Triple Therapy and Clinical Control in B+ COPD Patients: A Pragmatic, Prospective, Randomized Trial.

INTRODUCTION: Treatment with LABA/LAMA is recommended in GOLD B patients. We hypothesized that triple therapy (LABA/LAMA/ICS) will be superior to LABA/LAMA in achieving and maintaining clinical control (CC), a composite outcome that considers both impact and disease stability in a subgroup of GOLD B patients (here termed GOLD B+ patients) characterized by: (1) remaining symptomatic (CAT≥10) despite regular LABA/LAMA therapy; (2) having suffered one moderate exacerbation in the previous year; and (3) having blood eosinophil counts (BEC) ≥150cells/µL. METHODS: The ANTES B+ study is a prospective, multicenter, open label, randomized, pragmatic, controlled trial designed to test this hypothesis. It will randomize 1028 B+ patients to continue with their usual LABA/LAMA combination prescribed by their attending physician or to begin fluticasone furoate (FF) 92µg/umeclidinium (UMEC) 55µg/vilanterol (VI) 22µg in a single inhaler q.d. for 12 months. The primary efficacy outcome will be the level of CC achieved. Secondary outcomes include the clinical important deterioration index (CID), annual rate of exacerbations, and FEV1. Exploratory objectives include the interaction of BEC and smoking status, all-cause mortality and proportion of patients on LABA/LAMA arm that switch therapy arms. Safety analysis include adverse events and incidence of pneumonia. RESULTS: The first patient was recruited on February 29, 2024; results are expected in the first quarter of 2026. CONCLUSIONS: The ANTES B+ study is the first to: (1) explore the efficacy and safety of triple therapy in a population of B+ COPD patients and (2) use a composite index (CC) as the primary result of a COPD trial.

Levels of engagement among office-based opioid treatment (OBOT) patients with concurrent methamphetamine use.

BACKGROUND AND OBJECTIVES: Recent increases in methamphetamine use among people seeking treatment for opioid use disorder (OUD) has created significant demand for effective approaches to support this clinical population. This study assessed the extent to which office-based opioid treatment (OBOT) patients, who were diagnosed with methamphetamine use disorder (MUD), engaged with providers. METHODS: A retrospective analysis was conducted of adult patients (n = 470) seeking treatment for OUD who attended at least one visit between March 2020 and March 2023 at a rural regional OBOT provider. Approximately one quarter (28.7%) of patients were diagnosed with MUD in addition to receiving an OUD diagnosis. Bivariate methods and multivariate negative binomial regression models were estimated to examine the associations between clinical measures and the numbers of office visits, peer visits, and telehealth visits. RESULTS: Regression results indicated patients who met criteria for MUD in addition to OUD attended a higher rate of peer visits (incidence rate ratio [IRR] = 2.63, p = .036) when compared to patients who did not meet criteria for MUD. In contrast, patients with MUD and OUD diagnoses displayed significantly lower (IRR = 0.68, p < .001) engagement rates through fewer office visits relative to those who did not meet MUD criteria. DISCUSSION AND CONCLUSIONS: Patients seeking treatment for OUD who meet criteria for MUD are more likely to engage through peer support specialists rather than office visits. SCIENTIFIC SIGNIFICANCE: This study demonstrates the ways patients who meet criteria for OUD and MUD engage with providers to receive treatment.

Comparison of upfront haploidentical hematopoietic stem cell transplantation and salvage haploidentical hematopoietic stem cell transplantation after immunosuppressive therapy in children with acquired severe aplastic anemia - a multicenter study.

