Continuous flow operation of solar photo-Fenton fused with NaOCl as a novel tertiary treatment.

A novel strategy based on solar photo-Fenton mediated by ferric nitrilotriacetate (Fe3+-NTA) combined with NaOCl in continuous flow mode for wastewater reclamation has been studied. Escherichia coli (E. coli) inactivation attained ≥ 5 log10-units, meeting the most restrictive EU 2020/741 target (10 CFU/100 mL), and 75% of organic microcontaminant total load was removed. As a remarkable finding, trihalomethanes (THMs) concentration was insignificant, complying by far with the Italian legislation limit. To attain these results, first the effect of liquid depth on E. coli inactivation and imidacloprid (IMD) removal from spiked municipal effluents was evaluated in continuous flow pilot-scale raceway pond reactors at 60-min hydraulic residence time with low reagent concentrations (0.10 mM Fe3+-NTA, 0.73 mM H2O2 and 0.13 mM NaOCl). Disinfection was due to the bactericidal effect of chlorine. In contrast, liquid depth notably influenced microcontaminant removal, highlighting that operation at 10-cm liquid depth allows achieving treatment capacities higher than at 5 cm (16.50 vs 28.20 mg IMD/m2∙day). Next, the monitoring of THMs was carried out to evaluate the generation and degradation of disinfection by-products, along with the removal of actual microcontaminants. These promising results draw attention to the treatment potential and open the way for its commercial application.

A new solar photo-Fenton strategy for wastewater reclamation based on simultaneous supply of H2O2 and NaOCl.

This study presents, for the first time, the concurrent supply of the oxidants H2O2 and NaOCl in solar-driven Fenton-like processes at neutral pH with ferric nitrilotriacetate (Fe3+-NTA) for wastewater reclamation. Simultaneous Escherichia coli (E. coli) inactivation and the removal of the antibiotic sulfamethoxazole (SMX) at 50 µg/L in municipal effluents were investigated in 5-cm deep raceway pond reactors. First, the individual effects of reagent concentrations (1.47, 2.94 and 4.41 mM for H2O2; 0.134, 0.269 and 0.403 mM for NaOCl; 0.1 and 0.2 mM for Fe3+-NTA) on the economic efficiency (in terms of mass of SMX eliminated per Euro and per hour to attain complete E. coli inactivation and more than 50% of SMX removal) were considered. The highest economic efficiencies were 141 mgSMX/€·h with H2O2 and 222 with NaOCl, the reaction times being 105 and 60 min, respectively. Second, a new strategy for solar photo-Fenton with the combination of the most cost-effective conditions (1.47 mM H2O2 - 0.134 mM NaOCl - 0.1 mM Fe3+-NTA) was carried out in secondary effluents from two treatment plants with different technologies. Economic efficiency was substantially affected by wastewater composition, ranging from 178 to 1131 mgSMX/€·h with treatment times between 60 and 10 min, significantly improving the reported results for conventional solar photo-Fenton to date.

Working together to deliver stratified medicine research effectively.

INTRODUCTION OR BACKGROUND: Stratified medicine is an important area of research across all clinical specialties, with far reaching impact in many spheres. Despite recently formulated global policy and research programmes, major challenges for delivering stratified medicine studies persist. Across the globe, clinical research infrastructures have been setup to facilitate high quality clinical research. SOURCES OF DATA: This article reviews the literature and summarizes views collated from a workshop held by the UK Pharmacogenetics and Stratified Medicine Network and the NIHR Clinical Research Network in November 2016. AREAS OF AGREEMENT: Stratified medicine is an important area of clinical research and health policy, benefitting from substantial international, cross-sector investment and has the potential to transform patient care. However there are significant challenges to the delivery of stratified medicine studies. AREAS OF CONTROVERSY: Complex methodology and lack of consistency of definition and agreement on key approaches to the design, regulation and delivery of research contribute to these challenges and would benefit from greater focus. GROWING POINTS: Effective partnership and development of consistent approaches to the key factors relating to stratified medicine research is required to help overcome these challenges. AREAS TIMELY FOR DEVELOPING RESEARCH: This paper examines the critical contribution clinical research networks can make to the delivery of national (and international) initiatives in the field of stratified medicine. Importantly, it examines the position of clinical research in stratified medicine at a time when pressures on the clinical and social services are mounting.

Cutaneous squamous cell carcinoma in the lateral abdominal wall of local Libyan ewes.

