI using Sugaya and Castricini classifications. Clinical and radiological results were compared between both groups. Results All analyzed clinical scores, ranges of motion, and force measurements revealed no difference between both groups. Except for fatty infiltration (0° = 81% (21 of 26) vs. 68% (17 of 25); 1° = 15% (four of 26) vs. 28% (seven of 25); 2° = 4% (one of 26) vs. 4% (one of 25); and 3° = 0% (0 of 26) vs. 4% (one of 25); p < 0.01), no differences between both groups concerning the integrity (re-rupture rate = 27% (seven of 26) vs. 20% (five of 25); p = 0.39) and quality of the SSP tendon were found. Conclusions Tenodesis of the LHB performed in addition to rotator cuff repair is not associated with detrimental clinical outcomes than rotator cuff repair without surgery of the LHB. Except for fatty infiltration, which was lower in the tenodesis group, the results of the present study suggest that concomitant tenodesis of the LHB produces in patients who received rotator cuff repair have no detrimental effect in terms of clinical outcomes and re-rupture rates as well as tendon quality. Therefore, when indicated, simultaneous tenodesis of the LHB appears to be a safe and effective procedure that has no negative impact on the postoperative outcome after SSP tendon reconstruction., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Review Board of University of Ulm issued approval 155/19. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sgroi et al.)

In this paper, a novel methodology and extended hybrid model for the real time control, prediction and reduction of direct emissions of greenhouse gases (GHGs) from wastewater treatment plants (WWTPs) is proposed to overcome the lack of long-term data availability in several full-scale case studies. A mechanistic model (MCM) and a machine learning (ML) model are combined to real time control, predict the emissions of nitrous oxide (N 2 O) and carbon dioxide (CO 2 ) as well as effluent quality (COD - chemical oxygen demand, NH 4 -N - ammonia, NO 3 -N - nitrate) in activated sludge method. For methane (CH 4 ), using the MCM model, predictions are performed on the input data (VFA, CODs for aerobic and anaerobic compartments) to the MLM model. Additionally, scenarios were analyzed to assess and reduce the GHGs emissions related to the biological processes. A real WWTP, with a population equivalent (PE) of 125,000, was studied for the validation of the hybrid model. A global sensitivity analysis (GSA) of the MCM and a ML model were implemented to assess GHGs emission mechanisms the biological reactor. Finally, an early warning tool for the prediction of GHGs errors was implemented to assess the accuracy and the reliability of the proposed algorithm. The results could support the wastewater treatment plant operators to evaluate possible mitigation scenarios (MS) that can reduce direct GHG emissions from WWTPs by up to 21%, while maintaining the final quality standard of the treated effluent., 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 Elsevier Ltd. All rights reserved.)

The mutualistic arbuscular mycorrhizal (AM) symbiosis arose in land plants more than 450 million years ago and is still widely found in all major land plant lineages. Despite its broad taxonomic distribution, little is known about the molecular components underpinning symbiosis outside of flowering plants. The ARBUSCULAR RECEPTOR-LIKE KINASE (ARK) is required for sustaining AM symbiosis in distantly related angiosperms. Here, we demonstrate that ARK has an equivalent role in symbiosis maintenance in the bryophyte Marchantia paleacea and is part of a broad AM genetic program conserved among land plants. In addition, our comparative transcriptome analysis identified evolutionarily conserved expression patterns for several genes in the core symbiotic program required for presymbiotic signaling, intracellular colonization, and nutrient exchange. This study provides insights into the molecular pathways that consistently associate with AM symbiosis across land plants and identifies an ancestral role for ARK in governing symbiotic balance., Competing Interests: Competing interests statement:The authors declare no competing interest.

Purpose  Arthroscopy is one of the most common interventions in orthopedics. Hence it is important to train users early in order to ensure the safest possible identification of access portals (AP). This prospective study aimed to compare a palpatory (PalpMethod) with a sonographic (SonoMethod) method for AP location in the shoulder and knee joints. Materials and Methods  The study included trainee doctors (n=68) attending workshops (lasting approx. 90 minutes). In these workshops a teaching video initially demonstrated the PalpMethod and SonoMethod of AP identification. An experienced operator first marked the access portals on the test subject with a UV pen (determined ideal point [DIP]). Adhesive film was then affixed to the puncture regions. Subsequently participants marked on shoulders and knees first the point determined by palpation, then the point determined by sonography. Analysis involved DIP visualization with a UV lamp and employed a coordinate system around the central DIP. In addition, participants completed an evaluation before and after the workshop. Results  The analysis included 324 measurements (n=163 shoulders and n= 161 knees). The majority of participants had not previously attended any courses on manual examination (87.9%) or musculoskeletal ultrasound (93.9%). Overall, the markings participants made on the shoulder using the SonoMethod were significantly closer to the DIP than those made by the PalpMethod (Palp 18.8mm ± 14.5mm vs. Sono 11.2mm ± 7.2mm; p<0.001). On the knee, however, the markings made by the PalpMethod were significantly closer to the DIP overall (Palp 8.0mm ± 3.2mm vs. Sono 12.8mm ± 5.2mm; p<0.001). Conclusion The results show that the SonoMethod produces more accurate markings on the shoulder, while the PalpMethod is superior for the knee., Competing Interests: Conflict of Intrest The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Purpose: Although there have been improvements in the management of metastatic retinoblastoma, most patients do not survive, and all patients suffer from multiple short- and long-term treatment toxicities. Reliable and informative models to assist clinicians are needed. Thus we developed and comprehensively characterized a novel preclinical platform of primary cell cultures and xenograft models of metastatic retinoblastoma to provide insights into the molecular biology underlying metastases and to perform drug screening for the identification of hit candidates with the highest potential for clinical translation., Methods: Orbital tumor, bone marrow, cerebrospinal fluid, and lymph node tumor infiltration specimens were obtained from seven patients with metastatic retinoblastoma at diagnosis, disease progression, or relapse. Tumor specimens were engrafted in immunodeficient animals, and primary cell lines were established. Genomic, immunohistochemical/immunocytochemical, and pharmacological analysis were performed., Results: We successfully established five primary cell lines: two derived from leptomeningeal, two from orbital, and one from lymph node tumor dissemination. After the intravitreal or intraventricular inoculation of these cells, we established cell-derived xenograft models. Both primary cell lines and xenografts accurately retained the histological and genomic features of the tumors from which they were derived and faithfully recapitulated the dissemination patterns and pharmacological sensitivity observed in the matched patients., Conclusions: Ours is an innovative and thoroughly characterized preclinical platform of metastatic retinoblastoma developed for the understanding of tumor biology of this highly aggressive tumor and has the potential to identify drug candidates to treat patients who currently lack effective treatment options.

