Removal of pharmaceutical compounds from the liquid phase of anaerobic sludge in a pilot-scale high-rate algae-bacteria pond

This study evaluates the effectiveness of a pilot-scale high-rate algae-bacteria pond (HRAP) to remove pharmaceutical compounds (PhACs) from municipal centrate. The studied PhACs belonged to different classes of synthetic active compounds: antihypertensives, antiepileptics, antidepressants, neuroprotectors, and anti-inflammatory drugs. The HRAP, growing a mixed microalgal consortium made of Chlorella spp. and Scenedesmus spp., was operated in continuous mode (6 days hydraulic retention time) from May to November 2021. Removal efficiencies were high (>85 %) for Sulfamethoxazole and Lamotrigine, promising (65-70 %) for Metoprolol, Fluoxetine, and Diclofenac but low (30-40 %) for Amisulpride, Ofloxacin, Carbamazepine, and Clarithromycin. Propyphenazone and Irbesartan were not removed, and their concentrations increased after the treatment. The combination of abiotic and biotic drivers (mostly global radiation and the synergy between microalgae and bacteria metabolisms) fostered photo and biodegradation processes. Overall, results suggest that microalgae-based systems can be a valuable solution to remove PhACs from wastewater.

Integrating microalgae growth in biomethane plants: Process design, modelling, and cost evaluation

The integration of microalgae cultivation in anaerobic digestion (AD) plants can take advantage of relevant nutrients (ammonium and ortho-phosphate) and CO2 loads. The proposed scheme of microalgae integration in existing biogas plants aims at producing approximately 250 t·y-1 of microalgal biomass, targeting the biostimulants market that is currently under rapid expansion. A full-scale biorefinery was designed to treat 50 kt·y-1 of raw liquid digestate from AD and 0.45 kt·y-1 of CO2 from biogas upgrading, and 0.40 kt·y-1 of sugar-rich solid by-products from a local confectionery industry. An innovative three-stage cultivation process was designed, modelled, and verified, including: i) microalgae inoculation in tubular PBRs to select the desired algal strains, ii) microalgae cultivation in raceway ponds under greenhouses, and iii) heterotrophic microalgae cultivation in fermenters. A detailed economic assessment of the proposed biorefinery allowed to compute a biomass production cost of 2.8 ± 0.3 €·kg DW-1, that is compatible with current downstream process costs to produce biostimulants, suggesting that the proposed nutrient recovery route is feasible from the technical and economic perspective. Based on the case study analysis, a discussion of process, bioproducts and policy barriers that currently hinder the development of microalgae-based biorefineries is presented.

The impact of family alexithymia on the severity of restrictive eating disorders in adolescent patients

BACKGROUND

Alexithymia is the inability to identify and describe one's own emotions. Adolescents who suffer from Restrictive Eating Disorders (REDs) show a higher prevalence of alexithymia than the general population.

METHODS

The study explored the correlation between levels of alexithymia in mothers, fathers, and adolescents affected by REDs and patients' ability to recognize their emotions. The study also aimed to evaluate if patients' emotional distress can significantly impact the severity of their disorder and functioning measured by the Clinical Global Impression Scale - Severity (CGI-S) and the Children's Global Assessment Scale (CGAS). We enrolled 67 families of adolescents affected by REDs. Parents and patients' levels of alexithymia were assessed through the Toronto Alexithymia Scale (TAS-20). Spearman's correlation shows a statistically significant correlation between mothers and patients' levels of alexithymia.

RESULTS

Our findings also suggest that fathers and mothers' TAS scores correlate with each other. However, there is no statistically significant relationship between the influence of the TAS scores of fathers and sons/daughters.

CONCLUSIONS

In conclusion, mothers' level of alexithymia could influence both fathers and patients' difficulty in identifying and describing their own emotions. This relationship can be investigated further when considering externally oriented thinking. However, the severity of the disease and overall functioning do not appear to be affected by patients' levels of alexithymia.

