Role of intraretinal cysts in the prediction of postoperative closure and photoreceptor damages of the idiopathic full-thickness macular hole.

BACKGROUND: To determine whether it would be effective in predicting the results of the postoperative full-thickness macular hole (FTMH) closure when intraretinal cyst (IRC) is present. METHODS: Case-control study. Patients with idiopathic FTMH who underwent pars plana vitrectomy with internal limiting membrane peeling were retrospectively reviewed. Preoperative spectral-domain optical coherence tomography was undertaken in all patients. The new parameter, macular hole closing factor (MHCF) was defined as the base diameter - (arm length + IRC height) by adding IRC to the existing parameter. After surgery, patients were classified and analyzed according to the type of hole closure and the damage of photoreceptor. RESULTS: Of the 35 patients, 28 (80.00%) had type 1 closure and seven (20.00%) had type 2 closure. There was a significant difference in postoperative BCVA (P < 0.01), base diameter (P = 0.037), arm length (P = 0.045), and IRC height (P = 0.011) between the two groups. In the type 1 closure, they were further divided into two subgroups according to photoreceptor damage, and it was confirmed that there were significant differences in postoperative BCVA (P = 0.045), hole height (P = 0.048), and IRC height (P = 0.046) in the two subgroups. As for the new parameters, a significant difference between the three groups was confirmed (P < 0.01). CONCLUSION: IRC may help predict hole closure along with the known horizontal parameters. Therefore, the new parameter containing both two factors can help predict not only hole closure but also damage to photoreceptors that affects postoperative visual prognosis.

Sharing pro-marijuana messaging on social media: The moderating role of legislation.

ObjectivesThis study investigates whether recreational marijuana legislation and perceived social norms (descriptive and injunctive) affect college students' propensity to share pro-marijuana messages. We examine which referent group (close friends, typical student, parents) most influence those norms. Participants: A sample of 343 college students participated in the study. Of these students, 214 were from Washington State, where recreational marijuana is legal, and 129 were from Wyoming, where recreational marijuana is illegal. Method: Data, from an online survey, were analyzed through PROCESS analyses. Results: College students in Washington State who believed a typical peer would want them to share pro-marijuana messaging were marginally more likely to share pro-marijuana messages than their counterparts in Wyoming. However, among students who thought a typical peer would not approve of them sharing pro-marijuana messaging, the opposite pattern emerged. Conclusion: Restrictive recreational marijuana legislation does not uniformly abate related message sharing on social media.

Anisocoria after scopolamine transdermal patch contamination: A case report.

RATIONALE: We report a case of anisocoria that occurred after contamination with a scopolamine transdermal patch, and introduce a diagnostic approach for anisocoria patients. PATIENT CONCERNS: A 35-year-old woman with no past ophthalmologic history presented to the ophthalmology department complaining of a dilated pupil in the right eye. Corrected visual acuities was 20/20 in both eyes, and the intraocular pressures were 20 and 18 mm Hg in the right and left eye, respectively. The anterior chambers in both eyes were unremarkable on slit-lamp examination. The pupil size was 5.0 mm in the right eye and 2.0 mm in the left eye, and the extraocular muscles of both eyes were intact. DIAGNOSIS: The patient neither did present with facial anhidrosis nor did she present with ptosis. Furthermore, as we did not observe dilatation lag in the smaller pupil, we applied 1% apraclonidine in the left eye in order to rule out Horner syndrome and did not observe dilatation of the pupil. We then applied 0.125% and 1% pilocarpine to exclude oculomotor nerve palsy; however, it could not be ruled out as constriction of pupil to 3.1 mm in the right eye was observed after applying 1% pilocarpine. Moreover, upon further investigation, we discovered that the patient had a scopolamine transdermal patch applied for 2 days prior to the clinic visit. INTERVENTIONS: Artificial tears were administered and the patient was observed and monitored. OUTCOMES: The pupil size in the right eye gradually decreased to 4.5 mm on the second day of observation and to 3.6 mm on the fourth day of observation. LESSONS: A detailed history of the use of medications such as scopolamine patches in patients with unilateral dilated pupils without vision loss is of utmost importance. We report the exclusion of important diseases using pilocarpine and apraclonidine hydrochloride. It was confirmed that improvement naturally occurs over time.

Aqueous humor cytokine levels through microarray analysis and a sub-analysis based on optical coherence tomography in wet age-related macular degeneration patients.

