Removal of chromium(III) from contaminated waters using cobalt ferrite: how safe is remediated water to aquatic wildlife?

The release of hazardous elements by industrial effluents to aquatic ecosystems is a potential threat to the environment. Chromium (Cr) is one of the elements whose levels in several freshwater ecosystems should be reduced to promote water reuse. In recent years, magnetic materials have gained increasing interest as sorbents because of their easy removal from treated water through magnetic separation. In this study, colloidal cobalt ferrite (CoFe2O4) particles were investigated as magnetic sorbents for chromium-aqueous chemical species. The oxidative stress responses of Mytilus galloprovincialis mussels exposed to 200 µg/L of Cr, resembling remediated water, were evaluated. More than 95% of Cr was removed from contaminated solutions by CoFe2O4 aqueous suspensions at pH 6 and pH 10. The kinetics of sorption experiments were examined using pseudo-1st order, pseudo-2nd order and Elovich models to evaluate which mathematical model has a better adjustment to the experimental data. The present study revealed that the levels of Cr that remained in remediated water induced limited biochemical changes in mussels, being considered safe for aquatic systems. Overall, the use of cobalt ferrite-based sorbents may constitute a promising approach to remediate contaminated water.

Enhanced removal of rare earth elements from aqueous media: exploring the potential of AM-3 and AM-4 titanosilicates.

This study investigates the impact of three key variables on the performance of nanoporous AM-3 and layered AM-4 titanosilicates in removing nine REEs (Y, La, Ce, Pr, Nd, Eu, Gd, Tb, and Dy) from natural mineral water and identifies optimal operational conditions using Response Surface Methodology (RSM). The experimental conditions were determined by a Box-Behnken Design of 3 factors-3 levels (pH 4, 6, and 8; sorbent dose 20, 100, and 180 mg/L; and element concentration 1, 3, and 5 µmol/L). Three-dimensional response surfaces were used to assess the linear, quadratic, and interaction influences of each factor on the REEs' removal percentage. The pH was the most significant factor in the removal process using AM-3, while the sorbent dose was more important for AM-4. The results highlighted the sorbents' strong capacity for REE removal. The optimal operating conditions obtained by RSM were applied to aqueous solutions with salinity 10 (common in coastal and transitional systems) and 30 (average seawater salinity). The results showed that AM-3 has a strong potential for removing REEs in solutions with salinity 10 and 30, while AM-4 was less efficient due to competition between REEs and other ions present in the solution.

Seasonal characterization of mercury contamination along the Portuguese coast: human health and environmental risk assessment.

A seasonal characterization of mercury (Hg) accumulation in three different estuaries along the Portuguese coast (i.e. Ria de Aveiro, Tagus estuary and Ria Formosa) was done. For that, it was evaluated: (1) Hg concentrations in abiotic (water) and biotic matrices (flora and fauna); (2) the risk of consumption of local seafood species (e.g. bivalves) to human health; and (3) the environmental risk to Hg exposure. During 1 year, water and biological samples were collected during low tide, in each system for Hg quantification. Our findings revealed that total Hg concentrations in surface waters were higher in Ria de Aveiro and Tagus estuary than in Ria Formosa. In Ria de Aveiro, a particular attention should be given in autumn periods, where Hg levels (≈ 100 µg L-1) were considered quite high according to European quality parameters. The same was observed for the Tagus estuary during spring time. Regarding macrofauna Hg levels, no clear seasonal trend was observed. Also, total Hg concentrations in edible species (< 0.5 µg. g-1 ww) represent no risk for consumption. However, considering the environmental risk, in Ria de Aveiro, there is a moderate risk (RQ > 0.1) in autumn periods, which can be a matter of concern.

Eco-friendly methodology for removing and recovering rare earth elements from saline industrial wastewater.

