[Paraneoplastic cerebellar degeneration (PCD) - an interdisciplinary challenge in neurology, oncology and palliative care]. / Paraneoplastische cerebelläre Degeneration (PCD) ­ eine interdisziplinäre Herausforderung in der Neurologie, Onkologie und Palliativmedizin.

Paraneoplastic neurological syndromes describe a very heterogeneous group of neurological disorders. Paraneoplastic cerebellar degeneration is frequently associated with gynecological tumors, lung cancer and Hodgkin lymphoma. The following case report shows the typical course of this disease as well as the diagnostic and therapeutic challenges. Furthermore the importance of interdisciplinary cooperation between neurology, oncology and palliative care for prognosis and symptom stabilization is highlighted.

Combined nitritation-anammox: advances in understanding process stability.

Efficient nitrogen removal from wastewater containing high concentrations of ammonium but little organic substrate has recently been demonstrated by several full-scale applications of the combined nitritation-anammox process. While the process efficiency is in most cases very good, process instabilities have been observed to result in temporary process failures. In the current study, conditions resulting in instability and strategies to regain efficient operation were evaluated. First, data from full-scale operation is presented, showing a sudden partial loss of activity followed by recovery within less than 1 month. Results from laboratory-scale experiments indicate that these dynamics observed in full scale can be caused by partial inhibition of the ammonia oxidizing bacteria (AOB), while anammox inhibition is a secondary effect due to temporarily reduced O(2) depletion. Complete anammox inhibition is observed at 0.2 mg O(2) · L(-1), resulting in NO(2)(-) accumulation. However, this inhibition of anammox is reversible within minutes after O(2) depletion. Thus, variable AOB activity was identified as the key to reactor stability. With appropriate interpretation of the online NH(4)(+) signal, accumulation of NO(2)(-) can be detected indirectly and used to signal an imbalance of O(2) supply and AOB activity (no suitable online NO(2)(-) electrode is currently available). Second, increased abundance of nitrite-oxidizing bacteria (NOB; competing with anammox for NO(2)(-)) is known as another cause of instability. Based on a comparison of parallel full-scale reactors, it is suggested that an infrequent and short-term increased O(2) supply (e.g., for maintenance of aerators) that exceeds prompt depletion of oxygen by AOB may have caused increased NOB abundance. The volumetric air supply as a proxy for O(2) supply thus needs to be linked to AOB activity. Further, NOB can be washed out of the system during regular operation if the system is operated at a sludge age in the range of 45 days and by controlling the air supply according to the NO(3)(-) concentration in the treated effluent. Early detection of growing NOB abundance while the population is still low can help guide process operation and it is suggested that molecular methods of quantifying NOB abundance should be tested.

[Erythropoiesis stimulating proteins for the treatment of anemia in cancer patients]. / Stellenwert der Erythropoietine in der Therapie der Anämie bei Tumorpatienten.

Erythropoiesis stimulating proteins are approved for chemotherapy-induced anemia. Treatment with ESPs results in an increase in hemoglobin in 60 - 70 % of patients and in a significant reduction in transfusion need. A marked increase in hemoglobin levels usually is associated with an improvement in quality of life. Relevant side effects include an increase in thromboembolic complications and, in case of use in unapproved indications, a minimally increased mortality, which is not seen when ESPs are used in the approved indications. Treatment with ESPs should be initiated at hemoglobin levels < 100 g/l and a target level of 120 g/l should not be exceeded.

Full-scale nitrogen removal from digester liquid with partial nitritation and anammox in one SBR.

Full-scale application of partial nitritation and anammox in a single suspended-growth sequencing batch (SBR) reactor presented here confirm the process suitable for removing nitrogen from ammonium-rich wastewater with low concentrations of BOD and suspended solids: details of simple and robust process control based on online ammonium or conductivity signals are discussed by describing the full-scale startup at three municipal plants (five reactors in total). Ammonium oxidation rates of up to 500 gN m(-3) d(-1) with conversion to N2 of over 90% are achieved in a full-scale plant, but pilot results indicate that significantly higher rates are feasible. With continuous aeration at dissolved oxygen concentrations <1 mgO2 x L(-1), the nitrite oxidation and the anammox reaction occur simultaneously, allowing increased overall performance and simplified process control compared to separate aerobic end anaerobic phases (segregated either temporally or in different reactors). Sedimentation of the sludge requires special attention only during startup. Although the observed N2O emissions were slightly higher than in conventional nitrogen removal, the overall greenhouse gas emissions were lower, mainly due to energy-saving.