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Background: Simulation-based training plays a significant role in surgical education, especially in minimally invasive pediatric surgery and urology. This study aimed to evaluate a novel 3D-printed model as training tool for endoscopic injection of bulking agent. Methods: Forty-three attendees and ten teaching faculty members were invited to complete a post hoc questionnaire after completing training sessions using the Fish Tank Simulation Model (FTSM). The survey consisted of a 7-question 5-point Likert scale to assess the model's realism (face validity) and its effectiveness as training tool (content validity). Results: Regarding the training status, 20/53 (37.7%) participants were fellow and/or specialist in pediatric surgery and 33/53 (62.3%) were surgeons in training. Their level of confidence in endoscopic injection procedure was defined as novice (< 10 procedures per year) in 33/53 (62.3%), intermediate (10–20 procedures per year) in 10/53 (18.9%), and expert (> 20 procedures per year) in 10/53 (18.9%). Regarding both face validity and content validity assessments, no statistically significant differences were found between scores given by novice vs intermediate/expert groups. Similarly, no statistically significant differences emerged between scores given by participant vs faculty groups assessing the content validity of the FTSM. The FTSM was considered a good teaching tool for beginners by 44/53 (83%) and for pediatric surgeons/urologists by 38/53 (71.7%). Conclusions: The 3D-printed Fish Tank Simulation Model proved to be a valuable, high-fidelity, easily accessible, cost-effective, hygienic, and domestic-use training tool for pediatric surgeons/urologists conducting the procedure. The model's user-friendly design and realistic environment enhanced learning opportunities for trainees, regardless of their experience level or training status. Nevertheless, further development is necessary, particularly in enhancing the realism of the ureteral hiatus and reproducing more complex anatomy, to make it beneficial for the training of advanced surgeons. [ABSTRACT FROM AUTHOR]

Introduction: No data are available on the diagnostic algorithms recommended by guidelines for the assessment of diastolic dysfunction (DD) in patients with arterial hypertension. Aim: To fill this gap, we evaluated diastolic function in hypertensive patients with and without LVH matched with healthy subjects by applying 2016 American Society of Echocardiography-European Association of Cardiovascular Imaging Guidelines for the evaluation of LV diastolic function. Methods: 717 healthy and hypertensives with normal LV ejection fraction and with and without LV hypertrophy (LVH), matched 1:1:1 from two prospective registries, represented the study population. Results: By applying algorithm A, indeterminate pattern was found in 0.4% of healthy, in 6.3% of hypertensives without LVH, and in 21% with LVH (overall p < 0.05 vs. healthy). DD was absent in healthy, however present in 2 and 8% of hypertensives without and with LVH (p = 0.06 and p = 0.001 vs. healthy, respectively). By applying algorithm B, no cases of indeterminate pattern were found. DD was observed in 2.9% of healthy, 7 and 10.5% of hypertensives without and with LVH (p < 0.05 vs. healthy). Conclusions: The use of algorithm A should be limited only to truly normal subjects, whereas algorithm B should be applied to all patients with hypertension, even without comorbidities and irrespective of LVH. [ABSTRACT FROM AUTHOR]

Purpose: In Italy, the training of sports workers was carried out through national sports federations (NSF), sports promotion bodies (SPB) and associated disciplines (AD) since there were no laws regarding specific professional figures on a par with other labor sectors. New and recent legislation stipulates that specific training is the responsibility of universities, with the 3-year bachelor's degree program in Exercise and Sports Science (L22) for the cultural and scientific profiling of the new professional figure of the basic kinesiologist. The study measures the perceptions and opinions that students have with respect to the training in their studies and also analyze any gaps in terms of knowledge and skills to be applied in the professional field. Methods: A questionnaire was administered to 30 students consisting of 15 questions divided into three sections: Sect. 1 of sample identification, Sect. 2 assessing perceptions on knowledge acquired, and Sect. 3 assessing perceptions on skills learned. A chi-square (χ2) analysis was performed to check for significant differences. Results: The results showed a difference of opinion. Although 84.2% of the sample thought highly of the training offered, discordant data emerged on the knowledge and skills taught within the courses of study. Although this high percentage is convinced and entrusts their training to the university pathway, it is found that 19% have qualifications issued by NSF, 4.8% by other and 1.6% by SPB. In addition there is significance P =.001 demonstrating liking with respect to the training received. Conclusion: The basic kinesiologist is a key figure within sports organizations, and university training is also considered positive by those trained by NSF, SPB, and AD. [ABSTRACT FROM AUTHOR]

Hypertrophic cardiomyopathy (HCM) is mainly caused by sarcomeric mutations which may affect myocardial mechano-energetic efficiency (MEE). We investigated the effects of sarcomeric mutations on MEE. A non-invasive pressure/volume (P/V) analysis was performed. We included 49 genetically screened HCM patients. MEEi was calculated as the ratio between stroke volume and heart rate normalized by LV mass. Fifty-seven percent (57%) HCM patients carried a sarcomeric mutation. Patients with and without sarcomeric mutations had similar LV ejection fraction, heart rate, LV mass, and LV outflow gradient. Younger age at diagnosis, family history of HCM, and lower MEEi were associated with presence of sarcomeric mutation (p = 0.017; p = 0.001 and p = 0.0001, respectively). Lower MEEi in HCM with sarcomeric mutation is not related to significant differences on filling pressure as shown on P/V analysis. Sarcomeric mutations determine a reduction of the LV pump performance as estimated by MEEi in HCM. Lower MEEi may predict a positive genetic analysis. [ABSTRACT FROM AUTHOR]

Background: Anal fistula and perianal abscess are commonly acquired anorectal pathologies in children. Surgical treatment options commonly adopted are fistulotomy, fistulectomy, cutting seton placement, and more recently video-assisted anal fistula treatment (VAAFT). Optimal postoperative wound dressing remains debated. This study aimed to report our series of pediatric patients, who received VAAFT and postoperative wound dressing using ozonide oil. Methods: All patients who underwent VAAFT between August 2018 and May 2023 were included in the study. Demographics, clinical features, pre-operative imaging, surgical details, outcome, and mid-term outcome data were retrospectively reviewed for each patient. All VAAFT procedures were performed under general anesthesia and using a 10-Ch fistuloscope. Results: Thirty-three VAAFT procedures were performed in 30 patients over the study period. The median patient age was 5.7 years (range 1.75–14). Anal fistula was idiopathic in 26/30 (86.6%), iatrogenic in 2/30 (6.7%), and secondary to Crohn's disease in 2/30 (6.7%). The median duration of surgery was 23 min (range 18–40). All patients received ozonide oil dressing twice a day for 5 weeks postoperatively. The median hospital stay was 24 h (range 9–36). The median healing time was 28 days (range 17–39). With a median follow-up of 2 years (range 0.5–5), disease recurrence occurred in 3/30 (10%) patients with idiopathic fistula, who were re-operated using the same technique, with no further recurrence. No fecal incontinence or soiling was observed. Conclusion: Our series confirmed that VAAFT is a safe and effective technique to treat children with perianal fistula. The technique is versatile, allowing to treat fistulae of different etiologies. Postoperative course was painless and fast. Future comparative prospective studies are needed to better establish these conclusions. [ABSTRACT FROM AUTHOR]

Heart failure (HF) with preserved ejection fraction (HFpEF) is a prevalent global condition affecting approximately 50% of the HF population. With the aging of the worldwide population, its incidence and prevalence are expected to rise even further. Unfortunately, until recently, no effective medications were available to reduce the high mortality and hospitalization rates associated with HFpEF, making it a significant unmet need in cardiovascular medicine. Although HFpEF is commonly defined as HF with normal ejection fraction and elevated left ventricular filling pressure, performing invasive hemodynamic assessments on every individual suspected of having HFpEF is neither feasible nor practical. Consequently, several clinical criteria and diagnostic tools have been proposed to aid in diagnosing HFpEF. Overall, these criteria and tools are designed to assist healthcare professionals in identifying and evaluating patients who may have HFpEF based on a combination of signs, symptoms, biomarkers, and non-invasive imaging findings. By employing these non-invasive diagnostic approaches, clinicians can make informed decisions regarding the best pharmacological and rehabilitation strategies for individuals with suspected HFpEF. This literature review aims to provide an overview of all currently available methods for diagnosing and monitoring this disabling condition. [ABSTRACT FROM AUTHOR]