In this study, response surface methodology (RSM) was applied with a Box-Behnken design to optimize the biosorption (removal and bioconcentration) of rare earth elements (REEs) (Y, La, Ce Eu, Gd, Tb) by living Ulva sp. from diluted industrial wastewaters (also containing Pt and the classic contaminants Hg, Pb, Zn, Cu, Co, and Cd). Element concentration (A: 10-190 µg/L), wastewater salinity (B: 15-35), and Ulva sp. dosage (C: 1.0-5.0 g/L) were the operating parameters chosen for optimization. Analysis of the Box-Behnken central point confirmed the reproducibility of the methodology and p-values below 0.0001 validated the developed mathematical models. The largest inter-element differences were observed at 24 h, with most REEs, Cu, Pb and Hg showing removals ≥ 50 %. The factor with the greatest impact (positive) on element removal was the initial seaweed dosage (ANOVA, p < 0.05). The optimal conditions for REEs removal were an initial REEs concentration of 10 µg/L, at a wastewater salinity of 15, and an Ulva sp. dosage of 5.0 g/L, attaining removals up to 88 % in 24 h. Extending the time to 96 h allowed seaweed dosage to be reduced to 4.2 g/L while achieving removals ≥ 90 %. The high concentrations in REE-enriched biomass (∑REEs of 3222 µg/g), which are up to 3000 times higher than those originally found in water and exceed those in common ores, support their use as an alternative source of these critical raw materials.

Respiratory muscle training for obstructive sleep apnea: Systematic review and meta-analysis.

Obstructive sleep apnea is the most common sleep disorder. This review aims to evaluate the effectiveness and safety of respiratory muscle training in the treatment of patients with obstructive sleep apnea. The study protocol was registered in Prospero Platform (CRD42018096980). We performed searches in the main databases: Medical Literature Analysis and Retrieval System Online (MEDLINE) via Pubmed; Excerpta Medica dataBASE (Embase) via Elsevier; Cochrane Central Register of Controlled Trials (CENTRAL) via Cochrane Library; Latin American and Caribbean Literature on Health Sciences (LILACS) through the Portal of the Virtual Health Library and Physiotherapy Evidence Database (PEDro) for all randomised-controlled trials published before July 2022. The randomised-controlled trials were assessed for risk of bias and certainty of evidence. Thirteen randomised-controlled trials were included. All studies had an overall high risk of bias. Inspiratory muscle training probably improves systolic blood pressure and sleepiness when compared with sham. However, inspiratory muscle training probably does not improve diastolic blood pressure and maximum expiratory pressure, and may not be superior to sham for apnea-hypopnea index, forced expiratory volume in 1 s, forced vital capacity, sleep quality and quality of life. In addition, it is uncertain whether there is any effect of inspiratory muscle training on maximum inspiratory pressure and physical capacity. Inspiratory muscle training may also improve maximum inspiratory pressure and maximum expiratory pressure compared with oropharyngeal exercises. However, it may not be superior for apnea-hypopnea index, sleep quality, sleepiness, quality of life and functional capacity. When associated with physical exercise, inspiratory muscle training may not be superior to physical exercise alone for maximum inspiratory pressure, maximum expiratory pressure, systolic and diastolic blood pressure, and functional capacity. At the same time, when associated with cardiac rehabilitation exercises, inspiratory muscle training may reduce apnea-hypopnea index, improve inspiratory muscle strength, sleepiness and sleep quality compared with cardiac rehabilitation alone. However, it may not be superior for improving quality of life. Regarding expiratory muscle training, it may improve expiratory muscle strength and sleep quality, but not sleepiness when compared with sham. The evidence on the effects of expiratory muscle training in apnea-hypopnea index is very uncertain.

Application of response surface methodology and box-behnken design for the optimization of mercury removal by Ulva sp.

