Greywater treatment in a green wall using different filter materials and hydraulic loading rates.

Green walls in urban environments can be both an aesthetic feature and be of practical use in greywater treatment. This study evaluates the effect of different loading rates (4.5 l/d, 9 l/d, and 18 l/d) on the efficiency of treating actual greywater from a city district in a pilot-scale green wall with five different filter materials as substrates (biochar, pumice, hemp fiber, spent coffee grounds (SCG), and composted fiber soil (CFS)). Three cool climate plant species, Carex nigra, Juncus compressus, and Myosotis scorpioides, were chosen for the green wall. The following parameters were evaluated: biological oxygen demand (BOD), fractions of organic carbon, nutrients, indicator bacteria, surfactants, and salt. Three of the five materials investigated - biochar, pumice, and CFS - showed promising treatment efficiencies. The respective overall reduction efficiencies of BOD, total nitrogen (TN) and total phosphorus (TP) were 99%, 75%, and 57% for biochar; 96%, 58%, and 61% for pumice; and 99%, 82% and 85% for CFS. BOD was stable in the biochar filter material with effluent concentrations of 2 mg/l across all investigated loading rates. However, higher loading rates had a significantly negative effect on hemp and pumice for BOD. Interestingly, the highest loading rate (18 l/d) flowing over pumice removed the highest levels of TN (80%) and TP (86%). Biochar was the most effective material in removing indicator bacteria, with a 2.2-4.0 Log10 reduction for E. coli and enterococci. SCG was the least efficient material, giving a higher BOD in the effluent than in the influent. Therefore, this study presents the potential of natural and waste-derived filter materials to treat greywater effectively and the results can contribute to the future development of nature-based greywater treatment and management practices in urban areas.

Treatment of road runoff by coagulation/flocculation and sedimentation.

A laboratory investigation of the treatment potential of a coagulation process in the context of stormwater treatment was undertaken. The initial 25 L road runoff generated from four rain events was collected and subjected to a jar-testing regime with two commercial coagulants. The treatment effect was assessed by analysing the runoff before and after treatment for turbidity, suspended solids and metal content. The coagulation process resulted in particle and total metal reduction of more than 90% compared to 40% for only sedimentation. Up to 40% reduction of dissolved Cr, Cu and Pb was also observed compared to 0% for sedimentation. This study shows that coagulation may be a useful process for stormwater treatment systems when the treatment requirements are high.

[New possibilities with retroflexed functional endoscopy]. / Neue Wege der Funktionsendoskopie mit Retroflexion.

BACKGROUND: Anterograde transnasal flexible endoscopy of the pharynx, larynx, and proximal trachea without sedation has been established since the 1990s. Retroflexed endoscopic functional analysis has recently been introduced. OBJECTIVES: Adding retroflexed functional endoscopy from the oral cavity up to the duodenum to anterograde diagnostics allows the precise demonstration of how different factors interact in a complex way, e. g., in case of dysphagia or pathological reflux. MATERIALS AND METHODS: A 70-cm-long high-definition endoscope without a channel system is equipped with a 200° retroflexed view, a mm-cm scale, and a roller system. The endoscope can be lengthened, stopped, or shortened during the procedure. Standard positions, viewing directions and display details ensure that findings are comparable. Mastication, food transport and digestion are observed in the unsedated patient. RESULTS: Depending on indication and symptoms, we defined a diagnostic algorithm including three specific pathways: (1) for conditions that originate in the oral cavity, larynx or pharynx, (2) for suspected reflux disease, or for neurological or neuromuscular disorders of food transport, (3) for duodenogastric, gastroesophageal and esophagopharyngeal reflux, as well for benign or malignant tumors. CONCLUSION: The advantages of functional endoscopy have an impact not only on the medical staff and patients. Its precise and participatory approach is relevant to healthcare, enlarges the diagnostic horizon, and forms a basis for interdisciplinary collaboration.

The transnasal VideoPanendoscopy (ViP): diagnostics of the upper aerodigestive tract using an anatomically correct model from the model to the patient.

