Insight into the effects of H2SO4 and HNO3 acidification processes on the properties of coal as an enhanced adsorbent for ciprofloxacin residuals: Steric and energetic studies.

A sub-bituminous natural coal sample (R.C) was treated with sulfuric acid (S.C) and nitric acid (N.C) as modified products and enhanced adsorbents for obtaining ciprofloxacin (CFX) antibiotic residuals from water. The characterization studied demonstrates enhancement in the surface area and the incorporation of new active oxygenated, sulfur-bearing, and nitrogen-bearing chemical groups into the structure of coal samples. This was reflected in the adsorption capacities that were enhanced from 164.08 mg/g (R.C) to 489.2 mg/g and 518.5 mg/g for N.C and S.C, respectively. The impact of the acid modification processes was evaluated based on the energetic and steric properties of their adsorption systems considering the parameters of the advanced monolayer equilibrium model with one energy site. The determined occupied active sites' density of R.C (46.32-61.44 mg/g), N.C (168.7-364.9 mg/g), and S.C (159.2-249.9 mg/g) reflects an increase in the quantities of active centers after the acid treatment processes, especially with HNO3. The higher efficiencies of the active sites of S.C to adsorb more CFX molecules (n = 2.08-2.31) than N.C (n = 1.41-2.16) illustrate its higher adsorption capacity. The energetic investigation [adsorption (˂40 kJ/mol) and Gaussian (˂8 kJ/mol) energies] suggested adsorption of CFX by N.C and S.C mainly by physical processes such as van der Waals forces, hydrogen bonding, dipole bonding, and π-π interactions. Moreover, the determined thermodynamic functions including entropy, internal energy, and free enthalpy reflect the spontaneous and endothermic uptake of CFX on the surfaces of N.C and S.C.

Experimental study of an asymmetric valveless pump to elucidate insights into strategies for pediatric extravascular flow augmentation.

Asymmetric pumping is a sub-category of valveless pumping in which a flexible tube is rhythmically compressed in the transverse symmetry plane. Due to the resulting asymmetry between the suction and discharge pipes, a net pumping head is achieved. Asymmetric pumping is regarded as one of the main mechanisms responsible for the Liebau effect in addition to impedance pumping. However, there remains a paucity of research surrounding the governing parameters of asymmetric pumping. Here, we conducted an experimental study of the performance of an asymmetric pump, with an aim to assess its potential for extravascular flow augmentation. A custom flexible latex tube and experimental platform were developed for this purpose. We tested various tube thicknesses and pinching frequencies. Our results demonstrate that the performance is within the range of physiological requirements for pediatric circulatory devices (~ 1 L/min and < 30 mmHg). We conclude that due to the absence of reverse flow and its mechanical simplicity, pure asymmetric pumping is promising for selected cardiovascular applications with less complexity than other valveless techniques.

Endovenous laser ablation of saphenous veins - favorable clinical results confirm theoretical advantages of the 1940nm diode laser.

INTRODUCTION: Endovenous laser ablation (EVLA) is a recognized alternative to surgical treatment of varicose veins, although an optimal laser generator and its settings still remain a matter of debate. The aim of our study was to correlate clinical results with the theoretical advantage of the 1940nm diode laser characterized by high absorption of heat in a thin layer of coagulated tissue. METHODS: From 1/2010 to 12/2021 EVLA was performed in a total of 3529 consecutive patients with varicose veins and ultrasonographically documented superficial venous reflux of lower extremities. Three types of laser were used successively with the wavelengths of 1064 nm, 1470 nm and 1940 nm, respectively. All patients were prospectively enrolled in our registry. An early postoperative followup visit was scheduled including an assessment of venous closure; additional visits were performed only in case of complications. RESULTS: The success of venous closure did not differ (p=0.054) between the three laser types and was over 98%. The catheterbased method made it possible to perform multiple ablations in one procedure the trend was 1.08, 1.31 and 1.62. In 2021 the number of ablations per patient with the laser DL Tethys 1940 nm was 1.79. With this laser it was possible to reduce the total energy applied to one half (8 W, 5080 J/cm). The postoperative course of patients treated using the 1940nm laser was smoother - no other but the early followup visit was needed in 95.6% cases (p.

Comparison of 30-Day Outcomes after Carotid Artery Stenting in Patients with Near-Occlusion and Severe Stenosis: A Propensity Score Matching Analysis.

