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Cirrhosis and its complications may affect gut microbiota (GM) composition. Transjugular intrahepatic portosystemic shunt (TIPS) represents the most effective treatment for portal hypertension (PH). We aimed to evaluate whether TIPS placement modifies GM composition and metabolic function.A compositional and functional GM analysis was prospectively performed in 13 cirrhotic patients receiving TIPS. Patients receiving systemic or non-absorbable antibiotics for any indications were excluded. Fecal samples were collected before and three months after TIPS. GM was analyzed by 16S ribosomal RNA sequencing. Small- and medium-chain fatty acids (SCFAs and MCFAs, respectively) were measured by gas chromatography/mass spectrometry.TIPS placement resulted in a mean 48% reduction in portal-caval pressure gradient. No recurrence of PH related complications was observed. After TIPS, increased levels of Flavonifractor spp. (p = 0.049), and decreased levels of Clostridiaceae (p = 0.024), these latter linked to abdominal infections in cirrhotic patients, were observed. No differences were found in the SCFAs signature while analysis of MCFA profiles showed a decreased abundance of pro-inflammatory isohexanoic (p0.01), 2-ethylhexanoic (p0.01) and octanoic acids (p0.01) after TIPS.Correction of PH following TIPS results in modifications of GM composition which could be potentially beneficial and reduces the levels of fecal pro-inflammatory MCFAs.

Background and Aims Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) improves survival in patients with cirrhosis with refractory ascites and portal hypertensive bleeding. However, the indication for TIPS in older adult patients (greater than or equal to 70 years) is debated, and a specific prediction model developed in this particular setting is lacking. The aim of this study was to develop and validate a multivariable model for an accurate prediction of mortality in older adults. Approach and Results We prospectively enrolled 411 consecutive patients observed at four referral centers with de novo TIPS implantation for refractory ascites or secondary prophylaxis of variceal bleeding (derivation cohort) and an external cohort of 415 patients with similar indications for TIPS (validation cohort). Older adult patients in the two cohorts were 99 and 76, respectively. A cause-specific Cox competing risks model was used to predict liver-related mortality, with orthotopic liver transplant and death for extrahepatic causes as competing events. Age, alcoholic etiology, creatinine levels, and international normalized ratio in the overall cohort, and creatinine and sodium levels in older adults were independent risk factors for liver-related death by multivariable analysis. Conclusions After TIPS implantation, mortality is increased by aging, but TIPS placement should not be precluded in patients older than 70 years. In older adults, creatinine and sodium levels are useful predictors for decision making. Further efforts to update the prediction model with larger sample size are warranted.

Syngas produced by biomass and waste gasification processes must be ade-quately clean of tar compounds before being utilized in value-added applica-tions. Syngas cleaning by tar cracking at high temperatures is a promisingtechnique that can utilize different kinds of catalysts. However, their use islimited by the deposition of coke layers, which induces a masking phenome-non on the active surface, and, consequently, the rapid deactivation of the cat-alyst. This study addresses how the temperature (750 and 800 C) and thesteam concentration (0% and 7.5%) can affect the extent of water–gas andreforming reactions between steam and coke deposits. Two catalysts wereused: a market-available activated carbon and an iron-based alumina catalyst.The tests showed better performance of the Fe/γ-Al2O3catalyst. A massincrease of the bed was measured in tests with both the catalysts, which con-firms the deposition of the coke layer produced by tar dehydrogenation andcarbonization. Scanning electronic microscopy-energy-dispersive X-ray analy-sis (SEM-EDX) and Raman spectroscopy were utilized to investigate the natureof coke layers over the catalyst surface, with the aim of acquiring informationabout their reactivity towards the water gas reaction. SEM-EDX observationsindicate that the thickness of these carbon layers is less than 2μm. Ramanspectra suggest a negligible effect of the reaction temperature in the testedrange and, in particular, that the amorphous nature of coke layers deposited inthe presence of steam is relatively more graphitic than that obtained withoutsteam.

Hepatocellular carcinoma (HCC) is a common tumour often diagnosed with a multifocal presentation. Patients with multifocal HCC represent a heterogeneous group. Although Trans-Arterial ChemoEmbolization (TACE) is the most frequently employed treatment for these patients, previous data suggested that liver resection (LR) could be a safe and effective procedure.To compare LR and TACE in patients with multifocal HCC in terms of procedure-related morbidity and oncologic outcomes.All patients with multifocal HCC who underwent LR or TACE as the first procedure between May 2011 and March 2021 were enrolled. The decision to perform surgery or TACE was made after a multidisciplinary team evaluation. Only patients in Child-Pugh class A or B7 and stage B (according to the Barcelona Clinic Liver Cancer staging system, without severe portal hypertension, vascular invasion, or extrahepatic spread) were included in the final analysis. Propensity score matching was used to adjust the baseline differences between patients undergoing LR and the TACE group [number and diameter of lesions, presence of cirrhosis, alpha-fetoprotein (AFP) levels, and Model for End-Stage Liver Disease score]. The Kaplan-Meier method was used to estimate overall survival (OS) and disease-free survival (DFS). The outcomes of LR and TACE were compared using the log-rank test.After matching, 30 patients were eligible for the final analysis, 15 in each group. Morbidity rates were 42.9% and 40% for LR and TACE, respectively (In a small cohort of patients with multifocal HCC, LR confers longer DFS compared with TACE, with similar OS and post-procedural morbidity.

Circulating endothelial progenitor cells (EPC) predict tumor vascularization and disease progression, but limited information is available on their dynamics in hepatocellular carcinoma (HCC) undergoing systemic treatment.We prospectively analyzed different populations of EPC in 16 patients with advanced HCC receiving sorafenib. Patients were studied before therapy (T0, n = 16) and after two (T2, n = 12) and eight weeks (T8, n = 8), using high-performance flow-cytometry. The tumor response at T8 was categorized as progressive disease (PD) or clinical benefit (CB, all other responses).At T0, higher levels of CD34In patients with advanced HCC, EPC are directly correlated with platelet count, suggesting a common activation of selected bone marrow pathways. Levels of a CD34

In patients affected by myelofibrosis with hepatic myeloid metaplasia (HMM), portal hypertension (PHT) complications may develop. In this case series, we analysed the efficacy and safety of transjugular portosystemic shunt (TIPS) in the treatment of PHT-related complications and its effects on the nutritional status. Six patients were evaluated and the average follow-up period after TIPS was 33 (IQR 5) months. None of the patients developed hepatic failure, nor any recurrence of variceal bleeding was recorded. No additional paracentesis or endoscopic prophylactic treatment for PHT-related complications were required. In all subjects, the average dose of diuretics was almost halved three months after TIPS. Three patients died during the follow-up, but none for liver-related causes. All patients showed an improvement in the global nutritional status. In conclusion, TIPS represent an effective and safe treatment option for patients affected by complications of PHT secondary to HMM and drives to an improvement of the nutritional status.

