Ecotoxicological assessment of waste-derived organic fertilizers and long-term monitoring of fertilized soils using a multi-matrix and multi-species approach

The present study investigates the ecotoxicity of 7 biofertilizers, including biowaste-derived organic matrices. Real-field tests were conducted to assess the impacts of soil fertilization with sewage sludge digestate from high-solid thermophilic anaerobic digestion (HSTAD) compared to those obtained on non-amended and urea-fertilized soils. The physical-chemical and ecotoxic impact of HSTAD digestate on soil was monitored for 12 months, at 5 time points and 2 soil depths, on a maize field divided in 3 portions (non-treated, fertilized with urea, amended with digestate). The chemical and physical characteristics of the soil were previously analyzed for 3 years to provide a long-term outlook of the impacts of biofertilizer application. Seven bioindicators were utilized for direct (on whole soil) and indirect (on soil elutriates) ecotoxicological tests on fertilizers and amended soils, including plant seeds (Lepidium sativum, Sorghum saccharatum, and Sinapsis alba), the aquatic organism Daphnia magna, the alga Raphidocelis subcapitata, the luminescent bacterium Aliivibrio fischeri, and the Nematode Caenorhabditis elegans. No serious negative effects on soil fertilized with HSTAD digestate were evidenced. Conversely, bioassays rather showed positive effects, encouraging the utilization of HSTAD digestate in agriculture, considering the proper concentrations of use. The obtained data were interpolated and a test battery integrated index was generated, confirming the absence of ecotoxicological risk for the soils amended with the applied fertilizers. The long-term evolution of the physical-chemical soil characteristics (including the concentrations of potential contaminants) was similar for both HSTAD digestate and urea application as well as for non-fertilized soil, indicating no negative effects due to digestate application on land. On the contrary, digestate application improved the content of stabilized organic matter and nutrients in soil. This study proposes a more correct approach to ecotoxicity assessment of fertilized soils for biofertilizer evaluation and demonstrates the long-term safe application of HSTAD digestate on agricultural soil.

Acidogenic fermentation of food waste to generate electron acceptors and donors towards medium-chain carboxylic acids production

This study investigated the optimum pH, temperature, and food-to-microorganisms (F/M) ratio for regulating the formation of electron acceptors and donors during acidogenic fermentation to facilitate medium-chain carboxylic acids (MCCAs) production from food waste. Mesophilic fermentation at pH 6 was optimal for producing mixed volatile fatty acids (719 ± 94 mg COD/g VS) as electron acceptors. Under mesophilic conditions, the F/M ratio (g VS/g VS) could be increased to 6 to generate 22 ± 2 g COD/L of electron acceptors alongside 2 ± 0 g COD/L of caproic acid. Thermophilic fermentation at pH 6 was the best condition for producing lactic acid as an electron donor. However, operating at F/M ratios above 3 g VS/g VS under thermophilic settings significantly reduced lactic acid yield. A preliminary techno-economic evaluation revealed that converting lactic acid and butyric acid generated during acidogenic fermentation to caproic acid was the most profitable food waste valorization scenario and could generate 442-468 €/t VS/y. The results presented in this study provide insights into how to tailor acidogenic fermentation reactions to desired intermediates and will help maximize MCCAs synthesis.

Operational strategies enhancing sewage sludge minimization in a combined integrated fixed-film activated sludge - oxic settling anaerobic system

A lab-scale integrated fixed-film activated sludge (IFAS) reactor was mplemented with the oxic-settling anaerobic (OSA) cycle for reducing sewage sludge production through the addition of an anoxic/anaerobic sludge holding tank (SHT) along the sludge recycle line. The IFAS-OSA system was operated under the different hydraulic retention time (HRT) in the SHT (HRTSHT) of 12 h and 6 h, at an oxidation-reduction potential (ORP) < -91 mV and solid retention time (SRT) between 39 and 126 d. Furthermore, the effect of temperature increase in the SHT (TSHT) from ambient (19.8-25.6 °C) to mesophilic (35 °C) conditions was investigated. The system performances were monitored in terms of sludge minimization and dewaterability efficiencies as well as carbon and nutrients reduction. The observed sludge yield (Yobs) for the IFAS system was 0.37(±0.06) mg VSS/mg COD. After OSA implementation Yobs decreased by 32% and 46-65% at HRTSHT of 12 h and 6 h, respectively, indicating that prolonged exposure to anoxic/anaerobic conditions was not beneficial for sludge reduction. The lowest Yobs of 0.09(±0.05) mg VSS/mg COD (76% lower than that in the IFAS system) was obtained at an HRTSHT of 6 h and when TSHT was set at 35 °C. OSA implementation did not affect COD and NH4+ oxidation of the IFAS system (90-96% and 99%, respectively) and improved total nitrogen (TN) reduction (31-53%) due to improved denitrification in the SHT. On the contrary, sludge dewaterability worsened following OSA implementation, which was linked to the increased levels of exopolymeric substances in the suspended biomass.

Application of high-intensity static magnetic field as a strategy to enhance the fertilizing potential of sewage sludge digestate

Anaerobic digestion (AD) is a sustainable and well-established option to handle sewage sludge (SS), as it generates a methane-rich biogas and a digestate with potential fertilizing properties. In the past, different strategies have been proposed to enhance the valorization of SS. Among these, the application of a static magnetic field (SMF) has been poorly evaluated. This study aims to determine the effects of a high-intensity SMF (1.5 and 2 T) on the chemical composition of SS anaerobic digestate. Several strategies (i.e., number of magnetization cycles, addition of different sources and quantities of magnesium, and digestate aeration) have been applied to evaluate the possible formation of compounds with valuable fertilizing properties in the digestate. Experimental results showed that by combining different strategies promoting digestate exposure to the magnetic field it is possible to favour the reduction in the liquid phase of NH4+, NO3-, PO43-, SO42- and Mg2+ concentrations up to 28%, 38%, 34%, 39% and 31%, respectively. The XRD analyses conducted on the solid phase of the same magnetized digestate samples showed an increase in crystalline and amorphous phases of nitrogen and phosphorus compounds with fertilizing value, such as struvite. These results highlight that SMF application can increase the fertilizing potential of sewage sludge digestate and promote its valorization in a sustainable and circular perspective.