BACKGROUND AND PURPOSE: Carotid artery near-occlusion is a type of severe stenosis with complete or partial distal luminal collapse and intracranial collaterals. This study aimed to compare 30-day outcomes and 10-year survival in patients undergoing carotid artery stenting for near-occlusion with a control group of patients with severe stenosis. MATERIALS AND METHODS: We used data from a registry of 639 patients who underwent 789 carotid artery stenting procedures between 2005 and 2021. The primary end point was any stroke or death within 30 days after carotid artery stenting. Patients were matched using propensity scores based on 6 variables. RESULTS: Propensity score matching yielded 84 subjects in the near-occlusion group matched with 168 subjects in the control group. In the matched cohort, the primary end point occurred in 7 (8.3%) and 11 (6.6%) patients in the near-occlusion and control groups, respectively (P = .611). In the unmatched cohort, the primary end point occurred in 7 (8.3%) and 19 (4.1%) patients (P = .101). Survival in the near-occlusion group versus the control group in the matched cohort at 5 and 10 years was 69.8% (95% CI, 58.0%-78.8%) versus 77.3% (95% CI, 70.0%-83.1%) and 53.3% (95% CI, 39.9%-65.0%) versus 53.3% (95% CI, 44.5%-61.4%) (log-rank, P = .798). CONCLUSIONS: Carotid stent placement in patients with ICA near-occlusion was not associated with an increased 30-day risk of stroke or death compared with severe stenosis. Survival up to 10 years after carotid artery stenting was similar in both groups.

[Myasthenia gravis associated with nivolumab]. / Miastenia grave asociada a nivolumab.

TITLE: Miastenia grave asociada a nivolumab.

Catheter laser ablation of superficial veins of the lower extremities in the symptomatic treatment of venous reflux comparison of the immediate results of two types of laser.

INTRODUCTION: Catheter-Based Endovenous Laser Ablation (EVLA) is a commonly used alternative to surgical treatment of varicose veins. Recently, catheterization methods have proved to be methods of choice due to the preference of patients who value minimal invasiveness. Research of EVLA currently focuses on optimization of the procedure, which includes study of the benefits of the individual types of laser generators and the wavelengths used. In this observational study we compared our early results in a non-selected population of consecutive patients treated with two different types of lasers. METHODS: In the period from February 2010 to June 2017, EVLA was performed in a total of 1747 consecutive patients (74% were female) with venous reflux. The average vein width was 8.5 mm (525 mm). Our study sought to compare a more economical 1470nm diode laser (DL) generator (Velas 2, China) - used to operate on 630 patients - with a Nd-Yag crystal generator (Fotona - Slovenia) used in 1117 patients. All operations were performed using the same methodology, in an outpatient setting, in one specialized center. All procedures were completed in local tumescent anesthesia under peroperative ultrasound control. Postoperative sonography was performed in all patients. RESULTS: The results did not show a statistically significant difference in early closure rates (98.8% for Nd-Yag versus 99.8 for DL p-ns). Early recurrence was observed in 9 patients (15 vein segments) and managed successfully with early re-intervention and closure in all cases. The causes of incomplete closure included mainly the known risk factors (anticoagulation therapy, history of varicophlebitis). There was no correlation with larger venous diameter. In 6 patients, thrombus prolapse was observed in the deep femoral vein lumen. All cases were successfully cured after a week of low-molecular-weight heparin therapy. Only one case of low-risk pulmonary embolism was reported in a patient who failed to follow the regime recommendations. CONCLUSION: This evidence did not show a significant difference in closure reliability and the amount of complications of the endovenous laser ablation of large and small saphenous vein with a 1060nm Nd-Yag crystal compared to the more economical 1470nm diode laser generator.

A systematic review of the indirect costs of schizophrenia in Europe.

Background: Schizophrenia is a chronic disease associated with significant and long-lasting effects on health, and it is also a social and financial burden, not only for patients but also for families, other caregivers, and the wider society. It is essential to conduct the assessment of indirect costs, to understand all the effects of the disease on society. Our aim is to gain a better understanding of the indirect costs of schizophrenia in Europe. Methods: We conducted a comprehensive systematic literature review covering EMBASE, Medline, and PsycINFO as well as reviewing Health Technology Assessment databases from different countries. We used a qualitative research synthesis for presenting information, as most of the studies were methodologically diverse, a quantitative analysis would have been impractical. Results: Indirect cost adjusted to inflation ranged vastly between studies included in the review from 119 Euros to 62, 034 Euros annually. The average proportion of indirect costs of total costs was 44%. Studies highlighted important cost drivers as age, gender, and disease severity, explaining the variation in costs between treatment and patient groups. Conclusions: Regardless of the methodological heterogeneity of the reviewed studies, there was an agreement about the significance of indirect costs of schizophrenia on the society. Considering the relatively high prevalence of schizophrenia in Europe, a need for more cost of illness studies especially from Central Eastern and Southern Europe is suggested.

