Critical review of technologies for the on-site treatment of hospital wastewater: From conventional to combined advanced processes.

This review aims to assess different technologies for the on-site treatment of hospital wastewater (HWW) to remove pharmaceutical compounds (PhCs) as sustances of emerging concern at a bench, pilot, and full scales from 2014 to 2020. Moreover, a rough characterisation of hospital effluents is presented. The main detected PhCs are antibiotics and psychiatric drugs, with concentrations up to 1.1 mg/L. On the one hand, regarding the presented technologies, membrane bioreactors (MBRs) are a good alternative for treating HWW with PhCs removal values higher than 80% in removing analgesics, anti-inflammatories, cardiovascular drugs, and some antibiotics. Moreover, this system has been scaled up to the pilot plant scale. However, some target compounds are still present in the treated effluent, such as psychiatric and contrast media drugs and recalcitrant antibiotics (erythromycin and sulfamethoxazole). On the other hand, ozonation effectively removes antibiotics found in the HWW (>93%), and some studies are carried out at the pilot plant scale. Even though, some families, such as the X-ray contrast media, are recalcitrant to ozone. Other advanced oxidation processes (AOPs), such as Fenton-like or UV treatments, seem very effective for removing pharmaceuticals, Antibiotic Resistance Bacteria (ARBs) and Antibiotic Resistance Genes (ARGs). However, they are not implanted at pilot plant or full scale as they usually consider extra reactants such as ozone, iron, or UV-light, making the scale-up of the processes a challenging task to treat high-loading wastewater. Thus, several examples of biological wastewater treatment methods combined with AOPs have been proposed as the better strategy to treat HWW with high removal of PhCs (generally over 98%) and ARGs/ARBs (below the detection limit) and lower spending on reactants. However, it still requires further development and optimisation of the integrated processes.

Impact of hospital pharmacist interventions on the combination of citalopram or escitalopram with other QT-prolonging drugs.

Background Citalopram and escitalopram can both induce dose-dependent QT prolongation. The risk of arrhythmia may be increased with concomitant use of other drugs that induce QT prolongation. Objective To evaluate the prevalence and impact of pharmacist interventions on the combination of citalopram or escitalopram with other drugs that induce QT prolongation. Setting A French hospital with 517 computerized beds. Method All cardiac adverse drug reactions (ADRs) related to citalopram or escitalopram reported to the French pharmacovigilance database (FPDB) were analyzed. Then, over a 6-month period, all computerized prescriptions including citalopram or escitalopram and drug-drug interactions (DDI) were analyzed by pharmacists using a computerized provider order entry system (DXCare®, Medasys). Results Only 27 cardiac ADRs related to citalopram or escitalopram were reported in the database. Among the 57,857 prescriptions and 2116 contraindicated DDIs (3.7 %) that were analyzed. 444 DDIs (0.8 %) were considered to be clinically relevant by pharmacists and physicians and 168 (i.e., approximately 30 %) were related to a combination including citalopram or escitalopram. Most of the prescriptions related to DDIs including citalopram or escitalopram were discontinued in response to a pharmacist intervention when initiated during the hospital stay. Conclusion A high number of hospital prescriptions including citalopram or escitalopram with another QT-prolonging drug occurred, highlighting the importance of involvement of clinical pharmacists in prevention of potential ADRs related to such contraindications.

Survival Rates and Complications for Zirconia-Based Fixed Dental Prostheses in a Period up to 10 Years: A Systematic Review.

AIMS: The purpose of this study was to methodically review the literature concerning the success and survival rates of zirconia fixed dental prostheses (FDPs). METHODS: A systematic search was conducted of MEDLINE, Elsevier and the Cochrane Library to identify relevant articles about zirconia FDPs. In order to obtain suitable articles, rigorous criteria were applied. The minimum follow-up period was five years. RESULTS: From a total of 986 articles identified in the first electronic search, only 10 matched the inclusion criteria. A total of 368 patients with 430 zirconia FDPs were included in this systematic review. The survival rate was 89.43% ± 10.01% and chipping of the veneering ceramic occurred in 16.97% of the cases. CONCLUSION: Zirconia-based fixed dental prostheses perform reasonably well and can serve as an alternative to metal-ceramic fixed dental prostheses.

