Transforming pollution into solutions: A bibliometric analysis and sustainable strategies for reducing indoor microplastics while converting to value-added products

Microplastics (MPs), as emerging indoor contaminants, have garnered attention due to their ubiquity and unresolved implications for human health. These tiny particles have permeated indoor air and water, leading to inevitable human exposure. Preliminary evidence suggests MP exposure could be linked to respiratory, gastrointestinal, and potentially other health issues, yet the full scope of their effects remains unclear. To map the overall landscape of this research field, a bibliometric analysis based on research articles retrieved from the Web of Science database was conducted. The study synthesizes the current state of knowledge and spotlights the innovative mitigation strategies proposed to curb indoor MP pollution. These strategies involve minimizing the MP emission from source, advancements in filtration technology, aimed at reducing the MP exposure. Furthermore, this research sheds light on cutting-edge methods for converting MP waste into value-added products. These innovative approaches not only promise to alleviate environmental burdens but also contribute to a more sustainable and circular economy by transforming waste into resources such as biofuels, construction materials, and batteries. Despite these strides, this study acknowledges the ongoing challenges, including the need for more efficient removal technologies and a deeper understanding of MPs' health impacts. Looking forward, the study underscores the necessity for further research to fill these knowledge gaps, particularly in the areas of long-term health outcomes and the development of standardized, reliable methodologies for MP detection and quantification in indoor settings. This comprehensive approach paves the way for future exploration and the development of robust solutions to the complex issue of microplastic pollution.

Chinese family care partners of older adults in Canada have grit: A qualitative study

AIM

To explain the process taken by Chinese family care partners of older adults in the Greater Toronto Area, Canada, to access health and social services in their communities. The research question was: What mechanisms and structures impact the agency of Chinese family care partners of older adults, in the process of assisting them to access health and social services?

DESIGN

This qualitative study was informed by critical realism.

METHODS

Chinese family care partners of older adults in the Greater Toronto Area, Canada, were interviewed from August 2020 to June 2021. Transcripts underwent thematic analysis.

FINDINGS

Twenty-eight Chinese family care partners expressed a firm commitment to maintain caregiving conditions and to judiciously access health and social services. Their commitment was made up of three parts: (a) legislative and cultural norms of family, work, and society; (b) their perseverance to fill gaps with limited social and financial resources; (c) the quality of their relationship to, and illness trajectory of the older adults. The social structures created tension in how Chinese family care partners made decisions, negotiated resources, and ultimately monitored and coordinated timely access with older adults.

CONCLUSION

Participants' commitment and perseverance were conceptualized as "grit," central to their agency to conform to legislative and cultural norms. Moreover, findings support grit's power to motivate and sustain family caregiving, in order for older adults to age in place as long as possible with finite resources.

IMPLICATIONS FOR THE PROFESSION

This study highlights the importance of cultural awareness education for nurses, enabling continuity of care at a systems level and for a more resilient healthcare system.

IMPACT

Family care partners' grit may be crucial for nurses to harness when together, they face limited access to culturally appropriate health and social services in a system grounded in values of equity and inclusion, as in Canada.

REPORTING METHOD

When writing this manuscript, we adhered to relevant EQUATOR guidelines of the Consolidated Criteria for Reporting Qualitative Research (COREQ).

PATIENT OR PUBLIC INVOLVEMENT AND ENGAGEMENT

No patient or public involvement.

Uncovering environmental performance patterns of plastic packaging waste in high recovery rate countries: An example of EU-27

Plastic consumption and its end-of-life management pose a significant environmental footprint and are energy intensive. Waste-to-resources and prevention strategies have been promoted widely in Europe as countermeasures; however, their effectiveness remains uncertain. This study aims to uncover the environmental footprint patterns of the plastics value chain in the European Union Member States (EU-27) through exploratory data analysis with dimension reduction and grouping. Nine variables are assessed, ranging from socioeconomic and demographic to environmental impacts. Three clusters are formed according to the similarity of a range of characteristics (nine), with environmental impacts being identified as the primary influencing variable in determining the clusters. Most countries belong to Cluster 0, consisting of 17 countries in 2014 and 18 countries in 2019. They represent clusters with a relatively low global warming potential (GWP), with an average value of 2.64 t CO2eq/cap in 2014 and 4.01 t CO2eq/cap in 2019. Among all the assessed countries, Denmark showed a significant change when assessed within the traits of EU-27, categorised from Cluster 1 (high GWP) in 2014 to Cluster 0 (low GWP) in 2019. The analysis of plastic packaging waste statistics in 2019 (data released in 2022) shows that, despite an increase in the recovery rate within the EU-27, the GWP has not reduced, suggesting a rebound effect. The GWP tends to increase in correlation with the higher plastic waste amount. In contrast, other environmental impacts, like eutrophication, abiotic and acidification potential, are identified to be mitigated effectively via recovery, suppressing the adverse effects of an increase in plastic waste generation. The five-year interval data analysis identified distinct clusters within a set of patterns, categorising them based on their similarities. The categorisation and managerial insights serve as a foundation for devising a focused mitigation strategy.

Policy-driven municipal solid waste management assessment using relative quadrant eco-efficiency: A case study in Malaysia

Despite studies encouraging sustainable waste management, most municipal wastes remain in landfills, particularly in developing countries. Lack of holistic planning and national policy alignment might impair the waste management facility implementation. Policy-driven waste treatment scenarios should be designed to strongly link to the local conditions when assessing the eco-efficiency impacts of the waste management system. Taking Malaysia as a case study, a relative quadrant life cycle eco-efficiency indicator is developed to investigate the eco-efficiency of waste treatment scenarios. The relative quadrant life cycle eco-efficiency indicator depicts the eco-efficiency of various waste management scenarios. Compared with Scenario S1 - business-as-usual (i.e., 71.5% open landfill, 10% sanitary landfill, 1% composting, 17.5% recycling), five waste treatment scenarios (S2-S6) are designed based on Malaysia's existing and future policy targets. Scenario S5 (15.5% sanitary landfill, 22.25% composting, 22.25% anaerobic digestion, 40% recycling) and Scenario S6 (5% sanitary landfill, 22.25% composting, 22.25% anaerobic digestion, 40% recycling, 10.5% incineration) demonstrate that the 40% recycling rate is 32.9-33.6 times more environmentally favorable and 10-20% more economically viable than business-as-usual. Another four scenarios (NS1-NS4) are designed to investigate zero waste in landfills and the need to implement incineration or material recovery. Scenario NS3 suggests increasing incineration capacity to 33% could be an option should incineration is implemented. Adopting home or centralized windrow composting and increasing 2.5-5.5 times of current Feed-in Tariff rates are recommended to improve the eco-efficiency of the waste treatment scenarios. This study could facilitate policymakers to set waste minimization targets and incentives through various scenarios via sensitivity and comparative analyses.