Phosphorus recovery as struvite and hydroxyapatite from the liquid fraction of municipal sewage sludge with limited magnesium addition

Phosphorus (P) is an essential element to produce feed and fertilizers but also a nonrenewable resource. Both the predicted exhaustion of phosphatic rocks and the risk of eutrophication lead to an increasing necessity for P recovery methodologies to be applied in municipal wastewater treatment plants (WWTPs). One of the most promising solutions involves the precipitation of P-based minerals reusable as slow-release fertilizers. In this study, P recovery as struvite and hydroxyapatite from a municipal WWTP digestate liquid fraction (centrate) was investigated at varying pH (8-10), reagent typologies (MgCl₂ , NaOH, Ca(OH)₂ , and CaCl₂ ), and concentrations under limiting magnesium doses through liquid- and solid-phase analyses and thermodynamical modeling. A maximum P recovery of 87.3% was achieved at pH 9 by adding NaOH and MgCl₂ at a dose of 656 mg/L (the higher tested). According to these data, it was estimated that 92.0 tons/year of struvite and 33.2 tons/year of hydroxyapatite could be recovered from the WWTP centrate with a cost for reagent consumption being almost 50% of the mean P market value. An increase in P precipitation was observed while comparing experiments with the same pH values but with a higher Mg²⁺ dose. Ca²⁺ addition led to extensive P precipitation but mainly as amorphous phases that interfere with struvite formation.

Re-sleeve gastrectomy: weight loss, comorbidities and gerd evaluation in a large series with 5 years of follow-up

INTRODUCTION

Laparoscopic sleeve gastrectomy (SG) has rapidly become one of the most commonly performed procedures in bariatric surgery. Weight regain and insufficient weight loss are the most common causes for surgical failure. Re-sleeve gastrectomy (ReSG) can represent an option when there is evidence of a dilated gastric tube.

OBJECTIVES

The aim of the study is to evaluate safety, efficacy and rate of gastro-esophageal reflux disease (GERD) after ReSG in one of the largest series present in literature with long-term follow up.

METHODS AND STUDY DESIGN

Retrospective study design. From February 2010 to August 2018, 102 patients underwent ReSG at our Centre. We divided patients into two groups, according to the main reason for surgical failure: insufficient weight loss or progressive weight regain.

RESULTS

One hundred-two patients (78 women, 24 men) with BMI 38 ± 6 kg/m² underwent ReSG (mean age 44 years). Rate of postoperative complications was 3.9% (4/102). After a mean follow-up of 55 months, mean BMI decreased to 30,4 kg/m² and the mean percentage of excess weight loss (%EWL) was 51 ± 38.6. Symptoms of GERD were present in 35/102 patients (34.3%) and the need for a new operation occurred in six patients. Forty-five patients were submitted to ReSG for progressive weight regain (group A) and 57 for insufficient weight loss (group B). No differences were found in terms of postoperative BMI and %EWL.

CONCLUSION

ReSG is a feasible procedure after primary SG failure in selected patients, but its efficacy in reducing the BMI under 30 kg/m² is still unclear. In addition, over 30% of patients suffer from long-term gastro-esophageal reflux.

Dynamic Photoresponse of a DNTT Organic Phototransistor

The photosensitivity, responsivity, and signal-to-noise ratio of organic phototransistors depend on the timing characteristics of light pulses. However, in the literature, such figures of merit (FoM) are typically extracted in stationary conditions, very often from IV curves taken under constant light exposure. In this work, we studied the most relevant FoM of a DNTT-based organic phototransistor as a function of the timing parameters of light pulses, to assess the device suitability for real-time applications. The dynamic response to light pulse bursts at ~470 nm (close to the DNTT absorption peak) was characterized at different irradiances under various working conditions, such as pulse width and duty cycle. Several bias voltages were explored to allow for a trade-off to be made between operating points. Amplitude distortion in response to light pulse bursts was also addressed.

Impact of operational strategies on a sidestream enhanced biological phosphorus removal (S2EBPR) reactor in a carbon limited wastewater plant

Water resource recovery facilities are faced with stringent effluent phosphorus limits to reduce nutrient pollution. Enhanced biological phosphorus removal (EBPR) is the most common biological route to remove phosphorus; however, many facilities struggle to achieve consistent performance due to limited carbon availability in the influent wastewater. A promising process to improve carbon availability is through return activated sludge (RAS) fermentation via sidestream EBPR (S2EBPR). In this study, a full-scale S2EBPR pilot was operated with a sidestream plus carbon configuration (SSRC) at a carbon-limited facility. A model based on the pilot test was developed and calibrated in the SUMO platform and used to explore routes for improving orthophosphate (OP) effluent compliance. Modeling results showed that RAS diversion by itself was not sufficient to drive OP removal to permit limits of 1 mg L^-1, therefore, other strategies were evaluated. Supplemental carbon addition of MicroC® at 1.90 L min^-1 and controlling the phosphorus concentration below 3.5 mgP L^-1 in the primary effluent (PE) proved to be valid supplemental strategies to achieve OP removal below 1 mg L^-1 most of the time. In particular, the proposed supplemental carbon flow rate would result in an improvement of the rbCOD:P ratio from 17:1 to 26:1. The synergistic approach of RAS diversion and supplemental carbon addition increased the polyphosphate accumulating organisms (PAO) population while minimizing the supplemental carbon needed to achieve consistent phosphorus removal. Overall, this pilot and modeling study shows that joint strategies, including RAS diversion, carbon addition and PE control, can be effective to achieve optimal control of OP effluent.

Recent progress and challenges in biotechnological valorization of lignocellulosic materials: Towards sustainable biofuels and platform chemicals synthesis

Lignocellulosic materials (LCM) have garnered attention as feedstocks for second-generation biofuels and platform chemicals. With an estimated annual production of nearly 200 billion tons, LCM represent an abundant source of clean, renewable, and sustainable carbon that can be funneled to numerous biofuels and platform chemicals by sustainable microbial bioprocessing. However, the low bioavailability of LCM due to the recalcitrant nature of plant cell components, the complexity and compositional heterogeneity of LCM monomers, and the limited metabolic flexibility of wild-type product-forming microorganisms to simultaneously utilize various LCM monomers are major roadblocks. Several innovative strategies have been proposed recently to counter these issues and expedite the widespread commercialization of biorefineries using LCM as feedstocks. Herein, we critically summarize the recent advances in the biological valorization of LCM to value-added products. The review focuses on the progress achieved in the development of strategies that boost efficiency indicators such as yield and selectivity, minimize carbon losses via integrated biorefinery concepts, facilitate carbon co-metabolism and carbon-flux redirection towards targeted products using recently engineered microorganisms, and address specific product-related challenges, to provide perspectives on future research needs and developments. The strategies and views presented here could guide future studies in developing feasible and economically sustainable LCM-based biorefineries as a crucial node in achieving carbon neutrality.