Co-gasification tests were carried out in a pilot scale bubbling fluidized bed gasifier, large enough to exclude any scale-up effect, and able to treat up to 100 kg/h of plastics and biomass mixtures. It was operated under chemical and thermal steady-state, with equivalence ratios varying from 0.19 to 0.28, and plastics/biomass blending ratios from mono gasification of plastics to that of biomass. The results are reported in terms of main process performance parameters and axial profiles of syngas composition and reactor temperature. They indicate that plastics/biomass ratio and equivalence ratio remarkably affect the gasifier performances, even though the obtained syngas was always of rather good quality, with a low heating value between 7 and 10 MJ/m3N. The axial syngas compositions showed a monotonic reduction of carbon dioxide concentration (of about 20–30%) and a corresponding increase of hydrogen concentration (of about 90–110%), highlighting the key role of water gas shift, and steam and dry reforming reactions. The overall set of results provides information about the feasibility of co-gasification of plastics waste and biomass at a demonstration scale and supports the optimisation of design or operating criteria as well as the implementation of reliable numerical models of bubbling fluidized bed gasifiers.

The focus is on current and innovative management schemes of plastics waste coming from electric and electronic equipment, end-of-life vehicles, and construction and demolition waste. Their complex compositions, due to the presence of several polymers, different (also hazardous) additives, and non-plastics fractions, make difficult finding sustainable management options. The study aimed at an assessment of social performances of currentmanagement schemes for these challenging plastics, compared with those of alternative schemes, including advanced innovative process options (dissolution/precipitation, supercritical fluid extraction with CO2, catalytic pyrolysis). A social life cycle assessment was developed at European level, by also exploiting synergies with parallel environmental analyses. The results indicated that innovative solutions could lead to good performances for human health ofworkers, but also for improvement of economies of local communities and society. The still limitedmaturity of proposed technologies would require a sufficiently long period of economic incentives to demonstrate process validity in the recovery of polymers, suitable to be accepted by the market. Accordingly, the estimated potential social effects should be further studiedwhen the proposed innovative processeswill be implemented at larger scale, to include aspects strictly related to the behaviour of a specific company going beyond the single process. Results contribute to define a complete set of environmental and social data and information, which can help European decision makers to define new criteria for sustainable management of the waste plastics of interest.

A new management scheme of plastics from waste of electrical and electronic equipment (WEEE), which includes novel treatments of sorting, dissolution/precipitation, extrusion, catalytic pyrolysis, and plastic upgrading, is proposed. Its environmental performances are quantified by an attributional Life Cycle Assessment and compared with those of European currently adopted schemes, which include conventional mechanical recycling and thermal treatments as well as improper options of dumping and open burning, largely applied to WEEE plastics exported to developing countries. The proposed innovative scheme greatly enhances the environmental sustainability of WEEE plastics management, by increasing the annual amounts of polymers sent to recycling (from 390 kt/y up to 530 kt/y), decreasing residues to be sent to combustion (from 360 kt/y up to 60 kt/y), and reducing the potential impacts of all the midpoint categories under analysis (up to 580% for that of Global Warming). These results are mainly related to the adoption of a dissolution/precipitation process, which allows recovering target polymers such as ABS, HIPS and PC, with improvements in terms of Global Warming, Non-Carcinogens, and Carcinogens equal to 246%, 69% and 35%, even when the stages of polymer upgrading and catalytic pyrolysis are not included in the analysis. The sensitivity analysis shows that advantages of the new approach substantially disappear if the awful contributions of exportation outside Europe are taken into account. This clearly indicates that the first step to enhance the sustainability of WEEE plastics management is a strong limitation of improper treatments applied to exported wastes. A new management scheme of plastics from waste of electrical and electronic equipment (WEEE), which includes novel treatments of sorting, dissolution/precipitation, extrusion, catalytic pyrolysis, and plastic upgrading, is proposed. Its environmental performances are quantified by an attributional Life Cycle Assessment and compared with those of European currently adopted schemes, which include conventional mechanical recycling and thermal treatments as well as improper options of dumping and open burning, largely applied to WEEE plastics exported to developing countries. The proposed innovative scheme greatly enhances the environmental sustainability of WEEE plastics management, by increasing the annual amounts of polymers sent to recycling (from 390 kt/y up to 530 kt/y), decreasing residues to be sent to combustion (from 360 kt/y up to 60 kt/y), and reducing the potential impacts of all the midpoint categories under analysis (up to 580% for that of Global Warming). These results are mainly related to the adoption of a dissolution/precipitation process, which allows recovering target polymers such as ABS, HIPS and PC, with improvements in terms of Global Warming, Non-Carcinogens, and Carcinogens equal to 246%, 69% and 35%, even when the stages of polymer upgrading and catalytic pyrolysis are not included in the analysis. The sensitivity analysis shows that advantages of the new approach substantially disappear if the awful contributions of exportation outside Europe are taken into account. This clearly indicates that the first step to enhance the sustainability of WEEE plastics management is a strong limitation of improper treatments applied to exported wastes.

Life cycle assessment (LCA) has been used in waste management for the last two decades and hundreds of journal papers have been published. The use of LCA in waste management has provided a much-improved holistic view of waste management including waste flows and potential environmental impacts. Although much knowledge has been obtained from LCA studies, there is still a need to use LCA models in integrated waste management. This paper describes six areas where LCA is expected to play a role in waste management in the future: 1) understanding an existing waste management system; 2) improving existing waste management systems; 3) comparing alternative technologies/ technology performance; 4) technology development/prospective technologies; 5) policy development/strategic development; and 6) reporting. Illustrative examples are provided for each application area.

Transjugular intrahepatic portosystemic shunt (TIPS) represents a very effective treatment of complications of portal hypertension. Established indications to TIPS in cirrhotic patients include portal hypertensive bleeding and refractory ascites. Over the years additional indications have been proposed, such as the treatment of vascular disease of the liver, hepatic hydrothorax, hepatorenal syndrome and bleeding from ectopic varices. Indications under evaluation include treatment of portal hypertension prior to major abdominal surgery and treatment of portal vein thrombosis. In spite of these advances, there are still uncertainties regarding the appropriate workup for patients to be scheduled for TIPS. Moreover, prevention and management of post-TIPS complications including hepatic encephalopathy and heart failure are still suboptimal. These issues are particularly relevant considering aging in TIPS candidates in Western countries. Correct selection of patients is mandatory to prevent complications which may eventually frustrate the good hemodynamic results and worsen the patient's quality of life or even life expectancy. The possible role of small diameter TIPS to prevent post-procedural complications is discussed.

