Post hoc analysis of initial treatments and control status in the INITIAL study: an observational study of newly diagnosed patients with asthma.

BACKGROUND: The 12-week, multicentre, observational INITIAL study (NCT02143739) assessed asthma severity in newly diagnosed Chinese patients. METHODS: Post hoc analysis of medication combinations prescribed per routine clinical practice at baseline, and the impact on control levels evaluated using 2012 vs 2018 Global Initiative for Asthma (GINA) criteria. RESULTS: In total, 4491 patients were included in the analysis. At baseline, intermittent, mild, moderate and severe asthma was reported in 3.9, 12.0, 22.6 and 61.6% of patients, respectively. Most patients (90.2%) were prescribed inhaled corticosteroid/long-acting ß2 agonist (ICS/LABA). ICS/LABA plus ≥1 additional medication(s) was prescribed to 66.7% of patients, with leukotriene receptor antagonist (LTRA, 54.7%) being the most common additional medication. Distribution of ICS/LABA vs ICS/LABA+LTRA was comparable in patients with intermittent (3.2% vs 3.0%), mild (11.5% vs 9.7%), moderate (21.2% vs 19.9%) and severe asthma (64.1% vs 67.4%). Control levels among patients using ICS/LABA+LTRA vs ICS/LABA were comparable using GINA 2012 and lower using GINA 2018 criteria. The proportion of patients using ICS/LABA+LTRA vs ICS/LABA with intermittent, mild, moderate and severe asthma controlled at Week 12 (using GINA 2012) were 78.1% vs 80.0, 86.5% vs 85.8, 78.5% vs 71.3, and 59.6% vs 61.8%, respectively. Using GINA 2018 criteria proportions were 86.8% vs 95.9, 86.1% vs 93.2, 82.1% vs 85.3, and 71.9% vs 77.6%, respectively. CONCLUSIONS: Asthma control was not improved by adding LTRA to ICS/LABA and may have been unnecessary for some newly diagnosed patients. These findings were irrespective of the GINA criteria (2012 vs 2018) used and baseline severity.

Fe3O4 nanoparticles loading on cow dung based activated carbon as an efficient catalyst for catalytic microbubble ozonation of biologically pretreated coal gasification wastewater.

Cow dung based activated carbon was successfully modified by Fe3O4 nanoparticles as the novel catalyst (Fe3O4 nanoparticles@CDAC) to improve the microbubble ozonation treating biologically pretreated coal gasification wastewater (BPCGW). When the pH, ozone dosage, ozone bubble diameter and catalyst dosage of the ozonation were 7, 0.4 L/min, 5 µm and 3 g/L, the chemical oxygen demand (COD) removal efficiency reached 74% and the ratio of biochemical oxygen demand in five days/COD (BOD5/COD) increased from 0.04 to 0.52, which were attributed to the electron transfer of Fe2+ and Fe3+ in Fe3O4 and enhanced hydroxyl radicals generation by the reaction of iron ions and ozone. Meanwhile, benzene derivatives, naphthalene and aromatic proteins were significantly removed while multiple chain hydrocarbons and their derivatives composed the main residual organic matters. The catalytic activity was slightly decreased even the catalyst has been reused for five times. Therefore, catalytic microbubble ozonation using Fe3O4 nanoparticles@CDAC represented excellent performance treating BPCGW and it is a promising process for wastewater advanced treatment.

Factors Associated With Prolonged Viral Shedding in Patients With Avian Influenza A(H7N9) Virus Infection.

