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Infants affected by Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) may require non-invasive ventilation (NIV) in the post-operative period after elective extubation, especially if born preterm. The aim of the paper is to evaluate the role of different ventilation strategies on anastomotic complications, specifically on anastomotic leak (AL).Retrospective single Institution study, including all consecutive neonates affected by EA with or without TEF in a 5-year period study (from 2014 to 2018). Only infants with a primary anastomosis were included in the study. All infants were mechanically ventilated after surgery and electively extubated after 6-7 days. The duration of invasive ventilation was decided on a case-by-case basis after surgery, based on the pre-operative esophageal gap and intraoperative findings. The need for non-invasive ventilation (NCPAP, NIPPV, and HHHFNC) after extubation and extubation failure with the need for mechanical ventilation in the post-operative period were assessed. The primary outcome evaluated was the rate of anastomotic leak.102 EA/TEF infants were managed in the study period. Sixty-seven underwent primary anastomosis. Of these, 29 (43.3%) were born preterm. Patients who required ventilation (n = 32) had a significantly lower gestational age as well as birthweight (respectively p = 0.007 and p = 0.041). 4/67 patients had an AL after surgical repair, with no statistical differences among post-operative ventilation strategies.We found no significant differences in the rate of anastomotic leak (AL) according to post-operative ventilation strategies in neonates operated on for EA/TEF.

Objectives The early detection and stratification of asphyxiated infants at higher risk for impaired neurodevelopment is challenging. S100B protein is a well-established biomarker of brain damage, but lacks conclusive validation according to the “gold standard” methodology for hypoxic-ischemic encephalopathy (HIE) prognostication, i.e. brain MRI. The aim of the present study was to investigate the predictive role of urinary S100B concentrations, assessed in a cohort of HIE infants receiving therapeutic hypothermia (TH), compared to brain MRI. Methods Assessment of urine S100B concentrations was performed by immunoluminometric assay at first void and at 4, 8, 12, 16, 20, 24, 48, 72, 96, 108 and 120-h after birth. Neurologic evaluation, routine laboratory parameters, amplitude-integrated electroencephalography, and cerebral ultrasound were performed according to standard protocols. Brain MRI was performed at 7–10 days of life. Results Overall, 74 HIE neonates receiving TH were included in the study. S100B correlated, already at first void, with the MRI patterns with higher concentrations in infants with the most severe MRI lesions. Conclusions High S100B urine levels soon after birth constitute trustable predictors of brain injury as confirmed by MRI. Results support the reliability of S100B in clinical daily practice and open the way to its inclusion in the panel of parameters used for the selection of cases suitable for TH treatment.

9 Páginas.-- 4 Figuras.-- 1 Tabla, Facilitating the anaerobic degradation of long chain fatty acids (LCFA) is the key to unlock the energy potential of lipids-rich wastewater. In this study, the feasibility of psychrophilic anaerobic treatment of LCFA-containing dairy wastewater was assessed and compared to mesophilic anaerobic treatment. The results showed that psychrophilic treatment at 15 ℃ was feasible for LCFA-containing dairy wastewater, with high removal rates of soluble COD (>90%) and LCFA (∼100%). However, efficient long-term treatment required prior acclimation of the biomass to psychrophilic temperatures. The microbial community analysis revealed that putative syntrophic fatty acid bacteria and Methanocorpusculum played a crucial role in LCFA degradation during both mesophilic and psychrophilic treatments. Additionally, a fungal-bacterial biofilm was found to be important during the psychrophilic treatment. Overall, these findings demonstrate the potential of psychrophilic anaerobic treatment for industrial wastewaters and highlight the importance of understanding the microbial communities involved in the process., The authors thank Arrabawn Dairies and Dairygold Co-Operative Society for providing the inoculum; Sandra O’Connor, Alison Graham, and Andrew Bartle for assisting reactor operations and Dr Anna Christine Trego for scientific discussions. The authors acknowledge the facilities and scientific and technical assistance of the Centre for Microscopy & Imaging at University of Galway (www.imaging.universityofgalway.ie). This work was supported by the Enterprise Ireland Technology Centres Programme (TC/2014/0016) and Science Foundation Ireland (19/FFP/6746 and 16/RC/3889), as well as the European Union's Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement N° 101033411

A comprehensive sustainable Food Waste (FW) management is globally needed in order to reduce the environmental pollution and the financial costs due to FW disposal; anaerobic digestion is considered as one of the best environmental-friendly alternatives to this aim. A deep investigation of the chemical composition of different Food waste types (cooked kitchen waste (CKW), fruit and vegetable scraps (FVS) and organic fraction of municipal solid waste (OFMSW)) is here reported, in order to evaluate their relevant substance-specific properties and their impact on anaerobic biodegradability by means of a sophisticated automatic batch test system. Suitability for a mild thermal pre-treatment (T = 134 °C and p = 3.2 bar) to enhance the biological degradation of hardly accessible compounds was investigated. The pre-treatment affected significantly the carbohydrates solubilisation, and was able in reducing part of the lignocellulosic matrix. Moreover, in mesophilic conditions, the high solubilized sugars content favoured the initial recovery of hydrogen (not consumed by hydrogenotrophic methanogenesis), allowing to newly assess the extent of prompt fermentability. Pre-treatment enhanced hydrogen yields of FVS and OFMSW, with gains up to +50%, while the successive methane production, occurring in the same reactor, resulted affected by the lack of the soluble part of carbohydrates, “subtracted” for H2 production. Only in thermophilic conditions, when no hydrogen in the biogas was detected, pre-treatment of OFMSW significantly increased methane yield (from 0.343 to 0.389 L CH4 g−1 VSfed). A thermal pre-treatment seems the recommended solution in order to reduce part of the recalcitrant lignocellulosic matrix of food waste, to improve energy recovery and to eliminate the extra cost needed for pasteurization.