Background: The Baveno VI consensus proposed a dual liver stiffness (LS) by transient elastography threshold of 15 kPa for excluding and diagnosing compensated advanced chronic liver disease (cACLD) in the absence of other clinical signs. Herein, we aimed to validate these criteria in a real-world multicentre study. Methods: We included 5,648 patients (mean age 51 ± 13 years, 53% males) from 10 European liver centres who had a liver biopsy and LS measurement within 6 months. We included patients with chronic hepatitis C (n = 2,913, 52%), non-alcoholic fatty liver disease (NAFLD, n = 1,073, 19%), alcohol-related liver disease (ALD, n = 946, 17%) or chronic hepatitis B (n = 716, 13%). cACLD was defined as fibrosis stage ≥F3. Results: Overall, 3,606 (66%) and 987 (18%) patients had LS 15 kPa, respectively, while cACLD was histologically confirmed in 1,772 (31%) patients. The cut-offs of 15 kPa showed 75% sensitivity and 96% specificity to exclude and diagnose cACLD, respectively. Examining the ROC curve, a more optimal dual cut-off at 12 kPa, with 91% sensitivity and 92% specificity for excluding and diagnosing cACLD (AUC 0.87; 95% CI 0.86–0.88; p 15 kPa dual cut-offs, we found that the 12 kPa dual cut-offs have better diagnostic accuracy in cACLD. Lay summary: The term compensated advanced chronic liver disease (cACLD) was introduced in 2015 to describe the spectrum of advanced fibrosis and cirrhosis in asymptomatic patients. It was also suggested that cACLD could be diagnosed or ruled out based on specific liver stiffness values, which can be non-invasively measured by transient elastography. Herein, we assessed the suggested cut-off values and identified alternative values that offered better overall accuracy for diagnosing or ruling out cACLD.

Background Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a well-established treatment for complications of portal hypertension. Aims To analyze the impact of TIPS on virologic response and safety profile in patients treated with direct-acting antivirals (DAAs). Methods We analyzed data from HCV-positive cirrhotic patients treated with DAAs. Twenty-one patients with previous TIPS placement were compared with 42 matched subjects without TIPS. Logistic regression was used to identify predictors of hepatic function worsening and adverse events. Results No differences were found between the two groups in particular regarding sustained virologic response (92.5 and 97.6% in TIPS vs no-TIPS, p = 0.559). Model for End-stage Liver Disease (MELD) of both TIPS and no-TIPS groups declined from baseline to week 24 of follow-up (from 12.5 ± 3.5 to 10.8 ± 3.4 and from 11.1 ± 3.5 to 10.3 ± 3.4, p = 0.044 and 0.025). There were no differences in adverse event rates. At univariate analysis, age was associated with MELD increase from baseline to week 24 (OR 1.111, 95% CI 1.019-1.211, p = 0.017), and patients with higher baseline MELD developed serious adverse events more frequently (OR 0.815, 95% CI 0.658–1.010, p = 0.062). Patients with or without TIPS did not show differences in transplant-free survival. Conclusion TIPS placement does not affect virologic response and clinical outcome of patients receiving DAAs.

The Mediterranean area is endemic for the zoonotic form of visceral leishmaniasis (VL) caused by Leishmania infantum, a species which has been recently associated with unexpected epidemiological and clinical features. We report the result of a systematic review of the literature on VL unusually presenting with spleen focal lesions, including three previously unpublished cases. A total of 28 cases of VL with multiple spleen focal lesions were retrieved. Twenty-six (93%) were acquired in the Mediterranean area, where L. infantum is endemic. Thirteen cases were diagnosed in children, and the remaining 15 cases in middle-aged adults, of whom 9 were immunosuppressed. Four patients (14%) underwent diagnostic splenectomy, while the diagnosis was confirmed by less invasive techniques in the remaining patients. The most common radiological patterns were: multiple subcentimetric or centimetric spleen lesions (size ≤ 1 cm in 14 of 19 cases, 74%), hypoechoic at ultrasonography (25 of 26 cases, 99%) and hypodense at CT scan (9 of 10 cases, 90%). PET-CT (available for four patients) showed an intense FDG spleen uptake. MRI and contrast-enhanced ultrasonography, available for two and one cases each, showed complex patterns. VL must be added to the list of possible differential diagnosis of spleen focal lesions and health care provider awareness about this condition will avoid unnecessary invasive diagnostic procedures.

The study provides for the first time a life cycle inventory model for the fluidized bed gasification of wastes, based on a large amount of high-quality data. All of them have been obtained from a pilot scale fluidized bed gasifier, fed with ten types of waste and biomass, under a wide range of operating conditions. The model refers to commercial scale gasifiers having a “thermal configuration”, where the generated syngas is immediately burned downstream of the reactor. Key relationships between process and waste-specific parameters have been defined. The model quantifies the main inputs and outputs of the gasification process (emissions, energy recovery, ash disposal, resource consumptions), providing high-quality data that could contribute to improve life cycle assessment modelling of waste gasification. Finally, some case studies have been implemented in the EASETECH software to illustrate the model applicability, evaluate the role of main parameters, and compare the environmental performances of gasification power units with that of the European electricity mix. The performances appear highly affected by metal contents in the waste-derived fuels, while the model results to a limited extent are sensitive to the equivalence ratio and the net electrical efficiency of the energy conversion. The study provides for the first time a life cycle inventory model for the fluidized bed gasification of wastes, based on a large amount of high-quality data. All of them have been obtained from a pilot scale fluidized bed gasifier, fed with ten types of waste and biomass, under a wide range of operating conditions. The model refers to commercial scale gasifiers having a “thermal configuration” where the generated syngas is immediately burned downstream of the reactor. Key relationships between process- and waste-specific parameters have been defined. The model quantifies the main inputs and outputs of the gasification process (emissions, energy recovery, ash disposal, resource consumptions), providing high-quality data that could contribute to improve life cycle assessment modelling of waste gasification. Finally, some case studies have been implemented in the EASETECH software to illustrate the model applicability, evaluate the role of main parameters, and compare the environmental performances of gasification power units with that of the European electricity mix. The performances appear highly affected by metal contents in the waste-derived fuels, while the model results to a limited extent are sensitive to the equivalence ratio and the net electrical efficiency of the energy conversion.

Activated carbons are recognised as inexpensive, easily available, and efficient catalysts for tar cracking reactions at high temperatures. Their use in hot syngas cleaning is limited by the rapid deactivation resulting from the coke deposition, and the consequent masking phenomenon over the activated carbon surface. This study contributes to a better understanding of the problem and sheds light on possible solutions, by investigating how the temperature (750 °C–850 °C) and the steam concentration (0%–10%) can affect the extent of the water-gas and reforming reactions occurring between steam and the coke covering the catalyst surface. The activated carbons have been fully characterised before and after the tests utilizing naphthalene as a tar model compound, to study the evolution of their structure after long duration tests. Steam positively affects the naphthalene conversion efficiency, preserving the characteristics of the material. For example, at a temperature of 800 °C and a steam concentration of 7.5%, a naphthalene conversion of over 90% is achieved even after 7 h of testing. XRD and Raman spectroscopy analyses suggest that naphthalene cracking produces a coke layer that is more amorphous and, above all, more reactive towards the water gas reaction than the original activated carbon structure.

