Prevalence of multidrug-resistant coagulase-positive staphylococci in canine and feline dermatological patients over a 10-year period: a retrospective study.

Coagulase-positive staphylococci (CPS) are common cutaneous pathogens often requiring multiple courses of antibiotics, which may facilitate selection for methicillin-resistant (MR) and/or multidrug-resistant (MDR) strains. To determine the prevalence of canine and feline MR/MDR CPS associated with skin diseases, medical records were retrospectively searched from April 2010 to April 2020. Pets with at least one positive culture for CPS were selected. Age, sex, antimicrobial sensitivity, previous history of antimicrobial/immunomodulatory medications and methicillin resistance/multidrug resistance status were recorded. Staphylococcus pseudintermedius (SP) (575/748) and Staphylococcus schleiferi (SS) (159/748) in dogs, and Staphylococcus aureus (12/22) in cats, were the most common CPS isolated. Three hundred and twenty-three out of 575 isolates were MR-SP (56.2 %), 304/575 were MDR-SP (52.8 %), 100/159 were MR-SS (62.9 %) and 71/159 were MDR-SS (44.6 %). A trend analysis showed a significant increase of resistance to oxacillin and chloramphenicol for S. pseudintermedius (r=0.86, 0.8; P=0.0007, 0.0034, respectively). Major risk factors for MDR-SP included oxacillin resistance (OR: 3; 95 % CI: 1.4-6.5; P=0.0044), positivity for PBP2a (OR: 2.3; 95 % CI: 1-5; P=0.031) and use of antibiotics in the previous year (OR: 2.8; 95 % CI: 1.3-5.8; P=0.0071). Oxacillin resistance was identified as a major risk factor for MDR-SS (OR: 8.8; 95 % CI: 3.6-21.1; P<0.0001). These results confirmed the widespread presence of MR/MDR CPS in referred dermatological patients. Judicious antibiotic use, surveillance for MR/MDR infections and consideration of alternative therapies are crucial in mitigating the development of resistant strains.

Model-based investigation of the chemical phosphorus removal potential of the peroxide regenerated iron-sulfide control technology.

In this study, the potential of using peroxide regenerated iron-sulfide control (PRI-SC®) for chemical phosphorus removal utilizing the existing iron sulfide found in wastewaters was investigated in batch tests and compared in full-scale facility-wide simulations to using iron salts. PRI-SC is a combination treatment that utilizes iron salts and hydrogen peroxide in a synergetic fashion, where hydrogen peroxide is used in regenerating the spent iron salt in situ in the form of iron sulfide, yielding ferric iron and colloidal sulfur. A simplified kinetic model was developed, calibrated, and integrated into a facility-wide model to simulate the process at the full-scale. Experimental results showed that dosing hydrogen peroxide, even at doses lower than the stoichiometrically required to oxidize iron sulfide, freed, and oxidized sulfide bound ferrous iron to ferric iron, which was consequently hydrolyzed and affected phosphorus removal. Higher dosing of hydrogen peroxide did not affect change in the speciation of sulfur remaining predominantly as elemental sulfur. Simulations showed that the application of PRI-SC with supplemental ferric iron dosing was able to cut the costs of chemicals addition up to 53% while maintaining a steady-state effluent phosphate concentration below 0.01 mg/L. PRACTITIONER POINTS: The kinetic model was used to optimize ferric iron and hydrogen peroxide dosing. The developed model can be integrated in existing wastewater process simulators. Dosing hydrogen peroxide effectively oxidized ferrous iron to ferric iron. The combination of hydrogen peroxide and iron salts can reduce the chemical addition cost by 53%.

Biological nutrient removal enhancement using fermented primary and rotating belt filter biosolids.