Background: For children with severe aplastic anemia, if the first immunosuppressive therapy (IST) fails, it is not recommended to choose a second IST. Therefore, for patients without matched sibling donor (MSD) and matched unrelated donor (MUD), haploidentical hematopoietic stem cell transplantation (Haplo-HSCT) can be chosen as a salvage treatment. This article aims to explore the comparison between upfront Haplo-HSCT and salvage Haplo-HSCT after IST. Methods: 29 patients received salvage Haplo-HSCT, and 50 patients received upfront Haplo-HSCT. The two groups received Bu (Busulfan, 3.2mg/kg/d*2d on days -9 to-8), CY (Cyclophosphamide, 60mg/kg/d*2d on days -4 to-3), Flu (fludarabine, 40mg/m2/d*5d on days -9 to -5) and rabbit ATG (Anti-thymocyte globulin, total dose 10mg/kg divided into days -4 to -2). Results: The OS of the salvage Haplo-HSCT group showed no difference to the upfront Haplo-HSCT group (80.2 ± 8.0% vs. 88.7 ± 4.8%, p=0.37). The FFS of the salvage Haplo-HSCT group also showed no difference to the frontline Haplo-HSCT group (75 ± 8.2% vs. 84.9 ± 5.3%, p=0.27). There was no significant difference in the incidence of other complications after transplantation between the two groups, except for thrombotic microangiopathy (TMA). In the grouping analysis by graft source, the incidence of II-IV aGVHD in patients using PBSC ± BM+UCB was lower than that in the PBSC ± BM group (p=0.010). Conclusion: Upfront Haplo-HSCT and salvage Haplo-HSCT after IST in children with acquired severe aplastic anemia have similar survival outcomes. However, the risk of TMA increases after salvage Haplo-HSCT. This article provides some reference value for the treatment selection of patients. In addition, co-transplantation of umbilical cord blood may reduce the incidence of GVHD.

Microbial Polysaccharides Extracted from Different Mature Muds of the Euganean Thermal District Show Similar Anti-Inflammatory Activity In Vivo.

The Euganean Thermal District, situated in North-East Italy, is one of Europe's largest and oldest thermal centres. The topical application of its therapeutic thermal muds is recognised by the Italian Health System as a beneficial treatment for patients suffering from arthro-rheumatic diseases. Polysaccharides produced by the mud microbiota have been recently identified as anti-inflammatory bioactive molecules. In this paper we analysed the efficacy of Microbial-Polysaccharides (M-PS) derived from mature muds obtained at different maturation temperatures, both within and outside the codified traditional mud maturation range. M-PSs were extracted from six mature muds produced by five spas of the Euganean Thermal District and investigated for their chemical properties, monosaccharide composition and in vivo anti-inflammatory potential, using the zebrafish model organism. Additionally, mature muds were characterized for their microbiota composition using Next-Generation Sequencing. The results showed that all M-PSs exhibit similar anti-inflammatory potential, referable to their comparable chemical composition. This consistency was observed despite changes in cyanobacteria populations, suggesting a possible role of the entire microbial community in shaping the properties of these biomolecules. These findings highlight the importance of scientific research in untangling the origins of the therapeutic efficacy of Euganean Thermal muds in the treatment of chronic inflammatory conditions.

Impacts of vegetable processing and cheese making effluent on soil microbial functional diversity, community structure, and denitrification potential of land treatment systems.

The cheese making and vegetable processing industries generate immense volumes of high-nitrogen wastewater that is often treated at rural facilities using land applications. Laboratory incubation results showed denitrification decreased with temperature in industry facility soils but remained high in soils from agricultural sites (75% at 2.1°C). 16S rRNA, phospholipid fatty acid (PLFA), and soil respiration analyses were conducted to investigate potential soil microbiome impacts. Biotic and abiotic system factor correlations showed no clear patterns explaining the divergent denitrification rates. In all three soil types at the phylum level, Actinobacteria, Proteobacteria, and Acidobacteria dominated, whereas at the class level, Nitrososphaeria and Alphaproteobacteria dominated, similar to denitrifying systems such as wetlands, wastewater resource recovery facilities, and wastewater-irrigated agricultural systems. Results show that potential denitrification drivers vary but lay the foundation to develop a better understanding of the key factors regulating denitrification in land application systems and protect local groundwater supplies. PRACTITIONER POINTS: Incubation study denitrification rates decreased as temperatures decreased, potentially leading to groundwater contamination issues during colder months. The three most dominant phyla for all systems are Actinobacteria, Proteobacteria, and Acidobacteria. The dominant class for all systems is Nitrosphaeria (phyla Crenarchaeota). No correlation patterns between denitrification rates and system biotic and abiotic factors were observed that explained system efficiency differences.

Integration of lactic acid biorefinery with treatment of red mud from alumina refinery: win-win paradigm for waste valorization.

