Conceptual system for sustainable and next-generation wastewater resource recovery facilities.

Shifting the concept of municipal wastewater treatment to recover resources is one of the key factors contributing to a sustainable society. A novel concept based on research is proposed to recover four main bio-based products from municipal wastewater while reaching the necessary regulatory standards. The main resource recovery units of the proposed system include upflow anaerobic sludge blanket reactor for the recovery of biogas (as product 1) from mainstream municipal wastewater after primary sedimentation. Sewage sludge is co-fermented with external organic waste such as food waste for volatile fatty acids (VFAs) production as precursors for other bio-based production. A portion of the VFA mixture (product 2) is used as carbon sources in the denitrification step of the nitrification/denitrification process as an alternative for nitrogen removal. The other alternative for nitrogen removal is the partial nitrification/anammx process. The VFA mixture is separated with nanofiltration/reverse osmosis membrane technology into low-carbon VFAs and high-carbon VFAs. Polyhydroxyalkanoate (as product 3) is produced from the low-carbon VFAs. Using membrane contactor-based processes and ion-exchange techniques, high-carbon VFAs are recovered as one-type VFA (pure VFA) and in ester forms (product 4). The nutrient-rich fermented and dewatered biosolid is applied as a fertilizer. The proposed units are seen as individual resource recovery systems as well as a concept of an integrated system. A qualitative environmental assessment of the proposed resource recovery units confirms the positive environmental impacts of the proposed system.

Highly selective recovery of medium chain carboxylates from co-fermented organic wastes using anion exchange with carbon dioxide expanded methanol desorption.

The aim of this work was to recover a mixture of carboxylates ranging from 2 to 7 carbon atoms using a strong anion exchange resin, followed by desorption with CO2-expanded methanol. Medium chain carboxylates hexanoate and heptanoate adsorbed better than acetate, and the corresponding medium chain carboxylic acids desorbed easier than acetic acid. Consequently, hexanoate and heptanoate were concentrated up to 14.6 and 20.7 times, respectively. These findings will enable effective separation and purification of the produced carboxylic acids. Notably, the presence of inorganic ions in the sample, such as chloride, decreased the adsorption affinity compared to a synthetic mixture only of carboxylates.

Cáncer de mama en mujeres pinareñas menores de 45 años, serie cronológica de 23 años / Breast cancer in Pinar del Río on women under 45 years old: chronological series of 23 years

RESUMEN Introducción: el cáncer de mama es un problema de salud mundial, constituye la primera causa de muerte por tumor maligno en féminas. En los últimos años se ha apreciado un descenso en la edad de presentación de la enfermedad, y la necesidad de disponer de una investigación que la reporte en la provincia. Objetivo: caracterizar el cáncer de mama en mujeres menores de 45 años atendidas en el Hospital General Docente "Abel Santamaría Cuadrado" de Pinar del Río en el período 1995-2018. Métodos: se realizó un estudio, observacional, descriptivo, longitudinal y retrospectivo en mujeres menores de 45 años operadas por cáncer de mama. Universo 1 223 mujeres, el muestreo fue intencional (n=256). Se aplicaron métodos de estadística descriptiva, los datos fueron obtenidos de la base de datos de la consulta central de mama del hospital. Resultados: el 21,48 % tenían antecedente familiar de cáncer, la mama derecha fue la más afecta (57,42 %), el estadio clínico más frecuente fue IIA, (31,25 %), la técnica quirúrgica frecuente fue la cirugía conservadora (69,14 %), el carcinoma ductal con sus diferentes variables fue el tipo histológico predominante (56,64 %). Conclusiones: el cáncer de mama es un problema de salud pública, cada año aparece en pacientes más jóvenes y con antecedentes familiares de cáncer, el diagnostico se realiza precoz en la mayoría de los casos y las técnicas quirúrgicas conservadoras fueron las empleadas.

ABSTRACT Introduction: breast cancer is a worldwide health problem; it is the leading cause of death from malignant tumor in female gender. In recent years there has been a decrease in the age of onset of this disease, and it is a need for the province to carry out research works regarding this entity. Objective: to characterize breast cancer in women under the age of 45 treated at Abel Santamaría Cuadrado General Teaching Hospital in Pinar del Río during in the period 1995 - 2018. Methods: an observational, descriptive, longitudinal and retrospective study was conducted including women less than 45 years old operated on breast cancer. The target group comprised 1223 women, the sampling was intentional (n=256). Methods of descriptive statistics were applied; data were obtained from the central database of the clinic of breast cancer. Results: 21,48 % had a family history of cancer, the right breast was the most affected (57,42 %), the most frequent clinical stage was IIA (31,25 %), conservative surgery was the most frequent surgical technique applied (69,14 %); duct carcinoma with its different variables was the predominant histological type (56,64 %). Conclusions: breast cancer is a public health problem, each year it emerges in younger patients with a family history of cancer, diagnosis is early made in most cases and conservative surgical procedures were the ones applied.

