Five-year followup of a prospective trial of radical cystectomy and neoadjuvant chemotherapy: Nordic Cystectomy Trial I. The Nordic Cooperative Bladder Cancer Study Group

PURPOSE: Chemotherapy is widely used in patients with locally advanced bladder cancer but until now there has been no conclusive evidence that this therapy improves survival. The Nordic Cooperative Bladder Cancer Study Group conducted a randomized phase III study to assess the possible benefit of neoadjuvant chemotherapy in patients with bladder cancer undergoing radical cystectomy after short-term radiotherapy. MATERIALS AND METHODS: Our trial included 325 patients with locally advanced stage T1 grade 3 or stages T2 to T4aNXM0 bladder cancer allocated randomly into a chemotherapy or no chemotherapy group (control). The chemotherapy schedule consisted of 2 cycles of 70 mg./m.2 cisplatin and 30 mg./m.2 doxorubicin with a 3-week interval between the cycles. RESULTS: After 5 years the overall survival rate was 59% in the chemotherapy group and 51% in the control group (p = 0.1). The corresponding cancer specific survival rate was 64 and 54%, respectively. In regard to treatment, no difference was observed for stages T1 and T2 disease, while there was a 15% difference in overall survival for patients with stages T3 to T4a disease (p = 0.03). In a multivariate analysis only chemotherapy and T category emerged as independent prognostic factors. The relative death risk for patients who received chemotherapy was 0.69 (95% confidence interval 0.49 to 0.98) compared to the control group after adjustment for the other tested factors. CONCLUSIONS: Neoadjuvant chemotherapy seems to improve long-term survival after cystectomy in patients with stages T3 to T4a bladder carcinoma, while no survival benefit was found for stages T1 to T2 disease.     

Functional results following the antegrade continence enema procedure

BACKGROUND: Forty children who underwent the antegrade continence enema (ACE) procedure for faecal soiling were studied to determine factors predictive of outcome. METHODS: There were four patient groups: (1) ambulant with spinal dysraphism (n = 13), (2) wheelchair bound with spinal dysraphism (n = 14), (3) ambulant with miscellaneous disorders (n = 11) and (4) wheelchair bound with miscellaneous disorders (n = 2). Effectiveness of the procedure was assessed using technical evaluation and quality-of-life improvement (QOLI) scores (0-5). Objective assessment included colonic transit time (CTT) and anorectal manometry. Median follow-up was 21 (range 5-37) months. RESULTS: Some 28 of 40 children achieved continence. The procedure was reversed in four of 40 children. Of the other 36 children with a functioning ACE stoma, all reported improvement in quality of life (mean QOLI score 3.5). There were no significant differences in technical evaluation score, QOLI score, CTT, manometry findings or continence between ambulant groups and the wheelchair-bound group with miscellaneous disorders. QOLI score, anorectal squeeze pressure and continence were significantly poorer in those who were wheelchair bound with spinal dysraphism. Absent squeeze pressure was associated with poor outcome. CONCLUSION: Wheelchair-bound children with spinal neuropathy have a poorer outcome following the ACE procedure. Although ACE is an effective method of promoting faecal continence, it is essential to determine the aetiology of incontinence and sphincter function before operation.     

Thermophilic anaerobic digestion of pulp and paper mill primary sludge and co-digestion of primary and secondary sludge

Anaerobic digestion of pulp and paper mill primary sludge and co-digestion of primary and secondary sludge were studied for the first time in semi-continuously fed continuously stirred tank reactors (CSTR) in thermophilic conditions. Additionally, in batch experiments, methane potentials of 210 and 230 m³CH₄/t volatile solids (VS)_added were obtained for primary, and 50 and 100 m³CH₄/tVS_added for secondary sludge at 35 °C and 55 °C, respectively. Anaerobic digestion of primary sludge was shown to be feasible with organic loading rates (OLR) of 1-1.4 kgVS/m³d and hydraulic retention times (HRT) of 16-32 d resulting in methane yields of 190-240 m³CH₄/tVS_fed. Also the highest tested OLR of 2 kgVS/m³d and the shortest HRT of 14-16 d could be feasible, if pH stability is confirmed. Co-digestion of primary and secondary sludge with an OLR of 1 kgVS/m³d and HRTs of 25-31 d resulted in methane yields of 150-170 m³CH₄/tVS_fed. In the digestion processes, cellulose and hemicellulose degraded while lignin did not. pH adjustment and nitrogen deficiency needs to be considered when planning anaerobic digestion of pulp and paper mill wastewater sludges.     

Methane oxidation in a boreal climate in an experimental landfill cover composed from mechanically-biologically treated waste

The present study evaluated microbial methane (CH4) oxidation in a boreally located outdoor landfill lysimeter (volume 112 m3, height 3.9 m) filled with mechanically-biologically treated waste (MBT residual) and containing a cover layer made from the same MBT residual. The calculations based on gas emission and pore gas measurements showed that, between April and October 2005, a significant proportion (> 96%) of the methane produced (< 23 l CH4 m(-2) d(-1)) in the lysimeter was oxidized. Methane was oxidized mainly at the depths of 35-75 cm, as indicated by the upward decrease both in the methane concentration and in the methane-to-carbon dioxide ratio in the pore gas. Lower methane oxidation (< 0.8 CH4 m(-2) d(-1); this was < 22% of the methane produced) was observed only during the coldest time of the year (January 2006), apparently due to the fall in temperature at the depths of 25-70 cm (from 9-25 degrees C during April to October to 2-9 degrees C in January). Unexpectedly, the highest methane oxidation potential (MOP) was observed in samples from the top layer where exposure to methane was low. Overall, the results show that MBT residual is a suitable support medium for methane oxidation in landfill covers in field conditions in a boreal climate.     

