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In this study, a sequential process (heterotrophic up-flow column and completely mixed membrane bioreactors) was proposed combining advantages of the both processes. The system was operated for 249 days with simulated and real groundwater for nitrate removal at concentrations varying from 25 to 145 mg·L−1 NO3−-N. The contribution of heterotrophic process to total nitrate removal in the system was controlled by dozing the ethanol considering the nitrate concentration. By this way, sulfur based autotrophic denitrification rate was decreased and the effluent sulfate concentrations were controlled. The alkalinity requirement in the autotrophic process was produced in the heterotrophic reactor, and the system was operated without alkalinity supplementation. Throughout the study, the chemical oxygen demand in the heterotrophic reactor effluent was (23.7 ± 22) mg·L−1 and it was further decreased to (7.5 ± 7.2) mg·L−1 in the system effluent, corresponding to a 70% reduction. In the last period of the study, the real groundwater containing 145 mg·L−1 NO3−-N was completely removed. Membrane was operated without chemical washing in the first 114 days. Between days 115–249 weekly chemical washing was required.

BACKGROUND Conductive materials have become the focus of recent studies to accelerate and stabilize the conversion of organic wastes to methane in anaerobic digestion processes. In this study, the effect of the addition of reduced graphene oxide (rGO) on biogas/biomethane production from municipal organic solid wastes in anaerobic batch reactors was investigated. In this context, the effect of loading ratios (0, 0.5, 1 and 2 gVS inoculum (gVS nutrient)(-1)) and rGO addition at different concentrations (0, 10, 20 and 30 mg L-1) was examined during a 45-day study period. RESULTS The highest biogas production reached a level of 816 +/- 14 mL (gVS)(-1) when substrate/inoculum ratio was 1 and 20 mg L-1 rGO was added (50% more than the group without rGO added). Addition of 30 mg L-1 rGO resulted in 667 +/- 12 mL (gVS)(-1) corresponding to 23% higher biogas production compared to the control reactor without rGO. The highest cumulative biomethane production was observed to be 525 +/- 20 mL (gVS)(-1) in the reactor with 20 mg L-1 rGO added in which substrate/inoculum ratio was 1. In the reactors with 10 and 30 mg L-1 and without rGO addition biomethane productions were 448 +/- 21, 401 +/- 13 and 323 +/- 23 mL (gVS)(-1), respectively. CONCLUSIONS Results revealed that the addition of rGO increased biomethane production from municipal organic solid wastes. It is concluded that rGO addition has the potential to be applied for real-scale facilities within the scope of renewable energy production and circular economy. (c) 2021 Society of Chemical Industry

Objective: Upper extremity electrical burn can create severe sequela and debilitation if not treated properly. Immediate decompression with fasci- otomy and carpal tunnel release seem to be the most promising choice of treatment. Neurologic functional loss can be avoided if median nerve is liberated. Material and Methods: During 6-year time interval, 50 out of 1158 burn patients underwent upper extremity decompressive fasciotomy with carpal tunnel release. Their hand motor function based on nerve innervation and daily usage questionnaire were followed in 12-month intervals. Results: Average score rose markedly after 18th month and reached nearly normal at the end of 66th month. Median, ulnar and radial nerve function tests were all positive, and no irreversible nerve function loss observed. Conclusion: All compartments of the forearm should be explored and carpal tunnel release should be added into upper extremity decompressive fasciotomy after electrical burns.

This study aims to present a novel gas counter and to demonstrate its suitability for biochemical methane potential tests. In this system, the gas to be measured is collected in a chamber enclosed with two one-way solenoid valves and the absolute pressure is continuously monitored. After a trigger pressure is reached, a portion of the gas is released and the amount of the released gas is calculated according to ideal gas law and recorded. Three iterations of the supervisory control and data acquisition unit were constructed and tested for BMP measurement. Although it can be further improved and variations are possible, the presented final version works with eight reactors simultaneously and the recommended maximum gas flow is 1.24 mL/min. For those reactors, the measured/theoretical BMP ratio was 65.3% with 4.2% standard uncertainty, which is subjectively acceptable. Therefore, it can be concluded that the concept is valid and applicable to BMP tests.

One of the factors that impair anastomosis healing in patients undergoing hepaticojejunostomy is tension of the anastomosis. There may be tension, especially in cases with a short mesojejunum. In cases where the jejunum cannot be brought higher, positioning the liver a little lower may be a solution. We placed a Bakri balloon between the liver and diaphragm to position the liver to a lower level. Here we present a successful hepaticojejunostomy case in which we placed a Bakri balloon to decrease the anastomosis tension.

In this study, we introduce a new conformable derivative, namely the beta-conformable derivative. We derive Taylor?s theorem for this derivative. We also investigate some new properties of Taylor?s theorem and some useful related theorems for the beta-conformable derivative. In the light of the new operator, we extend some recent and classical integral inequalities including Steffensen and Hermite-Hadamard inequality.