Gross and histopathological features of surgically excised squamous cell carcinomas (SCC) observed in thirteen local Libyan ewes were reported. The age of the ewes enrolled in the current study ranged from 2 to 3 years. The cases were admitted to private veterinary clinics in south-western region of Tripoli, Libya, during the period between July 2014 and October 2015. All lesions were located in the right and left lateral abdominal wall (caudo-ventrally) with a size range of 8 to 11cm in diameter. The tumor masses have been removed by surgical excision. The histopathological examination of surgically excised masses has revealed the characteristic cell nests of SCC showing central keratinization and hyalinization with presence of apoptotic bodies, fattened keratinocytes, and a heavy interstitial infiltration of neutrophils and lymphocytes. The follow up of the cases showed no signs of tumor reoccurrence. In conclusion, SCC in Libyan sheep affects mainly the woolless areas and can be successfully removed by surgical excision.

Hypolipidemic and antioxidant activity of the aqueous extract from the uneaten pulp of the fruit from Cordia dichotoma in healthy and hyperlipidemic Wistar albino rats.

Hyperlipidemia is a major risk factor for coronary heart disease. Hyperlipidemia increases the incidence of myocardial ischemia and cardiac events. This study evaluated the potential hypolipidemic and antioxidant action of the aqueous extract from the uneaten pulp of the fruit from Cordia dichotoma ("CDNP extract"). In vivo studies were performed for 10 weeks on dietary hyperlipidemic and healthy Wistar albino rat models that received two dose levels of the CDNP extract (0.50 and 1.00 g/kg body weight). Serum lipid profiles were determined for the experimental animals. Dietary hyperlipidemic rats were characterized by an elevated lipid profile compared to the healthy control, i.e., increased levels of serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), very low density lipoprotein cholesterol (VLDL-C), and triglycerides (TG), although the level of high-density lipoprotein (HDL-C) was reduced. Levels of antioxidant enzymes, i.e., glutathione reductase (GR), glutathione peroxidase (GPx), glutathione-S-transferase (GST), superoxide dismutase (SOD), and catalase (CAT), were significantly higher in the dietary hyperlipidemic rats than in the normal healthy ones, while the level of malondialdehyde (MDA) was significantly lower. Force-feeding hyperlipidemic Wistar albino rats with the CDNP extract at two doses decreased TC, LDL-C, VLDL-C, and TG to normal levels. The risk ratio, which was as high as 870 % for the hyperlipidemic rats was decreased by the treatment to levels close to that calculated for the healthy control rats. Levels of high-density lipoprotein cholesterol (HDL-C) were very low in the hyperlipidemic Wistar albino rats but increased significantly when CDNP extract was adminstered, attaining similar HDL-C levels to those of healthy control rats. Treatment with the CDNP extract also improved the levels of antioxidant enzymes (GR, GST, GPx, SOD, and CAT) in hyperlipidemic Wistar albino rats. Thus, the CDNP extract improves the lipid metabolism of healthy and hyperlipidemic Wistar albino rats and can be employed in the management of dietary hyperlipidemia.

Surgical intervention of nonvertebral osseous metastasis.

BACKGROUND: Nonvertebral osseous metastases can result in pain and disability. The goals of surgical intervention are to reduce pain and to improve function if nonsurgical treatment fails. The indications for proceeding with surgical intervention depend on anatomic location, amount of local destruction, extent of skeletal and visceral disease and, most important, the patient's performance status and life expectancy. METHODS: This article reviews the evaluation and treatment of metastatic nonvertebral osseous lesions from the perspective of the orthopedic surgeon, based mainly on an assessment of the surgical literature. RESULTS: This article summarizes the approaches to preoperative evaluation, patient selection, and medical optimization. Guidelines for estimating osseous stability and fracture risk are discussed, and surgical implants and their relation to postoperative outcomes are examined. This review also describes less invasive ablative procedures currently available. CONCLUSIONS: The surgical management of nonvertebral osseous metastases involves multidisciplinary collaboration. The surgical construct must be a stable, reliable, and durable intervention that is individually tailored and matched to a patient's prognosis and performance status.

Radiological changes in rheumatoid arthritis patients at a teaching hospital in Saudi Arabia.

The frequency of radiological changes of the hands and the feet were investigated in a well-defined hospital population of patients with rheumatoid arthritis in Jeddah, Saudi Arabia. A total of 57 patients who fulfilled the American College of Rheumatology 1987 criteria for the diagnosis of rheumatoid arthritis were randomly chosen from the rheumatology outpatient clinic at King AbdulAziz University Hospital. Erosions were seen in 60% of the patients and periarticular osteopenia in 34%; deformity and soft tissue swelling were present in 26% and 14% of patients respectively. The proportion with erosions is lower than data reported from Western European and North American populations but higher than previous data from the Central region of Saudi Arabia.

