Hydrothermal carbonization of digested sewage sludge: The fate of heavy metals, PAHs, PCBs, dioxins and pesticides.

Hydrothermal carbonization (HTC) is emerging as a promising technology for the management of sewage sludge. The fate of phytosanitary products, Polycyclic aromatic hydrocarbons (PAHs) and PCBs (Polychlorinated biphenyls) after HTC, as well as the formation of dioxins and furans, is still unclear. Moreover, only little information is available on the distribution of heavy metals and major nutrients between the hydrochars and the process water. Here, we aim to contribute to fill these gaps. HTC of sewage sludge from six different wastewater treatment plants has been carried out at 220 °C for 85 min. Feedstock, hydrochars and spent liquor have been then characterized and discussed. HTC is here proven to be a suitable technology for the immobilization of both heavy hydrocarbons and heavy metals, with the exception arsenic, which was also found in the spent liquor at a significant proportion (∼15-∼50%). DDD, DDT, DDE were detected in all sludge samples and their content was reduced by nearly one order of magnitude after the process. HTC is here proven to not be responsible at an appreciable extent of PCBs enrichment of the processed solids. Moreover, the sum of PCDDs and PCDFs in hydrochars never exceeded 20 ng kg-1 s.s. The results obtained encourage further developing of HTC, with the aim to improve the sustainability of sewage sludge management. Additional studies on the environmental impact of hydrochar when used as alternative fuel, as well as soil amendment, could lead to the overcoming of the issues which still hinder these applications.

Obesity and kidney stone disease: a systematic review.

INTRODUCTION: Currently, abdominal obesity has reached an epidemic stage and obesity represents an important challenge for worldwide health authorities. Epidemiologic studies have demonstrated that the stone risk incidence increases with Body Mass Index, through multiple pathways. Metabolic syndrome and diabetes are associated with an increased renal stones disease incidence. The aim of this systematic review was to investigate the prevalence, morbidity, risk factors involved in the association between obesity and urolithiasis. EVIDENCE ACQUISITION: The search involved finding relevant studies from MEDLINE, EMBASE, Ovid, the Cochrane Central Register of Controlled Trials, CINAHL, Google Scholar, and individual urological journals between January 2001 and May 2017. The inclusion criteria were for studies written in the English language, reporting on the association between obesity and urinary stones. EVIDENCE SYNTHESIS: The underlying pathophysiology of stone formation in obese patients is thought to be related to insulin resistance, dietary factors, and a lithogenic urinary profile. Uric acid stones and calcium oxalate stones are observed frequently in these patients. Insulin resistance is thought to alter the renal acid-base metabolism, resulting in a lower urine pH, and increasing the risk of uric acid stone disease. Obesity is also associated with excess nutritional intake of lithogenic substances and with an increase in urinary tract infection incidence. Recent studies highlighted that renal stone disease increases the risk of myocardial infarction, progression of chronic kidney disease, and diabetes. Contemporary, bariatric surgery has been shown to be associated with hyperoxaluria and oxalate nephropathy. Certainly, the many health risks of obesity, including nephrolithiasis, will add more burden on urologists and nephrologists. CONCLUSIONS: Obesity related nephrolithiasis seems to necessitate weight loss as primary treatment, but the recognition of the associated complications is necessary to prevent induction of new and equally severe medical problems. The optimal approach to obesity control that minimizes stone risk needs to be determined in order to manage obesity-induced renal stones disease.

State of the art of the environmental behaviour and removal techniques of the endocrine disruptor 3,4-dichloroaniline.

In recent years, the presence of Endocrine Disrupting Chemicals (EDCs) in wastewater discharges from agricultural and industrial sources, [1] fresh- and estuarine-waters, as well as soils, has been reported in the literature. [2] Studies of adverse changes in wildlife, linked to environmental exposure to these substances, and the suggestion that humans could also be at similar risk of adverse health effects, [3-5] have raised concern for urgent action to understand and reduce such risks. 3,4-Dichloroaniline (3,4-DCA) has been recognized as an EDC, with regards to endocrine disruption data for both wildlife populations and human health. [5] 3,4-DCA is present in the environment as a product of the biodegradation of phenylurea and phenylcarbamate pesticides [6,7] ; furthermore, it can be introduced from industrial and municipal wastewater that is insufficiently purified, or via accidental spills. [8-10] Increasing concentrations of 3,4-DCA in soil and water are the result of its high persistence and accumulation, as well as its low biodegradability. [11,12] Hence, remediation techniques require in-depth study, especially when considering the low removal achieved by traditional activated sludge treatments, and the generation of carcinogenic trihalomethanes as a consequence of the chlorine oxidation methods frequently used in drinking water plants. [13] Fe0/H2O2 systems, photodegradation using doped TiO2, and the use of dielectric barrier discharge reactors, seem to be the most promising techniques for the removal of 3,4-DCA from water.

Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group.

OBJECTIVE: Diet interventions may reduce the risk of urinary stone formation and its recurrence, but there is no conclusive consensus in the literature regarding the effectiveness of dietary interventions and recommendations about specific diets for patients with urinary calculi. The aim of this study was to review the studies reporting the effects of different dietary interventions for the modification of urinary risk factors in patients with urinary stone disease. MATERIALS AND METHODS: A systematic search of the Pubmed database literature up to July 1, 2014 for studies on dietary treatment of urinary risk factors for urinary stone formation was conducted according to a methodology developed a priori. Studies were screened by titles and abstracts for eligibility. Data were extracted using a standardized form and the quality of evidence was assessed. RESULTS: Evidence from the selected studies were used to form evidence-based guideline statements. In the absence of sufficient evidence, additional statements were developed as expert opinions. CONCLUSIONS: General measures: Each patient with nephrolithiasis should undertake appropriate evaluation according to the knowledge of the calculus composition. Regardless of the underlying cause of the stone disease, a mainstay of conservative management is the forced increase in fluid intake to achieve a daily urine output of 2 liters. HYPERCALCIURIA: Dietary calcium restriction is not recommended for stone formers with nephrolithiasis. Diets with a calcium content ≥ 1 g/day (and low protein-low sodium) could be protective against the risk of stone formation in hypercalciuric stone forming adults. Moderate dietary salt restriction is useful in limiting urinary calcium excretion and thus may be helpful for primary and secondary prevention of nephrolithiasis. A low-normal protein intake decrease calciuria and could be useful in stone prevention and preservation of bone mass. Omega-3 fatty acids and bran of different origin decreases calciuria, but their impact on the urinary stone risk profile is uncertain. Sports beverage do not affect the urinary stone risk profile. HYPEROXALURIA: A diet low in oxalate and/or a calcium intake normal to high (800-1200 mg/day for adults) reduce the urinary excretion of oxalate, conversely a diet rich in oxalates and/or a diet low in calcium increase urinary oxalate. A restriction in protein intake may reduce the urinary excretion of oxalate although a vegetarian diet may lead to an increase in urinary oxalate. Adding bran to a diet low in oxalate cancels its effect of reducing urinary oxalate. Conversely, the addition of supplements of fruit and vegetables to a mixed diet does not involve an increased excretion of oxalate in the urine. The intake of pyridoxine reduces the excretion of oxalate. HYPERURICOSURIA: In patients with renal calcium stones the decrease of the urinary excretion of uric acid after restriction of dietary protein and purine is suggested although not clearly demonstrated. HYPOCITRATURIA: The administration of alkaline-citrates salts is recommended for the medical treatment of renal stone-formers with hypocitraturia, although compliance to this treatment is limited by gastrointestinal side effects and costs. Increased intake of fruit and vegetables (excluding those with high oxalate content) increases citrate excretion and involves a significant protection against the risk of stone formation. Citrus (lemons, oranges, grapefruit, and lime) and non citrus fruits (melon) are natural sources of dietary citrate, and several studies have shown the potential of these fruits and/or their juices in raising urine citrate levels. CHILDREN: There are enought basis to advice an adequate fluid intake also in children. Moderate dietary salt restriction and implementation of potassium intake are useful in limiting urinary calcium excretion whereas dietary calcium restriction is not recommended for children with nephrolithiasis. It seems reasonable to advice a balanced consumption of fruit and vegetables and a low consumption of chocolate and cola according to general nutritional guidelines, although no studies have assessed in pediatric stone formers the effect of fruit and vegetables supplementation on urinary citrate and the effects of chocolate and cola restriction on urinary oxalate in pediatric stone formers. Despite the low level of scientific evidence, a low-protein (< 20 g/day) low-salt (< 2 g/day) diet with high hydration (> 3 liters/day) is strongly advised in children with cystinuria. ELDERLY: In older patients dietary counseling for renal stone prevention has to consider some particular aspects of aging. A restriction of sodium intake in association with a higher intake of potassium, magnesium and citrate is advisable in order to reduce urinary risk factors for stone formation but also to prevent the loss of bone mass and the incidence of hypertension, although more hemodynamic sensitivity to sodium intake and decreased renal function of the elderly have to be considered. A diet rich in calcium (1200 mg/day) is useful to maintain skeletal wellness and to prevent kidney stones although an higher supplementation could involve an increase of risk for both the formation of kidney stones and cardiovascular diseases. A lower content of animal protein in association to an higher intake of plant products decrease the acid load and the excretion of uric acid has no particular contraindications in the elderly patients, although overall nutritional status has to be preserved.

