Impact of allogeneic stem cell transplantation on thyroid function.

PURPOSE: Primary hypothyroidism is a main endocrine complication after allogeneic stem cells transplantation (allo-SCT) in children, but in adults data on post-SCT hypothyroidism are limited. The aims of this observational, cross-sectional study were to assess the prevalence of hypothyroidism in adult allo-SCT recipients according to time from transplantation, and to identify risk factors. METHODS: One hundred and eighty-six patients (M 104; F 82; median age 53.4 years) who underwent allo-SCT between January 2010 and December 2017 were enrolled and divided into three groups, according to time from allo-SCT (1-3 years; 3-5 years; > 5 years). Pre-transplant TSH and fT4 levels were available for all patients. After transplantation, TSH, fT4 and anti-thyroperoxidase antibodies (TPO-Ab) were evaluated. RESULTS: After a follow-up of 3.7 years, 34 (18.3%) patients developed hypothyroidism, with higher prevalence in females (p < 0.001) and in patients who received matched unrelated donor grafts (p < 0.05). No difference in prevalence was found at different time points. Patients who developed hypothyroidism showed higher rate of TPO-Ab positivity (p < 0.05) and higher pre-transplant TSH levels (median 2.34 µU/ml) compared to those with preserved thyroid function (median 1.53 µU/ml; p < 0.001). Multivariable analysis identified higher pre-transplant TSH levels as a positive predictor of hypothyroidism (p < 0.005). The ROC curve analysis identified a pre-SCT TSH cutoff of 1.84 µU/ml, which can predict hypothyroidism with sensitivity 74.1% and specificity 67.2%. CONCLUSIONS: About one out of four patients developed hypothyroidism after allo-SCT, with a greater incidence in females. Pre-transplant TSH levels seem to predict the onset of post-SCT hypothyroidism.

Validation of a decision support tool for wastewater treatment selection.

Wastewater treatment selection is a complex task usually addressed by applying separate tools for the correct assessment of multi-criteria evaluation. Novedar_EDSS integrates technical, environmental, economic and social assessment capabilities in one single platform. The aim of this work is to evaluate and demonstrate the capabilities of this environmental decision support system (EDSS). For that purpose, 4 case studies of real projects were selected to validate the results in the EDSS by comparing them with those from the study of alternatives performed by the decision makers. Moreover, 1 conceptual case study was applied to support the selection of the most properly strategy for plant retrofitting. Results have demonstrated that the EDSS provides key aspects when deciding the retrofitting process to apply and, when compared to real projects, it recommends analogue treatments as those applied in the projects, ranking them in the same order. Therefore, results in the validation process performed show that this tool provides a reliable basis to support decision makers to select properly treatment alternatives in wastewater treatment plant pre-design.

Isospin Mixing in

The isospin mixing was deduced in the compound nucleus ^{80}Zr at an excitation energy of E^{*}=54 MeV from the γ decay of the giant dipole resonance. The reaction ^{40}Ca+^{40}Ca at E_{beam}=136 MeV was used to form the compound nucleus in the isospin I=0 channel, while the reaction ^{37}Cl+^{44}Ca at E_{beam}=95 MeV was used as the reference reaction. The γ rays were detected with the AGATA demonstrator array coupled with LaBr_{3}:Ce detectors. The temperature dependence of the isospin mixing was obtained and the zero-temperature value deduced. The isospin-symmetry-breaking correction δ_{C} used for the Fermi superallowed transitions was extracted and found to be consistent with ß-decay data.

Implications of alternative electron sinks in increased resistance of PSII and PSI photochemistry to high light stress in cold-acclimated Arabidopsis thaliana.

