Sorafenib with or without everolimus in patients with advanced hepatocellular carcinoma (HCC): a randomized multicenter, multinational phase II trial (SAKK 77/08 and SASL 29).

BACKGROUND: Sorafenib (S), a multitargeted tyrosine kinase inhibitor, is the standard of care for first-line systemic treatment of advanced hepatocellular carcinoma (HCC). Everolimus (E) is a potent inhibitor of mTOR, a pathway frequently activated in HCC. Preclinical data suggest that the combination S + E has additive effects compared with single-agent S. PATIENTS AND METHODS: Patients with unresectable or metastatic HCC and Child-Pugh ≤7 liver dysfunction were randomized to receive daily S 800 mg alone or with E 5 mg until progression or unacceptable toxicity. The primary end point was progression-free survival at 12 weeks (PFS12). The secondary end points included response rate, PFS, time to progression (TTP), overall survival (OS), duration of disease stabilization (DDS), safety, and quality-of-life (QoL) assessments. RESULTS: A total of 106 patients were randomized: 46 patients received S and 60 patients received S + E. Ninety-three patients were assessable for the primary end point and 105 patients for the safety analysis. The PFS12 rate was 70% [95% confidence interval (CI) 54-83] and 68% (95% CI 53-81) in patients randomized to S and S + E, respectively. The RECIST (mRECIST) response rate was 0% (23%) in the S arm and 10% (35%) in the S + E arm. Median PFS (6.6 versus 5.7 months), TTP (7.6 versus 6.3 months), DDS (6.7 versus 6.7 months), and OS (10 versus 12 months) were similar in the S and S + E arms, respectively. Grade 3/4 adverse events occurred in 72% and 86% of patients in arm S and arm S + E, respectively. Patients had similar QoL scores over time, except for a greater worsening in physical well-being and mood in the arm S + E. CONCLUSIONS: No evidence was found that S + E improves the efficacy compared with S alone. Combining 5 mg E with full-dose S is feasible, but more toxic than S alone. Further testing of this drug combination in molecularly unselected HCCs appears unwarranted. CLINICALTRIALSGOV: NCT01005199.

Short Chemotherapy-Free Interval Improves Oncological Outcome in Patients Undergoing Two-Stage Hepatectomy for Colorectal Liver Metastases.

BACKGROUND: In patients undergoing two-stage hepatectomy (TSH) for colorectal liver metastases (CRLM), chemotherapy is discontinued before portal vein occlusion and restarted after curative resection. Long chemotherapy-free intervals (CFI) may lead to tumor progression and poor oncological outcomes. OBJECTIVE: The aim of this study was to investigate the impact of the length of CFI on oncological outcome in patients undergoing TSH for CRLM. PATIENTS AND METHODS: Overall, 74 patients suffering from bilobar CRLM who underwent ALPPS (associating liver partition with portal vein ligation for staged hepatectomy; n = 43) or conventional TSH (n = 31) at two tertiary centers were investigated. The impact of CFI on long-term outcomes was analyzed by univariable and multivariable analysis. RESULTS: Preoperative chemotherapy was administered in 91 % (67/74) of patients, and chemotherapy was resumed postoperatively in 69 % (44/64) of patients who completed TSH. The use of postoperative chemotherapy was significantly associated with improved mean overall survival (36 ± 3 vs. 13 ± 3 months; p < 0.001). Overall, the median CFI from surgery to postoperative chemotherapy was 16 weeks (interquartile range 11-31) and was significantly shorter in the ALPPS group when compared with the conventional TSH group (10 vs. 21 weeks; p < 0.001). Multivariable analysis revealed a CFI ≤ 10 weeks as an independent factor associated with improved overall survival (p = 0.006) and disease-free survival (p = 0.010). CONCLUSION: A short CFI is associated with improved oncological outcome in patients undergoing TSH for CRLM. Decreased interstage intervals after ALPPS may facilitate the timely resumption of chemotherapy.

Post-treatment of molasses wastewater by electrocoagulation and process optimization through response surface analysis.