The cost of detoxification and neutralization poses certain challenges to the development of an economically viable lactic acid biorefinery with lignocellulosic biomass as feedstock. Herein, red mud, an alkaline waste, was explored as both a detoxifying agent and a neutralizer. Red mud treatment of lignocellulosic hydrolysate effectively removed the inhibitors generated in dilute acid pretreatment, improving the lactic acid productivity from 1.0 g/L·h-1 to 1.9 g/L·h-1 in later fermentation. In addition, red mud could replace CaCO3 as a neutralizer in lactic acid fermentation, which in turn enabled simultaneous bioleaching of valuable metals (Sc, Y, Nd, and Al) from red mud. The neutralization of alkali in red mud by acids retained in lignocellulosic hydrolysate and lactic acid produced from fermentation led to effective dealkalization, rendering a maximum alkali removal efficiency of 92.2 %. Overall, this study offered a win-win strategy for the valorization of both lignocellulosic biomass and red mud.

The effect of clay therapy on hopelessness and depression levels in chronic stroke patients in addition to physical therapy.

BACKGROUND: Clay art therapy can be used as part of rehabilitation for chronic stroke patients. OBJECTIVE: The objective of this study is to examine the effect of clay therapy on hopelessness and depression levels in chronic stroke patients who receive physical therapy and compare them to patients who only receive physical therapy. METHODS: This randomized controlled study was conducted between August 1st - September 28th, 2022 in Turkiye, with 60 patients who agreed to participate in the study and met the inclusion criteria, which were chronic stroke patients who received physical therapy. The patients were divided into two groups (30 in the experimental group, 30 in the control group) with the control group receiving only their routine physical therapy and rehabilitation (5 days a week, 40 sessions in total), while the experimental group received their routine physical therapy and rehabilitation program as well as clay therapy twice a week, 60 min per session, for 8 weeks. Demographic information of all the participants was recorded, and the Beck Depression Inventory and Beck Hopelessness Scale were administered before and after treatment. RESULTS: The patients' depression posttest scores (t(58) = -11.386; p = 0.000 < 0,05), and hopelessness posttest scores (t(58) = -10.247; p = 0.000 < 0,05) differed significantly based on their groups. The control group's depression posttest scores (x¯ =25,033) and hopelessness posttest scores (x¯ =15,000) were higher than the experimental group's depression posttest scores (x¯ =9,067) and hopelessness posttest scores (x¯ =8,000). The control group's feeling about the future posttest scores (x¯ =2,967) were higher than the experimental group's posttest scores (x¯ =0,967). The control group's loss of motivation posttest scores (x¯ =6,400) were higher than the experimental group's posttest scores (x¯ =2,667). CONCLUSION: It was seen that clay therapy, in addition to physical therapy, was effective in reducing depression and hopelessness in chronic stroke patients.

[Analysis of efficacy and prognosis of allogeneic hematopoietic stem cell transplantation for the treatment of combined immunodeficiency].

Objective: To evaluate the efficacy of allogeneic hematopoietic stem cell transplantation for the treatment of combined immunodeficiency (CID) and explore prognostic risk factors. Methods: In this retrospective cohort study, clinical characteristics, laboratory tests and prognosis of 73 CID children who underwent allogeneic hematopoietic stem cell transplantation from February 2014 to April 2022 in the Children's Hospital of Fudan University were analyzed. Based on the subtypes of diseases, all patients were divided into severe combined immunodeficiency disease (SCID) group and other CID group. Based on the types of donors, all patients were divided into matched sibling donor group, matched unrelated donor group, unrelated cord blood group, and haploidentical donor group. Kaplan-Meier method and Log-Rank test were used to analyze the survival data. Cox regression was used to analyze prognostic factors. Results: Among the 73 patients, there were 61 (84%) males and 12 (16%) females. Fifty-five (75%) patients were SCID, and 18 (25%) patients were other CID. Donor source included 2 (3%) matched sibling donors (MSD), 3 (4%) matched unrelated donors (MUD), 64 (88%) unrelated cord blood (UCB), and 4 (5%) haploidentical donors. The age at transplant was 10.7 (5.9, 27.5) months, and the follow-up time was 36.2 (2.5, 62.9) months. The 3-year overall survival rate of 73 patients with CID was (67±6) %. No significant difference was found in the 3-year overall survival rates between patients with SCID (55 cases) and other CID (18 cases) ((64±7) % vs. (78±10) %, χ2=1.31, P=0.252). And no significant difference was found in the 3-year overall survival rates among patients who received MSD or MUD (5 cases), UCB (64 cases), and haploidentical donor (4 cases) transplant (100% vs. (66±6)% vs. (50±25) %, χ2=2.30, P=0.317). Cox regression analysis showed that the medical history of sepsis (HR=2.55, 95%CI 1.05-6.20, P=0.039) and hypoalbuminemia at transplant (HR=2.96, 95%CI 1.14-7.68, P=0.026) were independent risk factors for the prognosis of allogeneic hematopoietic stem cell transplantation in pediatric patients with CID. Conclusions: Allogeneic hematopoietic stem cell transplantation is an effective treatment for CID. The medical history of sepsis and hypoalbuminemia at transplant were risk factors for prognosis. Enhancing infection prevention and nutritional intervention before transplant can improve patient prognosis.

