Combining thermophilic aerobic reactor (TAR) with mesophilic anaerobic digestion (MAD) improves the degradation of pharmaceutical compounds.

The removal efficiency of nine pharmaceutical compounds from primary sludge was evaluated in two different operating conditions: (i) in conventional Mesophilic Anaerobic Digestion (MAD) alone and (ii) in a co-treatment process combining Mesophilic Anaerobic Digestion and a Thermophilic Aerobic Reactor (MAD-TAR). The pilot scale reactors were fed with primary sludge obtained after decantation of urban wastewater. Concerning the biodegradation of organic matter, thermophilic aeration increased solubilization and hydrolysis yields of digestion, resulting in a further 26% supplementary removal of chemical oxygen demand (COD) in MAD-TAR process compared to the conventional mesophilic anaerobic digestion. The highest removal rate of target micropollutants were observed for caffeine (CAF) and sulfamethoxazole (SMX) (>89%) with no substantial differences between both processes. Furthermore, MAD-TAR process showed a significant increase of removal efficiency for oxazepam (OXA) (73%), propranolol (PRO) (61%) and ofloxacine (OFL) (41%) and a slight increase for diclofenac (DIC) (4%) and 2 hydroxy-ibuprofen (2OH-IBP) (5%). However, ibuprofen (IBP) and carbamazepine (CBZ) were not degraded during both processes. Anaerobic digestion affected the liquid-solid partition of most target compounds. Sorbed fraction of pharmaceutical compounds on the sludge tend to decrease after digestion, this tendency being more pronounced in the case of the MAD-TAR process due to much lower concentration of solids.

Study of inelastic nuclear interactions of 400 GeV/c protons in bent silicon crystals for beam steering purposes.

Inelastic nuclear interaction probability of 400 GeV/c protons interacting with bent silicon crystals was investigated, in particular for both types of crystals installed at the CERN Large Hadron Collider for beam collimation purposes. In comparison to amorphous scattering interaction, in planar channeling this probability is ∼ 36 % for the quasi-mosaic type (planes (111)), and ∼ 27 % for the strip type (planes (110)). Moreover, the absolute inelastic nuclear interaction probability in the axial channeling orientation, along the ⟨ 110 ⟩ axis, was estimated for the first time, finding a value of 0.6 % for a crystal 2 mm long along the beam direction, with a bending angle of 55 µ rad. This value is more than two times lower with respect to the planar channeling orientation of the same crystal, and increases with the vertical angular misalignment. Finally, the correlation between the inelastic nuclear interaction probability in the planar channeling and the silicon crystal curvature is reported.

Enrichment and adaptation yield high anammox conversion rates under low temperatures.

This study compared two anammox sequencing batch reactors (SBR) for one year. SBRconstantT was kept at 30 °C while temperature in SBRloweringT was decreased step-wise from 30 °C to 20 °C and 15 °C followed by over 140 days at 12.5 °C and 10 °C. High retention of anammox bacteria (AnAOB) and minimization of competition with AnAOB were key. 5-L anoxic reactors with the same inoculum were fed synthetic influent containing 25.9 mg NH4+-N/L and 34.1 mg NO2--N/L (no COD). Specific ammonium removal rates continuously increased in SBRconstantT, reaching 785 mg NH4+-N/gVSS/d, and were maintained in SBRloweringT, reaching 82.2 and 91.8 mg NH4+-N/gVSS/d at 12.5 and 10 °C respectively. AnAOB enrichment (increasing hzsA and 16S rDNA gene concentrations) and adaptation (shift from Ca. Brocadia to Ca. Kuenenia in SBRloweringT) contributed to these high rates. Rapidly settling granules developed, with average diameters of 1.2 (SBRconstantT) and 1.6 mm (SBRloweringT). Results reinforce the potential of anammox for mainstream applications.

Safety of preoperative enoxaparin in head and neck cancer surgery.

BACKGROUND: Thromboembolism is a risk in major head and neck cancer surgery patients predisposed to thrombosis. This study was designed to determine whether enoxaparin (a low molecular weight heparin) administered prior to surgery induces perioperative bleeding. METHODS: Forty patients scheduled for major cervicofacial cancer surgery were randomized in a double-blind study to receive either 20 mg enoxaparin or placebo, 12 hours before surgery. Blood losses were measured at the end of surgery and 6 hours later. RESULTS: Bleeding was equal in the placebo group and in the enoxaparin group, with losses of 648 +/- 106 mL and 602 +/- 106 mL (p = 0.76), respectively. Six hours after surgery, blood collected was 159.3 +/- 25.7 mL in the placebo group vs 151.4 +/- 21 mL in the enoxaparin group (p = 0.81). CONCLUSION: Preoperative administration of enoxaparin is safe in head and neck cancer surgery, but further studies are required to evaluate its efficacy in preventing thromboembolism.