The 2022 Assisi Think Tank Meeting: White paper on optimising radiation therapy for breast cancer

The present white paper, referring to the 4th Assisi Think Tank Meeting on breast cancer, reviews state-of-the-art data, on-going studies and research proposals. < 70% agreement in an online questionnaire identified the following clinical challenges: 1: Nodal RT in patients who have a) 1-2 positive sentinel nodes without ALND (axillary lymph node dissection); b) cN1 disease transformed into ypN0 by primary systemic therapy and c) 1-3 positive nodes after mastectomy and ALND. 2. The optimal combination of RT and immunotherapy (IT), patient selection, IT-RT timing, and RT optimal dose, fractionation and target volume. Most experts agreed that RT- IT combination does not enhance toxicity. 3: Re-irradiation for local relapse converged on the use of partial breast irradiation after second breast conserving surgery. Hyperthermia aroused support but is not widely available. Further studies are required to finetune best practice, especially given the increasing use of re-irradiation.

Wastewater from textile digital printing as a substrate for microalgal growth and valorization

This study aims at evaluating an innovative biotechnological process for the concomitant bioremediation and valorization of wastewater from textile digital printing technology based on a microalgae/bacteria consortium. Nutrient and colour removal were assessed in lab-scale batch and continuous experiments and the produced algae/bacteria biomass was characterized for pigment content and biomethane potential. Microbial community analysis provided insight of the complex community structure responsible for the bioremediation action. Specifically, a community dominated by Scenedesmus spp. and xenobiotic and dye degrading bacteria was naturally selected in continuous photobioreactors. Data confirm the ability of the microalgae/bacteria consortium to grow in textile wastewater while reducing the nutrient content and colour. Improvement strategies were eventually identified to foster biomass growth and process performances. The experimental findings pose the basis of the integration of a microalgal-based process into the textile sector in a circular economy perspective.

Production of microalgal-based carbon encapsulated iron nanoparticles (ME-nFe) to remove heavy metals in wastewater

The integration of microalgae-bacteria consortia within existing wastewater treatment plants as alternative biological treatment could be an interesting option to improve the sustainability of these facilities. However, the fate of the produced biomass is decisive to make that option economically attractive. The present study aimed to valorize the microalgae grown at a pilot scale and used for the treatment of the centrate from municipal sewage sludge, producing microalgal-based iron nanoparticles (ME-nFe), by hydrothermal carbonization. The final product had high carbon content, strong sorbent power, and reducing properties, due to the presence of zerovalent iron. Different synthesis conditions were tested, comparing iron (III) nitrate nonahydrate (Fe (NO₃)₃·9H₂O) and ammonium iron (III) sulfate dodecahydrate (NH₄ Fe (SO₄)₂·12 H₂O) as iron sources, four different Fe/C molar ratios (0.02, 0.05, 0.1, 0.2), and three process temperatures (180, 200, 225 °C). Based on the characterization of all the prototypes, the best one (having a specific area of 110 m²g^-1) was chosen and tested for the removal of selected heavy metals by Jar tests. The removal of copper, zinc, cadmium, and nickel from the treated effluent from the wastewater treatment plant was 99.6%, 97.8%, 96.4%, and 80.3%, respectively, also for very low starting concentrations (1 mg L^-1). The removal of total chromium, on the contrary, was only 12.4%. Thanks to the magnetic properties, the same batch of ME-nFe was recovered and used effectively for three consecutive Jar tests.

Psychotropic drug purchases during the COVID-19 pandemic in Italy and their relationship with mobility restrictions

Recent literature on the mental health consequences of social distancing measures has found a substantial increase in self-reported sleep disorders, anxiety and depressive symptoms during lockdown periods. We investigate this issue with data on monthly purchases of psychotropic drugs from the universe of Italian pharmacies during the first wave of the COVID-19 pandemic and find that purchases of mental health-related drugs have increased with respect to 2019. However, the excess volumes do not match the massive increase in anxiety and depressive disorders found in survey-based studies. We also study the interplay between mobility, measured with anonymized mobile phone data, and mental health and report no significant effect of mobility restrictions on antidepressants and anxiolytics purchases during 2020. We provide three potential mechanisms that could drive the discrepancy between self-reported mental health surveys and psychotropic drugs prescription registries: (1) stockpiling practices in the early phases of the pandemic; (2) the adoption of compensatory behavior and (3) unexpressed and unmet needs due to both demand- and supply-side shortages in healthcare services.

