Identification of Benzodiazepine Use Based on Dried Blood Stains Analysis.

Biological matrices are typically used in forensic toxicological or pharmacological analysis: mainly blood, vitreous humor or urine. However, there are many cases in which crimes are a consequence of drug intoxication or drug abuse and they are not closed because over the months or years the samples become altered or decomposed. A dried blood stains test (DBS-MS) has recently been proposed to be used in drug toxicology when blood is found at a crime scene. This test could help an investigator to reveal what a person had consumed before the perpetration of the crime. In order to check the possibilities of this test, we analyzed several dried blood stains located on a cotton fabric. Therefore, the aim of this study was to determine if the analysis of a dried blood spot located on a cotton fabric could be an alternate source of obtaining toxicological results, particularly regarding benzodiazepines. We splashed blood stains on cotton fabric with different concentrations of the following benzodiazepines: alprazolam, bromazepam, clonazepam, diazepam and lorazepam, which were dried for 96 h and subsequently quantified by high-performance liquid chromatography coupled mass spectrometry (HPLC-MS). Our results show that it is possible to identify several benzodiazepines contained in a cotton fabric blood stain; consequently, this method may add another sample option to the toxicological analysis of biological vestiges found at a crime scene.

Headache and Other Factors Modifying Cerebrospinal Fluid Opening Pressure in Pediatric Patients.

Cerebrospinal fluid opening pressure values are associated with various neurologic diseases; however, numerous factors can modify this measurement. This study aims to describe factors related to modifications in opening pressure measurements in pediatric patients. Methods: A retrospective analysis of lumbar punctures in pediatric patients conducted by the neuropediatrics group with institutional standardization. Bivariate and linear regression analyses were performed to determine the association between opening pressure and variables included in the study. Results: 544 events, median age 107 months, median opening pressure 19.7 cm H2O. Bivariate analysis found no association with medication use; anesthetics that increased opening pressure were remifentanil (P = .02) and propofol (P = .05), along with a positive linear correlation between opening pressure and age (P < .0001). Multiple linear regression analysis revealed that age, BMI, male gender, and remifentanil use were associated with an increase in opening pressure, whereas corticosteroid withdrawal was associated with a reduction in opening pressure. There is an interaction between age and headache, with an association with increased opening pressure up to around 140 months. Conclusion: This study identifies factors associated with changes in opening pressure, crucial for estimating normal opening pressure values in children. Headaches, anesthetic use, and corticosteroid withdrawal are confirmed as significant factors.

Effects of PEEP on intracranial pressure in patients with acute brain injury: An observational, prospective and multicenter study.

OBJECTIVE: To analyze the impact of positive end-expiratory pressure (PEEP) changes on intracranial pressure (ICP) dynamics in patients with acute brain injury (ABI). DESIGN: Observational, prospective and multicenter study (PEEP-PIC study). SETTING: Seventeen intensive care units in Spain. PATIENTS: Neurocritically ill patients who underwent invasive neuromonitorization from November 2017 to June 2018. INTERVENTIONS: Baseline ventilatory, hemodynamic and neuromonitoring variables were collected immediately before PEEP changes and during the following 30 min. MAIN VARIABLES OF INTEREST: PEEP and ICP changes. RESULTS: One-hundred and nine patients were included. Mean age was 52.68 (15.34) years, male 71 (65.13%). Traumatic brain injury was the cause of ABI in 54 (49.54%) patients. Length of mechanical ventilation was 16.52 (9.23) days. In-hospital mortality was 21.1%. PEEP increases (mean 6.24-9.10 cmH2O) resulted in ICP increase from 10.4 to 11.39 mmHg, P < .001, without changes in cerebral perfusion pressure (CPP) (P = .548). PEEP decreases (mean 8.96 to 6.53 cmH2O) resulted in ICP decrease from 10.5 to 9.62 mmHg (P = .052), without changes in CPP (P = .762). Significant correlations were established between the increase of ICP and the delta PEEP (R = 0.28, P < .001), delta driving pressure (R = 0.15, P = .038) and delta compliance (R = -0.14, P = .052). ICP increment was higher in patients with lower baseline ICP. CONCLUSIONS: PEEP changes were not associated with clinically relevant modifications in ICP values in ABI patients. The magnitude of the change in ICP after PEEP increase was correlated with the delta of PEEP, the delta driving pressure and the delta compliance.

