Infectious complications following allogeneic stem cell transplantation: reduced-intensity vs. myeloablative conditioning regimens.

BACKGROUND: In allogeneic stem cell transplantation (allo-SCT), reduced-intensity conditioning (RIC) is known for producing less regimen-related toxicity. However, whether or not RIC reduces the risk for infection and infection-related mortality (IRM) remains controversial. METHODS: We retrospectively analyzed infectious episodes and IRMs after allo-SCTs by time period and by the intensity of the conditioning regimen (RIC [n = 81] vs. myeloablative conditioning, MAC [n = 150]). RESULTS: The cumulative incidence of any kind of infection was lower in the RIC group through the entire period (72% vs. 87%; P = 0.007). The onset of infections was deferred in the RIC group as compared with the MAC group (P = 0.012). Bacteremia occurred less frequently in the RIC group through the entire period (5% vs. 14%; P = 0.044). However, the incidences of cytomegalovirus reactivation and disease, herpes zoster, virus-associated hemorrhagic cystitis, and invasive fungal infection were not different between the two groups. Furthermore, there was no difference in relapse-free survival and IRM between the two conditioning regimens. CONCLUSION: Careful monitoring and appropriate preventive/therapeutic strategies for infectious complications, comparable to those for allo-SCT recipients with MAC, should also be applied to those with RIC, especially after engraftment.

Effects of influent COD/N ratio and internal recycle ratio on nitrogen removal efficiency in the KNR process.

In this study, with the KNR process that has many advantages, the nitrogen removal efficiency of KNR was experimentally investigated at various COD/N ratios of influent conditions. The optimal operating condition of internal recycle ratio was evaluated. The TN removal efficiencies were 59.1, 72.5 and 75.9% at the COD/N ratios of 3, 5 and 7, respectively. These high removal efficiencies resulted from high denitrification rate in UMBR with high microorganism concentration. Furthermore, specific endogenous denitrification at MLVSS of 10.3 g/L that is similar to MLVSS in UMBR was over two times higher than that at MLVSS of 2.06 g/L. This result suggests that endogenous denitrification rate in UMBR is so high that the requirement of an external carbon source can be saved. As the internal recycle ratio increased from 100 to 400%, the TN removal efficiency also improved from 69.5 to 82.9%, and the optimal internal recycle ratio was 300%.

Biological nutrient removal in simple dual sludge system with an UMBR (upflow multi-layer bioreactor) and aerobic biofilm reactor.

In this study, a simple dual sludge process was developed for small sewage treatment. It is a hybrid system that consists of upflow multi-layer bioreactor (UMBR) as anaerobic and anoxic reactor with suspended growth microorganisms and post aerobic biofilm reactor with inclined plates. UMBR is a multifunction reactor that acts as primary sedimentation tank, anaerobic reactor, anoxic reactor, and thickener. The sludge blanket in the UMBR is maintained at a constant level by automatic control so that clear water (30 mg-SS/L) can flow into the post aerobic biofilm reactor. It leads to improving performance of the biofilm reactor due to preventing of excess microbial attachment on the media surface and no requirment for a large clarifier caused by low solid loading. The HRT in the UMBR and the aerobic biofilm reactor were about 5.8 h and 6.4 h, respectively. The temperature in the reactor during this study varied from 12.5 degrees C to 28.3 degrees C. The results obtained from this study show that effluent concentrations of TCOD, TBOD, SS, TN, and TP were 29.7 mg/L, 6.0 mg/L, 10.3 mg/L, 12.0 mg/L, and 1.8 mg/L, which corresponded to a removal efficiency of 92.7%, 96.4%, 96.4%, 74.9%, and 76.5%, respectively. The sludge biomass index (SBI) of the excess sludge in the UMBR was about 0.55, which means that the sludge in the UMBR was sufficiently stabilized and may not require further treatment prior to disposal.

Influence of final search direction on tactile line bisection in normal subjects.

