Improving biological removal of pharmaceutical active compounds and estrogenic activity in a mesophilic anaerobic osmotic membrane bioreactor treating municipal sewage.

The contamination of water sources by pharmaceutically active compounds (PhACs) and their effect on aquatic communities and human health have become an environmental concern worldwide. Membrane bioreactors (MBRs) are an alternative to improve biological removal of recalcitrant organic compounds from municipal sewage. Their efficiency can be increased by using high retention membranes such as forward osmosis (FO) and membrane distillation (MD). Thus, this research aimed to evaluate the performance of an anaerobic osmotic MBR coupled with MD (OMBR-MD) in the treatment of municipal sewage containing PhACs and estrogenic activity. A submerged hybrid FO-MD module was integrated into the bioreactor. PhACs removal was higher than 96% due to biological degradation, biosorption and membrane retention. Biological removal of the PhACs was affected by the salinity build-up in the bioreactor, with reduction in biodegradation after 32 d. However, salinity increment had little or no effect on biosorption removal. The anaerobic OMBR-MD removed >99.9% of estrogenic activity, resulting in a distillate with 0.14 ng L-1 E2-eq, after 22 d, and 0.04 ng L-1 E2-eq, after 32 d. OMBR-MD treatment promoted reduction in environmental and human health risks from high to low, except for ketoprofen, which led to medium acute environmental and human health risks. Carcinogenic risks were reduced from unacceptable to negligible, regarding estrogenic activity. Thus, the hybrid anaerobic OMBR-MD demonstrated strong performance in reducing risks, even when human health is considered.

Integration of ozonation and an anaerobic expanded granular sludge bed reactor for micropollutant removal from sewage.

Conventional sewage treatment systems are generally not designed to remove micropollutants, requiring the development of new technologies, such as the combination of biological processes with advanced oxidative processes. The configuration of an anaerobic expanded granular sludge bed (EGSB) reactor stands out for its use of granular biomass and high sludge bed expansion. Ozonation is an advanced oxidative process that stands out as one of the most promising technologies for the degradation of micropollutants. Thus, the present work aimed to evaluate the removal of drugs through the application of ozonation as a polishing process for the effluent of an EGSB reactor that was fed with synthetic sewage. Ozonation was shown to be efficient in the degradation of these compounds, reaching removals above 90%. It was found that the degradation profile of each drug varied according to its chemical structure since some drugs are more susceptible to oxidation than others and since the concentrations of pharmaceuticals are also related to their removal. Moreover, the assessment of risks to the environment and human health confirmed the need to assess the best scenario for risk reduction considering all drugs, since even with almost complete removal of some compounds, the effluents still showed toxicity. Thus, the high removal efficiencies found for the evaluated micropollutants showed that this technique has the potential to be used to improve the quality of biological reactor effluents or even to be combined in effluent reuse systems.

Polycomb-mediated repression of EphrinA5 promotes growth and invasion of glioblastoma.

Glioblastoma (GBM) is the most common and most aggressive intrinsic brain tumour in adults. Integrated transcriptomic and epigenomic analyses of glioblastoma initiating cells (GIC) in a mouse model uncovered a novel epigenetic regulation of EfnA5. In this model, Bmi1 enhances H3K27me3 at the EfnA5 locus and reinforces repression of selected target genes in a cellular context-dependent fashion. EfnA5 mediates Bmi1-dependent proliferation and invasion in vitro and tumour formation in an allograft model. Importantly, we show that this novel Polycomb feed-forward loop is also active in human GIC and we provide pre-clinical evidence of druggability of the EFNA5 signalling pathway in GBM xenografts overexpressing Bmi1.

Removal of organic matter of electrodialysis reversal brine from a petroleum refinery wastewater reclamation plant by UV and UV/H202 process.

