Occurrence of chlorinated volatile organic compounds (VOCs) in a sanitary sewer system: Implications for assessing vapor intrusion alternative pathways.

Sewer systems have been recently recognized as potentially important exposure pathways to consider during vapor intrusion assessments; however, this pathway has not been well-characterized and there is need for additional information about the occurrence of volatile organic compounds (VOCs) in sewer systems. This paper reports the results of sewer gas sampling conducted in a sanitary sewer over the years of 2014-2017. Sewer gas samples were collected and analyzed using several different techniques, including TO-15 (grab), TO-17 (passive), Radiello® (passive) and a novel continuous monitoring technique, the Autonomous Rugged Optical Multigas Analyzer (AROMA). The applicability of each of the different approaches used in this study is discussed in the context of investigating sanitary sewers as a vapor intrusion alternative pathway. The data confirmed that trichloroethylene (TCE) concentrations in sewer gas were detected adjacent to and extending hundreds of feet away from a previously defined vapor intrusion area, where TCE was a primary contaminant. TCE concentrations detected in sewer gas ranged from non-detect to 1600µg/m3. Temporal variability was observed in TCE concentrations over timescales that ranged from minutes to months to years at discrete sampling locations. Spatial variability in sewer gas concentrations was also observed throughout the study area. Temporal and spatial variability may be caused by groundwater contamination sources in the study area, as well as sewer gas transport mechanisms.

EPICON consensus: recommendations for proper management of switching to eslicarbazepine acetate in epilepsy. / Consenso Delphi EPICON: recomendaciones sobre el manejo adecuado del cambio a acetato de eslicarbazepina en epilepsia.

INTRODUCTION: The objective of the EPICON Project is to develop a set of recommendations on how to adequately switch from carbamazepine (CBZ) and oxcarbazepine (OXC) to eslicarbazepine acetate (ESL) in some patients with epilepsy. METHODS: A steering committee drafted a questionnaire of 56 questions regarding the transition from CBZ or OXC to ESL in clinical practice (methodology and change situation). The questionnaire was then distributed to 54 epilepsy experts in 2 rounds using the Delphi method. An agreement/disagreement consensus was defined when a median ≥ 7 points or ≤ 3 was achieved, respectively, and a relative interquartile range ≤ 0.40. We analysed the results obtained to reach our conclusions. RESULTS: Our main recommendations were the following: switching from CBZ to ESL must be carried out over a period of 1 to 3 weeks with a CBZ:ESL dose ratio of 1:1.3 and is recommended for patients who frequently forget to take their medication, those who work rotating shifts, polymedicated patients, subjects with cognitive problems, severe osteoporosis-osteopaenia, dyslipidaemia, or liver disease other than acute liver failure, as well as for men with erectile dysfunction caused by CBZ. The transition from OXC to ESL can take place overnight with an OXC:ESL dose ratio of 1:1 and it is recommended for patients who frequently forget to take their medication, those who work rotating shifts, polymedicated patients, or those with cognitive problems. The transition was not recommended for patients with prior rash due to CBZ or OXC use. CONCLUSION: The EPICON Project offers a set of recommendations about the clinical management of switching from CBZ or OXC to ESL, using the Delphi method.

A study of thin film solid phase microextraction methods for analysis of fluorinated benzoic acids in seawater.

Fluorinated benzoic acids (FBAs) are frequently used as tracers by the oil industry to characterize petroleum reservoirs. The demand for fast, reliable, robust, and sensitive approaches to separate and quantify FBAs in produced water, both in laboratory and field conditions, has not been yet fully satisfied. In this study, for the first time, thin film solid phase microextraction (TF-SPME) is proposed as a versatile sample preparation tool for the determination of FBAs in produced water by pursing two different approaches. First, an automated high throughput TF-SPME method using solvent desorption for fast and simultaneous preparation of multiple samples prior to liquid chromatographic separation and high resolution mass spectrometric detection (LC-MS) of FBAs was demonstrated for routine laboratory analysis. This method was optimized in terms of extraction phase chemistry, sample pH and ionic strength, extraction/desorption times using two representative FBAs (4-FBA and 2,3,4,5-tetra FBA). It incorporates a relatively simple sample pretreatment involving pH adjustment prior to the TF-SPME, and obtained limits of quantification (LOQ) are at the 1.0ngmL(-1) level. Second, the applicability of TF-SPME for fast mass spectrometric (MS) determination of FBAs with omission of derivatization and gas chromatographic (GC) separation was proven. This second method consists of manual extractions of analytes from seawater samples with a thermally stable TF-SPME membrane and direct thermal desorption of the extracted FBAs to a MS via a thermal desorption unit (TDU). It was demonstrated that the TF-SPME extracts and thermally releases analytes quantitatively and with good reproducibility. This approach opens up the possibility for on-site measurements with portable analyzers.

