Nelfinavir and lenalidomide/dexamethasone in patients with lenalidomide-refractory multiple myeloma. A phase I/II Trial (SAKK 39/10).

The antiretroviral agent nelfinavir has antimyeloma activity and can overcome resistance to bortezomib. Our phase I/II trial investigated whether adding nelfinavir to lenalidomide-dexamethasone can overcome lenalidomide resistance in lenalidomide-refractory multiple myeloma (MM). Twenty-nine patients were included (high-risk cytogenetic aberrations 31%; ≥2 prior therapy lines 93%; lenalidomide-bortezomib double-refractory 34%). Twenty-four patients (83%) had prior bortezomib and 10 (34%) were lenalidomide-bortezomib double-refractory. They received four cycles of nelfinavir 2500 mg/day with standard-dose lenalidomide (25 mg days 1-21) and dexamethasone (40/20 mg days 1, 8, 15, 22). Minor response or better was achieved in 16 patients (55%; 95% CI 36-74%), including 40% of those who were lenalidomide-bortezomib double-refractory, and partial response or better in nine patients (31%; 95% CI 15-51%). Median progression-free survival was 3.4 (95% CI 2.0-4.9) months and median overall survival 21.6 (13.0-50.1) months. Lenalidomide-related pneumonitis, pneumonia, and neutropenic fever occurred, but there were no unexpected adverse events. Peripheral blood mononuclear cells showed a 45% (95% CI 40-51%) reduction in total proteasome activity from baseline and significant induction of unfolded protein response and autophagy. Thus, nelfinavir-lenalidomide-dexamethasone is an active oral combination in lenalidomide-refractory MM.

Short Chemotherapy-Free Interval Improves Oncological Outcome in Patients Undergoing Two-Stage Hepatectomy for Colorectal Liver Metastases.

BACKGROUND: In patients undergoing two-stage hepatectomy (TSH) for colorectal liver metastases (CRLM), chemotherapy is discontinued before portal vein occlusion and restarted after curative resection. Long chemotherapy-free intervals (CFI) may lead to tumor progression and poor oncological outcomes. OBJECTIVE: The aim of this study was to investigate the impact of the length of CFI on oncological outcome in patients undergoing TSH for CRLM. PATIENTS AND METHODS: Overall, 74 patients suffering from bilobar CRLM who underwent ALPPS (associating liver partition with portal vein ligation for staged hepatectomy; n = 43) or conventional TSH (n = 31) at two tertiary centers were investigated. The impact of CFI on long-term outcomes was analyzed by univariable and multivariable analysis. RESULTS: Preoperative chemotherapy was administered in 91 % (67/74) of patients, and chemotherapy was resumed postoperatively in 69 % (44/64) of patients who completed TSH. The use of postoperative chemotherapy was significantly associated with improved mean overall survival (36 ± 3 vs. 13 ± 3 months; p < 0.001). Overall, the median CFI from surgery to postoperative chemotherapy was 16 weeks (interquartile range 11-31) and was significantly shorter in the ALPPS group when compared with the conventional TSH group (10 vs. 21 weeks; p < 0.001). Multivariable analysis revealed a CFI ≤ 10 weeks as an independent factor associated with improved overall survival (p = 0.006) and disease-free survival (p = 0.010). CONCLUSION: A short CFI is associated with improved oncological outcome in patients undergoing TSH for CRLM. Decreased interstage intervals after ALPPS may facilitate the timely resumption of chemotherapy.

Sorafenib with or without everolimus in patients with advanced hepatocellular carcinoma (HCC): a randomized multicenter, multinational phase II trial (SAKK 77/08 and SASL 29).

