Potential directions for future development of mainstream partial nitrification-anammox processes: Ammonia-oxidizing archaea as novel functional microorganisms providing nitrite.

The application of ammonia-oxidizing archaea (AOA)-based partial nitrification-anammox (PN-A) for mainstream wastewater treatment has attracted research interest because AOA can maintain higher activity in low-temperature environments and they have higher affinity for oxygen and ammonia-nitrogen compared with ammonia-oxidizing bacteria (AOB), thus facilitating stabilized nitrite production, deep removal of low-ammonia, and nitrite-oxidizing bacteria suppression. Moreover, the low affinity of AOA for ammonia makes them more tolerant to N-shock loading and more efficiently integrated with anaerobic ammonium oxidation (anammox). Based on the limitations of the AOB-based PN-A process, this review comprehensively summarizes the potential and significance of AOA for nitrite supply, then gives strategies and influencing factors for replacing AOB with AOA. Additionally, the methods and key influences on the coupling of AOA and anammox are explored. Finally, this review proposes four AOA-based oxygen- or ammonia-limited autotrophic nitritation/denitrification processes to address the low effluent quality and instability of mainstream PN-A processes.

Carbonized Cellulose Aerogel Derived from Waste Pomelo Peel for Rapid Hemostasis of Trauma-Induced Bleeding.

Uncontrollable massive bleeding caused by trauma will cause the patient to lose a large amount of blood and drop body temperature quickly, resulting in hemorrhagic shock. This study aims to develop a hemostatic product for hemorrhage management. In this study, waste pomelo peel as raw material is chosen. It underwent processes of carbonization, purification, and freeze-drying. The obtained carbonized pomelo peel (CPP) is hydrophilic and exhibits a porous structure (nearly 80% porosity). The water/blood absorption ratio is significantly faster than the commercial Gelfoam and has a similar water/blood absorption capacity. In addition, the CPP showed a water-triggered shape-recoverable ability. Moreover, the CPP shows ideal cytocompatibility and blood compatibility in vitro and favorable tissue compatibility after long terms of subcutaneous implantation. Furthermore, CPP can absorb red blood cells and fibrin. It also can absorb platelets and activate platelets, and it is capable of achieving rapid hemostasis on the rat tail amputation and hepatectomized hemorrhage model. In addition, the CPP not only can quickly stop bleeding in the rat liver-perforation and rabbit heart uncontrolled hemorrhage models, but also promotes rat liver and rabbit heart tissue regeneration in situ. These results suggest the CPP has shown great potential for managing uncontrolled hemorrhage.

Negative role of filamentous bulking and its elimination in anammox process.

In this study, the filamentous bulking (FB) with moderate and excessive levels were demonstrated to induce anammox failure by inhibiting nitrogen (N) removal and biomass retention. The low external mass transfer resulted from high liquid-surface friction and low turbulence of filamentous surface was considered the "trigger" of anammox failure, which decreased flux of nitrogen flow toward granular surface and directly limited N-removal loading, which meanwhile exposed granules with N-scarcity environment and indirectly inhibited N-removal bio-activity. Low bio-activity performed poor extracellular polymeric substances secretion further destroyed bio-aggregation with low suface hydrophobicity, which acted as "accelerator" for granule disintegration and biomass washout, ultimatly leading to anammox failure. Fortunately, incresing hydraulic shear stress could eradicate FB's negative effects without inhibiting FB itself, which promoted re-granulation and N-remval restore by enhancing external mass transfer more than hydraulic detachment. Enhancing mechanical stirring with FB level was necessary to maintain stable operation of granular anammox system.

The Endoscopic Retrograde Appendicitis Therapy for Acute Appendicitis in Children: A Systematic Review and Meta-Analysis.

