First-Line Use of Core Needle Biopsy for High-Yield Preliminary Diagnosis of Thyroid Nodules

BACKGROUND AND PURPOSE

Although core needle biopsy was introduced as a diagnostic alternative to fine-needle aspiration, the utility and safety of core needle biopsy for thyroid nodules in a large population has yet to be studied comprehensively. We evaluate core needle biopsy yields on a large-scale basis to investigate its potential in the preliminary diagnosis of thyroid nodules.

MATERIALS AND METHODS

Between March 2005 and December 2013, 2448 initially detected thyroid nodules from 2120 consecutive patients who underwent core needle biopsy were retrospectively evaluated. Of these, 72 thyroid nodules from 63 patients were excluded due to prior fine-needle aspiration attempts. The inconclusive and conclusive result rates, diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and unnecessary surgery rate of core needle biopsy were evaluated.

RESULTS

With core needle biopsy as the first-line method, the inconclusive result rate was 11.9% (283/2376) and the conclusive result rate was 88.1% (2093/2376). The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of core needle biopsy for the diagnosis of malignancy were 96.7% (1160/1200), 89.7% (347/387), 100% (813/813), 100% (347/347), and 95.3% (813/853), respectively. There were no major complications and 12 minor complications.

CONCLUSIONS

We have demonstrated that first-line use of core needle biopsy may well improve diagnostic accuracy in thyroid nodules, reducing inconclusive or false-negative results and unnecessary operations. Such benefits underscore the promising role of core needle biopsy in managing thyroid nodules and optimizing related surgical decision-making.

Fate and fouling characteristics of fluorescent dissolved organic matter in ultrafiltration of terrestrial humic substances

Ultrafiltration (UF) membrane fouling caused by terrestrial input of dissolved organic matter (DOM), especially during high flood periods, is poorly understood. In this study, we examined the fouling characteristics of three different terrestrial humic substances (HS) on regenerated cellulose (RC) UF membranes with the pore sizes of 30 k-3 kDa via conventional bulk HS measurements as well as an advanced fluorescence spectroscopy. The fluorescence excitation-emission matrix coupled with parallel factor analysis (EEM-PARAFAC) identified one protein-like (C1) and three humic-like fluorescent components (C2-C4) from soil and leaf-derived HS. The fate of the different fluorescent components was individually tracked for the UF processes. The higher removal rates were found generally on the order of high molecular weight (HMW) C1 to smaller sized humic-like components (C4 > C3 > C2) regardless of the HS sources, implying the importance of HS molecular sizes on the UF operation. Among the humic-like components, C2 was the most associated with irreversible fouling, while other two humic-like components contributed more to reversible fouling. For soil-derived HS, C4 can be suggested as a good surrogate for membrane fouling, as evidenced by the highest correlation between the removal rates and the total fouling indices among the tested HS variables including conventional bulk parameters. Our study demonstrated a promising application of EEM-PARAFAC for probing membrane fouling of terrestrial DOM, which provided additional insight into the fate of different fluorescent components on the UF processes.

Influences of NOM composition and bacteriological characteristics on biological stability in a full-scale drinking water treatment plant

The influences of natural organic matter (NOM) and bacteriological characteristics on the biological stability of water were investigated in a full-scale drinking water treatment plant. We found that prechlorination decreased the hydrophobicity of the organic matter and significantly increased the high-molecular-weight (MW) dissolved organic matter, such as biopolymers and humic substances. High-MW organic matter and structurally complex compounds are known to be relatively slowly biodegradable; however, because of the prechlorination step, the indigenous bacteria could readily utilise these fractions as assimilable organic carbon. Sequential coagulation and sedimentation resulted in the substantial removal of biopolymer (74%), humic substance (33%), bacterial cells (79%), and assimilable organic carbon (67%). Rapid sand and granular activated carbon filtration induced an increase in the low-nucleic-acid content bacteria; however, these bacteria were biologically less active in relation to enzymatic activity and ATP. The granular activated carbon step was essential to securing biological stability (the ability to prevent bacterial growth) by removing the residual assimilable organic carbon that had formed during the ozone treatment. The growth potential of Escherichia coli and indigenous bacteria were found to differ in respect to NOM characteristics. In comparison with E. coli, the indigenous bacteria utilised a broader range of NOM as a carbon source. Principal component analysis demonstrated that the measured biological stability of water could differ, depending on the NOM characteristics, as well as on the bacterial inoculum selected for the analysis.

