Second-line treatment strategies for RAS wild-type colorectal cancer: A systematic review and Network Meta-analysis (NMA)

BACKGROUND

The optimal strategy for second-line (IIL) treatment in KRAS wt metastatic colorectal cancer (mCRC) is not determined yet.

METHODS

A random-effect NMA of phase II/III RCTs was conducted to evaluate IIL treatment for all-RAS wt mCRC, comparing anti-EGFR or anti-VEGF, and chemotherapy (CT).

RESULTS

Overall, 11 RCTs (3613 patients) were included. In KRAS wt patients, PFS was improved with anti-VEGF (HR 0.43) and anti-EGFR (HR 0.63) vs CT. However, anti-VEGF based therapy had the highest likelihood of being ranked as the best treatment in terms of PFS (SUCRA 99.3%) and OS (SUCRA 99.4%). Bevacizumab-based treatment is most likely to be the best treatment in terms of PFS (SUCRA 89.1%) and OS (SUCRA 86.7%).

CONCLUSIONS

Second line treatment with anti-VEGF and anti-EGFR improved PFS in mCRC patients, however, anti-VEGF based therapy, particularly CT plus bevacizumab, is the best treatment according to SUCRA in terms of PFS and OS.

Multigenerational tests on Daphnia spp.: a vision and new perspectives

Multigenerational toxicity testing is a valuable tool for understanding the long-term effects of contaminants on aquatic organisms. This review focuses on the use of multigenerational tests with Daphnia, a widely used model organism in aquatic toxicological studies. The review highlights the importance of studying multiple generations to assess Daphnia spp. reproductive, growth, and physiological responses to various contaminants. We discuss the outcomes of multigenerational tests involving different contaminants, including nanoparticles, pesticides, and pharmaceuticals. The results reveal that multigenerational exposure can lead to transgenerational effects, where the impacts of contaminants are observed in subsequent generations even after the initial exposure has ceased. These transgenerational effects often manifest as reproduction, growth, and development alterations. Furthermore, we emphasize the need for standardized protocols in multigenerational testing to ensure comparability and reproducibility of results across studies. We also discuss the implications of multigenerational testing for ecological risk assessment, as it provides a more realistic representation of the long-term effects of contaminants on populations and ecosystems. Overall, this review highlights the significance of multigenerational tests with Daphnia in advancing our understanding of the ecological impacts of contaminants. Such tests provide valuable insights into the potential risks associated with long-term exposure to pollutants and contribute to the development of effective mitigation strategies for aquatic ecosystems.

Relationship between Mitral Regurgitation and Transcatheter Aortic Valve Implantation: a Multi-Institutional Follow-up Study

BACKGROUND

Mitral regurgitation (MR) is prevalent in patients undergoing transcatheter aortic valve implantation (TAVI). There are some controversies about the prognostic impact of MR in survival of TAVI patients.

OBJECTIVE

To examine the relationship between TAVI and MR in a patient population from the Brazilian TAVI Registry.

METHODS

Seven hundred and ninety-five patients from the Brazilian TAVI Registry were divided at baseline, discharge, and follow-up according to their MR grade as follows: absent/mild (AMMR) or moderate/severe (MSMR). They were subsequently regrouped according to their immediate and late changes in MR severity after TAVI as follows: no change, improved, or worsened MR. Predictors and prognostic impact on baseline as well as changes in MR severity were analyzed. Statistical significance was set at p < 0.05.

RESULTS

Baseline MSMR was present in 19.3% of patients and was a predictor of increased late mortality. Immediately after TAVI, 47.4 % of cases improved to AMMR, predicted by a higher Society of Thoracic Surgeons score and a higher grade of baseline aortic regurgitation. Upon follow-up, 9.2% of cases of AMMR worsened to MSMR, whereas 36.8% of cases of MSMR improved to AMMR. Lower baseline left ventricular ejection fraction (LVEF) and improvement in LVEF at follow-up were predictors of MR improvement. Progressive worsening of MR upon follow-up was an independent predictor of higher late mortality after TAVI (p = 0.005).

