Acute kidney injury: the experience of a tertiary center of Pediatric Nephrology / Insuficiência renal aguda: experiência de um centro terciário de Nefrologia Pediátrica

ABSTRACT Introduction: Acute kidney injury (AKI) is an abrupt deterioration of kidney function. The incidence of pediatric AKI is increasing worldwide, both in critically and non-critically ill settings. We aimed to characterize the presentation, etiology, evolution, and outcome of AKI in pediatric patients admitted to a tertiary care center. Methods: We performed a retrospective observational single-center study of patients aged 29 days to 17 years and 365 days admitted to our Pediatric Nephrology Unit from January 2012 to December 2021, with the diagnosis of AKI. AKI severity was categorized according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The outcomes considered were death or sequelae (proteinuria, hypertension, or changes in renal function at 3 to 6 months follow-up assessments). Results: Forty-six patients with a median age of 13.0 (3.5-15.5) years were included. About half of the patients (n = 24, 52.2%) had an identifiable risk factor for the development of AKI. Thirteen patients (28.3%) were anuric, and all of those were categorized as AKI KDIGO stage 3 (p < 0.001). Almost one quarter (n = 10, 21.7%) of patients required renal replacement therapy. Approximately 60% of patients (n = 26) had at least one sequelae, with proteinuria being the most common (n = 15, 38.5%; median (P25-75) urinary protein-to-creatinine ratio 0.30 (0.27-0.44) mg/mg), followed by reduced glomerular filtration rate (GFR) (n = 11, 27.5%; median (P25-75) GFR 75 (62-83) mL/min/1.73 m2). Conclusions: Pediatric AKI is associated with substantial morbidity, with potential for proteinuria development and renal function impairment and a relevant impact on long-term prognosis.

RESUMO Introdução: Insuficiência renal aguda (IRA) é uma deterioração abrupta da função renal. A incidência de IRA pediátrica está aumentando em todo o mundo, em ambientes críticos e não críticos. Nosso objetivo foi caracterizar apresentação, etiologia, evolução e desfechos da IRA em pacientes pediátricos internados em um centro de atendimento terciário. Métodos: Realizamos estudo retrospectivo observacional de centro único de pacientes com idade entre 29 dias a 17 anos e 365 dias internados em nossa Unidade de Nefrologia Pediátrica, de janeiro de 2012 a dezembro de 2021, com diagnóstico de IRA. A gravidade da IRA foi categorizada de acordo com os critérios do Kidney Disease Improving Global Outcomes (KDIGO). Os desfechos considerados foram óbito ou sequelas (proteinúria, hipertensão ou alterações na função renal em avaliações de acompanhamento de 3 a 6 meses). Resultados: Incluímos 46 pacientes com idade mediana de 13,0 (3,5-15,5) anos. Cerca de metade (n = 24; 52,2%) apresentou um fator de risco identificável para o desenvolvimento de IRA. Treze pacientes (28,3%) eram anúricos; todos foram classificados como IRA KDIGO 3 (p < 0,001). Quase um quarto (n = 10; 21,7%) dos pacientes necessitaram de terapia renal substitutiva. Aproximadamente 60% (n = 26) apresentou pelo menos uma sequela, sendo proteinúria a mais comum (n = 15; 38,5%; mediana (P25-75) da relação proteína/creatinina urinária 0,30 (0,27-0,44) mg/mg), seguida de taxa de filtração glomerular (TFG) reduzida (n = 11; 27,5%; mediana (P25-75) da TFG 75 (62-83) mL/min/1,73 m2). Conclusões: A IRA pediátrica está associada à morbidade substancial, com potencial para desenvolvimento de proteinúria e comprometimento da função renal e impacto relevante no prognóstico de longo prazo.

Dexmedetomidine in Palliative Care: A Versatile New Weapon Against Delirium and Pain-Systematic Review.