This research compared the impact of two primary treatment options (i.e. primary clarification and rotating belt filtration (RBF)) on biological nutrients removal (BNR) process, using sludge fermentation liquid (SFL) as a carbon source. The liquid fraction of both fermented primary and RBF sludges comparably enhanced BNR. Despite the significant contribution of the unpurified SFL to the sharp increase in nutrient levels; i.e. 47%-64% (primary effluent; PE), and 45%-53% (RBF) of the soluble nitrogen and phosphorus loads; readily biodegradable COD and volatile fatty acids (VFAs) fractions of the combined feed increased significantly (2.5-6.1 times), compared to the original feed by additional SFL. Removal efficiencies in the reactors reached 57% (total nitrogen) and 92% (total phosphorus) after addition of SFL. Effluent nitrogen and phosphorus of the two reactors were close in the range of 15 ± 6 mg N/L, and 0.5 ± 0.3 mg P/L, respectively. Kinetics studies showed denitrification rates of 1.3, and 1.13 kg NO3-N/m3.d for primary effluent and RBF effluent-fed reactors, respectively. Phosphorus release rates were 11.7 and 9.7 mg PO4-P/g VSS.h, for primary, and RBF effluents, respectively; showing 20%-22% lower rates in the RBF SFL. Incorporating experimental data into a plant-wide model for a 100 MLD facility receiving typical medium strength wastewater, showed that although primary treatment enhanced the biogas production by 96% (primary clarification) and 62% (RBF) trains; combined fermentation and anaerobic digestion was effective to enhance the biogas production by 59% on average, compared to the base scenario without primary treatment. Additionally, if primary clarification exists, then the addition of fermentation results in additional revenue of C$1890/d in the plant, considering additional revenue of C$2230/d due to VFA generation in contrast to only C$340/d loss due to the reduced methane production.

Vitamin D Boosts Alendronate Tail Effect on Bone Mineral Density in Postmenopausal Women with Osteoporosis.

Vitamin D modulates bisphosphonate (BP) efficacy, but its contribution to bone mineral density (BMD) after BP discontinuation is not known. To address this topic, we performed a retrospective analysis of postmenopausal women exposed to alendronate (ALN) to treat osteoporosis who regularly continued the supplementation of cholecalciferol or calcifediol at recommended doses. In the ninety-six recruited women (age 61.1 ± 6.9 years), ALN was administered for 31.2 ± 20.6 months and then discontinued for 33.3 ± 18.9 months. The modification of 25(OH)D serum levels over time was associated with a change of alkaline phosphatase (r = -0.22, p = 0.018) and C-terminal collagen type 1 telopeptide (r = -0.3, p = 0.06). Women in the tertile of the highest increase in 25(OH)D level showed a 5.7% BMD gain at lumbar spine, that was twice as great in comparison with participants with a lower 25(OH)D variation. At a multiple regression analysis, BMD change was associated with time since menopause (ß = 2.28, SE 0.44, p < 0.0001), FRAX score for major fracture (ß = -0.65, SE 0.29, p = 0.03), drug holiday duration (ß = -2.17, SE 0.27, p < 0.0001) and change of 25(OH)D levels (ß = 0.15, SE 0.03, p = 0.0007). After ALN discontinuation, improving the vitamin D status boosts the ALN tail effect on BMD.

Current Management of Hyperkalemia in Non-Dialysis CKD: Longitudinal Study of Patients Receiving Stable Nephrology Care.

BACKGROUND: No study has explored the limitations of current long-term management of hyperkalemia (HK) in outpatient CKD clinics. METHODS: We evaluated the association between current therapeutic options and control of serum K (sK) during 12-month follow up in ND-CKD patients stratified in four groups by HK (sK ≥ 5.0 mEq/L) at baseline and month 12: Absent (no-no), Resolving (yes-no), New Onset (no-yes), Persistent (yes-yes). RESULTS: We studied 562 patients (age 66.2 ± 14.5 y; 61% males; eGFR 39.8 ± 21.8 mL/min/1.73 m2, RAASI 76.2%). HK was "absent" in 50.7%, "resolving" in 15.6%, "new onset" in 16.6%, and "persistent" in 17.1%. Twenty-four hour urinary measurements testified adherence to nutritional recommendations in the four groups at either visit. We detected increased prescription from baseline to month 12 of bicarbonate supplements (from 5.0 to 14.1%, p < 0.0001), K-binders (from 2.0 to 7.7%, p < 0.0001), and non-K sparing diuretics (from 34.3 to 41.5%, p < 0.001); these changes were consistent across groups. Similar results were obtained when using higher sK level (≥5.5 mEq/L) to stratify patients. Mixed-effects regression analysis showed that higher sK over time was associated with eGFR < 60, diabetes, lower serum bicarbonate, lower use of non-K sparing diuretics, bicarbonate supplementation, and K-binder use. Treatment-by-time interaction showed that sK decreased in HK patients given bicarbonate (p = 0.003) and K-binders (p = 0.005). CONCLUSIONS: This observational study discloses that one-third of ND-CKD patients under nephrology care remain with or develop HK during a 12-month period despite low K intake and increased use of sK-lowering drugs.