Background In congenital diaphragmatic hernia (CDH) survivors, failure to thrive is a well-known complication, ascribed to several factors. The impact of lung volume on growth of CDH survivors is poorly explored. Our aim was to evaluate if, in CDH survivors, lung volume (LV) after extubation correlates with growth at 12 and 24 months of life. Methods LV (measured as functional residual capacity-FRC) was evaluated by multibreath washout traces with an ultrasonic flowmeter and helium gas dilution technique, shortly after extubation. All CDH survivors are enrolled in a dedicated follow-up program. For the purpose of this study, we analyzed the correlation between FRC obtained shortly after extubation and anthropometric measurements at 12 and 24 months of age. We also compared growth between infants with normal lungs and those with hypoplasic lungs according to FRC values. A p 0.05 was considered as statistically significant. Results We included in the study 22 CDH survivors who had FRC analyzed after extubation and auxological follow-up at 12 and 24 months of age. We found a significant correlation between FRC and weight Z-score at 12 months, weight Z-score at 24 months and height Z-score at 24 months. We also demonstrated that CDH infants with hypoplasic lungs had a significantly lower weight at 12 months and at 24 months and a significantly lower height at 24 months, when compared to infants with normal lungs. Conclusion We analyzed the predictive value of bedside measured lung volumes in a homogeneous cohort of CDH infants and demonstrated a significant correlation between FRC and growth at 12 and 24 months of age. An earlier identification of patients that will require an aggressive nutritional support (such as those with pulmonary hypoplasia) may help reducing the burden of failure to thrive.

Background Pediatric medical traumatic stress (PMTS) is a psychological and physiological response of children and their families to pain, serious illness, and invasive medical procedures. We aimed to apply the PMTS model to parents of newborns operated at birth for a congenital malformation and to identify clinical and sociodemographic risk factors associated with PMTS symptoms at 6 months. Methods We designed a cross-sectional study to assess PMTS symptoms (avoidance, arousal, reexperiencing) in parents of six months children operated on for a congenital anomaly, with the Italian version of the Impact of Event Scale – Revised (IES-R). Results One-hundred-seventy parents form the object of the study. Eighty-two parents (48.2%) fell over the clinical cut-off. Ventilatory time (p = 0.0001), length of hospital stay (p = 0.0001), associated anomalies (p = 0.0002), medical devices at discharge (p = 0.0001) and Bayley motor scale (p = 0.0002) were significantly correlated with IES-R Total and Subscale Scores. Multivariate linear regression showed length of hospital stay and number of associated anomalies as significant predictors of IES-R Scores. Conclusions Regardless the type of anomaly and sociodemographic factors, it is the clinical history of the child which seems to predict the severity of PMTS symptoms in this population of parents. PMTS represents a useful model to describe the psychological reactions of parents of newborns operated at birth for a congenital malformation. NICU and outpatient pediatric staff should be aware of risk factors to identify families who may request early multidisciplinary interventions since the first admission. Level of evidence Prognosis study, level II.

A novel biorefinery platform integrating thermal pretreatment and solid-liquid separation unit is here proposed to fully exploit food waste (FW) potential for production of valuable chemicals and energy through semi-continuous anaerobic bioconversion. The liquid fraction deriving from raw or pretreated FW, was fermented into volatile fatty acids (VFAs, from acetic to caproic acid) while the residual fraction was converted into biomethane. Thermal pretreatment effectively extracted a portion of the macromolecular organics, especially starch, to the liquid phase, promoting acidogenic fermentation and chain elongation pathways (0.43 gVFA g-1VSfed and 0.58 gVFA g-1VSfed with raw and pretreated extract, respectively). In parallel, anaerobic digestion of solid residue in 10 L reactors showed process stability and higher conversion rate for the pretreated residue (0.31 against 0.26 Nm3CH4 kg-1VSfed). The mass-transfer balance coupled with the economic assessment, calculated in terms of direct gross added value, indicated promising revenues by integrating the thermal upstream treatment.

Summary Data on neurodevelopmental outcomes of infants born with esophageal atresia (EA) are still scarce and controversial. The aims of our study were to evaluate motor and cognitive development during the first year of life, in patients operated on of EA and to investigate potential risk factors for motor and cognitive development both at 6 and 12 months. This is an observational prospective longitudinal study in a selected cohort of type C and D EA infants enrolled in our follow-up program from 2009 to 2017. In order to exclude possible confounding factors, the following exclusion criteria were applied: (i) gestational age ≤ 32 weeks and/or birth weight ≤ 1500 g; (ii) genetic syndrome or chromosomal anomaly known to be associated with neurodevelopmental delay; (iii) neurologic disease; (iv) esophageal gap ≥three vertebral bodies. Patients were evaluated at 6 and 12 months of life (corrected age for infants with a gestational age of 32–37 weeks) with the Bayley Scales of Infant and Toddler Development—3rd Edition. In our selected cohort of EA infants, 82 were evaluated at 6 months and 59 were reevaluated at 12 months. Both Motor and Cognitive average scores were within the norm at both time points. However, we report increased number of infants with motor delay with time: 14% at 6 months and 24% at 12 months. Multiple regression analysis for Motor scores at 6 [F(4,74) = 4.363, P = 0.003] and 12 months [F(6,50) = 2.634, P = 0.027] identified (i) low birth weight, (ii) longer hospital stay and (iii) weight Our selected cohort of EA patients shows, on the average, Motor and Cognitive scores within the norm both at 6 and 12 months. Nevertheless, the percentage of infants with Motor scores below the average increases regardless gestational age. None of clinical and sociodemographic variables taken into consideration was able to predict cognitive development both at 6 and 12 months whereas risk factors for Motor development change during the first year of life. Healthcare providers should pay particular attention to patients with low birth weight, longer hospital stays and weight under fifth percentile at 1 year. Future studies should include long-term outcomes to reveal possible catch up in motor development and/or possible findings in Cognitive scores.