BACKGROUND: Sorafenib (S), a multitargeted tyrosine kinase inhibitor, is the standard of care for first-line systemic treatment of advanced hepatocellular carcinoma (HCC). Everolimus (E) is a potent inhibitor of mTOR, a pathway frequently activated in HCC. Preclinical data suggest that the combination S + E has additive effects compared with single-agent S. PATIENTS AND METHODS: Patients with unresectable or metastatic HCC and Child-Pugh ≤7 liver dysfunction were randomized to receive daily S 800 mg alone or with E 5 mg until progression or unacceptable toxicity. The primary end point was progression-free survival at 12 weeks (PFS12). The secondary end points included response rate, PFS, time to progression (TTP), overall survival (OS), duration of disease stabilization (DDS), safety, and quality-of-life (QoL) assessments. RESULTS: A total of 106 patients were randomized: 46 patients received S and 60 patients received S + E. Ninety-three patients were assessable for the primary end point and 105 patients for the safety analysis. The PFS12 rate was 70% [95% confidence interval (CI) 54-83] and 68% (95% CI 53-81) in patients randomized to S and S + E, respectively. The RECIST (mRECIST) response rate was 0% (23%) in the S arm and 10% (35%) in the S + E arm. Median PFS (6.6 versus 5.7 months), TTP (7.6 versus 6.3 months), DDS (6.7 versus 6.7 months), and OS (10 versus 12 months) were similar in the S and S + E arms, respectively. Grade 3/4 adverse events occurred in 72% and 86% of patients in arm S and arm S + E, respectively. Patients had similar QoL scores over time, except for a greater worsening in physical well-being and mood in the arm S + E. CONCLUSIONS: No evidence was found that S + E improves the efficacy compared with S alone. Combining 5 mg E with full-dose S is feasible, but more toxic than S alone. Further testing of this drug combination in molecularly unselected HCCs appears unwarranted. CLINICALTRIALSGOV: NCT01005199.

Post-treatment of molasses wastewater by electrocoagulation and process optimization through response surface analysis.

Molasses wastewater is a high strength effluent of food industry such as distilleries, sugar and yeast production plants etc. It is characterized by a dark brown color and exhibits a high content in substances of recalcitrant nature such as melanoidins. In this study, electrocoagulation (EC) was studied as a post treatment step for biologically treated molasses wastewater with high nitrogen content obtained from a baker's yeast industry. Iron and copper electrodes were used in various forms; the influence and interaction of current density, molasses wastewater dilution, and reaction time, on COD, color, ammonium and nitrate removal rates and operating cost were studied and optimized through Box Behnken's response surface analysis. Reaction time varied from 0.5 to 4 h, current density varied from 5 to 40 mA/cm(2) and dilution from 0 to 90% (v/v expressed as water concentration). pH, conductivity and temperature measurements were also carried out during each experiment. From preliminary experiments, it was concluded that the application of aeration and sample dilution, considerably influenced the kinetics of the process. The obtained results showed that COD removal varied between 10 and 54%, corresponding to an operation cost ranging from 0.2 to 33 euro/kg COD removed. Significant removal rates were obtained for nitrogen as nitrate and ammonium (i.e. 70% ammonium removal). A linear relation of COD and ammonium to the design parameters was observed, while operation cost and nitrate removal responded in a curvilinear function. A low ratio of electrode surface to treated volume was used, associated to a low investment cost; in addition, iron wastes could be utilized as low cost electrodes i.e. iron fillings from lathes, aiming to a low operation cost due to electrodes replacement. In general, electrocoagulation proved to be an effective and low cost process for biologically treated molasses-wastewater treatment for additional removal of COD and nitrogen content and color reduction. Treated effluent samples with good quality were produced by EC, with COD, NH4-N and NO3-N concentrations of 180, 52 and 2 mg/l respectively. Response surface analysis revealed that optimized conditions could be established under moderate molasses wastewater dilution, (e.g. 45%), at 3.5 h treatment time and 33 mA/cm(2) current density.

Evaluation of interactions between soil and coal fly ash leachates using column percolation tests.