Molasses wastewater is a high strength effluent of food industry such as distilleries, sugar and yeast production plants etc. It is characterized by a dark brown color and exhibits a high content in substances of recalcitrant nature such as melanoidins. In this study, electrocoagulation (EC) was studied as a post treatment step for biologically treated molasses wastewater with high nitrogen content obtained from a baker's yeast industry. Iron and copper electrodes were used in various forms; the influence and interaction of current density, molasses wastewater dilution, and reaction time, on COD, color, ammonium and nitrate removal rates and operating cost were studied and optimized through Box Behnken's response surface analysis. Reaction time varied from 0.5 to 4 h, current density varied from 5 to 40 mA/cm(2) and dilution from 0 to 90% (v/v expressed as water concentration). pH, conductivity and temperature measurements were also carried out during each experiment. From preliminary experiments, it was concluded that the application of aeration and sample dilution, considerably influenced the kinetics of the process. The obtained results showed that COD removal varied between 10 and 54%, corresponding to an operation cost ranging from 0.2 to 33 euro/kg COD removed. Significant removal rates were obtained for nitrogen as nitrate and ammonium (i.e. 70% ammonium removal). A linear relation of COD and ammonium to the design parameters was observed, while operation cost and nitrate removal responded in a curvilinear function. A low ratio of electrode surface to treated volume was used, associated to a low investment cost; in addition, iron wastes could be utilized as low cost electrodes i.e. iron fillings from lathes, aiming to a low operation cost due to electrodes replacement. In general, electrocoagulation proved to be an effective and low cost process for biologically treated molasses-wastewater treatment for additional removal of COD and nitrogen content and color reduction. Treated effluent samples with good quality were produced by EC, with COD, NH4-N and NO3-N concentrations of 180, 52 and 2 mg/l respectively. Response surface analysis revealed that optimized conditions could be established under moderate molasses wastewater dilution, (e.g. 45%), at 3.5 h treatment time and 33 mA/cm(2) current density.

Contribution to the sustainable management of resources by novel combination of industrial solid residues into red ceramics.

Limited amounts of industrial residues are recycled while the remaining huge quantities are stockpiled or disposed of, thus frequently leading to soil contamination. The utilization of industrial residues as valuable secondary resources into ceramics can contribute to efficient waste management and substitution for massive amounts of natural resources (clayey minerals) demanded for ceramic production. The low cost of these residues and even possible energy savings during mixture firing may also be beneficial. In the present study, the innovative combination of lignite fly ash with steel-making dust into clay-based red ceramics is undertaken, to contribute both to sustainable use of resources and prevention of soil contamination. Brick specimens were shaped by extrusion and fired, their microstructure was examined and the effect of the mixture composition and firing temperature on physico-mechanical properties was determined. Ceramic microstructures were successfully obtained by a suitable combination of fly ash with steel dust (5 + 5 wt%) into clays. Properties can be predicted and tailored to meet the needs for specific applications by appropriately adjusting the mixture composition and sintering temperature.

Utilization of phosphogypsum in tannery sludge stabilization and evaluation of the radiological impact.

The current global trend towards increasingly stringent environmental standards and efforts for efficient utilization and re-use of available by-products and/or wastes, favors the use of low-cost sorbent materials for the treatment of heavy metal-contaminated solid wastes. In this study, the stabilization of tannery sludge, produced from the physicochemical and biological treatment of tannery wastewaters, was examined by the addition of phosphogypsum (PG) at a ratio of 1:1. Characterization of the tannery sludge leachates showed high amounts of chromium which exceeded the acceptable level for disposal in non-hazardous waste landfills, while the dissolved organic carbon (DOC) concentrations exceeded the limits for disposal in landfills for hazardous wastes, according to the EU Decision 2003/33/EC. Leachates of the waste stabilized with PG presented chromium and DOC concentrations below the regulation limits for disposal in landfills for non-hazardous wastes. Moreover, mixing PG with tannery sludge resulted in a stabilized waste with reduced radioactivity.

A test for adequate wastewater treatment based on glutathione S transferase isoenzyme profile.