Enhanced precipitation performance for treating high-phosphorus wastewater using novel magnetic seeds from coal fly ash

Magnetic coagulation is a promising approach for treating high phosphorous (high-P) wastewater by enhancing precipitation efficiency using magnetic particles. In this study, a cost-effective and environmentally friendly magnetic seed from coal fly ash (MS-CFA) was used as an alternative material for Fe₃O₄ magnetic seed (MS) coagulation. The potential effect of MS-CFA was explored to reduce the settling time and the dosage of coagulant aid of polyacrylamide (PAM) in treating high-phosphorous (high-P) simulated wastewater at 100 and 200 mg P/L. The physicochemical characteristics of MS-CFA were analysed through particle size distribution (20-100 μm), pore size distribution (14-30 nm), specific surface area (1.654 m²/g), X-ray diffraction (XRD), specific gravity (4.2), and magnetic induction intensity (49.8 emu/g). The characteristics met the requirements as magnetic coagulation material. MS-CFA was combined with polyaluminum chloride (PAC) and polyacrylamide (PAM) to improve phosphorous precipitation performance. The synergised magnetic coagulation effect using MS-CFA and PAM reduced the settling time of flocs to less than 1 min due to the high specific gravity. This represents a reduction of 90% of the settling time compared to the control using PAM alone (15 min) without MS-CFA. MS-CFA efficiently reduced PAM dosage by 83% and 87% for treating 100 and 200 mg P/L, respectively. The presence of PAM (1 mg/L for 100 mg P/L and 2 mg/L for 200 mg P/L) was imperative for binding the MS-CFA and flocs, hence increasing the particle size of the magnetic flocs. The characteristics of the magnetic flocs were analysed through microscopy, particle size distribution, zeta potential measurements, and magnetic induction intensity. The characteristics of the magnetic flocs confirmed that MS-CFA could be an alternative material for Fe₃O₄ as the magnetic seeds in the magnetic coagulation process for treating high-P wastewater.

Forecasting plastic waste generation and interventions for environmental hazard mitigation

Plastic waste and its environmental hazards have been attracting public attention as a global sustainability issue. This study builds a neural network model to forecast plastic waste generation of the EU-27 in 2030 and evaluates how the interventions could mitigate the adverse impact of plastic waste on the environment. The black-box model is interpreted using SHapley Additive exPlanations (SHAP) for managerial insights. The dependence on predictors (i.e., energy consumption, circular material use rate, economic complexity index, population, and real gross domestic product) and their interactions are discussed. The projected plastic waste generation of the EU-27 is estimated to reach 17 Mt/y in 2030. With an EU targeted recycling rate (55%) in 2030, the environmental impacts would still be higher than in 2018, especially global warming potential and plastic marine pollution. This result highlights the importance of plastic waste reduction, especially for the clustering algorithm-based grouped countries with a high amount of untreated plastic waste per capita. Compared to the other assessed scenarios, Scenario 4 with waste reduction (50% recycling, 47.6% energy recovery, 2.4% landfill) shows the lowest impact in acidification, eutrophication, marine aquatic toxicity, plastic marine pollution, and abiotic depletion. However, the global warming potential (8.78 Gt CO₂eq) is higher than that in 2018, while Scenario 3 (55% recycling, 42.6% energy recovery, 2.4% landfill) is better in this aspect than Scenario 4. This comprehensive analysis provides pertinent insights into policy interventions towards environmental hazard mitigation.

Post COVID-19 ENERGY sustainability and carbon emissions neutrality

This review covers the recent advancements in selected emerging energy sectors, emphasising carbon emission neutrality and energy sustainability in the post-COVID-19 era. It benefited from the latest development reported in the Virtual Special Issue of ENERGY dedicated to the 6th International Conference on Low Carbon Asia and Beyond (ICLCA'20) and the 4th Sustainable Process Integration Laboratory Scientific Conference (SPIL'20). As nations bind together to tackle global climate change, one of the urgent needs is the energy sector's transition from fossil-fuel reliant to a more sustainable carbon-free solution. Recent progress shows that advancement in energy efficiency modelling of components and energy systems has greatly facilitated the development of more complex and efficient energy systems. The scope of energy system modelling can be based on temporal, spatial and technical resolutions. The emergence of novel materials such as MXene, metal-organic framework and flexible phase change materials have shown promising energy conversion efficiency. The integration of the internet of things (IoT) with an energy storage system and renewable energy supplies has led to the development of a smart energy system that effectively connects the power producer and end-users, thereby allowing more efficient management of energy flow and consumption. The future smart energy system has been redefined to include all energy sectors via a cross-sectoral integration approach, paving the way for the greater utilization of renewable energy. This review highlights that energy system efficiency and sustainability can be improved via innovations in smart energy systems, novel energy materials and low carbon technologies. Their impacts on the environment, resource availability and social well-being need to be holistically considered and supported by diverse solutions, in alignment with the sustainable development goal of Affordable and Clean Energy (SDG 7) and other related SDGs (1, 8, 9, 11,13,15 and 17), as put forth by the United Nations.

Dilution rate of compost leachate from different biowaste for the fertigation of vegetables

Compost leachate (CL) is often treated as sewage. Limited studies have characterised the use of CL for agriculture application due to the variation of nutrient range, potential pollutants and need for pretreatment before use. This paper reviewed the characteristics of CL in terms of its nutrients and physical characteristics from three types of biowastes, i.e. the organic portion of municipal solid waste (OP-MSW), animal manure and green waste. The nutrient range characterised are used to develop the dilution rate of the CL as fertigation water for three types of vegetables. The dilution rate of CL developed is based on the fertigation standards set by the Food and Agriculture Organization of the United Nations and Malaysia Standards. The results show that all CL contain high organic content and micronutrients, which exceeded the upper limits. For the fertigation of vegetables using the CL, based on the requirement of COD and micronutrients (Fe, Mn, Zn, Cu, Pb, Ni, Cd, Cr) of the vegetables, the CL from green waste required the lowest dilution rate (8-45 fold), followed by animal waste (33-65 fold) and the OP-MSW (193-1770 fold). The novel dilution range developed is vital to balance the essential nutrients in the CL while avoiding phototoxicity on plant and soil pollution. The dilution strategy developed is essential to support the conversion of CL as an organic liquid fertiliser for agricultural application.