In order to investigate Li 2 S as a potential protective coating for lithium anode batteries using superionic electrolytes, we need to describe reactions and transport for systems at scales of >10,000 atoms for time scales beyond nanoseconds, which is most impractical for quantum mechanics (QM) calculations. To overcome this issue, here, we first report the development of the reactive analytical force field (ReaxFF) based on density functional theory (DFT) calculations on model systems at the PBE0/TZVP and M062X/TZVP levels. Then, we carry out reactive molecular dynamics simulations (RMD) for up to 20 ns to investigate the diffusion mechanisms in bulk Li 2 S as a function of vacancy density, determining the activation barrier for diffusion and conductivity. We show that RMD predictions for diffusion and conductivity are comparable to experiments, while results on model systems are consistent with and validated by short (10-100 ps) ab initio molecular dynamics (AIMD). This new ReaxFF for Li 2 S systems enables practical RMD on spatial scales of 10-100 nm (10,000 to 10 million atoms) for the time scales of 20 ns required to investigate predictively the interfaces between electrodes and electrolytes, electrodes and coatings, and coatings and electrolytes during the charging and discharging processes., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Introduction: The aim of this examination was to assess, which risk factors impair bone healing after triple pelvic osteotomy (TPO) in the treatment of symptomatic hip dysplasia., Methods: A consecutive series of 241 TPO was reviewed retrospectively. Of these, a set of five postoperative radiographs was available, performed in a standardized regimen in the first year after surgery. Two experienced observers had to agree on the existence of a non-union on the radiographs obtained 1 year after TPO. Both observers measured the lateral center edge angle (LCEA) and acetabular index (AI) on all radiographs. Besides patient-specific risk factors, the magnitudes of acetabular correction and the amounts of a detectable slight change in acetabular correction were assessed. Binary logistic regression analysis and chi-squared test were used to detect the impact of the risk factor on bone healing., Results: A total of 222 cases were left for further examination. In 19 of these, at least one osteotomy was not healed completely one year after surgery. Binary logistic regression showed a significant relationship between the risk factors "age" (p < 0.001; odds ratio (OR) 1.109 (95% CI 1.05-1.18)) as well as "magnitude of acetabular correction (LCEA)" (p = 0.01; OR 1.087 (95% CI 1.02-1.16)) and non-union. Pearson's chi-square test showed a relationship between the risk factor "wound healing disorder" and non-union (p < 0.001). LCEA and AI showed a slight increase from the first to the last follow-up (observer 1: 1.6° and 1.3°, resp.), but regression analysis for the risk factor "amount of postoperative change of acetabular correction (LCEA, AI)" did not show statistically significant values., Conclusion: The age at surgery and the magnitude of acetabular correction negatively influenced the healing progress of the osteotomy sites. The amount of a slight postoperative change of LCEA and AI did not correlate with a non-union., (© 2023. The Author(s).)