Clinical and neuroimaging characteristics of 14 patients with prionopathy: a descriptive study.

INTRODUCTION: Prionopathy is the cause of 62% of the rapidly progressive dementias (RPD) in which a definitive diagnosis is reached. The variability of symptoms and signs exhibited by the patients, as well as its different presentation, sometimes makes an early diagnosis difficult. METHODS: Patients withdiagnosis of definite or probable prionopathy during the period 1999-2012 at our hospital were retrospectively reviewed.The clinical features and the results of the complementary tests (14-3-3 protein, EEG, MRI, FDG-PET, and genetic analysis) were evaluated in order to identify some factors that may enable an earlier diagnosis to be made. RESULTS: A total of 14 patients are described: 6 with definite sporadic Creutzfeldt-Jakob (sCJD) disease, 3 with probable sCJD, 4 with fatal familial insomnia, and 1 with the new variant. The median age at diagnosis was 54 years old. The mean survival was 9.5 months. Mood disorder was the most common feature, followed by instability and cognitive impairment. 14-3-3 protein content in the cerebrospinal fluid was positive in 7 of 11 patients, and the EEG showed typical signs in 2 of 12 patients. Neuroimaging (FDG-PET, MRI) studies suggested the diagnosis in 13 of the 14 patients included. CONCLUSIONS: Most patients presenting with RPD suffer from a prion disease. In our series the most useful complementary tests were MRI and FDG-PET, being positive in 13 of the 14 patients studied.

Identifying single molecular ions by resolved sideband measurements.

The masses of single molecular ions are nondestructively measured by cotrapping the ion of interest with a laser-cooled atomic ion, (40)Ca(+). Measurement of the resolved sidebands of a dipole forbidden transition on the atomic ion reveals the normal-mode frequencies of the two ion system. The mass of two molecular ions, (40)CaH(+) and (40)Ca(16)O(+), are then determined from the normal-mode frequencies. Isotopes of Ca(+) are used to determine the effects of stray electric fields on the normal mode measurement. The future use of resolved sideband experiments for molecular spectroscopy is also discussed.

The np Rydberg series of boron monohydride: l-uncoupling and its evolution for intermediate principal quantum numbers n = 4 to n = 11.

Using optical-optical-optical triple-resonance spectroscopy, we assign rotational levels with N = 0-5 in the vibrationless, lower-n, p Rydberg states of (11)BH. We apply the Hill and Van Vleck formulation for energy levels with l = 1 in a Hund's case intermediate between (b) and (d) to gauge the energy separating (1)Π and (1)Σ(+) states with zero rotation for n = 4-11. This energy difference, A(l, ξ), represents the strength of the coupling, ξ, between the electron orbital angular momentum, l, and the internuclear axis, which determines the Λ-splitting constant, q(0). The np series exhibits a large q(0) that increases monotonically with n to reach a magnitude similar to the rotational constant, B(0), by n = 9. For higher principal quantum numbers, Λ ceases to be a good quantum number, and l-uncoupling becomes virtually complete for n > 10.

The np Rydberg series of boron monohydride: l-uncoupling and Rydberg electron interactions with the rovibrational motion of the ion core.

A simple two-channel quantum defect theory approach accounts for resonance positions in the np Rydberg series of (11)BH. The transition from Hund's case (b) to (d) in the interacting levels of this np series represents a fundamental example of electron orbital ⇔ cation core rotational coupling, and frame transformation theory offers a means to connect close-coupled electronically excited-state potentials and l-uncoupled Rydberg positions. This evolving interaction of the np Rydberg electron with the rotational and the vibrational motion of the (11)BH(+) core is formulated in terms of quantum defects, µ(λ)(v(+)).

[Video-EEG monitoring and simultaneous ECG for the differential diagnosis of transient consciousness disorders. A case report]. / Monitorización con vídeo-EEG y ECG simultáneo para el diagnóstico diferencial de trastornos de conciencia transitorios. A propósito de un caso.

