This review aims to assess different technologies for the on-site treatment of hospital wastewater (HWW) to remove pharmaceutical compounds (PhCs) as sustances of emerging concern at a bench, pilot, ...and full scales from 2014 to 2020. Moreover, a rough characterisation of hospital effluents is presented. The main detected PhCs are antibiotics and psychiatric drugs, with concentrations up to 1.1 mg/L. On the one hand, regarding the presented technologies, membrane bioreactors (MBRs) are a good alternative for treating HWW with PhCs removal values higher than 80% in removing analgesics, anti-inflammatories, cardiovascular drugs, and some antibiotics. Moreover, this system has been scaled up to the pilot plant scale. However, some target compounds are still present in the treated effluent, such as psychiatric and contrast media drugs and recalcitrant antibiotics (erythromycin and sulfamethoxazole). On the other hand, ozonation effectively removes antibiotics found in the HWW (>93%), and some studies are carried out at the pilot plant scale. Even though, some families, such as the X-ray contrast media, are recalcitrant to ozone. Other advanced oxidation processes (AOPs), such as Fenton-like or UV treatments, seem very effective for removing pharmaceuticals, Antibiotic Resistance Bacteria (ARBs) and Antibiotic Resistance Genes (ARGs). However, they are not implanted at pilot plant or full scale as they usually consider extra reactants such as ozone, iron, or UV-light, making the scale-up of the processes a challenging task to treat high-loading wastewater. Thus, several examples of biological wastewater treatment methods combined with AOPs have been proposed as the better strategy to treat HWW with high removal of PhCs (generally over 98%) and ARGs/ARBs (below the detection limit) and lower spending on reactants. However, it still requires further development and optimisation of the integrated processes.
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•This review focuses on 2014 to 2020 papers related to hospital effluents treatments.•Membrane bioreactors remove pharmaceuticals (>80%) at pilot plant scale.•Advanced Oxidation processes require further development at high scales.•Combined technologies also remove antibiotic resistance bacteria and genes.•Advanced oxidation processes are promising alternatives to treat hospital effluents.
Purpose
Familial papillary thyroid microcarcinoma (FPTMC) can present a more aggressive behavior than the sporadic microcarcinoma. However, few studies have analyzed this situation. The objective is ...to analyze the recurrence rate of FPTMC and the prognostic factors which determine that recurrence in Spain.
Methods
Spanish multicenter longitudinal analytical observational study was conducted. Patients with FPTMC received treatment with curative intent and presented cure criteria 6 months after treatment. Recurrence rate and disease-free survival (DFS) were analyzed. Two groups were analyzed: group A (no tumor recurrence) vs. group B (tumor recurrence).
Results
Ninety-four patients were analyzed. During a mean follow-up of 73.3 ± 59.3 months, 13 recurrences of FPTMC (13.83%) were detected and mean DFS was 207.9 ± 11.5 months. There were multifocality in 56%, bilateral thyroid involvement in 30%, and vascular invasion in 7.5%; that is to say, they are tumors with histological factors of poor prognosis in a high percentage of cases. The main risk factors for recurrence obtained in the multivariate analysis were the tumor size (OR: 2.574, 95% CI 1.210–5.473;
p
= 0.014) and the assessment of the risk of recurrence of the American Thyroid Association (ATA), both intermediate risk versus low risk (OR: 125, 95% CI 10.638–1000;
p
< 0.001) and high risk versus low risk (OR: 45.454, 95% CI 5.405–333.333;
p
< 0.001).
Conclusion
FPTMC has a recurrence rate higher than sporadic cases. Poor prognosis is mainly associated with the tumor size and the risk of recurrence of the ATA.
Graphical abstract
The aim of this study was to clarify which cognitive mechanisms underlie Trail Making Test (TMT) direct and derived scores. A comprehensive review of the literature on the topic was carried out to ...clarify which cognitive factors had been related to TMT performance. Following the review, we explored the relative contribution from working memory, inhibition/interference control, task-switching ability, and visuomotor speed to TMT performance. Forty-one healthy old subjects participated in the study and performed a battery of neuropsychological tests including the TMT, the Digit Symbol subtest Wechsler Adult Intelligence Scale (Third Version) (WAIS-III), a Finger Tapping Test, the Digits Forward and Backward subtests (WAIS-III), Stroop Test, and a task-switching paradigm inspired in the Wisconsin Card Sorting Test. Correlation and regression analyses were used in order to clarify the joint and unique contributions from different cognitive factors to the prediction of TMT scores. The results suggest that TMT-A requires mainly visuoperceptual abilities, TMT-B reflects primarily working memory and secondarily task-switching ability, while B-A minimizes visuoperceptual and working memory demands, providing a relatively pure indicator of executive control abilities.
We present a 3D map of extinction in the northern Galactic plane derived using photometry from the INT/WFC Photometric Hα Survey of the northern Galactic plane. The map has fine angular ( ∼ 10 ...arcmin) and distance (100 pc) sampling allied to a significant depth (≳5 kpc). We construct the map using a method based on a hierarchical Bayesian model described in a previous article by Sale. In addition to mean extinction, we also measure differential extinction, which arises from the fractal nature of the interstellar medium, and show that it will be the dominant source of uncertainty in estimates of extinction to some arbitrary position. The method applied also furnishes us with photometric estimates of the distance, extinction, effective temperature, surface gravity, and mass for ∼38 million stars. Both the extinction map and the catalogue of stellar parameters are made publicly available via http://www.iphas.org/extinction.