[Nephrolithiasis: metabolic defects and terapeutic implications]. / Nefrolitiasi: aspetti metabolici e implicazioni terapeutiche.

Over the past 10 years, major progress has been made in the knowledge of urinary lithogenesis, including the potential pathogenetic role of Randall's plaques and renal tubular crystal retention. Urine supersaturation is the driving force of this process and can be induced by some risk factors, including low urine volume, high urinary excretion of calcium oxalate and uric acid and low urinary excretion of citrate. Primary hypercalciuria can be due to intestinal overabsorption renal leak and bone reabsorption of calcium. Prophilaxis is mainly conducted with thiazides and low calcium diet which is indicated only in the intestinal form. Primary hyperoxaluria is treated with pyridoxine and may require in the severe forms simultaneous renal and liver transplantation. Enteric hyperoxaluria is secondary to fatty acids malabsorption and requires diet, oral calcium and cholestiramine. Hyperuricosuria is caused by diet endogenous overproduction, mainly due to enzymatic defects or high renal excretion of uric acid. Urine alkalinization with K or K and Mg citrate can prevent stone formation even in idiopathic uric acid nephrolithiasis, in which a defect of urine acidification is supposed to be the main abnormality, and in hypocitraturic patients. Cystinuria is a rare inherited defect with an intense clinical impact. It can be classified in three forms and urinary stone formation is the role. Increased solubility and conversion of cystine in a more soluble form are the main goals of the prophylaxis which includes K citrate and thiol agents administration. Tiopronin is preferred to D-penicillamine due to its lower side effects.

A single-center study of 100 consecutive patients with localized prostate cancer treated with stereotactic body radiotherapy.

BACKGROUND: Radiotherapy is an increasingly preferred treatment option for localized prostate cancer, and stereotactic body radiation therapy (SBRT) a relatively established modality of therapeutic irradiation. The present study analyzes the toxicity and biochemical efficacy of SBRT in 100 consecutive prostate cancer patients treated with CyberKnife Robotic Radiosurgery System. METHODS: One hundred patients were treated with SBRT at the Radiation Oncology department of San Bortolo Hospital, Vicenza, Italy. All patients included in this IRB-approved protocol-driven prospective study had biopsy-proven prostate cancer. Risk category was low in 41, intermediate in 42, and high in 17 patients. The patients were treated with CyberKnife-SBRT (CK-SBRT), the prescription dose was 35 Gy in five fractions, corresponding to 92 Gy in 2-Gy fractions (α/ß =1.5 Gy); 29 patients also received androgen deprivation therapy (ADT). RESULTS: Median follow-up was 36 months (range, 6-76 months). Acute Grade 2 genitourinary and gastrointestinal toxicity occurred in respectively 12% and 18% of the patients; there were no Grade 3 or higher acute toxicities. Late Grade 1, 2, and 3 genitourinary toxicities occurred in 4%, 3%, and 1% of the patients, respectively; late Grade 1 gastrointestinal toxicity occurred in two patients and Grade 2 toxicity in one patient; no late gastrointestinal toxicities of grade 3 or 4 were observed. Median PSA nadir was 0.45 ng/ml at 36 months for all patients. In the SBRT-monotherapy group, the median PSA nadir at 36 months was 0.62 ng/ml; in the ADT-SBRT group, it was 0.18 ng/ml. Four patients had clinical recurrence: one local, two lymph nodes, and one to the bone. Ninety-six patients had no evidence of biochemical or clinical recurrence. A benign PSA bounce of median 1.08 ng/ml occurred in 12% of the 71 SBRT monotherapy patients at a mean 23 months (range, 18-30 months). CONCLUSIONS: In this study CK-SBRT has provided promising outcomes in localized prostate cancer with good PSA response, minimal toxicity and patient inconvenience.

Treatment of small lower pole calculi--SWL vs. URS vs. PNL?

According to current guideline recommendations extracorporeal shock wave lithotripsy (SWL) remains the first choice treatment for small and mid-sized renal calculi. However, the results of SWL treatment for lower pole stones can be disappointing whilst more invasive endoscopic modalities, such as flexible ureterorenoscopy (fURS) and percutaneous nephrolithotomy (PNL) are often considered more effective. This article summarizes a point-counterpoint discussion at the 9th eULIS symposium in Como, Italy, and discusses the potential advantages and disadvantages of the different therapeutic approaches.

Metabolic syndrome and bariatric surgery in stone disease etiology.

