Surgical repair of an aortoesophageal fistula after salvage thoracic endovascular aortic repair: a case report.

BACKGROUND: An aortoesophageal fistula can prove to be fatal. Salvage thoracic endovascular aortic repair as a bridging therapy and radical surgery with thoracotomy should be considered while treating aortoesophageal fistula without spontaneous closure. Moreover, it is essential to select a technique that reduces the risk of reinfection. Here we report a rare case of a ruptured thoracic aortic aneurysm related to esophageal perforation by a fish bone that led to massive hematemesis and shock, and the surgical treatment of an aortoesophageal fistula that developed after salvage thoracic endovascular aortic repair. CASE PRESENTATION: A 70-year-old Japanese female patient was admitted with hematemesis, thoracic pain, and shock related to esophageal perforation of a ruptured descending aortic aneurysm caused by fish bone aspiration and esophageal perforation 1 month previously. An emergency thoracic endovascular aortic repair was performed. Postoperatively, an aortoesophageal fistula that remained open and a food intake-related increase in the inflammatory response was noted. Radical blood-vessel prosthesis implantation and fistula closure were performed. The patient's postoperative course was favorable and the patient was discharged 22 days after the blood vessel prosthesis implantation. CONCLUSION: Such a case of rupture of a descending aortic aneurysm related to perforation by a fish bone and an aortoesophageal fistula is considerably rare. Thus, we report the therapeutic strategy of this particular case and review the relevant literature.

Development of an internal two-stage upflow anaerobic reactor integrating biostimulation strategies to enhance the degradation of aromatic compounds in wastewater from purified terephthalic acid and dimethyl terephthalate manufacturing processes.

In this study, we aimed to establish high-rate biological treatment of purified terephthalic acid (PTA) and dimethyl terephthalate (DMT) wastewater that minimizes the inhibitory effects of high concentration benzoate and acetate. To achieve this, we developed a novel bioreactor system and biostimulation strategy. An internal two-stage upflow anaerobic (ITUA) reactor was operated with (i) a packed bed containing green tuff medium underlying (ii) a compartment seeded with anaerobic granular sludge. Ethylene glycol was amended to stimulate syntrophic interactions. Continuous operation of the system for 1,026 days achieve an organic removal rate of 11.0 ± 0.6 kg COD/m3/d. The abundance of aromatic degraders significantly increased during operation. Thus, we successfully developed a high-rate treatment system to treat wastewater from the PTA/DMT manufacturing processes by activating syntrophs in an ITUA reactor.

Physicochemical parameters affecting the adhesion of ciprofloxacin-resistant Escherichia coli to activated sludge.

To investigate the physicochemical conditions necessary to stably remove antibiotic-resistant bacteria (ARB) via contact with activated sludge (AS), the adhesion of ciprofloxacin (CIP)-resistant and -susceptible Escherichia coli to AS was simulated by contact tests in the laboratory. The CIP-resistant E. coli and susceptible E. coli were removed by a 3 log smaller concentration by a 5 h contact test at maximum. Considering the hydraulic retention time of a reaction tank (∼5 h) and step-feeding operation, we considered the removal rate of E. coli in the current simulated contact test to be in agreement with the actual situation where 1-2 log concentrations of E. coli were reported to be removed from an AS reaction tank. With the increase in the AS concentration and/or dissolved oxygen, the removal rate of E. coli increased. The removal rate of CIP-resistant E. coli was greater than that of susceptible E. coli under all experimental conditions. Although the mechanism by which CIP-resistant E. coli preferably adhered to AS was not clearly understood in detail, finding optimum conditions under which bacteria, including ARB, were efficiently removed by the AS process may be possible.

Collaborative metabolisms of urea and cyanate degradation in marine anammox bacterial culture.

