[Impact of social support for schizophrenia patients on their quality of life and family life satisfaction].

Objective: To explore the relationship of social support to patients with schizophrenia, family burden with patients' quality of life and family life satisfaction. Methods: Multi-stage stratified cluster random sampling was used to select 358 patients with schizophrenia and 358 patients' family members in Gansu Province who met the inclusion criteria were included. The Social Support Rating Scale, Family Burden Scale, Satisfaction with Life Scale and Quality of Life Scale were used in the survey. AMOS 24.0 was used to explore the pathway of influence of family burden on social support to patients with schizophrenia, patients' quality of life and patients' family life satisfaction. Results: There was a two-by-two significant correlation between patients' access to social support, family burden, patients' life quality and family life satisfaction (P<0.05), and the total score of the social support scale negatively predicted the total score of the life quality scale (ß=-0.28, P<0.05) and positively predicted the total score of the life satisfaction scale (ß=0.52, P<0.05). Family burden was a full mediator between the social support to the patient and the patient's quality of life, and as a partial mediator between the social support to the patient and the family's life satisfaction. Conclusions: Social support to people with schizophrenia is a significant predictor of their quality of life and family life satisfaction. Family burden mediates the relationship of social support to patients with their quality of life and family life satisfaction. Interventions can focus on increasing social support for the patient and reducing the burden on the patient's family to improve the patient's quality of life and increase the satisfaction of the patient's family.

Application of combined multimodal neuroimaging and video-electroencephalography in intractable epilepsy patients for improved post-surgical outcome prediction.

AIM: To investigate the ability of a multidisciplinary approach that combines multimodal neuroimaging with video-electroencephalography (v-EEG) to predict post-surgical outcomes in patients with intractable epilepsy, and explore prognostic predictors for these patients. MATERIALS AND METHODS: Fifty-eight patients with intractable epilepsy who underwent surgery between March 2016 and October 2019 were reviewed retrospectively. Demographic, clinical, v-EEG, neuroimaging, surgical, and regular follow-up seizure outcome data were collected. Forty-six patients with a follow-up of at least 12 months were graded by Engel scores. Univariate and multivariate analyses were applied to explore prognostic factors that could predict post-surgical seizure outcomes. RESULTS: Of the 58 patients, 28 were males. The median age was 27 years, the median age at first seizure was 11 years, and the median duration of seizures was 10 years. The Kaplan-Meier log-rank test showed that regardless of whether the follow-up duration was considered, epilepsy type, v-EEG, PET/CT, image post-processing methods, and a multidisciplinary approach that combined multimodal imaging with v-EEG were all correlated with seizure outcomes. Multivariate analysis found that the multidisciplinary approach was an independent predictor of post-surgical outcomes in patients with intractable epilepsy (hazard ratio = 11.400, 95% confidence interval = 2.249-57.787, p=0.003). CONCLUSIONS: The present study showed that the multidisciplinary approach could provide independent prognostic information for patients with intractable epilepsy undergoing surgery. This approach has strong potential for the easier selection of patients to undergo surgical treatment and accurate prognostication.

[Health-related quality of life of diabetes patients and related factors before and after healthcare reform in Gansu province].

Objective: The study investigated and analyzed the health-related quality of life of diabetes patients in Gansu province before and after the healthcare reform and its influencing factors, so as to provide scientific evidence to improve the health-related quality of life of diabetes patients. Methods: The study used data of the fourth and sixth national health service household survey in Gansu province before (2008) and after (2018) medical reform separately, and EQ-5D health utility index was calculated on the basis of Chinese time frade-off values for EuroQol Five-Dimensions Questionnaire Utility Value scoring system. Results: Compared with the period before the healthcare reform, the five dimensions of EQ-5D for residents, aged 15 and above in Gansu, changed significantly after the healthcare reform: action capability improved by 8.08% (27.43% vs. 19.35%), self-care improved by 16.16% (26.55% vs. 10.39%), normal activity improved by 8.97% (28.32% vs. 19.35%), pain/discomfort worsened by 1.38% (38.05% vs. 39.43%), anxiety/depression worsened by 1.83% (16.81% vs. 18.64%), and the EQ-VAS score increased by 3.36 (60.53 vs. 63.89). The health utility index increased by 0.04 (0.83 vs. 0.87). Multivariate regression analysis results showed that the dimension influence factors were not completely consistent, on the whole, the health-related quality of life of diabetes patients with older age, lower education level, no physical exercise and multi chronic diseases was worse (P<0.05), and multiple chronic disease had the most serious effect on the health of patients with diabetes. The health-related quality of life of diabetes patients with the medical insurance in urban area and after the new medical reform was higher (P<0.05). Conclusion: The new healthcare reform has active influence on the health-related quality of life of diabetes patients in Gansu province, health care providers and policy makers should pay attention to the impacts of multi prechronic diseases on the health-related quality of life of diabetes patients and the mental health of patients with diabetes.

