Economic Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Severe Aortic Stenosis and Low Surgical Risk: Results from the PARTNER 3 Trial.

BACKGROUND: In patients with severe symptomatic aortic stenosis at low surgical risk, transfemoral transcatheter aortic valve replacement (TAVR) with the SAPIEN 3 valve has been shown to reduce the composite of death, stroke, or rehospitalization at 2-year follow-up compared with surgical aortic valve replacement (SAVR). Whether TAVR is cost-effective compared with SAVR for low-risk patients remains uncertain. METHODS: Between 2016 and 2017, 1000 low-risk patients with aortic stenosis were randomly assigned to TAVR with the SAPIEN 3 valve or SAVR in the PARTNER 3 trial (Placement of Aortic Transcatheter Valves). Of these patients, 929 underwent valve replacement, were enrolled in the United States, and were included in the economic substudy. Procedural costs were estimated using measured resource use. Other costs were determined by linkage with Medicare claims or by regression models when linkage was not feasible. Health utilities were estimated using the EuroQOL 5-item questionnaire. With the use of a Markov model informed by in-trial data, lifetime cost-effectiveness from the perspective of the US health care system was estimated in terms of cost per quality-adjusted life-year gained. RESULTS: Although procedural costs were nearly $19 000 higher with TAVR, total index hospitalization costs were only $591 more with TAVR compared with SAVR. Follow-up costs were lower with TAVR such that TAVR led to 2-year cost savings of $2030/patient compared with SAVR (95% CI, -$6222 to $1816) and a gain of 0.05 quality-adjusted life-years (95% CI, -0.003 to 0.102). In our base-case analysis, TAVR was projected to be an economically dominant strategy with a 95% probability that the incremental cost-effectiveness ratio for TAVR would be <$50 000/quality-adjusted life-year gained (consistent with high economic value from a US health care perspective). These findings were sensitive to differences in long-term survival, however, such that a modest long-term survival advantage with SAVR would render SAVR cost-effective (although not cost saving) compared with TAVR. CONCLUSIONS: For patients with severe aortic stenosis and low surgical risk similar to those enrolled in the PARTNER 3 trial, transfemoral TAVR with the SAPIEN 3 valve is cost saving compared with SAVR at 2 years and is projected to be economically attractive in the long run as long as there are no substantial differences in late death between the 2 strategies. Long-term follow-up will be critical to ultimately determine the preferred treatment strategy for low-risk patients from both a clinical and economic perspective.

PTEN: an emerging target in rheumatoid arthritis?

Phosphatase and tensin homolog deleted on chromosome 10 (PTEN) is a critical tumor suppressor protein that regulates various biological processes such as cell proliferation, apoptosis, and inflammatory responses by controlling the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (PI3K/AKT) signaling pathway. PTEN plays a crucial role in the pathogenesis of rheumatoid arthritis (RA). Loss of PTEN may contribute to survival, proliferation, and pro-inflammatory cytokine release of fibroblast-like synoviocytes (FLS). Also, persistent PI3K signaling increases myeloid cells' osteoclastic potential, enhancing localized bone destruction. Recent studies have shown that the expression of PTEN protein in the synovial lining of RA patients with aggressive FLS is minimal. Experimental upregulation of PTEN protein expression could reduce the damage caused by RA. Nonetheless, a complete comprehension of aberrant PTEN drives RA progression and its interactions with other crucial molecules remains elusive. This review is dedicated to promoting a thorough understanding of the signaling mechanisms of aberrant PTEN in RA and aims to furnish pertinent theoretical support for forthcoming endeavors in both basic and clinical research within this domain.

Insight into the status of plasma renin and aldosterone measurement: findings from 526 clinical laboratories in China.

