Metastatic Cervical Cancer: A Case That Recalls the Importance of a Multidisciplinary Approach.

Cervical cancer is one of the most common neoplasms in women. Usually, this cancer is only symptomatic in advanced stages and is associated with a poor prognosis. We present the case of a 34-year-old woman with localized cervical cancer at diagnosis treated with surgery in 2011. Six years later, she presented recurrent disease with vaginal, pelvic, and lung metastases. Since then, the patient completed three lines of chemotherapy and a line of immunotherapy, and she was submitted to external radiotherapy and orthopedic surgery. Currently, the patient keeps regular follow-ups and maintains a good performance status. The treatment of recurrent cervical cancer remains a challenge, and the prognosis is poor. This case emphasized the importance of multidisciplinary discussion towards cases of locally advanced or metastatic cervical cancer, which may change this paradigm.

Enhancement of EDDS-photo-Fenton process with plant-based coagulants for winery wastewater management.

To achieve an efficient remediation of a winery wastewater (WW), it was studied a physical-chemical process (coagulation-flocculation-decantation - CFD) involving plant-based coagulants (PBC) with advanced oxidation processes (AOPs), aiming to achieve the Portuguese legal limits. Initially, one invasive (Acacia dealbata) and three native species (Quercus ilex, Platanus x acerifólia and Tanacetum vulgare) were collected and used as plant-based coagulants (PBCs). The combination of Platanus acerifólia (P.a.) seeds with polyvinylpolypyrrolidone (PVPP) achieved high turbidity (97.3%) and chemical oxygen demand (COD = 48.2%) removals, from raw WW, with [PBC] = 0.1 g/L, [PVPP] = 5 mg/L, pH = 3.0, fast mix = 150 rpm/3 min, slow mix = 20 rpm/20 min, sedimentation time = 12 h. Different AOPs were studied to treat raw WW, with photo-Fenton process revealing the highest COD efficiency (88.0%). To enhance the capabilities of photo-Fenton, ethylenediamine-N,N'-disuccinic acid trisodium salt (EDDS) was assessed as a chelation agent, reducing iron precipitation. The pre-treatment of WW by PBCs followed by EDDS/photo-Fenton (pH = 6.0, [H2O2] = 175 mM, [Fe2+] = 5 mM, [EDDS] = 1 mM, T = 298 K, time = 240 min) increased the COD removal, whatever the radiation source applied (UV-C, UV-A and solar). Among the different processes, the combined P. a. seeds and UV-C/EDDS/Fenton allowed increase the WW biodegradability from 0.26 to 0.46, and achieved a COD removal of 95.7%, reaching the Portuguese legal limits. As final remark, the synergy of PBCs and EDDS/photo-Fenton is considered effective and sustainable process for raw WW remediation and water reuse.

Treatment of Winery Wastewater by Combined Almond Skin Coagulant and Sulfate Radicals: Assessment of HSO5- Activators.

The large production of wine and almonds leads to the generation of sub-products, such as winery wastewater (WW) and almond skin. WW is characterized by its high content of recalcitrant organic matter (biodegradability index < 0.30). Therefore, the aim of this work was to (1) apply the coagulation-flocculation-decantation (CFD) process with an organic coagulant based on almond skin extract (ASE), (2) treat the organic recalcitrant matter through sulfate radical advanced oxidation processes (SR-AOPs) and (3) evaluate the efficiency of combined CFD with UV-A, UV-C and ultrasound (US) reactors. The CFD process was applied with variation in the ASE concentration vs. pH, with results showing a chemical oxygen demand (COD) removal of 61.2% (0.5 g/L ASE, pH = 3.0). After CFD, the germination index (GI) of cucumber and corn seeds was ≥80%; thus, the sludge can be recycled as fertilizer. The SR-AOP initial conditions were achieved by the application of a Box-Behnken response surface methodology, which described the relationship between three independent variables (peroxymonosulfate (PMS) concentration, cobalt (Co2+) concentration and UV-A radiation intensity). Afterwards, the SR-AOPs were optimized by varying the pH, temperature, catalyst type and reagent addition manner. With the application of CFD as a pre-treatment followed by SR-AOP under optimal conditions (pH = 6.0, [PMS] = 5.88 mM, [Co2+] = 5 mM, T = 343 K, reaction time 240 min), the COD removal increased to 85.9, 82.6 and 80.2%, respectively, for UV-A, UV-C and US reactors. All treated wastewater met the Portuguese legislation for discharge in a municipal sewage network (COD ≤ 1000 mg O2/L). As a final remark, the combination of CFD with SR-AOPs is a sustainable, safe and clean strategy for WW treatment and subproduct valorization.

Degradation of Agro-Industrial Wastewater Model Compound by UV-A-Fenton Process: Batch vs. Continuous Mode.

