RESUMO
BACKGROUND: Systemic lupus erythematosus (SLE), characterized by the production of autoantibodies and widespread deposition of immune complexes, predominantly affects women of childbearing age. More than one-third of SLE patients present ocular manifestations. Choroidal disease is currently not completely understood, and its precise differentiation from central serous chorioretinopathy is rarely achieved. To date, no more than 60 patients with choroidal involvement have been reported. CASE SUMMARY: A 37-year-old Chinese woman experienced decreased visual acuity bilaterally, accompanied by increasing periorbital swelling and severe conjunctival chemosis. Decreased breath sounds in both bases were detected via auscultation, as well as pitting edema in both ankles. SLE and lupus nephritis were diagnosed based on serositis, renal disorder, leukopenia and positive anti-Smith and anti-nuclear antibodies. Lupus choroidopathy was diagnosed based on ocular presentation and imaging. The patient was treated with systemic corticosteroids, spironolactone, hydroxychloroquine (HCQ), mycophenolate mofetil (MMF), and intravenous immunoglobulin. After 4 wk of hospitalization, the patient was discharged. Indocyanine green angiography showed no leakage from choroidal vessels, and ocular coherence tomography detected low amounts of subretinal fluid right before discharge. The patient was prescribed oral methylprednisolone, HCQ, and MMF. Two months after the first visit, ophthalmological examination revealed a visual acuity of 20/20 bilaterally, and SLE disease activity was well controlled; her symptoms disappeared completely. CONCLUSION: Here we presented a case of lupus choroidopathy, successfully treated with systemic corticosteroids, and discussed previously reported cases, focusing on differential diagnosis with a central serous chorioretinopathy.
RESUMO
High free ammonia nitrogen (FAN) is regarded as a main factor that inhibits biogas production in high solid anaerobic digestion systems with dewatered sludge. Two mesophilic semi-continuous anaerobic digesters fed with dewatered sludge (input total solids=15%) were operated and their performance under different FAN concentrations by two regulation methods including pH reduction and total ammonia nitrogen (TAN) promotion were investigated. Results showed that when FAN was elevated from (400±174) mg·L-1 to (526±25) mg·L-1 with the increase of TAN, the daily biogas yield declined from (11.9±0.3) L·d-1 to (10.3±0.2) L·d-1. Meanwhile, volatile solids (VS) reduction rate decreased by 33.7%. When FAN dropped from (330±99) mg·L-1 to (47±13) mg·L-1 due to pH reduction, daily biogas yield declined from (14.4±1.1) L·d-1 to (10.8±0.3) L·d-1 and VS reduction rate decreased by 26.9%. The system performance was not enhanced with the reduction of FAN. With the stop of pH regulation, FAN gradually raised again to 300 mg·L-1 and digester performance recovered to the same as the situation before regulation. The result suggested that inhibition occurred during pH reduction. By 16S rRNA pyrosequencing analysis on bacterial and archaeal diversity and quantitative PCR analysis aiming at methanogens, it was found that bacterial community structure both changed obviously with obvious performance decline in the two digesters. Excessive FAN (>500 mg·L-1) could change the main bacteria species which degrade protein from Tepidimicrobium and Proteiniborus to Anaerobranca. On the other hand, some carbohydrate and protein degrading bacteria were also inhibited by pH reduction for FAN control, leading to the decline of hydrolysis rates of organic matters. As a result, the shortage of substrate supply for the methanogens weakened the biogas production of the digestion system.