Mevcut çalışmada çeşitli nanofiltrasyon (NF) ve ters ozmoz (TO) membranları ile tekstil endüstrisi atıksularınınfiltrasyon performansları değerlendirilmiştir. Çalışmalar sonlu filtrasyon düzeneği ile farklı basınçlar altındayapılmıştır (10, 15, 20 ve 25 Bar). Test edilen nanofiltrasyon membranları NF90, NF270, NFTS40, NFXN45,NFDK ve NFDL’dir. Ters ozmoz membranları ise ROX201, ROBW30FR ve ROACM5’tir. Nanofiltrasyonmembranları için basınç başına en yüksek geçirgenlik NF270 membranı ile elde edilmiş olup bu değer 5,95L/(m2.h.Bar)’tır. Diğer nanofiltrasyon membranlarına nazaran NF270 ile daha yüksek geçirgenlik değerineulaşılmasına rağmen, geçirgenlikteki birim zamanda en yüksek azalma da bu membranda olmuştur. 15 bar basınçaltında başlangıç geçirgenlik değeri olan 12,41 L/(m2.h.Bar) 1 saatlik test süresi sonunda, 4,41 L/(m2.h.Bar)’adüşmüştür. Ters ozmoz membranlarında ise en yüksek geçirgenlik değeri ROACM5 membranı ile 2,96L/(m2.h.Bar) olarak tespit edilmiştir. En yüksek geçirgenlik düşüşü de yine ROACM5 membranındagözlemlenmiştir (hem 10 hem de 15 bar basınç için yaklaşık olarak 4,14 L/(m2.h.Bar)’dan 2,48 L/(m2.h.Bar)’a).Nanofiltrasyon membranları için en yüksek renk, iletkenlik ve KOİ giderimi, NF90 ile 4515 µS/cm iletkenlik; 518Pt-Co renk ve 119 mg/L KOİ giriş koşulları için sırasıyla >95%, >99% ve >97% olarak bulunmuştur. Daha yüksekiletkenlik giderimi istendiğinde ise ters ozmoz membranlarının kullanılması gerekmektedir. Test edilen ters ozmozmembranları için iletkenlik giderim yüzdeleri aynı atıksuda ROBW30FR, ROX201 ve ROACM5 için sırasıyla>97%, >98% ve >98%’dir. In this study, filtration performance of various nanofiltration and reverse osmosis membranes and textile industry wastewater were evaluated. The work was carried out under different pressures (10–15–20 and 25 Bar) with a dead end filtration system. The nanofiltration membranes tested were NF90, NF270, NFTS40, NFXN45, NFDK and NFDL. Reverse osmosis membranes are ROX201, ROBW30FR and ROACM5. The highest permeability per pressure for nanofiltration membranes was obtained with NF270 membrane, which is 5.95 L/(m2 .h.Bar). Although higher permeability was achieved with NF270 compared to other nanofiltration membranes, the highest reduction in permeability per unit time was also found in this membrane. The initial permeability value of 12.41 L/(m2 .h.Bar) under a pressure of 15 Bar decreased to 4.41 L/(m2 .h.Bar) after a 1 hour test period. In reverse osmosis membranes, the highest permeability value was determined as 2.96 L/(m2 .h.Bar) by ROACM5 membrane and the highest permeability decrease was observed again in ROACM5 membrane (approximately from 4.14 L/(m2 .h.Bar) to 2.48 L/(m2 .h.Bar) for both 10 and 15 Bar pressures). Highest color, conductivity and COD removal for nanofiltration membranes was obtained with NF90 membranes. The influent was contained 4515 µS / cm conductivity; 518 Pt-Co color and 119 mg / L COD , and >95% ,>99% and >97% removal efficiency were obtained, respectively. When higher conductivity removal is desired, reverse osmosis membranes are required The percent conductivity removal for the tested reverse osmosis membranes is >97%, >98% and >98% for ROBW30FR, ROX201 and ROACM5 in the same wastewater, respectively.

Suspended substances in car washes can often be easily removed by physicochemical processes. The main problem is to remove dissolved substances such as detergents from the water. In this study, a biodegradable substance Sodium Lauryl Sulfate (SLS) was removed from the car wash wastewater by the use of Phragmites australis in the subsurface constructed wetland. For this study, 4 plexiglass reactors having an effective volume of 10.8 L with the dimensions of 15cm×45cm×20 cm were used. The experiments were conducted with vegetation which was called SCW and without vegetation which was named control group (CG), as two groups. A serial connection of two reactors was performed for each group. Up to 90% detergent removal was observed with the vegetation in the SCW with a loading rate of 75 L/(m2.d) The effluents quality showed that the treated water can be reused carwash or irrigation for landscaping.

Objective: This study aimed to compare the pay for performance system applied nationally in Turkey and in other countries around the world and to reveal the effects of the system applied in our country on the general surgery. Material and Methods: Current literature and countries’ programs on the implementation of the pay for performance system were recorded. The results of the Turkish Surgical Association’s performance and Healthcare Implementation Communique (HIC) commission studies were evaluated in light of the literature. Results: Many countries have implemented performance systems on a limited scale to improve quality, speed up the diagnosis, treatment, and control of certain diseases, and they have generally applied it as a financial promotion by receiving the support of health insurance companies and nongovernmental organizations. It turns out that surgeons in our country feel that they are being wronged because of the injustice in the current system because the property of their works is not appreciated and they cannot get the reward for the work they do. This is also the reason for the reluctance of medical school graduates to choose general surgery. Conclusion: Authorities should pay attention to the opinions of associations and experts in the related field when creating lists of interventional procedures related to surgery. Equal pay should be given to equal work nationally, and surgeons should be encouraged by incentives to perform detailed, qualified surgeries. There is a possibility that the staff positions opened for general surgery, as well as, all surgical branches will remain empty in the near future.