A bottom‐up, multiscale modeling approach is presented to carry out high‐fidelity virtual mechanical tests of composite materials and structures. The strategy begins with the in situ measurement of ...the matrix and interface mechanical properties at the nanometer‐micrometer range to build up a ladder of the numerical simulations, which take into account the relevant deformation and failure mechanisms at different length scales relevant to individual plies, laminates and components. The main features of each simulation step and the information transferred between length scales are described in detail as well as the current limitations and the areas for further development. Finally, the roadmap for the extension of the current strategy to include functional properties and processing into the simulation scheme is delineated.
A bottom‐up, multiscale modeling approach is presented to carry out high‐fidelity virtual mechanical tests of composite materials and structures. The strategy begins with the in situ measurement of the matrix and interface mechanical properties from the nanometer to micrometer range to build up a “ladder” of the numerical simulations, which take into account the relevant deformation and failure mechanisms at different length scales relevant to individual plies, laminates, and components.
•Fermentative strategy and varietal factors modulated the chemical profile of wines.•The chemometric approach identified potential markers for each fermentative strategy.•EBBAs and cinnamates ...highlighted as markers of sequential fermentations.•2-Phenyl acetate and stone fruit highlighted as markers of spontaneous fermentations.•The fermentative strategies contributed to variability and quality of white wines.
This study evaluates the impact on two varietal white wines from ‘Chardonnay’ and ‘Verdejo’ cultivars of different fermentative strategies: inoculation with Saccharomyces cerevisiae yeast (CT), sequential inoculation (Torulaspora delbrueckii/Saccharomyces cerevisiae) (SI), and spontaneous fermentation (SP). The wines’ chemical composition was characterized by oenological parameters, organic acids, metals, major volatile compounds, ester compounds and sensory analyses. The fermentative strategy (CT, SI and SP) was found to be a key factor for assessing different styles of white wines. SI wines showed enhanced ‘mature fruit’ nuances and a chemical profile characterized by higher content of ethyl propanoate, ethyl isobutyrate and ethyl dihydrocinnamate. Meanwhile, the SP wines presented enhanced “stone fruit” nuances possible related to the higher contents of 2-phenyl acetate and isobutyl acetate. After a chemometric approach the above esters were identified as the markers of each fermentative strategy, independently of the variety.
The DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. It involves ...the management by different specialists. The correct identification of the culprit drug is essential for future safe therapeutical options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. Objective: To draft a review and guidelines on the clinical and allergy diagnosis, management treatment and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of multidisciplinary experts.
These guidelines have been elaborated by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Wherever evidence was lacking, a consensus was reached among the experts.
The first Spanish guidelines on DRESS syndrome are now being published. Important aspects as practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm and allergy study have been addressed. Management, treatment and prevention recommendations are provided. Algorithms about management of DRESS in acute and recovery phase have been elaborated. An expert consensus step-wise guidelines for management and treatment of DRESS syndrome are provided.
Background
Nucleic acids, RNA among them, are widely used in biomedicine and Biotechnology. Because of their susceptibility to degradation by RNases, the handling and extraction process of RNA from ...cells and tissues require specialized personnel and standardized methods to guarantee high purity and integrity. Due to the diversity of techniques found in the market, a comparative study between different RNA extraction methods is useful to facilitate the best choice for the researcher or in research service platforms such as biobanks to see the traceability of the samples.
Methods and results
In this study, we have compared seven different RNA extraction methods: manual (TRIzol™), semiautomated (QIAGEN™, Bio-Rad, Monarch®, and Canvax™), and fully automated (QIAcube™ and Maxwell®) processes, from two biological matrices: human Jurkat T cells and peripheral blood mononuclear cells (PBMC). Results showed marked differences in the RNA quality and functionality according to the method employed for RNA extraction and the matrix used.
Discussion
QIAcube™ and semi-automated extraction methods were perceived as the best options because of their lower variability, good functionality, and lower cost (P < 0.001). These data contribute to facilitating researchers or research service platforms (Biobanks) in decision-making practices and emphasize the relevance of the selection of the RNA extraction method in each experimental procedure or traceability study to guarantee both quality standards and its reproducibility.
The misuse of antibiotics has been related to increased morbidity, mortality and bacterial resistance. The development of antimicrobial stewardship programmes (ASPs) has been encouraged by scientific ...societies as an essential measure. An educational, institutionally supported ASP was developed in our tertiary-care centre. Local guidelines on the management of infectious syndromes were created. Antimicrobial prescriptions were chosen arbitrarily weekly and counselling interviews by expert clinicians were carried out, using a paedagogic, non-restrictive methodology. Satisfaction with the interview was assessed using anonymous questionnaires. The appropriateness of antimicrobial prescriptions as well as consumption was assessed prospectively throughout the year. Feedback regarding the correct use of treatments was communicated to each participating department periodically. The improvement in antimicrobial prescription was included among the annual objectives linked to economic incentives in every department. A total of 1206 counselling interviews were carried out during the first year. Fifty-three per cent of antimicrobial prescriptions (176/332) were inappropriate when the programme started. The rate of inappropriate prescriptions continuously declined to 26.4% (107/405) in the fourth trimester (p <0.001; RR = 0.38; 95% CI, 0.23–0.43). Antimicrobial consumption decreased from 1150 defined daily doses (DDDs) per 1000 occupied bed-days in the first trimester to 852 DDDs in the fourth, reflecting a reduction in antimicrobial expenditures of 42%. A total of 352 satisfaction questionnaires were received and 98% described the advice as positive. In conclusion, the implementation of an education-based ASP achieved a significant improvement in all antimicrobial prescriptions in the centre and a reduction in antimicrobial consumption, even when no restrictive measures were implemented. The programme was highly accepted by all prescribers.
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