Introduction: The prognosis of patients undergoing transarterial chemoembolization (TACE) is extremely variable, and a confounding factor is that TACE is often repeated several times. We retrospectively evaluated the accuracy of different prognostic scores and staging systems in estimating overall survival (OS) in patients with hepatocellular carcinoma (HCC). Methods: An analysis considering prognostic models as time-varying variables was performed, calculating OS from the time of TACE to the time of the subsequent treatment. Total follow-up time for each patient was therefore split into several observation times accounting for each TACE procedure. Values of the likelihood ratio test (LRT) and Akaike information criterion (AIC) were used to compare different systems. Univariable and multivariable analyses were conducted to identify additional factors predictive of OS. We analyzed 1,610 TACE performed in 1,058 patients recorded in the Italian Liver Cancer database from 2008 through 2016. Results: The median OS of the enrolled patients was 41 months. According to LRT χ2 and AIC values based on the time-varying analysis, mHAP-III achieved the best values (41.72 and 4,625.49, respectively, p < 0.0001), indicating the highest predictive performance compared with all other scores (HAP, mHAP-II, ALBI, and pALBI) and staging systems (MELD, ITALICA, CLIP, MESH, MESIAH, JIS, HKLC, and BCLC). In the multivariable Cox proportional hazards model, mHAP-III maintained an independent effect on OS (hazard ratio 1.31, 95% CI: 1.10–1.55, p < 0.0001). Time-varying age, alcoholic etiology, radiologic response to TACE, and performing ablation or surgery after TACE were additional significant variables resulting from the multivariable model. Conclusion: An innovative time-varying analysis revealed that mHAP-III was the most accurate model in predicting OS in patients with HCC undergoing TACE. Other clinical pre- and post-TACE variables were also found to be relevant for this prediction.

A huge increase of waste of electrical and electronic equipment (WEEE) is observing everywhere in the world. Plastic component in this waste is more than 20% of the total and allows important environmental advantages if well treated and recycled. The resource recovery from WEEE plastics is characterised by technical difficulties and environmental concerns, mainly related to the waste composition (several engineering polymers, most of which containing heavy metals, additives and brominated flame retardants) and the common utilisation of sub-standard treatments for exported waste. An attributional Life Cycle Assessment quantifies the environmental performances of available management processes for WEEE plastics, those in compliance with the European Directives and the so-called substandard treatments. The results highlight the awful negative contributions of waste exportation and associated improper treatments, and the poor sustainability of the current management scheme. The ideal scenario of complete compliance with European Directives is the only one with an almost negligible effect on the environment, but it is far away from the reality. The analysed real scenarios have strongly negative effects, which become dramatic when exportation outside Europe is included in the waste management scheme. The largely adopted options of uncontrolled open burning and illegal open dumping produce huge impacts in terms of carcinogens (3.5·10+7 and 3.6·10+4 person⋅year, respectively) and non-carcinogens (1.7·10+8 and 2.0·10+6 person⋅year) potentials, which overwhelm all the other potential impacts. The study quantifies the necessity of strong reductions of WEEE plastics exportation and accurate monitoring of the quality of extra-Europe infrastructures that receive the waste.

Activated carbons are efficient catalysts for tar cracking, suitable for hot cleaning of the syngas produced during biomass- and waste-to-energy gasification processes. This study investigates the conversion of naphthalene, utilised as reference for tar compounds, when catalysed by a coal-derived activated carbon. The attention focuses on the influence of the operating temperature, in the range 750-900°C, and the size of selected activated carbon, which has been used under form of pellets, granules and powders. The conversion efficiency improves when the temperature raised from 750°C to 900°C (from 79% to 99%, for the pellets), and when the catalyst size reduced from pellets to powders (from 79% to 97%, at 750°C). The diffusional resistance in the catalyst particles has been then quantified in terms of Thiele modulus and internal effectiveness factor. A gradual reduction of catalyst surface area has been also observed for longer tests, due to the progressive deposition of soot from naphthalene decomposition over and inside the porous structure of the activated carbon. The carbon content of these deposits has been quantified, showing larger percentages on the surface of granules and powders. Activated carbons are efficient catalysts for tar cracking, suitable for hot cleaning of the syngas produced during biomass- and waste-to-energy gasification processes. This study investigates the conversion of naphthalene, utilised as reference for tar compounds, when catalysed by a coal-derived activated carbon. The attention focuses on the influence of the operating temperature, in the range 750–900 °C, and the size of selected activated carbon, which has been used under form of pellets, granules and powders. The conversion efficiency improves when the temperature raised from 750 °C to 900 °C (from 79% to 99%, for the pellets), and when the catalyst size reduced from pellets to powders (from 79% to 97%, at 750 °C). The diffusional resistance in the catalyst particles has been then quantified in terms of Thiele modulus and internal effectiveness factor. A gradual reduction of catalyst surface area has been also observed for longer tests, due to the progressive deposition of soot from naphthalene decomposition over and inside the porous structure of the activated carbon. The carbon content of these deposits has been quantified, showing larger percentages on the surface of granules and powders.

Industrial solid waste management encompasses a vital part of developed and developing countries strategies alike. It manages waste generated from vital industries and governs the hazardous waste generated as a major component of integrated waste management strategies. This article reviews the practices that govern the management approaches utilized in the developed world for industrial spent catalysts. It critically assesses the current situation of waste management within the developing world region focusing on the industrial waste component, in a novel attempt to crucially develop a strategy for a way forward based on best practices and future directions with major European industries. The review also draws parallels with European countries to compare their practices with those of the State of Kuwait, which rely solely on landfilling for the management of its industrial waste. Spent catalysts recovery methods are discussed at length covering conventional methods of valuable metals and chemicals recovery (e.g., hydrometallurgical, solid–liquid and liquid–liquid extraction) as well as biological recovery methods. A major gap exists within regulations that govern the practice of managing industrial waste in Kuwait, where it is essential to start regulating industries that generate spent catalysts inview of encouraging the establishment of valorization industries for metal and chemical recovery. This will also create a sustainable practice within state borders, and can reduce the environmental impact of landfilling such waste in Kuwait. Industrial solid waste management encompasses a vital part of developed and developing countries strategies alike. It manages waste generated from vital industries and governs the hazardous waste generated as a major component of integrated waste management strategies. This article reviews the practices that govern the management approaches utilized in the developed world for industrial spent catalysts. It critically assesses the current situation of waste management within the developing world region focusing on the industrial waste component, in a novel attempt to crucially develop a strategy for a way forward based on best practices and future directions with major European industries. The review also draws parallels with European countries to compare their practices with those of the State of Kuwait, which rely solely on landfilling for the management of its industrial waste. Spent catalysts recovery methods are discussed at length covering conventional methods of valuable metals and chemicals recovery (e.g., hydrometallurgical, solid-liquid and liquid-liquid extraction) as well as biological recovery methods. A major gap exists within regulations that govern the practice of managing industrial waste in Kuwait, where it is essential to start regulating industries that generate spent catalysts in-view of encouraging the establishment of valorization industries for metal and chemical recovery. This will also create a sustainable practice within state borders, and can reduce the environmental impact of landfilling such waste in Kuwait.

