Monthly Archives: April 2020

Treatment f organophenolic and organoaromatics from textile wastewater using NiCO2O4 doped Bi2O2CO3 nanocomposite

DOI: 10.31038/NAMS.2020313

Abstract

The textile wastewaters could not be treated effectively with conventional treatment processes due to high polyphenol and aromatic compounds and colour content. In this study, by doping of NiCO2O4 to  Bi2O2CO3 the generated NiCO2O4to Bi2O2CO3nanocomposite was used for the photocatalytic oxidation of COD components (CODtotal, CODdissolved, CODinert), color, organophenols and organoaromatic compounds from a textile industry wastewaters (TW) at different operational conditions such as, at different photooxidation times (5 min, 15 min, 30 min, 60 min, 80 min and 100 min), at diferent NiCO2O4ratios (0.5wt% , 1wt%, 1.5wt%, 2wt%), at different NiCO2O4 / Bi2O2CO3nanocomposite concentrations (1, 5, 15, 30 and 45 mg/L), under 10, 30, 50 and 100 W solar irradiations, respectively. The maximum CODtotal, CODinert, total flavonols, total aromatic amines (TAAs) and color photooxidation yields were 99%, 92%, 91%, 98% and 99% respectively, under the optimized conditions, at 30 mg/L Ni/BiO nanocomposite with a Ni mass ratio of 1.5 wt% under 50 W UV (ultraviolet) light, after 60 min photooxidation time, at 25°C. The photooxidation yields of kaempferol (KPL), quercetin (QEN), patuletin (PTN), rhamnetin (RMN) and rhamnazin (RHAZ) from flavonols and 2-methoxy-5-methylaniline (MMA), 2,4-diaminoanisole(DAA); 4,40-diamino diphenyl ether (DDE), o-aminoazotoluene (OAAT), and 4-aminoazobenzol (AAB) from polyaromatic amines were > 82%.The pollutants of textile industry wastewater were effectively degraded with Ni doped BiO nanocomposite.

Keywords

Flavonols; Nickel cobaltite NiCO2O4 nanocomposite; bismuth subcarbonate (Bi2O2CO3) nanocomposite; Photooxidation; Polyaromatic amines; Ultraviolet (UV) light irradiation.

Biographical notes

Delia Teresa Sponza is a Professor at the Department of Environmental Engineering, Engineering Faculty, Dokuz Eylül University,İzmir, Turkey. She graduated her MSc and PhD degrees from Dokuz Eylül University, Turkey, in Environmental Engineering. Her research interests are environmental microbiology,environmental sciences and toxicity. She has published a number ofresearch papers at the national and international journals.

Rukiye Oztekin is a Researcher at the Department of Environmental Engineering, Engineering Faculty, Dokuz Eylül University, İzmir, Turkey. She graduated her MSc and PhD degrees from Dokuz Eylül University, Turkey, in Environmental Engineering. Her research interestsinclude environmetal sciences and toxic industrial wastewater treatment.

Introduction

Textile industry is one of those industries that consume large amounts of water in the manufacturing process [1] and, also, discharge great amounts of effluents with synthetic dyes to the environment causing public concern and legislation problems. Synthetic dyes that make up the majority (60–70%) of the dyes applied in textile processing industries [2] are considered to be serious health risk factors. Apart from the aesthetic deterioration of water bodies, many colorants and their breakdown products are toxic to aquatic life [3] and can cause harmful effects to humans [4,5]. Several physico-chemical and biological methods for dye removal from wastewater have been investigated [6-8] and seem that each technique faces the facts of technical and economical limitations [7]. The traditional physical, chemical and biologic means of wastewater treatment often have little degradation effect on this kind of pollutants. On the contrary, the technology of nanoparticulate photodegradation has been proved to be effective to them. Compared with the other conventional wastewater treatment means, this technology has such advantages as: (1) wide application, especially to the molecule structure-complexed contaminants which cannot be easily degraded by the traditional methods; (2) the nanoparticles itself have no toxicity to the health of our human livings and (3) it demonstrates a strong destructive power to the pollutants and can mineralize the pollutants into carbondipxide (CO2) and water (H2O) [9].

Bi2O2CO3 has gained much attention due to its promising photocatalytic activity for wastewater treatment [10-12]. Although Bi2O2CO3 has been widely studied in the photocatalytic degradation of wastewater, little attention has been poured to investigate the microwave catalytic performance of Bi2O2CO3 for microwave catalytic oxidation degradation of wastewater, up to now. At the same time, the magnetic NiCO2O4 has intriguing advantages, such as excellent microwave absorption performance, low cost, magnetically separable property, and high stability [13]. To the best of our knowledge, NiCO2O4-Bi2O2CO3 composite as microwave catalyst for degradation o more semiconductor photocatalysts have been found to be capable of photocatalytic degradation of organic macromolecular contaminants in wastewater [14, 15]. Therefore, photocatalytic degradation has become the most environmentally friendly, energy-saving, and efficient water pollution treatment method. In view of the fact that the traditional photocatalysts (such as TiO2) have large band gap energy and low response to visible light, their application is greatly limited. Among these miconducting photocatalysts, bismuth molybdate (Bi2MoO6) as a ternary oxide compound of Aurivillius phase becomes one of the promising materials. This is because it has a unique layered structure sandwiched between the perovskite octahedral (MoO4)2sheets and bismuth oxide layers of (Bi2O2)2+ [16-18]. Its dielectric property, ion conductivity, and catalytic performance have obvious advantages in bismuth-based semiconductors [19, 20]. Nevertheless, the light absorption property of the pure Bi2MoO6 primarily appears in the ultraviolet light region, which is only a small part of the solar spectra. Meanwhile, it presents a high recombination rate of electronhole
pairs in the process of photocatalytic reaction [21]. Therefore, researchers have improved the performance of Bi2MoO6 by means of
morphology controlling, semiconductor compounding, and doping modification [22]. Among these measures, doping has proven to be an effective method to ameliorate the surface properties of photocatalysts and enhance photocatalytic performance.

It was reported that carbon-doped Bi2MoO6 exhibited significantly enhanced and stable photocatalytic properties compared with Bi2MoO6 [23], which carbon replaced the O2anion in the lattice of Bi2MoO6, resulting in lattice expansion and grain diameter reduction, enhancement of specific surface area [24]. prepared Graphene-Bi2MoO6 (G-Bi2MoO6) hybridphotocatalysts by a simple one-step process, and an increase in photocatalytic activity was observed for G-Bi2MoO6 hybrids compared with pure Bi2MoO6 under visible light. Xing et al., (2017) reported the photocatalytic activity of 0.5% Pd–3C/BMO was robustly enhanced about 5-fold for Rhodamine B (RhB) degradation within 40 min under UV + visible light irradiation and 29-fold for O-phenylphenol (OPP) degradation within 120 min under visible light irradiation in comparison with pristine Bi2MoO6, respectively. [25] prepared a B-doped Bi2MoO6 photocatalyst with hydrothermal method by using HBO3 as a dopant source. It was found that B-doping increases the amount of Bi5+ and oxygen vacancies, so that the visible light absorption of catalyst is stronger, and the band gap energy is lower, which significantly improves the photocatalytic activity of Bi2MoO6. [26] successfully synthesized sulfur-doped copper-cobalt bimetal oxide by coprecipitation method, which significantly improved the catalytic performance and stability of the catalyst. [27] fabricated Bi2MoO6 surface co-doped with Ni2+ and Ti4+ ions through an incipient-wetness impregnation technology and calcination method, with the results suggesting Ni2+ and Ti4+ codoping increases visible-light absorption by Bi2MoO6 and promotes the separation of photogenerated charge carriers. Density functional theory calculations and systematical characterization results revealed that Biself-doping could not only promote the separation and transfer of photo generated electron-hole pairs of Bi2MoO6 but also alter the position of valence and conduction band without changing its preferential crystal orientations, morphology, visible light absorption, as well as band gap energy [28, 29] synthesized pure and various contents of Ce3+ doped Bi2MoO6 nano structures by a facile hydrothermal method. The 0.5%Ce3+ doped Bi2MoO6 exhibitsthe best photocatalytic activity of 96.6% within 20 min for RhB removal.

The photocatalytic performance of NiCO2O4-doped Bi2MoO6 nanoparticles has not been investigated extensively for the removals of aromatics and polyphenols from a textile industry. In this work, the phsicochemical properties of NiCO2O4 doped Bi2O2CO3 nanocomposite was investigated using microscope (SEM), transmission electron microscopy (TEM), Fourier transform infrared spectroscopy (FT-IR), X-ray photoelectron spectroscopy (XPS), photoluminescence spectra (PL), N2 adsorption–desorption, elemental mapping, Raman and diffused reflectances pectra (DRS) analysis. The photocatalytic oxidation of pollutant parameters [COD components (CODtotal, CODdissolved, CODinert), flavonols (kaempferol, quercetin, patuletin, rhamnetin and rhamnazin), polyaromatic amines (2-methoxy-5-methylaniline, 2,4-diaminoanisole, 4,40-diamino diphenyl ether, o-aminoazotoluene, and 4-aminoazobenzol) and color] from the TW at different operational conditions such as, at increasing photooxidation times (5 min, 15 min, 30 min, 60 min, 80 min and 100 min), at diferent Ni mass ratios (0.5wt% , 1wt%, 1.5wt%, 2wt%), at different Ni-BiO photocatalyst concentrations (1, 5, 15, 30 and 45 mg/L), at different pH ranges (4, 6, 8, 10) under 10, 30, 50 and 100 W UV light irradiations, respectively, were investigated .

Materials and methods

Raw wastewater

The characterization of raw TW was given in Table 1.

Table 1. Characterization values of TW at pH=5.7 (n=3, mean values ± SD). (SD: standard deviation; n: the repeat number of experiments in this study).

Parameters

Values

Minimum

Medium

Maximum

pH

5.00 ± 0.18

5.27 ± 0.19

6.00 ± 0.21

DO (mg/L)

1.30 ± 0.05

1.40 ± 0.05

1.50 ± 0.05

ORP (mV)

85.00 ± 2.98

106.00 ± 3.71

128.00 ± 4.48

TSS (mg/L)

285.00 ± 9.98

356.00 ± 12.46

430.00 ± 15.05

TVSS (mg/L)

192.00 ± 6.72

240.00 ± 8.40

290.00 ± 10.15

CODtotal (mg/L)

931.70 ± 32.61

1164.60 ± 40.76

1409.20 ± 49.32

CODdissolved (mg/L)

770.40 ± 26.96

962.99 ± 33.71

1165.22 ± 40.78

TOC (mg/L)

462.40 ± 16.18

578.00 ± 20.23

700.00 ± 24.50

BOD5 (mg/L)

251.50 ± 8.80

314.36 ± 11.00

380.38 ± 13.31

BOD5/CODdis

0.26 ± 0.01

0.33 ± 0.012

0.40 ± 0.014

Total N (mg/L)

24.80 ± 0.87

31.00 ± 1.09

37.51 ± 1.31

NH4-N (mg/L)

1.76 ± 0.06

2.20 ± 0.08

2.66 ± 0.09

NO3-N (mg/L)

8.00 ± 0.28

10.00 ± 0.35

12.10 ± 0.42

NO2-N (mg/L)

0.13 ± 0.05

0.16 ± 0.06

0.19 ± 0.07

Total P (mg/L)

8.80 ± 0.31

11.00 ± 0.39

13.30 ± 0.47

PO4-P (mg/L)

6.40 ± 0.22

8.00 ± 0.28

9.68 ± 0.34

SO4-2 (mg/L)

1248.00 ± 43.70

1560.00 ± 54.60

1888.00 ± 66.10

Color (1/m)

70.90 ± 2.48

88.56 ± 3.10

107.20 ± 3.75

Flavonols (mg/L)

30.9 ± 1.08

38.6 ± 1.35

46.1 ± 1.61

Flavonols

Kaempferol

4.2 ± 0.20

5.7 ± 0.2

7.2 ± 0.3

Quercetin

7.3 ± 0.26

9.2 ± 0.32

11.1 ± 0.4

Patuletin

8.3 ± 0.30

10.3 ± 0.36

12.2 ± 0.43

Rhamnetin

6.0 ± 0.21

7.2 ± 0.25

8.4 ± 0.3

Rhamnazin

5.1 ± 0.18

6.15 ± 0.22

7.2 ± 0.25

TAAs (mg benzidine/L)

891.84 ± 31.21

1038 ± 36.33

1183.8 ± 41.43

Polyaromatics

2-methoxy-5-methylaniline

128.5 ± 4.5

134.6 ±  4.71

140.6 ± 4.92

2,4-diaminoanisole

250.2 ± 8.76

275.8 ±  9.7

301.3 ± 10.6

4,40-diamino diphenyl ether

146.54 ± 5.13

156.0 ± 5.5

165.4 ± 5.8

o-aminoazotoluene

265.4 ± 9.3

293.6 ± 10.3

321.7 ± 11.3

4-aminoazobenzol

101.2 ± 3.54

178 ± 6.23

254.8 ± 8.92

Chemical structure of flavonols and poliaromatics present in the TW

The structure of flavonols in the TW was shown in Figure 1. The structure of polyaromatics in the TW was given Figure 2.

NAMS-3-1-305-g001

Figure 1. Chemical structure of flavonoids in the TW.

NAMS-3-1-305-g002

Figure 2. Chemical structure of polyaromatics in the TW

Preparation of photocatalysts

Ni-doped BiO nano particles were prepared by co-precipitation method using nickel nitrate hexahydrate [Ni(NO3)2.6H2O] (Analytical grade, Merck ) and Bismuthnitrate hexahydrate [Bi(NO3)2·6H2O] (Sigma, Aldrich) as the precursors of nickel and bismuth, respectively. Ni(NO3)2.6H2O and sodium carbonate anhydrous (Na2CO3) were dissolved separately in double distilled H2O to obtain 0.5 mol/Lsolutions. Nickel nitrate solution (250 mL of 0.5 mol/L) was slowly added into vigorously stirred 250 mL of 0.5 mol/L Na2CO3 solution. Nickel nitrate in the required stoichiometry was slowly added into the above solution and a white precipitate was obtained. The precipitate was filtered, repeatedly rinsed with distilled H2O and then washed twice with ethanol. The resultant solid product was dried at 100°C for 12 h and calcined at 300°C for 2 h. BiO particles were also prepared by the same procedure without the addition of nickel nitrate solution. The doping Ni mass ratios of Bismuth are expressed as wt%.

X-Ray diffraction (XRD) analysis

XRD patterns of the samples are going to carry out using a D/Max-2400Rigaku X-ray powder diffractometer operated in the reflection mode with Cu Ka (λ = 0.15418 nm) radiation through scan angle (2θ) from 20° to 80°.

Scanning electron microscopy (SEM) analysis

The morphological structures of the Ni-BiO nanocomposites before photocatalytic degradation with UV light irradiations and after photocatalytic degradation with UV by means of a SEM.

Fourier transform infrared spectroscopy (FTIR)analysis

The FTIR spectra of Ni, BiO and Ni-BiO samples were measured with FTIR spectroscopy measurements.

Photocatalytic degradation reactor

A 2 L cylinder kuvars glass reactor was used for the photodegradation experiments in the TW under different UV powers, at different operational conditions. 1000 mL TW was filled for experimental studies and the photocatalyst were added to the cylinder glass reactor. The photocatalytic reaction was operated with constant stirring during the photocatalytic degradation process. 10 mL of the reacting solution were sampled and centrifugated (at 10000 rpm) at different time intervals.

Used chemicals

Ni(NO3)2.6H2O (Analytical Grade, Merck, Germany) and Bi(NO3)3·6H2O (Analytical grade, Merck, Germany) were used as nickel and bismuth sources, respectively. Na2CO3 was purchased from Merck (Analytical grade). Helium, He(g) (GC grade, 99.98%) and nitrogen, N2(g) (GC grade, 99.98%) was purchased from Linde, (Germany). Kaempferol (99%), quercetin (99%), patuletin (99%), rhamnetin (99%), rhamnazin (99%), 2-methoxy-5-methylaniline (99%), 2,4-diaminoanisole (99%), 4,40-diamino diphenyl-ether (99%), o-aminoazotoluene (99%), 4-aminoazobenzol (99%) were purchased from Aldrich, (Germany).

Analytical methods

pH, T(°C), ORP, DO, BOD5, CODtotal, CODdissolved, total suspended solids (TSS), Total-N, NH3-N, NO3-N, NO2N, Total-P and PO4-P measurements were monitored following the Standard Methods 2310, 2320, 2550, 2580, 4500-O, 5210 B, 5220 D, 2540 D, 4500-N, 4500-NH3, 4500-NO3, 4500-NO2 and 4500-P [30]. Inert COD was measured according to glucose comparison method [31]. The samples were analyzed by high pressure liquid chromatography (HPLC) with photodiode array and mass spectrometric detection using an Agilent 1100 high performance liquid chromatography system consisting of an automatic injector, a gradient pump, a Hewlett–Packard series 1100 photodiode array detector, and an Agilent series 1100 VL on-line atmospheric pressure ionization electrospray ionization mass spectrometer to detect flavonols namely kaempferol, quercetin, patuletin, rhamnetin, rhamnazin and polyaromatics namely, 2-methoxy-5-methylaniline, 2,4-diaminoanisole, 4,40-diamino diphenyl-ether, o-aminoazotoluene, 4-aminoazobenzol, respectively. All the  metabolites were measured in the same HPLC by mass spectrometric detections. Operation of the system and data analysis were done using ChemStation software, and detection was generally done in the negative ion [M − H]– mode, which gave less complex spectra, although the positive ion mode was sometimes used to reveal fragmentation patterns—especially patterns of sugar attachment. Separation of flavonol components was made on a Vydac C18 reversed phase column (2.1 μm dia. × 250 mm long; 5-μm particle size). Columns were eluted with acetonitrile-water gradients containing 0.1% formic acid in both solvents. The quality of the raw (un-treated) and photooxidated wastewater were determined by measuring the absorbances of the supernatans at wavelengths varying between 200 nm, 250 nm, 300 nm, 350 nm and 540 nmusing an Aquamate Termoelectron Corporation UV-vis spectrophotometer.

Measurement of photonic efficiency (lr) of Ni doped BiO

The relative photonic efficiency of the catalyst is obtained by comparing the photonic efficiency of Ni-doped BiO with that of the standard photocatalyst (BiO). In order to evaluate lr, a solution of 1-Methylcyclopropene-MCP (40 mg/L) with a pH of 10 was irradiated with 100 mg of BiO and Ni-doped BiO for 60 min. From the degradation results, Ir was calculated as follows (Eq. 1).

NAMS-3-1-305-e001

Operational conditions

Under 10-30-50 and 100 W  UV light powers the photocatalytic oxidation of the pollutant parameters in the TW at different operational conditions such as at increasing Ni mass ratios in the Ni-BiOnanocomposite(0.5wt% , 1wt%, 1.5wt%, 2wt%), at increasing photooxidation times (5 min, 15 min, 30, 60 min, 80 min and 100 min), at different Ni-BiOphotocatalyst concentrations (1, 5, 15, 30 and 45 mg/L), under acidic, neutral and basic conditions, respectively.

All the experiments were carried out following the batch-wise procedure. All experiments were carried out three times and the results were given as the means of triplicate sampling with standard deviation (SD) values.

Results and analysis

XRD Analysis results

The powder XRD patterns of BiO and Ni-doped BiO with different lanthanum mass ratios are shown in Figure 3. The XRD patterns of all the Ni-doped BiO catalysts are almost similar to that of BiO, suggesting that there is no change in the crystal structure upon Ni loading. This also indicates that Ni+2 is uniformly dispersed on BiO nanoparticles in the form of small Ni2O2 cluster. However the Ni-doped samples have a wider and lower intense diffraction peaks than pure BiO. Moreover, the XRD peaks of Ni-doped BiO continuously get broader with increasing the Ni loading up to a mass ratio of 2%wt.

NAMS-3-1-305-g003

Figure 3. XRD patterns of BiO and Ni doped BiO (a) pure BiO, (b) 2 wt% Ni doped BiO, (c) 0.5wt% Ni doped BiO, (d) 1.0wt% Ni doped BiO, and (e) 1.5wt% Ni doped BiO.

SEM Analysis results

The morphology of nanocomposite particles is analyzed by SEM. Figure 4 shows that the nanocomposite material is partly composed of clusters containing composite nanoparticles adhering to each other with a mean size of around 20-80 nm before photooxidation process (Figure 4a) while the size increased to 24-86 nm after photooxidation (Figure 4b) with intermediates and remaining not photodegraded pollutants.

NAMS-3-1-305-g004

Figure 4. SEM micrographs of pure and nickel modified BiO, (a) pure BiO at 25°C, (b) Ni doped BiO at 25°C.

FTIR Analysis results

Figure 5 shows the FTIR spectrum of BiO and Ni-doped BiO, BiO powder synthesized under laboratory conditions. The peak between 400 and 700 cm-1 give the information of Bi–O and Ni–Bi–O on the FTIR spectra. The peak at 437–455 cm-1 give the information about stretching vibration of crystalline hexagonal zinc oxide (Bi–O stretching, vibration) and the peaks from 902 to 1020 cm-1 are attributed to the bond between lanthanum and oxygen (Ni–O). The broad peak between 3400 to 3900 cm-1 indicate the OH groups, due to the H2O which indicates the existence of atmospheric H2O adsorbed on the surface of nanocrystalline powder. An absorption band and a peak have been observed at 2350 cm-1, respectively, which arises from the absorption of atmospheric CO2 on the metal cations.

NAMS-3-1-305-g005

Figure 5. FTIR Spectra of pure BiO and Ni-doped BiO nanoparticles, with different concentration of dopant

Results and Discussions

Effect of increasing Ni-BiOnanocomposite concentrations on the removals of TW pollutants

The effects of increasing Ni-BiO nanocomposite concentrations (1 mg/L, 5 mg/L, 15 mg/L, 30 mg/L and 45 mg/L), on the photocatalytic oxidation of polutant parameters in the TW was investigated. The preliminary studies showed that the maximum removal of COD with 20 mg/L Ni-BiO nanocomposite was 89% with 70 min photooxidation time at pH=7.8 with 40 W UV power (Data not shown). Based on these yields the operational conditions for photocatalytic time were choosen as 60 min at a power of 50 W and at a pH of 8. The maximum photocatalytic oxidation removals for all pollutants in the TW were observed at 30 mg/L Ni-BiO nanocomposite concentrations, at pH=8.0, after 60 min photooxidation time and at 25°C at a power of 50 W (Figure 6). Removal efficiencies slightly decreased at 45 mg/L Ni-BiO nanocomposite concentration, because over load of surface area of Ni-BiO nanocomposites (Figure 6). This limiting the power of UV irradiation. Lower photo-removal efficiencies was measured for 1, 5, and 15 mg/L Ni-BiO concentrations due to low surface areas in the nanocomposite. On the contrarily, the surface area is high at 30 mg/L Ni-BiO nanocomposite concentrations. Therefore, the maximum photodegradation yield was observed in this nanocomposite concentration. The CODtotal, CODinert, total flavonols, total aromatic amines and color removals increased linearly as the Ni-BiO nanocomposite concentrations were increased from 1 mg/L up to 5 mg/L, to 15 mg/L, and up to 30 mg/L, respectively (Table 2 and Figure 6). Furher increase of nanocomposite concentration to 45 mg/L affect negatively the all the pollutant yields. The reason for this is the optimum amount of catalyst increases the number of active sites on the photocatalyst surface, which in turn increase the number of OH and superoxide radicals (O2 ●) to degrade pollutant parameters (COD components, flavonols, polyaromatics, color). When the concentration of the catalyst increases above the optimum value, the degradation decreases due to the interception of the light by the suspension [32]. reported that as the excess catalyst (turbidity) prevent the illumination of light, OH, a primary oxidant in the photocatalytic system decreased and the efficiency of the degradation reduced accordingly. Furthermore, the increase in catalyst concentration beyond the optimum may result in the agglomeration of catalyst particles; hence, the part of the catalyst surface becomes unavailable for photon absorption, and thereby, photocatalytic oxidation efficiency decreases [33]. Maximum CODtotal, CODinert, total flavonols, TAAs and color removal efficiencies were obtained after 60 min photooxidation process with yields of 99%, 92%, 91%, 98% and 99%, respectively, at pH=8.0, at 30 mg/L Ni-BiO nanocomposite concentration at 50 W power and at 25°C (Figure 6). Flavonols such as kaempferol, quercetin, patuletin, rhamnetin, rhamnazin removal efficiencies were 87%, 88%, 90%, 87% and 85% respectively, after 60 min photooxidation time, at pH=8.0, at 30 mg/L Ni-BiO nanocomposite concentration and at 25°C temperature (Table 2). Polyaromatic amines such as, 2-methoxy-5-methylaniline, 2,4-diaminoanisole, 4,40-diamino diphenyl ether, o-aminoazotoluene, 4-aminoazobenzol removal efficiencies after photooxidation process were 93%, 95%, 87%, 84% and 82%, respectively, after 60 min photooxidation time, at pH=8.0, at 30 mg/L Ni-BiO nanocomposite concentration at 50 W  UV power and at 25°C (Table 2).

