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An innovative step-feed Anaerobic-(Oxic/Anoxic)"-Membrane Bioreactor [An-(O/A)"-MBR] process was developed to treat synthetic domestic wastewater. Performance of the lab-scale system was investigated at different dissolved oxygen (DO) concentration (0.4-2.4mg/L) in the aerobic tank of the multiple A/O zone. The results showed that, under the conditions imposed, the DO level has little influence on chemical oxygen demand removal and the removal efficiency was more than 94% throughout the operation. However, DO levels have great influence on nitrogen and phosphorus removal. Better nitrification efficiency could be obtained when DO was in the range of 0.8-2.4mg/L; the ammonia removal efficiency was more than 99%. High total nitrogen (TN) and total phosphorus (TP) removal performance can be obtained when DO was in the range of 0.8-1.2mg/L; the average removal efficiency was 74.8 and 71.4%, respectively. In this condition, DO can meet the demand of nitrification and phosphorus uptake simultaneously, and the simultaneous nitrification and denitrification occurred in the aerobic tanks under lower DO concentration. Meanwhile, since the DO circulated from the aerobic tank to the anoxic tank decreased, denitrification was enhanced and the nitrate quantities in the sludge recycle system decreased, resulting in the decrease of carbon substrate competition between denitrification and phosphorus release in the anaerobic zone. Ultimately, the performance of TN and TP removal was enhanced. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the postoperatively hidden blood loss of elderly intertrochanteric fracture patients fixed with combined external fixator, and to explore the correlation between hidden blood loss and age. Methods: A retrospective analysis was conducted on 60 elderly intertrochanteric fracture patients who were admitted to the Department of Orthopedics of Hebei Provincial Hospital from January 2016 to May 2019. All the fractures were fixed with combined external fixators. The patients were divided into two groups according to the age: there were 31 cases in group A (60-80 years old) and 29 cases in group B (≥80 years old). The Gross equation and the Nandler formula were used to evaluate the amount of hidden blood loss based on changes in hematocrit (Hct) at the day preoperatively, 3 days postoperatively and the weight. The data were compared between the two groups by independent-sample t test. Results: The decreased Hct, hemoglobin(Hb) and the dominant blood loss and hidden blood loss in group A and B was 3.4%±1.7%, (13±7) g/L, (25±6) ml, (186±7) ml and 3.8%±1.2%, (13±3) g/L, (24±8) ml, (194±7) ml, respectively. There was no significant differences in the dominant and hidden blood loss between the groups ( t= 0.309, 0.883, both P> 0.05). Conclusion: The age doesn't affect the hidden blood loss in elderly intertrochanteric fracture patients fixed with combined external fixator, which indicated that the operation is safe and reliable for such patients.

Background: The role of Helicobacter pylori (H. pylori) infection in the development of colorectal neoplasia has been a matter of scientific debate with controversial findings., Aims: This study examined the association between H. pylori infection and colorectal cancer (CRC) in a nationwide population-based Chinese cohort study., Methods: A total of approximately 3936 individuals with newly diagnosed H. pylori infection (the H. pylori-infected cohort) and 15 744 age- and sex-matched patients with diagnoses absence of H. pylori infection (the comparison cohort) from 2000 to 2005 were identified from Taiwan's National Health Insurance Research Database. The Kaplan-Meier method was used for measuring the cumulative incidence of CRC in each cohort. Cox proportional hazards models were used to compute hazard ratios (HRs) and accompanying 95% confidence intervals (CIs) for the estimation of the association between H. pylori infection and CRC., Results: The cumulative incidence of CRC was higher in H. pylori-infected cohort than that in the comparison cohort (log-rank test, P < 0.001). After adjustment for potential confounders, H. pylori infection was associated with a significantly increased risk of CRC (adjusted HR 1.87; 95% CI 1.37-2.57). In addition, the HR of CRC appeared to increase with increasing frequency of clinical visits for H. pylori infection., Conclusions: Our study demonstrated that H. pylori infection was associated with an increased risk of CRC, which warrants confirmation and exploration of the underlying biologic mechanisms by future studies., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The aim of this study was to investigate the clinical application of a high-sensitivity cardiac troponin T (hs-cTnT) test in the diagnosis of acute myocardial infarction (AMI). Serum levels of hs-cTnT and cardiac troponin I (cTnI) were detected in 240 AMI patients and 200 healthy donors and used to plot receiver operating characteristic (ROC) curves. A clinically applicable diagnostic cut-off value of hs-cTnT was determined from the ROC curve and the diagnostic accuracy of hs-cTnT and cTnI levels in AMI were compared.The serum hs-cTnT levels in the AMI group were higher than 0.014 ng/mL (the 99th percentile of the healthy population), among which hs-cTnT levels in patients with ST-segment elevation myocardial infarction (STEMI) were higher than in patients with non-STEMI (NSTEMI). The area under the ROC curve (AUC) for hs-cTnT was significantly higher than for cTnI, and the detection combining hs-cTnT and creatine kinase isoenzyme (CK-MB) further increased the AUC. When 0.014 ng/mL was set as the cut-off value for hs-cTnT, the diagnostic sensitivity for AMI reached 100% but the specificity was only 45.5%. The diagnostic ability of hs-cTnT for AMI peaked at a cut-off value of 0.035 ng/mL, resulting in the highest Youden index (0.654) and sensitivity and specificity values of 91.8 and 74.9%, respectively. The diagnostic utility of the hs-cTnT test for AMI is superior to the traditional cTnI method. However, since hs-cTnT levels of non-AMI patients can be over the diagnostic cut-off value, further studies are necessary to define clinically applicable cut-off values of hs-cTnT.