Efficacy and safety of antibiotics for treatment of leptospirosis: a systematic review and network meta-analysis.

BACKGROUND: Leptospirosis, an important zoonotic bacterial disease, commonly affects resource-poor populations and results in significant morbidity and mortality worldwide. The value of antibiotics in leptospirosis remains unclear, as evidenced by the conflicting opinions published. METHODS: We conducted a search in the PubMed, Web of Science, and Cochrane Library databases for studies. These studies included clinical trials and retrospective studies that evaluated the efficacy or safety of antibiotics for leptospirosis treatment. The primary outcomes assessed were defervescence time, mortality rate, and hospital stays. Subgroup analyses were performed based on whether there were cases involving children and whether there were cases of severe jaundice. Safety was defined as the prevalence of adverse events associated with the use of antibiotics. p scores were utilized to rank the efficacy of the antibiotics. RESULTS: There are included 9 randomized controlled trials (RCTs), 1 control trial (CT), and 3 retrospective studies (RS) involving 920 patients and 8 antibiotics. Six antibiotics resulted in significantly shorter defervescence times compared to the control, namely cefotaxime (MD, - 1.88; 95% CI = - 2.60 to - 1.15), azithromycin (MD, - 1.74; 95% CI = - 2.52 to - 0.95), doxycycline (MD, - 1.53; 95% CI = - 2.05 to - 1.00), ceftriaxone (MD, - 1.22; 95% CI = - 1.89 to - 0.55), penicillin (MD, - 1.22; 95% CI = - 1.80 to - 0.64), and penicillin or ampicillin (MD, - 0.08; 95% CI = - 1.01 to - 0.59). The antibiotics were not effective in reducing the mortality and hospital stays. Common adverse reactions to antibiotics included Jarisch-Herxheimer reaction, rash, headache, and digestive reactions (nausea, vomiting, diarrhea, abdominal pain, and others). CONCLUSIONS: Findings recommend that leptospirosis patients be treated with antibiotics, which significantly reduced the leptospirosis defervescence time. Cephalosporins, doxycycline, and penicillin are suggested, and azithromycin may be a suitable alternative for drug-resistant cases. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022354938.

[Pelotherapy and pelotherapy combined with intravenous laser blood irradiation at the sanatorium-resort stage of treatment of patients with psoriasis vulgaris]. / Peloidoterapiya i peloidoterapiya v sochetanii s vnutrivennym lazernym osvechivaniem krovi na sanatorno-kurortnom etape lecheniya bol'nykh vul'garnym psoriazom.

