Effect of Oral Moxifloxacin vs Intravenous Ertapenem Plus Oral Levofloxacin for Treatment of Uncomplicated Acute Appendicitis: The APPAC II Randomized Clinical Trial.

Importance: Antibiotics are an effective and safe alternative to appendectomy for managing uncomplicated acute appendicitis, but the optimal antibiotic regimen is not known. Objective: To compare oral antibiotics with combined intravenous followed by oral antibiotics in the management of computed tomography-confirmed uncomplicated acute appendicitis. Design, Setting, and Participants: The Appendicitis Acuta (APPAC) II multicenter, open-label, noninferiority randomized clinical trial was conducted from April 2017 until November 2018 in 9 Finnish hospitals. A total of 599 patients aged 18 to 60 years with computed tomography-confirmed uncomplicated acute appendicitis were enrolled in the trial. The last date of follow-up was November 29, 2019. Interventions: Patients randomized to receive oral monotherapy (n = 295) received oral moxifloxacin (400 mg/d) for 7 days. Patients randomized to receive intravenous antibiotics followed by oral antibiotics (n = 288) received intravenous ertapenem (1 g/d) for 2 days followed by oral levofloxacin (500 mg/d) and metronidazole (500 mg 3 times/d) for 5 days. Main Outcomes and Measures: The primary end point was treatment success (≥65%) for both groups, defined as discharge from hospital without surgery and no recurrent appendicitis during 1-year follow-up, and to determine whether oral antibiotics alone were noninferior to intravenous and oral antibiotics, with a margin of 6% for difference. Results: Among 599 patients who were randomized (mean [SD] age, 36 [12] years; 263 [44%] women), 581 (99.7%) were available for the 1-year follow-up. The treatment success rate at 1 year was 70.2% (1-sided 95% CI, 65.8% to ∞) for patients treated with oral antibiotics and 73.8% (1-sided 95% CI, 69.5% to ∞) for patients treated with intravenous followed by oral antibiotics. The difference was -3.6% ([1-sided 95% CI, -9.7% to ∞]; P = .26 for noninferiority), with the confidence limit exceeding the noninferiority margin. Conclusion and Relevance: Among adults with uncomplicated acute appendicitis, treatment with 7 days of oral moxifloxacin compared with 2 days of intravenous ertapenem followed by 5 days of levofloxacin and metronidazole resulted in treatment success rates greater than 65% in both groups, but failed to demonstrate noninferiority for treatment success of oral antibiotics compared with intravenous followed by oral antibiotics. Trial Registration: ClinicalTrials.gov Identifier: NCT03236961; EudraCT Identifier: 2015-003633-10.

Large-scale spatial synchrony in red squirrel populations driven by a bottom-up effect.

Spatial synchrony between populations emerges from endogenous and exogenous processes, such as intra- and interspecific interactions and abiotic factors. Understanding factors contributing to synchronous population dynamics help to better understand what determines abundance of a species. This study focuses on spatial and temporal dynamics in the Eurasian red squirrel (Sciurus vulgaris) using snow-track data from Finland from 29 years. We disentangled the effects of bottom-up and top-down forces as well as environmental factors on population dynamics with a spatiotemporally explicit Bayesian hierarchical approach. We found red squirrel abundance to be positively associated with both the abundance of Norway spruce (Picea abies) cones and the predators, the pine marten (Martes martes) and the northern goshawk (Accipiter gentilis), probably due to shared habitat preferences. The results suggest that red squirrel populations are synchronized over remarkably large distances, on a scale of hundreds of kilometres, and that this synchrony is mainly driven by similarly spatially autocorrelated spruce cone crop. Our research demonstrates how a bottom-up effect can drive spatial synchrony in consumer populations on a very large scale of hundreds of kilometres, and also how an explicit spatiotemporal approach can improve model performance for fluctuating populations.

Acetotrophic Activity Facilitates Methanogenesis from LCFA at Low Temperatures: Screening from Mesophilic Inocula.