Radiological changes in rheumatoid arthritis patients at a teaching hospital in Saudi Arabia

The frequency of radiological changes of the hands and the feet were investigated in a well-defined hospital population of patients with rheumatoid arthritis in Jeddah, Saudi Arabia. A total of 57 patients who fulfilled the American College of Rheumatology 1987 criteria for the diagnosis of rheumatoid arthritis were randomly chosen from the rheumatology outpatient clinic at King AbdulAziz University Hospital. Erosions were seen in 60% of the patients and periarticular osteopenia in 34%; deformity and soft tissue swelling were present in 26% and 14% of patients respectively. The proportion with erosions is lower than data reported from Western European and North American populations but higher than previous data from the Central region of Saudi Arabia

Auxotrophy in rhizobia revisited.

Among the various types of mutations studied in rhizobia, the auxotrophic mutations (which confer on the mutants the inability to synthesize certain essential substances such as amino acids, vitamins and nucleic acids), are the most favoured ones as these can be used as suitable markers for genetic analysis. An important property of rhizobia is their effectiveness i.e. their ability to fix atmospheric nitrogen into ammonia within the nodule. Special interest in this category of mutations by rhizobial geneticists is due to the fact that there is a strong correlation between the metabolic defects and the ineffectiveness (Nod(-) and/or Fix(-)) of the rhizobial strains. Auxotrophic mutants of various species of rhizobia with defects in the synthesis of nucleic bases, vitamins and amino acids have been obtained by mutagenising with physical, chemical and Tn5 mutagens. These mutants have been used in mapping studies as well as in establishing a correlation between its metabolic requirement and symbiotic relationship with the host plant. The present review deals with the isolation of auxotrophs, and their genetic, biochemical and symbiotic characterization. The review also encompasses the studies on the elucidation of biosynthetic pathways of nutritional substances in rhizobia.

Characterization of heat resistant mutant strains of Rhizobium sp. [Cajanus] for growth, survival and symbiotic properties.

Fourteen heat resistant mutant strains were isolated from a wild-type strain (PP201, Nod(+) Fix(+)) of Rhizobium sp. (Cajanus) by giving it a heat shock of 43°C. These mutant strains showed a greater increase in optical density (O.D.) and a higher viable cell count in both rhizospheric and non-rhizospheric soil at high temperature. Symbiotic studies showed that pigeon pea plants inoculated with a few mutant strains had ineffective nodules (Nod(+) Fix(-)) under controlled temperature (43°C) conditions, but under natural high temperature (40-45°C) conditions, the host plants infected with all the mutant strains showed higher total shoot nitrogen than the plants inoculated with the parent strain. Four mutant strains (HR-3, HR-6, HR-10 and HR-12) were found to be highly efficient for all the symbiotic parameters, and thus have the potential to be used as bioinoculants in the North-Western regions of India during the summer season.

High temperature-induced changes in exopolysaccharides, lipopolysaccharides and protein profile of heat-resistant mutants of Rhizobium sp. (Cajanus).

A thermosensitive wild-type strain (PP201) of Rhizobium sp. (Cajanus) and its 14 heat-resistant mutants were characterized biochemically with regard to their cell surface (exopolysaccharides (EPSs) and lipopolysaccharides (LPSs)) properties and protein profile. Differences were observed between the parent strain and the mutants in all these parameters under high temperature conditions. At normal temperature (30 degrees C), only half of the mutant strains produced higher amounts of EPSs than the parent strain, but at 43 degrees C, all the mutants produced higher quantities of EPS. The LPS electrophoretic pattern of the parent strain PP201 and the heat-resistant mutants was almost identical at 30 degrees C. At 43 degrees C, the parent strain did not produce LPS but the mutants produced both kinds of LPSs. The protein electrophoretic pattern showed that the parent strain PP201 formed very few proteins at high temperature, whereas the mutants formed additional new proteins. A heat shock protein (Hsp) of 63-74 kDa was overproduced in all mutant strains.

Alteration of the aurophilic interactions in trimeric gold(I) compounds through charge transfer. Behavior of solvoluminescent Au(3)(MeN=COMe)(3) in the presence of electron acceptors.

