Abstract
Background
There has been a shift in recent years to using ultrasound (US) and magnetic resonance imaging (MRI) as first-line investigations for suspected cranial large vessel vasculitis ...(LVV) and is a new recommendation by the EULAR 2018 guidelines for imaging in LVV. This cross-sectional study compares the performance of US and MRI and contrast-enhanced magnetic resonance angiography (MRA) for detecting vasculitis in patients with giant cell arteritis (GCA).
Methods
Patients with new-onset or already diagnosed GCA were recruited. The common temporal arteries and supra-aortic large vessels were evaluated by US and MRI/MRA. Blinded experts read the images and applied a dichotomous score (vasculitis: yes/no) in each vessel.
Results
Thirty-seven patients with giant cell arteritis (GCA) were recruited. Two patients were excluded. Of the remaining patients, nine had new-onset disease and 26 had established disease. Mean age was 71 years, and median C-reactive protein (CRP) was 7.5 mg/L. The median time between US and MRI was 1 day. Overall, US revealed vasculitic changes more frequently than MRI (
p
< 0.001). US detected vascular changes in 37% of vessels compared to 21% with MRI. Among patients with chronic disease, US detected vascular changes in 23% of vessels compared to 7% with MRI in (
p
< 0.001). The same was true for patients with new-onset disease. US detected vasculitic changes in 22% of vessels and MRI detected disease in 6% (
p
= 0.0004). Compared to contrast-enhanced MRA, US was more sensitive in detecting vasculitic changes in the large arteries, including the axillary, carotid, and subclavian arteries.
Conclusion
US more frequently detects vasculitic changes in the large arteries compared to contrast-enhanced MRA. When evaluating the cranial vessels, US performs similarly to MRI. This data supports the recommendation that US be considered as a first-line evaluation in patients suspected to have GCA.
Anaerobic digestion is one of the common methods of managing and stabilizing sludge. However, due to the limitations of the biological sludge hydrolysis stage, anaerobic decomposition is slow and ...requires a long time. This study evaluated the effects of thermal (80 °C) (TH-PRE) and a combination of thermal with the lysozyme enzyme (LTH-PRE) pretreatments on the enhancement of anaerobic activated sludge digestion. Response surface methodology was implemented to optimize enzyme pretreatment conditions (enzyme and mixed liquid suspended solids concentration). The results showed that both pretreatment methods increase soluble chemical oxygen demand (COD) and reduces total and volatile suspended solids (VSS), and phosphate concentration. The COD removal rate in LTH-PRE and TH-PRE was 95% and 81%, respectively. The value of VSS reduction in LTH-PRE and TH-PRE was 41% and 31%, more than the control operation, respectively. The biogas production in LTH-PRE and in TH-PRE also increased by 124% and 96%, respectively.
The aim of this study was to evaluate the performance of anaerobic co-digestion of food waste (FW) and sewage sludge (SS) at high organic load with the aid of an inorganic adsorbent supplementary. ...From BMP tests of seven mesophilic reactors, it was found that the stability of the system was hindered at higher organic load due to low alkalinity capacity of sludge (1600 mg/L) and excessive accumulation of inhibitory substances such as free ammonia and VFA. Thus, the low-cost adsorbent was applied to enhance the digestion process stability at high organic load (12.8 g VS/L). The results showed that addition of 1 g of sorghum-based activated carbon (SAC) (4 g TS/L) stabilized the system, reduced ammonia and T-VFA concentration from 267 to 39 mg/L, and 1300 to under 600 mg/L, respectively. Consequently, the methane yield increased from 201 to 272 mL/g VS (35%), solid retention time (SRT) reduced by 34%, and T-COD removal achieved by 79.38%. However, with a further increase of SAC the biogas generation decreased due to excessive adsorption of VFAs.
Graphic abstract
Abstract
In this research, the fate and removal of microplastics (MPs) entering and leaving a wastewater treatment plant (WWTP) was investigated. Additionally, application of the microfiltration ...membrane technique for MPs removal was evaluated. In the first phase, the quantity, type and size of the MPs were studied from three different points of the WWTP. The results showed that the average amount of MPs entering into the WWTP, accumulated in the sludge matrix and discharged from the effluent were 206, 183 and 94 MP/L, respectively. The MPs were observed mainly in the forms of fibers, pellets, and fragments, with a proportion of 35%, 39%, 22%, and 34%, 22%, 38%, and 31%, 39%, 37.7% in the influent, effluent and sludge of the WWTP, respectively. It should be noted, a minor amount of foam (2%) and film (0.3%) was also observed. The particle size distribution of the MPs in the effluent of the system was almost identical (6–14% for 1–5,000 μm), while the influent mostly contained particles within 1–100 μm (above 26%) with other particle sizes within 100–5,000 μm (8–17%). Particle size within a range of 500–5,000 μm was abundant in the sludge. In the second phase, a micro-filtration (MF) membrane with a pore size of 0.1 μm was applied to eliminate the MPs from the WWTP effluent. It was observed the application of the MF membrane technique could achieve MPs removal efficiency up to 98% in the effluent of the system.
