Concentrated Ionic Fluids: Is There a Difference Between Chloride-Based Brines and Deep Eutectic Solvents?

Deep Eutectic Solvents (DESs) have been lauded as novel solvents, but is there really a difference between them and concentrated aqueous brines? They provide a method of adjusting the activity of water and chloride ions which can affect mass transport, speciation and reactivity. This study proposes a continuum of properties across concentrated ionic fluids and uses metal processing as an example. Charge transport is shown to be governed by fluidity and there is no discontinuity between molar conductivity and fluidity irrespective of cation, charge density or ionic radius. Diffusion coefficients of iron(III) and copper(II) chloride in numerous concentrated ionic fluids show the same linear correlation between diffusion coefficient and fluidity. These oxidising agents were used to etch copper, silver and nickel and while the etching rate increased with fluidity for copper, etching of silver and nickel only occurred at high chloride and low water activity as passivation occurred when water activity increased. Overall, brines provide a high chloride content at a lower viscosity than DESs, but unlike DESs, brines are unable to prevent passivation due to their high water content. The results show how selective etching of mixed metal waste streams can be achieved by tuning chloride and water activity.

NICU infants who require a feeding gastrostomy for discharge.

OBJECTIVE: To determine population data for infants receiving a gastrostomy tube (GT) in our Neonatal Intensive Care Unit (NICU) to better understand the premature infant population at risk for GT prior to discharge. STUDY DESIGN: We identified all NICU infants born 2015-2016 who received a GT and determined the birth gestational age below which GTs were placed due to oral feeding failure secondary to prematurity-related comorbidities, rather than anomalies or other reasons. Aggregate data were used to compare infants born <30 weeks (w) gestation who received a GT with those who did not. RESULTS: GTs were placed in 117 infants. More than half of the NICU patients who receive GTs were actually >32 weeks gestation; a cut-off of <30w was a good identifier for those who failed achieving full oral feeds due to prematurity-related problems. Infants born <30w (n = 282) not receiving GTs were discharged at a significantly lower postmenstrual age (36w) and lower weight (2.3 kg) compared with infants who received a GT (49w, 5 kg). CONCLUSIONS: The population of premature infants born <30w gestation constitute the population of infants at risk for a GT based solely on prematurity. LEVELS OF EVIDENCE: III.

Association Between CYP2C19*17 Alleles and pH Probe Testing Outcomes in Children With Symptomatic Gastroesophageal Reflux.

Esophageal pH monitoring remains a primary diagnostic tool for detecting gastroesophageal reflux disease (GERD). GERD that is refractory to proton pump inhibitor (PPI) medications may be related to CYP2C19 variants. Current PPI dosing practices in children do not take into account CYP2C19 allelic variants, which may lead to underdosing and subsequently to a misperception of PPI therapy failure. We hypothesized that pH probe acid exposure outcomes associate with CYP2C19*17 alleles among children with clinical concern for GERD. We identified a retrospective cohort of 74 children (age range 0.71-17.1 years, mean 8.5, SD 4.6) with stored endoscopic tissue samples and who had also undergone esophageal pH testing while on PPI therapy. These individuals were genotyped for common CYP2C19 alleles and were dichotomized to either CYP2C19*17 allelic carriers without corresponding loss of function alleles as cases vs controls. Associations between pH probe acid exposure outcomes and CYP2C19*17 alleles were investigated. Compared to controls, children who carry CYP2C19*17 alleles without corresponding loss-of-function alleles demonstrated statistically significant longer times with pH < 4 (76.46 vs 33.47 minutes, P = .03); and higher percent of time with pH < 4.0 (5.71 vs 2.67 minutes, P = .04). These findings remained statistically significant using multiple-regression modeling with test duration, PPI dose, and race as confounding variables. PPI therapy in children with *17 alleles may be better optimized with CYP2C19 genotype-guided dosing prior to pH probe testing.

Association between CYP2C19 extensive metabolizer phenotype and childhood anti-reflux surgery following failed proton pump inhibitor medication treatment.