Mercury (Hg) is a global and top priority contaminant, toxic at low concentrations. Although it has been progressively eliminated from processes, this metal continues to circulate in the atmosphere, soil, and water. In this work, the Response Surface Methodology (RSM) combined with a Box-Behnken Design (3 factors - 3 levels) was used to optimize key operational conditions that influence the removal and uptake of Hg by living macroalga Ulva sp. in a complex mixture containing several elements used in industry (potentially toxic elements, rare earth elements, and platinum-group elements) (initial concentration 10, 100 and 190 µg/L, salinity 15, 25 and 35, seaweed stock density 1.0, 3.0 and 5.0 g/L). Results evidenced the great capability of Ulva sp. to remove Hg, with removal efficiencies between 69 % and 97 %. 3-D surfaces showed that the most impactful variable was seaweed stock density, with higher densities leading to higher removal. Regarding the uptake, a positive correlation between initial concentration and qt values was observed. The appliance of RSM made possible to obtain optimal operating conditions for removing virtually 100 % of Hg from waters with high ionic strength, which is a pivotal step in the direction of the application of this remediation biotechnology at large scale.

Validation of a methodology to quantify macro, micro, and potentially toxic elements in food matrices.

To routinely assess whether consumed food meets international guidelines, a single analytical method able to quantify minerals and potentially toxic elements (PTEs) in real food matrices is required. This work validated a simple and efficient method to quantify nine elements in different food matrices by ICP-MS. Samples from local markets (chicken, mussels, fish, rice, and seaweed) and certified reference materials were digested with HNO3 68 % and H2O2 30 %. All performance criteria (working range, linearity, LOD, LOQ, selectivity, repeatability, and trueness) met the requirements of the Portuguese Association of Accredited Laboratories. Comparison between raw and cooked food showed significant changes in most element levels, and PTEs contents complied with the maximum permissible values (EC N° 1881/2006). The minimum and maximum amounts of the foods studied, alone or in combination, raw or cooked, that can be daily consumed to meet EFSA and WHO nutritional and safety requirements were analysed.

Algorithm for screening and management of locomotive syndrome in elderly individuals and development of a short version of the 25-question Geriatric Locomotive Function Scale-Portuguese.

OBJECTIVE: To develop a short version of the 25-question Geriatric Locomotive Function Scale-Portuguese and to create an algorithm for locomotive syndrome screening and management. METHODS: The 25-question Geriatric Locomotive Function Scale-Portuguese was applied to individuals aged 60 years or older seen at the Geriatrics and Gerontology Department of Universidade Federal de São Paulo, between 2016 and 2018. Items of the 25-question Geriatric Locomotive Function Scale-Portuguese were submitted to exploratory factor analysis using the principal component method. Internal consistency was investigated using Cronbach's alpha coefficient. The ROC curve was used to determine the cut-off point of the short version developed. Finally, a simple and objective algorithm was created for locomotive syndrome screening and management using the Delphi method. RESULTS: A total of 202 elderly individuals aged 61 to 101 years (mean age, 84.67 years) were evaluated. Fifteen items were excluded from the 25-question Geriatric Locomotive Function Scale-Portuguese to compose the 10-question Geriatric Locomotive Function Scale-Portuguese, a 10-item instrument with appropriate psychometric properties. A cut-off point of ten (ROC curve) was determined for potential locomotive syndrome, with 96.5% sensitivity and 86.2% specificity. A very simple algorithm was developed for locomotive syndrome screening and management. CONCLUSION: The short version (10-question) of the Geriatric Locomotive Function Scale-Portuguese has appropriate psychometric properties and provides a practical tool for detection of locomotive problems in elderly individuals.

Efetividade e segurança do treinamento muscular respiratório na apneia obstrutiva do sono: protocolo de uma revisão sistemática / Effectiveness and safety of respiratory muscle training in obstructive sleep apnea: systematic review protocol