Objective: As one of the oldest and main branches of medicine, process of General Surgery speciality training is long, expensive and difficult. Along with the principle of using limited sources wisely, there is a need for national forward planning in order to keep the number of General Surgery specialists in the proper level and in the proper quality. This study is made for the assurement of training quality specialists and for the sustainability in the best conditions after determining of the number of general surgeons, work force, and working conditions. Material and Methods: The number of General Surgery specialists (professors, associate professors, specialists or General Surgery subspecialists) and assistants who actively work in our country from the end of 2017 in the public sector, private sector, and university hospitals, is examined. These numbers were subjected to cross evaluation according to the provinces, academic titles and number of assistants. The estimated ratio of the existing number of General Surgery specialists to upcoming five and ten years were calculated according to the data of Turkish Statistical Institute. Results: From the end of 2017, 3957 General Surgery specialists are actively working in 1031 of 1499 health facilities. Four hundred and forty of them are titled as professors, 324 of them are titled as associate professors. For every 25 thousand people, there exist 1.22 surgeons. Ten years ago, this ratio was calculated as 1.27. The number of assistans, which was 1005 ten years ago, is decreased to 768 today, but the increase of the number of specialists is 409. Conclusion: The number of General Surgeons in our country is above the ideal ratio, which is one for 25 thousand people. In case rate of increase of the number of General Surgeons for the last 10 years continues, when the decrease of population growth rate is considered, there will be an uncontrolled increase in the number of surgeon per 25 thousand people. Just as the distribution of General Surgery specialists -whether or not having an academic title- is not balanced, the number of instructor per assistant is also excessive. Giriş ve Amaç: Tıbbın en eski ve ana dallarından birisi olan Genel Cerrahi uzmanlığı eğitimi, uzun, pahalı ve zahmetli bir süreçtir. Kısıtlı kaynakların akılcı kullanımı ilkesi yanında bir meslek olarak Genel Cerrahinin uzmanı sayısının olması gereken seviyede ve kalitede tutulabilmesi için ileriye dönük ulusal planlamalara ihtiyaç vardır. Bu çalışma ülkemizdeki Genel Cerrah hekim iş gücü, sayısı, dağılımı ve çalışma koşullarının tespitini takiben kaliteli uzman yetiştirilmesi ve en iyi şartlarda sürdürülebilirliğinin temini için yapılmıştır. Gereç ve Yöntem: Ülkemizde 2017 yılı sonu itibarı ile kamu, özel sektör ve üniversite tıp fakülteleri hastanelerinde faal olarak çalışan Genel Cerrahi uzmanı (profesör, doçent, uzman veya genel cerrahi yan dal uzmanı) ve asistan (araştırma görevlisi) sayıları irdelenmiştir. Bu sayılar illere, akademik unvanlara ve asistan sayılarına göre çapraz değerlendirmelere tabii tutulmuştur. Türkiye İstatistik Kurumu nüfus verilerine ve tahminlerine göre halihazırda Genel Cerrah sayılarının nüfusa oranları, önümüzdeki beş ve 10 yılda gerçekleşecek tahmini oranları hesaplanmıştır. Bulgular: Ülkemizde 2017 yılı sonu itibarı ile 1499 sağlık tesisinin 1031’inde 3957 Genel Cerrahi uzmanı aktif çalışmaktadır. Bunların 440’ı profesör, 324’ü doçent unvanlıdır. Her 25 bin kişiye 1,22 cerrah düşmektedir. Bu oran 10 yıl önce 1,27 olarak bulunmuştu. On yıl önce 1005 olan asistan sayısının günümüzde 768’e düşmüş olmasına rağmen uzman sayısı 409 artış göstermiştir. Sonuç: Ülkemizde Genel Cerrah sayısı ideal oran olan 25 bin kişiye bir sayısının üzerindedir. Nüfus artış hızındaki azalma dikkate alındığında, son 10 yıldaki Genel Cerrah artış hızının korunması durumunda 25 bin kişiye düşen cerrah sayısında kontrolsüz bir şekilde artış olacaktır. Ülkemizde akademik unvanlı olsun olmasın Genel Cerrahi uzmanı dağılımı dengeli olmadığı gibi asistan başına düşen eğitici sayısı da fazladır. WOS:000596036500016 2-s2.0-85085596336 PubMed: 32637880

Aim:Hidradenitis suppurativa (HS) is a chronic infection of apocrine sweat glands. HS related morbidities such as chronic infection, and carcinoma development reduce the life quality of the patients. Non-surgical management cannot provide complete recovery. The aim of the surgical treatment of HS is full control of the illness and prevention of recurrence.Method:From January 2014 to May 2018, ten male patients underwent treatment of HS in the gluteal and sacral area. A protocol of wide excision, followed by negative pressure wound therapy with instillation (NPWTi) to decrease bioburden and promote angiogenesis of defect area and a splitthickness skin graft was used. The mean age was 40 years. Patients are examined for granulation tissue formation, graft condition, hospitalization time, and recurrence.Results:The period for granulation tissue formation was 5.4 (4-8) days. NPWTi was put off on the fifth day after surgical excision and graft were observed three more days with wound dressing. Patients were discharged on the 10th postoperative day. The mean hospitalization time was 14.3 (range=12-16) days. There was no graft loss in nine patients. Approximately 20% of graft loss was observed in one patient. Secondary healing was obtained with local wound care measures in this patient. The patients had neither contour irregularity nor contracture. There was no recurrence after a median of 23.4 (range=12-36) months follow-up time.Conclusion:NPWTi can be used in the surgical management of HS either at graft preparation period or after grafting for better graft survival rate and shorter hospitalization duration.