Background: Acute appendicitis (AA) is a prevalent abdominal emergency in children, and there has been growing interest in the use of endoscopic retrograde appendicitis treatment (ERAT) over the past two decades. A meta-analysis of published retrospective studies was conducted to investigate the clinical characteristics and therapeutic efficacy of ERAT for AA in children. Methods: A systematic review and meta-analysis of retrospective studies were carried out, encompassing data from PUBMED, MEDLINE, Cochrane, China National Knowledge Infrastructure (CNKI), WanFang, and VIP Database. The search was limited to studies published between January 1, 2012, and June 31, 2022, with the final search conducted on October 31, 2022. No restrictions were imposed regarding publication or study design filters. The registration number in PROSPERO was CRD42022377739. Results: Seven retrospective cohort studies with 423 patients were included. The majority of children who underwent ERAT were male (57.6%, 95% CI 52.8%-62.4%). The ERAT procedure had a high success rate (99.5%, 95% CI 98.2%-100.0%) and averaged around 49 minutes. ERAT's efficacy for treating acute appendicitis was high (99.0%, 95% CI 96.5%-100.0%), with a low recurrence rate (4.2%, 95% CI 2.2%-6.7%). Patients typically stayed in the hospital for about 4.3 days, and the rate of postoperative complications was around 3.9% (95% CI 2.0%-6.2%). Conclusions: Despite the heterogeneity among studies, ERAT appears to be an effective treatment for acute uncomplicated appendicitis in children. It has a high success rate, a low recurrence rate, preserves the appendix's function, and causes minimal damage. ERAT could be considered a safe and effective treatment option for pediatric appendicitis.

Effects of rhubarb peony decoction combined with antibiotics in treating pediatric periappendiceal abscess.

Background/purpose: Rhubarb peony decoction (RPD) is a formula of traditional Chinese medicine that has been widely used to treat intra-abdominal inflammatory diseases. To investigate the therapeutic efficacy of RPD in pediatric periappendiceal abscess, patients who received intravenous antibiotics alone were compared with those treated with intravenous antibiotics combined with RPD. Methods: A retrospective review of children with periappendiceal abscess who received conservative treatment in our hospital between January 2013 and April 2022 was performed. The patients were divided into an intravenous antibiotic group (the control group) and an intravenous antibiotic combined with RPD group (the intervention group). Interval appendectomy (IA) was generally performed 10-12 weeks after conservative treatment. The primary outcome was the cure rate of conservative treatment, while the secondary outcomes included the recurrence rate, days of total intravenous antibiotic use, length of hospital stay (LOS), postoperative complications, and liver injury caused by RPD. Results: A total of 142 patients (77 girls and 65 boys) were included, 52 in the control group and 90 in the intervention group. The two groups were similar in demographic data and clinical characteristics (P > 0.05). The mean total course of RPD in the intervention group was 11.82 days. The intervention group had a significantly higher cure rate than the control group (93.33% vs. 80.77%, P = 0.029), and the length of total intravenous antibiotic use (P = 0.150), LOS (P = 0.077), recurrence rate (9.52% vs. 4.76%, P = 0.439), as well as the operation time (P = 0.101), LOS (P = 0.572), and postoperative complications (P = 0.549) were not significantly different between the two groups when the patients received IA. No patient had a liver injury caused by RPD during the treatment. Conclusion: Intravenous antibiotics combined with RPD demonstrated high effectiveness and safety for treating pediatric periappendiceal abscess.

Improving mechanical stability of anammox granules with organic stress by limited filamentous bulking.

Under organic stress, the limited filamentous bulking (FB) was demonstrated to improve anammox capability by inhibiting granule disintegration and washout. The accumulation of internal stress played a more important role than the adverse physicochemical properties (low viscoelasticity and hydrophobicity) of granules in limiting granular strength by consuming the granular elastic energy. Different from the floc-forming heterotrophic bacteria (HB) that stored its growth stress as internal stress by pushing the surrounded anammox micro-colonies outwards under the spatial constraint of elastic anammox "shell", the filamentous HB grew into a uniform network structure within granules, endowed granules low internal stress and acted as the granular skeleton due to its rich amyloid substance, which was benefited from the elimination of inhomogeneous growth and the consequent expansion competition for living space. Combined with the mechanical instability and sticking-spring models, controlling FB at limited level was effective for improving granular strength without affecting sludge-water separation.

Silencing of TMED5 inhibits proliferation, migration and invasion, and enhances apoptosis of hepatocellular carcinoma cells.

