Coupling high-rate activated sludge process with aerobic granular sludge process for sustainable municipal wastewater treatment.

Achieving a neutral/positive energy balance without compromising discharge standards is one of the main goals of wastewater treatment plants (WWTPs) in terms of sustainability. Aerobic granular sludge (AGS) technology promises high treatment performance with low energy and footprint requirement. In this study, high-rate activated sludge (HRAS) process was coupled to AGS process as an energy-efficient pre-treatment option in order to increase energy recovery from municipal wastewater and decrease the particulate matter load of AGS process. Three different feeding strategies were applied throughout the study. AGS system was fed with raw municipal wastewater, with the effluent of HRAS process, and with the mixture of the effluent of HRAS process and raw municipal wastewater at Stage 1, Stage 2 and Stage 3, respectively. Total suspended solids (TSS), chemical oxygen demand (COD), ammonia nitrogen (NH4+-N), and total phosphorus (TP) concentrations in the effluent were less than 10 mg/L, 60 mg/L, 0.4 mg/L, and 1.3 mg/L respectively at all stages. Fluctuations were observed in the denitrification performance due to changes in the influent COD/total nitrogen (TN) ratio. This study showed that coupling HRAS process with AGS process by feeding the AGS process with the mixture of HRAS process effluent and raw municipal wastewater could be an appropriate option for both increasing the energy recovery potential of WWTPs and enabling high effluent quality.

Characterization of the mechanical properties of human parietal bones preserved in modified larssen solution, formalin and as fresh frozen.

PURPOSE: Although the fresh frozen (FF) cadaver is preferred for surgical applications, it is limited due to short usage time, unsuitable for reuse and the risk of infection. Due to its limited use, FF cadavers, which are covered by import in countries with insufficient body donation cause low-cost effectiveness. With the increase of real human tissue specimen necessities for surgical training, long-term preservation of the cadavers is crucial due to changes in mechanical properties. Therefore, studies on embalming solutions have increased in recent years. METHODS: We quantify the biomechanical properties of human parietal bones preserved via modified larssen solution (MLS) and compare the results with the specimens preserved as FF and fixed with 10% formalin-based solution (F10). The rectangular samples of 24 parietal bones of male individuals were resected from MLS-embalmed, F10-embalmed and FF cadavers to form three groups each containing eight samples. These specimens were tested longitudinally to identify mechanical properties. RESULTS: The tensile test results showed that there is not a significant difference between the groups in terms of stiffness, elastic modulus, strain at ultimate stress, failure strain and effective plastic strain. However, the yield stress, ultimate stress, yield strain, failure stress and total energy and post-yield properties are significantly lower in F10 than MLS and FF groups. CONCLUSION: It is observed that the mechanical properties of MLS preserved and FF parietal bones have almost similar properties. Thus, it can be concluded that MLS is a suitable fixative solution for bone studies and bone-related surgical anatomy training applications.

A surgical and anatomo-histological study on Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA).

BACKGROUND: The number of TOETVA surgeries has increased worldwide but the anatomical passage of trocars is not clearly defined. We aimed to define detailed surgical anatomical passage of the trocars in cadavers. The incisions in oral vestibule, anatomical pathways of trocars, affected mimetic muscles, neurovascular relations of trocars and histological correlation of surgical anatomy were investigated. METHODS: Four cadavers and 6 six patient oral vestibules were used. The locations of optimised vestibular incisions were measured photogrammetrically. Initial steps of TOETVA surgery were performed on cadavers according to those optimal incisions. TOETVA preformed cadavers dissected to determine anatomical passages of the trocars. Afterwards, flap of lower lip and chin were zoned by software appropriate to the trocars routes. Histological analyses of the zones were made in correlation with dissections. RESULTS: Mimetic muscles associated with median (MT) and lateral trocars (LT) are orbicularis oris, mentalis, depressor anguli oris, depressor labii inferioris and platysma muscles. Trocars affect mimetic muscles in the perioral, chin and submental regions in different ways. The risk of mental nerve injury by MT is low. LT pass through the DLI muscle. The transmission of LT to the subplatysmal plane in the submental regions can be in two different ways. The arterial injury risk is higher with LT than the MT. CONCLUSIONS: The surgical anatomy of the perioral, chin and submental regions for the initial TOETVA steps has been defined. Detailed surgical anatomical passages of the MT and LT were determined. Anatomical pattern to reach subplatysmal plane are presented. Mimetic muscles effected by trocars were determined. Endocrine surgeons should know the anatomical passage of TOETVA trocars.