Anaerobic digestion is applied worldwide to treat food waste (FW) with the aim of obtaining renewable bioenergy by exploiting the methane gas produced. However, there are several problems in practical applications, primarily due to system instability. Although exhaustive knowledge regarding anaerobic microbial community composition has been established, few studies have investigated long-term correlations between microbial consortia, operative conditions and feedstock characteristics. Here, microbial community shifts as a response to feedstock variations were investigated in long-term semi-continuous systems, which were evaluated by an in situ cell detection method and 16S rRNA gene amplicon sequencing. FW digestion showed progressive system instability caused by the inhibition of methanogens, which resulted in volatile fatty acid accumulation and process failure at the low organic loading rate (OLR). Conversely, by co-digesting FW with waste-activated sludge (WAS), a stable process with methane yields of up to 0.27 Nm3 kg−1VSfed for OLR = 1.7 gVS L−1d−1 was achieved. This stabilizing effect was not related to the buffering capacity of WAS, but to its capacity to avoid volatile fatty acid accumulation and falls in pH by overcoming methanogenic activity inhibition. WAS addition promoted the establishment of a stable and active archaeal population in anaerobic co-digestion (AcoD) reactors. The continuous supply of trace elements together with the seeding of microbial functional groups were the main drivers that positively affected process stability.

More than 400 papers in the last 5 years have been published on FW into energy. Food waste complexity and composition affects anaerobic conversion. Scaling up of the AD process is fundamental to assess the real methane potential. Methanogenesis is often rate limiting step leading to pH drop and instability. Strategies to improve AD performances and stability are here reviewed.

Methanogenic biomass plays a key role with regard to methane production during anaerobic bioconversion of organic substrates. In this study, the effect of two different acclimated inocula on digestion performances was investigated by means of anaerobic batch tests on untreated and sonicated waste-activated sludge. Organics solubilization and removal kinetics, the abundance and physiological conditions of archaeal cells on ultimate methane yield were evaluated. The simultaneous presence of Methanosarcina and Methanosaeta in the archaeal biomass, the higher initial archaeal cells relative abundance and their occurrence in the aggregated forms were the main factors positively affecting the conversion into methane. The presence of the acclimated inoculum at the start-up influenced positively the methane improvement due to sonication, and the methane-specific production increased from 0.335 ± 0.03 to 0.420 ± 0.05 Nm3/kg VSfed. Moreover, the better physiological state of methanogens permitted to appreci...

Biowaste valorization through anaerobic digestion is an attractive option to achieve both climate protection goals and renewable energy production. In this paper, a complete set of batch trials was carried out on kitchen waste to investigate the effects of mild thermal pretreatment, temperature regimen and substrate/inoculum ratio. Thermal pretreatment was effective in the solubilisation of macromolecular fractions, particularly carbohydrates. The ability of the theoretical methodologies in estimating hydrogen and methane yields of complex substrates was evaluated by comparing the experimental results with the theoretical values. Despite the single batch configuration, a significant initial hydrogen production was observed, prior to methane yield. Main pretreatment effect was the gain in hydrogen production; the extent was highly variable according to the other parameters values. High hydrogen yields, up to 113 mL H2/g VSfed, were related to the prompt transformation of soluble sugars. Thermophilic regimen resulted, as expected, in faster digestions (up to 78 mL CH4/gVS/day) and sorted out pH inhibition. The relatively low methane yields (342-398 mL CH4/g VSfed) were the result of the consistent lignocellulosic content and low lipid content. Thermal pretreatment proved to be a promising option for the enhancement of hydrogen production in food waste dark fermentation. (c) 2019 The Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences. Published by Elsevier B.V.

Background Oesophageal atresia (OA) is characterized by a significant morbidity during the neonatal period. Affected infants are exposed to multiple potentially nephrotoxic factors, predisposing them to acute kidney injury (AKI), which is associated with poorer outcomes. Children who survive neonatal AKI are at risk of long-lasting renal complications (including chronic kidney disease and hypertension). Aims The purpose of this study is to investigate AKI prevalence in infants with OA and identify potential contributing factors. Methods Retrospective analysis was conducted on clinical records of patients with OA between 2017 and 2018 in a single referral centre. AKI severity was defined according to established international pRIFLE criteria (Risk of renal dysfunction, kidney Injury, Failure or Loss of kidney function and End-stage renal disease) based on change in serum creatinine and urine output during hospitalization collected 5 days after birth. Risk factors, (including potentially nephrotoxic medications, significant infection, urine output, blood pressure), and outcome data (length of hospitalization, duration of intubation) were recorded. Statistical analysis was performed using Graphpad. Results Thirty-nine OA cases were identified; 6 were excluded for lack of data and 33 were included in the study group. Eighteen (55%), who developed AKI (pRIFLE category Risk or Injury), were compared with 15 patients (45%) with no AKI. AKI was significantly higher in infants with long-gap OA (P = 0.02), significantly associated with vancomycin administration (P = 0.03), with the use of three or more antibiotics during hospitalization (P = 0.0005), and with postoperative muscle paralysis (P = 0.001). Infants with OA and AKI experienced longer mechanical ventilation (P = 0.004) and hospital stay (P = 0.003). No significant association was found with hypotension, or steroid exposure. Incomplete recording of urine output prevented stratification of AKI based on this parameter. Conclusions OA, particularly more severe cases, are at risk of AKI. Renal function should be routinely assessed, during hospitalization and follow-up. Focusing on prevention and avoiding prolonged courses of nephrotoxic medications may improve outcome.

Background Vascular anomalies (VA) may cause severe tracheomalacia in some cases. Chronic upper airway obstruction (UAO) is the most common symptom. Increased pulmonary pressure and cardiac dysfunction have been described in patients with chronic UAO, but not in infants with VA. Aim The aim of this study was to evaluate myocardial strain in infants with VA. Method Demographics characteristics, respiratory symptoms, and the percentage of tracheal obstruction measured on CT were collected. Left and right ventricle (LV, RV) systolic function were measured with speckle tracking longitudinal strain (LS) analysis. Pulmonary artery pressure was evaluated on tricuspid regurgitation (TR) jet and quantified by end-systolic eccentricity index (EI). Conclusion Of 15 cases, 6 had tracheal obstruction 50%. LS LV and RV was significantly reduced in cases with obstruction > 50% compared to those with 50%. There are no significant data for TR and EI. Results In cases with VA with severe tracheomalacia RV and LV myocardial strain is reduced, suggesting myocardial impairment. Further studies with larger sample size are needed to confirm these data and investigate cardiac function. Association with lung function test may be investigated too.

