Lessons learnt from a pilot study on residual dye removal by an aerated treatment wetland.

Treatment wetlands (TWs) have shown good capacity in dye removal from textile wastewater. However, the high hydraulic retention times (HRTs) required by these solutions and the connected high area requirements, remain a big drawback towards the application of TWs for dye treatment at full scale. Aerated TWs are interesting intensified solutions that attempt to reduce the TW required area. Therefore, an aerated CW pilot plant, composed of a 20 m2 horizontal subsurface flow TW (HF) and a 21 m2 Free Water System (FWS), equipped with aeration pipelines, was built and monitored to investigate the potential reduction of required area for dye removal from the effluent wastewater of a centralized wastewater treatment plant (WWTP). During a 8 months long study, experimenting with different hydraulic retention times (HRTs - 1.2, 2.6 and 3.5 days) and aeration modes (intermittent and continuous), the pilot plant has shown a normal biological degradation for organic matter and nutrients, while the residual dye removal has been very low, as demonstrated by the absorbance measure at three wavelengths: at 426 nm (blue) the removal varies from -55% at influent absorbance of 0.010 to 41% at 0.060; at 558 nm (yellow) the removal is negative at 0.005 (-58%) and high at higher influent concentrations (72% at 0.035 of absorbance for the inlet); at 660 nm (red) -82% of removal efficiency was obtained at influent absorbance of 0.002 and 74% at 0.010. These results are a consequence of the biological oxidation processes taking place in the WWTP, so that the residual dye seems to be resistant to further aerobic degradation. Therefore, TWs enhanced by aeration can provide only a buffer effect on peak dye concentrations.

An emergency department-based randomized trial of nonbronchoscopic bronchoalveolar lavage for early pathogen identification in severe community-acquired pneumonia.

STUDY OBJECTIVES: Many patients with community-acquired pneumonia are treated empirically without an aggressive search for causative pathogens, an approach adopted largely because of the costs and difficulties encountered during efforts to identify the causative organisms. Blood and sputum cultures are not sensitive, and the more invasive techniques of bronchoscopy and lung biopsy are generally time consuming and not cost-effective. The technique of nonbronchoscopic bronchoalveolar lavage (BAL) has been shown to accurately diagnose the causes of nosocomial pneumonia. The purpose of this study was to determine whether an emergency department-based BAL protocol would lead to more frequent isolation of pneumonia pathogens and result in more changes to tailored antibiotic therapy in comparison with standard care. METHODS: We studied all adult patients admitted with a diagnosis of pneumonia who were tracheally intubated and who had obtainable familial consent in the ED of an urban county hospital from March 1998 to October 1999. Exclusions included antibiotic use within the past 5 days, pneumothorax, hemoptysis, or persistent hypoxia using 100% oxygen. Patients were randomized to standard care versus standard care plus BAL. Blood culture specimens were drawn from all patients before the initiation of antibiotics. All other diagnostic tests were ordered at the discretion of treating physicians. BAL fluid, sputum, and blood culture specimens were tracked, and patient antibiotic course was followed to assess any change in regimen. RESULTS: Twenty-six of 64 patients evaluated for study participation met all eligibility criteria; 14 patients received standard care, and 12 patients received standard care plus BAL. Pneumonia pathogens were identified in 10 (83.3%) of 12 patients in the BAL group and in 4 (28.6%) of 14 patients in the standard care group (P =.007). Comparing BAL versus non-BAL groups, there was no significant difference in the likelihood of overall antibiotic regimen changes (P =.149), but there was a difference with regard to antibiotic changes made in patients with positive culture test results (P =.026). No major complications occurred with BAL catheterizations. CONCLUSION: ED-based BAL catheterization allows for early identification of pathogens in severe community-acquired pneumonia, which leads to changes in antibiotic therapy.

Insulin down-regulates the inducible nitric oxide synthase pathway: nitric oxide as cause and effect of diabetes?

Evidence in this paper indicates that insulin can down-regulate the inducible nitric oxide synthase (iNOS) pathway in vivo. The iNOS pathway is up-regulated in diabetes-prone rats and mice and is associated with an autoimmune process. However, the results presented here indicate that macrophage nitric oxide (NO) production and iNOS mRNA expression are also elevated in rats or mice made diabetic by streptozotocin injection in which there is no primary autoimmune component. Insulin administration reduces NO production in autoimmune-prone and streptozotocin-induced diabetic rodents. Finally, insulin decreases macrophage NO production in normal hosts. These results indicate that the autoimmune paradigm is inadequate to explain increased NO in diabetes. As a potential mechanism to explain insulin-mediated regulation of NO production, TGF-1 may be involved because 1) macrophages from diabetic mice produce less TGF-beta1 than macrophages from normal hosts; 2) the circulating TGF-beta1 level is lower in diabetic mice; and 3) insulin administration increases circulating TGF-beta1 in normal mice. Together, these results provide evidence that increased NO in diabetes is not only a cause but also an effect of beta-cell destruction and results in part from a heretofore unrecognized immunomodulatory activity of insulin.

