Three-Year Outcomes of Oral Antibiotics vs Intravenous and Oral Antibiotics for Uncomplicated Acute Appendicitis: A Secondary Analysis of the APPAC II Randomized Clinical Trial.

Importance: Current short-term evidence has shown that uncomplicated acute appendicitis can be treated successfully with oral antibiotics alone, but longer-term results are lacking. Objective: To assess the treatment effectiveness of oral antibiotic monotherapy compared with combined intravenous (IV) and oral antibiotics in computed tomography-confirmed uncomplicated acute appendicitis at a longer-term follow-up. Design, Setting, and Participants: This secondary analysis of a predefined year 3 follow-up of the Appendicitis Acuta II (APPAC II) noninferiority, multicenter randomized clinical trial compared oral moxifloxacin with combined IV ertapenem plus oral levofloxacin and metronidazole for the treatment of uncomplicated acute appendicitis. The trial was conducted at 9 university and central hospitals in Finland from April 2017 to November 2018, with the last follow-up in November 2022. Participants included patients aged 18 to 60 years, who were randomized to receive either oral antibiotics monotherapy (n = 301) or combined IV and oral antibiotics (n = 298). Interventions: Antibiotics monotherapy consisted of oral moxifloxacin, 400 mg/d, for 7 days. Combined IV and oral antibiotics consisted of IV ertapenem sodium, 1 g/d, for 2 days plus oral levofloxacin, 500 mg/d, and metronidazole, 500 mg 3 times/d, for 5 days. Main Outcomes and Measures: The primary end point was treatment success, defined as the resolution of acute appendicitis and discharge from hospital without the need for surgical intervention and no appendicitis recurrence at the year 3 follow-up evaluated using a noninferiority design. The secondary end points included late (after 1 year) appendicitis recurrence as well as treatment-related adverse events, quality of life, length of hospital stay, and length of sick leave, which were evaluated using a superiority design. Results: After exclusions, 599 patients (mean [SD] age, 36 [12] years; 336 males [56.1%]) were randomized; after withdrawal and loss to follow-up, 582 patients (99.8%) were available for the year 3 follow-up. The treatment success at year 3 was 63.4% (1-sided 95% CI, 58.8% to ∞) in the oral antibiotic monotherapy group and 65.2% (1-sided 95% CI, 60.5% to ∞) in the combined IV and oral antibiotics group. The difference in treatment success rate between the groups at year 3 was -1.8 percentage points (1-sided 95% CI, -8.3 percentage points to ∞; P = .14 for noninferiority), with the CI limit exceeding the noninferiority margin. There were no significant differences between groups in treatment-related adverse events, quality of life, length of hospital stay, or length of sick leave. Conclusions and Relevance: This secondary analysis of the APPAC II trial found a slightly higher appendectomy rate in patients who received oral antibiotic monotherapy; however, noninferiority of oral antibiotic monotherapy compared with combined IV and oral antibiotics could not be demonstrated. The results encourage future studies to assess oral antibiotic monotherapy as a viable treatment alternative for uncomplicated acute appendicitis. Trial Registration: ClinicalTrials.gov Identifier: NCT03236961.

The role of ubiquitous metal ions in degradation of microplastics in hot-compressed water.

Hydrothermal processing (HTP) is an efficient thermochemical technology to achieve sound treatment and resource recovery of sewage sludge (SS) in hot-compressed subcritical water. However, microplastics (MPs) and heavy metals can be problematic impurities for high-quality nutrients recovery from SS. This study initiated hydrothermal degradation of representative MPs (i.e., polyethylene (PE), polyamide (PA), polypropylene (PP)) under varied temperatures (180-300 °C) to understand the effect of four ubiquitous metal ions (i.e., Fe3+, Al3+, Cu2+, Zn2+) on MPs degradation. It was found that weight loss of all MPs in metallic reaction media was almost four times of that in water media, indicating the catalytic role of metal ions in HTP. Especially, PA degradation at 300 °C was promoted by Fe3+ and Al3+ with remarkable weight loss higher than 95% and 92%, respectively, which was ca. 160 °C lower than that in pyrolysis. Nevertheless, PE and PP were more recalcitrant polymers to be degraded under identical condition. Although higher temperature thermal hydrolysis reaction induced severe chain scission of polymers to reinforce degradation of MPs, Fe3+ and Al3+ ions demonstrated the most remarkable catalytic depolymerization of MPs via enhanced free radical dissociation rather than hydrolysis. Pyrolysis gas chromatography-mass spectrometry (Py GC-MS) was further complementarily applied with GC-MS to reveal HTP of MPs to secondary MPs and nanoplastics. This fundamental study highlights the crucial role of ubiquitous metal ions in MPs degradation in hot-compressed water. HTP could be an energy-efficient technology for effective treatment of MPs in SS with abundant Fe3+ and Al3+, which will benefit sustainable recovery of cleaner nutrients in hydrochar and value-added chemicals or monomers from MPs.