BACKGROUND: Many variables influence the tactile bisection performance of normal subjects. Of these, studies that investigated the starting point effect have reported inconsistent results. OBJECTIVE: To determine if the final search direction rather than the initial search direction (starting point) may have an effect on tactile bisection performance, especially when subjects are making multiple searches. METHODS: The authors divided the experiment into single- and multiple-search tasks. Thirty-two blindfolded normal subjects were asked to indicate the midpoint of a rod after a one-way search (single-search task) or after two or more one-way searches (multiple-search task). In each task, the subject started on either end of the horizontally placed rods. The same procedure was also conducted with rods oriented vertically or radially. Therefore, there were six conditions (two starting points x three orientations). RESULTS: In the single-search task, there was a significant effect of starting point or movement direction in all six conditions, with biases occurring toward the starting point from the true midpoint (this is termed the "overshoot phenomenon"). In the multiple-search task, however, there was no significant effect of the starting point in all six conditions. Rather, biases depended on the final movement direction in five of the six conditions, occurring toward the starting point of the final search. CONCLUSION: Future research is needed to understand the mechanism of the overshoot phenomenon in tactile bisection by normal subjects and how the overshoot phenomenon influences patients with neglect.

Nonconvulsive status epilepticus presenting as a subacute progressive aphasia.

We report a 62-year-old man with non-convulsive status epilepticus (NCSE) presenting as a progressive aphasia that developed insidiously over 5 weeks. On video-EEG monitoring, aggravation of the aphasia coincided with occurrence of seizure activities arising from the left fronto-temporal area. Brain MRI was noncontributory but a fluorodeoxyglucose-PET scan revealed a hypometabolism in the left anterior temporal area. Following anticonvulsant treatment, aphasia recovered gradually over several weeks despite prompt resolution of epileptic discharges on EEG. Our patient's findings, gradual onset of isolated aphasia with gradual resolution after initiation of treatment, may differ from previously reported cases with aphasic status epilepticus because their aphasia showed abrupt onset and rapid resolution with anticonvulsant medication.

Serial diffusion-weighted MR Imaging in delayed postanoxic encephalopathy. A case study.

We report a case of delayed postanoxic encephalopathy (DPE) studied with serial diffusion weighted imaging five times in a one-year period along with apparent diffusion coefficient (ADC) map as well as ADC values of periventricular white matter. Compared to the normal value, the ADC values of the white matter were initially low on the three (0.68 +/- 0.08 x 10(-3) mm(2)/s) and seven-week images (0.67 +/- 0.08 x 10(-3) mm(2)/s) but gradually recovered to the normal range on the four, six, and twelve-month images (0.78 +/- 0.05, 0.80 +/- 0.05 and 0.87 +/- 0.11 x 10(-3) mm(2)/s, respectively). Among the several pathogenetic mechanisms associated with DPE, these serial changes may be consistent with cytotoxic edema, from apoptosis, triggered by hypoxia.

Small sewage treatment system with an anaerobic-anoxic-aerobic combined biofilter.

The objective of this study was to investigate a small sewage treatment system that could improve nitrogen and BOD5 removal efficiency as well as generate less solid using an anaerobic-anoxic-aerobic biofiltration system. Wastewater temperature was in the range of 14-25 degrees C, and hydraulic residual times were 12 h for each reactor. The upflow anaerobic digester equipped with anoxic filter was fed with both raw sewage and recycled effluent from the aerobic filter to induce denitrification and solid reduction simultaneously. In the subsequent aerobic filter, residual organic carbon and ammonia might be oxidized and finally nitrate formed. In the anaerobic reactor, about 71% of influent TCOD was removed by sedimentation of the un-filterable COD at the recycle ratio of 300%. Another 20% of influent TCOD was removed in the anoxic filter by denitrification of the recycled nitrate. After 100 days operation, solid reduction and nitrification efficiency were about 30% and 95%, respectively. Overall removal efficiencies of COD and total nitrogen (T-N) were above 94% and 70% at the recycle ratio of 300%, respectively. Total wasted solid from the system after 100 days operation was about 316 g, which was only 44% of the solid generated from a controlled activated sludge system operated at sludge retention time of 8 days.