Morphometric assessment of important landmarks on skull intended for Vidian nerve surgery.

PURPOSE: The aim of our study was to determine guide parameters for clinicians by morphometric assessment of important landmarks on cranium intended for Vidian nerve surgery. METHODS: For the study, 23 half-skull bases, 40 skull bases and 40 skulls were obtained from the Department of Anatomy, Ege University Medicine Faculty. The vertical distances were measured using a digital caliper to the nearest 0.01 mm. RESULTS: The anterior opening of the Vidian canal (pterygoid canal) was observed as oval shaped on 57 specimens (31.1%), funnel shaped on 58 specimens (31.7%), round shaped on 64 specimens (35%) and septated on 4 specimens (2.2%). Vidian canal was embedded into the body of sphenoid on 55 specimens (52.4%) (embedded type) and protruded to sphenoidal sinus on 50 specimens (47.6%) (protruded type). 21 specimens of 50 were partial and 29 specimens were total. There were dehiscences on 21 specimens of 50 protruded type on the base of sphenoidal sinus (20%). Anterior opening of the Vidian canal was assessed according to medial lamina of pterygoid process. It was located medially in 169 of the specimens (92.3%) and laterally in 14 specimens (7.7%). CONCLUSION: Vidian canal and Vidian nerve are deeply located structures on skull. Vidian canal and surrounding structures are important landmarks for microsurgery and endoscopic approaches to Vidian nerve. We consider that knowledge of anatomical features of Vidian canal and preoperative imaging by CT (computed tomography) will be supportive when choosing and planning a safe surgical approach.

Assessment of Nutritional Status and Malnutrition Risk at Diagnosis and Over a 6-Month Treatment Period in Pediatric Oncology Patients With Hematologic Malignancies and Solid Tumors.

In total, 74 pediatric oncology patients with hematologic malignancies (n=56) or solid tumors (n=18) and a median age of 78.5 months were included in this prospective study. The aims were to assess malnutrition risks and nutritional status over a 6-month treatment period measured at regular intervals. The rate of patients with high risk for malnutrition at diagnosis was 28.4% by Screening Tool for Risk of Impaired Nutritional Status and Growth tool and 36.5% by Pediatric Yorkhill Malnutrition Score. Body mass index (BMI) z-scores at diagnosis showed 12.3% undernutrition (<-2 SD) and 6.8% overnutrition (>2 SD), which changed to 6.7% and 11.1% at the sixth month, respectively. Malnutrition (BMI<5th age percentile) was detected in 13.7% at diagnosis. Despite an initial deterioration noted in BMI, BMI for age percentile, and z-scores at month 1 in all malignancy subgroups (at month 3 for acute lymphoblastic leukemia), the scores improved later on. There was an increase in weight from baseline in 88.2% of patients over 6 months. This study revealed a decrease in the prevalence of undernutrition and malnutrition over a 6-month treatment period with improved anthropometrics despite an initial deterioration in all malignancy subgroups and even in patients with high risk for malnutrition at baseline screening. Solid tumors and acute lymphoblastic leukemia seem to be associated with higher likelihood of undernutrition and overnutrition, respectively, during treatment.

Pseudo-plaque reduction neutralization test (PPRNT) for the measurement of neutralizing antibodies to Crimean-Congo hemorrhagic fever virus.