CONCLUSIONS

Baseline MSMR predicts late mortality after TAVI. Lower LVEF and improved LVEF at follow-up predict MR improvement after TAVI. Progressive worsening of MR severity at follow-up is an independent predictor of late mortality, which is a rare finding in the literature.

The unsurpassed value of cardiopulmonary exercise testing in assessing the prognosis of heart failure

Introduction

Cardiopulmonary exercise testing (CPET) has become an important clinical tool to predict outcome in patients with chronic heart failure (CHF) and help to select candidates for heart transplantation (HTx) or left ventricular assist devices (LVAD).

Purpose

To evaluate CPET measurements in advanced CHF patients that are being considered for HTx or LVAD and its association to early mortality regardless of the performed procedure.

Methods

Maximum intensity CPET was performed on a treadmil and ramp protocol in 65 patients with patients with CHF and reduced ejection fraction, NYHA functional classes III and IV between 2012 and 2018. Measurements derived from CPET were the following: peak V'O2, VO2 at the anaerobic threshold (AT), percentage of the VO2 of the anaerobic threshold in relation to the peak, the VE/VCO2 slope, maximum heart rate (HR), respiratory quotient (R), oxygen kinetics, circulatory power (CP), the recovery HR in the first minute and the oxygen uptake efficiency slope (OUES) and the relation (VE/VCO2 slope)/VO2 peak.

Results

Seventy-four percent were male. Mean age of 67±12 years. Amost half (47%) had ischemic etiology. There were no complications related to CPET. Ten patients were transplanted, six had an intracorporeal LVAD implanted and the reminder (49 patients) were kept in supervised physical rehabilitation program. There were 11 deaths, 2 in HTx, 2 in LVAD, 7 in the rehabilitation group. Mean follow-up among the survivors was 43 months ± 40.6 and it was 12.1±10.3 months in those who died. CPET derived measurements between survivors and non-survivors were as follows: V'O2 peak (mL kg–1 min–1): 12.6±4.6 and 8.6±2.7 (p=0.002); the VO2 AT (mL kg–1 min–1): 9.9±3.3 and 6.1±3.0 (p=0.002); VE/VCO2 slope: 34.2±12.1 and 68.1±68.7 (p=0.0003); R peak: 1.1±0.2 and 1.0±0.1 (p=0.009); t1/2, in seconds: 135.8±47.9 and 170.1±82.0 (p=0.03); HR at the first minute 16.6±13 and 7±5 (p=0.009); OUES (L min–1): 1.1±0.4 and 0.9±0.3 (p=0.04) and CP [(ml O2 kg–1 min–1) mmHg] 1.516.2±689. 3 and 960.6±363.6 (p=0.005). and the relation (VE/VCO2 slope)/V'O2 peak were 3.2±2.0 and 11.4±19.5 (p=0.001), respectively.

Conclusion

The predisposition to early death could be stratified by V'O2 peak, VO2 of the ventilatory threshold, VE/VCO2 slope, t1/2, recovery HR, OUES, CP, and by the relation (VE/VCO2 slope)/V'O2 peak.

Funding Acknowledgement

Type of funding source: Private hospital(s). Main funding source(s): own financing

Current emerging SARS-CoV-2 pandemic: Potential direct/indirect negative impacts of virus persistence and related therapeutic drugs on the aquatic compartments

The purpose of the present work is to provide a complete overview of possible direct/indirect implications on the quality of aquatic compartments due to the recent SARS-CoV-2 outbreak. With this aim, the environmental impacts are mainly related to i) the virus persistence in sewage and wastewaters, and ii) possible fate in aquatic compartments of drugs tested and administered to SARS-CoV-2 infected patients. Because SARS-CoV-2 spread is very recent, and there is a lack of specific studies on this strain, the virus persistence in wastewaters, the parameters influencing the persistence, as well as the detection methodologies are referenced to the general coronaviruses group. However, the present detailed report of up-to-date knowledge on this topic can provide a useful source for further studies focusing on more deepened investigations of SARS-CoV-2 behaviour in the environment. Such a perspective is significant not only for the control of virus diffusion but also represents a crucial point for the identification of produced alteration to the environmental quality.

