Electrocatalytic Behavior of an Amide Functionalized Mn(II) Coordination Polymer on ORR, OER and HER.

The new 3D coordination polymer (CP) [Mn(L)(HCOO)]n (Mn-CP) [L = 4-(pyridin-4-ylcarbamoyl)benzoate] was synthesised via a hydrothermal reaction using the pyridyl amide functionalized benzoic acid HL. It was characterized by elemental, FT-IR spectroscopy, single-crystal and powder X-ray diffraction (PXRD) analyses. Its structural features were disclosed by single-crystal X-ray diffraction analysis, which revealed a 3D structure with the monoclinic space group P21/c. Its performance as an electrocatalyst for oxygen reduction (ORR), oxygen evolution (OER), and hydrogen evolution (HER) reactions was tested in both acidic (0.5 M H2SO4) and alkaline (0.1 M KOH) media. A distinct reduction peak was observed at 0.53 V vs. RHE in 0.1 M KOH, which corresponds to the oxygen reduction, thus clearly demonstrating the material's activity for the ORR. Tafel analysis revealed a Tafel slope of 101 mV dec-1 with mixed kinetics of 2e- and 4e- pathways indicated by the Koutecky-Levich analysis. Conversely, the ORR peak was not present in 0.5 M H2SO4 indicating no activity of Mn-CP for this reaction in acidic media. In addition, Mn-CP demonstrated a noteworthy activity toward OER and HER in acidic media, in contrast to what was observed in 0.1 M KOH.

Predictors of unfavourable outcome in aneurysmal subarachnoid haemorrhage.

BACKGROUND: Mortality rates following aneurysmal subarachnoid haemorrhage (aSAH) have decreased due to improvements in diagnoses and the management of complications, as well as early obliteration of the aneurysms. Neurogenic pulmonary oedema (NPO) is a clinical syndrome associated with an acute increase in intracranial pressure and a release of catecholamines into the circulation. This study investigated independent predictors of unfavourable outcomes (Glasgow Outcome Scores 1, 2 or 3) in patients with aSAH. MATERIALS AND METHODS: A total of 262 patients with aSAH (162 females) were included in this prospective study. Clinical characteristics were assessed, and electrocardiographic, serum cardiac and inflammatory biomarker measurements were recorded on admission. Outcomes were assessed three months after admission. Univariate and multivariate analyses of these data were used to predict unfavourable outcomes. RESULTS: A total of 156 patients (59.54%) had unfavourable outcomes. Compared to those who had favourable outcomes, patients with unfavourable outcomes were significantly older (54.37 ± 10.56 vs. 49.13 ± 10.77 years; p < 0.001) and had more severe aSAHs (Hunt and Hess grades ≥ 3: 82.7% vs. 39.6%; p < 0.001). Patients with unfavourable outcomes were more likely to have NPO (10.3% vs. 2.8%; p = 0.023), hydrocephalus (34.0% vs. 20.8%; p = 0.02), and aneurysm reruptures (28.2% vs. 3.8%; p < 0.001). Independent predictors of an unfavourable outcome included Hunt and Hess grades ≥ 3 (odds ratio [OR], 4.291; 95% confidence interval [CI], 2.168-8.491; p < 0.001), increased systolic blood pressure on admission (OR, 1.020; 95% CI, 1.002-1.038; p = 0.03), increased heart rate (HR) on admission (OR, 1.024; 95% CI, 1.001-1.048; p = 0.04), and aneurysm rerupture (OR, 4.961; 95% CI, 1.461-16.845; p = 0.01). CONCLUSIONS: These findings suggest that aneurysm reruptures, as well as increased blood pressure and HR, are associated with unfavourable outcomes in patients with aSAH.

Early mortality after hip fracture: what matters?

BACKGROUND: Hip fractures in the elderly are followed by increased mortality, which is highest in the period immediately after the fracture. Predictors for early mortality have neither been well identified nor summarized. Identification of early postoperative mortality predictors enables the stratification of high-risk patients and can help in the development of strategies aimed at reducing risk and improving outcome after hip fracture. The primary aim of this study was to investigate the incidence of 30-day mortality. The secondary aim was to investigate factors related to early mortality. METHODS: We examined 384 elderly patients with hip fracture. Multivariate logistic regression analysis was used to explore independent prognostic factors for 30-day mortality. RESULTS: By the end of the 30-day follow-up period, 22 patients (6.4%) had died. Postoperative delirium was the only variable independently related to 30-day mortality after hip fracture. Older, male patients with a lower cognitive status had a higher chance of developing postoperative delirium. DISCUSSION: Postoperative delirium is a strong independent marker of high risk for 30-day mortality. Older, male patients with more severe cognitive impairment are at increased risk of developing postoperative delirium. Identifying patients at risk for developing postoperative delirium upon admission and early detection of delirium enable the development of targeted prevention and intervention strategies in older patients with hip fracture.