Endoscopy of the upper aerodigestive tract (UADT) develops rapidly. New endoscopes in combination with special imaging techniques allow complete examinations of the UADT in an ambulatory setting. Therefore, it is necessary to educate and train young physicians in a standardized protocol. A special anatomical training model has been designed to allow a stepwise endoscopy training course. It can be used by specialists who would like to take advantage of transnasal VideoPanendoscopy for examination of suitable candidate patients. This method offers advantages for ENT doctors, gastroenterologists as well as endoscopic surgeons.

Insight into the beneficial immunomodulatory mechanism of the sevoflurane metabolite hexafluoro-2-propanol in a rat model of endotoxaemia.

Volatile anaesthetics such as sevoflurane attenuate inflammatory processes, thereby impacting patient outcome significantly. Their inhalative administration is, however, strictly limited to controlled environments such as operating theatres, and thus an intravenously injectable immunomodulatory drug would offer distinct advantages. As protective effects of volatile anaesthetics have been associated with the presence of trifluorinated carbon groups in their basic structure, in this study we investigated the water-soluble sevoflurane metabolite hexafluoro-2-propanol (HFIP) as a potential immunomodulatory drug in a rat model of endotoxic shock. Male Wistar rats were subjected to intravenous lipopolysaccharide (LPS) and thereafter were treated with HFIP. Plasma and tissue inflammatory mediators, neutrophil invasion, tissue damage and haemodynamic stability were the dedicated end-points. In an endotoxin-induced endothelial cell injury model, underlying mechanisms were elucidated using gene expression and gene reporter analyses. HFIP reduced the systemic inflammatory response significantly and decreased endotoxin-induced tissue damage. Additionally, the LPS-provoked drop in blood pressure of animals was resolved by HFIP treatment. Pathway analysis revealed that the observed attenuation of the inflammatory process was associated with reduced nuclear factor kappa B (NF-κΒ) activation and suppression of its dependent transcripts. Taken together, intravenous administration of HFIP exerts promising immunomodulatory effects in endotoxaemic rats. The possibility of intravenous administration would overcome limitations of volatile anaesthetics, and thus HFIP might therefore represent an interesting future drug candidate for states of severe inflammation.

Magnetic separation-based blood purification: a promising new approach for the removal of disease-causing compounds?

Recent studies report promising results regarding extracorporeal magnetic separation-based blood purification for the rapid and selective removal of disease-causing compounds from whole blood. High molecular weight compounds, bacteria and cells can be eliminated from blood within minutes, hence offering novel treatment strategies for the management of intoxications and blood stream infections. However, risks associated with incomplete particle separation and the biological consequences of particles entering circulation remain largely unclear. This article discusses the promising future of magnetic separation-based purification while keeping important safety considerations in mind.

[Position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology - current state of clinical and endoscopic diagnostics, evaluation, and therapy of swallowing disorders in children and adults]. / Positionspapier der DGHNO und der DGPP - Stand der klinischen und endoskopischen Diagnostik, Evaluation und Therapie von Schluckstörungen bei Kindern und Erwachsenen.

Position Paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology - Current State of Clinical and Endoscopic Diagnostics, Evaluation, and Therapy of Swallowing Disorders in Children and AdultsSwallowing disorders are frequent. The main concern is mortality due to aspiration induced pneumonia and malnutrition. On the other hand quality of life is severely affected. The demographic trend indicates an increase of dysphagia in the future. Neurodegenerative diseases, tumors of the digestive tract and sequelae of tumor treatment in the head and neck region are the main pathologic entities.Predominantly ENT physicians and phoniatrists, are asked for diagnostics and therapy who will coordinate the interdisciplinary treatment according to the endoscopic findings.A differentiated approach in history, diagnostics, and symptom oriented treatment is necessary for the mostly complex disorders. The integration of non-medical personnel such as logopeds (speech language pathologists), physiotherapists, and occupational therapists in planning and executing an effective therapy expands and completes the patient-oriented care. Conservative treatment by these therapists is an important pillar in the treatment. Parts of the specific diagnostics can be taken over by them in close cooperation.In particular an interdisciplinary cooperation with the staff from intensive care medicine is indispensable.The diagnostic procedures of specific endoscopy as described in this position paper are part of the primary and fundamental tasks of ENT specialists and phoniatrists.Endoscopy is a medical service that is basically not delegable. Consequently substitution of the physician is precluded.

Effect of hypoxia and dexamethasone on inflammation and ion transporter function in pulmonary cells.

