Estrogen activity was measured in wastewater effluent before and after polishing via soil-aquifer treatment (SAT) using both a (hER-β) competitive binding assay and a transcriptional activation ...(yeast estrogen screen, YES) assay. From the competitive binding assay, the equivalent 17α-ethinylestradiol (EE2) concentration in secondary effluent was 4.7 nM but decreased to 0.22 nM following SAT. The YES assay indicated that the equivalent EE2 concentration in the same effluent sample was below the method-detection limit (<2.5 × 10-3 nM) but increased to 0.68 nM in effluent polished via SAT processes. It was hypothesized that test-dependent differences arose because the competitive binding assay responds positively to both estrogen mimics and anti-estrogens; the YES assay responds to estrogen mimics, but test response is inhibited by anti-estrogens. The hypothesis was supported when organics extracted from wastewater effluent inhibited the YES test response to EE2 (anti-estrogenic effect). A similar extract prepared from SAT-polished effluent augmented the EE2 curve (agonist response). When hydrophobic organics in secondary effluent were fractionated, assay results indicated that several physically distinct anti-estrogens were present in the sample. From this work, it is evident that transcription−activation bioassays alone should not be relied upon to measure estrogenic activity in complex environmental samples because the simultaneous presence of both agonists and antagonist compounds can yield false negatives. Multiple in vitro bioassays, sample fractionation or tests designed to measure anti-estrogenic activity can be used to overcome this problem. It is also clear that there are circumstances under which SAT does not completely remove estrogenic activity during municipal wastewater effluent polishing.
•Depression is clearly associated with mortality in age-adjusted analyses.•Multivariate regression analyses show depression to elevate mortality by multifactorial pathways.•Contrasting previous ...research, depression had a significant effect on mortality in women.
The association of depression with mortality and the significance of explanatory factors, in particularly gender, have remained an issue of debate. We therefore aimed to estimate the effect of depression on all-cause mortality, to examine potential explanatory factors and to assess effect modification by gender.
We used Cox regression models to estimate the effect of depression on mortality based on data from the Gutenberg Health Study, which is a prospective cohort study of the adult population in the districts of Mainz and Mainz-Bingen, Germany. Baseline assessment was between 2007 and 2012. Effect modification by gender was measured on both additive and multiplicative scales.
Out of 14,653 participants, 7.7% were depressed according to Patient Health Questionnaire 9 (PHQ-9), and 1,059 (7.2%) died during a median follow-up of 10.7 years. Depression elevated the risk of mortality in men and women in age-adjusted models (HR: 1.41, 95%-CI: 1.03–1.92; resp. HR: 1.96, 95%-CI: 1.43–2.69). Adjustment for social status, physical health and lifestyle covariates attenuated the effect and in the fully-adjusted model the hazard ratio was 0.96 (95%-CI: 0.69–1.33) in men and 1.53 (95%-CI: 1.10–2.12) in women. For effect modification by gender, the measure on multiplicative interaction was 0.68 (95%-CI 0.44–1.07) and on additive interaction was RERI=-0.47 (95%-CI -1.24–0.30).
The PHQ-9 is a single self-report measure of depression reflecting symptoms of the past two weeks, limiting a more detailed assessment of depression and course of symptoms, which likely affects the association with mortality.
Depression elevates mortality by multifactorial pathways, which should be taken into account in the biopsychosocially informed treatment of depression. Effect modification by gender was not statistically significant.
Abstract Purpose Bulb syringes can be used for the self-clearance of earwax and, in the short term, appear effective. We compared the long-term effectiveness of self-irrigation using a bulb syringe ...with routine care in United Kingdom (UK) family practice clinics where irrigating ears to remove wax is a common procedure. Methods We assessed the impact on health service utilization as a follow-up to a single-blind, randomized, controlled trial of 237 patients attending 7 UK family practice clinics with symptomatic, occluding earwax who were randomized to an intervention group (ear drops, bulb syringe, instructions on its use and re-use) or a control group (ear drops, then clinic irrigation). After 2 years, a retrospective notes search for earwax-related consultations was carried out. We used an intention-to-treat analysis to assess differences in dichotomous outcomes between groups. Results In the 2-year trial follow-up, more control group patients returned with episodes of earwax: 85 of 117 (73%) control vs 70 of 117 (60%) intervention, χ2 = 4.30; P = .038; risk ratio 1.21 (95% CI, 1.01–1.37). The numbers of consultations amounted to 1.15 (control) vs 0.64 (intervention) (incidence rate ratio 1.79; 95% CI, 1.05–3.04, P = .032), ie, a difference of 0.50 consultations, thus saving a consultation on average for every 2 people. Conclusion For patients who have not already tried bulb syringes, self-irrigation using a bulb syringe significantly reduces subsequent demand for ear irrigation by health professionals. Advocating the initial use of bulb syringes could reduce demand for ear irrigation in family practice clinics.