Species-specific sensitivity of three microalgae to sediment elutriates

Microalgae are considered good bioindicators of marine environmental quality. Frequently, they are used to investigate the toxicity of sediment elutriates, but their sensitivity is disputed. This paper compared the sensitivity of Phaeodactylum tricornutum (diatom), Skeletonema costatum (diatom), and Dunaliella tertiolecta (green alga), analyzing 257 samples of elutriates (1:4 sediment: water ratio), considering growth inhibition (72 h) as the reference endpoint and sediment chemical (metals, metalloids and polyaromatic hydrocarbons) and grain size. Results of the toxicity tests showed that the microalgae sensitivity was not correlated. The integration of chemical data did not allow to discriminate toxicity effects but contributed to highlight that D. tertiolecta was the most sensitive microalgae (no cell wall) followed by P. tricornutum and S. costatum. Further analysis, including lines of evidence and weight of evidence approaches to calculate risk quotients of elutriate samples, confirmed these results.

P247 Added value of 3D echo in diagnosing and monitoring transcatheter valve in mac procedure in a patient with severe mitral stenosis

INTRODUCTION

Mitral annular calcification (MAC) is a chronic degenerative process involving calcification of the fibrous base of the mitral valve accounting for 12% to 26% of all mitral stenosis (MS) and eventually for significant mitral regurgitation. Calcification often extends to other parts of the mitral valve apparatus but, unlike rheumatic stenosis, does not produce commissural fusion. Surgical treatment carries a high mortality rate due to technical difficulties involving the heavily calcified annulus, advanced age and comorbidities of affected patients. In recent years, transcatheter mitral valve replacement using ballon expandable transcatheter aortic valves in severe MAC (valve-in-MAC) has been used with acceptable success rates.

PURPOSE

To describe the added value of 3D echo in the diagnostic work-up, decision making and monitoring during the interventional procedure of valve-in-MAC.

CASE PRESENTATION

Two years ago a 90-year-old female in sinus rhythm with hypertension and known coronary artery disease (CAD) was admitted with symptoms of pulmonary congestion (PC). At that time, a transthoracic 3D echocardiogram showed important MAC with a mitral valve area (MVA) estimated through 3D planimetry of 1.1 cm2, pulmonary artery pressure (PAP) of 53 mmHg, preserved biventricular function and left atrial enlargement. One year later, she was readmitted with unstable CAD and treated with percutaneous transluminal angioplasty. At that time a 3D transesophageal echocardiogram (3DTOE) showed worsening of the MVA now estimated in 0.6 cm2, a mean gradient of 19 mmHg and PAP of 88 mmHg. Albeit optimized medical therapy, her functional status worsened and less than a month later she was again readmitted in NYHA functional class III. Therefore decision making for valve-in-MAC was undertaken. Valve sizing was performed with computed tomography (CT) using the D-shape method with similar findings when compared with 3D TOE measurements. Both methods showed a favourable anatomy of the left ventricular outflow tract. Valve-in-MAC procedure was performed through transvenous transseptal access and an Edwards Sapien3-nr 29 balloon-expandable valve was deployed uneventfully, except for a residual interatrial septal defect measuring 2.2x0.8cm closed two weeks after, as she persisted with PC and pulmonary hypertension. During the procedure, 3DTOE showed a partial thrombosis involving one of the prosthesis leaflets with preserved transvalvular gradients despite anticoagulation. After that, PC resolved and PAP dropped dramatically. The patient was discharged under lifelong anticoagulation and remains asymptomatic until now.