Piggery wastewater treatment with algae-bacteria consortia: Pilot-scale validation and techno-economic evaluation at farm level

The efficiency of an outdoor pilot-scale raceway pond treating the wastewaters generated by a large-scale piggery farm in Northern Italy was evaluated. The biomass productivity over 208 days of experimentation was 10.7 ± 6.5 g TSS·m^-2·d^-1, and ammoniacal nitrogen, orthophosphate, and COD average removal efficiencies were 90%, 90%, and 59%, respectively. Results were used to perform a comprehensive techno-economic analysis for integrating algae-based processes in farms of different sizes (100-10000 pigs). The amount of N disposed of on agricultural land could be reduced from 91% to 21%, increasing the fraction returned to the atmosphere from 2.4% to 63%, and the fraction in the biomass from 6.2% to 16%. For intensive farming, the release of 110 t N·ha^-1·y^-1 contained in the digestate could be avoided by including algae-bacteria processes. The biomass production cost was as low as 1.9 €·kg^-1, while the cost for nitrogen removal was 4.3 €·kg N^-1.

LongITools: Dynamic longitudinal exposome trajectories in cardiovascular and metabolic noncommunicable diseases

The current epidemics of cardiovascular and metabolic noncommunicable diseases have emerged alongside dramatic modifications in lifestyle and living environments. These correspond to changes in our "modern" postwar societies globally characterized by rural-to-urban migration, modernization of agricultural practices, and transportation, climate change, and aging. Evidence suggests that these changes are related to each other, although the social and biological mechanisms as well as their interactions have yet to be uncovered. LongITools, as one of the 9 projects included in the European Human Exposome Network, will tackle this environmental health equation linking multidimensional environmental exposures to the occurrence of cardiovascular and metabolic noncommunicable diseases.

Lab-like findings from online experiments

Laboratory experiments have been often replaced by online experiments in the last decade. This trend has been reinforced when academic and research work based on physical interaction had to be suspended due to restrictions imposed to limit the spread of Covid-19. Therefore, data quality and results from web experiments have become an issue which is currently investigated. Are there significant differences between lab experiments and online findings? We contribute to this debate via an experiment aimed at comparing results from a novel online protocol with traditional laboratory settings, using the same pool of participants. We find that participants in our experiment behave in a similar way across settings and that there are at best weakly significant and quantitatively small differences in behavior observed using our online protocol and physical laboratory setting.

Assessment of anammox, microalgae and white-rot fungi-based processes for the treatment of textile wastewater

The treatability of seven wastewater samples generated by a textile digital printing industry was evaluated by employing 1) anammox-based processes for nitrogen removal 2) microalgae (Chlorella vulgaris) for nutrient uptake and biomass production 3) white-rot fungi (Pleurotus ostreatus and Phanerochaete chrysosporium) for decolorization and laccase activity. The biodegradative potential of each type of organism was determined in batch tests and correlated with the main characteristics of the textile wastewaters through statistical analyses. The maximum specific anammox activity ranged between 0.1 and 0.2 g N g VSS-1 d-1 depending on the sample of wastewater; the photosynthetic efficiency of the microalgae decreased up to 50% during the first 24 hours of contact with the textile wastewaters, but it improved from then on; Pleurotus ostreatus synthetized laccases and removed between 20-62% of the colour after 14 days, while the enzymatic activity of Phanerochaete chrysosporium was inhibited. Overall, the findings suggest that all microbes have great potential for the treatment and valorisation of textile wastewater after tailored adaptation phases. Yet, the depurative efficiency can be probably enhanced by combining the different processes in sequence.

