Ethnic disparities in progression to advanced liver disease and overall survival in patients with chronic hepatitis C: impact of a sustained virological response

BACKGROUND

Chronic hepatitis C (CHC) can lead to cirrhosis and hepatocellular carcinoma (HCC). A sustained virological response (SVR) is associated with improved outcomes, however, its impact on different ethnic groups is unknown.

AIM

To evaluate ethnic differences in the natural history of CHC and the impact of SVR.

METHODS

We conducted a cohort study of 8039 consecutive adult CHC patients seen at two medical centres in California between January 1997 and June 2016. Individual chart review confirmed CHC diagnosis.

RESULTS

Asian and Hispanic but not African American patients had significantly higher cirrhosis and HCC incidence than Caucasians. On multivariate analysis, Hispanic ethnicity was independently associated with increased cirrhosis (adjusted HR 1.37, CI, confidence interval 1.10-1.71, P=.006) and HCC risk (adjusted HR 1.47, CI 1.13-1.92, P=.004) compared to Caucasian. Asian ethnicity had a significant association with cirrhosis (adjusted HR 1.28, CI 1.02-1.61, P=.034) and HCC risk (adjusted HR 1.29, CI 0.94-1.77, P=.025). In patients who achieved SVR, Hispanic ethnicity was no longer independently associated with cirrhosis (adjusted HR 1.76, CI 0.66-4.71, P=.26) or HCC (adjusted HR 1.05, CI 0.27-4.08, P=.94); nor was Asian ethnicity (adjusted HR 0.62, CI 0.21-1.82, P=.38 for cirrhosis; 2.01, CI 0.63-6.36, P=.24 for HCC). Similar findings were observed with overall survival among the ethnicities by SVR status.

CONCLUSION

Hispanic and Asian ethnicity was independently associated with increased cirrhosis and HCC risk. Achieving an SVR eliminates the ethnic disparity in liver disease progression and overall survival between Hispanic and Asian vs Caucasian CHC patients.

Effect of Load Deflection on Corrosion Behavior of NiTi Wire

For dental orthodontic applications, NiTi wires are used under bending conditions in the oral environment for a long period. The purpose of this study was to investigate the effect of bending stress on the corrosion of NiTi wires using potentiodynamic and potentiostatic tests in artificial saliva. The results indicated that bending stress induces a higher corrosion rate of NiTi wires in passive regions. It is suggested that the passive oxide film of specimens would be damaged under bending conditions. Auger electron spectroscopic analysis showed a lower thickness of passive films on stressed NiTi wires compared with unstressed specimens in the passive region. By scanning electron microscopy, localized corrosion was observed on stressed Sentalloy specimens after a potentiodynamic test at pH 2. In conclusion, this study indicated that bending stress changed the corrosion properties and surface characteristics of NiTi wires in a simulated intra-oral environment.

Effectiveness and tolerability of simeprevir and sofosbuvir in nontransplant and post-liver transplant patients with hepatitis C genotype 1

BACKGROUND

Hepatitis C virus genotype 1a (HCV-1a), prior treatment, cirrhosis and post-transplant status are historically associated with poor treatment responses. The new oral direct-acting agents appear to be effective and safe in these patients.

AIMS

To evaluate the effectiveness and tolerability of simeprevir and sofosbuvir in a diverse real-life cohort of patients, including difficult-to-treat patients.

METHODS

We conducted a retrospective cohort study in 198 consecutive patients with hepatitis C genotype 1 (148 nontransplant, 50 post transplant), who were treated with simeprevir and sofosbuvir for 12 weeks between December 2013 and December 2014. Primary outcome was sustained virological response with undetectable HCV RNA 12 weeks after completion of therapy (SVR12). Risk factors evaluated for lack of SVR12 included HCV 1a (vs. 1b), prior treatment (vs. none), and cirrhosis (vs. no cirrhosis).