The inoculum source plays a crucial role in the anaerobic treatment of wastewaters. Lipids are present in various wastewaters and have a high methanogenic potential, but their hydrolysis results in the production of long chain fatty acids (LCFAs) that are inhibitory to anaerobic microorganisms. Screening of inoculum for the anaerobic treatment of LCFA-containing wastewaters has been performed at mesophilic and thermophilic conditions. However, an evaluation of inocula for producing methane from LCFA-containing wastewater has not yet been conducted at low temperatures and needs to be undertaken. In this study, three inocula (one granular sludge and two municipal digester sludges) were assessed for methane production from LCFA-containing synthetic dairy wastewater (SDW) at low temperatures (10 and 20°C). A methane yield (based on mL-CH4/g-CODadded) of 86-65% with acetate and 45-20% with SDW was achieved within 10 days using unacclimated granular sludge, whereas the municipal digester sludges produced methane only at 20°C but not at 10°C even after 200 days of incubation. The acetotrophic activity in the inoculum was found to be crucial for methane production from LCFA at low temperatures, highlighting the role of Methanosaeta (acetoclastic archaea) at low temperatures. The presence of bacterial taxa from the family Syntrophaceae (Syntrophus and uncultured taxa) in the inoculum was found to be important for methane production from SDW at 10°C. This study suggests the evaluation of acetotrophic activity and the initial microbial community characteristics by high-throughput amplicon sequencing for selecting the inoculum for producing methane at low temperatures (up to 10°C) from lipid-containing wastewaters.

Microalgae grow on source separated human urine in Nordic climate: Outdoor pilot-scale cultivation.

Human urine contributes approximately 80% of nitrogen and 50% of phosphorous in urban wastewaters while having a volume of only 1-1.5 L/d per capita compared to 150-200 L/d per capita of wastewater generated. There is interest to study source separation of urine and search methods to recover the nutrients form the urine. In this study, the objective was to use the nutrients in source separated urine for outdoor cultivation of microalgae in Nordic climate. A freshwater green microalga Scenedesmus acuminatus was grown in different dilutions (1:20 and 1:15) of source separated human urine, in a semi-continuously operated outdoor raceway pond with a liquid volume of 2000 L, at hydraulic retention time of 15 d. The microalgae could remove 52% nitrogen and 38% phosphorus even at culture temperatures as low as 5 °C, while obtaining a biomass density of 0.34 g VSS/L. Harvested microalgal biomass could be used to produce methane with a yield of 285 L CH4/kg volatile solids.

Semi-continuous mono-digestion of OFMSW and Co-digestion of OFMSW with beech sawdust: Assessment of the maximum operational total solid content.

In this study, mono-digestion of the organic fraction of municipal solid waste (OFMSW) and co-digestion of OFMSW with beech sawdust, simulating green waste, were used to investigate the maximum operational total solid (TS) content in semi-continuous high-solids anaerobic digestion (HS-AD). To alleviate substrate overloading in HS-AD, the effluent mass was relatively reduced compared to the influent mass, extending the mass retention time. To this aim, the reactor mass was daily evaluated, permitting to assess the reactor content removal by biogas production. During mono-digestion of OFMSW, the NH3 inhibition and the rapid TS removal prevented to maintain HS-AD conditions (i.e. TS ≥ 10%), without exacerbating the risk of reactor acidification. In contrast, the inclusion of sawdust in OFMSW permitted to operate HS-AD up to 30% TS, before acidification occurred. Therefore, including a lignocellulosic substrate in OFMSW can prevent acidification and stabilize HS-AD at very high TS contents (i.e. 20-30%).

Activin inhibition limits early innate immune response in rat kidney allografts-a pilot study.

Activins are members of the transforming growth factor-beta (TGF-ß) superfamily of cytokines. They play critical roles in the onset of acute and chronic inflammatory responses. The aim of this study was to investigate how activin inhibition affects acute kidney injury and inflammation after transplantation. The study was carried out in kidney transplantation and renal ischemia-reperfusion models in the rat. Soluble activin type 2 receptor (sActRIIB-Fc) was used to inhibit activin signaling. Transplantation groups were as follows: (i) cyclosporine A (CsA) (ii) CsA + sActRIIB-Fc, (iii) CsA+ inactive protein control Fc-G1. IRI groups were as follows: (i) no treatment, (ii) sActRIIB-Fc. Serum activin B concentration was significantly elevated after transplantation and IRI, whereas activin A was produced locally in renal allografts. Activin inhibition efficiently limited neutrophil, macrophage, and dendritic cell infiltration to the allografts measured 72 h after transplantation. In addition, sActRIIB-Fc treatment modulated serum cytokine response after transplantation and reduced the early accumulation of fibroblasts in the graft interstitium. In conclusion activin inhibition reduces the innate immune response early after renal transplantation in the rat. It also limits the accumulation of fibroblasts in the graft suggesting that activins may be involved in the fibrogenic signaling already early after kidney transplantation.