PURPOSE OF REVIEW: To review the prevalence and mechanisms of stone formation in patients with metabolic syndrome and in those submitted to bariatric surgery. RECENT FINDINGS: MetS is associated with urinary stone disease, which appears to be sustained by dietetic factors and insulin resistance. The latter represented in obesity and diabetes favors uric acid precipitation in urine via a more acidic urinary load. Patients submitted to modern bariatric surgery are at risk of nephrolithiasis and nephropathy as a consequence of malabsorption and hyperoxaluria, which are more consistent after Roux-en-Y gastric bypass than after gastric banding. Other stone risk factors such as hypocitraturia may also be present. SUMMARY: Patients with metabolic syndrome and those submitted to modern bariatric surgery are both at risk of nephrolithiasis and nephropathy. Accurate stone screening careful monitoring of renal function and diet counseling are strongly encouraged in these patients.

Image-guided stereotactic body radiation therapy for clinically localized prostate cancer: preliminary clinical results.

Stereotactic body radiotherapy (SBRT) is a new treatment modality for prostate cancer. The current study evaluates CyberKnife SBRT and reports toxicity and early Prostate-Specific Antigen (PSA) kinetics. From June 2006 to August 2009, 45 low-and intermediate-risk prostate cancer patients received Cyberknife SBRT of 35 Gy in five fractions with 95% minimum target coverage. Median follow-up was 20-months (range 6-42-months). Seventeen patients received androgen-deprivation therapy also. Acute complications were mild, short-lived and no greater than Grade 2 by RTOG scale. Late toxicities consisted of one patient (2.2%) experiencing Grade 2 rectal, one patient (2.2%) Grade 3 and four patients (8.8%) with Grade 1 urinary toxicity. PSA in all patients progressively declined from a mean 4.7 ng/ml baseline to 1.48 ng/ml at three months, to 0.68 ng/ml at 12 months and to 0, 35 ng/ml at 24 months. The 28 hormon-naive patients had the mean PSA value of 1.1 ng/ml at one year from a mean 6.65 ng/ml baseline. There was a significant PSA value reduction in 11 hormone therapy patients with low baseline PSA value (< or = 1 ng/ml) from 0.37 down 0.14 ng/ml (p value 0.0068) at one year. Moreover, 14 low risk patients gave better results of mean PSA value than 17 Intermediate risk patients 0.43 ng/ml vs. 0.93 ng/ml (p value 0.02) at one year. No patient had biochemical failure at last follow-up. Hypofractionated SBRT appears to have potential against prostate cancer. Low toxicity and encouraging biochemical control support its use in early-stage prostate cancer. Results encourage further follow-up and larger studies.

Lymphatic and vascular embolizations are independent predictive variables of inguinal lymph node involvement in patients with squamous cell carcinoma of the penis: Gruppo Uro-Oncologico del Nord Est (Northeast Uro-Oncological Group) Penile Cancer data base data.

BACKGROUND: The objective of the current study was to identify independent clinical and pathologic variables that were predictive of lymph node involvement in patients with squamous cell carcinoma of the penis in a multicenter series with the intent to select patients who were suitable to undergo immediate inguinal lymphadenectomy. METHODS: Data were analyzed from 175 patients who underwent surgery for penile carcinoma in 11 urologic centers participating in the Gruppo Uro-Oncologico del Nord-Est (Northeast Uro-Oncological Group) Penile Cancer Data Base. Pathologically positive lymph nodes were defined as the presence of histologically confirmed lymph node metastasis in patients who underwent either immediate or delayed inguinal and/or pelvic lymphadenectomy. Patients who had clinically positive lymph nodes with cytologically positive fine-needle aspiration results and who had not undergone lymphadenectomy were censored. RESULTS: Overall, lymph-node involvement was observed in 71 of 175 patients (40.6%) included in the analyses. After analyzing the whole group of patients, the following variables were identified as independent predictors of pathologic lymph node metastasis: clinical lymph node status, pathologic stage of the primary tumor, venous and lymphatic embolizations, and histologic grade. In the subgroup of patients with clinically negative lymph nodes, tumor thickness, histologic grade, lymphatic and venous embolizations, infiltration of both corpus spongiosum and urethra, and pathologic stage of the primary tumor (according to the 1997 TNM classification system) were predictive of lymph node involvement on univariate analysis. The generated logistic regression model showed that venous and/or lymphatic embolizations and infiltration of the corpus spongiosum and/or urethra were independent predictors of pathologic lymph node metastasis in patients with clinically negative lymph nodes. CONCLUSIONS: Venous and/or lymphatic embolizations played relevant roles as predictors of pathologic lymph node involvement in patients with penile neoplasia and should be considered important parameters in determining which patients with clinically negative lymph nodes should undergo immediate lymphadenectomy.