RESULTS

SVR12 rates were similar in non- and post-transplant settings, 82% and 88%, respectively. There were no significant differences in adverse events in patients regardless of cirrhosis or transplant status. On multivariate analysis also inclusive of gender and liver transplant status, negative predictors of SVR12 were having at least 2 or 3 risk factors (OR 0.30, 95% CI 0.10-0.87, P = 0.027 or 0.29, 95% CI 0.09-0.85, P = 0.025, respectively).

CONCLUSION

Simeprevir and sofosbuvir combination is a safe and effective regimen for the treatment of non- and post-transplant patients with traditional risk factors for poor treatment response, unless more than 2 difficult-to-treat risk factors are present.

The triple-phase CT image appearance of post-irradiated livers

Objective To evaluate the sequential CT appearance of the liver after hepatic irradiation and to investigate the correlation between CT findings and radiation-induced hepatic injury.

Material and Methods: The triple-phase CT images of 18 patients with hepatocellular carcinomas (HCC) after hepatic irradiation were retrospectively reviewed (in total 41 CT studies). The high-dose region within the liver was defined as the area receiving more than 90% of the prescribed irradiation dose. The mean radiation dose was 55.5 Gy. Density changes and patterns of enhancement in the high-dose region were classified as three types: type I, constant low-density change in all phases; type II, low-density change in both pre-contrast and arterial phases, and iso-density change in the portal phase; type III, low- or iso-density change in the pre-contrast phase, low- or high-density change in the arterial phase, and persistent high-density change in the portal phase. The interval between completion of radiotherapy and the CT examinations ranged from 9 to 469 days, with a mean of 147 days.

Results: Nine of the 41 CT studies presented with type I, 9 with type II, and 16 with type III CT findings. The mean interval between completion of radiotherapy and the appearance of types I, II, and III CT findings were 74, 183, and 220 days, respectively. The interval was significantly shorter for type I findings than for type II and type III. The difference in interval was not significant between type II and type III. A type I finding with constant low-density change in the high-dose region of the liver was the most common pattern of CT findings within the first 3 months after hepatic irradiation. Either types II or III findings were frequently seen after 3 months.

Conclusion: The sequential CT appearance and the density changes may indicate correlation with the pathogenesis of veno-occlusive disease.

Risk factors associated with postcraniotomy meningitis: A retrospective study

Postcraniotomy meningitis (PCM) is a major challenge in neurosurgery, and changing patterns of infectious agents in PCM have been noted. The limited epidemiological data and urgent clinical needs motivated this research. We conducted this study to determine a risk assessment for PCM and the current pattern of infectious agents.We performed a retrospective case-control study of significant cases of postcraniotomy meningitis in the Changhua Christian Hospital System between January 1, 2008, and December 31, 2012. Postcraniotomy meningitis was diagnosed in 22 out of 4392 surgical patients; this data was reviewed for risk assessment.This study assessed the risk factors for postcraniotomy meningitis and found that it was more frequently seen in patients who were elderly (OR = 1.57, 95% CI = 1.32-2.98, P = 0.013), underwent emergency procedures (OR = 4.82, 95% CI = 1.50-14.53, P = 0.008), had leak of cerebrospinal fluid (OR = 4.62, 95% CI = 2.03-10.50, P = 0.012), had external ventricular drainage (OR = 4.68, 95% CI = 2.46-8.87, P = 0.006), were admitted to the intensive care unit (OR = 2.41, 95% CI = 1.53-8.08, P = 0.012), had used drain placement >72 hours (OR = 2.66, 95% CI = 1.04-4.29, P = 0.007), had surgery >4.5 hours (OR = 2.38, 95% CI = 1.39-4.05, P = 0.005), had repeat operations (OR = 2.74, 95% CI = 1.31-5.73, P = 0.018), endured trauma (OR = 5.97, 95% CI = 1.57-17.61, P = 0.007), or had 30-days mortality (OR = 5.07, 95% CI = 2.20-11.48, P = 0.001). The predominant pathogens isolated from cerebrospinal fluid were Staphylococcus aureus in 8 patients (36.7%) and Acinetobacter baumannii in 7 patients (31.8%). In our study, the mortality rate was 5.1% among all postcraniotomy patients.Accurate risk assessment, early diagnosis, and choice of appropriate antibiotics in accordance with epidemiologic information are the cornerstones of reducing mortality and morbidity in PCM. The changing pattern of infectious agents in PCM over time suggests the necessity of further studies to provide the most up-to-date insight to physicians.