NAMS-3-1-305-g006

Figure 6. Removal efficiencies of CODtotal, CODinert, total flavonols and TAAs at Ni-BiO=1 mg/L, BiO=5 mg/L, BiO=15 mg/L and BiO=30 mg/L.

Table 2. Effect of increasing Ni-BiO nanocomposite concentrations on the TW during photooxidation process after 60 min, at 50 W UV irradiation, at pH=8.0, at 25°C.

Parameters

Removal efficiencies (%)

Ni-BiO concentrations (mg/L)

1
mg/L

5
mg/L

15
mg/L

30
mg/L

45
mg/L

CODtotal

51

65

84

99

79

CODinert

45

63

78

92

76

CODdissolved

50

64

82

98

80

Color

62

69

85

99

83

Total flavonols

40

58

79

91

72

Flavonols

Kaempferol

35

57

72

87

65

Quercetin

36

61

73

88

67

Patuletin

37

62

79

90

74

Rhamnetin

38

56

72

87

64

Rhamnazin

34

53

71

85

66

TAAs

58

75

81

98

77

Polyaromatics

2-methoxy-5-methylaniline

55

66

83

93

79

2,4-diaminoanisole

54

71

79

95

73

4,40-diamino diphenyl ether

52

58

68

87

63

o-aminoazotoluene

49

65

75

84

72

4-aminoazobenzol

47

62

76

82

70

Kaempferol metabolies such as, 3-O-[2-O,6-O-bis(α-L-rhamnosyl)-( β-D-glucosyl] quercetin, 3-O-[6-O-(α-L -rhamnosyl)-( β-D-  glucosyl]quercetin, 3-O-{2-O-[6-O-(p-hydroxy-trans-cinnamoyl)-{ )-, β-D-glucosyl]- á-L-rhamnosyl}kaempferol decreased from 5.7 mg/L to 0.86 mg/L, from 5.7 mg/L to 1.08 mg/L, from 5.7 mg/L to 1.25 mg/L, respectively, after 60 min photooxidation time, at pH=8.0, at 30 mg/L Ni-BiO nanocomposite concentration at 50 W  UV power and at 25°C (Table 3). Quercetin metabolites such as, 3-O-[6-O-( α-L -rhamnosyl)- )-(β-D-glucosyl]quercetin, 3-O-{2-O-[6-O-(p-hydroxy-trans-cinnamoyl)-( β-D -glucosyl]– á-L-rhamnosyl}quercetin reduced from 9.2 mg/L to 1.28 mg/L, from 9.2 mg/L to 2.30 mg/L, respectively, after 60 min photooxidation time, at pH=8.0, at 30 mg/L Ni-BiO nanocomposite concentration at 50 W  UV power and at 25°C (Table 3). Patuletin metabolites such as, (E)-ascladiol, (Z)-ascladiol dropped off from 10.3 mg/L to 1.55 mg/L, from 10.3 mg/L to 1.85, respectively, after 60 min photooxidation time, at pH=8.0, at 30 mg/L Ni-BiO nanocomposite concentration at 50 W  UV power and at 25°C (Table 3). Rhamnetin metabolites such as, methyl quercetin, tetrahydroxy-7-methoxyflavone decreased from 7.2 mg/L to 1.15 mg/L, from 7.2 mg/L to 1.44 mg/L, respectively, after 60 min photooxidation time, at pH=8.0, at 30 mg/L Ni-BiO nanocomposite concentration at 50 W  UV power and at 25°C (Table 3). Rhamnazin metabolites such as, Rhamnazin-3-0-β-D-glucopyranosyl-(l →5)- α-L-arabinofuranoside, Rhamnazin-3-O-β-D- glucopyranosyl-(l—»5)-[β-D-apiofuranosyl-(-1→2)]-α -L-arabinofuranoside reduced from 6.5 mg/L to 1.42 mg/L, from 6.5 mg/L to 1.66 mg/L, respectively, after 60 min photooxidation time, at pH=8.0, at 30 mg/L Ni-BiO nanocomposite concentration at 50 W  UV power and at 25°C (Table 3).

Table 3. The metabolites of flavonols in the TW.

Flavonoids

Flavonoids metabolites

Influent concentrations (mg/L)

Effluent Concentrations (mg/L)

Removal efficiencies (%)

Kaempferol

3-O-[2-O,6-O-bis(α-L-rhamnosyl)-( ß-D-glucosyl]-quercetin

5.7

0.86

85

3-O-[6-O-(α-L -rhamnosyl)-( ß-D-  glucosyl]quercetin

5.7

1.08

81

3-O-{2-O-[6-O-(p-hydroxy-trans-cinnamoyl)-{ )-, ß-D-glucosyl]- á-L-rhamnosyl}kaempferol

5.7

1.25

78

Quercetin

3-O-[6-O-(α-L -rhamnosyl)- )-( ß-D-glucosyl]quercetin

9.2

1.28

86

3-O-{2-O-[6-O-(p-hydroxy-trans-cinnamoyl)-( ß-D -glucosyl]– á-L-rhamnosyl}quercetin

9.2

2.30

75

Patuletin

(E)-ascladiol

10.3

1.55

85

(Z)-ascladiol

10.3

1.85

82

Rhamnetin

Methyl quercetin

7.2

1.15

84

Tetrahydroxy-7-methoxyflavone

7.2

1.44

80

Rhamnazin

Rhamnazin-3-0-ß-D-glucopyranosyl-(l →5)-α-L-
arabinofuranoside

6.15

1.42

77

Rhamnazin-3-O-ß-D- glucopyranosyl-(l—»5)-[ß-D-apiofuranosyl-(-1→2)]-α -L-arabinofuranoside

6.15

1.66

73

2-methoxy-5-methylaniline metabolite such as, 5-nitro-o-toluidine decreased from 134.6 mg/L to 36.34, after 60 min photooxidation time, at pH=8.0, at 30 mg/L Ni-BiO nanocomposite concentration at 50 W  UV power and at 25°C (Table 4). 2,4-diaminoanisole such as, 4-acetylamino-2-aminoanisole, 2,4-diacetylaminoanisole reduced from 275.8 mg/L to 22.06 mg/L, from 275.8 mg/L to 38.61 mg/L, respectively, after 60 min photooxidation time, at pH=8.0, at 30 mg/L Ni-BiO nanocomposite concentration at 50 W  UV power and at 25°C (Table 4). 4,40-diamino diphenyl ether metabolites such as, N,NI-diacetyl-4,4I-diaminobenzhydrol, N,NI-diacetyl-4,4 I –diaminophenylmethane dropped off from 156 mg/L to 28.08 mg/L, from 156 mg/L to 40.56 mg/L, respectively, after 60 min photooxidation time, at pH=8.0, at 30 mg/L Ni-BiO nanocomposite concentration at 50 W  UV power and at 25°C (Table 4). o-aminoazotoluene metabolites such as, hydroxy-OAT (I), 4′-hydroxy-OAAT,  2′-hydroxymethyl-3-methyl-4-aminoazobenzene, 4, 4′-bis(otolylazo)-2, 2′ -dimethylazoxybenzene decreased from 293.6 mg/L to 58.72 mg/L, from 293.6 mg/L to 79.27 mg/L, from 293.6 mg/L to 85.14 mg/L, from 293.6 mg/L to 117.44 mg/L, respectively, after 60 min photooxidation time, at pH=8.0, at 30 mg/L La-ZnO nanocomposite concentration at 50 W  UV power and at 25°C (Table 4). 4-aminoazobenzol metabolites such as phenylhydroxylamine, nitrosobenzol reduced from 178 mg/L to 39.16 mg/L, from 178 mg/L to 44.5 mg/L, respectively, after 60 min photooxidation time, at pH=8.0, at 30 mg/L Ni-BiO nanocomposite concentration at 50 W  UV power and at 25°C (Table 4).

Table 4. The metabolites of polyaromatic amines in the TW.

Polyaromatic amines

Polyaromatic amines metabolites

Influent concentrations (mg/L)

Effluent Concentrations (mg/L)

Removal efficiencies (%)

2-methoxy-5-methylaniline

5-nitro-o-toluidine

134.6

36.34

87

2,4-diaminoanisole

4-acetylamino-2-aminoanisole

275.8

22.06

92

2,4-diacetylaminoanisole

275.8

38.61

86

4,40-diamino diphenyl ether

N,NI-diacetyl-4,4I-diaminobenzhydrol

156

28.08

82

N,NI-diacetyl-4,4 I -diaminophenylmethane

156

40.56

74

o-aminoazotoluene

hydroxy-OAT (I)

293.6

58.72

80

4′ -hydroxy-OAAT

293.6

79.27

73

2′ -hydroxymethyl-3-methyl-4-aminoazobenzene

293.6

85.14

71

4, 4′-bis(otolylazo)-2, 2′ -dimethylazoxybenzene

293.6

117.44

60

4-aminoazobenzol

Phenylhydroxylamine

178

39.16

78

Nitrosobenzol

178

44.5

75

[34] researched the photocatalytic activity of pure and Ni+2-doped BiO samples for the degradation of Rhodamine B (RhB). The effect of Ni+2 doping concentration on the photocatalytic activity of RhB wasalso investigated. 9 g/L Ni+2-doped BiO with a mass ratio of 2wt% had high photocatalytic efficiency [34]. 4-nitrophenol degradation was studied in the presence of Ni doped BiO nanoparticles with a Ni mass ratio of 4% [35]. 78.26% 4-nitrophenol removal was observed the aforementioned nanocomposite after 195 min photodegradation time and at 30 W  UV light irradiation at pH=8 [35]. 68.57% Acid Yellow 29 55% Coomassie Brilliant Blue G250 and 37.27% Acid Green 25 degradations was obtained after 120 min of irradiation in the presence of 0.9% Ni-doped BiO, at 500 W UV light irradiation, under atmospheric oxygen, at 25°C, respectively [36]. The color and pollutant yields obtained in our study exhibited higher yields compared to the studies given above with low Ni-BiO nanocomposite concentrations.

Effect of increasing Ni mass ratios on 30 mg/L Ni doped BiO nanocomposite for photodegradation of TW pollutants

Were researched the effects of different La mass ratios (0.5wt%, 1wt%, 1.5wt% and 2wt% ) in 30 mg/L Ni-BiO nanocomposite concentrations on the photooxidation yields of all pollutants in the TW during photooxidation experiments. Maximum CODtotal, CODinert, total flavonols, TAAs and color removal efficiencies were 99%, 92%, 91%, 98% and 99%, respectively, after 60 min photooxidation time, at pH=8.0, at 1.5wt% Ni mass ratio and at 25°C (Table 5 and Figure 7). Removal efficiencies increased as the Ni mass ratio in the Ni doped BiO nanocomposite were increased from 0.5wt% to 1wt% and to 1.5wt%. Maximum removal efficiencies was measured at 1.5wt% Ni mass ratio in the nanocomposite. The photocatalytic degradation efficiency of BiO nanoparticles increases with an increase in the Ni loading and shows a maximum activity at 1.5 wt%. Then decreases in photooxidation yield was observed on further Ni doping (to 2 wt%). The reason of this can be explained as follows: excessive amounts of dopants can retard the photocatalysis process, because excess amount of dopants deposited on the surface of BiO increases the recombination rate of free electrons and energized holes, thus inhibiting the photodegradation process. Hence, further increase in Ni doping to 2wt% results in the decrease of photocatalytic degradation efficiency.

Table 5. Effect of increasing Ni mass ratios on the TW during photooxidation process after 60 min, at 50 W UV irradiation, 30 mg/L Ni-BiO nanocomposite concentrations, at pH=8.0, at 25°C.

 

Parameters

Removal efficiencies (%)

Ni mass ratios (%)

0.5wt%

1wt%

1.5wt%

2wt%

CODtotal

46

71

99

80

CODinert

40

69

92

74

CODdissolved

45

70

98

78

Color

57

76

99

81

Total flavonols

35

64

91

75

Flavonols

Kaempferol

30

63

87

68

Quercetin

31

67

88

69

Patuletin

32

68

90

75

Rhamnetin

33

62

87

68

Rhamnazin

30

60

85

67

TAAs

53

81

98

77

Polyaromatics

2-methoxy-5-methylaniline

50

72

93

69

2,4-diaminoanisole

49

77

95

75

4,40-diamino diphenyl ether

47

64

87

64

o-aminoazotoluene

44

71

84

70

4-aminoazobenzol

41

70

82

66

NAMS-3-1-305-g007

Figure 7. Removal efficiencies of CODtotal, CODinert, total flavonols and TAAs at 0.5wt%, 1wt%, 1.5wt%, and 2 wt% Ni mass ratio.

The synthesized Ni-doped BiO catalyst possesses smaller particle size distribution than pure BiO nanoparticles. Apart from their small size, as Ni+2 was doped in BiO, more surface defects are produced as reported by [37]. Consequently, the migration of the photo-induced electrons and holes toward surface defects is reasonable [37]. Thus, the separation efficiency of the electron–hole pairs of Ni-doped BiO with more oxygen defects should be more than that of the pure BiO nanoparticles. Therefore, the enhancement in the photocatalytic degradation efficiency of Ni doping BiO increases due to small particle size and higher defect concentration compared to BiO alone.

UV absorbances of Ni-doped BiO

The UV–vis absorption spectra of BiO and Ni-doped BiO are shown in Figure 8. It can be clearly seen from Figure 8. The maximum absorbance shifts is 410 nm for pure nano BiO while the maximum absorbance of Ni-doped BiO with a Ni mass ratio 0.5wt% is observed at a wavelentgh of 380 nm. The wave of absorbance of Ni-doped BiO also increases gradually with increasing the Ni loading and is much higher as compared to that of pure BiO. This could be mainly attributed to the quantum size effect as well as the strong interaction between the surface oxides of Bi and Ni. These observations strongly suggest that the Ni doping significantly affects the absorbance properties.

NAMS-3-1-305-g008

Figure 8. UV-vis absorption spectra of Ni doped BiO catalysts

The strong UV band gap emission (375–395 nm) results from the radiative recombination of an excited electron in the conduction band with the valence band hole. The broad visible or deep-trap state emissions (410–440 nm and 540–580 nm) are commonly defined as the recombination of the electron-hole pair from localized states with energy levels deep in the band gap, resulting in lower energy emission. These deep-trap emissions indicate the presence of defects or oxygen vacancies of BiO nanostructures [38]. Since the band gap excitation of electrons in BiO or Ni-doped BiO with 254 nm can promote electrons to the conduction band with high kinetic energy, they can reach the solid-liquid interface easily, suppressing electron–hole recombination in comparison with 365 nm. Hence, the observation of low rate at 254 nm is therefore unexpected [39]. The UV band gap emission of Ni-doped BiO nanostructures was increased between 380 and 410 nm after the photocatalytic process of pollutant parameters. The results show that 1.5 wt% Ni-doped BiO has maximum activity as compared to other photocatalysts.

Effect of increasing photooxidation time on the photooxidation yields of pollutants in the TW

Six different photooxidation times (5 min, 15 min, 30 min, 60 min, 80 min and 100 min) was examined during photocatalytic oxidation of the pollutants in the TW. To determine the optimum time for maximum removals these pollutant parameters in the TW. The maximum photocatalytic oxidation removals was observed at 60 min photooxidation time, at pH=8.0 using 30 mg/L Ni doped BiO with a La mass ratio of 1.5wt% at an UV power of 50 W (Figure 9). The removals of CODtotal, CODinert, total flavonols, total aromatic amines and color were found to increase linearly with increase in retention time from 5 min up to 80 min. A further increase in retention time to and 100 min lead to a decrease in yields of pollutant parameters. In other words the removal efficiencies of pollutant parameters (COD components, flavonols, polyaromatics, color) decreased for photooxidation time > 60 min since at long irradiation times since the surface energy of Ni doped – BiO decreases [40]. The photooxidation can form small molecules such as H2O, carbonmonoxide (CO), CO2 and benzene etc. after long irradiation; it will lead to the decrease of the polar groups and the oxygen content of pollutant surface. The dispersive component of surface energy, the density of polymer surface has great influence on dispersivity of pollutants in the TW. However, the rate of photodegradation of Ni doped-BiO blends increases with the increase of irradiation time, and is higher than that of photocrosslinking after long irradiation time, leading to the decrease of the density of the polymer surface and the dispersivity of COD, dyes and other pollutants to Ni doped–BiO [41]. The photooxidation can form small molecules such as H2O, CO, CO2 and benzene etc. after long irradiation; it will lead to the decrease of the polar groups and the oxygen content of polymer surface, therefore the dispersivity decreaeses resulting in low photooxidation yields [41]. Aromatic and phenolic metabolites which would adsorb strongly onto titania surface and block significant part of photoreactive sites.

NAMS-3-1-305-g009

Figure 9. Removal efficiencies of CODtotal, CODinert total flavonols and TAAs after 5, 15, 30, 60, 80 and 100 min retention times.

The maximum CODtotal, CODinert, total flavonols, total aromatic amines and color removal efficiencies were 99%, 92%, 91%, 98% and 99%, respectively, after 60 min photooxidation time, at 1.5 wt% Ni mass ratio in 30 mg/L Ni-BiO nanocomposite concentration, at pH=8.0 and at 25°C under 50 W irradiation (Table 6). Also, flavonols such as kaempferol, quercetin, patuletin, rhamnetin, rhamnazin removal efficiencies were 87%, 88%, 90%, 87% and 85%, respectively (Table 6). The photooxidation removals of polyaromatic amines such as, 2-methoxy-5-methylaniline, 2.4-diaminoanisole, 4.40-diamino diphenyl ether, o-aminoazotoluene, 4-aminoazobenzol were 93%, 95%, 87%, 84% and 82%, respectively, after 60 min at pH=8.0 and at 25°C (Table 6). Kaempferol, quercetin, patuletin, rhamnetin, rhamnazin concentrations decreased from 5.7 to 0.741 mg/L, from 9.2 to 1.104 mg/L, from 10.3 to 1.03 mg/L, from 7.2 to 0.936 mg/L, from 6.15 to 0.923 mg/L, respectively. 2-methoxy-5-methylaniline, 2.4-diaminoanisole, 4.40-diamino diphenyl ether, o-aminoazotoluene, 4-aminoazobenzol concentrations decreased from 134.6 to 9.422 mg/L, from 275.8 to 13.79 mg/L, from 156 to 5.46 mg/L, from 293.6 to 10.28, from 178 to 6.23 mg/L, respectively.

Table 6. Effect of increasing photooxidation time on the TW during photooxidation process, at 50 W UV irradiation, at pH=8.0, 30 mg/L Ni-BiO nanocomposite concentrations, 1.5 wt% Ni mass ratio, at 25°C.

 

Parameters

Removal efficiencies (%)

5
min

15 min

30
min

60
min

80
min

100 min

CODtotal

56

69

87

99

99

99

CODinert

50

67

81

92

92

92

CODdissolved

55

68

85

98

98

98

Color

67

74

88

99

99

99

Total flavonols

45

63

82

91

91

91

Flavonols

Kaempferol

40

61

75

87

86

86

Quercetin

41

65

77

88

86

85

Patuletin

41

66

81

90

89

89

Rhamnetin

43

61

74

87

85

84

Rhamnazin

39

58

72

85

84

84

TAAs

63

78

84

98

98

98

Polyaromatics

2-methoxy-5-methylaniline

60

71

86

93

93

92

2,4-diaminoanisole

59

75

82

95

94

94

4,40-diamino diphenyl ether

57

62

71

87

79

78

o-aminoazotoluene

55

69

78

84

82

80

4-aminoazobenzol

51

62

75

82

81

79

The color yields obtained in this study for TW are higher than the studies given below: [42] investigated the effects of Bi0.95Ni0.05O and Bi0.90Ni0.10O on the treatment of Methylene Blue (MB) dyestuff removal under 18 UV irradiation for 1 h. 81% color yields were observed for the aforementioned Ni-Bi-O nanocomposites, respectively [42]. [43] found 80% color yields based on Reactive Black 5 after 60 min irradiation time under 90 W irradiation using Bi-Ni nanocomposite.

Effect of increasing UV powers on the yields of pollutants in the TW

In this study, four UV light powers were used (10 W, 30 W, 50 W and 100 W) to detect the optimum UV irradiation power for maximum photo-removal of the pollutant parameters in the TW using 30 mg/L Ni doped BiO nanocomposite with a Ni mass ratio of 1,5%w. The maximum photocatalytic oxidation removals was observed at 50 W  UV light irradiation, at pH=8.0, after 30 min photooxidation time and at 25°C (Table 7 and Figure 10). The CODtotal, CODinert total flavonols, total aromatic amines and color were found to increase linearly with increase in UV light irradiation from 10 W, up to 30 W, up to 50 W, respectively (Table 7 and Figure 10). Further increase of UV power up to 100 W did not affect positively the pollutant yields. Maximum CODtotal, CODinert, total flavonols, TAAs and color removal efficiencies after photooxidation process were 99%, 92%, 91%, 98% and 99%, respectively, for the aforementioned operational conditions (Figure 10). Flavonols such as kaempferol, quercetin, patuletin, rhamnetin, rhamnazin removal efficiencies were 87%, 88%, 90%, 87% and 85%, respectively, after 60 min photooxidation time, at 50 W  UV light, at pH=8.0, at 30 mg/L Ni-BiO nanocomposite concentration and at 25°C (Table 7). Polyaromatic amines such as, 2-methoxy-5-methylaniline, 2, 4-diaminoanisole, 4, 40-diamino diphenyl ether, o-aminoazotoluene, 4-aminoazobenzol removal efficiencies after photooxidation process were 93%, 95%, 87%, 84% and 82%, respectively (Table 7).

Table 7. Effect of increasing UV light irradiations on the TW during photooxidation process after 60 min, at 30 mg/L Ni-BiO photocatalyst concentration, at pH=8.0, at 25°C.

Parameters

Removal efficiencies (%)

UV light irradiation

10 W

30 W

50 W

100 W

CODtotal

49

82

99

97

CODinert

43

76

92

90

CODdissolved

48

81

98

96

Color

60

83

99

99

Total flavonols

38

76

91

90

Flavonols

Kaempferol

33

70

87

87

Quercetin

34

71

88

86

Patuletin

35

78

90

89

Rhamnetin

36

70

87

87

Rhamnazin

33

71

85

85

TAAs

56

79

98

96

Polyaromatics

2-methoxy-5-methylaniline

53

81

93

92

2,4-diaminoanisole

52

77

95

93

4,40-diamino diphenyl ether

50

66

87

86

o-aminoazotoluene

47

73

84

81

4-aminoazobenzol

45

71

82

80

NAMS-3-1-305-g010

Figure 10. Removal efficiencies of CODtotal, CODinert, total flavonols and TAAs at 10 W, 30 W, 50 W and at 100 W.

The UV power determines the extent of light absorption by the semiconductor catalyst at a given wavelength. During initiation of photocatalysis, electron–hole formation in the photochemical reaction is strongly dependent on the optimum light intensity [44]. In this study, as the UV power increase from 10 W up to 50 W might favor a high-level surface defects, which account for the increase in the defect emission relative to the UV emission as reported by [39]. Higher UV powers > 50 W decrease the defects in the surface of the nanoparticle by disturbing the active holes.