Nitric oxide mediates early dysfunction of rat and mouse islets after transplantation.

Evidence presented in this paper indicates that nitric oxide (NO), generated by a nonspecific "wound"-type of inflammation, is an important mediator of the early dysfunction of transplanted islets in rodents. Although allogeneic islets stimulate NO production to a greater degree than syngeneic islets, the amounts of NO produced after either are significantly elevated above baseline. Inhibition of NO production by N(G)-monomethyl-L-arginine (NMA), markedly decreases the time needed to restore euglycemia after intraportal transplantation of syngeneic islets in diabetic rats. The dose of NMA used was not observably toxic, with no significant changes in blood pressure, hepatic artery blood flow, serum hepatic enzyme levels, or in weight compared with control animals. In rat recipients of intraportal syngeneic transplants, evidence that NO is produced at the site of implantation includes (1) an early and transient increase in posttransplant hepatic vein nitrate levels (pretransplant, 90 microM; 24 hr, 230 microM; 48 hr, 250 microM; 72 hr, 170 microM; and 96 hr, 140 microM), (2) concurrent appearance of inducible NO synthase mRNA in liver extracts, and (3) immunohistochemical localization of inducible NO synthase within the transplanted islets. Suppression of NO production or inhibition of NO activity is a potential strategy to increase the early function and engraftment transplanted islets in the clinical setting.

Expression of intrahepatic inducible nitric oxide synthetase mRNA correlates with production of nitric oxide during intraportal isogeneic and allogeneic rat islet transplantation.

Intrahepatic NO production is related to the islet mass transplanted. Nitric oxide production is higher in recipients of allogeneic rather than syngeneic islets. In addition, in allogeneic recipients a possible second peak of NO production was observed at 120 hours corresponding to the time of cellular rejection of the islet grafts (P = .22 vs 96 hours). Finally, the time to rejection of Wistar rat donor islets transplanted into Lewis rat diabetic recipients treated with NMA was not affected. However, inhibiting NO production in the minimal islet transplant model decreased the time to islet function, it does not affect the time to clinical rejection in recipients of a high number of allogeneic islet, which functions immediately. High-level NO has been shown to inhibit T-cell activation in vitro, and thus decreasing the levels by administrating NMA may accentuate the rejection response, canceling out the beneficial effect that might otherwise have occurred on islet function. Further experiments are required to clarify these issues.

[Hemicrania and cerebral ischemia in young adults]. / Emicrania e ischemia cerebrale nei giovani adulti.

A retrospective study was conducted on a young adults population affected by permanent symptoms of cerebral focal ischemia. Within 6 years, 24 patients between the ages of twenty and fifty were admitted to the Neurological and Medical department of our Hospital because of cerebral ischemic stroke. In 7 (29.2%) there was a previous history of common or classic migraine. No patients suffered headache at the time of neurologic deficit onset. In the other 17 patients in the study, 6 (25%) had valvular heart disease, 2 (8.3%) had signs suggestive of vasculitis, 2 (8.3%) had a story of head and neck injury, and in the remaining 7 (29.2%) patients no discernible etiology was demonstrated. Our data confirm the hypothesis that migraine may be considered an etiologic factor for persistent cerebral ischemia in young adults.

A prospective study on Candida as a gastric opportunistic germ.

Report of results from a study on the presence of Candida as a stomach opportunistic germ in 149 patients consecutively undergoing gastroscopy. Candida was isolated in 23 patients (15.4%). None of the following factors influenced the appearance of the fungus as an opportunist in the stomach: age, sex, smoking, alcohol intake, associated systemic diseases, concomitant gastroduodenal diseases or gastric histological findings. The only favoring factor revealed was that of cardiotonic treatment in 43.5% of the patients with a positive outcome, and in 15.1% of those with a negative outcome (p less than 0.01). Species isolated were Candida albicans in 15 patients (65.2%), Candida tropicalis, Candida pseudo-tropicalis and Candida glabrata in 2 patients each (8.7%), Candida krusei and Candida guillermondi in 1 patient each.