Acidification and solar drying of manure-based digestate to produce improved fertilizing products.

The increase in energy and fertilizer consumption makes it necessary to develop sustainable alternatives for agriculture. Anaerobic digestion and digestates appeared to be suitable options. However, untreated digestates still have high water content and can increase greenhouse gas emissions during storage and land application. In this study, manure-derived digestate and solid fraction of digestate after separation were treated with a novel solar drying technology to reduce their water content, combined with acidification to reduce the gaseous emissions. The acidified digestate and acidified solid fraction of digestate recovered more nitrogen and ammonia nitrogen than their respective non-acidified products (1.5-1.3 times for TN; 14 times for TAN). Ammonia and methane emissions were reduced up to 94% and 72% respectively, compared to the non-acidified ones, while N2O increased more than 3 times. Dried digestate and dried acidified digestate can be labeled as NPK organic fertilizer regarding the European regulation, and the dried solid fraction and the improved dried acidified solid fraction can be labeled as N or P organic fertilizer. Moreover, plant tests showed that N concentrations in fresh lettuce leaves were within the EU limit with all products in all the cases. However, zinc concentration appeared to be a limitation in some of the products as their concentration exceeded the European legal limits.

Lung ultrasound protocol decreases radiation in newborn population without side effects: A quality improvement project / La implementación de un protocolo de ecografía pulmonar disminuye la radiación sin efectos secundarios: proyecto de mejora cualitativa

Objective To reduce radiation exposure in newborns admitted due respiratory distress based on the implementation of lung ultrasound (LUS). Design Quality improvement (QI), prospective, before-after, pilot study. Setting Third level neonatal intensive care unit (NICU) level with 25-bed and 1800 deliveries/year. Patients Inclusion criteria were neonates admitted with respiratory distress. Interventions After a theoretical and practical LUS training a new protocol was approved and introduced to the unit were LUS was the first-line image. To study the effect of the intervention we compare two 6-month periods: group 1, with the previous chest X-ray (CXR)-protocol (CXR as the first diagnostic technique) vs. group 2, once LUS-protocol had been implemented. Main variables of interest The main QI measures were the total exposure to radiation. Secondary QI were to evaluate if the LUS protocol modified the clinical evolution as well as the frequency of complications. Results 122 patients were included. The number of CXR was inferior in group 2 (group 1: 2 CXR (IQR 1–3) vs. Group 2: 0 (IQR 0–1), p<0.001), as well as had lower median radiation per baby which received at least one CXR: 56 iGy (IQR 32–90) vs. 30 iGy (IQR 30–32), p<0.001. Respiratory support was similar in both groups, with lower duration of non-invasive mechanical ventilation and oxygen duration the second group (p<0.05). No differences regarding respiratory development complications, length of stay and mortality were found. Conclusions The introduction of LUS protocol in unit decreases the exposure radiation in infants without side effects (AU)

Objetivo Reducir la exposición a la radiación en neonatos ingresados por distrés respiratorio mediante implementación de la ecografía pulmonar (EP). Diseño Estudio piloto, prospectivo, anterior-posterior, mejoría de la calidad. Ámbito Unidad de cuidados intensivos neonatal (UCIN) de tercer nivel con 25 camas y 1800 partos/anuales. Pacientes Criterio de inclusión neonatos con distrés respiratorio. Intervenciones Después de una formación teórico-práctica en EP un nuevo protocolo fue implementado y aprobado siendo la EP la primera técnica de imagen. Para estudiar el efecto de la intervención comparamos dos períodos de 6 meses: grupo 1, con el protocolo de radiografía de tórax (RTX) (RTX primera técnica diagnóstica) vs. grupo 2, una vez implementado el protocolo de EP. Variables de interés La principal variable de interés fue la exposición total a la radiación. Las secundarias fueron la evolución clínica y la frecuencia de complicaciones. Resultados Se incluyeron 122 pacientes. El número de RTX fue inferior en el grupo 2 (grupo 1: 2 RTX [RIQ 1-3] vs. grupo 2: 0 [RIQ 0-1], p<0,001), con una menor dosis de radiación media por cada paciente que recibió al menos una RTX: 56 iGy (RIQ 32-90) vs. 30 iGy (RIQ 30-32), p<0,001. El soporte respiratorio fue similar en ambos grupos, con menor duración de la ventilación no invasiva y oxigenoterapia en el segundo grupo (p< 0,05). No hubo diferencias en el desarrollo de complicaciones respiratorias, días de ingreso o mortalidad. Conclusiones La introducción de un protocolo de EP en una unidad disminuye la exposición a la radiación sin efectos secundarios (AU)

Lung ultrasound protocol decreases radiation in newborn population without side effects: A quality improvement project.