CONCLUSION

Diagnosing and treating patients with severe MS due to MAC remains a challenge as traditional parameters and interventional procedures don’t apply for this population. Valve-in-MAC is a feasible alternative and 3DTOE may have a pivotal role in the diagnostic work-up and interventional monitoring of these cases.

Abstract P247 Figure. 3D echo timeline valve in MAC

Sentinel lymph node biopsy with intraoperative touch imprint cytology (TIC) in breast cancer: experience of a mild-volume center

Although considered the gold standard in treatment of EBC, sentinel node biopsy still remains a debated issue. What to do in case of positive sentinel node and the need of intraoperative histological examination are the most topics under discussion. In this study we have retrospectively evaluate our case series of 359 sentinel node biopsy in the managing of breast cancer from January 2011 to December 2018, focusing on the TIC technique for performing intraoperative examination. It results in 12,8% "FALSE NEGATIVE" rate, in which only 4,2% in macrometastases, with an overall sensitivity of 68,4% (macrometastases: 86%; micrometastases: 11%), overall specificity of 98,7% and an overall accuracy of 89,7%. The intraoperative examination of SLN allows to reduce delayed surgery procedures and greater therapeutic safety in case of mastectomy. The TIC method can be considered valid, simple and rapid in identifying macrometastases, also allowing to avoid under-staging. The low sensitivity for micrometastases is not a limit, considering that recent evidence has drastically reduced the indications for ALND in these cases. Further ongoing trials and the possible validation of NOMOGRAMMS and SCORE are necessary to identify low risk cases in which to definitively omit the ALND and/or even the SLNB itself.

Cerium and erbium effects on Daphnia magna generations: A multiple endpoints approach

Cerium (Ce, CeCl₃) and Erbium (Er, ErCl₃) are increasingly used in many electronic devices facilitating the alteration of their biogeochemical cycles (e.g. e-waste). Previous surveys stated that their environmental concentrations due to natural or anthropogenic events can reach up to 161 μg/L in ore mine effluent for Ce with a mean water concentration of 0.79 μg/L, and 11.9 μg/L for Er in ore mine effluents with a mean water concentration of 0.004 μg/L. Their potential effects onto aquatic organisms are still relatively unexplored. In this study, long-term multigenerational effects on Daphnia magna were assessed using various exposure times (3, 7, 14, and 21 days) in three generations (F0, F1 and F2). Each generation was exposed to environmental concentrations of Ce and Er (0.54 and 0.43 μg/L, respectively - mean values) and effects included organisms' size, parental reproduction, and survival, determination of reactive oxygen species (ROS), enzymatic activity (superoxide dismutase (SOD), catalase (CAT), and glutathione S-transferase (GST)), gene expression of ATP-binding cassette (ABC) transporter, and uptake. Results evidenced that chronic multi-generational exposure of daphnids to Ce and Er reduced survival, growth and reproduction, decreasing ROS, SOD and CAT from F0 to F2. Ce reduced the number of generated offsprings after each generation, while Er delayed the time of offsprings emergence, but not their number. ROS, SOD, CAT and GST evidenced that Er is slightly more toxic than Ce. Up- and downregulation of genes was limited, but Ce and Er activated the ABC transporters. Uptake of Ce and Er decreased through exposure time and generations.

Plasma peroxiredoxin changes and inflammatory cytokines support the involvement of neuro-inflammation and oxidative stress in Autism Spectrum Disorder

BACKGROUND

It has been established that children with Autism Spectrum Disorders (ASD) are affected by oxidative stress, the origin of which is still under investigation. In the present work, we evaluated inflammatory and pro-oxidant soluble signature in non-syndromic ASD and age-matched typically developing (TD) control children.

