Reusable and inductively regenerable magnetic activated carbon for removal of organic micropollutants from secondary wastewater effluents.

This work introduces a new sustainable alternative of powdered activated carbon (PAC) - magnetically harvestable and reusable after regeneration via inductive heating - for the adsorptive removal of organic micropollutants (OMP) from secondary wastewater effluents. For this purpose, two commercial PACs - lignite "L" (1187 m2/g) and coconut "C"-based (1524 m2/g) - were modified with magnetic iron oxide following two different synthesis approaches: infiltration ("infiltr") and surface deposition ("depos") route. The resulting magnetic powdered activated carbons (mPAC) and their precursor PACs were fully characterized before application. The iron oxide content of the modified "L" and "C" samples was ∼30 % and ∼20 %, respectively. Iron oxide gives the PAC beneficial magnetic properties for easy magnetic separation and simultaneously acts as an inductively heatable agent for the carbon regeneration. The infiltrated samples displayed better inductive heating performance and regeneration than their deposited counterparts. Tests with real wastewater showed fast adsorption kinetics of the organic load following the pseudo-second-order kinetic model. Adsorption isotherms were compliant with the Freundlich isotherm model. Sample "L-infiltr" had the best overall adsorption performance throughout 5 reuse cycles when intermediately inductively regenerated (<3 % drop in organics removal per cycle with intermediate regeneration vs. ∼10 % drop per cycle without regeneration). The treated supernatant was additionally tested for 31 representative organic micropollutants and their transformation products (pharmaceuticals, personal care products, industrial chemicals, etc.), where 26 OMPs had consistently high removal (>85 %) throughout 5 cycles with intermediate regeneration and for 28 OMPs the total adsorption efficiency dropped by <5 % after 5 cycles.

Off-label use of intravitreal bevacizumab: A global conundrum.

Bevacizumab is a monoclonal, humanized, full-length antibody targeting vascular endothelial growth factor(VEGF-A), known for its anti-angiogenic properties. The off-label use of bevacizumab has stirred legal, financial, industrial, and ethical complexities. With its potential to treat diverse ocular conditions, this commentary delves into the multifaceted dimensions of bevacizumab's off-label utilization, encompassing clinical trials, regulatory frameworks, safety considerations, comparative effectiveness, and economic implications.

Soluble urokinase plasminogen activator receptor levels predict survival in patients with portal hypertension undergoing TIPS.

Background & Aims: Transjugular intrahepatic portosystemic shunt (TIPS) is the most effective therapy for complications of portal hypertension. However, clinical outcomes following TIPS placement vary widely between patients and identifying ideal candidates remains a challenge. Soluble urokinase plasminogen activator receptor (suPAR) is a circulating marker of immune activation that has previously been associated with liver inflammation, but its prognostic value in patients receiving TIPS is unknown. In the present study, we evaluated the potential clinical relevance of suPAR levels in patients undergoing TIPS insertion. Methods: suPAR concentrations were measured by ELISA in hepatic vein (HV) and portal vein (PV) blood samples from 99 patients (training cohort) as well as peripheral venous blood samples from an additional 150 patients (validation cohort) undergoing TIPS placement. The association between suPAR levels and patient outcomes was assessed using Kaplan-Meier methods and Cox-regression analyses. Results: suPAR concentrations were significantly higher in HV samples compared to PV samples and correlated with PV concentration, the presence of ascites, renal injury, and consequently with the Child-Pugh and MELD scores. Patients with lower suPAR levels had significantly better short- and long-term survival after TIPS insertion, which remained robust after adjustment for confounders in multivariate Cox-regression analyses. Sensitivity analysis showed an improvement in risk prediction in patients stratified by Child-Pugh or MELD scores. In an independent validation cohort, higher levels of suPAR predicted poor transplant-free survival after TIPS, particularly in patients with Child-Pugh A/B cirrhosis. Conclusion: suPAR is largely derived from the injured liver and its levels are predictive of outcome in patients undergoing TIPS. suPAR, as a surrogate of hepatic inflammation, may be used to stratify care in patients following TIPS insertion. Impact and implications: Transjugular intrahepatic portosystemic shunt (TIPS) is the most effective therapy for complications of portal hypertension. However, clinical outcomes following TIPS placement vary widely between patients and identification of the ideal candidates remains challenging. We show that soluble urokinase plasminogen activator receptor (suPAR), a circulating marker of immune activation that can easily be measured in routine clinical practice, is a novel marker to identify patients who will benefit from TIPS and those who will not.