Surgeons' attitudes during laparoscopic appendectomy: do subjective intraoperative assessments affect the choice of peritoneal irrigation? A spin-off analysis from the REsiDENT-1 multicentre prospective observational trial

AIMS

Laparoscopic appendectomy (LA) for acute appendicitis (AA) is one of the most performed procedures. The effects of peritoneal lavage (PL) and the reasons to perform it have not been cleared and all meta-analyses didn't show a statistical advantage to prevent infectious complications. This study aims to investigate surgeons' perceptions during LA, comparing intraoperative findings with histological results, and exploring how surgeons' subjectivity influences the decision-making process on PL.

METHODS

Data were extracted from the two-year data lock from REsiDENT-1 registry, a prospective resident-led multicentre observational trial. This study investigates the relationships between PL and postoperative intraabdominal abscesses (pIAA) introducing a classification for AA to standardize the intraoperative grading. We included pre, intra, and postoperative variables. We applied our classification proposal, used a five-point Likert scale (Ls) to assess subjective LA difficulty and ran a concordance analysis between the assessment of AA and histology. Subsequently, a multivariate logistic regression model was built to find factors influencing PL.

RESULTS

561 patients were enrolled from twenty-one hospitals and 51 residents. 542 procedures were included in the logistic regression analysis and 441 in the concordance analysis, due to missing data. PL was used in 222 LA (39, 6%). We discovered a moderate positive monotonic relationship between surgical evaluation and histology, p < 0.001. Despite this, the reliability of the surgeon's assessment of appendicitis is progressively lower for gangrenous and perforated forms. The increasing grade of contamination, the increasing grade of subjective difficulty and the intraoperative finding of a gangrenous or perforated appendicitis were independent predictors of PL.

CONCLUSION

This study shows how surgeons' evaluation of AA severity overestimated more than half of gangrenous or perforated appendices with the perception of a challenging procedure. These perceptions influenced the choice of PL. We proved that the evaluation during LA could be affected by subjectivity with a non-negligible impact on the decision-making process.

Sleeve Gastrectomy with Rossetti Fundoplication Increases Lower Esophageal Sphincter Tone Preventing Gastroesophageal Reflux Disease: High-Resolution Manometry Assessment

Background: Laparoscopic sleeve gastrectomy (LSG) is associated with the long-term development of gastroesophageal reflux disease (GERD). Recent studies on LSG with fundoplication showed a lower rate of postoperative GERD than LSG alone; however, there is a lack of objective instrumental data in the literature. This study aimed to evaluate whether and how fundoplication associated with Sleeve Gastrectomy affects the esophagogastric physiology. Materials and Methods: This prospective observational study included 20 patients with morbid obesity, GERD, and lower esophageal sphincter (LES) hypotonia. All the patients underwent LSG with Rossetti fundoplication. High-resolution manometry was performed pre- and postoperatively. All the patients completed the 6 months follow-up. Results: The fundoplication increased LES tone in all patients. The increase in the LES tone was statistically significant (330% increase). The integrated relaxation pressure and the distal contractile integral both increased accordingly, indicating an increased esophageal effort to pass through the modified esophagogastric junction. Conclusion: Rossetti fundoplication associated with LSG increased LES tone and decreased the chance of developing long-term GERD after LSG.

Impact of temperature and biomass augmentation on biosulfur-driven autotrophic denitrification in membrane bioreactors treating real nitrate-contaminated groundwater

Nitrate (NO₃^-) contamination of groundwater is a major health concern worldwide as it can lead to serious illnesses such as methemoglobinemia and cancer. Autotrophic denitrification is a smart approach for treating groundwater, being typically organic-deficient. Lately, biogenic sulfur (S⁰_bio) has emerged as a sustainable, free, and high-efficiency substrate to fuel membrane bioreactors (MBRs) treating contaminated groundwater. However, the effects of moderate temperature and biomass concentration on the performance and fouling of the S⁰_bio-fed MBR were not investigated previously. This study shows that biomass levels of ~1 g MLVSS/L limit membrane fouling but also denitrification efficiency. Biomass augmentation up to 3 g MLVSS/L enhanced denitrification but worsened fouling due to increase of extracellular polymeric substance (EPS) levels in the bulk liquid. Temperature decrease from 30 °C to 20 °C halved denitrification efficiency, which could be partially recovered through bioaugmentation. The mechanisms affected by temperature decrease, practical applications, and future research needs were discussed.

Enhancement and mechanisms of micron-pyrite driven autotrophic denitrification with different pretreatments for treating organic-limited waters

Pyrite-driven autotrophic denitrification (PAD) represents a cheap and promising way for nitrogen removal from organic-limited wastewater, which has obtained increasing attention in recent years. However, the limited denitrification rate and unclear mechanism underlying the process have hindered the engineered application of PAD. This study aims to shed light on the impacts of different pretreatments (i.e., ultrasonication, acid-washing and calcination) on micron-pyrite surface characteristics, denitrification performance and biofilm formation during PAD in batch reactors. A series of solid-phase analyses revealed that all pretreatments could significantly promote biofilm attachment on pyrite granules, but impacted the proportion, distribution and chemical oxidation state of sulfur (S) and iron (Fe) at varying degrees. Batch tests showed that ultrasonication and acid-washing could enhance the total nitrogen reduction rate by 14% and 99%, and decrease the sulfate production rate by 51% and 42%, respectively, when compared with untreated pyrite. Microbial community analysis indicated that Thiobacillus and Rhodanobacter dominated in PAD systems. Two types of indirect mechanisms (i.e., contact and non-contact) for pyrite leaching may co-occur in PAD system, resulting in ferrous iron (Fe²⁺), thiosulfate (S₂O₃^2-) and sulfide (S^2-) as the main electron donors for denitrification. A PAD mechanism model was proposed to describe the PAD electron transfer pathway with the aim to optimize the engineered application of PAD for nitrogen removal.