METHODS

We analyzed leukocyte gene expression of inflammatory cytokines and inflammation/oxidative-stress related molecules in 21 ASD and 20 TD children. Moreover, in another-comparable-group of non-syndromic ASD (N = 22) and TD (N = 21) children, we analyzed for the first time the protein expression of the four members of the antioxidant enzyme family of peroxiredoxins (Prx) in both erythrocyte membranes and in plasma.

RESULTS

The gene expression of IL6 and of HSP70i, a stress protein, was increased in ASD children. Moreover, gene expression of many inflammatory cytokines and inflammation/oxidative stress-related proteins correlated with clinical features, and appeared to be linked by a complex network of inter-correlations involving the Aryl Hydrocarbon Receptor signaling pathway. In addition, when the study of inter-correlations within the expression pattern of these molecules was extended to include the healthy subjects, the intrinsic physiological relationships of the inflammatory/oxidative stress network emerged. Plasma levels of Prx2 and Prx5 were remarkably increased in ASD compared to healthy controls, while no significant differences were found in red cell Prx levels.

CONCLUSIONS

Previous findings reported elevated inflammatory cytokines in the plasma of ASD children, without clearly pointing to the presence of neuro-inflammation. On the other hand, the finding of microglia activation in autoptic specimens was clearly suggesting the presence of neuro-inflammation in ASD. Given the role of peroxiredoxins in the protection of brain cells against oxidative stress, the whole of our results, using peripheral data collected in living patients, support the involvement of neuro-inflammation in ASD, and generate a rational for neuro-inflammation as a possible therapeutic target and for plasma Prx5 as a novel indicator of ASD severity.

Polymicrobial antibiofilm activity of the membranotropic peptide gH625 and its analogue

This work illustrates a new role for the membranotropic peptide gH625 and its derivative gH625-GCGKKK in impairing formation of polymicrobial biofilms. Mixed biofilms composed of Candida and bacterial species cause frequently infections and failure of medical silicone devices and also show a major drug resistance than single-species biofilms. Inhibition and eradication of biofilms were evaluated by complementary methods: XTT-reduction, and crystal violet staining (CV). Our results indicate that gH625-GCGKKKK, better than the native peptide, strongly inhibited formation of mixed biofilms of clinical isolates of C. tropicalis/S. marcescens and C. tropicalis/S. aureus and reduced the biofilm architecture, interfering with cell adhesion and polymeric matrix, as well as eradicated the long-term polymicrobial biofilms on silicone surface.

Effects of ZnO nanoparticles in the Caspian roach (Rutilus rutilus caspicus)

Most studies investigating the toxicity of zinc oxide nanoparticles (ZnO NPs) focused on the effect of size, whereas exposure concentration and duration remained poorly understood. In this study, the effect of acute and sub-acute exposures of ZnO NPs on Zn compartmentalization and biomarkers' expression were investigated in Rutilus rutilus caspicus (Caspian roach) considering various exposure scenarios: i) the assessment of the concentration-response curves and median lethal concentration (LC₅₀); ii) the assessment of the effects of organisms exposed at LC₅₀ value and one tenth of LC₅₀ value of ZnO NPs suspensions for 4 d and 28 d, respectively; iii) the assessment of 14 d depuration period. The same concentrations of ZnSO₄ were investigated. The highest Zn accumulation was detected in gill after sub-acute exposure (4.8 mg/L; 28 d) followed by liver, kidney and muscle. In gill, liver and muscle, Zn from Zn NPs accumulated higher concentrations. Depuration (14 d) decreased Zn content in each organ, but no complete removal occurred except for muscle. Biomarkers' activity was significantly over expressed after treatments, but depuration brought back their values to background levels and most effects were related to acute concentrations (48 mg/L; 4 d) and in presence of ZnSO₄. Histopathological analyses showed that the exposure to ZnO NPs increased lesions in gill, liver and kidney, with a direct proportionality between alterations and Zn accumulated in the target organs. After depuration, lesions regressed for both ZnO NPs and ZnSO₄, but not in a complete way. These data could contribute to increase the knowledge about ZnO NPs risk assessment in aquatic vertebrates, suggesting that the size of ZnO NPs can influence biomarker and histopathological effects.