Background: Data are limited on the impact of neuraminidase inhibitor (NAI) treatment on avian influenza A(H7N9) virus RNA shedding. Methods: In this multicenter, retrospective study, data were collected from adults hospitalized with A(H7N9) infection during 2013-2017 in China. We compared clinical features and A(H7N9) shedding among patients with different NAI doses and combination therapies and evaluated factors associated with A(H7N9) shedding, using Cox proportional hazards regression. Results: Among 478 patients, the median age was 56 years, 71% were male, and 37% died. The median time from illness onset to NAI treatment initiation was 8 days (interquartile range [IQR], 6-10 days), and the median duration of A(H7N9) RNA detection from onset was 15.5 days (IQR, 12-20 days). A(H7N9) RNA shedding was shorter in survivors than in patients who died (P < .001). Corticosteroid administration (hazard ratio [HR], 0.62 [95% confidence interval {CI}, .50-.77]) and delayed NAI treatment (HR, 0.90 [95% CI, .91-.96]) were independent risk factors for prolonged A(H7N9) shedding. There was no significant difference in A(H7N9) shedding duration between NAI combination treatment and monotherapy (P = .65) or between standard-dose and double-dose oseltamivir treatment (P = .70). Conclusions: Corticosteroid therapy and delayed NAI treatment were associated with prolonged A(H7N9) RNA shedding. NAI combination therapy and double-dose oseltamivir treatment were not associated with a reduced A(H7N9) shedding duration as compared to standard-dose oseltamivir.

Treatment of stabilized landfill leachate by Fenton-like process using Fe3O4 particles decorated Zr-pillared bentonite.

Fe3O4 particles decorated Zr pillared bentonite (Fe3O4/Zr-B) were successfully synthesized, which were used to treat stabilized landfill leachate by Fenton-like process. The organics removal and biodegradability were both significantly improved owing to good catalytic stability of the magnetically recoverable catalyst. With the catalyst dosage of 1.0 mg L-1, initial pH of 2 and peroxide concentration of 0.1 mmol L-1, the COD removal efficiency increased to 68% and BOD5/COD of 0.27 was achieved. According to the results of the GC-MS, Fenton-like reaction with Fe3O4/Zr-B had an excellent removal performance for almost all the heterocyclic compounds. The 3D-EEM fluorescence spectra indicated that the fluorescence intensity was dramatically reduced and the UV humic-like and fulvic-like substances were removed effectively during the catalytic degradation. It seemed advisable to implement this process as a pre-treatment to facilitate the further biological treatment.

Effect of Intraperitoneal Instillation of Dexmedetomidine With Local Anesthetics in Laparoscopic Cholecystectomy: A Systematic Review and Meta-analysis of Randomized Trials.

OBJECTIVE: Dexmedetomidine (DEX) can strengthen the analgesic effects of local anesthetics (LAs) when used as an adjuvant through intrathecal, perineural, and intraperitoneal routes. Many studies have used intraperitoneal instillation of DEX with LAs in laparoscopic cholecystectomy (LC) to relieve postoperative pain. We performed a systematic review and meta-analysis to synthesize evidence of the efficacy and safety of intraperitoneal instillation of DEX as an adjuvant of LAs in patients undergoing LC. METHODS: A comprehensive literature search of the MEDLINE, PubMed, EMBASE, and Cochrane Library databases was performed to identify randomized controlled trials in which patients received intraperitoneal instillation of DEX combined with LAs during LC. A meta-analysis and sensitivity analysis of the results were conducted. We also performed a subgroup analysis to investigate the source of heterogeneity. The Egger test was used to check for publication bias. RESULTS: Eleven randomized controlled trials involving 890 patients were analyzed. We found that the addition of DEX to LAs significantly decreased pain scores at six postoperative time points (0.5, 1, 2, 4, 12, and 24 h) and significantly prolonged the time to the first analgesic request by patients. In addition, 24-hour postoperative analgesic consumption was decreased in the experimental group, and no significant difference in the incidence of nausea and vomiting was observed. CONCLUSION: Our findings indicate that intraperitoneal instillation of DEX with LAs can reduce postoperative pain and prolong the time to first request analgesia after LC.

Sodium valproate sensitizes non-small lung cancer A549 cells to γδ T-cell-mediated killing through upregulating the expression of MICA.