The effects of COVID-19 lockdown on fairness and cooperation: Evidence from a lablike experiment

We run an experiment to study the effects of Covid-19 lockdown in Italy on preferences for fairness and cooperation. Given the impossibility of having participants in the lab during the lockdown, we adopted an online methodology based on a multi-platform architecture that brings experimental subjects in a "Lab on the Web". Results from standard Ultimatum and linear Public Good games show that the circumstances in which participants lived the lockdown significantly affect their behavior in the two games. In particular, participants are more selfish in the ultimatum bargaining and contribute more to the public good when social isolation is stronger. However, cooperation decreases when lockdown is longer. We interpret these results as evidence of "social embeddedness" to compensate for "social distancing".

Bioremediation of aquaculture wastewater with the microalgae Tetraselmis suecica: Semi-continuous experiments, simulation and photo-respirometric tests

Tetraselmis suecica was cultivated in a semi-continuously operated tubular photobioreactor fed on aquaculture wastewater (AW) testing two hydraulic retention times (HRT): 10 and 7 days (RUN_1 and RUN_2, respectively). The integrated mechanistic model BIO_ALGAE was validated with experimental data in order to simulate the biomass production and nutrient uptake of T. suecica. Moreover, AW was used as substitute synthetic cultivation medium to test the production of lipids, proteins, and carbohydrates in the microalgal biomass. Preliminary photo-respirometric tests were carried out on the AW suspension containing microalgae and bacteria. Dissolved Inorganic Nitrogen (DIN) and Dissolved Inorganic Phosphorus (DIP) were analyzed for the two RUNs, and no significant difference was highlighted (p > 0.05). On the contrary, the productivity of the Total suspended solids (TSS) was significantly higher (p < 0.05) for RUN_1 (900 mg TSS/L) than for RUN_2 (550 mg TSS/L). The analysis of the biochemical composition of biomass has demonstrated a higher content of proteins than of lipids and carbohydrates for the two RUNs. BIO_ALGAE model was validated by comparing simulated results to experimental data. The model was able to reproduce the pattern of these experimental data quite well, for both nutrient uptake and biomass production. The simulated curve follows the same pattern as the experimental data for both RUNs. The wavelike trend indicates the good accuracy of the simulated curves to reproduce the microalgae growth and nutrient uptake that occurring during daytime and at night. With this study, BIO_ALGAE Model was demonstrated to be useful to simulate bioremediation and microalgae production in aquaculture wastewater in a semi-continuous system with different environmental factors. The photo-respirometric outputs were compared with the process rates affecting dissolved oxygen dynamics computed by the mathematical model.

Outdoor pilot-scale raceway as a microalgae-bacteria sidestream treatment in a WWTP

This study aims at demonstrating the feasibility of using microalgae-bacteria consortia for the treatment of the sidestream flow of the supernatant from blackwater dewatering (centrate) in an urban wastewater treatment plant in Northern Italy. A 1200 L raceway reactor was used for the outdoor cultivation of a diverse community of Chlorella spp., Scenedesmus spp. and Chlamydomonas spp. in continuous operation mode with 10 days hydraulic retention time. During the trial, an average daily areal productivity of 5.5 ± 7.4 g TSS m^-2 day^-1 was achieved while average nutrient removal efficiencies were 86% ± 7% and 71% ± 10% for NH₄-N and PO₄-P, respectively. The microalgal nitrogen assimilation accounted for 10% of the nitrogen in the centrate while 34% was oxidized to nitrite and nitrate. The oxygen produced by microalgae fully covert the oxygen demand for nitrification. This suggests that the proposed process would reduce the aeration demand for nitrification in the water line of the plant, while producing algal biomass to be further valorized for energy or material recovery.