OBJECTIVES: Accurate measurements of renin and aldosterone levels play an important role in primary aldosteronism screening, which is of great importance in the management and categorization of hypertension. The objective of this study is to investigate the current status of plasma renin and aldosterone measurements in China, which is achieved by analyzing the results of 526 clinical laboratories nationwide for three pooled fresh plasma samples derived from more than 2,000 patients. METHODS: Renin and aldosterone in three pooled plasma samples were measured four times in 526 laboratories employing various measurement systems. The inter- and intra-laboratory %CV were calculated and compared. To determine the source of the substantial inter-laboratory %CV, laboratories were categorized according to the measurement systems they are using, and both the inter- and intra-measurement-system %CV were calculated and compared. RESULTS: Regarding renin, the majority of laboratories use four primary commercial immunoassays. However, for aldosterone, in addition to commercial immunoassays, laboratory-developed liquid chromatography-tandem mass spectrometry (LC-MS) methods are also used by laboratories. The median values of intra-laboratory %CVs, intra-measurement-system %CVs, inter-laboratory %CVs, and inter-measurement systems %CVs varied between 1.6 and 2.6 %, 4.6 and 14.9 %, 8.3 and 25.7 %, and 10.0 and 34.4 % for renin, respectively. For aldosterone, these values ranged from 1.4 to 2.2 %, 2.5-14.7 %, 9.9-31.0 %, and 10.0-35.5 %, respectively. CONCLUSIONS: The precision within laboratories and measurement systems for plasma renin and aldosterone measurements is satisfactory. However, the comparability between laboratories using different measurement systems remains lacking, indicating the long way to achieve standardization and harmonization for these two analytes.

Continuous flow aerobic granular sludge: recent developments and applications.

Aerobic granular sludge (AGS) in continuous-flow reactors (CFRs) has attracted significant interest, with notable progress in research and application over the past two decades. Cumulative studies have shown that AGS-CFRs exhibit comparable morphology, settleability, and pollutant removal efficiency to AGS cultivated in sequencing batch reactors, despite their smaller particle sizes. Shear force and selection pressure are the primary drivers of granulation. While not mandatory for granulation, feast/famine conditions play a crucial role in ensuring long-term stability and nutrient removal. Additionally, bioaugmentation can facilitate the granulation process. Furthermore, this paper comprehensively assesses the application of AGS-CFRs in full-scale wastewater treatment plants (WWTPs). Currently, AGS-CFRs have been implemented in nine WWTPs, encompassing two distinct processes. Hydrocyclone-based densified activated sludge significantly enhances sludge density, settleability, and biological phosphorus removal efficiency, thus increasing treatment capacity. The microaerobic-aerobic configuration with internal separators can induce granulation, ensuring long-term stability, eliminating the need for external clarifiers, and reducing land and energy requirements. This review demonstrates the high potential of AGS-CFRs for intensifying existing WWTPs with minimal retrofitting needs. However, further research is required in granulation mechanisms, long-term stability, and nutrient removal to promote the widespread adoption of AGS.

The spike of acute angle closure after the epidemic downgrade of COVID-19 management: a hospital-based comparative study from China.

PURPOSE: To analyse and compare the clinical characteristics and treatment outcomes of patients with acute angle closure (AAC) who presented before the COVID-19 pandemic, during the COVID-19 management and after their downgrading. METHODS: Consecutive AAC patients were recruited from our hospital and divided into three groups: those treated before the COVID-19 pandemic (Group1), during the COVID-19 management (Group2) and after the management downgrade (Group3). The demographic variables, clinical characteristics, treatment methods and therapeutic outcomes of the groups were compared. RESULTS: When compared to Groups1 and 2, Group3 showed a significantly higher incidence of AAC (0.27%, P < 0.001), a longer time from symptoms to treatment (TST; 160.88 ± 137.05 h, P = 0.031) and worse uncorrected visual acuity (P = 0.009) at presentation. In Group3, 68.9% had a history of COVID-19 and 28.5% developed ocular symptoms of AAC after taking medication for COVID-19 symptoms. The average time from the onset of COVID-19 to the appearance of eye symptoms was 3.21 ± 4.00 days. CONCLUSIONS: The COVID-19 has had a multifaceted impact on the incidence of AAC. Therefore, it is crucial to strengthen health education on glaucoma, especially AAC. The prevention and timely treatment of AAC should be emphasised to combat global blindness.

Amorphous TiO2 shells: an Essential Elastic Buffer Layer for High-Performance Self-Healing Eutectic GaSn Nano-Droplet Room-Temperature Liquid Metal Battery.