Nitrate (NO

For prediction of mortality and clinical course, various scoring systems had been developed. We choose four well known burn specific scoring systems and a general scoring system that using in Intensive Care Units. The primary outcome of this study was evaluate the predictive performances of this models and define the optimal one for our patient population.Variables analyzed were age, gender, burn type, total burned surface area (TBSA), total partial thickness burn area, total full thickness burn area, inhalation injuries, mechanical ventilation supports, blood products usage, total scores of Abbreviated Burn Severity Index (ABSI), revised Baux, Belgian Outcome in Burn Injury, Fatality by Longevity, Acute Physiology and Chronic Health Eval-uation II (APACHE II) score, Measured Extent of burn and Sex (FLAMES) and APACHE II, and their relations with mortality.In our study, a statistically significant relationship was found with mortality between age, TBSA, full thickness burn percent-age, inhalation injury, burn type, and it was similar to literature. Female gender was found to be a significant risk factor for mortality.We compared several burn mortality scoring systems and their predictional mortality rates. ABSI scores of patients for estimated mortality rates were similar to our mortality rate. Consequently, it was thought that ABSI was included all mortality-re-lated parameters.

In this paper, we use the Delta Riemann-Liouville fractional integrals to establish some new integral inequalities for the Chebyshev functional in the case of two synchronous functions on time scales. Our results improve the inequalities for the discrete and continuous cases.

Obturator hernia (OH) constitutes 0.07% to 0.4% of all intraabdominal hernias and 0.2% to 5.8% of small intestinal hernias. OH is usually seen in elderly, multiparous females and patients with a low body weight. This multicenter study includes patients who were treated in Adnan Menderes University Medical Faculty Hospital, Bozyaka Education and Research Hospital and İnönü University Medical Faculty Hospital between January 2010 and June 2015. The diagnosis of OH was made preoperatively or perioperatively in patients who underwent emergency laparotomy for the treatment of ileus. A total of 14 patients were included in this study; 3 patients were treated by laparoscopic method (transabdominal approach) under general anesthesia and 2 of these patients (66.6%) died after the surgery. A total of 7 patients were treated by laparotomy. The remaining 4 patients were treated with a minimally invasive approach by using an epidural block without general anesthesia (3 patients with Pfannenstiel and 1 patient with a median inferior incision). The overall mortality rate was 42.8%. Anesthesia and surgery types have an important effect on mortality in elderly OH patients with multiple comorbidities. Minimally invasive approach with the use of epidural anesthesia can reduce the mortality rates in patients with OH. Abdominal computed tomography is the golden standard in the diagnosis of OH.

Efficient and cost-effective solutions for nitrogen removal are necessary to ensure the availability of safe drinking water. This study proposes a combined treatment for nitrogen-contaminated groundwater by sequential autotrophic nitrogen removal in a sulfur-packed bed reactor (SPBR) and excess sulfate rejection via nanofiltration (NF). Autotrophic nitrogen removal in the SPBR was investigated under both denitrification and denitritation conditions under different NO3- and NO2- loading rates (LRs) and feeding strategies (NO3- only, NO2- only, or both NO3- and NO2- in the feed). Batch activity tests were carried out during SPBR operation to evaluate the effect of different feeding conditions on nitrogen removal activity by the SPBR biofilm. Bacteria responsible for nitrogen removal in the bioreactor were identified via Illumina sequencing. Dead-end filtration tests were performed with NF membranes to investigate the elimination of excess sulfate from the SPBR effluent. This study demonstrates that the combined process results in effective groundwater treatment and evidences that an adequately high nitrogen LR should be maintained to avoid the generation of excess sulfide.

The virus COVID-19, which emerged in China in December 2019, was announced by the World Health Organization as a pandemic in January 2020. It is known that infection is not severe and may even progress without symptoms in patients who have come into contact with COVID-19. Although various organizations have been informed about how to take measures to protect the patient and the surgeon in case of diseases requiring urgent or elective surgery in people infected with COVID-19 or in cases with high suspicion, there is still no definite judgment between patients, physicians and health authorities. In this study, which was prepared with the initiative of the Turkish Surgical Association, we tried to shed light on what should be done and how surgeons should act in patients whose operation is mandatory in light of the available data.