The aim of this work was the assessment of the environmental impact of different origin fly ashes with regard to their final disposal. The experimental procedure included the performance of single column tests and column tests of fly ash and soil in series. The appraisal of the potential environmental hazards was implemented using physicochemical analyses and bioassays. Two different fly ash samples were examined, one fly ash produced from the combustion of sub-bituminous coal (CFA) and one fly ash produced from the combustion of lignite (LFA). Single column percolation tests were performed according to NEN 7343 protocol, while fly ash/soil experiments were conducted incorporating slight modifications to this protocol. The study focused on the release of metals Ba, Cr, Cu, Mo, Se and Zn and the ecotoxic behavior of leachates on crustacean Daphnia magna and bacteria Vibrio fischeri. The infiltration of the leachates of both fly ashes through soil affected considerably their leaching profile. The transport of Cu and Zn was facilitated by the dynamic leaching conditions and influenced by the pH of the leachates. Moreover, the release and bioavailability of Cr, Cu and Zn was probably altered during the infiltration experiments and organisms' response was not always correlated with the concentration of metals. Nevertheless, the results are signalling that possible manipulations and final disposal of fly ash should be considered when environmental threats are investigated.

Occurrence of Cr(VI) in drinking water of Greece and relation to the geological background.

This study provides a survey on potential Cr(VI) exposure attributed to drinking water in Greece. For this reason, a wide sampling and chemical analysis of tap waters from around 600 sites, supplied by groundwater resources, was conducted focusing on areas in which the geological substrate is predominated by ultramafic minerals. Results indicate that although violations of the current chromium regulation limit in tap water are very rare, 25% of cases showed Cr(VI) concentrations above 10 µg/L, whereas Cr(VI) was detectable in 70% of the samples (>2 µg/L). Mineralogy and conditions of groundwater reservoirs were correlated to suggest a possible Cr(VI) leaching mechanism. Higher Cr(VI) values are observed in aquifers in alluvial and neogene sediments of serpentine and amphibolite, originating from the erosion of ophiolithic and metamorphic rocks. In contrast, Cr(VI) concentration in samples from ophiolithic and metamorphic rocks was always below 10 µg/L due to both low contact time and surface area, as verified by low conductivity and salt concentration values. These findings indicate that under specific conditions, pollution of water by Cr(VI) is favorable by a slow MnO2-catalyzed oxidation of soluble Cr(III) to Cr(VI) in which manganese products [Mn(III)/Mn(II)] are probably re-oxidized by oxygen.

Contribution to the sustainable management of resources by novel combination of industrial solid residues into red ceramics.

Limited amounts of industrial residues are recycled while the remaining huge quantities are stockpiled or disposed of, thus frequently leading to soil contamination. The utilization of industrial residues as valuable secondary resources into ceramics can contribute to efficient waste management and substitution for massive amounts of natural resources (clayey minerals) demanded for ceramic production. The low cost of these residues and even possible energy savings during mixture firing may also be beneficial. In the present study, the innovative combination of lignite fly ash with steel-making dust into clay-based red ceramics is undertaken, to contribute both to sustainable use of resources and prevention of soil contamination. Brick specimens were shaped by extrusion and fired, their microstructure was examined and the effect of the mixture composition and firing temperature on physico-mechanical properties was determined. Ceramic microstructures were successfully obtained by a suitable combination of fly ash with steel dust (5 + 5 wt%) into clays. Properties can be predicted and tailored to meet the needs for specific applications by appropriately adjusting the mixture composition and sintering temperature.

Utilization of phosphogypsum in tannery sludge stabilization and evaluation of the radiological impact.

