Comparison of outcome in stroke patients admitted during working hours vs. off-hours; a single-center cohort study.

INTRODUCTION: We aimed to disprove an in-hospital off-hour effect in stroke patients by adjusting for disease severity and poor prognostic findings on imaging. PATIENTS AND METHODS: Our study included 5378 patients from a single center prospective stroke registry of a large teaching hospital in the Netherlands, admitted between January 2003 and June 2015. Patients were categorized by admission time, off-hours (OH) or working hours (WH). The in-hospital mortality, 7-day mortality, unfavorable functional outcome (modified Rankin scale > 2) and discharge to home were analyzed. Results were adjusted for age, sex, stroke severity (NIHSS score) and unfavorable findings on imaging of the brain (midline shift and dense vessel sign). RESULTS: Overall, 2796 patients (52%) were admitted during OH, which had a higher NIHSS score [3 (IQR 2-8) vs. 3 (IQR 2-6): p < 0.01] and had more often a dense vessel sign at admission (7.9% vs. 5.4%: p < 0.01). There was no difference in mortality between the OH-group and WH-group (6.2% vs. 6.0%; p = 0.87). The adjusted hazard ratio of in-hospital mortality during OH was 0.87 (95% CI: 0.70-1.08). Analysis of 7-day mortality showed similar results. Unadjusted, the OH-group had an unfavorable outcome [OR: 1.14 (95% CI: 1.02-1.27)] and could less frequently be discharged to home [OR: 1.16 (95% CI: 1.04-1.29)], which was no longer present after adjustment. DISCUSSION AND CONCLUSIONS: The overall outcome of stroke patients admitted to a large Dutch teaching hospital is not influenced by time of admission. When studying OH effects, adjustment for disease severity and poor prognostic findings on imaging is crucial before drawing conclusions on staffing and material.

Incidence and outcome of acquired demyelinating syndromes in Dutch children: update of a nationwide and prospective study.

INTRODUCTION: Acquired demyelinating syndromes (ADS) are immune-mediated demyelinating disorders of the central nervous system in children. A nationwide, multicentre and prospective cohort study was initiated in the Netherlands in 2006, with a reported ADS incidence of 0.66/100,000 per year and MS incidence of 0.15/100,000 per year in the period between 2007 and 2010. In this study, we provide an update on the incidence and the long-term follow-up of ADS in the Netherlands. METHODS: Children < 18 years with a first attack of demyelination were included consecutively from January 2006 to December 2016. Diagnoses were based on the International Paediatric MS study group consensus criteria. Outcome data were collected by neurological and neuropsychological assessments, and telephone call assessments. RESULTS: Between 2011 and 2016, 55/165 of the ADS patients were diagnosed with MS (33%). This resulted in an increased ADS and MS incidence of 0.80/100,000 per year and 0.26/100,000 per year, respectively. Since 2006 a total of 243 ADS patients have been included. During follow-up (median 55 months, IQR 28-84), 137 patients were diagnosed with monophasic disease (56%), 89 with MS (37%) and 17 with multiphasic disease other than MS (7%). At least one form of residual deficit including cognitive impairment was observed in 69% of all ADS patients, even in monophasic ADS. An Expanded Disability Status Scale score of ≥ 5.5 was reached in 3/89 MS patients (3%). CONCLUSION: The reported incidence of ADS in Dutch children has increased since 2010. Residual deficits are common in this group, even in monophasic patients. Therefore, long-term follow-up in ADS patients is warranted.

Suppressors of interictal discharges in idiopathic childhood occipital epilepsy of Gastaut.

Idiopathic childhood occipital epilepsy of Gastaut (ICOE-G) is a rare form of epilepsy, characterized by visual hallucinations, periods of blindness, motor seizures, and migraine-like symptoms. A characteristic EEG feature is fixation-off sensitivity: epileptiform discharges are suppressed by visual input. Here, we present an 11-year-old girl suffering from ICOE-G, who was studied to identify potential additional suppressors of the epileptiform discharges.

On the biocompatibility of a novel Ti-based amorphous composite: structural characterization and in-vitro osteoblasts response.

