Long-term impact of basin-wide wastewater management on faecal pollution levels along the entire Danube River.

The Danube River is, at 2857 km, the second longest river in Europe and the most international river in the world with 19 countries in its catchment. Along the entire river, faecal pollution levels are mainly influenced by point-source emissions from treated and untreated sewage of municipal origin under base-flow conditions. In the past 2 decades, large investments in wastewater collection and treatment infrastructure were made in the European Union (EU) Member States located in the Danube River Basin (DRB). Overall, the share of population equivalents with appropriately biologically treated wastewater (without disinfection) has increased from 69% to more than 85%. The proportion of tertiary treatment has risen from 46 to 73%. In contrast, no comparable improvements of wastewater infrastructure took place in non-EU Member States in the middle and lower DRB, where a substantial amount of untreated wastewater is still directly discharged into the Danube River. Faecal pollution levels along the whole Danube River and the confluence sites of the most important tributaries were monitored during four Danube River expeditions, the Joint Danube Surveys (JDS). During all four surveys, the longitudinal patterns of faecal pollution were highly consistent, with generally lower levels in the upper section and elevated levels and major hotspots in the middle and lower sections of the Danube River. From 2001 to 2019, a significant decrease in faecal pollution levels could be observed in all three sections with average reduction rates between 72 and 86%. Despite this general improvement in microbiological water quality, no such decreases were observed for the highly polluted stretch in Central Serbia. Further improvements in microbiological water quality can be expected for the next decades on the basis of further investments in wastewater infrastructure in the EU Member States, in the middle and lower DRB. In the upper DRB, and due to the high compliance level as regards collection and treatment, improvements can further be achieved by upgrading sewage treatment plants with quaternary treatment steps as well as by preventing combined sewer overflows. The accession of the Western Balkan countries to the EU would also significantly boost investments in wastewater infrastructure and water quality improvements in the middle section of the Danube. Continuing whole-river expeditions such as the Joint Danube Surveys is highly recommended to monitor the developments in water quality in the future.

Reappraisal of the Genus Exsudoporus (Boletaceae) Worldwide Based on Multi-Gene Phylogeny, Morphology and Biogeography, and Insights on Amoenoboletus.

The boletoid genera Butyriboletus and Exsudoporus have recently been suggested by some researchers to constitute a single genus, and Exsudoporus was merged into Butyriboletus as a later synonym. However, no convincing arguments have yet provided significant evidence for this congeneric placement. In this study, we analyze material from Exsudoporus species and closely related taxa to assess taxonomic and phylogenetic boundaries between these genera and to clarify species delimitation within Exsudoporus. Outcomes from a multilocus phylogenetic analysis (ITS, nrLSU, tef1-α and rpb2) clearly resolve Exsudoporus as a monophyletic, homogenous and independent genus that is sister to Butyriboletus. An accurate morphological description, comprehensive sampling, type studies, line drawings and a historical overview on the nomenclatural issues of the type species E. permagnificus are provided. Furthermore, this species is documented for the first time from Israel in association with Quercus calliprinos. The previously described North American species Exsudoporus frostii and E. floridanus are molecularly confirmed as representatives of Exsudoporus, and E. floridanus is epitypified. The eastern Asian species Leccinum rubrum is assigned here to Exsudoporus based on molecular evidence, and a new combination is proposed. Sequence data from the original material of the Japanese Boletus kermesinus were generated, and its conspecificity with L. rubrum is inferred as formerly presumed based on morphology. Four additional cryptic species from North and Central America previously misdetermined as either B. frostii or B. floridanus are phylogenetically placed but remain undescribed due to the paucity of available material. Boletus weberi (syn. B. pseudofrostii) and Xerocomus cf. mcrobbii cluster outside of Exsudoporus and are herein assigned to the recently described genus Amoenoboletus. Biogeographic distribution patterns are elucidated, and a dichotomous key to all known species of Exsudoporus worldwide is presented.

New objective method in reporting the breast cosmesis after breast-conservative treatment based on nonstandardized photographs: The Objective Breast Cosmesis Scale.