Anammox process greatly contributes to nitrogen loss occurring in oceanic oxygen minimum zones (OMZs), where the availability of NH4+ is scarce as compared with NO2-. Remineralization of organic nitrogen compounds including urea and cyanate (OCN-) into NH4+ has been believed as an NH4+ source of the anammox process in oxygen minimum zones. However, urea- or OCN-- dependent anammox has not been well examined due to the lack of marine anammox bacterial culture. In the present study, urea and OCN- degradation in a marine anammox bacterial consortium were investigated based on 15N-tracer experiments and metagenomic analysis. Although a marine anammox bacterium, Candidatus Scalindua sp., itself was incapable of urea and OCN- degradation, urea was anoxically decomposed to NH4+ by the coexisting ureolytic bacteria (Rhizobiaceae, Nitrosomonadaceae, and/or Thalassopiraceae bacteria), whereas OCN- was abiotically degraded to NH4+. The produced NH4+ was subsequently utilized in the anammox process. The activity of the urea degradation increased under microaerobic condition (ca. 32-42 µM dissolved O2, DO), and the contribution of the anammox process to the total nitrogen loss also increased up to 33.3% at 32 µM DO. Urea-dependent anammox activities were further examined in a fluid thioglycolate media with a vertical gradient of O2 concentration, and the active collaborative metabolism of the urea degradation and anammox was detected at the lower oxycline (21 µM DO).

Microbiological insights into anaerobic phenol degradation mechanisms and bulking phenomenon in a mesophilic upflow anaerobic sludge blanket reactor in long-term operation.

In this study, a long-term operation of 2,747 days was conducted to evaluate the performance of the upflow anaerobic sludge blanket (UASB) reactor and investigated the degradation mechanisms of high-organic loading phenol wastewater. During the reactor operation, the maximum chemical oxygen demand (COD) removal rate of 6.1 ± 0.6 kg/m3/day under 1,680 mg/L phenol concentration was achieved in the mesophilic UASB reactor. After a significant change in the operating temperature from 24.0 ± 4.1 °C to 35.9 ± 0.6 °C, frequent observations of floating and washout of the bloated granular sludge (novel types of the bulking phenomenon) were made in the UASB reactor, suggesting that the change in operating temperature could be a trigger for the bulking phenomenon. Through the metagenomic analysis, phenol degradation mechanisms were predicted that phenol was converted to 4-hydroxybenzoate via two possible routes by Syntrophorhabdaceae and Pelotomaculaceae bacteria. Furthermore, the degradation of 4-hydroxybenzoate to benzoyl-CoA was carried out by members of Syntrophorhabdaceae and Smithellaceae. In the bulking sludge, a predominant presence of Nanobdellota, belonging to DPANN archaea, was detected. The metagenome-assembled genome of the Nanobdellota lacks many biosynthetic pathways and has several genes for the symbiotic lifestyle such as trimeric autotransporter adhesin-related protein. Furthermore, the Nanobdellota have significant correlations with several methanogenic archaea that are predominantly present in the UASB reactor. Considering the results of this study, the predominant Nanobdellota may negatively affect the growth of the methanogens through the parasitic lifestyle and change the balance of microbial interactions in the granular sludge ecosystem.

Microscopic and metatranscriptomic analyses revealed unique cross-domain parasitism between phylum Candidatus Patescibacteria/candidate phyla radiation and methanogenic archaea in anaerobic ecosystems.

To verify whether members of the phylum Candidatus Patescibacteria parasitize archaea, we applied cultivation, microscopy, metatranscriptomic, and protein structure prediction analyses on the Patescibacteria-enriched cultures derived from a methanogenic bioreactor. Amendment of cultures with exogenous methanogenic archaea, acetate, amino acids, and nucleoside monophosphates increased the relative abundance of Ca. Patescibacteria. The predominant Ca. Patescibacteria were families Ca. Yanofskyibacteriaceae and Ca. Minisyncoccaceae, and the former showed positive linear relationships (r2 ≥ 0.70) Methanothrix in their relative abundances, suggesting related growth patterns. Methanothrix and Methanospirillum cells with attached Ca. Yanofskyibacteriaceae and Ca. Minisyncoccaceae, respectively, had significantly lower cellular activity than those of the methanogens without Ca. Patescibacteria, as extrapolated from fluorescence in situ hybridization-based fluorescence. We also observed that parasitized methanogens often had cell surface deformations. Some Methanothrix-like filamentous cells were dented where the submicron cells were attached. Ca. Yanofskyibacteriaceae and Ca. Minisyncoccaceae highly expressed extracellular enzymes, and based on structural predictions, some contained peptidoglycan-binding domains with potential involvement in host cell attachment. Collectively, we propose that the interactions of Ca. Yanofskyibacteriaceae and Ca. Minisyncoccaceae with methanogenic archaea are parasitisms.IMPORTANCECulture-independent DNA sequencing approaches have explored diverse yet-to-be-cultured microorganisms and have significantly expanded the tree of life in recent years. One major lineage of the domain Bacteria, Ca. Patescibacteria (also known as candidate phyla radiation), is widely distributed in natural and engineered ecosystems and has been thought to be dependent on host bacteria due to the lack of several biosynthetic pathways and small cell/genome size. Although bacteria-parasitizing or bacteria-preying Ca. Patescibacteria have been described, our recent studies revealed that some lineages can specifically interact with archaea. In this study, we provide strong evidence that the relationship is parasitic, shedding light on overlooked roles of Ca. Patescibacteria in anaerobic habitats.