Introduction Patients affected by esophageal atresia (EA) often faced airway problems, due to multifactorial dynamics (tracheomalacia, gastroesophageal reflex disorder, etc.). The aim of this study was to longitudinally evaluate the lung function test (LFT) in those infants to explore how the LFT modifies at mid-term follow-up. Methods Retrospective evaluation of lung functions in infants treated for EA (2010–2017) was performed at three time points: 6 months, 12 months, and 24 months. Tidal volume (Vt), respiratory rate (RR), and time to peak tidal expiratory flow as a percentage of total expiratory time (tPTEF/te) were analyzed. ANOVA test was used as appropriate. Results During the study period 172 patients were treated for EA. Of those 50 infants (28%) underwent LFT at 6 months, 30 at 12 months, and 11 at 24 months. Tracheomalacia was present in 20 infants (42%). Both Vt (6,79 ml/kg vs 7,82 ml/kg vs 8,37 ml/kg—p = 0,001) and RR (49,7 a/min vs 40,6 a/min vs 34,0 a/min—p = 0,020) significantly improved, while there was no significant difference for tPTEF/te (0,25 vs 0,26 vs 0,29—p = 0,62) despite the data showing an improvement trend. Conclusion The preliminary data suggest that, although EA patients may present impaired LTF in early infancy, lung function seems to improve over time, showing normal pulmonary function test at 24 months. The presence of selection bias and the retrospective nature of the study limit our result. Nonetheless, evaluation of lung function is warranted in EA infants to early detect respiratory symptoms, ideally reducing the impact on short- and long-term pulmonary outcomes.

Background Esophageal atresia (EA) prognosis have improved significantly over the past three decades. Research and clinical attention has shifted to neurodevelopmental outcomes and quality of life. Aim The aim of this study wasto examine neurodevelopmental outcomes and to identify clinical and sociodemographic risk factors in a cohort of infants with EA. Methods An observational prospective longitudinal study was conducted between 2009 and 2017. Neurodevelopment was assessed at 6 and 12 months by Bayley Scales of Infants and Toddler Development—3rd Edition. Clinical and sociodemographic variables included were gender, birthweight, gestational age, associated malformations, number of hospitalizations, surgeries and dilatations at 12 months, days of mechanical ventilation, parental age, education level, and socioeconomic status. Results Ninety-six infants were enrolled in the study at 6 months and 73 of them were evaluated also at 12 months. Analysis showed significant differences between motor development at 6 and 12 months (M6 = 95.39, SD = 15.71; M12 = 91.83, SD = 12.87; t = 0.245, P = 0.017); significant differences emerged also between cognitive development at 6 and 12 months (M6 = 91.80, SD = 11.70; M12 = 100.92, SD = 15.39; t = −5.10, p = .000). Infants with long-gap AE achieved the worst scores in cognitive (r = -.28, P Conclusions Infants operated on for AE are at risk of neurodevelopmental impairment in the first year of life. Findings support the association between neurodevelopmental outcomes and clinical risk factors. Careful interdisciplinary follow-up is essential for early detection of neurodevelopmental delay.

In order to enhance anaerobic biodegradability of food waste (FW), thermal pretreatment was applied. The effectiveness in terms of biodegradability extent and process rate improvement was investigated. To this aim, Biomethane Potential tests were carried out under mesophilic and thermophilic conditions. The IWA anaerobic digestion Model 1 (ADM1), a powerful tool for modeling the anaerobic digestion (AD) of different substrates, was implemented to predict the methane production. Disintegration constant (k_dis) and maximum acetate uptake rate (km_ac) were identified as the most sensitive parameters and were calibrated over the observed methane production. Pretreatment improvement was more evident in enhancing parameters related to the process rate, such as solubilization extent (+153%) and disintegration constant (+18%), rather than increasing substrate biodegradability. Thermophilic conditions proved to be effective in speeding up the whole AD process, since all the kinetics were significantly improved (disintegration rate increased up to fivefold). Furthermore, it was demonstrated that, after k_dis and km_ac calibration, default thermophilic ADM1 parameters can be suitable to model FW digestion.

Quorum sensing signals regulate various functions within activated sludge processes such as formation of microbial aggregates. Disturbance of this signaling system, known as quorum quenching (QQ), provides opportunities for eliminating some problems related to biological wastewater treatment (e.g., biofouling and excess sludge production). However, it is poorly understood how and to what extent QQ systems can affect the microbial aggregation processes and the following floc formation. In particular, an in-depth structural characterization at the scale of microbial aggregate while considering nutrient conditions in the reactor is still largely disregarded. Here, we evaluated the QQ effects at the short-term time scale (i.e., after 4 h for the exogenous period and 19 h for exogenous/endogenous period), by combining advanced techniques for microbial characterization (flow cytometry, CARD-FISH, and confocal laser scanning microscopy) and conventional physical-chemical assessments. The results indicated that by implementing QQ agents (immobilized Acylase I enzyme in porous alginate beads) the abundance of single cells and suspended microbial aggregates in the supernatant did not show significant changes during the exogenous period. Conversely, at the end of the exogenous/endogenous period a significant increase of single prokaryotic cells, small and large microbial aggregates favored the growth of grazers, including free-living nanoflagellates and ciliates. Flocs became looser and thinner than those in the control reactor, thus affecting the sludge settling behavior. Inability of microbial community in degradation of soluble protein during the endogenous period confirmed that the QQ agents are likely to inhibit the secretion of protease enzyme within microbial communities of activated sludge.

This study investigates for the first time, on laboratory scale, the possible application of an innovative enhanced stabilization process based on sequential mesophilic/thermophilic anaerobic digestion of waste-activated sludge, with low-energy sonication pretreatment. The first mesophilic digestion step was conducted at short hydraulic retention time (3-5 days), in order to favor volatile fatty acid production, followed by a longer thermophilic step of 10 days to enhance the bioconversion kinetics, assuring a complete pathogen removal. The high volatile solid removals, up to 55%, noticeably higher compared to the performances of a single-stage process carried out in same conditions, can guarantee the stability of the final digestate for land application. The ultrasonic pretreatment influenced significantly the fatty acid formation and composition during the first mesophilic step, improving consequently the thermophilic conversion of these compounds into methane. Methane yield from sonicated sludge digestion reached values up to 0.2 Nm(3)/kgVSfed. Positive energy balances highlighted the possible exploitation of this innovative two-stage digestion in place of conventional single-stage processes.

