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This review aims to assess different technologies for the on-site treatment of hospital wastewater (HWW) to remove pharmaceutical compounds (PhCs) as sustances of emerging concern at a bench, pilot, and full scales from 2014 to 2020. Moreover, a rough characterisation of hospital effluents is presented. The main detected PhCs are antibiotics and psychiatric drugs, with concentrations up to 1.1 mg/L. On the one hand, regarding the presented technologies, membrane bioreactors (MBRs) are a good alternative for treating HWW with PhCs removal values higher than 80% in removing analgesics, anti-inflammatories, cardiovascular drugs, and some antibiotics. Moreover, this system has been scaled up to the pilot plant scale. However, some target compounds are still present in the treated effluent, such as psychiatric and contrast media drugs and recalcitrant antibiotics (erythromycin and sulfamethoxazole). On the other hand, ozonation effectively removes antibiotics found in the HWW (>93%), and some studies are carried out at the pilot plant scale. Even though, some families, such as the X-ray contrast media, are recalcitrant to ozone. Other advanced oxidation processes (AOPs), such as Fenton-like or UV treatments, seem very effective for removing pharmaceuticals, Antibiotic Resistance Bacteria (ARBs) and Antibiotic Resistance Genes (ARGs). However, they are not implanted at pilot plant or full scale as they usually consider extra reactants such as ozone, iron, or UV-light, making the scale-up of the processes a challenging task to treat high-loading wastewater. Thus, several examples of biological wastewater treatment methods combined with AOPs have been proposed as the better strategy to treat HWW with high removal of PhCs (generally over 98%) and ARGs/ARBs (below the detection limit) and lower spending on reactants. However, it still requires further development and optimisation of the integrated processes.

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A coupled coagulation-Fenton process was applied for the treatment of cosmetic industry effluents. In a first step, FeSO(4) was used as coagulant and the non-precipitated Fe(2+) remaining in dissolution was used as catalyst in the further Fenton process. In the coagulation process a huge decrease in total organic carbon (TOC) was achieved, but the high concentration of phenol derivatives was not diminished. The decrease in TOC in the coagulation step significantly reduces the amount of H(2)O(2) required in the Fenton process for phenol depletion. The coupled process, using a H(2)O(2) dose of only 2 g l(-1), reduced TOC and total phenol to values lower than 40 and 0.10 mg l(-1), respectively. The short reaction period (less than 15 min) in TOC and phenol degradation bodes well for improving treatment in a continuous regime. The combination of both processes significantly reduced the ecotoxicity of raw effluent and markedly increased its biodegradability, thus allowing easier treatment by the conventional biological units in conventional sewage treatment plants (STPs).

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The ozonation of an effluent from the secondary clarifier of two Municipal Wastewater Treatment Plants was performed by using alkaline ozone and a combination of ozone and hydrogen peroxide. Alkaline ozonation achieved only a moderate degree of mineralization, essentially concentrated during the first few minutes; but the addition of hydrogen peroxide eventually led to a complete mineralization. The evolution of total organic carbon (TOC) as a measure of the extent of mineralization and the concentration of dissolved ozone were analyzed and linked in a kinetic model whose parameter represented the product of the exposure to hydroxyl radicals and the kinetic constant of indirect ozonation. This rate parameter yielded the highest values during the first part of O(3)/H(2)O(2) runs. The kinetic constant for the decomposition of ozone at the end of the run was also measured and computed for the non-oxidizable water matrix and yielded essentially the same values regardless of whether or not hydrogen peroxide was used. A group of 33 organic compounds, mainly pharmaceuticals and some relevant metabolites present in the wastewater effluents, were evaluated before and after the ozonation process using a liquid chromatography-hybrid triple-quadrupole linear ion trap system (LC-QqLIT-MS). The results demonstrate that the ozonation degrades these compounds with efficiencies of over 99% in most cases, even under low mineralization conditions in alkaline ozonation.

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The influence of the oxide support (i.e., Al2O3, Nb2O5, SiO2, and TiO2,) on the surface properties, reduction and oxidation properties, acid-base properties, and catalytic activity of supported indium oxide catalysts has been investigated by temperature-programmed reduction/oxidation, thermogravimetry coupled to differential scanning calorimetry, ammonia and sulfur dioxide adsorption calorimetry, and reduction of NOx by ethene in highly oxygen-rich atmosphere. Two series of In2O3-containing catalysts at low (approximately 3 wt %) and at theoretical geometric monolayer (from 20 to 40 wt %) In2O3 content were prepared and their properties were compared with unsupported In2O3 material. Supports able to disperse the In2O3 aggregates with high In stabilization gave rise to active catalytic systems. Among the studied oxide supports, Al2O3 and, to a lower extent, TiO2 were found to be the best supports for obtaining active de-NOx catalysts.