Municipal wastewater spiramycin removal by conventional treatments and heterogeneous photocatalysis

This study assessed the effects and removal options of the macrolide spiramycin, currently used for both in human and veterinary medicine- with a special focus on advanced oxidation processes based on heterogeneous TiO₂^_assisted photocatalysis. Spiramycin real concentrations were investigated on a seasonal basis in a municipal wastewater treatment plant (up to 35μgL^-1), while its removal kinetics were studied considering both aqueous solutions and real wastewater samples, including by-products toxicity assessment. High variability of spiramycin removal by activated sludge treatments (from 9% (wintertime) to >99.9% (summertime)) was observed on a seasonal basis. Preliminary results showed that a total spiramycin removal (>99.9%) is achieved with 0.1gL^-1 of TiO₂ in aqueous solution after 80min. Integrated toxicity showed residual slight acute effects in the photocatalytic treated solutions, independently from the amount of TiO₂ used, and could be linked to the presence of intermediate compounds. Photolysis of wastewater samples collected after activated sludge treatment during summer season (SPY 5μgL^-1) allowed a full SPY removal after 80min. When photocatalysis with 0.1gL^-1 of TiO₂ was carried out in wastewater samples collected in winter season (SPY 30μgL^-1) after AS treatment, SPY removal was up to 91% after 80min.

Intrasellar Paraganglioma with Suprasellar Extension: Case Report

Paragangliomas are usually benign tumors which can be found in many sites of the body, from the base of the skull down to the pelvic floor. In the central nervous system the sellar region is very rarely involved; only three well studied cases have been reported to date. We present the cytological, histological, histochemical, immunocytochemical and ultrastructural features of an intrasellar and suprasellar paraganglioma in an 84-year-old man.

Biodegradation, ecotoxicity and UV254/H2O2 treatment of imidazole, 1-methyl-imidazole and N,N'-alkyl-imidazolium chlorides in water

Imidazole-based compounds are used as reagents for the manufacturing of other compounds including imidazolium-based ionic liquids, which have been recently proposed as a green alternative to conventional solvents. Since some imidazole-based compounds have been demonstrated to be harmful to aquatic organisms, the removal of imidazole, 1-methylimidazole, 1-ethyl-3-methyl-imidazolium chloride and 1-butyl-3-methyl-imidazolium chloride from aqueous solutions was attempted by biological oxidation, direct UV₂₅₄ photolysis, and UV₂₅₄/H₂O₂ process at pH 5.5 and 8.5. Results showed that UV₂₅₄/H₂O₂ treatment is an effective tool for the removal of the selected compounds at both pHs. In fact, the kinetic constants of the reaction between the photogenerated HO radicals and the four target compounds, estimated by means of both numerical and competition kinetic method, range between 2.32·10⁹ M^-1 s^-1 and 5.52 ·10⁹ M^-1 s^-1. Moreover, an ecotoxicity assessment of the contaminated water before and after initial treatment without further processing was assessed by using two living aquatic organisms: Raphidocelis subcapitata and Daphnia magna. The results of this assessment not only corresponded closely to previous findings (in terms of EC₅₀ values) reported in the literature, but also indicated that, in some cases, UV₂₅₄/H₂O₂ oxidation by-products could be even more toxic than parent compounds.

