Il trattamento delle acque reflue risulta prioritario nell'ottica di uno sviluppo sostenibile, in quanto l'utilizzo delle moderne biotecnologie può produrre effluenti di elevata qualità, pronti allo sversamento e/o al riutilizzo. In quest’ottica, i bioreattori a membrana (MBR) risultano una tecnologia promettente. Il riscontro maggiormente osservato dalla comunità scientifica riguarda la qualità dell'effluente dopo il trattamento con MBR: esso risulta di qualità elevata e sostanzialmente disinfettato.  D'altro canto, la problematica del fouling va a ridurre il loro utilizzo a scala reale. Recenti studi hanno fatto luce su vari scenari volti al  miglioramento degli MBR per mitigare il fenomeno del fouling e per migliorare le performance depurative. Le tecnologie che si analizzano in questo articolo sono le membrane dinamiche autoformanti (SFDM), l'applicazione di processi elettrochimici al trattamento delle acque reflue (eMBR) e l'inoculazione di microalghe con fanghi attivi nel bioreattore (AS-MBR).

A patient with diagnosed MELAS (mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes) syndrome had developed psychological and behavioural disturbances at a later stage of his illness. Psychiatric care for this patient would not be possible without a multidisciplinary team approach involving multi-prong interventions from the different team members.

La tematica approfondita riguarda i rifiuti solidi urbani, il loro smaltimento negli impianti predisposti, ovvero discariche controllate, la normativa afferente ed il recupero energetico. Tali tematiche rappresentano un problema molto importante per l’impatto che hanno sull’ecosistema. La problematica è dovuta agli elementi che si creano nell’impianto, come biogas e percolato, i quali devono essere controllati per evitare emissioni nell’ambiente circostante. Il seguente elaborato ha come obiettivo lo studio e l’analisi di un impianto per lo smaltimento dei rifiuti e le normative ad esso collegate, al fine di individuare il progresso delle già menzionate leggi negli anni e le procedure attuabili per la captazione del biogas. Lo studio prevede un percorso basato sulla ricerca e confronto di dati, partendo da un’analisi dei rifiuti che arrivano all’impianto fino ad arrivare alle tecnologie che lo rappresentano. Dopodiché verrà realizzato un modello virtuale con l’utilizzo di un software, ed un plastico in scala al fine di descriverlo al meglio. Mediante tali strumenti possiamo far emergere lo scopo dell’elaborato, ovvero quello di evidenziare come un corretto smaltimento dei rifiuti, nel rispetto delle norme, può portare ad una diminuzione delle problematiche legate alle discariche. Dal lavoro svolto, inoltre, si è individuata l’importanza delle tecnologie esistenti negli impianti, in grado di proteggere l’ambiente e riutilizzare i prodotti come nel caso del biogas.

Nutrition support is essential in children with cancer, including those undergoing bone marrow transplant (BMT), to reduce the risk of malnutrition and associated deleterious outcomes. Enteral nutrition is more commonly provided via nasogastric than gastrostomy tubes due to safety concerns with the latter in immunocompromised children. This systematic review investigated the incidence and type of complications and outcomes in pediatric cancer patients fed by gastrostomy. Across studies, 54.6% of children developed ≥1 complication, of which 76.6% were classified as minor, 23.4% major. The most frequent complications included inflammation (52% of episodes), infection (42.1%), leakage (22.3%) and granuloma (21%). Evidence regarding infection rates in cancer/BMT patients compared with other disease states was inconclusive. Gastrostomy feeding was associated with improvement or stabilization of nutritional status in 77-92.7% of children. Gastrostomy feeding in this population is safe and effective in stabilizing or improving nutritional status throughout treatment. Complications are frequent but mostly minor.