Purpose: The implementation of the 2021 sports reform in Italy introduced new professional figures, including the sports manager, defined by Legislative Decree no. 36/2021. According to this law, a master's degree in Organization and Management of Services for Exercise and Sport Sciences (LM-47) is required to practice as a sports manager. However, some universities offer bachelor's and master's degree courses in sports management under different study classes, such as Sciences of Legal Services (L-14), Administration and Organization Sciences (L-16), Business and Management Sciences (L-18), and Business Economics (LM-77). These degree courses may qualify individuals as pseudo-sports managers, despite substantial differences in the educational content compared to the legally defined sports manager profile. This study aimed to assess the illegitimate overlap of degree courses outside the class LM-47 and the discrepancies in their study plans compared to those of LM-47, which is the only one corresponding to the sports manager profile. Methods: This documentary investigation used the two Ministerial Decrees of 2007 of the bachelor's and master's degree classes to extrapolate the degree courses involved in the overlap. Universitaly portal was used to identify the relevant subjects included in the individual degree courses in sports management other than the LM-47. The textual analysis of the objectives and content of the degree courses was done through the literature review tool Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), highlighting the relevant or consistent elements of the profile of the sports manager as established by law. Results: Degree courses in Law and Sports Management in class L-14 have a juridical professional profile, which is minimally relevant to the sports manager's role. Similarly, degree courses in Economics and Business Management Sciences in the class L-18 and Administration and Organization Sciences in the class L-16 focus on economic–financial administration and management control, lacking alignment with the sports manager profile. Even master's degree courses in the class LM-77 exhibit disparities with the sports manager profile as defined by the law. Furthermore, all these degree courses lack European credit transfer system (ECTS) credits in the exercise and sport sciences area, an essential aspect of the sports manager profession. Conclusion: There are evident contradictions in the degree courses designed for sports managers other than LM-47. According to the law, a master's degree in study class LM-47 is required to pursue this profession, but there are several degree programs from different classes of study (juridical and economic) available in the national educational offering. This situation may lead to the misapplication of Legislative Decree no. 36/2021 and result in problems with professional accreditation and limited employment opportunities for graduates of such courses. To promote the development of this professional figure, it is necessary to improve the educational offerings in the LM-47 with a more integrated approach to various economic and juridical knowledge to meet the educational needs of future sports managers who navigate the real dynamics of the sports industry. [ABSTRACT FROM AUTHOR]

In the last 20 years, endoscopic injection (EI) has affirmed as a valid alternative to open surgery for management of pediatric vesicoureteral reflux (VUR). This study aimed to investigate and discuss some debated aspects such as indications, bulking agents and comparison, techniques of injection and comparison, predictive factors of success, use in specific situations. EI is minimally invasive, well accepted by patients and families, with short learning curve and low-morbidity profile. It provides reflux resolution rates approaching those of open reimplantation, ranging from 69 to 100%. Obviously, the success rate may be influenced by several factors. Recently, it is adopted as first-line therapy also in high grade reflux or complex anatomy such as duplex, bladder diverticula, ectopic ureters. The two most used materials for injection are Deflux and Vantris. The first is absorbable, easier to inject, has lower risk of obstruction, but can lose efficacy over time. The second is non-absorbable, more difficult to inject, has higher risk of obstruction, but it is potentially more durable. The two main techniques are STING and HIT. To date, the ideal material and technique of injection has not yet clearly established, but the choice remains dependent on surgeon’s preference and experience. [ABSTRACT FROM AUTHOR]

Environmental pollution in considered an established determinant of non-communicable illness, including cardiovascular diseases (CVDs). Air pollution is the result of a complex combination of chemical, physical, and biological agents, and represents one of the main causes of mortality and morbidity in the world population. It is responsible for 7.6% of global mortality. In this regard, it has been documented that it increases the risk of CVDs and major adverse cardiovascular and cerebrovascular events. In northern regions of China, long-term exposures to the particulate matter < 2.5 µm (PM2.5) increase in the risk of ischemic heart disease by almost two-folds. Similarly, the additional risk for stroke, increases by almost 10% for long-term exposure to PM2.5. The detrimental effects of air pollution on cardiovascular system are particularly manifest in vulnerable subjects, such as the elderly, patients with heart disease, and obese individuals. Therefore, nowadays, cardiovascular prevention strategies, in addition to controlling traditional risk factors, should also include measures to improve the environment. This goal can be achieved by the implementation of the health surveillance in occupational medicine and by the extensive application of the national and international legislative measures. In fact, the health surveillance represents a crucial preventive measure for workers exposed to health risks (chemical, physical agents, etc.) that may lead to occupational diseases after long-term exposure. On the other hand, since environmental pollution does not recognize well-defined boundaries, only the implementation of regulations among large territorial areas can be useful to improve the quality of environment. [ABSTRACT FROM AUTHOR]

Background: Elderly status is steadily increasing among patients with acute coronary syndrome (ACS). Dual antiplatelet therapy (DAPT) with aspirin and a potent P2Y12 receptor inhibitor is the cornerstone of treatment to prevent recurrent thrombotic complications in patients with ACS. However, DAPT in older patients is challenged by a concurrent heightened risk of ischemia and bleeding. The aim of this study is to evaluate the pharmacodynamic and pharmacokinetic profile of a lower dose of ticagrelor (60 mg twice daily) among elderly patients during the early phase of ACS. Study Design: PLINY THE ELDER (PLatelet INhibition with two different doses of potent P2y12 inhibitors in THE ELDERly population) (NCT04739384) is a prospective, randomized, open-label, crossover trial to evaluate the non-inferiority of a lower dose of ticagrelor (60 mg twice daily) compared with a standard dose (90 mg twice daily) among elderly patients with ACS undergoing percutaneous coronary intervention (PCI). A total of 50 patients, aged 75 years or more, with indication to potent P2Y12 receptor inhibitors will be randomized within 3 days from PCI for the index ACS. Patients with indication to oral anticoagulant therapy, treatment with glycoprotein IIb/IIIa inhibitors, or active bleeding will be excluded. The primary endpoint is platelet reactivity determined by P2Y12 reaction units (PRU) (VerifyNow, Accumetrics, San Diego, CA, USA) after treatment with ticagrelor 60 or 90 mg twice daily for 14 days. Secondary endpoints will include other pharmacodynamic tests of ADP-induced aggregation (light transmittance aggregometry and multiple electrode aggregometry) and determination of pharmacokinetic profile (plasma levels of ticagrelor and its metabolite AR-C124910XX) by high performance liquid chromatography-tandem mass spectrometry. Conclusions: The PLINY THE ELDER trial will determine whether a lower dose of ticagrelor confers non-inferior platelet inhibition compared with the standard dose in the early phase of ACS among elderly patients undergoing PCI, informing future clinical investigation. [ABSTRACT FROM AUTHOR]

Acute decompensation often represents the onset of symptoms associated with severe degenerative aortic stenosis (AS) and usually complicates the clinical course of the disease with a dismal impact on survival and quality of life. Several factors may derange the faint balance between left ventricular preload and afterload and precipitate the occurrence of symptoms and signs of acute heart failure (HF). A standardized approach for the management of this condition is currently lacking. Medical therapy finds very limited application in this setting, as drugs usually indicated for the control of acute HF might worsen hemodynamics in the presence of AS. Urgent aortic valve replacement is usually performed by transcatheter than surgical approach whereas, over the last decades, percutaneous balloon valvuloplasty gained renewed space as bridge to definitive therapy. This review focuses on the pathophysiological aspects of acute advanced AS and summarizes current evidence on its management. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to measure the number of scientific production of Italian professors, as framed on academic disciplines of Physical training and methodology (code M-EDF/01) and Sport sciences and methodology (code M-EDF/02), afferents to academic recruitment field of Exercise and sports sciences (code 06/N2) and Didactics, special education and educational research (code 11/D2). Methods: The sample consisted of the entire population of full professors (n = 30) of M-EDF/01 and M-EDF/02, plus a proportional representation of the two academic recruitment fields with at least one associate professor per university, for a total of 78 professors. The titles of the first ten scientific products in terms of more citations from the Google Scholar database were analysed for each scientist. The title's full coherence at the scientific declaration of the two academic disciplines of M-EDF/01 and M-EDF/02 and biomedicine and pedagogy domains were assessed. One-way ANOVA with Bonferroni post hoc test was used to compare the two academic disciplines of the two academic recruitment fields with the three domains to highlight the separated data's greater, average and lesser significance. Results: The aggregate data showed a prevalence of the biomedicine domain over the sport and physical activity ones in M-EDF/01 and M-EDF/02 in the academic recruitment field of 06/N2. On the other hand, in the academic recruitment of 11/D2, there was a prevalence of sport and physical activity domain over the biomedicine ones. In addition, a modest pedagogy scientific production in 06/N2 and biomedical in 11/D2 were found. Conclusion: The existence of the problem of the different coherence of the scientific profiles of the researchers concerning the relevant academic recruitment field and possibly also to the two academic disciplines was confirmed. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to assess the association between body mass index (BMI) and platelet reactivity in STEMI patients treated with oral 3rd generation P2Y12 inhibitors. Methods: Overall, 429 STEMI patients were enrolled in this study. Patients were divided into two groups according to BMI (BMI < 25 vs ≥ 25 kg/m2). A propensity score matching (1:1) was performed to balance potential confounders in patient baseline characteristics. Platelet reactivity was assessed by VerifyNow at baseline and after 3rd generation P2Y12 inhibitor (ticagrelor or prasugrel) loading dose (LD). Blood samples were obtained at baseline (T0), 1 h (T1), 2 h (T2), 4–6 h (T3), and 8–12 h (T4) after the LD. High on-treatment platelet reactivity (HTPR) was defined as a platelet reactivity unit value ≥ 208 units. Results: After propensity score matching, patients with BMI ≥ 25 had similar values of baseline platelet reactivity, while they had higher level of platelet reactivity at 1 and 2 h after the LD and higher rate of HRPT. Furthermore, multivariate analysis demonstrated that BMI ≥ 25 was an independent predictor of HTPR at 2 h (OR 2.01, p =.009). Conversely, starting from 4 h after the LD, platelet reactivity values and HRPT rates were comparable among the two study groups. Conclusions: A BMI ≥ 25 kg/m2 is associated with delayed pharmacodynamic response to oral 3rd generation P2Y12 inhibitor LD, and it is a strong predictor of HTPR in STEMI patients treated by dual antiplatelet therapy with ticagrelor or prasugrel. [ABSTRACT FROM AUTHOR]

