Plastic waste gasification using oxygen-enriched air and steam: Experimental and model results from a large pilot-scale reactor.

Advanced thermochemical technologies for plastic waste valorization represent an interesting alternative to waste-to-energy options. They are particularly appealing for waste-to-hydrogen and waste-to-chemicals applications, with autothermal steam-oxygen gasification in fluidized bed reactors showing the greatest market potential. The study describes a series of experimental tests carried out on a large pilot-scale fluidized bed gasifier, using steam and O2-enriched air, with increasing fractions of oxygen. Different values of the main operating parameters are varied: equivalence ratio (0.22-0.25), steam-to-carbon ratio (0.7-1.13), and steam-to-oxygen ratio (up to 3.2). The fuel consists of real mixed plastic waste coming from separate collection of municipal solid wastes. The data obtained are used to investigate in depth the role of the main operating parameters and to improve and validate a recently developed one-dimensional kinetic model for waste gasification. The validation shows a good agreement between experimental data and model results, suggesting the reliability of the model to predict the reactor behavior under conditions of pure steam-oxygen gasification, relevant to many industrial applications. It has been found that the equivalence ratio is the parameter that most affects the syngas composition. At a constant equivalent ratio, the molar fraction of oxygen in the enriched air shows a limited influence on syngas composition while the steam is crucial in controlling the temperature along the reactor. Provided that the steam-to-carbon molar ratio is larger than 1.5, steam affects mainly the reactor temperature rather than the syngas composition, qualifying the steam-to-oxygen molar ratio as an instrumental parameter for smooth plant operation.

Waste-derived catalysts for tar cracking in hot syngas cleaning.

Catalytic tar cracking is a promising technique for hot syngas cleaning unit in gasification plants because it can preserve tars chemical energy, so increasing the syngas heating value. The cost associated with catalyst preparation is a key issue, together with its deactivation induced by coke deposition. Iron is a cheap and frequently used catalyst, which can also be found in some industrial wastes. The study aims to assess the catalytic efficiency for tar cracking of two waste-derived materials (red mud and sewage sludge) having high content of iron. The catalysts were supported on spheres of γ-Al2O3, and their efficiency was compared to that of a pure iron catalyst. The role of support was investigated by testing pure red mud, with and without the support. A series of long-term tests using naphthalene as tar model compound were carried out under different values of process temperatures (750 °C-800 °C) and steam concentrations (0 %-7.5 %). The waste derived catalysts showed lower hydrogen yields compared to pure iron catalyst, due to their lower content of iron. On the other hand, the conversion efficiencies of all the tested catalysts resulted rather similar, since the Alkali and Alkaline-Earth Metallic species present on the surface of waste-derived catalyst help in preventing coke deposition. The iron oxidation state appears to play an important role, with reduced iron more active than its oxidised form in the tar cracking reactions. This indicates the importance of tuning steam concentration to keep constant the reduced state of iron while limiting coke deposition.

NAIF: A novel artificial intelligence-based tool for accurate diagnosis of stage F3/F4 liver fibrosis in the general adult population, validated with three external datasets.

OBJECTIVE: The purpose of this study was to determine the effectiveness of a new AI-based tool called NAIF (NAFLD-AI-Fibrosis) in identifying individuals from the general population with advanced liver fibrosis (stage F3/F4). We compared NAIF's performance to two existing risk score calculators, aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 (Fib4). METHODS: To set up the algorithm for diagnosing severe liver fibrosis (defined as Fibroscan® values E ≥ 9.7 KPa), we used 19 blood biochemistry parameters and two demographic parameters in a group of 5,962 individuals from the NHANES population (2017-2020 pre-pandemic, public database). We then assessed the algorithm's performance by comparing its accuracy, precision, sensitivity, specificity, and F1 score values to those of APRI and Fib4 scoring systems. RESULTS: In a kept-out sub dataset of the NHANES population, NAIF achieved a predictive precision of 72 %, a sensitivity of 61 %, and a specificity of 77 % in correctly identifying adults (aged 18-79 years) with severe liver fibrosis. Additionally, NAIF performed well when tested with two external datasets of Italian patients with a Fibroscan® score E ≥ 9.7 kPa, and with an external dataset of patients with diagnosis of severe liver fibrosis through biopsy. CONCLUSIONS: The results of our study suggest that NAIF, using routinely available parameters, outperforms in sensitivity existing scoring methods (Fib4 and APRI) in diagnosing severe liver fibrosis, even when tested with external validation datasets. NAIF uses routinely available parameters, making it a promising tool for identifying individuals with advanced liver fibrosis from the general population. Word count abstract: 236.