Introdução: A apneia obstrutiva do sono (AOS) é o distúrbio respiratório do sono mais comum. O treino muscular respiratório tem surgido como uma intervenção promissora para a melhora dos sintomas e com boa adesão, porém muito ainda se tem discutido sobre sua efetividade e segurança. Objetivo: Avaliar a efetividade e segurança do TMR no tratamento de pacientes com AOS. Métodos: Para tanto, realizaremos uma revisão sistemática de ensaios clínicos randomizados (ECR). O protocolo do estudo foi registrado na Plataforma Prospero (CRD42018096980). Incluiremos indivíduos de idade superior ou igual a 18 anos, com diagnóstico de AOS, em uso ou não de pressão positiva nas vias aéreas. Excluiremos estudos com pacientes diagnosticados com lesão da medula espinhal ou doenças neuromusculares. As buscas serão realizadas nas bases de dados: Medical Literature Analysis and Retrieval System Online (Medline) via Pubmed, Excerpta Medica dataBASE (Embase) via Elsevier, Cochrane Central Register of Controlled Trials (Central) via Cochrane Library, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) via Portal da Biblioteca Virtual em Saúde e Physiotherapy Evidence Database (PEDro), sem restrições de idioma ou ano de publicação. Avaliaremos o rigor metodológico dos estudos incluídos e a certeza da evidência dos principais desfechos da revisão sistemática utilizando a ferramenta Risco de Viés 2.0 da Cochrane e a abordagem Grading of Recommendations Assessment, Development and Evaluation (GRADE), respectivamente. A seleção dos estudos, extração de dados, avaliação do viés dos estudos incluídos e avaliação da certeza da evidência serão realizados por dois pesquisadores independentes. Resultados esperados: Espera-se que os resultados desta revisão forneçam informações úteis para a tomada de decisão clínica, exponham lacunas de conhecimento, assim como forneçam um bom embasamento para futuros ECR de alta qualidade sobre o assunto.

Microporous Framework (Nb, Fe)-Silicate with Much Potential to Remove Rare-Earth Elements from Waters.

Nanoparticles of a new small-pore metal silicate formulated as Na2.9 (Nb1.55 Fe0.45 )Si2 O10 ⋅ xH2 O and exhibiting the structure of previously reported Rb2 (Nb2 O4 )(Si2 O6 ) ⋅ H2 O have been synthesized under mild hydrothermal conditions. Replacement of the bulky Rb+ by smaller Na+ ions was accomplished by stabilizing the framework structure via partial occupancy of the Nb5+ sites by Fe3+ ions. Exploratory ion-exchange assays evidence the considerable potential of this new silicate to remove rare-earth elements from aqueous solutions.

In Vitro Hepatotoxic and Neurotoxic Effects of Titanium and Cerium Dioxide Nanoparticles, Arsenic and Mercury Co-Exposure.

Considering the increasing emergence of new contaminants, such as nanomaterials, mixing with legacy contaminants, including metal(loid)s, it becomes imperative to understand the toxic profile resulting from these interactions. This work aimed at assessing and comparing the individual and combined hepatotoxic and neurotoxic potential of titanium dioxide nanoparticles (TiO2NPs 0.75-75 mg/L), cerium oxide nanoparticles (CeO2NPs 0.075-10 µg/L), arsenic (As 0.01-2.5 mg/L), and mercury (Hg 0.5-100 mg/L) on human hepatoma (HepG2) and neuroblastoma (SH-SY5Y) cells. Viability was assessed through WST-1 (24 h) and clonogenic (7 days) assays and it was affected in a dose-, time- and cell-dependent manner. Higher concentrations caused greater toxicity, while prolonged exposure caused inhibition of cell proliferation, even at low concentrations, for both cell lines. Cell cycle progression, explored by flow cytometry 24 h post-exposure, revealed that TiO2NPs, As and Hg but not CeO2NPs, changed the profiles of SH-SY5Y and HepG2 cells in a dose-dependent manner, and that the cell cycle was, overall, more affected by exposure to mixtures. Exposure to binary mixtures revealed either potentiation or antagonistic effects depending on the composition, cell type and time of exposure. These findings prove that joint toxicity of contaminants cannot be disregarded and must be further explored.

Development of a Clinical Prediction Rule for Treatment Success with Transcranial Direct Current Stimulation for Knee Osteoarthritis Pain: A Secondary Analysis of a Double-Blind Randomized Controlled Trial.