BACKGROUND: Transmembrane P24 trafficking protein 5 (TMED5) is highly expressed in cervical and bladder cancer cell lines. Moreover, TMED5 promotes nuclear autophagy and the malignant behavior of cervical cancer cells. However, the role of TMED5 in hepatocellular carcinoma (HCC) has not been extensively reported. OBJECTIVES: To investigate the role of TMED5 in HCC cells. MATERIAL AND METHODS: Bioinformatics was used to analyze the messenger-ribonucleic acid (mRNA) expression of TMED5 in HCC and its relationship with overall survival and disease-free interval of HCC patients. After TMED5 was decreased in SMMC-7721 and Hep3B cells, they were assayed for proliferation, cell cycle, apoptosis, migration, and invasion. RESULTS: The expression of TMED5 mRNA in HCC tissues was higher than in adjacent normal tissues, and the overall survival of HCC patients with high TMED5 transcription levels was worse. Moreover, the overexpression of TMED5 was associated with HCC progression. The downregulation of TMED5 suppressed cell proliferation, migration and invasion, and enhanced apoptosis. Therefore, TMED5 may be involved in the regulation of the cell cycle, the mammalian target of rapamycin signaling pathway, and the transforming growth factor beta (TGF-ß) signaling pathway. CONCLUSIONS: The TMED5 has the potential to promote HCC progression. Therefore, lowering TMED5 levels could represent a potential strategy for the treatment of HCC.

Improving anammox performance by limited filamentous bulking for wastewater treatment with organic stress.

In this study, the filamentous bulking was demonstrated to improve anammox capability and anammox bacteria (AnAOB) population density under organic stress. The selective heterotrophic bacteria (HB) washout that involved in shear detachment, enmeshment and biomass washout was triggered. The microbial spatial distribution and granular detachment properties revealed that the filamentous bulking transferred the "location advantage" of HB from granules interior to surface, and endowed granular surface low shear tolerance for shear detachment, ultimately resulted in selective HB detachment. The detached filaments-mediated enmeshment provided additional selective pressure for free HB-flocs, eventually achieving the retention time differentiation between AnAOB (34 - 141 days) and HB (3 - 15 days), and a high anammox population density. Controlling dissolved oxygen level was crucial for regulating sludge bulking. Collectively, the filamentous bulking was developed as an effective anti-organic stress strategy to broaden the application of granular anammox process in actual wastewater treatment.

The Current Status and Prevention of Antibiotic Pollution in Groundwater in China.

The problem of environmental pollution caused by the abuse of antibiotics has received increasing attention. However, only in recent years have antibiotic pollution and its risk assessment to the environment been deeply studied. Although there has been a large number of reports about the input, occurrence, destination, and influence of antibiotics in the past 10 years, systemic knowledge of antibiotics in the groundwater environment is still lacking. This review systematically expounds the sources, migration and transformation, pollution status, and potential risks to the ecological environment of antibiotics in groundwater systems, by integrating 10 years of existing research results. The results showed that 47 kinds of antibiotics in four categories, mainly sulfonamides and fluoroquinolones, have been detected; antibiotics in groundwater species will induce the production of resistance genes and cause ecological harm. In view of the entire process of antibiotics entering groundwater, the current antibiotic control methods at various levels are listed, including the control of the discharge of antibiotics at source, the removal of antibiotics in water treatment plants, and the treatment of existing antibiotic contamination in groundwater. Additionally, the future research direction of antibiotics in groundwater is pointed out, and suggestions and prospects for antibiotic control are put forward.

Effect of 2,4-dichlorophenol on the production of methane from anaerobic granular sludge during anaerobic digestion through spectroscopy analysis.

Chlorophenols in urban high organic wastewater increases, which plays an inhibitory role in the process of anaerobic fermentation and methanogenesis. The release rules of extracellular polymers (EPS) and soluble microbial products (SMP) and the production of methane from anaerobic granular sludge were evaluated by spectroscopic analysis. The methane production was reduced by 21.6%, 41.4% and 50.5% respectively by adding 2,4-DCP of different concentrations (25, 50 and 100 mg/L). Activity tests of methanogenic functional enzymes indicated that F420 was more susceptible to the toxic of 2, 4-DCP than Acetyl-CoA and NADH. The decrease in methane production was due to the reduction in the activity of conversion enzymes rather than the loss of crucial precursors for methanogenesis. 2,4-DCP disintegrated the protein 'shell' of anaerobic granular sludge by destroying α-helix and ß-sheet structures. After the protein 'shell' in EPS was destroyed, 2, 4-DCP entered the interior of granular, which inhibited the activity of functional enzymes and affected the process of acidogenesis and methanogenesis. At the same time, due to the partial rupture of the cells after being affected by the toxicity of 2,4-DCP, the protein material could be dissolved into the aqueous phase and complexed with 2,4-DCP to reduce the toxic effect of 2,4-DCP.

Insight into dead space effects in granular anammox process with organic stress.