[Incidence of chronic obstructive pulmonary disease and pneumoconiosis in different occupational positions among populations from jinchang cohort].

Objective: To investigate the incidence and rank of chronic obstructive pulmonary disease and pneumoconiosis to the workers in different occupational positions in Jinchang Cohort. Methods: In January 2014, a cohort of follow-up population in jinchang city was taken as the research object, 17843 individuals among follow-up populations in Jinchang Cohort Study, removed the individuals with chronic obstructive pulmonary disease and pneumoconiosis before 2013, and counted the new incidence individuals diagnosed by the A-Class hospital in Grade III in Jinchang City, Gansu Province, as the investigation objects to investigate the incidence rate & rank of chronic obstructive pulmonary disease and pneumoconiosis. The statistical significance was tested by chi-square test. Results: The 2-year incidence rate of Chronic Obstructive Pulmonary Disease and Pneumoconiosis in the population of Jinchang Cohort Study were 11.60‰, 13.51‰ for male and 8.46‰ for female. the ranks of 2-year incidence rates of chronic bronchitis, emphysema, pneumoconiosis and other phenotypes of chronic obstructive pulmonary disease were 7.06‰ã€3.42‰ã€0.84‰ã€0.34‰, respectively. Incidence rate of chronic bronchitis among administrators and executive staffs were 10.45‰; incidence rate of chronic bronchitis among service staffs were 10.45‰; incidence rate of pneumoconiosis among mining staffs were 3.44‰. Conclusion: The first incidence rank of chronic obstructive pulmonary disease and pneumoconiosis in Jinchang cohort is chronic bronchitis, and the risk factors are smoking and occupational exposure.

[Study on calculating the curative care expenditure of injury in Gansu Province based on "A System of Health Accounts 2011"].

Objective: To study the distribution and related factors of curative care expenditure (CCE) of injury in Gansu Province in 2017. Methods: Based on the "A System of Health Accounts 2011 (SHA 2011)", the curative care expenditure of injury in Gansu Province was calculated and analyzed. The five-stage stratified cluster sampling method was adopted to extract 149 medical and health institutions, 120 township hospitals (including community health service centers), 150 individual clinics and 600 village clinics (including community health service stations). The top-down allocation method was used to calculate the cost of injury treatment in Gansu Province, and the influencing factors were analyzed by multiple linear regression. Results: In 2017, the CCE of injury in Gansu province was 3.831 billion yuan, and the expense in general hospitals was 2.708 billion yuan. Among them, the cost of lower limb injury and head injury were 1.090 and 0.847 billion yuan. People aged 40 to 69 years old spent 1.901 billion yuan on injury treatment, and the CCE of injury treatment for men and women were 2.422 and 1.409 billion yuan respectively. The results of multiple linear regression showed that hospitalization expenditure was significantly associated with length of stay, operation, hospital grade, age, payment method and gender (P<0.001). Conclusion: The economic burden of injury in Gansu Province is relatively heavy, so it is necessary to focus on preventions for different groups and costly injury sites.

[Targeting diagnosis and treatment value of chelating anti-IL-1ß mAb-SPIONs in temporal lobe epilepsy model].

