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Conventional bioretention filters lack satisfactory performance in nitrogen removal. In this study, we used a mixture of cultivated soil and river sand as the bioretention filter to remove nitrogen pollutants from simulated rainwater runoff. To improve its permeability and nitrogen removal performance, both activated carbon and ceramsite were used as additives. The nitrogen removal processes and its mass accumulation in the modified bioretention filters were studied. The contribution of adsorption and biotransformation processes, together with the effects of percolate rate on nitrogen removal performance was explored. The results showed that an activated carbon layer in the bioretention filters could obviously improve nitrogen removal efficiencies, but its location made no significant difference in nitrogen removal performance. Bioretention filters modified with 20% of ceramsite could achieve the optimal percolate rate and nitrogen removal efficiencies. At given conditions, the average removal efficiencies of ammonium nitrogen (NH3–N), nitrate-nitrogen (NO3–N), and total nitrogen (TN) by the modified bioretention filter reached 80.27%, 41.48%, and 59.45%, respectively. During the leaching processes, organic nitrogen originated in the filter materials can be mineralised into NH3–N, then be denitrified and completely removed in the anaerobic environment under flooding conditions. Biotransformation in the modified bioretention filters caused a reduction of NH3–N removal efficiency by 15.41% and an increase of NO3–N removal efficiency by 31.03%. The modified bioretention filter can withstand a long-term operation. Compared with NO3–N and TN, the pollutant of NH3–N in rainwater runoff is not easy to form a mass accumulation in the modified bioretention filter. Highlights The modified bioretention filter showed high percolation rate and nitrogen removal. Hydraulic residence time is a critical design parameter to achieve nitrogen removal. NH3–N is not easy to form a mass accumulation in the filler media as NO3–N. Biodegradation increased NO3–N removal efficiency by 31.03% at given conditions. [ABSTRACT FROM AUTHOR]

Introduction: Eltrombopag (EPAG), a thrombopoietin receptor agonist, was approved for the treatment of severe aplastic anemia (SAA) combined with immunosuppressive therapy (IST). However, EPAG contains a typical biphenyl structure, which causes liver function damage., Methods: Twenty patients with SAA who were intolerant or refractory to EPAG were enrolled in a multicenter prospective registry of the Chinese Eastern Collaboration Group of Anemia (ChiCTR2100045895) from October 2020 to June 2023., Results: Eight patients who were ineffective to EPAG, six with kidney impairment, and nine with abnormal liver function (two with concomitant liver and kidney impairment) were converted to avatrombopag (AVA) therapy with the median duration of AVA treatment was 6 (3-24) months. 17 cases (85%) achieved trilineage hematological response (HR): complete remission (CR) in 3 cases (15%), good partial remission (GPR) in 4 cases (20%), partial remission (PR) in 10 cases (50%), and no response (NR) in 3 cases (15%). The median time to response was 1.7 (0.5-6.9) months, with 16 cases (94%) achieving response within six months and 17 cases (100%) within 12 months. 9 cases (50%) achieved transfusion independence. AVA converted treatment was associated with higher neutrophil counts (0.8×10 9 /L vs 2.2×10 9 /L, p=0.0003), platelet counts (11×10 9 /L vs 39×10 9 /L, p=0.0008), hemoglobin count (59g/L vs 98g/L, p=0.0002), red cell count (1.06×10 12 /L vs 2.97×10 12 /L, p=0.001), and absolute reticulocyte count (31.99 ×10 9 /L vs 67.05×10 9 /L p=0.0004) were all significantly elevated compared with the pre-treatment level. After the conversion to AVA therapy, liver and kidney function indexes were maintained within the normal range, no AVA related grade 2 or higher adverse events occurred, and no thrombotic events occurred., Conclusion: The conversion to AVA was an optimal choice for patients with SAA who were EPAG intolerant or refractory., Clinical Trial Registration: http://www.chictr.org.cn/showproj.html?proj=125480, identifier ChiCTR2100045895., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhang, Yu, Chen, Yang, Gong, Zhang, Liu, Yang, Fang, Yan, Zhou, Shi and He.)

Transfusion-dependent non-severe aplastic anemia (TD-NSAA) is a rare condition of bone marrow failure that can persist for a long time or develop into severe aplastic anemia (SAA). Little is known about the clinical and laboratory characteristics, and disease prognosis and outcomes in TD-NSAA patients. The clinical and laboratory data of 124 consecutive TD-NSAA patients in the Chinese Eastern Collaboration Group of Anemia from December 2013 and January 2017 were analyzed retrospectively. In 124 TD-NSAA patients, the median age was 32 years (range: 3-80) and the median disease course was 38 months (range: 3-363). Common complications were iron overload (53/101, 52.5%), liver and kidney dysfunction (42/124, 33.9%), diabetes mellitus/impaired glucose tolerance (24/124, 19.4%), and severe infection (29 cases, 23.4%). 58% of patients (57/124) developed severe aplastic anemia with a median progression time of 24 months (range: 3-216). Patients with absolute neutrophil count (ANC) <0.5×10 9 /L, severe infection, or iron overload had a higher probability of progression to SAA (P=0.022, P=0.025, P=0.001). Patients receiving antithymocyte globulin (ATG) plus Cyclosporin A (CsA) had a higher overall response rate compared to those receiving CsA alone (56.7% vs 19.3%, P < 0.001). The addition of ATG was the favorable factor for efficacy (P=0.003). Fourteen patients developed secondary clonal hematologic disease: eleven patients with paroxysmal nocturnal hemoglobinuria, two patients with myelodysplastic syndromes, and one patient with acute myeloid leukemia, respectively. Ten patients (8.1%) died with a median follow-up of 12 months (range: 3- 36 months). Patients with TD-NSAA usually have a prolonged course of disease, and are prone to be complicated with important organ damage and disease progression to SAA. Intensive immunosuppressive therapy based on ATG might be an appropriate approach for TD-NSAA. Clinical trial registration: http://www.chictr.org.cn/edit.aspx?pid=125480&htm=4, identifier ChiCTR2100045895., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zhang, He, Wang, Sun, Jia, Gong, He and Li.)