Effect of increasing pH values on the pollutant yields in the TW

The effects of increasing pH values (4.0, 6.0, 8.0 and 10.0) on the photocatalytic oxidation of polutant parameters in TW was examined by considering the solubility of BiO nanoparticles in acidic as well as in highly basic solutions. The maximum photocatalytic oxidation removals was obtained at pH=8.0, after 60 min photooxidation time with a Ni mass ratio 1.5wt% using 30 mg/L Ni-BiO nanocomposite concentration at 50 W  UV power (Table 8 and Figure 11). In acidic medium, less photocatalytic degradation of pollutant parameters (COD components, flavonols, polyaromatics, color) was observed. The extent of photocatalytic degradation of polutant parameters was found to increase with increase in initial pH to 8.0 and a decrease in maximum photocatalytic degradation was found at pH 10. The possible explanation of this is that the pH at zero point charge (zpc) of BiO is 9.0 ± 0.3 [45]. Below pH 8.0, active sites on the positively charged catalyst surface are preferentially covered by pollutant molecules. Thus, surface concentration of the polutant parameters (COD components, flavonols, polyaromatics, color) is relatively high, while those of OH and OH are low. Hence, photocatalytic degradation decreases at acidic pH. On the other hand, above pH 8.0, catalyst surface is negatively charged by means of metal-bound OH, consequently the surface concentration of the polutant parameters (COD components, flavonols, polyaromatics, color) is low, and OH is high. In addition, polutant parameters are not protonated above pH 8.0. The electrostatic repulsion between the surface charges and Ni doped BiO nanocomposite hinders the amount of polutant parameters and the adsorption, consequently surface concentration of the polutant parameters decreases, which results in the decrease of photocatalytic degradation at pH 10.0. In conclusion, pH 8.0 can provide moderate surface concentration of polutant parameters which react with the holes to form OH.

Table 8. Effect of increasing pH values on the TW during photooxidation process, at 50 W UV irradiation, after 60 min, at 25°C.

 

Parameters

Removal efficiencies (%)

pH values

pH=4.0

pH=6.0

pH=8.0

pH=10.0

CODtotal

53

74

99

72

CODinert

47

72

92

70

CODdissolved

52

73

98

71

Color

64

79

99

77

Total flavonols

42

68

91

66

Flavonols

Kaempferol

37

66

87

64

Quercetin

38

70

88

68

Patuletin

39

71

90

69

Rhamnetin

40

66

87

64

Rhamnazin

45

62

85

60

TAAs

60

83

98

81

Polyaromatics

2-methoxy-5-methylaniline

57

76

93

74

2,4-diaminoanisole

56

80

95

78

4,40-diamino diphenyl ether

54

67

87

65

o-aminoazotoluene

52

74

84

72

4-aminoazobenzol

50

65

82

63

NAMS-3-1-305-g011

Figure 11. Removal efficiencies of CODtotal, CODinert, total flavonols and TAAs at pH=4.0, pH=6.0, pH=8.0, pH=10.0.

Photocatalytic oxidation mechanisms of Ni doped BiOnanocomposite

The higher activity of Ni doped BiO can beattributed to successful e–h+ separation and production of ●O2 and OH. Ni-modified BiO sample manifests the highest efficiency, which may be explained by the highest number of O2 vacancies (related to the different charge and electronegativity of Ni and Bi ions) and as a result of stronger adsorption of OHions onto the BiO surface [46]. This favors the formation of OH by reaction of hole and OH. The OH and photogenerated ●O2has extremely strong non-selective oxidants lead to the degradation of the organic pollutant at the surface of Ni modified BiO [41]. The photocatalytic degradation mechanism starts with the illumination of BiO nanoparticles and production of electron–hole pairs in Eq. (2):

NAMS-3-1-305-e002

Major roles of metal ions in this study are to increase the concentration of BiO on the surface of the catalyst and to prolong the individual life-time of electrons and holes and hence, inhibit their recombination. The ability of Ni+3 to scavenge photogenerated electrons is as follows: (Eq. 3):

NAMS-3-1-305-e003

However, stabilities of Ni+3 ions may be disturbed in their reduced forms (Ni+2). This can be achieved by transferring the trapped electron to O2 [Eq. (4)]:

NAMS-3-1-305-e004

The produced O2● is responsible from the generation of OH, known as highly reactive electrophilic oxidants [Eqs. (5-7)]:

NAMS-3-1-305-e005-6-7

In the meantime, photogenerated holes may react with H2O molecules and produce OH (Eq. 8):

NAMS-3-1-305-e008

The color removal by photooxidation of dyes reactions were given in Eqs (9-14):

NAMS-3-1-305-e009-14

Thus, loading of metal ions such as Ni on the surface of BiO matrix can suppress the recombination of photoinduced charge carriers either with only electron capture ability or with steps forward to produce OH. For Ni–BiO, electron accepting ability, production of more OH, the highest surface roughness value and the higher dark adsorption capacity result in pronounced photoactivity. The decay profile of the products includes the subsequent attacks of OH, known as highly reactive electrophilic oxidants. The main reaction pathway (60% of OH) is the addition of the OH to the double bond of the azo group, resulting in the rapid disappearance of color; however, addition to the aromatic ring also occurs (40% of OH) [47, 48]. Further OH attacks and the increment in OH concentration in the solution increase the yield of OHadduct in the degradation progress of each product. The opening of the dye aromatic rings due to consecutive oxidation reactions leads to low-molecular weight compounds [49].

Photonic efficiency of Ni doped BiO

In order to evaluate the relative photonic efficiency (Ir), a solution of MCP (40 mg/L) adjusted to pH 10 was irradiated with 100 mg BiO (Merck) and Ni-doped BiO, separately. The relative photonic efficiencies of light of wavelengths 254 and 365 nm for BiO and Ni-doped BiO are presented in Table 9. For comparison, the relative photonic efficiency of TiO2 is also presented in Table 9. The relative photonic efficiencies of Ni-doped BiO are greater as compared to those of BiO and TiO2, revealing the effectiveness of metal-doped systems. It is also interesting to note that the relative photonic efficiency for Ni-doped BiO for light of wavelength 254 nm are much higher as compared to that for 365 nm. The results are in good agreement with degradation and mineralization studies. Comparing the high efficiency of Ni doped BiO catalysts with standard BiO and TiO2 catalyst, the photocatalytic efficiency of 1.5 wt% Ni-doped BiO is higher as compared to that of BiO and TiO2 and other Ni doped BiO nanacomposites.

Table 9. Comparison of relative photonic efficiencies in the photodegradation of pollutants in TW by BiO and Ni-doped BiO photocatalysts (*)

 

Parameters

Relative photonic efficiency (Ir)

256 nm

370 nm

Pure BiO

1.01 ± 0.001

0.79 ± 0.01

0.1wt% Ni–BiO

1.09 ± 0.01

0.93 ± 0.01

0.5 wt% Ni–BiO

1.28 ± 0.02

0.94 ± 0.01

1.0wt% Ni–BiO

2.59 ± 0.01

2.22 ± 0.01

1.5wt% Ni–BiO

2.98 ± 0.01

2.25 ± 0.01

2wt% Ni–BiO

1.02± 0.01

1.98 ± 0.01

Commercial BiO

1.02 ± 0.01

1.02 ± 0.01

TiO2

1.38 ± 0.01

1.03 ± 0.01

(*): pH 5; UV = 8 lamps; ë = 254 and 365 nm; 50 W UV power, 60 min photooxidation time

Reusability of Ni doped BiO

As shown in Figure 12, after the first cycle of photocatalytic oxidation within 60 min, 99% of the Ni doped BiO with a mass ratio of 1.5wt% was recovered. After three cycles, the phoooxidation ability of Ni doped BiO nanocomposite was retained at 93% of the original value. After 8th cycles the nanocomposite was reatined at 80%. One of the reasons for the slight decline in photooxidation is that the surface of the reused photocatalysts may exist with some low residual substances which did not occupy the photocatalytic sites and did not block the adsorption. The presence of Ni significantly changed the binding site of the pollutant molecules. It is possible that the oxygen atom in Ni-BiO was bound to the dopant Ni [50]. The speedily recovering of the photodegradation capacity of Ni doped BiO for pollutans photodegradation will benefit to their photocatalytic activity.

NAMS-3-1-305-g012

Figure 12. The reusability of Ni doped BiO

Conclusions

By using 30 mg/L Ni-BiO with a Ni mass ratio of 1.5w% the CODtotal, CODinert, flavonols, polyaromatics and color were photodegraded with yields as high as 82-99% within 60 min photooxidation time, at 25°C under 50 W  UV power, at pH=8.0. The addition of Ni to BiO lead to enhance the photocatalytic activity by increasing the total surface area. The flavonoids and polyaromatic amines and their metabolites in the TW were firstly determined photodegraded with high rates and photonic efficiency using 30 mg/L Ni-BiO with a Ni mass ratio of 1.5w% at pH 8.

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Abundance, Composition and Spatial Distribution of Marine Plastic Litter in Sea Surface Waters Around Cap Corse

DOI: 10.31038/NAMS.2020312

Abstract

Marine litter is a widespread problem affecting all the oceans of the world. Plastics represent around 90% of marine litter, and it is estimated that there are between 15 and 51 trillion plastic particles floating on the surface of the oceans. The objectives of this study are to: (i) identify and characterize the main categories of floating items sampled in surface waters off the Cap Corse peninsula, (ii) provide estimates of the occurrence of floating items in this area, and (iii) get an overview of the potential areas of litter accumulation. We highlighted a heterogeneous distribution of floating litter as the plastic density characterizing the area between Bastia and Macinaggio (27 027 items/km2) was, on average, 2.31 times higher than the density estimated between Macinaggio and Pino (11 688 items.km2). Several studies highlighted that spatio-temporal variability of plastic densities and sizes of plastics (micro, meso, macroplastics) could be tightly linked with hydrodynamics and wind regime, distance to land, coastal human population and maritime traffic. Beyond the need to further raise awareness, providing more evidences and information regarding such marine pollution may hopefully foster urgent management strategies, whereby the most effective mitigation strategy implies reducing the input at its source.

Keywords

Plastic, marine litter, manta-net, Mediterranean Sea.

Introduction

Marine litter is a widespread problem affecting all the oceans of the world. Plastic pollution has gained attention by scientists and public perception in the last decade [1, 2]. Plastics represent around 90% of marine litter [3], and it is estimated that there are between 15 and 51 trillion plastic particles floating on the surface of the oceans [4].Global plastic production increased from 5 million tonnes in 1950 to 322 million tonnes in 2015 [5] It is considered that, on average, around 80–90% of ocean plastic comes from land-based sources, including via rivers, with a smaller proportion arising from ocean-based sources such as fisheries, ships and aquaculture. Plastic inputs from land to ocean was estimated to represent at least 4.8 to 12.7 million tonnes in the year 2010 [6]. Because of their abundance, durability and persistence, marine plastics constitute today a major threat to the marine environment [7].

The most visible impacts of marine plastics are the ingestion, suffocation and entanglement of hundreds of marine species, including species listed on the IUCN Red List as near threatened or above [8]. Microplastics (less than 5 mm in diameter), in particular, have recently become a source of concern, as their ingestion has been observed in a wide variety of taxa including zooplankton, marine invertebrates, fish, turtles, seabirds, and marine mammals [9–11]. Once ingested, microplastics can cause starvation, alterations in intestinal functions, a reduction in feeding capacity, energy reserves and reproductive output [12]. Also, contaminated preys can be consumed by predators leading to the transfer of plastics accross trophic levels [13]. Moreover plastics are polymers that may contain a large variety of chemical additives and contaminants, including organic pollutants and endocrine disruptors, that pollute the environment [14] and can be harmful to marine biota [15, 16].

Floating marine litter also plays an important role in the spread of marine or terrestrial organisms, including the dispersal of invasive species that may pose a threat to local ecosystems [17]. Also, the hydrophobic nature of plastics stimulates the formation of biofilms and allows the establishment of numerous organisms, called “epiplastic” organisms, which constitute a new marine ecosystem called “plastisphere”[18]. It can host different groups, in particular microbial organismsincluding pathogenic viruses or bacteria but also fungi, algae, molluscs, cnidarians, and crustaceans [19–21]. The surge in the number of litter introduced into the marine environment currently offers a great variability of objects that may serve as « novel habitat » or as « hitch-hiking raft »  [22, 23].

In addition to causing harm and threatening marine ecosystems, marine litter, especially plastic, can also negatively affect human wellbeing, food security and socioeconomic sectors such as tourism, aquaculture, fishing and navigation [24-26].

The Mediterranean Sea is considered as a biodiversity hotspot [27], besieged by multiple human pressures. Indeed, its shores are home to around 10% of the world’s coastal population and around 100 million people live within 10 km of the coast [28]. Moreover, the Mediterranean basin is one of the busiest shipping routes in the world and receives the waters of densely populated watersheds, e.g. the Nile, the Ebro, the Po [29]. It is therefore not surprising that the basin is nowadays described as one of the areas most affected by marine litter in the world, whereby the average density of plastic as well as its frequency of occurrence throughout the basin were comparable to accumulation zones in ocean gyres [29–31]. In Europe, various regulatory directives have been put in place to limit and reduce this pollution, such as the Marine Strategy Framework Directive (MSFD). In order to define the concept of « Good Environmental Status », the MSFD proposed 11 descriptors including descriptor n° 10 describing good status for marine litter as follows: “Properties and quantities of marine litter do not cause harm to the coastal and marine environment” [32]. Also new knowledge on this topic may have impact in the implementation of other environmental regulations such as the new European Strategy for Plastics in a Circular Economy (COM/ 2018/028 final), which has recently agreed on banning certain single use plastic (SUP) items.

To develop and validate indices of ecosystem status or pollution, it is necessary to have access to areas with low human impact and then validate them along local pressure gradients [33]. Corsica, is a privileged area in the North-Western Mediterranean. It is at the centre of one of the most touristic regions in the world still sheltered from heavy pollution of anthropic origin. This area should come closer to the concept of Good Ecological Status in terms of pollution by plastic marine litter. Our study intends to provide further information on marine litter regarding the northeastern waters of Corsica, part of the Cap Corse and Agriate Marine Natural Park (PNMCCA). This area is also comprised within the Pelagos Sanctuary, a large marine area subject to an agreement between Italy, Monaco and France for the protection of marine mammals.

In detail, the objectives of this study are to: (i) identify and characterize the main categories of floating items sampled in surface waters off the Cap Corse peninsula, (ii) provide estimates of the occurrence of floating items in this area, and (iii) get an overview of the potential areas of litter accumulation.

Material and method

In August 2019, the Corsican Blue Project team carried out a marine litter sampling campaign  within the perimeter of the Cap Corse and Agriate Marine Natural Park (PNMCCA). A total of six manta-net tows were conducted along the coast of the Cap Corse peninsula between Bastia and Pino, including three transects along the eastern coast (Bastia-Macinaggio) and three transects along the northwestern coast (Pino-Macinaggio). The manta-net, characterized by a rectangular opening of 86 x 46 cm and a net opening of 330 μm, was deployed at the surface beyond the boats’ wake at an average speed of 2.2 to 2.4 knots and for about 30 min per tow. General characteristics of each transect were recorded. After each sampling, the entire net was thoroughly rinsed with seawater from the opening to the collection bag to ensure that all the debris were concentrated in the cod end before being retrieved.

Collected samples were sent for analysis to the STARESO (STAtion de REcherches Sous-marines et Océanographique) research station.In the laboratory, the samples were rinsed with seawater on a 300 μm sieve.Then the mesh was rinsed with tap water and the sample was collected. Sampling consists of direct extraction from the environment of items that are recognizable by the naked eye. Several steps have been taken to separate the litter from the biological matrix and water [34]. Litter was manually separated from natural debris by removing the largest pieces of biological material (leaves, algae, wood …) and rinsing them with water that underwent a second sorting to avoid any loss of debris [35]. Items that were visually identified as litter were collected using fine forceps and then counted. To avoid misidentification and underestimation of microplastics it is necessary to standardize the plastic particle selection, following certain criteria to guarantee proper identification [34]. Plastics were identified according morphological characteristics and physical response features (e.g. response to physical stress; microplastics were bendable or soft, colors) [34, 36]. Identified plastic items were measured over their largest cross-section (total length) in order to be classified into three categories: microplastics (<5 mm), mesoplastics (5-200 mm) and macroplastics (> 200 mm) [37]. Plastic items were also classified, as proposed by [21], into six categories according to their visual characteristics:

1. Fragment: this category is generally the most abundant. They are rigid, thick, with sharp, pointed edges and an irregular shape. They can be of different colors.

2. Film: they also appear in irregular shapes, but compared to the fragments, they are fine and flexible and generally transparent.

3. Pellet: they are generally from the plastics industry. These are irregular round shapes, about 5 mm in diameter. They are generally flat on one side and can be of different colors.

4. Granule: they have a regular round shape and generally smaller, around 1 mm in diameter. They appear in natural colors (white, beige, brown).

5. Filament: these are, with the fragments, the most abundant type of particles. They can be short or long, with different thicknesses and colors.

6. Foam: they most often come from large particles of polystyrene foam. They have a soft, irregular shape and are white to yellow in color.

The surface of the surveyed area was estimated by multiplying the observation width by the transect distance, and litter density (items/km2) was calculated by dividing the items count with the surveyed area surface [29].

Results and discussion

In this study, plastic litter was encountered in 100% of the hauls made off Cap Corse, representing a total of 238 itemsand a mean density of 19357 items/ km2.

We highlighted a heterogeneous distribution of floating litter as the plastic density characterizing the area between Bastia and Macinaggio (27 027 items/km2) was, on average, 2.31 times higher than the density estimated between Macinaggio and Pino (11 688 items.km2) (Fig.1). Several studies highlighted that spatio-temporal variability of plastic densities and sizes of plastics (micro, meso, macroplastics)could be tightly linked withhydrodynamics and wind regime [31, 38], distance to land [29, 39], coastal human population [40, 41] and maritime traffic [23]. In our case, the difference in densities found between the regions Bastia-Macinaggio and Macinaggio-Pino, could be consistent with coastal human population pressurewhereby the area with an estimated higher density is located close to Bastia, a city of more than 44 000 inhabitants.As an example, a sampling campaign conducted in the Ligurian Sea, mainly along the French continental coast, reported that highest densities were found in front of Nice [40]. Corsica has been identified as a reference area where contamination by microplastics was lower compared to other regions off the French Mediterranean coasts (e.g. Antibes, Marseille, Toulon) [42].

NAMS-3-1-304-g001

Figure 1. Average concentration of plastic litter, expressed as debrits per km2, in surface water off Cap Corse.

Moreover, the area between Corsica and Elba has been identified as displaying the highest natural marine debris concentration throughout the Central Western Mediterranean, suggesting therefore that the area is under great influence of terrigenous input [43]. However, the identification of the source of the collected litter remains challenging without the consideration of dispersion models, and items being subject to surface water circulation [44] may drift from their source of input. Indeed, studies investigating on debris transport and dispersion due to marine circulation strongly suggest that floating litter might drift during periods ranging from a few weeks to several years before eventually sinking or beaching [45]. Taking into account thatthe Tyrrhenian Sea has been identified as an important accumulation zone [23] and that the eastern coast of Corsica  is under the influence of the Tyrrhenian sea current which flows along the Italian coast before entering the Corsica channel [46] it is very likely that the area between Bastia and Macinaggiois supplied by debris drifting northwards.

It remains particularly challenging to compare our litter concentrations with those reported inother studies given the large variety of sampling methodologies. However, based on the same sampling methodology, sampled in the northern coast of Corsica, at the same season and at a rather similar distance to land, and concentrations were found to be in a same order of magnitude, ranging from tens of thousands to hundreds of thousands of items per square kilometer [30, 31, 40] (Table 1). However, in our case, densitieswere overall lower, andhigherdensities in the Bay of Calvi might be linked tothe different demographic pressures. Indeed, during summer season, population in Calvi may rise up to 60 000 inhabitants while the northwestern part of Cap Corse does not have such large population centre. However, these densities might also be linked to thedifference inwind stress during the sampling campaign [38], and also, as previously mentionned, to the water circulation properties of the considered coastal areas.

Table 1. Literature data on floating plastic densities for stations along the northen Corsican coast.

Site (NorthernCorsica)

Method

Mesh size (µm)

Density
(items / km2)

Source

Calvi

Manta trawl

333

400 000

[30]

Cap Corse

80 000

Cap Corse

40 000 – 80 000

[31]

Calvi

20 000 – 150 000

[40]

Regarding size classes, 62% of the total number of items was smaller than 5mm (microplastics), 26% measured between 5 and 200mm (mesoplastics), and 12% was bigger than 200mm (macroplastics) (Fig.2). In other words microplastics were 2.4 times more abundant than mesoplastics,and 5.3 times more abundant than macroplastics (> 200 mm).Such proportion is very similar to the study carried out in the Bay of Calvi, reporting that microplastics, mesoplastics and macroplastics accounted for 54%, 28% and 18% of total collected items, respectively [38].

NAMS-3-1-304-g002

Figure 2. Size class of the litter found during the sampling campaign.

Beyond the size-based classification,items were additionnaly classified according to their shape and appearance and it was found that fragments were largely predominant (62%), followed by films (26%), filaments (9%), foams (2%) and pellets (1%) (Fig.3). No granule was found. Such proportion is consistent with previous results reported [39] and it was highlighted that the proportion of fragments was especially important in the north of Corsica compared to other stations throughout the Western Mediterranean Sea [31].

NAMS-3-1-304-g003

Figure 3. Main categories of litter found during the sampling campaign.

While on land, the island of Corsica is currently facing a major litter crisis,  due to overloaded garbage dumps, its coastal marine waters are not exempted from marine litter pollution. In this context and despite a relatively small sampling effort compared to other major sea campaigns, our study provides information regarding the type and occurrence of marine litter and plastics in the local coastal waters off the Cap Corse peninsula. While the average density and types of litter items were in agreement with other comparable studies, we highlighted a potential heterogeneous distribution within the Cap Corse marine waters, with higher densities found in the transects of the eastern coast than in those from the northwestern area of the peninsula. To this, different explanations were proposed, such as terrestrial inputs and the influence of large population centres or the influx of debris through the marine circulation and wind forcing.

Conclusion

We highly advise further marine litter sampling campaigns to be conducted within these waters that are positionned at a bio-geogaphical crossroad where several major currents meet. Moreover such study would be scientifically supported and potentially technically facilitated given the fact that the Cap Corse waters are included within the Cap Corse and Agriate Marine Natural Park and the Pelagos Sanctuary. Field information could, for example, be useful in the risk assessment of whale or mammals exposure to microplastics by validating simulated plastic distribution, in parallel to whale habitat models [47]. Moreover, Corsica is also subject to high tourist flows during summer which also translates into an increment of boating, maritime shipping and passengers transport. It would therefore be advisable to conduct sampling all year round, to highlight any annual variability. This study also intends to promote and encourage further « participatory sciences » by which citizens are involved in data collection, in association with the scientific world.

Beyond the need to further raise awareness, providing more evidences and information regarding such marine pollution may hopefully foster urgent management strategies, whereby the most effective mitigation strategy implies reducing the input at its source.

Acknowledgments

This research was funded by the “Agence de l’eau Rhône Méditerranée Corse” and the “Collectivité de Corse” (CdC), as part of the STARE CAPMED project research.

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Treatment and Management in the Corona Virus Crisis: Think outside the Box While inside the Box

DOI: 10.31038/IDT.2020112

Perspective

I wrote this position paper as someone who wears several hats, each one separately, and primarily, onehat on top of the other. My many personal, family-community, and professional roles overlap and enhanceeach other. In this periodof crisis and challenge, of many difficulties and struggles,new knowledge and new experiences accumulate. In this text, I have chosen to share my personal message, comingfrom weeks of quarantine, and mydiscovery ofadministrative and professional modes of action that were new to me.