PURPOSE: Subjective scoring is the most widely used approach in reporting the cosmetic outcome after breast-conservative therapy. This work introduces an objective system to document the breast cosmetic changes using nonstandardized photographs without scale calibration. METHODS AND MATERIALS: Two hundred twenty-eight photographs of 114 breast cancer patients were analyzed. Baseline photographs were taken after breast-conservation surgery and before partial breast irradiation. Further photographs were taken during followup. The photographs were taken with a frontal view of the patient and without any skin marks for scaling. The baseline and the last followup photographs were analyzed by measuring certain anatomic distances (representing the nipple displacement and the asymmetry in breast dimensions and contour) to calculate the objective breast cosmesis score (OBCS). The measurements represent the nipple displacement and the asymmetry in breast dimensions and contour. Same photographs were scored subjectively by a multidisciplinary team (MDT) using the Harvard breast cosmesis scale. The patient-reported self-scoring was also recorded. RESULTS: The MDT results were favorable (excellent∖good) in 72.3% of the photographs and adverse in 27.7%. Agreement among the MDT members was strong (intraclass correlation coefficient = 0.798, p < 0.001, 95% CI: 0.753-0.937, Cronbach's alpha = 0.809). The patient self-scoring was satisfactory in 82.5% of the cases and nonsatisfactory in 17.5%. The results of the OBCS ranged between 0.0 and 20.4 with a median value of 4.5. There was a strong significant correlation between the OBCS and both the MDT subjective scoring (p < 0.001) and the patient self-scoring (p < 0.001). CONCLUSIONS: The OBCS seems to be eligible for the objective assessment of cosmesis after breast-conservative therapy using nonstandardized photographs without scale calibration.

Identification of phosphorus emission hotspots in agricultural catchments.

An enhanced transport-based management approach is presented, which is able to support cost-effective water quality management with respect to diffuse phosphorus pollution. Suspended solids and particulate phosphorus emissions and their transport were modeled in two hilly agricultural watersheds (Wulka River in Austria and Zala River in Hungary) with an improved version of the catchment-scale PhosFate model. Source and transmission areas were ranked by an optimization method in order to provide a priority list of the areas of economically efficient (optimal) management alternatives. The model was calibrated and validated at different gauges and for various years. The spatial distribution of the emissions shows that approximately one third of the catchment area is responsible for the majority of the emissions. However, only a few percent of the source areas can transport fluxes to the catchment outlet. These effective source areas, together with the main transmission areas are potential candidates for improved management practices. In accordance with the critical area concept, it was shown that intervention with better management practices on a properly selected small proportion of the total area (1-3%) is sufficient to reach a remarkable improvement in water quality. If soil nutrient management is also considered in addition to water quality, intervention on 4-12% of the catchment areas can fulfill both aspects.

Balancing between retention and flushing in river networks--optimizing nutrient management to improve trophic state.

River basin management can frequently involve decisive situations, when conflicting interests must be resolved. In the Zala River catchment (Western Hungary) local efforts to improve water quality by reducing algal biomass are not always harmonized with the requirement of sustaining the same objective in its recipient, Lake Balaton. The PhosFate catchment model is a GIS tool designed to estimate the spatial variability and fate of diffuse phosphorus emission during transport. Besides diffuse pollution, a simplified annual hydrologic balance is also calculated. A new module was added to PhosFate that tracked the development of entrained algae during their travel downstream. The extended model was used to simulate the current average algal concentrations in the river network. The numerous small reservoirs and impoundments on the tributaries of the Zala River were identified as the key elements in determining algal biomass, since they fundamentally increase the water residence time (WRT) in the system. Without reservoirs, the short WRT in the drainage network would successfully prevent the development of suspended algal biomass despite the fairly high SRP concentrations. However, the removal of such standing waters is impossible for socio-economic reasons and reducing the overall P load to Lake Balaton would also require increasing WRT in the system. As a resolution to these conflicting interests, a hybrid management strategy was designed to simultaneously reach both goals: (i) switching from WRT to P limitation in reservoirs responsible for most of algal growth, and (ii) optimized deployment of buffer zones and the introduction of best agricultural practices on the remaining majority of the catchment to reduce the overall P load. The suggested management approach could be applied in other river catchments too, due to the extensive presence of reservoirs and impoundments in many stream networks.

