Fate of antibiotics and antibiotic resistance genes during conventional and additional treatment technologies in wastewater treatment plants.

Information on the removal of antibiotics and ARGs in full-scale WWTPs (with or without additional treatment technology) is limited. However, it is important to understand the efficiency of full-scale treatment technologies in removing antibiotics and ARGs under a variety of conditions relevant for practice to reduce their environmental spreading. Therefore, this study was performed to evaluate the removal of antibiotics and ARGs in a conventional wastewater treatment plant (WWTP A) and two full-scale combined with additional treatment technologies. WWTP B, a conventional activated sludge treatment followed by an activated carbon filtration step (1-STEP® filter) as a final treatment step. WWTP C, a treatment plant using aerobic granular sludge (NEREDA®) as an alternative to activated sludge treatment. Water and sludge were collected and analysed for 52 antibiotics from four target antibiotic groups (macrolides, sulfonamides, quinolones, tetracyclines) and four target ARGs (ermB, sul 1, sul 2 and tetW) and integrase gene class 1 (intI1). Despite the high removal percentages (79-88%) of the total load of antibiotics in all WWTPs, some antibiotics were detected in the various effluents. Additional treatment technology (WWTP C) showed antibiotics removal up to 99% (tetracyclines). For ARGs, WWTP C reduced 2.3 log followed by WWTP A with 2.0 log, and WWTP B with 1.3 log. This shows that full-scale WWTP with an additional treatment technology are promising solutions for reducing emissions of antibiotics and ARGs from wastewater treatment plants. However, total removal of the antibiotics and ARGS cannot be achieved for all types of antibiotics and ARGs. In addition, the ARGs were more abundant in the sludge compared to the wastewater effluent suggesting that sludge is an important reservoir representing a source for later ARG emissions upon reuse, i.e. as fertilizer in agriculture or as resource for bioplastics or bioflocculants. These aspects require further research.

Student attitudes towards computer-aided testing.

INTRODUCTION: Computer-aided learning (CAL) is a viable alternative to traditional teaching methods. While CAL is used for teaching only, computer-aided testing (CAT) can be applied as a computer-based examination method. The aim of the present study was to evaluate students' attitude towards CAT as compared to written multiple choice tests. MATERIALS AND METHODS: Forty-one undergraduate dental students underwent a mock examination consisting of 15 written multiple choice questions and 15 questions delivered using the interactive MobiTed® system. A questionnaire based on an eight-item seven-point Likert scale was used to evaluate the students' attitude towards CAT. The students' performance in both tests was analysed using paired t-tests. Correlations between test performance and questionnaire were expressed by Pearson correlation coefficients. RESULTS: Despite study-design-related differences, students' test performance between written multiple choice and MobiTed® was comparable. No correlations between test results and questionnaire could be set up. Students rated MobiTed® to be equivalent to written multiple choice and had no difficulties with the CAT set up. The pre-defined sequence of questions with each question being shown only once was considered to be a major disadvantage of the CAT system. Complex questions should be displayed longer compared to short questions. DISCUSSION: Computer-aided testing appeared to be equivalent to written multiple choice tests not only in terms of student performance but also to their perception. This is consistent with previous studies. CONCLUSIONS: Interactive multiple choice tests may provide an alternative to written tests, but should allow examinees to have control over the sequence, as well as the length of time the questions are displayed.

Association studies on 11 published colorectal cancer risk loci.

BACKGROUND: Recently, several genome-wide association studies (GWAS) have independently found numerous loci at which common single-nucleotide polymorphisms (SNPs) modestly influence the risk of developing colorectal cancer. The aim of this study was to test 11 loci, reported to be associated with an increased or decreased risk of colorectal cancer: 8q23.3 (rs16892766), 8q24.21 (rs6983267), 9p24 (rs719725), 10p14 (rs10795668), 11q23.1 (rs3802842), 14q22.2 (rs4444235), 15q13.3 (rs4779584), 16q22.1 (rs9929218), 18q21.1 (rs4939827), 19q13.1 (rs10411210) and 20p12.3 (rs961253), in a Swedish-based cohort. METHODS: The cohort was composed of 1786 cases and 1749 controls that were genotyped and analysed statistically. Genotype-phenotype analysis, for all 11 SNPs and sex, age of onset, family history of CRC and tumour location, was performed. RESULTS: Of eleven loci, 5 showed statistically significant odds ratios similar to previously published findings: 8q23.3, 8q24.21, 10p14, 15q13.3 and 18q21.1. The remaining loci 11q23.1, 16q22.1, 19q13.1 and 20p12.3 showed weak trends but somehow similar to what was previously published. The loci 9p24 and 14q22.2 could not be confirmed. We show a higher number of risk alleles in affected individuals compared to controls. Four statistically significant genotype-phenotype associations were found; the G allele of rs6983267 was associated to older age, the G allele of rs1075668 was associated with a younger age and sporadic cases, and the T allele of rs10411210 was associated with younger age. CONCLUSIONS: Our study, using a Swedish population, supports most genetic variants published in GWAS. More studies are needed to validate the genotype-phenotype correlations.