Global indicators of the environmental impacts of invasive alien species and their information adequacy.

Monitoring the extent to which invasive alien species (IAS) negatively impact the environment is crucial for understanding and mitigating biological invasions. Indeed, such information is vital for achieving Target 6 of the Kunming-Montreal Global Biodiversity Framework. However, to-date indicators for tracking the environmental impacts of IAS have been either lacking or insufficient. Capitalizing on advances in data availability and impact assessment protocols, we developed environmental impact indicators to track realized and potential impacts of IAS. We also developed an information status indicator to assess the adequacy of the data underlying the impact indicators. We used data on 75 naturalized amphibians from 82 countries to demonstrate the indicators at a global scale. The information status indicator shows variation in the reliability of the data and highlights areas where absence of impact should be interpreted with caution. Impact indicators show that growth in potential impacts are dominated by predatory species, while potential impacts from both predation and disease transmission are distributed worldwide. Using open access data, the indicators are reproducible and adaptable across scales and taxa and can be used to assess global trends and distributions of IAS, assisting authorities in prioritizing control efforts and identifying areas at risk of future invasions. This article is part of the theme issue 'Ecological novelty and planetary stewardship: biodiversity dynamics in a transforming biosphere'.

Outcome of transarterial radioembolization in patients with hepatocellular carcinoma as a first-line interventional therapy and after a previous transarterial chemoembolization.

Purpose: Due to a lack of data, there is an ongoing debate regarding the optimal frontline interventional therapy for unresectable hepatocellular carcinoma (HCC). The aim of the study is to compare the results of transarterial radioembolization (TARE) as the first-line therapy and as a subsequent therapy following prior transarterial chemoembolization (TACE) in these patients. Methods: A total of 83 patients were evaluated, with 38 patients having undergone at least one TACE session prior to TARE [27 male; mean age 67.2 years; 68.4% stage Barcelona clinic liver cancer (BCLC) B, 31.6% BCLC C]; 45 patients underwent primary TARE (33 male; mean age 69.9 years; 40% BCLC B, 58% BCLC C). Clinical [age, gender, BCLC stage, activity in gigabecquerel (GBq), Child-Pugh status, portal vein thrombosis, tumor volume] and procedural [overall survival (OS), local tumor control (LTC), and progression-free survival (PFS)] data were compared. A regression analysis was performed to evaluate OS, LTC, and PFS. Results: No differences were found in OS (95% CI: 1.12, P = 0.289), LTC (95% CI: 0.003, P = 0.95), and PFS (95% CI: 0.4, P = 0.525). The regression analysis revealed a relationship between Child-Pugh score (P = 0.005), size of HCC lesions (>10 cm) (P = 0.022), and OS; neither prior TACE (Child-Pugh B patients; 95% CI: 0.120, P = 0.729) nor number of lesions (>10; 95% CI: 2.930, P = 0.087) correlated with OS. Conclusion: Prior TACE does not affect the outcome of TARE in unresectable HCC.

The cumulative niche approach: A framework to assess the performance of ecological niche model projections.

