Progress and challenges in valorisation of biomass waste from ornamental trees pruning through pyrolysis processes. Prospects in the bioenergy sector

Nowadays, the scarcity of energy resources is promoting the search for alternative energy sources, boosting interest in the use of forest lignocellulosic residue in the energy sector. In this study, the focus is on the energy recovery from two lignocellulosic residues originated during the pruning of ornamental trees (Horse Chestnut, CI, and False Acacia, FA). Both conventional and flash pyrolysis techniques were applied. The experimental pyrolysis variables were obtained from the study of the thermal behaviour of the pruning residues in thermogravimetric analysis. It was carried out under 5 heating rates and kinetic parameters were estimated using Flynn-Wall-Ozawa method. Results denoted higher maximum mass loss rate values for the same release temperature regions under FA experiments. Also, FA samples had lower final residues for the processes. However, activation energy values were so close for both species. FA was also linked to the faster reactions according frequency factor outcomes. Conventional pyrolysis of pruning residues was carried out in a horizontal oven of original design at a heating rate of 25 °C/min, at 750 °C and 60 min of permanence at that temperature; flash pyrolysis was tested in that oven at 750 and 850 °C. In these pyrolysis processes, three fractions were obtained: bio-char, bio-oil and gas. The physicochemical attributes of the bio-chars suggested their potential utility as biofuels (28.4-29.8 MJ/kg), adsorbent precursors or soil additives. Conventional pyrolysis bio-oils had a dominant monoaromatic hydrocarbons nature, with phenols being the most abundant (≥60%), while flash bio-oils contain mainly polycyclic aromatic hydrocarbons. Conventional pyrolysis gases contained up to 60 vol% of CO2; flash pyrolysis gases had high combustible gas content (CO, CH4, H2) and a low CO2 content (<25 vol%). As a result, their calorific value (18.06 MJ/kg) exhibited a threefold increase compared to the gas produced through conventional pyrolysis (6.04 MJ/kg).

Intermediate-Term Clinical Outcomes of High-Density Autologous Chondrocyte Implantation in Patients with Concomitant Anterior Cruciate Ligament Reconstruction and Focal Chondral Lesions

OBJECTIVE

To investigate intermediate-term clinical results in patients with concomitant anterior cruciate ligament (ACL) reconstruction and chondral defect treated with high-density autologous chondrocyte implantation (HD-ACI) compared to patients without ACL tear but with a chondral lesion and HD-ACI treatment.

DESIGN

Forty-eight patients with focal chondral lesions underwent HD-ACI (24 with ACL reconstruction after an ACL injury and 24 with an intact ACL). Follow-up assessments occurred at 6, 12, and 24 months. Patient-reported knee function and symptoms were assessed using the International Knee Documentation Committee (IKDC) questionnaire, pain was measured using the Visual Analog Scale (VAS), and adverse events were monitored. Physical activity was assessed using the Tegner Activity Level Scale, and cartilage healing was evaluated with the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score.

RESULTS

No significant adverse events occurred during follow-up. Both groups showed significant improvements at 2 years compared to baseline (VAS: 8.0 ± 1.3 to 1.4 ± 2.0 [normal ACL]; 7.4 ± 2.3 to 2.1 ± 2.3 [ACL reconstruction]; IKDC: 39.2 ± 10.6 to 76.1 ± 22.0 [intact ACL]; 35.6 ± 12.1 to 74.6 ± 20.9 [ACL reconstruction]). Patients in both groups exceeded the minimal clinically important difference (MCID) for IKDC scores. The Tegner Activity Level Scale decreased immediately after surgery and increased after 2 years, with 70.6% (normal ACL) and 89.5% (ACL reconstruction) returning to their preinjury activity levels. No significant differences in the MOCART score were observed between the groups.

CONCLUSIONS

ACL reconstruction does not appear to reduce the outcomes (at 2 years) of HD-ACI.

Food industrial biowaste-based magnetic activated carbons as sustainable adsorbents for anthropogenic mercury emissions

Bio-derived magnetic activated carbons from industrial chestnut shell waste have been obtained through a novel, optimized and sustainable methodology where impregnation, pyrolysis, acid washing or other intermediate steps commonly used in the activation process were eliminated saving time, energy and costs. The resulting materials (MACs) were obtained at 220-800 °C showed interesting properties: textural (SBET up to 568 m² g-1) and magnetic (different iron species developed), depending on the activation temperature employed. Data showed outstanding results when MACs were tested for Hg removal in pollution emissions at 150 °C in lab-scale device. In MACs obtained at 500-600 °C, where the highest concentration of magnetite was found, the best Hg adsorption capacity was achieved, while it decreased when metallic iron or iron carbides were present (MACs obtained at 800 °C). Moreover, the difference of Hg0 removal/adsorption in N2+O2 and Simulated Flue Gas atmosphere between MACs obtained at 500 and 600 °C pointed out the influence on Hg removal of additional parameters, as surface chemistry and the existence of sulfur or chloride. The determination of Hg species in post-retention solids confirmed the mercury oxidation by high-valence iron ions (Fe3+) and the involvement of physisorption and chemisorption processes for the gas-solid interaction mechanism.

