Effect of Thoracic Paravertebral Nerve Block on Blood Coagulation in Patients After Thoracoscopic Lobectomy: A Prospective Randomized Controlled Clinical Trial.

PURPOSE: Ultrasound-guided thoracic paravertebral block (TPVB) has become increasingly popular for postoperative analgesia after thoracic surgery. We designed this prospective, randomized, double-blind, placebo-controlled trial to investigate the effect of TPVB on blood coagulation in patients after thoracoscopic lobectomy. PATIENTS AND METHODS: Sixty patients scheduled for thoracoscopic lobectomy were randomly allocated to two groups. Patients underwent ultrasound-guided TPVB with 0.33% ropivacaine (T group) or 0.9% saline (C group) at the end of the surgery under general anesthesia. Patient-controlled intravenous analgesia (PCIA) was administered for both group after the surgery. The primary outcome was the thromboelastogram (TEG) parameters before anesthesia (T0), at the end of operation (T1) and in 1 day (T2) and 2 days (T3) after the operation, the second outcomes were the analgesic effect and the amount of intraoperative opioid consumption, operation time, infusion volume, blood loss and urine volume. RESULTS: The visual analog scale (VAS) scores in group T were lower than group C (P < 0.05). In group T, compared with T0, the R value at T1 and T2 is significantly reduced, and the K value at T1 were significantly shortened, the α-angle and MA value at T1 were significantly increased (P < 0.05). In group C, compared with T0, the R value and K value were significantly shortened, the α-angle and MA value were significantly increased at all postoperative time points (P < 0.05). Compared with group C at the same time point, the R and K values of group T were significantly longer, and the α-angle and MA values were significantly reduced at T2 and T3 points, with statistically significant differences (P<0.05). CONCLUSION: TPVB is beneficial to improve postoperative hypercoagulability and promote postoperative rehabilitation of patients after thoracoscopic lobectomy.

Advanced nitrogen removal from municipal wastewater via two-stage partial nitrification-simultaneous anammox and denitrification (PN-SAD) process.

A modified two-stage anammox process was constructed and achieved advanced nitrogen removal from municipal wastewater. The first stage was Partial Nitrification (PN), in which nitrite accumulation rate was over 95% by controlling dissolved oxygen concentration (<1 mg/L) and aeration time (90-120 min). The second stage was simultaneous anammox and denitrification (SAD), in which the reactor was fed with the effluent of the first stage and a part of raw wastewater. The effluent total inorganic nitrogen (NH4+-N, NO2--N and NO3--N) was only 1.6 ± 0.8 mg N/L and the nitrogen removal efficiency reached 97.1%. The proportion of anammox in nitrogen removal was up to 73-82% and Candidatus Brocadia was the main anammox genus accounted for 8.0-2.2%. And partial denitrification occurred with the appearance of Thauera (0-1.0%). The PN-SAD process is an energy-saving treatment for municipal wastewater with a total hydraulic retention time of 6 h.