Clinical manifestations, course, and outcome of patients with neutralizing anti-interferon-γ autoantibodies and disseminated nontuberculous mycobacterial infections

Neutralizing anti-interferon-γ autoantibody (nAIGA)-associated immunodeficiency is an emerging medical issue worldwide. In the present study, we describe and discuss the clinical features and outcomes of patients with nAIGAs and disseminated infections by nontuberculous mycobacteria (dNTM).We thoroughly reviewed the medical records of all patients. Microorganisms and nAIGAs were identified using previously described methods with modifications. All data were calculated and analyzed using SPSS software.Among 46 adult patients with dNTM infections, we identified 45 cases (97.8%) with nAIGAs. The average patient age was 58.6 years, and there was no sex predominance. Cervical lymphadenitis (81.8%) was the most common clinical manifestation. Endocrine disorder was the leading comorbidity (7 cases). Malignancies were found in 4 patients, and all of the malignancies originated from the T-cell/macrophage lineage. More than half of the identifiable isolates were slow-growing NTMs. Twenty-eight (62.2%) and 18 (40.0%) patients had a history of zoster and salmonellosis, respectively. A high proportion of patients with recurrent episodes of NTM infection or a history of zoster and dNTM infection had initial nAIGA titers ≥10 dilution (P < 0.05). Twenty-seven patients (60.0%) required long-term antimycobacterial therapy and had at least 1 episode of recurrent NTM disease. No mortality was related to dNTM infection.In Taiwan, nAIGAs are a recently recognized mechanism of dNTM infection. Long term of antibiotic treatment and adherence to medical advice are necessary to improve the clinical outcome of patients with nAIGAs.

Low-frequency fluctuations in an external-cavity laser leading to extreme events

We experimentally investigate the dynamical regimes of a laser diode subject to external optical feedback in light of extreme-event (EE) analysis. We observe EEs in the low-frequency fluctuations (LFFs) regime. This number decreases to negligible values when the laser transitions towards fully developed coherence collapse as the injection current is increased. Moreover, we show that EEs observed in the LFF regime are linked to high-frequency pulsing events observed after a power dropout. Finally, we prove experimentally that the observation of EEs in the LFF regimes is robust to changes in operational parameters.

The experience of intramuscular benzathine penicillin for prophylaxis of recurrent cellulitis: A cohort study

BACKGROUND/PURPOSE

Recurrent cellulitis is an important clinical issue but the optimal strategy for prophylaxis is not determined. Intramuscular benzathine penicillin at a 4-week interval had been adopted in our hospital and the study was conducted to evaluate the efficacy.

METHODS

From January 1, 2009 to May 31, 2013, all patients aged ≥ 18 year, with a history of recurrent cellulitis and having received at least three shots of intramuscular benzathine penicillin for prophylaxis were retrospectively recruited for analysis. Two treatment periods (prophylaxis period and nonprophylaxis period) were defined. The effects of benzathine penicillin prophylaxis and patient characteristics on the incidence rate of recurrent cellulitis were analyzed using Poisson regression model.

RESULTS

A total of 72 patients were enrolled, including 26 (36.1%) men. The most common underlying conditions were past surgery at the proximal side of the affected limb (38, 52.8%), malignancy (31, 43.1%), and diabetes mellitus (24, 33.3%). The incidence rate of recurrent cellulitis in the prophylaxis period was 0.73 episode/patient-year, significantly lower than that of 1.25 episodes/patient-year in the nonprophylaxis period (p < 0.001). Tinea pedis was a significant factor associated with increasing incidence of recurrent cellulitis in our cohort.