An LCA answer to the mixed plastics waste dilemma: Energy recovery or chemical recycling?

The study focuses on mixed plastics waste (MPW), whose complex and unpredictable composition (due to high polymer heterogeneity, additives, and contaminants) makes its valorisation a true technical, environmental, economic, and regulatory challenge. Chemical recycling by means of advanced thermochemical treatments (ATT) could be a successful strategy, able to support the transition from a carbon intensive to a carbon negative sector, and alternative to the current treatments of energy recovery or mechanical downcycling. Some of these ATTs provide an efficient recovery of valuable resources, such as fuels and chemicals, but their role is mainly limited by time necessary to complete the process optimization and implement the required infrastructures. A reliable identification of the best alternatives is thus crucial. A specific LCA approach quantifies the environmental performances of a selected set of ATT technologies for resource recovery from MPW. It includes plastics-to-energy, by combustion or gasification; plastics-to-methane and plastics-to-hydrogen, by gasification; and plastics-to-oil, by thermal pyrolysis. The results highlight the crucial role of carbon capture and storage (CCS) units, which partially reduces that of the specific thermochemical treatment. The best performances, particularly for Climate Change category, are those of the MPW-to-hydrogen by gasification, followed by those of MPW-to-energy by combustion or gasification, all equipped with CCS. The sensitivity analysis considers the evolution of the European energy mix, characterised by a larger utilisation of renewable energy sources, and highlights the corresponding increased sustainability of chemical recycling by ATTs. This suggests that the MPW dilemma should be definitively solved in a close future.

Transjugular intrahepatic Porto-systemic shunt positively influences the composition and metabolic functions of the gut microbiota in cirrhotic patients.

BACKGROUND & AIMS: Cirrhosis and its complications may affect gut microbiota (GM) composition. Transjugular intrahepatic portosystemic shunt (TIPS) represents the most effective treatment for portal hypertension (PH). We aimed to evaluate whether TIPS placement modifies GM composition and metabolic function. METHODS: A compositional and functional GM analysis was prospectively performed in 13 cirrhotic patients receiving TIPS. Patients receiving systemic or non-absorbable antibiotics for any indications were excluded. Fecal samples were collected before and three months after TIPS. GM was analyzed by 16S ribosomal RNA sequencing. Small- and medium-chain fatty acids (SCFAs and MCFAs, respectively) were measured by gas chromatography/mass spectrometry. RESULTS: TIPS placement resulted in a mean 48% reduction in portal-caval pressure gradient. No recurrence of PH related complications was observed. After TIPS, increased levels of Flavonifractor spp. (p = 0.049), and decreased levels of Clostridiaceae (p = 0.024), these latter linked to abdominal infections in cirrhotic patients, were observed. No differences were found in the SCFAs signature while analysis of MCFA profiles showed a decreased abundance of pro-inflammatory isohexanoic (p<0.01), 2-ethylhexanoic (p<0.01) and octanoic acids (p<0.01) after TIPS. CONCLUSION: Correction of PH following TIPS results in modifications of GM composition which could be potentially beneficial and reduces the levels of fecal pro-inflammatory MCFAs.

Mortality after transjugular intrahepatic portosystemic shunt in older adult patients with cirrhosis: A validated prediction model.