Aerobic moving bed biofilm reactor treating thermomechanical pulping whitewater under thermophilic conditions

The continuously operated laboratory scale Kaldnes moving bed biofilm reactor (MBBR) was used for thermophilic (55 degrees C) aerobic treatment of TMP whitewater. In the MBBR, the biomass is grown on carrier elements that move along with the water in the reactor. Inoculation with mesophilic activated sludge gave 60-65% SCOD removal from the first day onwards. During the 107 days of experiment, the 60-65% SCOD removals were achieved at organic loading rates of 2.5-3.5 kg SCODm(-3) d(-1), the highest loading rates applied during the run and HRT of 13-22h. Carbohydrates, which contributed to 50-60% of the influent SCOD. were removed by 90-95%, while less than 15% of the lignin-like material (30-35% of SCODin) was removed. The sludge yield was 0.23g VSSg SCOD(-1)removed. The results show that the aerobic biofilm process can be successfully operated under thermophilic conditions.     

Nitrogen removal from on-site treated anaerobic effluents using intermittently aerated moving bed biofilm reactors at low temperature

On-site post-treatment of anaerobically pre-treated dairy parlour wastewater (DPWWe; 10 degrees C) and mixture of kitchen waste and black water (BWKWe; 20 degrees C) was studied in moving bed biofilm reactors (MBBR). The focus was on removal of nitrogen and of residual chemical oxygen demand (COD). Moreover, the effect of intermittent aeration and continuous vs. sequencing batch operation was studied. All MBBRs removed 50-60% of nitrogen and 40-70% of total COD (CODt). Complete nitrification was achieved, but denitrification was restricted by lack of carbon. Nitrogen removal was achieved in a single reactor by applying intermittent aeration. Continuous and sequencing batch operation provided similar nitrogen and COD removal, wherefore simpler continuous feeding may be preferred for on-site applications. Combination of pre-treating upflow anaerobic sludge blanket (UASB) -septic tank and MBBR removed over 92% of CODt, 99% of biological oxygen demand (BOD7), and 65-70% of nitrogen.     

Depressive symptomatology in persons with spinal cord injury who reside in the community

Depressive symptomatology was studied in a community-based sample of 100 men and 40 women with spinal cord injury. The mean for the Center for Epidemiologic Studies Depression Scale was higher than that reported previously for the general population, and the mean for women was higher than that for men. Findings from the Mobility dimension of the Craig Handicap Assessment and Reporting Technique (CHART) suggested that differences between men and women in degree of mobility within home and community partly mediate the gender difference in depressive symptomatology. Other CHART dimensions, Social Integration and Occupation, were inversely related with depression scores, although these dimensions did not differentiate men and women. A statistically significant relationship was not obtained between depression and disability, assessed by a self-report version of the Functional Independence Measure, or between depression and impairment, reflected by the ASIA Total Motor Index Score. Depression was not related with the presence of either pressure ulcers or presumptive evidence of urinary tract infection.     

Simplified hydrolysis models for the optimal design of two-stage anaerobic digestion.

This note shows that Contois kinetics, when used to describe the hydrolysis of biodegradable solids, are preferable to the traditional first-order kinetics when considering the optimal design of a steady-state two-stage anaerobic digester system.     

One-stage H2 and CH4 and two-stage H2 + CH4 production from grass silage and from solid and liquid fractions of NaOH pre-treated grass silage

In the present study, mesophilic CH₄ production from grass silage in a one-stage process was compared with the combined thermophilic H₂ and mesophilic CH₄ production in a two-stage process. In addition, solid and liquid fractions separated from NaOH pre-treated grass silage were also used as substrates. Results showed that higher CH₄ yield was obtained from grass silage in a two-stage process (467 ml g⁻¹ volatile solids (VS)_original) compared with a one-stage process (431 ml g⁻¹ VS_original). Similarly, CH₄ yield from solid fraction increased from 252 to 413 ml g⁻¹ VS_original whereas CH₄ yield from liquid fraction decreased from 82 to 60 ml g⁻¹ VS_original in a two-stage compared to a one-stage process. NaOH pre-treatment increased combined H₂ yield by 15% (from 5.54 to 6.46 ml g⁻¹ VS_original). In contrast, NaOH pre-treatment decreased the combined CH₄ yield by 23%. Compared to the energy value of CH₄ yield obtained, the energy value of H₂ yield remained low. According to this study, highest CH₄ yield (495 ml g⁻¹ VS_original) could be obtained, if grass silage was first pre-treated with NaOH, and the separated solid fraction was digested in a two-stage (thermophilic H₂ and mesophilic CH₄) process while the liquid fraction could be treated directly in a one-stage CH₄ process.     

Categorizing pain in patients seen in a veterans health administration hospital: Pain as the fifth vital sign.

Previous research has supported the concept of classifying pain intensity into distinct categories (of mild, moderate, and severe) based on the effects of pain on functioning. Such categories, however, have not been studied in samples of veterans. The current study sought to validate the concept of pain intensity classification in a sample of veterans with mixed types of chronic pain. There were 632 veterans referred to a pain program and asked to complete a packet of questionnaires that included a 0 to 10 measure of pain intensity and measures of pain-related interference, depressive symptomatology, and disability. The results indicated that the veterans' ratings of pain at its worst could be classified into the categories of mild, moderate, and severe, with cutpoints of a maximum rating of 3 for mild and 7 for moderate pain. The findings suggest that pain treatment studies of veterans with diverse types of chronic pain should include ratings of pain intensity at its worst that can be reliably classified as mild, moderate, or severe and related to other important outcomes such as daily function and mood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)