BACKGROUND: To identify disease-specific cytokine and growth factor profile differences in the aqueous humor between wet age-related macular degeneration (AMD) patients and age-matched controls and to correlate their levels with the optical coherence tomography (OCT) findings. METHODS: Aqueous humors were obtained from 13 wet AMD eyes and 10 control eyes. Twenty cytokines and growth factors were measured using a RayBio antibody microarray technology in wet AMD and control eyes. RESULTS: The samples obtained from wet AMD patients exhibited a significantly increased expression of MCP-1, MIP-1α, MIP-1ß, and vascular endothelial growth factor (VEGF). Subretinal fluid (SRF) patients showed significantly lower levels of proinflammatory cytokines, such as IL-1α and GM-CSF, than those without SRF. Pigment epithelial detachments (PED) patients showed lower levels of inflammatory cytokines, such as GM-CSF, IFN-γ, and TNF-α, than those without PED. Subretinal tissue (SRT) patients showed a higher level of IFN-γ than those without SRT. Compared with the controls, type 1 macular neovascularization (MNV) patients showed increased levels of MCP-1, MIP-1α, and MIP-1ß, but not VEGF (p = 0.083). However, type 2 MNV patients showed increased levels of MCP-1 and VEGF (p = 0.040 and p = 0.040). CONCLUSION: Inflammatory cytokines varied according to the type of AMD- and OCT-based parameters. Our observation of low levels of VEGF in patients with type 1 MNV implies that the inhibition of VEGF alone appears to be insufficient treatment for these patients and that cytokines such as MCP-1, MIP-1α, and MIP-1ß should be modulated. And the presence of SRF in MNV may be associated with a positive prognosis because we found relatively low levels of proinflammatory cytokines.

Comparison of corneal endothelial cell changes after phacoemulsification between type 2 diabetic and nondiabetic patients.

ABSTRACT: The aim of this study is to compare the endothelial cell density (ECD) and morphology between diabetic mellitus (DM) and nondiabetic patients at 1 year after phacoemulsification in operated eyes and nonoperated eyes.Evaluation was performed in 28 patients (56 eyes) with type 2 diabetes and 37 patients (74 eyes) without diabetes who underwent 1-year interval cataract surgery. Using a noncontact specular microscope and Scheimpflug rotating camera, corneal parameters were analyzed before and 1 year after surgery. Subgroups analysis was performed based on a disease duration 10 years and HbA1c concentration 7% and Pearson correlation analysis was performed.The mean change in ECD at 1 year after surgery was 13.28% in the DM group and 11.40% in the control group. In the fellow nonoperated eyes, the mean change was 4.47% and 3.63% in the DM and control groups, respectively. There was no significant difference in postoperative ECD, coefficient of variance, hexagonality, and central corneal thickness between 2 groups. In the subgroup analysis, the long disease duration DM group (≥10 years) had a significantly greater ECD loss than the control and short disease duration DM groups (<10 years). Blood urea nitrogen (BUN) showed a significant correlation with postoperative ECD change (r = -0.474, P = .011).The diabetic group with a longer disease duration showed significantly greater ECD decrease compared to the nondiabetic group and BUN correlated with ECD changes after phacoemulsification. Postoperative ECD loss may be high if the disease duration is long or if the BUN level is high.

Usefulness of the Components of Full-Field Electroretinography to Predict Postoperative Visual Outcomes in Patients With Epiretinal Membranes.

Purpose: To confirm the predictors of postoperative visual outcomes by performing full-field electroretinography (ffERG) before surgery in patients with epiretinal membranes (ERMs). Methods: Sixty-one eyes of patients with ERMs who underwent pars plana vitrectomy with membrane peeling were prospectively reviewed. Correlations between preoperative data (ffERG and optical coherence tomography) and postoperative best-corrected visual acuity (BCVA) were investigated. Receiver operating characteristic (ROC) curve analysis was performed to obtain cutoff values of the ffERG parameters predicting good visual outcome (final BCVA ≥ 20/30). Results: Postoperative BCVA was significantly correlated with the implicit time and amplitude of the b-wave in light-adapted (LA) 3.0 electroretinography (ERG), with the amplitude difference between N1 and P1 in the LA 30-Hz flicker ERG, and with the sum of the amplitudes of OS1, OS2, and OS3 in dark-adapted (DA) oscillatory potential (OP) ERG (P < 0.01). The area under the ROC curve to predict good visual outcome was statistically significant for the four parameters (0.787, 0.815, 0.757, and 0.792, respectively). Conclusions: The postoperative BCVA in patients with ERM was significantly correlated with the implicit time and amplitude of the b-wave in the LA 3.0 ERG, the amplitude difference between N1 and P1 in the LA 30-Hz flicker ERG, and the sum of the amplitudes of OS1, OS2, and OS3 in DA OP ERG of ffERG. It is thought that ffERG before surgery may help predict visual outcomes after surgery. Translational Relevance: It was confirmed that the degree of retinal function in the ERM can predict BCVA after treatment.