Objective: In order to study the diagnosis and treatment value of chelating anti-IL-1ß mAb-SPIONs in temporal lobe epilepsy model induced by lithium chlorid and pilocarpine. Methods: Forty-five temporal lobe epilepsy model rats were randomly and equally divided into saline group, plain-SPIONs group, anti-IL-1ß mAb-SPIONs group. Each group was injected with equal particles at day 3 and day 14 after the onset of seizures. MRI were conducteds before and 4 hours after particles injection and T2 values were measured. The distribution of iron particles in the epileptic tissue was observed and the neuronal loss, astrocyte proliferation and microglia activation were detected. The expressions of IL-1ß and NF-κBp65 in each group were detected meanwhile. Results: At day 14 after seizure, the value of T2 was 84±14 after injecting anti-IL-1ß mAb-SPIONs. Compared with the control group, the value of T2 obviously declined. These phenomena of neuron loss, astrocyte proliferation and microglia activation had been improved obviously. IL-1ßand NF-κBp65 expression also significantly reduced. Conclusion: Anti-IL-1ß mAb-SPIONs can penetrate blood brain barrier and plays an important role in targeting positioning and targeting therapy in temporal lobe epilepsy.

[Association between fatty liver and type 2 diabetes in the baseline population of Jinchang Cohort].

Objective: To explore the association between fatty liver and type 2 diabetes mellitus (T2DM) in the baseline-population of Jinchang cohort study. Methods: Data from all the participants involved in the baseline-population of Jinchang cohort study was used, to compare the risks of T2DM in fatty liver and non fatty liver groups and to explore the interaction between family history or fatty liver of diabetes and the prevalence of T2DM. Results: Among all the 46 861 participants, 10 574 were diagnosed as having fatty liver (22.56%), with the standardized rate as 20.66%. Another 3 818 participants were diagnosed as having T2DM (8.15%) with standardized rate as 6.90%. The prevalence of T2DM increased in parallel with the increase of age (trend χ(2)=2 833.671, trend P<0.001). The prevalence of T2DM in the fatty liver group was significantly higher than that in the non-fatty liver group, both in men or women and in the overall population. Compared with the group of non-fatty liver, the risks of T2DM in fatty liver group were seen 1.78 times higher in males, 2.33 times in women and 2.10 times in the overall population, after adjustment for factors as age, levels of education, smoking, drinking, physical exercise, BMI, family history of diabetes and some metabolic indicators (pressure, TC, TG, uric acid, ALT, AST, gamma-glutamyl transferase). Date from the interaction model showed that fatty liver and family history of diabetes present a positive additive interaction on T2DM (RERI=1.18, 95%CI: 0.59-1.78; AP=0.24, 95%CI: 0.14-0.34; S=1.43, 95%CI: 1.21-1.69). Conclusions: Fatty liver could significantly increase the risk of T2DM and a positive additive interaction was also observed between fatty liver and family history of diabetes on T2DM. It was important to strengthen the prevention program on T2DM, in order to effectively control the development of fatty liver.

[Present situation and influencing factors on classroom mobile phone dependence syndrome in college students].

Objective: To explore the current situation and influencing factors on Classroom Mobile Phone Dependence Syndrome (CMPDS) among college students, and to provide scientific basis for guiding college students to use mobile phones reasonably and healthily. Methods: Stratified cluster sampling method was used. Students from different majors and different grades in Lanzhou University were included as the research objects. Classes were recognized as a unit in receiving basic field investigation in this questionnaire related study. Informed consent principles were followed and process of survey was anonymously carried out. Results: The overall rate of CMPDS in college students was 8.7%, including 'mild rate' as 6.6% and 'seriously mild rate' as 2.1%. No significant differences were found on genders or grades. Factors as shopping in the classroom shopping (OR=3.720), being bored on courses (OR=1.740), WiFi coverage (OR=1.787), time of practice in the classrooms (OR=1.514), and the total time of daily mobile phone use (OR=1.513) etc, appeared as risk factors related to CMPDS among the college students. However. shooting courseware (OR=0.579) appeared as a protective factor. Conclusions: Rate of CMPDS was high in college students and we suggested to form a joint task force among the college authority, teachers and students to work on the related problems. Hopefully, the serious CMPDS condition will be minimized and both physical and mental health of the college students be improved.

[Risk factors of gout in Jinchang cohort: a Cox regression analysis].