Direct (UV) and hydrogen peroxide-assisted (UV/H2O2) photolysis were investigated in bench-scale for removing the organic compounds present in the electrodialysis reversal (EDR) brine from a refinery wastewater reclamation plant. In the UV/H2O2 experiments, a COD:H2O2 molar ratios of 1:1, 1:2 and 1:3 were tested by recirculating the brine in the UV reactor for 120 min. Results showed a significant reduction in UVA254, whereas no reduction was observed for chemical oxygen demand (COD), in the UV process, suggesting great cleavage but limited mineralization of the organic matter. UV/H2O2 with C:H2O2 ratio of 1:3 exhibited high efficiency in removing the organic matter (COD removal of 92% with an electrical energy per removal order (EEO) value of 22 kW h m-3). Although the EDR brine has high salinity, no strong scavenging effect of •OH was found in the water matrix due to the high concentration of anions, especially chloride and bicarbonate. Finally, UV/H2O2 with C:H2O2 ratio of 1:3 and residence time of 120 min is an efficient alternative for organic matter removal of EDR brine from refinery wastewater reclamation plant showing total capital cost (CapEx) estimated at US$ 369,653.00 and total operational cost (OpEx), at US$ 1.772 per cubic meter of effluent.

Sugarcane vinasse treatment by two-stage anaerobic membrane bioreactor: Effect of hydraulic retention time on changes in efficiency, biogas production and membrane fouling.

This research investigated the effect of hydraulic retention time (HRT) on two-stage anaerobic membrane bioreactor (2-SAnMBR) performance treating sugarcane vinasse. The experimental setup consisted of an upflow acidogenic reactor and a continuous stirred methanogenic reactor, fitted with submersed microfiltration hollow-fiber membranes. The results indicated excellent performance and robustness of 2-SAnMBR. The reduction in HRT of 5.3-3.1days did not cause loss of its performance. The 2-SAnMBR showed high capacity of removing organic matter (97%), producing biogas (6.3Nm3 of CH4 per m3 of treated vinasse) and did not completely remove important nutrients to fertigation. Reducing the HRT, the average mass of soluble microbial products (SMP) and extracellular polymeric substances (EPS) per mass of mixed liquor volatile suspended solids (MLVSS) increased. Consequently, the transmembrane pressure (TPM) rate and fouling resistance rise. Despite the fouling effect, physical and chemical cleaning processes were able to recover operational permeability.

Aflatoxin B1 Risk Management in Parmigiano Reggiano Dairy Cow Feed.

This study investigated aflatoxin B1 (AFB1) contamination in dairy cow feed and the risk management of AFB1 content in concentrates undertaken by feed industries in the Parmigiano Reggiano area. Data on aflatoxin contamination risk management applied in 29 feed industries were collected and the AFB1 content of 70 feed samples was analysed. Data were collected within the framework of a quality control programme promoted by the Parmigiano Reggiano Consortium in 2013 and 2014. Audit results showed that the control procedures to prevent AFB1 contamination mainly focused on maize and its by-products. AFB1 concentration resulted lower than 5 ppb [legal European Union (EU) limit] in all samples; in one out of 70 samples, AFB1 content was 3.8 ppb and in all the other samples it was lower than 3 ppb. Results showed that AFB1 risk management applied by Italian feed industries effectively monitors AFB1 levels in feed below the EU legal limit.

Assessment of nanofiltration and reverse osmosis potentialities to recover metals, sulfuric acid, and recycled water from acid gold mining effluent.

This work assessed the potential of nanofiltration (NF) and reverse osmosis (RO) to treat acid streams contaminated with metals, such as effluent from the pressure oxidation process (POX) used in refractory gold ore processing. NF and RO were evaluated in terms of rejections of sulfuric acid and metals. Regarding NF, high sulfuric acid permeation (∼100%), was observed, while metals were retained with high efficiencies (∼90%), whereas RO led to high acid rejections (<88%) when conducted in pH values higher than 1. Thus, sequential use of NF and RO was proved to be a promising treatment for sulfuric acid solutions contaminated by metals, such as POX effluent. In this context, a purified acid stream could be recovered in NF permeate, which could be further concentrated in RO. Recovered acid stream could be reused in the gold ore processing or commercialized. A metal-enriched stream could be also recovered in NF retentate and transferred to a subsequent metal recovery stage. In addition, considering the high acid rejection obtained through the proposed system, RO permeate could be used as recycling water.

Pilot aerobic membrane bioreactor and nanofiltration for municipal landfill leachate treatment.