Uncovering the dynamics in global carbon dioxide utilization research: a bibliometric analysis (1995-2019)

The anthropogenic emission of carbon dioxide (CO₂) into the atmosphere is recognized as the main contributor to global climate change. To date, scientists have developed various strategies, including CO₂ utilization technologies, to reduce global carbon emissions. This paper presents the global scientific landscape of the CO₂ utilization research from 1995 to 2019 based on a bibliometric analysis of 1875 publications extracted from Web of Science. The findings indicate a major increase in the number of publications and citations received from 2015 to 2019, denoting a fast-emerging research trend. The dynamics of global CO₂ utilization research is partly driven by China's policies and research funding to promote low-carbon economic development. Applied Energy is recognized as a core journal in this research topic. The utilization of CO₂ is a multidisciplinary topic that has progressed by multidimensional collaborations at the country and organizations levels, while the formation of co-authorship networks at the individual level is mostly influenced by the authors' affiliations. Keyword co-occurrence analysis reveals a rapid evolution in the CO₂ utilization strategies from chemical fixation in carbonates and epoxides to pilot-scale testing of power-to-gas technologies in Europe and the USA. The development of efficient power-to-fuel technologies and biological utilization routes (using microalgae and bacteria) will probably be the next research priorities in CO₂ utilization research.

Microplastics and nanoplastics in global food webs: A bibliometric analysis (2009-2019)

This paper presents the research landscape on microplastics and nanoplastics (M/NPs) in global food webs based on a bibliometric analysis of 330 publications published in 2009-2019 extracted from Web of Science. The publications increased tremendously since 2013. Marine Pollution Bulletin is one of the top productive journals for this topic. The publication landscape related to M/NPs in global food webs, as interdisciplinary research, is highly dependent on the funding availability. The high productivities of England, China, USA and European countries are attributed to the funding from the agencies at regional or national levels. Keyword analysis reveals the shift of research hotspots from investigations on M/NPs absorbed by various organisms in the ecosystems to studies on the trophic transfer of M/NPs and sorbed contaminants in the food webs and their associated adverse impacts. Funding agencies play important roles in leading the future development of this topic.

Effect of aquaculture salinity on nitrification and microbial community in moving bed bioreactors with immobilized microbial granules

The novel immobilized microbial granules (IMG) shows a significant effect of nitrification for freshwater aquaculture. However, there is lack of evaluation study on the performance of nitrification at high salinity due to the concentration of recycled water or seawater utilization. A laboratory scale moving bed bioreactor (MBBR) with IMG was tested on recycled synthetic aquaculture wastewater for the nitrification at 2.5 mg/L NH₃-N daily. The results indicated that IMG showed a high salinity tolerance and effectively converted ammonia to nitrate up to 92% at high salinity of 35.0 g/L NaCl. As salinity increased from near zero to 35.0 g/L, the microbial activity of nitrite oxidation bacteria (NOB) in the IMG decreased by 86.32%. The microbial community analysis indicated that salinity significantly influenced the community structure. It was found that Nitrosomonas sp. and Nitrospira sp. were the dominant genera for ammonia oxidation bacteria (AOB) and NOB respectively at different salinity levels.

Environmental and economic feasibility of an integrated community composting plant and organic farm in Malaysia

Waste prevention and management become a significant issue worldwide to achieve sustainable development. Similar to many developing countries, Malaysia has faced severe problems in waste management due to its rapid economic growth and urbanisation. The municipal solid waste (MSW) production rate in Malaysia had increased significantly in a recent year, ranging from 0.8 to 1.25 kg/person∙d. The wastes generated contain a high amount of organic portion with high moisture content. Improper MSW management practice or delayed in waste collection and transportation can lead to severe health issues. This paper presents a case study in Johor Bahru, Malaysia (FOLO Farm), in which a composting prototype is used as the waste management technology to recycle the food and vegetable wastes. The greenhouse gases (GHG) mitigation and economic feasibility of the integrated composting and organic farming in this study are reported. This study showed a reduction of 27% of GHG by diverting the food and vegetable wastes from open dumping to the composting plant. Higher reduction rate (∼44%) can be achieved with better planning of waste collection route and applying the mitigation strategies during the composting process. By adapting the membership concept, this project not only ensures the economic feasibility of running a composting plant but also secures a channel for the growth of vegetable distribution. This study provides an insight into the feasibility and desirability to implement a pilot-scale composting for organic waste management to achieve the low carbon and self-sustain community.

Raw oil palm frond leaves as cost-effective substrate for cellulase and xylanase productions by Trichoderma asperellum UC1 under solid-state fermentation

Production of cellulases and xylanase by a novel Trichoderma asperellum UC1 (GenBank accession no. MF774876) under solid state fermentation (SSF) of raw oil palm frond leaves (OPFL) was optimized. Under optimum fermentation parameters (30 °C, 60-80% moisture content, 2.5 × 10⁶ spores/g inoculum size) maximum CMCase, FPase, β-glucosidase and xylanase activity were recorded at 136.16 IU/g, 26.03 U/g, 130.09 IU/g and 255.01 U/g, respectively. Cellulases and xylanase were produced between a broad pH range of pH 6.0-12.0. The enzyme complex that comprised of four endo-β-1,4-xylanases and endoglucanases, alongside exoglucanase and β-glucosidase showed thermophilic and acidophilic characteristics at 50-60 °C and pH 3.0-4.0, respectively. Glucose (16.87 mg/g) and fructose (18.09 mg/g) were among the dominant sugar products from the in situ hydrolysis of OPFL, aside from cellobiose (105.92 mg/g) and xylose (1.08 mg/g). Thermal and pH stability tests revealed that enzymes CMCase, FPase, β-glucosidase and xylanase retained 50% residual activities for up to 15.18, 4.06, 17.47 and 15.16 h of incubation at 60 °C, as well as 64.59, 25.14, 68.59 and 19.20 h at pH 4.0, respectively. Based on the findings, it appeared that the unique polymeric structure of raw OPFL favored cellulases and xylanase productions.

Factors associated with food insecurity among older homeless adults: results from the HOPE HOME study

BACKGROUND

The US homeless population is aging. Older adults and those living in poverty are at a high risk of food insecurity.

METHODS

We conducted a cross-sectional analysis of baseline data from a population-based study of 350 homeless adults aged ≥50. We assessed food security and receipt of food assistance. We used multivariable logistic regression to examine factors associated with very low food security.

RESULTS

The majority of the cohort was male and African American. Over half (55.4%) met criteria for food insecurity, 24.3% reported very low food security. Half (51.7%) reported receiving monetary food assistance. In the multivariable model, those who were primarily sheltered in the prior 6 months, (multi-institution users [AOR = 0.44, 95% CI: 0.22-0.86]) had less than half the odds of very low food security compared with those who were unsheltered. Depressive symptoms (AOR = 3.01, 1.69-5.38), oral pain (AOR = 2.15, 1.24-3.74) and cognitive impairment (AOR = 2.21, 1.12-4.35) were associated with increased odds of very low food security.

CONCLUSIONS

Older homeless adults experience a high prevalence of food insecurity. To alleviate food insecurity in this population, targeted interventions must address specific risk groups.