The Assisi Think Tank Meeting Survey of post-mastectomy radiation therapy in ductal carcinoma in situ: Suggestions for routine practice

BACKGROUND

Risk factors for local recurrence after mastectomy in ductal carcinoma in situ (DCIS) emerged as a grey area during the second "Assisi Think Tank Meeting" (ATTM) on Breast Cancer.

AIM

To review practice patterns of post-mastectomy radiation therapy (PMRT) in DCIS, identify risk factors for recurrence and select suitable candidates for PMRT.

METHODS

A questionnaire concerning DCIS management, focusing on PMRT, was distributed online via SurveyMonkey.

RESULTS

142 responses were received from 15 countries. The majority worked in academic institutions, had 5-20 years work-experience and irradiated <5 DCIS patients/year. PMRT was more given if: surgical margins <1 mm, high-grade, multicentricity, young age, tumour size >5 cm, skin- or nipple- sparing mastectomy. Moderate hypofractionation was the most common schedule, except after immediate breast reconstruction (57% conventional fractionation).

CONCLUSIONS

The present survey highlighted risk factors for PMRT administration, which should be further evaluated.

Digestate treatment with algae-bacteria consortia: A field pilot-scale experimentation in a sub-optimal climate area

This paper addresses the efficiency of a microalgae-based agricultural digestate treatment at pilot-scale in an outdoor raceway pond (880 L, pH-dependent CO₂ dosage) and in a bubble column (74.5 L, air-bubbling). Specifically, nitrogen removal, evolution of the algae-bacteria consortium, and the actual process applicability in the Po Valley climate are discussed. The performance of the two reactors varied seasonally. The average algal productivity in the raceway was 32.4 ± 33.1 mg TSS·L^-1·d^-1 (8.2 ± 8.5 g TSS·m^-2·d^-1) while in the PBR it was 25.6 ± 26.8 mg TSS·L^-1·d^-1; the average nitrogen removal was 20 ± 29% (maximum 78%) and 22 ± 29% (maximum 71%) in the raceway and in the column, respectively. Nevertheless, nitrification had a key role as 61 ± 24% and 52 ± 32% of the nitrogen load was oxidized in the raceway and in the column, respectively.

Activity assessment of microalgal-bacterial consortia based on respirometric tests

Respirometric techniques are useful tools to evaluate bacterial activities in activated sludge processes due to their fast execution and the possibility to obtain several kinetic parameters from a single test. Using such techniques in microalgae-bacteria consortia treating wastewater could allow a better understanding of mutual interactions between the microbial populations as a function of environmental parameters. This work aims at developing and testing a novel experimental respirometric protocol to determine oxygen uptake rates and oxygen production rates by a microalgae-bacteria consortium. The defined protocol is characterized by alternating light/dark regimes and by dosing substrates/inhibitors to selectively activate/inactivate microalgal and bacterial metabolisms. The protocol was then applied on microalgal and bacterial consortia, which were grown on the liquid fraction of black water from biogas plants fed on agricultural and municipal waste sludge. Results elucidate the presence and activity of microalgae and nitrifying bacteria in the tested systems, suggesting that the respirometric tests could be included into monitoring procedures of photobioreactors/algal ponds.

Antibiotic resistant bacteria in urban sewage: Role of full-scale wastewater treatment plants on environmental spreading

The presence of antibiotic resistant bacteria (ARB) in wastewater was investigated and the role of wastewater treatment plants (WWTPs) in promoting or limiting antibiotic resistance was assessed. Escherichia coli (E. coli) and total heterotrophic bacteria (THB) resistance to ampicillin, chloramphenicol and tetracycline was monitored in three WWTPs located in Milan urban area (Italy), differing among them for the operating parameters of biological process, for the disinfection processes (based on sodium hypochlorite, UV radiation, peracetic acid) and for the discharge limits to be met. Wastewater was collected from three sampling points along the treatment sequence (WWTP influent, effluent from sand filtration, WWTP effluent). Antibiotic resistance to ampicillin was observed both for E. coli and for THB. Ampicillin resistant bacteria in the WWTP influents were 20-47% of E. coli and 16-25% of THB counts. A limited resistance to chloramphenicol was observed only for E. coli, while neither for E. coli nor for THB tetracycline resistance was observed. The biological treatment and sand filtration led to a decrease in the maximum percentage of ampicillin-resistant bacteria (20-29% for E. coli, 11-21% for THB). However, the conventionally adopted parameters did not seem adequate to support an interpretation of WWTP role in ARB spread. Peracetic acid was effective in selectively acting on antibiotic resistant THB, unlike UV radiation and sodium hypochlorite. The low counts of E. coli in WWTP final effluents in case of agricultural reuse did not allow to compare the effect of the different disinfection processes on antibiotic resistance.

