Influence of flue gas cleaning system on the energetic efficiency and on the economic performance of a WTE plant.

Gas cleaning systems of MSW (Municipal Solid Waste) incinerators are characterised by the process employed to remove acid gases. The commonly used technologies for acid gas removal are: (1) dry treatment with Ca(OH)(2) or (2) with NaHCO(3), (3) semi-dry process with Ca(OH)(2) and (4) wet scrubbing. In some recent plants beside a wet cleaning system, a dry neutralization with Ca(OH)(2) is used. The goal is to reduce the amount of acid to be removed in the wet treatment and the liquid effluents produced. The influence of these different technologies on the electrical efficiency was investigated by a detailed simulation of a WTE (Waste To Energy) plant with a capacity of about 100,000 t/y of MSW. The effects of the different gas cleaning systems on electrical efficiency were significant. The difference of efficiency between the most advantageous technology, which is dry treatment with NaHCO(3), and the least advantageous technology which is semi-dry treatment, is about 0.8%. A simple economic analysis showed that the few advantages of dry technologies can often be lost if the costs of chemicals and the disposal of products are considered.

Pericranium graft in reconstructive surgery of atrophied maxillary bones.

In preprosthetic surgery the autologous bone is universally considered the gold standard. Calvaria is, among many options, one of the preferred for its unique characteristics of hardness, easy of harvest and very low morbidity at donor site. Moreover, it gives the possibility of harvesting the pericranium. This technique, recently introduced in common practice in Milan, allows to harvest a large quantity of periosteum to cover bone grafts perioperativly. Periosteal tissue is used to cover bone grafts for two reasons. First, it would provide a layer of tissue that, thanks to its osteogenic potential, would prevent bone resorption. Second, this would interpose a layer of soft tissue to act as a cushion between the bone and mucosal flap to minimize the risk of wound dehiscence, that would bring to bone exposure and consequent failure of reconstruction. Five jaw reconstructions were performed with autologous bone and pericranium. In all cases the outcome was good, the grafts took with correct bone volume preservation. Implants were positioned according to prosthetic needs. In one case a vascular necrosis of a mucosal flap occurred. Bone exposure was prevented by the periosteum, which was revascularized after few days, allowing bone integration. Considering its potential protective capability towards bone grafts and the lack of donor site morbidity, this technique should be considered as a standard procedure in preprosthetic reconstructive surgery.

A short overview on the role of alpha-synuclein and proteasome in experimental models of Parkinson's disease.

The Ubiquitin Proteasome System is a multi-enzymatic pathway which degrades polyubiquinated soluble cytoplasmic proteins. This biochemical machinery is impaired both in sporadic and inherited forms of Parkinsonism. In the present paper we focus on the role of the pre-synaptic protein alpha-synuclein in altering the proteasom based on the results emerging from experimental models showing a mechanistic chain of events between altered alpha-synuclein, proteasome impairment and formation of neuronal inclusions and catecholamine cell death.

A hypothesis on prion disorders: are infectious, inherited, and sporadic causes so distinct?

Prion diseases include a group of either sporadic, inherited or infectious disorders characterized by spongiform neurodegeneration and reactive glyosis in several brain regions. Whatever the origin, the neuropathological hallmark of prion diseases is the presence of brain aggregates containing an altered isoform of a cellular protein, named prion protein. Recent findings show the potential toxicity of the normal cellular prion protein, which occurs when its physiological metabolism is altered. In particular, several studies demonstrate that accumulation of the prion protein in the cytosol can be a consequence of an increased amount of misfolded prion proteins, a derangement of the correct protein trafficking or a reduced activity of the ubiquitin-proteasome system. The same effects can be a consequence of a mutation in the gene coding for the prion protein. In all these conditions, one assists to accumulation and self-replication of insoluble prion proteins which leads to a severe disease resembling what observed following typical "prion infections". This article provides an opinion aimed at reconciling the classic Prusiner's theory concerning the "prion concepts" with the present knowledge arising from experimental studies on neurodegenerative disorders, suggesting a few overlapping steps in the pathogenesis of these diseases.

Mood and anxiety psychopathology and temporomandibular disorder: a spectrum approach.

