Single Use Personal Protective Equipment Reinforced Asphalt.

Due to the COVID-19 pandemic, global personal protective equipment (PPE) volume production and demand increased by 300-400% between 2019 and 2021. In this scenario, the present study aims to propose and validate an innovative circular economy scenario for end of life (EoL) PPEs, reusing them to produce reinforced bituminous mixtures. Despite that several studies confirmed the possibility of reusing plastic in the asphalt mixtures, none of them investigated the potential of PPEs, highlighting the innovativeness in the scientific panorama. Five different alternatives of EoL PPE mixtures (different products, materials, dosages, etc.) were tested at laboratory scale to verify the technical feasibility of the proposed scenario. The most promising solution resulted to be the mix of gloves and face masks composed by polypropylene, polyethylene, nitrile and lattice at a dosage of 0,5% weight/weight that allowed to produce bituminous mixtures with acceptable performances in terms of relevant mechanical parameters while recycling waste PPEs. This leads to environmental benefits, since more than 3kg of EoL PPEs per square meter of road pavement can be reused instead of disposed (about 1,5 million tons/year considering the bituminous mixtures produced at European level), as well as economic benefits for public administrations and the collectivity, due to the reduced landfilling of solid wastes.

Effects of two different treatments with continuous renal replacement therapy in patients with chronic renal dysfunction submitted to coronary invasive procedures.

BACKGROUND: Percutaneous coronary intervention (PCI) requires the use of iodinated contrast medium and consequently poses the risk of contrast-induced nephropathy (CIN), which can negatively impact on outcome. Patients with chronic kidney disease (CKD) are at particularly high risk of CIN. In this study, we investigated the role of continuous renal replacement therapy (CRRT) performed before and after versus only after PCI in patients with CKD. METHODS: We studied 46 consecutive patients with CKD (mean creatinine >2 mg/dL) submitted to PCI: 21 (mean creatinine 2.7 ± 1.6 mg/dL) treated with CRRT only after PCI (CRRTpost) and 25 (mean creatinine 3.0 ± 1.3 mg/dL) with CRRT before and after PCI (CRRTpre-post). CRRT was performed with hemofiltration (creatinine <3 mg/dL) or hemodiafiltration (creatinine >3 mg/dL), initiated 6-8 hours before PCI and re-started immediately post PCI for 18-24 hours. RESULTS: Creatinine showed a greater reduction in CRRTpre-post (2.4 ± 1.0 vs. 3.0 ± 1.3 mg/dL; P=.002) with respect to CRRTpost (2.6 ± 1.3 vs 2.7 ± 1.6 mg/dL; P=.667). At median 14.7-month follow-up, CKD worsened in 3 patients (12%) of CRRTpre-post and in 9 (43%) of CRRTpost (P=.042). Kaplan-Meier analysis at 18 months showed a significantly higher overall mortality in patients treated with CRRTpre-post vs. CRRTpost (P=.041), which became even more significant during the entire follow-up period (P=.026) and an increase in cardiovascular deaths (5 vs. 0, respectively). CONCLUSIONS: Our results suggest that in CKD patients undergoing PCI, CRRT performed before and after is more effective in preventing a further deterioration of renal function and is associated with an improved long-term outcome when compared to CRRT performed only after.

Early invasive strategy and outcomes of non-ST-elevation acute coronary syndrome patients: is time really the major determinant?

In non-ST-elevation acute coronary syndromes (ACS), an early invasive strategy is recommended for middle/high-risk patients; however, the optimal timing for coronary angiography is still debated. The aim of this study was to evaluate the prognostic implications of the time of angiography in ACS patients treated in accord with an early invasive strategy. We analyzed the relationship between the time of angiography and outcomes at follow-up in 517 ACS patients, of whom 482 were revascularized with percutaneous coronary intervention (PCI) (86.9%) or coronary artery by-pass graft (13.1%). We also evaluated the influence of clinical, biohumoral and angiographic variables on the patients' outcomes at follow-up. Among patients submitted to angiography at different time intervals from both hospital admission and symptom onset, significant differences neither in mortality nor in cardiac ischemic events at follow-up were observed. At univariate analysis, complete versus partial revascularization, longer hospital stay, higher TIMI risk score, diabetes mellitus, higher discharge creatinine and admission anemia were associated with mortality and cardiac ischemic events at follow-up; a lower left ventricular ejection fraction was associated with mortality; higher peak troponin I and previous PCI were associated with cardiac ischemic events at follow-up. At multivariate analysis longer hospital stay, higher discharge creatinine levels, and previous PCI were independent predictors of cardiac ischemic events at follow-up. Our evaluation in ACS patients treated with an early invasive strategy does not support the concept that angiography should be performed as soon as possible after symptom onset or hospital admission. Rather, an unfavorable long-term outcome is influenced principally by the clinical complexity of patients.