Утилизация сульфидно-мышьяковистого кека

When processing sulfide copper-zinc concentrates at copper smelters, sulfide-arsenic cakes are formed, which are subject to disposal. To solve the global environmental problem of arsenic in the metallurgical and mining industries, it must be reliably concentrated and fixed in technological flows with subsequent waste disposal. The fusion of arsenic cake with elemental sulfur leads to the formation of vitreous sulfides, which are less toxic in comparison with dispersed powdered cake, homogeneous and compact in shape. The fusion product is represented by non-stoichiometric arsenic sulfide, similar in composition to As2S5. The high chemical stability of glassy arsenic sulfides is confirmed by the results of leaching by TCLP method. The fusion products have 100 times lower solubility compared to the initial cake. Achieving the solubility of arsenic in the alloy below the threshold concentration (5 mg/dm3 ) makes it possible to recommend the disposal of arsenic cake by fusing it with elemental sulfur. The fusion products belong to non-hazardous waste and are suitable for long-term storage. The composition and structure of cake fusions with iron powder have been studied. New compounds of variable composition were identified in the fused samples: arsenides and sulfides of iron, arsenic sulfides and arsenopyrites. Studies have shown that the products of fusion with iron have a solubility 10–15 times lower than the arsenic compounds in the initial cake but above the threshold concentration as per TCLP method. Therefore, fusion with iron cannot be recommended for practical use for the disposal of arsenic cakes.При переработке сульфидных медно-цинковых концентратов на медеплавильных заводах образуются сульфидномышьяковистые кеки, подлежащие утилизации. Для решения глобальной экологической проблемы мышьяка в металлургической и горнодобывающей отраслях промышленности он должен быть надежно сконцентрирован и иммобилизован в технологических потоках с последующим удалением отходов. Сплавление мышьяковистого кека с элементной серой приводит к образованию стекловидных сульфидов, которые менее токсичны в сравнении с дисперсным порошкообразным кеком, однородны и обладают компактной формой. Продукт сплавления представлен нестехиометрическим сульфидом мышьяка, близким по составу к As2S5. Высокая химическая устойчивость стеклообразных сульфидов мышьяка подтверждается результатами выщелачивания по методике TCLP. Продукты сплавления имеют в 100 раз меньшую растворимость по сравнению с исходным кеком. Достижение растворимости мышьяка в сплаве ниже пороговой концентрации (5 мг/дм3 ) позволяет рекомендовать утилизацию мышьяковистого кека способом сплавления его с элементной серой. Продукты сплавления относятся к неопасным отходам и пригодны для длительного хранения. Изучены состав и структура сплавов кека с железным порошком. В сплавленных образцах выявлены новые соединения переменного состава: арсениды и сульфиды железа, сульфиды мышьяка и арсенопириты. Исследования показали, что продукты сплавления с железом обладают растворимостью в 10–15 раз меньшей, чем соединения мышьяка в исходном кеке, но выше пороговой концентрации по методике TCLP. Поэтому сплавление с железом не может быть рекомендовано к практическому использованию для утилизации мышьяковистых кеков

Российский консенсус по профилактике, диагностике и лечению рака желудка

The Russian consensus on prevention, diagnostic and treatment of gastric cancer was prepared on the initiative of the Moscow clinical scientific center named after A. S. Loginov according to the Delphi method. Its aim was to clarify and consolidate the opinions of specialists on the most relevant issues of prevention, diagnosis and treatment of gastric cancer. An interdisciplinary approach was provided by the participation of leading gastroenterologists, oncologists and surgeons.Российский консенсус по профилактике, диагностике и лечению рака желудка подготовлен по инициативе Московского клинического научного центра им А. С. Логинова ДЗМ по Дельфийской системе. Его целью явилась консолидация мнений отечественных специалистов по наиболее актуальным вопросам профилактики, скрининга, диагностики и лечения рака желудка. Междисциплинарный подход обеспечен участием ведущих гастроэнтерологов, онкологов и хирургов.Цель статьи: представить положения Российского консенсуса по профилактике, диагностике и лечению рака желудка

Intraoperative transfusion practices in Europe

BACKGROUND: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. METHODS: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. RESULTS: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl(-1) and increased to 9.8 (1.8) g dl(-1) after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). CONCLUSION: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl(-1)), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold. CLINICAL TRIAL REGISTRATION: NCT 01604083

Use of sedation for routine diagnostic upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy Survey of National Endoscopy Society Members.

Sedation rates may vary among countries, depending on patients' and endoscopists' preferences. The aim of this survey was to investigate the rate of using premedication for routine diagnostic upper gastrointestinal (UGI) endoscopy in endoscopy societies, members of the European Society of Gastrointestinal Endoscopy (ESGE). We evaluated a multiple-choice questionnaire which was e-mailed to representatives of national endoscopy societies, which are members of the ESGE. The questionnaire had 14 items referring to endoscopy practices in each country and the representatives' endoscopy units. The response rate was 76% (34/45). In 47% of the countries, less than 25% of patients undergo routine diagnostic UGI endoscopy with conscious sedation. In 62% of the responders' endoscopy units, patients are not asked their preference for sedation and do not sign a consent form (59%). Common sedatives in use are midazolam (82%), diazepam (38%) or propofol (47%). Monitoring equipment is not available 'in most of the endoscopy units' in 46% (13/28) of the countries. Though they were available in 91% of the national representatives' endoscopy units, they are rarely (21%) used to monitor unsedated routine diagnostic UGI endoscopy. In about 50% of ESGE-related countries, less than 25% of patients are sedated for routine diagnostic UGI endoscopy. Major issues to improve include availability of monitoring equipment and the use of a consent form

Mortality after surgery in Europe: a 7 day cohort study

Background: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.Methods: We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ² and Fisher’s exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p<0·05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries.Findings: We included 46 539 patients, of whom 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9–3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0–3·0] for Iceland to 21·5% [16·9–26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19 1·05; p=0·06] for Finland to 6·92 [2·37–20·27; p=0·0004] for Poland).Interpretation: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.Funding: European Society of Intensive Care Medicine, European Society of Anaesthesiology