Psychological factors play an important role in the aetiopathogenesis of temporomandibular disorders (TMD), as demonstrated by an increase in stress, anxiety, depression and somatization in TMD patients. The aim of this work was to investigate the presence of mood and panic-agoraphobic symptoms in different groups of TMD patients by means of a spectrum approach to psychopathology. A total of 131 subjects were included in this study and TMD signs and symptoms were investigated by means of a standardized clinical examination. Two self-report questionnaires were used to evaluate mood (MOODS-SR) and panic-agoraphobic (PAS-SR) spectrum. anova and Bonferroni's post hoc test for multiple comparisons were used to compare mean scores of all TMD groups for MOODS-SR, PAS-SR and all their domains. Results revealed a significantly higher prevalence of both mood (P < 0.001) and panic-agoraphobic (P < 0.01) symptoms in myofascial pain patients than in all other diagnostic groups (TMD-free, disc displacement and joint disorders). With regard to mood spectrum, strong differences emerged for all domains evaluating depressive symptoms. As for the panic-agoraphobic spectrum, myofascial pain patients differed from the other groups for the presence of stress sensitivity, panic, separation anxiety, hypochondriac and agoraphobic symptoms. It was concluded that myofascial pain patients differed from those with disc displacement, joint disorders and no TMD in relation to some psychopathological symptoms, while the last three groups presented very similar profiles.

A critical review on the importance of psychological factors in temporomandibular disorders.

Recent researches on temporomandibular disorders (TMD) have been focused on the interaction between physical and psychological factors. In this work, studies on the role of the latter have been critically reviewed and analysed. A number of works proved the existence of an association between TMD and anxiety, depression and stress, but none demonstrated causality of that relation. In consideration of that, debates are still open to discuss the possible predisposing, triggering and/or worsening role played by some psychic disorders in TMD subjects. Nevertheless, considering the usefulness of recent taxonomic proposals, it seems logical to adopt a broad therapeutic approach, directed both to the physical and psychic component of TMD symptoms. Besides, from this review it is underlined the need for controlled trials which, regardless of the causality of TMD-psychic disorders associations, definitively evaluate the efficacy of the various psychotherapy modalities proposed.

A spectrum approach for the assessment of manic-depressive symptoms accompanying temporomandibular disorders.

AIM: Temporomandibular disorders (TMD) are a number of conditions which are frequently associated with depressive symptoms, but the possible existence of some form of manic-depressive illness in TMD patients has never been investigated. The aims of this work were to evaluate the reliability of a newly adopted spectrum model of psychopathology to detect depressive symptoms in TMD patients, and to produce pilot data on the presence of manic symptoms in TMD patients. METHODS: Ninety-one consecutive TMD patients (72 females, 19 males; mean age 26.3) and 26 TMD-free subjects (21 females, 5 males; mean age 24) were administered a validated questionnaire to evaluate mood spectrum (MOODS-SR). Helkimo's Clinical Dysfunction Index (CDI) was calculated for all patients. One-way ANOVA and Bonferroni's post-hoc test for multiple comparisons were used to compare mean MOODS-SR scores of the groups identified as TMD-free (CDI=0), mild dysfunctionals (CDI=1), moderate or severe dysfunctionals (CDI= or >2). RESULTS: Total scores of domains evaluating depression were significantly higher in moderate or severe dysfunctionals than in both TMD-free (mean difference 8.87+/-3.5; p=0.017) and mild dysfunctionals (m.d. 9.41+/-2.62; p=0.001). As regards manic symptoms, differences between groups were not significant (F=1.299; p=0.277). CONCLUSION: Our findings support the reliability of MOODS-SR to detect depressive symptoms associated with TMD. The hypothesis that depressive symptoms in TMD patients could be an expression of a more complex manic-depressive illness has to be rejected, since no differences between TMD patients and TMD-free subjects have been revealed for the presence of manic symptoms.

Characterization of viro-immunological responses in a closely followed cohort of heavily pretreated patients: evidence from the GenPheRex Study.

OBJECTIVES: To assess prevalence and predictive factors of viro-immunological discordant trends in a cohort of heavily pretreated patients. METHODS: Factors associated with viro-immunological discordant trends either as categorical or continuous measures have been studied in 159 heavily pretreated HIV-positive patients from a multicentre prospective study of real- vs. virtual-phenotype. Univariate and multivariate logistic regressions were used to assess risk factors for categorical discordant responses, ceasing follow-up at week 32 since enough patients had been on the original drug combination for a sufficient amount of time to evaluate their immune response. Complementary linear regression analysis was performed over the entire 48 weeks' follow-up considering CD4 and plasma viral load (pVL) as continuous measures. RESULTS: Among 58 virological responder patients (> or =1 log10 HIV-1 RNA copies/mL decrease) and 101 virologically non-responders, immunological discordances (increase in CD4 count of< or > or =100 cells/microL) were observed in 58.6% and 38.6%, respectively. Baseline CD4 count was associated with discordant responses in both groups. Multivariable linear regression over the entire 48 weeks' follow-up demonstrated significant correlation between absolute decrease in pVL and increase in CD4 count (HR 28.06, 95%CI 35.32-20.79; P<0.001), also the use of protease inhibitors (PIs) in the salvage regimen (HR 36.57, 95%CI 15.45-57.68; P<0.001) and >8 months on treatment (HR 41.64, 95%CI 19.27-64.01; P<0.001) correlated with highly significant immune recovery. CONCLUSIONS: These data confirm that therapy, possibly including PIs, should be continued in heavily pretreated patients and that hard-to-reach pVL undetectability is not essential to obtain immunologic recovery; however, this is strongly increased by the degree of pVL reduction that should be achieved.