Steps towards highly-efficient water splitting and oxygen reduction using nanostructured ß-Ni(OH)2.

ß-Ni(OH)2 nanoplatelets are prepared by a hydrothermal procedure and characterized by scanning and transmission electron microscopy, X-ray diffraction analysis, Raman spectroscopy, and X-ray photoelectron spectroscopy. The material is demonstrated to be an efficient electrocatalyst for oxygen reduction, oxygen evolution, and hydrogen evolution reactions in alkaline media. ß-Ni(OH)2 shows an overpotential of 498 mV to reach 10 mA cm-2 towards oxygen evolution, with a Tafel slope of 149 mV dec-1 (decreasing to 99 mV dec-1 at 75 °C), along with superior stability as evidenced by chronoamperometric measurements. Similarly, a low overpotential of -333 mV to reach 10 mA cm-2 (decreasing to only -65 mV at 75 °C) toward hydrogen evolution with a Tafel slope of -230 mV dec-1 is observed. Finally, ß-Ni(OH)2 exhibits a noteworthy performance for the ORR, as evidenced by a low Tafel slope of -78 mV dec-1 and a number of exchanged electrons of 4.01 (indicating direct 4e--oxygen reduction), whereas there are only a few previous reports on modest ORR activity of pure Ni(OH)2.

Low Au-content CoAu electrodes for environmental applications.

Six cobalt gold (CoAu) electrodes were prepared by electroless deposition using different gold-containing solutions (acidic and weakly acidic) and different Au deposition times. Characterization of CoAu electrodes was done by scanning electron microscopy with energy-dispersive X-ray spectroscopy, N2-sorption, and X-ray powder diffraction techniques. The possibility of using the prepared electrodes in environmental applications, i.e., for the electrochemical sensing of a trace amount of arsenic(iii) in weakly alkaline media was assessed. Employing the CoAu electrode (prepared by immersing Co/Cu into 1 mM HAuCl4 (pH 1.8) at 30 °C for 30 s) under optimized conditions (deposition potential -0.7 V and deposition time of 60 s), a low limit of detection of 2.16 ppb was obtained. Finally, this CoAu electrode showed activity for arsenic oxidation in the presence of Cu(ii) as a model interferent as well as in real samples. Furthermore, the use of CoAu electrode as an anode in fuel cells, namely, direct borohydride - hydrogen peroxide fuel cells was also assessed. A peak power density of 191 mW cm-2 was attained at 25 °C for DBHPFC with CoAu anode at a current density of 201 mA cm-2 and cell voltage of 0.95 V, respectively. The peak power density further increased with the increase of the operating temperature to 55 °C.

Impact of intraoperative blood pressure, blood pressure fluctuation, and pulse pressure on postoperative delirium in elderly patients with hip fracture: A prospective cohort study.

AIM: Postoperative delirium (PD) is a frequent complication of hip fracture surgery, but its pathophysiology remains poorly understood. We investigated the impact of a single episode of intraoperative hyper/hypotension, blood pressure (BP) fluctuation (ΔMAP), and pulse pressure (PP) on hyper/hypoactive PD in elderly patients undergoing surgery for hip fracture. We also assessed the effect of PD on clinical outcomes. METHODS: This was a prospective 1-year follow-up study of patients over 60 years of age with a primary diagnosis of acute low-energy hip fracture. Perioperative delirium was assessed using the Confusion Assessment Method (CAM); the development of PD and the type, hyperactive or hypoactive PD, were recorded. Cognitive assessment was evaluated using the Short Portable Mental Status Questionnaire (SPMSQ). The lowest and highest BP values were extracted from the patients' anaesthesia charts. Postoperative complications, reinterventions and 1-month mortality were recorded. RESULTS: PD occurred in 148 (53%) patients during the first postoperative week, with 75% of the cases diagnosed as hypoactive PD. Patients developing PD of any type were older, had a lower body mass index, higher SPMSQ and Charlson scores, more severe systemic diseases, a lower lowest intraoperative BP, a higher ΔMAP, a lower PP, and a higher postoperative pain score. They also took more drugs and received more blood transfusion intraoperatively. Multivariate logistic regression analyses showed that a higher MAP min had a protective effect on the occurrence of any type of PD, as well as hypoactive and hyperactive. PD had negative effect on outcomes. CONCLUSION: Our results provide evidence of an association between maximal hypotension, the lowest intraoperative mean blood pressure (MAP), ΔMAP, PP, and PD. A progressive decrease in MAP during surgery was associated with the increased odds of developing either type of PD.