Introduction: At the end of life, the prevalence of delirium and pain is high. Current therapy is not satisfactory. Dexmedetomidine could be useful in the control of delirium and pain but is not approved outside of intensive care setting. Our objectives are to evaluate existing evidence in the literature that assessed the efficacy of dexmedetomidine in pain and delirium control and its safety in palliative care patients outside intensive care units. This systematic review was prospectively registered with PROSPERO and included a risk of bias assessment. Methods: PubMed and SCOPUS were examined for literature published until 2023. Experimental, cohort, cross-sectional, case-control studies, and case series/reports were included if they evaluate the use of dexmedetomidine in delirium and/or pain management in hospitalized palliative care adult patients. Studies were excluded if they were carried out in intensive care units. Results: Of the initial 529 records, 14 were included. Although only two studies were randomized trials, most were small and only one had low risk of bias. In most case reports and in the two retrospective cohort studies, dexmedetomidine appears to be a better option for these symptoms, although differences were not significant in the randomized trials. Discussion: Dexmedetomidine seems to be a promising option for refractory pain and delirium and may contribute to a reduction in opioid administration to control pain. This is the first systematic review of dexmedetomidine in palliative care. Quality evidence is limited, but clinical properties of dexmedetomidine justify the conduction of controlled trials in palliative care.

Rabbits as a Reservoir of Multidrug-Resistant Escherichia coli: Clonal Lineages and Public Health Impact.

Escherichia coli, including extended-spectrum ß-lactamases (ESBL)-producing strains, poses a global health threat due to multidrug resistance, compromising food safety and environmental integrity. In industrial settings, rabbits raised for meat have the highest consumption of antimicrobial agents compared to other food-producing animals. The European Union is facing challenges in rabbit farming as rabbit consumption declines and antibiotic-resistant strains of E. coli cause enteric diseases. The aim of this study was to investigate the antibiotic resistance profile, genetic diversity, and biofilm formation in cefotaxime-resistant E. coli strains isolated from twenty rabbit farms in Northern Portugal to address the effect of the pressing issue of antibiotic resistance in the rabbit farming industry. Resistance to critically antibiotics was observed, with high levels of resistance to several categories, such as tetracycline, ampicillin, aztreonam, and streptomycin. However, all isolates were susceptible to cefoxitin and imipenem. Multidrug resistance was common, with strains showing resistance to all antibiotics tested. The blaCTX-M variants (blaCTX-3G and blaCTX-M9), followed by the tetracycline resistance genes, were the most frequent resistance genes found. ST10 clones exhibiting significant resistance to various categories of antibiotics and harboring different resistance genes were detected. ST457 and ST2325 were important sequence types due to their association with ESBL-E. coli isolates and have been widely distributed in a variety of environments and host species. The strains evaluated showed a high capacity for biofilm formation, which varied when they were grouped by the number of classes of antibiotics to which they showed resistance (i.e., seven different classes of antibiotics, six classes of antibiotics, and three/four/five classes of antibiotics). The One Health approach integrates efforts to combat antimicrobial resistance in rabbit farming through interdisciplinary collaboration of human, animal, and environmental health. Our findings are worrisome and raise concerns. The extensive usage of antibiotics in rabbit farming emphasizes the urgent need to establish active surveillance systems.

Valorization of plant by-products in the biosynthesis of silver nanoparticles with antimicrobial and catalytic properties.

Biosynthesis based on natural compounds has emerged as a sustainable approach for the production of metallic nanoparticles (MNP). The main objective of this study was to biosynthesize stable and multifunctional silver nanoparticles (AgNP) using different plant by-products as reducers and capping agents. Extracts obtained from Eucalyptus globulus, Pinus pinaster, Citrus sinensis, Cedrus atlantica and Camellia sinensis by-products, were evaluated. From all plant by-products tested, aqueous extract of eucalyptus leaves (EL), green tea (GT) and black tea (BT) were selected due to their higher antioxidant phenolic content and were individually employed as reducers and capping agents to biosynthesize AgNP. The green AgNP showed zeta potential values of -31.8 to -36.3 mV, with a wide range of particle sizes (40.6 to 86.4 nm), depending on the plant extract used. Green AgNP exhibited an inhibitory effect against various pathogenic bacteria, including Gram-negative (P. putida, E. coli, Vibrio spp.) and Gram-positive (B. megaterium, S. aureus, S. equisimilis) bacteria with EL-AgNP being the nanostructure with the greatest antimicrobial action. EL-AgNP showed an excellent photodegradation of indigo carmine (IC) dye under direct sunlight, with a removal percentage of up to 100% after 75 min. A complete cost analysis revealed a competitive total cost range of 8.0-9.0 €/g for the biosynthesis of AgNP.