Direct healthcare cost of schizophrenia - European overview.

PURPOSE: To provide an overview on the magnitude of the impact of schizophrenia on the healthcare system in Europe and to gain a better understanding on the most important factors influencing the variation of costs. METHODS: Studies reporting costs and healthcare utilization among patients with schizophrenia were searched in MEDLINE (via Scopus), EMBASE (via Scopus) and Cochrane Database of Systematic Reviews on 19th January 2017. RESULTS: Twenty-three studies, from the 1075 references initially identified, were included in this review. The annual cost per patient ranged from €533 in Ukraine to €13,704 in the Netherlands. Notably drug costs contributed to less than 25% of the direct healthcare cost per patient in every country, which might be explained by similar pharmaceutical prices among countries due to the reference pricing system applied in Europe. Inpatient costs were the largest component of health service costs in the majority of the countries. Despite methodological heterogeneity across studies, four major themes could be identified (age, severity of symptoms, continuation of treatment/persistence, hospitalization) that have substantial impact on the costs of schizophrenia. CONCLUSIONS: Schizophrenia represents a substantial cost for the healthcare system in Europe driven by the high cost per patient. Substantial savings could potentially be achieved by increasing investment in the following areas: (1) reducing the number of hospitalizations e.g. by increasing the efficiency of outpatient care; (2) working out interventions targeted at specific symptoms; (3) improving patient persistence and adherence in antipsychotic therapy.

Healthcare resource use in schizophrenia, EuroSC findings.

Background: It is unclear if the burden associated with schizophrenia is affected by the type and severity of patient's symptoms. Objective: This study aims to quantify healthcare resource use associated with different profiles of schizophrenia symptoms. Study design: Post-hoc analysis of data from a naturalistic follow-up study. Setting: Secondary psychiatric services in France, Germany and the UK. Patients: EuroSC cohort:, representative sample of 1,208 schizophrenia patients Main outcome measure: We classified patients into eight health states, according to the Lenert classification (HS1-HS8), and estimated 6-month healthcare resource use (outpatient and day clinic visits, and hospitalisations) across the health states. Results: Approximately half of the patients were classed as having mild symptoms (HS1), with around 20% experiencing moderate, predominantly negative symptoms (HS2). The remaining health states were represented by <10% of patients each. Very few patients experienced extremely severe symptoms (HS8). No health state was associated with excess utilisation across all resource types. In terms of outpatient visits, patients were estimated to see a psychiatrist most often (3.01-4.15 visits over 6 months). Hospital admission was needed in 11%(HS1) - 35%(HS8) of patients and inpatient stays were generally prolonged for all health states (39-57 days). The average number of inpatient days was highest for patients in HS8 (18.17 days), followed by patients with severe negative symptoms (HS4; 13.37 days). In other health states characterised by severe symptoms (HS5-HS7), the average number of inpatient days was approximately half of those seen for HS4 (6.09-7.66). Conclusion: While none of the symptom profiles was associated with excess resource usage, hospitalization days were highest for HS with severe, predominantly negative or extremely severe symptoms. Patients with predominantly negative, moderate or severe symptoms appeared to have a high number of psychologist visits - an interesting finding that may reflect a specific therapeutic approach to the treatment of these patients.

Additive solutions differentially affect metabolic and functional parameters of platelet concentrates.

BACKGROUND: Pathogen inactivation (PI) of platelet concentrates with extension of shelf life to 7 days requires the use of platelet additive solutions (PAS). We examined the quality of platelets resuspended in three different PAS stored for up to 7 days. MATERIALS AND METHODS: Twelve triple adult dose platelet concentrates (PC) were collected using the TrimaAccel® collection system. Each highly concentrated product was divided into three equal parts, and the additive solutions (Composol® or SSP+® or Intersol™) were added to a final concentration of 56% PAS and 44% plasma. Samples were drawn on days 1, 5 and 7 to measure pH, glucose, lactate dehydrogenase (LDH), lactate, mean platelet volume (MPV) and the aggregation response to collagen and the thrombin receptor agonist peptide-6. Further, p-selectin expression on platelets was assessed. RESULTS: No statistically significant changes were observed for pH and MPV during 7 days of storage in all PAS containing PCs, whereas glucose decreased and LDH and lactate increased over time (P < 0·05). These changes were particularly evident in Intersol PCs on days 5 and 7 compared with Composol® PCs or SSP+® PCs (P < 0·05). Platelets from Intersol PCs exhibited the highest baseline activation of p-selectin and showed reduced collagen- and TRAP-6-induced aggregation. CONCLUSION: Resuspension of platelets in Intersol for 7 days results in increased platelet activation and platelet metabolism compared with SSP+® or Composol®. Further clinical studies are needed to evaluate whether the observed differences in PAS-PCs affect the recovery rate or the life span of transfused platelets.