Exposure of control (non-hardened) Arabidopsis leaves to high light stress at 5 °C resulted in a decrease of both photosystem II (PSII) (45 %) and Photosystem I (PSI) (35 %) photochemical efficiencies compared to non-treated plants. In contrast, cold-acclimated (CA) leaves exhibited only 35 and 22 % decrease of PSII and PSI photochemistry, respectively, under the same conditions. This was accompanied by an accelerated rate of P700(+) re-reduction, indicating an up-regulation of PSI-dependent cyclic electron transport (CET). Interestingly, the expression of the NDH-H gene and the relative abundance of the Ndh-H polypeptide, representing the NDH-complex, decreased as a result of exposure to low temperatures. This indicates that the NDH-dependent CET pathway cannot be involved and the overall stimulation of CET in CA plants is due to up-regulation of the ferredoxin-plastoquinone reductase, antimycin A-sensitive CET pathway. The lower abundance of NDH complex also implies lower activity of the chlororespiratory pathway in CA plants, although the expression level and overall abundance of the other well-characterized component involved in chlororespiration, the plastid terminal oxidase (PTOX), was up-regulated at low temperatures. This suggests increased PTOX-mediated alternative electron flow to oxygen in plants exposed to low temperatures. Indeed, the estimated proportion of O(2)-dependent linear electron transport not utilized in carbon assimilation and not directed to photorespiration was twofold higher in CA Arabidopsis. The possible involvement of alternative electron transport pathways in inducing greater resistance of both PSII and PSI to high light stress in CA plants is discussed.

Process analysis and economics of drinking water production from coastal aquifers containing chromophoric dissolved organic matter and bromide using nanofiltration and ozonation.

In regions characterized by water scarcity, such as coastal Southern California, groundwater containing chromophoric dissolved organic matter is a viable source of water supply. In the coastal aquifer of Orange County in California, seawater intrusion driven by coastal groundwater pumping increased the concentration of bromide in extracted groundwater from 0.4 mg l⁻¹ in 2000 to over 0.8 mg l⁻¹ in 2004. Bromide, a precursor to bromate formation is regulated by USEPA and the California Department of Health as a potential carcinogen and therefore must be reduced to a level below 10 µg l⁻¹. This paper compares two processes for treatment of highly coloured groundwater: nanofiltration and ozone injection coupled with biologically activated carbon. The requirement for bromate removal decreased the water production in the ozonation process to compensate for increased maintenance requirements, and required the adoption of catalytic carbon with associated increase in capital and operating costs per unit volume. However, due to the absence of oxidant addition in nanofiltration processes, this process is not affected by bromide. We performed a process analysis and a comparative economic analysis of capital and operating costs for both technologies. Our results show that for the case studied in coastal Southern California, nanofiltration has higher throughput and lower specific capital and operating cost, when compared to ozone injection with biologically activate carbon. Ozone injection with biologically activated carbon, compared to nanofiltration, has 14% higher capital cost and 12% higher operating costs per unit water produced while operating at the initial throughput. Due to reduced ozone concentration required to accommodate for bromate reduction, the ozonation process throughput is reduced and the actual cost increase (per unit water produced) is 68% higher for capital cost and 30% higher for operations.

Carbon footprint of aerobic biological treatment of winery wastewater.

The carbon associated with wastewater and its treatment accounts for approximately 6% of the global carbon balance. Within the wastewater treatment industry, winery wastewater has a minor contribution, although it can have a major impact on wine-producing regions. Typically, winery wastewater is treated by biological processes, such as the activated sludge process. Biomass produced during treatment is usually disposed of directly, i.e. without digestion or other anaerobic processes. We applied our previously published model for carbon-footprint calculation to the areas worldwide producing yearly more than 10(6) m(3) of wine (i.e., France, Italy, Spain, California, Argentina, Australia, China, and South Africa). Datasets on wine production from the Food and Agriculture Organisation were processed and wastewater flow rates calculated with assumptions based on our previous experience. Results show that the wine production, hence the calculated wastewater flow, is reported as fairly constant in the period 2005-2007. Nevertheless, treatment process efficiency and energy-conservation may play a significant role on the overall carbon-footprint. We performed a sensitivity analysis on the efficiency of the aeration process (alphaSOTE per unit depth, or alphaSOTE/Z) in the biological treatment operations and showed significant margin for improvement. Our results show that the carbon-footprint reduction via aeration efficiency improvement is in the range of 8.1 to 12.3%.

Temperature modelling and prediction for activated sludge systems.