Purpose: The aim of this examination was to assess whether there is a change of acetabular correction after triple pelvic osteotomy (TPO) and if so, whether there is a correlation with patient-specific risk factors or with certain periods in the postoperative course., Methods: A consecutive series of 241 TPO was reviewed retrospectively. The close-meshed radiographic follow-up of the first 12 weeks comprised pelvic radiographs performed immediately after the procedure, 5 days, 6 and 12 weeks after TPO. Three observers measured the lateral center edge angle, acetabular index and the craniocaudal offset of the pubic osteotomy. Patient-specific risk factors (e. g. age, gender, body mass index, nicotine abuse) and certain periods in the postoperative course were correlated with a change of acetabular correction., Results: After application of the exclusion criteria, 225 hips were available for further examination. Intraclass correlation coefficient resulted in predominantly excellent agreement between the measurements of the three observers (0.74-0.91). In 27 cases (12%), the three observers agreed on a change of acetabular correction. In 18 cases (8%), there was a slight change, in 9 cases (4%), a relevant change. The latter entailed consequences in the postoperative aftercare. General equation estimation did not show any correlation between a change of acetabular correction and patient-specific risk factors or certain periods in the postoperative course (p = 0.79-0.99)., Conclusion: Every once treated hip should be followed-up with the same attention, irrespective of the apparent risk profile. There is no rationale to skip a radiographic follow-up in the first 12 weeks after TPO., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Introduction: As interest in medicine grows, admissions committees must review an increasingly competitive pool of medical school and residency candidates. Nearly all admissions committees have moved towards a holistic review, which considers an applicant's experiences and attributes in addition to academic metrics. As such, identifying nonacademic predictors of success in medicine is necessary. Parallels between skills necessary to succeed in athletics and in medicine have been drawn, including teamwork, discipline and resiliency. This systematic review synthesises the current literature to evaluate the relationship between participation in athletics and performance in medicine., Methods: The authors searched five databases to conduct a systematic review following PRISMA guidelines. Included studies assessed medical students, residents or attending physicians in the United States or Canada and used prior athletic participation as a predictor or explanatory variable. The review examined associations between prior athletic participation and outcomes in medical school, residency and/or as an attending physician., Results: Eighteen studies evaluating medical students (78%), residents (28%) or attending physicians (6%) met inclusion criteria for this systematic review. Twelve (67%) studies specifically assessed participants based on skill level, and five (28%) studies specifically assessed participants based on type of athletic participation (team versus individual). Sixteen studies (89%) found that former athletes performed significantly better than their counterparts (p < 0.05). These studies found significant associations between prior athletic participation and better outcomes in multiple performance indicators, including exam scores, faculty ratings, surgical errors and burnout., Conclusions: Current literature, although limited, suggests that prior participation in athletics may be a predictor of success in medical school and residency. This was demonstrated through objective scoring methods, such as USMLE, and subjective outcomes, such as faculty ratings and burnout. Specifically, multiple studies indicate that former athletes demonstrated increased surgical skill proficiency and decreased burnout as medical students and residents., (© 2023 Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Purpose: In pelvic osteotomies, unfavorable balancing of the anterior and posterior acetabular wall can affect the longevity of the natural joint. This raises the question, whether intraoperative fluoroscopy is sufficiently accurate. The objective was to assess the correlation between acetabular parameters [lateral center edge angle (LCEA), acetabular index (AI), anterior wall index (AWI), posterior wall index (PWI)] acquired on intraoperative fluoroscopic images and postoperative pelvic radiographs and to analyze intra- and interobserver reliability of these parameters., Methods: A retrospective examination was conducted on 206 consecutive cases (176 patients) after triple pelvic osteotomy (TPO). Every patient received a pre- and postoperative pelvic radiograph in supine position in exactly the same technique. A highly standardized surgical sequence allowed consistent intraoperative fluoroscopic imaging. LCAE, AI, PWI and AWI were measured by an experienced orthopedic surgeon and an orthopedic surgeon in training. Statistics comprised a priori power analysis, Bland-Altman analysis and intraclass correlation coefficient (ICC)., Results: A total of 165 cases were included. ICC between the parameters of the fluoroscopic images and postoperative radiographs was for LCEA: 0.935, AI: 0.936, AWI: 0.725 and PWI: 0.878. Intraobserver ICC for all parameters ranged from 0.953 to 0.989, interobserver ICC from 0.798 to 0.968, respectively., Conclusion: In the surgical treatment of hip dysplasia by means of TPO, intraoperative fluoroscopic imaging has proven to be reliable and accurate. Intraobserver correlation was excellent for all parameters. The correlation between the intraoperative fluoroscopic images and postoperative radiographs ranged from good to excellent, with the lowest values for the acetabular wall indices (AWI and PWI)., (© 2022. The Author(s).)

Polyethylene (PE) pipes have been widely used in drinking water distribution systems across the world. In many cases, chlorine dioxide (ClO 2 ) is used to maintain a residual disinfectant concentration in potable water. Practical experiences have shown that the lifetime of PE pipes is significantly reduced due to exposure to drinking water with ClO 2 . Recently, many companies have proposed new PE pipes with a modified formulation, which are more resistant to chlorine dioxide. However, a standardized test method for evaluating the long-term performances of PE pipes is still missing. This literature review was performed to provide a description of chlorine dioxide uses and degradation mechanisms of polyethylene pipes in real water distribution systems. Current accelerated aging methods to evaluate long-term performances of PE pipes exposed to ClO 2 are described and discussed along with the common technics used to characterize the specimens. Accelerate aging methods can be distinguished in immersion aging tests and pressurized pipe loop tests. Wide ranges of operational conditions (chlorine dioxide concentration, water pressure, water temperature, etc.) are applied, resulting in a great variety of results. It was concluded that pressurized looping tests applying semi-realistic operational conditions could better replicate the aging mechanisms occurring in service. Despite this, the acceleration and the evaluation of the long-term performance are still difficult to determine precisely. Further experimentation is needed to correlate chemical-mechanical characterization parameters of PE pipes with their lifetime in service., 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 Ltd.)