The ability of the triangular gold(I) complex, Au(3)(MeN=COMe)(3), which as a solid displays the novel property of solvoluminescence (see: Vickery, J. C.; Olmstead, M. M.; Fung, E. Y.; Balch, A. L. Angew.Chem., Int. Ed. Engl. 1997, 36, 1179) to function as an electron donor has been demonstrated through spectroscopic studies and isolation of crystalline adducts with organic acceptor molecules. Four such adducts with nitro-9-fluorenones have been isolated and subject to single-crystal X-ray diffraction study. These are deep yellow [Au(3)(MeN=COMe)(3)].[2,4,7-trinitro-9-fluorenone], red [Au(3)(MeN=COMe)(3)].[2,4,5,7-tetranitro-9-fluorenone], red [Au(3)(MeN=COEt)(3)](2).[2,7-dinitro-9-fluorenone], and red [Au(3)(MeN=COEt)(3)](2).[2,4,7-trinitro-9-fluorenone]. The solid-state structures of [Au(3)(MeN=COMe)(3)].[2,4,7-trinitro-9-fluorenone] and [Au(3)(MeN=COMe)(3)].[2,4,5,7-tetranitro-9-fluorenone] consist of columns in which the planar gold(I) trimers and the nearly planar nitro-9-fluorenones are interleaved with the gold trimers making face-to-face contact with the nitroaromatic portion of the electron acceptor. Thus the organic acceptors disrupt the aurophilic interactions present in crystalline [Au(3)(MeN=COMe)(3)] itself. However, in [Au(3)(MeN=COEt)(3)](2).[2,7-dinitro-9-fluorenone] and [Au(3)(MeN=COEt)(3)](2).[2,4,7-trinitro-9-fluorenone], aurophilic interactions are found which produce dimers, [Au(3)(MeN=COEt)(3)](2), with nearly trigonal prismatic Au(6) cores. These dimers are interleaved with the nitro-9-fluorenone molecules to again form extended columns in which the components make face-to-face contact. Despite the fact that the gold atoms in [Au(3)(MeN=COMe)(3)] and [Au(3)(MeN=COEt)(3)] are in exposed sites and only two-coordinate, there is no evidence of additional coordination of the nitro-9-fluorenones with gold centers in the crystalline adducts.

Heparinless partial cardiopulmonary bypass for the repair of aortic trauma.

OBJECTIVE: We hypothesized that partial cardiopulmonary bypass with a heparin-bonded system would be a technically simple, effective adjunct for reducing paraplegia during repair of traumatic aortic rupture. It avoids the risk of heparin, but, unlike left atrial-arterial bypass, it can heat, cool, oxygenate, and rapidly infuse volume if needed. METHODS: A retrospective review was conducted of patients admitted for aortic trauma from July 1994 to December 1999. Bypass consisted of femoral venous (right atrial) cannulation, a centrifugal pump, and an oxygenator-heater/cooler. Arterial return was to the femoral artery or distal aorta. The entire system was heparin-bonded and no systemic heparin was given. RESULTS: Heparin-bonded partial bypass was established in 50 patients (mean age 43 +/- 17 years). Crossclamp time was 32 +/- 11 minutes (range 14-70 minutes), mean flow 3.0 +/- 0.8 L/min, and bypass time 64 +/- 43 minutes. During repair, 58% of patients received volume through the system (mean 1.1 +/- 1.9 L). Core temperature rose slightly (35.9 degrees C +/- 0.7 degrees C to 36.3 degrees C +/- 0.8 degrees C). Three of the 15 patients who underwent percutaneous femoral arterial and venous cannulation concomitant with their angiograms had vessel injury, with one limb loss, and this procedure was discontinued. Thirty-five patients underwent percutaneous femoral vein and direct distal aortic cannulation without event. The mortality rate for patients supported by bypass was 10%, and all deaths were due to other injuries. There were no new cases of paraplegia and no worsening of intracranial or pulmonary injuries. CONCLUSIONS: Heparin-bonded bypass is technically simple to use and avoids the risk of anticoagulation. Paraplegia was avoided. The ability to correct hypothermia, oxygenate, and rapidly infuse volume may simplify management and improve outcomes.

Bronchoscopy, indications, safety and complications.