Anaerobic digestion of lignocellulosic waste: Environmental impact and economic assessment

Lignocellulosic waste (LW) is abundant in availability and is one of the suitable substrates for anaerobic digestion (AD). However, it is a complex solid substrate matrix that hinders the hydrolysis stage of anaerobic digestion. This study assessed various pre-treatment and post-treatments of lignocellulosic waste for anaerobic digestion benefiting from advanced P-graph and GaBi software (Thinkstep, Germany) from the perspective of cost and environmental performances (global warming potential, human toxicity, ozone depletion potential, particulate matter, photochemical oxidant creation, acidification and eutrophication potential). CaO pre-treatment (P4), H₂S removal with membrane separation post-treatment (HSR MS) and without the composting of digestate is identified as the cost-optimal pathway. The biological (P7- Enzyme, P8- Microbial Consortium) and physical (P1- Grinding, P2- Steam Explosion, P3- Water Vapour) pre-treatments alternatives have lower environmental impacts than chemical pre-treatments (P4- CaO, P5- NaOH, P6- H₂SO₄) however they are not part of the near cost optimal solutions. For post-treatment, the near cost optimal alternatives are H₂S removal with organic physical scrubbing (HSR OPS) and H₂S removal with amine scrubbing (HSR AS). HSR AS has a better performance in the overall environmental impacts followed by HSR MS and HSR OPS. In general, the suggested cost-optimal solution is still having relatively lower environmental impacts and feasible for implementation (cost effective). There is very complicated to find a universal AD solution. Different scenarios (the type of substrate, the scale, product demand, policies) have different constraints and consequently solutions. The trade-offs between cost and environment performances should be a future extension of this work.

Effects of different vermicompost extracts of palm oil mill effluent and palm-pressed fiber mixture on seed germination of mung bean and its relative toxicity

Several treatment technologies are available for the treatment of palm oil mill wastes. Vermicomposting is widely recognized as efficient, eco-friendly methods for converting organic waste materials to valuable products. This study evaluates the effect of different vermicompost extracts obtained from palm oil mill effluent (POME) and palm-pressed fiber (PPF) mixtures on the germination, growth, relative toxicity, and photosynthetic pigments of mung beans (Vigna radiata) plant. POME contains valuable nutrients and can be used as a liquid fertilizer for fertigation. Mung bean seeds were sown in petri dishes irrigated with different dilutions of vermicomposted POME-PPF extracts, namely 50, 60, and 70% at varying dilutions. Results showed that at lower dilutions, the vermicompost extracts showed favorable effects on seed germination, seedling growth, and total chlorophyll content in mung bean seedlings, but at higher dilutions, they showed inhibitory effects. The carotenoid contents also decreased with increased dilutions of POME-PPF. This study recommends that the extracts could serve as a good source of fertilizer for the germination and growth enhancement of mung bean seedlings at the recommended dilutions.

Anaerobic digestion of municipal solid waste: Energy and carbon emission footprint

Anaerobic digestion (AD) serves as a promising alternative for waste treatment and a potential solution to improve the energy supply security. The feasibility of AD has been proven in some of the technologically and agriculturally advanced countries. However, development is still needed for worldwide implementation, especially for AD process dealing with municipal solid waste (MSW). This paper reviews various approaches and stages in the AD of MSW, which used to optimise the biogas production and quality. The assessed stages include pre-treatment, digestion process, post-treatment as well as the waste collection and transportation. The latest approaches and integrated system to improve the AD process are also presented. The stages were assessed in a relatively quantitative manner. The range of energy requirement, carbon emission footprint and the percentage of enhancement are summarised. Thermal hydrolysis pre-treatment is identified to be less suitable for MSW (-5% to +15.4% enhancement), unless conducted in the two-phase AD system. Microwave pre-treatment shows consistent performance in elevating the biogas production of MSW, but the energy consumption (114.24-8,040 kW_eh t^-1) and carbon emission footprint (59.93-4,217.78 kg CO₂ t^-1 waste) are relatively high. Chemical (∼0.43 kW_eh m^-3) and membrane-based (∼0.45 kW_eh m^-3) post-treatments are suggested to be a lower energy consumption approach for upgrading the biogas. The feasibility in terms of cost (scale up) and other environmental impacts (non-CO₂ footprint) needs to be further assessed. This study provides an overview to facilitate further development and extended implementation of AD.

Evaluation of Effective Microorganisms on home scale organic waste composting

Home composting can be an effective way to reduce the volume of municipal solid waste. The aim of this study is to evaluate the effect of Effective Microorganism™ (EM) for the home scale co-composting of food waste, rice bran and dried leaves. A general consensus is lacking regarding the efficiency of inoculation composting. Home scale composting was carried out with and without EM (control) to identify the roles of EM. The composting parameters for both trials showed a similar trend of changes during the decomposition. As assayed by Fourier Transform Infrared Spectroscopy (FTIR), the functional group of humic acid was initially dominated by aliphatic structure but was dominated by the aromatic in the final compost. The EM compost has a sharper peak of aromatic CC bond presenting a better degree of humification. Compost with EM achieved a slightly higher temperature at the early stage, with foul odour suppressed, enhanced humification process and a greater fat reduction (73%). No significant difference was found for the final composts inoculated with and without EM. The properties included pH (∼7), electric conductivity (∼2), carbon-to-nitrogen ratio (C: N < 14), colour (dark brown), odour (earthy smell), germination index (>100%), humic acid content (4.5-4.8%) and pathogen content (no Salmonella, <1000 Most Probable Number/g E. coli). All samples were well matured within 2 months. The potassium and phosphate contents in both cases were similar however the EM compost has a higher nitrogen content (+1.5%). The overall results suggested the positive effect provided by EM notably in odour control and humification.

Fetal Development: Voice Processing in Normotensive and Hypertensive Pregnancies

Recent observation of maternal voice recognition provides evidence of rudimentary memory and learning in healthy term fetuses. However, such higher order auditory processing has not been examined in the presence of maternal hypertension, which is associated with reduced and/or impaired uteroplacental blood flow. In this study, voice processing was examined in 40 fetuses (gestational ages of 33 to 41 weeks) of hypertensive and normotensive women. Fetuses received 2 min of no sound, 2 min of a tape-recorded story read by their mothers or by a female stranger, and 2 min of no sound while fetal heart rate was recorded. Results demonstrated that fetuses in the normotensive group had heart rate accelerations during the playing of their mother's voice, whereas the response occurred in the hypertensive group following maternal voice offset. Across all fetuses, a greater fetal heart rate change was observed when the amniotic fluid index was above compared to below the median (i.e., 150 mm), indicating that amniotic fluid volume may be an independent moderator of fetal auditory sensitivity. It was concluded that differential fetal responding to the mother's voice in pregnancies complicated by maternal hypertension may reflect functional elevation of sensorineural threshold or a delay in auditory system maturation, signifying functional differences during fetal life or subtle differences in the development of the central nervous system.