When pediatric gastroesophageal reflux disease (GERD) that is refractory to proton pump inhibitor (PPI) medication treatment is identified in clinical practice and anti-reflux surgery (ARS) is being considered, genetic factors related to PPI metabolism by the CYP2C19 enzyme are currently not part of the clinical decision-making process. Our objective was to test the hypothesis that the distribution of the extensive metabolizer (EM) phenotypes among children undergoing ARS after failing PPI therapy would differ compared to controls (children with no history of ARS). We conducted a case-control study between children across the Nemours Health System from 2000 to 2014 who received ARS after failing PPI therapy and a control group comprised of healthy children. Our results demonstrated 2.9% of ARSs vs 20.8% of controls were poor metabolizers (PMs), 55.9% of ARSs vs 49.0% of controls were normal metabolizers (NMs), and 41.2% of ARSs vs 30.2% of controls were EMs; p = 0.035. Next, we performed a multiple-regression model to account for race as a potential confounding variable and the EM group was significantly associated with ARS compared to controls (OR 9.78, CI 1.25-76.55, p < 0.03). CONCLUSION: Among children with medically refractory GERD despite PPI therapy, carriage of CYP2C19*17 allele corresponding to the EM phenotype was associated with ARS. Prospective comparative personalized medicine effectiveness studies are needed to determine if CYP2C19 genotype-guided dosing improves response to PPI therapy without a corresponding increase in adverse effects in children. What is known: • Anti-reflux surgery (ARS) is one of the most common surgical procedures performed in children for the indication of refractory gastroesophageal reflux disease (GERD). What is new: • Individualizing PPI medication dosing based on CYP2C19 diplotype may avoid GERD treatment failures and reduce the need for anti-reflux surgery (ARS).

Integration of Data to Establish a Standard Operating Procedure for the Diabetic Patient Undergoing Hyperbaric Oxygen Therapy.

PURPOSE: The purpose of this study was to describe occurrences of hypoglycemia in the diabetic population undergoing hyperbaric oxygen therapy (HBOT). We also examined 2 secondary aims: link industry standards for management of hypoglycemia in the general diabetic population to the HBOT environment; and integrate HBOT data into an electronic health record system, as patients transition across inpatient and outpatient services and settings. DESIGN: A retrospective, descriptive study. SUBJECTS AND SETTING: The study took place within a hyperbaric medicine department located in a 1393-bed acute care medical center, part of a large, multihospital system. The study sample comprised 100 diabetic patients who underwent HBOT between January 1 and May 31, 2015. Sixty-seven percent were male; the mean age of participants was 62 years (range 32-92 years). Admission status was nearly equal with 53% hospital inpatients and 47% ambulatory outpatients. Hospital protocol required all patients to have a minimal prehyperbaric blood glucose level (BGL) of 100 mg/dL. RESULTS: The incidence of hypoglycemia (defined as a BGL <100 mg/dL, 5.5 mmol/L) was 122 of 1175 treatments (10.4%). Additional analysis was based on records for 66 of the 122 incidences with evaluable data from electronic medical records. The mean BGL pre-HBOT was 177.86 mg/dL, 6.54 mmol/L (range 53-439 mg/dL, 2.94-24.36 mmol/L); the mean BGL after HBOT was 165.09 mg/dL, 9.16 mmol/L (range 56-414 mg/dL, 3.11-22.98 mmol/L). Analysis of these 66 occurrences revealed that 52 of 66 (79%) were managed with high-carbohydrate juices and snacks; 8 of 66 (12%) received oral glucagon; and 6 of 66 (9%) received glucagon and high-carbohydrate snack. We found that standard treatment protocols for hypoglycemia ranged from 70 to 100 mg/dL, 3.89 to 5.55 mmol/L, for the general population and 80 to 120 mg/dL, 4.44 to 6.66 mmol/L, for the general diabetic population. We also found that HBOT diabetic data were not fully integrated into the electronic health records across all settings. CONCLUSIONS: Hypoglycemia is prevalent during HBOT. We recommend a minimum pre-treatment serum glucose of 120 mg/dL, 6.7 mmol/L.

Effectiveness of botulinum toxin B in the treatment of drooling.

The aim of this audit was to assess the effectiveness of botulinum toxin B (NeuroBloc(®), Eisai Ltd.) in the treatment of drooling. Over a period of 18 months patients treated with NeuroBloc(®) botulinum toxin (BTX) for serious drooling (drooling score more than 7) were invited to complete a questionnaire on their experience of drooling and the impact of treatment. A total of 170 questionnaires were given to consecutive patients or carers and 145 (85%) responded. Of these, 128 (88%) reported that symptoms had improved by 6/10 or more on a visual analogue scale (VAS), and 54 (37%) reported compete resolution of drooling (10/10 VAS). A total of 139 (96%) would recommend the treatment to others.