CONCLUSION

Intramuscular benzathine penicillin at a 4-week interval may be an effective prophylactic strategy to reduce the incidence of cellulitis. Further studies are necessary to determine the factors associated with failure of prophylaxis as well as optimal individualized dosage and dosing interval of the prophylactic agent.

First records of parasitic copepods (Crustacea, Siphonostomatoida) from marine fishes in Korea

The knowledge of the biodiversity of parasitic copepods in South Korea is increasing. Interestingly we report here, some parasitic copepods considered as the first record of findings from Korea. Nine species of parasitic copepods (Siphonostomatoida) including six genera of three different families [Caligidae (7), Lernaeopodidae (1), Lernanthropidae (1)] were recovered from eight species of wild fishes in Korea: 1) Caligus hoplognathi Yamaguti & Yamasu, 1959 (♀, ♂) from the body surface of barred knifejaw Oplegnathus fasciatus (Temminck & Schlegel); 2) Caligus lagocephali Pillai, 1961 (♀) from the gills of panther puffer Takifugu pardalis (Temminck & Schlegel); 3) Euryphorus brachypterus (Gerstaecker, 1853) (♀, ♂) from the opercular cavity of Atlantic bluefin tuna Thunnus thynnus (Linnaeus); 4) Euryphorus nordmanni Milne Edwards, 1840 (♀, ♂) from the opercular cavity of common dolphin fish Coryphaena hippurus Linnaeus; 5) Gloiopotes huttoni (Thomson) (♀, ♂) from the body surface of black marlin Istiompax indica (Cuvier); 6) Lepeophtheirus hapalogenyos Yamaguti & Yamasu, 1959 (♀) from the gill filaments of O. fasciatus; 7) Lepeophtheirus sekii Yamaguti, 1936 (♀, ♂) from the body surface of red seabream Pagrus major (Temminck & Schlegel); 8) Brachiella thynni Cuvier, 1830 (♀) from the body surface of longfin tuna or albacore Thunnus alalunga (Bonnaterre); 9) Lernanthropinus sphyraenae (Yamaguti & Yamasu, 1959) (♀) from the gill filaments of moon fish Mene maculata (Bloch & Schneider). Since the female was already reported in Korea, it is a new record for the male of C. hoplognathi. A checklist for the parasitic copepods of the family Caligidae, Lernaeopodidae and Lernanthropidae of Korea is provided.

An unexpected route for otolaryngology bacterial contamination with a Venturi atomizer

BACKGROUND

The Venturi-principle atomizer is a commonly used device in otolaryngology practices. The purpose of this study is to evaluate the possible route of bacterial contamination from the nasal vestibule to the atomizer tip through the jet airflow created during the use of the Venturi atomizer.

METHODS

Thirty nostrils from 15 enrolled volunteers were tested. The aerosols generated by spraying sterilized saline into the nostrils were collected using a specially made aerosol-collecting nozzle cap. The collected samples were sent for bacterial culture, and nasal vestibular swab cultures were performed for comparison.

RESULTS

In the aerosol-exposed group, 18 out of 30 samples (60%) were positive for bacterial growth, confirming the bacterial contamination from the nasal vestibule to the atomizer tip through the reverse jet airflow. The bacteria species in 8 of the 18 positive samples were identical to those from the nasal swab culture results from the same nostril.

CONCLUSION

In ordinary otolaryngology practices, there are significant risks for bacterial contamination from the nasal vestibule to the tip of the Venturi atomizer even without direct contact. Clinicians must be more aware of this pattern of contamination, which has not been reported in the existing literature.

Cardiac transplantation and concomitant coronary artery bypass grafting: our experiences in 11 cases

INTRODUCTION

The shortage of donor hearts for transplantation could be alleviated by including the hearts of older donors. Previous literature revealed similar early and medium-term survival outcomes compared with those of younger donors. This study presents our experience with patients who underwent orthotopic heart transplantation and concomitant coronary artery bypass grafting at our institution.