Complement C5a induces the formation of neutrophil extracellular traps by myeloid-derived suppressor cells to promote metastasis

Myeloid-derived suppressor cells (MDSCs) play a major role in cancer progression. In this study, we investigated the mechanisms by which complement C5a increases the capacity of polymorphonuclear MDSCs (PMN-MDSCs) to promote tumor growth and metastatic spread. Stimulation of PMN-MDSCs with C5a favored the invasion of cancer cells via a process dependent on the formation of neutrophil extracellular traps (NETs). NETosis was dependent on the production of high mobility group box 1 (HMGB1) by cancer cells. Moreover, C5a induced the surface expression of the HMGB1 receptors TLR4 and RAGE in PMN-MDSCs. In a mouse lung metastasis model, inhibition of C5a, C5a receptor-1 (C5aR1) or NETosis reduced the number of circulating-tumor cells (CTCs) and the metastatic burden. In support of the translational relevance of these findings, C5a was able to stimulate migration and NETosis in PMN-MDSCs obtained from lung cancer patients. Furthermore, myeloperoxidase (MPO)-DNA complexes, as markers of NETosis, were elevated in lung cancer patients and significantly correlated with C5a levels. In conclusion, C5a induces the formation of NETs from PMN-MDSCs in the presence of cancer cells, which may facilitate cancer cell dissemination and metastasis.

P1188Oral antibiotic treatment for local cardiac implantable electronic device infections: our 6-year experience

INTRODUCTION

Cardiac implantable electronic device (CIED) infection is a severe disease with an increasing incidence due to the rise in the number of CIEDs implanted world-wide. Complete hardware removal is the treatment of choice, but there is little clinical data about the best antimicrobial strategy, such as the best choice of antibiotics, treatment duration and when to switch to oral administration in cases of local CIED infections.

PURPOSE

  In 2013, we designed a new protocol for CIED infection management, by which local infections were treated with complete hardware removal followed by empiric parenteral antibiotic during the first 72h, which was replaced to an oral agent (in case of negative blood cultures) and continued for 10 days. The oral antibiotic was selected according to the local cultures when positive, or to Clindamicin, Levofloxacin or Cotrimoxazole when no germ was identified. Our purpose is to describe our experience and results after the implementation of this strategy.

METHODS

We retrospectively reviewed all consecutive local CIED infection cases from the implementation of the protocol until September 2019, and evaluated the population characteristics, type of infection, rate of positive cultures and outcomes.

RESULTS

We identified 74 cases of CIED infection, of which 46 (62%) were local. The average age of this population was 75.3 ± 13.2 yo and 65% (30) were male. The predominant comorbidities were diabetes (41%), congestive heart failure (30%), and malignancies (22%). Eighteen patients (39%) had previous local infection treated medically without hardware removal. Mean number of previous procedures was 2.65 ± 1.8, and 34 (74%) of the devices were pacemakers (single and dual chamber), 5 (11%) ICDs, 6 (13%)CRT-P and 1 (2%) CRT-D. Blood cultures were negative in all cases, whereas local cultures (exudate or intraoperative tissue) were positive in 32 (70%). The most frequent microorganisms were Staphylococcus epidermidis in 18 (56%) and Staphylococcus aureus in 8 (25%), including 1 case of meticillin-resistance.  Intravenous Vancomycin was administered in all cases during 72 h, followed by oral antibiotics for a mean duration of 8.8 ± 3.3 days. Hardware removal was intended in all cases, with complete or clinical success in 42 and 3 cases respectively (global success rate 97.8%), and in one case (2.2%) an epicardial lead was not removed. During a mean follow-up of 30 months, 1 infection-related death occurred (2%) due to a side effect of intravenous antibiotic therapy, and there was 1 infection relapse (2%) in the only patient without complete hardware removal, related to the remnant epicardial lead.

CONCLUSIONS

Oral antimicrobial treatment with good bioavailability agents, associated with complete hardware removal is an effective strategy for the management of local CIED infections, with a low recurrence rate, and avoiding long hospitalizations and potential side effects of intravenous antibiotic therapy.