The increasing production of modern bioenergy carriers and biomaterials intensifies the competition for different applications of biomass. To be able to optimize and develop biomass utilization in a ...sustainable way, this paper first reviews the status and prospects of biomass value chains for heat, power, fuels and materials, next assesses their current and long-term levelized production costs and avoided emissions, and then compares their greenhouse gas abatement costs. At present, the economically and environmentally preferred options are wood chip and pellet combustion in district heating systems and large-scale cofiring power plants (75–81 US$2005/tCO2-eqavoided), and large-scale fermentation of low-cost Brazilian sugarcane to ethanol (−65 to −53$/tCO2-eqavoided) or biomaterials (−60 to −50$/tCO2-eqavoided for ethylene and −320 to −228 $/tCO2-eqavoided for PLA; negative costs represent cost-effective options). In the longer term, the cultivation and use of lignocellulosic energy crops can play an important role in reducing the costs and improving the emission balance of biomass value chains. Key conversion technologies for lignocellulosic biomass are large-scale gasification (bioenergy and biomaterials) and fermentation (biofuels and biomaterials). However, both routes require improvement of their technological and economic performance. Further improvements can be attained by biorefineries that integrate different conversion technologies to maximize the use of all biomass components.
Quinine is a common treatment for nocturnal leg cramps but has potential side effects. An uncontrolled study suggested that calf-stretching exercises could prevent nocturnal leg cramps (night cramps) ...but these findings have never been confirmed.
To assess the effect of calf-stretching exercises and cessation of quinine treatment for patients with night cramps taking quinine.
Randomised controlled trial.
Twenty-eight general practices in southern England.
One hundred and ninety-one patients prescribed quinine for night cramps were randomised to one of four groups defined by two "advice" factors: undertake exercises and stop quinine. After 6 weeks they were advised that they could take quinine and undertake the exercises freely. Documentation of cramp at 12 weeks was achieved in 181 (95%) patients. Main outcome measures were: symptom burden score, and frequency of night cramps and quinine usage.
At 12 weeks there was no significant difference in number of cramps in the previous 4 weeks (exercise = 1.95, 95% confidence interval CI = -3.01 to 6.90; quinine cessation = 3.45, 95% CI = -1.52 to 8.41) nor symptom burden or severity of cramps. However, after 12 weeks 26.5% (95% CI = 13.3% to 39.7%) more patients who had been advised to stop quinine treatment reported taking no quinine tablets in the previous week (odds ratio OR = 3.32, 95% CI = 1.37 to 8.06), whereas advice to do stretching exercises had no effect (OR = 0.73, 95% CI = 0.27 to 1.98).
Calf-stretching exercises are not effective in reducing the frequency or severity of night cramps. Advising those on long-term repeat prescriptions to try stopping quinine temporarily will result in no major problems for patients, and allow a significant number to stop medication.
EU bioenergy development to 2050 Mandley, S.J.; Daioglou, V.; Junginger, H.M. ...
Renewable & sustainable energy reviews,
July 2020, 2020-07-00, Letnik:
127
Journal Article
Recenzirano
Odprti dostop
Bioenergy is the EU's leading renewable energy source at present. Understanding bioenergy's contribution to the future EU energy mix is strategically relevant for mid to long term climate targets. ...This review consolidates recent projections of both supply and demand dynamics for EU bioenergy to 2050, drawing from resource-focused, demand-driven and integrated assessment approaches. Projections are synthesised to identify absolute ranges, determine cohesion with policy and draw insights on the implications for the scale of development, trade and energy security. Supply side studies have undergone methodological harmonisation efforts in recent years. Despite this, due to assumptions on key uncertainties such as feedstock yields, technical potential estimates range from 9 to 25 EJyr-1 of EU domestically available biomass for energy in 2050. Demand side projections range between 5 and 19 EJyr-1 by 2050. This range is primarily due to variations in study assumptions on key influential developments such as economic competitivity of bioenergy, EU energy efficiency gains within the power sector, flexibility for meeting mitigation targets and technological portfolios. Upper bound technical supply estimates are able meet future demand wholly from the domestic resource base, holding the potential to reduce total EU primary energy import dependency 22% points from the current EU roadmap trajectory. However, due to part of this domestic resource base being deemed economically inaccessible or of insufficient quality, interregional imports are projected to increase from current 4% to 13–76%. Emergence of non-energy applications are projected to compete for at least 10% of the biomass needed to fulfil bioenergy demand in 2050.