Background: Retearing of the supraspinatus (SSP) tendon after repair is relatively common, but its cause is rarely clear. Although the role of acromion morphology and glenoid orientation in the pathogenesis of primary SSP tendon tears have frequently been analyzed, their association with the risk of rerupture of a repaired SSP tendon is poorly understood., Questions/purposes: (1) Is acromial morphology associated with the risk of retear after SSP tendon repair? (2) Is there an association between inclination and version of the glenoid and the odds for retear of the SSP tendon after repair? (3) Are there differences in outcome scores between patients who had intact cuff repairs and those who had retears?, Methods: Between August 2012 and December 2015, we treated 92 patients for SSP tendon tears; all of these patients were considered for inclusion in the present study. We considered patients with complete tear of the SSP that was reconstructed with a double-row repair and a minimum follow-up of 2 years as potentially eligible. Based on these criteria, 28% (26 of 92) were excluded because they had a partial rupture and did not receive a double-row reconstruction. A further 9% (eight of 92) were excluded because of missing planes or slices (such as sagittal, axial, or frontal) on MRI, and another 3% (three of 92) were lost before the minimum study follow-up interval or had incomplete datasets, leaving 60% (55 of 92) for inclusion in the present analysis. All included patients had a minimum follow-up of 2 years; follow-up with MRI occurred at a mean duration of 2.3 ± 0.4 years postoperatively. All patients were asked to complete the Western Ontario Rotator Cuff Index and Oxford Shoulder Scores, and they underwent MRI of the operated-on shoulder. Preoperative true AP radiographs and MR images of the affected shoulders were retrospectively assessed by measuring the acromiohumeral interval, critical shoulder angle, acromial slope, acromial tilt, acromial index, lateral acromial angle, and glenoid version and inclination. The patients also underwent acromioplasty, in which the underface of the acromion was flattened. To rule out any change in the above parameters because of acromioplasty, these parameters were compared using preoperative and postoperative MR images and showed no difference. In addition, the tendon integrity and quality on postoperative MRI were analyzed independently of one another by the same two observers using the Sugaya and Castricini classifications, accounting for atrophy and fatty degeneration of the SSP muscle. To assess interobserver reliability, the two observers took measurements independently from each other. They were orthopaedic residents who completed a training session before taking the measurements. All measurements had excellent intrarater (Cronbach alpha 0.996 [95% confidence interval (CI) 0.99 to 1.00; p > 0.01) and interrater (interrater correlation coefficient 0.975 [95% CI 0.97 to 0.98]; p > 0.01) reliabilities. To answer the study's first question, SSP integrity on postoperative MRI was compared with acromial morphologic parameters measured on preoperative AP radiographs and MR images. To answer the second question, the postoperative integrity and quality of the SSP tendon were correlated with glenoid inclination and glenoid version. To answer our third question, we compared outcome scores between patients with intact SSP tendons and those with reruptured SSP tendons. To investigate any correlation among the acromial morphology, glenoid orientation, and postoperative outcomes, a binomial logarithmic regression analysis was performed. Receiver operating characteristic curves were used to determine cutoff points for the radiologic parameters that showed a correlation in the binomial regression analysis., Results: After controlling for potentially confounding variables such as acromioplasty or preoperative fatty infiltration as well as muscle atrophy, the only morphological parameters associated with a higher risk (adjusted odds ratio) of SSP tendon rerupture were the acromiohumeral interval (adjusted OR 0.9 [95% CI 0.9 to 0.99]; p < 0.01) and acromial slope (adjusted OR 1.4 [95% CI 1.1 to 1.8]; p < 0.01). The critical shoulder angle, acromial tilt, acromial index, and lateral acromial angle were not associated with the risk of rerupture. The cutoff values for acromial slope and acromiohumeral interval were 24.5° and 7.4 mm, respectively. Patients with an acromiohumeral interval smaller than 7.4 mm or an acromial slope greater than 24.5° had higher odds (acromiohumeral interval: OR 11 [95% CI 2 to 46]; p = 0.01 and acromial slope: OR 9 [95% CI 2 to 46]; p = 0.04) for rerupture of the SSP. No difference was found between patients with intact SSP tendons and those with reruptured SSP tendons in terms of glenoid inclination (6° ± 4° versus 6° ± 3°, mean difference 0.8° [-1° to 3°]; p < 0.48) and glenoid version (-2° ± 3° versus -3° ± 3°, mean difference 1° [-1° to 3°]; p < 0.30). No difference was found between the intact and reruptured SSP groups regarding clinical outcomes (Western Ontario Rotator Cuff Index: 98 ± 2 versus 97 ± 3, mean difference 0.73 [95% CI -0.30 to 0.31]; p = 0.96; Oxford Shoulder Score: 26 ± 13 versus 23 ± 10, mean difference 2.80 [95% CI -4.12 to 9.72]; p = 0.41)., Conclusion: The preoperative acromiohumeral interval and acromial slope are associated with SSP tendon rerupture after repair. Conversely, the critical shoulder angle, acromial tilt, lateral acromial angle, and acromial index had no association with the postoperative outcome. Additionally, glenoid inclination and version were not associated with the rerupture rate after SSP tendon repair. A detailed analysis of the acromiohumeral interval and acromial slope is recommended in clinical practice in patients undergoing SSP tendon repair. Surgeons should consider measuring the acromiohumeral interval and acromial slope preoperatively when performing SSP repair, especially in the context of planned acromioplasties. Future studies should investigate the role of acromioplasty during SSP repair in patients with a pathologic acromial slope and acromiohumeral interval. In this context, it should be determined whether a more-radical acromioplasty could reduce the risk of rerupture of the SSP in these patients., Level of Evidence: Level III, therapeutic study., Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2022 by the Association of Bone and Joint Surgeons.)

