Surgiflo® hemostatic matrix versus NasoPore® nasal packing following postassium titanyl phosphate laser surgery for hereditary hemorrhagic telangiectasia: A randomized controlled trial.

Background: To help ensure adequate hemostasis immediately following potassium titanyl phosphate (KTP) laser treatment, many centres treating hereditary hemorrhagic telangiectasia (HHT) routinely use nasal packing post-operatively. The purpose of this study was to compare hemostatic thrombin matrix with standard packing for postoperative bleeding, patient pain, and comfort. Methods: A prospective, randomized, double-blinded, non-inferiority study was conducted with participants at an HHT centre of excellence (COE) and randomized to the treatment group with reconstituted thrombin gelatin matrix (Surgiflo®) or control group with a biodegradable synthetic polyurethane foam (NasoPore®). Adult subjects with confirmed HHT and moderate to severe epistaxis (a minimum calculated epistaxis severity score [ESS] of 4.0) warranting KTP laser treatment were recruited. Data was collected 2 weeks post operatively by a blinded reviewer completing a visual outcomes evaluation and each patient completing a subjective symptoms questionnaire. Non-parametric statistical analysis was employed. Results: Twenty-eight adult patients were randomized to the treatment and control arms with comparable preoperative epistaxis severity scores. Postoperative nasal bleeding was equivalent. Significantly less pain was found in the treatment arm (p = .005). While there were trends towards less obstruction and increased satisfaction in the treatment group as well as less crusting in the control group, these findings were not statistically significant. Allocation to the treatment group was associated with an approximately $75 higher cost. Conclusions: When compared to NasoPore® for hemostasis, Surgiflo® hemostatic matrix performed equivalently while causing less discomfort in HHT patients following nasal KTP treatment. Level of evidence: 1b.

Accuracy and Reliability of 3D Imaging for Facial Movement Evaluation: Validation of the VECTRA H1.

Three-dimensional imaging can be used to obtain objective assessments of facial morphology that is useful in a variety of clinical settings. The VECTRA H1 is unique in that it is relatively inexpensive, handheld, and does not require standardized environmental conditions for image capture. Although it provides accurate measurements when imaging relaxed facial expressions, the clinical evaluation of many disorders involves the assessment of facial morphology when performing facial movements. The aim of this study was to assess the accuracy and reliability of the VECTRA H1, specifically when imaging facial movement. Methods: The accuracy, intrarater, and interrater reliability of the VECTRA H1 were assessed when imaging four facial expressions: eyebrow lift, smile, snarl, and lip pucker. Fourteen healthy adult subjects had the distances between 13 fiducial facial landmarks measured at rest and the terminal point of each of the four movements by digital caliper and by the VECTRA H1. Intraclass correlation and Bland-Altman limits of agreement were used to determine agreement between measures. The agreement between measurements obtained by five different reviewers was evaluated by intraclass correlation to determine interrater reliability. Results: Median correlation between digital caliper and VECTRA H1 measurements ranged from 0.907 (snarl) to 0.921 (smile). Median correlation was very good for both intrarater (0.960-0.975) and interrater reliability (0.997-0.999). The mean absolute error between modalities, and both within and between raters was less than 2 mm for all movements tested. Conclusion: The VECTRA H1 met acceptable standards for the assessment of facial morphology when imaging facial movements.

Masticator space abscess following intramuscular stimulation.

A male in his 50s presented to the hospital with preauricular tenderness, trismus and dysphagia. He had intramuscular stimulation of his left temporomandibular joint region performed 4 days prior and described worsening pain and swelling since. A CT scan revealed an abscess involving the left masticator space. Incision and drainage of the abscess was performed, and the patient was discharged home on oral antibiotics 11 days later. This is the first report of masticatory space abscess following intramuscular stimulation of the temporomandibular joint area. Acupuncture and intramuscular stimulation are common complementary medicine therapies that are generally considered safe; however, adverse events such as deep neck space infection have been reported in the literature. Current regulation of training requirements and licensure for needling therapies is highly variable. Standardisation of training and practice guidelines may help mitigate the risk of adverse events related to needling therapies in the future.

The Modified Alberta Reconstructive Technique: A prospective cohort study.

