Severe heart failure and intracardiac thrombosis: going beyond the appearance for diagnosis and treatments.

We describe the case of a 45-year-old female affected by asthma and nasal polyposis who presented to the emergency department because of worsening dyspnea and paresthesia of the left lower limb. Comprehensive instrumental examinations revealed the presence of severe left ventricle dysfunction, intra-cardiac thrombus, deep vein thrombosis, pulmonary embolism, lung infiltrates, polyserositis, and neurological involvements. Finally, the patient was diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA), formerly Churg-Strauss syndrome, a rare vasculitis of small-medium blood vessels with several organ involvements. Treatment with anticoagulants, corticosteroids, and cyclophosphamide led to a significant clinical improvement. However, a subcutaneous cardiac defibrillator was implanted because of the persistence of severe left ventricular dysfunction and the high cardiovascular risk phenotype. Indeed, several cardiac manifestations may occur in EGPA, particularly in patients with anti-neutrophil cytoplasmic antibody-negative disease. Therefore, clinicians should have high clinical suspicion because cardiac involvement in EGPA results in a poor prognosis if not diagnosed and adequately treated.

Optimization of the treatment cycle of pressed-off leachate produced in a facility processing the organic fraction of municipal solid waste.

The paper investigates, at a laboratory scale, the applicability of anaerobic digestion for the treatment of pressed-off leachate produced in a biomechanical treatment plant for municipal solid waste. Batch tests show that the anaerobic process proceeds smoothly and produces about 10,000 mL of methane per litre of treated leachate. The process is characterized by a lag phase lasting about 30 days, and is completed in about 2 months. Chemical oxygen demand (COD) and volatile fatty acids monitoring allows studying process kinetics that are modelled through a triple linear expression. Physical and biological treatments are also investigated to reduce the residual organic charge of the produced digestate. The best performances are obtained via aerobic degradation followed by assisted sedimentation. This cycle reduces the residual COD of about 85%, and allows the correct disposal of the final waste stream.

An environmental friendly cycle for Cr(III) removal and recovery from tannery wastewater.

Results of a lab-scale experimental study are presented that aim to verify the use of ground shrimp shells, not otherwise conditioned, as an adsorbent material to remove chromium(III) from tannery wastewater. The obtained removal efficiency is found to be always over 90%, confirming the capacity of the tested materials to remove chromium(III). The adsorption process is well described by the Brauner-Emmett-Teller isotherm, indicating the existence of both weak and strong adsorption sites inside the shells. Kinetic tests allow to verify that the removal process takes place rapidly during the first 2 h and then tends to reach a plateau: the pseudo second-order model is found to be able to simulate with good approximation, the adsorption process. Analyses comparing the treatment process using shrimp shells vs. other chemical products frequently used for chromium removal, supported by microscopic observations, indicate that the efficiency obtained using shrimp shell is comparable to the efficiency obtained using sodium bicarbonate and sodium hydroxide, but the removal mechanism is different as the adsorption on the polysaccharidic matrix of the shells prevails over the precipitation of chromium salts. The skin tanned with recovered chromium is found to be of low quality; on the contrary satisfying tanning results are obtained using, as tanning agent, the sludge produced by the adsorption process without any further treatment, except for pH correction.

Comparison of safety and efficacy of bivalirudin versus unfractionated heparin in high-risk patients undergoing percutaneous coronary intervention (from the Anti-Thrombotic Strategy for Reduction of Myocardial Damage During Angioplasty-Bivalirudin vs Heparin study).

Bivalirudin, a direct thrombin inhibitor, is as effective as unfractionated heparin (UFH), with decreased bleeding in patients with acute coronary syndromes who undergo percutaneous coronary intervention (PCI). The aim of this study was to evaluate the effectiveness of bivalirudin versus UFH in selected PCI patients at high bleeding risk. Four hundred one consecutive patients who underwent PCI fulfilling ≥ 1 enrollment criterion (age >75 years, chronic renal failure, and diabetes mellitus) were randomized to bivalirudin (bolus 0.75 mg/kg followed by infusion during the procedure; n = 198) or UFH (75 IU/kg; n = 203). In the overall population, 39% were aged >75 years, 22% had renal failure, 63% had diabetes, and 29% had acute coronary syndromes. The primary efficacy end point was the 30-day incidence of major adverse cardiac events (cardiac death, myocardial infarction, stent thrombosis, or target vessel revascularization). The primary safety end point was the occurrence of any bleeding or entry-site complications after PCI. All patients were preloaded with clopidogrel 600 mg. Glycoprotein IIb/IIIa inhibitors were used at the operators' discretion. Thirty-day major adverse cardiac event rates were 11.1% in the bivalirudin group and 8.9% in the UFH group (p = 0.56); the primary efficacy end point was reached mainly because of periprocedural myocardial infarction; 1 patient in the bivalirudin group had stent thrombosis. Occurrence of the primary safety end point was 1.5% in the bivalirudin group and 9.9% in the UFH group (p = 0.0001); this benefit was essentially driven by the prevention of entry-site hematomas >10 cm (0.5% vs 6.9%, p = 0.002). In conclusion, Anti-Thrombotic Strategy for Reduction of Myocardial Damage During Angioplasty-Bivalirudin vs Heparin (ARMYDA-7 BIVALVE) indicates that bivalirudin, compared with UFH, causes significantly lower bleeding and has a similar incidence of major adverse cardiac events in patients with older age, diabetes mellitus, or chronic renal failure who undergo PCI.

Optimization of automated large-scale production of [(18)F]fluoroethylcholine for PET prostate cancer imaging.

INTRODUCTION: PET tumor imaging is gaining importance in current clinical practice. FDG-PET is the most utilized approach but suffers from inflammation influences and is not utilizable in prostate cancer detection. Recently, (11)C-choline analogues have been employed successfully in this field of imaging, leading to a growing interest in the utilization of (18)F-labeled analogues: [(18)F]fluoroethylcholine (FEC) has been demonstrated to be promising, especially in prostate cancer imaging. In this work we report an automatic radiosynthesis of this tracer with high yields, short synthesis time and ease of performance, potentially utilizable in routine production sites. METHODS: We used a Modular Lab system to automatically perform the two-step/one-pot synthesis. In the first step, we labeled ethyleneglycolditosylate obtaining [(18)F]fluoroethyltosylate; in the second step, we performed the coupling of the latter intermediate with neat dimethylethanolamine. The final mixture was purified by means of solid phase extraction; in particular, the product was trapped into a cation-exchange resin and eluted with isotonic saline. RESULTS: The optimized procedure resulted in a non decay corrected yield of 36% and produced a range of 30-45 GBq of product already in injectable form. The product was analyzed for quality control and resulted as pure and sterile; in addition, residual solvents were under the required threshold. CONCLUSION: In this work, we present an automatic FEC radiosynthesis that has been optimized for routine production. This findings should foster the interest for a wider utilization of this radiomolecule for imaging of prostate cancer with PET, a field for which no gold-standard tracer has yet been validated.