Dental treatments under sedation-analgesia in patients who are unable to collaborate: a prospective observational study.

Background: Excessive fear of dental procedures leads to disruptive behavior during dental examinations and treatments. Dental examinations and treatments of these patients usually require additional techniques, such as sedation. The most commonly used techniques are inhalation of nitrous oxide, infusion of propofol with fentanyl, and premedication and infusion of midazolam. Methods: A prospective observational epidemiological study was conducted on patients who required sedoanalgesia techniques for dental exploration and procedures. The reasons for the inability of patients to cooperate (excessive fear or intellectual disability), age, sex, weight, systemic pathology, oral pathology, treatment performed, time of intervention, anesthetic technique performed, and occurrence of complications were recorded. Results: In total, 218 patients were studied. Sixty-five patients came for fear of dental treatment and 153 for presenting with a diagnosis of intellectual disability and not collaborating in the treatment with local anesthesia. The average age of all patients was 30.54 ± 17.30 years. The most frequent oral pathologies found in patients with excessive fear were tartar (6.8%) and wisdom teeth (6.4%), followed by missing teeth (5%). In patients with disabilities, a combination of tartar and cavities appeared most frequently (41.3%), followed by cavities (15.6%). The most frequently used sedoanalgesia technique was the infusion of propofol with fentanyl in both groups of patients, followed by nitrous oxide. Conclusion: The combination of propofol and fentanyl was the most frequently used alternative in patients who were unable to collaborate because of intellectual disability or carry out longer or more complex treatments. Inhaled nitrous oxide and midazolam were the sedative techniques of choice for simpler oral treatments, such as tartrectomies, shallow obturations, and shorter interventions, or in younger patients.

Manejo quirúrgico del paciente con patología pseudoquística sinusal: a propósito de un caso / Surgical management of the patient with sinusal pseudocyst pathology: a case report

Introducción: la patología sinusal puede comprometer el éxito del tratamiento de implantes. Existe una elevada incidencia de patología sinusal. El tratamiento de esta patología puede implicar a otros profesionales, lo que supone un mayor coste sanitarios y demora en la realización de los tratamientos de implantes. El objetivo del presente artículo es presentar un caso clínico representativo de la patología pseudoquística del seno maxilar y una alternativa de su manejo quirúrgico simultáneo a la regeneración ósea requerida para su posterior rehabilitación mediante implantes, así como actualizar la evidencia científica disponible. Caso clínico: se presenta una paciente de 46 años con una lesión pseudoquística sinusal que es remitida para rehabilitar mediante implantes en 1.4 y 1.7, por movilidad y dolor en relación a prótesis fija dentosoportada en maxilar derecho. Se realiza el tratamiento quirúrgico de exodoncias, elevación de seno maxilar y eliminación de la lesión pseudoquística de manera simultánea. Discusión: existe controversia sobre el momento idóneo para realizar el tratamiento sinusal. Algunos estudios muestran éxito de la cirugía endoscópica simultáneamente a la eliminación de la fuente odontogénica. Otros han demostrado que realizar primero la cirugía sinusal tiene el mismo porcentaje de curación que realizar primero el tratamiento odontológico. Conclusión: el diagnóstico de la patología y la planificación quirúrgica deben tener en cuenta el tipo de patología, la extensión y las necesidades de tratamiento del paciente. El manejo quirúrgico de la patología sinusal de manera simultánea a la regeneración ósea es una alternativa segura y beneficiosa para el paciente. (AU)

Introduction: Sinus pathology can compromise the success of implant treatment. There is a high incidence of sinus pathology. The treatment of this pathology may involve other professionals, which means higher healthcare costs and delays in carrying out implant treatments. Besides updating available scientific evidence, the objective of this article is to present a representative clinical case of pseudocystic pathology of the maxillary sinus and an alternative to its simultaneous surgical management in the bone regeneration required for subsequent rehabilitation using implants. Clinical case: A 46-year-old patient with a pseudocystic sinus lesion, referred for rehabilitation using implants in 1.4 and 1.7, due to mobility and pain in relation to a tooth-supported fixed prosthesis in the right maxilla. The surgical treatment, consisting of extractions, maxillary sinus elevation and removal of the pseudocystic lesion, was performed simultaneously. Discussion: There is controversy about the ideal time to perform sinus treatment. Some studies show success of endoscopic surgery simultaneously with removal of the odontogenic source. Others have shown that performing sinus surgery first has the same cure rate as performing dental treatment first. Conclusion: Pathology diagnosis and surgical planning must take into account the type and extent of the pathology and the treatment needs of the patient. Surgical management of sinus pathology simultaneously with bone regeneration is a safe and beneficial alternative for the patient. (AU)

