Proceedings of the ACEWATER2 Scientific Workshop Accra (Ghana) 31 Oct – 3 Nov 2016

The African Centers of Excellence on Water (ACEWATER2) project, in its second phase (2016/19), promoted by the African Ministers of Water and financed by DG DEVCO, aims at supporting the establishment of Human Capacity Development Programme of the AMCOW (African Ministers’ Council on Water) in the Water Sector, strengthens institutional networking and improving research support to policy making by scaling up the approach of the pilot phase (phase I). The main activities of the project consist in: • Strengthening of two existing NEPAD water Centers of Excellence networks in West and Southern Africa; • Expanding the NEPAD water Centres of Excellence network to Central and Eastern Africa; • Strengthening institutional networking and improving research support to policy making in the water sector; • Supporting the implementation of the African Water Ministers’ declaration urging AUC and NEPAD Centers of Excellence to develop a “Human Capacity Development Programme for junior professional and technician level capacity challenges in the water sector”; • Developing an Atlas on Regional Water Cooperation. The project geographical scope covers three major regions: Southern Africa (7 countries), Western Africa (4 countries) and Eastern/Central Africa. The project is implemented by DG JRC (overall project management and scientific cluster) with UNESCO (human capacity development cluster). Within this project, a Workshop has been organized in Accra (Ghana) from October 31st to November 3rd, specifically devoted to the sharing among CoEs of scientific interests, competences and methods towards the effective planning of (scientific) activities, achievement and delivery of scientific tools and products to support (science-based) decision making processes. By means of scientific as well as technical presentations, round tables and participative sessions, the participants (35 people representing more than 30 Institutions among Universities, Research Centres, River Basin Authorities, Regional Economic Communities and key stakeholders on water issues, further to European research Institutions as CIRAD and CREAF) shared valuable experiences and competences, including case studies, around key thematic pillars, such as: Climate Issues (Session 1), African Water-Energy-Food nexus (Session 2), Groundwater (Session 3) and Water Governance&Diplomacy (Session 4). Workshop Proceedings gather all relevant contributions in the form of (extended) abstracts and short papers, providing a general overview of key relevant issues and partners scientific interests, turning to be a valuable resource for effective planning of next project steps.JRC.D.2-Water and Marine Resource

Surgical Repair of Postinfarction Ventricular Septal Rupture: Systematic Review and Meta-Analysis.

Background. Ventricular septal rupture (VSR) is a rare but life-threatening complication after acute myocardial infarction. Although surgical correction is challenging and associated with high mortality, it remains the treatment of choice. This systematic review and meta-analysis aimed to evaluate the early outcome of surgical VSR repair.Methods. We searched electronic databases from January 1998 to February 2020. Studies reporting patients undergoing surgical treatment for VSR were analyzed. The primary outcome assessed was operative mortality. Differences were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) to assess the relationships of predefined surgical variables and clinical prognosis.Results. A total of 6361 adult patients from 41 studies were identified. Operative mortality was 38.2%. Pooled ORs showed increased odds of operative mortality in patients with preoperative or perioperative intraaortic balloon pump insertion (OR = 3.48; 95% CI, 3.01-4.02; P >= .001), right ventricular dysfunction (OR = 2.85; 95% CI, 1.47-5.52; P = .002), posterior VSR (OR = 1.73; 95% CI, 1.30-2.31; P >= .001), and emergency surgery (OR = 3.79; 95% CI, 2.52-5.72; P >= .001). Temporal trend evaluation revealed no difference over time in the operative mortality rate; it was 34% in both time-related groups (1971-2000 versus 2001-2018).Conclusions. Ventricular septal rupture repair has a high operative mortality. Patients with preoperative or perioperative intraaortic balloon pump support, right ventricular dysfunction at presentation, or posterior defects, and those undergoing emergent VSR correction have increased odds of operative mortality. (C) 2021 by The Society of Thoracic Surgeons. Published by Elsevier Inc