Can online particle counters and electrochemical sensors distinguish normal periodic and aperiodic drinking water quality fluctuations from contamination?

Early warning systems monitoring the quality of drinking water need to distinguish between normal quality fluctuations and those caused by contaminants. Thus, to decrease the number of false positive events, normal water quality fluctuations, whether periodic or aperiodic, need to be characterized. For this, we used a novel flow-imaging particle counter, a light-scattering particle counter, and electrochemical sensors to monitor the drinking water quality of a pressure zone in a building complex for 109 days. Data were analyzed to determine the feasibility of the sensors and particle counters to distinguish periodic and aperiodic fluctuations from real-life contaminants. The concentrations of particles smaller than 10 µm and N, Small, Large, and B particles showed sudden changes recurring daily, likely due to the flow rate changes in the building complex. Conversely, the concentrations of larger than 10 µm particles and C particles, in addition to the responses of electrochemical sensors, remained in their low typical values despite flow rate changes. The aperiodic events, likely resulting from an abnormally high flow rate in the water mains due to maintenance, were detected using particle counters and electrochemical sensors. This study provides insights into choosing water quality sensors by showing that machine learning-based particle classes, such as B, C, F, and particles larger than 10 µm are promising in distinguishing contamination from aperiodic and periodic fluctuations while the use of other particle classes and electrochemical sensors may require dynamic baseline to decrease false positive events in an early warning system.

Incidence of parastomal and incisional hernia following emergency surgery for Hinchey III-IV diverticulitis: A systematic review.

PURPOSE: The aim of this systematic review was to evaluate the risk of parastomal (PSH) and incisional hernias (IH) after emergency surgery for Hinchey III-IV diverticulitis, with comparison between the Hartmann procedure and other surgical techniques. METHODS: The Cochrane Library, Embase, PubMed (MEDLINE), Web of Science and Scopus databases were systematically searched. The primary endpoint was parastomal hernia incidence. The secondary endpoint was incisional hernia incidence. RESULTS: Five studies (four randomized controlled trials and one retrospective cohort) with a total of 699 patients were eligible for inclusion. The PSH rate was 15%-46% for Hartmann procedure, 0%-85% for primary anastomosis, 4% for resection, and 2% for laparoscopic lavage. The IH rates were 5%-38% for Hartmann procedure, 5%-27% for primary anastomosis, 9%-12% for primary resection, and 3%-11% for laparoscopic lavage. CONCLUSIONS: Both the parastomal and incisional hernia incidences are poorly evaluated and reported, and varied greatly between the studies.

The effects of digestate pyrolysis liquid on the thermophilic anaerobic digestion of sewage sludge - Perspective for a centralized biogas plant using thermal hydrolysis pretreatment.

The use of pyrolysis process to valorize digestate from anaerobic digestion (AD) of municipal sewage sludge for biochar production was piloted in a central biogas plant. The pyrolysis also generates pyrolysis liquid with high organics and nutrient contents that currently has no value and requires treatment, which could potentially be done in AD. As the pyrolysis liquid may contain inhibitory compounds, we investigated the effects of adding the pyrolysis liquid on AD of sewage sludge and thermal hydrolysis pretreated sewage sludge (THSS) simulating the full-scale centralized biogas plant conditions. In batch assays, the pyrolysis liquid as such did not produce any methane, and the 1% and 5% (v/w) shares suppressed the methane production from THSS by 14-19%, while a smaller decrease in methane production was observed with sewage sludge. However, in the semi-continuous reactor experiments, pyrolysis liquid at a 1% (v/w) share was added in sewage sludge or THSS feed without affecting the methane yields or digestate characteristics. The laboratory results indicated that pyrolysis liquid can be treated in AD, while extrapolating the results to the centralized biogas plant indicated minor increase in the overall methane production and an increased potential for ammonium recovery.

