Preservation of Fat-free Mass after Bariatric Surgery: A Comparison of Malabsorptive and Restrictive Procedures

2015 ◽  
Vol 81 (8) ◽  
pp. 812-815 ◽  
Author(s):  
Jason Wells ◽  
Megan Miller ◽  
Brittonni Perry ◽  
Joseph A. Ewing ◽  
Allyson L. Hale ◽  
...  
Keyword(s):  
Protein Intake ◽  
Analysis Data ◽  
Fat Free Mass ◽  
Composition Analysis ◽  
Vertical Sleeve Gastrectomy ◽  
Significant Weight Loss ◽  
Restrictive Procedures ◽  
Significant Difference ◽  
The Difference ◽  
Malabsorptive Procedures

The Roux-en-Y gastric bypass (RYGB) has been shown to cause significant weight loss. However, fat-free mass (FFM) is often lost with this rapid weight change. It is suggested that the loss of FFM is minimized with restrictive-only procedures, such as the vertical sleeve gastrectomy (VSG), when compared with malabsorptive surgery. The purpose of the study was to determine the difference in the postoperative loss of FFM between RYBG and VSG patients. We reviewed all patients who underwent RYGB or VSG between May 2012 and January 2013. Patients were evaluated one month before their procedure and 12 months after for comparison of results. Preoperative and postoperative body analysis data were procured using a body composition analysis device. Within the study period, 33 patients underwent a RYGB procedure and 20 patients a VSG. After 12 months, RYGB patients had an average increase of 38.15 per cent in their proportion of FFM, whereas VSG patients had an average FFM increase of 22.09 per cent, a statically significant difference ( P = 0.004). The RYGB helps preserve overall FFM as compared with the VSG. These findings are unexpected because malabsorptive procedures require increased protein intake, resulting in a stronger likelihood of inadequate protein intake, which may lead to protein malnutrition.

scholarly journals The impact of image and performance enhancing drugs on bi-ventricular structure and function in strength-trained athletes and the association to fat-free mass

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
B Morrison ◽  
N Chester ◽  
R Mcgregor-Cheers ◽  
G Kleinnibbelink ◽  
C Johnson ◽  
...  
Keyword(s):  
Allometric Scaling ◽  
Strain Imaging ◽  
Fat Free Mass ◽  
Composition Analysis ◽  
Lv Mass ◽  
Significant Difference ◽  
And Performance ◽  
Performance Enhancing Drugs ◽  
The Impact ◽  
Performance Enhancing

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Canadian Institute of Health Research Michael Smith Foreign Study Supplement Background Image and performance enhancing drugs (IPED) cause cardiac enlargement and dysfunction. Previous work has not assessed impact of user status (current [CU] vs. past [PU]) or allometric scaling cardiac dimensions for individual differences in fat-free mass (FFM). Purpose To investigate CU and PU of IPED and allometric scaling on LV and RV remodeling in strength-trained athletes. Methods Thirty-four (29 ± 6 years; 82% male) strength-trained athletes were recruited. Fourteen were CU, 9 PU and 11 non-users (NU) of IPEDs.  Participants underwent bioelectric impedance body composition analysis, IPED and training questionnaire and 2D echocardiography with strain imaging. All structural data was allometrically scaled to FFM according to the laws of geometric similarity. Results CU and PU had significantly higher FFM compared to NU (82.4 ± 10.1 kg vs. 72.0 ± 6.3 kg vs. 58.2 ± 14.0 kg). Absolute values of all RV and LV size were larger between CU and NU. LV mean wall thickness (MWT) was larger in CU compared to PU but there were no differences between PU and NU. Allometric scaling eliminated all differences with exception of LV mass and LVMWT. LVEF was significantly lower in CU and PU compared to NU (55 ± 3 vs. 57 ± 4 vs. 61 ± 4) whilst LV GLS was lower in CU compared to PU and NU and LV GCS was lower in CU compared to NU but not PU. There was no significant difference between groups for RV functional indices. Conclusion  Strength-trained athletes currently using IPEDs have bi-ventricular enlargement as well as reduced LV function. Allometric scaling highlights that increased size is partially associated with a larger FFM, with exception of LVMWT which is independently increased through IPED use. PUs demonstrate reverse structural remodeling whilst functional differences partially remain. CU PU NU RVD1 (mm) 45 ± 5* 43 ± 6 37 ± 6 Scaled RVD1 (mm/kg^0.33) 10.5 ± 0.9 10.4 ± 1.5 9.7 ± 1.0 LVd (mm) 58 ± 7* 55 ± 4 50 ± 4 Scaled LVd (mm/kg^0.33) 13.4 ± 1.2 13.3 ± 0.7 13.1 ± 0.6 MWT (mm) 10 ± 1*” 8 ± 1 8 ± 1 Scaled MWT (mm/kg^0.33) 2.3 ± 0.2*” 2.0 ± 0.1 2.0 ± 0.2 LVEDV (ml) 169 ± 42* 135 ± 28 116 ± 28 Scaled LVEDV (ml/kg) 2.0 ± 0.4 1.9 ± 0.3 2.0 ± 0.2 LV Mass (g) 255 ± 85*” 179 ± 30 137 ± 40 LV mass index (g/kg) 3.1 ± 0.8* 2.5 ± 0.3 2.4 ± 0.4 * CU and NU “ CU and PU ^ PU and NU Abstract Figure. Myocardial strain imaging