Titanium and its alloys are frequently used as dental and orthopaedic implants due to their high mechanical strength, low elastic modulus and biocompatibility. However, as these materials have a poor wear resistance, tribo-chemical reactions during use produce debris accumulation, resulting in adverse cellular responses. In that sense, amorphous based materials are potential candidates, considering their hardness and crack growth resistance. This paper reports on the structural characterization of the as-quenched Ti45Zr38Ni17 alloy. This system displays a duplex structure never mentioned before with a low dispersion of nanometric beta-phase particles in an amorphous matrix. Moreover, in order to explore the biocompatibility of such composite, primary osteoblasts cultures are used to analyse cell behaviour around and upon the metallic surface. Osteoblasts attach and proliferate on the material as demonstrated by scanning electron microscopy. Cell proliferation and bone nodule formation are also observed in cultures with Ti45Zr38Ni17 particles by phase contrast microscope. In addition, transmission electron microscopy reveals ultrastructural features very close to those observed in vivo during intramembranous ossification with active osteoblasts surrounded by an extracellular matrix and a mineralized one. In conclusion, these results demonstrate that osteoblasts, cultured in presence of Ti45Zr38Ni17 alloy, proliferate, differentiate and synthesize bone matrix.

Toxoplasmosis after renal transplantation: implications of a missed diagnosis.

We describe a renal transplant patient with a primary Toxoplasma gondii infection presenting as pneumonitis, with subsequent chorioretinitis and encephalitis. The diagnostic challenges of T. gondii infection in immunocompromised patients are discussed.

Pecan shell-based granular activated carbon for treatment of chemical oxygen demand (COD) in municipal wastewater.

The present investigation was undertaken to compare the adsorption efficiency of pecan shell-based granular activated carbon with the adsorption efficiency of the commercial carbon Filtrasorb 200 with respect to uptake of the organic components responsible for the chemical oxygen demand (COD) of municipal wastewater. Adsorption efficiencies for these two sets of carbons (experimental and commercial) were analyzed by the Freundlich adsorption model. The results indicate that steam-activated and acid-activated pecan shell-based carbons had higher adsorption for organic matter measured as COD, than carbon dioxide-activated pecan shell-based carbon or Filtrasorb 200 at all the carbon dosages used during the experiment. The higher adsorption may be related to surface area as the two carbons with the highest surface area also had the highest organic matter adsorption. These results show that granular activated carbons made from agricultural waste (pecan shells) can be used with greater effectiveness for organic matter removal from municipal wastewater than a coal-based commercial carbon.

Adsorption of volatile organic compounds by pecan shell- and almond shell-based granular activated carbons.

The objective of this research was to determine the effectiveness of using pecan and almond shell-based granular activated carbons (GACs) in the adsorption of volatile organic compounds (VOCs) of health concern and known toxic compounds (such as bromo-dichloromethane, benzene, carbon tetrachloride, 1,1,1-trichloromethane, chloroform, and 1,1-dichloromethane) compared to the adsorption efficiency of commercially used carbons (such as Filtrasorb 200, Calgon GRC-20, and Waterlinks 206C AW) in simulated test medium. The pecan shell-based GACs were activated using steam, carbon dioxide or phosphoric acid. An almond shell-based GAC was activated with phosphoric acid. Our results indicated that steam- or carbon dioxide-activated pecan shell carbons were superior in total VOC adsorption to phosphoric acid-activated pecan shell or almond shell carbons, inferring that the method of activation selected for the preparation of activated carbons affected the adsorption of VOCs and hence are factors to be considered in any adsorption process. The steam-activated, pecan shell carbon adsorbed more total VOCs than the other experimental carbons and had an adsorption profile similar to the two coconut shell-based commercial carbons, but had greater adsorption than the coal-based commercial carbon. All the carbons studied adsorbed benzene more effectively than the other organics. Pecan shell, steam-activated and acid-activated GACs showed higher adsorption of 1,1,1-trichloroethane than the other carbons studied. Multivariate analysis was conducted to group experimental carbons and commercial carbons based on their physical, chemical, and adsorptive properties. The results of the analysis conclude that steam-activated and acid-activated pecan shell carbons clustered together with coal-based and coconut shell-based commercial carbons, thus inferring that these experimental carbons could potentially be used as alternative sources for VOC adsorption in an aqueous environment.

Adsorption of metal ions by pecan shell-based granular activated carbons.

