The application of anammox technology in low-strength wastewater treatment is still challenging due to unstable nitrite (NO2 ––N) generation. Partial denitrification (PD) of nitrate (NO3 ––N) ...reduction ending with NO2 ––N provides a promising solution. However, little is known about the feasibility of accelerating nitrogen removal toward the practical application of anammox combined with heterotrophic denitrification. In this work, an ultrafast, highly stable, and impressive nitrogen removal performance was demonstrated in the PD coupling with an anammox (PD/A) system. With a low-strength influent 50 mg/L each of ammonia (NH4 +–N) and NO3 ––N at a low chemical oxygen demand/NO3 ––N ratio of 2.2, the hydraulic retention time could be shortened from 16.0 to 1.0 h. Remarkable nitrogen removal rates of 1.28 kg N/(m3 d) and excellent total nitrogen removal efficiency of 94.1% were achieved, far exceeding the applicable capacity for mainstream treatment. Stimulated enzymatic reaction activity of anammox was obtained due to the fast NO2 ––N jump followed by a famine condition with limited organic carbon utilization. This high-rate PD/A system exhibited efficient renewal of bacteria with a short sludge retention time. The 16S rRNA sequencing unraveled the rapid growth of the genus Thauera, possibly responsible for the incomplete reduction of NO3 ––N to NO2 ––N and a decreasing abundance of anammox bacteria. This provides new insights into the practical application of the PD/A process in the energy-efficient treatment of low-strength wastewater with less land occupancy and desirable effluent quality.
Aims
The aim of this study is to examine the association between diabetes mellitus and postoperative urinary retention on cerebral angiography (including intravascular interventional therapy).
...Methods
We collected data on the demographic characteristics and comorbidities, imaging and routine laboratory data, surgical information, and medications of patients who underwent cerebral angiography. Multivariate logistic regression was used to explore the correlation between diabetes and the incidence of postoperative urinary retention.
Results
A total of 932 patients were included, with a mean age of 59.7 years (74.1% men). Postoperative urinary retention occurred in 40.8% of the diabetes mellitus group and 30.3% of the group without diabetes. Compared with the group without diabetes, those with diabetes were more likely to experience postoperative urinary retention. Patients with higher glycosylated hemoglobin A1c levels had a higher risk of developing postoperative urinary retention.
Conclusions
Diabetes was independently linked to postoperative urinary retention following cerebral angiography and patients with glycosylated hemoglobin A1c levels > 6% were more likely to experience postoperative urinary retention. Therefore, clinically regulating blood glucose levels may help to reduce the likelihood of postoperative urinary retention after cerebral angiography.
A flipped classroom is a growing pedagogy in higher education. Many research studies on the flipped classroom have focused on student outcomes, with the results being positive or inconclusive. A few ...studies have analyzed confounding variables, such as student's previous achievement, or the impact of a flipped classroom on long-term retention and knowledge transfer. In the present study, students in a Doctor of Physical Therapy program in a traditional style lecture of gross anatomy (n = 105) were compared to similar students in a flipped classroom (n = 112). Overall, students in the flipped anatomy classroom had an increase in semester average grades (P = 0.01) and performance on higher-level analytical questions (P < 0.001). Long-term retention and knowledge transfer was analyzed in a subsequent semester's sequenced kinesiology course, with students from the flipped anatomy classroom performing at a higher level in kinesiology (P < 0.05). Student's pre-matriculation grade point average was also considered. Previously lower performing students, when in a flipped anatomy class, outperformed their traditional anatomy class counterparts in anatomy semester grades (P < 0.05), accuracy on higher-level analytical anatomy multiple-choice questions (P < 0.05) and performance in subsequent course of kinesiology (P < 0.05). This study suggests that the flipped classroom may benefit lower performing student's knowledge acquisition and transfer to a greater degree than higher performing students. Future studies should explore the underlying reasons for improvement in lower performing students.
Urinary catheters are commonly placed during laparoscopic inguinal hernia repair as a presumed protection against postoperative urinary retention (PUR), one of the most common complications following ...this operation. Data from randomized clinical trials evaluating the effect of catheters on PUR are lacking.
To investigate the effect of intraoperative catheters on PUR after laparoscopic inguinal hernia repair.