High-frequency ultrasounds have recently gained interest as oxidative technique for sonochemical degradation of organic contaminants in water. In this study an innovative approach applying 200. kHz ultrasounds to improve both sludge anaerobic biodegradability and decontamination is proposed. Digestion tests were performed on batch reactors fed either with untreated or sonicated sludge, at different food/inoculum (F/I) ratio, in the range 0.3-0.9. First order kinetic highlighted a decreasing trend of the hydrolysis rate by increasing F/I, both for untreated and sonicated sludge. Positive effect of ultrasounds on specific biogas production was evident, but the conversion rate for pretreated sludge was strongly affected by F/I, and decreased by increasing F/I. Anionic surfactants anaerobic removal occurred in all tests, but the effect of ultrasounds was significant only at F/I. = 0.3. By pretreating sludge with high frequency ultrasounds, low F/I was the ideal ratio improving both sludge anaerobic digestion and decontamination. © 2014 Elsevier Ltd.

Summary Data on the neurodevelopmental outcome of esophageal atresia (EA) survivors are scarce, controversial, and based on small samples. This is an observational prospective longitudinal study on a selected cohort of low-risk EA survivors. We considered a low-risk EA survivor a patient with the following characteristics: gestational age >32 weeks, no long gap, no genetic or chromosomic anomaly associated with neurodevelopmental delay, and no further major surgical congenital anomalies. Infants were evaluated with scales derived from the Bayley Scales of Infant and Toddler Development – 3rd Edition at 6 and 12 months, with a score of 100 considered normal for each scale. Analysis of variance was used to assess differences of cognitive and motor development. Linear regression was used to assess the impact of the following clinical and sociodemographic variables: gender, birthweight, gestational age, length of hospital stay, number of surgeries and number of esophageal dilatations during first hospitalization, days of mechanical ventilation, weight at follow up, number of surgeries and esophageal dilatations at follow up, parental age, educational level, and socioeconomic status. Thirty children form the object of the study. The mean (standard deviation [SD]) cognitive scale's score was 93.7 (7.5) and 98.2 (9.6) at 6 and 12 months, respectively (P 5° percentile: 88.8 (6.3) and 100.5 (8.9), respectively. At 12 months, children with unemployed mothers had a mean (SD) motor score significantly lower when compared with those in the other socioeconomic classes: 87.7 (9.8) and 100.6 (12.4), respectively. In conclusion, parents of babies operated on for low-risk EA can be reassured about neurodevelopmental outcome at least up to 1 year of age. When offering a multidisciplinary follow-up program, underweight patients should deserve particular attention to promote their quality of life and support their global development.

A 2-year sampling campaign was conducted in three wastewater treatment plants of various sizes in the Rome area to assess the occurrence of nutrients and micropollutants among primary, secondary and digested sludge. The primary purpose was to evaluate the quality of different sludge types and their suitability for agricultural use. Primary sludge was consistently more polluted than secondary in terms of organic micropollutants, whereas heavy metals partitioned equally among the sludge types. In digested sludge, the heavy metal concentrations were always below limit values proposed for agricultural utilisation. In contrast, organic micropollutants concentrated during anaerobic digestion and affected the quality of the digested sludge. Secondary sludge resulted less polluted and richer in nitrogen and phosphorus (up to three times) than primary sludge and is hence more suitable for agricultural use. Separate processing of primary and secondary sludge might therefore be an innovative option for sludge management that could maximise the possibilities of agricultural use of secondary sludge and limit disposal problems only to primary sludge. In fact, primary sludge could be easily treated and disposed of by conventional processes including thickening, anaerobic digestion, centrifugation and incineration, whereas the difficult digestibility of secondary sludge could be improved by disintegration pre-treatment before stabilisation.

Separation between primary and secondary sludge treatment could be a valuable solution for sludge management. According to this approach, secondary sludge can be conveniently used in agriculture while primary sludge could be easily dried and incinerated. It follows that some concern may arise from incinerating primary sludge with respect to the current practice to incinerate mixed digested sludge. Incineration of primary and mixed digested municipal sludge was investigated with a lab-scale equipment in terms of emissions of products of incomplete combustion (PICs) during incineration failure modes. PICs can be grouped in three sub-categories, namely aliphatic hydrocarbons (alkanes and alkenes), compounds with a single aromatic ring, and polycyclic aromatic hydrocarbons (PAHs). After-burning temperature was the most important parameter to be controlled in order to minimize emissions of alkanes and alkenes. As for mono-aromatic compounds, benzene and toluene are the most thermally resistant compounds, and in some cases, an after-burning temperature of 1100 °C was not enough to get the complete destruction of benzene leading to a residual emission of 18 mg/kgsludge. PAHs showed an opposite trend with respect to aliphatic and mono-aromatic hydrocarbons being the thermal failure mode the main responsible of PIC emissions. A proper oxygen concentration is more important than elevated temperature thus reflecting the high thermal stability of PAHs. Overall, obtained results, even though obtained under flameless conditions that are different from those of the industrial plants, demonstrated that separation of primary and secondary sludge does not pose any drawbacks or concern regarding primary sludge being disposed of by incineration even though it is more contaminated than mixed digested sludge in terms of organic pollutants.