Temperature is an important factor affecting biomass activity, which is critical to maintain efficient biological wastewater treatment, and also physiochemical properties of mixed liquor as dissolved oxygen saturation and settling velocity. Controlling temperature is not normally possible for treatment systems but incorporating factors impacting temperature in the design process, such as aeration system, surface to volume ratio, and tank geometry can reduce the range of temperature extremes and improve the overall process performance. Determining how much these design or up-grade options affect the tank temperature requires a temperature model that can be used with existing design methodologies. This paper presents a new steady state temperature model developed by incorporating the best aspects of previously published models, introducing new functions for selected heat exchange paths and improving the method for predicting the effects of covering aeration tanks. Numerical improvements with embedded reference data provide simpler formulation, faster execution, easier sensitivity analyses, using an ordinary spreadsheet. The paper presents several cases to validate the model.

CO2 and N2O from water resource recovery facilities: Evaluation of emissions from biological treatment, settling, disinfection, and receiving water body.

Water resource recovery facilities (WRRFs) contribute to climate change and air pollution, as they are anthropogenic potential sources of direct and indirect emission of greenhouse gases (GHGs). Studies concerning the monitoring and accounting for GHG emissions from WRRFs are of increasing interest. In this study, the floating hood technique for gas collection was coupled with the off-gas method to monitor and apportion nitrous oxide (N2O) and carbon dioxide (CO2) emissions from both aerated and non-aerated tanks in a municipal water resource recovery facility, in order to investigate its carbon footprint (CFP). To our knowledge, this is the first time that the chamber technique was applied to evaluate gas fluxes from the settler, where an emission factor (EF) of 4.71 ∗ 10-5 kgCO2,eq kgbCOD-1 was found. Interesting results were found in the disinfection unit, which was the major contributor to direct N2O emissions (with a specific emission factor of 0.008 kgCO2,eq kgbCOD-1), due to the chemical interaction between hydroxylamine and the disinfectant agent (hypochlorite). The specific emission factor of the biological aerated tank was 0.00112 kgCO2,eq kgbCOD-1. The average direct CO2 emission was equal to 0.068 kgCO2 kgbCOD-1 from the activated sludge tank and to 0.00017 kgCO2 kgbCOD-1 from the secondary clarifier. Therefore, taking into account the contribution of both direct N2O and CO2 emissions, values of 0.069 kgCO2,eq kgbCOD-1, 0.008 kgCO2,eq kgbCOD-1 and 0.00022 kgCO2,eq kgbCOD-1, were found for the net CFP of the aerated compartment, the disinfection unit and the clarifier, respectively. The plant energy Footprint (eFP) was also evaluated, confirming that the aeration system is the major contributor to energy consumption, as well as to indirect CO2 emission, with a specific eFP of 1.49 kWh kgbCOD-1.

A Compton scattering setup for pulse shape discrimination studies in germanium detectors.

Pulse shape discrimination is an important handle to improve sensitivity in low background experiments. A dedicated setup was built to investigate the response of high-purity germanium detectors to single Compton scattered events. Using properly collimated γ-ray sources, it is possible to select events with known interaction location. The aim is to correlate the position dependent signal shape with geometrical and electrical properties of the detector. We report on design and performance of the setup with a first look on data.

Surfactant effects on alpha factors in full-scale wastewater aeration systems.

Aeration is an essential process in the majority of wastewater treatment processes, and accounts for the largest fraction of plant energy costs. Aeration systems can achieve wastewater oxygenation by shearing the surface (surface aerators) or releasing bubbles at the bottom of the tank (coarse- or fine-bubble aerators). Surfactants accumulate on gas-liquid interfaces and reduce mass transfer rates. This reduction in general is larger for fine-bubble aerators. This study was conducted to evaluate mass transfer effects on the characterization and specification of aeration systems in clean and process water conditions. Tests at different interfacial turbulence regimes were analysed, showing higher gas transfer depression for lower turbulence regimes. Higher turbulence regimes can offset contamination effects, at the expense of operating efficiency. This phenomenon is characteristic of surface aerators and coarse bubble diffusers and is here discussed. The results explain the variability of alpha factors measured at small scale, due to uncontrolled energy density. Results are also reported in dimensionless empirical correlations that describe mass transfer as a function of physiochemical and geometrical characteristics of the aeration process.