Treatment with interferon-alpha2b of naive non-cirrhotic patients with chronic hepatitis C according to viraemia and genotype. Results of a randomized multicentre study. The North West Italian Hepatological Group.

OBJECTIVE: To establish whether tailoring the dosage of interferon (IFN)-alpha2b in non-cirrhotic naive patients with chronic hepatitis C according to hepatitis C virus (HCV) genotype and viraemic level improves the rate of sustained response (normal alanine aminotransferase values and HCV-RNA negativity 6 months after the end of therapy). PATIENTS: A total of 538 consecutively collected HCV-positive patients with non-cirrhotic chronic hepatitis who had not been previously treated. METHODS: Quantitative viraemia and genotype were determined in each patient by a core laboratory. The patients were randomized to: Group 1, 86 patients with genotype non-1 and viraemia < 1,000,000 HCV genome equivalents/ml (GenEq/ml) treated with 3 Million Units (MU) IFN three times weekly (t.i.w.) for 1 year; Group 2, 42 patients with genotype 1 and viraemia < 1,000,000 GenEq/ ml treated with 3 MU IFN t.i.w. for 1 year; Group 3, 46 patients with genotype 1 and viraemia < 1,000,000 GenEq/ ml treated with 5 MU IFN t.i.w. for 1 year; Group 4, 85 patients with genotype non-1 and viraemia > 1,000,000 GenEq/ml treated with 3 MU IFN t.i.w. for 1 year; Group 5, 88 patients with genotype non-1 and viraemia > 1,000,000 GenEq/ml treated with 5 MU IFN t.i.w. for 1 year; Group 6, 94 patients with genotype 1 and viraemia > 1,000,000 GenEq/ml treated with 3 MU IFN t.i.w. for 1 year; Group 7, 97 patients with genotype 1 and viraemia > 1,000,000 GenEq/ml treated with 5 MU IFN daily for 2 months followed by 5 MU t.i.w. for a further 10 months. RESULTS: According to an intention-to-treat analysis, a sustained virological response (negative HCV-RNA by polymerase chain reaction 6 months after the end of therapy) was observed in 42% of Group 1 patients, in 21% of Group 2 patients versus 24% of Group 3 patients [P = not significant (NS)], in 28% of Group 4 patients versus 35% of Group 5 patients (P = NS), and in 8.5% of Group 6 patients versus 12% of Group 7 patients (P = NS). CONCLUSIONS: Even though a trend towards a therapeutic improvement is observed, the adoption of more aggressive IFN protocols, such as induction therapy, does not appear to significantly improve the rate of sustained response in patients with chronic hepatitis C associated with HCV genotype 1 and highly viraemic levels compared with standard therapy. Moreover, patients with only one unfavourable predictive factor (genotype 1 or high viraemia) do not gain major therapeutic benefits when treated with high doses of IFN.

Plasma viral load concentrations in women and men from different exposure categories and with known duration of HIV infection. I.CO.N.A. Study Group.

CONTEXT: According to recent studies, women have lower plasma HIV RNA concentrations than men. However, these studies did not take into account the duration of HIV infection. OBJECTIVES: To analyze the relationship between viral load and gender among individuals with known date of seroconversion. SETTING: Sixty infectious disease clinics in Italy. DESIGN: Cross-sectional analysis of data collected at enrollment in a cohort study. PARTICIPANTS: Injecting drug users and heterosexual contacts naive to antiretroviral therapy at enrollment (245 men; 170 women). MAIN OUTCOME MEASURES: Plasma HIV RNA concentrations, measured using quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) or signal amplification b-DNA assays before antiretroviral therapy. RESULTS: Plasma HIV RNA concentrations were similar by age and exposure category (p =.80 and p =.39, respectively). Median viral load among women was roughly half that of men (p =.002). The association between viral load and gender remained significant after fitting a two-way analysis of variance (p =.03) and after adjusting for CD4 count, modality of HIV transmission, and age at enrollment in a regression model. Viral load was 0.27 log10 copies/ml (95% confidence interval, 0.05-0.40; p =.01) lower in women (i.e., 50% lower in the raw scale). CONCLUSIONS: Plasma HIV RNA concentrations were found to be lower among women, even when considering the duration of HIV infection. Compared with men, it is possible women should be given highly aggressive antiretroviral therapy at lower HIV-RNA concentrations.