Sixteen-and-a-half syndrome with metastatic pons tumor: A case report.

RATIONALE: One-and-a-half syndrome (OAAH) is characterized as the combination of ipsilateral horizontal gaze palsy and internuclear ophthalmoplegia. OAAH syndrome accompanied with 7th and 8th cranial nerve palsy is called 16-and-a-half syndrome. We aimed to report the case of 16-and-a-half syndrome with metastatic pons tumor. PATIENT CONCERNS: A 57-year-old male diagnosed with nonsmall-cell lung cancer (NSCLC) with brain metastasis occurring 15 months ago was referred to our clinic with the chief complaint of horizontal diplopia and right gaze palsy. DIAGNOSIS: According to the patient symptom, ocular examination, and radiographic findings, he was diagnosed as 16-and-a-half syndrome which was caused by brain tumor metastasis from NSCLC. INTERVENTIONS: We referred him to hemato-oncology department and he was treated with radiation and supportive therapy. OUTCOMES: Unfortunately, the patient passed away 1 month later without improvement of ophthalmoplegia. LESSONS: The clinical findings of our case indicate 16-and-a-half syndrome caused by brain tumor metastasis from NSCLC, which to our knowledge has not been previously reported. The case highlights a rare cause of OAAH spectrum disease and the importance of a systemic work-up including associated neurologic symptoms and brain imaging in patients with horizontal gaze palsy.

Effect of Annealing Temperature on Morphology and Electrical Property of Hydrothermally-Grown ZnO Nanorods/p-Si Heterojunction Diodes.

In this study, ZnO nanorods (NRs) were synthesized using the hydrothermal method, and the effects of annealing temperature (150 °C-600 °C) on morphology, crystallinity, defects states of the NRs, and electrical property of the n-type ZnO NRs/p-type Si heterojunction diodes were investigated. No appreciable changes in the morphology and crystal structure of the ZnO NRs were observed with increasing annealing temperature up to 450 °C. As the temperature increased to 600 °C, the average length and diameter of the NRs decreased due to the partial melting and sintering in the NRs. From the X-ray photoelectron spectroscopy (XPS) results, the concentration of internal oxygen vacancies decreased with increasing annealing temperature to 450 °C due to thermal diffusion of oxygen vacancies to the surface. The electrical conductivity of the NRs increased to 450 °C, which was attributed to the increased crystallinity and low defects concentration (oxygen vacancy) in the NRs. Conversely, the electrical conductivity degraded at 600 °C due to the decreased effective contact area.

One-year survivor of adult alveolar rhabdomyosarcoma of the maxillary sinus with orbital extension: Case report.

INTRODUCTION: Rhabdomyosarcoma is uncommon in adults. Adult and maxillary rhabomyosarcoma with direct orbital extension has been rarely reported. To our knowledge, there is no reported case about adult patient with alveolar maxillary rhabdomyosarcoma and orbital extension survived 1 year with intact ocular function. CASE PRESENTATION: A 21-year-old female presented with protrusion of the right eye and an obstructed nasal passage for the past month. Her symptoms were not relieved by oral antibiotic or irrigation. She was referred to our clinic. Computed tomography and magnetic resonance imaging showed a large homogenous well-enhanced mass with surrounding bony erosion and remodeling. The mass extended to the ipsilateral nasal cavity and orbit. Endoscopic biopsy of the nasal cavity confirmed alveolar rhabdomyosarcoma. The maxillary mass was excised using the Caldwell-Luc approach, and the orbital mass was excised using a transconjuctival and transcaruncular approach. A systemic work-up confirmed ipsilateral lymph node metastasis. The patient received 6 cycles of chemotherapy with vincristine, dactinomycin, and cyclophosphamide, as well as 5120 cGy radiotherapy. Her ocular function was intact 1 year after treatment, and magnetic resonance imaging showed complete regression of the tumor. CONCLUSION: Rhabdomyosarcoma, which is usually an aggressive malignancy, should be considered in the differential diagnosis of a rapidly growing orbital mass. Aggressive treatment, including surgery, chemotherapy, and radiation therapy, can increase local remission rates and improve the prognosis.