Removal of benzoylecgonine from water matrices through UV254/H2O2 process: Reaction kinetic modeling, ecotoxicity and genotoxicity assessment

Benzoylecgonine (BE), the main cocaine metabolite, has been detected in numerous surface water and treatment plants effluents in Europe and there is urgent need for effective treatment methods. In this study, the removal of BE by the UV254/H2O2 process from different water matrices was investigated. By means of competition kinetics method, the kinetic constant of reaction between BE and the photogenerated hydroxyl radicals (OH) was estimated resulting in kOH/BE=5.13×10(9)M(-1)s(-1). By-products and water matrices scavengers effects were estimated by numerical modeling of the reaction kinetics for the UV254/H2O2 process and validated in an innovative microcapillary film (MCF) array photoreactor and in a conventional batch photoreactor. The ecotoxicity of the water before and after treatment was evaluated with four organisms Raphidocelis subcapitata, Daphnia magna, Caenorhabditis elegans, and Vicia faba. The results provided evidence that BE and its transformation by-products do not have significant adverse effects on R. subcapitata, while D. magna underwent an increase of lipid droplets. C. elegans was the most sensitive to BE and its by-products. Furthermore, a genotoxicity assay, using V. faba, showed cytogenic damages during the cell mitosis of primary roots.

Emerging Concern from Short-Term Textile Leaching: A Preliminary Ecotoxicological Survey

Textile dyes and their residues gained growing attention worldwide. Textile industry is a strong water consumer potentially releasing xenobiotics from washing and rinsing procedures during finishing processes. On a decentralised basis, also final consumers generate textile waste streams. Thus, a procedure simulating home washing with tap water screened cotton textiles leachates (n = 28) considering physico-chemical (COD, BOD₅, and UV absorbance) and ecotoxicological data (Daphnia magna, Pseudokirchneriella subcapitata and Lepidium sativum). Results evidenced that: (i) leachates presented low biodegradability levels; (ii) toxicity in more than half leachates presented slight acute or acute effects; (iii) the remaining leachates presented "no effect" suggesting the use of green dyes/additives, and/or well established finishing processes; (iv) no specific correlations were found between traditional physico-chemical and ecotoxicological data. Further investigations will be necessary to identify textile residues, and their potential interactions with simulated human sweat in order to evidence potential adverse effects on human health.

Recovery of ammonia in digestates of calf manure through a struvite precipitation process using unconventional reagents

Land spreading of digestates causes the discharge of large quantities of nutrients into the environment, which contributes to eutrophication and depletion of dissolved oxygen in water bodies. For the removal of ammonia nitrogen, there is increasing interest in the chemical precipitation of struvite, which is a mineral that can be reused as a slow-release fertilizer. However, this process is an expensive treatment of digestate because large amounts of magnesium and phosphorus reagents are required. In this paper, a struvite precipitation-based process is proposed for an efficient recovery of digestate nutrients using low-cost reagents. In particular, seawater bittern, a by-product of marine salt manufacturing and bone meal, a by-product of the thermal treatment of meat waste, have been used as low-cost sources of magnesium and phosphorus, respectively. Once the operating conditions are defined, the process enables the removal of more than 90% ammonia load, the almost complete recovery of magnesium and phosphorus and the production of a potentially valuable precipitate containing struvite crystals.

CT and MR imaging evaluation of neck infections with clinical correlations

Infection of the neck is a common clinical problem in all age groups, especially children and young adults. The clinical symptoms and signs are often suggestive of the diagnosis. Imaging studies including CT and MR imaging are frequently required to confirm the diagnosis but more importantly to localize the infectious process and search for and delineate an abscess cavity. Ultrasound has also been used in the evaluation of superficial neck infections, especially to determine fluid accumulation. Conventional films consisting of an anteroposterior and lateral view were the examination before the introduction of CT in 1972. Conventional films can still be used for a preliminary survey, especially of the retropharyngeal space when there is a question of a retropharyngeal phlegmon or abscess.

Encapsulated intracerebral hematoma: a case report and review of the literature

A case of encapsulated intracerebral hematoma is described in the light of the relevant literature. The etiopathogenesis, diagnostic problems and treatment of this rare entity are also discussed.