Smartphone-Based Psychotherapeutic Micro-Interventions to Improve Mood in a Real-World Setting

BACKGROUND

Using mobile communication technology as new personalized approach to treat mental disorders or to more generally improve quality of life is highly promising. Knowledge about intervention components that target key psychopathological processes in terms of transdiagnostic psychotherapy approaches is urgently needed. We explored the use of smartphone-based micro-interventions based on psychotherapeutic techniques, guided by short video-clips, to elicit mood changes.

METHOD

As part of a larger neurofeedback study, all subjects-after being randomly assigned to an experimental or control neurofeedback condition-underwent daily smartphone-based micro-interventions for 13 consecutive days. They were free to choose out of provided techniques, including viscerosensory attention, emotional imagery, facial expression, and contemplative repetition. Changes in mood were assessed in real world using the Multidimensional Mood State Questionnaire (scales: good-bad, GB; awake-tired, AT; and calm-nervous, CN).

RESULTS

Twenty-seven men participated on at least 11 days and were thus included in the analyses. Altogether, they underwent 335, generally well-tolerated, micro-intervention sessions, with viscerosensory attention (178 sessions, 53.13%) and contemplative repetition (68 sessions, 20.30%) being the most frequently applied techniques. Mixed models indicated that subjects showed better mood [GB: b = 0.464, 95%confidence interval (CI) [0.068, 0.860], t (613.3) = 2.298, p = 0.022] and became more awake [AT: b = 0.514, 95%CI [0.103, 0.925], t (612.4) = 2.456, p = 0.014] and calmer [CN: b = 0.685, 95%CI [0.360, 1.010], t (612.3) = 4.137, p < 0.001] from pre- to post-micro-intervention. These mood improvements from pre- to post-micro-intervention were associated with changes in mood from the 1st day until the last day with regard to GB mood (r = 0.614, 95%CI [0.297, 0.809], p < 0.001), but not AT mood (r = 0.279, 95%CI [-0.122, 0.602], p = 0.167) and CN mood (r = 0.277, 95%CI [0.124, 0.601], p = 0.170).

DISCUSSION

Our findings provide evidence for the applicability of smartphone-based micro-interventions eliciting short-term mood changes, based on techniques used in psychotherapeutic approaches, such as mindfulness-based psychotherapy, transcendental meditation, and other contemplative therapies. The results encourage exploring these techniques' capability to improve mood in randomized controlled studies and patients. Smartphone-based micro-interventions are promising to modify mood in real-world settings, complementing other psychotherapeutic interventions, in line with the precision medicine approach. The here presented data were collected within a randomized trial, registered at ClinicalTrials.gov (Identifier: NCT01921088) https://clinicaltrials.gov/ct2/show/NCT01921088.

Comparison of Antibiotic Resistance Removal Efficiencies Using Ozone Disinfection under Different pH and Suspended Solids and Humic Substance Concentrations

This study mainly evaluated the effectiveness of ozonation toward the enhancement of the removal efficiencies of antibiotic-resistant bacteria (ARB), pB10 plasmid transfer, and pB10 plasmids under different pH and suspended solids (SS) and humic acid concentrations. First, chlorination was tested as a reference disinfection process. Chlorination at a very high dose concentration of Cl2 (75 mg L(-1)) and a long contact time (10 min) were required to achieve approximately 90% ARB and pB10 plasmid transfer removal efficiencies. However, even these stringent conditions only resulted in a 78.8% reduction of pB10 plasmid concentrations. In case of ozonation, the estimated CT (concentration × contact time) value (at C0 = 7 mg L(-1)) for achieving 4-log pB10 plasmid removal efficiency was 127.15 mg·min L(-1), which was 1.04- and 1.25-fold higher than those required for ARB (122.73 mg·min L(-1)) and a model nonantibiotic resistant bacterial strain, E. coli K-12, (101.4 mg·min L(-1)), respectively. In preventing pB10 plasmid transfer, ozonation achieved better performance under conditions of higher concentrations of humic acid and lower pH. Our study results demonstrated that the applicability of CT concept in practice, conventionally used for disinfection, might not be appropriate for antibiotic resistance control in the wastewater treatment process. Further studies should be conducted in wastewater engineering on how to implement multiple barriers including disinfection to prevent ARB and ARG discharge into the environment.

