WASTE PLASTICS MANAGEMENT IN MUNICIPALITIES: LOGISTICS AND PROCESSES IN LOMBARDIA (NORTHERN ITALY)

A partnership of 49 Municipalities lying in Lombardia (Northern Italy) and belonging to the District \u201cMonza and Brianza\u201d has entrusted the management of the Municipal Solid Waste (MSW) to two Public Companies: \u201cC.E.M. Ambiente S.p.A.\u201d - which owns and operates a transfer station and a multi-material centre - and \u201cSERUSO S.p.A.\u201d, whose single facility is set up and equipped for a high performance factory sorting of the dry fraction of the urban waste. The catchment area is populated by 448 000, living in an area of 366 km2. The management system starts with household sorting for multi-bin curbside collection; followed by hauling to selection and physical treatment facilities; and last, transport of the selected fractions to final destinations. The yearly throughput of \u201cC.E.M. Ambiente\u201d is about 296 000 t, of which over 70% home-sorted. Extra-CEM customers add to this amount about 40 000 t/yr. When calculated on the partner municipalities, the waste generation rate is almost 1.8 kg/capita per day including waste from craftsmen and workshops. Less than 1% of the collected waste goes to landfill and about 8% to incineration with energy recovery (WTE). Since \u201cC.E.M. Ambiente\u201d operates mainly the logistics, however; and part of the materials recovery is actually made downstream its gate at \u201cSERUSO\u201d facility, where some by-products are unavoidably generated; the overall share of WTE will be slightly higher. Electric energy produced from the combustible by-products of \u201cC.E.M. Ambiente\u201d and \u201cSERUSO\u201d covers largely the energy needs of the recovery and cleaning processes. It is worthwhile stressing that in this district also waste from street sweeping \u2013 as much as 8 200 t/yr \u2013 is turned into sand, gravel and like for civil works. \u201cC.E.M. Ambiente\u201d uses also fuel energy, to operate collection and hauling vehicles and factory handling machines, all of them powered by Diesel engines. Fuel requirements for TS and MMC in 2011 were 78 405 and 14 605 litres, respectively. Regrettably, these needs cannot be satisfied in any way with recovered energy

R(-)-O-desmethylangolensin is the main enantiomeric form of daidzein metabolite produced by human in vitro and in vivo

After ingestion, human intestinal bacteria transform daidzein into dihydrodaidzein, which can be further metabolised to O-desmethylangolensin. This metabolite, unlike daidzein, has a chiral centre and can therefore occur as two distinct enantiomers; however, it is unclear which enantiomer is present in humans. The aim of this study was to define in vitro and in vivo the structure of O-desmethylangolensin and then to evaluate its pharmacokinetic parameters. Daidzein metabolism was preliminarily investigated in anaerobic batch cultures inoculated with mixed faecal bacteria from O-desmethylangolensin producer volunteers. The transformation was monitored by liquid chromatography-mass spectrometry and a chiral column was used to distinguish dihydrodaidzein and O-desmethylangolensin enantiomers. These were purified, analysed by circular dichroism and the results established R(-)-O-desmethylangolensin as the main product (enantiomer excess 91%). However, both dihydrodaidzein enantiomers were detected. Similar results were obtained by in vivo trials. The in vitro formation of O-desmethylangolensin seems to be directly correlated with the number of transforming microorganisms. This correlation was found in vivo for tmax but not for other pharmacokinetic indexes. The pharmacokinetics of daidzein, dihydrodaidzein and O-desmethylangolensin were then evaluated in 11 healthy adult O-desmethylangolensin producers after the single administration of soy milk containing 100mg daidzein. The conjugated forms of daidzein, dihydrodaidzein and O-desmethylangolensin represent more than 90 and 95% of the plasmatic and urinary forms, respectively. The Cmax, tmax and half-life of O-desmethylangolensin in plasma were 62\ub153nM, 28\ub111 and 15\ub16h, respectively. Relevant inter-individual variations were observed as indicated by the high standard deviations

New frontiers and emerging applications of 3D printing in ENT surgery: A systematic review of the literature