In ordinary times, which characteristically have greater degrees of freedom, we often encounter an avoidance approach tochange.The necessary experimentation with unfamiliar modalities/ techniques may even threaten our routine. However, in the face of another reality, there is an opportunity to grow and expand, precisely from a narrow and restricted physical boundary. I found myself in this time in therapeutic and administrative work at the Feeding Clinic, charting new ways andunfamiliar tracks. The deliberations and questionsand observations following my own process are presented below.

From protocol to practice

Protocol is formulatedin routine times, shaped by habits and consistency and based on personal and collective knowledge and experience. These are accompanied by a familiar reality, which at times is nottaken into account.The relevance of accepted practicesdiminishes in times of crisis. Work protocols that have served us well until now require renewal and change, according to the given needs.

We naturally tend to prefer familiar treatment plans and methods, thinking that they will achieve optimal results. However, relianceon conventionalapproaches can lead to missed therapeutic and administrative opportunities that are appropriate for these periods of crisis. As we become more creative and liberated from therapeutic conventions, we can achieve a broad and refreshing newreality-based therapeutic practice. For example, telephone or e-mailsduring the corona crisis can provide a reframing of the situation as well as a calmresponse and guidance on the challenge at hand.

Online treatment and management

The interpersonal encounter is a basic component of therapeutic work in the field of early childhood mental health. The session includes eye contact in which the therapist observes emotional states and the quality of the interaction, based on mimicry and body language. The encounter sometimes invites physical contact .Treatmentina period of quarantine eliminates some elements of nonverbal communication but may well sharpen other therapeutic skills.

The richness and diversity of online treatment depends on the technological means and skills of both the therapist andthe family in treatment. The quality of the therapy is also affected by the economic level and accessible material, which isexpensive. A flexible and open approachmakes remote communication with diverse populations possible and is combined withsensitivityto the populations’ unique character and needs.

The advantages of remote support are both technical, such as a high level of accessibility, and qualitative. For example, in a phone conversation with parents, sensitive and attentive listening can compensate for the lack of eye contact whileways to introduce new foods to a picky eater are presented.

Intake as a diagnostic and therapeutic tool

The face-to-face intake is currently replaced by telephone intake. Many new applicants experiencea high level of distress.In many cases, it is my professionalresponsibility to refer callers to emergency medical centers after consulting with the physician in the community.

Telephone intake for non-urgent callers is usually necessaryfor parents waiting for their children’s acceptance tothe feeding center. The intake is primarily intended to address their feelings of anger, frustration and disappointment. These intense emotions are not necessarily related to the child’s medical condition, and often reflect the parents’ cognitive and emotional state and need for an attentive ear, with or without eye contact.

Anxiety vs. Distress

Parents turn to a feeding center with possible distress in the background. How threatening or disruptive the situation is will affect the situation, as well as the parental resources that are mobilized. Currently, as the level of collective anxiety rises, the internal and private threat is sometimes temporarily reduced. Accordingly, and also because of the life-threatening possibility of increased exposure to Covid-19 virusin the medical center, parents refrain from contacting us unless there isimmediate danger.As therapeutic alternatives are developed; we bolster the parents’ confidence who willthen appreciate conventional therapy when it becomes possible .

Creativity and Productivity

While curiosity is the primary driving force when seeking therapeutic solutions, creativity is the fuel for finding the therapeutic path. There are different examples. For instance, a toddler was initially described on the phone, as refusing to eat. He achieved independent eating and avaried dietafter one therapy (phone) call, which came after a consultation and preliminary information from the educational and rehabilitation staff of the daycare center he attended prior to quarantine with his family.

Thinking outside the box, while being physically inside the box of my home, and physically distant from the patient and his family, led me to enlist family members as modelsfor social eating. The patient’s achievement delighted all those who saw themselves, and rightly so, as partners in his success.

Multidisciplinary team

The uniqueness of our feeding center is the skilled, sensitive, multidisciplinary response that can be individualized and family-oriented under one umbrella. Our staff support and complement each other so that the whole is worth more than the sum ofits parts. At this time, this integrative work continues, in shared thinking and discussion and supportive, encouraging conversations, with the hope of resuming non-virtual work sessions, as the danger passes.

Unpaid leave, layoffs and a reduced workforce at the feeding clinic as in other medical and treatment centers, arevague, unresolved, but solvable. I leave issues to the experts in economics, with the challenge of translating unique therapeutic productivity into the materialworld.

“Talk. Share. Work on youemotionally and psychologically, now is the time.” Dr. Guy Winch believes that the real threat during the Corona virus’s active period is mental. In an article in the Haaretzsupplement (Ayelet Shani, April 10, 2020), he emphasizes the importance of strengthening our coping tools and recommends that the mental health community not give in to helplessness oravoidance.

The routine of our lives can bring calm and stability, based on familiar and fixed events, their high predictability, clarity and logic. When I realized that the Corona virus had entered my personal and professional life, and might rob me of a stable routine, I understood theneed for a response anchored in the new reality.

This understanding led toa therapeutic thought process using methods nottypically included in early childhood mental health. The new reality has also sharpened my understanding of unique ways of managing and maintaining workrelationshipsin my work as coordinator of a multidisciplinary therapy center.

The work methods described above, adapted to extraordinary disruption, are also important for a promptresponse to non-urgent inquiries. Other cases are currently referred to emergency medical units, according to need and the recommendation of community doctors.

I warmly embrace the recommendation of psychologist Dr. Guy Winch. I do not succumb to helplessness . I invite in energized thinking and shared action in the current situation and believe that new insights are beginning to emerge.

Evolution of COVID-19 in Italy, Spain, United Kingdom and the United States

DOI: 10.31038/IDT.2020111

Abstract

This paper aims to help the authorities but especially the EU / EEA public health authorities in monitoring and managing the COVID-19 pandemic. The study provides concrete data on up-to-date and future developments in different countries and territories. The best results can be analyzed and pharmaceutical measures can be implemented in other countries. Thus, in order to have a clear picture of the danger of COVID-19, we studied a possible method of calculating the death rate among the positively confirmed cases. Thus, we have developed different equations, specific for each country, with which we can calculate the death rate. For example, for cases up to 19.03., For Italy, the death rate after 9 days was 25.58170% (9136 deaths / 28.03.) practically and theoretically 24.8% (8857 deaths); for cases up to the date of 4.04. the death rate at a minimum of 9 days was 16.6081% (19901 deaths / 13.04.) practically and theoretically 16% (19172 deaths); for the date of 19.04. the death rate will theoretically be 16.49187% and 23686 deaths, ie from 14.04. by including 19.04 there will probably be 3785 deaths. The method can be used for Italy, Spain and United States of America or other countries. The advantage of this method is that it is specific to each country. It helps us to have an overview and correlating with the number of tests and the age of the patients to choose the best treatments.

Keywords

Cases Italy, Spain, United Kingdom, United States of America deaths COVID.

Introduction

If we consider the total number of cases, 147577 and the number of deaths, 18851, from Italy until April 11, according to https://www.ecdc.europa.eu/en/cases-2019-ncov-eueea then we can say that the death rate increased from 9.50% to 12.77% compared to March 24. But considering that death usually occurs after 14 days, then we can say that this calculation is wrong [1-4].

Using the available preliminary data, the average time from onset to clinical recovery for mild cases is approximately 2 weeks and is 3-6 weeks for patients with severe or critical illness. Preliminary data suggest that patients develop severe disease symptoms, including hypoxia, at 1 week. Among patients who have died, the time from onset of symptoms to outcome varies from 2-8 weeks. [5, 6].

This paper aims to help the authorities but especially the EU / EEA public health authorities in monitoring and managing the COVID-19 pandemic. The study provides concrete data on up-to-date and future developments in different countries and territories. The best results can be analyzed and pharmaceutical measures can be implemented in other countries.

From the desire to be well informed and to have a clear picture of the danger of COVID-19, we studied a possible method of calculating the death rate among the positively confirmed cases. Studying the preliminary data available, there is an increase in deaths at nine or eleven days from increases in confirmations.

According to the model in [4, 5, 7] we have redone the graphs overlapping the deaths until 20.03.2020 with the cases until 11.03.2020 for Italy, Spain, United Kingdom and United States of America, different but representative countries and territories, cultures, approaches, behaviors , different equipment. The graphs overlap at 9 or 10 days. Thus, we have developed different equations, specific for each country, with which we can calculate the death rate. The method can be used for Italy, Spain and United States of America or other countries. The advantage of this method is that it is specific to each country. It helps us to have an overview and correlating with the number of tests and the age of the patients to choose the best treatments.

Results and discussions

In the case of Italy, we noticed, on April 11, changes in the data on the official website regarding the days of March 3, 4, 15, 16. The data used in this study are from the official website.

For Italy, there is an increase in deaths nine or eleven days after the confirmation increases. Because of this, we studied the 9-day death rate using the formula below.

Death rate at least 9 days = (total number of deaths day a + 9/ total number of cases day a) * 100.

There is a greater decrease in the death rate corresponding to 21.03 cases. the medical system was probably helped or was effective.

Graphically representing the death rate at a minimum of 9 days, we deduced the corresponding equation. With this equation we can calculate the death rate and the number of deaths 6 days in advance. If we adapt the method for a longer period of time, we will be able to calculate ahead with that interval.

Table 1. Death rate at least 9 days – Italy.

Criterion number
(x)

Date of confirmed cases

Date of deaths

Death rate after 9 days%(y)

1

11.03.

20.03.2020

33.5698

2

13.03.

22.03.

31.9393

3

15.03.

24.03.

28.7233

4

17.03.

26.03.

26.8227

5

19.03.

28.03.

25.5817

6

21.03.

30.03.

22.9280

7

23.03.

1.04.

21.0186

8

25.03.

3.04.

20.1182

9

27.03.

5.04.

19.0739

10

29.03.

7.04.

17.8702

11

31.03.

9.04.

17.3669

12

2.04.

11.04.

17.0483

In the deduced equations x represents Criterion number and y represents the Death rate after 9 days.

Day 11.03 is the 20th day for Italy and for Spain day 13.03 is the 20th day, if we consider the number of consecutive days in which cases were registered.

The death rate after 9 days is higher initially in Spain but falls more than in Italy. The evolution for these countries is encouraging, the major problem being the number of cases.

IDT-1-1-102-g001

Figure 1. Cases and deaths on 11 / 20.03.2020 – Italy. The deaths on 20.03.2020 correspond to the cases from 11.03.2020. x: Criterion number; y: Rate of death %.

Table 2. Death rate at least 9 days – Spain.

Criterion number
(x)

Date of confirmed cases

Date of deaths

Death rate after 9 days %
(y)  

1

11.03.

20.03.

46.7968

2

13.03.

22.03.

44.1558

3

15.03.

24.03.

37.9280

4

17.03.

26.03.

37.3626

5

19.03.

28.03.

35.4184

6

21.03.

30.03.

32.6726

7

23.03.

1.04.

28.6609

8

25.03.

3.04.

25.2136

9

27.03.

5.04.

20.9012

10

29.03.

7.04.

18.0699

11

31.03.

9.04.

17.0843

12

2.04.

11.04.

15.5116

IDT-1-1-102-g002

Figure 2. Cases and deaths on 11 / 20.03.2020 – Spain.. The deaths on 20.03.2020 correspond to the cases from 11.03.2020. x: Criterion number; y: Rate of death %.

Later I studied the situation in the United Kingdom. Initially, the social spacing measures were not applied here. Studying the appropriate United Kingdom charts, we observed correlations between the number of confirmed cases and deaths from 9 to 12 days later. We calculated the death rate 10 days after confirmation.

March 11 is the 19th day in which cases have been registered in the United Kingdom but the 13th in a row, so we can say that the United Kingdom is behind Italy with 6 days. Spain versus Italy with 3 days.Comparing the death rate corresponding to 11.03.For Spain with the day corresponding to 13.03.for the United Kingdom there is a big difference, the latter registering a much lower death rate initially but a later stay.

In this case it is difficult at the moment to elaborate the corresponding equation.

Studying the appropriate graphs United States of America we observed correlations between the number of confirmed cases and deaths from 9 to 12 days later. But more at 11 days. In order to make comparisons I calculated the death rate 10 days after confirmation.

In this case, the most favorable evolution is the United States of America.

If we consider air pollution, according to [8] then the most polluted is the United Kingdom followed by Italy and Spain which have similar and much lower values.

Table 3. Death rate after 9 and 10 days – United Kingdom.

Criterion number
(x)

Date of confirmed cases

Date of death
after 9 days

Date of death
after 10 days

Death rate after 9 days%
(y)  

Death rate after 10 days %
(y) 

1

11.03.

20.03.

21.03.

38.6058

47.4530

2

13.03.

22.03.

23.03.

39.4915

47.6271

3

15.03.

24.03.

25.03.

29.3859

37.0175

4

17.03.

26.03.

27.03.

30.0064

37.4594

5

19.03.

28.03.

29.03.

28.8593

38.7452

6

21.03.

30.03.

31.03.

30.8310

35.3502

7

23.03.

1.04.

2.04.

31.4798

44.5539

8

25.03.

3.04.

4.04.

36.1644

44.6329

9

27.03.

5.04.

6.04.

36.9960

42.3228

10

29.03.

7.04.

8.04.

31.4412

36.0407

11

31.03.

9.04.

10.04.

32.0536

36.0326

12

2.04.

11.04.

12.04.

30.3928

33.5041

IDT-1-1-102-g003

Figure 3. Cases and deaths on 11 / 20.03.2020 United_Kingdom.
a). The deaths from 20.03.2020 correspond to the cases from 11.03.2020.
b). The deaths from 21.03.2020 correspond to the cases from 11.03.2020.

Table 4. Death rate after 9 and 10 days – United States of America.

Criterion number
(x)

Date of confirmed cases

Date of death
after 9 days

Date of death
after 10 days

Death rate after 9 days %
(y)  

Death rate after 10 days %
(y) 

1

11.03.

20.03.

21.03.

14.6341

25.3658

2

13.03.

22.03.

23.03.

20.4449

28.3223

3

15.03.

24.03.

25.03.

19.9932

27.1433

4

17.03.

26.03.

27.03.

22.5273

27.8051

5

19.03.

28.03.

29.03.

18.1306

23.2713

6

21.03.

30.03.

31.03.

12.7853

16.1536

7

23.03.

1.04.

2.04.

11.5860

14.5941

8

25.03.

3.04.

4.04.

10.9594

12.9583

9

27.03.

5.04.

6.04.

9.8859

11.2186

10

29.03.

7.04.

8.04.

8.8148

10.3437

11

31.03.

9.04.

10.04.

9.0007

10.1385

12

2.04.

11.04.

12.04.

8.6641

9.5090

IDT-1-1-102-g004

Figure 4. Cases and deaths on 11 / 20.03.2020 – United States of America.
a). The deaths from 20.03.2020 correspond to the cases from 11.03.2020.
b). The deaths from 21.03.2020 correspond to the cases from 11.03.2020.

Conclusion

We have proposed a possible method of calculating the death rate among the positively confirmed cases.

We have developed different equations, specific for each country, with which we can calculate the death rate. adapt the method for a longer time we will be able to calculate before that time. For example, for cases up to 19.03., for Italy, the death rate was 25.58170% (9136 deaths / 28.03.) practically and theoretically 24.8% (8857 deaths); for cases up to the date of 4.04. the death rate at a minimum after 9 days was 16.6081% (19901 deaths / 13.04.) practically and theoretically 16% (19172 deaths); for the date of 19.04. the death rate will theoretically be 16.49187% and 23686 deaths, ie from 14.04. by including 19.04 there will probably be 3785 deaths. With this equation we can calculate the death rate 3-4 days before and implicitly the number of deaths for the next 4 days. If we adapt the method for a longer period of time we will be able to calculate ahead with that time interval. The method can be used for Italy, Spain and United States of America or other countries.

The advantage of this method is that it is specific to each country. It does not require sophisticated calculations that involve advanced mathematics or special statistical programs. It helps us to have an overview and correlating with the number of tests, comorbidities and the age of the patients the authorities can choose the best treatments.If we consider the particular cases studied in this paper, we can say that: for Italy, there is a greater decrease in the death rate corresponding to the cases 21.03. the medical system was probably helped or was efficient. The death rate is initially higher in Spain, but is lower than in Italy. The evolution for these countries is encouraging, the major problem being the number of cases. Comparison of the corresponding death rate 11.03.for Spain with the corresponding day 13.03. for the United Kingdom there is a big difference, the latter registering a much lower death rate initially, but a later stay.

In this case, the most favorable evolution is in the United States of America.

References

  1. https://www.ecdc.europa.eu/en/cases-2019-ncov-eueea.
  2. Ezekiel JE, Govind Persad JD, Ross Upshur, Beatriz Thome, Michael Parker, et al. (2020) Fair Allocation of Scarce Medical Resources in the Time of Covid-19. The NEW ENGLAND Journal of Medicine. [Crossref]
  3. Pengfei Sun, Xiaosheng Lu, Chao Xu, Wenjuan Sun, Bo Pan (2020) Understanding of COVID‐19 based on current evidence. Journal of Medical Virology. [Crossref]
  4. Dumitraș CA (2020) Warning – Italy mortality of 32.35%. EdituraSfântulNicolae. http://librariascriitorilor.ro/Lectura/Atentie%20Italia%20mortalitate%20%2032,35_/index.html
  5. DumitraşHuţanu CA, Zaharia M, Pintilie O (2013) Quenching of Tryptophan Fluorescence in the Presence of 2, 4-DNP, 2,6-DNP, 2,4-DNA and DNOC and Their Mechanism of Toxicity. Molecules 18: 2266-2280. [Crossref]
  6. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19).
  7. Dumitraş CA (2015) Poluanți majori ai mediului: dinitrofenoli și dinitrofenil eteri, sinteză, caracterizarechimică, activitate biologică, Ed MatrixRom, București.
  8. waqi.info/ro.

CoVid-19 its Impact on Healthcare Workers and the Need for Occupational Healthcare Provision

DOI: 10.31038/IMROJ.2020523

 

The world woke up in November 2019 [1] to the arrival of a new “enemy” in its parade of infectious pathogens, firstly in China and in an ominous fashion, now across the globe – the coronavirus, named CoVid-19 by the WHO [2,3]. A dreaded new pandemic [4] has now announced its presence, swept through the globe with an unimaginable speed [5] and savagely wreaked havocto healthcare systems, financial sectors and lives [6] across the world.It has disrupted life as we knew it before the crisis, to an extent we have never imagined possible. The magnitude of this disaster and its multifaceted ramifications, together with its speed of spread [5] is a new and novel experience in history. Life cannot be the same again.

The healthcare worker (HCW) has now suddenly been thrown into the frontline of this storm again, battling a terrible new foe that has crossed the paradigm between its natural host to man. Many of us are not prepared for this [7]

The health of the HCW is of paramount importance in this war. The sheer lack of systemic support for the HCW is obvious in many countries. In developing countries, a lack of investment in systemic development, in manpower development, resource allocation, professional recognition and support in Occupational Health will now manifest itself and the price is costly in terms of lives. The ravage to the HCW will translate to lives lost for both the patient and the HCW. The economic impact [8] and cost of this will be in millions of lives impacted or lost [9,10].

“More than 4,000 people have died worldwide [9] reaching 7529 as of 17 Mar 2020 [10] and more than 113,000 cases on 10th Mar 2020 (reaching 184,976 as of 17th Mar 2020) [10], have been confirmed in over 110 countries  [10]. But unfortunately, the economic impacts also have dramatic effects on the wellbeing of families and communities. For vulnerable families, lost income due to an outbreak can translate to spikes in poverty, missed meals for children, and reduced access to healthcare far beyond COVID-19. While the spread in the United States and Europe absorbs much of the media coverage, confirmed cases [9] from Bangladesh to Brazil, from Cameroon to Costa Rica, and in many other low- and middle-income countries mean that many of the economic impacts may affect the world’s most vulnerable populations”[8].

The outcry to develop a robust Occupational Health system that provides guidance tohealth at work [11] in particular in the Healthcare system itself, has now escalated to a scream. Where governmental and private healthcare systems did not and will not invest in this area, a desperate stage will arrive when default or demise from the frontline will lead to massive losses in healthcare provision itself for the population in a crisis. The healthcare workforce can be destitute when it goes into war with an unprepared workforce.

We need to galvanise development in this area at a rapid and sadly, crisis mode if this has not been done previously.  In many countries, Occupational Medical services do not exist. Even in many modern healthcare systems, the presence of a doctor who is trained to look after HCWs within the healthcare system is itself lacking. Circumstances now prove that healthcare provision for the HCW is an essential component of healthcare delivery as it is now being tested to its limits.  Our priorities need to reorganise as we realise that to win this battle, the HCW needs to survive the crisis.

The essentials of a viable Occupational Health Service within the healthcare system fundamentally comprise two critical components – a clinical service and an administrative occupational health governance / policy structure. The latter is often neglected but is essential to provide guidance and drives the priorities of the Occupational Health system. Creating the structures and funding these,providing manpower, training and logistic supportarecritical to our survival in a crisis.

One demonstration of thisgap, that has become obvious even to the public,is the need for respiratory protection and personal protective equipment for the healthcare worker. Respirators and masks have become scarce resources. How many of our HCWs knew the fundamental differences between a mask and a respirator before the crisis?

HCWs can become tired and fatigued. Physical and mental exhaustion can take its toll and superheroes will also die.  How about the families and psychological needs of those that toll?  What is the price for heroes fallen in this travesty? HCWs are human and will also need care. We need to act rapidly. We must not forget that we too, are human.  As my young colleague in the frontline opined, “We also want to live”.

References

  1. First Covid-19 case happened in November, China government records show – report. South Morning China Post, 13th Mar 2020.
  2. What’s in a name? Why WHO’s formal name for the new corona virus disease matters- WHO, 11th Feb 2020
  3. A Joint Statement on Tourism and COVID-19 – UNWTO and WHO Call for Responsibility and Coordination. WHO 27th Feb 2020
  4. Cucinotta D, Vanelli M (2020) WHO announces COVID-19 outbreak a pandemic. Acta Biomed 91:157-160. [crossref]
  5. Wu J, Leung K, Leung GM et al. (2020) Now-casting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China- a modelling study. The Lancet 395: 689-697.
  6. Weiss P, Murdoch DR (2020) Clinical course and mortality risk of severe CoVid19. Lancet 395:1014-1015. [crossref]
  7. Chaolin Huang, Yeming Wang, Xingwang Li, Ren L, Zhao Jet al. (2020) Clinical features of patients infected with 2019 novel corona virus in Wuhan, China. Lancet 395: 497-506.[crossref]
  8. The Economic Impact of COVID-19 in Low- and Middle-Income Countries. Evans, Over M. Center for Global Development (CDG), USA.  12th Mar 2020.
  9. Corona virus disease 2019 (COVID-19) Situation Report – 50. WHO 10th Mar 2020
  10. Novel Corona virus (COVID-19) Situation WHO 17th Mar 2020
  11. Guidance on Preparing Workplaces for COVID-19. U.S Department of Labour Occupational Safety and Health Administration OSHA 3990-03 2020.

Minimally invasive proximal cavities restored with a hybrid, flowable and low-shrinking composite: effect of marginal ridge preservation on failure pattern

DOI: 10.31038/JDMR.2020314

Abstract

Objectives: The present study assessed the restorative potential of silorane, flowable or hybrid-based composite resin for the ultraconservative occlusal fossa technique.

Materials and methods: Thirty-two intact human molars received in the proximal ridge a 1x2x4 mm size occlusal cavity leaving the enamel ridge intact. The bur was then tilted at 30° alongside enamel ridge to simulate a typical carious cavity. After enamel etching and application of adhesive system, cavities were filled with three composites and then, a 0.8 mm diameter hole was prepared beneath the proximal contact area to simulate an incipient enamel carious lesion. Restored molars were submitted to mechanical loading. The adhesive interfaces before and after loading were evaluated with SEM. The fracture test was performed on fatigued molars and maximum breaking loads were recorded.