The current global trend towards increasingly stringent environmental standards and efforts for efficient utilization and re-use of available by-products and/or wastes, favors the use of low-cost sorbent materials for the treatment of heavy metal-contaminated solid wastes. In this study, the stabilization of tannery sludge, produced from the physicochemical and biological treatment of tannery wastewaters, was examined by the addition of phosphogypsum (PG) at a ratio of 1:1. Characterization of the tannery sludge leachates showed high amounts of chromium which exceeded the acceptable level for disposal in non-hazardous waste landfills, while the dissolved organic carbon (DOC) concentrations exceeded the limits for disposal in landfills for hazardous wastes, according to the EU Decision 2003/33/EC. Leachates of the waste stabilized with PG presented chromium and DOC concentrations below the regulation limits for disposal in landfills for non-hazardous wastes. Moreover, mixing PG with tannery sludge resulted in a stabilized waste with reduced radioactivity.

Protozoans as indicators of sequential batch processes for phenol treatment; an autoecological approach.

The objective of this study was the investigation of the potential use of protistan species as quality indicators of the activated sludge performance in sequential batch processes receiving toxic compounds. Two laboratory scale sequential batch reactors (SBR) were used, a conventional one and a system with plastic biofilm carriers (SBBR), treating wastewater containing phenol at concentrations ranging from 1 up to 40 mg/L. Physicochemical analyses of the samples included the determination of MLSS, effluent suspended solids, BOD5, nitrogen-ammonia, nitrogen-nitrate and phenol. The activated sludge protistan community was identified and enumerated in each reactor. Statistical analyses included Canonical Correspondence Analysis and Indicator Species Analysis of the collected experimental data. Canonical Correspondence Analysis showed inversely proportional relationships between the protozoa and the physicochemical parameters of the effluent as well as protozoan species competition. Indicator species analysis revealed the presence and the prevalence of different species under various phenol influent concentrations. No indicator species were observed for the period of operation under 5 mg/L influent phenol in both reactors, while no indicator species were observed for 20 mg/L influent phenol in the SBR reactor. Carchesium and Epistylis sp. showed the higher values for 1 mg/L phenol in the SBR, while Holophrya sp. showed lower indicator values for the same period in the SBBR. Although several species showed a good correlation to the treatment efficiency of the reactors, Blepharisma sp., could be used as the primary indicator species in both reactors for the operation period under 40 mg/L phenol, as deduced by statistical analysis.

A test for adequate wastewater treatment based on glutathione S transferase isoenzyme profile.

Discharge to the environment of treated or non-treated municipal wastewater imposes several threats to coastal and estuarine ecosystems which are difficult to assess. In our study we evaluate the use of the isoenzyme profile of glutathione S transferase (GST) in combination with the kinetic characteristics of the whole enzyme and of heme peroxidase, as a test of adequate treatment of municipal wastewater. For this reason, Artemia nauplii were incubated in artificial seawater prepared by wastewater samples, such as secondary municipal effluents produced by a conventional activated sludge unit and advanced treated effluents produced by the employment of coagulation, activated carbon adsorption and chlorination as single processes or as combined ones. Characteristic changes of the isoenzyme pattern and the enzymes' kinetic properties were caused by chlorinated secondary municipal effluent or by secondary non-chlorinated effluent. Advanced treatment by combination of coagulation and/or carbon adsorption resulted to less prominent changes, suggesting more adequate treatment. Our results suggest that GST isoenzyme profile in combination with the kinetic properties of the total enzyme family is a sensitive test for the evaluation of the adequateness of the treatment of reclaimed wastewater and the reduction of potentially harmful compounds. Potentially, it may offer a 'fingerprint' characteristic of a particular effluent and probably of the treatment level it has been subjected.

Environmental hazard assessment of coal fly ashes using leaching and ecotoxicity tests.