Anaerobic digestion (AD) is one of the few sustainable technologies that both produce energy and treat waste streams. Driven by a complex and diverse community of microbes, AD may be affected by different factors, many of which also influence the composition and activity of the microbial community. In this study, the biodiversity of microbial populations in innovative mesophilic/thermophilic temperature-phased AD of sludge was evaluated by means of fluorescence in situ hybridization (FISH). The increase of digestion temperature drastically affected the microbial composition and selected specialized biomass. Hydrogenotrophic Methanobacteriales and the protein fermentative bacterium Coprothermobacter spp. were identified in the thermophilic anaerobic biomass. Shannon-Weaver diversity (H?) and evenness (E) indices were calculated using FISH data. Species richness was lower under thermophilic conditions compared with the values estimated in mesophilic samples, and it was flanked by similar trend of the evenness indicating that thermophilic communities may be therefore more susceptible to sudden changes and less prompt to adapting to operative variations. © 2014 Springer-Verlag Berlin Heidelberg.

Purpose Identify clinical and socio-demographic risk-factors affecting short-term neurodevelopmental outcome (NDO) in children operated on for abdominal and thoracic congenital anomalies (CA). Methods Prospective cohort observational study on newborns operated on for non-cardiac major CA. Evaluations were conducted at 6 and 12months of age. Univariate linear regression and multivariate regression were conducted to analyze the impact on NDO of clinical and sociodemographic variables. Infants were evaluated with the Bayley Scales of Infant and Toddler Development—3rd Edition. Results One-hundred-fifty-five children were enrolled. They were affected by the following anomalies: Esophageal Atresia (N=41), Congenital Diaphragmatic Hernia (N=42), Midgut Malformations (N=34), Abdominal Wall Defects (N=18), Colorectal Malformations (N=20). There were no statistically significant differences among the five groups of CA as to NDO. Variables which reached statistical significance at multivariate regression (p≤0.001) at 6 and 12months as to cognitive and motor development were: ventilatory time, associated malformations, medical appliances for feeding, number of surgery and length of hospital stay. Conclusions On the average, children born with CA show a NDO within normal range. The identified risk-factors could prompt health care professionals to conduct a close surveillance on most vulnerable children giving them the best chance to reach their full potential.

The European Union (EU) Project Routes aimed to discover new routes in sludge stabilization treatments leading to high-quality digested sludge, suitable for land application. In order to investigate the impact of different enhanced sludge stabilization processes such as (a) thermophilic digestion integrated with thermal hydrolysis pretreatment (TT), (b) sonication before mesophilic/thermophilic digestion (UMT), and (c) sequential anaerobic/aerobic digestion (AA) on digested sludge quality, a broad class of conventional and emerging organic micropollutants as well as ecotoxicity was analyzed, extending the assessment beyond the parameters typically considered (i.e., stability index and heavy metals). The stability index was improved by adding aerobic posttreatment or by operating dual-stage process but not by pretreatment integration. Filterability was worsened by thermophilic digestion, either alone (TT) or coupled with mesophilic digestion (UMT). The concentrations of heavy metals, present in ranking order Zn > Cu > Pb > Cr ~ Ni > Cd > Hg, were always below the current legal requirements for use on land and were not removed during the processes. Removals of conventional and emerging organic pollutants were greatly enhanced by performing double-stage digestion (UMT and AA treatment) compared to a single-stage process as TT; the same trend was found as regards toxicity reduction. Overall, all the digested sludges exhibited toxicity to the soil bacterium Arthrobacter globiformis at concentrations about factor 100 higher than the usual application rate of sludge to soil in Europe. For earthworms, a safety margin of factor 30 was generally achieved for all the digested samples. © 2014 Springer-Verlag Berlin Heidelberg.

Olive husks, typical solid by-products from the olive oil industry, were selected to carry out anaerobic digestion tests. Before digestion, olive husks were subjected to ultrasonic or thermal pretreatments in order to release the organic matter into solution. Both sonication and thermal pretreatment allowed to solubilize the particulate matter with 22% and 72% increase in soluble organics of olive husks, respectively. Nevertheless, such pretreatments caused the release of unwanted molecules in solution, with the related risks of inhibition of the methanogenic process. Biochemical Methane Potential (BMP) tests on olive husks mixed with olive-mill wastewater and dairy wastewater, either pretreated or not, showed that ultrasound pretreatment resulted in 15% increase in volatile solids reduction and a 13% increase in biogas production, while after thermal pretreatment no benefits were observed.

The performance of thermophilic digestion of waste activated sludge, either untreated or thermal pretreated, was evaluated through semi-continuous tests carried out at organic loading rates in the range of 1–3.7 kg VS/m 3 d. Although the thermal pretreatment at T = 134 °C proved to be effective in solubilizing organic matter, no significant gain in organics degradation was observed. However, the digestion of pretreated sludge showed significant soluble COD removal (more than 55%) whereas no removal occurred in control reactors. The lower the initial sludge biodegradability, the higher the efficiency of thermal pretreated digestion was observed, in particular as regards higher biogas and methane production rates with respect to the parallel untreated sludge digestion. Heat balance of the combined thermal hydrolysis/thermophilic digestion process, applied on full-scale scenarios, showed positive values for direct combustion of methane. In case of combined heat and power generation, attractive electric energy recoveries were obtained, with a positive heat balance at high load.

This paper deals with the comparison of ultrasound (mechanical) and ozone (chemical) pre-treatment on the performances of excess sludge semi-continuous digestion. Sludge solubilisation has been investigated by varying specific energy input. For each pre-treatment, long anaerobic digestion tests were carried out by two parallel digesters: one reactor, as control unit, was fed with untreated waste activated sludge, and the other one was fed with disintegrated sludge. To evaluate and compare the efficacy of both pre-treatments, the specific energy was maintained approximately the same. The digestion tests were carried out to investigate the feasibility of anaerobic digestion performance (total biogas production, volatile solids removal, sludge dewaterability) and to assess the heat balance. Results obtained from the digestion of sonicated sludge at 4% disintegration degree (∼2500 kJ/kg TS) showed that the ultrasound pre-treatment may be effective both in increasing VS destruction (+19%) and cumulative biogas production (+26%). On the contrary, the digestion test with ozonized sludge (ozone dose of 0.05 g O 3 /g TS corresponding to ∼2000 kJ/kg TS) did not indicate a significant improvement on the digestion performances. By doubling the ozone dose an improvement in the organics removal and cumulative biogas production was observed. Relevant differences in terms of colloidal charge and filterability were discussed.