ACEWATER2 Regional database: hydro-climatology data-analysis

The report presents the architecture of a regional hydro-climatology information system, developed in the framework of the ACEWATER2 project, in order to support effective organization of information. Information includes both freely available large and regional scale data sources, as well as databases compiled by the CoEs (Centers of Excellence) and submitted as part of their scientific undertakings. The information system builds upon and specializes the JRC knowledge sharing platform Aquaknow (https://aquaknow.jrc.ec.europa.eu/), including: • at the system core, a relational database; its schema has been designed to store both detailed metadata and, where relevant (avoiding duplication of information otherwise accessible), data themselves. Metadata include, among others, datasets extended description, spatial extent, temporal frequency, reference Institutions/authors, credits and limitations, web links to access original data and/or any further documentation. Data can be stored as public or private, depending upon confidentialy and sharing policies; • user friendly facilities, supporting the end user in efficiently browsing, querying, uploading and downloading information (metadata and data). System access is limited to accredited audience, via password authentication. Dedicated groups for the three ACEWATER CoE networks (Western, Southern and Central-Eastern Africa) have been setup and scientists invited to register. Currently the system is operational and we submitted databases documented and, depending upon confidentiality and authorization issues, also stored. A general review and classification of freely available information at continenal, regional and local scale of interest to ACEWATER2 project, and particularly to selected study areas (Senegal, Gambia and Niger; Zambezi; Blue Nile and Lake Victoria), have been completed. Metadata and, where relevant, data themselves have been stored to the information system database. Information submitted by the CoE (a continuous ongoing process) is migrated to the database as well, depending upon sharing authorization and/or limitations. The report also documents the ongoing scientific research at JRC on climate variability analysis based on L-Moments statistics. In particular maps of estimated precipitation deficit for different return periods at the river basins of interest are presented and included in the database.JRC.D.2-Water and Marine Resource

A rare case of appendicular skeleton localization in a patient with chronic lymphocytic leukemia successfully treated with salvage radiation therapy

Bone involvements in chronic lymphocytic leukemia (CLL) are considered rare events, and the English-language medical literature describes them only in sporadic case reports. Consequently, robust indications for a rational clinical management are lacking. We report the case of a middle-aged man in clinical follow-up for CLL who experienced pain at the right tibial level that was refractory to nonsteroidal anti-inflammatory drugs and an acute episode of anemia. Instrumental examinations and a bioptic sample surprisingly demonstrated a bone tibial localization by CLL

Edge-to-Edge Technique to Minimize Ovelapping of Multiple Bioresorbable Scaffolds Plus Drug Eluting Stents in Revascularization of Long Diffuse Left Anterior Descending Coronary Artery Disease

Background: Implantation of Drug Eluting Stents (DES) plus bioresorbable scaffolds (BVS) in very long diffuse left anterior descending coronary artery (LAD) disease may be problematic because of multiple devices overlapping. We sought to assess the short and mid-tern outcomes of combined implantation of DES and BVS using a novel "edge-to-edge" technique in patients with diffuse LAD disease. Methods: Patients with long diffuse LAD disease were enrolled in a prospective registry from 1st August 2014 to 1st August 2015 and treated with IVUS-aided percutaneous coronary intervention using a DES plus a single or multiple BVS using a novel "edge-to-edge" technique. Clinical follow up and invasive follow up driven by clinical justification was performed. Results: Twenty-three patients (5 females, mean age 59.1 +/- 9.1 years) were enrolled. Mean length of LAD disease was 73.1 +/- 20.6 mm. Mean number of DES and BVS implanted was 1.2 +/- 0.4 and 1.7 +/- 1.3, respectively. At a mean follow-up of 11.3 +/- 3.8 months, no stent thrombosis or MACE were observed. Angiographic and IVUS follow-up at a mean of 6.6 +/- 0.7 months showed no significant angiographic restenosis and no appreciable stent gaps. Conclusions: In revascularization of long diffuse disease of the LAD, the edge-to-edge implantation technique appears to be feasible resulting in no restenosis or thrombosis on the short-term follow-up