The increasing production of sewage sludge at global level has addressed the search for technical solutions to take advantage from it, reducing the environmental burden originating from its disposal. Anaerobic digestion is a suitable option to handle sewage sludge in accordance with circular economy principles, as it generates a methane-rich biogas and a digestate with potential fertilizing properties. Several techniques have been proposed to enhance anaerobic digestion performances and, among these, the application of static magnetic field (SMF) has recently gained attention. Nonetheless, the effects of high-intensity SMF on the sewage sludge destined to anaerobic digestion and its impact on the anaerobic digestion process have not been evaluated yet. This study aims to determine the effects of a 1.5 T SMF on the chemical composition of sewage sludge as well as on methane generation during anaerobic digestion. The main parameters influencing the SMF (i.e., flow rate, mixing ratio of magnetized to non-magnetized sludge, number of pumping cycles, and total solid content) were varied to evaluate the impact of different exposure conditions on the chemical characteristics and methane potential of sewage sludge. An extensive exposure to the high-intensity SMF applied resulted in a 24% decrease of methane production, reduced the concentration of the monitored ionic species (i.e., NH4+, NO3−, PO43−, SO42− and Mg2+) in the liquid phase of sewage sludge, and promoted the precipitation of compounds with valuable fertilizing properties, e.g., struvite. These outcomes suggest that high-intensity SMF, although negatively influencing methane generation, can promote the precipitation, and possibly the recovery/recycle of valuable compounds from sewage sludge, enhancing its proper management in a circular economy perspective. [ABSTRACT FROM AUTHOR]

The assessment of vascular complexity in the lower limbs provides relevant information about peripheral artery occlusive diseases (PAOD), thus fostering improvements both in therapeutic decisions and prognostic estimation. The current clinical practice consists of visually inspecting and evaluating cine-angiograms of the interested region, which is largely operator-dependent. We present here an automatic method for segmenting the vessel tree and compute a quantitative measure, in terms of fractal dimension (FD), of the vascular complexity. The proposed workflow consists of three main steps: (i) conversion of the cine-angiographies to single static images with a broader field of view, (ii) automatic segmentation of the vascular trees, and (iii) calculation and assessment of FD as complexity index. In particular, this work defines (1) a method to reduce the inter-observer variability in judging vascular complexity in cine-angiography images from patients affected by peripheral artery occlusive disease (PAOD), and (2) the use of Fractal Dimension as a metric of shape complexity of vascular tree. The inter-class correlation coefficient (ICC) is computed as inter-observer agreement metric and to account for possible systematic error, that depends on the experience of the raters. The automatic segmentation of vascular tree achieved an Area Under the Curve mean value of 0.77 ± 0.07 , with a min-max range of 0.57 - 0.87 . Absolute operator agreement was higher over the segmented image ( I C C = 0.96 ) compared to the video ( I C C = 0.76 ) and the a broader field of view image ( I C C = 0.92 ). Fractal Dimension computed on both manual segmented images (ground truths) and automatically showed a good correlation with the clinical score (0.85 and 0.75, respectively). Experimental analyses suggest that extracting the vascular tree from cine-angiography can substantially improve the reliability of visual assessment of vascular complexity in PAOD. Results also reveal the effectiveness of FD in evaluating complex vascular tree structures. [ABSTRACT FROM AUTHOR]

The aim of this study was to develop a mathematical model to assess the effect of soluble microbial products production and external carbon source addition on the performance of a sulfur-driven autotrophic denitrification (SdAD) process. During SdAD, the growth of autotrophic biomass (AUT) was accompanied by the proliferation of heterotrophic biomass mainly consisting of heterotrophic denitrifiers (HD) and sulfate-reducing bacteria (SRB), which are able to grow on both the SMP derived from the microbial activities and on an external carbon source. The process was supposed to occur in a sequencing batch reactor to investigate the effects of the COD injection on both heterotrophic species and to enhance the production and consumption of SMP. The mathematical model was built on mass balance considerations and consists of a system of nonlinear impulsive differential equations, which have been solved numerically. Different simulation scenarios have been investigated by varying the main operational parameters: cycle duration, day of COD injection and quantity of COD injected. For cycle durations of more than 15 days and a COD injection after the half-cycle duration, SdAD represents the prevailing process and the SRB represent the main heterotrophic family. For shorter cycle duration and COD injections earlier than the middle of the cycle, the same performance can be achieved increasing the quantity of COD added, which results in an increased activity of HD. In all the performed simulation even in the case of COD addition, AUT remain the prevailing microbial family in the reactor. [ABSTRACT FROM AUTHOR]

Performing transcatheter aortic valve implantation with high implantation technique, i.e. with an aorto-ventricular ratio > 60/40, reduces the need of permanent pacemaker implantation. Valve calcification and prosthesis oversizing are predictors of permanent pacemaker implantation, but there are no available data on their role when transcatheter aortic valve implantation is performed with an aorto-ventricular ratio > 60/40. The aim of this study was to evaluate the effect of leaflets/annulus calcification and prosthesis oversizing on the incidence of permanent pacemaker implantation after transcatheter aortic valve implantation with a high implantation technique. Transcatheter aortic valve implantation was performed in 48 patients implanting a balloon-expandable transcatheter heart valve with an aorto-ventricular ratio > 60/40. Calcium burden was assessed by preprocedural multidetector computed tomography. An invasive electrophysiological study was performed before and after transcatheter aortic valve implantation. Five patients (10.4%) needed permanent pacemaker implantation. At univariate analysis, baseline right bundle branch block and postprocedural PR, QRS and His-ventricular interval elongation significantly predicted permanent pacemaker implantation (p < 0.05). Receiver-operating characteristic curve analysis showed a correlation between transcatheter heart valve oversizing and permanent pacemaker implantation need, with the best cut-off being 17% (AUC = 0.72, p = 0.033). Linear regression analysis demonstrated that QRS complex elongation was related to total, left and non-coronary leaflet calcification (p < 0.05). This study demonstrates that, when transcatheter aortic valve implantation is performed using a balloon-expandable transcatheter heart valve deployed with an aorto-ventricular ratio > 60/40, the presence of leaflets/annulus calcification or the need to oversize the prosthesis correlate with the occurrence of pathological cardiac conduction delays. [ABSTRACT FROM AUTHOR]

To evaluate longitudinal systolic function in patients with myocarditis, its correlation with cardiac magnetic resonance (CMR) features, and its predictive value in functional recovery and arrhythmias onset during follow-up (FU) on optimized medical therapy (OMT). Patients with acute myocarditis, confirmed through CMR criteria, and age- and sex-matched healthy controls were enrolled. Two-dimensional (2D) transthoracic echocardiography, including speckle tracking analysis, was performed at admission and after 6 months of FU. Patients of myocarditis group also underwent 24 h ECG Holter monitoring during FU. 115 patients with myocarditis (mean age 41 ± 17, 70% males) and 70 healthy subjects were enrolled. Global longitudinal strain (GLS) and sub-epicardial strain were markedly lower in the myocarditis group than in controls (mean GLS%: − 14.1 ± 5.1 vs − 23.1 ± 3.6, p < 0.001). A strong positive correlation between total scar burden (TSB) on CMR and baseline LV GLS was found (r = 0.67, p < 0.0001). GLS improved after 6 months of FU in myocarditis on OMT (mean GLS%: − 14.1 ± 5.1 vs − 16.5 ± 4.8, p < 0.01). By bivariate correlation analysis, baseline LVEF, GLS, and TSB were all associated with LVEF at 6 months of FU. Moreover, by multivariable linear regression analysis, these parameters confirmed to be independent predictors of functional recovery at 6 months (LVEF β 0.38, p < 0.01; GLS β − 0.35, p < 0.01; total scar burden β − 0.52, p < 0.0001). Segmental peak systolic strain was significantly different between segments with and without late gadolinium enhancement on CMR (− 13.2 ± 3.1% vs − 18.1 ± 3.5%, p < 0.001). A segmental strain of − 12% identified scar with a sensitivity of 79% and a specificity of 84% (AUC = 0.91; 95% CI 0.73–0.97; p < 0.001). In addition, baseline LV GLS in myocarditis resulted predictive of non-sustained ventricular tachycardias (cut-off value > − 12%; sensitivity84%; specificity74.4%; AUC = 0.75). Parameters of myocardial longitudinal deformation are importantly associated with the presence of a scar on CMR and are predictors of functional outcome and ventricular arrhythmias in patients with acute myocarditis. Their assessment during ultrasound examination should be considered to get more information about the prognosis and risk stratification of this subset of patients. [ABSTRACT FROM AUTHOR]