BACKGROUND AND AIMS: Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) improves survival in patients with cirrhosis with refractory ascites and portal hypertensive bleeding. However, the indication for TIPS in older adult patients (greater than or equal to 70 years) is debated, and a specific prediction model developed in this particular setting is lacking. The aim of this study was to develop and validate a multivariable model for an accurate prediction of mortality in older adults. APPROACH AND RESULTS: We prospectively enrolled 411 consecutive patients observed at four referral centers with de novo TIPS implantation for refractory ascites or secondary prophylaxis of variceal bleeding (derivation cohort) and an external cohort of 415 patients with similar indications for TIPS (validation cohort). Older adult patients in the two cohorts were 99 and 76, respectively. A cause-specific Cox competing risks model was used to predict liver-related mortality, with orthotopic liver transplant and death for extrahepatic causes as competing events. Age, alcoholic etiology, creatinine levels, and international normalized ratio in the overall cohort, and creatinine and sodium levels in older adults were independent risk factors for liver-related death by multivariable analysis. CONCLUSIONS: After TIPS implantation, mortality is increased by aging, but TIPS placement should not be precluded in patients older than 70 years. In older adults, creatinine and sodium levels are useful predictors for decision making. Further efforts to update the prediction model with larger sample size are warranted.

Evaluating the best treatment for multifocal hepatocellular carcinoma: A propensity score-matched analysis.

BACKGROUND: Hepatocellular carcinoma (HCC) is a common tumour often diagnosed with a multifocal presentation. Patients with multifocal HCC represent a heterogeneous group. Although Trans-Arterial ChemoEmbolization (TACE) is the most frequently employed treatment for these patients, previous data suggested that liver resection (LR) could be a safe and effective procedure. AIM: To compare LR and TACE in patients with multifocal HCC in terms of procedure-related morbidity and oncologic outcomes. METHODS: All patients with multifocal HCC who underwent LR or TACE as the first procedure between May 2011 and March 2021 were enrolled. The decision to perform surgery or TACE was made after a multidisciplinary team evaluation. Only patients in Child-Pugh class A or B7 and stage B (according to the Barcelona Clinic Liver Cancer staging system, without severe portal hypertension, vascular invasion, or extrahepatic spread) were included in the final analysis. Propensity score matching was used to adjust the baseline differences between patients undergoing LR and the TACE group [number and diameter of lesions, presence of cirrhosis, alpha-fetoprotein (AFP) levels, and Model for End-Stage Liver Disease score]. The Kaplan-Meier method was used to estimate overall survival (OS) and disease-free survival (DFS). The outcomes of LR and TACE were compared using the log-rank test. RESULTS: After matching, 30 patients were eligible for the final analysis, 15 in each group. Morbidity rates were 42.9% and 40% for LR and TACE, respectively (P = 0.876). Median OS was not different in the LR and TACE groups (53 mo vs 18 mo, P = 0.312), while DFS was significantly longer with LR (19 mo vs 0 mo, P = 0.0001). Subgroup analysis showed that patients in the Italian Liver Cancer (ITA.LI.CA) B2 stage, with AFP levels lower than 400 ng/mL, less than 3 lesions, and lesions bigger than 41 mm, benefited more from LR in terms of DFS. Patients classified as ITA.LI.CA B3, with AFP levels higher than 400 ng/mL and with more than 3 lesions, appeared to receive more benefit from TACE in terms of OS. CONCLUSION: In a small cohort of patients with multifocal HCC, LR confers longer DFS compared with TACE, with similar OS and post-procedural morbidity.

Dynamics of endothelial progenitor cells in patients with advanced hepatocellular carcinoma.

BACKGROUND AND AIMS: Circulating endothelial progenitor cells (EPC) predict tumor vascularization and disease progression, but limited information is available on their dynamics in hepatocellular carcinoma (HCC) undergoing systemic treatment. METHODS: We prospectively analyzed different populations of EPC in 16 patients with advanced HCC receiving sorafenib. Patients were studied before therapy (T0, n = 16) and after two (T2, n = 12) and eight weeks (T8, n = 8), using high-performance flow-cytometry. The tumor response at T8 was categorized as progressive disease (PD) or clinical benefit (CB, all other responses). RESULTS: At T0, higher levels of CD34+CD133+KDR+ and CD34+KDR+ were observed in patients with alpha-fetoprotein ≥400 ng/ml or non-viral liver disease, whereas CD34+CD133+KDR+ cells were virtually absent in patients with vascular invasion. CD34+KDR+ and CD34+CD133+KDR+ were directly correlated with platelet count. Frequencies of all populations of EPC declined in patients receiving sorafenib. Levels of CD34+CD133+ were higher at T0 in patients with CB compared to patients with PD. In patients belonging to the CB group CD34+KDR+ cells at T0 were directly correlated to platelet count. CONCLUSION: In patients with advanced HCC, EPC are directly correlated with platelet count, suggesting a common activation of selected bone marrow pathways. Levels of a CD34+KDR+ are higher at baseline in patients responding to sorafenib.