The purpose of this article is to evaluate the integration of the air stripping, membrane bioreactor (MBR) and nanofiltration (NF) processes for the treatment of landfill leachate (LFL). Pretreatment by air stripping, without adjustment of pH, removed 65% of N-NH3 present in LFL. After pretreatment, the effluent was treated in MBR obtaining 44% of COD removal, and part of the N-NH3 was converted to nitrite and nitrate, which was later removed in the post-treatment. Nanofiltration was shown to be an effective process to improve the removal of organic compounds, the high toxicity present in LFL and nitrite and nitrate generated in the MBR. The system (air stripping + MBR + nanofiltration) obtained great efficiency of removal in most parameters analyzed, with overall removal of COD, ammonia, color and toxicity approximately 88, 95, 100 and 100%, respectively. By this route, treated landfill leachate may be reused at the landfill as water for dust arrestment and also as earth work on construction sites.

Gossypol Content of Cotton Free Commercial Feed for Dairy Cows.

Gossypol is a yellow pigment occurring in all parts of cotton plants, with the highest levels found in seeds, and it exhibits a variety of toxic effects. Few data are available on the content of gossypol in the commercial complementary feed and in feed raw materials. The present study was focused on the investigation of the presence of free gossypol in commercial complementary feed not containing cotton. A total of 50 samples of commercial complementary feed for dairy cows were performed in 29 feed mills both using and not using cotton as feed material. The free gossypol contamination resulted under the detection limit of the technique (4 mg/kg) in 12 out of 50 samples analysed and ranged from 4 to 20 mg/kg in 28 samples. In 10 samples the level of free gossypol ranged from 20 to 29.5 mg/kg. Average contamination of samples was 12.2±9.2 SD mg/kg. No significant difference (P=0.571) was shown in free gossypol concentration between feed produced in cotton free plants and in plants where cotton is used as feed material. Free gossypol content detected in the present study allows considering complementary feed for dairy cows not at risk. On the other hand, the detection of free gossypol in cotton free complementary feed, probably attributable to cross contamination of feed materials upstream of the feed mill, should be further investigated.

Role of sphingosine kinase/S1P axis in ECM remodeling of cardiac cells elicited by relaxin.

The initiation and progression of heart failure is linked to adverse cardiac remodeling of the extracellular matrix (ECM) during disease mainly through the deregulation of myocardial metalloproteinases (MMPs). Relaxin (RLX), a peptide hormone acting as a physiological cardiac effector, is a key regulator of ECM remodeling in reproductive and nonreproductive tissues. Studying primary cultures of mouse cardiac muscle cells and rat H9c2 cardiomyoblasts, we have obtained evidence for a new signaling pathway activated by RLX to induce ECM remodeling that involves the bioactive sphingolipids sphingosine-1-phosphate (S1P) and ceramide. In both cell populations, recombinant human RLX increased sphingosine kinase activity and S1P formation, whereas sphingomyelin and ceramide content were decreased in [(3)H]serine-labeled cells. According to the literature, RLX promoted MMP-2 and MMP-9 expression/release. Pharmacological inhibition of sphingolipid metabolism and silencing of sphingosine kinase 1, the enzyme responsible for S1P formation, were able to prevent MMP expression/release elicited by the hormone and induce the expression of tissue inhibitor of MMPs. In addition, we found that sphingolipid signaling is required for the regulation of connective tissue growth factor, a member of the CCN 1-3 family of genes that are involved in cell proliferation and differentiation. Finally, the induction of cardiomyoblast maturation induced by RLX was also found to be counteracted by inhibition of S1P formation. In conclusion, these findings provide a novel mechanism by which RLX acts on cardiac ECM remodeling and cardiac cell differentiation and offer interesting therapeutic options to prevent heart fibrosis and to favor myocardial regeneration.

A cross selectional survey in a critical care: the job satisfaction and functioning team of the health professionals.