METHODS

We present our experience with 11 patients with end-stage cardiomyopathy (8 men and 3 women) undergoing orthotopic heart transplantation and concomitant coronary artery bypass grafting from September 2002 to November 2011 at our institute.

RESULTS

All 11 donor organs would otherwise have been rejected, depriving potential recipients of organ transplantation. Two patients received concurrent 2-coronary-artery bypass, and the other 9 patients received concurrent single-coronary-artery bypass during orthotopic heart transplantation. All patients had an uneventful postoperative course, with follow-up completed 3 to 128 months after cardiac transplantation and concomitant coronary artery bypass grafting surgery.

CONCLUSIONS

Our experiences suggest that donor hearts requiring coronary artery bypass grafting, which form a small but significant donor subgroup, can be used effectively and safely when matched to the recipients' age and medical condition.

Changing epidemiology of candidemia in a medical center in middle Taiwan

BACKGROUND

Candidemia remains a major cause of morbidity and mortality in the health care setting, and the epidemiology of Candida infection is changing.

METHODS

Clinical and laboratory data from patients with candidemia were collected retrospectively at a tertiary medical center in Taiwan from July 1, 2009 to June 30, 2012 (a 36-month period). Demographics, clinical characteristics, and drug susceptibility of the invading Candida species of patients at the onset of candidemia were analyzed and compared with previous study from January 1, 2001 to June 30, 2003 (a 30-month period).

RESULTS

A total of 209 episodes of candidemia in 205 patients were identified in this study period. When compared with the previous study period, more patients were admitted for medical conditions at percentages ranging from 49.5% to 69.8%; the incidence rate of health care-associated candidemia increased from 0.76 to 1.14 per 1000 discharges; the proportion of Candida albicans in patients with candidemia decreased from 64.8% to 43.6% whereas the proportion of Candida glabrata increased greatly from 1.1% to 21.6% and the proportions of Candida tropicalis and Candida parapsilosis were slightly elevated (19.8-22.0% and 2.2-7.3%, respectively). All of the C. albicans isolates remained susceptible to fluconazole, whereas 66.7% of C. glabrata isolates were dose-dependent susceptible, and 4.4% of C. glabrata isolates and 11.6% C. tropicalis isolates were resistant. There was one C. glabrata and one Candida guilliermondii resistant to echinocandin. The predictors for 30-day mortality included the high Acute Physiology and Chronic Health Evaluation II (APACHE II) score, use of parenteral nutrition, underlying malignancy, liver cirrhosis, and neutropenia whereas candidemia by C. parapsilosis or C. glabrata is a favorable predictor when compared with C. albicans.

CONCLUSION

The distribution of Candida species in candidemia was changed. Although C. albicans remained the major species, the isolation of non-C. albicans spp., especially C. glabrata, increased. Patients with candidemia still had high mortalities due to severity of illness and underlying conditions.

Can iterative reconstruction improve imaging quality for lower radiation CT perfusion? Initial experience

BACKGROUND AND PURPOSE

Initial results using IR for CT of the head showed satisfactory subjective and objective imaging quality with a 20-40% radiation dose reduction. The aim of our study was to compare the influence of IR and FBP algorithms on perfusion parameters at standard and lowered doses of CTP.

MATERIALS AND METHODS

Forty patients with unilateral carotid stenosis post-carotid stent placement referred for follow-up CTP were divided into 2 groups (tube currents were 100 mAs in group A and 80 mAs in group B). Datasets were reconstructed with IR and FBP algorithms; and SNRs of gray matter, white matter, and arterial and venous ROIs were compared. CBF, CBV, and MTT means and SNRs were evaluated by using linear regression, and qualitative imaging scores were compared across the 2 algorithms.