Gallium-based alloy liquid metal batteries currently face limitations such as volume expansion, unstable solid electrolyte interface (SEI) film and substantial capacity decay. In this study, amorphous titanium dioxide is used to coat eutectic GaSn nanodroplets (eGaSn NDs) to construct the core-shell structure of eGaSn@TiO2 nanodroplets (eGaSn@TiO2 NDs). The amorphous TiO2 shell (~6.5 nm) formed a stable SEI film, alleviated the volume expansion, and provided electron/ion transport channels to achieve excellent cycling performance and high specific capacity. The resulting eGaSn@TiO2 NDs exhibited high capacities of 580, 540, 515, 485, 456 and 426 mAh g-1 at 0.1, 0.2, 0.5, 1, 2 and 5 C, respectively. No significant decay was observed after more than 500 cycles with a capacity of 455 mAh g-1 at 1 C. In situ X-ray diffraction (in situ XRD) was used to explore the lithiation mechanism of the eGaSn negative electrode during discharge. This study elucidates the design of advanced liquid alloy-based negative electrode materials for high-performance liquid metal batteries (LMBs).

Fluoranthene determination based on a rapid and sensitive syringe extraction and solid-phase fluorescence technique.

A rapid and sensitive strategy was proposed for the detection of fluoranthene (FL), which is a polycyclic aromatic hydrocarbon (PAH), in water samples. In this work, syringe solid-phase extraction (SPE) combined with solid-phase fluorescence spectrometry was used to determine FL in PAHs polluted environmental samples. The fluorescence signals were directly monitored on the membrane surface after FL was enriched by syringe SPE. Under the optimal conditions, the proposed method showed a linear relationship in the concentration range 2-50 µg/L with a correlation coefficient (R2 ) of 0.998, and the limit of detection was 0.143 µg/L. The recoveries varied from 93.47% to 109.81% in the actual samples, with the relative standard deviations (n = 3) ranging from 2.06% to 6.32%. According to the results, the established method can be applied in the field of rapid detection as it is fast, simple, portable, and highly sensitive, and has strong anti-interference.

A novel dealloying strategy for fabricating nanoporous Ag via ζ'-AgGa alloy.

A mild strategy for fabricating nanoporous silver (np-Ag) pieces was reported via preparation of Ag-Ga alloys in relatively low temperature and subsequent electrochemical dealloying in nitric acid (HNO3) aqueous solution. After selectively etching Ga out of the Ag-Ga alloy, a typical three-dimensional (3D) bicontinuous nanoporous structure with a pore size of ∼67.21-159.33 nm was observed. A series of studies have shown that the addition of sodium dodecyl sulfate (SDS) results in minimum pore size. The coarsen exponent (n) is 1.61, and the activation energy was calculated to be 27.04 kJ mol-1. Theζ'-AgGa alloy prepared at low temperature can be used as the precursor for the preparation of fine np-Ags, and this method provides a new strategy for the industrial production of dealloyed np-Ag.

Hydrogenotrophic methanogenic granular sludge formation for highly efficient transforming hydrogen to CH4.

This paper presents a potential process that can enhance H2 transformation to CH4 and simultaneously upgrading biogas by using hydrogenotrophic methanogens. For the first time, anaerobic granules were developed in upflow anaerobic sludge blanket (UASB) reactor feeding H2/CO2 syngas as the sole substrate and the granule characterization was thoroughly investigated. The results from experiment revealed that the H2 consumption rates of UASB reactor increased from 32.2 mmol L-1·d-1 at H2 feeding rate 0.08 g L-1·d-1 to 132.0 mmol L-1·d-1 at 0.37 g L-1·d-1, indicating that the hydrogenotrophic methanogenesis pathway was stimulated by injection of H2. Abundant cavities and cracks were observed on the surface and cross-section of granules, which greatly facilitated internally transferring H2/CO2 synthesis gas and biogas escape. The abundance of hydrogenotrophic Methanobacterium increased, while Methanosaeta, Methanosarcina, and Methanomassiliicoccus decreased with increasing H2 feeding rate. In general, this paper offers a feasible solution in terms of energy transformation and connecting power to fuel.

Feasibility of Distal Radial Access for Coronary Angiography and Percutaneous Coronary Intervention: A Single Center Experience.