Does the method of resection affect the margins of tumours in the oral cavity? Prospective controlled study in pigs.

It is important to obtain tumour-free resection margins in patients with oral cancer. Pathological processing is known to cause tissue to shrink, which affects the reported margins, and it is postulated that the method of resection also has an effect. We marked standardised simulated lesions on the tongues of 15 live anaesthetised pigs and divided each lesion into four equal sections. They were resected each with a margin of 10mm using cutting diathermy, coagulative diathermy, Harmonic scalpel, and a conventional scalpel. After processing, the excision margins were measured. With cutting diathermy and coagulative diathermy, shrinkage of the soft tissues was minimal relative to the margin of the simulated lesion compared with the Harmonic scalpel (p=0.001) and conventional scalpel (p=0.001). Cutting diathermy and coagulative diathermy caused significant thermal damage (p=0.001). The method of resection affects the surgical margin. Diathermy resulted in thermal injury and denaturing of the underlying muscle, but there was less tissue contraction than when the Harmonic scalpel and conventional scalpel were used. The ethics committee approved the study, which was undertaken in a registered European Scientific Institute in Hamburg.

Parotid surgery for benign tumours.

PURPOSE: The majority of parotid tumours are benign, making parotid surgery a compromise between adequate tumour excision and preservation of function and facial harmony. Besides the traditional superficial or total parotidectomy, less invasive techniques have been described with similar recurrent rates. The aim of this review is to assess the evidence in the published literature and to summarise the advantages and disadvantages of the available techniques. METHODS: A systematic search in Pubmed for studies on surgery of benign parotid tumours (BPTs) published between January 2000 and January 2012 was conducted. Case series with a clear description of the surgical technique and a minimum number of 10 patients were included. RESULTS: Four hundred sixty-three articles were found, 49 abstracts reviewed and 37 case series were selected for this review. The surgical techniques for benign parotid tumours can largely be grouped into facial nerve dissecting (superficial parotidectomy, partial superficial parotidectomy and total parotidectomy) and non-nerve dissecting techniques (extracapsular dissection). With all of the currently used techniques, a low recurrence (<3 %) with a low incidence of permanent facial nerve morbidity (0.2-4 %) can be achieved. The tumour-facial nerve interface and pseudopodia are areas at risk for positive margins. CONCLUSION: There is currently no agreement in the literature about the extent of surgery for BPTs to obtain an adequate margin. The tumour nerve interface is the predetermined area at risk for tumour spillage and positive margin. A prolonged follow-up is recommended. Further long-term randomised clinical trials are required to address the question of the extent of the excision in benign parotid surgery.

Relationship between behavior, adrenal activity, and environment in zoo-housed western lowland gorillas (Gorilla gorilla gorilla).

Monitoring adrenal activity through noninvasive fecal hormone sampling is rapidly gaining popularity as a tool to assess zoo animal welfare. However, few studies have sought to investigate the interrelationships between behavior, adrenal activity, and environment, and ask whether both behavioral and adrenal monitoring strategies are required to assess welfare sufficiently. We present the findings of a 9-month study of a small group (one male, two females) of Western lowland gorillas, Gorilla gorilla gorilla. First, we examined the effect of environmental variables on gorilla behavior. Second, we examined the effect of environmental variables on the concentration of fecal glucocorticoid metabolites (FGC) and the relationship between behavior and FGC. Environmental variables had similar effects on all three gorillas. Negative vigilance of visitors (NVV; staring, posturing, and charging at visitors) significantly increased in all subjects as environmental noise levels increased, and food-related behavior significantly decreased in all subjects as crowd size increased. Exhibit modifications had a number of positive effects on behavior. Notably, when privacy screens were used, NVV significantly decreased in two subjects. We found no significant effects of environmental variables on FGC. However, we did find significant relationships between behavior and FGC in one female. Specifically, her NVV was significantly higher one day before, and on the same day as, raised FGC. Also, hair plucking significantly increased in the two days following raised FGC. Overall, this study demonstrates how concurrent noninvasive fecal and behavioral monitoring can be used for gorilla welfare assessment.

Interventions performed by New Zealand community pharmacists while dispensing prescription medications.

