Improving Nonenzymatic Biosensing Performance of Electrospun Carbon Nanofibers decorated with Ni/Co Particles via Oxidation.

Nonenzymatic biosensors do not require enzyme immobilization nor face degradation problem. Hence, nonenzymatic biosensors have recently attracted growing attention due to the stability and reproducibility. Here, a comparative study was conducted to quantitatively evaluate the glucose sensing of pure/oxidized Ni, Co, and their bimetal nanostructures grown on electrospun carbon nanofibers (ECNFs) to provide a low-cost free-standing electrode. The prepared nanostructures exhibited sensitivity (from 66.28 to 610.6 µA mM-1 cm-2), linear range of 2-10 mM, limit of detection in the range of 1 mM, and the response time (< 5 s), besides outstanding selectivity and applicability for glucose detection in the human serum. Moreover, the oxidizable interfering species, such as ascorbic acid (AA), uric acid (UA), and dopamine (DA), did not cause interference. Co-C and Ni-C phase diagrams, solid-state diffusion phenomena, and rearrangement of dissolved C atoms after migration from metal particles were discussed. This study undoubtedly provides new prospects on the nonenzymatic biosensing performance of mono-metal, bimetal, and oxide compounds of Ni and Co elements, which could be quite helpful for the fabrication of biomolecules detecting devices.

Rheological Behavior and Filtration of Water-Based Drilling Fluids Containing Graphene Oxide: Experimental Measurement, Mechanistic Understanding, and Modeling.

Any improvement in drilling technology is critical for developing the oil and gas industry. The success of drilling operations largely depends on drilling fluid characteristics. Drilling fluids require enough viscosity to suspend the particles and transport them to the surface and enough capability to control the fluid loss into the formation. Rheology and filtration characteristics of drilling fluids are crucial factors to consider while ensuring the effectiveness of a drilling operation. Graphene oxide (GO), xanthan gum (XG), and low-viscosity carboxymethyl cellulose (CMC LV) are being utilized in this research to produce high-performance, low-solid water-based drilling fluids (WDFs). Rheological and filtration behaviors of GO/XG/CMC LV-WDF were investigated as a function of GO, XG, and CMC LV at low concentrations (0.0-0.3% w/w) and atmospheric conditions. According to the findings, GO improved the rheological and filtration capabilities of the WDF. By adding 0.15 wt % GO, shear stress could be doubled, especially at a high shear rate of 1022 s-1. The plastic viscosity of the fluid could be expanded from 6 to 13 centipoise, and a fluid loss of 8.7 mL over 30 min was observed during the API fluid test, which would be lower than the suggested fluid loss value (15.0 mL) for water-based mud. At the same concentration of XG and CMC LV, XG had a more significant influence on rheological characteristics in the presence of GO. Adding 0.3 wt % XG could increase fluid shear stress from 20.21 to 30.21 Pa at a high shear rate of 1022 s-1. In contrast, CMC LV had more impact on filtration properties, acting as a filtration control agent by decreasing the API fluid loss of fluid from 21.4 to 14.2 mL over 30 min. The addition of XG and CMC LV to the GO solution may influence the microstructure of the filter cake, resulting in a tree-root morphology. Indeed, in the GO/CMC LV solution, the individual platelets may bind together, form a jellyfish shape, and block the micropores. The incorporation of CMC LV helped develop compact filter cakes, resulting in excellent filtration. Five rheological models were employed to match the fluid parameters quantitatively. The Herschel-Bulkley model outperformed the other models in simulating fluid rheological behavior. The findings of this study can be utilize to provide low-cost, stable, and environmentally compatible additives for drilling low-pressure, depleted, and fractured oil and gas reservoirs.

Excellent outcomes in older patients with primary CNS lymphoma treated with R-MPV/cytarabine without whole brain radiotherapy or autologous stem cell transplantation therapy.

Primary CNS lymphoma (PCNSL) in immunocompetent patients is a disease of older adults who are often unsuitable for the high dose therapy or experience substantial morbidity from whole brain radiotherapy. As therapeutic studies in older patients are limited, there is a need for real world data to guide patient care. Here we report a series of 38 consecutive immunocompetent patients with PCNSL treated with curative intent using R-MPV/Ara-C with omission of consolidative radiotherapy in older patients. Outcomes for patients aged < 60 years and > 60 years were similar with overall response rates of 100% vs 85%, (p = .30), 4-year PFS of 81% vs 82% (p = .92) and 4-year OS of 80% vs 77% (p = .52) respectively. This study supports the premise that older patients with PCNSL can be effectively treated with sequential and response-adapted methotrexate (MTX) dosing without the need for WBRT or autologous stem cell transplantation (ASCT).

Pralatrexate in relapsed/refractory T-cell lymphoma: a retrospective multicenter study.