Identification of antibiotic-resistant Escherichia coli isolated from a municipal wastewater treatment plant

The emergence and diffusion of antibiotic-resistant bacteria has been a major public health problem for many years now. In this study, antibiotic-resistance of coliforms and Escherichia coli were investigated after their isolation from samples collected in a municipal wastewater treatment plant in the Milan area (Italy) along different points of the treatment sequence: inflow to biological treatment; outflow from biological treatment following rapid sand filtration; and outflow from peracetic acid disinfection. The presence of E. coli that showed resistance to ampicillin (AMP) and chloramphenicol (CAF), used as representative antibiotics for the efficacy against Gram-positive and Gram-negative bacteria, was evaluated. After determining E. coli survival using increasing AMP and CAF concentrations, specific single-resistant (AMP^R or CAF^R) and double-resistant (AMP^R/CAF^R) strains were identified among E. coli colonies, through amplification of the β-lactamase Tem-1 (bla) and acetyl-transferase catA1 (cat) gene sequences. While a limited number of CAF^R bacteria was observed, most AMP^R colonies showed the specific resistance genes to both antibiotics, which was mainly due to the presence of the bla gene sequence. The peracetic acid, used as disinfection agent, showed to be very effective in reducing bacteria at the negligible levels of less than 10 CFU/100 mL, compatible with those admitted for the irrigation use of treated waters.

Optimal flow for brown trout: Habitat - prey optimization

The correct definition of ecosystem needs is essential in order to guide policy and management strategies to optimize the increasing use of freshwater by human activities. Commonly, the assessment of the optimal or minimum flow rates needed to preserve ecosystem functionality has been done by habitat-based models that define a relationship between in-stream flow and habitat availability for various species of fish. We propose a new approach for the identification of optimal flows using the limiting factor approach and the evaluation of basic ecological relationships, considering the appropriate spatial scale for different organisms. We developed density-environment relationships for three different life stages of brown trout that show the limiting effects of hydromorphological variables at habitat scale. In our analyses, we found that the factors limiting the densities of trout were water velocity, substrate characteristics and refugia availability. For all the life stages, the selected models considered simultaneously two variables and implied that higher velocities provided a less suitable habitat, regardless of other physical characteristics and with different patterns. We used these relationships within habitat based models in order to select a range of flows that preserve most of the physical habitat for all the life stages. We also estimated the effect of varying discharge flows on macroinvertebrate biomass and used the obtained results to identify an optimal flow maximizing habitat and prey availability.

COD, nutrient removal and disinfection efficiency of a combined subsurface and surface flow constructed wetland: A case study

A constructed wetland system composed of a subsurface flow wetland, a surface flow wetland and a facultative pond was studied from July 2008 until May 2012. It was created to treat the domestic sewage produced by a hamlet of 150 inhabitants. Monthly physicochemical and microbiological analyses were carried out in order to evaluate the removal efficiency of each stage of the process and of the total treatment system. Pair-wise Student's t-tests showed that the mean removal of each considered parameter was significantly different (α = 0.05) between the various treatment phases. Two-way ANOVA and Tukey's HSD tests were used to find significant differences between wetland types and seasons in the removal efficiency of the considered water quality parameters. Significant differences in percent removal efficiency between the treatment phases were observed for total phosphorus, total nitrogen, ammonia nitrogen and organic load (expressed as Chemical Oxygen Demand). In general, the wastewater treatment was carried by the sub-superficial flow phase mainly, both in growing season and in quiescence season. Escherichia coli removal ranged from 98% in quiescence season to >99% in growing season (approximately 2-3 orders of magnitude). The inactivation of fecal bacteria was not influenced by the season, but only by the treatment phase.