Effectiveness of polymyxin B-immobilized fiber column in sepsis: a systematic review

INTRODUCTION: Severe sepsis and septic shock are common problems in the intensive care unit and carry a high mortality. Endotoxin, one of the principal components on the outer membrane of gram-negative bacteria, is considered important to their pathogenesis. Polymyxin B bound and immobilized to polystyrene fibers (PMX-F) is a medical device that aims to remove circulating endotoxin by adsorption, theoretically preventing the progression of the biological cascade of sepsis. We performed a systematic review to describe the effect in septic patients of direct hemoperfusion with PMX-F on outcomes of blood pressure, use of vasoactive drugs, oxygenation, and mortality reported in published studies. METHODS: We searched PubMed, the Cochrane Collaboration Database, and bibliographies of retrieved articles and consulted with experts to identify relevant studies. Prospective and retrospective observational studies, pre- and post-intervention design, and randomized controlled trials were included. Three authors reviewed all citations. We identified a total of 28 publications - 9 randomized controlled trials, 7 non-randomized parallel studies, and 12 pre-post design studies - that reported at least one of the specified outcome measures (pooled sample size, 1,425 patients: 978 PMX-F and 447 conventional medical therapy). RESULTS: Overall, mean arterial pressure (MAP) increased by 19 mm Hg (95% confidence interval [CI], 15 to 22 mm Hg; p < 0.001), representing a 26% mean increase in MAP (range, 14% to 42%), whereas dopamine/dobutamine dose decreased by 1.8 microg/kg per minute (95% CI, 0.4 to 3.3 microg/kg per minute; p = 0.01) after PMX-F. There was significant intertrial heterogeneity for these outcomes (p < 0.001), which became non-significant when analysis was stratified for baseline MAP. The mean arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio increased by 32 units (95% CI, 23 to 41 units; p < 0.001). PMX-F therapy was associated with significantly lower mortality risk (risk ratio, 0.53; 95% CI, 0.43 to 0.65). The trials assessed had suboptimal method quality. CONCLUSION: Based on this critical review of the published literature, direct hemoperfusion with PMX-F appears to have favorable effects on MAP, dopamine use, PaO2/FiO2 ratio, and mortality. However, publication bias and lack of blinding need to be considered. These findings support the need for further rigorous study of this therapy

Volume Assessment in Mechanically Ventilated Critical Care Patients Using Bioimpedance Vectorial Analysis, Brain Natriuretic Peptide, and Central Venous Pressure

Purpose. Strategies for volume assessment of critically ill patients are limited, yet early goal-directed therapy improves outcomes. Central venous pressure (CVP), Bioimpedance Vectorial Analysis (BIVA), and brain natriuretic peptide (BNP) are potentially useful tools. We studied the utility of these measures, alone and in combination, to predict changing oxygenation. Methods. Thirty-four mechanically ventilated patients, 26 of whom had data beyond the first study day, were studied. Relationships were assessed between CVP, BIVA, BNP, and oxygenation index (O2I) in a cross-sectional (baseline) and longitudinal fashion using both univariate and multivariable modeling. Results. At baseline, CVP and O2I were positively correlated (R = 0.39; P = .021), while CVP and BIVA were weakly correlated (R = −0.38; P = .025). The association between slopes of variables over time was negligible, with the exception of BNP, whose slope was correlated with O2I (R = 0.40; P = .044). Comparing tertiles of CVP, BIVA, and BNP slopes with the slope of O2I revealed only modest agreement between BNP and O2I (kappa = 0.25; P = .067). In a regression model, only BNP was significantly associated with O2I; however, this was strengthened by including CVP in the model. Conclusions. BNP seems to be a valuable noninvasive measure of volume status in critical care and should be assessed in a prospective manner