scholarly journals The Difference Plaque Index of Brushing Teeth A Combination to Grade Students

2018 ◽  
Vol 12 (1) ◽  
pp. 44
Author(s):  
Yessi Yuzar ◽  
Lisnayetti Lisnayetti ◽  
Nurul Amelia
Keyword(s):  
Random Sampling ◽  
Analysis Data ◽  
T Test ◽  
Tooth Brushing ◽  
Plaque Index ◽  
P Value ◽  
Significant Difference ◽  
The Difference ◽  
Objective Research ◽  
Quasi Experiment

Plaque is caused of the caries and periodontal deseases. Plaque can be cleaned up by mechanization that is brushing teeth. The data show that decline in behave right of brushing teeth from 6.2% in 2007 become 1.7% in 2013. Best on the kinds of the movement of tooth brusing, there are six methode. Every techniques of brushing teeth having a overbalance and shortage. The objective research is knowing the differences plaque index of brushing teeth a combination of techniques roll and horizontal with a combination techniques vertical and horizontal to grade IV – V students in SDN 08 Kubang Duo Koto Panjang. The methode research is quasi experiment with pretest and postest approach. Technique sampling is random sampling as many as 54 people. Data retrival through observation dan treatment. The analysis data statistic with T-Test showed the significant difference between plaque index of brushing teeth a combination of techniques roll and horizontal with a combination techniques vertical and horizontal with p value 0,03. A combination of techniques roll and horizontal is more effectivly lowering plaque. Suggestion for the students to apply tooth brushing a combination of techniques roll and horizontal routinely every day 2 times to prevent the oral deseases.

scholarly journals Relapse and post-discharge body composition of children treated for acute malnutrition using a simplified, combined protocol: A nested cohort from the ComPAS RCT

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0245477
Author(s):  
Natasha Lelijveld ◽  
Eunice Musyoki ◽  
Susan Were Adongo ◽  
Amy Mayberry ◽  
Jonathan C. Wells ◽  
...  
Keyword(s):  
Body Composition ◽  
Standard Care ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Analysis Data ◽  
Fat Free Mass ◽  
Acute Malnutrition ◽  
Post Discharge ◽  
Significant Difference ◽  
Z Scores

Introduction Severe and moderate acute malnutrition (SAM and MAM) affect more than 50 million children worldwide yet 80% of these children do not access care. The Combined Protocol for Acute Malnutrition Study (ComPAS) trial assessed the effectiveness of a simplified, combined SAM/MAM protocol for children aged 6–59 months and found non-inferior recovery compared to standard care. To further inform policy, this study assessed post-discharge outcomes of children treated with this novel protocol in Kenya. Methods Six ‘combined’ protocol clinics treated SAM and MAM children using an optimised mid-upper arm circumference (MUAC)-based dose of ready-to-use therapeutic food (RUTF). Six ‘standard care’ clinics treated SAM with weight-based RUTF rations; MAM with ready-to-use supplementary food (RUSF). Four months post-discharge, we assessed anthropometry, recent history of illness, and body composition by bioelectrical impedance analysis. Data was analysed using multivariable linear regression, adjusted for age, sex and allowing for clustering by clinic. Results We sampled 850 children (median age 18 months, IQR 15–23); 44% of the original trial sample in Kenya. Children treated with the combined protocol had similar anthropometry, fat-free mass, fat mass, skinfold thickness z-scores, and frequency of common illnesses 4 months post-discharge compared the standard protocol. Mean subscapular skinfold z-scores were close to the global norm (standard care: 0.24; combined 0.27). There was no significant difference in odds of relapse between protocols (SAM, 3% vs 3%, OR = 1.0 p = 0.75; MAM, 10% vs 12%, OR = 0.90 p = 0.34). Conclusions Despite the lower dosage of RUTF for most SAM children in the combined protocol, their anthropometry and relapse rates at 4 months post-discharge were similar to standard care. MAM children treated with RUTF had similar body composition to those treated with RUSF and neither group exhibited excess adiposity. These results add further evidence that a combined protocol is as effective as standard care with no evidence of adverse effects post-discharge. A simplified, combined approach could treat more children, stretch existing resources further, and contribute to achieving Sustainable Development Goal Two.