Pursuing Quality in the Application of Bladder Cancer Quality of Life Research

Patient-reported outcomes (PRO), including health-related quality of life (HRQOL) measures, represent important means for evaluating patients' health outcomes and for guiding health care decisions made by patients, practitioners, investigators, and policy makers. In spite of the large number of studies examining HRQOL in patients with bladder cancer, very few review articles investigated this topic. Because these review studies report mixed results, incorporating bladder cancer HRQOL measures into standard urological practice is not a viable option. In this non-systematic review of the literature and commentary we note some general concerns regarding PRO research, but our primary focus is on the HRQOL methodology within the context of two types of bladder cancer: muscle invasive and non-muscle invasive bladder cancer. Considering bladder cancer HRQOL as the interaction of four areas of the assessment process (i.e., what model of HRQOL to choose, what instruments are available to fit the choice, how interpretation of the resulting data fits the model, and how to derive some utility from the chosen model) and the two types of disease (i.e., muscle invasive and non-muscle invasive) may move us toward a better understanding of bladder cancer HRQOL. Establishing a useful model of perceived general health or specific symptoms is the first and most important step in developing the responsive bladder cancer HRQOL measures necessitated by clinical settings.

Physicochemical profile of microbial-assisted composting on empty fruit bunches of oil palm trees

This study was carried out to investigate the physicochemical properties of compost from oil palm empty fruit bunches (EFB) inoculated with effective microorganisms (EM∙1™). The duration of microbial-assisted composting was shorter (∼7 days) than control samples (2 months) in a laboratory scale (2 kg) experiment. The temperature profile of EFB compost fluctuated between 26 and 52 °C without the presence of consistent thermophilic phase. The pH of compost changed from weak acidic (pH ∼5) to mild alkaline (pH ∼8) because of the formation of nitrogenous ions such as ammonium (NH4 (+)), nitrite (NO2 (-)), and nitrate (NO3 (-)) from organic substances during mineralization. The pH of the microbial-treated compost was less than 8.5 which is important to prevent the loss of nitrogen as ammonia gas in a strong alkaline condition. Similarly, carbon mineralization could be determined by measuring CO2 emission. The microbial-treated compost could maintain longer period (∼13 days) of high CO2 emission resulted from high microbial activity and reached the threshold value (120 mg CO2-C kg(-1) day(-1)) for compost maturity earlier (7 days). Microbial-treated compost slightly improved the content of minerals such as Mg, K, Ca, and B, as well as key metabolite, 5-aminolevulinic acid for plant growth at the maturity stage of compost. Graphical Abstract Microbial-assisted composting on empty fruit bunches.

Clinicopathologic and prognostic significance of c-MYC copy number gain in lung adenocarcinomas

BACKGROUND

c-MYC copy number gain (c-MYC gain) has been associated with aggressive behaviour in several cancers. However, the role of c-MYC gain has not yet been determined in lung adenocarcinomas classified by genetic alterations in epidermal growth factor receptor (EGFR), KRAS, and anaplastic lymphoma kinase (ALK) genes. We investigated the clinicopathologic and prognostic significance of c-MYC gain for disease-free survival (DFS) and overall survival (OS) according to EGFR, KRAS, and ALK gene status and stages in lung adenocarcinomas.

METHODS

In 255 adenocarcinomas resected in Seoul National University Bundang Hospital from 2003 to 2009, fluorescence in situ hybridisation (FISH) with c-MYC probe and centromeric enumeration probe 8 (CEP8) was analysed using tissue microarray containing single representative core per each case. EGFR (codon 18 to 21) and KRAS (codon 12, 13, and 61) mutations were analysed by polymerase chain reaction and direct sequencing method from formalin-fixed, paraffin-embedded tissue sections. ALK rearrangement was determined by FISH method. c-MYC gain was defined as >2 copies per nucleus, chromosome 8 gain as ⩾3 copies per nucleus, and gain of c-MYC:CEP8 ratio (hereafter, c-MYC amplification) as ⩾2.

RESULTS

We observed c-MYC gain in 20% (51 out of 255), chromosome 8 gain in 5.5% (14 out of 255), c-MYC amplification in 2.4% (6 out of 255), EGFR mutation in 49.4% (118 out of 239), KRAS mutation in 5.7% (7 out of 123), and ALK rearrangement in 4.9% (10 out of 205) of lung adenocarcinomas. c-MYC gain was observed in 19% (22 out of 118) of patients with lung adenocarcinomas with an EGFR mutation, but not in any patients with a KRAS mutation, or an ALK rearrangement. c-MYC gain (but not chromosome 8 gain or c-MYC amplification) was an independent poor-prognostic factor in the full cohort of lung adenocarcinoma (P=0.022, hazard ratio (HR)=1.71, 95% confidence interval (CI), 1.08-2.69 for DFS; P=0.032, HR=2.04, 95% CI, 1.06-3.91 for OS), as well as in stage I subgroup (P=0.023, HR=4.70, 95% CI, 1.24-17.78 for DFS; P=0.031, HR=4.65, 95% CI, 1.15-18.81 for OS), and in EGFR-mutant subgroup (P=0.022; HR=2.14; 95% CI, 1.11-4.10 for DFS).

CONCLUSIONS

c-MYC gain (but not chromosome 8 gain or c-MYC amplification) was an independent poor-prognostic factor for DFS and OS in lung adenocarcinomas, both in full cohort and stage I cancer, and possibly for DFS in EGFR-mutant adenocarcinomas. Additional studies are required to determine if patients with lung adenocarcinoma with c-MYC gain are candidates for additional first-line treatment to mitigate their increased risk for disease progression and death.

Crystallization mechanisms of phase change (GeSbSn)(100-x)Co(x) optical recording films

In this study, the (GeSbSn)(100-x0Co(x) films (x = 0-13.3) were deposited on natural oxidized silicon wafer and glass substrate by dc magnetron co-sputtering of GeSbSn and Co targets. The ZnS-SiO2 films were used as protective layers. The thicknesses of the (GeSbSn)(100-x)Co(x) films and protective layer were 100 nm and 30 nm, respectively. We investigated the effects of Co addition on the thermal property, crystallization kinetics, and crystallization mechanism of the GeSbSn recording film. The crystallization temperatures of (GeSbSn)(100-x)Co(x) films were decreased with Co content. It was found that the activation energy of the (GeSbSn)(100-x)Co(x) films will decrease from 1.53 eV to 0.55 eV as Co content increased from 0 at.% to 13.3 at.%.

Concurrent intracardiac metastasis in a patient with intestinal perforation

The administration of anaesthesia to subjects with intracardiac lesions poses the potential for cardiac complications. Cardiac metastases should be identified in susceptible cases and transthoracic echocardiography performed to elucidate the nature of the cardiac lesions. We describe a case of an intracardiac metastasis in a 65-year-old subject with a small bowel tumour leading to intestinal perforation and presenting for surgical treatment. Oncological assessment of the situation, in conjunction with the anaesthetic risks, led to abandonment of surgery and palliative treatment.