Objective: This retrospective cohort study investigated the radiation exposure and clinical efficiency of a new institutional low-dose protocol for computed tomography (CT)-guided lumbar periradicular infiltration (PRI)., Methods: This was a retrospective matched-pair comparison of patients undergoing single-level lumbar PRI therapy employing a new low-dose CT protocol consisting of a helical scan with reduced energy levels and tube current versus the institutional standard CT protocol. The following variables were collected: dose-length product for the planning step, interventional step, and total examination, number of CT guidance scans, examination time, and postprocedural improvement on the numerical rating scale for radicular pain., Results: Forty-five patients were allocated to each group. A sufficient radiation dose reduction of 30% during PRI was achieved with the low-dose protocol with a median dose-length product of 9.8 mGy∗cm compared to 32.9 mGy∗cm with the standard protocol (P < 0.001). No need for additional multiple scans during the interventional mode was observed in the low-dose group, resulting in a comparable procedure time between the groups. Furthermore, the short-term pain-reducing effect of PRI was comparable between the low-dose and standard protocols (median delta numerical rating scale = 4 in both groups)., Conclusions: Our low-dose protocol with less tube voltage and lower electric current leads to less radiation exposure with the same safety and efficiency. In conclusion, every facility that performs CT-based procedures should check whether a further dose reduction is applicable to avoid stochastic radiation damage to the patient., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: This retrospective cohort study investigated the efficacy of a sublingual sufentanil tablet system (SSTS) in comparison to intravenous patient-controlled analgesia (IV-PCA) with piritramide for the management of postoperative pain following lumbar spinal fusion surgery., Methods: This was a retrospective analysis of patients undergoing single- or two-level lumbar spinal fusion surgery and receiving the SSTS or IV-PCA for postoperative pain relief as part of multimodal pain management that included IV paracetamol and oral metamizole. The following variables were collected: postoperative pain intensity and frequency scores using the numerical rating scale (NRS), hospital anxiety and depression scale (HADS), occurrence of nausea, postoperative mobilization, and patient satisfaction (MacNab criteria)., Results: Sixty-four patients were included. Those receiving the SSTS (n = 30) had significantly lower pain intensities on the operative day (NRS: 4.0, CI: 3.6-4.3 vs. 4.5, CI: 4.2-4.9; p < 0.05) and one day postoperatively (NRS: 3.4, CI: 3.1-3.8 vs. 3.9 CI: 3.6-4.3; p < 0.05) compared to patients receiving IV-PCA (n = 34). No differences were observed on postoperative days 2 to 5. SSTS patients experienced more nausea than IV-PCA patients (p = 0.027). Moreover, SSTS patients had a higher percentage of early mobilization following surgery than IV-PCA patients (p = 0.040). Regarding patient satisfaction, no significant differences were seen between the groups., Conclusion: The SSTS is a potentially advantageous alternative to opioid IV-PCA for use within a multimodal approach to managing postoperative pain after lumbar fusion surgery. Furthermore, the potentially higher emetic effect of SSTS should be considered, and the patient should be able to perform the application., (© 2022. The Author(s).)

Despite that normal values for the hip joint are reached at the end of ultrasound-monitored-treatment, the development of the acetabulum can be compromised during the growth phase. The acetabular index (AI) measured on a pelvic radiograph has been proven to be a reliable parameter. The aim of this study is to gain a better understanding of the dynamics of once-treated, residually dysplastic hips. This should be achieved by radiographically following these hips up to a milestone-examination at the end of preschool age. A total of 120 hips of consecutive 60 infants were included in this examination, each presenting with a residual developmental dysplasia of the hips (DDH) after successful ultrasound-monitored harness treatment. Radiographic follow-up was assessed retrospectively around 18 months, 3 years and 6 years of age, and the AI was measured. The age-dependent Tönnis classification was applied. The hips were assigned normal, mildly or severely dysplastic. Dependent t -test for paired samples indicated a highly significant improvement of the AI-values, including from the first to the second and from the second to the third follow-up. The percentage distribution into the Tönnis classification changed remarkably: in the first follow-up, 36 of the 120 hips were evaluated 'severely dysplastic', in the third follow-up only 1. On the other hand, three hips underwent acetabuloplasty. Even after normal values have been achieved at the end of ultrasound-monitored treatment, there remains a risk of residual dysplasia of the hips. Particularly, when the first radiographic examination shows nonphysiological findings, further close-meshed follow-up is recommended. Level of evidence: retrospective study of therapeutic outcome, consecutive patients, level II., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Bony Bankart lesions larger than a certain size can lead to a high redislocation rate, despite treatment with Bankart repair. Detection and measurement of glenoid bone loss play key roles in selecting the appropriate surgical therapy in patients with shoulder instability. There is controversy about which diagnostic modalities, using different measurement methods, provide the best diagnostic validity., Questions/purposes: (1) What are the diagnostic accuracies of true AP radiographs, West Point (WP) view radiographs, MRI, and CT to detect glenoid bone loss? (2) Are there differences in the measurements of glenoid bone loss on MRI and CT? (3) What are the intrarater and interrater reliabilities of CT and MRI to measure glenoid bone loss?, Methods: Between August 2012 and February 2017, we treated 80 patients for anterior shoulder instability. Of those, we considered patients with available preoperative true AP radiographs, WP radiographs, CT images, and MR images of the affected shoulder as potentially eligible. Based on that, 63% (50 of 80) of patients were eligible for analysis; 31% (25 of 80) were excluded because not all planes or slices (such as sagittal, axial, or frontal) of each diagnostic imaging modalities were available and 7% (5 of 80) because of the insufficient quality of diagnostic images (for example, setting of the layers did not allow adequate en face view of the glenoid). Preoperative true AP radiographs, WP radiographs, CT images and MR images of the affected shoulders were retrospectively assessed for the presence of glenoid bone loss by two blinded observers at a median (range) 25 months (12 to 66) postoperatively. To evaluate sensitivity, specificity, positive predictive value, negative predictive value, accuracy, diagnostic odds ratio, positive likelihood ratio, negative likelihood ratio, and area under the curve (AUC), we compared the detection of glenoid bone loss at follow-up achieved with the aforementioned imaging modalities with intraoperative arthroscopic detection. In all patients with glenoid bone loss, two blinded observers measured the size of the glenoid bone loss on preoperative CT and MR images using six measuring techniques: depth and length of the glenoid bone loss, Bigliani classification, best-fit circle width loss method, AP distance method, surface area method, and Gerber X ratio. Subsequently, the sizes of the glenoid bone loss determined using CT and MRI were compared. To estimate intraobserver and interobserver reliability, measurements were performed in a blinded fashion by two observers. Their level of experience was equivalent to that of orthopaedic residents, and they completed a training protocol before the measurements., Results: For the ability to accurately diagnose Bankart lesions, the AUC (accuracy of a diagnostic test; the closer to 1.0, the more accurate the test) was good for MRI (0.83 [95% confidence interval 0.70 to 0.94]; p < 0.01), fair for CT (0.79 [95% CI 0.66 to 0.92]; p < 0.01), poor for WP radiographs (0.69 [95% CI 0.54 to 0.85]; p = 0.02) and failed for true AP radiographs (0.55 [95% CI 0.39 to 0.72]; p = 0.69). In paired comparisons, there were no differences between CT and MRI regarding (median [range]) lesion width (2.33 mm [0.35 to 4.53] versus 2.26 mm [0.90 to 3.47], p = 0.71) and depth (0.42 mm [0.80 to 1.39] versus 0.40 mm [0.06 to 1.17]; p = 0.54), and there were no differences concerning the other measurement methods: best-fit circle width loss method (15.02% [2.48% to 41.59%] versus 13.38% [2.00% to 36.34%]; p = 0.66), AP distances method (15.48% [1.44% to 42.01%] versus 12.88% [1.43% to 36.34%]; p = 0.63), surface area method (14.01% [0.87% to 38.25] versus 11.72% [2.45% to 37.97%]; p = 0.68), and Gerber X ratio (0.75 [0.13 to 1.47] versus 0.76 [0.27 to 1.13]; p = 0.41). Except for the moderate interrater reliability of the Bigliani classification using CT (intraclass correlation coefficient = 0.599 [95% CI 0.246 to 0.834]; p = 0.03) and acceptable interrater reliability of the Gerber X ratio using CT (0.775 [95% CI 0.542 to 0.899]; p < 0.01), all other measurement methods had good or excellent intrarater and interrater reliabilities on MRI and CT., Conclusion: The results of this study show that CT and MRI can accurately detect glenoid bone loss, whereas WP radiographs can only recognize them poorly, and true AP radiographs do not provide any adequate diagnostic accuracy. In addition, when measuring glenoid bone loss, MRI images of the analyzed measurement methods yielded sizes that were no different from CT measurements. Finally, the use of MRI images to measure Bankart bone lesions gave good-to-excellent reliability in the present study, which was not inferior to CT findings. Considering the advantages including lower radiation exposure and the ability to assess the condition of the labrum using MRI, we believe MRI can help surgeons avoid ordering additional CT imaging in clinical practice for the diagnosis of anterior shoulder instability in patients with glenoid bone loss. Future studies should investigate the reproducibility of our results with a larger number of patients, using other measurement methods that include examination of the opposite side or with three-dimensional reconstructions., Level of Evidence: Level I diagnostic study., Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2022 by the Association of Bone and Joint Surgeons.)