INTRODUCTION: Jaw defect reconstructions have been transformed by the development of free tissue transfer using vascularized bone incorporating osseointegrated dental implants. We recently developed a modification our method this procedure and termed it the Modified Alberta Reconstruction Technique (MART). The objective of this study aimed to assess the soft tissue component and outcomes of the MART as compared to the Alberta Reconstructive Technique (ART) or conventional (BDD) reconstructions. PATIENTS AND METHODS: This was a prospective cohort study of adult patients who underwent jaw reconstruction with dental implant rehabilitation between 2000 and 2019 in Edmonton, Alberta. Patients were aged-matched and placed into a cohort based on the type of reconstruction they received. Outcomes were compared between the groups. Expert and aesthetic analyses were performed. Statistical analysis was conducted to determine significance. RESULTS: A total of 46 patients (15 BDD, 15 ART and 16 MART) were included. Demographics were similar between groups. There was no difference in complications. The soft tissue component of the MART cohort was more favourable to work with as judged by the occlusal reconstructive experts. The MART was rated as more aesthetically appealing in comparison to the BDD and ART (p = 0.049). CONCLUSIONS: The MART is a safe, effective, and aesthetically appealing procedure. It yields a good functional result and a clinically better soft tissue component for occlusal reconstructions. For a select group of patients requiring jaw reconstruction, the MART is an ideal reconstructive option as the modification provides good control of the soft tissue around the implants.

BTEX and heavy metals removal using pulverized waste tires in engineered fill materials.

In this study, the potential of pulverized waste tires (PWTs), either on their own or mixed with soil (well graded sand), to act as adsorptive fill materials was evaluated by conducting laboratory tests for accessing their adsorption and geotechnical properties. PWT (0, 5, 10, 15, 25, and 100 wt%) was mixed with soil to evaluate the removal of benzene, toluene, ethylbenzene, and xylene (BTEX) components and two heavy metal ions (Pb2+ and Cu2+). Adsorption batch tests were performed to determine the equilibrium sorption capacity of each mixture. Subsequently, compaction, direct shear, and consolidation tests were performed to establish their geotechnical properties. The results showed that BTEX had the strongest affinity based on the uptake capacity by the soil-PWT mixtures. The adsorption of BTEX increased for greater PWT content, with pure PWT having the highest adsorption capacity toward BTEX removal: uptake capacities for xylene, ethylbenzene, toluene, and benzene were 526, 377, 207 and 127 µg/g sorbent, respectively. Heavy metal removal was increased by increasing the amount of PWT up to 10 wt%, and then decreased beyond this ratio. Compacted soil-PWT mixtures comprising 5-25 wt% PWT have relatively low dry unit weight, low compressibility, adequate shear capacity for many load-bearing field applications, and satisfactory adsorption of organic/inorganic contaminants, such that they could also be used as adsorptive fill materials.

Engineering Reactive Clay Systems by Ground Rubber Replacement and Polyacrylamide Treatment.

This study investigates the combined performance of ground rubber (GR), the additive, and polyacrylamide (PAM), the binder, as a sustainable solution towards ameliorating the inferior geotechnical attributes of an expansive clay. The first phase of the experimental program examined the effects of PAM concentration on the soil's mechanical properties-consistency, sediment volume attributes, compactability, unconfined compressive strength (UCS), reactivity and microstructure features. The second phase investigated the effects of GR content, with and without the optimum PAM concentration. An increase in PAM beyond 0.2 g/L, the identified optimum concentration, caused the excess PAM to act as a lubricant rather than a flocculant. This feature facilitated reduced overall resistance to sliding of soil particles relative to each other, thereby adversely influencing the improvement in stress-strain-strength response achieved for ≤0.2 g/L PAM. This transitional mechanism was further verified by the consistency limits and sediment volume properties, both of which exhibited only minor variations beyond 0.2 g/L PAM. The greater the GR content, the higher the mobilized UCS up to 10% GR, beyond which the dominant GR-to-GR interaction (i.e., rubber-clustering) adversely influenced the stress-strain-strength response. Reduction in the soil's swell-shrink capacity, however, was consistently in favor of higher GR contents. Addition of PAM to the GR-blended samples amended the soil aggregate-GR connection interface, thereby achieving further improvements in the soil's UCS and volume change behaviors. A maximum GR content of 20%, paired with 0.2 g/L PAM, managed to satisfy a major decrease in the swell-shrink capacity while improving the strength-related features, and thus was deemed as the optimum choice.