Recent approvals for novel agents such as the small molecule Janus kinase inhibitors (JAKi), combined with the advent of biosimilars has widened the gamut of available therapeutic options in the ...treatment of rheumatoid arthritis (RA). This combined with the introduction of mandatory non- medical switches to biosimilars in some jurisdictions by both public and private payors has led to a significant increase in the volume of therapeutic changes for patients. Pharmacists are well positioned to ensure effective and safe transitions, however there is a significant unmet need for objective and subjective clinical guidance around therapy as well disease state monitoring in RA that facilitates best practices throughout the patient journey.
In this paper we aim to create a consensus derived monitoring algorithm for pharmacists to facilitate best practices throughout therapeutic transitions from originator biologic to other originator biologics, biosimilars, and Janus kinase inhibitors in RA.
The Nominal Group Technique (NGT) was used to understand if consensus could be found among the participants. Clinically relevant questions were developed to capture solutions to the identified unmet need. The faculty considered the questions as individuals, and privately generated answers/ideas. After discussion and consideration, the participants ranked the ideas and established a consensus.
Based on the outcome of the consensus discussions, an algorithm was created to help guide pharmacists through therapeutic transitions in RA. The tool covers important topics such as pre-transition considerations, avoiding the nocebo effect for biosimilars, specific considerations for each drug or class, monitoring efficacy, and when to refer.
New classes of anti-rheumatic drugs including JAKi, along with the introduction of biosimilars are presenting more opportunity for therapeutic changes and monitoring in patients with RA. We hope our evidence-based consensus derived guidance tool will assist frontline pharmacists in supporting their patients to a successful therapeutic transition in RA.
To date there is limited data on the immune profile and outcomes of solid organ transplant recipients who encounter COVID-19 infection early post-transplant. Here we present a unique case where the ...kidney recipient’s transplant surgery coincided with a positive SARS-CoV-2 test and the patient subsequently developed symptomatic COVID-19 perioperatively. We performed comprehensive immunological monitoring of cellular, proteomic, and serological changes during the first 4 critical months post-infection. We showed that continuation of basiliximab induction and maintenance of triple immunosuppression did not significantly impair the host’s ability to mount a robust immune response against symptomatic COVID-19 infection diagnosed within the first week post-transplant.
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The impacts of different operational temperatures, and organic load (OL) on the fate of SARS-CoV-2 during the anaerobic co-digestion of food waste (FW) and sewage sludge (SS) was ...evaluated. The lab-scaled batch reactors (i.e. R1-R7) were performed under psychrophilic, mesophilic, and thermophilic conditions and the OL of systems was 1.5, 3.5, 6 gVS/L. The performance parameters showed that at higher OL the stability of systems failed and low biogas was produced. In contrast, increasing of operational temperature of systems induced more biogas generation due to the increment of metabolic activity of bacteria. Therefore, R1-R7 achieved biogas yield of 202.5, 249, 187, 260, 246, 163, and 300 mL/gVS respectively. Both SARS-CoV-2 genes i.e. ORF1ab, and N genes were detected in the effluent of psychrophilic reactors i.e. R1, and R2, with a total concentration of 46 × 103, and 11 × 103 copies/L respectively. In R3, no viral genes were observed, when the VFAs was accumulated up to 2000 mg/L and caused a pH drop to 5.6. At the mesophilic condition, the viral concentration was significantly declined, and no viral genes were observed at an OL of 3.5 gVS/L. Furthermore, the synergistic effect of temperature and accumulation of intermediate metabolites provided a sever condition for SARS-CoV-2 survival at an operational temperature and OL of 50 °C, and 1.5 gVS/L respectively.