Depth Dependent Variations in Human Achilles Tendon as a Result of Active Smoking: An Elastographic Study

2021 ◽  
Vol 11 (5) ◽  
pp. 1495-1500
Author(s):  
Mahdi Al-Qahtani ◽  
Eraj Humayun Mirza ◽  
Rimsha Siddiqui ◽  
Mohammed Almijalli ◽  
Ravish Javed
Keyword(s):  
Body Composition ◽  
Achilles Tendon ◽  
Fat Free Mass ◽  
Composition Analysis ◽  
Active Smoking ◽  
Significant Difference ◽  
Anatomical Images ◽  
Tendon Stem Cells ◽  
Body Mass Indexes ◽  
The Impact

Current study was set to determine the impact of active smoking on Achilles Tendon (AT) as soft tissue using an elastographic technique. This study comprises of 54 male individuals having sedentary lifestyle. Volunteers were categorized into two groups of smokers (n = 20) and non-smokers (n = 34). Body composition analysis was performed to evaluate the physiological changes in human body mass indexes. Ultrasound Strain Elastog-raphy (USE) technique was used to find the stiffness along with anatomical images to envisage the anomalous status of Achilles tendon. Statistical analysis of data obtained through body composition, tendon anatomy and Strain Elastography (SE) was used to scrutinize the physiological, anatomical and elasticity variations within the tendon. A reduction in Fat Free Mass Index (FFMI) was observed among smokers with a significant difference (P = 0.042). Further, an increased significant difference (P = 0.029) was found in AT Strain Ratios (SR) of smokers as compared to non-smokers. Lightening in tendon mass and dilution in tendon stiffness indicates that smoking mechanism may generate excessive apoptosis and decrease the density of tenocytes. Nicotine is the key element that inhibits the functional capacity of Tendon Stem Cells and is highly responsible for tendinopathy, eventually leading to tendon rupture and injury.

scholarly journals PERBEDAAN BENTUK DAN UKURAN RUGAE PALATINA ANTARA MAMAK DAN KAMANAKAN LAKI-LAKI SUKU MINANGKABAU DI WILAYAH LUHAK NAN TIGO

2017 ◽  
Vol 5 (1) ◽  
pp. 8-19
Author(s):  
Ovy Prima Damara ◽  
Nila Kasuma ◽  
Eni Rahmi
Keyword(s):  
Low Cost ◽  
Analysis Data ◽  
Forensic Odontology ◽  
Cross Sectional ◽  
Victim Identification ◽  
Internal Position ◽  
Palatal Rugae ◽  
Significant Difference ◽  
The Difference ◽  
Shape And Size

Forensic odontology in dentistry is used to identify victims. Several methods can be used, such as rugoscopy. Rugoscopy is a victim identification method by evaluating the palatal rugae. Rugoscopy is very advantageous due to its low cost, fast results and practical nature. Palatal rugae is protected from trauma and high temperature due to its internal position in the oral cavity. Palatal rugae is an individualistic structure, though it bears several resemblance with the hereditary pattern due to the polygenic mechanism. The purpose of this research is to determine the difference of palatal rugae shape and size between uncle and nephew in Minangkabau ethnics. This study is an analytical observational study with a cross sectional approach. A total of 78 pairs of uncle and nephew of the Minangkabau ethnicity in Luhak Nan Tigo. Palatal rugae is classified using the Thomaz and Khutze classification. Data were analyzed by using Mann Whitney non-parametric statistical analysis. Data analysis show the palatal rugae shape of uncle and nephew from the Minangkabau ethnicity is dominated by a wavy shape, followed by curvy, straight, unified and circular shapes. The palatal rugae size of uncle and naphew from the Minangkabau ethnicity is dominated by primary size, followed by secondary and fragmenter size. Mann Whitney analysis revealed no significant difference of palatal rugae shape and size between uncle and nephew in Minangkabau ethnics (p>0,05), though there is a significant difference in the unified shape (p<0,05). Palatal rugae shape and size have a similar pattern with hereditery patterns, though not identical. Palatal rugae may be used as a secondary method of victim identification Keywords : Rugoscopy, palatal rugae, uncle and nephew