Ventajas en técnica Nyhus versus Lichtenstein para el tratamiento quirúrgico de la hernia inguinal bilateral / Advantages of Nyhus versus Lichtenstein technique for surgical treatment of bilateral inguinal hernia

RESUMEN Introducción: la técnica de Lichtenstein y Nyhus representan hernioplastias seguras; Nyhus es un proceder que aún no se reporta como elección para la hernia inguinal bilateral. Objetivo: describir las ventajas de la técnica Nyhus en comparación con la técnica de Lichtenstein en el tratamiento de elección en pacientes afectos de hernia inguinal bilateral. Métodos: se realizó un estudio observacional, analítico, y transversal, de casos control, en el Hospital General Docente "Abel Santamaría Cuadrado" Pinar del Río, Cuba, 2014-2017. La muestra quedó constituida por 62 casos, en dos grupos de 31; Grupo A: operados por técnica de Nyhus. Grupo B: operados en dos tiempos por técnica de Lichtenstein. Se aplicaron herramientas de estadística descriptiva e inferencial. Resultados: en el grupo A, la media del tiempo quirúrgico fue 42 minutos, el grupo B resultó por encima de los 60, el estadígrafo Chi-Cuadrado mostró la no homogeneidad entre las frecuencias, al ser una estadística significativa con un valor de p=0,00020. El tiempo de hospitalización en A promedió 26 horas, el grupo B predominó más de 48 horas, el estadígrafo Chi-Cuadrado mostró la no homogeneidad entre las frecuencias al ser la diferencia con un valor de p=0,00000059, una estadística significativa. La razón de complicaciones del grupo A y B fue de 1,57. En los pacientes del grupo A no se presentaron recurrencia ni inguinodinias, en los del grupo B se precisaron tres inguinodinias. Conclusiones: la técnica Nyhus es de elección preferente para el tratamiento quirúrgico de la hernia inguinal bilateral.

ABSTRACT Introduction: Lichtenstein's and Nyhus techniques represent safe hernioplasties; Nyhus is a procedure not yet reported as the choice for bilateral inguinal hernia. Objective: to describe the advantages of Lichtenstein technique comparing Nyhus technique for the management of inguinal hernia as the treatment of choice in patients suffering from bilateral inguinal hernia. Methods: an observational, analytical, and cross-sectional study of control cases was conducted at Abel Santamaría Cuadrado General Teaching Hospital during 2014-2017 in Pinar del Río, Cuba. The sample consisted of 62 cases, in two groups that included 31 patients; Group A: operated by Nyhus technique. Group B: operated in two stages by Lichtenstein technique. Descriptive and inferential statistical tools were applied. Results: in group A, the standard surgical time was 42 minutes, group B was over 60, the chi-square statistician showed the non-homogeneity between the frequencies being statistically significant the difference when observing the value of p=0,00020. The hospitalization time in A averaged 26 hours, in group B predominated more than 48 hours, the statistician chi-square showed the non-homogeneity between the frequencies being statistically significant the difference when observing the value of p=0.00000059. The ratio of complications of group A and B was 1.57. Patients belonging to Group A had no recurrence or inguinodynia symptoms, patients from Group B presented 3 inguinodynia episodes. Conclusions: Nyhus technique is the preferred choice for surgical treatment of bilateral inguinal hernia.

Esters production via carboxylates from anaerobic paper mill wastewater treatment.

This paper describes a new option for integrated recovery and esterification of carboxylates produced by anaerobic digestion at a pH above the pKa. The carboxylates (acetate, propionate, butyrate, valerate and lactate) are recovered using a strong anion exchange resin in the bicarbonate form, and the resin is regenerated using a CO2-expanded alcohol technique, which allows for low chemicals consumption and direct esterification. Paper mill wastewater was used to study the effect of pH and the presence of other inorganic anions and cations on the adsorption and desorption with CO2-expanded methanol. Calcium, which is present in paper mill wastewater, can cause precipitation problems, especially at high pH. Esters yields ranged from 1.08±0.04mol methyl acetate/mol of acetatein to 0.57±0.02mol methyl valerate/mol of valeratein.

Tumor phyllodes de la mama / Phyllodes Breast Tumor

El tumor phyllodes de la mama, es una neoplasia poco frecuente, de origen fibroepitelial con potencial agresivo, que representa el 0,3% al 1,0% de todos los tumores de mama. Objetivo: caracterizar clínica y patológicamente los tumores phyllodes diagnosticados. Método: se realizó un estudio retrospectivo, descriptivode las pacientes portadoras de tumor phyllodes de la mama, atendidas en el servicio de cirugía general del Hospital General Docente «Abel Santamaría Cuadrado¼ de Pinar del Río, durante el periodo comprendido entre los años 1991 y 2009. Resultados: fueron operadas 2000 pacientes con tumores en las mamas durante este periodo, en 82 mujeres (4,1%), el diagnostico histopatológico fue de tumor phyllodes, de estas, 6 de forma bilateral, 48 (58,53%), presentaron afectación de la mama derecha, 70 fueron benignos (85,36%), 5 malignos (6,09%), y 7 borderline (8,53%). El 91,46% de las pacientes tenían una edad menor o igual a 50 años. El tamaño tumoral fue variable, sin embargo, de los 5 casos informados como malignos, 3 presentaron diámetros mayores de10 cm. De las 5 pacientes con tumores malignos, 4 (80%), fueron tratadas con mastectomías simples y 1 (20%) con cirugía conservadora. Una paciente presentó metástasis a la cadera, a los 5 años y en las demás la evolución fue satisfactoria. Conclusión: el tumor phyllodes es una entidad poco frecuente, que afecta principalmente a mujeres menores de 50 años, el tratamiento de elección es quirúrgico.