The environmental hazard of six coal fly ash samples collected from various coal incineration plants were examined in the present study, using various leaching tests along with physicochemical and ecotoxicological analyses. Physicochemical analyses indicated that the concentration of Ba, Cr, Mo, Se, sulfates and total dissolved solids (TDS) exceeded the threshold values, according to the European Council decision 2003/33/EC for inert, non-hazardous or hazardous waste. The highest sensitivity, among examined organisms, was presented by Daphnia magna and was ascribed to the lowest tolerance of the organism to Cr. The toxic effect profile of the leachates toward Vibrio fischeri revealed that its bioluminescence was significantly altered by the presence of heavy metals in the leachates (such as Cu, Ni and Zn) in low or sub-lethal doses. Although the toxicity of the leachates toward Pseudokirchneriella subcapitata was relatively high, the correlation between the toxicity and heavy metals concentration was rather poor, indicating the significance of the bioavailability of constituents and the importance of toxicity testing. Based on the classification of the samples resulted by physicochemical analyses of the leachates and the results of ecotoxicity tests, Physicochemical and Ecotoxicological indices were also defined, for an overall evaluation of the environmental impact assessment of fly ashes. The suggested indices showed that ecotoxicity tests were in some cases inconsistent with the outcome of waste classification based on physicochemical analyses. Moreover, the examination of leaching protocols and obtained results showed that one stage leaching test (L/S=10 L/kg) underestimated the fly ash classification, when compared with the two stage test EN 12457-3 at the cumulative ratio L/S=10 L/kg. In addition, the application of availability test NEN 7341 provided useful results about the ecotoxicity wastes. Thus, NEN 7341 is strongly suggested for the implementation of such studies, since the bioavailability of constituents may not be altered by pH adjustment tactics and pH-originated toxicity effects may be avoided.

Risk-adapted FDG-PET/CT-based follow-up in patients with diffuse large B-cell lymphoma after first-line therapy.

BACKGROUND: The purpose of this study was to evaluate the impact of 2-[fluorine-18]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) during follow-up of patients with diffuse large B-cell lymphoma (DLBCL) being in complete remission or unconfirmed complete remission after first-line therapy. PATIENTS AND METHODS: DLBCL patients receiving FDG-PET/CT during follow-up were analyzed retrospectively. Confirmatory biopsy was mandatory in cases of suspected disease recurrence. RESULTS: Seventy-five patients were analyzed and 23 (30%) had disease recurrence. The positive predictive value (PPV) of FDG-PET/CT was 0.85. Patients >60 years [P = 0.036, hazard ratio (HR) = 3.82, 95% confidence interval (CI) 1.02-7.77] and patients with symptoms indicative of a relapse (P = 0.015; HR = 4.1; 95% CI 1.20-14.03) had a significantly higher risk for relapse. A risk score on the basis of signs of relapse, age >60 years, or a combination of these factors identified patients at high risk for recurrence (P = 0.041). CONCLUSIONS: FDG-PET/CT detects recurrent DLBCL after first-line therapy with high PPV. However, it should not be used routinely and if only in selected high-risk patients to reduce radiation burden and costs. On the basis of our retrospective data, FDG-PET/CT during follow-up is indicated for patients <60 years with clinical signs of relapse and in patients >60 years with and without clinical signs of relapse.

A multi-criteria assessment of scenarios on thermal processing of infectious hospital wastes: a case study for Central Macedonia.

In Greece more than 14,000 tonnes of infectious hospital waste are produced yearly; a significant part of it is still mismanaged. Only one off-site licensed incineration facility for hospital wastes is in operation, with the remaining of the market covered by various hydroclave and autoclave units, whereas numerous problems are still generally encountered regarding waste segregation, collection, transportation and management, as well as often excessive entailed costs. Everyday practices still include dumping the majority of solid hospital waste into household disposal sites and landfills after sterilization, still largely without any preceding recycling and separation steps. Discussed in the present paper are the implemented and future treatment practices of infectious hospital wastes in Central Macedonia; produced quantities are reviewed, actual treatment costs are addressed critically, whereas the overall situation in Greece is discussed. Moreover, thermal treatment processes that could be applied for the treatment of infectious hospital wastes in the region are assessed via the multi-criteria decision method Analytic Hierarchy Process. Furthermore, a sensitivity analysis was performed and the analysis demonstrated that a centralized autoclave or hydroclave plant near Thessaloniki is the best performing option, depending however on the selection and weighing of criteria of the multi-criteria process. Moreover the study found that a common treatment option for the treatment of all infectious hospital wastes produced in the Region of Central Macedonia, could offer cost and environmental benefits. In general the multi-criteria decision method, as well as the conclusions and remarks of this study can be used as a basis for future planning and anticipation of the needs for investments in the area of medical waste management.