Results: The hybrid and silorane composites showed, after the fatigue test, higher percentages of continuous margins (81±12 and 75±17, respectively) in comparison to flowable material (53±24). Similar fracture resistance was recorded by the three composite types, but significantly lower than the fracture resistance of the non-restored group. Nevertheless, a trend to a ductile behaviour, i.e. better capacity for elastic deformation, was observed in the group restored with the hybrid composite.

Conclusions: Minimally invasive occlusal restorations with marginal ridge preservation and simulated proximal decay can be efficiently restored with hybrid and low shrinking composites. The flowable composite might not be indicated in this cavity type, in view of the marginal degradation observed after the fatigue test.

Clinical relevance: The ultraconservative occlusal fossa restorations realized with hybrid composite or silorane, may be a valid alternative to conventional class II restorations.

Keywords

Occlusal fossa technique, modified class II cavities, interproximal carious lesions, minimal invasive, marginal adaptation, resin composite, marginal ridge preservation.

Introduction

For many years, Black’s idea of extension for prevention [1] has been an important principle in dentistry. In this approach, caries lesions are surgically removed and the restorative margins extended to areas enabling an easy cleaning. But in recent years, this idea has been considered outmoded due to an increased understanding of caries process and the development of restorative adhesive materials. A more conservative concept called ‘minimally invasive dentistry’ has been progressively introduced into the dental profession. In this philosophy, the preservation of natural tooth structure is paramount as no actual restorative material can replace enamel and dentine at a hundred percent.

The conventional class II cavity for the treatment of interproximal caries lesions, even if it is a commonly used restorative procedure, is particularly destructive because of the indirect approach to access the lesion. The marginal ridge removal undermines tooth resistance [2] and there is a high risk of iatrogenic damage to adjacent tooth during preparation [3-5]. In addition, the technical difficulties to correctly shape restorations in the proximal region [6] and the large perimeter of the restoration most likely lead to its long-term failure. To avoid these disadvantages, several attempts were made to restore proximal caries lesions.

Remineralization with fluoride and proximal sealing may be the most conservative ways to treat incipient caries or small proximal lesions in combination with limited demineralization areas in the enamel wall in patients with a rather low caries activity [7]. Thanks to a better understanding of the carious process, it is widely accepted that, in many cases, demineralized enamel lesions without cavitation can be remineralized with fluoride [8]. In respect to proximal sealing, this technique consists of the infiltration of a low-viscosity resin into demineralized enamel to reduce microporosities and improve mechanical support [8]. Nevertheless, both techniques, i.e. fluoride application and proximal sealing, are indicated when caries is confined to enamel.

In cases where caries has involved also dentinal tissue, a restorative approach is necessary and several techniques such as minibox, tunnel and ultraconservative occlusal fossa, are currently available. The minibox or vertical slot technique [9], in which the marginal ridge is removed whilst preserving as much tooth tissue as possible, is a more conservative approach than conventional class II cavity. Another attempt to even more conservative approach is the tunnel technique allowing partial preservation of marginal ridge. Nevertheless, none of the suggested conservative intervention modalities gave satisfactory results, especially when glass-ionomer cement was used as restorative material. One review [10] stated that both efficiency in caries removal and marginal ridge strength were reduced in glass-ionomer tunnel restorations with an annual failure rate of 7-10%. Another study [11] found that glass-ionomer tunnel restoration was more damaging than minimal class II composite restoration as evidenced by the stiffness, load at fracture and proximity of the restoration to the pulp.

Finally an ultraconservative occlusal fossa [9,12] or extended sealing [13] technique was suggested in which dentin caries were removed through a small occlusal cavity while preserving the marginal ridge. Other names such as ‘internal preparation’, ‘partial tunnel’, ‘blind tunnel’ and ‘class I tunnel’ have also been used to describe this technique [9]. These procedures avoid the disadvantages of other techniques described above and can be considered the most conservative alternative to conventional class II approach. While some studies observed more risk of failure, mainly due to fracture of the marginal ridge [7,10,11,14], for tunnel or occlusal fossa restorations compared to those of conventional class II, adhesive restorative materials can often re-establish support for fragile enamel marginal ridge [9,15] especially when the proximal carious lesion is more than 2.5 mm below the crest [16]. Moreover, low-shrinkage composite materials might limit weakening of enamel ridge during restorative work due to the generation of lower contraction stresses during polymerization.

Only a few studies evaluated the occlusal fossa procedure [7,17,18] and none of them had the same approach as the present study since they were in-vivo trials and cavities were restored with glass ionomer material. Findings of these studies were very diverse. In-vivo studies reported failure rates of 0 to 10 per cent per year in 2 to 7 years. The comparison of results between tunnel and occlusal fossa restorations was also contradictory; one study reported higher failure rates of occlusal fossa restorations to those of tunnel restorations [18] and another similar study reported the exact contrary [19] but 5 years after, the same author reported that there was no difference in failure rate between two types of restorations [7]. However, it is interesting to see that in the above mentioned limited in-vivo trial with 20 restorations and a mean final assessment time of 23.3 months, no collapse of the marginal ridge was observed while it was thought to be a common occurrence. This fact gives clinical potential to this technique [17]. Another study concluded that maintaining the residual tooth ‘bridge’ in the form of proximal ridge has the potential to limit tooth deformation [20].

For the occlusal fossa procedure, an alternative material to glass ionomer could be resin composites with different mechanical properties (Table 1). Silorane and flowable composite have similar elastic modulus but develop different contraction forces whilst hybrid composite has a higher elastic modulus with contraction forces within the range of the two other materials. All three materials present a high filler load by weight to ensure mechanical strength of the restorations and could be potentially used for the definitive restoration of proximal incipient carious lesions. And given the fact that there is no available technique to reproduce artificial carious lesions through the enamel, in our study the proximal carious lesions were simulated by a cavity, drilled into the proximal wall, as this was the only way to simulate proximal enamel demineralization. This method might demonstrate if restorative procedures with different resin composites are capable to resist fatigue test and provide sufficient mechanical support to the restored teeth, even in cases in which enamel substance is eliminated beneath proximal contact area of the marginal ridge.

Table 1. Material Properties (information provided by manufacturers)

Material

Elastic modulus [GPa]

Filler load by weight [%]

Contraction force [Kg]

Flowable

10.5

81

4.2

Hybrid

22.0

92

2.4

Silorane

11.7

76

1.4

Therefore, the aim of this study was to assess the restorative potential of a silorane, flowable or hybrid-based composite resin for the ultraconservative occlusal fossa technique. The first null hypothesis was that there would be no difference in marginal adaptation amongst molars restored with different materials, before and after cyclic mechanical loading. The second null hypothesis was that there would be no difference in the marginal ridge fracture resistance amongst different experimental groups (molars restored with different materials).

Materials and methods

Thirty-two caries-free human third molars were used for this study and randomly assigned to four equal experimental groups. Group description and material properties are detailed in Tables 1 and 2.

Table 2. Description of experimental groups and materials used

Batch numbers

Flowable

Flowable composite
(Clearfil Majesty™ Flow; Kuraray Medical Inc., Okayama, Japan)

0304BA

Hybrid

Inhomogeneous micro hybrid composite with pre-polymerized
homologous splinters
(Clearfil Majesty™ Posterior; Kuraray Medical Inc., Okayama, Japan)

0006CA

Silorane

Silorane-based composite
(Filtek™ Silorane; 3M ESPE, Seefeld, Germany)

N391668

Control

Natural teeth without any preparation
(Positive control for the fracture strength test)

Adhesive system

Clearfil SE Bond
(Kuraray Medical Inc., Okayama, Japan)
Silorane System Adhesive – Bond, for Silorane group
(Filtek™ Silorane; 3M ESPE, Seefeld, Germany)

041780
N391668

Each tooth received in the proximal ridge an occlusal cavity of dimension 1x2x4mm (Fig. 1a) prepared with a 0.9 mm diameter and 80 µm diamond-coated cylinder bur (Intensiv SA, Grancia, Switzerland) mounted on a red contra-angle handpiece leaving the whole enamel ridge intact. The bur was then tilted at 30° alongside enamel ridge to simulate a typical carious cavity (Fig. 1b). The marginal edge was bevelled with a 25 µm flame-shaped bur (Intensiv SA, Grancia, Switzerland). The cavities were subsequently sealed with a 2-step self-etching adhesive system (Clearfil SE Bond, Kuraray Medical Inc., Okayama, Japan). A 35 % H3PO4 gel was used as an etching agent for 30 s on enamel only and rinsed off with a generous water spray. After careful drying of the cavities with a gentle air spray, the primer was applied for 20 s with a microbrush and gently air-dried. Then the bond was applied for 20 s, gently air-dried and light-cured (Demi plus, 1100 mW/cm2 to 1330 mW/cm2, Kerr Corporation, Orange, USA) for 20 s. For the silorane group, the bond of silorane system adhesive (SSA) was then applied and light-cured (Demi plus, 1100 mW/cm2 to 1330 mW/cm2, Kerr Corporation, Orange, USA) for 20 s to avoid chemical incompatibility between the layer of SE Bond and silorane composite. There are two main reasons for use of the combination SE Bond and bond of SSA; in order to make the comparison of 3 different types of restorations possible, and because the interface primer-bond of SSA have shown nanoleakage in microtensile tests [21,22]. As a result, few attempts have been made to use the methacrylate adhesive for silorane restorations and acceptable results have been obtained when a hydrophobic resin coating layer, i.e. bond of SSA, was placed on top of the methacrylate adhesive layer [23,24,25]. Thus, this method was applied for the silorane group in this study. The cavities were then filled with the restorative materials (a hybrid, flowable and silorane-based composite) in two subsequent layers, light-cured (Demi plus, 1100 mW/cm2 to 1330 mW/cm2, Kerr Corporation, Orange, USA) for 40 s per layer. Finishing and polishing procedures were performed immediately after light curing with a 40 µm point-ended pear bur (Intensiv SA, Grancia, Switzerland) and composite polishing points (Shofu Dental GmbH, Ratingen, Germany) with slight pressure with intermittent water spray under a 10x magnification. Then, to simulate proximal enamel carious lesion, a 0.8 mm diameter hole was prepared with a round bur (Intensiv SA, Grancia, Switzerland) through the enamel just beneath the proximal contact surface area (Fig. 1c). Restored molars were then maintained for 1 week in a moist atmosphere before mechanical loading.

JDMR-3-1-302-g001

Figure 1. Figures of cavity configuration: (a) occlusal view, (b) proximal view, (c) frontal view. Dimensions are in mm.

All restored molars were submitted to 200’000 cycles of mechanical loading. The mechanical function of the device used in this study closely resembles to the one described by Krejci et al [26] (Figure. 2). The loading force generated by solenoids (Magnet AG, Hausen am Albis, Switzerland) was set at 50 N with a 1.5 Hz frequency, following a one-half sine wave curve. The maximal force was attained at the end of a 2.5 mm total course of the solenoid cores (including the first 1 mm free displacement). The restored molars remained immersed in a saline solution, at room temperature, during the entire test course. The position of the artificial cusps in the test chambers of the mechanical fatigue device was adjusted to maintain a 1 mm distance to the core top, allowing a free initial movement. The artificial cusps contacting the restored molars were made of stainless steel, with hardness similar to natural enamel (Vickers hardnesses: enamel = 320-325; Actinit stainless steel = 315). They were positioned to ensure a perpendicular contact with the restorations.

JDMR-3-1-302-g002

Figure 2. Illustration of the mechanical loading device.

Before and after loading, restored molars were cleaned with toothpaste by using a rotating nylon brush and subsequently thoroughly rinsed in tap water. After careful drying, polyvinylsiloxane impressions (President light body, ColtèneWhaledent, Altstätten, Switzerland) were performed. Gold-sputtered resin replicas (Epofix, Struers, Rodrove, Denmark) were fabricated from these impressions and used for a quantitative analysis of the enamel-restoration adhesive interface, using a Scanning Electron Microscope (XL 20, Philips, Eindhoven, The Netherlands). The evaluation was performed at a standard 200x magnification. In order to standardize the assessment, the following parameters were considered: percentages of continuous margins (%CM) and percentages of non-continuous margins (%NCM) either due to the presence of enamel fractures (%NCM EF) or pure gaps (%NCM PG).

The fracture resistance test was performed by using a universal testing machine (Instron, Model 1114, Instron Corp, High Wycombe, Great Britain) on the previously fatigued restored molars. Each tooth was inserted into a custom-made holding device, and a controlled load was applied using a stainless steel rod vertically to the longitudinal axis of the root. Pressure on the tip was applied at a crosshead speed of 1 mm/min applied on the occlusal surface of the marginal ridge. All restored molars were loaded until fracture and the maximum breaking loads were recorded in Newtons (N).

Statistical analysis

All data was statistically evaluated by using SPSS for Macintosh. Differences in fracture strength % of continuous margins, in % of enamel fractures and in % of pure gaps among the 3 groups were tested with ANOVA and Duncan post-hoc test at a level of confidence of 95 %.

Results

The results of marginal adaptation (mean ± standard deviation of %CM, %NCM EF and %NCM PG), both before and after loading, are presented in Table 3.

Table 3. Percentage of Continuous Margins (%CM), of non CM due to the presence of Enamel Fractures (%NCM EF) and of NCM due to the presence of Pure Gaps (%NCM PG) before loading (BL) and after loading (AL).

Groups

%CM
Mean ± SD

%NCM EF
Mean ± SD

%NCM PG
Mean ± SD

BL

AL

BL

AL

BL

AL

Flowable

95 ± 5a

53 ±24b

0a

3 ± 6a

6 ± 5a

41 ± 20c

Hybrid

85 ± 11b

81 ±12a

10 ± 10b

12 ± 9b

2 ± 3a

1 ± 2a

Silorane

95 ± 5a

75 ±17a

1 ± 3a

4 ± 9a

3 ± 3a

18 ± 10b

Numbers designated by different letters are significantly different and apply to each column

Before loading, the groups restored with flowable and silorane composite performed statistically similar and presented significantly higher %CM than the one restored with the hybrid composite.

After loading, the groups restored with silorane and hybrid composite attained statistically similar %CM and were significantly higher than the one restored with the flowable composite. The flowable group attained the lowest %CM.

When comparing the results between intervals before-after loading, the group restored with flowable showed an important decrease of marginal adaptation. In this group, almost 50% of the margins were opened after loading, whereas hybrid group showed only a little decrease of 4.1%.

In respect to the %NCM, enamel fractures were significantly more present in margins of groups restored with the hybrid composite whereas pure gaps were typically observed in groups restored with the flowable and silorane composite.

Representative micrographs of the different marginal characteristics on each group, i.e. continuous margin, para-marginal enamel fracture and pure gaps are shown in Fig. 3.

JDMR-3-1-302-g003

Figure 3. Representative SEM micrographs of restorations’ enamel-composite interface after loading. The arrows indicate: (a) continuous margin, (b) para-marginal enamel fracture, (c) pure gaps. (E=enamel, S=silorane, P=hybrid composite, F=flowable composite).

The means with standard deviations of fracture resistance test on fatigued restored molars, as well as the minimum and maximum forces registered during the fracture test are presented in Table 4. No significant differences in fracture strength were detected between the three restored groups. A significantly higher fracture strength was observed in the non-restored group control, that is, the one in which the marginal ridge was intact.

Table 4. Results of fracture resistance. Mean and SD expressed in Newtons. Minimum and maximum loading forces registered for each group

Groups

Mean ± SD

Minimum

Maximum

Flowable

324 ± 70b

211

402

Hybrid

296 ± 89b

169

398

Silorane

251 ± 93b

76

362

Control (non-restored tooth)

552 ± 111a

358

706

Levels designated by different letters are significantly different and apply to each column

The typical stress-strain curves for brittle and elastic materials [27] were used for comparison with each group during the fracture test, figure 4 (a to d) for the flowable, silorane, hybrid and control group, respectively. It was interesting to see that although no significant differences in fracture strength were observed among the three materials, the shape of the stress-strain curve was specific for each group. The profile of the stress-strain curves in the flowable group (Fig. 4a) evidenced a material poorly ductile (represented by a short length of the horizontal line within the curve which shows that the material can be extended but does not show plastic deformation). A similar behavior was observed in the silorane group (Fig. 4b). Conversely, the curves of the hybrid composite (Fig. 4c) evidenced a slightly more elastic behavior (represented by a long horizontal line within the curve which shows the plastic deformation of the material) before fracturing. Finally, the curve profile of the control group (Fig. 4d) were typical of a stiff material (represented by a steep gradient of the curve) like enamel.

JDMR-3-1-302-g004

Figure 4. Stress-strain curves of the 4 groups.

Discussion

This study was designed to understand how different categories of composite materials, when used in the ultraconservative occlusal fossa cavity, influence the mechanical behavior of these restorations. Its main purpose was to assess which type of material may be most suitable for the minimally invasive restorations of proximal caries. For this purpose, the study design included three materials with different mechanical properties, which would explain the diversity obtained in our results (Table 1). In addition, cavities with a high C-factor were prepared to enable the behavioral comparison of three different materials in extremely difficult conditions concerning contraction stresses. The marginal ridge fracture strength was an important evaluation criteria, especially in comparison with the control group, as it was pointed out to be the main failure cause in occlusal fossa restorations. Nonetheless, the secondary decay and cavitation in enamel were revealed as other principal failure origin in clinical trials [7], therefore the assessment of marginal adaptation before and after mechanical loading was performed as well. The carious lesions were simulated by a cavity which was drilled into the proximal wall. We found that this was the only way to simulate proximal enamel demineralization, given the fact that there is no available technique to reproduce artificial carious lesions through the enamel; a recent study showed that the deepest subsurface lesion produced had a mean depth of 86 micrometer [28].

Marginal adaptation

As statistically significant differences of marginal adaptation rate could be demonstrated between groups, before and after mechanical loading, the first null hypothesis could be rejected. These findings can be explained by differences in the modulus of elasticity (E) and polymerization contraction between materials.

During polymerization, the resin composite contracts and generates stresses at the adhesive interface. These stresses are accompanied by undesirable consequences, such as deformation of the tooth’s cusps, gap formation, and/or para-marginal enamel fractures [29,30]. A stiff restorative material induces more tooth deformation and increases pre-loading stress following polymerization contraction [31,32], which can lead to an immediate margin failure, as it was the case in the hybrid group.

The polymerization contraction undergoes two phases: the phase before and the phase after the gel point. During the first phase, the resin retains its capacity to flow, and therefore, it compensates the contraction forces by rearrangement of the molecules by preventing strain that would otherwise develop at the interfaces [33]. When the gel point is reached, stress is transmitted from the composite toward surrounding bonded structure; the contraction must be compensated by strain of the composite, tooth or adhesive [27]. If the stress surpass the low tensile strength of enamel (10 MPa) [34], para-marginal enamel fracture appears. For reference, the average bond strength is 15-40 MPa [35].

On the contrary, a low-elastic modulus composite, thanks to its elasticity, induces less tooth deformation, thus less pre-loading stress. Reduced E-modulus leads to reduced gap formation [36]. That is why good marginal adaptation could be observed in flowable and silorane groups before loading. Moreover, flowable composites are considered to wet the cavity better than restorative composites due to their flowability, to have thus a better adaptation to the dental surface [37]. And compared to the commercial methacrylate-based composite, the time of gelation of silorane is found to be significantly longer [38]; it decreases the contraction stress and consequently better interfacial integrity scores could be expected [39,40].

As already mentioned, the hybrid composite used in our trial was a stiff material. A higher filler load would lead to an increase in stiffness [41] and generally, it may reduce the overall contraction of composites due to less molecules available for the polymerization reaction [42]. This means, in the contrary, an elastic material like flowable composite would suffer more from polymerization contraction, leading to pre-stressed obturations which allows for more marginal failure under occlusal load [36,43,44]. Moreover, the displacement of cusp under load is inversely proportional to composites’ rigidity [45]. It is in accordance with the results of our trial, where the hybrid group showed better behavior after loading than the flowable group which presented a drastic change. And it should be noted that the silorane group, after loading, had better behavior than the flowable group despite their similar elasticity. Low polymerization contraction of silorane could lead to less pre-stressed obturations than flowable material.

Overall, material chemico-mechanical properties (such as filler/matrix and consequently the material’s elasticity/rigidity and viscosity) proved to influence the marginal adaptation before and after loading, probably because it has impacts on tooth deformation and stress development. And satisfactory initial marginal adaptation didn’t necessarily predict an optimal functional behavior, as shown by the results of flowable group which showed a sufficiently high score in marginal adaptation before loading but incurred a drastic reduction in marginal adaptation after loading. These results are in agreement with a recent review [46]. Elasticity and polymerization contraction have two opposite effects. The benefits of the elasticity of the flowable composite are probably surpassed by its contraction [33]. And at the use of hybrid composite, a certain degree of initial stress should be accepted in order to guarantee sufficient rigidity to the restoration, particularly since para-marginal enamel fractures could present less serious consequences for the longevity of the restorations than pure gaps [32]. According to the literature, there is a general agreement on the fact that a high E-modulus composite (15-20 GPa) would minimize marginal deterioration of restorations under loading and therefore perform well clinically [36,47,48].

Fracture resistance of marginal ridge

The second null hypothesis could be accepted hence no significant differences in fracture strength were noticed within the restored groups, with exception for the group control; it appeared that the marginal ridge strength of restored teeth were significantly reduced in comparison to those of intact teeth. It is difficult to compare these findings with other studies as the experimental set-up in terms of method and materials used are diverse. But considering this fact, abovementioned results are in accordance with Purk’s findings [49] but diverge from other studies where they found no difference in strength of the tunnel prepared and restored teeth and that of sound teeth [8,50-52]. Another author found that a conservative tunnel restoration situated 2 mm from the marginal ridge, does not significantly weaken an otherwise intact tooth [50]. And other researches showed that tooth with tunnel preparation could be reinforced when restored with composite resin, compared to cavity prepared but non restored or cermet restored tooth [49,50].

Given that average masticatory force on a single tooth is 39-146 N depending on the type of food [53-55] and the forces exerted in normal chewing on the occlusal surface seldom exceed 45-60 N [56], mean fracture strength values obtained in all three restored groups showed sufficient reinforcement of resistance to normal masticatory function. Additionally, a study demonstrated that strains in the vicinity of marginal ridges are lower than near the cement-enamel junction, hence the marginal ridges are not highly stressed areas during simulated occlusal loading [57]. The high SD could be explained by the use of non-homogeneous samples, which were natural human teeth. Although each tooth was carefully examined prior to restoration in order to detect enamel fracture lines near to the proximal ridges, variations in tooth morphology like enamel fracture lines might have influenced the results to some extent. Enamel cracks are a regular occurrence in mature human enamel and an experimental study confirmed the importance of margin cracks as a potential source of tooth failure [58].

Despite laboratory testing set-up, investigated samples and experiment protocols could influence the results, in-vitro models allow to test in a controlled way hypotheses that would be unviable to test in-vivo [32]. But these results have to be interpreted with caution due to an extreme cavity design as a “hole” was made in the proximal enamel to simulate demineralization. Possibly, enamel and dentin removal was more pronounced in respect to a real demineralization lesion, and this could have adversely affected the results. This may explain why fracture strength of all restored groups was significantly lower than the non-restored control group. Nevertheless, this “worst case scenario” served to demonstrate that even in cases in which tooth substance is removed below the marginal ridge, restorative procedures with composite are able to provide sufficient reinforcement of restored teeth to normal masticatory function and withstand fatigue test. For example, the hybrid composite used in this study delivered a %CM above 80% after loading, which is considered a sufficiently high score. Additionally, it should be emphasized that marginal integrity and resistance of enamel ridge are not the only parameters implicated in clinical success. Other factors such as retention, marginal and surface discoloration, anatomic form, para-functional forces and secondary caries may influence, clinically, the long-term behavior of this type of restorations. In this sense, future studies should evaluate these parameters on other composite materials than the ones used in this study, to determine if this restorative technique can be validated for clinical use.