Growth of the Nitrosomonas europaea cells in the biofilm and planktonic growth mode: Responses of extracellular polymeric substances production and transcriptome.

Nitrosomonas europaea, an aerobic ammonia oxidizing bacterium, is responsible for the first and rate-limiting step of the nitrification process, and their ammonia oxidation activities are critical for the biogeochemical cycling and the biological nitrogen removal of wastewater treatment. In the present study, N. europaea cells were cultivated in the inorganic or organic media (the NBRC829 and the nutrient-rich, NR, media, respectively), and the cells proliferated in the form of planktonic and biofilm in those media, respectively. The N. europaea cells in the biofilm growth mode produced larger amounts of the extracellular polymeric substances (EPS), and the composition of the EPS was characterized by the chemical analyses including Fourier transform infrared spectroscopy (FT-IR) and 1H-nuclear magnetic resonance (NMR) measurements. The RNA-Seq analysis of N. europaea in the biofilm or planktonic growth mode revealed that the following gene transcripts involved in central nitrogen metabolisms were abundant in the biofilm growth mode; amo encoding ammonia monooxygenase, hao encoding hydroxylamine dehydrogenase, the gene encoding nitrosocyanine, nirK encoding copper-containing nitrite reductase. Additionally, the transcripts of the pepA and wza involved in the bacterial floc formation and the translocation of EPS, respectively, were also abundant in the biofilm-growth mode. Our study was first to characterize the EPS production and transcriptome of N. europaea in the biofilm and planktonic growth mode.

A simple and rapid method for detecting fecal pollution in urban rivers by measuring the intrinsic ß-D-glucuronidase activity of Escherichia coli.

As urban rivers are domestic, industrial, and agricultural water resources, fecal pollution poses human health and environmental risks. In this study, we developed a simple and rapid method to detect fecal pollution in urban rivers. Water samples were mixed with liquid medium, including a fluorescent substrate and fluorescence intensity (F.I.) was measured using a microplate reader to determine Escherichia coli (E. coli) ß-D-glucuronidase (GUS) activity instead of E. coli concentration. GUS activities measurements in pure E. coli cultures revealed that E. coli incubated with a GUS substrate accumulated GUS enzymes in their cells, whereas those incubated without a GUS substrate did not. The increase in GUS activity corresponded to the proliferation of E. coli and the GUS activity increased linearly even during the lag growth phase of E. coli, indicating the presence of intrinsic GUS (iGUS) in E. coli cells before incubation. iGUS activity persisted at 81 % in the chlorinated samples, even though the E. coli concentration was reduced by a factor of 106. The iGUS activity persisted for approximately three days. Therefore, we assumed that E. coli present in fecal contaminants, in which GUS substrates are present, could be distinguished from those surviving in the natural environment for three days or longer by measuring iGUS activity. River water samples were collected upstream and downstream of the discharge outlets of municipal wastewater treatment plants and a combined sewer outlet. The iGUS activities were <0.24 mMFU/mL for the upstream samples and >0.21 mMFU/mL for the downstream samples. Interestingly, E. coli concentrations were not necessarily associated with fecal pollution. This indicates that by setting a threshold for iGUS activity, our method can be used as a simple and rapid method for detecting fecal pollution in urban rivers. Because the limit of detection for our method is 20 CFU/mL, our method is applicable to detecting high fecal pollution in a small river.