Outcome of stent grafting for esophageal perforations: single-center experience.

BACKGROUND: Recent studies showed that stent grafting is a promising technique for treatment of esophageal perforation. However, the evidence of its benefits is still scarce. METHODS: Forty-three consecutive patients underwent stent grafting for esophageal perforation at the Oulu University Hospital, Finland. The main endpoints of this study were early and mid-term mortality. Secondary outcome endpoints were the need of esophagectomy and additional surgical procedures on the esophagus and extraesophageal structures. RESULTS: Patients' mean age was 64.6 ± 13.4 years. The mean delay to primary treatment was 23 ± 27 h. The most frequent cause of perforation was Boerhaave's syndrome (46.5%). The thoraco-abdominal segment of the esophagus was affected in 58.1% of cases. Minor primary procedures were performed in 25 patients (58.1%) and repeat surgical procedures in 23 patients (53.5%). Forty-nine repeat stent graftings were performed in 22 patients (50%). Two patients (4.7%) underwent esophagectomy, one for unrelenting preprocedural stricture of the esophagus and another for persistent leakage of a perforated esophageal carcinoma. The mean length of stay in the intensive care unit was 6.0 ± 7.5 days and the in-hospital stay was 24.3 ± 19.6 days. In-hospital mortality was 4.6%. Three-year survival was 67.2%. CONCLUSIONS: Stent grafting seems to be an effective less invasive technique for the treatment of esophageal perforation. Repeat stent grafting and procedures on the pleural spaces are often needed to control the site of perforation and for debridement of surrounding infected structures. Stent grafting allows the preservation of the esophagus in most of patients. The mid-term survival of these patients is suboptimal and requires further investigation.

Interannual variation and long-term trends in proportions of resident individuals in partially migratory birds.

Partial migration - a part of a population migrates and another part stays resident year-round on the breeding site - is probably the most common type of migration in the animal kingdom, yet it has only lately garnered more attention. Theoretical studies indicate that in partially migratory populations, the proportion of resident individuals (PoR) should increase in high latitudes in response to the warming climate, but empirical evidence exists for few species. We provide the first comprehensive overview of the environmental factors affecting PoR and the long-term trends in PoR by studying 27 common partially migratory bird species in Finland. The annual PoR values were calculated by dividing the winter bird abundance by the preceding breeding abundance. First, we analysed whether early-winter temperature, winter temperature year before or the abundance of tree seeds just before overwintering explains the interannual variation in PoR. Secondly, we analysed the trends in PoR between 1987 and 2011. Early-winter temperature explained the interannual variation in PoR in the waterbirds (waterfowl and gulls), most likely because the temperature affects the ice conditions and thereby the feeding opportunities for the waterbirds. In terrestrial species, the abundance of seeds was the best explanatory variable. Previous winter's temperature did not explain PoR in any species, and thus, we conclude that the variation in food availability caused the interannual variation in PoR. During the study period, PoR increased in waterbirds, but did not change in terrestrial birds. Partially migratory species living in physically contrasting habitats can differ in their annual and long-term population-level behavioural responses to warming climate, possibly because warm winter temperatures reduce ice cover and improve the feeding possibilities of waterbirds but do not directly regulate the food availability for terrestrial birds.

Agronomic characteristics of five different urban waste digestates.

The use of digestate in agriculture is an efficient way to recycle materials and to decrease the use of mineral fertilizers. The agronomic characteristics of the digestates can promote plant growth and soil properties after digestate fertilization but also harmful effects can arise due to digestate quality, e.g. pH, organic matter and heavy metal content. The objective of this study was to evaluate the differences and similarities in agronomic characteristics and the value of five urban waste digestates from different biogas plants treating either food waste, organic fraction of organic solid waste or a mixture of waste-activated sludge and vegetable waste. The digestate agronomic characteristics were studied with chemical analyses and the availability of nutrients was also assessed with growth experiments and soil mineralization tests. All studied urban digestates produced 5-30% higher ryegrass yields compared to a control mineral fertilizer with a similar inorganic nitrogen concentration, while the feedstock source affected the agronomic value. Food waste and organic fraction of municipal solid waste digestates were characterized by high agronomic value due to the availability of nutrients and low heavy metal load. Waste-activated sludge as part of the feedstock mixture, however, increased the heavy metal content and reduced nitrogen availability to the plant, thus reducing the fertilizer value of the digestate.