Search of new rational ways to increase the effectiveness of treatment and rehabilitation measures for patients with psoriasis vulgaris continues to be one of the urgent problems in modern clinical dermatology. OBJECTIVE: To carry out a comparative analysis of the impact of different variants of sanatorium-resort treatment (SRT) - pelotherapy and pelotherapy in combination with intravenous laser blood irradiation (ILBI) - on the level of IL-17 and TNF-a, dermatological status, psychoemotional state and quality of life (QL) assessment of patients with psoriasis vulgaris. MATERIAL AND METHODS: A naturalistic comparative study included 120 patients with psoriasis vulgaris, who were undergoing SRT: 57 patients in the pelotherapy group and 63 in the group of pelotherapy in combination with ILBI. The SRT effectiveness was assessed using the PASI index, the HARS and HDRS scales and the DLQI questionnaire. The dynamics of IL-17 and TNF-a plasma levels in blood plasma was studied. The study duration was 6 months 14 days. RESULTS: After 14 days of SRT, a decrease in IL-17 and TNF-a levels in blood plasma was statistically significant both in the pelotherapy group and in the group of pelotherapy in combination with ILBI, no statistically significant differences between the groups were found. Furthermore, the comprehensive use of pelotherapy in combination with ILBI has contributed to a more pronounced statistically significant decrease in the PASI index, the HARS and HDRS scales' total scores and an increase in the level of QL. The number of patients with clinical remission was statistically higher in the group of pelotherapy combined with ILBI compared to the pelotherapy group (87.3% versus 42.1%) six months after SRT. CONCLUSION: The advantage of comprehensive application of pelotherapy and ILBI in comparison with pelotherapy in patients with psoriasis vulgaris in SRT has been shown. The comprehensive application of pelotherapy and ILBI reduces the level of inflammatory biomarkers, improves dermatological and psychoemotional status, improves QL and is well tolerated by patients.

[Effects of organic fertilizer from traditional Chinese medicine residues on growth and soil microbial community of Salvia miltiorrhiza by metagenomic technique].

Soil microbiome is a key evaluation index of soil health. Previous studies have shown that organic fertilizer from traditional Chinese medicine(TCM)residues can improve the yield and quality of cultivated traditional Chinese medicinal materials. However, there are few reports on the effects of organic fertilizer from TCM residues on soil microbiome. Therefore, on the basis of evaluating the effects of organic fertilizer from TCM residues on the yield and quality of cultivated Salvia miltiorrhiza, the metagenomic sequencing technique was used to study the effects of organic fertilizer from TCM residues on rhizosphere microbiome community and function of cultivated S. miltiorrhiza. The results showed that:(1) the application of organic fertilizer from TCM residues promoted the growth of S. miltiorrhiza and the accumulation of active components, and the above-ground and underground dry weight and fresh weight of S. miltiorrhiza increased by 371.4%, 288.3%, 313.4%, and 151.9%. The increases of rosmarinic acid and salvianolic acid B were 887.0% and 183.0%.(2)The application of organic fertilizer from TCM residues significantly changed the rhizosphere bacterial and fungal community structures, and the microbial community composition was significantly different.(3)The relative abundance of soil-beneficial bacteria, such as Nitrosospira multiformis, Bacillus subtilis, Lysobacter enzymogenes, and Trichoderma was significantly increased by the application of organic fertilizer from TCM residues.(4)KEGG function prediction analysis showed that metabolism-related microorganisms were more easily enriched in the soil environment after organic fertilizer application. The abundance of functional genes related to nitrification and denitrification could also be increased after the application of organic fertilizer from TCM residues. The results of this study provide guidance for the future application of organic fertilizer from TCM residues in the cultivation of traditio-nal Chinese medicinal materials and enrich the content of green cultivation technology of traditional Chinese medicinal materials.

The impact of recycling polyaluminium chloride and anionic polyacrylamide water treatment residuals on heavy metal adsorption in soils: implications for stormwater bioretention systems.

Despite the high adsorption capacity of polyaluminum chloride and anionic polyacrylamide water treatment residuals (PAC-APAM WTRs) for Pb2+, Cd2+, Cu2+, and Zn2+, their influence on the adsorption behavior of heavy metals in traditional bioretention soil media remains unclear. This study investigated the impact of PAC-APAM WTRs at a 20% weight ratio on the adsorption removal of Pb2+, Cd2+, Cu2+, and Zn2+ in three types of soils. The results demonstrated improved heavy metal adsorption in the presence of PAC-APAM WTRs, with enhanced removal observed at higher pH levels and temperatures. The addition of PAC-APAM WTRs augmented the maximum adsorption capacity for Pb2+ (from 0.98 to 3.98%), Cd2+ (from 0.52 to 10.99%), Cu2+ (from 3.69 to 36.79%), and Zn2+ (from 2.63 to 13.46%). The Langmuir model better described the data in soils with and without PAC-APAM WTRs. The pseudo-second-order model more accurately described the adsorption process, revealing an irreversible chemical process, although qe demonstrated improvement with the addition of PAC-APAM WTRs. This study affirms the potential of PAC-APAM WTRs as an amendment for mitigating heavy metal pollution in stormwater bioretention systems. Further exploration of the engineering application of PAC-APAM WTRs, particularly in field conditions for the removal of dissolved heavy metals, is recommended.