Exploring Optimization of Zeolites as Adsorbents for Rare Earth Elements in Continuous Flow by Machine Learning Techniques.

Unsupervised machine learning (ML) techniques are applied to the characterization of the adsorption of rare earth elements (REEs) by zeolites in continuous flow. The successful application of principal component analysis (PCA) and K-Means algorithms from ML allowed for a wide range assessment of the adsorption results. This global approach permits the evaluation of the different stages of the sorption cycles and their optimization and improvement. The results from ML are also used for the definition of a regression model to estimate other REEs' recoveries based on the known values of the tested REEs. Overall, it was possible to remove more than 70% of all REEs from aqueous solutions during the adsorption assays and to recover over 80% of the REEs entrapped on the zeolites using an optimized desorption cycle.

Current Challenges for Biological Treatment of Pharmaceutical-Based Contaminants with Oxidoreductase Enzymes: Immobilization Processes, Real Aqueous Matrices and Hybrid Techniques.

The worldwide access to pharmaceuticals and their continuous release into the environment have raised a serious global concern. Pharmaceuticals remain active even at low concentrations, therefore their occurrence in waterbodies may lead to successive deterioration of water quality with adverse impacts on the ecosystem and human health. To address this challenge, there is currently an evolving trend toward the search for effective methods to ensure efficient purification of both drinking water and wastewater. Biocatalytic transformation of pharmaceuticals using oxidoreductase enzymes, such as peroxidase and laccase, is a promising environmentally friendly solution for water treatment, where fungal species have been used as preferred producers due to their ligninolytic enzymatic systems. Enzyme-catalyzed degradation can transform micropollutants into more bioavailable or even innocuous products. Enzyme immobilization on a carrier generally increases its stability and catalytic performance, allowing its reuse, being a promising approach to ensure applicability to an industrial scale process. Moreover, coupling biocatalytic processes to other treatment technologies have been revealed to be an effective approach to achieve the complete removal of pharmaceuticals. This review updates the state-of-the-art of the application of oxidoreductases enzymes, namely laccase, to degrade pharmaceuticals from spiked water and real wastewater. Moreover, the advances concerning the techniques used for enzyme immobilization, the operation in bioreactors, the use of redox mediators, the application of hybrid techniques, as well as the discussion of transformation mechanisms and ending toxicity, are addressed.

Group B Streptococcal Neonatal Meningitis.

Neonatal bacterial meningitis is a devastating disease, associated with high mortality and neurological disability, in both developed and developing countries. Streptococcus agalactiae, commonly referred to as group B Streptococcus (GBS), remains the most common bacterial cause of meningitis among infants younger than 90 days. Maternal colonization with GBS in the gastrointestinal and/or genitourinary tracts is the primary risk factor for neonatal invasive disease. Despite prophylactic intrapartum antibiotic administration to colonized women and improved neonatal intensive care, the incidence and morbidity associated with GBS meningitis have not declined since the 1970s. Among meningitis survivors, a significant number suffer from complex neurological or neuropsychiatric sequelae, implying that the pathophysiology and pathogenic mechanisms leading to brain injury and devastating outcomes are not yet fully understood. It is imperative to develop new therapeutic and neuroprotective approaches aiming at protecting the developing brain. In this review, we provide updated clinical information regarding the understanding of neonatal GBS meningitis, including epidemiology, diagnosis, management, and human evidence of the disease's underlying mechanisms. Finally, we explore the experimental models used to study GBS meningitis and discuss their clinical and physiologic relevance to the complexities of human disease.

Ligninolytic enzymes production during polycyclic aromatic hydrocarbons degradation: effect of soil pH, soil amendments and fungal co-cultivation.

