Use of agricultural by-products in the development of an agro-energy chain: A case study from the Umbria region.

Use of agricultural and livestock by-products for anaerobic digestion (AD), in total or partial substitution of the maize silage was evaluated from an environmental and economical point of view. The evaluation process included three methodological interdependent and consequential steps: the chemical stage at laboratory and plant level, the environmental and economic steps developing the Life Cycle Assessment and Life Cycle Costing jointly. The laboratory test showed that the two mixtures prepared with by-products, in partial (MIX A) and total (MIX B) substitution of maize silage, did not show differences in bio-methane production compared to a reference mixture with the 33% of maize silage. All mixtures tested at full-scale plant, showed the same performances, resulting in a similar energy production. Environmentally, MIX B increased greenhouse gas credits derived from the avoided production of mineral fertiliser for the energetic crops, resulting also in better economic performances. The break-even transport distances follow the positive environmental pattern result, in contrast to what was found for the break-even transport distances from the economic point of view.

Long-term distribution, mobility and plant availability of compost-derived heavy metals in a landfill covering soil.

The application of municipal waste compost (MWC) and other organic materials may serve to enhance soil fertility of earthen materials and mine spoils used in land reclamation activities, particularly in the recovery of degraded areas left by exhausted quarries, mines and landfill sites among others. The long-term distribution, mobility and phytoavailability of heavy metals in such anthropogenic soils were studied by collecting soil samples at different depths over a 10 y chronosequence subsequent to amendment of the top layer of a landfill covering soil with a single dose of mechanically-separated MWC. Amendment resulted in a significant enhancement of the metal loadings in the amended topsoils particularly for Cu, Zn and Pb, which were also the predominant metals in the compost utilised. Although metals were predominantly retained in the compost amended soil horizon, with time their vertical distribution resulted in a moderate enrichment of the underlying mineral horizons, not directly influenced by compost amendment. This enrichment generally resulted from the leaching of soluble organo-metal complexes and subsequent adsorption to mineral horizons. However, in the course of the 10-y experimental period, metal concentrations in the underlying horizons generally returned to background concentrations suggesting a potential loss of metals from the soil system. Analysis of the tissues of plants growing spontaneously on the landfill site suggests that metal phytoavailability was limited and generally species-dependent.

Oxidative biodegradation of dissolved organic matter during composting.

Dissolved organic matter (DOM) plays an important role in the microbial degradation of compost since it represents the most active organic fraction, both biologically and chemically. The detailed evaluation of the changes in the chemical and biochemical characteristics of DOM induced by oxidative biodegradation, presented in this work highlights the mechanisms involved in the degradation of soluble organic matter during composting. In fact, the results show that during the initial stages of composting, DOM is highly degradable under aerobic conditions, particularly due to the predominance of labile, hydrophilic compounds such as carbohydrates, amino acids and proteins. As such compounds are degraded more resistant aromatic moieties accumulate in solution resulting in a reduction in the degradability of DOM with composting time. This decrease in degradability was found to be highly correlated with microbial oxygen demand, and could have important implications in the evaluation of the composting process.

Precision determination for the specific oxygen uptake rate (SOUR) method used for biological stability evaluation of compost and biostabilized products.

This work represents the first attempt to evaluate the precision of the specific oxygen uptake rate method expressed in terms of repeatability (r) and reproducibility limits (R). Three laboratories were involved in an inter-laboratory test for the validation of respiration analyses on six biomass samples (three composts and three biostabilized products) having different degrees of biological stability. Both the maximum specific oxygen uptake rate peak (SOUR) and the cumulative oxygen demand after 12 h (OD(12)) and 20 h (OD(20)) of respiration test were investigated. Precisions expressed as the relative standard deviation were in the range of 9-41%. Linear regressions found for r and R, versus OD(12) and OD(20), enabled derivation of precision values (r and R) for all respirometric levels within the operating range. The OD(12) and OD(20) indices were found to be more adequate to indicate biological stability since they were less influenced by random errors than the SOUR index.

Changes in the chemical composition of water-extractable organic matter during composting: distribution between stable and labile organic matter pools.

Aerobic decomposition and stabilization of organic matter during the composting of waste materials is primarily due to the biochemical transformation of water-soluble compounds in the liquid phase by the microbial biomass. For this reason water-soluble organic matter represents the most active fraction of compost, both biologically and chemically, and thus should directly reflect the biochemical alteration of organic matter. This work aims to elucidate the microbial-mediated processes responsible for the distribution of soluble organic matter between stable and labile pools with composting time. Accordingly, chemical analysis as well as UV absorption, and 1H and 13C-NMR spectroscopy of samples collected during the industrial composting of urban waste revealed microbial induced transformation of water-extractable organic matter over time. The chemical composition changed from labile, hydrophilic, plant-derived organic compounds in the beginning to predominately stable, hydrophobic moieties comprising lignin-derived phenols and microbially-derived carbohydrates at later stages of composting.