Narrow-band imaging with magnifying endoscopy for the screening of esophageal cancer in patients with primary head and neck cancers

BACKGROUND AND STUDY AIM

Although narrow-band imaging (NBI) in endoscopy can improve detection of early-stage esophageal malignancies in patients with head and neck cancers, false-positive results may be obtained in areas with nonspecific inflammatory changes. This study evaluated the feasibility of primary screening with NBI and magnification for the presence of esophageal malignancies in these cancer patients.

PATIENTS AND METHODS

Sixty-nine patients with documented head and neck cancers were enrolled from April 2008 to January 2009. All patients underwent a meticulous endoscopic examination of the esophagus using a conventional white-light system followed by re-examination using the NBI system and final confirmation with NBI plus magnification.

RESULTS

Twenty-one patients (30.4 %) were confirmed to have esophageal neoplasia. Among these 21, 16 (76.2 %) had synchronous lesions, 9 (42.9 %) were asymptomatic, and 10 (47.6 %) had early-stage neoplasia. The incidence of multiple esophageal neoplasia was 57.1 %. NBI was more effective than conventional endoscopy in detecting neoplastic lesions (35 lesions in 21 patients vs. 22 lesions in 18 patients) and was particularly effective in patients with dysplasia (13 lesions in 9 patients vs. 3 lesions in 3 patients). The sensitivity and accuracy of detection were 62.9 % and 64.4 % for conventional endoscopy, 100 % and 86.7 % for NBI alone, and 100 % and 95.6 % for NBI with high magnification, respectively.

CONCLUSIONS

Compared with current approaches, NBI followed by high magnification significantly increases the accuracy of detection of esophageal neoplasia in patients with head and neck cancers. The result warrants conducting prospective randomized controlled study to confirm its efficacy.

M(1)-like muscarinic acetylcholine receptors regulate fast-spiking interneuron excitability in rat dentate gyrus

Cholinergic transmission through muscarinic acetylcholine receptors (mAChRs) plays a key role in cortical oscillations. Although fast-spiking (FS), parvalbumin-expressing basket cells (BCs) are proposed to be the cellular substrates of gamma oscillations, previous studies reported that FS nonpyramidal cells in neocortical areas are unresponsive to cholinergic modulation. Dentate gyrus (DG) is an independent gamma oscillator in the hippocampal formation. However, in contrast to other cortical regions, the direct impact of mAChR activation on FS BC excitability in this area has not been investigated. Here, we show that bath-applied muscarine or carbachol, two mAChR agonists, depolarize DG BCs in the acute brain slices, leading to action potential firing in the theta-gamma bands in the presence of blockers of ionotropic glutamate and gamma-aminobutyric acid type A receptors at physiological temperatures. The depolarizing action persists in the presence of tetrodotoxin, a voltage-gated Na(+) channel blocker. In voltage-clamp recordings, muscarine markedly reduces background K(+) currents. These effects are mimicked by oxotremorine methiodide, an mAChR-specific agonist, and largely reversed by atropine, a non-selective mAChR antagonist, or pirenzepine, an M(1) receptor antagonist, but not by gallamine, an M(2/4) receptor antagonist. Interestingly, in contrast to M(1)-receptor-mediated depolarization, M(2) receptor activation by the specific agonist arecaidine but-2-ynyl ester tosylate down-regulates GABA release at BC axons-the effect is occluded by gallamine, an M(2) receptor antagonist. Overall, muscarinic activation results in a net increase in phasic inhibitory output to the target cells. Thus, cholinergic activation through M(1)-like receptor enhances BC activity and promotes the generation of nested theta and gamma rhythms, thereby enhancing hippocampal function and associated performance.

Modeling of oscillatory bursting activity of pancreatic beta-cells under regulated glucose stimulation

A mathematical model to describe the oscillatory bursting activity of pancreatic beta-cells is combined with a model of glucose regulation system in this work to study the bursting pattern under regulated extracellular glucose stimulation. The bursting electrical activity in beta-cells is crucial for the release of insulin, which acts to regulate the blood glucose level. Different types of bursting pattern have been observed experimentally in glucose-stimulated islets both in vivo and in vitro, and the variations in these patterns have been linked to changes in glucose level. The combined model in this study enables us to have a deeper understanding on the regime change of bursting pattern when glucose level changes due to hormonal regulation, especially in the postprandial state. This is especially important as the oscillatory components of electrical activity play significant physiological roles in insulin secretion and some components have been found to be lost in type 2 diabetic patients.

Modeling of glucose regulation and insulin-signaling pathways

A model of glucose regulation system was combined with a model of insulin-signaling pathways in this study. A feedback loop was added to link the transportation of glucose into cells (by GLUT4 in the insulin-signaling pathways) and the insulin-dependent glucose uptake in the glucose regulation model using the Michaelis-Menten kinetic model. A value of K(m) for GLUT4 was estimated using Genetic Algorithm. The estimated value was found to be 25.3 mM, which was in the range of K(m) values found experimentally from in vivo and in vitro human studies. Based on the results of this study, the combined model enables us to understand the overall dynamics of glucose at the systemic level, monitor the time profile of components in the insulin-signaling pathways at the cellular level and gives a good estimate of the K(m) value of glucose transportation by GLUT4. In conclusion, metabolic modeling such as displayed in this study provides a good predictive method to study the step-by-step reactions in an organism at different levels and should be used in combination with experimental approach to increase our understanding of metabolic disorders such as type 2 diabetes.

O17. The development of 'time release' nail enamels

In our recent studies on the effects of plasticizers on nail enamel films, we developed a high interest in a phenomenon that we named as 'internal flow'[1]. During the film forming process there is an area that develops beneath the film surface where the film components remain dynamic and mobile. The time frame during which the film maintains this status is directly related to the balance of the resins, plasticizers, polymers and solvents utilized. We found that the longer this 'internal flow' persists, the better the nail enamel wears. At Tevco, we have been able to control the rate at which the solvents and plasticizers flash off the substrate during the film forming process by regulating the interactions and the levels of film constituents. This 'time release' action is the foundation of our study. This study shows that the alkyl adipates are an integral component in controlling the film's internal flow through time release. As plasticizers, these materials, when in proper balance with other components, can create a film surface that is crack-and scuff-resistant. Finally, the substrate in this study is the human nail. The film we developed has to adhere and provide consistent performance over a wide range of temperatures, oil content and the surface abrasion of human nails. We have found that by utilizing adhesion promoters in conjunction with our optimized internal flow time release formula, our film meets all required criteria and generally outperforms conventional quick dry films. In conclusion, we have been able to optimize the film characteristics of conventional quick dry nail enamels. By controlling the internal flow of the film, we can enhance the performance criteria generally expected by consumers in nail enamels.