Tracing morphological characteristics of activated sludge flocs by using a digital microscope and their effects on sludge dewatering and settling.

ABSTRACTIn wastewater treatment by the activated sludge (AS) process, settleability and dewaterability of AS are key issues that are directly related to the treated water quality and sludge treatment costs. Several studies investigated the relationship between the shape of AS flocs and their settling/dewatering property. To quantify the floc morphology, it is imperative to attach a camera to a microscope or move the stage manually. Hence, labour and equipment costs may increase. In this study, by combining a digital microscope and an automatic stage, more than 100 magnified floc images were rapidly obtained from one AS sample dropped on a slide glass, and shape parameters were collectively calculated using an analysis software. During 1-year monitoring of four wastewater treatment plants in Sapporo City (Hokkaido, Japan), the morphological parameters and extracellular polymeric substances (EPS) quantity/quality of AS were analyzed on the basis of their correlation to the time to filtration (TTF) and sludge volume index (SVI), which are indicators for describing the dewatering and settling properties of AS, respectively. In one plant, larger, denser, and smoother flocs tended to contain less EPS and exhibited better sludge dewaterability. In another plant, larger, denser, and smoother flocs were considered to contribute to better settlement. Especially, an equivalent high-density floc diameter and the ratio of mixed liquor suspended solids (MLSS) concentration to the total floc area were commonly suggested to explain AS dewaterability and settleability.

[Mitral Valve Repair under Ventricular Fibrillation for Acute Mitral Valve Regurgitation in a Patient with Aortitis Syndrome].

A 73-year-old woman with a history of aortitis syndrome was referred to our hospital presenting with congestive heart failure caused by acute severe mitral regurgitation due to posterior leaflet prolapse. Upon admission, the patient fell into shock state while undergoing an examination. Medical treatment including mechanical ventilation could not alleviate circulatory collapse, so emergency surgery was performed on the day of admission. Severe calcification of the ascending aorta and severe stenosis or occlusion of the aortic arch vessels resulted from the patient's aortitis syndrome precluded aortic cannulation and aortic clamp. Therefore, mitral valve repair was performed under ventricular fibrillation at moderate hypothermia. Surgery was successful, and the patient recovered well without any cerebral complications after the surgery.

Simple enumeration of Escherichia coli concentrations in river water samples by measuring ß-d-glucuronidase activities in a microplate reader.

Monitoring of Escherichia coli concentrations in river water (RW) is essential to identify fecal pollution of the river. The objective of this study was to assess the suitability of a novel, simple and high throughput method developed in our laboratory to enumerate E. coli concentrations in RW samples. The method is based on the use of the synthetic substrate specific for the ß-d-glucuronidase (GUS) produced by E. coli. GUS activities and E. coli concentrations were monitored at eight selected sites in rivers running through Sapporo, Japan. Because the fluorescence intensities of the synthetic substrate in the RW samples increased linearly over a 4-h incubation period, we could estimate the GUS activities of the RW samples. The GUS activities were highly correlated with E. coli concentrations at >100 most probable numbers 100 mL-1 with a correlation coefficient of 0.87. The GUS activities of the RW samples collected from all sampling sites fitted well to a single correlation equation, which indicates that it was applicable to the estimation of E. coli concentrations regardless of the sampling sites. This method is simple, rapid, reliable, inexpensive, and high throughput, and is therefore useful for monitoring E. coli in RW.

Simple assay for colorimetric quantification of unamplified bacterial 16S rRNA in activated sludge using gold nanoprobes.