Space charge distributions in insulating polymers: A new non-contacting way of measurement.

A new technique for the determination of space charge profiles in insulating polymers is proposed. Based on the evolution of an existing thermal wave technique called Focused Laser Intensity Modulation Method ((F)LIMM), it allows non-contact measurements on thin films exhibiting an internal charge to be studied. An electrostatic model taking into account the new sample-cell geometry proposed was first developed. It has been shown, in particular, that it was theoretically possible to calculate the internal charge from experimental measurements while allowing an evaluation of the air layer appearing between the sample and the electrode when non-contact measurements are performed. These predictions were confirmed by an experimental implementation for two thin polymer samples (25 µm-polyvinylidenefluoride and 50 µm-polytetrafluoroethylene (PTFE)) used as tests. In these cases, minimum air-layer thickness was determined with an accuracy of 3% and 20%, respectively, depending on the signal-to-noise ratio during the experimental procedure. In order to illustrate the reachable possibilities of this technique, 2D and 3D cartographies of a negative space charge implanted by electron beam within the PTFE test sample were depicted: like in conventional (F)LIMM, a multidimensional representation of a selectively implanted charge remains possible at a few microns depth, but using a non-contacting way of measurement.

AMS analyses of I-129 from the Fukushima Daiichi nuclear accident in the Pacific Ocean waters of the Coast La Jolla--San Diego, USA.

This paper presents the results of an experimental study we performed by using the Accelerator Mass Spectrometry (AMS) method with iodine 129 (T1/2 = 15.7 My), to determine the increase of the radionuclide content in the USA West Pacific Coast waters, two years after the March 2011 Fukushima Daiichi nuclear power plant accident. The collection of the water samples took place between April and July 2013 at regular intervals of time, from the Pacific Ocean, at the cove of La Jolla, San Diego, USA. The results of the experiments showed a significant increase of the radionuclide concentration during the late spring of 2013. Compared to the isotopic ratio (129)I/(127)I, measured at a 40 km distance, offshore of Fukushima and immediately after the accident, our results show an increase on the USA West Coast that was more than a 2.5 factor higher. Also, compared with the pre-Fukushima background values, our results show an isotopic ratio of about two orders of magnitude higher. A distinct feature of the reconstructed radioactive plume was that it traveled with a speed of 12 cm s(-1), which we estimated and is consistent with the zonal speed in the Pacific. We coupled our (129)I results with the measurements from the June 2011 KOK cruise and we derived the levels of activity for (3)H and (137)Cs. On the USA West Coast, they did not exceed the international regulatory limits.

Autoconcepto físico de escolares chilenos: diferencias en función del género y del estatus socioeconómico y su relación con la intensidad percibida en la clase de educación física / Physical self-awareness of chileans students: differences in function of gender and socioeconomic status and its relationship with physical education's class perceived intensity

El objetivo del presente trabajo fue comparar el Autoconcepto Físico de escolares chilenos en función del género y el nivel socioeconómico. La muestra estuvo compuesta por escolares de quinto curso de la región metropolitana. La escala de percepción del esfuerzo de Borg fue administrada durante 3 semanas en cada clase de EF, finalmente la escala del Autoconcepto Físico fue rellanada al final del proceso. La correlación de Spearman se utilizó para establecer relaciones entre la intensidad de la clase de EF y el Autoconcepto Físico. El estudio de las diferencias en función del género y del nivel socioeconómico se analizó con la U de MannWhitney. Se encontraron diferencias significativas en el Autoconcepto Físico en función del nivel socioeconómico, pero no en función del género. Los resultados sugieren un cambio en la metodología de enseñanza del profesorado de Educación Física.