Manejo odontológico del paciente con frenillo lingual corto: a propósito de un caso / Dental management of the patient with short lingual frenulum: a case report

Introducción: El frenillo lingual corto puede provocar dificultades en la lactancia durante los primeros meses de vida en el neonato. A partir del desarrollo del lenguaje puede ser la causa de una fonética inadecuada. El tratamiento quirúrgico del frenillo debe ir acompañado por un adecuado tratamiento multidisciplinar para favorecer la corrección de las dificultades en la pronunciación. El objetivo del presente artículo es presentar un caso clínico representativo del diagnóstico, tratamiento quirúrgico y rehabilitación miofuncional del frenillo lingual corto, así como analizar la evidencia científica disponible. Caso clínico: Se presenta un paciente varón de 6 años diagnosticado de anquiloglosia severa que acude por dificultad en la pronunciación del fonema “RR”. Se realiza el tratamiento quirúrgico del frenillo mediante electrobisturí y su seguimiento por un logopeda. Conclusiones: El diagnóstico de la patología y la planificación quirúrgica y miofuncional deben tener en cuenta la clasificación del frenillo, la edad del paciente y la anatomía de la región. El tratamiento de la patología asociada al frenillo lingual corto requiere de un equipo multidisciplinar para evitar la recidiva. (AU)

Introduction: The short lingual frenulum can cause breastfeeding difficulties during the first months of life in the neonate. From language development they can be the cause of inadequate phonetics. Surgical treatment of the frenulum must be accompanied by adequate multidisciplinary treatment to improve the correction of pronunciation difficulties. The objective of this article is to present a representative clinical case of the diagnosis, surgical treatment and myofunctional rehabilitation of the short lingual frenulum, as well as to update the available scientific evidence. Case Report: A 6-year-old male patient is presented, diagnosed with severe ankyloglossia who came due to difficulty in pronouncing the phoneme “RR”. Surgical treatment of the frenulum was performed using electrocautery and its follow-up by a speech therapist. Conclusions: The diagnosis of the pathology and the surgical and myofunctional planning must take into account the classification of the frenulum, the age of the patient and the anatomy of the region. The treatment of the pathology associated with short lingual frenulum requires a multidisciplinary team to avoid recurrence. (AU)

Manejo odontológico del paciente con frenillo lingual corto: a propósito de un caso / Dental management of the patient with short lingual frenulum: a case report

Introducción: El frenillo lingual corto puede provocar dificultades en la lactancia durante los primeros meses de vida en el neonato. A partir del desarrollo del lenguaje puede ser la causa de una fonética inadecuada. El tratamiento quirúrgico del frenillo debe ir acompañado por un adecuado tratamiento multidisciplinar para favorecer la corrección de las dificultades en la pronunciación. El objetivo del presente artículo es presentar un caso clínico representativo del diagnóstico, tratamiento quirúrgico y rehabilitación miofuncional del frenillo lingual corto, así como analizar la evidencia científica disponible. Caso clínico: Se presenta un paciente varón de 6 años diagnosticado de anquiloglosia severa que acude por dificultad en la pronunciación del fonema “RR”. Se realiza el tratamiento quirúrgico del frenillo mediante electrobisturí y su seguimiento por un logopeda. Conclusiones: El diagnóstico de la patología y la planificación quirúrgica y miofuncional deben tener en cuenta la clasificación del frenillo, la edad del paciente y la anatomía de la región. El tratamiento de la patología asociada al frenillo lingual corto requiere de un equipo multidisciplinar para evitar la recidiva. (AU)