Evaluation of cerebrovascular reserve in patients undergoing carotid artery stenting and its usefulness in predicting significant hemodynamic changes during temporary carotid occlusion.

We investigated the usefulness of cerebrovascular reserve (CVR) testing to predict severe hemodynamic changes during proximally protected carotid artery stenting. Of 90 patients referred, 63 eligible underwent complete evaluation of the extent of carotid artery disease and transcranial Doppler ultrasound (TCD) assessment of CVR by means of a breath-holding test and ophthalmic artery flow pattern evaluation. Periprocedural TCD monitoring of the ipsilateral middle cerebral artery flow was performed in 24 patients undergoing proximally protected procedure (requiring induction of flow arrest within internal carotid artery). Abnormal CVR was significantly less common in patients with unilateral compared to bilateral carotid artery disease (26.3 % vs. 76.9 %, p=0.02), while ophthalmic artery flow reversal was rare in patients with unilateral carotid artery disease (2.5 % vs. 42.9 %, p<0.01). During the induction of carotid flow arrest, the average mean flow velocity drop following external carotid artery occlusion was low (3.5 %, p=0.67) compared to the induction of complete flow arrest (32.8 %, p<0.01). Six patients had a total mean flow velocity drop >50 %, including 2 patients with normal pre-procedural CVR. Our results suggest that TCD evaluation of CVR is not a reliable predictor of hemodynamic changes induced during proximally protected carotid artery stenting in patients with unilateral carotid artery disease.

Preparation and characterisation of ceramic-based thoron sources for thoron calibration chamber.

The aim of this study is to explore the correlations between the properties of the source's material and the thoron flux produced. This means a complex procedure that involves morphological characterisation (the determination of specific surface area and pore size distribution) and thoron emanation and exhalation measurements as well. In this work, the preparation of 27 thoron sources has been carried out. Three types of ceramics with different morphological properties were used as a matrix material with three different thorium contents. Spheres were formed from the dollop, and they were fired at different temperatures (200, 600 and 900°C). The phase analysis of the samples was performed by powder X-ray diffraction. The pore size distribution was determined by mercury penetration. The thoron emanation was measured using an accumulation chamber; the measured thoron emanation coefficients were from 0.34 ± 0.03 to 7.69 ± 0.13 %. Based on the results, the preparation parameters of the thoron source optimised for the calibration procedure have been given.

Clinical research informatics and electronic health record data.

OBJECTIVES: The goal of this survey is to discuss the impact of the growing availability of electronic health record (EHR) data on the evolving field of Clinical Research Informatics (CRI), which is the union of biomedical research and informatics. RESULTS: Major challenges for the use of EHR-derived data for research include the lack of standard methods for ensuring that data quality, completeness, and provenance are sufficient to assess the appropriateness of its use for research. Areas that need continued emphasis include methods for integrating data from heterogeneous sources, guidelines (including explicit phenotype definitions) for using these data in both pragmatic clinical trials and observational investigations, strong data governance to better understand and control quality of enterprise data, and promotion of national standards for representing and using clinical data. CONCLUSIONS: The use of EHR data has become a priority in CRI. Awareness of underlying clinical data collection processes will be essential in order to leverage these data for clinical research and patient care, and will require multi-disciplinary teams representing clinical research, informatics, and healthcare operations. Considerations for the use of EHR data provide a starting point for practical applications and a CRI research agenda, which will be facilitated by CRI's key role in the infrastructure of a learning healthcare system.

Comparison of proton channel, phagocyte oxidase, and respiratory burst levels between human eosinophil and neutrophil granulocytes.

