Diclofenac biotransformation in the enhanced biological phosphorus removal process.

Diclofenac is a pharmaceutical active compound frequently detected in wastewater and water bodies, and often reported to be persistent and difficult to biodegrade. While many previous studies have focussed on assessing diclofenac biodegradation in nitrification and denitrification processes, this study focusses on diclofenac biodegradation in the enhanced biological phosphorus removal (EBPR) process, where the efficiency of this process for diclofenac biodegradation as well as the metabolites generated are not well understood. An enrichment of Accumulibacter polyphosphate accumulating organisms (PAOs) was operated in an SBR for over 300 d, and acclimatized to 20 µg/L of diclofenac, which is in a similar range to that observed in domestic wastewater influents. The diclofenac biotransformation was monitored in four periods of stable operation and linked to the microbial community and metabolic behaviour in each period. Nitrification was observed in two of the four periods despite the addition of a nitrification inhibitor, and these periods were positively correlated with increased diclofenac biodegradation. Interestingly, in two periods with excellent phosphorus removal (>99%) and no nitrification, different levels of diclofenac biotransformation were observed. Period 2, enriched in Accumulibacter Type II achieved more significant diclofenac biotransformation (3.4 µg/gX), while period 4, enriched in Accumulibacter Type I achieved lower diclofenac biotransformation (0.4 µg/gX). In total, 23 transformation products were identified, with lower toxicity than the parent compound, enabling the elucidation of multiple metabolic pathways for diclofenac biotransformation. This study showed that PAOs can contribute to diclofenac biotransformation, yielding less toxic transformation products, and can complement the biodegradation carried out by other organisms in activated sludge, particularly nitrifiers.

A constant postpacing interval in response to overdrive pacing with variable number of beats: An aid in the identification of entrainment for a particular pacing train during macroreentrant atrial tachycardias.

BACKGROUND: When pacing trains with a constant cycle length (CL) but increasing number of beats are introduced during a macroreentrant atrial tachycardia (MAT), the postpacing interval (PPI) is expected to increase if entrainment does not occur but could be stable if entrainment occurs. We tested the ability of PPI analysis to detect entrainment. METHODS: Synchronized pacing trains with increasing number of beats (1-20) were delivered from the coronary sinus (CS) and lateral right atrium (RA) at a CL 20 ms shorter than the MAT CL. Pacing trains were grouped in pairs differing by one-paced beat, and the ∆PPI measured. RESULTS: In an initial prospective cohort of 21 patients (48% had left atrial flutter) the mean ∆PPI was 21.3 ± 5.6 ms for pairs of pacing trains in which neither entrained the MAT and 2.8 ± 1.4 ms for those in which both entrained the MAT (P < .0001). Results were similar for common vs atypical flutter, PPI-TCL ≤30 ms vs PPI-TCL >30 ms, presence vs absence of antiarrhythmic drugs and faster vs slower MAT. When an index pacing train was compared to one with two-paced beats less, a PPI difference of <19 ms identified entrainment with 95% sensitivity and 98% specificity. In a validation cohort of 16 patients, this cut-off value resulted in sensitivity and specificity of 90% and 94%. CONCLUSIONS: A relatively constant ∆PPI in response to overdrive pacing with identical CL but different number of beats allows accurate discrimination between trains that entrained vs those which did not entrain a MAT.

Performance of the SA-VA Difference to Differentiate Atrioventricular Nodal Reentrant Tachycardia from Orthodromic Reentrant Tachycardia in a Large Cohort of Consecutive Patients.

BACKGROUND: The stimulus-atrial (SA) interval minus ventriculoatrial (VA) interval (SA-VA) difference represents a simple diagnostic maneuver to distinguish between atrioventricular nodal reentrant tachycardia (AVNRT) and orthodromic reentrant tachycardia (ORT) during electrophysiology study. However, its usefulness has largely been studied in selected patient subgroups. The purpose of this study was to evaluate the performance of the SA-VA difference against commonly used diagnostic maneuvers in a large cohort of consecutive patients. METHODS: Consecutive patients with inducible supraventricular tachycardia and successful entrainment through pacing trains from right ventricular apex during an electrophysiological study were included. Atrial tachycardias were excluded. The following intervals were calculated for each patient: SA-VA difference, His potential, and atrial electrogram during entrainment minus His potential and atrial electrogram during tachycardia, and the corrected return cycle. RESULTS: A total of 456 patients fulfilled the inclusion criteria, of which electrophysiological study revealed 265 typical AVNRT, 38 atypical AVNRT, and 54 and 108 ORT through a septal and free-wall accessory pathway, respectively. An SA-VA difference >99 ms identified AVNRT in all patients with sensitivity, specificity, and positive and negative predictive values of 97.7%, 96.9%, 98.3%, and 95.7%, respectively. CONCLUSIONS: This study confirms the high ability to distinguish AVNRT from ORT using the SA-VA difference, not only in selected patient subgroups, but as whole when a cut-off of >99 ms is used.