Wastewater disposal to landfill-sites: a synergistic solution for centralized management of olive mill wastewater and enhanced production of landfill gas

The present paper focuses on a largely unexplored field of landfill-site valorization in combination with the construction and operation of a centralized olive mill wastewater (OMW) treatment facility. The latter consists of a wastewater storage lagoon, a compact anaerobic digester operated all year round and a landfill-based final disposal system. Key elements for process design, such as wastewater pretreatment, application method and rate, and the potential effects on leachate quantity and quality, are discussed based on a comprehensive literature review. Furthermore, a case-study for eight (8) olive mill enterprises generating 8700 m(3) of wastewater per year, was conceptually designed in order to calculate the capital and operational costs of the facility (transportation, storage, treatment, final disposal). The proposed facility was found to be economically self-sufficient, as long as the transportation costs of the OMW were maintained at <= 4.0 (sic)/m(3). Despite that EU Landfill Directive prohibits wastewater disposal to landfills, controlled application, based on appropriately designed pre-treatment system and specific loading rates, may provide improved landfill stabilization and a sustainable (environmentally and economically) solution for effluents generated by numerous small- and medium-size olive mill enterprises dispersed in the Mediterranean region

Toward an Expert System for Terrain Analysis.

Terrain analysis is the systematic study of image patterns relating to the origin, and composition of distinct terrain units called landforms. It takes into account and provides information about physical site factors which are used by civil engineers for evaluating the suitability of a site for a terrain related engineering application. Terrain analysis is a time consuming labor intensive process and requires a significant degree of expertise. In this dissertation, an expert system paradigm has been adopted, for developing a computational approach to terrain analysis problem solving. A methodology was developed for the representation and management of uncertain terrain knowledge. The vagueness that is inherent in the descriptions of terrain analysis terms was represented using fuzzy models. The Dempster-Shafer theory of evidence was adopted to establish hypotheses about the type of terrain based on observed evidences. A goal directed backward form of reasoning was employed for evaluating the suitability of a site for a terrain related engineering application. The reasoning strategy was formalized in production rules, and the fuzzy models of terrain terms were formalized in frames. Procedural computations were formalized in LISP code. The methodology was implemented in the Terrain Analysis eXpert (TAX) system. TAX was developed by employing the expert system shell KEE (Knowledge Engineering Environment) and the image processing package ELAS (Earth resources Laboratory Application Software). TAX was tested with a real data set consisting of a digitized color infra-red photograph and digital elevation data. The conclusions arrived at by TAX compared favorably to those reached by an expert who analyzed the same site using traditional photointerpretation techniques

Early or Delayed Intervention for Bile Duct Injuries following Laparoscopic Cholecystectomy? A Dilemma Looking for an Answer

Background. To evaluate the effect of timing of management and intervention on outcomes of bile duct injury. Materials and Methods. We retrospectively analyzed 92 patients between 1991 and 2011. Data concerned patient’s demographic characteristics, type of injury (according to Strasberg classification), time to referral, diagnostic procedures, timing of surgical management, and final outcome. The endpoint was the comparison of postoperative morbidity (stricture, recurrent cholangitis, required interventions/dilations, and redo reconstruction) and mortality between early (less than 2 weeks) and late (over 12 weeks) surgical reconstruction. Results. Three patients were treated conservatively, two patients were treated with percutaneous drainage, and 13 patients underwent PTC or ERCP. In total 74 patients were operated on in our unit. 58 of them underwent surgical reconstruction by end-to-side Roux-en-Y hepaticojejunostomy, 11 underwent primary bile duct repair, and the remaining 5 underwent more complex procedures. Of the 56 patients, 34 patients were submitted to early reconstruction, while 22 patients were submitted to late reconstruction. After a median follow-up of 93 months, there were two deaths associated with BDI after LC. Outcomes after early repairs were equal to outcomes after late repairs when performed by specialists. Conclusions. Early repair after BDI results in equal outcomes compared with late repair. BDI patients should be referred to centers of expertise and experience