OBJECTIVE: To reduce radiation exposure in newborns admitted due respiratory distress based on the implementation of lung ultrasound (LUS). DESIGN: Quality improvement (QI), prospective, before-after, pilot study. SETTING: Third level neonatal intensive care unit (NICU) level with 25-bed and 1800 deliveries/year. PATIENTS: Inclusion criteria were neonates admitted with respiratory distress. INTERVENTIONS: After a theoretical and practical LUS training a new protocol was approved and introduced to the unit were LUS was the first-line image. To study the effect of the intervention we compare two 6-month periods: group 1, with the previous chest X-ray (CXR)-protocol (CXR as the first diagnostic technique) vs. group 2, once LUS-protocol had been implemented. MAIN VARIABLES OF INTEREST: The main QI measures were the total exposure to radiation. Secondary QI were to evaluate if the LUS protocol modified the clinical evolution as well as the frequency of complications. RESULTS: 122 patients were included. The number of CXR was inferior in group 2 (group 1: 2 CXR (IQR 1-3) vs. Group 2: 0 (IQR 0-1), p<0.001), as well as had lower median radiation per baby which received at least one CXR: 56 iGy (IQR 32-90) vs. 30 iGy (IQR 30-32), p<0.001. Respiratory support was similar in both groups, with lower duration of non-invasive mechanical ventilation and oxygen duration the second group (p<0.05). No differences regarding respiratory development complications, length of stay and mortality were found. CONCLUSIONS: The introduction of LUS protocol in unit decreases the exposure radiation in infants without side effects.

COVID-19 vaccines and decreased transmission of SARS-CoV-2.

A massive COVID-19 vaccination campaign is underway worldwide. Epidemiological data from studies indicate excellent efficacy and safety profile for COVID-19 vaccines. However, there are few data from studies on the effect of decreasing the probability of infection of vaccinated subjects compared to unvaccinated subjects. In this short communication, we describe some evidence on this important and current topic providing useful personal reflections.

Pharmacological approach for the reduction of inflammatory and prothrombotic hyperactive state in COVID-19 positive patients by acting on complement cascade.

The novel Coronavirus SARS-CoV-2 is the viral pathogen responsible for the ongoing global pandemic, COVID-19 (Coronavirus disease 2019). To date, the data recorded indicate 1.62 Mln deaths and 72.8 Mln people infected (WHO situation report Dec 2020). On December 27, the first anti-COVID-19 vaccinations started in Europe. There are no direct antivirals against SARS-CoV-2. Understanding the pathophysiological and inflammatory/immunological processes of SARS-CoV-2 infection is essential to identify new drug therapies. In the most severe COVID-19 cases, an unregulated immunological/inflammatory system results in organ injury that can be fatal to the host in some cases. Pharmacologic approaches to normalize the unregulated inflammatory/immunologic response is an important therapeutic solution. Evidence associates a non-regulation of the "complement system" as one of the causes of generalized inflammation causing multi-organ dysfunction. Serum levels of a complement cascade mediator, factor "C5a", have been found in high concentrations in the blood of COVID-19 patients with severe disease. In this article we discuss the correlation between complement system and COVID-19 infection and pharmacological solutions directed to regulate.

Neonatal alloimmune thrombocytopenia due to anti-HPA 5a in a HPA-5a homozygous neonate.

The most frequently involved antigen in severe fetal and neonatal alloimmune thrombocytopenia (FNAIT) is the human platelet antigen 1a. Cases of FNAIT caused by HPA-5a antigen are extremely rare, and usually not severe. We report a case of FNAIT caused by anti-HPA antibodies directed to the HPA-5a antigen. The thrombocytopenia was moderate with a minimal platelet count of 36 × 109/L by day 3, and spontaneously resolved by day 10. The pregnancy had been obtained by in vitro fertilization using embryo donation, creating a complete genetic disparity between the HPA 5b5b mother and the HPA 5a5a homozygous neonate. The use of ART with gamete donation can increase the risk and the severity of alloimmune thrombocytopenia and must be considered in new and subsequent pregnancies.

Malignant pleural mesothelioma: Treatment patterns and outcomes from the Spanish Lung Cancer Group.