3D printing systems have revolutionised prototyping in the industrial field by lowering production time from days to hours and costs from thousands to just a few dollars. Today, 3D printers are no more confined to prototyping, but are increasingly employed in medical disci- plines with fascinating results, even in many aspects of otorhinolaryngology. All publications on ENT surgery, sourced through updated electronic databases (PubMed, MEDLINE, EMBASE) and published up to March 2017, were examined according to PRISMA guidelines. Overall, 121 studies fulfilled specific inclusion criteria and were included in our systematic review. Studies were classified according to the specific field of application (otologic, rhinologic, head and neck) and area of interest (surgical and preclinical education, customised surgical planning, tissue engineering and implantable prosthesis). Technological aspects, clinical implications and limits of 3D printing processes are discussed focusing on current benefits and future perspectives

Development of a novel Italian speech-in-noise test using a roving-level adaptive method: adult population-based normative data

Negli ultimi anni, il crescente sviluppo di dispositivi acustici ha condotto a unanalisi critica dei metodi standard che sono stati impiegati per valutare la funzione uditiva. Gli esami audiologici tradizionali, basati sulla soglia audiometrica tonale e sulle liste di parole mono/ bisillabiche nel silenzio, si sono nel tempo dimostrati inadeguati perché troppo distanti dalla realtà. Un test audiometrico vocale nel rumore, che utilizza un metodo roving-level adattivo, adopera segnali target e segnali competitivi modificabili con lo scopo di riprodurre le condizioni di eloquio della vita quotidiana, quindi esplorare un più ampio range uditivo. A oggi, solamente pochi test roving-level adattivi sono disponibili in letteratura. Gli autori hanno condotto un test roving-level adattivo in adulti italiani sani, al fine di ottenere nuovi dati normativi in una lingua di origine latina

Modern management of paediatric obstructive salivary disorders: long-term clinical experience

I disordini ostruttivi salivari sono infrequenti nelletà pediatrica. I recenti progressi tecnologici nel distretto della testa e del collo hanno modificato la strategia diagnostica e terapeutica dei disordini salivari. La diagnosi è oggi basata sulleco color Doppler, sulla scialo-RMN, sulla cone beam 3D TC, mentre la litotrissia extracorporea ed intracorporea, la scialoendoscopia interventistica, la chirurgia scialoendoscopico- assistita, sono attualmente utilizzati come procedure conservative e mininvasive per la preservazione funzionale della ghiandola affetta. Abbiamo analizzato i risultati dellesperienza clinica a lungo termine nel trattamento dei disordini ostruttivi delletà pediatrica. Un gruppo consecutivo di 66 pazienti pediatrici (38 femmine) con sintomi salivari ostruttivi causati da parotite ricorrente pediatrica (32 pazienti), calcoli (20), stenosi duttali (5), e ranule (9) è stato incluso nello studio. 45 pazienti sono stati sottoposti a scialoendoscopia interventistica per parotite ricorrente, calcoli e stenosi, 12 pazienti sono stati sottoposti ad un ciclo di litotrissia extracorporea (ESWL), tre pazienti a chirurgia transorale scialoendoscopico-assistita, un paziente a drenaggio, sei a marsupializzazione e due a sutura della ranula. Nel 90,9% è stato raggiunto un risultato favorevole. Lapproccio combinato di litotrissia salivare extracorporea e di scialoendoscopia interventistica è stato utilizzato in tre pazienti ed una procedura secondaria è stata eseguita in sette pazienti. Nessun paziente è stato sottoposto a scialoadenectomia nonostante la persistenza di modesti sintomi ostruttivi in sei pazienti. Non è stata osservata alcuna complicanza maggiore. Adottando un adeguato iter diagnostico mediante eco color Doppler delle ghiandole salivari, scialo-RMN e cone beam 3D TC, i pazienti pediatrici con disordini ostruttivi salivari possono essere efficacemente trattati con un approccio moderno mini-invasivo mediante tecniche di litotrissia extracorporea ed intracorporea, scialoendoscopia interventistica, e chirurgia transorale scialoendoscopico-assistita; questo approccio garantisce un risultato favorevole nella maggior parte dei pazienti evitando così il ricorso alla scialoadenectomia invasiva e mantenendo così la preservazione funzionale della ghiandola coinvolta

Valutazione clinico/morfologica di Amukine Med® e Braunol®, su CVC in spisilicone