Sludge minimization in mainstream wastewater treatment: Mechanisms, strategies, technologies, and current development

Excess sludge production in wastewater treatment plants has become an enormous environmental issue worldwide mainly due to the increased efforts towards wastewater purification. Researchers and plant operators are looking for technological solutions to reduce sludge production through the upgrading of existing technologies and configurations or by substituting them with alternative solutions. Several strategies have been identified to reduce sludge production, including the use of biological and physical-chemical methods (or a combination of them) and novel technologies, although many have not been sufficiently tested at full-scale. To select the most suitable system for sludge reduction, understanding the reduction mechanisms, advantages, disadvantages, and the economic and environmental impact of each technology is essential. This work offers a comprehensive and critical overview of mainstream sludge reduction technologies and underlying mechanisms from laboratory to full scale, and describes potential application, configuration, and integration with conventional systems. Research needs are highlighted, and a techno-economic-environmental comparison of the existing technologies is also proposed.

Simultaneous nitrification-denitrification in biofilm systems for wastewater treatment: Key factors, potential routes, and engineered applications

Simultaneous nitrification-denitrification (SND) is an advantageous bioprocess that allows the complete removal of ammonia nitrogen through sequential redox reactions leading to nitrogen gas production. SND can govern nitrogen removal in single-stage biofilm systems, such as the moving bed biofilm reactor and aerobic granular sludge system, as oxygen gradients allow the development of multilayered biofilms including nitrifying and denitrifying bacteria. Environmental and operational conditions can strongly influence SND performance, biofilm development and biochemical pathways. Recent advances have outlined the possibility to reduce the carbon and energy consumption of the process via the "shortcut pathway", and simultaneously remove both N and phosphorus under specific operational conditions, opening new possibilities for wastewater treatment. This work critically reviews the factors influencing SND and its application in biofilm systems from laboratory to full scale. Operational strategies to enhance SND efficiency and hints to reduce nitrous oxide emission and operational costs are provided.

Radiation Damage in Polyethylene Naphthalate Thin-Film Scintillators

This paper describes the scintillation features and the radiation damage in polyethylene naphthalate 100 µm-thick scintillators irradiated with an 11 MeV proton beam and with a 1 MeV electron beam at doses up to 15 and 85 Mrad, respectively. The scintillator emission spectrum, optical transmission, light yield loss, and scintillation pulse decay times were investigated before and after the irradiation. A deep blue emission spectrum peaked at 422 nm, and fast and slow scintillation decay time constants of the order of 1-2 ns and 25-30 nm, respectively, were measured. After irradiation, transmittance showed a loss of transparency for wavelengths between 380 and 420 nm, and a light yield reduction of ~40% was measured at the maximum dose of 85 Mrad.

Phosphorous removal and recovery from urban wastewater: Current practices and new directions

Phosphate rocks are an irreplaceable resource to produce fertilizers, but their availability will not be enough to meet the increasing demands of agriculture for food production. At the same time, the accumulation of phosphorous discharged by municipal wastewater treatment plants (WWTPs) is one of the main causes of eutrophication. In a perspective of circular economy, WWTPs play a key role in phosphorous management. Indeed, phosphorus removal and recovery from WWTPs can both reduce the occurrence of eutrophication and contribute to meeting the demand for phosphorus-based fertilizers. Phosphorous removal and recovery are interconnected phases in WWTP with the former generally involved in the mainstream treatment, while the latter on the side streams. Indeed, by reducing phosphorus concentration in the WWTP side streams, a further improvement of the overall phosphorus removal from the WWTP influent can be obtained. Many studies and patents have been recently focused on treatments and processes aimed at the removal and recovery of phosphorous from wastewater and sewage sludge. Notably, new advances on biological and material sciences are constantly put at the service of conventional or unconventional wastewater treatments to increase the phosphorous removal efficiency and/or reduce the treatment costs. Similarly, many studies have been devoted to the development of processes aimed at the recovery of phosphorus from wastewaters and sludge to produce fertilizers, and a wide range of recovery percentages is reported as a function of the different technologies applied (from 10-25% up to 70-90% of the phosphorous in the WWTP influent). In view of forthcoming and inevitable regulations on phosphorous removal and recovery from WWTP streams, this review summarizes the main recent advances in this field to provide the scientific and technical community with an updated and useful tool for choosing the best strategy to adopt during the design or upgrading of WWTPs.

Pyrite-assisted denitrification in recirculated biofilter tolerates pH lower than 5

This study demonstrates the feasibility of pyrite-assisted denitrification to treat mildly acidic wastewaters and proposes a convenient solution for nitrogen removal from acidic mining waters. Pyrite is a highly available and low-cost electron donor for autotrophic denitrification, whereas mining waters represent a source of nitrogen (N) contamination due to the use of N-containing explosives during mining operations and cyanide (CN)-based compounds for ore processing. In this study, the denitrification performance of a recirculated pyrite-packed biofilter (RPPB) treating simulated N-contaminated acidic mining waters is evaluated under decreasing pH conditions. The effect of feed organic carbon on the autotrophic process has been also investigated. N removal efficiencies (NRE) > 60% could be achieved at feed pH ≥ 4.5 and HRT ≥ 5 h. Decrease of influent pH to 3.0 reduced the NRE to 20%. The addition of 10 and 20 mg/L of ethanol to the influent did not significantly impact NRE of the RPPB. PRACTITIONER POINTS: Pyrite-assisted denitrification is proposed for treating acidic wastewaters. Nitrogen removal >60% was maintained at feed pH as low as 4.7. Decrease of feed pH to 3 strongly inhibited denitrification. The presence of organic carbon in the feed did not affect the autotrophic process.