Introduction: The short lingual frenulum can cause breastfeeding difficulties during the first months of life in the neonate. From language development they can be the cause of inadequate phonetics. Surgical treatment of the frenulum must be accompanied by adequate multidisciplinary treatment to improve the correction of pronunciation difficulties. The objective of this article is to present a representative clinical case of the diagnosis, surgical treatment and myofunctional rehabilitation of the short lingual frenulum, as well as to update the available scientific evidence. Case Report: A 6-year-old male patient is presented, diagnosed with severe ankyloglossia who came due to difficulty in pronouncing the phoneme “RR”. Surgical treatment of the frenulum was performed using electrocautery and its follow-up by a speech therapist. Conclusions: The diagnosis of the pathology and the surgical and myofunctional planning must take into account the classification of the frenulum, the age of the patient and the anatomy of the region. The treatment of the pathology associated with short lingual frenulum requires a multidisciplinary team to avoid recurrence. (AU)

Effects of a sidestream concentrated oxygen supply system on the membrane filtration performance of a high-loaded membrane bioreactor.

To investigate the influence of high-pressure and shear effects introduced by a concentrated oxygen supply system on the membrane filtration performance, a laboratory-scale membrane bioreactor (MBR) fed artificial municipal wastewater was operated continuously for 80 days in four phases equipped with different aerations systems: (P1) bubble diffusers (days 0-40), (P2) concentrated oxygen supply system, the supersaturated dissolved oxygen (SDOX) (days 41-56), (P3) bubble diffusers (days 57-74), and (P4) SDOX (days 75-80). Various sludge physical-chemical parameters, visual inspection of the membrane, and permeability evaluations were performed. Results showed that the high-pressure effects contributed to fouling of the membranes compared to the bubble diffuser aeration system. Biofouling by microorganisms appeared to be the main contributor to the cake layer when bubble diffusers were used, while fouling by organic matter seemed to be the main contributor to the cake layer when SDOX was used. Small particle size distribution (PSD) (ranging from 1 to 10 and 1-50 µm in size) fractions are a main parameter affecting the intense fouling of membranes (e.g., formation of a dense and thin cake layer). However, PSD alone cannot explain the worsened membrane fouling tendency. Therefore, it can be assumed that a combination of several factors (which certainly includes PSD) led to the severe membrane fouling caused by the high-pressure and shear.

Putative metabolism of Ca. Accumulibacter via the utilization of glucose.

Ca. Accumulibacter was the predominant microorganism (relative FISH bio-abundance of 67 ± 5%) in a lab-scale sequential batch reactor that accomplished enhanced biological phosphorus removal (EBPR) while using glucose and acetate as the carbon sources (1:1 COD-based ratio). Both organic compounds were completely anaerobically consumed. The reactor's performance in terms of P/C ratio, phosphorous release and uptake, and overall kinetic and stoichiometric parameters were on the high end of the reported spectrum for EBPR systems (100:9.3 net mg phosphate removal per mg COD consumed when using glucose and acetate in a 1:1 ratio). The batch tests showed that, to the best of our knowledge, this is the first time a reactor enriched with Ca. Accumulibacter can putatively utilize glucose as the sole carbon source to biologically remove phosphate (COD:P (mg/mg) removal ratio of 100:6.3 when using only glucose). Thus, this research proposes that Ca. Accumulibacter directly anaerobically stored the fed glucose primarily as glycogen by utilizing the ATP provided via the hydrolysis of poly-P and secondarily as PHA by balancing its ATP utilization (glycogen generation) and formation (PHA storage). Alternative hypotheses are also discussed. The reported findings could challenge the conventional theories of glucose assimilation by Ca. Accumulibacter, and can be of significance for the biological removal of phosphorus from wastewaters with high contents of fermentable compounds or low VFAs.

Dental treatment under general anesthesia in patients with severe intellectual disability at the Gregorio Marañón General University Hospital: a 10-year retrospective study.