Synchrotron Small-Angle X-ray Scattering Study of Cross-Linked Polymeric Micelles

Polymeric micelles of methoxypoly(ethylene glycol)-b-poly(lactide) containing lysine units (mPEG-PLA-Lys4) were cross-linked by reacting of lysine moieties with a bifunctional bis(N-hydroxy-succinimide ester). The micelles were characterized in aqueous solution using dynamic light scattering, transmission electron microscopy, and synchrotron small-angle X-ray scattering. The mPEG-PLA-Lys4 was synthesized through the ring-opening polymerization of N6-carbobenzyloxy-L-lysine N-carboxyanhydride with amine-terminated mPEG-PLA and subsequent deprotection. The polymeric micelles showed enhanced micelle stability after cross-linking, which was confirmed by adding sodium dodecyl sulfate as a destabilizing agent. The average diameters measured via dynamic light scattering were 19.1 nm and 29.2 nm for non-cross-linked polymeric micelles (NCPMs) and cross-linked polymeric micelles (CPMs), respectively. The transmission electron microscopy images showed that the size of the polymeric micelles increased slightly due to cross-linking, which was in good agreement with the DLS measurements. The overall structures and internal structural changes of NCPMs and CPMs in aqueous solution were studied in detail using synchrotron X-ray scattering method. According to the structural parameters of X-ray scattering analysis, CPMs with a more densely packed core structure were formed by reacting bifunctional cross-linking agents with lysine amino groups located in the innermost core of the polymeric micelles.

Effects of Anesthetic Agent Propofol on Postoperative Sex Hormone Levels

Introduction: Several studies have found anesthetic agents including propofol in ovarian follicular fluid. However, little is known about the effect of anesthetic agents on ovarian function. We aimed to investigate whether there were differences in the postoperative levels of sex hormones when propofol was used as the anesthetic agent. Methods: A retrospective review was done of 80 patients who underwent ovarian surgery, with 72 infertile women serving as controls. Patients were included in the study if their serum estradiol (E2) and follicle stimulating hormone (FSH) levels were measured during their first postoperative menstrual cycle. Results: Patients were grouped according to the use or non-use of propofol as follows: propofol group (n = 39) and non-propofol group (n = 41). The control group did not undergo surgery. Postoperative E2 levels did not differ between the three groups, but FSH levels were significantly higher in the patients who had undergone surgery compared to controls (p < 0.05). Post-hoc analysis of E2 and FSH levels in the propofol and non-propofol groups did not show any significant differences. Conclusions: The use of propofol did not result in any differences compared to other anesthetic agents in terms of postoperative sex hormone levels after gynecologic surgery. The type of anesthetic agent does not seem to affect the postoperative levels of female sex hormones.

Antioxidative and antiinflammatory activities of quercetin-loaded silica nanoparticles

Utilizing the biological activities of compounds by encapsulating natural components in stable nanoparticles is an important strategy for a variety of biomedical and healthcare applications. In this study, quercetin-loaded silica nanoparticles were synthesized using an oil-in-water microemulsion method, which is a suitable system for producing functional nanoparticles of controlled size and shape. The resulting quercetin-loaded silica nanoparticles were spherical, highly monodispersed, and stable in an aqueous system. Superoxide radical scavenging effects were found for the quercetin-loaded silica nanoparticles as well as free quercetin. The quercetin-loaded silica nanoparticles showed cell viability comparable to that of the controls. The amounts of proinflammatory cytokines produced by macrophages, such as interleukin 1 beta, interleukin 6, and tumor necrosis factor alpha, were reduced significantly for the quercetin-loaded silica nanoparticles. These results suggest that the antioxidative and antiinflammatory activities of quercetin are maintained after encapsulation in silica. Silica nanoparticles can be used for the effective and stable incorporation of biologically active natural components into composite biomaterials.