Prompt detection of cardiovascular abnormalities in children with anorexia nervosa and physical instability requiring hospitalization is essential to identify patients at higher cardiovascular risk. We studied all anorexia nervosa children requiring admission at Paediatric Institute in the period 2015–2019. Anorexia nervosa cardiopathy at admission was defined by the presence of at least two of the following clinical findings: pericardial effusion, mitral regurgitation, bradycardia, mitral billowing, aortic regurgitation, altered LV morphology and ECG abnormalities. Echocardiographic data were compared with those registered at 3–8-month follow-up and with data from a healthy population. Thirty-eight anorexia nervosa children were examined. Prevalence of anorexia nervosa cardiopathy at admission was 63% (24 patients). Pericardial effusion, bradycardia and mitral regurgitation were present together in 26% of patients. Most cardiovascular changes recovered at follow-up. Anorexia nervosa cardiopathy was associated with significantly lower left ventricle end-diastolic diameters and mass, and higher E wave, E/A and E/e′ ratios and left ventricle sphericity index values vs healthy population and vs anorexia nervosa children without cardiopathy (p<0.05). Left ventricle global longitudinal strain was significantly reduced only in anorexia nervosa cardiopathy patients but recovered, whereas end-diastolic diameters, E/A ratio and sphericity index values remained impaired. Conclusion: Among anorexia nervosa children requiring hospitalization, those presenting several cardiac findings together express an acute anorexia nervosa cardiopathy which is characterized by worse LV filling, geometry and subclinical myocardial deformation impairment. Despite treatment, in those patients, some alterations persist at mid-term follow-up. What is Known: • Cardiac and electrocardiographic changes are present in anorexia nervosa children at diagnosis or during stable disease, and most recover after body-weight treatment. • It is unknown if anorexia nervosa children with more severe cardiac impairment during hospitalization present higher cardiovascular-risk profile despite treatment. What is New: • In anorexia nervosa children needing hospitalization for physical reasons, prevalence of acute anorexia nervosa cardiopathy at admission is high, around 60%. • By advanced echocardiography, children with anorexia nervosa cardiopathy at admission have a worse cardiac filling, impaired cardiac geometry and systolic deformation that only partially recover at mid-term follow-up. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the efficacy of oxygen-enriched oil-based gel dressing on wound healing and postoperative outcome in children who underwent distal hypospadias repair. Methods: We included all patients with distal hypospadias, who underwent Snodgrass urethroplasty and preputioplasty over an 18-months period. The patients were randomized in two groups according to the type of medication: oxygen-enriched oil-based gel (G1) and hyaluronic acid cream (G2). After discharge, parents changed the dressing twice a day for 2–3 weeks postoperatively. The patients were evaluated at 7, 14, 21, 30, 60 and 180 postoperative days and thereafter annually. Results: One-hundred and fourteen patients (median age 18 months) were included in the study and randomized in two groups, each of 57 patients. The wound healing was significantly faster in G1 compared with G2 (p = 0.001). G1 reported significantly higher SWAS and modified HOPE scores compared with G2 (p = 0.001) at all steps of follow-up. No adverse skin reactions occurred. Foreskin dehiscence and re-operations rates were significantly lower in G1 compared with G2 (p = 0.001). Postoperative foreskin retractability was better in G1, with a significantly higher incidence of secondary phimosis in G2 (p = 0.001). The median treatment costs were significantly lower in G1 compared with G2 (p = 0.001). Conclusion: Postoperative dressing using oxygen-enriched oil-based gel was highly effective, promoting a faster wound healing in patients who underwent distal hypospadias repair. It reported a lower incidence of foreskin dehiscence and better foreskin retractability compared with the control group. It was cost-effective and clinically safe without allergy or intolerance to the product. [ABSTRACT FROM AUTHOR]

Due to the multiplicity of biogeochemical processes taking place in anaerobic digestion (AD) systems and limitations of the available analytical techniques, assessing the bioavailability of trace elements (TEs) is challenging. Determination of TE speciation can be facilitated by developing a mathematical model able to consider the physicochemical processes affecting TEs dynamics. A modeling framework based on anaerobic digestion model no 1 (ADM1) has been proposed to predict the biogeochemical fate TEs in AD environments. In particular, the model considers the TE adsorption–desorption reactions with biomass, inerts and mineral precipitates, as well as TE precipitation/dissolution, complexation reactions and biodegradation processes. The developed model was integrated numerically, and numerical simulations have been run to investigate the model behavior. The simulation scenarios predicted the effect of (i) organic matter concentration, (ii) initial TEs concentrations, (iii) initial Ca–Mg concentrations, (iv) initial EDTA concentration, and (v) change in TE binding site density, on cumulative methane production and TE speciation. Finally, experimental data from a real case continuous AD system have been compared to the model predictions. The results prove that this modelling framework can be applied to various AD operations and may also serve as a basis to develop a model-predictive TE dosing strategy. [ABSTRACT FROM AUTHOR]

The process dynamics of anaerobic oxidation of methane (AOM) coupled to sulfate reduction (SR), and the potential role of elemental sulfur as intermediate are presented in this paper. Thermodynamic screening and experimental evidence from the literature conclude that a prominent model to describe AOM-SR is based on the concept that anaerobic methane oxidation proceeds through the production of the intermediate elemental sulfur. Two microbial groups are involved in the process: (a) anaerobic methanotrophs (ANME-2) and (b) Desulfosarcina/Desulfococcus sulfur reducers cluster (DSS). In this work, a dynamic model was developed to explore the interactions between biotic and abiotic processes to simulate the microbial activity, the chemical composition and speciation of the liquid phase, and the gas phase composition in the reactor headspace. The model includes the microbial kinetics for the symbiotic growth of ANME-2 and DSS, mass transfer phenomena between the gas and liquid phase for methane, hydrogen sulfide, and carbon dioxide and acid–base reactions for bicarbonate, sulfide, and ammonium. A data set from batch experiments, running for 250 days in artificial seawater inoculated with sediment from Marine Lake Grevelingen (The Netherlands) was used to calibrate the model. The inherent characteristics of AOM-SR make the identification of the kinetic parameters difficult due to the high correlation between them. However, by meaningfully selecting a set of kinetic parameters, the model simulates successfully the experimental data for sulfate reduction and sulfide production. The model can be considered as the basic structure for simulating continuous flow three-phase engineered systems based on AOM-SR. [ABSTRACT FROM AUTHOR]

Accumulating evidence suggests that modifications of gut function and microbiota composition might play a pivotal role in the pathophysiology of several cardiovascular diseases, including heart failure (HF). In this study we systematically analysed gut microbiota composition, intestinal barrier integrity, intestinal and serum cytokines and serum endotoxin levels in C57BL/6 mice undergoing pressure overload by transverse aortic constriction (TAC) for 1 and 4 weeks. Compared to sham-operated animals, TAC induced prompt and strong weakening of intestinal barrier integrity, long-lasting decrease of colon anti-inflammatory cytokine levels, significant increases of serum levels of bacterial lipopolysaccharide and proinflammatory cytokines. TAC also exerted effects on microbiota composition, inducing significant differences in bacterial genera inside Actinobacteria, Firmicutes, Proteobacteria and TM7 phyla as shown by 16S rDNA sequencing of fecal samples from TAC or sham mice. These results suggest that gut modifications represent an important element to be considered in the development and progression of cardiac dysfunction in response to TAC and support this animal model as a valuable tool to establish the role and mechanisms of gut-heart crosstalk in HF. Evidence arising in this field might identify new treatment options targeting gut integrity and microbiota components to face adverse cardiac events. [ABSTRACT FROM AUTHOR]