Improved microbubble (MB) Localisation Using Particle Detecting algorithm:Evaluation of Algorithm Performance for Different Beamforming Methods

International audienceThe performance of image analysis techniques (particle detection) on contrast enhanced ultrasound (CEUS) images could be enhanced by using it in combination with the right beamformer (BF). The current study investigates the best performing combination of a particle detecting algorithm (Kanoulas et al. 2019) with four beamformers (BFs), classical and adaptive. In a series of in silico experiments, adjacent MBs are placed in distances comparable to the lateral resolution limit, the CEUS images of the MBs were simulated in FieldII, and finally beamformed with the four methods. The images were processed with the MB detection algorithm and the results were evaluated by the true detections (TD), missed MBs, spurious detections, and localisation uncertainty (LU). For the smallest distances all methods deteriorate but the MV methods provided 4-12% more TD. For the intermediate distances the TD were comparable for all BFs but the adaptive methods provided lower LU. When a set of evaluation metrics is used, the adaptive methods provide marginally but systematically improved results which suggests that, under the appropriate imaging conditions, they could be used to enhance vessel mapping

Early apoptosis of blood monocytes in the septic host: is it a mechanism of protection in the event of septic shock?

INTRODUCTION: Based on the central role of the triggering of monocytes for the initiation of the septic cascade, it was investigated whether apoptosis of blood monocytes in septic patients is connected to their final outcome. METHODS: Blood monocytes were isolated from 90 patients with septic syndrome due to ventilator-associated pneumonia on days 1, 3, 5 and 7 from the initiation of symptoms. Apoptosis was defined after incubation with annexin-V-fluorescein isothiocyanate and propidium iodine and reading by a flow cytometer. The function of first-day monocytes was evaluated from the concentrations of tumour necrosis factor alpha (TNFα) and IL-6 in supernatants of cell cultures after triggering with endotoxins. TNFα, IL-6 and IL-8 were estimated in serum by an enzyme immunoassay. RESULTS: Mortality rates of patients with apoptosis ≤50% compared with patients with apoptosis >50% were 49.12% and 15.15%, respectively (P < 0.0001). Kaplan-Meier analysis showed a 28-day survival benefit in patients with septic shock and monocyte apoptosis >50% compared with those patients with apoptosis ≤50% (P = 0.0032). Production of IL-6 by monocytes on the first day by patients with apoptosis ≤50% was similar compared with monocytes isolated from healthy controls. Serum concentrations of TNFα were higher in patients with monocyte apoptosis ≤50% and septic shock compared with patients with apoptosis >50% on day 7; similar findings occurred for serum IL-6 on days 1 and 7 and for serum IL-8 on days 1 and 5. CONCLUSION: Early apoptosis of monocytes upon presentation of clinical signs of sepsis is connected to a favourable outcome. These findings are of particular importance for the patient with septic shock, where they might constitute a mechanism of pathogenesis

Effect of Clarithromycin in Patients with Sepsis and Ventilator-Associated Pneumonia

Background. Because clarithromycin provided beneficiary nonantibiotic effects in experimental studies, its efficacy was tested in patients with sepsis and ventilator-associated pneumonia (VAP). Methods. Two hundred patients with sepsis and VAP were enrolled in a double-blind, randomized, multicenter trial from June 2004 until November 2005. Clarithromycin (1 g) was administered intravenously once daily for 3 consecutive days in 100 patients; another 100 patients were treated with placebo. Main outcomes were resolution of VAP, duration of mechanical ventilation, and sepsis-related mortality within 28 days. Results. The groups were well matched with regard to demographic characteristics, disease severity, pathogens, and adequacy of the administered antimicrobials. Analysis comprising 141 patients who survived revealed that the median time for resolution of VAP was 15.5 days and 10.0 days among placebo- and clarithromycin-treated patients, respectively (P=.011); median times for weaning from mechanical ventilation were 22.5 days and 16.0 days, respectively (P=.049). Analysis comprising all enrolled patients showed a more rapid decrease of the clinical pulmonary infection score and a delay for advent of multiple organ dysfunction in clarithromycin-treated patients, compared with those of placebo-treated patients (P=.047). Among the 45 patients who died of sepsis, time to death was significantly prolonged in clarithromycin-treated compared with placebo-treated patients (P=.004). Serious adverse events were observed in 0% and 3% of placebo- and clarithromycin-treated patients, respectively (P=.25). Conclusions. Clarithromycin accelerated the resolution of VAP and weaning from mechanical ventilation in surviving patients and delayed death in those who died of sepsis. The mortality rate at day 28 was not altered. Results are encouraging and render new perspectives on the management of sepsis and VA