OBJECTIVES: There is a high demand for dental treatment in a hospital setting for patients with severe intellectual disability (ID), due to their inability to cooperate. The objective was to determine the types of dental treatment carried out on patients with severe ID, as well as the possibility of performing clinical and radiographic examinations prior to treatment and to identify their characteristics. METHOD AND MATERIALS: A retrospective observational study was performed, based on the medical histories of patients with severe ID or a disability included in the portfolio of dental services of Community of Madrid, who underwent dental treatment at the Stomatology Service of the Gregorio Marañón General University Hospital from the year 2009 to 2019. Data on age, sex, etiology of disability, and dental treatment were obtained. RESULTS: A total of 1,845 patients were included. The type of disability in the majority of cases was unknown, followed by encephalopathy, cerebral paralysis, and Down syndrome. In total, 8,439 dental extractions were performed on 1,548 patients (83.9%). Clinical and radiographic exploration were carried out on 874 patients (47.4%). CONCLUSIONS: Ultrasonic scaling was the most frequently performed treatment in patients. Dental extractions were the next most common treatment. An increase in age showed a higher demand for surgical procedures and extractions. Over half of the patients (52.6%) did not tolerate clinical or radiographic examinations.

Brain complications from odontogenic infections: A systematic review.

PURPOSE: Odontogenic infections can spread through different routes to more remote anatomical areas, such as the brain. Brain abscesses have an incidence of 0.3-1.3 / 100,000 population and only 2-5% are of dental origin. The main objective is to research brain complications derived from odontogenic infections. Secondary objectives were to identify the most common symptoms in brain abscess, to describe the microbiology involved in these infectious processes, report which parts of the brain complex are most commonly affected and report the sequelae of this patients. METHODS: A systematic review following the PRISMA Guide and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports was carried out in PubMed, Scopus and Web of Science. The search terms were: Brain infection, brain abscess, oral health oral origin, odont* infect*. RESULTS: The database search identified a total of 1000 articles. A total of 18 publications were identified after applying inclusion and exclusion criteria. A total of 38 patients were analyzed. Mean age was 49.64±18.80 years. CONCLUSION: The most common symptoms of patients with brain abscess are neurological affectations first and then fever and headache second, without necessarily presenting as a symptomatological triad. Microbiological diagnosis is key to determining the origin of the infection. Anaerobic pathogens such as Streptococcus (F. Milleri), Fusobacterium Nucleatum and Porfiromonas Gingivalis families are common bacterial agents. The frontal lobe is the most frequently affected, followed by the parietal and temporal lobe. The most frequent brain complications are neurological disorders. However, most patients with brain abscesses recover without sequelae.

Burnout syndrome assessment among Spanish oral surgery consultants: A two populations comparative pilot study

Background: The professional Burnout Syndrome (BOS) or Burnout is considered a professional disease made up of three interrelated dimensions (emotional exhaustion, depersonalization and lack of personal fulfillment). BOS has been documented to most severely affect the healthcare professions, especially dentists. On the other hand, its appearance has been documented at an early age, during dental training. However, there are no studies that analyze its incidence in professionals dedicated to Oral Surgery and Implantology, determining the age of onset and related factors. Material and Methods: The modified Maslach questionnaire was carried out anonymously among the professors and students of the Master of Oral Surgery and Implantology at the Complutense University of Madrid. A total of 36 participants were enrolled in this study and the results of the modified Maslach Questionnaire were established into four groups [1st year (n=6), 2nd year (n=6), 3rd year (n=6) postgraduate students and clinical teachers (n=18)]. The following variables were recorded: Age, sex, years of experience, weekly hours of work, dedication on weekends and scope of work. The statistical analysis performed included Pearson's correlation, analysis of variance, Student's t-test, F-Anova, Chi-Square and Gamma correlation. Statistical Significance of the tests was established of p≤0.05. Results: 36 questionnaires were analyzed, of which 22.2% (n = 8) presented BOS, and 77.8% (n = 28) a medium risk of suffering it. The mean values and standard deviation ​​of emotional exhaustion (7.50 ± 2.43; 9.83 ± 4.12; 15.83 ± 6.21; 30.22 ± 7.86), depersonalization (5.50 ± 1.23; 50 ± 3.27; 11.33 ± 1.75; 17.56 ± 4.13), low personal fulfillment (39.67 ± 3.72; 39.33 ± 2.34; 43.17 ± 3, 55; 37.33 ± 5.51) and professional burnout (54.33 ± 2.66; 61.67 ± 2.88; 70.33 ± 5.43; 85.11 ± 9.05) in the four groups respectively. A significant association was found in the appearance of emotional exhaustion and depersonalization, years of experience, weekly work hours and the work environment. Conclusions: BOS is a disease that can appear from 30 years of age, after 5 years of professional experience and when there is a clinical consultation of 40 hours a week. Oral Surgery and Implantology seems to be a risk activity for the manifestation of depersonalization.(AU)