Clinical and sociodemographic characteristics as predictors for quality of life in transmasculine and transfeminine individuals receiving gender-affirming hormone therapy.

Healthcare systems and providers have increasingly acknowledged the role and impact of social determinants in overall health. However, gender-diverse individuals face persistent health disparities due to their identities. There is limited research on the impact of clinical and sociodemographic characteristics on mood and quality of life (QoL) for transgender (TG) individuals. Our study aims to understand and better elucidate social and clinical characteristics of transmasculine (TM) and transfeminine (TF) individuals and their impact on quality of life and depressive symptoms. In this cross-sectional study, 298 TF and TM individuals on gender-affirming hormone therapy (GAHT) were surveyed about their demographic characteristics (age, gender identity, body mass index (BMI), and education), social needs, mood, and quality of life. Multivariable regression modelling was performed to assess the effect of each variable listed above on three domains of QoL (psychological, environmental, and physical) as well as depressive symptoms. We find that QoL scores are similar between TM and TF individuals, with scores in the psychological domain particularly low in both cohorts. TM individuals report higher rates of stress and restroom avoidance than TF individuals. In particular, psychological well-being (measured by the psychological domain of QoL and depressive symptoms) is significantly associated with increased BMI, financial instability, and stress in TM individuals while for TF individuals, psychological well-being is associated with stress and social integration. These data suggest that social circumstances are key drivers of QoL and psychological well-being among gender-diverse individuals receiving GAHT with specific differences between TF and TM individuals. This information may be utilized by healthcare providers and policymakers to address and improve clinical care and social policies to improve health equity for gender-diverse individuals.

The millipede genus Iulidesmus Silvestri, 1895 in Colombia (Polydesmida, Paradoxosomatidae, Catharosomatini).

The paradoxosomatid genus Iulidesmus Silvestri, 1895 in the fauna of Colombia is shown to presently contain nine species. Three of them are still obscure, two of which could be revised based on type (I. alacer (Attems, 1944)) or new material (Orthomorpha proxima Silvestri, 1898), one is a nomen dubium (Strongylosoma glabrum Peters, 1864), while further six are described as new here: Iulidesmus garciae n. sp., I. minerus n. sp., I. florezi n. sp., I. sabaneta n. sp., I. icni n. sp., and I. jeekeli n. sp. A key to all six new species of the genus and their distribution map are provided.

The History of Flow Chemistry at Eli Lilly and Company.

Flow chemistry was initially used for speed to early phase material delivery in the development laboratories, scaling up chemical transformations that we would not or could not scale up batch for safety reasons. Some early examples included a Newman Kwart Rearrangement, Claisen rearrangement, hydroformylation, and thermal imidazole cyclization. Next, flow chemistry was used to enable safe scale up of hazardous chemistries to manufacturing plants. Examples included high pressure hydrogenation, aerobic oxidation, and Grignard formation reactions. More recently, flow chemistry was used in Small Volume Continuous (SVC) processes, where highly potent oncolytic molecules were produced by fully continuous processes at about 10 kg/day including reaction, extraction, distillation, and crystallization, using disposable equipment contained in fume hoods.

Sarcoidosis cardíaca como causa muy infrecuente de muerte súbita en pacientes jóvenes asintomáticos / Cardiac sarcoidosis as an infrequent cause of sudden death in asymptomatic young patients

La afectación cardíaca en la sarcoidosis ha sido descrita tanto en presencia de síntomas como en su ausencia. Este trabajo ayuda a comprender la sarcoidosis y su presentación clínico-morfológica. Presentamos dos pacientes jóvenes (37 y 27años), con muerte súbita, a quienes se les realizó la autopsia completa con estudio toxicológico. El hombre de 37años presentaba una sarcoidosis pulmonar generalizada, en ganglios mediastínicos y granulomas sarcoideos intramiocárdicos en el ventrículo izquierdo, que producían un espesor de pared de 14mm. Esto derivó en una miocardiopatía dilatada secundaria que debutó como muerte súbita. El segundo caso, un varón de 27años, presentaba sarcoidosis con importante afectación pulmonar y mediastínica. La presencia de granulomas en el tabique cardíaco sobre un fondo fibrótico podría ser el origen de un mecanismo arritmogénico de muerte súbita. La autopsia clásica y el examen del sistema de conducción cardíaco son cruciales en la muerte súbita.(AU)