Discharge to the environment of treated or non-treated municipal wastewater imposes several threats to coastal and estuarine ecosystems which are difficult to assess. In our study we evaluate the use of the isoenzyme profile of glutathione S transferase (GST) in combination with the kinetic characteristics of the whole enzyme and of heme peroxidase, as a test of adequate treatment of municipal wastewater. For this reason, Artemia nauplii were incubated in artificial seawater prepared by wastewater samples, such as secondary municipal effluents produced by a conventional activated sludge unit and advanced treated effluents produced by the employment of coagulation, activated carbon adsorption and chlorination as single processes or as combined ones. Characteristic changes of the isoenzyme pattern and the enzymes' kinetic properties were caused by chlorinated secondary municipal effluent or by secondary non-chlorinated effluent. Advanced treatment by combination of coagulation and/or carbon adsorption resulted to less prominent changes, suggesting more adequate treatment. Our results suggest that GST isoenzyme profile in combination with the kinetic properties of the total enzyme family is a sensitive test for the evaluation of the adequateness of the treatment of reclaimed wastewater and the reduction of potentially harmful compounds. Potentially, it may offer a 'fingerprint' characteristic of a particular effluent and probably of the treatment level it has been subjected.

Protozoans as indicators of sequential batch processes for phenol treatment; an autoecological approach.

The objective of this study was the investigation of the potential use of protistan species as quality indicators of the activated sludge performance in sequential batch processes receiving toxic compounds. Two laboratory scale sequential batch reactors (SBR) were used, a conventional one and a system with plastic biofilm carriers (SBBR), treating wastewater containing phenol at concentrations ranging from 1 up to 40 mg/L. Physicochemical analyses of the samples included the determination of MLSS, effluent suspended solids, BOD5, nitrogen-ammonia, nitrogen-nitrate and phenol. The activated sludge protistan community was identified and enumerated in each reactor. Statistical analyses included Canonical Correspondence Analysis and Indicator Species Analysis of the collected experimental data. Canonical Correspondence Analysis showed inversely proportional relationships between the protozoa and the physicochemical parameters of the effluent as well as protozoan species competition. Indicator species analysis revealed the presence and the prevalence of different species under various phenol influent concentrations. No indicator species were observed for the period of operation under 5 mg/L influent phenol in both reactors, while no indicator species were observed for 20 mg/L influent phenol in the SBR reactor. Carchesium and Epistylis sp. showed the higher values for 1 mg/L phenol in the SBR, while Holophrya sp. showed lower indicator values for the same period in the SBBR. Although several species showed a good correlation to the treatment efficiency of the reactors, Blepharisma sp., could be used as the primary indicator species in both reactors for the operation period under 40 mg/L phenol, as deduced by statistical analysis.

Environmental hazard assessment of coal fly ashes using leaching and ecotoxicity tests.

The environmental hazard of six coal fly ash samples collected from various coal incineration plants were examined in the present study, using various leaching tests along with physicochemical and ecotoxicological analyses. Physicochemical analyses indicated that the concentration of Ba, Cr, Mo, Se, sulfates and total dissolved solids (TDS) exceeded the threshold values, according to the European Council decision 2003/33/EC for inert, non-hazardous or hazardous waste. The highest sensitivity, among examined organisms, was presented by Daphnia magna and was ascribed to the lowest tolerance of the organism to Cr. The toxic effect profile of the leachates toward Vibrio fischeri revealed that its bioluminescence was significantly altered by the presence of heavy metals in the leachates (such as Cu, Ni and Zn) in low or sub-lethal doses. Although the toxicity of the leachates toward Pseudokirchneriella subcapitata was relatively high, the correlation between the toxicity and heavy metals concentration was rather poor, indicating the significance of the bioavailability of constituents and the importance of toxicity testing. Based on the classification of the samples resulted by physicochemical analyses of the leachates and the results of ecotoxicity tests, Physicochemical and Ecotoxicological indices were also defined, for an overall evaluation of the environmental impact assessment of fly ashes. The suggested indices showed that ecotoxicity tests were in some cases inconsistent with the outcome of waste classification based on physicochemical analyses. Moreover, the examination of leaching protocols and obtained results showed that one stage leaching test (L/S=10 L/kg) underestimated the fly ash classification, when compared with the two stage test EN 12457-3 at the cumulative ratio L/S=10 L/kg. In addition, the application of availability test NEN 7341 provided useful results about the ecotoxicity wastes. Thus, NEN 7341 is strongly suggested for the implementation of such studies, since the bioavailability of constituents may not be altered by pH adjustment tactics and pH-originated toxicity effects may be avoided.