Dobutamine stress echocardiography (DSE) is sensitive but subjective diagnostic tool to detect inducible ischemia. Nowadays, speckle tracking allows an objective quantification of regional wall function. We aimed to investigate the feasibility and accuracy of global (GLS) and regional longitudinal strain (RLS) during DSE to detect significant coronary stenosis (SCS). We conducted a prospective observational multicenter study including patients undergoing DSE for suspected SCS. 50 patients with positive DSE underwent coronary angiography. Besides visual regional wall motion score index (WMSI), GLS and RLS were determined at rest and at peak stress by Automated Function Imaging. DSE GLS feasibility was 96%. Among 35 patients with SCS, 12 patients were affected by multivessel disease, 18 had stenosis of left anterior descending artery (LAD), 18 of left circumflex (LCX) and 15 of right coronary artery (RCA). At peak stress, both GLS reduction (p = 0.037) and WMSI worsening (p = 0.04) showed significant agreement with coronary angiography for detecting SCS. When single lesion was considered, peak stress GLS and LAD RLS were lower in the obstructed LAD regions than in normo-perfused territories (17.4 ± 5.5 vs. 20.5 ± 4.4%, p = 0.03; 17.1 ± 7.6 vs. 21.6 ± 5.5%, p < 0.02, respectively). Furthermore, the addition of RLS to regional WMSI was able to improve accuracy in LAD SCS prediction (AUC 0.68, p = 0.037). Conversely, in presence of LCX or RCA SCS, LS was less accurate than WMSI at peak stress. In conclusion, DSE strain analysis is feasible and may improve prediction of LAD SCS, whereas regional WMSI assessment performs better in presence of SCS of LCX and RCA. [ABSTRACT FROM AUTHOR]

In Anderson–Fabry disease (AFD) the impact of left ventricular (LV) function on cardiac outcome is unknown. Noninvasive LV pressure–strain loop analysis is a new echocardiographic method to estimate myocardial work (MW). We aimed to evaluate whether LV function was associated with outcome and whether MW had a prognostic value in AFD. Ninety-six AFD patients (41.8 ± 14.7 years, 43.7% males) with normal LV ejection fraction were retrospectively evaluated. Inclusion criteria were sinus rhythm and ≥ 2-year follow-up. Standard echocardiography measurements, myocardial mechano-energetic efficiency (MEE) index, global longitudinal strain (GLS) and MW were evaluated. Adverse cardiac events were defined as composite of cardiac death, malignant ventricular tachycardia, atrial fibrillation and severe heart failure development. During a median follow-up of 63 months (interquartile range 37–85), 14 events occurred. Patient age, cardiac biomarkers, LV mass index, left atrium volume, E/Ea ratio, LV ejection fraction, MEE index, GLS and all MW indices were significantly related to adverse outcome at univariate analysis. After adjustment for clinical and echocardiographic parameters, which were significant at univariate analysis, GLS and MW resulted independent predictors of adverse events (p < 0.01). By ROC curve analysis, constructive MW ≤ 1513 mmHg% showed the highest sensitivity and specificity in predicting adverse outcome (92.9% and 86.6%, respectively). MW did not improve the predictive value of a model including clinical data, LV diastolic function and GLS. LV function impairment (both systolic and diastolic) is associated with adverse events in AFD. MW does not provide additive information over clinical features and systolic and diastolic function. [ABSTRACT FROM AUTHOR]

Antithrombotic therapy is a critical component of the management of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI). Rapid and profound inhibition of platelet reactivity has been shown to mitigate the ischemic risks and improve myocardial salvage. High residual platelet reactivity (HRPR) has been reported up to 4 or 6 h after loading dose of prasugrel or ticagrelor; therefore, multiple alternative strategies, including crushed or chewed oral tables or intravenous agents, have been investigated to provide a more rapid and sustained inhibition of platelet function and bridge the initial treatment gap. The FABOLUS FASTER is the first investigator-initiated, multicentre, open-label, prospective, randomized study to directly compare the pharmacodynamics effects of cangrelor, tirofiban, chewed or integer prasugrel. This study will add new insights in the management of antiplatelet therapy in patients with STEMI undergoing primary PCI and might be hypothesis-generating for future clinical trials in this field. The trial is registered on clinicaltrials.gov NCT02978040, and EudraCT 2017-001065-24. [ABSTRACT FROM AUTHOR]

Microalgal biofilms are increasingly attracting attention as a cultivation platform for different biotechnological purposes. The initial adhesion of algae to a surface, one of the key factors for the formation of a biofilm, was analyzed by coupling image analysis techniques and mathematical modeling. Two isolated microalgae, Chlorella vulgaris ACUF_809 and Chlorella sp. ACUF_802, were identified by molecular techniques. Their health condition and biomass growth were measured using pulse amplitude modulated (PAM) fluorometry; the carrier colonization was studied by imaging analysis (Weka Segmentation) and measuring the green tones of the biofilm through CIELAB colorimetry. Structural features and biofilm vertical distribution were determined by multichannel confocal laser scanning microscopy (CLSM), and some parameters were aligned to the Gompertz model. Chlorella vulgaris ACUF_809 showed good adaptation to form biofilm on cotton fabric measured as high biomass growth reflected in the high F0 (0.42) and biofilm colonization through the CIELAB colorimetry (a*− 9.3), coverage area 32.3%, and average biofilm thickness (106.37 ± 47 μm). This work demonstrated the feasibility of C. vulgaris ACUF_809 and Chlorella sp. ACUF_802 biofilm formation on cotton fabric which potentially provides an alternative for cultivating and producing microalgae biomass. [ABSTRACT FROM AUTHOR]

In Anderson–Fabry disease (AFD), left ventricular (LV) radial function has been scarcely investigated. We hypothesized that LV function may be affected by disease specific mechanisms and sought to comprehensively evaluate LV radial, circumferential and longitudinal function in a large population of AFD patients looking at the influence of LV geometry and fibrosis. We prospectively studied 94 consecutive AFD patients (41.5 ± 14.5 years; 41 men) with preserved LV ejection fraction (EF) utilizing speckle-tracking echocardiography. A subset of patients underwent gadolinium-enhanced cardiac magnetic resonance. Cases were compared to 48 healthy subjects matched for age and sex. LV concentric hypertrophy was found in 33 AFD patients while LV concentric remodeling (relative wall thickness ≥ 0.43) in 16 out 61 patients with normal LV mass. AFD patients had lower radial, longitudinal and circumferential strains than controls, independently by LV geometry pattern. Patients with LV hypertrophy showed reduced global longitudinal strain (p < 0.001) and early diastolic untwisting rate (p = 0.002) as compared to patients with normal geometry. In the whole AFD population, neither radial strain nor circumferential strain correlated with LV mass, while global longitudinal strain and early diastolic untwisting rate did (both p < 0.001). Late gadolinium enhancement was significantly associated with longitudinal strain, twisting rate and early diastolic untwisting rate, with twisting rate being the most powerful independent predictor (β = − 0.461; p = 0.002). Findings demonstrate impairment of LV radial strain in AFD patients with preserved EF, even in a pre-hypertrophic stage. Development of LV hypertrophy and fibrosis make worse mostly longitudinal dysfunction. [ABSTRACT FROM AUTHOR]

This study proposes a comparison of different ex situ technologies aimed at the removal of polycyclic aromatic hydrocarbons from marine sediments in terms of performances, costs and energy balance. In accordance with the principles of water-energy nexus, anaerobic bioremediation, soil washing and thermal desorption were investigated under low liquid phase and temperature conditions using phenanthrene (PHE) as model compound. After 42 days of anaerobic bioremediation, the highest PHE biodegradation of 68 and 64% was observed under denitrifying and methanogenic conditions, respectively, accompanied by N2 and CH4 production and volatile fatty acid accumulation. During soil washing, more than 97% of PHE was removed after 60 min using a solid-to-liquid ratio of 1:3. Along the same treatment time, low-temperature thermal desorption (LTTD) allowed a PHE removal of 88% at 200 °C. The economic analysis indicated that LTTD resulted in a higher cost (i.e. 1782 € m−3) than bioremediation and soil washing (228 and 371 € m−3, respectively). The energy balance also suggested that bioremediation and soil washing are more sustainable technologies as a lower required energy (i.e. 16 and 14 kWh m−3, respectively) than LTTD (i.e. 417 kWh m−3) is needed. [ABSTRACT FROM AUTHOR]