BACKGROUND AND AIM OF THE WORK: Health care workers, especially those who are part of the OS core, are essential in the delivery of services, as they represent the institution at the time of the contact with the user and they represent also the image of the organization. Health administrations, therefore, are called to improve the performance through a better motivation and satisfaction of the staff, in view of two strategic aspects: job satisfaction of professionals and team collaboration. METHOD: Between January and September 2014, a survey at the OU (UUOO) intensive care and sub intensive has been made inside three hospitals in Emilia Romagna. It' s been a multicentre cross-sectional quantitative study by administering a self-report questionnaire designed to investigate the different constructs. On 742 questionnaires were spread 454 professionals gave it back  (response rate = 73%). Of those, 273 (60.1%) were nurses, 119 (26.2%) were physicians and 62 (13.7%) were healthcare operators. 62 (13.7%) Job Satisfaction was measured with the McCloskey Mueller Satisfaction Scale. Team Functioning was measured with the Index of Interprofessional Team Collaboration. RESULTS: Results from MANOVA indicated that physicians were less satisfied of scheduling than both nurses and healthcare operators. For professional opportunities, instead, healthcare operators showed the lower level of satisfaction. The participants seem to perceive a high level of team effectiveness and therefore the professionals involved in the care of critically ill patients than the two dimensions analysed, (reflection between the processes and interdependent roles), also state a greater tendency to respect the roles interdisciplinary, maintaining their professional autonomy and a lower tendency to use critical thinking to act professionally in order to improve the effectiveness of care provided. CONCLUSION: The study results oriented healthcare administrators, to take paths that feed the job satisfaction and the collaboration of professionals by developing the aspects investigated. Considering the shared perception among the professions studied, compared to the constructs under investigation, it seems to be clear how the routes should be designed in a systematic order to involve, in an integrated way the best professionals (nurses, doctors and OSS) involved in taking managing critical patients. No statistically significant difference have been found between these three professions considered, on most dimensions of job satisfaction investigated (relations between colleagues, 'social interactions, work-family balance, time work organization and working professional opportunity). There is a difference between two specific factors: the work time planning organization and wich is seen less by the nurses, while the job opportunities that are perceived less from the OOS.

Stapled transanal rectal resection for outlet obstruction syndrome: results and follow-up.

BACKGROUND: The objective of the present study was to assess safety, effectiveness, and long-term outcomes of stapled transanal rectal resection (STARR) for the cure of outlet obstruction syndrome (OOS). METHODS: Data were collected over a 3-year period (2004-2007), at the Department of Surgery of the University of Genoa, from 25 consecutive subjects (19 of them females) undergoing STARR because of OOS that had not responded to medical treatment,. RESULTS: Preoperatively, patients were submitted to clinical examination, defecography, colonoscopy, manometry, and recto-anal reflexes determination. All patients had mucosal prolapse, 15 rectal intussusception, 15 rectocele. Postoperatively no deaths were observed; one patient had a hemorrhage requiring reintervention. Mean time to resumption of normal activity was 8.5 +/- 4.5 days. Patients were followed for a mean of 24.7 +/- 10.9 months (range: 6-42 months). Late specific complications included 3 cases of urge to defecate, 8 of incontinence to flatus. Functional outcome was positive for 22 patients (excellent in 4 cases, good in 15, fairly good in 3). Six months postoperatively (25 s), patients had improvement of the mean Constipation Score (p = 0.0002), less pain during evacuation (p = 0.0003), and reduced use of digital assistance to defecate (p < 0.0001). Continence Grading Scale and enema use remained stable after intervention. Patients had increase in basal sphincter pressure (p = 0.0078) and maximal squeeze pressure (p = 0.0051). Recto-anal reflex study showed increase in abdominal pain threshold (p < 0.0001); anal sphincter relaxation threshold and desire to defecate threshold did not change. CONCLUSIONS: According to the present study, STARR seemed to be a safe and effective treatment for OOS associated with symptomatic rectocele and intussusception.

[Crohn's disease surgery: problems of postoperative recurrence]. / La chirurgia della malattia di Crohn: problematiche delle recidive postoperatorie.