RESULTS

The mean effective radiation dose of group B (2.06 mSv) was approximately 20% lower than that of group A (2.56 mSv). SNRs for ROIs in the dynamic contrast-enhanced images were significantly higher than those for the FBP images. Correlations of the SNRs for CBF, CBV, and MTT across the 2 algorithms were moderate (R² = 0.46, 0.23, and 0.44, respectively). ROIs in gray matter rather than the IR algorithm predicted increasing SNRs in all CBF, CBV, and MTT maps. Two cases of significant restenosis were confirmed in both algorithms. CBV, CBF, and MTT imaging scores did not differ significantly across algorithms or groups.

CONCLUSIONS

Lower dose CTP (20% below normal dose) without IR can effectively identify oligemic tissue in poststenting follow-up. IR does not alter the absolute values or increase the SNRs of perfusion parameters. Other methods should be attempted to improve SNRs in settings with low tube currents.

Multiplex polymerase chain reaction assay for the detection of minute virus of mice and mouse parvovirus infections in laboratory mice

Mouse parvoviruses are among the most prevalent infectious pathogens in contemporary mouse colonies. To improve the efficiency of routine screening for mouse parvovirus infections, a multiplex polymerase chain reaction (PCR) assay targeting the VP gene was developed. The assay detected minute virus of mice (MVM), mouse parvovirus (MPV) and a mouse housekeeping gene (α-actin) and was able to specifically detect MVM and MPV at levels as low as 50 copies. Co-infection with the two viruses with up to 200-fold differences in viral concentrations can easily be detected. The multiplex PCR assay developed here could be a useful tool for monitoring mouse health and the viral contamination of biological materials.

Adverse postoperative outcomes in surgical patients with immune thrombocytopenia

Background

Patients with immune thrombocytopenia (ITP) are likely to have various medical co-morbidities, yet their global features regarding adverse postoperative outcomes and use of medical resources when undergoing major surgery are unknown. The objective of this study was to validate whether ITP is an independent risk factor for adverse postoperative outcomes, and to explore the potential clinical predictors of outcomes after major surgery among patients with ITP.

Methods

A retrospective population-based cohort study was conducted using Taiwan's National Health Insurance Research Database, controlling for preoperative co-morbidities by means of multiple logistic regression. Major postoperative complication and mortality rates, and in-hospital medical costs were analysed.

Results

The study included 11 085 surgical patients with ITP and 44 340 controls without ITP matched for sex, age, and type of surgery and anaesthesia. Surgical patients with ITP had a higher risk of postoperative death (odds ratio (OR) 1·89, 95 per cent confidence interval 1·57 to 2·27), and overall postoperative complications (OR 1·47, 1·39 to 1·56), and increased hospital stay (OR 1·90, 1·80 to 2·01), admission to the intensive care unit (OR 1·73, 1·63 to 1·83) and medical costs (OR 1·89, 1·79 to 1·99). Amount of preoperative platelet and/or red blood cell transfusion, emergency visits and admission to hospital for ITP care were identified as risk factors for adverse postoperative outcomes.

Conclusion

Patients with ITP undergoing surgery are at increased risk of adverse perioperative events, particularly if blood or blood product transfusion are required preoperatively, or the procedure is done as an emergency.

Nonadverse effects on allergenicity of isopentenyltransferase-transformed broccoli

BACKGROUND

Genetically modified organisms (GMOs) provide modern agriculture with improvements in efficiency and the benefits of enhanced food production; however, the potential impact of GMOs on human health has not yet been clarified.

OBJECTIVE

To investigate the allergenicity of isopentenyltransferase (ipt)-transformed broccoli compared with non-GM broccoli.

METHODS

Sera from allergic individuals were used to identify the allergenicity of GM and non-GM broccoli. Immunoglobulin (Ig) binding of different lines of GM and non-GM broccoli was identified using immunoblotting, enzyme-linked immunosorbent assay, and the histamin release assay.

RESULTS

Positive reactions to broccoli (Brassica Oleracea) were observed in 7.02% of individuals. Specific IgE to broccoli and total IgE fro allergic individuals were well correlated. The different tests performed showed no significant differences in the allergenicity of conventionally raised and GM broccoli, indicating the absence of unexpected effects on allergenicity in ipt-transformed plants. Using Western blot analysis we detected heterogeneous IgE-reactive allergenic components in broccoli-allergic sera, but no significant differences between GM an non-GM broccoli were observed in serum from the same patients.