Intensive perioperative simvastatin treatment protects from chronic kidney allograft injury.

BACKGROUND/AIMS: Ischemia-reperfusion injury (IRI) and innate immune response augment adaptive immunity and may also trigger repair processes that lead to uncontrolled fibrosis and atherosclerosis as seen in chronic allograft injury. Simvastatin has been shown to protect from renal IRI in several experimental studies. The aim of this study was to examine the effect of donor simvastatin pretreatment and early initiation of recipient simvastatin treatment on chronic kidney allograft injury. METHODS: A rat renal transplantation model was used. Simvastatin was administered perorally for donor (5 mg/kg) and/or for recipient (2 mg/kg) 2 hours before transplantation and/or as daily treatment starting on the first postoperative day (2 mg/kg/day). The study included 5 groups: (1) no simvastatin, (2) donor pretreatment, (3) daily recipient treatment, (4) donor pretreatment + daily recipient treatment and (5) donor pretreatment + recipient pretreatment + daily recipient treatment. The grafts were recovered at day 90 for histopathological and immunohistochemical analysis. Kidney function was followed weekly with serum creatinine, and 24-hour urine protein was measured 60 and 90 days after transplantation. RESULTS: We found that donor and recipient simvastatin pretreatment combined with daily recipient treatment reduced graft inflammation and chronic allograft injury. Treatment using only statins started after transplantation reduced inflammation to some extent, but did not affect chronic kidney allograft injury. Pretreatment using only donor statins impaired graft function and increased proteinuria. CONCLUSION: Our data suggest that perioperative recipient statin treatment reduces inflammation and may protect the graft in the long term.

Mechanisms of density dependence in ducks: importance of space and per capita food.

The growth rate of populations usually varies over time, often in a density-dependent manner. Despite the large amount of literature on density dependence, relatively little is known of the mechanisms underlying the density-dependent processes affecting populations, especially per capita natality. We performed a 20-year study on the density dependence of brood production in two duck species differing in the stability of habitat use. Our study was conducted in a boreal watershed in southern Finland. We predicted that a diving duck common goldeneye Bucephala clangula, with more stable habitat use, would show stronger density dependence than a dabbling duck common teal Anas crecca. We investigated reproductive output in relation to the duck pair density per se as well as in relation to per capita food availability. As predicted, the reproductive output of the goldeneye showed a more density-dependent pattern than that of the teal. The number of goldeneye broods per pair decreased when the pair density increased. This was not the case with the teal. However, when the breeding success was measured by taking into account per capita food availability, both species showed density dependence. Our results imply that the occurrence of density dependent processes may vary even in sympatric ducks breeding in the same, relatively stable landscape. Our analysis also emphasizes that it is important to take into account per capita resource availability when studying the density dependence of breeding success. Both findings have important implications for the management and conservation of species.

Dynamics of microbial communities in untreated and autoclaved food waste anaerobic digesters.

This study describes the microbial community richness and dynamics of two semi-continuously stirred biogas reactors during a time-course study of 120 days. The reactors were fed with untreated and autoclaved (160 °C, 6.2 bar) food waste. The microbial community was analysed using a bacteria- and archaea-targeting 16S rRNA gene-based Terminal-Restriction Fragment Length Polymorphism (T-RFLP) approach. Compared with the archaeal community, the structures and functions of the bacterial community were found to be more complex and diverse. With the principal coordinates analysis it was possible to separate both microbial communities with 75 and 50% difference for bacteria and archaea, respectively, in the two reactors fed with the same waste but with different pretreatment. Despite the use of the same feeding material, anaerobic reactors showed a distinct community profile which could explain the differences in methane yield (2-17%). The community composition was highly dynamic for bacteria and archaea during the entire studied period. This study illustrates that microbial communities are dependent on feeding material and that correlations among specific bacterial and archaeal T-RFs can be established.

