Dredged sediments as a plant-growing substrate: Estimation of health risk index.

Dredging of sediments is conducted worldwide to maintain harbours and water bodies. As a result, large amounts of materials generated require proper management and could have useful applications in a circular economy context. The current use of peat as organic material in cultivating plants requires urgent replacement by more sustainable alternatives. In this context, using nutrient-rich sediments generated by dredging could be an attractive option. However, due to contaminants in dredged sediments, more investigations are required. The present study investigated the potential to employ dredged material as a plant-growing substrate to cultivate lettuce (Lactuca sativa). The study employed compost and dredged sediments from Malmfjärden Bay, Sweden, with low and high nutritional content (LN and HN, respectively), with and without polymer (PO) used for dewatering. The tests were carried out under controlled conditions in a greenhouse, and the studied substrates were (% vol): (1) 100 % sediment (100SHN); (2) 50 % sediment +50 % compost (50SLN-50C); (3) 70 % sediment +30 % compost (70SLN-30C); (4) 50 % polymer sediment +50 % compost (50SPO-50C); and (5) 100 % compost (100C). Fertilisers were added to 50SLN-50C and 70SLN-30C during the experiment. Lettuces with the highest weight were harvested from substrates 100C, 50SPO-50C and 50SLN-50C. However, the lettuces only reached a weight of 18.57 ± 4.67 g. The results showed that a main limitation of the growth was probably a lack of aeration of the sediments during sampling and development of the experiment. The low aeration possibly caused a lack of available forms of N in the substrates, hindering the growth. Lettuces harvested from substrates containing sediments presented Cd concentrations slightly overpassing the Swedish thresholds, and the health risk index was marginally exceeding 1. Hence, sediments need to be pre-treated before using them to cultivate edible crops, or they could be employed to cultivate ornamental or bioenergy plants.

The impact of chronic kidney disease on lower extremity bypass outcomes in patients with critical limb ischemia.

OBJECTIVE: Patient selection for open lower extremity revascularization in patients with chronic kidney disease (CKD) remains a clinical challenge. This study investigates the impact of CKD on early graft failure, postoperative complications, and mortality in patients undergoing lower extremity bypass for critical limb ischemia. METHODS: The National Surgical Quality Improvement Program database was queried for all patients with critical limb ischemia from 2012 to 2015 who underwent lower extremity bypass using the targeted vascular set. The glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration Study equation. CKD categories were determined from the National Kidney Foundation Kidney Disease Outcomes Quality Initiative staging criteria. Patients were classified into three groups: CKD stages 3 or lower (mild to moderate CKD), CKD stages 4 or 5 (severe CKD), and on hemodialysis (HD). Multiple variable analysis was used to examine graft failure, mortality, and postoperative complications. RESULTS: The Surgical Quality Improvement Program database identified 6978 patients who underwent infrainguinal lower extremity arterial bypass during the study period. There were 6101 patients (87.4%) with mild to moderate CKD, 327 (4.7%) with severe CKD, and 550 (7.9%) on HD. Patients with severe CKD and on HD were more likely to have revascularization for tissue loss (54.9% vs 68.8% and 74.7%; P < .01). Patients with severe CKD and those on HD had higher rates of early graft failure, postoperative myocardial infarction, and rates of reoperation. Multiple variable analysis confirmed these results showing that HD was associated with postoperative myocardial infarction, readmission, and increased mortality. It also demonstrated that severe CKD was associated with graft failure (odds ratio [OR], 1.67; 95% confidence interval [CI], 1.12-2.50; P = .01), postoperative myocardial infarction (OR, 2.16; 95% CI, 1.35-3.45; P < .01), and readmission (OR, 1.38; 95% CI, 1.06-1.80; P = .02). Other factors associated with graft failure include functional status (OR, 1.39; 95% CI, 1.08-1.80; P = .01), African American race (OR, 1.72; 95% CI, 1.39-2.13; P < .01), and distal bypass (OR, 1.33; 95% CI, 1.09-1.61; P < .01). CONCLUSIONS: CKD is a significant predictor of perioperative morbidity after lower extremity bypass. Patients with severe CKD have worse postoperative outcomes without increased mortality. Those on HD have worse survival and postoperative outcomes.