•Consolidation of projections on EU bioenergy development to 2050.•Comparison of supply and demand dynamics for EU bioenergy.•EU biomass production holds potential to meet future bioenergy demand.•EU biomass import is widely projected to increase to 2050.•Non energy applications of biomass may compete for the resource base by 2050.
Insertional activation of cellular proto-oncogenes by replication-defective retroviral vectors can trigger clonal dominance and leukemogenesis in animal models and clinical trials. Here, we addressed ...the leukemogenic potential of vectors expressing interleukin-2 receptor common gamma-chain (IL2RG), the coding sequence required for correction of X-linked severe combined immunodeficiency. Similar to conventional gamma-retroviral vectors, self-inactivating (SIN) vectors with strong internal enhancers also triggered profound clonal imbalance, yet with a characteristic insertion preference for a window located downstream of the transcriptional start site. Controls including lentivirally transduced cells revealed that ectopic IL2RG expression was not sufficient to trigger leukemia. After serial bone marrow transplantation involving 106 C57Bl6/J mice monitored for up to 18 months, we observed leukemic progression of six distinct clones harboring gamma-retroviral long terminal repeat (LTR) or SIN vector insertions in Evi1 or Prdm16, two functionally related genes. Three leukemic clones had single vector integrations, and identical clones manifested with a remarkably similar latency and phenotype in independent recipients. We conclude that upregulation of Evi1 or Prdm16 was sufficient to initiate a leukemogenic cascade with consistent intrinsic dynamics. Our study also shows that insertional mutagenesis is required for leukemia induction by IL2RG vectors, a risk to be addressed by improved vector design.
The aim of the present study was to study the effect of combined therapy of teriparatide (PTH) or strontium ranelate (SR) with whole-body vibration (WBV) on bone healing and muscle properties in an ...osteopenic rat model. Seventy-two rats (3 months old) were bilaterally ovariectomized (Ovx), and 12 rats were left intact (Non-Ovx). After 8 weeks, bilateral transverse osteotomy was performed at the tibia metaphysis in all rats. Thereafter, Ovx rats were divided into six groups (
n
= 12): (1) Ovx—no treatment, (2) Ovx + vibration (Vib), (3) SR, (4) SR + Vib, (5) PTH, and (6) PTH + Vib. PTH (40 μg/kg BW sc. 5×/week) and SR (613 mg/kg BW in food daily) were applied on the day of ovariectomy, vibration treatments 5 days later (vertical, 70 Hz, 0.5 mm, 2×/day for 15 min) for up to 6 weeks. In the WBV + SR group, the callus density, trabecular number, and Alp and Oc gene expression were decreased compared to SR alone. In the WBV + PTH group, the cortical and callus widths, biomechanical properties, Opg gene expression, and Opg/Rankl ratio were increased; the cortical and callus densities were decreased compared to PTH alone. A case of non-bridging was found in both vibrated groups. Vibration alone did not change the bone parameters; PTH possessed a stronger effect than SR therapy. In muscles, combined therapies improved the fiber size of Ovx rats. WBV could be applied alone or in combination with anti-osteoporosis drug therapy to improve muscle tissue. However, in patients with fractures, anti-osteoporosis treatments and the application of vibration could have an adverse effect on bone healing.
Background and aims
The purpose of this review is to provide updated recommendations for the surgical management of primary (pHPT) and renal (rHPT) hyperparathyroidism, formulating a new guideline of ...the German Association of Endocrine Surgeons (CAEK).
Methods
Evidence-based recommendations for the diagnosis and therapy of pHPT and rHPT were assessed by a multidisciplinary panel using PubMed for a comprehensive literature search together with a structured consensus dialogue (S2k guideline of the Association of the German Scientific Medical Societies, AWMF).
Results
During the last 20 years, a variety of new preoperative localization procedures, such as sestamibi-SPECT, 4D-CT, and various PET/CT procedures, were established for pHPT. High-resolution imaging, together with intraoperative parathyroid hormone (IOPTH) measurement, enabled focused or minimally invasive surgery to become the most favored surgical technique. Patients with pHPT and nonlocalizing imaging have a higher risk of multiglandular disease. Surgical therapy provides very high cure rates, with a clear relation to the surgeon’s experience in parathyroid procedures. Reoperative parathyroidectomy, children with pHPT or familial forms, and parathyroid carcinoma are addressed and require special surgical expertise. A multidisciplinary team of experienced nephrologists, transplant, and endocrine surgeons should assess the diagnosis and treatment of renal HPT.
Conclusion
Surgery is the only curative treatment for pHPT and should be considered for all patients with pHPT. For rHPT, a more selective approach is required, and parathyroidectomy is indicated only when conservative treatment options fail. In parathyroid carcinoma, the adequacy of local resection influences local disease control.
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