Cardiac involvement in sarcoidosis has been described in both symptomatic and asymptomatic patients. The aim of this report is to further the understanding of sarcoidosis and its clinical presentation. We report the autopsy and toxicology results of two cases of sudden death in young men. A 37-year-old male had generalized sarcoidosis, in mediastinal glands and intramyocardial sarcoid granulomas in the left ventricle, which had caused a 14mm thickening of the ventricular wall and a secondary dilated myocardiopathy causing sudden death. A 27-year-old male had extensive sarcoidosis of the lungs and mediastinum. Granulomas with a fibrotic background were found in the cardiac wall which could have originated an arrhythmogenic mechanism causing sudden death. Post-mortem study including careful examination of cardiac conduction pathways are vital to ascertain the cause of sudden death.(AU)

[Cardiac sarcoidosis as an infrequent cause of sudden death in asymptomatic young patients]. / Sarcoidosis cardíaca como causa muy infrecuente de muerte súbita en pacientes jóvenes asintomáticos.

Cardiac involvement in sarcoidosis has been described in both symptomatic and asymptomatic patients. The aim of this report is to further the understanding of sarcoidosis and its clinical presentation. We report the autopsy and toxicology results of two cases of sudden death in young men. A 37-year-old male had generalized sarcoidosis, in mediastinal glands and intramyocardial sarcoid granulomas in the left ventricle, which had caused a 14mm thickening of the ventricular wall and a secondary dilated myocardiopathy causing sudden death. A 27-year-old male had extensive sarcoidosis of the lungs and mediastinum. Granulomas with a fibrotic background were found in the cardiac wall which could have originated an arrhythmogenic mechanism causing sudden death. Post-mortem study including careful examination of cardiac conduction pathways are vital to ascertain the cause of sudden death.

The Merger of Benzophenone HAT Photocatalysis and Silyl Radical-Induced XAT Enables Both Nickel-Catalyzed Cross-Electrophile Coupling and 1,2-Dicarbofunctionalization of Olefins.

A strategy for both cross-electrophile coupling and 1,2-dicarbofunctionalization of olefins has been developed. Carbon-centered radicals are generated from alkyl bromides by merging benzophenone hydrogen atom transfer (HAT) photocatalysis and silyl radical-induced halogen atom transfer (XAT) and are subsequently intercepted by a nickel catalyst to forge the targeted C(sp3)-C(sp2) and C(sp3)-C(sp3) bonds. The mild protocol is fast and scalable using flow technology, displays broad functional group tolerance, and is amenable to a wide variety of medicinally relevant moieties. Mechanistic investigations reveal that the ketone catalyst, upon photoexcitation, is responsible for the direct activation of the silicon-based XAT reagent (HAT-mediated XAT) that furnishes the targeted alkyl radical and is ultimately involved in the turnover of the nickel catalytic cycle.

Efecto del cambio en el peso tras el trasplante renal en la supervivencia del injerto / Effect of weight change after renal transplantation on outcomes of graft survival

Antecedentes y objetivo: Tras el trasplante renal se produce de manera global un incremento del peso pudiendo aumentar el riesgo de enfermedad renal crónica (ERC) y de pérdida del injerto. Pero no todos los pacientes ganan peso, y la repercusión sobre el injerto de esta diferente evolución, no está bien estudiado. El objetivo fue determinar las causas de esta diferente evolución y su efecto sobre el injerto. Pacientes y métodos: Estudio de cohortes retrospectivo unicéntrico de 201 pacientes seguidos tras el trasplante, analizando los determinantes de la variación del peso al año mediante regresión logística, y su efecto sobre la pérdida del injerto al final del seguimiento mediante regresión de Cox. Resultados: Globalmente se produjo durante el primer año un aumento de peso de 4,5kg de media, pero un 26,6% perdieron peso. El 37,2% aumentó su índice de masa corporal (IMC), mientras que el 9,5% lo disminuyó. Los determinantes de la diferente evolución del peso fueron la edad (OR por cada 10 años: 0,6; p=0,002), la modalidad de diálisis previa (ref. hemodiálisis) (OR: 0,3; p=0,003) y el IMC previo al trasplante (OR: 0,9; p=0,003). La diferente evolución del peso no influyó en la pérdida del injerto. Sí influyeron el IMC al año como variable continua (HR: 1,3; p=0,003) y la obesidad, con peor evolución (HR: 7,0; p=0,025). Conclusiones: Aunque no todos los pacientes ganan peso tras el trasplante renal, la diferente evolución del peso no influye en la supervivencia del injerto. (AU)