We present the case of a 36 year-old woman, with history of transient consciousness disorders with vegetative state, interpreted as epileptic crises and treated with valproate for two years. After nine asymptomatic years, they reappeared associated with migraine, vomiting and some generalized convulsions. Electroencephalogram and cerebral magnetic resonance turned out normal, and treatment with zonisamide was started, without beneficial results. Later cardiological studies objectified a blockage of the left branch that coincided with dizziness. The study was completed with Video-EGG monitoring, where there was an episode that showed temporary right epileptiform activity, with a diagnosis established of focal epilepsy of unknown cause. At present, she remains asymptomatic with oxycarbazepine.

Quality of life and treatment satisfaction in Spanish epilepsy patients on monotherapy with lamotrigine or valproic acid.

BACKGROUND: Patients suffering from epilepsy have an impaired health related quality of life (HRQoL) because of seizures and treatment adverse events. Epilepsy affects differently both genders, due to hormonal influence in women. The aim of this study is to assess the impact on HRQoL and treatment satisfaction in epilepsy patients treated with stable doses of lamotrigine and valproic acid. METHODS: Observational cohort prospective study was conducted in 18 Spanish neurology sites. Patients with clinically stable partial or generalized epilepsy, already receiving lamotrigine or valproic acid on monotherapy, were assessed in two visits: baseline and at 6 months. Socio-demographic and clinical variables were recorded at baseline; HRQoL (QOLIE-10) treatment satisfaction and women image self-perception were assessed at both visits. Impact on HRQoL was assessed in both treatment arms overall and in the women subgroup. RESULTS: A total of 107 patients were evaluated; 53 (14 men, 39 women) on lamotrigine and 54 (27 men, 27 women) on valproic acid. Mean (SD) age was 30.4 (9.1) years and mean (SD) time since epilepsy diagnosis was 8 (8.1) years. Mean (SD) QOLIE-10 score at baseline was 73.9 (15.7) points (76.6 and 71.4 for lamotrigine and valproic, respectively). At follow up, patients reported better HRQoL on both lamotrigine (78.8 points) (p<0.05) and on valproic (72.4 points) in comparison with baseline. Women's HRQoL at follow up was better on the lamotrigine arm compared with valproic acid: 78.8 (12.8) vs. 70.3 (15.9) (p<0.05). Women on the lamotrigine arm declared higher satisfaction with treatment and higher disagreement with the different statements referred to a negative image self-perception. CONCLUSIONS: Chronic patients with epilepsy already treated with lamotrigine slightly improved HRQoL at 6 month follow up, whereas no significant changes were observed in the valproic acid group. Lamotrigine impact on patients' HRQoL seems to be even more positive in the subgroup of women.

Infrared spectra of C2H6, C2H4, C2H2, and CO2 aerosols potentially formed in Titan's atmosphere.

Pure and mixed aerosols of ethane, ethylene, acetylene and carbon dioxide were generated in a collisional cooling cell and characterized by Fourier transform infrared spectroscopy between 600 and 4000 cm(-1). Pure ethane, pure ethylene, and mixed ethane/ethylene initially form supercooled liquid droplets, which over time crystallize to their stable solid phases. These droplets are found to be long-lived (up to hours) for pure ethane and mixed ethane/ethylene, but short-lived (up to seconds) for pure ethylene. Acetylene and carbon dioxide form solid aerosol particles. Acetylene particles have a partially amorphous structure, while carbon dioxide particles are crystalline. The structure of the infrared bands of carbon dioxide is strongly determined by the particles' shape due to exciton coupling. The comparison of various mixed systems reveals that acetylene very efficiently induces heterogeneous crystallization. As reported earlier, the co-condensation of acetylene and carbon dioxide can lead to the formation of a metastable mixed crystalline phase. Our preliminary calculations show that this mixed phase has a monoclinic rather than the cubic structure proposed previously.

LC method for the therapeutic drug monitoring of lamotrigine: evaluation of the assay performance and validation of its application in the routine area.

An accurate and precise high-performance liquid chromatographic method using diode array detection for the determination of lamotrigine in human plasma has been developed and validated for use in pharmacokinetic studies. A validation strategy based on the accuracy profiles was used to select the most appropriate regression model and to determine the limits of quantitation as well as the concentration range. On the other hand, the present paper also shows this validation approach as a suitable tool to guaranty the quality of the results obtained by the use of the analytical validated methodology for plasma lamotrigine determination in a routine setting and to ensure the risk of obtaining the future measurements outside the previously fixed acceptance limits.