BACKGROUND: Malignant mesothelioma is a rare but aggressive tumor arising from the pleura, typically associated with exposure to asbestos. The purpose of this investigation was to describe mesothelioma patient characteristics, treatment patterns, and outcomes in Spain. MATERIAL AND METHODS: Patients diagnosed with malignant mesothelioma of the pleura were recorded in an anonymous online database (BEMME, Epidemiologic Spanish Malignant Mesothelioma Database) from June 2008 through May 2013. Patient and tumor characteristics at time of diagnosis, as well as subsequent treatments (surgery, radiation, and chemotherapy), were collected. Among patients treated with chemotherapy, we explored type of chemotherapy regimen and outcomes by treatments. RESULTS: A total of 560 malignant pleural mesothelioma (MPM) patients were recorded. The median age at diagnosis was 68 years, mainly with epithelioid histology (62 %), and any asbestos exposure was noted in 45 % of patients. Nearly two-thirds of patients (71 %) received chemotherapy, mainly platinum-pemetrexed combination, as part of their treatment. Surgery and radiotherapy were given in 36 % and 17 % of patients, respectively. The median overall survival (OS) in the whole cohort was 13.0 months (95 % confidence interval (CI), 11.1-14.8 months) with 1-year OS of 53.2 % (95 % CI, 48.7-57.7 %). In patients receiving first-line chemotherapy (N = 315), the median OS was 13.4 months (95 % CI, 10.8-16.0 months), reaching 20.2 months (95 % CI, 17.2-23.2 months) for those 68 patients receiving maintenance chemotherapy. Results of multivariate analyses showed significant association of ECOG-performance status, histology and treatment response with improved OS in MPM patients treated with palliative chemotherapy. CONCLUSIONS: Despite multimodal therapeutic intervention, survival of patients with mesothelioma in Spain remains poor. Although it did not reach significance in the multivariate analysis, a meaningful additional survival benefit was observed among those patients receiving maintenance chemotherapy.

Efficacy of pirfenidone for idiopathic pulmonary fibrosis: An Italian real life study.

BACKGROUND: In this retrospective Italian study, which involved all major national interstitial lung diseases centers, we evaluated the effect of pirfenidone on disease progression in patients with IPF. METHODS: We retrospectively studied 128 patients diagnosed with mild, moderate or severe IPF, and the decline in lung function monitored during the one-year treatment with pirfenidone was compared with the decline measured during the one-year pre-treatment period. RESULTS: At baseline (first pirfenidone prescription), the mean percentage forced vital capacity (FVC) was 75% (35-143%) of predicted, and the mean percentage diffuse lung capacity (DLCO) was 47% (17-120%) of predicted. Forty-eight patients (37.5%) had mild disease (GAP index stage I), 64 patients (50%) had moderate IPF (stage II), and 8 patients (6.3%) had severe disease (stage III). In the whole population, pirfenidone attenuated the decline in FVC (p = 0.065), but did not influence the decline in DLCO (p = 0.355) in comparison to the pre-treatment period. Stratification of patients into mild and severe disease groups based on %FVC level at baseline (>75% and ≤75%) revealed that attenuation of decline in FVC (p = 0.002) was more pronounced in second group of patients. Stratification of patients according to GAP index at baseline (stage I vs. II/III) also revealed that attenuation of decline in lung function was more pronounced in patients with more severe disease. CONCLUSIONS: In this national experience, pirfenidone reduced the rate of annual FVC decline (p = 0.065). Since pirfenidone provided significant treatment benefit for patients with moderate-severe disease, our results suggest that the drug may also be effective in patients with more advanced disease.

Transglutaminase-mediated macromolecular assembly: production of conjugates for food and pharmaceutical applications.

Various strategies have been explored in the last 20 years to modify the functional properties of proteins and, among these, protein/polymer conjugation resulted one of the most successful approaches. Thus, the surface modification of polypeptides of potential industrial interest by covalent attachment of different macromolecules is nowadays regarded as an extremely valuable technique to manipulate protein activities. Protein derivatives with a number of either natural or synthetic polymers, like different polysaccharides or polyethylene glycol, have been obtained by both chemical and enzymatic treatments, and in this context, the crosslinking enzyme transglutaminase is attracting an increasing attention as a simple and safe means for protein processing in vitro. In this short review, we summarized the most significant experimental findings demonstrating that a microbial form of the enzyme is an effective tool to obtain several biopolymer-based conjugates potentially useful for both food and pharmaceutical applications.