Major histocompatibility complex (MHC) class I chain-related protein A (MICA) is involved in γδ T-cell recognition of target tumor cells. The aim of this study was to investigate the feasibility of utilization of sodium valproate (VPA), a histone deacetylase inhibitor, to sensitize non-small cell lung cancer A549 cells to γδ T-cell-mediated killing. VPA induced a dose-dependent increase in the mRNA and protein expression of MICA in A549 cells. γδ T cells showed cytotoxicity to A549 cells, which was increased by about 50% in the presence of VPA. The concomitant addition of MICA antibody significantly attenuated the VPA-mediated sensitization to γδ T-cell killing. VPA enhanced the cleavage of caspase-3 and caspase-9 in A549 cells cocultured with γδ T cells, and such enhancement was reversed by the MICA antibody. In conclusion, VPA sensitizes tumor cells to γδ T-cell-mediated cytotoxicity through the upregulation of MICA and may thus have benefits in improving γδ T-cell-based cancer immunotherapy.

Mechanism analysis of efficient degradation of carbamazepine by chalcopyrite-activated persulfate.

In this study, natural chalcopyrite (NCP) was used to activate peroxymonosulfate (PMS) to degrade carbamazepine (CBZ) oxidatively. Before and after the NCP reaction, the physical and chemical properties were characterized by SEM-EDS, XRD, XPS, XRF, and VSM. The effects of the amount of NCP and PMS, the initial pH value, and the reaction temperature on the catalytic performance of NCP were systematically studied. The research results show that the degradation efficiency of the NCP/PMS system for CBZ can reach 82.34% under the optimal reaction conditions, and the degradation process follows a pseudo-second-order kinetic model. The results of the radical quenching experiment and EPR analysis show that the active species in the system are OH·, SO4-·, and 1O2, of which SO4-· is the main active species. In addition, this study shows that the NCP/PMS system can degrade CBZ with high efficiency of 90.73% only with the assistance of 0.15 g/L Fe0. This study determined the optimal reaction conditions for natural chalcopyrite to activate PMS to degrade CBZ and clarified the activation mechanism, which broadened the application of natural ores in the field of water treatment.

Sonoelectrochemical activation of peroxymonosulfate: Influencing factors and mechanism of FA degradation, and application on landfill leachate treatment.

In this work, sonoelectrochemically activated peroxymonosulfate (US-EC/PMS) was used to degrade fulvic acid (FA) in water. Compared with other technologies, the US-EC/PMS system can achieve higher FA decolorization in a short time. Moreover, the benefits of synergy are more prominent in the US-EC/PMS system. The effects of operating parameters on the sonoelectrochemical degradation of FA were investigated, including initial pH, initial FA concentration, current density, ultrasonic power, PMS dosage. The results showed the initial FA concentration and current density were critical to the degradation of FA. Under optimized parameters: initial pH of 2, 50 mg L-1 initial FA concentration, 30 mA cm-2 current density, 50 W ultrasonic power, 1 mM PMS dosage, the US-EC/PMS system can achieve 93% FA decolorization. The calculation results of current efficiency and energy consumption indicate that the introduction of PMS into the US-EC system has economic applicability. Scavenger experiments and electron paramagnetic resonance suggest that hydroxyl radicals, sulfate radicals, and singlet oxygen were the main ROS produced in the US-EC/PMS system. Accordingly, the possible mechanism of FA degradation by sonoelectrochemical activation PMS was proposed. Finally, the US-EC/PMS system was used to treat the aged landfill leachate. Three-dimensional fluorescence analysis showed that most of the humic substances (Hss) were effectively removed, and the biodegradability of the leachate was considerably improved. In addition, the effective removal of COD, chroma, and ammonia nitrogen were observed, proving that this technology is a powerful means to treat organic wastewater contaminated by Hss.

A Combined Catalytic Ozonation-MBR Approach to Remove Contaminants from the Mature Landfill Leachate in the Yellow River Basin.