Phyllodes Breast Tumor, is a very rare type of neoplasm having a fibroepithelial origin with aggressive potential, which represents from 0,3% to 1,0% of all breast cancers. Objective: clinical and epidemiological characterization of the diagnosed Phyllodes Breast Tumors. Method: a retrospective, descriptive study of patients suffering from phyllodes breast tumor who attended to "Abel Santamaria Cuadrado" General University Hospital, Pinar del Rio from 1991 to 2009. Results: 2000 patients who suffered from breast tumors in the period of the study, in 82 women (4,1%) which histopathological diagnosis was phyllodes breast tumor, out of them, 6 presented bilateral form, 48 (58,53%), presented the tumor in the right breast, 70 were benign (85,36%), 5 malignant, and 7 in the borderline (8,53%). The 91,46% of patients were younger than 50 years old or in the 50s. The size of tumor was inconsistent, though, from the 5 malignant cases, 3 presented more than 10cm greater. Out of the 5 patients suffering from malignant tumors 4 (80%) underwent simple mastectomy and 1 (20%) by conservative surgery. One patient presented metastasis in the hip, at five years and in the other check-ups the evolution was satisfactory. Conclusion: phyllodes breast tumor is a very rare entity which affects 50 years old women or under this age, surgery is the elective treatment.

Tumor filoide de la mama / Phyllodes Breast Tumor

El tumor filoide de la mama, es una neoplasia poco frecuente, de origen fibroepitelial con potencial agresivo, que representa el 0,3 por ciento al 1,0 por ciento de todos los tumores de mama. El objetivo fue caracterizar clínica y patológicamente los tumores filoides diagnosticados. Se realizó un estudio retrospectivo, descriptivo de las pacientes portadoras de tumor filoide de la mama, atendidas en el servicio de cirugía general del Hospital General Docente Abel Santamaría Cuadrado de Pinar del Río, durante el periodo comprendido entre los años 1991 y 2009. Fueron operadas 2000 pacientes con tumores en las mamas durante este periodo, en 82 mujeres (4,1 por ciento), el diagnostico histopatológico fue de tumor filoide, de estas, 6 de forma bilateral, 48 (58,53 por ciento), presentaron afectación de la mama derecha, 70 fueron benignos (85,36 por ciento), 5 malignos (6,09 por ciento), y 7 borderline (8,53 por ciento). El 91,46 por ciento de las pacientes tenían una edad menor o igual a 50 años. El tamaño tumoral fue variable, sin embargo, de los 5 casos informados como malignos, 3 presentaron diámetros mayores de10 cm. De las 5 pacientes con tumores malignos, 4 (80 por ciento), fueron tratadas con mastectomías simples y 1 (20 por ciento) con cirugía conservadora. Una paciente presentó metástasis a la cadera, a los 5 años y en las demás la evolución fue satisfactoria. El tumor filoide es una entidad poco frecuente, que afecta principalmente a mujeres menores de 50 años, el tratamiento de elección es quirúrgico(AU)

Phyllodes Breast Tumor, is a very rare type of neoplasm having a fibroepithelial origin with aggressive potential, which represents from 0,3 percent to 1,0 per cent of all breast cancers. The objective was a clinical and epidemiological characterization of the diagnosed Phyllodes Breast Tumors. A retrospective, descriptive study of patients suffering from phyllodes breast tumor who attended to Abel Santamaria Cuadrado General University Hospital, Pinar del Rio from 1991 to 2009. 2000 patients who suffered from breast tumors in the period of the study, in 82 women (4,1 per cent) which histopathological diagnosis was phyllodes breast tumor, out of them, 6 presented bilateral form, 48 (58,53 per cent), presented the tumor in the right breast, 70 were benign (85,36 percent), 5 malignant, and 7 in the borderline (8,53 percent). The 91,46 percent of patients were younger than 50 years old or in the 50s. The size of tumor was inconsistent, though, from the 5 malignant cases, 3 presented more than 10cm greater. Out of the 5 patients suffering from malignant tumors 4 (80 per cent) underwent simple mastectomy and 1 (20 per cent) by conservative surgery. One patient presented metastasis in the hip, at five years and in the other check-ups the evolution was satisfactory. Phyllodes breast tumor is a very rare entity which affects 50 years old women or under this age, surgery is the elective treatment(AU)