Background and objective: After kidney transplantation, there is an overall increase in weight, which may increase the risk of chronic kidney disease (CKD) and graft loss. But, not all patients gain weight, and the impact on the graft of this different evolution has not been well studied. The objective was to determine the causes of this different evolution and its effect on the graft. Patients and methods: Retrospective single-center cohort study of 201 patients followed up after transplantation, analyzing the determinants of the variation in weight at one year using logistic regression, and its effect on graft survival at the end of follow-up using Cox regression. Results: Globally, there was an average weight gain of 4.5kg in the first year, but 26.6% lost weight. 37.2% increased their BMI, while 9.5% decreased it. The determinants of the different evolution of weight were age (OR for every 10 years: 0.6, P=.002), previous dialysis modality (ref. hemodialysis) (OR 0.3, P=.003), and BMI before transplantation (OR 0.9, P=.017). The different evolution of weight did not influence the final situation of the graft. The BMI at one year did influence as a continuous variable (HR 1.3, P=.003), and obesity, with a worse evolution (HR 7.0, P=.025). Conclusions: Although not all patients gain weight after kidney transplantation, the different evolution of weight does not influence graft survival. (AU)

Carbamazepine Overdose after Psychiatric Conditions: A Case Study for Postmortem Analysis in Human Bone.

Carbamazepine is the main option used as a preventive medication to treat bipolar disorder when there is no response to lithium. Carbamazepine toxicity is defined as serum levels greater than 12 µg/mL, with severe toxicity occurring over 40 µg/mL, reduced to 30 µg/mL when combined with pharmacological treatment, i.e., benzodiazepines or antidepressants. For these reasons, it is necessary to find a validated tool to determine carbamazepine levels in an autopsy to rule out suicide or to know if the death was a consequence of an adverse drug reaction (ADR), especially when only bones can be accessed. We have validated a tool to detect and quantify drug concentration in bone. Our results showed a peak for carbamazepine at minute 12 and a mass fragment of 193 m/z. This case study is the first time in the literature that carbamazepine has been detected and quantified in bone. These results demonstrate that carbamazepine can be detected in bone tissue from forensic cases, but almost more importantly, that the method proposed is valid, reliable, and trustworthy.

High-sensitivity troponin in the prognosis of patients hospitalized in intensive care for COVID-19: a Latin American longitudinal cohort study. / Troponina de alta sensibilidade no prognóstico de pacientes internados em terapia intensiva por COVID-19: um estudo de coorte longitudinal latino-americano.

OBJECTIVE: The current study assessed the prevalence of troponin elevation and its capacity to predict 60day mortality in COVID-19 patients in intensive care. METHODS: A longitudinal prospective single-center study was performed on a cohort of patients in intensive care due to a COVID-19 diagnosis confirmed using real-time test polymerase chain reaction from May to December 2020. A Receiver Operating Characteristic curve was constructed to predict death according to troponin level by calculating the area under the curve and its confidence intervals. A Cox proportional hazards model was generated to report the hazard ratios with confidence intervals of 95% and the p value for its association with 60day mortality. RESULTS: A total of 296 patients were included with a 51% 60-day mortality rate. Troponin was positive in 39.9% (29.6% versus 49.7% in survivors and non-survivors, respectively). An area under the curve of 0.65 was found (95%CI: 0.59 - 0.71) to predict mortality. The Cox univariate model demonstrated a hazard ratio of 1.94 (95%CI: 1.41 - 2.67) and p < 0.001, but this relationship did not remain in the multivariate model, in which the hazard ratio was 1.387 (95%CI: 0.21 - 1.56) and the p value was 0.12. CONCLUSION: Troponin elevation is frequently found in patients in intensive care for COVID-19. Although its levels are higher in patients who die, no relationship was found in a multivariate model, which indicates that troponin should not be used as an only prognostic marker for mortality in this population.