Phosphorus Leaching from an Organic and a Mineral Arable Soil in a Rainfall Simulation Study.

Phosphorus derived from agricultural systems has been found to cause eutrophication of surface waters. To combat this, the specific location of soil profile P release is necessary for development of effective mitigation strategies. This paper describes a P leaching study of two Swedish arable soils, an organic (Typic Haplosaprist) and a mineral soil (Typic Hapludalf), both with high P content. Undisturbed soil columns isolated 0- to 20-, 20- to 40-, 40- to 60-, and 60- to 80-cm depth intervals. These were placed in a rainfall simulator and subjected to four 50-mm rainfall events to identify the origin of P leachate as a function of soil depth interval and physicochemical properties. Phosphorus losses were greatest from the two uppermost layers of both soils after 200 mm of artificial rainfall was applied at 5 mm h. Total P concentration in leachate from the 0- to 20-cm layer ranged from 2.1 to 8.8 mg L for the mineral and 3.7 to 10.3 mg L from the organic soil, with most (95-100%) in dissolved reactive P form. Degree of P saturation correlated well with total P leaching losses from the organic soil ( = 0.84) but not the mineral soil ( = 0.69), suggesting that the presence of Al and Fe (hydr)oxides has a stronger influence on P leaching in the organic soil. Results indicate that both soils have the potential to contribute concentrations of P above those known to cause eutrophication of surface waters.

Long-Term Outcomes of Fistula First Initiative in an Urban University Hospital-Is It Still Relevant?

PURPOSE: Dialysis access failure is a major cause of morbidity in patients with end-stage renal disease. The Fistula First Breakthrough Initiative (FFBI) dictates arteriovenous fistulae (AVFs) should be preferred over arteriovenous grafts (AVGs) as first line for surgically placed accesses. The purpose of this study was to compare patency rates of surgical dialysis accesses in our mature, urban population after the FFBI. METHODS: Current dialysis patients with accesses placed between 2006 and 2011 were included. Patient characteristics, access outcomes, interventions, and survival outcomes were analyzed. RESULTS: We report outcomes of 220 patients undergoing dialysis access. Of those 220, 75 received numerous accesses. All outcomes are evaluated as per access itself, that is, a patient may have numerous access types, each individually analyzed. Of the accesses, 138 were AVF and 190 were AVG. The average age of patients was 59.8 years. The groups were evenly matched in distribution of race and prevalence of hypertension, diabetes, coronary artery disease, and Peripheral Vascular Disease (PVD). Average number of complications requiring intervention per access were fewer with AVF than AVG (1.21 vs 1.72, P = .02). The AVF had greater rates of stenosis (51.4% vs 40.6%, P = .0182), whereas AVG had greater thrombosis rates (14.6% vs 31.9%, P < .001). Both AVF and AVG had similar primary patency (median: 186 vs 142 days, P = .1774) and 3-year secondary patency (59.2% vs 49.2%, P = .0945). Arteriovenous fistula in patients aged <60 years was found to have the greatest primary ( P = .0078) and secondary patency ( P = .0400). Outcomes did not differ between AVF and AVG in those aged >60 years. CONCLUSIONS: Although complications requiring intervention are greater with AVG, primary and secondary patency rates are similar between AVF and AVG, except when considering AVF in patients aged <60 years.

Applicability of models to predict phosphorus losses in drained fields: a review.

Most phosphorus (P) modeling studies of water quality have focused on surface runoff loses. However, a growing number of experimental studies have shown that P losses can occur in drainage water from artificially drained fields. In this review, we assess the applicability of nine models to predict this type of P loss. A model of P movement in artificially drained systems will likely need to account for the partitioning of water and P into runoff, macropore flow, and matrix flow. Within the soil profile, sorption and desorption of dissolved P and filtering of particulate P will be important. Eight models are reviewed (ADAPT, APEX, DRAINMOD, HSPF, HYDRUS, ICECREAMDB, PLEASE, and SWAT) along with P Indexes. Few of the models are designed to address P loss in drainage waters. Although the SWAT model has been used extensively for modeling P loss in runoff and includes tile drain flow, P losses are not simulated in tile drain flow. ADAPT, HSPF, and most P Indexes do not simulate flow to tiles or drains. DRAINMOD simulates drains but does not simulate P. The ICECREAMDB model from Sweden is an exception in that it is designed specifically for P losses in drainage water. This model seems to be a promising, parsimonious approach in simulating critical processes, but it needs to be tested. Field experiments using a nested, paired research design are needed to improve P models for artificially drained fields. Regardless of the model used, it is imperative that uncertainty in model predictions be assessed.

