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In Greece, 5.8 million tons of municipal solid wastes (MSW) are produced annually, of which 2.47 million tons are bio-wastes. Composting is an alternative treatment of bio-wastes instead of landfill. Τwo composting plants operate in Greece, one in Ano Liossia (capacity 1,200 tons/day, producing 120 tpd compost) and another in Chania (capacity 70,000 tons/year, producing 20,000 tpa compost). In addition, since 2018, the first integrated waste management plant was set off in the region of Kozani (capacity 120,000 tons/year). An alternative utilization of the compost, produced in the latter plant, was investigated in this study. In particular, instead of using compost as fertilizer, the energy recovery from this bio-waste was attested. Utilization of compost of MSW for energy production purposes has rarely been studied in the literature. Several blends of compost with lignite were prepared and their energetic potential was determined. Proximate analyses and gross calorific value (GCV) determination were conducted. Wastes and biomass-based fuels differ in many ways from fossil fuels. The CLOF sample revealed the highest GCV and the lowest ash content than all analyzed samples. Based on all analytical determinations, compost and its mixtures with lignite could be regarded suitable for energy recovery by thermal processes, such us combustion. Further studies should be done including emission analysis, ash deposition during combustion (corrosion, slagging and fouling).

Stelzenmüller, Vanessa ... et al.-- 9 pages, 5 figures, 2 tables, supplementary data https://doi.org/10.1016/j.scitotenv.2017.08.289, Marine ecosystems are increasingly threatened by the cumulative effects of multiple human pressures. Cumulative effect assessments (CEAs) are needed to inform environmental policy and guide ecosystem-based management. Yet, CEAs are inherently complex and seldom linked to real-world management processes. Therefore we propose entrenching CEAs in a risk management process, comprising the steps of risk identification, risk analysis and risk evaluation. We provide guidance to operationalize a risk-based approach to CEAs by describing for each step guiding principles and desired outcomes, scientific challenges and practical solutions. We reviewed the treatment of uncertainty in CEAs and the contribution of different tools and data sources to the implementation of a risk based approach to CEAs. We show that a risk-based approach to CEAs decreases complexity, allows for the transparent treatment of uncertainty and streamlines the uptake of scientific outcomes into the science-policy interface. Hence, its adoption can help bridging the gap between science and decision-making in ecosystem-based management, This article is based upon work from COST Action 15121 ‘Advancing marine conservation in the European and contiguous seas (MarCons) - supported by COST (European Cooperation in Science and Technology, CA15121)

Katsanevakis, Stelios ... et al.-- 16 pages, 2 figures, Cumulative human impacts have led to the degradation of marine ecosystems and the decline of biodiversity in the European and contiguous seas. Effective conservation measures are urgently needed to reverse these trends. Conservation must entail societal choices, underpinned by human values and worldviews that differ between the countries bordering these seas. Social, economic and political heterogeneity adds to the challenge of balancing conservation with sustainable use of the seas. Comprehensive macro-regional coordination is needed to ensure effective conservation of marine ecosystems and biodiversity of this region. Under the European Union Horizon 2020 framework programme, the MarCons COST action aims to promote collaborative research to support marine management, conservation planning and policy development. This will be achieved by developing novel methods and tools to close knowledge gaps and advance marine conservation science. This action will provide support for the development of macro-regional and national policies through six key actions: to develop tools to analyse cumulative human impacts; to identify critical scientific and technical gaps in conservation efforts; to improve the resilience of the marine environment to global change and biological invasions; to develop frameworks for integrated conservation planning across terrestrial, freshwater, and marine environments; to coordinate marine conservation policy across national boundaries; and to identify effective governance approaches for marine protected area management. Achieving the objectives of these actions will facilitate the integration of marine conservation policy into macro-regional maritime spatial planning agendas for the European and contiguous seas, thereby offsetting the loss of biodiversity and ecosystem services in this region, This article is based upon work from COST (European Cooperation in Science and Technology) Action 15121 ‘Advancing marine conservation in the European and contiguous seas (MarCons) - supported by the Horizon 2020 framework programme for research and innovation

The coincidence of coronary and carotid artery disease (uni- or bilateral, with or without involvement of the supra-aortic branch) is still a problem with regards to surgical strategy. Since the opening of the Heart Centre Duisburg in 1989 the authors have favoured a simultaneous approach to lesions in both arterial systems in order to avoid myocardial infarction or stroke. The aim of this retrospective study was to review the early and late results of the combined procedures for the endpoints of death, myocardial infarction and stroke. During a 7-year period (1990-1997) a total of 18,050 patients underwent cardiac surgery and extracorporeal circulation. Simultaneous intervention in both arterial systems was performed in 313 patients (1.73%). All patients underwent preoperative ultrasonic diagnostics, digital subtraction angiography, neurological examination and cardiac catheterization. The principal indication was the need for myocardial revascularization, and symptomatic or asymptomatic carotid stenosis of 80% diameter reduction or more (with or without contralateral disease). The mean age was 66.4 +/- 6.9 years; 240 patients (76.7%) were male, 73 patients (23.3%) female; 243 patients (77.6%) had triple-vessel disease, 82 patients (26.2%) had left main stenosis and 94 patients (43.5%) had a reduced ejection fraction. A total of 171 patients (54.6%) had a previous myocardial infarction, 54 patients (17.3%) presented with unstable angina and nine patients (2.9%) had prior coronary artery bypass grafts. Eighty-seven patients (27.8%) had an internal carotid artery stenosis on the right side, 75 patients (24%) on the left side and 151 patients (48.2%) lesions in both carotid arteries. Prior carotid endarterectomy was performed in 14 patients (4.5%), and the contralateral carotid was occluded in 24 patients (7.7%). Fifty patients had a previous stroke (16%) and 185 patients (59.1%) were asymptomatic. During surgery, the the carotid artery was first exposed, followed by median sternotomy, systemic heparinization, cannulation and cardiopulmonary bypass. After achieving mild hypothermia (30 degrees C), endarterectomy was performed with a venous patch closure. An occluded contralateral carotid artery was always an indication for shunting. Coronary artery bypass grafting was carried out with intermittent cross-clamping under moderate hypothermia (22-27 degrees C). Ten patients suffered a myocardial infarction (3.2%), seven patients (2.2%) had an apoplectic insult perioperatively ( < 30 days) and one patient (0.3%) had an event during long-term follow-up. Early overall mortality was 28 (8.9%), of which 13 were cardiac related (4.2%). Overall late mortality was eight (2.6%), of which six were cardiac related (1.9%). Mean survival time was 6.18 years. Simultaneous carotid endarterectomy and myocardial revascularization can be justified as a routine surgical management of severe lesions in both arterial systems. The risk of myocardial infarction, apoplectic stroke or mortality was not significantly different than isolated procedures.