In this work the potential of high frequency ultrasounds as pretreatment for sludge anaerobic digestion has been assessed. Irradiation with 200 kHz ultrasounds was efficient in disintegrating the floc structure increasing the available fraction of soluble organic matter (up to seven times at 25,000 kJ/kg TS). Batch anaerobic digestion tests were carried out on lab-scale reactors fed either with untreated or disintegrated sludge inoculated with anaerobic sludge, at different feed/inoculum ratio (F/I = 0.5 and 1). Degradation of particulate matter, biogas production and related microbial community composition (estimated by fluorescence in situ hybridization, FISH) were investigated. Sludge ultrasounds pretreatment led to an overall improvement of the digestion performances, with a maximum biogas gain of 40% at F/I = 0.5. FISH showed a key-role of Methanosarcina spp. in the main reactions of biogas synthesis.

The objective of this work was to maximize the digestibility of biological sludge to elucidate the feasibility of a new sludge management strategy to recover good quality sludge for agricultural use. The combined effects of organic loading rates (from 0.7 to 2.8 g VS L −1 d −1 ) and the degree of disintegration by anaerobic digestion of sonicated activated sludge were discussed, and the thermal and energetic balances were evaluated. Despite low sonication inputs, sludge digestion performance improved in terms of solids degradation and biogas production depending on the soluble organic load. The biogas production by sonicated sludge was higher (up to 30%) with respect to the control. Filterability improved during digestion of sonicated sludge at medium OLR due to a significant abatement of the fines. Thermal balances indicated that sonication may be a proper system to guarantee self-sustaining WAS mesophilic digestion. Nevertheless, thickening is a pre-requisite to achieve a positive energy balance.

Degradation kinetics of particulate matter in anaerobic digestion of secondary sludge, untreated and sonicated, was investigated by carrying out batch tests at different feed/inoculum ratio (F/I) (in the range of 0.1-4.0). Particulate COD degradation data were analysed using the four equations most widely utilized to model the hydrolysis process and the related kinetic parameters were evaluated. The increase of F/I results in a correspondent increase of the process rate up to one order of magnitude in the investigated interval for both untreated and sonicated sludge. The maximum step increase is observed in the range of 0.1-2.0 while for F/I varying from 2.0 to 4.0 only a modest enhancement of the process kinetics is detected. The effect of sonication on kinetics is not appreciable at low F/I, due to the low fraction of fed sludge and to the consequent strong substrate limitation, whereas at high F/I a slight increase is evidenced.

This study investigates for the first time, on laboratory scale, the possible application of an innovative enhanced stabilization process based on sequential mesophilic/thermophilic anaerobic digestion of waste-activated sludge, with low-energy sonication pretreatment. The first mesophilic digestion step was conducted at short hydraulic retention time (3–5 days), in order to favor volatile fatty acid production, followed by a longer thermophilic step of 10 days to enhance the bioconversion kinetics, assuring a complete pathogen removal. The high volatile solid removals, up to 55 %, noticeably higher compared to the performances of a single-stage process carried out in same conditions, can guarantee the stability of the final digestate for land application. The ultrasonic pretreatment influenced significantly the fatty acid formation and composition during the first mesophilic step, improving consequently the thermophilic conversion of these compounds into methane. Methane yield from sonicated sludge digestion reached values up to 0.2 Nm3/kgVSfed. Positive energy balances highlighted the possible exploitation of this innovative two-stage digestion in place of conventional single-stage processes.

Background/Purpose: Despite surgical refinements, perioperative use of tracheobronchoscopy (TBS) as part of surgical approach to esophageal atresia (EA) is still controversial. The purpose of this study was to evaluate the influence of preoperative TBS in newborns with EA in preventing complications and improving diagnosis and surgical treatment. Methods: In the period ranging from 1997 to 2003, 62 patients with EA underwent preoperative TBS. The procedure was carried out with flexible bronchoscope maintaining spontaneous breathing. When a wide carinal fistula was found, this was mechanically occluded by Fogarty catheter and cannulated with rigid bronchoscopy. Type of EA, surgical procedure variations caused by TBS, and associated anomalies not easily detectable were recorded. Results: Before TBS, the Gross classification of the 62 patients was as follows: type A, 9 patients; type B, none; type C, 51 patients. At TBS, however, 3 of 9 type A patients had an unsuspected proximal fistula (type B). These 3 patients, plus the 2 with H-type fistula, were repaired through a cervical approach. In 4 patients, previously undetected malformations of the respiratory tree (2 aberrant right upper bronchus and 2 hypoplastic bronchi) were found at TBS. Carinal fistulas in 14 type C patients were occluded by Fogarty catheter to improve ventilation during repair. No complications were observed. Overall, TBS was clinically useful in 28 (45.2%) of 62 patients, including 15 (24.2%) of 62 infants in whom it was crucial in modifying the surgical approach. Conclusion: Tracheobronchoscopy is a useful and safe procedure and should be recommended in tertiary centers for babies with EA before surgical repair.

BACKGROUND Wolf-Hirschhorn syndrome (WHS) is a well-known genetic condition characterized by typical facial anomalies, midline defects, skeletal anomalies, prenatal and postnatal growth retardation, hypotonia, mental retardation, and seizures. Affected patients with a microdeletion on distal 4p present a milder phenotype that lacks congenital malformations. WHS is rarely associated with congenital diaphragmatic hernia (CDH), and only 8 cases are reported in the literature. In almost all cases of CDH and WHS a large deletion of the short arm of chromosome 4 is present. CASE A microdeletion of 2.6 Mb on distal 4p associated with CDH and multiple congenital malformations (i.e., cleft palate) is reported for the first time. CONCLUSIONS Such a microdeletion should prompt a molecular study for WHS when in a fetus/newborn with CDH the association with cleft lip/palate and typical facial appearance (flat facial profile, hypertelorism) is found. Birth Defects Research (Part A), 2006. © 2006 Wiley-Liss, Inc.