The aim of the study was to analyze differences between Physical Self Awareness in Chilean primary students according to gender and socioeconomic status. The sample was composed by fifth graders of the metropolitan region. The rate of perceived exertion was filled after P.E. classes during a period of three weeks. The Physical Self-Awareness questionnaire was filled at the end of the process. The Spearman correlation was used to analyze the relations between P.E. class intensity and Physical self-awareness. The Mann–Whitney U test was used to analyze differences between gender and socioeconomic status. Differences were found between according socioeconomic status but not between genders. The results suggest changes in P.E. the teachers´ methodology.

Treatment of a wastewater from a pesticide manufacture by combined coagulation and Fenton oxidation.

The treatment of a non-biodegradable agrochemical wastewater has been studied by coupling of preliminary coagulation-flocculation step and further Fenton oxidation. High percentages of chemical oxygen demand (COD) removal (up to 58 %) were achieved in a first step using polyferric chloride as coagulant. This reduced significantly the amount of H2O2 required in the further Fenton oxidation. Using the stoichiometric amount relative to COD around 80 % of the remaining organic load was mineralized. The combined treatment allowed achieving the regional discharge limits of ecotoxicity at a cost substantially lower than the solution used so far where these wastewaters are managed as hazardous wastes.

Novel method for proliferation of oral keratinocyte stem cells.

BACKGROUND AND OBJECTIVE: Stem cell-based tissue engineering offers clear advantages over conventional normal cell approaches. Owing to their specific characteristics, oral keratinocyte stem cells represent an attractive solution for therapeutic applications. However, when cultured in vitro, these cells lose their unique properties, acquiring a limited capacity for self-renewal, and differentiate rapidly into normal functional keratinocytes. The main aim of the present study was to develop an in-vitro method for the expansion of oral keratinocyte stem cells using a biomaterial approach. MATERIAL AND METHODS: Oral keratinocyte stem cells were isolated based on the identification of two surface markers - integrin α6ß4 and CD71 - using a magnetic method. The cells were cultured on specific substrates formed from blends of polymers: poly(lactide-co-glycolide) (PLGA); poly(lactide-co-glycolide) + polyurethane (PLGA + PU); and poly(lactide-co-glycolide) + extracellular matrix (PLGA + ECM). The polymers were deposited using a laser-based technique - matrix-assisted pulsed laser evaporation. The cells were analyzed for cell size, cell proliferation, colony-forming efficiency, cell adhesion markers (such as E-cadherin and beta 1 integrin), keratinocyte stem cells and differentiation markers. The methods included ELISAs, immunofluorescence and atomic force microscopy imaging. RESULTS: After 14 d in culture, cells seeded on PLGA + PU stained positive for p63, cd44H, cytokeratin 19 and integrin α6ß4 and negative for involucrin, cytokeratin 14 and cytokeratin 10. The levels of adhesion molecules were significantly increased in cells grown on PLGA + PU: at 14 d the E-cadherin levels were 5.4 ± 0.2 ng/mL (for cells grown on PLGA + PU) vs. 4.1 ± 0.4 ng/mL (for cells grown on control medium) (n = 5, p < 0.05 Bonferroni). Oral keratinocyte stem cells grown on PLGA + PU had the highest colony-forming efficiency and proliferation rate, together with the smallest cell size, compared with cells grown on control medium or other polymeric substrates. CONCLUSION: The present study demonstrates that by culturing oral keratinocyte stem cells on PLGA blended with PU it is possible to preserve their phenotype in vitro and to guide their short-term expansion and proliferation. Certain stem-cell characteristics are preserved and their short-term expansion may be enhanced.

Coagulation-Fenton coupled treatment for ecotoxicity reduction in highly polluted industrial wastewater.

A coupled coagulation-Fenton process was applied for the treatment of cosmetic industry effluents. In a first step, FeSO(4) was used as coagulant and the non-precipitated Fe(2+) remaining in dissolution was used as catalyst in the further Fenton process. In the coagulation process a huge decrease in total organic carbon (TOC) was achieved, but the high concentration of phenol derivatives was not diminished. The decrease in TOC in the coagulation step significantly reduces the amount of H(2)O(2) required in the Fenton process for phenol depletion. The coupled process, using a H(2)O(2) dose of only 2 g l(-1), reduced TOC and total phenol to values lower than 40 and 0.10 mg l(-1), respectively. The short reaction period (less than 15 min) in TOC and phenol degradation bodes well for improving treatment in a continuous regime. The combination of both processes significantly reduced the ecotoxicity of raw effluent and markedly increased its biodegradability, thus allowing easier treatment by the conventional biological units in conventional sewage treatment plants (STPs).