The degradation of a model agro-industrial wastewater phenolic compound (caffeic acid, CA) by a UV-A-Fenton system was investigated in this work. Experiments were carried out in order to compare batch and continuous mode. Initially, batch experiments showed that UV-A-Fenton at pH 3.0 (pH of CA solution) achieved a higher generation of HO•, leading to high CA degradation (>99.5%). The influence of different operational conditions, such as H2O2 and Fe2+ concentrations, were evaluated. The results fit a pseudo first-order (PFO) kinetic model, and a high kinetic rate of CA removal was observed, with a [CA] = 5.5 × 10−4 mol/L, [H2O2] = 2.2 × 10−3 mol/L and [Fe2+] = 1.1 × 10−4 mol/L (kCA = 0.694 min−1), with an electric energy per order (EEO) of 7.23 kWh m−3 order−1. Under the same operational conditions, experiments in continuous mode were performed under different flow rates. The results showed that CA achieved a steady state with higher space-times (θ = 0.04) in comparison to dissolved organic carbon (DOC) removal (θ = 0−0.020). The results showed that by increasing the flow rate (F) from 1 to 4 mL min−1, the CA and DOC removal rate increased significantly (kCA = 0.468 min−1; kDOC = 0.00896 min−1). It is concluded that continuous modes are advantageous systems that can be adapted to wastewater treatment plants for the treatment of real agro-industrial wastewaters.

Combined organic coagulants and photocatalytic processes for winery wastewater treatment.

Due to the consumers demand for quality wines, washing and disinfection operations are necessary in wine productions, leading to the generation of large volumes of winery wastewater (WW) with a high organic content which has the potential to cause irreversible environmental impacts. The aim and novelty of this work is the production of natural organic coagulants (NOCs) to be applied in coagulation-flocculation-decantation (CFD) process. To complement this treatment process, it is also aimed the performed a photo-Fenton process, combining hydrogen peroxide (H2O2) and potassium persulfate (KPS). The Fourier-transform infrared spectroscopy (FTIR) and scanning electron microscope (SEM) showed that NOCs are carbon-based materials with adsorption capacity. Under the best operational conditions, NOCs achieved a turbidity removal between 86.2 and 98.9%, a total suspended solids (TSS) removal ranging between 85.0 and 94.9% and a dissolved organic carbon (DOC) removal ranging between 14.1 and 44.9%. To degrade the DOC present in the WW, different advanced oxidation processes (AOPs) were tested. Results showed that KPS-photo-Fenton, under the best operational conditions [Fe2+] = 2.5 mM, [KPS] = 1.0 mM, pH = 3.0, radiation UV-C mercury lamp (254 nm), agitation 350 rpm, temperature 298 K, reaction time 240 min achieved a DOC removal of 91.2 and 96.8%, with a H2O2 consumption of 156.9 and 199.0 mM, respectively for red and white WW. With application of combined CFD-KPS-photo-Fenton process, it was observed an increase of DOC removal with lower H2O2 consumptions. The energy consumption of the photosystem was evaluated by application of electric energy per mass (EEM). The application of KPS-photo-Fenton process achieved an EEM of 0.308 and 0.0309 kWh/g/L DOC, with a cost of 2.05 and 2.59 €/g/L DOC respectively for red and white WW. The combination of CFD-KPS-photo-Fenton decreased significantly the costs of treatment and the treated wastewater achieved the Portuguese legal values for wastewater discharge. This work shows that NOCs are a promising technology that can be an alternative to traditional metal salts, the combination of sulfate radicals with hydroxyl radicals can achieve high DOC removal and the combination of CFD with KPS-photo-Fenton process can decrease the operational costs.

Combination of Coagulation-Flocculation-Decantation and Ozonation Processes for Winery Wastewater Treatment.

This research assessed a novel treatment process of winery wastewater, through the application of a chemical-based process aiming to decrease the high organic carbon content, which represents a difficulty for wastewater treatment plants and a public health problem. Firstly, a coagulation-flocculation-decantation process (CFD process) was optimized by a simplex lattice design. Afterwards, the efficiency of a UV-C/ferrous iron/ozone system was assessed for organic carbon removal in winery wastewater. This system was applied alone and in combination with the CFD process (as a pre- and post-treatment). The coagulation-flocculation-decantation process, with a mixture of 0.48 g/L potassium caseinate and 0.52 g/L bentonite at pH 4.0, achieved 98.3, 97.6, and 87.8% removals of turbidity, total suspended solids, and total polyphenols, respectively. For the ozonation process, the required pH and ferrous iron concentration (Fe2+) were crucial variables in treatment optimization. With the application of the best operational conditions (pH = 4.0, [Fe2+] = 1.0 mM), the UV-C/ferrous iron/ozone system achieved 63.2% total organic carbon (TOC) removal and an energy consumption of 1843 kWh∙m-3∙order-1. The combination of CFD and ozonation processes increased the TOC removal to 66.1 and 65.5%, respectively, for the ozone/ferrous iron/UV-C/CFD and CFD/ozone/ferrous iron/UV-C systems. In addition, the germination index of several seeds was assessed and excellent values (>80%) were observed, which revealed the reduction in phytotoxicity. In conclusion, the combination of CFD and UV-C/ferrous iron/ozone processes is efficient for WW treatment.