These findings are not surprising, as human fecal bacteria has also been noted in concrete biofilms in previous studies [7–9]. Sections of wastewater pipes exhibit conditions that are favorable for the establishment of oxic zones, e.g., at the top of the pipe (TP). In fact, the dominant TP biofilm members were associated with aerobic and facultative anaerobic bacteria (e.g. Thiobacillus Acidiphilium Xanthomonas Bradyrhizobium). The biofilms did not contain a significant presence of photosynthetic organisms (e.g. Cyanobacteria), which dominated biofilms in

concrete corroded city-surface structures [10]. The latter is supported by the low number of genes assigned to the photosynthesis CB-839 cost subsystems in our metagenome libraries ( Additional file 1, Figure S1). Taxonomic analysis based on annotated proteins show two distinct archaeal communities (Figure 1). The BP biofilm was dominated by the classes Methanomicrobia (55%), Thermococcus (10%) and Thermoprotei (8%). The classes Methanomicrobia (38%) and Thermoprotei (17%) were also abundant in the TP site although Halobacteria (15%) and Thaumarchaeota (7%) were also abundant. Members of the Thaumarchaeota phylum are chemolithoautotrophic

ammonia-oxidizers, which suggest that they may be playing a role in the nitrogen cycle in wastewater concrete biofilms [35]. Halobacteriales have been previously reported in wastewater sludge PF-562271 clinical trial and may suggest the presence of alkaline hypersaline microenvironments in wastewater concrete biofilms [36]. The anaerobic niches in the wastewater pipe provide

conditions for methanogenesis as suggested by the annotated sequences associated with genera TCL such as Methanospirillum Methanobrevibacter Methanosphaera Methanosaeta Methanosarcina, and Methanococcoides[37]. However, the more favourable anaerobic conditions at the bottom of the pipe provide better conditions for this process. Indeed, there are a higher percentage of annotated sequences related to methanogenesis in the BP (69%) than in TP metagenomes (47%). Conversely, more methanotrophic and methylotrophic bacteria proteins were present in the TP (3.7%) than in BP biofilm (1.8%). Specifically, many of the sequences were related to proteins affiliated with Methylibium Methylobacillus Methylobacterium Methylocella Methylococcus, and Methylacidiphilum. The dominant annotated methane-oxidizing bacteria in the TP biofilm were affiliated with Methylocella silvestris, a moderately acidophilic (pH values between 4.5 and 7) and mesophilic species [38]. In general, our analysis identified microorganisms associated with one-carbon compound pathways (e.g. methanogenesis, methanotrophs and methylotrophs), although the importance of these metabolic processes in wastewater pipes remains unknown.

These values reflect the ‘intent-to-treat’ population which includes all patients regardless of whether they survived their injuries. Mean mortality rate in the published studies was 22% which compares well with the values in the current study of 20%. A 3% mean percentage of patients in the published literature developed a fistula during therapy (ranging from 7 to STI571 datasheet 0%). The value in the current study of 5% compares well, especially considering that a single patient developed a fistula which was apparent at only one dressing change and was resolved by the next dressing change. In terms of the rate of other complications, the data was less reliable because not

all the relevant studies reported selleck kinase inhibitor complications (not shown). In conclusion, there is no evidence that the device used in this study is any less efficacious than the VAC™ device in the treatment of Grade 1 and 2 open abdomen wounds derived from traumatic patients. Table 6 Comparison with published literature Reference Method n Fascial closure Mortality Fistula This Study RENASYS -AB 20 13 (65%) 4

(20%) 1 (5%) Miller et al. 2004 [12] VAC™ 53 38 8 (15%) 1 (2%) Garner et al. 2003 [6] 14 13 NR 0 Suliberk et al. 2003 [13] 29 25 6 (21%) 2 (8) Stone et al. 2004 [14] 48 23 16 (33%) 2 (4%) Weinberg et al. 2008 [15] 9* 6 NR NR Arigon et al. 2008†[16] 22 6 3 (14%) 0 Batacchi et al. 2010 [17] 35* NR 8 (23%) NR Labler et al. 2005 [18]   18 12 5 (33%) 0 Total patients reporting relevant end-point 228 193 205 5 Weighted mean (%)   63.7 23.5 2.7 NR = Not Recorded. NA = Not Applicable. * refers to the relevant subgroup (treated with NPWT) of a wider analysis. † data extracted from abstract only (article in French). All studies described traumatic patients except Arigon Morin Hydrate et al. [16] and Batacchi et al. [17] who described a mixed group of aetiologies with the majority of reported patients being relevant to this study. Discussion In this study, the rate of

fascial closure was 65% on an intent-to-treat basis which compares well with comparable published studies (63.7%) of patients (Table 6). All comparisons were carried out with studies using the predominant commercially available abdominal NPWT kit, Abdominal VAC™ (KCI San Antonio, Tx USA). One significant drawback of this study design was the non-comparative design. A large comparative study would be required to confirm equivalence of these two devices. The present study provides evidence that application of the alternative dressing (RENASYS™ AB Smith & Nephew St Petersburg, FL USA) is likely to achieve similar outcomes. Concurrent application of fascial tension: for example through the use of ‘dynamic suturing’, along with NPWT may further improve the frequency of fascial closure [19, 20] although, to date, no comparative studies have been carried out to support this.

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