Elaboration of the preliminary Rheumatoid Arthritis Impact of Disease (RAID) score: a EULAR initiative.

BACKGROUND: Current response criteria in rheumatoid arthritis (RA) usually assess only three patient-reported outcomes (PROs): pain, functional disability and patient global assessment. Other important PROs such as fatigue are not included. OBJECTIVE: To elaborate a patient-derived composite response index for use in clinical trials in RA, the RA Impact of Disease (RAID) score. METHODS: Ten patients identified 17 domains or areas of health relevant for inclusion in the score, then 96 patients (10 per country in 10 European countries) ranked these domains in order of decreasing importance. The seven most important domains were selected. Instruments were chosen for each domain after extensive literature research of psychometric properties and expert opinion. The relative weight of each of the domains was obtained from 505 patients who were asked to "distribute 100 points" among the seven domains. The average ranks of importance of these domains were then computed. RESULTS: The RAID score includes seven domains with the following relative weights: pain (21%), functional disability (16%), fatigue (15%), emotional well-being (12%), sleep (12%), coping (12%) and physical well-being (12%). Weights were similar across countries and across patient and disease characteristics. Proposed instruments include the Health Assessment Questionnaire and numerical ratings scales. CONCLUSION: The preliminary RAID score is a patient-derived weighted score to assess the impact of RA. An ongoing study will allow the final choice of questionnaires and assessment of validity. This score can be used in clinical trials as a new composite index that captures information relevant to patients.

Recent advances in p53 research: an interdisciplinary perspective.

The TP53 gene is one of the most studied genes in human cancer. In recent years, considerable interest was focused on mutant p53, the abnormal protein product of TP53 somatic or germline alleles with missense mutations that often accumulate in cancer cells. There is now compelling experimental evidence that many mutations can exert mutant-specific, gain-of-function effects by perturbing the regulation of expression of multiple genes. This notion is supported by the observation that targeted mutant p53 expression enhances the formation of specific cancers in the mouse even in the absence of wild-type p53 expression. In addition, clinical studies are producing a wealth of functional pathway data demonstrating correlations between specific TP53 mutations and gene expression patterns identified by transcriptome studies. These correlations imply that alteration of p53 function is critical in shaping gene expression patterns in cancer. Finally, progress is being made in the development of new therapeutic approaches targeting p53 alterations. Key advances regarding the structural, biochemical and functional properties of normal and mutant p53 proteins, their abnormal regulation and distribution in human cancers, and their associations with clinical and pathological cancer characteristics are reviewed. New opportunities for translational research for improving cancer detection, prognosis, prevention and therapy based upon the integration of this knowledge are described.

[The possibilities for improving the serological diagnosis of active tuberculosis by using new mycobacterial antigens and immunoblot and ELISA technics]. / Studiu asupra posibilitatilor de perfectionare a diagnosticului serologic al tuberculozei active prin utilizarea unor noi antigene micobacteriene si a tehnicilor imunoblot si ELISA.

The study concerns 264 cases among which: 119 active lung tb. eliminating and 11 cases not-eliminating M. Tuberculosis; 17 cases of extrarespiratory tb. confirmed by bacteriology and/or by anatomopathology; 18 cases of bone-joint non-tb disease; 38 cases of chronic lung disease other than tb; 61 healthy persons (controls). Sera from these cases were collected before treatment and submitted concomitantly to two different methods: (1) Mycodot test (immunoblot) with lipoarabinomannan (LAM) as antigen, on nitrocellulose discs (Dynagen, Cambridge, MA, USA); (2) ELISA test with antigen 60 (A60) (ANDA-Biologicals, Strasbourg, France) and with antigen I.C. (Cantacuzino Institute, Bucharest). The results were estimated on terms of sensitivity and specificity. As for sensitivity the results show 74-90%. the highest values were reached in ELISA with A60 IgA. The specificity of the Mycodot test was highest: 90-100% in the two successive experiments. The active tb diagnosis discrimination capacity of the studied methods allows the following classification: 1. Mycodot test with LAM antigen 2. ELISA with A60-Ig G complex 3. ELISA with I.C. antigen The Mycodot test is more advantageous being more rapid and more simple to perform.