Portosystemic shunt is an effective treatment for complications of portal hypertension in hepatic myeloid metaplasia and improves nutritional status.

In patients affected by myelofibrosis with hepatic myeloid metaplasia (HMM), portal hypertension (PHT) complications may develop. In this case series, we analysed the efficacy and safety of transjugular portosystemic shunt (TIPS) in the treatment of PHT-related complications and its effects on the nutritional status. Six patients were evaluated and the average follow-up period after TIPS was 33 (IQR 5) months. None of the patients developed hepatic failure, nor any recurrence of variceal bleeding was recorded. No additional paracentesis or endoscopic prophylactic treatment for PHT-related complications were required. In all subjects, the average dose of diuretics was almost halved three months after TIPS. Three patients died during the follow-up, but none for liver-related causes. All patients showed an improvement in the global nutritional status. In conclusion, TIPS represent an effective and safe treatment option for patients affected by complications of PHT secondary to HMM and drives to an improvement of the nutritional status.

How to enhance the environmental sustainability of WEEE plastics management: An LCA study.

A new management scheme of plastics from waste of electrical and electronic equipment (WEEE), which includes novel treatments of sorting, dissolution/precipitation, extrusion, catalytic pyrolysis, and plastic upgrading, is proposed. Its environmental performances are quantified by an attributional Life Cycle Assessment and compared with those of European currently adopted schemes, which include conventional mechanical recycling and thermal treatments as well as improper options of dumping and open burning, largely applied to WEEE plastics exported to developing countries. The proposed innovative scheme greatly enhances the environmental sustainability of WEEE plastics management, by increasing the annual amounts of polymers sent to recycling (from 390 kt/y up to 530 kt/y), decreasing residues to be sent to combustion (from 360 kt/y up to 60 kt/y), and reducing the potential impacts of all the midpoint categories under analysis (up to 580% for that of Global Warming). These results are mainly related to the adoption of a dissolution/precipitation process, which allows recovering target polymers such as ABS, HIPS and PC, with improvements in terms of Global Warming, Non-Carcinogens, and Carcinogens equal to 246%, 69% and 35%, even when the stages of polymer upgrading and catalytic pyrolysis are not included in the analysis. The sensitivity analysis shows that advantages of the new approach substantially disappear if the awful contributions of exportation outside Europe are taken into account. This clearly indicates that the first step to enhance the sustainability of WEEE plastics management is a strong limitation of improper treatments applied to exported wastes.

Time-Varying mHAP-III Is the Most Accurate Predictor of Survival in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization.