Avaliação do impacto do tempo de espera para admissão em Unidade de Terapia Intensiva no desfecho clínico do paciente crítico / Assessment of the impact of waiting time until admission in the Intensive Care Unit on the clinical outcome of critical patients

RESUMO: Este estudo tem por base a premissa de que com um maior número de leitos de Unidade de Terapia Intensiva (UTI) disponíveis o tempo de espera para admissão em UTI é menor, o que resulta no melhor desfecho clínico, justifi-cando, portanto, a importância do presente estudo. Objetivo: Avaliar se o tempo de espera no Departamento de Emergência até a admissão em UTI tem influência no desfecho clínico do paciente crítico. Metodologia: Estudo ob-servacional, retrospectivo, do tipo antes e depois, realizado em um hospital público do município de Joinville/SC no ano de 2019. Foram incluídos os dados referentes aos pacientes adultos admitidos na UTI com até 72 horas de es-pera no Departamento de Emergência desde a chegada ao hospital. Comparou-se o último trimestre de 2017 (fase 1), período durante o qual havia 14 leitos de UTI no hospital, e último trimestre de 2018 (fase 2), período durante o qual havia 30 leitos de UTI. Resultados: Analisaram-se 173 prontuários elegíveis de 2017 e 2018. Houve diferen-ça estatisticamente significativa no tempo decorrido na emergência até a admissão em UTI entre 2017 e 2018 (me-diana de 22 vs. 15; p=0,0002). A diferença estatística também foi relevante para a mortalidade em até 24 horas após a admissão em UTI, comparando-se os dois anos em questão (9,61% vs. 2,47%; p=0,04). Não houve diferen-ça estatística significante na mortalidade hospitalar entre 2017 e 2018 (34,6% vs. 35,5%; p=0,57). Também não houve diferença estatisticamente relevante entre os demais parâmetros analisados. Conclusão: Comparando-se 2017 a 2018, percebeu-se que o tempo de espera pelo leito de UTI diminuiu, bem como a mortalidade em até 24h da admissão intensiva. No entanto, isto não se refletiu na mortalidade hospitalar. (AU)

ABSTRACT: The premise that underpins this study is that the more Intensive Care Unit (ICU) beds available, the shorter the waiting time for ICU admission, resulting in better clinical outcomes, which justifies the relevance of this study. Objective: Assess if the waiting time in the Emergency Room until ICU admission influences on the clinical outcome of critical patients. Methods: An observational longitudinal retrospective study performed in a public hospital in Joinville/SC in 2019. This study analyzed data from patients admitted to the ICU with up to 72h of waiting time in the Emergency Room. It compares Q4'2017 (phase 1), when there were 14 ICU beds in the hospital vs. Q4'2018 (phase 2), when there were 30 ICU beds. Results: 173 medical records were analyzed in 2017-2018. There was a statistically significant difference in the time for ICU admission between 2017 and 2018 (median 22h vs. 15h; p=0.0002). There was also a statistically significant difference for mortality rates up to 24h of admission (9.61% vs. 2.47%; p=0.04). There was no statistically significant difference for hospital mortality rates (34.6% vs. 35.5%; p=0.57). There was also no statistically significant difference between the other parameters analyzed. Conclusion:Comparing 2017 and 2018, waiting time for an ICU bed was shorter in 2018, and the mortality rates up to 24 hours of ICU admission were lower. However, waiting time in the Emergency Room until ICU admission did not show as-sociation with hospital mortality rates. (AU)

Fifteen years of offgas transfer efficiency measurements on fine-pore aerators: key role of sludge age and normalized air flux.

Fine-pore diffusers, often called fine-bubble diffusers, have nearly replaced coarse bubble diffusers in municipal wastewater treatment over the past 20 years. The rapid increases in energy costs, which began in the 1970s, created financial incentives to upgrade to this more expensive and maintenance-intensive method of aeration. Fine-pore diffusers have the added benefit of reducing volatile organic compound stripping and reduced aeration heat loss. This paper summarizes 15 years of oxygen transfer efficiency measurements using the offgas technique. Efficiencies are shown for different types of diffusers at various tank geometries (depth, diffuser size, and number), airflow rates, and mean cell retention times (MCRT or sludge age). By normalizing the airflow rates per unit of depth and diffusing area, efficiencies measured in different plants can be compared. The results show that aeration efficiencies are logarithmically related to the ratio between MCRT and the normalized air flux, with transfer rates suppressed by low MCRT or high normalized air flux systems. There is no evidence for different alpha factors among the different types of fine-bubble diffuser types.