Domestic and industrial wastewater treatment systems are vital in the protection of natural ecosystems and human health. Identification of microbial communities in the systems is essential to stable treatment performance. However, the current tools of microbial community analysis are labor intensive and time consuming, and require expensive equipment. Therefore, we developed a simple assay for colorimetric quantification of bacterial 16S rRNA extracted from environmental samples. The assay is based on RNA extraction with commercial kits, mixing the unamplified RNA sample with Au-nanoprobes and NaCl, and analyzing the absorbance spectra. Our experimental results confirmed that the assay format was valid. By analyzing the synthesized DNA, we optimized the operational parameters affecting the assay. We achieved adequate capture DNA density by setting the capture DNA probe concentration at 10 µM during the functionalization step. The required incubation time after NaCl addition was 30 min. The binding site of the target had negligible effect on DNA detection. Under the optimized condition, a calibration curve was created using 16S rRNA extracted from activated sludge. The curve was linear above 5.0 × 107 copies/µL of bacterial 16S rRNA concentration, and the limit of detection was 1.17 × 108 copies/µL. Using the calibration curve, the bacterial 16S rRNA concentration in activated sludge samples could be quantified with deviations between 48% and 208% against those determined by RT-qPCR. The findings of our study introduce an innovative tool for the quantification of 16S rRNA concentration as the activity of key bacteria in wastewater treatment processes, achieving stable treatment performance.

Synthesis of a Fluorescent Solvatochromic Resin Using Suzuki-Miyaura Cross-Coupling and Its Optical Waveguide Spectra to Measure the Solvent Polarity on the Surface.

We have established a novel analytical method for solvent polarity on resin surface by combining the synthesis of fluorescent solvatochromic resin with optical waveguide spectrometry. The fluorescent solvatochromic resin was obtained via Suzuki-Miyaura cross-coupling between 4-iodobenzoic acid immobilized on Wang resin and 5-[4-(N,N-dihexylamino)phenyl]-2-thienylboronic acid N-methyl-iminodiacetic acid (MIDA) ester. The optical waveguide spectrometry studies on the resin showed a strong fluorescent solvatochromism in various organic solvents.

Cell Density-dependent Anammox Activity of Candidatus Brocadia sinica Regulated by N-acyl Homoserine Lactone-mediated Quorum Sensing.

The activity of anaerobic ammonia-oxidizing (anammox) bacteria is considered to depend on cell density; however, this has not yet been confirmed due to the fastidious nature of anammox bacteria (e.g., slow growth, oxygen sensitivity, and rigid aggregate formation). In the present study, the cell density-dependent occurrence of anammox activity (14-15N2 gas production rate) was investigated using planktonic enrichment cultures of Candidatus Brocadia sinica. This activity was detectable when the density of cells was higher than 107| |cells| |mL-1 and became stronger with increases in cell density. At the cell densities, the transcription of the BROSI_A1042 and BROSI_A3652 genes, which are potentially involved in the biosynthesis and reception of N-acyl homoserine lactone (AHL), was detectable in Brocadia sinica cells. The presence of AHL molecules in the MBR culture of B. sinica was confirmed by an AHL reporter assay and gas chromatography mass spectrometry analysis. The exogenous addition of the MBR culture extract and AHL molecules (a cocktail of C6, C8, C10, and C12-homoserine lactones) increased the specific 14-15N2 production rate of B. sinica. These results suggest that the specific anammox activity of B. sinica is regulated by AHL-mediated quorum sensing.

Redox stratification within cryoconite granules influences the nitrogen cycle on glaciers.

Cryoconite granules are naturally occurring microbial structures on glacier surfaces worldwide. They play a key role in carbon and nitrogen cycling in glacier ecosystems and can accelerate the melting of snow and ice. However, detailed mechanism of nitrogen cycling in cryoconite granules remains unclear. Here, we demonstrate that redox stratification affects the spatial distribution of N cycling processes in cryoconite granules. Based on microsensor measurements for O2, NH4+, NO2- and NO3-, we identified the presence of fine-scale redox stratification within cryoconite granules. Cyanobacteria at the surface layer of the granules created oxic conditions, whereas the inner core of the granules was anoxic. Metatranscriptomic analyses indicated the active occurrences of nitrification in the inner core, whereas denitrification actively occurred both in the inner core and the surface layer of the granules. Cyanobacteria in the inner core of the granules were inactive, and likely dead and being degraded, providing carbon and nitrogen to support nitrifiers and denitrifiers. Quantities of nitrification genes/transcripts were greater in large cryoconite granules than small ones, most likely because nitrogen substrates were more abundantly present in the inner core of large granules due to distinct redox stratification. Our results suggest that the development of a granular structure of cryoconite granules can largely affect carbon and nitrogen cycling on glaciers.