Dexamethasone has been found to reduce the incidence of high-altitude pulmonary oedema. Mechanisms explaining this effect still remain unclear. We assessed the effect of dexamethasone using established cell lines, including rat alveolar epithelial cells (AEC), pulmonary artery endothelial cells (RPAEC) and alveolar macrophages (MAC), in an environment of low oxygen, simulating a condition of alveolar hypoxia as found at high altitude. Inflammatory mediators and ion transporter expression were quantified. Based on earlier results, we hypothesized that hypoxic conditions trigger inflammation. AEC, RPAEC and MAC, pre-incubated for 1 h with or without dexamethasone (10(-7) mol/l), were subsequently exposed to mild hypoxia (5% O(2), or normoxia as control) for 24 h. mRNA and protein levels of cytokine-induced neutrophil chemoattractant-1, monocyte chemoattractant protein-1 and interleukin-6 were analysed. mRNA expression and functional activity of the apical epithelial sodium channel and basolateral Na(+)/K(+)-ATPase were determined using radioactive marker ions. In all three types of pulmonary cells hypoxic conditions led to an attenuated secretion of inflammatory mediators, which was even more pronounced in dexamethasone pretreated samples. Function of Na(+)/K(+)-ATPase was not significantly influenced by hypoxia or dexamethasone, while activity of epithelial sodium channels was decreased under hypoxic conditions. When pre-incubated with dexamethasone, however, transporter activity was partially maintained. These findings illustrate that long-term hypoxia does not trigger an inflammatory response. The ion transport across apical epithelial sodium channels under hypoxic conditions is ameliorated in cells treated with dexamethasone.

Intestinal Anastomotic Healing: What do We Know About Processes Behind Anastomotic Complications.

Colorectal surgery has developed rapidly in the recent decades. Nevertheless, colorectal anastomotic leakage continues to appear postoperatively in unpleasant rates and leads to life-threatening conditions. The development of valid complication-preventing methods is inefficient in many aspects as we are still lacking knowledge about the basics of the process of anastomotic wound healing in the gastrointestinal tract. Without the proper understanding of the crucial mechanisms, research for prevention of anastomotic leakage is predestined to be unsuccessful. This review article discusses known pathophysiological mechanisms together with the most lately found processes to be further studied. The aim of the article is to facilitate the orientation in the topic, support the better understanding of known mechanisms and suggest promising possibilities and directions for further research.

[Functional endoscopy : the physiological and pathophysiological basis of reflux disease, diagnosis and therapy]. / Funktionelle Endoskopie : Physiologische und pathophysiologische Grundlagen der Refluxerkrankung, ihre Diagnostik und Therapie.

ENT specialists and gastroenterologists are increasingly confronted with the question of how to recognize and evaluate extra-esophageal complications of reflux. Both specialities need to collaborate, since they are connected via the esophagus, and both need to know more about the speciality of their neighbor than was hitherto usual. This publication presents the observations and measurements of little-known physiological functions. This is followed by an attempt to define the border between healthy and diseased. Finally, the possible consequences of functional disorders are described. The leap from observation of function to the microcosm of biochemical links is discussed and supported using experimental work. This overview highlights the limitations of our current knowledge. The success of functional endoscopy in terms of therapeutic approaches is immense. The required therapy is finally based on a clear diagnostic concept; probatory therapy is a waste of money.

Tb3+-doped LaF3 nanocrystals for correlative cathodoluminescence electron microscopy imaging with nanometric resolution in focused ion beam-sectioned biological samples.

Here, we report the use of rare earth element-doped nanocrystals as probes for correlative cathodoluminescence electron microscopy (CCLEM) bioimaging. This first experimental demonstration shows potential for the simultaneous acquisition of luminescence and electron microscopy images with nanometric resolution in focused ion beam cut biological samples.

Theranostic body fluid cleansing: rationally designed magnetic particles enable capturing and detection of bacterial pathogens.

We report on theoretical and experimental considerations on bacteria capturing and enrichment via magnetic separation enabling integrated diagnosis and treatment of blood stream infections. We show optimization of carrier-pathogen interactions based on a mathematical model followed by an experimental proof-of-concept study along with investigations on the process safety.