The mature landfill leachate (MLL) is characterized by a large number of fulvic acids and humic acids, which is refractory organic matter and can be cleaned by ozone oxidation. However, the poor property of mass transfer prohibits the widespread use of ozone oxidation in actual leachate treatment. Meanwhile, some combined processes are adopted to treat the mature landfill leachate, which places catalytic ozonation before the membrane bioreactor (MBR) process to enhance the biodegradability of MLL. Thus, this research is conducted to investigate the practicability of applying nano-Fe3O4 loaded cow-dung ash (Fe3O4@CDA) and biological post-treatment with MBR for the effective removal of pollutants from MLL and puts forward the variation of organics in leachate between catalytic ozonation and MBR. The addition of catalytic ozonation not only improved the removal of hazardous organics but also enhanced the biodegradability of the leachate and favored the subsequent MBR process. Chemical oxygen demand (COD) removal in the catalytic ozonation step was optimized, and 53% removal was obtained at pH = 7, catalyst dosage = 1.0 g/L, and O3 dosage = 3.0 g/L. After the MBR process, COD in effluent stabilized in the range of 57.85-65.38 mg/L, and the variation range of the ammonia nitrogen (NH3-N) concentration was 5.98-10.24 mg/L. The catalytic ozonation-MBR integrated process showed strong feasibility in dealing with the biologically pre-treated leachate.

Catalytic ozonation of 2, 2'-methylenebis (4-methyl-6-tert-butylphenol) over nano-Fe3O4@cow dung ash composites: Optimization, toxicity, and degradation mechanisms.

Composite magnetic oxide at cow dung ash, nano-Fe3O4@cow dung ash (nano-Fe3O4@CDA), was used as catalytic material for the degradation of 2, 2'-methylenebis (4-methyl-6-tert-butylphenol) (AO 2246) in real biologically pretreated landfill leachate. The Fe3O4@CDA composite exhibited catalytic ozonation activity and allowed material separation and magnetic recovery. The effects of several operating parameters including O3 concentration, catalyst dosage, temperature and scavengers were evaluated in parallel. Over 70% of AO 2246 were removed by the nano-Fe3O4@CDA/O3 system under optimum conditions within 120min reaction time. The EPR, GC-MS and free-radical quenching experiments expatiated the mechanism of this degradation process. It was confirmed that the AO 2246 was degraded efficiently in this catalytic micro-ozonation process, Additionally, GC-MS analysis state clearly that the 3,5-bis(1,1-dimethylethyl)phenol, 4-(1,5-dihydroxy-2,6,6-trimethylcyclohex-2-enyl)but-3-en-2-one, ethanone, 1-(1,4-dimethyl-3-cyclohexen-1-yl)-, 5-tert-butyl-6-3, 5-diene-2-one, 2-hydroxyhexanoic acid, 2-propenoic acid 1,1-dimethylethyl ester, butanoic acid, 2-methyl-, methyl ester and propanoic acid, 2, 2-dimethyl- were the dominant oxidation products (OPs) during the degradation of the AO 2246. The EPR results showed that the catalytic ozonation over Fe3O4@CDA led to produce more hydroxyl radicals, which were in favor of AO 2246 degradation. The toxicity evolution was also performed through a QSAR analysis calculated by the ECOSAR program which further demonstrated the different responses toward the AO 2246 and its OPs.

Frequency of Signs and Symptoms in Persons With Asthma.