In this study, the dead space was demonstrated to enhance the robustness of anammox nitrogen (N)-removal under organic stress. Different from the "yellow aggregates" that inhabit in mixing space were assembled by anammox and heterotrophic micro-colonies, the "red granules" that inhabit in dead space were formed by initial anammox aggregates that growing outward with higher anammox-activity, settleability and sludge stability, which endowed the dead space the role of "anammox-stabilizer" with prominent anammox N-removal contribution (63.8%) especially under high organic stress. The extracellular polymeric substances (EPS) dynamic balance test revealed that the high and stable EPS contents in dead space were attributed to the low EPS degradation rate and low proportion of heterotrophic bacteria (HB)-produced EPS, respectively. The weak hydrodynamic forces were the key to less HB-colonization and high granular stability in dead space. Retaining a certain dead space is necessary to prevent anammox bacteria (AnAOB) loss under organic stress.

[Preparation and Application of Magnetic Water Treatment Materials Based on Iron Sludge].

In recent years, solid waste iron sludge (red mud, iron-containing water treatment residues, and iron-rich sludge) has been widely used to remove pollutants in the water environment; however, the difficulty of separating powdered iron sludge from the water environment media makes it impossible to apply it as a water treatment material on a large scale, and preparing iron sludge into magnetic materials that are easy to be separated is one of the effective strategies to solve this bottleneck. According to the existing research on iron sludge-based magnetic materials at home and abroad, the preparation methods of magnetic materials using iron sludge as raw materials are summarized, including a series of methods, including the thermal decomposition method, hydrothermal and solvothermal method, co-precipitation method, reduction roasting method, and carbonization method. Additionally, it is pointed out that the currently commonly used preparation methods are thermal decomposition, hydrothermal and solvothermal, and co-precipitation. In addition, the performance and application of these magnetic materials as adsorbents or catalysts in water treatment are also summarized. In general, iron sludge-based magnetic materials can better absorb heavy metals and organic pollutants in water. The main adsorption mechanisms are complexation, electrostatic interaction, reduction, cation exchange, and precipitation. As a catalyst, it can efficiently oxidize and degrade organic pollutants by generating strong oxidizing substances:SO4-· and ·OH. Although there have been many studies on the preparation and application of iron sludge-based magnetic materials, because the raw material iron sludge contains many impurities, the magnetic materials prepared from iron sludge also have certain impurities. Therefore, it is still necessary to strengthen the research on the safety of iron sludge-based magnetic materials in the future to further ensure that they can be used as environmentally friendly materials for water environment restoration.

Enhancing 2,6-dichlorophenol degradation and nitrate removal in the nano-zero-valent iron (nZVI) solid-phase denitrification system.

Nano-zero-valent iron (nZVI), as a typical nano-material, has been recently used in wastewater treatment and combination with bioreactors. Using nZVI coupled denitrification system research the effect and influence of nZVI enhanced denitrification sludge on the degradation of toxic compounds and system performance. The nZVI coupled denitrification system showed better resistance to 2,6-DCP impact, and the concentrations of effluent NO2- and NO3- were below 2.0 mg/L. At the same time, the addition of nZVI enabled the denitrification system to quickly adapt to the toxic environment of 2,6-DCP within 15 days, and the degradation efficiency of 2,6-DCP reached 99.9%. The released SMP reduced after nZVI coupled with denitrification sludge in 2,6-DCP environment, which could improve the effluent water quality. Nuclear magnetic resonance spectroscopy showed that the addition of nZVI would change the structure of EPS in denitrification sludge. After 90 days of operation, the dominant bacteria in the denitrifying sludge have undergone great changes. Moreover, Thauera was responsible as the dominant bacteria for degrading 2,6-DCP in the denitrification system. The increased in the proportion of functional bacteria with nitrate_reduction, nitrogen_respiration, nitrate_respiration and nitrite_respiration in the presence of NZVI further reveals the mechanism of enhanced denitrification.

Preparation and Characterization of Sludge-Based Magnetic Biochar by Pyrolysis for Methylene Blue Removal.