Hydrothermal carbonization of pulp and paper industry wastewater treatment sludges - characterization and potential use of hydrochars and filtrates.

The pulp and paper industry's mixed sludge represents waste streams with few other means of disposal than incineration. Hydrothermal carbonization (HTC) could be advantageous for the sludge refinement into value-added products, thus complementing the concept of pulp and paper mills as biorefineries. Laboratory HTC was performed on mixed sludge (at 32% and 15% total solids) at temperatures of 210-250 °C for 30 or 120 min, and the characteristics of the HTC products were evaluated for their potential for energy, carbon, and nutrient recovery. The energy content increased from 14.9 MJ/kg in the mixed sludge up to 20.5 MJ/kg in the hydrochars. The produced filtrates had 12-15-fold higher COD and 3-5-fold higher volumetric methane production than untreated sludge filtrates, even though the methane yield against g-COD was lower. The increased value of the hydrochars in terms of energy content and carbon sequestration potential promote HTC deployment in sludge treatment and upgrading.

Monocarboxylate Transporters 1 and 4 and Prognosis in Small Bowel Neuroendocrine Tumors.

Monocarboxylate transporters (MCTs) are cell membrane proteins transporting lactate, pyruvate, and ketone bodies across the plasma membrane. The prognostic role of MCTs in neuroendocrine tumors is unknown. We aimed to analyze MCT1 and MCT4 expression in small bowel neuroendocrine tumors (SB-NETs). The cohort included 109 SB-NETs and 61 SB-NET lymph node metastases from two Finnish hospitals. Tumor samples were immunohistochemically stained with MCT1 and MCT4 monoclonal antibodies. The staining intensity, percentage of positive cells, and stromal staining were assessed. MCT1 and MCT4 scores (0, 1 or 2) were composed based on the staining intensity and the percentage of positive cells. Survival analyses were performed with the Kaplan-Meier method and Cox regression, adjusted for confounders. The primary outcome was disease-specific survival (DSS). A high MCT4 intensity in SB-NETs was associated with better DSS when compared to low intensity (85.7 vs. 56.6%, p = 0.020). A high MCT4 percentage of positive cells resulted in better DSS when compared to a low percentage (77.4 vs. 49.1%, p = 0.059). MCT4 scores 0, 1, and 2 showed DSS of 52.8 vs. 58.8 vs. 100% (p = 0.025), respectively. After adjusting for confounders, the mortality hazard was lowest in the patients with a high MCT4 score. MCT1 showed no association with survival. According to our study, a high MCT4 expression is associated with an improved prognosis in SB-NETs.

An online flow-imaging particle counter and conventional water quality sensors detect drinking water contamination in the presence of normal water quality fluctuations.

Contamination detection in drinking water is crucial for water utilities in terms of public health; however, current online water quality sensors can be unresponsive to various possible contaminants consisting of particulate and dissolved content or require a constant supply of reagents and sample preparation. We used a two-line test environment connected to a drinking water distribution system with flow-imaging particle counters and conventional sensors to assess their responses to the injection of contaminants into one line, including stormwater, treated wastewater, wastewater, well water, and Escherichia coli, while simultaneously measuring responses to normal water quality fluctuations in the other line. These water quality fluctuations were detected with all of the conventional sensors (except conductivity) and with 3 out of 5 of the size- and shape-derived particle classes of the flow-imaging particle counter. The flow-imaging particle counter was able to detect all of the studied contaminants, e.g. municipal wastewater at 0.001% (v/v), while the oxidation-reduction potential sensor outperformed other conventional sensors, detecting the same wastewater at 0.03% (v/v). The presence of particles less than 1 µm in size was shown to be a generic parameter for the detection of particulates present in the studied contaminants; however, they manifested a considerable response to fluctuations which led to lower relative response to contaminants in comparison to larger particles. The particle size and class distributions of contaminants were different from those of drinking water, and thus monitoring particles larger than 1 µm or specific particle classes of flow-imaging particle counter, which are substantially more abundant in contaminated water than in pure drinking water, can improve the detection of contamination events. Water utilities could optimize contamination detection by selecting water quality parameters with a minimal response to quality fluctuations and/or a high relative response to contaminants.