Objective: To explore the incidence and risk factors of gout in Jinchang cohort and provide scientific evidence for the prevention and control of gout. Methods: People without gout detected by baseline survey in Jinchang cohort were selected as study subjects. All the subjects were followed up through questionnaire interview, physical examination as well as laboratory test from January 24, 2013 to November 24, 2015. Cox regression model was used to analyze the risk factors for gout in Jinchang cohort. In addition, log-linear model was used to analyze the interaction between risk factors. Results: A total of 33 153 subjects were followed up, and there were 277 newly diagnosed gout cases in the cohort. The overall incidence of gout was 0.8%. The incidence of gout in males was higher than that in the females, but the incidence of gout in males and females was similar after the age of 60 years. Cox regression analysis showed that age >40 years (at age 40 to 59 years: HR=2.982, 95%CI: 1.503-5.981; at age 60 to 91 years: HR=2.588, 95%CI: 1.107-6.049), alcohol abuse (HR=2.234, 95% CI: 1.128-4.427), obesity (HR=2.204, 95% CI: 1.216-3.997), diabetes (HR=2.725, 95% CI: 1.500-4.950) and high uric acid (HR=5.963, 95%CI: 3.577-9.943) were risk factors for gout, while weekly beans intake ≥0.25 kg (HR=0.528, 95%CI: 0.345-0.808) and regular physical exercise (HR=0.499, 95% CI: 0.286-0.869) were protective factors for gout. The analysis with log-linear model showed that there were two order effects between the risk factors. Conclusions: Age, beans intake, alcohol abuse, physical exercises, obesity, diabetes and high uric acid were important factors influencing the incidence of gout. It is important to have healthy lifestyle and dietary habits, receive regular health examination to prevent and control the incidence of gout in this cohort.

[Effect of combination model on fitting cancer mortality and prediction].

Objective: To reduce the cancer burden in the Jinchang cohort and provide evidence for developing cancer prevention strategies and performing effectiveness evaluation in the Jinchang cohort. We are fitting thirteen years of cancer mortality data from the Jinchang cohort by using six kinds of predicting methods to compare relative fitness and to select good predicting methods for the prediction of cancer mortality trends. Methods: The mortality data of cancer in Jinchnag cohort from 2001-2013 were fitted using six kinds of predicting methods: dynamic series, linear regression, exponential smoothing, autoregressive integrated moving average (ARIMA) model, grey model (GM), and Joinpoint regression. Weight coefficients of combination models were calculated by four methods: the arithmetic average method, the variance inverse method, the mean square error inverse method, and the simple weighted average method. Results: The cancer mortality was fitted and compared by using six kinds of forecasting methods; the fitting precision of the Joinpoint linear regression had the highest accuracy (87.64%), followed by linear regression (87.32%), the dynamic series (86.99%), GM (1, 1) (86.25%), exponential smoothing (85.72%) and ARIMA (1, 0, 0) (81.98%), respectively. Prediction accuracy of the combination model derived from GM (1, 1) and linear regression (>99%) was higher than that of the combination model derived from ARIMA (1, 0, 0) and GM (1, 1). The combination model derived from the GM (1, 1) and linear regression, with weight coefficients based on the arithmetic average method and the mean square error inverse method, had the best prediction effect of the four weight calculation methods. Conclusion: Prediction accuracy of the combination model, with accuracy >95%, was higher than that of the single prediction methods.

Genetic association study of ABCB1 gene polymorphisms with hypertension in Han Chinese population.

OBJECTIVE: Hypertension is a common disorder related to cardiovascular diseases and stroke. Identification of genetic variations related to hypertension may advance our knowledge of the molecular mechanism underlying blood pressure regulation. Here, we aimed to investigate the associations between ABCB1 gene polymorphisms and hypertension-related traits in 1154 Han Chinese subjects. PATIENTS AND METHODS: A total of 13 SNPs in ABCB1 were genotyped. RESULTS: Three SNPs were significantly associated with systolic blood pressure (SBP), including rs17327624 (p = 6.167 × 10-4, beta = 5.650), rs3789243 (p = 4.331 × 10-3, beta = 2.800), and rs4148734 (p = 3.514 × 10-3, beta = 3.692). Rs17327624 (p = 2.818 × 10-4, beta = 2.753) and rs3789243 (p = 6.345 × 10-3, beta = 1.497) were significantly associated with diastolic blood pressure (DBP) and rs17327624 was significantly associated with hypertension (p = 1.746 × 10-4, OR = 1.605). These three SNPs (rs17327624, rs3789243 and rs4148734) were also associated with hypertension in female subjects but no significant signal was detected in males. CONCLUSIONS: Our results suggest that ABCB1 polymorphisms may contribute to the blood pressure variation in Han Chinese population and the effect may be specific in females. Further studies performed in other populations are needed to confirm our findings and elucidate the underlying molecular mechanism.