Three-Year Outcomes of Oral Antibiotics vs Intravenous and Oral Antibiotics for Uncomplicated Acute Appendicitis: A Secondary Analysis of the APPAC II Randomized Clinical Trial.

Importance: Current short-term evidence has shown that uncomplicated acute appendicitis can be treated successfully with oral antibiotics alone, but longer-term results are lacking. Objective: To assess the treatment effectiveness of oral antibiotic monotherapy compared with combined intravenous (IV) and oral antibiotics in computed tomography-confirmed uncomplicated acute appendicitis at a longer-term follow-up. Design, Setting, and Participants: This secondary analysis of a predefined year 3 follow-up of the Appendicitis Acuta II (APPAC II) noninferiority, multicenter randomized clinical trial compared oral moxifloxacin with combined IV ertapenem plus oral levofloxacin and metronidazole for the treatment of uncomplicated acute appendicitis. The trial was conducted at 9 university and central hospitals in Finland from April 2017 to November 2018, with the last follow-up in November 2022. Participants included patients aged 18 to 60 years, who were randomized to receive either oral antibiotics monotherapy (n = 301) or combined IV and oral antibiotics (n = 298). Interventions: Antibiotics monotherapy consisted of oral moxifloxacin, 400 mg/d, for 7 days. Combined IV and oral antibiotics consisted of IV ertapenem sodium, 1 g/d, for 2 days plus oral levofloxacin, 500 mg/d, and metronidazole, 500 mg 3 times/d, for 5 days. Main Outcomes and Measures: The primary end point was treatment success, defined as the resolution of acute appendicitis and discharge from hospital without the need for surgical intervention and no appendicitis recurrence at the year 3 follow-up evaluated using a noninferiority design. The secondary end points included late (after 1 year) appendicitis recurrence as well as treatment-related adverse events, quality of life, length of hospital stay, and length of sick leave, which were evaluated using a superiority design. Results: After exclusions, 599 patients (mean [SD] age, 36 [12] years; 336 males [56.1%]) were randomized; after withdrawal and loss to follow-up, 582 patients (99.8%) were available for the year 3 follow-up. The treatment success at year 3 was 63.4% (1-sided 95% CI, 58.8% to ∞) in the oral antibiotic monotherapy group and 65.2% (1-sided 95% CI, 60.5% to ∞) in the combined IV and oral antibiotics group. The difference in treatment success rate between the groups at year 3 was -1.8 percentage points (1-sided 95% CI, -8.3 percentage points to ∞; P = .14 for noninferiority), with the CI limit exceeding the noninferiority margin. There were no significant differences between groups in treatment-related adverse events, quality of life, length of hospital stay, or length of sick leave. Conclusions and Relevance: This secondary analysis of the APPAC II trial found a slightly higher appendectomy rate in patients who received oral antibiotic monotherapy; however, noninferiority of oral antibiotic monotherapy compared with combined IV and oral antibiotics could not be demonstrated. The results encourage future studies to assess oral antibiotic monotherapy as a viable treatment alternative for uncomplicated acute appendicitis. Trial Registration: ClinicalTrials.gov Identifier: NCT03236961.

Establishing Criteria for Tumor Necrosis as Prognostic Indicator in Colorectal Cancer.

Tumor necrosis has been reported to represent an independent prognostic factor in colorectal cancer, but its evaluation methods have not been described in sufficient detail to introduce tumor necrosis evaluation into clinical use. To study the potential of tumor necrosis as a prognostic indicator in colorectal cancer, criteria for 3 methods for its evaluation were defined: the average percentage method (tumor necrosis percentage of the whole tumor), the hotspot method (tumor necrosis percentage in a single hotspot), and the linear method (the diameter of the single largest necrotic focus). Cox regression models were used to calculate cancer-specific mortality hazard ratios (HRs) for tumor necrosis categories in 2 colorectal cancer cohorts with more than 1800 cases. For reproducibility assessment, 30 cases were evaluated by 9 investigators, and Spearman's rank correlation coefficients and Cohen's kappa coefficients were calculated. We found that all 3 methods predicted colorectal cancer-specific survival independent of other prognostic parameters, including disease stage, lymphovascular invasion, and tumor budding. The greatest multivariable HRs were observed for the average percentage method (cohort 1: HR for ≥ 40% vs. <3% 3.03, 95% CI, 1.93-4.78; cohort 2: HR for ≥ 40% vs. < 3% 2.97; 95% CI, 1.63-5.40). All 3 methods had high reproducibility, with the linear method showing the highest mean Spearman's correlation coefficient (0.91) and Cohen's kappa (0.70). In conclusion, detailed criteria for tumor necrosis evaluation were established. All 3 methods showed good reproducibility and predictive ability. The findings pave the way for the use of tumor necrosis as a prognostic factor in colorectal cancer.