Risk-adapted FDG-PET/CT-based follow-up in patients with diffuse large B-cell lymphoma after first-line therapy.

BACKGROUND: The purpose of this study was to evaluate the impact of 2-[fluorine-18]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) during follow-up of patients with diffuse large B-cell lymphoma (DLBCL) being in complete remission or unconfirmed complete remission after first-line therapy. PATIENTS AND METHODS: DLBCL patients receiving FDG-PET/CT during follow-up were analyzed retrospectively. Confirmatory biopsy was mandatory in cases of suspected disease recurrence. RESULTS: Seventy-five patients were analyzed and 23 (30%) had disease recurrence. The positive predictive value (PPV) of FDG-PET/CT was 0.85. Patients >60 years [P = 0.036, hazard ratio (HR) = 3.82, 95% confidence interval (CI) 1.02-7.77] and patients with symptoms indicative of a relapse (P = 0.015; HR = 4.1; 95% CI 1.20-14.03) had a significantly higher risk for relapse. A risk score on the basis of signs of relapse, age >60 years, or a combination of these factors identified patients at high risk for recurrence (P = 0.041). CONCLUSIONS: FDG-PET/CT detects recurrent DLBCL after first-line therapy with high PPV. However, it should not be used routinely and if only in selected high-risk patients to reduce radiation burden and costs. On the basis of our retrospective data, FDG-PET/CT during follow-up is indicated for patients <60 years with clinical signs of relapse and in patients >60 years with and without clinical signs of relapse.

Hodgkin's lymphoma in remission after first-line therapy: which patients need FDG-PET/CT for follow-up?

BACKGROUND: The purpose of the study was to evaluate the impact of 2-[fluorine-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET)/computed tomography (CT) during follow-up of patients with Hodgkin's lymphoma. PATIENTS AND METHODS: Patients in complete remission or an unconfirmed complete remission after first-line therapy who received FDG-PET/CT during their follow-up were analyzed retrospectively. Confirmatory biopsy was mandatory in case of recurrence. RESULTS: Overall, 134 patients were analyzed. Forty-two (31.3%) patients had a recurrence. The positive predictive value of FDG-PET/CT was 0.98. Single-factor analysis identified morphological residual mass [P = 0.0005, hazard ratio (HR) 3.4, 95% confidence interval (CI) 1.7-6.6] and symptoms (P < 0.0001, HR 4.9, 95% CI 2.4-9.9) as significant risk factors for relapse. By multivariate analysis, morphological residual mass was the only significant risk factor for early follow-up (<24 months) (P = 0.0019, HR 7.6, 95% CI 2.1-27.3). Advanced stage (P = 0.0426, HR 3.6, 95% CI 1.1-12.3) and the presence of symptoms (P = 0.0009, HR = 14.6, 95% CI 3.0-69.7) were found to be significant risk factors for later follow-up (>24 months). CONCLUSIONS: Asymptomatic patients without morphological residues and an early stage of disease do not need a routine FDG-PET/CT for follow-up. Asymptomatic patients with morphological residues should receive routine follow-up FDG-PET/CT for the first 24 months. Only patients with advanced initial stage do need a routine follow-up FDG-PET/CT beyond 24 months.

Real-time tissue elastography versus FibroScan for noninvasive assessment of liver fibrosis in chronic liver disease.

PURPOSE: Transient elastography (FibroScan, [TE]) and serum fibrosis markers such as the FibroTest (FT) are established methods for the noninvasive staging of liver fibrosis. A study using real-time elastography (HI-RTE), which is integrated in a conventional ultrasound system, was recently published with comparable results to transient elastography. The aim of the present study was to validate real-time elastography using the formulas calculated in previous studies and to compare the results to transient elastography and FibroTest for the noninvasive assessment of liver fibrosis. MATERIALS AND METHODS: One hundred and thirty-four patients with chronic liver disease and either histological assessment of liver fibrosis (n = 112) or proven liver cirrhosis (n = 22) were included in the study. All patients received TE, HI-RTE, and biochemical evaluation on the same day as presentation. The calculation of the elasticity score of real-time elastography was performed in accordance with the two previously published studies. RESULTS: The Spearman correlation coefficient between transient elastography, real-time elastography and FibroTest with the histological Chevallier score was statistically significant with 0.78, 0.34, and 0.67, respectively (p < 0.01). The diagnostic accuracy expressed as areas under ROC curves was 0.84, 0.69 and 0.85 for the diagnosis of significant fibrosis (F > or = 2), and 0.97, 0.65, and 0.83 for the diagnosis of cirrhosis, respectively. CONCLUSION: Real-time elastography in its present form cannot replace transient elastography for noninvasive assessment of liver fibrosis.

