Insights about the Choice of Pig Manure Processing System in Three Italian Regions: Piemonte, Friuli Venezia Giulia, and Veneto

The adoption of best available technologies (BATs) by the livestock sector has a fundamental role in developing a sustainable agricultural system. Italy is the EU member with the highest percentage of manure treated, but processing facilities are regionally scattered and the adoption of BATs is far from being scaled-up. The adoption is a matter of multicriteria decision-making and full knowledge on how to foster the transition is still lacking. The present research aims to deepen the available knowledge by analysing the perception of 40 pig farm managers about decision criteria behind the adopted manure management system across three different Italian regions. We assessed farms in Piemonte, Friuli Venezia Giulia, and Veneto. All farms have adequate storage facilities, but 82.5% adopt no processing technique. The two most important decision criteria are economic, i.e., the minimization of treatment and spreading costs. The emerging picture allows us to conclude that BAT adoption is still adopted as a mere consequence of legal obligation. Economic constraints prevail as there is a lack of information and uncertainty. Clear perspectives and recognition of virtuous behavior prevent farmers from making decisions based on environmental or social criteria. Therefore, effective policies oriented to fill these gaps are needed to accelerate the transition towards sustainability

Oral azacitidine maintenance therapy for acute myeloid leukemia in first remission

Background: Although induction chemotherapy results in remission in many older patients with acute myeloid leukemia (AML), relapse is common and overall survival is poor. Methods: We conducted a phase 3, randomized, double-blind, placebo-controlled trial of the oral formulation of azacitidine (CC-486, a hypomethylating agent that is not bioequivalent to injectable azacitidine), as maintenance therapy in patients with AML who were in first remission after intensive chemotherapy. Patients who were 55 years of age or older, were in complete remission with or without complete blood count recovery, and were not candidates for hematopoietic stem-cell transplantation were randomly assigned to receive CC-486 (300 mg) or placebo once daily for 14 days per 28-day cycle. The primary end point was overall survival. Secondary end points included relapse-free survival and health-related quality of life. Results: A total of 472 patients underwent randomization; 238 were assigned to the CC-486 group and 234 were assigned to the placebo group. The median age was 68 years (range, 55 to 86). Median overall survival from the time of randomization was significantly longer with CC-486 than with placebo (24.7 months and 14.8 months, respectively; P<0.001). Median relapse-free survival was also significantly longer with CC-486 than with placebo (10.2 months and 4.8 months, respectively; P<0.001). Benefits of CC-486 with respect to overall and relapse-free survival were shown in most subgroups defined according to baseline characteristics. The most common adverse events in both groups were grade 1 or 2 gastrointestinal events. Common grade 3 or 4 adverse events were neutropenia (in 41% of patients in the CC-486 group and 24% of patients in the placebo group) and thrombocytopenia (in 22% and 21%, respectively). Overall health-related quality of life was preserved during CC-486 treatment. Conclusions: CC-486 maintenance therapy was associated with significantly longer overall and relapse-free survival than placebo among older patients with AML who were in remission after chemotherapy. Side effects were mainly gastrointestinal symptoms and neutropenia. Quality-of-life measures were maintained throughout treatment

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Sex-Based Evaluation of Lipid Profile in Postoperative Adjuvant Mitotane Treatment for Adrenocortical Carcinoma

Background: A wide interindividual variability in mitotane concentrations and treatment-related dyslipidemia have been reported. Here, we aimed to underline the sex-related differences in the lipid profile in patients that underwent radical surgery of adrenocortical carcinoma during treatment with adjuvant mitotane. Methods: A chromatographic method was used to quantify the drug in plasma collected from adult patients with complete tumor resection, also considering active metabolite o,p&rsquo;-DDE. Results: We observed different lipid profiles between males and females and between pre- and post-menopausal women. Considering the mitotane-related effects on lipid levels, we observed that higher drug concentrations were correlated with higher HDL in all the considered groups (p &lt; 0.001), with total cholesterol both in males (p = 0.005) and females (p = 0.036), with triglycerides in postmenopausal females (p = 0.002) and with LDL in male patients (p &lt; 0.001). Increases in o,p&rsquo;-DDE were positively correlated with HDL levels in all the groups (p &lt; 0.001) and negatively with LDL in all the groups (males p = 0.008, pre- and post-menopausal females p &lt; 0.001), with total cholesterol in pre- (p = 0.016) and post-menopausal women (p = 0.01) and with triglycerides in premenopausal females (p = 0.005). Conclusions: This is the first study designed to evaluate sex differences in lipoprotein and lipid levels during mitotane adjuvant treatment; the results suggest that a gender and personalized approach could be useful to prevent and manage alterations in the lipid profile

Facteurs de risque cardiovasculaire et surdité brusque: étude rétrospective sur une série de 141 patients.