The thermodynamic essence of the reversible inactivation of Na+/K+-transporting ATPase by various digitalis derivatives is relaxation of enzyme conformational energy.

This paper reports on the kinetic and thermodynamic parameters describing the interaction of selected digitalis derivatives with hog and guinea-pig cardiac (Na+ + K+)-ATPase (Na+/K+-transporting ATPase EC 3.6.1.37). 32 digitalis derivatives were characterized as to the values of the delta G0', delta G----not equal to, and delta G----not equal to quantities in their interaction with (Na+ + K+)-ATPase from hog cardiac muscle in the presence of ATP, Mg2+, Na+ and K+. Nine derivatives were additionally characterized as to the values of the delta H0', delta S0', delta H----not equal to, delta S----not equal to, delta H not equal to, and delta S not equal to quantities in their interaction with the hog enzyme promoted by ATP, Mg2+ and Na+ in the presence or absence of K+. The formation of the inhibitory complexes is in any case an endothermic, entropically driven process. The Gibbs energy barriers in the formation and dissociation of the complexes, delta G----not equal to and delta G----not equal to, are imposed by large, unfavourable delta H not equal to values. K+ decreases the delta G0' value by increasing the delta G----not equal to value more than the delta G----not equal to value. In comparison with hog (Na+ + K+)-ATPase, the interaction of three derivatives with guinea-pig cardiac enzyme in the presence of ATP, Mg2+, Na+ and K+ is characterized by lower delta G0' values caused by lower favourable delta S0' values, and is accompanied by lower delta G----not equal to values. The magnitude of the kinetic parameters and the characteristic of the thermodynamic quantities describing the interaction between various digitalis derivatives and (Na+ + K+)-ATPase, indicate the induction of substantial conformational changes in the enzyme protein. A large entropy gain in the enzyme protein, observed irrespective of enzyme origin and ligation, appears to be the common denominator of the inhibitory action of all digitalis derivatives studied, suggesting that the digitalis-elicited relaxation of high conformational energy (negentropy strain) of the enzyme protein is the thermodynamic essence of the reversible inactivation of (Na+ + K+)-ATPase.

Differentiating sepsis from non-infectious systemic inflammation based on microvesicle-bacteria aggregation.

Sepsis is a severe medical condition and a leading cause of hospital mortality. Prompt diagnosis and early treatment has a significant, positive impact on patient outcome. However, sepsis is not always easy to diagnose, especially in critically ill patients. Here, we present a conceptionally new approach for the rapid diagnostic differentiation of sepsis from non-septic intensive care unit patients. Using advanced microscopy and spectroscopy techniques, we measure infection-specific changes in the activity of nano-sized cell-derived microvesicles to bind bacteria. We report on the use of a point-of-care-compatible microfluidic chip to measure microvesicle-bacteria aggregation and demonstrate rapid (≤1.5 hour) and reliable diagnostic differentiation of bacterial infection from non-infectious inflammation in a double-blind pilot study. Our study demonstrates the potential of microvesicle activities for sepsis diagnosis and introduces microvesicle-bacteria aggregation as a potentially useful parameter for making early clinical management decisions.

In vivo labeling of platelets with 75Se -- selenomethionine in patients with hepatic cirrhosis and thrombocytopenia.

Labeling of platelets in vivo by 75Se -- Selenomethionine (75Se-M) was performed in nine cases of hepatic cirrhosis and thrombocytopenia for evaluation of the kinetics of platelet maturation. Folic acid and vitamin B12 deficiency was excluded by pretreatment of the patients with these agents. The platelet maturation time -- time between the injection of the isotope and maximum radioactivity of separated blood platelets -- was shortened to 7.7 +/- 1.1 days (mean +/- SD) compared to the normal 9.1 +/- 1.4 days. For explanation a disturbance of megakaryocyte maturation and/or platelet release from the bone marrow is suggested.

Interaction of cardiac glycosides and Na,K-ATPase is regulated by effector-controlled equilibrium between two limit enzyme conformers.