OBJETIVO: O presente estudo avaliou a prevalência da elevação da troponina e sua capacidade de prever a mortalidade em 60 dias em pacientes com COVID-19 internados em unidade de terapia intensiva. METÓDOS: Um estudo longitudinal prospectivo e unicêntrico foi realizado em uma coorte de pacientes em terapia intensiva devido a diagnóstico de COVID-19 confirmado, usando teste de reação em cadeia da polimerase em tempo real de maio a dezembro de 2020. Uma curva Característica de Operação do Receptor foi construída para predizer o óbito de acordo com o nível de troponina, calculando a área sob a curva e seus intervalos de confiança. Um modelo de risco proporcional de Cox foi gerado para relatar as razões de risco com intervalo de confiança de 95% e o valor de p para sua associação com mortalidade em 60 dias. RESULTADOS: Foram incluídos 296 pacientes com taxa de mortalidade em 60 dias de 51%. A troponina foi positiva em 39,9% (29,6% versus 49,7% em sobreviventes e não sobreviventes, respectivamente). Foi encontrada área sob a curva de 0,65 (IC95% 0,59 - 0,71) para prever a mortalidade. O modelo univariado de Cox demonstrou razão de risco de 1,94 (IC95% 1,41 - 2,67) e p < 0,001, mas essa relação não se manteve no modelo de análise multivariado, no qual a razão de risco foi de 1,387 (IC95% 0,21 - 1,56) e o valor de p foi de 0,12. CONCLUSÃO: A elevação da troponina é frequentemente encontrada em pacientes em terapia intensiva para COVID-19. Embora seus níveis sejam maiores em pacientes que vão a óbito, nenhuma relação foi encontrada em um modelo de análise multivariado, o que indica que a troponina não deve ser utilizada como único marcador prognóstico de mortalidade nessa população.

Troponina de alta sensibilidade no prognóstico de pacientes internados em terapia intensiva por COVID-19: um estudo de coorte longitudinal latino-americano / High-sensitivity troponin in the prognosis of patients hospitalized in intensive care for COVID-19: a Latin American longitudinal cohort study

RESUMO Objetivo: O presente estudo avaliou a prevalência da elevação da troponina e sua capacidade de prever a mortalidade em 60 dias em pacientes com COVID-19 internados em unidade de terapia intensiva. Metódos: Um estudo longitudinal prospectivo e unicêntrico foi realizado em uma coorte de pacientes em terapia intensiva devido a diagnóstico de COVID-19 confirmado, usando teste de reação em cadeia da polimerase em tempo real de maio a dezembro de 2020. Uma curva Característica de Operação do Receptor foi construída para predizer o óbito de acordo com o nível de troponina, calculando a área sob a curva e seus intervalos de confiança. Um modelo de risco proporcional de Cox foi gerado para relatar as razões de risco com intervalo de confiança de 95% e o valor de p para sua associação com mortalidade em 60 dias. Resultados: Foram incluídos 296 pacientes com taxa de mortalidade em 60 dias de 51%. A troponina foi positiva em 39,9% (29,6% versus 49,7% em sobreviventes e não sobreviventes, respectivamente). Foi encontrada área sob a curva de 0,65 (IC95% 0,59 - 0,71) para prever a mortalidade. O modelo univariado de Cox demonstrou razão de risco de 1,94 (IC95% 1,41 - 2,67) e p < 0,001, mas essa relação não se manteve no modelo de análise multivariado, no qual a razão de risco foi de 1,387 (IC95% 0,21 - 1,56) e o valor de p foi de 0,12. Conclusão: A elevação da troponina é frequentemente encontrada em pacientes em terapia intensiva para COVID-19. Embora seus níveis sejam maiores em pacientes que vão a óbito, nenhuma relação foi encontrada em um modelo de análise multivariado, o que indica que a troponina não deve ser utilizada como único marcador prognóstico de mortalidade nessa população.