Detection of Approximal Caries Lesions in Adults: A Cross-sectional Study

Detection and management of posterior approximal caries lesions are still problematic. Inspection of approximal surfaces is challenging, and bitewing radiographs are used when direct vision is not possible. Unfortunately, there is no definite radiographic appearance to identify lesion cavitation with absolute certainty. Many lesions detected radiographically within the outer half of dentin are not cavitated, often resulting in unnecessary restorative treatment. Our study compared radiographic depth of approximal caries lesions with presence of cavitation in adults using visual inspection following temporary tooth separation (TTS). We conducted this observational descriptive cross-sectional study at two dental schools in two cities in Chile. Clinicians were unaware of radiographic depths of lesions and examined 147 participants (57.3% female and 42.7% male) following TTS. Using the common classification system that consists of E0 (no lesion), E1 (lesion within the outer half of enamel), E2 (lesion within the inner half of enamel), D1 (lesion within the outer third of dentin), D2 (lesion within the middle third of dentin), and D3 (lesion within the inner third of dentin), a trained dentist evaluated all the processed films. Cavitation was detected in only three sites (0.22%) within the E0 category, seven sites (3.41%) in E1, five sites (14.8%) in E2, four sites (14.8%) in D1, six sites (50%) in D2, and eight sites (61.5%) in D3. Considering that restorative treatment should be indicated strictly for cavitated lesions, our findings support indication for restorative treatment for D3 lesions and the rationale for TTS for D1-D2 caries lesions to allow direct visual inspection to determine whether there is surface cavitation.

Sewage biogas efficient purification by means of lignocellulosic waste-based activated carbons

The present paper evaluates the efficiency of sustainable activated carbons obtained from the valorization of lignocellulosic waste in removing siloxanes and volatile organic compounds for the purification of anaerobic digester biogas. Pyrolized and non-pyrolized lignocellulosic residues generated in food and wood industries were used as precursor materials to obtain experimental adsorbents by a chemical activation process using several activating agents. The highest porosity was obtained by non-pyrolized residue activated by K₂CO₃ at 900 °C. The performance of the experimental materials was compared with that of commercial activated carbons in gas adsorption tests of siloxanes (octamethylcyclotetrasiloxane and hexamethyldisiloxane) and volatile organic compounds (toluene and limonene). The waste-based activated carbons developed in this work proved to be more efficient for the removal of both siloxanes and VOCs than the commercial samples in most of the conditions tested. Adsorption capacities correlated with porosity, while the more relevant pore size depends on the adsorbate.

Hydrochars from industrial macroalgae "Gelidium Sesquipedale" biomass wastes

Macroalgae wastes from the Agar-Agar industry were used as a feedstock to obtain hydrochars by means of hydrothermal carbonization. The effect of temperature (200 °C and 230 °C) and time (2 h and 6 h) on the yield, higher heating value (HHV) and chemical-morphological-textural properties of the hydrochars was studied. The carbon content and the higher heating value were observed to increase with the hydrothermal carbonization. The hydrochars yields (up to 60%) were much higher than yields obtained using conventional char (27.5-33.5%). The hydrochar obtained at 230 °C and after 6 h showed a HHV of 23.25 MJ/kg, which is similar to that of lignite HHV. The H/C and O/C atomic ratios decreased as a consequence of the dehydration and decarboxilation reactions. Hydrothermal carbonization barely changed the vegetal structure of the macroalgae waste. The hydrochars were found to be essentially meso-macroporous with average pore sizes of up to 110.5 nm.

IgE-Api m 4 Is Useful for Identifying a Particular Phenotype of Bee Venom Allergy

BACKGROUND AND OBJECTIVE

Different clinical behaviors have been identified in patients allergic to bee venom. Compound-resolved diagnosis could be an appropriate tool for investigating these differences. The aims of this study were to analyze whether specific IgE to Api m 4 (sIgE-Api m 4) can identify a particular kind of bee venom allergy and to describe response to bee venom immunotherapy (bVIT).

METHODS

Prospective study of 31 patients allergic to bee venom who were assigned to phenotype group A (sIgE-Api m 4 <0.98 kU/L), treated with native aqueous (NA) extract, or phenotype group B (sIgE-Api m 4 ≥0.98 kU/L), treated with purified aqueous (PA) extract. Sex, age, cardiovascular risk, severity of preceding sting reaction, exposure to beekeeping, and immunological data (intradermal test, sIgE/sIgG4-Apis-nApi m 1, and sIgE-rApi m 2-Api m 4 were analyzed. Systemic reactions (SRs) during bVIT build-up were analyzed. Immunological and sting challenge outcomes were evaluated in each group after 1 and 2 years of bVIT.