In vitro Screening for Antioxidant, Antimicrobial, and Antidiabetic Properties of Some Korean Native Plants on Mt. Halla, Jeju Island

In this study, Prunus padus, Lonicera caerulea, Berberis amurensis, and Ribes maximowiczianum, which are mainly distributed on Mt. Halla, Jeju Island, have been investigated for their antioxidant, antimicrobial, and antidiabetic activities. The methanol extracts of R. maximowiczianum leaves and P. padus branches exhibited significant and dose-dependent antioxidant activity including electron-donation ability and reducing power. To analyze the antimicrobial activity, each extract was tested by a serial two-fold dilution method against five selected gram-positive bacteria and four gram-negative bacteria, and this suggested that P. padus branches possessed the maximum antimicrobial activity against most of the gram-positive bacteria tested. In addition, the methanol extracts of P. padus branches exhibited the highest α-glucosidase inhibitory activity with an IC₅₀ value of 1.0±0.1 μg/ml, indicating that P. padus is a promising source as a herbal medicine.

Evaluating integrated strategies for robust treatment of high saline piggery wastewater

In this study, we integrated physicochemical and biological strategies for the robust treatment of piggery effluent in which high levels of organic constituents, inorganic nutrients, color, and salts remained. Piggery effluent that was stabilized in an anaerobic digester was sequentially coagulated, micro-filtered, and air-stripped prior to biological treatment with mixotrophic algal species that showed tolerance to high salinity (up to 4.8% as Cl(-)). The algae treatment was conducted with continuous O2 supplementation instead of using the combination of high lighting and CO2 injection. The microalga Scenedesmus quadricauda employed as a bio-agent was capable of assimilating both nitrogen (222 mg N g cell(-1) d(-1)) and phosphorus (9.3 mg P g cell(-1) d(-1)) and utilizing dissolved organics (2053 mg COD g cell(-1) d(-1)) as a carbon source in a single treatment process under the heterotrophic growth conditions. The heterotrophic growth of S. quadricauda proceeded rapidly by directly incorporating organic substrate in the oxidative assimilation process, which coincided with the high productivity of algal biomass, accounting for 2.4 g cell L(-1) d(-1). The algae-treated wastewater was subsequently ozonated to comply with discharge permits that limit color in the effluent, which also resulted in improved biodegradability of residual organics. The integrated treatment scheme proposed in this study also achieved 89% removal of COD, 88% removal of TN, and 60% removal of TP. The advantage of using the hybrid configuration suggests that this would be a promising strategy in full-scale treatment facilities for piggery effluent.

Folic Acid-Functionalized Polythiophene for Targeted Cellular Imaging

Polythiophene containing pendant N-hydroxysuccinimide (NHS) ester groups was reacted with poly(ethylene glycol) (PEG) and oleylamine, which was subsequently modified with folic acid to prepare a targeting fluorescent cellular imaging probe. The amphiphilic character of the folic acid-functionalized polythiophene induced the formation of nanoparticles with an average diameter of 95.3 nm in water. This polymer shows good photostability and low toxicity toward KB cells at a high concentration (100 µg/mL), which meets the crucial requirement for cellular imaging and other biological applications. The folic acid-functionalized polythiophene could be internalized efficiently into KB cells and accumulated in the cytoplasm to yield bright fluorescence, indicating that it is a good candidate material for the fluorescence imaging of living cells.

Development and clinical validation of a novel photography-based skin pigmentation evaluation system: a comparison with the calculated consensus of dermatologists

OBJECTIVE

Various cosmetics, medicines, and light and laser treatments have been increasingly developed to improve pigmentary skin alterations such as melasma, actinic lentigo and dyschromia. To determine the efficacy of these modalities in view of the changes in pigmentation, an objective and reliable device that has a comparable performance to that of physicians is required. We developed a novel photography-based skin pigmentation evaluation system and validated its accuracy and reliability with a newly proposed method.

METHODS

A novel photography-based system was developed that integrates a consistent photography setting and image processing diagnostic algorithms. To automatically detect areas of pigmentation, the diagnostic algorithms were applied to photographs, which were obtained from 31 female patients. To validate its performance in comparison with the physicians' evaluation, five dermatologists independently evaluated the area of pigmentation. The clinical consensus area of pigmentation (CCAP) was calculated based on the consensus of five dermatologists' to exclude subjectivity or bias, and it was compared with the pigmentation area determined by the system.