Removal of enteric viruses and Escherichia coli from municipal treated effluent by zebra mussels

Dreissena polymorpha is a widespread filter-feeder species, resistant to a broad range of environmental conditions and different types of pollutants,which has recently colonized Italian freshwaters. Although widely used to monitor pollution in freshwater environments, this species is also an important food source for some fish and water birds. It can also be used to concentrate or remove particulate organic matter to interrupt avian-to-human transmission of pollutants and control health risks for animals and humans. In this study, the accumulation/inactivation in D. polymorpha of human health-related spiked enteric viruses was described. The removal of endogenous Escherichia coli, the classical indicator of fecal contamination,was tested as well.Our preliminary lab-scale results demonstrate that zebra mussels can reduce significantly poliovirus titer after 24 h and rotavirus titer after 8 h. E. coli counts were also reduced in the presence of zebra mussels by about 1.5 log after 4 h and nearly completely after 24 h. The fate of the two enteric viruses after concentration by zebra mussels was also investigated after mechanical disruption of the tissues. To our knowledge, the accumulation from water and inactivation of human health-related enteric viruses by zebra mussels has never been reported.

Nutritional counselling and oral nutritional supplements in head and neck cancer patients undergoing chemoradiotherapy

BACKGROUND

The role of nutritional counselling (NC) with or without oral nutritional supplements (ONS) in patients receiving chemoradiotherapy (CRT) for head and neck cancer (HNC) still remains to be clearly defined, particularly with regard to CRT-related toxicity.

METHODS

Patients undergoing CRT for HNC received NC by the dietitian within the first 4 days of radiotherapy and weekly for the course of radiotherapy (approximately 6 weeks). A weekly supply of oral nutrition supplements [1560 kJ (373 kcal) per 100 g] for up to 3 months was provided to all patients.

RESULTS

Twenty-one patients completed CRT. Mucositis G3 developed in seven (33.3%) patients, whereas mucositis G4 was absent. Dysphagia was present before the start of treatment in four patients. In the remaining 17 patients, dysphagia G3 developed during/at the end of treatment in five cases. The percentage of patients interrupting anti-neoplastic treatment for was 28% for ≥6 days, 28% for 3-5 days and 44% for 0-2 days. Mucositis G3 frequency was lower in patients with a baseline body mass index (BMI, kg m(-2) ) ≥25 (two out of 12; 16.6%) than in patients with BMI <25 (five out of nine; 55.5%) (P = 0.161) and in patients with a baseline mid arm circumference >30 cm than in those with a mid arm circumference in the range 28.1-30 cm and <28 cm, and higher in patients with a greater weight loss and a greater reduction of serum albumin and mid arm circumference.

CONCLUSIONS

Nutritional counselling and ONS are associated with relatively low CRT-related toxicity and with mild deterioration of nutritional parameters.

[Steroids, interferon-alpha and ribavirin treatment of cryoglobulinemic glomerulonephritis concurrent with HCV infection]

The treatment of mixed cryoglobulinemia concurrent with HCV infection is still under debate. We report the case of a patient referred to our unit for a membranoproliferative glomerulonephritis associated with HCV infection. A nephrotic syndrome and a slight reduction of glomerular filtration rate were present. We treated him with alpha-interferon for six months and prednisone for two months. We achieved a remission of the nephrotic syndrome without any significant reduction of the viral load. One year after the therapy had been suspended, the nephrotic syndrome relapsed and subsequently responded to a combined treatment with interferon ribavirin and prednisone. HCV-RNA became suddenly and persistently negative.