Two sulfur-oxidizing membrane bioreactors (SMBRs) performing autotrophic denitrification at different HRTs (6-26 h), one supplemented with biogenic elemental sulfur (S-bio(0)) and the other with chemically-synthesized elemental sulfur (S-chem(0)), were compared in terms of nitrate reduction rates, impact on membrane filtration and microbial community composition. Complete denitrification with higher rates (up to 286 mg N-NO3-/L d) was observed in the SMBR supplemented with S-bio(0) (SMBRbio), while nitrate was never completely reduced in the SMBR fed with S-chem(0) (SMBRchem). Trans membrane pressure was higher for SMBRbio due to smaller particle size and colloidal properties of S-bio(0). Microbial communities in the two SMBRs were similar and dominated by Proteobacteria, with Pleomorphomonas and Thermomonas being the most abundant genera in both bioreactors. This study reveals that S-bio(0) can be effectively used for nitrate removal in autotrophic denitrifying MBRs and results in higher nitrate reduction rates compared to S-chem(0).

This study aims at investigating the simultaneous nitrate and chromate reduction by combining the advantages of sulfur-based autotrophic denitrification, heterotrophic denitrification and membrane bioreactor (MBR) technologies. A laboratory-scale MBR equipped with hydrophilic flat sheet polyethersulfone (PES) membranes (0.45μm) was used to evaluate the performance of mixotrophic denitrification at varying nitrate and Cr(VI) concentrations. Methanol was supplied at C/N (mg methanol/mg NO3--N) ratio of 1.33. In the absence of Cr(VI), almost complete denitrification of 50mg/L NO3--N was obtained and the methanol requirement (3.60±0.9mg COD/(mg NO3--N)) for heterotrophic denitrifiers, was quite close to the theoretical value (3.7mg COD/(mg NO3--N)). Around 54% of the influent nitrate was denitrified by heterotrophs and the rest (56%) was denitrified by autotrophic sulfur oxidizers. The effluent sulfate averaged around 200mg/L, which was below than the theoretical sulfate concentration if autotrophic denitrification process was used alone. Autotrophic denitrification activity completely ceased at 5mg/L Cr(VI), but heterotrophic denitrification did not show any inhibition. Almost complete chromate and nitrate reduction was observed at 1mg/L Cr(VI). MBR was operated for around 200days and a weekly physical membrane cleaning was enough at a flux of 15 LMH.

Sulfide produced in an ethanol fed anaerobic baffled reactor, was utilized to precipitate metals separately in a pH controlled system. Sulfide produced in the reactor (780±27 mg/L S2–) was transported with N2 gas to the metal precipitation chamber at pH 2.5 to precipitate Cu2+ separately from Fe2+. Cu precipitation was completed at 98% efficiency within 5 min. The remaining Fe2+ was then precipitated at elevated pHs by mixing the reactor effluent. XRD patterns of the precipitates showed that copper was precipitated in the form of CuS with a particle size of 14–22 nm whereas iron was precipitated as FeS with 32-85 nm particle size.

Perchlorate is a naturally occurring and manufactured chemical anion and can be present in water sources together with nitrate. This study aims at (1) determining the nitrate and perchlorate contamination in a semi-arid plain (Harran Plain) and (2) evaluating the performance of a heterotrophic-autotrophic sequential denitrification process for nitrate and perchlorate removal from the groundwater of this plain. The nitrate in the groundwater samples varied between 4.07 and 83.22 mg l−1 NO3--N. Perchlorate was added to groundwater samples externally and its concentration was increased from 100 to 1500 μg l−1. The total nitrogen concentrations in the sequential system effluent throughout the study were always below 0.5 mg l−1. C/N ratio was 2.44 which was slightly lower than the theoretical level of 2.47. Therefore the average NO3−-N in the heterotrophic reactor effluent was 19 ± 3.7 mg l−1 corresponding to an efficiency of 75% reduction. The remaining nitrate and nitrite were almost completely reduced in the autotrophic process. The system's perchlorate removal efficiency was above 98%, except during the last period (82%), at which influent perchlorate was 1500 μg l−1. The maximum perchlorate reduction rate throughout the study was around 15 mg/(L.d). Both perchlorate and nitrate reduction were partial in the heterotrophic reactor, but completed in the following autotrophic process.

Pilonidal sinus disease (PSD) effects mainly young men's social and work life with frequent recurrence rate. Reoperation for unimproved or recurrent disease is somehow troublesome. Surgeons may think that changing treatment strategy after recurrence may prevent further relapses of PSD. We analyzed patients with recurrent pilonidal sinus to determine their predisposing features for recurrence and the outcomes of the preferred surgical methods.From 2007 to 2012, out of 95 recurrent pilonidal sinus disease (rPSD) patients, 62 operated cases were included and examined retrospectively. Their retrospective data were examined for demographics, 1(st) and 2(nd) operation types, patient satisfaction and pain scores. For cases with insufficient preoperative or postoperative data, phone call and interviews were done to obtain data. Some were kindly invited to the outpatient examination. Student's t test, Mann-Whitney U test, and Kaplan Meier test for disease free survival time were used where appropriate. P values less than 0.05 were accepted to be statistically significant.Total of 62 rPSD patients were examined. Male:female ratio was 2.9:1. The mean age after 1(st) and 2(nd) operations were 24.7 and 28.1 years, respectively. One and five-year recurrence rates were 33.9% and 66.1%, respectively. The mean interval between the 1(st) and 2(nd) operations was 45.6 months. Excision and midline closure was the most frequent type of operation followed by flap reconstructions and excision-lay open procedures. The 1(st) operation types of rPSD cases were different from that of 2(nd) operations. Pain perception and satisfaction scores were better in flap reconstruction groups.Reoperative surgery of rPSD is satisfactory with certain precautions. Relapses after flap reconstruction procedures with a well-being period should be referred as second primary disease. Changing surgical strategy is not always indicated as some patients with recurrence have relapsing or second primary disease that have distinct clinical course. Re-flap surgery after any kind of relapse is well appreciated.