OBJECTIVE: To investigate the number and type of interventions performed by New Zealand community pharmacists when dispensing new prescriptions. METHOD: All community pharmacies in Dunedin, New Zealand (29) were asked to use a tally system to record the types of interventions performed, the time taken and the number of prescription items processed per day. Data was collected for one full week for 20 pharmacies. RESULTS: In total 24,059 prescription items were dispensed by the 20 pharmacies over one week. There were 1,551 separate interventions recorded with a recorded time of 1,684 min. These interventions occurred at a rate of 64 interventions per 1,000 prescription items. Of recorded interventions, bureaucratic and generic substitution problems accounted for 81%. These combined interventions occurred at a rate of 52 per 1,000 prescription items and totalled 50% of the time spent on prescription interventions. Whilst clinical interventions were recorded at a rate of 13 per 1,000 items, they accounted for the remaining 50% of time spent. CONCLUSION: Half of the time spent by community pharmacists in Dunedin, New Zealand on prescription interventions consists of correcting bureaucratic and legal issues, limiting the time pharmacists can spend on clinical services.

Large differences in blood measures, tissue weights, and focal areas of damage 1 year after postseizure treatment with acepromazine or ketamine.

Approximately 1 year after rats were seized as young adults with lithium (3 mEq/kg) and pilocarpine (30 mg/kg) and given acepromazine or ketamine, 18 blood measures, wet tissue weights, and detailed damage scores for 107 brain structures were completed. Compared with normal and ketamine-treated rats, acepromazine-treated seized rats (total n=54) had lighter pancreata and spleens and elevated aspartate aminotransferase and alanine aminotransferase blood levels. Even though average damage did not differ, the mosaic of brain damage completely discriminated the two seized groups. Differential effects of postseizure treatment on functions of the thyroid, pancreas, and spleen were indicated. Ketamine-treated seized rats were healthier than acepromazine-treated seized rats or normal rats. This experiment demonstrates the importance of whole-organism assessment and that the single administration of a specific drug after onset of status epilepticus can produce marked differences in the evolution of brain damage and its influence on specific organs for the rest of the animal's life.

Wasting syndrome and disruption of the somatotropic axis in simian immunodeficiency virus-infected macaques with Mycobacterium avium complex infection.

Mycobacterium avium is a common opportunistic infection of patients with acquired immunodeficiency syndrome (AIDS). We used the simian immunodeficiency virus (SIV)-infected rhesus macaque (Macaca mulatta) model to examine whether disseminated M. avium is associated with disruption of the somatotropic axis in AIDS. Macaques were followed prospectively, and body composition was determined by dual-energy x-ray absorption. Serum levels of insulin-like growth factor (IGF)-1, IGF binding protein-3, growth hormone (GH), and somatostatin were measured. SIV-infected macaques inoculated with mycobacteria had significant changes in body composition, perturbations of the somatotropic axis (characterized by increased GH/IGF-1 ratios) (day 0 [2.21] vs. day of death [DOD] [28.06]; P=.015, Mann-Whitney rank sum test), and increased serum somatostatin levels (day 0 [2.00 ng/mL] vs. DOD [8.58 ng/mL]; P=.026, Mann-Whitney rank sum test). These data document alterations in the somatotropic axis secondary to experimental disseminated M. avium infection and suggest that similar changes may contribute to alterations in body composition during AIDS.

Lymphocyte subpopulations and hematologic variables in dogs with congestive heart failure.

Alterations in lymphocyte subpopulations and in other hematologic variables have been documented in people with heart failure. The purpose of the current study was to compare flow cytometric and hematologic variables in dogs with congestive heart failure (CHF) to healthy controls. CD4+ peripheral blood mononuclear cells (PBMC) and CD8+ lymphocytes were analyzed by flow cytometry, and white blood cell count, platelet count, hematocrit, and hemoglobin were determined by a complete blood count. Twenty-five dogs with CHF (International Small Animal Cardiac Health Council [ISACHC] class 2 [n = 12] and ISACHC class 3a [n = 13]) and 13 healthy controls were enrolled in the study. Compared with the controls, dogs with CHF had markedly lower percentages of CD4+ PBMC, CD8+ lymphocytes, hematocrit, and hemoglobin, but markedly higher leukocytes, neutrophils, and platelets. There were no differences in these variables between dogs with dilated cardiomyopathy (n = 6) and those with chronic valvular disease (n = 19). Dogs in ISACHC class 3a had a markedly lower total lymphocyte number, CD4+ and CD8+ cells, and hematocrit, but markedly higher leukocyte and neutrophil numbers relative to the control group. CD4+ and CD8+ subpopulations and other blood cell variables are altered in dogs with CHF. Future studies to determine possible clinical implications of these changes are warranted.