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During the atheroma plaque formation, smooth muscle cells (SMC) have to change their differentiated phenotype in order to proliferate, migrate and synthesize collagen. These phenotypic changes are stimulated by insulin and IGF-1, and we have studied the effect of L-type calcium channel blockade produced by diltiazem on such changes. Mitotic activity was measured using bromodeoxyuridine DNA incorporation, the migration capability as chemotaxis index in a Boyden chamber, and cytoskeleton changes related to SMC movement in immunofluorescence studies. Diltiazem (10(-7)-10(-6) M) reduced insulin-induced mitotic activity in cultured human vascular SMC more effectively than in IGF-1-induced mitotic activity, but at 10(-5) M, the inhibitory effects were similar. Diltiazem also showed a clear inhibition of migration ability, both under basal conditions (p < 0.05) and after addition of insulin (p = 0.0001) and IGF-1 (p < 0.0001). Finally, diltiazem inhibited membrane ruffling induced both by insulin and IGF-1 in a similar manner, and similar results were obtained with SMC from rat aorta. We conclude that substances blocking the L-type calcium channels such as diltiazem, could inhibit those processes which in vivo lead SMC to form the atheroma plaque.

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This work studied the proliferation activity in cultures of vascular smooth muscle cells (SMC) from individuals of different ages. The cells derived from arteries of 12 donors of both sexes from 45 to 91 years of age. The main parameter considered was the 'proliferation rate' (cells grown per day in the different culture passages) taking into account the age of the donor. No significant relationship between age of the donor and the cell life in proliferation was found. On the contrary, the mean time of passage duration for reaching the maximum of proliferation as well as its 'efficiency' (maximum of proliferation rate registered/mean time of passage duration) show a statistically significant dependence on the age of the donor. Furthermore, the proliferation rate measured in each passage is statistically significant related to donor age. The regressions obtained show a similar negative slope (VC 4%). Considering the first five culture passages, the regression crosses the x-axis at the age of 105.6+/-11.7 years. This age in which no proliferative activity of human SMC would be expected lies near the limit of maximum life potential for human beings. Our results suggest that with advancing donor age there is an increasing number of senescent SMC either primarily transferred or appeared in the culture. Vascular SMC of individuals whose life is near the end would almost be all senescent and therefore show extremely low proliferation rates in the culture. If the proliferative activity of arterial SMC is a condition for atherogenesis, the proportion of senescent cells would be inversely related to the propensity of developing the atheroma because of the inability of these cells to divide.

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The process of aging results in an increase in collagen in arterial walls, but the blood levels of insulin-like growth factor 1 (IGF-1) decrease remarkably as adults age. There is an almost simultaneous increase in insulin secretion, particularly in obese individuals. It is not known if, under these hormonal conditions, the enrichment of collagen in the arterial wall is due to insulin. We studied the effect of insulin on the production of collagen in vascular smooth muscle cells (VSMC) from elderly persons with high levels of insulin secretion after blocking the insulin receptors with a monoclonal antibody. Results were compared to those without insulin receptor blockage and to those with IGF-1. Despite the inhibition of 14C-glucose uptake, insulin clearly stimulated the release of procollagen III, and increased the collagen synthesis. The hydroxyproline labelling rate from 3H-proline increased to more than twice the control values. IGF-1 is a more potent effector than insulin, but the effect of insulin on the rate of collagen production became similar to IGF-1 when the specific receptors were blocked. The results indicate that under special conditions that occur with aging, insulin interacts with nonspecific receptors in VSMC, especially IGF-1, stimulating these cells to produce collagen.

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We examined the mechanisms by which insulin may be atherogenic during aging. We postulated that an increase in insulin secretion during aging produces growth factor effects on vascular smooth muscle cells (VSMCs), promoting these cells to synthesize collagen and to migrate. We have previously demonstrated that insulin stimulates collagen synthesis and release in senescent VSMCs that were obtained from a human organism with high levels of insulin secretion. Using the same experimental model, we now study the effects of insulin on VSMC migration. We demonstrate that insulin has a chemoattractant effect on VSMCs which occurs through insulin binding to its own specific receptors as opposed to its effect on collagen production. Blocking the insulin receptor significantly eliminates the insulin effect on cell migration. At the same molarity, the chemotactic effect of insulin is less pronounced than that of insulin-like growth factor-1. In spite of different mechanisms, there is a remarkable correlation between the insulin effects on collagen secretion and cell migration (r2 = 97%, p < 0.0005). Our results indicate that distinct but closely related mechanisms may exist by which insulin becomes atherogenic. Our results also suggest the importance of normal aging processes in the development of atherosclerosis.