Temporary femoral artery bifurcation shunting following penetrating trauma.

Penetrating common femoral artery injuries are life-threatening, especially when the femoral bifurcation has been destroyed. In the presence of other associated injuries which preclude immediate definitive vascular reconstruction, temporary arterial shunting may be useful. Presently available shunts, however, are tubular and allow for distal perfusion to only one vessel. We have utilized a modified bifurcated hemodialysis catheter (Mahurkar MAXID; Tyco Healthcare, Mansfield, Mass) to successfully provide simultaneous perfusion from the proximal common femoral artery to both the superficial and deep femoral vessels. Such catheters are readily available in most institutions, can be quickly modified, and are easy use in urgent trauma situations.

Managing PAD with multiple platelet inhibitors: the effect of combination therapy on bleeding time.

PURPOSE: Patients with lower-extremity peripheral arterial disease (PAD) face a high risk of cardiovascular morbidity and mortality. Platelet inhibition (PI) significantly reduces this risk. Combination PI is common and increasingly indicated in patients with PAD; however, the effect on platelet function has not been objectively evaluated. Aspirin (ASA), clopidogrel (Clop), and cilostazol (Cilo) are the three most commonly used PI drugs in patients with PAD. A prospective, sequential evaluation of platelet function using the template bleeding time (BT) was performed for PAD patients taking these medications singly and in combination. METHODS: Twenty-one patients with PAD, averaging 65.9 years of age, were studied. Patients were placed on sequential two-week regimens of the following therapies: washout (no PI), ASA (325 mg daily), ASA + Cilo (100 mg twice daily), washout, Cilo, Cilo + Clop (75 mg each day), washout, Clop, Clop + ASA, and Clop + ASA + Cilo. At the end of each phase, trained personnel measured the BT. RESULTS: Baseline bleeding time for the group was 4.29 +/- 1.69 minutes. ASA (BT = 6.64 +/- 3.52) and Clop (BT = 10.17 +/- 5.4) significantly prolonged bleeding time (P < 0.01); however, no significant effect was observed with Cilo alone (BT = 5.41 +/- 2.69). Combined treatment with ASA + Clop (BT = 17.39 +/- 4.59) had a more pronounced effect on BT compared with either agent alone (P < 0.01). The addition of Cilo to either ASA (BT = 8.3 +/- 4.27) or Clop (BT = 12.7 +/- 7.46) or the combination of ASA + Clop (BT = 17.92 +/- 4.69) did not prolong BT. CONCLUSION: All patients with PAD require platelet inhibition, and many require pharmacotherapy for intermittent claudication. The platelet inhibitors aspirin and clopidogrel are used for the reduction of ischemic events. They significantly prolong bleeding time individually and to a greater extent in combination. Cilo is used to improve walking distance in patients with intermittent claudication. When Cilo is added to ASA, Clop, or the combination of the two, there is no additional increase in bleeding time. Therefore, Cilo can be used in combination with other platelet inhibitors without an additional effect on platelet function as reflected by the bleeding time.

Lipid-induced insulin resistance in human muscle is associated with changes in diacylglycerol, protein kinase C, and IkappaB-alpha.