Soil microorganisms play an important role in the degradation of PAHs and use various metabolic pathways for this process. The effect of soil pH, different soil amendments and the co-cultivation of fungi on the degradation of PAHs in soil and on the activity of ligninolytic enzymes was evaluated. For that purpose, three fungi were studied: Trichoderma viride, Penicillium chrysogenum and Agrocybe aegerita. Biodegradation assays with a mixture of 200 ppm PAHs (fluorene, pyrene, chrysene, and benzo[a]pyrene-50 ppm each) were set up at room temperature for 8 weeks. The maximum laccase activity by solid state fermentation-SSF (7.43 U/g) was obtained by A. aegerita on kiwi peels with 2 weeks and the highest manganese peroxidase activity (7.21 U/g) was reached in 4 weeks, both at pH 7. Fluorene, pyrene, and benzo[a]pyrene achieved higher degradation rates in soil at pH 5, while chrysene was more degradable at pH 7. About 85-90% of the PAHs were degraded by fungal remediation. The highest degradation of fluorene was achieved by co-cultivation of A. aegerita and P. chrysogenum, remaining 14% undegradable. Around 13% of pyrene stay undegradable by A. aegerita and T. viride and by A. aegerita and P. chrysogenum, both systems supported in kiwi peels, while 11% of chrysene remained in soil by the co-cultivation of these fungi, supported by peanut shells. Regarding benzo[a]pyrene, 13% remained in soil after treatment with A. aegerita. Despite the increase in degradation of some PAHs with co-cultivation, higher enzyme production during degradation was observed when fungi were cultivated alone.

Development of a packed bed reactor for the removal of aromatic hydrocarbons from soil using laccase/mediator feeding system.

Polyaromatic hydrocarbons (PAH) are persistent pollutants of great concern due to their potential toxicity, mutagenicity and carcinogenicity. A biotechnological approach to remove PAH from soil was evaluated in this work using a laccase mediator system. Initially, laccase was produced by fungal co-cultivation, using kiwi peels as substrate. The produced laccase was applied to PAH contaminated soil to evaluate its efficiency on enzymatic bioremediation. Results showed that laccase mediator system was effective in the degradation of pyrene, fluorene, chrysene and a lower extension anthracene. Mediators improved the PAH degradation and natural mediators (ferulic acid and p-coumaric acid) were as effective as the synthetic mediator ABTS. However, the process was not effective in the benzo[a]pyrene degradation, one of the most recalcitrant and toxic PAH. This low degradation rate could be related to the low activity of the laccase mediator system in an environment lacking water. To overcome this issue, a PAH contaminated soil degradation system was developed in packed bed reactor (PBR) fed with laccase/mediator. Continuous flow of laccase/mediator improved the PAH degradation, achieving 74.8 %, 71.9 %, 72.2 %, 81.8 % and 100 % degradation for fluorene, anthracene, phenanthrene, chrysene and pyrene, respectively. This system was able to degrade 96 % benzo[a]pyrene, which was 90 % higher than the degradation in batch system. Results indicated that the produced laccase as well as the fed-batch degradation system developed in PBR could be successfully applied in the degradation of soil PAH pollutants, with the advantage of achieving higher degradation rates than in simple batch, as well as being a faster and simpler process than microorganism bioremediation.

Evaluation of multi-starter S. cerevisiae/ D. bruxellensis cultures for mimicking and accelerating transformations occurring during barrel ageing of beer.

During beer ageing, endogenous barrel microbes grow spontaneously and transform wort/beer composition, being Dekkera bruxellensis and Saccharomyces cerevisiae among the main contributors to the chemical and sensory profile of aged beer. This work aims at the application of multi-starter cultures to mimic and accelerate biological modifications occurring during barrel ageing of beer, in controlled fermentation processes. Co-cultures of D.bruxellensis/S.cerevisiae were conducted under conditions commonly found in barrel aged beer production: different pitching rates, high glucose concentration and presence of ethanol and wood extracts. Selective pressures and competition between yeasts influenced microbial growth and metabolite production, namely ethanol, acetic acid and target volatile compounds (esters, alcohols, terpenols, volatile acids and volatile phenols). Metabolic profiles of co-cultures combined traits of both species, and differed from those of pure cultures. Lastly, multi-starters were successfully applied in combination with wood in a controlled and accelerated fermentation process for mimicking barrel ageing transformations.

A Review on Biological Processes for Pharmaceuticals Wastes Abatement-A Growing Threat to Modern Society.