Supersaturated-oxygen aeration effects on a high-loaded membrane bioreactor (HL-MBR): Biological performance and microbial population dynamics.

Conventional diffused aeration systems (such as fine-bubble diffusers) exhibit a poor oxygen transfer in wastewater treatment plants (WWTPs), particularly when operating at sludge concentrations higher than 15 g L-1. The supersaturated dissolved oxygen (SDOX) system has been proposed as an alternative for supplying dissolved oxygen (DO) at high mixed liquor suspended solids (MLSS) concentrations. The advantages introduced by such technology include the possibility of operating WWTPs at much higher than usual MLSS concentrations, increasing the treatment capacity of WWTPs. Recent studies have demonstrated that the SDOX system has higher oxygen transfer rates (OTRs) and oxygen transfer efficiencies (OTEs) relative to fine-bubble diffusers. However, it is unknown if the high-pressure conditions introduced by SDOX may possibly impact the biological performance of WWTPs. In this study, the effects of SDOX technology on the biological performance of a membrane bioreactor (MBR) were evaluated. The MBR was operated at an MLSS concentration of approximately 15 g L-1 in four phases as follows: (P1) with bubble diffusers, (P2) with an SDOX unit, (P3) with the bubble diffusers, and (P4) with the SDOX unit. The performance of the MBR was assessed by monitoring the sludge concentration, as well as changes in the particle size distribution (PSD), sludge activity, organic matter removal and nitrification performance, and changes in the microbial community within the MBR. The operational conditions exerted by the SDOX technology did not affect the concentration of active biomass during the study period. The biological performance of the MBR was not affected by the introduction of the SDOX technology. Finally, the microbial community was relatively stable although some variations at the family and genus level were evident during each of the study phases. Therefore, the SDOX system can be proposed as an alternative technology for DO supply in WWTPs increasing the overall treatment capacity.

Use of near-infrared spectroscopy on predicting wastewater constituents to facilitate the operation of a membrane bioreactor.

The use of near-infrared (NIR) spectroscopy in wastewater treatment has continuously expanded. As an alternative to conventional analytical methods for monitoring constituents in wastewater treatment processes, the use of NIR spectroscopy is considered to be cost-effective and less time-consuming. NIR spectroscopy does not distort the measured sample in any way as no prior treatment is required, making it a waste-free technique. On the negative side, one has to be very well versed with chemometric techniques to interpret the results. In this study, filtered and centrifuged wastewater and sludge samples from a lab-scale membrane bioreactor (MBR) were analysed. Two analytical methods (conventional and NIR spectroscopy) were used to determine and compare major wastewater constituents. Particular attention was paid to soluble microbial products (SMPs) and extracellular polymeric substances (EPSs) known to promote membrane fouling. The parameters measured by NIR spectroscopy were analysed and processed with partial least squares regression (PLSR) and artificial neural networks (ANN) models to assess whether the evaluated wastewater constituents can be monitored by NIR spectroscopy. Very good results were obtained with PLSR models, except for the determination of SMP, making the model qualitative rather than quantitative for their monitoring. ANN showed better performance in terms of correlation of NIR spectra with all measured parameters, resulting in correlation coefficients higher than 0.97 for training, testing, and validation in most cases. Based on the results of this research, the combination of NIR spectra and chemometric modelling offers advantages over conventional analytical methods.

Plant Organellar DNA Polymerases Evolved Multifunctionality through the Acquisition of Novel Amino Acid Insertions.