The development of low-cost adsorbent is an urgent need in the field of wastewater treatment. In this study, sludge-based magnetic biochar (SMB) was prepared by pyrolysis of sewage sludge and backwashing iron mud without any chemical agents. The samples were characterized by TGA, XRD, ICP, Organic element analysis, SEM, TEM, VSM and BET. Characterization analysis indicated that the magnetic substance in SMB was Fe3O4, and the saturation magnetization was 25.60 emu·g-1, after the adsorption experiment, SMB could be separated from the solution by a magnet. The batch adsorption experiment of methylene blue (MB) adsorption showed that the adsorption capacities of SMB at 298 K, 308 K and 318 K were 47.44 mg·L-1, 39.35 mg·L-1, and 25.85 mg·L-1, respectively. After one regeneration with hydrochloric acid, the maximum adsorption capacity of the product reached 296.52 mg·g-1. Besides, the adsorption kinetic described well by the pseudo-second order model revealed that the intraparticle diffusion was not just the only rate controlling step in adsorption process. This study gives a reasonable reference for the treatment of sewage sludge and backwashing iron mud. The product could be used as a low-cost adsorbent for MB removal.

[Removal Efficiency and Mechanism of Ammonia Nitrogen in a Low Temperature Groundwater Purification Process].

To explore the mechanism and efficiency of ammonia nitrogen removal, a pilot-scale biofilter for the simultaneous removal of high concentrations of iron, manganese, and ammonia nitrogen[Fe(Ⅱ) 11.9-14.8 mg·L-1, Mn(Ⅱ) 1.1-1.5mg·L-1, and NH4+-N 1.1-3.2 mg·L-1] from low temperature(5-6℃) groundwater was operated in a water supply plant in Northeast China. Results indicated excellent performance for ammonia nitrogen removal during the initial start-up stage. According to theoretical analysis and experimental verification, TNloss was driven by the adsorption of ammonia nitrogen by iron oxides, and the conversion of ammonia nitrogen into nitrate nitrogen occurred via biological nitrification. When the concentration of ammonia nitrogen increased, due to limited adsorption sites, the adsorption capacity of iron oxides remained stable at approximately 1 mg·L-1. For the same period, the amount of ammonia nitrogen removal via oxidation continued to increase, with higher quantities removed in the upper filter layer than in the lower filter layer. Dissolved oxygen(DO) is the limiting factor in the further increase in the removal of ammonia nitrogen by oxidation. With an increase in the filtration rate, the adsorption time of ammonia nitrogen by iron oxides was shortened, and the adsorption amount was reduced. Meanwhile, the shortening of EBCT reduced the ammonia nitrogen removed by nitrification under the action of nitrifying bacteria in the unit volume of the filter material. Based on these findings, it is recommended that the thickness of the filter layer should be increased to improve ammonia nitrogen removal performance.

Predictive Indicators for Necrotizing Enterocolitis With the Presence of Portal Venous Gas and Outcomes of Surgical Interventions.

Objectives: Portal venous gas (PVG) was an important clinical sign in stage II or III necrotizing enterocolitis (NEC) in preterm neonates. Not a proper predictive indicator was found to predict the diseases (NEC with the presence of PVG) up to now. There is a need to put forward predictive indicators and compare the predictive effects among them. Methods: We conducted a retrospective study of preterm neonates with NEC-PVG (n = 61) or NEC-non PVG (n = 62) from 2014 to 2021. Predictive indicators were put forward and determined by receiver operating characteristic curve analysis. An analysis of the surgical interventions and their outcomes was performed. Results: The incidence rate of NEC among preterm neonates was 4.99%; surgical and conservative interventions accounted for 20.47 and 75.07%, and the mortality rate was 0.03%. The composition ratio of shock in the NEC-PVG group increased 13.2% (P = 0.029). C-reactive protein, fibrinogen degradation product, and blood glucose had better predictive effects in the predictive indicators (P < 0.05). Intestinal necrosis and subependymal hemorrhage in the outcomes of surgical interventions had a strong relationship with the presence of PVG in NEC II/III (P < 0.05). Conclusion: Early and reasonable use of antibiotics, improvement of coagulation function, rectification of acidosis, and decreased blood glucose could cut down the occurrence of the disease (NEC with the presence of PVG). Except for subependymal hemorrhage and intestinal necrosis, NEC with the presence of PVG did not increase the occurrence of other outcomes after surgery.

Operational mode affects the role of organic matter in granular anammox process.