We present a retrospective multicenter study of pralatrexate treatment outcomes in an Australian practice setting for patients with relapsed/refractory T-cell lymphoma who had failed 1+ systemic therapies, treated via a compassionate access program. Endpoints assessed included response rates, toxicities, and subsequent therapies. Progression-free survival (PFS), time to next treatment (TTNT), event-free survival (EFS), overall survival (OS), and time to best response, were assessed by Kaplan-Meier analysis. The study included 31 patients, with median age 69 years. We demonstrated ORR of 35.5% (n = 11), including 4 complete responses (13%) and 7 partial responses (23%). The predicted median OS was 10 months, with EFS of 9 months, and PFS of 9 months. Median TTNT was 8 months. Mucositis was the most commonly observed toxicity. This study - the second largest real-world cohort reported to date - underscores the importance of pralatrexate in relapsed/refractory T-cell lymphoma, as well as its acceptable toxicity profile.

Acquired Pure Red Cell Aplasia Associated with Chronic Myelomonocytic Leukemia: Too Many of One, Not Enough of the Other.

There is a growing body of literature outlining the association between certain hematological malignancies, such as chronic myelomonocytic leukemia (CMML), and systemic autoimmune diseases. Diagnosis and management can be difficult, particularly when autoimmune phenomena overlap with features of the underlying illness. This is especially the case in patients who develop immune-mediated cytopenias in the context of underlying bone marrow disease. CMML associated with immune thrombocytopenia and hemolytic anemia has been reported a number of times in the literature; however, there are only scattered case reports describing CMML associated with acquired pure red cell aplasia. Here, we describe the diagnostic and management approach to a patient who developed both diseases.

Addition of low dose acetazolamide as an adjunct in patients undergoing high dose methotrexate is safe and beneficial.

BACKGROUND: High-dose methotrexate (HDMTx) is utilised in central nervous system lymphoma and acute lymphoblastic leukaemia due to its ability to penetrate the blood-brain barrier. Despite its efficacy, nephrotoxicity is a potentially serious toxicity that could also exacerbate other methotrexate-related toxicities and compromise dose intensity. Acetazolamide (AZL) is a carbonic anhydrase inhibitor that causes an increase in bicarbonate excretion and consequently urine alkalinisation. Following occurrences of HDMTx-induced acute kidney injury (AKI) due to inadequate urine alkalinisation at our institution, routine AZL was administered to appropriate patients from 2010 onwards. AIMS: To analyse the addition of AZL to routine renoprotective measures, given that inadequate urinary alkalinisation is the major risk factor for methotrexate crystal precipitation and prolonged excretion. In addition, since fluid overload is a common consequence of HDMTx treatment, the effect of AZL on fluid balance was also examined. METHODS: This is a retrospective, single-centred cohort study examining the mitigation of HDMTx-induced toxicities by AZL in 92 patients over a 6-year period. RESULTS: AZL showed a strong trend of preventing either AKI (as per CTCAE version 4.03) or delayed methotrexate elimination (>5 days), especially in males. Furthermore, AZL also resulted in reduced weight gain and fewer episodes of urinary pH <7.0. CONCLUSION: AZL appeared to diminish the incidence of HDMTx-induced toxicities, including reducing oedema-related weight gain. With mild, preventable hypokalaemia as the only noteworthy toxicity, AZL could be considered as an adjunct to HDMTx patient care.

Dose-reduced fludarabine, cyclophosphamide and rituximab is well tolerated in older patients with chronic lymphocytic leukemia and has preserved therapeutic efficacy.

Despite its efficacy in prospective trials, full dose fludarabine, cyclophosphamide and rituximab (FCR) may be too toxic for elderly patients with chronic lymphocytic leukemia (CLL) in clinical practice. We retrospectively reviewed the impact of dose reductions in FCR therapy on the outcomes of 42 consecutive patients aged 65-87 (median 72) years. Despite a median cumulative fludarabine dose reduction of 50% from full dose, the objective response and complete response rates were 86% and 38% respectively (frontline 94%/59%; previously treated 80%/24%). Dose reductions of 25-75% were not significantly associated with inferior progression free survival compared to minimal reductions (≤25%) (p=0.49), and did not preclude deep responses, including six cases (14%) of minimal residual disease negativity. Although hematological and infectious toxicities were common, treatment limiting adverse effects were infrequent. Dose attenuated FCR appears to have preserved efficacy and may be a viable therapeutic option for elderly patients with CLL.

Use of Lenalidomide in 5q-Myelodysplastic Syndrome Provides Novel Treatment Prospects in Management of Pulmonary Sarcoidosis.

We present the case of a 71-year-old woman with a long-standing history of refractory pulmonary sarcoidosis, who, upon commencement of treatment with lenalidomide for her newly diagnosed 5q-myelodysplastic syndrome, showed a remarkable, immediate, unexpected response and recovery of her sarcoidosis-related symptoms, improvement of her vital capacity, and complete clearance of her bibasal alveolor infiltrates. To our knowledge, this is the first case to report on the significant and immediate efficacy of lenalidomide in the management of pulmonary sarcoidosis. It provides a potential role for the use of lenalidomide as a novel therapeutic agent in patients with refractory pulmonary sarcoidosis.