Evaluating the efficacy of an avian-specific probiotic to reduce the colonization of Campylobacter jejuni in broiler chickens.

Campylobacteriosis is the most frequent zoonotic disease in humans worldwide, and the contaminated poultry meat by Campylobacter jejuni can be considered one of the important sources of enteric infections in humans. The use of probiotics, which can help to improve the natural defense of animals against pathogenic bacteria, is an alternative and effective approach to antibiotic administration for livestock to reduce bacterial contamination. In vitro experiments showed that Enterococcus faecium, Pediococcus acidilactici, Lactobacillus salivarius, and Lactobacillus reuteri isolated from healthy chicken gut inhibited the growth of C. jejuni. To demonstrate this effect in vivo, 1-d-old broiler chicks received 2 mg/bird per day of a multispecies probiotic product via the drinking water. Controls received no probiotic treatment, and all chicks were infected with C. jejuni orally. Results showed that the cecal colonization by C. jejuni was significantly reduced by probiotic treatment at both 8 and 15 d postchallenge. To confirm this effect, in a second in vivo experiment, 1-d-old broiler chicks received the same dose of the same probiotic via the drinking water and controls received no probiotic, and all chicks were infected with C. jejuni orally. Similarly, probiotic treatment reduced (P=0.001) cecal colonization by C. jejuni at both 8 and 15 d postchallenge. The results of our in vivo experiments conclude that probiotic administration reduced the colonization of C. jejuni in broiler chickens.

Composite anatomical-clinical-molecular prognostic model in non-small cell lung cancer.

The objective of the present study was to elaborate a survival model that integrates anatomic factors, according to the 2010 seventh edition of the tumour, node and metastasis (TNM) staging system, with clinical and molecular factors. Pathologic TNM descriptors (group A), clinical variables (group B), laboratory parameters (group C) and molecular markers (tissue microarrays; group D) were collected from 512 early-stage nonsmall cell lung cancer (NSCLC) patients with complete resection. A multivariate analysis stepped supervised learning classification algorithm was used. The prognostic performance by groups was: areas under the receiver operating characteristic curve (C-index): 0.67 (group A), 0.65 (Group B), 0.57 (group C) and 0.65 (group D). Considering all variables together selected for each of the four groups (integrated group) the C-index was 0.74 (95% CI 0.70-0.79), with statistically significant differences compared with each isolated group (from p = 0.006 to p < 0.001). Variables with the greatest prognostic discrimination were the presence of another ipsilobar nodule and tumour size > 3 cm, followed by other anatomical and clinical factors, and molecular expressions of phosphorylated mammalian target of rapamycin (phospho-mTOR), Ki67cell proliferation index and phosphorylated acetyl-coenzyme A carboxylase. This study on early-stage NSCLC shows the benefit from integrating pathological TNM, clinical and molecular factors into a composite prognostic model. The model of the integrated group classified patients with significantly higher accuracy compared to the TNM 2010 staging.

Brain metastases from lung cancer responding to erlotinib: the importance of EGFR mutation.

Median survival of patients with brain metastases from nonsmall cell lung cancer (NSCLC) is poor and more effective treatments are urgently needed. We have evaluated the efficacy of erlotinib in this setting and its association with activating mutations in the epidermal growth factor receptor (EGFR) gene. We retrospectively identified patients with NSCLC and brain metastases treated with erlotinib. EGFR mutations in exons 19 and 21 were analysed by direct sequencing. Efficacy and tolerability were compared according to EGFR mutational status. 69 NSCLC patients with brain metastases were identified, 17 of whom harboured EGFR mutations. Objective response rate in patients with EGFR mutations was 82.4%; no responses were observed in unselected patients (p<0.001). Median (95% CI) time to progression within the brain for patients harbouring EGFR mutations was 11.7 (7.9-15.5) months, compared to 5.8 (5.2-6.4) months for control patients whose EGFR mutational status had not been assessed (p<0.05). Overall survival was 12.9 (6.2-19.7) months and 3.1 (2.5-3.9) months (p<0.001), respectively. The toxicity of erlotinib was as expected and no differences between cohorts were observed. Erlotinib is active in brain metastases from NSCLC; this clinical benefit is related to the presence of activating mutations in exons 19 or 21 of the EGFR gene.

Swelling, mechanical, and barrier properties of albedo-based films prepared in the presence of phaseolin cross-linked or not by transglutaminase.