Conclusion

Under the conditions of the present in-vitro study, the ultraconservative occlusal fossa technique may be a valid alternative to conventional class II restorations if used after a careful case selection. The first null hypothesis could be rejected; the hybrid composite and silorane material provided the highest percentages of continuous margin after fatigue test. The flowable material produced marginal failures under load, probably due to a lower elastic modulus and a higher contraction force in respect to the other materials. The second null hypothesis could be accepted; while no statistically significant differences in fracture strength were found amongst groups except for control, the hybrid group showed a trend to a slightly more ductile behavior i.e. better capacity for elastic deformation.

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Errors in Diagnosing Types of Diabetes in Young Adult Patients – Constantly Valid Topic

DOI: 10.31038/EDMJ.2020421

Abstract

The correct differentiation of diabetes types is still a problem. This is especially true for groups of young adult patients between 20 and 55 years old. In this group of patients Type 2 diabetes is still routinely diagnosed, without a thorough analysis of the patient’s history, phenotype, as well as disregarding the need to perform all necessary laboratory tests. Such diagnostic irregularities lead to taking wrong therapeutic decisions. As far as the patient’s history is concerned, attention should be paid to the incidence or non-incidence of a positive history of diabetes in the patient’s family. In the autoimmune diabetes such incidence usually does not occur. In Type 2 diabetes it is usually high, whereas most often it occurs on the patient’s mother’s and well as father’s side. A feature that is usually very characteristic is high incidence on one side of the family, typical for monogenic diabetes. A very important indicator is the occurrence or non-occurrence of obesity. Clear obesity suggests the diagnosis of Type 2 diabetes, whereas in patients without obesity LADA or MODY diabetes needs to be taken into account. Conclusive in this respect are the results of tests checking the levels of C-peptide and the titre of autoantibodies, predominantly of a/GAD. When MODY diabetes is suspected, it is necessary to run genetic tests. It is extremely important to undertake efforts aiming at a correct diagnosis of the etiological cause of diabetes, i.e. determining whether we deal with the autoimmunization process, insulin resistance, or with a genetic defect, as it influences therapeutic decisions. In the presence of the autoimmunization process, it is recommended to provide the insulin therapy at an early stage. In patients with clearly marked insulin resistance an early onset of the insulin therapy should be avoided. The first choice drugs in this condition are metformin, incretin drugs, as well as drugs from the group of SGLT-2 inhibitors. In monogenic diabetes therapeutic decisions depend on the type of the genetic defect.

Keywords

diabetes, C peptide, anti-GAD antibodies, LADA diabetes, type 2 diabetes, MODY diabetes

Introduction

Differentiation of Types of diabetes has a long and still uncompleted history. After an era of regarding diabetes as a homogeneous disease, 1907 brought its differentiation into an acute and a chronic form. Over subsequent years criteria applied to the differentiation of diabetes were changing. The division in force at the moment dates back to 1999 and it differentiates four types of diabetes, that is Type 1 diabetes, Type 2 diabetes, other specific types of diabetes, and gestational diabetes mellitus.

The introduction of immunological and genetic tests broadened the possibilities of diagnosing mechanisms of glucose metabolism disorders. This is responsible for the fact that the breakdown of types of diabetes adopted so far has been becoming less and less legitimate. Still, it is a breakdown in force today [1]. Nevertheless, over subsequent years we should expect a revision of this classification [2- 5]. In the everyday practice, when the diagnosis of diabetes is based on the clinical picture and basic laboratory tests, the determination of the type of diabetes is often erroneous [6]. According to many authors, after some time in numerous cases it is necessary to verify the initially determined type of diabetes. It refers particularly to young adults. Correct diagnostics taking into account etiological indicators allows for a more precise determination of the type of diabetes, and consequently also the selection of the correct therapy [7]. Individual types of diabetes are triggered by different mechanisms leading to these disorders. The knowledge of these mechanisms leads to therapeutic decisions. Naturally, one should take into account that performing state-of-the-art diagnostics entails an increase of costs of the diagnostic process. There are, however, many elements which may be used in the initial diagnostics without any significant cost increase.

Medical History

This stage covers an assessment of the following elements:

− Dynamics of the development of symptoms of the disease,

− Occurrence or non-occurrence of obesity,

− The patient’s age,

− Positive history of diabetes in the patient’s family,

− Observation of insulin demand.

Rapid accumulation of clinical symptoms is suggestive of autoimmunological diabetes. This refers predominantly to adolescent patients with the ‘classical’ Type 1 diabetes. This process develops a bit more slowly in LADA diabetes, where the course of the process of autoimmune destruction of the β cells is fluctuate.

The occurrence or non-occurrence of obesity could be a certain indicator in the process of differentiating the types of diabetes. In Type 1 diabetes, LADA diabetes, and MODY diabetes, overweight is usually not present as of the moment of its diagnosis.

The occurrence of overweight, especially significant obesity, is characteristic for Type 2 diabetes. A diversified picture may refer to the group of secondary diabetes.

The age at which diabetes reveals itself may constitute a certain, although not final, indicator. Early manifestation of diabetes may refer to the ‘classical’ Type 1 diabetes, monogenic diabetes, as well as certain forms of secondary diabetes. In our latitude, rarely do we deal with Type 2 diabetes in young patients.

A positive family history of diabetes is very characteristic for monogenic diabetes, whereas in such cases it is principally on one side only. A positive family history on both sides is frequent in Type 2 diabetes. In autoimmune diabetes (Type 1 and LADA) such a family history is relatively rare.

The insulin demand can also constitute a certain indicator suggestive of the level of destruction of the β cells and insulin resistance.

Laboratory Diagnostics

In the laboratory tests, besides the routine monitoring of glycaemia, the content of sugar and acetone in urine and the level of glycated hemoglobin HbA1c, the possibility of determining the level of c-peptide is essential. The concentration of C-peptide in serum is used in the diagnostics of the efficiency of pancreatic islets in terms of insulin production [8-12]. Serum C-peptide concentration illustrates the function of β cells and is useful in differentiating types of diabetes [13, 14]. In the Type 1 diabetes, the concentration of C-peptide gets rapidly reduced and it is usually clearly lowered as of the clinical manifestation of diabetes. A different picture is presented by the level of C-peptide in the latent autoimmune diabetes of adults (LADA). Here the initial level of C-peptide as of the moment of the diagnosis is usually lowered, but it can be normal; the glucagon test, however, demonstrates the lack of the physiological increase of this level [15-17]. In Type 2 diabetes the level of C-peptide is usually elevated, especially in the early period. It is connected with the usually significant insulin resistance that accompanies this form of diabetes [18]. The level of C-peptide in this form of diabetes can get reduced in later stages of the disease, when the secondary insufficiency of the β cells occurs. In other forms of diabetes the level of C-peptide may be different. It depends on mechanisms that lead to the disease development. In monogenic diabetes the level of C-peptide is correct [19-21]. The determination of autoantibody titers is another very important indicator in the differentiation of diabetes types. Often precise differentiation of the form of diabetes requires immunological tests. At this stage these tests should be recognised as a routine in most cases [22- 25]. Antibodies against the antigens of pancreatic islets are connected with the development of autoimmune diabetes. This category covers the ‘classical’ Type 1 diabetes, but also the slowly developing latent autoimmune diabetes in adults (LADA) [26, 27]. The diagnostic sensitivity of GADA and IA-2 depends on the subjects’ age – at the same level of specificity. In patients aged below 40 the determination of the GADA antibodies is more useful, and in older patients – the determination of the IA-2 antibodies is more beneficial. Confirmation of a high titre of autoantibodies against the structures of pancreatic islets decides about diagnosing diabetes with autoimmune etiology (Type 1 diabetes, LADA). In Type 2 diabetes an elevated titre of antibodies is sometimes detected, as well; nevertheless, it is usually much lower than in diabetes with autoimmune aetiology and it usually soon disappears. Recently, many authors pay attention to the diverse picture of LADA diabetes. This applies to both the clinical picture and treatment options [28, 29]. One of the ideas is to link this diversity with the patient’s age at the time of LADA diabetes [30]. The assessment of the presence of autoantibodies is also useful in the differentiation of autoimmune diabetes and Type 2 diabetes in the elderly [31]. Studies in a group of 1,114 patients with LADA diabetes have shown that the type of autoantibodies is important. Presence of N-terminally truncated GAD65 autoantibodies is associated with the need for early implementation of insulin therapy [32]. In MODY diabetes the absence of the antibodies is recognised as a principle. It is established, however, that the presence of the antibodies in the group of monogenic diabetes may result from the presence of genetic defect of the β cell, as well [33]. Sometimes the final diagnosis requires that genetic tests are run. If the presence of the autoantibodies is not detected in young patients with mild course of diabetes, the suspicion of monogenic diabetes becomes very likely. Most frequently diagnostic errors concern young adult patients.

Case Studies

Several cases are presented to illustrate the diagnostic dilemmas.

1. A 25-year-old female patient, without obesity, with a negative family history of diabetes. In the patient history there was a persistent inflammation in the urethral fossa, vagina, and vulva, treated with no success. Due to deterioration of her health condition, increased thirst, and increased diuresis, the patient was admitted to hospital. At admission, the level of glucose in the blood serum was 425 mg/ dl (23.47 mmol/l), pH 7.4, creatinine 60 μmol/l. After administering insulin the level of glucose in blood was reduced to 225 mg/dl (12.74 mmol/l). The insulin treatment was ceased, metformin was started 3 x 500 mg. The level of C-peptide was determined to be 0.87 mg/l. The patient was discharged home on the fourth day of observation with a recommendation of a follow-up visit in the Primary Care Outpatient Clinic. The type of diabetes was not determined. Recommendations included a diet and metformin therapy. During the first days after the discharge, with a strict diet and the prescribed doses of metformin, the glucose levels in self-management oscillated within the range of 127- 192 mg/dl (7.05 – 10.7 mmol). The patient was referred to diabetes consultation. Due to the suspicion of the diagnosis of LADA diabetes, the autoantibodies tests was recommended, in which a very high titre of a/GAD was detected: 1080 IU/ml. This confirmed the diagnosis of LADA diabetes. Lantus insulin in 4 units was prescribed and selfcontrol was recommended.

2. A 36-year-old male patient, without obesity. At the age of 31 the patient was diagnosed with Type 2 diabetes, treated with insulin of short effect, and then with sulfonylurea derivatives. After 5 years after the diagnosis there was a deterioration of the general health condition, the patient was referred to diabetic consultation. Due to the suspicion of the diagnosis of LADA diabetes, intensive insulin therapy was administered. The level of C-peptide was 1.26 ng/ml; a/GAD > 2000 IU/ml, HbA1c 11.5%. Ophthalmological consultation revealed the occurrence of retinopathy. The suspicion of the diagnosis of LADA diabetes was confirmed.

3. A 28-year-old patient, with normal body weight. At the age of 25 he was diagnosed with Type 2 diabetes and a metformin preparation was prescribed. After 3 years, due to the deterioration of the general health condition, the patient was referred to diabetes consultation. During the consultation the level of HbA1c was 11.31%. On the basis of the clinical picture, LADA diabetes was diagnosed. Intensive insulin therapy was started. The results of the remaining tests confirmed the diagnosis: C-peptide 0.78 ng/ml; a/GAD 140 IU/ ml.

4. A 42-year-old male patient, without obesity. At the age of 39 he was diagnosed with Type 2 diabetes. Concentration of glucose in blood was 400 mg/dl; HbA1c 9.3%. Insulin therapy was started. After reaching improvement in the test results, the insulin therapy was stopped and metformin and a sulfonylurea derivative was prescribed. After a year pharmacotherapy was stopped. 3 years after the diagnosis, due to the deterioration of his general health condition the patient was referred to diabetes consultation. Due to the suspicion of LADA diabetes, insulin and diet therapy was started. The tests performed confirmed the diagnosis of LADA diabetes. Level of C-peptide 0.69 ng/ml; a/GAD >2000IU/ml.

5. A 37-year-old female patient with diabetes diagnosed as Type 2 diabetes, for three years treated with insulin mixtures. The patient chronically unbalanced HbA1c 84%. During the diabetes consultation a revision of the diagnosis was performed. The tests performed detected a low level of C-peptide 0.1 ng/ml; a high titre of the autoantibodies a/GAD 1251.94 IU/ML, which enabled to diagnose autoimmune LADA diabetes. A high titre of a/TPO 339.1 IU/ml and an elevated titre of parietal cell antibodies. Intense insulin therapy was prescribed, with the administration of analogue insulins.

Discussion

In research carried out over recent years it was demonstrated that 5-10% of diabetes diagnosed after the age of 35 as Type 2 diabetes is in fact LADA diabetes [2, 34, 35]. Analysis of cases qualified as LADA diabetes confirms the need to perform a thorough analysis of glucose homeostasis disorders in patients aged 25-55, especially in patients without obesity and without a positive family history of diabetes [36-38]. A factor that is decisive for the differentiation process is the assessment of the titre of antibodies. An early correct diagnosis of LADA diabetes and starting insulin therapy is extremely important due to the improvement of the metabolic control, as well as due to the fact that there is much evidence that apart from the substitution activity, insulin has also immunomodulating activity, influencing the inhibition of the process of destruction of pancreatic islets [39- 42]. The use of sulfonylurea derivatives in such patients is very disadvantageous, and it often results from a wrong diagnosis. In this age group it must be borne in mind that there can also occur monogenic forms of diabetes, predominantly MODY diabetes [43- 47]. Monogenic forms of diabetes are mainly associated with juvenile patients. Nevertheless, one needs to bear in mind that MODY diabetes can manifest itself in adults, in families where such a diagnosis has never been given before. Genetic tests are crucial in diagnosing MODY diabetes [48, 49]. However, it may also be useful to analyze other markers, including C-peptide levels, compared to clinical picture analysis [50, 51]. Type 2 diabetes is the form of diabetes that is still most often routinely diagnosed in adults, especially when the course of the disease is relatively mild [52]. The most common form is MODY2, which is a result of a mutation of the glucokinase gene, and MODY3 occurring due to a mutation in the HNF-1α gene, which is a transcription factor subjected to expression in pancreas, liver, and kidneys [53]. A rare form of diabetes is MODY5, related to a mutation in the HNF1B gene [54-56]. This issue has been discussed in earlier publications. They present cases where MODY diabetes was diagnosed [57, 58]. From amongst the four patients presented therein, in two patients the MODY3 type diabetes was diagnosed, MODY2 diabetes was diagnosed in one female patient, and in one male patient a rare form of MODY5 was detected. This publication also presents results of a discussion devoted to recommendations for genetic diagnostics in these syndromes.

Summary

To conclude, it should be once again emphasized how important the correctness of diagnosis of the diabetes pathogenesis is. This is decisive for the administered therapy. The most errors in the correct diagnosis pertain to the group of young adult patients. These errors result from the assessment of the patient’s history and phenotype that is not thorough enough. A serious source of mistakes is neglecting the test of the level of C-peptide, as well as of the titre of anti-pancreatic antibodies, predominantly GAD. It should be remembered that in this age group all types of diabetes can occur. A wrong diagnosis of Type 2 diabetes in cases of diabetes with the autoimmune etiology is particularly frequent. However, it should be also borne in mind that it is possible that monogenic diabetes will manifest itself, too. First secondary diabetes must be always ruled out.

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  32. Achenbach P, Hawa MI, Krause S6, Lampasona V,Jerram ST, Williams AJK et al. (2018) Action LADA consortium. Autoantibodies to N-terminally truncated GAD improve clinical phenotyping of individuals with adult-onset diabetes: Action LADA 12.  Diabetologia.61(7):1644-1649.
  33. McDonald TJ, Colclough K, Brown R, Shields B, Shepherd M, Bingley P, et al. (2011) Islet autoantibodies can discriminate maturity-onset diabetes of the young (MODY) from Type 1 diabetes.  Diabet Med.28:1028-1033.
  34. Carlsson S (2019) Etiology and Pathogenesis of Latent Autoimmune Diabetes in Adults (LADA) Compared to Type 2 Diabetes. Front Physiol.10:320.
  35. Naik R G, Brooks-Worrell B M, Palmer J P (2009) Latent autoimmune diabetes in adults.  J. Clin. Endocrinol.Metab.94: 4635–4644.
  36. Chwalba A, Otto-Buczkowska E (2015) Type LADA diabetes – still even diagnostic problem in general practice. Med. Metabol. 19:34-40 [ISSN 1428-1430].
  37. Grill V, Åsvold BO (2019) A form of Autoimmune Diabetes in Adults Named LADA – An Update on Essential Features and Controversies. Curr Diabetes Rev.15 (3):172-173.
  38. Otto-Buczkowska E, Marciniak-Brzezińska M (2013) Type LADA diabetes – what does his mean? Med. Rodz. 16:23-26 [ISSN 1505-3768].
  39. Cernea S, Buzetti R, Pozzilli P (2009) Beta-cell protection and therapy for latent autoimmune diabetes in adults. Diabetes Care.32 Suppl 2:S246-52.
  40. Liu B, Xiang Y, Liu Z, Zhou Z (2020) Past, present and future of latent autoimmune diabetes in adults. DiabetesMetab Res Rev.36(1):e3205.
  41. Pieralice S, Pozzilli P (2018) Latent Autoimmune Diabetes in Adults: A Review on Clinical Implications and Management. Diabetes Metab J. Dec42(6):451-464.
  42. Poudel R R (2012) Latent autoimmune diabetes of adults: From oral hypoglycemic agents to early insulin. Indian J. Endocrinol.Metab.16 (supl. 1): S41–S46.
  43. Borowiec M, Fendler W, Antosik K,  Ciepiela A, Baranowska A, Hogendorf A.  et al. (2010) Optimization of monogenic diabetes screening programme–initial report on recruitment efficacy of the TEAM project. PediatrEndocrinol Diabetes Metab.16:73-76.
  44. Fendler W, Małachowska B, Baranowska-Jazwiecka A, Borowiec M, Wyka K, Malecki MT. et al. (2014) PolPeDiab Study Group. Population-based estimates for double diabetes amongst people with glucokinase monogenic diabetes, GCK-MODY.Diabet Med.31:881-883.
  45. Gaál Z, Balogh I (2019) Monogenic Forms of Diabetes Mellitus.Exp Suppl.111:385-416.
  46. Małachowska B, Borowiec M, Antosik K, Michalak A, Baranowska-Jaźwiecka A, Deja G. et al. (2018) Monogenic diabetes prevalence among Polish children-Summary of 11 years-long nationwide genetic screening program. Pediatr Diabetes.19(1):53-58.
  47. Schwitzgebel VM (2014) Many faces of monogenic diabetes.J Diabetes Investig.5: 121-133.
  48. Wang X, Wang T, Yu M, Zhang H, Ping F, Zhang Q.  et al. (2019) Screening of HNF1A and HNF4A mutation and clinical phenotype analysis in a large cohort of Chinese patients with maturity-onset diabetes of the young.  ActaDiabetol.56(3):281-288.
  49. Wędrychowicz A, Tobór E, Wilk M, Ziółkowska-Ledwith E, Rams A, Wzorek K. et al. (2017) Phenotype Heterogeneity in Glucokinase-Maturity-Onset Diabetes of the Young (GCK-MODY) Patients. J Clin Res PediatrEndocrinol.9(3):246-252.
  50. Fu J, Wang T, Liu J, Wang X, Zhang Q, Li M, Xiao X (2019) Using Clinical Indices to Distinguish MODY2 (GCK Mutation) and MODY3 (HNF1A Mutation) from Type 1 Diabetes in a Young Chinese Population. Diabetes Ther.Aug 10(4):1381-1390.
  51. Szopa M, Klupa T, Kapusta M, Matejko B, Ucieklak D, Glodzik W. et al. (2019) A decision algorithm to identify patients with high probability of monogenic diabetes due to HNF1A mutations. Endocrine.64(1):75-81.
  52. Biesecker LG (2018) Genomic screening for monogenic forms of diabetes.BMC Med.16(1):25.
  53. Pinés Corrales PJ, López Garrido MP, Louhibi Rubio L, Aznar Rodríguez S, López Jiménez LM, Lamas Oliveira C.  et al. (2011) Importance of clinical variables in the diagnosis of MODY2 and MODY3. EndocrinolNutr. 58:341-346.
  54. Clissold RL, Hamilton AJ, Hattersley AT, Ellard S, Bingham C (2015) HNF1B-associated renal and extra-renal disease-an expanding clinical spectrum.  Nat Rev Nephrol.11:102-112.
  55. Musetti C, Quaglia M, Mellone S, Pagani A, Fusco I, Monzani A. et al. (2014) Chronic renal failure of unknown origin is caused by HNF1B mutations in 9% of adult patients: a single centre cohort analysis.  Nephrology (Carlton).19:202-209.
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  57. Otto-Buczkowska E, Marciniak-Brzezińska M (2015) Mody (maturity onset diabetes of the young) should be also considered in adult persons, casual presentation. Med Metabol 19:25-28 [ISSN 1428-1430].
  58. Otto-Buczkowska E, Stańczyk J (2015) About MODY (Maturity onset diabetes of the young) one should also think in adults patients – Complementary causal description (II). Med. Metabol 19:41-43 [ISSN 1428-1430].

Global Approach to Neuroendocrine Tumors Neoplasms

DOI: 10.31038/MIP.2020122

Introduction

The incidence of neuroendocrine tumors (TNE) is about 2.5-5 new cases per 100,000 inhabitants annually. They can appear in any location and 15% are diagnosed in the small bowel. TNEs can be functional with diarrhea, hot flashes, weight loss … or not functionaries, that usually debut unspecifically with nausea, abdominal pain, anorexia intestinal obstruction and bleeding. This case reflects the evolution, monitoring and management of an intestinal TNE.

History

A 55-year-old male patient without medical illnesses to be highlighted consulted in June 2018 for 3-4 daily episodes of watery diarrhea, dizziness and loss of 5 kilos in the last two months.

Physical Examination

Constants: Blood pressure: 120/75 mmHg, 98% baseline saturation, afebrile.

Laterocervical, submandibular, supra or infraclavicular adenopathies are not palpated.

Pulmonary and cardiac auscultation was normal. The abdomen wasn`t pain and without megalias or masses.

Supplementary Tests

• Analytical with renal function, ions, liver profile and hemograme within normal.

• Basal chromogranin 159.5 ng / Ml (<84.7ng / ml), Urinary 5-hydroxyindoleacetic acid (5-HIAA): 21 μmol / d (0-14 μmol / d)

• Thoracoabdominopelvic CT scan showed a carcinoid tumor located in jejunal loops, liver metastases for all segments (the largest is 26 mm) and is located in the liver segment 4. (Figure 1)

• Somatostatin receptor imaging: Liver metastases and jejunal tumor is confirmed.

• Endoscopy: without injuries.

• Liver biopsy: metastasis of well-differentiated TNE GRADE 1 (WHO 2010). Ki-67 1-2%. The Cells are positive for neuroendocrine markers such as chromogranin, synaptophysin, CD56.

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Figure 1.Somatostatin receptor imaging: liver metastases

Diagnosis

Neuroendocrine tumor well-differentiated ileo-jejunal Grade 1 (Ki-67 1-2%) with metastatic involvement in all liver segments.

Treatment

The patient started treatment with lanreotide autogel 120 mg every 28 days in October 2018 with improvement of the carcinoid syndrome. The primary tumor is intervened in January 2019 (small bowel resection: p T3, N1, LV0, Pn1 R0.) No possibility of liver resection due to extensive tumor involvement without the possibility of leaving enough hepatic remnants.

Evolution

After surgery, the study with serum chromogranin A and 5-HIAA was normal.

The patient continued with somatostatin analogues since January 2019 being completely asymptomatic and with an excellent quality of life. The patient followed clinical controls and radiological images every 6 months.

In November 2019, he went again to the emergency room for asthenia and watery diarrhea (4-5 daily episodes) the week prior to the administration of the analog. Markers were not elevated.

A thoracoabdominopelvic scan showed hepatic tumor progression with growth of all hepatic metastases. No other visceral or adenopathic lesions.

The somatostatin analogue was taken biweekly, so the symptoms disappeared again.

A new somatostatin receptor imaging showed positivity for liver metastases. Chromogranin A markers and 5-HIAA did not rise at any time.