Mit der Zunahme koronarchirurgischer Eingriffe ist eine Vermehrung der Patienten zu beobachten, bei denen eine inadaquate Menge oder Qualitat an autologem Gefasmaterial fur die aortokoronare Revaskularisation vorliegen. Hier ist die Durchfuhrung einer kompletten Revaskularisation gefahrdet, wenn nicht sogar unmoglich, so das auch die Risiken einer inkompletten Revaskularisation einzugehen sind. Trotz vielfaltiger Bemuhungen gibt es bis heute keinen zufriedenstellenden heterologen Gefasersatz fur die myokardiale Revaskularisation. Das Ziel dieser Arbeit war es, das Verhalten einer neuen heterologen Gefasprothese zu evaluieren.

Burkitt’s lymphoma is rare in the general population [1–2% of non-Hodgkin’s lymphomas (NHL)]. Its prevalence in HIV-positive patients is grossly increased (35–40%) and it must always be taken into consideration for differential diagnosis. We describe the case of a 44-year-old man with acquired immune deficiency syndrome (AIDS) who came to the emergency department suffering from acute low back pain. He was treated conservatively for disc hernia, with recommendation for home therapy. A couple of weeks later, he was hospitalized for further research because of fever, night sweats, and no pain relief. After elaborate clinical and laboratory research consisting of physical examination, blood tests, CT of lungs and abdomen, and MRI of pelvis and spine followed by bone marrow biopsy, the patient was found to have Burkitt’s lymphoma. By recognizing the heterogeneity of AIDS-associated NHL presentation and the potential clinical overlap between malignancy, infection, and other rheumatologic abnormalities, physicians may obtain appropriate diagnostic studies and offer treatment recommendations.

Iatrogenic injuries of the trachea are rare. We report a case of tracheobronchial rupture in a 77-year-old woman after emergency intubation. Early bronchoscopy showed a rupture of the posterior wall of the trachea into the right main bronchus with a total length of 9.5 cm. A right thoracotomy was performed and the tracheal rupture was managed successfully by primary suture. Surgical treatment and possible causes of this lesion are discussed with reference to the literature.

Malignant Mixed Mullerian tumors (MMMT) are rare gynecological tumors. Even with surgical treatment, chemotherapy, and/or radiotherapy, outcome is poor. MMMTs are known to metastasize to the liver, the abdomen, and the lungs. One case of an ocular metastasis has been reported. In a 61-year-old female patient who had undergone surgical resection of a Mullerian tumor of the uterus 26 months prior to being admitted to our department, we found an obstructing left atrial mass. Histopathologic assessment of this lesion after surgical resection revealed a Mullerian tumor metastasis. Immediately after surgery, the patient was asymptomatic, but was readmitted 4 months later with dyspnoea. Echocardiography and CT revealed new masses in the left atrium and left ventricle. On a literature review, we did not find any description of left atrial and left ventricular occluding metastases of MMMT.

Following the increasing number of patients with heart valve replacement and an extended indication (older age groups, acute infective endocarditis, multivalvular procedures) the indicence of malfunction of valve prostheses is continuously growing. The prognosis of patients with a malfunctioning prosthesis mainly depends on early diagnosis and adequate therapy. In a retrospective study (1970 to 1984) 3,533 implanted heart valve prostheses were followed up and the cases with malfunction (n = 150; 4.2%) were analyzed. During the follow-up period after 1963 mitral valve replacements (MVR) there were 78 cases of malfunction (4.6%), after 1806 aortic valve replacements (AVR) 73 (4.1%), and after 34 tricuspid valve replacements (TVR) 4 malfunctions (11.8%). These malfunctions concerned periprosthetic leakages (n = 65), prosthetic endocarditis (n = 42), prosthetic valve thrombosis (n = 13), mechanical dysfunction including bioprosthetic degeneration (n = 17), valve related hemolysis (n = 3), and unsatisfactory hemodynamics (n = 10). Special attention was turned to the problem of prosthetic endocarditis (1963-1984) found in a total of 71 patients following 3,878 prosthetic valve replacements (1.9%). In 42 reoperated cases (1970-1984) the causing microorganisms were analyzed, demonstrating staphylococci in a leading position. Secondary complications and additional risk factors are discussed. There has been no change concerning the basis and the strategy of management for prosthetic endocarditis for many years: After a short time of conservative management with tested antibiotics, early reoperation and exchange of the prosthesis seems to be the optimal therapy, despite a distinctly high postoperative mortality (17%).(ABSTRACT TRUNCATED AT 250 WORDS)