The possibility that lipid-induced insulin resistance in human muscle is related to alterations in diacylglycerol (DAG)/protein kinase C (PKC) signaling was investigated in normal volunteers during euglycemic-hyperinsulinemic clamping in which plasma free fatty acid (FFA) levels were increased by a lipid/heparin infusion. In keeping with previous reports, rates of insulin-stimulated glucose disappearance (G(Rd)) were normal after 2 h but were reduced by 43% (from 52.7 +/- 8.2 to 30.0 +/- 5.3 micromol. kg(-1). min(-1), P < 0.05) after 6 h of lipid infusion. No changes in PKC activity or DAG mass were seen in muscle biopsy samples after 2 h of lipid infusion; however, at approximately 6 h, PKC activity and DAG mass were increased approximately fourfold, as were the abundance of membrane-associated PKC-betaII and -delta. A threefold increase in membrane-associated PKC-betaII was also observed at approximately 2 h but was not statistically significant (P = 0.058). Ceramide mass was not changed at either time point. To evaluate whether the fatty acid-induced insulin activation of PKC was associated with a change in the IkB kinase (IKK)/nuclear factor (NF)-kappaB pathway, we determined the abundance in muscle of IkappaB-alpha, an inhibitor of NF-kappaB that is degraded after its phosphorylation by IKK. In parallel with the changes in DAG/PKC, no change in IkappaB-alpha mass was observed after 2 h of lipid infusion, but at approximately 6 h, IkappaB-alpha was diminished by 70%. In summary, the results indicated that the insulin resistance observed in human muscle when plasma FFA levels were elevated during euglycemic-hyperinsulinemic clamping was associated with increases in DAG mass and membrane-associated PKC-betaII and -delta and a decrease in IkappaB-alpha. Whether acute FFA-induced insulin resistance in human skeletal muscle is caused by the activation of these specific PKC isoforms and the IKK-beta/IkappaB/NFkappaB pathway remains to be established.

Naked plasmid DNA encoding fibroblast growth factor type 1 for the treatment of end-stage unreconstructible lower extremity ischemia: preliminary results of a phase I trial.

OBJECTIVE: The objective of this study was to evaluate the safety and tolerance of increasing single and repeated (n = 2) doses of intramuscular naked plasmid DNA encoding for fibroblast growth factor (FGF) type 1 (NV1FGF) administered to patients with unreconstructible end-stage peripheral arterial occlusive disease (PAD). The secondary objectives were to determine the biologic activity of NV1FGF on hemodynamic and clinical parameters associated with improved perfusion. METHODS: Fifty-one patients with unreconstructible peripheral arterial occlusive disease with rest pain or tissue necrosis underwent treatment with intramuscular NV1FGF. Increasing single (500, 1000, 2000, 4000, 8000, and 16,000 microg) and repeated (2 x 500, 2 x 1000, 2 x 2000, 2 x 4000, and 2 x 8000 microg) doses of NV1FGF were injected into the ischemic thigh and calf. Arteriography was performed before treatment and was repeated 12 weeks after treatment. Side effects and serious adverse events were monitored. Measurements of plasma and urine levels were performed to evaluate NV1FGF plasmid distribution. Serum FGF-1 was measured as an analysis of gene expression at the protein level. Transcutaneous oxygen pressure, ankle brachial index, toe brachial index, pain assessment with visual analog scale, and ulcer healing also were assessed. The safety results are presented for 51 patients, and the clinical outcomes are presented for the first 15 patients (500 to 4000 microg) who completed the 6-month follow-up study. RESULTS: NV1FGF was well tolerated. Sixty-six serious adverse events were reported; however, none were considered to be related to NV1FGF. Four patients had adverse events that were possibly or probably related to the study treatment: injection site pain, pain, peripheral edema, myasthenia, and paresthesia. No laboratory adverse events were related to the study treatment. Two deaths remote from the treatment were considered not related. Biodistribution of plasmid was limited and transient in plasma and absent in urine. No increase in the FGF-1 serum level was detected. A significant reduction in pain (P <.001) and aggregate ulcer size (P <.01) was associated with an increased transcutaneous oxygen pressure (P <.01) as compared with baseline pretreatment values. A significant increase in ankle brachial index (P <.01) was seen. CONCLUSION: NV1FGF is well tolerated and potentially could be effective for the treatment of patients with end-stage limb ischemia. Biologic parameters indicate improved perfusion after NV1FGF administration. Dose response is not yet evident. The safety of NV1FGF and the magnitude of improvement observed in this study encourage further investigation with a placebo-controlled, double-blind clinical trial.