OBJECTIVE: Asymptomatic radial artery occlusion remains the most common complication in transradial coronary interventional procedure. To prevent radial artery occlusion, distal transradial access (dTRA) has been suggested recently. In this article, we aim to describe our experience and to assess feasibility and safety of this new access site for routine coronary angiography (CAG) and percutaneous coronary intervention (PCI). METHODS: We retrospective analyzed 1,063 consecutive patients who were assigned to undergo CAG or procedural PCI through dTRA between 1 January 2018 and 31 December 2019 at Affiliated Zhongshan Hospital of Dalian University. The size of radial sheath used was 5 or 6 French. The sheath was removed at procedure termination, and hemostasis was obtained by compression bandage with gauze. The success rate of dTRA access defined by successful radial artery cannulation on the first dTRA side attempted, the cause of access failure, the hemostasis duration, the incidence of post-catheterization radial artery occlusion, and the other access-related complications including hematoma of forearm and thumb numbness were assessed. RESULTS: Radial artery cannulation via dTRA was successful in 953 of 1,063 patients with a success rate of 89.7%. Mean age of successful cases was 64.6 ± 11.2 years (26-94 years) with 339 (35.6%) women. A total of 363 (38.1%) cases were PCI. Among them, 95 cases (10%) underwent urgent PCI, including primary PCI in 64 patients with ST-segment elevation myocardial infarction and immediate PCI (<2 h from hospital admission) in 31 patients with very high-risk non-ST-segment elevation acute coronary syndrome. A total of 269 (28.2%) cases were via left dTRA. The 6 French sheath was used in 602 (63.2%) cases. Hemostasis was obtained within 2 h in 853 (89.5%) patients. There were 110 (10.3%) procedural failures: 59 (5.6%) cases of artery puncture failure, 49 (4.9%) cases of guide wire insertion failure, and 2 (0.2%) cases of sheath insertion failure. Complications potentially related to distal radial access included radial artery occlusion at the access site (13 cases, 1.4%), forearm radial artery occlusion (4 cases, 0.4%), hematoma of forearm (5 cases, 0.5%), and transient thumb numbness (2 cases, 0.2%). CONCLUSION: dTRA is a feasible and safe access and can be used as a rational alternative to traditional radial access for routine coronary interventional procedure.

Formation factors and hazard evaluation of halogenated methyl sulfonic acid in drinking water.

Halogenated methyl sulfonic acid (HMSAs) is a new type of disinfection by-product recently reported, and there are few relevant studies, so its source and harm are still unclear. This study mainly discusses the source of halogenated methyl sulfonic acid from the macroscopic level and evaluates the harm to human health. This study clarified that chlorine disinfection is one of the main ways of generating halogenated methyl sulfonic acids (HMSAs) in drinking water. The macroscopic properties of HMSA precursors were analyzed through liquid chromatograph-mass spectrometry (LC-MS/MS), 3D fluorescence, and Fourier transform infrared spectrometry. The results showed that polar and positively charged organic compounds with molecular weights of >3 KDa or <0.5 KDa can readily generate HMSAs. By analyzing the main components of natural organic compounds in water and comparing them with the characteristics of organic compounds such as dimethyl sulfoxide and ethyl mercaptan, it meant that natural organic compounds are easily degraded. Humic and fulvic acids contribute the most to HMSA generation. This study lasted for three years and collected water samples from 102 waterworks in 24 cities in China, and the existence of HMSAs in drinking water in different cities was analyzed. The potential health risks associated with HMSAs were used by the United States Environmental Protection Agency (U.S. EPA) health risk assessment model. The average and maximum concentrations of HMSAs in tap water from key cities in China were taken as evaluation objects. The results showed that the carcinogenic risk coefficient (R) value of both concentrations was far lower than the lowest acceptable carcinogenic risk (1.0 × 10-6) provided by U.S. EPA. Therefore, HMSAs in drinking water in China currently pose no human health risks.

Optimization of pretreatment in pymetrozine production wastewater via reactive distillation and side-stream distillation methods with response surface methodology.

Lots of highly concentrated saline organic wastewater is produced during the pymetrozine production process, causing environmental pollution and waste of resources if discharged directly. Research on actual pymetrozine wastewater treatment is quite scarce. Existing treatment methods of pesticide wastewater usually have disadvantages of long treatment time, low processing efficiency and low recovery rate. To solve these problems, a pretreatment process for pymetrozine wastewater was studied based on material recovery and pollutant degradation. The ammonia conversion process was experimentally investigated by reactive distillation. The reaction product vapor was neutralized and then separated by side-stream distillation. Aspen Plus and response surface methodology were employed to simulate and optimize the operating conditions. Box-Behnken design was used to investigate the individual and interaction effects on methanol purification and sodium acetate removal. Experimental study was carried out on the basis of theoretical simulation data. The result showed that the optimized methanol content on tower top was 99.28% with a yield of 99.95% and methanol content of side withdrawal was 0.01%. The process can be applied for pesticide wastewater treatment to recycle high purity chemical materials, and meets the national sewage comprehensive emission standard.