Once the case has been assessed in the TNE committee, it is agreed to start treatment with radionuclides (Lutetium-177) 200 mCi in December 2019 and maintenance of somatostatin analogues (monthly dosage) between Lutetium dose.

The patient to date has received three doses of 177-LUDOTETATE with excellent tolerance, asymptomatic and without any documented adverse effects. At the present time, there is no evidence of disease progression.

Discussion

This case reflects the evolution and management of a jejunal TNE with hepatic metastatic at baseline which was considered unresectable.

In all TNE, the possibility of primary surgery should always be assessed even if there is metastatic disease since up to 30% of these tumors have liver involvement at diagnosis and survival at 5 years after primary resection is greater than 95% [1].

After surgery, it was decided to continue treatment with analogue because it was a stage IV with liver metastases that could not be resected.

The treatment controlled the symptoms during 13 months, according to the CLARINET study [2].

After confirming the progression, systematic treatment with radionuclides (PRRT) is decided. The PRRT consists of the systemic administration of the Ytrio-90 or Lutetium-177 conjugated radionuclides with a somatostatin analogue, through the acid chelating agent 1,4,7,10-tetraazacyclo-dodecane-1,4,7,10-tetraacetic acid (DOTA).

Radionuclide therapy has a phase III trial (NETTER-1) that compared treatment with 177Lu-DOTATATE every 4 weeks vs. LAR high dose octreotide, in patients with bowel TNE unresectable, with positive somatostatin receptors and with progression to analogs in the first line. Progression-free survival was 28.4 months versus 8 months in the control arm. (hazard ratio (HR) 0.21, 95% CI, 0.14-0.33, p <0.0001) [3].

In conclusion, PRRTs is indicated in patients with midgut TNEs well differentiated, metastatic, unresectable, in progression to somatostatin analogues and with positive somatostatin receptors.

References

  1. Chan DL, Moody L, Segelov E, Metz D, Strosberg J, Pavlakis N, et al. (2018) Follow-up for resected gastroenteropancreatic neuroendocrine tumours (GEP-NETs): a practice survey of the Commonwealth Neuroendocrine collaboration (CommNETs) and North American Neuroendocrine Tumor Society (NANETS). Neuroendocrinology107(1):32–41.
  2. Caplin MEPavel MĆwikła JBPhan ATRaderer M, et al. (2014)  Lanreotide in metastatic enteropancreatic neuroendocrine tumors.N Engl J Med371:224-33.
  3. Strosberg J, El-Haddad G, Wolin E, Hendifar A, Yao J, Chasen B, et al. (2017) Phase 3 trial of 177Lu-dotatate for midgut neuroendocrine tumors. N Engl J Med376:125–35

Exosome Extracellular Vesicles: A Vehicle for Simultaneous Immune and Genetic Therapy

DOI: 10.31038/MIP.2020121

Short Review

Exosomes are newly recognized universal minute nanosize particles made by all cells in all species that transfer genetic instructions between cells. They additionally can be made immune specific by antibody coating to achieve dual specific antigen targeting of particular acceptor cells, as well as being vehicles to deliver genetic information as RNAs to alter targeted cell function. Because of exceptional resistance properties, some therapeutic exosomes can be administered orally.

What are exosomes?

Exosomes are minute nano-sized lipid sacs called vesicles that are produced and then secreted by all cell types in all animal species. They are a sensational biologic discovery. As universal nano-particles of life, they are very small, but a big thing since they seem to be involved in nearly all biological and clinical processes. Importantly, these Nanovesicles may lead to new and highly advantageous therapies. Exosomes are the most common subset among a large very diverse group that exists outside of cells called extracellular vesicles. Exosomes are tiny spheres with an average diameter of 100 Nano meters, or about one hundredth the sizes of the producing cells (Figure 1). Production and release of extracellular vesicles, occurs in all animals, plants, fish, fungi and also in the basic single cell forms of life; such as bacteria and even most primitive archaea (Figure 2).

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Figure 1. Scanning electron microscopy of individual exosome that are spheres in their native state but here distorted in processing.

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Figure 2. Staphylococcus aureus outer membrane exosome-like vesicles pinched out from the surface of the bacteria.

The exosome nano world

Therefore, exosomes and other diverse extracellular vesicles from many cell types are present in all body fluids and can be described as a cloud of mixed nano particles between cells (Figure 4). In humans and mice, exosomes in the peripheral blood are about a billion per milliliter compared to white blood cells that are present at ten thousand per milliliter. Among the myriad of extracellular vesicle subsets, exosomes have been show to alter functions in targeted cells. The main and entirely new biologic function of exosomes is their ability to enter other acceptor cells, near or far via the blood stream, in order to transfer the genetic-acting molecules they carry [1-5].

In particular, they transfer micro RNAs (miRNAs) that are small ribonucleotide polymers of only about 22 base pairs (Figure 3). These exosomes carry and transfer extracellular miRNAs can produce modifications of the DNA in the nucleus of the acceptor cells to alter their genetic mediated production of proteins that in turn alters target cell function. In sum, exosomes are a completely unanticipated nano entity that can mediate entirely new biological processes, and alter molecular and metabolic pathways of acceptor cells. As such, they are likely involved in many diseases.

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Figure 3. Cross section of an individual idealized exosome showing surface signature of various adhesion molecules that can include antigen specific antibodies. These respectively can mediate semi-specific binding to comparable receptors on the surface of acceptor cells, or antigen specific targeting of acceptor cells. Inside the exosome are various RNAs, including miRNAs and proteins..

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Figure 4. Intercellular tissue cloud of various extracellular vesicles between the cells, of which some are secreted exosomes.

Clinical consequences

As the dominant mechanism for inter cellular transfer of genetic function, exosomes have great medical importance. They introduce many new possibilities; such as: better understanding of disease mechanisms, new ways for making diagnoses after isolation from blood and body fluids (so called liquid biopsies) and then analyzed molecularly, and as vehicles for new natural nano vesicle therapies. Appropois of this last point they have great advantages over the current numerous problems associated with designing artificial nano therapeutic particles that lack specificity, are unable to cross tissue barriers, and are rapidly eliminated by natural mechanisms that detect their artificiality.

Exosome therapies

Exosomes are a very promising therapy because of their very small size, their ability to cross natural tissue barriers such as those that protect the brain, and when administered into the circulation have prolonged life over days. This is because they are natural nanovesicles that are able to avoid host cells that remove the artificial particles. Compared to cells used for therapy, exosomes have unusual stability; resistance to noxious environments, and long storage ability of biologically active genetic contents. Exosome vesicles are a physiological natural system for delivering genetic and antiinflammatory molecules; thus constituting new treatment modalities for a variety of diseases.

Exosomes can be isolated from healthy individuals and easily enriched for delivery to individuals with a disease. Further, exosomes in some instances can be used across species, or even from plants can be used without concern for immunologic or genetic incompatibility, since the miRNAs are often universal across species. They usually contain no DNA and thus are without danger of transformation to cancers; compared to therapies with cells. New work in a variety of fields indicates that exosomes may be effective therapy for cancers, arthritis, stroke, spinal cord injury, myocardial infarction, lung fibrosis, and other diseases. Also, investigations have begun in autoimmune conditions, such as multiple sclerosis, and in degenerative conditions, such as Alzheimer’s or Parkinson’s diseases, and even in autism.

Exosomes have unusual durability, stability and ability to resist harsh conditions

Unlike cells, exosomes have special membranes composed of unusual proportions of lipid components, resulting in high surface viscosity and rigidity. This enables them to resist harsh conditions that cells cannot survive. These properties of resistance are postulated to be derived from their ancient origins near the beginning of biologic evolution. Some current exosomes are proposed as being related to the “pro cells” from that primordial era that existed before the development of bacteria.

Other unusual related properties of some current day exosomes, that are derived from activated immune cells, include the ability to bind antigen-specific antibody chains on their surface, and further accept added selected miRNAs. Together, these abilities can achieve unprecedented combined immune antigen-specific cell targeting via the surface antibodies binding the acceptor cells, as well as subsequent exosome delivery of particular gene-altering functional miRNAs.

Exosomes in milk survive harsh conditions of gastric digestion

Mothers breast milk is an outstanding example of the strong resistance of exosomes to harsh conditions. Milk is loaded with exosomes carrying diverse and unusual miRNAs, and have strong resistance to the noxious environment in the neonatal stomach. This consists of the combined actions of a variety of digestive enzymes in high acidity. Surviving this noxious gastric environment, the breast milk exosomes can be intestinally absorped by the neonate for subsequent transfer of their miRNAs to potentially regulate a variety of developing systems.

Successful therapy with exosomes; including dual immune and gene specific oral treatment

The unusual property of resistance to stomach degradation can allow oral administration of therapeutic exosomes to patients. These natural nano-vesicles can be constructed to be immune Ag-specific suppressive exosomes by surface sbinding of chosen antibody for specific acceptor cell targeting. Further, these exosomes can be constructed to carry chosen particular inhibitory miRNAs. After intestinal absorption, such exosomes can strongly suppress immune inflammatory antigen-specific T cell allergy responses in the skin of recipients for several days, as demonstrated in Figure 5.

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Figure 5.The figure shows experiments with milk protein (casein) allergy, expressed as swelling in the ear skin of mice following local injection. Systemic treatments with exosomes from suppressor T cells were begun at the 24 hour height of the positive ear swelling response (black line). These immune allergic tissue swelling responses and were strongly inhibited for the subsequent four days by administration of exosomes that were casein antigen-specific via surface antibody chains, and miRNA-150 transferring. They were adminisered by several routes, and were most strongly inhibitory when given orally (PO, red line), compared to the usually employed systemic routes of administration; such as intravenous (IV, orange line), or into the peritoneum (IP, purple line), or subcutaneous at a skin site distant from the ears (intradermal, ID, green line).

The oral route of administration has been superior (black line) compared to the usual intravenous, intraperitoneal and subcutaneous routes. This evidence suggests that oral treatment is a more physiological route of administration, compared to the usual injection routes. To our knowledge, such chosen dual antigen-specific and selected miRNA mediated gene expression altering exosome therapy has not been achieved previously. The prospect of efficacious oral administration would undoubtedly have greater patient acceptance and comfort, especially in children. For example, in treatment of cancers, exosome’s ability to target specific cells and regulate protein synthesis in combination with chemotherapy and radiotherapy, likely will allow their reduced dose which in turn lessens toxicity of these existing therapeutic approaches. (1114 words)

Acknowledgement

The author is grateful for grant support from the NIH, the hard laboratory work of Krzysztof Bryniarski and Katarzyna Nazimek who produced the quoted and presented data. I am particularly indebted to Dr. Irwin Braverman for his thorough review and recommendations.

References

  1. Krzysztof  Bryniarski, WlodzimierzPtak, Emilia  Sikora, KatarzynaNazimek, et al. (2018) Free extracellular  miRNA  functionally targets cells by transfecting exosomes  from  their  companion  cells, PLoS One 10:e0122991.
  2. Bryniarski K, Ptak W, Jayakumar A, Tuschl T, Hafner M, Püllmann K, et al. (2013) Antibody light chain coated antigen-specific exosomes deliver suppressor T cell-derived miRNA-150 to inhibit effector T cells. J Allergy ClinImmunol132:170-81.
  3. Krzysztof  Bryniarski, KatarzynaNazimek, WlodzimierzPtak, Tom Groot Kormelink, and Philip W Askenase (2020)Orally Administered T and B cell Antigen-Specific Suppressor Exosomes Deliver miRNA-150 to Inhibit DTH Via Their Surface Antibody Light Chains Binding Antigen Peptides in MHC on APC Targeted Cells.
  4. Magdalena Wąsik , KatarzynaNazimek , Bernadeta Nowak , Philip W Askenase , and Krzysztof Bryniarski (2019) Delayed-Type Hypersensitivity Underlying Casein Allergy Is Suppressed by Extracellular Vesicles Carrying miRNA-150.Nutrients11:9
  5. Carolina de la Torre Gomez , Renee V Goreham, Joan J Bech Serra, Thomas Nann and Martin Kussmann (2018)“Exosomics”—A Review of Biophysics, Biology and Biochemistry of Exosomes With a Focus on Human Breast Milk.Front Genet 27.
  6. Kamerkar S, LeBleu V, Sugimoto H. et al. (2017) Exosomes facilitate therapeutic targeting of oncogenic KRAS in pancreatic cancer. Nature 546: 498–503.
  7. Jeppesen DK, FenixAM, Franklin JL, et al. (2019) Reassessment of Exosome Composition. Cell177:428–445.e18.
  8. Sukhvinder Gill, Ryan Catchpole and Patrick Forterre (2019) Extracellular membrane vesicles in the three domains of life and beyond.FEMS Microbiology Reviews43: 273–303
  9. Carmen Schwechheimer and Meta J Kuehn (2015) Outer-membrane vesicles from Gram-negative bacteria: biogenesis and functions. Nat Rev Microbiol13:605-19.
  10. Jack W Szostak (2016)On the origin of life. MEDICINA (Buenos Aires)76: 199-203
  11. Raposo G, Stoorvogel W (2019) Extracellular vesicles: exosomes, microvesicles, and friends. J Cell Biol200:373-383.
  12. ClotildeThéry (2011) Exosomes: secreted vesicles and intercellular communications. F1000 Biol Rep3:15.

Commercial fisheries in the Mediterranean, focusing on the environmental status and the corresponding management measures

DOI: 10.31038/AFS.2020214

Abstract

The Mediterranean Sea is the largest semi-enclosed European sea with an area of 2.5 million km² and bordered by 23 countries. The basin exhibits two openings, towards the Atlantic Ocean and towards the Indian Ocean through the Red Sea. It is known to be a sea rich in oxygen, oligotrophic and with higher salinity than other European marine waters. Its heterogeneity and isolation allowed the generation of a large number of habitats, leading to a high biodiversity and in turn, provision and sustenance of natural services and resources such as fisheries. Fisheries in the Mediterranean Sea are characterized by a fishing fleet of approximately 82000 vessels, of which small-scale accounts for 80 % of the total. The total catch from the Mediterranean marine fisheries rose from 420,000 tonnes in 1950 to approximately 1,000,000 tonnes in the 1980s, with a peak of 1,093,000 tonnes in 1995. Ever since, the level of catches has been slowly decreasing until today. The total landed value follows a similar pattern, with a clear peak in 1985 at US$ 3 billion followed by an almost-constant decrease trend, down to US$ 1.5 billion. Mediterranean fishery sector is very important from the social and economic view of supporting small rural fisheries-dependent communities, without at the same time, being an important part of the agriculture GDP of the bordering countries. Most of these fisheries are exploited at an unsustainable level, which directly threatens stocks with overexploitation, increasing economic costs and employment losses and creating negative rents. Within a period of 15 years (1991-2006) overexploitation of the Mediterranean fishery resources reached 60% with negative effects mainly on benthic-pelagic species and apex predators (tunas etc.). This is evident mainly for the north Mediterranean countries due to technological progress and high investment values.

Introduction

The Mediterranean Sea is the largest (2,969,000 km²) and deepest (average 1,460 m, maximum 5,267 m) semi-enclosed European sea, consisting of two major interacting sub-basins, the western and eastern Mediterranean, connected by the Straits of Sicily with depth ~ 350 m. The western basin is connected with the Atlantic Ocean through the Gibraltar Strait. The Ionian, Levantine, Adriatic and Aegean are located in the eastern basin, which communicates with the Black Sea through the Strait of Dardanelles and with the Red Sea through the Suez Canal. Several, smaller basins, are recognizable within the two main sections, which show remarkable differences in terms of general oceanographic conditions.

From the oceanographic point of view, which is a pressure to the fisheries state in the area, the Mediterranean Sea can be considered as comprising three main water masses.

a) the Atlantic Water, found in the surface layer, having a thickness of 150-200 m and characterized by a salinity of 36.2 ‰ near Gibraltar to 38.6 ‰in the Levantine basin;

b) the Levantine Intermediate Water (the main water body of the Mediterranean) formed in the Levantine Basin, from the overlying Levantine Surface Water (LSW) lying in depth between 200 and 500 m, and characterized by temperatures of 13-15.5 °C and salinity of 38.4-39.1 ‰;

c) the Mediterranean Deep Water formed in both the western and eastern basins; the Eastern Mediterranean Deep Water (EMDW) is characterized by a temperature of 13.6 °C and a salinity of 38.7 ‰.

It is known that the Mediterranean Sea is a sea rich in oxygen, poor in nutrients and saltier than other European seas. The Mediterranean Sea as a whole has been referred as an “evaporated basin” since surface evaporation, particularly in the Levantine region, accounts for this net inflow, and more than compensates for the inflow of lower salinity water from Black Sea, rivers and other freshwater inflows dominated by discharges, primarily of the rivers Po, Rhone, Nile and Ebro. The biological productivity of the Mediterranean is among the lowest in the world. Average primary production in the western basin corresponds to an assimilation of 50 gCm-2y-1 [1] while in the eastern basin the primary production amounts to about 26 Cm-2y-1 [2]. Primarily productivity can, however, be unusually high at mouths of the rivers and at urban centers.

Specificities of the Mediterranean Sea

The Mediterranean Sea has a very distinct geographical, climatic and biological nature that makes it very different from other sea basins. Its heterogeneity and isolation have generated a great number of habitats, which lead to a high biodiversity spot.

Biological Specificities

a) Biodiversity: in the Northern Hemisphere, marine biodiversity increases from the North Pole toward the equator. This is reflected in a greater number of commercial species in the Mediterranean Sea, with generally smaller individuals compared with the EU waters in the North Atlantic.

b) Increased complexity of the marine ecosystem: This is the direct result of a greater number of species, with greater potential interactions between them as well.

c) Presence of invasive species: while this can also be found in other closed or semi-closed seas such as the Baltic Sea, it is a very common phenomenon in the eastern Mediterranean, with a high number of invasive species coming from the Red Sea through the Suez Canal.

Governance Specificities

a) Shared stocks: Because of the distribution of territorial waters, most of the surface of the Mediterranean Sea is made up of international waters and most commercial fish stocks are shared with other coastal states, many of which are not part of the EU. This shared responsibility increases from west to east and not so much from north to south.

b) International management of fisheries: Fisheries on shared stocks are managed by two regional fisheries organizations:

• International Commission for the Conservation of Atlantic Tunas (ICCAT) for highly migratory species (these count for more than 10% of the value of the total catches in the Mediterranean)

• General Fisheries Council for the Mediterranean (GFCM) for other species.

The political context can also make disciplined management difficult in cases of political instability (wars, post-war situations, migratory movements, etc.).

Specificities in fleet composition and fleet activity

a) Daily activity of boats: the vast majority of Mediterranean fishing vessels come back to port every day, generally with catches mixing several species. As each species is usually below the 50 kg threshold set by the Control Regulation, the catches are not declared.

b) Fleet composition: most of the vessels composing the Mediterranean fleet are less than 10 m long and therefore not covered by the rules on registering catches. As a result, many catches are unrecorded. Small-scale operations involving small vessels with low daily catches represent 80 % of the Mediterranean fishing fleet, 60 % of jobs and 23 % of landings.

c) Economic performance: the 2015 Annual Economic Report noted a progressive deterioration in the economic performance of the small-scale coastal fleet. In sharp contrast to many EU fleets of other regions, which showed steady improvement, EU fleets in the Mediterranean region did not improve their economic performance significantly over the 2008-2013 period.

Effects of human activities on the marine ecosystem

Human socioeconomic activities along the Mediterranean coastline have been identified as pressures that lead to the degradation of the marine environment.

a) Pollution: Reduction of fish stocks due to localized pockets of pollution (in areas with strong human concentration and improper waste treatment).

b) Traffic: there is heavy maritime traffic (particularly south of Sicily and in the Alboran Sea).

c) Highly climate change: Mediterranean is a vulnerable region, with expected shifts on species’ distribution and fish population dynamics, and introduction of invasive species.

d) Biological blooms: there is a relatively high number of algal and jellyfish blooms, which may change the flux of energy of the food web (e.g. greater predation of fish food, eggs or larvae).

e) Top-predators: there is a decline in certain populations of toppredators, notably sharks, which otherwise help adjust the balance between fish populations.

Mediterranean biodiversity

Mediterranean Sea exhibits a high diversity of habitats, both pelagic and demersal. Most of these habitats (bathyal, mesopelagic or bathypelagic) are poorly known in relation to coastal and continental shelves ecosystems, which are more easily surveyed, while at the same time there is a relatively good knowledge of their commercial species stock status, by means of fisheries surveys and commercial captures. Some 12.000 marine species are counted in the Mediterranean Sea, while many of them are introduced. The number of introduced species (NIS) in the Mediterranean has increased spectacularly since the start of the last century. How many species are recent arrival? NIS enter the Mediterranean Sea mainly via the Suez Canal (actively or passively), but also via Gibraltar and Dardanelles through shipping (ballast water, fouling) and aquaculture (EEA 2006). Until the mid-20th century, the NIS introduction, establishment, and expansion rates were low. This number begins to increase at the last decade of the century, mainly because of the water temperature and salinity barriers between the Red Sea and the Mediterranean Sea [3-5]. Extrapolating from initial surveys of selected taxonomic phyla an overall estimate of about 1,000 invaders may not be unrealistic [6]. Following Zenetos [7] the number of reported alien species in the Mediterranean, reached 903 by April 2008 and 947 by October 2009 while the estimate of Galil [8] is of 573 species, 80 species introduced in the period 2000-2007. The lower level of biodiversity, at least as far as species diversity is concerned, in the eastern Mediterranean reflects a general trend of biodiversity reduction in the Mediterranean Sea from the West to the East, given that the conditions of the Levantine Basin are not conducive for the thriving of the Atlantic contingent, being so biased by a founder effect.

The Suez Canal, the Gibraltar Strait, and the Marmara Strait constitute a corridor going through different species from Red Sea, Atlantic Ocean and Black Sea respectively. A lot of marine species moving from Atlantic Ocean in the Mediterranean Sea through the Gibraltar Strait and established, mainly, in its western basin, where the faunistical and hydrological parameters are almost similar between the two areas, while a smaller number of species arrived the eastern basin. The Indo-Pacific and Erythrean origin marine species, which migrate to the Mediterranean through the Suez Canal, named Lessepsian immigrants. The main abiotic difference between the Red Sea and the Mediterranean is the temperature regime, which is stable in the tropical Red Sea, but appears wide fluctuations in the subtropical Mediterranean. Finally, some species migrate from Black Sea established mainly in the Aegean Sea, which act as a barrier for their ongoing distribution.

The fauna of the Mediterranean Sea is mainly temperate Atlantic origin with the Gibraltar Strait to be an important gate for the Atlantic originated fish species distribution in the Mediterranean Sea. On the other hand, tropical Indo-Pacific origin fishes from Red Sea entered in the eastern Mediterranean through the Suez Canal. This eastern region captures less than half of the known Mediterranean species diversity, with 43% of the total listed Mediterranean species. The ichthyofauna of the Eastern Mediterranean began to be actively studied only the last fifty years. Thus, it should be stressed that the inventory of the fishes in the area has been a matter of discussion only in the last four or five decades, in spite of the studies carried out during international scientific expeditions in the beginning of the twentieth century.

Several lists concerning the number of Mediterranean fish has been completed the last 50 years. Tortonese [9] registered 543 species in his list, including 579 species (501 Osteichthyes and 78 Chondrichthyes) in a later revision [10]. Quignard [11] lists a total of 562 species, while Whitehead et al. mention 589 species. Fredj and Maurin [12] list a total of 612 species (~ 30 uncertain). Quignard & Tomasini [13] increased the number at 664 species. According to the data available by Psomadakis et al. [14], the Mediterranean fish diversity can be summarized as follows: 602 (including subspecies) bony fish species (Osteichthyes), 79 cartilagineous fish species (Chodrichthyes) and 3 cyclostomes (Agnatha); making a total of 684 species, belonging to 173 families (147 Osteichthyes, 24 Chodrichthyes, 2 Agnatha).