[Skeletal anchorage: use of miniscrews for impacted maxillary canine management]. / Szkeletális elhorgonyzás: minicsavarok alkalmazása az impaktált szemfogak kezelésében.

Impaction of maxillary canines is a frequently encountered clinical problem. Patients' refusal to a long orthodontic treatment or ankylosis of the impacted tooth results in various treatment difficulties. The aim of this study was to evaluate the possible role of miniscrews in the management of impacted upper canines. In a series of 28 consecutive patients with a total of 31 impacted maxillary canines (12 men and 16 women aged from 14 to 63 years, mean 24 years), each impacted tooth was surgically exposed and an attachment was bonded. An intraosseous screw (1.5 mm in diameter and 8-10 mm long) with an endosseous body and intraoral neck section was inserted into the premolar-molar interradicular space. Following soft tissue healing, orthodontic traction was initiated. After correction of the angulation of the canine, the mini-screw was removed and traditional orthodontic therapy was completed. Twenty-seven canines were extruded successfully (87%), the duration of the orthodontic treatment with fixed appliances was decreased. In the 3 cases that failed due to ankylosis, the skeletal anchorage spared the patients and the clinicans the disappointment of a long-term unsuccessful traditional orthodontic treatment. In one patient, the mini-screw was removed because of inflammation and pain before the beginning of the orthodontic traction. This study shows that mini screw anchorage should be taken into consideration when extrusion of an impacted canine is planned.

Do we need three-dimensional computed tomography in maxillofacial surgery?

In a retrospective clinical study (2000-2003), 121 patients' radiographs and computed tomography scans were reviewed to establish the clinical value of three-dimensional computed tomography. Eighty patients had computed tomography scans; 48 had three-dimensional computed tomography scans for diagnosing facial fractures, 3 for diagnosing temporomandibular joint ankylosis, 1 for tumor with bone destruction, and 1 for a mandibular cyst. It is concluded that axial, coronal, and three-dimensional computed tomography is of crucial importance and should be mandatory for all suspected comminuted and displaced midface fractures instead of plain radiographs. Three-dimensional computed tomography is also recommended for comminuted mandibular fractures and temporomandibular joint ankylosis. Three-dimensional computed tomography is not recommended for the diagnosis of minimally displaced fractures.

Blow-out fracture of the orbital floor in early childhood.

Because of the anatomy of the developing bones in early childhood, blow-out fractures are rare before the age of 8 years. We present two cases where after a fall, computed tomography examinations revealed a blow-out fracture of the left orbital floor in a 12-month-old child and 27-month-old child. Because no associated symptoms were noted, both cases were managed conservatively.

Etiology and patterns of facial fractures in the United Arab Emirates.

A retrospective study on facial fractures was carried out in the Department of Oral and Maxillofacial Surgery at Tawam Hospital (Al Ain, United Arab Emirates) between January 1, 1998 and December 31, 2001. The study included 144 patients with a mean age of 26.5 years; the most frequently injured patients belonged to the 16- to 20-year-old age group. The male predilection was 83%. Road traffic accident was the most common causative factor (59%), followed by falls (21.5%), accidents where camels were involved (5.5%), work- and sport-related accidents (4.8% and 4.8%, respectively), and assault (4.1%). A total of 53.4% of the patients suffered isolated mandibular fractures, 32.6% had isolated midface fractures, and 13.8% had combined midface and mandibular fractures. Associated injuries were noted in 22.2% of the patients. The number of patients treated increased from 28.3 (1990-1995) to 36 (1998-2001) on an annual average; a reduction in isolated nasal fractures and associated injuries, including facial lacerations, was noted with no change in age or etiology predilection. Sufficient data could not be obtained to determine if the favorable results with the associated injuries were a result of the effect of a compulsory seat belt law introduced on June 1, 1998, but the increasing number of maxillofacial injuries suggests that the seat belt law is ignored in this country.