Vitamin D and Glomerulonephritis.

Vitamin D presents a plethora of different functions that go beyond its role in skeletal homeostasis. It is an efficient endocrine regulator of the Renin-Angiotensin-Aldosterone System (RAAS) and erythropoiesis, exerts immunomodulatory effects, reduces the cardiovascular events and all-cause mortality. In Chronic Kidney Disease (CKD) patients, Vitamin D function is impaired; the renal hydrolyzation of its inactive form by the action of 1α-hydroxylase declines at the same pace of reduced nephron mass. Moreover, Vitamin D major carrier, the D-binding protein (DBP), is less represented due to Nephrotic Syndrome (NS), proteinuria, and the alteration of the cubilin-megalin-amnionless receptor complex in the renal proximal tubule. In Glomerulonephritis (GN), Vitamin D supplementation demonstrated to significantly reduce proteinuria and to slow kidney disease progression. It also has potent antiproliferative and immunomodulating functions, contributing to the inhibitions of kidney inflammation. Vitamin D preserves the structural integrity of the slit diaphragm guaranteeing protective effects on podocytes. Activated Vitamin D has been demonstrated to potentiate the antiproteinuric effect of RAAS inhibitors in IgA nephropathy and Lupus Nephritis, enforcing its role in the treatment of glomerulonephritis: calcitriol treatment, through Vitamin D receptor (VDR) action, can regulate the heparanase promoter activity and modulate the urokinase receptor (uPAR), guaranteeing podocyte preservation. It also controls the podocyte distribution by modulating mRNA synthesis and protein expression of nephrin and podocin. Maxalcalcitol is another promising alternative: it has about 1/600 affinity to vitamin D binding protein (DBP), compared to Calcitriol, overcoming the risk of hypercalcemia, hyperphosphatemia and calcifications, and it circulates principally in unbound form with easier availability for target tissues. Doxercalciferol, as well as paricalcitol, showed a lower incidence of hypercalcemia and hypercalciuria than Calcitriol. Paricalcitol demonstrated a significant role in suppressing RAAS genes expression: it significantly decreases angiotensinogen, renin, renin receptors, and vascular endothelial growth factor (VEGF) mRNA levels, thus reducing proteinuria and renal damage. The purpose of this article is to establish the Vitamin D role on immunomodulation, inflammatory and autoimmune processes in GN.

A microsieve-based filtration process for combined sewer overflow treatment with nutrient control: Modeling and experimental studies.

Combined sewer overflows contain a highly variable, wide range of contaminants, both in particulate and soluble form, making conventional water treatment processes unable to offer adequate public health protection. In this study, an integrated treatment process designed to simultaneously remove typical combined sewer overflow pollutants (suspended solids, chemical oxygen depends, turbidity) in conjunction with nutrient (nitrogen and phosphorus), was developed. The removal of particulates as well as dissolved nitrogen and phosphorus was achieved by first adsorbing soluble pollutants on zeolite and powdered activated carbon, and subsequently applying filtration carried out by polymer-enhanced microsieving. Laboratory experiments were designed using design-of-experiment techniques and carried out to assess the effects of the various treatment variables (cationic polymer, zeolite, powder activated carbon and microsieve size) in the designed combinations. A response surface model was fitted to the experimental dataset in order to capture and describe the non-linear relationships between treatment variables and treatment objectives. Finally, an optimization study was carried out using Pareto analysis showing that cationic polymer, zeolite, and powdered activated carbon, followed by fine mesh microsieving, worked synergistically in the integrated treatment process. Several optimal process conditions emerged, in particular, a treatment combination consisting of 1.1 mg/L of the cationic polymer, 250 mg/L of zeolite, 5 mg/L of powdered activated carbon, and a 370 µm mesh size. Under this condition, expected performance would be reductions of 72%, 56%, 35%, and 75% for turbidity, total Kjeldahl nitrogen, total chemical oxygen demand, and total phosphorous, respectively. The findings presented in this paper demonstrate the possibility of achieving multiple treatment objectives in a single and integrated treatment step, hence providing municipalities with viable treatment options where the issues of combined sewer overflow and nutrient management are simultaneously tackled.