Despite improvements in clinical management, mortality of congenital diaphragmatic hernia (CDH) remains high. Early prediction of mortality risk helps in comparing strategies and/or performances of different centers. Birth weight (BW), Apgar Score at 5 minutes, and modified McGoon Index (MGI) calculated by the ratio between the diameters of pulmonary arteries and the descending aorta have been used to determine mortality of CDH.The purpose of this study is to evaluate the relationship between early detectable variables and survival in newborns with CDH intubated at birth, managed with "gentle" ventilation and delayed surgery.All medical records of patients affected by high-risk CDH and treated with a standardized protocol at Bambino Gesù Children's Hospital, Rome, Italy, between January 2002 and September 2004 were reviewed. Prenatal diagnosis, gestational age, BW, sex, side of hernia, and MGI were recorded on admission. The relationship with mortality of each variable was evaluated by univariate analysis. Subsequently, a predictive model of mortality was developed using a logistic regression: the explanatory variables, BW, and MGI were dichotomized in high (HBW and HMGI) and low (LBW and LMGI) according to the best cutoff found with receiver-operating characteristic curves.Thirty-four newborns with CDH, treated with a standardized protocol, were studied. The main characteristics of the 34 patients were BW, 2886 g (1500-3620 g); gestational age, 37.7 weeks (32-42 weeks); male/female, 22/12; right/left, 8/26; prenatal diagnosis, 29; MGI, 1.31 (0.9-1.85). Only BW and MGI were significantly (P.05) associated with mortality at the univariate analysis. The best cutoff values were 2755 g for BW (sensitivity, 70%; specificity, 74%) and 1.25 for MGI (sensitivity, 73%; specificity, 78%). Using these limits, BW and MGI resulted independently associated with mortality in the multivariate analysis. Using the 4 possible combinations, the LBW associated with the LMGI presented the highest prediction of mortality (80%).Birth weight and MGI, variously combined, were predictive of mortality. Because they are not influenced by subsequent modalities of care, they can be considered as valid early severity scores in CDH and used for comparing strategies and/or performances of different centers.

Background Cardiorespiratory stabilization is recommended before surgical repair of congenital diaphragmatic hernia (CDH) because surgery may induce a transitory deterioration of chest compliance and gas exchange. It is not known if surgical intervention can affect cerebral circulation and oxygenation. Aim The aim of the study was to assess noninvasively, by near-infrared spectroscopy, the possible changes in cerebral hemodynamics and oxygenation associated with surgical repair of CDH. Subjects Twenty-five newborns with severe CDH (birth weight, 3057 ± 354 g; gestational age, 37.8 ± 1.8 weeks; male/female newborns, 15/10; left/right CDH, 19/6) were sedated, paralyzed, and mechanically ventilated by conventional gentle ventilation and surgically corrected at a median age of 2.7 days (min-max, 2-14 days) after cardiorespiratory stabilization. Methods Heart rate (HR [beats per minute]), preductal transcutaneous oxygen saturation (tcSao 2 [%]), carbon dioxide tension (tcPco 2 [Torr]), and mean arterial blood pressure (mm Hg) were continuously monitored. Inspired fractional oxygen concentration (Fio 2 ) was adjusted to maintain and preductal tcSao 2 of greater than 80%, whereas the ventilator's settings were kept unchanged throughout the surgical procedure. Cerebral hemodynamics was assessed by near-infrared spectroscopy (NIRO 300, Hamamatsu Photonics, Japan), recording continuously and noninvasively the relative changes in concentration of oxygenated ( Δ O 2 Hb [ μ mol/L]), deoxygenated ( Δ HHb [ μ mol/L]), and total ( Δ tHb [ μ mol/L]) hemoglobin; the tissue oxygenation index (TOI [%]) was also calculated (TOI = O 2 Hb/O 2 Hb + HHb). Total hemoglobin concentration is considered to be representative of cerebral blood volume. Arterial blood gases were also measured at the beginning ( T 1 ) and at the end of surgery ( T 2 ). For all measurements, results at T 1 and at T 2 , as well as the differences between T 1 and T 2 , have been expressed as means or medians and SDs or 95% confidence intervals or ranges. The differences between T 1 and T 2 were considered statistically significant for a P value of less than .05 by the Student t test for paired values. Results At T 1 , mean tcSao 2 % was 94.1 % (SD, 4.6) with a Fio 2 of 0.25 (SD, 0.1); at T 2 , to obtain similar values of tcSao 2 (93.4%; SD, 4.4), it was necessary to increase the Fio 2 to 0.37 (SD, 0.14; P T 1 was 149.5 beats per minute (SD, 9.1) and increased significantly ( P T 2 (165.2 beats per minute; SD, 14.2). Mean arterial blood pressure was 54.7 mm Hg (SD, 7.7) at T 1 and did not change appreciably at T 2 (55.6 mm Hg; SD, 8.1). Moreover, tcPco 2 did not change significantly during the procedure (mean tcPco 2 = 49.9 Torr [SD, 12.8] at T 1 and 57.3 mm Hg [SD, 17.9] at T 2 ). O 2 Hb and tHb decreased ( P P Δ [SD]: Δ O 2 Hb= −10.9 μ mol/L [9.7], Δ tHb = −7.5 μ mol/L [11.7], and Δ HHb = −3.5 μ mol/L [6.8]). Mean TOI was 70% at T 1 (normal values >60%) and decreased significantly at T 2 (mean Δ TOI = −6.1% [SD, 10.6]). In all infants, the greatest changes occurred when the viscera were positioned into the abdomen. Conclusions Notwithstanding the initial cardiorespiratory stabilization, surgical repair of CDH was associated with a rise in HR and oxygen requirement and a drop in cerebral tHb and O 2 Hb, suggesting a reduction in cerebral blood volume and oxygenation. These events were probably due to the combined effects of an increase in right to left shunting (as indicated by the increased oxygen requirement) and a decrease in venous return (possibly due to compression of the inferior vena cava by the viscera positioned into the abdomen). These preliminary results reinforce the importance of achieving a good cardiorespiratory stability before undertaking surgical correction of CDH to minimize the possible interference of the procedure with cerebral circulation and oxygenation.