Ecological Niche Models (ENMs) are often used to project species distributions within alien ranges and in future climatic scenarios. However, ENMs depend on species-environment equilibrium, which may be absent for actively expanding species. We present a novel framework to estimate whether species have reached environmental equilibrium in their native and alien ranges. The method is based on the estimation of niche breadth with the accumulation of species occurrences. An asymptote will indicate exhaustive knowledge of the realised niches. We demonstrate the CNA framework for 26 species of mammals, amphibians, and birds. Possible outcomes of the framework include: (1) There is enough data to quantify the native and alien realised niches, allowing us to calculate niche expansion between the native and alien ranges, also indicating that ENMs can be reliably projected to new environmental conditions. (2) The data in the native range is not adequate but an asymptote is reached in the alien realised niche, indicating low confidence in our ability to evaluate niche expansion in the alien range but high confidence in model projections to new environmental conditions within the alien range. (3) There is enough data to quantify the native realised niche, but not enough knowledge about the alien realised niche, hindering the reliability of projections beyond sampled conditions. (4) Both the native and alien ranges do not reach an asymptote, and thus few robust conclusions about the species' niche or future projections can be made. Our framework can be used to detect species' environmental equilibrium in both the native and alien ranges, to quantify changes in the realised niche during the invasion processes, and to estimate the likely accuracy of model projections to new environmental conditions.

AI-based automated detection and stability analysis of traumatic vertebral body fractures on computed tomography.

PURPOSE: We developed and tested a neural network for automated detection and stability analysis of vertebral body fractures on computed tomography (CT). MATERIALS AND METHODS: 257 patients who underwent CT were included in this Institutional Review Board (IRB) approved study. 463 fractured and 1883 non-fractured vertebral bodies were included, with 190 fractures unstable. Two readers identified vertebral body fractures and assessed their stability. A combination of a Hierarchical Convolutional Neural Network (hNet) and a fracture Classification Network (fNet) was used to build a neural network for the automated detection and stability analysis of vertebral body fractures on CT. Two final test settings were chosen: one with vertebral body levels C1/2 included and one where they were excluded. RESULTS: The mean age of the patients was 68 ± 14 years. 140 patients were female. The network showed a slightly higher diagnostic performance when excluding C1/2. Accordingly, the network was able to distinguish fractured and non-fractured vertebral bodies with a sensitivity of 75.8 % and a specificity of 80.3 %. Additionally, the network determined the stability of the vertebral bodies with a sensitivity of 88.4 % and a specificity of 80.3 %. The AUC was 87 % and 91 % for fracture detection and stability analysis, respectively. The sensitivity of our network in indicating the presence of at least one fracture / one unstable fracture within the whole spine achieved values of 78.7 % and 97.2 %, respectively, when excluding C1/2. CONCLUSION: The developed neural network can automatically detect vertebral body fractures and evaluate their stability concurrently with a high diagnostic performance.

Modelling the probability of meeting IUCN Red List criteria to support reassessments.

Comparative extinction risk analysis-which predicts species extinction risk from correlation with traits or geographical characteristics-has gained research attention as a promising tool to support extinction risk assessment in the IUCN Red List of Threatened Species. However, its uptake has been very limited so far, possibly because existing models only predict a species' Red List category, without indicating which Red List criteria may be triggered. This prevents such approaches to be integrated into Red List assessments. We overcome this implementation gap by developing models that predict the probability of species meeting individual Red List criteria. Using data on the world's birds, we evaluated the predictive performance of our criterion-specific models and compared it with the typical criterion-blind modelling approach. We compiled data on biological traits (e.g. range size, clutch size) and external drivers (e.g. change in canopy cover) often associated with extinction risk. For each specific criterion, we modelled the relationship between extinction risk predictors and species' Red List category under that criterion using ordinal regression models. We found criterion-specific models were better at identifying threatened species compared to a criterion-blind model (higher sensitivity), but less good at identifying not threatened species (lower specificity). As expected, different covariates were important for predicting extinction risk under different criteria. Change in annual temperature was important for criteria related to population trends, while high forest dependency was important for criteria related to restricted area of occupancy or small population size. Our criteria-specific method can support Red List assessors by producing outputs that identify species likely to meet specific criteria, and which are the most important predictors. These species can then be prioritised for re-evaluation. We expect this new approach to increase the uptake of extinction risk models in Red List assessments, bridging a long-standing research-implementation gap.

Percutaneous Transhepatic Portosystemic Shunt Creation in a Preterm Infant With Total Anomalous Pulmonary Venous Connection.

A male preterm infant with total anomalous pulmonary venous connection developed progressive respiratory distress but was considered too high risk for surgical repair because of his critical condition. We demonstrated that percutaneous transhepatic stent implantation for portosystemic shunt creation is a feasible bridging procedure when surgery is not possible.