This 2-arm registry-based single-blinded randomized clinical trial was conducted at 6 academic and community hospitals in the US from March 2019 to March 2021 with a 30-day follow-up period following surgery. All patients who presented with inguinal hernias were assessed for eligibility, 534 in total. Inclusion criteria were adult patients undergoing laparoscopic, elective, unilateral, or bilateral inguinal hernia repair. Exclusion criteria were inability to tolerate general anesthesia and failure to understand and sign the written consent form. A total of 43 patients were excluded prior to intervention.
Patients in the treatment arm had placement of a urinary catheter after induction of general anesthesia and removal at the end of procedure. Those in the control arm had no urinary catheter placement.
PUR rate.
Of the 491 patients enrolled, 241 were randomized to catheter placement, and 250 were randomized to no catheter placement. The median (IQR) age was 61 (51-68) years, and 465 participants (94.7%) were male. Overall, 44 patients (9.1%) developed PUR. There was no difference in the rate of PUR between the catheter and no-catheter groups (23 patients 9.6% vs 21 patients 8.5%, respectively; P = .79). There were no intraoperative bladder injuries. In the catheter group, there was 1 incident of postoperative urethral trauma in a patient who presented to the emergency department with PUR leading to a suprapubic catheter placement.
Intraoperative urinary catheters did not reduce the risk of PUR after laparoscopic inguinal hernia repair. While their use did not appear to be associated with a high rate of iatrogenic complications, there may be a low rate of catastrophic complications. In patients who voided urine preoperatively, catheter placement did not appear to confer any advantage and thus their use may be reconsidered.
ClinicalTrials.gov Identifier: NCT03835351.
Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory ...evidence surrounds potential risk factors.
To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR.
The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR.
Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia.
The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients.
In total, 4151 patients (3882 male and 269 female; median IQR age, 56 43-68 years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72).
The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies.
The sequence-specific retention calculator algorithm (SSRCalc) Krokhin, O. V. Anal. Chem. 2006, 78, 7785 was adapted for the prediction of retention times of N-glycopeptides separated by ...reversed-phase high performance liquid chromatography (RPLC). The retention time shifts (dHI = HIglyco – HIdeglyco, where HI is the hydrophobicity index, measured in percent acetonitrile units) used for modeling were measured for 602 glycopeptides versus 123 of their deglycosylated analogues. Our method used a tryptic digest of 12 purified glycoproteins, glycopeptide enrichment, deglycosylation with PNGaseF, and RPLC-MS/MS analysis of combined (deglycosylated and intact) peptide mixtures. On average, glycosylation yields a 0.79% acetonitrile unit decrease in retention, compared with the hydrophobicity indices of their deglycosylated analogues. These values, however, are drastically different for asialo (−1.37% acetonitrile units), monosialylated (−0.47% acetonitrile units), disialylated (+0.61% acetonitrile units), and trisialylated (+1.94% acetonitrile units) glycans. Peptide retention time shifts upon glycosylation (dHI) vary depending on the number of monosaccharide units, the presence or absence of sialic acid, peptide hydrophobicity, and the number of position-dependent features. These features are mostly driven by competing effects of acidic residues (aspartic acid and sialic acid) on ion-pair formation and by nearest-neighbor effects of hydrophilic glycans. The accuracy of the modified prediction model for glycopeptides approaches that of the prediction for nonmodified species (R 2 = 0.97 vs 0.98). However, retention time prediction based on the experimental retention values of deglycosylated analogues (HIglyco = HIdeglyco + dHI, R 2 = 0.995) is much more accurate, thus providing a solid support for glycopeptide identification in complex samples based on mass and retention time.