Background Groove pancreatitis is a form of focal chronic pancreatitis in the pancreatic tissue between the duodenal wall and the intrapancreatic portion of the common bile duct. Groove pancreatitis, paraduodenal pancreatitis, and duodenal dystrophy are regarded as synonyms by some authors whereas others use the term duodenal dystrophy. We aimed to review this rare entity and discuss its clinical features, diagnosis, and therapy.

The robustness of anaerobic dynamic membrane bioreactor (AnDMBR) for synthetic textile wastewater treatment was investigated. Textile wastewatermay contain high concentrations of NaCl and sulfate, hence their impact on the AnDMBR performancewas investigated in detail. A dynamic membrane was formed on a 20-mu m pore sized nylon support layer at a constant flux of around 8 LMH. In the absence of sulfate addition, total and filtered (soluble) COD averaged 96 +/- 49 mg/L (91% removal) and 75 +/- 35 mg/L (93% removal), respectively. Sulfate addition increased total CODin the permeate to 222 +/- 68 mg/L (79% removal). Average SS concentrationwas lower than 30 mg/L in the permeate although its concentration in the bioreactor reached 10 g/L. Throughout the AnDMBR operation dye removal averaged >97%. Sludge filterability, which was assessed by specific resistance to filtration, supernatant filtration, capillary suction time and viscosity, decreased after sulfate addition. Organic and inorganic matters in the dynamic layer were characterized by SEM-EDS and FTIR analyses. (C) 2020 Elsevier B.V. All rights reserved.

The study aimed at investigating the performance of anaerobic dynamic MBR (AnDMBR) for the treatment of synthetic textile wastewater. A laboratory scale anaerobic bioreactor was operated to test nylon mesh support materials with different pore sizes (20 μm, 53 μm and 100 μm). The performances of the AnDMBR were evaluated with a stimulated wastewater containing 1,000 mg.L−1 COD and 100 mg.L−1 dye (Remazol Brilliant Violet 5R). To develop an effective dynamic cake layer on the support material, different operational strategies, i.e. high flux, continuous and intermittently biogas recycle were studied for process optimization and increase the filtration performances. Initially, the bioreactor was operated under continuous biogas recycle. Under this operation strategy, the cake layer was not formed, then intermittent biogas recycle was applied to improve the development of dynamic layer. Effluent SS decreased below 20 mg-SS.L−1 for all the tested different pore sized supports after the development of the cake layer. Almost complete color (>99%) and high COD removal efficiencies (95–97%) were observed. For all the three supports, the bioreactor was operated at fluxes of 5–15 L.(m2.h)−1 (LMH), which was quite high compared to conventional AnMBRs equipped with micro/ultra-filtration membranes. In order to better understand the formation and its structure, detailed cake layer characterization analyses were conducted with scanning electron microscopy (SEM), SEM coupled Energy Dispersive X-ray Spectroscopy (EDS) and inductively coupled plasma-optical emission spectrometer (ICP). Provided the formation of the cake layer, the comparable flux and removal performances with AnMBRs for all three tested support materials were possible. © 2020 Elsevier Ltd

Acid mine drainage is the outflow from a mining site which contains high sulfate and metal concentrations and low pH. Appropriate disposal of this drainage relies on the removal and preferably recovery of heavy metals and neutralizing pH. Sulfidogenic electron donor oxidation generates alkalinity which increases water pH. In this study, sulfate reduction was studied comparatively in two up-flow reactors fed with acetate and ethanol, respectively. Reactors were operated in parallel for 148 days and the influent 2000 mg/L sulfate was decreased to 51 +/- 7 and 31 +/- 6 mg/L in ethanol and acetate fed reactors, respectively. With the produced hydrogen sulfide, metal precipitation in a simulated AMD containing both copper and nickel was studied. Copper was precipitated at low pH (pH < 2) by the gaseous hydrogen. Cu precipitation was completed within 35 min and Ni did not precipitate during Cu removal. Nickel recovery was studied at higher pH values (pH = 8) using reactor effluent containing dissolved sulfide and alkalinity. Mineralogical characterization of the precipitates using X-ray diffraction indicated that CuS and NiS were precipitated selectively in the two metal removal stages.