BACKGROUND: Crimean-Congo hemorrhagic fever virus (CCHFV) is a tick-borne virus of the genus Nairovirus family Bunyaviridae, which are enveloped viruses containing tripartite, negative polarity, single-stranded RNA. CCHF is characterized by high case mortality, occurring in Asia, Africa, the Middle East and Europe. Currently, there are no specific treatments or licensed vaccines available for CCHFV. Recently, two research groups have found adult mice with defective interferon responses allowed to lethal CCHFV infection. These mouse models could provide invaluable information for further studies. Efforts to develop a vaccine against CCHFV are being made. To determine the efficacy of vaccine candidates it is important to conduct serological studies that can accurately measure levels of protective antibodies. In the present study, a pseudo-plaque reduction neutralization test (PPRNT) based on enzyme-catalyzed color development of infected cells probed with anti-CCHFV antibodies was used to measure neutralization antibody of CCHFV. METHODS: Sixty-nine human serum samples (20 acute and 49 convalescent) were tested. The presence of CCHFV antibodies was determined and confirmed by a commercial ELISA kit. CCHFV RNA was determined by RT-PCR. All the samples were analyzed by PPRNT and fluorescent focus reduction neutralization test (FFRNT) to measure of CCHFV-neutralizing antibodies. RESULTS: Pseudo-plaque reduction neutralization test showed a high sensitivity (98%), specificity (100%) and agreement (96,6%) in qualitative comparison with those of the FFRNT. There was a high correlation between the titers obtained in PPRNT and FFRNT (R2 = 0.92). The inter- and intra-assay variation of PPRNT revealed good reproducibility and positive cut-off of PPRNT was defined as 1:4 by the geometric mean titers for the individual samples distributed. CONCLUSION: The pseudo-plaque reduction neutralization test described in this study is a fast, reproducible and sensitive method for the measurement of CCHF neutralizing antibodies. This novel assay could serve as useful tools for CCHF research in epidemiology, vaccine development and other studies of immunity. It also provides an alternative to PRNT when viruses with no or poor CPE in cell culture.

A tablet game or training booklet? Two methods for evaluating symptom management and quality-of-life of children receiving chemotherapy.

PURPOSE: In chemotherapy process, the innovative and educational roles of nurses come to the forefront so that children can manage the symptoms they will encounter and thus increase their quality-of-life. Therefore, a tablet game was developed by the authors of this study to evaluate the effect of training children aged 10-16 who receive chemotherapy by a tablet game and a booklet on symptom management and quality-of-life. METHODS: This was a non-randomized pre and post-test control group study. The study sample consisted of 50 children (game: 25; booklet: 25) who met the inclusion criteria and hospitalized between February 2017-July 2018 in two hospitals' Paediatric Haematology-Oncology Units. Data collection tools consisted of a child evaluation form, Memorial Symptom Assessment Scale, KINDL-Cancer Module, a tablet game, and booklet. RESULTS: When groups were evaluated within themselves after the intervention, the decrease of disturbance level of symptoms at the game group was higher than the booklet group (p:.004). Before the intervention, there was not any difference in the quality-of-life mean between groups (p < .05). After the intervention quality-of-life total (p:.000), mental (p:.030), and treatment (p:.009) subscale means were statistically significantly less at game group than booklet group. CONCLUSIONS: Both interventions were effective for symptom management, and they were not superior to each other, but the quality-of-life was higher in the game group.

Alteration in Hepatitis B Serology in Children Receiving Chemotherapy.

Chemotherapy-induced immunosuppression can lead to hepatitis B virus (HBV) reactivation in cancer patients. Both HBV carriers and individuals with serological signs of previously resolved HBV exposure are under the risk of severe hepatitis and liver failure during and after chemotherapy. The objective of this largest retrospective study was to analyze the consequences of HBV status in children receiving chemotherapy. A total of 479 patients (273 boys and 206 girls) aged 1-211 months diagnosed with acute hematologic malignancies and solid tumors were included in the study. Serological markers for HBV before and after chemotherapy and clinical data of the patients were evaluated retrospectively. Two hundred thirty-four of the participants were found to have protective antibody titers to HBV at admission. Five children were carrying HBV before chemotherapy. They received antiviral therapy during treatment and no reactivation was detected. Antibody against hepatitis B surface antigen (antiHBs) remained positive in 194 patients after chemotherapy. However, 17.09% (40/234) lost antiHBs positivity. In this group, three patients (1.28%) who initially had positive antiHBs and antihepatitis B core antibody experienced HBV reactivation and lost their protective antiHBs at the end of the therapy. Median antiHBs titer significantly decreased after chemotherapy (213.14 [range: 24-888] vs. 180.85 [range: 0-850]) (p = 0.0094). The current relatively large trial demonstrated that protective antibody titers remarkably altered after chemotherapy, and at least 17% of the pediatric oncology cases lost antiHBs positivity. Therefore, vaccine prevention and close monitoring of serology should be considered during chemotherapy.

Changes in tissue gadolinium biodistribution measured in an animal model exposed to four chelating agents.