Super-Resolution Contrast Enhanced Ultrasound Methodology for the Identification of in-Vivo Vascular Dynamics in 2D

\u3cp\u3eObjectives The aim of this study was to provide an ultrasound-based super-resolution methodology that can be implemented using clinical 2-dimensional ultrasound equipment and standard contrast-enhanced ultrasound modes. In addition, the aim is to achieve this for true-to-life patient imaging conditions, including realistic examination times of a few minutes and adequate image penetration depths that can be used to scan entire organs without sacrificing current super-resolution ultrasound imaging performance. Methods Standard contrast-enhanced ultrasound was used along with bolus or infusion injections of SonoVue (Bracco, Geneva, Switzerland) microbubble (MB) suspensions. An image analysis methodology, translated from light microscopy algorithms, was developed for use with ultrasound contrast imaging video data. New features that are tailored for ultrasound contrast image data were developed for MB detection and segmentation, so that the algorithm can deal with single and overlapping MBs. The method was tested initially on synthetic data, then with a simple microvessel phantom, and then with in vivo ultrasound contrast video loops from sheep ovaries. Tracks detailing the vascular structure and corresponding velocity map of the sheep ovary were reconstructed. Images acquired from light microscopy, optical projection tomography, and optical coherence tomography were compared with the vasculature network that was revealed in the ultrasound contrast data. The final method was applied to clinical prostate data as a proof of principle. Results Features of the ovary identified in optical modalities mentioned previously were also identified in the ultrasound super-resolution density maps. Follicular areas, follicle wall, vessel diameter, and tissue dimensions were very similar. An approximately 8.5-fold resolution gain was demonstrated in vessel width, as vessels of width down to 60 μm were detected and verified (λ = 514 μm). Best agreement was found between ultrasound measurements and optical coherence tomography with 10% difference in the measured vessel widths, whereas ex vivo microscopy measurements were significantly lower by 43% on average. The results were mostly achieved using video loops of under 2-minute duration that included respiratory motion. A feasibility study on a human prostate showed good agreement between density and velocity ultrasound maps with the histological evaluation of the location of a tumor. Conclusions The feasibility of a 2-dimensional contrast-enhanced ultrasound-based super-resolution method was demonstrated using in vitro, synthetic and in vivo animal data. The method reduces the examination times to a few minutes using state-of-the-art ultrasound equipment and can provide super-resolution maps for an entire prostate with similar resolution to that achieved in other studies.\u3c/p\u3

Cushing's syndrome in pregnancy: a review of reported cases

Cushing’s syndrome (CS) causes hypogonadotropic hypogonadism and anovulatory infertility due to hypercortisolism, and it is very rare in pregnancy. CS in pregnancy is associated with important maternal-foetal morbidity and mortality, such as preeclampsia and premature delivery. A systematic search was conducted in the MEDLINE library to retrieve articles reporting cases of CS in pregnant women, during the period between 2010 and 2020.Thirty-five reported cases are presented focusing on the ability of diagnosis, treatment therapies, and foetal outcomes. Diagnosis of CS during pregnancy can be challenging and is often delayed, adrenal adenoma being the predominant cause. Both medical treatment and surgery aiming at restoring the cortisol balance reduce maternal and foetal complications