Endobronchial indocyanine green instillation to identify the intersegmental plane for successful segmentectomy.

The traditional indications for lobectomy for resectable Non-small Cell Lung Cancer (NSCLC) may be set to change. Recently, anatomical segmentectomy (AS) versus lobectomy as an approach for early-stage NSCLC has been described in phase 3 randomised controlled trials. The demand for methods to facilitate AS may increase as a consequence. We describe three cases of AS using the combination of endobronchial infiltration of indocyanine green (ICG) to identify the intersegmental plane (critical for the performance of AS), and Computed Tomography (CT) guided methylene blue injection for lesion localisation. The operations were completed successfully demonstrating satisfactory post-operative outcomes including lesion resection with clear surgical margins and acceptable length of stay. We believe that endobronchial instillation of ICG and CT-guided methylene blue injection for lesion localisation show promise as a technique to complement parenchymal sparing thoracic oncological surgery.

Performance evaluation and model-based optimization of the mainstream deammonification in an integrated fixed-film activated sludge reactor.

This study aimed to model and optimize mainstream deammonification in an integrated fixed-film activated sludge (IFAS) pilot plant under natural seasonal temperature variations. The effect of gradually decreasing temperature on the performance was evaluated during a winter season and a transition period to summer conditions, and the correlation of the performance parameters was investigated using principal component analysis (PCA). The optimization of intermittent aeration in the long-term (30 days) dynamic conditions with on/off ratio and dissolved oxygen (DO) set-point control was used to maximize the N-removal rate (NRR) and N-removal efficiency (NRE). Optimization results (DO set-point of 0.2-0.25 mgO2/L, and on/off ratio of 0.05) increased the NRE and NRR of total inorganic N (daily average) from 30% to > 50% and 15 gN/m3d to 25 gN/m3d, respectively. This novel long-term optimization strategy is a powerful tool for enhancing the efficiency in mainstream deammonification.

Discovery of a new genus of anaerobic ammonium oxidizing bacteria with a mechanism for oxygen tolerance.

In the past 20 years, there has been a major stride in understanding the core mechanism of anaerobic ammonium-oxidizing (anammox) bacteria, but there are still several discussion points on their survival strategies. Here, we discovered a new genus of anammox bacteria in a full-scale wastewater-treating biofilm system, tentatively named "Candidatus Loosdrechtia aerotolerans". Next to genes of all core anammox metabolisms, it encoded and transcribed genes involved in the dissimilatory nitrate reduction to ammonium (DNRA), which coupled to oxidation of small organic acids, could be used to replenish ammonium and sustain their metabolism. Surprisingly, it uniquely harbored a new ferredoxin-dependent nitrate reductase, which has not yet been found in any other anammox genome and might confer a selective advantage to it in nitrate assimilation. Similar to many other microorganisms, superoxide dismutase and catalase related to oxidative stress resistance were encoded and transcribed by "Ca. Loosdrechtia aerotolerans". Interestingly, bilirubin oxidase (BOD), likely involved in oxygen resistance of anammox bacteria under fluctuating oxygen concentrations, was identified in "Ca. Loosdrechtia aerotolerans" and four Ca. Brocadia genomes, and its activity was demonstrated using purified heterologously expressed proteins. A following survey of oxygen-active proteins in anammox bacteria revealed the presence of other previously undetected oxygen defense systems. The novel cbb3-type cytochrome c oxidase and bifunctional catalase-peroxidase may confer a selective advantage to Ca. Kuenenia and Ca. Scalindua that face frequent changes in oxygen concentrations. The discovery of this new genus significantly broadens our understanding of the ecophysiology of anammox bacteria. Furthermore, the diverse oxygen tolerance strategies employed by distinct anammox bacteria advance our understanding of their niche adaptability and provide valuable insight for the operation of anammox-based wastewater treatment systems.

Video-assisted thoracoscopic parenchymal sparing "rotational" bronchoplasty for managing bronchial carcinoid tumor.

We present a modified bronchoplasty technique involving rotation of the bronchial structures. Our goal was to reconstruct the bronchus without using any foreign material while fully preserving the parenchyma. We used a biportal VATS approach. The centrally located bronchial tumor at the juncture between the right main bronchus, the right upper lobe bronchus, and the bronchus intermedius was first resected. The right upper lobe bronchus was rotated caudally, toward the bronchus intermedius, together with a slight clockwise rotation posteriorly to facilitate the approximation and tension-free closure of the bronchial defect. This video tutorial demonstrates the operative steps and explains how the rotational aspect is achieved.

Activities and metabolic versatility of distinct anammox bacteria in a full-scale wastewater treatment system.