RESULTS

Forty-four photographs with pigmented areas were evaluated by the system and the physicians. In contrast to the individual physician assessments, CCAP reduced the error that occurred due to subjectivity and bias, particularly for areas with indistinct pigmentation, and it was set as the gold standard. The results from the system showed a mean accuracy of 92.1% and a standard deviation of 4.6% in comparison with CCAP.

CONCLUSION

This pigmentation evaluation system can reproduce the physicians' consensus, suggesting that this system can support the dermatologists' objective evaluation of pigmentation.

Novel strategies for diagnosing the cause of short-term organic fouling in ultrafiltration

The main objective of this study was to demonstrate the usefulness of a multi-strategic approach for identifying the extent and mechanism of fouling in the ultrafiltration (UF) of wastewater effluent organic matter (EfOM). In this study, we combined EfOM fractionation with spectroscopic autopsies for clean and fouled UF membranes. The EfOM fractions were sequentially removed from the wastewater effluent using relatively gentle techniques (neutral pH and no extractions). The residual EfOM samples were then used in UF tests. This work showed that resistance to filtration was partially reduced with the removal of particles (>20 nm), but almost all of the short-term fouling was eliminated with the removal of organic acids, which constitute 22% of the total organic carbon. The membrane autopsies were conducted using attenuated reflectance infrared spectroscopy for the top and bottom fouled membranes, and comparison was made with the infrared spectra of a clean membrane. Hydrophilic base/neutrals were the dominant EfOM constituents at the top of the fouled membranes. Hydrophobic acids were adsorbed onto the pore walls deep inside the membranes, which coincided with the permeability recovery of fouled membranes. The fouling mechanisms were examined by measuring the resistance to filtration as a function of permeate flux using various operational conditions and by investigating the effectiveness of hydraulic and chemical cleaning on the restoration of membrane permeability.

Performance of HbA1c for the prediction of diabetes in a rural community in Korea

AIM

To investigate the performance of HbA1c in predicting incident diabetes among Korean adults with normal fasting glucose and impaired fasting glucose levels.

METHODS

This study used data from the Korean Genome Epidemiology Study-Kangwha Study. A prospective analysis was carried out on 2079 people (820 men and 1259 women) who completed follow-up examinations up until 2013. Diabetes was defined as fasting blood glucose level ≥ 7.0 mmol/l, HbA1c level ≥ 48 mmol/mol (6.5%), or current treatment for diabetes. Areas under the receiver-operating characteristic curves were used to assess the different performances of HbA1c , glucose and insulin in predicting diabetes.

RESULTS

The median follow-up time was 3.97 years, during which 7.7% of men and 6.3% of women developed incident diabetes. The areas under the receiver-operating curves (95% CI) for diabetes prediction were 0.740 (0.692-0.787) for HbA1c , 0.716 (0.667-0.764) for glucose and 0.598 (0.549-0.648) for insulin. HbA1c showed better predictive power in people with impaired fasting glucose (area under the curve 0.753, 95% CI 0.685-0.821) than in those with normal glucose (area under the curve 0.648, 95% CI 0.577-0.719). An HbA1c threshold of 40 mmol/mol (5.8%) was found to have the highest predictive value for diabetes, with a relative risk of 6.30 (95% CI 3.49-11.35) in men and 3.52 (95% CI 2.06-6.03) in women after adjusting for age, waist circumference, triglycerides, hypertension, family history of diabetes, smoking, alcohol intake, exercise and baseline glucose level.

CONCLUSIONS

HbA1c can be used to identify people at high risk for the development of diabetes, especially in those with impaired fasting glucose levels.

Gastrointestinal stromal tumours (GISTs) with a thousand faces: atypical manifestations and causes of misdiagnosis on imaging

Gastrointestinal stromal tumours (GISTs) can lead to emergency situations, such as gastrointestinal bleeding, intestinal obstruction, and tumoural rupture with haemoperitoneum or peritonitis. In addition, if a GIST grows exophytically to a large size, it is often misdiagnosed as a tumour arising from adjacent organs. Sometimes, the atypical appearance of GISTs on imaging causes diagnostic confusion. In this article, we illustrate a variety of GISTs with atypical presentations and also discuss the important diagnostic clues for differentiating GISTs from other lesions.