Cost-Effectiveness of Transcatheter Mitral Valve Repair Versus Medical Therapy in Patients With Heart Failure and Secondary Mitral Regurgitation: Results From the COAPT Trial.

BACKGROUND: The COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) demonstrated that edge-to-edge transcatheter mitral valve repair (TMVr) with the MitraClip resulted in reduced mortality and heart failure hospitalizations and improved quality of life compared with maximally tolerated guideline-directed medical therapy (GDMT) in patients with heart failure and 3 to 4+ secondary mitral regurgitation. Whether TMVr is cost-effective compared with GDMT in this population is unknown. METHODS: We used data from the COAPT trial to perform a formal patient-level economic analysis of TMVr+GDMT versus GDMT alone for patients with heart failure and 3 to 4+ secondary mitral regurgitation from the perspective of the US healthcare system. Costs for the index TMVr hospitalization were assessed using a combination of resource-based accounting and hospital billing data (when available). Follow-up medical care costs were estimated on the basis of medical resource use collected during the COAPT trial. Health utilities were estimated for all patients at baseline and 1, 6, 12, and 24 months with the Short Form Six-Dimension Health Survey. RESULTS: Initial costs for the TMVr procedure and index hospitalization were $35 755 and $48 198, respectively. Although follow-up costs were significantly lower with TMVr compared with GDMT ($26 654 versus $38 345; P=0.018), cumulative 2-year costs remained higher with TMVr because of the upfront cost of the index procedure ($73 416 versus $38 345; P<0.001). When in-trial survival, health utilities, and costs were modeled over a lifetime horizon, TMVr was projected to increase life expectancy by 1.13 years and quality-adjusted life-years by 0.82 years at a cost of $45 648, yielding a lifetime incremental cost-effectiveness ratio of $40 361 per life-year gained and $55 600 per quality-adjusted life-year gained. CONCLUSIONS: For symptomatic patients with heart failure and 3 to 4+ secondary mitral regurgitation, TMVr increases life expectancy and quality-adjusted life expectancy compared with GDMT at an incremental cost per quality-adjusted life-year gained that represents acceptable economic value according to current US thresholds. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01626079.

Cost-Effectiveness of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis at Intermediate Risk.

BACKGROUND: In patients with severe aortic stenosis (AS) at intermediate surgical risk, treatment with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) results in similar rates of death or stroke at 2 years. Whether TAVR is cost-effective compared with SAVR for intermediate-risk patients remains uncertain. METHODS: Between 2011 and 2014, 3110 intermediate-risk AS patients were treated with TAVR or SAVR in the PARTNER 2 trial (Placement of Aortic Transcatheter Valves 2). A total of 2032 patients were randomized to receive TAVR using the SAPIEN XT valve (XT-TAVR) or SAVR in the PARTNER 2A trial, whereas the PARTNER S3i registry included an additional 1078 patients treated with TAVR using the SAPIEN 3 valve (S3-TAVR), which offers a lower delivery profile and sealing skirt designed to reduce paravalvular regurgitation compared with XT-TAVR. Procedural costs were estimated using measured resource utilization. Other in-trial costs were assessed by linkage of trial data with Medicare claims (n=2333) or by linear regression models for unlinked patients (n=682). Health utilities were estimated using the EQ-5D at baseline and 1, 12, and 24 months. Using a Markov model informed by in-trial costs, utilities, and survival data, lifetime cost-effectiveness from the perspective of the US healthcare system was estimated in terms of cost per quality-adjusted life-year gained. RESULTS: Although procedural costs were ≈$20 000 higher with TAVR than SAVR, total cost differences for the index hospitalization were only $2888 higher with XT-TAVR ( P=0.014) and were $4155 lower with S3-TAVR ( P<0.001) owing to reductions in length of stay with TAVR. Follow-up costs were significantly lower with XT-TAVR (Δ=-$9304; P<0.001) and S3-TAVR (Δ=-$11 377; P<0.001) than with SAVR. Over a lifetime horizon, TAVR was projected to lower total costs by $8000 to $10 000 and to increase quality-adjusted survival by 0.15 to 0.27 years. XT-TAVR and S3-TAVR were found to be economically dominant compared with SAVR in 84% and 97% of bootstrap replicates, respectively. CONCLUSIONS: Among intermediate-risk AS patients, TAVR is projected to be economically dominant from the perspective of the US healthcare system by providing both greater quality-adjusted life expectancy and lower long-term costs than SAVR. If long-term data demonstrate comparable late mortality with TAVR and SAVR, these findings suggest that TAVR might be the preferred treatment strategy for intermediate-risk AS patients based on both clinical and economic considerations. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01314313.