WOS: 000504472800025 Acidic mine drainage is known to have a low pH and contain high concentrations of heavy metals and constitute a serious risk for the receiving environment. Because of the fact that factors affecting the formation and mineralogy of acidic mine drainage vary a lot, treatment of it is difficult and costly. In this study, the treatment of acidic mine drainage together with the pH neutralization and metal precipitation (Fe, Cu, Co, Mn, Zn, Ni) in two stage ethanol fed up-flow anaerobic sulfate reducing bioreactor were investigated. The reactor was operated in a temperature controlled room (30 degrees C) at a HRT of 1 day for 245 days. The COD/SO42- mass ratio was 0.67-0.87. Sulfide and alkalinity produced in the reactor were recycled to a pre-treatment unit where pH was neutralized and metals were precipitated. Throughout the study, up to 4000 mg/L sulfate was added to feed and the effluent sulfate was 325 +/- 9.75 mg/L, corresponding to 91.25% removal. The feed was contained 400 mg/L Fe, 200 mg/L Cu, 50 mg/L Co, Mn, Zn and Ni and over 87% Fe, over 98% Cu, Co, Zn and Ni and 49% Mn removals were achieved in the pre-treatment unit. The remaining metals were also filtered in the sulfidogenic reactor. This study demonstrated that by setting a reactor configuration, pH neutralization, metal precipitation as well as sulfate reduction can be achieved in two stage reactor system.

Bu çalışmanın amacı; üç farklı ters ozmoz (TO) membranının gerçek tekstil endüstrisi atıksularının arıtımındaki performanslarının değerlendirilmesi ve kıyaslanmasıdır. Çalışmada tekstil endüstrisi atıksularını arıtan gerçek ölçekli atıksu arıtma tesisi çıkış suları kullanılmış olup, membran performansları kimyasal oksijen ihtiyacı (KOİ), renk, iletkenlik ve membran akısı açısından değerlendirilmiştir. Çalışmada 10 saatlik filtrasyon çalışmalarında çapraz akışlı filtrasyon düzeneği ile B400FR, B400HR ve BW30 membranları test edilmiştir. Aynı basınçta yapılan çalışmada, en yüksek permeabilite değerini (3,45±0,12 LMH/bar) ve en düşük akı kaybını (%69) B400HR membranı verirken, akıdaki en fazla azalma (%82) BW30 membranında gözlemlenmiştir. Kullanılan atıksu 4570±130 μS/cm iletkenlik, 188±2 Pt-Co renk ve 35±2 KOİ konsantrasyonlarına sahip olup, test edilen tüm membranlar için süzüntü KOİ değeri 10 mg/L'nin altına düşürülmüş olup, en iyi KOİ giderim performansını B400FR membranı göstermiştir. Ortalama iletkenlik giderimi ise tüm membranlar için %92 değerinin üzerinde olup, B400FR, B400HR ve BW30 için sırasıyla %96, 94 ve 92 değerlerindedir. Benzer şekilde tüm membranlar için renk giderimi %99’un üzerinde gerçekleşmiştir. Elde edilen sonuçlarla süzüntü suyunun aynı endüstride geri kullanımı mümkündür. The aim of this study is the evaluation and comparison of the performance of three different reverse osmosis membranes on the treatment of real textile industry wastewater. The effluent of a real scale wastewater treatment plant which treats the textile industry wastewater, were used and the membrane performances were evaluated in terms of COD, color, conductivity removal and membrane flow rate. B400FR, B400HR and BW30 membranes were tested in a 10-hour filtration tests with a cross-flow filtration system. In the studies conducted at same pressure, the highest permeability value (3.45 ± 0.12 LMH/bar) and the lowest flux loss (69%) were found in the B400HR membrane while the highest decrease in flow was observed in the BW30 membrane (82%). The wastewater conductivity, color and COD concentrations were 4570±130 μS/cm; 188±2 Pt-Co and 35±2 mg/L, respectively and permeate COD values for all tested membranes were reduced below 10 mg/L and B400FR membrane was showed the best COD removal performance. The conductivity removal rates for B400FR, B400HR and BW30 membranes were 96, 94 and 92%, respectively and the average conductivity decrease for tested membranes were over 92%. Similarly, the color removal efficiency for all membranes was over 99%. According to these results, it is possible to reuse the filtrate of tested membranes in the same industry.

This study aims at comparatively evaluating anaerobic and aerobic MBRs for the treatment of azo-dye containing synthetic wastewater. Also, the filtration performances of AnMBR and AeMBR were compared under similar operating conditions. In both MBRs, high COD removal efficiencies were observed. Although almost complete color removal was observed in AnMBR, only partial (30-50%) color removal was achieved in AeMBR. AnMBR was successfully operated up to 9 L/(m(2) h) (LMH) and no chemical cleaning was required at 4.5 LMH for around 50 days. AeMBR was operated successfully up to 20 LMH. The filtration resistance of AnMBR was generally higher compared to AeMBR although reversible fouling rates were comparable. In both MBRs, offline chemical cleaning with NaOCl and sulfuric acid almost completely removed irreversible fouling and the resistances of chemically cleaned membranes were close to those of new membranes. (C) 2015 Elsevier Ltd. All rights reserved.

The biological reduction of nitrate and perchlorate was comparatively evaluated in autotrophic and mixotrophic bioreactors using elemental sulfur and/or methanol as the energy source. The mixotrophic reactor was supplemented with methanol at CH3OH/NO3−-N ratio of 1 or 1.4. The mixotrophic reactor completely reduced perchlorate in the feed up to 1,000 μg l−1. The autotrophic reactor also showed high perchlorate reduction performance and decreased perchlorate from 1,000 μg l−1 to around 33 μg l−1. Complete reduction of 25 mg NO3−-N l−1 was achieved in both reactors, corresponding to a maximum nitrate reduction rate of 300 mg NO3−-N l−1d−1 and 400 mg NO3−-N l−1d−1 in the autotrophic and mixotrophic processes, respectively. Autotrophic denitrification caused an increase of effluent sulfate concentration, which may exceed the drinking water guideline value of 250 mg l−1. In the mixotrophic denitrification process, the effluent sulfate concentration was controlled by adjusting the C/N ratio in the influent. Mixotrophic denitrification was stimulated by 25 mg l−1 methanol addition and 53% of influent nitrate was reduced by the heterotrophic process, which decreased the effluent sulfate concentration to half of the autotrophic counterpart. Therefore, the mixotrophic process may be preferred over the autotrophic process when effluent sulfate concentration is of concern and a higher perchlorate reduction efficiency is desired.