Purpose: We reported our preliminary experience using ICG fluorescence in pediatric minimally invasive surgery (MIS) with the aim to standardize indications, dose, timing, and modality of administration of ICG according to different organs.Methods: ICG technology was adopted in 46 MIS procedures performed in our unit over the last 18 months: 30 left varicocele repairs; 5 cholecystectomies in obese adolescents; 3 tumor excisions; 3 nephrectomies; 2 partial nephrectomies; 3 lymphoma excisions. ICG solution was injected intravenously in all cases except for varicocelectomy in which it was injected into the testis. The ICG injection was performed intra-operatively in all cases except for cholecystectomy in which it was injected 18 h prior to the procedure.Results: All procedures were completed laparoscopically without conversions or intra-operative complications. No adverse or allergic reactions to ICG were reported.Conclusion: Our preliminary experience showed that ICG fluorescence is a safe, useful, and versatile technique to adopt in pediatric MIS to achieve a better identification of anatomy and an easier surgical dissection or resection in challenging cases. Currently, the main indications are varicocelectomy, difficult cholecystectomy, tumor excision, nephrectomy, and partial nephrectomy. The main limitation is the needing of a special equipment to use ICG technology. [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve replacement (TAVR) has been recognized as a well-established alternative to surgical aortic valve replacement (SAVR) for symptomatic aortic stenosis with high surgical risk. With this updated systematic review and meta-analysis, we evaluated TAVR vs. SAVR in low- and intermediate-risk subjects. Studies comparing TAVR and SAVR in low-risk patients (defined as STS ≤ 8% or EuroSCORE ≤ 20%) were identified with electronic searches. The principal endpoint was all-cause mortality at short term (< 3 months), 1, and 2 years. Other outcomes of interest were cardiac mortality, neurological events, paravalvular leakage (PVL), myocardial infarction (MI), major bleeding, acute kidney injury (AKI), vascular complications, and new pacemaker (PM) implantation. Seventeen articles including 9805 (4956 TAVR and 4849 SAVR) patients were eligible. There was no significant difference in all-cause mortality at short term [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.63–1.09], 1 year (OR 1.01, 95% CI 0.86–1.20) and 2 years (OR 0.86, 95% CI 0.64–1.16) between treatment groups. Subgroup analyses stratified by surgical risk score (low-risk subgroup: STS < 4% or EuroSCORE < 10%, intermediate-risk subgroup: the others) did not show interaction on primary endpoints. Compared to SAVR, TAVR had similar rates of neurological events, significantly lower risk of MI and AKI, but higher risk of vascular complications, new PM implantation and moderate/severe PVL. In low- and intermediate-risk patients, TAVR and SAVR have similar short- and mid-term all-cause mortality. Compared to SAVR, TAVR carries higher rates of vascular complications, PM implantation and moderate/severe PVL, but lower risk of MI and AKI. [ABSTRACT FROM AUTHOR]

Delftia lacustris is reported for the first time as a selenate and selenite reducing bacterium, capable of tolerating and growing in the presence of ≥ 100 mM selenate and 25 mM selenite. The selenate reduction profiles of D. lacustris were investigated by varying selenate concentration, inoculum size, concentration and source of organic electron donor in minimal salt medium. Interestingly, the bacterium was able to reduce both selenate and selenite under aerobic conditions. Although considerable removal of selenate was observed at all concentrations investigated, D. lacustris was able to completely reduce 0.1 mM selenate within 96 h using lactate as the carbon source. Around 62.2% unaccounted selenium (unidentified organo-selenium compounds), 10.9% elemental selenium and 26.9% selenite were determined in the medium after complete reduction of selenate. Studies of the enzymatic activity of the cell fractions show that the selenite/selenate reducing enzymes were intracellular and independent of NADPH availability. D. lacustris shows an unique metabolism of selenium oxyanions to form elemental selenium and possibly also selenium ester compounds, thus a potential candidate for the remediation of selenium-contaminated wastewaters in aerobic environments. This novel finding will advance the field of bioremediation of selenium-contaminated sites and selenium bio-recovery and the production of potentially beneficial organic and inorganic reactive selenium species. [ABSTRACT FROM AUTHOR]

Purpose: Selenium (Se) toxicity or deficiency disorders are chiefly associated with Se concentration and speciation in soils. Elevated soil Se content may lead to contamination of water bodies and groundwaters due to the leaching caused by rainfall and irrigation. This study is focused on Se removal by in situ (biostimulation and bioaugmentation) and ex situ (soil washing) bioremediation as well as on its recovery.Materials and methods: In this research, in situ bioremediation of Se-rich soil collected from rice fields in Ludhiana, Northwest India was studied in microcosms. The effect of biostimulation was determined by amending soil with different organic sources (fermentable, non-fermentable, and non-hydrolysable electron donors). The effect of bioaugmentation was determined by adding anaerobic granular sludge to the microcosms. With regard to ex situ bioremediation, the Se-rich soil was leached with water and the resulting leachate was biologically treated in an upflow anaerobic sludge blanket (UASB) reactor using lactate as electron donor. The UASB reactor was operated for 78 days in different conditions of lactate (electron donor) dosing to achieve maximum Se removal and recovery as elemental Se(0) on the granular sludge. The effluent of the UASB reactor was regularly analyzed to determine Se removal efficiencies.Results and discussion: The effect of biostimulation and bioaugmentation showed no significant difference in terms of Se reduction profiles in the microcosms. This suggested that the indigenous Se-reducing microorganisms and oxidizable organic carbon present in the soil are sufficient for in situ soil bioremediation. During treatment of soil leachate in the UASB reactor, 90% Se removal was achieved irrespective of the lactate dosing and mineral salt medium composition of the reactor influent. Analysis of the granular sludge using scanning electron microscopy coupled with energy dispersive X-ray spectroscopy (SEM-EDS) and powder X-ray diffraction (P-XRD) confirmed the presence of elemental Se on the granular sludge. The total Se concentration in the anaerobic granular sludge amounted to 43.5 (± 0.7) μg Se per gram of granular sludge.Conclusions: In situ bioremediation achieved Se reduction in the Se-rich soil investigated. However, risk of Se re-oxidation and leaching into groundwater after in situ remediation cannot be disregarded. In contrast, during ex situ treatment, effluent from the UASB reactor contained less than the USEPA guideline value 5 μg L−1 Se. This study showed biological treatment of Se-rich soils is suitable for cleaning the soil, Se recovery, and environmentally acceptable effluent discharge of the soil washing leachate treatment. [ABSTRACT FROM AUTHOR]

Biological reduction of sulphate at low hydraulic retention time (HRT) is presented in this paper. A sulphidogenic inverse fluidized-bed bioreactor (IFBB) was operated successfully at a progressively decreasing HRT from 1 to 0.125 days for a total of 155 days. Synthetic wastewater containing sulphate at a concentration of 745 (± 17) mg/L was used. COD was supplied as lactate in variable concentrations at COD/SO42− ratios of 1.2-2.4. The pH of the feed ranged between 5.2 and 6.2. The highest measured removal rates were 2646 and 4866 mg SO42−/L day at an HRT of 0.25 and 0.125 days, respectively, using a COD/SO42− ratio of 2.3. The biological sulphate reduction was limited by the influent COD concentrations at a COD/SO42− ratio < 2.3. The IFBB ensured biomass retention at a maximum liquid residence time of θ = 3.84 (± 0.013), according to the residence time distribution analysis. Hydrodynamic studies were carried out at recirculation rates of 0, 200, 300, 350, 400, and 500 L/h to measure the relative bed expansion, the mixing pattern, and the fluidization characteristics of the reactor. A dynamic model is also developed based on COD and sulphate as the two limiting substrates in a Monod-type kinetic equation describing the kinetics of lactate oxidation by SRB. A set of the following parameters YVSS/COD′ = 0.23 mg COD of VSS/mg lactate, µmax = 1.758 day− 1, KCOD = 956 mg COD of lactate/L, KSO4 = 316 mg SO42−/L, kd = 0.024 day− 1, tres = 5.7 days, and kexchange = 0.4 day− 1 simulated adequately the residual effluent COD and sulphate concentrations, the produced sulphide concentration as well as the pH of the IFBB effluent. Low HRT values, shown efficient in this study, are prerequisite for industrial applicability and economic feasibility of the sulphur reduction process. In addition, the developed model can be used for optimum experimental design and further process upscale and development. [ABSTRACT FROM AUTHOR]

Dual antiplatelet therapy (DAPT) is a cornerstone of treatment for patients with acute coronary syndromes (ACS). Mounting evidences have opened the debate about the optimal DAPT duration. Considering the ACS-pathophysiology, the most recent guidelines recommend DAPT in all ACS patients for at least 12 months unless there are contraindications such as excessive risk of bleeding. Thus, it can be considered acceptable earlier discontinuation if the risk of morbidity from bleeding outweighs the anticipated benefit. On the other hand, several studies have clearly indicated that a significant burden of platelet related-events, such as stroke and new ACS might occur after this period, suggesting that potential benefits might derive by prolonging DAPT beyond 12 months (Long DAPT). Indeed, although current guidelines give some indications about patients eligible for Long DAPT, they do not embrace several real-life clinical scenarios. Thus, in such scenarios, how to decide whether a patient is eligible for Long DAPT or not might be still challenging for clinicians. This position paper presents and discusses various “real-life” clinical scenarios in ACS patients, in order to propose several possible recommendations to overcome guidelines potential limitations. [ABSTRACT FROM AUTHOR]

The online version of the original article can be found at https://doi.org/10.1007/s10741-023-10312-7. To rectify this, we wish to clarify that the author's surname is Immobile Molaro and her name is simply Maddalena, with no middle name. B Correction to: Heart Failure Reviews b https://doi.org/10.1007/s10741-023-10312-7 Unfortunately, there was an error in the name of one of the authors. [Extracted from the article]