Hepatitis C virus genotypes in a non-cirrhotic Italian population with chronic hepatitis C: correlation with clinical, virological and histological parameters. Results of a prospective multicentre study.

To identify correlations between the distribution of hepatitis C virus (HCV) genotypes and demographic, pathological and virological parameters of HCV-infected patients, we prospectively recruited 650 patients with biopsy-proven chronic hepatitis C without histological aspects of cirrhosis; none had been treated with antiviral therapy. Data regarding gender, age, mode of HCV transmission, alanine aminotransferase (ALT) and HCV RNA levels, immunoglobulin M (IgM) anticore values, liver histology and histological activity were obtained from each patient and correlated on multivariate analysis with infecting HCV genotype. Fifty-five per cent of the patients were infected with HCV genotype 1, 20% with HCV genotype 2, 18% with HCV genotype 3 and 7% with HCV genotype 4. Non-transfusional HCV transmission, low ALT levels, IgM anticore reactivity and a low histological grading score were independent variables associated with HCV genotype 1. Older age, female gender, post-transfusional transmission and a high histological grading score were related to HCV genotype 2, whilst younger age, history of current/previous drug abuse, high ALT values, low IgM anticore reactivity and high viraemic levels were associated with HCV genotype 3. History of illicit use of intravenous drugs and low HCV RNA levels were the only independent variables correlated with HCV genotype 4. Genotype 1 remains predominant in Italy but the prevalence of HCV genotypes is changing in relation to age and mode of transmission: Italian patients with HCV genotype 3 are younger and exhibit higher levels of ALT and HCV RNA than patients with other genotypes.

Levels of nitric oxide, gamma interferon and interleukin-12 in AIDS patients with toxoplasmic encephalitis.

The production of nitric oxide (NO) by macrophages is important for the killing of intracellular pathogens, such as Toxoplasma gondii. Gamma interferon (IFN-gamma) and lipopolysaccharide stimulate NO production. The aim of this study was to investigate the importance of NO, IFN-gamma and interleukin-12 (IL-12) in the host immune response in AIDS patients suffering from toxoplasmic encephalitis (TE). It was demonstrated that the production of NO, detected as nitrite/nitrate in the sera and in the cerebrospinal fluid (CSF) of 32 AIDS patients with TE, was normal. In addition, levels of IFN-gamma in the sera and in the CSF of patients with TE were not increased. In contrast, serum levels of IL-12 in these patients were significantly increased (6.5 +/- 7.1 pg/ml; P = 0.0368), compared to the control patients (1.7 +/- 3.5 pg/ml). Furthermore, increased but not significant levels of IL-12 were also observed in the CSF of patients with TE (2.2 +/- 4.7 pg/ml; controls: 0.5 +/- 1.9 pg/ml). The results of this study indicate that reactivation or recurrence of T. gondii infection in HIV-1-infected patients is probably due to a down-regulation of IFN-gamma along with a resulting non-optimal NO activity.

Population pharmacokinetics of rifabutin in human immunodeficiency virus-infected patients.

Rifabutin pharmacokinetics were studied by the population approach (NONMEM) with 40 human immunodeficiency virus-infected patients receiving rifabutin at different doses for prophylaxis or therapy of mycobacterial infections. A two-compartment open model with first-order absorption was used as the structural pharmacokinetic model. Parameter estimates were the absorption rate constant (0. 201/h), clearance/bioavailability (CL/F; 60.9 liters/h), volume of the central compartment/bioavailability (231 liters), intercompartmental clearance (60.3 liters/h), and volume of the peripheral compartment/bioavailability (Vp/F; 1,050 liters). The distribution and elimination half-lives were 1.24 and 25.4 h, respectively. The covariates tested for influence on CL/F and Vp/F were sex, age, weight, height, body surface area, tobacco smoking, drug addiction, alanine aminotransferase levels, creatinine clearance, total protein, bilirubin, numbers of CD4(+) cells, presence of diarrhea, cachexia index, rifabutin use (prophylaxis versus therapy), rifabutin dose, study site, and the concomitant administration of clarithromycin, fluconazole, phenobarbital, ciprofloxacin, azithromycin, or benzodiazepines. The only statistically significant effects on rifabutin pharmacokinetic parameters were a 27% decrease in Vp/F due to the concomitant administration of azithromycin and a 39% increase in Vp/F due to tobacco smoking. Such effects may be considered clinically unimportant. Our results confirm the lack of a correlation of rifabutin pharmacokinetic parameters with parameters of disease progression and gastrointestinal function. Also, the lack of a correlation with covariates which were previously found to be significant, such as concomitant fluconazole and clarithromycin use, may suggest that the effect of such covariates may be less important in the real clinical setting, in which several concomitant factors may influence pharmacokinetic parameters, with an overall effect of no apparent correlation.