INTRODUCTION: The prognosis of patients undergoing transarterial chemoembolization (TACE) is extremely variable, and a confounding factor is that TACE is often repeated several times. We retrospectively evaluated the accuracy of different prognostic scores and staging systems in estimating overall survival (OS) in patients with hepatocellular carcinoma (HCC). METHODS: An analysis considering prognostic models as time-varying variables was performed, calculating OS from the time of TACE to the time of the subsequent treatment. Total follow-up time for each patient was therefore split into several observation times accounting for each TACE procedure. Values of the likelihood ratio test (LRT) and Akaike information criterion (AIC) were used to compare different systems. Univariable and multivariable analyses were conducted to identify additional factors predictive of OS. We analyzed 1,610 TACE performed in 1,058 patients recorded in the Italian Liver Cancer database from 2008 through 2016. RESULTS: The median OS of the enrolled patients was 41 months. According to LRT χ2 and AIC values based on the time-varying analysis, mHAP-III achieved the best values (41.72 and 4,625.49, respectively, p < 0.0001), indicating the highest predictive performance compared with all other scores (HAP, mHAP-II, ALBI, and pALBI) and staging systems (MELD, ITALICA, CLIP, MESH, MESIAH, JIS, HKLC, and BCLC). In the multivariable Cox proportional hazards model, mHAP-III maintained an independent effect on OS (hazard ratio 1.31, 95% CI: 1.10-1.55, p < 0.0001). Time-varying age, alcoholic etiology, radiologic response to TACE, and performing ablation or surgery after TACE were additional significant variables resulting from the multivariable model. CONCLUSION: An innovative time-varying analysis revealed that mHAP-III was the most accurate model in predicting OS in patients with HCC undergoing TACE. Other clinical pre- and post-TACE variables were also found to be relevant for this prediction.

About the environmental sustainability of the European management of WEEE plastics.

A huge increase of waste of electrical and electronic equipment (WEEE) is observing everywhere in the world. Plastic component in this waste is more than 20% of the total and allows important environmental advantages if well treated and recycled. The resource recovery from WEEE plastics is characterised by technical difficulties and environmental concerns, mainly related to the waste composition (several engineering polymers, most of which containing heavy metals, additives and brominated flame retardants) and the common utilisation of sub-standard treatments for exported waste. An attributional Life Cycle Assessment quantifies the environmental performances of available management processes for WEEE plastics, those in compliance with the European Directives and the so-called substandard treatments. The results highlight the awful negative contributions of waste exportation and associated improper treatments, and the poor sustainability of the current management scheme. The ideal scenario of complete compliance with European Directives is the only one with an almost negligible effect on the environment, but it is far away from the reality. The analysed real scenarios have strongly negative effects, which become dramatic when exportation outside Europe is included in the waste management scheme. The largely adopted options of uncontrolled open burning and illegal open dumping produce huge impacts in terms of carcinogens (3.5·10+7 and 3.6·10+4 person⋅year, respectively) and non-carcinogens (1.7·10+8 and 2.0·10+6 person⋅year) potentials, which overwhelm all the other potential impacts. The study quantifies the necessity of strong reductions of WEEE plastics exportation and accurate monitoring of the quality of extra-Europe infrastructures that receive the waste.

Refining the Baveno VI elastography criteria for the definition of compensated advanced chronic liver disease.

BACKGROUND: The Baveno VI consensus proposed a dual liver stiffness (LS) by transient elastography threshold of <10 and >15 kPa for excluding and diagnosing compensated advanced chronic liver disease (cACLD) in the absence of other clinical signs. Herein, we aimed to validate these criteria in a real-world multicentre study. METHODS: We included 5,648 patients (mean age 51 ± 13 years, 53% males) from 10 European liver centres who had a liver biopsy and LS measurement within 6 months. We included patients with chronic hepatitis C (n = 2,913, 52%), non-alcoholic fatty liver disease (NAFLD, n = 1,073, 19%), alcohol-related liver disease (ALD, n = 946, 17%) or chronic hepatitis B (n = 716, 13%). cACLD was defined as fibrosis stage ≥F3. RESULTS: Overall, 3,606 (66%) and 987 (18%) patients had LS <10 and >15 kPa, respectively, while cACLD was histologically confirmed in 1,772 (31%) patients. The cut-offs of <10 and >15 kPa showed 75% sensitivity and 96% specificity to exclude and diagnose cACLD, respectively. Examining the ROC curve, a more optimal dual cut-off at <7 and >12 kPa, with 91% sensitivity and 92% specificity for excluding and diagnosing cACLD (AUC 0.87; 95% CI 0.86-0.88; p <0.001) was derived. Specifically, for ALD and NAFLD, a low cut-off of 8 kPa can be used (sensitivity=93%). For the unclassified patients, we derived a risk model based on common patient characteristics with better discrimination than LS alone (AUC 0.74 vs. 0.69; p <0.001). CONCLUSIONS: Instead of the Baveno VI proposed <10 and >15 kPa dual cut-offs, we found that the <8 kPa (or <7 kPa for viral hepatitis) and >12 kPa dual cut-offs have better diagnostic accuracy in cACLD. LAY SUMMARY: The term compensated advanced chronic liver disease (cACLD) was introduced in 2015 to describe the spectrum of advanced fibrosis and cirrhosis in asymptomatic patients. It was also suggested that cACLD could be diagnosed or ruled out based on specific liver stiffness values, which can be non-invasively measured by transient elastography. Herein, we assessed the suggested cut-off values and identified alternative values that offered better overall accuracy for diagnosing or ruling out cACLD.