Comparison between computer-aided testing and traditional multiple choice: an equivalence study.

AIMS: Computer-aided learning (CAL) is a viable alternative to traditional teaching methods. While CAL is used for teaching only, computer-aided testing (CAT) can be applied as a computer-based examination method. The aim of the present study was to compare the performance of undergraduate students in computer-interactive tests and traditional multiple choice tests and to evaluate the influence of question length and language skills on test results. MATERIALS AND METHODS: Fifty-two native German-speaking students and five non-native speaking students were randomly assigned to two groups. They were required to answer 20 conventional multiple choice questions and 20 questions using the interactive MobiTed system. An analysis of variance and t-tests (alpha = 0.05) were used to compare scores. RESULTS: Non-native speakers scored significantly lower on the interactive test compared with the native speaking students (P = 0.048 for long questions and P = 0.003 for short questions). There were no significant group differences on the conventional multiple choice test (P = 0.052 for long questions and P = 0.089 for short questions). Based on the results of the native speaking students neither test method nor question length had an influence on overall performance. CONCLUSION: Interactive multiple choice tests may provide an alternative to written tests, especially when considering time expenditure. Language skills and question length should be taken into account when setting time limits for examination.

Dental anxiety--an epidemiological study on its clinical correlation and effects on oral health.

Pronounced dental anxiety could lead to avoidance strategies to evade dental visits. The aim of the present epidemiological study was to investigate the prevalence and related oral disease patterns of dental anxiety in young adult male soldiers. Therefore, the intensity and frequency of dental anxiety are presented and the correlation with oral clinical findings are evaluated. Three hundred seventy-four soldiers who underwent a compulsory dental check-up were randomly assigned to this study. Psychological parameters were collected based on a protocol integrating the Dental Anxiety Scale (DAS) and the Gatchell Fear Scale (GaFS). Patient-based measures included D3,4MF-scores for dental status and the Community Periodontal Index of Treatment Need (CPITN) for periodontal status. Thirty-two individuals (8.6%) showed DAS-scores of 13 or 14 (anxious), while 4.6% had a DAS-score > or = 15 (highly anxious/phobic). Highest DAS-values were measured among patients' aged 19-29 (n = 262). DMFS-values of anxious and less anxious patients showed only minor differences. However, anxious patients had significantly more carious lesions (P < 0.001). CPITN periodontal values showed no significant differences between both groups. 89.2% of less anxious individuals and 79.6% of anxious patients went for regular dental check-ups. Thus, every tenth patient was considered to have high dental anxiety. Anxiety results in avoidance behaviour, which can only be discovered upon compulsory examinations and which is associated with higher caries morbidity and need for oral rehabilitation. As anxiety has a direct influence on oral health, it should be detected and accounted for in a treatment concept integrating dental and cognitive-behavioural therapeutic approaches.

Changes in neurophysiologic parameters in a patient with dental anxiety by hypnosis during surgical treatment.

It was hypothesized that dental anxiety, which leads to neurophysiologic alterations in heart rate, respiratory rate and blood pressure prior, during and subsequent to dental treatment, can be influenced by medical hypnosis. We report the positive impact from non-invasive hypno-sedation during dental implant surgery on a 54-year-old female patient who experienced neurophysiologic reactions as a result of the psychosomatic process of dental anxiety (dental anxiety scale value = 13). The neurophysiologic changes during dental surgery performed with and without hypnosis were compared after the patient underwent the same surgical treatment protocol. This case report was part of a study designed to evaluate hypnosis as a non-invasive therapy for dental-anxious patients over six sessions using subjective experience and objective parameters, which included electroencephalogram, electrocardiogram, heart rate, blood pressure, oxygen saturation of the blood, respiration rate, salivary cortisol concentration and body temperature.