Microbial community assembly and dynamics in Granular, Fixed-Biofilm and planktonic microbiomes valorizing Long-Chain fatty acids at 20 °C.

Distinct microbial assemblages evolve in anaerobic digestion (AD) reactors to drive sequential conversions of organics to methane. The spatio-temporal development of three such assemblages (granules, biofilms, planktonic) derived from the same inoculum was studied in replicated bioreactors treating long-chain fatty acids (LCFA)-rich wastewater at 20 °C at hydraulic retention times (HRTs) of 12-72 h. We found granular, biofilm and planktonic assemblages differentiated by diversity, structure, and assembly mechanisms; demonstrating a spatial compartmentalisation of the microbiomes from the initial community reservoir. Our analysis linked abundant Methanosaeta and Syntrophaceae-affiliated taxa (Syntrophus and uncultured) to their putative, active roles in syntrophic LCFA bioconversion. LCFA loading rates (stearate, palmitate), and HRT, were significant drivers shaping microbial community dynamics and assembly. This study of the archaea and syntrophic bacteria actively valorising LCFAs at short HRTs and 20 °C will help uncover the microbiology underpinning anaerobic bioconversions of fats, oil and grease.

Thirty years of esophageal cancer surgery in Oulu University Hospital.

BACKGROUND: Esophagectomy is the mainstay of surgical treatment of esophageal cancer, but involves high operative risk. The aim of this study was to review the evolution surgical treatment of esophageal cancer in Northern Finland, with introduction of minimally invasive techniques. METHODS: All elective esophagectomies performed in Oulu University Hospital between years 1987 and 2020 were included. Treatment strategies were compared to current guidelines including staging and use of neoadjuvant therapy, and benchmark values including postoperative morbidity, hospital stay, readmissions and 90-day mortality. Long-term survival was compared to previous national studies. RESULTS: Between years 1987 and 2020 a total of 341 underwent an esophagectomy. Transhiatal resection was performed to 167 (49.3%), Ivor Lewis to 129 (38.1%) and McKeown to 42 (12.4%) patients. MIE was performed to 49 (14.5%) patients. During the past four years 83.7% of locally advanced diseases received neoadjuvant treatment. Since 1987, gradual improvements have occurred especially in incidence of pleural effusion requiring additional drainage procedure (highest in 2011-2013 and in last four years 14.0%), recurrent nerve injuries (highest in 2008-2010 29.4% and lowest in 2017-2020 1.8%) and in 1-year survival rate (1987-1998 68.4% vs. 2017-2020 82.1%). No major changes in comorbidity, complication rate, anastomosis leaks, hospital stay or postoperative mortality were seen. CONCLUSIONS: Esophageal cancer surgery has gone through major changes over three decades. Current guideline-based treatment has resulted with progressive improvement in mid- and long-term survival. However, despite modern protocol, no major improvement has occurred for example in major complications, anastomosis leak rates or hospital stay.

Hydrothermal carbonisation of mechanically dewatered digested sewage sludge-Energy and nutrient recovery in centralised biogas plant.