ABSTRACT Objective: The current study assessed the prevalence of troponin elevation and its capacity to predict 60day mortality in COVID-19 patients in intensive care. Methods: A longitudinal prospective single-center study was performed on a cohort of patients in intensive care due to a COVID-19 diagnosis confirmed using real-time test polymerase chain reaction from May to December 2020. A Receiver Operating Characteristic curve was constructed to predict death according to troponin level by calculating the area under the curve and its confidence intervals. A Cox proportional hazards model was generated to report the hazard ratios with confidence intervals of 95% and the p value for its association with 60day mortality. Results: A total of 296 patients were included with a 51% 60-day mortality rate. Troponin was positive in 39.9% (29.6% versus 49.7% in survivors and non-survivors, respectively). An area under the curve of 0.65 was found (95%CI: 0.59 - 0.71) to predict mortality. The Cox univariate model demonstrated a hazard ratio of 1.94 (95%CI: 1.41 - 2.67) and p < 0.001, but this relationship did not remain in the multivariate model, in which the hazard ratio was 1.387 (95%CI: 0.21 - 1.56) and the p value was 0.12. Conclusion: Troponin elevation is frequently found in patients in intensive care for COVID-19. Although its levels are higher in patients who die, no relationship was found in a multivariate model, which indicates that troponin should not be used as an only prognostic marker for mortality in this population.

Accelerated and Scalable C(sp3)-H Amination via Decatungstate Photocatalysis Using a Flow Photoreactor Equipped with High-Intensity LEDs.

Carbon-nitrogen bonds are ubiquitous in biologically active compounds, prompting synthetic chemists to design various methodologies for their preparation. Arguably, the ideal synthetic approach is to be able to directly convert omnipresent C-H bonds in organic molecules, enabling even late-stage functionalization of complex organic scaffolds. While this approach has been thoroughly investigated for C(sp2)-H bonds, only few examples have been reported for the direct amination of aliphatic C(sp3)-H bonds. Herein, we report the use of a newly developed flow photoreactor equipped with high intensity chip-on-board LED technology (144 W optical power) to trigger the regioselective and scalable C(sp3)-H amination via decatungstate photocatalysis. This high-intensity reactor platform enables simultaneously fast results gathering and scalability in a single device, thus bridging the gap between academic discovery (mmol scale) and industrial production (>2 kg/day productivity). The photocatalytic transformation is amenable to the conversion of both activated and nonactivated hydrocarbons, leading to protected hydrazine products by reaction with azodicarboxylates. We further validated the robustness of our manifold by designing telescoped flow approaches for the synthesis of pyrazoles, phthalazinones and free amines.

Echocardiographic 60-day mortality markers in patients hospitalized in intensive care for COVID-19.

BACKGROUND: Coronavirus disease COVID-19 produces a predominantly pulmonary affection, being cardiac involvement an important component of the multiorganic dysfunction. At the moment there are few reports about the behavior of echocardiographic images in the patients who have the severe forms of the disease. OBJECTIVE: Identify the echocardiographic prognostic markers for death within 60 days in patients hospitalized in intensive care. METHODS: A single-center prospective cohort was made with patients hospitalized in intensive care for COVID-19 confirmed via polymerase chain reaction who got an echocardiogram between May and October 2020. A Cox multivariate model was plotted reporting the HR and confidence intervals with their respective p values for clinical and echocardiographic variables. RESULTS: Out of the 326 patients included, 153 patients got an echocardiogram performed on average 6.8 days after admission. The average age was 60.7, 47 patients (30.7%) were females and 67 (44.7%) registered positive troponin. 91 patients (59.5%) died. The univariate analysis identified TAPSE, LVEF, pulmonary artery systolic pressure, acute cor pulmonale, right ventricle diastolic dysfunction, and right ventricular dilatation as variables associated with mortality. The multivariate model identified that the acute cor pulmonale with HR= 4.05 (CI 95% 1.09 - 15.02, p 0.037), the right ventricular dilatation with HR= 3.33 (CI 95% 1.29 - 8.61, p 0.013), and LVEF with HR= 0.94 (CI 95% 0.89 - 0.99, p 0.020) were associated with mortality within 60 days. CONCLUSIONS: In patients hospitalized in the intensive care unit for COVID-19, the LVEF, acute cor pulmonale and right ventricular dilatation are prognostic echocardiographic markers associated with death within 60 days.

