No abstract

The bacterial community composition of the full-scale biologically active, granular activated carbon (BAC) filters operated at the St. Paul Regional Water Services (SPRWS) was investigated using Illumina MiSeq analysis of PCR-amplified 16S rRNA gene fragments. These bacterial communities were consistently diverse (Shannon index, >4.4; richness estimates, >1,500 unique operational taxonomic units [OTUs]) throughout the duration of the 12-month study period. In addition, only modest shifts in the quantities of individual bacterial populations were observed; of the 15 most prominent OTUs, the most highly variable population (a Variovorax sp.) modulated less than 13-fold over time and less than 8-fold from filter to filter. The most prominent population in the profiles was a Nitrospira sp., representing 13 to 21% of the community. Interestingly, very few of the known ammonia-oxidizing bacteria (AOB; <0.07%) and no ammonia-oxidizing Archaea were detected in the profiles. Quantitative PCR of amoA genes, however, suggested that AOB were prominent in the bacterial communities (amoA/16S rRNA gene ratio, 1 to 10%). We conclude, therefore, that the BAC filters at the SPRWS potentially contained significant numbers of unidentified and novel ammonia-oxidizing microorganisms that possess amoA genes similar to those of previously described AOB. P ublic water utilities use surface water to produce high-quality, potable drinking water for almost 70% of the people residing in the United States (1). The conventional process for treating surface water involves a series of unit operations that include coagulation, flocculation, sedimentation, filtration, and disinfection (2). The application of these technologies has generally proven effective for protecting public health (2), although numerous exceptions have been reported (3). Given the presumptive safety of public water supplies, water consumers are increasingly concerned about the taste and odor of public water supplies as well as other esthetic concerns (4).Public water utilities, therefore, have begun to augment their treatment processes to specifically remove taste-and odor-causing compounds, such as geosmin and 2-methylisoborneol (5-7). Although a few alternative technologies can be used, filtration using biologically active, granular activated carbon (BAC) has proven successful because of its simplicity (i.e., it is easily retrofitted into preexisting operations) and effectiveness (8, 9). Filtration with BAC differs from filtration with conventional granular media (e.g., sand and anthracite) because of its high sorptive capacity (6, 8) as well as the active biofilm that grows on its surface (10-13). The biofilm on the BAC filter medium provides direct biodegradation of dissolved geosmin as well as biological regeneration of the filter medium by metabolizing the initially sorbed geosmin as it desorbs from the carbon (8,14).In this study, we investigated the bacterial community dynamics of the full-scale BAC filters at the Saint Paul Regional Water Surfaces (SPRWS) in St. Pau...

Introduction. The log odds of positive lymph nodes (LODDS) is an empiric transform formula that incorporates positive and negative lymph node data into a single ratio for prognostic utility. We sought to determine the value of the log odds ratio as a prognostic indicator compared with established lymph node indices in advanced-stage rectal cancer patients who have undergone curative resection. Methods. Retrospective analysis of rectal cancer operations from 1995 to 2013 identified all stage III cancer patients who underwent curative resection. Patients were stratified into three groups according to calculated lymph node ratios (LNRs) and log odds ratios (LODDS). The relationship between LNR, LODDS, and 5-year overall survival (OS) were assessed.

Background The prevalence of super obesity (SO, BMI > 50.0 kg/m 2) and super-super obesity (SSO, BMI > 60 kg/m 2) is increasing. Current data are limited and discrepant on the relationship between SSO and post-bariatric surgery complication risk. We hypothesized there would be increased complications for both laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG) in SSO compared to SO, but the relative risk (RR) would support the use of LSG in SSO patients. Methods Metabolic and Bariatric Surgery Accreditation and Quality Improvement 2016 data were queried for SO and SSO patients undergoing LRYGB or LSG. Thirty-day post-operative complications were calculated. Univariate analyses were performed with a χ 2 or Student's t test. Comparisons between multiple groups were performed using a one-way ANOVA. Statistical significance was defined as p < 0.05. Results A total of 5723 patients with SSO and 24,940 with SO were included for analysis. Patients with SSO had more comorbidities. Patients with SSO had a higher likelihood of complications compared to SO patients (15.2% vs 12.6%, p < 0.0005). SSO patients, and specifically SSO RYGB, were significantly more likely to experience an unplanned intubation, prolonged ventilation, and unplanned ICU admission. Compared to SO LRYGB, the RR for complications in SSO LRYGB and LGS were 1.19 and 0.76 respectively (p < 0.0005). Discussion We found SSO patients had increased 30-day post-operative complications after both LRYGB and LSG compared to SO patients. LSG may be the preferred procedure for this high-risk population.

BACKGROUND: Optimal management of neutropenic appendicitis (NA) in children undergoing cancer therapy remains undefined. Management strategies include upfront appendectomy or initial nonoperative management. We aimed to characterize the effect of management strategy on complications and length of stay (LOS) and describe implications for chemotherapy delay or alteration.METHODS: Sites from the Pediatric Surgery Oncology Research Collaborative performed a retrospective review of children with NA over a 6-year period.RESULTS: Sixty-six children, with a median age of 11 years (range 1-17), were identified with NA while undergoing cancer treatment. The most common cancer diagnoses were leukemia (62%) and brain tumor (12%). Upfront appendectomy was performed in 41% of patients; the remainder had initial nonoperative management. Rates of abscess or perforation at diagnosis were equivalent in the groups (30% vs 24%; P = .23). Of patients who had initial nonoperative management, 46% (17 of 37) underwent delayed appendectomy during the same hospitalization. Delayed appendectomy was due to failure of initial nonoperative management in 65% (n = 11) and count recovery in 35% (n = 6). Cancer therapy was delayed in 35% (n = 23). Initial nonoperative management was associated with a delay in cancer treatment (46% vs. 22%, P = .05) and longer LOS (29 vs 12 days; P = .01). Patients who had initial nonoperative management and delayed appendectomy had a higher rate of postoperative complications (P , .01). CONCLUSIONS:In pediatric patients with NA from oncologic treatment, upfront appendectomy resulted in lower complication rates, reduced LOS, and fewer alterations in chemotherapy regimens compared to initial nonoperative management. WHAT'S KNOWN ON THIS SUBJECT:The optimal management of neutropenic appendicitis in children undergoing cancer therapy remains undefined. Management strategies include upfront appendectomy or initial nonoperative management. There are no accepted consensus guidelines. As a result, there is provider-dependent variation in treatment strategies.WHAT THIS STUDY ADDS: In this largest sample to date of pediatric patients with appendicitis and neutropenia secondary to oncologic treatment, upfront appendectomy was associated with lower complication rates, reduced lengths of stay, and fewer alterations in chemotherapy regimens, as compared to upfront nonoperative management.