Effectiveness of ozonation and chlorination on municipal wastewater treatment evaluated by a battery of bioassays and biomarkers.

A battery of bioassays, including biological toxicity as well as in vitro mouse spleen lymphoproliferative responses and cytokine production, was conducted to compare the effectiveness of tertiary treatment methods such as coagulation (Coag) and absorption on granular activated carbon (GAC) and disinfection processes such as chlorination and ozonation in removing toxic or stress inducing agents from reclaimed wastewater. Whole effluent toxicity (WET) testing of secondary treated (ST) wastewater using as test species Vibrio fischeri, Daphnia magna and Tetrahymena thermophila as well as phytotoxicity revealed moderate toxicity effects that depend on the organism used. All bioassays exhibited decrease of the ecotoxicological responses after tertiary treatment. However, mitogenic responses were proved to be more sensitive. Endotoxin present in ST samples may be responsible for the increased strong lymphoproliferative activity as well as interleukin-1 (IL-1) production by mouse splenocytes. Tertiary treatment of ST with coagulation and/or adsorption on granular activated carbon (GAC) in combination with ozonation reduced WET to control levels. Ozonation alone or in combination with any other treatment removed endotoxin more efficiently than chlorination and thus reduced spleen lymphoproliferative responses and IL-1 production.

Nelfinavir and lenalidomide/dexamethasone in patients with lenalidomide-refractory multiple myeloma. A phase I/II Trial (SAKK 39/10).

The antiretroviral agent nelfinavir has antimyeloma activity and can overcome resistance to bortezomib. Our phase I/II trial investigated whether adding nelfinavir to lenalidomide-dexamethasone can overcome lenalidomide resistance in lenalidomide-refractory multiple myeloma (MM). Twenty-nine patients were included (high-risk cytogenetic aberrations 31%; ≥2 prior therapy lines 93%; lenalidomide-bortezomib double-refractory 34%). Twenty-four patients (83%) had prior bortezomib and 10 (34%) were lenalidomide-bortezomib double-refractory. They received four cycles of nelfinavir 2500 mg/day with standard-dose lenalidomide (25 mg days 1-21) and dexamethasone (40/20 mg days 1, 8, 15, 22). Minor response or better was achieved in 16 patients (55%; 95% CI 36-74%), including 40% of those who were lenalidomide-bortezomib double-refractory, and partial response or better in nine patients (31%; 95% CI 15-51%). Median progression-free survival was 3.4 (95% CI 2.0-4.9) months and median overall survival 21.6 (13.0-50.1) months. Lenalidomide-related pneumonitis, pneumonia, and neutropenic fever occurred, but there were no unexpected adverse events. Peripheral blood mononuclear cells showed a 45% (95% CI 40-51%) reduction in total proteasome activity from baseline and significant induction of unfolded protein response and autophagy. Thus, nelfinavir-lenalidomide-dexamethasone is an active oral combination in lenalidomide-refractory MM.

Influence of ozonation on the in vitro mutagenic and toxic potential of secondary effluents.

Reclamation of municipal effluents by advanced treatment processes is an attractive perspective for facing certain water shortage problems. However, the application of tertiary techniques should be thoroughly examined for their potential hazardous effects. Ozonation is an efficient chemical oxidation method, often used in wastewater reclamation, which may result in by-products that may alter the toxic and mutagenic properties of effluents. In this study, Ames test and Microtox test were used for the evaluation of ozonation efficiency to upgrade secondary effluents quality. In general, the toxic response and mutagenic effect without metabolic activation of test species were influenced mainly by the ozone dose and ozonation duration, whereas the mutagenic effect with metabolic activation was influenced mainly by ozone dose, indicating that ozone conditions strongly affect the formation of by-products. In most cases, the toxicity was increased and reached up to 100% (in relation to that of secondary effluent) after ozonation with 8.0 mg O3/L for 5 min. On the contrary, in most cases the mutagenic activity towards strain TA98 without metabolic activation was reduced, when ozone dose and contact time increased. However, the mutagenicity was also increased after ozonation at low ozone doses and for contact times less than 5 min. The mutagenic activity of treated effluents towards strain TA98 with metabolic activation remained about the same or was reduced, compared to that of secondary effluent, and was even eliminated after ozonation with 8.0 mg O3/L for contact times higher than 5 min.