The majority of DNA polymerases (DNAPs) are specialized enzymes with specific roles in DNA replication, translesion DNA synthesis (TLS), or DNA repair. The enzymatic characteristics to perform accurate DNA replication are in apparent contradiction with TLS or DNA repair abilities. For instance, replicative DNAPs incorporate nucleotides with high fidelity and processivity, whereas TLS DNAPs are low-fidelity polymerases with distributive nucleotide incorporation. Plant organelles (mitochondria and chloroplast) are replicated by family-A DNA polymerases that are both replicative and TLS DNAPs. Furthermore, plant organellar DNA polymerases from the plant model Arabidopsis thaliana (AtPOLIs) execute repair of double-stranded breaks by microhomology-mediated end-joining and perform Base Excision Repair (BER) using lyase and strand-displacement activities. AtPOLIs harbor three unique insertions in their polymerization domain that are associated with TLS, microhomology-mediated end-joining (MMEJ), strand-displacement, and lyase activities. We postulate that AtPOLIs are able to execute those different functions through the acquisition of these novel amino acid insertions, making them multifunctional enzymes able to participate in DNA replication and DNA repair.

Inactivation of indicator organisms on different surfaces after urban floods.

The high frequency and intensity of urban floods caused by climate change, urbanisation and infrastructure failures increase public health risks when the flood water contaminated from combined sewer overflows (CSOs) or other sources of faecal contamination remains on urban surfaces. This study contributes to a better understanding of the effects of urban and recreational surfaces on the occurrence of waterborne pathogens. The inactivation of selected indicator organisms was studied under controlled exposure to artificial sunlight for 6 h followed by 18 h in dark conditions. Concrete, asphalt, pavement blocks and glass as control were inoculated with artificial floodwater containing, as indicator organisms, Escherichia coli bacteria, which are common faecal indicator bacteria (FIB) for water quality assessment, Bacillus subtilis spores chosen as surrogates for Cryptosporidium parvum oocysts and Giardia cysts, and bacteriophages MS2 as indicators for viral contamination. On practically all the surfaces in this study, E. coli had the highest inactivation under light conditions followed by MS2 and B. subtilis, except asphalt where MS2 was inactivated faster. The highest inactivation under light conditions was seen with E. coli on a concrete surface (pH 9.6) with an inactivation rate of 1.85 h-1. However, the pH of the surfaces (varying between 7.0 and 9.6) did not have any influence on inactivation rates under dark conditions. MS2 bacteriophage had the highest inactivation under light conditions on asphalt with a rate of 1.29 h-1. No die-off of B. subtilis spores was observed on any of the surfaces during the experiment, neither in light nor in dark conditions. This study underpins the need to use different indicator organisms to test their inactivation after flooding. It also suggests that given the sunlight conditions, concentration of indicator organisms and type of surface, the fate of waterborne pathogens after a flood could be estimated.

Die-off of E. coli as fecal indicator organism on different surfaces after urban floods.

A better understanding of the effects of different urban and recreational surfaces on the die-off of water-borne pathogens that can cause infections after urban floods if released from surcharged combined sewers and other sources of fecal contamination is needed. The die-off of fecal indicator Escherichia coli was studied under controlled exposure to simulated sunlight on a range of different surfaces found in urban environments: gravel, sand, asphalt, pavement blocks, concrete, playground rubber tiles and grass, using glass as control. The surfaces were inoculated with artificial flooding water containing 105 colony forming units (CFU) of E. coli per mL and sampled periodically using the sterile cotton swab technique, after lowering the water level. The results show that dark inactivation was not statistically significant for any surface, suggesting that chemical composition and pH (varying between 6.5 ±â€¯0.8 and 9.2 ±â€¯0.4) did not affect the die-off rates. The highest light-induced die-off rates for E. coli after the floodwater recession, observed on rubber (>3.46 h-1) and asphalt (2.7 h-1), were attributed to temperature stress and loss of surface moisture.

Effect of Lactate on the Microbial Community and Process Performance of an EBPR System.