Mediterranean living resources

Management of the fisheries resources

The Mediterranean Sea (GFCM – major fishing area 37) have sustained important fisheries activities since ancient times. Since the Mediterranean Sea is semi-enclosed sea, with an overall lack of exclusive economic zones (EEZs) and consequently with stocks that are often shared among fleets from different countries, the fishery sector has always played an important role in the region. Today, industrial, semi-industrial and small-scale fisheries coexist in the region, using a large variety of fishing gear. In contrast with other major fishing areas, Mediterranean Sea fisheries generally lack large mono-specific stocks, and instead exploit a variety of benthic and pelagic stocks of fish, as well as mollusks and crustaceans. In fact, despite its relatively low economic output compared to other economic activities in the region (e.g. tourism, oil and gas exploration), the annual production of roughly 1.12 million tonnes offers employment opportunities to several hundred thousand people, supplies seafood products for human consumption to local and regional markets, and creates many other indirect benefits, maintaining the social fabric of coastal communities. Fisheries are also an intrinsic part of the cultural landscape of Mediterranean Sea.

In the Mediterranean is essential the absence of the knowledge of the stock status as well as complete or independent information on fishery mortality, biomass estimation or other biological or management parameters. Lleonart [15] describing the fisheries assessment methodologies applied in the Mediterranean, concluded that the most fisheries research projects have a local contingency. The methods that have been using so far (technical measures, the recently established landing obligations, national management plans) are only good as ‘preventive’ measures. Even the ‘symptomatic treatments’ that occasionally administer (EU multiannual plans, GFCM management plans) take a long time to produce effects and anyway do not eradicate the ‘disease’. To treat the causes of this problem and reverse the steady decline of fish stocks, needs a proper cure. In this case the cure consists of immediate, exceptional measures at both EU and international level. Such measures need to be embraced by all Mediterranean countries in unison and need to take into account the economic risks as well as the environmental ones.

Knowledge of the status of the fish stocks is a prerequisite for the implementation of the management measures applied in the Mediterranean Sea. The first organize research effort named Mediterranean Trawl Survey (MEDITS) and organized and carried out by France, Greece, Italy and Spain at 1994 [16] funded from the EU. The MEDITS survey program at the beginning intended to produce basic information on benthic and demersal species in terms of population distribution as well as demographic structure on the continental shelves and along the upper slopes at a global scale in the Mediterranean. Nevertheless, the intention was to organize the protocols in such a way as to easily permit the enlargement of the program to other Mediterranean countries. One of the mail challenges of the project was the adoption of common standardized sampling protocols. The four first partners early in 1994 just before the first survey have adopted the basic protocols. These protocols included the design of the survey, the sampling gear, the information collected, and the management of the data as far as the production of the common standardized analyses of the data. The manual has been established from different experiences and particularly from that of the IBTS Group [17]. The protocols have been amended for the following surveys, and particularly in 1995 to take into account the experience gained during the first survey.

In 2002, the European countries bordering the Mediterranean made a commitment to curry out MEDITS surveys yearly according to Data Collection Framework (DCF). Permanent links were organized with the relevant EU bodies, such as the Regional Coordination Group of the Mediterranean and Black Sea and the Scientific and Economic Committee for Fisheries (STEFC). Thus, the program has been integrated as an indispensable obligation of all EU countries in all the community seas, in the context of the implementation of the Common Fisheries Policy (CFP). Links were also maintained with the General Fisheries Council for the Mediterranean (GFCM), the FAO regional fisheries management organization. The strength of the MEDITS surveys so far has been the agreement among the participants to share standardized methods as a Mediterranean level using the same gear, sampling scheme and protocols for collecting, checking and analyzing data. From 2008 the program was extended to include the small-scale fisheries and the small pelagic. At that time all the protocols changed in order to include all the new information with common methodologies e.g. small-scale fisheries with different fishing gear and small pelagic by acoustic methodologies. The program is commitment of all the Mediterranean countries, at the same time, similar programs are being implemented by all EU member states covering their surrounding seas. The program is constantly updated with new information aimed at a better management of fish stocks e.g. more target taxonomic categories and fish species, data collection on marine macro-litter, etc.

Recognizing the importance and peculiarities of fisheries in the Mediterranean, and the need for strong regional cooperation, the GFCM was established to promote the development, conservation, rational management and best utilization of living marine resources in the region. Among its various responsibilities, the GFCM since 1970, periodical updating of the research activities dealing with demersal and small pelagic Mediterranean living resources during working group occasions and technical consultation at a region level. The GFCM Data Collection Reference Framework (DCRF) is the first GFCM framework for the collection and submission of fisheriesrelated data in the GFCM area of application. FAO fisheries statistics data based has now uploaded until 1994. All this allows to draw a fairly complete panoramic synthesis of this situation. Time series of fisheries landings can provide important information for changes in a fishery, or changes to the underlying environment [18]. Often, as in the case of Mediterranean fisheries, this is essential in the absence of complete or independent information such as on the fishing intensity or fishing mortality affecting the stock. Mediterranean fisheries are now confronted with serious challenges originating from environmental impacts of coastal activities, climate change, over exploitation of fishery stocks and poor management of the shared resources [19].

It underpins the formulation of sound scientific advice by relevant GFCM subsidiary bodies (i.e. Scientific Advisory Committee on Fisheries), ultimately supporting the GFCM decision-making progress towards sustainable Mediterranean fisheries. Formalized in 2017, the DCRF covers in a standardized and optimized way catch (landing and catch per species), fishing fleet operating in the GFCM fisheries restricted areas, fishing effort (per fleet segment, fishing gear) socioeconomic data, and biological information such as stock assessment, length, size at first maturity, European eel abundance. The last years GFCM regularly reviews the state of fisheries, including the economic and social aspects of the fishing industry, as a basis for the formulation of scientific and management advice conducive to sustainable and responsible fisheries.

The scientific knowledge of large pelagic stocks and fisheries is annually updated for more than 40 years by International Commission for the Consultations of Atlantic Tunas (ICCAT). In general, EU catch limits or quotas are not applicable in the Mediterranean, with the exception of limits on Bluefin tuna that have been introduced in response to recommendations by the ICCAT for the protection of shared stocks.

In order to study, understand and implement the biodiversity and habitat productivity objectives in the Mediterranean, which are essential elements in ecosystem fisheries management of an extensive sea region, all states bordering the Mediterranean should organize and implement common management measures to control fishing. These measures should aim at protecting and conserving fishery resources, including legislation requiring the licensing of fishing vessels and regulating the characteristics and use of fishing gear. In addition, almost every Mediterranean country has designated marine or specially protected areas (although varying by type and objectives) and/or had adopted temporal closures to protect, in part, certain species during their reproductive period. Other management tools in use include total allowable catches (TAC) or quotas for large pelagics, minimal landing sizes, protected species and limits on the days at sea. Legislation regarding the treatment of by-catch is rare in the Mediterranean although this is to be expected given its mixed fisheries. Other than licensing, rights or incentive-adjusting measures are infrequently used.

Fisheries management is conducted by regional bodies based on data and scientific advice, and control measures to ensure that rules are applied fairly to and complied with by all fishermen. Intense international cooperation encourages all countries bordering the Mediterranean Sea to play by the same rules. However the European Commission believes an extra effort by all is now required. To avoid the collapse of fish stocks and its impact on the ecosystem, and to guarantee a future for the fisheries industry in the region, all Mediterranean countries need to act urgently and collectively.

CFP was first enforced in the 1970s and has been successively updated in 2002 and recently in 2014. The CFP keystone is the sustainable exploitation of marine resources both in environmental and socio-economic terms toward a dynamic fishing industry and ensuring a fair standard of living for fishing communities. The current CFP specifies that between 2015 and 2020 exploitation will be conducted according to MSY objectives based on the consensus that this strategy will maintain fish stocks in the long term. The impact of fishing on the marine environment is not fully comprehended and for this reason, CFP adopts a precautionary approach based on selective fisheries practices and a total ban of discards. Similarly, the Marine Strategy Framework Directive [20, 21] requires EU Member States to take measures to achieve Good Environmental Status (GES) of all European marine waters by 2020.

From the management perspective, Mediterranean countries limit their management plans mainly to control fishing effort and fishing capacity together with specific technical measures, such as gear regulation (mainly mesh size and net configuration, as for example for the purse seine), establishment of a minimum conservation reference size, and closures of areas and seasons for fishing to control which vessels have access to which waters and areas. Moreover, the Article 19 of Council Regulation 1967/2006 foreseen that management plans within their territorial waters are adopted for trawling and other fishing activities. In this context, it is important to notice that spatial and temporal closures apply mainly to trawls, which are prohibited within 3 nautical miles from the coast or within the 50 m isobath, where this is closer to the coast. Also, temporal closures regard bottom and mid-water trawl nets are mainly enforced for 30–45 days during summer (Demestre et al., 2008). A second set of management measures in the Mediterranean Sea incorporate the establishment of permanent marine protected areas. Apart from the general absence of catch limits, in all other respects the region is subject to the same type of EU management measures as the rest of the EU, including requirements relating to the EU vessel register, licensing, monitoring and control arrangements, and new data collection measures.

State of fish stocks

Based on different documents that have been submitted to the GFCM Technical Consultation, as well as on the 65-year-time series of landings in the Mediterranean some general observations can be reached for the West and the East Mediterranean (a) despite some significant differences, the overall pictures from the West to East Mediterranean are not strikingly different, (b) from the study of the trends, it is clear that a high proportion of species or species groups in both Mediterranean basins have shown increases in landings over the whole period; either of these increases were linear, or concave upwards or concave downwards, and (c) from the perspective of stock assessment, very few time series show stable yield levels, suggesting a considerable dynamism caused by environmental and/or trophic or fishery-related impacts in the fisheries of the sub-region.

According to the scientific advice, the large majority of fish stocks assessed are shrinking and some are on the verge of depletion. All in all, only 9 % of fish stocks assessed are fished at levels below MSY levels [20] (COM (2016) 396). Despite recent improvements, the number of stocks whose status is unknown remains still large. For fish stocks such as hake, red mullet, anglerfish and blue whiting, current fishing mortality rates have been more than six times higher than MSY. These species represent around 43 % in volume of the total reported trawl catches of the EU fishing fleet (source: STECF and GFCM reports). Fishermen themselves report that they catch fewer and fewer fish every year, with potentially serious repercussions on the industry’s performance and on the economy of coastal communities. There are several reasons for the poor state of fish stocks, with the most important the overfishing, while pollution and climate change certainly play a role, there can be no doubt that extensive overfishing is one of the key causes. The EU has been using a number of methods to counter overfishing: EU countries have been reducing their fleets and our legislation features national and international fisheries management plans, catch limitations and environmental requirements.

Fisheries provides around 314000 direct jobs (www.fao.org). Total landings in the Mediterranean Sea increased irregularly from about to 900000 tonnes in 1970 to almost 1750000 tonnes in 1982 (Figure 1). Total landings remained relatively stable during most of the ‘80s before declining abruptly at the end the decade largely due to the overfishing of pelagic fisheries. There is an increased in landings until 1994, reaching 1.087.000 tonnes, continuing with a limited increase to 1200000 tonnes in 2000. In the following years until 2005, the landings appear slightly up and down fluctuations since 2007 showing the maximum 1.300.000 tonnes until today. In the coming years, there is a continuous increase of 900000 tonnes in 2014. This production remains almost constant until 2018, with a modest increase of 930000 tonnes in 2016 (Figure 1).

AFS-2-1-204-g001

Figure 1. Annual fluctuation of fishing landings in the Mediterranean Sea since 2000 as a whole and by geographical areas.

In the GFCM Mediterranean area, the ranking of capture fisheries production in 2014-2016 dominated by Turkish production, followed by Italy, Algeria and Greece maintained almost the same percentage in landing contribution, while Tunisia and Croatia show an increase compared. Total annually landings for Spain slightly decreased between 2014 and 2016. Despite the long-term upwards trends, the short-term trends over the last 4 years (2014-2017) tell a different story. One tentative explanation is that multispecies landings may now be approaching a peak for the Mediterranean as a whole, with new increases (especially in South and East Mediterranean) being balanced by recent declines, especially in the West and North basins. (Table 1) (Figure1).

Table 1. Landings by major groups of species between 2014 and 2016 in GFCM and Black Sea.

Group of species

Landings (tones)

2014

2015

2016

contribution
average
values (%)

Herrings, sardines, anchovies

 518248

 693966

 576341

 48,7

Miscellaneous coastal fishes

 142160

 152776

 162137

 12,5

Miscellaneous pelagic fishes

 84482

 78503

 80487

 6,6

Squids, cuttlefishes, octopuses

 52602

 50132

 50525

 4,2

Clams, cockles, ark shells

 40963

 56808

 43413

 3,8

Shrimps, prawns

 39810

 44664

 44407

 3,5

Marine fishes not identified

 51875

 38537

 34273

 3,4

Cod, hakes, haddocks

 37625

 40031

 38219

 3,2

Shads

 13127

 21515

 23704

 1,6

Others

 136312

 137861

 183583

 12,5

Total

 1117204

 1314793

 1237089

Compared with the whole GFCM area including and the Black Sea, the main groups of species contributing to landing in the whole area are very similar. Nonetheless, the contribution of small pelagic species (e.g. sardines, anchovies, sprat, etc.) is slightly less important (48%) of the total landings, while the contribution of the other group species is slightly higher. In comparison with the average landings of the last three years in the Mediterranean and Black Sea (Table 1), the main groups of species contributing at least to 1% of the catches remain stable. According to GFCM [18] there groups of species, namely “herrings, sardines, anchovies” (596000 tonnes), “Miscellaneous coastal fisheries” (152400 tonnes) and “Miscellaneous pelagic fishes” (81000 tonnes), constitute around 69% of the total reported landings in the entire GFCM and Black Sea area. Six other groups of species contributing to more than 1% of the landings amount to 20% of the total landings, and the constitution of all remaining species amount to approximately 12% overall.

The Mediterranean Fishing Fleet

Fisheries in the Mediterranean Sea are characterized by a fishing fleet of approximately 75.000 vessels at 2017-2018 where small- scale accounts for 80 % of the total (though these numbers should be considered an underestimation). In the area, fish stocks are exploited by EU fishing vessels almost exclusively in the northwestern Mediterranean (e.g. the Balearic Islands, the Gulf of Lion, Corsica, Sardinia and the Ligurian and Tyrrhenian Seas) and in the north Adriatic Sea, while the central Mediterranean (e.g. the Strait of Sicily and the Ionian Sea) and the eastern Mediterranean (e.g. the Aegean Sea and the Levantine Sea) are jointly exploited with non-EU countries.

The Mediterranean fisheries according to EU regulations can be broken down into three main categories: (a) small-scale fisheries, (b) trawling and (c) seining fisheries. The term “small-scale fisheries” attempting to integrate aspects of the “coastal” and “artisanal” fisheries and to avoid the vagueness, inconsistencies and differences of the previous definition, is virtually absent from the official terminology of the most Mediterranean countries. This term was introduced at first at 1990 by the European Commission, when the commission presented a proposal (COM (90) 358 final of 7 September 1990) [18] to amend Regulation 4028/86 on measures to improve and structures in the fisheries and aquaculture sector.

GFCM proposed the following fleet segments for data reporting purpose; (a) Polyvalent (P), small-scale vessels without engine using passive gear, small-scale vessels with engine using passive gear and Polyvalent vessels; (b) Seiners (S), Purse seines and Tuna seiners; (c) Dredgers (D); (d) Trawlers (T), Beam trawlers, Pelagic trawlers and Trawlers; (e) Longines (L).

Official statistics from 2017-2018 for the total fisheries fleet suggest that in the GFCM Mediterranean countries appear 74.748 fishing units (Table 2), of which 74,8%, 8,3%, 4,6% and 4% are registered as Polyvalent, Trawlers, Purse Seiners and unallocated fishing vessels respectively [19]. A number of 62201 coastal vessels equipped with the above fishing gear, together with the dredgers and longliners operate in all the countries of the Mediterranean Sea. A number of 6183 trawlers operate in the Mediterranean and most of them could be considered as semi-industrial or industrial vessels, taking into account the international practice. The purse seines, one of the main fishing gear used in the area, amount 3423 vessels and are distinguished into two major types: purse -seines operating during the day and purse –seines operating during the night. There are no significant differences between the two types as far as equipment and their activity focus on different species. Concerning the total distribution of the Mediterranean fishing fleet, there and vessel construction are concerned. The difference is that they employ a different fishery methodology, are no significant differences between the Eastern (30,6%) and Central (30,5%) Mediterranean and less in the Western (20,0%) and Adriatic Sea (14,2%). The number of operating fishing vessels by a group of fleet segment in the different GFCM Mediterranean countries are presented in Figure 2.

Table 2. Fluctuation of Number of vessels and total tonnage between 1970 and 1995 (FAO-FIGIS).

1970

1975

1980

1985

1990

1995

Number of vessels

56.936

61.970

68,515

72,976

86.272

82.004

Total tonnage (GT)

1.538.195

1.860.553

2.084.836

2.101.905

2.613.136

1.832.318

AFS-2-1-204-g002

(*) The coastal category includes polyvalent, dredgers and longline vessels.

Figure 2. Number of operating fishing vessels grouped by fleet segment (2017-2018) in the different GFCM Mediterranean countries.

According to the most-up-to-date GFCM information, the capacity of the operating fishing vessels in the Mediterranean is about 769000 GT and 4720000 kilowatts (KW) unevenly distributed among the various countries, with four of them, Turkey (19,7%), Italy (16,2%), Egypt (13,7%) and Tunisia (11,3%) holding about 60% of the total fishing capacity. Other national fleet with substantial capacity (more than 50000 GT) are those of Greece, Algeria and Spain. (Figure 3).

AFS-2-1-204-g003

Figure 3. Number, capacity (GT) and kilowatts (KW) of operating fishing vessels by GFCM Mediterranean countries (2017-2018).

The evolution of the number and GT of the fishing fleet in Mediterranean Countries between 1970 and 1995 is summarized in Table 2 (source: FAO-FIGIS/Fisheries Global Information System). Of the data processed this way (Table 2), it can be concluded that until the beginning of the 1990s an expansion of the effort took place regarding vessels, and the capacity of Mediterranean fishing fleets of the countries analyzed. From the mid-1990s both dimensions started to decrease although, this reduction is especially important in fleets operating in other seas, such in the case of France, Spain and Morocco.

Employment

The human dimensions of Mediterranean fisheries are as complex and divers as the species and the ecosystems upon which they depend. For example the Mediterranean states’ economies range from lowincome food-deficit to highly developed, their coastlines from deserted to heavily urbanized, and their fisheries from unindustrialized and labor intensive to modern and capital intensive.

Although often overlooked in the statistics, these fisheries are important for the welfare of coastal inhabitants as well as job and income security. They also act synergistically with other activities (tourism, recreation etc.). According to GFCM and DCRF data collection program, total employment onboard fishing vessels for the Mediterranean account for 227250 jobs, an increase by 10% since 2016, while 900.000 others are employed in related services and industries. Four countries in the region represent 55% of all employment onboard fishing vessels: Tunisia, Turkey, Algeria and Italy (Figure 4).

AFS-2-1-204-g004

Figure 4.FAO [19] estimates that pre- and post-harvest labour, gleaning activity or other in-kind labour, such as support from family members may account for an additional 50% in employment figure (approximately additional 25000-26000 people) [22]. The central, eastern and western Mediterranean subregions jointly represent 85% of all employment onboard fishing vessels in the GFCM area of application.

Small-scale fisheries is a very important segment for the Mediterranean for job and income security of the fisheries dependent coastal communities. Even though, SSF accounts for 26% of total revenues of the region, they provide employment for the 59% of the total people working in the Mediterranean fisheries sector (approximately 135000 persons on board SSF vessels). SSF as a source of employment is more important for the Central Mediterranean region where it resents 75% of all on vessel employment. In the other Mediterranean regions (West, East Mediterranean and Adriatic Sea), 54% and 46% (on average) of the employment is offered by industrial fisheries and small-scale fisheries respectively (Figure 5).

AFS-2-1-204-g005

Figure 5.On-board fishing vessel employment (numbers and percent) per Mediterranean sub-region

Specific Case: The exploitation of tuna

The exploitation of tuna is one of the oldest and most complex fishing activities of the Mediterranean. It is practiced on a species of very high economic value whose main target is the Japanese markets, and this causes a strong fishing effort. Tuna is a trans-zonal species swimming in international and national waters of many countries and in large aggregates of individuals, which facilitates its location and capture on a large scale. It should be noted that tuna is characterized by complex breeding, low maturation and by being vulnerable to reductions in their feed (small pelagic) and very much affected by overfishing. Taking into consideration all these factors, it is easy to understand the critical situation of these resources. The ICCAT regulates the Bluefin tuna fishery, of which the EU and its Member States are members.

The source of information on production/capture data reported in Table 6 is FISHSTAT, and due to the characteristics of this fishery, the reliability and coverage of these data are limited. This circumstance also makes it difficult to determine these catches used for fattening. In accordance with available statistics, production of tunas, bonitos and billfishes in the Mediterranean Sea has been decreasing since the year 1995 (Table 6), after various decades of expansion. The expansion of production that took place between 1975 and 1985, when it more than doubled, has proved to be unsustainable. Amongst the species exploited, we could highlight the Atlantic Bonito, Atlantic Bluefin tuna and Swordfish. These three species account for 90% of the total capture of these large pelagic in the Mediterranean; some 130,000 t in 2005 (Table 3).

Table 3. Capture production (in tonnes) of tuna fishes in the Mediterranean and Black Sea by species (all countries included).

Species

 1975

 1985

 1995

 2000

 2005

Albacore

 500

 4,129

 1,587

 5,578

 3,657

Atlantic bluefin tuna

 11,266

 19,296

 37,560

 23,106

23,886

Atlantic bonito

 6,038

 18,487

 15,371

 18,760

77,460

Atlantic white marlin

 1

 1

Frigate and bullet tuna

 2,644

 5,240

 5,205

 2,763

 3,029

Little tunny (=Atlantic Black skipjack tuna)

 1,386

 2,040

 1,894

 3,298

 1,660

Marlins, sailfishes, etc.

 1

 1

 50

Plain bonito

 9

 115

 145

 5

Skipjack tuna

 6

 13

 43

 90

 29

Swordfish

 4,304

15,293

 12,432

 15,570

14,582

Tuna-like fishes nei

 780

 2,125

 1,264

 3,353

 4,739

TOTAL

 26,924

 66,632

 75,473

 72,665

129,097

Today the situation is changed and bluefin tuna is indeed a primary example of sustainable management, having gone from heavy over-exploitation to full recovery in the space of a few years thanks to a massive international effort led by the EU. The European Commission is pleased with the work and commitment of the Member states to ensure compliance with the rules in this fishery in the past few years, and is also appreciative of the significant role played by the European Fisheries Control Agency in ensuring the coordination of these controls. It will remain vigilant to ensure that all rules, and particularly the individual vessels’ quotas, are fully respected. Will be continued to monitor catches and analyze Vessel Monitoring System data (a satellite-based control system) on a constant basis and will continue to send out inspectors.

Following advice from ICCAT scientists in 2014, ICCAT has agreed to an increase of 60% of the Total Allowable Catch (TAC) over three years (2015, 2016 and 2017) [23-25]. In 2016, this brings the European TAC to 11203 tonnes. The quota is shared between the 8 EU countries actively involved in the bluefin tuna fishery (Spain, France, Italy, Croatia, Greece, Portugal, Malta, and Cyprus), with Spain and France having the largest shares.

To this date, it is the only stock in good state in the Mediterranean, while a great majority of stocks remains overfished. To ensure that no overfishing takes place and similarly to previous years, a strict control and inspection program are in place: it sets concrete control priorities and benchmarks and deploys a significant number of inspectors, patrol vessels and aircraft, all coordinated by the European Fisheries Control Agency and the Member States concerned. For the first time in 2016, ICCAT is also implementing the eBCD, a new state-of-the-art electronic tuna catch document system which greatly improves the traceability of all bluefin tuna products. The use of this program, combined with the rest of the measures of the recovery plan, makes this fishery one the most controlled in the world, and provides the best guarantees to consumers that the resource is being used sustainably.

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