The lifetime reproductive success (LRS) of individuals is affected by random events such as death, realized growth, or realized reproduction, and the outcomes of these events can differ even when individuals have identical probabilities. Another source of randomness arises when these probabilities also change over time in variable environments. For structured populations in stochastic environments, we extend our recent method to determine how birth environment and birth stage determine the random distribution of the LRS. Our results provide a null model that quantifies effects on LRS of just the birth size or stage. Using Roe deer Capreolus capreolus as a case study, we show that the effect of an individual’s birth environment on LRS varies with the frequency of environments and their temporal autocorrelation, and that lifetime performance is affected by changes in the pattern of environmental states expected as a result of climate change.

The congenital sideroblastic anemias (CSAs) are a heterogeneous group of inherited disorders of erythropoiesis characterized by pathologic deposits of iron in the mitochondria of developing erythroblasts. Mutations in the mitochondrial glycine carrier SLC25A38 cause the most common recessive form of CSA. Nonetheless, the disease is still rare, there being fewer than 70 reported families. Here we describe the clinical phenotype and genotypes of 31 individuals from 24 families, including 11 novel mutations. We also review the spectrum of reported mutations and genotypes associated with the disease, describe the unique localization of missense mutations in transmembrane domains and account for the reoccurrence of several alleles in different populations.

A simplified delivery technique for the frozen elephant trunk procedure allows the distal suture to be performed on a perfused and loaded aorta in moderate hypothermia—or even normothermia—reducing circulatory arrest time to just a few minutes. Two surgical sealing tourniquets are placed around the aortic arch, usually between the brachiocephalic trunk (BCT) and the left common carotid artery and the aorta is cross-clamped and cardioplegia started. Once in mild hypothermia, the BCT is disconnected and circulatory arrest is initiated while cerebral perfusion is maintained. This modified technique can be used in all pathologies, including dissections.

Molecular level insights into the mechanism and thermodynamics of CO oxidation by a (TiO2)6 cluster have been obtained through density functional calculations. Thereby, we have considered as an example, two different structural isomers of (TiO2)6 with the purpose of understanding the interplay between local structure and activity for the CO oxidation reaction. Active sites in the two isomeric forms were identified on the basis of global and local reactivity descriptors. For the oxidation of CO to CO2 we considered both sequential and simultaneous adsorption of CO and O2 on (TiO2)6 cluster through the ER and LH mechanisms, respectively. Three different pathways were obtained for CO oxidation by (TiO2)6 cluster, and the mechanistic route of each pathway were identified by locating the transition-state and intermediate structures. The effects of temperature on the rate of the reaction was investigated within the harmonic approximation. The structure-dependent activity of the cluster was rationalized through reactivity descriptors and analysis of the frontier orbitals. Finally, we also considered the effects of a support, i.e., graphene, on the oxidation mechanism.

The current coronavirus disease 2019 (COVID-19) outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged in Wuhan, China and has rapidly become global challenges, creating major challenges to health systems in almost every country in the world it has turned into a pandemic. COVID-19 poses a risky clinical situation that can range from mild illness to severe respiratory failure requiring admission to intensive care. It is known to cause cytokine storm in some critically ill patients. However, more and more evidence showed that there is a dramatic increase in cytokine levels in patients diagnosed with COVID-19. Midkine (MK) is involved in various physiological and pathological processes, which some of them are desired and beneficial such as controlling tissue repair and antimicrobial effects, but some others are harmful such as promoting inflammation, carcinogenesis and chemo-resistance. Also, MK is expressed in inflammatory cells and released by endothelial cells under hypoxic conditions. Considering all this information, there are strong data that MK, an important cytokine known to increase in inflammatory diseases, may overexpressed in patients who are positive for COVID-19. The overexpression of MK reveals a picture leading to fibrosis in the lung damage. Therefore, questions arise about how the concentration of MK changes in CoVID-19 patients and can we use it as an inflammation biomarker or in the treatment protocol in the future.