Hodgkin's lymphoma in remission after first-line therapy: which patients need FDG-PET/CT for follow-up?

BACKGROUND: The purpose of the study was to evaluate the impact of 2-[fluorine-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET)/computed tomography (CT) during follow-up of patients with Hodgkin's lymphoma. PATIENTS AND METHODS: Patients in complete remission or an unconfirmed complete remission after first-line therapy who received FDG-PET/CT during their follow-up were analyzed retrospectively. Confirmatory biopsy was mandatory in case of recurrence. RESULTS: Overall, 134 patients were analyzed. Forty-two (31.3%) patients had a recurrence. The positive predictive value of FDG-PET/CT was 0.98. Single-factor analysis identified morphological residual mass [P = 0.0005, hazard ratio (HR) 3.4, 95% confidence interval (CI) 1.7-6.6] and symptoms (P < 0.0001, HR 4.9, 95% CI 2.4-9.9) as significant risk factors for relapse. By multivariate analysis, morphological residual mass was the only significant risk factor for early follow-up (<24 months) (P = 0.0019, HR 7.6, 95% CI 2.1-27.3). Advanced stage (P = 0.0426, HR 3.6, 95% CI 1.1-12.3) and the presence of symptoms (P = 0.0009, HR = 14.6, 95% CI 3.0-69.7) were found to be significant risk factors for later follow-up (>24 months). CONCLUSIONS: Asymptomatic patients without morphological residues and an early stage of disease do not need a routine FDG-PET/CT for follow-up. Asymptomatic patients with morphological residues should receive routine follow-up FDG-PET/CT for the first 24 months. Only patients with advanced initial stage do need a routine follow-up FDG-PET/CT beyond 24 months.

Real-time tissue elastography versus FibroScan for noninvasive assessment of liver fibrosis in chronic liver disease.

PURPOSE: Transient elastography (FibroScan, [TE]) and serum fibrosis markers such as the FibroTest (FT) are established methods for the noninvasive staging of liver fibrosis. A study using real-time elastography (HI-RTE), which is integrated in a conventional ultrasound system, was recently published with comparable results to transient elastography. The aim of the present study was to validate real-time elastography using the formulas calculated in previous studies and to compare the results to transient elastography and FibroTest for the noninvasive assessment of liver fibrosis. MATERIALS AND METHODS: One hundred and thirty-four patients with chronic liver disease and either histological assessment of liver fibrosis (n = 112) or proven liver cirrhosis (n = 22) were included in the study. All patients received TE, HI-RTE, and biochemical evaluation on the same day as presentation. The calculation of the elasticity score of real-time elastography was performed in accordance with the two previously published studies. RESULTS: The Spearman correlation coefficient between transient elastography, real-time elastography and FibroTest with the histological Chevallier score was statistically significant with 0.78, 0.34, and 0.67, respectively (p < 0.01). The diagnostic accuracy expressed as areas under ROC curves was 0.84, 0.69 and 0.85 for the diagnosis of significant fibrosis (F > or = 2), and 0.97, 0.65, and 0.83 for the diagnosis of cirrhosis, respectively. CONCLUSION: Real-time elastography in its present form cannot replace transient elastography for noninvasive assessment of liver fibrosis.

Toxicological and ecotoxic impact of secondary and tertiary treated sewage effluents.