The study's objective was to develop a clinical prediction rule that predicts a clinically significant analgesic effect on chronic knee osteoarthritis pain after transcranial direct current stimulation treatment. This is a secondary analysis from a double-blind randomized controlled trial. Data from 51 individuals with chronic knee osteoarthritis pain and an impaired descending pain inhibitory system were used. The intervention comprised a 15-session protocol of anodal primary motor cortex transcranial direct current stimulation. Treatment success was defined by the Western Ontario and McMaster Universities' Osteoarthritis Index pain subscale. Accuracy statistics were calculated for each potential predictor and for the final model. The final logistic regression model was statistically significant (p < 0.01) and comprised five physical and psychosocial predictor variables that together yielded a positive likelihood ratio of 14.40 (95% CI: 3.66−56.69) and an 85% (95%CI: 60−96%) post-test probability of success. This is the first clinical prediction rule proposed for transcranial direct current stimulation in patients with chronic pain. The model underscores the importance of both physical and psychosocial factors as predictors of the analgesic response to transcranial direct current stimulation treatment. Validation of the proposed clinical prediction rule should be performed in other datasets.

Algorithm for screening and management of locomotive syndrome in elderly individuals and development of a short version of the 25-question Geriatric Locomotive Function Scale-Portuguese

ABSTRACT Objective To develop a short version of the 25-question Geriatric Locomotive Function Scale-Portuguese and to create an algorithm for locomotive syndrome screening and management. Methods The 25-question Geriatric Locomotive Function Scale-Portuguese was applied to individuals aged 60 years or older seen at the Geriatrics and Gerontology Department of Universidade Federal de São Paulo, between 2016 and 2018. Items of the 25-question Geriatric Locomotive Function Scale-Portuguese were submitted to exploratory factor analysis using the principal component method. Internal consistency was investigated using Cronbach's alpha coefficient. The ROC curve was used to determine the cut-off point of the short version developed. Finally, a simple and objective algorithm was created for locomotive syndrome screening and management using the Delphi method. Results A total of 202 elderly individuals aged 61 to 101 years (mean age, 84.67 years) were evaluated. Fifteen items were excluded from the 25-question Geriatric Locomotive Function Scale-Portuguese to compose the 10-question Geriatric Locomotive Function Scale-Portuguese, a 10-item instrument with appropriate psychometric properties. A cut-off point of ten (ROC curve) was determined for potential locomotive syndrome, with 96.5% sensitivity and 86.2% specificity. A very simple algorithm was developed for locomotive syndrome screening and management. Conclusion The short version (10-question) of the Geriatric Locomotive Function Scale-Portuguese has appropriate psychometric properties and provides a practical tool for detection of locomotive problems in elderly individuals.

Response surface approach to optimize the removal of the critical raw material dysprosium from water through living seaweeds.

Dysprosium (Dy) is a rare earth element with a high economic and strategic value, and simultaneously an emerging contaminant, whose removal from wastewaters is gaining increasing attention. In this work, the Response Surface Methodology (RSM) combined with a Box-Behnken Design (3 factors-3 levels) was used to optimize the key operational conditions that influence the uptake of Dy by two living seaweed, Ulva sp. and Gracilaria sp.. The initial concentration of Dy (10-500 µg/L), water salinity (10-30), and seaweed dosage (0.5-5.5 g/L) were the independent variables, while the removal efficiency (%) and bioaccumulation (q, µg/g) were the response variables. Results highlighted the high capacity of both species to capture Dy. After 168 h, the optimal conditions that led to a maximum of 91 % of Dy removed by Gracilaria sp. were: 500 µg of Dy per L of water, salinity 10, and 5.5 g of seaweed per L. For Ulva sp., a maximum removal percentage of 79 % was achieved in the conditions: any initial concentration of Dy, salinity 20, and seaweed dosage of 3.7 g/L. Independently of the species, the response surfaces showed that the most important variable for the removal is the seaweed dosage, while for bioaccumulation is the initial concentration of Dy. Using RSM, it was possible to obtain the optimal operating conditions for Dy removal from waters, which is a fundamental step toward the application of the proposed technology at large scale.