Facet Control of Subunits in Anatase TiO2 Mesocrystal by Diethanolamine for Enhanced Photocatalytic Activity.

Controllable TiO2 architectures with different facets play a key role in the adjustment of the surface area and charge recombination efficiency in photocatalysts. In this study, we synthesized anatase TiO2 mesocrystals with diethanolamine (DEA, 0-5 mM) as a nontoxic capping agent to control the facet of subunits using hydrothermal method, and determine the effect of DEA on subunits, by-products, and consequent photocatalytic performance of TiO2 mesocrystals. The pure TiO2 was spindle-like shaped mesocrystal having bipyramidal subunits with high portion of {101} facets. As DEA concentration was increased, the percentage of {001} exposed facet of subunits increased, but the number of subunits was gradually reduced. When a large amount of DEA (≥3 mM) was added, TiO2 exhibited single crystals rather than mesocrystal, probably because the long chain of DEA interfered with the oriented attachment of subunits. The photocatalytic activity of the TiO2 improved at 0.5 mM of DEA due to low charge recombination rate by increasing {001} facet. On the other hand, subsequent deterioration with further increase of DEA was attributed to the increased by-products and reduced the number of subunits despite the increase in specific surface area. These results imply that charge separation efficiency, rather than specific surface area, is highly responsible for the photocatalytic activity of TiO2.

Synergistic effect of Indium and Gallium co-doping on growth behavior and physical properties of hydrothermally grown ZnO nanorods.

We synthesized ZnO nanorods (NRs) using simple hydrothermal method, with the simultaneous incorporation of gallium (Ga) and indium (In), in addition, investigated the co-doping effect on the morphology, microstructure, electronic structure, and electrical/optical properties. The growth behavior of the doped NRs was affected by the nuclei density and polarity of the (001) plane. The c-axis parameter of the co-doped NRs was similar to that of undoped NRs due to the compensated lattice distortion caused by the presence of dopants that are both larger (In3+) and smaller (Ga3+) than the host Zn2+ cations. Red shifts in the ultraviolet emission peaks were observed in all doped NRs, owing to the combined effects of NR size, band gap renormalization, and the presence of stacking faults created by the dopant-induced lattice distortions. In addition, the NR/p-GaN diodes using co-doped NRs exhibited superior electrical conductivity compared to the other specimens due to the increase in the charge carrier density of NRs and the relatively large effective contact area of (001) planes. The simultaneous doping of In and Ga is therefore anticipated to provide a broader range of optical, physical, and electrical properties of ZnO NRs for a variety of opto-electronic applications.

Facet-controlled anatase TiO2 nanoparticles through various fluorine sources for superior photocatalytic activity.

Reactive surface-exposed anatase TiO2 (a-TiO2) is highly desirable for applications requiring superior photocatalytic activity. In order to obtain a favorable surface, morphology control of the a-TiO2 using capping agents has been widely investigated. Herein, we systematically study the effects of different F sources (HF, TiF4, and NH4F) as the capping agent on the morphology control and photocatalytic activities of a-TiO2 in a hydrothermal process. When either HF or TiF4 was added, large truncated bipyramids formed with the photocatalytically active {001} facet, whereas the NH4F was not effective for facet control, yielding nanospheres similar to the pure a-TiO2. The morphology changes were related to the decomposition behaviors of the F sources in the solvent material: HF and TiF4 decomposed and supplied F(-) ions before a-TiO2 nucleation, which changed the nucleation rate and growth direction, leading to the resultant a-TiO2 morphology. On the other hand, NH4F supplied F(-) ions after a-TiO2 nucleation and could not change the growth behavior. In terms of the photocatalytic effect, the HF- and TiF4-treated a-TiO2 effectively decomposed ∼90% and ∼80% of methylene blue, respectively, in 1 h, while ∼60% was decomposed for the NH4F-treated a-TiO2. Note that pure a-TiO2 photocatalytically decomposed only ∼10% of methylene blue over the same time. These results pave the way to precise control of the facet of TiO2 through using different capping agents.

Hydrothermally Grown In-doped ZnO Nanorods on p-GaN Films for Color-tunable Heterojunction Light-emitting-diodes.