Comparison of Laparoscopic Sleeve Gastrectomy Bleeding and Leakage Rates in Four Staple-Line Reinforcement Methods: A Prospective Observational Study

Introduction: Staple-line bleeding and gastric leakage are the most serious complications of laparoscopic sleeve gastrectomy (LSG). Reinforcement of the staple line is reported to be a method to reduce these complications rates, but the question of which method is preferable is a matter of controversy in the literature. In this study, we compared different staple-line reinforcement methods to assess their efficiency in preventing staple-line bleeding and leakage. Materials and Methods: Two hundred patients eligible for LSG were enrolled in the study and randomized into five groups based on the reinforcement method used during surgery: no reinforcement, oversewing using 3-0 polydioxanone (PDS) suture, oversewing using 4-0 barbed absorbable closure device (V-Lock), fibrin sealant glue, and buttress material. Intraoperative and postoperative complications were recorded and analyzed. Differences were considered statistically significant for P < .05. Results: The no-reinforcement group showed higher bleeding rates (20%), although only 2.5% of the patients required reintervention. All groups using staple-line reinforcement showed better outcomes in bleeding rates (P < .05). No statistically significant differences were observed among the groups in terms of the leakage rate, reintervention rate, intraoperative complications, and operative times. Conclusion: The reinforcement of the staple line decreased the bleeding rate in sleeve gastrectomy but did not affect the gastric leakage rate.

An Unexpected High Rate of Internal Hernia in Our OAGB Experience as Revisional Surgery for Morbid Obesity

Introduction: Internal hernia (IH) is a well-known complication of laparoscopic roux-en-y gastric bypass (LRYGB) with a reported incidence that ranges from 0% to 5%. In one anastomosis gastric bypass (OAGB), internal herniation is reported to be absent due to the lack of a jejuno-jejunostomy, which is present in LRYGB. Several papers reported large case series of patients undergoing OAGB with no IH through Petersen mesenteric defect. Consequently, there is no recommendation for routine closure of the mesenteric defects in OAGB. However, starting from 2015, some authors started reporting this complication in OAGB procedures. Material andMethods: The outcomes of 98 cases of revisional OAGB performed at our institution from 2014 were retrospectively collected. OAGB was secondary surgery following laparoscopic Sleeve Gastrectomy (LSG) in 96% of patients. The indications for secondary surgery were weight regain and/or severe Gastro-esophageal Reflux Disease (GERD). Outcomes of all OAGB procedures were collected at baseline and at 1, 3, 6, 12 and 24 months. Results: The rate of complications ( 30 days after discharge) requiring new surgery was 21.4% (21/98). The main causes of reintervention were the persistence of severe GERD/Biliary Reflux (14/21) and bowel obstruction due to Internal Hernia (4/21). IH was found in 4% of patients. Conclusion: Internal Hernia could be more common than reported in literature. The closure of mesenteric defects in OAGB should always be performed during revisional surgery for complicated IH.

Sequential sulfur-based denitrification/denitritation and nanofiltration processes for drinking water treatment

Efficient and cost-effective solutions for nitrogen removal are necessary to ensure the availability of safe drinking water. This study proposes a combined treatment for nitrogen-contaminated groundwater by sequential autotrophic nitrogen removal in a sulfur-packed bed reactor (SPBR) and excess sulfate rejection via nanofiltration (NF). Autotrophic nitrogen removal in the SPBR was investigated under both denitrification and denitritation conditions under different NO₃^- and NO₂^- loading rates (LRs) and feeding strategies (NO₃^- only, NO₂^- only, or both NO₃^- and NO₂^- in the feed). Batch activity tests were carried out during SPBR operation to evaluate the effect of different feeding conditions on nitrogen removal activity by the SPBR biofilm. Bacteria responsible for nitrogen removal in the bioreactor were identified via Illumina sequencing. Dead-end filtration tests were performed with NF membranes to investigate the elimination of excess sulfate from the SPBR effluent. This study demonstrates that the combined process results in effective groundwater treatment and evidences that an adequately high nitrogen LR should be maintained to avoid the generation of excess sulfide.

Air side-stream ammonia stripping in a thin film evaporator coupled to high-solid anaerobic digestion of sewage sludge: Process performance and interactions

Air side-stream ammonia stripping in a thin-film evaporator (TFE) is proposed for the first time to control total ammonia nitrogen (TAN) concentration in a centralized full-scale plant performing high-solid anaerobic digestion (HSAD) of sewage sludge (SS). In this process, anaerobically digesting sludge (ADS) is continuously recirculated from the digester to the TFE unit where ammonia is stripped by an air stream. The stripped ammonia reacts with sulfuric acid in an absorption unit to produce ammonium sulfate. Overall, HSAD coupled to air side-stream ammonia stripping results in a twofold production of fertilizers (i.e. ammonium sulfate and SS digestate) recycling nutrients from organic wastes in agreement with the principles of circular economy. This study evaluates the influence of different operational airflow rates, temperatures and CO₂ concentrations on air side-stream ammonia stripping in the TFE without alkali addition and the impact of air-based ammonia stripping on HSAD performance at full-scale. The study also investigates the chemistry and the interaction between the ammonia and carbonate subsystems of ADS and clarifies the stoichiometric relationship between ammonia and CO₂ stripping.

Shortcut nitrification-denitrification and biological phosphorus removal in acetate- and ethanol-fed moving bed biofilm reactors under microaerobic/aerobic conditions

This study investigated the feasibility of coupling simultaneous partial nitrification and denitrification (SPND) to biological phosphorus removal in continuous-flow intermittently-aerated moving bed biofilm reactors (MBBRs) fed with different carbon sources, i.e. ethanol and acetate. Bacterial cultivation at pH 8.2 (±0.2), 26-28 °C and SRT of 4 day and microaerobic/aerobic MBBR operation allowed to achieve average dissolved organic carbon (DOC), total inorganic nitrogen (TIN) and P-PO₄^3- removal efficiencies (REs) of 100%, 81-88% and 83-86% at HRT of 1 day, dissolved oxygen (DO) range of 0.2-3 mg L^-1 and feed C/N and C/P ratios of 3.6 and 11, respectively. Acetate supplementation favored a diversified microbial community, while overgrowth of heterotrophs was observed when increasing feed C/N ratio in ethanol-fed MBBR. Illumina sequencing displayed the presence of putative phosphorus accumulating organisms (PAOs) such as Hydrogenophaga and Pseudomonas in MBBR biofilm and suspended biomass, whereas no typical NOB was identified during the study.