In the presence of organic matter, the granular anammox system under sequencing batch mode showed more robust anammox performance than that under completely mixed mode, which was attributed to the better biomass retention with high settling ability and stability of granular sludge. Based on the specific anammox activity test, stratified and mixed distribution of heterotrophic bacteria was found under completely mixed and sequencing batch mode, respectively. The stratified microbial distribution resulted in low enzyme activity of anammox bacteria and sludge disintegration by hindering substrate transfer with a large accumulation of EPS on the granular surface. Whereas the heterotrophic bacteria mixed in granules (mixed microbial distribution) act as a "skeleton", which increased the particle size, density, and stability of granular sludge. Compared with biokinetic-based selection, diffusion-based selection with high substrate penetration depth more likely resulted in the mixed granular structure and strong resistance to organic inhibition under sequencing batch mode.

Preparation of adsorbent based on water treatment residuals and chitosan by homogeneous method with freeze-drying and its As(V) removal performance.

Although the chitosan-WTRs particulate adsorbent prepared by embedding method has been proved to have arsenic adsorption capacity, the capacity of it is greatly weakened compared with the original water treatment residuals (WTRs). In this study, WTRs and chitosan were used as raw materials to prepare a new kind of adsorbent beads by a homogeneous method. At the same time, in order to enhance the adsorption capacity and reduce the limitation of kinetics, freeze-drying method was chosen to dry the adsorbent. The WTRs-chitosan beads by homogeneous method (WCB) were characterized by SEM, XRD, XPS and other methods. According to the characterization results, there are regularly arranged pores inside the particles, and the iron in the particles mainly exists in the form of amorphous iron oxyhydroxide. According to the results of batch experiment, the pseudo-second-order kinetic model has a higher degree of fit, indicating that the WCB adsorbs As(V) mainly by chemical adsorption. The maximum adsorption capacity estimated from the Langmuir isotherm model is 42.083 mg/g, which is almost same as the WTRs. Weak acid and neutral conditions are conducive to adsorption, while alkaline conditions have a significant inhibitory effect on arsenic adsorption.

Insight into enrichment of anaerobic ammonium oxidation bacteria in anammox granulation under decreasing temperature and no strict anaerobic condition: Comparison between continuous and sequencing batch feeding strategies.

A continuous flow reactor (CFR) and a sequencing batch reactor (SBR) were operated in parallel to investigate the difference between anammox granulation in CFR and SBR under decreasing temperature and no strict anaerobic condition. The results showed that the biomass achieved initial granulation successfully (D [4, 3] = 280.44 and 346.28 µm) in both CFR and SBR on day 70. Compared with SBR, a better performance (0.33 kg N m-3 d-1) was gotten in CFR due to a better retention capacity of biomass (1397 mg L-1), when seasonal drop of water temperature occurred (18-14 °C). Thus, different operations led to different granulation styles of anammox. Granules in CFR had better rheological properties than that in SBR. Based on a stable and suitable environment provided by CFR, anaerobic ammonium oxidation bacteria (AnAOB) are able to self-aggregate easily and secret extracellular polymeric substances (EPS), which can capture other bacteria as home guardians. In SBR, AnAOB live inside the tan granules under the protection of other bacteria and thick EPS; other aggregations stick to solid carrier surface to form biofilm.

Performance and operational strategy of simultaneous nitrification, denitrification, and phosphorus removal system under the condition of low organic loading rate in wet weather.

A pilot-scale aerobic granular sequencing batch reactor (SBR) with domestic wastewater was operated to evaluate the effects of the low organic loading rate (OLR) due to wet weather flow conditions on simultaneous nitrification, denitrification, and phosphorus removal (SNDPR). As the OLR decreased from 0.85 to 0.43 kg COD m-3 d-1, the total nitrogen (TN) and total phosphorus (TP) removal efficiencies decreased from 84.0% and 94.1% to 51.3% and 73.8%, respectively, the sludge volume index (SVI) increased from 42.3 to 85.5 mL g-1, and the average granular size decreased from 1022 to 742 µm; however, no sludge disintegration and biomass loss were observed. The poor nutrient removal efficiencies and settling ability were due to the shrinking anoxic zone and substrate scarcity inside the granules, wherein the activity decay of ammonia-oxidizing bacteria and overgrowth of filamentous bacteria played an important role. Alternating the aeration intensity was effective in enhancing nitrogen removal and sludge settling by improving the anoxic activity in granules and inhibiting the proliferation of filamentous bacteria. Returning 20% of sludge from the end of one anaerobic stage to the beginning of the next anaerobic stage (midway sludge return) was beneficial for phosphorus removal as it improved phosphorus storage by phosphorus-accumulating bacteria. A smaller granular size with stronger stability and better nutrient removal performance was the new steady state of the SNDPR system under wet-weather flow conditions.