Elemental composition of whole body soft tissues in bivalves from the Bijagós Archipelago, Guinea-Bissau.

Marine bivalves are bioindicators of coastal environmental pollution, integrating monitoring programs worldwide. Nonetheless, the choice of particular species as an indicator requires validation, achieved by understanding the differences in element concentrations among and within species. The present study compares the chemical composition of whole body soft tissues of four common bivalve species from the Bijagós Archipelago, a pristine region of West Africa. Significant differences were recorded in the concentrations of various elements among studied species, which likely arise from species-specific uptake and bioaccumulation processes. Overall, there was a segregation between a group including the bloody cockle Senilia senilis and oyster Crassostrea tulipa (with high Cd and Zn concentrations) versus the two other species, Austromacoma nymphalis (with low Cu and high Mn, Se, Hg, Pb concentrations) and Diplodonta spp. (with high values of Cu, Al, Fe, V, Cr, Hg, Pb). C. tulipa was sampled in two different substrates (rock beds and mangrove roots), and the two groups revealed different chemical profiles, with significantly higher concentrations of P, Si, Zn and Cr and lower Cu in specimens fixed in mangrove roots. These results strongly suggest the influence of small-scale environmental variability on the accumulation of particular elements. We found extremely high Cd concentrations in S. senilis (27.1 ± 7.53 µg g-1 DW) and identified C. tulipa as another high Cd-accumulating species (ca. 10 µg g-1 DW). Our results suggest a detoxifying mechanism linked with the presence of Se to reduce the potential toxic effects of Cd in these two species. Cadmium concentrations reported for some bivalve species in this area largely exceed the maximum values proposed by the European Union, emphasizing the need for a regular contamination assessment.

Sustainable recovery of neodymium and dysprosium from waters through seaweeds: Influence of operational parameters.

The high demand for greener energy and technological innovation require some crucial elements, such as the rare earths Nd and Dy. Being considered two of the most critical elements (high supply risk), it is vital to recover them from wastes/wastewaters, for later reuse. Here, the influence of operational parameters, such as biosorbent stock density (0.5, 3.0, and 5.5 g L-1), ionic strength (salinity 10 and 30) and contact time (24, 72 and 168 h), in the biosorption/bioaccumulation of Nd and Dy by two living marine macroalgae was evaluated in artificial seawater, seeking the improvement of the process. Results demonstrated that stock density is the most influential parameter, while the ionic strength showed to be a selective parameter, with a major influence only for Dy removal, which can be attributed to the different chemical characteristics observed between light rare earth elements (LREE) and heavy rare earth elements (HREE). For the ranges studied, the greatest removal/recovery for Gracilaria sp. was achieved with a stock density of 3.0 g L-1 at salinity 10, after 72 h for both REEs. For Ulva lactuca optimal conditions were: stock density of 5.5 g L-1 at salinity 10 with a contact time of 72 h for both REEs. Between species, U. lactuca showed to be the most promising, with removal efficiencies up to 98% for Nd and 89% for Dy. Findings substantiate the potential of the proposed process for obtaining Nd and Dy from secondary sources, particularly from low-level contaminated waters.

Motor cortex transcranial direct current stimulation effects on knee osteoarthritis pain in elderly subjects with dysfunctional descending pain inhibitory system: A randomized controlled trial.