Energy and Protein Intake and Nutritional Status of Primary Schoolchildren 5 to 10 Years of Age in Schools with and without Feeding Programmes in Nyambene District, Kenya

1998 ◽  
Vol 19 (4) ◽  
pp. 334-342 ◽  
Author(s):  
M. M. Meme ◽  
W. Kogi-Makau ◽  
N. M. Muroki ◽  
R. K. Mwadime
Keyword(s):  
Nutritional Status ◽  
Protein Intake ◽  
Child Growth ◽  
Income Sources ◽  
Significant Difference ◽  
Need To Evaluate ◽  
Food Expenditure ◽  
Per Capita ◽  
The Difference ◽  
Caloric Consumption

The dietary intake and nutritional status of 162 children in a school with a lunch programme (the feedingprogramme group) and 163 children in a school without a lunch programme (the no-feeding-programme group) in Nyambene District, Kenya, were compared. The relationship between such child growth determinants as income sources, per capita weekly food expenditure and consumption frequency, per capita energy and protein intake, and the nutritional status of the children was also compared between the two groups. Daily caloric consumption in the group with a feeding programme was significantly higher than in the group without a feeding programme: 1,590 kcal, or 86% of the recommended daily allowance (RDA), versus 1,457 kcal, or 76% of the RDA ( p < .05). The protein intake was mainly of plant origin. Although not significantly different between the two groups, it was higher for children without a feeding programme (62 g; 238% of the RDA) than for those with a feeding programme (56 g; 216% of the RDA). The prevalence of wasting among children with a feeding programme (9%) was significantly higher than among those without a feeding programme (2%) ( p < .05). The level of stunting was about the same in both groups: 24% in the group with a feeding programme and 25% in the group without a feeding programme. There was no significant difference in the prevalence of underweight between the two groups. Overall, the nutritional status of girls was better than that of boys, although the difference was not statistically significant. It is evident that children participating in the feeding programme did not have a nutritional advantage over non-participants. Thus, there is need to evaluate school feeding programmes in Kenya to identify and address the weaknesses that curtail their impact.

Cranial crassicaudiasis in two coastal dolphin species from South Africa is predominantly a disease of immature individuals

2020 ◽  
Vol 139 ◽  
pp. 93-102 ◽  
Author(s):  
MF Van Bressem ◽  
P Duignan ◽  
JA Raga ◽  
K Van Waerebeek ◽  
N Fraijia-Fernández ◽  
...  
Keyword(s):  
South Africa ◽  
Bone Development ◽  
Bottlenose Dolphins ◽  
Fatal Outcome ◽  
Population Level ◽  
Cape Coast ◽  
Osteolytic Lesions ◽  
Immune Mediated ◽  
Significant Difference ◽  
The Difference

Crassicauda spp. (Nematoda) infest the cranial sinuses of several odontocetes, causing diagnostic trabecular osteolytic lesions. We examined skulls of 77 Indian Ocean humpback dolphins Sousa plumbea and 69 Indo-Pacific bottlenose dolphins Tursiops aduncus, caught in bather-protecting nets off KwaZulu-Natal (KZN) from 1970-2017, and skulls of 6 S. plumbea stranded along the southern Cape coast in South Africa from 1963-2002. Prevalence of cranial crassicaudiasis was evaluated according to sex and cranial maturity. Overall, prevalence in S. plumbea and T. aduncus taken off KZN was 13 and 31.9%, respectively. Parasitosis variably affected 1 or more cranial bones (frontal, pterygoid, maxillary and sphenoid). No significant difference was found by gender for either species, allowing sexes to be pooled. However, there was a significant difference in lesion prevalence by age, with immature T. aduncus 4.6 times more likely affected than adults, while for S. plumbea, the difference was 6.5-fold. As severe osteolytic lesions are unlikely to heal without trace, we propose that infection is more likely to have a fatal outcome for immature dolphins, possibly because of incomplete bone development, lower immune competence in clearing parasites or an over-exuberant inflammatory response in concert with parasitic enzymatic erosion. Cranial osteolysis was not observed in mature males (18 S. plumbea, 21 T. aduncus), suggesting potential cohort-linked immune-mediated resistance to infestation. Crassicauda spp. may play a role in the natural mortality of S. plumbea and T. aduncus, but the pathogenesis and population level impact remain unknown.