Subdural hemorrhage - a serious complication post-intrathecal chemotherapy. A case report and review of literature.

We need to have a high index of suspicion for subdural hemorrhage (SDH) post-lumbar puncture in hematological patients given their increased risk and the significant morbidity and mortality associated with SDHs.

Venous thromboembolism prevention in patients undergoing colorectal surgery for cancer.

INTRODUCTION: Patients undergoing surgery for colorectal cancer are at high risk of post-operative venous thromboembolism (VTE). Thromboprophylaxis has been shown to have significant risk reduction, although there remains some controversy surrounding the optimal duration of pharmacological prophylaxis. Our institution does not routinely practise extended prophylaxis. The aim of this study was to retrospectively review the rate of post-operative thromboprophylaxis in colorectal cancer patients, and incidence of symptomatic VTE. METHODS: We conducted a retrospective audit of 200 consecutive patients who underwent colorectal surgery for cancer. Data to 90 days post-operatively were collected from medical records and imaging and phone calls to patients and family practitioners. RESULTS: Of the patients, 98% received pharmacological prophylaxis, with a median duration of eight days. Eight (4%) symptomatic VTEs were diagnosed within the 90-day follow-up period: two deep vein thrombosis (DVTs), five pulmonary emboli (PE) and one patient with both PE and DVT. A higher proportion of patients developed DVT/PE if they received prophylaxis other than low molecular weight heparin and similarly there was a trend in increased risk of DVT in the presence of metastatic disease. However, using univariate analysis, these results were not statistically significant (P = 0.18 and 0.11, respectively). DISCUSSION: The use of thromboprophylaxis was high in our centre, and the incidence of VTE was low when patients received a median of 8 days pharmacological prophylaxis combined with mechanical prophylaxis. The VTE incidence of 4% is similar to previous studies using extended prophylaxis. Our study findings do not support changing local protocol to extended prophylaxis.

Hypophysitis due to IgG4-related disease responding to treatment with azathioprine: an alternative to corticosteroid therapy.

PURPOSE: Fifteen cases of lymphocytic hypophysitis due to IgG4-related disease have been reported demonstrating marked improvement with corticosteroid therapy. This is the first case of IgG4-related hypophysitis demonstrating improvement with azathioprine, where corticosteroids were initially tried but ceased due to concern regarding enlargement of the pituitary infiltrate. METHODS: Case description and review of 15 cases reported in the literature. A 40 year old male was diagnosed with IgG-4 related disease based on pituitary and lacrimal gland biopsies associated with raised serum concentration of IgG4. The patient was commenced on prednisolone 30 mg/day, as rapid response to prednisolone treatment has been described in the literature for other cases of IgG4-related hypophysitis. Over the next 3 months, prednisolone treatment resulted in a reduction of serum IgG4 levels, but repeat MRI scan showed an enlarging pituitary mass with new optic nerve compression. Azathioprine 75 mg twice daily was commenced and in the subsequent 3 months, IgG4 levels normalised (0.58 g/L) and MRI scan showed 50% shrinkage of the pituitary mass. After 10 months of azathioprine treatment the MRI showed a normal sized pituitary but persistence of the infraorbital nerve thickening. CONCLUSIONS: Hypophysitis due to IgG4-related disease usually demonstrates prompt response to corticosteroids. This case highlights the need to image promptly after starting treatment to exclude an enlarging pituitary mass despite corticosteroid treatment. Alternative therapy with azathioprine can result in marked improvement. It should be remembered that IgG-4 related hypophysitis is part of a multi-organ disease.

Perioperative management of anticoagulation in elective surgery.

Surgeons commonly need to treat patients receiving anticoagulant and anti-platelet therapy. This requires risk assessment and management to balance minimization of bleeding complications and avoidance of further ischaemic or thrombotic events. This review considers the evidence available to guide management of patients on anti-platelet and anticoagulant therapy, including some of the new classes of anti-platelets and anticoagulants which clinicians may be less familiar with.

Predicting survival in chronic lymphocytic leukemia.

There is increasing interest in the use of prognostic markers that may predict survival and guide management in patients diagnosed with the early stages of chronic lymphocytic leukemia (CLL). Currently, the most important traditional prognostic factors include clinical staging, lymphocyte doubling time and ß2-microglobulin/thymidine kinase; and the most important novel markers include karyotypic aberrations (typically assessed by FISH probes or CpG oligonucleotide karyotyping) and IgVH mutation status. Although each of these factors have individually shown significant correlations with survival, there is increasing appreciation that the most complete information may be obtained by using a combination of several factors in prognostic normograms or models. In this article, we review the current state-of-the-art with regards to CLL prognostic factors and discuss how they can be applied in the clinic.