[Usefulness of directional power Doppler sonography in the ultrasound-guided percutaneous native kidney biopsy]. / Utilita' dell'Eco Power Doppler direzionale nella biopsia transcutanea su rene nativo.

BACKGROUND: The study was aimed to analyze the pattern of bleeding throughout the kidney tissue after renal biopsy and evaluate its relationship with the onset of renal biopsy side effects by using directional power-Doppler sonography. PATIENTS: Eighty-five consecutive subjects with clinical evidence of renal disease underwent to percutaneous renal biopsy using directional power Doppler sonography. In each patient, the pattern of kidney hemorrhage immediately after the renal biopsy was evaluated. RESULTS: Fifty-seven patients, representing 67% of all biopsies performed, evidenced renal bleeding lasting 5.3+/-5.7 min; fifty-five patients, representing 65% of all biopsies, developed a post biopsy hematoma (x = 2.9+/-2.0 cm); 36% of patients developed a perirenal hematoma (x = 1.8+/-2.1 cm). A subcapsular hematoma was experienced by 45% of patients (x = 2.7+/-1.1 cm); 16% of these patients had a combined perirenal-subcapsular hematoma; 5% of hematomas were larger than 5 cm. Hematoma dimensions were related to the length of bleeding (r = 0.6331; p < 0.0001). Hemoglobin and hematocrit levels significantly reduced from 12.7+/-2.3 g/dL to 11.7+/-2.3 g/dL (-7%, p < 0.0001) and 37.6+/-6.5% to 35.4+/-6.5% (-6%, p < 0.0001) respectively, and such variations were related to the hematoma size (Delta Hb: r = -0.5171; p < 0.0001; Delta Htc: r = -0.3465; p < 0.0001). CONCLUSIONS: This study demonstrates that directional power Doppler sonography allows medical personnel to clearly evidence all renal biopsy-related side effects and identify, through the evaluation of renal bleeding immediately after the kidney biopsy, those patients who will develop renal hematomas.

[Traditional ultrasonography, directional Doppler power, and levovist in the morphological and functional evaluation of single kidney]. / Ecografia tradizionale, power Doppler direzionale e Levovist nello screening morfofunzionale del monorene.

Either the color and the power Doppler have given important information on renal haemodynamics, but these methods are limited. The power directional Doppler (pdD) surpasses such limits; again, administration of Levovist increases the intensity of vascular signal. The aim of this study is the evaluation, in subjects with a solitary kidney, but without evident nephropathies, the morphology, the cortical vascularization and the functional status of the kidney. We studied 21 patients divided into three groups. Group A: subjects with normal renal function; group B: patients with caliceal and pielic dilation; group C: patient with chronic renal failure (CRF). In all subjects, a pdD was effected. Only in three patients it was necessary to administer Levovist, in order to emphasize the parenchymal vascularization. The A group subjects, on echographic B-mode examination, presented a normal morphology and volume of the kidney; on pdD exam, a regular intense and homogeneous parenchymal vascularization, with resistance index (RI) = 0.53 divided by 0.66. In B group, pdD showed an irregular vascularization, with RI > 0.7; also the glomerular filtration rate (GFR) was reduced (70 ml/min). In C group, at the pdD it was relevant a reduced and irregular vascularization in whole renal tissue. If possible, the echographic B-mode examination must be completed with the pdD, with or without Levovist, in order to identify unknown renal pathologies, moreover in subjects with a single kidney.

[Suicide in Sanremo during the period of 1975-1990]. / Il suicidio a Sanremo negli anni 1975/1990.

The aim of this study is to consider the quantity features and variations in time of suicide in Sanremo during the period 1975-1990. The authors have carefully analyzed the source of their data, reading through the Coroner's registers and excluding all those cases of doubtful interpretation where the suicidal intention was only suspected, but not proven. The authors take into account different aspects such as: sociodemographic variables (sex; age; civil state; educational level; social position; geographical origin); method variables and correlations with psychiatric illness.

The right to refuse treatment: an application of the economic principles of decision-making under uncertainty.

When courts do not defer to professional judgment, alternative ways must be used to make treatment decisions for persons who are deemed incompetent. Rather than impose the preferences of society on the mentally ill individual, courts have favored alternative procedures. The two most common approaches are substituted judgment and best interests. In using both the substituted judgment standard and the best interest standard the guardian of a patient who is judged incompetent to make a treatment decision tries to make the decision the patient would have made, had he been competent. The guardian must consider the individual's attitude toward risk in making this assessment. Substituted judgment can be used when clear and convincing evidence of the patient's preferences exists. The evidence would come from a study of the patient's expressed attitudes towards medical treatment and behavior before he or she became incompetent. This approach is effective only if the patient has revealed his or her preferences toward relevant medical treatment in the past. The best interest standard is used when no clear and convincing evidence of the patient's treatment preferences exists. The treatment decisions of competent patients whose characteristics are similar to the incompetent patient's, and who have faced a similar situation, can be used as a proxy for the decision the incompetent patient would have made. Using the choice function of similar people may make it possible to develop a reasonably objective basis for determining what course of action is in the patient's best interest.