Plasma membrane integrity and oxidative stress index outcomes of canine progenitor epidermal keratinocytes (CPEKs) exposed to virgin coconut oil (VCO).

BACKGROUND: There is a rapidly growing market for topical use of virgin coconut oil (VCO). Studies of topical use in dogs are lacking. HYPOTHESIS/OBJECTIVE: The objective of this study was to measure the release of lactate dehydrogenase (LDH, a plasma membrane disruption marker) and production of nitrite (Griess reaction, an oxidative stress marker) from a canine keratinocyte cell line after exposure to VCO as an initial toxicity screening to suggest future studies. METHODS AND MATERIALS: Canine progenitor epidermal keratinocytes (CPEKs) were plated onto permeable transwell membranes and cultured with undiluted organic VCO or control media. Following a 24 h incubation, an LDH assay and a Griess reaction were performed on the collected subnatants. RESULTS: Exposure of CPEKs to VCO significantly increased LDH release compared to controls, 62.29 ± 16.32% versus 8.88 ± 5.82% (P = 0.0056) and there was no significant difference in production of nitrite compared to controls, 2.47 ± 1.56 µmol/L versus 1.42 ± 0.95 µmol/L (P = 0.086). CONCLUSIONS AND CLINICAL IMPORTANCE: Based on this study VCO induced an increased disruption of plasma membrane integrity, as measured by LDH. However, VCO did not induce increased oxidative stress, as measured by nitrite production. Based on these preliminary data, further studies to assess the toxicity of VCO are needed.

In search of potential predictors of erythropoiesis-stimulating agents (ESAs) hyporesponsiveness: a population-based study.

BACKGROUND: Evidences show that around 20% of biosimilar or originator erythropoiesis-stimulating agents (ESAs) users are hyporesponsive. Controversial post-marketing data exist on the predictors of ESA hyporesponsiveness. The aim of this study was to identify predictors of ESA hyporesponsiveness in patients with chronic kidney disease (CKD) or cancer in clinical practice. METHODS: During the years 2009-2015, a multi-center, population-based, cohort study was conducted using claims databases of Treviso and Caserta Local Health Units (LHUs). All incident ESA users were characterized at baseline and the differences between the baseline hemoglobin (Hb) value, that is the Hb registered within 30 days prior to the first ESA dispensing (index date, ID) and each outcome Hb value (registered between 30 and 180 days after ID) were calculated and defined as delta Hb (ΔHb). Incident ESA users were defined as hyporesponsive if, during follow-up, they registered at least one ΔHb < 0 g/dL. Including all potential predictors of ESA hyporesponsiveness and stratifying by indication for use, univariate and multivariate binary logistic regression models and Receiver Operating Characteristic (ROC) curves were carried out. RESULTS: In general, 1080 incident ESA users (CKD: 57.0%; cancer: 43.0%) were identified. In CKD, predictors of ESA hyporesponsiveness were C-reactive protein (OR = 1.2, 95% CI: 1.0-1.5; P-value = 0.060) and high levels of baseline Hb (OR = 1.7, 95% CI: 1.2-2.2; P-value< 0,001), the latter being also predictor of ESA hyporesponsiveness in cancer (OR = 1.7, 95% CI: 1.1-2.4; P-value = 0.007). Both in CKD and in cancer, the type of ESA, biosimilar or originator, was not a predictor of ESA hyporesponsiveness. In CKD, concomitant use of iron preparations (OR = 0.3, 95% CI: 0.2-0.7; P-value = 0.002) and of high dosage of angiotensin-converting enzyme inhibitors/angiotensin II-receptor blockers (OR = 0.5, 95% CI: 0.3-0.9; P-value = 0.022) were protective factors against ESA hyporesponsiveness. CONCLUSIONS: The study confirmed traditional potential predictors of hyporesponsiveness to ESA. The use of biosimilar or originator ESA was not a predictor of hyporesponsiveness in an outpatient setting from two large Italian areas. A better knowledge of the predictors of ESA response would allow a better anemia management to improve patients' quality of life.