Randomized trial of trimethoprim-sulfamethoxazole versus pyrimethamine-sulfadiazine for therapy of toxoplasmic encephalitis in patients with AIDS. Italian Collaborative Study Group.

The aim of the present pilot study was to compare the efficacy and safety of trimethoprim (TMP) and sulfamethoxazole (SMX) with those of the standard therapy pyrimethamine (P)-sulfadiazine (S) for the treatment of toxoplasmic encephalitis in patients with AIDS. This was a pilot, multicenter, randomized, and prospective study. Patients were randomly assigned to receive TMP (10 mg/kg of body weight/day) and SMX (50 mg/kg/day) or P (50 mg daily) and S (60 mg/kg/day) as acute therapy (for 4 weeks) and then as maintenance therapy for 3 months at half of the original dosage. Seventy-seven patients were enrolled and randomized to the study: 40 patients were treated with TMP-SMX and 37 were treated with P-S. There was no statistically significant difference in clinical efficacy during acute therapy. In contrast, patients randomized to TMP-SMX appeared more likely to achieve a complete radiologic response after acute therapy. Adverse reactions were significantly more frequent in patients treated with P-S, and skin rash was the most common adverse event noted in these patients. In conclusion, the results of the study suggest that TMP-SMX appears to be a valuable alternative to P-S, in particular in patients with opportunistic bacterial infections.

[Recurrent hernia of the Douglas pouch. Surgical reconstruction by the vaginal route using a mersylene net]. / Ernia del Douglas recidivante. Correzione e riparazione per via vaginale mediante l'uso di rete in Mersilene.

The paper reports an interesting case of Douglas' hernia in a patient who had previously undergone gynecological surgery using a vaginal and abdominal route. The paper is illustrated by radiographic image. The importance of the clinical, anatomical and morphological conditions of the patient is underlined in the evolution of the hernial pathology. Reconstructive surgery was performed by creating a support barrier of mersylene net in order to avoid further recurrences.

[Epidemiological and clinical aspects of a survey of viral non-A, non-B hepatitis in the province of Alessandria]. / Rilievi epidemiologici e clinici su una casistica di epatiti virali non A-non B (NANB) nella provincia di Alessandria.

An epidemiological and clinical research on 48 cases of nonA-nonB hepatitis hospitalized in Alessandria, Infectious Diseases Department, from 1-1-1983 to 1-3-1984 is reported. NonA-nonB hepatitis formed 25% of full cases of viral hepatitis in the same period (192 cases); it was mainly related to hemotransfusion (33,3%) and drug addiction (29,2%); its chronic evolution was observed in the 37,5% of the cases.

[A case of allergy to a copper-medicated IUD. Etiopathogenetic and clinical aspects]. / Su di un caso di allergia a I.U.D. medicato al rame. Considerazioni etiopatogenetiche e cliniche.

PIP: The use of copper medicated IUDs has replaced the use of inert IUDs, thanks to their increased effectiveness, a Pearl index of 1% as compared to 2.5%. There are very few reported cases of copper allergy due to IUDs; this article presents 1 such case. A 22 year old healthy woman was inserted with a Cu 250 IUD; 1 week after insertion she presented widespread erythematous patches all over her body, excluding her face. Cortisone and antihistamine treatment were ineffective; the IUD was removed, and all symptoms disappeared in less than 20 days; subsequent tests revealed the patient to be allergic to copper sulphate.^ieng

[Viral neuraxitis. Epidemiological and clinical aspects]. / Nevrassiti virali. Aspetti epidemiologici e clinici.

Seven cases of acute neuraxitis due to Coxsackie B3, 2 to mumps, 1 to measles, and 1 to influenza B observed in the province of Alessandria between Jan. 1975 and July 1977 are described. In the coxsackie cases, blood chemistry and clinical examinations were coupled with determination of serum levels of complement fixing, haemagglutin-inhibiting and neutralising antibodies on two successive specimens, isolation of virus from cerebrospinal fluid and faeces, and, in one case, from a cerebral biopsy specimen, and determination of cerebrospinal fluid IgA, IgG, and IgM. Some particularly interesting epidemiological, immunological and clinical features of teh series are discussed more fully.