Anaerobic digestion of dried/shredded food waste in a periodic anaerobic baffled reactor.

The objective of the current work is to study the impact of the operational parameters' variation (HRT, OLR and T) on biomethane productivity in a periodic anaerobic baffled reactor (PABR). The feedstock used was a biomass product named food residue biomass (FORBI), which is dried and shredded source-separated household food waste. The PABR is an innovative, high-rate bioreactor. Apart from the hydraulic retention time (HRT) and the organic loading rate (OLR), an important operational parameter is the switching period (T) of the feeding compartment: when T is high, the bioreactor operation is similar to an anaerobic baffled reactor (ABR), while when it is low, the operation approaches that of an upflow anaerobic sludge blanket reactor (UASBR). Nine distinct experimental phases were conducted, during which the operational parameters of the PABR were consecutively modified: the HRT varied from 9 to 2.5 days, T between 2 days and 1 and finally the OLR from 1.24 gCOD/Lbioreactor*d to 8.08 gCOD/Lbioreactor*d. The maximum biomethane yield was 384 LCH4/kgFORBI corresponding to the operation at HRT = 5 d, OLR = 2.14 gCOD/Lbioreactor*d and T = 2 days. Similar efficiency (333 LCH4/kg-FORBI) was achieved at higher OLR (4.53 gCOD/Lbioreactor*d).

[Peripheral truncal blocks-Overview and assessment]. / Periphere Rumpfwandblockaden ­ Übersicht und Bewertung.

By implementation of sonography for regional anesthesia, truncal blocks became more relevant in the daily practice of anesthesia and pain therapy. Due to visualized needle guidance ultrasound supports more safety and helps to avoid complications during needle placement. Additionally, complex punctures are possible that were associated with higher risk using landmarks alone. Next to the blocking of specific nerve structures, interfascial and compartment blocks have also become established, whereby the visualization of individual nerves and plexus structures is not of relevance. The present review article describes published and clinically established puncture techniques with respect to the indications and procedures. The clinical value is reported according to the scientific evidence and the analgesic profile. Moreover, the authors explain potential risks, complications and dosing of local anesthetic agents.

Prediction of the annuloplasty ring size in patients undergoing mitral valve repair using real-time three-dimensional transoesophageal echocardiography.

AIMS: We sought to investigate the additional value of real-time three-dimensional transoesophageal echocardiography (RT 3D TOE)-guided sizing for predicting annuloplasty ring size during mitral valve repair. METHODS AND RESULTS: In 53 patients undergoing elective mitral valve repair, an RT 3D TOE was performed pre- and post-operatively. The digitally stored loops were imported into a software for mitral valve assessment. The annuloplasty ring size was predicted by superimposing computer-aided design (CAD) models of annuloplasty rings onto Live 3D zoom loops, measurement of the intercommissural distance, or the height of the anterior mitral leaflet. The surgeon implanted the annuloplasty ring according to the usual surgical technique and was blinded to the echocardiographic measurement results. Pre-operative correlation between the selected ring size with mitral valve assessment and the actual implanted annuloplasty ring size was 0.91. The correlation for measurement of the intercommissural distance was 0.55 and for measurement of the height of the anterior mitral leaflet 0.75. The post-operative correlation with the actual implanted ring size was 0.96 for mitral valve assessment, 0.92 for intercommissural distance, and 0.79 for the anterior mitral leaflet height. CONCLUSION: Superimposition of annuloplasty ring CAD models on the Live 3D zoom loops of the mitral valve using mitral valve assessment is superior to two-dimensional measurements of the intercommissural distance or the height of the anterior mitral leaflet in predicting correct annuloplasty ring size.

Surgical treatment of an aorto-right atrial fistula as a complication of tricuspid valve repair.

UNLABELLED: We report a case in which implantation of a rigid tricuspid annuloplasty ring resulted in an aorto-atrial fistula. In addition the patient had a series of complications which had occurred in the perioperative management of the initial operation, characterized by reoperation for mitral and tricuspidal ring dehiscence, and two reopenings for bleeding as well as postoperative sepsis. The attempt to close the fistula on the arrested heart failed. On presentation to our hospital the patient was in decompensated heart failure (NYHA class IV, ascites and pulmonary edema). Our surgical approach (fifth resternotomy) consisted of mitral valve replacement under cardioplegic arrest and re-tricuspid valve repair and closure of the AV fistula on the beating heart. Postoperatively, the patient was extubated on postoperative day one and discharged on postoperative day 41 in NYHA class II. CONCLUSION: Performing a right heart procedure on the beating heart allowed proper identification of the fistula and easy closure.

Pyruvate: immunonutritional effects on neutrophil intracellular amino or alpha-keto acid profiles and reactive oxygen species production.

For the first time the immunonutritional role of pyruvate on neutrophils (PMN), free α-keto and amino acid profiles, important reactive oxygen species (ROS) produced [superoxide anion (O(2) (-)), hydrogen peroxide (H(2)O(2))] as well as released myeloperoxidase (MPO) acitivity has been investigated. Exogenous pyruvate significantly increased PMN pyruvate, α-ketoglutarate, asparagine, glutamine, aspartate, glutamate, arginine, citrulline, alanine, glycine and serine in a dose as well as duration of exposure dependent manner. Moreover, increases in O(2) (-) formation, H(2)O(2)-generation and MPO acitivity in parallel with intracellular pyruvate changes have also been detected. Regarding the interesting findings presented here we believe, that pyruvate fulfils considerably the criteria for a potent immunonutritional molecule in the regulation of the PMN dynamic α-keto and amino acid pools. Moreover it also plays an important role in parallel modulation of the granulocyte-dependent innate immune regulation. Although further research is necessary to clarify pyruvate's sole therapeutical role in critically ill patients' immunonutrition, the first scientific successes seem to be very promising.