Perbedaan Penggunaan Antikoagulan K2EDTA DAN K3EDTA Terhadap Hasil Pemeriksaan Indeks Eritrosit

2018 ◽  
Vol 1 (2) ◽  
pp. 114
Author(s):  
Wahdaniah Wahdaniah ◽  
Sri Tumpuk
Keyword(s):  
Screening Test ◽  
Venous Blood ◽  
The Body ◽  
Ethylene Diamine ◽  
P Value ◽  
Cross Sectional ◽  
Significant Difference ◽  
Ethylene Diamine Tetra Acetate ◽  
The Difference ◽  
Index Value

Abstract: Routine blood examination is the earliest blood test or screening test to determine the diagnosis of an abnormality. Blood easily froze if it is outside the body and can be prevented by the addition of anticoagulants, one of which Ethylene Diamine Tetra Acetate (EDTA). Currently available vacuum tubes containing EDTA anticoagulants in the form of K2EDTA and K3EDTA. K3EDTA is usually a salt that has better stability than other EDTA salts because it shows a pH approaching a blood pH of about 6.4. The purpose of this research is to know the difference of erythrocyte index results include MCH, MCV and MCHC using K3EDTA anticoagulant with K2EDTA. This research is a cross sectional design. This study used venous blood samples mixed with K2EDTA anticoagulant and venous blood mixed with K3EDTA anticoagulants, each of 30 samples. Data were collected and analyzed using paired different test. Based on data analysis that has been done on MCH examination, p value <0,05 then there is a significant difference between samples with K3EDTA anticoagulant with K2EDTA to erythrocyte index value. Then on the examination of MCV and MCHC obtained p value <0.05 then there is no significant difference between samples with K3EDTA anticoagulant with K2EDTA to erythrocyte index value.Abstrak: Pemeriksaan darah rutin merupakan pemeriksaan darah yang paling awal atau screening test untuk mengetahui diagnosis suatu kelainan. Darah mudah membeku jika berada diluar tubuh dan bisa dicegah dengan penambahan antikoagulan, salah satunya Ethylene Diamine Tetra Acetate (EDTA). Dewasa ini telah tersedia tabung vakum yang sudah berisi antikoagulan EDTA dalam bentuk  K2EDTA dan  K3EDTA. K3EDTA  biasanya berupa garam yang mempunyai stabilitas yang lebih baik dari garam EDTA yang lain karena menunjukkan pH yang mendekati pH darah yaitu sekitar 6,4. Tujuan dari penelitian ini adalah untuk mengetahui perbedaan hasil indeks eritrosit meliputi MCH, MCV dan MCHC menggunakan antikoagulan K3EDTA dengan K2EDTA. Penelitian ini merupakan penelitian dengan desain cross sectional. Penelitian ini menggunakan sampel darah vena yang dicampur dengan antikoagulan K2EDTA dan darah vena yang dicampur dengan antikoagulan K3EDTA, masing-masing sebanyak 30 sampel. Data dikumpulkan dan dianalisis menggunakan uji beda berpasangan. Berdasarkan analisis data yang telah dilakukan pada pemeriksaan MCH didapatkan nilai p < 0,05 maka ada perbedaan yang signifikan antara sampel dengan antikoagulan K3EDTA dengan K2EDTA terhadap nilai indeks eritrosit. Kemudian pada pemeriksaan MCV dan MCHC didapatkan nilai p < 0,05 maka tidak ada perbedaan yang signifikan antara sampel dengan antikoagulan K3EDTA dengan K2EDTA terhadap nilai indeks eritrosit.