The paper describes the dissociation parameters of the complexes between [3H]-digitoxin and Na,K-ATPase (Na+ + K+-activated, Mg2+-dependent ATP phosphohydrolase, E.C. 3.6.1.3) from pig cardiac muscle and brain cortex formed and dissociated in the presence of different combinations and concentrations of the enzyme effectors ATP, Mg2+, Na+ and K+. Systematic variation of effector-ligation of Na,K-ATPase allowed production of glycoside complexes with two enzyme conformers only, which showed either rapid or slow dissociation kinetics. Appropriate changes of enzyme ligation allowed the interconversion of the two conformer types. Biphasic, rapid and slow glycoside release was not bound with the presence of two Na,K-ATPase isozymes, but caused by the enzyme ligation-determined coexistence of the two conformers of Na,K-ATPase. The rate constants for the rapid and slow glycoside release were within the complexes of each dissociation type much alike indicating uniform isomerization kinetics of the two conformers even when differently liganded. Taken together, the observations indicated the effector-controlled isomerizations of two conformers of Na,K-ATPase possessing different geometries of the glycoside binding domain. Present findings and relevant literature data were integrated in a circular, consecutive and simultaneous model for induced conformation changes that accounted for the regulation of the interaction of cardiac glycosides and Na,K-ATPase through an effector-controlled equilibrium between two limit enzyme conformers.

Beta-adrenoceptor blockade by atenolol, metoprolol and propranolol in the anaesthetized cat.

The inhibitory effects of atenolol, metoprolol and propranolol on isoprenaline-induced tachycardia, broncho-relaxation and vasodilatation were investigated in the reserpinized and anaesthetized cat. In low doses all three antagonists inhibited the heart rate response to isoprenaline, the order of potency being propranolol greater than metoprolol greater than atenolol. While propranolol inhibited the bronchodilation and vasodilation responses to isoprenaline in the same dose range as it blocked the heart rate response, atenolol and metoprolol had to be given in considerably higher doses to block these effects. The results indicate that both metoprolol and atenolol, in contrast to propranolol, are selective beta1-adrenoceptor antagonist. No statistically significant difference in the degree of selectivity was found between metoprolol and atenolol. The three compounds were devoid of intrinsic beta-mimetic activity.

Periodontal indices around natural and titanium abutments: a longitudinal multicenter study.

This multicenter prospective study on the use of an implant system involved 9 centers and reports on the periodontal aspects after 3 years of observation. A total of 558 implants in 159 patients with 197 bridges all independent from natural teeth were originally included. Because of failures and patient withdrawals the number of implants was reduced to 460 and bridges to 174. The cumulative success rate for implants, starting from implant placement, is 94.3% after 2 years and 93.9% after 3 years indicating a leveling of implant loss. Failures concentrated in patients with a high plaque index. The loss of marginal bone was during the second and third years only 0.03 mm per year as an average while it was 0.4 mm during the first year. There were no reports of intense gingival inflammation in any of the patients and the plaque and gingivitis index behaved similarly around abutments and teeth. The probing pocket depth was significantly reduced over the observation time. The resistance towards marginal bone loss around these implants confirms the previous studies on fully edentulous patients.

[Cinematographic study of the pathologic mechanisms of aspiration pneumonia]. / Kinematographische Untersuchung des Pathomechanismus der Aspirationspneumonie.

6% of all patients suffering from a cerebrovascular injury die from aspiration pneumonia within the first year. The high temporal resolution of high-speed cineradiography (HFK) (50 frames/sec.) allows the recording of the 0.7 sec. process of pharyngeal swallow. Five case-examples are presented (total number of cases: 95) illustrating the possibility of differentiation between three types of aspiration by means of cineradiography. These types are the so-called pre-, intra- and postdeglutitive aspiration, that is aspiration before or after triggering of the swallowing reflex. This differentiation is of great therapeutic importance. The analysis of disturbances of pharyngo-laryngeal motility and the temporal coordination allows setting up individual surgical and/or conservative programme for rehabilitation.

The wide fixture: a solution for special bone situations and a rescue for the compromised implant. Part 1.

This paper describes a new 5.0-mm-diameter self-tapping implant, a modification of the standard Brånemark fixture designed to increase the amount of bone-to-titanium surface contact and to capture dense bone at the lateral and crestal borders of the alveolus. Indications for its use include (1) areas of inadequate bone height, (2) areas of poor bone quality (type IV), and (3) immediate replacement of non-integrated or fractured implants. This preliminary report discusses the design alterations and surgical techniques available to treat these difficult bone situations.