Simultaneous denitrification, phosphorus recovery and low sulfate production in a recirculated pyrite-packed biofilter (RPPB)

The simultaneous removal of nitrate (15 mg N-NO₃^- L^-1) and phosphate (12 mg P-PO₄^3- L^-1) from nutrient-polluted synthetic water was investigated in a recirculated pyrite-packed biofilter (RPPB) under hydraulic retention time (HRT) ranging from 2 to 11 h. HRT values ≥ 8 h resulted in nitrate and phosphate average removal efficiency (RE) higher than 90% and 70%, respectively. Decrease of HRT to 2 h significantly reduced the RE of both nitrogen and phosphorus. The RPPB showed high resiliency as reactor performance recovered immediately after HRT increase to 5 h. Solid-phase characterization of pyrite granules and backwashing material collected from the RPPB at the end of the study revealed that iron-phosphate, -hydroxide and -sulfate precipitated in the bioreactor. Thermodynamic modeling predicted the formation of S⁰ during the study. Residence time distribution tests showed semi-complete mixing hydrodynamic flow conditions in the RPPB. The RPPB can be considered an elegant and low-cost technology coupling biological nitrogen removal to the recovery of phosphorus, iron and sulfur via chemical precipitation.

Simultaneous nitrification, denitrification and phosphorus removal in a continuous-flow moving bed biofilm reactor alternating microaerobic and aerobic conditions

A continuous-flow moving bed biofilm reactor (IAMBBR) alternating microaerobic and aerobic conditions was used to remove carbon, nitrogen and phosphorus through simultaneous nitrification and denitrification coupled to phosphorus removal (SNDPR). The IAMBBR was operated under different dissolved oxygen (DO) ranges (0.2-2, 0.2-3 and 0.2-4 mg L^-1) and feed C/N ratios (2.8, 3.6 and 4.2) at HRT of 1 day. At a DO range of 0.2-3 mg L^-1 and feed C/N ratio of 3.6, the IAMBBR achieved simultaneous removal of dissolved organic carbon (DOC), total inorganic nitrogen (TIN) and P-PO₄^3- with average efficiencies of 100%, 62% and 75%, respectively. Illumina sequencing revealed the coexistence of nitrifiers and P-accumulating denitrifiers (e.g. Hydrogenophaga) in the IAMBBR biofilm. Batch activity tests showed that phosphorus uptake did not occur under stable anaerobic or anoxic conditions, nor under aerobic conditions in absence of nitrate.

Comparison of biogenic and chemical sulfur as electron donors for autotrophic denitrification in sulfur-fed membrane bioreactor (SMBR)

Two sulfur-oxidizing membrane bioreactors (SMBRs) performing autotrophic denitrification at different HRTs (6-26 h), one supplemented with biogenic elemental sulfur (S⁰_bio) and the other with chemically-synthesized elemental sulfur (S⁰_chem), were compared in terms of nitrate reduction rates, impact on membrane filtration and microbial community composition. Complete denitrification with higher rates (up to 286 mg N-NO₃^-/L d) was observed in the SMBR supplemented with S⁰_bio (SMBR_bio), while nitrate was never completely reduced in the SMBR fed with S⁰_chem (SMBR_chem). Trans membrane pressure was higher for SMBR_bio due to smaller particle size and colloidal properties of S⁰_bio. Microbial communities in the two SMBRs were similar and dominated by Proteobacteria, with Pleomorphomonas and Thermomonas being the most abundant genera in both bioreactors. This study reveals that S⁰_bio can be effectively used for nitrate removal in autotrophic denitrifying MBRs and results in higher nitrate reduction rates compared to S⁰_chem.

Effect of carbon-to-nitrogen ratio on simultaneous nitrification denitrification and phosphorus removal in a microaerobic moving bed biofilm reactor

In this study, long-term simultaneous nitrification denitrification (SND) and phosphorous removal were investigated in a continuous-flow microaerobic MBBR (mMBBR) operated at a dissolved oxygen (DO) concentration of 1.0 (±0.2) mg L^-1. The mMBBR performance was evaluated at different feed carbon-to-nitrogen (C/N) ratios (2.7, 4.2 and 5.6) and HRTs (2 days and 1 day). Stable long-term mMBBR operation and chemical oxygen demand (COD), total inorganic nitrogen (TIN) and phosphorous (P-PO₄^3-) removal efficiencies up to 100%, 68% and 72%, respectively, were observed at a feed C/N ratio of 4.2. Lower TIN removal efficiency and unstable performance were observed at feed C/N ratios of 2.7 and 5.6, respectively. HRT decrease from 2 days to 1 day resulted in transient NH₄⁺ accumulation and higher NO₂^-/NO₃^- ratio in the effluent. Batch activity tests showed that biofilm cultivation at a feed C/N ratio of 4.2 resulted in the highest denitrifying activity (189 mg N gVSS^-1 d^-1), whereas the highest nitrifying activity (316 mg N gVSS^-1 d^-1) was observed after cultivation at a feed C/N ratio of 2.7. Thermodynamic modeling with Visual MINTEQ and stoichiometric evaluations revealed that P removal was mainly biological and can be attributed to the P-accumulating capacity of denitrifying bacteria.

Transient-state operation of an anoxic biotrickling filter for H2S removal

The application of an anoxic biotrickling filter (BTF) for H₂S removal from contaminated gas streams is a promising technology for simultaneous H₂S and NO₃^- removal. Three transient-state conditions, i.e. different liquid flow rates, wet-dry bed operations and H₂S shock loads, were applied to a laboratory-scale anoxic BTF. In addition, bioaugmentation of the BTF with a H₂S removing-strain, Paracoccus MAL 1HM19, to enhance the biomass stability was investigated. Liquid flow rates (120, 60 and 30 L d^-1) affected the pH and NO₃^- removal efficiency (RE) in the liquid phase. Wet-dry bed operations at 2-2 h and 24-24 h reduced the H₂S elimination capacity (EC) by 60-80%, while the operations at 1-1 h and 12-12 h had a lower effect on the BTF performance. When the BTF was subjected to H₂S shock loads by instantly increasing the gas flow rate (from 60 to 200 L h^-1) and H₂S inlet concentration (from 112 (± 15) to 947 (± 151) ppm_v), the BTF still showed a good H₂S RE (>93%, EC of 37.8 g S m^-3 h^-1). Bioaugmentation with Paracoccus MAL 1HM19 enhanced the oxidation of the accumulated S⁰ to sulfate in the anoxic BTF.