BACKGROUND: Signs and symptoms of asthma are well established; however, no study has been performed to rank them. Therefore, we performed this systematic review and meta-analysis to determine the pooled frequencies of different signs and symptoms of asthma in subjects age ≥ 14 y to develop a patient-specific questionnaire. METHODS: Specific search queries were developed to include records published in Embase, PubMed, Cochrane Library, and Google Scholar, until November 2016. We planned to include randomized controlled trials (RCTs) and observational studies for determining the pooled proportions of signs and symptoms and association between combination of symptoms and asthma severity in subjects age ≥ 14 y. The quality assessment was performed using 3 parameters: reported number or percentage of subjects with asthma symptoms, respiratory disorder history, and method for data collection. RESULTS: Of the 4,939 records retrieved, 67 observational studies (N = 57,033 subjects; age ≥ 14 y) were considered eligible for inclusion in the analysis. A total of 10 symptoms were reported across the studies, with pooled proportions of nasal congestion, sleep disturbances, breathlessness, chest tightness, and wheezing being 61.57%, 56.56%, 50.31%, 50.41%, and 46.97%, respectively. In records of medical history, the pooled proportion of rhinitis was 76.37%, followed by allergy/atopy at 63.53%. The pooled proportion of asthma medication use was 83.27%. In terms of the symptom combinations, the combination of wheezing, breathlessness, chest tightness, and cough was reported in 71.26% of subjects from 4 studies (n = 12,014 subjects). Nasal congestion, sleep disturbance, and chest tightness were the most common symptoms of asthma, followed by wheezing and breathlessness with a combination of symptoms (ie, wheezing, breathlessness, chest tightness, and cough) affecting the highest proportion of subjects. CONCLUSIONS: Asthma severity was dependent on variety of symptoms, consisting mostly of wheezing, breathlessness, chest tightness, and cough. On the basis of our analysis, we recommend a combination of symptoms be included in diagnostic-based questionnaires to aid early diagnosis.

INITIAL - An observational study of disease severity in newly diagnosed asthma patients and initial response following 12 weeks' treatment.

In China, there are an estimated 30 million people with asthma, a condition that remains poorly controlled in many patients. The INITIAL study (NCT02143739) was a 12-week, multicentre, prospective, observational study comprising 45 centres across Northern and Southern China that aimed to assess asthma severity among newly diagnosed patients as well as their prescribed medications and response to treatment. The primary objective was to evaluate asthma severity using Global Initiative for Asthma (GINA) 2006 research criteria. Secondary objectives included the distribution of asthma medication by GINA severity category and evaluation of GINA 2012-defined control levels. Medications were prescribed as per usual clinical practice. At baseline, among 4491 patients, 3.9%, 12.0%, 22.6% and 61.6% had intermittent, mild persistent, moderate persistent and severe persistent asthma, respectively. Inhaled corticosteroid/long-acting ß2 agonist was the most common initial therapy in 90.2% of patients. GINA 2012-defined controlled asthma levels increased in all groups, rising from 6.1% at baseline to 43.0%, 53.8% and 67.8% at Weeks 4, 8 and 12, respectively. Most patients presented with severe persistent asthma. Newly diagnosed patients with asthma could benefit from at least 3 months of regular treatment followed by long-term pharmacological management.

Catalytic micro-ozonation by Fe3O4 nanoparticles @ cow-dung ash for advanced treatment of biologically pre-treated leachate.

In this work, the biologically pre-treated leachate was subjected to catalytic micro-ozonation using cow-dung ash composites loaded with Fe3O4 nanoparticles (nano-Fe3O4@CDA) as the catalyst. The optimal conditions used were nano-Fe3O4@CDA dosage of 0.8 g/L, input ozone of 3.0 g/L, and reaction time of 120 min. This environment yielded the following results: The COD and color number (CN) removal reached 53% and 89%, respectively, and the BOD5/COD increased from 0.05 to 0.32. The catalytic micro-ozonation partially degraded the refractory substances into intermediates with lower molecular weight. The percentage of phenolic compounds decreased sharply from 28.08% to 8.56%, largely due to the opening of the ring as well as to the formation of organic intermediates with a low molecular weight. Based on the results culled from the electron paramagnetic resonance (EPR), it is evident that the nano-Fe3O4@CDA catalyst can accelerate in order to generate OH. This was the main mechanism involved in its excellent ability to degrade refractory pollutants. These results demonstrated the potential use of nano-Fe3O4@CDA as a catalyst in the catalytic micro-ozonation process.