Use of routine laboring epidurals at Naval hospitals: a physician survey.

Physicians and patients have complained about a lack of laboring epidurals at Naval hospitals. In order to assess this situation, a survey was mailed to all physicians specializing in obstetrics and gynecology (OB) and family practice who were stationed at Naval hospitals in the United States and abroad. Respondents were queried regarding the availability of routine laboring epidurals (RLEs) at their hospitals, as well as their attitudes toward the use of RLEs. RLEs were reported to be available for most patients who might benefit at OB teaching hospitals but not at other Naval hospitals. Most physicians stated that patients complained about a lack of RLEs and that the patient could obtain one at a civilian hospital in the area. Most physicians, especially OBs, had favorable attitudes regarding the use of RLEs and would employ them if available. The discussion includes how the Department of Defense has taken steps toward making epidurals available to all military women and dependents.

Advantages of treatment with Reprimun in sarcoidosis.

Favourable results were obtained by treatment with Reprimun alone or in association with low doses of Prednisone in 112 patients with sarcoidosis (59% with active sarcoidosis and 33% failures of a previous corticotherapy). Treatments were applied during 3-6 series each one of 6 weeks at intervals of 2 weeks between series. In comparison with the classical corticotherapy, treatment with Reprimun has better results, namely: absence of any major adverse reactions; reduction of the treatment period to 6-12 months (3-6 series); 95% lasting remissions in the sarcoidoses with initial treatment and 78% remissions in the case of failures of a previous corticotherapy.

[Preliminary results of the use of a new derivative of rifamycin SV in the treatment of sarcoidosis]. / Rezultate preliminare privind utilizarea unui nou derivat de rifamicina SV in tratamentul sarcoidozei.

Seven patients with advanced forms of mediastino-pulmonary sarcoidosis (involvement of the pulmonary parenchyma, and restrictive respiratory syndrome), confirmed by histopathologic investigation, have been treated with a new SV-rifamycin derivative, 1246-EH, or "Reprimum" without any other association. Reprimun was given in daily doses of 10 mg/kg of body weight for a period of two weeks, then, for another 4-5 weeks, the drugs was given intermittently in doses of 15 mg/kg of body weight twice weekly. Between two cycles of therapy a period of 14 days was free of drug administration. In all patients the treatment with the new derivative was well tolerated. The treatment was not followed by adrenal deficiencies, neither was noted obesity, bone decalcification, gastric ulcers, etc., which are commonly associated with prolonged corticoid therapy. The treatment with "Reprimun" efficient for all patients. A clear clinical and X-ray improvement was noted after the first three months of treatment with the new drug. Respiratory function, as well as clinical and radiological signs improved, the serum immunologic parameters, and the biochemical ones were also significantly improved (Ig, C3 total serum proteins and gammaglobulins). All parameters which were tested were finally improved and became normal. In only two of the seven patients the radiological aspects of the lung suggested the presence of sequellae at the end of the treatment. In these two patients there was a persistant reduction in the respiratory volume, as well as a discret hypoxemia. However, both these patients had a more advanced form of the disease, with extensive pulmonary fibrosis, and in these cases prolonged corticoid therapy which had previously been applied had failed. Reprimun had an immunological-modulatory effect in all patients, resulting in normal levels of IgG, IgA, and C3 in the first three months of therapy. There was a direct correlation between the normalization of immunological indicators and the good evolution of the diseases, a fact which suggests once again the existence of some immune mechanisms involved in the maintenance of sarcoidosis.