Effect of activated carbons modification on porosity, surface structure and phenol adsorption.

The primary objective of this work was the examination of modified activated carbons with tailored adsorption capacity properties. Production of activated carbons with desired properties was accomplished by modification of surface functional groups and introduction of acidic/basic properties. Modification of an activated carbon was performed using partial oxygen gasification, nitric acid treatment, urea impregnation followed by pyrolysis and pyrolysis in a urea saturated stream. The surface properties of the produced samples were estimated by the multibasic titration method of Boehm and by the CO/CO2 gas evolution profiles, while pore structure development was measured by the N2 and CO2 gas adsorption isotherms. Oxygen gasification resulted in samples with surface area slightly lower that the raw activated carbon; the introduction of surface functional groups depended upon the severity of the treatment: carbonylic and phenolic type groups were introduced in all partially gasified samples, while low temperatures and short reaction times enhanced the basic character of the carbon. However, nitric acid treatment resulted in the introduction of high nitrogen amounts in the samples, the reduction of surface area and the development of a surface containing carboxylic, lactonic, phenolic and carbonylic groups with negligible HCl neutralization capacity. Treatment of activated carbon by urea supported the formation of basic groups and carbonyls. The presence of surface functional groups affected the adsorption capacity of the produced samples for the removal of specific pollutants such as phenols. Urea treated samples with a basic character and high nitrogen content presented the highest phenol uptake capacity; nitric acid treated carbons and oxygen gasified samples presented an acidic surface functionality and a low phenol adsorption capacity. The beneficial role of nitrogen on phenol adsorption was attributed to adsorbate-adsorbent interactions.

Investigation of sewage sludge stabilization potential by the addition of fly ash and lime.

The aim of this work was the examination of stabilization potential of sewage sludge by the addition of fly ash and/or lime and the investigation of the effect of stabilization time on the properties of produced mixtures. Five samples were prepared by mixing fly ash, sewage sludge and lime in various ratios and the mixtures were stabilized for a period of 35 d. The addition of alkaline agents resulted in the increase of sample pH up to 12, the increase of total solids content to about 50% and the reduction of the organic fraction of the solids. The produced samples presented inhibition effects to seed germination and root length growth of three higher plants (one monocotyl and two dicotyls); however, samples with high sludge content resulted in negligible seed germination inhibition at prolonged stabilization times. The standard TCLP leaching procedure was applied in all the produced samples in order to evaluate the extraction potential of certain metallic elements; the content of metals in the eluates was varied, depending upon their speciation and form. Eluates presented significant inhibition to the marine photobacterium Vibrio fischeri bioluminescence, while the lowest inhibition was detected for the samples containing higher sludge content. These samples potentially could be applied as soil amendment, offering an efficient method for the combined utilization of two different solid wastes; however, low dosages of fly ash should be used for the production of a stabilized material presenting negligible effects with respect to its phytotoxic and ecotoxic properties.

Bioassays and biomarkers for ecotoxicological assessment of reclaimed municipal wastewater.

The aim of this work was to examine the ecotoxicity of reclaimed wastewater by the use of bioassays and the determination of immunological parameters. Secondary and tertiary mucicipal wastewater samples were examined for their physicochemical and microbiological characteristics as well as for their endotoxin concentrations. The ecotoxicological characteristics were assessed by a battery of bioassays, using Vibrio fischeri, Daphnia magna and Tetrahymena thermophilla as test species and phytotoxicity. The mitogenic responses of mouse splenocytes were as well used as bioassay. The cytokines of IL-1, IL-2, IL-10, IFNgamma and TNFalpha, were also determined in the supernatant of splenocyte cultures and served as molecular biomarkers. All bioassays exhibited decrease of the ecotoxicological responses after tertiary treatment. However, mitogenic responses were proved to be more sensitive. IL-1 increased, while IL-2 production was unaffected. The fact that IL-10 production increased in response to secondary treated effluents in conjunction with the increased endotoxin levels, suggest Th2 type immune responses. Although results obtained from the toxicity bioassays after the tertiary treatment showed comparable results to those of controls, cytokine levels indicated the induction of immune response even after tertiary treatment. Consequently, cytokine production could be used as a sensitive biomarker for the evaluation of treatment efficiency of the reclaimed wastewaters intended for reuse.