Evaluation of bacterial association in methane generation pathways of an anaerobic digesting sludge via metagenomic sequencing.

Anaerobic digestion, a recently hot technology to produce biogases especially methane generation for biofuel from wastewater, is considered an effective explanation for energy crisis and global pollution threat. A complex microbiome population is present in sludge, which plays an important role in the digestion of complex polymer into simple monomers. 16S rRNA approaches simply are not enough for amplification due to the involvement of extreme complex population. However, Illumina sequencing is a recent powerful technology to reveal the entire microbiome structure and methane generation pathways in anaerobic digestion. Metagenomic sequencing was tested to reveal the microbial structure of a digested sludge from a local wastewater treatment plant in Beijing. The Illumina HiSeq program was used to extract about 5 GB of data for metagenomic analysis. The classification investigation revealed about 97.64% dominancy of bacteria while 1.78% were detected to be archaea using MG-RAST server. The most abundant bacterial communities were reported to be Actinobacteria, Bacteroidetes, Firmicutes and Proteobacteria. Furthermore, the important microbiome involved in methane generation was revealed. The dominant methanogens were detected (Methanosaeta and Methanosarcina), with affiliation of dominant genes involved in acetoclastic methanogenesis in a digesting sludge. The metagenomic analysis showed that microbial structure and methane generation pathways were successfully dissected in an anaerobic digester.

Dissecting microbial community structure in sewage treatment plant for pathogens' detection using metagenomic sequencing technology.

Continuous observation of wastewater treatment plants is very crucial to keep them safe for proper use and protection from pathogenic contamination. Illumina sequencing technology was used for microbiome structuring from various samples taken from different portions of the wastewater treatment plant, including influent, activated, return sludge and effluent, where different microbial compositions were found. The effluent section was found to have pathogenic microbes such as viruses, Alpha- and deltaproteobacteria, Actinobacteria, Bacteroidetes, clostridia, and bacilli in various concentrations. The presence of viruses, Mycobacterium sp., Mycobacterium fortuitum, bacteroidia, and bacilli was investigated. The species Mycobacterium was found to be higher in quantity in the effluent section. Viruses, including hepatitis A and E, were detected in higher quantity in the effluent part of the sludge in comparison with the influent part of the plant. Our discovery reveals the significance and observation of wastewater treatment plants for the existence of water-borne pathogens in the effluent, principally due to the effect on humans while reusing the water.

Evaluation of chemistry and key reactor parameters for industrial water treatment applications of the UV/O3 process.

In this study, the main influence factors of combined UV/O3 process in practical industrial application were explored through laboratory trials and industrial pilot tests. Dimethyl phthalate (DMP) was analyzed as the research subject through different experiments in laboratory. The degradation effect of organic compounds by O3 and UV/O3 processes in different air distribution methods was compared independently, and the mechanism of free radical generation by the two processes was analyzed. This study found that the combined UV/O3 process for organic matter mineralization is clearly better than that of independent effect of O3 process as mixed gas-liquid distribution method was superior to the bubble aeration method. The experimental conditions included inlet O3 concentration between 70 and 75 mg/L, reactor internal relative pressure at 0.3 MPa, contact reaction time of 12 min, DMP mineralization efficiency reaching 63.07%. The calculated dosing ratio of O3 in the dynamic experiment was around 0.74 mg CODCr/mg O3. The results showed that the best effect in wastewater treatment was achieved when the conditions of ultraviolet lamp irradiation intensity and the O3 dosage reached 822.88 W/m2 15 mg/L and utilized in conjunction with biochemical reactions. The resulting CODCr concentration of effluent reached 39.8 mg/L. Finally, it is determined that the main influence factors affecting the economically efficient operation of UV/O3 process were the efficient O3 distribution mode, control of the relative pressure within the reactor, proportion of ozone addition and light source configuration.