Protective effect of resin adsorption on septic plasma-induced tubular injury

Introduction: A pro-apoptotic effect of circulating mediators on renal tubular epithelial cells has been involved in the pathogenesis of sepsis-associated acute kidney injury (AKI). Adsorption techniques have been showed to efficiently remove inflammatory cytokines from plasma. The aim of this study was to evaluate the efficiency of the hydrophobic resin Amberchrom CG161 M to adsorb from septic plasma soluble mediators involved in tubular injury. Methods: We enrolled in the study 10 critically ill patients with sepsis-associated AKI and we evaluated the effects of their plasma on granulocyte adhesion, apoptosis and functional alterations of cultured human kidney tubular epithelial cells. We established an in vitro model of plasma adsorption and we studied the protective effect of unselective removal of soluble mediators by the Amberchrom CG161 M resin on septic plasma-induced tubular cell injury. Results: Plasma from septic patients induced granulocyte adhesion, apoptosis and altered polarity in tubular cells. Plasma adsorption significantly decreased these effects and abated the concentrations of several soluble mediators. The inhibition of granulocyte adhesion to tubular cells was associated with the down-regulation of ICAM-1 and CD40. Resin adsorption inhibited tubular cell apoptosis induced by septic plasma by down-regulating the activation of caspase-3, 8, 9 and of Fas/death receptor-mediated signalling pathways. The alteration of cell polarity, morphogenesis, protein reabsorption and the down-regulation of the tight junction molecule ZO-1, of the sodium transporter NHE3, of the glucose transporter GLUT-2 and of the endocytic receptor megalin all induced by septic plasma were significantly reduced by resin adsorption. Conclusions: Septic plasma induced a direct injury of tubular cells by favouring granulocyte adhesion, by inducing cell apoptosis and by altering cell polarity and function. All these biological effects are related to the presence of circulating inflammatory mediators that can be efficiently removed by resin adsorption with a consequent limitation of tubular cell injury

KULTURisk regional risk assessment methodology for water-related natural hazards - Part 2: Application to the Zurich case study

The aim of this paper is the application of the KULTURisk regional risk assessment (KR-RRA) methodology, presented in the companion paper (Part 1, Ronco et al., 2014), to the Sihl River basin, in northern Switzerland. Flood-related risks have been assessed for different receptors lying on the Sihl River valley including Zurich, which represents a typical case of river flooding in an urban area, by calibrating the methodology to the site-specific context and features. Risk maps and statistics have been developed using a 300-year return period scenario for six relevant targets exposed to flood risk: people; economic activities: buildings, infrastructure and agriculture; natural and semi-natural systems; and cultural heritage. Finally, the total risk index map has been produced to visualize the spatial pattern of flood risk within the target area and, therefore, to identify and rank areas and hotspots at risk by means of multi-criteria decision analysis (MCDA) tools. Through a tailored participatory approach, risk maps supplement the consideration of technical experts with the (essential) point of view of relevant stakeholders for the appraisal of the specific scores weighting for the different receptor-relative risks. The total risk maps obtained for the Sihl River case study are associated with the lower classes of risk. In general, higher (relative) risk scores are spatially concentrated in the deeply urbanized city centre and areas that lie just above to river course. Here, predicted injuries and potential fatalities are mainly due to high population density and to the presence of vulnerable people; flooded buildings are mainly classified as continuous and discontinuous urban fabric; flooded roads, pathways and railways, most of them in regards to the Zurich central station (Hauptbahnhof) are at high risk of inundation, causing severe indirect damage. Moreover, the risk pattern for agriculture, natural and semi-natural systems and cultural heritage is relatively less important mainly because the scattered presence of these assets. Finally, the application of the KR-RRA methodology to the Sihl River case study, as well as to several other sites across Europe (not presented here), has demonstrated its flexibility and the possible adaptation of it to different geographical and socioeconomic contexts, depending on data availability and particulars of the sites, and for other (hazard) scenarios