A review of technologies for closing the P loop in agriculture runoff: contributing to the transition towards a circular economy

Phosphorus (P) scarcity and the environmental hazards posed by P discharges have triggered the development of technologies for P sequestration and removal from waste streams. Agriculture runoff usually has P concentrations high enough to contribute to eutrophication and harmful algal blooms, but they are still too low for successful P removal with conventional technologies commonly applied in wastewater treatment. For this reason, realistic approaches to remove P from agricultural waste streams mainly include natural assimilation and constructed wetlands. Although these technologies have been implemented for some time, P removal is not always achieved to the needed extent and sometimes sufficient surface areas required are unattainable. Phosphorus sorbing materials, especially materials rich in calcium, have emerged to increase the removal potential of runoff treatment wetlands and at the same time sequester P for potential subsequent reuse. This paper analyses the current strategies and technologies for P removal and reuse from agriculture surface runoff streams taking a circular economy approach. It particularly addresses the current state of calcium rich materials commonly used for P removal that have also shown positive results as fertilizers or soil.This work has been possible thanks to the European funding programme “Iniciativa de Empleo Juvenil” and the Spanish Ministry of Science and Innovation (project reference: PEJ2018-005586-A).Peer ReviewedPostprint (published version

Evaluation of subclinical cardiovascular disease in patients with DM1

La diabetes mellitus tipo 1 (DM1) se caracteriza por un déficit absoluto de insulina. Los pa-cientes con DM1, poseen mayor riesgo de enfermedad cardiovascular (ECV) (enfermedad coronaria, miocar-diopatías, accidente cerebrovascular - ACV), y arterio-patía periférica (calcificaciones arteriales, enfermedad arterial oclusiva, presencia de amputaciones no trau-máticas). En estudios realizados con DM1 se observa que la Enfermedad coronaria se presenta en edades más tempranas, entre los 28-38 años, comparado con la población general donde el primer evento ocurre a partir de los 44 años. La asociación de anomalías vas-culares y aterosclerosis es muy frecuente en pacientes con DM1, siendo la detección del engrosamiento de ín-tima media carotideo un método útil para realizar diag-nóstico de enfermedad aterosclerótica subclínica. Objetivos: realizar diagnóstico precoz de ECV subclí-nica e instaurar medidas terapéuticas tempranas

Guidelines for chemotherapy of biliary tract and ampullary carcinomas

Few randomized controlled trials (RCTs) with large numbers of patients have been conducted to date in patients with biliary tract cancer, and standard chemotherapy has not been established yet. In this article we review previous studies and clinical trials regarding chemotherapy for unresectable biliary tract cancer, and we present guidelines for the appropriate use of chemotherapy in patients with biliary tract cancer. According to an RCT comparing chemotherapy and best supportive care for these patients, survival was significantly longer and quality of life was significantly better in the chemotherapy group than in the control group. Thus, chemotherapy for patients with biliary tract cancer seems to be a significant treatment of choice. However, chemotherapy for patients with biliary tract cancer should be indicated for those with unresectable, locally advanced disease or distant metastasis, or for those with recurrence after resection. That is why making the diagnosis of unresectable disease should be done with greatest care. As a rule, pathological diagnosis, including cytology or histopathological diagnosis, is preferable. Chemotherapy is recommended in patients with a good general condition, because in patients with general deterioration, such as those with a performance status of 2 or 3 or those with insufficient biliary decompression, the benefit of chemotherapy is limited. As chemotherapy for unresectable biliary tract cancer, the use of gemcitabine or tegafur/gimeracil/oteracil potassium is recommended. As postoperative adjuvant chemotherapy, no effective adjuvant therapy has been established at the present time. It is recommended that further clinical trials, especially large multi-institutional RCTs (phase III studies) using novel agents such as gemcitabine should be performed as soon as possible in order to establish a standard treatment

Feasibility, safety and pharmacokinetic study of hepatic administration of drug-eluting beads loaded with irinotecan (DEBIRI) followed by intravenous administration of irinotecan in a porcine model

Irinotecan eluting embolization beads (DEBIRI) are currently being evaluated in the clinic for the treatment of colorectal cancer metastases to the liver. The aim of this study was to determine the safety and pharmacokinetics associated with two cycles of hepatic embolization using DEBIRI followed by intravenous administration of irinotecan. Pigs were embolized with DEBIRI (100–300 μm, 100 mg dose, n = 6) and blood samples taken over 24 h to determine plasma levels of irinotecan and SN-38 metabolite and for haematology and biochemistry. At 24 h an IV infusion of 250 mg/m2 of irinotecan was administered and the plasma levels taken again. This cycle was repeated 3 weeks later. A single animal was subjected to a more aggressive regimen of embolization with 200 mg bead dose and IV of 350 mg/m2 for two cycles. Three animals were sacrificed at 6 weeks and the remaining four (n = 3 standard dose, n = 1 high dose) animals at 12 weeks and detailed histopathology performed. All animals tolerated the treatments well, with only minor changes in haematological and biochemical parameters. There was no overlap in drug plasma levels observed from the bead and IV treatments when given 24 h apart and no difference between the pharmacokinetic profiles of the two cycles separated by 3 weeks. Irinotecan plasma AUC values were similar in both the embolization and IV arms of the study. Cmax values obtained during the IV arms of the study are approximately double that of the embolization arms whilst Tmax times are shorter in the IV arms, supporting extended release of drug from the beads. Bioavailability for bead-based delivery was double that for IV administration, which was attributed to reduced clearance of the drug when delivered by this route. No additive toxicity was observed as a consequence of the combined treatments. The combination of irinotecan delivery via drug eluting bead and IV was well-tolerated with no significant clinical effects. Pharmacokinetic analyses suggest the bioavailability from bead-based delivery of drug is double that of IV infusion, attributable to reduced drug clearance for the former.Andrew L. Lewis, Rachel R. Holden, S. Ting Chung, Peter Czuczman, Timothy Kuchel, John Finnie, Susan Porter, David Foste