Secondary sewage effluents are discharged in significant quantities in aquatic environments delivering pollutants that were not removed during treatment; yet advanced treated effluents are not lacking of contaminants. In this study, biochemical biomarkers were measured in liver and kidney of rainbow trout (Oncorynchus mykiss) exposed to unchlorinated, chlorinated and tertiary treated secondary sewage effluents. In addition, organic matter, nitrogen and suspended solids were assayed, while a common bioassay, Daphnia magna 21d reproduction test was also applied in order to examine potential relation between the performed bioassay and the biomarkers. Processes using oxidative conditions, such as ozonation and chlorination, resulted in significantly increased breeding rate (up to 74%) of the organism. Biomarkers measurements incorporated the determination of total glutathione (GSH), glutathione S-transferases (GST), glutathione peroxidase (GPX), lipid peroxidation (LPO) and an innovative biomarker in such applications, haem peroxidase. In general, the response of biomarkers was dependent upon the treatment method and it was tissue specific. Secondary effluents inhibited liver GST and haem peroxidase, while GSH levels and LPO were significantly provoked in liver. Ozonation provoked hepatic peroxidation, in terms of haem peroxidase and LPO, and GST; while the protective (to Reactive Oxidant Species - ROS) GSH was depleted, suggesting extended ROS attack to the organism. Similar response of biomarkers (but to a lesser extend) was observed after exposure of trout to effluents submitted to both coagulation and ozonation, emphasizing the significance of removing the residual organic matter by other methods than oxidative ones. Ozonation also enhanced renal LPO and GPX; however the former employment of coagulation limited the peroxidation phenomena. Chlorination mainly affected the levels of total GSH in both tissues.

Effectiveness of ozonation and chlorination on municipal wastewater treatment evaluated by a battery of bioassays and biomarkers.

A battery of bioassays, including biological toxicity as well as in vitro mouse spleen lymphoproliferative responses and cytokine production, was conducted to compare the effectiveness of tertiary treatment methods such as coagulation (Coag) and absorption on granular activated carbon (GAC) and disinfection processes such as chlorination and ozonation in removing toxic or stress inducing agents from reclaimed wastewater. Whole effluent toxicity (WET) testing of secondary treated (ST) wastewater using as test species Vibrio fischeri, Daphnia magna and Tetrahymena thermophila as well as phytotoxicity revealed moderate toxicity effects that depend on the organism used. All bioassays exhibited decrease of the ecotoxicological responses after tertiary treatment. However, mitogenic responses were proved to be more sensitive. Endotoxin present in ST samples may be responsible for the increased strong lymphoproliferative activity as well as interleukin-1 (IL-1) production by mouse splenocytes. Tertiary treatment of ST with coagulation and/or adsorption on granular activated carbon (GAC) in combination with ozonation reduced WET to control levels. Ozonation alone or in combination with any other treatment removed endotoxin more efficiently than chlorination and thus reduced spleen lymphoproliferative responses and IL-1 production.

Comparative study of phenol and cyanide containing wastewater in CSTR and SBR activated sludge reactors.

The objectives of this work were the examination of the performance of two bench scale activated sludge systems, a conventional Continuous Stirring Tank Reactor (CSTR) and a Sequential Batch Reactor (SBR), for the treatment of wastewaters containing phenol and cyanides and the assessment of the toxicity reduction potential by bioassays. The operation of the reactors was monitored by physicochemical analyses, while detoxification potential of the systems was monitored by two bioassays, the marine photobacterium Vibrio fischeri and the ciliate protozoan Tetrahymena thermophila. The reactors influent was highly toxic to both organisms, while activated sludge treatment resulted in the reduction of toxicity of the influent. An increased toxicity removal was observed in the SBR; however CSTR system presented a lower ability for toxicity reduction of influent. The performance of both systems was enhanced by the addition of powdered activated carbon in the aeration tank; activated carbon upgraded the performance of the systems due to the simultaneous biological removal of pollutants and to carbon adsorption process; almost negligible values of phenol and cyanides were measured in the effluents, while further toxicity reduction was observed in both systems.