In this paper, we are concerned with the positive continuous entire solutions of the Wolff-type integral system \begin{equation*} \left\{ \begin{array}{ll} &u(x) =C_{1}(x)W_{\beta,\gamma} (v^{-q})(x), \\[3mm] &v(x) =C_{2}(x)W_{\beta,\gamma} (u^{-p})(x), \end{array} \right. \end{equation*} where $n\geq1$, $\min\{p,q\}>0$, $\gamma>1$, $\beta>0$ and $\beta\gamma\neq n$. In addition, $C_{i}(x) \ (i=1,2)$ are some double bounded functions. If $\beta\gamma\in (0,n)$, the Serrin-type condition is critical for existence of the positive solutions for some double bounded functions $C_{i}(x)$ $(i=1,2)$. Such an integral equation system is related to the study of the $\gamma$-Laplace system and $k$-Hessian system with negative exponents. Estimated by the integral of the Wolff type potential, we obtain the asymptotic rates and the integrability of positive solutions, and studied whether the radial solutions exist.

Introduction: The subcutaneous-ICD (S-ICD) and its electrode were developed to avoid long-term complications of transvenous leads in the vasculature. Methods: We report a case of unexpected, inappropriate S-ICD shocks due to oversensing of high amplitude, non-physiologic, electrical noise artifacts that were not preceded by high impedance alerts or sensing electrogram noise detections. Results: Following explant, high-magnification, X-ray imaging of the S-ICD electrode demonstrated partial fracture of the distal sensing conductor located near a short radius bend in the electrode at the electrode-header interface. Conclusions: Clinicians should be aware of a potential for fatigue failure fracture of the S-ICD electrode. Recommendations for systematic S-ICD follow-up and troubleshooting are discussed.

Persistent Pulmonary Hypertension of the Newborn (PPHN) is defined as a failure of the normal circulatory transition after birth. PPHN manifests as a progressive and potentially fatal hypoxemic respiratory failure. The condition is associated with a persistent increase in pulmonary vascular resistance and reduced blood flow in the pulmonary vessels without an accompanying congenital heart defect. The abnormalities in pulmonary circulation lead to right-to-left shunting through the foramen ovale and usually also through the ductus arteriosus, with resultant hypoxemia, which manifests clinically as cyanosis. Management options in PPHN include optimal lung inflation, oxygenation, prevention of acidosis, stabilization of blood pressure, sedation and pulmonary vasodilator therapy. While inhaled nitric oxide (iNO) is the most commonly used treatment option, alternative methods can be used whenever is unavailable or contraindicated. We report three cases of severe PPHN, in which due to the lack of adequate response to intravenous MgSO4, the patients were switched to milrinone.

Opportunistic diversification has allowed ferns to radiate into epiphytic niches in angiosperm dominated landscapes. However, our understanding of how ecophysiological function allowed establishment in the canopy and the potential transitionary role of the hemi-epiphytic life form remain unclear. Here, we surveyed 39 fern species in Costa Rican tropical forests to explore epiphytic trait divergence in a phylogenetic context. We examined leaf responses to water deficits in terrestrial, hemi-epiphytic, and epiphytic ferns and related these findings to functional traits that regulate leaf water status. Epiphytic ferns had reduced xylem area (-63%), shorter stipe lengths (-56%), thicker laminae (+41%), and reduced stomatal density (-46%) compared to terrestrial ferns. Epiphytic ferns exhibited similar turgor loss points, higher osmotic potential at saturation, and lower tissue capacitance after turgor loss than terrestrial ferns. Overall, hemi-epiphytic ferns exhibited traits that share characteristics of both terrestrial and epiphytic species. Our findings clearly demonstrate the prevalence of water conservatism in both epiphytic and hemi-epiphytic ferns, via selection for anatomical and structural traits that avoid leaf water stress. Even with likely canalized physiological function, adaptations for drought avoidance have allowed epiphytic ferns to successfully endure the stresses of the canopy habitat.

Metastasis of renal cell carcinoma to the heart is a rare event. Herein we present a case of renal cell carcinoma presenting with progressive fatigue, abdominal pain, and weight loss. Imaging studies revealed complex renal mass with extension to right atrium and histopathology confirmed the metastatic renal cell carcinoma.