Crohn's disease is associated with high rates of postoperative recurrence. By 10 years postoperatively a high percentage of patients suffer clinical relapses (as many as 75% and above) and many of these (up to 45%) require re-intervention. The aim of the study was to identify, among the various potentially predictive factors, those which today can be considered real risk factors for postoperative recurrence. A review of the literature of the last two decades was carried out. Factors related to the patient, disease, type of surgery and pharmacological treatment were analysed. The relapse rate we recorded was 41.17% (28 of 62 patients operated on in the last 20 years and included in an average 6-year follow-up (range: 1-19 years). Significant predictive factors, in adition to duration of the follow-up and smoking, are also the location of the disease in the colon, extent more than 100 cm and the absence of postoperative pharmacological prophylaxis. The high incidence of postoperative recurrence in Crohn's disease mandates a strict follow-up (clinical, laboratory and instrumental monitoring). Identifying patients at increased risk would enable physicians to implement a rational pharmacological prophylaxis.

[Transcutaneous excision of the submandibular and sublingual glands: notes on anatomy and surgical technique]. / Exeresi delle ghiandole sottomandibolari e sottoinguali per via transcutanea: note di anatomia e di tecnica chirurgica.

Removal of the submandibular and sublingual glands requires in-depth knowledge of the anatomy and scrupulous technique for the purposes of limiting the functional and aesthetic damage, which is unjustifiable above all in the treatment of benign lesions (sialodenitis, lithiasis). After presenting the main aspects of the surgical anatomy of the submandibular space, the operative technique for its dissection with removal of the submandibular gland and excision of the sublingual gland is described. The complexity of the anatomical structures that may be involved in submandibular and sublingual gland lesions is the cause of unsatisfactory functional and aesthetic outcomes in some cases. The most feared complications are lesions to nerve formations, due both to the resulting deficits and the possible legal implications.

Appendectomy or right hemicolectomy in the treatment of appendiceal carcinoid tumors?

AIMS AND BACKGROUND: Carcinoids of the appendix continue to be of interest, despite their low incidence. There is still considerable controversy surrounding these tumors, especially with regard to the role of right hemicolectomy in the surgical management. The aim of this work was to explicate the current therapeutic knowledge and to review the criteria for the indications of appendectomy or hemicolectomy. METHODS: The records of patients who underwent appendectomies from 1990 to 2000 were analyzed. Seven patients were included in the study. The clinical data were reviewed for demographic details, tumor size, localization in the appendix, histological patterns and surgical procedures. All patients underwent appendectomy including removal of the mesenteriolum, and in one of them a right hemicolectomy was performed 3 weeks later. The mean follow-up was 7 years (range, 4-14). Follow-up data included symptoms, urinary 5-hydroxyindoleacetic acid, ultrasound examination, computerized tomography, and octreotide scanning. RESULTS: Seven patients (0.9% of all appendectomies) were reported to have carcinoid tumors of the appendix. They were 3 men and 4 women with a mean age of 29 years. All patients were admitted for appendicitis. None suffered from the carcinoid syndrome. The site of the tumor was the apex of the appendix in 4 cases, the body in 2 cases and the base in 1 case. Mean tumor diameter was 8 mm (range, 5-29 mm); in 6 patients it was <2 cm. Treatment was appendectomy in all cases; additional right hemicolectomy was necessary in one case because of a tumor of more than 2 cm with invasion of the mesoappendix and lymph nodes. The 7-year survival rate is 100%. Six patients are without disease, while 1 patient (the one who underwent a right hemicolectomy) developed metastases in the liver 6 years after the operation. This patient, who was treated with a liver resection, is still alive. CONCLUSIONS: According to current guidelines, an appendectomy may be performed for small carcinoid tumors (<1 cm). Reasons for more extensive surgery than appendectomy are tumor size >2 cm, lymphatic invasion, lymph node involvement, spread to the mesoappendix, tumor-positive resection margins, and cellular pleomorphism with a high mitotic index. The criteria that direct us towards major (hemicolectomy) or minor surgery (appendectomy) are controversial. Tumor size is still considered the most important prognostic factor, with a presumed increase in the risk of metastasis for tumors greater than 2.0 cm. The accepted treatment of such tumors is a right hemicolectomy. However, there is no evidence demonstrating a survival benefit for right hemicolectomy over simple appendectomy in patients with carcinoids greater than 2.0 cm in diameter.