Candidatus Accumulibacter phosphatis is in general presented as the dominant organism responsible for the biological removal of phosphorus in activated sludge wastewater treatment plants. Lab-scale enhanced biological phosphorus removal (EBPR) studies, usually use acetate as carbon source. However, the complexity of the carbon sources present in wastewater could allow other potential poly-phosphate accumulating organism (PAOs), such as putative fermentative PAOs (e.g., Tetrasphaera), to proliferate in coexistence or competition with Ca. Accumulibacter. This research assessed the effects of lactate on microbial selection and process performance of an EBPR lab-scale study. The addition of lactate resulted in the coexistence of Ca. Accumulibacter and Tetrasphaera in a single EBPR reactor. An increase in anaerobic glycogen consumption from 1.17 to 2.96 C-mol/L and anaerobic PHV formation from 0.44 to 0.87 PHV/PHA C-mol/C-mol corresponded to the increase in the influent lactate concentration. The dominant metabolism shifted from a polyphosphate-accumulating metabolism (PAM) to a glycogen accumulating metabolism (GAM) without EBPR activity. However, despite the GAM, traditional glycogen accumulating organisms (GAOs; Candidatus Competibacter phosphatis and Defluvicoccus) were not detected. Instead, the 16s RNA amplicon analysis showed that the genera Tetrasphaera was the dominant organism, while a quantification based on FISH-biovolume indicated that Ca. Accumulibacter remained the dominant organism, indicating certain discrepancies between these microbial analytical methods. Despite the discrepancies between these microbial analytical methods, neither Ca. Accumulibacter nor Tetrasphaera performed biological phosphorus removal by utilizing lactate as carbon source.

Limitations imposed by conventional fine bubble diffusers on the design of a high-loaded membrane bioreactor (HL-MBR).

The operation of membrane bioreactors (MBRs) at higher than usual mixed liquor suspended solids (MLSS) concentrations may enhance the loading rate treatment capacity while minimizing even further the system's footprint. This requires operating the MBR at the highest possible MLSS concentration and biomass activity (e.g., at high loading rates and low solid retention times (SRTs)). Both a negative effect of the MLSS concentrations and a positive effect of the SRT on the oxygen transfer have been reported when using conventional fine bubble diffusers. However, most of the evaluations have been carried out either at extremely high SRTs or at low MLSS concentrations eventually underestimating the effects of the MLSS concentration on the oxygen transfer. This research evaluated the current limitations imposed by fine bubble diffusers in the context of the high-loaded MBR (HL-MBR) (i.e., high MLSS and short SRT-the latter emulated by concentrating municipal sludge from a wastewater treatment plant (WWTP) operated at a short SRT of approximately 5 days). The high MLSS concentrations and the short SRT of the original municipal sludge induced a large fraction of mixed liquor volatile suspended solids (MLVSS) in the sludge, promoting a large amount of sludge flocs that eventually accumulated on the surface of the bubbles and reduced the free water content of the suspension. Moreover, the short SRTs at which the original municipal sludge was obtained eventually appear to have promoted the accumulation of surfactants in the sludge mixture. This combination exhibited a detrimental effect on the oxygen transfer. Fine bubble diffusers limit the maximum MLSS concentration for a HL-MBR at 30 g L-1; beyond that point is either not technically or not economically feasible to operate; an optimum MLSS concentration of 20 g L-1 is suggested to maximize the treatment capacity while minimizing the system's footprint.

Recent advances in bio-P modelling - a new approach verified by full-scale observations.

This paper summarizes recent developments in biological phosphorus removal modelling, with special attention to side-stream enhanced biological phosphorus removal (S2EBPR) systems on which previous models proved to be ineffective without case-by-case parameter adjustments. Through the research and experience of experts and practitioners, a new bio-kinetic model was developed including an additional group of biomass (glycogen accumulating organisms - GAOs) and new processes (such as aerobic and anoxic maintenance for PAO and GAO; enhanced denitrification processes; fermentation by PAOs which - along with PAO selection - is driven by oxidation-reduction potential (ORP)). This model successfully described various conditions in laboratory measurements and full plant data. The calibration data set is provided by Clean Water Services from Rock Creek Facility (Hillsboro, OR) including two parallel trains: conventional A2O and Westbank configurations, allowing the model to be verified on conventional and side-stream EBPR systems as well.