PURPOSE: This study investigated the potential to reduce gadolinium levels in rodents after repetitive IV Gadodiamide administration using several chelating agents. MATERIALS AND METHODS: The following six groups of rats were studied. Group 1: Control; Group 2: Gadodiamide only; Group 3: Meso-2,3-Dimercaptosuccinic acid (DMSA) + Gadodiamide; Group 4: N-Acetyl-L-cysteine (NAC) + Gadodiamide; Group 5: Coriandrum sativum extract + Gadodiamide; and Group 6: Deferoxamine + Gadodiamide. Brain, kidney, and blood samples were evaluated via inductively coupled plasma mass spectrometry. The brain was also evaluated histologically. RESULTS: Kidney gadolinium levels in Groups 4 and 5 were approximately double that of Group 2 (p = 0.033 for each). There was almost no calcification in rat hippocampus for Group 4 rodents when compared with Groups 2, 3, 5 and 6. CONCLUSION: Our preliminary study shows that excretion to the kidney has a higher propensity in NAC and Coriandrum sativum groups. It may be possible to change the distribution of gadolinium by administrating several agents. NAC may lower Gadodiamide-induced mineralization in rat hippocampus.

Chylous ascites after lymphadenectomy in a Wilms` tumor patient.

Yörük MA, Erat-Nergiz M, Timur Ç, Canbolat-Ayhan A, Ergüven M. Chylous ascites after lymphadenectomy in a Wilms` tumor patient. Turk J Pediatr 2018; 60: 436-438. Wilms` tumor is the most common renal malignancy in children and the fourth most common childhood cancer. It accounts 6-7% of all childhood malignancies. Surgical resection is an important therapy option and transabdominal or transperitoneal resection with lymph node sampling is preferred. Development of chylous ascites following intraabdominal or retroperitoneal resection in pediatric age group generally results from extensive lymph node dissection, accidental ligation or interruption of lymphatic ducts. Diseases or conditions affecting abdominal and/or retroperitoneal lymph nodes may cause chylous ascites. Postoperative chylous ascites is associated with significant morbidity and may cause mechanic, nutritional and immunological complications. In the present study, a 16-month-old infant with Stage IV Wilms` tumor who developed chylous ascites after left nephrectomy and lymphadenectomy will be presented; chylous ascites treatment with enteral nutrition and surgical treatment approach for Wilms` tumor will be reviewed.

A large-scale outbreak of bovine ephemeral fever in Turkey, 2012.

Regional cases of bovine ephemeral fever (BEF) were documented previously in Turkey. Previous cases were confirmed in South-East Turkey with low cow mortality. Recent BEF-suspected outbreaks with high mortality were documented in many regions of Turkey in 2012. The aim of study was the epidemiological examination of the outbreak and molecular characterization of the viruses detected from the outbreak. For this reason, blood samples were collected from BEF-suspected outbreak regions. From the results of RT-PCR, high rate of BEF-suspected samples (48/60 or 80%) was found positive for BEF virus (BEFV) RNA. The nucleotide sequences of the G1 region of G gene of BEFV in the current study during the 2012 outbreak were grouped into cluster II of BEFV. It was suggested that BEFV may be spread out to other neighbor countries in the future years.

Application of the pseudo-plaque assay for detection and titration of Crimean-Congo hemorrhagic fever virus.

A pseudo-plaque assay was developed for detection and quantitation of Crimean-Congo hemorrhagic fever virus Turkey-Kelkit06. Enzyme-catalyzed color development of infected cells probed with anti-Crimean-Congo hemorrhagic fever virus antibodies was used for determining the titer of Crimean-Congo hemorrhagic fever Turkey-Kelkit06 and for its detection in samples from persons infected with the Crimean-Congo hemorrhagic fever virus. The pseudo-plaque assay accuracy was confirmed by comparing pseudo-plaque assay titers with fluorescent immunofocus assay and focus formation assay titers using three stocks of virus. No significant difference in virus titers of Crimean-Congo hemorrhagic fever Turkey-Kelkit06 among the three methods was observed. The pseudo-plaque assay is more sensitive than the fluorescent immunofocus assay for detecting the virus in primary isolates of Crimean-Congo hemorrhagic fever virus collected from humans, but no difference in sensitivity between the two methods was observed in the cell-adapted strain of Crimean-Congo hemorrhagic fever Turkey-Kelkit06. The pseudo-plaque assay is suitable for titration of Crimean-Congo hemorrhagic fever Turkey-Kelkit06, which does not develop plaques, suggesting it may also be suitable for the detection of other viruses.