Effect of biodegradation on the consolidation properties of a dewatered municipal sewage sludge.

The effect of biodegradation on the consolidation characteristics of an anaerobically digested, dewatered municipal sewage sludge was studied. Maintained-load oedometer consolidation tests that included measurement of the pore fluid pressure response were conducted on moderately degraded sludge material and saturated bulk samples that had been stored under static conditions and allowed to anaerobically biodegrade further (simulating what would happen in an actual sewage sludge monofill or lagoon condition). Strongly degraded sludge material was produced after a storage period of 13 years at ambient temperatures of 5-15 degrees C, with the total volatile solids reducing from initially 70% to 55%. The sludge materials were highly compressible, although impermeable for practical purposes. Primary consolidation generally occurred very slowly, which was attributed to the microstructure of the solid phase, the composition and viscosity of the pore fluid, ongoing biodegradation and the high organic contents. The coefficient of primary consolidation values decreased from initially about 0.35m2/yr to 0.003-0.03m2/yr with increasing effective stress (sigmav'=3-100kPa). Initially, the strongly degraded sludge material was slightly more permeable, although both the moderately and strongly degraded materials became impermeable for practical purposes (k=10(-9)-10(-12)m/s) below about 650% and 450% water contents, respectively. Secondary compression became more dominant with increasing effective stress with a mean secondary compression index (Calphae) value of 0.9 measured for both the moderately and strongly degraded materials.

Sewage sludge to landfill: some pertinent engineering properties.

More stringent controls on the quality of wastewater discharges have given rise to increasing volumes of sewage sludge for disposal, principally to land, using either land-spreading or sludge-to-landfill operations. Current sludge-to-landfill methods generally involve mixing the concentrated sludge with other solid waste in municipal landfills. However, stricter waste disposal legislation and higher landfill taxes are forcing the water industry to look for more efficient disposal strategies. Landfill operators are also increasingly reluctant to accept sludge material in the slurry state because of construction difficulties and the potential for instability of the landfill slopes. The engineering and drying properties of a municipal sewage sludge are presented and applied, in particular, to the design, construction, and performance of sewage sludge monofills. Sludge handling and landfill construction are most effectively conducted within the water content range of 85% water content, the optimum water content for standard proctor compaction, and 95% water content, the sticky limit of the sludge material. Standard proctor compaction of the sludge within this water content range also achieves the maximum dry density of approximately 0.56 tonne/m3, which maximizes the storage capacity and, hence, the operational life of the landfill site. Undrained shear strength-water content data (pertinent to the stability of the landfill body during construction) and effective stress-strength parameters, which take into account the landfill age and the effects of ongoing sludge digestion, are presented. Landfill subsidence, which occurs principally because of creep and decomposition of the solid organic particles, is significant and continues indefinitely but at progressively slower rates.

Mechanical properties of dewatered sewage sludge.

The mechanical properties of dewatered, anaerobically digested sewage sludge were determined from soil laboratory tests. The sludge material is largely composed of organic clay sized-particles, a sizable fraction of which is in an active state of biological digestion which can continue over many years under field conditions. Moderately digested sludge material was found to have a typical specific gravity of solids value of 1.55, and loss on ignition (LOI) value of 70% dry mass. Strongly digested sludge, produced by digesting the liquid sludge further at 35 degrees C in the laboratory, was found to have a lower LOI value of 55% dry mass, and a higher specific gravity of solids value of about 1.72. The maximum dry density of 0.56 tonne/m3 for the dried sludge material was produced using standard Proctor compaction at roughly 85% moisture content (54% solids content). Air-dried, compacted sludge material was tested in quick-undrained triaxial compression and vane shear. Undrained shear strength-moisture content plots are presented. Shear strength values measured in triaxial compression and vane shear were consistent. The effective angle of shearing resistance (phi') was determined from consolidated-undrained, triaxial compression tests on pasteurized, normally consolidated samples of the sludge material. The mechanical properties of the sludge material changed with the level of sludge digestion. The phi' value increased from 32 degrees for moderately digested sludge, to 37 degrees for strongly digested sludge. The effective cohesion of the sludge material remained zero throughout. The shrinkage, swelling and adhesion properties of the sludge material were also studied. Significant shrinkage occurred as the compacted material dried. The sludge material lost its adhesion below about 95% moisture content (51% solids content). Re-hydration of the dry material caused the bulk volume to double.