The difference between energy consumption and energy cost: Modelling energy tariff structures for water resource recovery facilities.

The objective of this paper is to demonstrate the importance of incorporating more realistic energy cost models (based on current energy tariff structures) into existing water resource recovery facilities (WRRFs) process models when evaluating technologies and cost-saving control strategies. In this paper, we first introduce a systematic framework to model energy usage at WRRFs and a generalized structure to describe energy tariffs including the most common billing terms. Secondly, this paper introduces a detailed energy cost model based on a Spanish energy tariff structure coupled with a WRRF process model to evaluate several control strategies and provide insights into the selection of the contracted power structure. The results for a 1-year evaluation on a 115,000 population-equivalent WRRF showed monthly cost differences ranging from 7 to 30% when comparing the detailed energy cost model to an average energy price. The evaluation of different aeration control strategies also showed that using average energy prices and neglecting energy tariff structures may lead to biased conclusions when selecting operating strategies or comparing technologies or equipment. The proposed framework demonstrated that for cost minimization, control strategies should be paired with a specific optimal contracted power. Hence, the design of operational and control strategies must take into account the local energy tariff.

Case of the month: June 1997--a 42 year old man with left facial weakness.

A 42 yr old male presented with left facial weakness. MRI showed lesions affecting the distal seventh nerve and third division of the trigeminal nerve. The seventh nerve was biopsied and showed a malignant epithelioid schwannoma. The patient underwent extensive resection followed by irradiation. This is one of very few examples of intracranial malignant peripheral nerve sheath tumors and the first reported example of an intracranial malignant epithelioid schwannoma. The literature is reviewed and completeness of resection appears to be the most pertinent prognostic factor.

Double microcatheter technique for detachable coil treatment of large, wide-necked intracranial aneurysms.

We describe a technique used to treat two patients with large, wide-necked aneurysms during the past 2 years. In the initial attempts at embolization, evidence of coil instability within the aneurysm or significant impingement of coil loops on the parent artery was observed. Advancement of a second microcatheter into the aneurysm allowed two coils to be braced across the aneurysmal neck before the detachment of either coil. This technique permitted successful coil treatment in both patients.

Cavernous aneurysm rupture with balloon occlusion of a direct carotid cavernous fistula: postmortem examination.

We present a unique case of a patient with a symptomatic carotid cavernous fistula treated successfully with balloon embolization. Her subsequent death from other disease processes allowed direct visualization of the balloon occlusion in situ at postmortem examination.

Intracranial dural arteriovenous fistulae with pial venous drainage: combined endovascular-neurosurgical therapy.

BACKGROUND: Intracranial dural arteriovenous fistula with pial venous drainage may present with hemorrhage or focal neurologic deficit and may be difficult to treat. We wish to summarize the therapeutic approaches to these potentially dangerous lesions and to demonstrate how endovascular and neurosurgical therapies may have complimentary roles in their management. METHODS: The clinical and radiological records of all patients who presented to our institution with intracranial dural arteriovenous fistula over the last 5 years were reviewed. In those cases demonstrating pial venous drainage, details of presentation, imaging features, endovascular and surgical therapy and outcome were analyzed. RESULTS: We identified 13 patients with these lesions, 7 of whom presented with intracranial hemorrhage. Six patients were treated with embolization alone. Angiographic cure was achieved in 4. There was one complication in this group, a subarachnoid hemorrhage following glue injection. Four patients were treated with embolization followed by surgical occlusion of the pial venous drainage. Angiographic cure was achieved in all 4. There was one complication in this group, a facial nerve palsy following glue injection. Three patients were treated by surgery alone, with no complications and complete cure in all. CONCLUSION: Endovascular therapy of intracranial dural arteriovenous fistula may be curative but is often complex and carries definite risks. Neurosurgical ligation of pial draining veins, with pre-operative embolization when safe, may be a relatively more controlled method to achieve complete cure.

Prevalence of risk factors in acute ischemic cerebrovascular disease (CVD) in elderly patients from eastern Sicily.