Over the last decades, the production and consumption of pharmaceuticals and health care products grew manifold, allowing an increase in life expectancy and a better life quality for humans and animals, in general. However, the growth in pharmaceuticals production and consumption comes with an increase in waste production, which creates a number of challenges as well as opportunities for the waste management industries. The conventional current technologies used to treat effluents have shown to be inefficient to remove or just to reduce the concentrations of these types of pollutants to the legal limits. The present review provides a thorough state-of-the-art overview on the use of biological processes in the rehabilitation of ecosystems contaminated with the pharmaceutical compounds most commonly detected in the environment and eventually more studied by the scientific community. Among the different biological processes, special attention is given to biosorption and biodegradation.

Factors affecting extraction of adsorbed wine volatile compounds and wood extractives from used oak wood.

During ageing, wood adsorbs volatile compounds from beverages. However, chemical interactions involved in sorption still remain unclear, as well as wood capacity to transfer such compounds to subsequent matrices when reused. Therefore, extractions were conducted from used wood manipulating variables such as ethanol concentration, contact temperature and pH, in order to determine their effect in the interaction and consequent recovery of wine volatiles from wood. Mathematical models were outlined, which demonstrated an exclusive effect of ethanol concentration on the extraction of wine volatiles adsorbed in wood, more prominent for compounds of higher hydrophobicity. Thus adsorption of wine volatiles was shown to be based on hydrophobic interactions. Recovery of wood extractives was also modeled, confirming the known positive effect of ethanol and temperature on the overall extraction of characteristic wood compounds. When reused, wood transferred wine compounds to hydroalcoholic matrices, demonstrating its impact and potential as a vector for aroma transference.

Avaliação da satisfação e das preferências do doente com o diário em cuidados intensivos / Assessment of patient satisfaction and preferences with an intensive care diary

RESUMO Objetivos: Avaliar a satisfação dos doentes internados em uma unidade de cuidado intensivo com o diário e analisar possíveis pontos de melhoria deste instrumento. Métodos: Estudo retrospectivo observacional, decorrido entre março de 2014 e julho de 2017, em uma unidade de cuidado intensivo polivalente de um hospital distrital. Foi iniciado o diário em doentes sedados por 3 ou mais dias. Depois de 3 meses da alta, foi avaliada a satisfação deles por meio de um questionário. O doente que concordou com as cinco afirmações que visavam avaliar esclarecimento, preenchimento de lacunas de memória, ajuda na recuperação, tranquilização e recomendação da intervenção foi definido como satisfeito. Resultados: Foram incluídos 110 doentes, dos quais 55 responderam o questionário. Destes, 36 (65,5%) foram classificados como satisfeitos. Cada item teve uma resposta positiva em mais de 74% dos casos. Sugeriram o aumento do número de fotografias 60% dos participantes. Não foram encontradas diferenças estatisticamente significativas na análise de subgrupos (idade, sexo, tempo de sedação e ventilação, tempo de diário, gravidade à admissão, delirium, depressão ou ansiedade na unidade de cuidado intensivo). Conclusões: A maioria dos doentes mostrou-se satisfeita com o diário, sugerindo, no entanto, o aumento do número de fotografias.

ABSTRACT Objectives: To evaluate the satisfaction of patients admitted to the intensive care unit using a diary and analyze possible points for improving this instrument. Methods: This was an observational, retrospective study, conducted between March 2014 and July 2017, in a multidisciplinary intensive care unit of a district hospital. The diary was implemented in patients sedated for 3 or more days. Three months after discharge, their satisfaction was assessed using a questionnaire. A patient who agreed with the 5 statements assessing the diary's help in clarifying the intensive care unit stay, in filling memory gaps, in recovery, in reassurance, and in the recommendation of this intervention was defined as satisfied. Results: A total of 110 patients were included, of whom 55 answered the questionnaire. Of these, 36 (65.5%) were classified as satisfied. Each item had a positive response in more than 74% of cases. A total of 60% of the participants suggested increasing the number of photographs. No significant differences were found in the subgroup analysis (age, sex, duration of sedation and ventilation, length of diary keeping, severity on admission, or delirium, depression, or anxiety in the intensive care unit). Conclusions: Most patients were satisfied with the diary but suggested an increase in the number of photographs.