Role of the virulence plasmid pR99 and the metalloprotease Vvp in resistance of Vibrio vulnificus serovar E to eel innate immunity

Vibrio vulnificus biotype 2 serovar E (VSE) is a bacterial pathogen that produces a haemorrhagic septicaemia called vibriosis in eels. Its ability to grow in blood is conferred by a recently described virulence plasmid [Lee CT, Amaro C, Wu KM, Valiente E, Chang YF, Tsai SF, et al. A common virulence plasmid in biotype 2 Vibrio vulnificus and its dissemination aided by a conjugal plasmid. Journal of Bacteriology, submitted for publication.]. In this study, we analyzed the role of this plasmid together with the role played by the metalloprotease (Vvp) in the interaction between bacteria and eel innate immunity. To this end, we compared and statistically analyzed the differences in resistance to serum and mucus factors (complement, selected antimicrobial peptides, transferrin and lysozyme) and also to phagocytosis/opsonophagocytosis between one VSE strain and its derivatives: a plasmid-cured strain and a vvp-deficient mutant. The wild-type and the metalloprotease-deficient strains were resistant to both the bactericidal action of fresh serum and the phagocytosis and opsonophagocytosis by eel phagocytes, confirming that Vvp is not involved in resistance to eel innate immunity. In contrast, the cured strain was sensitive to both the bactericidal action of eel serum activated by the alternative pathway and phagocytosis/opsonophagocytosis. Since no plasmid-encoded ORF, with homology to known genes, is related to the resistance to innate immunity [Lee CT, Amaro C, Wu KM, Valiente E, Chang YF, Tsai SF, et al. A common virulence plasmid in biotype 2 Vibrio vulnificus and its dissemination aided by a conjugal plasmid. Journal of Bacteriology, submitted for publication.], this function could be codified by one or more new genes. Further studies are underway to characterize the plasmid-encoded system responsible for V. vulnificus resistance to the innate immune system of eels.

An immortalized rat ventral mesencephalic cell line, RTC4, is protective in a rodent model of stroke

One therapeutic approach to stroke is the transplantation of cells capable of trophic support, reinnervation, and/or regeneration. Previously, we have described the use of novel truncated isoforms of SV40 large T antigen to generate unique cell lines from several primary rodent tissue types. Here we describe the generation of two cell lines, RTC3 and RTC4, derived from primary mesencephalic tissue using a fragment of mutant T antigen, T155c (cDNA) expressed from the RSV promoter. Both lines expressed the glial markers vimentin and S100beta, but not the neuronal markers NeuN, MAP2, or beta-III-tubulin. A screen for secreted trophic factors revealed substantially elevated levels of platelet-derived growth factor (PDGF) in RTC4, but not RTC3 cells. When transplanted into rat cortex, RTC4 cells survived for at least 22 days and expressed PDGF. Because PDGF has been reported to reduce ischemic injury, we examined the protective functions of RTC4 cells in an animal model of stroke. RTC4 or RTC3 cells, or vehicle, were injected into rat cortex 15-20 min prior to a 60-min middle cerebral artery ligation. Forty-eight hours later, animals were sacrificed and the stroke volume was assessed by triphenyl-tetrazolium chloride (TTC) staining. Compared to vehicle or RTC3 cells, transplanted RTC4 cells significantly reduced stroke volume. Overall, we generated a cell line with glial properties that produces PDGF and reduces ischemic injury in a rat model of stroke.

Determinants of diagnostic bronchial washing in peripheral lung cancers

OBJECTIVE

To establish clinical determinants affecting the diagnostic yield of bronchial washing.

SETTING

We performed bronchial washing in 241 consecutive patients with bronchoscopically invisible lung tumours. Of these, 150 patients known to have lung cancer were enrolled for the final analysis.

DESIGN

A multi-centre study.

RESULTS

Bronchial washing provided a diagnosis of lung cancer in 30 of the 150 patients (20%). Tumour size > or = 3 cm (P = 0.005), the location of the tumour within 8 cm of the carina (P = 0.003), and exposed type bronchus sign of tumour (P < 0.001) were factors affecting diagnostic bronchial washing for bronchoscopically invisible lung cancers. However, multivariate logistic regression revealed that exposed type bronchus sign was the sole determinant (OR 19.22, 95% CI 4.23-87.46, P < 0.001).

CONCLUSION

Bronchial washing is a useful procedure for the diagnosis of bronchoscopically invisible lung cancers. As the tumour-bronchus relationship is the most important determinant of a diagnostic yield, the routine use of bronchial washing should be considered for tumours with exposed type bronchus sign.

Differential interactions of plasmid DNA, RNA and endotoxin with immobilised and free metal ions

Separation of negatively charged molecules, such as plasmid DNA (pDNA), RNA and endotoxin forms a bottleneck for the development of pDNA vaccine production process. The use of affinity interactions of transition metal ions with these molecules may provide an ideal separation methodology. In this study, the binding behaviour of pDNA, RNA and endotoxin to transition metal ions, either in immobilised or free form, was investigated. Transition metal ions: Cu2+, Ni2+, Zn2+, Co2+ and Fe3+, typically employed in the immobilised metal affinity chromatography (IMAC), showed very different binding behaviour depending on the type of metal ions and their existing state, i.e. immobilised or free. In the alkaline cell lysate, pDNA showed no binding to any of the IMAC chemistries tested whereas RNA interacted significantly with Cu2+-iminodiacetic acid (IDA) and Ni2+-IDA but showed no substantial binding to the rest of the IMAC chemistries. pDNA and RNA, however, interacted to varying degrees with free metal ions in the solution. The greatest selectivity in terms of pDNA and RNA separation was achieved with Zn2+ which enabled almost full precipitation of RNA while keeping pDNA soluble. For both immobilised and free metal ions, ionic strength of solution affected the metal ion-nucleic acid interaction significantly. Endotoxin, being more flexible, was able to interact better with the immobilised metal ions than the nucleic acids and showed binding to all the IMAC chemistries. The specific interactions of immobilised and/or free metal ions with pDNA, RNA and endotoxin showed a good potential, by selectively removing RNA and endotoxin at high efficiency, to develop a simplified pDNA purification process with improved process economics.

Lack of association between COPD and transforming growth factor-beta1 (TGFB1) genetic polymorphisms in Koreans

OBJECTIVE

Many genetic variations have been suggested as genetic risk factors for the development of chronic obstructive pulmonary disease (COPD), including single nucleotide polymorphisms in the transforming growth factor-beta1 (TGFB1) gene. We attempted to elucidate the association between TGFB1 genetic polymorphisms and COPD among Koreans.

DESIGN

The genotypes of 102 male patients with COPD and 159 volunteers with similar distributions of age, sex and smoking intensity, as well as normal pulmonary function, were determined for three previously associated TGFB1 single nucleotide polymorphisms (SNPs), -10807G/A (rs2241712) and -509T/C (rs1800469), located in or near the promoter, and 29T/C (rs1982073), located in exon 1 of the TGFB1 gene.