Background: Retinoblastoma survivors in low- and middle-income countries are exposed to high-intensity treatments that potentially place them at higher risk of early subsequent malignant neoplasms (SMNs)., Methods: We followed 714 (403 [56.4%] nonhereditary and 311 [43.5%] hereditary) retinoblastoma survivors diagnosed from August 1987 to December 2016, up to the age of 16 years. We quantified risk of SMNs with cumulative incidence (CI) and standardized incidence ratios (SIR) analysis. Multivariate regression Cox model was used to determine the association of treatments and risk of SMNs., Results: Median follow-up was of 9 years (range: 0.18-16.9) and 24 survivors (3.36%) developed 25 SMNs (n = 22 hereditary, n = 2 nonhereditary). SMNs included sarcomas (osteosarcomas, Ewing sarcomas, rhabdomyosarcomas; n = 12), leukemias (n = 5), and central nervous system tumors (CNS; n = 3). All cases of acute myeloid leukemia (AML) and most of Ewing sarcomas occurred within 5 years of retinoblastoma diagnosis. The type of SMN was the main indicator of mortality (five of five patients with leukemias, six of 12 with sarcomas, and zero of three with CNS tumors died). Compared to the general population, radiation increased the risk of Ewing sarcoma in hereditary survivors by 700-fold (95% CI = 252-2422.6) and chemotherapy increased the risk of AML by 140-fold (95% CI = 45.3-436). The CI of SMNs for hereditary survivors was 13.7% (95% CI = 8.4-22.1) at 15 years., Conclusion: Retinoblastoma survivors from Argentina are at higher risk of developing SMNs early in life compared to the general Argentinean population, especially those treated with radiation plus chemotherapy. AML and Ewing sarcoma presented within 5 years of retinoblastoma diagnosis are associated with chemotherapy and radiation exposure., (© 2022 Wiley Periodicals LLC.)

Purpose: The purpose of this study was to evaluate ophthalmological findings in patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) in a Latin American population., Materials and Methods: This was a single-center, retrospective study. The observational analysis was conducted in AML and ALL patients seen as a routine examination at the department of ophthalmology of tertiary care center in Argentina between March 1, 2017, and February 28, 2018., Results: Overall, 137 patients with acute leukemia were included. The mean age was 7.9 ± 5.2 years (0-18), and 55% were male ( n = 75) and 45% female ( n = 45). At least one-fifth ( n = 31) of the patients presented some type of ocular manifestation (23%). The most frequently observed manifestation was retinal hemorrhages ( n = 14), followed by papilledema ( n = 9) and ocular surface involvement ( n = 5). The eye involvement was more frequently identified in the AML group (24%), compared to the ALL group (22%), especially papilledema with central nervous system compromise ALL (5%) and AML (11%), P < 0.01. The presence of hemorrhages was similar in both groups. In patients with retinal hemorrhage ( n = 14), the mean hematological findings were hemoglobin 7.4 ± 0.4 g/dL (6.5-8.0), erythrocytes 2.5M ± 0.3/mm 3 (confidence interval [CI], 2.0-3.1), and platelets 76,000 ± 32,000/mm 3 (CI, 8000-384,000). Patients without retinal findings ( n = 123), the mean hematological findings were hemoglobin 9.1 ± 0.6 g/dL (8.0-10.2), erythrocytes 3.2M ± 0.6/mm 3 (CI, 2.5-3.5), and platelets 92,000 ± 44,000/mm 3 (CI, 42.000-390.000). Multivariable analysis found that hemoglobin levels were the most reliable predictive factor for retinal findings. It was observed that the risk diminishes in patients with levels higher than 8.5 g/dL, and that it increased in patients with levels ranging between 6.5 and 7.5 g/dL at least twice ( P < 0.01)., Conclusions: Our results show that ocular involvement occurs in a high percentage of patients with leukemia with a clear clinical, humoral, and sometimes prognostic correlation, suggesting routine ophthalmologic evaluation in these patients., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Oman Ophthalmic Society.)