Edible films were obtained from Citrus paradisi grapefruit albedo homogenates and bean protein phaseolin modified or not by the enzyme transglutaminase. Swelling capability, barrier performance to water vapor, oxygen and carbon dioxide, and mechanical properties of such films were investigated. The addition of the protein, mostly in the presence of transglutaminase, provide films less swellable at pH values above 5 compared to films made by albedo homogenates only, whereas the action of the enzyme clearly improves mechanical properties producing more stretchable and elastic films. Moreover, transglutaminase-mediated cross-linking of phaseolin gives rise to films less permeable to carbon dioxide and able to offer a high barrier to water vapor. These findings suggest that albedo-phaseolin film prepared in the presence of transglutaminase can be a promising candidate to be used as food edible wrap.

Sublobar resection for lung cancer.

Sublobar resection for small lung cancers has been debated frequently and is still a controversial issue. The only randomised trial comparing lobectomy with sublobar resections found a significantly higher recurrence rate for the latter, but failed to show significant differences in survival, although survival was better for the lobectomy group. One meta-analysis and several nonrandomised comparisons have confirmed these results. In general, lobectomy and sublobar resections have similar 5-yr survival rates. Local recurrence after wedge resection is higher than after segmentectomy. However, for patients aged >71 yrs, lobectomy and wedge resection are associated with similar survival. For tumours of /=1 cm wide to avoid recurrence. For pure bronchioloalveolar carcinoma of

Fennel waste-based films suitable for protecting cultivations.

Biodegradable, flexible, and moisture-resistant films were obtained by recycling fennel waste and adding to fennel homogenates the bean protein phaseolin that was modified or not modified by the enzyme transglutaminase. All films were analyzed for their morphology, mechanical properties, water vapor permeability, and susceptibility to biodegradation under soil-like conditions. Our experiments showed that transglutaminase treatment of the phaseolin-containing fennel waste homogenates allowed us to obtain films comparable in their mechanical properties and water vapor permeability to the commercial films Ecoflex and Mater-Bi. Furthermore, biodegradability tests demonstrated that the presence of the enzyme in the film-casting sample significantly influences the integrity of such a product that lasts longer than films obtained either with fennel waste alone or with a mixture of fennel waste and phaseolin. These findings indicate the fennel-phaseolin film prepared in the presence of transglutaminase to be a promising candidate for a new environmentally friendly mulching bioplastic.

Lesión quística mediastínica de histología indeterminada / Mediastinal cystic lesion of unknown histology

Los quistes mediastínicos son malformaciones benignas de origen congénito que representan el 20% del total de lesiones primarias del mediastino. Se clasifican según el tipo celular de revestimiento epitelial que contienen. En un 20% de los casos, debido a procesos infecciosos y/o hemorrágicos, se produce una desestructuración del epitelio originario, y es enestos casos cuando los denominamos quistes de histología indeterminada o inespecífica. Aunque existe una amplia variedad, tanto en histología como en localización, cuando presentan clínica lo hacen de forma similar. El dolor torácico es el síntoma más frecuente seguido de la tos, la disnea y la disfagia. Presentamos el caso de un varón de 45 años de edad que consultó por un dolor centrotorácico intenso de aparición brusca. La tomografía axial computarizada (TAC) y la resonanciamagnética (RM) evidenciaron una gran lesión quística que ocupaba el mediastino posterior. La ecoendoscopiaesofágica descartó el origen esofágico de la lesión. Se intervino el paciente mediante toracotomía posterolateral derecha y se realizó la exéresis de la lesión. El curso postoperatorio transcurrió sin complicaciones. El diagnóstico histopatológicoconcluyó que se trataba de una lesión quística de histología indeterminada

Mediastinal cysts are uncommon congenital and benign malformations that represent 20% of all primary mediastinal lesions. They are classified by their specific histologic features. 20% of mediastinal cysts lack specific histologic features, possibly because of haemorrhage or infection, and are termed indeterminate or non-specific cysts. Despite varied location and histology, clinical presentation of mediastinal cysts is similar. Chest pain is the most common symptom followed by cough, dyspnoea and dysphagia. We report the case of a 45-year-old man who sought medical attention for acute chest pain. Computed tomography and magnetic resonance showed a large cystic lesion in the posterior mediastinum. Endoscopic ultrasound excluded a communication of the cyst with the oesophagus. The tumor was resected through a right thoracotomy. No postsurgical complications occurred. The histopathological diagnosis was cystic lesion of nonspecific histology2