La gestione infermieristica riveste un ruolo importante per la sopravvivenza dell'accesso vascolare per emodialisi, soprattutto quando per la sua realizzazione sono stati utilizzati materiali protesici etcrologhi. Scopo di questo studio è di valutare in vitro e in vivo gli eventuali effetti collaterali e l'efficacia di due disinfettanti tra i più comunemente usati (ipoclorito di sodio allo 0,057 Amukine Med® e iodopovidone al 10% Braunol®,) per le medicazioni dei cateteri venosi centrali. Lo studio è stato effettuato da gennaio 2003 a gennaio 2004. In tale periodo abbiamo valutato in vitro mediante esame morfologico gli effetti sui cateteri incubati a breve e lungo termine nei 2 disinfettanti e in vivo l'incidenza di reazioni cutanee locali e la positività dell'esame colturale del tampone cutaneo, in 17 malati uremici con "Tesio cat®" Medcomp (spisilicone) come accesso vascolare per emodialisi. Non si sono notate differenze morfologiche significative nello studio in vitro tra i campioni trattati con i due disinfettanti. Il contatto prolungato dello spisilicone con Amukine Med e Braunol anche in ambiente libero non ha determinato alterazioni morfologiche della parete all'esame macro e microscopico. Nello studio in vivo, condotto su due gruppi composti da 10 pazienti nel gruppo Amukine Med e 7 pazienti in quello con Braunol, sono state effettuate 1088 medicazioni (640 con Amukine Med pari al 58,8% medicazioni totali e 448 con Braunol pari al 41,2% medicazioni totali) pari al 40,5% delle sedute dialitiche con ambo le tecniche di disinfezione. Dagli esami colturali (271 tamponi) in 71 casi è stata riportata crescita batterica; 68 Staphilococcus Epidermidis; 2 Escherichia Coli (gruppo Amuchina Med) 1 Pseudomonas Aeruginosa (gruppo Braunol). Negli ultimi 3 casi (1/68 mesi d'esposizione) era presente sepsi locale. Non si sono rilevate differenze nell'incidenza di infezioni locali o di effetti collaterali indotti dai due disinfettanti

Modern management of paediatric obstructive salivary disorders: long-term clinical experience=La gestione moderna dei disordini ostruttivi salivari in età pediatrica: Esperienza clinica a lungo termine

Recent technological improvements in head and neck field have changed diagnostic and therapeutic strategies for salivary disorders. Diagnosis is now based on colour Doppler ultrasonography (US), magnetic resonance (MR) sialography and cone beam 3D computed tomography (CT), and extra-and intracorporeal lithotripsy, interventional sialendscopy and sialendoscopy-assisted surgery are used as minimally invasive, conservative procedures for functional preservation of the affected gland. We evaluated the results of our long-term experience in the management of paediatric obstructive salivary disorders. The study involved a consecutive series of 66 children (38 females) whose obstructive salivary symptoms caused by juvenile recurrent parotitis (JRP) (n = 32), stones (n = 20), ranula (n = 9) and ductal stenosis (n = 5). 45 patients underwent interventional sialendoscopy for JRP, stones and stenoses, 12 a cycle of extracorporeal shockwave lithotripsy (ESWL), three sialendoscopy-assisted transoral surgery, one drainage, six marsupialisation, and two suturing of a ranula. Three children underwent combined ESWL and interventional sialendoscopy, and seven a secondary procedure. An overall successful result was obtained in 90.9% of cases. None of the patients underwent traditional invasive sialadenectomy notwithstanding persistence of mild obstructive symptoms in six patients. No major complications were observed. Using a diagnostic work-up based on colour Doppler US, MR sialography and cone beam 3D TC, children with obstructive salivary disorders can be effectively treated in a modern minimally-invasive manner by extracorporeal and intracorporeal lithotripsy, interventional sialendoscopy and sialendoscopy-assisted transoral surgery; this approach guarantees a successful result in most patients, thus avoiding the need for invasive sialadenectomy while functionally preserving the gland

The prognostic-nutritional index in HPV-negative head and neck squamous cell carcinoma treated with upfront surgery: a multi-institutional series