Calcitonin negative Medullary Thyroid Carcinoma: a challenging diagnosis or a medical dilemma?

BACKGROUND

Medullary thyroid carcinoma is a neuroendocrine tumor belonging form a malignant growth of the thyroid parafollicular C-cells, representing from 1 to 10% of all thyroid cancer. The biochemical activity of medullary thyroid carcinoma includes the production of calcitonin and carcinoembryogenic antigen, which are sensitive tumor markers, facilitating the diagnosis, follow-up and prognostication. The diagnosis is reached through the identification of high basal calcitonin serum level or after pentagastrin stimulation test. Medullary thyroid carcinoma is able to produce other relevant biomarkers as procalcitonin, carcinoembryionic antigen and chromogranin A. In Literature are described few cases of medullary thyroid carcinoma without elevation of serum calcitonin, an extremely rare event. The aim of this study was to analyse the presentation, the main features and therapeutic management of medullary thyroid carcinoma associated with negative serum calcitonin levels.

METHODS

Using the PubMed database, a systematic review of the current Literature was carried out, up to February 2018. Finally, nineteen articles met our inclusion criteria and were selected according to the modified Newcastle-Ottawa scale.

RESULTS

Fourty-nine patients with definitive pathology confirming medullary thyroid carcinoma and with calcitonin serum level in the normal range were identified (24 female, 24 male and not reported gender in 1 case). Mean age was 51.7 years. Serum calcitonin levels were reported for 20 patients with a mean value of 8.66 pg/mL and a range of 0.8-38 pg/mL. Despite the low or undetectable calcitonin serum level, at immunochemistry in almost the half of the cases reported by the Authors, the tumors presented diffuse or focal positivity for calcitonin and carcinoembryionic antigen, while was reported a chromogranin A positivity in 41 of the 43 tested patients.

CONCLUSIONS

Calcitonin negative medullary thyroid carcinoma is an extremely rare pathology. The diagnosis and the surveillance is often challenging and delayed, due to the lack of elevation of serum markers as calcitonin and carcinoembryionic antigen. Further studies are needed, to better define options for management of non secretory medullary thyroid carcinoma and to identify new and reliable biomarkers associated to diagnosis and relapse of this medical dilemma.

The role of prophylactic central compartment lymph node dissection in elderly patients with differentiated thyroid cancer: a multicentric study

BACKGROUND

Prophylactic central neck lymph-nodes dissection is still a topic of major debate in Literature. There is a lack of randomized controlled trials proving advantages in its application in terms of overall survival and local recurrence. Due to the recent rapid increase of elderly population, differentiated tumor carcinoma diagnosis increased in patients over 65 years old. The aim of this study was to compare recurrence rate, complications rate and histological features of tumors in elderly population.

METHODS

A retrospective study was carried out collecting data from 371 patients with differentiated thyroid cancer without clinical evidence of lymph-nodes involvement in three Italian referral centers from 2005 to 2015. All patients were aged ≥ 65 years and were divided in two groups based on the performed surgery (total thyroidectomy alone or associated with central lymph-nodes dissection). Moreover, patients were stratified according to the age between 65 and 74 years old and over 75 years old.

RESULTS

Total thyroidectomy alone was performed in 184 patients (group A) and total thyroidectomy with prophylactic central neck dissection was performed in 187 cases (group B). There was a statistically significant difference in complications between the groups in terms of neck hematoma (0.5% group A vs 3.7% group B), temporary hypoparathyroidism (11.4% group A vs 21.4% group B), and temporary unilateral recurrent nerve injury (1.5% group A vs 6.4% group B). Lymph nodes recurrence rate was 9.2% in group A and 8.5% in group B, with no statistically significant difference. There was a statistically significant difference in patients over 75 years old in terms of temporary hypoparathyroidism (24% group A vs 11% group B), permanent hypoparathyroidism (2,7% group A vs 0,3% group B) and recurrent nerve injury (9,5% group A vs 2% group B).

CONCLUSIONS

The role of prophylactic central neck dissection is still controversial, especially in elderly patients, and an aggressive surgical approach should be carefully evaluated. The Authors reported a similar low recurrence rate between total thyroidectomy and total thyroidectomy associated with prophylactic central neck dissection, with increased postoperative complications in the lymphadenectomy group and in patients over 75 years old, advocating a tailored surgical approach in elderly population.

H2S removal and microbial community composition in an anoxic biotrickling filter under autotrophic and mixotrophic conditions

Removal of H₂S from gas streams using NO₃^--containing synthetic wastewater was investigated in an anoxic biotrickling filter (BTF) at feed N/S ratios of 1.2-1.7 mol mol^-1 with an empty bed residence time of 3.5 min and a hydraulic retention time of 115 min. During 108 days of operation under autotrophic conditions, the BTF showed a maximum elimination capacity (EC) of 19.2 g S m^-3 h^-1 and H₂S removal efficiency (RE) >99%. When the BTF was operated under mixotrophic conditions by adding organic carbon (10.2 g acetate m^-3 h^-1) to the synthetic wastewater, the H₂S EC decreased from 16.4 to 13.1 g S m^-3 h^-1, while the NO₃^- EC increased from 9.9 to 11.1 g NO₃^--N m^-3 h^-1, respectively. Thiobacillus sp. (98-100% similarity) was the only sulfur-oxidizing nitrate-reducing bacterium detected in the BTF biofilm, while the increased abundance of heterotrophic denitrifiers, i.e. Brevundimonas sp. and Rhodocyclales, increased the N/S ratio during BTF operation. Residence time distribution tests showed that biomass accumulation during BTF operation reduced gas and liquid retention times by 17.1% and 83.5%, respectively.