[Video-electroencephalography: a necessity]. / Vídeo-electroencefalografía: una necesidad.

The video-EEG is a common diagnostic tool nowadays. The technical achievements of the last decade have brought a simplification of the equipment required to obtain good quality recordings, with little more than a computer and a video camera being necessary. However, the medical and technical staff must be well trained to execute and interpret the study. It is very useful in the diagnosis of paroxysmal events, for the classification and characterization of epileptic seizures and to quantify epileptiform discharges. Due to the importance of a correct diagnosis to avoid mistreating many neurological patients, this tool should be accessible to clinicians. In spite of the advances of recent years, 20-30% of patients diagnosed with epilepsy are not really epileptic, a fact that it is excessive and unacceptable.

[Management of first epileptic seizure and status epilepticus in the emergency department]. / Manejo de la primera crisis epiléptica y del status en urgencias.

First epileptic seizure is a common reason for attending the emergency department. Its management is focused on diagnosis of the episode and on identification and treatment of the underlying cause. Occasionally, anti-epileptic treatment will be required. However, when the seizure is prolonged - a condition known as status epilepticus - it becomes a life-threatening process and requires immediate treatment. In this article, general advice and guidelines for the management of seizures and of status epilepticus in emergency departments is reviewed.

[Validation of the Spanish version of the QOLIE-10 quality of life in epilepsy questionnaire]. / Validación de la versión española del cuestionario de calidad de vida en epilepsia QOLIE-10.

INTRODUCTION: Epilepsy patients not only have to deal with the disease itself but also the side effects of some treatments, fear about sudden occurrence of seizures, stigmatization, and restrictions in activities of daily living. For this reason, it is accepted that seizure control is only one feature of the clinical management of epilepsy, since cognitive, physical and psychological deterioration also affects quality of life. It is essential to have measurement tools that rapidly and accurately evaluate the complex aspects included in the concept of quality of life in persons with epilepsy. This study has aimed to validate the specific Health-Related Quality of Life (HRQoL) questionnaire for epileptic patients, QOLIE-10 (Quality of Life in Epilepsy Inventory-10), a reduced version having easier clinical application than the QOLIE-31 in a Spanish population. METHODS: Naturalistic, prospective, national and multicenter study, in which 21 Spanish neurologists took part. Patients with partial or generalized epilepsy from 18 to 50 years, who were under monotherapy with lamotrigine or valproic acid and clinically stables, were included. Two visits were carried out, one basal visit and a 6, month follow-up visit. Sociodemographic, clinical (ti-me since diagnosis, previous treatment, current treatment and perceived adverse events) and social variables (QOLIE-31, QOLIE-10) were collected. RESULTS: A total of 107 patients were included. Mean age was 30.4 (deviation standard [DE]: 9.1) years and 61.7% were women. Mean time since epilepsy diagnosis was 8 (SD: 8.1) years. A total of 84.1% of the patients answered all the items correctly (feasibility). The Kaiser- Myer-Olkin measure was 0.822, with an associated pvalue<0.001 (content validity). QOLIE-10 scores did not show any relationship with the type of seizures (p>0.05), either globally or for its different domains (cross-sectional validity). The mean score went from 73.9 (SD: 15.7) to 75.5 (SD: 14.9) between the two visits, equivalent to an increase of HRQoL of 1.6 (SD: 7.6) points (p=0.37) (longitudinal validity). A Cronbach's alpha coefficient of 0.811 was obtained (internal consistency). Interclass correlation coefficients were higher than 0.7 (reliability). In the overall score the effect size obtained was of 0.10 (responsiveness to change). CONCLUSIONS: The Spanish version of the QOLIE-10 has been shown to be feasible, valid, reliable and responsive to changes. The QOLIE-10 is a useful tool to measure HRQoL in usual clinical practice.

[Epilepsy and sleep]. / Epilepsia y sueño.

The relationship between sleep and epilepsy is known from more than a century ago. At the end of the XIXth century a temporal relationship between the onset of epileptic seizures and the wake-sleep cycle was observed. The introduction of the electroencephalogram allowed establishing the effect of sleep and sleeping deprivation on epileptiform interictal discharges and on epileptic seizures. The recognition of the variety of generalized and partial epileptic syndromes associated to sleep is important to make a correct differential diagnosis of patients presenting with motor and behavioural disturbances of sleep. This article reviews the different aspects of the relationship between epilepsy and sleep.