Reporte del primer caso de lobectomía para el tratamiento de epilepsia refractaria de lóbulo temporal en el Perú / Report of the first case of lobectomy for the treatment of refractory temporal lobe epilepsy in Peru

Se presenta el caso de una paciente con epilepsia refractaria de lóbulo temporal debida a esclerosis mesial temporal, sometida a la primera lobectomía temporal efectuada en el Perú. El resultado ha sido exitoso, ya que la paciente continúa libre de crisis convulsivas después de más de 4 años de periodo post-operatorio. Se comentan las implicaciones de lo que puede constituir un hito en la historia de la neurología y neurocirugía en el Perú.

The case of a female patient with the diagnosis of refractory temporal lobe epilepsy due to mesial temporal sclerosis is presented. She underwent temporal lobectomy, the first intervention of this type performed in Peru. The outcome has been successful, as the patient remains seizure-free four years into her post-surgical period. The implications of what may be considered a landmark in the history of neurology and neurosurgery in Peru are commented upon.

Denitrification of nitrate and nitrite by 'Candidatus Accumulibacter phosphatis' clade IC.

Phosphate accumulating organisms (PAO) are assumed to use nitrate as external electron acceptor, allowing an efficient integration of simultaneous nitrogen and phosphate removal with minimal organic carbon (COD) requirements. However, contradicting findings appear in literature regarding the denitrification capacities of PAO due to the lack of clade specific highly enriched PAO cultures. Whereas some studies suggest that only PAO clade I may be capable of using nitrate as external electron acceptor for anoxic P-uptake, other studies indicate that PAO clade II may be responsible for anoxic P-removal. In the present study, a highly enriched PAO clade IC culture (>99% according to FISH) was cultivated in an SBR operated under Anaerobic/Oxic conditions and subsequently exposed to Anaerobic/Anoxic/Oxic conditions using nitrate as electron acceptor. Before and after acclimatization to the presence of nitrate, the aerobic and anoxic (nitrate and nitrite) activities of the PAO I culture were assessed through the execution of batch tests using either acetate or propionate as electron donor. In the presence of nitrate, significant P-uptake by PAO I was not observed before or after acclimatization. Using nitrite as electron acceptor, limited nitrite removal rates were observed before acclimatization with lower rates in the acetate fed reactor without P-uptake and slightly higher in the propionate fed reactor with a marginal anoxic P-uptake. Only after acclimatization to nitrate, simultaneous P and nitrite removal was observed. This study suggests that PAO clade IC is not capable of using nitrate as external electron acceptor for anoxic P-removal. The elucidation of the metabolic capacities for individual PAO clades helps in better understanding and optimization of the relation between microbial ecology and process performance in enhanced biological phosphate removal processes.

Metabolic Response of "Candidatus Accumulibacter Phosphatis" Clade II C to Changes in Influent P/C Ratio.

The objective of this study was to investigate the ability of a culture highly enriched with the polyphosphate-accumulating organism, "Candidatus Accumulibacter phosphatis" clade IIC, to adjust their metabolism to different phosphate availabilities. For this purpose the biomass was cultivated in a sequencing batch reactor with acetate and exposed to different phosphate/carbon influent ratios during six experimental phases. Activity tests were conducted to determine the anaerobic kinetic and stoichiometric parameters as well as the composition of the microbial community. Increasing influent phosphate concentrations led to increased poly-phosphate content and decreased glycogen content of the biomass. In response to higher biomass poly-phosphate content, the biomass showed higher specific phosphate release rates. Together with the phosphate release rates, acetate uptake rates also increased up to an optimal poly-phosphate/glycogen ratio of 0.3 P-mol/C-mol. At higher poly-phosphate/glycogen ratios (obtained at influent P/C ratios above 0.051 P-mol/C-mol), the acetate uptake rates started to decrease. The stoichiometry of the anaerobic conversions clearly demonstrated a metabolic shift from a glycogen dominated to a poly-phosphate dominated metabolism as the biomass poly-phosphate content increased. FISH and DGGE analyses confirmed that no significant changes occurred in the microbial community, suggesting that the changes in the biomass activity were due to different metabolic behavior, allowing the organisms to proliferate under conditions with fluctuating phosphate levels.