Erysipeloid lesions caused by Erysipelothrix rhusiopathiae in a dog: clinical and histopathological findings, molecular diagnosis and treatment.

BACKGROUND: Erysipelothrix rhusiopathiae is a widespread Gram-positive, nonsporulating rod bacterium predominantly associated with skin disease in swine and cetaceans. Cutaneous lesions have yet to be described in dogs. OBJECTIVE: To describe the clinical presentation, molecular and histopathological diagnosis, and treatment of a case of erysipeloid caused by E. rhusiopathiae in a dog. ANIMALS: A 6-month-old spayed female standard poodle dog presented with lethargy, fever, vomiting and diarrhoea. Skin lesions appeared 20 days post first examination. METHODS AND MATERIALS: Complete blood count, serum chemistry profile, urinalysis, urine culture, blood culture, computed topography, forelimb radiography, joint and cerebrospinal fluid aspiration were performed; samples were collected for skin cytological evaluation, culture and histopathological analysis. RESULTS: Blood cultures yielded Gram-positive, catalase-negative bacilli. Histopathological evaluation of skin biopsies revealed lymphoplasmacytic, neutrophilic and histiocytic perivascular and periadnexal dermatitis, and vasculitis. Cutaneous and blood PCR and sequencing of 16S rRNA identified the bacteria as E. rhusiopathiae. Clinical resolution was observed following the use of of amoxicillin/clavulanic acid and ciprofloxacin therapies. CONCLUSIONS AND CLINICAL IMPORTANCE: To the best of the authors' knowledge, this is the first confirmed case of erysipeloid caused by E. rhusiopathiae in a dog. Clinical resolution was attained with the extended use of antibiotics. After 13 months, no clinical signs had returned.

Role of Vitamin D Status in Diabetic Patients with Renal Disease.

Diabetes mellitus (DM) poses a major public health problem worldwide, with ever-increasing incidence and prevalence in recent years. The Institute for Alternative Futures (IAF) expects that the total number of people with type 1 and type 2 DM in the United States will increase by 54%, from 19,629,000 to 54,913,000 people, between 2015 and 2030. Diabetic Nephropathy (DN) affects about one-third of patients with DM and currently ranks as the first cause of end-stage kidney disease in the Western world. The complexity of interactions of Vitamin D is directly related with progressive long-term changes implicated in the worsening of renal function. These changes result in a dysregulation of the vitamin D-dependent pathways. Various studies demonstrated a pivotal role of Vitamin D supplementation in regression of albuminuria and glomerulosclerosis, contrasting the increase of glomerular basement membrane thickening and podocyte effacement, with better renal and cardiovascular outcomes. The homeostasis and regulation of the nephron's function are absolutely dependent from the cross-talk between endothelium and podocytes. Even if growing evidence proves that vitamin D may have antiproteinuric, anti-inflammatory and renoprotective effects in patients with DN, it is still worth investigating these aspects with both more in vitro studies and randomized controlled trials in larger patient series and with adequate follow-up to confirm the effects of long-term vitamin D analogue supplementation in DN and to evaluate the effectiveness of this therapy and the appropriate dosage.

[Nutritional diet therapy in the management of the patient with Chronic Kidney Disease in advanced phase to delay the beginning and reduce the frequency of dialysis. An option also in the pre-emptive transplant program].