RESULTS

Phenotype B patients had more severe reactions (P=.049) and higher skin sensitivity (P=.011), baseline sIgE-Apis (P=.0004), sIgE-nApi m 1 (P=.0004), and sIgG4-Apis (P=.027) than phenotype A patients. Furthermore, 41% of patients in group B experienced SRs during the build-up phase with NA; the sting challenge success rate in this group was 82%. There were no significant reductions in serial intradermal test results, but an intense reduction in sIgE-nApi m 1 (P=.013) and sIgE-Api m 4 (P=.004) was observed after the first year of bVIT.

CONCLUSION

Use of IgE-Api m 4 as the only discrimination criterion demonstrated differences in bee venom allergy. Further investigation with larger populations is necessary.

Probiotic Compared with Standard Milk for High-caries Children

The aim of this study was to compare milk supplemented with probiotic lactobacilli with standard milk for the increment of caries in preschool children after 10 mo of intervention. The study was a triple-blind, placebo-controlled randomized trial. Participants were children aged 2 and 3 y ( n = 261) attending 16 nursery schools in a metropolitan region in Chile. Nursery schools were randomly assigned to 2 parallel groups: children in the intervention group were given 150 mL of milk supplemented with Lactobacillus rhamnosus SP1 (107 CFU/mL), while children in the control group were given standard milk. Interventions took place on weekdays for 10 mo. Data were collected through a clinical examination of participants. The primary outcome measure was the increment of caries in preschool children. This was assessed using the International Caries Detection and Assessment System (ICDAS). The dropout rate was 21%. No differences in caries prevalence were detected between the groups at baseline ( P = 0.68). After 10 mo of probiotic intake, the caries prevalence was 54.4% in the probiotic group and 65.8% in the control group. The percentage of new individuals who developed cavitated lesions (ICDAS 5-6) in the control group (24.3%) was significantly higher than that in the probiotic group (9.7%). The increment of dental caries showed an odds ratio of 0.35 ( P < 0.05) in favor of the probiotic group. At the cavitated lesion level, the increment of new caries lesions within the groups showed 1.13 new lesions per child in the probiotic group compared with 1.75 lesions in the control group ( P < 0.05). The probiotic group showed an increment of 0.58 ± 1.17 new lesions compared with 1.08 ± 1.70 new lesions observed in the control group. The difference in caries increment was significant at the cavitated lesion level ( P < 0.01). In conclusion, the regular long-term intake of probiotic-supplemented milk may reduce caries development in high-caries preschool children (ClinicalTrials.gov: NCT01648075).

Impact of oxy-fuel combustion gases on mercury retention in activated carbons from a macroalgae waste: effect of water

The aim of this study is to understand the different sorption behaviors of mercury species on activated carbons in the oxy-fuel combustion of coal and the effect of high quantities of water vapor on the retention process. The work evaluates the interactions between the mercury species and a series of activated carbons prepared from a macroalgae waste (algae meal) from the agar-agar industry in oxy-combustion atmospheres, focussing on the role that the high concentration of water in the flue gases plays in mercury retention. Two novel aspects are considered in this work (i) the impact of oxy-combustion gases on the retention of mercury by activated carbons and (ii) the performance of activated carbons prepared from biomass algae wastes for this application. The results obtained at laboratory scale indicate that the effect of the chemical and textural characteristics of the activated carbons on mercury capture is not as important as that of reactive gases, such as the SOx and water vapor present in the flue gas. Mercury retention was found to be much lower in the oxy-combustion atmosphere than in the O2+N2 (12.6% O2) atmosphere. However, the oxidation of elemental mercury (Hg0) to form oxidized mercury (Hg2+) amounted to 60%, resulting in an enhancement of mercury retention in the flue gas desulfurization units and a reduction in the amalgamation of Hg0 in the CO2 compression unit. This result is of considerable importance for the development of technologies based on activated carbon sorbents for mercury control in oxy-combustion processes.

Possible interaction between letrozole and long-acting injectable zuclopenthixol

Mrs A, a 68-year-old woman with paranoid schizophrenia, was on long-term psychiatric treatment with long-acting intramuscular zuclopenthixol, quetiapine and alprazolam when, in April 2012, she was diagnosed with right breast infiltrating ductal carcinoma. After starting treatment with letrozole on 4 July, Mrs A progressively developed extrapyramidal symptoms and these were particularly evident after each zuclopenthixol administration. On 9 January, both quetiapine and alprazolam were stopped due to excessive lethargy. After the administration of the last dose of zuclopenthixol on 26 January, she presented with sedation, sialorrhea, festinant gait, axial dystonia and dysphagia, all of which were severe. The introduction of letrozole was the only change that had been made to her pharmacotherapeutic regimen in that period. The rest of the findings on neurological examination were normal. Renal function was adequate. Slow symptom onset and progressive worsening until full-blown clinical presentation after 6 months, and the dramatic improvement in the clinical picture achieved 2 days after treatment with biperiden, suggests a long-term insidious interaction leading to zuclopenthixol accumulation. To the best of our knowledge, this is the first report of a possible interaction between letrozole and zuclopenthixol. We consider that it warrants further investigation. In the meanwhile, physicians should be aware of the occurrence of this potentially serious drug-drug interaction.