Benefit-Harm Analysis of Earlier Initiation of Triple Therapy for Prevention of Acute Exacerbation in Patients with COPD.

Rationale: Reducing the risk of exacerbation is a fundamental goal in managing stable COPD. Guidelines recommend triple therapy (inhaled corticosteroids, long-acting muscarinic antagonists, and long-acting beta-agonists [ICS/LAMA/LABA]) only as a step-up from dual therapy (LAMA/LABA) for patients at continued high risk of exacerbation, due to the trade-off of an increased risk of pneumonia associated with ICS-containing therapies. However, there is little evidence on the optimum timing of initiating triple therapy. Objectives: To perform a benefit-harm analysis to evaluate the net benefit of earlier initiation of triple therapy for the prevention of acute exacerbations in patients with COPD, compared to standard timing recommended in current guidelines. Methods: We used a validated whole disease microsimulation model of COPD in the Canadian general population aged ≥40 years to determine the benefit-harm of earlier initiation of triple therapy over a 20-year time horizon, compared to standard care. We assessed net change in quality-adjusted life-years (QALYs) from the reduction in risk of acute exacerbations and the increased risk of treatment-related pneumonia in subgroups of patients with COPD defined by exacerbation history, symptoms, and disease severity. Model parameters were determined from clinical trials and other published literature. Key parameters were varied in one-way sensitivity analysis. Results: In patients at high risk of acute exacerbation (54.7% female, mean age 74.0, 68% GOLD grade I-II), earlier initiation of triple therapy was associated with a net QALY gain of 4.8 per 100 COPD patients over 20 years, compared to standard care. The net QALY gain increased to 5.9 per 100 patients in the subgroup of patients with a high symptom burden (mMRC>1). Earlier initiation remained net beneficial in all subgroup and sensitivity analysis scenarios. Conclusions: Modeling suggests that earlier initiation of triple therapy is likely to be net beneficial for patients at high risk of acute exacerbation, with an even greater benefit to patients with a high symptom burden. Further clinical research is needed to verify these findings in empirical studies.

Biological wastewater treatment: a comprehensive sustainability analysis using life cycle assessment.

The research conducts a life cycle assessment (LCA) on wastewater treatment (WWT) methods-membrane bioreactor (MBR), soil biotechnology (SBT), and bio-electrochemical constructed wetlands (BCW)-in comparison with the conventional activated sludge process (ASP). Employing SimaPro v9.5 with a cradle-to-gate system boundary, the analysis utilizes the IMPACT 2002 + method, employing per cubic meter of treated wastewater as the functional unit. The analysis shows that SBT exhibits the lowest environmental impacts among the considered WWT methods. The global warming potential was 0.0996 kg CO2 eq. for SBT, 1.33 kg CO2 eq. for MBR, 0.131 kg CO2 eq. for BCW, and 0.544 kg CO2 eq. for ASP. BCW demonstrates a 75.91% decrease, while MBR exhibits a 144.48% increase compared to ASP. Notably, electricity consumption emerges as the primary contributor to environmental impact in MBR and ASP. The resource impact category varies with a 138.15% increase in MBR and an 83.41% decrease in SBT compared to ASP. Additionally, the research indicates that the high human health impact observed in MBR results mainly from increased carcinogens (0.00176 kg C2H3Cl eq.), non-carcinogens (0.01 kg C2H3Cl eq.), and ionizing radiation (3.34 Bq C-14 eq.). The findings underscore the importance of considering treatment efficiency and broader environmental implications in selecting WWT methods. As the world emphasizes sustainability, such LCA studies provide valuable insights for making informed decisions in wastewater management.