This study aimed to assess the role of hydrothermal carbonisation (HTC) in digestate processing in centralised biogas plants receiving dewatered sludge from regional wastewater treatment plants and producing biomethane and fertilisers. Chemically conditioned and mechanically dewatered sludge was used as such (total solids (TS) 25%) or as diluted (15% TS) with reject water in 30 min or 120 min HTC treatments at 210 °C, 230 °C or 250 °C, and the produced slurry was filtered to produce hydrochars and filtrates. The different hydrochars contributed to 20-55% of the original mass, 72-88% of the TS, 74-87% of the energy content, 71-92% of the carbon, above 86% of phosphorous and 38-64% of the nitrogen present in the original digestates. The hydrochars' energy content (higher heating values were 11.3-12.2 MJ/kg-TS) were similar to that of the digestates, while the ash contents increased (from 43% up to 57%). HTC treatments produced filtrates in volumes of 42-76% of the dewatered digestate, having a soluble chemical oxygen demand (SCOD) of 28-44 g/L, of which volatile fatty acids (VFAs) contributed 10-34%, and methane potentials of 182-206 mL-CH4/g-SCOD without any major indication of inhibition. All 32 pharmaceuticals detected in the digestates were below the detection limit in hydrochars and filtrates, save for ibuprofen and benzotriazole in filtrate, while heavy metals were concentrated in the hydrochars but below the national limits for fertiliser use, save for mercury. The integration of HTC to a centralised biogas plant was extrapolated to enhance the annual biogas production by 5% and ammonium recovery by 25%, and the hydrochar was estimated to produce 83 GJ upon combustion or to direct 350 t phosphorous to agriculture annually.

The Effect of Laparoscopic Technique on the Surgical Outcome of Colorectal Cancer in a Small-Volume Rural Finnish Lapland Central Hospital.

INTRODUCTION: Laparoscopic colorectal surgery has become widely used in treating colorectal cancer. Multicenter studies have shown that laparoscopy decreases postoperative complications and provides equivalent long-term oncological results compared to open surgery. Previous studies were conducted in high-volume institutions, with selected patients, which may influence the reported outcome of laparoscopy. METHODS: All patients with colorectal cancer that underwent surgery for a primary tumor between 2005 and 2015 in the Lapland Central Hospital were retrospectively collected. We retrieved data on the primary surgical outcome and complications within the first 30 days after surgery from patient records. We surveyed the national patient registry to determine long-term oncological results and patient survival. RESULTS: We identified 349 patients treated for colorectal cancer during 2005-2015. Of these, 219 patients (median age 71 years) underwent laparoscopy and 130 (median age 72 years) underwent open surgery. The 5-year disease-specific survival rates for stages I-III colon cancer were 83.3 and 87.7%, respectively. The 3-year disease-specific survival rates for stages I-III rectal cancer were 86.1 and 65.0%, respectively. CONCLUSION: Our results showed that the introduction of laparoscopic colorectal surgery for treating cancer in a rural, small-volume hospital provided short- and long-term results comparable to findings from previous studies conducted in high-volume centers. Therefore, laparoscopy should be considered the treatment of choice for colorectal cancer in small, rural clinics.

Effect of Oral Moxifloxacin vs Intravenous Ertapenem Plus Oral Levofloxacin for Treatment of Uncomplicated Acute Appendicitis: The APPAC II Randomized Clinical Trial.

Importance: Antibiotics are an effective and safe alternative to appendectomy for managing uncomplicated acute appendicitis, but the optimal antibiotic regimen is not known. Objective: To compare oral antibiotics with combined intravenous followed by oral antibiotics in the management of computed tomography-confirmed uncomplicated acute appendicitis. Design, Setting, and Participants: The Appendicitis Acuta (APPAC) II multicenter, open-label, noninferiority randomized clinical trial was conducted from April 2017 until November 2018 in 9 Finnish hospitals. A total of 599 patients aged 18 to 60 years with computed tomography-confirmed uncomplicated acute appendicitis were enrolled in the trial. The last date of follow-up was November 29, 2019. Interventions: Patients randomized to receive oral monotherapy (n = 295) received oral moxifloxacin (400 mg/d) for 7 days. Patients randomized to receive intravenous antibiotics followed by oral antibiotics (n = 288) received intravenous ertapenem (1 g/d) for 2 days followed by oral levofloxacin (500 mg/d) and metronidazole (500 mg 3 times/d) for 5 days. Main Outcomes and Measures: The primary end point was treatment success (≥65%) for both groups, defined as discharge from hospital without surgery and no recurrent appendicitis during 1-year follow-up, and to determine whether oral antibiotics alone were noninferior to intravenous and oral antibiotics, with a margin of 6% for difference. Results: Among 599 patients who were randomized (mean [SD] age, 36 [12] years; 263 [44%] women), 581 (99.7%) were available for the 1-year follow-up. The treatment success rate at 1 year was 70.2% (1-sided 95% CI, 65.8% to ∞) for patients treated with oral antibiotics and 73.8% (1-sided 95% CI, 69.5% to ∞) for patients treated with intravenous followed by oral antibiotics. The difference was -3.6% ([1-sided 95% CI, -9.7% to ∞]; P = .26 for noninferiority), with the confidence limit exceeding the noninferiority margin. Conclusion and Relevance: Among adults with uncomplicated acute appendicitis, treatment with 7 days of oral moxifloxacin compared with 2 days of intravenous ertapenem followed by 5 days of levofloxacin and metronidazole resulted in treatment success rates greater than 65% in both groups, but failed to demonstrate noninferiority for treatment success of oral antibiotics compared with intravenous followed by oral antibiotics. Trial Registration: ClinicalTrials.gov Identifier: NCT03236961; EudraCT Identifier: 2015-003633-10.