Longitudinal Validation of the Spanish Version of the Health-Related Quality of Life Questionnaire for Hymenoptera Venom Allergy (HRQLHA)

BACKGROUND AND OBJECTIVE

The Spanish version of the health-related quality of life questionnaire for allergy to hymenoptera venom (HRQLHA) has been shown to be reliable, internally consistent, and externally valid. The aim of this study was to complete the validation of the HRQLHA by analyzing its sensitivity to changes (longitudinal validity) using the sting challenge test (SCT) as the variable of change.

PATIENTS AND METHODS

Patients over the age of 17 years with a systemic allergic reaction to Apis, Vespula, or Polistes venom were included during their first year of venom-specific immunotherapy. Patients were assigned to either a group that underwent the SCT or a control group that did not. All patients completed the HRQLHA at baseline and after a period of 2 to 4 months, during which time the SCT was performed in the active group, with no intervention in the control group.

RESULTS

Fifty patients were included in the study: 25 in the SCT group and 25 in the control group. The patients in the SCT group showed a significant improvement in mean HRQLHA score (+0.35, P=.03) after the SCT, while those in the control group showed no significant changes in questionnaire scores.

CONCLUSIONS

Our results demonstrate the sensitivity of the HRQLHA to changes and thus complete the longitudinal validation of the questionnaire. A well-tolerated SCT improves the quality of life of venom-allergic patients as it reduces anxiety associated with the fear of being stung.

Citrus essential oils and their influence on the anaerobic digestion process: an overview

Citrus waste accounts for more than half of the whole fruit when processed for juice extraction. Among valorisation possibilities, anaerobic digestion for methane generation appears to be the most technically feasible and environmentally friendly alternative. However, citrus essential oils can inhibit this biological process. In this paper, the characteristics of citrus essential oils, as well as the mechanisms of their antimicrobial effects and potential adaptation mechanisms are reviewed. Previous studies of anaerobic digestion of citrus waste under different conditions are presented; however, some controversy exists regarding the limiting dosage of limonene for a stable process (24-192 mg of citrus essential oil per liter of digester and day). Successful strategies to avoid process inhibition by citrus essential oils are based either on recovery or removal of the limonene, by extraction or fungal pre-treatment respectively.

Investigating an outbreak of Clostridium perfringens gastroenteritis in a school using smartphone technology, London, March 2013

Binary file ES_Abstracts_Final_ECDC.txt matches

Acute adverse reactions to iopromide vs iomeprol: a retrospective analysis of spontaneous reporting from a radiology department

OBJECTIVE

To compare the safety of iopromide and iomeprol use in a hospital that switched from the former to the latter and found an apparent increase in the number (and a different profile) of adverse reactions reported for iomeprol, putting the safety of its use into question.

METHODS

This was a retrospective study of cases of acute reactions to iopromide and iomeprol reported in two successive time periods. Data from examinations using iopromide (62539 CT scans and 10348 urography scans) and iomeprol (34308 CT scans and 2846 urography scans) were obtained from the computer system of the hospital.

RESULTS

For each period, 154 cases of reactions were reported for iopromide and 86 for iomeprol, being severe in 10 (6.5%) patients for iopromide vs 17 (19.8%) patients for iomeprol; a statistically significant difference of p<0.003 was recorded. The most frequent adverse reactions (%/%) for iopromide/iomeprol were urticaria (29.1/17.2), pruritus (22.6/15.6), upper respiratory tract signs and symptoms (12.1/16.7), oedema (4.3/0), erythemas (3.4/5.0), nausea or vomiting (1.2/11.7) and chest pain (0/3.9) (p<0.0001 for the global comparison). The distribution of the reactions (%/%) by System Organ Class for iopromide/iomeprol was skin (56.7/41.1), respiratory (19.2/26.7), vascular (6.8/2.2), general (5.3/7.2), gastrointestinal (4.6/15.0) and others (7.4/7.9) (p<0.0002 for the global comparison).

CONCLUSION

Adverse reactions were more severe for iomeprol. Skin and vascular reactions with no chest pain were more frequent for iopromide, whereas gastrointestinal reactions were more frequent for iomeprol.

ADVANCES IN KNOWLEDGE

Comparative studies of media contrast safety are scarce and summary information on product characteristics is insufficient. This study showed the differences in severity and profile of adverse reactions between iopromide and iomeprol.