[Effects of Rehmannia root decoction serum on cell proliferation and EPO expression in cultured human umbilical vein endothelial cells].

OBJECTIVE: To explore the efficacy of the rehmannia root decoction containing serum in enhencing the proliferation of HUVECs-1 and EPO expression and to give libratory evidence for the tonifying blood and kidney therapy with rehmannia root. METHOD: Twenty-four male Sprague-Dawley rats were randomly devided into 4 group and administrered by gastrogavage rehmannia root decoction of 3, 6, 10 g x kg(-1) once a day for 1 weeks. Using serum pharmacologic method, the proliferation of HUVECs-1 cell was determined by MTT chromatometry at 48 h points by co-culturing with medicated serum containing different concentration of rehmannia root decoction. The expression of EPO on HUVECs-1 were observed by immunity cytochemistry and Western blot. NS serum was taken as control. RESULT: After the HUVECs-1 cultivating with medicated serum for 48 h, compared with NS serum, 20% serum containing rehmannia root (6 g x kg(-1)) could obviously increase proliferation of HUVEC-1 (P < 0.05) and increase the level of the expression of EPO on HUVECs-1 (P < 0.05). CONCLUSION: Rehmannia root extract has good actions of proliferation of HUVECs-1 and increase EPO expression, which is the mechanisms of nourishing yin and blood and tonifying essence of rehmannia root.

Anaerobic digestion of kitchen wastes in a single-phased anaerobic sequencing batch reactor (ASBR) with gas-phased absorb of CO2.

The performance of the single-stage anaerobic digestion of kitchen wastes was investigated in an anaerobic sequencing batch reactor(ASBR) with gas-phased absorb of CO2. The ASBR was operated at four chemical oxygen demand(COD) loading rates, 2.8, 5.1, 6.2 and 8.4 g/(L x d) respectively. The COD loading rate was increased with the TS concentration and HRT changing. At maximum COD loading rate of 8.4 g/(L x d), the COD, total solid(TS) removal rate and methane gas yield were 69%, 68% and 2.5 L/(L x d) respectively. The operation of the reactor with gas-phased absorb of CO2 was stable in spite of the low pH (2.6-3.9) and high concentration of TS (142 g/L) of input mixture. The output volatile fatty acid(VFA) concentration was between 2.7-4.7 g/L and had no inhibition on the methanogenic microorganism. The reactor without gas-phased absorb of CO2 became acidified when the total COD loading rate was increased to 5.1 g/(L x d). Stoichiometry of the methanogenesis for kitchen wastes showed a considerable amount of alkaline will be required to keep pH in the appropriate range for the methanogenic microorganism based on theoretical calculation. Gas-phased absorb of CO2 effectively reduced the alkaline consumption, hence avoided excessive cation into the reactor.

Visible light induced photodegradation of organic pollutants on nitrogen and fluorine co-doped TiO2 photocatalyst.

The nitrogen and fluorine co-doped TiO2 polycrystalline powder was synthesized by calcinations of the hydrolysis product of tetrabutyl titanate with ammonium fluoride. Nitrogen and fluorine co-doping causes the absorption edge of TiO2 to shift to a lower energy region. The photocatalytic activity of co-doped TiO2 with anatase phases was found to be 2.4 times higher than that of the commercial TiO2 photocatalyst Degussa P25 for phenol decomposition under visible light irradiation. The co-doped TiO2 powders only contain anatase phases even at 1000 degrees C. Apparently, ammonium fluoride added retarded phase transformation of the TiO2 powders from anatase to rutile. The substitutional fluorine and interstitial nitrogen atoms in co-doped TiO2 polycrystalline powder were responsible for the vis light response and caused the absorption edge of TiO2 to shift to a lower energy region.