Our patient is a 19-year-old female who presented with left shoulder pain. Diagnostic arthroscopy revealed an articular-sided supraspinatus tear. When the shoulder was taken out of traction and placed in 90 degrees of abduction and external rotation, we visualized the biceps tendon directly impinging the undersurface of the supraspinatus tendon.

We report two cases of patients with concurrent osteoarthritis of the knee and the ipsilateral ankle. Patients were treated with high tibial osteotomy (HTO). In well-planned and selected cases, HTO may be effective in treating not only the knee but also the ankle in patients with ipsilateral double-joint osteoarthritis.

Surgical site infections (SSI) after left ventricular assist device (LVAD) implantation are associated with high mortality, while surgical prophylaxis is variable. This retrospective study included adult patients who underwent LVAD implantation at a single center. We compared outcomes in patients who received narrow antimicrobial prophylaxis (cefazolin, vancomycin or both) to those who received broad antimicrobial prophylaxis (any antimicrobial combination targeting gram-positive and gram-negative organisms not included in the narrow group) at 30 days and 1 year post-implantation. Cox-proportional hazards models and log-rank tests were used for survival analysis. Among the 39 and 65 patients comprising narrow and broad groups respectively, there was no difference in rate of SSI at 30 days (6.2% vs 12.8%, p = 0.290) and 1 year (16.9% vs 25.6%, p = 0.435). Comparing narrow to broad prophylaxis, the risk of mortality [HR (95% CI): 0.44 (0.15. 1.35), logrank P = 0.14], and composite of mortality and infection was reduced [HR (95% CI): 0.92 (0.45, 1.88), logrank P = 0.83], but did not reach statistical significance. Most culture positive infections were due to gram-positive bacteria (70%) and the most common organisms were the Staphylococcus spp (47%). There were no significant differences in the rate of SSI at 1-year (p=1.00) and mortality (p=0.33) by device type. The rates of infection and all-cause mortality were not different between patients who received narrow or broad prophylaxis. This highlights an opportunity for institutions to narrow their surgical infection prophylaxis protocols to primarily cover gram-positive organisms.

Acute liver failure precipitated by acute Budd–Chiari syndrome and complete portal vein thrombosisYuji Suzuki MD, PhD; Akiko Suzuki MD, PhD; Keisuke Kakisaka MD, PhD; Yasuhiro Takikawa MD, PhDDivision of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba-cho, Iwate, Japan

A phytobezoar occurring in the stomach is uncommon. The most frequent symptoms are dyspepsia, abdominal pain, nausea and vomiting. It is an important differential to remember in those patients with risk factors for developing phytobezoars, as phytobezoars can be managed conservatively in most cases.

Sarcoidosis shows various clinical and radiologic manifestations. Nodular sarcoidosis is an uncommon form of pulmonary sarcoidosis. Cases presenting as solid nodules are especially rare. We herein present a case of nodular sarcoidosis with a solid nodule that was suspected to be lung cancer.

Aims of the study Vaccines are considered to be our greatest hope of defeating SARS-CoV-2. However, before we claim victory, there are some important questions that are in need of an urgent answer. In this paper we address a particularly relevant one, which unfortunately has not attracted much attention: whether approved vaccines provide us with sterilizing immunity (or to what concrete level). Methods used to conduct the study This study was based on the revision of the existing academic literature. Results of the study The capacity of approved vaccines to provide sterilizing immunity is key to designing our vaccination policies in an optimal way. We propose ways to obtain this knowledge and we assess the consequences that a lack of sufficient immunity would bring to publc health policies. Conclusions drawn from the study and clinical implications If further evidence proves that vaccines do not provide sterilizing immunity, prioritization strategies should introduce changes by providing preferential access to vulnerable populations instead of health care professionals or caregivers working in nursing homes. Policies aimed at promoting adherence to vaccination should consider that altruistic incentives would clearly diminish. In addition, policy makers should be aware that, in general, reaching herd immunity could take much longer than expected.