The Wyckoff positional order and polyhedral intergrowth in the M3B2- and M5B3-type boride precipitated in the Ni-based superalloys.

Ni-based single superalloys play a crucial role in the hottest parts of jet engines. However, due to the complex geometry and macro-segregation during the solidification process, the cast defect such as stray grains is inevitable. Therefore, the transient liquid phase (TLP) bonding which can join several small single crystalline castings together is gradually believed to be an effective method for improving the yields of production of the complex components. The melting point depressant element B is always added into the interlayer filler material. Consequently, borides including the M3B2 and M5B3 phase usually precipitate during the TLP bonding process. So a comprehensive knowledge of the fine structural characteristics of the borides is very critical for an accurate evaluation of the TLP bonding process. In this work, by means of the aberration-corrected transmission electron microscopy, we show, at an atomic scale, the Wyckoff positional order phenomenon of the metal atoms in the unit cell of M3B2- and M5B3-type boride. Meanwhile, the defect along the (001) plane of the above two types of boride are determined to be the polyhedral intergrowth with complex configurations.

Intralesional copper wire retention and pingyangmycin injection: an effective combinational therapy for complex venous malformation in soft tissue.

OBJECTIVES: Complex venous malformations (VMs) may extensively involve the soft tissue. The treatment remains a challenge till now. Here we introduce a combinational therapy of copper wires and pingyangmycin (bleomycin A5,PYM). METHODS: Copper wires were retained in VMs by repeated penetration with a straight needle. Subsequently, PYM solution was injected into the lesion. Eight to 10 days later, copper wires were removed. The dressing was changed every day until the puncture pores healed. Magnetic resonance imaging scanning was performed to observe the change of VMs. RESULTS: From January 2001 to December 2011, 56 patients were treated. During the follow-up period, most of the VMs shrunk obviously. The symptoms were relieved or disappeared. The complications included local pain, temporary paraesthesia and moderate fever, which disappeared quickly after the removal of copper wires. CONCLUSIONS: This combinational therapy is a safe and effective approach for the complex VMs in soft tissue.

Biofilm regeneration on carriers in MBBR used for vitamin C wastewater treatment.

Methods were investigated for biofilm regeneration on carriers in a moving bed biofilm reactor used for vitamin C production wastewater treatment. Three ordinary chemical cleaning agents (hydrochloric acid, sodium hydroxide, and sodium hypochlorite) and physical drying were chosen for evaluation as methods for biofilm detachment. The results showed that these methods all had some degree of biofilm removal effectiveness. Treatment with 3% hydrochloric acid (w/w) achieved the maximum degree of biofilm detachment, at 75.2%. Biofilm biomass re-formed on carriers, from the maximum degree of biofilm detachment, quickly by an increase of 76.17 g m(-2) month(-1). It was concluded that treatment with 3% acid was the best choice for biofilm removal and regeneration.

Transcriptional activity of an ovarian-specific promoter from rat in dairy goat granulosa cells.

Ovarian-specific promoter 1 (OSP-1) is a retrovirus-like element isolated from the complementary DNA library of rat that has been thought to be specifically expressed in ovary. To exploit this promoter in dairy goat ovary granulosa cells (GCs), OSP-1 from rat was used to construct the reporter vector pOSP-1-EGFP, in which egfp coding for enhanced green fluorescent protein (EGFP) was used as a reporter to examine the activity of OSP-1 in GCs. EGFP was successfully expressed in dairy goat GCs transfected with pOSP-1-EGFP. Reverse transcriptase-polymerase chain reaction analysis confirmed the tissue-specific transcription of EGFP messenger RNA in dairy goat GCs transfected with pOSP-1-EGFP. We concluded that OSP-1 promoter from rat can specifically drive foreign gene expression in dairy goat GCs. Thus, we obtained a tissue-specific regulation element and provided a potential tool for the research of regulation and development of the ovary in dairy goats.

MiRNA-21 reverses high glucose and high insulin induced insulin resistance in 3T3-L1 adipocytes through targeting phosphatase and tensin homologue.