Environmental performances of a modern waste-to-energy unit in the light of the 2019 BREF document.

The study compares the environmental performances of a new-generation, large scale, combustion-based waste-to-energy unit, active since 2010, with those of different "virtual" units, defined in the light of the Best Available Techniques REFerence document (BREF) for Waste Incineration published by the European Community on December 2019. The average performances of these units have been evaluated in terms of air emissions, material consumptions and energy recovery, based on data related to 355 "existing" European waste incineration lines and those established for the future "new" plants. An attributional Life Cycle Assessment has been used to compare and quantify the environmental performances of the selected units, all equipped with a moving grate furnace and similar air pollution control systems. A sensitivity analysis quantifies how even more severe requests for emission and energy performances as well as the evolution of the European electricity mix until the year 2030 can affect the comparative assessment. The results indicate that the considered large scale waste-to-energy plant has good environmental performances, even in an electricity mix characterised by 45% of renewable sources. This allows an easy compliance with the Best Available Techniques Associated Emission Levels of the new waste incineration BREF document. Possible further improvements of its performances should be focused mainly on a further increase of the energy efficiency, provided that it is economically viable.

Transjugular intrahepatic portosystemic shunt (TIPS): current indications and strategies to improve the outcomes.

Transjugular intrahepatic portosystemic shunt (TIPS) represents a very effective treatment of complications of portal hypertension. Established indications to TIPS in cirrhotic patients include portal hypertensive bleeding and refractory ascites. Over the years additional indications have been proposed, such as the treatment of vascular disease of the liver, hepatic hydrothorax, hepatorenal syndrome and bleeding from ectopic varices. Indications under evaluation include treatment of portal hypertension prior to major abdominal surgery and treatment of portal vein thrombosis. In spite of these advances, there are still uncertainties regarding the appropriate workup for patients to be scheduled for TIPS. Moreover, prevention and management of post-TIPS complications including hepatic encephalopathy and heart failure are still suboptimal. These issues are particularly relevant considering aging in TIPS candidates in Western countries. Correct selection of patients is mandatory to prevent complications which may eventually frustrate the good hemodynamic results and worsen the patient's quality of life or even life expectancy. The possible role of small diameter TIPS to prevent post-procedural complications is discussed.

A review of the valorization and management of industrial spent catalyst waste in the context of sustainable practice: The case of the State of Kuwait in parallel to European industry.

Industrial solid waste management encompasses a vital part of developed and developing countries strategies alike. It manages waste generated from vital industries and governs the hazardous waste generated as a major component of integrated waste management strategies. This article reviews the practices that govern the management approaches utilized in the developed world for industrial spent catalysts. It critically assesses the current situation of waste management within the developing world region focusing on the industrial waste component, in a novel attempt to crucially develop a strategy for a way forward based on best practices and future directions with major European industries. The review also draws parallels with European countries to compare their practices with those of the State of Kuwait, which rely solely on landfilling for the management of its industrial waste. Spent catalysts recovery methods are discussed at length covering conventional methods of valuable metals and chemicals recovery (e.g., hydrometallurgical, solid-liquid and liquid-liquid extraction) as well as biological recovery methods. A major gap exists within regulations that govern the practice of managing industrial waste in Kuwait, where it is essential to start regulating industries that generate spent catalysts in-view of encouraging the establishment of valorization industries for metal and chemical recovery. This will also create a sustainable practice within state borders, and can reduce the environmental impact of landfilling such waste in Kuwait.