The incorporation of doping elements in ZnO nanostructures plays an important role in adjusting the optical and electrical properties in optoelectronic devices. In the present study, we fabricated 1-D ZnO nanorods (NRs) doped with different In contents (0% ~ 5%) on p-GaN films using a facile hydrothermal method, and investigated the effect of the In doping on the morphology and electronic structure of the NRs and the electrical and optical performances of the n-ZnO NRs/p-GaN heterojunction light emitting diodes (LEDs). As the In content increased, the size (diameter and length) of the NRs increased, and the electrical performance of the LEDs improved. From the electroluminescence (EL) spectra, it was found that the broad green-yellow-orange emission band significantly increased with increasing In content due to the increased defect states (oxygen vacancies) in the ZnO NRs, and consequently, the superposition of the emission bands centered at 415 nm and 570 nm led to the generation of white-light. These results suggest that In doping is an effective way to tailor the morphology and the optical, electronic, and electrical properties of ZnO NRs, as well as the EL emission property of heterojunction LEDs.

Surface-Tunable Bioluminescence Resonance Energy Transfer via Geometry-Controlled ZnO Nanorod Coordination.

The use of ZnO nanorods (NRs) as an effective coordinator and biosensing platform to create bioluminescence resonance energy transfer (BRET) is reported. Herein, a hydrothermal approach is applied to obtain morphologically controlled ZnO NRs, which are directly bound to luciferase (Luc) and carboxy-modified quantum dot (QD) acting as a donor-acceptor pair for BRET. BRET efficiency varies significantly with the geometry of ZnO NRs, which modulates the coordination between hexahistidine-tagged Luc (Luc-His6 ) and QD, owing to the combined effect of the total surface area consisting of (001) and (100) planes and their surface polarities. Unlike typical QD-BRET reactions with metal ions (e.g., zinc ions), a geometry-controlled ZnO NR platform can facilitate the design of surface-initiated BRET sensors without being supplemented by copious metal ions: the geometry-controlled ZnO NR platform can therefore pave the way for nanostructure-based biosensors with enhanced analytical performance.

Dielectric functions of solution-processed GdAlO(x)/Si films measured with vacuum ultra-violet spectroscopic ellipsometry.

The dielectric functions of amorphous GdAlO(x) (GAO) films grown by the sol-gel process were investigated from 1.12 to 8.5 eV as a function of annealing temperature using spectroscopic ellipsometry (SE). A GAO precursor sol with a molar ratio of Gd:Al = 1:1 was prepared. Thin layers were formed by spin-coating on p-type Si substrates. The layers were sintered at 400 degrees C for 2 h in an ambient atmosphere, then rapid-thermal-annealed (RTA) at 700 or 800 degrees C for 1 min in an N2 ambient. The optical properties were measured via variable angle SE, at room temperature. The angle of incidence was varied from 50 to 70 degrees in 10 degrees steps. The dielectric functions of the resulting GAO films were obtained from the measured pseudodielectric functions by multilayer-structure calculations using the Tauc-Lorentz (TL) dispersion relation. The real and imaginary parts of the dielectric functions were found to increase with increasing RTA temperature. The film thicknesses and TL parameters (threshold energy E(g) and broadening C) decrease with increasing RTA temperature.

Growth behavior and electrical performance of Ga-doped ZnO nanorod/p-Si heterojunction diodes prepared using a hydrothermal method.

The incorporation of foreign elements into ZnO nanostructures is of significant interest for tuning the structure and optical and electrical properties in nanoscale optoelectronic devices. In this study, Ga-doped 1-D ZnO nanorods were synthesized using a hydrothermal route, in which the doping content of Ga was varied from 0% to 10%. The pn heterojunction diodes based on the n-type Ga-doped ZnO nanorod/p-type Si substrates were constructed, and the effect of the Ga doping on the morphology, chemical bonding structure, and optical properties of the ZnO nanorods was systematically investigated as well as the diode performance. With increasing Ga content, the average diameter of the ZnO nanorods was increased, whereas the amount of oxygen vacancies was reduced. In addition, the Ga-doped ZnO nanorod/p-Si diodes showed a well-defined rectifying behavior in the I-V characteristics and an improvement in the electrical conductivity (diode performance) by the Ga doping, which was attributed to the increased charge carrier (electron) concentration and the reduced defect states in the nanorods by incorporating Ga. The results suggest that Ga doping is an effective way to tailor the morphology, optical, electronic, and electrical properties of ZnO nanorods for various applications such as field-effect transistors (FETs), light-emitting diodes (LEDs), and laser diodes (LDs).

The effect of sintering temperature on the microstructure and electrical performance of sol-gel-deposited SnInZnO thin film transistors.