Dynamics of dissociative recombination versus electron ejection in single rovibronic resonances of BH.

Optical-optical-optical triple resonance spectroscopy isolates transitions to vibrationless Rydberg states of BH with principal quantum numbers from n=7 to 50. Corresponding resonances appear in the excitation spectrum of excited boron atoms produced by the dissociative relaxation of these states. The decay to neutral products occurs on a nanosecond time scale. Yet, corresponding resonances show Fano coupling widths that approach 1 cm-1. Above threshold, spontaneous ionization dominates, but line shapes match for resonances with the same electron orbital quantum numbers built on v+=0 and v+=1 cores. This striking feature-for-feature similarity in predissociation and autoionization line shapes affirms that inelastic electron-cation scattering pathways leading to electron ejection and dissociative recombination proceed through a common continuum.

Rovibrational characterization of X 2Sigma+ 11BH+ by the extrapolation of photoselected high Rydberg series in 11BH.

Optical-optical-optical triple-resonance spectroscopy of (11)BH isolates high Rydberg states that form series converging to rotational state specific ionization potentials in the vibrational levels of (11)BH(+) from nu(+)=0 through 4. Limits defined by a comprehensive fit of these series to state-detailed thresholds yield rovibrational constants describing the X (2)Sigma(+) state of (11)BH(+). The data provide a first determination of the vibrational-rotational interaction parameter alpha(e)=0.4821 cm(-1) and a more accurate estimate of omega(e)=2526.58 cm(-1) together with the higher-order anharmonic terms omega(e)x(e)=61.98 cm(-1) and omega(e)y(e)=-1.989 cm(-1). The deperturbation and global fit of series to state-detailed limits also yield a precise value of the adiabatic ionization potential of (11)BH of 79 120.3+/-0.1 cm(-1), or 9.810 33+/-1x10(-5) eV. High precision is afforded here by the use of graphical analysis techniques, narrow-bandwidth laser systems, and an analysis of newly observed, high principal quantum number Rydberg states that conform well with Hund's case (d) electron-core coupling limit.

[Ictal asystolia in the differential diagnosis of dizziness]. / Asistolia ictal en el diagnóstico diferencial del mareo.

Frequently, epileptic seizures are accompanied by changes in the heart rate. They are usually transient and irrelevant for the patient's symptoms and the patient recorders his usually baseline rhythm in second or a few minutes. In this report we present a case of a patient diagnosed previously of epilepsy who presented episodes of dizziness and presyncope. During the video-EEG study we recorded one of these spells. The diagnosis of this spell was a focal seizure associated with asystole: the seizure was almost asymptomatic, and only when the asystole developed (40 seconds after the EEG ictal changes) the patient complained about dizziness. Recovery was fast, but treatment with pacemaker must be considered.

[Safety of levetiracetam as adjunctive therapy in epilepsy: the SKATE trial in Spain]. / Seguridad del levetiracetam como tratamiento adyuvante en la epilepsia: el estudio SKATE en España.

AIM: To continue assessing safety and to evaluate the efficacy of levetiracetam and to assess the optimal dose in community based practice. PATIENTS AND METHODS: Single-arm, open label, multicenter, observational and prospective trial lasting 16-22 weeks. Criteria for inclusion: patients > 16 years experiencing epilepsy with partial seizures taking at least one concomitant antiepileptic drug. The initial dose was 1,000 mg/day, up to the maximal dose of 3,000 mg/day. Safety evaluation was adverse events reporting. Efficacy evaluation were reduction in seizure frequency; QOLIE-10 questionnaire and global evaluation scale of disease severity. RESULTS: Of the 342 subjects, 296 (86.5%) completed the treatment period. 103 subjects (30.1%) experienced at least one adverse event. The most frequently adverse events reported were somnolence (11.7%), dizziness (5.8%) and headache (3.5%). The events were majority (93.1%) of mild to moderate intensity. The median percent reduction in partial seizure frequency per week was 55%. 51.2% of patients experienced a reduction 50% in partial seizure frequency. Similar results were observed for total seizures. An increase of QOLIE-10 total score was observed (10.2 +/- 17.8). A total of 63.5% patients were rated as having moderate or marked improvement in their disease severity. CONCLUSIONS: These data confirm and provide additional support of levetiracetam safety and efficacy demonstrated in phase III trials.