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To study the expression of extrahepatic apolipoprotein E (apoE) under hypercholesterolemic conditions, apoE mRNA levels were evaluated in 14 tissues of rabbits fed on a cholesterol rich diet and compared to age-matched control animals. In hypercholesterolemic rabbits apoE expression was significantly induced in adipose tissue, adrenals, aorta, lung and spleen. The increase in apoE mRNA levels in lung and spleen was associated with the presence of cholesterol-loaded macrophages. These cells were found to express high levels of apoE mRNA as demonstrated by in situ mRNA hybridization. Our results suggest that extrahepatic tissues would be partially responsible for the rise in serum apoE levels detected under hypercholesterolemic conditions.

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The efficacy and safety of loratadine and terfenadine in the treatment of 3- to 6-year-old children with seasonal allergic rhinitis were compared in a third-party-blind, randomized, parallel-group study. A total of 96 children were included in the efficacy analysis: 49 children received 5 or 10 mg of loratadine once daily, and 47 received 15 mg of terfenadine twice daily, for 14 days. The mean total score for both nasal and non-nasal symptoms was decreased significantly from baseline at days 3, 7, and 14 in both treatment groups. At endpoint, these scores had improved 73% in each group. There were no statistically significant differences between the two groups in the total symptom scores at any point during the study. Both treatments were effective in relieving individual nasal and nonnasal symptoms. Therapeutic response to treatment was good or excellent in 82% of loratadine-treated children and in 60% of terfenadine-treated children. Few adverse events were reported during the study; all were mild or moderate and were not significantly different between the two treatment groups. There were no reports of sedation or dry mouth in either group. Once-daily treatment with 5 or 10 mg of loratadine was as effective as twice-daily treatment with 15 mg of terfenadine in improving the symptoms of seasonal allergic rhinitis in children 3 to 6 years old. Both treatments were well tolerated.

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The static and dynamic aspects of nasal anatomy determine the characteristics of the air flow passing through the nose and the thermo-hygrometric and particulated conditioning of the inhaled air. Through rhinomanometry it is possible to measure nasal cavities resistance to the passage of inhaled and exhaled air. Ventilation obstacles in the nose are frequent and varied: they are examined with the consequences of nasal obstruction at local and zonal level.

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We present 87 patients with cancer of the nasopharynx treated in the Fundación "Jiménez Díaz" de Madrid, in the last fifteen years. The clinical aspects of the illness, the therapeutic techniques and the results are analyzed. The global survival and the disease free survival at 5 years were 34 and 22% respectively. Survival in patients with squamous cell carcinoma was somewhat better. Distant metastases was presented in 30% of patients. At present 16 patients are alive and free of disease.

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The aneurysm of subclavian artery is uncommon, and its differential diagnosis is posed with other mediastinal expansive processes in a conventional RX level. A case of right subclavian aneurysm is presented.

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The influence of dipyridamole and lysine acetylsalicylate on the incidence of atherosclerotic lesions and on arterial prostacyclin formation was studied in rabbits. Male New Zealand rabbits received i.m. for 16 months dipyridamole (12.5 mg/kg/day) and lysine acetylsalicylate (0.5 mg/kg/day). The incidence of spontaneous atherosclerotic lesions in the aorta was reduced by 16.4% with respect to untreated animals. Administration of the drugs significantly increased prostacyclin formation with respect to the untreated rabbits both in animals developing (1124 +/- 197 pg/mg/3 min vs 316 +/- 49 pg/mg/3 min) or not developing lesions (499 +/- 40 pg/mg/3 min vs 246 +/- 19 pg/mg/3 min). The observed increase in prostacyclin formation could account for the lowered incidence of atherosclerotic lesions in rabbits receiving the combination of dipyridamole and lysine acetylsalicylate.

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Radical neck dissection remains the keystone to lymph nodes control in modern Head and Neck Surgery. Like any major operation, it has inherent complications ranging from minor surgical complications such as wound infection to potentially life-threatening complications such as fistula or carotid rupture. We have observed two cases of surgical damage of the phrenic nerve following radical neck dissection. Transient or definitive phrenic nerve palsy after radical neck dissection has been previously reported. The physiopathology according to the age and the clinical implications of that rare complication are discussed.

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