We reported the capability of the SnInZnO (TIZO) film, fabricated using the sol-gel process, to act as a channel layer for printed electronics. We varied the sintering temperature to examine the potential of both the material and the process for application at low processing temperatures. The structure of the film sintered at 300 degrees C consisted of amorphous phase and the nanocrystalline structure began to appear locally at 400 degrees C. With increasing sintering temperature, the ratio of the crystalline structure was increased. In addition, the saturation mobility (mu sat) and off current were increased, the I(on)/I(off) was decreased, and the threshold voltage was shifted in the negative direction by increasing the sintering temperature (mu sat of 11.91 cm2 V(-1) s(-1) and 0.11 cm2 V(-1) s(-1) for the 700 degrees C- and 300 degrees C-sintered samples, respectively). This study could encourage in developing cost-effective TIZO TFTs with robust performances.

Fabrication of solution-processed InSnZnO/ZrO2 thin film transistors.

We fabricated InSnZnO (ITZO) thin-film transistors (TFTs) with a high-permittivity (K) ZrO2 gate insulator using a solution process and explored the microstructure and electrical properties. ZrO2 and ITZO (In:Sn:Zn = 2:1:1) precursor solutions were deposited using consecutive spin-coating and drying steps on highly doped p-type Si substrate, followed by annealing at 700 degrees C in ambient air. The ITZO/ZrO2 TFT device showed n-channel depletion mode characteristics, and it possessed a high saturation mobility of approximately 9.8 cm2/V x s, a small subthreshold voltage swing of approximately 2.3 V/decade, and a negative V(TH) of approximately 1.5 V, but a relatively low on/off current ratio of approximately 10(-3). These results were thought to be due to the use of the high-kappa crystallized ZrO2 dielectric (kappa approximately 21.8) as the gate insulator, which could permit low-voltage operation of the solution-processed ITZO TFT devices for applications to high-throughput, low-cost, flexible and transparent electronics.

Investigation of the dielectric function of solution-processed InGaZnO films using ellipsometry.

The optical properties of InGaZnO (IGZO) films grown through the sol-gel process as a function of sintering time were investigated with spectroscopic ellipsometry (SE). The IGZO precursor sol was prepared by mixing In nitrate, Ga nitrate, and Zn acetate at a molar ratio of In:Ga:Zn = 3:1:1. The solution was deposited on a SiO2/Si substrate via spin coating. Sintering was performed at 400 degrees C for 1-15 h in an ambient atmosphere. The optical properties were measured over the range 1.12-6.52 eV via variable angle SE, at room temperature. The angle of incidence was varied from 50 to 70 degrees in 5 degree steps. To extract the pure optical properties of IGZO, multilayer-structure calculation with Tauc-Lorentz dispersion relation for IGZO was performed. The changes in the dielectric function of the IGZO films with varying sintering time were observed. The resultant optical properties can be related to the concentration of oxygen vacancies in the material, which can be controlled by the sintering time.

Nitrification and denitrification using biofilters packed with sulfur and limestone at a pilot-scale municipal wastewater treatment plant.

A pilot-scale municipal wastewater treatment plant composed of a fixed film activated sludge (IFAS) system with sulfur-limestone autotrophic denitrification (SLAD) was operated for a year and the influence of different operational factors was investigated. Nitrification efficiency was found to be above 91% at temperatures above 25 degrees C even at short hydraulic residence times (HRTs), but declined to 51 +/- 2% when the temperature dropped to 22 +/- 3 degrees C. The minimum HRT (HRT(min)) to achieve nitrification efficiency > 90% was found to be 12 h at temperatures above 25 degrees C. Denitrification efficiencies were found to be 89% and 79% at a nitrate loading of 0.36 kg NO3(-)-N m(-3) d(-1) and at 0.18 kg NO3(-)-N m(-3) d(-1), respectively. The minimum empty bed residence time (EBRT) to achieve denitrification efficiency above 80% without methanol addition was 3 h at a nitrate loading rate of 0.27-0.38 kg NO3(-)-N m(-3) d(-1). The amount of nitrate removed as a function of the sulfate formed was found to be 0.188 g NO3(-)-N/g SO4(2-). The nitrate load removed by the biofilter as a function of the alkalinity consumed was found to be very close to the theoretical stoichiometric value. The application of the pilot plant was proven to be feasible and the performance of the SLAD system, especially with respect to the minimum EBRT to achieve denitrification efficiency above 80%, the maximum denitrification rate and performance at temperatures below 10 degrees C. To achieve a nitrification efficiency above 90% in the IFAS system, temperature changes and the minimum HRT were found to be the most influential operational parameters.