A therapeutic ERCP in an only 5.9 kg infant with obstruction jaundice using JF-260V duodenoscope.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) has found extensive use in pediatric patients; however, challenges persist in the application of therapeutic ERCP in infants. CASE PRESENTATION: This case report details the presentation of a 5.9-kilogram infant with obstructive jaundice and suspected hemolytic anemia who underwent ERCP to alleviate biliary obstruction. The infant was admitted due to clay-colored stools, jaundice, and liver injury. Ultrasound and magnetic resonance cholangiopancreatography (MRCP) revealed dilation of the common bile duct (CBD) accompanied by the presence of stones. ERCP was conducted using a JF-260V duodenoscope under general anesthesia. Successful stone extraction and biliary drainage were achieved. CONCLUSIONS: In centers with considerable expertise in ERCP and pediatric anesthesia, the use of a conventional adult duodenoscope for therapeutic ERCP in infants can be considered safe and feasible, provided careful and stringent patient selection criteria are applied. In the future, clear guidelines and standardized protocols for the indications and procedures of pediatric ERCP should be established.

Treatment of low-pH rubber wastewater using ureolytic bacteria and the production of calcium carbonate precipitate for soil stabilization.

Rubber wastewater contains variable low pH with a high load of nutrients such as nitrogen, phosphorous, suspended solids, high biological oxygen demand (BOD), and chemical oxygen demand (COD). Ureolytic and biofilm-forming bacterial strains Bacillus sp. OS26, Bacillus cereus OS36, Lysinibacillus macroides ST13, and Burkholderia multivorans DF12 were isolated from rubber processing centres showed high urease activity. Microscopic analyses evaluated the structural organization of biofilm. Extracellular polymeric substances (EPS) matrix of the biofilm of the strains showed the higher abundance of polysaccharides and lipids which help in the attachment and absorption of nutrients. The functional groups of polysaccharides, proteins, and lipids present in EPS were revealed by ATR-FTIR and 1H NMR. A consortium composed of B. cereus OS36, L. macroides ST13, and B. multivorans DF12 showed the highest biofilm formation, and efficiently reduced 62% NH3, 72% total nitrogen, and 66% PO43-. This consortium also reduced 76% BOD, 61% COD, and 68% TDS. After bioremediation, the pH of the remediated wastewater increased to 11.19. To reduce the alkalinity of discharged wastewater, CaCl2 and urea were added for calcite reaction. The highest CaCO3 precipitate was obtained at 24.6 mM of CaCl2, 2% urea, and 0.0852 mM of nickel (Ni2+) as a co-factor which reduced the pH to 7.4. The elemental composition of CaCO3 precipitate was analyzed by SEM-EDX. XRD analysis of the bacterially-induced precipitate revealed a crystallinity index of 0.66. The resulting CaCO3 precipitate was used as soil stabilizer. The precipitate filled the void spaces of the treated soil, reduced the permeability by 80 times, and increased the compression by 8.56 times than untreated soil. Thus, CaCO3 precipitated by ureolytic and biofilm-forming bacterial consortium through ureolysis can be considered a promising approach for neutralization of rubber wastewater and soil stabilization.

Performance of wood waste biochar and food waste compost in a pilot-scale sustainable drainage system for stormwater treatment.

Sustainable drainage system (SuDS) for stormwater reclamation has the potential to alleviate the water scarcity and environmental pollution issues. Laboratory studies have demonstrated that the capacity of SuDS to treat stormwater can be improved by integrating biochar and compost in the filter media, whereas their performance in scaled-up applications is less reported. This study examines the effectiveness of a pilot-scale SuDS, bioswale followed by bioretention, amended with wood waste biochar (1, 2, and 4 wt.%) and food waste compost (2 and 4 wt.%) to simultaneously remove multiple pollutants including nutrients, heavy metals, and trace organics from the simulated stormwater. Our results confirmed that SuDS modified with both biochar (2 wt.%) and compost (2 wt.%) displayed superior water quality improvement. The system exhibited high removal efficiency (> 70%) for total phosphorus and major metal species including Ni, Pb, Cd, Cr, Cu, and Zn. Total suspended solids concentration was approaching the detection limit in the effluent, thereby confirming its capability to reduce turbidity and particle-associated pollutants from stormwater. Co-application of biochar and compost also moderately immobilized trace organic contaminants such as 2,4-dichlorophenoxyacetic acid, diuron, and atrazine at field-relevant concentrations. Moreover, the soil amendments amplified the activities of enzymes including ß-D-cellobiosidase and urease, suggesting that the improved soil conditions and health of microbial communities could possibly increase phyto and bioremediation of contaminants accumulated in the filter media. Overall, our pilot-scale demonstration confirmed that the co-application of biochar and compost in SuDS can provide a variety of benefits for soil/plant health and water quality.