Gallbladder carcinoma: causes of misdiagnosis at CT

Gallbladder carcinomas can present with varied imaging features on computed tomography. The three major imaging features include (1) focal or diffuse wall thickening with or without irregularity of the gallbladder; (2) polypoidal intraluminal mass; and (3) large mass obscuring and replacing the gallbladder, often extending to the liver. Patterns of wall thickening or polypoid growth are often confused with various benign gallbladder diseases due to overlap of imaging findings. Moreover, gallbladder carcinomas that coexist with benign gallbladder diseases make accurate preoperative diagnosis more difficult. Recently, high-resolution ultrasound (HRUS) has been regarded as a problem-solving tool for gallbladder diseases. In this article, we will illustrate various imaging presentations of gallbladder cancer, along with imaging pitfalls and recently updated HRUS findings.

Magnetic nanoparticle-conjugated polymeric micelles for combined hyperthermia and chemotherapy

Magnetic nanoparticle-conjugated polymeric micelles (MNP-PMs) consisting of poly(ethylene glycol)-poly(lactide) (PEG-PLA) and iron oxide nanoparticles were prepared and used as nanocarriers for combined hyperthermia and chemotherapy. Doxorubicin (DOX) was encapsulated in MNP-PMs, and an alternating magnetic field (AMF) resulted in an increase to temperature within a suitable range for inducing hyperthermia and a higher rate of drug release than observed without AMF. In vitro cytotoxicity and hyperthermia experiments were carried out using human lung adenocarcinoma A549 cells. When MNP-PMs encapsulated with an anticancer drug were used to treat A549 cells in combination with hyperthermia under AMF, 78% of the cells were killed by the double effects of heat and the drug, and the combination was more effective than either chemotherapy or hyperthermia treatment alone. Therefore, MNP-PMs encapsulated with an anticancer drug show potential for combined chemotherapy and hyperthermia.

A multi-parametric approach assessing microbial viability and organic matter characteristics during managed aquifer recharge

Soil column (SC) experiments were conducted to investigate the feasibility of using silver nanoparticles (AgNPs) as microbial inhibitors; the microbial viability affecting the degradation of pharmaceutically active compounds (PhACs) and the characteristics of organic matter during managed aquifer recharge were specifically evaluated. Natural surface water samples treated with AgNPs (0, 2.5, 5, and 10 mg L(-1)) were continually fed into the soil columns for 2 years. The adverse impact of AgNPs on the cell membrane integrity and microbial enzymatic activity was quantitatively determined using flow cytometry and adenosine triphosphate analysis. The increase in AgNP concentration in the feed water (up to 10 mg L(-1)) resulted in a corresponding deterioration in the performance of the managed aquifer recharge (MAR), with respect to the removal of organic carbon, oxidation of nitrogenous compounds, and PhAC attenuation. The fluorescence excitation-emission matrices of feed water and treated water showed the favorable removal of protein-like substances compared to humic-like substances regardless of the AgNP concentrations; however, the extent of removed fractions decreased noticeably when the microbial viability was lowered via AgNP treatment. The biological oxidation of organic nitrogen was almost completely inhibited when 10 mg L(-1) AgNP was added during soil passage. The attenuation of bezafibrate, ketoprofen, diclofenac, clofibric acid, and gemfibrozil was strongly associated with the significant deterioration in biodegradation as a result of AgNP activity.

In-line coagulation with quaternary amine polymer prior to microfiltration of humic-rich water

This work was designed to investigate the feasibility of using a low molecular-weight epichlorohydrin/dimethylamine (epi/DMA) polymer as a primary coagulant for the pretreatment of terrestrial humic-rich water prior to the microfiltration (MF) process, without removal of the flocs produced via the coagulation pretreatment. The main issue explored was the effects of different coagulation conditions on the particle characteristics that would also significantly affect the performance of membranes when filtering coagulated humic-rich water. The size distribution and morphological properties of flocs formed through the coagulation of humic-rich water were characterized and the impact of Ca(2+) on these characteristics that were associated with the performance of the MF membrane was also determined. Epi/DMA additions from 50% to 150% of the charge neutralization dose substantially decreased fouling compared to when filtering raw humic-rich water. Short-term fouling was increased when 1 mM Ca(2+) was added, but the charge neutralization coagulation removed almost all of the fouling tendency that had occurred when filtering Ca-humic solution. The median diameter and the fractal dimension of flocs produced were increased as the zeta potential reached close to zero, which resulted in the formation of a cake layer that was easily removed from the surface of the membrane.