Electro-Fenton (EF), an advanced oxidation process, can be combined with a biological process for efficient treatment of wastewater containing refractory pollutants such as pharmaceuticals. In this study, a biological process was implemented in a sequencing batch reactor (SBR), which was either preceded or followed by EF treatment. The main goal was to evaluate the potential of two sequences of a combined electrochemical-biological process: EF/SBR and SBR/EF for the treatment of real wastewater spiked with 0.1 mM of caffeine and 5-fluorouracil. The biological removal of COD and pharmaceuticals was improved by extending the acclimation time and increasing concentration of biomass in the SBR. Hardly biodegradable caffeine and COD were completely removed during the EF post-treatment (SBR/EF). During the EF/SBR sequence, complete removal of pharmaceuticals was achieved by EF within 30 min at applied current 800 mA. With a current of 500 and 800 mA, the initially very low BOD5/COD ratio increased up to 0.38 and 0.58, respectively, after 30 min. The efficiency of the biological post-treatment was influenced by the biodegradability enhancement after EF pre-treatment. The choice of an adequate sequence of such a combined process is significantly related to the wastewater characteristics as well as the treatment objectives. [ABSTRACT FROM AUTHOR]

Cytostatic drugs are a troublesome class of emerging pollutants in water owing to their potential effects on DNA. Here we studied the removal of 5-fluorouracil from water using the electro-Fenton process. Galvanostatic electrolyses were performed with an undivided laboratory-scale cell equipped with a boron-doped diamond anode and a carbon felt cathode. Results show that the fastest degradation and almost complete mineralization was obtained at a Fe2+ catalyst concentration of 0.2 mM. The absolute rate constant for oxidation of 5-fluorouracil by hydroxyl radicals was 1.52 × 109 M−1 s−1. Oxalic and acetic acids were initially formed as main short-chain aliphatic by-products, then were completely degraded. After 6 h the final solution mainly contained inorganic ions (NH4+, NO3− and F−) and less than 10% of residual organic carbon. Hence, electro-Fenton constitutes an interesting alternative to degrade biorefractory drugs. [ABSTRACT FROM AUTHOR]

Industrial wastewaters containing high concentrations of sulphate, such as those generated by mining, metallurgical and mineral processing industries, require electron donor for biological sulfidogenesis. In this study, five types of lignocellulosic biowastes were characterized as potential low-cost slow release electron donors for application in a continuously operated sulphidogenic inverse fluidized bed bioreactor (IFBB). Among them, natural scourer and cork were selected due to their high composition of volatile solids (VS), viz. 89.1 and 96.3%, respectively. Experiments were performed in batch (47 days) and in an IFBB (49 days) using synthetic sulphate-rich wastewater. In batch, the scourer gave higher sulphate reduction rates (67.7 mg SO42− L−1 day−1) in comparison to cork (12.1 mg SO42− L−1 day−1), achieving >82% sulphate reduction efficiencies. In the IFBB packed with the natural scourer, the average sulphate reduction efficiency was 24 (±17)%, while the volumetric sulphate reduction rate was 167 (±117) mg SO42− L−1 day−1. The long incubation time in the batch experiments (47 days) allowed higher sulphate reduction efficiencies in comparison to the short hydraulic retention time (24 h) in the IFBB. This suggests the hydrolysis-fermentation was the rate-limiting step and the electron donor supply (through hydrolysis of the lignocellulosic biowaste) was limiting the sulphate reduction.Lignocellulose as carrier material and slow release electron donor for sulphidogenesis [ABSTRACT FROM AUTHOR]

Intramyocardial dissecting hematoma is an uncommon complication of myocardial infarction potentially leading to cardiac rupture. The aim of the present study was to investigate coronary reperfusion results, left ventricular (LV) function recovery and remodeling and clinical outcomes in patients with anterior STEMI complicated by intramyocardial hematoma. We prospectively studied 87 patients (mean age 59 ± 10 years; 88% male) with anterior STEMI (42 with intramyocardial hematoma) in order to evaluate coronary reperfusion results, LV remodeling (≥15% increase in end-systolic volume) and clinical outcomes (cardiac death, non-fatal reinfarction, and hospitalization for congestive heart failure) at 24 months. Thrombolysis in myocardial infarction (TIMI) flow score and myocardial blush grade (MBG) were assessed both pre- and post-percutaneous coronary intervention (PCI) and speckle-tracking echocardiography was performed post PCI and at 6-month follow-up. Patients with hematoma had lower post-PCI TIMI score and MBG, higher heart rate, worse LV ejection fraction and longitudinal or rotational function than their counterparts. LV remodeling occurred in 33 (78.6%) patients with hematoma and 11 (24.4%) patients without (p < 0.001). Independent predictors of LV remodeling were heart rate (p = 0.018), MBG (p = 0.036) and presence of hematoma (p < 0.001). Hematoma (log-rank test, χ2 = 9.849; p = 0.002) and LV remodeling (log-rank test, χ2 = 13.770; p < 0.001) were associated to a higher rate of adverse events. Cox analysis identified LV remodeling as the only independent predictor of adverse events (hazard ratio = 3.912; 95% confidence interval, 1.429–10.714; p = 0.008). Intramyocardial dissecting hematoma complicating anterior STEMI is an independent determinant of LV remodeling and is associated to poor prognosis. [ABSTRACT FROM AUTHOR]

Sulfate-reducing bacteria in marine sediments mainly utilize sulfate as a terminal electron acceptor with different organic compounds as electron donors. This study investigated microbial sulfate-reducing activity of coastal sediment from Marine Lake Grevelingen (MLG), the Netherlands using different electron donors and electron acceptors. All four electron donors (ethanol, lactate, acetate and methane) showed sulfate-reducing activity with sulfate as electron acceptor, suggesting the presence of an active sulfate-reducing bacterial population in the sediment, even at dissolved sulfide concentrations exceeding 12 mM. Ethanol showed the highest sulfate reduction rate of 55 µmol g day compared to lactate (32 µmol g day), acetate (26 µmol g day) and methane (4.7 µmol g day). Sulfide production using thiosulfate and elemental sulfur as electron acceptors and methane as the electron donor was observed, however, mainly by disproportionation rather than by anaerobic oxidation of methane coupled to sulfate reduction. This study showed that the MLG sediment is capable of performing sulfate reduction by using diverse electron donors, including the gaseous and cheap electron donor methane. [ABSTRACT FROM AUTHOR]

The microbial community inhabiting the shallow sulfate-methane transition zone in coastal sediments from marine Lake Grevelingen (The Netherlands) was characterized, and the ability of the microorganisms to carry out anaerobic oxidation of methane coupled to sulfate reduction was assessed in activity tests. In vitro activity tests of the sediment with methane and sulfate demonstrated sulfide production coupled to the simultaneous consumption of sulfate and methane at approximately equimolar ratios over a period of 150 days. The maximum sulfate reduction rate was 5 μmol sulfate per gram dry weight per day during the incubation period. Diverse archaeal and bacterial clades were retrieved from the sediment with the majority of them clustered with Euryarchaeota, Thaumarcheota, Bacteroidetes, and Proteobacteria. The 16S rRNA gene sequence analysis showed that the sediment from marine Lake Grevelingen contained anaerobic methanotrophic Archaea (ANME) and methanogens as archaeal clades with a role in the methane cycling. ANME at the studied site mainly belong to the ANME-3 clade. This study provides one of the few reports for the presence of ANME-3 in a shallow coastal sediment. Sulfate-reducing bacteria from Desulfobulbus clades were found among the sulfate reducers, however, with very low relative abundance. Desulfobulbus has previously been commonly found associated with ANME, whereas in our study, ANME-3 and Desulfobulbus were not observed simultaneously in clusters, suggesting the possibility of independent AOM by ANME-3. [ABSTRACT FROM AUTHOR]

A comparison of Cu extraction yields for three different ethylenediamine- N, N′-disuccinic acid (EDDS)-enhanced washing configurations was performed on a Cu-contaminated soil. Batch experiments were used to simulate a single-stage continuous stirred tank reactor (CSTR) and a multi-stage (side feeding and counter-current) reactor. Single-stage CSTR conditions were simulated for various EDDS:(Cu + Cd + Pb + Co + Ni + Zn) molar ratio (EDDS:M ratio) (from 1 to 30) and liquid to soil (L/S) ratio (from 15 to 45). The highest Cu extraction yield (≃56%) was achieved with EDDS:M = 30. In contrast, a Cu extraction yield decrease was observed with increasing L/S ratio with highest extracted Cu achievement (≃48%) for L/S = 15. Side feeding configuration was tested in four experimental conditions through different fractionation mode of EDDS dose and treatment time at each washing step. Results from the four tests showed all enhanced Cu extraction (maximum values from ≃43 to ≃51%) achieved at lower treatment time and lower EDDS:M molar ratio compared to CSTR configuration with L/S = 25 and EDDS:M = 10. The counter-current washing was carried out through two washing flows achieving a process performance enhancement with 27% increase of extracted Cu compared to single-stage CSTR configuration. Higher Cu extraction percentage (36.8%) was observed in the first washing phase than in the second one (24.7%). [ABSTRACT FROM AUTHOR]