Volatile fatty acid production from Kraft mill foul condensate in upflow anaerobic sludge blanket reactors.

The utilization of foul condensate (FC) collected from a Kraft pulp mill for the anaerobic production of volatile fatty acids (VFA) was tested in upflow anaerobic sludge blanket (UASB) reactors operated at 22, 37 and 55°C at a hydraulic retention time (HRT) of ∼75 h. The FC consisted mainly of 11370, 500 and 592 mg/L methanol, ethanol and acetone, respectively. 42-46% of the organic carbon (methanol, ethanol and acetone) was utilized in the UASB reactors operated at an organic loading of ∼8.6 gCOD/L.d and 52-70% of the utilized organic carbon was converted into VFA. Along with acetate, also propionate, isobutyrate, butyrate, isovalerate and valerate were produced from the FC. Prior to acetogenesis of FC, enrichment of the acetogenic biomass was carried out in the UASB reactors for 113 d by applying operational parameters that inhibit methanogenesis and induce acetogenesis. Activity tests after 158 d of reactor operation showed that the biomass from the 55°C UASB reactor exhibited the highest activity after the FC feed compared to the biomass from the reactors at 22 and 37°C. Activity tests at 37°C to compare FC utilization for CH4 versus VFA production showed that an organic carbon utilization >98% for CH4 production occurred in batch bottles, whereas the VFA production batch bottles showed 51% organic carbon utilization. Furthermore, higher concentrations of C3-C5 VFA were produced when FC was the substrate compared to synthetic methanol rich wastewater.

Low concentration of zeolite to enhance microalgal growth and ammonium removal efficiency in a membrane photobioreactor.

The aim of this work was to study the growth and nutrient removal efficiency of a mixed microalgal culture with and without the addition of low concentrations (0.5, 1, and 5 g L-1 of total liquid volume in the reactor) of natural zeolite. A control test in which only zeolite was added into a similar membrane photobioreactor was also conducted. The addition of 0.5 g L-1 zeolite to a continuously-fed membrane photobioreactor increased the microalgal biomass concentration from 0.50 to 0.90-1.17 g particulate organic carbon per L while the average ammonium removal efficiency increased from 14% to 30%. Upon microscopic inspection, microalgal cells were observed growing on the surface of zeolite particles, which indicates that zeolite can support attached microalgal growth. With higher zeolite doses (1 and 5 g L-1) inside the reactor, however, the breaking apart of added zeolite particles into finer particles dramatically increased solution turbidity, which likely was not beneficial for microalgal growth and ammonium removal due to reduced light penetration. This work shows that low doses of zeolite can be used as microcarriers to enhance microalgal biomass concentration and ammonium removal efficiency, while minimizing zeolite dose would likely reduce the turbidity effects.

Superior primary fascial closure rate and lower mortality after open abdomen using negative pressure wound therapy with continuous fascial traction.

