Postoperative Delirium in Patients with Oral Cancer: Is Intraoperative Fluid Administration a Neglected Risk Factor?

Squamous cell carcinoma (SCC) is a malignant tumor derived from squamous cells and can be found in different localizations. In the oral cavity especially, it represents the most common type of malignant tumor. First-line therapy for oral squamous cell carcinoma (OSCC) is surgery, including tumor resection, neck dissection, and maybe reconstruction. Although perioperative mortality is low, complications such as delirium are very common, and may have long-lasting consequences on the patient's quality of life. This study examines if excessive fluid administration, among other parameters, is an aggravating factor for the development of postoperative delirium. A total of 198 patients were divided into groups concerning the reconstruction technique used: group A for primary wound closure or reconstruction with a local flap, and group B for microsurgical reconstruction. The patients with and without delirium in both groups were compared regarding intraoperative fluid administration, fluid balance, and other parameters, such as blood loss, duration of surgery and overall ventilation, alcohol consumption, and creatinine, albumin, natrium, and hematocrit levels. The logistic regression for group A shows that fluid intake (p = 0.02, OR = 5.27, 95% CI 1.27-21.8) and albumin levels (p = 0.036, OR = 0.22, CI 0.054-0.908) are independent predictors for the development of delirium. For group B, gender (p = 0.026, OR = 0.34, CI 0.133-0.879) with a protective effect for females, fluid intake (p = 0.003, OR = 3.975, CI 1.606-9.839), and duration of ventilation (p = 0.025, OR = 1.178, CI 1.021-1.359) are also independent predictors for delirium. An intake of more than 3000 mL for group A, and 4150 mL for group B, increases the risk of delirium by approximately five and four times, respectively. Fluid management should be considered carefully in patients with OSCC, in order to reduce the occurrence of postoperative delirium. Different factors may become significant for the development of delirium regarding different surgical procedures.

A new concept of a rotating hollow fibre membrane module:impact of rotation on fine-bubble aeration.

A new concept of a rotating membrane module in a membrane bioreactor (MBR) system was tested for its effect on oxygen transfer in clean water and wastewater. The membrane module consists of horizontally aligned hollow fibres connected to the vertically positioned permeate tube which rotates. The results indicated that oxygen transfer can be improved by up to 50% at the highest applied rotational speed (50 rpm) and that the additional energy demand required for the rotation can be compensated by the enhanced oxygen transfer. However, at the highest rotational speed (50 rpm), the fine bubbles bypassed the MBR module, and, consequently, could not contribute to any cleaning effect. The α-factors at different rotational speeds showed similar results. This indicates that the depletion was caused neither by surfactants nor by viscosity phenomena but rather by the floc/solid holdup of the sludge.

Disturbance and temporal partitioning of the activated sludge metacommunity.

The resilience of microbial communities to press disturbances and whether ecosystem function is governed by microbial composition or by the environment have not been empirically tested. To address these issues, a whole-ecosystem manipulation was performed in a full-scale activated sludge wastewater treatment plant. The parameter solids retention time (SRT) was used to manipulate microbial composition, which started at 30 days, then decreased to 12 and 3 days, before operation was restored to starting conditions (30-day SRT). Activated sludge samples were collected throughout the 313-day time series in parallel with bioreactor performance ('ecosystem function'). Bacterial small subunit (SSU) rRNA genes were surveyed from sludge samples resulting in a sequence library of >417,000 SSU rRNA genes. A shift in community composition was observed for 12- and 3-day SRTs. The composition was altered such that r-strategists were enriched in the system during the 3-day SRT, whereas K-strategists were only present at SRTs⩾12 days. This shift corresponded to loss of ecosystem functions (nitrification, denitrification and biological phosphorus removal) for SRTs⩽12 days. Upon return to a 30-day SRT, complete recovery of the bioreactor performance was observed after 54 days despite an incomplete recovery of bacterial diversity. In addition, a different, yet phylogenetically related, community with fewer of its original rare members displaced the pre-disturbance community. Our results support the hypothesis that microbial ecosystems harbor functionally redundant phylotypes with regard to general ecosystem functions (carbon oxidation, nitrification, denitrification and phosphorus accumulation). However, the impacts of decreased rare phylotype membership on ecosystem stability and micropollutant removal remain unknown.

Floc volume effects in suspensions and its relevance for wastewater engineering.

The aim of this paper is to better understand oxygen transfer reduction caused by floc suspensions. We demonstrate that the overall floc volume significantly influences oxygen transfer depletion. Submerged fine bubble and coarse bubble diffusers are affected in the same way by this phenomenon. The mixed liquor suspended solids concentration (MLSS concentration) is not an appropriate parameter for describing or relating phenomena that are caused by the overall floc volume in activated sludge (e.g., oxygen transfer depression and sludge sedimentation characteristics). A better correlation is achieved by using the mixed liquor volatile suspended solids concentration (MLVSS concentration). To characterize the effects of the overall floc volume in suspensions whose MLVSS concentration cannot be determined (e.g., inorganic iron hydroxide flocs), a new method-the hydrostatic floc volume (HFV)-that approximates the overall floc volume in floc suspensions is introduced. Application of this method demonstrates that oxygen transfer depression caused by iron hydroxide flocs and activated sludge flocs is similar.

Free water content and sludge retention time: impact on oxygen transfer in activated sludge.

To investigate the effect of sludge retention time (SRT) and the concentration of mixed liquid volatile suspended solids (MLVSS) on oxygen transfer in activated sludge, we studied mass transfer coefficients (k(L)a) in a pilot-scale membrane bioreactor, which treated synthetic greywater. Additionally, experiments with iron hydroxide flocs were performed to examine the role of free water content in oxygen transfer. The results demonstrate that the alpha-factor is reduced when free water content decreases and floc volume increases. Because the MLVSS concentration in activated sludge mainly regulates floc volume, a reduction of oxygen transfer with increasing MLVSS concentration was observed. If the floc volume remains unchanged, oxygen transfer increases with increasing SRT.

Oxygen transfer in membrane bioreactors treating synthetic greywater.

Mass transfer coefficients (k(L)a) were studied in two pilot scale membrane bioreactors (MBR) with different setup configurations treating 200L/h of synthetic greywater with mixed liquor suspended solids' (MLSS) concentrations ranging from 4.7 to 19.5g/L. Besides the MLSS concentration, mixed liquor volatile suspended solids (MLVSS), total solids (TS), volatile solids (VS), chemical oxygen demand (COD) and anionic surfactants of the sludge were measured. Although the pilot plants differed essentially in their configurations and aeration systems, similar alpha-factors at the same MLSS concentration could be determined. A comparison of the results to the published values of other authors showed that not the MLSS concentration but rather the MLVSS concentration seems to be the decisive parameter which influences the oxygen transfer in activated sludge systems operating at a high sludge retention time (SRT).