Determination of waste decay rate for a large Finnish landfill by calibrating methane generation models on the basis of methane recovery and emissions.

The aim of this study was to determine the methane (CH(4)) generation factor (k) and CH(4) generation potential (L) for bulk waste in order to calibrate a CH(4) generation model (USEPA Landgem 3.02) and provide information on the remaining CH(4) generation potential in a large (54 ha) municipal solid waste landfill located in a boreal climate. The CH(4) generation model was calibrated by actual CH(4) recovery and emission measurement data. Moreover, waste characterisation information from a previous study was considered.The appropriate k for bulk waste was 0.18 in the studied landfill, which indicated a higher rate of degradation than proposed by the Intergovernmental Panel on Climate Change as a default k value of 0.09 for wet conditions in boreal and temperate climes, whereas the calibrated L of 100 m(3)/t was lower than estimated on the basis of a previous waste characterisation study. The results demonstrate the importance of model calibration, as inappropriate model parameters may result in a large discrepancy (approximately 100 % or 119 million m(3) having an energy equivalent of nearly 1.2 TWh) in cumulative CH(4) generation estimates within a 18-year timescale (2012­30) at the studied landfill.

Can online particle counters and electrochemical sensors distinguish normal periodic and aperiodic drinking water quality fluctuations from contamination?

Early warning systems monitoring the quality of drinking water need to distinguish between normal quality fluctuations and those caused by contaminants. Thus, to decrease the number of false positive events, normal water quality fluctuations, whether periodic or aperiodic, need to be characterized. For this, we used a novel flow-imaging particle counter, a light-scattering particle counter, and electrochemical sensors to monitor the drinking water quality of a pressure zone in a building complex for 109 days. Data were analyzed to determine the feasibility of the sensors and particle counters to distinguish periodic and aperiodic fluctuations from real-life contaminants. The concentrations of particles smaller than 10 µm and N, Small, Large, and B particles showed sudden changes recurring daily, likely due to the flow rate changes in the building complex. Conversely, the concentrations of larger than 10 µm particles and C particles, in addition to the responses of electrochemical sensors, remained in their low typical values despite flow rate changes. The aperiodic events, likely resulting from an abnormally high flow rate in the water mains due to maintenance, were detected using particle counters and electrochemical sensors. This study provides insights into choosing water quality sensors by showing that machine learning-based particle classes, such as B, C, F, and particles larger than 10 µm are promising in distinguishing contamination from aperiodic and periodic fluctuations while the use of other particle classes and electrochemical sensors may require dynamic baseline to decrease false positive events in an early warning system.

The role of ubiquitous metal ions in degradation of microplastics in hot-compressed water.

Hydrothermal processing (HTP) is an efficient thermochemical technology to achieve sound treatment and resource recovery of sewage sludge (SS) in hot-compressed subcritical water. However, microplastics (MPs) and heavy metals can be problematic impurities for high-quality nutrients recovery from SS. This study initiated hydrothermal degradation of representative MPs (i.e., polyethylene (PE), polyamide (PA), polypropylene (PP)) under varied temperatures (180-300 °C) to understand the effect of four ubiquitous metal ions (i.e., Fe3+, Al3+, Cu2+, Zn2+) on MPs degradation. It was found that weight loss of all MPs in metallic reaction media was almost four times of that in water media, indicating the catalytic role of metal ions in HTP. Especially, PA degradation at 300 °C was promoted by Fe3+ and Al3+ with remarkable weight loss higher than 95% and 92%, respectively, which was ca. 160 °C lower than that in pyrolysis. Nevertheless, PE and PP were more recalcitrant polymers to be degraded under identical condition. Although higher temperature thermal hydrolysis reaction induced severe chain scission of polymers to reinforce degradation of MPs, Fe3+ and Al3+ ions demonstrated the most remarkable catalytic depolymerization of MPs via enhanced free radical dissociation rather than hydrolysis. Pyrolysis gas chromatography-mass spectrometry (Py GC-MS) was further complementarily applied with GC-MS to reveal HTP of MPs to secondary MPs and nanoplastics. This fundamental study highlights the crucial role of ubiquitous metal ions in MPs degradation in hot-compressed water. HTP could be an energy-efficient technology for effective treatment of MPs in SS with abundant Fe3+ and Al3+, which will benefit sustainable recovery of cleaner nutrients in hydrochar and value-added chemicals or monomers from MPs.