[Reports of 12 Cases of Stanford Type A Acute Aortic Dissection Emergent Surgery for Jehovah's Witnesses patients].

The Jehovah's Witnesses (JW) is well known for declining blood transfusions. Especially, cardiovascular surgery on JW poses unique challenges. We herein report 12 JW emergent cases of Stanford type A acute aortic dissection which underwent graft replacement between 2003 and 2019. Graft replacement of ascending aorta was performed in all cases. Operative time and anesthetic time were 344±100 and 396±109 minutes respectively. The mean intraoperative hemoglobin nadir was 4.9±1.2 g/dl. The postoperative hemoglobin nadir was 6.3 ±2.4 g/dl. There were 2 deaths within 24 hours after surgery. We did not transfuse any packed red blood cells, fresh frozen plasma or platelets for JW patients of Stanford type A acute aortic dissection surgery.

Simple and reliable enumeration of Escherichia coli concentrations in wastewater samples by measuring ß-d-glucuronidase (GUS) activities via a microplate reader.

Monitoring of Escherichia coli concentrations at wastewater treatment plants (WWTPs) is important to ensure process performance and protect public health. However, conventional E. coli enumeration methods are complicated and time- and labor-consuming. Here, we report a novel simple and reliable method based on ß-d-glucuronidase (GUS) activity assay to enumerate E. coli concentrations in wastewater (WW) samples. An aliquot (20 µL) of the medium with fluorogenic enzyme substrate for E. coli and 180 µL of a WW sample were added to one well of a 96-well microplate. The microplate was placed in a microplate reader at 37 °C. To this end, the fluorescence intensity of a fluorogenic enzyme substrate for E. coli was measured every 10 min over 3 h to determine GUS activity. The linear increase in the fluorescence intensity representing the GUS activities showed a positive correlation with E. coli concentrations in wastewater samples. However, the correlation equations were specific to WWTPs, which could be due to the difference in the E. coli population structures among WWTPs. We observed that the wastewater matrix is not a limitation to measure the GUS activity, and a WWTP-specific correlation equation can be used as a calibration curve to estimate the E. coli concentrations in the samples collected from that site. A comparison of the results with those of culture-dependent Colilert method proved that the current method is simple and useful for the enumeration of E. coli concentrations in wastewater samples reliably.

Development of a simple analytical method to determine arsenite using a DNA aptamer and gold nanoparticles.

A simple analytical method was developed to determine the arsenite (As(III)) concentration using a DNA aptamer and gold nanoparticles (AuNPs). Prior to sample measurements, the method sensing mechanism was confirmed by analyzing the particle size of the AuNPs at each step of the analysis procedure, and the key operational parameters that affect the method performance were optimized. The optimal final NaCl concentration, incubation time with NaCl and pH of a 3-(N-morpholino) propanesulfonic acid buffer were 60 mM, 10 min and 7.3, respectively. A calibration curve was created under optimized operational conditions. The calibration curve was linear from a 1.0- to 10-µM As(III) concentration. The detection limit was 2.1 µM (161 µg/L). Using the calibration curve, we evaluated groundwater samples spiked with As(III). As(III) concentrations in groundwater pretreated with a 0.2-µm-pore-size membrane filter and cation-exchange resin were determined by using the method, which suggests that the proposed method can be used to determine the As(III) concentration in groundwater.

Digestion performance and contributions of organic and inorganic fouling in an anaerobic membrane bioreactor treating waste activated sludge.

This study evaluates the performance of an anaerobic membrane bioreactor (AnMBR) digesting waste activated sludge. A digestion reactor equipped with an external hollow fiber microfiltration membrane module was operated in continuous-mode for 248 days. The system demonstrated 56% volatile solids degradation at an organic loading rate of 0.40 g-VS/(L·d) in 15 days of hydraulic retention time. The average methane content in the biogas produced was 76% which is considerably high compared to that from a typical continuously stirred tank reactor. The transmembrane pressure remained under 12 kPa without membrane cleaning during the experimental period due to low filtration flux (0.01-0.07 m/d) and cross-flow-mode filtration. Ex situ membrane cleaning revealed that physically irreversible fouling was the dominant form of membrane fouling. Inorganic and organic fouling accounted for 16% and 45% of total membrane fouling, respectively.