Effect of feeding strategy on the performance of a pilot scale vertical flow wetland for the treatment of landfill leachate.

Landfill leachate is one of the most challenging types of wastewater to treat using constructed wetlands. The objective of this study was to evaluate the effect of two feeding strategies on the treatment efficiency of a landfill leachate using vertical flow wetlands (VFWs) planted with Typha domingensis or Canna indica. The tolerance of these macrophytes to the leachate was also evaluated. Coarse sand and light expanded clay aggregates (LECA) were used as substrates. Two feeding strategies (FS) were applied: FSA = 1 pulse per day of 0.21 m pulse-1, FSB = 3 pulses per day of 0.07 m pulse-1. VFWs planted with T. domingensis presented removal efficiencies of 34/74% (NH4+) and 16/48% (TN) for FSA/FSB, respectively. VFWs planted with C. indica presented removal efficiencies of 27/72% (NH4+) and 18/46% (TN) for FSA/FSB, respectively. NH4+ and total nitrogen (TN) removal efficiencies were significantly higher in FSB than in FSA, but there were no significant differences between macrophyte species. COD removal showed no significant differences between FSs or between macrophyte species. T. domingensis and C. indica demonstrated to be tolerant to the leachate studied. VFWs planted with T. domingensis or C. indica are suitable to treat diluted landfill leachate with high ammonium concentrations using a feeding strategy of pulses. However, an anaerobic stage may be added after the VFW to get higher TN and COD removal.

Overextended Criteria Donors: Experience of an Italian Transplantation Center.

The increasing gap between the number of patients who could benefit from liver transplantation and the number of available donors has fueled efforts to maximize the donor pool using marginal grafts that usually were discarded for transplantation. This study included data of all patients who received decreased donor liver grafts between January 2004 and January 2013 (n = 218) with the use of a prospectively collected database. Patients with acute liver failure, retransplantation, pediatric transplantation, and split liver transplantation were excluded. Donors were classified as standard donor (SD), extended criteria donor (ECD), and overextended criteria donor (OECD). The primary endpoints of the study were early allograft primary dysfunction (PDF), primary nonfunction (PNF), and patient survival (PS), whereas incidence of major postoperative complications was the secondary endpoint. In our series we demonstrated that OECD have similar outcome in terms of survival and incidence of complication after liver transplantation as ideal grafts.

Diagnosis and Management of Hepatic Artery Complications After Liver Transplantation.

BACKGROUND: We assessed the usefulness of color Doppler imaging in diagnosis and monitoring hepatic artery complications after liver transplantation. METHODS: Subjects were 421 liver transplant recipients who underwent serial ultrasound (US) color Doppler evaluations of the hepatic arteries after surgery. RESULTS: We saw 4 hepatic arterial complications after liver transplantation (13 thrombosis, 29 stenosis, 2 kinking, 2 pseudo-aneurysm, and 2 pseudo-aneurysm rupture). All subjects underwent US color Doppler examination periodically after surgery. In 6 cases of early thrombosis, hepatic arterial obstruction was diagnosed with absence of Doppler signals; in the other 7 cases (late hepatic artery thrombosis), thrombosis was suspected for the presence of intra-parenchymal "tardus-parvus" waveforms. In all of the cases, computed tomography angiography showed obstruction of the main arterial trunk and the development of compensatory collateral circles (late hepatic artery thrombosis). In 10 of the 29 cases of stenosis, Doppler ultrasonography examination revealed stenotic tract and intra-hepatic tardus-parvus waveforms; in 17 stenosis cases, the site of stenosis could not be identified, but intra-parenchymal tardus-parvus waveforms were recorded. In 2 patients, hepatic artery stenosis occurred with ischemic complications. CONCLUSIONS: The use of US color Doppler examination allows the early diagnosis of hepatic arterial complications after liver transplantation. Tardus-parvus waveforms indicated severe impairment of hepatic arterial perfusion from either thrombosis or severe stenosis. The presence of these indirect signs enhanced the accuracy of color Doppler diagnosis, and detection should prompt therapy.