Obtaining high quality syngas from sewage sludge (SS) means transferring a low-grade SS into a highgrade fuel or raw materials for chemical products. In this study, Fe is added to SS in form of Fe2(SO4)3 to produce an effective and self-sufficient catalyst in order to obtain more syngas and minimize liquid products from SS pyrolysis. The Fe-embedded sewage sludge chars (SSCs) were used as catalysts for volatile reforming at 600 °C. It has been found that the gas yield increases from 15.9 to 35.8 wt% of the SS and that of liquids decreases from 31.9 to 10.2 wt% after volatile reforming with Fe-embedded SSC when Fe was added equal to 7 % in the dried SS. In addition, the content of nitrogen-containing compounds in the oily products decreased. After reforming with Fe-embedded SSC, the molar fractions of syngas combustible components, including H2, CH4 and CO, increase, and the higher heating value of the syngas increased to 17.0 MJ/Nm3 from the original 12.5 MJ/Nm3 obtained from SS pyrolysis at 550 °C. Moreover, the volatile reforming seems to reduce the level of some important syngas pollutants, like H2S, HCl and HCN, even though it was also observed an increase of the contents of SO2, NH3, NO2, HCNO and N2O. Obtaining high quality syngas from sewage sludge (SS) means transferring a low-grade SS into a high-grade fuel or raw materials for chemical products. In this study, Fe is added to SS in form of Fe2(SO4)3 to produce an effective and self-sufficient catalyst in order to obtain more syngas and minimize liquid products from SS pyrolysis. The Fe-embedded sewage sludge chars (SSCs) were used as catalysts for volatile reforming at 600 °C. It has been found that the gas yield increases from 15.9 to 35.8 wt% of the SS and that of liquids decreases from 31.9 to 10.2 wt% after volatile reforming with Fe-embedded SSC when Fe was added equal to 7 % in the dried SS. In addition, the content of nitrogen-containing compounds in the oily products decreased. After reforming with Fe-embedded SSC, the molar fractions of syngas combustible components, including H2, CH4 and CO, increase, and the higher heating value of the syngas increased to 17.0 MJ/Nm3 from the original 12.5 MJ/Nm3 obtained from SS pyrolysis at 550 °C. Moreover, the volatile reforming seems to reduce the level of some important syngas pollutants, like H2S, HCl and HCN, even though it was also observed an increase of the contents of SO2, NH3, NO2, HCNO and N2O.

The study aims to demonstrate the overall environmental sustainability of biomethane production by anaerobic digestion of the separately collected organic fraction of municipal solid waste. There is a great interest in the utilisation of biofuels produced from biowaste in the transport sector, due to the benefits of reduced pollutant emissions and diversified transport fuel supplies. An attributional, process-based life cycle assessment study quantifies and compares the potential environmental impacts of an anaerobic digestion plant, where the produced biogas is upgraded to biomethane for the transport sector instead that directly burned in a combined heat and power unit. The avoided impacts related to the utilisation of biomethane instead of diesel, petrol or natural gas have been evaluated with reference to a vehicle fleet made of passenger cars and small rigid trucks. They appear large enough to make the biomethane production the cleanest option for the management of biowaste. The global warming and non-renewable energy potentials of the Biowaste-to-Biomethane scenario improve of 79% and 36%, respectively, with reference to the Biowaste-to-Energy scenario. A sensitivity analysis evaluates the effect of several key parameters. Some of them are peculiar for the analysed application, such as the composition of the vehicle fleet, specific biomethane consumptions of these vehicles, and methane slip in the biogas upgrading unit. Some other parameters are more general, such as the final destination of solid digestate, gas engine efficiency, national electric energy mix. The results of the analysis provide data and information to policy-makers, planners and operators that would like or have to approach the management of the separately collected organic fraction of municipal solid waste. They also inform on the environmental advantages connected with the utilisation for road transportation of biomethane produced from this waste fraction.

The study evaluated the environmental performances of an integrated material recovery facility (MRF) able to treat 32 kt/y of unsorted mixed waste, made of residuals from household source separation and separate collection. The facility includes a mechanical sorting platform for the production of a solid recovered fuel (SRF) utilized in an external waste-to-energy plant, bio-cells for tunnel composting of organic fraction, and a sanitary landfill for the safe disposal of ultimate waste. All the MRF sub-units have been analysed in depth in order to acquire reliable data for a life cycle assessment study, focused on the environmental performances of different configurations of the facility. The study investigated a “past” configuration, including just mechanical sorting, landfilling and biogas combustion in a gas engine, and the “present” one, which includes also a composting unit. Two possible “future” configurations, having a gasifier inside the MRF battery limits, have been also analysed, assessing the performances of two fluidized bed reactors of different size, able to gasify only the residues generated by the sorting platform or the whole amount of produced SRF, respectively. The analysis evaluated the contributions of each unit in the different configurations and allowed a reliable assessment of the technological evolution of the facility. The results quantified the positive effect of the inclusion of an aerobic treatment of the waste organic fraction. The SRF gasification in situ appears to improve the MRF environmental performances in all the impact categories, with the exclusion of that of global warming.

SummaryBackground The accuracy of available non-invasive tools for staging severe fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) is still limited. Aim To assess the diagnostic performance of paired or serial combination of non-invasive tools in NAFLD patients. Methods We analysed data from 741 patients with a histological diagnosis of NAFLD. The GGT/PLT, APRI, AST/ALT, BARD, FIB-4, and NAFLD Fibrosis Score (NFS) scores were calculated according to published algorithms. Liver stiffness measurement (LSM) was performed by FibroScan. Results LSM, NFS and FIB-4 were the best non-invasive tools for staging F3-F4 fibrosis (AUC 0.863, 0.774, and 0.792, respectively), with LSM having the highest sensitivity (90%), and the highest NPV (94%), and NFS and FIB-4 the highest specificity (97% and 93%, respectively), and the highest PPV (73% and 79%, respectively). The paired combination of LSM or NFS with FIB-4 strongly reduced the likelihood of wrongly classified patients (ranging from 2.7% to 2.6%), at the price of a high uncertainty area (ranging from 54.1% to 58.2%), and of a low overall accuracy (ranging from 43% to 39.1%). The serial combination with the second test used in patients in the grey area of the first test and in those with high LSM values (>9.6 KPa) or low NFS or FIB-4 values (

Volatile products obtained from pyrolysis of municipal solid waste (MSW), including syngas and pyrolysis oil, were forced to contact the hot char from the same pyrolysis process at 500-600 degrees C in a fixed bed reactor to be reformed. The yields and properties of syngas, char and pyrolysis liquid Were investigated; and the energy re-distribution among the products due to char reforming was quantified. The preliminary investigation at lab scale showed that hot char-catalytic reforming of the volatiles leads to an increase in the dry syngas yield from 0.25 to 0.37 N m(3) kg(-1) msw at 550 degrees C. Accordingly, the carbon conversion ratio into syngas increases from 29.6% to 35.0%; and the MSW chemical energy transferred into syngas increased from 41.8% to 47.4%. The yield of pyrolysis liquid products, including pyrolysis oil and water, decreased from 27.3 to 16.5 wt%, and the molecular weight of the oil becoming lighter. Approximately 60% of the water vapour contained in the volatiles converted into syngas. After reforming, the concentrations of SO2 and HCN in the syngas decreases, while those of NO and NO2 increase. The char concentrations of N, H, C and alkali metal species decreased and its higher heating value decreased too. (C) 2017 Elsevier Ltd. All rights reserved.