Hundred and forty elderly patients (76 males and 64 females, over 65 years of age) were consecutively admitted to the Institute between November 1989 and April 1993, in order to (i) verify if the risk factors, reported in other Italian areas and regions of the world, are prevalent also in our region, and (ii) outline a secondary prevention strategy against the statistically most important risk factors. There were 111 cases of ischemic stroke (58 males and 53 females) and 29 cases of reversible ischemic attack (RIA) (18 males and 11 females). The percental occurrence of the following risk factors were determined: total cholesterol > 240 mg/dl, HDL cholesterol < 35 mg/dl, triglycerides > 180 mg/dl, fibrinogen > 450 mg/dl, hematocrit > 45%, hypertension, diabetes mellitus, cigarette smoking, familial ischemic events, previous ischemic CVD, ischemic cardiac disease, embolic cardiopathy. In males with ischemic stroke the most frequent risk factors were: hypertension (43%), fibrinogen > 450 mg/dl (37.9%), diabetes mellitus, cigarette smoking and previous ischemic CVD (25.8%). In females with ischemic stroke a clear prevalence of hypertension (69.8%), ischemic cardiopathy and previous ischemic CVD (47%) and diabetes mellitus (41.5%) were observed. In males with RIA hypertension (50%) and cigarette smoking (38%). Females with RIA presented a high prevalence of reduced HDL cholesterol, lower than 35 mg/dl (77.7%), hypertension (63.6%) and ischemic cardiopathy (54.5%). The results indicate that there are no highly significant differences between the data reported by other authors on the most important acute ischemic CVD risk factors in Italy and elsewhere. Arterial hypertension and diabetes mellitus are the most important risk factors of cerebral ischemic events in both sexes. The diffusion of cigarette smoking among women in the last thirty years must be taken into consideration. Although it does not represent a risk factor for elderly women today, it may do in the future. Therefore, antismoking campaigns must be more decisive and targeted at both sexes.

Pathological lesions in senile diabetes: possible pathogenetic interpretations.

Pathohistological alterations of the kidney and pancreas were studied in a group of elderly diabetics divided into "aged diabetics" (AD) (onset of diabetes before 60 years of age) and "senile diabetics" (SD) (onset of diabetes after 70 years of age). The control groups were formed by middle-aged non-insulin dependent diabetics (NIDDM) and non-diabetic elderly subjects. The non-diabetic elderly subjects showed no damage of pancreatic islets and the arterioles were also intact. The middle-aged NIDDM group having had diabetes for less than one year presented no alterations either. Middle-aged NIDDM patients affected by the disease for longer than 10 years, displayed the characteristic diabetic damage (hyalinization of the islets and arteriolar damage). In addition, AD presented pancreatic lesions characteristic of long-term NIDDM. SD were divided into two groups depending on the duration of disease: shorter than 6 and longer than 10 years. The former presented small islets with few fibrotic cells and arteriolar damage, while the latter presented a picture of transition between SD with duration of disease shorter than 6 years and AD. The kidney in AD and SD affected by diabetes longer than 10 years resembled the kidney of NIDDM patients. SD with duration of disease shorter than 6 years had aspecific age-related damage. These lesions seem to confirm that macroangiopathy represents the main pathogenesis of senile diabetes, being aggravated by the persisting hyperglycemia causing microangiopathy.

Hepatitis C virus genotypes in elderly patients with chronic hepatitis C.

The importance of determination of hepatitis C virus (HCV) genotypes and subtypes has been demonstrated not only as epidemiological characteristics, but also as prognostic factors regarding the seriousness of the disease and response to interferon (IFN) in patients with chronic hepatitis C (CHC). Aim of this study was to determine HCV genotypes in a group of elderly patients with CHC, in order to acquire epidemiological data on the prevalence of HCV genotypes in Eastern Sicily, and to evaluate any relationship with the seriousness of the disease and with the response to IFN. The study was carried out on 22 patients with CHC, aged from 65 to 75 years. The prevalence of HCV-RNA subtypes in elderly patients (Group A) was compared with two other groups: Group B aged from 36 to 64 years; and Group C aged from 20 to 35 years. HCV-RNA proved to be positive in 20 of the 22 patients in Group A, and in 100% of these cases the prevalent subtype was 1b; in the other two groups the occurrence of other subtypes was more frequent, especially in the younger ages. In conclusion, the subtype 1b is indigenous in our region and it cannot be proposed as the only prognostic factor for seriousness of the disease and response to IFN, especially in elderly patients.