Assessment of patient satisfaction and preferences with an intensive care diary. / Avaliação da satisfação e das preferências do doente com o diário em cuidados intensivos.

OBJECTIVES: To evaluate the satisfaction of patients admitted to the intensive care unit using a diary and analyze possible points for improving this instrument. METHODS: This was an observational, retrospective study, conducted between March 2014 and July 2017, in a multidisciplinary intensive care unit of a district hospital. The diary was implemented in patients sedated for 3 or more days. Three months after discharge, their satisfaction was assessed using a questionnaire. A patient who agreed with the 5 statements assessing the diary's help in clarifying the intensive care unit stay, in filling memory gaps, in recovery, in reassurance, and in the recommendation of this intervention was defined as satisfied. RESULTS: A total of 110 patients were included, of whom 55 answered the questionnaire. Of these, 36 (65.5%) were classified as satisfied. Each item had a positive response in more than 74% of cases. A total of 60% of the participants suggested increasing the number of photographs. No significant differences were found in the subgroup analysis (age, sex, duration of sedation and ventilation, length of diary keeping, severity on admission, or delirium, depression, or anxiety in the intensive care unit). CONCLUSIONS: Most patients were satisfied with the diary but suggested an increase in the number of photographs.

OBJETIVOS: Avaliar a satisfação dos doentes internados em uma unidade de cuidado intensivo com o diário e analisar possíveis pontos de melhoria deste instrumento. MÉTODOS: Estudo retrospectivo observacional, decorrido entre março de 2014 e julho de 2017, em uma unidade de cuidado intensivo polivalente de um hospital distrital. Foi iniciado o diário em doentes sedados por 3 ou mais dias. Depois de 3 meses da alta, foi avaliada a satisfação deles por meio de um questionário. O doente que concordou com as cinco afirmações que visavam avaliar esclarecimento, preenchimento de lacunas de memória, ajuda na recuperação, tranquilização e recomendação da intervenção foi definido como satisfeito. RESULTADOS: Foram incluídos 110 doentes, dos quais 55 responderam o questionário. Destes, 36 (65,5%) foram classificados como satisfeitos. Cada item teve uma resposta positiva em mais de 74% dos casos. Sugeriram o aumento do número de fotografias 60% dos participantes. Não foram encontradas diferenças estatisticamente significativas na análise de subgrupos (idade, sexo, tempo de sedação e ventilação, tempo de diário, gravidade à admissão, delirium, depressão ou ansiedade na unidade de cuidado intensivo). CONCLUSÕES: A maioria dos doentes mostrou-se satisfeita com o diário, sugerindo, no entanto, o aumento do número de fotografias.

Recovery of Rare Earth Elements from Wastewater Towards a Circular Economy.

The use of rare earth elements is a growing trend in diverse industrial activities, leading to the need for eco-friendly approaches to their efficient recovery and reuse. The aim of this work is the development of an environmentally friendly and competitive technology for the recovery of those elements from wastewater. Kinetic and equilibria batch assays were performed with zeolite, with and without bacterial biofilm, to entrap rare earth ions from aqueous solution. Continuous assays were also performed in column setups. Over 90% removal of lanthanum and cerium was achieved using zeolite as sorbent, with and without biofilm, decreasing to 70% and 80%, respectively, when suspended Bacillus cereus was used. Desorption from the zeolite reached over 60%, regardless of the tested conditions. When in continuous flow in columns, the removal yield was similar for all of the rare earth elements tested. Lanthanum and cerium were the elements most easily removed by all tested sorbents when tested in single- or multi-solute solutions, in batch and column assays. Rare earth removal from wastewater in open setups is possible, as well as their recovery by desorption processes, allowing a continuous mode of operation.

Understanding wine sorption by oak wood: Modeling of wine uptake and characterization of volatile compounds retention.

Cooperage wood is a porous material and beverages exchange compounds with it by penetrating into its pores. This work demonstrates the enrichment of wood with wine during ageing. Three oak varieties were cut into different sized chips and immersed in fortified wine and water. Wine and water uptake were measured along time and sorption was described based on a saturation empirical model. Maximum uptake varied among wood types and was independent of particle size, which affected only equilibrium time. Sorption of wine volatiles such as alcohols, esters and acids in wood was shown, which was also dependent on wood type and independent of particle size. Multivariate analysis demonstrated differences and similarities in depletion of wood extractives and sorption of wine volatiles depending on wood variety. Sorption shown in this work demonstrates wood as a vector for aroma recombination, when reused for ageing between different beverages.