Splanchnic vein thrombosis (SVT) is one of the vascular complications of myeloproliferative neoplasms (MPN). We designed a phase 2 clinical trial to evaluate safety and efficacy of ruxolitinib in reducing splenomegaly and improving disease-related symptoms in patients with MPN-associated SVT. Patients diagnosed with myelofibrosis (12 cases), polycythemia vera (5 cases) and essential thrombocythemia (4 cases) received ruxolitinib for 24 weeks in the core study period. Spleen volume was assessed by magnetic resonance imaging (MRI) and splanchnic vein circulation by echo-Doppler analysis. Nineteen patients carried JAK2V617F, one had MPLW515L, and one CALRL367fs*46 mutation. Eighteen patients had spleno-portal-mesenteric thrombosis, two had Budd-Chiari syndrome, and one had both sites involved; 16 patients had esophageal varices. Ruxolitinib was well tolerated with hematological toxicities consistent with those of patients without SVT and no hemorrhagic adverse events were recorded. After 24 weeks of treatment, spleen volume reduction ≥35% by MRI was achieved by 6/21 (29%) patients, and a ≥50% spleen length reduction by palpation at any time up to week 24 was obtained by 13/21 (62%) patients. At week 72, 8 of the 13 (62%) patients maintained the spleen response by palpation. No significant effect of treatment on esophageal varices or in splanchnic circulation was observed. MPN-related symptoms, evaluated by MPN-symptom assessment form (SAF) TSS questionnaire, improved significantly during the first 4 weeks and remained stable up to week 24. In conclusion, this trial shows that ruxolitinib is safe in patients with MPN-associated SVT, and effective in reducing spleen size and disease-related symptoms.

The study compares the environmental performances of a new-generation, large scale, combustion-based waste-to-energy unit, active since 2010, with those of different “virtual” units, defined in the light of the Best Available Techniques REFerence document (BREF) for Waste Incineration published by the European Community on December 2019. The average performances of these units have been evaluated in terms of air emissions, material consumptions and energy recovery, based on data related to 355 “existing” European waste incineration lines and those established for the future “new” plants. An attributional Life Cycle Assessment has been used to compare and quantify the environmental performances of the selected units, all equipped with a moving grate furnace and similar air pollution control systems. A sensitivity analysis quantifies how even more severe requests for emission and energy performances as well as the evolution of the European electricity mix until the year 2030 can affect the comparative assessment. The results indicate that the considered large scale waste-to-energy plant has good environmental performances, even in an electricity mix characterised by 45% of renewable sources. This allows an easy compliance with the Best Available Techniques Associated Emission Levels of the new waste incineration BREF document. Possible further improvements of its performances should be focused mainly on a further increase of the energy efficiency, provided that it is economically viable.

Sewage sludge pyrolysis liquid (SSPL) is a mixture of various toxic organic compounds and moisture, its disposal or valorization are crucial for the sustainability of any pyrolysis plant of sewage sludge (SS). As SSPL showed strong inhibition on anaerobic digestion (AD), in order to fulfill its clean disposal, the study investigates its AD in cow dung matrix under thermophilic condition with sewage sludge char (SSC) addition. Three SSCs produced at different temperatures and two biochars were added into the AD system for comparison. Batch experiments (55 °C, 26 days) reveal that addition of SSCs/biochars could increase cumulative methane yield by 57.5–128.7%/120.7–133.7% compared with the group without char addition. Among three SSCs, the one produced at 550 °C (550SSC) shows the best effect and has similar promotion effects to those of conventional biochars. The mechanism involved is explained by the following facts: SSCs/biochars addition alleviated microbial inhibition effect of SSPL by adsorbing the toxic organic compounds in the liquid at the early stage, hosting microbes to grow, improving the reaction rate and stabilizing the pH of AD system at around 8, finally helping to obtain an earlier occurrence of daily methane yield peak and contributing to higher methane yields. The rich trace elements contained in SSCs, especially in 550SSC, help to promote the growth of microbes and contribute to the decomposition of toxic organic compounds. GC-MS analyses of digestates reveal that SSPL can be well degraded with help of SSCs/biochars addition after AD process. The obtained results suggest that AD of SSPL in cow dung matrix with 550SSC addition is a reliable and economy alternative for its treatment and valorization.

Biomethane produced from waste-derived biomass (biowaste) is a clean and renewable fuel, which offers substantial reductions of greenhouse gas emissions and resource consumption. Biomethane is currently produced via the ‘‘biogas road”, which includes the anaerobic digestion of wet biowaste and a successive upgrading of obtained biogas, with good environmental performance. An alternative production strategy is the ‘‘syngas road”, which includes the gasification of dry or semi-dry biowaste followed by cleaning, conditioning, methanation, and final upgrading of obtained syngas. It is still at a demonstration level but appears of great interest for the highest values of energy efficiency and carbon utilisation. The study acquired technical data from existing plants of both these strategies, and developed a quantitative environmental assessment by means of holistic tools of sustainable engineering: material and substance flow analyses and an attributional life cycle assessment. The technical and environmental performance of the two biomethane roads have been then compared, in terms of energy and process efficiency as well as potential impacts in the main midpoint categories (global warming, respiratory inorganics, and nonrenewable energy). The syngas road appears to have higher levels of carbon utilisation and better environmental performance, even though an extended sensitivity analysis shows different results if alternative plant configurations and energy mix are considered. This suggests that R&D studies and policies of economic incentives have to be further implemented for both the analysed strategies, even because they deal with different kind of biowaste, having different availability in different countries. Biomethane produced from waste-derived biomass (biowaste) is a clean and renewable fuel, which offers substantial reductions of greenhouse gas emissions and resource consumption. Biomethane is currently produced via the "biogas road", which includes the anaerobic digestion of wet biowaste and a successive upgrading of obtained biogas, with good environmental performance. An alternative production strategy is the "syngas road", which includes the gasification of dry or semi-dry biowaste followed by cleaning, conditioning, methanation, and final upgrading of obtained syngas. It is still at a demonstration level but appears of great interest for the highest values of energy efficiency and carbon utilisation. The study acquired technical data from existing plants of both these strategies, and developed a quantitative environmental assessment by means of holistic tools of sustainable engineering: material and substance flow analyses and an attributional life cycle assessment. The technical and environmental performance of the two biomethane roads have been then compared, in terms of energy and process efficiency as well as potential impacts in the main midpoint categories (global warming, respiratory inorganics, and non-renewable energy). The syngas road appears to have higher levels of carbon utilisation and better environmental performance, even though an extended sensitivity analysis shows different results if alternative plant configurations and energy mix are considered. This suggests that R&D studies and policies of economic incentives have to be further implemented for both the analysed strategies, even because they deal with different kind of biowaste, having different availability in different countries. (C) 2019 Elsevier Ltd. All rights reserved.

The study reviews and compares the most utilised techniques to obtain high quality biomethane by upgrading biogas from anaerobic digestion of the organic fraction of municipal solid waste. Environmental and economic aspects of membrane separation, water scrubbing, chemical absorption with amine solvent, and pressure swing adsorption have been quantified in a life cycle perspective. An attributional environmental Life Cycle Assessment has been implemented with the support of a Material Flow Analysis and in combination with a complementary environmental Life Cycle Costing. The analyses are based on data largely obtained from Italian existing plants but they can be generalised to the whole European Union, as demonstrated by a companion sensitivity analysis. The comparative assessment of the results indicates all the examined options as fully sustainable, also identifying the “win-win” situations. In particular, the membrane separation technique appears to have the best performances, even though in some cases with limited differences. With reference to base case scenarios, this technique shows better results for the respiratory inorganics potential (up to 34%, i.e. up to 328 kgPM2.5eq/y), global warming potential (up to 7%, i.e. up to 344 tCO2eq/y), and non-renewable energy potential (up to 12%, i.e. up to 6400 GJprimary/y) as well as for life cycle costs (up to 3.4%, i.e. about 60 k€/y). The performances of the examined techniques appear anyway dependent on site-specific conditions (such as the injection pressure in the gas grid or the existence/amount of local economic incentives) and commercial strategies for the market of interest.