The Italian nephrology has a long tradition and experience in the field of dietetic-nutritional therapy (DNT), which is an important component in the conservative management of the patient suffering from a chronic kidney disease, which precedes and integrates the pharmacological therapies. The objectives of DNT include the maintenance of an optimal nutritional status, the prevention and / or correction of signs, symptoms and complications of chronic renal failure and, possibly, the delay in starting of dialysis. The DNT includes modulation of protein intake, adequacy of caloric intake, control of sodium and potassium intake, and reduction of phosphorus intake. For all dietary-nutritional therapies, and in particular those aimed at the patient with chronic renal failure, the problem of patient adherence to the dietetic-nutritional scheme is a key element for the success and safety of the DNT and it can be favored by an interdisciplinary and multi-professional approach of information, education, dietary prescription and follow-up. This consensus document, which defines twenty (20) essential points of the nutritional approach to patients with advanced chronic renal failure, has been written, discussed and shared by the Italian nephrologists together with representatives of dietitians (ANDID) and patients (ANED).

Nutritional treatment of advanced CKD: twenty consensus statements.

The Italian nephrology has a long tradition and experience in the field of dietetic-nutritional therapy (DNT), which is an important component in the conservative management of the patient suffering from a chronic kidney disease, which precedes and integrates the pharmacological therapies. The objectives of DNT include the maintenance of an optimal nutritional status, the prevention and/or correction of signs, symptoms and complications of chronic renal failure and, possibly, the delay in starting of dialysis. The DNT includes modulation of protein intake, adequacy of caloric intake, control of sodium and potassium intake, and reduction of phosphorus intake. For all dietary-nutritional therapies, and in particular those aimed at the patient with chronic renal failure, the problem of patient adherence to the dietetic-nutritional scheme is a key element for the success and safety of the DNT and it can be favored by an interdisciplinary and multi-professional approach of information, education, dietary prescription and follow-up. This consensus document, which defines twenty essential points of the nutritional approach to patients with advanced chronic renal failure, has been written, discussed and shared by the Italian nephrologists together with representatives of dietitians (ANDID) and patients (ANED).

Evaluation on the effects of 0.1% Peumus boldus leaf and Spiraea ulmaria plant extract combination on bacterial colonization in canine atopic dermatitis: A preliminary randomized, placebo controlled, double-blinded study.

Defective skin barrier characterize canine atopic dermatitis (AD). Pyoderma is the most common complication. Herbal compounds have been suggested as alternatives to control bacterial colonization for their effect on natural antimicrobial peptides (AMPs). This study evaluated the effects of 0.1% Peumus boldus leaf and Spiraea ulmaria plant extract combination on clinical signs, bacterial colonization and AMPs secretion in atopic dogs compared to placebo. Twenty privately-owned atopic dogs were randomly divided in 2 groups (treatment: n = 10; placebo: n = 10) and their abdomen was sprayed every 24 h for 4 weeks. Total and inguinal clinical scores (CADESI-03), manual bacterial count, and skin washes for AMPs (cBD3-like and cCath) were performed on days 0, 14 and 28. AMPs were detected using in-house, previously-validated, canine-specific ELISAs. Data were statistically analyzed and a p < 0.05 was considered significant. Clinical scores and AMPs secretion did not differ significantly between the two groups at any time point. A significant reduction of the clinical scores was seen in the placebo group at 14 and 28 days (p < 0.04). On days 14 and 28, a reduction in the bacterial count was seen in the treated group compared with placebo (p < 0.009 and p = 0.04, respectively). Compared to baseline, a reduction in Staphylococcus spp. was seen in the treated group after 14 days of treatment (p < 0.03). These results show the efficacy of this plant extract combination against bacterial colonization, suggesting its potential usefulness in preventing bacterial infection in atopic dogs. The influence of this compound on AMPs secretion or other mechanisms should be further evaluated.

Vitamin D Status and the Relationship with Bone Fragility Fractures in HIV-Infected Patients: A Case Control Study.

