Recovery patterns in patients undergoing revision surgery of the primary knee prosthesis.

PURPOSE: Despite good survival rates of revised knee prostheses, little is known about recovery trajectories within the first 12 months after surgery. This retrospective observational study explored recovery trajectories in terms of pain, function and quality of life in patients after revision knee arthroplasty over 12 months. METHODS: Eighty-eight revision knee arthroplasty patients rated changes in daily physical functioning using the anchor question (0: very much worsened; 7: very much improved). Patient reported outcome measures (PROMs) of pain (range 0-10), function (Oxford Knee Score) and quality of life (EQ-5D-3L) were assessed preoperatively, at 3 and 12 months postoperatively. Four recovery trajectories were identified using the anchor question at 3 and 12 months postoperatively: no improvement, late improvement, early improvement, and prolonged improvement. Repeated measures ANOVA was conducted with recovery trajectories as dependent variable and PROM assessments as independent variables. RESULTS: Sixty percent reported improvement in daily physical functioning at 12 months postoperatively. Age and reason for revision differed between groups. Pain, function and EQ-5D-3L differed between groups over time. Late and prolonged improvement groups improved on all PROMs at 12 months. The early improvement group did not report improvement in daily physical functioning at 12 months, while improvements in function and pain during activity were observed. CONCLUSIONS: Different recovery trajectories seem to exist and mostly match PROMs scores over time. Not all patients may experience beneficial outcome of revision knee arthroplasty. These findings are of importance to provide appropriate information on possible recovery trajectories after revision knee arthroplasty to patients. LEVEL OF EVIDENCE: III.

SHARON process evaluated for improved wastewater treatment plant nitrogen effluent quality.

New stricter nitrogen effluent standards and increasing influent loads require existing wastewater treatment plans (WWTPs) to extend or optimize. At WWTPs with limited aeration capacity, limited denitrification capacity or shortage of aerobic sludge age, implementation of SHARON to improve nitrogen effluent quality can be a solution. SHARON is a compact, sustainable and cost-effective biological process for treatment of nitrogen-rich rejection waters. At WWTP Rotterdam-Dokhaven and WWTP Utrecht a SHARON has been in operation for several years. For both WWTPs the effect of SHARON on the nitrogen effluent quality has been evaluated. WWTP Rotterdam-Dokhaven has limited aeration capacity. By implementation of SHARON, the ammonia load of the effluent was reduced by 50%. WWTP Utrecht had limited denitrification capacity. The implementation of SHARON improved the effluent nitrate load by 40%. The overall TN removal efficiency increased from 65% to over 75% and strict nitrogen effluents standards (TN = 10 mg N/l) could be reached. Through modelling and supported by full scale practice it has been shown that by implementation of SHARON in combination with enhanced influent pre-treatment, the aerobic sludge age can be extended to maintain total nitrogen removal at lower temperatures.

Overview: full scale experience of the SHARON process for treatment of rejection water of digested sludge dewatering.

A SHARON system has been constructed at the Utrecht WWTP and at the Rotterdam Dokhaven WWTP. In the SHARON process rejection water from dewatering of digested sludge is treated for N-removal. It concerns a high active process operating without sludge retention. Due to differences in growth rate nitrite oxidisers can be washed out of the system while ammonia oxidisers are maintained, resulting in N-removal over nitrite. The SHARON process was selected in competition with several other techniques. The feed of a SHARON system is concentrated, with ammonia concentrations ranging from 0.5 to 1.5 g N/l. The results show that conversion rates of 90% are well possible with N-removal mainly via the nitrite route. The process was shown to be stable. Due to the high ammonium influent concentrations pH control is of great importance, preventing process inhibitions. The acidifying effect of nitrification can be compensated completely by CO2 stripping during aeration and by denitrification. Heat production by biological conversions is significant, due to the high inlet concentrations, and contributes to the optimal operating temperature of 30-40 degrees C.

Full-scale application of the SHARON process for treatment of rejection water of digested sludge dewatering.

At the Rotterdam Dokhaven WWTP the first full-scale application of the SHARON process has been constructed. In the SHARON process, rejection water from dewatering of digested sludge is treated for N-removal. It concerns a highly active process operating without sludge retention. The single tank reactor is intermittently aerated. Due to differences in growth rate nitrite oxidisers are washed out of the system while ammonia oxidisers can be maintained, resulting in N-removal over nitrite. The SHARON process has been selected after comparison with several other techniques. The feed of the SHARON tank is concentrated, with ammonia concentrations over 1 g N/l. The first results show that conversion rates of 90% are quite possible with N-removal mainly via the nitrite route. The process was shown to be stable. Due to the high inlet concentrations pH control is of great importance, preventing process inhibitions. The acidifying effect of nitrification can be compensated completely by CO2 stripping during aeration and by denitrification. Heat production by biological conversions appeared to be significant, due to the high inlet concentrations, and contributes to the optimal operating temperature of 30-40 degrees C.

Studies on the contractile vacuole of Poterioochromonas malhamensis Peterfi. II. Antimonate stains the contractile vacuole of Poterioochromonas.

Fixation of the chrysophycean flagellate Poterioochromonas malhamensis in the presence of potassium (pyro) antimonate have been carried out. Intense antimonate deposits are characteristic of the various elements of the contractile vacuole as well as a portion of the plasma membrane adjacent to the contractile vacuole. Neither pretreatment of the cells with EGTA or EDTA nor the treatment of sections with these chelators is successful in removing the antimonate precipitates. Despite this, X-ray microanalyses of these deposits indicate the presence of calcium.

Cell wall development in Oocystis solitaria in the presence of polysaccharide binding dyes.

Cell wall and thus cellulose microfibril formation in the presence of Congo red or Calcofluor white by Oocystis solitaria autospores was investigated ultrastructurally and chemically. The prevention of microfibril formation by both substances is accompanied by drastic changes of microfibril synthesis and orientation as well as the morphology of plasma-membrane-associated E-face terminal complexes. Removal of Congo red and Calcofluor white from the culture medium results in the recovery of microfibril formation, of a normal patterned microfibril arrangement, and of terminal complexes with extending microfibril imprints.