Nitrate and perchlorate were identified as significant water contaminants all over the world. This study aims at evaluating the performances of the heterotrophic-autotrophic sequential denitrification process for reductive nitrate and perchlorate removal from drinking water. The reduced nitrate concentration in the heterotrophic reactor increased with increasing methanol concentrations and the remaining nitrate/nitrite was further removed in the following autotrophic denitrifying process. The performances of the sequential process were studied under varying nitrate loads of [Formula: see text] at a fixed hydraulic retention time of 2 h. The C/N ratio in the heterotrophic reactor varied between 1.24 and 2.77 throughout the study. Nitrate and perchlorate reduced completely with maximum initial concentrations of [Formula: see text] and 1000 µg/L, respectively. The maximum denitrification rate for the heterotrophic reactor was [Formula: see text] when the bioreactor was fed with [Formula: see text] and 277 mg/L methanol. For the autotrophic reactor, the highest denitrification rate was [Formula: see text] in the first period when the heterotrophic reactor performance was low. Perchlorate reduction was initiated in the heterotrophic reactor, but completed in the following autotrophic process. Effluent sulphate concentration was below the drinking water standard level of 250 mg/L and pH was in the neutral level.

BACKGROUND This study aims at comparing the performances of sulfur-based autotrophic and methanol-based heterotrophic denitrification processes for simultaneous removal of perchlorate and nitrate. Influent nitrate concentration was kept at 25 mg L−1 NO3−-N throughout the study and perchlorate concentration was varied between 50 and 1000 µg L−1. RESULTS The heterotrophic process reduced nitrate and perchlorate completely in all tested conditions (i.e. various nitrate and perchlorate loadings). As for the autotrophic process, although high perchlorate removals were attained, perchlorate was always detected in the effluent with varying concentrations from 21.88–85 µg L−1 depending on the perchlorate and nitrate loadings. Perchlorate was reduced from 1000 µg L−1 to 53 ± 21.36 µg L−1, corresponding to around 95% reduction in the autotrophic process at HRT of 2 h. The presence of perchlorate did not adversely affect the denitrification performance of autotrophic and heterotrophic processes under the conditions studied. The presence of nitrate inhibited autotrophic perchlorate reduction and prevented complete perchlorate reduction. CONCLUSION An autotrophic process may be preferred over a heterotrophic one due to the elimination of organic supplementation and the risk of effluent contamination with organic substrate, but further polishing steps may also be required. © 2015 Society of Chemical Industry

Sulfur-oxidizing autotrophic denitrification process has drawn significant attention due to its high efficiency, elimination of carbon requirement and the effluent contamination by organic compounds. In the process, nitrate and sulfur are used as electron acceptor, and electron donor, respectively. In the present study, a novel sulfur based autotrophic denitrification process utilizing membrane bioreactor (MBR) was tested for nitrate removal from drinking water. A bench-scale MBR equipped with hydrophilic flat sheet polyethersulfone (PES) membranes (0.45 μm) was used. Sulfur was externally added to the MBR considering the theoretical requirement. Almost complete denitrification efficiency was achieved when the influent nitrate concentrations were 25–50 mg NO3−-N/L at HRT as low as 5 h corresponding to nitrate loading rates up to 0.24 g NO3−-N/(L d). The generated sulfate concentrations were close to the theoretical values. Membrane fouling was not significant at fluxes ⩽20 L/(m2 h).

Mastitis is inflammation of breast tissue that may or may not originate from an infection. Two different forms of mastitis have been described, lactational and non-lactational. Lactational mastitis is the most common type and generally conservative therapy that includes milk removal and physical therapy provides symptomatic relief, but antibiotic therapy is also needed. Common types of non-lactational mastitis are periductal mastitis and idiopathic granulomatous mastitis. Treatment includes antibiotics, drainage, and surgery, but usually this is a chronic process and a therapeutic management algorithm for chronic breast inflammation is unclear and has no consensus. Negative-pressure wound therapy is commonly used for various types of wounds but is limited for breast wounds. In this report, we present and discuss two patients with chronic breast inflammation who underwent surgery and were successfully treated using negative-pressure wound therapy to minimize wide tissue defects and cosmetic problems after surgery. Use of negative-pressure wound therapy for breast wounds might be benefical as it is with other wounds but there is scarce information in the literature.

WOS: 000353524600022 Holder's inequalities and their extensions have received considerable attention in the theory of differential and difference equations. In this paper, we establish some new generalizations and refinements of Holder's inequality and some related inequalities on time scales. We also show that many existing inequalities related to the Holder's inequality are special cases of the inequalities presented on time scales.