Estimating the effect of incident delirium on short-term outcomes in aged hip fracture patients through propensity score analysis.

AIM: We aimed to evaluate the factors contributing to delirium after hip fracture and assess the effect of incident delirium on short-term clinical outcomes. METHODS: A total of 270 non-delirious, consecutive hip fracture patients 60 years and older were included in a prospective cohort study. The patients were assessed with respect to physical status according to the American Society of Anesthesiologists classification, medical comorbidities with the Charlson Comorbidity Index, cognitive function with the Portable Mental Status Questionnaire and depression with the Geriatric Depressive Scale. Incident delirium was evaluated daily. Clinical outcomes and 1-month mortality were recorded. RESULTS: Incident delirium was present in 53.0% of patients. Patients with delirium were older (P = 0.046), had higher American Society of Anesthesiologists and Charlson Comorbidity Index scores (P < 0.001), lower Portable Mental Status Questionnaire scores and higher Geriatric Depressive Scale scores (P < 0.001, P = 0.003, respectively). After adjusting for age, multivariate regression analysis in the first model showed that patients with delirium were at higher risk of reintervention plus death (P < 0.05), complications P < 0.001), a higher severity complication score (P < 0.05) and longer length of hospital stay (P < 0.001). In the second model, after adjusting for propensity score, patients with delirium were at higher risk of reintervention plus death (P < 0.05) and longer length of hospital stay (P < 0.01). CONCLUSIONS: Patients who are older, with worse physical status, worse cognitive function and depression are more likely to develop delirium after hip fracture. Incident delirium has negative independent effects on short-term outcomes in elderly patients after hip fracture.

Risk factors for ventilator-associated pneumonia in patients with severe traumatic brain injury in a Serbian trauma centre.

INTRODUCTION: The aims of this study were (1) to assess the incidence of ventilator-associated pneumonia (VAP) in patients with traumatic brain injury (TBI), (2) to identify risk factors for developing VAP, and (3) to assess the prevalence of the pathogens responsible. PATIENTS AND METHODS: The following data were collected prospectively from patients admitted to a 24-bed intensive care unit (ICU) during 2013/14: the mechanism of injury, trauma distribution by system, the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the Abbreviated Injury Scale (AIS) score, the Injury Severity Score (ISS), underlying diseases, Glasgow Coma Scale (GCS) score, use of vasopressors, need for intubation or cardiopulmonary resuscitation upon admission, and presence of pulmonary contusions. All patients were managed with a standardized protocol if VAP was suspected. The Sequential Organ Failure Assessment (SOFA) score and the Clinical Pulmonary Infection Score (CPIS) were measured on the day of VAP diagnosis. RESULTS: Of the 144 patients with TBI who underwent mechanical ventilation for >48h, 49.3% did not develop VAP, 24.3% developed early-onset VAP, and 26.4% developed late-onset VAP. Factors independently associated with early-onset VAP included thoracic injury (odds ratio (OR) 8.56, 95% confidence interval (CI) 2.05-35.70; p=0.003), ISS (OR 1.09, 95% CI 1.03-1.15; p=0.002), and coma upon admission (OR 13.40, 95% CI 3.12-57.66; p<0.001). Age (OR 1.04, 95% CI 1.02-1.07; p=0.002), ISS (OR 1.09, 95% CI 1.04-1.13; p<0.001), and coma upon admission (OR 3.84, 95% CI 1.44-10.28; p=0.007) were independently associated with late-onset VAP (Nagelkerke r(2)=0.371, area under the curve (AUC) 0.815, 95% CI 0.733-0.897; p<0.001). The 28-day survival rate was 69% in the non-VAP group, 45.7% in the early-onset VAP group, and 31.6% in the late-onset VAP group. Acinetobacter spp was the most common pathogen in patients with early- and late-onset VAP. CONCLUSIONS: These results suggest that the extent of TBI and trauma of other organs influences the development of early VAP, while the extent of TBI and age influences the development of late VAP. Patients with early- and late-onset VAP harboured the same pathogens.

Effect of the overlap syndrome of depressive symptoms and delirium on outcomes in elderly adults with hip fracture: a prospective cohort study.