HIV-infected patients show high risk of fracture. The aims of our study were to determine the prevalence of vertebral fractures (VFs) and their associations with vitamin D in HIV patients. 100 patients with HIV infection and 100 healthy age- and sex-matched controls were studied. Bone mineral density was measured by quantitative ultrasound at the non-dominant heel. Serum osteocalcin and C-terminal telopeptide of collagen type 1 served as bone turnover markers. Bone ultrasound measurements were significantly lower in patients compared with controls (Stiffness Index (SI): 80.58 ± 19.95% vs. 93.80 ± 7.10%, respectively, p < 0.001). VFs were found in 16 patients and in 2 controls. HIV patients with vertebral fractures showed lower stiffness index (SI) (70.75 ± 10.63 vs. 83.36 ± 16.19, respectively, p = 0.045) and lower vitamin D levels (16.20 ± 5.62 vs. 28.14 ± 11.94, respectively, p < 0.02). The majority of VFs (87.5%) were observed in HIV-infected patients with vitamin D insufficiency, and regression analysis showed that vitamin D insufficiency was significantly associated with vertebral fractures (OR 9.15; 95% CI 0.18-0.52, p < 0.04). VFs and are a frequent occurrence in HIV-infected patients and may be associated with vitamin D insufficiency.

Carbon and Phosphorus Removal from Primary Municipal Wastewater Using Recovered Aluminum.

In this work, recovery of aluminum from coagulated primary sludge and its reuse potential as secondary coagulant were investigated. The recovery process consisted of releasing the particle-bound aluminum from primary sludge by acidification (HCl or H2SO4), followed by separation using centrifugation for dissolved coagulant recovery. The recovered coagulant was then reused for treating primary wastewater and overall coagulation efficiency was determined. While with fresh alum, the removal efficiencies of total suspended solids, chemical oxygen demand, total phosphorus, and total nitrogen were 85%, 65%, 80% and 33%, respectively, a drop in removal efficiency of total suspended solids and chemical oxygen demand was observed for recovered aluminum (85-60% and 65-50%, respectively). Nitrogen concentration remained almost constant with each cycle, while phosphorus in the effluent increased by 1 mg/L and 3 mg/L in the first and second cycle, respectively. Precipitation of various aluminum species was modeled for determining the recovery potential of aluminum at low pH. Preliminary cost analysis indicates that optimum recovery of aluminum occurred at a pH of 1.5 for both acids. Struvite precipitation effectively removed increased phosphorus solubilized by acidification at the end of second cycle, however, it also decreased the amount of aluminum available for recycle.

Evaluation of the in vitro effect of Boldo and Meadowsweet plant extracts on the expression of antimicrobial peptides and inflammatory markers in canine keratinocytes.

Dogs with allergies are prone to skin infections and treatments/preventatives to boost innate immune-defenses are beneficial. The aim of this study was to evaluate the effects of Boldo and Meadowsweet extracts on the expression of ß-defensins (cBD), cathelicidin (cCath), and pro-inflammatory cytokines in canine keratinocyte. This study had two phases. Phase I evaluated mRNA expression of cBD103 and cCath, and secretion of cCath, IL-8 and TNF-α by keratinocytes harvested from healthy (n=5) and atopic (n=5) age-matched beagles exposed to Boldo (2% to 0.2%) and Meadowsweet (1% to 0.2%) extracts. Phase II focused on atopic keratinocytes (n=14) exposed to 0.2% Boldo, 0.2% Meadowsweet, and a mixture of 0.1% of both extracts. Phase I: cBD103 mRNA (all concentrations) and TNF-α secretion (2% Boldo) were increased in atopic compared with healthy keratinocytes. In atopic keratinocytes, cBD103 was increased after exposure to 1.5% and 0.2% Boldo. In healthy keratinocytes, 1% and 0.2% Meadowsweet, and 2% Boldo increased and decreased IL-8 secretion, respectively. In atopic keratinocytes, IL-8 increased after exposure to 1% and 0.4% Meadowsweet extract. Phase II: cBD103 mRNA increased after exposure to 0.2% Meadowsweet and to 0.1% mixture. cCath was increased after 0.2% Boldo, but decreased after 0.2% Meadowsweet or the 0.1% mixture. TNF-α secretion was decreased after 0.2% Boldo. It is concluded that low concentrations of both extracts and their combination may have some effects on cCath and cBD103 without stimulating an inflammatory response. However, more studies are needed to clarify the effects of these extracts on the local immunity.