Real-time dosimetry with radiochromic films

Radiochromic film dosimetry has been widely employed in most of the applications of radiation physics for over twenty years. This is due to a number of appealing features of radiochromic films, such as reliability, accuracy, ease of use and cost. However, current radiochromic film reading techniques, based on the use of commercial densitometers and scanners, provide values of dose only after the exposure of the films to radiation. In this work, an innovative methodology for the real-time reading of radiochromic films is proposed for some specific applications. The new methodology is based on opto-electronic instrumentation that makes use of an optical fiber probe for the determination of optical changes of the films induced by radiation and allows measurements of dose with high degree of precision and accuracy. Furthermore, it has been demonstrated that the dynamic range of some kinds of films, such as the EBT3 Gafchromic films (intensively used in medical physics), can be extended by more than one order of magnitude. Owing to the numerous advantages with respect to the commonly used reading techniques, a National Patent was filed in January 2018.

Open-Hardware and Application Specific Design for the Monitoring System of the Belle II Forward/Backward Electromagnetic Calorimeter

Control and monitoring of experimental facilities as well as laboratory equipment requires handling a blend of different tasks. Often in industrial or scientific fields there are standards or form factor to comply with and electronic interfaces or custom busses to adopt. With such tight boundary conditions, the integration of an off-the-shelf Single Board Computer (SBC) is not always a possible or viable alternative. The availability of electronic schematics and PCBs with open-source Hardware license for various SBCs overcomes such integration problems, making feasible the implementation of a custom architecture composed by a central core inherited from a vendor reference design (most likely the microprocessor, static RAM and flash memory) augmented with application-specific integrated circuits and hardware resources, in order to handle the requirements of the specific environment. The user is then able to exploit most of the supported tools and software provided by opensource community, fulfilling all the constraints enforced by his environment. We have used such an approach for the design and development of the monitoring system of the endcap electromagnetic calorimeter of the Belle II experiment, presently running at KEK Laboratory (Tsukuba, Japan). Here we present and discuss the main aspects of the hardware architectures and noise performances tailored on the needs of a detector designed around CsI crystal scintillators.

Single center experience with laparoscopic adrenalectomy on a large clinical series

BACKGROUND

Laparoscopic adrenalectomy is considered the gold standard technique for the treatment of benign small and medium size adrenal masses (<6 cm), due to low morbidity rate, short hospitalization and patient rapid recovery. The aim of our study is to analyse the feasibility and efficiency of this surgical approach in a broad spectrum of adrenal gland pathologies.

METHODS

Pre-operative, intra-operative and post-operative data from 126 patients undergone laparoscopic adrenalectomy between January 2003 and December 2015 were retrospectively collected and reviewed. Diagnosis was obtained on the basis of clinical examination, laboratory values and imaging techniques. Doxazosin was preoperatively administered in case of pheochromocytoma while spironolactone and potassium were employed to treat Conn's disease. Laparoscopic adrenalectomies were all performed by the same surgeon (CG). First 30 procedures were considered as learning curve adrenalectomies.

RESULTS

One hundred twenty-six patients were included in the study. Functioning tumors were diagnosed in 84 patients, 27 patients were affected by pheochromocytomas, 29 by Conn's disease, 28 by Cushing disease. Surgery mean operative time was 137.33 min (range 100-180) during the learning curve adrenalectomies and 96.5 min (range 75-110) in subsequent procedures. Mean blood loss was respectively 160.2 ml (range 60-280) and 90.5 ml (range 50-200) in the first 30 procedures and the subsequent ones. Only one conversion to open surgery occurred. No post-operative major complications were observed, while minor complications occurred in 8 patients (0,79%). In 83 out of 84 functioning neoplasms, laparoscopic adrenalectomy was effective in normalization of endocrine profile.

CONCLUSIONS

Laparoscopic adrenalectomy is a safe and feasible procedure, even for functioning masses and pheochromocytomas. A multidisciplinary team including endocrinologists, endocrine surgeons and anaesthesiologists, is recommended in the management of adrenal pathology, and adrenal surgery should be performed in referral high volume centers. A thirty-procedures learning curve is recommended to improve surgical outcomes.

Effects of different nickel species on autotrophic denitrification driven by thiosulfate in batch tests and a fluidized-bed reactor

Nickel is a common heavy metal and often occurs with nitrate (NO₃^-) in effluents from mining and metal-finishing industry. The present study investigates the effects of increasing concentrations (5-200mgNi/L) of NiEDTA^2- and NiCl₂ on autotrophic denitrification with thiosulfate (S₂O₃^2-) in batch tests and a fluidized-bed reactor (FBR). In batch bioassays, 50 and 100mgNi/L of NiEDTA^2- only increased the transient accumulation of NO₂^-, whereas 25-100mgNi/L of NiCl₂ inhibited denitrification by 9-19%. NO₃^- and NO₂^- were completely removed in the FBR at feed NiEDTA^2- and NiCl₂ concentrations as high as 100 and 200mgNi/L, respectively. PCR-DGGE revealed the dominance of Thiobacillus denitrificans and the presence of the sulfate-reducing bacterium Desulfovibrio putealis in the FBR microbial community at all feed nickel concentrations investigated. Nickel mass balance, thermodynamic modeling and solid phase characterization indicated that nickel sulfide, phosphate and oxide precipitated in the FBR during NiCl₂ injection.

Applications of Accelerators and Radiation Sources in the Field of Space Research and Industry

Beyond their important economic role in commercial communications, satellites in general are critical infrastructure because of the services they provide. In addition to satellites providing information which facilitates a better understanding of the space environment and improved performance of physics experiments, satellite observations are also used to actively monitor weather, geological processes, agricultural development and the evolution of natural and man-made hazards. Defence agencies depend on satellite services for communication in remote locations, as well as for reconnaissance and intelligence. Both commercial and government users rely on communication satellites to provide communication in the event of a disaster that damages ground-based communication systems, provide news, education and entertainment to remote areas and connect global businesses. The space radiation environment is an hazard to most satellite missions and can lead to extremely difficult operating conditions for all of the equipment travelling in space. Here, we first provide an overview of the main components of space radiation environment, followed by a description of the basic mechanism of the interaction of radiation with matter. This is followed by an introduction to the space radiation hardness assurance problem and the main effects of natural radiation to the microelectronics (total ionizing dose, displacement damage and the single-event effect and a description of how different effects occurring in the space can be tested in on-ground experiments by using particle accelerators and radiation sources. We also discuss standards and the recommended procedures to obtain reliable results.