CONCLUSIONS

Our study demonstrates that there are no differences between GM (ipt-transformed) broccoli and non-GM broccoli, as determined by specific IgE in sera from broccoli-allergic patients. This indicates that there were no unexpected effects on allergenicity in this GM broccoli.

Combined heart transplantation and total replacement of thoracic aorta in Marfan's syndrome with recurrent aortic dissection: a case report

It is extremely rare for a patient to need simultaneous heart transplantation (HTx) and replacement of the thoracic aorta. A 23-year-old woman with Marfan's syndrome underwent Bentall's operation and replacement of the ascending aorta (AsA) due to a type A aortic dissection (AD) in August 2001. In March 2005, she began to experience dyspnea on exertion and was found to have a huge pseudoaneurysm at the aortic root, which had caused dehiscence of the aortic conduit. In July 2009, she suffered acute chest pain followed by hypotension and cold sweating. The computed tomography (CT) scan showed a recurrent dissection with a long intimal tear extending from the arch to the mid-portion of the descending thoracic aorta (DTA). Due to technical difficulties in the repair of the aortic root, she was placed on the HTx waiting list. The next day, she received a donor heart and underwent combined HTx and total replacement of the thoracic aorta. Explantation of the heart improved the exposure of the DTA. With the use of a vascular ring connector (Vasoring), the operation was successfully performed without need for a blood transfusion. The patient was still well at 2 years after the operation. Simultaneous replacement of the heart and the whole segment of the thoracic aorta is technically possible in Marfan patients who are complicated with aortic dissection.

Effect of organic loading rate on organic matter and foulant characteristics in membrane bio-reactor

In this study, the influence of organic loading rate (OLR) on the performance of a membrane bio-reactor (MBR) was investigated. The MBR was operated with 6 different OLRs between 0.5 and 3.0 kg COD/m(3)d. The hydrodynamic parameters of the MBR were kept constant. The hydraulic retention time and sludge retention time were kept at 8h and 40 d respectively. From the experimental investigation, it was found that the removal efficiency of DOC, COD and NH(4)-N decreased when OLRs were increased from 0.5 to 3.0 kg COD/m(3)d. Higher OLRs of 2.75-3.0 kg COD/m(3)d resulted in a higher transmembrane pressure development. The fractionation of organic matters showed more hydrophilic substances with higher OLRs. A detailed organic matter characterization of membrane foulant, soluble microbial product and extracellular polymeric substances showed that bio-polymers type substances together with humic acid and lower molecular neutral and acids were responsible for membrane fouling.

Monitoring peri-therapeutic cerebral circulation time: a feasibility study using color-coded quantitative DSA in patients with steno-occlusive arterial disease

BACKGROUND AND PURPOSE

Intracranial hemodynamics are important for management of SOAD. This study aimed to monitor peri-stent placement intracranial CirT of patients with SOAD.

MATERIALS AND METHODS

Twenty-five patients received stent placement for extracranial ICA stenosis, and 34 patients with normal CirT were recruited as controls. Their color-coded DSAs were used to define the Tmax of selected intravascular ROI. A total of 20 ROIs of the ICA, OphA, ACA, MCA, FV, PV, OV, SSS, SS, IJV, and MCV were selected. rTmax was defined as the Tmax at the selected region of interest minus Tmax at the cervical segment of the ICA (I1 on AP view and IA on lateral view). rTmax of the PV was defined as intracranial CirT. Intergroup and intragroup longitudinal comparisons of rTmax were performed.