Biowaste-to-Biomethane: An LCA study on biogas and syngas roads.

Biomethane produced from waste-derived biomass (biowaste) is a clean and renewable fuel, which offers substantial reductions of greenhouse gas emissions and resource consumption. Biomethane is currently produced via the "biogas road", which includes the anaerobic digestion of wet biowaste and a successive upgrading of obtained biogas, with good environmental performance. An alternative production strategy is the "syngas road", which includes the gasification of dry or semi-dry biowaste followed by cleaning, conditioning, methanation, and final upgrading of obtained syngas. It is still at a demonstration level but appears of great interest for the highest values of energy efficiency and carbon utilisation. The study acquired technical data from existing plants of both these strategies, and developed a quantitative environmental assessment by means of holistic tools of sustainable engineering: material and substance flow analyses and an attributional life cycle assessment. The technical and environmental performance of the two biomethane roads have been then compared, in terms of energy and process efficiency as well as potential impacts in the main midpoint categories (global warming, respiratory inorganics, and non-renewable energy). The syngas road appears to have higher levels of carbon utilisation and better environmental performance, even though an extended sensitivity analysis shows different results if alternative plant configurations and energy mix are considered. This suggests that R&D studies and policies of economic incentives have to be further implemented for both the analysed strategies, even because they deal with different kind of biowaste, having different availability in different countries.

Transjugular Intrahepatic Portosystemic Shunt does not affect the efficacy and safety of direct-acting antivirals in patients with advanced cirrhosis: A real-life, case-control study.

BACKGROUND: Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a well-established treatment for complications of portal hypertension. AIMS: To analyze the impact of TIPS on virologic response and safety profile in patients treated with direct-acting antivirals (DAAs). METHODS: We analyzed data from HCV-positive cirrhotic patients treated with DAAs. Twenty-one patients with previous TIPS placement were compared with 42 matched subjects without TIPS. Logistic regression was used to identify predictors of hepatic function worsening and adverse events. RESULTS: No differences were found between the two groups in particular regarding sustained virologic response (92.5 and 97.6% in TIPS vs no-TIPS, p = 0.559). Model for End-stage Liver Disease (MELD) of both TIPS and no-TIPS groups declined from baseline to week 24 of follow-up (from 12.5 ±â€¯3.5 to 10.8 ±â€¯3.4 and from 11.1 ±â€¯3.5 to 10.3 ±â€¯3.4, p = 0.044 and 0.025). There were no differences in adverse event rates. At univariate analysis, age was associated with MELD increase from baseline to week 24 (OR 1.111, 95% CI 1.019-1.211, p = 0.017), and patients with higher baseline MELD developed serious adverse events more frequently (OR 0.815, 95% CI 0.658-1.010, p = 0.062). Patients with or without TIPS did not show differences in transplant-free survival. CONCLUSION: TIPS placement does not affect virologic response and clinical outcome of patients receiving DAAs.

Life cycle assessment of construction and demolition waste management in a large area of São Paulo State, Brazil.

The study evaluated the environmental performance of the construction and demolition waste (C&DW) management in the area of PCJ Watershed, located in the São Paulo State, Brazil, by means of an attributional Life Cycle Assessment. The entire C&DW management under the responsibility of the municipal government was considered. The potential environmental impacts were assessed by using two specific life cycle impact assessment methodologies, CML baseline (v3.03) and Impact 2002+ (v2.12). The results obtained by both methodologies highlighted the importance of the avoided impacts from recovered materials, mainly those related to steel, glass and plastics recycling. In particular, the CML baseline indicated "Human Toxicity" as the most important category, mainly due to the avoided impacts from steel recycling and the generated impacts from transportation in all the C&DW management stages. The Impact 2002+ highlighted instead the role of the categories of "Respiratory Inorganics" and "Global Warming", in accordance with the results related again to steel recycling and transportation but also to landfilling of solid residues. The study considered some alternative scenarios of the mineral fraction management, which quantified the expected advantages of increasing C&DW recycling and improving the quality of recycled aggregates.