Antimicrobial prophylaxis for major head and neck cancer surgery with piperacillin and ornidazole.

A prospective study in 53 eligible patients, undergoing major head and neck cancer surgery was carried out to assess the combination of an ureido penicillin, piperacillin with a nitro imidazole agent, ornidazole, in order to prevent post-operative general and wound infections. Both antibiotics were administered for five days. Each patient had piperacillin 4 gm every eight hours and ornidazole 1 gm every 24 hours. The overall rate of infections was 13.2 per cent (n = 7), with 3.8 per cent (n = 2) wound infections and 11.3 per cent (n = 6) general infections (one patient presented both complications). There was no wound infection in the total surgery group (n = 12). General infections who only consisted of pneumonias were respectively 12.2 per cent (n = 5) in the group with partial procedures (n = 41) and 8.3 per cent (n = 1) in the total surgery group. This antibioprophylaxis can be recommended in major oncological neck surgery, specially in the case of partial procedures.

[Difficult intubations. A prospective study]. / Les intubations difficiles. Une étude prospective.

A prospective tubing of tracheal tubing in view of general anesthia was performed in 441 adults undergoing scheduled surgery. Before surgery, the anesthesists and ENT specialists tried to independently predict the cases of difficult tubing, according to different criteria. Tubing actually was difficult in 38 patients (8.6ù) instead of the 21 (55.2%) expected by the ENT specialists and/or the anesthesists. These difficulties were solved by bronchoscopy, which allowed tubing to be performed with a guide-probe (3 cas), by scheduled fiberendoscopy (6), tracheotomy (1), nasotracheal tubing (1), spontaneous ventilation (2), and orotracheal tubing in 25 cases. Current knowledge of the predictive criteria is incomplete: anesthesists must be aware of the assistance techniques required in case of difficult tubing in a non-ENT context.

[Intubation in otorhinolaryngologic surgery: propofol versus propofol-suxamethonium]. / Intubation en chirurgie ORL: propofol vs propofol-suxaméthonium.

This study was carried out to assess the conditions of intubation in head and neck surgery when using propofol alone or associated with suxamethonium. Sixty patients were randomly allocated in two groups of 30. Group I was given 3 mg.kg-1 propofol and Group II 3 mg.kg-1 propofol immediately followed by 1.5 mg.kg-1 suxamethonium. All patients were premedicated orally with midazolam 0.1 mg.kg-1, 0.5 to 1 mg atropine and 7 to 10 micrograms.kg-1 alfentanil, while a colloidal solute (Plasmion) up to 250-500 ml was infused. One minute after injection of propofol, lidocaine 5% was pulverized on the glottis and intubation performed. The mean time required for intubation was similar in both groups: 128 +/- 10 sec in group I vs 132 +/- 9.7 sec in group II. Thirty-five % of patients had to be considered as difficult to intube but the mean times in these cases were not statistically different: 169 +/- 14 sec in group I vs 175 +/- 13 sec in group II. Opening of the glottis was found to be better in group II than in group I (p less than 0.01) and bucking was more frequent in group I (p less than 0.01). Successful intubation was obtained after one attempt at a similar rate in the two groups. The haemodynamic variations consisted in a significant decrease of systolic blood pressure compared to the initial value but these variations were similar in the two groups at each time (2.3 and 5 min) from induction.(ABSTRACT TRUNCATED AT 250 WORDS)

[Anesthesia in high class athletes]. / Anesthésie chez le sportif de haut niveau.

A case of general anaesthesia in a 49 year old male, high level specialist in triathlon, is reported. At the preoperative assessment, the patient had a sinus bradycardia of 45 b.min-1. The electrocardiogram (ECG) exhibited 2 mm ST segment elevation in leads V3-V5, an inverted T wave in leads V1 and V4, and a prolonged QT interval. The QRS axis was 60 degrees, the Sokolow index 44 mm; there was a partial right bundle branch block. These ECG anomalies disappeared during exercise. Heart sounds and blood pressure were normal. On chest X-ray the heart was enlarged. Five mg of midazolam were given orally 30 min before induction, and 1 mg atropine intravenously to increase the heart rate (40 b.min-1). Anaesthesia was induced with 2.5 mg.kg-1 propofol and alfentanil 15 micrograms.kg-1. Vecuronium 0.05 mg.kg-1, alfentanil 0.5 mg, 0.5% isoflurane in a mixture of 40% oxygen and 60% nitrous oxide were used to maintain anaesthesia. A further bolus of 0.5 mg atropine was necessary because of persisting sinus bradycardia. Surgery lasted 70 min. Heart rate and blood pressure returned to their initial values when the patient recovered from anaesthesia. Cardiac abnormalities are common in athletes; they must be distinguished from pathological conditions. When carrying out anaesthesia in these patients, it would seem highly recommendable to give 1-2 mg atropine, and to avoid associating negative chronotropic drugs.