Anaerobic ammonium oxidation (anammox) is a key N2-producing process in the global nitrogen cycle. Major progress in understanding the core mechanism of anammox bacteria has been made, but our knowledge of the survival strategies of anammox bacteria in complex ecosystems, such as full-scale wastewater treatment plants (WWTPs), remains limited. Here, by combining metagenomics with in situ metatranscriptomics, complex anammox-driven nitrogen cycles in an anoxic tank and a granular activated carbon (GAC) biofilm module of a full-scale WWTP treating landfill leachate were constructed. Four distinct anammox metagenome-assembled genomes (MAGs), representing a new genus named Ca. Loosdrechtii, a new species in Ca. Kuenenia, a new species in Ca. Brocadia, and a new strain in "Ca. Kuenenia stuttgartiensis", were simultaneously retrieved from the GAC biofilm. Metabolic reconstruction revealed that all anammox organisms highly expressed the core metabolic enzymes and showed a high metabolic versatility. Pathways for dissimilatory nitrate reduction to ammonium (DNRA) coupled to volatile fatty acids (VFAs) oxidation likely assist anammox bacteria to survive unfavorable conditions and facilitate switches between lifestyles in oxygen fluctuating environments. The new Ca. Kuenenia species dominated the anammox community of the GAC biofilm, specifically may be enhanced by the uniquely encoded flexible ammonium and iron acquisition strategies. The new Ca. Brocadia species likely has an extensive niche distribution that is simultaneously established in the anoxic tank and the GAC biofilm, the two distinct niches. The highly diverse and impressive metabolic versatility of anammox bacteria revealed in this study advance our understanding of the survival and application of anammox bacteria in the full-scale wastewater treatment system.

More than a decade of experience of landfill leachate treatment with a full-scale anammox plant combining activated sludge and activated carbon biofilm.

The performance of biological treatment for high ammonium removal from landfill leachate has been demonstrated. The plant was upgraded combining the activated sludge process followed by activated carbon reactor. Based on a long-term analysis of data collected from 2006 to 2015, the average total nitrogen removal efficiency of 94% was achieved for wastewaters with a C: N ratio varying from 1 to 5 kg-COD kg-TN-1. But without the presence of activated carbon reactor, the average of biological removal efficiency for total nitrogen was only 82% ± 6% for the activated sludge stage. It means that up to 20% of the nitrogen in the influent can only be eliminated by microorganisms attached to granular activated carbon. After upgrades of the plant, the energy efficiency showed a reduction in the specific energy demand from 1.6 to less than 0.2 kWh m-3. Methanol consumption and sludge production was reduced by 91% and 96%, respectively. Fluorescent in situ Hybridization was used for microbial diversity analysis on floccular sludge and granular biofilm samples. Anaerobic ammonium oxidation (anammox) bacteria and nitrifiers were detected and Candidatus Scalindua was found in two forms of flocs and biofilms. Due to stochastic risk assessment based on the long-term data analysis given in this research, the treatment criteria were achieved and the combination of granular activated carbon biofilm process and activated sludge can be a novel and sought approach to better enrich anammox biomass for full-scale treatment applications to reduce operating costs and promote nutrient removal stability and efficiency.

Formulations generated from ethanol-based proliposomes for delivery via medical nebulizers.

Multilamellar and oligolamellar liposomes were produced from ethanol-based soya phosphatidyl-choline proliposome formulations by addition of isotonic sodium chloride or sucrose solutions. The resultant liposomes entrapped up to 62% of available salbutamol sulfate compared with only 1.23% entrapped by conventionally prepared liposomes. Formulations were aerosolized using an air-jet nebulizer (Pari LC Plus) or a vibrating-mesh nebulizer (Aeroneb Pro small mesh, Aeroneb Pro large mesh, or Omron NE U22). All vibrating-mesh nebulizers produced aerosol droplets having larger volume median diameter (VMD) and narrower size distribution than the air-jet nebulizer. The choice of liposome dispersion medium had little effect on the performance of the Pari nebulizer. However, for the Aeroneb Pro small mesh and Omron NE U22, the use of sucrose solution tended to increase droplet VMD, and reduce aerosol mass and phospholipid outputs from the nebulizers. For the Aeroneb Pro large mesh, sucrose solution increased the VMD of nebulized droplets, increased phospholipid output and produced no effect on aerosol mass output. The Omron NE U22 nebulizer produced the highest mass output (approx. 100%) regardless of formulation, and the delivery rates were much higher for the NaCl-dispersed liposomes compared with sucrose-dispersed formulation. Nebulization produced considerable loss of entrapped drug from liposomes and this was accompanied by vesicle size reduction. Drug loss tended to be less for the vibrating-mesh nebulizers than the jet nebulizer. The large aperture size mesh (8 mum) Aeroneb Pro nebulizer increased the proportion of entrapped drug delivered to the lower stage of a twin impinger. This study has demonstrated that liposomes generated from proliposome formulations can be aerosolized in small droplets using air-jet or vibrating-mesh nebulizers. In contrast to the jet nebulizer, the performance of the vibrating-mesh nebulizers was greatly dependent on formulation. The high phospholipid output produced by the nebulizers employed suggests that both air-jet and vibrating-mesh nebulization may provide the potential of delivering liposome-entrapped or solubilized hydrophobic drugs to the airways.