Air gasification tests have been carried out in a pilot scale bubbling fluidized bed gasifier, able to treat up to 100 kg/h of Eucalyptus wood chips, and operated, under chemical and thermal steady-state conditions, at different values of equivalence ratio. The results are reported in terms of the main process performance parameters and transfer coefficients, which indicate the fate of carbon in the different output streams (syngas, fines, tars). The results can be transferred to commercial scale reactors and confirm the technical feasibility of the air gasification of the biomass in the range 0.25–0.34 of equivalence ratio, yielding a good quality syngas, with a low heating value between 5000 and 6000 kJ/m3N,syngas. The measured axial syngas composition profiles along the reactor indicate a monotonic reduction of methane and carbon dioxide concentrations and an increase of that of hydrogen. This suggests that water gas shift and steam and dry reforming reactions play a significant role, together with a limited contribution of tar cracking reactions, probably enhanced by alkali and alkaline earth metallic species contained in the inorganic fraction of elutriated fines. Results can support the implementation of reliable numerical models of bubbling fluidized bed gasifiers and the optimisation of design/operating criteria.

The gasification of biomass and waste is a potentially high efficiency process for energy generation. However, the appropriate cleaning of the produced fuel gas is a major issue, in particular for tar removal. This study investigates the performance of three new-generation activated carbons, which are able to adsorb a wide spectrum of tars at high temperature, from 750°C up to 900°C. For this purpose, a laboratory scale hot gas filtration apparatus was designed and set-up. Experimental tests were carried out with naphthalene as the reference tar compound. The selected activated carbons were tested under different conditions of temperature, test duration and naphthalene concentration. The procedure allows evaluating the contributions of adsorption and cracking phenomena on the overall tar removal efficiency. Complete naphthalene removal was obtained with two of the selected activated carbons, at 850 °C and 900 °C, respectively. Simultaneously, a partial reforming of adsorbed naphthalene was observed, and molecular hydrogen was detected in the gas phase. Results were correlated to the differences in porosimetry and chemical surface of the selected activated carbons, as well as to those highlighted by Scanning Electronic Microscopy and X-ray analyses. Finally, a procedure for activated carbon regeneration by carbon dioxide is reported, together with results from preliminary tests. The gasification of biomass and waste is a potentially high efficiency process for energy generation. However, the appropriate cleaning of the produced fuel gas is a major issue, in particular for tar removal. This study investigates the performance of three new-generation activated carbons, which are able to adsorb a wide spectrum of tars at high temperature, from 750 degrees C up to 900 degrees C. For this purpose, a laboratory-scale hot gas filtration apparatus was designed and set-up. Experimental tests were carried out with naphthalene as the reference tar compound. The selected activated carbons were tested under different conditions of temperature, test duration and naphthalene concentration. The procedure allows evaluating the contributions of adsorption and cracking phenomena on the overall tar removal efficiency. Complete naphthalene removal was obtained with two of the selected activated carbons, at 850 degrees C and 900 degrees C respectively. Simultaneously, a partial reforming of adsorbed naphthalene was observed, and molecular hydrogen was detected in the gas phase. Results were correlated to the differences in porosimetry and chemical surface of the selected activated carbons, as well as to those highlighted by Scanning Electronic Microscopy and X-ray analyses. Finally, a procedure for activated carbon regeneration by carbon dioxide is reported, together with results from preliminary tests. (C) 2016 Elsevier B.V. All rights reserved.

The accuracy of non-invasive methods for the quantification of liver fibrosis in primary biliary cholangitis (PBC) is still debated.To determine the histo-morphometric measurement of fibrotic tissue and to explore the possible association between indirect markers (APRI, FORNS, FIB-4, and Lok) and morphometry.Retrospective analysis of medical data from patients with PBC, on whom needle liver biopsy was performed as part of the diagnostic assessment. One section of each biopsy stained with Sirius red was used for calculating the percentage of collagen. Quantitative measure of fibrotic tissue (fibrosis morphometry) was calculated as a percentage of collagen content by digital image analysis. Morphometry results were divided into four groups reflecting Ludwig's staging and compared with values for indirect serum markers.50 PBC patients were enrolled (86% females, mean age 57 ± 12.30 years), 19 were Ludwig's stage I (38%), 14 stage II (28%), 12 stage III (24%), and five stage IV (10%). Morphometry results were significantly different among Ludwig stages (p0.05). No significant differences were found for indirect serum markers. A significant correlation was found between morphometry results and indirect serum markers tested (p0.05).In our cohort, the histo-morphometric values of fibrotic tissue increased progressively with Ludwig's stages of PBC, while non-invasive markers did not.

The environmental performances of four market-available thermochemical and biochemical processes for energy production from municipal solid biowaste have been compared by means of a combined utilisation of Life Cycle Assessment and Material Flow Analysis. The thermochemical options are those of co-combustion and co-gasification with an unsorted residual municipal waste. The biochemical options are those of anaerobic digestion, with energy cogeneration from the obtained biogas or biomethane. The production of 1 MJ of primary energy from the biowaste fed to these treatment plants has been assumed as the functional unit. The study identified the life cycle stages where a specific improvement can better contribute to a remarkable increase of the environmental performances of each of the examined energy production scenarios. A sensitivity analysis investigated the effect of the local electric energy mix, taking into account its evolution until 2030. The results indicate that anaerobic digestion is the biowaste-to-energy process with the best environmental performances, particularly when energy generation is obtained from the combustion of biomethane produced by biogas upgrading (with improvements up to 167% for Global Warming Potential and up to 107% for Non-Renewable Energy Potential).

The study evaluated the environmental performance of the construction and demolition waste (C&DW) management in the area of PCJ Watershed, located in the Sao Paulo State, Brazil, by means of an attributional Life Cycle Assessment. The entire C&DW management under the responsibility of the municipal government was considered. The potential environmental impacts were assessed by using two specific life cycle impact assessment methodologies, CML baseline (v3.03) and Impact 2002+ (v2.12). The results obtained by both methodologies highlighted the importance of the avoided impacts from recovered materials, mainly those related to steel, glass and plastics recycling. In particular, the CML baseline indicated "Human Toxicity" as the most important category, mainly due to the avoided impacts from steel recycling and the generated impacts from transportation in all the C&DW management stages. The Impact 2002+ highlighted instead the role of the categories of "Respiratory Inorganics" and "Global Warming", in accordance with the results related again to steel recycling and transportation but also to landfilling of solid residues. The study considered some alternative scenarios of the mineral fraction management, which quantified the expected advantages of increasing C&DW recycling and improving the quality of recycled aggregates.