Antiosteoporotic Activity of Genistein Aglycone in Postmenopausal Women: Evidence from a Post-Hoc Analysis of a Multicenter Randomized Controlled Trial.

Genistein has a preventive role against bone mass loss during menopause. However, experimental data in animal models of osteoporosis suggest an anti-osteoporotic potential for this isoflavone. We performed a post-hoc analysis of a previously published trial investigating the effects of genistein in postmenopausal women with low bone mineral density. The parent study was a randomized, double-blind, placebo-controlled trial involving postmenopausal women with a femoral neck (FN) density <0.795 g/cm². A cohort of the enrolled women was, in fact, identified at the baseline as osteoporotic (n = 121) on the basis of their T-score and analyzed thereafter for the 24 months' treatment with either 1000 mg of calcium and 800 IU vitamin D3 (placebo; n = 59); or calcium, vitamin D3, and Genistein aglycone (54 mg/day; genistein; n = 62). According to the femoral neck T-scores, 31.3% of the genistein and 30.9% of the placebo recipients were osteoporotic at baseline. In the placebo and genistein groups, the 10-year hip fracture probability risk assessed by Fracture Risk Assessment tool (FRAX) was 4.1 ± 1.9 (SD) and 4.2 ± 2.1 (SD), respectively. Mean bone mineral density (BMD) at the femoral neck increased from 0.62 g/cm² at baseline to 0.68 g/cm² at 1 year and 0.70 g/cm² at 2 years in genistein recipients, and decreased from 0.61 g/cm² at baseline to 0.60 g/cm² at 1 year and 0.57 g/cm² at 2 years in placebo recipients. At the end of the study only 18 postmenopausal women had osteoporosis in the genistein group with a prevalence of 12%, whereas in the placebo group the number of postmenopausal women with osteoporosis was unchanged, after 24 months. This post-hoc analysis is a proof-of concept study suggesting that genistein may be useful not only in postmenopausal osteopenia but also in osteoporosis. However, this proof-of concept study needs to be confirmed by a large, well designed, and appropriately focused randomized clinical trial in a population at high risk of fractures.

Controversial issues in CKD clinical practice: position statement of the CKD-treatment working group of the Italian Society of Nephrology.

This position paper of the study group "Conservative treatment of Chronic Kidney Disease-CKD" of the Italian Society of Nephrology addresses major practical, unresolved, issues related to the conservative treatment of chronic renal disease. Specifically, controversial topics from everyday clinical nephrology practice which cannot find a clear, definitive answer in the current literature or in nephrology guidelines are discussed. The paper reports the point of view of the study group. Concise and practical advice is given on several common issues: renal biopsy in diabetes; dual blockade of the renin-angiotensin-aldosterone system (RAAS); management of iron deficiency; low protein diet; dietary salt intake; bicarbonate supplementation; treatment of obesity; the choice of conservative therapy vs. dialysis. For each topic synthetic statements, guideline-style, are reported.

A Delphi consensus panel on nutritional therapy in chronic kidney disease.

The conservative management of chronic kidney disease (CKD) includes nutritional therapy (NT) with the aim to reduce the intake of proteins, phosphorus, organic acids, sodium, and potassium, while ensuring adequate caloric intake. While there is evidence that NT may help to prevent and control metabolic alterations in CKD, the criteria for implementing a low-protein regimen in CKD are still debated. There is no final consensus on the composition of the diet, nor indications for specific patient settings or different stages of CKD. Also when and how to start dietary manipulation of different nutrients in CKD is not well defined. A group of Italian nephrologists participated, under the auspices of the Italian Society of Nephrology, in a Delphi exercise to explore the consensus on some open questions regarding the nutritional treatment in CKD in Italy, generating a consensus opinion for 23 statements on: (1) general principles of NT; (2) indications for and initiation of NT; (3) role of protein-free products; (4) NT safety; (5) integrated management of NT. This Delphi exercise shows that there is broad consensus regarding NT in CKD across a wide range of management areas. These clinician-led consensus statements provide a framework for appropriate guidance on NT in patients with CKD, and are intended as a guide in decision-making whenever possible.