BACKGROUND: Although evidence has indicated a positive effect of transcranial direct current stimulation (tDCS) on reducing pain, few studies have focused on the elderly population with knee osteoarthritis (KOA). OBJECTIVE: To evaluate whether tDCS reduces KOA pain in elderly individuals with a dysfunctional descending pain inhibitory system (DPIS). METHODS: In a double-blind trial, individuals ≥ 60 years with KOA pain and a dysfunctional DPIS, we randomly assigned patients to receive 15 daily sessions of 2 mA tDCS over the primary motor cortex (anode) and contralateral supraorbital area (cathode) (M1-SO) for 20 min or sham tDCS. Change in pain perception indexed by the Brief Pain Inventory (BPI) at the end of intervention was the primary outcome. Secondary outcomes included: disability, quantitative sensory testing, pain pressure threshold and conditioned pain modulation (CPM). Subjects were followed-up for 2 months. RESULTS: Of the 104 enrolled subjects, with mean (SD) age of 73.9 (8.01) years and 88 (84.6%) female, 102 finished the trial. In the intention-to-treat analysis, the active tDCS group had a significantly greater reduction in BPI compared to the sham group (difference, 1.59; 95% CI, 0.95 to 2.23; P < 0.001; Cohen's d, 0.58); and, also a significantly greater improvement in CPM-pressure in the knee (P = 0.01) and CPM-pain in the hand (P = 0.01). These effects were not sustained at follow-up. The intervention was well tolerated, with no severe adverse effects. CONCLUSION: M1-SO tDCS is associated with a moderate effect size in reducing pain in elderly patients with KOA after 15 daily sessions of stimulation. This intervention has also shown to modulate the DPIS.

Nutshells as Efficient Biosorbents to Remove Cadmium, Lead, and Mercury from Contaminated Solutions.

The release of potentially toxic elements into the environment, and their effects on aquatic ecosystems still present a real threat. To avoid such contamination, the use of biological sorbents as an alternative to conventional and expensive water remediation techniques has been proposed. The present study evaluated the potential of 0.5 g L-1 of peanut, hazelnut, pistachio, walnut, and almond shells to remove the requisite concentrations of cadmium (Cd), lead (Pb), and mercury (Hg) from contaminated water. Hazelnut shells were identified as the sorbent with the highest potential and were evaluated in mono- and multi-contaminated mineral water. The influence of sorbent-intrinsic and solution-intrinsic characteristics were assessed. Differences among sorbents were attributed to varying percentages of their main components: cellulose, hemicellulose, and lignin. Matrix complexity increase caused a decrease in Cd removal, presumably due to the diminution in electrostatic interaction, and complexation with anions such as Cl-. When simultaneously present in the solution, contaminants competed, with Pb showing higher affinity to the sorbent than Hg. High efficiencies (>90%) obtained for hazelnut shells for all elements in ultrapure water and for Pb and Hg in mineral water) reveals the high potential of this low-cost and abundant waste for use in the remediation of contaminated waters (circular economy).

Transcranial direct current stimulation for fatigue in patients with Sjogren's syndrome: A randomized, double-blind pilot study.

BACKGROUND: Transcranial direct-current stimulation (tDCS) has shown promise to decrease fatigue. However, it has never been examined in primary Sjogren Syndrome (pSS). OBJECTIVE: To assess the effect of a tDCS protocol on fatigue in patients with pSS. METHODS: This is a parallel, double-blind pilot study (NCT04119128). Women aged 18-65 years, with pSS, on stable pharmacological therapy, with complaints of fatigue for at least three months, and with scores >5 on Fatigue Severity Scale (FSS) were included. We randomized 36 participants to receive five consecutive or sham tDCS sessions, with an intensity of 2 mA, for 20 min/day. RESULTS: After five tDCS sessions, fatigue severity assessed by the FSS (primary outcome) demonstrated a mean group difference of -0.85 [95% confidence interval (CI) -1.57, -0.13; effect size 0.80] favouring the active group. The active group presented significantly greater reductions in fatigue as measured by the EULAR Sjögren's Syndrome Patient Reported Index after five tDCS sessions [mean group difference: 1.40; 95%CI -2.33, -0.48; effect size 1.04]. Although there were no between-group differences in the secondary outcomes of sleep, mood and anxiety, within-group comparisons evidenced a small but significant difference in the active group for pain and sleep. There were no significant cortisol changes. All reported adverse events were mild and transitory. CONCLUSION: tDCS seems to be safe and reduce fatigue in pSS. A differential effect on pain and sleep may underlie its effects. Further studies are needed to optimise tDCS treatment strategies in pSS.