Dans cette étude rétrospective, les auteurs ont évalué les aspects épidémiologiques et pronostiques des principaux facteurs de risque cardiovasculaire chez un groupe de Patients porteurs d'une surdité brusque

Green walls to treat kitchen greywater in urban areas: Performance from a pilot-scale experiment

An increase in water use in urban areas is forcing scientists and policy makers to find alternative solutions for freshwater management, aimed at attaining integrated water resources management. Here, we tested in a 2 year experiment (June 2017–April 2019) the treatment performance of an innovative wall cascade constructed wetland (WCCW) system. The aimwas to combine themultifunctional benefits of greenwalls (e.g. aesthetic, surface area requirements) with those of constructed wetland systems (e.g. high pollutants removal efficiencies, water recycling) to treat kitchen greywaters. The WCCW was a terraced system of six phytoremediation lines, each ofwhichwas composed of three plastic tanks (3 × 0.04m3), filled with lightweight porousmedia, and vegetated with different ornamental species, namely Mentha aquatica L., Oenanthe javanica (Blume) DC., and Lysimachia nummularia L. Physicochemical (temperature, pH, electrical conductivity, dissolved oxygen, turbidity) and chemical parameters (chemical oxygen demand, biochemical oxygen demand, anionic surfactants, Kjeldahl, ammoniumand nitric nitrogen, total orthophosphate)weremonitored at a frequency of at least 15 days, depending on the season andWCCWmanagement. Results showed that theWCCWsignificantly reduced the mainwater pollutants (e.g. organic compounds, nutrients), suggesting its potential application in urban environments for water recycling in the context of green infrastructures and ecological sanitation. A culture-independent taxonomic assessment of suspended bacterial communities before and after the treatment showed clear treatment-related shifts, being the functional ecology attributes changed according to changes in greywater chemical parameters. Future research should attempt to optimize theWCCWsystemmanagement by regulating the nutrients balance to avoidmacronutrients deficiency, and setting themost suitablewater flowdynamics (hydraulic retention time, saturation-desaturation cycles) to improve the greywater treatmen

Acute Mastoiditis in Cochlear Implanted children: a single-centre experience

Background: Acute mastoiditis (AM) is the most common complication of acute otitis media and primarily affects children under the age of two; current data on its prevalence in paediatric patients with cochlear implant (CI) are still scant. Proper management of AM in CI children is crucial in order to avoid the implications (financial and emotional) of an explant. Aim of this paper is to describe the cases of AM occurred among young patients with CI in follow up at our department, also in order to evaluate its prevalence, potential predisposing factors, clinical course and therapeutic strategies. Patients and methods: Retrospective study. Medical records of all paediatric patients with CI, who had at least one year of follow-up, were searched aiming to identify those who developed AM, from January 1 st 2002 to January 31 st 2022. The following data were collected and analysed: demographic features, implant type and side, interval between CI surgery and AM, treatment, laboratory tests, clinical course, vaccination history, associated diseases. Results: AM was developed by six (1.3%) of the 439 children with CI (541 implanted ears). In total, 9 episodes (2.05 %) were recorded, as three patients reported two consecutive infections. Average time interval between CI surgery, to the first or only AM diagnosis, was 13.8 months (range 3-30 months). Furthermore, 3/6 of patients had a history of recurrent acute otitis media; 2/6 an autism spectrum disorder, associated to a combined immune deficiency in one case. All patients were hospitalized and promptly treated by intravenous antibiotic therapy; 4/6 also underwent a mastoidectomy. CI was not explanted in any cases of this series. Conclusions: Over a 20-year period, AM rate in CI children was 1.3%, which is consistent with the current literature rates of 1 - 4.7 %. All cases were successfully treated, preserving the integrity of the device. In our experience, the early parenteral antibiotic therapy and, when necessary, surgical treatment were adequate to eradicate the infection