Acute Liver Failure in an Adult, a Rare Complication of Alagille Syndrome: Case Report and Brief Review.

Alagille syndrome (AS) is an autosomal-dominant, multisystem disorder affecting the liver, heart, eyes, skeleton, and face. The manifestations are predominantly pediatric. Diagnosis is based on findings of a paucity of bile ducts on liver biopsy combined with ≥3 of 5 major clinical criteria. Orthotopic liver transplantation (OLT) is the only option for treating patients who developed liver failure, portal hypertension, severe itching, and xanthomatosis. It is difficult to establish clear criteria for OLT; indications are controversial because of the wide variety of clinical symptoms and the multisystem involvement. Generally, AS-associated liver disease is never an acute illness. We report the case of a 28-year-old woman with AS who underwent urgent OLT for acute liver failure. At 24 months posttransplant, the patient is in good clinical condition and with normal hepatic and renal function.

After-effects of cognitive control on pain.

BACKGROUND: The higher order processes involved in self-regulation are generally thought to depend on cognitive (attentional/executive) functions with limited resources. Experimental studies further show that exerting self-control in a first task results in decreased performance in other following self-control tasks, which may be interpreted as the consequence of either effective or perceived resource depletion outlasting the first task. Given that higher order cognitive/attentional processes are also considered to be involved in pain modulatory mechanisms, we tested the idea that pain could be influenced by prior mobilization of cognitive resources. METHODS: The present study investigated the consequences of performing a cognitively demanding task on subsequent pain (ratings) and spinal nociceptive responses (nociceptive flexion reflex, NFR) elicited by noxious electrical stimulations in healthy volunteers. Participants received four noxious stimulations immediately after each of six successive blocks (2 min each) of a numerical Stroop task in a neutral condition (low cognitive demand) and six successive blocks in an interference condition (high cognitive demand). RESULTS: Results revealed that pain was rated higher following the condition requiring higher cognitive control. A similar effect was observed on the NFR. CONCLUSIONS: These findings suggest that pain regulation mechanisms including the descending pain modulatory system may be less efficient after the performance of tasks requiring high cognitive control resulting in stronger pain experience.

Induction with basiliximab plus thymoglobulin is effective and safe in old-for-old renal transplantation: six-month results of a prospective clinical study.

Old-for-old renal transplantation is becoming more frequent, but the optimal immunosuppressive regimens for this transplant population are still unclear. The aim of this pilot prospective study was to evaluate the efficacy and safety of the combination of basiliximab with a short course of low-dose thymoglobulin induction therapy among a group of patients receiving kidneys from donors >60 years (OLD), compared with those receiving organs from donors <60 years (YNG). Forty-six consecutive deceased donor kidney transplant patients received induction therapy with a combination of basiliximab (20 mg IV on days 0 and 4) and thymoglobulin (200 mg total dose IV on days 0-3). As maintenance immunosuppression starting on day 4, patients received a low dose of calcineurin inhibitor and steroids. Demographic characteristics at baseline were not significantly different between the 2 groups. At 6 months, patient survival, graft survival, and acute rejection rates were similar between the YNG and OLD groups: 100% and 95%, 96% and 95%, and 8% and 0%, respectively. Patients in the OLD group showed higher serum creatinine concentrations (YNG 1.5 +/- 0.3 vs OLD 1.9 +/- 0.3 mg/dL; P = .0002) but not proteinuria (YNG 0.11 +/- 0.11 vs OLD 0.15 +/- 0.14 g/24 h; P = ns). No significant difference was evident between the 2 groups regarding infectious, hematologic, or posttransplantation lymphoproliferative disorder complications. This study showed that a combination of basiliximab and a short course of low-dose thymoglobulin provided effective and safe immunosuppression, in old-for-old renal transplantation, with good renal function without an increased risk of posttransplantation infectious or hematologic complications.