A Telemedicine Center Reduces the Comprehensive Carbon Footprint in Primary Care: A Monocenter, Retrospective Study.

INTRODUCTION: Telemedicine reduces greenhouse gas emissions (CO2eq); however, results of studies vary extremely in dependence of the setting. This is the first study to focus on effects of telemedicine on CO2 imprint of primary care. METHODS: We conducted a comprehensive retrospective study to analyze total CO2eq emissions of kilometers (km) saved by telemedical consultations. We categorized prevented and provoked patient journeys, including pharmacy visits. We calculated CO2eq emission savings through primary care telemedical consultations in comparison to those that would have occurred without telemedicine. We used the comprehensive footprint approach, including all telemedical cases and the CO2eq emissions by the telemedicine center infrastructure. In order to determine the net ratio of CO2eq emissions avoided by the telemedical center, we calculated the emissions associated with the provision of telemedical consultations (including also the total consumption of physicians' workstations) and subtracted them from the total of avoided CO2eq emissions. Furthermore, we also considered patient cases in our calculation that needed to have an in-person visit after the telemedical consultation. We calculated the savings taking into account the source of the consumed energy (renewable or not). RESULTS: 433 890 telemedical consultations overall helped save 1 800 391 km in travel. On average, 1 telemedical consultation saved 4.15 km of individual transport and consumed 0.15 kWh. We detected savings in almost every cluster of patients. After subtracting the CO2eq emissions caused by the telemedical center, the data reveal savings of 247.1 net tons of CO2eq emissions in total and of 0.57 kg CO2eq per telemedical consultation. The comprehensive footprint approach thus indicated a reduced footprint due to telemedicine in primary care. DISCUSSION: Integrating a telemedical center into the health care system reduces the CO2 footprint of primary care medicine; this is true even in a densely populated country with little use of cars like Switzerland. The insight of this study complements previous studies that focused on narrower aspects of telemedical consultations.

Can intravitreal injections with higher volume cause higher intraocular eye pressure? Considerations for anti-complement injections in normal and glaucomatous eyes.

The approval of Syfovre® (pegcetacoplan) and Iverzay® (avacincaptad pegol) for the treatment of geographic atrophy (GA) marks a significant advancement in retinal disease therapy, offering both complement 3 and complement 5 inhibitors. With this breakthrough, an increase in intravitreal injections (IVI) is expected to treat GA, raising questions about potential effects on intraocular pressure (IOP). This concern is exacerbated by the larger injection volume required for GA treatment, potentially impacting IOP. Previous studies have shown that IVI can lead to a temporary increase in IOP with a 0.05 ml injection. This transient elevation is challenging to manage with glaucoma drops, and a preventive approach, such as paracentesis immediately before IVIs, may be more effective. Despite concerns, clinical significance and long-term effects of IOP changes with a 0.05 ml injection remain uncertain. To address these concerns, routine evaluations including macular optical coherence tomography (OCT), fundus autofluorescence, IOP measurements, and retinal nerve fiber layer OCT before the first IVI with avacincaptad pegol and pegcetacoplan are recommended to detect potential changes early. Further research is needed to determine the extent to which IOP changes impact GA patients and whether cumulative effects occur with repeated IVIs, especially in those with additional eye conditions.

Use and outcome of TIPS in hospitalized patients in Germany: A Nationwide study (2007-2018).