Aim: Invasive alien species (IAS) threaten ecosystems and humans worldwide, and future climate change may accelerate the expansion of IAS. Predicting the suitable distributions of IAS can prevent their further expansion. Ageratina adenophora is a invasive weed over 30 countries in tropical and subtropical regions. However, the potential suitable distribution of A. adenophora remains unclear along with its response to climate change. This study explored and mapped the current and future potential distributions of Ageratina adenophora. Location: Global Taxa: Asteraceae A. adenophora (Spreng.) R.M.King & H.Rob. Commonly known as Crofton weed. Methods: Based on A. adenophora occurrence data and climate data, we predicted its potential distribution of this weed under current and future (four RCPs in 2050 and 2070) by MaxEnt model. We used ArcGIS 10.4 to explore the distribution characteristics of this weed and the ‘ecospat’ package in R to analyse its altitudinal distribution changes. Results: The area under the curve value (>0.9) indicated excelled model performance. Among environment factors, Mean Temperature of Coldest Quarter contributed most to the model. Globally, the suitable habitat for A.adenophora invasion decreased under climate change scenarios, although regional increase were observed, including in six biodiversity hotspot regions. The potential suitable habitat of A.adenophora under climate change moved toward regions with higher elevation. Main Conclusions: Temperature was the most important variable influencing the distribution of A. Adenophora. Under the background of warming climate, the potential distribution range of A.adenophora will shrink globally but increase regionally. The distribution of A.adenophora will shift toward higher elevation under climate change. Mountain ecosystems are of special concern as they are rich in biodiversity and sensitive to climate change, and increasing human activities provide more opportunities for IAS invasion.

The hypothesis that feed ingredients could serve as vehicles for the transport and transmission of viral pathogens was first validated under laboratory conditions. To bridge the gap from the laboratory to the field, this current project tested whether three significant viruses of swine could survive in feed ingredients during long-distance commercial transport across the continental US. One-metric ton totes of soybean meal (organic and conventional) and complete feed were spiked with a 10 mL mixture of PRRSV 174, PEDV, and SVA and transported for 23 days in a commercial semi-trailer truck, crossing 29 states, and 10,183 km. Samples were tested for the presence of viral RNA by PCR, and for viable virus in soy-based samples by swine bioassay and in complete feed samples by natural feeding. Viable PRRSV, PEDV, and SVA were detected in both soy products and viable PEDV and SVA in complete feed. These results provide the first evidence that viral pathogens of pigs can survive in representative volumes of feed and feed ingredients during long-distance commercial transport across the continental US.

The effects of human disturbance on the stability of alpine meadow communities, their diversity–stability relationship, and the underlying mechanisms are still not fully understood. Here, we performed a 12-year-long (2007–2018) two-factor (2 × 3) controlled experiment on Kobresia humilis on the Tibetan Plateau. The manipulations included three clipping levels (no clipping, NC; moderate clipping, MC; heavy clipping, HC) and two fertilization levels (no fertilization, NF; fertilization, F). Our results revealed that the two clipping manipulations significantly increased the temporal stability of alpine meadow communities, whose significant increase was more pronounced under the MC than HC treatment. Moreover, asynchrony effects, portfolio effects, and facilitation interactions were all present in the communities under the six types of experimental treatment combinations. Additionally, a selection effect was detected in the compound communities, demonstrating characteristics that are common to different mechanisms. There were no significant differences in the effects of these mechanisms on community temporal stability between the NC–NF and MC–NF interactive communities. The portfolio effects predominated when clipping intensity was moderate under both fertilization and non-fertilization conditions. By contrast, in the compound communities, the selection effect predominated. In summary, we conclude that in meadow communities that undergo clipping and fertilization disturbances, facilitation interactions and weak interactions make a greater contribution toward maintaining their temporal stability.