OBJECTIVES: To analyze the incidence of the overlap syndrome of depressive symptoms and delirium, risk factors, and independent and dose-response effect of the overlap syndrome on outcomes in elderly adults with hip fracture. DESIGN: Prospective cohort study. SETTING: University hospital. PARTICIPANTS: Individuals with hip fracture without delirium (N = 277; aged 78.0 ± 8.2) consequently enrolled in a prospective cohort study. MEASUREMENTS: Depressive symptoms were assessed using the Geriatric Depression Scale and cognitive status using the Short Portable Mental Status Questionnaire upon hospital admission. Incident delirium was assessed daily during the hospital stay using the Confusion Assessment Method. Information on complications acquired in the hospital, severity of complications, re-interventions, length of hospital stay, and 1-month mortality was recorded. RESULTS: Thirty (10.8%) participants had depressive symptoms alone, 88 (31.8%) delirium alone, 60 (21.7%) overlap syndrome, and 99 (35.7%) neither condition. According to multivariate regression analysis, participants with the overlap syndrome had significantly higher incidence of vision impairment (P = .02), longer time-to-surgery (P = .03), and lower cognitive function (P < .001) than participants with no depressive symptoms and no delirium. In the adjusted regression analysis, participants with neither condition were at lower risk of complications than those with the overlap syndrome (P = .03). After adjustment, participants with the overlap syndrome were at higher risk of longer hospital stay independently (P = .003) and in a dose-response manner in the following order: no depression and no delirium, depressive symptoms alone, delirium alone, and the overlap syndrome (P = .002). CONCLUSION: Depressive symptoms and delirium increase the likelihood of adverse outcomes after hip fracture in a step-wise manner when they coexist. To reduce the risk of adverse outcome in individuals with hip fracture, efforts to identify, prevent, and treat this condition need to be increased.

Predictors of severe pain in the immediate postoperative period in elderly patients following hip fracture surgery.

INTRODUCTION: The aim of this study was to identify risk factors for severe postoperative pain immediately after hip-fracture surgery. PATIENTS AND METHODS: Three hundred forty-four elderly patients with an acute hip fracture were admitted to the hospital during a 12-months period. All patients who entered the study answered a structured questionnaire to assess demographic characteristics, previous diseases, drug use, previous surgery, and level of education. Physical status was assessed through the American Society of Anesthesiologists' preoperative risk classification, cognitive status using the Short Portable Mental Status Questionnaire, and depression using the Geriatric Depression Scale. The presence of preoperative delirium using the Confusion Assessment Method was assessed during day and night shifts until surgery. Pain was measured using a numeric rating scale (NRS). An NRS ≥ 7 one hour after surgery indicated severe pain. RESULTS: Patients with elementary-level education (8 yr in school) presented a higher risk for immediate severe postoperative pain than university-educated patients (> 12 yr in school) (P < 0.05). Higher cognitive function was associated with higher postoperative pain (P < 0.01). Patients with symptoms of depression and patients with preoperative delirium presented a higher risk for severe pain (P < 0.05, P < 0.01, respectively). Multivariate analysis showed that depression and a low level of education were independent predictors of severe pain immediately after surgery. CONCLUSION: Depression and lower levels of education were independent predictors of immediate severe pain following hip-fracture surgery. These predictors could be clinically used to stratify analgesic risk in elderly patients for more aggressive pain treatment immediately after surgery.

[The selection of best anesthesiological technique for hip fracture surgery in older high-risk patients]. / Izbor najbolje anestezioloske tehnike za operaciju preloma kuka kod visokorizicnih starijih pacijenata.

INTRODUCTION: Hip fracture is a pathological condition, more common in older age, i.e. in people over 65 years. The prevalence of this disorder is continuously increasing, simultaneously with higher age limit. In evaluation of risk for operation and anesthesia, older age itself represents higher risk and calls for special attention. In selection of anesthesiological technique, it is more usual to apply neuroaxial block or peripheral nerve block, which is more advantageous over general anesthesia. CASE REPORT: A female, 80-year old, patient B.D. was admitted to hospital for hip fracture, with the diagnosis of the right, lateral, basicervical femoral fracture. On admission, heart decompensation (decompensated dilated myocardiopathy), pulmonary edema and the left lateral pleural effusion were established. Due to high risk (ASA III) of intraoperative and postoperative complications, it was decided to apply combined peripheral nerve block. Using the neurostimulators, 3-in-1 block, lumbosacral block and sciatic nerve block were applied. During the operation, the patient was sedated by Propofol and had spontaneous respiration through the laryngeal mask. Intra- and postoperatively, the patient's hemodynamics was stable. CONCLUSION: Peripheral nerve blocks are safe and effective anesthesiological technique, which may reduce the mortality in patients with the hip fracture and maintain the hemodynamic stability, both during and after the surgical intervention.