Stimulating effect of hydrostatic pressure on ultrasonic sewage sludge treatment for COD solubilization and methane production.

The performance of ultrasonic treatment was assessed under different hydrostatic pressures for two different waste activated sludges. The impact of pressurized sonication was evaluated based on the degree of disintegration (DDCOD) and the specific methane yield (SMY). An enhancement of DDCOD was observed at an intermediate pressure level (max. 53% at 1.0 bar), but at higher pressure levels (up to 3.5 bar), the enhancement was not as pronounced as for the intermediate ranges (max. 11%). In contrast to DDCOD, SMY increased with increasing pressure for both sludge samples tested (max 17% at 3.5 bar) so that SMY did not show a notable correlation with DDCOD. A positive energy balance (max. 167%) considering the energy input for ultrasonication and the additional methane generated was only achieved in samples treated under elevated hydrostatic pressure. Since this can be achieved with negligible effort, the enhancement can be considered as "methane for free".

Ultrasound guided anterior approach to intra-articular injection of the knee.

In this clinical practice article, we describe a novel, anterior, approach for therapeutic intra-articular injection of the knee under ultrasound guidance. The benefits of this approach are improved accuracy in knees that do not have an effusion, simplified sonoanatomy for learners, and easy localization in patients with enlarged body habitus or altered anatomy. This article describes the positioning, sonographic anatomy, risks, and technical considerations for this anterior approach.

Comprehensive Immune Profiling of a Kidney Transplant Recipient With Peri-Operative SARS-CoV-2 Infection: A Case Report.

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.

Monitoring the transition of patients on biologics in rheumatoid arthritis: Consensus guidance for pharmacists.

BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Monitoring the transition of patients on biologics in rheumatoid arthritis: Consensus guidance for pharmacists

Background: 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. Objective: 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. Methods: 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. Results: 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 (AU)

A new approach to enhance the conventional two-phase anaerobic co-digestion of food waste and sewage sludge.

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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40201-020-00603-8.

Impacts of different operational temperatures and organic loads in anaerobic co-digestion of food waste and sewage sludge on the fate of SARS-CoV-2.

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.

Magnetic resonance imaging compared to ultrasonography in giant cell arteritis: a cross-sectional study.

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.

An evaluation of lysozyme enzyme and thermal pretreatments on dairy sludge digestion and gas production.

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.

Synergistic effects of co-trace elements on anaerobic co-digestion of food waste and sewage sludge at high organic load.

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 NH3-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.

EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice summary.

Large vessel vasculitis (LVV) is the most common form of primary vasculitis comprising of giant cell arteritis (GCA), Takayasu's arteritis (TAK) and idiopathic aortitis. Early diagnosis and treatment of LVV are paramount to reduce the risk of ischemic complications such as visual loss and strokes, vascular stenosis and occlusion, and aortic aneurysm formation. Use of imaging modalities [ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT) and [18F]-fluorodeoxyglucose positron emission tomography (PET)] has steadily increased to enable assessment of cranial and extracranial arteries, as well as the aorta. These imaging modalities are less invasive, more sensitive and readily available compared to temporal artery biopsy (TAB). Modern imaging methods have changed the role of TAB in diagnosing GCA and have replaced diagnostic angiography. Over the last two decades, several studies have evaluated the use of US, MRI, CT and PET in LVV. However, these various imaging tools are not yet uniformly used in routine clinical practice and controversy exists as to which imaging modality best provides meaningful assessments of disease activity and damage in LVV. In January 2018, evidence-based recommendations for the use of imaging modalities in LVV were published. The aim of this review is to summarize the current evidence of imaging in patients with or suspected of having LVV, and to highlight the clinical implications of the EULAR recommendations.