Usefulness of the ratio of orbital fat to total orbit area in mild-to-moderate thyroid-associated ophthalmopathy

OBJECTIVE

To identify a useful predictor of thyroid-associated ophthalmopathy (TAO) from orbital CT images; to evaluate the orbital fat and extraocular muscle area ratio as a CT-derived measure; and to investigate the correlations between this ratio and the clinical manifestations in mild-to-moderate TAO.

METHODS

Between January 2012 and March 2013, 44 patients with TAO and 23 controls were studied prospectively. All of the patients underwent ophthalmic examinations, including clinical activity score, exophthalmometry, clinical photographs, alternate prism and cover test, duction and version test, Hess screen test, binocular single vision test, thyroid function tests and orbital CT. The cross-sectional areas of the four rectus muscles, superior oblique muscle, optic nerve and total orbit area were calculated in the coronal view 6 mm posterior from the posterior pole of globe.

RESULTS

The cross-sectional area measured on orbital CT showed increased orbital fat in patients with TAO and an increased orbital fat to total orbit area ratio (fat/orbit) in TAO with retraction and proptosis. There were significant correlations between fat/orbit and margin reflex distance 1 (p = 0.022), margin reflex distance 2 (p = 0.013) and the exophthalmometric value (p = 0.007).

CONCLUSION

The orbital fat to total orbit area ratio (fat/orbit) is a useful diagnostic index in mild-to-moderate TAO.

ADVANCES IN KNOWLEDGE

The orbital CT offers a useful diagnostic index in TAO.

Simultaneous removal of phosphorus and EfOM using MIEX, coagulation, and low-pressure membrane filtration

The feasibility of using magnetic ion exchange (MIEX) treatment, in-line alum coagulation, and low-pressure membrane filtration was investigated for the simultaneous removal of total phosphorus (TP) and effluent organic matter (EfOM) from biologically treated wastewater. The focus was also placed on minimizing fouling of polyvinylidene fluoride and polyethersulfone membranes, which are the most commonly used low-pressure membranes in new and retrofit wastewater treatment plants. MIEX alone was effective for the removal of EfOM, and MIEX plus a small alum dose was very effective in removing both EfOM and TP. MIEX removed phosphorus, but organic acids in EfOM were preferentially removed, and the effects of competing anions on the removal of EfOM were insignificant. All the pretreatment strategies decreased the resistance to filtration. The greatest decrease in fouling was achieved by using MIEX (15 mL L⁻¹) plus a very low dose of alum (∼0.5 mg Al L⁻¹). Sweep floc coagulation using alum and without MIEX also significantly decreased fouling but did not effectively remove EfOM and produced high floc volume that could be problematic for inside-out hollow-fibre modules. The addition of these reagents into rapid mix followed by membrane filtration would provide operational simplicity and could be easily retrofitted at existing membrane filtration facilities.

Membrane distillation combined with an anaerobic moving bed biofilm reactor for treating municipal wastewater

A fermentative strategy with an anaerobic moving bed biofilm reactor (AMBBR) was used for the treatment of domestic wastewater. The feasibility of using a membrane separation technique for post-treatment of anaerobic bio-effluent was evaluated with emphasis on employing a membrane distillation (MD). Three different hydrophobic 0.2 μm membranes made of polytetrafluoroethylene (PTFE), polyvinylidene fluoride (PVDF), and polypropylene (PP) were examined in this study. The initial permeate flux of the membranes ranged from 2.5 to 6.3 L m(-2) h(-1) when treating AMBBR effluent at a temperature difference between the feed and permeate streams of 20 °C, with the permeate flux increasing in the order PP < PVDF < PTFE. The permeate flux of the PTFE membrane gradually decreased to 84% of the initial flux after the 45 h run for distillation, while a flux decline in MD with either the PVDF or PP membrane was not found under the identical distillation conditions. During long-term distillation with the PVDF membrane, total phosphorus was completely rejected and >98% rejection of dissolved organic carbon was also achieved. The characterization of wastewater effluent organic matter (EfOM) using an innovative suite of analytical tools verified that almost all of the EfOM was rejected via the PVDF MD treatment.