Experiencing art creation as a therapeutic intervention to relieve anxiety - a case study of a university's ceramic art course.

Background: University students are anxiety prone. Due to their changing their social roles, the proportion of university students with anxiety is relatively high. In this study, using the simple random sampling, we surveyed 53 university students, including sophomores, juniors, and seniors. Aims: This paper examines the relationship between art creation and anxiety. Methods: This study uses the Self-Assessment Anxiety Scale (SAS). The test form measures the presence and extent of their anxiety problems through a series of questions. We tested the effects of an art creation process on SAS scores and suggest best practices for course settings and teaching methods for art-related subjects. Results: Art therapy intervention reduced anxiety. The most effective technique was found to be slapping the clay board during the creation process. Other actions relieved anxiety as well. Results suggest that the art creation process is an application of art therapy effective in relieving anxiety in university students. Conclusion: Key actions in the process of creating art are closely related to the treatment approaches used in art therapy interventions. This has the potential to not only improve mental health, but also to promote the health and well-being of students. Implications for future research: Rapid societal changes increasing competition for employment creates work and life pressures. University students face challenges with learning, peer competition, and employment, often resulting in anxiety. A diversified curriculum can alleviate anxiety through proper curricular planning and design. Based on this, the university's arts courses should be able to study how to improve and optimize the existing teaching and learning outcomes and can be integrated with the university's general education curriculum planning. Through appropriate teaching content and learning methods, the courses of university general education can play a role in reducing students' anxiety and promote physical and mental health, thus contributing to sustainable development of the society.

Role of plasma process gas on permeate flux augmentation of cellulose nitrate membrane for mud water treatment.

A comparative study between Nitrogen (N2) and Argon (Ar) plasma is carried out to investigate its effect on surface morphology, hydrophilicity, permeate flux and ageing of cellulose nitrate polymeric membranes in the present work. Langmuir probe and Optical Emission Spectroscopy are used to characterize the plasma. The SEM analysis reveals the noticeable macro-void creations and pore enlargement for both N2 and Ar plasma. The AFM analysis shows a higher surface roughness for Ar plasma treatment as compared to N2 plasma treatment. XPS analysis confirms the changes in the polymer matrix along with the incorporation of various functional groups on the membrane surface as a result of the plasma treatment. A better hydrophilic nature with prolonged plasma treatment is observed for Ar plasma as compared to N2 plasma treatment. The present results show a higher permeate flux with a high rejection rate for Ar plasma treatment in comparison to N2 plasma, which might be due to the pore size and pore area enlargement of the membrane. The hydrophobic recovery for both the plasma-treated membranes is found significant for the initial ageing period of 7 days and found almost stable in nature after 7 days. A diffusion-based theoretical model is developed to study the hydrophobic recovery of plasma-treated membranes. A strong alignment between experimental and theoretical results is observed in the present work. The Cake Filtration model, derived from the Hermia model, is identified as the most suitable model for describing the fouling mechanisms for the present work.

A Fe(III) intercalated clay nanoplatform for combined chemo/chemodynamic therapy.

A Fe(III) intercalated montmorillonite nanoplatform (Fe-MMT) was engineered for doxorubicin (DOX) loading. The constructed Fe-MMT/DOX nanoplatform could not only improve the production of H2O2 to enhance chemodynamic therapy but interfere with DNA damage repair to amplify the efficacy of DOX, proving an ideal combination of chemotherapy and chemodynamic therapy.