RESULTS

No significant associations between COPD and the three TGFB1 SNPs could be identified. In addition, the haplotypes composed of three TGFB1 SNPs were not associated with the presence of COPD.

CONCLUSION

These results differ from previous reports involving Caucasians, and might reflect racial differences in the pathogenesis of COPD.

Recombinant human erythropoietin independence in chronic hemodialysis patients: clinical features, iron homeostasis and erythropoiesis

AIMS

Recombinant human erythropoietin (r-HuEPO) is widely used to correct renal anemia in uremic patients. Interestingly, some chronic hemodialysis (HD) patients can maintain high hemoglobin level without the need of r-HuEPO. The aim of this study is to investigate clinical features, iron metabolism and erythropoiesis of these r-HuEPO-independent HD patients.

METHODS

r-HuEPO independence was defined in dialysis patients as hemoglobin greater than 12 g/dl and no use of r-HuEPO for at least 6 months. An age- and sex-matched group was selected for comparison. Their underlying diseases, duration of hemodialysis therapy, efficacy of dialysis (Kt/V), normalized protein catabolic rate (nPCR) and body mass index (BMI) were recorded. Laboratory data including: hemoglobin, albumin, high sensitivity C-reactive protein, serum iron, total iron binding capacity, transferrin saturation, ferritin, intact parathyroid hormone, soluble transferrin receptor (sTfR), serum EPO, cortisol, testosterone, aluminum and leptin levels were measured. Renal sonography was also performed in each patient to evaluate renal cyst formation.

RESULTS

About 2.3% of all HD patients (21/888; M : F = 18 : 3) were r-HuEPO-independent. These patients had significantly longer HD duration and higher serum EPO and sTfR levels, and lower transferrin saturation rate than dependent groups. Correlation analysis revealed that hemoglobin level strongly correlated with HD duration, serum sTfR and EPO levels. Levels of sTfR were positively related with serum EPO levels and BMI. Multivariate regression analysis showed that level of sTfR was the only independent factor related to r-HuEPO independence.

CONCLUSION

R-HuEPO independence is rare among chronic hemodialysis patients. Factors contributing to this dependence are complex and multiple. Level of serum sTfR parallels erythropoiesis and is the most significant factor associated with r-HuEPO independence in chronic HD patients.

Hypercalcaemia and haemophagocytic syndrome: rare concurrent presentations of disseminated tuberculosis in a dialysis patient

Tuberculosis remains an important cause of infection in chronic haemodialysis patients. Frequent extrapulmonary involvement, non-specific presentation and limited diagnostic tools usually make early diagnosis difficult. Herein, we report on an 83-year-old female patient who had been on regular heamodialysis therapy for 15 years, who presented with asymptomatic hypercalcaemia and pancytopenia. Haemophagocytic syndrome was documented during the admission period. Mycobacterium tuberculosis was cultured from bone marrow 1 month after her demise. This case report highlights the non-specific manifestations of extrapulmonary tuberculosis in dialysis patients and the limited value of conventional diagnostic methods. We would like to recommend aggressive intervention and early tissue aspiration from possible infectious sites when tuberculosis cannot be completely ruled out. Disseminated tuberculosis should be considered as an indication of hypercalcaemia where haemophagocytic syndrome occurs simultaneously.

Response of pulmonary tuberculomas to anti-tuberculous treatment

Pulmonary tuberculomas are well-circumscribed masses caused by Mycobacterium tuberculosis. However, the response of tuberculomas to anti-tuberculous (TB) treatment has not been well defined as yet. The response of pulmonary tuberculomas to anti-TB treatment was retrospectively reviewed in 45 patients diagnosed between January 1997 and December 2001. The areas of pulmonary tuberculomas were estimated by calculating products of the longest and their perpendicular short diameters on chest radiographs. The response to anti-TB treatment was categorised as "decreased" (> 25% reduction in area versus its initial area), "increased" (> 251% increase) and "no change" (the remainder). The mean of treatment duration was 11.5 +/- 3.6 months. Three months after treatment, 18 patients (40.0%) were categorised as decreased, 25 (55.6%) as no change and two (4.4%) as increased. Twelve months after treatment, out of 42 patients available for chest radiographs, 32 patients (76.2%) were categorised as decreased, nine (21.4%) as no change and one patient (2.4%) as increased. At the last follow-up (mean follow-up 27.0 +/- 10.2 months), 37 patients (82.2%) were categorised as decreased. The majority of pulmonary tuberculomas were decreased by anti-tuberculosis treatment during and even after treatment, although a transient enlargement during the early period of treatment was observed infrequently.

Isolated fatal renal mucormycosis in a patient with chronic obstructive pulmonary disease and tuberculosis

Renal mucormyosis is a rare entity and normally diagnosed at postmortem. Isolated cases diagnosed antemortem are even rarer and only a few cases have been reported. The disease is associated with a high mortality rate, especially in patients with underlying disease. Clinical presentation is non-specific and includes flank pain, fever and pyuria with or without haematuria. Identifying fungal hyphae microscopically is essential for diagnosis. We present a rare isolated fatal case of renal mucormycosis in a 77-year-old man with chronic obstructive pulmonary disease (COPD) and old tuberculosis (TB) who had been diagnosed after a right nephrectomy. We believe early diagnosis and appropriate treatment for fungal infection, together with the predisposing underlying disease, is crucial for survival.

Tuberculous peritonitis in uremic patients

AIMS

To identify clinical features and treatment response of tuberculous peritonitis (TBP) in a uremic population, a retrospective case-control study was performed.

MATERIALS AND METHODS

Thirteen uremic patients with TBP (Group I: 62.7 +/- 6.8 years, male 54%) collected between January 1986 and January 2002 were compared with another two age- and sex-matched controls: 19 non-azotemic patients with TBP (Group II: 62.9 +/- 7.3 years, male 47%) and 30 uremic patients without TBP (Group III: 61.1 +/- 8.7 years, male 47%). Clinical information and data of ascites and blood examinations were evaluated.

RESULTS

Significant differences between Groups I and II were found in comorbidity, hypertension, anorexia, percentages of neutrophil and lymphocyte from blood and ascites, and serum calcium (sCa), phosphorus and albumin-adjusted calcium (sAACa). However, no significant differences in duration of symptoms, coexistent pulmonary tuberculosis (p = 0.061), duration or complications of therapy and mortality (p = 0.13) were detected. Significant differences between Groups I and III were found in peripheral white cell counts and percentages of neutrophil and lymphocyte as well as in serum creatinine (sCr), albumin, sCa, sAACa and intact parathyroid hormone (iPTH).

CONCLUSIONS

Non-specific symptoms make the diagnosis of TBP in a uremic population difficult. However, neutrophil predominance in blood and ascites, hypoalbuminemia, relatively lower sCr and hypercalcemia with suppressed serum iPTH were found to be characteristic. In TBP uremic patients, therapy complications were not common and there was a tendency for higher mortality, largely due to septic shock.