Background: Both knotted and knotless single-anchor repair techniques are used to repair transmural ruptures of the upper subscapularis (SSC) tendon. However, it is still unclear which technique provides better clinical and radiological results., Purpose/hypothesis: To compare the clinical and magnetic resonance imaging (MRI) outcomes of knotless and knotted single-anchor repair techniques in patients with a transmural rupture of the upper SSC tendon at 2-year follow-up. It was hypothesized that the 2 techniques would not differ significantly in outcomes., Study Design: Cohort study; Level of evidence, 3., Methods: Forty patients with a transmural tear of the upper SSC tendon (grade 2 or 3 according to Fox and Romeo) were retrospectively enrolled. Depending on the repair technique, patients were assigned to either the knotless single-anchor or knotted single-anchor group. After a mean follow-up of 2.33 ± 0.43 years, patients were assessed by the ASES, WORC, OSS, CS, and SSV. A clinical examination that included the bear-hug, the lift-off, and the belly-press tests was performed, in which the force exerted by the subjects was measured. In addition, all patients underwent MRI of the affected shoulder to assess repair integrity, tendon width, fatty infiltration, signal-to-signal ratio of the upper and lower SSC muscle, and atrophy of the SSC muscle., Results: No significant difference was found between the 2 groups on any of the clinical scores [ASES ( P = .272), WORC ( P = .523), OSS ( P = .401), CS ( P = .328), SSV ( P = .540)] or on the range-of-motion or force measurements. Apart from a higher signal-to-signal ratio of the lower SSC muscle in the knotless group ( P = .017), no significant difference on imaging outcomes was found between the 2 groups., Conclusion: Both techniques can be used in surgical practice, as neither was found to be superior to the other in terms of clinical or imaging outcomes at 2-year follow-up., Competing Interests: The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2022.)

A 6-year-old girl with visual impairment in the right eye (OD) was referred for an eye evaluation. The fundus of the OD showed a fibrotic orange endophytic lesion located adjacent to the optic disc. In retinal optical coherence tomography, a local tractional retinal detachment and choroidal neovascular membrane were observed together also with the presence of subretinal fluid. Due to the vision of the OD evolved to nonlight perception in the following exam, enucleation was performed. The pathology report was correlated with hemangioblastoma. Herein, we describe a case of a young girl with a retinal hemangioblastoma with quick evolution and without prior systemic diagnosis., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Oman Ophthalmic Society.)

Background: Knotted and knotless single-anchor reconstruction techniques are frequently performed to reconstruct full-thickness tears of the upper portion of subscapularis tendon. However, it is unclear whether one technique is superior to the other., Questions/purposes: (1) When comparing knotless and knotted single-anchor reconstruction techniques in full-thickness tears of the upper subscapularis tendon, is there a difference in stiffness under cyclic load? (2) Are there differences in cyclic gapping between knotless and knotted reconstructions? (3) Are there differences in the maximal stiffness, yield load, and ultimate load to failure? (4) What are the modes of failure of knotless and knotted reconstruction techniques?, Methods: Eight matched pairs of human cadaveric shoulders were dissected, and a full-thickness tear of the subscapularis tendon (Grade 3 according to the Fox and Romeo classification) was created. The cadavers all were male specimens, with a median (range) age of 69 years (61 to 75). Before biomechanical evaluation, the specimens were randomized into two equal reconstruction groups: knotless single anchor and knotted single anchor. All surgical procedures were performed by a single orthopaedic surgeon who subspecializes in sports orthopedics and shoulder surgery. With a customized set up that was integrated in a dynamic material testing machine, the humeri were consecutively loaded from 10 N to 60 N, from 10 N to 100 N, and from 10 N to 180 N for 50 cycles. Furthermore, the gapping behavior of the tear was analyzed using a video tracking system. Finally, the stiffness, gapping, maximal stiffness, yield loads, and maximum failure loads of both reconstruction groups were statistically analyzed. Failure was defined as retearing of the reconstructed gap threshold due to rupture of the tendon and/or failure of the knots or anchors. After biomechanical testing, bone quality was measured at the footprint of the subscapularis using microCT in all specimens. Bone quality was equal between both groups. To detect a minimum 0.15-mm difference in gap formation between the two repair techniques (with a 5% level of significance; α = 0.05), eight matched pairs (n = 16 in total) were calculated as necessary to achieve a power of at least 90%., Results: The first study question can be answered as follows: for stiffness under cyclic load, there were no differences with the numbers available between the knotted and knotless groups at load stages of 10 N to 60 N (32.7 ± 3.5 N/mm versus 34.2 ± 5.6 N/mm, mean difference 1.5 N/mm [95% CI -6.43 to 3.33]; p = 0.55), 10 N to 100 N (45.0 ± 4.8 N/mm versus 45.2 ± 6.0 N/mm, mean difference 0.2 N/mm [95% CI -5.74 to 6.04]; p = 0.95), and 10 N to 180 N (58.2 ± 10.6 N/mm versus 55.2 ± 4.7 N/mm, mean difference 3 N/mm [95% CI -5.84 to 11.79]; p = 0.48). In relation to the second research question, the following results emerged: For cyclic gapping, there were no differences between the knotted and knotless groups at any load levels. The present study was able to show the following with regard to the third research question: Between knotted and knotless repairs, there were no differences in maximal load stiffness (45.3 ± 8.6 N/mm versus 43.5 ± 10.2 N/mm, mean difference 1.8 [95% CI -11.78 to 8.23]; p = 0.71), yield load (425.1 ± 251.4 N versus 379.0 ± 169.4 N, mean difference 46.1 [95% CI -276.02 to 183.72]; p = 0.67), and failure load (521.1 ± 266.2 N versus 475.8 ± 183.3 N, mean difference 45.3 [95% CI -290.42 to 199.79]; p = 0.69). Regarding the fourth question concerning the failure modes, in the knotted repairs, the anchor tore from the bone in 2 of 8, the suture tore from the tendon in 6 of 8, and no suture slipped from the eyelet; in the knotless repairs, the anchor tore from the bone in 2 of 8, the suture tore from the tendon in 3 of 8, and the threads slipped from the eyelet in 3 of 8., Conclusion: With the numbers available, we found no differences between single-anchor knotless and knotted reconstruction techniques used to repair full-thickness tears of the upper portion of subscapularis tendon., Clinical Relevance: The reconstruction techniques we analyzed showed no differences in terms of their primary stability and biomechanical properties at the time of initial repair and with the numbers available. In view of these experimental results, it would be useful to conduct a clinical study in the future to verify the translationality of the experimental data of the present study., Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2021 by the Association of Bone and Joint Surgeons.)