BACKGROUND: The number of complications in patients admitted for cirrhosis has increased over time. Portal hypertension is the driver of many complications of cirrhosis. TIPS placement is the most effective treatment of portal hypertension. The aim of this study was to analyze the use and impact of TIPS placement in the last decade in a nationwide study in Germany. METHODS: We analyzed 14,598 admissions of patients for TIPS insertions in Germany from 2007 to 2018 using the DRG system, 12,877 out of 2,000,765 total admissions of patients with cirrhosis. All diagnoses and procedures were coded according to ICD-10-CM and OPS codes. The data were analyzed, focusing on the number of admissions and in-hospital mortality. RESULTS: The number of TIPS placements increased over the last decade. In-hospital mortality of cirrhotic patients with TIPS decreased when it was placed for severe bleeding (15.2% [TIPS] vs. 19.5% [endoscopy treatment]), ascites (8.7% [TIPS] vs. 14.4% [paracentesis]), and hepatorenal syndrome (HRS) (17.1% [TIPS] vs. 43.3% [no-TIPS]). In the case of bleeding, TIPS significantly decreased in-hospital mortality and also in ascites and HRS. During hospitalization, 22.6% admissions of patients with TIPS insertion showed HE. However, in-hospital mortality in patients admitted with HE grades 1 or 2 and TIPS was lower than in patients without TIPS. In the logistic regression, a higher HE grade(3 and 4), infection, and circulatory disease were found to be independently associated with in-hospital mortality in patients with TIPS insertion. CONCLUSION: Our nationwide study demonstrates that TIPS insertion is increasingly used in Germany. TIPS improves outcomes, especially in patients with ascites and HRS, regardless of lower HE grades, while higher HE grades, infection, and circulatory diseases seem to be associated with risk of in-hospital mortality.

Prioritizing the reassessment of data-deficient species on the IUCN Red List.

Despite being central to the implementation of conservation policies, the usefulness of the International Union for Conservation of Nature (IUCN) Red List of Threatened Species is hampered by the 14% of species classified as data-deficient (DD) because information to evaluate these species' extinction risk was lacking when they were last assessed or because assessors did not appropriately account for uncertainty. Robust methods are needed to identify which DD species are more likely to be reclassified in one of the data-sufficient IUCN Red List categories. We devised a reproducible method to help red-list assessors prioritize reassessment of DD species and tested it with 6887 DD species of mammals, reptiles, amphibians, fishes, and Odonata (dragonflies and damselflies). For each DD species in these groups, we calculated its probability of being classified in a data-sufficient category if reassessed today from covariates measuring available knowledge (e.g., number of occurrence records or published articles available), knowledge proxies (e.g., remoteness of the range), and species characteristics (e.g., nocturnality); calculated change in such probability since last assessment from the increase in available knowledge (e.g., new occurrence records); and determined whether the species might qualify as threatened based on recent rate of habitat loss determined from global land-cover maps. We identified 1907 species with a probability of being reassessed in a data-sufficient category of >0.5; 624 species for which this probability increased by >0.25 since last assessment; and 77 species that could be reassessed as near threatened or threatened based on habitat loss. Combining these 3 elements, our results provided a list of species likely to be data-sufficient such that the comprehensiveness and representativeness of the IUCN Red List can be improved.

Priorización de la reevaluación de las especies con datos deficientes en la Lista Roja de la UICN Resumen No obstante que es fundamental para la implementación de políticas de conservación, la utilidad de la Lista Roja de Especies Amenazadas de la Unión Internacional para la Conservación de la Naturaleza (UICN) está limitada por el 14% de especies clasificadas con datos deficientes (DD) debido a que la información para evaluar el riesgo de extinción de estas especies no existía cuando fueron evaluadas la última vez o porque los evaluadores no consideraron la incertidumbre apropiadamente. Se requieren métodos robustos para identificar las especies DD con mayor probabilidad de ser reclasificadas en alguna de las categorías en la Lista Roja UICN con datos suficientes. Diseñamos un método reproducible para ayudar a que los evaluadores de la lista roja prioricen la reevaluación de especies DD y lo probamos con 6,887 especies DD de mamíferos, reptiles, anfibios, peces y Odonata (libélulas y caballitos del diablo). Para cada una de las especies DD en estos grupos, calculamos la probabilidad de ser clasificadas en una categoría con datos suficientes si fuera reevaluada hoy a partir de covariables que miden el conocimiento disponible (e.g., número de registros de ocurrencia o artículos publicados disponibles), sustitutos de conocimiento (e.g., extensión del rango de distribución) y características de la especie ((e.g., nocturnidad); calculamos el cambio en tal probabilidad desde la última reevaluación a partir del incremento en el conocimiento disponible (e.g., registros de ocurrencia nuevos); y determinamos si las especies podrían calificar como amenazadas con base en pérdidas de hábitat recientes a partir de mapas globales de cobertura de suelo recientes. Identificamos 1,907 especies con una probabilidad >0.5 de ser reclasificados en una categoría con datos suficientes; 624 especies cuya probabilidad aumentó en >0.25 desde la última evaluación, y 77 especies que podrían ser reclasificadas como casi en peligro con base en la pérdida de hábitat. Combinando estos 3 elementos, nuestros resultados proporcionaron una lista de especies probablemente con datos suficientes de tal modo que la exhaustividad y la representatividad de la Lista Roja de la UICN pueden ser mejoradas.