OBJECTIVE: To review the safety, indications, complications of flexible fiberoptic bronchoscopies performed at university teaching hospital, and to correlate the bronchoscopic findings with radiology, histology, and history of smoking. METHODS: A total of 124 consecutive flexible fiberoptic bronchoscopies were reviewed in the last 3 years. A special form that contains personal data, indications, premedications, route of insertion, bronchoscopic findings, and complications in subjects-undergone bronchoscopy was completed. RESULTS: A suspicion of pulmonary tuberculosis (31%), lung mass (19%) and hemoptysis (18%) were the most common indications. Hypoxemia (14%) during procedure and pneumothorax post procedure were the most common complications. Mortality rate was 0%. For 57% of subjects who had histology, lung cancer (44%), and tuberculosis (15.5%) were commonly found. Lung cancer (72%) and tuberculosis granuloma (18%) were mainly responsible for narrow segments during bronchoscopy. A radiological tumor like mass was found histopathologically to be as lung cancer in 86% and as tuberculous granuloma in 5%. About 84% of lung cancer patients were either smokers (57%) or ex-smokers (27%) as compared to only 35% in smokers and 13% in ex-smokers in patients without lung cancer, P-value<0.01. CONCLUSION: Flexible fiberoptic bronchoscopy can be performed safely whenever indicated. Complications occurred were minor and self limiting. Appropriate preparation, and close supervision and adherence to the protocol were essential for a successful and safe procedure.

Traumatic aortic rupture: recent outcome with regard to neurologic deficit.

BACKGROUND: Traumatic aortic rupture is highly lethal, and its surgical treatment is complicated by a high rate of paraplegia. METHODS: The charts of 263 patients with traumatic aortic rupture from vehicular accidents treated between 1971 and 1998 were reviewed. Patients were grouped according to four periods: group 1, 1971 to 1975, (n = 31); group 2, 1976 to 1985, (n = 83); group 3, 1986 to 1994, (n = 82); and group 4, 1994 to 1998 (n = 67). Seventy-one patients died of exsanguination before definitive care. One hundred-ninety two patients had surgical repair with the following techniques: clamp and sew, 6 in group 1, 22 in group 2, 54 in group 3, none in group 4; shunt, 23 in group 1, 39 in group 2, 2 in group 3; cardiopulmonary bypass, 2 in group 1, 1 in group 3. Forty-three patients had partial bypass with the centrifugal pump and heparin-coated circuits in group 4. RESULTS: Operative mortality was 6 of 31 (19%) in group 1, 22 of 61 (36%) in group 2, 15 of 57 (26%) in group 3, and 7 of 43 (16%) in group 4. There was one case of paraplegia in group 1 (4%), ten in group 2 (18%), 11 in group 3 (26%), and none in group 4. This difference of paraplegia between the groups was significant (p<0.002). Significant factors for paraplegia were intraoperative hypotension (p<0.000002), cross-clamp time longer than 30 minutes (p<0.008), pump versus no pump (p<0.008), and younger age group (28+/-11 versus 39+/-17 years) (p<0.03). CONCLUSIONS: There were no statistically significant improvements in mortality rate over the four periods, although, the mortality rate was lowest in the last period when partial bypass with the centrifugal pump was used exclusively. Further, the use of the centrifugal pump with heparin-coated circuits, with femoral vein cannulation into the right atrium and distal aortic perfusion, reduced paraplegia significantly.

Anal warts, sexually transmitted diseases, and anorectal conditions associated with human immunodeficiency virus.

Sexually transmitted diseases (STDs) are the cause of many different anorectal symptoms and complaints. Patients often present concerned that they have hemorrhoids. It is very important for primary care providers to be aware of the prevalance of anorectal STDs, common presentations, and management options. This article specifically addresses anal warts, gonorrhea, chlamydia, syphilis, herpes, and anorectal manifestations associated with HIV.

Superior sulcus (Pancoast) tumor: experience with 105 patients.

BACKGROUND: The evolution of therapy in 105 patients with superior sulcus (Pancoast) tumor over the past 42 years was reviewed. METHODS: There were 82 men and 23 women aged 30 to 75 years. Tumor cell types were: squamous, 41 (39%); adenocarcinoma, 23 (21.9%); anaplastic, 14 (13.3%); undetermined, 12 (11.4%); mixed, 9 (8.7%); and large cell 6 (5.7%). Therapy was based on extent of disease and lymph node involvement. There were 5 treatment groups: I, preoperative radiation and operation (n = 28); II, operation and postoperative radiation (n = 16); III, radiation (n = 37); IV, preoperative chemotherapy, radiation, and operation (n = 11); and V, operation (n = 12). RESULTS: The median survival for group I was 21.6 months; group II, 6.9 months; group III, 6 months; and group V, 36.7 months. Median survival for group IV has not yet been reached (estimated at 72% at 5 years). On univariate analysis, mediastinal lymph node involvement, Horner syndrome, TNM classification, and method of therapy affected survival. On multivariate regression analysis, only N2 and N3 disease and method of therapy were significant (p < 0.05). CONCLUSIONS: The optimal treatment for superior sulcus tumor was preoperative radiation and operation. However, triple modality therapy, although promising, requires longer follow-up.