Robust production of reactive oxygen species (ROS) by phagocyte NADPH oxidase (phox) during the respiratory burst (RB) is a characteristic feature of eosinophil and neutrophil granulocytes. In these cells the voltage-gated proton channel (Hv1) is now considered as an ancillary subunit of the phox needed for intense ROS production. Multiple sources reported that the expression of phox subunits and RB is more intensive in eosinophils than in neutrophils. In most of these studies the eosinophils were not isolated from healthy individuals, and a comparative analysis of Hv1 expression had never been carried out. We performed a systematic comparison of the levels of essential phox subunits, Hv1 expression and ROS producing capacity between eosinophils and neutrophils of healthy individuals. The expression of phox components was similar, whereas the amount of Hv1 was ∼ 10-fold greater in eosinophils. Furthermore, Hv1 expression correlated with Nox2 expression only in eosinophils. Additionally, in confocal microscopy experiments co-accumulation of Hv1 and Nox2 at the cell periphery was observed in resting eosinophils but not in neutrophils. While phorbol-12-myristate-13-acetate-induced peak extracellular ROS release was ∼ 1.7-fold greater in eosinophils, oxygen consumption studies indicated that the maximal intensity of the RB is only ∼ 1.4-fold greater in eosinophils. Our data reinforce that eosinophils, unlike neutrophils, generate ROS predominantly extracellularly. In contrast to previous works we have found that the two granulocyte types display very similar phox subunit expression and RB capacity. The large difference in Hv1 expression suggests that its support to intense ROS production is more important at the cell surface.

Neonatal intensive care unit handoffs: a pilot study on core elements and epidemiology of errors.

OBJECTIVE: To define the core data elements of a neonatal intensive care unit (NICU) handoff compare NICU residents' written and verbal handoff data with real-time, auto-populated data and identify the epidemiology of handoff errors. STUDY DESIGN: We defined nine core data elements for a NICU patient handoff. We then compared residents' written and verbal handoffs against real-time, auto-populated data for each core element. RESULT: A total of 101 NICU patient handoffs (31 unique patients) were analyzed. Per patient, residents made more written errors for infants in critical-care beds than for infants in step-down beds (2.33 vs 1.67, P=0.04). Replacing residents' written handoffs with the gold-standard, auto-populated data would have prevented 92% of written errors. CONCLUSION: NICU infants are subjected to many handoff errors. Sicker infants are at higher risk for error. Auto-population can reduce written handoff errors and allow residents more time for training and educational opportunities.

Using tobacco plants as biomonitors of contaminated norm areas.

One of the largest biomonitoring tasks is the assessing and environment monitoring of radiological wastes produced by mining. Po-210 and Pb-210 are easy to mobilise even in a weak acidic medium and as we know the biological behaviour and accumulation capacity of tobacco, this could be a suitable option for biomonitoring. During our work the Pb-210 and Po-210 concentration values of tobacco parts and soil samples originating from a Hungarian remediated uranium mine site were determined. The source preparation was spontaneous deposition following combined acidic leaching with a Po-209 tracer; the detection was carried out with a semiconductor ('PIPS') detector alpha-spectrometer. According to the results for the tobacco plant parts and soil samples, secular equilibrium could be found between the Pb-210 and Po-210 isotopes, and the isotope content of the lower leaves of the tobacco plants was in correlation with the isotope concentration of the soil; therefore, the measurement of the activity concentration is suitable for tracing smaller levels of washing out. The Po-210 activity concentration values of tobacco (average: 15.5 ± 3.6 Bq kg(-1)) and soil (average: 60.1 ± 15.2 Bq kg(-1)) samples originating from the area investigated compared with samples from another part of Hungary, Balatonalmádi (tobacco: 12.5 ± 1.0 Bq kg(-1), soil: 57.0 ± 4.7 Bq kg(-1)), do not show significant radionuclide migration.

Dopamine receptor D1 and postsynaptic density gene variants associate with opiate abuse and striatal expression levels.

Opioid drugs are highly addictive and their abuse has a strong genetic load. Dopamine-glutamate interactions are hypothesized to be important for regulating neural systems central for addiction vulnerability. Balanced dopamine-glutamate interaction is mediated through several functional associations, including a physical link between discs, large homolog 4 (Drosophila) (DLG4, PSD-95) and dopamine receptor 1 (DRD1) within the postsynaptic density to regulate DRD1 trafficking. To address whether genetic associations with heroin abuse exist in relation to dopamine and glutamate and their potential interactions, we evaluated single-nucleotide polymorphisms of key genes within these systems in three populations of opiate abusers and controls, totaling 489 individuals from Europe and the United States. Despite significant differences in racial makeup of the separate samples, polymorphisms of DRD1 and DLG4 were found to be associated with opiate abuse. In addition, a strong gene-gene interaction between homer 1 homolog (Drosophila) (HOMER1) and DRD1 was predicted to occur in Caucasian subjects. This interaction was further analyzed by evaluating DRD1 genotype in relation to HOMER1b/c protein expression in postmortem tissue from a subset of Caucasian subjects. DRD1 rs265973 genotype correlated with HOMER1b/c levels in the striatum, but not cortex or amygdala; the correlation was inversed in opiate abusers as compared with controls. Cumulatively, these results support the hypothesis that there may be significant, genetically influenced interactions between glutamatergic and dopaminergic pathways in opiate abusers.