Pleomorphic xanthoastrocytoma: clinical, imaging and pathological features of four cases

Four cases of pleomorphic xanthoastrocytoma (PXA) were collected from among 688 glioma patients who underwent operation at the Institute of Neurosurgery, University of Naples "Federico II" between January 1973 and December 1994. Three were females and one male, ranging in age from 10 months to 65 years. Three tumors were superficial in location, appearing as a meningo-cerebral mass in the temporo-parietal region. In one case, the tumor was situated deep within the brain (capsulo-thalamic region), without contact with leptomeninges. Three patients had experienced epileptic seizures, whereas one patient presented with an ictal episode. Tumor excision was grossly total in two cases, and subtotal in the remaining two. In three cases, histological examination demonstrated a "typical" PXA; conversely one tumor (subtotal excised) was an "atypical" PXA. The two patients with incomplete surgical resection were postoperatively treated with fractionated brain radiation therapy. Of the two patients who had grossly total removals, one showed tumor recurrence 6 years after surgery, and underwent operation (the recurrent neoplasm did not exhibit malignant transformation); the second patient was free of tumor at 14 months following craniotomy. Of the two patients who had undergone subtotal removals, one died because of massive regrowth of the lesion 22 months after surgery, whereas the second patient was asymptomatic at 1 year follow up.

[Gastrointestinal angiodysplasia. Clinical, endoscopic, angiographic and histologic study]

The authors report 10 cases of gastrointestinal bleeding angiodysplasia (4 male and 6 female). The surgical treatment was normally provided and the main clinical features, were observed by radiological, endoscopic and pathological findings. Angiodysplasia was observed in the colon (4 cases), in the small intestine (3 cases) and in the stomach (3 cases). Common symptoms (bleeding and sideropenic anaemia), where possible associated with endoscopic and angiographic study, permitted to determine diagnosis and lesion's extension. Pathological findings showed that vascular dilatation wasn't present only in the mucosa and in the submucosa, as in the amartomatous congenital forms, but was present in all intestinal wall, as in the secondary forms, more frequent.

Renal Hemodynamics, Plasma Amino Acids and Hormones after a Meat Meal in Progressive Nephron Loss

Ten patients with chronic renal failure (GFR 29–97 ml/min), on free diets providing 1 g/kg B.W. of proteins, ingested an oral protein load (meat meal, 2 g/kg B.W.). GFR and RPF increased significantly over baseline with no change in filtration fraction. Within 30 min of the meal and for the next 3 h a statistically significant increase was observed in the plasma concentrations of the following amino acid groups: essential, nonessential, total, branched-chain, ketogenic, glycogenic, glycogenic and ketogenic, basic, acid, polar and non-polar. At 30 min the smallest increase was seen in acid and polar amino acids (6.7% and 7.6%, respectively). At 180 min the largest increase (78.8%) was seen for glycogenic and ketogenic amino acids and total plasma amino acids were 1.58 times baseline. After the meat meal plasma glucagon and insulin rose significantly, while growth hormone, plasma renin activity and aldosterone did not vary.

Predicted creatinine clearance to assess glomerular filtration rate in chronic renal disease in humans

The work was designed to assess the suitability of both measured endogenous creatinine clearance (CCR) and predicted creatinine clearance (P-CCR) to evaluate GFR in chronic renal disease (CRD) by utilizing the renal clearance of inulin (CIN) as gold standard. A total of 124 subjects were studied (62 healthy, 62 with CRF). CCR significantly overestimated GFR in healthy subjects as well as in CRF, whereas P-CCR was identical to GFR. The CCR/CIN ratio which calculates the fractional creatinine clearance and provides a rough estimation of the contribution of creatinine secretion in explaining the differences between CCR and GFR was increased in CRD and especially in CRD of glomerular origin. The ration P-CCR/CIN was significantly lower than CCR/CIN in healthy subjects and in patients with CRD of glomerular origin. The data are against the use of CCR in assessing GFR in healthy subjects and in patients with CRD.