Pilot-scale sorption studies of diethylketone in the presence of Cd2+ and Ni2.

The effect of pH on the sorption capacity of vermiculite towards cadmium and nickel was tested in batch systems and it was shown that the sorption percentages increase with an increase in the mass of vermiculite and with an increase in the initial pH. Maximum sorption percentages were obtained for a pH of 8 and 4 g of vermiculite (86.5% for Cd2+ and 86.1% for Ni2+, for solutions with 100 mg/L of metal). As a consequence, it was possible to establish a range of optimal pH for biosorption processes, by combining the so determined optimal sorption pH of vermiculite with the optimal growth pH of Streptococcus equisimilis, a bacterium used to treat contaminated water. Pilot-scale experiments with a S. equisimilis biofilm supported on vermiculite were conducted in closed-loop conditions, aiming to treat large volumes of diethylketone aqueous solutions, eventually containing Cd2+ or Ni2+. The excellent capacity of this joint system to simultaneously biodegrade diethylketone and biosorb Cd2+ or Ni2+was proved. The removal percentage and the uptake increase through time, even with the replacement of the initial solution by new ones. The breakthrough curves that best describe the results achieved for Cd2+ and Ni2+ are respectively the Adams-Bohart and the Yoon and Nelson model.

Wicherhamomyces anomalus biofilm supported on wood husk for chromium wastewater treatment.

A Wickeramomyces anomalus biofilm supported on wood husk was used to remediate water bodies contaminated with chromium (Cr), in batch and open systems. The favorable adhesion ability of the chromium-resistant yeast strain on the wood husk was predicted by XDLVO theory and confirmed by environmental scanning electronic microscopy. The chromium decontamination was then optimized in a batch mode using a central composite design (CCD). Analysis of variance (ANOVA) showed a high coefficient of determination (R2) value of 0.93-0.91 for Cr(VI) and total Cr removal, respectively, ensuring a satisfactory fitting of the second-order regression model to the experimental data. In batch system, the concentration of biomass exhibited the minimal effect on the process. An acidic pH of 3.72 and 5.48, an initial chromium concentration of 10 and 16.91 mg/L and a support dose of 6.95 and 8.20 g/L were optimal for Cr(VI) and total Cr removal, respectively. The breakthrough curves were determined in open system for different initial chromium concentrations. The study of glucose concentration effect on the yeast extracellular polymeric substances (EPS) production showed that a medium exempt of glucose allowed maximal EPS production and minimal chromium removal efficiency, while 20 g/L glucose concentration of presented the optimal condition for chromium removal.

Predicting prognosis in patients with advanced cancer: A prospective study.

BACKGROUND: Prognosis is one of the most challenging questions with which physicians are confronted. Accuracy in the prediction of survival is necessary for clinical, ethical, and organizational reasons. AIM: Evaluate young doctors' clinical prediction of survival and the aids they could get: expert opinion, Palliative Prognostic score, and Palliative Prognostic Index. DESIGN: Prospective, observational study. SETTING/PARTICIPANTS: Advanced cancer patients under observation of an inhospital palliative care team, from April to July 2014. A total of 38 patients were included, mostly male (65.8%), average age 68.5 years. Average survival time was 24 days. Follow-up concluded with death or after 90 days. RESULTS: Young doctors' clinical prediction of survival was adequate at 10.5%, with 55.3% severe errors in an optimistic direction. Palliative care experts were more adequate (23.7%) and made less severe errors (42.1%). Palliative Prognostic score and Palliative Prognostic Index were even more adequate (47% and 55%, respectively) and made even less severe errors (0% and 11%, respectively). The best correlation with observed survival was achieved when palliative care experts used palliative prognostic score ( rs = -0.629; p < 0.01). CONCLUSION: Young doctors' clinical prediction of survival is often inadequate. Palliative Prognostic score, which includes clinical prediction of survival, calculated by palliative care experts had the best performance. Our results support the recommendation of using clinical prediction of survival together with prognostic scores.