The opportunities and challenges of applying micronutrients (MiNs) in full-scale anaerobic digestion (AD) plants has been reviewed. The review discusses the underlying mechanisms and the role of ...different micronutrients (Fe, Ni, Co, Mo, Zn, Cu, Se) in the enhancement of AD performance, as well as their environmental and economic implications in full-scale AD systems. Bioavailability is a key factor affecting the effectiveness of micronutrients application on the biochemical aspects of AD. Accordingly, the technical aspects of AD with a direct impact on bioavailability have been identified and critically addressed. Mono-supplementation is not the most favorable strategy to increase micronutrient bioavailability due to limited solubility, formation of insoluble compounds, interaction with other compounds, and specific microbial requirements. Nonetheless, co-supplementation can increase the bioavailability due to the simultaneous synergetic effects of co-micronutrients supplementation on the biochemical aspects of AD. However, the inconsistency of reported lab-scale results and the lack of protocols or guidelines for analyzing the bioavailability of micronutrients limit results interpretation and full-scale application. The environmental and economic implications of these micronutrients are other critical factors that need further research. The economic results showed that the mono-supplementation can be economically favorable when a methane enhancement of 20% is achieved. Co-supplementation of micronutrients is the most economically feasible option since this strategy allows reducing the total dosage of micronutrients when compared with mono-supplementation.
•The effect of micronutrients addition to anaerobic digestion was reviewed.•Fe, Ni, and Co are the most studied co-MiNs while Fe is the most used mono-MiNs.•Biochemical factors affecting bioavailability of MiNs are discussed.•The environmental impacts of MiNs at biogas plants are not fully understood.•The application of co-MiNs can improve the economics compared to mono-MiNs.
Trace elements play an indispensable role in stabilizing the performance of anaerobic co-digestion (Co-AD) of food waste (FW) and sewage sludge (SS) at greater organic load (OL). The results of high ...organic-loaded reactors showed that the stability of the system failed due to the buildup of volatile fatty acid (VFA) and ammonia. At the OL of 6.5 g/L, the stability of the system failed due to the buildup of propionic acid. The optimum dosage of Fe (5000 mg/L), Ni (200 mg/L), Zn (320 mg/L), and Mo (2.2 mg/L) was experimentally determined and added to reduce the inhibition condition. Consequently, the propionic acid concentration, which was above 1500 mg/L reduced to under 500 mg/L during Co-AD. Hence, higher biogas production, and biodegradability of 236 ± 23 mL/g VS, and 41.75%, respectively, were obtained. Increasing OL (9.5 g/L), the stability of the system was hindered due to only the buildup of ammonia (up to 188 ± 6 NH
3
-N mg/L). Therefore, the trace elements of Cu (250 mg/L) and Co (3 mg/L) were experimentally determined and added into the Co-AD to diminish ammonia accumulation and process instability. The experimental results showed that at OL of 14 g/L, biogas production, low ammonia concentration and biodegradability of 332 ± 21 mL/g VS, and 70 NH3-N mg/L, and 57.89%, respectively, were achieved. However, the performance and stability of the system failed at the higher OL due to the more increased ammonia and VFA concentration, and the greater dosages of trace elements did not enhance the process stability.
Background
Two-phase anaerobic co-digestion (TAcoD) is a versatile technology for the simultaneous treatment of organic materials and biogas production. However, the produced digestate and ...supernatant of the system contain heavy metals and organic substances that need to be treated prior to discharge or land application. Therefore, in this study, an innovative TAcoD for organic fertilizer and high supernatant quality achievement was proposed.
Methods
In the conventional TAcoD, mixed sewage sludge (SS) and food waste (FW) were first hydrolyzed in the acidogenic reactor, and then the hydrolyzate substrate was subjected to the methanogenic reactor (TAcoD 1). In the modified TAcoD (TAcoD 2), only FW was fed into the acidogenic reactor, and the produced hydrolyzed solid was directly converted to the organic fertilizer, while the supernatant with high soluble chemical demand (SCOD) concentration was further co-digested with SS in the methanogenic reactor.
Results
Although TAcoD 1 produced bio-methane yield and potential energy of 56.18% and 1.6-fold higher than TAcoD 2, the economical valorization of TAcoD 2 was 9-fold of that from TAcoD 1. The supernatant quality of TAcoD 2 was far better than TAcoD 1, since the SCOD, total nitrogen (TN), and total phosphor (TP) removal in TAcoD 2 and TAcoD 1 were 94.3%, 79.4%, 90.7%, and 68.9%, 28%, 46%, respectively. In terms of solid waste management, the modified TAcoD converted FW to organic fertilizer and achieved a solid reduction of 43.62% higher than that of conventional TAcoD.
Conclusions
This new modification in two-phase anaerobic co-digestion of food waste and sewage sludge provides a potentially feasible practice for simultaneous bio-methane, organic fertilizer, and high supernatant quality achievement.
Graphical abstract
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