The present investigation was undertaken to evaluate the adsorption effectiveness of pecan shell-based granular activated carbons (GACs) in removing metal ions (Cu(2+), Pb(2+), Zn(2+)) commonly found in municipal and industrial wastewater. Pecan shells were activated by phosphoric acid, steam or carbon dioxide activation methods. Metal ion adsorption of shell-based GACs was compared to the metal ion adsorption of a commercial carbon, namely, Calgon's Filtrasorb 200. Adsorption experiments were conducted using solutions containing all three metal ions in order to investigate the competitive effects of the metal ions as would occur in contaminated wastewater. The results obtained from this study showed that acid-activated pecan shell carbon adsorbed more lead ion and zinc ion than any of the other carbons, especially at carbon doses of 0.2-1.0%. However, steam-activated pecan shell carbon adsorbed more copper ion than the other carbons, particularly using carbon doses above 0.2%. In general, Filtrasorb 200 and carbon dioxide-activated pecan shell carbons were poor metal ion adsorbents. The results indicate that acid- and steam-activated pecan shell-based GACs are effective metal ion adsorbents and can potentially replace typical coal-based GACs in treatment of metal contaminated wastewater.

Inhibition of polyglutamine aggregation in R6/2 HD brain slices-complex dose-response profiles.

Huntington's disease (HD) is a late onset neurodegenerative disorder caused by a CAG/polyglutamine (polyQ) repeat expansion. PolyQ aggregates can be detected in the nuclei and processes of neurons in HD patients and mouse models prior to the onset of symptoms. The misfolding and aggregation pathway is an important therapeutic target. To better test the efficacy of aggregation inhibitors, we have developed an organotypic slice culture system. We show here that the formation of polyQ aggregates in hippocampal slices established from the R6/2 mouse follows the same prescribed sequence as occurs in vivo. Using this assay, we show that Congo red and chrysamine G can modulate aggregate formation, but show complex dose-response curves. Oral administration of creatine has been shown to delay the onset of all aspects of the phenotype and neuropathology in R6/2 mice. We show here that creatine can similarly inhibit aggregate formation in the slice culture assay.

Immobilized microbe bioreactors for waste water treatment.

The application of adapted microbial populations immobilized on a porous diatomaceous earth carrier to pre-treat and reduce toxic concentration of volatile organics, pesticides, petroleum aliphatics and aromatics has been demonstrated for several industrial sites. In the pre-treatment of industrial effluents and contaminated groundwaters, these bioreactors have been used to optimize and reduce the cost of conventional treatment systems, i.e. steam stripping, carbon adsorption and traditional biotreatment. Additionally, these systems have been employed as seeding devices for larger biotreatment systems. The cost effective utilization of an immobilized microbe reactor system for water supply regeneration in a microgravity environment is presented. The feasibility of using immobilized biomass reactors as an effluent treatment technology for the biotransformation and biodegradation of phenols, chlorinated halocarbons, residual oils and lubricants was evaluated. Primary biotransformation tests of two benchmark toxicants, phenol and ethylene dichloride at concentrations expected in life support effluents were conducted. Biocatalyst supports were evaluated for colonization potential, surface and structural integrity, and performance in continuous flow bioreactors. The implementation of such approaches in space will be outlined and specific areas for interfacing with other non-biological treatment approaches will be considered for advanced life support, tertiary waste water biotreatment.

Comparison of effective toxicant biotransformation by autochthonous microorganisms and commercially available cultures in the in situ reclamation of abandoned industrial sites.

Biotransformation and biodegradation of polycyclic aromatic hydrocarbons by the subsurface autochthonous microflora collected from an abandoned petroleum refinery site was investigated. In addition, the inoculation of a commercially available blend of bacterial cultures, with known ability to degrade polycyclic aromatics, was evaluated. This supplemental addition of select microorganisms has been referred to by commercial interests as "bioaugmentation". Their biodegradative potential was evaluated using laboratory mesocosms (simulations) containing a predetermined optimal waste loading rate based on % oil and grease, mixed with predetermined optimal loading rates of clay and river silt materials. The waste consisted primarily of aliphatic and aromatic hydrocarbons found in buried sludges and abandoned lagoons. All mesocosms received nutrient amendment without additional energy sources. Experimental mesocosms were inoculated with adapted indigenous microflora and/or commercial strains. Microbial ATP, microbial diversity, and related enzyme assays were used to establish the detoxification efficiency of the experimental microflora. Quantitative toxicant concentrations and transformations were documented by GC/MS data. Information will be presented mainly on the kinetics of toxicant biotransformation processes to identify "bioaugmentation" contribution and relevancy in the recovery of abandoned polluted sites.