Metagenomic analysis and characterization of acidogenic microbiome and effect of pH on organic acid production.

Organic acid production including lactate and acetate is an economically attractive technology that has gained momentum worldwide over the past years. These series of action need to be performed by an esoteric and complex microbial community, in which different members have distinct roles in the establishment of a collective organization. In this study, we analyzed the bioma from bioreactors with various pH conditions of 4.0, 5.0 and 6.0 (R1, R2 and R3), respectively, involved in acidogenic digestion for stable production of various organic acids by means of high-throughput Illumina sequencing, disclosing thousands of genes and extracting more than 53 microbial genomes. At pH 5.0, the hydrolysis reaction was enhanced and thus the lactic acid fermentation was stably improved to 45.96 mm/L and acetic acid to 73.77 mm/L. R2 was found with the most suitable pH condition for stable organic acids production as Lactobacilli and Bifidobacteria were the major members. Both the members have the key roles in heterofermentation and produce higher transcripts of key encoding enzymes involved in the dominant heterofermentation pathways.

Interferents of Automated Reticulocyte Analysis Integrated with Relevant Clinical Cases.

BACKGROUND: Reticulocyte count (RET) has been used for many years to estimate the erythropoietic activity of the bone marrow. Fully automated methods not only provide enhanced precision and accuracy, but also enable reliable measurements of mRNA content and cellular indices. However, problems still exist, such as interference. The aim of the present study was to investigate the interferents of Sysmex XN 9000 reticulocyte analysis and ensure the accuracy of the results. METHODS: We collected a total of 510 specimens from normal control patients and patients with various diseases including anemias, leukemias, infectious diseases, immune diseases, kidney disease, etc. Correlation of the agreement for reticulocytes between the new methylene blue (NMB) visual microscopy method and automated reticulocyte counting was evaluated by paired sample method according to the CLSI-ICSH document H44-A2-Methods for Reticulocyte Count. Blood smear microscopic examination was carried out on the disturbed samples, and the interferents were analyzed with the medical history, flagging algorithms, the warning information, and the microscopic examination. RESULTS: A total of 44 (8.6%) cases exhibited interference. The main interferents of spuriously high reticulocyte count were caused by parasites, such as malaria, as well as suspicious autofluorescence due to drugs, while the main interferents of spuriously low reticulocyte count were caused by RBC fragments. CONCLUSIONS: Detection of potential interferences may be accomplished through alarm information and flagging algorithms incorporated into the instrument and by examination of a blood film to ensure absence of relevant interferences.

Comparability of three intraocular pressure measurement: iCare pro rebound, non-contact and Goldmann applanation tonometry in different IOP group.

BACKGROUND: Measurement of intraocular pressure (IOP) is essential for glaucoma patients. Many factors such as central corneal thickness (CCT) can affect the accuracy of IOP measurement. The purpose of this study was to evaluate the agreement of IOP measured by non-contact tonometer (NCT), iCare pro rebound tonometer (iCare), and Goldmann applanation tonometer (GAT) in different IOP group. METHODS: This was a Hospital-based cross-sectional study. Two hundred subjects were enrolled in this study. All subjects underwent IOP measurement using an NCT-iCare-GAT sequence. Bland-Altman, Pearson correlation and intraclass correlation analysis were performed using SPSS 17.0 software. The influence of CCT on each IOP measurement methods was evaluated by linear regression analysis. RESULTS: The mean difference (Δ) of NCT-GAT did not differ from (Δ) iCare-GAT in IOP < 10 and 10-21 mmHg group. However, (Δ) NCT-GAT was significantly higher than (Δ) iCare-GAT in IOP 22-30 and > 30 mmHg group (P < 0.05). Bland-Altman analysis showed significant agreement between the three devices (P < 0.01). IOP measurements of the three methods were significantly correlated with CCT (P < 0.01). CONCLUSIONS: ICare pro shows a higher agreement with GAT over a wide range of IOP compared with NCT. The consistency between the three tonometers was similar in a low and normal IOP range. However, NCT shows a greater overestimate of IOP in moderate and higher IOP group. The variability of IOP measurement affected by CCT is NCT > iCare pro > GAT.