ZusammenfassungHintergrundZiel der Operation von Wirbelsäulenverletzungen ist eine stabile Ausheilung in physiologischer Stellung. Für offene und perkutane Operationen stehen unterschiedliche ...Techniken zur Verfügung.FragestellungDas Ausmaß der offenen Reposition und das Retentionspotenzial der Techniken nach AOSpine (AT) und nach Kluger (KT) sollen verglichen werden. Der Einfluss von Frakturmorphologie, Alter, Geschlecht und Knochenqualität auf Reposition und Retention werden untersucht.Material und MethodenIn dieser monozentrischen retrospektiven Kohortenstudie wurden Daten von Patienten mit traumatischen thorakolumbalen und lumbalen Frakturen untersucht, welche entweder mit AT oder KT reponiert wurden. Mittels bisegmentalen Grund-Deckplatten-Winkels (bGDW) wurde die Stellung des verletzten Wirbelsäulenabschnitts beschrieben. Normalwerte für die bGDW wurden anhand von Literaturdaten angenommen. Die Veränderung des bGDW im zeitlichen Verlauf wurde unter Einbeziehung der Knochenqualität in Hounsfield Units (HU), der Verletzungsschwere nach AOSpine und des Patientenalters und -geschlechts analysiert.ErgebnisseEs wurden 151 Datensätze ausgewertet. Beide Methoden reponieren vom Umfang nicht unterschiedlich (AT 10 ± 6°, KT 11 ± 8°; p = 0,786). Im Follow-up trat ein Korrekturverlust von −5 ± 4° auf. Die Technik (p = 0,998) hatte keinen Einfluss darauf. Die Frakturmorphologie zeigte einen knapp signifikanten Einfluss (p = 0,043). Niedrige HU korrelierten mit geringerem Repositionsumfang (r = 0,241, p < 0,003) und größerem Korrekturverlust (r = 0,272, p < 0,001) signifikant, aber schwach. In der Altersgruppe 50 bis 65 Jahre wiesen 21 % der Männer und 43 % der Frauen eine Knochenqualität von HU < 110 auf. Alter und HU korrelieren signifikant (r = −0,701, p < 0,001).DiskussionDie Techniken sind gleichwertig bezüglich der Repositions- und Retentionseigenschaften. Der hohe Anteil von Patienten mit HU < 110 in der Gruppe unter 65 Jahren bei Frauen und Männern und der Einfluss auf Reposition und Retention weisen auf die Notwendigkeit einer präoperativen Knochendichtemessung hin.
Introduction
Women undergoing instrumental delivery are known to be at higher risk of urinary retention, which can lead to long‐term complications such as voiding dysfunction. Nulliparous women ...undergo a pronounced and sudden change in the perineum due to stretching during delivery, which may add to the perineal trauma from an episiotomy, increasing the risk of urinary retention. We aim to study the incidence and risk factors associated with postpartum urinary retention in women undergoing instrumental delivery.
Material and methods
Pregnant women who had an instrumental delivery after 37 weeks of gestation at JIPMER, Puducherry, India, between January 2017 and June 2017 were included in the study. Postpartum urinary retention was defined as the inability to void spontaneously or ultrasonographic documentation of post‐void residual volume of >150 mL, 6 hours after delivery. Demographic factors, clinical profile and follow‐up of these patients were noted. Multivariate logistic regression analysis was performed to assess the risk factors associated with urinary retention and was presented as adjusted odds ratios (OR) with 95% confidence intervals (CI).
Results
Postpartum urinary retention was noted in 124 (20.6%) women undergoing instrumental delivery. Overt and covert urinary retention occurred in 2.3% and 18.3%, respectively. After adjusting for other risk factors, nulliparity (adjusted OR = 4.05, 95% CI 2.02‐8.12 compared with multiparity) and prolonged second stage (OR = 3.96, 95% CI 1.53‐10.25) compared with suspected fetal compromise as an indication for instrumental delivery was associated with increased risk of postpartum urinary retention. Interaction was noted between parity and episiotomy on the occurrence of postpartum urinary retention (P = .010). Among nulliparous women, those with episiotomy (adjusted OR = 6.10, 95% CI 2.65‐14.04) have higher odds of developing postpartum urinary retention compared with those without episiotomy.
Conclusions
Approximately one of five (20.6%) women undergoing instrumental delivery developed postpartum urinary retention. Among women undergoing instrumental delivery, episiotomy increased the chances of developing postpartum retention in nulliparous but not multiparous women. Prolonged second stage as an indication for instrumental delivery also increased the chances of retention. Future studies are needed to define the cutoff for diagnosis and to evaluate the long‐term effects of covert postpartum urinary retention, as well to study the effect of episiotomy on development of postpartum urinary retention in women undergoing instrumental delivery.
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