Acute increase in plasma osmolality as a cause of hyperkalemia in patients with renal failure.

These studies were performed in patients with chronic renal failure to understand the mechanism(s) of hyperkalemia secondary to hypertonic NaCl infusion. In 10 patients, after intravenous infusion of either 5% or 2.5% NaCl (6 mEq per kg body wt for 120 minutes in both solutions), the maximum increase in plasma potassium averaged 0.6 (range 0.3 to 1.3) mmol/liter (P less than 0.01) or 0.3 (range 0.2 to 0.6) mmol/liter (P less than 0.01), respectively. The rise of both plasma potassium and osmolality was significantly higher during 5% NaCl than during 2.5% NaCl infusion (P less than 0.01). A significant linear correlation (P less than 0.01) between plasma potassium and osmolality was observed. Urinary potassium excretion was increased to a similar extent by 5% NaCl and 2.5% NaCl infusion. The observed hyperkalemia, secondary to NaCl infusion, was independent of venous pH, plasma bicarbonate, anion gap, insulin levels, and urinary norepinephrine and epinephrine excretion, and was associated with a fall in plasma aldosterone concentration. In separate studies, nine patients were treated with desoxycorticosterone acetate (DOCA; 20 mg i.m. for three days) before receiving saline (5%) infusion. DOCA did not prevent the level increase in plasma potassium that remained significantly correlated with plasma osmolality (P less than 0.01). In conclusion, hypertonic NaCl infusion in patients with renal failure causes a clinically relevant hyperkalemia despite increased renal excretion of potassium. This hyperkalemia is independent of acid-base or hormonal mechanisms known to regulate extrarenal homeostasis of potassium, and is strictly correlated with a rise in plasma osmolality.

The right to refuse treatment: an application of the economic principles of decision-making under uncertainty.

When courts do not defer to professional medical judgement alternative ways must be found to make treatment decisions for persons who are deemed incompetent. Rather than impose the preferences of society upon the mentally ill individual, US courts favoured alternative procedures such as substituted judgement and the principle of the patient's best interest.

Acute cyclosporine renal dysfunction reversed by dopamine infusion in healthy subjects.

Up to now, no studies have been performed in normal humans to investigate the role of renal hemodynamic abnormalities in relation to acute-cyclosporin A (CsA) renal dysfunction and to verify whether the specific renal vasodilator, dopamine, can counteract these abnormalities. Eight normal subjects were examined both (A) after oral CsA (12 mg/kg body wt) and (B) after oral CsA + dopamine infusion (2 mg/kg body wt/min), under water diuresis. Both in protocols A and in B, four basal renal clearances were performed before CsA and every twenty minutes for four hours after CsA administration. In protocol A, after CsA, inulin (GFR) and PAH clearance (RPF) fell by up to 27% and to 41%, respectively, so that filtration fraction (FF) increased (P less than 0.01). A slight (not significant) hypertension occurred while renal resistances were markedly raised (P less than 0.001). Fractional urine and Na+ excretion as well as CH2O decreased, while UOsm increased (P less than 0.01). In protocol B, dopamine was infused from 120 to 180 minutes after CsA (that is, when the maximal adverse effects of CsA on renal hemodynamics had been observed in A). Dopamine infusion could reverse completely the effects of CsA on RPF, GFR, fractional urine output and CH2O; only UOsm remained higher than normal in conclusion with an increased fractional excretion of sodium (P less than 0.01). No changes were observed in plasma renin activity, aldosterone and in urinary epinephrine and norepinephrine excretion both in protocols.(ABSTRACT TRUNCATED AT 250 WORDS)

Bile acid binding in plasma: the importance of lipoproteins.

Bile acid (BA) hydrophobicity, evaluated by the octanol-water partition coefficient, decreases along the series deoxycholic acid-chenodeoxy cholic acid-hyodeoxycholic acid-ursodeoxycholic acid-cholic acid (CA)-ursocholic acid (UCA). In vitro experiments carried out using dialysis techniques (to determine the maximum BA binding) and ultrafiltration of plasma pre-incubated with 0.1 mM BA (to assess the distribution of BA between the different lipoprotein fractions) showed that the maximum binding of BA to plasma and lipoproteins follows the same order of hydrophobicity. The fraction not bound to proteins, greater with the hydrophilic BA (UCA and CA), is distributed in the lipoprotein fractions and in particular in high density lipoproteins.