RESULTS

rTmax values of the normal cohorts were as follows: ICA-AP, 0.12; ICA-LAT, 0.10; A1, 0.28; A2, 0.53; A3, 0.81; M1, 0.40; M2, 0.80; M3, 0.95; OphA, 0.35; FV, 4.83; PV, 5.11; OV, 5.17; SSS, 6.16; SS, 6.51; IJV, 6.81; and MCV, 3.86 seconds. Before stent placement, the rTmax values of arterial ROIs, except A3 and M3, were prolonged compared with values from control subjects (P < .05). None of the rTmax of any venous ROIs in the stenotic group was prolonged with significance. After stent placement, the rTmax of all arterial ROIs shortened significantly, except A1and M3. Poststenting rTmax was not different from the control group.

CONCLUSIONS

Without extra contrast medium and radiation dosages, color-coded quantitative DSA enables real-time monitoring of peri-therapeutic intracranial CirT in patients with SOAD .

Preventive vertebroplasty for adjacent vertebral bodies: a good solution to reduce adjacent vertebral fracture after percutaneous vertebroplasty

BACKGROUND AND PURPOSE

Adjacent VCF frequently occurs after percutaneous vertebroplasty. Our aim was to evaluate PrVP in the prevention of PVNO-adjacent VCF.

MATERIALS AND METHODS

Radiographs of 68 patients who initially presented with a single-level unhealed fracture and underwent vertebroplasty were retrospectively reviewed for the occurrence of PVNO fracture. Patients in the nonpreventive group (n = 33) underwent TVP only for a vertebra with an unhealed fracture. The preventive group (n = 35) underwent PrVP combined with TVP. We injected bone cement into the caudal part of the superior adjacent vertebra and the cephalic part of the inferior adjacent vertebra to perform PrVP.

RESULTS

The incidences of PVNO fracture in adjacent vertebra next to a vertebra cemented at the patient's first vertebroplasty (within 6 months: 24% versus 3%, P = .012; within 1 year: 30% versus 3%, P = .006; >4 years: 39% versus 3%, P = .006) markedly decreased in the preventive group compared with the nonpreventive group. PVNO fracture was found in 26% of vertebrae adjacent to the first TVP level in the nonpreventive group and in 2% of vertebrae adjacent to a PrVP level in the preventive group after inclusion of all PrVP procedures. Approximately 33% of patients in the nonpreventive group underwent repeat vertebroplasty, mainly due to adjacent fractures. Only 3% of patients in the preventive group underwent repeated procedures. None of the vertebrae cemented for PrVP or TVP developed PVNO refracture.

CONCLUSIONS

Preventive vertebroplasty for the adjacent vertebra combined with TVP for the fractured vertebra is effective in the prevention of propagation of PVNO adjacent fractures, thus reducing the necessity of multiple repeat vertebroplasty procedures.

Effects of spiked metals on the MSW anaerobic digestion

This study aimed to investigate the effects of eight metals on the anaerobic digestion of the organic fraction of municipal solid waste (OFMSW) in bioreactors. Anaerobic bioreactors containing 200 mL MSW mixed completely with 200 m L sludge seeding. Ca and K (0, 1000, 2000 and 6,000 mg L(-1)) and Cr, Ni, Zn, Co, Mo and W (0, 5, 50 and 100 mg  L(-1)) of various dose were added to anaerobic bioreactors to examine their anaerobic digestion performance. Results showed that except K and Zn, Ca (~728 to ~1,461 mg  L(-1)), Cr (~0.0022 to ~0.0212 mg  L(-1)), Ni (~0.801 to ~5.362 mg  L(-1)), Co (~0.148 to ~0.580 mg  L(-1)), Mo (~0.044 to ~52.94 mg  L(-1)) and W (~0.658 to ~40.39 mg  L(-1)) had the potential to enhance the biogas production. On the other hand, except Mo and W, inhibitory concentrations IC(50) of Ca, K, Cr, Ni, Zn and Co were found to be ~3252, ~2097, ~0.124, ~7.239, ~0.482, ~8.625 mg  L(-1), respectively. Eight spiked metals showed that they were adsorbed by MSW to a different extent resulting in different liquid metals levels and potential stimulation and inhibition on MSW anaerobic digestion. These results were discussed and compared to results from literature.