BACKGROUND: Open abdomen (OA) is a useful option for treatment strategy in many acute abdominal catastrophes. A number of temporary abdominal closure (TAC) methods are used with limited number of comparative studies. The present study was done to examine risk factors for failed delayed primary fascial closure (DPFC) and risk factors for mortality in patients treated with OA. METHODS: This study was a multicenter retrospective analysis of the hospital records of all consecutive patients treated with OA during the years 2009 to 2016 at five tertiary referral hospitals and three secondary referral centers in Finland. RESULTS: Six hundred seventy-six patients treated with OA were included in the study. Vacuum-assisted closure with continuous mesh-mediated fascial traction (VACM) was the most popular TAC method used (N = 398, 59%) followed by VAC (N = 128, 19%), Bogota bag (N = 128, 19%), and self-designed methods (N = 22, 3%). In multivariate analysis, enteroatmospheric fistula and the number of needed TAC changes increased the risk for failed DPFC (odds ratio [OR], 8.9; 95% confidence interval [CI], 6.2-12.8; p < 0.001 and OR, 1.1; 95% CI, 1.0-1.3; p < 0.001, respectively). Instead, VACM and ruptured abdominal aortic aneurysm as cause for OA both decreased the risk for failed DPFC (OR, 0.1; 95% CI, 0.0-0.3; p < 0.001 and OR, 0.2; 95% CI, 0.1-0.7; p = 0.012). The overall mortality rate was 30%. In multivariate analysis for mortality, multiorgan dysfunction (OR, 2.4; 95% CI, 1.6-3.6; p < 0.001), and increasing age (OR, 4.5; 95% CI, 2.0-9.7; p < 0.001) predicted increased mortality. Institutional large annual patient volume (OR, 0.4; 95% CI, 0.3-0.6; p < 0.001) and ileus and postoperative peritonitis in comparison to severe acute pancreatitis associated with decreased mortality (OR, 0.2; 95% CI, 0.1-0.4; p < 0.001; OR, 0.5; 95% CI, 0.3-0.8; p = 0.009). Kaplan-Meier analysis showed increased survival in patients treated with VACM in comparison with other TAC methods (LogRank p = 0.019). CONCLUSION: We report superior role for VACM methodology in terms of successful primary fascial closure and increased survival in patients with OA. LEVEL OF EVIDENCE: Therapeutic/care management, level IV.

Effect of tungsten and selenium on C1 gas bioconversion by an enriched anaerobic sludge and microbial community analysis.

The effect of trace metals, namely tungsten and selenium, on the production of acids and alcohols through gas fermentation by a CO-enriched anaerobic sludge in a continuous gas-fed bioreactor was investigated. The CO-enriched sludge was first supplied with a tungsten-deficient medium (containing selenium) and in a next assay, a selenium-deficient medium (containing tungsten) was fed to the bioreactor, at a CO gas flow rate of 10 mL/min. In the absence of tungsten (tungstate), an initial pH of 6.2 followed by a pH decrease to 4.9 yielded 7.34 g/L acetic acid as the major acid during the high pH period. Subsequently, bioconversion of the acids at a lower pH of 4.9 yielded only 1.85 g/L ethanol and 1.2 g/L butanol in the absence of tungsten (tungstate). A similar follow up assay in the same bioreactor with two consecutive periods at different pH values (i.e., 6.2 and 4.9) with a selenium deficient medium yielded 6.6 g/L acetic acid at pH 6.2 and 4 g/L ethanol as well as 1.88 g/L butanol at pH 4.9. The results from the microbial community analysis showed that the only known CO fixing microorganism able to produce alcohols detected in the bioreactor was Clostridium autoethanogenum, both in the tungsten and the selenium deprived media, although that species has so far not been reported to be able to produce butanol. No other solventogenic acetogen was detected.

Large-scale spatial synchrony in red squirrel populations driven by a bottom-up effect.