Fe(II)-mediated autotrophic denitrification with four different microbial cultures under different pH and EDTA/Fe(II) conditions was investigated in batch bioassays. Initially, the highest nitrate removal (72%) was achieved with an activated sludge inoculum. The use of pure cultures of Pseudogulbenkiania strain 2002 and Thiobacillus denitrificans resulted in a 55 and 52% nitrate removal, respectively. No denitrification was observed for a mixed culture dominated by Thiobacillus thioparus and T. denitrificans. A longer enrichment on Fe(II) and the supplementation of thiosulfate as additional electron donor were needed to stimulate the denitrifying activity of the Thiobacillus-mixed culture. A second subculture on Fe(II) as sole electron donor resulted in higher denitrification efficiencies for all microbial cultures. In particular, nitrate removal reached up to 84% with a specific nitrate removal rate of 1.160 mM·(g VSS·day) in the bioassays seeded with the Thiobacillus-mixed culture. All cultures were favored by decreasing the EDTA/Fe(II) molar ratio from 2.0 to 0.5. The most significant denitrification enhancement was observed for the Pseudogulbenkiania species, indicating a lower tolerance to EDTA. The two pure cultures effectively maintained denitrification at pH 7.0 and were more sensitive to a pH decrease. Conversely, the optimal pH was 6.0 for the Thiobacillus-mixed and activated sludge cultures. [ABSTRACT FROM AUTHOR]

The current study aims to tackle one of the main obstacles in the application of anaerobic ammonium oxidation (Anammox) technology, i.e., the extreme slow growth of the Anammox bacteria. Three conventional sludge has been tested in sequencing batch reactor for Anammox enrichment, including conventional aerobic sludge, denitrification sludge, and anaerobic sludge. With a high selection stress and insufficient oxygen control, the reactor seeded with aerobic sludge reached 50-60% total nitrogen removal after 240 days whereas that seeded with anaerobic sludge failed to establish Anammox activity. Anammox process was successfully established in the reactor seeded with denitrification sludge with a total nitrogen removal of approximately 80% after 150 days under strict oxygen control (DO <0.2 mg/L) and low selection stress. Under the same operational condition, the reactor seeded with anaerobic sludge reached only 20-30% total nitrogen removal. All the reactors experienced fluctuating performances during the enrichment process, which was believed to be the consequence of inhibitory factors such as dissolved oxygen, nitrite and free ammonia as well as undesirable coexisting bacteria which compete for the same substrate. The denaturing gradient gel electrophoresis (DGGE) band from the amplified DNA samples extracted from different enrichment stage showed a clear evolution of the microbial composition as reflected by the change in the band locations and their intensity. [ABSTRACT FROM AUTHOR]

The present paper analyzes literature data dealing with the use of aminopolycarboxylates for chemical washing of heavy metals contaminated soils. The aim is to rationalize and organize the up-to-date knowledge of process dependence on different parameters, in order to give a contribution to the development of washing protocols applicable for process optimization. Process efficiency is found to be dependent on i) parameters related to soil composition, ii) parameters related to contaminant characteristics and iii) operating parameters. The effect that each of them, according to the reviewed experimental studies, has on process efficiency, is highlighted, and the interdependence among them is presented as a key point to understand the overall removal mechanism and therefore to calibrate its application case-by-case. [ABSTRACT FROM AUTHOR]

The kinetic trend for Cu extraction from contaminated soil through ethylenediamine-N,N′-disuccinic acid (EDDS)-enhanced soil washing is investigated. Long-term tests are conducted over 96 h at five different values of EDDS-Cu ( M) molar ratio (mol/mol) and five different values of liquid-to-soil ( L/ S) ratio ( v/ w). The overall Cu extraction efficiency at different M ratios ranges from ≃47 to ≃60 % as the ratio increases from stoichiometric values to EDDS excess ( M = 50). An increase in the L/ S ratio generally leads to the Cu extraction efficiency decrease, from ≃60 % ( L/ S = 5) to ≃49 % ( L/ S = 45). The highest decrease of Cu extraction yield is observed while increasing the L/ S ratio from 5 to 15, with negligible differences occurring as the L/ S ratio increases further. The collected data show a two-step kinetic tendency during the extraction process, first characterized by a fast extraction kinetic which is followed by a slow extraction step. Two sets of experimental data are used for calibration and validation of a two-step mathematical model used to simulate Cu mobilization efficiency as a function of treatment time and M ratio. The proposed model is a useful tool for Cu extraction efficiency prediction and can be applied to improve the decision-making process regarding the EDDS-enhanced soil washing approach. [ABSTRACT FROM AUTHOR]

Total selenium removal by the activated sludge process, where selenite is reduced to colloidal elemental selenium nanoparticles (BioSeNPs) that remain entrapped in the activated sludge flocs, was studied. Total selenium removal efficiencies with glucose as electron donor (2.0 g chemical oxygen demand (COD) L) at neutral pH and 30 °C gave 2.9 and 6.8 times higher removal efficiencies as compared to the electron donors lactate and acetate, respectively. Total selenium removal efficiencies of 79 (±3) and 86 (±1) % were achieved in shake flasks and fed batch reactors, respectively, at dissolved oxygen (DO) concentrations above 4.0 mg L and 30 °C when fed with 172 mg L (1 mM) NaSeO and 2.0 g L COD of glucose. Continuously operated reactors operating at neutral pH, 30 °C and a DO >3 mg L removed 33.98 and 36.65 mg of total selenium per gram of total suspended solids (TSS) at TSS concentrations of 1.3 and 3.0 g L, respectively. However, selenite toxicity to the activated sludge led to failure of a continuously operating activated sludge reactor at the applied loading rates. This suggests that a higher hydraulic retention time (HRT) or different reactor configurations need to be applied for selenium-removing activated sludge processes. [Figure not available: see fulltext.] [ABSTRACT FROM AUTHOR]

This paper reviews the formation, structure, and stability of bioaggregates with an emphasis on the composition and distribution of extracellular polymeric substances (EPS) and their role in bioaggregation. Bioaggregation is ubiquitous in natural environment and is of great importance in biological wastewater treatment processes. It greatly influences the flocculability, settleability, and dewaterability for flocs and sludge retention and shear resistance for biofilms. The physico-chemical and microbial structures of bioaggregates are dependent on operational conditions as well as microbial diversity and spatial distribution. The formation of bioaggregates is mediated by the physico-chemical interactions as well as the microbial interactions such as EPS production and quorum sensing. EPS are composed of a mixture of macromolecules including proteins, polysaccharides, humic-like substances, and nucleic acids, which entrap the microbial cells in a three-dimensional matrix. The composition and physico-chemical characteristics of EPS have significant influence on the maintenance of the bioaggregate structure and the process performance of the wastewater treatment. However, the mechanisms of bioaggregation are still unclear and the conclusions on the role of EPS were mostly drawn from the established correlations and hypotheses. This paper expects to provide up-to-date knowledge on bioaggregation and insights for further studies and applications. [ABSTRACT FROM AUTHOR]

Introduction: Nutraceuticals (NUT) are forms of compounds with biological activity commonly used to improve health in dosage largely exceeding those obtainable in food. Aim: We compared, in a double blind randomized cross-over trial, the effects of two NUT combinations on the control of glico-lipidic metabolism in patients with hypercholesterolemia not on statins. Methods: At study start patients were given dietary counseling and received placebo for 2 weeks. After this run-in period, patients were randomized: (1) Combination A [Policosanol, Red yeast rice (Monakolin K 3 mg), Berberine 500 mg, Astaxantine, Folic Acid and Coenzyme Q10] for 4 weeks followed by 4 weeks of Combination B [Red yeast rice (Monakolin K 3.3 mg), Berberine 531.25 mg and leaf extract of Morus alba]; (2) Combination B for 4 weeks followed by 4 weeks of Combination A. Results: Combination B reduced LDL cholesterol below 130 mg/dl in 56.5 % of the patients, and Cambination A only in 21.7 % of them (p ≤ 0.027). Both treatments reduced plasma levels of triglycerides, total and LDL cholesterol and increased HDL cholesterol (all p < 0.03). Total and LDL cholesterol reduction was more pronounced in patients taking Combination B (p < 0.005). Combination B reduced also glycated hemoglobin, fasting glucose and insulin plasma levels as well as HOMA index (p < 0.005). Conclusions: An increased content of Berberin and Monacolin K and the addition of Morus alba extract improves the effect on plasma cholesterol and on glucose metabolism of the NUT Combination. These effects may allow the speculation of a more marked improvement in cardiovascular prognosis. [ABSTRACT FROM AUTHOR]