This work evaluated different advanced oxidation processes (AOPs) operated at pilot-scale as tertiary treatment of municipal wastewater in terms of energy efficiency, disinfection by-products formation and pathogens inactivation. Investigated AOPs included UV/H 2 O 2 , UV/Cl 2 , O 3 , O 3 /UV, H 2 O 2 /O 3 /UV, Cl 2 /O 3 /UV. AOPs were operated using various ozone doses (1.5-9 mg L -1 ), and UV fluences (191-981 mJ cm -2 ). Electrical energy costs necessary for the oxidation of contaminants of emerging concern (CEC) (i.e., carbamazepine, fluoxetine, gemfibrozil, primidone, sulfamethoxazole, trimethoprim) were calculated using the electrical energy per order (E EO ) parameter. Ozonation resulted by far the most energy efficient process, whereas UV/H 2 O 2 and UV/Cl 2 showed the highest energy costs. Energy costs for AOPs based on the combination of UV and ozone were in the order O 3 /UV ≈ Cl 2 /O 3 /UV > H 2 O 2 /O 3 /UV, and they were significantly lower than energy costs of UV/H 2 O 2 and UV/Cl 2 processes. Cl 2 /O 3 /UV increased bromate formation, O 3 /UV and O 3 had same levels of bromate formation, whereas H 2 O 2 /O 3 /UV did not form bromate. In addition, UV photolysis resulted an effective treatment for NDMA mitigation even in combination with ozone and chlorine in AOP technologies. Ozonation (doses of 1.5-6 mg L -1 ) was the least effective process to inactivate somatic coliphages, total coliform, escherichia coli, and enterococci. UV irradiation was able to completely inactivate somatic coliphages, total coliform, escherichia coli at low fluence (191 mJ cm -2 ), whereas enterococci were UV resistant. AOPs that utilized UV irradiation were the most effective processes for wastewater disinfection resulting in a complete inactivation of selected indicator organisms by low ozone dose (1.5 mg L -1 ) and UV fluence (191-465 mJ cm -2 )., 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.)

An exact understanding of the interplay between the articulating tissues of the knee joint in relation to the osteoarthritis (OA)-related degeneration process is of considerable interest. Therefore, the aim of the present study was to characterize the biomechanical properties of mildly and severely degenerated human knee joints, including their menisci and tibial and femoral articular cartilage (AC) surfaces. A spatial biomechanical mapping of the articulating knee joint surfaces of 12 mildly and 12 severely degenerated human cadaveric knee joints was assessed using a multiaxial mechanical testing machine. To do so, indentation stress relaxation tests were combined with thickness and water content measurements at the lateral and medial menisci and the AC of the tibial plateau and femoral condyles to calculate the instantaneous modulus (IM), relaxation modulus, relaxation percentage, maximum applied force during the indentation, and the water content. With progressing joint degeneration, we found an increase in the lateral and the medial meniscal instantaneous moduli ( p < 0.02), relaxation moduli ( p < 0.01), and maximum applied forces ( p < 0.01), while for the underlying tibial AC, the IM ( p = 0.01) and maximum applied force ( p < 0.01) decreased only at the medial compartment. Degeneration had no influence on the relaxation percentage of the soft tissues. While the water content of the menisci did not change with progressing degeneration, the severely degenerated tibial AC contained more water ( p < 0.04) compared to the mildly degenerated tibial cartilage. The results of this study indicate that degeneration-related (bio-)mechanical changes seem likely to be first detectable in the menisci before the articular knee joint cartilage is affected. Should these findings be further reinforced by structural and imaging analyses, the treatment and diagnostic paradigms of OA might be modified, focusing on the early detection of meniscal degeneration and its respective treatment, with the final aim to delay osteoarthritis onset., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Seitz, Osthaus, Schwer, Warnecke, Faschingbauer, Sgroi, Ignatius and Dürselen.)

Competing Interests: The authors report no conflicts of interest.