The study describes an attributional Life Cycle Assessment carried out accordingly to the ISO standards and focused on a typical Italian multifamily residential building. The aim was developing an exhaustive and reliable inventory of high-quality primary data for direct, indirect and avoided burdens, and comparing the potential environmental impacts along the three stages of the building life cycle. The pre-use phase takes into account the production of all the construction materials or components, their transportation, and final on-site assembling. The use-phase quantifies the resource consumptions for 50 years of the building utilization and ordinary maintenance. The end-of-life phase includes the activities of building demolition and those of management of generated wastes. The obtained results quantify how the design criteria affect the environmental performances of the analysed residential building along its life cycle. The role of pre-use phase appears remarkable, mainly in terms of global warming potential, due to the huge impacts related to steel and concrete production processes. The use phase gives the most important contributions to the overall impact, which reach 77% and 84% of the total, for the categories of global warming and non-renewable energy, respectively. The energy consumptions for the heating and air conditioning is responsible for 41% of the total global warming potential and 42% of the total non-renewable energy potential. The end-of-life phase has a rather negligible role, since the recovered resources provide only limited avoided impacts. A comparative analysis finally quantifies the improvements achievable with an alternative type of partitions and external walls. The study describes an attributional life cycle assessment carried out according to the ISO standards and focused on an Italian multifamily residential building. The aim was developing an exhaustive and reliable inventory of high-quality primary data, comparing the environmental impacts along the three stages of the building life cycle. The pre-use phase takes into account the production of all the construction materials, transportation, and on-site assembling. The use phase quantifies the resource consumptions for 50 years of the building utilization and ordinary maintenance. The end-of-life phase includes the building demolition and the management of generated wastes. The results quantify how the design criteria affect the environmental performances of the residential building along its life cycle. The role of the pre-use phase appears remarkable for global warming potential (GWP), due to the huge impacts of steel and concrete production processes. The use phase gives the largest contributions, which reach 77% and 84% of the total, for the categories of global warming and non-renewable energy. The end-of-life phase provides limited avoided impacts. A comparative analysis quantifies the improvements achievable with an alternative type of partitions and external walls.

BACKGROUND Cryoglobulinaemic vasculitis (CV) is a lymphoproliferative disorder related to hepatitis C virus (HCV) infection; anti-viral therapy is the first therapeutic option. CV can be incapacitating, compromising the patients' quality of life (QoL). In a controlled study, interferon-based therapy was associated with a lower virological response in vasculitic patients than in patients without vasculitis. Limited, uncontrolled data on direct-acting anti-virals are available. AIM To evaluate safety, clinical efficacy, virological response and the impact of interferon-free treatment on QoL in HCV patients with and without mixed cryoglobulinaemia (MC). METHODS We prospectively studied HCV patients with cryoglobulinaemia (with vasculitis-CV- and without vasculitis-MC-) and without cryoglobulinaemia (controls), treated with direct-acting anti-virals. Hepato-virological parameters, CV clinical response and impact on QoL were assessed. RESULTS One hundred and eighty-two HCV patients were recruited (85 with CV, 54 with MC and 43 controls). A sustained virological response at 12 weeks (SVR12) was achieved in 166 (91.2%) patients (77/85 CV, 48/54 MC, 41/43 controls). In CV SVR patients, cryocrit levels progressively decreased and clinical response progressively improved, reaching 96.7%, 24 weeks after treatment. QoL, baseline physical and mental component summaries were lower in the CV group compared to the other groups (P < 0.05). Scores improved in all groups, and significantly in CV patients after SVR. CONCLUSIONS No significant differences in SVR rates were recorded between cryoglobulinaemic patients and controls and a high clinical and immunological efficacy was confirmed in CV, supporting the role of interferon-free therapy as the first therapeutic option. Interestingly, CV patients had worse baseline QoL than other HCV-positive groups and interferon-free therapy was effective in significantly increasing QoL, suggesting the important role of direct-acting anti-viral-based therapy in improving CV's individual and social burden.

An attributional, process-based, comparative Life Cycle Assessment has been developed to quantify and compare the environmental performances of a detached house, located in a seismic area of the Southern Italy, designed following two different approaches for its structural components: by using Cold Formed Steel (CFS), with sheathing and insulating panels, or a more conventional reinforced concrete, with brick walls. Both the houses have been designed to minimise energy consumptions. The analysis has been carried out along the whole building life cycle, broken down into three main phases: pre-use, use and end-of-life. The study quantifies the environmental impacts related to each of these phases, based on high quality data, which have been in large part collected on the field. The results show that the contributions of pre-use and use phases to the overall environmental performances are significant for both the design solutions. The outcomes of the life cycle impact assessment indicate that the house made of CFS has a better performance for the more important environmental impact categories, namely Respiratory Inorganics, Global Warming and Non-Renewable Energy. These advantages increase further, up to 24%, if the possibility of an easy and total disassembly of the CFS structure is taken into account, with the related recovery of great part of the CFS members as well as sheathing and insulating panels. This aspect, together with the good answer to seismic events and the lower capital costs, make the CFS solution particularly appealing for a detached house, in the considered residential area. An attributional, process-based, comparative Life Cycle Assessment has been developed to quantify and compare the environmental performances of a detached house, located in a seismic area of the Southern Italy, designed following two different approaches for its structural components: by using Cold Formed Steel (CFS), with sheathing and insulating panels, or a more conventional reinforced concrete, with brick walls. Both the houses have been designed to minimise energy consumptions. The analysis has been carried out along the whole building life cycle, broken down into three main phases: pre-use, use and end-of-life. The study quantifies the environmental impacts related to each of these phases, based on high quality data, which have been in large part collected on the field. The results show that the contributions of pre-use and use phases to the overall environmental performances are significant for both the design solutions. The outcomes of the life cycle impact assessment indicate that the house made of CFS has a better performance for the more important environmental impact categories, namely Respiratory Inorganics, Global Warming and Non-Renewable Energy. These advantages increase further, up to 24%, if the possibility of an easy and total disassembly of the CFS structure is taken into account, with the related recovery of great part of the CFS members as well as sheathing and insulating panels. This aspect, together with the good answer to seismic events and the lower capital costs, make the CFS solution particularly appealing for a detached house, in the considered residential area.

Background & Aims Controlled attenuation parameter (CAP) can be performed together with liver stiffness measurement (LSM) by transient elastography (TE) and is often used to diagnose fatty liver. We aimed to define the validity criteria of CAP. Methods CAP was measured by the M probe prior to liver biopsy in 754 consecutive patients with different liver diseases at three centers in Europe and Hong Kong (derivation cohort, n = 340; validation cohort, n = 414; 101 chronic hepatitis B, 154 chronic hepatitis C, 349 non-alcoholic fatty liver disease, 37 autoimmune hepatitis, 49 cholestatic liver disease, 64 others; 277 F3-4; age 52 ± 14; body mass index 27.2 ± 5.3 kg/m2). The primary outcome was the diagnosis of fatty liver, defined as steatosis involving ≥5% of hepatocytes. Results The area under the receiver-operating characteristics curve (AUROC) for CAP diagnosis of fatty liver was 0.85 (95% CI 0.82–0.88). The interquartile range (IQR) of CAP had a negative correlation with CAP (r = −0.32, p