Conventional and microwave pyrolysis of a macroalgae waste from the Agar-Agar industry. Prospects for bio-fuel production

A comparative study of the pyrolysis of a macroalgae industrial solid waste (algae meal) in an electrical conventional furnace and in a microwave furnace has been carried out. It was found that the chars obtained from both pyrolyses are similar and show good properties for performing as a solid bio-fuel and as a precursor of activated carbon. Bio-oils from conventional pyrolysis have a greater number of phenolic, pyrrole and alkane compounds whereas benzene and pyridine compounds are more predominant in microwave pyrolysis with a major presence of light compounds. The bio-gas fraction from microwave pyrolysis presents a much higher syngas content (H2+CO), and a lower CO2 and CH4 proportion than that obtained by conventional pyrolysis. Yields are similar for both treatments with a slightly higher gas yield in the case of microwave pyrolysis due to the fact that microwave heating favors heterogeneous reactions between the gases and the char.

Anaerobic co-digestion of cattle manure with rice straw: economic & energy feasibility

Rice straw (RS) is one of the most abundant wastes generated in Valencia (Spain). Traditional waste disposal methods are harmful to the environment. The straw burning emits large amounts of toxic air pollutants and the straw burying produces uncontrolled anaerobic fermentation in the soil. The aim of this research was to evaluate the feasibility of cow manure anaerobic co-digestion with RS in a semi-continuous plug flow pilot-scale reactor. Three different periods of co-digestion were carried out as the RS dose was increased. When the addition of RS was 1, 2 and 5% (on weight basis) the biogas productivity increased by 4, 28 and 54% respectively. Furthermore, economic and energy feasibility were analysed considering the logistics cost of the RS (baling, collection, crushing and transportation). Two different scenarios were analysed. In scenario 1, the anaerobic co-digestion process was considered that take place in a new biogas installation, and in scenario 2 the process was considered that take place in a biogas plant already in operation. In scenario 1, the cow manure co-digestion with 2% of RS in a biogas installation of 500 kW showed the best economic analysis (net present value of 13.23%). In scenario 2, the results showed that the maximum distance between the rice field and the biogas plant that produces a positive economic balance was less than 95 km (2% RS) and 74 km (5% RS). In the case of the addition of 1% RS the economic balance is negative. Energy balance is positive in the three mixtures analysed.

Selective serotonin reuptake inhibitors and gastrointestinal bleeding: a case-control study

Background

Selective serotonin reuptake inhibitors (SSRIs) have been associated with upper gastrointestinal (GI) bleeding. Given their worldwide use, even small risks account for a large number of cases. This study has been conducted with carefully collected information to further investigate the relationship between SSRIs and upper GI bleeding.

Methods

We conducted a case-control study in hospitals in Spain and in Italy. Cases were patients aged ≥18 years with a primary diagnosis of acute upper GI bleeding diagnosed by endoscopy; three controls were matched by sex, age, date of admission (within 3 months) and hospital among patients who were admitted for elective surgery for non-painful disorders. Exposures to SSRIs, other antidepressants and other drugs were defined as any use of these drugs in the 7 days before the day on which upper gastrointestinal bleeding started (index day).

Results

581 cases of upper GI bleeding and 1358 controls were considered eligible for the study; no differences in age or sex distribution were observed between cases and controls after matching. Overall, 4.0% of the cases and 3.3% of controls used an SSRI antidepressant in the week before the index day. No significant risk of upper GI bleeding was encountered for SSRI antidepressants (adjusted odds ratio, 1.06, 95% CI, 0.57–1.96) or for whichever other grouping of antidepressants.

Conclusions

The results of this case-control study showed no significant increase in upper GI bleeding with SSRIs and provide good evidence that the magnitude of any increase in risk is not greater than 2.

NLRP1 influences the systemic sclerosis phenotype: a new clue for the contribution of innate immunity in systemic sclerosis-related fibrosing alveolitis pathogenesis

BACKGROUND

Recent evidence has highlighted a potential role of interleukin 1β (IL-1β) in systemic sclerosis (SSc). NLRP1 provides a scaffold for the assembly of the inflammasome that promotes the processing and maturation of pro-IL-1β. In addition, NLRP1 variants were found to confer susceptibility to autoimmune disorders.

OBJECTIVE

/st> To study a possible association of the NLRP1 rs6502867, rs2670660 and rs8182352, rs12150220 and rs4790797 with SSc in the European Caucasian population.

METHODS

NLRP1 single nucleotide polymorphisms were genotyped in 3227 individuals comprising a discovery set (870 SSc patients and 962 controls) and a replication set including individuals from Germany (532 SSc patients and 324 controls) and Italy (527 SSc patients and 301 controls), all individuals being of European Caucasian origin.