Right ventricular ejection fraction assessed by computed tomography in patients undergoing transcatheter tricuspid valve repair.

AIMS: The role of right ventricular function in patients undergoing transcatheter tricuspid valve repair (TTVR) is poorly understood. This study investigated the association of right ventricular ejection fraction (RVEF) assessed by cardiac computed tomography (CCT) with clinical outcomes in patients undergoing TTVR. METHODS AND RESULTS: We retrospectively assessed three-dimensional (3D) RVEF by using pre-procedural CCT images in patients undergoing TTVR. RV dysfunction was defined as a CT-RVEF of <45%. The primary outcome was a composite outcome, consisting of all-cause mortality and hospitalization due to heart failure, within 1 year after TTVR. Of 157 patients, 58 (36.9%) presented with CT-RVEF <45%. Procedural success and in-hospital mortality were comparable between patients with CT-RVEF <45% and ≥45%. However, CT-RVEF of <45% was associated with a higher risk of the composite outcome (hazard ratio: 2.99; 95% confidence interval: 1.65-5.41; P = 0.001), which had an additional value beyond two-dimensional echocardiographic assessments of RV function to stratify the risk of the composite outcome. In addition, patients with CT-RVEF ≥45% exhibited the association of procedural success (i.e. residual tricuspid regurgitation of ≤2+ at discharge) with a decreased risk of the composite outcome, while this association was attenuated in those with CT-RVEF <45% (P for interaction = 0.035). CONCLUSION: CT-RVEF is associated with the risk of the composite outcome after TTVR, and a reduced CT-RVEF might attenuate the prognostic benefit of TR reduction. The assessment of 3D-RVEF by using CCT may refine the patient selection for TTVR.

[Haemoptysis]. / Hämoptysen.

Haemoptysis describes the expectoration of blood originating from the tracheobronchial tree and lung. Its presentation varies from mild to massive haemoptysis, the latter entailing the risk of asphyxia and thus requiring rapid intervention that spans multiple specialties.

How Controlled is the Expansion of VIATORR CX?

PURPOSE: To investigate and compare the physical properties of the new generation Gore VIATORR-Controlled Expansion Endoprosthesis (VCX) to those of the predecessor VIATORR stent in an in vitro experimental setup. MATERIALS AND METHODS: A total of 12 stents (8 VCX; 4 VIATORR; GORE, USA) were examined. Radial resistive force (RRF) and chronic outward force (COF) were assessed using a radial force testing machine (RX-650, Machine Solutions Inc., USA). To assess the radial forces of the VCX above 8 mm, balloon expansion was performed between cycles. RESULTS: All VCX stents show an abrupt decrease in COF at an external diameter of 8.3 mm; RRF decreases likewise at an external diameter of 8.5 mm. The predecessor VIATORR stent without the "controlled expansion" feature shows linear radial force reduction until full expansion at a diameter of 10 mm. The physical properties of the VCX can be altered by balloon modulation. Point of COF (RRF) reduction shifts to 8.5 mm (8.6 mm), 8.6 mm (8.8 mm) and 9.3 mm (9.6 mm) following modulation with a 8 mm, 9 mm and 10 mm balloon. CONCLUSIONS: The VCX shows an abrupt and disproportionate decrease in COF and RRF at an external diameter of 8.3 mm, thus passive expansion to its nominal diameter of 10 mm is not to be expected. By means of balloon dilatation the physical properties of the stent can be altered, enabling customized TIPS creation. The previous VIATORR stent shows continuous COF and RRF until total expansion.