AIMS/HYPOTHESIS: Our previous study showed there was a change of microRNA (miRNA) expression profile, and miR-21 was significantly down regulated in insulin-resistant adipocytes (IR-adipocytes). Phosphatase and tensin homologs deleted on chromosome 10 (PTEN), a negative regulator of the phosphatidylinositol 3-kinase (PI3K)/AKT pathway, was identified to be a target gene of miR-21, which suggested miR-21 might be associated with insulin resistance (IR) or diabetes. However, it is not known whether miR-21 play any role in the development of IR in 3T3-L1 adipocytes. METHODS: Normal adipocytes and adipocytes transfected with pre-miR-21(pmiR-21) or negative control (pNeg) were treated with high glucose and high insulin for 24 h, insulin-stimulated glucose uptake was determined by 2-Deoxyglucose transport assay, miR-21 expression level was measured by using quantitative real-time RT-PCR (qRT-PCR). The protein expression levels of PTEN, Akt, phospho-Akt (Ser473), IRß, GSK3ß, phospho-GSK3ß (Ser9) and GLUT4 were detected by western blotting assay. RESULTS: We further confirmed that miR-21 was down regulated in IR-adipocytes by qRT-PCR. Over-expression of miR-21 significantly increased insulin-induced glucose uptake and decreased PTEN protein expression, while it had no significant effect on PTEN mRNA expression in IR-adipocytes. Moreover, over-expressing miR-21 significantly increased insulin-induced phosphorylation of AKT (Ser473), GSK3ß (Ser9) and the translocation of glucose transporter 4 (GLUT4) in IR-adipocytes. CONCLUSIONS: In this study, our data demonstrate that miR-21 reverses high glucose and high insulin induced IR in 3T3-L1 adipocytes, possibly through modulating the PTEN-AKT pathway, and miR-21 may be a new therapeutic target for metabolic diseases such as T2DM and obesity.

Acute and subacute dual energy CT findings of pulmonary embolism in rabbits: correlation with histopathology.

OBJECTIVE: The purpose of this study was to describe quantitative dual energy CT (DECT) findings and their accuracy in the detection of acute and subacute pulmonary embolism (PE) in rabbits. METHODS: Pulmonary emboli were created in 24 rabbits by gelatin sponge femoral vein injection. Conventional CT pulmonary angiography (CTPA) and DECT were obtained at either 2 h, 1 day, 3 days or 7 days after embolisation (n=6 rabbits for each time point). The location and number of PEs in the different stages were recorded at CTPA and iodine maps from DECT on a per-lobe basis. With histopathology as the reference standard, sensitivity and specificity of CTPA and DECT were calculated. CT and iodine map overlay values of the embolic and non-embolic areas were measured for each scan. RESULTS: With histopathology as the reference standard, the overall sensitivity and specificity of CTPA were 98% and 100% and those of iodine maps were 100% and 95%, respectively. Conventional CT and iodine map values of the embolised and non-embolised areas were significantly different between 2 h and 1 day (p<0.001), but not between 3 days and 7 days (p>0.05). A statistical difference was found for overlay values measured in the embolic and non-embolic regions for four groups. CONCLUSION: Iodine maps derived from DECT show alterations in lung perfusion for acute and subacute PE in an experimental rabbit model and show comparable sensitivity for PE detection and conventional CTPA.

Effect of reflux ratio on COD and nitrogen removals from coke plant wastewaters.

A laboratory-scale anaerobic-anoxic-aerobic-moving bed biofilm reactor (A1-A2-O-MBBR) system was undertaken to treat coke plant wastewaters from two different factories (wastewater A and B). Wastewater B had higher BOD5/COD ratio and COD/TN ratio than wastewater A. The effects of reflux ratios on COD, TN and NH3-N removals were studied. Results indicated that, with the reflux ratio increased from 2 to 5, COD removals of wastewater A and wastewater B increased from 57.4% to 72.6% and 78.2% to 88.6%, respectively. Meanwhile, TN removals were also increased accompanying reflux ratio rise, from 53.1% to 74.4% for wastewater A and 64.2% to 83.5% for wastewater B. At the same reflux ratio, compared with wastewater A, higher COD and TN removal efficiencies were observed in wastewater B, which had higher BOD5/COD and COD/TN ratio. Reflux ratio had no significant influence on NH3-N removal; 99.0% of the overall NH3-N removal efficiency was achieved by the system for both coke plant wastewaters at any tested reflux ratio. MBBR was effective in NH3-N removal, and about 95% of the NH3-N was removed in the MBBR.