RESULTS

Conditional analyses revealed a significant association for the NLRP1 rs8182352 variant with both anti-topoisomerase-positive and SSc-related fibrosing alveolitis (FA) subsets under an additive model: p=0.0042, OR 1.23 (95% CI 1.07 to 1.41) and p=0.0065 OR 1.19 (95% CI 1.05 to 1.36), respectively. Logistic regression analysis showed an additive effect of IRF5 rs2004640, STAT4 rs7574865 and NLRP1 rs8182352 risk alleles on SSc-related FA.

CONCLUSIONS

Our results establish NLRP1 as a new genetic susceptibility factor for SSc-related pulmonary fibrosis and anti-topoisomerase-positive SSc phenotypes. This provides new insights into the pathogenesis of SSc, underlining the potential role of innate immunity in particular in the FA-positive SSc subphenotype, which represents a severe subset of the disease.

The initial rise method extended to multiple trapping levels in thermoluminescent materials

The well known Initial Rise Method (IR) is commonly used to determine the activation energy when only one glow peak is presented and analysed in the phosphor materials. However, when the glow peak is more complex, a wide peak and some holders appear in the structure. The application of the Initial Rise Method is not valid because multiple trapping levels are considered and then the thermoluminescent analysis becomes difficult to perform. This paper shows the case of a complex glow curve structure as an example and shows that the calculation is also possible using the IR method. The aim of the paper is to extend the well known Initial Rise Method (IR) to the case of multiple trapping levels. The IR method is applied to minerals extracted from Nopal cactus and Oregano spices because the thermoluminescent glow curve's shape suggests a trap distribution instead of a single trapping level.

Association of the TNFAIP3 rs5029939 variant with systemic sclerosis in the European Caucasian population

BACKGROUND

TNFAIP3 encodes the ubiquitin-modifying enzyme, a key regulator of inflammatory signalling pathways. Convincing associations between TNFAIP3 variants and autoimmune diseases have been reported.

OBJECTIVE

To investigate the association of TNFAIP3 polymorphisms with systemic sclerosis (SSc).

METHODS

Three single nucleotide polymorphisms (SNPs) in a set of 1018 patients with SSc and 1012 controls of French Caucasian origin were genotyped. Two intergenic SNPs, rs10499194 and rs6920220, and one located in TNFAIP3 intron 2, rs5029939, were selected. The TNFAIP3 rs5029939 found to be associated with SSc in this first set was then genotyped in a second set of 465 patients with SSc and 182 controls from Germany and 184 patients with SSc and 124 controls from Italy. Pooled odd ratios were calculated by Mantel-Haenszel meta-analysis.

RESULTS

The rs5029939 G allele was found to be significantly associated with SSc susceptibility (pooled OR=2.08 (95% CI 1.59 to 2.72); p=1.16×10⁻⁷), whereas the rs10499194 and rs6920220 variants displayed no association. Only one of the predicted haplotypes investigated in the French sample was significantly associated with SSc (p=8.91×10⁻⁸), and this haplotype was discriminating only in the presence of the rs5029939 risk allele, suggesting that this SNP tags the association signal. The strongest associations of rs5029939 with subphenotypes, having large magnitudes for complex genetic disorders, were observed for diffuse cutaneous SSc (pooled OR=2.71 (1.94 to 3.79), p=5.2×10⁻⁹), fibrosing alveolitis (pooled OR=2.26 (1.61 to 3.17), p=2.5×10⁻⁶) and pulmonary arterial hypertension (pooled OR=3.11 (1.86 to 5.17), p=1.3×10⁻⁵).

CONCLUSION

These results suggest that TNFAIP3 is a genetic susceptibility factor for SSc.

Progression of a solitary, malignant cutaneous plasma-cell tumour to multiple myeloma in a cat

An 11-year-old male domestic shorthair cat was examined because of a soft-tissue mass on the left tarsus previously diagnosed as a malignant extramedullary plasmacytoma. Findings of further diagnostic tests carried out to evaluate the patient for multiple myeloma were negative. Five months later, the cat developed clinical evidence of multiple myeloma based on positive Bence Jones proteinuria, monoclonal gammopathy and circulating atypical plasma cells. This case represents an unusual presentation for this disease and documents progression of an extramedullary plasmacytoma to multiple myeloma in the cat.