Spatial synchrony between populations emerges from endogenous and exogenous processes, such as intra- and interspecific interactions and abiotic factors. Understanding factors contributing to synchronous population dynamics help to better understand what determines abundance of a species. This study focuses on spatial and temporal dynamics in the Eurasian red squirrel (Sciurus vulgaris) using snow-track data from Finland from 29 years. We disentangled the effects of bottom-up and top-down forces as well as environmental factors on population dynamics with a spatiotemporally explicit Bayesian hierarchical approach. We found red squirrel abundance to be positively associated with both the abundance of Norway spruce (Picea abies) cones and the predators, the pine marten (Martes martes) and the northern goshawk (Accipiter gentilis), probably due to shared habitat preferences. The results suggest that red squirrel populations are synchronized over remarkably large distances, on a scale of hundreds of kilometres, and that this synchrony is mainly driven by similarly spatially autocorrelated spruce cone crop. Our research demonstrates how a bottom-up effect can drive spatial synchrony in consumer populations on a very large scale of hundreds of kilometres, and also how an explicit spatiotemporal approach can improve model performance for fluctuating populations.

Anaerobic treatment of LCFA-containing synthetic dairy wastewater at 20 °C: Process performance and microbial community dynamics.

Facilitating anaerobic degradation of long-chain fatty acids (LCFA) is key for tapping the high methane production potential of the fats, oil and grease (FOG) content of dairy wastewaters. In this study, the feasibility of using high-rate granular sludge reactors for the treatment of mixed LCFA-containing synthetic dairy wastewater (SDW) was assessed at 20 °C. The effects of the LCFA concentration (33-45% of COD) and organic loading rates (2-3 gCOD/L·d) were determined using three parallel expanded granular sludge bed reactors. For the first time, long term anaerobic treatment of LCFA-containing feed at 20 °C was shown to be feasible and was linked to the microbial community dynamics in high-rate reactors. During a two-month operation, a soluble COD removal of 84-91% and COD to methane conversion of 44-51% was obtained. However, granular sludge flotation and washout occurred after two months in all reactors without volatile fatty acids (VFA) accumulation, emphasizing the need for sludge retention for long-term granular sludge reactor operation with LCFA-containing feed at low ambient temperatures. The temporal shifts in microbial community structure were studied in the high-rate treatment of SDW, and the process disturbances (elevated LCFA loading, LCFA accumulation, and batch operation) were found to decrease the microbial community diversity. The relative abundance of Methanosaeta increased with higher LCFA accumulation in the settled and flotation layer granules in the three reactors, therefore, acetoclastic methanogenesis was found to be crucial for the high-rate treatment of SDW at 20 °C. This study provides an initial understanding of the continuous anaerobic treatment of LCFA-containing industrial wastewaters at low ambient temperatures.

Acetotrophic Activity Facilitates Methanogenesis from LCFA at Low Temperatures: Screening from Mesophilic Inocula.

The inoculum source plays a crucial role in the anaerobic treatment of wastewaters. Lipids are present in various wastewaters and have a high methanogenic potential, but their hydrolysis results in the production of long chain fatty acids (LCFAs) that are inhibitory to anaerobic microorganisms. Screening of inoculum for the anaerobic treatment of LCFA-containing wastewaters has been performed at mesophilic and thermophilic conditions. However, an evaluation of inocula for producing methane from LCFA-containing wastewater has not yet been conducted at low temperatures and needs to be undertaken. In this study, three inocula (one granular sludge and two municipal digester sludges) were assessed for methane production from LCFA-containing synthetic dairy wastewater (SDW) at low temperatures (10 and 20°C). A methane yield (based on mL-CH4/g-CODadded) of 86-65% with acetate and 45-20% with SDW was achieved within 10 days using unacclimated granular sludge, whereas the municipal digester sludges produced methane only at 20°C but not at 10°C even after 200 days of incubation. The acetotrophic activity in the inoculum was found to be crucial for methane production from LCFA at low temperatures, highlighting the role of Methanosaeta (acetoclastic archaea) at low temperatures. The presence of bacterial taxa from the family Syntrophaceae (Syntrophus and uncultured taxa) in the inoculum was found to be important for methane production from SDW at 10°C. This study suggests the evaluation of acetotrophic activity and the initial microbial community characteristics by high-throughput amplicon sequencing for selecting the inoculum for producing methane at low temperatures (up to 10°C) from lipid-containing wastewaters.