Agricultural potential of anaerobically digested industrial orange waste with and without aerobic post-treatment.

The potential of anaerobically digested orange waste with (AAD) and without (AD) aerobic post-treatment for use in agriculture was evaluated through chemical analyses, short-term phytotoxicity and long-term plant assays. Chemical analyses showed that AD contained ammonia and organic acids, and aerobic post-treatment did not significantly remove these phytotoxins. The N:P2O5:K2O ratio in AD was 1:0.26:0.96 and aerobic post-treatment did not change the composition in AAD except for K2O (1:0.26:1.24). Heavy metal contents in AD and AAD were more or less the same and were below the upper limit recommended for non-sewage sludge application on agricultural soils. Short-term phytotoxicity tests showed that seed germination and root elongation of Chinese cabbage and ryegrass were severely inhibited at digestate concentrations of 60-100%. Germination index values were well below the score of 50% required to indicate the phytotoxic-free nature of compost. Long-term plant assays showed that AD and AAD, when supplemented with a base fertilizer, resulted in higher plant growth, and fresh weight and dry matter production than AD without base fertilizer. The results thus indicate that aerobic post-treatment did not have any significant beneficial effect on reducing phytotoxicity, and AD could be used as such on agricultural soils, especially with high P.

The effects of digestate pyrolysis liquid on the thermophilic anaerobic digestion of sewage sludge - Perspective for a centralized biogas plant using thermal hydrolysis pretreatment.

The use of pyrolysis process to valorize digestate from anaerobic digestion (AD) of municipal sewage sludge for biochar production was piloted in a central biogas plant. The pyrolysis also generates pyrolysis liquid with high organics and nutrient contents that currently has no value and requires treatment, which could potentially be done in AD. As the pyrolysis liquid may contain inhibitory compounds, we investigated the effects of adding the pyrolysis liquid on AD of sewage sludge and thermal hydrolysis pretreated sewage sludge (THSS) simulating the full-scale centralized biogas plant conditions. In batch assays, the pyrolysis liquid as such did not produce any methane, and the 1% and 5% (v/w) shares suppressed the methane production from THSS by 14-19%, while a smaller decrease in methane production was observed with sewage sludge. However, in the semi-continuous reactor experiments, pyrolysis liquid at a 1% (v/w) share was added in sewage sludge or THSS feed without affecting the methane yields or digestate characteristics. The laboratory results indicated that pyrolysis liquid can be treated in AD, while extrapolating the results to the centralized biogas plant indicated minor increase in the overall methane production and an increased potential for ammonium recovery.

Incidence of parastomal and incisional hernia following emergency surgery for Hinchey III-IV diverticulitis: A systematic review.

PURPOSE: The aim of this systematic review was to evaluate the risk of parastomal (PSH) and incisional hernias (IH) after emergency surgery for Hinchey III-IV diverticulitis, with comparison between the Hartmann procedure and other surgical techniques. METHODS: The Cochrane Library, Embase, PubMed (MEDLINE), Web of Science and Scopus databases were systematically searched. The primary endpoint was parastomal hernia incidence. The secondary endpoint was incisional hernia incidence. RESULTS: Five studies (four randomized controlled trials and one retrospective cohort) with a total of 699 patients were eligible for inclusion. The PSH rate was 15%-46% for Hartmann procedure, 0%-85% for primary anastomosis, 4% for resection, and 2% for laparoscopic lavage. The IH rates were 5%-38% for Hartmann procedure, 5%-27% for primary anastomosis, 9%-12% for primary resection, and 3%-11% for laparoscopic lavage. CONCLUSIONS: Both the parastomal and incisional hernia incidences are poorly evaluated and reported, and varied greatly between the studies.