Appropriate combination of physico-chemical methods (coagulation/flocculation and ozonation) for the efficient treatment of landfill leachates.

An integrated technique consisted of ozonation and coagulation/flocculation processes was studied, aiming to provide an efficient method for the treatment of stabilized/biologically pre-treated leachates, in order to reduce the organic pollutants' content to concentration values lower than the corresponding limits, imposed by the legislation. Leachates were collected from a municipal landfill site; samples containing around 1000 mg l(-1) COD and BOD(5)/COD ratio about 0.17 were treated by using two different processes or combinations between them, i.e. ozonation, coagulation-flocculation, ozonation followed by coagulation/flocculation and coagulation/flocculation followed by ozonation. The application of single ozonation resulted to the efficient removal of color and organic loading, due to the respective oxidation, induced by ozonation; however, COD values lower than 200 mg l(-1) could be only achieved after prolonged reaction times and for high ozone production rates. The coagulation of leachate samples was studied by the addition of ferric chloride or poly-aluminum chloride agents at various dosages. Maximum COD removal rates (up to 72%) were achieved by the addition of 7 mM Fe, or of 11 mM Al respectively. However, final COD values higher than 200 mg l(-1) were obtained indicating the requirement of an additional treatment step. Pre-ozonation followed by coagulation/flocculation was not found to be an efficient treatment approach for this aim, but coagulation/flocculation followed by ozonation, was proved to be an efficient process for the reduction of COD to lower than 180 mg l(-1).

The effect of coagulation on the toxicity and mutagenicity of reclaimed municipal effluents.

The objectives of this work were the assessment of the effectiveness of coagulation on the reclamation of secondary effluents and the evaluation of the quality of reclaimed waters by the examination of their ecotoxic and mutagenic properties. Aluminum coagulants resulted in higher removal of organic content, than iron coagulant, reaching up to 40%; the removal of heavy metals, such as zinc and copper was enhanced by the addition of a low strength anionic flocculant. The toxicity of pre-concentrated samples to the bacteria Vibrio fischerii was related to the heavy metal content, especially zinc and copper, indicating the significance of the metals bioavailability and their potential interactive effects. The secondary effluents exhibited mutagenic effects on strain TA 98; these effects were increased during coagulation with ferric chloride (both in absence and presence of flocculant). However, the addition of aluminum coagulants resulted in a decrease of mutagenic potential of secondary effluents, due to the extended removal of organic matter.

Evaluation of interactions between soil and coal fly ash leachates using column percolation tests.

The aim of this work was the assessment of the environmental impact of different origin fly ashes with regard to their final disposal. The experimental procedure included the performance of single column tests and column tests of fly ash and soil in series. The appraisal of the potential environmental hazards was implemented using physicochemical analyses and bioassays. Two different fly ash samples were examined, one fly ash produced from the combustion of sub-bituminous coal (CFA) and one fly ash produced from the combustion of lignite (LFA). Single column percolation tests were performed according to NEN 7343 protocol, while fly ash/soil experiments were conducted incorporating slight modifications to this protocol. The study focused on the release of metals Ba, Cr, Cu, Mo, Se and Zn and the ecotoxic behavior of leachates on crustacean Daphnia magna and bacteria Vibrio fischeri. The infiltration of the leachates of both fly ashes through soil affected considerably their leaching profile. The transport of Cu and Zn was facilitated by the dynamic leaching conditions and influenced by the pH of the leachates. Moreover, the release and bioavailability of Cr, Cu and Zn was probably altered during the infiltration experiments and organisms' response was not always correlated with the concentration of metals. Nevertheless, the results are signalling that possible manipulations and final disposal of fly ash should be considered when environmental threats are investigated.