Objectives. To evaluate the prognostic value of pre-treatment prognostic-nutritional index (PNI) in patients with HPV-negative head and neck squamous cell carcinoma (HNSCC). Methods. A multi-institutional retrospective series of HPV-negative, Stages II-IVB, HNSCCs treated with upfront surgery was evaluated. Correlation of pre-operative blood markers and PNI with 5-year overall (OS) and relapse-free (RFS) survival was tested using linear and restricted cubic spline models, as appropriate. The independent prognostic effect of patient-related features was assessed with multivariable models. Results. The analysis was conducted on 542 patients. PNI ≥ 49.6 (HR = 0.52; 95% CI, 0.37-0.74) and Neutrophil-to-Lymphocyte Ratio (NLR) > 4.2 (HR = 1.58; 95% CI, 1.06-2.35) confirmed to be independent prognosticators of OS, whereas only PNI ≥ 49.6 (HR = 0.44; 95% CI, 0.29-0.66) was independently associated with RFS. Among pre-operative blood parameters, only higher values of albuninaemia and lymphocyte count (> 1.08 x 103/microL), and undetectable basophile count (= 0 103/microL) were independently associated with better OS and RFS. Conclusions. PNI represents a reliable prognostic tool providing an independent measure of pre-operative immuno-metabolic performance. Its validity is supported by the independent prognostic role of albuminaemia and lymphocyte count, from which it is derived

Head and neck region consolidation radiotherapy and prophylactic cranial irradiation with hippocampal avoidance delivered with helical tomotherapy after induction chemotherapy for non-sinonasal neuroendocrine carcinoma of the upper airways

Background: Non-sinonasal neuroendocrine carcinomas (NSNECs) of the head and neck are considered an unfrequent clinico-pathological entity. Combined modality treatment represents an established therapeutic option for undifferentiated forms where distant metastasis is a common pattern of failure.Methods: We report on a case of NSNEC treated with sequential chemo-radiation consisting of 6 cycles of cisplatin and etoposide followed by loco-regional radiation to the head and neck and simultaneous prophylactic cranial irradiation to prevent from intracranial spread, delivered with helical tomotherapy with the 'hippocampal avoidance' technique in order to reduce neuro-cognitive late effects.Results: One year after the end of the whole combined modality approach, the patient achieved complete remission, with no treatment-related sub-acute and late effects.Conclusions: The present report highlights the importance of multidisciplinary management for NSNECs of the head and neck, as the possibility to achieve substantial cure rates with mild side effects with modern radiotherapy techniques. © 2012 Franco et al; BioMed Central Ltd

Interventional sialendoscopy for radioiodine-induced sialadenitis: quo vadis?

La tossicità delle ghiandole salivari rappresenta un noto effetto indesiderato dello iodio radioattivo (I) utilizzato per il trattamento di neoplasie tiroidee, con una prevalenza che varia dal 2% al 67% della popolazione esposta. Recentemente, la scialoendoscopia è stata introdotta come un interessante strumento diagnostico e terapeutico per la gestione dei pazienti affetti da scialoadenite radioiodio-indotta non responsiva ai trattamenti medici standard. Lobiettivo della presente revisione è stato valutare linfluenza di questa procedura sulla storia clinica di pazienti affetti da scialoadenite conseguente a trattamento con radioiodio. Complessivamente, la revisione ha incluso 8 studi, 122 pazienti e 264 scialoendoscopie. Le stenosi duttali ed i tappi mucosi hanno rappresentato l85.7% dei reperti endoscopici, sostenendo il ruolo dellostruzione duttale nella fisiopatologia della scialoadenite da radioiodio. Circa l89.3% dei pazienti riportarono una risoluzione parziale o completa degli episodi di scialoadenite ricorrente, senza complicanze post-operatorie maggiori. Un solo caso è stato sottoposto a parotidectomia per fallimento del trattamento scialoendoscopico e persistenza dei sintomi. Tuttavia, i risultati della letteratura riguardarono principalmente valutazioni soggettive e solamente in due esperienze cliniche furono prese in considerazione misure oggettive con risultati discordanti. La xerostomia fu analizzata in pochi studi, con benefici differenti rispetto ai sintomi ostruttivi. La tempistica ideale per la videoendoscopia delle ghiandole salivari necessita di ulteriori analisi, al fine di definire la miglior gestione delle scialoadeniti ostruttive radioiodio-indotte