Prevalence of CYP2C9 polymorphisms in the south of Europe

CYP2C9 is a major liver enzyme responsible of the metabolism of many clinically important drugs. The presence of CYP2C9 genetic polymorphisms has been associated with marked interindividual variability in its catalytic activity that could result in drug toxicity. Here we present frequencies of the most common CYP2C9 coding variants CYP2C9*2 (C430T) and CYP2C9*3 (A1075C) in representative samples of four regions from Spain (Basque Country, n=358; Catalonia, n=240; Central Spain, n=190 and Galicia, n=288) and one northern Italian region, (Verona, n=164), which range between 0.125 and 0.165 in the case of CYP2C9*2 and between 0.071 and 0.085 for CYP2C9*3. No significant differences between CYP2C9 allele frequencies were found comparing all the sampled populations. A more extensive comparative analysis using allele frequency data of populations widely spread over Europe was performed, showing significant differences in the CYP2C9*2 allele frequencies distribution between some of the regions, being quite homogeneous in the case of CYP2C9*3 variant. The results obtained show that above 40% of our samples carry a mutate allele, which can result in a poor metabolization of low therapeutic index drugs as oral anticoagulants (warfarin, acenocoumarol), oral antidiabetic drugs and some non-steroidal anti-inflammatory drugs. Our study constitutes both a large (n=1240) and robust allele frequency database on CYP2C9 polymorphisms, which represents one of the most numerous CYP2C9*2 and *3 database existing to date.

Angiogenesis in systemic sclerosis: impaired expression of vascular endothelial growth factor receptor 1 in endothelial progenitor-derived cells under hypoxic conditions

OBJECTIVE

To assess angiogenesis and explore the expression and regulation of vascular endothelial growth factor (VEGF), VEGF receptor 1 (VEGFR-1), and VEGFR-2, the leading mediators of angiogenesis, in SSc patients and controls.

METHODS

Late-outgrowth endothelial progenitor cells (EPCs), isolated from the peripheral blood of systemic sclerosis (SSc) patients and controls, and human umbilical vein endothelial cells (HUVECs) were assessed under normal and hypoxic conditions. Genomic background was evaluated in a large case-control study (including 659 patients with SSc and 511 controls) using tag single-nucleotide polymorphisms on VEGFR1 and VEGFR2 genes.

RESULTS

EPCs from SSc patients had the phenotype of genuine endothelial cells and displayed in vitro angiogenic properties similar to those of HUVECs and control EPCs under basal conditions, as determined by flow cytometry, tube formation, and migration assay. However, after 6 hours of hypoxic exposure, EPCs from SSc patients exhibited lower induced expression of VEGFR-1 at the messenger RNA and protein levels, but similar VEGF and VEGFR-2 expression, compared with HUVECs or EPCs from healthy controls. There was no evidence of defective expression of hypoxia-inducible factor 1alpha. These results were supported by the lower serum levels of soluble VEGFR-1 found in SSc patients (n = 187) compared with healthy controls (n = 48) (mean +/- SD 163.7 +/- 98.5 versus 210.4 +/- 109.5 pg/ml; P = 0.0042). These abnormalities did not seem to be related to genomic background.

CONCLUSION

Our findings shed new light on the possible role of VEGFR-1 in the main vascular disturbances that occur in SSc and lead to more severe disease.

Factors predicting hospital readmissions related to adverse drug reactions

OBJECTIVE

To analyse the contribution of adverse drug reactions (ADR) to hospital readmissions.

METHODS

This was a case-control study in which unscheduled admissions of patients who had been admitted to the hospital during the two previous months were assessed during a 21-month period. The patient was considered a case when the main diagnosis of readmission complied with the World Health Organisation's definition of an ADR. For each case, two controls were selected from those patients that had been admitted for ADR without readmission (n = 177). Information on drugs and other risk factors was obtained from cases by interview and from controls by clinical record review.

RESULTS

There were 26,559 unscheduled admissions of which 81 were readmissions associated with ADR (4.5% of the unscheduled readmissions). There were no statistically significant correlations with sex, age or medical history, with the exception of arterial hypertension. The main drug products causing readmission were acenocoumarol (15, 18.5%), antihypertensive-diuretics (14, 17.3%), anticancer drugs (11, 13.6%) and digoxin (seven, 8.6%). In the multivariate logistic analysis, the variables predicting readmission were acenocoumarol [odds ratio (OR) 12.2, 95% confidence interval (CI) 3.8-38.3, P < 0.0001], a record of diabetes mellitus (OR 2.6, 95% CI 1.3-5.5, P < 0.01), the number of drugs taken at the moment of ADR (OR 1.2, 95% CI 1.1-1.4, P < 0.001) and high blood pressure (OR 0.3, 95% CI 0.2-0.6, P < 0.001) even though the latter was a negative predictor, preventing readmission. Of the 81 readmissions associated with ADR, 28 (34.6%) were preventable.

CONCLUSION

A medical record of diabetes mellitus, polypharmacy and acenocoumarol treatment were risk factors predicting hospital readmission related to ADR.