Expression of interleukin 1-beta, transforming growth factor beta-1, and vascular endothelial growth factor in soft tissue over the implant before uncovering.

BACKGROUND: Overexpression of inflammatory cytokines interleukin 1-beta (IL-1beta), transforming growth factor beta-1 (TGF-beta1), and vascular endothelial growth factor (VEGF) may cause healing impairment following implant insertion, jeopardizing success especially in patients previously irradiated. Limited data is available regarding expression pattern of inflammatory cytokines in peri-implant soft tissue caused by the surgical intervention itself. STUDY DESIGN: This study examined 21 patients receiving dental implants. Biopsies of peri-implant tissue were harvested at re-entry 4 months after initial surgery. Eight patients underwent probing of untreated mucosa. Three groups were created (group 1: regular peri-implant mucosa; group 2: patients with irradiated peri-implant mucosa, radiation treatment due to oral squamous cell cancer; group 3: control). Immunohistochemical staining was performed for TGFss1, IL-1ss, and VEGF. RESULTS: Following the placement of dental implants (group 1 vs group 3) a significant increase (P > .05) in TGF-beta1, IL-1beta, and VEGF expression in the peri-implant mucosa was demonstrated. No alteration of this distinct pattern was found for previously irradiated tissue (group 1 vs. group 2). CONCLUSIONS: The study highlights the fundamental involvement of TGF-beta1, IL-1beta, and VEGF during the regeneration of peri-implant soft tissue structures. The use of extended interim solutions may be one clinical implication of these prolonged tissue remodeling processes.

Indole-3-pyruvic and -propionic acids, kynurenic acid, and related metabolites as luminophores and free-radical scavengers.

Chemiluminescence associated with oxidation by free radicals was investigated in an alkaline, hemin-catalysed hydrogen peroxide system, using the following tryptophan metabolites as radical scavengers: indole-3-pyruvic, indole-3-propionic, kynurenic, xanthurenic and quinaldic acids and 4-hydroxy-quinoline. Light emission from oxidation of the indolic compounds was only partially inhibited by the hydroxyl-radical scavenger DMSO, but strongly suppressed by the superoxide-anion scavenger Tiron, whereas chemi-luminescence generated from kynurenic acid was strongly inhibited by either of these compounds. Light emission from oxidation of kynurenic acid lasts for a surprisingly long period of time: At 0.4 mM and 20 degrees C, luminescence increased for 5 hours and continued at a high rate for more than a day. Comparison of structural analogues indicated that the 4-hydroxyl and carboxyl groups of kynurenic acid are essential for effective light emission, and that an additional 8-hydroxyl residue leading to an intramolecular hydrogen bond diminishes the reaction rate.

Fulguration-ablation of atypical accessory urethra.

A male adolescent presented with perineal dribbling during voiding. Evaluation revealed an accessory urethra originating from the prostatic urethra. There was persistent anatomical and functional dominance of the dorsal orthotopic urethra, constituting a reversal of the arrangement most commonly described for urethral duplication. Successful ablation of the accessory urethra was accomplished by electrofulguration. The salient features of urethral duplication are reviewed.

Pyelo-choledochal fistula accompanying operative cholangiography.

Fistulous communications between the biliary system and the urinary tract are encountered infrequently and, routinely, they are associated with operative dissections involving both systems. We report a case of opacification of the right renal collecting system during cholangiography following uneventful cholecystectomy. Prompt spontaneous resolution was verified by subsequent excretory urography.

Safety of an intravenous immunoglobulin preparation: lack of seroconversion for human immunodeficiency virus antibodies.

A retrospective analysis of 18 patients who had received a human intravenous immunoglobulin (IGIV) preparation was undertaken to ascertain the safety of this preparation with respect to transmission of human immunodeficiency virus (HIV), the virus that causes the acquired immune deficiency syndrome (AIDS). Patients were followed up by means of periodic enzyme-linked immunosorbent assay (ELISA) for the presence of circulating antibodies against HIV; a negative ELISA was evidence that HIV had not been transmitted to the recipients of IGIV. Results in 16 patients were negative, and two patients were determined to have had false-positive ELISAs because the Western blot test was negative for seroconversion. It is thus concluded that the IGIV product tested has little or no potential for transmitting HIV.