Pengaruh Jumlah Pencucian Beras dengan Kadar Klorin

2017 ◽  
Vol 1 (1) ◽  
pp. 89
Author(s):  
Indah Purwaningsih ◽  
Supriyanto Supriyanto
Keyword(s):  
Mucous Membrane ◽  
Confidence Level ◽  
Iodometric Titration ◽  
Titration Method ◽  
Anova Test ◽  
Average Value ◽  
Significant Difference ◽  
The Difference

Abstract: Chlorine is a green halogen-shaped halogen gas at normal temperature and serves as bleach, stain remover and disinfectant. Chlorine is now widely used for bleaching rice so that less quality rice looks like quality rice. Chlorine is very toxic and causes mucous membrane irritation, highly reactive and very powerful oxidizer. The purpose of this research was to determine the difference of chlorine level in chlorinated rice washed once, twice and 3 times. The sample in this study amounted to 11 samples calculated by replication formula. Each sample was treated 3 times, ie 1 washed once, 2 washed twice and washed 3 times. The samples then examined by iodometric titration method. Based on the results of the study using ANOVA test, 11 samples obtained the average value of chlorine after washed once amount of 0.0176%, after washed twice amount of 0.0111%, and after washed 3 times amount of 0.0052% with the value significance p = 0.03 (p <0.05) at 95% confidence level which means there was a significant difference between chlorine levels in chlorinated rice washed once, twice and 3 times.Abstrak: Klorin merupakan unsur halogen berbentuk gas berwarna kuning kehijauan pada suhu normal danberfungsi sebagai pemutih, penghilang noda maupun desinfektan. Klorin sekarang banyak digunakan untuk bahan pemutih beras agar beras yang kurang berkualitas tampak seperti beras berkualitas. Klorin sangat toksik dan menyebabkan iritasi membran mukosa, sangat reaktif dan merupakan oksidator yang sangat kuat. Tujuan dari penelitian ini ialah untuk mengetahui perbedaan kadar klorin pada beras berklorin yang dicuci sebanyak 1 kali, 2 kali dan 3 kali. Sampel dalam penelitian ini berjumlah 11 sampel yang dihitung dengan rumus replikasi. Setiap sampel diberi perlakuan sebanyak 3 kali, yaitu 1 kali pencucian, 2 kali pencucian dan 3 kali pencucian. Sampel penelitian kemudian diperiksa dengan metode titrasi iodometri. Berdasarkan hasil penelitian menggunakan uji Anova secara komputerisasi terhadap 11 sampel diperoleh nilai rata-rata kadar klorin setelah 1 kali pencucian sebesar 0,0176 %, setelah 2 kali pencucian sebesar 0,0111 %, dan setelah 3 kali pencucian sebesar 0,0052 % dengan nilai signifkansi p = 0,03 (p<0,05) pada tingkat kepercayaan 95% yang artinya ada perbedaan yang bermakna antara kadar klorin pada beras berklorin yang dicuci sebanyak 1 kali, 2 kali dan 3 kali.

P-Removal in Completely Mixed Systems

1985 ◽  
Vol 17 (11-12) ◽  
pp. 325-326 ◽  
Author(s):  
H J. G. W. Donker ◽  
P. Opic ◽  
H. P. de Vries
Keyword(s):  
Mixed System ◽  
Domestic Waste ◽  
Recirculation Flow ◽  
Start Up ◽  
Significant Difference ◽  
Aerobic Reactor ◽  
The Difference ◽  
Positive Effect ◽  
Mixed Systems ◽  
P Removal

Ca. 60 % of the Dutch activated sludge plants consist of completely mixed systems, experiments have been carried out in completely mixed pilot plants to study the biological P-removal. The research was carried out in two pilot plants. The pilot plants consisted of: anaerobic reactor, anoxic reactor, aerobic reactor and a clarifier. All the reactors were completely mixed. Both plants were fed with settled domestic waste water at a sludge loading of 400 and 250 g COD/kg sludge.day respectively. The results are given below:sludge loading (g COD/kg sludge.day)400400250ratio Anaerobic : Anoxic : Aerobic1: 1:2,71:1:4,11:1:2,7P-removal (%)802875N-removal (%)505065COD-removal (%)858585 It has been shown that there is no significant difference between the results at the two different sludge loadings. Remarkable is the difference between the ratio 1:1:2,7 in combination with the internal recirculation flow anoxic-anaerobic of 160 % and the ratio 1:1:4,1 with a recirculation flow of 30 %. During the start-up at a sludge loading of 250 g COD/kg sludge.day and an internal recirculation flow of 30 %, bulking sludge developed almost immediately. The Premoval was completely disturbed. Increasing the internal recirculation flow to 160% had a positive effect on settling properties and P-removal. This investigation has pointed out that a completely mixed system is suitable for biological P-removal, without negatively affecting the nitrification. Important factors in the process are the ratio anaerobic:anoxic:aerobic and the recirculation flows.

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