Degradation of high concentrations of azithromycin when present in a high organic content wastewater by using a continuously fed laboratory-scale UASB bioreactor.

As the presence of emergent contaminants in wastewater, such as antibiotics, has become a threat for public health, the evaluation of strategies to treat them has been gaining importance. A critical example of this situation can be found in wastewaters coming from the pharmaceutical industry, where high concentrations of antibiotics are sometimes accompanied by high organic contents. Even the agroindustry can be affected by a similar problem when cattle infections are treated with antibiotics and part of the antibiotic-contaminated milk has to be wasted. With these situations in mind, in the present study we evaluated a progressive acclimation strategy for a granular sludge in a UASB reactor treating a high organic-content synthetic wastewater contaminated with azithromycin. In parallel, we tested a previously reported low-cost method for azithromycin determination by spectrophotometry, obtaining results comparable with liquid chromatography coupled to mass spectrometry. Although azithromycin has been reported as recalcitrant and resistant to biological degradation, the antibiotic was removed with efficiencies over 50% for wastewater with 10 mg L-1 of azithromycin and a COD of more than 4000 mgO2 L-1. Furthermore, efficiencies over 40% were achieved for wastewater with higher azithromycin concentrations (80 mg L-1) and a COD of 20,000 mgO2 L-1. A careful acclimation strategy permitted the partial removal of azithromycin from wastewater when treating concentrations comparable and higher than what would be expected for domestic and hospital wastewaters, even when its chemical oxygen demand is considerably higher than the average maximum of around 1000 mgO2 L-1.

Self-Optimization of Continuous Flow Electrochemical Synthesis Using Fourier Transform Infrared Spectroscopy and Gas Chromatography.

A continuous-flow electrochemical synthesis platform has been developed to enable self-optimization of reaction conditions of organic electrochemical reactions using attenuated total reflection Fourier transform infrared spectroscopy (ATR FT-IR) and gas chromatography (GC) as online real-time monitoring techniques. We have overcome the challenges in using ATR FT-IR as the downstream analytical methods imposed when a large amount of hydrogen gas is produced from the counter electrode by designing two types of gas-liquid separators (GLS) for analysis of the product mixture flowing from the electrochemical reactor. In particular, we report an integrated GLS with an ATR FT-IR probe at the reactor outlet to give a facile and low-cost solution to determining the concentrations of products in gas-liquid two-phase flow. This approach provides a reliable method for quantifying low-volatile analytes, which can be problematic to be monitored by GC. Two electrochemical reactions the methoxylation of 1-formylpyrrolidine and the oxidation of 3-bromobenzyl alcohol were investigated to demonstrate that the optimal conditions can be located within the pre-defined multi-dimensional reaction parameter spaces without intervention of the operator by using the stable noisy optimization by branch and FIT (SNOBFIT) algorithm.

Effect of weight change after renal transplantation on outcomes of graft survival.

BACKGROUND AND OBJECTIVE: After kidney transplantation, there is an overall increase in weight, which may increase the risk of chronic kidney disease (CKD) and graft loss. But, not all patients gain weight, and the impact on the graft of this different evolution has not been well studied. The objective was to determine the causes of this different evolution and its effect on the graft. PATIENTS AND METHODS: Retrospective single-center cohort study of 201 patients followed up after transplantation, analyzing the determinants of the variation in weight at one year using logistic regression, and its effect on graft survival at the end of follow-up using Cox regression. RESULTS: Globally, there was an average weight gain of 4.5 kg in the first year, but 26.6% lost weight. 37.2% increased their BMI, while 9.5% decreased it. The determinants of the different evolution of weight were age (OR for every 10 years: 0.6, p = 0.002), previous dialysis modality (ref. hemodialysis) (OR 0.3, p = 0.003), and BMI before transplantation (OR 0.9, p = 0.017). The different evolution of weight did not influence the final situation of the graft. The BMI at one year did influence as a continuous variable (HR 1.3, p = 0.003), and obesity, with a worse evolution (HR 7.0, p = 0.025). CONCLUSIONS: Although not all patients gain weight after kidney transplantation, the different evolution of weight does not influence graft survival.